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P Janowitz

Publications and source records attributed to P Janowitz.

53 records · Page 3Linked to original sources
PubMed1990

[Comparison of ultrasound-controlled fine needle and coarse needle puncture of defined lesions in the abdomen].

Within a 2-year period 677 diagnostic fine needle (DFP) and coarse needle punctures (DGP) were performed in 536 patients. In 34 patients (14 women; 20 men; 54 +/- 17.6 years) the abdominal tumour mass was punctured with the fine needle (22 g) as well as with the coarse (18 g) needle. Sensitivity of DGP accounted for 72%, sensitivity of DFP was 82.6%. Specificity was 100%, respectively. Complications could not be observed, neither with the coarse needle nor with the fine needle. Due to the high sensitivity of DFP this method should be employed first in the diagnostic work up of abdominal tumours.

Abdominal Neoplasms↗
PubMed1990

[Morphological changes in the gallbladder after extracorporeal shock-wave lithotripsy].

The present study reports on 51 patients with symptomatic cholecystolithiasis, who accordingly underwent extracorporeal shock-wave lithotripsy (ESWL). In all cases, computed tomography (CT) was performed prior to and after the therapeutic procedure to delineate changes in gall-bladder morphology. Slight edematous thickening of the gall-bladder wall was found in 15 patients. One patient presented a rupture of the gall-bladder with formation of a bilioma in the adjacent liver tissue. In case of calcific concrements, CT revealed a characteristic pattern of fragment distribution following shock-wave treatment, and fragments of various sizes exhibited distinct adhesion to the gall-bladder wall.

Adolescent↗
PubMed1990

[Percutaneous transhepatic lysis of gallstones].

The present study reports on morphological findings obtained from 15 patients who were submitted to percutaneous transhepatic contact dissolution of gallbladder concrements with methyl-tert.-butyl ether (MTBE) and--in case of slightly calcified gallstones (n = 10)--with ethylene diamine tetraacetic acid (EDTA). At a maximum intracystic catheter placement time of four days complete lysis was obtained in 12 patients. As could be depicted by CT, the solvents induced significant regional or disseminated chemical cholecystitis in the majority of all cases. However, these changes proved to be completely reversible within about five weeks. It is concluded that with certain types of gallstones contact dissolution can be an effective alternative therapeutic technique which, however, requires meticulous morphological controlling in view of the time-consuming treatment of calcified concrements.

Adult↗
PubMed1990

Comparison of gall bladder bile and endoscopically obtained duodenal bile.

In 10 patients with gall stone disease (eight women, two men; mean (SD) age 47.4 (13) years), bile was obtained by endoscopic aspiration after stimulation of the gall bladder with ceruletid and also by fine needle puncture of the gall bladder under local anaesthetic. The total lipid concentration of the puncture bile samples was mean (SD) 11.9 (4.7) g/dl, significantly higher than the endoscopic bile samples (3.9 (3.3) g/dl, p less than 0.001). Total bile acids, phospholipids, and biliary cholesterol (expressed in mol%) and cholesterol saturation index showed no significant differences between the two types of samples. The glycocholic acid concentration in the endoscopically obtained bile (27.7 (6.6) mol% v 23.3 (5.4) mol%; p less than 0.01) was significantly higher than the puncture bile samples. Puncture bile exhibited a significantly shorter nucleation time (3.5 (3.3) days v 19.6 (11.9) days; p less than 0.001). For determination of the nucleation time, endoscopic bile aspiration after gall bladder stimulation with ceruletid led to adequately concentrated samples in 50% of the study subjects. Cholesterol monohydrate crystal formation in native bile was observed in six samples of puncture bile and in three samples of the endoscopically obtained bile. The presence of cholesterol crystals and the determination of nucleation time in the puncture bile were the best discriminants between cholesterol and pigment gall stones and correlated well with computed tomogram analysis.

Adult↗
PubMed1990

[Nucleation time and age in patients with gallstones].

The relationship between nucleation time (NT), total lipid concentration (TLC) and age was studied in a group of 45 gallstone patients (10 male, 35 female, age 50.1 +/- 14.5 yrs). Bile was obtained by direct fine needle puncture of the gallbladder under local anaesthesia and sonographic monitoring. There was a positive correlation between age and nucleation time (r = 0.626, p less than 0.001), in addition to a negative correlation between age and total bile lipid concentration (TLC) (r = -0.414, p = 0.005). The negative correlation between age and TLC indicates that gallbladder's ability to concentrate the bile decreases significantly with age. It is possible that the decreased concentration is a result of the chronic pathogenetic effects of gallbladder stones. Practically all patients showed a prolonged nucleation time after the 60th year (11.54 +/- 5.50 vs. 2.65 +/- 2.52 days). This would seem to indicate that these patients suffered primarily from bilirubin or calcified stones, currently unsuited for conservative therapy methods.

