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M Stolte

Publications and source records attributed to M Stolte.

At least 217 records · Page 12Linked to original sources
PubMed1999

Malabsorption with progressive weight loss and multiple intestinal ulcers in a patient with T-cell lymphoma.

We describe a 52-year-old woman who presented with severe diarrhea, nausea, intermittent abdominal pain and weight loss of 18 kg within ten months. Jejunal and duodenal ulcers were detected by endoscopy and multiple biopsies revealed villous atrophy of the jejunum. However, neither gliadin nor endomysium antibodies were detected and no clinical and histological improvement was achieved after gluten withdrawal. Despite strong clinical suspicion for intestinal lymphoma many unrevealing biopsies were done. The patient developed intermittent septic fever and diagnostic laparotomy revealed jejunal perforation. Partial jejunal resection was performed and histology confirmed the diagnosis of an intestinal T-cell lymphoma without celiac disease. Malabsorption and all intestinal ulcers disappeared during the course of chemotherapy (six cycles CHOP) and the patient recovered remarkably.

Biopsy↗
PubMed1999

[Changes in Helicobacter pylori gastritis caused by therapy with inhibitors of gastric acid secretion].

UNLABELLED: In patients with Helicobacter pylori (Hp) gastritis long-term treatment with omeprazole leads to a worsening of the corpus gastritis. In the present overview we have analyzed the literature and our own studies to determine whether this also applies to other proton pump inhibitors (PPI), H2-receptor antagonists (H2-RA) and antacids. RESULTS: Every antisecretory therapy--vagotomy, antacids, H2-RA and PPI--in patients with Hp gastritis leads to a worsening of the following parameters: Grade of gastritis, activity of gastritis, grade of replacement of foveolar epithelium by regenerative epithelium and grade of mucus depletion. The incidence of intestinal metaplasia does not increase. Atrophic gastritis has not been observed after one year of treatment; after five years of treatment with PPI, development of atrophy is uncertain. In the antrum treatment with PPI, but not with antacids or H2-RA, leads to an improvement in the gastritis parameters. The question whether the aggravation of corpus gastritis under antisecretory treatment might be detrimental over the long-term, whether, for example, the more pronounced gastritis might increase the risk of a subsequent carcinoma, remains to be clarified by long-term studies.

Antacids↗
PubMed1999

[Investigations on the sulfate concentration in milk substitutes and milk products and its effect on feces composition in calves].

In continuing investigations on effects of milk replacers with high ash and mineral contents (KAMPHUES et al., 1999a) on feces' quality and composition in calves in the present study the sulfate concentration (and its effects) in milk replacers and whey products were proved. In 13 samples of milk replacers the SO4 concentration varied between 2.4 and 6.7 g/kg dry matter, in 14 samples of dried whey products SO4- concentrations of 1.4 up to 41.8 g/kg dm were found. In general higher sulphur contents were caused by higher concentrations of sulfate. In feeding a milk replacer (6.7 g SO4/kg dm) about 20% of the consumed sulfate were excreted via feces (app. digestibility of about 80%). In experiments with elevated SO4 intake (in liquid diets: 560-1980 mg/l) the digestibility rate of sulfate decreased dose dependently (75-->65%). By analysis of milk replacers (used in previous experiments, TSCHENTSCHER, 1998) resulting in diarrhea in all treated calves unexpected SO4- concentrations were found of 16.3 and 10.2 g/kg dm. In feeding experiments (6 calves) by addition of Na2SO4 (85%) and MgSO4 (15%) sulfate concentration in the liquid diet was elevated from 560 mg to 1980 mg/l. Here the SO4 concentration in the diet and the dry matter content in calves' feces were correlated significantly (r = -0.86). Presented results on the SO4 concentration in milk replacers and the observed effects of sulfate intake on feces quality (i.e. dry matter content of feces) indicate by the first time that the SO4 content in milk replacers and dried whey products is an essential parameter when an estimation of milk replacers or whey products' quality is required.

Animal Feed↗
PubMed1999

Well-differentiated adenocarcinoma or dysplasia of the gastric epithelium: rationale for a new classification system.

