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Biomedical subjects

G Lock

Publications and source records attributed to G Lock.

At least 19 recordsLinked to original sources
PubMed2001

[A new paracentesis needle for ascites and pleural effusion compared with the venous indwelling catheter. A prospective, randomized study].

BACKGROUND: Diagnostic or therapeutic paracentesis of ascites or pleural effusions is part of the daily routine on many hospital wards and in outpatient clinics. In Germany, paracentesis is usually performed with angiocaths. However, the therapeutic large volume paracentesis of ascites and paracentesis of pleural effusions with angiocaths is often cumbersome and quite often paracentesis fails, forcing the physician to repuncture. This is mainly due to the fact that angiocaths are not designed for such interventions. PATIENTS AND METHOD: 45 patients with ascites or pleural effusions were treated with a new needle specially designed for paracentesis, or with an angiocath. The new paracentesis needle was compared with the angiocath needle under the following aspects: necessity and number of positional corrections of the needle, necessity of and reasons for repuncture, duration of puncture, flow capacity, subjective practicability of paracentesis and patient acceptance of the paracentesis needle. RESULTS: The paracentesis needle was superior to the angiocath in all investigated respects. Significantly, the paracentesis needle had a much higher success rate in the complete drainage than had the angiocath. CONCLUSION: The paracentesis needle was objectively superior as compared to the angiocath. It might help to avoid additional complications due to repuncture and it will increase the patients' comfort.

Adult↗
PubMed2001

Acute intestinal ischaemia.

The subsets of acute mesenteric ischaemia include mesenteric arterial occlusion (by embolus or thrombosis), mesenteric venous thrombosis and non-occlusive mesenteric ischaemia. Despite advances in pathophysiology, laboratory diagnosis and imaging techniques, acute mesenteric ischaemia is still associated with mortality rates of more than 60% and continues to be a challenging diagnostic problem. The key to a better outcome (and the main problem in clinical practice) is early diagnosis. Clinical presentation may be unspecific, but is often characterized by an initial discrepancy between severe subjective pain and relatively unspectacular findings on physical examination. Up to now, there are no simple and non-invasive diagnostic tests of sufficient sensitivity and specificity; thus, angiography remains the cornerstone of diagnosis and should be performed early in all patients in which mesenteric ischaemia is a realistic differential diagnosis. Treatment for obstructive mesenteric arterial syndromes and most patients with mesenteric venous thrombosis is surgical, whereas non-occlusive mesenteric ischaemia may be managed by pharmacological vasodilation.

Acute Disease↗
PubMed2001

[Intercostal percutaneous ultrasound guided decompressive gastrostomy (PUG)--a case report].

Percutaneous gastrostomies (PG) are nowadays usually placed endoscopically (PEG). Due to stenoses in the pharynx or the esophagus or in case of a lack of diaphany, other methods for the placement of PG such as computed tomography (CT-) guided or ultrasound-guided PG (PUG) are performed. We present a case of a 63-year old male patient with a retroperitoneal liposarcoma and multivisceral resection who presented with the symptoms and signs of an ileus due to metastatic occlusion of the small bowel. The placement of a decompression-PEG was impossible due to interposition of colon between the stomach and the abdominal wall. After filling the stomach with water via a naso-gastral decompression tube, the stomach could be visualized at the left thoracic wall, since the spleen and the left kidney had been removed at prior surgery. A transcostal decompression-PUG was inserted. The intervention described is the first published ultrasound guided transcostal decompression gastrostomy and is an example for the growing significance of interventional ultrasound.

Catheters, Indwelling↗
PubMed2001

Brain electrical activity mapping of EEG for the diagnosis of (sub)clinical hepatic encephalopathy in chronic liver disease.

We studied the role of brain electrical activity mapping (BEAM) in the assessment of neuropsychiatric disturbances in 48 cirrhotic patients without clinical evidence of hepatic encephalopathy (no HE, n = 19), with subclinical HE (grade 0, denoting pathological psychometric tests, n = 13) and mild-to-moderate HE (grade I, n = 6; grade II, n = 10). Results were compared with 23 healthy controls. BEAM variables quantified were: (i) the peak frequency (PF); (ii) the amplitude of PF; and (iii) the topographic localization of the maximum peak amplitude digitized for quantification by using a coordinate system. Mean amplitudes and their topographic localization in the following frequency-bands were analysed: delta (1.0-3.5 Hz), theta (4.0-7.5 Hz), alpha 1 (8.0-9.5 Hz), alpha 2 (10.0-11.5 Hz), beta 1 (12.0-15.5 Hz), beta 2 (16.0-19.5 Hz), and beta 3 (20.0-23.5 Hz). The PF was significantly slower in all HE patients than in healthy controls (8.5 +/- 2.0 Hz v. 10.1 +/- 1.0 Hz, P< 0.001). Even in no HE, the PF was significantly slower than in controls (8.6 +/- 1.5 Hz v. 10.1 +/- 1.0 Hz, P< 0.01). No relevant topographic differences of PF were observed. The mean amplitudes of the following bands differed significantly between controls and patients: theta (increased in HE, P< 0.05), alpha 2 (decreased in HE, P< 0.05), and beta 2 and beta 3 (increased in HE, (P < 0.05). In HE patients, the topographic localization of all beta bands showed a significant shift from parieto-occipital areas to central areas of the cortex. We conclude that BEAM is a sensitive tool for detecting neuropsychiatric disturbances in cirrhotics with no HE and with subclinical HE. The combination of PF in the theta band, increased mean amplitude in the beta 2 band, and the localization of the latter band in the frontocentral area of the cortex is an objective and sensitive tool for identifying neuropsychiatric disturbances in 85% of cirrhotic patients with no HE. Further studies are required to determine the clinical implications of these abnormal findings in the absence of overt clinical symptoms.

