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Wiesinger T, Elsner D, Gröber M, Stölzel U, Streithoff F. [Abdominal pain and seizure in a 26-year-old student from England]. Internist (Berl) 2021; 62:985-990. [PMID: 34009428 DOI: 10.1007/s00108-021-01029-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 11/24/2022]
Abstract
A 26-year-old female presented to the emergency department due to abdominal pain in spite of painkillers. After extensive clinical diagnostics, no specific cause could be found. The further course was aggravated by a seizure due to hyponatremia. The combination of abdominal and neurological symptoms as well as darkening of the urine led to the diagnosis of porphyria. Drugs that were known to be triggers were avoided and treatment with heme arginate and glucose was started. In addition, treatment of the delirium and infection led to a complete remission of symptoms.
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Affiliation(s)
- T Wiesinger
- III. Medizinische Klinik für Kardiologie, Pneumologie und internistische Intensivmedizin, Klinikum Passau, Innstraße 76, 94032, Passau, Deutschland.
| | - D Elsner
- III. Medizinische Klinik für Kardiologie, Pneumologie und internistische Intensivmedizin, Klinikum Passau, Innstraße 76, 94032, Passau, Deutschland
| | - M Gröber
- III. Medizinische Klinik für Kardiologie, Pneumologie und internistische Intensivmedizin, Klinikum Passau, Innstraße 76, 94032, Passau, Deutschland
| | - U Stölzel
- Klinik für Innere Medizin II, Gastroenterologie, Hepatologie, Diabetologie, Infektiologie, Onkologie, Intensivmedizin, Klinikum Chemnitz, Chemnitz, Deutschland
| | - F Streithoff
- Institut für Radiologie, Klinikum Passau, Passau, Deutschland
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Semen I, Meusch U, Stölzel U, Boese-Landgraf J, Gasser M. Bedeutung des Lymphknotenbefalls bei neoadjuvant vorbehandelten Patienten mit Magenkarzinom. Zentralbl Chir 2016. [DOI: 10.1055/s-0036-1586330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Scherübl H, Faiss S, Jahn HU, Knoefel WT, Liehr RM, Schwertner C, Steinberg J, Stölzel U, Weinke T, Zimmer T, Wardelmann E. [Early asymptomatic GIST of the stomach]. Dtsch Med Wochenschr 2012; 137:1650-3. [PMID: 22875693 DOI: 10.1055/s-0032-1305210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- H Scherübl
- Klinik für Gastroenterologie, GI Onkologie und Infektiologie, Vivantes Klinikum Am Urban, Berlin.
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Scherübl H, Cadiot G, Jensen RT, Rösch T, Stölzel U, Klöppel G. Neuroendocrine tumors of the stomach (gastric carcinoids) are on the rise: small tumors, small problems? Endoscopy 2010; 42:664-71. [PMID: 20669078 DOI: 10.1055/s-0030-1255564] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Well differentiated neuroendocrine tumors (NETs) of the stomach (gastric carcinoid tumors) are observed more often, with a tenfold increase in the US in the last 30 - 35 years, and the prognosis has improved greatly in that time. Nowadays most carcinoids of the stomach are diagnosed at an early stage. Four types of gastric NETs have been proposed and recognition of the type is important for defining the diagnostic approach and treatment. Often gastric NETs (especially type 1) are found incidentally during a gastroscopy performed for other reasons; most of these NETs are smaller than 20 mm in size. Conservative management and endoscopic surveillance is adequate for well differentiated, multifocal gastric carcinoids (type 1 or type 2 gastric NETs) that are less than 10 - 20 mm in diameter, unless they show angioinvasion, infiltrate the muscular wall, or have a proliferation rate above 2 %. Endoscopic ultrasound is the method of choice to determine tumor size and depth of infiltration. It is essential to distinguish between multifocal (types 1 and 2) and unifocal type 3 or type 4 gastric NETs, since surgery is indicated for type 3 gastric NETs larger than 10 mm in diameter and for poorly differentiated (localized) neuroendocrine gastric carcinomas (type 4 gastric NET). For optimal management, the type, biology, and stage of the tumor as well as the individual situation of the patient must be considered. Most patients with well differentiated gastric NETs can be treated conservatively and be followed up with endoscopic surveillance.
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Affiliation(s)
- H Scherübl
- Klinik für Gastroenterologie und GI Onkologie, Vivantes Klinikum Am Urban, Berlin, Germany.
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Scherübl H, Schwertner C, Steinberg J, Stölzel U, Pohl J, Dralle H, Klöppel G. [Neuroendocrine tumors of the small bowels are on the rise: early tumors and their management]. Z Gastroenterol 2010; 48:406-13. [PMID: 20183784 DOI: 10.1055/s-0028-1109862] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Neuroendocrine tumors (NETs) of the small bowels are on the rise: in the US they have increased by 300-500% in the last 35 years. At the same time their prognosis has been much improved. Most NETs of the duodenum are nowadays detected "incidentally" and therefore recognized at an early stage. Duodenal NETs that are well differentiated, not larger than 10 mm in greatest dimension and limited to the mucosa/submucosa can be endoscopically resected. In NETs with a size between 10 mm and 20 mm the therapeutic strategy has to be individually discussed. Endoscopic ultrasound is the method of choice to determine tumor size and depth of infiltration. Surgery is indicated for well differentiated duodenal NETs greater than 20 mm, for localized sporadic gastrinomas and for localized poorly differentiated NE cancers. Surgery is also indicated for localized/regional ileal NETs. Advanced ileal NETs with a carcinoid syndrome are treated with stable somatostatin analogs. This treatment also significantly improves the (progression-free) survival in patients with metastatic NETs of the ileum. For optimal NET management tumor biology, type, localization and stage of the neoplasm as well as the individual situation of the patient have to be taken into account.
