[MR-Cholangiopancreatography as a single-shot projection: techniques and results of 200 examinations]. / MR-Cholangiopankreatikographie als Einzelschussprojektion: Erfahrungen und Ergebnisse bei 200 Untersuchungen.

PURPOSE: Evaluation of utility and value of a selective projection technique for bile and pancreatic ducts in MRI. MATERIAL AND METHODS: 200 patient examinations of the pancreaticobiliary duct system using a turbo-SE pulse sequence in "single-shot" technique were evaluated in retrospect concerning anatomic display and diagnostic accuracy compared to surgery, ERCP, i.v. cholangiography, ultrasound and clinical course. RESULTS: Non-dilated ducts allowed visualisation of gallbladders in 78%, common bile ducts in 97%, cystic ducts in 80%, intrahepatic main ducts in 71% and pancreatic main ducts in 69%. When dilatation was present, all common bile, intrahepatic main and pancreatic ducts were visible. Display of cystic ducts and gallbladders with a detection rate of 69 and 85%, respectively, did not improve. Sensitivities for diagnosing papillary stenoses (n = 6), pancreatic ductal stenoses and dilatation (n = 13), compressions and dilatations of the biliary tree (n = 33) as well as for one choledochal cyst were 100%. Choledocholithiasis could correctly be predicted in 11/15 cases (73%), cholecystolithiasis in 71/120 cases (59%). CONCLUSION: "Single-shot" MR-cholangiopancreatography is a fast and non-invasive modality which can replace i.v. cholangiography and restrict the indication for ERCP to therapeutic indications and problem cases.

[Epidemiological research on primary hyperparathyroidism. A prospective multicenter study]. / Epidemiologische Untersuchungen zum primären Hyperparathyreoidismus. Eine prospektive Multizenterstudie.

Serum calcium determination of 11,588 hospitalized patients during a twelve-month period revealed hypercalcaemia in 74 (0.64%). Further clinical and biochemical investigation established primary hyperparathyroidism in 20 of them (27%), and in 15 (20%) a malignant tumour (with bone metastases in six) as the cause of the hypercalcaemia. Rarer causes were found in 11 patients (15%): diuretic medication (5), lithium treatment (3), immobilization (2) or hyperthyroidism (1). In the remaining 28 patients (38%) no cause of the hypercalcaemia could be established with certainty. In at least six patients, however, there were clinical pointers towards hyperparathyroidism in the absence of unequivocal biochemical findings. Leaving out of account borderline cases, one must reckon on a prevalence of hyperparathyroidism in 0.17% of an unselected group of hospitalized patients. Parathyroid hyperfunction must always be considered in the differential diagnosis because of its manifold clinical presentation.

Primary multiple colonic carcinoma.

Polypoid lesions of the colon are commonly accepted risk factors for the development of carcinomas of the colon. Fifty-two of 266 patients with one or more polypoid lesions of the colon showed a carcinoma in one of the polyps, 6 patients had a second carcinoma. Our study demonstrates the importance of preoperative investigation of the total colon in patients with carcinoma of the colon. Furthermore, the necessity of total exstirpation of each polypoid lesion is discussed.

[Side effects and safety of the new histamine H2 receptor antagonist ranitidine in the long-term treatment of patients with stomach and duodenal ulcers]. / Nebenwirkungen und Sicherheit des neuen Histamin-H2-Rezeptor-Antagonisten Ranitidin in der Langzeitbehandlung von Patienten mit Ulcus ventriculi und duodeni.

The safety and various side effects of ranitidine (2 X 150 mg daily), a new selective H2-receptor antagonist, were evaluated in the long-term treatment of patients with prepyloric or duodenal ulcer. A total of 6 adverse effects was reported by 5 out of 32 patients (18.7%). Thus, the overall incidence was low and almost half of the adverse effects involved minor or functional gastrointestinal symptoms. In no case were side effects severe enough to necessitate interruption of therapy. There were no detectable changes in haematological or biochemical blood parameters attributable to ranitidine. Long-term therapy with ranitidine appears to be safe and well tolerated; however, continued surveillance must be maintained.

Ranitidine in the treatment of duodenal and prepyloric ulcer: comparison of two dosage regimens.

In a double-blind controlled study eight-two patients with duodenal or prepyloric ulcer were treated with either 100 mg of 150 mg ranitidine twice daily. After 4 weeks of treatment the ulcer had healed in twenty-two of forty-one patients (54%) on 200 mg of ranitidine and in thirty-six of forty-one patients (88%) on 300 mg of ranitidine. In the x2-test this difference was statistically significant (p less than 0.01). Relief of pain and reduction of mucosal inflammation were similar in both groups. There were no drug-related side-effects nor consistent changes in laboratory findings. We conclude that a daily dose of 300 mg ranitidine is superior to 200 mg ranitidine in the treatment of duodenal and prepyloric ulcer and that the short-term use of ranitidine seems to be safe for the treatment of these ulcers.

