Biomedical subjects
W Kratzer
Publications and source records attributed to W Kratzer.
Pericystic metabolic activity in alveolar echinococcosis: assessment and follow-up by positron emission tomography.
Information on parasite viability in alveolar echinococcosis (AE) cannot be obtained by conventional imaging techniques. We evaluated the glucose metabolism of AE lesions by use of [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) in 12 inoperable patients. Eight patients showed either perilesional or focal enhancement ("hot spots"), whereas 4 patients had nonenhancing (metabolically inactive) lesions. With PET, necrotic parasitic lesions and areas of enhanced metabolic activity could be clearly discriminated. Most notably, 3 of 8 patients with metabolically active lesions who were reexamined after chemotherapy treatment clearly showed improvement: the initial surrounding hot spots had disappeared in 2 of them, and had significantly decreased in 1. PET may prove valuable in assessing the efficacy of chemotherapy by showing the disappearance of metabolic activity and may also be useful for timely detection of relapses and metastases. Although costly and not readily available, FDG-PET is a promising tool toward improved management of AE and may thus help lower costs of long-term chemotherapy.
An epidemiologic survey of human alveolar echinococcosis in southwestern Germany. Römerstein Study Group.
The inhabitants of a rural community in southwestern Germany were examined for alveolar echinococcosis (AE). The study was prompted by the recent increase of the prevalence of the parasite in foxes and the increase of fox populations: in the study area, 75% of the foxes carried Echinococcus multilocularis. The human population was screened using hepatic ultrasound and serology. All participants were interviewed for demographic and potential risk factors. Of 2,560 participants, one was identified with active AE, while 3 others had suspicious liver lesions. Another 9 participants were seropositive for specific antibodies without detectable lesions. Demographic and behavioral factors were not correlated with active or suspected cases nor with seropositivity. If the prevalence of 40/100,000 (95% confidence interval = 15-295/100,000) for active cases would be representative for the rural population in high endemicity areas, the current number of AE cases in southwestern Germany is considerably higher than previously suspected.
[Prevalence of cholecystolithiasis in South Germany--an ultrasound study of 2,498 persons of a rural population].
Gallbladder stones represent one of the most common reason for morbidity in western industrial nations. There remains a paucity of exact information regarding the prevalence and risk factors for this disease entity in Germany. As part of a whole-community survey focusing on the prevalence of echinococcosis multilocularis conducted in a population in southwestern Germany (response rate: 66.6%), 2,560 subjects underwent an upper abdominal ultrasound examination at which the presence of gallbladder stones was ascertained. In each case, upper abdominal sonography was performed following completion of a standardized interview. In 62 subjects, the gallbladder could not be adequately visualized due to an insufficient fasting period; the remaining 2,498 subjects (1,326 females, age 38.9 +/- 19.9 years; 1,172 males, age 37.7 +/- 18.8 years) were included in the study collective. Gallbladder stones (sonographically visualized gallbladder stones or history of cholecystectomy for cholecystolithiasis) were found in 196 participants (7.8%; 139 females [10.5%] versus 57 males [4.9%]). Statistical treatment of the data using multiple logistical regression techniques revealed a significant influence of the variables age, gender, body mass index (BMI) and positive family history on the development of gallbladder stones. The prevalence of gallbladder stones in the present study population is lower than figures reported for a study in Brandenburg and at 7.8% is rather low in comparison with other European studies. One explanation may be the low average age of study participants, almost 50% of whom were less than 35 years. Besides age, subjects' gender, BMI and positive family history were identified as significant risk factors.
[Chemotherapy of alveolar echinococcosis with benzimidazoles. A prospective long-term study].
BACKGROUND: Mebendazole and albendazole are the drugs of choice for the treatment of alveolar echinococcosis. In this prospective study we present and evaluate the outcome of the long-term treatment with both drugs. PATIENTS AND METHODS: Forty-four patients were treated with either mebendazole or albendazole and they were followed up for an average of 42 months. Success of treatment was defined as non-progression for more than 1 year. RESULTS: The overall success-rate was approximately 80% (35/44). An initial regimen was recurrence-free in 64% of cases under mebendazole and in 73% of cases under albendazole. Half of the cases with recurrent disease could be stabilized after changing the therapeutic regimen. Seven patients received a continuous regimen with albendazole. They were observed over an average of 19 months without signs of progression nor significant side effects. CONCLUSION: 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. In Germany, serum levels for mebendazole can easily be obtained at numerous institutes, while serum levels for albendazole are rarely available. On the other hand, albendazole reduces costs by over 40%. A simplified mode of intake and a reduced number of side effects argue in favor of the preferred use of albendazole. Albendazole in alveolar echinococcosis is only licensed for intermittent application. Nonetheless, continuous treatment may be considered in inoperable cases or progressive disease.
