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Biomedical subjects

G Machnik

Publications and source records attributed to G Machnik.

At least 37 records · Page 2Linked to original sources

Enzyme activities of collagen peptidase (CP), monoaminoxidase (MAO) and N-acetyl-beta-D-glucosaminidase (beta-NAG) as fibrosis marker in chronic liver diseases.

The activities of enzymes collagen peptidase (CP), monoaminoxidase (MAO) and N-acetyl-beta-D-glucosaminidase (beta-NAG) in the serum are related to the development of hepatic fibrosis. These enzymes were determined in the sera of 121 liver-biopsied patients who were subdivided by morphological criteria into 4 different grades of fibrosis (0 to greater than or equal to 3). CP shows the best correlation with the extent of fibrosis. beta-NAG, indeed, bears of relationship to the morphologically proven extent of fibrosis, however, significant increases in activity are also encountered in patients with liver diseases, but without liver fibrosis. The validity of these fibrosis markers is calculated in order to differentiate between low- and high-grade fibrosis. With a sensitivity of 86% and a specificity of 92%, CP possesses the best predictive value of 85.7%. The results can still be improved by the combination of CP and beta-NAG.

Acetylglucosaminidase

[The nomenclature and typing of drug-induced liver changes. The opinion of a group of pathologists].

A working group of histopathologists with specialised liver training has established guidelines for a nomenclature of drug-induced liver lesions. It is recommended to use the term of drug-induced hepatitis for all cases of virus hepatitis-like picture. The most frequent type is that of hepatitis with confluent necrosis. This type of hepatitis was subdivided into three subtypes of diagnostic probability for differential diagnosis versus virus hepatitis.

Chemical and Drug Induced Liver Injury

[Primary clinical, endoscopic and histologic findings in solitary rectal ulcer].

This study presents clinical, endoscopical and histological primary findings of solitary ulcer of the rectum obtained in 24 patients. Solitary ulcer of the rectum is preferably a disease of young women. The main symptom is recurrent rectal bleeding. Endoscopically in 50% of all cases mucosal ulcerations can be observed. The other cases are non-ulcerous lesions with uncharacteristic endoscopical findings. The majority of the lesions are within 6-8 cm of the anal margin. In 44% of the patients there are findings, which are suspicious of preexisting rectal prolapse. The histological main criterion is a fibromuscular hyperplasia of the lamina propria. Full agreement of endoscopical and histological diagnosis at primary examination could be obtained in only 17% of the cases.

Adult

[Hyperplasiogenic polyps and risk of stomach cancer].

In 731 hyperplasiogenic polyps which have been removed by endoscopical polypectomy there were 9 polyps with an early cancer and 8 polyps with severe dysplasias (borderline lesions) as well as 1 polyp, in which an advanced carcinoma has been developed. This is the outstanding greatest number of hyperplasiogenic polyps with a malignant transformation. In addition in 9 patients with hyperplasiogenic polyps carcinomas could be discovered, i.e. a rate for malignant developments of 3.7%. It seems that stomachs with multiple polyps are endangered in particular. The recurrence rate of follow-up examinations covering a period of up to 8 years was 36.1%.

Cell Transformation, Neoplastic

[Drug-induced hepatitis after dihydralazine treatment with fatal consequences].

Adverse drug side effects of the antihypertensive substance dihydralazine have been increasingly observed in recent years. Damage is concentrated on the liver and is characterized by drug-induced hepatitis with confluent necrosis. Three cases (60 year old woman, 79 year old woman, 61 year old man) with lethal course after antihypertensive treatment, using dihydralazine are reported in this paper.

Aged

[Value of alpha 1-fetoprotein (AFP) determination with an ultramicro-ELISA immunoassay in chronic liver diseases with special reference to hepatocellular cancer].

920 determinations of alpha 1-fetoprotein were performed in 564 patients with mainly hepatological diseases. For AFP determination double antibody sandwich technique with 10 microliter final volume was used. The ultramicro-ELISA-method, which meets all criteria of a screening parameter, is simple and far more economic than RIA or a commercial enzyme immunoassay. The 3s limit was determined to be 23.2 for men and 29.8 ng/ml for women. 24/26 (= 92.0%) hepatocellular carcinomas (HCC) showed elevated serum AFP concentrations. The serum AFP concentrations in the hepatocellular carcinoma showed different constellations of the findings: 1. AFP below 215 ng/ml (= range suspicious of hepatome, according to Poltenauer); 2. AFP moderately exceeds 215 ng/ml; 3. AFP weeks before death excessively increasing from moderately elevated ranges; 4. AFP decreasing prior to death; 5. AFP course fluctuating; 6. AFP within normal range. 231 liver cirrhoses showed elevated values in 28.1%. Active liver cirrhoses had significantly more often AFP concentrations above 30 ng/ml than inactive had (31.9% as opposed to 10.8%). Active liver cirrhoses and cirrhoses with decompensation of the portal vein had significantly more often (34.9% of 83 probands) increased AFP values than inactive, compensated cirrhoses had (11.9% of 42 probands). Various pathomechanisms of the neosynthesis of AFP in HCC, in liver metastases and in benign liver diseases are discussed. Increases in AFP above 500 ng/ml are practically indicative of hepatocellular carcinoma. Low-grade elevations of AFP in benign liver diseases and liver metastases can be categorized by considering other criteria (persistent or transitory AFP?/trend - increase?/serum concentration) including clinical/paraclinical features. The determination of AFP by the above-mentioned method allows to make a better hepatologic diagnosis. It ist suitable for the still improvable early diagnosis of HCC. AFP screening should be employed in risk groups (liver cirrhoses, HBsAg carriers, chronic HV-B patients).

