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Biomedical subjects

H Wurzer

Publications and source records attributed to H Wurzer.

At least 19 recordsLinked to original sources
PubMed2001

Intraductal papillary-mucinous tumors of the pancreas: presentation of eight cases.

BACKGROUND AND STUDY AIMS: The mucinsecreting intraductal papillary-mucinous tumors of the pancreas are a rare entity with characteristic duodenoscopic and radiological features. These tumors have a broad spectrum of presentation. The diagnosis requires highly experienced and attentive endoscopists. Once diagnosed, resection of the tumor is recommended to prevent progression to malignancy. This surgical procedure has a low acceptance, mainly in the elderly patients. Therefore, a "wait and see" strategy may be necessary in those patients refusing operation. PATIENTS AND METHODS: Between 1996 and 2000, intraductal papillary-mucinous tumors of the pancreas were diagnosed in eight patients (5 females, 3 males) using endoscopic retrograde cholangiopancreatography, and confirmed by brush cytology and/or histology and analyzed retrospectively. RESULTS: The patients showed typical endoscopic and radiological findings: dilatation and mucin extrusion of the papillary orifice, easy passage of instruments into the dilated main pancreatic duct, which showed patchy filling defects after application of contrast medium. Patients were informed about the diagnosis in detail. Two patients were inoperable. Surgery was recommended to the other six patients. Two of the six patients agreed to surgical treatment. The remaining four patients were included in a follow-up protocol. These patients were observed for up to 5 years. Only one patient showed minor progression of ERCP-findings. CONCLUSION: Intraductal papillary-mucinous tumors of the pancreas can be well characterized by means of endoscopy and radiology. Poor compliance to surgical treatment makes individual multidisciplinary management and follow-up necessary.

Adenocarcinoma, Mucinous↗
PubMed2000

Pantoprazole 20 mg is an effective maintenance therapy for patients with gastro-oesophageal reflux disease.

OBJECTIVES: To compare the efficacy of 20 mg with 40 mg pantoprazole in maintaining symptomatic and endoscopic remission in patients with gastro-oesophageal reflux disease (GORD). STUDY DESIGN: Patients (18-84 years old; n = 433) with healed GORD II or III were included in this prospective multi-centre, randomized, parallel, double-blind study. Pantoprazole was administered once daily for up to 1 year as either a 20 mg or 40 mg enteric-coated tablet to 221 and 212 patients, respectively. Symptoms of GORD were assessed every 3 months. Endoscopy was performed at entry, after 6 and 12 months, or when symptoms of GORD were perceived on at least three consecutive days. The primary efficacy parameter was the time until endoscopically proven relapse of GORD occurred (stage I or greater); the secondary parameters included tolerability, safety, and time until symptomatic relapse occurred. RESULTS: In the 20 mg treatment group, 87% and 75% of patients were in endoscopic remission after 6 and 12 months, respectively; the corresponding rates in the 40 mg treatment group were 91% and 78%. In both treatment groups, GORD stage I accounted for about 50% of endoscopic relapses. The symptomatic remission rates in the 20 mg group were estimated as 85% and 77% after 6 and 12 months, respectively; the corresponding values in the 40 mg group were 87% and 76%. No correlation was seen either between the endoscopically proven relapse and perception of symptoms, or between the severity of the pre-treatment stage of GORD and the maintenance dose of pantoprazole. Both doses were well tolerated. CONCLUSIONS: Both the 20 mg and 40 mg doses of pantoprazole are safe and effective in maintaining patients with healed reflux oesophagitis in remission. Moreover, for the majority of patients, the 20 mg dose provides adequate long-term therapeutic efficacy at a minimal drug exposure and lower costs.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1999

Famotidine versus omeprazole in combination with clarithromycin and metronidazole for eradication of Helicobacter pylori--a randomized, controlled trial.

