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Biomedical subjects

M Hartleb

Publications and source records attributed to M Hartleb.

At least 19 recordsLinked to original sources
PubMed2001

Severe hepatic involvement in visceral larva migrans.

Because of its anatomical position, the liver may be involved in many protozoan and helminthic gastrointestinal infections. Visceral larva migrans caused by Toxocara canis is rarely taken into account in adult patients with cholestatic syndrome, especially when liver disease is not associated with hypereosinophilic reaction. We report on a 74-year-old immunocompetent woman who presented with fever, bronchospasm, erythema nodosum, weight loss and progressive jaundice. A liver biopsy showed caseating granulomatous hepatitis with secondary portal fibrosis and paucity of interlobular bile ducts. A step-by-step search for aetiological factors led us to a diagnosis of toxocariasis (positive enzyme-linked immunosorbent assay IgG test). An excellent clinical response to combined treatment with steroid and diethylcarbamazine, and a reduction in the antibody level against T. canis supported the diagnosis. Computed tomography and laparoscopy demonstrated multiple small mass lesions and fibrous perihepatitis. This report shows that visceral larva migrans may be a cause of prostrating chronic liver disease and should be suspected in every febrile patient with cryptogenic cholestatic hepatitis.

Aged↗
PubMed2001

[Chylous ascites following resection of abdominal aortic aneurysm].

Chylous ascites is an extremely rare complication of abdominal aortic surgery. We report on a case of chyloperitoneum following resection of aortic aneurysm. The diagnosis of lymphatic tear was confirmed by paracentesis which revealed milky fluid characterized by very high content of triglicerydes. Conservative management with a low-fat diet and diuretics resulted in a successful outcome.

Aged↗
PubMed2000

Effects of a spleen peptide preparation as supportive therapy in inoperable head and neck cancer patients.

Patients with inoperable head and neck cancer were treated with a spleen peptide preparation (Polyerga) in a phase III randomized, placebo-controlled double-blind study during chemotherapy (cisplatin/carboplatin, 5-fluorouracil) to investigate further the efficacy of this peptide preparation as supportive treatment under chemotherapy. Immunological changes as well as quality of life aspects were examined. Forty patients were included in this study. The peptide preparation had a significant stabilizing effect on the peripheral blood lymphocyte status during chemotherapy cycles (Student t-test, p = 0.05) and tended to stabilize the shift of granulocyte count (Student t-test, p = 0.18). In addition, the group receiving the verum showed a remarkable stabilization of body weight (Mann-Whitney U-test, p = 0.17) during chemotherapy treatment and the generally observed increase of fatigue-inertia during the chemotherapy cycles was significantly reduced (Student t-test, p = 0.01).

Antineoplastic Agents↗
PubMed2000

Usefulness of thoracic electrical bioimpedance in detection of ejection fraction changes.

The aim of this study was to evaluate a usefulness of thoracic electrical bioimpedance (TEB) in following adaptive haemodynamic adjustments to postural change and isometric exercise. Sixteen subjects with intact cardiovascular system took part in this study. Haemodynamic parameters were obtained in recumbency and after taking up erect posture. Besides, TEB was performed during handgrip test and the results were compared with baseline resting data. Each time the radionuclide ventriculography (RV) was performed concurrently with TEB to obtain an independent measurement of ejection fraction (EF). Active orthostasis was associated with a change in stroke volume, cardiac output and total vascular resistance by -29.7%, -3.4%, +3.9%, respectively. The handgrip produced a significant increase in cardiac output by 16.3%, however it was not associated with an enhancement of stroke volume. Although there was a moderate correlation between EF calculated by TEB and RV in supine position (r=0.66; p < 0.001), TEB failed to reflect changes of EF in orthostasis and isometric exercise. In conclusion, our results suggest that TEB offers in subjects with normal cardiovascular function a valuable alternative to cardiovascular monitoring of stroke volume and cardiac output, but calculation of EF is associated with a risk of serious error.

Electric Impedance↗
PubMed1999

Acute cholestatic hepatitis associated with pravastatin.

