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Ramchandani M, Lakhtakia S, Costamagna G, Tringali A, Püspöek A, Tribl B, Dolak W, Devière J, Arvanitakis M, van der Merwe S, Laleman W, Ponchon T, Lepilliez V, Gabbrielli A, Bernardoni L, Bruno MJ, Poley JW, Arnelo U, Lau J, Roy A, Bourke M, Kaffes A, Neuhaus H, Peetermans J, Rousseau M, Reddy DN. Fully Covered Self-Expanding Metal Stent vs Multiple Plastic Stents to Treat Benign Biliary Strictures Secondary to Chronic Pancreatitis: A Multicenter Randomized Trial. Gastroenterology 2021; 161:185-195. [PMID: 33741314 DOI: 10.1053/j.gastro.2021.03.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/01/2021] [Accepted: 03/06/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Benign biliary strictures (BBS) are complications of chronic pancreatitis (CP). Endotherapy using multiple plastic stents (MPS) or a fully covered self-expanding metal stent (FCSEMS) are acceptable treatment options for biliary obstructive symptoms in these patients. METHODS Patients with symptomatic CP-associated BBS enrolled in a multicenter randomized noninferiority trial comparing 12-month treatment with MPS vs FCSEMS. Primary outcome was stricture resolution status at 24 months, defined as absence of restenting and 24-month serum alkaline phosphatase not exceeding twice the level at stenting completion. Secondary outcomes included crossover rate, numbers of endoscopic retrograde cholangiopancreatography (ERCPs) and stents, and stent- or procedure-related serious adverse events. RESULTS Eighty-four patients were randomized to MPS and 80 to FCSEMS. Baseline technical success was 97.6% for MPS and 98.6% for FCSEMS. Eleven patients crossed over from MPS to FCSEMS, and 10 from FCSEMS to MPS. For MPS vs FCSEMS, respectively, stricture resolution status at 24 months was 77.1% (54/70) vs 75.8% (47/62) (P = .008 for noninferiority intention-to-treat analysis), mean number of ERCPs was 3.9 ± 1.3 vs 2.6 ± 1.3 (P < .001, intention-to-treat), and mean number of stents placed was 7.0 ± 4.4 vs 1.3 ± .6 (P < .001, as-treated). Serious adverse events occurred in 16 (19.0%) MPS and 19 (23.8%) FCSEMS patients (P = .568), including cholangitis/fever/jaundice (9 vs 7 patients respectively), abdominal pain (5 vs 5), cholecystitis (1 vs 3) and post-ERCP pancreatitis (0 vs 2). No stent- or procedure-related deaths occurred. CONCLUSIONS Endotherapy of CP-associated BBS has similar efficacy and safety for 12-month treatment using MPS compared with a single FCSEMS, with FCSEMS requiring fewer ERCPs over 2 years. (ClinicalTrials.gov, Number: NCT01543256.).
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Affiliation(s)
| | | | - Guido Costamagna
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Andrea Tringali
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Andreas Püspöek
- Centre for Endoscopic Research Therapeutics and Training (CERTT), St. John's Hospital, Eisenstadt, Austria
| | | | | | | | | | | | - Wim Laleman
- University Hospitals Leuven, Leuven, Belgium
| | | | | | | | - Laura Bernardoni
- Università degli Studi Verona Policlinico G.B. Rossi, Verona, Italy
| | | | | | - Urban Arnelo
- CLINTEC, Division of Surgery, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
| | - James Lau
- Prince of Wales Hospital, New Territories, Hong Kong
| | - André Roy
- Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Michael Bourke
- Western Clinical School, University of Sydney, Westmead Hospital, Sydney, NSW, Australia
| | - Arthur Kaffes
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Horst Neuhaus
- Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
| | - Joyce Peetermans
- Endoscopy Division, Boston Scientific Corporation, Marlborough, Massachusetts
| | - Matthew Rousseau
- Endoscopy Division, Boston Scientific Corporation, Marlborough, Massachusetts
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Spindelböck W, Kump PK, Püspök A, Koch R, Mayerhöfer M, Haug A, Fritz E, Obermayer-Pietsch B, Raderer M, Tribl B. [Neuroendocrine tumors in daily gastroenterology and endoscopy - a practice manual]. Z Gastroenterol 2019; 57:1493-1513. [PMID: 31826281 DOI: 10.1055/a-1013-4279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Neuroendocrine tumors of the gastrointestinal tract (GI-NET) are rare tumors. Functional tumors with hormonal syndromes (e. g., insulinoma, gastrinoma) are less common than non-functional tumors, which usually have an indolent course. Therapy for GI-NET is multimodal, including endoscopic or surgical procedures aiming at complete removal of tumor tissue. Patients in later stages may benefit from interventional radiology or medical therapy. This article gives an overview regarding the key aspects of GI-NET therapy in daily gastroenterology practice with emphasis on endoscopic diagnosis and therapy.
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Affiliation(s)
- Walter Spindelböck
- Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Graz, Austria
| | | | - Andreas Püspök
- Abteilung für Innere Medizin II, Krankenhaus Barmherzige Brüder Eisenstadt, Austria
| | - Robert Koch
- Universitätsklinik für Innere Medizin I, Medizinische Universität Innsbruck, Austria
| | - Marius Mayerhöfer
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Austria
| | - Alexander Haug
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Austria
| | - Eva Fritz
- Abteilung für Innere Medizin I, Klinikum Wels - Grieskirchen GmbH, Wels, Austria
| | | | - Markus Raderer
- Klinische Abteilung für Onkologie, Medizinische Universität Wien, Austria
| | - Barbara Tribl
- Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Wien, Universitätsklinik für Innere Medizin III, Wien, Austria
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3
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Abstract
ZusammenfassungErworbene Faktor-V-Inhibitoren sind eine seltene Gerinnungsstörung. Weltweit wurden bisher 72 Fälle publiziert. Die Inzidenz scheint jedoch zuzunehmen, was wahrscheinlich auf den gehäuften Einsatz von Fibrinklebern zurückzuführen ist. Diese Metaanalyse untersucht die prädiponierenden Faktoren, die Pathogenese, diagnostische Methoden, klinisches Erscheinungsbild, therapeutische Möglichkeiten und den langfristigen Verlauf aller bisher publizierten Fälle von Faktor-V-Inhibitoren.
