Biomedical subjects

Guntram Lock

Publications and source records attributed to Guntram Lock.

8 recordsLinked to original sources

PubMed2004

Comparison of interobserver agreement for different scoring systems for reflux esophagitis: Impact of level of experience.

BACKGROUND: The Savary-Miller, the Los Angeles, and the MUSE (metaplasia, ulcer, stricture, erosion) scoring systems have been developed to assess esophageal lesions related to GERD. Interobserver agreement for these systems was compared, with particular reference to the experience of the endoscopist. METHODS: By using videoendoscopes, videotapes were made of the gastroesophageal junction of 60 patients who presented with symptoms suggestive of GERD. The Savary-Miller, the Los Angeles, and the MUSE systems were used to score all video clips by 9 endoscopists who were subgrouped by level of experience (3 levels, 3 endoscopists per level). Agreement was assessed by using weighted kappa statistics (kappa). RESULTS: The Savary-Miller scoring system revealed moderate agreement for the experienced group (kappa=0.41) but performed poorly when applied by inexperienced raters (kappa=0.16). The Los Angeles system was most reproducible in all subgroups, irrespective of the level of experience (kappa=0.49 to 0.65). The MUSE scoring system was highly similar to the Los Angeles scoring system with respect to erosions and, in addition, allowed assessment of complications of GERD. CONCLUSIONS: The Los Angeles and the MUSE scoring systems are most reliable for the assessment of erosions caused by GERD. Because of low reliability, use of the Savary-Miller scoring system is not recommended. For all scoring systems, interobserver agreement varies with the level of experience in the performance of upper endoscopy.

Endoscopy, Gastrointestinal↗

PubMed2004

Russell body gastritis: an unusual, tumor-like lesion of the gastric mucosa.

The case of an 80-year-old woman who presented with epigastric symptoms is reported. Upper gastrointestinal endoscopy displayed Candida esophagitis and a localized swelling of the fundic mucosa. Histologic examination of the gastric biopsy showed a distinctive accumulation of numerous uniform plasma cells filled with so-called Russell bodies. On low-power view, the lesion resembled a neoplastic process due to the marked expansion of the lamina propria with distension of fundic glands. However, immunohistochemistry confirmed a polyclonal pattern of the plasma cells. This unusual reactive lesion of the gastric mucosa has only rarely been described and has been termed Russell body gastritis.

Aged↗

PubMed2003

A novel MCP-1 gene polymorphism is associated with hepatic MCP-1 expression and severity of HCV-related liver disease.

BACKGROUND AND AIMS: Factors influencing the progression of chronic hepatitis C virus (HCV) infection are poorly understood. Monocyte chemotactic protein-1 (MCP-1) is a potent chemokine, and its hepatic expression is up-regulated during chronic HCV infection mainly in activated hepatic stellate cells (HSC). In this study, we investigated the correlation of the functional -2518 MCP-1 promoter polymorphism with hepatic MCP-1 expression and the disease outcome in patients with HCV. METHODS: MCP-1 genotyping was performed in 206 patients and 139 healthy controls. Hepatic MCP-1 messenger RNA (mRNA) expression was quantified by real-time PCR in 58 HCV patients. Cytokine-induced MCP-1 secretion of activated human HSC (n = 13) was determined by enzyme-linked immunosorbent assay (ELISA). Mobility-shift assays were performed using probes corresponding to the MCP-1 promoter sequence (-2511 to -2528) with or without the A to G mutation at -2518. RESULTS: Frequency of MCP-1 genotypes did not differ between HCV patients and controls. However, carriers of the G allele were significantly more frequent in HCV patients with more advanced fibrosis and severe inflammation. In accordance, hepatic MCP-1 mRNA levels were significantly higher in patients with more advanced fibrosis and in patients carrying the G allele. Furthermore, cytokine-induced MCP-1 secretion of HSC isolated from carriers of the G allele was significantly higher, and there was binding activity in nuclear extracts from activated HSC specifically to the G allele, providing a potential mechanism for the differences seen. CONCLUSIONS: Inheritance of the -2518 MCP-1 G allele, which appears to affect hepatic MCP-1 expression, may predispose HCV patients to more severe hepatic inflammation and fibrosis.

Adult↗

PubMed2003

HFE C282Y heterozygosity in hepatocellular carcinoma: evidence for an increased prevalence.

