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Biomedical subjects

H C Spangenberg

Publications and source records attributed to H C Spangenberg.

At least 19 recordsLinked to original sources
PubMed2007

[Regional therapy of liver tumors].

Malignant liver tumors are either originating from the liver, such as the primary liver tumors hepatocellular carcinoma and the cholangiocellular carcinoma, or metastases from extrahepatic malignancies. Apart from surgical procedures (resection, liver transplantation) percutaneous local-ablative (ethanol injection, radiofrequency thermal ablation as well as radiation therapy) and transarterial interventions are non-surgical therapeutic options. While these regional therapies have been shown in randomised controlled studies to be effective for hepatocellular carcinoma, their therapeutic efficacy in cholangiocellular carcinoma and liver metastases has not been shown. In the following we will summarize the regional therapeutic options in primary and secondary liver tumors.

Bile Duct Neoplasms↗
PubMed2006

[Vasculitis and liver disease].

Extrahepatic manifestations of liver diseases especially the hepatitis B virus (HBV)-infection and hepatitis C virus (HCV)-infection may occur during acute and/or chronic viral hepatitis. Besides a serum like illness with fever, arthralgia and urticaria, haematological disorders with transient bone marrow suppression and cryoglobulinemia have been described. Vasculitis is a rare complication of viral hepatitis. However, HCV can trigger a cryoglobulinemic vasculitis and may clinically present with purpura, arthritis, neuropathy, glomerulonephritis and fatigue. Panarteritis nodosa is frequently associated with HBV infection, which is caused by deposits of immune complexes in the arterial wall. Therapy of both types of vasculitis depends on the severity of disease and may include immunosuppressive agents as well as antivirals.

Cryoglobulinemia↗
PubMed2006

Serum markers of hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in some areas of the world with increasing incidence worldwide. Most of patients with HCC are diagnosed at a late stage. Therefore, the prognosis of HCC patients is generally very poor with a 5-year survival rate of less than 5%. Screening strategies including alpha-fetoprotein (AFP) and ultrasound every 6 months in patients with liver cirrhosis, the major risk factor for HCC development, have been recommended to detect HCC at earlier stages amenable to effective treatment strategies. AFP, however, is a marker with poor sensitivity and specificity and the ultrasound is highly dependent on the operator's experience. Apart from AFP, lens culinaris agglutinin-reactive AFP and des-gamma carboxyprothrombin and several other biomarkers (e.g., glypican-3, human hepatocyte growth factor, and insulin-like growth factor) have been proposed as markers for HCC detection. In addition, with recently employed techniques, such as gene-expressing microarrays and proteomics, it is to be expected that new HCC-specific markers will become available in the near future. For all such proposed markers, however, the clinical usefulness has to be carefully evaluated and validated.

Biomarkers, Tumor↗
PubMed2004

[Best supportive care of hepatocellular carcinoma].

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in some areas of the world. The major etiologic risk factors include toxins (alcohol, aflatoxin B(1)), hepatitis B and C virus infection as well as various inherited metabolic disorders. The prognosis of HCC patients is generally very poor with a 5-year survival rate of less than 5%. The diagnosis is based on biochemical and imaging tests as well as histology. Therapeutic strategies include surgery (resection or liver transplantation) and non-surgical interventions, such as percutaneous ethanol injection or radiofrequency thermal ablation as well as transarterial embolization or chemoembolization. Radio- or chemotherapy are mostly ineffective. Therefore, the development and evaluation of novel HCC treatment strategies as well as the implementation of existing and the development of new measures to prevent HCC are of utmost importance. The better understanding of the clinical and molecular pathogenesis of HCC should lead to improved diagnostic, therapeutic and preventive strategies with the aim to reduce the incidence of HCC, one of the most devastating malignancies worldwide.

Carcinoma, Hepatocellular↗
PubMed2004

[Hereditary liver diseases].

In recent years the identification and characterization of gene defects underlying hereditary liver diseases lead to a better understanding of their pathogenesis. Heditary hemochromatosis, Wilson's disease and alpha1-antitrypsin deficiency are the most common hereditary liver diseases. While gene defects and disease manifestation may correlate, genetic testing is generally not contributing to diagnosis. This review summarizes the clinical manifestations, diagnosis and therapy of the most frequent hereditary liver diseases: hereditary hemochromatosis, Wilson's disease and alpha1-antitrypsin deficiency.

Algorithms↗
PubMed2004

[Local ablation of malignant lesions of the liver - potential applications and limitations of the different methods].

Malignant lesions of the liver are among the most frequent and difficult problems in clinical practice. Liver tumors can be classified as primary (hepatocellular carcinoma HCC, cholangiocarcinoma CC) and secondary liver lesions (metastasis). The therapeutic principle of resecting liver tumours, applies to both types of liver lesions. Unfortunately many patients with primary and secondary liver lesions are inoperable because of technical difficulties or comorbidity. This stimulated the development of percutaneous ablation methods. These procedures allow to destroy tumors percutaneously with alcohol, acetic acid, radiofrequency, microwaves or laser. Potential applications and limitations of the methods are discussed.

Acetic Acid↗
PubMed2004

[The role of the virus specific T-cell response in acute and chronic HBV and HCV infection].

