[Long-term manometry in diffuse esophageal spasm].
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Biomedical subjects
Publications and source records attributed to D Ricken.
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In 50 diabetic patients without gallstones, including 26 patients with cardiovascular autonomic dysfunction, and 60 normal volunteers the fasting volume and volume reduction of the gallbladder after a liquid fatty meal were determined ultrasonically in intervals of ten minutes up to one hour. Simultaneously the gastric emptying of the liquid meal was followed by ultrasound imaging. Despite an association of other complications of diabetic disease (peripheral neuropathy, retinopathy) with autonomic cardiovascular dysfunction, an altered gallbladder resting volume or impaired fat-induced volume reduction was not evident in this group of patients when compared the diabetics without cardiovascular dysfunction or controls. The time to reach the minimal residual gallbladder volume was only tendentiously prolonged in diabetics with autonomic cardiovascular dysfunction. The residual volume of the stomach showed no significant difference between the three study groups using a liquid test meal. In conclusion neuropathic dysfunction of the gallbladder is unlikely to play a major pathogenetic role in the development of gallstones in diabetic patients.
Patients with H.pylori positive peptic ulcer disease were treated with a two weeks regimen consisting of 20 mg omeprazole twice daily and 500 mg amoxicillin six times daily. Subsequently, an H2-receptor antagonist was started (300 mg ranitidine) at night time for four weeks. Before and one month after completion of antibiotic therapy an upper GI-tract endoscopy was performed for determination of H.pylori infection [biopsy urease test (BUT), specific culture and histologic demonstration]. A total of 12 patients completed the study protocol. H.pylori eradication, defined as a negative result in BUT, culture and histology) four weeks after completion of the combined omeprazole/amoxicillin treatment regimen was achieved in 91.6% (11 of 12 patients). Complete ulcer healing was confirmed in all patients. A stomatitis was observed in one female patient as a possible side effect of antibiotic treatment, but this did not necessitate discontinuation of therapy. Only complicated drug regimen with many side effects have been available so far for successful eradication of H.pylori. Thus, the present drug combination might prove as an effective therapeutic option in the future. These data, however, await confirmation in larger study population.
A case of splenic rupture after an uneventful diagnostic colonoscopy in a 68-year old man is reported. Conservative management of this complication was successful. Splenic rupture is a unique and severe complication of colonoscopy, which can rarely be managed conservatively.
The diagnostic value of carcinoembryonic antigen (CEA) was studied prospectively in 18 patients with ascites of malignant and 28 patients with ascites of benign genesis. Both sensitivity and specificity reached 83%. With a prevalence of malignant disease of 38%, the positive and negative predictive values were 75% and 89%, respectively. In contrast to frequent false-positive CEA values in the serum of liver cirrhotics (48.3%), false-positive CEA values in the ascites of the same patients were observed in only 17.3%. It is thus recommended that if CEA determination is to be employed, it should be done in the ascites itself.
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Factor AF2, a now standardized extract from liver and spleen of newborn lambs, showed myeloprotective capacity on platelet- and erythrocyte-count as well as on hemoglobinconcentration in patients undergoing aggressive chemotherapy. In addition, a possible influence on prolonged remission duration in patients with mammary carcinoma had been claimed. In this study, the effect of Factor AF2 on mitogen-induced interferon-gamma release by PBMC was tested in 23 healthy humans and in 23 tumor patients. All patients were prior to surgery and had not yet received radio- or chemotherapy at the time of examination. The interferon-gamma concentration of the supernatants was measured using an enzyme-linked immunosorbent assay (ELISA). The cells were stimulated with PHA at 7.5 micrograms/ml. In the reference group, interferon-gamma concentration rose to 26 units/ml and to 15.5 units/ml in the tumor patients. In the reference persons, an addition of Factor AF2 at concentrations from 10(1) micrograms/ml to 10(3) micrograms/ml resulted in a small non-significant decrease of interferon-gamma release. At 10(4) micrograms/ml, neither test group showed measurable interferon-gamma concentration. In the tumor patients, cocultivation with Factor AF2 until concentration of 10(2) micrograms/ml resulted in a dose-dependent increase of interferon-gamma release, where 20.5 units/ml interferon-gamma were reached. At 10(3) micrograms/ml, Factor AF2 showed no effect on interferon-gamma release compared with the stimulation with mitogen alone. Flow-cytometry analysis of CD3, CD4, CD8, CD16, CD19, CD56, and HLA-DR expression of the PBMC deriving either from reference persons or from patients revealed an almost identical distribution. A slight difference in CD16-positive and HLA-DR positive cells, respectively, was not significant.
Gallbladder volume and contraction after a fatty meal was determined in 14 patients with gastric cancer before and 3-4 months after gastrectomy (7 total and 7 subtotal gastrectomies) with Roux-en-Y anastomosis. All patients had an increased gallbladder resting volume (p less than 0.001) and 10 of 14 patients (6 after total gastrectomy and 4 after subtotal gastrectomy) had an increased minimal residual volume after fatty meal stimulation (p less than 0.01) in the postoperative state, when compared to the preoperative values. It can be concluded that gastrectomy is followed by an impairment of gallbladder tone and contraction, both possibly increasing the risk of gallstone formation.
In this study, the gastric emptying of a liquid fatty meal and the consecutive gallbladder contraction were simultaneously measured by ultrasound in four different age- and sex-related groups of normal subjects: group A, 15 women less than 50 yr (premenopausal); group B, 15 women greater than 50 yr (postmenopausal); group C, 15 men less than 50 yr; and group D, 15 men greater than 50 yr. Apart from a significantly delayed gastric emptying in the premenopausal women, no significant differences in the postprandial relative gallbladder emptying rates were observed between the four study groups. Ninety-five percent of all study subjects had a gallbladder volume reduction of more than 50% after a liquid fatty meal. It is therefore concluded, that 1) endogenous or contraceptive female sex hormones may have a delaying effect on gastric emptying of caloric liquids in the premenopausal state, 2) aging or gender do not significantly influence the fat-induced gallbladder contraction in man, and 3) a 50% residual volume of the gallbladder after a fatty meal should be considered as the upper limit of normal gallbladder contractility (95 percentile of a normal collective).
Among carcinoembryonic antigens CEA and AFP have an exceptional range. The detection of AFP in the serum is a valuable and sensitive serological marker of primary hepatic carcinoma. The quota of primary hepatic carcinoma without AFP-synthesis is for less than 5%.
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Serum CK-MB is regarded as a specific indicator for myocardial diseases. Total CK and the isoenzyme CK-MB were measured in 69 patients with myocardial infarction. In 5 of the cases no pathological CK-MB-activities have been seen. Nevertheless, the clinical importance of CK-MB determination as a differential diagnostic aid remains.
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