The fine structure of colonic submucosal nerves in patients with chronic laxative abuse

Ultrastructural studies of colonic biopsies from patients with a history of long-term laxative abuse, predominantly with stimulant cathartics such as anthraquinone derivatives or bisacodyl, indicated that submucosal nerve fibres may be severely damaged in relation to dosage and time of addiction. The main pathological features found were ballooning of axons, reduction of nerve-specific cell organelles, lysosomal activity, and increase of melanin-loaded macrophages. Morphometric analysis revealed a significant increase (P less than 0.01) in axonal area, with simultaneous reduction of neurotubules. Nerve endings showed a significant decrease of neurosecretory granules when compared with those of normals. It is concluded that these alterations might be a morphological correlation to the clinically evident disturbance of gut motility in patients with chronic laxative abuse, because the intact enteric plexus system is a prerequisite for coordination of normal gut peristalsis.

Endoscopy of the biliary tract and the pancreas in children

ERCP is a useful method in adults for diagnosing bilio-pancreatic disorders. The application of this technique in children is limited until now according to the rare case reports in the literature. Our experience with this procedure, based on the examination of six children and 12 youths, shows that ERCP can be employed with great benefit, when taking into account the correct indication. ERCP is mainly applied to clarify obstructive jaundice, especially when anomalies of the bile duct system are suspected, and to discover a reason for relapsing pancreatitis where other procedures fail. Blunt abdominal traumata with upper GI bleeding may well be another reason. In general our first reported data are encouraging.

Ultrastructural changes of colonic mucosa in patients with chronic laxative misuse

Laxatives are amongst the most widely used and misused drugs. Especially the "irritant chathartics" are associated with severe cell poisoning. Electrolyte disturbances like potassium deficiency may occur as a result of enhanced potassium secretion into the colon. Ultrastructural studies of patients with chronic laxative misuse demonstrate, that this functional disorder is correlated with damage of the colonic epithelial cells consisting in stereotyped lesions as changes in microvilli, reduction and structural defects of cytoplasmic organelles and an increase of lysosomes and dense bodies. The lesions have a focal distribution and may explain the potassium loss from a morphological point of view.

Bacteriological efficiency of a standardized cleansing and disinfection technique for duodenoscopes

Adequate cleansing and disinfection of the endoscopes is desirable to prevent bacteriaemia and septicemia following gastrointestinal endoscopy, especially endoscopic retrograde cholangiopancreatography and duodenoscopic sphincterotomy. A practical method, proved in our department over a period of 12 months, is described. As the result of this standardized cleansing and disinfection technique using the aldehyde derivative Gigasept (succine dialdehyde and 2,5-dimethoxytetrahydrofuran) in a 10% concentration as chemical disinfectant, sterile cultures from the biopsy channel were obtained in 75% of tested instruments. The remaining fiberscopes exhibited only a few bacteria left, resulting in a sufficient success of disinfection according to hygienic standards.

Synopsis of endoscopic and related morphological findings in Whipple's disease

Whipple's disease is characterized by typical endoscopic lesions in the duodenal wall. They consist of a thickened and inflamed mucosa with yellowish-white spots, in part solitary, in part confluent. Petechial hemorrhages mark the high mucosal vulnerability. Clumsy and dilated villi with ectatic lymph vessels and PAS-positive macrophages are the corresponding histologic feature. In the ultrastructure numerous rod-shaped micro-organisms are evident. Following treatment with tetracycline the mucosal surface normalizes rapidly, the bacteria disappear, whereas other histologic changes remain over a longer period of time.

[Collagenous sprue (author's transl)]

Malabsorption is the main functional abnormality in gluten-sensitive enteropathy or endemic sprue. The malabsorption is related to villous flattening, which is the main histological feature. The diagnosis is also based on a good response to gluten-free diet. On the other hand, collagenous sprue is not an independent disease but a variant of gluten-sensitive enteropathy, as documented in three personal cases. Its course is characterised by a malabsorption syndrome unresponsive to gluten withdrawal, with massive subepithelial collagen formation. The pathogenesis remains unknown, prognosis poor, compared to the endemic gluten-sensitive enteropathy.

[Malignant tumors of the gastrointestinal tract and their early diagnosis]

Malignant tumors of the gastrointestinal tract belong to the main causes of death. The overall 5-years-survival rate is low. Systematic investigations of early gastric cancer and polyps of the colon revealed that asymptomatic carcinomas are detectable and have a definite chance for curative treatment. Mass survey of the population by means of endoscopic or radiological procedures are impossible due to high financial expense. Therefore, other diagnostic tools have to be inaugurated. Besides a maximum diagnostic effort in each individual with gastrointestinal complaints, high risk groups with a significantly increased incidence rate of malignant tumor development have been established. Thorough observation of those persons is necessary as are simple, inexpensive and practicable methods for screening examinations.

[Acute pancreatitis: diagnosis and therapy in general practice]

Acute pancreatitis is a frequently serious abdominal condition. The cause remains unknown. Biliary tract diseases as well as alcohol are the most important etiological factors. Diagnostic measures, of help in the emergency situation, differential diagnosis and therapeutic procedures, which can be initiated in general practice, are discussed.

Further electron microscopic evidence of virus-like particles in Crohn's disease

Electron microscopic investigation of patients with Crohn's disease of the colon revealed virus-like particles mainly in epithelial cells and macrophages near ulcerative lesions. The particles had a double membrane, a sometimes electron-opaque central core, were round to oval in shape with the size, ranging from 30-70 nm in diameter. They commonly were located in clusters, but also singly in the cell cytoplasm, not intranuclear. These findings are in good agreement with recent culture studies in Crohn's disease.

[Diagnosis of cancer and early detection. Clinical methods]

The etiology of cancer--as one of the most important causes of death--remains unknown. Therapy seems promising only in its early stages and if the exact diagnosis of carcinoma is possible. Diagnostic procedures today have gained a high standard demonstrated on malignancies of the gastrointestinal tract and the lung. The whole spectrum of methods can be employed only after having selected the patients according to "high risk" groups and methods of early cancer detection respectively. Effective and pragmatic progress has been made but is not fully utilized yet. Future trends in the diagnostic development are discussed.

[Syndrome of the unilateral or partially "hyperlucent lung"]

The paper presents the picture of the unilateral or partial "hyperlucent lung" syndrome. The most common causes of this anomaly are described according to pathological and anatomical criteria. The difficult diagnosis of its X-ray-appearance is discussed. The value of differential diagnostic criteria is demonstrated in suitable cases. Differentiation from the pseudo-syndrome is also outlined. Various methods of radiological examination are described and evaluated.

[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.