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  • 1
    ISSN: 1365-2036
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Background : A pegylated interferon-alpha-induced decrease in platelet counts may become a limiting factor for continuation of therapy.Aim : To evaluate the effect of pegylated interferon-α administration on platelet plug formation and von Willebrand factor antigen release in patients with chronic hepatitis C.Methods : Thirty patients with chronic hepatitis C (genotype 1; fibrosis 1–3: n = 16, cirrhosis: n = 14) received a single dose of 9 MU interferon-α2a, followed by weekly administration of 180 μg of pegylated interferon-α2a/ribavirin for 48 weeks. Platelet counts, platelet function (collagen–epinephrine-induced closure time) and von Willebrand factor antigen were measured.Results : Platelet counts and collagen–epinephrine-induced closure time decreased by 13% and 16%, respectively, 24 h after the first dose of interferon-α2a, and von Willebrand factor antigen levels increased by 31% (P 〈 0.01) compared with baseline. During a 48-week observation period, platelet counts decreased by a maximum of 33% (P 〈 0.001), von Willebrand factor antigen levels increased by 69% (P 〈 0.001) whereas collagen–epinephrine-induced closure time did not change. In noncirrhotic patients, the increase of von Willebrand factor antigen levels was maintained throughout therapy without a change in collagen–epinephrine-induced closure time. In contrast, in cirrhotics, von Willebrand factor antigen levels did not increase, while collagen–epinephrine-induced closure time was prolonged.Conclusion : Single-dose interferon-α decreases platelet counts but improves platelet function, possibly by the release of von Willebrand factor antigen. Accordingly, long-term antiviral treatment had no effect on collagen–epinephrine-induced closure time, despite the decrease in platelet count in noncirrhotic patients. Such a compensation of decreased platelet counts by increased von Willebrand factor antigen level did not occur in cirrhotics.
    Materialart: Digitale Medien
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  • 2
    ISSN: 1365-2036
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Extracorporeal photochemotherapy has been proven effective in selected T-cell mediated diseases.〈section xml:id="abs1-2"〉〈title type="main"〉Aim:To evaluate the safety and efficacy of extracorporeal photochemotherapy in patients with steroid-dependent Crohn’s disease by an open, monocentric trial in three phases of 24 weeks each.〈section xml:id="abs1-3"〉〈title type="main"〉Methods:In phase 1 standardized steroid tapering was initiated in patients with a history of steroid-dependent Crohn’s disease. Those with a prospectively evaluated maintenance dose of at least 10 mg/day prednisolone continued steroid-withdrawal under the application of extracorporeal photochemotherapy in phase 2. The duration of remission or response was followed during phase 3. Colonic tissue bioptically obtained before and after extracorporeal photochemotherapy was studied by immunofluorescence microscopy for the presence of photoadduct positive cells.〈section xml:id="abs1-4"〉〈title type="main"〉Results:Out of 24 patients included in phase 1, 10 entered phase 2 for extracorporeal photochemotherapy. Four subjects achieved remission and four others response. Significant reductions in serum C-reactive protein levels and intestinal permeability were measured, as well as increases in quality of life and plasma adrenocorticotropic hormone levels. No major side-effects were observed. Remission remained stable in three out of four patients during phase 3. In three patients, positive nuclear stainings of photoadducts were detected in colonic mononuclear cells after extracorporeal photochemotherapy.〈section xml:id="abs1-5"〉〈title type="main"〉Conclusions:Extracorporeal photochemotherapy represents a safe steroid-sparing approach in patients with Crohn’s disease and is associated with intestinal homing of photopheresed cells.
