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Biomedical subjects

E Kobler

Publications and source records attributed to E Kobler.

At least 19 recordsLinked to original sources
PubMed1997

[Effectiveness of short-term triple therapy for healing Helicobacter pylori infection in ulcer disease].

There is evidence that triple therapy with two antibiotics and a proton pump inhibitor is more cost-effective than various dual therapies for the eradication of Helicobacter pylori. We have analyzed the effectiveness and acceptability of the so-called "Italian protocol" (clarithromycin 250 mg b.i.d., metronidazole 500 mg b.i.d. and omeprazole 20 mg daily for one week, followed by 20 mg omeprazole daily for further 3 weeks) in a prospective study of 36 patients with Helicobacter pylori-associated ulcers (10 gastric ulcers, 26 duodenal ulcers). Primary eradication was achieved in 35 out of 36 patients (96%). Side effects such as dysgeusia and diarrhea were rare and rapidly reversible. We conclude that this triple therapy was cost-effective and well tolerated in our study population.

Adolescent↗
PubMed1997

[Clostridium difficile associated diarrhea in cephalosporin administration: experiences of the Swiss Adverse Drug Reaction Reporting System 1981-1995].

20-25% of antibiotics-associated diarrhea cases are caused by infection with toxin-producing Clostridium difficile. Since the advent of broad-spectrum antibiotics Clostridium difficile-associated diarrhea has been observed both in ambulatory practice and as a nosocomial infection in medical and nursing institutions. Clindamycin, aminopenicillins, and cephalosporines are by far the most common triggers for this infection. We reviewed all cases of Clostridium difficile-associated diarrhea due to cephalosporines which were reported to the Swiss Drug Monitoring Center (SANZ) between 1981 and 1995. 87 cases were reported (0.9% of 9720 spontaneous reports in this period), 69 (79%) of which were considered to be due to cephalosporines. In 74% of the cases the indication for the antibiotic treatment was an upper respiratory tract infection. 61 patients received cephalosporines by oral route and 9 patients by intravenous route. Two patients had to be hospitalized. There were no deaths. The pathogenesis, clinical picture, and therapy of Clostridium difficile-associated diarrhea is discussed. We conclude from these cases in the spontaneous reporting system of SANZ that Clostridium difficile infection due to cephalosporines is a frequent occurrence. Because the course can be severe, cephalosporines should be used restrictively.

Adolescent↗
PubMed1994

[Sulindac in familial adenomatous polyposis coli--preliminary findings of a prospective study].

Several authors have reported regression of rectal polyps after administration of sulindac in patients with familial adenomatous polyposis (FAP) and subtotal colectomy. However, only a few reports have been published about the effect of sulindac in the intact colon of FAP-patients. 12 patients (FAP n = 10, Lynch-I-syndrome n = 1, juvenile polyposis n = 1/patient with intact colon n = 6, ileorectal anastomosis n = 4, right-sided hemicolectomy n = 2) have been treated with sulindac (3 x 100 mg/d orally) for 4 months. In all patients colonoscopy (if postcolectomy, rectoscopy) with videotape documentation was performed before and after sulindac therapy. Some polyps were excised for histology. In 11/12 patients a regression of the number and size of polyps occurred. In addition, in patients with intact colon no polyps were observed proximal to the sigmoid colon. In one patient sulindac had to be discontinued after 4 weeks' course because of abdominal pain. A control colonoscopy revealed only slight reduction in polyps. In 3/12 patients no polyps remained after sulindac. In a further 3/12 patients with initial tubulous adenomatous polyps, only microadenomas were observed after treatment. We therefore conclude that sulindac is effective in FAP-patients (and very probably in other hereditary polyposis syndromes) with intact colon as well as after (hemi-)colectomy in reducing the number and size of polyps. Long term studies are needed to clarify the optimal dosage, treatment time period, and long term potential for development of carcinoma under sulindac treatment.

Adenomatous Polyposis Coli↗
PubMed1993

[Drug-induced liver disease: experiences of the Swiss Center for Adverse Drug Effects 1989-1991].

Drug-induced liver disease can mimic any form of acute or chronic liver disease. Suspected drug-induced liver disease makes up between 4 and 7% of all reports of adverse drug effects voluntarily reported to central registries. We report on all patients with drug-induced hepatotoxic reactions voluntarily reported to the Swiss Adverse Drug Reaction Center from 1989 to 1991. In that period there was a total of 2084 reports of which 140 (6.7%) concerned the liver. In 16 cases two drugs were simultaneously involved, so that 156 investigations were carried out. We found a causal relationship in 123 cases. Antibiotic and chemotherapeutic agents were the drugs most frequently involved. There were seven fatal cases (5%). Our data correspond with the data in the literature. Regarding the amount of drugs prescribed, the hepatic adverse effect can be regarded as common.

Adolescent↗
PubMed1991

[The value of computerized tomography and endoscopic retrograde cholangiopancreatography in the assessment of malignant jaundice].

US and direct cholangiography have considerably simplified the diagnostic workup of mechanical icterus. These procedures allow diagnosis of choledocholithiasis in most cases. We analyze the possible additional role of CT in the diagnostic workup of malignant jaundice in a retrospective study. Between January 1986 and December 1989. ERCP was performed in 37 patients with malignant jaundice. 21 of the lesions were located in the pancreas, 7 in the papilla and 6 in the bile duct; in 2 cases the choledochus was compressed by metastases and in one chronic pancreatitis was present. In 34 of 37 patients (92%), ERCP alone permitted a definite diagnosis. 22 patients underwent CT as the primary diagnostic procedure. In only 9 of these (41%) was an unequivocal diagnosis possible, as opposed to ERCP (19 of 22 or 86%). No complications of ERCP were observed. We therefore conclude that the diagnosis of malignant jaundice can be based on history, physical examination, laboratory results, US and ERCP alone. In the vast majority of cases CT is unnecessary.