Adult↗
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

[Liver histology in hepatitis C: correlation with different biochemical and virological parameters].

BACKGROUND AND AIM: According to the German consensus statement, the indication for treatment of HCV-RNA-positive chronic hepatitis C is not derived from histopathology but from elevated aminotransferases. The indication for liver biopsy has been discussed controversely. This study aimed at investigating the correlation between different biochemical and virological parameters and histological scores of inflammation and fibrosis in chronic hepatitis C. PATIENTS AND METHODS: In a retrospective study, data of 126 patients with chronic hepatitis C who had undergone liver biopsy between January 1994 and March 1998 were analyzed. Histology was interpreted according to a defined numerical score of inflammation and fibrosis by a single pathologist. Scores of fibrosis and inflammation were correlated with biochemical and virological parameters. RESULTS: Inflammatory grading showed a moderate but significant correlation with ALT (r = 0.33, p < 0.001), whereas staging of fibrosis did not correlate with ALT (r = 0.15). There was no association between grading or staging and HCV genotype (n = 110) or serum viral load (n = 57). Grading and staging showed a significant association with each other (p < 0.0001). CONCLUSION: Aminotransferases as "surrogate markers" reflect more or less the histological inflammatory activity but do not allow any estimation of the extent of fibrosis. Some patients may have a high inflammatory activity with low aminotransferases or high aminotransferases with low inflammatory activity. Virological parameters such as HCV genotype or viral load do not allow an estimation of histological findings. If prior to treatment of chronic hepatitis C liver biopsy is omitted and the decision for treatment depends solely on the measurement of surrogate markers, considerable misjudgement of the actual status of liver inflammation or fibrosis may result.

Adolescent↗
PubMed2000

[The sonographic picture of an echogenic liver is an indicator of pathologic glucose tolerance].

BACKGROUND: Almost all patients in departments of internal medicine routinely undergo abdominal ultrasound examination in which liver changes indicating hepatic steatosis are often detected. The aim of this study was to assess the occurrence of pathological oral glucose tolerance, manifest diabetes mellitus and other changes indicative of a metabolic syndrome in patients with sonographic signs of hepatic steatosis. PATIENTS AND METHODS: 577 patients were examined during a period of 6 months: 90 patients fulfilled the inclusion criteria. RESULTS: Among the 90 patients with echodense liver who were included in the study (42 female, 48 male) 36 patients presented with previous diagnosis of diabetes mellitus (40%). The oral glucose tolerance test was impaired in 19 patients (21%) and in four patients with manifest diabetes mellitus (4%). Among patients with echodense liver a high percentage presented with obesity and impaired fat metabolism. CONCLUSIONS: The large number of patients with an impaired oral glucose tolerance test converting to manifest diabetes, as well as the large number of patients with manifest disorders of fat metabolism suggest that screening for diabetes should be performed in patients who present with sonographic signs of hepatic steatosis.

Adolescent↗
PubMed2000

Pharmacokinetic interaction between proton pump inhibitors and roxithromycin in volunteers.

BACKGROUND: Triple therapy including two antibiotics and a proton pump inhibitor is a rational approach to the treatment of Helicobacter pylori induced peptic ulcer disease. The interaction of antimicrobial therapy and acid suppression is not yet well elucidated. AIMS: To investigate the effects of proton pump inhibitors on roxithromycin levels in plasma and gastric tissue under steady-state conditions in volunteers. METHODS: In two crossover studies omeprazole 20 mg b.d., lansoprazole 30 mg b.d., roxithromycin 300 mg b.d., and the combination of roxithromycin with either omeprazole or lansoprazole were administered to 12 healthy volunteers over 6 days. Blood plasma levels of the drugs were measured. In addition, roxithromycin concentrations were also determined in gastric juice and gastric tissue obtained during endoscopy. RESULTS: The proton pump inhibitors and roxithromycin did not alter the blood plasma pharmacokinetics of each other. When compared to roxithromycin administered alone, its combination with a proton pump inhibitor significantly increased the roxithromycin concentrations in gastric juice (3.0-5.0 microg/mL vs. 0.3-0.4 microg/mL) and gastric tissue (antrum: 3.8-4.0 vs. 2.8 microg/g, fundus: 5.9-7.4 vs. 4.2-4.4 microg/g). CONCLUSIONS: Proton pump inhibitors and roxithromycin do not alter the systemic bioavailability of each other. However, proton pump inhibitors increase the local concentration of roxithromycin in the stomach which may contribute to the clinically proven synergic beneficial action in eradication therapy of H. pylori.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2000

[The ultrasound centre as a medically and economically relevant alternative--a report of the Regensburg experience].

