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Biomedical subjects

G Lock

Publications and source records attributed to G Lock.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Liver histology in hepatitis C: correlation with different biochemical and virological parameters].

BACKGROUND AND AIM: According to the German consensus statement, the indication for treatment of HCV-RNA-positive chronic hepatitis C is not derived from histopathology but from elevated aminotransferases. The indication for liver biopsy has been discussed controversely. This study aimed at investigating the correlation between different biochemical and virological parameters and histological scores of inflammation and fibrosis in chronic hepatitis C. PATIENTS AND METHODS: In a retrospective study, data of 126 patients with chronic hepatitis C who had undergone liver biopsy between January 1994 and March 1998 were analyzed. Histology was interpreted according to a defined numerical score of inflammation and fibrosis by a single pathologist. Scores of fibrosis and inflammation were correlated with biochemical and virological parameters. RESULTS: Inflammatory grading showed a moderate but significant correlation with ALT (r = 0.33, p < 0.001), whereas staging of fibrosis did not correlate with ALT (r = 0.15). There was no association between grading or staging and HCV genotype (n = 110) or serum viral load (n = 57). Grading and staging showed a significant association with each other (p < 0.0001). CONCLUSION: Aminotransferases as "surrogate markers" reflect more or less the histological inflammatory activity but do not allow any estimation of the extent of fibrosis. Some patients may have a high inflammatory activity with low aminotransferases or high aminotransferases with low inflammatory activity. Virological parameters such as HCV genotype or viral load do not allow an estimation of histological findings. If prior to treatment of chronic hepatitis C liver biopsy is omitted and the decision for treatment depends solely on the measurement of surrogate markers, considerable misjudgement of the actual status of liver inflammation or fibrosis may result.

Adolescent↗
PubMed2000

[The sonographic picture of an echogenic liver is an indicator of pathologic glucose tolerance].

BACKGROUND: Almost all patients in departments of internal medicine routinely undergo abdominal ultrasound examination in which liver changes indicating hepatic steatosis are often detected. The aim of this study was to assess the occurrence of pathological oral glucose tolerance, manifest diabetes mellitus and other changes indicative of a metabolic syndrome in patients with sonographic signs of hepatic steatosis. PATIENTS AND METHODS: 577 patients were examined during a period of 6 months: 90 patients fulfilled the inclusion criteria. RESULTS: Among the 90 patients with echodense liver who were included in the study (42 female, 48 male) 36 patients presented with previous diagnosis of diabetes mellitus (40%). The oral glucose tolerance test was impaired in 19 patients (21%) and in four patients with manifest diabetes mellitus (4%). Among patients with echodense liver a high percentage presented with obesity and impaired fat metabolism. CONCLUSIONS: The large number of patients with an impaired oral glucose tolerance test converting to manifest diabetes, as well as the large number of patients with manifest disorders of fat metabolism suggest that screening for diabetes should be performed in patients who present with sonographic signs of hepatic steatosis.

Adolescent↗
PubMed2000

Pharmacokinetic interaction between proton pump inhibitors and roxithromycin in volunteers.

BACKGROUND: Triple therapy including two antibiotics and a proton pump inhibitor is a rational approach to the treatment of Helicobacter pylori induced peptic ulcer disease. The interaction of antimicrobial therapy and acid suppression is not yet well elucidated. AIMS: To investigate the effects of proton pump inhibitors on roxithromycin levels in plasma and gastric tissue under steady-state conditions in volunteers. METHODS: In two crossover studies omeprazole 20 mg b.d., lansoprazole 30 mg b.d., roxithromycin 300 mg b.d., and the combination of roxithromycin with either omeprazole or lansoprazole were administered to 12 healthy volunteers over 6 days. Blood plasma levels of the drugs were measured. In addition, roxithromycin concentrations were also determined in gastric juice and gastric tissue obtained during endoscopy. RESULTS: The proton pump inhibitors and roxithromycin did not alter the blood plasma pharmacokinetics of each other. When compared to roxithromycin administered alone, its combination with a proton pump inhibitor significantly increased the roxithromycin concentrations in gastric juice (3.0-5.0 microg/mL vs. 0.3-0.4 microg/mL) and gastric tissue (antrum: 3.8-4.0 vs. 2.8 microg/g, fundus: 5.9-7.4 vs. 4.2-4.4 microg/g). CONCLUSIONS: Proton pump inhibitors and roxithromycin do not alter the systemic bioavailability of each other. However, proton pump inhibitors increase the local concentration of roxithromycin in the stomach which may contribute to the clinically proven synergic beneficial action in eradication therapy of H. pylori.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2000

[The ultrasound centre as a medically and economically relevant alternative--a report of the Regensburg experience].

