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Biomedical subjects

K E Grund

Publications and source records attributed to K E Grund.

At least 19 recordsLinked to original sources
PubMed1995

Induction of cytochrome P4501A by smoking or omeprazole in comparison with UDP-glucuronosyltransferase in biopsies of human duodenal mucosa.

Drug-metabolizing enzymes were investigated in duodenal biopsy specimens. Cytochrome P4501A (CYP1A) activity was determined by measuring 7-ethoxyresorufin O-deethylase (EROD) activity in biopsies from 20 smokers (3-30 cigarettes per day), 21 nonsmokers, and 10 nonsmokers receiving omeprazole treatment (20-60 mg/day for at least 1 week). Omeprazole is known to act as a polycyclic aromatic hydrocarbon (PAH)-type inducer in humans. EROD activity was found to be significantly induced in smokers and omeprazole-treated patients, with medians of 2.1 and 1.1 pmol.min-1.mg protein-1, respectively, compared with 0.5 pmol.min-1.mg protein-1 in nonsmokers. Immunoblot analysis substantiated that EROD activity was correlated with CYP1A protein. In contrast, UDP-glucuronosyltransferase (UGT) activity towards 4-methylumbelliferone (an overlapping substrate of several constitutive and inducible UGTs) was not significantly affected. The results demonstrate CYP1A induction by omeprazole and by constituents of cigarette smoke in the human duodenum and support the utility of duodenal biopsies to monitor CYP1A induction by PAH-type inducers.

Cytochrome P-450 CYP1A1↗
PubMed1995

Therapeutic effect of argon plasma coagulation on small malignant gastrointestinal tumors.

In endoscopy, argon plasma coagulation (APC) is a new principle of non-contact electrocoagulation and has proved to be a sufficient tool for palliative endoscopic treatment of gastrointestinal neoplasms, predominantly of the oesophagus and colorectum. In a study of 67 patients suffering from histologically confirmed and endosonographic T1-staged tumours of the gastrointestinum, 10 patients were selected for endoscopic APC treatment because of the impossibility of surgical therapy. Although the application was primarily of a palliative nature, in 9 of 10 cases of minor neoplasms, no further tumour could be detected in biopsies during the observation period (9.45 +/- 2.8 months). One patient was not cured locally. In none of the patients was any serious complication noticed during the outpatient follow-up. The effective results and lack of severe complications suggest this technique as an alternative therapy in selected patients with smaller gastrointestinal tumours.

Aged↗
PubMed1995

[Highly flexible self-expanding metal mesh stents: a new kind of palliative therapy of malignant dysphagia].

Metal mesh stents are a new way in the treatment of malignant stenoses. Between 11/91 and 12/93 in 79 patients with malignant stenoses of the esophagus and the esophago-gastric junction 96 highly elastic, knitted, self-expanding nitinol stents (Ultraflex, Boston Scientific) were implanted. Most of the tumors being problematic, preoperated or preradiated, in 78 of 96 implantations endoscopic pretreatment (Laser, Argon Plasma Coagulation (APC), dilatation)--mostly in the same session--was necessary. Follow up time was 21 (2-108) weeks. In this pilot study 3.5 (1-27) controlendoscopies with 2.5 (1-10) endoscopic interventions were performed. 90 of 96 implantations were primarily successful and led to a functional success in 73 of 79 patients. The ability to swallow improved significantly, the score of dysphagia improved from 3.5 to 1.0 (p < 0.001). There were no relevant complications and no stent-related mortality. All stents could be kept patent during the follow up period using the new developed Argon-plasma-coagulation (APC) to treat the ingrowth of granulation tissue or tumor, which was observed during follow up in 72 of 93 implantations. Tumor ingrowth represents the main problem of the method and demands endoscopic posttreatment (APC) in cases with relevant re-obstruction. Impairment of the stent lumen by tumor ingrowth (granulation tissue plays no role) would have been observed in about 60% of the patients without such a treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Laser therapy for esophageal cancer. Results and additional endoscopic treatments.

Between 1/1/1988 and 5/31/1991, we treated 96 patients with laser therapy to the esophagus. In 61 inoperable patients, laser therapy has been performed initially. In 64% of these 61 patients, laser therapy alone gave sufficient relief of symptoms until death. However, in 36% of the patients, additional endoscopical interventions had to be performed. In 14 patients (23%), a prosthesis became necessary; 13 patients (21%) needed a percutaneous endoscopical gastrostomy. We conclude that laser therapy has an important role in the treatment of esophageal cancer, but in a significant number of patients, it might not be sufficient alone.

Adult↗
PubMed1994

Direct endoscopic percutaneous jejunostomy (EPJ). Clinical results.

