Biomedical subjects

M Trauner

Publications and source records attributed to M Trauner.

At least 55 records · Page 3Linked to original sources

PubMed1996

Divergent effects of propranolol and nadolol in isolated mesenteric arteries from normal and portal hypertensive rats.

Propranolol, a non-selective beta-blocker, is used for treatment of portal hypertension as it is believed to diminish splanchnic blood flow both by reducing cardiac output (beta(1)-blockade) and by increasing splanchnic arteriolar resistance (beta(2)-blockade). However, possible vasodilatory properties of propranolol at higher concentrations may counteract splanchnic vasoconstriction. Nadolol, another nonselective beta-blocker, has also been suggested for treatment of portal hypertension. The aim of the present study was to investigate the effects of various concentrations of propranolol and nadolol on vascular resistance in isolated perfused mesenteric arterial beds from normal and portal hypertensive rats. At concentrations of 10(-7) mol L-1 to 10(-6) mol L-1 neither propranolol nor nadolol changed pressor responses to noradrenaline in normal rats. However, nadolol 10(-5) mol L-1 significantly increased, whereas propranolol 10(-5) mol L-1 reduced, noradrenaline-induced vasoconstriction both in normal and in portal hypertensive rats. This unexpected vasodilatory effect of propranolol at high concentrations was present in preparations stimulated by both noradrenaline and methoxamine but not vasopressin and thus may be due to competitive alpha-receptor blockade. In contrast, nadolol lacked this effect and produced splanchnic arteriolar vasoconstriction at high concentrations also.

Adrenergic beta-Antagonists↗

PubMed1996

Sonographically-guided extracorporeal shockwave lithotripsy for pancreatic stones in patients with chronic pancreatitis.

Over a 2 year period, 10 patients with pancreatic stones due to alcohol induced chronic pancreatitis (proven by endoscopic retrograde pancreatography) underwent extracorporeal shockwave lithotripsy. Prior to shockwave therapy, all patients underwent endoscopic sphincterotomy. Targeting of shockwave lithotripsy was exclusively performed under sonographic control. All patients were treated with a second generation electrohydraulic spark gap lithotriptor and fragmentation of concrements could be achieved in all cases. Complete duct clearance was confirmed in seven patients by endoscopic retrograde pancreatography in one session, with endoscopic fragment extraction by basket and/or balloon catheter. In three patients, balloon dilation of concomitant strictures located in the head of the pancreas was performed prior to fragment extraction. All stone-free patients showed no further symptoms over the follow-up period of 12 months. Three patients in whom complete extraction of fragments was not successful experienced minor symptoms over the 12 month follow-up period.

Adult↗

PubMed1995

Endoscopic intracorporeal laser lithotripsy of difficult common bile duct stones with a stone-recognition pulsed dye laser system.

BACKGROUND: Endoscopic retrograde intracorporeal lithotripsy with a stone recognition laser system seems to be a promising alternative in patients with difficult bile duct stones. METHOD: Sixteen patients with bile duct stones not suitable for endoscopic standard procedures underwent intracorporeal laser lithotripsy during a 3-month period. An average of 6800 (120 to 25000) discharges were applied with a power setting of 100 mJ. Inserting the laser fiber into a radiopaque marked catheter or into a balloon catheter guaranteed a successful location on the stone surface in 70% of all discharges. The automatic feedback/cut-off at the fiber is not in contact with the stone surface. RESULTS: Fragmentation was achieved in all cases. Complete bile duct clearance was reached in 14/16 cases. In two cases, remaining fragments passed spontaneously through the papilla as controlled by ERCP. Minor complications were noted in two patients (hemobilia, cholangitis). Complete recovery was achieved in both patients with conservative management. CONCLUSIONS: For a selected group of patients with difficult common bile duct stones, intracorporeal laser lithotripsy with a stone recognition laser system was found to be a highly effective and safe technique.

Aged↗

PubMed1995

Laparoscopic diagnosis of peritoneal serous papillary carcinoma.

