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Biomedical subjects

R W Ammann

Publications and source records attributed to R W Ammann.

At least 55 records · Page 3Linked to original sources
PubMed1990

Recurrence rate after discontinuation of long-term mebendazole therapy in alveolar echinococcosis (preliminary results).

The recurrence rate was investigated in 19 patients with non-resectable alveolar echinococcosis after discontinuation of a long-term therapy with mebendazole (average treatment 4.3 years). A control group consisted of 14 patients who underwent radical surgery and finished a course of prophylactic postoperative mebendazole treatment of 2 years. In the controls, no recurrence was observed after a post-therapy period averaging 3.5 years. In contrast, recurrence occurred in 7/19 patients (37%) with non-resectable alveolar echinococcosis an average of 1.6 years after discontinuation of the long-term mebendazole therapy. The absence of clinically detectable recurrence in the remaining 12 patients seems to be due either to spontaneous inactivation of alveolar echinococcosis preceding chemotherapy or too short post-therapy surveillance. The patients with recurrence responded favorably to reintroduction of chemotherapy. The data indicate that mebendazole therapy is parasitostatic rather than parasiticidal.

Adult↗
PubMed1990

Secretin potentiates, caffeine does not affect caerulein--stimulated pancreatic enzyme depletion and growth in newborn rats.

We studied the effect of two peptides, the intracellular Ca2(+)-mobilizing caerulein and the cAMP-mediated secretin, and also the phosphodiesterase inhibitor caffeine on pancreatic secretion and growth in newborn rats. To investigate the secretory response of these substances, and to construct dose-response curves 10-day-old conscious rats were given subcutaneously a single injection of caerulein, secretin, caffeine or the combination of these compounds (caerulein + secretin, caerulein + caffeine). Fifteen min after the injection pancreatic specific trypsin activities were measured in order to estimate depletion of enzymes from the pancreas. To study the pancreatic growth--promoting effect of these substances, newborn rats were treated three times daily for 10 days from the day of birth, using the same experimental groups as described above. Caerulein stimulated both enzyme depletion and pancreatic growth. Secretin stimulated enzyme depletion and increased the trophic effects of caerulein on the pancreas. Caffeine alone or in combination with caerulein did not affect pancreatic enzyme depletion and growth.

Amylases↗
PubMed1990

Chronic pancreatitis in the elderly.

Idiopathic senile chronic pancreatitis (CP) appears to be a special subtype of nonalcoholic CP. Main clinical features are onset after the age of 50 years, prevalence in men, a painless clinical course, marked weight loss associated with diarrhea (steatorrhea) or diabetes mellitus, and pancreatic calcific deposits. Idiopathic senile CP constitutes about two thirds of cases of nonalcoholic CP, but it is rare compared with the incidence of alcoholic CP. The relationship of idiopathic senile CP to the "normal" age-related morphologic and functional abnormalities of the exocrine pancreas is unknown.

Age Factors↗
PubMed1988

Evolution and regression of pancreatic calcification in chronic pancreatitis. A prospective long-term study of 107 patients.

Pancreatic calcifications are virtually pathognomonic of chronic pancreatitis and develop in up to 90% of patients with alcoholic chronic pancreatitis in series with long-term results. We investigated the natural course of pancreatic calcification in a prospective longitudinal study over the past 23 yr. All patients were studied at regular intervals with particular regard to etiology, clinical findings, surgery, pancreatic function, and pancreatic calcification visible by x-ray (e.g., film series in three projections centered on the pancreas). We evaluated the findings of 107 patients with x-ray documentation of pancreatic calcification in at least three film series over a period of 4 yr or longer. Eighty-four patients had alcoholic chronic pancreatitis (group A) and 23 patients had nonalcoholic chronic pancreatitis (group B). Four hundred seventy-two film series of group A and one hundred forty-two film series of group B were reviewed independently by two expert teams. Both series were graded according to a score system in terms of intensity and distribution of pancreatic calcification (correlation of grading r = 0.91). The duration of calcification averaged 10 yr in group A and 12.6 yr in group B. Similar dynamic changes of pancreatic calcification were noted in groups A and B. Chronologically, three phases of evolution could be distinguished. After an initial increase (phase 1), greater than 50% of cases reached a plateau of stationary calcification (phase 2). Approximately one-third of cases showed a marked decrease of calcification in late phases of chronic pancreatitis (phase 3). Dissolution of pancreatic stones was related primarily to duration of chronic pancreatitis (duration of calcification and marked pancreatic dysfunction), and occurred frequently (but not exclusively) in patients after ductal drainage procedures. These results indicate that spontaneous dissolution of pancreatic stones is a rather common biologic phenomenon. The factors responsible for dissolution of stones remain to be elucidated.

Adolescent↗
PubMed1987

Differences in the natural history of idiopathic (nonalcoholic) and alcoholic chronic pancreatitis. A comparative long-term study of 287 patients.

