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C F Dietrich

Publications and source records attributed to C F Dietrich.

At least 37 records · Page 2Linked to original sources
PubMed2002

[3D real time contrast enhanced ultrasonography,a new technique].

While 3D sonography has become established in gynecology, abdominal applications have been mainly restricted to case reports. However, recent advances in computer technology have supported the development of new systems with motion detection methods and image registration algorithms - making it possible to acquire 3D data without position sensors, before and after administration of contrast enhancing agents. Hepatic (and also splenic) applications involve the topographic localization of masses in relation to the vessels, e.g. hepatic veins and portal vein branches prior to surgical procedures (segment localization). 3D imaging in the characterization of liver tumors after administration of contrast enhancing agents could become of special importance. We report on the first use of 3D imaging of the liver and spleen under real time conditions in 10 patients, using contrast enhanced phase inversion imaging with low mechanical index, which may improve the detection rate and characterization of liver and splenic tumors.

Adult↗
PubMed2002

Role of ultrasonography in the detection of small adrenal masses.

AIM: Computed tomography (CT) scanning is commonly used for evaluation of adrenal masses in adults. In this prospective study we evaluated whether adrenal gland masses of less or equal than 20 mm in diameter could be detected by modern abdominal ultrasonography (US). METHOD: Between July 1999 and June 2000, 44 consecutive patients with 50 adrenal masses documented by contrast-enhanced CT (left adrenal gland, n = 31; right adrenal gland, n = 19; bilateral, n = 6; median size, 15 [5 +/- 80] mm) and, additionally, 50 patients without CT findings of an adrenal mass were prospectively evaluated by high-resolution US performed by physicians. Based upon CT measurement, 34 adrenal masses were </= 20 mm and 16 were > 20 mm in diameter. RESULTS: The overall sensitivity of US for the detection of adrenal masses was 96 % (48/50) (94 % [29/31] for left and 100 % [19/19] for right adrenal masses, respectively). The overall specificity of US for the detection of adrenal masses was 92 % (92/100) (90 % [45/50] for left and 94 % [47/50] for right adrenal masses, respectively). Thus, the diagnostic accuracy of US for the detection of adrenal masses is 93 % (140/150). Sensitivity and specificity of US for the detection of adrenal masses </= 20 mm (n = 34) did not differ significantly from those > 20 mm (n = 16). CONCLUSION: US is effective for detecting small adrenal masses. In rare cases small masses of the left adrenal gland might be missed and nodular adrenal hyperplasia or retroperitoneal lymph nodes might be misinterpreted as adrenal masses.

Adrenal Gland Neoplasms↗
PubMed2002

TH1/TH2 serum cytokine profiles and soluble TNF-receptor response in patients with chronic hepatitis C during recombinant human interleukin-12 (rHuIL-12) treatment.

Interleukin-12 (IL-12) has many antiviral properties both in vitro and in vivo, such as enhancing cytotoxic lymphocyte reaction, promoting Th1-helper cell response and inducing interferon-gamma - (IFN-gamma) production. The present study investigated possible antiviral effects of recombinant human IL-12 in vivo in 11 chronic hepatitis patients treated with rHuIL-12 subcutaneously in 3 different dosages (0.03, 0.1, 0.5 microg/kg) once weekly for a period of 10 weeks. ELISA was employed to determine before onset of therapy the serum concentrations of IL-12, IL-12p40, IFN-gamma, IL-4, IL-10, tumor mecrosis factor-alpha (TNF-alpha), TNFR p55 and p75, as well as on days 3, 5, 8, 10, 12, 15, 17, 22 after onset of therapy and subsequently weekly until the end of the treatment period and at the end of the 12 months' postobservatory period. The HCV-RNS serum concentration was determined by means of an RT-PCR method. Two to three days after the subcutaneous rHuIL-12 injections there was a transient significant rise of n the serum concentrations of IL-12, IL-12p40, IFN-gamma and TNFR p55, followed by a decrease to the original level. The increases of the IL-12 and IFN-gamma serum concentrations were dose-dependent. In patients where there was a decline of the HCV-RNS concentration in the serum we confirmed a trend to higher IL-12 serum concentrations. The serum levels of IL-2, TNF-alpha and IL-10 fluctuated only during the treatment period. The present study showed that a once-a-week injection of rHuIL-12 results in a merely transient rise of the IL-12, IL-12-p40- and IFN-gamma serum concentrations. This may offer an explanation for the unsatisfactory clinical efficiency of the substance.

