Biomedical subjects

C Kuntz

Publications and source records attributed to C Kuntz.

At least 55 records · Page 3Linked to original sources

PubMed1995

Environmental and genetic factors affecting bone mass. Similarity of bone density among members of healthy families.

OBJECTIVE: To evaluate the relative importance of environmental and genetic factors in the determination of bone mineral density (BMD) and to quantify the risk of low BMD in healthy young adults in relation to the BMD of their parents. METHODS: Dual-energy x-ray absorptiometry study of a series of 129 nuclear families (441 subjects), including 183 children over age 15, was performed. Correlation of BMD in children with BMD in their parents was studied in a linear model, taking into account environmental factors. Logistic regression was used to quantify the relative risk of lower BMD according to the parents' BMD level. RESULTS: BMD was significantly correlated with weight, height, and body mass index (BMI) in all family members, and with parents' alcohol consumption and with physical activity in fathers and sons. The BMD of the children correlated with that of their parents (r = 0.27). The child's BMI, his/her father's BMD and daily calcium intake, and his/her mother's BMD, BMI, and body fat accounted for 41.4% of the variance in the child's BMD. A son had a 3.8 times higher risk of having a low BMD if his father had a low BMD, and a daughter had a 5.1 times higher risk if her mother had a low BMD. CONCLUSION: The BMD of children in healthy families was related to the BMD of their parents as well as to environmental factors, confirming the contribution of genetic inheritance in the determination of bone density in young adults, especially in girls.

Adolescent↗

PubMed1995

Segregation analysis and variance components analysis of bone mineral density in healthy families.

Bone mineral density (BMD) was measured in 1992-93 in 129 nuclear families, including 258 parents and 183 children, and was analyzed for familial resemblance factors. BMD measurements were adjusted on weight and age. Segregation analysis rejected the monogenic hypothesis and exhibited a strong polygenic component. Variance components analysis was then used to estimate the parameters of a multivariate normal model including an additive polygenic component, a common environment factor, and a residual specific to each individual. The genetic component was independent of sex and age. The common environmental factor was not significant. The variance of the residual specific factor appeared to be a quadratic function of age, reaching its minimum value at 26.4 years. Consequently, the maximum value for heritability (ratio of genetic variance to total variance) is observed at this age (h2 = 0.84). According to this model, the correlation between two relatives is a function of the ages of each individual in the pair.

Adolescent↗

PubMed1995

Cholecystolithiasis and infection of the biliary tract with Salmonella Virchow--a very rare case in early childhood.

In early childhood gallstones are rare. However, in the last years the number of patients has increased. A possible cause for calculous and acalculous cholecystitis are infections with Salmonella species. The following report describes a case of perforated cholecystitis and cholecystolithiasis accompanied by microbiological finding of Salmonella Virchow in the gallbladder in a three-and-a-half-year-old boy. A combination of symptomatic cholecystolithiasis and Salmonella Virchow has not yet been described in the literature. The belated diagnosis resulted in a sealed perforation of the gallbladder with local biliary peritonitis. After cholecystectomy and antimicrobial therapy, the patient could be discharged without any complaints. Diseases of the biliary tract are part of the differential diagnosis of unclear abdominal pain in early childhood.

Anti-Bacterial Agents↗

PubMed1995

General stress response to conventional and laparoscopic cholecystectomy.

OBJECTIVE: In many retrospective and prospective observational studies, laparoscopic cholecystectomy (LC) compares favorably with conventional cholecystectomy (CC), with respect to length of hospital stay, postoperative pain, and pulmonary function, indicating a diminished operative trauma. Comparison of laboratory findings (stress hormones, blood glucose, interleukins) are a possibility to objectify stress and tissue trauma of laparoscopic and conventional cholecystectomy. SUMMARY BACKGROUND DATA: Major body injury, surgical or accidental, evokes reproducible hormonal and immunologic responses. The magnitude of many of these changes essentially is proportional to the extent of the injury. METHODS: In a prospective study, biochemical stress parameters were measured in the blood of patients undergoing elective cholecystectomy because of symptomatic cholecystolithiasis. Patients with acute cholecystitis, pancreatitis, choledocholithiasis, or malignant disease were excluded. Values from 40 patients after LC and from 18 patients after CC were compared. Both groups had similar patient characteristics, baseline values, and perioperative care, except for deeper anesthesia during CC. RESULTS: On postoperative day 1, epinephrine (p = 0,05), norepinephrine (p = 0.02), and glucose (p = 0.02) responses were higher after CC. Two days postoperatively, norepinephrine remained higher after CC (p < 0.01). Interleukin-1 beta responses were higher during (p < 0.01) and 6 hours after CC (p = 0.03). Interleukin-6 responses were higher 6 hours (p = 0.03), 1 day (p = 0.02), and 2 days (p < 0.01) after CC. CONCLUSIONS: The results show significant lower values of intraoperatively and postoperatively measured epinephrine, norepinephrine, interleukin-1 beta, and interleukin-6 in patients with laparoscopic cholecystectomy, indicating a minor stress response and tissue trauma in this group of patients. The results correspond to the favorable results of most other trials evaluating clinical aspects of laparoscopic cholecystectomy.

