[Idiopathic eosinophilic esophagitis: a frequently overlooked disease with typical clinical aspects and discrete endoscopic findings]. / Idiopathische, eosinophile Osophagitis: eine häufig verkannte Krankheit mit typischer Klinik und diskretem endoskopischem Bild.

In 10 patients presenting with acute recurrent dysphagia, seen over a 4-year period, idiopathic, eosinophilic esophagitis (IEE) was diagnosed. The diagnosis was confirmed histologically. Dysphagia of other causes or other diseases causing eosinophilic infiltration was ruled out. Endoscopy showed discrete white structures in the esophagus which were partly finely reticular or plaque-like in 9 of the 10 patients. Of these one had a web and another a mucosal ring. Peripheral eosinophilia and elevated IgE-levels were found in 70% of the cases. To date IEE has been thought to be a rare disorder. Emerging evidence suggests its prevalence has been underestimated. It may also be the most frequent form of eosinophilic gastroenteropathy. The flat, only endoscopically visible form may be more common than the proliferative type. With knowledge of the typical history and of the distinct endoscopic pattern, and with adequate diagnostic workup, the disease will be found more often in the future. Prompt diagnosis also avoids further diagnostic procedures and permits rapid remission through treatment with steroids and antihistamines.

[Montaigne and Paracelsus]. / Montaigne und Paracelsus.

After some general remarks on Michel de Montaigne (1533-1592), who died just 400 years ago, the author compares him with another most original thinker of the 16th century: Paracelsus. Montaigne and Paracelsus were akin in their fundamental scepticism about human knowledge and convictions. Speaking, in his "Essais", of medicine Montaigne repeatedly quotes Paracelsus. These quotations show that Montaigne had some knowledge of Paracelsus' writings and that, to some extent, he was in sympathy with his ideas.

[Michel de Montaigne (1533-1592): report of a case of not perceiving own blindness]. / Michel de Montaigne (1533-1592): Bericht über einen Fall des Nichtwahrnehmens der eigenen Blindheit.

In the second book of the Essais towards the end of the twelfth chapter Montaigne mentions a nobleman who does not take note of his blindness. This case of not noticing his own blindness is presumably the first ever described. It belongs to the complex of anosognosia symptoms among which must be emphasized the Anton syndrome. The invalidity described by Montaigne means for him a crucial point of his critique of senses and thus of his doctrine of natural cognition.

Presenting characteristics of patients with duodenal ulcer and outcome of medical treatment in controlled clinical trials using cimetidine and diethylamine persilate to treat ulcer attack and diethylamine persilate and placebo to prevent relapses.

A double-blind controlled clinical trial on the medical treatment of the acute episode of duodenal ulcer and the prevention of symptomatic relapses was performed. A total of 164 patients with active duodenal ulcer were either treated with cimetidine 1 g/day (70 patients), diethylaminepersilate (DAP) 1.5 g/day (64 patients) or DAP 2.5 g/day (30 patients). DAP is an allegedly protective agent stimulating mucosal prostaglandin synthesis. Cumulative healing rates after 4 weeks in the 3 groups were 66, 28 and 28% and after 8 weeks 94, 70 and 63%, respectively. One hundred and five patients with healed duodenal ulcer received, in a second double-blind study, either DAP 0.5 g/day or placebo. Thus, ulcer healing was more rapid with cimetidine than with DAP. DAP did not prevent relapses. No presenting characteristic was associated with slow healing. Three presenting characteristics--smoking, teetotalling and bleeding episode in the past--were associated with early symptomatic relapse. The present study was compared with a previous study performed by the same group of investigators using a similar study protocol. In both trials, an early relapse was associated with smoking. No other presenting characteristic was identified which in both trials was associated with slow healing or early symptomatic relapse. Thus, smoking appears to be the only one of the commonly available presenting characteristics which allows a prediction of the course of duodenal ulcer disease.

[Misoprostol and cimetidine in the treatment of duodenal ulcer. A multicenter Swiss double-blind study]. / Misoprostol und Cimetidin bei der Behandlung des Ulcus duodeni. Eine multizentrische Schweizer Doppeltblindstudie.