Gallstone prevalence in Germany: the Ulm Gallbladder Stone Study.
The Ulm Gallbladder Stone Study is the first ultrasound-based epidemiologic survey of cholecystolithiasis in the former West Germany. A study population of 1116 blood donors (656 men, age 38.0 +/- 12.0 years; 460 women, age 34.1 +/- 11.2 years) at the Central Blood Bank of the German Red Cross in Ulm was examined between April 1994 and February 1995. Based on age, subjects were assigned to one of four groups (18-30, 31-40, 41-50, and 51-65 years). Following a structured interview of each study subject, an ultrasound examination was carried out and a blood sample obtained for laboratory study. Overall, 6.0% (95% (95% CI: 4.8%-7.6%) of all study subjects (5.8% of the men and 6.3% of the women) exhibited evidence of current or past gallbladder disease (cholelithiasis or history of cholecystectomy). The prevalence of gallbladder disease correlated positively with age, reaching a maximum of 13.7% (9.5-20.0) in the 51- to 65-year-old age group, and also correlated as with body mass index (BMI). Female subjects with previous full-term pregnancies showed a higher prevalence of cholelithiasis, but this difference was not statistically significant for age-adjusted analysis. Subjects with a family history of cholelithiasis were found to suffer from gallstones in 11.5% (8.0-16.7) of cases compared with 4.6% (3.4%-6.3%) of subjects without such family history. Autopsy studies conducted in Germany have shown the prevalence of gallstones to be about 13.1% in men and 33.8% in women. Our sonographic data are relatively low in comparison. This may be due, in part, to the specific selection characteristics inherent in retrospective autopsy studies, such as age distribution and the presence of other pathologic factors associated with increased risk for cholelithiasis. The Ulm data rank in the lower third of the prevalence range reported for European sonographic studies to date. Age, positive family history, and increased BMI all correlated positively with the prevalence of gallbladder disease (P < 0.05). For the study population as a whole, there was no gender-specific increased risk for the development of gallstones.
Axonal neuropathy and predominance of type II myofibers in infantile spinal muscular atrophy.
Two affected siblings with infantile spinal muscular atrophy (SMA I) presented with generalized muscular hypotonia, which progressed to early death. Quadriceps muscle biopsy did not show the typical neurogenic pattern of spinal muscular atrophy. The histochemical fiber type determination revealed a predominance of type II fibers without type I hypertrophy, an unprecedented finding in spinal muscular atrophy. Sural nerve biopsy exhibited findings typical for axonal neuropathy. In one patient, electrical stimulation of peripheral nerves showed an inexcitability of motor and sensory nerves. Genetic studies revealed homozygous deletions of the telomeric survival motor neuron (SMN) gene and the neuronal apoptosis inhibitory protein (NAIP) gene in the affected children. This is the second case report of molecular genetically proven spinal muscular atrophy associated with axonal neuropathy. We conclude atypical findings on muscle biopsy and evidence of axonal neuropathy are compatible with the diagnosis of infantile spinal muscular atrophy.
De novo duplication of 12pter-->p12.1: clinical and cytogenetic diagnosis confirmed by chromosome painting.
A 12.5-year-old male patient with a de novo derivative chromosome 22 is reported. A detailed description of the clinical features and comparison with the results of conventional cytogenetic banding methods indicated that the derivative chromosome might have been caused by a translocation between the short arms of chromosomes 12 and 22: der(22)t(12;22)(p12.1;p11.2). Fluorescence in situ hybridization with a chromosome 12-specific paint confirmed this supposition. The patient thus carries a pure duplication of 12pter-->p12.1. The phenotype of the patient described is compared to cases in the literature.
Gallstone prevalence in relation to smoking, alcohol, coffee consumption, and nutrition. The Ulm Gallstone Study.
BACKGROUND: Besides considering well-known risk factors for the development of gallbladder stones, such as age, sex, fecundity, and hereditary predisposition, efforts at prevention have focused increasingly on other factors, such as nicotine, alcohol, and caffeine consumption, as well as general nutrition, which may be modified. METHODS: A total of 1116 blood donors were examined between April 1994 and February 1995 in the central blood bank of the German Red Cross in Ulm, Germany. Each subject received a questionnaire and underwent to an upper abdominal ultrasound examination. RESULTS: Gallbladder stone disease (current cholecystolithiasis and history of cholecystectomy) was detailed in 5.8% of the men and 6.3% of the women. Neither regularity nor number of daily meals correlated with the frequency of gallstone disease. Vegetarians (n = 48), as a group, were not found to have gallstones. In relation to the consumption of alcohol, tobacco, or caffeine higher prevalence of cholecystolithiasis was found only in heavy drinkers of coffee (P = 0.051; odds ratio (OR), 1.083; 95% confidence interval (CI), 0.999, 1.174). CONCLUSION: Results of the present study do not show a definite relationship between nutritional factors and the consumption of alcohol, tobacco, or caffeine and an increased prevalence of gallbladder stone disease.
