Serum levels of beta 2-microglobulin: a new marker of activity in Crohn's disease?
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Adult↗
Biomedical subjects
W Kruis
Publications and source records attributed to W Kruis.
[Endoscopic diagnoses in patients with positive Hemoccult-test: critical consideration and negative Hemoccult-test (author's transl)].
Totally 170 patients with positive (n = 29) and with negative Hemoccult-test (n = 141) were examined by coloscopy. There were 29.0% false-negative Hemoccult-test results (carcinomas 5.6%, polyps 23.4%). Almost all patients with a endoscopically diagnosed carcinoma or polyp of the large bowel had clinical signs. It is concluded, that the Hemoccult-test is indicated only in patients, who do not show clinical symptoms, and that a negative Hemoccult-test result does not exclude a tumor of the large bowel.
Adolescent↗
[Differential diagnosis of fistulas in Crohn's disease].
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Crohn Disease↗
[Liver and ovulation inhibitors. Effects on liver function of estrogen-progestagen containing steroid oral contraceptives].
Since introduction of oral contraceptive steroids a variety of physiologic-adaptive and toxic side effects have been reported. -a review is given. The study reports also four cases of hepatic vein thrombosis (Budd-Chiari-Syndrome--Venoocclusive disease) and three cases of benign hepatic tumors (liver cell adenoma and focal nodular hyperplasia) in young women following 2- to 5-year treatment with oral contraceptive steroids.
Adenoma↗
[New aspects of the value of endotoxins in various gastrointestinal diseases].
Recent investigations of several authors on portal venous and systemic endotoxemia in healthy adults have shown that endotoxins absorbed from the intestinal mucosa are found in portal venous blood, cleared by the RES of the liver and usually cannot be determined in peripheral blood. In patients with liver disease, however, there was often a reduced endotoxin clearance with spillover of endotoxin resulting in systemic endotoxemia. Among the complications of systemic endotoxemia, hepatocytotoxicity, pyrogen reaction, disseminated intravascular coagulation, impaired renal function, and endotoxic shock are most hazardous. In addition, O-antibody titers and lipid-A-antibody titers were found to be higher in patients with liver disease and in patients with Crohn's disease than in control groups. The investigations indicate that intestinal endotoxins are of importance in the pathogenesis of liver disease and of Crohn's disease and that reduction of intestinal endotoxins by antibiotics may be of value in the therapy of these diseases.
Antigens, Bacterial↗
[The irritable colon syndrome. New therapeutic possibilities in the treatment of a frequent syndrome].
A double-blind clinical longterm trial with the musculotropic agent Mebeverine in 30 patients, suffering from the irritable colon syndrome, is reported. In 70% of patients, treated by this new antispasmodic preparation, most symptoms, related to the irregular activities of the lower alimentary tract--as abdominal cramps and distrubance of bowel habit--improved. Female patients were superior in getting symptom-free. No unpleasant drug-related side effects were seen. The double-blind controlled trial showed Mebeverine to be superior to a placebo preparation regarding relief of symptoms and demonstrates this agent to be a useful drug for controlling the symptoms of this functional disorder. The usefulness is enhanced by the fact that most of the patients studied had been pretreated by other preparations with low or limited therapeutic effectiveness. Despite facing the difficulties in documenting objective criteria of improvement in a condition such as the irritable colon, defined as a "collection of functional disorders of the colon of mixed aetiology" (Truelove), our results demonstrate that Mebeverine is able to improve abdominal cramps and disturbances of bowel habit in this common disorder without side effects, as seen with standard anticholinergic preparations.
Adolescent↗
[Heart rhythm during esophago-gastro-duodenoscopy].
The ECGs of 157 patients were registered continuously during the oesophago-gastro-duodenoscopy with a R-R intervall monitoring system. The behavior of frequencies and cardiac arrhythms of 53 patients with and 104 patients without heart diseases is reported. 32 patients were premedicated with 0,5 mg Atropin intravenously, 121 patients received intramuscular premedication. The influence of the vegetative nervous system is discussed in view of the heart actions during the diagnostic procedure. A clinically relevant danger for the heart and circulatory system caused by oesophago-gastro-duodenoscopy was not observed.