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Affiliation(s)
- H Scherübl
- Klinik für Innere Medizin-Gastroenterologie und GI Onkologie, Vivantes Klinikum Am Urban, Berlin.
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Scherübl H, Faiss S, Jahn HU, Liehr RM, Schwertner C, Steinberg J, Stölzel U, Weinke T, Zimmer T, Klöppel G. [Neuroendocrine tumors of the stomach (gastric carcinoids) are on the rise: good prognosis with early detection]. Dtsch Med Wochenschr 2009; 134:1529-35. [PMID: 19603370 DOI: 10.1055/s-0029-1233975] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Neuroendocrine tumors (NET) of the stomach are on the rise. In the United States they have increased about tenfold in the last 35 years. Prognosis has been much improved over the last three to four decades. Nowadays most of such NETs are diagnosed at an early stage. Quite often gastric NETs are found incidentally during a gastroscopy, performed for other reasons. Most of the asymptomatic, well differentiated gastric NETs are less than 2 cm in diameter. Conservative management and endoscopic surveillance is adequate for well differentiated, multifocal type 1 or type 2 gastric NETs (gastric carcinoids) of 10-20 mm , unless they are angio-invasive, have infiltrated into the muscularis propria or have metastasized. Endoscopic ultrasound is the method of choice to determine tumor size and depth of infiltration. Surgery is, however, indicated for all NETs larger than 20 mm. For optimal management tumor biology, type and stage of the neoplasm as well as the individual situation of the patient have to be taken into account. Most of the patients can be treated conservatively and be followed up with endoscopic surveillance.
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Affiliation(s)
- H Scherübl
- Klinik für Gastroenterologie und GI Onkologie, Vivantes Klinikum Am Urban, Berlin.
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Stölzel U, Brosche C, Koszka C, Stauch T, Teubner A, Doss MO. Safe and probably safe drugs in acute hepatic porphyria. Cell Mol Biol (Noisy-le-grand) 2009; 55:147-151. [PMID: 19656463] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Accepted: 05/29/2009] [Indexed: 05/28/2023]
Abstract
Acute porphyrias are caused by enzyme defects along the heme synthesis pathway. Patients usually present with abdominal pain, impaired intestinal motility, neurological and psychiatric symptoms, hypertension, tachycardia, hyponatriemia and reddish urine. This article gives an overview over drugs that are recommended in patients with acute hepatic porphyrias and represents a compilation of four so far existing lists.
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Affiliation(s)
- U Stölzel
- Porphyria Center Saxony, Medizinische Klinik II, Klinikum Chemnitz.
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Jürgensen C, Neser F, Stölzel U. Re: Treatment of a pancreatic endocrine tumor by ethanol injection (PEI) guided by endoscopic ultrasound. Endoscopy 2008; 40:963; author reply 963. [PMID: 19009494 DOI: 10.1055/s-2008-1077632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Schurr R, Stölzel U, Schuppan D, Schwertner C, Steinberg J, Scherübl H. [Increased incidence of hepatocellular and intrahepatic cholangiocellular carcinoma in northeast Germany]. Dtsch Med Wochenschr 2006; 131:1649-55. [PMID: 16850381 DOI: 10.1055/s-2006-947811] [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: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Hepatocellular cancer (HCC) is one of the five most common cancers worldwide. In Western countries the incidence of both HCC and intrahepatic cholangiocellular cancer (iCCC) has increased quite dramatically in the last 20 years. It was the aim of this study to assess the epidemiological changes of both cancers in the Northeast of Germany. METHODS Using the data base of the Joint German Cancer Registry of the New Federal States and of Berlin, the age- and world-population-adjusted incidence of HCC and iCCC and their 5-year survival were calculated. The states of Brandenburg, Mecklenburg-Vorpommern and Saxony were chosen for this study because of the high quality of their registration base. RESULTS In men the age-adjusted incidence of HCC increased from 3.6 in 1976 to 5.7 in 2002, the absolute number of newly diagnosed HCCs rising from 192 to 383 males within this period. In women the incidence was much lower. While only 30 males and 36 females were diagnosed with iCCC in 1976, in 2002 there were 64 men and 75 women with iCCC. In 1976, the corresponding age-adjusted incidence was 0.5 in men and 0.4 in women. Up to 2002 the incidence of iCCC rose to 0.8 and 0.6, respectively. The cumulative 5-year survival of HCC and iCCC was less than 10% for each. Comparison of the early period (1978-1979) with the later one (1998-1999) demonstrated a statistically significant improvement in survival for HCC. This was most likely due to earlier diagnosis and treatment of HCC. CONCLUSION In the Northeast of Germany the incidence of both HCC and iCCC have increased markedly in the last 20 years. The recently improved survival of HCC patients most likely reflects earlier diagnosis and treatment.
