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Biomedical subjects

H Lochs

Publications and source records attributed to H Lochs.

At least 145 records · Page 8Linked to original sources
PubMed1995

Screening for celiac disease: a prospective study on the value of noninvasive tests.

OBJECTIVE: Celiac disease is frequently diagnosed in patients with nonspecific abdominal symptoms. Therefore, highly sensitive, specific, and simple noninvasive screening tests are needed. METHODS: This study compared the usefulness of IgG- and IgA-antigliadin antibodies, IgA-endomysial antibodies, and intestinal permeability in diagnosing celiac disease in 102 adult patients with nonspecific abdominal symptoms. In addition, all patients underwent small bowel biopsy as a gold standard for the diagnosis of celiac disease. RESULTS: Forty-nine patients were ultimately diagnosed as having celiac disease because of flat mucosa. Flatulence and signs and symptoms dating back to childhood were more frequent and abdominal pain less frequent (p < 0.05) in celiac disease but were not helpful for screening. IgA-endomysial antibodies showed a sensitivity and specificity of 100%; an altered intestinal permeability had also a 100% sensitivity, but only 55% specificity. IgG- and IgA-antigliadin antibodies' sensitivity (73% and 82%, respectively) and specificity (74% and 83%, respectively) were much lower. Combining the two antigliadin antibodies did not significantly improve the sensitivity and specificity. CONCLUSIONS: Our data show the advantage of IgA-endomysial antibodies for screening of celiac disease except in the case of patients with IgA-deficiency or dermatitis herpetiformis. In these patients, the permeability test could improve noninvasive differential diagnosis.

Adult↗
PubMed1995

Disease-related worries and concerns: a study on out-patients with inflammatory bowel disease.

OBJECTIVE: To investigate the relationship between inflammatory bowel disease (IBD) patients' disease-related worries and concerns and their disease-related data, sociodemographic variables and perceived information level with respect to IBD. STUDY DESIGN: Prospective evaluation of disease-related concerns. SETTING: Out-patient IBD clinic of a university hospital. STUDY POPULATION: The study included 105 patients with IBD (72 with Crohn's disease and 33 with ulcerative colitis). MEASUREMENTS: Worries and concerns were measured using the standardized 25-item rating form of IBD patient concerns; actual disease activity was assessed by physicians using the Crohn's disease and clinical activity indices. Sociodemographic and other disease-related data were collected using a structured questionnaire. Patients' perceived information level was measured using a visual analogue scale. RESULTS: The issues of greatest concern to our patients were, in descending order of importance, having an ostomy bag (mean score +/- SD 63.6 +/- 38), the effects of medication (53.1 +/- 34), having surgery (51.6 +/- 36), the uncertain nature of the disease (46.5 +/- 32) and energy level (41.5 +/- 34). Patients with ulcerative colitis scored higher with respect to concern about loss of bowel control (P < 0.03). Disease-related worries and concerns correlated poorly with disease-related data (actual disease activity, severity of the course of IBD, diagnosis, disease duration or location, medication) but showed a significant negative correlation with patients' perceived information level about IBD (t = 0.2, P < 0.004). Lower information-level scores were associated with greater concerns. CONCLUSION: We conclude that the patients' information level about IBD and disease-related concerns have to be considered in clinical practice. Better information about IBD and psychosomatic counselling for patients who show high levels of concern may improve their quality of life and clinical care.

Adolescent↗
PubMed1994

Anemia in Crohn's disease. Importance of inadequate erythropoietin production and iron deficiency.

