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Biomedical subjects

H Lochs

Publications and source records attributed to H Lochs.

At least 181 records · Page 10Linked to original sources
PubMed1984

Substance P is markedly increased in plasma of patients with hepatic coma.

Substance P (determined as immunoreactive substance P [i-SP]), noradrenaline, and adrenaline were measured in plasma of 18 patients with hepatic coma (stage I-IV), 16 healthy controls, and 10 critically ill patients without evidence of hepatocellular disease. Plasma i-SP (119 +/- 13 fmol/ml) was significantly higher in patients with hepatic coma than in healthy controls (13 +/- 2 fmol/ml) or control patients (23 +/- 4 fmol/ml). Plasma i-SP rose in parallel with plasma noradrenaline and adrenaline. There was a significant direct correlation between plasma i-SP and noradrenaline. Increase in plasma i-SP and noradrenaline was associated with a decrease in systemic vascular resistance and an increase in cardiac index and was most pronounced in those patients who finally died in coma. Deterioration in the dying patients was accompanied by a further significant increase in plasma i-SP. Immunoreactivity was identified as authentic SP by high performance liquid chromatography in 3 representative patients. Accumulation of the vasodilating peptide SP in plasma of patients with hepatic coma may be important in the pathogenesis of the cardiovascular disturbances associated with this disease.

Adolescent↗
PubMed1984

[Enteral feeding--an alternative to parenteral feeding in the treatment of Crohn disease?].

Efficiency of parenteral nutrition and tube feeding were compared in two groups of 25 patients each who suffered from active Crohn's disease. Indication for treatment in these patient groups was an acute phase of the disease with an activity index of higher than 150 and/or body weight below 80% of optimum weight. During the trial no other therapy was given. Target parameters were the Crohn index, body weight, serum albium, hemoglobin, and in a part of the patients the creatinine index. In both groups signs and symptoms of activity were reduced significantly and nutritional status was improved; however, there were now significant differences between groups. From these results the conclusion can be drawn, that enteral nutrition is essentially equally effective as parenteral nutrition in treatment of the acute phase of Crohn's disease. For this reason only patients where there is an absolute contraindication against tube feeding should be supplied with parenteral nutrition.

Adolescent↗
PubMed1983

[Carcinoembryonic antigen (CEA) levels and their clinical significance in Crohn's disease].

25 patients with Crohn's disease were followed up with serial serum carcinoembryonic antigen (CEA) determinations during hospitalization and at a control investigation eight weeks following discharge. The CEA level was compared with extent, duration and clinical activity of disease, as well as with Crohn's Disease Activity Index (CDAI) and several acute phase reactants. The distribution of positive CEA levels (greater than 5 ng/ml) was similar in phases of acute inflamation and in remission. CEA levels did not show any significant correlation with CDAI, acute phase reactants, extent of involvement, duration of disease or histological findings. In this study CEA levels did not prove to be helpful indicators of disease activity or of cancer risk in Crohn's disease.

Acute Disease↗
PubMed1983

Growth of various bacteria and yeast in a peptide and an element diet.

Solutions of a peptide and an elemental diet were artificially contaminated with several bacterial and yeast strains. Their growth was measured after eight and 24 h incubation at 4 degrees and 22 degrees C. At 4 degrees C no increase in colony count could be observed in either diet within 24 h. At 22 degrees a significant increase of all but the campylobacter strains was obtained after 24 h in the peptide diet. In the elemental diet only the pseudomonas and the yeast strains showed a small increase, the campylobacters were reduced and the colony count of all the other test strains remained constant. As such diets are administered continuously for up to 24 h via a tube into the duodenum for severe intestinal disorders it is suggested (i) that they should be prepared under sterile conditions (ii) that peptide diets should be given for no longer than 8 h and (iii) that solutions of both diets should not be stored for longer than 24 h in the refrigerator.

Bacteria↗
PubMed1983

Has total bowel rest a beneficial effect in the treatment of Crohn's disease?