    Materialart: Digitale Medien
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  • 3
    Digitale Medien
    Digitale Medien
    Amsterdam : Elsevier
    Journal of Ultrasructure Research 85 (1983), S. 249-259 
    ISSN: 0022-5320
    Quelle: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Thema: Biologie
    Materialart: Digitale Medien
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  • 4
    Digitale Medien
    Digitale Medien
    Amsterdam : Elsevier
    Journal of Ultrasructure Research 85 (1983), S. 260-271 
    ISSN: 0022-5320
    Quelle: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Thema: Biologie
    Materialart: Digitale Medien
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  • 5
    Digitale Medien
    Digitale Medien
    Springer
    Langenbeck's archives of surgery 336 (1974), S. 67-89 
    ISSN: 1435-2451
    Schlagwort(e): Arterialization of the Liver Portocaval Shunt
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Zusammenfassung Die druck- und durchflußkontrollierte Arterialisation der Leber mit portocavalem End-zu-Seit-Shunt wurde bisher bei 17 Patienten durchgeführt, zweimal als „äakuter” und 15mal als „äselektiver” Shunt. Drei Patienten waren der Risikogruppe C nach Child zuzuordnen, 10 der Gruppe B und nur 4 der Gruppe A. 1. Vier Patienten sind postoperativ verstorben, 13 Patienten haben überlebt. 2. Bei 2 Patienten war es unmittelbar postoperativ zur Thrombose der Arterialisation gekommen bei durchgängigem portocavalem Shunt, bei weiteren 3 wurde ein hepatofugaler Blutfluß aufgedeckt, der die Ligatur der Arterialisation erforderlich machte. 3. Die Leberfunktionsprüfung zeigte gegenüber dem Spontanverlauf der Cirrhose keinen signifikanten Unterschied. 4. Die postoperative Hämodynamik ist gekennzeichnet durch eine Zunahme des intrasinusoidalen Widerstandes, eine allmëhliche Abnahme der Leberdurchblutung und einen unverënderten Lebervenenversehlußdruck. 5. Auch ohne diätetische Restriktion entwickelte keiner der Patienten bisher eine Shuntencephalopathie.
    Notizen: Summary Controlled arterialization of the liver after a portocaval end-to-aide shunt has been performed on 17 patients, in two cases as an “acute” and in 15 cases as an “elective” shunt. 3 patients belonged to risk group C, 10 to group B, and only 4 to group A (according toChild). 1. 4 patients died postoperatively, 13 survived. 2. In 2 patients a thrombosis of the arterialization occured immediately after the operation with the portocaval shunt patent, in 3 other patients hepatofugal collaterals were detected which necessitated a ligature of the arterialization. 3. The liver function-test did not significantly differ from the spontaneous development of cirrhosis. 4. Postoperative haemodynamics are characterized by an increase in intrasinusoidal resistance and a gradual decrease in blood supply to the liver, while the hepatic occluded portal pressure remains constant. 5. Even without dietetic restriction none of the patients has so far developed a shunt-encephalopathy.
    Materialart: Digitale Medien
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  • 6
    ISSN: 1432-1440
    Schlagwort(e): Lipids ; Intestinal mucosa ; Diabetes mellitus ; Biochemistry ; Ultrastructure ; Lipide ; Dünndarmschleimhaut ; Diabetes mellitus ; Biochemie ; Ultrastruktur
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Zusammenfassung Hyperlipidämien sind ein häufiger Befund bei Diabetes mellitus. Da neben der Leber auch die Dünndarmmukosa endogene Lipoproteine synthetisiert, war es von Interesse, bei 11 Erwachsenen mit juvenilem Diabetes und bei 7 Patienten mit Altersdiabetes den Lipidgehalt der Dünndarmmukosa zu bestimmen. Als Kontrolle dienten 11 nicht diabetische Patienten. Nach einer Nüchternperiode von 12–14 h erfolgte zunächst eine Blutabnahme zur Bestimmung von Nüchternblutzucker, Serumlipiden und glykosyliertem Hämoglobin AI, daraufhin wurden mittels einer hydraulischen Biopsiesonde oder endoskopisch mehrere Dünndarmbiopsien entnommen und zur biochemischen, histochemischen und elektronenoptischen Auswertung entsprechend aufgearbeitet. Biochemisch unterschieden sich die Patienten mit juvenilem und mit Altersdiabetes weder hinsichtlich der Serumlipidwerte noch der intestinalen Lipidkonzentrationen von den Kontrollpersonen. Auffallend war allerdings, daß Patienten mit Altersdiabetes eine signifikant höhere intestinale Triglyzeridkonzentration aufwiesen, als Patienten mit juvenilem Diabetes (p〈0,005). Nüchternblutzucker und Hämoglobin AI waren bei beiden Patientengruppen mäßig erhöht. Histochemisch waren sowohl bei den Patienten als auch bei den Kontrollpersonen Lipidpartikel in der Mukosa nachweisbar, allerdings mit großen individuellen Unterschieden. Elektronenoptisch unterschieden sich die Patienten mit Altersdiabetes nicht von den Kontrollen. Nur einer der Patienten mit juvenilem Diabetes zeigte gehäufte Lipidpartikel in den Zisternen des Golgi-Apparates. Somit konnte weder biochemisch, histochemisch, noch elektronenoptisch eine abnorme Lipidakkumulation in der Dünndarmschleimhaut von Patienten mit gut kontrolliertem Diabetes mellitus festgestellt werden.
