[Therapy of chronic hepatitis].
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Chronic Disease↗
Biomedical subjects
M Mörl
Publications and source records attributed to M Mörl.
[Portal hypertension associated with alcoholic liver damage (author's transl)].
Alcoholic liver damage is associated with the development of portal hypertension quite early, as a result of increasing fibrosis. By means of laparoscopic transhepatic manometry (LTM) in the branches of the portal and hepatic veins, we measured the pressure levels in 15 patients with early and transitional-stage alcoholic injury extending to cirrhosis of the liver, and compared them with histological and laboratory investigation criteria. We discovered that parenchymal damage with portal and centrolobular fibrosis already gave rise to some portal hypertension which, compared to a group showing histological changes of remodelling or cirrhosis, constantly increased. In completely developed alcoholic cirrhosis (n = 41), the pressure levels reached a peak. Despite this fact, bleeding from oesophageal varices cannot be predicted. Over the period of observation of 33 months, 4 deaths occurred (portal vein pressure between 4.5 to 5 kPa = 34.0 to 38.8 mm Hg), and three variceal bleedings we were able to manage were seen (pressures between 3.6 to 4.3 kPa = 27.0 and 32.0 mm Hg). Compared to hepatitic cirrhosis the prognosis was slightly more favourable.
Adult↗
[Portal hypertension in idiopathic haemochromatosis (author's transl)].
In contrast to hepatic and alcoholic cirrhosis of the liver, the life-threatening portal hypertension seen in idiopathic haemochromatosis (IH) responds well to therapy. With the aid of laparoscopic transhepatic manometry, we determined the pressures in the branches of the portal vein and the hepatic vein in four patients presenting with IH, and compared the values obtained with clinico-chemical and histological parameters. Three patients who had been suffering from the disease for periods varying between two and ten years, responded well to therapy. The fourth patient, who presented with the highest pressure in the portal vein (26.5 mm Hg) died, three months after the initial establishment of the diagnosis of advanced IH, in consequence of unmanagable haemorrhage from oesophageal varices.
Hemochromatosis↗
[Crohn's disease: course and prognosis in 169 patients (author's transl)].
The most common initial symptoms in 169 patients with Crohn's disease, followed from 1956 to 1973, were diffuse abdominal pain, diarrhoea without any blood admixture, loss of weight, and fever. At the onset of the disease 84% of patients were aged 10-39 years. The most important complications (in descending order of frequency) were fistulae and abscesses, ileus, anaemia, and malabsorption. A breakdown into active and passive phases indicated that the younger the patient at onset of the disease, the more severe its course. The disease seemed to take a more favourable course when only the colon, but not the terminal ileum, was involved. Recurrence occurred more frequently after a short than after a long preoperative history. Recurrences were more frequent in patients under than over 31 years of age at their first operation.
Adolescent↗
[Organic complications of alcoholism].
With the enormous increase of alcohol consumption after a period of latency of many years an increase of organic damage is associated, the knowledge of which leads to correct diagnosis. Most often the liver, the central organ of alcohol decomposition, is affected. Many other organs are involved in a specific way. Symptomatology and diagnosis are dealt with in detail.
Alcoholism↗
[Comparative manometric and histological studies on the course of portal hypertension in alcoholic liver cirrhosis].
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Adult↗
[Clinical, humoral, and histological findings in hepatic porphyrias].
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Adult↗
[Liver cirrhosis caused by genetic defects].
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Adult↗
[Pregnancy in ulcerative colitis and Crohn's disease (author's transl)].
Between 1967 and 1973 15 women with ulcerative colitis had 20 pregnancies. 14 ended with normal deliveries, 4 with spontaneous abortions, and 2 with therapeutic abortions. Fertility was normal. Malformations in the children were not observed. In the case of conception during remission or a latent phase of the disease in general a normal pregnancy is to be expected (12 out of 14). On the other hand conception during an active phase can lead to an unpredictable threat to the life of mother and child. Therapeutic abortion should be seriously considered when ulcerative colitis and pregnancy begin simultaneously. In the same period of time in 15 comparable patients with Crohn's disease (12 with ileo-colitis and 3 with terminal ileitis) who were not taking ovulation inhibitors 4 pregnancies were observed. Fertility is not significantly reduced in terminal ileitis whereas in ileo-colitis it is highly significantly reduced (bilateral tubal irritation). As in ulcerative colitis a normal pregnancy can be expected after conception in an inactive phase (2 out of 4).
Abortion, Spontaneous↗
[Therapy and prognosis of chronic hepatitis].
