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Biomedical subjects

G Strohmeyer

Publications and source records attributed to G Strohmeyer.

At least 91 records · Page 5Linked to original sources
PubMed1992

[An increased incidence of bacterial endocarditis in chronic inflammatory bowel diseases].

Of 92 consecutive patients treated for proven native valve endocarditis three had ulcerative colitis and 2 Crohn's disease. All 5 patients developed severe complications; three had to undergo emergency valve replacement. With a prevalence of 64.1/10(5) cases of inflammatory bowel disease the calculated incidence (5/92) revealed a significant over-representation of inflammatory bowel disease among patients with proven endocarditis (p less than 5.08 x 10(-9)). Possible explanations may be the suppression of cellular immune defense by therapeutic interventions, high frequency of bacteremia caused by increased permeability of the damaged mucosa for bacteria and a higher incidence of diagnostic and therapeutic interventions in this patient population. Therefore, prophylaxis for bacterial endocarditis should be carefully considered before expected bacteremias in patients with highly active inflammatory bowel disease even in the absence of cardiac factors predisposing to bacterial endocarditis.

Adult↗
PubMed1991

Wilson disease: clinical presentation, treatment, and survival.

OBJECTIVE: To evaluate the diagnostic features, clinical course, and overall long-term survival of patients with Wilson disease. DESIGN: Retrospective cohort study with a mean follow-up period of 14.2 years. SETTING: A university medical center and a community hospital. PATIENTS: Fifty-one consecutive patients with Wilson disease were evaluated between 1957 and 1989. INTERVENTIONS: Patients were treated with D-penicillamine (600 to 1800 mg/d). Two patients with end-stage liver disease had liver transplantation. MAIN RESULTS: Initial symptoms occurred at a mean age of 15.5 years. At diagnosis, the most common neurologic signs were dysarthria, tremor, writing difficulties, and ataxia followed by hypersalivation and headache. Somatic symptoms included abdominal pain, hepatomegaly, splenomegaly, cirrhosis of the liver, and thrombocytopenia. The mean serum concentrations of ceruloplasmin and copper were 44 mg/L and 4.7 mumol/L, respectively. The mean basal urinary copper excretion was 5.5 mumol/d, and the mean hepatic copper concentration was 19.6 mumol/g dry weight. Free serum copper concentration (mean, 2.7 mumol/L) was a reliable indicator of disease and was useful in assessing the effectiveness of therapy (values less than 1.6 mumol/L). Treatment with D-penicillamine improved most of the hematologic and neurologic abnormalities but had little effect on hepatomegaly and splenomegaly and did not reverse cirrhosis. Two patients died of fulminant hepatic failure during the observation period, whereas two others with end-stage liver disease had successful liver transplantation and remain asymptomatic. Long-term survival of patients with Wilson disease was similar to that of age- and sex-matched controls. CONCLUSION: Our results suggest that long-term treatment of patients with Wilson disease with D-penicillamine can relieve symptoms and improve prognosis.

Adolescent↗
PubMed1991

Antiarrhythmic drugs impair hepatic uptake and secretory function by different mechanisms in the isolated perfused rat liver.

In the present study the effect of various antiarrhythmic drugs on hepatic perfusion parameters, uptake capacity of organic anions and biliary secretion using the isolated perfused rat liver was examined. Infusion of verapamil (VP), diltiazem, N-propyl-ajmaline (NPAB), and quinidine at pharmacological doses induced consistently a 1.4-1.6-fold increase in portal pressure accompanied by a approximately 60% decrease in bile flow and a approximately 65% inhibition of biliary taurocholate (TC) excretion. Furthermore, hepatic uptake of oxygen, bromosulphthalein (BSP), and TC was significantly reduced. All these effects were dose-dependent and reversible upon withdrawal of the drugs. Studies of the hepatic circulation using a Trypan blue staining technique demonstrated a patchy perfusion pattern during infusion of the antiarrhythmic drugs as compared to the homogenously stained control organ. The hemodynamic alterations and the impairment of the hepatic initial uptake function could be entirely prevented by concomitant administration of the vasodilator papaverine. Bile flow and biliary TC excretion, however, were still inhibited under these conditions. The present results indicate that antiarrhythmic drugs produce cholestasis in the isolated perfused rat liver independently of their adverse effect on hepatic hemodynamics.