Peritoneal serous papillary carcinoma is a rare primary tumor of the peritoneum. We report here a case diagnosed by laparoscopy, and summarize the clinicopathological features previously reported in patients with this tumor. Laparoscopy was performed in a 66-year-old woman with high-protein ascites and a three-month history of lower abdominal pain. Macroscopically, the parietal and visceral peritoneum was studded with prominent white nodules up to 5 mm in diameter. Multiple biopsies revealed a tubulopapillary serous adenocarcinoma. After exclusion of metastatic peritoneal carcinomatosis (especially ovarian cancer) and malignant mesothelioma, the diagnosis of peritoneal serous papillary carcinoma was established. The patient was placed on chemotherapy (first-line: 5-fluorouracil, adriamycin, and mitomycin C; second-line: paclitaxel). She died 22 months after diagnosis. The present case is also remarkable for the coexistence of granulomatous peritonitis overshadowing the malignant nature of the process. This case report emphasizes the importance of laparoscopy with multiple biopsies in the workup of undetermined exudative ascites.

Aged↗

PubMed1995

Recurrent Salmonella enteritidis sepsis and hepatic tuberculosis.

A 33 year old woman with recurrent Salmonella enteritidis sepsis is described. Penicillins, ceftriaxone, ciprofloxacin, and chloramphenicol could not eradicate the salmonellas but a combination of high dose ciprofloxacin and ceftriaxone for the eighth episode successfully cured the infection. The combination of ciprofloxacin and ceftriaxone may be a valuable therapeutic regimen in patients with recurrent salmonella sepsis. Prolonged intrahepatic cholestasis resulting from granulomatous hepatitis in this patient improved considerably with empiric ursodeoxycholic acid treatment. A liver biopsy specimen showing non-caseating epitheloid granulomas was positive for mycobacterial DNA by polymerase chain reaction. Repeated bronchoscopy with multiple biopsies eventually revealed caseating granulomas with acid fast bacilli in the lung biopsy specimens. Therefore, tuberculosis was diagnosed as the underlying disease and the cause of granulomatous hepatitis in this patient and tuberculostatic treatment was started. Polymerase chain reaction for mycobacterial DNA may be helpful in the differential diagnosis of hepatic granulomas when routine histological examination and culture of biopsy specimens are not diagnostic. Tuberculosis should be considered as one of the diseases predisposing to recurrent salmonella sepsis.

Adult↗

PubMed1995

Lack of pineal growth during childhood.

During childhood, serum melatonin concentrations drop by approximately 80%, but the 24-h melatonin excretion is stable. Arrest of pineal growth after the end of infancy has been proposed as one possible mechanism underlying that phenomenon. To test this hypothesis, we reviewed 332 magnetic resonance imaging brain studies, classified as normal, of endocrine-normal children, aged 1 day to 15 yr, and estimated the pineal and pituitary sizes. The pineal was identified in 277 of 332 magnetic resonance imaging studies (83%). The average size (mean +/- SEM) of the pineal gland (transaxial diameter, 5.6 +/- 2.1; midsagittal diameter, 5.0 +/- 2.4; planimetric area, 28.5 +/- 17.8) did not differ with age. A total of 74 of 277 pineals with cysts (26.7%) were found. The occurrence of pineal cysts was equally distributed among the different age groups (chi 2 = 11.6; df = 14; P = 0.7). Ten pineals showed more than 1 cyst (3.6%). The pituitary was identified in 325 of 332 brain images (97.9%). The average pituitary size increased by some 100% from 1 to 15 yr of age [transaxial diameter: F = 2.2; P = 0.005 (by two-way analysis of variance); midsagittal diameter: F = 3.7; P = 0.0001; planimetric area: F = 7.1; P = 0.0001]. The pituitary was slightly larger in females than in males [midsagittal diameter: F = 8.8; P = 0.003 (by two-way analysis of variance); planimetric area: F = 7.9, P = 0.005]. The data presented indicate a lack of a discernible pineal growth after age 1 yr, which contrasts with pituitary development in the same individuals. The data are in agreement with a hypothesis suggesting a growth arrest of the pineal after infancy.

Adolescent↗

PubMed1995

Quantitative perfusion parameters of focal nodular hyperplasia and normal liver parenchyma as determined by electron beam tomography.