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Kamogawa-Schifter Y, Yamaoka Y, Uchida T, Beer A, Tribl B, Schöniger-Hekele M, Trauner M, Dolak W. Prevalence of Helicobacter pylori and its CagA subtypes in gastric cancer and duodenal ulcer at an Austrian tertiary referral center over 25 years. PLoS One 2018; 13:e0197695. [PMID: 29813089 PMCID: PMC5973618 DOI: 10.1371/journal.pone.0197695] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 05/07/2018] [Indexed: 12/11/2022] Open
Abstract
Background and aims The prevalence of Helicobacter pylori (H. pylori) tends to be lower in Western countries such as central Europe compared with Asia. The virulence of H. pylori is influenced by its subtype composition, most importantly by the presence or absence of different types of cytotoxin-associated gene A(CagA). This study aimed to assess the prevalence of H. pylori and its respective CagA phenotype in a large retrospective cohort of patients with gastric cancer or duodenal ulcer at a Western tertiary referral institution. Methods H. pylori positive gastric biopsy samples from patients diagnosed with the afore mentioned diseases within the past 25 years were re-evaluated by histology for H. pylori and status of gastritis. Confirmed H. pylori positive cases were processed for immunohistochemistry (IHC) for H. pylori,CagA, and EastAsiantype CagA. Results The prevalence of H. pylori positive gastric biopsy samples decreased from 20.7% to 2.3% within the study period. Among the gastric cancer patients, the H. pylori positive rate was 16.6%, and didn’t show significant changes over time (p = 0.38). Contrary, the H. pylori positive rate of duodenal ulcer decreased significantlyfrom 40% to 5% (p = 0.01). Within H. pylori positive groups ofboth diseases, CagA was highly detected at IHC (86% and 78%, respectively). Except for a few patients originating from East Asian countries, all CagA detected in this study were of Western type. Conclusion In this first Western investigation on the chronological prevalence of H. pylori and its most relevant subtypes, Western type of CagA was highly detected in two important index diseases of the pathogen. This raises further questions about the virulence of this subtype.
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Affiliation(s)
- Yumiko Kamogawa-Schifter
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Yoshio Yamaoka
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu-city, Oita, Japan
| | - Tomohisa Uchida
- Department of Molecular Pathology, Oita University Faculty of Medicine, Yufu-city, Oita, Japan
| | - Andrea Beer
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Barbara Tribl
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Maximilian Schöniger-Hekele
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Werner Dolak
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- * E-mail:
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Paula H, Tribl B, Presterl E, Diab-El Schahawi M. Prospective microbiologic evaluation of the forceps elevator in closed-channel duodenoscopes after reprocessing. Am J Infect Control 2017; 45:121-125. [PMID: 28341284 DOI: 10.1016/j.ajic.2016.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 08/12/2016] [Accepted: 08/12/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Endoscopes are well-known sources of bacterial transmission in health care facilities offering endoscopy services. The association between multidrug-resistant bacterial infections in patients who had undergone an endoscopic retrograde cholangiopancreatography procedure with reprocessed duodenoscopes has been much discussed. Bacterial contamination of duodenoscopes has been attributed to difficulties with reprocessing these devices, specifically the distal end of the scope, which features a movable forceps elevator. In light of a recent Food and Drug Administration warning letter to Olympus regarding their closed-channel duodenoscope model TJF-Q180V, the aim of our study was to prospectively evaluate the efficacy and safety of our current reprocessing procedures with regard to the TJF-Q180V duodenoscope models used in our hospital. METHODS From August 2015-March 2016, we prospectively collected microbiologic surveillance samples from 6 TJF-Q180V model duodenoscopes in routine use at the Division of Gastroenterology and Hepatology using the ESwab collection system (COPAN Diagnostics Inc, Murrieta, CA). RESULTS A total of 237 microbiologic samples from the forceps elevator were obtained during the survey period. None of the samples yielded microorganism growth. CONCLUSION These findings suggest that when following a diligent and validated reprocessing standard in accordance with manufacturer's recommendations, closed-channel endoscope models can still be used. Nevertheless, validated adaptions of current closed-channel duodenoscope models are needed to allow for simple and safe reprocessing. Furthermore, comprehensive postmarket surveillance needs to be established.
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Hoffmeister A, Mayerle J, Beglinger C, Büchler MW, Bufler P, Dathe K, Fölsch UR, Friess H, Izbicki J, Kahl S, Klar E, Keller J, Knoefel WT, Layer P, Loehr M, Meier R, Riemann JF, Rünzi M, Schmid RM, Schreyer A, Tribl B, Werner J, Witt H, Mössner J, Lerch MM. English language version of the S3-consensus guidelines on chronic pancreatitis: Definition, aetiology, diagnostic examinations, medical, endoscopic and surgical management of chronic pancreatitis. Z Gastroenterol 2015; 53:1447-95. [PMID: 26666283 DOI: 10.1055/s-0041-107379] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Chronic pancreatitis is a disease of the pancreas in which recurrent inflammatory episodes result in replacement of pancreatic parenchyma by fibrous connective tissue. This fibrotic reorganization of the pancreas leads to a progressive exocrine and endocrine pancreatic insufficiency. In addition, characteristic complications arise, such as pseudocysts, pancreatic duct obstructions, duodenal obstruction, vascular complications, obstruction of the bile ducts, malnutrition and pain syndrome. Pain presents as the main symptom of patients with chronic pancreatitis. Chronic pancreatitis is a risk factor for pancreatic carcinoma. Chronic pancreatitis significantly reduces the quality of life and the life expectancy of affected patients. These guidelines were researched and compiled by 74 representatives from 11 learned societies and their intention is to serve evidence-based professional training as well as continuing education. On this basis they shall improve the medical care of affected patients in both the inpatient and outpatient sector. Chronic pancreatitis requires an adequate diagnostic workup and systematic management, given its severity, frequency, chronicity, and negative impact on the quality of life and life expectancy.
