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Biomedical subjects

M Wienbeck

Publications and source records attributed to M Wienbeck.

At least 19 recordsLinked to original sources
PubMed1995

[Cholestatic jaundice after ingestion of amoxicillin and clavulanic acid].

HISTORY AND FINDINGS: A 61-year-old woman fell ill with recurrent nausea, loss of appetite and tiredness. Five days later she noted increasing jaundice of skin and sclerae, pale stools and dark urine, and she developed itching over the whole body. Among biochemical tests alkaline phosphatase (537 U/l) and bilirubin (32.0 mg/dl) were markedly increased, while both GOT (102 U/l) and GPT (39 U/l) were only slightly elevated. Ultrasonography was normal and extrahepatic cholestasis appeared unlikely on endoscopic retrograde cholangiopancreatography. Cholestasis due to virus hepatitis was also excluded. It was only on repeated and direct questioning that the patient reported having taken three tablets daily of Augmentin (amoxicillin and clavulanic acid) for 12 days 5 weeks before the onset of symptoms. TREATMENT AND COURSE: After symptomatic treatment with Colestyramine (4 g three times daily), ursodeoxycholic acid (250 mg twice daily) and the antihistaminic Clemastine (1 g two times daily) the severe pruritus decreased quickly and alkaline phosphatase concentration became normal. At follow-up examination 4 and 8 weeks later the laboratory tests were normal. CONCLUSIONS: This report of Augmentin-induced cholestasis is not unique. It shows that previous drug intake must be carefully investigated in any case of cholestasis of unknown cause.

Amoxicillin↗
PubMed1995

Antral emptying of semisolid meal measured by real-time ultrasonography in chronic renal failure.

The etiology of upper digestive complaints in uremic patients, which frequently cause morbidity, is unclear. By means of ultrasonography we studied the emptying of the gastric antrum in 15 patients suffering from end-stage renal disease and in 15 controls. In addition, we tested for autonomic neuropathy in the chronic renal failure (CRF) patients using cardiovascular tests. The antral filling and emptying of a semisolid standardized test meal was assessed by measuring cross-sectional areas of the antrum along the plane of the mesenteric vein at regular intervals after a semisolid test meal. Postprandial antral cross-sectional areas were similar in controls and in the total of the renal failure patients. CRF patients without autonomic neuropathy (4/15) showed hastened antral emptying as evidenced by significantly diminished postcibal antral expansion. Only the CRF subgroup with symptoms of both parasympathetic plus sympathetic autonomic neuropathy (6/15) had delayed antral emptying compared to controls as assessed by planimetry of the area under the curve in postprandial antral cross-sectional areas. The CRF subgroup with exclusively parasympathetic neuropathy (5/15) had antral emptying similar to the controls. The symptom score as assessed by a standardized questionnaire of the CRF group with autonomic neuropathy (11/15) correlated significantly both with the fasting antral cross-sectional area and inversely with antral expansion immediately after finishing the test meal. Antral emptying showed a trend towards an inverse relationship to the symptom score, which reached statistical significance only in the CRF subgroup with sympathetic plus parasympathetic autonomic damage.(ABSTRACT TRUNCATED AT 250 WORDS)

Autonomic Nervous System Diseases↗
PubMed1995

Effects of nutrient solutions on concentration analysis of non-absorbable dilution markers--implications for studies of gastric emptying.

Gastrointestinal luminal contents may interfere with concentration analysis of non-absorbable dyes. However, non-absorbable markers are broadly used for studies of gastric emptying rates of nutrient solutions. This prompted us to evaluate the properties of non-absorbable markers to mark such nutrient solutions. In vitro concentrations of polyethylene glycol, phenol red, dextran blue, two anthroquinone dyes and inulin were determined spectrophotometrically in the presence or absence of a formula diet, single compounds of the diet or an oligo-peptide diet, and the reproducibility and validity of the analyses were evaluated. The presence of the formula diet or the oligopeptide diet seriously impaired the analyses of marker concentrations, whereas single nutrient compounds did not uniformly interfere. The analysis of polyethylene glycol and phenol red concentrations was impaired by proteins, while the analysis of inulin concentration was impaired by carbohydrates. Dextran blue and the anthroquinones were completely eliminated by protein-precipitation procedures. In conclusion, phenol red and polyethylene glycol should only be used as marker substances for protein-free meals or nutrient solutions, while inulin should not be used with meals or nutrient solutions containing carbohydrates. Marker dilution techniques cannot be recommended for measurements of gastric emptying rates of complete meals.

Coloring Agents↗
PubMed1995

[Do proton pump inhibitors after endoscopic control of acute ulcer hemorrhage have an advantage over H2 receptor antagonists?].

