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Biomedical subjects

G Lepsien

Publications and source records attributed to G Lepsien.

At least 37 records · Page 2Linked to original sources
PubMed1992

Clinical and radiological findings in Gardner's syndrome: a case report and follow-up study.

Gardner's syndrome is characterized by colorectal adenomas, multiple osteomas, especially of the skull, and various soft-tissue tumours. The disease is inherited as an autosomal dominant disorder and all untreated patients will develop colorectal adenocarcinomas. Since the clinical and radiological stigmas in the maxillofacial area, such as exosteal and endosteal osteomas, skin cysts, atypical skin pigmentation and abnormal dental findings or radiopaque lesions can precede the often symptomless adenomas for many years, dentists, maxillofacial surgeons and radiologists should be familiar with the manifestations of this disease. A case is reported to illustrate the dentist's role in the diagnosis of Gardner's syndrome. In a follow-up study of 11 patients with colorectal adenomas, the typical triad of features of Gardner's syndrome was found in eight. In six patients, bony changes were demonstrated by panoramic radiography. It is proposed that radiography of the jaws may serve as a valuable tool for the early detection of carriers of Gardner's syndrome.

Adenomatous Polyposis Coli↗
PubMed1992

[Endoscopic hernia repair].

A laparoscopic procedure for surgical hernia repair is reported. In comparison to other methods we do not only remove the peritoneal sac, but close although the inguinal canal with a nonresorbable marlex mesh. Up to now we practiced this technique in 35 patients. First post-operative results are encouraging but nothing can be said about longterm results, especially the recurrence rate.

Adolescent↗
PubMed1991

[Fatal infection after splenectomy despite reimplantation of splenic tissue].

A fatal case of a postsplenectomy sepsis is presented which occurred in a 5-year-old boy 11 month following splenectomy due to trauma and reimplantation of splenic tissue. The patient died 4 h after admission to the hospital. The post mortem revealed an encephalitis and a sepsis although splenic regenerates were found in the omentum pouch. Our report increases the number of cases described to date in the literature to a total of 18. Autologous reimplantation of splenic tissue does not offer complete protection against over-whelming infection.

Brain↗
PubMed1991

Treatment of iatrogenic common bile duct injury during laparoscopic cholecystectomy through the laparoscopic insertion of a T-tube stent.

Iatrogenic injury to the common bile duct during laparoscopic cholecystectomy has previously necessitated an immediate laparotomy to alleviate bile leakage. In the course of 171 laparoscopic cholecystectomies performed at our hospital, intraoperative common bile duct injuries occurred in 2 patients. Each case was successfully treated using a laparoscopically placed T-tube, thus avoiding the need for a laparotomy. This novel intraoperative procedure successfully treated common bile duct injuries without resulting in postoperative complications.

Adult↗
PubMed1991

Real-time sonography of the mediastinum in adults: a study in 100 healthy volunteers.

Real-time sonography has proved to be a valuable tool in the evaluation of the mediastinum in children. In the literature there is a paucity of information on ultrasound examination of the mediastinum in adults. Using a 3.5-MHz sector scanner, we evaluated a new method for the examination of mediastinal organs in adults, which is practicable in routine as well as emergency diagnosis. The endpoints of this study were the visibility of mediastinal organs and the discomfort of the patient. In 100 healthy volunteers aged 20-40 years, the normal anatomy of the anterior and middle mediastinum was investigated. Neither the height nor the weight of the volunteers limited the examination. We found that this method causes no discomfort to the subject. Via the supra-, infra- and left parasternal approaches, anatomical structures of the mediastinum are visible in a high percentage of cases. To date, this method has proved its practicability in more than 250 patients suffering from blunt thoracic trauma, primary and metastatic tumours, and infections of the mediastinum.

Adult↗
PubMed1991

Contractile action of gastrin-releasing peptide on isolated preparations of human gastroduodenal muscle.

Mechanical activity was recorded in muscle preparations isolated from different regions of the human stomach (circular and longitudinal strips from fundus, corpus and antrum) and duodenum. Application of gastrin-releasing peptide (GRP, 10(-9) to 10(-7) mol/l) caused a concentration-dependent increase in the activity in all stomach strips, the height and the pattern of contraction was similar to the acetylcholine (ACh) responses (10(-7) to 10(-5) mol/l). Longitudinally cut duodenal strips were also excitable by GRP. Circularly cut duodenal strips, however, showed no responses to GRP. Both layers were excitable by ACh. The most prominent effect of GRP on longitudinal duodenal strips near the jejunum was a tonically appearing activation, which could reach up to 180% of the maximum ACh-induced activation.

