0000000000060003
AUTHOR
R. Wanitschke
Hydro-MRT mit schnellen Sequenzen bei Morbus Crohn: Vergleich mit der fraktionierten Magen-Darm-Passage
PURPOSE To compare the value of hydro-MRI with that of barium studies in patients with Crohn's disease. MATERIALS AND METHODS After an oral bowel opacification using 1000 ml of a 2.5% mannitol solution, axial and coronal breath-hold sequences (T2W HASTE +/- FS, contrast-enhanced T1W FLASH FS) were acquired in 46 patients with Crohn's disease at 1.0 T. The findings of hydro-MRI were compared with those of barium studies. RESULTS In the stomach and the small bowel, hydro-MRI and barium studies demonstrated similar numbers of Crohn's involvements (39 vs. 36); in the colon, hydro-MRI showed clearly more affections (23 vs. 10). Hydro-MRI showed 12.7 cm of inflamed bowel per patient, on average (…
Drugs and the Colon
It is not our intention to review drug effects in the colon, which was done extensively and profoundly by Forth and Rummel1 and Powell.2 Our contribution will present studies of drug effects on physiological absorption and secretion processes obtained in the intact human colon and based on results of intestinal perfusion studies of the whole colon and measurements of transepithelial electrical potential difference (PD) in the rectosigmoid colon. These are at present the practiced and—regarding perfusion studies—most accurate techniques in the hands of clinicians to directly study drug effects on a local dose-response scale in the intact human colon. Since these methods are relatively new an…
Anti-TNF-Antikörper zur Therapie von entzündlichen Darmstenosen bei Morbus Crohn
Stenoses are a frequent complication in patients with Crohn's disease and represent a major diagnostic and therapeutic challenge. The proper assessment of the nature of a stenosis as inflammatory or fibrotic is critical for appropriate treatment, since symptomatic fibrotic stenoses require surgical resection. Standard diagnostic procedures to assess the nature of a stenosis include endoscopy, conventional contrast radiography and magnetic resonance tomography. Recent data suggest, that the positron-emission-tomography possesses a high sensitivity and specificity to confirm inflammatory activity in the bowel. The recombinant monoclonal anti-TNF-antibody Infliximab (Remicade) has been approve…
Verlaufskontrolle des Morbus Crohn: Kann die Hydro-MRT die fraktionierte Magen-Darm-Passage ersetzen?
PURPOSE: To compare the value of hydro-MRI with follow-through examinations in the follow-up of Crohn's disease. METHOD: 22 patients known to be suffering from Crohn's disease were examined via 1.5 T-MR system; an oral contrast examination using 1000 ml of a 2.5% mannitol solution was performed in all patients. T2-weighted TSE sequences and T1-weighted SE sequences were performed before and after the intravenous injection of Gd-DTPA. To reduce movement artifacts caused by peristalsis of the gut, intravenous injection of 40 mg Buscopan was given. The findings of hydro-MRI were compared with the follow-through examinations. RESULTS: In the upper gastrointestinal tract, the follow-through exam…
Eine vergleichende Untersuchung zum Reizdarmsyndrom bei konsekutiven Patienten zweier internistischer Ambulanzen
OBJECTIVES We investigated the nature of illness behavior and the meaning of emotional deficiencies during childhood in patients with irritable bowel diseases (IBS). DATA A consecutive study in two tertiary referral centers was conducted with 48 patients suffering from irritable bowel diseases (IBS) and 91 patients with inflammatory bowel disease (IBD). METHODS The diagnosis of IBS was made by following the Manning criteria, a positive diagnosis of IBD was established through physical, endoscopic and radiologic examinations and was confirmed histologically. Psychological data were obtained by structured psychiatric interviews and psychological self-report measures (GBB). RESULTS We found th…
Intestinal filtration as a consequence of increased mucosal hydraulic permeability
Two mechanisms have been proposed to explain the secretory action of laxative compounds in the intestine: 1. increase of the intracellular amount of cyclic adenosine monophosphate due to stimulation of the adenylate cyclase system and 2. inhibition of intestinal transfer processes, in particular the Na,K-ATPase activated sodium absorption. In a set of in vivo and in vitro experiments in rat colon it could be demonstrated that dihydroxy bile acids (deoxycholate) and diphenolic laxatives (oxyphenisatin) enhance the hydraulic permeability of the mucosal tissue. The permeability changes take place--and there is good experimental evidence--at the zonulae occludentes which bind the epithelial cel…
Indomethacin treatment in amphotericin B induced nephrogenic diabetes insipidus.
