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Biomedical subjects

H J Schulz

Publications and source records attributed to H J Schulz.

At least 37 records · Page 2Linked to original sources
PubMed1991

[The pancreatic toxicity of cyclosporin A. An experimental study in rats].

Animal experiments were conducted to elucidate effects of cyclosporine A (CsA) treatment on pancreas. A daily dose of 15 mg/kg B.W. of cyclosporine A was orally administered to recipient animals (rats), over a period of 28 days. Both endocrinic and exocrinic pancreas tissues were morphometrically investigated, using optical light microscopy and electron microscopy. Increase in the exocrinic pancreas portion in response to cyclosporine A treatment was suggested by these morphometric findings. Disorders in the exocrinic pancreas were additionally revealed by electron microscopy. Some of the mitochondria exhibited degenerative alterations, while decline in matrix density as well as separation or rupture of mitochondrial cristae were recorded from others. The assumption might be derived from these results that even therapeutic CsA doses were capable of inflicting disorders on mitochondrial functionally and thus of generating toxic action.

Administration, Oral↗
PubMed1990

[Acute pancreatitis--etiology, pathological anatomy and pathogenesis].

Acute pancreatitis is a disease characterized by abdominal pain, low-grade fever, abdominal tenderness and rigidity, and moderate elevation of the white blood cell count. A widely used revised classification of pancreatitis is that proposed in 1984 at Marseille. It only distinguishes between acute and chronic pancreatitis. In 61 cases were 40 men and 21 women. The mean age in the total series was 52.5 years. The etiology of the acute condition was alcoholism in 32.8% and biliary tract disease in 23%. In 9.8% the acute pancreatitis is associated with alimentary tract diseases (adipositas, hyperlipidemia). The severity of acute pancreatitis is pathological anatomy determined by three stages. In pathogenesis the process of digestion is caused by activated pancreatic enzyme with acinar cell injury. The acinar cell is normally protected from the action of its own enzymes by elaborate intracellular compartmentation of enzymes. Acute pancreatitis is triggered by pancreatic phospholipase A leading to necrosis of lipolytically active fat cells with release of membrane-toxic fatty acids with following destruction of adjacent tissue. Fat necrosis initiates an acute inflammatory reaction with immigration of granulocytes and liberation of kinins, which activate pancreatic enzyme. Pancreatic enzymes are similar to lysosomal enzymes with regard to substrate specificity. Activation will be also triggered by lysosomal enzymes of necrotic acinar cells.

Adult↗
PubMed1990

[Diagnosis of rejection after pancreatic transplantation in the minipig model].

An allogenic transplantation of the total-pancreas with duodenum was carried out in the minipig model. The oral duodenum was closed blindly and the aboral part was led out as a stoma. The portal vein of the transplant was anastomosed end-to-side in the inferior vena cava and the celiac artery of the transplant in the distal aorta. Investigations for early diagnosis of rejection were carried out in this model parallelly respectively one by one. CT/MRT, selective angiography, laboratory chemical parameters were unsuitable for early detection. The pancreatic succus cytology and nuclear medical investigations show reproducible changes caused by rejection before the blood-sugar level was increased.

Amylases↗
PubMed1990

[Extracorporeal shockwave lithotripsy (ESWL)--a new procedure for treating choledocholithiasis].

UNLABELLED: ESWL offers a new possibility for the treatment of patients suffering from bile duct stones, in cases where endoscopic methods failed. From September 1987 to June 1989 80 patients (56 women, 24 men; mean age: 66 years) had been selected for ESWL at the Charité-Hospital. Indications were: Impacted stones (30 patients), very large stones (22 patients), stones above bile duct strictures (28 patients). 79 patients have been treated by device "Lithostar" (Siemens) during 114 sessions in abdominal position under X-ray visualization. ESWL-treatment was impossible in one patient because of technical reasons. Per treatment session 1000 to 5000 shock waves with an energy of 19 kV, directed on a single or distributed among several stones, have been applied. In 79 cases out of 114 treatments complete or partial fragmentation (69.3%) was attained. Stone fragments were removed endoscopically in 56 patients and in 1 patient percutaneously via biliary drainage. In 5 cases the fragments passed spontaneously. On the total, in 72.2% of our patients stones clearance was achieved. No severe side effects could be observed. CONCLUSION: ESWL represents a proper method increasing the effectiveness and lowering the risks of non-operative therapy by bile duct stones.

