Search PubMed⌕ Search

Biomedical subjects

G Oehler

Publications and source records attributed to G Oehler.

At least 19 recordsLinked to original sources
PubMed2004

[Social-medical aspects of chronic liver diseases].

In our country liver diseases are frequent and have many different causes. They can often develop into cirrhosis of the liver with mortality beetween 13.5% and 24.5%. Hepatitis B and C-viral infections frequently play a significant role in the recognition of an occupational disease in the case of medical staff, with histological criteria of major importance in this respect. A consequence of cirrhosis of the liver may be the development of hepatoencephalopathia of varying degrees of severity. As it is then likely that a patient will no longer be able to drive motor vehicles, it is important that attending physicians inform their patients accordingly. Liver transplants are an acknowledged method of treatment in the therapy of advanced liver cirrhosis. Rehabilitation shortly after transplantation is highly important to help ensure a speedy return to work. Surprisingly, reintegration is more difficult in patients suffering from alcohol related liver disease than in those with non-alcohol-related liver disease.

Biopsy↗
PubMed2002

[Hepatitis C. Virology, transmission modes, clinical aspects, prevention and therapy].

Of the various forms of chronic viral hepatitis, in Germany 60-70% are caused by the hepatitis C virus (HCV). The virus arrives inconspicuously, i.e. an acute infection only leads to an increase in transaminases in 40% of cases and to an increase in bilirubin in only 20%. However, approximately 90% of infections take a chronic course and in 20% this leads to cirrhosis after only 20 years. The infection rate of medical personnel is not significantly higher than in the general population. The transmission of HCV from patients to medical personnel, e.g. by needle stick injuries, is very rare and the risk of infection is less than 1%. Even less frequently transmission of HCV in the reverse direction from medical personnel to patients occurs. An active or passive prophylactic immunization is not possible and protective immunization is not yet foreseeable. Recently, progress has been made with chemotherapeutical treatment of HCV. The present state-of-the-art is pegylated interferon-a in combination with ribavirin. The success rate in HCV genotypes 2 and 3 is clearly higher with 70-80% than in genotypes 1 and 4 with approximately 40%. Both drugs have significant side-effects but better forms of medication are not yet available.

Genotype↗
PubMed1997

[Liver transplantation in familial amyloid polyneuropathy. Case report and review of the literature].

A 59-year old male of German origin noticed exercise-independent cardiac arrhythmia two years before admission. An alanine 47 transthyretin variant of Familial Amyloid Polyneuropathy with hypertrophic cardiomyopathy, peripheral sensory-motor polyneuropathy, I, degree AV heart block was diagnosed. To diminish production and deposition of mutant transthyretin and to prevent disease progression orthotopic liver transplantation was performed. Prior to transplant the patient complained of inappetence. Postoperatively, he received a chemically defined enteral nutrition regime that was discontinued after 30 months until return of appetite and weight gain indicated marked improvement. However, a duodenal biopsy still demonstrated amyloid deposits 24 months after transplantation. Echocardiographic findings remained unchanged. Neurologic examination showed an improvement of sensory-motor polyneuropathy with regression of electromyographic changes. Only traces of variant transthyretin were detectable in plasma samples taken 12 months after the operation. During the 3 year follow-up, no additional symptoms have occurred and progression of amyloidosis was prevented. Currently, orthotopic liver transplantation is the only specific treatment to prevent progression of familial amyloid polyneuropathy.

Amyloid↗
PubMed1996

[Liver transplantation--preparing patients, early postoperative care and occupational rehabilitation].

Authors summarize the results of liver transplantation first of all in the view of rehabilitation. Role of rehabilitation experts is discussed in the period before and after transplantation. The necessity of information for the patients is specially underlined already from the first raise of the possibility of liver transplantation. They express that after successful operation it is needed for the patients to return gradually to the used activities of everyday life. All the questions of immunosuppressive treatment, hygienic rules, physical activities, patient care at home and work place rehabilitation are discussed.

Adult↗
PubMed1994

New state markers for alcoholism. Comparison of carbohydrate deficient transferrin (CDT) and alcohol mediated (triantennary) transferrin (AMT).

