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Biomedical subjects

R W Ammann

Publications and source records attributed to R W Ammann.

At least 73 records · Page 4Linked to original sources
PubMed1983

[Mediastinal pancreatic pseudocysts. Report of 2 cases and review of the literature].

Mediastinal pancreatic pseudocysts are rare complications occurring in the course of pancreatitis. Two patients are described with chronic alcoholic pancreatitis who developed mediastinal pancreatic pseudocysts. The most prominent clinical findings were, respectively, recurrent pericardial and pleural effusions and dysphagia. The elevated amylase values in serum and urine and in the pericardial and pleural effusions pointed to pancreatic disease. The mediastinal pancreatic pseudocysts were found preoperatively by ultrasound and endoscopic retrograde cholangiopancreatography. Surgery was performed. In one case the pseudocyst was treated by external drainage and in the other case by marsupialization into the left pleural space. In each case pancreaticojejunostomy was performed in addition. Etiology, symptoms, diagnosis and therapy in 32 published cases are discussed on the basis of experience with these two patients.

Alcoholism↗
PubMed1983

High amylase content of neoplastic pleural and pericardial effusion probably secondary to amylase producing tumor cells: report of 2 cases.

We report two cases of malignant pleural and pericardial effusion respectively secondary to bronchogenic carcinomas. In both effusions, a significant elevation of the Salivary-type-amylase fraction was found, while the corresponding values were normal in serum and urine. Electronmicroscopy of the malignant tumor cells from the pleural effusion showed typical electron-dense granules, suggesting zymogen granules. It is concluded that the high amylase content of the effusions was due to secretion of S-type-isoamylase by the tumor cells.

Aged↗
PubMed1983

[Surgical resection procedures in chronic pancreatitis--counter arguments from the gastroenterologist's viewpoint].

A longitudinal study of a large mixed medical-surgical series of chronic pancreatitis indicates that the two main indications for pancreatic surgery are persistent pain due to pseudocysts or rarely recurrent severe pain despite alcohol abstinence in uncomplicated chronic pancreatitis. Drainage procedures of cysts and/or pancreatic duct are the method of choice. Resections are rarely indicated and are associated with a high late postoperative mortality particularly in alcoholics.

Calcinosis↗
PubMed1982

[Current approach to gastrointestinal diagnosis. With special reference to sonography and whole-body computer tomography].

In the last 10 years the diagnostic approach to gastrointestinal diseases has changed markedly. A new tactic, based upon modern diagnostic methods, is outlined. 1. Endoscopy has won a dominant position in diagnostic evaluation of the upper gastrointestinal tract and the colon, while routine x-ray plays a much reduced role. 2. In the diagnosis of liver, pancreatic and bile tract disease ultrasonography has largely replaced many of the previous procedures, particularly cholangiography, laparoscopy, scintigraphy, angiography and ERCP. 3. The diagnostic accuracy of ultrasonography appears to be equivalent to computer tomography in diseases of liver, pancreas and bile tract, and is less costly. 4. Ultrasonography has, however, its limits, which relate in part to the technic and still more to the technician. Its diagnostic accuracy is particularly limited in diffuse parenchymatous diseases of liver and pancreas.

Cholestasis↗
PubMed1982

Variations with age of immunoreactive serum trypsin: higher reference ranges in "healthy" elderly people.

According to the literature, the mean values of immunoreactive serum trypsin (IRT) (RIA-gnost Hoechst) in controls vary considerably between 150 and 283 ng/ml. The reasons for these variations are unknown. The purpose of the present investigation was to study the variations of IRT in relation to age in adults. We studied 124 hospital controls, who were without evidence of pancreatic disease or renal insufficiency and who varied in age between 17 and 84 years. Utilizing the kit of Hoechst, IRT was determined in fasting serum specimens. The mean (+/- SD) in patients over 60 years was 469.6 +/- 197.4 ng/ml, in contrast to 309.1 +/- 118.9 ng/ml (30-59 years) and 209.7 +/- 80.7 (less than 30 years). Of cases over 60 years 36.5% had elevated IRT levels above 500 ng/ml. In 25 cases over 60 years no correlation was found between IRT levels and creatinine clearance and in eight of ten cases of this group with high IRT (greater than 500 ng/ml) the serum pancreatic isoamylase levels were normal. The data indicate that in the diagnosis of pancreatic disease the higher reference ranges in the elderly people have to be taken into account. The age-related higher reference ranges seem not to be due to subclinical renal disease nor to clinically evident pancreatic disease.

