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Biomedical subjects

W Kratzer

Publications and source records attributed to W Kratzer.

At least 19 recordsLinked to original sources
PubMed2004

Type II diabetes mellitus and impaired glucose regulation in Caucasian children and adolescents with obesity living in Germany.

BACKGROUND: Recent studies reported an increased prevalence of type II diabetes mellitus in obese children and adolescents, especially in specific ethnic subgroups. The aim of this study was to determine the prevalence of type II diabetes mellitus and impaired glucose regulation in a large group of Caucasian children and adolescents with obesity living in Germany. PATIENTS AND METHODS: A total of 520 subjects (237 boys, 283 girls) (mean age: 14.0+/-2.0 y (range 8.9-20.4 y)) with a BMI>97th percentile, BMI-SDS: 2.7+/-0.5 (range 1.9-4.6), who were consecutively admitted to an in-patient obesity unit participated in the study. A 2-h oral glucose tolerance test (1.75 mg of glucose per kilogram of body weight) was performed before entering a weight-loss program and capillary blood glucose concentrations were measured. Patients were categorized into normal glucose regulation, impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and diabetes. In addition, fasting venous blood was taken to determine the circulating insulin, C-peptide and lipids. Insulin resistance was estimated by homeostatic model assessment. RESULTS: Type II diabetes was present in 1.5% (n=8) of the patients, two patients were admitted with already diagnosed type II diabetes and six patients were identified with yet unknown diabetes. IFG was detected in 3.7% (n=19) and IGT in 2.1% (n=11) of the patients. All together, in 6.7% (n=35) (95% confidence interval: 4.7-9.2%) of the patients, impaired glucose regulation (IFG, IGT) or diabetes was identified. These patients had a higher BMI-SDS, higher levels of fasting insulin and C-peptide and a higher insulin resistance index than the patients with normal glucose regulation. Risk factors for the occurrence of impaired glucose regulation were a BMI-SDS>2.5 as well as a positive parents' history for diabetes. CONCLUSIONS: This is the first report on the prevalence of type II diabetes in a large cohort of Caucasian children and adolescents with obesity living in Europe. Impaired glucose regulation and type II diabetes were present in a substantial proportion of the patients studied. Screening for diabetes in severely obese children and adolescents (BMI-SDS>2.5) is therefore recommended. Patients identified with impaired glucose regulation need specific treatment programs in order to prevent progression to diabetes.

Acanthosis Nigricans↗
PubMed2004

[Intestinal wall vascularisation in Crohn's disease].

BACKGROUND AND AIMS: In a pilot study the semi-quantitative classification of intestinal wall vascularisation as proposed by Limberg was evaluated. PATIENTS AND METHODS: 20 patients with confirmed Crohn's disease and clinical activity (10 male, 10 female, mean age 30.0 +/- 7.72 years, range 21 - 49 years, mean time since onset of disease 4.6 years, range 0 - 15 years) were included. CDAI, CRP, ESR, and the blood count were evaluated. Two and six weeks after inclusion into the study these examinations were repeated. All patients were treated with anti-inflammatory drugs. The intestinal wall thickness was measured with ultrasound. The vascularisation following the Limberg classification and the number of blood vessels per square centimetre were assessed in the power-Doppler mode. RESULTS: The mean length of bowel segments with increased wall thickness (> 3 mm) at the beginning of the study was 20.3 cm (range 5 - 50 cm), the mean intestinal wall diameter 5.9 mm (range 4 - 9 mm). The mean density of blood vessels in the power-Doppler mode was 3.8 vessels/cm (2) (range 0 - 8 vessels/cm (2)), the median of Limberg levels was 2 (range 1 - 4). The density of blood vessels per cm (2) well correlated with the Limberg classification throughout the study (r = 0.2 at start; r = 0.94 at 1st follow-up; r = 0.91 at 2nd follow-up). CONCLUSION: The classification for measuring intestinal wall vascularisation semi-quantitatively (as proposed by Limberg) proved to be easily applicable in routine sonography. Besides the measurement of intestinal wall thickness, activity indices, clinical and laboratory parameters, it may constitute an additional means for evaluation of disease activity.

