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Biomedical subjects

J Menzel

Publications and source records attributed to J Menzel.

At least 55 records · Page 3Linked to original sources
PubMed1999

Tumors of the papilla of Vater--inadequate diagnostic impact of endoscopic forceps biopsies taken prior to and following sphincterotomy.

BACKGROUND: It has been proposed that adenomas of the papilla of Vater are precursors of adenocarcinomas. Duodenoscopy with ERCP and forceps biopsies have substantially improved the morphologic exploration of the major duodenal papilla. Yet there is little and contradictory information as to the diagnostic accuracy of endoscopic biopsies in tumors of the papilla. Moreover, after endoscopic sphincterotomy data on the diagnostic impact of endoscopic biopsies from the papilla are scarce and, in most cases, retrospectively obtained. Thus, the aim of the present prospective and histopathologically controlled study was to assess the diagnostic accuracy of endoscopic biopsies taken from tumors of the papilla before and after sphincterotomy. PATIENTS AND METHODS: Forty patients with tumors of the papilla of Vater were included in the study. In each case, a comparison was made between endoscopic forceps biopsy diagnoses prior to and following sphincterotomy and the definitive histological diagnosis after surgical tumor resection. RESULTS: Resected tumors were diagnosed histomorphologically as follows: 19 adenocarcinomas (47%), 6 tubular adenomas (15%), 7 villous adenomas (17%), 7 inflammatory non-neoplastic lesions (pseudotumors) (17%), and one adenomyoma (2%). Overall accuracy for preoperative histopathological diagnosis was 62% (25 of 40, 95% CI: 47%-76%) prior to sphincterotomy while it was 70% (28 of 40, 95% CI: 55%-81%) following the procedure. Regarding adenocarcinomas, sensitivity was found to be 21% (4 of 19, 95% CI: 8%-43%) prior to and 37% (7 of 19, 95% CI: 19%-58%) after sphincterotomy while specificity was 100% at both times. CONCLUSIONS: Endoscopic forceps biopsies do not allow for reliable preoperative diagnosis of tumors of the papilla of Vater.

Adenocarcinoma↗
PubMed1999

Preoperative staging of esophageal carcinoma: miniprobe sonography versus conventional endoscopic ultrasound in a prospective histopathologically verified study.

BACKGROUND AND STUDY AIMS: Endosonographic staging of esophageal carcinoma may be limited by non-traversable tumor stenoses. Dilation of malignant esophageal strictures carries a significant risk of esophageal perforation. We therefore evaluated the use of ultrasonic miniprobes in the staging of stenotic esophageal carcinoma compared with conventional endoscopic ultrasound. PATIENTS AND METHODS: In a blinded, prospective study, which included histopathological evaluation, 53 consecutive patients (43 male, 10 female, mean age 61 years) with stenosing esophageal carcinomas were examined preoperatively. Endosonography was done using the optical GF-UM3 echo endoscope. If tumor strictures were not traversable with this instrument, a blind esophagoprobe, the MH-908 was used for endosonography. Miniprobe sonography (MPS) was done during esophagoscopy in all patients. The various imaging modalities were assessed in terms of complete tumor traversability and correct tumor staging. Every patient underwent surgical tumor resection. RESULTS: MPS of the esophagus and proximal parts of the stomach was possible in all 53 patients without prior dilation of tumor stenoses. Endosonography with the GF-UM3 instrument was precluded in 23 patients (43.4%) while in 20 of the latter patients the MH 908 esophagoprobe could be passed through tumor stenoses. The overall accuracy rates for depth of tumor infiltration (T) staging were: 62% (31/50) for endosonography (GF-UM3 plus esophagoprobe) and 86.8% (46/53) for MPS. The accuracy rates for T staging in tumors traversable both with the GF-UM3 echo endoscope and with miniprobes were 56.7% (17/30) for GF-UM3 and 80% (24/30) for MPS. The accuracy rates for T staging in tumors traversable only with the MH-908 esophagoprobe and with miniprobes were 70% (14/20) for the MH-908 and 95% (19/20) for MPS. With regard to the presence or absence of peri-esophageal metastatic lymph nodes (N staging), the accuracy rates were 83% (25/30) for MPS and 70% (21/30) for the GF-UM3, and 80% (16/20) for MPS and 70% (14/20) for the MH-908. CONCLUSION: Compared with conventional endosonography using 7.5-MHz large diameter instruments, MPS enables: a) safe passage through high-grade malignant esophageal strictures, achieving b) higher accuracy rates for T staging, and c) similar rates for N staging. The use of MPS can also represent an improvement in the comfort and safety of patients. Moreover, miniprobe sonography is highly cost-effective compared with conventional endosonography. Thus, MPS appears to be a valuable addition to the armamentarium for staging esophageal carcinoma.