Gallstone recurrence after successful dissolution therapy.
After successful dissolution therapy of cholesterol gallbladder stones bile again becomes supersaturated and recurrent gallstones may develop. Three different postdissolution treatments [500 mg ursodeoxycholic acid (UDCA) per day (N = 14, group I), 100 mg aspirin per day (N = 14, group II) and diet (N = 15, group III) versus a control group (no treatment, N = 15, group IV) aimed at preventing recurrence of gallstones were investigated in a prospective, randomized study in 58 gallstone patients (33 female, 25 male) after complete stone clearance. Bile samples (prior to dissolution therapy and at stone recurrence) were investigated for biliary cholesterol (C), phospholipids (PL), total bile acid concentration (BA), cholesterol saturation index (CSI), total lipid concentration (TLC), total biliary protein concentration (TP), and nucleation time (NT). In group IV multiple gallstones tended to recur more often than solitary stones (66.7% vs 16.7%) whereas in groups I-III only solitary stones recurred. Recurrent gallbladder stones were detectable in 10 patients (eight patients in group IV and one each in groups I and II, respectively) within one year after dissolution and in two patients (one each in groups III and IV, respectively) after 15 months. Furthermore, the probability of stone recurrence was significantly higher in untreated patients as compared to treated patients. In nine (group IV) of 12 patients with recurrent stones NT, C, CSI, PL, BA, TLC, TP, and bile acid spectrum remained nearly unchanged as compared to their pretreatment values, whereas in three (groups I-III) of 12 cases a decrease in C, CSI, and TP was observed during therapy. However, in each of these three patients, initial and after-treatment TP was significantly higher and NT shorter as compared to groups I-IV. Furthermore, in these cases (N = 3) NT was prolonged, whereas no significant changes were found in PL, BA, TLC, and bile acid spectrum. Recurrence of gallstones, which seems to occur more likely in patients with multiple stones as compared to solitary stones, will happen in the early stage after stone clearance, again causing biliary pain. UDCA, aspirin or diet will reduce the probability for recurrent stones after complete gallstone dissolution.
[Positive effect of ursodeoxycholic acid on liver enzymes in autoimmune hepatitis with little activity--a pilot study].
In a pilot study we investigated the effect of ursodeoxycholic acid therapy in 11 patients (mean age 45.8 +/- 13.2 years) with chronic active, ANA- and/or SMA-positive autoimmune hepatitis of moderate severity. All patients were clinical asymptomatic and no indication for immunosuppressive therapy could be established in any patient. After a washout period of at least 3 months, the treatment was administrated with 500 mg ursodeoxycholic acid twice daily. A statistically significant improvement in all important hepatic parameters was achieved within 3 months of therapy. No further improvement could be observed once 6 months had elapsed. Significant decreases of SGOT (29.9 +/- 20.2 vs 17.7 +/- 7.1 U/l, p = 0.020), SGPT (43.8 +/- 31.0 vs. 19.6 +/- 6.7 U/l, p = 0.0012), GLDH (20.1 +/- 20.9 vs. 5.2 +/- 2.6 U/l, p = 0.0001) und gamma-GT (152.0 +/- 124.8 vs. 60.6 +/- 49.2 U/l, p = 0.0064) were observed during treatment. Despite tendential improvement, serum biliruhin, levels (18.2 +/- 9.4 vs. 16.9 +/- 9.4 mumol/l, p = 0.287) did not change significantly during treatment. Ursodeoxycholic acid may be beneficial in altering the natural course of chronic active hepatitis and of value in preventing mild attacks of immune hepatitis. The simple fact that ursodeoxycholic acid administration is essentially free of side-effects can go a long way towards justifying further clinically controlled studies.
Effect of extracorporeal shock-wave lithotripsy on gallbladder emptying in patients with solitary and multiple gallbladder stones.
