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Biomedical subjects

J Pausch

Publications and source records attributed to J Pausch.

At least 37 records · Page 2Linked to original sources
PubMed1993

[Prognostic value of long-term pH-metry in the B-II resected stomach].

In a prospective study we investigated the clinical value of ambulatory 24-hour pH monitoring in the stomach after Billroth-II-resection. Recorded data of 10 patients with and 11 patients without ulcer recurrence after gastric resection were compared. The pH medians of the record periods "total time", "supine", "upright", "fasting" and "postprandial" were evaluated. Further the cumulative recording time of pH levels pH < 1, pH < 2, etc. was determined and compared in both groups. A pH median less than 2.8 "supine" indicated a postoperative ulcer recurrence with a sensitivity of 90% and specificity of 81%. A pH median less than 2.6 "fasting" predicted an ulcer relapse with a sensitivity of 90% and specificity of 72% (p < 0.001). In patients with ulcer recurrence pH was < 4 in more than 30% of total recording rime, pH < 5 in more than 45% and pH < 6 in more than 75% (sensitivity 90%, specificity 100%). According to these findings 24-hour pH monitoring seems to be useful for the prognostic assessment of the further course of ulcer disease after B II-surgery of the stomach. Thus pH monitoring results may be helpful in defining patient groups which may be candidates for acid reducing therapy to prevent ulcer recurrence.

Adult↗
PubMed1992

[Metal or plastic endoprostheses in malignant obstructive jaundice. A randomized and prospective comparison].

In a prospective randomized trial 58 patients (24 men, 34 women, mean age 67 +/- 13 [42-89] years) with inoperable malignant jaundice were treated with synthetic (S; n = 29) or expanding metal endoprostheses (M; n = 29). After endoscopic retrograde cholangiopancreatography patients were divided into a group with hilar (K: n = 7; M: n = 6) or distal involvement (K: n = 22, M: n = 23). In two cases with hilar involvement (28%) a synthetic endoprosthesis could not be implanted, while early prosthesis occlusion (after 2 days) was observed in one case. But in this group it was possible to implant all metal stents. In the group with distal involvement both synthetic and metal endoprostheses were successfully implanted. In the M group the proportion of patients with prosthesis failure (13.6%) was significantly higher than in the S subgroup (40.9%). The cholangitis incidence was 9% in the M group, significantly less (P less than 0.05) than in the K group (40.9%). Duration of hospital stay to treat prosthesis-related complications was significantly less in the M group (average 2.9 days) than the K group (12.9 days). It would be a great advance in palliative tumour treatment if it were possible significantly to reduce, by means of metal stents, the incidence of late cholangitis and the duration of hospital stay necessary to treat late complications. But improvement in the technique of implanting metal stents would be essential before their general use in distal lesions can be recommended.

Adult↗
PubMed1992

[The palliative therapy of malignant esophageal obstruction with self-expanding metal endoprostheses].

A total of 23 self-expanding metal stents were implanted in 17 patients (12 men, 5 women; mean age 66 [44-83] years) with inoperable malignant obstruction of the oesophagus or the oesophago-gastric junction. A primary success was achieved in all, a good functional result in 16 (94%). There were no complications. In the follow-up period (mean of 15.2 +/- 13 weeks) re-obstruction by the tumour process occurred in three patients. Twelve patients died after a mean survival time of 15.8 +/- 14 weeks. In ten of these the stent was still patent at death, while two had again developed dysphagia. The cumulative patency rate of the stents was 79%. These observations indicate that self-expanding metal stents can achieve satisfactory palliation in dysphagia due to a malignancy. The mortality and morbidity rates of the method seem to be less than those of other palliative measures.

Adenocarcinoma↗
PubMed1992

Technical failure of biliary metal stent deployment in a series of 116 applications.

