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1.
Chirurgie (Heidelb) ; 95(2): 115-121, 2024 Feb.
Article in German | MEDLINE | ID: mdl-37978073

ABSTRACT

A review and discussion of the current literature on liver transplantation for acute-on-chronic liver failure (ACLF) was performed. The ACLF represents an acute deterioration of liver function with pre-existing liver disease and is associated with increasing multiorgan failure, depending on the stage. The 28-day mortality ranges to well over 70% in stage 3 and requires rapid intensive medical treatment involving an interdisciplinary team experienced in transplantation medicine. Under optimized conditions, liver transplantation provides long-term survival rates comparable to other indications. Achieving this requires a differentiated donor selection, choosing the appropriate time for transplantation in the context of a dynamic disease course and the use of appropriate surgical techniques.


Subject(s)
Acute-On-Chronic Liver Failure , Liver Transplantation , Humans , Acute-On-Chronic Liver Failure/surgery , Multiple Organ Failure
2.
Chirurg ; 86(2): 139-45, 2015 Feb.
Article in German | MEDLINE | ID: mdl-25604306

ABSTRACT

The interdisciplinary management of postoperative complications in liver transplantation is of extreme importance. Due to organ shortage and prioritization of the most severely ill recipients in the model for end-stage liver disease (MELD)-based allocation, both donor and recipient associated morbidity are increasing. An interdisciplinary, structured monitoring concept is essential for the timely identification and specific treatment of postoperative complications. Interdisciplinary clinical rounds, laboratory testing and Doppler ultrasound monitoring of the graft perfusion are as important as comprehensive anti-infection prophylaxis and immunosuppression. Arterial perfusion disorders of any kind, biliary complications and postoperative fluid accumulation demand individualized therapeutic concepts. In summary, the success of liver transplantation depends on the communication and coordinated interdisciplinary cooperation of all disciplines involved.


Subject(s)
Cooperative Behavior , Interdisciplinary Communication , Liver Transplantation , Patient Safety/standards , Postoperative Complications/therapy , Graft Survival , Humans , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Reoperation
3.
Chirurg ; 82(10): 887-97, 2011 Oct.
Article in German | MEDLINE | ID: mdl-21984637

ABSTRACT

As part of oncologic visceral surgical operations the surgeon is confronted with anatomical barriers. In particular abdominal sarcomas and carcinomas sometimes require a vascular surgical procedure in order to achieve a radical and curative treatment. By using vascular surgical techniques there is the possibility for oncology patients to expand the boundaries of operability and to allow a long tumor-free survival. For each affected arterial and venous structure there are special reconstruction methods which require an optimal vascular graft. The aim of vascular resection and reconstruction should focus not only on the radicality of the operation but should also take the optimal circulation recovery of blood in the tumor resected area into account.


Subject(s)
Abdominal Neoplasms/blood supply , Abdominal Neoplasms/surgery , Blood Vessel Prosthesis Implantation/methods , Carcinoma/blood supply , Carcinoma/surgery , Sarcoma/blood supply , Sarcoma/surgery , Abdominal Neoplasms/mortality , Blood Vessel Prosthesis , Carcinoma/mortality , Disease-Free Survival , Humans , Image Processing, Computer-Assisted , Imaging, Three-Dimensional , Neoplastic Cells, Circulating , Palliative Care , Prosthesis Design , Sarcoma/mortality , Stents , Survival Rate , Tomography, X-Ray Computed
4.
Can Fam Physician ; 52(10): 1266-7, 2006 Oct.
Article in English | MEDLINE | ID: mdl-17279187

