Biomedical subjects
P Greiner
Publications and source records attributed to P Greiner.
Dieulafoy lesion in a one-year-old child.
The Dieulafoy lesion is a rare cause of severe upper gastrointestinal bleeding associated with a significant mortality. Rebleeding from undiscovered lesions is frequent and often fatal. The outcome depends on a high degree of suspicion for the condition. In any age group, the entity may be underdiagnosed rather than truly rare. It is particularly uncommon in infants. The authors report the case of the youngest patient so far to suffer from a Dieulafoy lesion.
Late onset group B streptococcal disease manifested by isolated cervical lymphadenitis.
Sepsis and meningitis are the major clinical manifestations of group B streptococcal (GBS) infections in neonates, but GBS can cause a wide spectrum of presentations ranging from asymtomatic bacteraemia to fulminate septicaemia and shock. To our knowledge this is the first report of isolated neonatal lymphadenitis as a manifestation of late onset GBS disease.
Lack of response to botulinum toxin A in patients with hypertrophic pyloric stenosis.
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Asymptomatic autoimmune hepatitis associated with anti-LC-1 autoantibodies.
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Impaired resistance to oxidation of low density lipoprotein in cystic fibrosis: improvement during vitamin E supplementation.
Antioxidants such as vitamin E protect unsaturated fatty acids of LDL against oxidation. In the ex vivo model used, LDL was exposed to Cu2+ ions, a potent prooxidant capable of initiating the oxidation of LDL. The lag time, indicating the delay of conjugated diene formation in LDL due to antioxidant protection, was measured in 54 cystic fibrosis (CF) patients with plasma alpha-tocopherol levels below (Group A, n = 30) or above (Group B, n = 24) 15.9 mumol/L (mean - 2 SD of Swiss population). Patients were reevaluated after 2 months on 400 IU/d of oral RRR-alpha-tocopherol. In group A, alpha-tocopherol concentrations in LDL increased significantly from 3.2 +/- 1.6 mol/mol LDL to 8.2 +/- 2.8 mol/mol (P < 0.001) and lag times increased from 79 +/- 33 min to 126 +/- 48 min (P < 0.001), whereas in the vitamin E sufficient group B no further increase neither in LDL alpha-tocopherol concentrations or in lag times was observed. LDL oleic acid concentrations were higher, and linoleic acid concentrations were lower in patients than in controls. After efficient vitamin E supplementation, lag times were positively related to LDL alpha-tocopherol (P < 0.01) and negatively to LDL linoleic and arachidonic acid content (P < 0.001). The maximum rate of oxidation correlated positively with linoleic and arachidonic acid concentrations, as did the maximum conjugated diene absorbance. These results indicate that LDL resistance to oxidation is impaired in vitamin E deficient CF patients but can be normalized within 2 months when alpha-tocopherol is given in sufficient amounts. Linoleic and arachidonic acid content exhibit a major influence on the LDL resistance to oxidation.
[Chronic intestinal diseases in children].
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Prenatal diagnosis of Wiedemann-Beckwith syndrome.
We report the prenatal diagnosis of Wiedemann-Beckwith syndrome in the 28th week of pregnancy in a primigravida. The cause of hospitalization was severe polyhydramnios with premature labour. Sonography revealed macrosomia, nephromegaly, cysts of adrenal glands and a striking macroglossia with opened mouth in all controls. The combination of all these symptoms suggested the prenatal diagnosis of Wiedemann-Beckwith syndrome, which could be confirmed post partum after a normal delivery in the 33rd week of pregnancy. The newborn (2700 g, 48 cm) exhibited typical features of this syndrome as moderate hypoglycemia and polycythemia in addition to the sonographic finding. Pathogenetic aspects and differential diagnosis of macrosomia are discussed.
[Rothmund syndrome or Thomson syndrome. An analysis of the literature exemplified by a personal case].
We report on a now 16 month old child, born with multiple bone defects. A characteristic poikiloderma leading to the diagnosis appeared after six months. A review of the literature is given and the clinical heterogeneity of the Rothmund-Thomson-Syndrome is discussed. It is suggested, that the combination of the described malformations represents a Thomson Syndrome.
[Posthepatic jaundice caused by abnormalities of the pancreaticobile duct system in early childhood].
