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Biomedical subjects

A Gangl

Publications and source records attributed to A Gangl.

At least 73 records · Page 4Linked to original sources
PubMed1997

No evidence of activated blood coagulation in Crohn's disease.

BACKGROUND: Thromboembolism seems to be a significant and serious complication in Crohn's disease (CD), and multifocal microvascular infarction of the intestinal mucosa may be an important effector mechanism in the pathogenesis of CD. Therefore, it has been hypothesized that an increased activation of the blood coagulation system may favour thromboembolic complications. OBJECTIVES: To assess the activity of blood coagulation as a potential index of thromboembolic risk in CD using thrombin-antithrombin III complex (TAT). DESIGN: Prospective evaluation of TAT. SETTING: Out-patients at the gastroenterological department of a university hospital. PATIENTS: Eighty patients with CD, 47 with inactive (Crohn's disease activity index (CDAI) < 150) and 33 with active disease, and 80 healthy controls were investigated in this study. METHODS: TAT and fibrinogen were used as parameters of blood coagulation. C-reactive protein and orosomucoid were used as serum inflammatory parameters. RESULTS: Fibrinogen was significantly higher in patients with active CD (median 535 mg/dl; interquartile range 402-620 mg/dl) than in patients with inactive CD (357 mg/dl; 300-467 mg/dl) or controls (268 mg/dl; 231-299 mg/dl). Fibrinogen correlated with CDAI, C-reactive protein and orosomucoid. TAT did not show any difference between patients with active CD (3.2 ng/ml; 2.5-4.6 ng/ml), inactive CD (3.0 ng/ml; 2.4-3.9 ng/ml) and controls (3.1 ng/ml; 2.3-3.6 ng/ml). Correspondingly, TAT correlated neither with serum inflammatory parameters and CDAI nor with fibrinogen. CONCLUSION: We could not find evidence of activation of the blood coagulation system as determined by TAT plasma levels in CD, not even in patients with active disease. TAT is not, therefore, a potential index of thromboembolic risk in CD and of microvascular infarction as an effector mechanism in the pathogenesis of CD.

Adult↗
PubMed1997

The distal colon provides reserve storage capacity during colonic fluid overload.

BACKGROUND: In addition to its absorptive function the capacity of the colon to retain fluid might be relevant in compensating for increased fluid loads and prevention of diarrhoea. The distal colon is considered to be mainly a conduit without extensive storage function. AIMS: To evaluate colonic volume capacity in a model of pure osmotic diarrhoea. METHODS: A non-absorbable, iso-osmotic solution (OS) containing polyethylene glycol (500 ml) was infused into the caecum of nine healthy volunteers; the control group (n = 5) received an equal amount of an easily absorbable electrolyte solution (ES). Fluids were radiolabelled with technetium-99m and gamma camera images were obtained for 48 hours. Counts in the proximal and distal colon were measured and regional and overall colonic transit and stool output were quantified. RESULTS: After OS, in contrast to ES, faecal output was increased significantly (p < 0.05), but colonic transit after OS was not different from transit after ES (p > 0.05). This indicates storage of OS in the colon: after OS infusion, counts in the proximal colon decreased linearly while the distal colon stored approximately 30% of radioactivity for the whole 48 hour study period. After OS, stool output correlated with distal (p < 0.01), but not with proximal (p > 0.05), colonic transit. In contrast, after ES, stool output was determined by proximal colonic transit (p < 0.05) but not by transit through the distal colon (p > 0.05). CONCLUSION: The distal colon retains non-absorbable fluid volumes extensively. In our model transit through the distal colon--but not the proximal colon--determined the time at which diarrhoea occurred.

Adult↗
PubMed1997

Forceps biopsy and brush cytology during endoscopic retrograde cholangiopancreatography for the diagnosis of biliary stenoses.

