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U Leuschner

Publications and source records attributed to U Leuschner.

At least 91 records · Page 5Linked to original sources
PubMed1987

[Alagille syndrome, a rare differential diagnosis of intrahepatic cholestasis].

In Alagille's syndrome cholestasis is caused by a congenital hypoplasia of the intrahepatic bile ducts. If cardiac and arterial malformations are present in conjunction with the typical-but not pathognomonic-facies, this rare syndrome must be considered. ERCP shows a highly rarified bile duct system. Liver histology with a paucity of interlobular bile ducts establishes the diagnosis. Inheritance appears to be autosomal dominant. The relatively good prognosis of the disease calls for caution concerning invasive procedures.

Abnormalities, Multiple↗
PubMed1986

EDTA solutions for the dissolution of calcium bilirubinate stones.

The calcium chelating of different EDTA solutions was investigated after addition of 5.49% calcium bilirubinate powder. Calcium chelating seems to be an essential step in disaggregation of pigment stones. We found that Ca chelating is pH dependent and that the system must be buffered in order to prevent pH shifting during the dissolution process. When an alkaline (pH 9.4), buffered 1% EDTA solution is mixed with bile in a ratio of 70:30, dissolution of Ca will decrease to 60% as compared to investigations without bile. Furthermore, we could demonstrate that the EDTA solution would not only dissolve Ca bilirubinate powder, but complete bovine pigment stones of homogeneous structure and mostly inhomogenously composed stones of man as well.

Animals↗
PubMed1986

Endoscopic therapy of biliary calculi.

Since 1973, biliary calculi can be extracted from the common bile duct after endoscopic papillotomy (EPT). The success rate amounts to 90%. Complications occur in 7%, and 1% of the patients will die. The most frequent complication is haemorrhage (30%), but only 10% of these cases require surgery. Results of EPT are more favourable than those of surgery. Prophylactic antibiotics are not necessary, but in the event of fever, beta-lactam antibiotics or modern cephalosporins are indicated. When stone extraction fails, several different methods of lithotripsy can be employed: endoscopic mechanic, endoscopic electrohydraulic, and the recently developed extracorporeally generated shock-waves. Lithotripsy will succeed in 80-90% of cases. As late sequelae after EPT cannot be completely excluded, dilatation of the papilla by balloon catheter was developed. However, the number of patients treated is still very small. When these methods fail or are not available, common bile duct stones can be chemically dissolved. Irrigation media are infused into the biliary tree via a nasobiliary tube after EPT or percutaneous transhepatic cholangiography. The substances used are cholesterol solvents such as mono-octanoin, GMOC or MTBE. A buffered 1% EDTA solution is used for calcium bilirubinate stones. Stone dissolution will succeed in 50-70% of cases. Side-effects include cholangitis and duodenitis.

Adult↗
PubMed1985

Gallstone dissolution with ursodeoxycholic acid in patients with chronic active hepatitis and two years follow-up. A pilot study.

Chemical dissolution of cholesterol gallstones using ursodeoxycholic acid (UDCA) in six patients with histologically confirmed HBsAg-negative chronic active hepatitis was started after a minimum of one year of therapy with steroids, azathioprine, or chloroquine and a treatment-free period of 8-15 months. The treatment with UDCA lasted 3-20 months with a daily dose of 8-11 mg/kg. Four patients served as controls. A decrease in transaminases (P less than 0.05) occurred in all patients during the UDCA therapy. After completion of the treatment, the figures rose again, but did not return to the initial value. The stones dissolved in five patients. A second liver biopsy was carried out in two patients after UDCA therapy, and this showed no detectable deterioration. Four patients refused biopsy because the laboratory parameters had improved under UDCA. A stone recurred in one patient six months after the end of therapy; the others have remained free of stones for up to 24 months.

Adult↗
PubMed1985

Diurnal rhythm of bile lipid composition after cholecystectomy and papillotomy. Postpapillotomy biliary lithogenicity.

The influence of the gallbladder and the sphincter of Oddi on the diurnal rhythm of bile lipid composition was assessed by determining the lithogenic index at 4-h intervals over a period of 24 h in 29 cholecystectomized and papillotomized patients with a nasobiliary tube receiving a normal hospital diet and in 9 during 1-day fast. With a normal diet, biliary cholesterol concentrations dropped during the daytime (p less than 0.05), and total biliary lipid, bile acid, phospholipid, and cholesterol concentrations rose at night (p less than 0.05). During fasting, total biliary lipid, phospholipid, and cholesterol concentrations rose continuously (p less than 0.01). Even with loss of function of the gallbladder and sphincter of Oddi, a diurnal rhythm of biliary lithogenicity persisted, caused mainly by cholesterol increases during fasting. Concomitant increases in phospholipids and, to a lesser extent, bile acids modulated these changes.

