Biomedical subjects
Publications and source records attributed to R Ammann.
Pancreatic ascites is a rare disease which is often misinterpreted as ascites secondary to alcoholic cirrhosis or to intraabdominal cancer. It can be diagnosed by a high protein and amylase/lipase content of the ascitic fluid. If diagnosis and subsequent surgery occur at an early stage, the prognosis is good. The natural course, therapy, prognosis, and pathogenesis of pancreatic ascites are discussed on the basis of experience with 7 patients.
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In Schweizerische Medizinische Wochenschrift 106, 894-897 (1976) an article was published on a kinship with hereditary "minor adenomatous polyposis" of the colon with a higher than expected incidence of carcinoma of the stomach. Evidence for a genetic relationship between this family (Sch.) and another branch with an isolated case (Sch. E.) of familial polyposis of the gastrointestinal tract was found. The patient Sch. E. is presented here. The polyposis of this patient is phenotypically identical with that found in the classical familial polyposis of the colon, but also exhibits features of "minor adenomatous polyposis". A systematic clinical-endoscopic examination of ten members of the patient's family produced no further cases of gastrointestinal polyposis of carcinomata. In the case of Sch. E., therefore, a spontaneous mutation is postulated. A new classification of the various types of colonic polyposis is suggested.
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15 patients are reviewed who had stenosis or obstruction at the hilus of the bile duct. Percutaneous transhepatic or endoscopic transduodenal cholangiography is indispensable for establishing the diagnosis before operation. Primary carcinomas involving the junction of the hepatic ducts may be regarded as resectable if proximal extension of the tumor is limited to below the second bifurcation of the intrahepatic bile ducts in both the right and left lobes and if the proper hepatic artery and portal vein are still free from tumor invasion. Our favourable operation procedures for resection or palliative decompression of the biliary tree are discussed.
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Among 192 cases of chronic pancreatitis, 51 (27%) were classifed as idiopathic after exclusion of all known aetiological factors. The age distribution of idiopathic chronic pancreatitis suggests that there are two separate entities, a "senile" (n = 38) (ISCP) and a "juvenile" form (n = 13) (IJCP). IJCP seems to represent a new nosological entity characterized by a low mean age at onset (25.6 years), a preponderance of males (n = 12), typical recurrent episodes of pancreatitis (n = 13), and a very high incidence of calcifications (n = 10). The course of IJCP seems to be rather benign but protracted. Despite lacking direct evidence, IJCP seems to be due to a genetic factor. The postulated causes of IJCP and ISCP may be identical with the primary factors which are considered to be responsible in combination with high alcohol intake, for the development of alcohol-induced chronic pancreatitis.
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A patient in whom Cushing syndrome had been diagnosed at the age of 23 was found 14 years later to have subclinical diabetes mellitus, subcutaneous calcified fat tissue necroses, and hypergastrinemia suggesting Zollinger-Ellison syndrome. Histopathologic investigation revealed pancreatic adenomatosis of the glucagon producing A2-cells with accompanying B-cell hyperplasia, and hyperplasia of the adrenal cortex. The origin of the increased serum gastrin concentration in this patient is not yet known. The significance of A2-cell proliferation in Zollinger-Ellison syndrome and and in multiple endocrine adenomatosis is discussed.
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