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Biomedical subjects

M Stolte

Publications and source records attributed to M Stolte.

At least 343 records · Page 19Linked to original sources
PubMed1995

Prognosis of gastric carcinoid tumours.

With the aim of evaluating the prognosis of carcinoid tumours of the stomach, the tumours were classified into subtypes on the basis of the type of gastritis, and a comparison made of the type of treatment, metastasizing rate, and the survival rates of the various groups of patients involved. Of the patients with atrophic autoimmune gastritis (type A gastritis) (n = 88) who had multiple carcinoid tumours in the corpus or fundus, usually not more than 1 cm in diameter, 98% were followed up clinically or by endoscopy and biopsy. In these patients, the metastasizing rate was 0%, and the age-corrected Kaplan-Meier survival rate revealed normal life expectancy. 25% of the patients with sporadic carcinoid tumours (n = 12)--most of whom had a Helicobacter pylori-related gastritis and usually solitary tumours located within the corpus of fundus, 25% of which exceeding 1 cm in diameter--underwent surgical treatment. In these patients the metastasizing rate was 16.7% and the age-corrected survival rate 79%. On the basis of our results, we conclude that, depending upon the subtype involved, the prognosis of gastric carcinoid tumours varies, such that regular endoscopy/biopsy follow-up suffices for patients with type A gastritis, while for patients with sporadic carcinoid tumours, surgical treatment is indicated.

Adult↗
PubMed1995

Histologic detection of trophozoites of Giardia lamblia in the terminal ileum.

BACKGROUND: The occurrence of trophozoites of Giardia lamblia in mucosal biopsy specimens obtained from the terminal ileum and associated histologic changes are reported. METHODS: In this retrospective histologic analysis an average of 3.2 (range, 1-7) Giardia-positive biopsy specimens obtained from the terminal ileum of 32 subjects was examined. Colonization was defined as sparse (1-10 trophozoites per specimen), intermediate (10-30 trophozoites per specimen), or heavy (more than 30 trophozoites). The number of intraepithelial lymphocytes (IEL) was assessed and the results expressed as the number of IEL/100 epithelial cells. Grade of villous flattening was determined semiquantitatively. The number of lymphoid follicles per biopsy specimen was counted, and the degree of mucosal inflammation determined semiquantitatively. Ileal mucosa biopsy specimens from 32 Giardia-free cases, classified histologically as normal, served as control. RESULTS: Twelve of the patients were female, and twenty male. The mean age was 46 years (range, 20-68 years). Light colonization with G. lamblia was observed in 13 (40.6%) patients, intermediate in 6 (18.8%), and heavy colonization in 13 (40.6%; range, 2-215 trophozoites/case). Normal villous architecture was seen in all cases. The numbers of lymphocytes and granulocytes in the lamina propria were considered to be within the normal range in all patients with giardiasis and in all controls. The occurrence of lymphoid follicles and the content in IEL did not differ significantly in Giardia-positive and -negative cases. CONCLUSIONS: G. lamblia can colonize the terminal ileum and may therefore be detected in biopsy specimens obtained from this area. Owing to the absence of associated histologic changes a search for the parasites themselves has to be made in the specimen.

Adolescent↗
PubMed1995

Cyst wall ultrastructure of two Sarcocystis spp. from European mouflon (Ovis ammon musimon) in Germany compared with domestic sheep.

Muscle samples from six wild and two captive European mouflons (Ovis ammon musimon) in Germany as well as one domestic sheep from a German zoo were infected with sarcocysts (Sarcocystis: Sarcocystidae, Apicomplexa). Sarcocystis tenella and S. arieticanis were identified by light and electron microscopy. Both species are determined for the first time from wild sheep, and this is the first description of S. arieticanis from wild sheep.

Animals↗
PubMed1995

Omeprazole/amoxicillin versus triple therapy for Helicobacter pylori in duodenal ulcer disease: two-year follow-up of a prospective randomized study.

The present study was designed to compare the efficacy and tolerability of triple therapy and dual therapy for Helicobacter pylori in duodenal ulcer patients and to evaluate the long-term clinical course of ulcer disease. Forty duodenal ulcer patients with proven H. pylori infection were enrolled into the study and randomly treated with either triple therapy consisting of bismuth subsalicylate, metronidazole and tetracycline plus ranitidine or with dual therapy comprising omeprazole and amoxicillin. Patients were investigated clinically and endoscopically including assessment of H. pylori infection by means or rapid urease test, culture, histology and urea breath testing 4 weeks after cessation of eradication therapy, in 1-year intervals and when dyspeptic symptoms recurred. One patient of each group was lost during follow-up. H. pylori infection was cured by triple therapy in 84.2% and by dual therapy in 78.9% (p = 1.00). During follow-up, all patients with cure of H. pylori infection (n = 31) remained in stable remission with respect to duodenal ulcer disease, while 6 out of 7 patients persistently infected with H. pylori developed an ulcer relapse (p < 0.001). One patient with cured infection had had an episode of dyspeptic symptoms requiring pharmacotherapy and in another 3 patients mild refluxesophagitis without necessity of medical treatment had been detected on the occasion of a scheduled endoscopy. In the short-term, cure of the infection resulted in a marked reduction of the degree of antral gastritis and in a loss of activity in all but one patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Pedicled polypoid carcinosarcoma: a very rare esophageal tumor].