Adult↗
PubMed1990

[Preventing the recurrence of common bile duct calculi following endoscopic papillotomy with ursodeoxycholic acid].

The effect of ursodeoxycholic acid on recurrence prevention of choledochal calculi after endoscopic sphincterotomy (EPT) was evaluated in 46 patients, whose bile duct stones had been removed endoscopically. 22 patients received 500 mg of ursodeoxycholic acid once a day, 24 patients received placebo. 1 recurrent stone could be detected in the ursodeoxycholic acid treated group 19 months after EPT, whereas 4 recurrent stones occurred in the placebo group about 16 months after EPT. Cholesterol saturation index decreased significantly by the ursodeoxycholic acid treatment 12 and 24 months after EPT (0.93 +/- 0.17 vs. 0.69 +/- 0.12 vs. 0.72 +/- 0.07). The nucleation time increased statistically significant from 9.0 days to 20.4 (12 months) and 17.7 (24 months) days, respectively. Obviously, pharmacological effects of ursodeoxycholic acid exist which modify important processes in the gallstone's pathogenesis.

Aged↗
PubMed1989

[Drug cholelitholysis and the nucleation time].

Nucleation time (time elapsed until first appearance of cholesterol crystals in incubated bile fluid) and the lithogenic index were measured on 25 patients (aged 45.1 +/- 16.8 years; Broca index 106.7 +/- 4.2%) with radiolucent gallstones, before receiving daily 500 mg chenodeoxycholic acid and ursodeoxycholic acid orally. The nucleation time in the group of nine patients in whom complete lysis was achieved was 4.7 +/- 0.8 days, compared with 15.0 +/- 2.2 days in those with only incomplete lysis (P less than 0.001). There was no statistically significant difference between the two groups as to age, Broca index, lithogenic index and biochemical values. Thus the determination of nucleation time can contribute to distinguishing between responders and nonresponders to oral treatment for dissolving gallstones and may improve the success rate of the method.

Adult↗
PubMed1989

[Pathophysiology of cholesterol gallstones].

Cholelithiasis is a civilization-related disease with multifactorial causation. The supersaturation of the bile with cholesterol is a deciding risk factor, which, however, does not lead to gallstone formation in each individual case. The connection between supersaturated bile and the formation of stone whose primary constituent is cholesterol, are the cholesterol-monohydrate crystals. Several risk factors lead to cholesterol supersaturation of the bile. Other risk factors induce or maintain the nucleation of the cholesterol crystals. In the following paper the nucleating and inhibiting factors and the pathophysiology of cholesterol gallstones will be discussed.

Bile Acids and Salts↗
PubMed1989

[Effect of omega-3-fatty acids on biliary lipids and lithogenicity].

Until now no studies are available about the influences of omega-3-fatty acids on biliary lipids in men. The effects of 1.5 g omega-3-fatty acids per day on biliary lipid concentration and composition were studied in 13 male healthy persons over six weeks. Biliary cholesterol concentration decreased from 5.4 +/- 0.53 mol% to 3.7 +/- 0.30 mol% (25%) statistically significant. Phospholipids and bile acids remained unchanged. Cholesterol saturation index (CSI) was lowered from 1.13 +/- 0.12 to 0.85 +/- 0.06 (p less than 0.05). Bile acid composition and conjugation rates were unchanged. No significant side effects could be observed. Substitution of omega-3-fatty acids induced in healthy male persons a decrease of biliary cholesterol and lithogenicity.

Adult↗
PubMed1989

[Changes in biliary lithogenicity caused by 4 weeks' weight reduction].

In 2 of 12 patients (16.6%) cholesterol monohydrate crystals occurred in duodenal bile samples after a 4 weeks fasting period (452 kcal/day). Cholesterol monohydrate crystals could be observed until recently mainly in patients with cholesterol gallstones. Therefore, this finding indicates increased biliary lithogenicity despite a non statistical decrease in CSI from 1.35 +/- 0.35 to 1.19 +/- 0.64. Presumably the increased lithogenicity may be caused by an increased glycoprotein concentration and an improvement in gallbladder contractility. Short time fasting obviously will be a risk factor for the development of gallstones, if weight and metabolic normalisation cannot be achieved.

Adult↗
PubMed1988

[Pathologic wall changes in the gallbladder in patients with gallstones and in healthy probands. Imaging using high frequency annular array sector transducers].

2154 computerized ultrasound diagnoses of 1623 patients were evaluated retrospectively from January 1st to October 31st 1987. The frequency of pathologic gallbladder wall changes in patients with stones and normal controls was examined applying 5 MHz annular array sector transducer. The occurrence of polyps, septae, sludge, kinking, carcinoma and adenomyomatosis was noted separately. The prevalence of polyps and septae in gallstone patients was increased fourfold if compared to the total number of examined patients. Sludge was found in 5.9% of gallstone patients compared to 2.2% in normal controls. Carcinoma and adenomyomatosis were present only in cases of cholelithiasis; the prevalence of these pathologic wall changes is obviously rare. The importance of polyps and septae in biliary lithogenicity is discussed.

