[Utilization of ambulatory-care facilities by older citizens].
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Biomedical subjects
Publications and source records attributed to E Kobler.
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In 262 patients with clinically suspect cancer of the large bowel, results of barium enemas were evaluated. Testing method was coloscopy. Out of 62 cases in which barium enema revealed a "typical" carcinoma, 17 were false positive. In 81 of 110 cases in which the result of barium enema was questionable, a malignant lesion could be ruled out. In 17 out of 90 cases with negative radiologic findings a carcinoma was found.
In upper gastrointestinal hemorrhage in nearly 100% of the cases it can be determined endoscopically whether it is bleeding from esophagus, stomach or duodenum. In more than 90% the bleeding source can be localized and diagnosed exactly. In the colon localization and diagnosis of bleeding lesions by endoscopy is possible in more than 90%. In some of these hemorrhages simultaneous endoscopic therapy is possible.
A lung infiltrate found incidentally in an adult was shown radiologically to be the result of a fistula arising from the upper esophagus. At the pulmonary site, the fistula demonstrated several branches with the typical configuration of a rudimentary bronchial three. The findings are consistent with an unusual type of congenital bronchopulmonary malformation. Ordinarily, accessory lungs are located at the lung base communicating in selected cases with the lower esophagus or the stomach. The embryological explanation lies in an incomplete separation of the tracheobronchial tree from the esophagus.
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A primary extranodal lymphogranuloma of Hodgkin was found in the small bowel (PS II AE) of a 34-year-old man. Two years after radical surgery followed by local telecobalt therapy, the patient is in good health. The symptomatology, therapy and prognosis of this rare form of Hodgkin's lymphogranuloma are briefly reviewed.
Postoperative examination of 600 patients with carcinoma of the large bowel showed: 1. in emergency operation mortality is 30%, in elective surgery 10%; 2. operation risk in elderly patients is not significantly higher than in young patients; 3. only a decrease in "patient and doctor delay" and/or mass screening will provide better results.
The only practicable method for mass screening for carcinoma of the colon is detection of occult blood in stool. In a coloscopically controlled study with the Haemoccult test, dependent from diet, 54-66% of polyps and 77-100% of carcinomas were detected. The Haemoccult test is therefore a suitable method for mass screening for colon carcinoma.
"Patient delay" in carcinoma of the stomach has been, in the past 10 years, 4 months on average. However, "doctor delay" has increased from 10 weeks to 8 months. A shortening of "doctor delay" is possible only if early endoscopy is carried out.
In 299 patients with negative cholecystocholangiogram, endoscopic retrograde cholangio-pancreatography (ERCP) was performed. In obstructive jaundice ERCP is the method of choice, while in cholestasis it is indicated if the intravenous cholecystocholangiogram is insufficient. In unclear abdominal conditions and in "postcholecystectomy syndrome" ERCP may be carried out after other abdominal diseases have been ruled out.
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