Deutsche Zeitschrift fur Verdauungs- und Stoffwechselkrankheiten最新文献

We examined 21 patients with duodenal ulcer confirmed by endoscopy for disturbances of esophageal function, using manometric techniques and long-term pH measurement. Pathological manometric findings, largely of a mild degree, were obtained in 48 per cent of the patients examined, and a pathological gastro-esophageal reflux was found in 81 per cent, with only 33 per cent suffering from reflux esophagitis as confirmed by endoscopy and/or histological examination. Although duodenal ulcer and disturbed esophageal function often appear simultaneously, a causal connection seems unlikely. Alcohol and nicotine stimulate reflux, with the degree of severity depending on the amount.

The domain of cryosurgery in proctology is in the field of inoperable anal and rectal carcinoma therapy with the aim of improving living quality. By intravital microscopy the role of microcirculation as the causative factor for counterheating could be proved. There by the cryodestruction is restricted. By temperature measurements we know that the limit for absolute tissue destruction is given at 3-8 mm tissue depth. A new device for cryosurgical treatment of inoperable anal and rectal carcinoma was developed (2nd generation of the device) and introduced into praxis. A total of 247 cases were our own patients at the average age of 75 years and a lethality of 0.25%. Generally, an improvement of living quality was achieved by the cryotherapy in those patients with stenosing colorectal carcinoma. 50% of all patients lived longer than 2 years. In 242 patients of the total of 247 cryosurgically treated patients the establishing of an anus praeter could be spared.

The iron content of liver and gastric mucosa was quantitatively examined by means of atomic absorption spectrometry in 36 patients with iron overload (22 with idiopathic haemochromatosis, 14 with therapy-resistant anaemia) and in 17 subjects without anomaly of iron metabolism. Diagnostically evaluable iron deposits in gastric mucosa were only found in severe iron overload. In this case it was correlated with the hepatic iron content, and was indicative of iron-related disturbances also in other organs. The quantitative iron determination represents a diagnostic enlargement. It is indicated, if simple noninvasive methods are failing, and it should never be omitted in suspected iron overload, whenever other reasons as well are demanding gastroscopy.

The activities of enzymes collagen peptidase (CP), monoaminoxidase (MAO) and N-acetyl-beta-D-glucosaminidase (beta-NAG) in the serum are related to the development of hepatic fibrosis. These enzymes were determined in the sera of 121 liver-biopsied patients who were subdivided by morphological criteria into 4 different grades of fibrosis (0 to greater than or equal to 3). CP shows the best correlation with the extent of fibrosis. beta-NAG, indeed, bears of relationship to the morphologically proven extent of fibrosis, however, significant increases in activity are also encountered in patients with liver diseases, but without liver fibrosis. The validity of these fibrosis markers is calculated in order to differentiate between low- and high-grade fibrosis. With a sensitivity of 86% and a specificity of 92%, CP possesses the best predictive value of 85.7%. The results can still be improved by the combination of CP and beta-NAG.

Specificity and sensitivity of ALTAB test have been estimated in 40 healthy children and 13 cystic fibrosis patients. The test has been carried out in the modification as 2-hour-serum PABA-test. The found specificity was 90%, the sensitivity 100% respectively. Therefore this test is suitable for evaluation of exocrine pancreas function.

Until recently, vasomotor effects of gastrointestinal polypeptide hormones have been observed primarily in animal experimentation. 33 volunteers were observed to survey the influence of secretin (1 CU/bw./h) and pentagastrin (0.75 micrograms/bw/h) on peripheral blood gas concentrations and on the acid/base balance. Compared to a control group, secretin caused a significant increase in pO2 and in O2 saturation (p less than 0.05). In contrast to secretin, pentagastrin caused a significant decrease in the pO2 as well as in the O2 saturation (p less than 0.05) pCO2, pH and HCO3 were not significantly affected by either secretin or pentagastrin. These results can be interpreted as possible direct vasodilatative/constrictive as well as local metabolic effects of secretin and pentagastrin.

Antithrombin III/AT III/, plasminogen (Plg) and proactivator of plasminogen [PPlg] activity were studied in 663 patients with various liver diseases and 547 healthy subjects. Parallel analysis of AT III, Plg and PPlg gives a very valuable prognostic information concerning the forthcoming evolution of viral hepatitis [v.h] and acute liver failure. The prognosis of v.h. in the cases with normal Plg activity is independent from the AT III activity in 98% of the cases it is associated with clinical improvement. The combination with low Plg and elevated AT III activity suggested clinical improvement in 65-90% of the patients. Most critical is the combination between low Plg and low AT III activity. This combination suggests clinical aggravation and danger of hepatic coma. The existence of 4 patterns of AT III activity is shown: elevated, normal in physiological condition, normal in pathological condition and decreased activity.

Bone marrow aplasia associated with acute viral hepatitis is a rare, in the rule late complication. A prognostic relation between the latency of acute hepatitis and the development of aplastic anemia is described. We report a case of nearly symptomless hepatitis in a 25 year old women with a fatal course of aplastic anemia. First clinical symptoms were caused by aplastic anemia. The pathogenesis of aplastic anemia associated to viral hepatitis is obscure. Genetic and immunological causes are discussed. A direct viral action is possible. Because the main part of the described cases is caused by non-A, non-B hepatitis, it seems apparent that at least a non-A, non-B virus strain could have an affinity to bone marrow cells. Ensuring this, relations will be impossible up to the identification of the virus.

Unlabelled: In 83 diabetics insulin secretion was examined after a mean diabetes duration of 7.5 years, when an insufficient metabolic situation could be found. Insulin secretion was stimulated with 100 g glucose (orally) and 1.0 mg glucagon i.v. (60 min after glucose intake). We investigated additionally in a retrospective manner blood-glucose and urine glucose behaviour as well as the development of the body weight. In dependence of the actual body weight at the time of investigation of insulin secretion, two groups were formed: b. w. less than 120% acc. Broca index, group A, n = 38; b. w. greater than 120% acc. Broca index. group B, n = 45). Immediately after manifestation of the disease 71 diabetes were treated with pure dietetic measures. At the examination of insulin secretion all patients were treated with glibenclamide. After this examination in 20 patients of the group A and in 17 patients of the group B an insulinisation was started. In the others glibenclamide treatment was continued. The general characteristics of the whole group was a significant reduction of the maximum stimulability of insulin secretion, compared with the insulin secretion of n = 19 healthy probands (11 probands with normal body weight and 8 obese probands). A hyperinsulinism (maximum values higher than mean + 1 s of the health persons) could not be found in any case. The mean of the maximum insulin values was below mean - 1 s of the healthy persons. Insulinisation provoked an improvement of the metabolic situation. This was correlated with an additional improvement of the subjective behaviour.

Conclusion: Evaluation of insulin secretion in obese diabetics with bad metabolic situation is necessary to find out those who are to be treated with insulin. We have no clinical or other possibilities to recognize patients with a hyperinsulinism or reduced insulin secretion than by evaluation of insulin secretion alone. But higher degrees of decompensated metabolism are nearly always explained by a significant reduction of insulin secretion.

A sufficient number of good retrieval rates (median value 88.9%) could be achieved by means of radiovitamin B12 in 20 patients who underwent a secretin-pancreozymin test. Losses of this amount can be tolerated for practical purposes. As a rule, marker losses are caused by a flow-off into deeper intestinal sections. The marker technique raises a great number of unexplained issues.