Adolescent↗
PubMed1982

Treatment of human echinococcosis with mebendazole. Preliminary observations in 28 patients.

Preliminary results of a long-term, prospective therapeutic trial with mebendazole in 28 patients mainly with inoperable echinococcosis are reported. The course of disease was monitored closely and plasma mebendazole levels were checked regularly. A major problem is the lack of reliable methods for defining and measuring early success or failure of therapy. Most of the patients improved clinically. No marked change of parasitic lesions was observed except in one patient with constantly low plasma mebendazole levels who deteriorated. No serious side effects occurred. The preliminary results are encouraging and suggest that mebendazole has a "parasitostatic" effect on larval growth.

Adult↗
PubMed1982

Comparative diagnostic accuracy of four tubeless pancreatic function tests in chronic pancreatitis.

The comparative sensitivity of 4 tubeless pancreatic function tests was evaluated in 125 patients with proved chronic pancreatitis associated with various degrees of pancreatic insufficiency. NBT-PABA, immunoreactive trypsin (IRT), and pancreatic isoamylase (P-iso) were studied in relation to the fecal chymotrypsin test (FCT) and steatorrhea. In advanced insufficiency (steatorrhea or FCT less than 20 micrograms/g) PABA, IRT, and P-iso were pathologically low in only 70-85% of patients. In less severe pancreatic insufficiency (FCT 21-120 micrograms/g) these tests yielded pathological results in 35-53% of patients. Thus the sensitivity of the three tests was comparable and rather low. IRT values (and P-iso) were constantly low or progressively decreasing in 64% of patients (30/47) studied repeatedly over an average of 17 months. The serum enzyme tests seem, therefore, to be valuable for monitoring pancreatic insufficiency, like the FCT. This is particularly important for the differential diagnosis of acute (reversible) and chronic (progressive) pancreatitis.

4-Aminobenzoic Acid↗
PubMed1981

Diagnostic value of the fecal chymotrypsin test in pancreatic insufficiency, particularly chronic pancreatitis: correlation with the pancreozymin-secretin test, fecal fat excretion and final clinical diagnosis.

The diagnostic value of the fecal chymotrypsin test (FCT) was reevaluated with regard to (a) proved pancreatic hypofunction of different severity (183 pancreozymin-secretin tests); (b) the final clinical diagnosis, and (c) fecal fat excretion (208 patients with chronic pancreatitis; CP). Progressive pancreatic disease (cancer, CP) was mainly associated with moderate or severe pancreatic hypofunction (119/138; 86.2%) and a low incidence of false-normal FCT values (14/138; 10.1%). Miscellaneous disorders (mainly reversible pancreatic hypofunction) were mainly associated with slight pancreatic hypofunction and a high incidence of false-normal FCT values (17/45; 37.8%). Pancreatic steatorrhea (greater than 10 g/day) was found only in patients with markedly depressed FCT values. Progressive deterioration of pancreatic function was demonstrated by repeated FCT in CP (n = 220).

Celiac Disease↗
PubMed1980

[Clinical aspects and differential diagnosis of chronic pancreatitis. Emphasis on the long term course in 258 patients].

Three typical clinical patterns can be distinguished based upon the experience with the long-term course in 258 cases of chronic relapsing pancreatitis. In chronic pancreatitis without local complications there is 1. an early phase, characterized by recurrent episodes of pancreatitis; 2. a late phase, characterized by the triad: absence of pain, severe global pancreatic insufficiency (diabetes/steatorrhea), and pancreatic calcifications (if any). 3. Local complications (e.g. pseudocysts) produce a different pattern characterized by persistent pain and the symptoms of the "pancreatitis tumor", which may cause many different complications such as cholostasis, gastrointestinal bleeding, duodenal obstruction etc. Local complications are observed mainly in the early phase of the disease. Late symptoms such as diabetes, steatorrhea and calcifications indicate that the pancreatitis is virtually "burned out". The occurrence of late symptoms in the course of the disease varies individually.

Adult↗
PubMed1980

High incidence of extrapancreatic carcinoma in chronic pancreatitis.

