Biomedical subjects
Publications and source records attributed to Z Tulassay.
The presence of daughter cysts within the original cyst is a typical feature of cystic echinococcus disease. Due to this, a reliable (preoperative) diagnosis by ultrasonography alone can be made when demonstrating these daughter cysts - as shown in 2 exemplary cases, verified by serology and histology.
Endoscopic papillotomy (EPT) was performed in 66 patients, 59 of whom had choledocholithiasis and the remaining seven had stenosis of the papilla of Vater. The stones passed spontaneously in 37 patients, but had to be extracted in 10 cases. All seven patients with stenosis showed free bile flow following EPT. Four patients become anicteric although the stones persisted. Four patients had a febrile complication which subsided in response to antibiotic therapy.
The clinical data of two patients are reported at whom after endoscopic retrograde cholangiography (ERC) acute pancreatitis has evolved. In the development of this acute pancreatitis the membrane rupture and parenchymography do not play a role, however the duct of Wirsungian did not fill with contrast material. The pathogenesis of complications and the possibilities of prophylaxis are described.
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A case of aneurysm of the abdominal aorta is presented. The clinical picture was suggestive of a pancreatic cyst, but the correct diagnosis was made on abdominal ultrasonography. Early diagnosis of the condition allowed removal of the aneurysm and implantation of a femoral by-pass. The value of ultrasonography in diagnosing aneuryms of the abdominal aorta is discussed. This completely safe procedure appears to supersede the reliability of invasive methods as a diagnostic tool and is recommended in cases of doubtful aneurysm since with early diagnosis and surgical intervention severe complications, including rupture, can be avoided.
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The endoscopic retrograde cholangiopancreatography (ERCP) findings in 30 patients with chronic pancreatitis and 25 cases of pancreatic cancer are presented in this report. The diagnosis was confirmed in every case by surgery or at autopsy. ERCP was found to be a reliable means of differentiating between pancreatic cancer and chronic pancreatitis in most cases. Multiple lesions are typical of chronic pancreatitis. In solitary lesions a diagnosis can be reached only by consideration of the pancreatographic findings in conjunction with the clinical picture.
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Features of 75 abnormal pancreatograms are analysed. Radiomorphology is conferred with surgical or postmortem findings in all cases. None of the anatomical alterations was found to be specific for any given diseases entity, some consistency was verified however. Solitary stenosis suggests cancer. Diffuse alterations point to chronic pancreatitis. Cave filling is a likely sign of cyst or pseudocyst. Since, however, these features are nonspecific, the diagnosis must be based on clinical data as well.
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A patient with Caroli's syndrome is reported; diagnosis was made by ERCP and ultrasonography. Caroli's disease occurred in its "pure" form in this patient, i.e. dilatation was present only in the intrahepatic biliary system while the extrahepatic bile ducts were normal. Pathogenesis and differential diagnosis are surveyed on the basis of available data. Further, the possibilities of treatment and prognosis are dealt with.
Portal hypertension is found in about one quarter of the cases with upper gastrointestinal bleeding. 57 patients with portal hypertension underwent endoscopy for gastrointestinal haemorrhage. Despite visible varices in all cases varice rupture underlies only 50% of the bleeding episodes. Conditions other than rupture were found to bleed in 50%. Superficial mucosal erosions, which escape radiological detection, were the most frequent other bleeding sources.
A wide range of enzymes was investigated following endoscopic retrograde cholangio-pancreatographie ERCP/. Of the 12 enzymes studied highly significant increase of levels were seen in amylase /AML/ and lipase /LIP/ activities. Increase in the other 13 enzymes were slight and failed to persist for 40 hours. The incidence rate of a subclinical pancreatitis-like disorder is high, but typical acute pancreatitis is rare. Likely post-ERCP complications must not be disregarded, however, in selecting patients for ERCP.
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Endoscopic retrograde cholangio-pancreatography performed in patients with bilodigestive anastomosis may furnish not only reliable radiograms revealing abnormal morphology of the two duct system but allows also endoscopic investigation of the stoma, which is often of equal diagnostic value in such patients. The size of the anastomosis is of crucial importance in such complications as cholangitis and secondary bile stone formation. In a significant portion of patients with biliodigestive anastomoses, i.e. in 75% of the present patient material, a morphologic abnormality could be demonstrated offering in many if not most cases the possibility of a surgical correction and eventual cure of the symptoms.