[Hyperplasiogenic polyps and stomach carcinoma risk--experiences following 1074 polypectomies and follow-up studies]. / Hyperplasiogene Polypen und Magenkarzinomrisiko--Erfahrungen nach 1074 Polypektomien und Follow-up-Studien.

In 731 hyperplasiogenic polyps which have been removed by endoscopical polypectomy there were ten polyps with an early cancer and eight polyps with severe dysplasias (borderline lesions) as well as one polyp, in which an advanced carcinoma had developed. This is to date the greatest series of hyperplasiogenic polyps with malignant transformation. In addition, in nine patients with hyperplasiogenic polyps carcinomas could be discovered, i.e. a rate for malignancy of 3.8%. It seems that stomachs with multiple polyps are particularly endangered. The recurrence rate on follow-up examinations covering a period of up to eight years was 36.1%.

[Results of electromyography studies of the rectosigmoid]. / Ergebnisse elektromyographischer Untersuchungen im Rektosigmoid.

In 80 clinically examined patients aged 9 to 67 years the basal myoelectric activity (BER) in the rectosigmoid was registered by using an intraluminally placed hexapolar ring electrode. The frequency analysis of the sinusoidal variations showed for the patients of the normal group predominantly (14 from 18) a mean frequency of the BER of 6 to 9 cycles per minute, for the patients suffering from functional diarrhea a slow frequency of 2.5 to 5 cycles per minute, for patients with obstipation of chronic intestinal diseases no uniform frequency behaviour, and for patients with diverticulosis predominantly (5 of 6) a mean frequency of the BER of 6 to 12 cycles per minute. The individual mean frequency of the BER proved to be unaffectable by intravenous administration of pyridostigmine or hyoscin-N-butylbromide and remained constant also in control examinations after 4 to 52 weeks.

[Colonoscopy - indications and utility]. / Koloskopie - Indikationen und Leistungsfähigkeit.

On the basis of own experiences in 600 examinations and 113 polypectomies a survey is given on indications, contraindications, evidence, therapeutic possibilities and complications of the coloscopy. 38.4% of the patients were referred to coloscopy on account of suspicion of presence of a tumor of the colon, 24.5% on account of a supposed inflammation of the large intestine, 19.2% on account of unclear rectal haemorrhage and 12.1% on account of radiologically diagnosed polyps. In 4.1% of the patients the cases in question were after examinations after coloscopic polypectomy and in 1.8% the cases in question were control examinations after operation of the intestine on account of carcinoma of the colon. The suspicion of tumour was coloscopically confirmed only in 18.1% of the patients who were examined on account of this indication, a supposed inflammation of the large intestine in 29.7%. A source of haemorrhage was proved in 64.8% of the patients who were examined under this question. The after examination of the polypectomized patients resulted in a new proof of polyps in 50%.

[Results of endoscopic polypectomy in the upper gastrointestinal tract--a multicenter study]. / Ergebnisse der endoskopischen Polypektomie im oberen Gastrointestinaltrakt--Eine multizentrische Studie.

The results of 1416 endoscopic polypectomies of the upper gastrointestinal tract are reported, realised in 15 endoscopic centers of the GDR. In 2,8% a polypoid carcinoma, in 0,7% a carcinoid and in 1,3% mesenchymic polyps were found. Complications was bleedings in 3,1% and perforations in 0,7%. Then the whole rate of complications was 3,17%. 5 patients (0.35%) had to be operated as a consequence of complications. One patient (0.07%) died from a fulminat hepatitis after transfusion. These results correspond with those reported in international literature on endoscopic polypectomies in the upper gastrointestinal tract.

[About the correlation of clinical, endoscopical and biopsy findings in inflammatory alterations of the rectal mucosa (author's transl)]. / Zur Korrelation von klinischen, endoskopischen und bioptischen Befunden bei entzündlichen Veränderungen der Rektumschleimhaut

Clinical, endoscopical and biopsy findings (of 725 samples of rectal mucosa) of two groups of patients with and without corresponding clinical complaints are compared and the conclusions are discussed, especially for morphologists. This examination perferably concerns the boderline between "still normal" and "inflammatory" findings.

