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Biomedical subjects

P Born

Publications and source records attributed to P Born.

At least 55 records · Page 3Linked to original sources
PubMed1995

[Hemorrhage caused by duodenal varices].

HISTORY AND CLINICAL FINDINGS: A 53-year-old man had been passing tarry stools and bright red blood per rectum for 6 days. He had a history of pyloroplasty for duodenal ulcers, alcoholic liver cirrhosis, stage B in Child's classification, a Le Veen shunt for ascites, grade I oesophageal varices and several episodes of intestinal bleeding of uncertain cause on repeated endoscopies. Haemoglobin levels was now 4.4 g/dl. Neither oesophago-gastro-duodenoscopy nor colposcopy, radiological examination of the small intestine nor scintigraphy discovered the source of bleeding. Computed tomography revealed varices in the horizontal part of the duodenum, confirmed by arteriography. TREATMENT AND COURSE: At a second endoscopy, this time with a long scope, acute bleedings were seen in the venous convolutions and stopped with 4 ml Polidocanol. Bleeding recurred after 10 days, thought to be due to persisting portal hypertension. A transjugular intrahepatic portosystemic stent shunt (TIPSS) was inserted to lower the pressure. Colour-coded Doppler examination at the time of another bleeding 10 weeks later demonstrated occlusion of the TIPSS. It was re-opened by balloon catheter dilatation, since when there have been no further episodes of bleeding. CONCLUSION: The implantation of a TIPSS is a new causative treatment for recurrent bleeding from ectopic varices due to portal hypertension that cannot be treated by endoscopy.

Angiography↗
PubMed1995

Candida albicans meningitis in a 27 weeks premature infant treated with liposomal amphotericin-B (AmBisome)

We report a case of Candida albicans meningitis in a neonate born after 27 weeks of gestation. To the best of our knowledge this is the first report of a premature infant with Candida-meningitis treated with liposomal amphotericin B (AmBisome(R)). The patient did not respond well to conventional Amphotericin B, but was successfully cured with Ambisome(R). Liposomal amphotericin B was well tolerated and the baby recovered with a postinfectious hydrocephalus which necessitated a permanent ventriculo-peritoneal shunt. Six months after the infection the baby appears to have a near-normal cerebral development.

Amphotericin B↗
PubMed1995

[Serious crimes during treatment in legal psychiatric commitment (section 63 StGB)].

The analysis of 11 cases of violent offenses committed during hospital order treatment in the Haina Forensic Psychiatric Hospital between 1985 and 1991 showed that biographical and forensic variables are more powerful predictors of dangerousness than treatment and psychopathological data. In more than half of these cases it was at least questionable whether the individuals had been placed correctly inside the hospital order system. In comparison to data found in inmate populations and a new study from North America the question arises as to whether the treatment might not have contributed to increase dangerousness in at least some of our cases.

Adult↗
PubMed1995

[Laser lithotripsy of refractory bile duct calculi after failure of extracorporeal shock wave treatment].

UNLABELLED: After failure of extracorporeal shockwave lithotripsy (ESWL) the benefit of further nonsurgical methods for treatment of difficult bile duct stones is undetermined. Endoscopic laserlithotripsy is a promising procedure providing target application of high energy levels. METHOD: Twenty patients (median age: 81 [67-91] years) were referred for laserlithotripsy of 1-8 (median, 2) difficult bile duct stones after failure of 1-4 (median, 3) ESWL sessions. The median diameter of each of the largest stone was 22 (10-48) mm. The laser used was a pulsed rhodamine laser (wavelength: 594 nm) with an automatic cut-out system upon no stone contact. The laser fiber was positioned by means of ERCP under fluoroscopic control or by use of mini-cholangio-scopes. Laserlithotripsy was cholangioscopically performed via the percutaneous transhepatic route in 8 patients because of retrogradely inaccessible bile ducts (n = 5) or because further ERCP was refused (n = 3). All procedures were carried out under intravenous sedation and/or analgesia. RESULTS: Laser lithotripsy and complete removal of fragments was achieved in 19 of the 20 patients after application of 70-25700 (median, 3310) pulses in 1.2 sessions per patient. Median duration of a single session was 70 (15-140) minutes. The procedure failed in one patient with an impacted stone at the cystic duct confluence. Cholangitis could be conservatively managed in 2 cases. No further complication was observed. The 30-day mortality rate was 0 %. CONCLUSION: Endoscopic laserlithotripsy is an effective, a rapid and safe procedure for bile duct stones even after failure of ESWL. The results compare favorably with open surgery, particularly in view of an increased risk in a group of elderly patients.

Aged↗
PubMed1994

[Carbohydrate substitutes: comparative study of intestinal absorption of fructose, sorbitol and xylitol].

