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Biomedical subjects

C Benz

Publications and source records attributed to C Benz.

At least 19 recordsLinked to original sources
PubMed1999

[The endoscopic diagnosis and therapy as well as the long-term course of Dieulafoy ulcer hemorrhage].

OBJECTIVE: To assess the effectiveness of endoscopic diagnosis and treatment as well as the long-term course in patients with bleeding from Dieulafoy's ulcer (DU). PATIENTS AND METHODS: Data were gathered on all cases coded "bleeding from Dieulafoy's ulcer" in an endoscopic data-bank. The following items were obtained from the case-notes: clinical symptoms, mean haemoglobin concentration, demand for infusion of erythrocyte concentrates and endoscopic procedures undertaken for diagnosis and treatment. There were 15 patients (mean age 64.8 years; 9 men and 6 women), seen between 1985 and 1998 with the diagnosis of DU. All lesions were located in the proximal stomach. The effectiveness of the various parameters was analysed. The long-term course was ascertained by telephone interviews with the patients and (or) their general practitioner. RESULTS: The suspected diagnosis of DU was confirmed by additional endoscopic means such as endoscopic Doppler sonography or endosonography. A combination of endoscopic techniques of stopping the bleeding (epinephrine injection and, if necessary, haemoclip application) was effective in 14 of the 15 patients, operative intervention being required in one. Three patients died during follow-up, none of bleeding. No recurrence of bleeding had occurred in the 10 patients followed for a mean of 20 (6-31) months. CONCLUSIONS: The endoscopic diagnosis of DU bleeding can be confirmed by endoscopic Doppler sonography or endosonography. It remains to be proven whether miniscope endosonography is of additional value. The combined method of stopping the bleeding has been effective in this patient collective, both during hospitalization and on long-term follow-up.

Adult↗
PubMed1999

Mechanism of hepatoprotective action of bile salts in liver disease.

Ursodeoxycholic acid (UDCA) improves liver enzymes and in many instances liver histology in cholestatic liver diseases such as primary biliary cirrhosis and primary sclerosing cholangitis. Besides classic cholestatic diseases, UDCA also improves liver biochemistry in alcoholic liver disease and in chronic viral hepatitis C. The main target of UDCA treatment, however, is cholestasis, and consequently the mechanisms responsible for the beneficial effects in these diseases are of interest, and are discussed in detail in this article.

Animals↗
PubMed1999

Influence of cholestasis on absorption of ursodeoxycholic acid.

Ursodeoxycholic acid (UDCA) has beneficial effects in cholestatic liver diseases. Absorption of UDCA is slow and incomplete. In the present study the effect of cholestasis on absorption was evaluated in 10 patients with pancreatic carcinoma and extrahepatic biliary drainage. At days 3 and 10 after insertion of the biliary drain, all patients received 750 mg UDCA in three divided doses. On both occasions intestinal absorption of UDCA was determined to evaluate the influence of cholestasis. Serum bilirubin was used as indicator of cholestasis. Biliary output of UDCA served as measure of absorption and was determined by gas-liquid chromatography. At days 4 and 11 bile consisted of less than 2% of UDCA, indicating that UDCA excretion was complete within 24 hr and no accumulation of UDCA had occurred. After insertion of the drain, serum bilirubin decreased from 12.2 +/- 2.4 mg/dl at day 3 to 5.4 +/- 0.9 mg/dl at day 10. Biliary secretion of bile acids increased from 2.0 +/- 0.3 to 3.1 +/- 0.4 mmol/day, whereas percentage of ursodeoxycholic acid in bile did not significantly increase (41.1% vs 42.1%). Absorption of UDCA increased from 39.8 +/- 5.0% to 61.1 +/- 6.2% of the administered dose, indicating an improvement of the absorption rate after decrease of cholestasis by 53.65% (P < 0.05). In conclusion, in severe cholestasis absorption of orally administered UDCA is markedly reduced. This may have implications in the treatment of patients with cholestatic disease.

Administration, Oral↗
PubMed1999

Adverse effects of nonsteroidal anti-inflammatory drugs on the small and large bowel.

