Biomedical subjects

B Gloor

Publications and source records attributed to B Gloor.

At least 37 records · Page 2Linked to original sources

PubMed2000

International Federation of Ophthalmological Societies statutes and regulations.

PURPOSE: To provide an understanding of the structure, role, and responsibility of the International Federation of Ophthalmological Societies, the International Council of Ophthalmology, and the International Congress of Ophthalmology. These established entities have recently codified their statutes and regulations and registered them in Zurich, Switzerland. METHODS: The International Council of Ophthalmology, which serves as the executive body of the International Federation of Ophthalmological Societies, used historical operating documents to prepare the statutes and regulations, which were reviewed and adopted by the International Federation of Ophthalmological Societies at the 28th International Congress of Ophthalmology in Amsterdam on June 23, 1998. RESULTS: The statutes and regulations of the International Federation of Ophthalmological Societies, the International Council of Ophthalmology, and the International Congress of Ophthalmology are available to supranational ophthalmological organizations, national ophthalmological societies, other ophthalmological organizations, and individual ophthalmologists. CONCLUSIONS: The statutes and regulations of the International Federation of Ophthalmological Societies, the International Council of Ophthalmology, and the International Congress of Ophthalmology provide a basis for an organizational structure in international ophthalmology. The International Congress of Ophthalmology, first held in 1857, is the longest continuing international meeting in medicine. The International Council of Ophthalmology was established in 1927, and the International Federation of Ophthalmological Societies was formed in 1933. These organizations coordinate the International Congress of Ophthalmology, which convenes with the International Federation of Ophthalmological Societies every 4 years. The International Council, as the executive body, meets annually. The International Council of Ophthalmology has for decades worked to coordinate and facilitate interchange, education, and standards in international ophthalmology. Currently, the International Council of Ophthalmology, working with other international organizations, is creating an international ophthalmology strategic plan, which includes focus on ophthalmic training, continuing education, advocacy for the preservation and restoration of vision, clinical guidelines, and research.

Constitution and Bylaws↗

PubMed2000

Endoscopic measurement of pancreatic tissue perfusion in patients with chronic pancreatitis and control patients.

BACKGROUND: Pancreatic blood flow is diminished in experimental models of acute and chronic pancreatitis. We attempted to develop a safe and reliable technique for its measurement in patients and to examine blood flow in patients with chronic pancreatitis and in control subjects. METHOD: Pancreatic blood flow was measured using the hydrogen gas clearance technique and an endoscopically placed platinum ductal electrode. Pancreatic blood flow was measured in 12 patients with chronic pancreatitis diagnosed clinically and radiographically, and in 11 control patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) for non-pancreatic pathology. RESULTS: Patients with chronic pancreatitis had a significantly lower pancreatic blood flow compared with control patients (51.5 versus 91.7 mL/min/100 gm, p < 0.01). With secretin stimulation pancreatic blood flow increased in two control patients, whereas this notable rise was not seen in three patients with chronic pancreatitis. CONCLUSIONS: Measurement of pancreatic blood flow with an endoscopically placed electrode is relatively safe and simple to perform. The scarring and vascular fibrosis associated histologically with chronic pancreatitis is reflected in lower pancreatic blood flow.

Adult↗

PubMed2000

[Acute pancreatitis--clinical and technical laboratory diagnostic and prognostic assessment].

The incidence of acute pancreatitis within 100,000 inhabitants a year differs between 5 (Bristol) and 80 (USA). Even though the diagnosis of pancreatitis has become easier by the measurement of specific pancreatic enzymes there are still 30-40% of the fatal cases which are first diagnosed at autopsy. It is of utmost importance to assess the diagnosis and the severity of acute pancreatitis in the beginning to identify those patients with severe or necrotising disease who benefit from an early initiated intensive care therapy. Additionally, in view of new therapeutical concepts (e.g. antibiotic therapy in severe forms) and for the evaluation of new drugs, patients should be staged into mild and severe disease as early as possible. In most cases it is not possible to assess the severity clinically on hospital admission. Up to now the "gold standard" are imaging procedures (contrast-enhanced CT and MRI) which should be reserved for the severe cases to estimate the extent of pancreatic necrosis. The ideal predictor in blood or in urine should be objective, reliable, inexpensive, easy to measure, widely available, sensitive and specific. There are a variety of mediators of the "systemic inflammatory response syndrome" which are elevated in this disease (C-reactive protein, antiproteases, enzyme activation peptides like trypsinogen activation peptide (TAP) and carboxypeptidase B activation peptide (CAPAP), PMN-elastase, complement factors, chemokines and interleukins and others). Among all these mediators, C-reactive protein is the parameter best analysed. It has to be taken into account that it is not specific for AP and it's highest efficacy is reached after > 48 hours after the onset of disease. However, because usually a certain time elapses (approximately 24-48 hours) until patients are hospitalised the time delay seems not to a major disadvantage.

