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Biomedical subjects

A Gangl

Publications and source records attributed to A Gangl.

At least 91 records · Page 5Linked to original sources
PubMed1994

Anemia in Crohn's disease. Importance of inadequate erythropoietin production and iron deficiency.

Intestinal blood loss as well as chronic inflammation are regarded as the most important mechanisms in the pathogenesis of anemia in Crohn's disease. In addition, cytokines such as interleukin-6 can suppress erythropoietin production. This study was performed to investigate the importance of iron status, inflammatory activity, and endogenous erythropoietin concentrations for the development of anemia in Crohn's disease. In 49 consecutive patients with Crohn's disease, hemoglobin, inflammatory activity (Crohn's disease activity index, C-reactive protein, alpha 1-acid glycoprotein), iron status (serum iron, transferrin, transferrin saturation, ferritin), and serum erythropoietin levels were studied. Anemic (Hb < 12.0 g/dl; N = 16) vs nonanemic patients (Hb > or = 12 g/dl; N = 33) showed reduced iron compartments (eg, ferritin 28.7 +/- 12.9 micrograms/liter vs 63.2 +/- 15.0 micrograms/liter, transferrin saturation 6.2 +/- 1.4% vs 11.5 +/- 1.3%, P < 0.01) but no differences in inflammatory activity. An inverse correlation between erythropoietin and hemoglobin concentrations was found (r = -0.62; P < 0.001), but the increase in erythropoietin levels was inadequate to the degree of anemia. There was no correlation between erythropoietin and interleukin-6 serum levels. Four of five anemic patients with hemoglobin below 10.5 g/dl and erythropoietin levels within the normal range were treated with parenteral iron (200 mg iron saccharate in 250 ml NaCl, weekly, intravenously). Two of them additionally received recombinant human erythropoietin (150 units/kg, 3x weekly, subcutaneously). After five weeks all patients had a marked increase in hemoglobin. However, the mean increase in erythropoietin-treated patients was 5.0 g/dl compared to 2.0 g/dl in the patients with iron therapy only.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Prophylactic endoscopic sclerotherapy of esophageal varices in liver cirrhosis--long-term follow-up and final results of a multicenter prospective controlled randomized trial in Vienna.

This study reports the final results of a randomized multicenter trial on prophylactic endoscopic sclerotherapy of large esophageal varices in patients with liver cirrhosis. Forty-one patients received prophylactic treatment and 41 patients were in the control group. A first analysis 3 years after beginning the study revealed no significant difference in the distribution of the bleeding free intervals between both groups, but indicated a tendency towards longer survival of patients with prophylactic sclerotherapy. The follow-up of patients was continued for an additional 3 years. After this time, 53.7% of patients in the sclerotherapy group and 39.1% of patients in the control group were still alive. During the study period of 6 years, variceal bleeding was observed in 31.7% of patients in the sclerotherapy group and in 36.6% of patients in the control group. Neither survival nor incidence of bleeding were statistically different between the two groups. The etiology of cirrhosis did not influence the survival.

Austria↗
PubMed1993

Wilson's disease: evidence of subgroups derived from clinical findings and brain lesions.

Using exploratory factor analysis, we prospectively investigated neuropsychiatric symptoms and structural brain lesions of 47 patients with proven Wilson's disease and identified three subgroups. The first subgroup clinically exhibited bradykinesia, rigidity, cognitive impairment, and an organic mood syndrome and by MRI showed a dilatation of the third ventricle. The second subgroup was characterized by ataxia, tremor, reduced functional capacity, and focal thalamic lesions. The third subgroup showed dyskinesia, dysarthria, an organic personality syndrome, and focal lesions in the putamen and in the pallidum.

Adolescent↗
PubMed1993

Primary leiomyosarcoma of the liver--a case report.