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Affiliation(s)
| | | | - C Beglinger
- Department of Gastroenterology and Hepatology, University Hospital Basel, Switzerland
| | - M W Büchler
- Department of General, Visceral and Transplantation Surgery, University Hospital, Heidelberg, Ruprecht Karls University, Heidelberg
| | - P Bufler
- Dr. von Haunersches Children's Hospital, Ludwig Maximilian University, Munich
| | - K Dathe
- German Society of Digestive and Metabolic Diseases (DGVS), Berlin
| | - U R Fölsch
- Department of General Internal Medicine, Christian Albrechts University, Kiel
| | - H Friess
- Surgical Clinic and Polyclinic at the Rechts der Isar Hospital, Technical University, Munich
| | - J Izbicki
- Department of General, Visceral and Thoracic Surgery at the University Medical Centre Hamburg-Eppendorf
| | - S Kahl
- Department of Internal Medicine, Specialisation Gastroenterology, Haematology and Oncology, Nephrology German Red Cross (DRK) Hospital Berlin-Köpenick
| | - E Klar
- General Surgery, Thoracic, Vascular and Transplantation Surgery, University of Rostock
| | - J Keller
- Department of Medicine, Israelitic Hospital Hamburg
| | - W T Knoefel
- Department of General, Visceral and Paediatric Surgery, University Hospital Dusseldorf of the Heinrich Heine University
| | - P Layer
- Department of Medicine, Israelitic Hospital Hamburg
| | - M Loehr
- Surgical Gastroenterology, Gastrocentrum, Karolinska University Hospital Huddinge
| | - R Meier
- Department for Gastroenterology, Kanton Hospital Liestal, Medical University Clinic
| | - J F Riemann
- Department of Medicine C at the Hospital of the City Ludwigshafen/Rhine gGmbH
| | - M Rünzi
- Division of Gastroenterology and Metabolic Disease, Clinics of South Essen
| | - R M Schmid
- Department of Medicine 2 at the Rechts der Isar Hospital, Technical University Munich
| | - A Schreyer
- Institute for Radiodiagnostics at the University Hospital of Regensburg
| | - B Tribl
- Internal Medicine IV, Dept. for Gastroenterology and Hepatology, University Hospital Vienna
| | - J Werner
- Department of General, Visceral and Transplantation Surgery, University Hospital, Heidelberg, Ruprecht Karls University, Heidelberg
| | - H Witt
- Department of Paediatric Medicine, Children's Hospital Munich Schwabing, Technical University of Munich
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7
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Dolak W, Mesteri I, Asari R, Preusser M, Tribl B, Wrba F, Schoppmann SF, Hejna M, Trauner M, Häfner M, Püspök A. A pilot study of the endomicroscopic assessment of tumor extension in Barrett's esophagus-associated neoplasia before endoscopic resection. Endosc Int Open 2015; 3:E19-28. [PMID: 26134766 PMCID: PMC4423329 DOI: 10.1055/s-0034-1377935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 07/15/2014] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Barrett's esophagus (BE) - associated neoplasia can be treated endoscopically, but accurate assessment before intervention is challenging. This study aimed to investigate the role of confocal laser endomicroscopy (CLE) as an adjunct in the endoscopic treatment of BE-associated neoplasia by assessing lateral tumor and subsquamous tumor (SST) extension. PATIENTS AND METHODS In the context of a prospective, single-arm pilot clinical trial, patients referred for endoscopic resection of BE-associated neoplasia (high grade dysplasia and esophageal adenocarcinoma) underwent high definition, white light endoscopy with narrow-band imaging (NBI). Then, CLE mapping of suspected neoplastic lesions was performed by another endoscopist, partially blinded to the previous findings, before the patients underwent endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), depending on lesion size and anticipated histology. RESULTS In 7 of 38 patients (18 %), CLE revealed additional neoplastic tissue compared with prior white light endoscopy and NBI: 2 concomitant lesions, 2 cases of lateral tumor extension within the Barrett's epithelium, and 3 cases of previously undetected SST extension. Overall, en bloc resection (tumor-free lateral margin) was achieved in 28 of 34 neoplastic lesions (82 %), and complete resection (tumor-free lateral and basal margins) in 21 of 34 neoplastic lesions (62 %). CONCLUSIONS CLE-assisted endoscopic resection of BE-associated neoplasia was safe and effective in this study, as proved by a high additional diagnostic yield of CLE (including visualization of occult SST extension) and a favorable rate of en bloc resection. The clinical value of CLE for assisting endoscopic therapy of BE-associated neoplasia deserves further evaluation in randomized controlled trials.
