Search PubMed⌕ Search

Biomedical subjects

G Holtmann

Publications and source records attributed to G Holtmann.

At least 91 records · Page 5Linked to original sources
PubMed1996

[Value of parametric esophageal scintigraphy with multi-swallow technique in comparison with esophageal manometry].

Diagnosis of esophageal motility disorders is difficult due to the large physiologic variability of bolus transport. With the help of a parametric multiple swallow technique (introduced by Tatsch), using "condensed images" of each single swallow action before creating a "mean image" of six swallows, this problem can be solved. For testing this relatively new method, 12 patients underwent 16 pairs of parametric esophageal scintigraphy and esophageal manometry. This collective of patients consisted of 4 with achalasia and secondary hypomobility of the tubular esophagus, 7 with unspecific esophageal dysfunction confirmed by manometry and 1 with clinical dysphagia and normal status in manometry. Fourteen of 15 pathological manometric findings could be confirmed with parametric scintigraphy. Esophageal manometry was false negative in one case and esophageal scintigraphy in another one case. The calculated emptying rates 10 and 12 s after beginning of swallowing are (mean +/- SD) 56 +/- 34% and 60 +/- 34% respectively for solid meal and 54 +/- 25% 57 +/- 22% respectively for liquid meal. Of 60 emptying rates, 48 are in the pathologic range of less than 80%. As expected, no significant difference was found between emptying rates after 10 and 12 s (two-tailed matched pairs t-test. 5% significance level). In conclusion, parametric esophageal multiple swallow scintigraphy has been proven to be a non-invasive and sensitive tool for pre- and posttherapeutic care of patients with esophageal motility disorders. It should be mentioned that esophageal scintigraphy can give additional information in some cases of normal esophageal manometry.

Administration, Oral↗
PubMed1996

A prospective randomized experimental evaluation of three-dimensional imaging in laparoscopy.

BACKGROUND: Restricted depth perception in laparoscopy with two-dimensional imaging has been reported to be a major disadvantage of minimally invasive procedures. Three-dimensional imaging units have been available for almost 2 years and are slowly being integrated into endoscopic surgery. So far, potential advantages or disadvantages have not yet been studied prospectively. METHODS: We evaluated the effects of three-dimensional imaging on surgical performance and its influence on surgeons at different experience levels in a prospective randomized trial. Twenty participants without laparoscopic experience (novices), 20 with less than 50 laparoscopic procedures (beginners), and 20 with more than 50 laparoscopic procedures (advanced surgeons) took part in two different tests (tube test and loop test) on a pelvitrainer. In random order, each test was conducted using a three-dimensional imaging unit under two-dimensional and three-dimensional conditions. During each test, the time was measured and the mistakes counted. The difference of time and number of mistakes for two-dimensional and three-dimensional conditions were calculated for each participant. RESULTS: Speed (p < 0.0001) and accuracy (p < 0.0001) were significantly better under three-dimensional conditions irrespective of the randomized sequence of each individual test. Speed was also influenced by individual experience (p > 0.02). Performance time decreased by 24.4% +/- 2.8% (m +/- SD), and the number of mistakes decreased by 52.5% +/- 27.9% (m +/- SD), as compared with the two-dimensional mode, with no significant influence of individual experience. CONCLUSIONS: Three-dimensional imaging significantly improves performance (speed and accuracy) regardless of previous laparoscopic experience. Thus, three-dimensional imaging may further improve the safety aspect of minimally invasive surgery.

Analysis of Variance↗
PubMed1996

Nutrients and cyclical interdigestive pancreatic enzyme secretion in humans.

BACKGROUND AND AIMS: It is hypothesised that nutrients increase pancreatic enzyme secretion by converting cyclical interdigestive secretion to a non-cyclical pattern. This study tested the hypotheses that nutrients do not interrupt cycles and determined the relation of nutrients, calories, and osmotic load to the rate of pancreatic secretion. METHODS: Twenty six healthy persons were intubated with oroduodenal and orogastric tubes. Each had one of four different solutions containing 12 to 36% of calories as protein, 24 to 48% as fat, and 40 to 64% as carbohydrate infused into the duodenum at 40, 90, or 160 kcal/h for 300 minutes. Nine g/l sodium chloride (290 mOsm) was added to 16 infusates; osmolality of the other 10 infusates was 24 to 98 mOsm. Pancreatic enzyme outputs were measured every 15 minutes and peaks of enzyme secretion were identified. RESULTS: The number of enzyme peaks was similar for the different infusates and the proportion of nutrients in the infusates did not affect secretion of individual enzymes. The nadir, but not the peak of the cycles of enzyme outputs correlated with increasing the caloric load (r = 0.55, p < 0.003 for nadir:peak ratio). Increasing osmolality did not affect cycling but reduced (p < 0.001) enzyme output. CONCLUSION: Nutrients entering the duodenum do not abolish cycles of enzyme secretion; instead they modulate cycles by increasing the nadir. Forty and 90 kcal infusions submaximally stimulate pancreatic secretion and might be used in patients with pancreatitis without producing pain; adding sodium chloride to solutions should increase this effect.