Anomalies of the pancreatico-biliary tract present the most frequent cause of posthepatic cholestasis in the young child, whereas calculous disease or infections or compression by vascular abnormalities or neoplasms are less frequent. Generally, abdominal pain and jaundice begin acutely and increase following progressive biliary congestion. The preoperative diagnosis by ERCP or PTC or the intraoperative diagnosis of a relevant pancreaticobiliary anomaly stress the necessity of an operative management performing a bypass of the Sphincter Oddi and of the site of the anomaly. Local operative revision alone seems to be associated with a frequent relapse of cholestasis.
Comparison of preoperative sonography with intraoperative findings in congenital hypertrophic pyloric stenosis.
In 17 infants with hypertrophic pyloric stenosis, the pyloric diameter was measured preoperatively by ultrasound. The mean pyloric diameter was 15.12 +/- 2.11 mm (mean +/- SD), range 11 to 19 mm. During pyloromyotomy, the hypertrophic pylorus was precisely measured craniocaudally and dorsoventrally, and measurements were obtained concerning muscular thickness and length of the pylorus. The preoperative and intraoperative measurements were subsequently compared. Differences of 0.76 +/- 1.68 mm and 1.24 +/- 2.04 mm were found for the dorsoventral and craniocaudal diameters, respectively. The intraoperative measurements were consistently greater than the sonographic findings. The length of the pylorus averaged 22.0 +/- 2.66 mm, the muscular thickness 6.53 +/- 1.68 mm, respectively. This prospective study confirms the diagnostic value of sonography in congenital hypertrophic pyloric stenosis.
Diagnostic procedures leading to successful separation of xipho-omphalopagus twins.
Xipho-omphalopagus twins with a pericardial bridge, extended liver tissue union and considerable intestinal herniation from one abdominal cavity to the other were separated successfully at the age of three months. Special diagnostic procedures including cardiac and abdominal sonography, catheterism of the umbilical vein with portal angiography, radionucleotide liver and bile duct imaging and separate oral glucose tolerance tests provided important information for perioperative and surgical patient management. Relevant items for determination of the favourable data and method of surgery are discussed.
[Therapeutic status of stomach cancer in East Germany in 1976 from the surgical viewpoint. A statistical analysis of national and clinical results].
Treatment results are reported about 6 220 cases, registered in the National Cancer Registry of the GDR in 1976. 43.7% had only a symptomatic treatment. 56.0% were operated and only 21.0% were resected. Overall postoperative mortality was 20.6%. Out of these patients resected radically only 24.7% had a 5-year-survival. The overall 5-year-survival rate was 5.1%. Regarding site, stage and surgical methods these results are not satisfying and have to be improved. Therefore, the necessity of regional concentration of gastric cancer treatment is emphasized.
[Late results of radical surgery of stomach cancer. Study of 380 patients from 1967 to 1977].
The report is based on the analysis of 380 cases. There was an absolute 5-year-survival rate of 12.6%, and a relative 5-year-survival rate of 25.3%. The dependence of late results on factors characterizing the tumorous process has been analysed and the modalities for improving the results are discussed.
[Results of treatment of early stomach cancer].
The results of surgical treatment of 40 patients with early gastric cancer are analysed. 57.5% of patients were operated on. Radical resection was performed in 41% and palliative one--in 20.5% of cases. The mortality rates in the radical surgery and palliative resection groups in postoperative period were 43.7 and 50%, respectively. 12.5% of radically-operated patients survived over 5 years. Pathogenetic forms of cancer developing in the gastric stump as well as optimal terms of the commencement of a regular follow-up are discussed.
[Clinical aspects of cancer of the resected stomach].
From 1962 to 1980 54 patients suffering from gastric carcinoma following partial gastrectomy were admitted to the Central Institute for Cancer Research of the Academy of Sciences of the GDR. No surgical therapy was possible in 13 additional cases due to distant metastases. In all patients operated upon a considerable expansion of the tumour could be observed. For an early detection of the carcinoma in the resected stomach a regular prophylactic examination by endoscopy should be practiced.
[Early gastric carcinoma; surgical problems (author's transl)].
In the period from 1965 to 1979 63 patients suffering from early gastric cancer underwent resection, i.e. 7,4% of all resected cases of cancer of the stomach in our hospital. The 3 year survival rate came up to 80%, 5 years survival was 75%. The postoperative mortality rate was less than 5%, since 1975 no postoperative mortality. Distal resection was performed in 74%, gastrectomy in 11%, upper partial resection in 6%, gastrotomy in combination with polypectomy in 9%.