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Affiliation(s)
- Werner Dolak
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, and Gastroesophageal Tumor Unit, Comprehensive Cancer Center, Vienna, Austria,Corresponding author Werner Dolak, MD Division of Gastroenterology and HepatologyDepartment of Internal Medicine IIIMedical University of ViennaWaehringer Guertel 18-201090 ViennaAustria+43 1 40400 47350
| | - Ildiko Mesteri
- Clinical Institute of Pathology, Medical University of Vienna, and Gastroesophageal Tumor Unit, Comprehensive Cancer Center, Vienna, Austria
| | - Reza Asari
- Department of Surgery, Medical University of Vienna, and Gastroesophageal Tumor Unit, Comprehensive Cancer Center, Vienna, Austria
| | - Matthias Preusser
- Division of Oncology, Department of Internal Medicine I, Medical University of Vienna, and Gastroesophageal Tumor Unit, Comprehensive Cancer Center, Vienna, Austria
| | - Barbara Tribl
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, and Gastroesophageal Tumor Unit, Comprehensive Cancer Center, Vienna, Austria
| | - Friedrich Wrba
- Clinical Institute of Pathology, Medical University of Vienna, and Gastroesophageal Tumor Unit, Comprehensive Cancer Center, Vienna, Austria
| | - Sebastian F. Schoppmann
- Department of Surgery, Medical University of Vienna, and Gastroesophageal Tumor Unit, Comprehensive Cancer Center, Vienna, Austria
| | - Michael Hejna
- Division of Oncology, Department of Internal Medicine I, Medical University of Vienna, and Gastroesophageal Tumor Unit, Comprehensive Cancer Center, Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, and Gastroesophageal Tumor Unit, Comprehensive Cancer Center, Vienna, Austria
| | - Michael Häfner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, and Gastroesophageal Tumor Unit, Comprehensive Cancer Center, Vienna, Austria
| | - Andreas Püspök
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, and Gastroesophageal Tumor Unit, Comprehensive Cancer Center, Vienna, Austria
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Hoffmeister A, Mayerle J, Beglinger C, Büchler M, Bufler P, Dathe K, Fölsch U, Friess H, Izbicki J, Kahl S, Klar E, Keller J, Knoefel W, Layer P, Loehr M, Meier R, Riemann J, Rünzi M, Schmid R, Schreyer A, Tribl B, Werner J, Witt H, Mössner J, Lerch M, Lerch MM. S3-Leitlinie Chronische Pankreatitis: Definition, Ätiologie, Diagnostik, konservative, interventionell endoskopische und operative Therapie der chronischen Pankreatitis. Leitlinie der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten (DGVS). Z Gastroenterol 2012; 50:1176-224. [PMID: 23150111 DOI: 10.1055/s-0032-1325479] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- A. Hoffmeister
- Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Universitätsklinikum Leipzig
| | - J. Mayerle
- Klinik für Innere Medizin A, Universitätsmedizin der Ernst-Moritz-Arndt Universität, Greifswald
| | - C. Beglinger
- Klinik für Gastroenterologie und Hepatologie Universitätsspital Basel, Schweiz
| | - M. Büchler
- Klinik für Allgemeine, Viszerale und Transplantationschirurgie, Universitätsklinikum Heidelberg, Ruprecht-Karls-Universität, Heidelberg
| | - P. Bufler
- Dr. von Haunersches Kinderspital, Ludwig Maximilian Universität München
| | - K. Dathe
- Deutsche Gesellschaft für Verdauungs- und Stoffwechselerkrankungen (DGVS), Berlin
| | - U. Fölsch
- Klinik für Allgemeine Innere Medizin, Christian-Albrechts-Universität zu Kiel
| | - H. Friess
- Chirurgische Klinik und Poliklinik am Klinikum Rechts der Isar, Technische Universität München
| | - J. Izbicki
- Klinik und Poliklinik für Allgemein-, Visceral- und Thoraxchirurgie am Universitätsklinikum Hamburg-Eppendorf
| | - S. Kahl
- Klinik für Innere Medizin Schwerpunkt Gastroenterologie, Hämatologie und Onkologie, Nephrologie DRK Kliniken Berlin-Köpenick
| | - E. Klar
- Allgemeine Chirurgie, Thorax-, Gefäß- und Transplantationschirurgie, Universität Rostock
| | - J. Keller
- Medizinische Klinik, Israelitisches Krankenhaus Hamburg
| | - W. Knoefel
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsklinikum Düsseldorf der Heinrich-Heine-Universität
| | - P. Layer
- Medizinische Klinik, Israelitisches Krankenhaus Hamburg
| | - M. Loehr
- Surgical Gastroenterology, Gastrocentrum, Karolinska University Hospital Huddinge
| | - R. Meier
- Abteilung für Gastroenterologie, Kantonsspital Liestal, Medizinische Universitätsklinik
| | - J. Riemann
- Medizinische Klinik C am Klinikum der Stadt Ludwigshafen/Rhein gGmbH
| | - M. Rünzi
- Klinik für Gastroenterologie u. Stoffwechselerkrankungen, Kliniken Essen Süd
| | - R. Schmid
- Medizinische Klinik 2 am Klinikum Rechts der Isar, Technische Universität München
| | - A. Schreyer
- Institut für Röntgendiagnostik am Universitätsklinikum Regensburg
| | - B. Tribl
- Innere Medizin IV, Abt. f. Gastroenterologie und Hepatologie, Universitätsklinik Wien
| | - J. Werner
- Klinik für Allgemeine, Viszerale und Transplantationschirurgie, Universitätsklinikum Heidelberg, Ruprecht-Karls-Universität, Heidelberg
| | - H. Witt
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Kinderklinik München Schwabing, Technische Universität München
| | - J. Mössner
- Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Universitätsklinikum Leipzig
| | - M. Lerch
- Klinik für Innere Medizin A, Universitätsmedizin der Ernst-Moritz-Arndt Universität, Greifswald
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Abstract
Adenocarcinoma is the most common malignant pancreatic tumor, affecting the head in 60-70% of cases. By the time of diagnosis, approximately 80% of tumors are unresectable. Helical CT is very effective in detection and staging of adenocarcinoma, with a sensitivity of 76-92% for detection and an accuracy of 80-90% for staging, but it has limitations in the detection of small cancers (< or =2 cm). Multidetector CT (MDCT) has brought substantial improvements with its inherent 3D imaging capability. Mangafodipir-enhanced MRI is a problem-solving tool in the depiction of small cancers following an equivocal CT imaging result. Gadolinium-enhanced 3D gradient-echo MRI is helpful in the assessment of vascular invasion of cancer and in determining the etiology of cystic lesions. Serous cystadenoma is benign, has a lobulated contour and contains innumerable small cysts of 0.1-2 cm in diameter. Mucinous cystic neoplasms are unilocular or multilocular (fewer than six cysts), and the cyst diameter exceeds 2 cm. The presence of solid nodular components should alert the radiologist to suspect cystadenocarcinoma. Neuroendocrine tumors are mostly hypervascular. Diagnosis of insulinoma is a challenge: they are <2 cm in 90% of cases and mostly hypervascular at CT or MRI. A combination of contrast-enhanced MDCT, MRI, endosonography, and/or somatostatin receptor scintigraphy is used to detect these small tumors. This review summarizes the imaging features of the most common pancreatic tumors and discusses the limitations of CT, MRI and endosonography.
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Affiliation(s)
- W Schima
- Universitätsklinik für Radiodiagnostik, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090 Wien, Osterreich.
