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Biomedical subjects

W Steinberg

Publications and source records attributed to W Steinberg.

At least 19 recordsLinked to original sources
PubMed1995

Trypsinogen and other pancreatic enzymes in patients with renal disease: a comparison of high-efficiency hemodialysis and continuous ambulatory peritoneal dialysis.

Although serum amylase and lipase levels have been studied extensively in patients with renal disease, there are fewer data regarding trypsinogen levels in patients with end-stage renal disease (ESRD) treated with different dialytic modalities. We therefore evaluated the blood concentrations of trypsinogen, amylase, and lipase in asymptomatic patients with chronic renal insufficiency (CRI) and ESRD, to determine whether treatment modality or renal handling of these enzymes is important in determining steady-state levels in asymptomatic patients with chronic renal disease. Mean trypsinogen concentration levels were higher in hemodialysis (HD) patients and patients with CRI compared with normal subjects when values in the different groups were compared. There was no difference in the mean trypsinogen levels between patients treated with HD and those with CRI, between patients treated with chronic ambulatory peritoneal dialysis (CAPD) and those treated with HD, or between CAPD patients and patients with CRI. The mean circulating trypsinogen concentration was elevated more frequently and to a higher level than amylase or lipase in patients with CRI and ESRD. HD treatment did not result in a lowering of mean circulating pancreatic enzyme levels. We propose that decreased peripheral clearance, pancreatic overproduction, increased release from the pancreas, or a combination of these mechanisms is responsible, at least in part, for the increased plasma concentration of trypsinogen in patients with CRI, rather than simply a decrease in renal clearance.

Adult↗
PubMed1994

Predicting gallstone pancreatitis with laboratory parameters: a meta-analysis.

OBJECTIVES: In order to define the usefulness of biochemical laboratory values in distinguishing gallstone from non-gallstone acute pancreatitis, we performed a meta-analysis. METHODS: Studies that utilized the bilirubin, alkaline phosphatase, alanine aminotransferase (ALT), and aspartate transaminase in the evaluation of the gallstone pancreatitis were included. RESULTS: Using receiver operating characteristic curves for each of these four parameters, we determined that the ALT level was the most clinically useful parameter. The higher the serum level of ALT, the greater its specificity and positive predictive value in diagnosing gallstone pancreatitis. At ALT levels greater than or equal to 150 IU/L (approximately a 3-fold elevation), the probability of gallstone pancreatitis is 95%. Our analyses of total bilirubin and alkaline phosphatase serum levels indicate that these tests are not useful in the diagnosis of gallstone pancreatitis. Aspartate transaminase levels are nearly as useful as ALT. CONCLUSIONS: A > or = 3-fold elevation of ALT in the presence of acute pancreatitis has a positive predictive value of 95% in diagnosing acute gallstone pancreatitis.

Acute Disease↗
PubMed1992

The admission serum lipase:amylase ratio differentiates alcoholic from nonalcoholic acute pancreatitis.

To determine whether the lipase:amylase ratio differentiates alcoholic from nonalcoholic pancreatitis, we conducted a retrospective review of charts with the diagnosis of acute pancreatitis at the George Washington University Medical Center between January 1988 and July 1990. A total of 446 charts were reviewed. For a patient to be included in the subsequent analysis, the following criteria were met: 1) the patient had typical symptoms of pancreatitis, 2) serum amylase and lipase were analyzed on admission, and 3) a computerized tomographic (CT) scan or ultrasound of the abdomen was obtained within 72 h of admission. Forty-seven charts satisfied the requirements for inclusion in the study. Data collected from the charts included history of alcohol consumption, age, sex, race, admission serum amylase and serum lipase (from this the amylase:lipase ratio was calculated), peak serum amylase and serum lipase, and number of days of abdominal pain before admission. Patients with alcoholic pancreatitis had significantly lower serum amylase levels and significantly higher lipase:amylase ratios than those with nonalcoholic pancreatitis (p < 0.01). There was no difference in the serum lipase between the groups. The higher the lipase:amylase ratio, the greater the specificity of alcohol as the etiology of acute pancreatitis. Only patients with alcoholic acute pancreatitis had lipase:amylase ratios > 5.0 (sensitivity 31%, specificity 100%). Our data point to the clinical utility of the lipase:amylase ratio in differentiating alcoholic from nonalcoholic acute pancreatitis. Prospective studies will be needed to confirm the clinical utility of this ratio.