Intestinal blood loss as well as chronic inflammation are regarded as the most important mechanisms in the pathogenesis of anemia in Crohn's disease. In addition, cytokines such as interleukin-6 can suppress erythropoietin production. This study was performed to investigate the importance of iron status, inflammatory activity, and endogenous erythropoietin concentrations for the development of anemia in Crohn's disease. In 49 consecutive patients with Crohn's disease, hemoglobin, inflammatory activity (Crohn's disease activity index, C-reactive protein, alpha 1-acid glycoprotein), iron status (serum iron, transferrin, transferrin saturation, ferritin), and serum erythropoietin levels were studied. Anemic (Hb < 12.0 g/dl; N = 16) vs nonanemic patients (Hb > or = 12 g/dl; N = 33) showed reduced iron compartments (eg, ferritin 28.7 +/- 12.9 micrograms/liter vs 63.2 +/- 15.0 micrograms/liter, transferrin saturation 6.2 +/- 1.4% vs 11.5 +/- 1.3%, P < 0.01) but no differences in inflammatory activity. An inverse correlation between erythropoietin and hemoglobin concentrations was found (r = -0.62; P < 0.001), but the increase in erythropoietin levels was inadequate to the degree of anemia. There was no correlation between erythropoietin and interleukin-6 serum levels. Four of five anemic patients with hemoglobin below 10.5 g/dl and erythropoietin levels within the normal range were treated with parenteral iron (200 mg iron saccharate in 250 ml NaCl, weekly, intravenously). Two of them additionally received recombinant human erythropoietin (150 units/kg, 3x weekly, subcutaneously). After five weeks all patients had a marked increase in hemoglobin. However, the mean increase in erythropoietin-treated patients was 5.0 g/dl compared to 2.0 g/dl in the patients with iron therapy only.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Importance of liver and kidney for the utilization of glutamine-containing dipeptides in man.

The impact of hepatic and renal failure on the metabolism of L-alanyl-L-glutamine (Ala-Gln) and glycyl-L-glutamine (Gly-Gln) was investigated in 11 healthy volunteers, five patients with liver cirrhosis, and six patients with chronic renal failure. The clearance (mL.kg-1.min-1) of Ala-Gln was significantly higher than that of Gly-Gln in all three groups. Renal failure significantly reduced clearances of both Ala-Gln and Gly-Gln (13.27 +/- 0.71 and 3.06 +/- 0.28) when compared with control values (21.68 +/- 1.21 and 7.08 +/- 0.38). Liver failure had no significant influence on the clearances of Ala-Gln and Gly-Gln (22.62 +/- 2.89 and 6.20 +/- 0.88). Liver failure delayed and renal failure almost abolished the increases in plasma concentrations of free amino acid residues after peptide injection. It is concluded that other organs can substitute for the peptide-clearing function of the liver, but not of the kidney. Kidney is the most important organ for the clearance of dipeptides and the release of amino acid residues into circulation. Our data show that clearance rates of both Ala-Gln and Gly-Gln are sufficient to avoid accumulation of either peptide if infused in the presently recommended doses. Both Ala-Gln and Gly-Gln could therefore be used as sources for glutamine in parenteral nutrition even in patients with chronic renal failure.

Adult↗
PubMed1994

Folate absorption in Crohn's disease.

An oral folate absorption test was performed in 100 consecutive patients with Crohn's disease (CD) and 20 healthy individuals to investigate the frequency of abnormal folate absorption in regard to the site of the disease and to investigate the possibility of defining a subgroup of patients requiring parenteral folate supplementation. The described oral folate absorption test can be performed quickly on an outpatient basis and is capable of distinguishing patients with altered folate absorption from those with normal folate absorption. In 25 patients, abnormal folate absorption was detected. 16 patients showed impaired folate absorption as indicated by a marked but insufficient increase in serum folate levels after oral folate intake, whereas no increase of the serum folate levels was detected in the remaining 9 patients. Abnormal folate absorption was not correlated with disease extent or activity. In patients with only impaired folate absorption, it might be sufficient to increase dietary intake of folates. In the remaining patients with no measurable increase of serum folate levels after oral folate intake, i.e. about 10% of all patients with CD, parenteral folate supplementation could be considered.

Administration, Oral↗
PubMed1993

Intestinal permeability and the prediction of relapse in Crohn's disease.

