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Biomedical subjects

U von Gaisberg

Publications and source records attributed to U von Gaisberg.

At least 19 recordsLinked to original sources
PubMed2000

[Fascioliasis after a stay in Turkey].

HISTORY AND ADMISSION FINDINGS: A 42-year-old man who had just returned from a trip to Turkey presented with recurrent right upper abdominal pain and bouts of fever. Physical examination was unremarkable except for an enlarged liver on palpation. INVESTIGATIONS: There was a slight increase in tests indicating cholestasis and in transminases. There was a marked eosinophilia of 57% in the differential blood count. Ultrasound examination indicated an inhomogeneous and enlarged right lobe of the liver with a 2.5 x 3 cm poorly circumscribed echo-poor space-occupying lesion. Computed tomography demonstrated multiple hypodense foci. Needle biopsy revealed a histological picture suggesting parasite infection. DIAGNOSIS, TREATMENT AND COURSE: The patient was referred to a department of tropical medicine. His symptoms progressed and the antibody titre for Fasciola hepatica was increased, but no Fasciola eggs were found in the stool. Administration of triclabendazole resulted in lasting regression of the symptoms and a dramatic fall in eosinophilia to ultimately 6%. CONCLUSION: In eosinophilia of undetermined origin parasitic infection should be considered and any previous visit to countries with endemic parasitic disease taken into account.

Adult↗
PubMed1997

[Primary pancreatic lymphoma. A rare cause of pain-free icterus].

HISTORY AND FINDINGS: A 54-year-old man was admitted because of increasing pain-free jaundice during the preceding two weeks. There was no resistance on palpation of the abdomen. The liver was palpable and of normal consistency, two finger-breadths below the right costal margin. Neither spleen nor lymph nodes were palpable. INVESTIGATIONS: Total bilirubin was 7.9 mg/dl, alkaline phosphatase 467 U/l, gamma-GT 850 U/l. WBC and differential counts were normal. The tumour marker CA 19-9 was raised to 117 U/l. Ultrasonography revealed dilatation of the intra- and extrahepatic bile ducts and a 3 cm echo-poor tumour in the head of the pancreas. Colour Doppler sonography showed both portal and splenic veins to be patent. Endoscopic retrograde cholangiopancreatography demonstrated a mild stenosis of the main pancreatic duct at the transition between the head and body of the pancreas, and a filiform stenosis of the choledochal duct. CT showed an nonhomogeneous head of the pancreas. As the suspected malignant tumour of the head of the pancreas seemed resectable no preoperative fine-needle biopsy was performed. TREATMENT AND COURSE: Whipple's operation (partial duodenopancreatectomy) was performed, but a small tumour infiltration in the portal vein had to be left. The resected specimen surprisingly showed a 2.5 cm centroblastic-centrocytic lymphoma which had infiltrated the head of the pancreas. Postoperative imaging showed para-aortic lymph nodes in the abdomen, maximally 1 cm in diameter. Subsequent radiotherapy was without complication. CONCLUSION: Primary pancreatic non-Hodgkin lymphoma is a rare lesion with special therapeutic consequences. The difficult differential diagnosis from pancreatic carcinoma is usually possible only, in operable cases, from the resected specimen. Every inoperable pancreatic tumour should be biopsied in case it is a malignant lymphoma.

Diagnosis, Differential↗
PubMed1996

-Severe hemobilia after percutaneous transhepatic biliary drainage. Successful treatment by arterial catheter embolization-.

We report on an 44-year-old man with Billroth-I-reoperation and transformation into Roux-Y-anastomosis, which was performed because of ulcer-relapse. The postoperative course was complicated by obstructive jaundice and cholangitis. Ultrasound and computed tomography could not clarify the cause. The subsequently performed percutaneous transhepatic cholangiography showed several small concrements in the biliary tract. For decompression of the dilated bile ducts percutaneous transhepatic biliary drainage was applied. Following that the patient developed recurrent episodes of hemobilia, which made the transfusion of altogether 17 units of blood necessary. Angiography clarified the bleeding source showing leakage of the right hepatic artery. By means of repeated selective transcatheter embolization definite hemostasis was achieved. Transcatheter embolotherapy is recommended as initial treatment to control serious iatrogenic hemobilia.

Adult↗
PubMed1995

[Ulcerative colitis as a primary manifestation of Churg-Strauss syndrome].