Direct puncture of the small bowel under endoscopic guidance (direct EPJ) is possible in patients whose stomach has been removed or whose small bowel cannot be punctured by other methods. From January 1990 to June 1992 a total of 39 patients underwent successful direct EPJ at our institution. The indications were malnutrition after partial or total gastrectomy (n = 19), insufficient anastomosis or a stenosis after esophageal resection and esophagojejunostomy (n = 13), esophageal perforation (n = 3), fistulas (n = 2), or severe trauma (n = 2). The tubes were inserted at the bedside under local anesthesia using the string pull-through technique. The procedure was attempted in five other patients but it was technically impossible to insert the tubes in these patients. Postoperative enteral feeding was possible in all 39 patients whose direct EPJ was successful. Complications included tube dysfunction due to plugging and fracture in five patients, pressure-induced enteric ulcers in two, and local infections in three patients. The ulcers and infections were managed conservatively. We conclude that direct EPJ is a safe, effective alternative to surgical catheter-jejunostomy.

Adult↗
PubMed1994

Endoscopic argon plasma coagulation (APC) first clinical experiences in flexible endoscopy.

Argon plasma coagulation (APC) is a new mode of non-contact electrocoagulation in which current is applied to tissues by means of ionised argon gas (argon plasma). In open surgery, APC is used for the haemostasis of superficial, diffuse haemorrhages from parenchymatous organs and for the devitalization of various tissues. Experimental studies have shown the superiority of APC to standard electrocoagulation modes and surgical techniques due to its efficiency and limited tissue traumatisation. After developing and designing special probes which can be applied through flexible endoscopes and after testing these in in vitro studies, we have been able to utilise APC in both the gastrointestinal tract and the tracheobronchial system. From June, 1991 to September, 1992, 102 patients were treated endoscopically in 189 sessions with APC in the upper and lower gastrointestinal tract as well as in the respiratory system. The indications were malignant and benign tumours, diffuse haemorrhages of various origins and sites, tissue overgrowth after stent implantation, tissue remnants after endoscopic adenomectomy, and the conditioning of fistulas prior to fibrin sealing. In all cases, APC in flexible endoscopy was highly effective and easy to perform, with advantages over standard electrocoagulation. No problems or complications were observed. The limited depth of tissue coagulation (2-3 mm) with concomitant, efficient tissue coagulation allows application even in critical areas where there is risk of perforation, such as the duodenum or colon. For many indications, APC has replaced the Nd:YAG-laser, which was formerly used widely in our unit, Except for vaporisation of extended tumours, the APC shows remarkable advantages in nearly all applications.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Technology of argon plasma coagulation with particular regard to endoscopic applications.

Argon plasma coagulation is especially suited for thermal coagulation of tissue surfaces, for the haemostasis of surface bleeding and for the devitalisation of defined pathologic tissue layers. The maximum coagulation depth achievable under good control is 3-4 mm. Argon plasma coagulation has been tested successfully and is presently being used clinically in open surgery, especially for the haemostasis of surface bleeding in parenchymal organs. Consequently, the coagulation technique described here is gaining more and more interest in endoscopic surgery. The absence of the adhesion effect between the coagulation electrode and coagulum, of smoke production and of carbonization of the coagulum have played an important role in this development. There are already various applicators available for the endoscopic application of argon plasma coagulation. Their success is an encouragement to further development of this coagulation technique for endoscopic operations.

Argon↗
PubMed1993

[Endoscopic argon gas coagulation--initial clinical experiences].

Argon-gas-coagulation represents a new method of contact free electrocoagulation, where RF-energy is applied to the tissue by means of ionized argon-gas. In the operative field argon-gas-coagulation has been used with success for hemostasis in several parenchymatous organs and for devitalization of various tissues. Experimental studies have shown the superiority of argon-gas-coagulation over standard electrocoagulation and surgical techniques due to its high efficiency and limited tissue traumatization. Having developed and designed special endoscopic probes and after in-vitro-studies we could utilize the method in flexible endoscopy as well. From June 1991 to September 1992, 102 patients were treated in 189 sessions with argon-gas-coagulation in the upper and lower gastrointestinal tract as well as respiratory system. The indications were: malignant and benign tumors, diffuse hemorrhages of various origins and of various sites, tissue overgrowth after stent-implantation, remaining tissue after endoscopic adenomectomy and conditioning of fistulas prior to fibrin sealing. In all cases argon-gas-coagulation in flexible endoscopy has been shown to be a very effective and easy to perform technique with advantages in comparison to standard electrocoagulation. Problems and complications have not been observed. The limited depth of tissue penetration (2-3 mm) coincident with efficient tissue coagulation allows the application even in critical areas such as the duodenum or colon. In many indications argon-gas-coagulation has replaced the former widely used Nd-YAG-laser in our unit. Except vaporisation of extended tumors, the argon-gas-coagulator shows remarkable advantages for nearly all applications.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenomatous Polyposis Coli↗
PubMed1990

[Meckel's diverticulum and lower gastrointestinal bleeding. Problems of preoperative diagnosis].