Adult↗
PubMed2003

Therapy of osteoporosis in patients with Crohn's disease: a randomized study comparing sodium fluoride and ibandronate.

BACKGROUND: Osteoporosis is a frequent complication in Crohn's disease. Although the efficacy of both sodium fluoride and aminobisphosphonates in postmenopausal osteoporosis has been investigated in long-term therapy studies, no long-term results are available regarding the effect of these agents in the management of osteoporosis in patients with Crohn's disease. METHODS: Eighty-four patients with Crohn's disease and pathological bone mineral density findings were randomized to receive either vitamin D3 (1000 IU) and calcium citrate (800 mg) daily (group A) or sodium fluoride (25 mg b.d., group B) or intravenous ibandronate (1 mg every 3 months, group C) in addition to daily calcium/vitamin D substitution. On admission to the study and after 12 and 27 months, patients underwent dual-energy X-ray absorptiometry and radiological examination of the spine. RESULTS: Sixty-eight patients completed the 1-year observation period and were available for the intention-to-treat analysis. No new vertebral fractures were diagnosed. In group A, lumbar bone density increased by 2.6% (P = 0.066, N.S.), in group B by 5.7% (P = 0.003) and in group C by 5.4% (P = 0.003). Therapy with sodium fluoride was associated with an increase in osteocalcin (N.S.), whereas administration of ibandronate was associated with a decrease in the resorption parameter, carboxy-terminal cross-linked type-I collagen telopeptide (P < 0.05). Both sodium fluoride and ibandronate resulted in significant decreases in the serum concentration of osteoprotegerin after 9 months (P < 0.001). CONCLUSIONS: The findings of the present study show that both sodium fluoride and ibandronate are effective in combination with calcium and vitamin D substitution in the management of osteopenia and osteoporosis in patients with Crohn's disease. Both agents are safe and well tolerated, and induce continuous increases in lumbar bone density.

Bone Density↗
PubMed2003

[Comparison of conventional enteroclysis, intestinal ultrasound and MRI-enteroclysis for determining changes in the small intestine and complications in patients with Crohn's disease].

BACKGROUND: Enteroclysis, intestinal wall ultrasound (IWU) and abdominal magnetic resonance imaging (MRI) are three established methods in the diagnosis of Crohn's disease (CD). To date, however, the three methods have not been compared in one patient collective. AIMS: The present prospective study compared the relative performance of IWU, MRI and enteroclysis in determining the extent of disease involvement and intestinal complications in patients with CD both at initial diagnosis and during follow-up. PATIENTS AND METHODS: Included in the present study were 48 patients with confirmed CD (age: 19-66 years) examined with all three methods between August 1999 and December 2000. IWU was performed in B-mode with a 4-7 MHz convex transducer head and a 5-12 MHz linear transducer head by an experienced examiner. At MRI, T1 and T2 weighted sequenced (Flash 2D before and after intravenous application of gadolinium DTPA or TSE) were acquired in coronal and transverse planes. Enteroclysis was performed using conventional biphasic technique. Interpretation was conducted on the basis of a standardized catalogue of findings. RESULTS: Changes in bowel segments consistent with inflammation were identified in 41 of 48 patients. All three methods returned equivalent findings with regard to the length of inflamed bowel segments (IWU, range: 3-25 cm, mean: 12 cm; MRI, range: 3-25 cm, mean: 10 cm; enteroclysis, range: 3-30 cm, mean: 11 cm) and wall thickness (IWU, range: 4-10 mm, mean: 7 mm; MRI, range: 5-10 mm, mean: 7 mm; of nine patients with stenotic change, five were correctly diagnosed with IWU (sensitivity, 55.6%; specificity, 97.4%), four with MRI (sensitivity, 44.4%; specificity, 100%) and six with enteroclysis (sensitivity, 66.7%; specificity, 100%). Fistulae were correctly identified in five patients with IWU (sensitivity, 55.6%; specificity, 97.4%), in four with MRI (sensitivity, 44.4%; specificity, 100%) and in six with enteroclysis (sensitivity, 66.7%; specificity, 100 %) of a total of nine patients with confirmed fistula formation. Abscesses were correctly identified in five patients with IWU (specificity, 66.7%; specificity, 100%), in five with MRI (sensitivity, 83.3%; specificity, 100%) and in no patients with enteroclysis (sensitivity, 0%; specificity, 100%) in six patients with abscesses. CONCLUSION: Both IWU and MRI identify extent, severity and intestinal complications with adequate diagnostic accuracy in patients with CD. Both techniques possess the potential for replacing enteroclysis in the work-up of CD. Enteroclysis should be reserved for the work-up of complex fistula systems.