Biliary metal stents are thought to offer improved long-term palliation of malignant biliary obstruction due to a lower incidence of migration and clogging. Placement of these stents is technically more complicated than that of plastic endoprostheses and requires two experienced physicians. We report the incidence and reasons for apparent malfunction of expandable metal stent deployment (Wallstents and Strecker stents). In 116 applications of 82 Wallstents (endoscopic approach: n = 33, transhepatic approach: n = 49), we observed 19 cases of stent malfunction due to technical problems of stent delivery. In 13 cases (15.8%), the restraining membrane of the Wallstent could not be retracted sufficiently to deliver the stent. There were 6 (17.6%) failures in 34 cases of Strecker stent deployment. In 3 cases, we noted difficult balloon removal, including avulsion of the balloon catheter shaft within the endoscope during attempted balloon removal in one case. In one case, the Strecker stent could only be released partially, requiring subsequent endoscopic extraction. In two patients, only partial expansion of one end of the Strecker stent could be achieved. Given the significant malfunction rate of expandable metal stents during stent delivery, further improvements in the delivery system of the metal stents are required.

Cholestasis, Extrahepatic↗
PubMed1992

Self-expanding metal stents for palliation of malignant esophageal obstruction--a pilot study of eight patients.

We sought to determine whether the application of a self-expanding metal stent enables palliation of malignant dysphagia with minimal risk. The results of pilot studies from two centers are reported. We treated 8 inoperable patients with a 14 mm self-expanding metal stent (Wallstent). The stent was applied without general anesthesia under mild i.v. sedation. The procedure was successful in all cases. No side effects were noted. In one patient, tumor ingrowth through the meshes of the stent occurred. This patient was additionally treated with a percutaneous gastrostomy. One patient experienced tumor overgrowth of the proximal end, necessitating laser treatment. Three patients were still alive after three months. The mean number of cumulative endoscopic interventions per patient was 2.2 (SD: +/- 2; median 2). The mean observation time was 10.7 weeks +/- 2 (median 12). Dysphagia was graded from 0 (normal swallowing) to 4 (inability to swallow saliva). Dysphagia was significantly (p less than 0.0005) reduced from grade 3.1 (SD: +/- 0.35) to 0.5 (SD: +/- 0.5) immediately after stenting. 62.5% of the patients were able to manage a virtually normal diet (in one of these patients dysphagia recurred six weeks after stent placement due to tumor ingrowth). Six patients (75%) were able to ingest all necessary calories orally. The application of a 14 mm self-expanding metal stent in cases of inoperable malignant esophageal obstruction seems to offer safe and effective palliation of malignant dysphagia.

Adenocarcinoma↗
PubMed1991

[Arterial embolization of an arteriovenous fistula with hemobilia after blind liver puncture].

Five days after percutaneous liver biopsy we observed in a 42-year-old man with alcoholic liver cirrhosis severe hemobilia requiring transfusions of packed red cells. By means of super-selective arterial embolization, using gelfoam, the bleeding source, an av-fistula, was successfully occluded. Iatrogenic hemobilia, although seen after percutaneous liver biopsy only in app. 0.005% of the cases, is today the most important cause of biliary bleeding, mainly as a complication (app. 3% of the cases) of the widespread use of interventional procedures of the biliary tree (e.g. PTCD). Therapeutically arterial embolization should be considered first if possible.

Adult↗
PubMed1989

[Litholysis and lithotripsy of gallstones. State of the art and prospects].

The combination of dissolution and shockwave treatment for cholesterol stones is successful in 80% of the patients. The indication is strictly limited to cholesterol stones of between ten and thirty millimeters in diameter, or three stones of similar mass. In 80% of common duct stones which cannot be removed by endoscopy, shockwave treatment is a successful adjuvant procedure. It is estimated that recurrent stones will occur in 50% of the cases after five years. As long as the problem of recurrent stones persists, the group of stone carriers suitable for conservative treatment cannot be definitevely defined.

Chenodeoxycholic Acid↗
PubMed1986

Non-surgical biliary drainage: endoscopic conversion of percutaneous transhepatic into endoprosthetic drainage.

Percutaneous transhepatic drainage (PTD) is associated with many long-term complications. Therefore a large-diameter endoscopic endoprosthesis is preferentially employed to bridge a malignant obstruction of the biliary tract. Only if the placement of an endoprosthesis fails, must PTD be established. We present a simple method for converting PTD into a large endoprosthesis (14 F) with the aid of endoscopy. We have performed this conversion successfully in 8 patients without complications.

