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Biomedical subjects

M Hinterreiter

Publications and source records attributed to M Hinterreiter.

11 recordsLinked to original sources
PubMed2002

[Indications and results of endoscopic examinations in intensive care units].

The aim of the study was to analyze retrospectively all endoscopies performed on 3 intensive care units in a tertiary referral center with more than thousand beds during a period of ten years. The study evaluates all endoscopies with regard to indication and findings. In the years 1989-1998 a total of 326 endoscopic examinations was performed, most of them were done as an upper gastrointestinal endoscopy (88%). In more than 87% the indication was a suspected gastrointestinal bleeding. The most frequent findings consisted in ulcers of the stomach or duodenum and esophageal varices, then followed by Mallory-Weiss-lesions, esophagitis and erosive gastritis. The etiology of gastrointestinal bleeding was similar to that of non intensive care patients. Specific causes of bleeding such as esophagitis caused by nasogastric tubes were only found in 3% of all bleedings. The numbers of endoscopies on the 3 intensive care units were increasing during the ten year period, however the numbers of the patients treated on the intensive care units were also increasing, but the increase of endoscopies was not always parallel to the rising number of intensive care patients.

Endoscopy↗
PubMed2002

Examination, prevention and treatment of osteoporosis in patients with inflammatory bowel disease: recommendations and reality.

BACKGROUND: Patients with inflammatory bowel disease (IBD) are at increased risk of developing osteopenia and osteoporosis. Our aim was to evaluate the current practices of examination, prevention and treatment of osteoporosis in IBD patients in a routine clinical setting. METHODS: A total of 154 consecutive patients with IBD (63 female, 91 male; 36 ulcerative colitis, 115 Crohn's disease, 3 indeterminate colitis), referred to two gastroenterological units for scheduled follow-up examinations, were included. Patient charts were evaluated regarding bone densitometry already performed and any prophylactic or therapeutic interventions in cases of low bone mineral density. RESULTS: Bone mineral density (BMD) measurements had been performed only in 38 patients (25%). BMD was abnormally low in 27 of the examined patients (71%), 20 of whom had osteopenia and seven had osteoporosis. Among the subgroup of patients on long-term steroid therapy (77 patients), 30 had been referred to bone densitometry during the course of disease, and 21 of them were found to have low bone mineral density. Preventive measures were prescribed in 12 patients (9% of the whole study population). In the majority of the patients with low bone mineral density, calcium and vitamin D were used as treatment. CONCLUSIONS: Despite the high prevalence of osteopenia and osteoporosis in patients with IBD, only a minority of these patients were included in a structured program in accordance with modern guidelines for diagnosing and preventing this extraintestinal complication in a routine clinical setting.

Absorptiometry, Photon↗
PubMed2002

[Colonoscopy and sigmoidoscopy in patients aged eighty years or older].

BACKGROUND: The demographic development will lead to an increase in endoscopic examinations in elderly patients. Indications, feasibility and therapeutic consequences following detection of pathologic findings are important assessing the relevance of endoscopy in geriatric patients. METHODS: We analyzed all colonoscopies and sigmoidoscopies which were performed between January 1995 and December 2000 in patients older than 80 years. The parameters indication, sedation, colonoscopy completion rate, endoscopic findings, therapeutic consequences and complications were evaluated. RESULTS: A total of 951 endoscopies in patients older than 80 years (781 colonoscopies, 170 sigmoidoscopies; mean age 84.3 years) were performed. The most frequent indications were: abdominal pain (n = 144; 15 %), bleeding (n = 115; 12 %), constipation (n = 97; 10 %), anemia (n = 85; 9 %), and history of polyps (n = 78; 8 %). Sedation was used in 183 examinations (19 %), mostly with midazolam (n = 179). Colonoscopy was completed successfully to the coecum in 71 %. 214 examinations were unremarkable (23 %). Frequent pathologic findings were: diverticular disease (n = 396; 42 %), polyps (n = 256; 27 %), and colorectal carcinoma (n = 75; 8 %). Curative surgery was possible in 55 % and palliative surgery in 9 % of patients with colorectal carcinoma, respectively. A complication was observed in six patients (0.6 %), four bleedings following polypectomy, one perforation after dilatation of a stenotic tumor, and one transient neurologic deficit. CONCLUSIONS: Endoscopy of the lower gastrointestinal tract is feasible in geriatric patients with a low rate of complications. The low number of normal findings and the frequent diagnosis of colorectal carcinoma were remarkable. In spite of old age more than half of the patients with carcinoma could be operated curatively emphasizing the importance of endoscopic investigations in this age group.