Aged↗
PubMed1985

Ileal and colonic mucosal bile acids in Crohn's disease and right colonic carcinoma.

Bile acids are supposed to promote colonic cancer. In Crohn's disease, colonic carcinomas are relatively rare. We, therefore, compared ileal and right colonic mucosal bile acids analysed by gas-liquid chromatography in 8 patients with ileal Crohn's disease (14-48 yrs.) and 7 patients with right colonic carcinoma (28-77 yrs.) who underwent surgery. In both ileal and colonic mucosa, nonsulphated bile acid concentrations were somewhat higher in Crohn's disease (20.98 micrograms/g +/- 4.77 SEM; 12.09 micrograms/g +/- 2.55) than in colonic carcinoma (16.06 micrograms/g +/- 3.46; 7.75 micrograms/g +/- 4.28). In ileal mucosa, percentages of lithocholic and deoxycholic acids were slightly higher in colonic carcinoma (3.9%; 23.2%) than in Crohn's disease (1.1%; 14.9%). In colonic mucosa, carcinoma patients had more lithocholic (7.6%) and less deoxycholic acid (11.9%) than patients with Crohn's disease (1.7%; 20.3%). Bile acid sulphate esters were similar in both diseases (ca. 3.0 micrograms/g in ileal, 1.4 micrograms/g in colonic mucosa). Our results show that ileal and right colonic mucosal nonsulphated bile acids tend to be even lower in right colonic carcinoma than in Crohn's disease. This agrees well with our earlier findings of low mucosal bile acid concentrations in patients with left colonic carcinoma (Tokai J Exp Clin Med 8: 59-69, 1983) and does not support the assumption that bile acids are envolved in right colonic carcinogenesis.

Adolescent↗
PubMed1984

Investigations on the toxicity of bile salt solutions, Capmul 8210 and a bile salt-EDTA solution for common bile duct perfusion in dogs.

The following perfusion media for dissolving bile duct calculi were infused via a cutaneobiliary tube into the biliary tract of 12 mongrel dogs: 4.3% cholate solution, 0.34% chenodeoxycholate solution, Capmul, GMOC (special formulation of Capmul), BA-EDTA and 0.9% saline. Infusion lasted 50 h. Postmortem examination revealed hemorrhagic, partly phlegmonous cholangitis, acute duodenitis, necrosis and abscesses in the liver. The lesions were most pronounced after the cholate solution and with Capmul and GMOC, but were only detected to a slight extent after BA-EDTA and the chenodeoxycholate solution. 0.9% saline had no side effects. The investigations could demonstrate that it is the very irrigation media that today are recommended for treatment of bile duct stones in patients, that cause considerable morphologic side effects. The alternating administration of an EDTA solution with a Capmul preparation may diminish local toxicity of the latter.

Animals↗
PubMed1984

Somatostatin-containing cells in the extrahepatic biliary tract of humans.

We investigated the presence of endocrine cells in the human extrahepatic biliary system using the avidin-biotin-peroxidase complex method. Twenty gallbladders obtained during operations for cholelithiasis, large portions of three common bile ducts obtained during Whipple's procedure for carcinoma of the head of the pancreas, and 155 endoscopic transpapillary biopsy specimens taken during control endoscopy from patients who had had a previous endoscopic sphincterotomy were examined. Somatostatin-containing cells were found in the glandular epithelium of the ampulla of Vater and the bile ducts. Only the surface epithelium in the ampulla contained endocrine cells. All somatostatinlike immunoreactivity was confined to cells and could not be detected in nerves. No somatostatinlike immunoreactivity was found in the gallbladder. These findings reveal a morphologic basis to reported actions of somatostatin on bile flow.

Ampulla of Vater↗
PubMed1984

Biochemical and morphological investigations of the toxicity of a Capmul preparation and a bile salt-EDTA solution in patients with bile duct stones.

Seventeen patients with bile duct calculi were treated alternately with a preparation of glycerol octanoate and a bile salt-EDTA solution via a nasobiliary tube. Of 14 patients (group I), it was necessary to operate on four immediately after irrigation therapy, success resulted from this conservative therapy in eight (57%) cases and two were unchanged. Laboratory investigations showed a decrease in zinc and copper concentrations in the serum. Of the patients 50-60% suffered from vomiting and diarrhea. For three patients (group II), there was an interval of 6-26 days between the end of the therapy and operation. Histological findings in the patients in group I and II subjected to operation included acute ulcerative and chronic inflammation in gallbladder and common bile duct walls. Since the alterations were of minor degree in four of the seven patients who subsequently underwent surgery the risk of irrigation therapy seems to be acceptable.

Aged↗
PubMed1984

Chemical dissolution of common bile duct stones.