Animals↗
PubMed1991

[Sex behavior and knowledge about AIDS among students].

604 out of 700 students (330 females, 274 males; mean age 23.3 [19-64] years) completed a questionnaire, which was handed out by their teachers and consisted of 26 questions concerning sexual practices and knowledge about AIDS. 285 subjects were studying natural sciences, 134 arts and 185 medicine. There were significant differences between the sexes (P less than 0.01) in drug use (alcohol, cannabis), use of condoms, promiscuity and with respect to discussion of AIDS. Fewer females than males said that they occasionally used intoxicants before sex (14% vs 25%). Women also used condoms less frequently than men (23% vs 44%), although more insisted on their use if their partner declined (68% vs 58%). 55% of the men and 72% of the women were living within a stable relationship. More women (70%) than men (56%) said they would discuss AIDS before having sex with a new partner. There were significant differences between students from individual disciplines (P less than 0.01) with regard to their knowledge, use of condoms, promiscuity, and discussion of AIDS: arts students were less well informed and changed sexual partners more frequently. The same was true of students more than 30 years old. There are important differences between students with regard to their knowledge about AIDS and sexual behaviour risk factors. Educational programmes need to take this fact into account.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Effects of the seleno-organic substance Ebselen in two different models of acute pancreatitis.

This study evaluated the effects of the seleno-organic substance Ebselen [2-phenyl-1,2-benzisoselenazol-3(2H)-one] in two models of acute hemorrhagic and acute edematous pancreatitis. Ebselen is known to catalyze glutathione peroxidase-like reactions and to inhibit lipid peroxidation. Hemorrhagic pancreatitis was induced by feeding a choline-deficient, ethionine-supplemented (CDE) diet to mice for 66 h. Edematous pancreatitis was induced by 7-h subcutaneous injections of 50 micrograms/kg of cerulein in mice. Ebselen was given from the beginning of the CDE diet either as a subcutaneous injection of 100 mg/kg at 6-h intervals or was mixed in with the CDE diet to yield a daily dose of 100 mg/kg of Ebselen. In further experiments, Ebselen was given at various time intervals after the beginning of the CDE diet as subcutaneous injections of 100 mg/kg at 6-h intervals. In the cerulein model, Ebselen was given 5 min prior to each cerulein injection at doses from 10-500 mg/kg. Prophylactic administration of Ebselen given orally or subcutaneously significantly improved survival from 38.5% in the control group of saline-injected CDE-fed mice to 61.9 and 65.0%, respectively. Ebselen also reduced increases in serum amylase and pancreatic weight in the diet model. Therapeutic administration of Ebselen significantly increased survival only when injections were started 20 h after the beginning of the CDE diet (64%), but not when started after 40 h (44%). Similarly, increases in serum amylase and pancreatic weight due to the CDE diet were significantly reduced by Ebselen only when injections were started after 20 h but not when started after 40 h.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1991

Does orthotopic liver transplantation heal Wilson's disease? Clinical follow-up of two liver-transplanted patients.

Two patients with Wilson's disease (WD) underwent orthotopic liver transplantation, one for subacute liver failure and the other for severe oesophageal haemorrhage. After transplantation both patients fully recovered within five months, and copper metabolism returned to normal. Follow-up examinations were continued for 4 and 6 years. Clinical as well as electrophysiological testing in these two patients yielded better results than in most of 12 WD-patients being conventionally treated for a similar period or even longer.

Adult↗
PubMed1991

Epidemiology, clinical course and treatment of chronic viral hepatitis.