The efficacy and tolerance of misoprostol a synthetic prostaglandin E1 analogue-and of cimetidine were evaluated in the treatment of duodenal ulcer following a double blind multicenter design. A group of Swiss gastroenterologists recruited 119 patients with endoscopically proven acute duodenal ulcer. They were enrolled and treated according to a uniform protocol either with misoprostol 4 X 50 micrograms daily, with misoprostol 4 X 200 micrograms daily or with cimetidine 4 X 300 mg daily. Patients who were healed after 4 or 8 weeks were followed during 6 months. Cumulative healing rates at 4 weeks in groups receiving misoprostol 200 micrograms, misoprostol 800 micrograms or cimetidine 1200 mg daily were 42%, 58% and 71% respectively. Patients treated with cimetidine showed a more rapid improvement of symptoms than patients treated with misoprostol. Symptomatic recurrences after ulcer healing occurred in almost 40% of the patients within 6 months, irrespective of the type of acute ulcer treatment. Risk factors for slowed healing and increased rate of recurrence were evaluated in the present study, and the results were compared with the results of two previous trials performed according to a similar protocol. Smoking appeared to slow healing and to favor relapses. Moderate consumption of alcohol appeared to decrease the relapse rate. In the present trial, ulcer size was associated with ulcer pain but not with ulcer healing.

[Localized colitis cystica profunda]. / Colitis systica profunda localisata.

Colitis cystica profunda is a rare and benign disease of the colon and rectum, generally encountered in younger adults. It is characterized by submucous displacement of tubular glands, formation of intramural glandular cysts and fibromuscular obliteration of the submucosa. It is chiefly located in the rectum and usually has the clinical aspect of a tumor. Clinical pattern, etiology and diagnosis are described with reference to a personal case and 84 cases in the literature. It is emphasized that cancer must be ruled out (i.e rectal amputation is unnecessary in cystic colitis.

[Peroral poisoning with isocyanate and methylenechloride]. / Perorale Intoxikation mit Isocyanant und Methylenchlorid.

Despite worldwide use of organic isocyanates and methylene chloride, little is known of oral intoxication with these substances in human beings. Two suicide attempts and their subsequent clinical course are reported. Coma, shock, relative bradycardia, leukocytosis and metabolic acidosis were ascribed to the effect of methylene chloride. The causes of the necrosis in the gastro-intestinal tract (as demonstrated endoscopically and histologically) of hemolysis and of intravascular clotting are discussed. The prognosis is good after survival of the acute phase. Untoward reactions in cases of pregnancy have not been observed.

[Erroneous diagnoses in the retrograde demonstration of the biliary and pancreatic ducts. Results of a prospective study involving 197 examinations (author's transl)]. / Fehldiagnosen retrograder Gallen- und Pankreasgangdarstellungen--Erfahrungen einer prospektiven Studie von 197 Untersuchungen.

The results of endoscopic retrograde cholangio-pancreatography were evaluated in a prospective study of 126 patients in respect of diagnostic accuracy, as compared with surgery and clinical follow-up. The diagnosis was incorrect in 11 patients; in seven it failed to differentiate between acute and chronic pancreatitis. The discrepancies in the other four patients are described in detail, particularly with reference to prepapillary filling defects. The indications, advantages and limitations of ERCP are discussed.

[Prospective study of the 1st 197 endoscopic retrograde cholangio-pancreatographies (ERCP) in Basel (1973-1975)]. / Prospektive Studie der ersten 197 endoskopische-retrograden Cholangio-Pankreatikographien (ERCP) in Basel (1973-1975).

Cannulation of the papilla has been successful in 144 out of 197 ERCPs. The rate of success increases with the experience of the endoscopist. The intended filling of the pancreatic duct was successful in 87%, of the bile ducts in 64% and of both duct systems in 28%. The correct diagnosis was made in 77% of pancreatic affections, 71% of biliary diseases and in 43% when both duct systems had to be evaluated. 10 ERCP findings disagreed with the final diagnosis, mainly because the distinction between acute and chronic pancreatitis was not correct. The differentiation of chronic pancreatitis from pancreatic carcinoma is not easy and the evaluation of processes localized to the papilla may be difficult. Complications occurred in 6.6%. It is concluded that the ERCP should be limited to regional hospital centers and should be performed only in cases with well defined indications.

[Peptic ulcer: new aspects of conservative therapy]. / Das Ulcus pepticum: neuere Aspekte der konservativen Therapie

In spite of the large number of preparations, medical therapy of peptic ulcer disease has long been unsatisfactory. Antacids, anticholinergics and diet neither accelerate healing of ulcers nor prevent recurrences. Carbenoxolone affects only gastric ulcers, while some medications exhibit substantial side effects. Cimetidine, a representative of the new generation of H2-receptor blockers which are potent inhibitors of gastric secretion, significantly enhances healing of duodenal ulcers. In addition, favorable effects on gastric ulcers, as well as on bleeding erosions and ulcers in the Zollinger-Ellison syndrome, have been reported. Thus far no severe adverse reactions with cimetidine have been observed, but data on effects of long term use are lacking. Synthetic prostaglandins are not yet sufficiently evaluated for clinical use.