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Biomedical subjects

R Ammann

Publications and source records attributed to R Ammann.

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

[Long-term therapy of Ménétrier disease using ranitidine and pirenzepine].

A 22-year-old woman with hypertrophic protein-losing gastropathy (Ménétrier's disease) is described. During treatment with ranitidine (Zantic) and pirenzepine (Gastrozepin) the gastric mucosa and protein loss were normalized within 4 years. Clinical and histological remission has now been observed for 5 and 3 years respectively. In a 57-year-old woman with hypertrophic gastropathy, 8 months' treatment with ranitidine and pirenzepine was associated with decrease in protein loss and improvement of the histological appearance of the gastric mucosa after one year. Long-term treatment of hypertrophic gastropathy with ranitidine and/or pirenzepine should, therefore, be considered in such cases instead of gastrectomy.

Adult↗
PubMed1991

[Prevalence and significance of ant-HCV-antibodies in ambulatory patients with raised transaminases].

From November 1989 to April 1990 we analyzed prospectively the prevalence of anti-hepatitis C virus antibodies and the possible mode of infection in 90 outpatients with repeatedly elevated alanine-aminotransferase levels. The clinical and serological course of these patients was evaluated after 1, 3 and 6 months. Initially, 24 patients (26.6%) were positive for anti-HCV antibodies, but subsequently only 14 of these patients (15.5%) were positive in the follow-up tests. 9 patients (10%) showed no antibodies against HCV in control evaluations and one patient dropped out of the investigation. The 9 patients with a negative result in the control tests had median relative anti-HCV concentrations of 2.0 (range 1.2-4.1) in contrast to 5.5 (range 1.6-256.5) in the 14 patients with a confirmed anti-HCV test (p less than 0.001). None of those 9 patients had received blood transfusions, 7 had consumed drugs intravenously and only 2 had no specific risk for HCV infection. The consistently anti-HCV positive patients had median alanine-aminotransferase levels between 115 and 200 U/l, whereas the levels in initially anti-HCV positive and subsequently negative patients ranged from 75-90 U/l. The initial prevalence of anti-HCV antibodies in 26.6% of our patients is related to the high rate of either false positive results or sero-conversion in 38% of this group. We recommend cautious interpretation of anti-HCV test results with relative anti-HCV concentrations less than or equal to 2 in equivocal clinical situations.

Adult↗
PubMed1990

[Ultrasonically-guided sclerosing of kidney and liver cysts using polidocanol].

First experiences are reported with percutaneous sclerosing therapy of cysts with polidocanol (aethoxysklerol 1%) using ultrasound for needle guidance. They cover two patients with symptomatic cysts of the liver and a patient with polyglobulinemia and an erythropoietin-producing renal cyst. These experiences are compared to previously reported ones.

Adult↗
PubMed1990

[Measurement of intestinal permeability in Crohn's disease, ulcerative colitis, sprue and idiopathic hyperamylasemia using polyethyleneglycol-400].

We investigated intestinal permeability in healthy adult volunteers, and in patients with Crohn's disease, ulcerative colitis, idiopathic sprue and idiopathic hyperamylasemia by oral administration of 10 g low molecular weight polyethylene glycol (PEG-400) and quantitation of its renal excretion over the subsequent 6 hours by high performance liquid chromatography (gel permeation HPLC). The mean amount of PEG-400 excreted during the first 6 hours by the 12 patients with Crohn's disease (3.1 +/- 0.3 g, mean +/- SE) and the 8 patients with ulcerative colitis (2.6 +/- 0.3 g) was not significantly different from the amount excreted by the 24 healthy volunteers (2.9 +/- 0.1 g). The 3 patients with idiopathic sprue excreted significantly less (1.4 +/- 0.3 g, p less than 0.05) and the 3 patients with idiopathic hyperamylasemia significantly more (4.0 +/- 0.4 g, p less than 0.05) than the healthy controls. In conclusion, no alteration of intestinal permeability could be demonstrated in patients with Crohn's disease or ulcerative colitis. However, intestinal permeability was decreased in patients with idiopathic sprue and increased in those with idiopathic hyperamylasemia.

Adult↗
PubMed1990

[The organization of gallstone lithotripsy using the MPL-9000 at the Zurich University Hospital, successes and failures. Initial results].