A 57-yr-old man presented with clinical and laboratory signs of acute cholestatic hepatitis. Symptoms had appeared 7 wk after he was started on pravastatin 20 mg/day for hypercholesterolemia. A full evaluation including ultrasound, computed tomography, endoscopic cholangiography, and liver biopsy confirmed the diagnosis of intrahepatic nonobstructive jaundice. The liver function abnormalities normalized 7 wk after cessation of therapy. Pravastatin should be considered as a potential cause of cholestatic hepatitis with favorable clinical outcome after drug withdrawal.

Acute Disease↗
PubMed1998

Post-traumatic hormonal disturbances: prolactin as a link between head injury and enhanced osteogenesis.

Traumatic brain injury (TBI) combined with fractures of long bones or large joints is often associated with enhanced osteogenesis (early fracture healing accompanied by hypertrophic callus formation and/or heterotopic ossifications). Humoral factors that cause enhanced osteogenesis in patients with TBI are not yet identified. The aim of this study was to reveal if post-traumatic change(s) of hormone levels in patients with TBI and bone fractures could be associated with the phenomenon of enhanced osteogenesis. The blood values of adrenocorticotropic hormone (ACTH), cortisol, growth hormone (GH), parathyroid hormone (PTH) and prolactin (PRL) were studied weekly over a period of three months after injury in patients with bone fractures only, those with TBI only or combined bone fractures and TBI (patients exerting enhanced osteogenesis). Stress-hormones, ACTH and cortisol, or the hormones related to the bone growth (GH and PTH) did not show any particular post-traumatic changes in the blood of patients with combined injury that could be associated with the enhanced osteogenesis. On the other hand, patients with combined bone fractures and TBI accompanied by enhanced osteogenesis had significantly elevated PRL levels in blood during the 5th week of the post-traumatic period. Thus, the maximal PRL values were measured at the time when in this group of patients fractures were in consolidation and hypertrophic callus or heterotopic ossifications were developing (as verified by x-ray imaging). Hence, PRL does not only influence physiology of the bone metabolism but also seems to be one of the humoral factors involved in the phenomenon of enhanced osteogenesis in patients with TBI.

Adrenocorticotropic Hormone↗
PubMed1998

Cardiovascular effects of ephedrine, caffeine and yohimbine measured by thoracic electrical bioimpedance in obese women.

Low caloric diet is a commonly accepted treatment in obesity. However, owing to moderate results, a pharmacological support has been proposed. As some efficacious drugs activate overall sympathetic activity, they might modify functions of the cardiovascular system. Three groups of subjects were studied: (1) nine obese women receiving only a standard hypocaloric diet; (2) nine obese women receiving a standard hypocaloric diet and ephedrine (2 x 25 mg) with caffeine (2 x 200 mg); (3) nine obese women receiving a standard hypocaloric diet and ephedrine (2 x 25 mg) with caffeine (2 x 200 mg) and yohimbine (2 x 5 mg). The cardiovascular state was evaluated by thoracic electrical bioimpedance, automatic sphygmomanometry and continuous ECG recording. In each patient, the haemodynamic study was performed twice: at rest, i.e. before treatment; and after 10 days of treatment. On the same days in each patient, the haemodynamic tests were performed during physical exercises (handgrip stress and cycloergometer exercise). Caffeine and ephedrine had no haemodynamic effect in resting patients. These two drugs led to an increase in ejection fraction during cycloergometer exercise. Addition of yohimbine increased diastolic pressure and heart rate but decreased ejection fraction and stroke index during rest. We also observed that addition of yohimbine decreased ejection fraction during the handgrip and cycloergometer exercise and increased cardiac load during dynamic exercise. Pharmacological supplement of ephedrine and caffeine to a low caloric diet modified the cardiovascular system weakly, but the addition of yohimbine to this regimen attenuated cardiac performance during rest and handgrip and increased cardiac work during dynamic exercise.

Adrenergic alpha-Antagonists↗
PubMed1998

Spleen peptides (Polyerga) inhibit development of artificial lung metastases of murine mammary carcinoma and increase efficiency of chemotherapy in mice.

