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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Der Internist 38 (1997), S. 582-589 
    ISSN: 1432-1289
    Keywords: Schlüsselwörter Colitis ulcerosa ; Therapie ; M. Crohn ; Therapie ; Immunsuppression ; chronische Darmerkrankungen
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Zusammenfassung Der immunsuppressiven Therapie kommt bei chronischen Darmerkrankungen große Bedeutung zu, insbesondere dort, wo die Standardtherapie nicht den gewünschten Erfolg zeigt. Als Therapie der ersten Wahl gelten bei Colitis ulcerosa 5-Aminosalizylsäure-freisetzende Medikamente, bei Morbus Crohn Kortikosteroide. Innerhalb der Gruppe immunsuppressiver Präparate gibt es erhebliche Wirkungsunterschiede. Darüber hinaus ist die Immunsuppression auch mit ernstzunehmenden Nebenwirkungen belastet. Über den Stellenwert der Immunsuppression als Ergänzung, mögliche oder bei Unverträglichkeit notwendige Substitution der Standardtherapien von Colitis ulcerosa und Morbus Crohn wird hier eingehend referiert. Auch die Behandlung dieser Erkrankungen in der Schwangerschaft wird dabei erläutert.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Der Internist 40 (1999), S. 1288-1299 
    ISSN: 1432-1289
    Keywords: Schlüsselwörter Morbus Crohn ; Colitis ulcerosa ; Therapie ; Komplikationen
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Zum Thema Trotz der Fortschritte in der Erfassung genetischer Grundlagen und im Verständnis der Mechanismen der Entzündungsreaktion in der intestinalen Mukosa ist die Behandlung der chronisch entzündlichen Darmerkrankungen auch am Ende dieses Jahrhunderts noch eine symptomatische Therapie, die keine Heilung, sondern nur eine Behandlung der Schübe der Erkrankung und den Versuch einer Erhaltung einer einmal erreichten Remission beinhaltet. Eine Ausnahme bildet die chirurgische Therapie der Colitis ulcerosa, die die Krankheit heilt, aber mit dem Verlust des Kolons und der Reservoirfunktion im Rektum ihrerseits wieder Beschwerden hervorrufen kann. Angesicht dieser Situation ist ein optimales Verhältnis von Wirkung und Nebenwirkungen besonders wichtig. Einer Verbesserung dieses Verhältnisses waren viele Bemühungen der letzten Jahre gewidmet.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1573-2568
    Keywords: acute pancreatitis ; granulocyte elastase ; C-reactive protein ; α1-antitrypsin, α2-macroglobulin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Complexes of granulocyte elastase and α1-antitrypsin are markers for granulocyte activation. In 75 patients with acute pancreatitis these complexes were immunologically determined daily in plasma during the first week of hospitalization. Patients were classified into three groups: mild pancreatitis (I, ≤1 complication, N=34), severe pancreatitis (II, ≥2 complications, N= 29), lethal outcome (III, N=12). Initially, granulocyte elastase (mean±sem) was lower in group I (348±39 μg/liter) as compared to groups II (897±183 μg/l) and III (799±244 μg/liter), P〈0.001 for I vs II + III. Initial elastase concentrations 〉400 μg/liter were consistent with a severe or fatal course of the disease but did not distinguish between severe and lethal pancreatitis. In patients with mild or severe disease, mean elastase concentrations decreased continuously during the following days (197±15 μg/liter in mild cases, 325±30 μg/liter in severe cases at day 7). In patients with lethal disease, however, mean elastase concentrations even increased at day 2 and remained higher than 700 μg/liter during the observation period. At days 1 and 2 the predictive value for severe or lethal disease of raised (〉400 μg/liter) elastase concentrations [positive predictive value (PPV) 82%, negative predictive value (NPV) 81%] was better than that of elevated (〉100 mg/liter) C-reactive protein (PPV 73%, NPV 73%), elevated (〉4.0 g/liter) α1-antitrypsin (PPV 59%, NPV 50%), or decreased (〈1.5 g/liter) α2-macroglobulin (PPV 82%, NPV 67%). When the time course of the concentrations of the acute-phase proteins was studied, it was found that rises of granulocyte elastase were followed by elevated C-reactive protein levels after one day, by elevated α1-antitrypsin levels after two days and by decreased α2-macroglobulin levels after three to four days. We conclude that granulocyte elastase is a good early marker for the severity of acute pancreatitis. Compared with elevated levels of C-reactive protein and α1-antitrypsin release of granulocyte elastase reflects an event that precedes acute-phase protein induction.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1573-2568
    Keywords: leukocyte scintigraphy ; technetium-99m-hexamethyl propylene amine oxine ; acute pancreatitis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The infiltration of leukocytes has been linked to the pathophysiology of complicated or severe pancreatitis. We have tested the ability of leukocyte scintigraphy using technetium-99m-hexamethyl propylene amine oxine (HM-PAO) as label to demonstrate the localization of leukocytes in the pancreas during acute pancreatitis. Twenty-eight patients with acute pancreatitis (eight with biliary, 13 with alcoholic, and seven with unknown origin) were studied with leukocyte scintigraphy using planar imaging and single photon emission computed tomography (SPECT). Fourteen patients had a mild (group I), 11 a severe (group II), and three a lethal outcome (group III) of pancreatitis. All patients of group III, six of group II, and two of group I had a positive leukocyte scan. Thus, the sensitivity of leukocyte scintigraphy for the detection of a lethal course, of acute pancreatitis was 100%, of a severe course 54%, and of a severe or lethal course 64%. The specificity of a negative scan for a mild pancreatitis was 86%. Comparison of the results of leukocyte scintigraphy with those of contrast enhanced CT showed that six of eight patients with pancreatic necrosis in CT had a positive leukocyte scan, but only five of 20 patients without detectable pancreatic necrosis in CT. In summary, leukocyte infiltration into the pancreas during pancreatitis can be demonstrated by noninvasive leukocyte scintigraphy using technetium-99m-HM-PAO as label. A correlation between the severity of the disease and leukocyte infiltration exists.
    Type of Medium: Electronic Resource
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