Acetylcholine↗
PubMed1991

Bombesin--the most stimulating peptide of human gastric smooth muscle.

The mechanical activity of isolated muscle strips from different regions of 33 human stomachs was measured under auxotonic conditions. After application of bombesin (stepwise increases in organ bath concentrations 10(-9) to 10(-6) mol/l) the following in vitro effects were observed in human gastric muscle: (1) Bombesin stimulated both circular and longitudinal preparations from all regions of the human stomach and circular duodenum. (2) The quality of the responses to bombesin application was dependent on the general myogenic characteristics of the preparations of the different stomach regions. The contraction pattern changed at high bombesin concentrations in the organ bath to slower fluctuations. (3) Bombesin resulted in a maximal tonic response in the pyloric region preparations. An increase in tone was usually observed in the inner pyloric preparations, being typical for the region. (4) The effects of bombesin on the human stomach were stronger than the effects of many other regulatory peptides and of the reaction to acetylcholine. (5) The bombesin-induced effects were unaltered by pretreatment with atropine or TTX. (6) The response to bombesin frequently lasted for hours after washing before reassuming the original state.

Acetylcholine↗
PubMed1991

Cisapride effects on canine lower esophageal sphincter under various pharmacological pretreatments.

Cisapride (Ci) stimulates lower esophageal sphincter pressure (LESP). This study aims to test whether the effect of Ci on LES in vivo is still present if LES is relaxed by atropine (Atr) and nifedipine (Nife) prior to the administration of Ci. LESP was continuously recorded by manometry in 6 mongrel dogs with esophageal fistulae. Ci was given as an intravenous bolus following either Atr (40 micrograms/kg i.v.) or Nife (20 mg subl.) at the time of maximal LESP decrease (5/15 min later). Basal LES values ranged between 24.5 +/- 2.5 mm Hg (Atr group) and 23.8 +/- 3.9 mm Hg (Nife group). Following Atr, LESP decreased to a minimal value of 7.0 +/- 0.5 mm Hg; after Nife LESP decreased to a minimal value of 12.3 +/- 2.0 mm Hg. Additional administration of Ci was not able to reincrease LESP. We conclude that the action of Ci on LES cannot take place if (1) muscarinergic receptors are blocked by Atr and (2) the Ca2+ activation system is blocked by Nife. Our results suggest that the action of cisapride on LES, as its action on gastrointestinal smooth muscle cells, is mediated by postsynaptic enhancement of acetylcholine release.

Animals↗
PubMed1991

[Helicobacter pylori colonization in surgical patients].

The prevalence of Helicobacter pylori (HP) was examined in 387 patients undergoing endoscopy of the upper gastrointestinal tract. Of central interest was the question to which extent surgical intervention influences the colonisation of the gastric mucosa with HP. The bacillic status was appraised using double microbiological examinations, histological determination and the CLO-test. In 229 patients a 13C-urea-breath test was also carried out (sensitivity 98%). HP could be detected in 90% of all patients presenting with duodenal ulcers as well as in 70% of patients with gastric ulcers, whereas in those patients in whom a lesion of the upper gastrointestinal tract could be excluded through endoscopy. HP was found in only 27%. The prevalence of HP did not increase with age. In patients having undergone distal gastric resection due to gastric ulcers, HP was only rarely found (19%) in the mucosa in the vicinity of the anastomosis following removal of the apparently pathogenetically important antrum mucosa. There was no association between anastomosis ulcers and bacillic colonisation. Following selective proximal vagotomy in patients with duodenal ulcers, HP was found in 80% of all cases. In these patients there was also no association between recurrent ulceration and a HP-positive status. Our results describe the postoperative HP-status after different surgical procedures of ulcer therapy: whereas a distal gastric resection removes the antrum mucosa, which provides the necessary environmental milieu, the HP-colonisation rate after selective proximal vagotomy is similar to that in non-operated ulcer disease.

Adolescent↗
PubMed1990

[Pancreatico-pleural fistula. Clinical aspects and therapy of a rare disease entity].

We report of 2 patients with pancreatic-pleural fistulas in chronic pancreatitis. In both cases abdominal symptoms were missed, the primary clinical manifestation was a recurrent pleural effusion with a high content of amylase. Endoscopic retrograde cholangiopancreaticography is necessary for a precise evaluation of the fistula and is indispensable to the surgical therapy. Computed tomography and ultrasonography showed in both cases a pancreatic pseudocyst. Our recommendation is surgical therapy when the fistula is not closed spontaneously within 2 weeks. Both patients were successfully treated by a left pancreatectomy.