There are numerous attempts to find novel anticancer drugs or to improve therapeutic protocols based on application of chemotherapeutic agents and immunomodulators (biological response modifiers, cytokines, various plant or bacterial products). Among the preparations that have beneficial effects for the cancer bearing organism are preparations of spleen peptides (Polyerga). Hence, we analyzed if treatment with spleen oligopeptides GP-1 (active substance for the manufacture of Polyerga ampoules' solution injected as 0.5 microgram/kg every second day) if given alone or combined with chemotherapy (Endoxan 50 mg/kg single i.p. dose) of mice bearing artificial lung metastases of mammary carcinoma will have an impact on the metastases count and survival of the animals. The results obtained have shown that chemotherapy reduced metastases count and increased survival of the tumor bearing mice, while the use of GP-1 alone did not affect metastases development. However, combined GP-1 treatment and chemotherapy were more efficient in prevention of the metastases development than chemotherapy alone. Thus, in mice treated with GP-1 and Endoxan, the average metastases count was four times lower than in the mice treated by chemotherapy only, while 2/12 animals were without tumor nodules in the lungs. Finally, all the animals treated by chemotherapy alone died until the 42nd day after tumor transplantation, while at the same time, only 5/10 animals died receiving combined therapy. Thus, these results give an experimental support for the use of the spleen peptides in biotherapy (or combined therapy) of cancer.

Animals↗
PubMed1997

Cardiovascular status after postural change in compensated cirrhosis: an argument for vasodilatory concept.

It seems that hypervolemia and vasodilatation coincide in compensated cirrhosis, but neither rank nor importance of these factors has been fully clarified in adaptive response to postural change. We studied, with gated equilibrium radionuclide angiography and thoracic electrical bioimpedance the hemodynamic status of 19 patients with compensated cirrhosis and 18 healthy subjects in upright and supine positions. In the upright position, the cirrhotic patients were hypotensive and had decreased peripheral vascular resistance despite increased cardiac output. The transition to the supine position was accompanied by a significant fall in the heart rate and an increase in the stroke volume in both controls (92 +/- 22 to 63 +/- 10 beats/min, and 38 +/- 9 to 62 +/- 19 ml/m2, respectively) and cirrhotic patients (101 +/- 20 to 79 +/- 13 beats/min, and 44 +/- 15 to 63 +/- 19 ml/m2, respectively). Besides, the diastolic arterial pressure fell in controls from 89 +/- 9 mmHg to 81 +/- 11 mmHg; p < 0.01, while it remained unchanged in cirrhotic patients (77 +/- 17 vs 82 +/- 13 mmHg). In the supine position, the cirrhotic patients presented tachycardia and left ventricular hyperkinesy (increased velocity of left ventricular filling and emptying). In conclusion, these results show that in compensated cirrhosis the decreased arterial tone and peripheral blood pooling are important factors of adaptive hemodynamic reaction to postural change.

Adult↗
PubMed1997

Relationship between portal pressure, esophageal varices, and variceal bleeding on the basis of the stage and cause of cirrhosis.

BACKGROUND AND METHODS: Hepatic venous pressure gradient, esophageal varices, and variceal bleeding were investigated in 957 patients with cirrhosis. The causes (alcoholic/virus) and stage (Child-Pugh's classification) of cirrhosis were also taken into account. RESULTS: The prevalence of variceal bleeding was 35% in patients with large varices and 17% in those with small varices (P < 0.05). It was higher in patients with alcoholic cirrhosis (41% and 19%, respectively) than in those with viral cirrhosis (22% and 10%, respectively). In patients with alcoholic cirrhosis the hepatic venous pressure gradient was higher in Child A and B patients with small or large varices than in those with no varices; these differences were not found in Child C patients and in patients with viral cirrhosis. In all subgroups the pressure gradient was higher in Child C patients than in Child A patients. There was no significant difference in the hepatic venous pressure gradient between patients with varices and previous variceal bleeding and those with no bleeding whatever the stage of cirrhosis. CONCLUSIONS: This study shows that the hepatic venous pressure gradient is associated with the stage and causes of cirrhosis and the presence of varices. These factors should be taken into account in studies evaluating the hepatic venous pressure gradient in heterogeneous groups of patients.

Esophageal and Gastric Varices↗
PubMed1997

Focal liver disease: neural network-aided diagnosis based on clinical and laboratory data.