Adult↗

PubMed1995

Carpal tunnel syndrome: correlation of magnetic resonance imaging, clinical, electrodiagnostic, and intraoperative findings.

We undertook a prospective study of 43 wrists in 32 patients who had been clinically diagnosed as having carpal tunnel syndrome (study group) and 5 wrists in people who had no symptoms (control group), correlating the clinical, electrodiagnostic, intraoperative, and magnetic resonance imaging (MRI) findings. MRI of the carpal tunnel and thenar eminence was performed, using coronal and axial T1- and T2-weighted, proton density, and short tau inversion recovery sequences. Abnormalities of the median nerve, as revealed by MRI, were found in 43 of 43 (100%) wrists in the study group and in 0 of 5 (0%) wrists in the control group. Increased signal of the median nerve was seen in 41 of 43 (95%) wrists, increased signal of the flexor tendon sheath in 41 of 43 (95%), volar bowing of the flexor retinaculum in 39 of 43 (91%), increased distance between the flexor tendons in 37 of 43 (86%), and abnormal nerve configuration in 28 of 43 (65%). Increased short tau inversion recovery signal of the thenar muscles was found in 5 of 43 (12%) wrists, all of which had undergone severe denervation changes, as revealed by electromyography. Operative release was performed for 27 of 43 (63%) wrists, and follow-up was obtained for 42 of 43 (98%). A good or excellent postoperative outcome resulted for 20 of 27 (74%) patients, a fair outcome for 2 of 27 (7%), and a poor outcome for 4 of 27 (15%), and 1 of 27 (4%) patients was lost to follow-up. For patients undergoing carpal tunnel release whose MRI revealed an abnormal nerve configuration, the outcome was improved, with good or excellent results in 15 of 18 (83%) patients. No association with outcome was seen with median nerve or flexor tendon signal changes, increased interspace between the flexor tendons, or flexor retinaculum bowing. Our results indicate that MRI is a sensitive diagnostic modality that can demonstrate signal and configurational abnormalities of the median nerve in patients diagnosed with carpal tunnel syndrome. Increased signal of the thenar muscles, as revealed by MRI, using short tau inversion recovery sequences, occurs only in muscles that have undergone severe denervation changes, as revealed by electromyography.

Carpal Tunnel Syndrome↗

PubMed1994

Endorectal ultrasound and leiomyosarcoma of the rectum.

Leiomyosarcomas of the rectum are uncommon neoplasms accounting for fewer than 1% of all malignancies of the colon and rectum. Approximately 215 cases have been described in the literature. Distinction from leiomyoma is often difficult, but regarding dignity is important. The case reported is that of a 68-year-old man in whom a 2.2-cm rectal mass covered by mucosa was diagnosed by rectoscopy and endorectal ultrasound. After treatment by wide local excision the histological specimen revealed a low-grade, highly differentiated leiomyosarcoma. Due to the lack of a large series of this disease, there is disagreement over the therapeutic strategy. At the moment a selective treatment approach seems to be the most frequently advocated. Large tumors and those extending beyond the rectal wall are treated by radical surgical resection. Leiomyosarcomas less than 2.5 cm in size and confined to the bowel wall can be treated by wide local excision. Endosonography can provide exact assessment of tumor size and expansion and is of great value in selecting the appropriate treatment.

Aged↗

PubMed1994

[Endo-anal ultrasound. Indications and results].

Between July 1991 and November 1993 106 patients have been examined by endoanal ultrasound with a 7.0 MHz transducer and a special hard plastic cone which is attached over the transducer. Indications for endoanal ultrasound have been anal carcinoma, perirectal or perianal fistulas, perianal abscesses and sphincter insufficiencies. All anal carcinomas and 2 anal cancer recurrences could be visualized with regard to their size and extension as well as the lymphnode infiltration. 28 of 35 fistulas have been seen by endoanal ultrasound. Endosonographical differentiation in inter- (10), trans- (12) extra- (1) or suprasphincteric (5) was possible in all detected fistulas and confirmed by operation in 27 of 28 cases. 34 cryptogen abscesses could be detected (15 intersphincteric, 12 ischiorectal, 7 pelvirectal) and confirmed by the operative situs with regard to their size and localisation. In 9 patients with a myogen sphincter insufficiency the morphological defect of the sphincter muscle could be localized by endoanal ultrasound and confirmed by the operative situs in all cases.