In most medical centres, ultrasonography is performed independently by several departments. In october 1997, the University hospital of Regensburg founded an ultrasound centre, integrating surgical and medical departments as well as the institutes for radiology and nuclear medicine. The aims of this centre were the concentration of organization, machines, financial resources, manpower and know-how, standardized training and quality, and strengthening of interdisciplinary cooperation in clinic, medical education and research. Booking, standardized reports and a joint archiving of reports are assisted by a collective computer system. Most examinations in the centre are performed by three all-day present gastroenterology, surgery and radiology residents who are supported by licensed sonographers of the other departments. Training is standardized, and the certification for ultrasound examinations is acquired after a test with theoretical and practical parts. The integration of various departments in the ultra-sound on-call service has led to significant savings. The pool of ultrasound machines is used jointly, department-specific resources for new machines have been put together. We are convinced that this way of a close interdisciplinary cooperation will result in improvements in quality, utilization of financial resources and clinical research.

Cost-Benefit Analysis↗
PubMed1999

[Fatal liver failure after corticosteroid treatment of a hepatitis B virus carrier].

HISTORY AND ADMISSION FINDINGS: A 69-year-old man, a known carrier of hepatitis B virus (HBV) after blood transfusion, developed increasingly severe jaundice with high transaminase levels after receiving steroids in high doses. Significant preceding conditions included chronic obstructive pulmonary disease, coronary heart disease, ulcerative colitis in remission and diabetes mellitus. On admission he was jaundiced and experienced pain on pressure below the right costal margin. INVESTIGATIONS: Serology demonstrated reactivated hepatitis B with an increase of the HBV-DNA concentration in serum, as well as seroconversion with HBe antigen, anti-HBc-IgM antibodies and absence of anti-HBe antibodies. DIAGNOSIS, TREATMENT AND COURSE: The history and serological findings indicated reactivation of the hepatitis B by the steroid treatment. Progressive liver failure developed. A marked reduction of virus particles in the blood occurred after a therapeutic trial with the nucleoside analog lamivudine, but the patient died of liver failure 30 days after admission. CONCLUSION: Steroids should be given to known hepatitis B carriers only if strictly indicated, because of the danger of acute deterioration of liver functions by reactivation of the disease with possibly fatal consequences. If steroids are administered, liver functions and serological hepatitis markers should be closely monitored so that any necessary treatment can be quickly initiated.

Adrenal Cortex Hormones↗
PubMed1999

["Cardiomegaly and pneumonia"--a misdiagnosis in long-standing achalasia].

HISTORY: A 65-year-old woman was admitted to another hospital with suspected status asthmaticus. While there was progressive respiratory failure, the chest X-ray showed bilateral congestion and infiltration with widened mediastinum and cardiomegaly. The patient was transferred to the authors' hospital after two days on ventilatory support because of suspected left-ventricular failure and pulmonary congestion with pneumonia. 30 years previously she had undergone a myotomy for achalasia. INVESTIGATIONS: Imaging of the oesophagus with water-soluble contrast medium, computed tomography of the thorax and gastroscopy revealed a siphon-like megaoesophagus (which had been misinterpreted radiologically as cardiomegaly) with a slightly open lower oesophageal sphincter. The pulmonary symptoms were thought to be due to aspiration pneumonia. TREATMENT AND COURSE: As there were no other reasonable treatment options a transmediastinal oesophageal resection with gastric pull-through and collar anastomosis was performed. CONCLUSION: In long-standing achalasia a megaoesophagus can develop despite previous myotomy. It should be included in the differential diagnosis of radiologically demonstrated mediastinal enlargement.

Aged↗
PubMed1999

[Parenteral and enteral nutrition in palliative medicine].

Artificial nutritional support does not alter the natural course in patients with malignant disease. The outcome of these patients is mainly determined by the type and stage of the underlying tumor. Progress of the underlying disease is often paralleled by malnutrition which in turn facilitates complications and may reduce survival and quality of life. Nutritional support can be applied to maintain body weight, immune function and quality of life. Enteral nutrition can be applied with a functioning gastrointestinal tract and has been proven to be superior compared to parenteral nutrition. Maintenance of intestinal mucosal function due to enteral substrate application prevents disruption of intestinal barrier function as well as the overgrowth of intestinal microorganisms. Using a step-by-step approach dietetic counselling in combination with augmented oral caloric intake should be the first measure. The next step to take is nutritional support by enteral tube feeding using formula diets. Parenteral feeding should only be used if other options to support caloric intake have failed.

Enteral Nutrition↗