Biomedical subjects
H Huchzermeyer
Publications and source records attributed to H Huchzermeyer.
[Histamine effects on the heart with special reference to cardiac side effects of H2 receptor antagonists].
The existence of cardiac h1- and h2-receptors is evidenced by pharmacologic studies. Despite of the relatively high content of cardiac histamine it is not clarified whether histamine actually plays a physiologic role - apart from pharmacologic effects - in the regulation of myocardial function and coronary blood flow. Under pathophysiologic conditions (during anaphylaxis, surgical procedures, accidents, stress etc.), however, when a local or systemic histamine release occurs both hemodynamic and arrhythmogenic effects are evident. Numerous studies in animal models conclusively demonstrated a role of cardiac histamine as a major mediator of serious arrhythmias. Consequently, a combination of h1- and h2-receptor antagonists (f.e. Dimetinden/Cimetidin) was recommended as a prophylactic treatment against severe anaphylaxis including life-threatening arrhythmias for cardiac patients at risk. There is pharmacologic evidence of both a positive inotropic and chronotropic effect in the human heart via h2-receptor and stimulation of adenylate cyclase. Histamine-induced coronary effects such as vasoconstriction via h1-receptor and coronary dilatation via h2-receptor are not yet sufficiently validated. Studies on the human heart in vitro using coronary strips from explanted hearts and in vivo investigations on the intact coronary system yielded conflicting results. H2-receptor blocking agents cimetidine, ranitidine and famotidine have qualitatively a different pharmocodynamic spectrum of side effects due to differences in chemical structure. Data on cardiac arrhythmias are mostly associated to cimetidine. Symptomatic bradycardia were reported for both ranitidine and cimetidine. A possible negative inotropic effect of famotidine, although presently not validated, requires further studies. Causative and adverse side effects of cimetidine on the cardiovascular system, however, are to be expected extremely seldom due to easily reversible competetive h2-receptor binding. For prophylaxis rapid intravenous injections of h2-blockers, particularly in elder patients with cardiac diseases, should be avoided. Compared to cimetidine, a tendency of explainable difference seems to become apparent for ranitidine and famotidine due to higher receptor affinity.
[Pathophysiologic aspects of gastrointestinal, pancreatic and hepatic osteopathies].
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[The syndrome of acute fatty liver in pregnancy].
It is reported on the syndrome of the acute fatty liver of pregnancy and pointed out that early diagnosis, subsequent early termination of pregnancy and intensive treatment of complications, especially of hepatic and renal failure and disturbed blood clotting could reduce the mortality from almost 90 to 45 per cent within the recent years.
Follow-up study of chronic gastric erosions.
Chronic gastric erosions were detected with a frequency of 4.4% in 8,468 patients over the six year period from 1971 to 1977. The lesions were usually multiple, chain-like or clustered, along the greater curvature. The age group most often afflicted was the 50-60 year olds, and male predominance were three to one. In one-third of the cases, chronic erosions were found in combination with gastric or duodenal ulceration. Longterm observation of 64 patients over a period of four and a half years revealed no change in the condition in 50%, increase, decrease or complete disappearance of the lesions were found in the remaining 50%. In 10% chain-like multiple erosions developed into a persisting fold in the gastric mucosa. No evidence suggesting that erosive lesions lead to chronic ulceration or development of either polyps or malignancy within 4 1/2 years was recorded, nor was there any association with gastric protein loss.
Endoscopic therapy of a congenital oesophageal stricture.
A sixteen months old girl with Down's-Syndrome suffered from congenital oesophageal membrane and segmental oesophageal stricture. In the neonatal period, two other associated malformations of the gastrointestinal tract (malrotation of gut and duodenal web) had been operated successfully. The first endoscopic examination of the eosophagus was performed at the age of sixteen months because of increasing dysphagia. A solid membrane in the lower part of the oesophagus was incised by diathermy. The associated segmental stenosis necessitated repeated bougienages. After this treatment the child developed well without clinical signs of dysphagia.
[Endoscopic retrograde cholangiopancreaticography (ERCP) and percutaneous transhepatic cholangiography (PTC) in cholestatic syndromes of children and adolescents (author's transl)].
Conventional cholangiography had failed to establish a diagnosis in 5 children aged 6 weeks to 14 years and in 6 adolescents aged 14 to 18 years suffering from cholestasis; therefore endoscopic retrograde cholangiopancreaticography (ERCP) was performed, allowing to establish congenital biliary tract anomalies, cholelithiasis and benign obstruction of the extrahepatic biliary tract as causes of the cholestatic syndromes. Thus ERCP again turned out to be a valuable diagnostic procedure. Percutaneous transhepatic cholangiography (PTC) using the Chiba technique has not yet been applied in infancy to a great extent. Application of PTC however should be considered as well in cholestasis. It cannot yet be decided, if ERCP or PTC is to be prefered in neonatal cholestasis; further investigations are needed to clear up this point.
[Preoperative detection of antrum mucosa in patients with peptic ulcer following gastric secretion -- indication for reintervention?].
In 6 of 23 patients with marginal ulcer after gastric resection (B II and Roux-Y anastomosis) a retained ("excluded") gastric antrum attached to the duodenal stump was detected by 99mTC pertechnetate scintiphotography; serum gastrin levels were normal in two of those cases. Resection has been abandoned as a treatment method, and transthoracic vagotomy is recommended for this disease.
[Equipment and technic of endoscopic examination of children].
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Response of basal and pentagastrin-stimulated gastric secretion and of serum gastrin to short- and long-term intravenous infusion of salmon calcitonin in hyperchlorhydric subjects.