ABSTRACT

OBJECTIVE: To explore whether general practitioners who request spinal x-ray investigations are less likely to refer, prescribe medication, or order additional tests when they intend only to reassure patients rather than to exclude or confirm disease. DESIGN: Cross-sectional survey. Physicians recorded reasons for requesting x-ray examinations and differential diagnoses on the request form. When they received a radiologist's report on a spinal x-ray test, GPs also received a questionnaire on their subsequent management. SETTING: Maastricht region of the Netherlands. PARTICIPANTS: All 90 GPs in the Maastricht region who referred patients for spinal x-ray examinations during 19 consecutive weeks. MAIN OUTCOME MEASURES: Reason for requesting spinal x-ray investigations, results, and subsequent management. RESULTS: We received completed questionnaires on 386 patient contacts. Physicians were significantly less likely to refer, prescribe medication, or order additional tests when they intended only to reassure patients rather than to exclude or confirm disease (odds ratio 0.3, 95% confidence interval 0.1 to 0.6). This effect was independent of the results of the x-ray examinations. CONCLUSION: Physicians seem to be aware that they have requested spinal x-ray examinations only to reassure patients, and they account for this in their management. These findings support debate on the negative consequences of requesting tests for other than purely medical reasons. Concerns about unjustified actions based on the results of x-ray examinations that were requested primarily to reassure patients should probably have only a minor role in the debate about unnecessary testing.


Subject(s)
Physicians, Family , Practice Patterns, Physicians'/statistics & numerical data , Spine/diagnostic imaging , Adult , Aged , Cross-Sectional Studies , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Netherlands , Osteoporosis/diagnosis , Radiography , Spinal Diseases/diagnosis , Spinal Fractures/diagnosis , Surveys and Questionnaires
5.
Gynecol Endocrinol ; 16(2): 155-62, 2002 Apr.
Article in English | MEDLINE | ID: mdl-12012627

ABSTRACT

This double-blind, randomized, multi-center study compared the metabolic tolerance of a combined formulation containing estradiol (E2) and trimegestone (TMG) with a standard hormone replacement therapy (HRT) containing estradiol valerate (EV) and norgestrel (NG). Blood lipids, glucose and fibrinogen concentrations were measured in the study which was conducted over 13 cycles, each of 28 days, and included 634 subjects in two randomized groups. A total of 481 subjects completed the study. The circulating concentrations of high density lipoprotein (HDL), HDL2, HDL3 cholesterol and apolipoprotein A1 were increased in the E2 + TMG group and reduced in the EV + NG group. Total cholesterol, low density lipoprotein (LDL) cholesterol, apolipoprotein B and lipoprotein(a) concentrations were decreased in both treatment groups; however, the reduction in LDL cholesterol was greater in the E2 + TMG group. Similar lipid findings were found in a subgroup that excluded subjects who had less than 3 months washout from a previous HRT, who provided a blood sample outside the day 17-28 window, or who were taking beta-blockers or thiazide diuretics. Blood glucose concentrations were reduced slightly in both treatment groups. A significant reduction in fibrinogen was also seen in both groups over the course of the study. The changes in lipid profile, especially HDL cholesterol, were more beneficial in the E2 + TMG group in comparison with the EV + NG group. This reflects the lack of androgenic action of trimegestone in comparison with norgestrel, which exhibits an androgenic effect and prevents the estrogen-induced increase in HDL cholesterol. The results of the study suggest that the use of trimegestone in combination with E2 may be preferable to norgestrel because of the more favorable lipid profile.


Subject(s)
Estradiol/analogs & derivatives , Estradiol/administration & dosage , Estrogen Replacement Therapy , Norgestrel/administration & dosage , Postmenopause , Promegestone/analogs & derivatives , Promegestone/administration & dosage , Apolipoprotein A-I/blood , Apolipoproteins B/blood , Blood Glucose/analysis , Cholesterol/blood , Cholesterol, HDL/blood , Cholesterol, LDL/blood , Double-Blind Method , Female , Fibrinogen/analysis , Humans , Lipids/blood , Lipoprotein(a)/blood , Lipoproteins, HDL/blood , Lipoproteins, HDL2 , Lipoproteins, HDL3 , Middle Aged
6.
Gynecol Endocrinol ; 15(5): 349-58, 2001 Oct.
Article in English | MEDLINE | ID: mdl-11727357

