Biomedical subjects
Publications and source records attributed to S Meryn.
The response to pirenzepin, a new acetylcholine receptor blocking agent, was assessed and compared to placebo in patients with reversible bronchoconstriction. A single intravenous injection of 20 mg of pirenzepin induced a significant reduction of airway resistance compared to placebo (p less than 0.05). The anticholinergic substance pirenzepin appears to be useful in the treatment of bronchospasm.
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According to the criteria of the FAB classification we diagnosed acute promyelocytic leukemia in 19 out of 191 AML blast cell populations. The reaction pattern with the anti-myeloid monoclonal antibodies VIM2, MCS2 and MY9 and the MHC-class II antibody VID1 in all cases showed the characteristics which were expected from the normal granulopoiesis. The monoclonal antibody VIM-D5, which recognizes the myeloid cell surface structure 3-fucosyl-N-acetyllactosamine (3-FAL), was not reactive with the majority of promyelocytic blast cells, however. In 13 cases 3-FAL was not detectable and in 6 cases only low or moderate reactivity of VIM-D5 with blast cells was observed. The phenotype of leukemic promyelocytes thus differs from the majority of normal promyelocytes in this respect.
Concentrations of 19 different proteins were measured after hospital admission, before hospital discharge and 3 months thereafter in 40 patients suffering from an acute episode of Crohn's disease. Serum levels of acute phase proteins (alpha 1-glycoprotein, alpha 1-antichymotrypsin, alpha 1-antitrypsin, CRP, haptoglobin) and immunoglobulin M corresponded to the severity of inflammatory symptoms and correlated significantly with CDAI (Crohn's disease activity index). Albumin and transferrin were characteristic for nutritional status of the patient under basal conditions and during nutritional therapy. Prealbumin and retinol-binding protein behaved similarly, but results were not significant. The measurement of the proteins mentioned give valuable clues in regard to the course of the disease and therapeutic success in Crohn's disease.
Tube feeding (TF) with elemental diets was used as primary therapy in 25 patients with an acute phase of Crohn's disease (CD). Feed was infused continuously via a nasoduodenal tube in a dosage of 2600-3200 kcal/day. The Crohn's disease activity index (CDAI), the serum levels of a1-antitrypsin, C-reactive protein (CRP) and haptoglobin were used as parameters for disease activity; the body weight and the serum levels of albumin, prealbumin and transferrin were parameters for the nutritional status. Disease activity could be reduced in the total group by TF shown by a reduction of CDAI from 269 +/- 72 to 174 +/- 103, a1-antitrypsin from 449 +/- 160 to 378 +/- 147 mg/dl, CRP from 6.12 +/- 5.6 to 3.23 +/- 5.4 mg/dl and haptoglobin from 414 +/- 167 to 344 +/- 152 mg/dl. Nutritional status was improved (body weight 83 +/- 12% to 87 +/- 10% ideal body weight, prealbumin 20.2 +/- 7.7 to 29.7 +/- 9.5 mg/dl, and transferrin 229 +/- 107 to 310 +/- 103 mg/dl). Albumin did not change significantly. In 15 patients the CDAI was reduced to levels below 150. These patients were characterized as responders. In ten patients a normalization of CDAI could not be achieved and therapy had to be changed. With a stepwise linear discriminant analysis it could be demonstrated that patients with colonic disease and fever do not react to TF, with a probability of 90%. We conclude that TF can be used as primary therapy for the acute phase of CD in patients with small bowel disease. In patients with colonic disease and fever it is not as effective.
Activity of Poly (C) avid ribonuclease was estimated in sera of 129 patients with different malignancies. All patients had histologically verified carcinomas, normal renal function, and no signs of acute catabolic condition. Activity values were compared with those of normal subjects (U-test, Mann and Whitney) separately for each age decade and type of carcinoma. Patients with ovarian and bronchus carcinoma had statistically elevated activity values throughout all age groups. Colon carcinoma patients showed elevated values in most instances. In patients with pancreatic carcinoma a difference could be detected in only one age group (51-60 years of age). No significant elevation of enzyme activity was detected in carcinoma of the stomach and of the prostate. It is concluded that there are carcinomas leading to elevated ribonuclease activity, although the biological basis of this phenomenon is not understood. No special sensitivity nor specificity of ribonuclease elevation could be demonstrated in pancreatic carcinoma patients. Up to now the usefulness of ribonuclease estimation in prospective carcinoma detection remains questionable.