Adult↗
PubMed1999

Standardized grey scale ultrasonography in Graves' disease: correlation to autoimmune activity.

OBJECTIVE: Graves' disease leads to thyroid enlargement and to reduction of tissue echogenicity. Our purpose was to correlate grey scale ultrasonography of the thyroid gland with clinical and laboratory findings in patients with Graves' disease. DESIGN: Fifty-three patients with Graves'disease were included in our study, 100 euthyroid volunteers served as control group. Free thyroxine (FT(4)), TSH and TRAb (TSH receptor antibodies) values were measured and correlated with sonographic echogenicity of the thyroid gland. METHODS: All patients and control persons underwent ultrasonographical histogram analyses under standardized conditions. Mean densities of the thyroid tissues were determined in grey scales (GWE). RESULTS: Compared with controls with homogeneous thyroid lobes of normal size (25.6 +/- 2.0GWE, mean +/- S.D.) echogenicity in patients with Graves' disease was significantly lower (21.3 +/- 3. 3GWE, mean +/- S.D., P < 0.0001). Among the patients with Graves' disease significant differences of thyroid echo levels were revealed for patients with suppressed (20.4 +/- 3.1 GWE, mean +/- S.D., n=34) and normalized TSH values (22.5 +/- 3.6GWE, mean +/- S.D., n=19, P < 0.02). Significantly lower echogenicities were also measured in cases of persistent elevated TRAb levels (19.9 +/- 2.9GWE, mean +/- S.D., n=31) in comparison with normal TRAb levels (22.9 +/- 3.5 GWE, mean +/- S.D., n=22, P < 0.0015). No correlation could be verified between echogenicity and either still elevated or already normalized FT(4) values or the thyroid volume. In coincidence of hyperthyroidism and Graves' ophthalmopathy (19.7 +/- 3.5GWE, mean +/- S.D., n=23) significantly lower echogenicity was measured than in the absence of ophthalmological symptoms (22.3 +/- 3.3GWE, mean +/- S.D., n=30, P < 0.016). Patients needing active antithyroid drug treatment revealed significantly lower thyroid echogenicity (20.3 +/- 3.1 GWE, mean +/- S.D., n=40) than patients in remission (23.7 +/- 3.4 GWE, mean +/- S.D., n=13, P < 0.001). Statistical evaluation was carried out using Student's t-test. CONCLUSIONS: Standardized grey scale histogram analysis allows for supplementary judgements of thyroid function and degree of autoimmune activity in Graves' disease. Whether these values help to estimate the risk of recurrence of hyperthyroidism after withdrawal of antithyroid medication should be evaluated in a prospective study.

Adolescent↗
PubMed1999

Budd-Chiari syndrome in a patient with factor V Leiden--successful treatment by TIPSS placement followed by liver transplantation.

The causes of Budd-Chiari syndrome (BCS) comprise several diseases leading to thrombophilia. One of the most common thrombophilic disorders is resistance against activated protein C, caused by a single point mutation of the factor V gene. In December 1993, a 22-year-old patient was given a diagnosis of subacute BCS with occlusion of all major hepatic veins. Placement of a transjugular intrahepatic portosystemic stent shunt led to rapid disappearance of ascites and hepatic encephalopathy. During the following two years, recurrent partial occlusions of the shunt were treated by balloon angioplasty. The cause of the BCS still being unknown, in October 1996 we performed extensive laboratory investigations concerning states of thrombophilia and found moderately elevated IgG anticardiolipin antibodies (19.7 U/ml) and a resistance against activated protein C caused by heterozygosity for a point mutation of the factor V gene (1691G-->A; factor V Leiden). As a consequence, oral anticoagulation with coumarin was initiated. In October 1997, elective liver transplantation was performed which led to disappearance of APC resistance. Moreover, IgG anticardiolipin antibodies have been negative since then. If BCS is caused by APC resistance, liver transplantation not only treats the chronic liver disease but also cures the state of thrombophilia since factor V is mainly synthesized in the liver.

