Effective treatment of gastrointestinal bleeding with thalidomide--Chances and limitations.

For more than 50 years bleeding from gastrointestinal angiodysplasias has been treated by hormonal therapy with estrogens and progesterons. After a randomized study finally demonstrated that hormones have no effect on bleeding events and transfusion requirements, therapy has switched to endoscopic coagulation. However, angiodysplasias tend to recur over months to years and endoscopy often has to be repeated for long time periods.

Intestinal congestion and right ventricular dysfunction: a link with appetite loss, inflammation, and cachexia in chronic heart failure.

Aims: Mechanisms leading to cachexia in heart failure (HF) are not fully understood. We evaluated signs of intestinal congestion in patients with chronic HF and their relationship with cachexia.

Methods And Results: Of the 165 prospectively enrolled outpatients with left ventricular ejection fraction ≤40%, 29 (18%) were cachectic.

Intestinal blood flow in patients with chronic heart failure: a link with bacterial growth, gastrointestinal symptoms, and cachexia.

Background: Blood flow in the intestinal arteries is reduced in patients with stable heart failure (HF) and relates to gastrointestinal (GI) symptoms and cardiac cachexia.

Objectives: The aims of this study were to measure arterial intestinal blood flow and assess its role in juxtamucosal bacterial growth, GI symptoms, and cachexia in patients with HF.

Methods: A total of 65 patients and 25 controls were investigated.

Radiofrequency thermal ablation of hepatic metastases of adrenocortical cancer--a case report and review of the literature.

Aim: Radiofrequency thermal ablation (RFA) has shown promise as a technique for treating solid tumors. This method has been suggested as an alternative to surgery in patients with adrenocortical carcinoma (ACC).

Materials And Methods: We reviewed the literature, and report the case of a patient with stage 4 ACC who received intraoperative and percutaneous RFA of two liver metastasis according to a standard ablation protocol.

Hepatic 11beta-HSD1 mRNA expression in fatty liver and nonalcoholic steatohepatitis.

Context: Nonalcoholic fatty liver disease represents the hepatic manifestation of the metabolic syndrome. Nonalcoholic steatohepatitis (NASH) is the progressive form of liver injury. The pathophysiology that leads to NASH is not well understood.

Improved detection of hepatic metastases of adrenocortical cancer by contrast-enhanced ultrasound.

Adrenocortical carcinoma (ACC) is a rare and heterogeneous malignancy whose pathogenesis and poor prognosis is poorly understood. Computerized tomography (CT) and magnetic resonance imaging (MRI) are routinely performed for the imaging of the adrenal mass and for standard staging of the chest and abdomen as the lung and liver are the primary organs for metastasis in ACC. Contrast-enhanced ultrasound has been shown to have a high sensitivity and specifity for the differentiation of hepatic and neuroendocrine tumors.

Severe weight loss caused by chewing gum.

Sorbitol intake should be considered in patients with bowel problems, chronic diarrhoea, and weight loss

Angiogenesis and vascular malformations: antiangiogenic drugs for treatment of gastrointestinal bleeding.

Treatment of gastrointestinal bleeding in patients with angiodysplasias and Osler's disease (hereditary hemorrhagic teleangiectasia) is clinically challenging. Frequently, vascular malformations occur as multiple disseminated lesions, making local treatment an unfavorable choice or impossible. After local therapy, lesions often recur at other sites of the intestine.

Altered intestinal function in patients with chronic heart failure.

Objectives: We evaluated morphology and function of the gut in patients with chronic heart failure (CHF).

Background: Intestinal translocation of bacterial endotoxin may contribute to the inflammatory state observed in patients with CHF. The morphology and function of the gut may be abnormal.

[Long-term follow-up of patients with suprasellar germinomas].

Background: Suprasellar germinomas are rare intracranial neoplasms, which mainly occur in children and adolescents and manifest with endocrine symptoms and/or compression syndromes.

Patients And Methods: The clinical, hormonal and morphological findings as well as treatment and complications were investigated in seven patients (six male, one female) with germinomas.

Results: Mean age at diagnosis was 19.

[Sonographic diagnosis of hilar cholangiocarcinomas by the use of contrast agents].