BACKGROUND: Gastric neoplastic lesions labelled as high-grade adenoma/dysplasia by Western pathologists are often diagnosed as mucosal carcinoma by Japanese pathologists. We examined whether stratifying histological diagnoses by invasion status could increase the extent of agreement between Western and Japanese pathologists and could reduce the frequency of discrepant diagnoses between biopsy samples and corresponding resected specimens. METHODS: Thirty-five histological slides of gastric lesions that had previously been individually reviewed by eight expert gastrointestinal pathologists from Japan, North America and Europe were reassessed by the same pathologists with particular attention to the aspect of invasion. Kappa statistics were used to determine the extent of agreement between Western and Japanese pathologists before and after reclassifying the diagnoses according to invasion status. Moreover, we examined the number of discrepant assessments regarding 14 lesions of which there were both biopsy specimens and resected specimens. RESULTS: There was agreement between the Western and Japanese pathologists in only 11 (31%) of the 35 slides (kappa coefficient 0.15) when traditional diagnostic categories were used. However, after high-grade adenoma/dysplasia, noninvasive carcinoma and suspected carcinoma were grouped together, there was better agreement, namely in 22 (63%) of the slides (kappa coefficient 0.41). Moreover, such reclassification significantly reduced the number of discrepant diagnoses between biopsy and endoscopic mucosal resection specimens by three Western pathologists, from 19 (45%) of 42 assessments when high-grade adenoma/dysplasia was grouped together with low-grade adenoma/dysplasia, to 6 (14%) of 42 assessments when grouped with suspected and definite carcinoma. CONCLUSIONS: To improve the international comparability of gastric histological diagnoses we recommend that high-grade adenoma/dysplasia, noninvasive carcinoma and suspicion of invasive carcinoma be grouped together as a single category of noninvasive high-grade epithelial neoplasia.

Adenocarcinoma↗
PubMed1999

[Are there differences between ex adenoma and de novo colorectal carcinomas?].

Colorectal carcinoma is a major cause of death throughout the Western world. It is increasingly recognized that any reduction in mortality must be achieved through the detection and removal of early and precancerous lesions. The primary attention for such a preventive strategy has been the polypoid adenoma and surveillance studies have shown a significant reduction in the incidence of carcinoma through systematic polypectomy of suspicious lesions. A potential problem with such a program, however, is raised by reports from Japan that some carcinomas seem to arise without a precursor polypoid adenoma, that is de novo. Although the histopathologic findings in such reports seem to clearly support this idea, this concept is not widely accepted in the Western world. We undertook a series of immunohistochemical (p53, bcl-2, Mib-1, E-cadherin, CD44, Stromelysin-3), and microsatellite analysis studies (on 17p (p53), 18q (DCC), 5q (APC), 8p, 2p and 1p), on groups of de novo and ex adenoma carcinomas in order to see if differences between the two groups of lesions exist. The results of these studies demonstrate that de novo carcinomas share several phenotypic and genotypic features with ex adenoma carcinoma (similar CD44 in the carcinomas, similar rates of LOH at APC and DCC loci), but have significantly higher rates of LOH at 17p, p53 over-expression and ST-3 expression indicating that tumor progression in de novo carcinoma is accelerated. These findings should help clarify the concept of de novo carcinoma and contribute to wider recognition of this important clinicopathologic entity.

Adenoma↗
PubMed1998

Lack of effect of treating Helicobacter pylori infection in patients with nonulcer dyspepsia. Omeprazole plus Clarithromycin and Amoxicillin Effect One Year after Treatment (OCAY) Study Group.