Nephrogenic diabetes insipidus (NDI) is a serious side effect of various drugs. Elevated renal prostaglandin E2 levels have been found in patients with lithium-induced NDI and have been implicated in the pathogenesis. We report the case of a patient who developed NDI following treatment with amphotericin B. Prostaglandin levels were elevated. Indomethacin had an antidiuretic effect and normalized prostaglandin levels.
Beurteilung der entzündlichen Aktivität des M. Crohn mit der Hydro-MRT∗
PURPOSE: To assess the value of hydro-MRI in the assessment of the activity of Crohn's disease. MATERIALS AND METHODS: After an oral bowel opacification using 1000 ml of a 2.5% mannitol solution, axial and coronal breath-hold sequences (T2W HASTE +/- FS, contrast-enhanced T1W FLASH FS) were acquired in 63 patients with Crohn's disease at 1.0 T. The enhancement of the bowel wall was correlated with other MRI findings, with the Crohn's disease activity index (CDAI), and the C-reactive protein (CRP). RESULTS: In Crohn's disease, contrast enhancement of the affected bowel wall is markedly increased in comparison with the normal bowel wall (+80 +/- 23% vs. +43 +/- 11%; p = 8 x 10(-11)). Positive…
Secretory effect of azodisalicylate (azodisal sodium) on the short circuited mucosa of the rat ileum in vitro.
Azodisalicylate (ADS) is one of the newly developed substitutes of sulphasalazine consisting of two molecules of 5-amino-salicylic acid. Azodisalicylate caused diarrhoea in some patients, apparently caused by an antiabsorptive secretagogue action of this compound. The mechanism of this was studied in the short circuited isolated mucosa of the rat ileum. Mucosal addition of ADS increased the potential difference (PD) and short circuit current (Isc) at a concentration of 1.3.10(-4) mol/l (4 mg/dl) with maximal effects at 1.3.10(-3) mol/l (40 mg/dl). Epithelial resistance was only slightly decreased at the higher concentrations of 40 and 100 mg/dl. Serosal ADS had no effect on electrical param…
Randomised trial of mycophenolate mofetil versus azathioprine for treatment of chronic active Crohn’s disease
BACKGROUNDCrohn’s disease is a chronic inflammatory disease of the alimentary tract. Azathioprine is an effective agent in the management of chronic active Crohn’s disease leading to long term remission of disease activity. Such treatment leads to limited efficacy or side effects in a small subset of patients.AIMSTo compare efficacy and side effects of treatment with azathioprine plus corticosteroids versus mycophenolate mofetil (MMF) plus corticosteroids in patients with chronic active Crohn’s disease.METHODSSeventy patients with chronic active Crohn’s disease (Crohn’s disease activity index (CDAI) greater than 150) were randomised for treatment with azathioprine/cortisone or MMF/cortisone…
Hydro-MRT bei entzündlichen Darmerkrankungen - Eine koloskopisch-histologische Vergleichsstudie*
PURPOSE To compare hydro-MRI with colonoscopy and biopsy specimen regarding the assessment of inflammatory activity and the differentiation of inflammatory bowel diseases. MATERIAL AND METHODS After an oral bowel opacification using 1000 ml of a 2.5% mannitol solution and a rectal bowel opacification using 250-500 ml of a 0.9% saline solution, axial and coronal breath-hold sequences +/- Gd-DTPA (HASTE-["half-Fourier acquisition single-shot turbo spin echo"] and dynamic FLASH-["fast low angle shot"]) were acquired in 27 patients with inflammatory bowel disease. The enhancement of the bowel wall as well as morphological MRI findings were correlated with colonoscopy and biopsy specimens. By me…
The effect of cathartic agents on transmucosal electrical potential difference in the human rectum.