To see whether intestinal permeability (IP) predicted relapse in Crohn's disease, we measured IP in 72 patients with quiescent Crohn's disease using the lactulose-mannitol test. The permeability index (lactulose/mannitol) was significantly higher in patients than in controls (0.046 [SEM 0.005] vs 0.018 [SEM 0.002], respectively). Patients were followed for 1 year after the test. 26 of the 37 patients with raised permeability, but only 6 of the 35 with normal permeability relapsed within 1 year after the test (p < 0.001). The sensitivity of the permeability test as a predictor for relapse was 81%. A significant correlation was found between the value of the permeability index and the probability of relapse (p < 0.01). These results show that increases in intestinal permeability precede clinical relapses in Crohn's disease and so are an indicator of subclinical disease. The measurement of intestinal permeability may lead to a better understanding of the pathogenesis of Crohn's disease.

Adult↗
PubMed1993

Endoscopic ultrasonography versus computed tomography in the differential diagnosis of perianorectal complications in Crohn's disease.

In this prospective study the performance of transrectal or transvaginal endoscopic ultrasonography (EUS) was compared with that of computed tomography (CT) in the diagnosis of perirectal fistulae, abscesses and diffuse inflammatory changes in the lower pelvis in 25 patients with Crohn's disease. Results were verified by surgery in eight patients and by correlation with findings on endoscopy, barium radiography and fistulography, and the clinical course in all other patients. EUS was superior to CT in diagnosing fistulae (14 vs 4 correct diagnoses) and inflammatory infiltration of the lower pelvic muscles (11 vs 2 correct diagnoses). The methods were equivalent in diagnosing perianorectal abscesses. CT was superior in the detection of inflammatory changes in the pararectal fasciae and fatty tissue which could not be detected by EUS. It is concluded that EUS should be used as the primary method for diagnosing perianorectal changes in patients with Crohn's disease especially in the case of fistulae and abscesses, having the added advantage of lack of radiation for the patient.

Abscess↗
PubMed1993

Removal of glycylglutamine from plasma by individual tissues: mechanism and impact on amino acid fluxes in postabsorption and starvation.

A possible source of glutamine, for inclusion in the parenteral solutions, is glycylglutamine. The aim of this article is to review briefly the information on metabolism of glycylglutamine when administered intravenously. The fact that there is efficient utilization of intravenously infused glycylglutamine was evident with very little excretion in the urine. Although all the tissues examined, except brain, participated in the removal of glycylglutamine from plasma, kidney predominated in this regard. This may be related to the presence of carrier-mediated systems for cellular uptake of glycylglutamine in the kidney and the lack of them in other tissues. Starvation did not alter the metabolic clearance of glycylglutamine, although it reduced the removal by the kidney. Renal metabolism of glycylglutamine resulted in the release of constituent amino acids that were largely utilized by the liver in the postabsorptive state and by skeletal muscle in starvation. This alteration was accompanied by a selective inhibition of muscle release of amino acids that are substrates for enhanced hepatic gluconeogenesis and renal ammoniagenesis in starvation. Because there was no change either in plasma glucose level or ammonia excretion during the infusion of glycylglutamine in starved human subjects, apparently the amino acid residues of glycylglutamine fulfilled the substrate needs for these functions. These results provide a metabolic basis for further investigations of the possible nutritional benefit of including glycylglutamine in parenteral nutrition.

Amino Acids↗
PubMed1993

Molecular forms of pseudocholinesterase in patients with Crohn's disease.

Previous studies have shown that pseudocholinesterase (PCHE) is low in patients with Crohn's disease (CD). This finding, however, failed to be of clinical relevance due to the wide normal range. PCHE consists of four main molecular forms designated as C1, C2, C3 and C4 according to their electrophoretic mobility. The question of the present study was to assess the influence of CD on the distribution and pattern of the PCHE isozymes. We therefore investigated the electrophoretic separation of PCHE in 16 healthy volunteers (HV), in 15 patients with quiescent CD (QCD; CD activity index: median = 71, interquartile range = 44-122) and in 10 patients with active CD (ACD; CD activity index: 229, 173-304). In most of the cases total serum PCHE activity was within the normal range even in patients with active CD. No changes of the isozyme pattern were found but the percentage distribution was significantly influenced by the inflammatory activity in patients with active CD:C1 (HV: 14.7%, 13.7-18.1%; QCD: 16.0%, 9.8-19.9%; ACD: 8.5%, 2.9-12.5%, p < 0.01) and C2 (HV: 8.0%, 6.7-10.5%; QCD: 9.0%, 7.9-9.7%; ACD: 6.7%, 3.2-8.6%, p < 0.05) were decreased in active CD while the C4 component (HV: 66.8%, 62.5-69.9%; QCD: 63.1%, 54.9-73.8%; ACD: 77.3%, 70.7-90.1%, p < 0.01) was increased. The percentage of the C3 band (HV: 5.7%, 4.6-6.9%; QCD: 6.8%, 4.6-8.4%; ACD: 5.3%, 2.8-6.8%, NS) was unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Primary leiomyosarcoma of the liver--a case report.

