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Biomedical subjects

W Doppl

Publications and source records attributed to W Doppl.

At least 19 recordsLinked to original sources
PubMed2004

Neutrophil CD177 (NB1 gp, HNA-2a) expression is increased in severe bacterial infections and polycythaemia vera.

The NB1 glycoprotein (CD177, HNA-2a antigen) is exclusively expressed on human neutrophils. As the clinical significance of CD177 expression is unknown, we investigated its expression in healthy individuals before and after stimulation with granulocyte colony-stimulating factor (G-CSF), in patients with rheumatoid arthritis, viral hepatitis, severe bacterial infections and polycythaemia vera. Expression was quantitatively determined by flow cytometry and by real time polymerase chain reaction. Only G-CSF-stimulated individuals and patients with severe bacterial infections and polycythaemia showed a significantly (P < 0.001) increased CD177 expression compared with healthy individuals, indicating that neutrophil CD177 expression can increase significantly in certain clinical conditions.

Adult↗
PubMed2001

Thyroid function, thyroid immunoglobulin status, and urinary iodine excretion after enteral contrast-agent administration by endoscopic retrograde cholangiopancreatography.

BACKGROUND AND STUDY AIMS: The aim of this study was to examine the occurrence of clinically relevant changes in thyroid function after enteral administration of contrast agent by endoscopic retrograde cholangiopancreatography (ERCP). PATIENTS AND METHODS: In this study 70 patients without a history of thyroid disease who had not recently undergone thyroid-specific or thyroid-influencing therapy were examined. Patients were examined on two or three occasions using a standardized questionnaire regarding symptoms of hypothyroidism and hyperthyroidism. The parameters of thyroid function (TT3, TT4, FT4, thyroid-stimulating hormone (TSH)) and urinary iodine excretion were measured on day 0 and on day 21 post-ERCP, and in 23 patients additionally on day 42 post-ERCP. Based on ultrasonographic results, four groups differing in thyroid morphology were distinguished. RESULTS: The data show that an average amount of only 4.7 g of enterally applied iodine is associated with a lasting decrease of TSH, especially in patients with enlarged organs with nodular transformation. As far as TT3 is concerned, there was a significant increase in all patient groups; regarding FT4 we only observed a marked increase in the group with enlarged, nodular thyroid glands. There was a notable increase in urinary iodine excretion on day 21, and a further increase on day 42 post-ERCP. Clinical symptoms of hyperthyroidism did not occur. CONCLUSIONS: We conclude that before administration of iodine-containing contrast agent for ERCP in patients without a history of thyroid disease, thyroid ultrasonographic examination, rather than TSH measurements, should be performed, in order to identify patients already at risk for hyperthyroidism before diagnostic enteral contrast-medium application.

Administration, Oral↗
PubMed2000

Octreotide in the prevention of pancreatic damage induced by endoscopic sphincterotomy.

Somatostatin and the long acting analogue octreotide have been proposed as a therapeutic agent in acute pancreatitis and for the prophylaxis of pancreatic damage by ERCP and EST for their ability to reduce exocrine pancreatic secretion. However, clinical trials could not show significant beneficial effects in acute pancreatitis and ERCP. In patients undergoing EST, data remained controversial, most authors describing positive effects of prophylaxis. In this study we investigated the use of octreotide prophylaxis to reduce EST-induced pancreatic damage in a randomised, double blind trial. 94 consecutive ERCP/EST-patients were randomised to receive either octreotide 200 microgram s.c. or placebo 3 times daily, starting the night before endoscopic procedures. In 59 patients EST was performed. Blood samples were collected before and 40 min, 2 hrs, 6 hrs, 24 hrs, 48 hrs and 72 hrs after the endoscopic procedures. Samples were analysed for pancreatic serum enzymes, acute phase proteins and blood counts. A clinical pain score was investigated. Post-EST-pancreatitis (amylase > 3x upper limit and persistent abdominal pain) was diagnosed in 3 patients in the treatment group, in 4 patients in the placebo group. There were no significant differences in the time-courses of serum enzymes or acute phase proteins in-between the groups, nor in the pain-score. According to these data, prophylactic octreotide application does not prevent acute pancreatic damage induced by endoscopic sphincterotomy.

