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Biomedical subjects

H Ditschuneit

Publications and source records attributed to H Ditschuneit.

At least 55 records · Page 3Linked to original sources
PubMed1991

The quality of gastroenterological reports based on free text dictation: an evaluation in endoscopy and ultrasonography.

The majority of physicians consider the use of free dictation for medical reports to be essential in many domains. One of the main criticisms of structured data entry is the possible lack of flexibility and completeness. Electronic documentation systems exist for endoscopy and ultrasonography examinations which are based on structured input as well as on free dictation. Endoscopy and ultrasonography reports based on free dictation were evaluated for omissive errors. The data evaluated was drawn from a database of 18,239 gastroscopy and 3,340 colonoscopy reports dictated by 28 physicians over 74 months, and 18,834 ultrasonography reports dictated by 37 physicians over 42 months. The error rates varied from 0% to 41.8% depending upon the particular feature and the particular examination, but were usually below 15%. The results were independent of the experience of the examiner. This study provides baseline measurements of omissive error rates for selected findings in gastrointestinal endoscopy and abdominal ultrasonography which can be used as standards for the development and evaluation of systems for collection of clinical data.

Database Management Systems↗
PubMed1991

Nucleation time, cholesterol saturation index, and biliary bile acid pattern. A comparison in responders and nonresponders to systemic litholysis with bile acids.

In a 24-month trial of a combination therapy with ursodeoxycholic acid and chenodeoxycholic acid complete dissolution of radiolucent gallstones was achieved in 15 of 55 patients (27.3%). A decrease of stone volume of greater than 35% was achieved in a further 28 patients (50.9%). In 12 patients (21.8%) inadequate compliance (3.6%), a nonfunctioning gallbladder (3.6%), absence of size decrease (10.9%), or acute cholecystitis (3.6%) required interruption of therapy. Determination of the cholesterol saturation index (CSI) did not facilitate patient selection, nor was there a statistically significant difference between responders and nonresponders to dissolution therapy. In the course of treatment the average CSI showed a statistically significant decrease from 1.54 +/- 0.12 to 0.82 +/- 0.06 (p less than 0.001). Patients in whom complete dissolution was achieved and those in whom no improvement was observed differed significantly in nucleation time (4.7 +/- 0.8 versus 15.0 +/- 2.2 days; p less than 0.001) and initial gallstone volume (274 +/- 78 versus 1045 +/- 180 mm3). The nucleation time increased statistically significantly during the therapy in the successfully treated group. The percentages of glycocholic acid (8.1 +/- 1.13 versus 4.1 +/- 0.55%; p less than 0.01), taurocholic acid (2.2 +/- 0.45 versus 0.8 +/- 0.23%; p less than 0.05), and glycodeoxycholic acid (4.9 +/- 0.70 versus 1.4 +/- 0.37%; p less than 0.001) were statistically significantly different after the treatment. There were no statistically significant differences between patients with complete and incomplete stone dissolution with regard to age, mean body weight, or laboratory variables.

Acute Disease↗
PubMed1991

Modulation of arachidonic acid metabolism by olsalazine and other aminosalicylates in leukocytes.

We investigated the action of the new aminosalicylate olsalazine (disodium azodisalicylate) on arachidonic acid metabolism in comparison with 5-aminosalicylic acid (5-ASA) and sulphasalazine (SASP) by in vitro incubation of cellular homogenates from human polymorphonuclear (PMNL) and mononuclear (MNL) leukocytes with 14C-labelled arachidonic acid. Olsalazine reduced the synthesis of leukotriene B4 (LTB4), 5-hydroxyeicosatetraenoic acid (5-HETE), 11-HETE, 12-HETE, and 15-HETE in PMNL and MNL slightly less than SASP. 5-ASA was significantly less inhibitory than olsalazine and SASP on the formation of lipoxygenase products in PMNL and on LTB4 synthesis in MNL. In contrast, in MNL the formation of 5-HETE was unaffected, and the production of 11-HETE, 12-HETE, and 15-HETE was even slightly activated by 5-ASA. Total prostaglandin synthesis was dose-dependently reduced by the aminosalicylates (SASP greater than olsalazine greater than 5-ASA), but only SASP markedly altered the prostaglandin (PG) profile, with an increase in PGE2 and PGF2 alpha at the expense of other cyclooxygenase products. It may be concluded that olsalazine resembled SASP with regard to the inhibition of the lipoxygenase but had effects intermediate between the other salicylates on cyclooxygenase. Furthermore, the alteration of the prostaglandin profile by SASP points to an overlying cofactor effect of this drug.