This is the 17th report on primary leiomyosarcoma of the liver in world literature. In 1980, a 69-year old white female patient was admitted with pain in the right upper abdomen and loss of weight of 12 kg. Increased blood sedimentation rate, elevated serum markers of the liver and ultrasound evolved a big tumor of the right liver without extrahepatic tumor nodules. Right hemihepatectomy was undertaken, the tumor was completely resected. After histologic examinations, leiomyosarcoma of the liver with 1 mitosis per 10 high power fields was diagnosed. 10 years later, the patient was readmitted with symptoms of pain, tiredness and night sweat. At this time, 3 intrahepatic and 1 retroperitoneal tumor nodules were detected. A sure-cut needle biopsy revealed the recurrent leiomyosarcoma with 4 mitoses per 10 high power fields. The survival period of 10+ years is the longest of all 17 patients with primary hepatic leiomyosarcoma reported so far. The low rate of mitoses per high power field and primary surgical resection are considered the reasons for the long survival period.

Aged↗
PubMed1993

[Effect of a lactose-free diet on irritable bowel syndrome].

Pathological lactose-H2-breath test is a frequent finding in patients with suspected irritable bowel syndrome. We found it in 33 of 55 patients (60%) with chronic non-specific abdominal symptoms. Follow-up examinations after 15 months (mean) exhibited that lactose-free diet relieved symptoms in 57% of these patients completely or nearly completely. In contrast, only 12% of the patients without lactose malabsorption showed equal amelioration on the various unspecific diets and medications. The lactose-free diet succeeded particularly in young patients and patients with a short history of complaints. Therefore, we recommend lactose-H2-breath test in all patients with suspected irritable bowel syndrome for optimizing therapy.

Adult↗
PubMed1992

Detailed evaluation of evoked potentials in Wilson's disease.

Detailed evoked potentials (EPs) were studied in 52 patients (28.7 +/- 11.9 years) with Wilson's disease (WD). Various peak latencies, interpeak latencies and amplitudes of somatosensory, auditory brain-stem and visual EPs were significantly abnormal in the group of 28 neurologically symptomatic patients as compared to controls. Interhemisphere latency and amplitude differences tended to be increased without reaching significance, indicating a symmetrical rather than focal subclinical brain involvement. Selected conduction times of at least 1 EP modality were prolonged in all 4 patients with severe, in 16 of 18 with moderate, in 4 of 6 with mild, and in 4 of 24 patients without neurological symptoms. Auditory brain-stem and somatosensory EPs were more frequently prolonged than visual EPs (more abnormalities with check sizes of 13 than 54 min of arc). Cortical somatosensory EPs correlated well (P much less than 0.01) with either Fz or earlobe reference.

Adolescent↗
PubMed1992

[Interventional endoscopy: what is new?].

New trends in therapeutic endoscopy are presented concerning endoprostheses of the esophagus, endoscopic sclerotherapy of varices and non-variceal bleeding, endoscopic therapy of bile duct stones, palliation of malignant stenoses of the bile duct, endoscopic therapy of acute pancreatitis. Advantages and disadvantages of these new techniques are discussed by analysis of preliminary results and compared with the well established techniques of endoscopy, radiology and surgery.

Acute Disease↗
PubMed1992

[Extrinsic impression or submucous tumor? Contribution of endosonography to clinical assessment].

Impressions of the lumen are frequently found during EGD. We examined 47 patients with 51 impressions by endoscopic ultrasonography and could clear their origin in 44 cases. We found 8 submucosal tumors, 1 submucosal cyst, 5 cysts and 2 malignancies of organs in the neighbourhood; in 28 cases the impression was caused by anatomical variations. In our opinion endoscopic ultrasonography is the method of choice in clearing the nature of impressions of the upper GI-tract.

Diagnosis, Differential↗
PubMed1991

Comparison of functional and structural brain disturbances in Wilson's disease.

We assessed the functional and structural brain disturbances in Wilson's disease (WD) by evoked potentials (EPs) and magnetic resonance imaging (MRI). All the 25 neurologically symptomatic and 44% of the 16 asymptomatic patients, assessed by both EPs (n = 48) and imaging (n = 41), had at least 1 abnormality of either prolonged EP conduction times, imaging-outlined presence of cerebral lesions, or brain atrophy. Our findings indicate that EPs and MRI are sensitive techniques for the evaluation of brain involvement in WD.

