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Biomedical subjects

E G Hahn

Publications and source records attributed to E G Hahn.

At least 325 records · Page 18Linked to original sources
PubMed1997

[Changes in regional CNS perfusion in obstructive sleep apnea syndrome: initial SPECT studies with injected nocturnal 99mTc-HMPAO].

Some of the clinical features of obstructive sleep apnoea syndrome (OSA) are suggestive of impaired cerebral blood flow. Cerebral blood flow alterations might, for example, be responsible for headaches, which are frequent complaints in patients with OSA. Even the high frequency of ischaemic cerebral complications in patients with OSA might be caused in part by sleep apnoea-associated impairment of cerebral perfusion. Previous studies have demonstrated reduced total cerebral blood flow in patients with OSA, but regional changes of cerebral perfusion have not been studied up to now. We performed SPECT studies using 99mTc-(d,l)-hexamethyl-propylenaminoxim (HMPAO) as a tracer in 14 adult patients with moderate to severe OSA (AHI > 30/h; mean AHI 59.2 +/- 4.3). The injection of the tracer took place between 2:00 and 4:00 a.m. while repeated episodes of obstructive apnoea were detected by polysomnography during stage II sleep. Data acquisition took place at 7:30 a.m. All measurements were repeated some nights later under effective treatment with nCPAP. Visual analysis showed marked frontal hyperperfusion in 5 patients. When regional perfusion indices were calculated for 32 regions of interest statistical analysis showed reduced perfusion of the left parietal region. These changes were completely reversed by effective nCPAP therapy. These data suggest that OSA is associated with reversible changes of regional cerebral perfusion. The underlying pathophysiologic mechanisms are matter of speculation so far. There might be an apnoea-associated effect of local vascular autoregulation mechanisms acting to compensate systemic blood flow alterations or blood gas changes in OSA. The observed frontal hyperperfusion might be caused by activation of the frontal lobe by repetitive cortical arousals.

Adult↗
PubMed1997

Lipopolysaccharide of Helicobacter pylori protects gastric mucosa via generation of nitric oxide.

Lipopolysaccharide (LPS) has been proposed to act as the major virulence factor in Helicobacter pylori (Hp)-infected stomach but its action on mucosal integrity has been little studied. We determined the effects of LPS of Hp, expressing cytotoxic antigens CagA and VacA on acute gastric lesions induced by 100% ethanol, mucosal blood flow (GBF) and expression of constitutive nitric oxide (NO) synthase (cNOS) mRNA and inducible NO synthase (iNOS) mRNA in gastric mucosa using RT-PCR. Two major series (A and B) of rats were employed; A--with suppressed NOS activity by nonspecific NOS inhibitor, such as NG-nitro-L-arginine methyl ester, (L-NAME) (5 mg/kg i.v.), or by specific iNOS inhibitor, NG-(1-Immunoethyl) lysine (L-NIL) (30 mg/kg i.g.), or with inhibited induction of NOS activity by dexamethasone (2 mg/kg i.p.) and series B--vehicle (saline)-treated controls. LPS (0.01-1.0 mg/kg) given i.p. attenuated dose-dependently ethanol-induced mucosal lesions and this protective effect was accompanied by a rise in the GBF and excessive mucosal production and luminal release of NO. LPS (1 mg/kg i.p.) administered at lower dose (1 mg/kg i.p.) to rats without ethanol instillation significantly elevated GBF and luminal release of NO, while higher doses of LPS (20 and 40 mg/kg i.p.) or SNAP (6 mg/kg), which produced systemic hypotension, were not protective. Suppression of NOS activity by pretreatment with standard dose of L-NAME or L-NIL and inhibition of NOS induction by treatment with dexamethasone reversed the protective and hyperemic effects of LPS and this reversal was significantly antagonized by the addition of the substrate for cNOS, L-arginine, but not D-arginine. Administration of L-NAME, L-NIL or dexamethasone, completely abolished the enhanced mucosal NO production and the hyperemia induced by LPS in rats without or with topical application of ethanol. Expression of cNOS was detected by RT-PCR in the intact mucosa but intense signals for expression of both cNOS and iNOS were detected by RT-PCR in the gastric mucosa of LPS-treated rats. We conclude that parenteral LPS protects gastric mucosa from acute ethanol-induced damage via an increase in mucosal microcirculation mediated by NO due to the overexpression of iNOS and activation of arginine-NO-system.