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Affiliation(s)
- R Schurr
- Medizinische Klinik I, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin
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Teubner A, Richter M, Schuppan D, Köstler E, Stölzel U. [Hepatitis C, hemochromatosis and porphyria cutanea tarda]. Dtsch Med Wochenschr 2006; 15:35-40. [PMID: 24470839 PMCID: PMC3901625 DOI: 10.12659/ajcr.889955] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 11/02/2013] [Indexed: 01/28/2023]
Abstract
Patient: Male, 47 Final Diagnosis: Porphyria cutanea tarda Symptoms: Chills • cough dry • thumb swelling Medication: — Clinical Procedure: — Specialty: Metabolic Disorders and Diabetics
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Affiliation(s)
- A Teubner
- Sächsisches Porphyriezentrum, Medizinische Klinik II (Gastroenterologie, Hepatologie, Diabetes und Stoffwechsel, Endokrinologie, Infektiologie und Reisemedizin, Onkologie und Internistische Intensivmedizin), Klinikum Chemnitz
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Abstract
Porphyria cutanea tarda (PCT) is characterized by decreased activity of the enzyme uroporphyrinogen decarboxylase (URO-D) and the accumulation of uro- and heptaporphyrins in the liver. Apart from increased alcohol exposure and certain drugs, PCT is associated with antibodies to the hepatitis C virus (HCV), with its prevalence increasing from Northern (8-10%) to Southern Europe (71 to 91%). Chronic HCV-infection is thus considered to be a major trigger for PCT and PCT is said to be an important extrahepatic manifestation of HCV-infection in predisposed individuals. Iron overload is common in PCT. Iron is an inhibitory co-factor of URO-D activity in hepatocytes. Accordingly, in support of the critical role of iron, the clinical efficacy of iron removal is coupled to an improvement of hepatic URO-D activities. Up to two thirds of Saxon patients with PCT carry the classical hemochromatosis (HFE) mutations (C282Y and/or H63D). HFE genotyping can help to further classify patients with PCT and associated hemochromatosis. Simple or compound heterozygosity of HFE mutations does not affect the therapeutic response to chloroquine in PCT. Since Patients carrying homozygous mutations (C282Y/C282Y) with hemochromatosis and PCT do not respond to chloroquine, phlebotomy should be first-line treatment to remove toxic iron.
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Affiliation(s)
- A Teubner
- Sächsisches Porphyriezentrum, Medizinische Klinik II (Gastroenterologie, Hepatologie, Diabetes und Stoffwechsel, Endokrinologie, Infektiologie und Reisemedizin, Onkologie und Internistische Intensivmedizin), Klinikum Chemnitz
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Gericke G, Liebert A, Willenberg HS, Stölzel U. Mineralocorticoid hypertension, bilateral adrenal masses and secondary osteoporosis in a patient with a newly identified steroid-17α-hydroxylase gene defect. Exp Clin Endocrinol Diabetes 2006. [DOI: 10.1055/s-2006-932896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wiegand J, Kaiser T, Lobstein S, Brand F, Wojan M, Stölzel U, Liebert UG, Mössner J, Tillmann HL. Low prevalence of chronic hepatitis C, but high prevalence of elevated aminotransferases in a cohort of 2026 patients referred for orthopaedic surgery in the eastern part of Germany. Z Gastroenterol 2006; 44:11-4. [PMID: 16397834 DOI: 10.1055/s-2005-858876] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
INTRODUCTION The prevalence of chronic hepatitis C in Germany is about 0.2 - 0.4 %. However, there seems to be regional differences between western and eastern states of the country. Thus, the present study analysed the prevalence of chronic hepatitis C in a cohort of orthopaedic patients in Thuringia. METHODS Tests for antibodies against hepatitis C virus (anti-HCV) were performed on serum samples of 2026 patients (1183 females, 843 males) admitted for orthopaedic surgery to a university hospital in Thuringia. If anti-HCV was positive, serum was tested for HCV-RNA by polymerase chain reaction (PCR). For the sake of anonymity only age and gender were reported in all patients. In 1465 cases, values of alanine (ALT) and aspartate (AST) aminotransferases were additionally available. The low HCV prevalence was confirmed in a second cohort of orthopaedic patients (n = 929, 599 females, 330 males) investigated at a university hospital in Saxonia. RESULTS In the Thuringian cohort, anti-HCV was detectable in 12/2026 (0.6 %) individuals (10 females (0.85 %) and 2 males (0.24 %: p = 0.14 %). HCV-RNA was positive in 3/10 of anti-HCV positive females (0.15 % of the study cohort). HCV infection was already known in two cases. Anti-HCV positive patients seemed to be older than anti-HCV negative individuals (64.25 vs. 59.48 years; p = 0.17), as well as HCV-RNA positive cases compared to non-viraemic patients (66.3 vs. 63.6 years; p = 0.32). All HCV-RNA positive females had elevated ALT values. However, ALT and AST were also elevated in 18.2 % and 11.7 % of anti-HCV negative individuals. There was no significant difference between males and females (p = 0.32). In the Saxonian cohort none of 929 individuals were HCV positive. CONCLUSION The prevalence of chronic hepatitis C is low in the investigated cohorts of orthopaedic patients in Thuringia and Saxonia. However, elevation of aminotransferases occurs surprisingly often. The reasons for elevated aminotransferases and a reliable analysis of the HCV prevalence in different subgroups of the Eastern German population require further evaluation.
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Affiliation(s)
- J Wiegand
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Leipzig
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Stölzel U, Teubner A, Ernstberger J, Habeck JO, Schuppan D. Isolated elevation of gGT: what should be the diagnostic approach? Dtsch Med Wochenschr 2004; 129 Suppl 2:S54-6. [PMID: 15368168 DOI: 10.1055/s-2004-831371] [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: 10/26/2022]
Affiliation(s)
- U Stölzel
- Medizinische Klinik II, Gastroenterologie, Hepatologie, Diabetes und Stoffwechsel, Endokrinologie, Infektiologie und Reisemedizin, Onkologie und Internistische Intensivmedizin, Klinikum Chemnitz gGmbH.