Aminosalicylic Acids↗
PubMed1991

Fine structure of active and healed duodenal ulcer.

In order to characterize the fine structure of active and healed duodenal ulcers, we examined tissue specimens of patients with active duodenal ulcer disease (n = 30) before and after treatment with either antacids (n = 16) or H2-receptor antagonists (n = 14), by light microscopy and various electron microscopic techniques, e.g., scanning and transmission electron microscopy. The characteristic histological feature of both the active and healed duodenal ulcer was the appearance of periodic acid-Schiff (PAS)-positive epithelial cells at the edge of the ulcers. Electron microscopy revealed that these cells were similar to a special type of mucus-secreting cell in the antrum (surface mucous cell). Their mucus granules contained mainly neutral glycoproteins. Helicobacter pylori were found attached to these cells in tissue specimens from 12 of 30 patients (40%). The mucous structure destroyed during the ulcerative phase regained its normal net-like structure after treatment. The ultrastructural healing process of duodenal ulcer was characterized by the presence of gastric metaplasia, by stunted microvilli of the duodenal epithelium (p less than 0.001 vs. control group), and an increased number of lysosome-like bodies (p less than 0.001 vs. control group) of the epithelial cells. These results were independent of the type of treatment, and showed that the repair mechanisms were incomplete after a 4-wk period of treatment.

Adult↗
PubMed1991

[Severe hyperemesis gravidarum--pathophysiologic observations and new therapeutic approach].

It is reported on a 27 year old female patient who was hospitalized twice during her first pregnancy (16th and 28th week) because of severe hyperemesis gravidarum. Severe clinical symptoms associated with severe alterations in the clinical chemistry posed a series of differential diagnoses. Several diseases as potential causes for unappeasable vomiting were taken into account. All traditional therapeutic efforts to relieve hyperemesis gravidarum including H2-blockers in high dosages were not successful. Treatment with omeprazole proved to be effective by stopping the vomiting immediately. After the delivery of a healthy child in the 37th week of pregnancy, several investigations were performed to exclude organic diseases. Etiology and symptoms of hyperemesis gravidarum are discussed with regard to the gastrointestinal tract and thyroid gland function.

Adult↗
PubMed1991

Comparison of different HMG-CoA reductase inhibitors.

The HMG-CoA reductase inhibitors have been shown to cause marked reduction of cholesterol and offer a new and effective approach to treatment of hyperlipoproteinemia. Three agents, pravastatin (P), lovastatin (L) and simvastatin (S), have been studied with reference to long-term lipid-lowering effect, tolerance and clinical safety. Following a dietary lead-in period of at least 6 weeks in every case, patients with primary hypercholesterolemia were enrolled from participants of short-term controlled studies which after completion were extended as open studies. Treatment was administered over 6 months with 20 mg S (84 patients), L (42 patients) or P (23 patients) twice daily. Total cholesterol was decreased with S by 30.2% of basal, with L by 25.5%, and with P by 28.2%. The decrease in apolipoprotein B was 28.4%, of basal, with S 16.4% and in P 19.2%. Triglycerides were lowered by 19.6% of basal with S by 17.4%, with L, and by 6.4% with HDL-cholesterol increased in the S group by 23% of basal, by 9.7% in the L group, and by 8.0% in the P group. No serious clinical or laboratory abnormalities were observed. In the S group headache (3.6% of patients), abdominal discomfort (2.4%), sleeping disturbances (3.6%), and muscle pain (2.4%) were reported. In the L group headache (7.1%), abdominal discomfort (4.8%), sleep disorders (4.8%), and muscle pain (4.8%) were observed. In the P group one patient complained of abdominal discomfort (8.7%) and one of sleep disorders (8.7%). Increases in CPK were observed in the S group (4.8% of patients) and in the L group (11.9%).(ABSTRACT TRUNCATED AT 250 WORDS)

Anticholesteremic Agents↗
PubMed1991

Bezafibrate fails to directly modulate HMG-CoA reductase or LDL catabolism in human mononuclear cells.