Nonsteroidal anti-inflammatory drugs (NSAID) account for a large part of prescriptions and self-administered medication worldwide. The adverse effects on the upper gastrointestinal tract are well documented. However, in an increasing number of publications adverse effects in the small and large intestine distal to the duodenum are being reported. This paper provides an updated review of current as well as earlier literature on the pathogenesis of such adverse effects and the potential damage to the small and large bowel caused by NSAID. In addition, suggestions for an appropriate diagnostic workup of NSAID damage are discussed.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1999

Treatment of difficult intrahepatic stones by using extracorporeal and intracorporeal lithotripsy techniques: 10 years' experience in 55 patients.

BACKGROUND: Intrahepatic lithiasis still is a complicated disease and merits special attention during therapeutic intervention. Although resection of the affected liver lobe or segment is the best therapeutic option to completely remove the source of recurrent infection, the need for endoscopic treatment modalities is evident because hepatic resections are combined with a high morbidity and mortality rate. METHODS: Over a 10-year period (1988-1997) 55 patients with intrahepatic stones that were not accessible to routine endoscopic extraction were treated at our department. These patients underwent either extracorporeal shock-wave lithotripsy (n=27) or intracorporeal electrohydraulic (n=12) or laser lithotripsy (n=16). RESULTS: Using these techniques, we achieved stone fragmentation in 33.3%, 41.6%, and 75%, respectively. With a combination of the different methods, more than 90% of intrahepatic stones could be removed endoscopically. Overall complication rate was 12.7%; complete recovery was achieved in all patients with conservative management. CONCLUSION: The endoscopic approach to intrahepatic lithiasis appears to be a useful alternative to surgery, with a lower morbidity and mortality. If endoscopic therapy fails, surgery is still possible.

Adult↗
PubMed1999

Typhoid fever due to Salmonella Kapemba infection in an otherwise healthy middle-aged man.

We report the case of a patient with a Salmonella Kapemba infection, who suffered, 3 weeks after a holiday in Israel, occurrences of high fever and lower back pain for 10 days and icterus for 2 days before admission. Laboratory findings revealed a slight cholestasis and elevation of acute phase protein levels. In the blood culture a Salmonella Kapemba-type organism was cultured. The patient was afebrile for 10 days after hospitalization and then suddenly developed a temperature of 40 degrees C again. At the same time leukopenia, thrombocytopenia, and a rise of D-dimer levels were detected. The patient was admitted to the intensive care unit for a few days, because a disseminated intravascular coagulation was suspected. With magnetic resonance imaging and bone scintigraphy no osteomyelitis or abscess formation could be found. A transesophageal ultrasonography of the heart revealed no signs of endocarditis. In multiple stool cultures no salmonellas could be detected. After antibiotic treatment with ciprofloxacin the fever and lower back pain subsided, and the patient was discharged a fortnight later. This is the first reported case of typhoid fever due to the bacterium Salmonella Kapemba.

Germany↗
PubMed1999

Prevalence and clinical importance of Helicobacter pylori infection in patients after partial gastric resection for peptic ulcer disease. A prospective evaluation of Helicobacter pylori infection on 50 resected patients compared with matched nonresected controls.

UNLABELLED: There have been only a few surveys on the prevalence of persistent Helicobacter pylori (Hp) infection in patients who have undergone surgery for peptic ulceration. The aim of the study was to evaluate the prevalence and clinical importance of Hp infection after partial gastric surgery due to peptic ulcer disease. METHODS: We examined 50 patients who had partial gastric resection for peptic ulcer disease and years later underwent upper gastrointestinal (GI) endoscopy. 50 controls matched with respect to indication for GI endoscopy, age and gender were also studied. Three specimens from the fundus of gastric remnant were examined for Hp infection (histology and rapid urease test). The prevalence of Hp infection and pathology findings were compared between the two groups using chi-square statistics. RESULTS: 32 men and 18 women were examined (40 x BII, 10 x BI). The prevalence of Hp infection was 38% in the resected group compared to 60% in the control group (p = 0.015). We found a significant association (p = 0.0004) between Hp infection and endoscopic findings in the control group but not in the group of partially resected patients (p = 0.66). CONCLUSION: The prevalence of Hp infection in hospitalized patients with partial gastric resection is significantly lower than in matched controls. Hp infection does not play a significant pathogenic role in recurrent ulcer after partial gastric resection in these patients.