Animals↗
PubMed1996

[Decision to use complementary medicine: fact oriented or irrational?].

PROBLEM AND OBJECTIVE: Complementary medicine is being used to varying extent in all industrial countries. There are incomplete data concerning efficacy, safety and costs of such treatment, while little is known about special features and motivation of those persons who choose complementary medicine. The aim of the study was to ascertain, among patients who use complementary medicine and those who prefer traditional medicine, any differences with regard to sociodemographic, disease-related and psychological characteristics and their life-style. PATIENTS AND METHODS: A total of 419 patients were studied by a standardised interview and questionnaire (168 items) and divided into two groups (group 1: those using conventional treatment [n - 197; 91 women, 106 men; average age 43.2 +/- 16.9 years]; group 2: those preferring complementary medicine [n = 222; 159 women, 63 men; average age 43.2 +/- 15.0 years]). They were recruited from specialist internal medical or generalist medical practice with or without offer of complementary medicine (additional term: natural healing methods). Statistical analysis was with Student's-t-test and the chi(2)-test [correction of gamma-test]. RESULTS: Those patients who chose to be treated by complementary medicine clearly differed from the others with respect to sociodemographic, disease-related and psychological characteristics, as well as life-style. The patient-doctor relationship also differed between the two groups. On average those of group 2 had a higher educational level (higher education: 10.3% in group 1; 15.9 in group 2) and lower risk factors (68.9% nonsmokers in group 1, 77.8% in group 2; alcohol abstinence: 33.2 vs 46.4%). Patients in both groups preferred conventional medicine for serious diseases (cardiac infarct; tumour; AIDS). CONCLUSIONS: In general, those patients who choose complementary medicine have a healthier life-style. As the number of these patients is on the increase. Since as yet the efficacy, risks and costs of complementary medicine have been inadequately investigated, research in this area should be intensified.

Adult↗
PubMed1996

[Prospective study of diagnosis, therapy and follow-up of acute gastrointestinal hemorrhage in 397 patients].

The mortality of acute GI hemorrhage in the literature varies considerably, depending on the study design and quality of the data evaluated. We therefore conducted a prospective study over 2.5 years of 397 patients with suspected acute GI hemorrhage at the University hospital of Erlangen for internal quality control. In 99% of cases diagnostic endoscopy identified one or more bleeding sources. 46% of the patients bled from duodenal or gastric ulcers, 21% from esophageal or gastric varices and 33% from other sources. 228 of the 397 patients (57%) were initially treated endoscopically, 76 patients (19%) experienced a recurrence of bleeding. Patients older than 60 years of age with a hemoglobin below 8 g/dl had a significantly higher rate of recurrent bleeding. The rate of complications during the hospital stay was 22% (n = 87), in-hospital mortality 17% (n = 68). The rates of recurrent bleeding (28 vs. 20%), complications (24 vs. 18%) and mortality (20 vs. 14%) were significantly higher for bleeding varices than for peptic ulcers. Patients with other causes of acute GI hemorrhage developed a recurrence of bleeding in 13%, complications in 26% and had a mortality rate of 19%. Bleeding varices as well as bleeding peptic ulcers and other causes of acute GI hemorrhage still have a high mortality and require intensive medical surveillance besides diagnostic and therapeutic endoscopy.

Acute Disease↗
PubMed1996

[Curcuma xanthorrhiza (Java tumeric) in clinical use].

The rhizome of Curcuma xanthorrhiza has been used for medical purposes for hundreds of years. A related plant, but which contains other constituents, is C. domestica, which is used in the manufacture of curry powder. Both experimental and clinical studies have revealed, in particular, a choleretic effect. In addition, in part in animal experimental studies, antilipidemic, analgesic-antiphlogistic and antimicrobial effects have also been found.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1996

[ICD diagnoses in university polyclinic naturopathy consultation].

In a special consulting office for complementary medicine, ambulatory patients interested in receiving adjuvant treatment with complementary medicine can obtain a relevant advice and critical information regarding non-evaluated therapies. Within the framework of a retrospective statistical analysis, the diagnosis documented over a period of 24 months in accordance with the 4-digit ICD code were evaluated. In particular patients with chronic and/or functional illnesses had additional treatment needs. The exponential growth in the numbers of patients during the course of the observation period illustrates the increasing importance of complementary medical measures. However, in view of the considerable political significance of the cost factor and the possible risks of the treatment, only properly evaluated complementary medical therapies should be employed.