Neoplasms of the esophagus normally appear either as a exophytic-polypoid form, or as an infiltrating carcinoma or as an ulcerating tumor. We report on a 86 year old man suffering from the rare case of a pedicle polypoid tumor of the esophagus histologically diagnosed as a carcinosarcoma. We discuss the histological problems and our diagnostic and therapeutic proceeding.

Aged↗
PubMed1995

The significance of Helicobacter pylori in relation to gastric cancer and lymphoma.

The evidence linking Helicobacter pylori and non-cardia gastric adenocarcinoma is accumulating. Patterns of strain specificities and host factors that increase epithelial proliferation and have implications for mutagenic effects are evolving. The decision by the World Health Organization and the International Agency for Research on Cancer to classify H. pylori as a 'definite' carcinogen, however, represents a milestone in the association of H. pylori with gastric carcinogenesis. The importance of H. pylori in gastric lymphoma has been underscored by the finding that H. pylori eradication can induce complete regression in low-grade mucosa-associated lymphoid tissue lymphomas, at least in the early stages of development.

Adenocarcinoma↗
PubMed1995

[Short-term triple therapy with pantoprazole, clarithromycin and metronidazole in eradication of Helicobacter pylori].

In a prospective study, thirty consecutive patients presenting with either H.pylori positive (histology and/or culture) ulcer disease (n = 17; acute ulcer: n = 11) or functional dyspepsia (n = 13) were treated over one week with pantoprazole 40 mg bd, clarithromycin 250 mg bd and metronidazole 400 mg bd. Four weeks after discontinuation of the study medication H.pylori eradication was assessed by means of an urease test, culture and histology. One patient had to be withdrawn from the study after one day because of a concomitant infectious disease requiring long-term antibiotic treatment. Another patient refused the final follow-up endoscopy. 28 patients completed the study without contravening the protocol. H.pylori infection was eradicated in 24 out of 28 patients (eradication rate: 86%; 95%-confidence interval: 57%-96%). Cure of bacterial infection was more frequently obtained in ulcer patients as compared to patients suffering from functional dyspepsia (94% vs 75%; p = 0.28). In 2 patients, treatment failure was associated with pretherapeutic resistance of H. pylori to either clarithromycin or metronidazole. Without antiulcer treatment beyond eradication therapy, ulcer healing was endoscopically confirmed after 5 weeks in 9 out of 10 patients available for follow-up (healing rate: 90%; 95%-confidence interval: 56%-100%). Seven patients reported mild adverse events that did not lead to discontinuation of the study medication (rate: 23%; 95%-confidence interval: 10%-42%). After cure of the infection, histology demonstrated a statistically highly significant improvement (p < 0.001) of both grade and activity of antrum and body gastritis.(ABSTRACT TRUNCATED AT 250 WORDS)

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1995

Double-blind dose-finding study of olsalazine versus sulphasalazine as maintenance therapy for ulcerative colitis.

OBJECTIVE: To determine the therapeutic efficacy and safety of three doses of olsalazine compared with the standard dose of sulphasalazine. DESIGN: Randomized double-blind multicentre 6-month study comparing three doses of olsalazine (0.5, 1.25 and 2.0 g daily) and sulphasalazine 2.0 g daily for maintaining remission in patients with ulcerative colitis. SETTING: Public hospitals and private practices in Germany, Austria and Switzerland. PATIENTS: A total of 162 patients with ulcerative colitis in remission. RESULTS: According to intention-to-treat analysis, the failure rates of the different treatment groups were not significantly different (36, 49 and 24% for 0.5, 1.25 and 2.0 g olsalazine daily and 32% for 2.0 g sulphasalazine daily). Olsalazine and sulphasalazine showed a tendency towards lower failure rates in extended (28%) than in distal disease (44%). The withdrawal rate due to adverse effects was 4%, the most frequent single event being diarrhoea (2.5, 5.2 and 11.7% for 0.5, 1.25 and 2.0 g olsalazine daily and 0% for sulphasalazine daily). CONCLUSION: This study found no significant differences between the therapeutic efficacy or safety of 0.5-2.0 g olsalazine daily. Because of its sulpha-free formulation olsalazine may, however, be preferred to sulphasalazine.

