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Biomedical subjects

W Stremmel

Publications and source records attributed to W Stremmel.

At least 145 records · Page 8Linked to original sources
PubMed1997

Clinical stable systemic mastocytosis with interferon alpha-2b therapy.

Systemic mastocytosis (SM) with progressive infiltration of various organs by mast cells is a rare disease with a mean survival of 2 years. So far there is no established therapy. We describe a patient with progressive mastocytosis who had a clinical response to interferon alpha-2b 3 x 5 Mio U s.c. three times a week. The response is stable 3 years after initiation of therapy and includes reduction of abdominal lymphadenopathy, ascites, decrease of serum and urinary histamine levels as well as pulmonary reticulonodular markings.

Antineoplastic Agents↗
PubMed1997

Tumor necrosis factor increases serum leptin levels in humans.

Leptin is a pleiotropic hormone believed to regulate body weight. Its function in wasting during inflammatory disease in humans is unknown. We studied the effect of repeated tumor necrosis factor (TNF) infusion on serum leptin levels in six patients with solid tumors. TNF infusion on day 1 resulted in an increase in serum leptin levels from 3.1 (SEM +/- 0.28) ng/mL to 5.2 (SEM +/- 0.6) ng/mL after 12 h (P < 0.001). The serum levels returned to baseline within 24 h. Similar results were obtained when TNF was infused on subsequent days. The study shows that leptin serum levels are under control of TNF.

Aged↗
PubMed1997

Risk of infection with Helicobacter pylori and hepatitis A virus in different groups of hospital workers.

OBJECTIVES: The purpose of this study was to determine whether different staff groups in an acute care hospital are at increased risk of acquiring Helicobacter pylori and hepatitis A virus infection. METHODS: We examined staff members of an acute care hospital for serum antibodies to H. pylori IgG (n = 457) and to hepatitis A virus (n = 434). The staff members were assigned to three groups: 1) nonmedical staff (n = 110), 2) medical and nursing staff (n = 272), and 3) medical and nursing staff working in a gastroenterology and endoscopy unit (n = 75). Serum antibodies were measured by validated enzyme immunoassays. A questionnaire inquiring about medical and professional history, history of upper GI pain and ulcer, as well as about the use of nonsteroidal anti-inflammatory drugs or medication for GI complaints and smoking habits was completed by each person. RESULTS: The seroprevalence of H. pylori was 35.5% in group I, 34.6% in group II, and 24.0% in group III (not significant). The seroprevalence of H. pylori antibodies increased with age (p < 0.001), and antibodies were present more frequently in women than in men (36.2 vs 25.4%, p < 0.05). After adjustment for age, duration of experience and the number of years working in the gastroenterology or endoscopy unit did not increase H. pylori seropositivity. No significant association was found between H. pylori seropositivity and history of upper GI pain, ulcers, use of nonsteroidal anti-inflammatory drugs or medication for GI complaints, or tobacco use. The prevalence of hepatitis A antibodies was similar in the three groups (group I, 26.4%; II, 26.5% III, 21.7%; not significant). Cross-tabulation showed that 67 subjects (15.4%) were seropositive for both H. pylori and hepatitis A (p < 0.001) and that 245 (56.5%) were negative for both. Seventy-seven (17.7.%) and 45 (10.4%) were seropositive for only H. pylori and for only hepatitis A, respectively. CONCLUSION: Occupational exposure to patients in an acute care hospital as well as to patients and to endoscopic procedures of a gastroenterology and endoscopy unit does not increase the rate of infection with H. pylori. The significant correlation between the seroprevalences of H. pylori and hepatitis A antibodies suggests fecal-oral transmission of H. pylori.

Adolescent↗
PubMed1997

Recurrent hepatitis C virus infection after liver transplantation--long-term follow-up with respect to the HCV genotypes/subtypes.

BACKGROUND/AIMS: Various factors may affect the postoperative course in recurrent hepatitis C virus (HCV) infection after liver transplantation (OLT). The aim of our study was to evaluate the potential role of HCV genotypes and immunosuppressive treatment. METHODS: 17 liver allograft recipients, HCV-RNA positive prior to OLT, were followed 26-102 months postoperatively. The diagnosis of HCV infection was based on clinical, serological and histological findings and detectable HCV-RNA in serum. The genotypes/subtypes were evaluated by a "reverse line probe" assay. RESULTS: After OLT hepatitis C viremia was evident in 16 of 17 allograft recipients (94%). Two patients acquired HCV infection after transplantation (incidence 0.84%). Clinically eight of 18 viremic patients remained asymptomatic. Ten of 18 had an acute hepatitis (eleven to 27 weeks after OLT), of those nine patients developed chronic hepatitis (hepatic activity indices: grade 1-3) with progression to fibrosis in two patients. One patient subsequently developed cirrhosis. Subtype 1 b was predominant (eleven of 18 patients). After transplantation subtype 1 b was not associated with a higher rate of recurrent hepatitis compared to other genotypes/subtypes (45% in type 1 b vs. 71% in type "non-1 b"; n.s.). CONCLUSION: Identical HCV genotypes/subtypes before and after OLT indicate a recurrent rather than a postoperatively acquired HCV infection of the allograft. Despite viremia most patients had no or mild to moderate hepatitis in the long-term follow-up. Different HCV genotypes were not associated with specific clinical courses of recurrent HCV infection after OLT.