ABSTRACT

This double-blind, randomized, multi-center study compared the efficacy and clinical tolerance of a combined formulation containing 2 mg estradiol (E2) and 0.5 mg trimegestone (TMG) with a standard hormone replacement therapy containing estradiol valerate (E2V) and norgestrel (NG) in the treatment of climacteric symptoms. The study was conducted over 13 cycles, each of 28 days, and involved 634 subjects, of whom 481 completed the study. The primary efficacy variable was the percentage of subjects who showed at least a 50% reduction from baseline in the mean daily number of hot flushes in cycle 3. This was observed in 98.5% of the subjects in the E2 + TMG group and 93.3% of the subjects in the E2V + NG group (95% confidence interval of the difference, -8.6, -1.9). Significant differences in favor of the E2 + TMG combination were observed in the reduction in the mean daily number and severity of hot flushes, and in the percentage of subjects who had hot flushes at baseline but no hot flushes during treatment. There were no significant differences between the treatments in the Kupperman index and in urogenital signs or symptoms. Treatment with the E2 + TMG combination was well tolerated and the incidences of adverse events were similar in the two treatment groups. Breast pain was the main adverse event, possibly related to treatment that resulted in discontinuation. The mean number of bleeding days per cycle was significantly lower with the E2 + TMG combination than with the E2V + NG combination. The incidences of endometrial hyperplasia were low and comparable in both treatment groups. It was concluded that the E2 + TMG combination was either equivalent or superior to the E2V + NG combination in the treatment of hot flushes and other climacteric symptoms, and that its bleeding profile was favorable.


Subject(s)
Estradiol/analogs & derivatives , Estradiol/administration & dosage , Estrogen Replacement Therapy/methods , Norgestrel/administration & dosage , Progesterone Congeners/administration & dosage , Promegestone/administration & dosage , Double-Blind Method , Drug Combinations , Drug Therapy, Combination , Estradiol/adverse effects , Estrogen Replacement Therapy/standards , Female , Hot Flashes/drug therapy , Humans , Middle Aged , Norgestrel/adverse effects , Postmenopause , Progesterone Congeners/adverse effects , Promegestone/adverse effects , Promegestone/analogs & derivatives , Statistics, Nonparametric
7.
Am J Surg Pathol ; 25(7): 930-5, 2001 Jul.
Article in English | MEDLINE | ID: mdl-11420465

ABSTRACT

Prospective multicenter evaluation of the WHO classification and the morphometric D-score to predict endometrial hyperplasia cancer progression. In 132 endometrial hyperplasias WHO classification was performed by two experienced gynecologic pathologists. The D-score was assessed blindly by technicians in a routine diagnostic setting. Development of endometrial carcinoma during a 1-10-year follow-up was used as the end point. Eleven of 132 patients (8%), 10 of 61 (16%) atypical hyperplasias, and 1 of 71 (1%) nonatypical hyperplasias developed cancer. Twenty-six curettings had a D-score < or = 0 ("unfavorable" or endometrial intraepithelial neoplasia) of which 10 (38%) developed cancer. None of the 86 cases with a D-score > 1 ("favorable") and one of the 20 (5%) cases with 0 < D-score < or = 1 ("uncertain") developed cancer. Sensitivity of the D-score was 100%, specificity 82%, the positive and negative predictive values were 38% and 100%, respectively. These values are similar to those in three prior retrospective D-score studies but higher than the WHO values (which are 91%, 58%, 16%, and 99%, respectively). The D-score in endometrial hyperplasias is a more sensitive and specific marker for cancer prediction than the WHO classification, can be assessed in a routine clinical setting on standard hematoxylin and eosin sections (15-30 minutes per case), and is highly reproducible and cost-effective (U.S. $50 per case).