At Zurich fragmentation of gallstones is a joint venture between the Visceral Surgery Clinic, the Medical Clinic, Medical Policlinic, Radiodiagnostic Central Institute and Urologic Clinic. Lithotripsy is performed by a team from the Visceral Surgery Clinic with apparatus placed at their disposal by the Urologic Clinic. Indications for lithotripsy include symptomatic cholecystolithiasis, functioning gallbladder, and up to 3 gallstones of at least 10 mm and at most 30 mm diameter. Bile duct stones, acute cholecystitis, coagulopathy, pregnancy, aortic aneurysm and pacemakers are exclusion criteria. Patients spend two days in hospital, lithotripsy is performed without anesthesia, and outpatient follow-up is performed 1, 3, 6 and 12 months afterwards. Our experiences show that lithotripsy is more difficult and more treatments are needed if multiple gallstones are present. We had to perform cholecystectomy in 6 of a total 48 patients, mainly because of therapy resistant biliary pain due to stone fragments. The intraoperative findings did not correspond to the ultrasonic examination before lithotripsy in two of the patients who underwent cholecystectomy. Histologic examination of the six gallbladders in the surgical cases showed no abnormality. After an average treatment duration of 209 days, 9 of 48 patients are stone-free, 15 patients show improvement, in 14 patients no distinct reduction of fragments could yet be shown in recent follow-ups and 4 patients have not yet been reached for follow-up. Of the 230 patients examined lithotripsy was indicated only in 48 (21%) cases.

Adult↗
PubMed1990

[Surgery of chronic pancreatitis].

Between 1982 and 1988 47 patients underwent surgery for chronic pancreatitis at our institution. The main etiological factor was alcohol (41 cases). The mean age of the patients with alcohol-induced chronic pancreatitis was 15 years below that of the other patients. Calcifications were found in 27 patients at the time of surgery. Calcifications and exocrine insufficiency increased from 40% and 27% to 80% and 79% respectively if the history was shorter than 5 years or more than 10 years. The main indications for surgery were cholestatic jaundice (23 cases) and pseudocysts (22 cases), while only 6 patients had surgical treatment for pain alone. Only one of seven recurrences of chronic pancreatitis were in a patient with a history of more than ten years. Operative mortality was 4%. The length of the history of chronic pancreatitis influences the indication for surgery, the surgical technique and postoperative prognosis. Studies comparing different operative techniques are only of value if they take the natural history of the disease into account.

Adult↗
PubMed1990

[MRT and CT in alveolar echinococcosis of the liver].

To compare the value of MRI and CT in evaluating hepatic alveolar echinococcosis a study was conducted on 30 patients. The liver was initially affected in all patients. At the time of examination, 15 patients had undergone partial liver resection. MRI showed no advantage over CT in demonstrating an echinococcal mass lesion. MRI was superior in identifying concomitant pathological changes of the intrahepatic and extrahepatic venous system due to the intrinsic contrast of vascular structures. However, CT was superior in identifying calcifications, an important attribute of the disease. MRI should only be used in imaging alveolar echinococcosis of the liver if diagnostic questions remain open after CT, in particular questions concerning venous pathology. MRI may also be used to replace CT in patients with a contraindication to urographic contrast material.

Adult↗
PubMed1990

[The so-called "fox tapeworm"].

The so-called "fox tapeworm" (Echinococcus multilocularis), the causative agent of a severe disease in man (alveolar echinococcosis), is presently under public discussion in Switzerland. Therefore, actual information is provided on the life cycle of the parasite, epidemiology, disease in humans, symptomatology, diagnosis, therapy and prophylaxis. It is recommended that in endemic regions hunters handling foxes should wear protective gloves, dead foxes should be transported in plastic bags and wild fruits, berries and vegetables should be carefully washed and--if possible--heated to more than 70 degrees C for some minutes prior to consumption. After contact with foxes or other final hosts (dogs, cats) infected with E. multilocularis, persons should be monitored with the highly sensitive and specific Em2-ELISA for serum antibodies aiming at an early diagnosis and treatment of a potential infection.

Animals↗
PubMed1989

[Clinical aspects, spontaneous course and therapy of chronic pancreatitis. With special reference to the problem of nomenclature].