Twenty patients with Crohn's disease were treated with parenteral nutrition (PN). The indication for PN was a bodyweight of less than 80% ideal bodyweight and/or a Crohn's disease activity index (CDAI) above 150 despite conventional therapy. A complete nutrition solution containing per litre 150 g glucose, 50 g sorbitol, 50 g amino acids, 50 g fat, electrolytes, trace elements and vitamins was infused via a central venous catheter to provide 72 kcal per kg bodyweight and day. No other medications were given during the study. The patients were randomized into two groups: both groups received PN in identical fashion. Group 1 was not allowed to eat or drink to reach total bowel rest; Group 2 ate formula diets and low residue diet ad libidum in addition to PN. Criteria for the nutritional status were bodyweight, serum albumin, prealbumin and hemoglobin and for disease activity the CDAI. Mean duration of treatment was 28 days in group 1 and 33.5 days in group 2. At the beginning both groups were comparable with respect to disease activity, nutritional status and extent of Crohn's disease. At the end of the study nutritional status was improved (increase of bodyweight and prealbumin) and disease activity was decreased by therapy in both groups with no significant difference between the two regimens. We conclude that PN improves the nutritional status and reduces the activity of Crohn's disease. The combination of PN and total bowel rest resulted in the same improvement as with PN alone. Total bowel rest is therefore unnecessary, when PN is given in patients with Crohn's disease.

Journal Article↗
PubMed1983

[Clinical significance of bacterial contamination of enteral nutrition solutions].

Tube feeding with elemental and peptide diets is used as therapy for the acute phase of Crohn's disease. It should improve the nutritional status of the patients and reduce bacterial counts in the intestine. In this study we investigated the frequency of bacterial contamination of solutions of chemically defined diets and the clinical effects of the application of contaminated diets (stool frequency, body temperature, leucocyte counts). 15 patients with acute phase of Crohn's disease were treated with chemically defined diets over a total period of 323 days via a nasoduodenal tube. 7 patients received BSD, 8 patients Peptisorb. In all 36 BSD solutions examined in concentration procedures we found microbes, most frequently Streptococcus and Bacillus spp. Without concentration procedures it was possible to cultivate bacteria in 12% out of BSD solutions and in 81% out of Peptisorb solutions; in BSD mostly Streptococcus and in Peptisorb solution E. coli, Bacillus spp. and aerobic spore forming bacilli. Stool frequency, body temperature and leucocyte counts did not show significant differences after application of contaminated solutions in comparison to the others. Deterioration of the disease has not been observed in any case.

Adult↗
PubMed1983

[Fat in the parenteral feeding of malnourished patients].

In malnutrition lipoprotein lipase activity in the liver and the beta-lipoprotein concentration in serum are reduced. The lipolysis is increased. One suspected a reduction of fat elimination in such patients. In 10 malnourished patients with a mean body weight of 73% ideal body weight an intravenous fat tolerance test was performed. The elimination rate was in mean 5.77%/min, that is in the normal range. Studies with radioactive triglycerides showed a metabolization of 30% of infused fat during 24 hours. These results were confirmed by measurements of gas exchange. Energy expenditure and nitrogen balance in malnourished patients correlate with the energy intake but not with the amount of fat in the parenteral nutrition. That could be confirmed in a prospective randomized study in 8 malnourished patients. The carbohydrate oxydation provided 70% to 80% of total energy expenditure independent from the dosage of fat in these patients. The minimum of fat needed in total parenteral nutrition to avoid essential fatty acid deficiency is 100 g per week. The tolerable maximum dose ist not known. In 10 malnourished patients with a mean time of 36 days of parenteral nutrition a dosage of 2.5 g/kg X d-1 was well tolerated and no side effects were seen. In 3 of these patients a previous cholostasis improved during parenteral nutrition.

Dose-Response Relationship, Drug↗
PubMed1983

[Emergency endoscopy in patients with liver cirrhosis].