Eight patients with known focal nodular hyperplasia (FNH) were studied by electron beam tomography (EBT) in a multisection flow mode at defined time intervals after intravenous contrast agent injection. Various regions of interest (ROIs) were defined in the areas of FNH, normal liver parenchyma, aorta and portal vein. In each ROI density changes were measured and plotted against time. In those time-density curves (TDCs) the slope, the time of maximal enhancement and the absolute density value of peak enhancement were determined. Arterial tissue perfusion was calculated for normal liver parenchyma and FNH. In all eight patients significant differences in peak density (123.88 +/- 18.92 HU vs 102.5 +/- 15.49 HU, p = 0.012), in the rate of arterial contrast enhancement (252.63 +/- 28.05 HU min-1 vs 38.88 +/- 4.19 HU min-1, p = 0.012) and in the arterial tissue perfusion (1.36 +/- 0.19 ml min-1 cm-3 vs 0.21 +/- 0.03 ml min-1 cm-3, p = 0.012) between FNH and normal liver parenchyma were found. Perfusion values of normal liver parenchyma correspond to those determined by inert gas clearance. Further studies will determine the practicability of this quantitative method in the evaluation of global and other focal liver diseases.

Adolescent↗

PubMed1995

Evaluation of carbohydrate-deficient transferrin for detection of alcohol abuse in patients with liver dysfunction.

The determination of carbohydrate-deficient transferrin (CDT) in serum has been suggested as a marker of alcohol abuse. We evaluated serum CDT in 199 patients admitted to our Department of Medicine using a commercially available radioimmunoassay kit for CDT. A history of alcohol consumption was obtained quantitatively by a self-administered questionnaire and qualitatively by the Munich Alcoholism Test. Using a cut-off level of 60 g ethanol per day according to the information from the questionnaire. CDT had a sensitivity of 70% and a specificity of 84%. False-positive values were primarily encountered in cases of hepatic malignoma, primary biliary cirrhosis and chronic hepatitis C. The sensitivity and specificity of CDT was superior to two other markers of chronic ethanol consumption, serum gamma-glutamyltransferase and mean cell volume, and thus proved to be the best single laboratory test for the detection of alcohol abuse.

Biomarkers↗

PubMed1995

Nitric oxide and liver disease.

Nitric oxide is a highly reactive, diffusible gas that is produced by many tissues, and it exerts a range of physiological and pathophysiological effects. The liver is one organ clearly influenced by nitric oxide, and acute versus chronic exposure to this substance has been associated with distinct patterns of liver disease. Bacterial infections, including the sepsis syndrome, acutely increase nitric oxide systemically and may lead to acute hepatic dysfunction. We review etiology, diagnosis, and treatment of cholestasis associated with these infections, because this condition in particular has been linked to nitric oxide. Chronic increases in nitric oxide may cause the hyperdynamic circulation seen in cirrhosis and portal hypertension. Therefore, we also review etiology, diagnosis, and treatment of the hepatorenal and hepatopulmonary syndromes, because both these syndromes occur in end-stage liver disease, and they may be linked to nitric oxide as well. An appreciation of nitric oxide and its evolving role in hepatology may be important to understand the pathogenesis of and treatment strategies for these different types of liver disease.

Humans↗

PubMed1994

Glomerulonephritis as late manifestation of severe alpha 1-antitrypsin deficiency.

An association of alpha 1-antitrypsin deficiency with glomerulonephritis is rare and has so far been observed only in children or young adults. We report a 63-year-old man with severe alpha 1-antitrypsin deficiency associated with pulmonary emphysema, cirrhosis of the liver, and mesangioproliferative glomerulonephritis with nephrotic syndrome. Following initial presentation with nephropathy, further work-up revealed alpha 1-antitrypsin deficiency of proteinase inhibitor Z. In the absence of glomerular alpha 1-antitrypsin deposits the relationship between renal disease and alpha 1-antitrypsin deficiency remains unclear. alpha 1-Antitrypsin deficiency should be considered in adults with abnormal renal function and chronic liver disease.

Fatal Outcome↗

PubMed1994

Carcinoembryonic antigen, cytokeratin expression and mucin composition in hyperplastic and neoplastic polyps of the colorectum.

