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R Jost

Publications and source records attributed to R Jost.

At least 37 records · Page 2Linked to original sources
PubMed1997

Human IgE binding capacity of tryptic peptides from bovine alpha-lactalbumin.

The specific IgE binding capacity of native bovine alpha-lactalbumin (alpha-La), a globular whey protein, and tryptic peptides was investigated using 19 sera from patients with cow's milk protein allergy. The specific anti-bovine alpha-La IgE titers ranged from 0.6 to 125 IU/ml. Highly purified tryptic peptides from native and disulfide-bond-reduced alpha-La were obtained by reverse phase chromatography. By ELISA technique using immobilized native protein or peptides, 11 of the 19 sera reacted exclusively with intact protein while 8 of them also presented a specific IgE response to different tryptic peptides. Polyclonal IgE population specificity was not related to anti-bovine alpha-La IgE levels. Sequence (17G-K58) and larger peptides sharing this sequence were most strongly and frequently recognized. Competitive ELISA inhibition tests confirmed this IgE-specific response and gave also clear evidence for IgE binding to smaller peptides corresponding to sequences (6C-R10):S-S:(115L-L123) and (109A-L123). IgE binding to native alpha-La and large peptides confirmed the importance of conformational epitope(s). However, in some sera reduced and S-alkylated peptide (59I-K94) exhibited a similar or higher IgE binding capacity than the native corresponding fragment, suggesting the existence of sequential epitope(s) exposed through protein denaturation. Moreover, IgE binding sequences were also located within hydrophobic regions of alpha-La and/or within parts with high sequence homology to human alpha-La.

Adult↗
PubMed1996

Benign and malignant stenoses of the stomach and duodenum: treatment with self-expanding metallic endoprostheses.

PURPOSE: To assess palliation of inoperable stenoses of the stomach and the duodenum with self-expanding metallic endoprostheses. MATERIALS AND METHODS: Under combined endoscopic and fluoroscopic guidance, 13 Wallstents were placed in nine consecutive patients, two with benign and seven with malignant obstruction. RESULTS: Technical success was achieved in eight patients (89%). One failure was due to stent dislocation during implantation. No major complications occurred; in two patients (22%), additional stents were implanted to improve patency. During the follow-up, which was 1-52 weeks (mean, 17 weeks) or until death there were no signs of stent obstruction. In seven patients (78%), quality of life improved substantially with restoration of oral food intake and relief of vomiting. CONCLUSION: The placement of Wallstents offers good palliation of inoperable outlet stenoses of the stomach and the duodenum. With a combined radiologic and endoscopic approach, it is an easy and rapid procedure that can be performed without general anesthesia.

Deglutition Disorders↗
PubMed1995

[Acute liver failure following tetrabamate].

Tetrabamate (Atrium), a composite preparation of phenobarbital, difebarbamate and febarbamate, is widely used to reduce ethanol withdrawal symptoms such as tremor, agitation and anxiety. Generally this drug is well tolerated and a few cases of reversible hepatitis as well as clinically mild symptoms of asthenia have been described. We report on a 28-year-old female patient admitted to hospital with acute liver failure after treatment with tetrabamate because of alcohol withdrawal symptoms. Liver biopsy revealed a drug-induced toxic alteration with extensive panlobular necrosis without signs of alcoholic hepatitis. Under supportive therapy liver parameters normalized in 3 months. In view of this potentially lethal adverse effect of tetrabamate, it should not be used for ethanol withdrawal symptoms.

Adult↗
PubMed1995

Hemosuccus pancreaticus as a source of obscure upper gastrointestinal bleeding: three cases and literature review.

We report three patients with chronic pancreatitis and recurrent episodes of severe upper gastrointestinal bleeding caused by hemosuccus pancreaticus. No bleeding source could be identified despite repeated endoscopies. In two patients, angiography disclosed a fistula between a peripancreatic artery and a pancreatic pseudocyst. In one patient, a fistula between the splenic artery and the pancreatic duct was found intraoperatively. No rebleeding occurred after operation. In cases of obscure upper gastrointestinal hemorrhage, the pancreas should be considered as a bleeding source, especially in patients with chronic pancreatitis.

Adult↗
PubMed1994

[Alcoholic pellagra encephalopathy: an underestimated treatable entity].

Alcoholic pellagra-encephalopathy is an underestimated entity, which is characterized by alteration in the level and content of consciousness, marked oppositional hypertonus and myoclonus. This entity should be included in the differential diagnosis of encephalopathy in ethanol abusers. The spontaneous course is potentially lethal. Therapy consists of substitution of nicotinic acid in the form of nicotinamide. It is emphasized that any chronic ethanol abuser with neurological symptoms should receive substitution of all B-group vitamins including nicotinamide.