A hitherto perfectly healthy 28-year-old man suddenly passed stools containing bright red blood, and haemoglobin concentration fell at first to 10.1 g/dl. No bleeding source was found on gastroscopy and coloscopy. Nor was the source found by enteroclysis during a bleeding-free interval. Emergency laparotomy was performed after a recurrence of massive bleeding and revealed, 60 cm oral of the ileocaecal (Bauhin's) valve, a Meckel's diverticulum with ulcerated heterotopic gastric mucosa, 5 x 3 x 2 cm in size, and this was resected. 17 red blood cell concentrates had to be infused pre- and postoperatively, but there were no further complications.

Adult↗
PubMed1990

The consequences of tubulo-interstitial changes for renal function in glomerulopathies. A morphometric and cytological analysis.

Morphometric investigation of the structures of the cortex in kidneys exhibiting various types of glomerulopathy revealed the following: 1. In various types of glomerulonephritis, diabetic glomerulosclerosis, and glomerular amyloidosis there are significant correlations between the severity of fibrosis of the renal cortical interstitium and tubular atrophy resulting from chronic interstitial inflammation, and the serum creatinine concentration, creatinine clearance, inulin clearance and PAH clearance. 2. As illustrated with the example of membranoproliferative glomerulonephritis type I, if glomerulopathy alone is present, there is no elevation of the serum creatinine concentration, even if the glomerular inflammatory changes are severe; neither are severe renal amyloidosis that is confined to the glomeruli and severe isolated diabetic glomerulosclerosis associated with elevation of the serum creatinine concentration. 3. There is a significant negative correlation between the severity of interstitial fibrosis resulting from chronic inflammation and the total number and cross-sectional area of the intertubular capillaries; i.e., the total cross-sectional area and number of capillaries per unit area decrease as the fibrosis of the cortical interstitium increases. 4. Cases of glomerulonephritis in which there is accompanying fibrosis of the renal cortical interstitium have a significantly worse long-term prognosis than those in which there is only severe glomerulitis. 5. Obliteration of the post-glomerular capillaries leads to an increase in the cross-sectional area of the glomerular capillary convolution, the morphological equivalent of an increase in intraglomerular pressure. 6. The cause of the disease of the renal cortical interstitium that may accompany the various types of glomerulonephritis is not known. It is considered possible, as a working hypothesis, that this inflammation represents a T-cell stimulated autoimmune process in which fibroblast proliferation occurs, leading to an increase in numbers of fibrocytes in the renal cortical interstitium and thus to increased production of collagen.

Creatinine↗
PubMed1990

[Etiopathogenesis of adhesions. Aspects of analysis of the literature 1888 to 1989].

Despite surgical efforts over a century, peritoneal adhesions are still an unsolved problem. Pathogenetic aspects derived from an analysis of the literature (700 papers, 1888-1989) are discussed: Two basic mechanisms play a role. Inhibition of the physiological regeneration of mesothelial defects and depression of peritoneal fibrinolytic activity mainly by ischemia and inflammation. Fibrinolysis in due time prevents the fibrinous adhesions from being transformed into fibrous ones. - All prophylactic and therapeutic measures have to be evaluated regarding these factors.

Abdomen↗
PubMed1983

[Crohn disease - value of coloscopy to the surgeon].

In a total of 1105 coloscopies, performed from 1977 to 1980, 36 patients with Crohn's disease could be found. 18 of them had an isolated involvement of the colon. In most cases coloscopy proved to be an important aid for surgical management. Using graded biopsies the diagnosis can be confirmed or excluded, despite the fact that Crohn-specific granulomas were seen only in 10 of 32 patients. The specificity of fistulas and stenoses can also be determined by coloscopy. With radiology producing false positive (4) and false negative (5) results in 30 patients, coloscopy in contrast proved to be the better diagnostic tool (2 false neg.). Every patient with Crohn's disease should be investigated preoperatively by additional coloscopy and biopsy.

Biopsy↗
PubMed1983

Extrabiliary obstructive jaundice.

Extrabiliary obstructive jaundice is only encountered in biliary digestive anastomosis when the draining bowel itself is obstructed. In two patients, the cause of obstruction was a local tumour recurrence.

Adult↗
PubMed1982

[Treatment of functional ileus: adrenergic blockade and stimulation (author's transl)].

Intestinal stimulation is among the basic therapeutic procedures in functional ileus. But the majority of cases of functional ileus is due not to paralysis but to adrenergic inhibition. Thus the primary treatment should not be to stimulate but to act against the inhibition. In over 100 patients a combined treatment schedule consisted of primary adrenergic blockade (trifluperidol, dihydroergotamine or chlorpromazine) followed by low doses of stimulants (ceruletide, neostigmine). 52 patients who had not responded to high doses of peristalsis-stimulating drugs acted as their own controls: in 48 of them intestinal function was restored by sympathicolysis. If indications and application are properly observed the method has a low risk and provides effective treatment of functional ileus, especially in cases resistant to other forms of treatment.

Adolescent↗