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Biomedical subjects

H Bühler

Publications and source records attributed to H Bühler.

At least 109 records · Page 6Linked to original sources
PubMed1985

Mucosal biopsy of vascular ectasia (angiodysplasia) of the large bowel detected during routine colonoscopic examination.

Between 1975 and 1983, 9434 colonoscopic examinations were performed at the University Hospital of Zürich. Localized vascular ectasia was detected in 84 patients and there were 48 mucosal biopsies from 46 patients. From the total of 48 biopsies only 24 (50%) showed vascular anomalies. The most frequent lesion encountered was groups of thin-walled dilated vessels in the lamina propria seen in 21 biopsies from 20 patients. These dilated vessels are not specific but in respect of age (median 69 years), location (predominantly in the caecum and the ascending colon) and frequent multiplicity, they are suggestive of angiodysplasia. Five of the 20 patients suffered from chronic anaemia due to haemorrhages. The three other positive biopsies (from two patients) revealed a tiny haemangioma in the sigmoid colon of a 28-year-old woman and a few large, thick-walled probably malformed vessels in the mucosa of the caecum of a 17-year-old boy. Twenty-four biopsies did not show any histologically significant vascular anomaly. Mucosal biopsy of vascular lesions detected during routine colonoscopic examination will, if positive, most frequently simply confirm the endoscopically diagnosed vascular ectasia and may in rare cases show or alert suspicion to vascular lesions other than angiodysplasia. Definitive morphological diagnosis will however only rarely be achieved by this method of investigation.

Cecum↗
PubMed1984

[The Mirizzi syndrome].

Three cases of Mirizzi's syndrome are reported, with special emphasis on differential diagnosis and preoperative evaluation. The syndrome consists of the triad cystic duct stone, inflammatory reaction and benign hepatic duct stenosis. Endoscopic retrograde cholangiography or percutaneous transhepatic cholangiography is mandatory for preoperative evaluation. Cholecystectomy with clearance of the bile duct is the treatment of choice.

Cholecystectomy↗
PubMed1984

[Clinical significance of colonic angiodysplasias].

Among 9343 colonoscopic examinations (1975-1983) colonic angiodysplasias (AD) were diagnosed in 78 patients (0.8%). The mean age of patients with AD was 68 (17-86) years which was significantly higher than that of patients without AD (p less than 0.0001). 76% of the AD were localized in cecum or colon ascendens, 13% in colon transversum, 4% in colon descendens and 6% in sigmoid colon. 69 patients (88.5%) had 1-4 AD; 4 (5.1%) 5-10 AD and 5 (6%) more than 10 AD. A high incidence of associated diseases leading to vascular complications (i.e. hypertension, diabetes mellitus) was noted. 14 of the 78 patients had anticoagulation or bleeding disorders, possibly precipitating intestinal bleeding. The 21 patients (26.9%) with symptomatic AD had either lower intestinal bleeding (n = 8) or severe anemia (n = 13). In 57 patients (73.1%) the AD were asymptomatic during a mean follow-up of 48 (1-108) months. Whereas age and sex distribution were not significantly different between symptomatic and asymptomatic patients, the number and size of AD were significantly increased in symptomatic patients (p less than 0.005).

Adolescent↗
PubMed1984

Endoscopic follow-up after colorectal cancer surgery. Early detection of local recurrence?

This study deals with 188 consecutive patients who had a radically resected colorectal carcinoma and who were later controlled by colonoscopy. The median interval between resection and endoscopy was 2.5 (0.5-19) years. In 20 patients, a local recurrence was found (10.6%). In 11 of these 20 patients the indication for colonoscopy was the clinical suspicion of a recurrence. The remaining nine patients were asymptomatic, and colonoscopy was done as a routine procedure. In six of nine asymptomatic patients, a potentially curative resection of the recurrent tumor was possible, which was not possible in any of the 11 symptomatic patients. Nineteen of the 20 patients with a local recurrence could be followed up. Five of the six patients with potentially curative resection of the recurrence were asymptomatic for a median time of 38 (12-72) months after surgery; in contrast, 9 of 13 patients without curative operation died after a median survival period of 8 (1-24) months. The results of this study suggest that good long-term prognosis may be expected in patients in whom local recurrence is detected at an early asymptomatic stage with the possibility of potentially curative resection. Therefore, the authors propose regular endoscopic examinations in the first years after curative colorectal cancer surgery.

Adult↗
PubMed1983

[Bedside diagnosis of pancreatitis using the urinary amylase test tape. Preliminary results].

A test strip for rapid detection of alpha-amylase in urine was evaluated in 12 patients with an acute episode of acute or chronic pancreatitis and in 16 patients with hyperamylasemia of varying origin. The test strip was positive in 11 of 12 patients with acute pancreatitis and in 8 of 13 patients with hyperamylasemia. In 3 patients with macroamylasemia the test strip was negative. The specificity was 98% in 100 ambulatory patients without evidence of pancreatic disease.

Acute Disease↗
PubMed1983

[Chymotrypsin activity in the stool: comparison of a new photometric technic and the standard titrimetric method].

A newly developed photometric assay for determination of fecal chymotrypsin is compared with the titrimetric standard method. Correlation of both technics was highly significant with a correlation coefficient of r = 0.975. The precision of both methods is satisfactory, with a coefficient of variation of 3.7% for the photometric and 1.8% for the titrimetric method. The clinical value of fecal chymotrypsin tests and other "tubeless" function tests is discussed with special reference to diagnosis and prognosis of chronic pancreatitis.