Alcoholism↗
PubMed1994

Chlorpromazine-induced vanishing bile duct syndrome leading to biliary cirrhosis.

We describe a 33-yr-old pregnant woman in whom a primary biliary cirrhosis-like syndrome developed after 2 wk of chlorpromazine therapy. The clinical course was characterized by severe jaundice lasting 22 mo, intense pruritus, fever, steatorrhea, high alkaline phosphatase levels and hypercholesterolemia. Jaundice resolved with initiation of ursodeoxycholic acid therapy, but subclinical cholestasis and low-level inflammatory activity persisted and ultimately evolved into biliary cirrhosis. The pathological substrate of this severe and prolonged cholestatic reaction was found to be the vanishing bile duct syndrome with a marked transient pseudoxanthomatosis.

Adult↗
PubMed1993

[Alcoholic ketoacidosis].

Alcoholic ketoacidosis (AKA) is an important and probably underdiagnosed differential diagnosis for metabolic acidosis with an increased anion gap. It occurs in patients with prolonged ethanol intake. After a brief period of starvation induced by alcoholic gastritis patients typically present with vomiting, abdominal pain and Kussmaul breathing. Routine testing for urine or serum ketones with ketostix may be negative, since they do not detect beta-hydroxybutyrate and this is characteristically elevated in AKA. We present three cases of AKA and discuss diagnosis, pathophysiology and management of this disorder.

3-Hydroxybutyric Acid↗
PubMed1993

[Recurrent, life-threatening anaphylaxis as initial manifestation of cystic echinococcosis (granulosus) of the liver].

A 34-year-old, previously healthy Yugoslav developed relapsing generalized anaphylactic reactions associated with life-threatening laryngospasm. After successful life support with volume-replacement, epinephrine, antihistamines and steroids, clinical workup disclosed a slight tenderness in the right upper abdomen and sonography a polycystic tumor with coarse calcification within the wall. The presumptive diagnosis of cystic liver echinococcosis with spontaneous rupture of a hydatid cyst was confirmed surgically and serologically. This case history shows that liver echinococcosis should be considered in otherwise unexplained anaphylaxis.

Adult↗
PubMed1993

[Alpha-interferon therapy in Crohn's disease: initial clinical results].

4 therapies in 3 patients (1 female, 2 male) suffering from steroid dependent Crohn's disease are described. Interferon alpha-2b was administered for 24 weeks (3 million I.U. per day for 4 weeks, and 3 x 3 million U.I. per week for 20 weeks). Prednisolone dosage at start of therapy depended on initial inflammatory activity (CDAI). The daily dose was reduced stepwise and omitted after 12 weeks. In two courses patients did not respond and therapy had to be halted after 12 and 14 weeks' duration because of increasing disease activity. During the other two treatments a decrease in disease activity of 118 and 70 CDAI units (in both cases after 8 weeks) could be achieved. In particular, the course in one patient with abundant intestinal and extraintestinal inflammatory activity was quite impressive: extraintestinal activity disappeared completely within 10 days, CDAI ameliorated substantially for 30 weeks and the patient could be treated without steroids for a total period of 18 weeks. As a preliminary conclusion from the cases described up to now, it can be speculated that females probably respond more favorably to a combined therapy with interferon alpha and corticosteroids. Moreover, we suggest that the potential of interferon in Crohn's disease might be to overcome a steroid refractory disease state rather than to allow omission of steroid medication which could not be further reduced without exacerbation. Clearly, present experience of interferon therapy in Crohn's disease is still too scarce and more work needs to be done to define the role of interferon in IBD.

Adult↗
PubMed1993

[Acute diarrhea--current assessment and therapy in clinical practice].

Acute diarrhea is most commonly caused by infectious agents. The first step in the evaluation is based on the medical history, clinical presentation and simple stool examinations (fecal leukocytes and occult blood). Thereby it can be decided, whether a microbial identification or an antibiotic therapy are indicated. In case of viral or noninvasive, enterotoxinogenic diarrhea oral rehydration is sufficient, whereas enteroinvasive diarrhea or enteric syndromes need further evaluation by stool and blood cultures. Depending on the clinical situation and the result of cultures, an appropriate or empiric therapy with antibiotics is indicated in acute febrile dysentery, shigellosis, cholera, typhoid fever, severe salmonellosis and Cl. difficile colitis.

Anti-Bacterial Agents↗
PubMed1993

[Rupture of an aneurysm of the common hepatic artery with pancreatic necrosis].