During a two year period (1992-1993) we investigated whether or not, after endoscopic therapy of bleeding ulcers, the suppression of gastric acid secretion with an administration of a proton pump blocker (Omeprazol) is more effective than the administration of H2-receptor antagonist (Ranitidin) with respect to prevention of recurrent bleeding episodes, frequency of surgical intervention and mortality. 106 patients (64 men, 42 women) were treated with the proton pump blocker and 126 patients (82 men, 44 women) received the H2-receptor antagonist. Patients were treated either with an initial dose of 80 mg Omeprazol followed by 3 x 40 mg Omeprazol i.v. or with a daily dose of 3 mg/kg body weight Ranitidin i.v. No significant differences could be detected between the two treatment regimes with respect to the parameters mentioned above. Rebleeding which could be controlled by endoscopic hemostasis occurred in 19.8% vs. 17.5% (Omeprazol/Ranitidin) of patients. Surgical intervention because of rebleeding was necessary on 8.5% vs. 8.7% of the patients. Mortality due to hemorrhage was 5.7% vs. 4.0%. From these results we conclude that, following endoscopic hemostasis of bleeding ulcers, Omeprazol has no advantage over Ranitidin using our dosage regimes.

Adult↗
PubMed1994

[Proven indication for manometry and pH determination of the esophagus].

Manometry and pH-metry are essential in the examination of functional disturbances of the esophagus. Before they are used, morphological lesions have to be excluded. Proven indications for functional methods are symptoms which cannot be clarified otherwise. Indications for manometry are: dysphagia of unknown origin, noncardiac chest pain and necessary preoperative studies. Indications for long-term pH-metry are: atypical reflux symptoms, (in particular chronic respiratory disease), noncardiac chest pain, atypical esophagitis and preoperative examination prior to antireflux surgery. Used critically, manometry and pH-metry can be very helpful as cost-effective diagnostic tools.

Chest Pain↗
PubMed1994

Long-term manometry of tubular esophagus in progressive systemic sclerosis.

Long-term manometry of the tubular esophagus was performed in 20 consecutive patients (18 females, 2 males; median age 56.5 years) with progressive systemic sclerosis (PSS) and a control group of 20 healthy subjects (18 females, 2 males; median age 56.5 years). The measurements were performed via a data logger of 1 MByte memory capacity with the help of two pressure sensors placed 8 and 18 cm above the lower esophageal sphincter. Esophageal contractions were analyzed with respect to pressure amplitudes in the esophagus distal and proximal, quotient of pressure amplitudes distal/proximal, number of contraction waves in a 24-h period, and kind of spreading (propulsive, simultaneous). In the PSS group there was a significant decrease in pressure amplitudes in the distal sensor (median 31.5 versus 39.5 mbar in controls, P < 0.02), in the quotient of pressure amplitudes distal/proximal (median 0.885 versus 1.25 in controls, P < 0.001), in the number of waves in 24 h (median 939.5 versus 1656 in controls, P < 0.01), and in the occurrence of propulsive waves (median 34% versus 57% in controls, P < 0.01). Fifteen patients (75%) had hypomotility disorders as compared to the control group, in which the lower limit of normal values was defined by the 5th percentile of descriptive analysis. These first data of long-term manometry in patients with PSS indicate that long-term manometry may be an effective method for identifying esophageal involvement in PSS.

Adult↗
PubMed1994

Long-term esophageal manometry in healthy subjects. Evaluation of normal values and influence of age.

Although long-term esophageal manometry is increasingly used in clinical practice, the normal values of contraction parameters are poorly defined. In addition, limited data are available on the effect of age on esophageal motility. Therefore, 44 healthy subjects (age range: 22-85 years) were investigated with a probe combining two pressure transducers 10 cm apart. All subjects were asked to follow their normal daily routine. The characteristics of contraction events (amplitude, duration) and type of propagation (propulsive, simultaneous) were analyzed for the total time and predefined periods: meal, daytime (interprandial), and supine. Equally high distal and proximal median pressure amplitudes (39.5 and 37 hPa) and durations (3.4 and 3.2 sec) were observed. The median percentages of propulsive and simultaneous waves were 56% and 10%. The individual contraction characteristics differed significantly in these three selected periods for most motility parameters: distal and proximal pressure amplitudes, distal duration, and propulsive contractions. To evaluate the influence of age on normal values, the subjects were divided into two age groups (median age: 28.5 and 62.4 years). In the elderly group the distal pressure amplitude, the distal duration, and the percentage of simultaneous waves increased, whereas the percentage of propulsive waves, the proximal pressure amplitude, and the proximal duration decreased. However, the differences observed were only minor and rarely reached the level of statistical significance (distal pressure amplitude and duration in the supine period). In conclusion, the physiological motor activity of the esophagus is characterized by significant diurnal variation. Furthermore the motility data are little influenced by age.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[The value of the urea/creatinine ratio for differentiation of up and lower gastrointestinal hemorrhage].

The urea/creatinine-ratio has been proposed as an instrument for differentiating upper from lower gastrointestinal haemorrhages. The predictability of this method was investigated in 105 cases with the source of bleeding to be in the upper gastrointestinal tract and in 31 cases in the lower gastrointestinal tract. Determination of the urea/creatinine-ratio predicted the site of bleeding in only 60% of the patients. The use of the ratio in diagnostic decision making would increase the number of unnecessary colonoscopies. Thus, the urea/creatinine-ratio does not appear to be clinically useful in predicting the localization of a gastrointestinal bleeding with adequate certainty.