Adult↗
PubMed2002

[Imaging of the abdomen.

In the last decade, innovative ultrasound technology has become the primary imaging method in Gastroenterology. Compared to other imaging techniques (e. g., computed tomography and magnetic resonance imaging), conventional ultrasound images have the disadvantage of a restricted field-of-view (width), thus producing images that are not always easy to read. During the examination, the many mosaic-like single images obtained in real-time sonography must be mentally pieced together by the user, in order to obtain a complex 3-dimensional picture of the anatomical structure and its surrounding tissue. The extended field-of-view of the Panoramic Imaging technique is a useful addition to conventional diagnostic ultrasound since it provides the enhanced overview required for exact topography of surrounding structures. This is especially true for the Power Mode Panoramic Imaging technique that allows the trading of vessels over greater distances, e.g., in the extremities. Thus, accuracy and reproducibility of measurements in the examination of larger structures and organs has improved. A clearer representation of these anatomical structures increases understanding and acceptance by referring clinicians. An exact diagnosis based on ultrasound imaging will certainly result in cost savings in health-care, since the use of further imaging methods (and therefore the total examination time) may be reduced.

Abdomen↗
PubMed2002

The value of routinely performed ultrasonography in patients with Crohn disease.

BACKGROUND: In active Crohn disease (CD), abdominal ultrasound can demonstrate morphological changes in the bowel wall. By contrast, the role of ultrasonography in periods with no disease activity has never been evaluated. In this prospective study we investigated the outcome of routinely performed abdominal ultrasonography in CD patients irrespective of symptoms and disease activity. METHODS: 255 consecutive patients with chronic CD (117 M, 138 F, mean age (+/-s) 38 +/- 14) were evaluated by high-resolution ultrasonography of the bowel wall and abdomen. The findings were graded with respect to further diagnostic and/or therapeutic implications. In addition, the CD activity index (CDAI) was determined. In patients with pathological sonographic findings, complementary procedures (e.g. endoscopy, computed tomography, biopsy or operation) were performed to validate the suspected diagnosis. RESULTS: In 46/255 (18%) patients with CD, the diagnosis of a transmural inflammatory reaction (TMR) with or without fistula was made by ultrasonography. In respect of CDAI, 29/46 (63%) of these patients were graded as active disease (CDAI > 150) and 17/46 (37%) as inactive disease (CDAI < or = 150). Of the 17 patients with a TMR and CDAI < or = 150, 4 patients revealed interenteric fistula, 7 patients mesenteric or perirectal fistula, whereas 6 patients presented with a transmural mesenteric inflammatory reaction without fistula. All fistulae were confirmed by radiography. Ultrasonography of the remaining abdominal organs revealed pathological findings with further diagnostic implications in 25/255 (10%) patients and with therapeutic implications in 9/255 (4%) patients. CONCLUSION: Routinely performed ultrasonography of the abdomen reveals pathological findings with therapeutic implications not only in symptomatic but also in asymptomatic patients with CD. It can therefore be recommended as a screening tool for this group of patients.

Abdomen↗
PubMed2001

Multiple adenomas and hepatocellular carcinoma in a renal transplant patient with glycogen storage disease type 1a (von Gierke disease).

We report on a 42-year-old female patient with glycogen storage disease type 1a (von Gierke disease, GSD 1a) who developed hepatic adenomas and finally a hepatocellular carcinoma 10 years after renal transplantation. The tumor was resected; however, the patient died 6 months later as a result of fulminant carcinoma recurrence. In patients who have GSD 1a with terminal renal failure, combined liver and kidney transplantation may be considered at an early stage of the disease.

Adenoma↗
PubMed2001

A new approach to evaluating intestinal acute graft-versus-host disease by transabdominal sonography and colour Doppler imaging.