Adult↗
PubMed1999

Improved tumor staging by diagnostic laparoscopy.

This study was performed to assess the role of additional diagnostic laparoscopy in the preoperative staging of patients with adenocarcinoma of the esophagus, gastric cancer and pancreatic cancer prior to intended curative surgery. 89 patients with primary solid abdominal tumors were eligible for evaluation; of those 49 patients had a gastric cancer, 33 a pancreatic cancer and seven an adenocarcinoma of the esophagus. Patients without histologically proven metastases proceeded to laparotomy. Metastases were detectable laparoscopically in nine of 49 patients (18.4%) with gastric cancer (peritoneum n = 5, omentum n = 2, liver n = 2). Intraoperatively metastases were evident in further five cases (liver n = 3, peritoneum n = 2). In eleven of 33 patients (33%) with pancreatic cancer metastases were detected by laparoscopy (liver n = 6, peritoneum n = 2, liver and peritoneum n = 3) and in further four patients intraoperatively (liver n = 2, peritoneum n = 2). One of seven patients with an adenocarcinoma of the esophagus had liver metastases detected by laparoscopy. Intraoperatively no metastases were evident in those patients. Laparotomies were avoidable in 21 of the 89 patients (23.6%) who had a diagnostic laparoscopy prior to intended curative resection. Preoperative staging by additional diagnostic laparoscopy proved effective in patients with gastric and pancreatic cancer.

Adenocarcinoma↗
PubMed1999

[A rare cause of iron deficiency anemia: recurrent hemorrhage from a carcinoid of the jejunum--diagnosis and therapy with enteroscopy].

We report a 66-year-old patient with previously diagnosed iron deficiency anemia. He complained of fatigue, but had no further symptoms. Hemoglobin was 9.1 g/dl. Test for occult blood in stool was positive, but gastroduodenoscopy and colonoscopy revealed no bleeding source. The man was referred to our department for push-type enteroscopy. By enteroscopy we diagnosed a pedunculated, large polyp in the upper jejunum. The polyp seemed to be submucosal, but had some ulcerations on its surface as the probable bleeding source. In the lower parts of the small intestine no further polyps were detected. After endoscopic doppler examination we injected adrenaline into the base of the polyp to prevent bleeding and the polyp was removed by snare without complications. The polyp was diagnosed to be a carcinoid and was removed in sano.

Aged↗
PubMed1998

Long-term results (7 to 10 years) of endoscopic papillotomy for choledocholithiasis. Multivariate analysis of prognostic factors for the recurrence of biliary symptoms.

BACKGROUND: The long-term outcome after endoscopic papillotomy is poorly defined. The aim of this study was to determine the long-term results of this method in the treatment of common duct calculi and to determine which prognostic factors are associated with the relapse of biliary symptoms. METHODS: Between 1985 and 1988, 223 consecutive (149 women, mean age 67.9 years) patients underwent endoscopic papillotomy for duct stones; 127 had already undergone cholecystectomy or underwent this operation during the same hospitalization. Follow-up data were obtained retrospectively from the patients and patients' relatives and general practitioners. RESULTS: The procedure was successful in 217 of 223 cases (97%), of which 203 were followed-up; 2 patients died in the first month after treatment (0.89%). Mean follow-up for the 201 patients was 6.2 years, during which 31 relapsed (15%). Three significant prognostic factors for late complications were identified in a multivariate analysis. The recurrence rate of biliary symptoms in patients who were left with an in situ gallbladder was 20.2%, and 11% for those whose gallbladder was removed (p = 0.04). Patients with a bile duct 15 mm or greater in diameter were more prone to recurrence of symptoms than those with a bile duct 10 mm or less in diameter (41% vs. 10%, p = 0.025) and were especially at higher risk to develop recurrent stones (19.5% vs. 4.9%, p = 0.019). Stone recurrence, but not biliary symptoms as a whole, was more frequent in patients with a peripapillary diverticulum (p = 0.035). CONCLUSIONS: The long-term results of endoscopic papillotomy are comparable with those of surgical techniques. The prognostic factors associated with relapse of biliary symptoms as a whole are gallbladder left in situ and choledochal diameter. Bile duct size and peripapillary diverticula are associated with recurrent bile duct stones.

