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Biomedical subjects

H Huchzermeyer

Publications and source records attributed to H Huchzermeyer.

At least 19 recordsLinked to original sources
PubMed1999

[Primary palliative treatment of malignant gastric outlet obstruction with a self-expanding metal stent].

BACKGROUND AND OBJECTIVE: A high operative mortality, diffuse local tumor growth and abnormal wound healing are significant risk factors in the palliative surgical treatment of gastric outlet obstruction caused by a malignant tumor. This study was undertaken to evaluate the use of self-expanding metal stents as an alternative. PATIENTS AND METHODS: Over a period of 33 months, nine previously unoperated patients (three women, six men; mean age 71.4 [66-76] years) with gastric outlet obstruction by a malignant tumor underwent endoscopic implantation of an uncoated self-expanding nitinol Ultraflex stent. The stent's length was 7 and 10 cm, respectively, the length of the carrier catheter was 92 cm. The stent was implanted after balloon dilatation of the stenosis and marking the distal tumor margin with lipiodol injected over a guide-wire under fluoroscopic control. RESULTS: The implantation was successful in only two of the first five patients, but after modifying the method of stent release in three of the four subsequent patients. All patients reported an improved quality of life. One patient died after 10 days of the underlying malignancy. There were no complications associated with the implantation. CONCLUSIONS: Insertion of a self-expanding metal stent can provide palliation in patients with inoperable gastric outlet stenosis due to malignant tumour. The number of successful implantations can probably be increased by optimizing some of the devices used, for example by lengthening the carrier catheter.

Aged↗
PubMed1999

A single dose of ceftriaxone administered 30 minutes before percutaneous endoscopic gastrostomy significantly reduces local and systemic infective complications.

OBJECTIVE: The aim of this study was to determine the efficacy of antibiotic prophylaxis in percutaneous endoscopic gastrostomy (PEG). METHODS: An open prospective, randomised, multicenter study was conducted in 141 patients; 72 received ceftriaxone 1 g i.v. 30 min preintervention, and 69 received no study medication. A standardized protocol was followed for PEG preparation, insertion, and aftercare; all patients received a 15-Fr gastrostomy tube. Follow-up of local and systemic infection and clinical course was continued to postintervention day 10. An aggregate erythema and exudation score >3 or the presence of pus was taken as indicative of peristomal infection. The pharmacoeconomics of antibiotic use were also examined. RESULTS: In no-prophylaxis patients, wound infection rates were 25% on day 4 and 26.4% on day 10, versus 10.1% (p = 0.03) and 14.5% (p = 0.10), respectively, in prophylaxis patients. Results were disproportionally better in tumor patients: systemic infection rates were 16.7% versus 5.8% in no-prophylaxis versus prophylaxis patients (p = 0.045), and overall infection rates 38.9% versus 17.4%, respectively (p = 0.046). Pneumonia was more frequent in patients with underlying neurological disease. Antibiotic costs were the same in both groups (p = 0.792). CONCLUSIONS: Single dose ceftriaxone 1 g is an effective prophylaxis against local and systemic infection after PEG.

Aged↗
PubMed1998

[Ticlopidine-induced acute cholestatic hepatitis].

HISTORY AND ADMISSION FINDINGS: A 52-year-old man who had sustained a cerebellar infarct was given the platelet inhibitor ticlopidine (2 x 250 mg/d) to prevent further thromboses. 28 days after starting the medication he complained of itchings, feeling unwell and diarrhoea. He had also noted darkened urine and faecal discoloration. Physical examination revealed marked jaundice and multiple scratch marks over the entire body. INVESTIGATIONS: The activities in serum of alkaline phosphatase (420 U/l) and of gamma-GT (470 U/l) were markedly elevated and total bilirubin concentration was maximally 26.4 mg/dl. Activities of GPT (197 U/l) and GOT (44 U/l) were slightly increased. No cause was found for any extra- or intrahepatic cholestasis with or without mechanical obstruction (e.g. viral or autoimmune hepatitis). A biopsy, which showed centro-acinar cholestasis also suggested drug-induced liver damage. TREATMENT AND COURSE: Despite discontinuing ticlopidine, the signs of cholestatic hepatitis had only disappeared 2 1/2 months after the onset of symptoms. CONCLUSION: Changes in the blood picture, allergic skin reactions and gastrointestinal disorders are among the significant clinical side effects of ticlopidine. As this drug is increasingly being prescribed world-wide, the possibility of toxic liver damage should be taken into account.

Alanine Transaminase↗
PubMed1997

[Normal values for 24-hour manometry of the esophagus].

