Urs Leonhardt

Acupuncture treatment of chronic low-back pain – a randomized, blinded, placebo-controlled trial with 9-month follow-up

&NA; There is some evidence for the efficacy of acupuncture in chronic low‐back pain (LBP), but it remains unclear whether acupuncture is superior to placebo. In a randomized, blinded, placebo‐controlled trial, we evaluated the effect of traditional acupuncture in chronic LBP. A total of 131 consecutive out‐patients of the Department of Orthopaedics, University Goettingen, Germany, (age=48.1 years, 58.5% female, duration of pain: 9.6 years) with non‐radiating LBP for at least 6 months and a normal neurological examination were randomized to one of three groups over 12 weeks. Each group received active physiotherapy over 12 weeks. The control group (n=46) received no further treatment, the acupuncture group (n=40) received 20 sessions of traditional acupuncture and the sham‐acupuncture group (n=45) 20 sessions of minimal acupuncture. Changes from baseline to the end of treatment and to 9‐month follow‐up were assessed in pain intensity and in pain disability, and secondary in psychological distress and in spine flexion, compared by intervention groups. Acupuncture was superior to the control condition (physiotherapy) regarding pain intensity (P=0.000), pain disability (P=0.000), and psychological distress (P=0.020) at the end of treatment. Compared to sham‐acupuncture, acupuncture reduced psychological distress (P=0.040) only. At 9‐month follow‐up, the superiority of acupuncture compared to the control condition became less and acupuncture was not different to sham‐acupuncture. We found a significant improvement by traditional acupuncture in chronic LBP compared to routine care (physiotherapy) but not compared to sham‐acupuncture. The trial demonstrated a placebo effect of traditional acupuncture in chronic LBP.

Release of glucagon-like peptide-1 (GLP-1) by carbohydrates in the perfused rat ileum

Abstract The effect of various carbohydrates on glucagon-like peptide-1 (GLP-1) release was studied in the in vivo perfused rat ileum. GLP-1 concentrations in the mesenteric venous effluent increased significantly after luminal perfusion with substrates of a sodium/glucose cotransporter (d-glucose, d-galactose, methyl-αd-glucoside, and 3-O-methyl-d-glucose). d-Fructose induced a sodium-independent release of GLP-1. Carbohydrates like 2-deoxy-d-glucose and N-acetyl-d-glucosamine, which are not substrates of a luminal sodium/glucose or fructose transporter, did not affect GLP-1 release. Since methyl-αd-glucoside is not a substrate of the basolateral glucose transport mechanism and 3-O-methyl-d-glucose is not metabolized within intestinal cells, it is concluded that intracellular metabolism of carbohydrates and intracellular removal are not essential to induce GLP-1 secretion in rats.

Simvastatin in primary biliary cirrhosis: effects on serum lipids and distinct disease markers

BACKGROUND/AIMS Primary biliary cirrhosis (PBC) is an autoimmune disease of the liver with inflammation of small and middle-sized bile ducts. Serum lipids are frequently elevated, but the use of a lipid lowering drug therapy in PBC is still a matter of debate. Application of an inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase in hypercholesterolemic PBC patients was therefore the subject of the present study. METHODS Six female patients (aged 46.5 (32-61) years; median (range)) were treated with the HMG-CoA reductase inhibitor simvastatin (5 or 20 mg/day). Levels of serum total cholesterol, low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol were determined prior to and after 2 months of treatment. Concentrations of serum markers of cholestasis, antimitochondrial antibodies (AMA), and immunoglobulins A, G and M were also assessed. RESULTS Simvastatin significantly (P<0.05) reduced serum levels of total cholesterol, LDL cholesterol, alkaline phosphatase, -glutamyltransferase, and immunoglobulin M (by 19, 26, 12, 37 and 14%, respectively). CONCLUSIONS The lipid lowering potency of the HMG-CoA reductase inhibitor simvastatin was confirmed in hypercholesterolemic patients with PBC. The drug might also prove useful as modulator of cholestasis and of immune response in this disease.

Detection of circulating albumin-mRNA by RT-PCR does not indicate metastasizing hepatocellular carcinoma.

ZusammenfassungHepatozelluläre Karzinome (HCC) weisen nach primärer Resektion bzw. orthotoper Lebertransplantation eine hohe Rezidivrate auf. Ein Grund hierfür sind möglicherweise im peripheren Blut zirkulierende Hepatomzellen. Der Nachweis von HCC-Zellen im Blut könnte das therapeutische Vorgehen entscheidend beein-flussen und als Nachweis einer hämatogenen Mikrometastasierung dienen. In der vorliegenden Studie wurde humane Albumin-mRNA als spezifischer Marker für zirkulierende Hepatozyten mittels RT-PCR im peripheren Blut von Patienten mit hepatozellulärem Karzinom verifiziert. Albumin-spezifische PCR-Produkte ließen sich im peripheren Blut aller untersuchten HCC-Patienten nachweisen. Ebenso fanden sie sich im Blut von gesunden Probanden. Die Ergebnisse der vorliegenden Arbeit lassen Albumin-mRNA nicht als geeigneten Marker für eine hämatogene und nicht als geeigneten Marker für eine hämatogene Metastasierung erscheinen.AbstractHepatocellular carcinomas (HCC) frequently recur after partial liver resection or orthotopic liver transplantation, possibly because of the presence of a small number of hepatoma cells in the peripheral blood. Detection of circulating HCC cells might improve therapeutic options and could predict disease recurrence resulting from a metastasizing disease. In the present study, human albumin-mRNA was detected by RT-PCR in the peripheral blood of patients with hepatocellular carcinoma. Circulating albumin-specific PRC products were detected in each patient with HCC, but also in healthy volunteers. It is concluded that albumin-mRNA is not specific to circulating hepatoma cells and therefore does not indicate metastasizing disease.