Carcinoma↗
PubMed1988

[Nucleation time and lithogenic index in obese patients and in patients with cholecystolithiasis].

The gallbladder bile of obese patients without gallstones is supersaturated with cholesterol. The cholesterol saturation index (CSI, LI) of 27 obese patients was 1.32 +/- 0.2. The CSI of 24 normal weight gallstone patients was determined with 1.16 +/- 0.37 and is therefore not significantly different from CSI of obese stone free individuals. The supersaturated bile from obese patients does not accelerated the nucleation of cholesterol crystals. The nucleation time of obese persons was statistically significant longer (16.0 +/- 3.0 days) than in gallstones patients (6.0 +/- 0.78 days) (p less than 0.001). In 50% of the patients with gallstones cholesterol monohydratcrystals were present in the native gallbladder bilde, whereas such crystals are found in only 3.7% of the obese group. Liquid crystals occurred more frequently and in larger number in the bile of the obese patients. The stone forming potency of gallbladder bile can be estimated better by the determination of nucleation time and cholesterol crystals occurrence than by the calculation of the saturation index (CSI).

Adult↗
PubMed1988

[Dietary modification of bile lipids].

The average incidence of gallstones in european countries is about 25%. Excessive secretion of cholesterol into the bile can predispose to saturation and gallstone-formation. Obesity, overnutrition, diets rich in refined carbohydrates, diets high in cholesterol intake and poor in dietary fibre, lipid lowering drugs, age and female sex hormones are recognized causing increased cholesterol secretion into the bile. These metabolic consequences may predispose to a higher incidence of cholesterol gallstone than in normal persons. Taking all the results of the literature together patients with gallstones should be encouraged to take a low cholesterol, low calorie, low refined carbohydrate and high polyunsaturated fat diet rich in bran und vegetable fibre. Obese patients should reduce their body weight. These dietary recommendations should be given for patients with gallstones during bile acid therapy and after successful dissolution in order to prevent gallstone recurrence.

Bile↗
PubMed1987

Analysis of conjugated bile acids in human serum by high-performance liquid chromatography using post-column enzyme reaction and off-line fluorimetric determination.

An assay for glycine and taurine conjugates of cholic (GC, TC), chenodeoxycholic (GCDC, TCDC), deoxycholic (GDC, TDC) and ursodeoxycholic (GUDC, TUDC) acids in human serum by high-performance liquid chromatography using an immobilized 3-alpha-hydroxysteroid dehydrogenase post-column reaction and an off-line spectrofluorimetric detection is described. The detection limit is 0.2 microM. Recoveries of extraction and chromatographic analysis range from 89.50 to 91.68% and from 96.75 to 98.83%, respectively. The analysis in serum reveals a coefficient of variation for reproducibility between 16.2% for GC and 4.7% for TDC; inter-assay variability ranges between 4.06% for TCDC and 8.24% for TUDC.

Bile Acids and Salts↗
PubMed1987

[Lithogenicity and bile acid pattern in choleretic administration (3-n-butoxy-1-phenoxy-propanol: febuprol) in patients with functional right upper quadrant pain].

10 patients with right upper quadrant pain were treated with a choleretic agent (Febuprol; 3 X 200 mg t. i. d.) and placebo in a cross-over double dummy technique for 16 weeks. Lithogenic index, bile acid profile and serum lipids were determined every 4 weeks. During Febuprol application the clinical symptoms were relieved (0.87 +/- 1.3 vs. 1.39 +/- 0.21 (placebo); p less than 0.05, semiquantitative score). Biliary lithogenicity (1.45 +/- 0.6 vs. 1.09 +/- 0.12; n. s.), bile acid profile and serum lipids showed no statistically significant change, although serum cholesterol levels seemed to fall during Febuprol application.

1-Propanol↗
PubMedDate not supplied

Radiographic aspects in transcatheter contact dissolution of calcified gallbladder concrements.

The present study on 10 patients reports upon an attempt to perform percutaneous contact dissolution of partially calcified gallbladder concrements. These gallstones, which exhibited structural calcifications on CT scans, required time-consuming complex dissolution procedures with transcatheter administration of methyl tert-butyl ether (MTBE) and ethylene diamine tetraacetic acid (EDTA). Insertion of the catheter system (5 F) was performed via a percutaneous transhepatic route. Catheter placement was maintained for a maximum of 4 days. Complete lysis was achieved in seven of the ten cases. In six patients, significant regional or disseminated chemically induced cholecystitis and pericholecystitis could be observed on CT examination. However, on follow-up CT examinations, these changes proved to be completely reversible. It has been demonstrated that tolerance of the gallbladder wall and adjacent tissue layer against the lytic media employed is rather limited and that meticulous controlling of the morphological reaction can be helpful in minimizing complications.

Adult↗