Age Factors↗
PubMed2001

[Risk of osteoporosis in steroid therapy. When and how to counter the risk].

Many chronic inflammatory diseases require treatment with steroids, however, a remarkable proportion of steroid-treated patients suffer from osteoporosis as a major complication following longterm treatment. Steroid-induced osteoporosis with its complex pathogenesis represents one of the most important secondary causes of osteoporosis. If we care for patients with steroid therapy we have both to consider this problem and to focus on strategies to evaluate patients at risk. The dosage of the steroid, life style factors, menopausal status, low bone mineral density at baseline and previous osteoporotic fractures predispose for the manifestation of steroid-induced osteoporosis. Decisions in regard of prevention and therapy depend on risk factors of the individual patient. Supplementation of calcium and vitamin D is usually appropriate, and postmenopausal women should be offered hormone replacement therapy. The prescription of bisphosphonates is strongly recommended to patients at elevated risk or to patients with already documented osteoporosis.

Anti-Inflammatory Agents↗
PubMed2001

Concomitant manifestation of achalasia and sphincter of Oddi dysfunction.

We report the case of a 44-year-old woman who suffered from biliary-type pain after cholecystectomy, dysphagia, and weight loss. Examinations revealed sphincter of Oddi dysfunction (SOD) and achalasia. Complete relief of symptoms was achieved by endoscopic sphincterotomy and pneumatic dilation of the distal esophagus. This case report demonstrates for the first time the concomitant manifestation of two motility disorders of the upper gastrointestinal tract, i.e. achalasia and SOD. At present, any causal relationship seems speculative; however, both diseases were successfully treated using endoscopic procedures.

Adult↗
PubMed2001

[Current concepts in therapy of reflux disease].

Proton pump inhibitors have replaced H2-blockers as first line agents for the therapy of gastroesophageal reflux disease due to their effective acid suppression and faster healing rate. The endoscopic severity of esophagitis and the clinical response are the most important determinants of dosing and duration of therapy. In patients with severe esophagitis continuous maintenance treatment with proton pump inhibitors is recommended. In recent years antireflux surgery has been established as an important alternative therapy.

Anti-Ulcer Agents↗
PubMed2000

Severe pancytopenia after leflunomide in rheumatoid arthritis.

Leflunomide is a novel drug recently introduced for treatment of rheumatoid arthritis as a DMARD (disease-modifying antirheumatic drug). So far, leflunomide has not been associated with severe bone marrow toxicity and pancytopenia. We report of a 62-year-old woman with a 14-year history of rheumatoid arthritis with bone marrow toxicity and reversible pancytopenia developing after treatment with leflunomide.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2000

Recurrent septicemia with lethal outcome during and after cyclosporine therapy in severe ulcerative colitis.

High dose corticosteroids have been the mainstay in the treatment of fulminant ulcerative colitis (UC) for a long time. In the last years intravenous cyclosporine (CyA) has been reported to be rapidly effective and relatively safe in patients with severe corticosteroid-resistant UC. We report on a 64 year old patient with a severe flare-up of UC who responded well to intravenous CyA after a standard therapy with high dose corticosteroids alone had been ineffective. However, recurrent staphylococcus aureus sepsis developed during CyA therapy. Despite a long-time antibiotic therapy two further episodes of staphylococcus aureus sepsis occurred after discontinuation of CyA treatment. Being in remission with his UC the patient died 14 months later of staphylococcus aureus sepsis despite intense antibiotic treatment. Infectious complications of this therapeutic regime in severe UC are known but to our knowledge a recurrent sepsis complicating this therapy even after cessation of CyA has not been reported in the literature so far.

Colitis, Ulcerative↗
PubMed1993

Myocardial infarction after chronic ergotamine abuse.

As a result of chronic ergotamine abuse, reversible arterial narrowing has been documented angiographically in peripheral, but not in coronary arteries. We report on a patient with no cardiovascular risk factors, but because of chronic ergotamine abuse suffered on acute myocardial infarction, complicated by ventricular fibrillation. Coronary angiography performed 3 days after resuscitation revealed a distal occlusion of the left anterior descending artery. Three months later, spontaneous recanalization had occurred, and no residual narrowing was seen angiographically. Thus, surveillance of patients with migraine headache to avoid chronic ergotamine abuse is recommended to prevent cardiovascular complications.

Coronary Disease↗