Active ion transport in the colon is generating a transmucosal electrical potential difference (PD) of about 40 mV. Cathartic agents inhibit electrolyte and water net-absorption or cause net-secretion which should be reflected in a change of PD. In 83 normal subjects the effect of an isotonic eletrolyte solution (control) and different cathartic agents on rectal PD was tested: Laxatives (bisacodyl, rhein), bile acids (cholic and deoxycholic acid), fatty acids (oleic and ricinoleic acid) and cardiac glycosides (meproscillarin, digitoxin, digoxin). Bisacodyl, deoxycholic acid in high concentration, meproscillarin and digitoxin significantly decreased PD, while the other substances did not. Ca…
Symptomatologie, klinische Pathophysiologie und therapeutische Aspekte des Reizdarmsyndroms
Das Reizdarmsyndrom ist mit einer Pravalenz von mindestens 15% [11] die haufigste gastrointestinale Funktionsstorung mit einer weltweiten Verbreitung. Es teilt das Schicksal aller „funktionellen Erkrankungen“ namlich jenes, dass es als „Ausschlussdiagnose“ verstanden wird. Immer dann, wenn bei bestehenden Abdominalbeschwerden in Frage kommende organische Erkrankungen ausgeschlossen sind, wird eine funktionelle Storung angenommen und einer entsprechenden Entitat zugeordnet. Dieses immer noch praktizierte Verfahren sollte in geeigneten Fallen — und diese sind fur klinisch erfahrene Gastroenterologen keineswegs selten — verlassen und durch die primare Diagnosestellung einer funktionellen Erkra…
Fragebogen zur Messung der psychosozialen Belastungen bei chronisch-entzündlichen Darmerkrankungen (FBCED): Konstruktion und Evaluation
The "Inflammatory Bowel Disease Stress Inventory (IBD-SI)" measures a broad spectrum of disease-specific every day stress factors in patients with inflammatory bowel disease (IBD). Based on a multistage factor analysis on 300 CED patients, the final form comprises 32 items assigned to 8 different domains: depressed mood, doctor-patient relationship, anxiety about loss of bowel control, occupational impairment, worries about deteriovation, stress from medical treatment, impairment of sexuality/partnership and physical complaints. In addition, a global stress score can be obtained. The reliability values of the 8 subscales with 4 items each indicate a good internal consistency (alpha = 0.76 -…
Inhibition of neuronally mediated secretion in rat colonic mucosa by prostaglandin D2
Abstract The effect of prostaglandin D 2 (PGD 2 ) on ion transport across the mucosa of the descending colon was studied in rats. PGD 2 dose-dependently decreased baseline short-circuit current of mucosa-submucosal preparations mounted either in the Ussing chamber or mounted as an everted sac. However, with the everted sac technique, the tissue was about 1000 times more sensitive to PGD 2 . Concomitant with the decrease in short-circuit current, PGD 2 increased the mucosal-to-serosal fluxes of sodium and chloride and decreased the serosal-tomucosal flux of chloride. PGD 2 inhibited the secretory action of the PGI 2 analogue iloprost, PGD 2α , and neurotensin. The action of these secretagogu…
Akuter Mesenterialarterienverschluß als seltene Manifestation eines primären Antiphospholipid-Antikörpersyndroms
Hintergrund: Das Antiphospholipid-Antikorpersyndrom ist eine thrombophile Erkrankung, in deren Verlauf es zu arteriellen und venosen Thrombosen kommen kann. Wir berichten den seltenen Fall eines akuten Mesenterialarterienverschlusses bei primarem Antiphospholipid-Antikorpersyndrom. Fallbericht: Ein 46jahriger Patient wurde mit starksten, anhaltenden, kolikartigen, rechtsseitigen Oberbauchschmerzen stationar aufgenommen. Unter dem klinischen Bild eines akuten Abdomens wurde laparotomiert. Es erfolgte bei einer Dunndarmgangran im Jejunum eine segmentale Dunndarmresektion. Bei der pathologisch-anatomischen Untersuchung zeigte sich ein partieller, sekundar hamorrhagischer Dunndarminfarkt mit fr…
Does uremic enterocolitis exist?