Aged↗
PubMed1990

[Duct-oriented classification of exocrine pancreatic carcinoma].

Histogenetic classification was applied to 416 cases of human exocrine pancreas carcinoma. Fundamental importance was attributed, in that context, to duct-associated histogenesis. A distinction was, therefore, made between ductal and ductular pancreas carcinomas. Invasive ductal carcinomas were subdivided by three categories: highly stromatous classical adenocarcinoma with poor prognosis, invasive ductal carcinoma with further differentiation (myxoma, squamous carcinoma, pleomorphous macrocellular and parvicellular types), and variations with specific differentiation (serous, mucinous tumours) with good prognosis. Invasive ductular carcinomas were subdivided by terminal non-papillary adenocarcinoma with protracted illness, ciliary adenocarcinoma, microglandular adenocarcinoma, ductulo-acinous tumour with excellent prognosis, and oncocytic carcinoma. These should be distinguished from intermediary cells with cellular transformation and neoplastic differentiation, such as adenocarcinoma with hepatocellular differentiation and mixed tumours (exocrine and endocrine) with alternatingly predominant cell spectra. Determination of prognostically differentiated tumours types is considered to be an indispensable prerequisite for adequately adjusted effective therapy. This appears to be the only approach which promises progress for the future.

Adenocarcinoma↗
PubMed1989

[Endoscopic papillotomy in the treatment of choledocholithiasis--technic, indications, results].

UNLABELLED: Endoscopic papillotomy (EPT) has good short- and long-term results in the non-operative treatment of common bile duct stones. Advantages are low risk, short hospital stay and short unfit to work. On the basis of the literature and own experiences that derive from 2,500 EPT the author discusses preparation, technique, indications, contraindications, complications, and results of the procedure. EPT successfully had been performed in 98.3% of cases. All bile duct stones could be removed in 92%. INDICATIONS: choledocholithiasis 2013 (456 with gallbladder in situ, 24 with acute biliary pancreatitis), benign papillary stenosis 125, papillary carcinoma 57, other indications 305. COMPLICATIONS: 4.6% (115); bleeding 36, pancreatitis 36, cholangitis/stone impaction 30, retroduodenal perforation 13; urgent operation 1.2% (30), mortality 0.5% (12).

Ampulla of Vater↗
PubMed1989

[Endoscopic-radiologic diagnosis and therapy of the bile ducts. Results of endoscopic papillotomy].

Endoscopic-radiologic methods for demonstrating the hepatobiliary and pancreatic ducts are an integrated part of the diagnostic spectrum of gastroenterologic centers. At the Charité since 1975 we have made more than 5,500 endoscopic-retrograde cholangio-pancreaticographies (ERCP's). This method provides immediately or later an adequate therapy as an alternative to the otherwise necessary surgery. The most frequently used and basic method is endoscopic papillotomy (EPT). In most cases it precedes endoscopic removal of concrements, prosthetic drainage of biliary pathways or extracorporal shockwave lithotripsy (ESWL). Since 1977 we have carried out 2,050 EPT's at the Charité, more than 60% of these for patients of higher age (above 60). With 98.3% successful interventions complications were seen in only 4.7% of the cases. The influence of close interdisciplinary cooperation of endoscopicists and radiologists on the results of the investigation and the rate of complications is discussed.

Adult↗
PubMed1989

[Changing trends in percutaneous and endoscopic bile duct drainage].

Analysis of 1,104 non-surgical biliary drainages (600 ERCD, 531 PTCD) from 1983 to 1988 concerning changing frequency, indications and success rates. With a continuous increase of the total numbers, the fraction of percutaneous-transhepatic drainages has decreased to 28%. With increasing degree of difficulty and risk PTCD (90.9% success) is indicated primarily in case of impossible ERCD (85.9% success) and hilar benign and malign biliary obstruction for temporary or permanent biliary drainage. Both methods are complementary and are increasingly used for combined palliative drainage.

Adolescent↗
PubMed1989

[Histogenetic classification of exocrine pancreatic carcinomas].

