Unusual negative side effects of non-steroidal anti-inflammatory drugs in the proximal colon.

Two cases of uncommon side effects of non-steroidal anti-inflammatory drugs (NSAID) are presented which show that in special cases NSAID lesions can be located predominantly in the proximal colon, that NSAID-caused lesions may present themselves as diaphragm-like strictures and that alterations by NSAID in this part of the bowel may bring enormous problems for the differential diagnosis.

[Metastatic small intestine carcinoma--delayed diagnosis due to misinterpretation of diagnostic imaging and symptom confusion due to Bechterew disease and duodenal ulcer]. / Metastasiertes Dünndarmkarzinom--verzögerte Diagnostik infolge Fehlinterpretation von bildgebenden Verfahren und Symptomüberlagerung durch Morbus Bechterew und Ulcus duodeni.

Misinterpretations of sonographic and computed tomography scans and reduced sensitivity to pain of a patient suffering from Bechterew's disease and duodenal ulcer caused delayed diagnosis of metastasized carcinoma of the small intestine.

[Success and complication rates of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography--a prospective study]. / Erfolgs- und Komplikationsraten der diagnostischen und der therapeutischen endoskopischen retrograden Cholangiopankreatikographie--eine prospektive Studie.

The aim of the prospective study was to evaluated the efficacy and the complications of 2,820 ERCP-examinations in 1,717 consecutive patients (performed over a three-year period). The rate of success was 82.8% for diagnostic ERCP, 96.6% for endoscopic sphincterotomy, 76.8% for the extraction of stones on common bile tract, 87.5% for drainage in bile tract obstruction, respectively. The rate of all complications amounted to 7.9% (4.9% diagnostic ERCP, 9.2% therapeutic ERCP, in detail: 3.8% acute pancreatitis, 2.1% cholangitis, 1.3% bleeding, 0.2% perforation, 0.5% other respectively). The total mortality was 0.1% (three cases of death). The frequency of complications increased with the number of procedure at the papilla Vateri in patients, who underwent needle knife papillotomy in combination with standard papillotomy.

[Value of endosonography in diagnosis of diffusely growing stomach carcinomas]. / Wertigkeit der Endosonographie in der Diagnostik diffus wachsender Magenkarzinome.

The diagnosis of diffuse type gastric carcinoma is very difficult. The delay of diagnosis is often due to false-negative endoscopic and histologic evaluation. The architecture of the stomach can be clearly visualized by endosonography. Therefore, already minor destructions of the gastric layers can be found. The endosonographic picture includes the presence of the layers, which are larger and of irregular contour. In infiltrating gastric cancer typically the submucosal layer and the muscularis are concentrically enlarged and appear folded. Based on the endosonographic picture diffuse type gastric carcinoma has been diagnosed in 32 patients. When compared to the histologic diagnosis after gastrectomy or autopsy the accuracy of the endosonographic diagnosis was 87.5%, (28 out of 32 patients). From the remaining four patients diagnosed to have diffuse type gastric cancer by endosonography three patients turned out to have malignant infiltrating tumors of different histologies. Therefore, the positive predictive value of endosonography in detection of infiltrating malignant tumors was 96.8% in our group. In contrast the accuracy of preoperative histologic diagnosis by biopsies was only 58%. Suspicious results of gastroscopy, especially in combination with a negative biopsy, should lead to further evaluation by endosonography to detect diffuse type gastric cancer earlier.

[Foreign bodies in the bile ducts and their endoscopic removal]. / Fremdkörper in den Gallenwegen und ihre endoskopische Entfernung.

The diagnostic and therapeutic management is described in four cases with foreign bodies of the biliary tract: ball of thread, T-bougie, shell splinter, peel of greens. The possibilities of therapeutic endoscopy are emphasized.

[Histologic and cell kinetic findings in stomach ulcer of different healing times]. / Histologische und zellkinetische Befunde bei Ulcera ventriculi unterschiedlicher Heilungsdauer.

The 3-month healing rate in gastric ulcer patients treated on an outpatient basis and with no H2 blockers is only some 40%. In order to be able to improve therapy at an early stage, prognosis-relevant parameters were searched for also among histological findings. The semiquantitatively evaluated morphological parameters from 62 gastric ulcer patients of a case control study were subjected to a computerized multivariate analysis. Accordingly, at the stage of healing of gastric ulcer, the features 'complete intestinal metaplasia' and 'incomplete intestinal metaplasia' separate with the aid of a non-elementary discriminant function between healing in an appropriate period (3 months) and delayed healing. Histoautoradiographic in vitro examinations of 50 gastric ulcer cases reveal that the mucous membrane around an ulcer healing with delay has a significantly higher cell labeling rate than the gastric mucosa of control persons. The influence of a reflux of bile from the duodenum is discussed, as there is no correlation with the degree of chronic gastritis.

[Stomach cancer survival rates]. / Magenkarzinomüberlebensrate.

The cumulative 5-year survival rates in the case material of the years 1979-1983 with endoscopically-histologically confirmed gastric carcinoma were compared to those of the 1974-1978 period, particularly with reference to operative therapy and the histological type of carcinoma. The percentage of curatively operated patients increased from 40.6 to 49.7%, the rate of non-operated patients fell from 42.5 to 22.4%. The histological evaluation revealed a rise in the percentage of the adenocarcinoma from 37.1 to 53.5%-while the percentage of the solid carcinoma decreased from 29.1 to 15.5%. Following curative therapy, the calculated cumulative 5-year survival rate rose from 35.6 to 51.8% in men, however, fell from 66.2 to 48.3% in women. Most recent investigations showed men with curatively operated adenocarcinoma to have the best survival rate (60.6%); in women, this is true of mixed-type carcinoma.