Subject(s)
Endometrial Hyperplasia/pathology , Adult , Aged , Aged, 80 and over , Discriminant Analysis , Disease Progression , Endometrial Hyperplasia/classification , Endometrial Neoplasms/pathology , Female , Humans , Middle Aged , Multivariate Analysis , Pathology/methods , Predictive Value of Tests , Prognosis , Prospective Studies , Sensitivity and Specificity , Single-Blind Method , World Health Organization
8.
J Pathol ; 193(1): 48-54, 2001 Jan.
Article in English | MEDLINE | ID: mdl-11169515

ABSTRACT

The aim of this study was to assess the value of Ki-67 immunoquantitation with a computerized image analysis system for grading support in cervical intraepithelial neoplasia (CIN). Sixty-five 'blind' consensus biopsies (23 CIN 1, 22 CIN 2, and 20 CIN 3) were used as a learning set. Measurements were done in the carefully selected most severely dysplastic part of the epithelium of each CIN case. The resulting discriminating combination of quantitative features was then prospectively applied on 121 new biopsies (test set) and compared with the classical CIN grade assessed routinely by six different pathologists and with the blind review grades assessed by two experienced pathologists. In the learning set of 65 cases, a jack-knifed stepwise discriminant analysis showed that the 90th percentile of the stratification index and the number of positive nuclei per 100 microm basal membrane are the best discriminating set of features to distinguish the three CIN grades at the same time. With these features, two CIN 1 cases were 'misclassified' as CIN 2 and nine CIN 2 cases as CIN 3. Overall agreement, therefore, was only 83%. However, recut of the paraffin blocks in the two 'misclassified' CIN 1 cases revealed CIN 2 in the first and CIN 3 in the other, while the other CIN 1 cases that were correctly classified with Ki-67 quantitation remained CIN 1. Likewise, nine CIN 2 cases were misclassified as CIN 3, but in two of these nine cases histological follow-up clearly indicated CIN 3. Agreement may thus be higher than the 83% in the learning set suggests. In the subsequent prospective evaluation on 121 routine CIN cases (test set), agreement between routine CIN grades (by six independent different pathologists) and quantitative Ki-67 classification was 78%. However, when compared with the blind review CIN grades of two expert pathologists, agreement was 97% and sensitivity, specificity, and positive and negative predictive value were very high. It is concluded that Ki-67 immunoquantitation is a useful diagnostic adjunct to distinguish different CIN grades and may also be a sensitive biological indicator of progression of seemingly low-grade CIN.


Subject(s)
Antigens, Neoplasm/metabolism , Biomarkers, Tumor/metabolism , Ki-67 Antigen/metabolism , Uterine Cervical Dysplasia/metabolism , Uterine Cervical Neoplasms/metabolism , Disease Progression , Female , Humans , Image Processing, Computer-Assisted/methods , Immunoenzyme Techniques , Predictive Value of Tests , Prospective Studies , Sensitivity and Specificity , Uterine Cervical Neoplasms/pathology , Uterine Cervical Dysplasia/pathology
9.
Ital J Gastroenterol Hepatol ; 31(9): 836-41, 1999 Dec.
Article in English | MEDLINE | ID: mdl-10669990

ABSTRACT

BACKGROUND: Helicobacter pylori infection is associated with an increased risk of gastric cancer. In Helicobacter pylori negative patients, factors different from those in Helicobacter pylori positive patients may be involved in gastric carcinogenesis. METHODS: Thirty-nine recently diagnosed consecutive patients with gastric cancer were investigated. Gastric biopsies were obtained for detection of Helicobacter pylori (by immunohistochemistry), non-Helicobacter pylori flora (by modified Giemsa and culture) and histological assessment according to the Sydney classification by Haematoxylin-Eosin staining. In serum samples, Helicobacter pylori antibodies were determined by IgG enzyme-linked immunosorbent assay, IgA enzyme-linked immunosorbent assay, and Western blotting. Furthermore, serum gastrin, pepsinogen A and C and plasma chromogranin A were determined. RESULTS: Helicobacter pylori was detected by immunohistochemistry in 53.8%, by IgG in 56.4%, by IgA in 33.3%, and by Western blotting in 74.4% of the 39 patients. Ten patients (25.6%) were negative by both histology and serology. Non-Helicobacter pylori flora was detected in 27 of the 39 patients (69.2%) with a similar frequency in Helicobacter pylori positive and negative patients. Helicobacter pylori positivity was found significantly more often in diffuse than intestinal type carcinoma patients (p < 0.05). Elevated gastrin levels and antrum-sparing atrophic gastritis were more frequent in Helicobacter pylori negative than in Helicobacter pylori positive patients (p < 0.05). CONCLUSIONS: In 10 out of 39 gastric cancer patients, no evidence of previous or current Helicobacter pylori infection could be demonstrated. Non-Helicobacter pylori was found in 69.2% of patients regardless of the Helicobacter pylori status. Further studies are needed to establish the contribution of non-Helicobacter pylori flora as well as antrum-sparing atrophic gastritis with hypergastrinaemia to the development of gastric cancer.