Acute Disease↗
PubMed1991

Cancer associated antigen CA19-9 in colonic effluent of patients with neoplasia of the colon and inflammatory bowel disease.

We measured colonic effluent samples from 10 patients with colorectal cancer, 13 with adenomatous polyps, 14 with normal colons and compared them to 10 patients with inflammatory bowel disease by measuring this CA19-9 content. Results showed considerable overlap between the different pathologic categories, making differentiation impossible. A lower level of CA19-9 in the effluent samples from patients with adenomas was noted. These differences were reproducible for assays performed several months apart. CA19-9 may originate from the upper gastrointestinal tract since large amounts are present in pancreatico-biliary secretions. This antigen is therefore not useful in the diagnosis of neoplasia or inflammatory bowel disease using colonic effluent samples as the test material.

Adult↗
PubMed1990

Increased expression of a putative adenoma-associated antigen in pre-colonoscopic effluent of patients with colorectal cancer.

A monoclonal antibody Adnab-9, was raised against antigens derived from benign polyps of the colon. Adnab-9 was tested against pre-colonoscopic effluent material obtained from groups of patients with a macroscopically normal colonscopic examination, histologically confirmed adenomatous polyps and patients with colorectal cancer (CRC). The resultant binding levels displayed little overlap between the CRC group and the normal, and the difference was statistically significant. Since this putative early neoplasia associated antigen is essentially not expressed in CRC extracts, it may originate from a region of the colon predisposed to neoplasia, increasing in expression as the tendency to malignancy progresses, useful in the diagnosis of early stage malignancy.

Adenoma↗
PubMed1990

Intestinal microsporidiosis as a cause of diarrhea in human immunodeficiency virus-infected patients: a report of 20 cases.

Chronic diarrhea accompanied by weight loss is a common and often debilitating problem associated with human immunodeficiency virus (HIV) infection. Enterocytozoon bieneusi, a newly identified species of the phylum of protozoa, Microspora, has been reported associated with chronic diarrhea and wasting in 11 acquired immunodeficiency syndrome (AIDS) patients in the United States, Europe, and Africa. Diagnosis has been based solely on the ultrastructural identification of this small, intracellular parasite in bowel biopsies. Seventy-one small bowel biopsies from 67 homosexual AIDS and AIDS-related complex patients with chronic diarrhea and with no pathogens identified by light microscopy on paraffin sections, were embedded in plastic and studied by light and transmission electron microscopy. Enterocytozoon bieneusi microsporidiosis was diagnosed by electron microscopy in 20 (22 biopsies) of the patients. More jejunal biopsies (16 of 36) were positive than duodenal biopsies (six of 35). Parasites and spores were clearly visible at the light microscopic level in the semi-thin plastic sections from 17 and 21 of the biopsies, respectively. In retrospect, parasites could be identified by light microscopy in standard hematoxylin and eosin-stained paraffin sections. Infection was confined to enterocytes covering the villi, especially the tips, and was associated with villous atrophy and cell degeneration, necrosis, and sloughing. Release of spores into the bowel lumen was evident. Colorectal biopsies from two of the patients with small bowel microsporidiosis were negative for microsporidia. Enterocytozoon bieneusi infection of the small bowel may be an important cause of diarrhea in HIV-infected persons.

Acquired Immunodeficiency Syndrome↗
PubMed1990

The clinical utility of the CA 19-9 tumor-associated antigen.