This is the 17th report on primary leiomyosarcoma of the liver in world literature. In 1980, a 69-year old white female patient was admitted with pain in the right upper abdomen and loss of weight of 12 kg. Increased blood sedimentation rate, elevated serum markers of the liver and ultrasound evolved a big tumor of the right liver without extrahepatic tumor nodules. Right hemihepatectomy was undertaken, the tumor was completely resected. After histologic examinations, leiomyosarcoma of the liver with 1 mitosis per 10 high power fields was diagnosed. 10 years later, the patient was readmitted with symptoms of pain, tiredness and night sweat. At this time, 3 intrahepatic and 1 retroperitoneal tumor nodules were detected. A sure-cut needle biopsy revealed the recurrent leiomyosarcoma with 4 mitoses per 10 high power fields. The survival period of 10+ years is the longest of all 17 patients with primary hepatic leiomyosarcoma reported so far. The low rate of mitoses per high power field and primary surgical resection are considered the reasons for the long survival period.

Aged↗
PubMed1993

Endosonographic features of the lower pelvic region in Crohn's disease.

Anorectal complications in long-term Crohn's disease are frequent and evaluation of inflammatory changes in the lower pelvic region is difficult. Abnormalities are fistulas and abscesses which can be demonstrated rapidly and easily by endosonographic measures. Further topographical localization of the abnormalities is possible. Over a period of 2 yr, 55 patients with anorectal complications were examined. Using endosonography, 46 fistulas were found in 36 patients. Forty patients presented inflammatory changes. Abscesses were demonstrated in four cases. Our findings were verified by surgery, fistulography, and correlation with clinical course of illness. Limiting factor of the examination procedure proved to be painful and strictures in male patients, whereas in female patients the alternative of performing the examination via vagina was given. Our results demonstrate that endosonography is an excellent screening method for detecting and evaluating fistulas and abscesses in Crohn patients. Omitting radiation exposure is a further advantage of endosonography.

Abscess↗
PubMed1993

Are single measurements of pseudocholinesterase and albumin markers for inflammatory activity or nutritional status in Crohn's disease?

Serum pseudocholinesterase (PCHE) activity and serum albumin concentration have been used as markers for inflammatory activity as well as malnutrition in Crohn's disease (CD) with controversial results. Therefore we investigated the valence of both proteins as markers of inflammation and/or malnutrition in 50 patients with active CD [Crohn's disease activity index (CDAI): median = 243; interquartile range = 191-288] and 70 patients with quiescent CD (CDAI: 62; 25-96). Thirty patients were malnourished, 18 with active [body weight: 84%; 79-88% IBW (ideal body weight)] and 12 with quiescent CD (87.5%; 81.5-88% IBW), and 90 patients were well nourished, 32 with active (96%; 93-112% IBW) and 58 with quiescent CD (104.5%; 96-116% IBW). Median values of PCHE activity and albumin concentration were within the normal range in both groups, in patients with active as well as quiescent CD. PCHE activity was decreased only in 24 patients (48%) with active, but also in 11 (15.7%) patients with quiescent disease. Albumin concentration was decreased in 12 patients (24%) with active and in one patient (1.4%) with quiescent disease. Comparing the two patient groups PCHE activity and albumin concentration were significantly lower in active than in quiescent CD [PCHE: 3.70 kU/l; 3.00-4.30 kU/l vs. 4.80 kU/l; 3.75-5.82 kU/l, p < 0.001; Albumin: 38.0 g/l; 35.1-39.9 g/l vs. 43.8 g/l; 40.8-46.3 g/l, p < 0.001]. Both proteins were significantly lower in malnourished than in well nourished patients, except albumin in patients with quiescent CD. Repeated measurements of PCHE and albumin in patients during and after active phases showed significant increases of both proteins.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Glycylglutamine: metabolism and effects on organ balances of amino acids in postabsorptive and starved subjects.