The structures of normal ductal and ductular epithelium were compared with cytological peculiarities of pancreas carcinoma. This provided the basis on which to propose histogenetic classification of exocrine pancreas carcinoma. Most of the pancreas carcinomas are adenocarcinomas and originate from small lateral ductules. Preneoplastic ductal alterations, such as proliferation of ductal epithelium, adenomatous dysplasia, and light-cell transformation, may be topographically distinguished from ductular changes, including centroacinic hyperplasia, oncocytic transformation, microglandular metaplasia, ductulo-acinic metaplasia, hepatocellular metaplasia, and peri-insular metaplasia. The close correlations that exist between ductular and acinic cells may be summarised under the cover term of terminal ductulo-acinic intercalated duct complex. Dysplasia is generally accompanied by decline in neutral glycosaminoglycans and occurrence of unsubstituted sialomucin of the embryonic type.

Adenocarcinoma↗
PubMed1988

[Dysplasia and carcinoma in situ of the pancreatic duct epithelium].

Histopathologic aspects of metaplasia, dysplasia and carcinoma in situ of the pancreas are described and diagnostic difficulties discussed. Morphological lesions of the pancreatic ducts were studied in 200 control autopsy cases, and in 85 clinical cases with primary pancreatic carcinoma. The following groups of morphologic lesions can be differentiated with sufficient reliability: normal ductepithelium, metaplasia and hyperplasia; mild and moderate epithelial dysplasia; severe dysplasia including carcinoma in situ; invasive ductal/ductular carcinoma. Important for a reliable diagnosis are good specimens and good histological sections. Severe dysplasia including carcinoma in situ in areas surrounding invasive carcinomas as well as isolated severe dysplasia herald a high risk of progressive tumor disease for the patient.

Adult↗
PubMed1988

[Isolation of islands of Langerhans from the human adult pancreas].

Nine of 38 islet isolation experiments, using the duct collagenase technique, were selected for quality checks on isolated islet tissue. Pancreas was harvested, following aortic multi-organ perfusion. The total number of islets isolated amounted to 112,461 +/- 11,828 in 13.7 ml of suspension on average. In vitro secretion of beta cells was increased by a factor of 3.8 in response to glucose stimulation. Isolated islets in morphologically intact condition were detected by histological investigations. A new viability test (MTT, Sigma) for isolated pancreas islets worked well, in that it provided very soon information on islet survival in the wake of collagenase preparation. These results produced evidence to an improvement of technical conditions for clinical use of adult islet transplantation in cases of type I diabetes.

Adult↗
PubMed1988

[Esophageal function in portal hypertension before and after sclerotherapy].

An examination of esophageal function using manometric techniques and long-term pH measurement was carried out on 14 patients suffering from cirrhosis of the liver who had esophageal varices. The resting pressure in the lower esophageal sphincter was found to be slightly reduced in 50 per cent of those examined, while 100 per cent showed a slightly reduced contraction amplitude in the distal tubular esophagus which became progressively lower in the distal direction, and a pathological gastro-esophageal reflux was observed in 57 per cent. We were able to carry out a control examination on 10 of these patients after sclerosing procedure. Sclerotherapy was found to have lowered resting pressures in the lower esophageal sphincter in 80 per cent of those patients, while all of them showed a grossly impaired tubular peristalsis in the form of simultaneous, mostly repetitive contractions with a considerably lowered contraction amplitude, however it had no negative influence on gastro-esophageal reflux patterns.

Adult↗
PubMed1988

[The TNM classification of pancreas cancer].

According to the TNM-System classification for the cancer of pancreas 331 subjects were collected. Some important factors were associated with the survival time of patients, i.g. the localization, the size and the histological type of tumors. It is well known that when distant metastases are found, only a palliative operation is possible while metastases in the regional lymph nodes are considered as a critical moment of the treatment of this disease. Teamwork is strongly recommended between the surgeon and pathologist to achieve better results as it is presented by classification. Following this fact it is possible to determine accurately the actual stage of any cancer of pancreas. As a result of the present findings it should be suggested to establish comparable and standardised programs for the treatment of pancreatic cancer.

Female↗
PubMed1987

[Sonographic diagnosis of bile duct calculi. Results of a prospective study of 222 cases of choledocholithiasis].

To evaluate sonographic accuracy in the diagnosis of choledochal calculi 490 patients with cholestasis were examined prospectively with real-time scanner before ERCP or surgery. Ultrasound detected duct stones in 177 of 222 patients (sensibility 80%) and their absence in 242 of 268 (specificity 90%). Dilated extrahepatic bile ducts were demonstrated via ultrasound in 84% of cases with choledocholithiasis, dilated intrahepatic bile ducts in 57%. Intestinal gas obscuring the distal common duct was the most important factor limiting the ability of ultrasound to detect duct stones.

Adolescent↗