Adult

[Histologic and cell kinetic findings in stomach ulcer of different healing times].

The 3-month healing rate in gastric ulcer patients treated on an outpatient basis and with no H2 blockers is only some 40%. In order to be able to improve therapy at an early stage, prognosis-relevant parameters were searched for also among histological findings. The semiquantitatively evaluated morphological parameters from 62 gastric ulcer patients of a case control study were subjected to a computerized multivariate analysis. Accordingly, at the stage of healing of gastric ulcer, the features 'complete intestinal metaplasia' and 'incomplete intestinal metaplasia' separate with the aid of a non-elementary discriminant function between healing in an appropriate period (3 months) and delayed healing. Histoautoradiographic in vitro examinations of 50 gastric ulcer cases reveal that the mucous membrane around an ulcer healing with delay has a significantly higher cell labeling rate than the gastric mucosa of control persons. The influence of a reflux of bile from the duodenum is discussed, as there is no correlation with the degree of chronic gastritis.

Cell Division

[Distribution of collagen in human livers].

The distribution of collagen (determined as hydroxyproline) is compared with the histological index of fibrosis in 32 cadaver livers. The results indicate a partly heterogeneous distribution of collagen between three topographic different regions of the liver. The possible reasons for the different distribution of collagen were discussed and compared with data of the literature. Our results suggest that one biopsy only is not representative for the whole organ in every case.

Biopsy

[Intraoperative peroral endoscopy and vague sources of bleeding in the jejuno-ileum].

Although bleedings in the part of the jejunoileum only amount to about 1% of bleedings of the whole gastrointestinal tract, they can raise outstanding problems because of the difficulties in discovering the sources of bleeding and their localization. The importance of intraoperative endoscopy will be emphasized by example of 5 patients who suffered from recurrent bleedings. All of the other diagnostic procedures like x-ray examinations (angiography included), endoscopy and scintigraphy were fruitless.

Adult

[Epidemiology of hormone dependent malignant tumors--ovulation inhibitors and liver tumors].

Since the first descriptions of liver tumours associated with the intake of steroid contraceptives, the literature has presented an increasing number of case reports as well as epidemiological studies on the relationship between benign liver tumours and the utilization of these drugs. We report 11 benign cases and one malignant case of liver tumours in connection with the intake of these steroid preparations.

Adenoma

[Colchicine therapy of fibrosing liver diseases--report of a randomized double-blind study].

It is reported on results of a double blind study of colchicine therapy in fibrotic liver diseases over a period of three years. The study includes 74 probands; 37 of them had been treated after randomization for five days a week with 4 X 0,25 mg/d colchicine, 37 with placebo. 53 probands attained the 12th month of treatment, 43 of them 24th, 24 probands were in the study for 36 months. 3 diagnoses groups had been formed with regard to the histological grades of fibrosis: chronic hepatitis (without structural transformation); structural liver transformation/moderate liver cirrhosis; severe liver cirrhosis. In 38 cases the disease was caused by alcohol. 45 data had been studied (clinical results, paraclinical data concerning hepatological diagnostic and connective tissue metabolism and morphologic data). The biometric evaluation was carried out with the stage variant analysis by Friedman. Rebiopsies have been carried out in 40 probands after 1 year, in 4 probands after 2 years. 4 data (Serumalbumine, Gamma-GT, ALAT, KP) showed significant changes in the colchicine-group as well as in the placebo-group. In both therapy groups the morphologic supervisions of the fibrosis grades (rebiopsies) showed improvements, no changes, and deterioration about in the same frequency. In this study there was no effectiveness of colchicine on the course of fibrotic liver diseases to be stated. Concerning the contradictions in the recent literature and probable the insufficient colchicine dose, the authors recommend further studies on colchicine therapy in liver diseases with incipient i.e. reversible fibrosis.

Clinical Trials as Topic

[Exploratory studies of the common incidence of cholelithiasis, status following cholecystectomy and colonic cancer].