BACKGROUND: It is uncertain whether treatment of Helicobacter pylori infection relieves symptoms in patients with nonulcer, or functional, dyspepsia. METHODS: We conducted a double-blind, multicenter trial of patients with H. pylori infection and dyspeptic symptoms (moderate-to-very-severe pain and discomfort centered in the upper abdomen). Patients were excluded if they had a history of peptic ulcer disease or gastroesophageal reflux disease and had abnormal findings on upper endoscopy. Patients were randomly assigned to seven days of treatment with 20 mg of omeprazole twice daily, 1000 mg of amoxicillin twice daily, and 500 mg of clarithromycin twice daily or with omeprazole alone and then followed up for one year. Treatment success was defined as the absence of dyspeptic symptoms or the presence of minimal symptoms on any of the 7 days preceding the 12-month visit. RESULTS: Twenty of the 348 patients were excluded after randomization because they were not infected with H. pylori, were not treated, or had no data available. For the remaining 328 patients (164 in each group), treatment was successful for 27.4 percent of those assigned to receive omeprazole and antibiotics and 20.7 percent of those assigned to receive omeprazole alone (P=0.17; absolute difference between groups, 6.7 percent; 95 percent confidence interval, -2.6 to 16.0). After 12 months, gastritis had healed in 75.0 percent of the patients in the group given omeprazole and antibiotics and in 3.0 percent of the patients in the omeprazole group (P<0.001); the respective rates of H. pylori eradication were 79 percent and 2 percent. In the group given omeprazole and antibiotics, the rate of treatment success among patients with persistent H. pylori infection was similar to that among patients in whom the infection was eradicated (26 percent vs. 31 percent). There were no significant differences between the groups in the quality of life after treatment. CONCLUSIONS: In patients with nonulcer dyspepsia, the eradication of H. pylori infection is not likely to relieve symptoms.

Adolescent↗
PubMed1998

Increased cell proliferation of the gastric mucosa in first-degree relatives of gastric carcinoma patients.

BACKGROUND: Studies not considering Helicobacter pylori infection have suggested the presence of a hereditary risk for gastric carcinoma. However, other studies have identified intrafamilial clustering of H. pylori infection as a causal factor in gastric carcinogenesis. This prompted the authors to study the effect of H. pylori and hereditary factors on the proliferation of gastric mucosa because hyperproliferation appears to be an early step in carcinogenesis. METHODS: In a total of 39 patients (19 first-degree relatives of patients with gastric carcinoma and 20 dyspeptic controls), 2 biopsy specimens each from the antrum and corpus were examined histologically. In addition, crude nuclei fractions were prepared from other biopsy specimens obtained in the same manner. Nuclei were fixed in 70% ethanol and stained with propidium iodine prior to measurement. A cell cycle analysis was performed using a flow cytometer. For analysis a proliferative index (PI) (percentage of nuclei in the S- and G2/M-phases) was calculated. RESULTS: In comparison with control patients, first-degree relatives of gastric carcinoma patients had increased mucosal proliferation of the antrum (Student's t test, P = 0.017). After excluding patients with H. pylori infection (12 in each group), relatives of gastric carcinoma patients had significantly increased proliferation not only in the antrum (PI: 16.5 vs. 12.1; P = 0.043), but also in the corpus (PI: 17.2 vs. 13.0; P = 0.024). CONCLUSIONS: A family history of gastric carcinoma may increase the risk for developing gastric carcinoma via mucosal hyperproliferation, irrespective of H. pylori infection.

Cell Division↗
PubMed1998

[Short-term triple therapy with pantoprazole, amoxicillin and metronidazole in Helicobacter pylori infection].

BACKGROUND: The present study was conducted to investigate the efficacy and tolerability of a 7-day treatment with pantoprazole, amoxicillin and metronidazole for the eradication of Helicobacter pylori (H. pylori) infection. PATIENTS AND METHODS: Fifty patients (26 male, 24 female, age 18 to 86, mean 54 years) with an active duodenal (n = 25) or gastric ulcer (n = 25) were recruited into the study, 48 patients being H. pylori positive at the study start. Patients were treated with pantoprazole (40 mg bid), amoxicillin (1 g bid) and metronidazole (500 mg bid) for 7 days and for another 21 days with pantoprazole (40 mg/od). Four weeks after the end of study medications the patients were re-examined endoscopically and their H. pylori status was re-assessed using urease test, histology and 13C-urea-breath test. RESULTS: In 39 of 48 intention to treat patients, H. pylori infection was cured, according to 81% (95%-CI = 67 to 91%). In the per protocol population in 35 of 41 patients H. pylori was eradicated, which results in an eradication rate of 85% (95%-CI = 71 to 94%). Ulcer healing was endoscopically confirmed in 45 of 48 patients (94%; 95%-CI = 83 to 99%) after 8 weeks. Six of 50 patients (12%) reported mild to moderate probable side-effects of the study medication. Cure of the infection was associated with a distinct reduction of the gastritis grade and activity. CONCLUSION: A 7-day triple therapy using pantoprazole, amoxicillin and metronidazole is an effective and cost-effective alternative to regimens including clarithromycin for the treatment of H. pylori infection.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1998