    Notizen: Summary Hyperlipemia is a frequent finding in diabetes mellitus. As not only the liver, but intestinal mucosa as well synthesizes endogenous lipoproteins, we have investigated the small intestinal mucosal lipid content in 11 adult patients with juvenile onset diabetes and in 7 patients with maturity onset diabetes. Eleven non-diabetic patients served as controls. After a fasting period of 12–14 h blood was drawn for determination of glucose, lipids and glycosylated hemoglobin AI. Then several small bowel biopsies were performed by an hydraulic multiple biopsy tube or endoscopically and the specimens were processed immediately for further biochemical, histochemical and electronmicroscopical workup. Patients with juvenile and with maturity onset diabetes did not differ from controls with regard to serum lipids and to intestinal mucosal lipids determined biochemically. Surprisingly, patients with maturity onset diabetes exhibited a significantly (p〈0,005) higher concentration of intestinal mucosal triglycerides than patients with juvenile onset diabetes. Fasting blood glucose and hemoglobin AI levels were slightly elevated in both groups of diabetic patients. Histochemically lipid particles were demonstrable in intestinal mucosa of diabetics and of controls with equal variability. The electronmicroscopical appearance of intestinal mucosa did not differ between diabetic patients and controls. Only in one patient with juvenile onset diabetes an accumulation of lipid particles within the cisternae of the Golgi apparatus was observed. In conclusion, neither biochemically, nor histochemically, nor electronmicroscopically an abnormal accumulation of lipids could be found in the small intestinal mucosa of patients with well controlled diabetes mellitus.
    Materialart: Digitale Medien
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  • 7
    ISSN: 1432-1335
    Schlagwort(e): Monoclonal antibodies ; Flow cytometry ; Carcinomas ; Surface antigens
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary Peripheral blood mononuclear cells (PBMC) from 40 patients with gastrointestinal carcinoma (GIC), 13 patients with primary carcinoma in other localizations(non-GIC), and from 57 apparently healthy donors were isolated by Ficoll-Paque gradient centrifugation. The separated cells were stained with several monoclonal antibodies and subjected to analysis on a fluorescence-activated cell sorter. A decreased percentage of PBMC expressing T cell antigens was noted amongst GIC patients, and was mainly due to a reduction of the Leu 2a subset, thus, leading to an increase in the Leu3a/Leu2a ratio from 1.4 to 2.1. Non-GIC patients had decreased numbers of both T helper and suppressor cells. Amongst PBMC from GIC and non-GIC patients a statistically increased percentage of cells expressed LeuM2 (P〈0.001), LeuM3 (P〈0.001), OKM 1 (P〈0.005), VEP 9 (P〈0.001), and HLA-DR (P〈0.001) antigens compared to healthy controls. The percentage of cells bearing these monocyte/macrophage antigens correlated well with the number of cells having monocyte morphology, stained for non-specific esterase, phagocytosed latex particles, and expressed Fc IgG receptor. Our results demonstrate clearly that tumor-bearing patients have an incrased relative number of monocytes. The data suggest that cells of the macrophage lineage may be involved in defense mechanisms and changes of the immune system evoked by various tumors.
    Materialart: Digitale Medien
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  • 8
    ISSN: 1573-2568
    Schlagwort(e): chronic idiopathic intestinal pseudoobstruction ; neuronal degeneration
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary Neuropathological examination of the gut in a patient with chronic idiopathic intestinal pseudoobstruction and temporal lobe epilepsy showed a degeneration of Auerbach's and of Meissner's plexus. The extent of degenerative changes increased in an aboral to oral direction. Neuronal degeneration was characterized by ballooning of the cytoplasm of the ganglial cells, by a hyperargyrophilia, a shortening and dilation of cell processes, and a progressive fragmentation and loss of axoris. In rectal biopsies, a PAS-positive granular material was detected in the cytoplasm of ballooned ganglial cells. A severe peripheral neuropathy with fiber degeneration in the posterior columns and axonal lesions within ventral nerve roots and a more recent fiber degeneration in the lateral columns corresponding to the picture of subacute combined degeneration of the spinal cord and a symmetrical Ammon's horn sclerosis was present. This case of progressive intestinal neuronal degeneration of unknown origin is a newly described condition leading to chronic idiopathic intestinal pseudoobstruction.