Acute Disease↗

PubMed2000

[Indications for surgical therapy and operative technique in acute pancreatitis].

Eighty to eighty-five percent of all episodes of acute pancreatitis are mild and self-limiting, subsiding within a few days. In the remaining 15 to 20% of cases, however, severe necrotizing disease complicated by multiple organ dysfunction syndrome (MODS) develops. Early stratification according to disease severity is a cornerstone in the management of patients with acute pancreatitis. Patients suffering from mild disease do not need to be operated upon unless specific conditions such as bile duct stones, a tumour at the papilla of Vater or in the head of the pancreas are present. Patients suffering from severe disease are best managed by early intensive care treatment, including antibiotics penetrating into the pancreas in order to prevent infection of the necrotic tissue. Despite such a treatment infection occurs in up to one third of necrotizing cases, asking for surgical treatment. The latter consists of an organ preserving procedure, combined with a continuous postoperative lavage of the retroperitoneum. In 75% of our patients treated operatively, one surgical intervention was sufficient. Overall mortality in patients with necrotizing pancreatitis ranges, according to the current literature, between 6 and 50% and reaches 8% in our own series.

Critical Care↗

PubMed2000

Acute necrotizing pancreatitis: treatment strategy according to the status of infection.

OBJECTIVE: To determine benefits of conservative versus surgical treatment in patients with necrotizing pancreatitis. SUMMARY BACKGROUND DATA: Infection of pancreatic necrosis is the most important risk factor contributing to death in severe acute pancreatitis, and it is generally accepted that infected pancreatic necrosis should be managed surgically. In contrast, the management of sterile pancreatic necrosis accompanied by organ failure is controversial. Recent clinical experience has provided evidence that conservative management of sterile pancreatic necrosis including early antibiotic administration seems promising. METHODS: A prospective single-center trial evaluated the role of nonsurgical management including early antibiotic treatment in patients with necrotizing pancreatitis. Pancreatic infection, if confirmed by fine-needle aspiration, was considered an indication for surgery, whereas patients without signs of pancreatic infection were treated without surgery. RESULTS: Between January 1994 and June 1999, 204 consecutive patients with acute pancreatitis were recruited. Eighty-six (42%) had necrotizing disease, of whom 57 (66%) had sterile and 29 (34%) infected necrosis. Patients with infected necrosis had more organ failures and a greater extent of necrosis compared with those with sterile necrosis. When early antibiotic treatment was used in all patients with necrotizing pancreatitis (imipenem/cilastatin), the characteristics of pancreatic infection changed to predominantly gram-positive and fungal infections. Fine-needle aspiration showed a sensitivity of 96% for detecting pancreatic infection. The death rate was 1.8% (1/56) in patients with sterile necrosis managed without surgery versus 24% (7/29) in patients with infected necrosis (P <.01). Two patients whose infected necrosis could not be diagnosed in a timely fashion died while receiving nonsurgical treatment. Thus, an intent-to-treat analysis (nonsurgical vs. surgical treatment) revealed a death rate of 5% (3/58) with conservative management versus 21% (6/28) with surgery. CONCLUSIONS: These results support nonsurgical management, including early antibiotic treatment, in patients with sterile pancreatic necrosis. Patients with infected necrosis still represent a high-risk group in severe acute pancreatitis, and for them surgical treatment seems preferable.

Adolescent↗

PubMed2000

Kupffer cell blockade reduces hepatic and systemic cytokine levels and lung injury in hemorrhagic pancreatitis in rats.