Adult↗
PubMed1990

[Esophageal endoprosthesis in advanced carcinoma. Personal experiences with the endoscopically inserted Häring tube].

The majority of esophageal carcinomas and cancers obstructing the cardia is still beyond surgical cure, and the need for effective palliative therapy is as great as ever. Among the various endoscopic techniques currently available, we prefer inserting prosthetic esophageal tubes and laser therapy. Here, we report our experience with 61 placements of prosthetic tubes in 58 patients. The insertion of the tube was always performed after successful dilatation of the stenosis under intravenous sedation and analgesia. The indications included carcinomas of the esophagus and the cardia, as well as neoplastic strictures after surgery. In seven patients, an additional esophageal-bronchial fistula was present. The median survival was 14 weeks (range: 1 to 60 weeks). 18 patients lived for more than 16 weeks. Six patients died from severe complications due to the endoscopic procedure, 13 patients had minor complications which were treated conservatively. In summary, endoscopic intubation is simple and effective as a palliative treatment for malignant esophageal obstruction. The relative value of intubation compared to laser therapy is not known yet and remains to be determined.

Aged↗
PubMed1990

[Ulcer symptoms without demonstration of ulcer: causative therapy with demonstration of Helicobacter pylori].

Helicobacter pylori-associated gastritis was found by endoscopy in 15 (= 28%) out of 53 patients presenting gastric pain of ulcer type without macroscopically detectable lesion of the gastric mucosa. Following a treatment of four weeks with bismuth subcitrate tablets (2 x 2 tablets daily), in 73% improvement of histological findings and in 87% elimination of bacteria could be attained. Thus, this causal therapy had a favourable effect on patient complaints.

Adult↗
PubMed1988

[Morbid obesity. Our results with the appetite-depressing stomach balloon].

Morbid obesity still remains a controversial topic with varied therapeutic approaches. In cases of unsuccessful conservative management we implant a gastric balloon or bubble. 30 balloons have been introduced in 24 patients with a mean age of 43 years (26-68 y.) and a mean body weight of 115 kg (87-160 kg). Mean overweight was 47 kg. The balloons were introduced immediately after gastroscopy performed to identify possible contraindications. Except in the initial 3 patients this procedure was carried out in the outpatient clinic. 25 silicon mammary prostheses were implanted until a special balloon (Ballobes-Balloon) became available for the last 5 cases. Implantation and follow-up has been uneventful in all cases. Our data suggest that a combination of this approach with close dietary management provides more efficient and rapid weight reduction than any diet alone.

Adult↗
PubMed1986

[Ranitidine therapy of duodenal ulcer: comparison of once-a-day and twice-a-day administration. A Swiss multicenter double-blind study].

In a Swiss multicenter double-blind trial ranitidine was given in doses of 300 mg nocte and 150 mg b.d. for the treatment of duodenal ulcer. Ninety-seven patients with endoscopically proven ulcer were treated for four, and in cases of non-healing for eight, weeks. Cumulative healing rates with 300 mg and 2 X 150 mg were 77% and 78% after four weeks and 90% and 94% after eight weeks respectively. 60 and 65% of the patients were asymptomatic after four weeks. Smoking did not adversely affect healing. Thus, ranitidine in a dose of 300 mg nocte is as effective as ranitidine in a dose of 150 mg b.d. in the treatment of duodenal ulcer.

Adolescent↗
PubMed1985

[Prevention of gastroduodenal stress lesions with secretion inhibitors in accident patients needing intensive care: incidence of lesions and adverse effects; consequences].

Prevention of gastrointestinal stress lesions by cimetidine or pirenzepine was investigated in a double blind study of trauma patients in an intensive care unit. Cimetidine or pirenzepine were administered intravenously to 55 consecutive randomized patients. All were checked by endoscopy on admission and 8 days later. 5 therapy failures were found in each group. Patients with more than 5 erosions and/or ulcerations were classified as failures. A side effect encountered was sinus tachycardia in 4 of 27 patients treated with pirenzepine. Overall, a trend towards fewer stress lesions was found in the pirenzepine protected group.

Adolescent↗
PubMed1983

[17-year results following vagotomy and pyloroplasty].

Report on 51 patients who underwent surgery for peptic ulcer between 1964 and 1966 by truncular vagotomy and pyloroplasty. The recurrence rate was 6.6% for duodenal ulcer and 19.9% for gastric ulcer. Two carcinomas were detected in the latter group. In neither group were dumping or diarrhea symptoms observed.

Duodenal Ulcer↗
PubMed1982

[Early diagnosis of stomach cancer: reality or illusion?].

Cancer of the stomach is, in Switzerland, the fourth most common malignant tumor in both sexes. The five year survival rate is between 10 and 20% in Europe; where the cancer is diagnosed early, however, the patients have a survival rate of 85-95%. Of the 305 cases diagnosed in the last 5 years, 51.5% were operatively curable. In 29.5% of the cases palliative surgery was possible and 19% were inoperable. The rate of early cancer is 12% and thereby constitutes the largest portion of the total five year survival rate. Improvement of prognosis is only realizable through early detection, but even today this prospect is largely illusory. Practicable ways of obtaining optimum results are demonstrated.

Aged↗