Adult↗
PubMed2003

[Quantifying the inflammatory activity in Crohn's disease using CE dynamic MRI].

PURPOSE: Evaluation of dynamic contrast enhanced MRI in patients with Crohn's disease to assess local inflammatory activity. MATERIAL AND METHODS: Prospective study of 13 patients with histologically proven Crohn's disease. Axial and coronal slices were acquired by a 1.5 T MR (Magnetom Vision, Siemens, Germany): T1 flash 2 D (TR 72.5 ms, TE 4.1 ms), T2 (TR 2730 ms, TE 138 ms), turbo-flash sequences T1 (TR 94.2 ms, TE 4.1 ms) post contrast media fat saturated (Magnevist, 0.2 ml/kg, flow 4 ml/s). In area of maximal thickening of terminal ileal wall, axial dynamic T1 sequences (TR 11 ms, TE 4.2 ms) were acquired every 1.5 s post contrast media application for a total duration of 1 min. Contrast uptake was subjectively measured by semiquantitative score and computed assisted ROI evaluation. MR parameters were correlated with CDAI (Crohn's disease activity index) and SAI (severe activity index). RESULTS: Contrast uptake in the intestinal wall occurred after 18.5 s (range: 3.0 - 28.0), contrast upslope until plateau phase lasted for 16.1 s (range: 8.0 - 50.0). Maximum contrast enhancement into the bowel wall was 266 % (105 - 450 %) of baseline. After maximum contrast uptake, we observed a plateau phase in all cases for the total duration of measurement. A significant correlation existed for maximum contrast uptake to CDAI (r = 0.591; p = 0.033), for beginning of contrast upslope to the time until plateau phase (r = 0.822; p = 0.001), and for the time until plateau phase to CDAI (r = 0.562; p = 0.046). CDAI was on average 108, median 106; SAI was on average 114, median 115. SAI correlated significantly to CDAI (r = 0.874). Maximum contrast uptake, beginning of contrast upslope, and time until plateau phase were independent to creeping fat, local lymphadenitis, laboratory parameters, temperature, body mass index, heart frequency and systolic blood pressure. CONCLUSION: Dynamic MRI enables to quantify local inflammatory activity of bowel wall in patients with Crohn's disease. Larger studies are necessary to establish this method in clinical routine.

Adult↗
PubMed2001

Long-term seropositivity against Echinococcus multilocularis in an epidemiological follow-up study in southwestern Germany (Römerstein).

BACKGROUND: Out of 2,560 participants in an epidemiological survey of alveolar echinococcosis (AE) performed in 1996 in southwestern Germany, 47 participants had tested seropositive in one of two crude antigen screening ELISAs and were inconspicuous on hepatic ultrasound. PATIENTS AND METHODS: Out of these 47 seroreactors, 36 attended a follow-up examination 30 months after the primary examination, including ultrasound and serology with various Echinococcus multilocularis-specific antigens. RESULTS: No lesion suspicious for AE was detected in any participant. Serology showed only minor changes as compared to the earlier results. CONCLUSION: Persistent seropositivity without detectable hepatic lesions could be interpreted as an early sign of sonographically not yet detectable AE, immunity to E. multilocularis or unspecific serological reactivity. For seropositive and clinically inconspicuous inhabitants of areas endemic for AE follow-up examinations at intervals of 2-3 years seem to be adequate.

Adolescent↗
PubMed2001

Stability of human gallbladder bile: effect of freezing.

