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R Ammann

Publications and source records attributed to R Ammann.

At least 19 recordsLinked to original sources
PubMed1992

[How does oligo- en asymptomatic non-tropical sprue present itself?].

According to the computerized ICD registration, 20 new cases of non-tropical sprue were detected in our outpatient clinic between 1979 and 1990. 8 of these patients had an oligo- or asymptomatic form of this disease (40%). The clinical presentation and spectrum of abnormal laboratory findings in these 8 cases are described in detail. It is concluded that laboratory parameters indicating malabsorption, especially hematologic changes, are helpful for the detection of the oligo- and asymptomatic form of non-tropical sprue, and that, in cases with undetermined anemia, this form of sprue must be considered in etiologic differential diagnosis. Finally, it seems advisable to perform a biopsy as a routine procedure during endoscopy in cases with unclear anemia.

Adult↗
PubMed1992

[Colonoscopic endosonography in the diagnosis and follow-up care of colorectal tumors].

We studied the usefulness and accuracy of a flexible endoscopic ultrasound system (EUS) in preoperative staging of tumor invasion and involvement of lymph nodes of rectal tumors. Comparison of preoperative EUS findings with histopathologic TNM classification (UICC 1987) was possible in 12 patients. The depth of tumor invasion was correctly staged in 9/12 patients (75%), and lymph node staging was correctly predicted in 9/12 patients (75%). Our results indicate that flexible coloscopic ultrasonography is as accurate as rigid systems for staging of colorectal cancer. It will become a sensitive method for early diagnosis of local recurrence. The flexible endoscopes are well tolerated by patients and more proximal lesions which cannot be reached with the rigid instruments can also be examined.

Colonoscopy↗
PubMed1992

[Helicobacter pylori colonization of the gastric remnant following partial resection].

Colonization by Helicobacter pylori (HP) in 53 patients after remote gastric surgery and Roux-en-Y anastomosis was investigated using a rapid urease test (CU-Test) and histology (H&E and Giemsa stain). The pH-value of gastric juice was measured. HP infection of the gastric remnant was found in 56% of 43 patients after partial resection and in no case after total gastric resection. HP-positive and HP-negative patients were comparable in age, sex distribution, indication and technique of gastric operation (except for total gastrectomy with jejunal gastric replacement), intake of acid inhibiting drugs and antibiotics was well as in the presence or absence of a macroscopically visible pathology of the gastric mucosa. On the other hand, the two groups differed in their histological findings, pH-value of gastric juice and time interval since surgery. HP infection of gastric remnants is associated with significant glandular atrophy and an additional rise in gastric intraluminal pH compared with HP-negative patients. Both changes may involve an increased risk for gastric cancer. In this report on patients with Y-en-Roux operation there is no decrease in gastric HP-colonization with an increasing interval since the time of operation, but rather an increase. This phenomenon seems to depend on the absence of enterogastric reflux.

Anastomosis, Roux-en-Y↗
PubMed1992

[Endosonography: progress in the diagnosis of endocrine pancreatic tumors].

Diagnostic procedures for secreting endocrine pancreatic tumors comprise biochemical tests, CT scans, conventional abdominal sonography, angiography and occasionally MR imaging and isotope scans. Due to their small size, insulinomas and gastrinomas, the most common of these tumors, elude these diagnostic procedures. Preoperative sonography and CT scans were negative in over 60%, angiograms in 35% of the patients. The example of a patient with insulinoma demonstrates that in the future endosonography will offer itself as an accurate method with little risk.

Aged↗
PubMed1992

[Diagnostic problems in infectious colitis in the framework of an HIV infection].

Between 1988/89 1207 HIV-positive patients were registered at the Medical Policlinic of the University Hospital Zurich. In 57 of these patients colonoscopy or rectosigmoidoscopy was performed because of serious symptoms or symptoms refractory to therapy (diarrhea, bloody diarrhea, massive abdominal pain, weight loss). 24/57 (42%) had a negative colonoscopy and in 6/57 patients (10%) Kaposi's sarcoma was found. 14/57 (25%) had unspecific colitis. In 13/57 (23%) cases with colitis, one or multiple bacterial or viral agents were diagnosed: CMV (n = 5), herpes (n = 2), Mycobacterium avium-intracellulare (n = 3), different bacterial agents (n = 5), HIV (n = 1). One patient had a double and one a triple infection. Another had colitis with HIV as the only isolated pathogenic agent in the colon epithelium.