Adult↗
PubMed1998

Accelerated schedule of hepatitis B vaccination in liver transplant candidates.

Liver transplantation has become the treatment of choice worldwide for many patients with end-stage liver disease. In terms of survival and quality of life, the results of the procedure in many centers are very good. However, the long-term function of the grafts may be affected by vascular, immunologic, or infection problems, the latter being a major cause of morbidity and mortality after orthotopic liver transplantation (OLT). Therefore, prophylactic vaccination against hepatitis B virus (HBV) infection is recommended in patients awaiting liver transplantation. Individuals with chronic advanced liver disease are known to be less responsive to HBV vaccination. On the other hand, the widely recommended standard schedule (months 0, 1, and 6) for immunization against hepatitis B takes 6 months, a regimen which may not be completed in time prior to OLT or which may not be completed due to noncompliance, possible reasons for the lower rates of seroprotection in OLT candidates. Studies show that, in principle, complete immunization with an accelerated hepatitis B vaccination protocol (0, 7, 21 days) induces early seroprotection with excellent seroprotection rates and anti-HBs titers in immunocompetent individuals. We therefore performed a prospective clinical trial to assess immunogenicity and reactogenicity of this accelerated vaccination regimen in OLT candidates compared to healthy controls.

Female↗
PubMed1998

Effect of tauroursodeoxycholic acid on bile-acid-induced apoptosis and cytolysis in rat hepatocytes.

BACKGROUND/AIMS: In cholestatic liver disease, bile acids may initiate or aggravate hepatocellular damage. Cellular necrosis and cell death may be due to detergent effects of bile acids, but apoptosis may also play a role. In cholestasis, the conditions determining either apoptotic or cytolytic cell death are still unclear. Primary rat hepatocytes in culture represent a suitable model to study bile-acid-induced liver damage. METHODS: Glycochenodeoxycholic acid, a hydrophobic bile acid, was used to induce cell damage. Tauroursodeoxycholic acid, a hydrophilic bile acid, served as substrate to study possible protective effects of such compounds. To study the time and concentration dependency of bile-acid-induced cytolysis and apoptosis, morphologic alterations, hepatocellular enzyme release and nucleosomal DNA fragmentation were evaluated. RESULTS: Bile-acid-induced cytolysis, as indicated by hepatocellular enzyme release and by morphologic signs of membrane destruction, increased with concentration and time. Addition of tauroursodeoxycholic acid to the incubation medium reduced cytolysis significantly, indicating a direct hepatoprotective effect of this bile acid against the detergent action of hydrophobic bile acids. In contrast to cytolysis, apoptosis with DNA fragmentation was induced by low concentrations of glycochenodeoxycholic acid a few hours after incubation. Coincubation with tauroursodeoxycholic acid in equimolar concentrations significantly reduced apoptosis, indicating another direct hepatoprotective effect of tauroursodeoxycholic acid. CONCLUSIONS: It seems likely that in severe cholestasis, bile-acid-induced injury of hepatocytes is due mainly to cytolysis, whereas in moderately severe cholestasis apoptosis represents the predominant mechanism of bile acid toxicity. Tauroursodeoxycholic acid may reduce both bile-acid-induced apoptosis and cytolysis.

Animals↗
PubMed1998

Effect of S-adenosylmethionine versus tauroursodeoxycholic acid on bile acid-induced apoptosis and cytolysis in rat hepatocytes.