We examined the expression of carcinoembryonic antigen (CEA) and cytokeratin (CK) as well as the sialo- and sulphomucin content of 40 hyperplastic polyps (HPs), 6 mixed hyperplastic-adenomatous polyps, 30 adenomas and 40 adenocarcinomas of the colorectum. HPs showed a positive CEA expression in 95% of cases and a decreased sialo- and sulphomucin content compared with normal mucosa. Similar changes were observed in adenomas with low-grade dysplasia. The increase in CEA expression from HPs and adenomas to carcinomas was accompanied by a reduction of sialo- and sulphomucins with about three fourths of carcinomas being sialo- and sulphomucin negative. Oncofetal antigen expression concomitant with mucin changes observed in HPs may indicate impaired cellular maturation at a functional level before dysplastic changes become visible. CEA and CK positive macrophages were found in carcinomas predominantly at sites of tumor disruption and necrosis as well as within veins and lymphatic vessels. Our findings suggest that macrophages may play a role in CEA and CK release into the circulation and thus may be determinants of tumor marker serum levels.

Adenocarcinoma↗

PubMed1994

[Ultrasound controlled extracorporeal shockwave lithotripsy of pancreatic calculi in patients with chronic recurrent pancreatitis].

A consecutive series of 10 patients with pancreatic stones due to chronic pancreatitis was treated by extracorporeal shockwave lithotripsy during an investigation period of 2 years. The first step of the therapeutic regime included an endoscopic sphincterotomy prior to shockwave treatment. The targeting procedure was performed strictly under sonographic control. All patients were treated with a second-generation electrohydraulic lithotriptor, fragmentation could be achieved in all 10 cases. In 7 patients stonefreeness could be reached by endoscopic stone extraction, all these patients were symptom-free over a follow-up period of 12 months. In 3 patients complete duct clearance could not be achieved, these patients presented with minor symptoms over the follow-up period.

Adult↗

PubMed1993

Lateral hypothalamic lesions cause gastric injury by stimulating gastric contractility.

Changes in gastric contractility following lateral hypothalamic (LH) lesions with and without bilateral cervical vagotomy were measured in urethan-anesthetized rats. LH lesions were induced with direct current passed through stereotaxically placed electrodes. Gastric contractility was recorded continuously for 4 h with acutely implanted strain gauge force transducers and analyzed by computer. LH lesions consistently stimulated gastric contractility and caused more gastric mucosal injury than control conditions. Vagotomy blocked both gastric mucosal injury and high-amplitude gastric contractions. In rats with LH lesions and exogenously infused intragastric hydrochloric acid, atropine methyl nitrate inhibited high-amplitude gastric contractions and gastric erosions. These findings indicate that LH lesions stimulate vagally mediated high-amplitude gastric contractions, which, in the presence of hydrochloric acid, cause gastric mucosal erosions.

Animals↗

PubMed1993

[Indications for liver transplantation in neoplasms of the liver].

Orthotopic liver transplantation for hepatic neoplasms is controversial. In the past, liver transplantation was utilized to treat various advanced hepatic neoplasms such as hepatocellular carcinoma including the fibrolamellar variant, cholangiocellular carcinoma, epithelioid hemangio-endothelioma, and liver metastases. In many cases, total hepatectomy with orthotopic liver replacement is the only treatment option with intent to cure because of reduced liver function in cirrhotic patients limiting resectability. On the other hand, results of transplantation are poor; for hepatocellular carcinoma, the 5-year-survival probability averages only 20%. Thus, hepatic neoplasms have to compete with benign liver diseases for a limited supply of donor organs. However, success rates of liver transplantation were higher for fibrolamellar carcinoma and for epithelioid hemangioendothelioma. New treatment strategies for hepatocellular carcinoma including neoadjuvant chemotherapy and chemoembolization are currently being investigated. Results of liver transplantation for cholangiocellular carcinoma or hepatic metastases have been disappointing. Single cases have been successfully treated with the "cluster operation" designed by Starzl in 1988.

Adenoma, Bile Duct↗

PubMed1992

Thyrotropin-releasing hormone analog injected into the raphe pallidus and obscurus increases gastric contractility in rats.