Adolescent↗
PubMed1995

Relationships between the degree of Helicobacter pylori colonisation and the degree and activity of gastritis, surface epithelial degeneration and mucus secretion.

This study investigates the question as to whether, in Helicobacter pylori (H.p.) gastritis, any statistically significant relationships are to be found between the following histological parameters: degree of H.p. colonisation, the degree and activity of gastritis, degree of replacement of the foveolar epithelium by regenerating epithelium, and degree of mucus depletion. Forceps biopsy material obtained from 240 patients with NUD and H.p. gastritis (3 specimens from the antrum, 2 from the corpus) were investigated. The 5 histological parameters employed were graduated semiquantitatively as follows: 0 = normal findings, 1 = minimal, 2 = low-grade, 3 = medium-grade, 4 = high-grade. The evaluation showed that the degree and activity of gastritis, the degree of replacement of foveolar epithelium by regenerating epithelial cells, and the degree of mucus depletion are dependent upon the degree of H.p. colonisation (p < 0.0001). The gastritis parameters were more marked in the antrum than in the corpus. The intercorrelations were highly significant for all five parameters investigated, both in the antrum and corpus (p < 0.0001). On the basis of these results it is concluded that for the histological assessment of H.p. gastritis, in addition to H.p. colonisation, and the degree and activity of gastritis, but also the state of the foveolar epithelium and the mucus production of these epithelial cells should be considered.

Adult↗
PubMed1995

Observation of gastric glandular cysts in the corpus mucosa of the stomach under omeprazole treatment.

In patients undergoing long-term treatment with omeprazole, tiny gastric polyps, described histologically as glandular cysts, have occasionally been reported. We report on a further nine patients (5 women and 4 men) undergoing omeprazole treatment who developed endoscopically visible and histologically verified glandular cysts. Eight patients were on long-term treatment with omeprazole for reflux oesophagitis, and the glandular cysts were observed between 8 and 60 months after the start of treatment. In one patient with an NSAID-induced ulcer, a tiny polyp was found only three weeks after initiation of treatment. None of the patients had Helicobacter pylori-associated gastritis. The cysts, which measured between 0.25 and 0.7 mm in diameter, were mostly lined with flattened parietal and chief cells, but in three cases also with foveolar epithelium, so that they could not be reliably distinguished from Elster's gastric glandular cysts. These glandular cysts are harmless, and do not require further diagnostic or therapeutic measures. They probably develop spontaneously independently of the omeprazole therapy.

Adult↗
PubMed1995

Helicobacter pylori eradication in the treatment and differential diagnosis of giant folds in the corpus and fundus of the stomach.

In an earlier study, we were able to show that giant fold gastritis is probably a special form of Helicobacter pylori-associated gastritis. Proof of this contention, however--namely regression of the giant folds following eradication of the organism--in a large number of patients was not then possible. To rectify this, Helicobacter pylori (HP) eradication treatment with omeprazole and amoxicillin was applied to 47 patients with HP gastritis and giant folds (5 patients with giant folds localized in the anterior or posterior wall, 42 patients with generalised giant folds within the corpus and fundus). The results of treatment were investigated by endoscopy and histology at the earliest 4 weeks after termination of treatment. In 40 of the 47 patients (85.1%), HP eradication treatment was successful. In 7 patients in whom treatment was unsuccessful, follow-up examinations revealed no changes in the endoscopic or histological findings. In 2 out of 3 patients in whom the endoscopic findings were unchanged despite successful HP eradication, biopsy material revealed the cause of the giant folds to be a signet ring cell carcinoma; in the remaining patient the cause of giant fold persistence was unclear. In 36 patients, the endoscopic--findings normalised completely, while in one patient there was obvious regression of the giant folds. We conclude from this study that giant fold gastritis is indeed a special form of HP gastritis, and that eradicating the organism in patients with gastric giant folds may help to distinguish between inflammatory, hyperplastic and tumorous giant folds.

Aged↗
PubMed1995

One-week low-dose triple therapy for the eradication of Helicobacter pylori infection.

OBJECTIVE: To evaluate the efficacy and safety of two 1-week low-dose triple therapy regimens for the treatment of Helicobacter pylori infection. PATIENTS AND METHODS: Eighty patients with H. pylori infection and peptic ulcer disease (n = 64) or functional dyspepsia (n = 16), with similar demographic and clinical characteristics, were treated for 1 week with either omeprazole 20 mg once in the morning and clarithromycin 250 mg and metronidazole 400 mg twice daily (OCM; n = 40) or with omeprazole 20 mg once in the morning and clarithromycin 250 mg and tetracycline 500 mg twice daily (OCT; n = 40). H. pylori infection was assessed by urease test, culture and histology performed before and 4 (or more) weeks after cessation of the eradication therapy. RESULTS: H. pylori infection was treated successfully in 38 out of 40 patients by OCM and in 26 out of 40 patients by OCT (95 versus 65%, respectively; P = 0.0015). The OCM regimen was well tolerated in all patients except for one who complained of epigastric pain. Three patients on the OCT regimen reported side effects (abdominal pain, diarrhoea, pruritus), two of whom discontinued the study medication after 1 day. CONCLUSIONS: The 1-week low-dose triple therapy comprising omeprazole, clarithromycin and metronidazole was highly effective in eradicating H. pylori and was well tolerated. The replacement of metronidazole by tetracycline resulted in a significant decrease in the eradication rate.

