[Barrett esophagus: apropos of 258 endoscopic observations].
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Biomedical subjects
Publications and source records attributed to J Fasel.
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The secondary hard palate is formed by fusion of the right and left palatal shelves. During this process the cells of the medial edge epithelium (MEE) undergo autolysis. The present study, carried out on golden hamsters demonstrates that the glycogen content and the activities of phosphorylase, lactate-dehydrogenase (LDH), and succinic dehydrogenase (SDH) increase in the MEE-cells when the palatal shelves contact. These histochemical characteristics persist during the phase of degeneration of MEE. Thus, the increased glycogen content of the degenerating cells cannot be explained by a decrease of activity of these enzymes.
A new method of treating a spondylolisthesis by means of bone grafting and a special hook screw is reported. With this method, the "restitutio ad integrum" of spondylolysis and at least partial reduction of a grade-I spondylolisthesis can be achieved. The surgical technique is simple. Ten patients in our series of 12 showed good or excellent results.
In the context of a cooperative clinical trial carried out in the Cantons of Basel and Vaud, Switzerland, the litholytic effect of ursodeoxycholic acid (Ursochol) in a daily dose of 9 mg/kg was investigated in 42 patients with radiotransparent gallstones. The litholytic effect was evident in 22 (73%) of the 30 patients followed up for a maximum period of 1 year. Complete dissolution of gallstones was obtained in 40% of cases. In addition, ursodeoxycholic acid significantly reduced (p less than 0,001) the dyspeptic-painful symptoms and the number of biliary colics. Tolerance was excellent. In particular, no cases of diarrhea were observed.
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73 patients presenting with hiatus hernia and reflux oesophagitis verified endoscopically, were controlled and checked by endoscopy 5 to 15 years after surgical correction of reflux. In half of these cases the intervention consisted of a "fundoplicatio" and in the other half, of a "hemi-fundoplicatio" or closure of the angle of His. The long-term results show a higher degree of efficiency of the "fundoplicatio" particularly that which concerns the curing of the oesophagitis. The adjunction of a vagotomy-pyloroplasty in 9 patients showed an increase in the frequency of bile reflux in the stomach. The absence of cancer in the oesophagus in the 73 patients controlled after a period of many years, suggests that correction of the reflux and of the oesophagitis constitutes a high measure of efficiency.
971 samples of urine and washes of the urinary bladder in 643 patients were investigated cytologically. Urothelial carcinoma was present in 27 patients. In 11 cases the carcinoma was diagnosed by urinary cytology; 7 of the carcinomas were localized in the urinary bladder, 3 in the renal pelvis and 1 in the ureter. By contrast, all 19 tumors diagnosed in washes were localized in the urinary bladder. Diagnostic sensitivity was 100% in urine and about 75% in bladder washes. In 5 other patients cytologic diagnosis of carcinoma could not be confirmed by histology. In 4 of these, urothelial papillomas were present and in 1 patient a carcinoma of the bladder had been resected previously. Thus, the diagnostic accuracy of urinary cytology is good if essential methodological prerequisites are fulfilled. Therefore, urinary cytology appears to be an appropriate method for screening programmes in high risk patients such as phenacetin abusers. The estimated costs of a screening programme in Basel are 50 000-150 000 Swiss francs. However, a preliminary study to verify the value of such a screening programme is suggested.
The study of gastric emptying by isotopic and barium feeding, in 43 patients, before and 6 months after highly selective vagotomy, showed no retention after this type of operation. Whereas during the first 45 minutes following ingestion of the test meal, there was no modification of emptying, a significant acceleration thereafter was demonstrated by both methods. The isotopic meal allows continuous study of gastric emptying which appears to be more regular after the operation. There was no difference in gastric emptying between patients suffering from post-prandial gastric fullness, mild diarrhea or dumping syndrome.
Postoperative reflux gastritis is generally considered a definite clinical syndrome. It is the possible sequel to any gastric surgery suppressing pyloric continence. Incidence of this complication is still difficult to evaluate, whereas enterogastric reflux is often seen during endoscopy. 75 patients were studied clinically and endoscopically, and their gastric mucosa histologically, after gastric surgery. Results were compared to those in a 2nd group of patients whose reflux induced symptoms had been brought under control by endoscopically confirmed surgical correction of reflux. Enterogastric reflux is common (80%), but its effect on the gastric mucosa is observed endoscopically only when it is relatively marked (69%). Clinical suspicion of reflux gastritis is most often confirmed by endoscopy, but endoscopic reflux gastritis is symptomatic in only half of patients undergoing surgery. Foveolar hyperplasia is the only histological criterion related to reflux gastritis.
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