Amylases↗
PubMed1996

Impaired small intestinal peristaltic reflexes and sensory thresholds are independent functional disturbances in patients with chronic unexplained dyspepsia.

OBJECTIVE: To study disturbances of gastrointestinal motility and afferent (sensory) dysfunction in functional (unexplained) dyspepsia, and the interrelationships between motility and sensory dysfunction. METHODS: Twelve patients with functional dyspepsia and 12 controls matched for age and gender were studied. Intestinal perception thresholds were tested by a standardized stepwise distension procedure in the third portion of the duodenum with a barostat device. Small intestinal motility was measured with a low compliance perfusion system proximal and distal to the distending balloon. RESULTS: First perception of duodenal balloon distension occurred at significantly (p <0.01) lower pressures in patients (23 +/- 3 mm Hg, mean +/- SEM) than in healthy controls (31 +/- 3 mm Hg). Patients had a lower maximal intestinal pain tolerance than controls (31 +/- 2 mm Hg vs. 39 +/- 1 mm Hg, p <0.05). Duodenal distension inhibited intestinal motility distal to the distending balloon (peristaltic reflex) more often in health controls (11/12) than in patients with functional dyspepsia (5/12, p <0.05). These alterations of small intestinal motility occurred at pressure values below the perception thresholds, and disturbed motility responses were not associated with perception thresholds. CONCLUSION: Disturbed peristaltic reflexes and decreased sensory thresholds for perception of intestinal sensations are prevalent but may be independent abnormalities in patients with unexplained dyspepsia.

Adult↗
PubMed1996

[Are proton pump inhibitors superior to H2 receptor antagonists within the scope of H. pylori eradication therapy? Meta analysis of current parallel group comparisons].

The combined treatment with acid lowering drugs and antibiotics is widely accepted for H. pylori-eradication therapy. There are, however, controversies regarding the influence of the acid lowering drug on H. pylori-eradication rates. Therefore, this meta-analysis aimed to assess the available parallel-group eradication studies with proton pump inhibitors and H2-receptor antagonists and to compare H. pylori-eradication rates for both classes of acid lowering drugs. METHODS. We performed a broad based medline search to retrieve all published treatment trails for H. pylori-infection. In addition, a manual search of the abstracts of major national and international meetings was conducted. In total seven publications of eight comparisons with a parallel group design comparing H2-receptor antagonists and proton pump inhibitors plus antibiotics with a total of 538 patients were identified. Non parametric tests were utilized to assess the influence of the acid lowering drug on eradication rates. Furthermore, logistic regression adjusting for duration of antibiotic treatment and the number of antibiotics was used to compare the different acid lowering drugs. RESULTS. All studies utilized omeprazole as the proton pump inhibitor with doses ranging from 20 mg/die to 2 x 20 mg/die. Ranitidine (with doses ranging from 2 x 150 mg/die to 2 x 300 mg/die) was used in six trials and nizatidine (2 x 300 mg/die) in one trial. H. pylori was successfully eradicated in 78.6% (95% 73.6-83.5) with the proton pump inhibitor and in 76.5% (95% Cl 71.4-81.5) in patients treated with the H2-receptor antagonists. Utilizing two antibiotics instead of one antibiotic significantly increased eradication rates by 16.1% (95% Cl 9.3-22.8, p < 0.001). However, neither in protocols with one nor in protocols with two antibiotics the eradication rates significantly differed for regimens using H2-receptor antagonists or proton pump inhibitors. CONCLUSION. H. pylori-eradication rates for treatment protocols with one or two antibiotics in combination with an acid lowering drug are not different for the proton pump inhibitors or h2-receptor antagonists. Therefore, the question whether H2-receptor antagonists or proton pump inhibitors should be used in combination with antibiotics for H. pylori eradication therapy is without clinical relevance.