Adolescent↗
PubMed1997

Prevalence of serum antibodies to Helicobacter pylori and to CagA protein in liver transplant recipients.

OBJECTIVE: To study Helicobacter pylori seroepidemiology before and after orthotopic liver transplantation. METHODS: Serum samples obtained from 118 liver transplant recipients before and after transplantation were examined for the presence of IgG antibodies to H. pylori whole cell extract and to the CagA protein of H. pylori. RESULTS: Of 118 patients, 64 (54.2%) were H. pylori positive, and 36 (56.3%) of these had CagA antibodies. Of the 64 seropositive patients, 22 (34.4%) remained positive and 42 (65.6%) became negative for H. pylori antibodies a median of 39 months after transplantation. Patients who seroreverted showed a tendency to lower pretransplantation antibody levels and had received antibiotic therapy for at least 4 days. Seroreversion or antibody persistence was not affected by age, sex, CagA antibody status, CagA antibody titer, duration of antibiotic therapy, or immunosuppressive drugs administered after liver transplantation. CONCLUSIONS: The prevalence of H. pylori infection, as detected by serological screening, in patients selected for liver transplantation is not different from that in the general population. In these patients, the seroprevalence of H. pylori drops after liver transplantation. This is largely due to the intake of antibiotics and immunosuppressants by transplant recipients. Seroreversion seems to be independent of the type of H. pylori bacteria.

Adult↗
PubMed1997

[Is preoperative scintigraphy in euthyroid nodular goiter necessary?].

Preoperative thyroid isotope scan would influence the operative procedure and the perioperative management in patients with nontoxic goiter only if it raises suspicion of malignancy. However, the scintigram shows significantly lower sensitivity and specificity in the detection and prediction of malignant nodules in the thyroid gland than the ultrasound examination. Thyroid isotope scan is more expensive than ultrasonography, and its routine use in the investigation of nontoxic nodular goiter should be abandoned.

Cost-Benefit Analysis↗
PubMed1996

[Current diagnosis: hereditary metabolic diseases of the liver (primary hemochromatosis, Wilson disease)].

Primary hemochromatosis is characterized by a specific pattern of clinical manifestations. It includes liver disease with hepatomegaly, glucose intolerance, e.g. diabetes, hyperpigmentation oft the skin, impotence/ amenorrhea, arthropathy, cardiomyopathy and fatigue. Laboratory investigation reveals significantly elevated serum ferritin and transferrin saturation with iron. The diagnosis is confirmed by liver biopsy and quantitative determination of elevated liver iron content. Wilson's disease represents a copper storage disease. Prominent clinical features are hepatomegaly and splenomegaly. Neurological alterations and detection of Kayser-Fleischer corneal rings are typical. In the acute initial phase the often young patients present with Coombs-negative hemolysis. Psychiatric alterations, cardiomyopathy, arthropathy, nephropathy, as well as thrombocytopenia and leucopenia are other clinical features. Laboratory parameters of Wilson's disease include low serum ceruloplasmin and serum copper. There is an elevated urinary copper excretion and elevated serum free copper concentration. The diagnosis is confirmed by liver biopsy with quantitative determination of an elevated liver copper content.

Adolescent↗
PubMed1996

Effect of dietary fatty acids on jejunal and ileal oleic acid uptake by rat brush border membrane vesicles.

