Biomedical subjects
Publications and source records attributed to J Loosli.
We present two cases initially diagnosed as Crohn's disease which were treated with immunosuppressive drugs. In both patients the development of an amoebic liver abscess led to the correct diagnosis of amoebic dysentery. The pitfalls of the diagnosis of amoebic colitis and the possible influence of immunosuppression in the development of extraintestinal amoebiasis are discussed.
In 10 patients presenting with acute recurrent dysphagia, seen over a 4-year period, idiopathic, eosinophilic esophagitis (IEE) was diagnosed. The diagnosis was confirmed histologically. Dysphagia of other causes or other diseases causing eosinophilic infiltration was ruled out. Endoscopy showed discrete white structures in the esophagus which were partly finely reticular or plaque-like in 9 of the 10 patients. Of these one had a web and another a mucosal ring. Peripheral eosinophilia and elevated IgE-levels were found in 70% of the cases. To date IEE has been thought to be a rare disorder. Emerging evidence suggests its prevalence has been underestimated. It may also be the most frequent form of eosinophilic gastroenteropathy. The flat, only endoscopically visible form may be more common than the proliferative type. With knowledge of the typical history and of the distinct endoscopic pattern, and with adequate diagnostic workup, the disease will be found more often in the future. Prompt diagnosis also avoids further diagnostic procedures and permits rapid remission through treatment with steroids and antihistamines.
The efficacy of flexible sigmoidoscopy as a screening method for colorectal cancer is still undetermined, and a reduction in mortality due to this cancer by mass screening has not been demonstrated so far. An important precondition for the practicability of screening sigmoidoscopy is its acceptability by the persons to be screened. Acceptability was tested in 294 volunteers without abdominal symptoms from a general medical outpatients clinic. Mean age of participants was 58 years (45-86), 65% were men and 35% women. Sigmoidoscopy was judged harmless by 221 persons (75.1%), painful by 62 (21.1%), very painful by 11 (3.7%), and unacceptable by none. Every participant would have agreed to repeat the examination. In 36 patients 52 polyps were detected, comprising one carcinoma, 18 adenomas (in 15 patients), 32 hyperplastic polyps and one lipoma. We conclude that sigmoidoscopy was well accepted in this study and should be evaluated further as a mass screening method for colorectal cancer.
In 1986 and 1987 the stool samples of 206 patients of the Medical Outpatient Clinic Basel were examined prospectively for bacteria, protozoa and worms. Clinical data of the patients were recorded by questionnaire. The patient group comprised 63 immunocompetent patients as well as 23 HIV-infected patients, all with symptoms of acute enteritis. The control group consisted of 120 healthy persons. Pathogenic organisms were found in the stools of 17.5% of the immunocompetent patients with enteritis. The most common germs were Campylobacter jejuni, Giardia lamblia and Salmonella enteritidis. Isospora belli, found in 2 cases (8.7%), was the only pathogen found in HIV-infected patients. The most frequent pathogen found in 7.5% of the control group was Giardia lamblia. The facultative pathogenic protozoon Blastocystis hominis was found in 16.7-19.0% of the 3 groups. There was no correlation between clinical symptoms and the results of stool examinations. Stool examinations in the immunocompetent patients corresponded to the known distribution of pathogenic germs in Switzerland. The homogeneous distribution of Blastocystis hominis in the 3 groups examined proves the high rate of infection. There is no evidence of a significant correlation between clinical symptoms of enteritis and infection with Blastocystis hominis in immunocompetent patients.
Survival after variceal bleeding depends greatly on the outcome of the immediate posthaemorrhagic period. This may in turn depend on the recurrence of bleeding. We therefore prospectively evaluated the influence of propranolol on the recurrence of variceal haemorrhage during the early period after the acute bleeding episode. Twenty consecutive patients with acute variceal haemorrhage and liver disease were randomly assigned to treatment either with propranolol or placebo orally for 14 days. Propranolol significantly decreased the rate of recurrence of variceal haemorrhage during this early period (p = 0.0028; 95% confidence interval in the placebo group, 90 +/- 20%; in the beta blocker group, 20 +/- 26%). Whereas a recurrence of variceal bleeding occurred in 9 of 10 patients in the placebo group, only 2 of 10 rebled during treatment with propranolol. These results suggest that propranolol may prevent rebleeding in the crucial early period after acute haemorrhage from oesophageal varices.
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Two women were admitted for increasing abdominal pain, vaginal discharge, and severe or moderate chronic ascites. Diffuse peritonitis without evidence of liver disease was found in both cases, and in one the ascites and vaginal discharge contained Chlamydia trachomatis. Both patients responded to doxycycline, and this and the laboratory findings pointed strongly to C trachomatis as the aetiological agent. C trachomatis may cause severe peritoneal infections with chronic ascites formation in the absence of liver disease in women with the Fitz-Hugh-Curtis syndrome. Prompt diagnosis and antibiotics lead to rapid cure.
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During an 18-mo period between 1981 and 1982, a prospective study was conducted in 119 adult patients with acute diarrhea. A diarrhea-inducing microorganism or toxin could be identified in 38.7% of the patients. Salmonella sp and Campylobacter jejuni were the leading agents that caused diarrheal illness in 25% of the investigated population. Clostridium difficile was found in 6%, mainly after previous antibiotic therapy. Rotavirus was rarely isolated and enterotoxigenic Escherichia coli were not found. Clinical features in patients in whom an invasive agent was isolated did not differ from those in patients in whom no enteropathogens were found, although the occurrence of fecal leukocytes and positive hemoccult tests in the former group was significantly more frequent. More than 30% of the patients with negative stool cultures, however, showed fecal leukocytes and positive occult blood, which is suggestive of the existence of one or more invasive agent(s) so far unknown or not recognized.
Acute infectious diarrhoea and its etiology are described. Toxin-induced diarrhoea, usually caused by foodstuffs, and travellers' diarrhoea (etiologically different from endemic diarrhoea) are mentioned. The epidemiology of acute diarrhoea in adults in Switzerland, which has so far not been investigated extensively, is documented from results of our own prospective study. These results demonstrate that 30% of endemic diarrhoea cases in Switzerland are caused by Salmonella and Campylobacter and 10% by Clostridium difficile and Rotavirus. Shigella and Protozoa are rarely sole agents in endemic diarrhoea.
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Small doses of subcutaneous heparin and infusions of dextran both reduce the incidence of fatal pulmonary embolism after elective general surgery. But both methods have disadvantages. Therefore, the protection against deep vein thrombosis afforded by sulfinpyrazone, a drug which can be taken by mouth as well as by injection, was assessed in a prospective study of 119 patients undergoing elective general or urological surgery. The prophylactic administration of sulfinpyrazone was compared with the effects of small doses of sodium heparin and infusions of dextran-70. The 125I-fibrinogen test was carried out in all patients during their hospitalization. Deep vein thrombosis was diagnosed in 13 of 30 patients (43%) who received sulfinpyrazone, in 9 of 29 (31%) receiving dextran-70 and in 2 of 22 (9%) having subcutaneous heparin. The difference between the sulfinpyrazone and heparin groups was statistically significant (p less than 0.01). Sulfinpyrazone in the dose used in this trial was not effective in reducing the incidence of deep vein thrombosis during elective general surgery.