A male patient known to have hemophilia A was operated on twice (1990, 1991) in the Department of Surgery, University Hospital, Zurich, first because of severe intraabdominal hemorrhage from a liver artery aneurysm, and then because of a ruptured common hepatic artery aneurysm. The second surgical intervention revealed necrosis of the head and body of the pancreas. We consider that the pancreatic necrosis had resulted from the aneurysm, in view of the patient's history of silent pancreatitis and the uncomplicated postoperative course. Immediate reconstruction of the common hepatic artery aneurysm (in the presence of an occluded gastroduodenal artery) was performed with saphenous vein interposition. Because visceral aneurysms may be multiple, further aneurysms must be sought at the time of the first diagnosis. Elective surgery is the method of choice, because 40-80% of visceral aneurysms rupture spontaneously, with a high mortality rate. The mortality rate for elective surgery is now low.

Aneurysm, False↗
PubMed1993

Dieulafoy's disease: endoscopic treatment and follow up.

The findings from 480 patients who had emergency endoscopy for acute upper gastrointestinal bleeding of non-variceal origin at our institution were analysed. Twenty eight patients (5.8%) had a Dieulafoy lesion. In 27 patients (96.4%) bleeding could be successfully managed by injection of norepinephrine and polidocanol, in repeated sessions if needed. Two patients had to be treated surgically: one because of uncontrollable bleeding from the Dieulafoy lesion and one despite endoscopic control of the bleeding Dieulafoy lesion because of a concomitant bleeding from an anastomosal ulcer after gastric resection. Three patients died during hospital stay from causes unrelated to bleeding from Dieulafoy lesion. Out of the 25 patients discharged from the hospital 21 treated by endoscopy and two treated with surgery were followed up for a mean of 28.3 and 22.5 months, respectively. Twenty endoscopically treated patients (95%) had no recurrence of Dieulafoy's bleeding. One patient experienced severe rebleeding from the original site after a transient endoscopy confirmed complete disappearance. He had emergency operation without a further attempt to control bleeding by endoscopy. It is concluded that bleeding from Dieulafoy's disease can be successfully managed by endoscopic injection treatment. The longterm outcome is favourable.

Adult↗
PubMed1993

IgA nephropathy and hypercalcemia in Whipple's disease.

In 2 patients an IgA nephropathy was found 2 and 5 years before gastrointestinal symptoms led to the diagnosis of Whipple's disease. One patient additionally presented with hypercalcemia. Subsequently 1 patient died, whereas treatment with trimethoprim/sulfamethoxazole resulted in an improvement of IgA nephropathy and in a complete recovery from hypercalcemia and all the manifestations of Whipple's disease in the other patient. IgA nephropathy and hypercalcemia may be considered as early manifestations of Whipple's disease.

Adult↗
PubMed1992

[Comparison of the efficacy of omeprazole/bismuth subcitrate or triple therapy in Helicobacter pylori gastritis. A prospective controlled study].

UNLABELLED: In a controlled, prospective, randomized trial, 10 patients with Helicobacter pylori positive gastritis were treated either with triple therapy (tetracycline, ornidazole, bismuth subcitrate; T, Or, CBS), or omeprazole/CBS (O/CBS) to test the eradication rate of each treatment, its effect on gastritis and meal stimulated gastrin release. METHOD: 6 patients were treated with triple therapy and 4 patients with O/CBS for 2 weeks. Initially, and 0.5, 1, 3, 6, and 12 months after therapy, patients were investigated by a highly specific, quantitative Helicobacter serology, 13C-urea breath test and measurement of meal-stimulated gastrin release. After 3 and 12 months antral biopsies were taken endoscopically for rapid urease testing and culture. Activity of histological gastritis was graded. RESULTS: Eradication for at least 12 months was achieved in 5 out of 6 patients with triple therapy. Serology normalized and gastritis activity improved. In all patients treated with O/CBS, HP was suppressed only temporarily. No eradication was achieved. Urease testing and histology proved to be reliable tests for detecting HP. Culturing of HP was successful in only 66% due to technical problems. The 13C-urea breath test was correct in all cases. The initially, increased meal-stimulated gastrin release was normalized after eradication of HP. CONCLUSION: (1) Triple therapy is also successful in short term treatment in up to 80% of patients with HP gastritis and improves gastritis activity. (2) The combination O/CBS failed to eradicate HP in all treated patients. (3) The 13C-urea breath test and HP serology are reliable non-invasive parameters during follow-up. (4) Normalization of meal stimulated gastrin release after eradication of HP supports the hypothesis that HP induces increased gastrin release and hyperacidity.

Antacids↗