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The safety and various side effects of ranitidine (2 X 150 mg daily), a new selective H2-receptor antagonist, were evaluated in the long-term treatment of patients with prepyloric or duodenal ulcer. A total of 6 adverse effects was reported by 5 out of 32 patients (18.7%). Thus, the overall incidence was low and almost half of the adverse effects involved minor or functional gastrointestinal symptoms. In no case were side effects severe enough to necessitate interruption of therapy. There were no detectable changes in haematological or biochemical blood parameters attributable to ranitidine. Long-term therapy with ranitidine appears to be safe and well tolerated; however, continued surveillance must be maintained.
25 patients with Crohn's disease were followed up with serial serum carcinoembryonic antigen (CEA) determinations during hospitalization and at a control investigation eight weeks following discharge. The CEA level was compared with extent, duration and clinical activity of disease, as well as with Crohn's Disease Activity Index (CDAI) and several acute phase reactants. The distribution of positive CEA levels (greater than 5 ng/ml) was similar in phases of acute inflamation and in remission. CEA levels did not show any significant correlation with CDAI, acute phase reactants, extent of involvement, duration of disease or histological findings. In this study CEA levels did not prove to be helpful indicators of disease activity or of cancer risk in Crohn's disease.
A case of congenital vascular bowel lesions in Turner's syndrome resulting in severe gastrointestinal bleeding is presented. The vascular malformations were verified by angiography. Pathogenesis, diagnosis, and treatment are discussed.
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Twenty patients with Crohn's disease were treated with parenteral nutrition (PN). The indication for PN was a bodyweight of less than 80% ideal bodyweight and/or a Crohn's disease activity index (CDAI) above 150 despite conventional therapy. A complete nutrition solution containing per litre 150 g glucose, 50 g sorbitol, 50 g amino acids, 50 g fat, electrolytes, trace elements and vitamins was infused via a central venous catheter to provide 72 kcal per kg bodyweight and day. No other medications were given during the study. The patients were randomized into two groups: both groups received PN in identical fashion. Group 1 was not allowed to eat or drink to reach total bowel rest; Group 2 ate formula diets and low residue diet ad libidum in addition to PN. Criteria for the nutritional status were bodyweight, serum albumin, prealbumin and hemoglobin and for disease activity the CDAI. Mean duration of treatment was 28 days in group 1 and 33.5 days in group 2. At the beginning both groups were comparable with respect to disease activity, nutritional status and extent of Crohn's disease. At the end of the study nutritional status was improved (increase of bodyweight and prealbumin) and disease activity was decreased by therapy in both groups with no significant difference between the two regimens. We conclude that PN improves the nutritional status and reduces the activity of Crohn's disease. The combination of PN and total bowel rest resulted in the same improvement as with PN alone. Total bowel rest is therefore unnecessary, when PN is given in patients with Crohn's disease.
In 100 consecutive patients the occurrence of bacteraemia and endotoxaemia after colonoscopy was studied. The Limulus Amoebocyte Lysate Test was used to detect endotoxaemia. No bacteraemia was detected after colonoscopy. Growth of Staph, epidermidis was considered as contamination. In 9% of the patients endotoxaemia was discovered after colonoscopy. The occurrence of endotoxaemia was found to be unrelated to the duration of the procedure, the number of the biopsies taken, or the cleansing of the bowel prior to colonoscopy. In patients with liver cirrhosis endotoxaemia occurred more often than in patients without liver disease. No clinical consequences of endotoxaemia were found in patients who developed endotoxaemia after colonoscopy. We conclude that colonoscopy is followed by endotoxaemia quite frequently. The clinical implication of these conditions, especially in patients with liver cirrhosis merits further consideration.
A case of teratoma and choriocarcinoma of the testis with a single metastasis to the jejunum is described. The patient had suffered from severe intestinal hemorrhage for several weeks. An uneventful endoscopic removal of the metastasis was performed. The report illustrates that, particularly in young patients, metastatic lesion of the small bowel should be considered a possible cause of intestinal bleeding in patients who have neoplasm.
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The Mirizzi syndrome consists of the trial cystic duct stone, cholecystitis and benign hepatic duct stenosis. The differentiation between intra- and extrahepatic cholestasis can be made sonographically in almost 100% of cases. In a high percentage of cases the ultrasound investigation can localise the level of the block. However, the additional use of endoscopic retrograde cholangiography (ERC) or percutaneous transhepatic cholangiography (PTC) is necessary for an exact pre-operative diagnosis. The most efficient diagnostic plan is illustrated by a case presentation of a patient with Mirizzi syndrome.