[Ulcus ventriculi healing time--anamnestic and psychosocial data]. / Ulcus-ventriculi-Heilungsdauer--anamnestische und psychosoziale Daten.

An age group of patients with endoscopically ascertained florid ventricular ulcer was asked with regard to the aspects own anamnesis and family anamnesis, social descent, social state, sparetime planning, alcohol consumption, nicotine consumption as well as use of analgesics. After the control of the course the patients were subdivided into such ones with healing of the ulcer within 12 weeks and such ones with retarded healing. As comparative groups served patients with duodenal ulcer and patients with functional gastropathy. As a result the family anamnesis does not bring any significant differences. Male patients with retardedly healing ventricular ulcer in 23% of the cases suffered from diabetes mellitus and/or hypertension, before the first appearance of the disease they more frequently performed a responsible activity and were more frequently on shift work team patients with a healing corresponding to time. Females with retarded healing of the ventricular ulcer have in a higher percentage family problems and significantly more frequently take analgesics than the comparative groups. A decreased adaptation of the patients with ventricular ulcer with retarded healing is discussed and they are compared with the patients with duodenal ulcer.

[The problem of malabsorption after resection of the small intestine]. / "Zur Frage der Resorptionsstörungen nach Dünndarmresektionen".

During the period from 1971 to 1981 in 145 patients (108 adults and 37 children) partial resections of the intestine were practiced (in the surgical clinic of the Friedrich-Schiller-University, Jena). Fatality on the whole was about 25%. The surgical intervention with an extensive resection (more than 150 cm) was well tolerated by seven among 13 patients. Even in cases of shorter resections disturbances of resorption could be found especially for carbohydrates and vitamin B 12. Control examinations are necessary and therapeutic consequences have to be drawn.

[Diagnosis and therapy of stomach cancer]. / Zur Diagnostik und Therapie des Magenkarzinoms.

In a random test of 95 patients with carcinoma of the stomach who were gastroscopised during 1974 to 1977 a sex distribution of 2:1 for men to women was found. The male patients had more frequently an adenocarcinoma, the female patients more frequently a solid carcinoma. The patients with carcinoma of the stomach had more frequently a chronic atrophic gastritis than a control group of patients with functional gastropathy. The precanceroses, such as the atypical intestinal metaplasia were found only among the carriers of carcinomas, but in no case in the control group. The curative operability was given in the antrum carcinomas in 72%, in the corpus carcinomas only in 30% of the cases. Despite a higher age average the operability of women was more favourable than that of men in a not different distribution of the carcinomas to corpus and antrum. The necessary early recognition of the carcinomas for the improvement of the results of therapy is emphasized.

[Gastritis and stomach ulcer]. / Gastritis und Ulcus ventriculi.

Patients with ventricular ulcer (n = 109) were examined endoscopically and bioptically concerning the frequency of an at the same time existing gastritis. It was shown that stomachs with ulcer practically without any exception, i.e. in 96 per cent, had a pangastritis. In the endoscopic comparative group without focal lesions (n = 231) a gradually less pronouncedly expressed gastritis is present than in patients with ulcer. Patients with gastric ulcer and such persons with endoscopical negative dyspepsia (endoscopic comparative group) have common the more pronounced appearance of the gastritis in the antrum (antritis) than in the corpus. Gastric ulcers appeared in males at the age from 30 to 49 years twice as often as in females. The latter showed an approximately linear increase of the frequency of corpus ulcers between 20 and 69 years. In antrum ulcers like in duodenal ulcers the males dominate at the age from 20 to 59 years, whereas the females prevail in the 7th decennium.

[Duodenitis]. / Duodenitis.

In 211 bulboscopies 108 normal findings, 29 duodenal ulcers, 44 cases of scar bulb, 4 times erosions of the bulb and 26 times a bulbitis alone (macroscopically) were found. The macroscopic findings duodenitis were confirmed histologically in 85%, the macroscopic findings normal bulbous mucous membrane only in 30% of the cases. In patients with the histological findings duodenitis the bulbous mucous membrane was endoscopically regarded as normal in 70% of the cases. Patients with duodenitis more frequently have an antrum gastritis and less frequently a corpus gastritis than a control group corresponding to age without any macroscopic changes at the stomach and duodenal bulb. On account of its clinico-therapeutic importance is referred to the fact to demarcate the peptic corrosive bulbitis (bulbitis with bulboscopically probable lesion) from the bulbitis without bulboscopic lesion.

[Chronic gastritis in stomach cancer]. / Chronische Gastritis bei Magenkrebs.

In a random test of 128 patients with neoplasms of the stomach and in a control group of 170 persons corresponding to age without any focal lesion at the stomach the connection between carcinoma of the stomach and the chronic gastritis was tested. The carcinoma of the stomach is always accompanied by chronic gastritis. The chronic atrophic gastritis with intestinal metaplasia is significantly more frequent than in control persons. We found the chronic atrophic gastritis with intestinal metaplasia more frequently than in the adenocarcinoma (environmental carcinoma) than in the solid carcinoma. The clear dependence of age of the carcinoma of the stomach is confirmed; particularly great increase of the frequency of the carcinoma in the male in the fourth to the seventh decennium of life, in which case males more frequently have an adenocarcinoma, females, on the other hand, a solid carcinoma.