[Colorectal carcinoma--relation to cholecystectomy or to cholelithiasis?]. / Kolorektales Karzinom--Beziehung zur Cholezystektomie oder zur Cholelithiasis?

On 2200 autopsy cases was investigated if patients after cholecystectomy or with cholelithiasis show a higher rate of colorectal cancer than those with normal gall bladder. Thereby was found that 7,6% of the cases with previously cholecystectomy and 7,0% of these with cholelithiasis had large bowel cancer, but only 2,9% of the dead without these findings. These differences were highly significant. In cases with state after gall bladder removing the significance was only given during the first four years post operation. Furthermore the connections were modified by age and sex. The results suggest that not a previously cholecystectomy seems to increase the danger of cancer in the colorectal area, but that the high risk factor could be connected with cholelithiasis.

[Endoscopic demonstration of heterotopic gastric mucosa in the duodenum]. / Zum endoskopischen Nachweis heterotoper Magenschleimhaut im Duodenum.

On the basis of 8 observations in 3,140 duodenoscopies is referred to the endoscopic picture of heterotopies of the gastric mucous membrane. The heterotopic mucous membrane of the stomach was found in polypoid rice-grain-sized to pea-sized lesions of the duodenum. The histological examination four times resulted in a mucous membrane of the stomach of corpus type, three times of antrum type and once only in foveolar epithelium. As to other findings endoscopically were twice observed erosions of the gastric mucous membrane or of the mucous membrane of the bulb, respectively, once an antrum polypus, in no case ulcers. Once an achlorhydria was present. A hyperchlorhydria was to be proved in no case. The clinical significance of the heterotopia of the gastric mucous membrane in the duodenum as well as the cause of its existence are discussed.

[Fiber-optic endoscopy demonstration, incidence and clinical significance of intestinal lymphangiectasis]. / Fiberendoskopischer Nachweis, Häufigkeit und klinische Bedeutung der intestinalen Lymphangiektasie.

The intestinal lymphangiectasia can be proved enteroscopically, laparoscopically as well as histologically after preceding aimed or unaimed biopsy. In 2,250 fibre-endoscopic examinations of the upper gastrointestinal tract we found 54 times endoscopically and 48 times also histologically a lymphangiectasia. Of these 54 patients 9 had an advanced carcinoma of the stomach. The evoking causes of the lymphangiectasia are discussed. When an intestinal lymphagniectasia is diagnosed it should always be sought for an evoking cause and last not least should be thought of a primary or secondary neoformation in the region of the epigastrium.

[The problem-oriented case report--a method for the improvement of clinical training]. / Das problemorientierte Krankenblatt--eine Methode zur Verbesserung der klinischen Ausbildung.

Abroad in the clinical education of the students the problem-oriented case report after Weed stood the test as a new training principle. In contrast to the classical case report the complaints and findings are formulated as problems and summarized in a list of problems. As problem is regarded what needs a diagnostic or therapeutic solution or a change of the patient's behaviour. For solution of the problem in a second step, the plan, the establishment of the ways of solution for every problem is done. In the notices of the course, the third part, the newly got findings are distributed to the adequate problems and their valency for the solution of the problem is tested. As advantages for the training are regarded: the establishment of the problems is more complete, the classification of psychic, social and health-educational problems is simpler. The physician is compelled to go over from the fixation on an individual problem to the valuation of all problems and to the correlations of several problems. Thus in the increasing specialisation an integrating role belongs to the problem-orientated case report. Independent formulation of the problems, development of the diagnostic and therapeutic steps, classification and valuation of their results in the notices of the course further the own responsibility of the student and renders possible a better control for the clinical instructor. The problem-oriented case report also forms the prerequisites for a problem-related letter of the physician.

[Ulcer anamnesis and gastroduodenoscopic findings--a contribution to the symptomatology of gastroduodenal ulcers]. / Ulkusanamnese und gastroduodenoskopischer Befund--ein Beitrag zur Symptomatologie des gastroduodenalen Ulkus.