BACKGROUND: The carbohydrate substitutes fructose, sorbitol and xylitol are gaining more and more importance in the production of dietary food. But they can provoke gastrointestinal side-effects. In a randomized double blind study the rate of malabsorption of these sugars was compared and the concomitant symptoms were recorded. SUBJECTS AND METHODS: 25 healthy controls received 25 g of each sugar within 3 consecutive days. The intestinal absorption was determined by H2-exhalation tests and the clinical symptoms were recorded. RESULTS: The rate of malabsorption was 84% for sorbitol, 36% for fructose and 12% for xylitol (p < 0.01 for sorbitol versus fructose and xylitol). 57% of the participants with pathological H2-test after sorbitol and 56% after fructose reported symptoms, while all of the 3 malabsorbers of xylitol were symptomatic. CONCLUSIONS: There is an advantage to administering xylitol and fructose with regard to the intestinal absorption and concomitant symptoms as compared with sorbitol. H2-exhalation tests appear to be a reliable diagnostic tool to detect carbohydrate malabsorption and should find broader application in patients suffering from non-specific abdominal complaints.

Adult↗
PubMed1994

[Substitution of factor XIII concentrate in treatment refractory ulcerative colitis. A prospective pilot study].

BACKGROUND: Severe acute inflammation in ulcerative colitis is often associated with major intestinal blood loss. Studies on hemostasis present a deficiency of F XIII which is important for clot formation and wound healing. PATIENTS AND METHODS: A total of ten patients had been treated with 5-aminosalicylic-acid and corticosteroids consequently for three weeks. Thereafter a clinical improvement did not occur, the colitis activity index (CAI) and the endoscopic score (ES) remained elevated (9.9 +/- 1.5 points and 8.9 +/- 2.3 points, respectively). Because of this therapy-resistant active stage of disease in an open and prospective pilot trial F XIII concentrate (1,250 IU, Fibrogammin HS, Behringwerke, Germany) was additionally administered intravenously for ten days. RESULTS: The additional substitution therapy resulted in a significant improvement of complaints, the stool frequency decreased from 9 +/- 4.1 to 2.4 +/- 1.5 (p < 0.001). Both, the clinical activity index (2.8 +/- 1.6; p < 0.0001, vs day 0) and the endoscopic score (4.4 +/- 2.2; p < 0.005, vs day 0) declined significantly during the F XIII substitution. The F XIII activity was markedly reduced initially (46.1 +/- 17.4%) and showed a significant increase after the substitution (171 +/- 41.7%; p < 0.001). CONCLUSION: The results may suggest that substitution therapy with F XIII concentrate can be beneficial in patients with therapy-resistant active stage of ulcerative colitis and proven F XIII deficiency. To verify this preliminary results, controlled clinical trials will have to be performed.

Acute Disease↗
PubMed1994

Pancreatic duct stenosis mimicking a tumor due to an aberrant vessel.

A case of a 74-year-old man is reported who had liver cirrhosis and a mass lesion in the left liver lobe. The search for a potential primary tumor showed a filiform duct stenosis in the pancreatic head on ERCP. The presumptive diagnosis of a pancreatic tumor with a liver metastasis was made. Due to the poor general condition of the patient no further diagnostic steps were undertaken and he died four weeks later from progressive liver failure. On autopsy an aberrant vessel originating from the superior mesenteric artery (arteria pancreatico-duodenalis dextra superior) was found to cause the ductal stenosis; an hepatocellular carcinoma in the left liver lobe, but no pancreatic tumor was detected.

Aged↗
PubMed1994

Endoscopic injection of fibrin glue versus polidocanol in peptic ulcer hemorrhage: a pilot study.

In this prospective, randomized trial, bleeding gastroduodenal ulcers in the Forrest I and II stages were treated endoscopically with injection of either fibrin glue or polidocanol. After exclusion of four patients for various reasons, 38 patients were treated with fibrin glue (mean: 5.4 ml) and 41 patients with polidocanol (mean: 12.1 ml) with control endoscopies routinely performed on days 1, 3, and 7 after treatment. The two groups were comparable with regard to age, sex, ulcer location and Forrest classification. Recurrent bleeding was observed in five cases in the fibrin group and in ten cases in the polidocanol group; three and two patients in the fibrin and polidocanol groups, respectively, had to undergo surgery. We conclude that fibrin glue injection is an effective method for the treatment of bleeding gastroduodenal ulcers.

Adult↗
PubMed1994

[Possibilities of endoscopy in bile duct lesions].

Biliary duct injuries are occasional complications of cholecystectomy, encountered especially during early experience of laparoscopic cholecystectomy. Beside surgical reintervention, several promising endoscopic therapeutic procedures are available. Endoscopic papillotomy, possibly in combination with the placement of a drain, brings about occlusion of biliary leakage and fistula in 80% of cases. Strictures and stenoses of biliodigestive anastomoses can be treated using endoscopic transpapillary or, additionally, transhepatic percutaneous techniques. The results are comparable to those of surgery with lower rates of complications. For final judgement, however, a longer period of observation is necessary. At the moment non-surgical procedures are to be considered for patients at high risk from surgery and patients with recurrent stenoses after surgical interventions. Management of choledocholithiasis, complicating cholecystolithiasis, is becoming more and more a task for the endoscopist, at least at the present stage of evolution of laparoscopic cholecystectomy. Endoscopic bile duct clearance with or without percutaneous clearance, if necessary in combination with modern techniques of lithotripsy, is successful in almost all cases. However, the indications for risky and time-consuming procedures should always be discussed between surgeons and internists.

