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Biomedical subjects

R Ammann

Publications and source records attributed to R Ammann.

At least 91 records · Page 5Linked to original sources
PubMed1987

Lipasuria in acute pancreatitis: result of tubular dysfunction?

Lipase, in contrast to amylase, is completely reabsorbed by the proximal tubules after glomerular filtration. Therefore, no lipase is detectable in the unconcentrated urine according to the current opinion. The handling of lipase (detected with an enzyme-immunoassay) by the kidney was investigated in comparison with creatinine, amylase, and beta-2-microglobulin by clearance studies in acute pancreatitis (n = 10), burn injury (n = 4), glomerular proteinuria (n = 8), and controls without evidence of pancreatic or renal diseases (n = 5). In initial stages of acute pancreatitis a measurable clearance of lipase (mean: 49.6 microliters/min, range: 0.5-234) was found in association with corresponding increased clearances of beta-2-microglobulin (mean: 10.5 ml/min, range: 0.02-58.9) and of amylase (mean: 8.9 ml/min, range: 2.4-22.6) in nine of ten patients. This finding is consistent with a defect of tubular function. However, regression analysis failed to show a significant correlation between lipase and beta-2-microglobulin clearance. Repeated measurements during the course of pancreatitis in seven patients showed reversibility of tubular dysfunction. In patients with burn injury a similar elevation of clearances of beta-2-microglobulin and of amylase was found, but tubular dysfunction in this condition was not associated with lipasuria. In glomerular proteinuria a lipase clearance was found in two of five cases with moderate, and in the other three cases with severe impairment of creatinine clearance. beta-2-microglobulin clearance was normal in the former and only slightly elevated in the latter group. In conclusion lipase is measurable in the urine of most patients with acute pancreatitis as a result of a reversible tubular dysfunction.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1986

[Mesenterial anemia as a cause of jogging anemia?].

Anemia in runners is common but its origin is unknown. The present study reports on frequency and origin of gastrointestinal blood loss in cross-country skiers and runners. 41 participants in the Engadin Ski Marathon were checked by questionnaire and occult blood test. 8 (19%) had diarrhea or abdominal pain during or immediately after skiing and 3 (7%) had hemoccult-positive stools. In addition, the blood flow of the superior mesenteric artery was measured by duplex scanning in two trained runners after standardized exercise. While the mesenteric blood flow in the asymptomatic runner changed only insignificantly there was an impressive decrease in the second runner, who had been treated for anemia, down to 20% and 40% (30 and 90 min respectively) after exercise. It is concluded that the occurrence of gastrointestinal blood loss in cross-country skiing, and the significant decrease in mesenteric blood flow in a symptomatic runner, indicate a close and possible causal relationship between mesenteric ischemia and "jogging anemia".

Adult↗
PubMed1986

Measurement of mesenteric blood flow by duplex scanning.

Ultrasonic imaging combined with a pulsed Doppler unit (duplex scanning) allows the noninvasive assessment of blood flow of the superior mesenteric artery. The changes in mesenteric blood flow associated with a standardized (1000 kcal) food load were measured and the results were compared with blood flow of the left common carotid artery. Twenty healthy subjects (aged 30.1 +/- 5 years) were studied fasting (12.4 +/- 2.6 hours' duration) and six times with a 15-minute interval after the test meal. The diameters of the superior mesenteric artery (0.60 +/- 0.09 mm) and of the common carotid artery (0.61 +/- 0.05 mm) were measured from the B-mode image. The Doppler frequency spectra were used to determine peak systolic, late systolic, and end-diastolic velocity and to compute the mean velocity. Although the flow parameters of the common carotid artery were virtually unaffected by food intake, a steep increase in mesenteric blood flow velocity and volume flow was observed. At rest, blood flow through the mesenteric artery was 6.3 +/- 2.6 ml/sec and 9.5 +/- 2.1 ml/sec in the carotid artery. After the test meal, mesenteric artery blood flow increased significantly (p less than 0.0001) and reached maximal hyperemia (20.3 +/- 7.4 ml/sec) after 45 minutes. The measurement of mesenteric blood flow before and after a test meal characterizes intestinal hemodynamics and should be suitable to evaluate ischemic disease and other disorders that lead to changes of mesenteric blood flow.

