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Biomedical subjects

M Heer

Publications and source records attributed to M Heer.

At least 73 records · Page 4Linked to original sources
PubMed1991

Valproic-acid-induced pancreatitis. Case report and review of the literature.

We report a case of pancreatitis with fatal liver failure, in a 21-year-old, mentally retarded patient, taking valproic acid (VPA) therapy, together with a review of the literature of this rare side effect. Until March 1991, only 24 cases of isolated pancreatitis and six cases (including ours) of pancreatitis with hepatic failure under VPA treatment have been published. Most of the patients were less than 20 years old, and injury to the pancreas developed during the first year of therapy in 72% of the patients, approaching a mortality of 21%. Pancreatitis associated with liver failure has a poor prognosis mainly because of the VPA hepatotoxicity. It seems that the pancreatic side effects fluctuate between two extremes: asymptomatic hyperamylasemia and fatal pancreatitis.

Adult↗
PubMed1991

Classification of the free fluid reservoir in the calf by electrical impedance tomography.

The Electrical impedance tomography computes images of resistivity distribution which allow to analyse the body fluid content. The Sheffield system, Applied Potential Tomography (APT) was chosen to examine fluid shifts in the calf following body postural change, saline infusion (FL), and lower body negative pressure stress (LBNP). The APT allows the detection of differently reacting regions in the tomogram. The overall images of APT showed an exponential resistivity increase after the body position change from upright to 6 degrees head down tilt (HDT). During LBNP the pattern of the APT images looked the same as during FL. Both showed a resistivity decrease in the overall images. The outer surface showed a different magnitude of resistivities compared to the inner region in all experiments. A comparison of the overall APT images with the tomograms simultaneously obtained by NMR in one test subject showed the same tendency. This leads to the conclusion that the changes in the fluid reservoir of the calf may be classified by electrical impedance tomography.

Adult↗
PubMed1990

[Risk of malignancies in celiac disease--a retrospective study].

A review of 52 patients with celiac disease showed the development of malignant tumors in eight cases (15%). The following malignomas were diagnosed: one malignant lymphoma, one multiple myeloma, one rhabdomyosarcoma, one carcinoma of the uterus, one carcinoma of the sigmoid colon and three adenocarcinomas of the small bowel. Patients with tumors showed significantly lower hemoglobin, lower serum albumin, and higher sedimentation rates than patients without tumors. The possibility of underlying malignoma must always be considered in all patients with newly diagnosed coeliac disease and in patients where symptoms of a known celiac disease change without alteration of the prescribed diet.

Aged↗
PubMed1990

[Adenocarcinoma of the small intestine in celiac disease. Case report and literature review].

We describe three patients with celiac disease complicated by adenocarcinoma of the small intestine, and summarize the 36 cases of this association that have been reported. Retrospectively we found an increased risk (relative risk 25-250) of developing adenocarcinoma of the small intestine in patients with celiac disease in the region of Winterthur (north-east Switzerland). We therefore suggest that celiac disease be considered a premalignant condition not only for malignant lymphoma and gastrointestinal tumors, but also for adenocarcinoma of the small intestine. Synchronous or metachronous development of carcinoma in one of our patients and in two cases reported in the literature offer further evidence that celiac disease is a premalignant condition for adenocarcinoma of the small bowel. In several patients celiac disease was diagnosed only after diagnosis of the carcinoma. With regard to asymptomatic or subclinical celiac disease, it seems justifiable to search for possible underlying celiac disease in all patients with established diagnosis of adenocarcinoma of the small intestine.

Adenocarcinoma↗
PubMed1989

[Segmental hemorrhagic colitis following amoxicillin therapy].

We report on three young females complaining of bloody diarrhea of acute onset due to hemorrhagic colitis associated with oral amoxicillin therapy. The bloody diarrhea with abdominal cramps began 4 to 6 days after starting the treatment. Right colon was involved in two patients, and the descending and sigmoid colon in the other. Stool cultures and search for Cl. difficile toxins were repeatedly negative. Biopsy revealed marked mucosal hemorrhage (2/3), erosions (2/3) and thrombosed vessels (2/6). Symptoms rapidly resolved after 2 to 6 days. Extensive allergic evaluation in one patient did not reveal a hypersensitivity reaction. A literature review reveals another 31 patients with this characteristic form of colitis associated with ampicillin or amoxicillin therapy.

Adult↗
PubMed1988

[Colorectal carcinoma following radiotherapy of gynecological carcinoma].

To assess the risk of radiation-induced cancer of the colon we studied 196 patients with a history of radiation treatment for cancer of the female genital system. After a median follow-up of 12.4 years (range 10-15 years) corresponding to 1172 patient-years, 94 (48%) patients were still alive. 84 (89%) of these patients were evaluated for a second primary cancer to the colon. In 38 (45%) colonoscopic examination was performed. 3 patients were found to have a second primary cancer to the colon compared with 0.32 expected (relative risk 9.3) on the basis of rates from the Zürich Tumor Registry. Due to partial long-term survival, patient non-compliance and non-feasibility of colonoscopic examination, only one fourth of all patients initially treated by radiotherapy for cancers of the female genital system were suitable for colon screening. For these high risk women, colorectal tumor screening should be integrated into a gynecologic tumor follow-up.

Adult↗
PubMed1988

[Loss of vision as a complication of acute pancreatitis].