An objective and non-invasive method to assess the extent, severity, course and prognosis of acute graft-versus-host disease (aGvHD) of the gastrointestinal tract would be of great importance. As high-resolution ultrasonography (HRU) and colour Doppler imaging (CDI) are used in inflammatory and ischaemic bowel diseases, we introduced these techniques to evaluate acute intestinal GvHD. In this study, 12 patients with suspected intestinal and/or severe cutaneous aGvHD were investigated by HRU and CDI. The structure and thickness of the bowel wall and the blood flow pattern in the superior mesenteric artery (SMA) as well as in the bowel wall were evaluated. All patients showed thickened bowel wall segments, especially in the ileocaecal region. Even in patients without any clinical signs of intestinal involvement (3/12), sonographic changes were observed. In six patients with severe diarrhoea, sonographic signs of secretory diarrhoea were observed. In 4/12 patients, an increased arterial blood flow in the bowel wall was demonstrated as a typical characteristic of an inflammatory bowel process. In contrast, in 4/12 patients, ischaemic bowel wall lesions with high-resistance flow pattern in the SMA were found. These patients did not respond to immunosuppressive therapy and died. In conclusion, HRU is a useful tool for detecting acute bowel GvHD even before clinical symptoms. Moreover, HRU and CDI can be applied to define the severity of aGvHD and to identify patients with a poor prognosis.

Acute Disease↗
PubMed2001

[Diagnosis related groups (DRG)--current significance in gastroenterology].

Prospective payment systems using the diagnosis related groups (DRG) payment mechanism have been introduced in many countries all over the world. In June 2000 the Australian Refined Diagnosis Related Groups System (AR-DRG) was chosen as the model which will be introduced in 2003 as the control instrument for the hospital dependent public health system in Germany. Background and possible implications for gastroenterologists and hepatologists are discussed.

Cost Control↗
PubMed2001

[Duplex sonography of visceral arteries].

Mesenterial bloodflow has been investigated routinely using colour Doppler ultrasound especially in patients with bowel disease. Examination protocols, however, differ considerably, because no standard technique has been established so far. Whereas there is agreement about the angle of ultrasonic application (< 60 degrees ), neither the exact location nor the relevant examination parameters have been standardized. Based on a search of the relevant literature, examination techniques and results were analysed. These findings are to serve as a basis for a prospective multi-center study for the determination of standard values.

Humans↗
PubMed2001

[Hypertransaminasaemia and impaired liver function in a patient with oligosymptomatic celiac disease].

Hypertransaminasaemia and impaired liver function in a patient with oligosymptomatic celiac disease. We describe the case of a 45-year-old man who was referred for evaluation of elevated aminotransferases. One year before referral the patient developed an ischemic stroke followed by a subdural hematoma three months later. In our outpatient clinic the patient presented with a malabsorption syndrome including diminished vitamin-K-dependent clotting factors. Serologic testing was positive for IgA antigliadin antibodies and IgA antiendomysial antibodies. Celiac disease was confirmed by an upper endoscopy examination and biopsies obtained from the distal duodenum. Histological examination showed villous atrophy, crypt hyperplasia and an increase in intraepithelial lymphocyte count consistent with celiac disease. After initiation of a gluten-free diet the malabsorption syndrome as well as liver dysfunction improved. Serum aminotransferase levels normalized within 6 months. The clinical course demonstrates involvement of the liver in patients with celiac disease.

Alanine Transaminase↗
PubMed2001

Qualitative and quantitative clinical evaluation of the laser-assisted ratio analyser for detection of Helicobacter pylori infection by (13)C-urea breath tests.