Anti-Ulcer Agents↗
PubMed1995

Perception of gastric distension. Influence of mode of distension on perception thresholds and gastric compliance.

Gastric distension has been used to evaluate gastric sensory function in humans, but the methodology is poorly validated and studies in vivo comparing different distension protocols are lacking. We aimed to compare the influence of the mode of gastric distension on sensation and gastric compliance utilizing a barostat device. In seven healthy volunteers, we positioned a barostat bag in the proximal stomach and tested in random order (in triplicate) four different distension protocols: (1) standard ramp distension with 4 mm Hg pressure step increments of 20 sec duration; (2) slow ramp distension with 2 mm Hg pressure increments of 40 sec duration; (3) random distension using a pressure ramp consisting of 2 mm Hg increments of 40 sec duration with randomly interposed pressure steps 50% below the preceding pressure step; and (4) rapid random distension with 4 mm Hg pressure increments of 10 sec duration with randomly interposed pressure steps 50% below the preceding pressure step. The distension procedures yielded mean airflow rates during the different distension protocols between 2.4 ml/sec for standard ramp and 18.4 ml/sec for rapid random distension. First perception and maximal tolerable pressure were 10.9 +/- 1.1 mm Hg and 19.6 +/- 1.5 mm Hg, respectively. First perception and maximal tolerable pressures were significantly correlated (r = 0.93, P < 0.005). The gastric pressure at occurrence of perception and the maximal tolerated pressure were not significantly different for the different distension protocols but gastric compliance was significantly reduced during rapid ramp distension (P < 0.01 vs slow ramp and P < 0.05 vs random distension) but not during standard ramp distension. We conclude that gastric sensory pressure thresholds as assessed by isobaric distension are not influenced by the mode of distension. The high correlation of pressure thresholds at first perception and maximal tolerated distension suggest a single population of gastric mechanoreceptors that mediate first sensation at low intensity stimulation and pain at intense stimulation.

Adult↗
PubMed1995

Report of a case with giant condyloma (Buschke-Löwenstein tumor) localized in the bladder.

Giant condyloma is a variation of condylomata acuminata caused by a sexually transmitted virus infection. Although it is a benign disease, it carries a risk of malignant transformation. Primary locations of giant condyloma are the perianal region and the external genitalia. Bladder involvement is rare. We report on a patient with multiple sclerosis in whom a giant condyloma developed in the bladder. Systemic immunosuppression for the treatment of multiple sclerosis and/or chronic cystitis as a result of neurogenic bladder dysfunction might be a risk factor for the development of giant condyloma of the bladder.

Adult↗
PubMed1995

Gastrointestinal problems in airline crew members.

The presence of intestinal and extraintestinal symptoms was investigated by a symptom questionnaire in crew members (n = 190) - and as controls in age and sex matched ground based administrative employees (n = 100) - of a charter carrier and was related to the actual flight schedule of the flying staff during one month. In addition, health and illness behaviors and personal, job and life satisfaction were assessed and related to symptom scores and flight schedules. Flying staff did report significantly more dyspeptic symptoms than did ground staff, and this was found mainly with long-distance flying, since staff with short-haul experience only did not report as much upper intestinal complaints. Also, cabin crew reported significantly more intestinal symptoms than did cockpit members, and part of the upper GI symptoms could be explained by different eating behaviors, specifically more fibre intake in flying staff. With increasing intestinal symptom frequency, doctor visits and sick-days increased, and satisfaction with job and personal life decreased. Flying staff had, however, more awareness of the importance of health behaviors. It is concluded that frequent flying specifically on long distances may result in increased intestinal symptoms, presumably due to time-shift.

Absenteeism↗
PubMed1994

Dyspepsia in healthy blood donors. Pattern of symptoms and association with Helicobacter pylori.