Differences in the diagnostic criteria used by Japanese and Western pathologists to diagnose colorectal carcinoma.

BACKGROUND: In view of the many studies of early stage colorectal carcinoma from Japan, it is essential to know whether the criteria for the histologic diagnosis of colorectal carcinoma are similar in Japan and Western countries. METHODS: Eight expert pathologists from Japan (4), North America (2), and Europe (2) individually reviewed microscope slides of 20 colorectal lesions from Japanese patients who had undergone endoscopic mucosal resection or surgery because early stage carcinoma and/or adenoma was suspected. The pathologists indicated the pathologic findings on which they based each diagnosis. RESULTS: For 11 slides that showed adenoma according to the Western pathologists with low grade dysplasia according to at least half of them, the Japanese diagnosed definite carcinoma with or without adenoma in 4 cases and adenoma in 5, and in 2 cases they were equally divided between a diagnosis of adenoma and carcinoma. For five slides showing adenoma with high grade dysplasia according to the Western pathologists, the Japanese diagnosed definite carcinoma with adenoma in three cases and adenoma in one, and in one case they were equally divided between a diagnosis of adenoma and carcinoma. For one case in which the Western pathologists were equally divided between a diagnosis of carcinoma and adenoma with high grade dysplasia, all the Japanese pathologists diagnosed definite carcinoma with or without adenoma. Three slides showed definite carcinoma with or without adenoma, according to both the Western and the Japanese pathologists. The presence of invasion was the most important diagnostic criterion of colorectal carcinoma for the Western pathologists, whereas for the Japanese the nuclear features and glandular structures were more important. CONCLUSIONS: In Japan, colorectal carcinoma is diagnosed on the basis of nuclear and structural criteria, even in cases considered by Western pathologists to be noninvasive lesions with low grade dysplasia. This diagnostic practice may contribute to the relatively high incidence of early stage colorectal carcinoma reported in Japan as compared with Western countries.

Adenoma↗
PubMed1998

An instructive false diagnosis: steroid-induced complete remission of a CNS tumor--probably lymphoma.

In recent years the incidence of primary cerebral lymphomas has increased. Diagnosis by imaging techniques (CCT, angiography, MRT) and stereotactic biopsy are considered as reliable diagnostic tools. Therapeutically a combination of radio-, steroid- and chemotherapy is recommended. We report a case of space-occupying CNS lesion in which the radiopaque enhancing process completely disappeared after biopsy and steroid therapy. A year later the tumor recurred on the other side and again regressed after steroid therapy. The first biopsy showed signs of a papillar tumor, so a choroid plexus papilloma was suspected. On examination of the treatment history, however, this diagnosis had to be revised. A primary CNS lymphoma seems most probable. The phenomenon of a tumor remission under steroid administration and the problems related to the differential diagnosis are discussed.

Aged↗
PubMed1998

[Helicobacter '98--epidemiology and significance in carcinogenesis].

Gastritis caused by infection with Helicobacter pylori is one of the most common infectious diseases worldwide. There are data on the epidemiology, pathophysiology and histology of this disease that show that Helicobacter pylori gastritis plays an important role in gastric carcinogenesis. However, we must remember that only a very few among those infected with Helicobacter pylori will develop gastric cancer. Hence, one of the main targets of future research will be to identify individuals who carry a greater risk for developing gastric cancer and may therefore benefit from eradication of Helicobacter pylori in terms of gastric cancer prevention.