Severe acute pancreatitis (AP) is associated with both the local (pancreatic) release of cytokines and an elevation in their systemic plasma concentrations. This may lead to organ dysfunction and death of the patient. The aims of this study were to investigate the source(s) of systemic cytokine production during experimental AP. Forty-two rats were allocated to five groups (control, sham operation and saline injection, sham operation and gadolinium chloride injection, intraductal sodium-taurocholate infusion and saline injection, or intraductal sodium-taurocholate infusion and gadolinium chloride injection). Blood from the iliac artery, portal vein, and hepatic vein, along with tissue from the pancreas, liver, and lung, were collected. Serum levels of TNFalpha, IL-1beta, IL-6, and IL-10 were determined by enzyme-linked immunosorbent assay. Tissue mRNA for IL-1beta and IL-10 was assessed by reverse-transcription polymerase chain reaction. In untreated animals with AP, the lowest serum cytokine levels were found in the portal vein. In the hepatic vein, the levels of TNFalpha, IL-1beta, and IL-6 were higher. The highest serum levels were detected in the systemic circulation. In the gadolinium chloride-treated group, there was no increase in hepatic or systemic cytokine levels and less lung injury was observed. Extrapancreatic cytokine production from both the liver and the lung contributed significantly to systemic levels of TNFalpha, IL-1beta, IL-6, and IL-10 in this experimental model of AP.

Acute Disease↗

PubMed2000

Fluconazole penetration into the pancreas.

Because of antibiotic prophylaxis for necrotizing pancreatitis, the frequency of fungal superinfection in patients with pancreatic necrosis is increasing. In this study we analyzed the penetration of fluconazole into the human pancreas and in experimental acute pancreatitis. In human pancreatic tissues, the mean fluconazole concentration was 8.19 +/- 3.38 microg/g (96% of the corresponding concentration in serum). In experimental edematous and necrotizing pancreatitis, 88 and 91% of the serum fluconazole concentration was found in the pancreas. These data show that fluconazole penetration into the pancreas is sufficient to prevent and/or treat fungal contamination in patients with pancreatic necrosis.

Animals↗

PubMed2000

Membrane formation in the chamber angle after failure of argon laser trabeculoplasty: analysis of risk factors.

AIM: Membrane formation in the chamber angle induced by argon laser trabeculoplasty (ALT) can be a cause of treatment failure. Identification of risk factors for membrane formation was the primary aim of this retrospective study. METHODS: Semithin sections of trabeculectomy specimens obtained in a 2 year period were examined by light microscopy. 122 eyes which were treated with one or more ALTs before trabeculectomy were identified. In 46 eyes, a sufficient amount of trabecular meshwork was obtained to permit morphological analysis. RESULTS: Eyes treated with ALT had a significantly higher incidence of membrane formation (p=0.001). In 23/46 specimens a cellular and collagenous membrane was observed covering the entire trabecular meshwork. In 14/23 specimens (61%), this membrane was readily visible at low power magnification (x40). Comparison of these eyes with those without membrane formation revealed a significant difference in the number of ALTs (mean 2.07 (SD 0.73) v 1.48 (0.59); p=0.026) and in preoperative IOP (32.0 (9. 7) v 26.2 (8.4) mm Hg; p=0.04). CONCLUSIONS: Membrane formation in the chamber angle is a frequent cause of ALT failure. The major risk factor is the number of ALTs performed.

Aged↗

PubMed2000

Role of procalcitonin and granulocyte colony stimulating factor in the early prediction of infected necrosis in severe acute pancreatitis.