513 patients who were gastroduodenoscopically examined on account of suspicion of ulcer were aimedly inquired for 18 typical ulcer complaints. Compared with patients with normal gastroduodenoscopic findings patients peptic ulcers of erosions of the gastric mucous membrane had significantly more frequently symptoms of the gastrointestinal haemorrhage, patients with ulcus ventriculi had, moreover, inappetence and vomiting, patients with duodenal ulcer a late pain in the centre of the epigastrium and in the right epigastrium. But these symptoms did not allow a significant differentiation between the patients with ventricular ulcer and duodenal ulcer. Patients without pathological gastroduodenoscopic findings had significantly more frequently an incompatibility of food and connected with this sensation of fullness. A typical symptomatology of ulcer may, indeed, be present in the individual case, but according to the results of the study it is no sufficient proof for the actual existence of a peptic ulcer and is thus of little differential-diagnostic value.

[Results of total parenteral nutrition in patients with an acute episode of chronic inflammatory bowel disease]. / Ergebnisse der totalen parenteralen Ernährung bei Patienten mit akutem Schub einer chronisch-entzündlichen Darmerkrankung.

We report on 33 patients with a chronic inflammatory intestinal disease who altogether 44 times were treated with a total parenteral nutrition. The indication for a total parenteral nutrition was above all the failure of the medicamentous therapy. In more than 90% a remission was achieved. The following complications occurred: temperatures caused by catheterization, subclavian thromboses, pneumothorax, pulmonary embolism by catheter. When the medicamentous therapy is unsuccessful the total parenteral nutrition is recommended for the treatment of the severe attack of the chronic inflammatory intestinal diseases.

[Relations between stomach polyps and stomach cancer--results of follow-up after endoscopic polypectomy]. / Beziehungen zwischen Magenpolypen und Magenkarzinom--Ergebnisse von Nachuntersuchungen nach endoskopischer Polypektomie.

We report on 468 polypectomies on 303 patients in 23,260 gastroscopies. In 230 endoscopic follow-up controls on 129 patients 4 carcinomas are found, and that once after a hyperplastic polyp and thrice after hyperplasiogenic polyps. In comparison to our routine gastroscopies the number of the carcinomas is distinctly lower in the control of polyps, so that the hyperplasiogenic polyps in our gastroscopies do not represent a particular risk group for a carcinoma of the stomach. After polypectomy should be controlled: adenimas, polyps with severe dysplasias, hyperplasiogenic polyposes and stomachs in which polyps remained.

[Prognostic parameters in peptic ulcer disease]. / Prognostische Parameter der peptischen Ulkuskrankheit.

Tendency of peptic ulcer to frequent recurrence and spontaneous healing as to life-threatening complications are apart of the natural history of ulcer disease. In a retrospective study of 7 years, we examined 27 simple factors for their prognostic value by 218 patients suffering from ulcer disease which were diagnosed by fibroscopy. The interpretation with help multi analysis, the variant and discriminant analysis showed by patients with stomach ulcer that, the prognosis of the combination between renunciation of nicotine the begin of the disease until 30th years of the people, more than three foods daily, stomach cancer in the family, blood group A and left finger position would be suitable. The prognosis was better for patients with duodenal ulcer who have nicotine abstinence, childlessness negative history of the family with view to ulcer disease, blood group 0, positive Rh-factor and the working time.

[The frequency of demonstration of Campylobacter pylori]. / Zur Häufigkeit des Nachweises von Campylobacter pylori.

In 376 patients who underwent gastroscopy the presence of Campylobacter pylori by microscopy, bacterial culture and urea test was studied. Additionally, the histological examination of the antral mucosa was performed. The organisms were detected in 47.9% of the biopsy specimens (37.2% in normal endoscopic findings and 70% in duodenal ulcers). Dependence on sex was not found and also no significant difference of Campylobacter pylori detection in patients younger than 45 years compared with those who are older. However there was a strong correlation between the presence of Campylobacter pylori and the histological results (p less than 0.05). In comparison with international literature we found a distinctly lower percentage of positive Campylobacter pylori rate in patients with peptic ulcer; the association between the presence of Campylobacter pylori and the degree of gastritis was confirmed.