Adult↗
PubMed1991

[Digitalized documentation of imaging and findings in ambulatory endoscopy of a gastroenterological department].

Digitalized storing of pictures and reports in gastrointestinal endoscopy achieves high quality and reduction in time and place in archiving. Rapid recall and easy statistical analysis becomes possible. We present hardware and software of the system developed in our department. Our experience promises large distribution of these systems in the near future with great advantages for clinical routine and scientific analysis.

Computers↗
PubMed1991

Endoscopic sclerotherapy of esophageal varices during pregnancy--case report.

Variceal hemorrhage in a patient with non cirrhotic portal hypertension occurring in mid pregnancy was treated by endoscopic intravasal injection sclerotherapy using polidocanol. It was effective, well tolerated and safe for both mother and child. This is the first report that this treatment is feasible and without risk in pregnancy.

Adult↗
PubMed1990

One-year treatment of chronic non-A, non-B hepatitis with interferon alfa-2b.

Thirty patients with chronic non-A, non-B hepatitis (24 male, six female; median age 38 years, range: 15-68 years) were treated with recombinant interferon alfa-2b for 1 year. Treatment was started with 5 million units interferon alfa-2b daily for 2 weeks followed by 2 million units daily for another 2 weeks. Further doses were titrated according to alanine aminotransferase values. After 1 year, treatment was stopped and a follow-up biopsy was obtained. Thereafter, patients were followed for 6 months. Of the 24 patients who completed the 1-year treatment period, 14 (58%) had normal alanine aminotransferase values at the end of the study, eight of whom showed transient increases while on treatment. In another seven (29%), alanine aminotransferase levels decreased by more than 50% of pre-treatment values but remained above the normal range. Biopsies at the end of treatment showed a complete disappearance of inflammatory activity in four and a marked improvement in eleven other patients. The results of this study indicate that a 1-year treatment with recombinant interferon alfa-2b of patients with non-A, non-B hepatitis was very effective at normalizing or improving serum transaminases and liver histology. However, the overall relapse rate was 57%, with relapse occurring in a greater proportion of patients with temporary breakthroughs during therapy (requiring dosage increase), and particularly of patients with only a partial response to treatment (serum transaminases decreased by greater than or equal to 50%). Thus, further studies are needed to establish the optimal dose and duration of treatment to induce a complete resolution of the disease.

Adult↗
PubMed1989

Intestinal neuronal degeneration in a patient with chronic idiopathic intestinal pseudoobstruction.

Neuropathological examination of the gut in a patient with chronic idiopathic intestinal pseudoobstruction and temporal lobe epilepsy showed a degeneration of Auerbach's and of Meissner's plexus. The extent of generative changes increased in an aboral to oral direction. Neuronal degeneration was characterized by ballooning of the cytoplasm of the ganglial cells, by a hyperargyrophilia, a shortening and dilation of cell processes, and a progressive fragmentation and loss of axons. In rectal biopsies, a PAS-positive granular material was detected in the cytoplasm of ballooned ganglial cells. A severe peripheral neuropathy with fiber degeneration in the posterior columns and axonal lesions within ventral nerve roots and a more recent fiber degeneration in the lateral columns corresponding to the picture of subacute combined degeneration of the spinal cord and a symmetrical Ammon's horn sclerosis was present. This case of progressive intestinal neuronal degeneration of unknown origin is a newly described condition leading to chronic idiopathic intestinal pseudoobstruction.

Adolescent↗
PubMed1989

Bone disease in vitamin D-deficient patients with Crohn's disease.