The effect of bezafibrate on HMG-CoA reductase, the key enzyme of cholesterol synthesis, and LDL metabolism was studied in human mononuclear cells. Bezafibrate at concentrations achieved during administration in patients did not suppress preformed reductase in mononuclear cells. Similarly, the drug was ineffective in regulating reductase when added to the medium of cultured cells. Also, the fibrate did not modulate the enzyme suppression mediated by LDL. At very high concentrations bezafibrate enhanced LDL binding, but both total cell association and degradation were unchanged. Thus, the previously observed decrease of HMG-CoA reductase activity in mononuclear cells of patients treated with fibrates is likely to be indirect and probably due to changes in LDL structure.

Bezafibrate↗
PubMed1990

[Efficacy of a bismuth combination preparation. Efficacy in the treatment of chronic active gastritis and non-ulcerous dyspepsia].

In an open, randomized controlled study, the effect of a combined bismuth preparation, bismuth nitrate and bismuth aluminate on the elimination of Helicobacter pylori, inflammatory activity in the gastric mucosa in chronic type B gastritis, and on the patient's symptoms was investigated. Included in the study were 36 patients with non-ulcerous dyspepsia and chronic gastritis. Twelve patients (Group A) received 4 x 1 tablet a day (800 mg total daily dose), 12 patients (Group B) 2 x 2 tablets a day (800 mg total daily dose), 12 patients (Group C) 2 x 1 tablet (400 mg total daily dose) for a period of 4 weeks. Elimination of Helicobacter pylori was observed in 73% of the patients in Group A, in 87% in Group B, but in only 16% in Group C. Inflammatory activity, measured in terms of polymorphonuclear cell infiltration, regressed noticeably in Group A und B (p less than 0.01), but not in Group C. In all patient groups symptoms regressed significantly (p less than 0.01). Bismuth and methemoglobin concentrations in the serum were within the normal range in all patients on conclusion of treatment.

Adult↗
PubMed1990

Computed tomography evaluation of radiolucent gallstones in vivo.

Computed tomography facilitates an in vivo classification of gallstones and can aid in the identification of calcifications that escape detection with conventional radiologic procedures. Of patients with radiolucent stones, 54.8% exhibited calcifications either in the form of discrete rims (41.9%) or at the center of the stone (12.9%). Densities of the noncalcified areas of partially calcified stones averaged 40.68 +/- 6.8 Hounsfield units (HU), which was not significantly higher than the average of 31.85 +/- 3.19 HU for noncalcified stones. Calcified regions showed significantly higher densities (240.0 +/- 28.6 HU, p less than 0.001, x +/- SEM). Of the identified stones, 16.1% showed densities greater than 50 HU. These were primarily bilirubin stones, which cannot yet be treated successfully with conservative therapeutic modalities.

Adult↗
PubMed1990

[Ultrasound evaluation of gallbladder function using planimetry].

Fourteen patients with gallstones (13 female, 1 male; mean age 45.1 +/- 14.6 years; mean body weight 105.7% +/- 18.7% of ideal body weight) were included in the present study. Prior to and 45 min. after administration of a standard fatty meal, patients were examined by ultrasound. The mean gallbladder volume decreased from 20.94 +/- 10.0 cm3 to 6.83 +/- 3.5 cm3 (ejection fraction (EF) = 61.7 +/- 27.9%), the mean cross-sectional area from 12.0 +/- 3.4 cm2 to 6.0 +/- 2.8 cm2 (percentage changes 48.0% +/- 25.5%). A correlation is shown to exist between the ejection fraction of gallbladder emptying and the decrease of gallbladder area (r = 0.91; p less than 0.001). The simple measurement of the gallbladder area of a section through the long axis adequately demonstrates gallbladder contraction.