Chymotrypsin↗
PubMed1983

[Endoscopic papillotomy in preserved gallbladder].

Endoscopic papillotomy was attempted in 60 high risk patients (mean age 76 years) with complications of common bile duct stones and preserved gallbladder. Successful papillotomy and bile duct clearance was achieved in 56 patients (93%). One patient died of bleeding shortly after papillotomy. In 5 patients without signs of complication, cholecystectomy was performed prophylactically. Three patients were lost to follow-up. No cholecystectomy was performed in 47 patients (mean follow-up 24 months). 35 (74%) of these cases were free of biliary symptoms; 5 (11%) complained of nonspecific dyspeptic pain and only 2 (4%) had biliary colic. Complications due to the preserved gallbladder occurred in 5 of 47 patients (11%). Two patients had a short transient bout of jaundice and cholangitis respectively. Three patients developed acute cholecystitis with subsequent empyema. Four out of five complications occurred within one month and in three of them the cystic duct was occluded at papillotomy. In summary, treatment of common bile duct stones by endoscopic papillotomy appears to be justified in high risk patients with preserved gallbladder. Gallbladder related complications are mainly to be expected early in the follow-up or in cases with cystic duct occlusion at papillotomy. Because of the risk of empyema, early cholecystectomy is indicated in cases of acute cholecystitis.

Adult↗
PubMed1983

[Findings in the upper gastrointestinal tract in Crohn disease].

The features, frequency and clinical significance of Crohn's lesions in the upper gastrointestinal tract have been investigated. In 11 out of 28 randomly selected patients, lesions which may be caused by Crohn's disease were found on panendoscopy. These were serpiginous ulcerations in the pars II of the duodenum, as well as aphthous-like lesions and polypoid mucosal folds in the esophagus, antrum and duodenum. In 2 cases each of polypoid folds and aphthous-like lesions, the diagnosis was corroborated by histological finding of a granulomatous inflammation. The lesions suspected to be caused by Crohn's disease were found especially in younger patients and were accompanied by upper abdominal symptoms, but showed no correlation with the clinical activity of the disease.

Adolescent↗
PubMed1983

[Endoscopic papillotomy--analysis of complications].

Complications were observed in 19 out of 250 patients undergoing endoscopic papillotomy. In 215 patients in whom papillotomy was successful the frequency of complications was 2.8%, in contrast to 37% in 35 patients with failed therapy (p less than 0.0001). Furthermore, the complications of successful papillotomy were observed immediately, except in one patient with gallstone ileus. The following 19 complications were observed: cholangitis (5), pancreatitis (5), bleeding (5), perforation (2), impaction of the Dormia basket (1), and gallstone ileus (1). Three patients died, all as a result of cholangitis (mortality 1.2%). All patients with pancreatitis had previously had a precutting.

Adult↗
PubMed1983

[Clinical significance of pancreas divisum].

Pancreas divisum was demonstrated in 22 of 500 consecutive ERCP (4.4%). Among patients with otherwise normal ERCP, pancreas divisum was found in 12.8%. In contrast, only 1.8% of patients with other pathology in the ERCP exhibited pancreas divisum (p less than 0.001). In relation to the clinical indication, pancreas divisum was found in 13.3% of patients with suspected or proven pancreatitis, in 1.9% of patients with suspicion of biliary tract disease (p less than 0.001), in 1.9% of patients with suspicion of pancreatic cancer (p less than 0,05) and in 4.4% of patients with epigastric pain of undetermined origin (p greater than 0.05). In 14 patients pancreas divisum was the only pathological finding in a thorough clinical and gastrointestinal workup; 6 of the 14 patients had had typical episodes of pancreatitis, in 6 other patients there was clinical and biochemical evidence of pancreatic disease (mainly pain and hyperenzymemia), and the last 2 cases had chronic epigastric pain without biochemical abnormalities. In 2 patients of this series the pancreas divisum was misinterpreted morphologically (sonography, autopsy) as tumor of the head of the pancreas. Based upon our experience and the literature, the following practical conclusions can be drawn: 1. Pancreas divisum may cause typical episodes of acute (relapsing) pancreatitis. 2. In patients with chronic epigastric pain associated with hyperenzymemia but without typical acute pancreatitis, pancreas divisum may be the cause. 3. Morphologically pancreas divisum may mimic a pancreatic tumor (sonography, computer-tomography, autopsy).

Abdomen↗
PubMed1983

Multiple hepatitis attacks with immunothrombocytopenia in a heroin addict.

A 25-year-old heroin-addict had four episodes of acute hepatitis, each of them associated with thrombocytopenia. Serologically, hepatitis A and B as well as cytomegalo- or Epstein-Barr virus infections were excluded. High levels of circulating immune complexes and antibodies reacting with aminophospholipids, a component of both liver cell and platelet membranes, were detected during the last two attacks of hepatitis, but were absent during remission. Platelet-associated antibodies of the IgM class paralleled the 'anti-phospholipid' antibodies during the fourth attack. These findings demonstrate an immunological basis of the thrombocytopenia and point to the possibility of a direct association between liver cell injury and peripheral platelet destruction in certain patients.

Adult↗
PubMed1983

[Megacolon as a rare complication of diabetes mellitus].

The clinical and radiological features of diabetic megacolon and gastroparesis occurring in a 48-year-old woman are presented. The only two other well-documented cases of diabetic megacolon from the literature are reviewed. The predominant dilatation of the sigmoidal colon in the setting of a generalized megacolon may be, especially if associated with bladder atony, a clue to the diagnosis of the diabetic nature of a megacolon.

Constipation↗