Biomedical subjects

R Meier

Publications and source records attributed to R Meier.

At least 127 records · Page 7Linked to original sources

PubMed1993

[Familial incidence of colorectal carcinoma and its significance for a screening program (the example of Upper Basel area)].

Primary prevention of colorectal carcinoma aims at interruption of the adenoma-carcinoma sequence. Colonoscopy is the most reliable screening method, but up to now has only been recommended for persons at high risk. The ongoing 10-year study defines a possible risk group and determines the efficacy of a preventive screening program based on family history. This paper reports on the descriptive statistics of the first five years. All patients with colonic carcinoma diagnosed between 1987 and 1991 living in the upper part of Canton Basel-Land were registered. According to the family history, patients with at least one first degree relative with colonic carcinoma were defined as index patients. Their first degree relatives entered a prospective screening program which includes colonoscopy. 230 colonic carcinomas were diagnosed in the upper part of Basel-Land, representing an incidence of 48/year/100,000 persons. They included 3 (1.3%) hereditary and 227 (98.7%) sporadic carcinomas. 23 (10%) patients had a positive family history. These patients defined 94 relatives at risk. The incidence of colonic carcinoma in the Canton studied does not differ from that reported in Switzerland. Therefore, this part of Basel-Land can be considered representative. The 1.3% hereditary carcinomas are in contrast to the published data of 6%.

Adenomatous Polyposis Coli↗

PubMed1993

[Results of a prospective open study of therapy of sudden deafness with flunarizine].

The treatment effect of the lipophilic calcium antagonist flunarizine on the recovery of sudden hearing loss was evaluated in a prospective phase-II study. Thirty-seven patients presenting with recent and sudden onset of unilateral sensorineural hearing loss were treated with 50 mg flunarizine intravenously for the first two days followed by 10 mg flunarizine orally for four weeks. Pure-tone audiometry was done before the beginning of the treatment and after one and four weeks. The absolute and relative hearing gains after one and four weeks were compared to those of 67 similar patients previously treated with saline infusions and placebo tablets in the same institutions during a double blind study (Probst et al. Acta Otolaryngol. 112 (1992) 435-443). The mean absolute hearing gains of the flunarizine group was 17 dB and 21 dB, after one and four weeks respectively (placebo group: 16 dB and 24 dB). The corresponding relative hearing gains (defined as absolute gain divided by initial hearing loss) were 35% and 43% for the flunarizine group and 33% and 42% for the placebo group. We conclude that flunarizine treatment does not improve the recovery of sudden hearing loss.

Administration, Oral↗

PubMed1993

Pharmacodynamic effects of Sandostatin in the gastrointestinal tract.

Somatostatin is widely distributed throughout the human gastrointestinal system. There it is found in neurons and fibers of both the submucosal and the myenteric plexus and the pancreas as well as in the D cells of the stomach, gut and pancreatic islets. Whereas in the intestinal nervous system, in the duodenum and the pancreas, somatostatin-14 appears to be the predominant molecular form, the endocrine-type D cells of the intestine primarily contain somatostatin-28. Somatostatin peptides may act very differently at different sites, as hormones, as paracrine substances or neurotransmitters. Because of this complexity of action, very little is known about the physiological effects of somatostatin in the gastrointestinal tract. In contrast, the pharmacological actions of natural synthetic somatostatin have been thoroughly studied and have given rise to many therapeutic applications. Octreotide, an analogue with a longer half-life and higher potency, has greatly facilitated the clinical application of somatostatin. This review deals with the pharmacological effects of octreotide on different gastrointestinal functions. The somatostatin analogue exerts a long-lasting inhibitory action on gastric acid, pancreatic enzyme and bicarbonate secretion as well as on bile flow. It is also able to inhibit stimulated intestinal secretion, the release of neuropeptides from the gut and the pancreas. It can also prolong orocecum transit time and prevent gallbladder contraction. It inhibits absorption of nutrients and exerts inhibitory effects on splanchnic hemodynamics. It is because of these actions that somatostatin has attracted so much attention in the treatment of different gastrointestinal disorders.

Digestive System↗

PubMed1993

[Preclinical management of accident patients].