OBJECTIVE: To obtain normal values of 24-hour manometry of the oesophagus. SUBJECTS AND METHODS: Oesophageal pressures were measured in 41 healthy volunteers who had given informed consent. Recordings were made for 24 hours via a two-channel catheter in 27 and via a 4-channel one in 14 subjects. The catheter orifices were 5 and 15 cm respectively 5, 10, 15 and 20 cm above the lower oesophageal sphincter. RESULTS: Median of contractions was 1523 at 5 cm and 1500 at 15 cm (1635 at 10 cm and 2135 at 20 cm) contraction amplitudes were 31 mm Hg at 5 cm, 26 mm Hg at 15 cm; 26 mm Hg at 10 cm and 37 mm Hg at 20 cm. On average 44% of the contractions were propulsive, 17% simultaneous and 30% nonpropulsive, the remainder not clearly defined. Neither age nor sex had a significant influence on the results. Motor activity was reduced during sleep. During eating the number of contractions, their amplitude and propulsive force increased. CONCLUSION: The listed measurements, by defining normal values, make it possible to diagnose hypo- and hypermotility of the oesophagus during long-time manometry. Two-point measurement is sufficient for assessing the smooth-muscle component.

Adult↗
PubMed1997

Lactulose--a multifaceted substance.

Lactulose is therapeutically used in hepatic encephalopathy, constipation, and salmonellosis. This semisynthetic disaccharide is neither metabolized nor absorbed in the normal small intestines. Comparable to plant-polysaccharides lactulose is bacterially fermented in the colon to short chain fatty acids and gases. Major consequences are a drop in pH and a change in composition and metabolic activity of the colonic flora. These and other potential effects suggest complex mechanisms of action of lactulose, with the potential for additional indications in diagnosis and therapy. The use of lactulose as substrate for the H2-breath-test is well known as a means for the measurement of oroeceal transit time and as test for small intestinal bacterial overgrowth. An extension of the diagnostic potential is given by the assessment of the permeability in diffuse intestinal disease with combined disaccharide/monosaccharide test solutions, especially in Crohn's disease. Explanations for positive effects in the prophylaxis of cholesterol-gallstones, in the therapy of hypercholesterolemia and in the prevention of colorectal adenoma and carcinoma can be found in changes in lipid- and bile acid metabolism found after lactulose ingestion. Lactulose may lead to an improved glucose-tolerance in parallel to fibre and acarbose effects which involve several mechanisms of carbohydrate metabolism. Lactulose presumably reduces pathogenic bacteria in favor of the health promoting bifidusflora; also, production and absorption of endotoxines may be reduced; this suggests that lactulose may have therapeutic effects on both infectious and idiopathic inflammatory bowel diseases. Numerous studies with interesting but not as yet convincingly documented clinical relevance suggest that the many effects of lactulose may be interesting subjects for future research.

Gastrointestinal Diseases↗
PubMed1996

[Association of chronic urticaria with Helicobacter pylori-induced antrum gastritis].

In spite of its high incidence, not much is known about the etiology of chronic urticaria. We performed gastroscopic evaluation of 10 patients in whom no cause for chronic urticaria had been found. In 8 of these 10 patients, Helicobacter pylori was identified in the gastric mucosa. The chronic urticarial lesions disappeared within a few days after starting therapy with amoxicillin and omeprazol.

Adult↗
PubMed1996

Tuberculosis in buffaloes (Syncerus caffer) in the Kruger National Park: spread of the disease to other species.

Tuberculosis, caused by Mycobacterium bovis, was recently diagnosed in a cheetah (Acinonyx jubatus), two lions (Panthera leo) and a chacma baboon (Papio ursinus) from the Kruger National Park (KNP). It is assumed that they contracted the disease directly or indirectly from tuberculous buffaloes in the park. Tuberculous granulomatous lesions in the lungs were extensive and constituted the predominant changes in all three animal species. These pulmonary lesions included tuberculous bronchiolitis and cavitation which would facilitate dissemination of M. bovis into the environment. Spread of the disease to free-ranging species (in which it has not previously been reported) that may act as maintenance hosts of the infection, is a matter of serious concern.

Acinonyx↗
PubMed1996

[Possibilities of ultrasonography of gastric emptying].

Assessment of gastric emptying time by ultrasonography is increasingly used to evaluate gastroparesis. At first normal values have to be defined. In 20 healthy volunteers the upper value of half emptying time after a semisolid meal was 50 min. A good correlation of gastric emptying time evaluated by scintigraphy was found. Diabetics with autonomous neuropathy had a remarkable delay in gastric emptying, not seen in patients with functional dyspepsia. In dyspeptic patients pathologic width of the antrum (measured by planimetry after overnight fasting) decreased during therapy with cisapride in correlation to the improvement of symptoms.

Adolescent↗
PubMed1995

[Lovastatin-induced acute cholestatic hepatitis].

Acute cholestatic hepatitis developed in two patients, a 58-year-old man and a 54-year-old woman, who had been treated for hypercholesterolaemia with the cholesterol-synthesis inhibitor lovastatin for 3 years and 2 months, respectively. Both of them at first complained only of tiredness and loss of appetite, but then developed jaundice with colourless stool and dark urine. Alkaline phosphatase concentration rose up to maximally 1227 and 569 U/l, gamma-GT to 403 and 410 U/l, respectively. The transaminases and glutamate dehydrogenase were also elevated, while serum cholinesterase had fallen to 2346 and 2418 U/l, respectively. Histological examination of liver biopsies 6 months and 4 weeks, respectively, after onset of jaundice also suggested drug-toxic liver damage. There was no evidence for other causes. After lovastatin had been discontinued the various cholestasis parameters regressed only slowly.