Controversies in the literature regarding definition, diagnosis, and therapy of chronic pancreatitis may be related in part to differences in the natural history of alcoholic and idiopathic (nonalcoholic) chronic pancreatitis. In order to evaluate this problem the long-term course of 205 patients with alcoholic (85.4% with calcifications) (group A) and 82 patients with idiopathic (nonalcoholic) chronic pancreatitis (76.8% with calcifications) (group B) has been analyzed prospectively since 1963. The patients were studied at regular intervals with particular regard to pain, pancreatic exocrine, and endocrine function and calcifications. The observation time was 2 years or longer in 230 patients with a median observation time of 6.7 years from diagnosis in group A and 10.6 years in group B. In group B over 50% of the cases had primary painless chronic pancreatitis. Progressive deterioration of exocrine and endocrine function was observed in both groups. However, in group A the rate of progression of exocrine dysfunction after diagnosis was more rapid and the incidence of diabetes in relation to marked exocrine insufficiency was much higher than in group B. Steatorrhea preceded diabetes in 56% (group A) and 80% (group B), respectively. Onset of pancreatic calcifications was closely associated with pancreatic exocrine insufficiency in group A in contrast to group B. In addition lasting pain relief occurred spontaneously in about 30% of patients in group B despite a normal exocrine function for 6 years or longer which is in disaccord with the results in alcoholic chronic pancreatitis. In conclusion group A and B have many features in common, in particular the high incidence of pancreatic calcifications and the progressive pancreatic dysfunction. However, the long-term profile of both groups differs in some important aspects, particularly in the clinical pattern and in the rate of progression of pancreatic dysfunction and morphology. These differences should be appreciated in the discussion of problems regarding definition, diagnosis, and surgical therapy of chronic pancreatitis.

Adult↗
PubMed1986

Acute (nonprogressive) alcoholic pancreatitis: prospective longitudinal study of 144 patients with recurrent alcoholic pancreatitis.

Over the last 10 years, a series of 144 consecutive patients with alcoholic recurrent pancreatitis have been studied prospectively at regular intervals with particular regard to exocrine function, calcifications, pancreatographic ductal changes, and histopathology of the pancreas. Based upon the long-term course, the patients were classified into two groups; group A (n = 95), those with chronic pancreatitis (78 of them with calcifications); and group B (n = 49), those with acute (nonprogressive) pancreatitis. The duration of disease from onset was 2-19 years (median, 9.7 and 8.3 years, respectively, in group A and B). The two groups were comparable at onset of the disease in age, sex, number of episodes of pancreatitis, and number of pseudocysts. In group A, all 95 cases fulfilled the strict diagnostic criteria of chronic pancreatitis within the period of observation (e.g., progressive exocrine insufficiency and/or typical morphological changes, particularly calcifications). In group B, the exocrine function remained normal over the entire period of observation. No histologic evidence of chronic pancreatitis was detected in five of seven large pancreatic specimens. Marked to moderate ductal changes were found in 10 of 16 patients in group B (despite normal exocrine function). Our data suggest that about one third of patients of the present series with alcoholic (recurrent) pancreatitis did not progress toward chronic (progressive) pancreatitis, although some demonstrated morphological alterations (except calcifications) in association with normally preserved exocrine function (residual scars?). The pathogenetic factor(s) responsible for progression (or nonprogression) of alcoholic (recurrent) pancreatitis to chronic pancreatitis remain(s) to be elucidated.

Acute Disease↗
PubMed1985

[Significance of immunoreactive lipase in the diagnosis of pancreatic diseases].

The diagnostic value of a new enzyme immunoassay for lipase (IRL) was evaluated in controls (n = 65), in acute pancreatitis (n = 11) and in extrapancreatic hyperamylasemia (n = 15) by comparing IRL with serum amylase (TA), pancreatic isoamylase (PA) and lipase (turbidimetrically: TL). IRL and immunoreactive trypsin (IRT) of 60 patients with alcoholic chronic calcified pancreatitis were also studied and correlated with duration of disease and degree of pancreatic insufficiency (based on fecal chymotrypsin test: FCT). IRL was constantly elevated in patients with acute pancreatitis. In extrapancreatic hyperamylasemia IRL was mainly normal, in contrast to PA, which was elevated in 7 patients with macroamylasemia. In 56.7% of all patients with chronic pancreatitis, IRL was pathologically low; in association with advanced insufficiency (FCT less than 20 micrograms/g) this figure was 74%, and after duration of disease of greater than or equal to 15 years 77%. For IRT comparable results were found in 79% and 77% respectively. This new lipase test thus seems to be useful for the diagnosis of acute pancreatitis, the differential diagnosis of extrapancreatic hyperamylasemia and the detection and monitoring of severe chronic pancreatitis.

Acute Disease↗
PubMed1985

[Etiology, therapy and prognosis of chronic hepatitis].