BACKGROUND: For evaluating pancreaticobiliary stenoses during endoscopic retrograde cholangiopancreatography (ERCP) tissue sampling techniques may be important. Brush cytology and forceps biopsy during ERCP are two potential, but so far only incompletely evaluated, tools for the diagnosis of malignant biliary or pancreatic stenoses. METHODS: Between 1992 and 1995 we acquired 133 cytologic and/or histologic samples from 119 patients who underwent ERCP because of biliary duct stenoses. Sixteen patients had to be excluded from the study due to insufficient follow-up information. After papillotomy, brush cytology was performed in 65 cases (63 patients), and forceps biopsy in 119 cases (106 patients under fluoroscopic guidance. Both methods were applied in combination 51 times (48 patients). The nature of the stenoses was confirmed by surgery, autopsy, or by the subsequent clinical course. RESULTS: The sensitivity was 46.7% for brush cytology and 64.9% for forceps biopsy. The combined application of both methods resulted in superior sensitivity (70.4%). Specificity was 100% for all methods. CONCLUSIONS: These numbers lead us to recommend a combined and more frequent application of brush cytology and forceps biopsy of bile duct stenoses to enhance the diagnostic yield whenever substantial influence on therapy can be expected.

Aged↗
PubMed1996

Dose increase augments response rate to interferon-alpha in chronic hepatitis C.

Approximately 50% of patients with chronic hepatitis C respond to treatment with interferon-alpha. The aim of this randomized controlled trial was to evaluate whether an increase in dose of interferon-alpha augments response rate. One hundred thirty-eight patients with newly diagnosed chronic hepatitis C received a three-month course of 3 MU IFN-alpha2b administered every two days. All patients were anti-HCV and HCV-RNA (PCR) positive. Prior to treatment, a liver biopsy was performed. Complete response was defined by normal serum ALT concentrations and disappearance of HCV-RNA. After three months, 60 nonresponders were randomized (stratified according to histology) either to continue 3 MU interferon-alpha2b every two days for another six months (group A, total dose: 410 MU) or to receive increasing doses of interferon-alpha2b (6 MU every two days for three months, followed by 10 MU every two days for three months) (group B, total dose: 870 MU). Serum ALT concentrations were measured monthly and HCV-RNA at three-month intervals. Liver biopsy was repeated six months after end of treatment. Pretreatment characteristics of the randomized patients were: group A: N = 30; male/female: 20/10; age: 54 +/- 10 years; CPH 9, CAH 8, cirrhosis 13; mean ALT 108 +/- 98 units/liter; group B: N = 30; male/female: 21/9; age: 57 +/- 15 years; CPH 10, CAH 9, cirrhosis 11; mean ALT 90 +/- 40 units/liter. At the end of treatment six patients in group B but none in group A became responders [P = 0.011 (Fisher's exact test), intent-to-treat analysis]. All six responders were noncirrhotics. High-dose interferon was not tolerated by six patients in group B. Noncompliance resulted in five dropouts in group A and one in group B. During the six-month follow-up, four of the six responders relapsed. A patient in group A with increased serum ALT concentration but negative HCV-RNA at the end of treatment became a full responder after six months. Of nonresponders to 3 MU interferon alpha2b every two days for three months, 20% responded to higher interferon doses, but none to continued standard dose. Prolonged treatment with interferon may be necessary to obtain a sustained response. However, treatment with higher-dose interferon was not tolerated in 20% of the patients.

Alanine Transaminase↗
PubMed1996

Effect of pluronic L-81 on intestinal lipoprotein secretion in the rat.

The hydrophobic nonionic detergent Pluronic L-81 has been shown to lower plasma very-low- and low-density lipoprotein cholesterol, thus preventing diet-induced atherogenesis. The major effect of this agent is a pronounced interference with intestinal lipid metabolism. For studying mesenteric lymph lipoproteins during detergent exposure, a combined micromorphological and biochemical assessment of mucosa and lymph during steady-state lipid absorption was performed. Pluronic L-81 was infused intraduodenally at a constant rate in combination with mixed micellar solutions or saline in mesenteric lymph fistula rats. Pluronic L-81 impairs transepithelial lipid flux during fat absorption, trapping export lipids within the enterocytes and leading to a cytosolic and endoplasmic reticulum lipid accumulation sparing the Golgi region. Pluronic L-81 markedly (P < 0.001) reduces mesenteric triglyceride, phospholipid, and total cholesterol secretion almost exclusively by a reduction of chylomicron formation. Chylomicron and very-low-density lipoprotein lipid composition was only insignificantly altered, except for somewhat higher phospholipid/triglyceride ratios. The chylomicron apoprotein pattern was almost unaffected. Thus, chylomicron formation decreased dramatically without major compositional alterations. The reduction of lipid and apoprotein secretion without particle augmentation is not in favour of a selective interference of Pluronic L-81 with intestinal apoprotein B-48 secretion.