Vitamin D deficiency is frequently observed in patients with Crohn's disease and may be associated with an increased risk of development of metabolic bone disease. To estimate the incidence of metabolic bone disease by noninvasive methods, 31 patients (17-75 years old) with Crohn's disease and low 25-hydroxyvitamin D (25-OHD) levels in winter were investigated in the following summer by measuring the bone mineral content (BMC) of the distal radius by single photon absorptiometry and the cortical area ratio (CAR) calculated from radiographs of the right hand and by x-ray of the lumbar spine. Forty-five percent of the patients showed signs of metabolic bone disease. BMC and CAR correlated with 25-OHD serum levels (P less than 0.05), especially in men. Furthermore, the amount of sun exposure has an influence not only on 25-OHD serum levels both in summer and in winter (P = 0.0006), but also on the BMC (P = 0.07). Consequently, vitamin D deficiency is of major importance for the development of metabolic bone disease in patients with Crohn's disease. Vitamin D deficiency can be prevented by increasing sun exposure and long-term vitamin D supplementation.

Adolescent↗
PubMed1989

Successful long-term treatment of portal-systemic encephalopathy by the benzodiazepine antagonist flumazenil.

A patient with portal-systemic encephalopathy refractory to standard therapy (40-g protein diet, oral neomycin and lactulose, supplementation of diet with branched chain amino acids) following extensive liver resection and construction of a portacaval shunt was treated with 25 mg of flumazenil twice daily by mouth. Before treatment with flumazenil she was encephalopathic and experienced 12 attacks of coma within 2 yr. When treated with flumazenil all signs of encephalopathy abated in spite of an unrestricted dietary intake of protein. Two days after discontinuation of flumazenil treatment she became comatose again. She remained chronically encephalopathic and had four further episodes of coma during the subsequent 3 mo. Since reinstitution of flumazenil treatment she has been well for 14 mo during follow-up without any signs of encephalopathy while on an unrestricted protein diet. Furthermore, flumazenil therapy reversed abnormalities of recordings of multimodality evoked potentials that were associated with hepatic encephalopathy. The striking remission of encephalopathy by treatment with flumazenil suggests that this benzodiazepine antagonist may be valuable in the long-term management of portal-systemic encephalopathy.

Adult↗
PubMed1989

Diagnostic significance of endoscopic biopsy in Crohn's disease.

We investigated the diagnostic value of biopsies taken from Crohn's lesions such as ulcers, aphthoid lesions, cobble-stone epithelium and "pseudopolyps". One hundred and forty-six colonoscopies performed in 141 patients with Crohn's disease (CD) were analyzed. Biopsies were taken during colonoscopy from different gross lesions. Histologic confirmation of CD by granulomas and microgranulomas was obtained in 36 cases from 146 colonoscopies (24.7%). In 80 investigations (54.8%) the histologic findings were consistent with, but not diagnostic of, CD, in 30 cases (20.5%) histology was non-diagnostic. The lesions most likely to contain granulomas were ulcers and we therefore conclude that biopsies taken from ulcer are diagnostically superior to those taken from other lesions seen in CD.

Adolescent↗
PubMed1989

Prophylactic endoscopic sclerotherapy of oesophageal varices in liver cirrhosis. A multicentre prospective controlled randomised trial in Vienna.

The effect of prophylactic treatment of oesophageal varices by endoscopic injection sclerotherapy before the first episode of variceal haemorrhage was studied in patients with cirrhosis in a prospective, randomised and controlled multicentre trial. From February 1984 to March 1987 patients with liver cirrhosis and large varices (stage III-IV according to Paquet) were treated and followed up. The sample comprised 87 patients: 45 in the prophylactic treatment and 42 in the control group. After excluding drop outs, 41 patients were treated in each group. Twenty nine per cent of patients in the sclerotherapy group and 34% in the control group had a variceal haemorrhage during the period of observation. There was no significant difference in the distributions of the bleeding free intervals between the sclerotherapy and the control groups. During the follow up period 24% of patients in the sclerotherapy group and 46% in the control group died. The distribution of survival times indicates a tendency towards longer survival of patients with prophylactic sclerotherapy, particularly in those with alcoholic cirrhosis.

Austria↗