Biomedical subjects
B Eibl-Eibesfeldt
Publications and source records attributed to B Eibl-Eibesfeldt.
Platelets of patients with peripheral arterial disease demonstrate a hypersensitive response to heparin.
We sought to verify earlier reports of increased platelet reactivity in patients with peripheral arterial disease (PAD) during perioperative heparin administration, and to test the hypothesis of platelet hypersensitivity to heparin in these patients. Before and after incubation of platelet rich plasma with unfractionated (UH), low molecular weight heparin (LMWH), and a low molecular weight heparinoid, real-time quantitative assessment of platelet function was performed by stagnation point flow adhesio-aggregometry (SPAA) in 21 patients with PAD and 14 healthy volunteers. With SPAA the occurrence of spontaneous aggregation is pathological. In the 15 patients requiring operation, platelet function and count were measured at regular intervals. To detect heparin dependent antibodies, the heparin induced platelet activation assay (HIPA) was performed preoperatively and after 10 days of heparin therapy. Mean baseline platelet adhesion in patients was double that observed in controls (p < 0.001). Spontaneous aggregation was seen in 9 (43%) patients and no controls (p < 0.001). In controls heparinoid reduced, whereas UH and LMWH slightly increased adhesion. Spontaneous aggregation was observed once with UH. Platelets from patients showed significantly enhanced adhesiveness and aggregability (p < 0.05) with UH and LMWH when compared to controls. Effects with the heparinoid were less pronounced and nonsignificant. In patients requiring operation, postoperative increases in platelet function and reductions in count were significant (p < 0.001). Ten (67%) experienced a fall in platelet count of > 50%. Preoperatively the HIPA assay showed no evidence of antibodies, whereas after heparin administration antibodies were verified in 4 (32%) patients and could not be ruled out in 6 (40%). Three developed postoperative thrombosis, in one case fatal. A hypersensitive in vitro and in vivo platelet response to heparin was verified in patients with PAD and a large number developed the immunological type of heparin-associated thrombocytopenia. Our findings suggest that a thrombin antagonist which does not interact with platelets may give the best perioperative protection in these patients.
Chronotherapy with 5-fluorouracil and folinic acid in advanced colorectal carcinoma. Results of a chronopharmacologic phase I trial.
BACKGROUND: Chronotherapy with antineoplastic drugs is a rather new strategy of reducing cytotoxic side effects. Because the circadian timing of 5-fluorouracil (5-FU) was reported to result in a higher efficacy and lower toxicity, the authors conducted a chronopharmacologic Phase I trial with 5-FU and folinic acid (FA). METHODS: Eight patients with advanced colorectal cancer received 5-FU (initial dose of 500 mg/m2/day) and FA (20 mg/m2/day) as a continuous intravenous infusion over 5 consecutive days. Using a portable, ambulatory drug delivery system, 75% of the daily dose of 5-FU and FA were given from Oh00-7h00, and the remaining 25% from 7h00-24h00. Treatment courses were repeated after 28 days. Dose escalations of 250 mg/m2/day of 5-FU and 10 mg/m2/day of FA per course were performed in the absence of any toxicity greater than WHO (World Health Organization) grade 2. RESULTS: Dose-limiting toxicity WHO grade 3 was observed at a dose of 750 mg/m2/day of 5-FU and 30 mg/m2/day of FA in five, and 1000 mg/m2/day of 5-FU and 40 mg/m2/day of FA in two patients, respectively. One patient tolerated 1000 mg/m2/day of 5-FU and 40 mg/m2/day of FA, but the treatment was stopped before further dose escalation because of rapid disease progression. Mucositis was the dose-limiting toxicity in seven patients and diarrhea in two. Disease stabilization occurred in three patients and disease progression in five. Compared with conventional Phase I/II trials using a 5-day infusion regimen, the maximal tolerated dose of 5-FU and FA was slightly higher but significantly lower than in a chronotherapeutic trial that used a different, sinusoidal mode of drug application. CONCLUSION: Based on these results, the authors feel justified to caution that the circadian timing of 5-FU plus FA may not always allow the safe application of high dose levels. Future Phase I/II studies need to define whether specific drug delivery systems or schedules are necessary for chronotherapy with 5-FU and FA in patients with colorectal carcinoma.
Interobserver agreement in defecography.
PURPOSE: This study was designed to test the reproducibility of the diagnostic assessment of defecographies in patients with a suspected disorder of defecation. METHODS: To evaluate interobserver agreement, 100 defecographic series of patients with complaints suggesting a disordered defecation were evaluated independently by three observers with a standardized questionnaire. After six weeks, a random sample of 35 of 100 defecographies was evaluated a second time with clinical data provided (history, proctologic examination). To evaluate whether the position of residual volume in the rectum would affect agreement, patients with substantial retention either in the upper or lower rectum were also evaluated separately. RESULTS: Total agreement regarding rectocele and internal prolapse was 0.81 and 0.75, respectively (1.0 = complete agreement), and was significantly higher than chance agreement. Total agreement regarding residual volume in the rectum at the end of defecography and clinical relevance of findings was not different from chance agreement, providing clinical data did not significantly improve agreement. When residual volume was situated in the lower rectum, agreement regarding incompleteness of emptying and its clinical relevance was much better (0.93). CONCLUSIONS: Interobserver agreement is good regarding the deformation of the rectum during defecography but not different from chance agreement regarding the completeness of evacuation.
Is the volume retained after defecation a valuable parameter at defecography?