Adult↗
PubMed1990

Effects of TRH on pancreatic growth and secretion in rats.

Thyrotropin-releasing hormone (TRH) has been shown to be scattered throughout the gastrointestinal tract. High concentrations of TRH are reported in the pancreas of animals and humans. The present study was designed to investigate the pattern of pancreatic adaptation following chronic TRH administration in rats. Ten male Wistar rats were injected daily at 8.00 and 16.00 h with TRH (total dose of 6 mg/kg of body weight/day) via a chronic gastric fistula. Ten pair-fed control animals were injected with a saline solution. After 10 days, the rats were killed after an overnight fast; pancreatic wet weight, DNA, protein, amylase, trypsin, and lipase content were determined. Blood TRH levels were measured using a specific RIA (TRH antiserum K2B7, normal range of 30-80 fmol/ml). TRH increased pancreatic wet weight (+70%, p less than 0.01), DNA content (+83%, p less than 0.01), and protein content (+42%, p less than 0.05). Pancreatic enzyme concentrations (U/mg of DNA) were decreased (amylase, -81%; trypsin, -47%; lipase, -59%, p less than 0.01). Absolute rates of amylase discharge (U/mg of DNA) in vitro were reduced in TRH-treated rats (p less than 0.01) but the relative amount of basal and stimulated amylase discharge (% of total) was not influenced by TRH. Blood TRH levels were significantly increased (324 +/- 53 vs. 48 +/- 6 fmol/ml, p less than 0.01) 12 h after the last TRH administration. These data indicate that chronic TRH administration in rats induces pancreatic hyperplasia but decreases the pancreatic concentration of digestive enzymes.(ABSTRACT TRUNCATED AT 250 WORDS)

Amylases↗
PubMed1990

Comparison of gall bladder bile and endoscopically obtained duodenal bile.

In 10 patients with gall stone disease (eight women, two men; mean (SD) age 47.4 (13) years), bile was obtained by endoscopic aspiration after stimulation of the gall bladder with ceruletid and also by fine needle puncture of the gall bladder under local anaesthetic. The total lipid concentration of the puncture bile samples was mean (SD) 11.9 (4.7) g/dl, significantly higher than the endoscopic bile samples (3.9 (3.3) g/dl, p less than 0.001). Total bile acids, phospholipids, and biliary cholesterol (expressed in mol%) and cholesterol saturation index showed no significant differences between the two types of samples. The glycocholic acid concentration in the endoscopically obtained bile (27.7 (6.6) mol% v 23.3 (5.4) mol%; p less than 0.01) was significantly higher than the puncture bile samples. Puncture bile exhibited a significantly shorter nucleation time (3.5 (3.3) days v 19.6 (11.9) days; p less than 0.001). For determination of the nucleation time, endoscopic bile aspiration after gall bladder stimulation with ceruletid led to adequately concentrated samples in 50% of the study subjects. Cholesterol monohydrate crystal formation in native bile was observed in six samples of puncture bile and in three samples of the endoscopically obtained bile. The presence of cholesterol crystals and the determination of nucleation time in the puncture bile were the best discriminants between cholesterol and pigment gall stones and correlated well with computed tomogram analysis.

Adult↗
PubMed1990

Interdigestive cycling and post-prandial release of pancreatic polypeptide in severe obesity.

Changes in pancreatic polypeptide plasma concentrations have been reported in obesity. It has been suggested that altered PP plasma levels may play a role in the abnormal food intake observed in obesity. Earlier studies, however, have not considered the physiological fluctuations of PP during fasting. We examined PP plasma concentrations in 12 subjects with severe obesity and in 10 normal subjects during the entire cycle of interdigestive motility and after the administration of a standard mixed meal. Obese patients and healthy controls showed similar fluctuations of PP during individual phases of the migrating motor complex (MMC) and reached their peak PP plasma levels (134 +/- 35 (s.e.m.) pg/ml in controls vs 113 +/- 17 pg/ml in obese subjects) during phase III activity. Following the test meal, prompt release of PP occurred which was significantly higher than basal values at each 15 min interval during the first postprandial hour in both controls and obese patients. The integrated PP postprandial response at 60 min did not differ between obese patients (163 +/- 15 pg/ml.h) and controls (198 +/- 37 pg/ml.h; n.s.). A putative causal role for PP in obesity thus seems very unlikely.