A report is given about emergency endoscopy in 389 patients because of bleeding from the upper gastrointestinal tract; 60 of these patients had cirrhosis of the liver as confirmed by biopsy. In the total group 17.4% were found to have bleeding from esophagus varices, in the cirrhotic group the incidence was 53%. Erosive lesions of the stomach came second in incidence, accounting for 27% of the cases in the latter group. In 60% of patients with cirrhosis, who had had acute bleeding, esophageal varices were present in abundance, whereas only 27% of patients without bleeding did have such excessive formation of varices. Thrombotest and thrombocyte count were equal in both groups. In 50% of 133 patients with cirrhosis of the liver without acute bleeding complications, a second potential source of bleeding beside esophageal varices could be detected. This underlines the importance of emergency endoscopy in patients with cirrhosis of the liver suffering from acute upper gastrointestinal bleeding.

Acute Disease↗
PubMed1982

[Mirizzi syndrome (author's transl)].

The Mirizzi syndrome consists of the trial cystic duct stone, cholecystitis and benign hepatic duct stenosis. The differentiation between intra- and extrahepatic cholestasis can be made sonographically in almost 100% of cases. In a high percentage of cases the ultrasound investigation can localise the level of the block. However, the additional use of endoscopic retrograde cholangiography (ERC) or percutaneous transhepatic cholangiography (PTC) is necessary for an exact pre-operative diagnosis. The most efficient diagnostic plan is illustrated by a case presentation of a patient with Mirizzi syndrome.

Adult↗
PubMed1982

[Complications of the central venous feeding of mobilized patients with an all-in-one solution].

35 mobilized patients received continuous parenteral nutrition consisting of an all-in-one solution mixed together in this department right before use over a total period of 1155 days (mean per patient 33 days). The primary complication rate was: second puncture in 14%, pneumothorax in 11% and haemothorax in 3% of cases. Secondary complications: catheter-related sepsis was documented in 8.5%. Metabolic complications were not seen. The all-in-one solution is a satisfactory nutrient for long-term, low-risk administration by the route, suitable even in the case of mobilized patients, without the necessity of intensive metabolic monitoring.

Adult↗
PubMed1982

[Clinical results with loperamide in the treatment of chronic diarrhoea of varied aetiology (author's transl)].

19 consecutive patients admitted with severe chronic diarrhoea which had failed to respond to standard therapeutic regimen were treated with 4 to 8 mg of loperamide daily for up to 50 weeks. A marked improvement was achieved in 13 out of the 19 patients (68%). The best results were observed in patients with ulcerative colitis and Crohn's disease. Patients with secretory diarrhoea did not improve. No major side effects were observed. It is concluded that loperamide is a highly effective and safe new drug in the treatment of patients with chronic inflammatory bowel diseases.

Adult↗
PubMed1982

[Atypical variant of a hepatocellular carcinoma with a favourable course (author's transl)].

The case of a 51 years old man with a hepatocellular carcinoma (HCC) is reported. Though the tumor is of multifocal origin and widespread the disease takes a favourable course. Histology revealed a well differentiated HCC with clusters of polygonal tumor cells and fibrous stroma, the pattern of which reminds of focal nodular hyperplasia (FNH). HCC has developed in a non cirrhotic liver. Clinically, the patient is in a good condition 22 months after diagnosis of the tumor. The value of all possible methods--invasive and not invasive--for diagnosis of HCC is assessed and compared with literature. According to the literature the survival time comes to 3 to 6 months on average, only single cases take a more favourable course. Correlation of morphology and biological behaviour of tumor is lacking. In our case the pattern of fibrosis similar to FNH is striking and points to a development of carcinoma in preexisting FNH. In literature, however, evidence for a malignant transformation of FNH is lacking.

Angiography↗
PubMed1982

[Effect of parenteral nutrition on serum proteins in patients with Crohn disease].

The concentration of 19 serum proteins was determined by radial immunodiffusion in 23 patients with Crohn's disease before and after treatment with parenteral nutrition. The results were related to body weight and Crohn's Disease Activity Index. An increased serum concentration of retinol-binding protein, prealbumin, and transferrin paralleled an increase of body weight. Alpha-1-glycoprotein, alpha-2-chymotrypsin, alpha-1-antitrypsin, C-reactive protein, and haptoglobin decreased during parenteral nutrition and showed a positive correlation to the Crohn's Disease Activity Index. The determination of certain proteins is clinically useful, since their serum concentration reflects the influence of parenteral nutrition on nutritional status and disease activity. Measurement of these proteins provides a useful guide to the management of patients with Crohn's disease treated with parenteral nutrition.