Adolescent↗
PubMed1996

[Technical and clinical success with extracorporeal shockwave lithotripsy in pancreatic duct calculi].

BACKGROUND: Chronic pancreatitis is often complicated by concrements obstructing the main pancreatic duct. Duct obstruction is discussed as potential mechanism responsible for recurrent and persistent pain. PATIENTS AND METHODS: 75 symptomatic patients (15 female, 60 male; 46 +/- 12 years) with stones in the main pancreatic duct (solitary n = 23; multiple n = 52) primarily not endoscopically extractable even after sphincterotomy of the pancreatic orifice were treated by means of a piezoelectric lithotripter (Piezolith 2500). Fragmentation and stone clearance were documented by ERP. The clinical benefit was evaluated in 35 patients (9 female, 26 male; 45 +/- 12 years) followed up meanwhile for more than 12 (29 +/- 14) months. RESULTS: After 3 +/- 2 (1 to 10) ESWL-sessions/patient the concrements were fragmented successfully in 80% of the patients. Focussing of the stones was achieved sonographically (15%), fluoroscopically (45%) or using both imaging techniques (40%). In total, 61% of the patients became stone free, 44% spontaneously, in further 17% all remaining fragments could be removed endoscopically. In 39% of the patients only a partial extraction was achieved. Severe complications due to shockwave application did not occur. The majority of the patients (stonefree n = 22, remaining fragments n = 13) followed up > or = 12 months kept free of pain (51%) or reported on pain relief (26%). Nine patients developed 13 recurrent calculi, which were again treated successfully by interventional measures in 8/9 patients. CONCLUSIONS: The data confirm the value of extracorporeal shockwave lithotripsy as an important tool in the interventional therapy of chronic pancreatitis. Even if recurrent calculi may occur, the majority of patients will experience at least a medium-term profit by those measures due to pain relief.

Adult↗
PubMed1996

Color doppler ultrasound of liver lesions: signal enhancement after intravenous injection of the ultrasound contrast agent Levovist.

Patients with focal liver lesions (hemangioma, focal nodular hyperplasia, adenoma, hepatocellular carcinoma, metastatic lesions, focal fatty lesion) received the ultrasound contrast agent Levovist (300 mg/mL and 400 mg/mL) intravenously. This ultrasound contrast agent (a suspension of micrometer-sized microparticles of galactose and microscopic gaseous bubbles) can pass through the lungs without impairment. After the administration of Levovist, increased color flow signals were detected in the liver. Five of 6 patients with metastatic liver lesions showed previously undetected blood flow in the rim of the tumor. In 4 patients with hepatocellular carcinoma, enhanced signal intensity was observed in the vessels of the rim and in 3 of those patients in the center of the tumor. One patient with adenoma and one patient with focal nodular hyperplasia showed signal enhancement in the central area of the tumor. No signal enhancement was observed in hemangiomas, a focal fatty lesion, or in a carcinoid metastatic lesion. Levovist increased the echointensity of normal and tumor vessels in liver lesions. This new ultrasound contrast agent led to the detection of tumor vessels previously not detectable by conventional color flow imaging.

Adenoma↗
PubMed1996

High- and low-compliance balloon dilators in patients with achalasia: a randomized prospective comparative trial.

BACKGROUND: Pneumatic dilation is the most effective nonsurgical method for treatment of achalasia. The most serious complication of this procedure is esophageal perforation, which occurs in about 5% of cases. We completed a randomized prospective comparative trial with a high-compliance latex balloon (HCB) mounted on an endoscope (40 mm maximum distension diameter, 6 psi inflation pressure) and a low-compliance balloon (LCB) (35 mm, 20 psi) with respect to efficacy and side effects. METHODS: Twenty-five patients (13 treated with HCB, 12 treated with LCB) were included. The symptom score was assessed both before and after dilation, biannually, for up to 2 years, and complications were graded for severity. All dilations lasted for 3 minutes and were performed under direct endoscopic control. Patients were randomly assigned to the two different balloon types. RESULTS: One perforation was observed in the LCB group (not significant between HCB and LCB). Superficial mucosal tears appeared in 40% of all dilations. Initial dilation treatment was successful in 20 of 25 (80%) patients (10 of 13 HCB, 10 of 12 LCB). There were no significant differences in the median pretreatment and post-treatment symptom scores. Three patients required repeated dilations during the observation period. They were treated with the competing balloon system and showed no difference compared with the initial posttreatment symptom score. CONCLUSIONS: No significant difference could be demonstrated between the HCB and LCB system as far as the complication rate and the clinical outcome are concerned. In consequence, both systems appear equally effective, although the endoscope-mounted system (HCB) can be handled more easily.