OBJECTIVES: Currently, the (13)C-urea breath test is the reference method for non-invasive diagnosis of Helicobacter pylori infection and therapy control. Therefore, new technologies have been developed to measure the ratio of (13)CO(2)/(12)CO(2) in breath. The laser-assisted ratio analyser (LARA) device is based on optogalvanic effects of the stimulated CO(2) molecules. DESIGN: In this study, the LARA system is prospectively compared to conventional isotope ratio mass spectrometry (IRMS) analysis of (13)C-urea breath tests. METHODS: The (13)C-urea breath test was used to screen 103 patients for H. pylori infection. Breath samples were analysed by LARA and IRMS techniques. RESULTS: Seven breath tests could not be analysed by the LARA system, one by IRMS. Out of the remaining 95 breath tests, 13 were positive for H. pylori infection (13.7%). In reference to IRMS analysis (with a cut-off of > 5 delta per thousand at 30 min), LARA produced one false positive and one false negative breath test result giving a sensitivity of 92.3% and a specificity of 98.8%. The mean difference in delta over baseline values between IRMS and LARA measurements was 2.02 delta per thousand +/- 5.48 delta per thousand. CONCLUSION: LARA allows the reliable qualitative evaluation of 13C-urea breath tests, but the quantitative results differ from IRMS findings.

Adolescent↗
PubMed2000

[Ultrasound diagnosis of penicillin-induced segmental hemorrhagic colitis].

INTRODUCTION: Penicillin-induced segmental haemorrhagic colitis (SHC) is a characteristic and striking but rarely diagnosed clinical entity. Bloody diarrhea and abdominal cramps start a few days after the intake of oral penicillin derivatives. We report the ultrasonographic and clinical findings in nine patients with SHC and compare the results with the findings in ten patients with antibiotic-related pseudomembranous colitis (PMC). METHODS: Nine consecutive patients with SHC (age: 32 +/- 10 years; five males, four females) with PMC-negative proctoscopic findings, stool cultures and negative clostridium difficile toxin and ten patients with PMC (age: 50 +/- 18 years; six males, four females) with positive proctoscopy and Clostridium difficile toxin were clinically evaluated and examined by high resolution ultrasonography. The sonographic findings of the colonic and small bowel walls as well as the clinical course of the diseases were documented. RESULTS: In all nine patients with SHC the wall of the ascending colon was asymmetrically thickened with loss of layer structure. Neither the small bowel nor the cecum were involved in patients with SHC. In all cases a distinct border between involved and uninvolved colon wall was found. During follow-up all patients recovered soon after stopping antibiotic treatment and symptomatic care. In seven of ten patients with PMC pancolitis and in three of ten with left-sided colitis were found at ultrasonography. In all patients with PMC the bowel wall was symmetrically thickened with the layers remaining distinct. DISCUSSION: The knowledge of the clinical characteristics and sonographic findings of penicillin-induced segmental haemorrhagic colitis may reduce the need for invasive endoscopic and radiological investigations in diagnosis and follow-up. The age of patients, clinical course and sonographic findings may be helpful in differentiating patients with SHC and PMC.

Adolescent↗
PubMed2000

Total iron-binding capacity and serum transferrin determination under the influence of several clinical conditions.

In this study TIBC and serum-transferrin concentrations were determined by immunochemical turbidimetry, immunochemical nephelometry and radial immunodiffusion under normal and pathological clinical conditions. A total of 246 (123 male/123 female) patients were included [iron deficiency: 60 (18/42), iron overload: 56 (39/17), chronic inflammation: 47 (23/24), undefined diseases: 35 (16/19), healthy volunteers 48 (27/21)]. The data show that determination of TIBC from conversion of transferrin values using a constant factor results in significantly higher values compared to conversion with a function of first degree. For clinical practice the influence of different diseases is negligible. This study indicates that it is not possible to develop a universal algorithm for the conversion of transferrin values into TIBC.

Adolescent↗
PubMed2000

[The mechanisms of antigen uptake in the small and large intestines: the roll of the M cells for the initiation of immune responses].