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Tribl B. [Acute and chronic pancreatitis--an overview]. Wien Klin Wochenschr 2007; 119:73-87. [PMID: 18402426 DOI: 10.1007/s11812-007-0024-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Barbara Tribl
- Klinische Abteilung für Gastroenterologie und Hepatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Osterreich.
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Tribl B, Filipp D, Bödeker H, Yu P, Hammerrmüller I, McKerlie C, Keim V, Sibbald WJ. Pseudomonas pneumonia-mediated sepsis induces expression of pancreatitis-associated protein-I in rat pancreas. Pancreas 2004; 29:33-40. [PMID: 15211109 DOI: 10.1097/00006676-200407000-00053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Severe impairment of exocrine pancreatic secretion has recently been demonstrated in a clinical study in sepsis and septic shock patients. The purpose of this study was to further evaluate involvement of the pancreas in the acute phase reaction in sepsis. Using a normotensive rat model of Pseudomonas pneumonia-induced sepsis, we assessed the expression of PAP-I, amylase and trypsinogen mRNA, PAPI protein levels, and cytokine expression in the pancreas by Northern and Western blot analysis and RT-M PCR, respectively. Presence of several well-established features of pancreatitis in sepsis-induced animals were examined by biochemical and histopathological methods as well as by a determination of both water and myeloperoxidase content. Sepsis resulted in an up-regulation of PAP-I gene expression and increase in its protein level in pancreas while the mRNA levels of amylase and trypsinogen were down-regulated. Differences in the pancreatic cytokine expression, serum amylase and serum lipase levels, the occurrence of pancreatic edema as well as the severity of inflammatory infiltration and necrosis were not significantly different between sham and pneumonia groups. Acinar cells showed increased vacuolization in pneumonia animals 24 hours after the treatment. These findings demonstrate that the pancreas is actively involved in the acute phase reaction in sepsis of remote origin. This involvement occurs without concomitant biochemical and histopathologic alterations observed in pancreatitis. Taken all together, these features are indicative of a sepsis-specific dysfunction of the pancreas.
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Affiliation(s)
- Barbara Tribl
- Sunnybrook and Women's College Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada.
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12
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Tribl B, Aschl G, Mitterbauer G, Novacek G, Vogelsang H, Chott A. Severe Malabsorption due to Refractory Celiac Disease Complicated by Extensive Gastric Heterotopia of the Jejunum. Am J Surg Pathol 2004; 28:262-5. [PMID: 15043318 DOI: 10.1097/00000478-200402000-00016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Refractory celiac disease denotes that patients considered to have celiac disease fail to respond histologically to treatment with a gluten-free diet. Among several causes of nonresponsiveness, enteropathy-type T-cell lymphoma is most important because of its almost invariably rapid lethal outcome. We present the case of a 44-year-old patient with refractory celiac disease complicated by unusually severe malabsorption. Repeated duodenal biopsies disclosed normal and slightly shortened villi, focal crypt hypertrophy, and a moderate increase of intraepithelial lymphocytes consistent with celiac disease, but unable to explain the severe malabsorption. To rule out cryptic lymphoma, push enteroscopy was done providing 21 biopsies taken along the entire jejunum. Surprisingly, about 70% of the biopsies were composed of gastric glands covered by nonabsorptive-type, strongly periodic acid-Schiff-positive surface epithelium and showed a villous architecture. Alternating with the gastric mucosa, there were areas of flat mucosa with elongated crypts and occasional erosions. Irrespective of the type of surface epithelium, intraepithelial lymphocytes were increased with counts up to 80/100 epithelial cells. Despite harboring an aberrant immunophenotype, overt T-cell lymphoma was ruled out histologically and by lack of monoclonality, as tested by polymerase chain reaction. To the best of our knowledge, this is the first case of refractory celiac disease complicated by extensive jejunal gastric heterotopia, which might have contributed to the severe malabsorption.
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Affiliation(s)
- Barbara Tribl
- Department of Internal Medicine IV, Vienna General Hospital, Vienna, Austria
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13
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Tribl B, Bateman RM, Milkovich S, Sibbald WJ, Ellis CG. Effect of nitric oxide on capillary hemodynamics and cell injury in the pancreas during Pseudomonas pneumonia-induced sepsis. Am J Physiol Heart Circ Physiol 2004; 286:H340-5. [PMID: 12969889 DOI: 10.1152/ajpheart.00234.2003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Sepsis-induced nitric oxide (NO) overproduction has been implicated in a redistribution of flow from the pancreas making it vulnerable to ischemic injury in septic shock. To test this hypothesis in a remote injury model of normotensive sepsis, we induced Pseudomonas pneumonia in the rat and used intravital video microscopy (IVVM) of the pancreas to measure functional capillary density, capillary hemodynamics [red blood cell (RBC) velocity, lineal density, and supply rate], and lethal cellular damage (propidium iodine staining) at 6 and 24 h after the induction of pneumonia. With pneumonia, plasma nitrite/nitrate [NO2(-)/NO3(-)(NOx(-))] levels were doubled by 21 h (P < 0.05). To assess the effect of NO overproduction on microvascular perfusion, N6-(1-iminoethyl)-L-lysine (L-NIL) was administered to maintain NOx(-) levels at baseline. Pneumonia did cause a decrease in RBC velocity of 23% by 6 h, but by 24 h RBC velocity and supply rate had increased relative to sham by 22 and 38%, respectively (P < 0.05). L-NIL treatment demonstrated that this increase was due to NO overproduction. With pneumonia, there was no change in functional capillary density and only modest increases in cellular damage. We conclude that, in this normotensive pneumonia model of sepsis, NO overproduction was protective of microvascular perfusion in the pancreas.
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Affiliation(s)
- Barbara Tribl
- Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Canada.
