Biomedical subjects
Publications and source records attributed to E Kobler.
Three patients with hepatitis B are presented whose common source of infection was attributed to a physician practising acupuncture. The contamination appears to be due to repetitive use of the same needles for insertion. Among the different side effects of acupuncture, hepatitis B may thus be a serious complication if the needles used are not properly autoclaved.
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In cases without a history of gastrointestinal or cardiac disease, acute odynophagia prompts the tentative diagnosis of drug-induced esophageal ulcer. Possible causes are tetracycline, clindamycin, emepronium bromide, potassium chloride, etc. Other diseases such as carcinoma can be ruled out by endoscopy and biopsy. To avoid such esophageal lesions drugs should be taken with sufficient fluid and not immediately before bedrest.
A retrospective analysis is presented of 38 cases of malignant lymphomas of the stomach, 20 of the reticulum cell type, 6 lymphoblastic, 6 lymphocytic and 4 mixed forms. Two patients had a primary Hodgkin's malignant lymphogranuloma. A follow-up was obtained for 35 patients. There proved to be no significant difference between the symptomatology of carcinoma and lymphoma of the stomach. In patients with lymphomas only signs of stenosis were missing, although the majority of the tumors were located in the antrum. As a consequence of the extreme tendency of the lymphomas to exulcerate (89%), the mean duration of symptoms of 21/2 months (patient's delay) is shorter than that for carcinomas. Malignant lymphomas of the stomach are very difficult to identify as such by radiology and endoscopy, because of their uncharacteristic macroscopic appearance. The best diagnostic method has proved to be endoscopic wire-loop biopsy, which serves to obtain adequate material for histology. An unexpected finding was that at the time of operation half of the patients had clinical stage I E. This indicates that lymphomas remain limited to the stomach longer than carcinomas do. The prognosis depends on both histological type and clinical stage. It is somewhat better than that of nodal malignant lymphomas. The 5-year survival rate of all cases with malignant lymphoma of the stomach is 31%.
93 neoplastic polyps measuring more than 2 cm in diameter have been removed from the colon by endoscopy. 15% of the polyps showed severe atypia (focal carcinoma), and in 15% an invasive carcinoma was found. Polypectomy was complicated in 14 cases by bleeding, in 12 cases it was cured by endoscopy. In 1 case in which the colon was injured by coagulation the lesion healed spontaneously. The surgery rate due to complications of the endoscopic removal procedure or due to invasive carcinoma was 7% for the polyps with a diameter of 2-3 cm, 15% for those of 3-5 cm and 50% for polyps with a diameter of more than 5 cm. It is therefore suggested that neoplastic polyps of more than 5 cm in diameter should be removed by endoscopy in high risk patients only.
Angiodysplasias of the colon are rare causes of intestinal bleeding. Diagnosis is by angiography or colonoscopy. In 6 patients with severe anemia in whom conventional methods had failed to reveal the source of bleeding, colonoscopy demonstrated angiodysplasias in the cecum or ascending colon. They were treated endoscopically. In a follow-up period of 3 months to 4 years only 1 patient has sometimes suffered occult fecal blood loss, but is adequately treated by oral iron therapy. No patient has had a severe recurrence of bleeding, nor was colonic resection necessary. It is concluded that endoscopic therapy of angiodysplasias is a valuable alternative to surgery with low risk and high efficiency.
Report on 12 patients with nonspecific ulcers of the colon diagnosed by colonscopy and biopsy. In 10 patients the course was favorable with conservative management. In 2 patients the symptoms were aggravated; in both patients this was due to a penetrating malignant tumour diagnosed at laparotomy a few weeks later. It is proposed that nonspecific ulcers of the colon should be managed conservatively. Further investigations and laparotomy are indicated only when symptoms progress.
Real-time scanning is of great importance as a screening method for the examination of parenchymal organs in the pigastrium and allows rapid evaluation and exact diagnosis of lesions in the biliary duct system and the pancreas. Sonographic findings are expanded by endoscopic cholangiopancreatography (ERCP). The two methods are complementary tools.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Up to now only early resection has proven of value in healing gastric carcinoma. It is therefore mandatory that the pathologic lesion be diagnosed as early as possible. Thus, patients with persistent epigastric complaints under symptomatic treatment should undergo endoscopy even if blood parameters are still within normal limits. The fact that, among all our gastric cancers diagnosed in 1977 by endoscopy, 23% were classified as early cancers indicates that the method is well suited to establishing true early diagnosis.
Mucosal biopsies of corpus and antrum were performed in 17 patients with pernicious anemia. In all patients the corpus mucosa showed atrophic gastritis, while in 16 the antrum was normal or showed only superficial gastritis. This combination is conclusive for pernicious anemia. Over 80% of megaloblastic anemias are caused by pernicious anemia. It is therefore proposed that endoscopy and biopsy be performed as the first examination in these patients. In this way the diagnosis is simple, rapid and economical.
Coloscopic polypectomy saves patients with polyps of the colon from diagnostic laparotomy and also serves for the diagnosis and in the majority of patients even therapy of early colonic cancer. Complications are rare and most can be controlled by endoscopy. Recurrences of the polyp are possible, and therefore, follow-up is necessary.
Within a one-year period seven patients were observed who had developed ulcers of the upper and mid oesophagus after treatment with doxycycline hydrochloride (n = 3), emepronium bromide (n = 3) or Pantogar (n = 1). In each instance the drug had apparently been swallowed dry. The typical symptoms were a sudden onset of retrosternal chest pain and odynophagia during bed rest. Once the drug had been discontinued and treatment with antacid combined with topical anaesthetics and/or alginic acid instituted the symptoms disappeared within a few days. The authors stress that drugs should be swallowed only with good amounts of fluid and generally not immediately before bed rest.