Since Koprowski and coworkers discovered the CA 19-9 antigen 10 yr ago, it has become the most useful blood test in the diagnosis and management of patients with cancer of the pancreas. With an upper limit of normal of 37 U/ml, the assay's overall sensitivity is approximately 80% and its specificity is 90%. If higher cutoffs are used, the specificity rises so that, at levels greater than 1000 U/ml, the marker's specificity approaches 100%. Acute cholangitis and cirrhosis are two benign conditions that might raise this assay significantly. This tumor-associated marker is also helpful in predicting unresectability of pancreatic adenocarcinoma, as 96% of tumors that result in blood levels greater than 1000 U/ml have been found to be unresectable. After potentially curative surgery, the CA 19-9 can help prognosticate survival. Patients who normalize their CA 19-9 postoperatively live longer than those who do not. Furthermore, the assay, when used serially, predicts recurrence of disease prior to radiographic or clinical findings. The CA 19-9 is currently the "gold" standard marker for pancreatic cancer, against which other assays in this field will be judged.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1989

Depression: a discussion of Jung's ideas.

Depression is differentiated into normal and pathological. Pathological depression is further divided into simple and melancholic. The characteristics of each disordered form are described. Jung's ideas on depression are described in terms of this theoretical standpoint. The concepts used by Jung to explain depression are derived from his libido theory. Through introversion unconscious contents necessary to compensate a one-sided attitude of the ego are made conscious. Introversion depletes the ego of its energy. Depression is the depleted ego's experience of itself. Jung's theory is useful to explain normal depression associated to the process of transformation. It has also been extended to explain disorders of depression via the concept of involuntary or forced introversion in the service of compensation. His therapeutic approach consisted of rectifying the imbalance of psychic energy by helping the ego to integrate unconscious contents. The subsequent accrual of psychic energy redresses the problem of the ego's depletion and depression eases. In the discussion, Jung's contributions to the understanding of depression are recognised, especially his insight into the relationship between normal depression and the process of transformation. The explanatory limitations of Jung's ideas for depressive disorder are also recognised and discussed in relation to aetiology, introversion-extraversion, aggression and psychotherapy. Current clinical information suggests that a theory of depression needs to integrate and also to reformulate some of Jung's ideas.

Depressive Disorder↗
PubMed1989

Biliary tract dilatation in chronic pancreatitis: CT and sonographic findings.

The authors retrospectively evaluated 44 patients with chronic pancreatitis to determine (a) what features on computed tomographic and sonographic scans were associated with biliary tract dilatation, (b) how these findings and biliary tract dilatation changed at follow-up, and (c) the correlation between the degree of biliary tract dilatation and the laboratory and histologic findings when available. Twenty-four patients had biliary tract dilatation; of this group 88% had pancreatic calcifications and 75% had a focal mass in the pancreatic head. Sixteen of the 24 patients underwent follow-up studies; in 12 there was no change in the degree of biliary tract dilatation or appearance of the pancreas. The levels of serum alkaline phosphatase and bilirubin were elevated in most of the 24 patients; at follow-up, however, there was no consistent relationship between these values and radiologic findings. Biopsy is recommended for those patients in whom the serum alkaline phosphatase level remains persistently elevated. Four of seven such patients in this study underwent biliary-enteric bypass procedures due to pathologic evidence of cholestasis.

Adult↗
PubMed1982

Hepatobiliary scanning in hemobilia-induced acute cholecystitis.

Radionuclide scanning of the hepatobiliary tree is highly accurate for the detection of patients with acute cholecystitis. Hemobilia, a rare complication of percutaneous liver biopsy, may result in blood clots within the biliary canaliculi. Such clots, like gallstones, may occlude the ducts and produce a clinical syndrome indistinguishable from acute cholecystitis. A patient with acute cholecystitis resulting from hemobilia following percutaneous biopsy of the liver is described. The diagnosis of acute cholecystitis secondary to blood clots was made with technetium 99mTc Iprofenin (Pipida [Sn]) scintigraphy. The patient was treated conservatively, and follow-up Pipida scan 6 weeks later demonstrated normal hepatobiliary function.

Adult↗