In rats a severe but compensated chronic renal insufficiency was induced by stepwise 9/10 nephrectomy. Despite this severe chronic renal insufficiency we observed no relevant pathological changes in the intestinal mucosa. In particular, we found no evidence of mucosal erosions, ulceration or pseudomembranous colitis, findings which are traditionally thought to be characteristic of the uremic state. This was also true of those animals dying prematurely from uremia. Thus serious doubts arise about the existence of “uremic enterocolitis”, doubts which also proved justified after a critical review of the literature on human pathology.
Mycophenolate mofetil versus azathioprine in patients with chronic active ulcerative colitis: a 12-month pilot study.
Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) of unknown etiology frequently requiring long-term therapy for control of symptoms and prevention of relapse. Azathioprine (AZA) has been shown to be effective and safe in the treatment of chronic active UC. However, the alternatives to treatment with AZA are limited. Our aim was to compare the efficacy and safety of treatment with mycophenolate mofetil (MMF)/prednisolone versus standard immunosuppressive treatment with azathioprine (AZA)/prednisolone in patients with chronic active UC.The study was designed as an open comparison of MMF versus AZA. Twenty-four patients with active UC (Rachmilewitz scoreor =6 points) were randoml…
The short-circuited everted sac of rat colon mucosa.
A short-circuited preparation of everted rat colon sacs is described. The serosal current electrode is a AgAgCl wire. A cylindrical agar bridge or AgAgCl electrode may be employed on the mucosal side. Effects of Ag+ ions liberated from the electrodes on ion transport could not be demonstrated. Fluid and sodium are absorbed and bicarbonate secreted. Potassium and chloride movements are not significantly different from zero. The preparation remains stable for at least 2 h. Sodium absorption is diminished by 50% and bicarbonate secretion abolished in the absence of glucose. In principle, similar ion transport properties were found as in Ussing-chamber preparations. The advantage of the everted…
Effect of the stable prostacyclin analogue iloprost on water and electrolyte transfer of the rat ileum and colon in vivo.
The effect of iloprost on water and ion transfer was measured simultaneously in tied-off loops of the rat ileum and colon in vivo. (1) In the ileal loops iloprost had no effect on water and ion transfer neither by intraluminal, nor intraaortal or intravenous application. (2) In the colonic loops only intraaortal bolus application of the high dose of 500 micrograms iloprost significantly decreased net water, sodium and chloride absorption, but did not induce net secretion. (3) Inhibition of endogenous prostaglandin synthesis by indomethacin did not change net water and electrolyte transfer in the ileum and colon. (4) Under this pretreatment i.v.-application of 100 micrograms iloprost, ineffe…
Enteropathische Spondarthritiden bei chronisch entzündlichen Darmerkrankungen: Prävalenz, Befallsmuster und HLA-Assoziation
Enteropathische Spondarthritiden stellen die haufigste extraintestinale Manifestation der chronisch entzundlichen Darmerkrankungen (CED), Morbus Crohn (MC) und Colitis ulcerosa (CU), dar. Ziel der vorliegenden Studie war es daher, ein groses Patientengut mit chronisch entzundlichen Darmerkrankungen auf die Pravalenz und das Befallsmuster von Spondarthritiden (SpA) sowie auf eine Assoziation der Spondarthritiden mit der Ausdehnung der Darmerkrankung und dem HLA-Typ des Patienten hin zu untersuchen. 521 Patienten (409 mit Morbus Crohn, 112 mit Colitis, ulcerosa) wurden prospektiv uber den Zeitraum eines Jahres untersucht. Bei der Diagnose einer Spondarthritis wurden anamnestische, klinische, …
Rhein stimulates active chloride secretion in the short-circuited rat colonic mucosa.
