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W Swobodnik

Publications and source records attributed to W Swobodnik.

At least 55 records · Page 3Linked to original sources
PubMed1990

Comparison of gall bladder bile and endoscopically obtained duodenal bile.

In 10 patients with gall stone disease (eight women, two men; mean (SD) age 47.4 (13) years), bile was obtained by endoscopic aspiration after stimulation of the gall bladder with ceruletid and also by fine needle puncture of the gall bladder under local anaesthetic. The total lipid concentration of the puncture bile samples was mean (SD) 11.9 (4.7) g/dl, significantly higher than the endoscopic bile samples (3.9 (3.3) g/dl, p less than 0.001). Total bile acids, phospholipids, and biliary cholesterol (expressed in mol%) and cholesterol saturation index showed no significant differences between the two types of samples. The glycocholic acid concentration in the endoscopically obtained bile (27.7 (6.6) mol% v 23.3 (5.4) mol%; p less than 0.01) was significantly higher than the puncture bile samples. Puncture bile exhibited a significantly shorter nucleation time (3.5 (3.3) days v 19.6 (11.9) days; p less than 0.001). For determination of the nucleation time, endoscopic bile aspiration after gall bladder stimulation with ceruletid led to adequately concentrated samples in 50% of the study subjects. Cholesterol monohydrate crystal formation in native bile was observed in six samples of puncture bile and in three samples of the endoscopically obtained bile. The presence of cholesterol crystals and the determination of nucleation time in the puncture bile were the best discriminants between cholesterol and pigment gall stones and correlated well with computed tomogram analysis.

Adult↗
PubMed1990

[Nucleation time and age in patients with gallstones].

The relationship between nucleation time (NT), total lipid concentration (TLC) and age was studied in a group of 45 gallstone patients (10 male, 35 female, age 50.1 +/- 14.5 yrs). Bile was obtained by direct fine needle puncture of the gallbladder under local anaesthesia and sonographic monitoring. There was a positive correlation between age and nucleation time (r = 0.626, p less than 0.001), in addition to a negative correlation between age and total bile lipid concentration (TLC) (r = -0.414, p = 0.005). The negative correlation between age and TLC indicates that gallbladder's ability to concentrate the bile decreases significantly with age. It is possible that the decreased concentration is a result of the chronic pathogenetic effects of gallbladder stones. Practically all patients showed a prolonged nucleation time after the 60th year (11.54 +/- 5.50 vs. 2.65 +/- 2.52 days). This would seem to indicate that these patients suffered primarily from bilirubin or calcified stones, currently unsuited for conservative therapy methods.

Adult↗
PubMed1990

[Preventing the recurrence of common bile duct calculi following endoscopic papillotomy with ursodeoxycholic acid].

The effect of ursodeoxycholic acid on recurrence prevention of choledochal calculi after endoscopic sphincterotomy (EPT) was evaluated in 46 patients, whose bile duct stones had been removed endoscopically. 22 patients received 500 mg of ursodeoxycholic acid once a day, 24 patients received placebo. 1 recurrent stone could be detected in the ursodeoxycholic acid treated group 19 months after EPT, whereas 4 recurrent stones occurred in the placebo group about 16 months after EPT. Cholesterol saturation index decreased significantly by the ursodeoxycholic acid treatment 12 and 24 months after EPT (0.93 +/- 0.17 vs. 0.69 +/- 0.12 vs. 0.72 +/- 0.07). The nucleation time increased statistically significant from 9.0 days to 20.4 (12 months) and 17.7 (24 months) days, respectively. Obviously, pharmacological effects of ursodeoxycholic acid exist which modify important processes in the gallstone's pathogenesis.

Aged↗
PubMed1989

[Drug cholelitholysis and the nucleation time].

Nucleation time (time elapsed until first appearance of cholesterol crystals in incubated bile fluid) and the lithogenic index were measured on 25 patients (aged 45.1 +/- 16.8 years; Broca index 106.7 +/- 4.2%) with radiolucent gallstones, before receiving daily 500 mg chenodeoxycholic acid and ursodeoxycholic acid orally. The nucleation time in the group of nine patients in whom complete lysis was achieved was 4.7 +/- 0.8 days, compared with 15.0 +/- 2.2 days in those with only incomplete lysis (P less than 0.001). There was no statistically significant difference between the two groups as to age, Broca index, lithogenic index and biochemical values. Thus the determination of nucleation time can contribute to distinguishing between responders and nonresponders to oral treatment for dissolving gallstones and may improve the success rate of the method.

Adult↗
PubMed1989

[Possibilities of 3-dimensional ultrasound imaging].