Biliary Fistula↗
PubMed1993

Circulating leucocyte subpopulations in sedentary subjects following graded maximal exercise with hypoxia.

Ten healthy sedentary subjects [age, 27.5 (SD 3.5) years; height, 180 (SD 5) cm; mass, 69.3 (SD 6.3) kg] performed two periods of maximal incremental graded cycle ergometer exercise in a supine position. Randomly ordered and using an open spirometric system, one exercise was carried out during normoxia [maximal oxygen consumption (VO2max) = 38.6 (SD 3.5) ml.min-1.kg-1; maximal blood lactate concentration, 9.86 (SD 1.85) mmol.l-1; test duration, 22.6 (SD 2.7) min], the other during hypoxia [VO2max = 33.2 (SD 3.2) ml.min-1.kg-1; maximal blood lactate concentration, 10.38 (SD 2.02) mmol.l-1; test duration, 19.7 (SD 2.8) min]. At rest, immediately (0 p) and 60 min (60 p) after exercise, counts of leucocyte subpopulations (flow cytometry), cortisol and catecholamine concentrations were determined. At 0 p in contrast to normoxia, during hypoxia there was no significant increase of granulocytes. There were no significant differences between normoxia and hypoxia in the increases from rest to 0 p in counts of monocytes, total lymphocytes and lymphocyte subpopulations [clusters of differentiation (CD), CD3+, CD4+CD45RO-, CD4+CD45RO+, CD8+CD45RO-, CD8+CD45RO+, CD3+HLA-DR+, CD3-CD16/CD56+, CD3+CD16/CD56+, CD19+] as well as adrenaline, noradrenaline and cortisol concentrations. The counts of CD3-CD16/CD56(+)- and CD8+CD45RO(+)-cells increased most. At 60 p, CD3-CD16/CD56+ and CD3+CD16/CD56(+)-cell counts were below pre-exercise levels and under hypoxia slightly but significantly lower than under normoxia. We concluded that the exercise-induced mobilization and redistribution of most leucocyte and lymphocyte subpopulations were unimpaired under acute hypoxia at sea level. Reduced increases of granulocyte counts during the study and reduced cell numbers of natural killer cells and cytotoxic, not major histocompatibility complex-restricted T-cells, only indicated marginal effects on the immune system.

Adult↗
PubMed1993

[Preliminary study of HTLV-I seroprevalence in Chilean Indian populations].

Aiming to seek the origin and define the prevalence of HTLV-1 infections, 464 blood samples from aboriginal populations proceeding from isolated regions of the north and south of Chile were studied. Antibodies against HTLV were measured with agglutination tests and confirmed with immuno-fluorescence and Western Blotting. Seven out of 107 (6.5%) blood samples from Atacama indians, 2 out of 202 (1%) from Mapuche indians and 3 out of 155 (1.9%) from Huilliche aborigines were positive. These results highlight an important presence of the virus in indigenous populations, specially in the extremes of the country. These findings could suggest an indigenous (mongoloid) origin of HTLV-1 in Chile, specially in Chiloe, where apparently there has been no contact with african or japanese populations, that could be the origin of the contamination.

Adolescent↗
PubMed1992

Differential mobilization of leucocyte and lymphocyte subpopulations into the circulation during endurance exercise.

A total of 14 healthy subjects [means (SD): 27.6 (3.8) years; body mass 77.8 (6.6) kg; height 183 (6) cm] performed endurance exercise to exhaustion at 100% of the individual anaerobic threshold (Th(an)) on a cycle ergometer (mean workload 207 (55) W; lactate concentrations 3.4 (1.2) mmol.l-1; duration 83.8 (22.2) min, including 5 min at 50% of individual Th(an)). Leucocyte subpopulations were measured by flow cytometry and catecholamines by radioimmunological methods. Blood samples were taken before and several times during exercise. Values were corrected for plasma volume changes and analysed using ANOVA for repeated measures. During the first 10 min of exercise, of all cell subpopulations the natural killer cells (CD3-CD16/CD56+) increased the most (229%). Also CD3+CD16/CD56+ (84%), CD8+CD45RO- (69%) cells, eosinophils (36%) and monocytes (62%) increased rapidly during that time. CD3+, CD3+HLA-DR+, CD4+CD45RO+, CD4+CD45RO-, CD8+CD45RO+ and CD19+ cells either did not increase or increased only slightly during exercise. Adrenaline and noradrenaline increased nearly linearly by 36% and 77% respectively at 10 min exercise. The increase of natural killer cells and heart rates between rest and 10 min of exercise correlated significantly (r = 0.576, P = 0.031). We conclude that natural killer cells, cytotoxic, non-MHC-restricted T-cells, monocytes and eosinophils are mobilized rapidly during the first minutes of endurance exercise. Both catecholamines and increased blood flow are likely to contribute this effect.

Adult↗