Adult↗
PubMed1996

Self-expanding metal stents for palliation of malignant obstruction in the upper gastrointestinal tract. Comparative assessment of three stent types implemented in 96 implantations.

Self-expanding metal stents provide a new option for the palliative treatment of malignant stenoses from tumors of the esophagus. Our present study provides a comparative assessment of clinical experience gained consecutively in the implementation of three stent versions in a total of 87 patients and 96 implantations. Thirty-one Wallstents (Scheider, Lusanne, Switzerland) (five coated) were implanted in 23 patients, 35 Ultraflex stents (Boston Scientific, Boston, MA, U.S.A.) (uncoated) in another 34 patients, and 30 Gianturco-Z stents (Cook, Winston-Salem, NC, U.S.A.) (all coated) in a group of 30 patients. In the three patient groups there were no significant differences as to the degree of dysphagia, number of pretreatments, length of the tumor stenosis, tumor location, or histological classification. Seven patients who had been treated with Gianturco-Z stents presented with an esophagorespiratory fistula. Technically, all 96 implantation procedures were successful. Complete sealing of the fistulas was verified by radiography in all patients who had developed fistulas. Severe early complications in the form of stent migration were encountered in only three of 96 implantations (3%). Within the early period after stent placement in five patients of the Wallstent group (22%), 13 patients of the Ultraflex group (37%), and three patients of the Gianturco group (10%), retreatments were necessary due to stent dislocation and/or insufficient stent expansion. The degree of dysphagia improved distinctly and with a comparable development in all three patient groups. The rate of reintervention (percentage of patients) due to major and minor problems in the follow-up period amounted to 43% (Wallstents), 35% (Ultraflex stents), and 21% (Gianturco-Z stents). In view of the low number of complications (3%) in the early stage of implantation, self-expanding metal stents provide an improved approach for palliative therapy of malignant stenoses of the esophagus. Nevertheless, further technological improvements are necessary to reduce the great frequency of unavoidable reinterventions (20-43%) in the follow-up period.

Adult↗
PubMed1996

Correlation of polypoid lesions in the distal colorectum and proximal colon in asymptomatic screening subjects.

OBJECTIVE: Knowledge of a possible correlation between distal polyps found at screening sigmoidoscopy and proximal colonic lesions is important for deciding whether to perform total colonoscopy or not. PATIENTS: A prospective analysis of 2439 consecutive patients with colorectal polyps. Of these, 304 were asymptomatic subjects who underwent complete colonoscopy for screening and were found to have adenomatous or hyperplastic polyps in the distal colorectum. RESULTS: Ten (15%) out of 65 patients with distal hyperplastic polyps only and 86 (36%) out of 239 with distal adenomatous polyps were found to have adenomatous polyps in the proximal colon as well (P < 0.001). The frequency of synchronous proximal adenomas in patients with small (< or = 5 mm) or large distal adenomas (> 5 mm) was comparable (37% and 35%, respectively). However, patients with small distal adenomas had significantly smaller proximal adenomas (P = 0.004) containing less villous component (P = 0.017) than those with large distal adenomas. Neither the patient's age nor the presence of multiple distal adenomas increased the prevalence of proximal adenomas. CONCLUSION: Hyperplastic polyps found on rectosigmoidoscopy do not indicate a need for a complete colorectal examination, as 15% of patients with distal hyperplastic polyps will have proximal adenomatous polyps, a figure that is comparable with that of asymptomatic patients having no distal polyps, either hyperplastic or adenomatous. When only small distal adenomas are found at screening sigmoidoscopy in asymptomatic persons the decision to do a total colonoscopy should be based on individual considerations, as in such cases only small polyps are to be expected in the proximal colon.

Adenomatous Polyps↗
PubMed1996

Acceleration of wound healing in gastric ulcers by local injection of neutralising antibody to transforming growth factor beta 1.