    Materialart: Digitale Medien
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  • 9
    ISSN: 1439-0973
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Zusammenfassung Bei insgesamt 120 Patienten wurden im Rahmen routinemäßiger gastroduodenoskopischer Untersuchungen Schleimhautbiopsien zur Kultivierung vonCampylobacter pyloridis entnommen. Bei sechs von sieben Patienten mit Ulcus ventriculi, 14 von 15 mit Ulcus duodeni, 15 von 20 mit Erosionen der Magenschleimhaut, 31 von 61 mit Gastritis und fünf von fünf mit Duodenitis konnteC. pyloridis isoliert werden. Hingegen war der Keimnachweis bei allen 12 Patienten mit histologisch unauffälliger Mukosa nicht möglich. Bei chronisch aktiver Gastritis ließ sichC. pyloridis signifikant häufiger als bei chronisch inaktiver Gastritis nachweisen (100 bzw. 50%). Diese Ergebnisse stützen die Hypothese vonMarshall undWarren, die besagt, daßC. pyloridis möglicherweise eine wichtige Rolle in der Entstehung von Gastritis und Ulcus pepticum zukommt.
    Notizen: Summary During routine gastroduodenoscopic examination of 120 patients, biopsies of gastric mucosa were taken for the isolation ofCampylobacter pyloridis. The organism was isolated from six of seven patients with ulcus ventriculi, 14 of 15 with ulcus duodeni, 15 of 20 with erosions of the gastric mucosa, 31 of 61 with gastritis and five of five with duodenitis. In contrast, the cultures were negative in all of the 12 patients with histologically normal mucosa.C. pyloridis was isolated significantly more frequently from patients with active chronic gastritis than from those with inactive chronic gastritis (100% vs. 50%). These results support the suggestion ofMarshall andWarren that this bacterium may play an important role in the development of gastritis and peptic ulcer.
    Materialart: Digitale Medien
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  • 10
    Digitale Medien
    Digitale Medien
    Springer
    Digestive diseases and sciences 39 (1994), S. 1930-1934 
    ISSN: 1573-2568
    Schlagwort(e): Crohn's disease ; anemia ; erythropoietin ; iron ; interleukin-6
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Intestinal blood loss as well as chronic inflammation are regarded as the most important mechanisms in the pathogenesis of anemia in Crohn's disease. In addition, cytokines such as interleukin-6 can suppress erythropoietin production. This study was performed to investigate the importance of iron status, inflammatory activity, and endogenous erythropoietin concentrations for the development of anemia in Crohn's disease. In 49 consecutive patients with Crohn's disease, hemoglobin, inflammatory activity (Crohn's disease activity index, C-reactive protein, α1-acid glycoprotein), iron status (serum iron, transferrin, transferrin saturation, ferritin), and serum erythropoietin levels were studied. Anemic (Hb〈12.0 g/dl;N=16) vs nonanemic patients (Hb≥12 g/dl;N=33) showed reduced iron compartments (eg, ferritin 28.7±12.9 µg/liter vs 63.2±15.0 µg/liter, transferrin saturation 6.2±1.4% vs 11.5±1.3%,P〈0.01) but no differences in inflammatory activity. An inverse correlation between erythropoietin and hemoglobin concentrations was found (r=-0.62;P〈0.001), but the increase in erythropoietin levels was inadequate to the degree of anemia. There was no correlation between erythropoietin and interleukin-6 serum levels. Four of five anemic patients with hemoglobin below 10.5 g/dl and erythropoietin levels within the normal range were treated with parenteral iron (200 mg iron saccharate in 250 ml NaCl, weekly, intravenously). Two of them additionally received recombinant human erythropoietin (150 units/kg, 3× weekly, subcutaneously). After five weeks all patients had a marked increase in hemoglobin. However, the mean increase in erythropoietin-treated patients was 5.0 g/dl compared to 2.0 g/dl in the patients with iron therapy only. No side effects were seen. Our data demonstrate that inadequate erythropoietin production and iron deficiency are pathogenetic factors of anemia in Crohn's disease. The therapeutic management using recombinant human erythropoietin and parenteral iron is reasonable and effective.
    Materialart: Digitale Medien
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