For studying the postulated relationship between prior cholecystectomy, cholelithiasis, and occurrence of subsequent colorectal cancer, we examined in a retrospective study autopsy cases to get information about the frequency of them. The material consisted of 10,000 cases (female:male = 1,08:1) with an age maximum in the 8. decennium. Among them were 2457 (902 male and 1555 female) cases of cholelithiasis and 646 (211 male and 435 female) cases of cholecystectomy. 449 colorectal cancer were found, altogether. The incidence of cancer in cases without gallbladder disease amounts to 4.13%, in cases with cholelithiasis 5.37%, and after cholecystectomy 4.95%, respectively. The results must be discussed with care because Berkon's Fallacy. Further exploratory investigations are necessary.

Age Factors

[Mucous membrane hyperplasia of the rectum--a clarification requiring biopsy].

The frequency of mucosal hyperplasia adjacent to the tumor was determined in 177 rectal biopsies with a diagnosis of adenocarcinoma. Previous rectal biopsies in these patients were analyzed. In a further step associated clinical and morphological findings were determined in 75 patients with mucosal hypertrophy on rectal biopsy. Half of these patients could be followed prospectively. Pathogenetic aspects of hyperplastic rectal mucosa are discussed. The need for improved clarification of the importance of these mucosal lesions particularly in unclear clinical situations is emphasized.

Aged

[Morphological reaction patterns of the liver induced by drugs].

Drugs are exogenous substances often requiring metabolic transformation to be therapeutically effective. This occurs primarily in the liver, the most important metabolic organ and a structure able to adapt to this burden. Should its adaptive potential be exceeded, damage can occur, affecting principally the liver parenchyma. Such damage manifests itself as disturbed secretory function and as reversible or irreversible structural alteration of the liver cells. The constellation of toxic-degenerative lesions is referred to as hepatosis (toxic hepatosis, toxic hepatopathy). A variety of patterns of damage (lipidosis, necrosis, cholestasis etc.) occur alone or in combination. Depending on the severity and extent of these alterations a secondary inflammatory reaction may result. These changes are manifest as cellular infiltration and proliferation with formation of reticulo-histiocytic nodules or minifocal epitheloid cell reactions and non-caseous epitheloid cell granulomas. The eosinophilic component is striking. In the face of continued toxic exposures, changes resembling those of chronic aggressive hepatitis may develop following the acute changes. Other drug-related liver damage may present as vascular lesions the afferent or efferent venous systems as well as in the sinusoids (i.e. peliosis hepatis, Budd-Chiari syndrome). Moreover there may be neoplastic alterations such as focal nodular hyperplasia or liver cell adenomas. Pathognomonic histologic criteria for drug-induced liver damage have as yet to be recognized, particularly in the case of facultative toxins. Morphologic indications can only suggest that a prior pharmaceutical agent was the likely cause of the damage. Histologic changes must however be viewed in the context of the medical history, clinical and laboratory findings, as well as results of other studies before the conclusion is drawn that the observed liver changes represent drug-induced injury.

Chemical and Drug Induced Liver Injury

[Value and results of coloscopic polypectomy].

From August 1976 till the end of February 1979 158 polyp in 83 patients (48 male and 35 female) were removed by means of the rectocoloscopic polypectomy with the high frequency diathermy loop. 66% of the polypi had a diameter of less than 1 cm. Most the polypi were with about 70% in the sigma and in the rectum. With 60.7% the adenomas appeared most frequently, followed by the hyperplastic polypi in 20% and by the inflammatory ones in 13.3% of the cases. With the increase of size of the polypi the proportion of the adenomas clearly increased in comparison to the other kinds of polypi. Severe epithelial atypias (altogether 23.1%) were more frequently in adenomas larger than 2 cm than in smaller ones. An invasive carcinoma was found in no polypus. Thus the endoscopic polypectomy in every case meant a curative therapy with great economic use. In patients a haemorrhage appeared as a complication of the coloscopic polypectomy. Only the removal of the polypi in toto allows an exact histological classification and the answer of the decisive question, whether in one adenoma only severe epithelial atypias are present and thus the polypectomy is therapeutically sufficient or whether there exists an adenocarcinoma, for the removal of which an operation according to the principles of the carcinoma surgery must be carried out. The endoscopic ablation of the adenomas thus means a genuine prophylaxis of cancer.

Adenocarcinoma

[Causes, shape and chemistry of gallstones].

Gallstones are precipitations of oversaturated bile fluid. They can develop in the gallbladder and in the efferent bile ducts; they are very often correlated with diseases of the gallbladder, bile ducts and neighboring organs. The gallstone disease (cholelithiasis) is increasing continually, especially in developed countries with overcaloric nourished population. Surgical interventions on the biliary tract are the most frequent abdominal operations at present.

Bile