Arrhythmias, Cardiac↗
[CEA blood level in patients with Crohn's disease with reference to localization, duration and severity of the disease].
CEA-serum-levels were determined in 24 patients with Crohn's disease over a period up to 35 months. 13 patients showed elevated CEA-Levels (greater than 3 ng/ml). A positive correlation between the extent of the lesion and the CEA-serum-level could be demonstrated. This correlation could not be demonstrated in regard to the duration of the disease. The attempt to utilize CEA-serum-levels for the estimation of the activity of Crohn's disease showed a good correlation between the activity and CEA-levels in a few cases; the activity was measured by means of the Crohn's Disease Activity Index (CDAI), which was recommended in the National Crohn's Disease Study in the United States.
Adolescent↗
[Embolization of the lung in echinococcosis (author's transl)].
Four months before her death of right heart failure, a 38-year-old woman with a known inoperable echinococcosis of the liver developed fever, increasing eosinophilia and pleuropneumonia. After improvement of the clinical, radiological and laboratory parameters under steroid medication, two months before her death hemoptysis and multifocal perfusion defects in the lung scintigram as a sign of pulmonary embolism occurred, for which heparin therapy was introduced. At autopsy a recurrent embolization due to echinococcus cysts with extensive displacement of the arterial pulmonary blood circulation were found.
Adult↗
[Hepatitis risk to dentists. Studies on the frequency of hepatitis in dentists in the Munich region and in the district of Upper Bavaria].
Dentists have a particular risk of acquiring viral hepatitis because of their close contact with blood and saliva during dental manipulations--especially as the majority of dentists do not use gloves during work and often have small cuts and abrasions on their hands. On the other hand personnel in the dentist's office offers several potential modes of parenteral and oral-intestinal transmission of hepatitis. In order to find out the risk of dentists exposing themselves to hepatitis-infection (especially hepatitis B-infection) we performed a questionnaire-study among practicing dentists all over Oberbayern. 858 replies were received after distribution of 1030 questionnaires (participation: 83.3%) and could by analyzed. 116 dentists had had a hepatitis during their professional work (13.5%). The frequency of hepatitis among the younger colleagues--who were practicing from 1 to 14 years--was about 5%. The number of hepatitis-infections increased continually up to 33% after 35--39 years of professional activity. In a second study blood samples were taken from 773 dentists and were tested for HB3Ag by radioimmunoassay. Of these 773 blood samples taken 25 (3.5%) were found to be antigen-positive. Compared to the general population the risk of infection is 6- to 30 times higher in dentists. The challenge of hepatitis-virus-infection can at present be met only-and at least in part-by scrupulous attention to prophylactic measures, such as using disposable gloves, needles and syringes and in autoclaving all non-disposable equipment. Besides dental personnel and patients should be screened at regular intervals for the presence of HBsAG.
Adult↗
[Differential diagnostic problems in pulmonary embolism caused by x-ray findings].
Using two case-histories it is shown that atypical radiological findings caused the delay in diagnosis of pulmonary embolism depsite clinical signs (such as fever and intermittent dyspnoea; cyanosis, haemoptoe and cough reflex were absent). The exact diagnosis was finally established after having excluded all diseases, which were of greater probability on the grounds of the x-ray findings.
Adult↗
[Lipid A antibody titers in Crohn's disease (author's transl)].
Lipid A antibody titers and O antibody titers against E. coli were determined in 18 patients with Crohn's disease, 28 patients with ulcerative colitis, 24 patients with acute enteritis and in 68 healthy adults. The patients with Crohn's disease showed a statistically significant elevation of the lipid A antibody titers and of the O antibody titers against E. coli compared with each of the three other groups investigated. The results could be indicative of bacterial involvement in the pathogenesis of Crohn's disease. The determination of lipid A antibody titers may be useful for the differential diagnosis between Crohn's disease and ulcerative colitis.
Adult↗
[Lipid A antibody titers and O antibody titers in Crohn's disease, ulcerative colitis and acute enteritis (author's transl)].