In a prospective study, we investigated the effect of extracorporeal shock-wave lithotripsy (ESWL) on gallbladder contractility and on fasting and residual gallbladder volume in patients with solitary and multiple gallbladder stones with stone densities < 100 Hounsfield units (HU) and adequate gallbladder function. Twenty-five patients (seven males and 18 females, mean age 48.5 +/- 11.7 years) treated with ESWL were assigned to either group I, consisting of 13 patients with solitary stones < 20 mm diameter, or group II, including patients with two to three stones and maximum stone diameter of 30 mm. ESWL was performed with the MPL 9000 lithotripter. Gallbladder ejection fraction was determined using the method of Dodds after a 12-hr fast and following application of a standard stimulative meal. Gallbladder volume was measured by ultrasound over 90 min at 10-min intervals before ESWL, then at 1, 30, 120, and 210 days after ESWL. At 24 hr after ESWL, residual gallbladder volume increased in group I from 7.4 ml to 13.9 ml (P = 0.0567) and in group II from 6.5 ml to 20.2 ml (P = 0.0076). Thereafter, residual volumes returned to pre-ESWL levels. In group II, post-ESWL fasting volumes were significantly increased over initial values at all time intervals. Correspondingly, only at 24 hr after ESWL, ejection fractions decreased from 73.1% to 64.9% in group I and from 76.5% to 62.7% in group II. No statistically significant differences in gallbladder contractility between the two groups were observed at any point of the follow-up period.(ABSTRACT TRUNCATED AT 250 WORDS)
Inter- and intrafamilial variability in mucolipidosis II (I-cell disease).
In this paper nine patients with mucolipidosis II (I-cell disease) are described. They had clinical features commonly found in mucolipidosis II, including disproportionate dwarfism, coarse facial features and mental retardation. However, there was remarkable variability in age of onset, organ manifestation and radiological findings. Some had unusual clinical symptoms including pericardial effusion and profound brain atrophy. Striking differences in phenotypic expression were also seen in two affected siblings. Clinical heterogeneity is observed not only in mucolipidosis II but also in many other lysosomal storage disorders. The factors that may contribute to this clinical diversity are discussed.
Combined bile acid therapy is more effective on biliary lipids and dissolution rates than monotherapy after gallstone lithotripsy.
BACKGROUND: Accurate sampling of gallbladder bile for biliary analysis is essential for determining any potential difference between combined bile acid therapy and monotherapy in gallstone patients. METHODS: In 104 gallstone patients undergoing extracorporeal shock wave lithotripsy with following bile acid therapy [either chenodeoxycholic acid (500 mg/day) and ursodeoxycholic acid (500 mg/day), group I (n = 53), or ursodeoxycholic acid alone (1000 mg/day), group II (n = 51)], bile samples, obtained by direct fine needle puncture of the gallbladder, were investigated for biliary lipids, total biliary protein concentration, and nucleation time before and after 12 months of bile acid therapy. RESULTS: Initially, a negative correlation was found between nucleation time and number of gallstones and between total biliary protein concentration and nucleation time (r = -0.52 and r = -0.49 in group I vs r = -0.56 and r = -0.51 in group II, p < 0.01 in each group). The correlation between total biliary protein concentration and nucleation time was also found after 12 months of bile acid treatment (r = -0.54 in group I vs r = -0.47 in group II, p < 0.01 in each group). In group I, the decrease in cholesterol saturation index, biliary cholesterol, cholic acid, deoxycholic acid, and total protein concentration was more pronounced than in group II (p < 0.01). The same effect was found concerning the prolongation of nucleation time (p < 0.01). Furthermore, dissolution rates were higher in group I compared with group II (80.4 vs 69.0%, p < 0.01). CONCLUSION: In gallstone patients, combined therapy with urso- and chenodeoxycholic acid is superior to either ursodeoxycholic acid alone or biliary parameters in bile samples obtained by direct fine needle puncture of the gallbladder.
Diagnostic value of fine-needle puncture of the gallbladder: side effects, safety, and prognostic value.
Bile sampling without the risk of contamination by pancreatic and duodenal secretions and avoiding unpredictable influences of general anesthesia during biliary surgery on biliary analytics are feasible with percutaneous puncture of the gallbladder. In 207 patients with gallstones, gallbladder puncture was performed under local anesthesia with a 22-gauge spinal needle under continuous real-time ultrasound guidance. Bile samples were investigated for biliary lipids and nucleation time. Complete aspiration of gallbladder bile could be achieved in all patients without complications such as bleeding, bile leak, or inflammation. Of these patients, 11.6% reported mild abdominal problems, 3.4% required analgetics, and in 1.0% biliary colics were observed. Elective cholecystectomy was performed in 1 patient. Of the bile samples, 10.1% were contaminated with bactobilia. Biliary lipids, cholesterol saturation index (CSI), total lipid concentration (TLC), and bacteriological contamination were independent of gallstone number, whereas patients with solitary gallbladder stones exhibited a significantly longer nucleation time (NT) in comparison with those with multiple stones. In patients with gallstones, fine-needle puncture of the gallbladder represents an important diagnostic procedure and can be performed within minutes without major side effects if performed by an experienced sonographer.