To test the effect of dietary fatty acids on fatty acid uptake, the influx kinetics of a representative long-chain fatty acid, 3H-oleic acid, in both the jejunum and ileum of rats has been studied using brush border membrane vesicles (BBMV). Animals were fed with semipurified diets containing 5 g fat/100 g diet, as corn oil (control group), safflower oil (unsaturated group) and coconut oil hydrogenated (saturated group). With increasing unbound oleate concentration in the medium, the three dietary groups showed saturable kinetics in both jejunal and ileal BBMV (controls: Vmax = 0.15 +/- 0.01 nmol x mg protein-1 x 5 min-1 and Km = 136 +/- 29.1 nmol for jejunum, and Vmax = 0.23 +/- 0.03 nmol x mg protein-1 x 5 min-1 and Km = 196 +/- 50.3 nmol for ileum; unsaturated: Vmax = 0.28 +/- 0.05 nmol x mg protein-1 x 5 min-1 and Km = 242.7 +/- 91.8 nmol for jejunum, and Vmax = 1.29 +/- 0.06 nmol x mg protein-1 x 5 min-1 and Km = 509.8 +/- 97.5 nmol for ileum; saturated: Vmax = 0.03 +/- 0.01 nmol x mg protein-1 x 5 min-1 and Km = 124.5 +/- 72.6 nmol for jejunum, and Vmax = 0.04 +/- 0.01 nmol x mg protein -1.5 min-1 and Km = 205.6 +/- 85.3 nmol for ileum). These results support the theory that feeding an isocaloric diet containing only unsaturated fatty acids enhanced oleic acid uptake, and feeding an isocaloric diet containing only saturated fatty acids decreased oleic acid uptake. The results obtained in the present work also show the adaptative ability of jejunum and ileum to the type of dietary fat.

Animals↗
PubMed1996

Oleic acid uptake by jejunal and ileal rat brush border membrane vesicles.

In previous works, a membrane fatty acid transport system has been identified in brush border membrane vesicles, but no different intestinal regions were considered in these studies. To test the existence of a proximal-to-distal gradient of fat absorption along the small intestine, transmembrane influx kinetics of a representative long-chain fatty acid, 3H-oleic acid, in both jejunum and ileum of rat has been studied using brush border membrane vesicles (BBMV). With increasing concentration of unbound oleate in the medium, both jejunal and ileal BBMV showed saturable uptake kinetics (Vmax = 0.15 +/- 0.01 nmol.mg protein-1 x 5 min-1 and Km = 136 +/- 29.1 nmol for jejunum, and Vmax = 0.23 +/- 0.03 nmol.mg protein-1 x 5 min1 and Km = 196 +/- 50.3 nmol for ileum). These results support the hypothesis that oleic acid uptake occurs via a carrier-mediated transport mechanism in both jejunum and ileum. Furthermore, the existence of a proximal-to-distal gradient for fat absorption was apparent with a higher density of transport units (Vmax) in ileum compared to jejunum.

Animals↗
PubMed1996

Prospective study of hand-sutured anastomosis after colorectal resection.

A total of 370 patients underwent colorectal resection: 320 had a primary single-layer seromucosal anastomosis without a protective colostomy, 22 had Hartmann's procedure and 28 abdominoperineal resection. There were 260 elective procedures and 110 patients had peritonitis and/or bowel obstruction at the time of surgery. Overall the mortality rate was 2.7 per cent, the morbidity rate was 18.3 per cent and clinical anastomotic leak rate 3.4 per cent. After elective operation, the leak rate for intraperitoneal anastomosis was 0.6 per cent and for low extraperitoneal anastomosis 7 per cent. The mortality rate was 1.2 per cent and morbidity rate 11.9 per cent. Patients with peritonitis had a significant increase in morbidity rate (46 per cent) in comparison with those having elective surgery (chi 2 = 31.5, 1 d.f., P < 0.0001). Patients who had bowel obstruction and no bowel preparation had a significantly higher morbidity rate of 26 per cent and mortality rate of 7 per cent, compared with those having an elective procedure (chi 2 = 11.2, 1 d.f., P < 0.001; chi 2 = 8.7, 1 d.f., P < 0.005 respectively). Patients having palliative surgery had the highest mortality rate (19 per cent), compared with those operated on with curative intent (1.5 per cent) (chi 2 = 28.7, 1 d.f., P < 0.0001). Cost-saving hand-sutured anastomosis is effective and, in experienced hands, technically feasible after all kinds of colorectal resection and should remain the standard in colorectal surgery.

Adult↗
PubMed1996

Phenprocoumon for prevention of shunt occlusion after transjugular intrahepatic portosystemic stent shunt: a randomized trial.