Acute Disease↗
PubMed2000

Frequency of pancreatitis after endoscopic retrograde cholangiopancreatography with iopromid or iotrolan: a randomized trial.

Blood isotone contrast media is considered to be less toxic to vascular and pancreatic duct endothelium than high-osmolar contrast media. In this study we assessed the impact of a low-osmolar contrast agent compared with a blood isotone product on pancreatic damage induced by endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic retrograde sphincterotomy (EST). In a prospective trial 42 consecutive ERCP/EST patients were randomized to receive either iopromid, a low-osmolar non-ionic contrast agent (770 mosmol/kg H2O), or iotrolan, a blood-isotone non-ionic product (320 mosmol/kg H2O). The endoscopies were performed by two experienced endoscopists. Forty patients were included in the study. Blood samples were collected before and 40 min, 2, 4, 6 and 24 h after the endoscopic procedure. Samples were analysed for pancreatic serum enzymes, acute-phase proteins and blood counts. A clinical pain score was investigated. Post-ERCP pancreatitis was diagnosed in 2 patients in the iopromid group and in 5 patients in the iotrolan group. There was no significant difference between groups in the time course of pancreatic serum enzymes, acute-phase proteins or in the pain score. Due to the small number of patients in this study, only stronger differences caused by the two contrast media could have led to statistically significant results. We did not observe statistically significant differences in comparing iotrolan and iopromid concerning ERCP/EST-induced pancreatic damage.

Adult↗
PubMed1999

[Purulent pericarditis as an initial manifestation of esophageal carcinoma].

HISTORY AND ADMISSION FINDINGS: A 71-year old heavy smoker was admitted because of chest pain unrelated to physical activity, radiating into the left arm and neck as well as exertional dyspnoea and dizziness. Physical examination was unremarkable except for mild venous congestion over the upper part of the body. Myocardial infarction was excluded. A haemodynamically significant pericardial effusion developed a few days later and required emergency pericardiocentesis. INVESTIGATIONS: Laboratory tests indicated marked inflammatory disease. Echocardiography demonstrated the pericardial effusion. Needle aspiration revealed coagulase-negative staphylococcus and plant cells. Chest X-ray showed a pneumopericardium. Computed thoracic tomography suggested malignant tumour of the oesophagus with spread to the surrounding lymph nodes and pericardial fistula. Proximal endoscopy showed a highly malignant looking ulcer, 30 cm in diameter, in the anterior wall of the oesophagus with a central fistula. The endoscopic biopsy indicated a poorly differentiated non-cornified squamous cell carcinoma. TREATMENT AND COURSE: An uncovered self-expanding metal stent was placed into the fistula, whereupon the perimyocarditis quickly healed. When the patient was discharged he was able to take food by mouth and the signs of inflammation subsided. He died at home 6 weeks later. CONCLUSION: An oesophageal carcinoma with fistula should be included in the differential diagnosis of purulent pericardial effusion even in the absence of dysphagia. Implantation of a self-expanding metal stent into the fistula is the treatment of choice for palliation.

Aged↗
PubMed1998

Whipple's disease - current status of diagnostics and therapy.

Whipple's disease is a multisystemic infectious disease whose pathogen, a gram-unstable actinomycete, has been characterized in the meantime by molecular-biological techniques (polymerase chain reaction). This infectious disease which was firstly described in 1907 by G.H. Whipple as intestinal lipodystrophy appears rarely and sporadically and can affect nearly every organ, in the course of which the small intestine is also concerned in the majority of patients. The symptoms and signs are polymorphous and depend on organic involvement and stage. This leads to significant difficulties concerning differential diagnosis and to a delay in diagnosis. Misjudging the syndromes provokes invalidism and death whereas correct therapy leads to a cure in most of the cases.

Biopsy↗
PubMed1997

Rapid spinal trabecular bone loss in female patients with ileitis terminalis Crohn and additional sacroiliac joint inflammation.