Adult↗
PubMed1982

[Effect of parenteral administration of fat on the glucose and fat metabolism in acute pancreatitis].

Glucose intolerance is well known in acute pancreatitis. The question of this study was to clarify, if fat used partly instead of glucose in the parenteral nutrition of these patients allows to reduce the insulin necessary to control the blood glucose. A second question was if hypertriglyceridemia is caused by long term infusion of fat in such patients. 10 patients with acute necrotising pancreatitis were divided in two groups: group I (5 patients) were infused with a parenteral nutrition with fat, group II (5 patients) with a parenteral nutrition without fat. As parameters the amount of insulin needed to maintain the blood glucose at levels less than 200 mg% and the serum triglycerides were used. The blood glucose was controlled three times a day. For statistical evaluation the Student-t-test was used. The patients in group I (parenteral nutrition with fat) were infused 44 days and received insulin on 40 days. 69 units insulin/day were needed with a glucose dose of 243 g/day. The insulin dose per 100 g glucose was 29.9 U. The fat dose was 74 g/day. Group II (parenteral nutrition without fat) was infused 45 days and received insulin on 38 days. 103 units insulin/day were needed metabolized 295 g of glucose. The insulin per 100 g glucose was 28.7 units. The dose of insulin per 100 g glucose was not different between the two groups. In 1 patient a hypertriglyceridemia occurred after infusion of fat and disappeared immediately after withdrawal of the fat infusion. In the other patients no hypertriglyceridemia occurred during fat infusion. The parenteral infusion of fat has no influence on the glucose intolerance of patients with acute necrotising pancreatitis.

Acute Disease↗
PubMed1982

[Disorders of kidney function in hepatic coma].

Renal function was evaluated in 80 patients with hepatic coma stage III-IV (24 patients had acute fulminant hepatic failure, 48 patients chronic hepatic failure, 8 patients had a mixed form). Urea, creatinine and electrolytes were measured in plasma and urine as well as creatinine clearance and sodium/potassium ratio in urine. Renal failure was defined as an increase of serum creatinine above 3 mg/dl. In 15 of the 24 patients with fulminant hepatic failure creatinine clearance was reduced; hyperaldosteronism was present in 13 cases; in 2 patients there was necrosis of the tubulus, in 9 patients overt renal failure. In patients with chronic hepatic failure creatinine clearance was pathological in 36 cases, hyperaldosteronism was diagnosed in 23 cases and necrosis of renal tubules in 3 cases; 8 patients had overt renal failure. In the group with the mixed form of hepatic coma creatinine clearance was pathological in 3 cases, in 6 cases hyperaldosteronism was diagnosed; necrosis of the tubules could not be found in this group; 4 patients had overt renal failure. It is suggested that for treatment of this condition dopamine should be given prophylactically as well as intravenous sodium and water substitution.

Acute Kidney Injury↗
PubMed1981

[Ischaemic colitis (author's transl)].

Attention must be drawn to the fact that especially in elderly patients with acute onset of abdominal pain concomitant with haemorrhagic, mucous diarrhoea, ischaemic colitis must be considered in the differential diagnosis. Ischaemic colitis arises as a consequence of insufficient blood flow through the peripheral branches of the middle colic artery and inferior mesenteric artery and mostly strikes the left colonic flexure, the colon descendens or sigmoid. Because of the segmental involvement and the macroscopic appearance on X-ray and endoscopy the disease is sometimes indistinguishable from Crohn's disease or ulcerative colitis. In every day clinical life ischaemic colitis is a relatively rare phenomenon, in spite of the high incidence of arterial occlusive disease in the patients treated at this unit. The increasing frequency of ulcerative colitis in elderly patients, as reported in the literature, may be partly associated with unidentified cases of ischaemic colitis and this possibility is discussed.

Aged↗