Abscess↗

PubMed1993

Endorectal ultrasound for control of preoperative radiotherapy of rectal cancer.

Endorectal ultrasound (EUS) is known to be a reliable method for preoperative staging of rectal tumors. In this study, EUS was used to select patients with rectal cancer suitable for preoperative radiation therapy. By performing EUS before and after radiation, the aim of the study was to evaluate the role of EUS in monitoring the effects of preoperative radiation therapy. In 17 patients with large T3 or T4 rectal tumors, a complete staging by EUS was done before and after radiation therapy. Beside a shrinkage of the tumor, there was a change of echopattern to more hyperechoic gray levels to be observed in the irradiated tumor. The rectal wall lost its normal architecture, and lymph nodes disappeared or changed their echopattern from echopoor to echorich. There was no down-staging of a tumor seen by EUS. Complete preoperative staging was correct in 13 of 17 patients because of endosonographic examination before and after preoperative radiation therapy. New interpretation criteria are given for evaluation of patients with rectal cancer treated by radiation therapy.

Adult↗

PubMed1993

[Influence of sonography on indications for laparoscopic cholecystectomy].

Because of therapeutic consequences preoperative sonography should be performed with a check list. Nevertheless false positive and false negative findings result in cases of gall-stones in the ductus cysticus, of acute cholecystitis and thickness of the gall-bladder wall. Therefore where sonographic findings differ from the intraoperative laparoscopic situs the operating surgeon should change to conventional cholecystectomy early enough to avoid complications.

Cholangitis↗

PubMed1993

[Endorectal ultrasound in diagnosis and therapy planning of broad-base rectal adenomas].

In this study the value of endorectal ultrasound in diagnosis and therapy of large rectal adenomas is shown. Between January 1988 and August 1992 93 patients with the primary diagnosis of adenoma proven by biopsy were examined by endorectal ultrasound. Sonographical differentiation of adenoma and carcinoma was done by echo-structure. Enlarged lymph nodes can be detected too. In 34 of 91 patients carcinoma was found by endorectal ultrasound and 28 were verified histologically. Sensitivity of endorectal ultrasound in detection of carcinoma in enlarged adenomas is 96%. Only preoperative endorectal ultrasound could give decisive criteria to take a second biopsy, to avoid mucosectomy in case of a malignoma or give the advice for a radical operation according to the tumor stage. Further staging of adenomas and small carcinomas is excellent by endorectal ultrasound and the right indication of local therapy can be confirmed.

Diagnosis, Differential↗

PubMed1992

[Analgesic consumption--laparoscopic versus conventional cholecystectomy].

We compared two groups of 50 patients each with symptomatic cholecystolithiasis treated by either conventional or by laparoscopic cholecystectomy with regard to duration of postoperative pain and sort and amount of analgetics. Laparoscopic operation time was on an average 115.4 min (65-180 min), conventionally operated 78.1 min (35-140 min). Eight patients with laparoscopic cholecystectomy did not need analgetics at all. The average number of days of postoperative pain was 2.7 days for conventional operation and 1.13 days for laparoscopic cholecystectomy. In this time the conventionally operated patients needed four to five times the amount of analgetics as well morphin analogues as low-potency analgetics.

Analgesics↗

PubMed1991

Pertussis in French adolescents: risk factors and respiratory sequels.

An analysis of the risk factors for pertussis and the possible respiratory sequels was carried out in a sample of 499 children and adolescents aged 10-16 years from the general population in north-eastern France. 44 subjects (8.8%) had pertussis during childhood; and the sex ratio was 1 in these cases. Pertussis was significantly associated with a maternal history of respiratory disease, residence in a rural area and coal heating. In a multiple logistic regression model, a maternal history of respiratory disease was the only significant factor (p = 0.01), the number of siblings being of borderline significance (p = 0.06). No increase in respiratory symptoms or asthma prevalence was found in our subjects who had pertussis during childhood.

Adolescent↗

PubMed1991

The form and function of the Leydig cells in hypophysectomized rams treated with pituitary extract when spermatogenesis is disrupted by heating the testes.