Activated Protein C Resistance↗
PubMed1999

[Can the function of the transjugular intrahepatic portosystemic shunt be evaluated noninvasively by Doppler sonography?].

Transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment of complications due to portal hypertension. Possible shunt stenosis or shunt occlusion make periodical assessment of stent function necessary. Direct portal venography is the gold standard in morphologic and functional surveillance of TIPS. Controversially discussed is whether Doppler ultrasonography is effective in hemodynamical evaluation of TIPS and sufficient in prediction of shunt dysfunction. In 39 patients, 147 Doppler ultrasonographical examinations were performed and correlated with the results obtained by direct portal venography in TIPS follow-up, 43 of 47 hemodynamically relevant stenoses, including six shunt occlusions, were being diagnosed correctly by Doppler ultrasonography, by assessing maximal flow velocity in portal vein proximal to the TIPS (sensitivity 91.5%; specificity 97%). If Doppler ultrasonographical measurement of maximal flow velocity was performed within the proximal stent itself, sensitivity was only 70.4% and specificity 27%. In conclusion, assessment of portal maximal flow velocity more accurately represents hemodynamical TIPS function than Doppler ultrasonographical measurement within the proximal stent tract itself. Since, according to data presented. Doppler ultrasonography appears to be able to detect hemodynamically significant TIPS stenoses, it might reduce the number of invasive angiographies and thus contribute to more cost-effective follow-up of TIPS patients.

Adolescent↗
PubMed1999

[Abrikossoff's tumor--a rare differential diagnosis in neoplastic lesions of the esophagus].

We report the case of a 49-year-old male patient who was referred to our department in February 1998. Due to his complaints of dysphagia and retrosternal pain an upper gastrointestinal endoscopy was performed showing a polypoid lesion of the lower esophagus. This lesion presenting with a wide base and indurated surface was removed by endoscopic snare and forceps biopsies. Histologic and immunohistochemical analyses revealed this lesion to be a benign granular-cell tumor (Abrikossoff's tumor) which is considered to be of neuroectodermal origin. Abrikossoff's tumor is a rare differential diagnosis of polypoid lesions of the esophagus.

Diagnosis, Differential↗
PubMed1998

Endothelial cell adhesion molecule and PMNL response to inflammatory stimuli and AGE-modified fibronectin.

BACKGROUND: Atherosclerotic vascular disease is the leading cause of death in patients with diabetes mellitus and end-stage renal disease. Advanced glycation end products (AGEs) are strongly suggested to be involved in the pathogenesis of atherosclerosis in these patients who also frequently experience infectious complications. We hypothesized that the interaction of AGEs and inflammatory mediators contributes to the up-regulation of endothelial cell activation. METHODS: We investigated the effect of advanced glycated fibronectin in the presence or absence of inflammatory stimuli on the endothelial cell surface and mRNA expression of cell adhesion molecules. Furthermore, the influence of advanced glycated fibronectin on the transendothelial migration pattern of polymorphonuclear cells was analyzed. RESULTS: Exposure to advanced glycated fibronectin together with inflammatory stimuli such as interleukin (IL)-1alpha, tumor necrosis factor-alpha (TNF-alpha) or lipopolysaccharide (LPS) led to a significant increase in the surface expression of the cell adhesion molecules E-selectin, ICAM-1, VCAM-1 and PECAM-1 on endothelial cells. Soluble AGEs in combination with advanced glycated fibronectin significantly enhanced the endothelial cell surface expression of ICAM-1, VCAM-1 and PECAM-1, whereas this was not the case for E-selectin. At the transcriptional level short-time exposure of endothelial cells to advanced glycated fibronectin and inflammatory mediators resulted in an increased expression of E-selectin, ICAM-1 and VCAM-1 mRNA levels, whereas PECAM-1 repeatedly showed a significant decrease of gene transcript levels. An increase of mRNA levels was also observed for E-selectin, ICAM-1, VCAM-1 and PECAM-1 following incubation with a combination of advanced glycated fibronectin and soluble advanced glycation end-products. Furthermore, polymorphonuclear cells responded with a sevenfold increase in transendothelial migration following exposure of endothelial cells to advanced glycated fibronectin and inflammatory mediators. CONCLUSIONS: These results suggest that the combination of matrix glycation and inflammation up-regulates the activation of the endothelial cell adhesion cascade, a mechanism that might contribute to the increased burden of atherosclerotic morbidity and mortality in patients suffering from diabetes mellitus or chronic renal failure.

