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Biomedical subjects

H Malchow

Publications and source records attributed to H Malchow.

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

A randomised controlled trial to evaluate the effects of flumazenil after midazolam premedication in outpatients undergoing colonoscopy.

The degree of sedation and amnesia, subjective assessment of awakening and side effects after intravenous injection of 3-4 mg midazolam and 1 mg flumazenil or placebo were studied directly after colonoscopy, and on the first and the eight day. A total of 91 patients were studied; 45 patients were given flumazenil and 46 patients a placebo. Five minutes after injection of the test drugs all 45 patients given flumazenil but only 38 patients given the placebo were alert (p = 0.006). All three response criteria (for sedation, amnesia and subjective assessment of awakening) were fulfilled by 84.4% of the patients given flumazenil and 45.7% of the patients given the placebo (p = 0.0002). Thirty minutes after injection of the test drugs dizziness, nausea, and fatigue were found in 3 patients given flumazenil and in 10 patients given placebo. One day after colonoscopy 9 of 45 patients (20%) given midazolam and flumazenil complained of fatigue and 9 of 46 patients (19.5%) given midazolam and placebo. Eight days (+/- 1 day) later two patients in each group complained of headache, nausea and fatigue. No patient developed phlebitis at the injection site. Flumazenil seems to be a safe and efficient drug for reversing the sedative effect of midazolam, premedication after colonoscopy. However, resedation due to the effects of midazolam may occur. Flumazenil thus permits administration of a higher dose of midazolam without prolongation of the surveillance time. Improved exploitation of time, space and nursing resources is thus possible without jeopardizing patient safety, although caution is necessary since patients may not be fit to resume all normal activities.

Adolescent↗
PubMed1990

Evaluation of the Crohn's Disease Activity Index (CDAI) and the Dutch Index for severity and activity of Crohn's disease. An analysis of the data from the European Cooperative Crohn's Disease Study.

In the European Cooperative Crohn's Disease Study a general documentation of clinical and laboratory data was made at the entry into the study in 452 patients. These patients were in different states of their disease from quiescent to very active. In all patients the Crohn's Disease Activity Index of Best (CDAI) and the Dutch Index of van Hees was calculated. Three gastroenterologists did a global clinical rating and a separate laboratory rating without knowledge of the indices. The ratings were then correlated with the indices in the individual patients. The clinical rating correlated well with the CDAI (r = 0.88) and less with the Dutch Index (r = 0.672). On the other hand the laboratory rating showed a better correlation with the Dutch Index (r = 0.742) than with the CDAI (r = 0.573). This demonstrates that the CDAI preferably is an estimate of the clinical severity of the disease and not of the activity of inflammation. Vice versa the Dutch Index is mainly reflecting the activity of the inflammatory process.

Colitis↗
PubMed1990

Feasibility and effectiveness of a defined-formula diet regimen in treating active Crohn's disease. European Cooperative Crohn's Disease Study III.

In a randomized multicenter trial the efficacy of treatment of active Crohn's disease by means of a liquid defined formula diet (DFD) was tested and compared with a combination of 6-methyl-prednisolone and sulfasalazine. A total of 95 patients participated in the study. By the end of 6 weeks, among 44 patients randomized to drug treatment, 32 showed improvement of the Crohn's disease activity index (CDAI) as compared with 21 of 51 patients receiving oral DFD (p less than 0.05). The proportion of withdrawals in the DFD group (29 of 51) was sevenfold higher than in the drug group (4 of 44). However, most patients (20 of 29) receiving DFD withdrew because of the unpalatability of the liquid diet. Analysis of patients in each group who finished the study showed equal effectiveness of DFD and the drug regimen. In these subsets of patients the CDAI decreased from 280.8 +/- 90.6 to 151.7 +/- 86.5 (DFD) and from 263.7 +/- 86.3 to 129.3 +/- 63.7 (drug), respectively. Improvement of inflammation factors was similar in both groups at the end of the study, although improvement was delayed in the DFD group. In conclusion, our data show a superiority of the drug combination over DFD in the treatment of Crohn's disease under the conditions of this trial. The results do suggest, however, that DFD offers a therapeutic alternative to prednisolone and sulfasalazine in a subgroup of patients, which has to be closer characterized in further studies.

Adult↗
PubMed1989

Postoperative recurrence of Crohn's disease in relation to radicality of operation and sulfasalazine prophylaxis: a multicenter trial.