The gut-associated lymphoid tissues, e.g., the Peyer's patches and the appendix, constantly internalize antigenic material to rapidly generate an immune response, if necessary. This sampling of antigens is performed by specialized epithelial cells, the "membranous" or "microfold" (M) cells of the dome epithelia. M cells possess a unique ultrastructure and are typically in contact with lymphoid cells. They endocytose macromolecules and particles, including entire microorganisms, at their apical membrane, transport these in vesicles to their basolateral membrane, and exocytose them to the intercellular space. This article reviews the structural and functional characteristics of M cells in the digestive tract in humans and other species. Specializations of M cells for antigen uptake and transport comprise the composition of their apical membrane, a modified cytoskeleton as compared to enterocytes, and a large pocket-like invagination of the basolateral membrane populated by lymphocytes. Besides ultrastructural characteristics, histochemical markers are listed that are available for detecting M cells. The origin and differentiation pathways of M cells and enterocytes of the dome epithelium are outlined and critically commented on. Because M cells are known entry sites of various pathogens and, in the future, might be employed for the oral application of drugs and vaccines, the clinical relevance of M cells in health and disease is discussed.

Animals↗
PubMed2000

Manometrically-guided endoscopic injection of botulinum toxin for esophageal achalasia: a pilot trial.

AIMS: Some patients gained only short-term response (< 6 months) after botulinum toxin (BTX) injection for achalasia. This may be due to an incorrect site of injection when targeting the lower esophageal sphincter by using endoscopic landmarks only. PATIENTS AND METHODS: 7 elderly patients (4 females, 67 +/- 20 years) with classical achalasia received manometrically-guided botulinum toxin injection by means of a double-channel endoscope. Thereafter, they were clinically re-evaluated at 6 weeks and later on at bi-monthly intervals. RESULTS: The mean symptom score decreased 6 weeks after the manometrically-guided BTX-treatment from 12 +/- 2 (before BTX) to 6 +/- 2 points (p = 0.02). However, according to the study criteria one patient did not respond to BTX-injection and underwent subsequent cardiomyotomy. The LES-resting pressure was found not to be altered in this patient (6 weeks after BTX-injection) but manometry revealed a marked decrease of the LES-tone in 3 other patients who benefitted from BTX-injection. 5 of the 6 patients, who initially benefited from BTX-injection, relapsed 10 months (range, 6-13 months) after their initial BTX-treatment. They all were treated with repeated BTX-injections. At completion of the study (1.5-year follow-up) the mean symptom score of the 6 patients was still significantly lower (6 +/- 2 points) than before study entry (p = 0.03). CONCLUSION: Manometrically-guided endoscopic BTX-injection is a simple, safe and highly effective (during 1.5-year follow-up) technique for treatment of esophageal achalasia. With the manometrically-guided injection technique one may obtain a longer lasting symptomatic response than with the traditional method of BTX-application.

Adult↗
PubMed2000

[Mediastinal lymphadenopathy: an extrahepatic manifestation of chronic hepatitis C?].

Normal and enlarged perihepatic and mediastinal lymph nodes are detectable by ultrasonography. Aim of the present study is to determine the detection rate, size, and correlation of mediastinal and perihepatic lymphadenopathy in patients with chronic hepatitis C, healthy controls, and patients with inflammatory or neoplastic mediastinal lymphadenopathy. The mediastinum and liver hilus of 89 patients with chronic hepatitis C as well as of 34 healthy volunteers and 20 patients with mediastinal lymphadenopathy of different origin with adequate sonographic visualization were screened for the number and size of lymph nodes by high resolution ultrasonography. Lymph nodes were detectable in the mediastinum of 75/89 (84%) patients with chronic hepatitis C and 22/34 (65%) healthy volunteers (total lymph node volume [LNV]: 1.0 +/- 0.8 mL versus 0.3 +/- 0.4 mL, p < 0.001). In all patients with mediastinal lymphadenopathy, the mediastinal lymph node volume was above 15 mL. In patients with chronic hepatitis C a trend could be observed, that patients with larger perihepatic lymph nodes reveal also larger mediastinal lymph nodes. High resolution ultrasonography is able to detect enlarged mediastinal lymph nodes in patients with chronic hepatitis C. Mediastinal lymphadenopathy is considered as an extrahepatic manifestation of chronic hepatitis C. In general, the mediastinal lymph node volume differs in size to patients with lymphadenopathy related to neoplasia or sarcoidosis. The mechanism of lymphadenopathy in the liver hilus and mediastinum in patients with chronic hepatitis C is yet unknown.

Adult↗