In the present study, the stability of the most essential biliary parameters of human gallbladder bile at -18 degrees C was examined over several months. In 12 patients with gallstone disease (10 female, two male; 52.1+/-13.3 years of age), bile was obtained through fine needle puncture of the gallbladder under local anesthetic. The concentrations of total lipids, cholesterol, phospholipids and bile acids, and the cholesterol saturation index and crystal appearance time were determined before and after freezing over a mean period of 4.38+/-2.9 months. Gallbladder bile obtained by fine needle puncture has proved to be of excellent quality. The total lipid concentration was unchanged before (8.30+/-4.16 g/dL) and after freezing (9.16+/-4.54 g/dL, P=0.6027). The biliary cholesterol, phospholipids and bile acid concentrations, and cholesterol saturation index showed no statistically significant differences before and after freezing. A significant difference arises in the context of subdivision of the group to the nucleation time. Before freezing, most patients had a nucleation time between five and eight days, which shortened to between one and four days after thawing (P=0.0100). The authors conclude that, with the exception of the nucleation time, human gallbladder bile can be stored at -18 degrees C for four months with stability of major lipid components.

Adult↗
PubMed2000

Sonographic measurement of thickened bowel wall segments as a quantitative parameter for activity in inflammatory bowel disease.

Inflammatory bowel disease (IBD) is associated with morphological changes of the bowel wall that can be visualized by abdominal ultrasound (US). This method is a tool to detect the extent of bowel wall thickening and the length of involved segments. The purpose of this study was to determine the value of sonographic measurement of inflamed bowel wall segments as a quantitative parameter for disease activity. 137 patients with Crohn's disease (CD) and 32 patients with ulcerative colitis (UC) were included in the present study. A total 356 US examinations were performed within a one-year period. In a segment-by-segment analysis we determined the "volume of inflamed bowel wall" (VIB) by measuring wall thickness and longitudinal extent of pathologically altered bowel segments. VIB was used as a quantitative parameter for disease activity based on sonomorphological findings. At the same time the following parameters were also determined: CD activity index (CDAI) in patients with CD, clinical activity index (CAI) in patients with UC, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). We found no relevant correlation between VIB and biochemical indices of inflammation (ESR, CRP) and between VIB and clinical activity of IBD (CDAI, CAI). All correlation coefficients were below 0.5. It can be concluded that the extent of inflammatory changes of the bowel wall detected by US is not strictly associated with clinical activity and laboratory parameters of inflammation.

Adolescent↗
PubMed2000

[Contrast enhanced power Doppler sonography: comparison of various administration forms of the ultrasound contrast agent Levovist].

PURPOSE: Objective of the present study was the comparison of various administration forms of the ultrasound contrast medium Levovist with regard to duration and intensity of contrast enhancement in patients with tumors of the liver or pancreas. PATIENTS AND METHODS: Seven patients with tumors of the liver or pancreas were examined prospectively using power Doppler sonography. Ultrasound contrast enhancement was achieved using Levovist (8 ml, 400 mg/ml) in three different administration forms: 1st as a bolus injection through the main channel, 2nd through the injection valve of an intravenous cannula, or 3rd as a continuous infusion. Semiquantitative evaluation of the degree of contrast enhancement over the course of the examination was conducted by three independent examiners. RESULTS: Levovist, administered by continuous infusion, resulted in a significantly longer average period of contrast enhancement (9:43 min (extratumoral), 7:34 min (intratumoral)) than did the same dosage administered as a bolus injection through the main channel (6:01 min (extratumoral), 4:54 min (intratumoral), p = 0.0156 (extratumoral); p = 0.0313 (intratumoral), but contrast intensity was decreased. Bolus injection through the injection valve of the i.v. cannula was associated with decreased duration and intensity of contrast enhancement compared with injection through the main channel. CONCLUSION: Compared with bolus injection, the continuous infusion of Levovist resulted in a significant prolongation of the duration but in a decreased intensity of contrast enhancement. Administration of Levovist through the injection valve does not result in optimal contrast enhancement and is therefore not recommended.

Adult↗
PubMed2000

[The research situation in abdominal sonography in the gastroenterology departments of university hospitals in the Federal Republic of Germany].