Patients with Crohn's disease are well known to have local and generalized osteopenia of varying degrees. The aim of this study was to investigate whether the additional involvement of the sacroiliac joint as an extraintestinal manifestation has an influence on bone turnover in female patients with Crohn's disease. Osteocalcin and other parameters of bone metabolism were measured in 79 female patients with Crohn's disease. Bone mineral density (BMD) was measured using dual energy X-ray absorptiometry (DEXA). Z scores were obtained by comparison with age- and sex-matched normal values. As regards the sacroiliac involvement (n = 26; group 1), we found a significantly lower BMD in the lumbar spine (L4) and in Ward's triangle of the femoral neck compared to controls (P < 0.05) and those patients (n = 53; group 2) with pure ileitis terminalis Crohn. Furthermore, the duration of the disease process in patients with Crohn's disease and extraintestinal involvement was markedly shorter than that of patients in group 2 (P < 0.05). In conclusion, osteoporosis in female patients with sacroiliac involvement manifested itself in a more severe way.

Adult↗
PubMed1993

[Increased activation of CD8-positive lymphocytes in patients with Crohn's disease].

CD8+ (suppressor/cytotoxic) T lymphocyte subpopulations were studied in the peripheral blood of patients with Crohn's disease by flow cytometry analysis. Consistent with earlier reports, increased numbers of CD8+CD57+ cells were observed as compared with controls. However, expanded CD8+CD57+ cells were not found to be present in a distinct clinical subset of patients. A substantial number of patients had enhanced numbers of DR+ and CD45RO CD8+ cells. In addition, high numbers of CD8+ cells which were CD57CD45RO double positive, and a correlation between numbers of CD8+CD57+ and CD8+DR+ lymphocytes were detected. By use of an enzyme immunoassay, significantly elevated levels of soluble CD8 antigen were demonstrated in patients' sera, and results were associated with ESR values. Taken together, the data suggest increased activation of CD8+ lymphocytes which might result from systemic disease activity. Disturbances within CD8+ lymphocytes do not seem to be specific to Crohn's disease since similar alterations could be observed in patients with another inflammatory condition, rheumatoid arthritis.

Adolescent↗
PubMed1990

[Hemodynamic and lung function analytic findings in so-called collagen diseases].

Twenty-four patients with connective tissue disease as defined by ARA criteria were submitted to a thorough cardiological and pulmonary diagnostic evaluation. Mean pulmonary arterial pressure was elevated in 54 per cent of the patients, a left-ventricular functional disorder taking the form of elevated pulmonary capillary occlusive pressure was almost equally as frequent. Interindividual comparisons suggest only a low progressivity of the cardiac involvement, while pulmonary involvement progresses rapidly, to become the prognostically predominating factor. This suspicion must be checked by performing follow-up examinations with repeated cath. examinations of the right heart in individual patients. In common with ACE determinations, haemodynamically effective pericardial disorders are of no significance in connective tissue diseases. Patients with "collagenosis" should be submitted to right-heart catheterisation early on. Attempts at therapy taking the form of aggressive treatment of the underlying disease or administration of nitrates or calcium antagonists, would appear meaningful.

Adult↗
PubMed1988

Evidence for a hepatocellular lineage in a combined hepatocellular-cholangiocarcinoma of transitional type.

A combined hepatocellular-cholangiocarcinoma (CHC) of transitional subtype and the surrounding cirrhotic liver tissue were investigated immunocytochemically by monoclonal antibodies specific for each of the keratin polypeptides 7, 8, 18 and 19. Different keratin subsets were found in different parts of the tumour. The hepatocellular component reveals keratins 8 and 18, with the bordering cells of trabecular formations additionally expressing keratins 7 and 19. The same keratins i.e. 7, 8, 18, 19 were found in normal bile duct epithelium as well as in cholangiocarcinomatous and transitional areas of hepatocellular and cholangiocellular differentiation. Normal hepatocytes express only keratin 8 and 18. In cirrhotic liver some modified hepatocytes additionally express keratin 7. When ductal transformation is observed in the marginal parts of portal tracts and fibrous septa the keratin polypeptide pattern mimics that of bile duct epithelium. The cholangiocellular metaplasia of hepatocytes observed here correlates well with findings in hepato-organogenesis and hepatocarcinogenesis and suggests that the transitional subtype of combined hepatocellular-cholangiocarcinoma is a variant of hepatocellular carcinoma.

Adenoma, Bile Duct↗