This is a report on the clinical use of sonographic imaging. Experimental studies have shown that parallel sonographic sections are available only in vitro, which means no in-vivo three-dimensional reconstruction is possible as it is with magnetic resonance and computed tomography. The idea that a coordinated sequence of sections can be obtained by spatial rotation of the plane of sound so that the individual sections differ from one another by defined angular distances, enables three-dimensional reconstruction of sonographic in-vivo sections. A transducer was constructed that enables the production of sonographic sections rotating around a fixed center of rotation. Its clinical usefulness was tried and confirmed in the imaging of early pregnancies, benign and malignant carcinomas of the breast, and in imaging a gallbladder with a solitary gallstone. Three-dimensional imaging can be achieved either as a ring-shaped structure or with a continuous surface. This points to the possibility of diagnosing malformations early in pregnancy if the number of sections is sufficiently high. In tumour imaging the malignant tumour seems to be clearly distinguishable from the benign one; three-dimensional diagnosis is likely to furnish important additional criteria in diagnosis. Further clinical studies will have to verify this.

Breast Neoplasms↗
PubMed1989

[Pathophysiology of cholesterol gallstones].

Cholelithiasis is a civilization-related disease with multifactorial causation. The supersaturation of the bile with cholesterol is a deciding risk factor, which, however, does not lead to gallstone formation in each individual case. The connection between supersaturated bile and the formation of stone whose primary constituent is cholesterol, are the cholesterol-monohydrate crystals. Several risk factors lead to cholesterol supersaturation of the bile. Other risk factors induce or maintain the nucleation of the cholesterol crystals. In the following paper the nucleating and inhibiting factors and the pathophysiology of cholesterol gallstones will be discussed.

Bile Acids and Salts↗
PubMed1989

[Effect of omega-3-fatty acids on biliary lipids and lithogenicity].

Until now no studies are available about the influences of omega-3-fatty acids on biliary lipids in men. The effects of 1.5 g omega-3-fatty acids per day on biliary lipid concentration and composition were studied in 13 male healthy persons over six weeks. Biliary cholesterol concentration decreased from 5.4 +/- 0.53 mol% to 3.7 +/- 0.30 mol% (25%) statistically significant. Phospholipids and bile acids remained unchanged. Cholesterol saturation index (CSI) was lowered from 1.13 +/- 0.12 to 0.85 +/- 0.06 (p less than 0.05). Bile acid composition and conjugation rates were unchanged. No significant side effects could be observed. Substitution of omega-3-fatty acids induced in healthy male persons a decrease of biliary cholesterol and lithogenicity.

Adult↗
PubMed1989

[Changes in biliary lithogenicity caused by 4 weeks' weight reduction].

In 2 of 12 patients (16.6%) cholesterol monohydrate crystals occurred in duodenal bile samples after a 4 weeks fasting period (452 kcal/day). Cholesterol monohydrate crystals could be observed until recently mainly in patients with cholesterol gallstones. Therefore, this finding indicates increased biliary lithogenicity despite a non statistical decrease in CSI from 1.35 +/- 0.35 to 1.19 +/- 0.64. Presumably the increased lithogenicity may be caused by an increased glycoprotein concentration and an improvement in gallbladder contractility. Short time fasting obviously will be a risk factor for the development of gallstones, if weight and metabolic normalisation cannot be achieved.

Adult↗
PubMed1988

[Pathologic wall changes in the gallbladder in patients with gallstones and in healthy probands. Imaging using high frequency annular array sector transducers].

2154 computerized ultrasound diagnoses of 1623 patients were evaluated retrospectively from January 1st to October 31st 1987. The frequency of pathologic gallbladder wall changes in patients with stones and normal controls was examined applying 5 MHz annular array sector transducer. The occurrence of polyps, septae, sludge, kinking, carcinoma and adenomyomatosis was noted separately. The prevalence of polyps and septae in gallstone patients was increased fourfold if compared to the total number of examined patients. Sludge was found in 5.9% of gallstone patients compared to 2.2% in normal controls. Carcinoma and adenomyomatosis were present only in cases of cholelithiasis; the prevalence of these pathologic wall changes is obviously rare. The importance of polyps and septae in biliary lithogenicity is discussed.

Carcinoma↗
PubMed1988

[Sonography as a screening examination method of the venous system in pregnancy. Comparative studies of the arm and leg vein system].

Comparative studies were conducted during the third trimenon of pregnancy between the 36th and 40th weeks of gestation and on the seventh day after delivery, at the venous system of the legs (vena iliaca, v. femoralis and v. poplitea) and at the venous system of the arms (v. brachialis). A marked reduction of the venous diameters was seen on the legs, whereas no difference was found in the venous system of the arms between both times of measurement. This points to the haemodynamic effect of the pregnant uterus, providing an obstacle to the flow of blood from the venous system of the legs. After delivery there is a relatively higher extensibility of the veins of the leg compared with the measurements in the third trimenon. This may be due on the one hand to the long-lasting overextension during pregnancy, and on the other hand also to the hormonal and enzymochemical changes that take place even during the puerperium. Doppler sonography of the v. femoralis showed clearly that the foetus obstructs blood flow from the venous system of the legs. Sonography seems to be able to visualise direct the changed morphology of the veins during pregnancy and to indirectly yield information on the extensibility of the venous system eg during standing, thus demonstrating in what way the venous system functions in a particular condition. Hence, sonography of the venous system of the legs during pregnancy should be used as a screening method wherever it is essential to discover extreme venous dilatations well in time and to initiate compression treatment.

