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Biomedical subjects

R Ammann

Publications and source records attributed to R Ammann.

At least 109 records · Page 6Linked to original sources
PubMed1984

[Clinical significance of colonic angiodysplasias].

Among 9343 colonoscopic examinations (1975-1983) colonic angiodysplasias (AD) were diagnosed in 78 patients (0.8%). The mean age of patients with AD was 68 (17-86) years which was significantly higher than that of patients without AD (p less than 0.0001). 76% of the AD were localized in cecum or colon ascendens, 13% in colon transversum, 4% in colon descendens and 6% in sigmoid colon. 69 patients (88.5%) had 1-4 AD; 4 (5.1%) 5-10 AD and 5 (6%) more than 10 AD. A high incidence of associated diseases leading to vascular complications (i.e. hypertension, diabetes mellitus) was noted. 14 of the 78 patients had anticoagulation or bleeding disorders, possibly precipitating intestinal bleeding. The 21 patients (26.9%) with symptomatic AD had either lower intestinal bleeding (n = 8) or severe anemia (n = 13). In 57 patients (73.1%) the AD were asymptomatic during a mean follow-up of 48 (1-108) months. Whereas age and sex distribution were not significantly different between symptomatic and asymptomatic patients, the number and size of AD were significantly increased in symptomatic patients (p less than 0.005).

Adolescent↗
PubMed1984

Endoscopic follow-up after colorectal cancer surgery. Early detection of local recurrence?

This study deals with 188 consecutive patients who had a radically resected colorectal carcinoma and who were later controlled by colonoscopy. The median interval between resection and endoscopy was 2.5 (0.5-19) years. In 20 patients, a local recurrence was found (10.6%). In 11 of these 20 patients the indication for colonoscopy was the clinical suspicion of a recurrence. The remaining nine patients were asymptomatic, and colonoscopy was done as a routine procedure. In six of nine asymptomatic patients, a potentially curative resection of the recurrent tumor was possible, which was not possible in any of the 11 symptomatic patients. Nineteen of the 20 patients with a local recurrence could be followed up. Five of the six patients with potentially curative resection of the recurrence were asymptomatic for a median time of 38 (12-72) months after surgery; in contrast, 9 of 13 patients without curative operation died after a median survival period of 8 (1-24) months. The results of this study suggest that good long-term prognosis may be expected in patients in whom local recurrence is detected at an early asymptomatic stage with the possibility of potentially curative resection. Therefore, the authors propose regular endoscopic examinations in the first years after curative colorectal cancer surgery.

Adult↗
PubMed1984

Monoclonal gammopathy in chronic active hepatitis.

Immunoelectrophoresis was performed in 31 of 272 patients with chronic active hepatitis (CAH) because of an M-spike component (seven patients, 2.6%) or hypergammaglobulinemia (24 patients) revealing a monoclonal gammopathy (MG) in 11 patients. In addition, 50 randomly selected patients with CAH and no evidence for an M-spike component were tested by immunoelectrophoresis. In 13 patients (26%), an MG was found. The mean age of the 24 patients with MG was 57.4 years (range: 23-76). HBsAg was present in nine patients (37.5%), no HBV-marker was detected in ten patients (41.7%). The immunoglobulin class of MG was IgG in ten patients (41.7%), IgA in one patient (4.2%) and IgM in 11 patients (45.8%). In two patients, Bence Jones protein was found in either serum or urine. In only one patient was the MG associated with multiple myeloma, whereas none of the other 23 patients developed a malignant lymphoproliferative disease within the median observation period of 6 years. We conclude that there is an unexpectedly high prevalence of benign MG in patients with CAH.

Adolescent↗
PubMed1984

[Chemotherapy of human echinococcosis].

In human echinococcosis, today as in the past, surgical removal of the parasite remains the treatment of choice. Beside certain conditions, adjuvant chemotherapy with Vermox is indicated for echinococcus multilocularis as well as echinococcus granulosus. A substantial decrease of the echinococcal parasite mass under Mebendazole is not yet known. Nevertheless jaundiced patients with diffuse liver infestation with echinococcus multilocularis became jaundice-free and able to work. Mebendazole toleration is very good. A closely interrelated medical control of patients under Mebendazole therapy ought to be interdisciplinarily carried through between internists and surgeons.

Administration, Oral↗
PubMed1983

[Bedside diagnosis of pancreatitis using the urinary amylase test tape. Preliminary results].

A test strip for rapid detection of alpha-amylase in urine was evaluated in 12 patients with an acute episode of acute or chronic pancreatitis and in 16 patients with hyperamylasemia of varying origin. The test strip was positive in 11 of 12 patients with acute pancreatitis and in 8 of 13 patients with hyperamylasemia. In 3 patients with macroamylasemia the test strip was negative. The specificity was 98% in 100 ambulatory patients without evidence of pancreatic disease.

Acute Disease↗
PubMed1983

[Chymotrypsin activity in the stool: comparison of a new photometric technic and the standard titrimetric method].

A newly developed photometric assay for determination of fecal chymotrypsin is compared with the titrimetric standard method. Correlation of both technics was highly significant with a correlation coefficient of r = 0.975. The precision of both methods is satisfactory, with a coefficient of variation of 3.7% for the photometric and 1.8% for the titrimetric method. The clinical value of fecal chymotrypsin tests and other "tubeless" function tests is discussed with special reference to diagnosis and prognosis of chronic pancreatitis.

Chymotrypsin↗
PubMed1983

[Endoscopic papillotomy in preserved gallbladder].