This clinical review is based on prospective long-term observation of 205 cases of alcoholic and 82 cases of non-alcoholic pancreatitis (CP). The long-term course of pancreatitis is the key to clinical classification, which thus far has been erroneously based one-sidely on morphologic criteria. CP exhibits a typical continuous alteration of the main variables (clinical picture, function, morphology) dependent on duration of the disease and etiology. Progress of the disease is determined, first, by progressive destruction of glandular tissue and, second, by possible occurrence of local complications in the pancreas. Basically there are three typical models of disease course from the clinico-biologic and morphologic viewpoint: in uncomplicated CP, (1) the early stage and (2) the late stage; in complicated CP, (3) CP with local complications (chiefly pseudocysts and duct obstruction). - In uncomplicated CP with durable pain syndrome there is a close relationship between pain attacks and pancreatic function, i.e. persistent freedom from pain occurs parallel with severe pancreas dysfunction in the late stage. Complicated CP with lasting pain syndrome, usually due to local complications, is reconverted by surgical eradication of the latter into uncomplicated CP with foreseeable course as regards postoperative pain recurrence, depending on the early or late stage of the disease. In clinical picture and long-term course, non-alcoholic CP differs in certain essential respects from alcoholic CP. The two forms do not differ essentially as regards mortality and survival.

Adolescent↗
PubMed1989

Comparison of three colon cleansing methods: evaluation of a randomized clinical trial with 300 ambulatory patients.

In a prospective randomized clinical trial, three colon cleansing methods for colonoscopy were compared with regard to a) side effects, b) patient acceptance, c) residual liquid and stool during colonoscopy, and d) quality of the examination. The patients were randomly assigned to one of the following three groups for colon preparation: Group 1 (n = 100) 4 liters of Golytely, group 2 (n = 102) 2 liters of Golytely combined with Cascara-Salax, and group 3 (n = 98) X-Prep (a Senna preparation) combined with an enema. X-Prep (group 3) caused significantly more abdominal cramps than 4 liters of Golytely (group 1) or 2 liters of Golytely with Cascara-Salax (group 2) (p less than 0.001). Vomiting was most frequent in group 1 (p less than 0.05 vs. group 3). The patients therefore preferred X-Prep to 4 liters of Golytely (p less than 0.01). The cleanest colon was obtained with 4 liters of Golytely, while 2 liters of Golytely with Cascara-Salax was least efficacious. The quality of the examination was equal in groups 1 and 3, and clearly better than in group 2 (p less than 0.01). We thus conclude that while 4 liters of Golytely and X-Prep plus enema have equivalent cleansing efficacy for colonoscopy, patients judged X-Prep to be less unpleasant.

Adolescent↗
PubMed1988

[The long-term course of 60 patients with alveolar echinococcosis in continuous therapy with mebendazole (1976-85)].

Since 1976 60 patients with inoperable alveolar echinococcosis caused by Echinococcus multilocularis were treated with high doses of mebendazole and examined at regular intervals prospectively according to our protocol regarding clinical course, liver function, morphology, immunologically and plasma mebendazole levels. The average duration of disease was 8(1-19) years, the average duration of chemotherapy was 4.25 (0.75-9) years. The long term results showed a correlation of the clinical course with the mean plasma mebendazole levels and the duration of chemotherapy, respectively. Death (n = 5) or transient progression of the disease process (n = 14) was observed primarily in patients with low plasma mebendazole levels in the early course and within the first two years of chemotherapy. Only 9 patients showed a decrease of the parasite mass. Immundiagnosis (total serum IgE and serum antibodies against Echinococcus antigen) gave some information with regard to therapy results, but only in the long-term course. The cumulative survival of the patients under study was 96% at 5 years and 84% at 10 years, respectively which is markedly higher compared to historical control series with a letality of greater than 90% within 10 years.

Adult↗
PubMed1988

[Recurrent chest wall abscess. Result of a probable percutaneous infection with Echinococcus multilocularis following a dormouse bite].

An unusual form of inoculation and of clinical manifestation of alveolar echinococcosis in the subcutaneous tissue of the thoracic wall is described. In 1970 the patient was bitten by a dormouse (Glis glis). Thereafter multiple recurrent abscesses and fistulae developed over a period of 11 years in the thoracic wall and were drained repeatedly. Several bacteriological and histological examinations revealed no specific cause until 1980. In 1983 radical surgical excision of the subcutaneous inflammatory tissue was performed and alveolar echinococcosis was demonstrated histologically. In the past 4 years the patient has remained asymptomatic and without evidence of recurrence. As a working hypothesis it is suggested that by way of the rodent bite infectious material (eggs of Echinococcus multilocularis) entered the subcutaneous tissue of the thoracic wall.