BACKGROUND & AIMS: Iron overload is observed frequently in chronic liver disease, and some studies have suggested that chronic iron overload may contribute to the pathogenesis of hepatocellular carcinoma (HCC). Heterozygosity for hereditary hemochromatosis (HH) is associated with increased body iron stores. The discovery of the HH gene HFE has enabled identification of the heterozygote status. The aim of this study was to evaluate if heterozygosity for HH is a risk factor for HCC. METHODS: The C282Y and the H63D mutation of the HFE gene were analyzed in 137 patients with HCC and no history of HH, 107 patients with cirrhosis without HCC and 126 healthy controls. Hepatic iron content was measured by using a semiquantitative histologic score. RESULTS: Seventeen of 137 HCC patients (12.4%) were C282Y heterozygote, compared with only 4 of 107 (3.7%) cirrhotic patients without HCC and 6 of 126 (4.8%) healthy controls (P < 0.05). The frequency of the H63D mutation showed no significant differences. C282Y heterozygote HCC patients had significantly higher levels of serum ferritin and transferrin saturation than C282Y wild-type patients (793 +/- 122 vs. 355 +/- 23 ng/mL, and 42.3% +/- 7.3% vs. 29.2% +/- 1.7%, respectively), and significantly higher iron deposition in HCC as well as in nontumorous liver tissue. CONCLUSIONS: The C282Y heterozygous genotype is significantly more common in HCC patients and is associated with significantly increased intrahepatic iron deposition and systemic iron stores. These results suggest that C282Y heterozygosity plays a role in liver iron deposition and could contribute to hepatocarcinogenesis via the accumulation of potentially carcinogenic iron. These findings may have implications for HCC screening and prevention strategies.

Biomarkers, Tumor↗

PubMed2003

Dysfunction of the hypothalamic-pituitary-glandular axes and relation to Child-Pugh classification in male patients with alcoholic and virus-related cirrhosis.

OBJECTIVE: To investigate anterior pituitary function (adrenal, somatotropic, thyroid and gonadal axes, and prolactin) in relation to the Child-Pugh score in male patients with alcoholic and virus-related liver cirrhosis. METHOD: Anterior pituitary function was evaluated in 52 male cirrhotics (26 Child-Pugh class A (CPA), 16 Child-Pugh class B (CPB) and 10 Child-Pugh class C (CPC)) by a combined pituitary stimulation test, and was compared with 50 age-matched controls. RESULTS: A normal cortisol response to corticotropin-releasing hormone (CRH) stimulation was demonstrated in 57.6% of CPA patients, 31.1% of CPB patients and 20% of CPC patients, while basal levels of adrenocorticotropic hormone (ACTH) and cortisol in cirrhotics were comparable to those in controls. Levels of basal growth hormone (P < 0.001) and stimulated growth hormone (P < 0.01) were significantly higher in cirrhotics compared with controls, while levels of insulin-like growth factor 1 (IGF-1) were significantly lower (P < 0.001). Basal prolactin levels were elevated significantly in CPC patients (P < 0.01), while stimulated prolactin as well as basal and stimulated thyroid-stimulating hormone (TSH) levels were comparable. Basal luteinizing hormone levels were significantly higher in CPA (P < 0.001) and CPB (P < 0.001) patients, and stimulated luteinizing hormone levels were significantly lower in CPC patients than in controls (P < 0.005). Basal and stimulated follicle-stimulating hormone (FSH) levels were comparable in all groups. Child-Pugh score was correlated positively to prolactin and was correlated negatively to IGF-1, stimulated luteinizing hormone and free testosterone. CONCLUSIONS: In cirrhotics, the hypothalamic-pituitary-adrenal and -gonadal axes and prolactin secretion are impaired. Growth hormone response to growth hormone-releasing hormone (GHRH) is accelerated in cirrhotics. Thus, elevated basal and stimulated levels of growth hormone probably reflect compensation for low levels of IGF-1, which are associated with deteriorating liver function. The aetiology of cirrhosis was found to have no influence on the degree of alteration of the hypothalamic-pituitary-glandular axes.

Adult↗

PubMed2002

[Acute mesenteric ischemia--frequently overlooked and often fatal].