Cross-Sectional Studies↗
PubMed1998

High incidence of upper gastrointestinal tract involvement in Crohn's disease.

A better definition of gastric mucosal histology in Crohn's disease permits a more accurate estimation of the frequency of upper gastrointestinal tract involvement in Crohn's disease. In a retrospective study of 792 patients with known Crohn's disease the incidence of lesions associated with the disease was determined in the duodenum, duodenal bulb, and gastric antrum and body mucosa. Crohn's disease was identified histologically in the antrum in 41.5%, in the body in 37.1%, in the duodenum in 12.1%, and in the duodenal bulb in 13%. In a further 15% and 17.4% of cases, Crohn's disease of the duodenum and duodenal bulb, respectively, was suspected. The positive predictive value of focal gastritis in patients undergoing upper endoscopy and not yet known to have Crohn's disease is as high as 94%. Thus, a high proportion of Crohn's disease patients show upper gastrointestinal tract involvement, with the major involvement in the antrum. Focal gastritis suggesting Crohn's disease turned out to have a high positive predictive value in patients not known to have Crohn's disease at the time of gastroscopy.

Adolescent↗
PubMed1998

Gastric carcinoma risk index in patients infected with Helicobacter pylori.

Epidemiological data show an association between Helicobacter pylori gastritis and gastric carcinoma. However, most people infected with H. pylori do not develop gastric cancer. We have therefore evaluated histological criteria indicating an increased risk for gastric cancer. H. pylori gastritis was investigated in 117 patients with small (O<2 cm) early gastric carcinomas and in 117 age-matched duodenal ulcer patients infected with H. pylori, who are known to have a low risk for developing gastric carcinoma. The results showed that infiltration with lymphocytes/plasma cells and infiltration with neutrophils predominating in the corpus, and intestinal metaplasia in antrum and corpus were associated with both types of gastric carcinoma (intestinal and diffuse, P<0.0001). If an index is computed by giving one point to each of these features, the predictive value for the presence of gastric carcinoma was 0.79 with a score of 2, and 0.94 with a score of 3 (all points on the index used). Application of this index might be a simple method of identifying patients infected with H. pylori and carrying a higher risk for gastric carcinoma.

Adult↗
PubMed1998

Adenocarcinoma in an ileal pouch after prior proctocolectomy for carcinoma in a patient with ulcerative pancolitis.

We report the first known case of pouch carcinoma in a 35-year-old female patient following proctocolectomy for adenocarcinoma in ulcerative pancolitis with backwash ileitis. Pouch cancer was diagnosed 2 years after the pelvic pouch procedure, illustrating that there might be a risk of pouch cancer in such patients. Adenocarcinoma arising in an ileoanal reservoir is rare. Two other cases have been reported: both patients concerned were believed to have developed cancer in small areas of residual remaining rectal mucosa.

Adenocarcinoma↗
PubMed1998

Comparison of CD44 expression in early colorectal carcinomas of the de novo and ex adenoma types.

Small colorectal carcinomas without morphological evidence of origin from an adenoma have been called "de novo" carcinomas. As changes in the expression of the adhesion molecule CD44 and its variants have been described along the adenoma-carcinoma sequence in colorectal carcinoma, we compared patterns of CD44 expression in early de novo and ex-adenoma colorectal carcinomas by staining specimens from a group of early (pT1) colorectal carcinomas by immunohistochemistry for CD44 (standard and variant forms v3, v5, v6, v7, v7/8, v10). We evaluated carcinoma, adenoma (ex-adenoma cases), transitional mucosal areas and apparently nonneoplastic mucosa peripheral to the lesions (when present). A marked increase was seen in numbers and intensity of standard and variant forms of CD44 in carcinomatous areas compared with nonneoplastic mucosa in both groups, with no significant difference between the groups. However, adenoma areas of the ex-adenoma cases and the transitional mucosa of the de novo carcinomas had nearly identical staining patterns. Together with data from other molecular studies, this may be interpreted as evidence for an adenoma-type precursor lesion in so-called de novo colorectal carcinomas.

Adenoma↗