PubMed Health⌕ Search

Biomedical subjects

K J Hengels

Publications and source records attributed to K J Hengels.

At least 37 records · Page 2Linked to original sources
PubMed1992

Incidence and pattern of peptic ulcer bleeding in a defined geographical area. DUSUK Study Group.

Despite the introduction of effective medical treatment for peptic ulcer disease, no decrease in the incidence of bleeding has been observed. Unfortunately, most incidence studies rely on a questionable case ascertainment and poor data. We therefore conducted a prospective study, to achieve an unbiased estimate of incidence and pattern of peptic ulcer bleeding in Düsseldorf (Germany). In a 1-year period all patients with endoscopically verified peptic ulcer bleeding who were admitted to the departments of internal medicine or surgery in nine hospitals or seen by nine general practitioners offering endoscopic service were included in the study. Incidence rates were calculated in accordance with sociodemographic variables and expressed per 100,000 person-years of observation. The overall incidence of peptic ulcer bleeding was 51.4, with almost even rates for gastric (26.5) and duodenal (24.9) ulcer. Age was associated with an increased likelihood of bleeding in gastric ulcer patients of 19 per decade from about 40 years onwards (duodenal ulcer, 15). The incidence was about twice as high in men as in women (relative risk = 1.9). The pattern of peptic ulcer bleeding was similar in gastric and duodenal ulcers with regard to ulcer size, multiple lesions, and bleeding activity at endoscopy. However, patients with gastric ulcer bleeding had significantly more often accompanying or underlying diseases. No significant differences were observed between gastric and duodenal ulcer bleeding with regard to nonsteroidal antiinflammatory drug intake and ulcer history. The incidence rates in our study are in the upper range of the literature and comparable to rates from the USA and UK both before and after the introduction of H2 blockers. We hypothesize that the persistently high incidence rate is a superposition of two trends: higher incidences due to a more elderly and diseased population and more NSAID intake, and lower incidences due to effective medical treatment.

Adult↗
PubMed1992

[DNA ploidy and dysplasia in ulcerative colitis--interim analysis of a prospective study].

DNA ploidy and cell cycle phases were evaluated by flow cytometry in colonic biopsy specimens from 107 patients with ulcerative colitis in order to analyse the prevalence of DNA aneuploidy as an indicator of numerical chromosomal aberrations and the cell proliferation in all forms of ulcerative colitis. Whereas G2/M-phase fractions in ulcerative colitis and in controls were comparable (2.7 +/- 1.1% vs. 2.8 +/- 1.1%), S-phase fractions in ulcerative colitis exceeded those of controls (7.5 +/- 3.2% vs. 6.5 +/- 2.3%; p < 0.01). In 28 control patients, only diploid DNA histograms existed. Single or multiple aneuploid stem lines were detected in 10 patients with ulcerative colitis (9.3%). Aneuploidy was nearly exclusively associated with pancolitis. Dysplasia was present in 13 patients (indefinite: 8; low-grade: 5), of whom 5 patients also showed DNA aneuploidy. 5 patients with non-dysplastic mucosa exhibited DNA aneuploidy. Because dysplasia and DNA aneuploidy can be discordant and might therefore identify different subgroups at risk, flow cytometry might play a role as a valuable complement to histological examination in surveillance programs of ulcerative colitis.

Adult↗
PubMed1991

Assessment of proliferative activity in carcinomas of the human alimentary tract by Ki-67 immunostaining.

The monoclonal antibody (MAb) Ki-67, which is directed against a proliferation-associated nuclear antigen, was used to measure tumor proliferation in 165 carcinomas of the esophagus, stomach, colon and rectum with an indirect immunoperoxidase technique. The percentage of Ki-67-positive tumor cells (Ki-67 index) was evaluated with the point-counting method. The Ki-67 index in gastric cancers (mean, 24.8%; standard deviation, 11.1%) was significantly lower than in tumors of the esophagus (35.7 +/- 12.6%), colon (37.6 +/- 15.2%), and rectum (34.3 +/- 16.4%). A wide range of the Ki-67 index (5.9-75.3%) could be observed within the various tumor types. In recurrent colorectal carcinomas, the Ki-67 index significantly increased to 51.9%. The Ki-67 index was independent of pathologic (e.g., TNM-stage, grading, tumor volume, tumor site) and clinical variables (age and gender of the patients). A marked heterogeneity of Ki-67 expression within different tumor stages was noted. Statistically significant regional variations in tumor proliferation existed between different areas within the same tumor.