Subject(s)
Helicobacter pylori/isolation & purification , Stomach Neoplasms/microbiology , Aged , Aged, 80 and over , Antibodies, Bacterial/blood , Chromogranin A , Chromogranins/blood , Female , Gastrins/blood , Helicobacter pylori/immunology , Humans , Male , Middle Aged , Pepsinogen A/blood , Pepsinogen C/blood , Prospective Studies , Stomach/microbiology , Stomach Neoplasms/blood
11.
Eur J Gastroenterol Hepatol ; 9(1): 49-53, 1997 Jan.
Article in English | MEDLINE | ID: mdl-9031899

ABSTRACT

BACKGROUND: Eradication of Helicobacter pylori by antibiotics in combination with gastric acid inhibition can result in overgrowth of non-H. pylori bacterial flora. This may confound the histological detection of H. pylori at eradication control if non-specific staining methods are used. OBJECTIVE AND METHODS: In 18 patients treated with amoxycillin (2 weeks) and omeprazole (6 weeks), endoscopically obtained gastric juice was cultured and two biopsies of corpus, antrum and duodenum were taken before and after eradication therapy (with gastric acid inhibition still going on) for culture and for histology to assess the intragastric bacterial flora. By histology, modified Giemsa (MG) and an H. pylori-specific immunohistochemical stain (IMM) were evaluated. RESULTS: Median pH of gastric juice was 1.5 (n = 18) before and 7 (n = 17) after eradication therapy, when patients were still on omeprazole. After therapy, culture showed a significant decrease (P < 0.05) in mean amount of H. pylori in corpus, antral and duodenal biopsies and a significant increase of non-H. pylori flora (P < 0.05) in gastric juice, corpus, antral and duodenal mucosa. With culture as a standard, 16 and 4 biopsy specimens were scored falsely positive for H. pylori by MG and IMM, respectively, and H. pylori was not detected in 23 and 13 biopsy specimens when culture was H. pylori-positive. CONCLUSION: Because of the possible presence of non-H. pylori flora after eradication therapy, the use of IMM is recommended in this situation for the histological detection of H. pylori, especially in those patients with ongoing gastric acid inhibitory therapy.


Subject(s)
Gastric Juice/drug effects , Helicobacter Infections/diagnosis , Helicobacter pylori/isolation & purification , Amoxicillin/therapeutic use , Anti-Ulcer Agents/therapeutic use , Biopsy , Endoscopy, Digestive System , Female , Gastric Acid/chemistry , Gastric Juice/cytology , Gastric Juice/microbiology , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/drug therapy , Helicobacter Infections/drug therapy , Humans , Hydrogen-Ion Concentration , Immunohistochemistry , Male , Middle Aged , Omeprazole/therapeutic use , Penicillins/therapeutic use , Retrospective Studies
12.
Injury ; 28(7): 459-62, 1997 Sep.
Article in English | MEDLINE | ID: mdl-9509087

ABSTRACT

A follow-up study was performed to assess the functional and radiological outcome after operative treatment of tibial plateau fractures. Of 62 patients operated upon from 1985 to 1993, 46 patients were traced and re-examined. Follow-up averaged 60 months. Three functional scores were applied: the HSS knee score, the Lysholm score and the Tegner score. Radiographs obtained at follow-up were rated for deformity and signs of arthrosis, using a score described by Reswick and Niwayama. Patients reported most functional complaints during the first 3 years and after 6 years. Patients seen between 3 and 6 years after injury showed better functional scores. Arthritic changes were seen from 5 years after the fracture. Patients over 60 years of age seemed to suffer less functional loss than younger patients, indicating that operative treatment should not be withheld on grounds of age alone.