Albumins↗
PubMed1998

Intraductal ultrasonography may localize islet cell tumours negative on endoscopic ultrasound.

Two patients with suspected insulinoma and one patient with a gastrinoma were referred to our hospital for preoperative tumour localization. Conventional imaging methods and even endoscopic ultrasonography did not detect any tumour in the pancreatic parenchyma. During endoscopic retrograde cholangiopan-creatography ultrasound miniprobes with a 2-mm diameter were applied via the biopsy channel of the duodenoscope. After insertion of the ultrasound probe into the pancreatic duct intraductal sonography (IDUS) was able to depict the tumours. The two insulinomas (1.8 x 2 mm and 5 x 8 mm, respectively) could be localized, as could the gastrinoma, which had a diameter of 6 mm. IDUS diagnosis was confirmed by surgery as the tumours were resected. Follow-up showed no evidence of tumour recurrence.

Adult↗
PubMed1998

[Preoperative staging of stenosing esophageal carcinoma--prospective comparison of mini-endosonography with conventional endosonography].

Staging of esophageal malignancies can easily and safely be performed with ultrasonic miniprobes. Unlike large-diameter ultrasonic instruments, miniprobes may pass even high-grade malignant esophageal strictures without prior bouginage. Image quality and resolution of miniprobe sonography exceeds that of conventional endosonography, thus achieving higher accuracy rates for T staging, while those for N staging have found to be similar. As miniprobe sonography is able to improve patients' convenience and security and is highly cost effective compared to conventional endosonography, miniprobe sonography appears to be a valuable addition to the staging armamentarium in esophageal carcinoma.

Adenocarcinoma↗
PubMed1997

[Intraductal ultrasound in the pancreaticobiliary duct system].

BASIC PROBLEM AND OBJECTIVE OF STUDY: The power of resolution of conventional imaging methods is too low for the diagnosis of very small pancreaticobiliary tumours. High-frequency ultrasound transducers (20 MHz), adapted to the dimensions of the pancreaticobiliary systems (2 mm diameter), make intraductal ultrasound examination possible during endoscopic retrograde cholangiopancreatography (ERCP). In a prospective study the invasiveness and diagnostic value of intraductal ultrasound (IDUS) was compared with ERCP, endosonography (ES) and computed tomography (CT). PATIENTS AND METHODS: During ERCP in 51 consecutive patients an intraductal ultrasound transducer was introduced into the pancreaticobiliary duct system, the results being compared with those obtained with the other imaging modalities and histopathological findings, if available. RESULTS: IDUS of the pancreatic and bile duct systems is a rapid, simple and reliable method during ERCP and provides valuable additional information on periductal tissues. In the diagnosis of carcinoma of the pancreas its sensitivity was 75% (six of eight cases), that of ERCP 37% (3/8), ES 50% (4/8) and CT 37% (3/8). In the diagnosis of biliary tract tumour the sensitivity of the different modalities (in the above order) was 89% (8/9), 78% (7/9), 33% (3/9) and 33% (1/3). Specificity was 67% (2/3), 67% (2/3), 67% (2/3) and 33% (3/9); predictability 89%, 88%, 75% and 60%. CONCLUSIONS: The use of small ultrasound catheter transistor system in the biliary and pancreatic ducts, introduced during ERCP, is technically simple and has few complications. It is a valuable addition to ERCP in the precise diagnosis of small pancreaticobiliary lesions.