The present study was designed to investigate the metabolism of glycylglutamine and its effects on organ balances of amino acids during intravenous infusion of this dipeptide (100 mumol.h-1.kg-1) in postabsorptive and briefly starved (84-86 h) human subjects. Arterial concentrations of glycylglutamine were not significantly different in postabsorptive (265 +/- 18 microM) and starved (241 +/- 13 microM) subjects. Among the organs examined, kidney predominated in clearance of glycylglutamine from plasma. Moreover, renal clearance of glycylglutamine was reduced by starvation (87 +/- 7 vs. 52 +/- 5 mumol/min, P less than 0.01), whereas neither splanchnic nor muscle clearance was significantly affected. Infusion of glycylglutamine raised plasma concentrations of glycine and glutamine by increasing renal release of these amino acids. In postabsorptive subjects the infusion significantly increased splanchnic balances of glycine and glutamine with little or no effect on the muscle balances; the opposite was found in starved subjects. As far as other amino acids are concerned, the infusion decreased the muscle release of alanine and increased renal release of serine. We conclude that the amino acid residues of glycylglutamine are largely metabolized by the splanchnic organs in postabsorptive subjects and by peripheral organs in starved subjects. The latter results in selective inhibition of muscle release of amino acids.

Adult↗
PubMed1991

Comparison of enteral nutrition and drug treatment in active Crohn's disease. Results of the European Cooperative Crohn's Disease Study. IV.

This study compared the effect of enteral nutrition as the sole therapy of active Crohn's disease with drug treatment. Patients with active Crohn's disease (Crohn's Disease Activity Index greater than 200) were randomized to receive either enteral nutrition with a liquid oligopeptide diet (n = 55) or a combination of 6-methylprednisolone, 48 mg daily, subsequently tapered, and sulfasalazine, 3 g daily (n = 52). The two groups were not different with respect to age, sex, body weight, location of disease, or treatment before the study. The severity of disease was similar at the beginning of the study in both groups [Crohn's Disease Activity Index (mean +/- SEM), 323 +/- 12 vs. 316 +/- 11]. Remission was defined as a decrease of the initial Crohn's Disease Activity Index by 40% or at least 100 points. Twenty-nine patients in the diet group and 41 patients in the drug group reached remission within 6 weeks of therapy (chi 2 test, P less than 0.01). The median elapsed time to remission was 30.7 days in the diet group compared with 8.2 days in the drug group (Mantel Cox, P less than 0.01). To determine whether one of these treatments was more beneficial for a subgroup of patients, the effectiveness of both treatments was analyzed separately in patients with very severe disease (initial Crohn's Disease Activity Index greater than 300) and less severe disease (initial Crohn's Disease Activity Index less than 300), and in patients with different disease location. However, no influence of initial disease activity or disease location on the effect of either treatment could be shown. These data show that enteral nutrition is less effective than a combination of 6-methylprednisolone and sulfasalazine in treating active Crohn's disease.

Adult↗
PubMed1991

Utilization of tyrosine dipeptides and acetyltyrosine in normal and uremic humans.