Adult↗
PubMed1991

Dose-related healing of duodenal ulcer with the proton pump inhibitor lansoprazole.

Lansoprazole (AG 1749) is a novel substituted benzimidazole which inhibits gastric acid secretion by blocking H+,K(+)-ATPase. This randomized, double-blind multicentre trial studied the dose-response relationship of lansoprazole on ulcer healing and compared it with ranitidine in 314 out-patients with endoscopically assessed, symptomatic duodenal ulcer. Cumulative healing rates with Lansoprazole 7.5, 15, and 30 mg o.m. were 48, 59, and 74% at 2 weeks and 75, 84, and 95% at 4 weeks, respectively (intention-to-treat); the difference of the healing rates between 7.5 and 30 mg groups was significant (P less than 0.001). Corresponding healing rates for 300 mg ranitidine nocte were 51 and 89%. Pain relief was similar in all treatment groups. Lansoprazole was well tolerated. During a follow-up of 6 months relapse rates after lansoprazole 7.5, 15, and 30 mg were 21, 29, and 22%, respectively; the relapse rate after ranitidine 300 mg was 20%. In conclusion, lansoprazole provides faster healing of duodenal ulcer than ranitidine and a similar relapse pattern. For further trials in peptic ulcer disease a daily dose of lansoprazole 30 mg o.m. is recommended.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1991

Low-dose antacid therapy in the treatment of duodenal ulcer--a multicentre double-blind trial vs. misoprostol.

We conducted a 4-week double-blind randomized controlled multicentre trial to compare low-dose-antacid (AA) therapy (225 meq total neutralizing capacity per day) with therapy using the prostaglandin E1-analogue, misoprostol (MS) (400 micrograms bid), on ulcer healing and relief of symptoms in 100 outpatients with endoscopically proven duodenal ulcer (DU, 49 patients on AA, 51 patients on MS). Of the 100 patients enrolled in the study 96 could be evaluated; 49 received AA, 47 MS. Endoscopies were performed before treatment, 2 and 4 weeks after initiation of treatment. Healing rates of AA- and MS-treatment were 36.7% vs. 25.5% (2 weeks) and 79.6% vs. 74.4% (4 weeks) and did not differ as much as relief of pain during the daytime. Rates of relief of nighttime pain were significantly higher on AA-treatment after 2 weeks of treatment (81.1% vs. 48.6%; p less than 0.05), but not during the later course of treatment. Thus, it can be concluded that low-dose AA-treatment using an aluminum/magnesium hydroxide preparation in tablet form represents an effective and safe therapy for duodenal ulcer.

Adult↗
PubMed1991

[Various genetic models in Crohn disease].

Crohn's disease has a genetic predisposition. In the light of epidemiological data, especially the type of familial clustering, simple modes of inheritance can be excluded. At the first glance, our results implied a polygenic multifactorial basis. Further processing of our data by the "mixed model" of Morton revealed a higher probability for a recessive gene with low penetrance. However, the differences in fit between the various models are relatively slight. Also considering ascertainment problems, a definite decision concerning an appropriate model must be deferred until sure genetic markers have been identified. Nevertheless, only a certain number of manifestations may be ascribed to a genetic predisposition, others have to be catagorized as phenocopies.

Adolescent↗
PubMed1990

[13C-urea breath test as a non-invasive method for the detection of Helicobacter (Campylobacter) pylori].

The 13C-urea breath test was used for diagnosing noninvasively the possible presence of Helicobacter (formerly called Campylobacter) pylori in 20 patients with dyspepsia (ten men and ten women, mean age 40.2 [24-74] years). H. pylori was cultured from 14 patients, while in six the culture was negative. The proportion of 13C in expired air was measured by isotope mass-spectrometer and expressed as Delta (basal value about 20%). A dose of 2.5 mg urea per kg body-weight (BW) was ingested after a standard meal. The test was repeated with 1.75 and 1.0 mg/kg BW in five subjects. Delta had increased significantly after 30 min in all H. pylori-positive patients (P less than 0.001). The maximal value after 90 min ranged from 38 to 114%; in the H. pylori-negative patients it was 24%. After 1.75 and 1.0 mg/kg urea the maximal value after 90 min was 39-52% and 30-52%, respectively. Using a dose of 2.5 or 1.75 mg/kg BW tagged urea one can reliably distinguish between presence and absence of H. pylori. It is sufficient to test a basal and a 90-min expired-air sample.

