[In memory of Harald Lindner].
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Biomedical subjects
Publications and source records attributed to M Classen.
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Eighteen elderly patients (average age 72.3 years) suffering from cardiac failure and from chronic gastric ulcers received carbenoxolone sodium, the risk of surgery being considered too high. The effects of this medical treatment were followed up closely. Side-effects were observed in 12 patients. In 9 patients these effects had to be taken care of (hypokalemia in 5 cases, rise of blood pressure in 3 cases, edema in 3 cases). In 2 cases treatment had to be stopped. The side effects observed in elderly patients with cardiac insufficiency make it mandatory to administer carbenoxolone sodium to this group only during hospitalization, which allows, frequent controls of body weight, blood pressure, serum potassium and transaminases. In most cases side effects can be detected early enough and treated.
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Planning the strategy in diagnosis of diarrhea some questions need to be answered: 1. Do the complaints in question fulfill the defined criteria of diarrhea? 2. Is it an acute diarrhea of infectious origin requiring fast microbiologic diagnosis? 3. Is it a chronic diarrhea? A) Do anamnestic findings and present status induce a certain suspected diagnosis, as in hyperthyreoidism, drugs, intestinal resections? B) Is a complete stepwise diagnostic planning needed as in Crohn's disease, insufficiency of the pancreas, non tropical sprue? Diagnostic measures have to be taken into consideration according to the answers given.
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Endoscopic papillotomy was attempted in 59 patients with extrahepatic obstruction of the biliary duct system and was actually performed in 50 patients. A special high-frequency diathermy knife was introduced via a duodenoscope into the terminal common bile duct and the roof of the papilla was incised. In 33 out of 39 patients with choledocholithiasis the stones passed into the duodenum spontaneously or were removed endoscopically. Papillary stenosis without ductal stones was successfully treated with this method in eight out of 11 patients. One perforation of the duodenocholedochal junction occurred and was repaired surgically. Endoscopic papillotomy and stone extraction is a relatively safe and effective method of treating extrahepatic jaundice.
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Dermatitis herpetiformis (DH) has been reported to be associated with various degrees of intestinal villous atrophy in 19 to 68 percent of the cases studied. This was true particularly in British and American populations. The present investigation deals with morphological and functional characteristics of small intestinal mucosa in a group of German DH patients (n=16): No case of villous atrophy could be detected, whereas interepithelial lymphocytes were shown to be slightly but significantly elevated. Intestinal disaccharidase activities were not statistically different from those of healthy control subjects, and oral lactose tolerance tests were normal in each of 8 patients tested. Genetical and immunological differences between our DH patients and those studied by British and American authors may be responsible for the basically different results as to "dermatogenic enteropathy".
Experimental studies carried out in 11 dogs have shown that, with the aid of a high frequency diathermy probe, satisfactory papillotomies can be performed. On the basis of these results, endoscopic papillotomies have been carried out in 23 patients. Indications for papillotomy were biliary calculi in 11 high-risk patients, in 6 cases calculi overlooked during bile duct surgery, and in 3 patients recurrent calculi after previous cholecystectomy. In 3 patients circumscribed papillary stenosis indicated endoscopic papillotomy. Papillotomy was successful in all 23 cases. In 9 cases the calculi had been passed spontaneously after 3-5 days. In 10 patients the stones had to be extracted using the Dormia basket or a wire loop, and in one patient the stone had to be removed surgically. In one of these patients endoscopic papillotomy was followed by an attack of pancreatitis which subsided after 3 days. Further complications, in particular the occurrence of massive bleeding after papillotomy, were not observed.
This is a report on a 36-year-old male patient presenting with a rare combination of ulcerative colitis and primary sclerosing cholangitis. The disease of the biliary tract was suspected on the basis of the endoscopic retrograde representation of the common bile duct, and serologically differentiated from a chronic destructive, non-supperative cholangitis on the basis of a lack of antimitochondrial antibodies. Subsequently, a hepaticojejunostomy was carried out to normalize the bile flow.
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