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14
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Abstract
BACKGROUND Sepsis in critical illness is associated with the progressive failure of multiple organs. This study aims to establish a correlation between the severity of sepsis and exocrine pancreatic dysfunction. MATERIALS AND METHODS In a prospective cohort study pancreatic exocrine function was tested by means of a secretin-cholecystokinin test in 21 critically ill, mechanically ventilated patients with sepsis according to criteria of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee (ACCP/SCCM): 11 patients with shock and 10 patients without shock. Data were compared with seven healthy controls. RESULTS The volume of duodenal fluid was not statistically different in the three groups. Sepsis patients without shock had significantly reduced content of amylase and chymotrypsin in duodenal juice compared with healthy controls (P < 0.01). Secretion of amylase, chymotrypsin, trypsin (P < 0.01 each) and bicarbonate in duodenal fluid (P < 0.05) was impaired in the septic shock patients when compared with the healthy controls. The content of trypsin was different between sepsis patients and septic shock patients (P < 0.05). Spearman correlation analysis was significant between the amylase secretion and the APACHE III and SOFA scores (P < 0.01). The SOFA score was also related to secretion of trypsin (P < 0.05). In patients on pressor therapy, use of norepinephrine was associated with a significant decrease in bicarbonate secretion (P < 0.05). CONCLUSIONS Sepsis is associated with secretory pancreatic dysfunction that is worse in septic shock than in sepsis without shock. Impaired exocrine function was significantly correlated to the APACHE III and SOFA scores.
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Affiliation(s)
- B Tribl
- Department of Internal Medicine IV, Division of Gastroenterology and Hepatology, University of Vienna, Vienna, Austria.
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15
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Tribl B, Madl C, Mazal PR, Schneider B, Spitzauer S, Vogelsang H, Gangl A. Exocrine pancreatic function in critically ill patients: septic shock versus non-septic patients. Crit Care Med 2000; 28:1393-8. [PMID: 10834684 DOI: 10.1097/00003246-200005000-00022] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To determine the exocrine pancreatic function in critically ill patients. DESIGN Prospective cohort study. SETTING Medical intensive care unit. PATIENTS A total of 18 critically ill patients (11 patients with septic shock according to the criteria of the American College of Chest Physicians/Society of Critical Care Medicine, 7 nonseptic patients). The results obtained in these subjects were compared with the data obtained in seven healthy volunteers. INTERVENTIONS Examination of exocrine pancreatic function was done by means of a cholecystokinin-secretin test. Intravenous stimulation of the exocrine pancreas with cholecystokinin and secretin (1 unit/kg body weight/hr each) and aspiration of duodenal fluid by a gastroscopically inserted oroduodenal tube was done during a period of 1 hr. MEASUREMENTS AND MAIN RESULTS The content of amylase, chymotrypsin, and trypsin in aspirated duodenal fluid was significantly reduced in patients with septic shock compared with nonseptic patients as well as healthy subjects (p < .01). The volume of aspirated fluid was significantly reduced in patients with septic shock compared with healthy controls (p = .03), but not in nonseptic patients. The content of bicarbonate was not statistically different in the three groups. No significant correlation was to find between variables of exocrine pancreatic function and Acute Physiology and Chronic Health Evaluation III score, sepsis-related organ failure assessment score, systolic arterial pressure and mean arterial pressure in septic shock patients. Positive end-expiratory pressure was significantly correlated with the content of trypsin (r2 = 0.52; p = .02). Postmortem examinations of five septic patients who died during the intensive care stay did not reveal gross morphologic alterations of pancreatic tissue. CONCLUSIONS The study shows two pancreatic enzyme systems, namely, amylase as a carbohydrate splitting enzyme and the proteolytic enzymes trypsin and chymotrypsin, strongly affected in critically ill patients with septic shock.
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Affiliation(s)
- B Tribl
- Clinic of Internal Medicine IV--Department of Gastroenterology and Hepatology, University of Vienna, Austria
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16
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Kurtaran A, Ofluoglu S, Traub T, Tribl B, Speiser P, Grabenwöger F, Schima W, Dudczak R, Virgolini I. An unusual visualization of the gallbladder by somatostatin receptor (SSTR) scintigraphy: usefulness of hepatobiliary imaging for differential diagnosis. Am J Gastroenterol 2000; 95:1367-8. [PMID: 10811361 DOI: 10.1111/j.1572-0241.2000.02043.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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17
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Abstract
Ammonia is considered the major pathogenetic factor of cerebral dysfunction in hepatic failure. The correlation between total plasma ammonia and the severity of hepatic encephalopathy (HE), however, is variable. Because ammonia that is present in gaseous form readily enters the brain, the correlation with the grade of HE of the pH-dependent partial pressure of gaseous ammonia (pNH(3)) could be better than that of total arterial ammonia levels. To test this hypothesis, 56 cirrhotic patients with acute episodes of clinical HE (median age, 54 years; range, 21-75) were studied by clinical examination and by long-latency median-nerve sensory-evoked potentials (SEPs) N70 peak, an objective and sensitive electrophysiological measure of HE. pNH(3) was calculated from arterial blood according to published methods. The clinical grade of HE correlated (P <.001) with both pNH(3) and total ammonia, but correlation was stronger with pNH(3) (r =.79 vs.69, P =.01). A similar correlation was found for N70 peak latency (r =.71 with pNH(3) vs.64 with total ammonia, respectively, P =.08). In summary, arterial pNH(3) correlates more closely than total ammonia with the degree of clinical and electrophysiological abnormalities in HE. These findings support the ammonia hypothesis of HE and suggest that pNH(3) might be superior to total ammonia in the pathophysiological evaluation of HE.
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Affiliation(s)
- L Kramer
- University Hospital Vienna, Department of Medicine IV, Vienna, Austria.