BACKGROUND: Application of neutralising antibodies (NAs) to transforming growth factor beta 1 (TGF beta 1) improves wound healing in experimental glomerulonephritis and dermal incision wounds. TGF beta 1 has been detected in the stomach, but despite the fact that this cytokine plays a central part in wound healing no information is available to determine if modulation of the TGF beta 1 profile influences the healing of gastric ulcers. This study examines gastric ulcer healing in the rat after local injection of NAs to TGF beta 1. METHOD: Chronic gastric ulcers were induced in Wistar rats by the application of 100% acetic acid to the serosal surface of the stomach. Immediately after ulcer induction and on day 2, NAs to TGF beta 1 (50 micrograms), TGF beta 1 (50 ng), saline or control antibodies (IgG; 50 micrograms) were locally injected into the subserosa. Controls received no subserosal injections. Animals were killed on day 5 or 11, the ulcer area was measured planimetrically, sections were embedded in paraffin wax, and stained with trichrome or haematoxylin and eosin. Depth of residual ulcer was assessed on day 11 by a scale of 0-3, the percentage of connective tissue was determined by a semiquantitative matrix score and granulocytes and macrophages in the ulcer bed were also assessed. RESULTS: The application of NAs to TGF beta 1 led to a significant acceleration of gastric ulcer healing on day 11 (0.6 (SD 0.8) v 3.7 (SD 2.6) mm2), a reduction in macrophages (23.7 (SD 22.6) v 38 (26) per 40 x power field) and granulocytes (8.5 (SD 5.6) v 20 (10) per 40 x power field), fewer histological residual ulcers (mean 1 (SD 0.9) v 2 (1.1)), a reduced matrix score, and a regenerative healing pattern. Excessive scarring was seen in the TGF beta 1 treated group. CONCLUSION: Further treatment of gastric ulcers may induce a new treatment modality by local injection of NA to TGF beta 1 in an attempt to accelerate and improve ulcer healing.

Animals↗
PubMed1996

'Functional relaxation' reduces acute airway obstruction in asthmatics as effectively as inhaled terbutaline.

BACKGROUND: 'Functional relaxation' (German: 'Funktionelle Entspannung') has been developed since 1944 by the German physiotherapist M. Fuchs. It is based on concentrating on body perception while moving the joints of the skeleton smoothly and at the same time breathing out. This procedure induces a physical and emotional relaxation in many cases. The aim of the study was to compare the efficiency of standardized elements of a somatopsychotherapy (eFE) and a standardized bronchodilatative test using terbutaline (IT). METHODS: Seventeen asthmatic patients with acute airway obstruction had either IT or eFE on 2 consecutive days. Airway resistance (R(aw)) was measured before and after IT and eFE. It was used for statistical evaluation as it is independent of the patient's will. RESULTS: Although both therapies lead to a significant mean decrease in R(aw) (p < 0.01), the comparison revealed no superiority of one over the other (ANOVA on repeated measurements, p > 0.78). CONCLUSIONS: This study supports the benefit of psychosomatic therapy in the relief of asthma and the procedure can be used as an easy-to-learn relaxation technique to be used during acute asthmatic airway obstruction.

Adult↗
PubMed1996

Expression of epidermal growth factor and transforming growth factor-alpha after exposure of rat gastric mucosa to stress.

BACKGROUND: This study was designed to determine whether transforming growth factor-alpha (TGF-alpha), epidermal growth factor (EGF), and their common receptor (EGFR) are involved in the recovery of the gastric mucosa after exposure to water immersion and restraint stress. METHODS: Wistar rats were exposed to a standard period (3.5 h) of water immersion and restraint stress. Animals were killed immediately or 2 h, 4 h, 6 h, or 12 h after the stress. Tissues were removed, the area of the ulcerations was measured planimetrically, half of the stomach was taken for measurement of DNA synthesis, and the other half was embedded in paraffin. Sections were stained immunohistochemically for proliferating nuclear antigen (an index of cellular proliferation) and TGF-alpha, EGF, and EGFR. RESULTS: A single stress insult resulted in numerous haemorrhagic erosions in the oxyntic mucosa and a significant drop in DNA synthesis. During the recovery phase a marked increase in the expression of EGF peaked at 4 h, whereas the expression of EGFR peaked 6 h after stress. Thereafter the labelling indices for EGF and EGFR decreased, whereas DNA synthesis showed a gradual increase starting after about 6 h and peaking 12 h after the stress. In contrast, immunohistochemical expression of TGF-alpha showed a constant increase for up to 12 h after stress. Cell proliferation reached a maximum after 6 h and returned to normal values 12 h after the stress. CONCLUSIONS: EFG and TGF-alpha and their receptors are involved in the mucosal recovery from stress, and this is followed by enhanced DNA synthesis and mucosal cell proliferation.

Animals↗