Carbohydrate deficient transferrin (CDTect-RIA, Pharmacia) was compared with an Immunoluminometric assay for isotransferrin separated by a short column Con-A sepharose which we have called alcohol mediated triantennary transferrin (AMT). 101 in-patients with alcohol dependency syndrome (alcohol consumption of more than 60 g/day) were grouped according to the time of abstinence A1 (0-7 days), A2 (8-14 days), A3 (> or = 15 days). Serum samples were obtained at admission (U0) and under abstinent conditions after 10-20 days (U1). All groups were controlled for AMT, CDT, GGT, MCV. Control groups were 30 in-patients with non alcoholic liver disease (NALD) and 31 healthy volunteers (alcohol consumption of less than 20g/day). Results showed for CDT and AMT highly significant differences between short abstinence period (group A1) and more than two weeks abstinence (group A3) alcoholics and between group A1 and healthy controls. In group A1 CDT was significantly elevated (P < or = .001) compared to NALD group whereas AMT showed no differences. CDT (cut off 22 mg/l) showed a high diagnostic specificity (A1/controls 97%, A1/NALD 83%, A1/A3 78%) but only a diagnostic sensitivity of 61%. AMT (cut off 260 mg/l) revealed a diagnostic test sensitivity of 74%. The diagnostic test specificity of AMT was inferior to CDT (A1/controls 74%, A1/NALD 50%, A1/A3 70%). Initial CDT and AMT values in alcoholics were highly correlated (P < or = .001) with time of abstinence. CDT and AMT decline was correlated with time of abstinence. CDT was proved for high significant (P < or = .001) decline over a longer period of abstinence (11-30 days) while AMT decline was significant (P = .008) only in early abstinence (0-10 days). Presence of a withdrawal syndrome was highly correlated (P < or = .01) with CDT values above 22 mg/l and AMT values above 260 mg/l. Furthermore in selected follow up cases it was shown that AMT seemed to be a more sensitive indicator for short alcoholic relapses than CDT.

Adult↗
PubMed1994

Prophylactic sclerotherapy for esophageal varices: long-term results of a prospective study.

Controlled trials of endoscopic sclerotherapy for the prevention of the first variceal hemorrhage have given controversial results. We continued a previously reported study and randomly assigned 141 patients with esophageal varices and no prior gastrointestinal bleeding to either prophylactic sclerotherapy (n = 70) or no treatment (n = 71). Sclerotherapy was performed until complete eradication of the varices was achieved; recurrent varices were treated with repeat sclerotherapy. The groups were well balanced in terms of demographic and clinical characteristics. Patients in both groups who bled from varices received sclerotherapy whenever possible. During a median follow-up of 56 months, variceal bleeding occurred in 7% in sclerotherapy patients and 44% of control patients (p < 0.01). In the sclerotherapy group 59% died, and in the control group 51% (n.s.). In both groups, the mortality rate increased with the severity of liver function impairment. Sclerotherapy was not found to improve survival in patients, irrespective of the etiology of cirrhosis (alcoholic or nonalcoholic) or variceal size (low-grade or high-grade). We conclude that sclerotherapy is a suitable method to reduce the occurrence of the first variceal hemorrhage, but it does not appear to have an effect on survival.

Adult↗
PubMed1994

Prognostic significance of the hepatitis B virus-DNA concentration in patients after orthotopic liver transplantation.

Hepatitis B virus-DNA was detected by polymerase chain reaction in 9 out of 10 patients after orthotopic liver transplantation. Three of these patients were at the same time positive for hepatitis B virus-DNA by dot-blot hybridization (hepatitis B virus-DNA > 1.5 pg/ml). In these three patients HBs-antigen (HBsAg) reappeared within a mean time of 12 weeks after orthotopic liver transplantation (range 7-18 weeks). Only two of the six polymerase chain reaction-positive and dot-blot-negative patients (hepatitis B virus-DNA between 0.4 fg/ml and 1.5 pg/ml) had recurrence of HBsAg within a mean time of 54 weeks (range 52-56 weeks). Passive immunoprophylaxis with anti-HBs antibodies (serum titers > 100 IU/l) did not prevent infection of the graft in the five reinfected patients. We conclude that a low concentration of serum hepatitis B virus-DNA after orthotopic liver transplantation, which is detectable only by polymerase chain reaction, indicates a delayed infection of the graft.

Adult↗
PubMed1989

[Ectopic gastric mucosa in the duodenal bulb].

The radiological and clinical findings of 12 patients with ectopic gastric mucosa in the duodenal bulb are presented. This is a defined disease with characteristic radiological features: multiple small nodular defects of the contrast medium of 1-3 mm diameter. Histology shows complete heterotopia. Pathogenesis and clinical significance are discussed with reference to the literature on this subject.

Adult↗
PubMed1988

Detection of soluble fibrin monomer complexes. Comparison of a haemagglutination assay with the ethanol gelation test.