Adult↗
PubMed1992

[The endoscopic treatment of malignant biliary tract stenoses with endoprostheses].

In 65 patients (36 men, 29 women; mean age 74 [43-90] years) obstructive jaundice caused by malignant biliary stenosis was treated by endoscopic retrograde insertion of a 10 or 12 F synthetic endoprosthesis. The rate of complications of the endoscopic intervention was 5% (n = 3), 30-day mortality rate was 11% (n = 7) and method-related mortality was 8% (n = 5). Good drainage was achieved in 39 of 41 patients (95%) with the 12 F endoprosthesis, and in 15 of 21 patients with a 10 F one (71%) (P less than 0.001). Renewed jaundice due to prosthesis occlusion occurred in 31 patients an average of 103 (11-350) days after placement. Interval until occlusion correlated with the site of the stenosis and the length of the endoprosthesis. Jaundice recurred earlier in patients with long prostheses and proximal biliary stenosis than in those with a short prosthesis and distal stenosis. In 20 patients with renewed jaundice the endoprosthesis was replaced endoscopically. At that time 13 of the patients had a cholangitis. Occlusion of the new endoprosthesis was more common in patients with cholangitis (9 of 13) than those without (2 of 7; P less than 0.05). These findings indicate that endoscopic biliary tract drainage should be performed with as short a 12 F endoprosthesis as possible. In view of the potential need for early change of endoprosthesis the biochemical parameters of cholestasis should be regularly monitored.

Adult↗
PubMed1992

Intestinal Enterocytozoon bieneusi microsporidiosis in an HIV-infected patient: diagnosis by ileo-colonoscopic biopsies and long-term follow up.

A 39-year-old patient with acquired immunodeficiency syndrome was diagnosed as having intestinal Enterocytozoon bieneusi microsporidiosis after persistent watery diarrhea for 30 months and a 16-kg weight loss. Microsporidian parasites were found by light and electron microscopy in tissue specimens of the duodenum, jejunum, and terminal ileum, and by light microscopic examination of stool specimens. When duodenal tissue sections obtained 16 months previously were reviewed retrospectively, E. bieneusi was also found. Until now, diagnosis of intestinal microsporidiosis has been based on examination of bioptic specimens of the upper small intestine because the sensitivity of new coprodiagnostic techniques has not been determined. Our findings of ileal microsporidiosis show that examination of the terminal ileum and ileal biopsy collection in tandem with colonoscopy is indicated for patients infected with human immunodeficiency virus and suffering from unexplained chronic diarrhea. The long-term course of our patient demonstrates that E. bieneusi, although not necessarily life threatening, can cause protracted debilitating diarrhea and wasting in severely immunodeficient patients.

AIDS-Related Opportunistic Infections↗
PubMed1992

Pancreatic and hepatic abscesses: a late complication in 10 patients with chronic pancreatitis.

In this prospective long-term study of chronic pancreatitis (n = 336) over the last 3 decades, 10 patients with advanced calcific pancreatitis developed a sepsis associated with intra-abdominal abscesses (6 pancreatic, 4 hepatic). None of the known precipitating factors were present (e.g., no pancreatic necrosis or recent surgical/endoscopic interventions, no evidence of cholangitis). Nine of 10 patients had alcoholic chronic pancreatitis. Interestingly a pancreatojejunostomy in 9 of 10 patients had been performed up to 12 years previously. Cultures from abscess aspirates and/or blood were polymicrobial, mainly a mixed enteric flora in 8 patients. All patients recovered after an appropriate antibiotic therapy with or without drainage procedures. The pathogenesis of "spontaneous" abscess formation in advanced chronic pancreatitis and its relationship to pancreatojejunostomy remain to be established.

Abscess↗
PubMed1992

Fecal immunoreactive lipase: a new tubeless pancreatic function test.