A 29-year-old woman with chronic bronchial asthma and inflammatory bowel disease, previously classified as idiopathic, was hospitalized because of bouts of fever and increasing dyspnoea and diarrhoea. Chest radiograph showed extensive bilateral pulmonary infiltrates. Thought to be suffering from bacterial pneumonia she was treated with broad-spectrum antibiotic, but without improvement even after a change of antibiotics. Numerous diagnostic tests failed to find any causative organism. Subsequently she was found to have peripheral eosinophilia and pericardial effusion associated with echocardiographic and electrocardiographic signs of myocarditis, which raised the suspicion of allergic granulomatous vasculitis (Churg-Strauss syndrome). The patient's acute illness contraindicated a lung biopsy, but the clinical picture left no doubt of the true diagnosis. Treatment with methylprednisolone (initially 250 mg, then 80 mg daily) rapidly improved the clinical, radiological and biochemical findings. But four months later, under maintenance treatment with 15 mg methylprednisolone daily, she experienced another bout of colitis and, a few days later, pulmonary recurrence of the Churg-Strauss syndrome, both clinically and radiologically. The dose of methylprednisolone was raised to 60 mg daily. The inflammatory bowel disease, endoscopically manifesting as ulcerative colitis, was most likely part of the systemic vasculitis.-This case demonstrates that colitis can be the primary manifestation of Churg-Strauss syndrome.

Adult↗
PubMed1995

Protein-losing enteropathy: first manifestation of sclerosing mesenteritis.

OBJECTIVE: To report the case of an unusual form of protein-losing enteropathy. PATIENT: A 54-year-old patient with hypoechoic tumours resembling lipomas in the mesentery. INTERVENTIONS: Following examination by ultrasound and computed tomography, the well-known intestinal and extra-intestinal forms of protein-losing enteropathy were excluded and a diagnostic laparotomy was performed. The whole mesentery was infiltrated by a large unresectable tumour. Histological examination showed that it was a sclerosing mesenteritis. MAIN OUTCOME MEASURES: Steroid therapy dramatically improved the protein-losing enteropathy. CONCLUSION: Pathogenically, the enteropathy may be interpreted as the result of disturbed lymphatic drainage caused by the sclerosed mesentery.

Adipose Tissue↗
PubMed1994

[Successful treatment of a life-threatening ileostomy diarrhea with the somatostatin analog octreotide].

A 72-year-old man with Crohn's disease for about 6 years was urgently hospitalized in hypovolaemic shock. On admission, serum creatinine concentration was 4.2 mg/dl, serum sodium 124 mmol/l, as a result of massive fluid and electrolyte loss via a loop ileostomy which had been placed 4 weeks previously because of a complicated perianal fistula. The basic aetiology of the diarrhoea probably lay in the previous resection of 30 cm of terminal ileum, other possible causes having been excluded. The ileostomy diarrhoea persisted despite the administration of loperamide, ranitidine, glucocorticoids, opium and pancreatic enzymes. Metronidazole, given in case the diarrhoea was due to a change in bacterial flora, also failed to achieve improvement. But when the somatostatin analogue octreotide was administered, the fluid loss via the ileostomy was quickly reduced so that both fluid and electrolyte infusions could be stopped. In subsequent months the initially required daily octreotide dosage of three times 100 micrograms could be reduced to once 50 micrograms subcutaneously. But it was not possible to stop this drug completely: it has now been continued and well tolerated for 2 years.

Aged↗
PubMed1994

[Somatostatin receptor scintigraphy in the primary diagnosis and follow-up care of gastrinoma].

Somatostatin receptor scintigraphy (SRS) was performed in 14 patients (five men, nine women; mean age 51.5 [20-71] years) with Zollinger-Ellison syndrome (ZES), a gastrinoma proven in 7 and suspected on clinical or biochemical grounds in 7. The results were compared with those obtained by other methods (ultrasound, computed tomography, angiography). All 12 known tumour manifestations were demonstrated by SRS in seven patients with histologically confirmed gastrinoma. In four patients previously non-localized tumour was revealed by SRS, while in seven other patients the procedure led to modification of the treatment (primary tumour resection: n = 3, resection of metastases: n = 2, percutaneous radiation or chemoembolization: one each). These results suggest the following indications for SRS: (1) staging or re-staging in histologically proven gastrinoma and (2) search for primary tumour in clinically and biochemically suspected ZES.

Adult↗
PubMed1993

[Value of ultrasound in diagnosis of bile duct tumors].

Resectability of biliary duct carcinomas depends mainly on the extension of the tumour mass. The value of ultrasonography (US) in demonstrating the tumour itself was compared with computed tomography (CT) and endoscopic retrograde cholangiography (ERCP)/percutaneous cholangiography (PTC) in 84 patients with biliary duct carcinoma (31 tumours of the hilar region, 50 distal tumours and 3 recurrent gallbladder carcinomas). The level of obstruction was correctly indicated by US in 96% of the cases. Correct visualisation by US of the tumour itself was possible in 68% of proximal tumours and 36% with distal tumours. CT accurately detected 74% of proximal and 48% of distal tumours. ERC/PTC identified intraductal tumour growth in all patients. The level of obstruction can be accurately identified by US and CT. The tumour itself cannot be visualised by imaging methods in 25-50% of the cases, depending on the localisation of the tumour.