BACKGROUND: One-week low-dose triple therapy is currently considered the gold standard regimen for treatment of Helicobacter pylori infection. However, the mechanisms involved in the synergy between antibiotics and proton pump inhibitors are controversial. AIMS: To test the hypothesis that acid suppression represents the crucial mechanism by which the antibacterial activity of antibiotics can be enhanced, and to assess the impact of primary resistance on treatment outcome. METHODS: One hundred and twenty patients with H. pylori infection and duodenal ulcer, gastric ulcer or non-ulcer dyspepsia were randomly assigned to a 1 week course of either famotidine 80 mg b.d., clarithromycin 250 mg b.d. and metronidazole 500 mg b.d. (FCM group; n = 60) or omeprazole 20 mg o.d., clarithromycin 250 mg b.d. and metronidazole 500 mg b.d. (OCM group; n = 60). Gastroscopy was performed at baseline and 5 weeks after completion of treatment. H. pylori status was assessed by biopsy urease test, histology and culture. RESULTS: In the intention-to-treat analysis, eradication of H. pylori was achieved in 47 of 60 patients (78%; 95% CI: 66-88%) in the FCM group, compared to 44 of 60 patients (73%; 95% CI: 60-84%) in the OCM group (N.S.). Using per protocol analysis, eradication therapy was successful in 47 of 52 patients (90%; 95% CI: 79-97%) treated with FCM and 44 of 57 patients (77%; 95% CI: 64-87%) treated with OCM (N.S.). Primary metronidazole resistance was present in 27% and primary clarithromycin resistance in 8% of strains. Overall per protocol eradication rates in strains susceptible to both antibiotics and strains with isolated metronidazole resistance were 93% and 84%, respectively. No patient with clarithromycin resistance responded to treatment. CONCLUSIONS: High-dose famotidine and omeprazole, combined with clarithromycin and metronidazole, are equally effective for eradication of H. pylori. In 1-week low-dose triple therapy, metronidazole resistance has no major impact on eradication rates whereas clarithromycin resistance is associated with a poor treatment outcome.

Adult↗
PubMed1998

Eradication of Helicobacter pylori by a 1-week course of famotidine, amoxicillin and clarithromycin.

OBJECTIVES: The combination of a proton pump inhibitor (PPI) such as omeprazole with amoxicillin and clarithromycin constitutes one of the most effective treatments for the eradication of Helicobacter pylori. Nevertheless, the mechanisms of interaction between these drugs remain unclear. It has been shown that minimal inhibitory concentration values of both antibiotics are considerably lower at neutral pH levels than in an acid environment. Further, omeprazole possesses bacteriostatic activity. To evaluate the significance of these mechanisms we replaced omeprazole with famotidine, a drug which only suppresses acid production, but has no intrinsic antimicrobial activity. METHODS: We evaluated the efficacy of a 1-week course of famotidine 80 mg b.i.d., amoxicillin 1000 mg b.i.d. and clarithromycin 500 mg b.i.d. in a pilot study (20 patients), and then confirmed our results in a larger replication study (87 patients). A total of 107 patients with H. pylori-associated duodenal ulcer (n = 54), gastric ulcer (n = 14) or non-ulcer dyspepsia (n = 39) were included. Endoscopy was performed at baseline and 4-6 weeks after discontinuation of treatment. H. pylori status was assessed by the urease test and histology. RESULTS: H. pylori was successfully eradicated in 94 of 104 patients who completed the study (90.4%; CI 95%, 83.0-95.3%). By intention-to-treat analysis, the eradication rate was 87.9% (CI 95%, 80.1-93.4%). Ulcer healing was observed in 98.1% of duodenal ulcers and 92.9% of gastric ulcers (based on per-protocol analysis). Mild side effects that did not require termination of treatment were reported by seven patients (6.7%). CONCLUSION: A 1-week course of famotidine, amoxicillin and clarithromycin is a highly effective, simple and safe eradication regimen. Our data indicate that acid suppression is the crucial mechanism by which the activity of amoxicillin and clarithromycin against H. pylori is enhanced, whereas additional antimicrobial activity or other specific effects of PPIs seem to be less important.

Adult↗
PubMed1998

Ranitidine bismuth citrate with clarithromycin given twice daily effectively eradicates Helicobacter pylori and heals duodenal ulcers.

OBJECTIVE: Ranitidine bismuth citrate (RBC) b.i.d. with clarithromycin q.i.d. eradicates Helicobacter pylori (H. pylori) in 82-94% of patients, and heals duodenal ulcers in 88-90% of patients. This double blind, placebo-controlled study examines the efficacy of a simpler b.i.d. treatment regimen, and examines the potential benefit of including a second antibiotic, metronidazole, to the b.i.d. treatment regimen. METHODS: A total of 648 patients with active duodenal ulcer received RBC 400 mg b.i.d. for 4 wk, coprescribed with clarithromycin 250 mg q.i.d., clarithromycin 500 mg b.i.d., or clarithromycin 500 mg b.i.d. with metronidazole 400 mg b.i.d. for the first 2 wk of treatment. Endoscopies were performed prestudy, after 4 wk of treatment, and at least 4 wk posttreatment. H. pylori status was assessed by CLOtest, 13C-urea breath test (UBT), and histology prestudy, and by UBT and histology at least 4 wk posttreatment. Adverse events were recorded at each visit. RESULTS: All three regimens were highly effective and well tolerated. H. pylori eradication rates were 84-94% and duodenal ulcer healing rates were 92-96% (observed data). Highest H. pylori eradication and ulcer healing rates were achieved with RBC 400 mg b.i.d. with clarithromycin 500 mg b.i.d. CONCLUSION: Ranitidine bismuth citrate with clarithromycin 500 mg b.i.d. provides an effective, simple and well tolerated regimen for the eradication of H. pylori and healing of duodenal ulcers.