We are reporting on the preclinical care of our patients taking the conditions of Davos into account. We present the manifold and exact work of the different rescue services, which goes on according the "rescue chain" and international standards. Measures of the prevention of accidents as well as the legal basis are presented. Finally we refer to the development during of rescue activities the past years.

Athletic Injuries↗

PubMed1993

[Colonic motility].

Colonic motility is provided by contraction of intramural smooth muscle under the control of the enteric and the extrinsic nervous system and humoral connections. In vivo measurement of colonic motility remains difficult because of the complexity of these interactions and anatomical considerations. The possibility that symptoms are due to colonic dysmotility should be considered in patients with normal barium enema and colonoscopy. Examples of this are patients with chronic constipation, irritable bowel syndrome or colonic symptoms associated with diabetes mellitus or diseases of the nervous system. A number of techniques have been developed to assess colonic motility. The simplest is to assess colonic transient with a single abdominal x-ray following ingestion of radio-opaque markers. This is cheap, reproducible and easy to perform. Normal values for age and sex are available. Colonic transit of both liquid and solid can be determined by scintigraphic measurement. This technique provides information about regional variations in colonic function; it is however relatively demanding and requires access to a gamma camera. Manometry provides a more direct assessment of colonic motor activity. Changes in the electrical potential of the colonic smooth muscle can be determined by electromyography. Both techniques are however difficult to perform, and are currently only used for research purposes. It is likely that the combination of techniques that examine transit with more direct measurement of motor function will provide further insights into the mechanisms responsible for colonic dysmotility.

Barium Sulfate↗

PubMed1993

[Drugs and assessment of gastrointestinal motility].

Any determination of gastrointestinal motility is based on two assumptions: (1) That the patient is examined in "physiological" conditions and (2) that the values measured truly reflect the parameter the investigator wishes to examine. A large array of very different drugs shares the ability to modify the digestive motility (i.e. gastrokinetics) or to alter the content of the digestive tube in such a way that it affects the outcome of some measurements (i.e. acid suppression leads to false results in ph-metry dependent methods). Therefore, it seems advisable to ask the patient whether he is taking any drug--including non prescription medications--and check if this substance or type of substances could affect the outcome of the motility measurement envisioned. In this paper, the authors present a list of the principal drugs known to affect different motility-measurement methods. The real or apparent stimulating or inhibitory effects of drugs on four main segments of the digestive tube (esophagus, stomach, small intestines and colon) are indicated in an alphabetically ordered table. In a short review, the drugs are broadly classified according to their mechanism and site of action. Besides a number of drugs used in practice because of their action on the enteric nervous system, there is a large spectrum of compounds affecting motility, whose main therapeutic application lies outside the digestive tract, such as: psychotropic drugs, antiparkinsonian drugs, bronchodilators, antitussives, antihistamines, antimigraine drugs, antihypertensive agents, etc. This second category is more likely to escape unnoticed as a potential source of false results in the measurement of digestive motility.

Depression, Chemical↗

PubMed1992

[Percutaneous endoscopic gastrostomy (PEG) for long-term nutrition--comparison of 2 different caliber tubes].

Percutaneous endoscopic gastrostomy (PEG) is often used nowadays for long-term enteral nutrition in patients with swallowing disorders and severely altered esophageal-duodenal transit. The most common indications for gastrostomy tubes were neurological disturbances and malignancies of the oropharynx and esophagus. We compared in a prospective sequential trial PEG-tubes of two different sizes (2.9 mm [CH-9] vs. 4.8 mm [CH-15]) with respect to placement, complications, durability and handling. The tube was successfully placed in 51 of 52 patients (98%). In 1 patient placement was impossible due to missing diaphanoscopy. The mean observation period was 22 weeks for the CH-9-tubes (n = 28) and 14 weeks for the CH-15-tubes (n = 23). The only early complication was 1 case with a hemorrhage at the site of implantation (CH-15). In both groups 2 cases of local infection were noted. In the CH-9-group 2 PEG-tubes disappeared into the stomach and in 1 case a cicatricial granuloma developed. In the CH-15-group a leak occurred 10 days after implantation. All complications were treated conservatively. There was no causal relationship between the size of tube and the complications. The period of implantation was mostly limited by the death due to the underlying disease of the patient and was not related to the type of PEG-tube. We conclude the both PEG-tubes were easy to place, safe and effective means of providing enteral nutrition. We would, however, recommend CH-15-tubes for long-term nutrition, since in our experience they were less frequently obstructed and handling for the nurses was easier.