In a short-circuited mucosa-submucosa preparation of the rat descending colon with preserved Meissner's plexus mounted as an everted sac rhein transiently increased the potential difference and short-circuit current (Isc) when administered serosally and mucosally, but serosal application was more effective. Maximal effects were obtained at rhein concentrations of 1.6 X 10(-4) and 3 X 10(-4) mol/l. Net chloride absorption was decreased. Indomethacin (5 X 10(-6) mol/l) did not inhibit the increase of Isc, but omission of calcium from the serosal side as well as tetrodoxin (2 X 10(-7) mol/l) decreased it by 50 and 60%. Mechanical removal of Meissner's plexus partly blocked the effect of rhein,…
Effects of controlled-release on the pharmacokinetics and absorption characteristics of a compound undergoing intestinal efflux in humans
Abstract Objective The number of active pharmaceutical ingredients (API) undergoing inhibitable and saturable intestinal efflux is considerable. As a consequence, absorption and bioavailability may depend on the intestinal concentration profile of the drug and may vary as a function of dose and release rate of the drug from the dosage form. The impact of controlled versus immediate-release on the absorption of P-glycoprotein substrates is currently unknown. Thus, the main focus of the present study was a comparison of the pharmacokinetics of the P-gp model substrate talinolol following administration of immediate-release (IR) and controlled-release (CR) tablets to healthy human volunteers w…
Enormous hemangiosarcoma of the heart
This report describes a 26-year-old patient with hemangiosarcoma of the heart and summarizes the clinicopathological features in previous reports of patients with cardiac angiosarcoma. The patient was admitted to our hospital because of a syncope and one episode of nocturnal dyspnea and hemoptysis. In his history he complained of progressive weakness and loss of weight over the past 2 months. Echocardiography and computed tomography of the chest showed inhomogeneous masses in the pericardial cavity completely surrounding the heart and involving the ascending aorta and the superior vena cava. Histological examination of the tissue obtained from the mass by fine needle technique revealed a po…
Thiamine for the treatment of nucleoside analogue-induced severe lactic acidosis
Nucleoside analogue-induced lactic acidosis is an often fatal condition in patients with HIV. There is only one report of successful treatment with riboflavin. We describe a 30-year-old female with AIDS and nucleoside analogue-induced lactic acidosis that exacerbated shortly after introducing total parenteral nutrition and reversed within hours after the addition of thiamine. Successful treatment of nucleoside analogue-induced lactic acidosis with a high dose of thiamine supports the hypothesis that vitamin deficiency is an important cofactor in the development of this rare and unpredictable condition in patients with HIV. We suggest that high dose B-vitamins should be given to any patient …
Epithelioides Hämangioendotheliom der Wirbelsäule
Hintergrund: Epithelioide Hamangioendotheliome sind seltene vaskulare Tumoren, die bevorzugt im Bindegewebe, in der Lunge oder in der Leber auftreten. Falldarstellung: Wir prasentieren den Fall einer 58-jahrigen Patientin, die mit oberer Einflussstauung, Horner-Syndrom und segmentalen Sensibilitatsstorungen in den Fingern der rechten Hand aufgenommen wurde. Die daraufhin durchgefuhrten Computertomographie- und Magnetresonanztomographieuntersuchungen der Wirbelsaule zeigten eine tumorose Raumforderung vom siebten Halswirbelkorper bis zum vierten Brustwirbelkorper. Wegen rascher Tumorprogression mit progredienter oberer Einflussstauung und neurologischen Ausfallen musste die Patientin wiederh…