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Biomedical subjects

R Münch

Publications and source records attributed to R Münch.

At least 19 recordsLinked to original sources
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

[Prevention and surveillance of risk groups for colorectal carcinoma].

Surgical eradication of premalignant or potentially malignant lesions decrease the overall mortality rate for colorectal cancer from about 60% to 20% or less. Therefore, increased efforts need to be focused on early detection of asymptomatic stages of the disease. This article serves as a guideline for early detection of colorectal cancer and its precursors in patients at high risk.

Adenomatous Polyposis Coli↗
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

[Suspicion of anemia-inducing gastrointestinal bleeding: how far should assessment go?].

In a retrospective evaluation of 362 patients with iron deficiency anemia or visible blood loss from the gastrointestinal tract (hematemesis or melena), the bleeding source could not be found in 18% of cases (66 patients) even by extensive gastrointestinal endoscopy. In these cases neither small bowel studies nor repetitive endoscopic examinations increased the diagnostic yield. On the other hand, gastrointestinal endoscopy resulted in the diagnosis of gastrointestinal malignancy in 25 cases, most of whom could be resected curatively. The fecal occult-blood test was positive in 85% of the cancer patients, indicating the usefulness of this test as a diagnostic tool. If the bleeding source remains obscure in spite of extensive gastrointestinal endoscopy and gastrointestinal malignancy has been excluded, further investigation by small bowel studies or angiography is unrewarding and only indicated in selected cases.

Adult↗
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

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↗
PubMed1991

[Primary sclerosing cholangitis].

In a 40-year-old patient unexplained recurrent attacks of epigastric colic with transient cholestatic icterus occurred over a 9-year period. When the patient was again hospitalised because of progressive pain-free icterus associated with mild pruritus (alkaline phosphatase 900 U/l, direct bilirubin 305 mumol/l, GOT 187 U/l, GPT 103 U/l) sonography revealed liver enlargement to 17 cm, extended intrahepatic bile ducts and an echodense area of about 1 cm size in the region of the bifurcation of the common hepatic duct. Fine-needle puncture did not yield clear cytological findings. Endoscopic retrograde cholangiopancreatography pointed to sclerosing cholangitis. This diagnosis was confirmed by liver punch biopsy. Since the patient did not agree to a liver transplantation, he was treated with 450 mg ursodeoxycholic acid twice daily, resulting in marked reduction of the liver parameters until severe cholangiosepsis and acute renal failure occurred about 4 months later. The septic condition and its complications could not be managed despite thorough intensive-care measures so that a liver transplant had to be performed after all. Histology of the explantate revealed a cholangiocarcinoma in the region of the bifurcation of the common hepatic duct. At first the patient's condition improved markedly but one and half months later the transplant was rejected and the patient died.

Adenoma, Bile Duct↗
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

[Non-surgical therapy of gall stones].

Currently, a remarkable selection of alternatives to cholecystectomy is available. These new techniques undoubtedly will expand management without laparotomy of both common bile duct and gallbladder disease. Endoscopic sphincterotomy with stone removal has gained wide acceptance for retained or recurrent common bile duct stones. Chenodiol and Ursodiol are save and effective agents, either alone or in combination for the medical dissolution of gallbladder stones in selected patients. Infusion of methyl tert-butyl ether, which is liquid at body temperature, via a catheter into the gallbladder allows rapid dissolution of cholesterol gallstones. Extracorporal shock-wave lithotripsy (ESWL), which has already revolutionized therapy of urolithiasis, has been introduced as another promising nonoperative treatment for selected patients with gallbladder stones. Again ESWL has been reported useful in patients with bile duct stones not amenable to manipulative, endoscopic measures. The choice of appropriate therapy for individual patients depends on different factors, i.e. medical condition of the patient, chemical composition of the stones and availability of lithotriptors, respectively. The appropriate therapy will depend on these factors and the patients preference.

Bile Acids and Salts↗
PubMed1991

[New methods for assessing gastrointestinal blood flow].