[Emergency endoscopy in patients with chronic alcohol abuse]. / Notfallendoskopie bei Patienten mit chronischem Alkoholabusus.

In this study we evaluated the findings of emergency endoscopy--carried out because of acute bleeding in the upper gastrointestinal tract--in 58 patients with chronic abuse of alcohol. These findings were compared with those bleeding sources which were seen within the emergency endoscopy of 199 patients without abuse of alcohol. Among the collective of the chronic alcoholics in 37,9% the bleeding lesion was found in the esophagus. In one third of the alcoholics with proved liver cirrhosis and esophageal varices another bleeding source than esophageal varices existed. In two patients of this collective, besides bleeding esophageal varices another more distally located bleeding source could be found. This shows the necessity to examine also stomach and duodenum in order to exclude an additional bleeding lesion, even when bleeding out of these varices is endoscopically proved. Erosive alterations in the area of the stomach and duodenum were observed very frequently when multiple lesions existed.

[Exogenous zinc deficiency syndrome]. / Das exogen bedingte Zinkmangelsyndrom.

Two cases of acquired zinc deficiency after excessive bowel resection and total pancreatectomy and after total parenteral nutrition are reported. Skin lesions include diffuse hair loss and a psoriasis like dermatitis localized mainly at acral areas and around body orifices, which disappeared rapidly after oral supplementation of zinc sulfate. Clinical symptoms, etiological factors, differential diagnosis and therapy are discussed.

[Mediastinitis and bilateral pleural effusion of pancreatic origin (author's transl)]. / Mediastinitis und bilateraler Pleuraerguss bei chronisch rezidivierender Pankreatitis.

A case report is presented of a patient admitted to a thoracic specialist unit on account of predominantly pulmonary symptomatology. There was a left-sided haemorrhagic pulmonary effusion, which rapidly returned after tapping. The patient then developed a high fever and shock. Mediastinal widening was noted on X-ray, as well as a right-sided pleural effusion. Repeated tapping of the pleural effusions and drainage of a mediastinal abscess, which was diagnosed on mediastinoscopy as well as the administration of antibiotics led to an improvement in the patient's previously poor general condition. Sonography and subsequent endoscopic retrograde pancreatography were instrumental in eventually diagnosing chronic recurrent pancreatitis with cyst formation and retroperitoneal perforation into the mediastinum and pleural space. Laparotomy with removal of the pancreatic cysts and abdominal drainage led to complete recovery. The pathogenetic processes involved in the formation of internal fistulae, diagnostic problems and therapeutic management are discussed.

[Endoscopic papillotomy in Austria]. / Endoskopische Papillotomie (EPT) in Osterreich.

In 5 gastroenterologic centres in Austria 383 EPT were performed at a total of 10031 ERCP until July 1980. In 350 cases this procedure was successful (91.3%). The most frequent indication was a choledocholithiasis in 300 cases (85.7%). Complete disappearance of gall stones was achieved in 94%. Complications happened in 14 patients (4%), in 4 patients (12%) surgical procedures were necessary consequently. The death rate was 0.6% (2 patients). These favorable results and the low rates of complications and letality of this procedure encourage for the more frequent use of this method for the treatment of choledocholithiasis also in Austria in capable and experienced hands. In view of reducing complications the limitation of the EPT to few specialised centres is demanded.

[Developments in the serological diagnosis of malignant diseases]. / Entwicklungen in der blutchemischen diagnostik maligner erkrankungen.

The present study gives an evaluation of carcinoembryonic antigen (CEA), macrophage electrophoretic mobility test (MEM), sialyltransferase, galactosyltransferase isoenzyme (SGT), ribonuclease and reverse transcriptase as diagnostic aids in malignant diseases. CEA and sialyltransferase are of certain value in the monitoring of cancer, as their values in the serum may rise before progression of disease or relapse. Both tests are not reliable parameters in the early diagnosis of malignancy. Our results with regard to the MEM test have not proved in any way useful in the diagnosis of cancer. Our preliminary results appear to indicate that, provided further simplification of the method can be achieved, SGT isoenzyme determination seems to be a better means of diagnosing cancer. In view of inherent-methodological difficulties reverse transcriptase has, at present, no clinical application in the diagnosis of cancer.

[Exploration of pancreaticojejunal anastomosis by postoperative endoscopic pancreaticography (author's transl)]. / Anwendbarkeit der endoskopischen retrograden Pankreatikografie zur Funktionsprüfung pankreatikojejunaler Anastomosen.

Endoscopic pancreaticography (EP) was performed in 9 patients after pancreaticojejunal anastomosis had been established surgically; in 2 of these patients EP was not successful. The anastomosis could be demonstrated in 5 cases to be functioning 1-6 years after operation; in 3 cases the duct system was found to be dilatated, in 2 cases diameters were normal. EP and clinical symptoms correlated well in 4 of 5 cases.