Abscess↗
PubMed1988

[Extracorporeal shock wave lithotripsy (ESWL) in the treatment of bile duct stones].

Ten patients with common bile duct stones not removable by endoscopic measures after sphincterotomy were treated by extracorporeally generated shock waves. In 9 patients stones up to 30 mm in diameter were disintegrated. Two patients became free of stone fragments spontaneously within one day and in 7 patients the stone fragments were extracted endoscopically. No complications occurred. Extracorporal shock wave treatment represents a promising alternative to surgery in cases where common bile duct stones cannot be extracted endoscopically.

Adult↗
PubMed1987

[Changes in the serum pancreas enzyme following i.v. stimulation with secretin in subjects with a normal pancreas].

The diagnostic value of serum enzyme provocative tests (SEP) is disputed. In particular, the specificity of the test has not been adequately investigated. New interest in the test has arisen with the introduction of pancreas-specific serum enzyme tests. It has been shown that a poststimulatory increase of serum enzymes is found in chronic pancreatitis with well preserved exocrine function, but also in healthy individuals and particularly cigarette smokers. Recently it has been postulated that the lack of a poststimulatory enzyme response is typical of advanced chronic pancreatitis. We investigated the effect of secretin (1 CU/kg i.v.) on serum levels of amylase, pancreasisoamylase, lipase and trypsin for 30 minutes in 48 volunteers without pancreatic disease (19 non-smokers, 19 smokers and 10 patients with hypoxemia). Mean values of all enzymes were significantly higher after stimulation. Enzyme response of trypsin and lipase was more pronounced than that of amylase or pancreasisoamylase. However, depending on the enzyme studied, no significant increase of serum values was found in 47.4% to 89.5% of smokers, 26.3 to 68.4% of non-smokers and 10 to 50% of patients with hypoxemia. The marked variability of enzyme response in controls demonstrates the low specificity of this test. Therefore, SEP are of no diagnostic value in pancreatic disease.

Adult↗
PubMed1987

[Chronic pancreatitis as a possible result of analgesic abuse].

Abuse of analgesics (AA) is a well known cause of chronic interstitial nephritis. Recently a noxious effect of AA on the pancreas has been suggested based upon case observations, and first evidence for association of AA with chronic pancreatitis was presented. In the present prospective clinical study 95 patients with chronic renal insufficiency, in 53 of them associated with AA, were investigated for evidence of chronic pancreatitis (e.g. history of pancreatitis, pancreatic calcifications, diabetes and exocrine function). The patients were divided into two groups: group A consisted of 53 patients with chronic nephropathy associated with AA, and control group B consisted of 42 patients with chronic nephropathy of other etiology. Pancreatic calcifications were observed in 5 cases of group A (10%), but in none of the patients of group B. Exocrine insufficiency was found in 2 of the 5 cases with pancreatic calcifications. Only one of the 5 patients had a history of pancreatitis in association with exocrine and endocrine insufficiency. Thus pancreatic calcifications, which are virtually pathognomonic for chronic pancreatitis, were found exclusively in the group with chronic nephropathy due to analgesic abuse. Chronic pancreatitis in this group of patients is likely to be overlooked because of the lack of clinical and laboratory evidence. The present data support our previous observations that AA may be an etiological factor in chronic calcifying pancreatitis. This first evidence for a drug-induced form of chronic pancreatitis is presented.

Adult↗
PubMed1987

Comparative diagnostic value of the calcium-pentagastrin test versus the tolbutamide test in a patient with a somatostatinoma.

We describe a patient with a small somatostatinoma of the papilla of Vater without clinical evidence for diabetes mellitus, diarrhea, steatorrhea, or cholelithiasis, showing normal plasma basal levels for somatostatinlike immunoreactivity. The diagnosis was based on histologic and immunohistochemical analysis of tumor tissue and hypersomatostatinemia induced by the calcium-pentagastrin test. Before removal of the tumor both diagnostic tests recommended for the detection of a somatostatinoma, a tolbutamide test and a calcium-pentagastrin test, were performed. Whereas the calcium-pentagastrin test provoked a markedly elevated plasma somatostatin level in association with a depressed plasma neurotensin level, the tolbutamide test surprisingly did not. After removal of the tumor the calcium-pentagastrin test no longer induced hypersomatostatinemia. Further studies are needed to determine whether the calcium-pentagastrin test is a more reliable diagnostic test than the tolbutamide test in somatostatinomas with normal plasma basal levels.

Adenoma, Islet Cell↗