Adult↗
PubMed1994

[Therapeutic strategy in constipation].

Therapy of constipation is complex. It is mainly based on general rules and treatment with dietary fibres. If drugs are necessary they should be applied according to the type of constipation as evidenced by the results of special diagnostic procedures. Surgical treatment is only the last choice. The aim of therapy is to relieve the patient from his symptoms and achieve a habit of regular defecation, if possible without the application of laxatives. The foremost problem in the treatment of constipation is to interrupt the vicious circle 'constipation/abuse of laxatives.' Many patients only consult a physician when they are already in that problem. Therapy then becomes difficult. Information on bowel movements and on how to prevent constipation by the way of living, therefore, should be widely spread in the general population in order to minimize constipation as a medical problem.

Biofeedback, Psychology↗
PubMed1993

[Diagnosis of functional esophageal disorders in non-cardiac chest pain syndrome].

The results of a cardiologic work-up in patients with retrosternal pain are negative in about 20-30% of cases. Overall one half of these patients exhibit an esophageal dysfunction. In order to diagnose esophageal dysfunction long-term pH-metry, transit scintigraphy and standard manometry are used as well as provocation tests. New diagnostic procedures such as long-term manometry and combined long-term pH-metry and manometry have recently been developed and are increasingly used. Long-term pH-metry is a valid, uncomplicated and sensitive procedure used to diagnose acid gastroesophageal reflux. The differential diagnosis of hypermotility esophageal dysfunction is, however, considerably more difficult. Scintigraphy appears unsuitable. The value of standard manometry is hindered by the short examination time and the rare possibility to correlate pain episodes and motility disorders. It is therefore recommended that a provocation test should be carried out after standard manometry. Preliminary results for long-term manometry are now available. These show that it is not only possible to correlate pain episodes and motility disorders but also to differentiate pathological manometry profile. This applies also to combined pH-metry and manometry reducing patients discomfort to one examination.

Chest Pain↗
PubMed1991

[Bedside determination of clinical-chemical quantities using dry chemistry in an emergency admission].

We evaluated the clinical relevance and reliability of a solid phase chemistry apparatus (Seralyzer) installed for near-patient testing of CK, GOT, glucose and potassium in the emergency admission of our hospital. Calibrations and quality controls were done by technologists of the central laboratory, the analyses were performed by the nursing staff after appropriate training. The rapid availability of the laboratory tests shortened the diagnostic process in only 8% of the patients. Clinical chemistry test results, therefore, appear to be of minor importance in making the diagnosis in an emergency room. The coefficients of variation of the inter-operator imprecision varied between 2.1 and 8.8% (means = 5.06%), when the measurements were performed by persons with no professional laboratory training, and between 2.7 and 8.5% (means = 3.98%) for skilled laboratory personal. In order to test the accuracy we correlated the dry chemistry values measured by the nurses in the daily routine with the results of a wet chemistry system. The Spearman rank correlation coefficients ranged between 0.916 and 0.950. Thus after appropriate training non-laboratory personal is able to perform dry chemistry testing with adequate precision and accuracy provided a competent supervision is guaranteed.

Aspartate Aminotransferases↗
PubMed1991

Colonic motility in humans--a growing understanding.

As yet, there is limited information about the relationship of colonic motility to colonic flow or transit. The overall flow in the colon is slow and highly variable. The measurement of total and segmental transit time is essential for the differentiation of motor disorders associated with delayed transit. Rapid movements of colonic contents (mass movements) occur only a few times during the day. Their motor equivalent is the giant contraction which migrates in the aborad direction at relatively high velocity. Motor activity in the colon is highly variable, with periods of contraction and motor quiescence. Contractions occur at different frequencies ranging from 2 to 13 cycles per minute. High frequency contractions are stationary. Their myoelectrical equivalent is short spike bursts. Long spike bursts result in sustained, low frequency contractions, which may migrate in both directions. Technological advances now make it possible to obtain ambulant manometric recordings from the colon for 24 h. Such studies show a circadian variation in colonic motility with increases of activity after meals and after awakening. Motor disorders of the colon are not associated with specific abnormal motor patterns. Rather, they are due to changes in the occurrence of motor patterns seen in health. In constipated patients with slow colonic transit the suppression of strong peristaltic activity is the most plausible common pathogenetic mechanism. In diarrhoeal states, propulsive activity such as the giant migrating contractions may be a major mechanism which promotes the passage of stools. There is no agreement that there is disordered basal colonic motor activity in IBS. There is, however, increasing evidence that in IBS the colon responds abnormally to eating, certain forms of stress and distension, and that this may relate to symptoms. The psychopathology of IBS patients is apparently the most important factor in the health care-seeking behaviour of the patients. No specific therapy has yet been shown to be convincingly effective.

Colon↗