Immunoreactive lipase (IRL) was measured in 368 stool samples from 231 individuals by means of a new enzyme-linked immunoabsorbent assay technic, to test its validity as an indicator of exocrine pancreatic insufficiency. Ninety-seven stool samples from 64 healthy volunteers showed a logarithmically normal distribution of IRL values and a median IRL concentration of 17 micrograms/g (range, 2.75-117.3 micrograms/g) with a statistically calculated lower normal limit of 4 micrograms/g. In 100 stool samples from patients with chronic pancreatitis and proven steatorrhea the median IRL concentration of 6 micrograms/g (range, 0.002-107 micrograms/g) was significantly lower than that of normal controls and of 52 stool samples from patients with chronic pancreatitis without steatorrhea (IRL, 40 micrograms/g; range, 0.55-302 micrograms/g), 45 stool samples from 23 patients with celiac disease (IRL, 96 micrograms/g; range, 6.05-563 micrograms/g), and 30 stool samples from 26 patients with chronic diarrhea (IRL, 57 micrograms/g; range, 4.2-573 micrograms/g). It is concluded that fecal IRL is a promising new enzyme test with low diagnostic sensitivity (34%) but excellent diagnostic specificity (98%) in chronic pancreatitis and for diagnostic study of chronic diarrheal disorders. In contrast to fecal chymotrypsin, the test results are unaffected by pancreatic enzyme replacement therapy.

Adult↗
PubMed1991

[Current treatment methods in cholelithiasis: the "Zürcher indications"].

The increasing number of therapeutic modalities and growing experience in the treatment of gallstones involve continuous changes in the indications and contraindication of each method. The advantages of the conservative, non-surgical and interventional procedures are that patients can become free of symptoms and stones without the use of general anaesthesia or surgery, however, there is the risk of recurrence. On the other hand, invasive surgical methods provide a definitive solution to the problem by removal of the focus, eliminating the risk of recurrent disease. To our opinion, it is important to offer as many therapeutic modalities possible to be selected as individual treatment by patients and physicians.

Chenodeoxycholic Acid↗
PubMed1991

[30-months extracorporeal electrohydraulic shock-wave lithotripsy of gallstones using the MPL-9000 at the Zurich University Hospital].

The effect of extracoporeal shockwave lithotripsy (ESWL) in combination with oral chemolitholysis on gallstone clearance was tested in a prospective study. We used a non-waterbath lithotripter, and the patients were treated without general anesthesia or intravenous analgesia. They solely received oral or subcutaneous premedication. Within the 30 months study-period 78 patients were selected according to the "Munich-criteriae". At the end of the study period 33 patients were free of stones, 20 patients had residual fragments, and 25 patients stopped the therapy prior to complete stone clearance because of compliance (n = 11), or methodological (n = 14) problems. This includes 3 patients in whom the ESWL had to be discontinued because of pain. No severe complications were seen with the exception of one attack of acute pancreatitis, from which the patient recovered. The rate of stone clearance was analyzed using the life-table calculation according to KAPLAN-MEIER to weigh the follow-up time of each patient. At 12 months it revealed a stonefree rate of 70% in patients who did not discontinue the treatment because of methodological problems. The advantage of ESWL is the possibility to treat gallstones without general anesthesia or intravenous analgesia. However, the patient-population must be highly selected, and there is the risk of recurrence.

Adult↗
PubMed1991

[Long-term therapy of Ménétrier disease using ranitidine and pirenzepine].

A 22-year-old woman with hypertrophic protein-losing gastropathy (Ménétrier's disease) is described. During treatment with ranitidine (Zantic) and pirenzepine (Gastrozepin) the gastric mucosa and protein loss were normalized within 4 years. Clinical and histological remission has now been observed for 5 and 3 years respectively. In a 57-year-old woman with hypertrophic gastropathy, 8 months' treatment with ranitidine and pirenzepine was associated with decrease in protein loss and improvement of the histological appearance of the gastric mucosa after one year. Long-term treatment of hypertrophic gastropathy with ranitidine and/or pirenzepine should, therefore, be considered in such cases instead of gastrectomy.

Adult↗
PubMed1991

[Prevalence and significance of ant-HCV-antibodies in ambulatory patients with raised transaminases].