Endoscopic papillotomy was attempted in 60 high risk patients (mean age 76 years) with complications of common bile duct stones and preserved gallbladder. Successful papillotomy and bile duct clearance was achieved in 56 patients (93%). One patient died of bleeding shortly after papillotomy. In 5 patients without signs of complication, cholecystectomy was performed prophylactically. Three patients were lost to follow-up. No cholecystectomy was performed in 47 patients (mean follow-up 24 months). 35 (74%) of these cases were free of biliary symptoms; 5 (11%) complained of nonspecific dyspeptic pain and only 2 (4%) had biliary colic. Complications due to the preserved gallbladder occurred in 5 of 47 patients (11%). Two patients had a short transient bout of jaundice and cholangitis respectively. Three patients developed acute cholecystitis with subsequent empyema. Four out of five complications occurred within one month and in three of them the cystic duct was occluded at papillotomy. In summary, treatment of common bile duct stones by endoscopic papillotomy appears to be justified in high risk patients with preserved gallbladder. Gallbladder related complications are mainly to be expected early in the follow-up or in cases with cystic duct occlusion at papillotomy. Because of the risk of empyema, early cholecystectomy is indicated in cases of acute cholecystitis.

Adult↗
PubMed1983

[Findings in the upper gastrointestinal tract in Crohn disease].

The features, frequency and clinical significance of Crohn's lesions in the upper gastrointestinal tract have been investigated. In 11 out of 28 randomly selected patients, lesions which may be caused by Crohn's disease were found on panendoscopy. These were serpiginous ulcerations in the pars II of the duodenum, as well as aphthous-like lesions and polypoid mucosal folds in the esophagus, antrum and duodenum. In 2 cases each of polypoid folds and aphthous-like lesions, the diagnosis was corroborated by histological finding of a granulomatous inflammation. The lesions suspected to be caused by Crohn's disease were found especially in younger patients and were accompanied by upper abdominal symptoms, but showed no correlation with the clinical activity of the disease.

Adolescent↗
PubMed1983

[Clinical significance of pancreas divisum].

Pancreas divisum was demonstrated in 22 of 500 consecutive ERCP (4.4%). Among patients with otherwise normal ERCP, pancreas divisum was found in 12.8%. In contrast, only 1.8% of patients with other pathology in the ERCP exhibited pancreas divisum (p less than 0.001). In relation to the clinical indication, pancreas divisum was found in 13.3% of patients with suspected or proven pancreatitis, in 1.9% of patients with suspicion of biliary tract disease (p less than 0.001), in 1.9% of patients with suspicion of pancreatic cancer (p less than 0,05) and in 4.4% of patients with epigastric pain of undetermined origin (p greater than 0.05). In 14 patients pancreas divisum was the only pathological finding in a thorough clinical and gastrointestinal workup; 6 of the 14 patients had had typical episodes of pancreatitis, in 6 other patients there was clinical and biochemical evidence of pancreatic disease (mainly pain and hyperenzymemia), and the last 2 cases had chronic epigastric pain without biochemical abnormalities. In 2 patients of this series the pancreas divisum was misinterpreted morphologically (sonography, autopsy) as tumor of the head of the pancreas. Based upon our experience and the literature, the following practical conclusions can be drawn: 1. Pancreas divisum may cause typical episodes of acute (relapsing) pancreatitis. 2. In patients with chronic epigastric pain associated with hyperenzymemia but without typical acute pancreatitis, pancreas divisum may be the cause. 3. Morphologically pancreas divisum may mimic a pancreatic tumor (sonography, computer-tomography, autopsy).

Abdomen↗
PubMed1983

Preliminary observations on the biliary elimination of mebendazole and its metabolites in patients with echinococcosis.

The biliary excretion of mebendazole has been investigated in two patients to whom it was given for the treatment of echinococcosis, although it was found to be only partly effective. Oral mebendazole was extensively metabolized and the conjugated parent substance and its metabolites were excreted in the bile. One patient without cholestasis and with normal liver function had an apparent total biliary clearance (776 ml/min) which approached the hepatic plasma flow. The other patient with cholestasis and impairment of the hepatic drug metabolizing capacity showed a drastically reduced apparent total biliary clearance of 3.8 ml/min. The average plasma level of mebendazole was significantly lower in the former and higher in the latter patient (0.06 and 0.91 nmol/ml, respectively). The data suggest that impaired metabolism and/or biliary elimination can account for the higher plasma mebendazole level in patients with liver damage.

Adult↗
PubMed1982

[Sonography vs. computer tomography in liver manifestations of echinococcosis].

Hepatic echinococcosis generally gives rise to typical signs by ultrasound and computed tomography, even though a relatively large number of conditions has to be considered in the differential diagnosis. Comparing the two methods in 29 patients with manifestations of hepatic involvement by echinococcosis it was demonstrated that ultrasound is only slightly inferior, in cases of small-size involvement, which fails to be diagnosed as focal disease of the liver parenchyma. But ultrasound is the primary method of investigation, especially when the differential diagnosis is still open, and it is preferred for serial studies during and after treatment. Computed tomography is the method of choice particularly when it is necessary pre-operatively to document involvement beyond the liver itself.

Diagnosis, Differential↗
PubMed1982

[Eosinophilic esophagitis, a rare manifestation of eosinophilic gastroenteritis].

Eosinophilic gastroenteritis is a rare disease characterized by gastrointestinal symptoms, peripheral eosinophilia and massive infiltration of segments of the gastrointestinal tract by eosinophils. A case of this disease in a 25-year-old patient with symptoms of slight dysphagia and isolated esophageal involvement is described. Improvement of the symptoms, but not of the histological abnormalities, was obtained by steroids combined with withdrawal of the food components probably responsible for the symptoms.

Adult↗