[The value of fiber gastroscopy and targeted gastrobiopsy in the diagnosis of stomach ulcers and tumors]. / Zur Aussagefähigkeit der Fibergastroskopie und gezielten Gastrobiopsie in der Diagnostik von Ulzera und Tumoren des Magens.

In 2,000 patients the fiber-gastroscopic and bioptic findings were tested with the help of control examinations, results of operations and course observations. Here the fibergastroscopic diagnosis tumour was confirmed in 89.4%. 13 times a wrong diagnosis of tumour was made. Here different substrates were in question (ventricular ulcers, polypous hyperblastic mucous membrane and others). 11 carcinomas were gastroscopically not recognized as tumour. In 25 cases (20%) of the histological investigation of bioptically taken tissue did not result in a confirmation of the fiber-gastroscopic diagnosis of tumour. But 19 times of them the histology was falsely negative. The supplementation of the gastroscopy by biopsy resulted in a right diagnosis in 93.6%. By control examinations a further increase of the accuracy to 96.8% could be reached.

[Humoral immune reaction in chronic liver diseases]. / Humorale Immunreaktionen bei chronischen Lebererkrankungen

In 60 patients with a morphologically ascertained chronic liver disease and 40 hepatologically examined patients with a healthy liver of a control group the quantitative determination of the immunoglobulin and the immunofluorescence-serological determination of antibodies against nuclei, smooth musculature and mitochondria were carried out. Only in one female patient with a chronic active hepatitis out of 51 patients with morphologically ascertained liver cirrhosis or chronic active hepatitis antibodies against nuclei and smooth musculature in a level of the titre of more than 1 : 40 and only in 2 female patients with a primary biliary cirrhosis antibodies against mitochondria could be proved in a level of the titre of more than 160. Titres of antibodies lying below were found in the group of patients with liver diseases and the control group in the same frequency, so that an autoimmune form of the cryptogenic cirrhosis could not be differentiated. The proof of antibodies against nuclei and smooth musculature of a high titre in connection with an isolated increase of the IgG is of special diagnostic importance for the autoimmune form of the chronic active hepatitis; the same is the case in the proof of antibodies against mitochondria of a high titre in connection with an isolated increase of IgM.

[Hyperplasiogenic polyps and risk of stomach cancer]. / "Hyperplasiogene Polypen und Magenkarzinom-Risiko".

In 731 hyperplasiogenic polyps which have been removed by endoscopical polypectomy there were 9 polyps with an early cancer and 8 polyps with severe dysplasias (borderline lesions) as well as 1 polyp, in which an advanced carcinoma has been developed. This is the outstanding greatest number of hyperplasiogenic polyps with a malignant transformation. In addition in 9 patients with hyperplasiogenic polyps carcinomas could be discovered, i.e. a rate for malignant developments of 3.7%. It seems that stomachs with multiple polyps are endangered in particular. The recurrence rate of follow-up examinations covering a period of up to 8 years was 36.1%.

[Therapeutic aspects of endoscopic polypectomy]. / Therapeutische Aspekte der endoskopischen Polypektomie.

466 endoscopic polypectomies of the upper and lower gastrointestinal tract were analysed according to their curative value. In 254 removed polyps of the upper gastrointestinal tract the result of the histological examination was twice a proof of a carcinoma. One it had to be after-resected, once a carcinoid, five times bleeding polyps were removed. Four times prolapsing gastric polyps were removed in the bulbus duodeni. In these cases intermittent disturbances of the passage could be repaired. Thus the endoscopic polypectomy in the upper gastrointestinal tract was of therapeutic value in 4.3%. In the lower intestinal tract in 204 polypectomies 16 focal carcinomas or invasive carcinomas removed in the healthy tissue, 1 carcinoid and 98 bleeding adenomas were cut away. Thus the coloscopic polypectomy was connected with a therapeutic use in 56.3%. 81.8% of the polyps was tubular, papillary or villous adenomas. Taking into consideration the "adenoma-cancer-sequence", the coloscopic polypectomy must thus be regarded as a prophylactic and curative method, while in the polypectomy in the upper gastrointestinal tract the diagnostic value is in the first place.