Adult↗

PubMed1992

Postoperative radiation therapy after radical prostatectomy for prostate carcinoma.

BACKGROUND: The role and benefit of adjuvant radiation therapy after radical prostatectomy is unclear. This role was evaluated in 58 patients who, after undergoing radical prostatectomy for prostate carcinoma, had local extension of disease beyond the prostate or positive surgical margins. Thirty-nine patients treated surgically alone were compared with 19 patients who received adjuvant postoperative radiation therapy. All patients were followed for at least 5 years, and 50 patients had 10-year follow-ups. RESULTS: At 10 years, the actuarial local failure rate was 31% for patients treated with prostatectomy alone versus 6% for the group receiving postoperative radiation therapy (P less than 0.05). The actuarial survival and metastasis-free survival were similar for both groups. When patients with involved lymph nodes were excluded from analysis, the addition of radiation therapy resulted in improved recurrence-free survival (91% versus 46% at 10 years, P = 0.04) and in a trend toward improved metastasis-free survival (91% versus 55%, P = 0.08). Complications occurred in similar frequencies in both groups. CONCLUSIONS: In patients with local disease extension or positive surgical margins after radical prostatectomy, adjuvant radiation therapy improved local control and was administered with acceptable side effects.

Adult↗

PubMed1992

Sarcomas of the head and neck. Prognostic factors and treatment strategies.

The authors reviewed 164 cases of head and neck sarcoma from adult patients seen at the University of California, Los Angeles (UCLA), between 1955 and 1988. The median follow-up was 70 months. Multivariate analysis demonstrated that tumor grade, size, and surgical margin status were the most important independent prognostic factors. Thirty-one percent (27 of 85) of patients with high-grade lesions were free of disease versus 81% (44 of 55) with low-grade lesions at last follow-up. Sixty-seven percent (50 of 76) of patients with lesions smaller than 5 cm were free of disease versus 38% (33 of 88) with lesions larger than 5 cm. In 16 patients, low-grade lesions, measuring less than 5 cm and with negative margins histologically, were controlled with surgery alone. For the 94 patients whose primary tumors were treated at UCLA, local control was achieved in 52% (26 of 50) of patients treated with surgery alone and 90% (20 of 22) with combined therapy (surgery and radiation therapy [RT] with or without chemotherapy). Seventy-five percent (6 of 8) of patients with positive surgical margins treated with postoperative RT achieved local control versus 26% (5 of 19) of patients receiving no additional treatment. In conclusion, surgery alone appears to be adequate treatment for small, low-grade tumors and negative surgical margins. Patients with incomplete resection or high-grade tumors should receive aggressive treatment--surgery and RT.

Adult↗

PubMed1992

[Somatostatin analog (octreotide) in clinical use: current and potential indications].

The long-acting somatostatin analogue octreotide is a synthetic cyclic peptide consisting of 8 amino acids. Depending on the organ, it acts either as a hormone or as a neurotransmitter. The effect on various physiological functions in the brain and the gastrointestinal tract is mainly inhibitory. Due to its inhibitory actions, the possibility of intravenous and subcutaneous administration and the lack of serious side-effects, octreotide offers a broad spectrum of possible indications. Today octreotide is recommended in acromegaly patients and for the treatment of hormone dependent symptoms in patients with gastroenteropancreatic tumours. New indications are enterocutaneous and pancreatic fistulas and the prevention of complications in major pancreatic surgery. In patients with dumping and short-bowel syndrome, octreotide may be helpful until dietary regimens are established. In Aids patients with severe diarrhea, octreotide can be used to stabilize patients with severe dehydration and malnutrition. The clinical effectiveness on upper GI-bleeding due to gastric ulcer and oesophageal varices is still controversial. Future studies must prove whether octreotide may be helpful in treating diabetic retino- and nephropathy because of the possibility of suppressing growth hormone and IGF-I. The antiproliferative effect of octreotide also allows its use in patients with somatostatin-receptor-positive, non-endocrine solid tumors (e.g. brain, breast and small-cell lung cancer). A promising area is the scintigraphic visualization of somatostatin-receptor-positive tumors with a radio-labelled octreotide analogue and the possible target irradiation of these tumors by beta-particle emitting isotopes attached to such analogues.