Adolescent↗
PubMed1998

Hormonal therapy in chronic radiation colitis.

Severe gastrointestinal bleeding is a rare complication of radiation therapy that requires frequent transfusions. This case report describes a patient with severe bleeding from radiation colitis after treatment of bladder cancer. During 5 months of therapy with multiple drugs, the patient needed 26 units of packed red cells. A subsequent hormone therapy consisting of an estrogen-progesterone combination significantly reduced the need for blood transfusions and hospitalization. We conclude that hormones might provide a promising new additional symptomatic therapy for bleeding radiogenic colitis.

Aged↗
PubMed1997

Short-course therapy with amoxycillin-clarithromycin triple therapy for 10 days (ACT-10) eradicates Helicobacter pylori and heals duodenal ulcer. ACT-10 Study Group.

BACKGROUND: Whilst the role of Helicobacter pylori eradication in managing duodenal ulcers has been established, consensus regarding the ideal regimen has not been achieved. METHODS: Patients with H. pylori-positive active duodenal ulcer were randomly assigned to receive triple therapy with amoxycillin 1000 mg b.d. + clarithromycin 500 mg b.d. + omeprazole 20 mg daily for 10 days (ACT-10) or dual therapy with clarithromycin 500 mg t.d.s. + omeprazole 40 mg daily for 14 days (Dual). No additional acid suppression was provided following eradication therapy. Endoscopy, with biopsy for culture and histology, as well as 13C-urea breath testing (13C-UBT) were performed pre-treatment to assess H. pylori infection. H. pylori eradication was established at 4-6 weeks follow-up with culture (2 antral, 1 corpus biopsies), histology (2 antral biopsies), and 13C-UBT. Ulcer healing by endoscopy and change in clinical symptoms were also assessed at 4-6 weeks. RESULTS: Two hundred and sixty-seven (267) patients were randomized to ACT-10 (n = 137) or Dual therapy (n = 130). By per-protocol and intention-to-treat analyses, H. pylori eradication at 4-6 weeks follow-up was 91% (115/127) and 88% (120/136), respectively, for ACT-10 patients and 59% (68/115) and 55% (72/130), respectively, for Dual therapy patients (P < 0.001 for both analyses). Ulcer healing was high in both treatment groups: ACT-10, 93% (118/127) and 90% (122/136), respectively; and Dual therapy, 91% (104/114) and 85% (111/130), respectively. Pre-treatment resistance to clarithromycin was low (4%, 8/214) as compared to metronidazole resistance which was over 40%. Emergence of resistance to clarithromycin was observed in 2% of patients receiving ACT-10 and in 25% of those receiving Dual therapy. ACT-10 and Dual therapy patients experienced similar rates of drug-related adverse events (33% vs. 32%, respectively) and discontinuation from therapy due to an adverse event (1.5% vs. 5%, respectively). More than 90% of patients were compliant with each prescribed medication. CONCLUSION: In patients with active duodenal ulcer, a 10-day course of amoxycillin-clarithromycin-based triple therapy without additional acid suppression is highly effective in eradicating H. pylori and healing duodenal ulcer.

Adult↗
PubMed1997

A spark counter as a control unit of a radio frequency surgery device.

A new approach in radio frequency (rf) electrosurgery, used for tissue treatment, is achieved by using a new process control method. An external control unit allows a commonly available rf-generator to automatically supply the appropriate power for differing tissue types, thus ensuring best cutting quality. The sparks, generated during the scalpel electrode interaction with the tissue, appear statistically distributed. The spark rate depends on various factors and is monotonic with the supplied electrical power. This allows it to be used as the controlled variable in the cutting process. The ac current passing through the tissue is evaluated by an external control unit using an analyzation algorithm to determine the number of sparks. The external unit is comprised of a system, which measures the spark rate, and a subsequent proportional integral (P.I.) controller. The functionality of the control method as well as the electrical circuitry is verified through cuts with different degrees of carbonization and cuts through tissue heterojunctions.

Adipose Tissue↗
PubMed1996

Influence of spasmolytic analgesics on motility of sphincter of Oddi.

The effects on the sphincter of Oddi of intravenous administration of dipyrone, 2.5 g; tramadol, 50 mg; indomethacin, 75 mg; N-butylscopolamine, 20 mg; and nitroglycerin, 1 mg, in comparison to physiological saline were assessed in a single-blind study in 36 patients hospitalized with upper abdominal pain. Basal sphincter pressure and sphincter motility were measured for a 5-min period after treatment by endoscopic manometry. Nitroglycerin and dipyrone both caused a significant fall in basal sphincter pressure, while N-butylscopolamine and nitroglycerin produced a significant decrease in contraction frequency. Therefore, dipyrone, in contrast to tramadol and indomethacin, exhibits spasmolytic activity in addition to analgesia in biliary pain.