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18
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Tribl B, Schöniger-Hekele M, Petermann D, Bakos S, Penner E, Müller C. Prevalence of GBV-C/HGV-RNA, virus genotypes, and anti-E2 antibodies in autoimmune hepatitis. Am J Gastroenterol 1999; 94:3336-40. [PMID: 10566740 DOI: 10.1111/j.1572-0241.1999.01452.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We investigated the prevalence of hepatitis G-RNA (GBV-C/HGV-RNA), a recently cloned new flavivirus, and of antibodies to the envelope 2 antigen (anti-E2), a marker of past infection, in patients with autoimmune hepatitis, and compared it with the prevalence in patients with chronic viral hepatitis and healthy control individuals. METHODS Sera of 63 patients with autoimmune hepatitis were studied for the presence of GBV-C/HGV-RNA by reverse-transcription polymerase chain reaction and for anti-E2 by enzyme-linked immunosorbent assay. GBV-C/HGV genotypes were determined by genome sequencing. RESULTS Patients with autoimmune hepatitis had a similar high prevalence of GBV-C/HGV-RNA and anti-E2 antibodies as patients with chronic viral hepatitis B or C. GBV-C/HGV-RNA was found significantly more often in patients with autoimmune hepatitis (11%, p = 0.045), hepatitis B (16%, p = 0.004), or hepatitis C (21%, p = 0.001) than in healthy controls (2%). The prevalence of anti-E2 antibodies in patients with autoimmune hepatitis was not different from healthy controls (17% vs 13%, NS). The various subtypes of autoimmune hepatitis had similar prevalence rates of GBV-C/HGV-RNA as patients with liver-kidney microsomal antibody-positive hepatitis C. All of our anti-E2+ (GBV-C/HGV-RNA-) patients were positive for anti-smooth-muscle antibody, whereas only 29% of GBV-C/HGV-RNA+ (anti-E2-) patients were positive (p = 0.025). All seven of the GBV-C/HGV-RNA+ patients with autoimmune hepatitis had genotype 2a, which is also the most prevalent genotype in our region. CONCLUSION The prevalence of GBV-C/HGV-RNA is significantly increased in patients with autoimmune hepatitis, compared with healthy controls, and is similar to the increased prevalence seen in chronic hepatitis B or C patients. Anti-E2 positivity was associated with antibodies against smooth-muscle antigen in all cases. All GBV-C/HGV+ autoimmune hepatitis patients were infected with genotype 2a.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies/analysis
- Antibodies, Viral/analysis
- Antigens, Viral/analysis
- Enzyme-Linked Immunosorbent Assay
- Female
- Flaviviridae/genetics
- Flaviviridae/immunology
- Genotype
- Hepatitis B, Chronic/immunology
- Hepatitis B, Chronic/virology
- Hepatitis C, Chronic/immunology
- Hepatitis C, Chronic/virology
- Hepatitis, Autoimmune/immunology
- Hepatitis, Autoimmune/virology
- Humans
- Kidney/immunology
- Male
- Membrane Glycoproteins/analysis
- Microsomes/immunology
- Microsomes, Liver/immunology
- Middle Aged
- Muscle, Smooth/immunology
- Polymerase Chain Reaction
- Prevalence
- RNA, Viral/genetics
- Sequence Analysis, RNA
- Viral Envelope Proteins/analysis
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Affiliation(s)
- B Tribl
- Universitätsklinik für Innere Medizin IV, Klinische Abteilung Gastroenterologie und Hepatologie, University of Vienna, Austria
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Tribl B, Vogelsang H, Pohanka E, Grampp S, Gangl A, Hörl WH. Broadband ultrasound attenuation of the calcaneus. A tool for assessing bone status in patients with chronic renal failure. Acta Radiol 1998; 39:637-41. [PMID: 9817034 DOI: 10.3109/02841859809175489] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate broadband ultrasound attenuation (BUA) for the assessment of bone status and to correlate this to dual-energy X-ray absorptiometry (DXA) in haemodialysis patients. MATERIAL AND METHODS In 60 patients, BUA (dB/MHz) was determined for the calcaneus. The results were expressed as Z-scores and T-scores, i.e. units of standard deviations respectively from age- and sex-matched normal values and from sex-matched normal mean values in healthy young adults. Ultrasound data were correlated to relevant clinical, biochemical and DXA data (g/cm2), which were examined at the femoral neck and at the lumbar spine in 50 patients. RESULTS The BUA Z-score was < -1 in 53% of the patients and < -2 in 22%. The BUA T-score was < -1 in 88% and < -2 in 62%. Moderate correlation was found for calcaneal BUA to DXA in men (r = 0.47-0.48, p < 0.01) and to DXA of the lumbar spine in women (r = 0.51, p < 0.05). The best correlation was observed for BUA to DXA of the femoral neck in women (r = 0.61, p < 0.01). CONCLUSION Calcaneal BUA is an additional tool for the surveillance of bone density in haemodialysed patients.
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Affiliation(s)
- B Tribl
- Department of Gastroenterology and Hepatology, University of Vienna, Austria
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20
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Tribl B, Turetschek K, Mostbeck G, Schneider B, Stain C, Pötzi R, Gangl A, Vogelsang H. Conflicting results of ileoscopy and small bowel double-contrast barium examination in patients with Crohn's disease. Endoscopy 1998; 30:339-44. [PMID: 9689505 DOI: 10.1055/s-2007-1001279] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND STUDY AIMS Ileoscopy has become a routine procedure for the diagnosis of Crohn's disease of the terminal ileum. The aim of this study was to compare the diagnostic accuracy of small bowel barium examination with that of ileoscopy. PATIENTS AND METHODS In a retrospective study the two methods were compared in 55 patients with Crohn's disease. First, routine radiology reports and second, reevaluation of the small bowel barium study by gastrointestinal radiologists with scoring of examination quality were compared with the results of ileoscopy. RESULTS Using routine radiology reports, 66% sensitivity and 82% specificity were reached for inflammatory changes of the terminal ileum by small bowel barium study. Sensitivity and specificity increased to 68% and 91% with double reading by experienced radiologists. Disagreement between endoscopic and radiologic results changed from 31% to 27% and were mainly because of false-negative barium studies. Sensitivity and specificity of barium studies were influenced by the quality of the examination with a sensitivity of 91% and specificity of 100% when the quality was good. CONCLUSIONS In patients in whom the terminal ileum is successfully intubated, ileoscopy is superior to barium examination in the evaluation of Crohn's disease of the terminal ileum. Results of the barium study were strongly influenced by the quality of the examination.