Adult↗
PubMed1991

[Severe osteoporosis in a young female patient with Crohn's disease].

Increasing pain in the region of the lumbar vertebrae occurred in a 23-year-old woman known for the past 6 1/2 years to have Crohn's disease affecting the ileocolon. Radiology revealed marked osteopenia with collapse and deformation of the vertebral bodies. The only pointer to a bone disease was a markedly lowered serum level of 25-OH-vitamin D (less than 10 ng/ml). Biopsy from the ileal crest revealed pure osteoporosis without osteomalacia. Decisive pathogenetic factors were, in the main, glucocorticoid medication, malnutrition and the long duration of Crohn's disease. During treatment with monofluorophosphate, 152 g daily, in fixed combination with 600 mg calcium as well as calcitonin (initially 100 I.U. daily subcutaneously for two weeks, then 100 I.U. every other day s.c.) and vitamin D (3 x 1,000 I.U. daily by mouth) she became free of symptoms, and she has remained so for 9 months.

Adult↗
PubMed1991

[Acute lead poisoning].

A 36-year-old woman had for two months experienced progressively more marked diffuse abdominal pain, at times colicky, as well as nausea, vomiting and severe constipation. In addition, paraesthesias and motor weakness developed in the thighs. This was accompanied by a normochromic, normocytic anaemia with a haemoglobin concentration of 9.6 g/l. A short time later her mother and daughter also fell ill with similar symptoms. After symptomatic treatment had failed, secondary coproporphyria due to lead poisoning was found. The poisoning had resulted from criminal contamination of food, especially of cocoa powder, with lead acetate. Raised lead concentrations in serum were found in two other members of the family. In all the patients treatment was undertaken with sodium calcium edetate (20 mg/kg body-weight) in several three-day cycles, achieving a gradual fall in serum lead concentration. When the level had fallen to below 4 mumol/l the symptoms disappeared. Below 3 mumol/l porphyria was no longer demonstrable and the anaemia regressed. It is pointed out that, as lead poisoning may be fatal, it should be considered in the differential diagnosis of acute abdominal colic of unclear cause.

Acute Disease↗
PubMed1991

Frequency and spectrum of microorganisms isolated from biopsy specimens in chronic colitis.

In 109 patients with chronic diarrhea colonic biopsies were examined for the presence of specific microorganisms. A positive result was obtained in 48% of patients with ulcerative colitis, 50% with Crohn's disease, 21% with non-specific colitis and 36% with non-specific proctitis. Chlamydiae were found most frequently in all groups. Obligate enteropathogenic bacteria were isolated in only three cases of nonspecific colitis. Of the facultatively enteropathogenic organisms Klebsiella and Pseudomonas aeruginosa were isolated in 31% and 24%, respectively, of patients with ulcerative colitis, in 21% and 7% of patients with Crohn's disease, and in 10% and 6% of patients with non-specific colitis. Whereas chlamydial proctitis is a well-known disease, the results of this study point also to a possible pathogenic role of chlamydiae in the proximal colon. Facultatively enteropathogenic organisms causing acute diarrhea might have aetiologic relevance in some cases of chronic non-specific colitis.

Adolescent↗
PubMed1991

[Gastric carcinoid in chronic atrophic gastritis with hypergastrinemia].

A 51 year-old woman with vomitus, intermittent epigastric pain and heartburn had chronic sideropenic anemia. Gastroscopy revealed a subcardial, submucosal tumor. The tumor was removed totally by endoscopic polypectomy. Histologically it was identified as a carcinoid. The endocrinologic examination showed hypergastrinemia caused by chronic atrophic gastritis. The association of this gastric carcinoid with chronic atrophic gastritis type A, hypergastrinemia, hyperplasia of the gastrin-producing antral cells and micronodular hyperplasia of endocrine cells in the gastric fundus, confirms the hypothesis about the pathogenesis of these extremely rare gastric tumors.

Carcinoid Tumor↗
PubMed1990

[Spontaneous bacterial peritonitis: studies of the incidence and clinical and laboratory chemical parameters].

In a prospective study on 151 patients with cirrhosis of the liver we found 9 episodes of spontaneous bacterial peritonitis (SBP) in 8 patients (5.3% of the whole population or 18% of the ascitic patients). There was a clear difference in WBC-count, polymorphonuclear cell count, LDH and lactate in the ascitic fluid between SBP and controls. Clinical symptoms were discrete. 6 of 8 patients had an advanced form of cirrhosis belonging to Child-grade C. Half of patients died. The clinical situation of the 4 survivors improved after antibiotic treatment. Ascitic analysis of WBC and PMC-count in combination with LDH and lactate may reveal SBP as the reason of fever or clinical impairment in cirrhotics.

Ascitic Fluid↗