Animals↗
PubMed1996

Symptomatic cerebral microangiopathy preceding initial manifestation of ulcerative colitis.

Focal white-matter lesions in the brain have been frequently found in patients with inflammatory bowel disease. These findings have been discussed as a novel extraintestinal manifestation of inflammatory bowel disease. In this case report we delineate the clinical relevance of such lesions by presenting a patient with ulcerative colitis and his associated neurological symptoms. The cerebral lesions were shown by magnetic resonance imaging, whereupon a successful treatment with corticosteroids was initiated.

Adult↗
PubMed1996

Relationship between the use of unconventional therapies and disease-related concerns: a study of patients with inflammatory bowel disease.

We studied the use of unconventional therapies of a well-defined population of 105 patients with inflammatory bowel disease (IBD; 72 with Crohn's disease and 33 with ulcerative colitis) who were attending a university out-patient clinic. The following items were used to compare those patients who used unconventional therapies with those who did not. We compared disease-related data, sociodemographic variables, patients' disease-related concerns, and their perceived level of information about IBD. Concerns were measured with the Rating Form of IBD Patient Concerns (RFIPC), inflammatory disease activity was assessed by physicians with the Crohn's disease activity index (CDAI) and the clinical activity index (CAI). Of the 97 (92.4%) patients who answered all questions, 33 (34%) reported using unconventional therapies in addition to conventional therapy. In their level of information about IBD and in their clinical and sociodemographic data, they were not different from the IBD patients who were not using alternative treatments. In their duration of disease, there was a significant difference (p < 0.0002). The longer the disease duration, the more often patients used unconventional therapies. The most important differences between users and nonusers were the following: patients who used unconventional therapies were more concerned about having surgery (p < 0.001), being treated as different (p < 0.04), and feeling out of control (p < 0.05). We conclude that there is a relationship between the use of unconventional therapies and some disease-related concerns, which should be considered in clinical practice. This may help these patients avoid using unproven and expensive alternative therapies.

Adult↗
PubMed1996

Two cases of fractured esophageal nitinol stents.

We report here on two cases of fractured nitinol stents in the esophagus. In case 1, the correctly inserted stent broke spontaneously shortly after insertion. In a second case, a nitinol stent broke after laser application due to tumor ingrowth with massive bleeding. In both cases, a second stent was implanted in order to reestablish food passage. The fracture of the stent in case 1 seemed to be caused by defective material, whilst in case 2 the stent broke because of thermal overstrain during laser application. The use of electrocoagulation or laser in the stent area should therefore be avoided; argon plasma coagulation may offer an effective alternative in treating tumor ingrowth. As there was a risk from piercing broken filaments with the second stent, covering a fracture using stents with tight walls or plastic tubes seems to be a more effective approach than the inserting an uncovered stent type.

Aged↗
PubMed1996

Changes in blood rheology caused by Crohn's disease.

BACKGROUND: Patients with Crohn's disease (CD) are at increased risk for thromboembolism, and multifocal microvascular infarction has even been suggested as a pathogenetic mechanism in CD. Abnormalities in blood rheology may contribute to the thromboembolism. OBJECTIVES: To assess blood rheology in CD patients. DESIGN: Prospective evaluation of rheological parameters. SETTING: Out-patients at the gastroenterological department of a university hospital. PATIENTS: Thirty-seven patients with inactive CD (Crohn's disease activity index (CDAI) < 150), 31 patients with active CD (CDAI > 150), and 39 control subjects with no CD were included in the study. METHODS: C-reactive protein and orosomucoid were used as serum inflammatory parameters. Fibrinogen, red cell aggregation (low shear, 3/s) and plasma viscosity were used as rheological parameters. RESULTS: Fibrinogen (active CD: median 530 mg/dl (interquartile range 410-630); inactive CD: 377 (316-499); and controls: 246 (220-280)), red cell aggregation (active CD: 9.97 arb. units (8.58-11.77); inactive CD: 9.03 (7.25-10.37); controls: 7.58 (7-8.52)); and plasma viscosity (active CD: 1.82 mPa.s (1.68-1.95); inactive CD: 1.72 (1.65-1.82), controls: 1.61 (1.58-1.64)) were all significantly higher in patients with active and inactive CD than they were in controls. Additionally, fibrinogen was significantly higher in patients with active CD than it was in patients with inactive CD. The rheological parameters correlated with serum inflammatory parameters. CONCLUSION: Changes in blood rheology seem to be associated with inflammatory activity in patients with CD. These changes may be involved in the development of thromboembolism and the pathogenesis of mucosal inflammation, especially in patients with high inflammatory activity.