OBJECTIVES: The purpose of this study was to evaluate the use of clinical and laboratory data in the diagnosis of benign or malignant focal liver disease. METHODS: Diagnosis was made by artificial neural network (NN), a system of simple computing units connected in a specific structural network. Seven clinical and laboratory variables were retrospectively studied in 172 patients with a liver mass (93 benign, 79 malignant) detected with ultrasound. The diagnostic efficacy of NN was compared with a score based on the logistic regression model (Beaujon score). RESULTS: Although the sensitivity of the Beaujon score and the neural network was similar (4 malignant tumors inversely classified), neural network-aided diagnosis was characterized by higher specificity and accuracy (respectively 98.9% vs 82.5%, P < 0.001, and 97.1% vs 88.4%, P < 0.002). CONCLUSION: In patients with a hepatic mass, neural network is a valuable method for differentiating malignant and benign tumors.

Adult↗
PubMed1997

Toxicological profile of a low molecular weight spleen peptide formulation used in supportive cancer therapy.

The toxicity of Polyerga (GP-1), a mixture of low molecular weight spleen peptides, extracted from porcine spleen was examined in in vitro and in vivo experiments. The following endpoints were examined: single dose toxicity, repeated dose toxicity, reproduction toxicity, mutagenic potential, local tolerance, immunotoxicity and general pharmacology. The standard therapeutic dose is 3 x 1 ml GP-1/week. The dosage can be increased temporarily to 2 ml/d. 1 ml injection solution contains 30 micrograms oligopeptides. The LD50 was determined in rats as 3.76 ml/kg b.w. i.v. Following repeated intramuscular administration of GP-1 no toxicity appeared in rats up to a dose level of 2 ml/kg b.w./d during the 13-week treatment period. In dogs the no-effect level of GP-1 was 0.32 ml/kg b.w./d i.m. (marginal body weight reduction at 0.80 ml/kg b.w./d i.m.). In an embryotoxicity study in rats, GP-1 possessed no teratogenic properties tested at dose levels exceeding the human therapeutic dose by a factor of 1000. No mutagenic potential was observed for GP-1 in the AMES test. No local irritations were observed at the intended injection sites and at injection sites made in error. None of the in vitro and in vivo pharmacological studies revealed any effect on the parameters tested, at doses up to 500 times the clinical dose. Hence, under the present test conditions, based on a daily therapeutic dose of 1 ml GP-1/patient (approximately 0.014 ml/kg b.w./d), the therapeutic ratio is at least 50 for the most sensitive endpoint 'repeated dose toxicity' reflecting the wide margin of safety for GP-1.

Animals↗
PubMed1996

Porcine splenic peptides (Polyerga) decrease the number of experimental lung metastases in mice.

Preparations of splenic peptides under the name of Polyerga are being tested in numerous experimental immunomodulating and antitumorous models and are also used during supportive treatment of tumorous patients. Further, the incidence of experimental lung metastases of melanoma cells in mice was significantly reduced if we used Polyerga preparations. The aim of our investigation was to determine whether Polyerga is active directly against tumor cells or whether its activity is manifested by modulating immune and other possible abilities of the organism. To clarify the problem glycopeptides containing Polyerga were incubated with melanoma B16F10 cells in vitro and the plating efficiency of these cells determined when cultivated in medium, or in medium with different doses of the same Polyerga preparation. The cells preincubated in medium only reacted to the addition of increasing doses of Polyerga, 150 pg or more, by raising colonies number. However, 24-h incubation of melanoma cells in the presence of 150 micrograms of Polyerga per ml significantly reduced the number of tumor cell colonies in comparison to the corresponding cell cultures previously not exposed to Polyerga. These in vitro studies were extended to in vivo application using C57B1/GoZgr mice injected i.v. with melanoma cells pretreated with Polyerga in vitro or previously not treated. A group of the treated mice was further injected i.p. with Polyerga. All the mice were killed at a particular time and the number of lung nodules determined. A significant difference to the control values was noticed in each group that used Polyerga, regardless of the exposure of melanoma cells to Polyerga in vitro, in vivo or to combined treatment. The efficiency of Polyerga application 7 days following i.v. injection of control melanoma cells (cultivated in medium only) when the nodules already exist, was further evaluated in a combined treatment using DTIC, a drug of choice in melanomas. The smallest incidence of experimental lung metastases was observed in the group exposed to the combination of DTIC and Polyerga. Polyerga preparation is thus active against melanoma cells, particularly in vivo and if combined with chemotherapy.

Animals↗