Biliary Tract Neoplasms↗
PubMed1986

Effect of 5-diazouracil on the catabolism of circulating pyrimidines in rat liver and kidneys.

The inhibitory effect of 5-diazouracil on the catabolism of circulating uracil and 5-fluorouracil was examined in the rat in vivo. Measurements of the activity of the entire enzymatic pathway of uracil catabolism in the cytosolic supernatant of different rat organs as well as the determination of the total amount of 5-fluorouracil catabolites, accumulated in these tissues, served to clarify their role in the complete systemic breakdown of uracil or 5-fluorouracil. The activity of the enzymatic pathway involved in uracil catabolism was estimated from the 14CO2 produced from [2-14C]uracil in the cytosolic supernatants. Complete degradation of uracil was detected only in the liver and, at a much lower rate, in the kidneys. Fifteen min after the i.p. injection of a tracer dose of 5-fluoro[6-14C]-uracil, more than 90% of the total radioactivity in blood plasma was associated with 5-fluorouracil catabolites. The relative amount of the major catabolite alpha-fluoro-beta-alanine and of dihydrofluorouracil in blood plasma was considerably suppressed after a pretreatment with 5-diazouracil inversely correlated with a 27-fold increase in the absolute amount of unchanged 5-fluorouracil. Control animals accumulated by far the highest amount of total acid-soluble radioactivity from 5-fluoro[6-14C]uracil in liver and kidneys. Total radioactivity in all other organs was much lower and was comparable to the amount of label in blood plasma. In liver and kidneys, the sum of total acid-soluble catabolites including dihydrofluorouracil, alpha-fluoro-beta-ureidopropionic acid, and alpha-fluoro-beta-alanine made up more than 98% of the label correlating with minimal salvage utilization of the base analogue in both organs. Injection of 5-diazouracil 2 h before a tracer dose of 5-fluoro[6-14C]uracil strongly inhibited the accumulation of labeled catabolites in liver and kidneys causing a fall in total acid-soluble radioactivity in both tissues by 75 and 66%, respectively. In blood plasma and all other organs, however, pretreatment with 5-diazouracil was followed by a 2-fold enhancement of the radioactivity contents, mostly due to the appearance of unchanged 5-fluorouracil. Under these conditions, there was a 2.6- to 4-fold increase in the relative proportion of cis-diol group-containing anabolites of 5-fluorouracil in liver and in kidneys. Within 2 h, 12.7% of the administered radioactivity from 5-fluorouracil was excreted into bile. 5-Diazouracil lowered the biliary excretion of radioactivity to 2% of the injected dose.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1986

[X-ray and endoscopic diagnosis of ulcerative colitis and Crohn disease].

The indication for radiologic or endoscopic examinations in ulcerative colitis and Crohn's disease depends on the stage of the disease. Advantages of the colonoscopy are the possibility to take biopsies, the coloured few of lesions and the avoidance of X-rays in the management of young patients. Radiology is superior to endoscopy in estimating shortening of the bowel, stenoses and fistulas.

Colitis, Ulcerative↗
PubMed1985

Hepatic carbamoyl phosphate metabolism. Role of cytosolic and mitochondrial carbamoyl phosphate in de novo pyrimidine synthesis.