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Capka E, Jürgensen C, Koszka C, Kulamarva G, Tannapfel A, Stölzel U. Endoscopic aspiration mucosectomy: a possibility for curative therapy of early gastric cancer. Dig Dis Sci 2003; 48:1088-93. [PMID: 12822867 DOI: 10.1023/a:1023760627955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- E Capka
- Department of Gastroenterology, Metabolic Disorders, Endocrinology, Oncology and Infectiology, Medizinische Klinik II, Klinikum Chemnitz, Teaching Hospital of the University of Leipzig, 09009 Chemnitz, Germany
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Tannapfel A, Stölzel U, Köstler E, Melz S, Richter M, Keim V, Schuppan D, Wittekind C. C282Y and H63D mutation of the hemochromatosis gene in German porphyria cutanea tarda patients. Virchows Arch 2001; 439:1-5. [PMID: 11499833 DOI: 10.1007/s004280100401] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [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: 12/16/2022]
Abstract
BACKGROUND AND AIMS Patients with porphyria cutanea tarda (PCT) have a susceptibility to reversible inactivation of hepatocyte uroporphyrinogen decarboxylase, which can be triggered by alcohol, hepatitis C virus, and other agents. Inherited factors that may predispose to PCT include the C282Y mutation in the hemochromatosis (HFE) gene. METHODS We analyzed the hemochromatosis mutations C282Y and H63D in liver biopsies and serum samples of 190 German patients (mean age 48+/-12.5 years) with sporadic PCT. The hepatic iron concentration was determined within the liver tissue. Age-matched healthy blood donors (115 donors) served as controls. RESULTS The C282Y and H63D mutations were found in 75 (39%) and 85 (45%) of 190 patients with PCT, respectively. Twenty-two patients (12%) were homozygous for the C282Y mutation, and eighteen patients (9%) were compound heterozygotes, displaying both the C282Y and the H63D mutation. Within the control group, 3 of 115 patients were heterozygous for C282Y (3%) and 12 for H63D (10%). Serum and hepatic iron, ferritin, transferrin saturation, or liver enzymes did not differ significantly between patients with or without HFE mutations. CONCLUSIONS The high frequency of homo- and heterozygosity for the C282Y and H63D alleles strongly suggests that these mutations are important predisposing factors for PCT in German patients.
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Affiliation(s)
- A Tannapfel
- Institute of Pathology, University of Leipzig, Germany
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Stölzel U, Schuppan D, Tillmann HL, Manns MP, Tannapfel A, Doss MO, Zimmer T, Koszka C, Köstler E. Autoantibodies in porphyria cutanea tarda: a controlled study. J Hepatol 2000; 33:858-9. [PMID: 11097501 DOI: 10.1016/s0168-8278(00)80324-4] [Citation(s) in RCA: 2] [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: 12/04/2022]
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Stölzel U, Tannapfel A. [Indications for liver biopsy in liver tumors]. Zentralbl Chir 2000; 125:606-9. [PMID: 10960970] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Significant progress has been made in the assessment of liver dysfunction by application of non-invasive physical and biochemical test procedures. However, liver biopsy remains an important tool for diagnosis, evaluation and prognosis of chronic liver diseases and hepatic neoplasms. Liver biopsy results are most useful when the biopsy is performed for well-defined indications following a complete work-up of the patient. In case of lesions highly suspicious for hepatocellular carcinoma, a biopsy should be performed in case surgical (curative) treatment is no option. Thus for the planning of a surgical intervention, biopsy of the tumor is not necessary. In case of concomitant liver cirrhosis, a biopsy taken from the non-neoplastic (cirrhotic) liver may help to assess the functional capacity or to clarify the etiology. Metastases of the liver with unknown primary tumor should be biopsied to obtain information of the primary tumor and the potential for cytostatic therapy. In case of hemangioma or focal nodular hyperplasia, diagnosed and confirmed by radiology or ultrasound, biopsy is usually not necessary. Concern has been expressed about seeding of the needle tract with malignant cells. Indeed, such instances have been recorded with various carcinomas, but they remain rare events and are seldom of clinical importance. With the use of needles with diameter < 1.3 mm to minimise also the risk of bleeding, the procedure is simple, safe and painless.
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Affiliation(s)
- U Stölzel
- Abteilung für Innere Medizin, Gastroenterologie und Infektiologie, Dr. Drogula GmbH, Krankenhaus Döbeln.
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Abstract
Neuroendocrine tumours (NETs) of the upper gastrointestinal tract are mainly located in the pancreas, stomach or duodenum. The aims of preoperative work-up are the localization of primary tumour(s), determination of local tumour invasion, of lymph node metastases and of the hormones secreted by the tumour. Endoscopic ultrasonography (EUS) offers ideal conditions to localize and stage NETs of the foregut. We report our results in localizing and staging NETs of the foregut in 40 patients examined between 1990 and 1997 by EUS, somatostatin receptor scintigraphy (SRS), computed tomography (CT), magnetic resonance imaging (MRI) and transabdominal ultrasound (US). EUS shows the highest sensitivity in localizing insulinomas compared with SRS, US, CT and MRI. US and EUS should be the first-line diagnostics if insulinoma has been proven by a fasting test. Further diagnostic procedures are unnecessary in most cases. Further diagnostics such as CT or MRI to search for distant metastases are necessary in large tumours or local invasive tumours. EUS shows the highest accuracy to detect or exclude pancreatic gastrinomas, but fails to detect extrapancreatic gastrinomas in about 50%. The combination of EUS and SRS gives additional information. First-line diagnostics in gastrinoma patients should be SRS and CT or MRI. If no metastases are detected, EUS should be the next preoperative imaging procedure. In nonfunctional NETs, EUS provides the best information on local tumor invasion and regional lymph node involvement.
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Affiliation(s)
- T Zimmer
- Department of Internal Medicine/Gastroenterology, Klinikum Benjamin Franklin, Freie Universität Berlin, Germany
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Stölzel U, Tannapfel A, Wittekind C, Hamm B, Schuppan D. [Indications for liver biopsy in liver tumors]. Dtsch Med Wochenschr 2000; 125:1041-4. [PMID: 11022600 DOI: 10.1055/s-2000-7210] [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: 10/16/2022]
Affiliation(s)
- U Stölzel
- Abteilung für Innere Medizin, Gastroenterologie und Infektiologie, Krankenhaus Döbeln.