In 18 patients with Crohn's disease, 28 patients with ulcerative colitis, 24 patients with acute enteritis and in 68 healthy adults lipid A antibody titers were determined by the passive hemolysis test. In addition O antibody titers to polyvalent Escherichia coli, Klebsiella, Proteus and Pseudomonas aeruginosa antigens were measured by indirect hemagglutination. The patients with Crohn's disease showed a statistically significant elevation of the lipid A antibody titers compared with each of the three other groups investigated. The O antibody titers for the four polyvalent antigens were higher in the patients with Crohn's disease than in the other groups. The results indicate that Enterobacteriaceae are involved in the pathogenesis of Crohn's disease. Thus, long-term treatment with wide spectrum antibiotics seems to be justified. The determination of lipid A antibody titers may be useful in differentiating between Crohn's disease and ulcerative colitis on diagnosis.
Antibodies, Bacterial↗
Is the pathogenesis of Crohn's disease similar to that juvenile recurrent pyelonephritis? A study of lipid A antibody titers in Crohn's disease, ulcerative colitis and acute enteritis.
In 18 patients with Crohn's disease, 28 patients with ulcerative colitis, 24 patients with enteritis and in 68 healthy adults lipid A antibody titers were determined by the passive hemolysis test. In addition, 0 antibody titers to polyvalent E. coli, Klebisella, Proteus, and Ps. aeruginosa antigens were measured by indirect hemagglutination. The patients with Crohn's disease showed a statistically significant elevation of the lipid A antibody titers compared with each of the three other groups investigated. The 0 antibody titers for the four polyvalent antigens were also higher in the patients with Crohn's disease than in the other groups. The results indicate that Enterobacteriaceae are involved in the pathogenesis of Crohn's disease. Thus long-term treatment with wide spectrum antibiotics seems to be justified. The determination of lipid A antibody titers may be a useful diagnostic tool in differentiating between Crohn's disease and ulcerative colitis.
Acute Disease↗
Addition of senna improves colonoscopy preparation with lavage: a prospective randomized trial.
Attempts have been made to further improve the widely performed colonoscopy preparation with lavage. In a prospective study, 120 outpatients and inpatients scheduled for total colonoscopy were randomized to two preparatory regimens. The day before endoscopy either extractum sennae (N = 60) or a placebo solution (N = 60) was given. Just before examination all patients underwent whole gut irrigation with a polyethylene glycol electrolyte lavage solution (PEG-ELS). Adequacy of preparation, patient tolerance, and the necessary amount of PEG-ELS were assessed. Physician assessment of colon cleansing showed superiority in the group with additional laxative. The colon was free of solid debris in 66.7% of patients after PEG-ELS and in 90% after senna/PEG-ELS administration (p less than 0.01). Patient tolerance was similar in both groups with 86.7% vs. 83.3% of subjects rating the preparation as tolerable. Severe adverse events were not observed. In the senna/PEG-ELS group, significantly less (p less than 0.05) lavage fluid was needed. We conclude that the combination of senna and PEG-ELS is more effective than PEG-ELS in cleansing the colon for colonoscopy.
Adolescent↗
Induced gall-bladder contraction accelerates fragment clearance after extracorporeal shockwave lithotripsy.
At the end of extracorporeal shockwave lithotripsy (ESWL) gallstone fragments are dispersed throughout the gall-bladder. In this state they should be expelled more easily than when later sedimented to the gall-bladder fundus. Thus, a randomized study was performed to evaluate the clinical benefit of induced gall-bladder contraction after ESWL. One hundred and five patients with radiolucent gallstones (1-3 stones, diameter < or = 30 mm) were randomized to received either saline or an infusion of 0.2 micrograms/kg ceruletide. Stone clearance rates and incidence of biliary symptoms were recorded. Clearance rates at 6 weeks and 3 months after ESWL were significantly (P < 0.025) improved by the ceruletide infusion. This effect, resulting in shortened bile acid therapy, was limited to patients with small solitary stones and dependent on a good initial fragmentation. Major side effects attributable to ceruletide were not observed. These results suggest that induced gall-bladder contraction can be successfully applied as an adjuvant treatment in a subgroup of patients with small solitary gallstones.
Ceruletide↗
Chronic inflammatory bowel disease and cancer.