Dissolution of bile duct calculi is complicated by the facts that about 30-40% of them are pigment stones and the stone cannot be unambiguously identified by radiography before the start of therapy. Thus it does not appear logical only to infuse irrigation media that dissolve cholesterol (cholate, Capmul) but to use solutions that also dissolve calcium bilirubinate. Calcium bilirubinate is the most important compound in primary pigment stones in the bile duct. Thin sections of calcium bilirubinate stones can be dissolved in EDTA 4Na. The rate is determined by the temperature, the pH, and the surface tension of the solution. In vitro experiments showed that cholesterol stones and composition stones can be dissolved more rapidly by alternating therapy with an EDTA solution and a Capmul preparation than by monotherapy with glycerol octanoate, and that bovine pigment stones can also be disaggregated. Since calcium bilirubinate stones consist up to 20-60% of an organic matrix, a mixture of glycerol octanoate and EDTA was prepared containing SH-activated papain. It was possible, by using this mixture, to disaggregate human calcium bilirubinate stones. The process of dissolution is complex and is not yet understood in detail. It is supposed that the important steps are the extraction of calcium, the chemical solution and molecular dispersion of bilirubin and cholesterol, and the disaggregation of the structure of the stone by surface-active substances. The irrigation media have but little effect on black pigment stones. Toxicity studies have shown that cholate, glycerol octanoate, and glycerol octanoate preparations are locally toxic and can lead to cholangitis and cholecystitis in animals. EDTA solutions bring about lesser changes. In humans, it has not been possible to distinguish these inflammatory changes unambiguously from those found in untreated gallstone patients.

Aged↗
PubMed1984

Radiological and ultrasonographic investigations with respect to patient selection and monitoring for chemical gallstone dissolution.

786 consecutive patients with suspected gallstones investigated radiologically and ultrasonographically, 231 (33.0%) were found to have stones. Radiological examinations showed that 59.3% of these were suitable for chemical dissolution with cheno- or ursodeoxycholic acid. The percentage of treatable patients fell from age 20 to age 65 from 71% to 48% (p less than 0.05) and then rose again to 61% (not significant). The benefit of litholysis is greater, the earlier it is begun. The results are in disagreement with those of two studies in operated patients. Here only 19-24% were suitable for stone dissolution. Comparative ultrasonographic and radiological studies in 23 patients have shown that monitoring of patients during litholysis can be carried out ultrasonographically. Stone size measured ultrasonographically corresponds sufficiently accurately with that obtained radiographically.

Adult↗
PubMed1983

Bile acids in patients suffering from colorectal carcinoma--a pilot study.

Bile acids are increasingly discussed in the genesis of colorectal carcinoma. In a pilot study we analysed bile acids in tumor tissue, tumor-free mucosa, serum, and feces of 6 patients with rectal and 3 patients with colonic carcinoma. 5 patients dead from nongastroenterological diseases and two operated on for benign colonic stenosis served as controls for colorectal mucosa, 16 healthy persons as controls for feces and serum. Bile acids and their sulphates were determined after differential solvolysis by gas-liquid chromatography on QF-1 columns. Serum lithocholic acid was significantly (p less than 0, 05) elevated in all carcinoma patients. The feces showed a trend towards increased secondary bile acids. Tumor-free mucosa of patients with rectal carcinoma showed elevated unsulphated bile acids, sulphated lithocholic acid (p less than 0, 05) and sulphated chenodeoxycholic acid (p less than 0, 025) were significantly decreased. In rectal carcinoma tissue total bile acids were elevated, cholic acid (p less than 0, 01) and sulphated lithocholic acid decreased (p less than 0, 05). In nonaffected colonic mucosa of patients with colonic carcinoma total bile acids were decreased, in colonic carcinoma tissue only traces of bile acids were found. Whether these changes are causes or rather consequences of colorectal tumors--e.g. tumor-induced stasis in the gut--and whether they may be useful for diagnosis remains to be elucidated in further studies.

Adult↗
PubMed1983

Dacarbazine (DTIC)-induced human liver damage light and electron-microscopic findings.

The first electron-microscopic description of DTIC-induced human liver injury is presented. A 61-year-old man developed signs of hepatic failure during the second treatment cycle with DTIC for malignant melanoma. Light-microscopic examination revealed extensive centrilobular liver necrosis. Terminal hepatic venules did not show any signs of vasculitis or thrombosis and there was a lack of inflammatory infiltration. At the ultrastructural level intracytoplasmic, membrane-bound, organelle-free vacuoles were found in the hepatocytes. Liver cells showed bleb formation. Bile canaliculi were dilated and their microvilli flattened. In the pericanalicular exoplasm electron-dense fibrillary material, thought to be of microfilamentous origin, accumulated. The patient received 250 mg methylprednisolone i.v. at the very onset of symptoms and was discharged 12 days after the peak rise of transaminases with normal liver parameters.

Chemical and Drug Induced Liver Injury↗