In the prospective clinical long-term study of 246 patients with chronic pancreatitis, 26 patients (24 men) developed 27 histologically proved malignant tumors (11%). Four additional patients with neoplasia were excluded (papilloma, two; Bowen's disease of the tonsils, one; and seminoma, one, occurring 8 years before onset of pancreatitis). In six patients pancreatic cancer was diagnosed (2.4%), which indicates a slightly increased risk over the general population. Interestingly, 21 patients developed extrapancreatic cancer (8.5%), including a very high incidence that has not been noted previously. The cancers were located in the oral cavity (in six), larynx (three), bronchus (eight), and gastrointestinal tract (four). The data suggest a causal relationship between chronic pancreatitis and cancer. As possible factors, smoking, alcohol abuse, diabetes, malnutrition, immune deficiency, and high dietary fat intake are discussed. There is, however, no definite evidence for any single known factor.

Adult↗
PubMed1980

High incidence of extrahepatic carcinomas in idiopathic hemochromatosis.

In a series of 36 consecutive patients with proved idiopathic hemochromatosis and with a mean follow-up time of 8 years, 10 patients developed 11 carcinomas (30.6%). Five patients had hepatomas and six patients extrahepatic carcinoma involving lungs (four), oral cavity (one), and thyroid (one). The findings suggest a causal relationship between hemochromatosis and extrahepatic cancer. The evidence of an increased cancer risk in relation to cirrhosis and to iron toxicity are discussed.

Adult↗
PubMed1979

Pain relief by surgery in chronic pancreatitis? Relationship between pain relief, pancreatic dysfunction, and alcohol withdrawal.

Since 1963, 57 consecutive patients with chronic pancreatitis, 44 of them alcoholics who had been operated upon for recurrent severe pain, have been controlled regularly for an average of 6 years. Thirty-two of them had a cyst drainage procedure (group A), and 25 had a ductal drainage procedure and/or distal pancreatectomy (group B). Ten patients died within 2 years (group A, n = 5). Lasting pain relief by surgery occurred in 19 patients only. Of 28 patients with pain relapses after surgery (group A, n = 15), however, 22 (78.6%) obtained late pain relief 1-8 years after surgery in association with marked increase of pancreatic dysfunction (group A, n = 12). Pain relief was associated with pancreatic calcifications in 71-86% of the alcoholics. Cyst drainage procedures were successful in preventing pain relapses mainly in patients with either advanced pancreatic dysfunction or in non-alcoholic pancreatitis. The data suggest that in chronic pancreatitis lasting pain relief is more often due to marked pancreatic dysfunction than to surgery. Alcohol abstinence after surgery was probably an additional factor for lasting pain relief in some patients.

Adolescent↗
PubMed1978

[Therapy of Cronh's disease in the acute stage, using ornidazole (Tiberal). Preliminary results].

9 patients with acute exacerbations of Crohn's disease were treated over 2.5 months or longer with ornidazole (nitroimidazole). While 3 patients showed no response at all to 5 cycles of ornidazole treatment, 6 patients improved markedly within 2-3 months. In all but 1 patient, the improvement lasted during long-term therapy (average 9 months). Therapy was discontinued in 5 of these patients after 2.5-14 months; 2 patients had severe recurrences within 2-10 weeks, while 3 patients remained well during the follow-up (average 4.7 months). Ornidazole appears to be a promising alternative to steroid therapy in acute exacerbations of Crohn's disease and to deserve further evaluation by a double-blind study.

Acute Disease↗
PubMed1977

Accessory lung arising from the upper esophagus. A rare congenital anomaly in the adult.

A lung infiltrate found incidentally in an adult was shown radiologically to be the result of a fistula arising from the upper esophagus. At the pulmonary site, the fistula demonstrated several branches with the typical configuration of a rudimentary bronchial three. The findings are consistent with an unusual type of congenital bronchopulmonary malformation. Ordinarily, accessory lungs are located at the lung base communicating in selected cases with the lower esophagus or the stomach. The embryological explanation lies in an incomplete separation of the tracheobronchial tree from the esophagus.

Aged↗
PubMed1976

Gastrointestinal involvement in systemic mastocytosis.

Four consecutive patients with systemic mastocytosis were studied. One patient had a malabsorption syndrome with only minor histological changes of the intestinal mucosa. Another patient with ulcer diathesis had a gastric secretory pattern resembling Zollinger-Ellison syndrome. Serum gastrin and histamine levels were consistently normal in all patients. Endoscopy of stomach and colon disclosed urticaria-like papulae either spontaneously or after topical provocation in all patients. No increase of mast cells was found in multiple mucosal biopsies. A markedly increased gastric tissue content of histamine was found, however, in the three patients studied. The findings suggest that urticaria-like lesions associated with a high tissue content of histamine may be more important that hyperhistaminaemia in causing the various gastrointestinal symptoms.

Adult↗