Colorectal cancer represents the major cause for excess morbidity and mortality by malignant disease in ulcerative colitis as well as in Crohn's disease. The risk for ulcerative colitis associated colorectal cancer is increased at least 2-fold compared to the normal population and colorectal cancer is observed in 5.5-13.5% of all patients with ulcerative colitis and 0.4-0.8% of patients with Crohn's disease. Established risk factors include long duration of the disease, large extent of the disease, low activity of the disease, young age at onset, presence of complicating primary sclerosing cholangitis or stenotic disease and possibly lack of adequate surveillance, inadequate pharmacological therapy, folate deficiency and non-smoking. Crohn's disease is associated with an increased risk of colorectal carcinoma in patients with long-standing disease, strictures and fistulae under the condition that the colon is involved, tumors of the small intestine may occur occasionally. Extracolonic malignancies are rare, with the exception of biliary tract cancer. Ulcerative colitis associated colorectal cancer typically can occur in the entire colon, is often multifocal and of undifferentiated histology. Stage distribution and prognosis of ulcerative colitis associated colorectal cancer appears to be similar to that of sporadic colorectal cancer with an overall survival of about 40% (15-65%) after 5 years with tumor stage at diagnosis being the most important predictive parameter for survival. Tumor markers helpful for the diagnosis of sporadic colorectal cancer fail to differentiate between inflammatory response and malignant transformation. In contrast the histologic evidence of dysplasia was shown to be a strong indicator of underlying carcinoma or developing malignant transformation. The presence of a surface projection termed dysplasia associated lesion or mass is highly indicative of underlying or associated cancer. While the routinely performed search for dysplasia is hampered by high interobserver variation the demonstration of DNA-aneuploidy or genetic changes which may confirm the ongoing malignant transformation has not yet become clinical routine. The genetic alterations found in ulcerative colitis associated colorectal cancer involve many of the same targets found in sporadic colorectal tumors and include multiple sites of allelic deletion, microsatellite instabilities, and mutations of APC, p53, Ki-ras as well as MSH2 and other genes. The progression of dysplasia to carcinoma is generally accompanied by an accumulation of these mutations and the similarities in the biology of colorectal cancer associated with ulcerative colitis and sporadic colorectal cancer appear to outweigh their difference. In regard to the management of dysplasia and cancer, the role of surveillance programs for the early detection of ulcerative colitis associated colorectal cancer at a curable stage is still under debate. Although these programs failed at tumor prevention and lethal carcinomas are still found inadvertently in patients under surveillance, the majority of surveillance programs could reduce mortality by detecting more cancers at a still curable stage. Current recommendations for surveillance include, therefore, biennial colonoscopy with extensive biopsies after 8-10 years of total colitis or after 15-20 years of left-sided colitis. In the presence of cancer or unequivocal high-grade dysplasia and/or dysplasia associated lesion or mass proctocolectomy is considered adequate. The evidence of low-grade dysplasia should be confirmed before proctocolectomy is considered.
Algorithms↗
Activation of resting T cells against the CA 72-4 tumor antigen with an anti-CD3/CA 72-4 bispecific antibody in combination with a costimulatory anti-CD28 antibody.
The poor prognosis of advanced gastric carcinoma requires new therapeutic approaches. Among these, the specific activation of resting lymphocytes by bispecific antibodies may be promising. Here we describe the generation and function of a bispecific monoclonal antibody (bi-mab) with specificity for CD3 and for the tumor antigen CA72-4 (TAG72) on various gastrointestinal tumors. We established a hybrid/hybridoma by somatic fusion of two hybridoma lines secreting antibodies against CA72-4 and CD3 respectively and characterized its bimab OKT3/B72.3. In combination with costimulatory anti-CD28 antibodies resting peripheral lymphocytes could be activated specifically by bi-mab OKT3/B72.3 with T cell proliferation and IL-2 secretion. The bi-mab OKT3/B72.3 could also trigger the cytotoxicity of these T cells toward, CA72-4+ cells in vitro. Our results indicate, that bi-mab OKT3/B72.3 in combination with an anti-CD28 mab can redirect T cell cytotoxicity specifically against CA72-4+ tumor cells implicating a novel strategy for the specific immunotherapy of CA72-4+ tumors.
Animals↗