Subject(s)
Knee Injuries/surgery , Knee Joint/physiopathology , Tibial Fractures/surgery , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Arthritis/etiology , Female , Follow-Up Studies , Humans , Knee Injuries/complications , Knee Injuries/rehabilitation , Knee Joint/diagnostic imaging , Male , Middle Aged , Radiography , Retrospective Studies , Tibial Fractures/complications , Tibial Fractures/rehabilitation , Time Factors , Treatment Outcome
13.
J Cardiovasc Surg (Torino) ; 37(3): 237-41, 1996 Jun.
Article in English | MEDLINE | ID: mdl-8698757

ABSTRACT

Three cases of compartment-syndrome of the lower extremity are presented as an example of a specific type of compartment syndrome of the donorleg after CABG. The possible factors contributing to this complication are being discussed, and guidelines are given to adequately diagnose and treat this problem.


Subject(s)
Anterior Compartment Syndrome/etiology , Coronary Artery Bypass , Postoperative Complications/etiology , Saphenous Vein/transplantation , Amputation, Surgical , Anterior Compartment Syndrome/surgery , Bandages , Female , Humans , Male , Middle Aged , Postoperative Complications/surgery
16.
Injury ; 25(5): 305-9, 1994 Jul.
Article in English | MEDLINE | ID: mdl-8034348

ABSTRACT

Distal intra-articular bicondylar humeral fractures are usually treated by means of cancellous screw(s) for the condylar block and one or two plates for fixation of the block to the shaft. The method and results of double tension band osteosynthesis instead of double plating for fixation of the condylar block to the shaft are described here. The advantages of double tension band wiring are an easier and faster procedure, less periosteal and muscle damage, and symmetrical compression. The functional results and complications of patients treated by this method are compared with the results of patients treated with plate fixation.


Subject(s)
Bone Wires , Elbow Injuries , Fracture Fixation, Internal/instrumentation , Fractures, Closed/surgery , Humeral Fractures/surgery , Adult , Aged , Aged, 80 and over , Arthrography , Elbow Joint/diagnostic imaging , Elbow Joint/surgery , Female , Fracture Fixation, Internal/methods , Fractures, Closed/diagnostic imaging , Fractures, Ununited/surgery , Humans , Humeral Fractures/diagnostic imaging , Male , Middle Aged
17.
Eur J Vasc Surg ; 7(3): 352-4, 1993 May.
Article in English | MEDLINE | ID: mdl-8513921

ABSTRACT

Two cases of aortocaval fistula are described in patients with an otherwise asymptomatic abdominal aortic aneurysm. Both presented because of cardiac symptoms, one with chest pain and acute heart failure and electrocardiogram signs of acute coronary ischaemia, the other with a long history of chronic cardiac failure resistant to therapy. In the first case the fistula was proven by means of a CAT scan. Positive proof of a fistula or leakage is important because asymptomatic aneurysms should not be operated on in cardiac compromised patients. On the other hand, if an aortocaval fistula is present, operation is necessary to prevent fatal cardiac failure.


Subject(s)
Aneurysm, Ruptured/surgery , Aortic Rupture/surgery , Arteriovenous Fistula/surgery , Blood Vessel Prosthesis , Heart Failure/surgery , Aged , Aneurysm, Ruptured/diagnostic imaging , Aortic Rupture/diagnostic imaging , Arteriovenous Fistula/diagnostic imaging , Diagnosis, Differential , Heart Failure/diagnostic imaging , Heart Rate/physiology , Humans , Male , Tomography, X-Ray Computed , Venous Pressure/physiology
18.
Bone Marrow Transplant ; 8(5): 333-8, 1991 Nov.
Article in English | MEDLINE | ID: mdl-1768966