Chronic hepatitis may take the form of a hepatitis B infection, a delta virus infection, or a non-A, non-B hepatitis including hepatitis C. All the viruses involved are transmitted predominantly by parenteral or sexual routes. New insights into the structure of the hepatitis B virus (HBV) and the immune response mechanisms of the organism permit a clear definition of the replicative state of the virus, and allow predictions to be made about the outcome of the disease. Development of cirrhosis and hepatocellular carcinoma are the major complications associated with impaired life expectancy. Recently, the hepatitis C virus (HCV) was identified as the agent responsible for most cases of chronic non-A, non-B hepatitis. The development of an assay for the detection of HCV-antibodies facilitated the diagnosis of this type of hepatitis. Moreover, the use of screening tests for hepatitis B and hepatitis C in blood donors will decrease the risk of acquiring hepatitis via contaminated blood products. Treatment of chronic hepatitis B and C with alpha-interferon has shown promising results. However, the dosage schedule, the period of treatment, and the selection of patients needs to be evaluated in further studies.

Hepacivirus↗
PubMed1991

[Effect of food characteristics on rate of hemorrhagic complications and early results of endoscopic sclerosing treatment of esophageal varices].

To evaluate the possible influence of the trauma of swallowing solids on the outcome and complication rate of endoscopic injection sclerotherapy we carried out a prospective randomized trial in 46 cirrhotics undergoing sclerotherapy because of recent or acute variceal bleeding. The patients were randomly assigned to mashed food (24 = group A) or normal solid food (22 = group B). Both groups were comparable according to age, sex, Child classes, size of the varices and patients undergoing emergency sclerotherapy (8 in each group). Duration of hospital care (A 26.6, B 27.3 days) (means), number of endoscopic studies (A 4.7, B 4.6), number of sclerotherapy sessions (A 2.4, B 2.5) and required amount of Polidicanol in each patient (A 62.7, B 56.4 ml) were not different. Variceal eradication was achieved in 13 cases in A, in 14 in B. III degrees varices remained in 6 patients in A (3 quit against advice before completing ST) and in 1 case in group B. Staple-gun transection and devascularization because of recurrent bleeding were necessary in 2 cases in A and in 1 case in B. Death occurred in 2 cases in A (liver failure), in 4 cases in B (3 cases of liver failure and in 1 case with recurrent bleeding, without operation because of hepatocellular carcinoma). Episodes of acute massive bleeding from varices or esophageal ulcers occurred 9 times in group A and 10 times in group B. Minor bleedings occurred 10 times in A and 9 times in B. Transfusion requirement was 110 units of packed red cells in A and 106 in B.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Twin pregnancy after liver transplantation].

Orthotopic liver transplantation was performed in a 29-year-old woman because of increasing decompensation of HBs-antigen positive post-hepatitic cirrhosis. Postoperatively she developed a mild rejection reaction and diabetes mellitus. Thirteen months after the transplant she conceived twins. This high risk pregnancy was complicated by a febrile viral infection with purulent tracheobronchitis at 9 weeks and a threatened abortion at 11 weeks. At 33 weeks there was a sudden drop in haemoglobin due to a minor uterine rupture which necessitated cesarean section. The female infants--of development in keeping with the dates--showed no clinical or ultrasound evidence of any malformations. Apart from initial difficulties--asphyxia (second twin), fluctuating glucose and calcium levels, an episode of neonatal jaundice which required phototherapy, reluctance to suck and hypotonia--the further development of both twins proceeded normally. The maternal diabetes disappeared after delivery, HBs-antigen remained negative and the HBs-antibody titre rose. The patient has remained in good condition, both mentally and physically.

Abortion, Threatened↗
PubMed1990

[Changes in the clinical symptomatology of initial manifestations of aids].

