Biomedical subjects
Publications and source records attributed to F Hauzeur.
A sufficient number of good retrieval rates (median value 88.9%) could be achieved by means of radiovitamin B12 in 20 patients who underwent a secretin-pancreozymin test. Losses of this amount can be tolerated for practical purposes. As a rule, marker losses are caused by a flow-off into deeper intestinal sections. The marker technique raises a great number of unexplained issues.
In addition to a previous paper [7] a survey is given of acute viral hepatitis, drug-induced liver-disease, chronic hepatitis, cirrhosis of the liver, hyperbilirubinemia, hepatic porphyria, and obstructive jaundice as hepatobiliary diseases independent of pregnancy. Finally, some questions of treatment of pregnant women suffering from liver disease are stressed.
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In its introduction, this review deals with the influence of normal pregnancy on the liver. Then, intrahepatic cholestasis of pregnancy and acute fatty liver of pregnancy as diseases peculiar to pregnancy are considered intensively. A second part will be dedicated to liver diseases independent of pregnancy.
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In 104 patients with longstanding abdominal pain of unknown origin endoscopic pancreatography was carried through after a thorough noninvasive exploration (Secretin-CCK-test included). Pancreatography revealed in 18% slight but distinct-pathological changes at the pancreatic duct system compatible with chronic pancreatitis. As the frequency of the pathological pancreatographic findings showed no correlation with duration of pain history but a significant correlation with age it is suggested that the duct changes encountered represent rather age-dependent irrelevant fibrosis of the pancreas tan clinically relevant chronic pancreatitis. Slight pathological duct changes are by themselves no proof of chronic pancreatitis because there is no possibility to discriminate between chronic pancreatitis and age-dependent fibrosis on the ground of pancreatography. ERP therefore is of little or no value in patients with otherwise insubstantial suspicion of chronic pancreatitis.
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Immunostaging was performed in patients with chronic pancreatitis of different etiologic groups. Immune responifveness was assessed by immunoglobulin serum levels, non specific autoantibody formation, C3 levels, antistreptolysin reaction, antibody titer against Toxoplasma gondii, E. coli, Herpes simplex-, Mumps- and Cytomegalovirus and screening for soluble immune-complexes (PEG precipitation assay), number of T- and B-lymphocytes, lymphocyte responsiveness to PHA, PPD, tetatoxoid and mumps-antigen in a whole blood assay, skin testing with candidin, trichophytin, tuberculin and streptokinase and HLA-typing. In some cases we found a depressed cell-mediated immune responsiveness. Patients were divided into two groups based on this main finding. Cellular hyporesponsiveness was correlated to the severity of the disease and a high incidence of HLA-B5 but not to any etiologic factor of the disease.
A discrepancy between the ERP and SPT was found in 16 patients (15,4%) out of 104 examinations. The results of these examinations were compared with the clinical diagnosis. A cause of false positive results of ERP could be operations on pancreas, of SPT the advancing years of the patients. Neither ERP nor SPT has a better diagnostic significance in chronic pancreatitis.
The authors have performed successively endoscopic retrograde pancreatography (ERP) and secretin-pancreozymin test (SPT) 104 times. A good correlation between ERP und SPT was demonstrated in 84.6%: 50% of patients with pathologic pancreatogram showed also an abnormal pancreatic function test while 36 (34.6%) out of 104 examinations demonstrated both normlal ERP und SPT. A discrepancy between both procedures was found only in 15.4%: pathologic ERP and normal SPT (9.6%) and reversal (5.8%). In conclusions, ERP and pancreatic function tests appear complementary to each other in the evaluation of pancreatic disorders.