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Leinung S, Gütz U, Stölzel U, Klengel S, Schwarze J. [Peliosis hepatis: problems of differential diagnosis]. Rontgenpraxis 2000; 52:295-301. [PMID: 10936959] [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: 04/15/2023]
Abstract
Peliosis hepatis is a syndrome manly known to internists and pathologists. It is described as roundish blood cysts up to 1 cm large to the found in the hepatic parenchyma and correlated to the hepatic sinusoids. The pathogenesis is still unclear. The presumably essential disturbance of the structure of the reticular fibres is etiologically associated with anabolic and androgenic steroid therapy. Peliosis hepatis is pathognomonic for treatment with contraceptives and for severe chronic diseases, as tuberculosis or tumour. Little is known of therapeutic methods on the diagnostic of peliosis alterations in the liver. As peliosis-type hepatic lesions are apt to involution, it is generally recommended just to wait and see, with controlling examinations for imaging diagnostics. A case is described where a female patient, aged 42, otherwise healthy, came to see the doctor for obscure pain in the upper abdomen. Sonography of the upper abdomen indicated multiple lesions. The diagnostic method is described taking into account possible malign differential diagnoses or associated malign results which finally lead to partial resection of the liver.
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Affiliation(s)
- S Leinung
- Chirurgische Abteilung, Kreiskrankenhaus Oschatz gGmbH.
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23
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Jahn HU, Jopke F, Stölzel U, Weinke T. [Primary sclerosing cholangitis. Treatment and prognosis]. Dtsch Med Wochenschr 1998; 123:1317-9. [PMID: 9824968 DOI: 10.1055/s-2007-1023872] [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: 10/21/2022]
Affiliation(s)
- H U Jahn
- Abteilung für Gastroenterologie und Infektiologie, Klinikum Ernst von Bergmann Potsdam
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24
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Zimmer T, Rucktäschel F, Stölzel U, Liehr RM, Schuppan D, Stallmach A, Zeitz M, Weber E, Riecken EO. Endoscopic sclerotherapy with fibrin glue as compared with polidocanol to prevent early esophageal variceal rebleeding. J Hepatol 1998; 28:292-7. [PMID: 9514542 DOI: 10.1016/0168-8278(88)80016-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [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: 02/06/2023]
Abstract
BACKGROUND/AIMS Endoscopic sclerotherapy is of proven benefit for patients after esophageal variceal bleeding, but is associated with substantial local and systemic complications. Since fibrin glue is a promising agent for endoscopic sclerotherapy of esophageal varices, we compared its safety and efficacy in patients after esophageal variceal bleeding. PATIENTS AND METHODS In a randomized, controlled trial, 36 patients with an acute episode of variceal bleeding were endoscopically treated with either polidocanol (18 patients) or fibrin glue (18 patients) by intravariceal injections within 12 h of admission. Tissue compatibility, incidence of various complications, episodes of rebleeding and overall survival rates were investigated. RESULTS Rebleeding, especially from enrollment to day 28, was less common in the fibrin group (p=0.046), and all patients treated with fibrin glue survived for more than 28 days, whereas five patients treated with polidocanol died within this period. The incidence of sclerotherapy-induced ulcers was significantly lower in the fibrin group than in the polidocanol group (p=0.001), and major complications such as perforation or ulcer bleeding were observed only in the polidocanol group. There were no complications in any group due to activation of systemic coagulation, fibrinolysis or clinically relevant pulmonary embolization. CONCLUSIONS We conclude that fibrin glue is an efficient and safe agent for endoscopic sclerotherapy of bleeding esophageal varices, especially in the immediate posthemorrhagic period.
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Affiliation(s)
- T Zimmer
- Department of Gastroenterology, Universitätsklinikum Benjamin Franklin, Free University of Berlin, Germany
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25
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Hemmen T, Stölzel U, Höffken G, Vesper J, Sieper J, Distler A, Braun J. [Costosternal swelling and diffuse bone pain in tubercular osteomyelitis]. Dtsch Med Wochenschr 1997; 122:610-4. [PMID: 9182026 DOI: 10.1055/s-2008-1047663] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
HISTORY AND CLINICAL FINDINGS For about a year a 28-year-old Nigerian had been suffering from diffuse bone pain, intermittent fever, weight loss and weakness. Physical examination was unremarkable except for a swelling at the sternal angle. INVESTIGATIONS The tuberculin test was clearly positive and tests for inflammatory disease were elevated, but the chest radiograph was normal. Bone scintigraphy demonstrated multiple sites of increased storage in the ribs and vertebral column. Magnetic resonance imaging revealed a large paravertebral abscess, which was needled under computed tomography monitoring. Polymerase chain reaction of the aspirate demonstrated Mycobacterium tuberculosis. TREATMENT AND COURSE While initial treatment with combined isoniazid, streptomycin, rifampicin and pyrazinamide, the first two drugs had to be discontinued, the microorganism not being sensitive to them, and were replaced by ethambutol and amikacin. The abscess was drained and the vertebral fracture surgically stabilised. There were no neurological abnormalities and the lesions largely healed. CONCLUSION Even without pulmonary involvement tuberculosis must be included in the differential diagnosis of rheumatic diseases with joint and vertebral column involvement, such as the SAPHO syndrome and other inflammatory bone diseases.