The present study was performed to investigate the influence of the chemical stimulation of medullary raphe nuclei by the stable TRH (thyrotropin-releasing hormone) analog, RX 77368, on gastric contractility. Urethane-anesthetized rats were acutely implanted with miniature strain gauge force transducers on the corpus of the stomach for continuous recording of gastric contractility. Traces were analyzed by computer. Microinjections of vehicle or RX 77368 into the raphe pallidus or raphe obscurus were performed using pressure injection of 50 nl through glass micropipettes 30 min following basal recording of gastric contractility. RX 77368 (0.7-77 pmol) dose dependently stimulated gastric contractility when microinjected into the raphe pallidus and raphe obscurus. The stimulation of gastric contractions induced by microinjection of RX 77368 (77 pmol) into these raphe nuclei was completely blocked by vagotomy and prevented (raphe obscurus) or reduced (raphe pallidus) by atropine. RX 77368 (7.7-77 pmol) microinjected into the inferior olive, pyramidal tract, medial lemiscus was ineffective. These results demonstrate that chemical stimulation of the raphe pallidus and obscurus by RX 77368 stimulates gastric contractility through vagal and muscarinic pathways. These data suggest a role for medullary raphe nuclei in the central vagal regulation of gastric contractility.

Animals↗

PubMed1992

Diagnostic problems in nodular regenerative hyperplasia (nodular transformation) of the liver. Review of the literature and report of two cases.

Nodular regenerative hyperplasia (NRH) is a rare lesion of the liver associated with portal hypertension in more than half of patients. We present two cases demonstrating complications and diagnostic problems of NRH and review the pathogenesis, clinical, radiologic, and pathologic features of 240 cases in the literature. Patient 1 died from variceal bleeding as a complication of NRH. Patient 2 presented with ascites. Sonographic, computed-tomographic and magnetic resonance findings did not differ from liver cirrhosis. Three needle biopsies showed nonspecific reactive hepatitis. Wedge liver biopsy provided the correct diagnosis of NRH and a shunt operation was performed. Non-Hodgkin's lymphoma (centroblastic type) was diagnosed three years after NRH. At present there is no clinical or radiologic evidence of progression of NRH in this patient. The diagnosis of NRH cannot be made without histologic examination. Correct diagnosis is difficult in percutaneous needle biopsy. Therefore, laparoscopically guided liver biopsy or wedge biopsy is often necessary for diagnosis. NRH should be included in the differential diagnosis of portal hypertension. Portal diversion can be considered.

Biopsy↗

PubMed1991

CRF microinjected into the dorsal vagal complex inhibits TRH analog- and kainic acid-stimulated gastric contractility in rats.

The effect of CRF microinjected into the dorsal vagal complex (DVC) on centrally-stimulated gastric contractility was investigated in fasted, urethane-anesthetized rats. Miniature strain gauge force transducers were acutely implanted on the corpus of the stomach and contractility was analyzed by computer. Microinjection of the stable thyrotropin-releasing hormone (TRH) analog, RX 77368, (26 pmol) into the DVC induced a 12.2-fold stimulation of gastric contractility within 30 min. Corticotropin-releasing factor (CRF) (63-210 pmol) microinjected into the DVC concomitantly with RX 77368 (26 pmol) induced a dose-related inhibition of stimulated gastric contractility. Neither CRF alone (210 pmol) nor vehicle modified basal gastric contractility. Microinjection of kainic acid (141 pmol) into the raphe pallidus nucleus induced a 3.6-fold stimulation of gastric contractility after 45 min. This stimulation was suppressed by bilateral microinjection of CRF (105 pmol/site) into the DVC. These results demonstrate that CRF acts in the DVC to inhibit centrally-stimulated gastric contractility and suggest that TRH and CRF may interact in the DVC to regulate gastric motor function.

Animals↗

PubMed1986

Forearm muscles of man can reverse their function after tendon transfers: an electromyographic study.

In patients suffering from paralysis of a major synergistic muscle group tendon transfers can be considered the therapy of choice in restoring the mobility of the affected joint(s). In order to study the mechanisms underlying the subsequent reversal of function in the transferred muscles, we have recorded the EMG of several forearm muscles in parallel and compared their activation periods with control data from healthy volunteers. Slow and fast extension-flexion movements of the wrist were evaluated. The findings demonstrated a 'new' phasic EMG activity within the transferred muscles, which correlated to their new mechanical function. However, the 'old' EMG pattern was not lost. In some muscles it was present in fast and slow wrist movements, in others only in fast ones. The results indicate that the reversal of function observed in the transferred muscles can be adjusted to meet the specific needs of the movement to be performed.

Adaptation, Physiological↗