Recurrence rate is high after operation for Crohn's disease. A multicenter trial was performed to study the effect of radical or nonradical operation and of sulfasalazine prophylaxis versus placebo on postoperative recurrence rate in 232 patients with Crohn's disease. Sixteen medical and surgical centers participated in the study, 7 operating radically and 9 nonradically. The follow-up period lasted 3 years, the allocation to drug treatment was randomized and double blind. Recurrence was significantly less frequent and occurred later in patients who were operated nonradically. Patients on sulfasalazine prophylaxis had a better prognosis than on placebo. This effect was statistically significant in the first 2 years of treatment. Both strategies were additive: nonradical operation and sulfasalazine had the best prognosis, radical operation and placebo was worst. It is concluded that postoperative recurrence is best prevented by resecting nonradically and prescribing 3 g of sulfasalazine daily at least over 2 years.

Adolescent↗
PubMed1989

Epidemiology of inflammatory bowel disease in the county of Tübingen (West Germany).

The incidence and prevalence of Crohn's disease (CD) and ulcerative colitis (UC) were investigated retrospectively for 1970-1980 and prospectively for 1981-1984 in the predominantly rural county of Tübingen (FRG). Eight hundred and twenty-eight patients with CD and 376 patients with UC were detected. Point prevalence at the end of 1984 was 54.6 for CD and 24.8 for UC, respectively. The occurrence of UC was stable during the period of investigation. The annual incidence of CD rose during the end of the seventies and afterwards reached a plateau of about 4 new cases per 100,000 inhabitants per annum. The prevalence of IBD was markedly greater in the cities than in the rural areas of the county.

Colitis, Ulcerative↗
PubMed1988

Dissipative pattern formation in ternary non-linear reaction-electrodiffusion systems with concentration-dependent diffusivities.

Conditions for the emergence of ionic dissipative structures after Turing instability of a spatially and temporaly homogeneous stationary concentration distribution are derived for electroneutral ternary ionic reaction systems with concentration-dependent diffusivities. The inhomogeneous solution branch first bifurcating while crossing a critical ratio of diffusivities is given as a series of eigenfunctions of the Laplace operator. The results are specified for a model reaction system and polynomial concentration dependence of diffusion. It is shown that the inclusion of concentration dependence controls the amplitudes of the spatial distribution.

Animals↗
PubMed1988

[Changes in the ileal mucosa in Crohn disease. Endoscopic and histologic study].

In 383 patients, suffering from Crohn's disease, ileum was studied both endoscopically and histologically. In patients without surgical interventions (n = 207), endoscopic lesions were observed in 69%, histologic lesions in 74%. Most numerous endoscopic lesions were redness (51%), vulnerability (29%) and ulcer (27%), most frequent histologic lesions discontinuous infiltration (30%) and ulcer (30%). In patients, operated on, endoscopic and histologic lesions were found more often in the ileal region, near to anastomosis than in the more proximal ileum. Overall, the endoscopic and histologic appearance of the distal segment of the ileum widely corresponded to that of the terminal ileum in patients without surgery. Several endoscopic parameters were correlated to histologic variables, but overall the correlation was low (maximal correlation coefficient 0.34). Granulomas were present in 7.4% of the biopsies and 9.1% of the patients. The occurrence was significantly correlated to the endoscopic variables cobblestone appearance and ulcer as well as to the histologic variables density of infiltration, ulcer, and activity of inflammation. In conservatively treated patients, the incidence of mucosal vulnerability, and cobblestone appearance significantly declined in long standing disease, the incidence of stenosis increased. In patients operated on, aphthous lesions and ulcers increased in longstanding disease.

Adolescent↗
PubMed1986

Morphologically different biopsy specimens of the human gastric mucosa. I. The use of enzymatic cell isolation for quantitative determination of parietal cells.

Single biopsies of human gastric mucosa from controls and different groups of patients were used for enzymatic cell isolation by pronase and collagenase and subsequent count of parietal and nonparietal cells. This procedure was tested in regard to its validity and delivered the following cell numbers. Total gastric cells/mg wet weight gastric mucosa: normal gastric mucosa [controls (C), n = 95] 31,500 +/- (SEM) 1,490, chronic superficial gastritis (GI; n = 49) 36,300 +/- 2,770, chronic gastritis with beginning atrophy (GII; n = 36) 44,100 +/- 3,050 (p less than 0.025), chronic atrophic gastritis (GIII; n = 12) 40,100 +/- 5,760, duodenal ulcer (DU; n = 26) 29,340 +/- 2,280, gastric ulcer (GU; n = 23) 37,090 +/- 3,000, gastric resection according to Billroth I (BI; n = 7) 57,480 +/- 12,360 (p less than 0.005) and Billroth II (BII; n = 12) 52,560 +/- 6,730 (p less than 0.005). Parietal cells/mg wet weight gastric mucosa: 1,910 +/- 490 (C), 1,980 +/- 140 (GI), 1,700 +/- 200 (GII), 1,170 +/- 220 (GIII, p less than 0.025), 2,580 +/- 240 (DU, p less than 0.05), 1,690 +/- 150 (GU), 1,500 +/- 250 (BI), 1,360 +/- 320 (BII). Parietal cell concentration (density) did not differ in males and females and did not change with age. The method delivers relevant cell numbers, is suitable to detect qualitative differences and can be used for the interpretation of biochemical studies.