From November 1989 to April 1990 we analyzed prospectively the prevalence of anti-hepatitis C virus antibodies and the possible mode of infection in 90 outpatients with repeatedly elevated alanine-aminotransferase levels. The clinical and serological course of these patients was evaluated after 1, 3 and 6 months. Initially, 24 patients (26.6%) were positive for anti-HCV antibodies, but subsequently only 14 of these patients (15.5%) were positive in the follow-up tests. 9 patients (10%) showed no antibodies against HCV in control evaluations and one patient dropped out of the investigation. The 9 patients with a negative result in the control tests had median relative anti-HCV concentrations of 2.0 (range 1.2-4.1) in contrast to 5.5 (range 1.6-256.5) in the 14 patients with a confirmed anti-HCV test (p less than 0.001). None of those 9 patients had received blood transfusions, 7 had consumed drugs intravenously and only 2 had no specific risk for HCV infection. The consistently anti-HCV positive patients had median alanine-aminotransferase levels between 115 and 200 U/l, whereas the levels in initially anti-HCV positive and subsequently negative patients ranged from 75-90 U/l. The initial prevalence of anti-HCV antibodies in 26.6% of our patients is related to the high rate of either false positive results or sero-conversion in 38% of this group. We recommend cautious interpretation of anti-HCV test results with relative anti-HCV concentrations less than or equal to 2 in equivocal clinical situations.

Adult↗
PubMed1990

[Ultrasonically-guided sclerosing of kidney and liver cysts using polidocanol].

First experiences are reported with percutaneous sclerosing therapy of cysts with polidocanol (aethoxysklerol 1%) using ultrasound for needle guidance. They cover two patients with symptomatic cysts of the liver and a patient with polyglobulinemia and an erythropoietin-producing renal cyst. These experiences are compared to previously reported ones.

Adult↗
PubMed1990

[Measurement of intestinal permeability in Crohn's disease, ulcerative colitis, sprue and idiopathic hyperamylasemia using polyethyleneglycol-400].

We investigated intestinal permeability in healthy adult volunteers, and in patients with Crohn's disease, ulcerative colitis, idiopathic sprue and idiopathic hyperamylasemia by oral administration of 10 g low molecular weight polyethylene glycol (PEG-400) and quantitation of its renal excretion over the subsequent 6 hours by high performance liquid chromatography (gel permeation HPLC). The mean amount of PEG-400 excreted during the first 6 hours by the 12 patients with Crohn's disease (3.1 +/- 0.3 g, mean +/- SE) and the 8 patients with ulcerative colitis (2.6 +/- 0.3 g) was not significantly different from the amount excreted by the 24 healthy volunteers (2.9 +/- 0.1 g). The 3 patients with idiopathic sprue excreted significantly less (1.4 +/- 0.3 g, p less than 0.05) and the 3 patients with idiopathic hyperamylasemia significantly more (4.0 +/- 0.4 g, p less than 0.05) than the healthy controls. In conclusion, no alteration of intestinal permeability could be demonstrated in patients with Crohn's disease or ulcerative colitis. However, intestinal permeability was decreased in patients with idiopathic sprue and increased in those with idiopathic hyperamylasemia.

Adult↗
PubMed1990

[The organization of gallstone lithotripsy using the MPL-9000 at the Zurich University Hospital, successes and failures. Initial results].

At Zurich fragmentation of gallstones is a joint venture between the Visceral Surgery Clinic, the Medical Clinic, Medical Policlinic, Radiodiagnostic Central Institute and Urologic Clinic. Lithotripsy is performed by a team from the Visceral Surgery Clinic with apparatus placed at their disposal by the Urologic Clinic. Indications for lithotripsy include symptomatic cholecystolithiasis, functioning gallbladder, and up to 3 gallstones of at least 10 mm and at most 30 mm diameter. Bile duct stones, acute cholecystitis, coagulopathy, pregnancy, aortic aneurysm and pacemakers are exclusion criteria. Patients spend two days in hospital, lithotripsy is performed without anesthesia, and outpatient follow-up is performed 1, 3, 6 and 12 months afterwards. Our experiences show that lithotripsy is more difficult and more treatments are needed if multiple gallstones are present. We had to perform cholecystectomy in 6 of a total 48 patients, mainly because of therapy resistant biliary pain due to stone fragments. The intraoperative findings did not correspond to the ultrasonic examination before lithotripsy in two of the patients who underwent cholecystectomy. Histologic examination of the six gallbladders in the surgical cases showed no abnormality. After an average treatment duration of 209 days, 9 of 48 patients are stone-free, 15 patients show improvement, in 14 patients no distinct reduction of fragments could yet be shown in recent follow-ups and 4 patients have not yet been reached for follow-up. Of the 230 patients examined lithotripsy was indicated only in 48 (21%) cases.

Adult↗