Analgesics, Opioid↗
PubMed1996

Development of an in vitro human nasal epithelial (HNE) cell model.

The upper respiratory tract is mainly involved in reactions to airborne substances. So the primary culture of human nasal tissue may provide an application model for assessment of toxic or inflammatory processes caused by environmental pollutants. HNE cells were isolated from nasal tissue biopsies by protease digestion and cultured in serum-free hormone-supplemented medium. When grown on porous membranes at the air-liquid interface, a higher portion of ciliated cells developed within 2 weeks compared with cells maintained submerged. Submerged grown cultures on collagen gel matrix maintained a cuboidal epithelial-like morphology and stained positive for cytokeratin. The primary cultures of nasal cells exhibited a marked activity for acid phosphatase. Second passage HNE cells exhibited marked enzymatic reactivity upon treatment with particulate matter. Induction of the lysosomal marker enzyme acid phosphatase was stronger in cells treated with toluene-extracted diesel exhaust particles compared with cells treated with native diesel exhaust particles. Non-specific esterase activity was increased more than 7-fold by native diesel particles, whereas the induction of esterase activity by extracted particles was relatively low compared with the control group.

Acid Phosphatase↗
PubMed1995

[Rhinosinusitis in AIDS patients].

We examined microbic infections and topical immunity in 36 AIDS patients with rhinosinusitis (AIDS CDC stage IV b-d) who had an average serum CD4 count of 90/microliters. We also examined the presence of the HIV genome in nasal mucous. Microbiological examination revealed an increased number of fungal infections in addition to bacterial infections with multiresistant strains. There was no evidence of CD4-T cells or HIV reverse transcriptase. The size of study was too small to permit generalised conclusions about the infectious risk of nasal mucous.

AIDS-Related Opportunistic Infections↗
PubMed1993

Effect of ranitidine and amoxicillin plus metronidazole on the eradication of Helicobacter pylori and the recurrence of duodenal ulcer.

BACKGROUND: Persistent infection with Helicobacter pylori is associated with the recurrence of duodenal ulcer. Whether the efficacy of bismuth therapy in reducing the rate of recurrence of duodenal ulcer is due to its antimicrobial effects on H. pylori or to a direct protective action on the mucosa is still a matter of debate. METHODS: To study the effect of the eradication of H. pylori on the recurrence of duodenal ulcer, we treated 104 patients with H. pylori infection and recurrent duodenal ulcer with either amoxicillin (750 mg three times daily) plus metronidazole (500 mg three times daily) or identical-appearing placebos, given orally for 12 days. All patients also received ranitidine (300 mg each night) for 6 or 10 weeks. Endoscopy was performed before treatment and periodically during follow-up for up to 12 months after healing. RESULTS: Among the 52 patients given antibiotics, H. pylori was eradicated in 46, as compared with 1 of the 52 given placebo (89 percent vs. 2 percent, P < 0.001). After six weeks, the ulcers were healed in 48 patients given antibiotics and 39 given placebo (92 percent vs. 75 percent, P = 0.011). Side effects, mainly diarrhea, occurred in 15 percent of the patients given antibiotics. Among the patients followed up for 12 months, duodenal ulcers recurred in 4 of 50 patients given antibiotics and 42 of 49 given placebo (8 percent vs. 86 percent, P < 0.001). Ulcers recurred in 1 of 46 patients in whom H. pylori had been eradicated, as compared with 45 of 53 in whom H. pylori persisted (2 percent vs. 85 percent, P < 0.001). CONCLUSIONS: In patients with recurrent duodenal ulcer, eradication of H. pylori by a regimen that does not have any direct action on the mucosa is followed by a marked reduction in the rate of recurrence, suggesting a causal role for H. pylori in recurrent duodenal ulcer.

Adult↗
PubMed1993

Paraneoplastic polymyositis associated with a renal carcinoma.

A 56-year-old patient was admitted to hospital because of difficulties in swallowing and in opening his mouth. The serological transaminases were increased. Over the next 6 weeks a bioptically proven polymyositis (more proximally located) caused a respiratory insufficiency which had to be treated by artificial respiration. A tetraplegia connected with a large increase of creatine-kinase was also seen. The general investigations were focused on malign processes with a particular search for bronchial carcinoma. At first a kidney cyst detected by ultrasound but was classified as harmless by several investigators. Finally, a computer tomogram of the abdomen demonstrated a cystic degenerated renal carcinoma, which had been cytologically tested also. The clinical course showed a typical aspect of a paraneoplastic syndrome: after extended nephrectomy a distinct regression of the musculary symptoms developed, but with the development of metastases the symptoms increased again. The interdependence of polymyositis and primary renal carcinoma would appear to be proven.

Carcinoma, Renal Cell↗