Infections with hepatitis B (HBV) and hepatitis C virus (HCV) are worldwide one of the most frequent causes for chronic liver disease, liver cirrhosis and hepatocellular carcinoma. The mechanisms responsible for the elimination or the persistence of the virus are not well understood. The immunopathogenesis of HBV and HCV infection is primarily mediated by virus specific CD4+- and CD8+-T-cells. During acute infection a strong and multispecific T-cell response against different viral epitopes can be detected and is associated with the clearance of the virus. In case of viral persistence virus specific T-cells contribute to liver inflammation. In this article we summarize the current concepts about the role of the virus specific T-cell response in acute and chronic HBV and HCV infection.

Animals↗
PubMed2003

[Systemic treatment for hepatocellular carcinoma].

Hepatocellular carcinoma (HCC) is one of the most frequent malignancies worldwide. A variety of pharmacological strategies has been evaluated in the treatment of HCC: classical chemotherapy, tamoxifen, octreotide, thymostimulin, pravastatin, (131)I-lipiodol as well as transarterial chemoperfusion (TAC) and chemoembolisation (TACE). TACE monotherapy or TACE combined with pravastatin resulted in a survival benefit of selected HCC patients. New strategies such as immunotherapy, antiangiogenic agents or cyclooxygenase inhibitors are under clinical investigation and might play a role in future therapies for HCC. Efficient strategies for the primary prevention of HCC are available and promising concepts in the secondary prevention have been reported.

Adjuvants, Immunologic↗
PubMed2001

A short sequence within domain C of duck carboxypeptidase D is critical for duck hepatitis B virus binding and determines host specificity.

Virus-cell surface receptor interactions are of major interest. Hepadnaviruses are a family of partially double-stranded DNA viruses with liver tropism and a narrow host range of susceptibility to infection. At least in the case of duck hepatitis B virus (DHBV), host specificity seems controlled partly at the receptor level. The middle portion in the pre-S region of the viral large envelope protein binds specifically to duck carboxypeptidase D (DCPD) but not to its human or chicken homologue. Although domain C of DCPD is implicated in ligand binding, the exact pre-S contact site remains to be determined. We prepared and tested a panel of chimeric constructs consisting of DCPD and human carboxypeptidase D (HCPD). Our results indicate that a short region at the N terminus of domain C (residues 920 to 949) is critical to DHBV binding and is a major determinant for the host specificity of DHBV infection. Replacing this region of the DCPD molecule with its human homologue abolished the DHBV interaction, whereas introducing this DCPD sequence into HCPD conferred efficient DHBV binding. Extensive analysis of site-directed mutants revealed that both conserved and nonconserved residues were important for the pre-S interaction. There were primary sequence variations and secondary structural differences that contributed to the inability of HCPD to bind the DHBV pre-S domain.

Amino Acid Sequence↗
PubMed1999

[The evaluation of HepatoConsult, a hepatological expert system--the initial results and trends].

BACKGROUND AND OBJECTIVE: HepatoConsult (HC) is a medical expert system, based on the expert system building block D3, designed to aid in the diagnosis of liver and biliary tract disease. It was the aim of this study to evaluate its diagnostic competence in clinical cases prospectively. PATIENTS AND METHODS: The diagnostic accuracy of HC was tested prospectively in 106 consecutive patients with the main diagnosis of liver disease. 57 were ambulant, 49 were in-patients. The data were obtained and stored at defined phases of the diagnosis. The diagnoses put forward by HC were compared with the final clinical diagnosis and, on the basis of the data, checked for plausibility by four experienced physicians. RESULTS: After history taking and physical examination HC put forward the main diagnosis, as established by the doctors in charge, in 60% of patients. After addition of the results of basic laboratory tests and sonography, HC provided the correct diagnosis in 85% and, after inclusion of all the findings, in 93%. In almost all cases HC put forward diagnoses that were, on the basis of the supplied data, considered correct by the four physicians experienced in liver disease. In 56% of cases HC provided more differentiated diagnoses or items in the differential diagnosis than the attending doctors. In the opinion of the four assessors HC had not put forward any seriously wrong diagnoses. CONCLUSION: HC can be useful in solving diagnostic problems and thus in ensuring the quality of medical diagnoses.

Diagnosis, Computer-Assisted↗
PubMed1998

[The patient with isolated pancreatic enzyme elevation].

Elevated serum lipase and amylase activities are the most common laboratory tests for pancreatitis. Next to pancreatic pathologies elevated pancreatic enzymes are associated with several other diseases. If no such association is found, an idiopathic form of pancreatic enzyme elevation can be diagnosed. For this entity no pancreatic pathologies have been found. In contrast to other diseases with elevated pancreatic enzymes, the idiopathic form needs neither further diagnostic management nor a regular follow-up.

Amylases↗
PubMed1996

[Diagnosis of hepatocellular carcinoma].

Hepatocellular carcinoma (HCC) is a frequent complication of chronic liver disease. The major causes of chronic liver diseases are hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, as well as chronic alcohol misuse. The clinical presentations of HCC patients are unspecific, with signs and symptoms of chronic liver disease. Early diagnosis of HCC in an asymptomatic and potentially curable stage is of highest priority. The present strategy for the detection of early HCC in patients with chronic liver disease is 6-monthly determination of alpha-fetoprotein (AFP) and ultrasound study of the liver. If these are abnormal, further diagnostic steps include computer tomography, magnetic resonance tomography, lipiodol-angiography and histopathology. By this sequential diagnostic strategy it should be possible to identify HCC in patients with chronic liver disease at an early and potentially curable stage.

Angiography↗