A report is presented on two patients with severe visual loss and scotoma following an episode of alcohol-induced pancreatitis. A 35-year-old man with pancreatitis developed visual loss in both eyes. Ophthalmoscopic examination revealed extensive ischemic infarcts with bilateral hemorrhage and cotton-wool spots, a clinical picture similar to that of (post-traumatic) Purtscher's retinopathy. Goldmann visual fields demonstrated paracentral scotomas. Fundoscopic lesions had disappeared 3 months after the acute event and visual acuity improved gradually from 0.1 to 1.0. In a 36-year-old man, cerebral infarction was established by CT as a possible cause of visual loss. CSF examination revealed Sudan-III positive material suggesting cerebral fat embolism as the cause of cerebral infarcts. Visual fields showed central scotomas. During the 4-year follow-up period there was a gradual improvement in visual acuity.

Acute Disease↗
PubMed1987

[Ischemic-granulomatous colitis: a new differential diagnosis from Crohn's colitis?].

In patients with inflammatory bowel disease the presence of epitheloid cell granuloma is considered to be the most reliable single criterion for the presence of Crohn's disease. We report on 6 patients (5 female, 1 male, mean age 73.5 years) with acute onset of inflammatory bowel disease, in whom the presence of epitheloid cell granuloma led to the diagnosis of Crohn's disease. However, concomitant major bleeding (4/6), absence of small intestinal involvement, and absence of extraintestinal manifestations suggested the presence of ischemic colitis. Histologic findings including thrombosed vessels (6/6), mucosal (5/6) and submucosal (3/4) hemorrhage, and mucosal (3/6) and submucosal (3/4) fibrosis supported this diagnosis. A review of the literature suggests that many clinical features of assumed Crohn's disease in elderly patients are atypical and would be most consistent with an ischemic pathogenesis: rarity of fistula, low recurrence rate, low rate of small intestinal involvement and extra-intestinal manifestations, and increased incidence of major colonic bleeding would best fit with an ischemic pathogenesis in at least some of these patients. We suggest that in elderly patients with "Crohn's colitis", even in the presence of epitheloid cell granuloma, an ischemic etiology should be considered.

Age Factors↗
PubMed1987

Acute ischaemic colitis in a female long distance runner.

A 34 year old female long distance runner is reported with bloody diarrhoea. Colonoscopy revealed patchy haemorrhagic mucosal lesions throughout the colon. The most extensive lesions were found in the sigmoid colon. Histologic examination disclosed mucosal haemorrhage, dilated capillaries, patchy fibrosis and superficial erosions. Additional findings in this patient were haemorrhagic gastritis, microscopic haematuria and rhabdomyolysis. The only medication taken by the patient was oral contraceptives. We conclude that ischaemic colitis is one of the possible mechanisms leading to gastrointestinal blood loss in competitive runners.

Acute Disease↗
PubMed1987

Angiodysplasia of the colon: an expression of occlusive vascular disease.

We performed a prospective case control study and found among 306 patients, in whom a complete colonoscopy was done, 19 patients (6%) with angiodysplasia of the colon. These patients were significantly older than control subjects (p less than 0.05). Nine patients (47%) with angiodysplasia had no bleeding and were identified incidentally by colonoscopy performed for other indications. To clarify the possible role of underlying occlusive arterial diseases we compared the 19 patients with angiodysplasia with a control group, matched for sex and age, in whom a complete colonoscopy did not reveal a vascular anomaly. An increased incidence of cardiovascular diseases was found (p less than 0.001). Risk factors for cardiovascular diseases were significantly associated with angiodysplasia (p less than 0.05). These data support the contention that these acquired vascular lesions might result from chronic submucosal arteriovenous shunting secondary to mucosal ischemia due to underlying occlusive arterial diseases.

Adult↗
PubMed1986

[Clinical value of gastrointestinal bleeding scintigraphy in vivo using 99mTc-labeled erythrocytes].

99mTc labeled red blood cell imaging was performed in 13 patients with clinical evidence of gastrointestinal bleeding from an unknown source. In all these patients the bleeding sites had remained unclear after the standard diagnostic evaluation, including upper gastrointestinal endoscopy (13 patients), colonoscopy (12 patients) and angiography (4 patients). Nine of 13 patients (70%) had a scan indicating active bleeding. In the 10 patients in whom the bleeding site was definitely identified by endoscopy, arteriography, or surgery, scintigraphy correctly localized the bleeding site in 6 (60%). One false positive localization was noted. Bleeding was detected in 7 of 9 patients with melena and in 2 of 4 patients with occult bleeding and chronic anemia. In all but 1 patient, additional diagnostic investigations were needed to finally establish the bleeding site. In patients in whom a potential bleeding site has been identified by standard diagnostic tests, 99mTc red blood cell imaging may provide a reliable noninvasive test by which to document active bleeding from the suspected source.

Adult↗
PubMed1986

[Actinomycosis of the colon: clinical, endoscopic, serological and therapeutic aspects].

The case of a 73-year-old woman with extensive abdominal actinomycosis is reported. It appears to be the first case of abdominal actinomycosis in which endoscopic and serologic investigations have been performed before and after medical therapy. Ultrasonography, CT scan and surgical exploration revealed an extensive inflammatory tumor of the sigmoid colon involving the urinary bladder and uterus. Histologic examination revealed typical sulfur granules. Longterm highdose therapy with penicillin was performed.

Actinomyces↗