Adult↗
PubMed1986

[Gastrointestinal involvement in acquired immunologic deficiency syndrome (AIDS)].

The gastrointestinal tract is a major target organ of the acquired immunodeficiency syndrome. Opportunistic infections or Kaposi's sarcoma within the gastrointestinal tract are the two most frequent lesions. Diarrhoea, weight loss or odynophagy may be the presenting symptoms or signs for which a gastroenterological consultation is sought. In this report we present our own observations of patients with AIDS. Diagnostic and therapeutic aspects of this new syndrome are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Diagnosis of achlorhydria by plasma secretin determination--a tubeless approach.

To investigate the value of plasma secretin determination in the diagnosis of impaired gastric secretion, blood samples were drawn for secretin assay (radioimmunoassay) at specified intervals before and after pentagastrin stimulation in 10 healthy volunteers and 11 subjects with suspected hypo- or achlorhydria (less than 10 mEq HCl/2 h). The tests were performed twice, once with and once without aspiration of gastric juice for estimation of acid output. In six other patients with proven achlorhydria, the test was performed once without gastric aspiration. The best discrimination of a single plasma secretion level between controls and patients with hypo- and achlorhydria was obtained 60 min after pentagastrin stimulation. All controls and four subjects with an acid output more than 10 mEq/2 h had secretin levels within normal limits. In contrast, 12 of the 13 subjects with hypochlorhydria had abnormally low basal corrected secretin levels at 60 min, including nine achlorhydria patients. It is concluded that secretin determinations after pentagastrin stimulation may be a valuable diagnostic and epidemiological tool to identify patients with impaired gastric secretion.

Achlorhydria↗
PubMed1985

[Postprandial hyperemia of the superior mesenteric artery].

With the use of ultrasonic duplex scanning it is now possible to assess the blood flow dynamics in the human mesenteric artery noninvasively. The changes associated with a standardized food load were measured and the results compared with the blood flow of the common carotid artery. 20 healthy subjects (age 30.1 +/- 5 years) were studied fasting and 6 times at 15 minutes interval after the test meal (1000 kCal). While the flow parameters of the carotid artery were virtually unaffected by food intake, a steep increase in mesenteric blood flow was observed. Maximal hyperemia (2.7-fold increase, range 1.4-5.7) was reached 45 minutes after food intake.

Adult↗
PubMed1985

[Endoscopic division of an obstructive intraluminal duodenal diverticulum].

Intraluminal duodenal diverticula are rare malformations which usually are noted first in adulthood. High intestinal obstruction predominates the clinical picture. Surgical resection of the diverticulum is the treatment of choice. In a 52-year-old woman it was possible to split the intraluminal obstruction along its whole length by endoscopic means. This method would seem to present a possible alternative to surgical intervention.

Diverticulum↗
PubMed1985

[Primary colon tuberculosis].

Two cases of primary gastrointestinal tuberculosis are reported. One patient showed radiologic, colonoscopic and histopathologic features of Crohn's disease. After a five-year follow-up, acid-fast bacilli were identified in colonic tissue cultures. In both patients fecal cultures were repeatedly negative for Mycobacterium tuberculosis. The two patients were successfully treated with antituberculous therapy. The authors emphasize the importance of considering tuberculosis in patients presenting with Crohn's disease. In this regard colonoscopy with tissue culture of targeted biopsy may be a valuable aid in establishing the diagnosis of tuberculous colitis.

Adult↗
PubMed1985

Mucosal biopsy of vascular ectasia (angiodysplasia) of the large bowel detected during routine colonoscopic examination.