Adult↗
PubMed1997

Interactions of lymphocytes from patients with psoriatic arthritis or healthy controls and cultured endothelial cells.

Psoriatic arthritis (PA) is an inflammatory rheumatic disease that can concomitantly occur in patients with psoriasis vulgaris. Psoriatic synovitis shows alterations of the synovial microvasculature. Inflammatory cells adhere to endothelial cells (EC) and migrate through the vascular wall of postcapillary venules located in the subintimal layer of the synovial membrane. The aim of our study was to investigate, first, the phenotype of lymphocytes (LC) of PA patients using flow cytometry (FC) with regard to activation antigens and adhesion molecules; second, the adhesion of LC of PA patients on cultivated resting or activated (with thrombin, LPS, IFN-gamma, or TNF-alpha) human umbilical vein endothelial cells (HUVEC) by counting the Feulgen-stained nuclei of both adherent LC and HUVEC using image analysis; and third, the synthesis of IL-6 and IL-8 in both LC and HUVEC 24 hr after cell contact. These cytokines were determined qualitatively by immunofluorescence and quantitatively at the single-cell level by FC as well as in the supernatants of the cultures using commercial cytokine ELISAs. Fourth, we investigated whether or not the LC adhesion on HUVEC as well as the cytokine production could be inhibited by monoclonal antibodies against LC- or EC-specific adhesion molecules. In contrast to controls PA patients showed an increased surface expression of CD11a, b, and c as well as of CD44 but a reduced surface expression of CD49d/CD29, and CD49e/CD29, and cell-bound fibronectin on CD3+ LC. The activation markers CD25 and HLA-DR were found to be slightly enhanced in PA. The cell adhesion was generally enhanced in PA patients vs controls. It could be reduced with monoclonal antibodies (MoAbs) against CD11a and CD18 on IFN-gamma- or TNF-alpha-activated HUVEC but was generally enhanced after treatment of HUVEC with MoAbs against CD54, CD62E, or CD106. Due to LC adhesion on HUVEC IL-6 and IL-8 were produced in significantly higher amounts in PA patients compared to controls. This effect occurred already in resting but was enhanced in activated HUVEC. While IL-6 is mainly produced by HUVEC but also in smaller quantities by LC, IL-8 is synthesized only by HUVEC and could be modified by preincubation with MoAbs against LC- or EC-specific adhesion molecules in parallel to the cell adhesion. The experiments show that the main adhesion pathway in LC homing of PA patients is the interaction of the LC adhesion molecule CD11a/CD18 with CD54 on EC followed by an enhanced synthesis of proinflammatory and chemotactic cytokines. These results favor the hypothesis that the pathological alterations of the microvasculature in PA patients are generated by altered homing processes.

Adult↗
PubMed1997

Scintigraphic evaluation of hepatic blood flow after intrahepatic portosystemic shunt (TIPS).

In patients with liver cirrhosis a transjugularly placed intrahepatic portocaval shunt (TIPS) is a non-surgical portosystemic device which aims to reduce portal venous pressure. In comparison with Doppler sonography, we evaluated in 28 patients the diagnostic impact of liver perfusion scintigraphy (with technetium-99m diethylene triamine penta-acetic acid) in the assessment of changes in the hepatic blood flow after TIPS shunting. The arterial and portal contributions to hepatic flow were calculated from the areas under the biphasic time-activity curve. In the course of TIPS shunting, patency is threatened by reocclusion. Angiography is the gold standard for TIPS shunt reassessment. However, there is a need for a less invasive diagnostic procedure, such as scintigraphy or Doppler sonography, for the early detection of shunt insufficiency. Scintigraphy demonstrated that prior to TIPS shunting the portal venous contribution to hepatic perfusion was reduced to 29.2%, this reduction being due to portal hypertension. After TIPS placement a significant increase in portal venous perfusion was observed (38.2%; P<0.02). TIPS shunt occlusion was identified in patients by a significant reduction in the scintigraphically measured portal venous contribution to hepatic blood flow. Hepatic perfusion scintigraphy appears to be a valuable method to determine the immediate effect of TIPS on hepatic blood flow. Post-TIPS follow-up studies of hepatic haemodynamics by liver perfusion scintigraphy appear able to contribute to the detection of TIPS shunt occlusion before the clinical consequences of this complication have become apparent.