Objective of the present study is to provide a current overview of the present state of research in abdominal ultrasound in the gastroenterological departments of university hospitals in Germany. We conducted a survey assessing the number of research projects in progress, sources of financial support, sponsorship by the private sector and publications generated. Reports from 28 of 35 gastroenterological departments responding to the survey indicated that a total of 124 research projects were in progress during the survey period, for an average of 3.5 projects per department. Clinical issues were addressed in 78 studies, technical questions in 33 studies and other questions in 13 studies. Of the 117 publications generated, 50 appeared in German-language journals and 67 in English-language journals. At present, neither the German Research Association (DFG) or the European Union (EU) is financially underwriting an ultrasound research project in the gastroenterological department of any German university hospital. Ultrasound remains the most frequently applied diagnostic imaging technique in gastroenterology. In order to convert the enormous technological progress into improved diagnostic capabilities, there must be a significant expansion in research support for gastrointestinal ultrasound.

Abdomen↗
PubMed2000

Benzimidazoles in the treatment of alveolar echinococcosis: a comparative study and review of the literature.

Mebendazole and albendazole are the drugs of choice for the treatment of alveolar echinococcosis. In this open-labelled observational study we present and evaluate the outcome of long-term treatment with these drugs and present results of different treatment regimens. Thirty-five patients were started on either mebendazole or albendazole at the beginning of 1992 and followed for an average of 39 months (range 12-79 months). Treatment was classed as successful if the disease had not progressed for >1 year and if there were no side-effects necessitating a change of treatment. Lack of progression was evaluated mainly using ultrasound and computed tomography and was further substantiated by laboratory tests and clinical findings. The overall success rate was 97%. An initial regimen for cases of alveolar echinococcosis was recurrence-free in 71% of those treated with mebendazole and in 78% of those treated with albendazole. Four out of five cases with progressive disease stabilized after the therapeutic regimen was changed. Seven patients received a continuous regimen with albendazole. These patients were observed over an average of 28 months (range 13-50 months) without signs of progression or significant side-effects. This open-labelled prospective study demonstrates the high therapeutic efficacy of both mebendazole and albendazole with similar response rates in the treatment of alveolar echinococcosis. Albendazole reduced costs by >40% and is easier for patients to take, further arguing in favour of its preferred use. Albendazole in alveolar echinococcosis is only licensed for intermittent application. None the less, continuous treatment is safe and well tolerated and showed promising results when applied to patients in whom other treatment regimens had failed. It should thus be strongly considered in inoperable cases or progressive disease.

Adolescent↗
PubMed1999

[The effect of ABO, Rhesus and Kell blood group antigens on gallstone prevalence. A sonographic study of 1030 blood donors].

BACKGROUND AND OBJECTIVE: Besides generally accepted risk factors of the pathogenesis of gallstone disease such as age, obesity, female sex and high number of births, hereditary factors are held responsible for different prevalence rates. A number of studies dealt with the question of a correlation between the prevalence of gallstone disease and different blood groups. The Ulm Gall Bladder Stone Study represents the first sonographic prospective study regarding this issue. SUBJECTS AND METHODS: Unselected blood donors (n = 1030, 606 men, mean age 38.0 years, 424 women, mean age 34.1 years) were sonographically examined for presence of gallstones at the German Red Cross blood donor centre in Ulm. Besides AB0, Rhesus and Kell blood group anthropometric data of the test subjects were recorded by means of a semi-standardized interview. RESULTS: The prevalence of gallstone disease in all test subjects was 6.0%. Within the AB0 system the prevalence in subjects with blood group AB was highest (12.1%). The prevalence in Rh-positive and Rh-negative subjects was nearly identical (6.0 vs. 6.1%). Kell factor positive subjects suffered less from gallstone disease than Kell factor negative subjects (2.0 vs. 6.3%). None of these differences in prevalence were statistically significant. CONCLUSION: This study revealed no significant correlation between the distribution of the AB0, Rhesus and Kell blood group antigens and the prevalence of gallstone disease.

ABO Blood-Group System↗
PubMed1999

Prevalence of gallstones in sonographic surveys worldwide.

The use of diagnostic sonography allows determination of the prevalence of gallstones in a representative sample of the general population. The objective of this article is to review the reports of sonographically based studies of gallstone prevalence in the world literature. All available published epidemiologic studies on the prevalence of cholecystolithiasis as determined by diagnostic sonography are summarized. The sonographically based studies published to date confirm that there are significant regional differences in the prevalence of gallstones. Certain risk factors, notably age and heredity, are present worldwide.

Adolescent↗