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Affiliation(s)
- T Hemmen
- Abteilung für Allgemeine Innere Medizin, Universitätsklinikum Benjamin Franklin, Freien Universität Berlin
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26
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Zimmer T, Stölzel U, Bäder M, Koppenhagen K, Hamm B, Buhr H, Riecken EO, Wiedenmann B. Endoscopic ultrasonography and somatostatin receptor scintigraphy in the preoperative localisation of insulinomas and gastrinomas. Gut 1996; 39:562-8. [PMID: 8944566 PMCID: PMC1383270 DOI: 10.1136/gut.39.4.562] [Citation(s) in RCA: 155] [Impact Index Per Article: 5.5] [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: 02/03/2023]
Abstract
BACKGROUND Endoscopic ultrasonography (EUS) and somatostatin receptor scintigraphy (SRS) can detect a high percentage of gastroenteropancreatic neuroendocrine tumours especially in the upper gastrointestinal tract. The ability of these procedures to localise primary tumour lesions and metastases of gastrinomas and insulinomas was evaluated in comparison with transabdominal ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI). PATIENTS AND METHODS In a prospective trial, patients with gastrinomas (n = 10) and insulinomas (n = 10) diagnosed by clinical signs and laboratory tests were assessed by EUS, SRS, US, CT and MRI. RESULTS In 10 patients with gastrinoma and 10 patients with insulinoma, a total of 14 separate primary tumour lesions were histologically confirmed for each of the tumour entities. The mean diameter was 2.1 cm for gastrinomas and 1.5 cm for insulinomas. All insulinomas and nine gastrinoma lesions were located in the pancreas. Three gastrinomas were found in the duodenal wall, one in a periduodenal lymph node, and one in the liver, For gastrinomas, sensitivities were 79% with EUS, 86% with SRS and 29% with CT, US, and MRI. For insulinomas, sensitivities were 93% with EUS, 14% with SRS, 21% with CT and 7% with US and MRI. CONCLUSIONS EUS is of high value for localising primary lesions of both tumour entities. SRS is a very sensitive procedure for diagnosing of gastrinomas but not insulinomas. CT, US and MRI are primarily useful for visualising metastases.
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Affiliation(s)
- T Zimmer
- Departmnt of Internal Medicine/Gastroenterology, Klinikum Benjamin Franklin, Frele Universität Berlin, Germany
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27
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Orzechowski HD, Beckenbach C, Herbst H, Stölzel U, Riecken EO, Stallmach A. Expression of CD44v6 is associated with cellular dysplasia in colorectal epithelial cells. Eur J Cancer 1995; 31A:2073-9. [PMID: 8562168 DOI: 10.1016/0959-8049(95)00452-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [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: 01/31/2023]
Abstract
There is increasing evidence that the expression of variants of the glycoprotein CD44 is related to the invasive and metastatic potential of tumour cells. By in situ hybridisation, we analysed the cellular expression of human homologues of a rat metastasis-associated CD44 variant v6 in invasive and non-invasive colorectal neoplasia and normal colonic mucosa. No specific hybridisation signals could be detected in epithelial cells of the normal crypt (n = 10). In contrast, we found moderate epithelial hybridisation signals in adenomatous polyps of mild dysplasia (n = 6). Adenoma cells of moderate or severe dysplasia (n = 7) showed increased hybridisation signals compared to mildly dysplastic adenomas (P < or = 0.01). We could not demonstrate significant differences in CD44v6 transcript levels between cells of dysplastic adenoma and primary adenocarcinoma (n = 11) (P > or = 0.05). Furthermore, we were not able to demonstrate a significant difference between primary and metastatic tumours (n = 7) (P > or = 0.05). However, there was a significant difference between metastatic carcinoma and adenomas with advanced dysplasia (P < or = 0.01). Our data demonstrate that significant transcriptional expression of CD44v6 is not confined to invasive tumour cells, but is already detectable in cells of adenomatous polyps showing mild dysplasia. The results of this study show a close relationship between cellular dysplasia and steady state levels of CD44 variant v6 transcripts in colorectal neoplasms.
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Affiliation(s)
- H D Orzechowski
- Free University of Berlin, Benjamin Franklin Klinikum, Department of Medicine, Germany
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28
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Zimmer T, Stölzel U, Bäder M, Fett U, Foss HD, Riecken EO, Rehfeld JF, Wiedenmann B. Brief report: a duodenal gastrinoma in a patient with diarrhea and normal serum gastrin concentrations. N Engl J Med 1995; 333:634-6. [PMID: 7637724 DOI: 10.1056/nejm199509073331005] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- T Zimmer
- Department of Gastroenterology, Klinikum Benjamin Franklin, Free University of Berlin, Germany
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29
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Stölzel U, Köstler E, Koszka C, Stöffler-Meilicke M, Schuppan D, Somasundaram R, Doss MO, Habermehl KO, Riecken EO. Low prevalence of hepatitis C virus infection in porphyria cutanea tarda in Germany. Hepatology 1995; 21:1500-3. [PMID: 7539393 DOI: 10.1002/hep.1840210604] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.1] [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: 01/25/2023]
Abstract
Previous studies from Spain, Italy, and France have demonstrated a high prevalence (71% to 91%) of antibodies against hepatitis C virus in patients with porphyria cutanea tarda (PCT). To determine the role of hepatitis C virus (HCV) in PCT in Germany, we have assessed the prevalence of antibodies against HCV and hepatitis B virus (HBV) in 106 patients (mean age, 60 +/- 14 years) with the disease. Eight of 106 patients (8%) were positive for HCV antibodies and HCV RNA using second-generation enzyme-linked immunosorbent assay (ELISA), recombinant immunoblot assay, and polymerase chain reaction. Antibodies against HBV core antigen were found in 14 patients (13%). Of the patients with antibodies against HCV alanine transaminase (ALT) (aspartate transaminase [AST]) levels above normal occurred in 71% (86%). Because elevated ALT (AST) levels were also found in 51% (64%) of 88 patients without markers of HCV or HBV, we suggest that liver damage in PCT may exist in absence of these viruses. This is supported by the finding that in patients without HCV or HBV markers, higher serum ALT and AST activities were found in patients with overt disease or relapse (ALT, 59 +/- 44 U/L; AST, 37 +/- 21 U/L), whereas patients in remission displayed significantly lower serum enzyme activities (ALT, 16 +/- 8 U/L; AST, 16 +/- 7 U/L), (P < .001). These results indicate that HCV infection does not play a major role in the pathogenesis of PCT in Germany.