ABSTRACT

Following the demonstration that adjuvant arthritis in rats can be cured with total body irradiation (TBI) and allogeneic or syngeneic bone marrow, the efficacy of autologous bone marrow was investigated in the experiments reported here. Bone marrow from arthritic rats, harvested at the same time that the recipients were irradiated, and real autologous bone marrow were found to be similarly effective as bone marrow grafts from naive syngeneic donors. Sublethal TBI with lower doses was less effective, but the highest tolerated doses of 8 Gy approached the effect of 9 Gy and bone marrow rescue. In contrast, partial body irradiation of either the affected limbs, or of the whole body except the limbs, resulted in only partial and temporary regression of the arthritis.


Subject(s)
Arthritis, Experimental/radiotherapy , Arthritis, Experimental/surgery , Bone Marrow Transplantation , Animals , Combined Modality Therapy , Female , Male , Rats , Rats, Inbred BUF , Remission Induction , Transplantation, Autologous , Whole-Body Irradiation
19.
J Clin Chem Clin Biochem ; 28(8): 513-7, 1990 Aug.
Article in English | MEDLINE | ID: mdl-2258713

ABSTRACT

Twenty two patients with exacerbation of inflammatory bowel disease (19 with Crohn's disease, 3 with ulcerative colitis) and thrombocytosis were tested for possible activation of the coagulation and platelet system. Fifteen patients had abnormal platelet function i.e. unphysiologically high sensitivity in vitro towards ADP 2 mumol/l aggregation induction. In 81.8% of the patients we found enhanced fibrinogen concentrations. In 22.7% of the patients thrombin-antithrombin III values exceeded the upper limit of the reference range, and in 68.2% of the patients the D-Dimer concentration exceeded the upper reference limit as a result of reactive fibrinolysis. The altered platelet count and function, and the increased levels of fibrinogen and thrombin-antithrombin III with reactive fibrinolysis activation indicate the presence of prethrombotic factors in patients with exacerbation of inflammatory bowel disease. The presence of enhanced fibrinolysis in these patients might have consequences for the therapeutic treatment.


Subject(s)
Blood Coagulation/physiology , Blood Platelets/physiology , Fibrinolysis/physiology , Inflammatory Bowel Diseases/blood , Platelet Count , Adult , Antithrombin III/physiology , Enzyme-Linked Immunosorbent Assay , Female , Fibrin/physiology , Fibrinogen/physiology , Humans , Inflammatory Bowel Diseases/physiopathology , Male , Middle Aged , Platelet Aggregation , Thrombin/physiology
20.
Proc Natl Acad Sci U S A ; 86(24): 10090-4, 1989 Dec.
Article in English | MEDLINE | ID: mdl-2690067

ABSTRACT

Total body irradiation followed by bone marrow transplantation was found to be an effective treatment for adjuvant arthritis induced in rats. This treatment is most effective when applied shortly after the clinical manifestation of arthritis--i.e., 4-7 weeks after administration of Mycobacterium tuberculosis. Transplantation of bone marrow at a later stage results in a limited recovery, in that the inflammatory reaction regresses but the newly formed excessive bone is not eliminated. Local irradiation of the affected joints had no effect on the disease. It could also be excluded that the recovery of arthritis following marrow transplantation is due to lack of available antigen. Transplantation of syngeneic bone marrow is as effective as that of allogeneic bone marrow from a rat strain that is not susceptible to induction of adjuvant arthritis. The beneficial effect of this treatment cannot be ascribed to the immunosuppressive effect of total body irradiation, since treatment with the highly immunosuppressive drug Cyclosporin A resulted in a regression of the joint swelling but relapse occurred shortly after discontinuation of the treatment.


Subject(s)
Arthritis, Experimental/surgery , Arthritis/surgery , Bone Marrow Transplantation/immunology , Animals , Arthritis, Experimental/pathology , Arthritis, Experimental/radiotherapy , Bone and Bones/pathology , Cyclosporins/therapeutic use , Female , Rats , Rats, Inbred BUF , Rats, Inbred Strains , Whole-Body Irradiation
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