The morphology and in-vivo function of the Leydig cells were studied in rams when spermatogenesis had been disrupted by a single exposure of the testes 20 days earlier to a temperature of about 42 degrees C for 45 min. To avoid complications due to changed negative feedback from the testes to the pituitary with consequent changes in the degree of gonadotrophic stimulation, ten of the animals (five heated and five unheated) were surgically hypophysectomized when the testes were heated and then treated twice daily with pituitary extract. Six intact rams (three heated and three unheated) were also studied. The heat-affected testes were about half the size of the unheated testes, and blood plasma flow was closely related to testis weight. There were no differences in the testosterone concentrations in spermatic venous blood, testicular lymph or rete testis fluid, or in oestradiol in spermatic venous plasma from heated or unheated testes. Consequently, testosterone secretion by the heat-affected testes was markedly reduced, and the concentrations in jugular blood were also lower in the heat-affected rams than in controls. The volume of the interstitial tissue was less in absolute terms in the heat-affected rams, but it made up a greater fraction of the testes. The absolute volume of the blood plus lymph vessels, and their fraction of the interstitial tissue were lower in the heat-affected testes, although there was no effect on their volume as a fraction of the whole testis. The heat-affected testes of the hormone-treated rams had fewer Leydig cells, but each cell was larger; no equivalent difference was found in the intact rams. However, the dose of pituitary extract chosen was somewhat excessive, as there were higher than normal concentrations of FSH, LH and testosterone in jugular blood plasma, of testosterone and oestradiol in testicular venous blood plasma and of testosterone in rete testis fluid in the hormone-treated hypophysectomized rams. The testes of the unheated hypophysectomized rams increased in size by about 20% during treatment with pituitary extract, although testicular blood plasma flow was lower per unit weight of testis. The absolute volume of each Leydig cell and the total volume in absolute terms and as a fraction of the interstitial tissue was greater in the hormone-treated than in the untreated rams, but not the volume as a fraction of the whole testis. The total number of Leydig cells was higher in the hormone-treated unheated rams than in all the other rams taken together.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

PubMed1990

[Endosonographic staging of rectal tumors].

Pre-operative staging was performed in 81 patients with rectal tumours by means of endorectal sonography. In 87% of cases (70 out of 81), the endosonographic findings corresponded with the histopathological appearance; the recognition of T0 and 1 tumours, which is important in deciding surgical procedures, was possible in 94% (51 out of 54). Differentiation between T0 and T1 tumours (i.e. between adenomas and carcinomas infiltrating the submucosa) was not possible. Five out of ten of T2 and 14 out of 16 T3 tumours were staged correctly. One T4 tumour was placed in too low a stage. A comparison of the echo structure of adenomas and carcinomas in 76 patients showed that 28 out of 43 adenomas (65%) have homogeneous echoes, while 24 out of 33 carcinomas (73%) showed inhomogeneous low intensity echoes.

Adult↗

PubMed1989

Endoluminal ultrasonic examination of sessile polyps and early carcinomas of the rectum.

The results of conventional endosonographic techniques in the assessment of early carcinomas and sessile polyps of the rectum have been unsatisfactory. We therefore developed a new technique in which the rectal cavity is filled directly with water. Using this technique, the anatomy of small rectal tumors is preserved and the layers of the rectal wall are easier to differentiate, especially with a 10-MHz scanner. The clinical results in 66 patients demonstrate that this new technique is very accurate in the preoperative staging of adenomas and T1-carcinomas of the rectum.

Carcinoma↗

PubMed1989

[New endosonographic examination technic for improving the assessment of small rectal tumors].

Conventional endosonographic techniques of examination in early carcinoma and sessile rectal adenoma have shown unsatisfactory results. We therefore fill the rectal cavity directly with water. Using this technique the anatomy of the rectal polyp is preserved, and the separate layers are easier to differentiate, especially when the 10-MHz scanner is used. The clinical results in 56 patients show an improvement concerning the preoperative staging especially in those tumors which are not palpable.

Carcinoma↗

PubMed1988

Pulmonary function following mild respiratory tract infections ("common cold") in teenagers.

Ventilatory function--forced vital capacity (VC)--forced expiratory volume (in 1-sec forced expiratory flows) static lung volumes, closing volume, and phase III slope (single-breath N2 test) were compared in 94 children with and 436 children without a history of recent mild acute respiratory infection. Their age ranged from 10 to 16 years; subjects with symptoms on the day of the study were excluded. We found no difference in lung function between the two groups, with the exception of a slight (inconsistently significant) increase in closing volume (CV) and the CV/VC ratio. Although the influence of a persistent increase in interstitial lung pressure leading to early small airways closure cannot be ruled out, this isolated functional abnormality probably represents a spurious positive result, arising by chance when a large number of statistical tests are done.

Acute Disease↗

PubMed1988

[Endorectal sonography in rectal cancer].

35 patients with rectal cancer were examined in a prospective trial by endorectal ultrasound. In 27 patients the sonographic diagnosis of tumour penetration was correct as compared with histologic findings, in 7 patients infiltration depth was overestimated, and in one case underestimated. In 21 resected specimens, examined postoperatively in a water tank with the same equipment, ultrasonic examination was correct in 17; in no case was the infiltration depth underestimated. The different technical approaches in local sonographic staging of rectal cancer are discussed.

Humans↗