Adult↗
PubMed1989

Regulation of tumor necrosis factor gene expression in colorectal adenocarcinoma: in vivo analysis by in situ hybridization.

Tumor necrosis factor (TNF) produced by macrophages is thought to contribute to the host defense against development of cancer. However, since tumor cells themselves are able to produce TNF, it is conceivable that TNF may also play an adverse pathological role in carcinogenesis. To better understand the functional significance of TNF in neoplastic disease, we have determined the cellular source of TNF activity produced in 10 patients with colorectal cancer. Northern blot analysis of RNAs extracted from fresh biopsy specimens revealed detectable TNF mRNA levels in all instances. By using in situ hybridization of frozen sections, scattered cells expressing TNF mRNA could be discerned. Based on morphological criteria, these TNF-positive cells most likely belong to the macrophage lineage. Macrophages in normal tissue surrounding the tumor did not express TNF mRNA, suggesting that macrophage activation occurs locally at the site of neoplastic transformation. Immunohistochemistry using anti-TNF monoclonal antibodies revealed that less than 1% of tumor-infiltrating macrophages synthesize TNF protein. Thus we present evidence that in colorectal cancer only a small proportion of tumor-infiltrating macrophages produces TNF, indicating that the microenvironment of the tumor provides adequate, yet suboptimal, conditions for macrophage activation.

Adenocarcinoma↗
PubMed1989

[Does the stomach balloon modify the function of the esophagus and lower esophageal sphincter, stomach emptying and release of gastrointestinal peptides?].

The Willmen gastric bubble has been used as an adjunct to weight loss in morbidly obese patients. 35 patients with morbid obesity were studied with routine manometry, esophageal 24-h-pH-measurement, and gastric emptying studies before and 4 weeks after bubble placement. During emptying studies blood samples were taken to measure gastrin, PP, CCK, VIP, neurotensin and insulin. No patient developed heartburn or regurgitation after bubble placement. Esophageal motility and LES function remained unchanged. There was no important pathological gastroesophageal reflux before and after gastric bubble. The gastric emptying time of solid food was unchanged by gastric bubble placement and the emptying time of liquids was accelerated up to normal. In patients with fasting gastrin levels less than 20 pg/ml at the beginning of the first test we found no differences in gastrin release before and after bubble insertion. In patients with primary high fasting values gastrin release was significantly increased. CCK, VIP, neurotensin and insulin levels were unchanged. With PP we measured significantly raised fasting levels after gastric bubble. We conclude that esophageal and LES functions are not altered by Willmen gastric bubble placement and that primary retardation of fluids is changed to normal. Bubble induced gastric tension increases fasting PP. In case of high fasting gastrin the bubble leads to an extremely high food response without any clinical signs.

Adult↗
PubMed1989

[Long-term results following conservative and surgical treatment of infantile hypertrophic pyloric stenosis].

UNLABELLED: From 1960 to 1970, 314 children (male:female = 3.9:1) were treated in our hospital for infantile hypertrophic pyloric stenosis (IHPS) (group 1 operatively: n = 216; group 2 conservatively: n = 98). The aim of the present study was to evaluate whether patients with IHPS do frequently have complaints in the upper gastrointestinal tract at long term. RESULTS: 1. Using the patients' files, a retrospective analysis of the familiar predisposition, symptoms, course of treatment and duration of ward treatment was made. Mortality due to operation was 0%, the postoperative rate of complications was low. 2. 17-27 years after treatment, the patients were questioned as to their subsequent health. 175 returned questionnaires able to be evaluated. According to these, only few of these patients had the symptoms of delayed gastric emptying (frequent vomiting, nausea). The velocity of gastric emptying has been measured for 53 patients for both solids and fluids (2.2 MBq 99mTc Sn colloid in a standard solid meal or in 300 ml of apple juice). There was no significant difference between the two groups, and the results were comparable to normal controls. CONCLUSION: Surgical therapy is superior to the conservative one, since the patient feels better sooner, complications are seldom and correspond with the long-term results of conservative therapy.

Adolescent↗
PubMed1989

Incidence and frequency or complications and management of Meckel's diverticulum.