BACKGROUND: Infected pancreatic necrosis (IPN) is the main cause of death in patients with severe acute pancreatitis. Therefore an early prediction of IPN is of utmost importance. AIM: Analysis of new blood variables as potential early predictors to differentiate between IPN and sterile pancreatic necrosis (SPN). PATIENTS: 64 consecutive patients with acute pancreatitis were enrolled in this prospective study; 29 were suffering from acute oedematous pancreatitis (AIP), and 35 from necrotising disease (NP) as diagnosed by contrast enhanced computed tomography. METHODS: Procalcitonin (PCT) and granulocyte colony stimulating factor (G-CSF) in the serum were examined and compared with C reactive protein (CRP). CRP was measured with a turbidimetric immunoassay (Autokit CRP; Wako, Osaka, Japan), and PCT and G-CSF by ELISA (Lumitest PCT; Brahms Diagnostica, Berlin, Germany; G-CSF-Elisa; R&D Systems, Abingdon, Oxon, UK). Monitoring was performed daily and related to the onset of symptoms. RESULTS: Within the first week, all three variables (CRP, PCT, and G-CSF) were significantly higher in patients with NP than in those with AIP (CRP, p<0.001; G-CSF, p<0. 001; PCT, p<0.001). During the course of the study, 12 of the 35 patients with NP developed late IPN after a median of 20.5 (range 3-49) days. Neither the peak nor the lowest concentrations during the monitoring period were of any value for predicting IPN (median peak values in SPN v IPN: PCT, 0.93 v 1.93 ng/ml; G-CSF, 347 v 421 pg/ml; CRP, 270 v 325 mg/l). CONCLUSIONS: Serum PCT, G-CSF, and CRP concentrations are of similar value for early differentiation between mild and severe acute pancreatitis. However, these variables are not suitable for the early prediction of IPN.

Acute Disease↗

PubMed2000

The role of surgery in the management of acute pancreatitis.

The clinical course of an episode of acute pancreatitis varies from a mild, transitory form to a severe necrotizing form characterized by multisystem organ failure and mortality in 20% to 40% of cases. Mild pancreatitis does not need specialized treatment, and surgery is necessary only to treat underlying mechanical factors such as gallstones or tumours at the papilla of Vater. On the other hand, patients with severe necrotizing pancreatitis need to be identified as early as possible after the onset of symptoms to start intensive care treatment. In this subgroup of patients, approximately 15% to 20% of all patients with acute pancreatitis, stratification according to infection status is crucial. Patients with infected necrosis must undergo surgical intervention, which consists of an organ-preserving necrosectomy followed by postoperative lavage and/or drainage to evacuate necrotic debris, which appears during the further course of the condition. Primary intensive care treatment, including antibiotic treatment, delays the need for surgery in most patients until the third or fourth week after the onset of symptoms. At that time, necrosectomy is technically easier to perform and the bleeding risk is reduced, compared with necrosectomy earlier in the disease course. In patients with sterile necrosis, the available data strongly support a conservative approach (ie, intensive care unit treatment). Surgery is rarely necessary in these patients.

Acute Disease↗

PubMed1999

[Surgical treatment of echinococcosis of the liver].

UNLABELLED: Echinococcosis is a parasitic disease which is most frequently located in the liver. The treatment of choice is surgery. METHODS: A total of 23 patients were hospitalised for liver echinococcosis during the period from January 1993 to September 1998. RESULTS: The diagnosis was in 20 cases (87%) cystic echinococcosis and in 3 patients (13%) alveolar echinococcosis. The regular intervention of cyst desinfection with cystectomy was carried out in 85% of the cases with cystic echinococcosis, whereas atypical or segmental liver resections were performed in 15%. Two patients with alveolar echinococcosis were operated upon by radical/extended liver resections, one was found intraoperatively inoperable. The mean hospital stay was 15.4 days with a mortality of 0% and a postoperative morbidity of 57%, including bile leaks in 30%. A perioperative antiparasitic chemotherapy with albendazole was prescribed in 91%. The apparent rate of recurrence was 7% for uncomplicated cystic echinococcosis. CONCLUSIONS: Cyst desinfection with cystectomy has been proved to be effective as the standard operative intervention for cystic echinococcosis. For alveolar echinococcosis, radical resections are required. Due to the risk of recurrence (especially in alveolar echinococcosis), the effectiveness of surgery should be improved by a perioperative chemotherapy with albendazole.

Adolescent↗

PubMed1999

Changing concepts in the surgical management of acute pancreatitis.