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Affiliation(s)
- U Stölzel
- Department of Gastroenterology, Universitätsklinikum Benjamin Franklin, Free University of Berlin, Germany
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30
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Zimmer T, Stölzel U, Liehr RM, Bäder M, Fett U, Hamm B, Wiedenmann B, Riecken EO. [Somatostatin receptor scintigraphy and endoscopic ultrasound for the diagnosis of insulinoma and gastrinoma]. Dtsch Med Wochenschr 1995; 120:87-93. [PMID: 7835241 DOI: 10.1055/s-2008-1047641] [Citation(s) in RCA: 8] [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: 01/27/2023]
Abstract
In a prospective study of 13 patients (three males and 10 females; mean age 53 [8-82] years) the value of somatostatin receptor scintigraphy (SRS) and endoscopic ultrasonography (EUS) was compared with transabdominal ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of insulinoma (six patients) or gastrinoma (seven patients). There were ten separate primary lesions of each tumour type, proven histologically. For insulinoma the sensitivity of EUS was 90%, SRS 10% and CT, US and MRI together 20%. For gastrinoma the sensitivity of EUS was 90%, SRS 100%, and 30% for the other three methods together. Thus EUS had a high diagnostic localizing sensitivity for both tumours, while SRS was highly sensitive only in the diagnosis of gastrinoma, not insulinoma. The value of CT, MRI and conventional ultrasonography lies in their ability to visualize distant metastases.
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Affiliation(s)
- T Zimmer
- Abteilung für Innere Medizin mit Schwerpunkt Gastroenterologie, Medizinische Klinik und Poliklinik, Universitätsklinikum Benjamin Franklin, Berlin
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31
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Schuppan D, Stölzel U, Oesterling C, Somasundaram R. Serum assays for liver fibrosis. J Hepatol 1995; 22:82-8. [PMID: 7545196] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- D Schuppan
- Department of Gastroenterology and Hepatology, Klinikum Steglitz, Free University of Berlin, Germany
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32
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Abstract
Neuroendocrine tumors (NETs) of the foregut type are frequently smaller than 2 cm in diameter and mainly located in the pancreas or the gastric and duodenal wall. Conventional cross-sectional imaging techniques, such as transabdominal ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) are limited by their inability to detect small tumors and especially those located within the gastrointestinal wall. Endoscopic ultrasonography (EUS) allows detailed visualization of the whole pancreas and almost all parts of the gastric and duodenal walls. Therefore, EUS is an important diagnostic tool for the preoperative localization of NETs of the foregut type. Several studies performed in a retrospective manner, as well as two studies performed in a prospective manner, indicate a clear superiority of EUS as compared to CT, US, MRI, and also angiography in detecting NETs of the foregut type. Somatostatin-receptor scintigraphy (SRS) also detects NETs of the foregut type in a very high percentage of cases, and the combination of EUS and SRS appears to increase the sensitivity even more. Thus EUS and also SRS should be employed early if NETs of the foregut type are suspected. Conventional imaging procedures such as US, CT, and MRI should be mainly used to exclude local and distant metastases.
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Affiliation(s)
- T Zimmer
- Department of Internal Medicine, Steglitz Medical Center, Free University of Berlin, Germany
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33
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Stölzel U, Koszka C, Wölfer B, Kleine U, Pommerien W, Riecken EO. Relief of heterogeneous symptoms after successful gall bladder stone lithotripsy and complete stone disappearance. Gut 1994; 35:819-21. [PMID: 8020812 PMCID: PMC1374886 DOI: 10.1136/gut.35.6.819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 01/28/2023]
Abstract
The symptoms of 100 patients with gall bladder stone disease were prospectively analysed before and after successful treatment with extracorporeal shock wave lithotripsy (ESWL) and oral bile acids. This is of considerable clinical interest because complaints after cholecystectomy persist in 21-47% of patients (postcholecystectomy syndrome). Before ESWL, 37 patients had unspecific abdominal symptoms (feeling of fullness and pressure, or slight pain, or both, in the right upper abdomen, flatulence, nausea, or food intolerance) and 63 patients had typical biliary symptoms (severe steady pain of more than 15 minutes and less than five hours duration in the right upper abdomen, in some cases radiating to the epigastrium or the back) either exclusively or with unspecific abdominal complaints. After becoming stone free, 72 of 100 patients lost the symptoms they had before treatment. All 28 patients with persisting symptoms had unspecific abdominal symptoms before treatment (exclusively unspecific symptoms and unspecific plus typical biliary symptoms). In contrast, patients with typical biliary symptoms before ESWL lost these in 95% of all cases. Although the anatomical structures are left intact after ESWL, the percentages of stone free patients with persisting symptoms are similar to those after cholecystectomy.
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Affiliation(s)
- U Stölzel
- Department of Gastroenterology, Klinikum Steglitz, Free University of Berlin, Germany
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34
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Stölzel U, Koszka C, Gregor M, Ziegler K, Zimmer T, Riecken EO. Lithotripsy of an impacted calcified stone in the cystic duct accompanied by cholecystitis in severe Crohn's disease. Gut 1993; 34:1145-7. [PMID: 8174971 PMCID: PMC1374372 DOI: 10.1136/gut.34.8.1145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 01/29/2023]
Abstract
A 35 year old women patient with Crohn's disease and previous multiple abdominal operations presented with a calcified stone of 12 mm diameter in the cystic duct giving rise to cholecystitis. The surgeons declined to operate because of extensive intra-abdominal adhesions caused by multiple intestinal resections and chronic enterocutaneous fistulas. It was possible to fragment the stone in three lithotripsy sessions. The fragments were excreted spontaneously through the ductus choledochus and the cholecystitis was cured by antibiotic treatment. The patient remained symptom free after 12 months.