The therapy and prognosis of chronic active hepatitis (CAH) depends upon the morphology (stage and activity of the liver process) and etiology. In our own long-term study (n = 167), HBV-markers were found in 72% of cases, and an additional 14% belonged to the non-B/non-autoimmune type. For neither form is an established therapy available. Interestingly, 50% of cases with autoimmune CAH had HBV markers. Steroid therapy seems to be beneficial only in cases with very active autoimmune CAH. The mortality in our series was around 50% for the HBV-type (with B-persistence) and for autoimmune CAH. In the HBV-type (with B-loss) and in the non-B/non-autoimmune type the mortality was around 15%.

Adrenal Cortex Hormones↗
PubMed1985

[Malignant-appearing retroperitoneal lymphography findings in Whipple's disease--a source of possible misdiagnosis].

Whipple's disease may mimic clinically primary intestinal lymphoma. In addition, lymphographic findings in the paraaortic lymph nodes in Whipple's disease simulate malignant lymphoma. These severe tumor-like lymphographic changes are described in three cases of Whipple's disease. The data highlight the risk of misinterpreting of Whipple's disease as malignant lymphoma on the basis of clinical data and lymphographic findings.

Adult↗
PubMed1985

Effect of plasma mebendazole concentrations in the treatment of human echinococcosis.

High oral doses of mebendazole were given for a mean period of 23 months to 22 patients with inoperable alveolar or cystic echinococcosis (Echinococcus multilocularis n = 18, E. granulosus n = 4). Clinical, morphological, biochemical and serological findings and plasma mebendazole levels were monitored. Clinical and biochemical improvement or stabilization was observed in 17 patients but the parasitic lesions did not decrease in size in most instances. One patient died shortly after onset of therapy with hemorrhage of esophageal varices. Three patients with alveolar and one with cystic echinococcosis had evidence of progressive disease such as increase of cholestasis, destruction of lumbar vertebrae and growth of an intraperitoneal cyst. The plasma mebendazole levels (4 hr after the morning dose) of the latter 4 patients were 0.09 +/- SD 0.02 mumol/l, while in those with clinical stabilization or improvement it was 0.30 +/- SD 0.14 mumol/l (P less than 0.001). These preliminary data indicate 1) a good clinical response to chemotherapy in most patients despite unchanged size of the parasitic lesions, and 2) a direct correlation of clinical response with plasma mebendazole levels.

Adult↗
PubMed1984

On the pathogenesis of pancreatic ascites.

The pancreatic ascites of 2 patients and the drainage fluid collected adjacent to the pancreas postoperatively of 1 of them were analyzed for protein composition and enzyme activity. We did not find a proteolytic activity, especially enzymatically active trypsin and chymotrypsin in these fluids. Immunoreactive (inactive) trypsin was, however, present in rather high concentrations. The drainage fluid changed from an inflammatory exudate to a fluid similar in composition to pancreatic juice later on. Our results indicate that pancreatic ascites consist of a combination of enzyme-rich pancreatic fluid and protein-rich exudate from the inflamed pancreas. No evidence of peritonitis or of proteolytic activity capable of inducing peritonitis was found.

Adult↗
PubMed1984

Course and outcome of chronic pancreatitis. Longitudinal study of a mixed medical-surgical series of 245 patients.

Over the last 20 yr, 245 patients with chronic pancreatitis (163 with alcoholic relapsing pancreatitis; 145 of them with calcific pancreatitis) were prospectively studied at regular intervals with particular regard to pain, pancreatic functions, calcifications, pancreatic surgery, and survival. The median period of observation in the group with alcoholic relapsing calcific pancreatitis was 10.4 yr. In this group of 145 patients, 85% experienced lasting pain relief within a median time of 4.5 yr from onset. A gradual increase of pancreatic calcifications and pancreatic dysfunction was observed with increasing duration of the disease. Pain relief was accompanied by a marked increase in pancreatic dysfunction and calcification. Of 163 patients with alcoholic relapsing pancreatitis, 87 (53%) needed no pancreatic surgery. Seventy-six patients (47%) with recurrent or persistent severe pain, mainly due to pseudocysts (n = 56), underwent either a cyst drainage procedure (n = 22), papillotomy (n = 4), distal pancreatectomy (40%-60%, n = 24), or Wirsungo-jejunostomy (n = 26). The proportion of patients experiencing lasting pain relief was similar in the operated and nonoperated group of patients. In both groups lasting relief from pain was correlated with the duration of the disease and was associated with marked pancreatic dysfunction. The 50% survival time in alcoholic chronic pancreatitis (with or without pancreatic surgery) was 20-24 yr (after onset), thus markedly shorter than in nonalcoholic pancreatitis. Of the 245 patients, 86 died. About 20% of deaths were related to pancreatitis and its complications. Most extrapancreatic causes of death were malignancies, cardiovascular diseases, severe infections, and nonpancreatic surgery.

Adult↗