Between 1975 and 1983, 9434 colonoscopic examinations were performed at the University Hospital of Zürich. Localized vascular ectasia was detected in 84 patients and there were 48 mucosal biopsies from 46 patients. From the total of 48 biopsies only 24 (50%) showed vascular anomalies. The most frequent lesion encountered was groups of thin-walled dilated vessels in the lamina propria seen in 21 biopsies from 20 patients. These dilated vessels are not specific but in respect of age (median 69 years), location (predominantly in the caecum and the ascending colon) and frequent multiplicity, they are suggestive of angiodysplasia. Five of the 20 patients suffered from chronic anaemia due to haemorrhages. The three other positive biopsies (from two patients) revealed a tiny haemangioma in the sigmoid colon of a 28-year-old woman and a few large, thick-walled probably malformed vessels in the mucosa of the caecum of a 17-year-old boy. Twenty-four biopsies did not show any histologically significant vascular anomaly. Mucosal biopsy of vascular lesions detected during routine colonoscopic examination will, if positive, most frequently simply confirm the endoscopically diagnosed vascular ectasia and may in rare cases show or alert suspicion to vascular lesions other than angiodysplasia. Definitive morphological diagnosis will however only rarely be achieved by this method of investigation.

Cecum↗
PubMed1985

Cholestasis in alcoholic chronic pancreatitis. Diagnostic value of the transaminase ratio for differentiation between extra- and intra-hepatic cholestasis.

In our long-term study of alcoholic chronic pancreatitis (median follow-up time, 10.4 years) 84 of 173 patients (48.6%) developed transient or persistent cholestasis with or without hyperbilirubinemia. We studied the discriminative value of the ASAT/ALAT ratio to differentiate intrahepatic (IHC) and extrahepatic cholestasis (EHC; due to stenosis of the distal common bile duct) in 75 of these patients. In 45 patients with persistent or recurrent cholestasis (group A) the cause of cholestasis was documented by accurate morphological methods. Thirty of the other 39 patients with transient cholestasis (group B) were classified on the basis of the overall clinical evaluation. Of 37 patients with IHC 36 had an ASAT/ALAT ratio of 1.5 or higher (one patient had normal values for both transaminases). Out of 38 patients classified as EHC 29 had an ASAT/ALAT ratio of 1.4 or lower (9 with normal transaminases being excluded). One patient with cholangitis secondary to EHC had a transient elevation of the ASAT/ALAT ratio to above 2.5. Thus our data suggest that in alcoholic chronic pancreatitis associated with cholestasis an ASAT/ALAT ratio of 1.4 or lower (or normal transaminases) usually indicates EHC. Diagnostic study and surgical decompression is mandatory in these cases if EHC persists.

Alanine Transaminase↗
PubMed1985

[Diagnosis and therapy of chronic alcoholic pancreatitis. A critical review of the status].

The practical implications of the new Marseilles classification (1984) of pancreatitis are discussed and the present-day diagnostic methods critically reviewed. The new classification distinguishes between two typical long-term profiles, i.e. acute (reversible) and chronic (progressive) pancreatitis. Modern diagnostic tests such as sonography, CT, ERCP and the secretin-CCK test do not provide a "gold standard" for early chronic pancreatitis. Thus, long-term studies of function and morphology are needed to differentiate chronic pancreatitis (progressive dysfunction, calcification, ERP changes) from acute (reversible) pancreatitis. The etiology is a helpful prognostic guide since gallstone pancreatitis virtually never becomes chronic. However, alcoholic "acute" pancreatitis may not always progress to chronic pancreatitis. Drug or surgical treatment of pain is symptomatic and empirical, since the pathomechanisms of pain are poorly understood. A prerequisite for optimum therapy is exact staging of the disease into: uncomplicated early stages with short, self-limiting episodes of pancreatitis: conservative therapy, persistent pain, mainly due to pseudocysts (diagnosis by morphological tests): surgical therapy, advanced painless forms of chronic pancreatitis associated with diabetes and/or steatorrhea: diet and substitution therapy. After successful surgical drainage persistent pain subsides, but postoperative episodic recurrences of pancreatitis are common in the early stages of the disease and in association with continued alcohol intake. However, spontaneous pain relief occurs in all cases in the late stages of the disease and with progressive pancreatic dysfunction (despite continued alcohol abuse).

Acute Disease↗
PubMed1984

[The Mirizzi syndrome].

Three cases of Mirizzi's syndrome are reported, with special emphasis on differential diagnosis and preoperative evaluation. The syndrome consists of the triad cystic duct stone, inflammatory reaction and benign hepatic duct stenosis. Endoscopic retrograde cholangiography or percutaneous transhepatic cholangiography is mandatory for preoperative evaluation. Cholecystectomy with clearance of the bile duct is the treatment of choice.

Cholecystectomy↗