In most medical centres, ultrasonography is performed independently by several departments. In october 1997, the University hospital of Regensburg founded an ultrasound centre, integrating surgical and medical departments as well as the institutes for radiology and nuclear medicine. The aims of this centre were the concentration of organization, machines, financial resources, manpower and know-how, standardized training and quality, and strengthening of interdisciplinary cooperation in clinic, medical education and research. Booking, standardized reports and a joint archiving of reports are assisted by a collective computer system. Most examinations in the centre are performed by three all-day present gastroenterology, surgery and radiology residents who are supported by licensed sonographers of the other departments. Training is standardized, and the certification for ultrasound examinations is acquired after a test with theoretical and practical parts. The integration of various departments in the ultra-sound on-call service has led to significant savings. The pool of ultrasound machines is used jointly, department-specific resources for new machines have been put together. We are convinced that this way of a close interdisciplinary cooperation will result in improvements in quality, utilization of financial resources and clinical research.

Cost-Benefit Analysis↗
PubMed1999

[Fatal liver failure after corticosteroid treatment of a hepatitis B virus carrier].

HISTORY AND ADMISSION FINDINGS: A 69-year-old man, a known carrier of hepatitis B virus (HBV) after blood transfusion, developed increasingly severe jaundice with high transaminase levels after receiving steroids in high doses. Significant preceding conditions included chronic obstructive pulmonary disease, coronary heart disease, ulcerative colitis in remission and diabetes mellitus. On admission he was jaundiced and experienced pain on pressure below the right costal margin. INVESTIGATIONS: Serology demonstrated reactivated hepatitis B with an increase of the HBV-DNA concentration in serum, as well as seroconversion with HBe antigen, anti-HBc-IgM antibodies and absence of anti-HBe antibodies. DIAGNOSIS, TREATMENT AND COURSE: The history and serological findings indicated reactivation of the hepatitis B by the steroid treatment. Progressive liver failure developed. A marked reduction of virus particles in the blood occurred after a therapeutic trial with the nucleoside analog lamivudine, but the patient died of liver failure 30 days after admission. CONCLUSION: Steroids should be given to known hepatitis B carriers only if strictly indicated, because of the danger of acute deterioration of liver functions by reactivation of the disease with possibly fatal consequences. If steroids are administered, liver functions and serological hepatitis markers should be closely monitored so that any necessary treatment can be quickly initiated.

Adrenal Cortex Hormones↗
PubMed1999

["Cardiomegaly and pneumonia"--a misdiagnosis in long-standing achalasia].

HISTORY: A 65-year-old woman was admitted to another hospital with suspected status asthmaticus. While there was progressive respiratory failure, the chest X-ray showed bilateral congestion and infiltration with widened mediastinum and cardiomegaly. The patient was transferred to the authors' hospital after two days on ventilatory support because of suspected left-ventricular failure and pulmonary congestion with pneumonia. 30 years previously she had undergone a myotomy for achalasia. INVESTIGATIONS: Imaging of the oesophagus with water-soluble contrast medium, computed tomography of the thorax and gastroscopy revealed a siphon-like megaoesophagus (which had been misinterpreted radiologically as cardiomegaly) with a slightly open lower oesophageal sphincter. The pulmonary symptoms were thought to be due to aspiration pneumonia. TREATMENT AND COURSE: As there were no other reasonable treatment options a transmediastinal oesophageal resection with gastric pull-through and collar anastomosis was performed. CONCLUSION: In long-standing achalasia a megaoesophagus can develop despite previous myotomy. It should be included in the differential diagnosis of radiologically demonstrated mediastinal enlargement.

Aged↗
PubMed1999

[Parenteral and enteral nutrition in palliative medicine].

Artificial nutritional support does not alter the natural course in patients with malignant disease. The outcome of these patients is mainly determined by the type and stage of the underlying tumor. Progress of the underlying disease is often paralleled by malnutrition which in turn facilitates complications and may reduce survival and quality of life. Nutritional support can be applied to maintain body weight, immune function and quality of life. Enteral nutrition can be applied with a functioning gastrointestinal tract and has been proven to be superior compared to parenteral nutrition. Maintenance of intestinal mucosal function due to enteral substrate application prevents disruption of intestinal barrier function as well as the overgrowth of intestinal microorganisms. Using a step-by-step approach dietetic counselling in combination with augmented oral caloric intake should be the first measure. The next step to take is nutritional support by enteral tube feeding using formula diets. Parenteral feeding should only be used if other options to support caloric intake have failed.

Enteral Nutrition↗
PubMed1998

[Chronic, pseudocystically altered splenic hematoma as the cause of left-sided chest pain: successful therapy using alcohol instillations].