During the last 27 years, 84 patients with Meckel's diverticulum (MD) have undergone resection at our institution (incidental findings, n = 50; MD with complications, n = 34). The most frequent complications of MD were obstruction and diverticulitis. Analysis of records of patients revealed that MD is a rare intraoperative finding. The calculated incidence was 2.4 per cent, and the ratio of diverticulectomy to appendectomy was 1:55. A preoperative diagnosis of MD was rare (4 per cent). Only in those patients with hemorrhage were diagnostic procedures (angiography, scintigraphy and roentgenography) useful. Ectopic tissues occurred in 23 per cent of all patients and were observed more often in patients with complications of MD. There was a correlation between hemorrhage and gastric heterotopic tissue. Another correlation was found between invagination and pancreatic tissue as well as diverticulitis. Postoperative adhesions causing ileus was the main complication found after resection for MD (8 per cent), whereas no other severe complications were observed (no insufficiency). There was no death as a result of resection. Because of the low rate of postoperative complications and the latent risk of complications arising sometime during life in sporadic episodes, a prophylactic resection is indicated but is often performed too late because the primary endangered group for complications is children who are less than two years of age. Predominantly in those with hemorrhage, the base of the diverticulum should be carefully checked for heterotopic tissue to prevent further complications.

Adolescent↗
PubMed1988

[Pathogenesis and therapy of gallbladder perforation].

Findings on admission to hospital and after surgery recorded from 35 patients with gallbladder perforation were compared to findings obtained from 98 patients with cholecystitis, with a view to establishing determining factors in pathogenesis of gallbladder perforation and for the purpose of improving therapeutic strategies. That comparison was part of a retrospective analysis. Biological behaviours regarding perforation were found to be hard to assess, though "early operation" was found to reduce the risk of perforation and post-perforation lethality.

Adult↗
PubMed1988

[Double-blind study of the effect of cyclotropium bromide on the smooth musculature of the esophagus. Description of a test of spasmolytic action].

Esophageal manometry can be employed to quantify the effects of antispasmodics in human subjects. Because of this, the effects of intravenously administered ciclotropium bromide (CTB) or hyoscine N-butylbromide (HNB) on esophagus smooth muscles were tested by manometry against saline (placebo) in 10 healthy volunteers in a randomized double-blind study. Tolerance as well as efficacy of CTB and HNB were evaluated. CTB administered intravenously significantly reduced the peristalsis amplitude following dry and wet acts of swallowing for at least 90 min. HNB caused a similar reduction which lasted only for 10 min. No reduction was observed following placebo except for physiological fluctuations. This shows that intravenous CTB causes a long-lasting reduction of smooth muscle contractions following the act of swallowing. Following placebo the lower esophageal sphincter (LES) pressure was higher than baseline values during the entire 90 min measurement period. CTB administration resulted in a significant reduction of the LES pressure compared to placebo. After HNB administration there was an initial decrease of the LES pressure lasting 30 min which was followed by an increase. None of the 3 drugs affected systolic or diastolic blood pressure. The heart rate did not change following placebo. After HNB administration heart rate was elevated at 15 min but decreased thereafter and was significantly lower than the baseline value at 45 min and later. CTB caused a significant increase of the heart rate at all sampling times. This increase corresponds well with the side-effects reported by 7 of the 10 subjects.

Adult↗
PubMed1988

[Peptone stimulation of the lower esophageal sphincter in patients with reflux disease].

Twenty patients with gastroesophageal reflux disease (10 with compensated and 10 with decompensated gastroesophageal incompetence) were examined to determine if there was a correlation between the ability of physiological stimuli to tonicize the lower esophageal sphincter (LES) and the response to pentagastrin stimulation (Gastrodiagnost). The pressure of the lower esophageal sphincter as well as blood levels of the hormones/neurotransmitters gastrin, PP and VIP were determined after giving a 300 ml intragastral bolus of either 0.9% NaCl or 20% peptone solution. All patients exhibited per definitionem a positive common-cavity phenomenon on abdominal compression. Intravenous pentagastrin stimulated the LES in patients with compensated gastroesophageal incompetence (GI) but not in those with decompensated GI (p less than or equal to 0.0005). Esophagoscopy revealed a severe esophagitis in 80% of the patients with decompensated GI but in only 10% of the patients with compensated GI. Peptone stimulated the LES in patients with compensated GI (p less than or equal to 0.005) at 5, 10 and 15 minutes, pepton vs. NaCl). Neither NaCl nor peptone increased the tone of the LES in patients with decompensated GI. Peptone but not NaCl caused a significant increase of serum gastrin in all patients: there was no difference between the two groups. Neither NaCl nor peptone influenced VIP levels in peripheral blood. PP levels increased significantly in both groups following peptone. Physiological responsiveness of the LES can be inferred from the manometric data and the results of the pentagastrin test. A negative reaction to pentagastrin is associated with a loss of response to physiological stimuli.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