Circulating human hepatic lipase mRNA in patients with hepatocellular carcinoma and healthy controls

OBJECTIVE To evaluate circulating human hepatic lipase mRNA as an indicator of circulating hepatoma cells by reverse transcriptase-polymerase chain reaction (RT-PCR) in patients with hepatocellular carcinoma (HCC). DESIGN Prospective study SETTING University hospital, Germany. SUBJECTS 15 patients with hepatocellular carcinoma and 8 healthy volunteers. INTERVENTIONS Peripheral venous blood was obtained and total RNA was extracted from the lymphocytic layer by caesium chloride gradient centrifugation. The mRNA was reverse transcripted, and hepatic lipase cDNA was amplified by hepatic lipase specific primers with PCR. The integrity of isolated RNA was confirmed by RT-PCR with beta-actin specific primers. Amplificates were visualised by agarose gel electrophoresis and ethidium bromide staining. MAIN OUTCOME MEASURES Detection of hepatic-lipase-specific RT-PCR products in peripheral blood. RESULTS Circulating hepatic lipase-specific PCR products were detected in all patients with HCC and in all healthy controls. CONCLUSION Detection of circulating human hepatic lipase-mRNA by RT-PCR does not indicate metastasising HCC.

Ultrasonographic guided laser-induced interstitial thermotherapy (LITT) of hepatic metastases

Background: In patients with unresectable hepatic metastases or primary liver tumors therapeutic options are limited. Laser-induced thermotherapy could be a minimal invasive option for palliative treatment of hepatic metastasized tumors. Thereby, absorption of laser light energy induces denaturation of proteins and thermocoagulation of tumor cells. Methods: Laser coagulation was performed by using a neodymium-yttrium alum/n/urn garnet (Nd:YAG) laser (Dornier MediLas fibertom 4100) with a scattering-dome light emitter and a water-cooled application catheter (Somatex). On the basis of ex vivo experiments 36 patients with unresectable hepatic tumors (15 colorectal carcinomas, 7 pancreatic adenocarcinomas, 4 gastric carcinomas, 4 metastasized midgut carcinoids, 5 hepatocellular carcinomas, 1 cholangiocellular carcinoma) were treated with LII3. After local anesthesia and intravenous sedation with midazolam laser probes were placed percutaneously under ultrasonographic guidance. Up to 5 metastases were treated per session. Results: During laser light emission uitrasonographic imaging showed a marked signal enhancement that allowed estimation of the coagulation zone. Percutaneous LITT was performed without any side effects such as bleeding, infection or liver injury. The 30 day mortality was zero. Patients left the hospital within 3 days after LITT. A significant tumor reduction was demonstrated by abdominal CT or MRT. Conclusions: It can be concluded that percutaneous LITT can be safely performed under ultrasonngraphic guidance in patients with malignant liver tumors. LITI induces significant destruction of tumor mass as verified by abdominal CT or MRT.

7005 Evaluation of a minilaparoscopical technique in the diagnosis of liver diseases.

INTRODUCTION: Explorative laparoscopy combined with guided liver biopsy offers many advantages in the diagnosis and staging of liver diseases. Its use might be limited by the invasivity of the technique and the development of non-invasive diagnostic imaging techniques, respectively. In the present publication we report about a minilaparoscopic technique that uses miniaturized scopes to reduce the risc of trauma. PATIENTS AND METHODS: Between April 1999 and Novembre 1999 30 patients (6 females and 24 males) underwent diagnostic assessment for chronic liver disease by minilaparoscopy. The mean age was 56 years in the female patients (range:27 to 73 years) and 43 years in the male patients (range: 20 to 72 years). Minilaparoscopy was performed in local anesthesia and weak sedation using a 1.9 mm optical instrument, which was inserted through the same 2.75 mm trocar as the Veress needle used for inflating the pneumoperitoneum. The minilaparoscop was connected to a video converting system that enabled monitoring on a video scope. Liver specimens were obtained under laparoscopical sight through an additional 2.3 mm trocar. RESULTS: Minilaparoscopy could be performed in all 30 patients without any severe complications. In one of the initial cases liver biopsy was not performed because of technical difficulties. In all other patients it was performed without any limitations. Macroscopic evaluation of the liver revealed a steatosis in 4 cases (histological diagnosis idem), acute hepatitis in 2 cases (histological diagnosis idem), cirrhosis in 7 cases (agreement with histological diagnosis in 6 cases), and no sighns of cirrhosis in 16 cases (histological diagnosis idem). In one patient a disseminated peritoneal carcinosis was found that appeared histologically as a low differenciated adenocarcinoma. CONCLUSIONS: The minilaparoscopical technique allows macroscopic and histological diagnosis of liver diseases with a minimum of invasiveness. It is tolerated excellent by the patients and is a safe technique. It is concluded that explorative minilaparoscopy is a useful technique in the diagnosis of liver diseases and peritoneal carcinosis.