The deep duodenoscopy serves for the endoscopico-bioptic clarification of radiologically unclear findings distally from the bulb (niches, sockets, stenoses) and of the positional relations between diverticulum and papilla. As a rule, it is connected with an endoscopic retrograde cholangiopancreaticography (ERCP). The endoscopic retrograde pancreaticography is indicated in relapsing chronic pancreatitis for proving or excluding of changes needing operation which are taken into consideration as partial factors of the relapsing course as well as in suspicion to a local pancreatitis complication and carcinoma of the pancreas. The endoscopic retrograde cholangiography is a decisive aid for the differentiation of the cholostatic icterus. It improves the diagnostics of complaints after operative interventions at the system of the biliary ducts, facilitates the diagnosis of the papillary stenosis and is indicated in insufficient conventional contrasting the biliary ducts. The complications (pancreatitis, cholangitis, cystic infection) have become rare with increasing experience. Contraindications are the florid pancreatitis and cholangitis.
The functional diagnostics is a corner-pillar of the difficult diagnostics of pancreas. Despite new tests many wishes remain open. The secretine-pancreozymine test and the Lundh-test give good informations, but they are expensive and for the patients considerably stressing. They certainly are not regarded as screening tests. The suitable and justifiable tests for epidemiologic examinations (estimations of stool enzymes and of serum isoamylase) are less specific and sensitive. A differentiation between chronic pancreatitis and neoplasm of the pancreas is not possible with the help of the functional diagnostics. The results of functional examinations may be correctly evaluated only within all informations which concentrate at the patient's bed.
A survey is given of the present state of the ERCP in the diagnostics of the chronic pancreatitis. The ERCP is not suited for the proof of early changes in the chronic pancreatitis; it does not allow an exclusion diagnosis. The value of the ERCP in the chronic pancreatitis consists in the fact to render the indication to operation by the proof changes which should be operated on, or to precise it, respectively, and to prevent unnecessary test laparotomies. For this reason the ERCP is indicated above all in the ascertained chronically relapsing pancreatitis and in the persistence of symptoms after an acute inflammatory attack. The most comprehensive information about the morphologic state of the pancreas is got by the combination of the ERCP with methods which reflect the size and the external form of the organ and give evidence concerning the structural changes (sonography, computer tomography).
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A survey is given on indications, results and complications of the deep duodenoscopy and endoscopic retrograde cholangiopancreaticography. The endoscopic retrograde pancreatography is indicated in the chronic forms of pancreatitis, in suspicion to cysts of the pancreas or tumours. Its results have a decisive influence on the indication to surgical procedure and on the planning of the intervention. The endoscopic retrograde cholangiography is of greatest practical significance for the differential diagnosis of the cholestatic icterus: non-obstructed bile ducts exclude an extrahepatic icterus and render a laparotomy useless. Furthermore, the endoscopic retrograde cholangiography is indicated when the demonstration of the duct is intravenously insufficient, when papillary or prepapillary narrowings are present and in the etiologically unclear syndrome of postcholecystectomy. The most dangerous complications of the endoscopic retrograde pancreatography are the acute pancreatitis and the infection of cysts. Cholangitides and septicaemias appear after the endoscopic retrograde cholangiography only in such cases when obstructions of the drainage are present.
Since glass fibre instruments are used, the number of oesophagoscopies very much increased. The complication rate is small. The oesophagus can be inspected without any gaps in all sections. Our knowledge on pathogenesis and distribution of certain diseases of the oesophagus has considerably been enlarged by modern biopsy and endoscopy. In the urgent clarification of acute causes of haemorrhage in the upper alimentary tract endoscopy stands in the first place compared with all other diagnostic methods. The interpretation of the findings in the oesophagus demands an experienced and critical examinator, as the bioptic particles frequently are very small.
In the clarification of circumscribed processes in stomach and duodenal bulb radiodiagnostics and endoscopy supplement themselves in an ideal way. The endoscopy seems to have advantages in recognition and explanation of findings on the cardial and subcardial parts of the stomach as well as on the operated stomach. Deformation of the duodenal bulb and changes of the post-stenotic parts can be better judged radiologically. The complete healing of an ulcer is exactly recognisable only by means of endoscopy. Linear ulcers are often not to be seen in radiodiagnostics. With the help of the aimed biopsy the decision on benignity or malignity of the ulcerating process has become easier. Every radiologically not certainly explainable findings and every discrepancy between X-ray picture and complaints of the patients should bring about an endoscopic examination.