Most episodes of acute pancreatitis are mild and self-limiting, but severe disease complicated by multiple system organ failure develops in up to 20% of cases. Early detection of those patients who subsequently develop necrotizing pancreatitis allows the start of supportive treatment in the intensive care unit before organ failure occurs. Conservative treatment in the intensive care unit, including the administration of intravenous antibiotics, is the gold standard. Surgery is indicated in patients with infected pancreatic necrosis but not in patients with sterile necrosis in the absence of deteriorating multi-organ failure despite maximal intensive care unit treatment, or other specific surgical complications. At our institution, out of 44 patients with necrotizing pancreatitis 29 (66%) had sterile necrosis and were managed conservatively while 15 (34%) had infected pancreatic necrosis and were treated by necrosectomy and continuous closed retroperitoneal lavage. There were two deaths resulting in an overall mortality of 5% in patients with severe acute pancreatitis.

Anti-Bacterial Agents↗

PubMed1999

Pancreatic surgery.

According to epidemiologic studies, the incidence of acute and chronic pancreatitis and carcinoma of the pancreas are increasing worldwide. This is the result not only of improved diagnostic methods introduced in the last decades (eg, contrast-enhanced computed tomography, "all-in-one" magnetic resonance imaging, single-photon emission computed tomography, and endoscopic retrograde cholangiopancreatography) but also of changes in the environment and nutritional behavior. Once a specific diagnosis has been made, the first-choice interventions in acute and chronic inflammatory pancreatic diseases are predominantly organ-and organ function-preserving surgical procedures. In pancreatic cancer, extended radical surgery and multimodal therapies seem to offer the most benefit. This article provides an overview of recently published articles focusing on surgical treatment options in acute and chronic pancreatitis and carcinoma of the pancreas.

Journal Article↗

PubMed1998

Mechanism of increased lung injury after acute pancreatitis in IL-10 knockout mice.

BACKGROUND: IL-10 is a potent anti-inflammatory cytokine which inhibits inflammatory cytokine release from all tissue sites. Hepatic cytokine release from Kupffer cells (KC) is one important source of inflammatory cytokines and may be the main one causing lung damage in acute pancreatitis (AP). Here we studied the KC contribution to lung injury in IL-10 knockout (KO) mice, in which tissue inflammatory cytokine release from all sites is unrestrained, and AP is more severe. METHODS: Three- to 4-week-old C57BL/6J mice and KO mice on a C57BL/6J background were used. Control mice received regular chow and gadolinium chloride (GD; 1 mg/100 g iv), to inhibit KC activity, or saline. Pancreatitis mice received a choline-deficient, ethionine-supplemented diet for 66 h to induce AP and saline or GD injections iv. After 66 h, lung tissue was assessed for edema, myeloperoxidase (MPO), and superoxide dismutase (SOD). Histology was scored in a blinded fashion. RESULTS: In pancreatitis KO mice, KC blockade had no effect on the degree of lung edema, lung neutrophil infiltration, and lung histology score. As expected, each of these parameters was more severe in the KO mice than in the normal mice: lung wet/dry ratio 5.3 +/- 0.2 versus 4.3 +/- 0.13; lung MPO (U/g) 1.9 +/- 0.2 versus 1.1 +/- 0.08; histology score 7.1 +/- 0.8 versus 5.3 +/- 0.5. CONCLUSION: Endogenous IL-10 is important in reducing the lung injury in this model of AP. KC-derived cytokines were of minor importance, compared to those derived from all other tissue sites.

Acute Disease↗

PubMed1998

[Risk factors for trabeculectomy failure].

BACKGROUND: Trabeculectomy is today the filtering procedure of choice, because complications are rare and success-rates high. A modification of our technique (fornix-based conjunctival flap closed by a running suture) introduced 3 years ago, has lead us to this retrospective assessment of complications and success-rates. Some of the risk factors for failure are known, others however remain obscure. This retrospective series was also used to further identify some of these risk factors for trabeculectomy failure. PATIENTS AND METHODS: All 388 trabeculectomies performed between January 1992 and June 1994 at our hospital were included in the study. Important pre- and postoperative data were retrospectively assessed from patients case notes, with a special interest in the course of post-operative intra-ocular pressure (IOP). Two major groups were differentiated: Those with open-angle glaucoma (OAG) (i.e. primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PEX) and pigment dispersion syndrome (PDS)), and other various glaucoma diagnoses. Risk factors were assessed using Cox-proportional hazard model adopting three different criteria for success. RESULTS: The best success-rate after 12 months of follow-up had patients with narrow angle glaucoma (93.1%)(at least those suitable for filtering surgery), followed by patients with POAG (92.8%), 2 degrees open-angle glaucoma (81.8%), aphakic (75%), juvenile (70.6%) and PDS (52.9%). Pseudophakia and development of an encapsulated bleb (Tenon' cyst) were identified as significant (p < 0.05) risk factors for failure. In addition, YAG-Laser Iridotomy in OAG-group and Aphakia in the group of various glaucoma diagnoses were identified as risk factors for successful post-operative IOP control. CONCLUSIONS: Filtering surgery (trabeculectomy) is a potent method to reduce IOP. Pseudophakia and an encapsulated bleb are the main risk factors for surgical failure. Because of amazingly high success-rates we tend to perform filtering surgery today earlier than ten years ago, especially as previous long-term topical antiglaucoma treatment may reduce filtering surgery success.