[Histotopographic demonstration of hepatitis-B-surface-antigen (HBSAg) in liver-biopsies with the peroxidase-antiperoxidase (PAP)-method in symptomfree HBSAg-carriers]. / Histotopographischer Nachweis von Hepatitis-B-Surface-Antigen (HBSAg) in Leberbiopsien mit der Peroxydase-Antiperoxydase (PAP)-Methode bei klinisch symptomfreien HBSAg-Trägern.

In 241 paraffin-embedded liver-biopsies of HBSAg-positive, voluntary blood-donors hepacellular HBSAg was demonstrated with the immunomorphologic peroxidase-antiperoxidase (PAP)-method. In all sections, HBSAg-positive liver-cells were estimated, their distribution-pattern was assessed and different types of cytoplasmatic localisation of HBSAg were described. Despite high sensitivity of the PAP-method, 24% of seropostive cases were histologically negative. A correlation of HBSAg-content and histologic diagnosis was lacking. An association of high HBSAg-content with non-aggressive liver-disease and of low HBSAg-content with aggressive liver-disease in a single biopsy could not be found in our material in contrast to the literature. 34 patients were followed up through 4-6 years. Constant or improved liver-histology was associated with increased, deterioration with decreased HBSAg-tissue-content.

OMGE--Study on prevalence of hepatitis B surface antigen in different liver diseases.

The prevalence of hepatitis B viral infection has been evaluated by means of a questionnaire. Contributions were made by 160 institutions from 39 countries and involved more than 400 collaborators. HBsAg was identified by a variety of test kits which were available at the time of the questionnaire. Data are presented for the prevalence of HBsAg in acute viral hepatitis, chronic hepatitis, cirrhosis of the liver and primary liver cancer. Wide variations in antigenaemia were identified in different countries and between the various forms of liver disease. HBsAg is positive more often in chronic hepatitis than cirrhosis. More data using sensitive tests are needed but it appears as if at least one-fifth of the world population has had a previous hepatitis B virus infection.

[Endoscopy and radiological investigations of the stomach and duodenum. Alternative or complementary procedures? (author's transl)]. / Röntgendiagnostik und Endoskopie von Magen und Duodenum. Alternative oder komplementäre Verfahren?

The results of radiological and endoscopic examination in 1,030 patients were compared. In one third of cases there was some discrepancy relating to a significant diagnostic finding (malignant process, peptic ulcer, polyp, stenosis or deformity, abnormal folds, diverticula or normal findings). In analysing false negative and false positive radiological diagnoses, the patients were divided into two groups (with or without a double contrast technique). Conventional radiography proved ten to 38% less reliable than the double contrast technique for a variety of reasons. In view of the high diagnostic accuracy of modern radiological investigations of the stomach and duodenum, endoscopy and biopsy are recommended as complementary procedures. In addition to the high degree of accuracy of radiological methods for various pathological processes, endoscopy places considerable demands during investigation of the upper intestinal tract. At present radiology is used 19 times as frequently as endoscopy, suggesting that there might have to be a tenfold increase in the capacity of pathological departments if endoscopy is used more frequently.

[Hepatitis b infection in renal transplant recipients (author's transl)]. / Nierentransplantation und Hepatitis-B-Infektion.

During a period of 4 1/2 years the incidence and clinical course of endemic hepatitis B infection was studied in 43 renal transplant recipients with an observation time of 3 to 47 (average: 26.3) months after surgery. During the investigation period 27 out of 43 patients (62.8 per cent) had hepatitis B infection. In 8 patients HBs antigenaemia persisted after chronic dialysis treatment. After surgery HBs antigenaemia was detected for the first time in 7 patients. Recurrence of HBs antigenaemia was noted in one patient. In 7 further cases with HBs antigenaemia after transplantation regular controls of HBsAg and HBsAb were not available before transplantation. In 2 patients HBs antibodies were detectable at the time of transplantation; 2 further patients developed HBs antibodies postoperatively. Hepatitis B infection showed a mild and persistent clinical course. 6 out of 7 icteric patients simultaneously had other severe mycotic and viral infections. Therefore, the conclusion was drawn that in patients with coexisting multiple infections liver damage is not necessarily attributable to HBs antigenaemia.

[Retroperitoneal lymphangiodysplasia with exudative enteropathy. A case of cystic dilated cisterna chyli and splenic cysts]. / Retroperitoneale Lymphangiodysplasie mit exsudativer Enteropathie. Ein Fall von zystisch erweiterter Cisterna chyli mit Milzzysten

In a 16 years old girl we found the syndrome of exsudative enteropathy with intestinal lymphangiectasy which differs from previous reported cases by several malformations of the lymphatic system. Besides changes in the intestinal lymphatics there was a retroperitoneal lymphangiodysplasia, a reduction and hypoplasia of the lymph vessels in the legs and cysts in the spleen. By substitution of albumin followed by a diet with middle chained triglycerids (MCT), serum protein was stablised but a relapse could not be prevented. Surgical treatment was not possible because the changes were too extensive. The value of diagnostic measures for differential diagnosis of the intestinal lymphangiectasy is presented.