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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Der Onkologe 6 (2000), S. 292-300 
    ISSN: 1433-0415
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Das hepatozelluläre Karzinom tritt in einigen Teilen von Asien und Afrika als häufigstes Malignom, in USA und Europa mit unterschiedlicher Inzidenz deutlich geringer, auf . Chronische Hepatitis B, Zirrhose jeglicher Ätiologie, Hepatitis-C-Virusinfektionen und Aflatoxinkontamination von Nahrungsmitteln zählen zu den Risikogruppen eines HCC. Screeninguntersuchungen sind daher von entscheidender Bedeutung zur Früherkennung, Verlaufs-und Prognosebeurteilung.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-0509
    Keywords: CT ; Pneumatosis intestinalis ; Pneumatosis cystoides intestinalis ; Intestinal ischemia ; Pneumoperitoneum
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Case reports of five patients with pneumatosis intestinalis diagnosed by computed tomography (CT) are presented. Etiology, differential diagnoses, and clinical consequences arising from CT imaging are discussed. In four of the patients, pneumatosis was found to be secondary to gastric ulcer, colon carcinoma, metastasis in the mesentery, and trauma-induced mesenteric ischemia. In one patient, the etiology remained elusive. Using CT, both the extent and the distribution pattern of pneumatosis could be depicted, allowing for differentiation of primary and secondary forms and assessment of prognosis. Evaluation with a lung window is a prerequisite for reliable diagnosis of pneumatosis with CT. The presence of gas in the mesenteric or portal venous system in mesenteric ischemia is indicative of an unfavorable prognosis.
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  • 3
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background:  Hypoxia may contribute to impairment of liver function and thus interfere with results of liver tests. In patients with cirrhosis, cytochrome P-450 mediated metabolism of substrates is facilitated in the presence of supplemental oxygen. It has not been studied how this relates to liver function and haemoglobin content.Aim:  We questioned how oxygen supplementation would influence the hepatic microsomal function as assessed by the 13C-methacetin breath test in patients with cirrhosis of different severity and different degrees of anaemia.Methods: 13C/12C ratios in exhaled breath assessed by non-dispersive infrared spectrometry were studied in 34 patients with cirrhosis (Child A/B/C 9/17/8) after administration of 75 mg 13C-methacetin p.o. with and without oxygen inhalation (4 L/min).Results:  In patients breathing room air the total amount of 13C exhaled weakly correlated both with the Child–Pugh score (r = − 0.41, P 〈 0.02) and haemoglobin concentrations (r = 0.46; p = 0.006). Oxygen supplementation increased the total amount of 13C exhaled by 68 ± 90% (P 〈 0.001). This effect was similar in Child–Pugh classes A (43 ± 55%), B (83 ± 80%) and C (66 ± 123%) and not related to the Child–Pugh score.Conclusions:  Our results suggest that tests of microsomal liver function are independently influenced both by oxygen delivery and the Child–Pugh score.
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  • 4
    ISSN: 1432-1440
    Keywords: Liver disease ; Liver function ; Caffeine elimination
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Fasting plasma caffeine concentration and various parameters of caffeine elimination from plasma obtained after a standardized oral dose of 140 mg caffeine have been compared in nine patients with liver cirrhosis, eight patients with non-cirrhotic liver disease and ten healthy volunteers with regard to their ability to discriminate between the different groups. Fasting plasma caffeine concentrations were significantly higher in cirrhotics (11.1±10.5 μmol/l) than in healthy volunteers (1.5±0.8 μmol/l). The respective values measured in patients with non-cirrhotic liver disease (3.1±3.1 μmol/l) did not differ significantly from the controls. Plasma disappearance rate and clearance of caffeine were significantly decreased in cirrhotics (0.11±0.02 h−1; 1.0±0.3 ml/min per kg) and in patients with non-cirrhotic liver disease (0.18±0.04 h−1; 2.2±0.7 ml/min per kg) as compared to healthy volunteers (0.23±0.04 h−1; 3.1±0.9 ml/min per kg). Plasma caffeine concentration determined 12 h after administration of the test dosage discriminated best between patients with cirrhosis (5.4±1.6 μmol/l), patients with noncirrhotic liver disease (2.0±1.4 μmol/l) and healthy volunteers (0.8±0.2 μmol/l). These results, the safety of the test compound and the simplicity of a single caffeine determination in plasma 12 h after a standardized dose of caffeine make this test attractive for evaluation of liver function.