Adult↗
PubMed1990

Gene and haplotype frequencies of HLA antigens in 269 patients with Crohn's disease.

Evidence of strong genetic markers in Crohn's disease (CD) is still absent. Many investigations have focused on HLA antigens, with conflicting results. To obtain more detailed information on the relation of HLA to the disease, we used the HLA data from 269 CD patients to compute the maximum-likelihood estimates of HLA gene and haplotype frequencies. These results provide further evidence that HLA B44 and Cw5 do indeed play a role in the development of CD. Furthermore, it is conceivable from our results that HLA Cw7 may protect against being affected with this disease.

Chi-Square Distribution↗
PubMed1990

[T-lymphocyte subpopulations in the peripheral blood of patients with Crohn disease].

Immunological disorders seem to be of considerable relevance to the pathogenesis of Crohn's disease (CD). T-cells play a central role in immunoregulation. The T-cell subpopulations of 70 patients with CD were compared to those of age- and sex-matched healthy controls. The suppressor-inducer subpopulations were found to be reduced in CD patients irrespective of wether they were taking steroids or not. In contrast to other subpopulations suppressor-inducer cells remained unchanged during follow-up. The results point to a disturbance in the regulation of suppressor T-cells in patients with Crohn's disease.

Adrenal Cortex Hormones↗
PubMed1990

Crohn's disease: what about the pancreas?

Crohn's disease (CD) is now accepted as a systemic illness. The importance of extraintestinal manifestations is underlined by the fact that such "complications" can be more prominent and even more difficult to control than the intestinal disease itself. Lately, evidence for a more than accidental association of pancreatitis and exocrine pancreatic insufficiency with CD is growing. This might have a significant impact on the treatment of abdominal pain and diarrhea in CD, symptoms which have so far been attributed exclusively to the intestinal rather than the extraintestinal manifestations of the disease.

Crohn Disease↗
PubMed1990

[Flow cytometry results in patients with ulcerative colitis and Barrett esophagus. An additional diagnostic tool in the early diagnosis of a malignant transformation?].

In this review the basic principles of flow cytometry for the measurement of DNA content are described. In addition to cell cycle phase distributions DNA ploidy can be analysed by flow cytometry. Flow cytometric results in patients with ulcerative colitis and Barrett's esophagus seem to indicate that besides histologic examinations flow cytometry may play a role in surveillance programs of patients with an increased risk of a malignant transformation. These first interesting results, however, have still to be confirmed in long term studies.

Barrett Esophagus↗
PubMed1989

Assessment of cell proliferation in colorectal carcinomas using the monoclonal antibody Ki-67. Correlation with pathohistologic criteria and influence of irradiation.

Cell proliferation was measured by a three-step immunoperoxidase technique on cryostat sections of 61 resected colorectal adenocarcinomas using the monoclonal antibody Ki-67 that is directed against a proliferation-associated nuclear antigen. The percentage of Ki-67-positive cells was quantified with the point-counting method. The frequency distribution of the percentage of Ki-67-positive tumor cells in 52 unirradiated carcinomas was gaussian with a mean of 38.7% (range, 7.7% to 75.3%). Analysis of the unirradiated tumors showed no relation between Ki-67 staining and various clinicopathologic features including age, sex, tumor volume, tumor differentiation, location, and tumor stage. Although some tumors demonstrated intratumor heterogeneity of immunoreactivity, there was no significant difference in proliferative activity among peripheral, intermediate, and central tumor areas. Whereas the Ki-67 index increased to 47.1% in recurrent carcinomas, it decreased significantly to 24.7% in rectal carcinomas given radiotherapy before surgery. Therefore, Ki-67 immunostaining might be used as a tool to select and monitor patients with colorectal cancers who might benefit from radiotherapy. The marked differences of Ki-67 expression among different tumors may relate to heterogeneity in growth kinetics and may therefore carry prognostic implications.

Aged↗
PubMed1989

[Noncirrhotic liver fibrosis after chronic arsenic poisoning].