Development of stenosis or occlusion of the transjugular intrahepatic portosystemic stent shunt (TIPSS) is one of the major limiting factors in the long-term viability of this procedure. The efficacy of anticoagulation with heparin which is used in different centers is still unclear. In the present study, we evaluated the effect of phenprocoumon on shunt patency after TIPSS placement using Palmaz stents; 49 patients with Child's A and B cirrhosis, who underwent successful TIPSS placement were randomized into the treatment group (n = 24) who received phenprocoumon and a control group (n = 25). After 11 to 13 weeks, all patients were admitted and had a reevaluation that included control angiography by transjugular approach. Phenprocoumon treatment was stopped after the first reevaluation and both groups were followed for 1 year after randomization. During the 3-month treatment period 11 of 22 patients of the treatment group and 12 of 23 patients of the control group required reintervention because of an increased portosystemic gradient. Five of the 12 patients in the control group showed complete occlusion of the shunt, whereas no occlusion in the treatment group was observed (P < .05). During the mean follow-up of 8 months after the treatment was stopped, in both groups stenosis occurred in 50% of patients, but no further occlusion of the stent was observed. These data indicate that occlusion of the stent is related to thrombosis, whereas stenosis does not appear to be dependent on blood coagulation. In patients with preserved liver function occlusion of the shunt may be prevented by phenprocoumon treatment in the first 3 months after TIPSS placement. Thereafter shunt occlusion was not observed and further phenprocoumon treatment seemed unnecessary.

Anticoagulants↗
PubMed1996

[PET studies with C-11 ethanol in intratumoral therapy of hepatocellular carcinomas].

Positron emission tomography (PET) is a noninvasive functional method for the study of solid tumor perfusion, metabolism and interaction with different therapeutic agents. The aim of the study was the investigation of the metabolism of hepatocellular carcinomas (HCC) and the kinetics during a treatment with intratumoral ethanol by PET. The ongoing study includes seven patients with child. A cirrhosis and HCC (UICC stage III-IVA; tumor size 3-6 cm). Dynamic PET studies (60 min) with 18F-fluordeoxyglucose (FDG) were performed prior to therapy to assess tumor viability. The evaluation of the FDG data demonstrated a liver-equivalent uptake in six of the tumors (well and moderately differentiated HCC), which were poorly delineated against the normal liver parenchyma. One moderately differentiated HCC showed an increased FDG metabolism, indicating no correlation between histology and metabolism. A dose of 37-80 MBq 11C-ethanol was applied together with a nonlabelled therapeutic dose of the drug via a puncture needle positioned under sonography. Five out of seven tumors demonstrated a high 11C uptake shortly after the end of the ethanol injection followed by constant 11C-ethanol concentration during the whole study period of 45 min. The PET data demonstrated no significant elimination of the 11C-ethanol from the tumor and no accumulation in the surrounding liver tissue. One case showed a decrease of the intra-tumoral 11C-ethanol concentration due to a punkture of a tumor vein, and in another case the surrounding liver parenchyma demonstrated significant 11C uptake in the early phase following paratumoral injection of the drug. In conclusion, PET is a useful tool for the study of the mechanism and the kinetics of percutaneous intratumoral ethanol injection of HCC.

Aged↗
PubMed1996

Sequence analysis of hepatitis GB virus C (GBV-C) isolates from 14 patients.

In 1995, a new human hepatitis virus belonging to the family Flaviviridae was described and designated hepatitis GBV-C. To investigate variations within the genome of GBV-C and to study the relationship of GBV-C to GBV-A/B or hepatitis C virus (HCV), we established a detection system using reverse transcriptase polymerase chain reaction (RT-PCR) of the putative helicase region (NS3). So far, isolates derived from 14 different GBV-C-positive sera were analyzed (GBV-C/S3-36), showing 80.1-89.4% (mean: 85%) identical nucleotides. The deduced amino acid sequences revealed 97.3% homology. Nucleotide sequences of GBV-C/S3-36 revealed about 60% identity to GBV-A as well as to HCV, but only 56% identity to GBV-B. Amino acid sequences revealed 73.4 and 68.6% similarity to GBV-A and GBV-B, respectively, but a slightly higher percentage of 78.5% to HCV sequences. Thus, according to the putative GBV-C helicase sequence, a subtyping of GBV-C into different genotypes may be necessary.

Adult↗
PubMed1996

Lymphocyte apoptosis induced by CD95 (APO-1/Fas) ligand-expressing tumor cells--a mechanism of immune evasion?

The CD95 (APO-1/Fas) system is an important mediator of T-cell cytotoxicity. We investigated this system in 22 hepatocellular carcinomas (HCCs) from patients. All HCCs had partially or completely lost the expression of the CD95 receptor constitutively expressed by normal liver cells and might thus evade CD95-mediated killing. We also considered a new mechanism of immune evasion, namely, the active destruction of T-lymphocytes by tumor cells expressing CD95 ligand (CD95L). CD95L messenger RNA and protein could be detected in the HCCs. In coculture experiments, HepG2 hepatoblastoma cells, expressing CD95L mRNA after treatment with cytostatic drugs, killed CD95+ Jurkat lymphocytes. Our data suggest that tumor cells can evade immune attack by down-regulation of the CD95 receptor and killing of lymphocytes through expression of CD95L.

Antimetabolites, Antineoplastic↗