Adult↗
PubMed1995

Prospective evaluation of interferon-alpha in treatment of chronic active Crohn's disease.

Several case reports suggested good effects of interferon-alpha in patients with Crohn's disease. In addition, a decreased production of interferon-alpha in Crohn's disease has been shown in vitro. Treatment with interferon-alpha may activate intestinal natural killer cells and down-regulate the overproduction of inflammatory cytokines like interleukin-6 in Crohn's disease. To evaluate the clinical efficacy of interferon-alpha, we treated 12 patients with a chronic active course of Crohn's disease with recombinant human interferon-alpha prospectively for 24 weeks. Prednisolone was continuously tapered and discontinued at week 12. The end point of the study was the prevention of worsening of clinical symptoms defined with the Crohn's disease activity index and was monitored by acute-phase proteins, interleukin-6 serum concentrations, and endoscopy. The biochemical activity of interferon-alpha was measured by 2',5'-oligo adenylate serum levels. The end point of the study was reached in four patients (33%). In these patients the final Crohn's disease activity index was above 150, which means that they did not achieve clinical remission. All other patients (66%) did not respond to interferon-alpha and had to be withdrawn prematurely. Interferon-alpha did not show any beneficial effect on interleukin-6 or acute-phase protein concentrations and on endoscopic activity. The 2',5'-oligo adenylate levels continuously increased during interferon therapy. Considerable side effects were noted. These results fail to demonstrate a therapeutic role of interferon-alpha in chronic active Crohn's disease.

Adenine Nucleotides↗
PubMed1995

Diagnosis of Wilson's disease in an asymptomatic sibling by DNA linkage analysis.

The molecular genetic diagnosis of Wilson's disease in the 5-year-old sister of a patient with Wilson's disease is reported. The girl was clinically free of disease and had no conventional biochemical markers of Wilson's disease (i.e., normal ceruloplasmin, normal copper in the serum, normal 24-hour urinary copper excretion). Diagnosis with restriction fragment length polymorphisms and a nonradioactive polymerase chain reaction-based analysis with microsatellite markers showed her to be homozygous for the disease-associated markers. A liver biopsy was performed, and a 20-fold increased liver copper content confirmed the diagnosis. The child was treated with chelation therapy with D-penicillamine. The report of this study clearly shows the advantage of DNA linkage analysis (especially polymerase chain reaction) over conventional laboratory methods for presymptomatic diagnosis of Wilson's disease before irreparable liver and neurological damage occurs. The only limitation of this DNA-based diagnosis is the fact that it is only applicable in siblings of an index patient whose diagnosis was made by phenotypic criteria.

Adult↗
PubMed1995

Dental and periodontal disease in patients with cirrhosis--role of etiology of liver disease.

BACKGROUND/AIMS: Bacterial infections are frequent complications in patients with cirrhosis, especially in alcoholics. A potential source of infection may be dental foci. The aim of the study was to assess the role of cirrhosis and chronic alcoholism in the development of dental or periodontal disease. METHODS: Dental and periodontal examinations were performed prospectively in 97 patients with cirrhosis (alcoholic: 64, nonalcoholic: 33), in 68 alcoholics without cirrhosis and in 71 healthy subjects (subdivided into age groups: 21-30, 31-40, 41-50, and 51-60 years). RESULTS: Measures of oral hygiene (p < 0.01), dental care (p < 0.001), and periodontal parameters were worse and the number of teeth requiring treatment (p < 0.001) was higher in alcoholics with or without cirrhosis than in healthy subjects and nonalcoholic patients with cirrhosis. Alcoholics had a lower total number of teeth than patients without alcohol abuse and healthy controls (p < 0.05). The dental and periodontal status of patients with nonalcoholic cirrhosis did not differ from the control group. The severity and duration of liver disease had no influence on dental and peridontal disease. CONCLUSION: The presence of cirrhosis itself, therefore, is not a predisposing factor for dental and periodontal diseases. In alcoholics, these diseases appear to be caused primarily by bad oral hygiene and poor dental care.