Hypercoagulability and disseminated intravascular coagulation (DIC) are characterized by the presence of circulating fibrin monomer complexes in plasma. In 342 patients with possible DIC fibrin monomers, fibrinogen, Reptilase Time, antithrombin III and other coagulation parameters were determined at frequent intervals. Testing of soluble fibrin monomer complexes was performed using a sensitive and reliable hemagglutation assay with red cells sensitized by fibrin monomers (FM-Test) and the ethanol gelation test (EGT). Method comparison regarding the influence of fibrinogen levels and fibrin degradation products shows that high fibrinogen levels lead to false-positive results with EGT. The same effect is observed for fibrin degradation products and EGT whereas no influence of fibrinogen level and fibrin degradation products on the FM-Test occurs. It is well-known that during DIC AT III level decreases caused by proteolytic activity. In this study it could be shown that fibrin monomer increases parallel to the decrease of AT III. The same effect does not occur due to fibrin degradation products.

Blood Coagulation Tests↗
PubMed1988

Alterations of antithrombin III after acute myocardial infarction.

The antithrombin III (AT III) activity and the AT III concentration were investigated in 62 consecutive patients with acute myocardial infarction (AMI). To identify the reactant pattern of AT III in postaggressive situations, we also determined labile and acute phase proteins. Firstly, 29 patients were nourished orally and then 33 patients were fed by i.v. hyperalimentation (additional caloric intake of approximately 1,000 cal). AT III activities and concentrations as well as prealbumin and retinol-binding protein decreased concomittantly and significantly whereas haptoglobin, C-reactive protein and fibrinogen increased significantly after AMI. The changes cannot be interpreted as being alterations of the haematocrit. The alterations of AT III correlated significantly with the changes of labile proteins but not with the acute phase reactant proteins. The AT III decrease in the postinfarctional phase may promote a prethrombotic state. In In addition it can be concluded from our results that AT III reacts as (nutritive-dependent) labile protein, which is lowered in postaggressive situation and does not increase as an acute phase reactant. This is in accordance with results from recent animal experiments.

Antithrombin III↗
PubMed1986

[Drug therapy of pulmonary embolism].

Heparin is indicated in pulmonary embolism suspicion, in minor and a part of submassive embolism. The dose is 15,000-20,000 U (acute) and 40,000 U/day subsequently. Fibrinolytic therapy with streptokinase or urokinase is indicated in massive embolism. Submassive embolism is treated by fibrinolysis if no contraindications against fibrinolysis are to be registered.

Combined Modality Therapy↗
PubMed1986

[Changes in the coagulation system in shock].

Disorders of the coagulation system in shock are caused by injuries of the endothelium, influx of thromboplastic material into the blood and stasis. In this way, the intrinsic and the extrinsic system is activated. Fibrin is generated in the blood stream and forms high molecular complexes together with fibrinogen (hypercoagulability). With progress of the shock fibrin can deposit in the small vessels with the consequence of impaired circulation. Finally clotting factors and inhibitors (e.g. antithrombin III) are consumed by disseminated intravascular coagulation. This results in a bleeding tendency (consumption coagulopathy). In this survey particular shock formes (endotoxin induced, cardiogenic, traumatic, hemorrhagic) are discussed with regard to the reflections of the blood coagulation. The therapy of shock-induced disorders of blood coagulation are focused on treatment of primary disease, prevention or elimination of microthrombi, substitution of blood respective plasma components.

Blood Coagulation↗
PubMed1984

[Antithrombin III changes following myocardial infarct].

The antithrombin III (AT III) activity and the AT III concentration were investigated in 62 consecutive patients with acute myocardial infarction (AMI). To identify the reactant pattern of AT III in postaggressive situations, we also determined labile and acute phase proteins. Firstly, 29 patients were nourished orally and then 33 patients were fed by i.v. hyperalimentation (additional caloric intake of approximately 1,000 cal). AT III activities and concentrations as well as prealbumin and retinol-binding protein decreased concomittantly and significantly whereas haptoglobin, C-reactive protein and fibrinogen increased significantly after AMI. The changes cannot be interpreted as being alterations of the haematocrit. The alterations of AT III correlated significantly with the changes of labile proteins but not with the acute phase reactant proteins. The AT III decrease in the postinfarctional phase may promote a prethrombotic state. In addition it can be concluded from our results that AT III reacts as (nutritive-dependent) labile protein, which is lowered in postaggressive situation and does not increase as an acute phase reactant. This is in accordance with results from recent animal experiments.

Antithrombin III↗