Purpose: Imaging of hilar cholangiocarcinomas (Klatskin tumour) is very difficult as these tumours spread along the bile ducts and are hardly distinguishable from the surrounding liver parenchyma. Improved imaging techniques are useful for diagnosis and monitoring of new treatment strategies like photodynamic therapy. In a prospective study, we investigated whether contrast-enhanced sonography is useful in the imaging of Klatskin tumours.

Osteoclast-like giant cell tumors of the pancreas and liver.

Osteoclast-like giant cell tumors (OGCT) are rare abdominal tumors, which mainly occur in the pancreas. The neoplasms are composed of two distinct cell populations and frequently show an inhomogenous appearance with cystic structures. However, due to the rarity of these tumors, only very limited clinical data are available.

Macroscopic appearance of intestinal angiodysplasias under antiangiogenic treatment with thalidomide.

Background And Study Aims: Angiodysplasias are the main cause of bleeding from the small intestine. Single lesions may be treated by endoscopic coagulation or surgical resection. However, multiple disseminated angiodysplasias are frequently present, making local therapy an unfavorable choice or impossible.

Role of intestinal function in cachexia.

Purpose Of Review: Cachexia is a prominent feature in many chronic diseases, but its pathogenesis is still not fully understood. This article reviews recent research into the role of the gut barrier in the pathogenesis of inflammation and cachexia with special emphasis on two potentially catabolic diseases: liver cirrhosis and chronic heart failure.

Recent Findings: There is increasing evidence that catabolic diseases such as liver cirrhosis and chronic heart failure are associated with increased gut permeability, endotoxemia and enhanced expression of proinflammatory cytokines.

Elevated transaminases during medical treatment of acromegaly: a review of the German pegvisomant surveillance experience and a report of a patient with histologically proven chronic mild active hepatitis.

Objective: The new GH receptor antagonist pegvisomant is the most effective medical therapy to normalize IGF-I levels in patients with acromegaly. Based on currently available data pegvisomant is well tolerated; however, treatment-induced elevation of transaminases has been reported and led to the necessity for drug discontinuation in some patients in the pivotal studies. The aim of this study was to evaluate and characterize the prevalence of elevated transaminases and to describe in detail the findings in a single case who required drug discontinuation because of elevation of transaminases which emerged during treatment and who underwent liver biopsy.

Hepatic steatosis in Dunnigan-type familial partial lipodystrophy.

Objectives: Characterization of familial clusters of subjects with metabolic derangements predisposing to hepatic steatosis and nonalcoholic steatohepatitis could facilitate genomic studies to identify risk factors for their development. Dunnigan-type familial partial lipodystrophy (FPLD) is an autosomal dominantly inherited disorder caused by mutations in the LMNA gene. Affected subjects have loss of subcutaneous fat from the extremities and symptoms similar to those characterizing the metabolic syndrome, including insulin resistance and dyslipidemia.

Primary neuroendocrine carcinoma of inguinal lymph node.

Ninety-seven percent of neuroendocrine carcinomas are located in the gastrointestinal tract or in the bronchopulmonary tree. Inguinal lymph nodes as the primary tumor site for neuroendocrine carcinoma represent a very unusual location, and have only been described in 2 patient series in the literature. A 64-year-old, previously healthy, Caucasian female presented with a 2-month history of an enlarged inguinal lymph node on the right side.

[Hypogonadism despite of normal testosterone levels].

We report on a 19 year old patient with clinical signs of hypogonadism (small testicles, missing pollutions and diminished beard growth) despite of normal testosterone levels. Further diagnostic procedures revealed panhypopituitarism with insufficiency of the gonadotrope, somatotrope and corticotrope axis due to a beta-HCG-producing suprasellar germinoma with intracerebral metastases. Paraneoplastic production of beta-HCG resulted in sufficient stimulation of Leydig cells with normal production of testosterone, which had partly masked clinical symptoms of gonatrope insufficiency.

Thalidomide for treatment of severe intestinal bleeding.

Apart from its anti-inflammatory activity, which has been used for the treatment of active Crohn's disease, thalidomide is also a potent inhibitor of angiogenesis. We therefore studied the effect of thalidomide in six patients with severe recurrent intestinal bleeding refractory to standard treatment (three patients with Crohn's disease (CD), three patients with obscure intestinal bleeding; mean of 56 blood transfusions within the last 24 months). Bleeding stopped within two weeks after the start of thalidomide in all patients.