Adult↗
PubMed1995

Disease-related worries and concerns: a study on out-patients with inflammatory bowel disease.

OBJECTIVE: To investigate the relationship between inflammatory bowel disease (IBD) patients' disease-related worries and concerns and their disease-related data, sociodemographic variables and perceived information level with respect to IBD. STUDY DESIGN: Prospective evaluation of disease-related concerns. SETTING: Out-patient IBD clinic of a university hospital. STUDY POPULATION: The study included 105 patients with IBD (72 with Crohn's disease and 33 with ulcerative colitis). MEASUREMENTS: Worries and concerns were measured using the standardized 25-item rating form of IBD patient concerns; actual disease activity was assessed by physicians using the Crohn's disease and clinical activity indices. Sociodemographic and other disease-related data were collected using a structured questionnaire. Patients' perceived information level was measured using a visual analogue scale. RESULTS: The issues of greatest concern to our patients were, in descending order of importance, having an ostomy bag (mean score +/- SD 63.6 +/- 38), the effects of medication (53.1 +/- 34), having surgery (51.6 +/- 36), the uncertain nature of the disease (46.5 +/- 32) and energy level (41.5 +/- 34). Patients with ulcerative colitis scored higher with respect to concern about loss of bowel control (P < 0.03). Disease-related worries and concerns correlated poorly with disease-related data (actual disease activity, severity of the course of IBD, diagnosis, disease duration or location, medication) but showed a significant negative correlation with patients' perceived information level about IBD (t = 0.2, P < 0.004). Lower information-level scores were associated with greater concerns. CONCLUSION: We conclude that the patients' information level about IBD and disease-related concerns have to be considered in clinical practice. Better information about IBD and psychosomatic counselling for patients who show high levels of concern may improve their quality of life and clinical care.

Adolescent↗
PubMed1995

Prevention of bone mineral loss in patients with Crohn's disease by long-term oral vitamin D supplementation.

OBJECTIVE: To determine whether long-term dietary supplementation with low doses of vitamin D helps to prevent bone loss and the development of osteoporosis or osteomalacia in out-patients with Crohn's disease. DESIGN: A randomized controlled study. SETTING: The out-patient clinic of a tertiary centre (university hospital). PATIENTS: Seventy-five out-patients (31 men and 44 women, aged 16-77 years) with Crohn's disease. INTERVENTIONS: All patients were randomly assigned to receive either an oral supplement of 1000 IU/day vitamin D for 1 year or no supplement. Bone mineral density, assessed in the distal part of the nondominant forearm using single photon absorptiometry, and serum levels of 25-hydroxyvitamin D, assessed using a competitive protein binding assay, were measured before and after the period of dietary supplementation. MAIN OUTCOME MEASURE: Relative change of bone mineral density. RESULTS: Serum levels of 25-hydroxyvitamin D increased in 57% of patients who received a supplement (compared with 37% of control patients). Bone mineral density decreased significantly in control patients [median -7%, interquartile range -12.6-(+0.4%)] but not in patients who received a supplement [median -0.2%, interquartile range -3.8-(+14%); P < 0.005]. Increases in bone mineral density were especially prevalent among patients who received the supplement and had normal serum levels of 25-hydroxyvitamin D (68%), whereas increases occurred in only 18% of patients with low serum levels of 25-hydroxyvitamin D (P = 0.008). Patients without an intestinal resection and receiving the vitamin D supplement had a marginally greater increase in bone mineral content than patients who had undergone a resection (P = 0.05). CONCLUSION: Long-term oral vitamin D supplementation seems to be an efficient means of preventing bone loss in patients with Crohn's disease and could be recommended, especially for patients at high risk of osteoporosis.

Absorptiometry, Photon↗