Whether Helicobacter pylori is causally linked to dyspepsia remains controversial. The aims of this study were to assess in healthy blood donors the prevalence of dyspepsia and dyspepsia subgroups, determine if H. pylori is associated with different categories of dyspeptic symptoms, and evaluate the association between dyspepsia and nicotine, alcohol, and analgesic use. Consecutive blood donors (N = 180) who had no clinical evidence of organic disease were included. Abdominal symptoms were measured by means of a standardized questionnaire that has been previously validated. Subjects with dyspepsia (defined as pain localized to the upper abdomen) were further subdivided into those with ulcer-like, dysmotility-like, reflux-like, or nonspecific dyspepsia. A total of 65 subjects reported abdominal pain or discomfort during the prior 12 months [36.1%, 95% confidence interval (CI) 29.1-43.1]; 44 subjects (24.4%, 95% CI 18.2-30.7) had dyspepsia. Dysmotility-like, reflux-like, and ulcer-like symptoms were reported by 19.4% (95% CI 13.7-25.2), 17.2% (95% CI 11.7-22.7), and 16.7% (95% CI 11.2-22.1) of subjects with dyspepsia, respectively. Fifty-seven subjects (31.7%, 95% CI 24.9-38.5) were H. pylori positive; 26% of subjects with H. pylori and 24% without H. pylori had dyspepsia (P > 0.50). The seroprevalence of H. pylori was also similar among the different categories of dyspepsia. We conclude that infection with H. pylori is not associated with abdominal complaints in otherwise healthy subjects.

Adolescent↗
PubMed1993

[Effect of the prostaglandin E2 analog nocloprost on motility and acid clearance of the tubular esophagus in man].

UNLABELLED: The effects of the E2 prostaglandin nocloprost (9b-chloro-16,16-dimethyl-prostaglandin E2) on esophageal motility and acid clearance were evaluated in a double-blind placebo controlled study in six healthy volunteers. Motility of the tubular esophagus was measured by means of a low compliance perfusion system (four channels, recording ports 10 cm apart, the distal localized in the stomach). After eight hours fasting and a 60-minutes baseline measurement (with standardized swallowing of 5 cc water every three minutes) the volunteers swallowed on two separate days in randomized order either 200 micrograms nocloprost (solved in 50 cc water) or placebo. Then the motility of the tubular esophagus was assessed for another 60-minutes during standardized swallowing. Thereafter, the motility probe was removed and a pH-electrode placed 10 cm above the lower esophageal sphincter. In order to assess the esophageal clearance, four times 5 cc of 0.1 N HCl were infused into the esophagus 10 cm above the electrode and the time between the infusion of HCl and the increase of the pH above pH 4.0 measured. RESULTS: In five out of six volunteers the duration of esophageal contractions were decreased after administration of nocloprost as compared to placebo (6.23 +/- 1.2 vs. 5.80 +/- 1.1 seconds, p = 0.07). In contrast, neither propagation velocity, nor amplitude of contraction or acid clearance were significantly affected by nocloprost. CONCLUSIONS: These findings suggest that in healthy volunteers nocloprost changes the pattern of esophageal contractions (duration) without affecting amplitude, velocity of propagation or acid clearance.

Adult↗
PubMed1993

[Y1 receptors mediate inhibitory and stimulatory effects of peptide YY in isolated small intestine and large intestine muscles of the rabbit].

Peptide YY has been shown to have stimulatory and inhibitory effects on gastrointestinal motility. However, the receptors mediating these effects are unknown. To determine if specific YY receptor agonists can mediate the effects on gastrointestinal motility we studied the effects of peptide YY (PYY), of Pro34PYY, a selective Y1 agonist, and of PYY 3-36, a selective Y2 agonist, on the motility in isolated smooth muscle strips from rabbit small and large intestine. In strips from distal colon, PYY stimulated spontaneous motility whereas it inhibited spontaneous contractions in circular strips from distal ileum. In distal circular colon maximal inotropic response (10.1 +/- 2.1% of a maximal response to carbachol 10(-5) M) was found at PYY 10(-8) M; (ED50 3.1 +/- 1.2 x 10(-9) M). In distal circular ileum maximal inhibition (by 39 +/- 20% of basal motility index) was found at 10(-7) M; (ID50 6.2 +/- 1.4 x 10(-9) M). PYY caused a dose-dependent inhibition of the on-contraction induced by electrical field stimulation. This inhibition could not be reversed by alpha- or beta-adrenergic blockade. PYY had no influence on the inotropic response evoked by carbachol. Both the stimulatory effect of PYY observed in distal colon and the inhibitory effect in distal ileum could be reproduced by the Y1 agonist Pro34PYY, but not by the Y2 agonist PYY 3-36. In distal circular colon the maximal inotropic response evoked by the Y1 agonist was 10 +/- 1.4%; (ED50 1.2 +/- 0.5 x 10(-8) M).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