In 25 patients with progressive systemic sclerosis esophageal involvement was studied prospectively by analysing subjective symptoms and radiological and manometric criteria. In all patients abnormal motility could be demonstrated by X-ray and/or manometry: radiologically in 18 (72%), manometrically in 22 (88%) cases. Dysphagia was present only in 11 patients (44%). Six patients (24%) had no subjective symptoms in spite of severe objective esophageal abnormalities. Therefore, the absence of esophageal symptoms does not exclude advanced affliction of the esophagus. To determine the pathogenesis of esophageal dysfunction the effects of 3.5 microgram/kg carbachol and of 0.6 microgram/kg pentagastrin i.m. on the lower esophageal sphincter pressure (LESP), on the amplitude and on the duration of peristaltic esophageal contractions were studied at random in 12 of the patients and 12 normal controls. The results suggest a primary myogenic genesis of the motor abnormalities by atrophy and sclerosis of esophageal smooth muscle.
ZusammenfassungMultiresistente Tuberkulosen (MDR-TB) machen zwar einen nur geringen Anteil an der Gesamtzahl aller TB-Erkrankungen aus, durch die erforderliche komplexe Medikation mit potenziell schweren und lebensbedrohlichen Nebenwirkungen, Langzeitfolgen und ungünstigem Verlauf ist jedoch besondere Sorgfalt geboten. Wir berichten über eine 30-jährige Altenpflegerin mit chronischem Husten und angeborenem Alpha-1-Antitrypsin-Mangel (AATM), die an einer MDR-TB erkrankte und erhebliche Medikamenten-Nebenwirkungen erlitt.
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