Acromegaly↗

PubMed1992

[Secondary oxalosis following small bowel resection with kidney insufficiency and oxalate vasculopathy].

A 58-year-old female patient admitted to hospital for advanced renal failure had a 40 years' history of Crohn's disease and had undergone ileocecal resection. Nevertheless, chronic diarrhea persisted. Subsequently calcium oxalate stones in the urine were repeatedly observed. Progressive renal failure developed. The investigation of the patient showed severe steatorrhea and pronounced hyperoxaluria, and renal biopsy showed severe chronic interstitial nephritis with calcium oxalate crystals. The skin biopsy revealed severe calcium oxalate vasculitis. The pathophysiology and therapy of secondary hyperoxaluria due to small bowel resection are discussed.

Calcium Oxalate↗

PubMed1992

Glucocorticoids downregulate gene expression of GM-CSF, NAP-1/IL-8, and IL-6, but not of M-CSF in human fibroblasts.

Cytokines such as granulocyte-macrophage colony-stimulating factor (GM-CSF), macrophage-CSF (M-CSF), neutrophil-activating peptide-1/interleukin-8 (NAP-1/IL-8), and interleukin-6 (IL-6) are pivotal in the regulation of hematopoiesis and immune responses. In mesenchymal cells, their expression is induced by tumor necrosis factor alpha (TNF) and other agents. We now show that, while induction of cytokine expression by TNF in human lung fibroblasts was parallel, glucocorticoid hormones differentially affected their production. Dexamethasone (1 mumol/L) concordantly repressed expression of GM-CSF, NAP-1/IL-8 and IL-6. RNA and protein levels were reduced to approximately 5%, 20%, and 30% of control cells, respectively, as determined by Northern blot analyses and immunoassays. A 50% reduction of RNA levels for all three cytokines occurred in the range of 1 hour. In contrast, dexamethasone (1 mumol/L) did not decrease M-CSF RNA levels and protein release. M-CSF RNA and protein levels were maintained even when dexamethasone (1 mumol/L) was present for the whole duration of a 48-hour TNF stimulation. Further experiments showed that dexamethasone downregulates expression of GM-CSF, NAP-1/IL-8, and IL-6 mainly by decreasing the mRNA stability of these cytokines, and that the dexamethasone-mediated repression of cytokine expression depends on ongoing protein and RNA syntheses. Our study suggests that glucocorticoid hormones repress expression of a set of cytokine genes important in conditions of stress. However, they seem not to affect M-CSF expression, which is likely to be more crucial in maintaining long-term functions of myeloid cells.

Blotting, Northern↗

PubMed1992

Vascular anatomy of the gastric tube used for esophageal reconstruction.

This study investigates the actual, as contrasted with the presumed, blood supply of the greater curvature gastric tube commonly used to reconstruct the gullet after esophagogastrectomy. Arterial and venous corrosion casts of this tube were created in 30 cadavers and demonstrated the following: (1) The right gastroepiploic artery is the exclusive conduit of blood in the pedicle. (2) The contribution of the right gastric artery is negligible. (3) Although tributaries of the left gastroepiploic artery are distributed over the central portion of the tube, the connection between the right and left gastroepiploic vessels is minute. (4) The blood supply of the cranial 20% of the greater curvature tube is through a microscopic network of capillaries and arterioles. These findings constitute an anatomical argument for extremely gentle handling of the stomach throughout its mobilization, during construction and positioning of the tube, and during the anastomosis.

Adult↗

PubMed1992

A physiological role for cholecystokinin as a regulator of gastrin secretion.