Blood Flow Velocity↗
PubMed1997

Colitis as the initial presentation of Wegener's granulomatosis.

Wegener's granulomatosis is a vasculitis which commonly presents with symptoms referable to the upper airway system, lungs, joints, eyes and kidneys. We present a case in which colitis combined with sinusitis could retrospectively be attributed as the initial manifestations of Wegener's disease.

Adult↗
PubMed1997

[Clinical pharmacology and possible applications of hyaluronidase with reference to Hylase "Dessau"].

Hyaluronidase is employed therapeutically since many years. The various detectable effects of hyaluronidase are referred to the action of this enzyme. Hyaluronidase depolymerises the mucopolysaccharide hyaluronic acid, a component of the mucoprotein ground substance or tissue cement. Hyaluronidase thereby increases in tissues the membrane permeability, reduces the viscosity and renders the tissues more readily permeable to injected fluids (spreading effect). The effects of hyaluronidase enables this enzyme to be used therapeutically to increase the speed of absorption and to diminish discomfort due to subcutaneous or intramuscular injection of fluid, to promote resorption of excess fluids and extravasated blood in the tissues and to increase the effectiveness of local anaesthesia. Hyaluronidase is widely used in many fields, i.e. in orthopaedia, surgery, ophthalmology, internal medicine, oncology, dermatology, gynaecology, etc. The following paper deals with the therapeutic uses of hyaluronidases and allows a review of the current and up to date status of the literature.

Absorption↗
PubMed1997

[Pyogenic skin infections of the extremities with vascular involvement. Local vascular reconstruction and systemic therapy concepts].

In a 6-year period, we treated 14 patients with severe groin infections involving the femoral artery following drug injection in addicts. In 13 cases, we used autologous material for arterial reconstruction; in one case of massive bleeding the femoral artery had been embolized. Ten patients were treated with full success, two patients had claudication postoperatively, and in two cases above-knee amputations were necessary.

Amputation, Surgical↗
PubMed1997

[What may surgical therapy of benign thyroid gland diseases cost? Extreme, moderate and ethically defensible calculations].

Since January 1996, Fallpauschalen (fee for case) and Sonderentgelte (fee for service) lead up to a new dictatorship of economy over surgeons affairs. A detailed economical analysis for the surgical treatment of benign diseases of the thyroid gland was made. Comparing the costs and our financial benefits, it is evident that there are no reserves for complications or longterm patients.

Cost Savings↗
PubMed1996

The role of adjuvant radiation and multiple resection within the surgical management of brain metastases.

Cerebral metastases occur in 25% to 35% of all cancer patients. The advances in systemic and topical treatment as well as the rising incidence of lung cancer and melanomas are associated with an increasing incidence of cerebral metastases. More than 20,000 patients die every year in the Federal Republic of Germany of this disease. This retrospective analysis covers 145 patients who underwent surgery. Survival analysis of different subgroups was performed. The patients were grouped according to their clinical status and the different therapeutical procedures which were performed. Group A, consisting of all those patients where a gross total resection could be performed and where no systemic disease was apparent at the time of craniotomy showed the best results, having the highest portion of long term survivors. Group B, consisting of those patients who underwent a subtotal resection and who had no systemic disease at the time of craniotomy, had a worse outcome. Group C patients (gross total resection and systemic disease) as well as Group D (subtotal resection and systemic disease) presented the poorest results with respect to survival. A benefit was mediated by adjuvant radiation as well as multiple resections. Surgery is the method of choice for the treatment of a single metastasis. Advances in microsurgery nowadays sometimes justify even the removal of multiple metastases, depending on their location, on the general condition of the patient and on prognosis.

Adult↗