We analysed the clinical spectrum of AIDS manifestations of HIV positive patients treated between 1985 and 1988 at the University Hospital of Düsseldorf, West-Germany. In 1985 32 patients with HIV infection (16 asymptomatic, eleven PGL/ARC, five AIDS), 1986 49 patients (17 asymptomatic, 19 PGL/ARC, 13 AIDS), 1987 104 patients (13 asymptomatic, 54 PGL/ARC, 37 AIDS) and 1988 206 patients (23 asymptomatic, 111 PGL/ARC, 72 AIDS) were treated on a in- and out-patient basis. In 1985 five, in 1986 13, in 1987 36 and in 1988 48 patients developed AIDS. Kaposi-sarcoma was seen in 1985 in 40%, in 1986 in 31%, in 1987 in 12% and in 1988 in 9% of these cases. At the same time the rate of patients with opportunistic infections as the primary manifestation of AIDS grew from 60% (1985), 69% (1986), 88% (1987) to 91% (1988). Concomitantly the rate of homosexual patients dropped from 90% (1985), 82% (1986), 60% (1987) to 62% (1988). The rate of i.v. drug abuser rose from 10% (1985) to 24% (1988). In 1985 10% of HIV patients were female. This rate rose up to 18% in 1988. 1987 and 1988 the main opportunistic infections as the primary manifestation of AIDS were pneumocystis carinii pneumonia, toxoplasma encephalitis and candida esophagitis. In summary there is an alteration in the HIV positive population in the last years and concomitantly the clinical spectrum of AIDS is changing.

AIDS-Related Complex↗
PubMed1990

[13C-urea breath test as a non-invasive method for the detection of Helicobacter (Campylobacter) pylori].

The 13C-urea breath test was used for diagnosing noninvasively the possible presence of Helicobacter (formerly called Campylobacter) pylori in 20 patients with dyspepsia (ten men and ten women, mean age 40.2 [24-74] years). H. pylori was cultured from 14 patients, while in six the culture was negative. The proportion of 13C in expired air was measured by isotope mass-spectrometer and expressed as Delta (basal value about 20%). A dose of 2.5 mg urea per kg body-weight (BW) was ingested after a standard meal. The test was repeated with 1.75 and 1.0 mg/kg BW in five subjects. Delta had increased significantly after 30 min in all H. pylori-positive patients (P less than 0.001). The maximal value after 90 min ranged from 38 to 114%; in the H. pylori-negative patients it was 24%. After 1.75 and 1.0 mg/kg urea the maximal value after 90 min was 39-52% and 30-52%, respectively. Using a dose of 2.5 or 1.75 mg/kg BW tagged urea one can reliably distinguish between presence and absence of H. pylori. It is sufficient to test a basal and a 90-min expired-air sample.

Adult↗
PubMed1990

Norepinephrine-induced cholestasis in the isolated perfused rat liver is secondary to its hemodynamic effects.

In this study we examined the effect of pharmacological doses of various alpha-adrenergic agents on hepatic portal perfusion, organic anion uptake and bile secretion using the isolated perfused rat liver. Addition of norepinephrine at portal perfusate concentrations ranging from 0.01 to 100 mumol/L induced a dose-related increase in portal pressure with a twofold increment at the highest concentration. This was accompanied by an inhibition of hepatocellular uptake of taurocholate by 16.8% +/- 1.8% and of sulfobromophthalein (BSP) by 32.9% +/- 3.0% compared with controls. Moreover, a 22.5% +/- 3% decrease in bile flow rate and a 22.8% +/- 4% inhibition of biliary excretion of taurocholate were observed. Addition of other alpha-adrenergic agonist (epinephrine, dopamine and phenylephrine) at similar concentrations produced the same hepatic effects as observed with norepinephrine. During infusion of these alpha-adrenergic agents, trypan blue infusion revealed a patchy perfusion pattern of the liver surface compared with the homogeneously stained organs in controls. The hemodynamic alterations could be confirmed by electron microscopy examination that demonstrated that increased portal pressure produced by norepinephrine was associated with sinusoidal shunting. All hemodynamic, metabolic and biliary changes induced by norepinephrine could be entirely prevented by concomitant infusion of the alpha-antagonist phentolamine, thus indicating that norepinephrine-induced hepatic effects were mediated by alpha-receptors. In contrast, simultaneous addition of papaverine, an unspecific vasodilator, prevented the hemodynamic and the biliary changes of norepinephrine, but failed to modify the metabolic effects of the drug.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