HISTORY AND CLINICAL FINDINGS: A 26-year-old man was admitted urgently because of breathing-related pain in the left thorax. This pain had started 3 months before, but had at first improved spontaneously. He had lost 13 kg during those weeks and had no recollection of any injury. Physical examination was unremarkable except for slight pain on upper-abdominal pressure and a palpably enlarged spleen. INVESTIGATIONS: All laboratory tests were normal, including the Quick value (100%), partial thromboplastin time (38 sec) and hemoglobin (14.2 g/dl). Chest radiogram showed a high left diaphragm. Abdominal sonography revealed a 12 x 10 cm moderately echogenic tumour in the spleen, extending from the splenic hilus to the upper splenic pole. Contrast-enhanced computed tomography demonstrated a hypodense tumour from which 300 ml of old blood were removed by needle puncture. Biopsy of the wall of the haematoma revealed pseudocystic transformation. TREATMENT AND COURSE: The pseudocyst again filled with blood in a few days. A drain was inserted and remained for 32 days. Six installations of alcohol achieved complete obliteration of the cystic haematoma, which did not recur. CONCLUSION: Splenic haematoma should be considered in the differential diagnosis of pain in the lower left thorax, even in the absence of a history of injury. Sonographically such a haematoma my imitate a solid tumor. Obliteration of the cavity by alcohol installation can be a successful alternative to surgical treatment.

Adult↗
PubMed1998

Effect of programmed endoscopic follow-up examinations on the rebleeding rate of gastric or duodenal peptic ulcers treated by injection therapy: a prospective, randomized controlled trial.

BACKGROUND AND STUDY AIMS: A second-look endoscopy is often performed to evaluate the efficacy of a prior injection therapy in patients with bleeding peptic gastric or duodenal ulcers. Although this strategy is widely established, it does not rely on unequivocal data from controlled studies. In a prospective, randomized, controlled multicenter trial we assessed the effect of programmed endoscopic follow-up examinations with eventual retreatment on the outcome of bleeding ulcers in these patients. PATIENTS AND METHODS: One hundred and five patients with gastric or duodenal peptic ulcers presenting with active (Forrest type I) or recent (Forrest type IIa and IIb) bleeding upon endoscopy within four hours after admission were included in the study. Emergency treatment consisted of the sequential injection of both epinephrine (1:10,000 v/v) and up to 2 ml of fibrin/thrombin around the ulcer base. Fifty-two patients were randomized to receive programmed endoscopic monitoring with eventual retreatment in cases of Forrest type I, IIa, or IIb ulcers beginning within 16-24 hours after the index bleed. Follow-up endoscopies were continued until the macroscopic appearance revealed a Forrest type IIc or III ulcer. Fifty-three patients in the control group were closely monitored, and only received a second endoscopy when there was clinical or biochemical evidence of recurrent bleeding. The groups did not differ with respect to age, sex, site and severity of bleeding. RESULTS: The numbers of patients with recurrent bleeding were similar whether they were endoscopically monitored or not (21% versus 17%, P=0.80 chi-squared test). In addition, there was no statistically significant difference between the two groups with respect to the number of blood units transfused, need for surgical intervention, hospital stay or number of deaths (Mann-Whitney U-test). Improving local ulcer stigmata was not related to a better outcome. CONCLUSIONS: Programmed endoscopic follow-up examinations with eventual retreatment in patients locally injected for an acute or recent hemorrhage from a gastric or duodenal ulcer did not influence their outcome when compared to patients receiving only a second endoscopic intervention upon evidence for recurrent hemorrhage. Scheduled control endoscopies cannot be recommended after an initial successful endoscopic treatment of peptic ulcer bleeding when selection of the patients for second-look endoscopy is directed by the Forrest criteria.

Aged↗
PubMed1998

[Percutaneous abscess drainage in Crohn disease].

PURPOSE: To evaluate the success of percutaneous, CT-guided abscess drainage (PAD) in patients with Crohn's disease. METHODS: Within the last 5 years 8 patients with Crohn's disease were treated by PAD for intra-abdominal abscesses. A fistula was determined to be the cause in 4 patients. The abscesses arose spontaneously in 7 patients while one patient had a postoperative abscess. We used single lumen 10 F- and double lumen 12 F- and 14 F-catheters for drainage (duration of drainage 8-20 days). RESULTS: In all cases the abscess was successfully drained by PAD. However, an operation-free interval of at least three months was achieved in only two patients. A healing of the fistula was not attained in any of the 4 patients with a proven fistula. No enterocutaneous fistulas arose within the course of PAD. CONCLUSIONS: PAD is also useful for patients with Crohn's disease since it improves the starting situation for the necessary operative interventions. In most cases (especially with enterogenic fistulas), however, a long-lasting therapeutic result cannot be expected.

Abdominal Abscess↗