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  • 5
    ISSN: 1432-1440
    Keywords: Adrenal insufficiency ; Basal ganglia calcifications ; Hypoparathyroidism
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Autoimmune polyglandular syndrome is characterized by a failure of multiple endocrine organs and the presence of circulating organ-specific autoantibodies targeted against the failing organs. Here we describe a patient with autoimmune polyglandular syndrome type I with the endocrine manifestations of hypoparathyroidism, adrenocortical insufficiency, and insulin-dependent diabetes mellitus. Long-standing hypoparathyroidism led to extensive calcification of the basal ganglia which resulted in the clinical presentation of an extrapyramidal movement disorder (choreoathetotic and hemiballistic hyperkinesia of the left extremities). Interestingly, parallel to rehydration and the initiation of cortisol replacement therapy a complete reversion of the hyperkinetic signs was achieved. This case shows a rare multiendocrine organ failure with complex metabolic interactions resulting in marked neurological signs. Furthermore, this case demonstrates for the first time that a hyperkinetic syndrome - most likely due to hypoparathyroidism-induced basal ganglia calcification - can be reversed solely by adequate treatment of the concomitant endocrine failures.
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  • 6
    ISSN: 1432-1289
    Keywords: Schlüsselwörter Protein C-Mangel ; Heparin-induzierte Thrombozytopenie Typ II
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Zusammenfassung Bei dem beschriebenen Fall wurde durch die Kombination aus einem hereditären Protein C-Mangel und einer Heparin-induzierten Thrombozytopenie Typ II mit ungewöhnlichem Verlauf eine erhebliche Thrombophilie verursacht. Ebenso wie Heparin-assoziierte Thrombosen auch ohne Thrombozytopenie auftreten können, scheint ein Wiederanstieg der Thrombozyten trotz Fortsetzung der Heparintherapie bei persistierender Thrombophilie im Rahmen dieses Krankheitsbildes möglich zu sein.
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  • 7
    ISSN: 1432-1289
    Keywords: Schlüsselwörter Obere gastrointestinale Blutung ; Gastroösophageale Varizen ; Peptisches Ulkus ; Endoskopische Therapie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Zum Thema Trotz Eradikation des Helicobacter pylori und des damit zwangsläufigen Rückgangs der peptischen Ulkuskrankheit und damit auch der Inzidenz ihrer Komplikationen stellt die obere Gastrointestinalblutung (OGI-Blutung) nach wie vor einen der häufigsten gastroenterologischen Notfälle dar. Anfang der neunziger Jahre wurde in retrospektiven Studien aus den USA eine jährliche Gesamtinzidenz von 30-102 Fällen pro 100.000 Einwohnern beschrieben, die zwischen der dritten und neunten Dekade auf das dreißigfache anstieg; Männer waren doppelt so häufig betroffen wie Frauen. Über 90% der Blutungen manifestierten sich außerhalb des Krankenhauses [1, 2]. In Großbritanien wurden Inzidenzien zwischen 103 und 170 pro 100.000 erwachsene Bevölkerung eruiert [3, 4]. Die Ursachen der oberen Gastrointestinalblutung haben sich in Deutschland über die Jahre wenig geändert. In einer kürzlich veröffentlichten multizentrischen Studie an 1139 Fällen von oberer Gastrointestinaler Blutung wurden folgende Blutungsquellen identifiziert: 27% Duodenalulzera, 24% Magenulzera, 19% gastroösophageale Varizen, 13% gastroduodenale Erosionen, 10%Refluxösophagitis, 7% Mallory-Weiss-Läsionen, 3% Tumoren, 1% Angiodysplasien. Nur bei 6% der Patienten konnte die Blutungsquelle bei der Notfallendoskopie nicht identifiziert werden [5]. Dies deckt sich mit zahlreichen älteren Studien [6] und einer fast zeitgleichen britischen Untersuchung zu diesem Problem [7]. Lediglich der Anteil der Blutungen aus Ösophagus- und Fundusvarizen variiert zwischen den einzelnen Serien stärker.
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  • 8
    ISSN: 1432-1440
    Keywords: First variceal hemorrhage ; Prophylaxis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Prophylaxis of bleeding from esophageal varices is a very tempting concept at first glance, especially under the assumption of a high mortality associated with first variceal hemorrhage. Up to now four different measures have been tried for prophylaxis: portacaval shunt operation, devascularization procedures, sclerotherapy, and drugs. With the exception of portacaval shunts, ongoing controlled trials show a weak trend toward reduction of variceal bleeding and prolongation of survival in selected patients with compensated cirrhosis and large varices. However, prophylaxis of first variceal bleeding must still be regarded as experimental and should be restricted to controlled clinical studies.
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  • 9
    ISSN: 1435-2451
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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