Alkaline Phosphatase↗
PubMed1995

[Villous rectal adenomas and secretory diarrhea].

Hypersecretion following villous adenomatosis of the rectum is demonstrated by two single case studies. Both patients exhibited a secretory diarrhea with a 2.000-2.500 and 1.000 ml daily stool volume respectively, resulting in severe and life-threatening (first patient) loss of water and electrolytes. With increasing stool volume, rising concentrations of Na and Cl were observed in the stool and approached plasma levels. Consecutively the potassium concentration decreased to values between 15 and 23.4 mmol/l in the first severe case and to 28 and 31 mmol/l in the patient with the lowest stool volume. Elevated PG-E2 concentrations in the fluid moiety of the stool (up to 13.3 ng/ml and 0.98 ng/ml respectively) as well as the response to treatment with Indomethacin support the idea of a PG-E2 induced pathological loss of water and electrolytes. While 100 mg Indomethacin/day led to cessation of symptoms in the less severe case, even 400 mg Indomethacin/day were not able to reduce the massive rectal water loss in the first most severe patient to less than 1,000 ml/day. Surgical removal of villous adenoma showing hypersecretory activity is the only promising therapy. In case of inoperability, denial of surgical intervention or just for palliative treatment prior to surgery we recommend the inhibition of PG-synthesis with Indomethacin.

Adenoma, Villous↗
PubMed1994

Advanced tuberculosis in an African buffalo (Syncerus caffer Sparrman).

A necropsy conducted on an emaciated 8-year-old female African buffalo (Syncerus caffer) in the Kruger National Park, revealed gross pathological changes compatible with generalised bovine tuberculosis. Macroscopic lesions in the lungs and associated lymph nodes were of a caseous necrotic nature with liquefied foci. Mycobacterium bovis was cultured from pulmonary lesions. The distribution and the characteristics of the lesions are described and the conclusion is made that the initial route of infection was aerogenous with secondary bacterial metastasis to the intestine. It would also appear that the spread of infection within the animal was extremely rapid. The conjecture is made that due to the cavernous state of the pulmonary lesions, the animal was probably highly infective at the time of death. Environmental factors that may have had an influence on the pathogenesis of the disease are seasonal rainfall fluctuations, extreme temperature variations and harsh ultra-violet exposure.

Animals↗
PubMed1989

[Histamine effects on the heart with special reference to cardiac side effects of H2 receptor antagonists].

The existence of cardiac h1- and h2-receptors is evidenced by pharmacologic studies. Despite of the relatively high content of cardiac histamine it is not clarified whether histamine actually plays a physiologic role - apart from pharmacologic effects - in the regulation of myocardial function and coronary blood flow. Under pathophysiologic conditions (during anaphylaxis, surgical procedures, accidents, stress etc.), however, when a local or systemic histamine release occurs both hemodynamic and arrhythmogenic effects are evident. Numerous studies in animal models conclusively demonstrated a role of cardiac histamine as a major mediator of serious arrhythmias. Consequently, a combination of h1- and h2-receptor antagonists (f.e. Dimetinden/Cimetidin) was recommended as a prophylactic treatment against severe anaphylaxis including life-threatening arrhythmias for cardiac patients at risk. There is pharmacologic evidence of both a positive inotropic and chronotropic effect in the human heart via h2-receptor and stimulation of adenylate cyclase. Histamine-induced coronary effects such as vasoconstriction via h1-receptor and coronary dilatation via h2-receptor are not yet sufficiently validated. Studies on the human heart in vitro using coronary strips from explanted hearts and in vivo investigations on the intact coronary system yielded conflicting results. H2-receptor blocking agents cimetidine, ranitidine and famotidine have qualitatively a different pharmocodynamic spectrum of side effects due to differences in chemical structure. Data on cardiac arrhythmias are mostly associated to cimetidine. Symptomatic bradycardia were reported for both ranitidine and cimetidine. A possible negative inotropic effect of famotidine, although presently not validated, requires further studies. Causative and adverse side effects of cimetidine on the cardiovascular system, however, are to be expected extremely seldom due to easily reversible competetive h2-receptor binding. For prophylaxis rapid intravenous injections of h2-blockers, particularly in elder patients with cardiac diseases, should be avoided. Compared to cimetidine, a tendency of explainable difference seems to become apparent for ranitidine and famotidine due to higher receptor affinity.

Animals↗
PubMed1987

[Treatment of uncomplicated duodenal ulcer using cimetidine alone and in combination with pirenzepine. A comparative study].

In a double-blind, randomised trial two drug regimens were compared in a group of 129 patients with uncomplicated duodenal ulcers, 64 receiving cimetidine (800 mg) and pirenzepine (50 mg) at bed-time, 65 receiving cimetidine (800 mg) and a placebo at bed-time. Neither statistically nor clinically was there an important difference in effectiveness and tolerance between the two drug regimens.

Adult↗