A 67-year-old woman with portal hypertension, splenomegaly without portal vein thrombosis, leucopenia and thrombocytopenia of splenic origin had repeated episodes of life-threatening haemorrhage from esophageal varices. Since childhood she had suffered from psoriasis and had been treated over a period of 15 years with Fowler's solution (in all about 25 g of arsenic trioxide). She had the characteristic skin lesions of arsenical poisoning-palmar hyperkeratoses and two basal cell carcinomas on the trunk. Histological examination of a wedge biopsy from the liver showed definite structural changes with fibrosis around the central veins and in the portal tracts. There was no evidence of cirrhotic alteration. The hepatocytes were normal by light microscopy and electron microscopy. This case of noncirrhotic hepatic fibrosis is considered to have been caused by chronic arsenical poisoning.

Aged↗
PubMed1989

Investigation of genetic markers in patients with Crohn's disease and ulcerative colitis.

Inflammatory bowel diseases (IBD) as Crohn's disease (CD) and ulcerative colitis (UC) are believed to have a genetic basis. Additional factors are supposed to promote the development of IBD. However, apart from a few reports of HLA associations which await confirmation by other groups strong associations to (a) particular genetic marker(s) are still lacking. We here report on previously unobserved associations of CD to MNSS and UC to the immunoglobulin heavy chain allotype Gm 1,-2,10. We suggest that these factors play a role in a wider spectrum of genetic markers for the development of IBD.

Acid Phosphatase↗
PubMed1989

Pepsinogens A and C: purification from human gastric mucosa and determination in serum by optimized radioimmunoassays.

Pepsinogen A and pepsinogen C were purified from human gastric mucosa. The preparations were immunochemically homogeneous and contained only their characteristic components. Specific, sensitive, and reliable radioimmunoassays for both pepsinogen A and pepsinogen C were developed. The concentration of pepsinogens in serum was log distributed. In 144 healthy control subjects the mean level of pepsinogen A (means +/- s) was 65.7 ng/ml (range: 49.8-86.6 ng/ml), significantly higher than the level of pepsinogen C (means = 12.2 ng/ml, range 9.2-16.1 ng/ml, p less than 0.001), with a Pg A/Pg C ratio of 5.8 +/- 2.7. In contrast, pepsinogen C was predominant in the serum of 26 patients with pernicious anemia. Since the mean level of the proenzyme (means = 10.2 ng/ml, range 7.7-13.4 ng/ml) did not differ (p greater than 0.05) from that of the control group, whereas the concentration of pepsinogen A was significantly lower (means = 6.1 ng/ml, range 3.7-9.5 ng/ml, p less than 0.001), the Pg A/Pg C ratio dropped to 0.6 +/- 0.3 (p less than 0.001). In 27 patients with total gastrectomy the levels of both pepsinogen A (means = 2.5 ng/ml, range 2.2-2.8 ng/ml) and pepsinogen C (means = 1.9 ng/ml, range 1.3-2.9 ng/ml) were significantly lower (p less than 0.001) than in patients with pernicious anemia. The results indicate that the stomach is the main source of serum pepsinogens, that under normal conditions the gastric chief cells release more pepsinogen A than pepsinogen C, and that only small amounts of the proenzymes originate from extragastric tissue.(ABSTRACT TRUNCATED AT 250 WORDS)

Anemia, Pernicious↗
PubMed1989

[Late initial manifestations of Crohn disease with atypical symptoms].

The case of a 55-year-old patient with Crohn's disease and chronic intermittent diarrhea as well as progressive weight loss of 20 percent of his body weight is reported. The establishment of the diagnosis was difficult at the beginning, since characteristic symptoms were missing and radiological and endoscopical findings were normal. Loam-coloured glossy stools, repeated registration of a reduced chymotrypsin concentration of the stool and the response of the symptoms to a substitution of pancreatic enzymes were initially regarded as signs of an exocrine pancreas insufficiency. Not before multiple biopsies were taken from the macroscopically largely normal small and large intestine during persisting complaints, an extensive infiltration with Crohn's disease could be shown. This case report emphasizes the importance of taking multiple biopsies in etiologically unexplained chronic diarrhea even from macroscopic inconspicuous intestinal mucosa. Because of the rising incidence of Crohn's disease late onset is gaining increasing significance in the differential diagnosis of chronic diarrhea in the elderly patients.

Biopsy↗