To explore the role of cholecystokinin (CCK) in regulating gastrin secretion in humans, the effect of a CCK antagonist (loxiglumide) on meal-stimulated hormone responses was investigated. Subjects received 500 mL of a liquid test meal in the presence and absence of loxiglumide (22 mumol.kg-1.h-1). In the control experiments, both plasma gastrin and CCK levels increased postprandially. In loxiglumide-treated subjects there was a marked elevation in gastrin (area under the curve, 11,042 +/- 1493/120 min vs. 2156 +/- 281 pg/120 min) and CCK levels compared with the control experiment. These observations were confirmed in experiments with modified sham feeding and gastrin-releasing peptide stimulation in which loxiglumide pretreatment also caused a significant increase in gastrin release compared with saline (P less than 0.05). Further studies with intravenous infusion of gastrin, CCK-8, and CCK-33 with and without loxiglumide showed that the increases in CCK and gastrin during loxiglumide application cannot be explained by alterations in clearance rates. The findings of this study show that postprandial gastrin secretion is influenced by CCK and support the concept of a negative feedback control of gastrin secretion by CCK.

Adult↗

PubMed1992

Pharmacodynamic effects of Sandostatin in the gastrointestinal tract.

Somatostatin (SST) is widely distributed throughout the human gastrointestinal system. There, it is found in neurons and fibers of both the submucosal and myenteric plexus and the pancreas, and also in the D cells of the stomach, gut, and pancreatic islets. Whereas in the intestinal nervous system, duodenum, and pancreas, somatostatin-14 (SST-14) appears to be the predominant molecular form, the endocrine-type D cells of the intestine primarily contain somatostatin-28 (SST-28). SST peptides may act very differently at different sites, as hormones, paracrine substances, or neurotransmitters. Because of this complexity of action, very little is known about the physiological effects of SST in the gastrointestinal tract. In contrast, the pharmacological actions of natural synthetic SST have been thoroughly studied and have given rise to many therapeutic applications. Octreotide, an analogue with a longer half-life and higher potency, has greatly facilitated the clinical application of SST. This review deals with the pharmacological effects of octreotide on different gastrointestinal functions. The SST analogue exerts a long-lasting inhibitory action on gastric acid, pancreatic enzyme, bicarbonate secretion, and on bile flow. It also inhibits stimulated intestinal secretion, ie, the release of neuropeptides from the gut and pancreas. It can also prolong orocecum transit time and prevent gallbladder contraction. It inhibits absorption of nutrients and exerts inhibitory effects on splanchnic hemodynamics. It is because of these actions that SST has attracted so much attention in the treatment of different gastrointestinal disorders.

Biological Transport↗

PubMed1992

[Autoregulation in the choroid].

The cerebral perfusion is continuously and highly sensitively dependent on arterial pCO2. Does the ocular perfusion behave in a similar manner? To answer this question, the authors measured the following parameters before and after the inhalation of 10% CO2: a) the increase of capillary pCO2, using a transcutaneous sensor, and b) the redness (pallor) of the retinal tissue, an expression of its hemoglobin content, was measured at two retinal locations with the Ocular Photometer (OPM). Initial results from young test-volunteers and patients with documented carotis stenoses show that the choroid is able to maintain constant its blood-volume even under changing loads.

Adult↗

PubMed1992

Enhancement of the oral absorption of cyclosporin in man.

1. The oral absorption of cyclosporin from three new semi-solid oral formulations was compared with the standard soft gelatine preparation in twelve healthy male volunteers. One formulation was based on a solid micellar solution, while the other two, with different in vitro release properties, were based on a microemulsion principle. 2. The results showed that the solid micellar solution and the faster releasing microemulsion formulation increased the extent of absorption on average by 45.2 and 49.0%, respectively, compared with the reference soft gelatine capsule.

Administration, Oral↗

PubMed1992

Cobalt cardiomyopathy. A report of two cases from mineral assay laboratories and a review of the literature.

Two young men employed in the mineral assay industry developed non-inflammatory cardiomyopathy. By review of clinical findings, elicitation of occupational and environmental histories, work-site evaluations, and ascertainment of tissue cobalt levels, Nevada Public Health authorities confirmed these cases to be due to occupational cobalt exposure. Hair and heart cobalt levels were elevated for the cases, but control samples had no detectable cobalt. Excess ischemic heart disease mortality among cobalt-exposed workers may reflect misdiagnosis of cardiomyopathy.

Adult↗