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Affiliation(s)
- U Stölzel
- Department of Gastroenterology, Klinikum Steglitz, Free University of Berlin, Germany
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35
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Siepmann M, Stölzel U, Sieg I, Leo-Rossberg I, Riecken EO, Doss MO. [Cimetidine in treatment of acute intermittent porphyria]. Z Gastroenterol 1993; 31:246-9. [PMID: 8493805] [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: 01/31/2023]
Abstract
Two female patients with repeated exacerbations of acute intermittent porphyria (20 exacerbations in 44 and 5 in 34 months, respectively) were treated with cimetidine (2 x 400 mg/d) over 4 months. Therapeutical aim of the medication was to prevent further porphyria manifestations. In contrast to previous casuistic reports and experimental studies in laboratory animals cimetidine did not stabilize porphyrin biosynthesis. One patient had an acute attack during the period of treatment, while the other had no further exacerbations. However, cimetidine did not worsen the clinical course of our patients either and therefore can safely be applied as an H2-antagonist in patients with acute intermittent porphyria. While administration of glucose and heme-preparations is considered to be an effective form of therapy for the acute episodes, long-lasting as well as prophylactic therapies in order to stabilize the period of remission are not known so far.
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Affiliation(s)
- M Siepmann
- Medizinische Klinik und Poliklinik mit Schwerpunkt Gastroenterologie, Universitätsklinikum Steglitz Berlin, Freien Universität Berlin
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36
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Frohburg E, Stölzel U, Lenz K, Schäfer JH, Tung LC, Riecken EO. Prognostic indicators in fulminant hepatic failure. Z Gastroenterol 1992; 30:571-5. [PMID: 1449004] [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: 12/27/2022]
Abstract
Because of the inhomogeneous prognosis in fulminant hepatic failure, prognostic criteria are required which help to establish the indication for liver transplantation as a successful therapeutic procedure. In our study of 33 patients with fulminant hepatic failure (94% viral hepatitis, 67% hepatitis B), serum bilirubin > 320 or < 160 mumol/L, serum creatinine > 110 mumol/L, prothrombin time < 15% of the normal value and duration of jaundice until onset of encephalopathy > 7 days indicated a fatal outcome. When criteria described by O'Grady et al. were used, only limited predictability was achieved. This, as well as the frequently contradictory results of the few prognostic studies published so far, is probably due to the regional differences in the etiology and the different clinical courses of fulminant hepatic failure.
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Affiliation(s)
- E Frohburg
- Department of Gastroenterology, Medical Center Steglitz of the Free University of Berlin, Bundesrepublik Deutschland
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37
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Stölzel U, Lenz K, Gregor M, Arntz R, Tung LC, Riecken EO. [Combination therapy of gallbladder stones using extracorporeal shock waves and bile acids: results in relation to stone diameter and stone number]. Z Gastroenterol 1992; 30:121-4. [PMID: 1553825] [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: 12/27/2022]
Abstract
420 patients were referred to our center for gallstone lithotripsy. 97 patients (23%) with radiolucent gallbladder stones (total diameter less than or equal to 3 cm) and intact gallbladder function were found suitable for extracorporal shock-wave lithotripsy. Disintegration of gallbladder stones was achieved in 92 of the 97 patients (95%). Chenodeoxycholic acid and ursodeoxycholic acid were used as adjuvant litholytic therapy. The therapeutic results were evaluated cumulatively in 90 patients after a follow-up of 10 months. 80% of patients with solitary stones (less than or equal to 20 mm in diameter (n = 46) had a stone-free gallbladder, whereas patients with solitary stones greater than 2 cm, less than or equal to 3 cm in diameter (n = 20) and multiple stones (n = 22) became stone-free in only 28% (p less than 0.01). During the observation period 21 patients (23%) experienced biliary colics, 2 (2%) mild pancreatitis, 2 (2%) showed fragment impaction in the common bile duct, and 17 (19%) displayed transient microscopic hematuria. Our results confirm previous studies showing that solitary stones sized up to 2 cm in diameter represent the best suited subgroup for extracorporeal shock-wave lithotripsy.
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Affiliation(s)
- U Stölzel
- Freie Universität Berlin, Klinikum Steglitz
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38
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Stölzel U, Schiffter R, Sörensen R, Karsten M, Kaiser D, Dissmann T, Riecken EO. [Sympathectomy in causalagia pain caused by arteriovenous malformations of the upper extremity]. Med Klin (Munich) 1988; 83:470-2. [PMID: 3216818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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39
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Stölzel U, Doss MO, Dissmann T, Cervós-Navarro J, Riecken EO. [Gastroenterologic and neurologic manifestations in acute intermittent porphyria]. Med Klin (Munich) 1987; 82:520-5. [PMID: 3627033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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40
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Frank KH, Stölzel U. [Serologic determination of non-A, non-B hepatitis]. Z Gesamte Inn Med 1983; 38:33-5. [PMID: 6410598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
As to the antigens of hepatitis non-A non-B there are controversial opinions concerning existence and demonstrability. Up to now they were not successful neither in standardizing nor in unifying their test systems. On the basis of own investigations of 1,600 sera of patients with hepatitis non-A non-B and of several control groups, no doubt, a high incidence of precipitations among the sera of hepatitis non-A non-B could be established, but we did not succeed in standardizing the material which was uniform also with regard to the causing virus. Since real antigen-antibody reactions are causative for the heterogeneous phenomena, there nature is to establish by means of suitable methods (methods of the 3rd generation, monoclonal antibodies).
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