Low pretreatment gallbladder stone densities at computed tomography predict rapid stone clearance following extracorporeal shock wave lithotripsy.
The importance of routine computer tomographic (CT) stone analysis in optimizing the therapeutic outcome after extracorporeal shock wave lithotripsy (ESWL) remains controversial. The aim of the present prospective study was to seek a correlation between CT findings and stone clearance rates after ESWL in 159 patients. One hundred fifty-nine symptomatic patients (116 females, 43 males) with solitary radiolucent gallbladder stones underwent CT for stone analysis before lithotripsy. In Group I (<50 HU, n=104), stone clearance was achieved in 55.8% of patients within 6.11+/- 6.95 months; in Group II (51-100 HU, n = 28), in 50.0% of patients within 11.2 +/- 10.3 months; in Group III (>100 HU, n = 27) in 29.7% of patients within 9.60 +/- 6.96 months. The mean follow-up period was 17.9 +/- 10.0 months. Patients in Group I showed a significantly higher rate of stone clearance than those in Groups II and III (p < 0.001) as well as a significantly shorter time for the achievement of total stone clearance than either of the other groups (p < 0.001). The authors conclude that CT stone analysis provides a more accurate method of selecting patients suitable for ESWL and may be of importance in predicting the expected length of time for achieving complete stone clearance.
The relation between biliary lipids, nucleation time, and number of gallbladder stones after percutaneous gallbladder puncture.
BACKGROUND: Biliary lipids and nucleation time are increasingly of importance in the understanding of the cholesterol nucleation process in gallstone patients. METHODS: Biliary lipids, total lipid concentration (TLC), cholesterol saturation index (CSI) and nucleation time (NT) were studied in 221 bile samples from patients with solitary (n = 120) and multiple (n = 101) gallbladder stones. RESULTS: Biliary cholesterol concentration and CSI did not differ between patients with solitary or multiple stones; however, it was positively correlated with the CSI (r = 0.93; p < 0.01). We found a negative correlation between CSI and TLC (r = -0.77 for solitary stones and r = -0.79 for multiple stones; p < 0.01). Furthermore, levels of total bile acids and phospholipids were similar in cases with solitary and multiple gallbladder stones. TLC did not correlate with single or multiple stones, whereas NT was determined to be negatively correlated with the number of gallstones (r = -0.39; p < 0.01). Patients with solitary stones had a significantly (p < 0.01) longer NT than those with multiple gallbladder stones (7.5 +/- 4.2 days versus 2.3 +/- 1.5 days). CONCLUSIONS: Our findings suggest that there exists a nucleation-promoting activity, which seems to be more pronounced in patients with multiple gallbladder stones than in those with solitary stones, indicating a major risk factor for the higher recurrence rate seen in these patients.
Gallbladder sludge: spontaneous course and incidence of complications in patients without stones.
Although the ultrasonic detection of gallbladder sludge is relatively frequent, its clinical importance remains unclear, partly because of the paucity of reliable investigations regarding its natural course in patients without stones. In a retrospective study we investigated the course and clinical significance of gallbladder sludge in patients without stones or other identified gallbladder abnormalities. The diagnosis of gallbladder sludge was made by ultrasound scan in 286 (1.7%) of 17,021 patients. The mean follow-up period for these patients was 20.3 +/- 11.5 mo. Of this group 56 patients were without both stones and sludge at the initial examination, and gallbladder sludge developed after a mean observation period of 11.2 +/- 10.6 mo. Within 2.0 +/- 3.5 mo after sludge detection, 40 (71.4%) patients were free of sludge and showed normal gallbladder findings. Gallbladder stones without sludge persistence developed in five patients (8.9%) within 2.5 +/- 0.6 mo after diagnosis of sludge, and gallstones with persistence of sludge developed in two other patients (3.6%) after 6.1 and 30.7 mo, respectively. In no cases did the stones become clinically symptomatic in the course of the follow-up period. Acute acalculous cholecystitis developed in four patients (7.1%) from 6.5 to 37.5 mo after the first examination. In five patients, sludge persisted after a mean 22.3 +/- 13.5 mo of follow-up. Although our data show that gallbladder sludge disappeared spontaneously within a relatively short time in 71.4% of patients, gallbladder sludge must be considered an important pathologic entity because gallbladder stones or complications such as acute cholecystitis occurred in 19.6% of patients.(ABSTRACT TRUNCATED AT 250 WORDS)