Adolescent↗

PubMed1998

Radical pancreatectomy.

In an effort to cure more patients, the standard pancreaticoduodenectomy (Whipple procedure) has been modified to include a wider soft tissue and lymph node dissection, and a resection of a segment of the superior mesenteric and portal veins. The operation is described, and the results are critically reviewed. Although the procedure can be performed safely, and with little additional morbidity compared to a standard resection, there is no objective evidence that it increases the cure rate.

Humans↗

PubMed1997

Diagnostic workup of patients with suspected pancreatic carcinoma: the University of California-Los Angeles approach.

BACKGROUND: A large number of diagnostic procedures (e.g., ultrasound, computed tomography [CT] scan, fine-needle aspiration [FNA], angiography, endoscopic retrograde cholangiopancreatography [ERCP], and laparoscopy), are available to the clinician as he/she pursues the workup of patients who are thought to have a pancreatic (periampullary) malignancy. Not all of these procedures should be used in every patient and some have been overused. METHODS: Based on a current literature review and their own experience, the authors describe the rationale of the diagnostic workup in patients with suspected pancreatic carcinoma in a single institution (a university medical center). RESULTS: Helical CT scan provides the best overall assessment of patients with periampullary malignancies, and it is often the only test required. If the patient's history and blood test abnormalities suggest pancreatic carcinoma and the helical CT scan shows a mass in the head of the pancreas that appears to be resectable, the patient should be prepared for surgery. If no mass is apparent on the helical CT scan, a diagnostic ERCP is indicated. If microscopic proof of the diagnosis will avoid surgery, then an FNA for cytology should be performed. When unresectability appears likely and cannot be confirmed in less invasive ways, laparoscopy is indicated. CONCLUSIONS: In patients with periampullary malignancies, helical CT scan provides the best overall assessment. Guidelines are presented for the selective use of ultrasound, FNA, ERCP, and laparoscopy, which are important for the most cost-effective workup of these patients.

Angiography↗

PubMed1997

Interleukin-10 reduces the systemic inflammatory response in a murine model of intestinal ischemia/reperfusion.

BACKGROUND: Intestinal ischemia/reperfusion (I/R) is known to increase systemic cytokine levels, as well as to activate neutrophils in distant organs. This study was designed to investigate the effect of interleukin-10 (IL-10) on cytokine release, pulmonary neutrophil accumulation, and histologic changes in a murine model of I/R. METHODS: Forty female Swiss-Webster mice were divided into four groups. Group 1 underwent 45 minutes of superior mesenteric artery occlusion followed by 3-hour reperfusion (I/R). Group 2 underwent laparotomy alone (Sham). Group 3 underwent I/R, but was treated with IL-10, 10,000 units IP every 2 hours, starting 1 hour before reperfusion (Pretreatment). Group 4 was treated with an equal dose of IL-10, starting 1 hour after reperfusion (Posttreatment). All animals were killed at 3 hours, standard assays were performed for serum cytokine levels, and lung myeloperoxidase activity and intestinal histology were scored. RESULTS: Serum cytokines (TNF-alpha and IL-6), lung myeloperoxidase levels, and histologic score were significantly reduced when IL-10 was administered either before or after reperfusion. CONCLUSIONS: IL-10 reduced the severity of local and systemic inflammation in a murine model of intestinal I/R when given before or after reperfusion injury. These observations suggest that IL-10 may exert its effect by blocking cytokine production and distant organ neutrophil accumulation.

Animals↗