BACKGROUND: Acute mesenteric ischemia still carries an appallingly high mortality rate. Subsets of acute mesenteric ischemia comprise mesenteric artery embolism and thrombosis, mesenterial vein thrombosis and non occlusive mesenteric ischemia. DIAGNOSIS: Clinical presentation initially is often dominated by a discrepancy between severe subjective pain and relatively unspectacular findings on physical examination. The key to better survival rates (and the main problem in clinical practice) are early and, if indicated, invasive and aggressive diagnosis and treatment. Unfortunately, there are no non invasive diagnostic tests of sufficient sensitivity and specificity so far, and mesenterial angiography (or abdominal CT, if mesenterial venous thrombosis is suspected) remains the gold standard of diagnosis. TREATMENT: In the obstructive forms of arterial mesenteric ischemia, the main therapeutic step after stabilization of the circulation remains an early laparotomy with embolectomy or revascularization and, if appropriate, resection of infarcted bowel. In patients with nonocclusive mesenteric ischemia, counteraction of mesenteric vasoconstriction is the main therapeutic principle. OBJECTIVES: This review describes the different forms of acute mesenteric ischemia and gives an overview of the currently established and recommended forms of diagnosis and treatment.

Diagnostic Imaging↗

PubMedDate not supplied

Acute mesenteric ischemia: classification, evaluation and therapy.

Mortality rates of acute mesenteric ischemia still range between 60 and 100%. Unfortunately, retrospective series have not shown any significant improvement in mortality in the past decades. With approximately 50%, superior mesenteric artery (SMA) embolism is the most common form of acute mesenteric ischemia, followed by SMA thrombosis (approximately 25%), nonocclusive mesenteric ischemia (approximately 20%) and mesenteric venous thrombosis (approximately 5%). Clinical presentation may be unspecific, but is often characterised by an initial discrepancy between severe subjective pain and relatively unspectacular findings on physical examination. The key to a better outcome (and the main problem in clinical practice) is early diagnosis. Up to now, helas, there are no simple and noninvasive diagnostic tests of sufficient sensitivity and specificity. Thus, angiography remains the cornerstone of diagnosis and should be performed early in all patients with a risk profile and a clinical presentation suspicious of AMI. The initial therapeutic step in all patients with AMI is resuscitation and a stabilization of circulation. If an advanced stage of ischemia is suspected, broad spectrum antibiotics have to be given. Nonocclusive mesenteric ischemia without signs of peritoneal infarction may be managed by pharmacological vasodilation, and vasodilators are also considered as a valuable supportive treatment option in patients with obstructive mesenteric ischemia. Patients with mesenteric venous thrombosis have to be treated by immediate anticoagulation, followed by laparotomy if peritoneal signs are present. Standard treatment for patients with obstructive mesenteric arterial syndromes is a laparotomy with embolectomy or revascularization and, if indicated, resection of infarcted bowel.--. This review will give an overview on the different forms of mesenteric ischemia and then focus on the diagnosis and on generally recommended forms of treatment.

Acute Disease↗

PubMedDate not supplied

Gallbladder motility in healthy volunteers: effects of age, gender, body mass index, and hair color.

BACKGROUND/AIMS: Ultrasonographic determination of gallbladder motility is sparsely performed in clinical practice as the examination is considered to be time consuming and there is uncertainty about a number of parameters possibly influencing the results. The aims of this study were a) to establish normal values for a simple ultrasonographic test and b) to evaluate the influence of different parameters on gallbladder motility. METHODOLOGY: In 62 systematically age- and sex-matched healthy volunteers, ultrasonographic measurements of gallbladder volume (ellipsoid method, planimetry and sum-of-cylinders method) were performed fasting and 5, 10, 20, 30, 40, 50, 60, 70 and up to 75 min after stimulation with a standardized high-caloric liquid meal. RESULTS: Using the ellipsoid method, gallbladder fasting volume (V0) reached a mean value (+/- SD) of 24.6 +/- 10.0 mL with an ejection fraction of 65.9 +/- 19.1%. Age, gender and hair color did not influence parameters of gallbladder contraction. Body mass index showed a weak correlation with V0 but not with ejection fraction. There was a highly significant correlation between the ellipsoid method and longitudinal planimetry and the sum-of-cylinders method, respectively. CONCLUSIONS: Ultrasonographic measurement of gallbladder motility in healthy volunteers shows a very wide scattering of normal values. In the interpretation of gallbladder emptying, age, gender and body mass index do not have to be considered. Determination of gallbladder motility may be performed by a rather simple approach with oral stimulation and ellipsoid method or longitudinal planimetry as easily applicable ultrasonographic measurements.

Adolescent↗