The impact of renal failure on the elimination and hydrolysis of three sources of tyrosine for parenteral nutrition, the dipeptides alanyltyrosine (Ala-Tyr), glycyltyrosine (Gly-Tyr), and N-acetyltyrosine (NAc-Tyr) was investigated in eight patients on regular hemodialysis therapy (HD) and seven healthy controls (CON). In CON, whole body clearance (Ctot) of Ala-Tyr (3,169 +/- 198 ml/min) was higher than Gly-Tyr (1,781 +/- 184, P less than 0.001), and both exceeded NAc-Tyr (284 +/- 24, P less than 0.001). In HD, Ctot of Ala-Tyr was not different from CON, but Ctot of Gly-Tyr (858 +/- 73, P less than 0.001) and NAc-Tyr (129 +/- 30, P less than 0.02) was decreased. The rise in plasma levels of constituent amino acids was higher in Ala-Tyr vs. Gly-Tyr (P less than 0.01). In HD, the pattern was similar, although the increase in Tyr was less than in CON. Plasma Tyr did not increase with NAc-Tyr in either group. Urinary loss of peptides was neglible, but 60% of NAc-Tyr infused was excreted by CON. The half-life of peptides incubated in CON and HD plasma was unchanged for Ala-Tyr (12.3 +/- 0.9 vs. 14.6 +/- 1.9 min) and prolonged for Gly-Tyr in HD (101.7 +/- 4.9 vs. 131.3 +/- 12, P less than 0.05). Thus renal failure does not impair Ala-Tyr disposal and delays Gly-Tyr utilization. These differential effects on peptide assimilation underscore the importance of peptide structure on metabolism. Both peptides, but not NAc-Tyr, may serve as a nutritional substrate in renal failure patients.

Adult↗
PubMed1990

Uptake and metabolism of dipeptides by human red blood cells.

A function of the abundant cytoplasmic peptidases in red blood cells could be hydrolysis of oligopeptides circulating in plasma. To investigate whether human red blood cells actively transport dipeptides for this purpose, these cells were incubated with 14C-labelled glycylproline, glycylsarcosine, glycine, proline and alanine. There was uptake of each dipeptide, as indicated by their recovery as dipeptides in the cell cytoplasm. However, after a brief time (1-2 min) uptake of dipeptides abruptly ceased, while that of amino acids continued. As a result, after 30 min red blood cell uptake of amino acids was 5-13-fold greater than that of any dipeptide. Investigation of intracellular contents after 1 min of incubation revealed different metabolism for different dipeptides. The composition of intracellular radioactivity was 19-71% as intact dipeptides, 0-20% as free amino acids and 8-77% as neither dipeptides nor constituent amino acids. Investigation of the mechanism of dipeptide uptake by red blood cells showed: (1) a lack of hydrolysis by the plasma membrane, (2) no non-specific binding to the plasma membrane, and (3) a lack of saturation over a wide range of concentrations (0.05-50 mM). The data suggest that the mechanism of uptake of trace amounts of dipeptides by human red blood cells is either by simple diffusion or by a carrier system which has a very weak affinity for dipeptides. Upon entry, depending on the molecular structure, dipeptides are either hydrolysed or transformed into new compounds. The red blood cell uptake, however, does not appear to play any appreciable role in clearance of dipeptides from the plasma in the human.

Alanine↗
PubMed1990

Splanchnic, renal, and muscle clearance of alanylglutamine in man and organ fluxes of alanine and glutamine when infused in free and peptide forms.

The present study was designed to investigate organ metabolism of intravenously (IV) infused (100 mumol.h-1.kg-1) alanylglutamine and its amino acid constituents in a group of healthy subjects. The dipeptide clearance (mumol/min) by kidney (51 +/- 3) was significantly (P less than .01) greater than the clearance by either splanchnic organs (19 +/- 6) or skeletal muscle (21 +/- 8). Infusion of alanylglutamine significantly (P less than .01) increased arterial plasma concentrations of free alanine (260 +/- 31 v 330 +/- 38 mumol/L) and free glutamine (620 +/- 66 v 764 +/- 65 mumol/L) when compared with the baseline period. Concurrently, splanchnic uptake of alanine and glutamine increased and muscle release of alanine ceased. However, muscle release of glutamine remained unaffected. Renal balances of alanine and glutamine changed from neutral to negative (net release) and from positive (net uptake) to neutral, respectively. Infusion of a corresponding mixture of alanine and glutamine had similar effects on arterial plasma concentrations and splanchnic and muscle balances of alanine and glutamine, but had no effect on renal balances of these amino acids. From these studies in man, we conclude that kidney predominates over other organs in clearance of alanylglutamine from plasma and that this may account for the different effect of infusion of alanine and glutamine in free and peptide forms on renal fluxes of these amino acids.

Adult↗