Adolescent↗
PubMed1985

[Crohn disease: initial experiences with cyclosporin A in an adolescent girl].

The diagnosis of Crohn's disease with extensive involvement of small intestine and colon was first made in a 12 3/4-year-old girl, now 15 1/2 years old. Despite continued treatment with prednisolone and salazosulfapyridine, as well as azathioprine and metronidazole, no lasting remission was obtained. Widespread severe osteoporosis with vertebral fractures made it necessary to discontinue the prednisolone, despite endoscopically and biochemically confirmed signs of activity of the disease. Administration of cyclosporin A in this situation produced phases of improved clinical and biochemical parameters. Regular control of biochemical levels failed to reveal any drug-specific acute side-effects. Because of the increased incidence of malignant lymphoma under cyclosporin A this drug should be held in reserve in the treatment of Crohn's disease, until results from controlled studies have become available.

Adolescent↗
PubMed1985

Colonoscopy in the investigation of drug absorption in healthy volunteers.

In order to evaluate the absorptive capacity of the colonic mucosa, colonoscopy was used to investigate in six healthy volunteers the colonic absorption of the nonsteroidal anti-inflammatory drug diclofenac (Voltaren). Oral and colonic administration of 100 mg of diclofenac resulted in comparable peak plasma concentrations and areas under the plasma concentration time curves. The apparent relative availability of diclofenac from the colon compared to the oral form, which was assumed to be 100%, ranged from 54% to 109% with a mean of 78%. There was no difference in absorption between application of the drug in the cecum and in the splenic flexure. This new indication for colonoscopy proved to be simple, well tolerated, and well suited for phase I studies with new drugs or formulations.

Colon↗
PubMed1985

Endoscopic and bioptic study of the upper gastrointestinal tract in Crohn's disease patients.

In the present study, virtually all of 225 patients suffering from Crohn's disease of the lower gastrointestinal tract (small and/or large bowel) were subjected to endoscopic examination of the upper gastrointestinal tract (esophagus, stomach, duodenum); while histologic examination of the upper gastrointestinal tract was performed in a portion of the patients (54 initial esophageal, 221 initial gastric and 210 initial duodenal examinations). Statistical evaluation of the findings from the upper gastrointestinal tract revealed that: Endoscopic lesions were observed in the esophagus of 15%, the stomach of 49%, and the duodenum of 34% of the 225 Crohn's disease patients. Of the 54 patients from which esophageal biopsies were taken, 31 (57%) revealed histopathologic alterations. Of the 221 patients from which gastric biopsies were obtained, 60% revealed histopathologic alterations; the rate was 53% in the 210 patients from which duodenal biopsies were taken. Calculated from the present data, noncaseating granulomas, i.e., Crohn's disease, were present only in the stomach of 29.4% of the patients, only in the duodenum in 3.4% of patients, and in both the stomach and duodenum in 4.9% of patients. Gastric granulomas were confined to the region of the stomach body and fundus in 3.4% of the patients from which gastric biopsies were obtained and to the antrum in 15.6% of the respective patients. Both gastric regions were involved in 8.3% of the respective patients. The incidence of gastric granulomas was significantly increased in young patients, patients with enterocolic manifestations of Crohn's disease, and those with brief duration of disease. Patient sex or previous drug therapy had no effect on the incidence of granulomas. The most frequent endoscopic findings in the stomach of patients with Crohn's disease were mucosal edema, mucosal redness, and acute or chronic erosions. Only chronic erosions were of significant predictive value for the presence of granulomas, i.e., diagnosis of Crohn's disease. The most frequent endoscopic lesion in the duodenum was mucosal redness, followed by mucosal edema and aphthous lesions. Ulcers, stenosis, and mucosal redness had significant predictive values for the presence of granulomas.

Adolescent↗
PubMed1985

Oxprenolol absorption in man after single bolus dosing into two segments of the colon compared with that after oral dosing.

The systemic availability of oxprenolol after colonic and oral administration has been compared in a crossover study involving six healthy male volunteers. Drug administration into two regions of the colon (caecum and left flexure) was achieved by means of a colonoscopic technique. There were no obvious differences in plasma concentrations after drug administration to the caecum and left flexure, although in one subject it was necessary to repeat colonic administration because of unexpectedly high plasma drug levels on the first occasion. The possible reasons for this abnormal response are discussed. The mean systemic availability of oxprenolol was 82% after colonic compared with oral dosing, although marked differences were observed in individual plasma levels following drug administration by the two routes. The results of this study support the concept of extending the duration of oxprenolol release from a rate-controlled dosage form to permit once-daily administration with this short elimination half-life drug.

Administration, Oral↗