In 23 volunteers with gastric hyperchlorhydria the effect of intravenous administration of salmon calcitonin (SMC) on basal (n = 11) and pentagastrin-stimulated gastric secretion (n = 12) and on immunoreactive serum gastrin (n = 11) was studied under various experimental conditions. SMC (0.075 microgram . kg(-1) . 2h(-1) and 0.3 microgram . kg(-1) . h(-1)) caused a statistically significant reduction of HCl output of 75% and 80% and of pepsin of 55% and 90%. Serum gastrin concentration showed a dose-dependent decrease of 17% and 31% respectively. Pentagastrin-stimulated acid secretion was moderately inhibited by short-term administration of SMC (0.15 and 0.30 microgram . kg(-1) . 30 min(-1)), the effect being confined to the period of application of the hormone. Long-term infusion of the smaller dose for 2 1/2 h induced a sustained decrease of HCl output by 55%. It is assumed that SMC inhibits gastric secretion mainly by interfering with the production or liberation, or both, of gastrin. Whether long-term administration of SMC has advantages over substances currently used as therapeutic inhibitors of gastric secretion, e.g. in gastroduodenal bleeding, has yet to be investigated.
[Endoscopic findings in massive intestinal hemorrhage in childhood].
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[Recent radiographic technics in biliary tract diseases. Excretion cholangiography, ERCP, invasive methods].
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Endoscopic results in five patients with Crohn's disease of the esophagus.
In our experience with five cases of Crohn's disease of the esophagus, the endoscopic appearance has been demonstrated. Corresponding to the basic pathological changes, the findings are very different, but two stages may be differentiated: Stage I in which inflammatory changes predominate as a mild or more often erosive-ulcerative esophagitis. Stage II is a stenosing form similar to a peptic stenosis or to a stenosing tumor. The morphological changes are predominantly limited to the lower part of the esophagus with a tendency to extend to the proximal regions. The diagnosis may be established endoscopically only in special cases with shallow ulcerations within a normal mucosa or with cobble-stone relief which is usually seen in the colon. In all other cases, a specific macroscopical appearance of Crohn's disease of the esophagus does not exist and no specific differentiation is possible from other forms of esophagitis. Only by a combination of endoscopy, radiology and histology can the diagnosis be suspected. Guided biopsies are not able to confirm the diagnosis histologically. The exact diagnosis of Crohn's disease of the esophagus is only possible by histological examination of the resected esophagus.
Dilatation of benign esophageal strictures by peroral fiberendoscopic bougienage.
A low risk procedure for dilation of esophageal strictures is peroral bougienage under direct endoscopic vision with a flexible fiberscope. First the stricture is inspected using the foreward lens of the fiberscope, and then dilated with conventional bougies according to its nature and size under direct visual control. In this paper we report on the treatment of 16 patients with inoperable advanced benign stenosis. In a total of 86 sittings an average of three bougienages each were performed without complication.
[The radiological diagnosis of non-calculous biliary duct obstruction (author's transl)].
A diagnosis of obstructive biliary duct disease was achieved in 80% of 63 patients using endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous trans-jugular cholangiography (PTJC) alone or in combination, and taking account of the clinical features. In obstructions of themajor intrahepatic ducts and of the hepatic ducts (type I) a smooth occlusion indicated a carcinoma. Narrow forms of stenoses could not be differentiated, but with a history of previous operation, fibrous strictures were most likely. Obstructions at the point of confluence (type II) showed smooth narrowing if due to fibrous strictures, whereas carcinomas produced an irregular termination. Obstructions of the common bile ducts (type III) resembled those of type II. A smooth termination within the pancreas indicates a pancreatic carcinoma. Inflammatory disease in the head of the pancreas usually produces a tubular stenosis, while cysts of the pancreas result in smooth impressions and displacement.
[Transjugular puncture of the portal vein. Portography and selective phlebography of abdominal organs. An experimental study in dogs (author's transl)].
Transjugular transhepatic portography is a new method for catheterising the portal vein and its tributaries. In order to gather experience of the method before applying it clinically, the transvenous approach was studied in six dogs. Transjugular portography has the following advantages as compared with umbilical vein catheterization and percutaneous, transhepatic portal vein catherterisation: 1. Because of the relative positions of the jugular veins, vena cava and portal vein, manipulation of the catheter for selective phlebography is simpler. 2. There is no risk of a haemoperitoneum or bile peritonitis if a correct technique is used since the liver capsule remains intact. 3. In the presence of portal hypertension, it may be possible in future to create an intrahepatic portocaval shunt by the transjugular approach without a major operation. Sclerosis of oesophageal varices is possible, as it is with the other procedures.
Determination of splenic blood flow by inhalation of radioactive rare gases.
We have evaluated the 133Xenon inhalation method for the determination of splenic blood flow. In twenty-two healthy persons the blood flow was on average 109 +/- 4 mg/100 g X min, which is equivalent to a total blood flow of about 170 ml/min. In patients with chronic fatty liver hepatitis specific blood flow was reduced (81 +/- 10 ml/100 g X min) as it was in patients with cirrhotic liver without splenomegaly (75 +/- 2 ml/100 g X min). With increasing weight of the spleen, the total blood flow rises, although specific blood flow is low. Our results obtained by the 133Xenon inhalation method are similar to results obtained by others using intraarterial injection of tracer gas. The advantages of the inhalation method as a non-traumatic method are: (1) the stress for the patient is very small; (2) blood flow measurements can be repeated within short periods of time. We consider for the present the 133Xenon inhalation method to be the method of choice for the determination of the splenic blood flow.
[The radiological findings in oesophagitis due to Crohn's disease (author's transl)].
The radiological changes in oesophagitis due to Crohn's disease are described in five patients. Like the pathological and anatomical findings, the appearances proved very variable. Neither in our own observations, nor in the literature, are there any radiological findings which are diagnostic. The diagnosis can only be made on the basis of radiological, endoscopic and histological findings.