Adult↗
PubMed1990

[Local lysis of peritoneovenous shunt thrombosis with rt-PA].

We report five instances of local lysis with rt-PA (recombinant tissue type plasminogen activator) in three patients with thrombotic occlusions of their peritoneovenous Denver shunts (PVS). In all cases liver cirrhosis was alcohol-induced and ascites was refractory to all medical measures. Because of rethrombosis two patients were treated again after 13 months. The occlusion had occurred 2-30 days before treatment. In four of the five instances the local lysis was successful. Complications were rare. This scintigraphic visualization of the catheter system allowed assessment of shunt patency under physiological flow conditions. The local lysis of a thrombotic shunt with rt-PA and scintigraphic monitoring is a low-risk alternative to reoperation. Possible benefits compared to other fibrinolytics must be confirmed by a greater patient collective.

Adult↗
PubMed1990

[Effect of pancreatin on diabetes mellitus in chronic pancreatitis].

The effect of pancreatin on insulinopenic diabetes was studied in 10 patients with chronic pancreatitis and exocrine function impairment. All patients were treated for 4 days in a randomized crossover trial with either pancreatin (6 x 2 capsules, 6 x 300 mg/d) or placebo. Blood glucose levels were determined 7 times every day and night. On day 5, the patients were studied by a glucose sensor with adjustment of blood glucose to 120 mg/dl until 8.00 in the morning. A test meal was applied with 2 capsules pancreatin or placebo. Blood glucose and plasma levels of C-peptide, glucagon and pancreatic polypeptide (PP) were determined in regular intervals for 4 hours. Blood glucose levels were not significantly altered by pancreatin. As shown by M-value according to Schlichtkrull (21.6 +/- 2.9 versus 32.4 +/- 7.4), there was a tendency towards smaller oscillations of blood glucose with pancreatin treatment. C-peptide levels (basal 0.081 +/- 0.008 ng/ml; postprandial 0.119 +/- 0.013 ng/ml) were not significantly altered by the administration of pancreatin. Basal and postprandial glucagon and PP plasma levels were not influenced by pancreatin. From these results, we conclude that pancreatic enzyme supplementation does not significantly alter the requirement of insulin in patients with diabetes mellitus secondary to chronic pancreatitis. Possible disturbances of the enteroinsular axis are discussed in this paper.

Blood Glucose↗
PubMed1990

[Exclusion diet in Crohn disease: a controlled, randomized study].

In a controlled study patients with Crohn's disease received an exclusion diet or an diet low in refined carbohydrates and rich in fiber. A total of 26 patients was observed for 1 year. The exclusion diet was not significantly superior to the standard diet with respect to the clinical course (Crohn's disease activity index according to Best or van Hees) or laboratory parameters of inflammatory activity. During dietary counselling relapses were infrequent and symptoms improved in both dietary groups.

Crohn Disease↗
PubMed1990

[Nucleation time and age in patients with gallstones].

The relationship between nucleation time (NT), total lipid concentration (TLC) and age was studied in a group of 45 gallstone patients (10 male, 35 female, age 50.1 +/- 14.5 yrs). Bile was obtained by direct fine needle puncture of the gallbladder under local anaesthesia and sonographic monitoring. There was a positive correlation between age and nucleation time (r = 0.626, p less than 0.001), in addition to a negative correlation between age and total bile lipid concentration (TLC) (r = -0.414, p = 0.005). The negative correlation between age and TLC indicates that gallbladder's ability to concentrate the bile decreases significantly with age. It is possible that the decreased concentration is a result of the chronic pathogenetic effects of gallbladder stones. Practically all patients showed a prolonged nucleation time after the 60th year (11.54 +/- 5.50 vs. 2.65 +/- 2.52 days). This would seem to indicate that these patients suffered primarily from bilirubin or calcified stones, currently unsuited for conservative therapy methods.

Adult↗