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Affiliation(s)
- B Tribl
- Dept. of Gastroenterology and Hepatology, University of Vienna, Austria
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21
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Tribl B, Oesterreicher C, Pohanka E, Sunder-Plassmann G, Petermann D, Müller C. GBV-C/HGV in hemodialysis patients: anti-E2 antibodies and GBV-C/HGV-RNA in serum and peripheral blood mononuclear cells. Kidney Int 1998; 53:212-6. [PMID: 9453021 DOI: 10.1046/j.1523-1755.1998.00738.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hepatitis G virus (GBV-C/HGV), a recently identified RNA virus adds to the risk of parenteral transmitted viral infections in hemodialysis patients. We studied the prevalence of GBV-C/HGV-RNA in serum and peripheral blood mononuclear cells (PMNC) by reverse transcription-polymerase chain reaction (RT-PCR) and determined antibodies against the envelope protein E2 of GBV-C/HGV by ELISA. A total of 119 dialysis patients were studied. GBV-C/HGV-RNA was found in 16 of 119 patients (13%) as compared with 2% of healthy controls (P = 0.014). Two of the 16 GBV-C/HGV-RNA+ patients were co-infected with HCV, and none was positive for HBV-DNA. In 38% of serum GBV-C/HGV-RNA+ patients GBV-C/HGV-RNA was also detected in PMNC. In addition, GBV-C/ HGV-RNA was identified in PMNC of 2 patients negative for GBV-C/ HGV-RNA in serum. Twenty-four patients had anti-E2 antibodies in serum (20%), but were GBV-C/HGV-RNA-. In addition, two of the 16 GBV-C/HGV-RNA+ patients were concomitantly positive for anti-E2 antibodies. Only one of the 16 GBV-C/HGV infected patients had elevated aminotransferases; this patient was co-infected with hepatitis C virus. GBV-C/HGV-RNA positivity was independent on duration of hemodialysis, but GBV-C/HGV-RNA+ patients had received more units of blood in the past. Combined data of past contact, as assessed by anti-E2 antibodies, and present infection, documented by GBV-C/HGV-RNA, indicate a high overall exposure to GBV-C/HGV in dialysis patients.
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Affiliation(s)
- B Tribl
- Klinische Abteilung für Gastroenterologie und Hepatologie, Allgemeines Krankenhaus, Universität Wien, Austria
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22
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Franz M, Pohanka E, Tribl B, Woloszczuk W, Hörl WH. Living on chronic hemodialysis between dryness and fluid overload. Kidney Int Suppl 1997; 59:S39-42. [PMID: 9185103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The hydration state of a hemodialysis patient reflects the balance between fluid overload, normovolemia and underhydration. Since chronic volume overload enhances the cardiac mortality, and chronic underhydration carries the risk for dialysis-associated hypotension, treatment for the deranged water homeostasis of hemodialysis patients needs to focus on an accurate assessment of dry body weight. Non-invasive methods such as echocardiography of the inferior caval vein diameter (ICVD) or conductivity measurements are considered as reliable techniques to estimate the hydration state of hemodialysis patients. The value of biochemical parameters for an adequate assessment of dry body weight remains controversial. In our study we have determined cyclic guanosine 3'5'-monophosphate (cGMP) serum levels in 125 patients undergoing regular hemodialysis. Predialytic cGMP significantly decreased from 46.1 +/- 26.0 to 17.0 +/- 9.3 pmol/liter post-dialysis (P < 0.001). In 35 patients cGMP level after hemodialysis remained > 20 pmol/liter, but non of these patients displayed any clinical signs of fluid overload. In a group of patients with normal heart function (N = 29) additional sonography of the ICVD revealed normovolemia in 16 patients, underhydration in 5 patients and fluid overload in 4 patients. The respective post-dialytic mean cGMP level was significantly higher in the overhydrated group compared to normovolemic and underhydrated patients (25.3 +/- 10.8 vs. 14.7 +/- 6.4 and 11.4 +/- 5.3 pmol/liter, P < 0.02). However, there was no significant correlation between cGMP level and ICVD (r = 0.5, NS). We conclude that there is no single parameter to define the adequate dry body weight of a hemodialysis patient. Our own data demonstrate the limitations using cGMP, particularly in estimating underhydration. ICVD and bioimpedance offer non-invasive methods for both volume overload and underhydration, and seem to be reliable in the routine assessment of dry body weight.
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Affiliation(s)
- M Franz
- Department of Internal Medicine, University of Vienna, Austria
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Tribl B, Knöbl P, Derfler K, Kapiotis S, Aspöck G, Jäger U, Hörl W, Lechner K. Rapid elimination of a high-titer spontaneous factor V antibody by extracorporeal antibody-based immunoadsorption and immunosuppression. Ann Hematol 1995; 71:199-203. [PMID: 7578528 DOI: 10.1007/bf01910319] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We report on the rapid elimination of a potent spontaneous factor V antibody of undetermined etiology by extracorporeal immunoadsorption on sepharose-bound polyclonal sheep antibodies to human immunoglobulins (Ig-Therasorb, Baxter) in combination with immunosuppressive treatment. A 68-year-old woman presented with severe hematuria. Severe factor V deficiency (< 1%) caused by an antibody to factor V (26 BU/ml) was found. Extracorporeal immunoadsorption (8.245 +/- 553 ml plasma processed per session) led to an average reduction of the antibody titer by 75% per session. The procedure was well tolerated without any side effects. Hematuria ceased after three immunoadsorptions and complete elimination of the antibody was achieved after seven sessions (day 15), followed by a rapid increase of the factor V activity to normal levels. Treatment with cyclophosphamide and prednisone was started on day 6 and continued for 2 months. The patient remains in remission at 6 months. Extracorporeal immunoadsorption is a highly effective method for eliminating antibodies to factor V (or other clotting factors) in selected cases, i.e., in patients with severe bleeding tendency, high antibody titer, and low probability of a rapid spontaneous remission.
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Affiliation(s)
- B Tribl
- Department of Medicine I, University of Vienna, Austria
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Moser G, Genser D, Tribl B, Vogelsang H. Psychological stress and disease activity in ulcerative colitis: a multidimensional cross-sectional study. Am J Gastroenterol 1995; 90:1904. [PMID: 7572933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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