Arm↗
PubMed1988

[Ulrich and Ulrich oculo-oscillodynamography: results in patients with healthy eyes].

Ulrich and Ulrich's method of oculo-oscillodynamography (OODG) is a relatively new method which enables the systolic retinal, systolic ciliary, and systolic ocular perfusion pressure or respectively blood pressure to be measured. The results obtained by the present authors are in good agreement with those of Ulrich and Ulrich (n = 30). The intraocular pressure values obtained with this method correlate somewhat less well with the systemic blood pressure than is the case with suction cup ophthalmodynamometry. However, the correlation coefficients are sufficiently high to permit their application in ophthalmological diagnosis. The results presented here indicate that the diastolic ocular pressure should be determined by applying the formoscillatory criterion. The positive intercept in the regression equations can be explained by the assumption that the regression is curvilinear at systemic blood pressure values which are generally not encountered in humans in whom OODG is of diagnostic importance. It is suggested that the linear regression is a sufficiently exact model at the systemic blood pressures most frequently measured. Normal OODG values can be read off easily from the diagrams published here.

Adult↗
PubMed1988

[Nucleation time and lithogenic index in obese patients and in patients with cholecystolithiasis].

The gallbladder bile of obese patients without gallstones is supersaturated with cholesterol. The cholesterol saturation index (CSI, LI) of 27 obese patients was 1.32 +/- 0.2. The CSI of 24 normal weight gallstone patients was determined with 1.16 +/- 0.37 and is therefore not significantly different from CSI of obese stone free individuals. The supersaturated bile from obese patients does not accelerated the nucleation of cholesterol crystals. The nucleation time of obese persons was statistically significant longer (16.0 +/- 3.0 days) than in gallstones patients (6.0 +/- 0.78 days) (p less than 0.001). In 50% of the patients with gallstones cholesterol monohydratcrystals were present in the native gallbladder bilde, whereas such crystals are found in only 3.7% of the obese group. Liquid crystals occurred more frequently and in larger number in the bile of the obese patients. The stone forming potency of gallbladder bile can be estimated better by the determination of nucleation time and cholesterol crystals occurrence than by the calculation of the saturation index (CSI).

Adult↗
PubMed1988

[Dietary modification of bile lipids].

The average incidence of gallstones in european countries is about 25%. Excessive secretion of cholesterol into the bile can predispose to saturation and gallstone-formation. Obesity, overnutrition, diets rich in refined carbohydrates, diets high in cholesterol intake and poor in dietary fibre, lipid lowering drugs, age and female sex hormones are recognized causing increased cholesterol secretion into the bile. These metabolic consequences may predispose to a higher incidence of cholesterol gallstone than in normal persons. Taking all the results of the literature together patients with gallstones should be encouraged to take a low cholesterol, low calorie, low refined carbohydrate and high polyunsaturated fat diet rich in bran und vegetable fibre. Obese patients should reduce their body weight. These dietary recommendations should be given for patients with gallstones during bile acid therapy and after successful dissolution in order to prevent gallstone recurrence.

Bile↗
PubMed1987

Analysis of conjugated bile acids in human serum by high-performance liquid chromatography using post-column enzyme reaction and off-line fluorimetric determination.

An assay for glycine and taurine conjugates of cholic (GC, TC), chenodeoxycholic (GCDC, TCDC), deoxycholic (GDC, TDC) and ursodeoxycholic (GUDC, TUDC) acids in human serum by high-performance liquid chromatography using an immobilized 3-alpha-hydroxysteroid dehydrogenase post-column reaction and an off-line spectrofluorimetric detection is described. The detection limit is 0.2 microM. Recoveries of extraction and chromatographic analysis range from 89.50 to 91.68% and from 96.75 to 98.83%, respectively. The analysis in serum reveals a coefficient of variation for reproducibility between 16.2% for GC and 4.7% for TDC; inter-assay variability ranges between 4.06% for TCDC and 8.24% for TUDC.

Bile Acids and Salts↗
PubMed1987

[Conservative cholelitholysis in the calculus-congested gallbladder].

Daily administration of 500 mg ursodeoxycholic acid and chenodeoxycholic acid (divided into two doses, morning and evening, corresponding to 8.5 mg per kg body-weight and substance), all concrements in the gall-bladder were dissolved over a period of 14 months in a 60-year-old man for whom surgical treatment was contra-indicated because of severe coronary heart disease. This case illustrates that, in the face of a high operative risk, the attempt to dissolve stones in the gall-bladder by drugs is justified.

Chenodeoxycholic Acid↗