The intention of this study was to correlate the retained volume at the end of defecography to certain defecographic findings and to the sense of incomplete emptying. In 170 defecographic series, the retained barium was estimated planimetrically. No particular defecographic finding determined a higher or lower amount of remaining volume, and the sense of incomplete evacuation did not depend on the amount of retained volume. Thresholds of urge and perception on anorectal manometry did not differ between patients with and without the feeling of incomplete evacuation. A rectocele, isolated or combined with an internal prolapse, caused the retained volume to be in the lowermost part of the rectum, whereas, in the case of an isolated intussusception, the remaining volume was located in the middle or higher part of the rectum. It is concluded that defecographic findings do not in general explain incomplete emptying or the sense of incomplete emptying, but they may determine the localization of the retained volume.
[Magnetic resonance tomography of the hepatobiliary system: indications, limitations and outlook].
In a prospective study we examined the diagnostic value of MRI and MR cholangiography (MRC) in patients suffering from hepatobiliary disease. By using hepatobiliary contrast media (Mn-DPDP, Gd-BOPTA), sensitivity and specificity of MRI were significantly increased. In 65 patients we comparatively analyzed the diagnostic results of MRI and MRC versus ultrasound, CT and invasive techniques such as ERCP. We conclude that the use of MRI and MRC improves the diagnostic evaluation of patients with hepatobiliary disease.
[The clinical value of Mn-DPDP: a new paramagnetic hepatobiliary contrast medium for magnetic resonance tomography of the liver].
In an open prospective study the tolerance and diagnostic value of the new hepatobiliary contrast agent Mn-DPDP in MR imaging was evaluated in 20 patients suspected of having focal liver lesions. T1- and T2-weighted spin-echo sequences and T1-weighted gradient-echo sequences were obtained before and after intravenous application of Mn-DPDP. In all patients the signal to noise (S/N) values of normal liver tissue increased significantly after application of Mn-DPDP. All focal lesions could be better localized and differentiated due to increased contrast to noise ratios of lesion to liver. Pathological examination revealed in 14 patients malignant and in 5 patients benign liver lesions; one patient had no pathological findings. In metastatic disease of the liver 25-120% more lesions could be detected in MRI after Mn-DPDP-application, compared with the unenhanced images. In 5 patients the lesions showed significant enhancement of Mn-DPDP (2 cirrhotic nodules, 2 hepatocellular carcinomas, 1 focal nodular hyperplasia). Our preliminary results indicate that Mn-DPDP is a well-tolerated contrast agent useful for the detection and differentiation of liver lesions in MR imaging.
[Enteral hyperoxalosis due to therapy with a somatostatin analog].
A 27-year-old woman with multiple bilobal liver metastases of a carcinoid tumour and carcinoid syndrome was treated with the somatostatin analogue Octreotide, 450-600 micrograms daily subcutaneously. This improved previous attacks of marked epigastric pain, while endocrine activity and tumour mass remained unchanged. Shortly after treatment had begun, soft fatty stools and oxaluria were noted. After six months severe renal colics were found to be due to non-opaque caliceal calculi, and a contracted non-functioning gallbladder was discovered. The calculi consisted of oxalate. The enteric hyperoxalosis, oxaluria and urolithiasis were presumably side effects of the Octreotide treatment.
Effects of androgen manipulations on chemically induced colonic tumours and on macroscopically normal colonic mucosa in male Sprague-Dawley rats.
Epidemiological and experimental studies suggest that androgens influence colonic carcinogenesis. We investigated the effects of hormonal manipulations (surgical and chemical castration, hormone substitution) on colonic tumour development, tumour and mucosal histopathology, and epithelial proliferation in macroscopically normal colonic mucosa in male rats, after induction of chemical colon carcinogenesis by subcutaneous injections of azoxymethane (AOM). Chemical castration with cyproterone acetate, but not surgical castration, resulted in increased colonic tumorigenesis, which was accompanied by decreased crypt length, decreased number of cells per crypt, and increased crypt epithelial mitotic index in the right colon. Chemically castrated rats also had crypt hyperplasia and increased numbers of dysplastic foci in the left colon which were not seen with surgical castration. By contrast, rats given testosterone after surgical castration showed decreased colonic tumorigenesis with an increased proportion of tumours in the left colon and lower percentage of tumours with invasion. The grossly normal mucosa of the testosterone-substituted castrated rats showed decreased crypt length in the right colon similar to the other groups of castrated rats, but no significant increase in mitotic index. Our results suggest that the anti-androgenic progestin cyproterone is a potent enhancer of colonic tumorigenesis and epithelial proliferative abnormalities after AOM administration. Exogenous testosterone after castration alters tumour distribution and characteristics and suppresses epithelial proliferative abnormalities. Finally, androgen effects on the colonic mucosa are more prominent in the right than in the left colon, suggesting different influences of hormones on the epithelium of these anatomical sites.
[The suction knife in liver surgery. Initial clinical experiences with a simple dissection instrument].
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Basic investigations on interaction of 5-fluorouracil and tumor ischemia in the treatment of liver malignancies.
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[Prevention of vascular injuries in tibial interlocking nailing].
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[Therapeutic procedure in "incidentaloma" of the adrenal glands].
Incidentally discovered adrenal masses are a therapeutic challenge. As benign lesions, like hyperplasias and adenomas, are much more common than malignant ones, an approach is needed, which incidental discovered mass should be removed. If the tumor is hormonally active or the lesion has a diameter of more than 3 cm, we advice surgery. The smaller mass should have a careful follow-up.
[Cystic liver with acute hemorrhage].
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[Psychodramatherapy with neurotics and psychotics using video-feedback (author's transl)].
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The suction knife in surgical treatment of hepatic hydatid disease. Surgical technique.
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