The classification of chronic hepatitis in a chronic persistent and a chronic aggressive form, the latter with mild or strongly inflammatory activity, has proven valid and had been widely accepted. The long-term therapy of the chronic persistent form (to be confirmed histologically several times) consists merely in a basis-therapy (diet, abstinency from alcohol, physical rest, vitamins). With same caution chronic aggressive hepatitis with little activity is being treated. Rival therapeutic measures for forms with a strongly inflammatory activity are only corticosteroids alone or in combination with azathioprine as well as D-penicillamine in small quantities.
Adrenal Cortex Hormones↗
[Drug-induced icterus].
From the clinical point of view, the classification of drug-induced liver damage into predictable, unpredictable and simulated, has proved useful (Popper and Greim 1973). Forms of jaundice can be predominantly cholestatic or predominantly hepatocellular and can closely imitate an obstructive syndrome or hepatitis. Mixed forms are also frequent.
Anticoagulants↗
[Liver tumors. Laparoscopic aspects].
A review is given on laparoscopic possibilities in the differentiation of tumours of the liver. Benign lesions are rare and usually discovered by chance. Primary cancer of the liver can be verified ante finem in a maximum of 40% of the cases. Characteristic is the endoscopic picture in the case of haemangiosarcoma after arsenic, Thorotrast, vinyl chloride (marked capsular fibrosis, net-like marking, "restless" surface of theliver). All the tumours need to be confirmed histologically. A tumour-like appearance is presented by echinococcus alveolaris and coarse-nodular granulomatous changes (sarcoidosis, lymphogranulomatosis, etc.).
Diagnosis, Differential↗
[Eosinophilia and sarcoma of the small intestine (author's transl)].
Eosinophilia occurs as a concomitant sign in multiple diseases of different etiology. Especially its occurrence in malignant diseases is still unknown. In three cases of primary sarcoma of the small intestine a constant eosinophilia is described. In one case this pronounced eosinophilia was present long before the final diagnose was made. The eosinophilic count was highest in the presence of clear symptoms of obstruction and normalized after surgical removal of the tumor. In one case a relapse was indicated by an increasing eosinophilic count. It is difficult to diagnose the sarcoma of the small intestine especially in its early stage because of the lack of typical symptoms. Concerning the described cases it is therefore pointed out, that in connection with undifferentiated abdominal complaints an obscure eosinophilia should be considered to be due to sarcomatous small bowel disease.
Aged↗
[Rare fistulation in enterocolitis regionalis (Crohn's disease) (author's transl)].
The transmural inflammation in Crohn's disease, the variable localization of the disease and the tendency to a descending spread, all lead to a multitude of possible fistulae, the presence of which is often difficult to demonstrate. This is a report on 5 unusual fistula systems: in 2 cases entero-enteral (one of which with hydronephrosis), 1 case of rectovaginal fistula, 1 case of a branched fistula system in the right buttock, 1 case of fistulae between an abscess system in the spleen "bed" and the greater curvature of the stomach. A radiological and endoscopic diagnosis is important since surgically opened fistula systems heal only with great difficulty or not at all.
Abscess↗
Multiple dermal perifollicular fibromas with polyps of the colon -- report of a peculiar clinical syndrome.
In the present study, a peculiar fibromatosis cutis in two siblings has been reported, the dermatosis being characterized by innumerable perifollicular fibromas on face, neck and trunk as well as multiple fibromata pendulantia. Since the father allegedly had skin lesions resembling those of his two affected children, an inherited condition is assumed for the disease which manifests itself rather late in age. In the female patient, several adenomatous colon polyps were found, one transformed into an incipient carcinoma. Since the clinical and dermatohistological features are anything but typical of Gardner's syndrome and, in particular, hamartomalike fibromas of the perifollicular hair sheath are not constituents of its well-known skin tumour complex, we have discussed in detail the possibility of a peculiar cutaneo-intestinal syndrome hitherto unknown.
Adult↗
[Thrombocythaemia - is there a primary form? ((author's transl)].
Within 5 years 11 patients with thrombocythaemia were admitted to the Department of Internal Medicine, University of Erlangen-Nuremberg. All cases were secondary forms in the course of other myelo-proliferative disorders. In one patient thrombocythaemia preceded the primary disorder for some time. There are some doubts whether the primary form of thrombocythaemia is an entity sui generis.
Adult↗
[Focal liver diseases--laparoscopic aspects].
A survey of the laparoscopic findings in such important focal diseases of the liver as metastasis, tumours, cysts and abscesses is given. Among the granulomatous changes, sarcoidosis, lymphogranulomatosis, tuberculosis and reticulosis deserve special attention. Definitive differentiation is, as a rule, only possible after carrying out a histological examination. In numerous infectious diseases, small granulomatous changes can be observed in conjunction with a so-called reactive hepatitis. Industrial noxae (e.g. beryllium, asbestos, silicates, and others) can also induce granulomatosis.
Cysts↗