Non-invasive tests for evaluation of intestinal blood flow include duplex scanning and laser Doppler flowmetry. Duplex scanning combines ultrasonic imaging with a pulsed doppler unit. By analysing flow curves and changes in Doppler frequency spectra blood flow in the mesenteric arteries and the coeliac trunc can be analysed. Laser Doppler flowmetry is another promising new technique. The fiber optic guides, which conduct laser light to the tissue and carry back-scattered light to a photodetector, can be placed endoscopically on the mucosal surface of the bowel, thus allowing examination of the intestinal mucosal microcirculation.

Blood Flow Velocity↗
PubMed1990

[Acute segmental hemorrhagic penicillin-associated colitis].

Four days after beginning a perioperative antibiotic prophylaxis with amoxicillin and clavulanic acid a 33-year-old patient developed an acute haemorrhagic diarrhoea with cramp-like lower abdominal pain. Coloscopy revealed diffuse mucosal oedema with map-like ulcerations, increased susceptibility to trauma and submucous haemorrhages extending from the middle of the ascending to the middle of the descending colon. Granulocytic inflammation with cryptal atrophy was seen histologically. Stool cultures, including tests for Clostridium difficile toxin, were normal. All symptoms disappeared within three days of discontinuing the medication. Coloscopy after one week revealed marked improvement, after three months nothing abnormal. Acute segmental haemorrhagic penicillin-associated colitis is rare and must be distinguished from antibiotic-associated pseudomembranous colitis.

Abdominal Pain↗
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↗
PubMed1989

Comparison of three colon cleansing methods: evaluation of a randomized clinical trial with 300 ambulatory patients.

In a prospective randomized clinical trial, three colon cleansing methods for colonoscopy were compared with regard to a) side effects, b) patient acceptance, c) residual liquid and stool during colonoscopy, and d) quality of the examination. The patients were randomly assigned to one of the following three groups for colon preparation: Group 1 (n = 100) 4 liters of Golytely, group 2 (n = 102) 2 liters of Golytely combined with Cascara-Salax, and group 3 (n = 98) X-Prep (a Senna preparation) combined with an enema. X-Prep (group 3) caused significantly more abdominal cramps than 4 liters of Golytely (group 1) or 2 liters of Golytely with Cascara-Salax (group 2) (p less than 0.001). Vomiting was most frequent in group 1 (p less than 0.05 vs. group 3). The patients therefore preferred X-Prep to 4 liters of Golytely (p less than 0.01). The cleanest colon was obtained with 4 liters of Golytely, while 2 liters of Golytely with Cascara-Salax was least efficacious. The quality of the examination was equal in groups 1 and 3, and clearly better than in group 2 (p less than 0.01). We thus conclude that while 4 liters of Golytely and X-Prep plus enema have equivalent cleansing efficacy for colonoscopy, patients judged X-Prep to be less unpleasant.

Adolescent↗
PubMed1988

[Rational diagnosis of pancreatic diseases].

Diagnosis and differential diagnosis of pancreatic disease are frequently difficult, and patience and diagnostic skill are required of the physician. Diagnosis is based on clinical findings, morphological imaging procedures (ultrasound, computer tomography, ERCP) and changes in biochemical parameters in serum, urine duodenal secretion and feces. History and clinical findings are starting-points for further chemical and technical investigations. The various diagnostic procedures and their importance in the diagnosis of acute and chronic pancreatitis and of pancreatic carcinoma are discussed and evaluated.

Amylases↗
PubMed1988

[Extracorporeal shock wave lithotripsy (ESWL) in the treatment of bile duct stones].

Ten patients with common bile duct stones not removable by endoscopic measures after sphincterotomy were treated by extracorporeally generated shock waves. In 9 patients stones up to 30 mm in diameter were disintegrated. Two patients became free of stone fragments spontaneously within one day and in 7 patients the stone fragments were extracted endoscopically. No complications occurred. Extracorporal shock wave treatment represents a promising alternative to surgery in cases where common bile duct stones cannot be extracted endoscopically.

Adult↗