The interrelationship between the two carbamoyl phosphate pools in intact hepatocytes and intact liver was studied with respect to de novo pyrimidine synthesis by use of selective inhibitors of the mitochondrial and the cytosolic carbamoyl-phosphate synthetase. Inhibition of mitochondrial carbamoyl phosphate synthesis by 4-pentenoate was without effect on galactosamine-stimulated pyrimidine synthesis. Conditions favouring mitochondrial carbamoyl phosphate accumulation, like excess ammonium ions or L-norvaline, led to an increase in pyrimidine synthesis bypassing the feedback inhibition of cytosolic carbamoyl-phosphate synthetase by UTP. A stimulation of pyrimidine synthesis was not observed when the carbamoyl phosphate accumulation was due to aspartate deficiency in the presence of aminooxyacetate. The full response of pyrimidine synthesis to excess ammonium ions was restored, even in the presence of aminooxyacetate, when aspartate was substituted. This is explained by an inhibition of aspartate carbamoyltransferase flux [in view of the Km (aspartate = 0.7 mmol/l) of this enzyme] resulting from a 90% decrease in aspartate tissue levels. Acivicin, the inhibitor of cytosolic carbamoyl-phosphate synthetase, completely abolished the galactosamine-induced stimulation of pyrimidine synthesis, but was without effect on the stimulation of pyrimidine synthesis by ammonium ions and L-norvaline. It is concluded that experimental changes in mitochondrial carbamoyl phosphate content exert effects on de novo pyrimidine synthesis; however, it is considered unlikely that relevant amounts of mitochondrial carbamoyl phosphate are used for pyrimidine synthesis under physiological conditions. In addition the data point to a potential regulatory role of aspartate in hepatic pyrimidine synthesis.

Aminooxyacetic Acid↗
PubMed1985

Uridine catabolism in Kupffer cells, endothelial cells, and hepatocytes.

Kupffer cells, endothelial cells, and hepatocytes were separated by centrifugal elutriation. The rate of uracil formation from [2-14C]uridine, the first step in uridine catabolism, was monitored in suspensions of the three different liver cell types. Kupffer cells demonstrated the highest rate of uridine phosphorolysis. 15 min after the addition of the nucleoside the label in uracil amounted to 51%, 13%, and 19% of total radioactivity in the medium of Kupffer cells, endothelial cells, and hepatocytes, respectively. If corrected for Kupffer cell contamination, hepatocyte suspensions demonstrated similar activities as endothelial cells. In contrast to non-parenchymal cells, hepatocytes continuously cleared uracil from the incubation medium. The lack of uracil consumption by Kupffer cells and endothelial cells points to uracil as the end-product of uridine catabolism in these cells. Kupffer cells and endothelial cells did not produce radioactive CO2 upon incubation in the presence of [2-14C]uridine. Hepatocytes, however, were able to degrade uridine into CO2, beta-alanine, and ammonia as demonstrated by active formation of volatile radioactivity from the labeled nucleoside. There was almost no detectable formation of thymine from thymidine or of cytosine, uracil, or uridine from cytidine by any of the different cell types tested. These results are in line with low thymidine phosphorolysis and cytidine deamination in rat liver. Our studies suggest a co-operation of Kupffer cells, endothelial cells, and hepatocytes in the breakdown of uridine from portal vein blood with uridine phosphorolysis predominantly occurring in Kupffer cells and with uracil catabolism restricted to parenchymal liver cells.

Animals↗
PubMed1985

De novo pyrimidine biosynthesis in isolated rat hepatocytes. Quantitative aspects of the regulation by UTP.

Quantitative aspects of de novo pyrimidine biosynthesis in rat hepatocytes were monitored. A reduction of intracellular UTP contents by different concentrations of D-galactosamine led to a dose-dependent increase of 14CO2 incorporation into the sum of all acid-soluble uracil nucleotides. In controls the rate of de novo synthesis which was calculated from the incorporation rate of 14CO2 into the sum of all acid-soluble uracil nucleotides was 0.014 mumol X h-1 X g-1 compared to 0.056 mumol X h-1 X g-1 wet weight of liver in situations of a maximally stimulated de novo synthesis. Incubation of hepatocytes with uridine led to a dose-dependent reduction of 14CO2 incorporation to less than 25% of the amount incorporated in the controls. Alterations of the CTP content had no influence on the 14CO2 incorporation. In the presence of high D-galactosamine concentrations the increase of the total amount of acid-soluble uracil nucleotides exceeded the rate of the de novo synthesis derived from the incorporation of 14CO2 into the sum of the acid-soluble uracil nucleotide pool. It was also greater than the increase of the total amount of intra- and extracellular orotate after acidic hydrolysis--even in the presence of 6-azauridine, which stimulated de novo pyrimidine biosynthesis by itself.

Adenosine Triphosphate↗