BACKGROUND: S-adenosylmethionine (SAMe) increases survival in alcoholic liver cirrhosis and may have a beneficial effect in cholestatic liver disease. SAMe repletes glutathione stores and protects tissue from oxygen free radicals. The effect of SAMe on bile acid-induced apoptosis is unknown. In the present study the possible hepatoprotective effect of SAMe was evaluated and compared with that of tauroursodeoxycholic acid (TUDCA). METHODS: Primary rat hepatocytes treated with glycochenodeoxycholic acid (GCDCA) were used as a model for cholestasis-induced hepatocellular damage, which served to study the effects of SAMe and TUDCA on bile acid-induced apoptosis and cytolysis. RESULTS: SAMe reduced bile acid-induced apoptosis but did not prevent bile acid-induced cytolysis. Compared with SAMe, TUDCA was more efficient in reducing apoptosis due to toxic bile acids. The combination of SAMe and TUDCA had additive effects in reducing apoptosis. CONCLUSION: The reduction in bile acid-induced apoptosis by SAMe may represent one of the factors responsible for its beneficial effects in the treatment of liver diseases.

Animals↗
PubMed1998

A new HF current generator with automatically controlled system (Endocut mode) for endoscopic sphincterotomy--preliminary experience.

BACKGROUND AND STUDY AIMS: The main complications of endoscopic sphincterotomy are pancreatitis, hemorrhage, perforation and cholangitis. In a prospective randomized trial, a conventional current generator was compared to a new generator with an automatically controlled cut system (Endocut) for sphincterotomy. The purpose was to establish whether the new device reduces the complication rate of sphincterotomy. Our experiences over the last 2 years with the new HF current generator are described here. PATIENTS AND METHODS: In this study 100 patients were randomly assigned to one of the two generators. The following points were documented in a protocol form: abrupt or continuous cutting; length of papillotomy; complications. RESULTS: There were no significant differences in sex, age or indication for sphincterotomy. Nor were there any significant differences in the length of the sphincterotomy or mild pancreatitis. In contrast, an abrupt opening of the papillary roof was more frequently observed with the conventional generator (18 patients) than with the new device (one patient, P < 0.001). Mild bleeding occurred in two patients with the new unit, but in 13 with the conventional unit (P = 0.002). Moderate or severe bleeds were observed in neither of the two groups. During the subsequent application phase lasting for 2 years, the following complications occurred in a total number of 850 sphincterotomies (EST): pancreatitis 2.8% (one patient died); hemorrhages requiring transfusion 1% (n = 8); concealed perforations 0.3% (n = 3). CONCLUSIONS: According to our experience to date and based on this study, this new HF surgery unit enables performance of controlled, bloodless sphincterotomies. The danger of papillary hemorrhage appears to be reduced. All examiners found the new system to be safer and more convenient.

Electric Power Supplies↗
PubMed1998

Markers of tumor angiogenesis and proteolysis independently define high- and low-risk subsets of node-negative breast cancer patients.

PURPOSE: To compare the prognostic impact of tumor angiogenesis factors (vascular endothelial growth factor [VEGF], angiogenin, and basic fibroblast growth factor [bFGF]), tumor proteolysis factors (urokinase-type plasminogen activator [uPA] and plasminogen activator inhibitor-1 [PAI-1]), and conventional tumor markers (stage, grade, and steroid receptors) in early breast cancer. PATIENTS AND METHODS: In the primary clinical study, tumor angiogenesis and other factors were detected in frozen biopsies from 305 primary breast tumors. VEGF expression was assessed by chemiluminescence immunosorbent assay (ICMA); angiogenin, bFGF, uPA, and PAI-1 by enzyme-linked immunosorbent assay (ELISA); and steroid receptors (estrogen receptor [ER] and progesterone receptor [PgR]) by enzyme immunoassay (EIA). In the validating clinical study, another set of 190 node-negative primary breast tumor samples were collected at a separate institution. RESULTS: Univariate analysis of the primary study showed that VEGF levels were positively correlated with recurrence (P < .001). Angiogenin levels were positively correlated with disease relapse (P < .005) for the overall collective group, but not within the node-negative subset. No significant correlations were found between tumor bFGF levels and patient survival. In multivariate regression analysis, the only independent predictors of relapse-free survival (RFS) were VEGF, uPA, and lymph node status. In the validation set, the distribution of VEGF and uPA values were similar to those in the primary study; low expression of both VEGF and uPA identified patients with a < or = 20% likelihood of recurrence within 7 years. CONCLUSION: Separate primary and validating clinical studies concur that tumor VEGF level is the most important prognostic parameter among several markers of tumor angiogenesis and proteolysis.

Adult↗