[Effect of preventive selenium administration on development of ERCP-induced acute pancreatitis]. / Einfluss einer prophylaktischen Selensubstitution auf die Entwicklung der ERCP-bedingten akuten Pankreatitis.

BACKGROUND: Sodium selenite may play a role in reduction of enhanced oxygen free radicals in the early phase of experimental acute pancreatitis. The aim of the study was to determine whether ERCP induced pancreatitis can be used as a human model for early acute pancreatitis and if a prophylactic antioxidant therapy with sodium selenite or a prophylactic antibiotic therapy has a beneficial effect on the clinical outcome in patients with ERCP. PATIENTS AND METHODS: Sixty patients were randomly allocated in 3 groups: A (n = 20, sodium selenite i.v. 1 day before ERCP 1 mg bolus/2 x 1 mg infusion); B (n = 20, metronidazole 0.5 g/ofloxacin 0.2 g before and 6 hours after ERCP); C (n = 20, controls, no prophylaxis). Various labor parameters and physical complaints after ERCP were determined. RESULTS: Patients with an antibiotic prophylaxis or with a sodium selenite substitution had no less physical complaints or pancreatitis than the controls. Seven patients (= 11.7%) developed a pancreatitis after ERCP. Concentration of zinc, copper, manganese, vitamin A and E did not differ significantly between the various groups. CONCLUSION: A prophylactic substitution with sodium selenite or prophylactic antibiotic therapy with metronidazole/ofloxacin has no beneficial effect on the clinical outcome in patients with ERCP.

[Significance of suprapubic puncture of the bladder as a diagnostic method]. / Die Bedeutung der suprapubischen Blasenpunktion als diagnostische Methode.

In 650 cases for the purpose of a methodical comparison was examined urine got by paracentesis of the bladder and midstream urine. The most important results were: 1. Urine got by paracentesis of the bladder was infected in 30.9%, midstream urine in 51.7%. 2. Further 39.4% of the samples of midstream urine were poor in germs; in 2.3% these findings corresponded to an infection. 3. Only 69.7% of the kinds of germs and 38.8% of the numbers of germs were identical. 4. 28.4% of the samples of midstream urine with a significant bacteriuria and 60.6% of those ones in the region of suspicion showed sterility in the corresponding urine got by paracentesis of the bladder. 5. On the other hand 30.8% of the infected urine got by paracentesis of the bladder did not reveal a significant bacteriuria in the midstream urine. These results confirm the relevance of the quickly performable and complicationless suprapubic paracentesis of the bladder as diagnostic method. It should more be taken into consideration in clinic and outpatient department.

[Incidence and significance of psychovegetative syndromes--demonstration on an example of an internal medicine diagnostic station]. / Die Häufigkeit und Bedeutung psychovegetativer Syndrome--Darstellung am Beispiel einer internistischen Diagnostikstation

It is reported on 215 patients in whom after detailed somatic and psychodiagnostic examination in a ward of internal diseases the diagnosis of neurosis was made. The cases in question were 33.3% of the whole number of patients during a selected period. In the majority of cases (74%) organic functional disturbances were diagnosed, above all cardiovascular and gastro-enterological syndromes. The screening diagnostics especially with the help of questionaires of complaints allowed of a comparatively certain conclusion to the existence of a psychovegetative syndrome. Altogether 51 patients exhibited the picture of a functional organic linkage syndrome, i.e. in an organic disease a characteristic functional syndrome remained ascertained. The duration of the diseases was always several years, they were chronified, mostly by iatrogenic influences and labelled by an organic pseudodiagnosis. Among the therapeutic measures possible in practice already the diagnosing of a neurosis represents a decisive step.

[Clinical aspects of the endocrinologically inactive small intestinal carcinoid]. / Zum klinischen Bild des endokrin inaktiven Dünndarmkarzinoids.

Casuistically is reported on two patients with an endocrine inactive ileum carcinoid, in whom the anamnesis with 5 weeks or 10 months was very short and atypical. Continuously increasing abdominal pain and gradual formation of a lower ileus of the small intestine or profuse watery diarrhoeas were the leading symptoms. Intraoperatively or autoptically in each case a very small (less than 1.5 cm) ileum carcinoid was found, which had led to a stenosing of high degree, there were no fibroses of the endocardium, no liver metastases--accordingly the secretion of serotonine metabolites (5-HIES) in the urine had been normal. The possibility of a so-called endocrine-nervous enteropathy in the female patient with the diarrhoea symptomatology and the necessity of a rapid diagnostic clarification in suspicion of a tumour in the lower small intestine are discussed, since such a suspicion in most cases corresponds to a carcinoid and thus there exists a great chance of cure.

[Liver cirrhosis and chronic hepatic porphyria]. / Leberzirrhosen und chronische hepatische Porphyrien.

Chronic hepatic porphyrias (CHP) are associated with different degrees of liver damage. They range from minimal histological changes to cirrhosis and primary liver carcinomas. Forty patients with early stages of porphyrias were compared to 85 patients with clinically manifest porphyrias, Porphyria cutanea tarda. This comparison resulted in the fact that cirrhosis occurred more often in early (or latent) stages (65%) than in PCT (31%) confirmed by laparoscopy. Thus the severity of the liver disease does not depend on the duration and intensity of cutaneous symptoms or pathobiochemical syndromes but they more often depend on the long-term influence of so-called trigger factors, among them above all alcohol and iron overloading. We conclude that the proof of latent CHP has an index function for severer liver damage.

[Surgical treatment of hemorrhaging gastroduodenal ulcer. Individually adapted indications]. / Chirurgische Therapie des blutenden Ulcus gastroduodenale. Individual-adaptierte Indikationsstellung.

Increase in application of emergency gastroscopy together with indications according to "Forrest" criteria, in the course of nine years, resulted in reduction of lethality by 15 per cent among patients who had been surgically treated for bleeding ulcers. Life-threatening postoperative risks were higher without gastroscopy. A critical appraisal is made in this paper of gastroscopic findings, with reference being made to surgical results.

[Paracrystalline needle-shaped cytoplasmic liver cell inclusions in chronic hepatic porphyria--light and electron microscopic examination of liver biopsy specimens]. / Zur Bedeutung parakristalliner Nadelstrukturen für die Diagnose der chronischen hepatischen Porphyrie--licht- und elektronenmikroskopische Untersuchungen an Biopsiematerial.

Paracrystalline needle-shaped cytoplasmic liver cell inclusions could be identified by light and electron microscopic examinations of 19 liver biopsy specimens in chronic hepatic porphyria. Light microscopically, they occurred in 6 cases, electron microscopically they were found in 13 ones. In the electron microscope these inclusions displayed tubular substructures with enhanced contrast of the membranes. They are specific for chronic hepatic porphyria; their light microscopic identification is of diagnostic value. Membranous material occurring in cisternae of the endoplasmic reticulum and adjacent to pigments and inclusions has not been described so far and is discussed with regard to its origin. Alterations of mitochondria and endoplasmic reticulum, observed in all cases, point to a general liver cell damage in chronic hepatic porphyria. Up to the present, the chemical structure and pathogenesis of the inclusions are still unknown.