Adult↗
PubMed1995

[Bleeding peptic ulcers--how can recurrent bleeding be prevented?].

Bleeding is the most frequent complication of peptic ulcer disease. Patients with a previous ulcer hemorrhage have a high risk for future bleeding episodes. Therefore, treatment aiming at ulcer prophylaxis is mandatory. Helicobacter pylori infection, acid/pepsin and intake of Aspirin or NSAIDs are the main causal factors involved in the pathogenesis of peptic ulcer disease. Ulcers induced by nonsteroidal anti-inflammatory drugs can be cured by gastric acid suppression (e.g. omeprazole) and prevented by withdrawal of the ulcerogenic substances or co-medication with omeprazole or misoprostol. Acid and Helicobacter pylori are necessary, albeit by themselves not sufficient factors in the causal web of the formerly idiopathic, gastritis-associated peptic ulcer disease of the stomach and the duodenum. Maintenance therapy with antisecretory drugs results in a marked decrease of ulcer recurrences and probably further ulcer complications after an index bleeding, but a definite cure of the ulcer disease is not feasible in the majority of patients. The proportion of patients remaining in remission is dependent on the degree of gastric acid suppression. Therefore, potent antisecretory drugs such as the proton pump inhibitor omeprazole should be used if a physician decides to initiate a long-term maintenance therapy. Several studies have demonstrated beyond doubt that cure of Helicobacter pylori eradication resulted in a stable remission of gastric and duodenal ulcer disease. In addition, a true reinfection after apparent eradication of the bacteria has been rarely observed in adults.(ABSTRACT TRUNCATED AT 250 WORDS)

Combined Modality Therapy↗
PubMed1995

[Mesenteric panniculitis].

We report three cases of mesenteric panniculitis in which the disease took different courses. The first case clinically mimicked an acute diverticulitis and consequently laparotomy was performed. During this operation a large space-occupying tumour was found in the lower abdomen. After resecting this tumour mass of uncertain classification (benign or malignant) a preternatural anus of sigmoid colon was formed. Histological exploration revealed mesenteric panniculitis. Six months later we restored continuity of large bowel by end-to-end anastomosis. No residues of the preexisting panniculitic alterations were seen. The second case concerned a female patient who again complained of discomfort after surgical treatment of colon carcinoma. We measured an elevated erythrocyte sedimentation rate and suspected a relapse of the malignant disease. Notwithstanding radiological and endoscopic diagnostics, the origin and classification of an intra-abdominal tumour could not be determined preoperatively. Laparoscopically we took a biopsy of the local mass, but a definite diagnosis was not found. Postoperatively undulant fever occurred, uninfluenced by cortisone treatment. Finally the patient died because of unstoppable hemorrhage under coagulopathy. Mesenteric panniculitis was identified as causative disease by autopsy.

Aged↗
PubMed1994

Expression of MUC2-mucin in colorectal adenomas and carcinomas of different histological types.

The expression of mucin MUC2 was investigated in normal colonic tissue, in colonic adenomas and in carcinomas of the mucinous and non-mucinous type. The latter were subdivided into carcinomas originating from the adenoma-carcinoma sequence (ACS) and de novo (DN) carcinomas. The expression was assayed by immunohistochemistry with the monoclonal anti-MUC2 antibody CCP58 and by mRNA semiquantitation. MUC2 protein epitope CCP58 was strongly expressed in 21% of normal colonic tissues, in 40% of villous and in 48% of tubular adenomas. Mucinous carcinomas exhibited strong expression in 72%, ACS carcinomas in 21% and DN adenocarcinomas in none of the tumors investigated. Compared with the adjacent non-malignant tissue (transitional mucosa), CCP58 epitope expression in the tumor was higher in 74% of mucinous carcinomas, but equal or lower in 69% of ACS carcinomas and in 100% of de novo carcinomas. The alterations of MUC2 expression detected by immunohistochemistry in adenocarcinomas were confirmed on mRNA level. These data indicate that the MUC2 expression pattern is different in the 3 carcinoma types investigated. MUC2 over-expression occurs in the adenomatous tissue. It is always maintained in mucinous carcinomas, but frequently decreased in non-mucinous ACS carcinomas. DN carcinomas are most frequently associated with decreased expression of MUC2.

Adenocarcinoma, Mucinous↗