Deutsche Zeitschrift fur Verdauungs- und Stoffwechselkrankheiten最新文献

The authors tried to clarify relations between autoimmune gastritis and isolated atrophic corpus gastritis by bioptic corporal and antral examinations from 150 probands as well as examinations of gastrin in serum and parietal cell antibody tests. Only 30% of all patients examined with isolated atrophic gastritis of the corpus part revealed criteria of an autoimmune gastritis. Therefore investigations of antibodies against parietal cells are necessary to mark off both clinical pictures. This differentiation seems to be necessary regarding the high risk of gastric cancer following an autoimmune gastritis.

A modified secretin-pancreozymin test was performed for the quantitative determination of both the pancreatic exocrine function and the biliary secretion of total bile acids followed by exogenous (secretin and pancreozymin) and endogenous (L-phenylalanine) stimulation of the pancreatic and biliary secretion. The outputs of lipase, alpha-amylase, trypsin, bicarbonate and total bile acids were estimated and the ratio of glycine to taurine conjugated bile acids was measured by thin layer chromatography. Polyethylene glycol 4,000 was used as a nonabsorbable marker for the correction of aspirated volumes. 40 patients were studied: 10 control subjects; 10 control subjects with previous cholecystectomy; 10 patients with chronic pancreatitis and 10 cholecystectomized patients with chronic pancreatitis. In cholecystectomized probands, not only the total bile acid output but also the output of bicarbonate, trypsin and lipase were diminished compared to the control subjects with a intact gallbladder. In noncholecystectomized and cholecystectomized patients with chronic pancreatitis both, the pancreatic secretion and the biliary bile acid secretion were significantly decreased. The ratio of glycine/taurine conjugated bile acids was found to be significantly higher in these patients compared to the controls.

A case of multiple abdominal haemangiomas (mesentery, intestine, liver) in a 19 year-old patient is described. The anomalies, at first incidentally found during appendectomy, were confirmed by angiographies and vascular surgery. Ascites and bleeding esophageal varices developed in further course. A short review of literature and classifications is given.

In patients with chronic pancreatitis (48), gastric ulcer (6), duodenal ulcer (6) and controls (12) duodenal pH was measured continuously by a glass electrode before and 90 minutes after a standard meal. The capacity of the stomach to secrete acid was known in all test persons, the degree of exocrine pancreatic insufficiency was determined according to the results of the S-CCK-test: 6 had no, 29 moderate and 13 severe pancreatic insufficiency. There were no significant differences between the mean interdigestive duodenal pH of the groups. After a meal, however, even patients with a normal pancreatic function but with hyperchlorhydria had a significantly lower pH (mean pH 5.5) than those with normo-chlorhydria (mean pH 6.1) and hypochlorhydria (mean pH 6.5). In patients with severe pancreatic insufficiency and normo-/hyperchlorhydria duodenal pH was much lower (mean pH 4.2) in some cases to pH 3.5, thus well below a level known as inactivating pancreatic enzymes. The total duration of the pH being less than 4.5 amounted to 12% of the postprandial measuring time (11 of 90 min). If, however, severe pancreatic insufficiency was combined with a-/hypochlorhydria duodenal pH did not differ from controls. Thus, reduced acid secretion of the stomach exerts beneficial effect on duodenal pH in patients with severe pancreatic insufficiency.

The absorption of protein nitrogen by the colon was assessed in 8 infants with colostomy by giving [15N] yeast protein in a dosage of 5-20 mg 15N/kg (92.4 atom-% 15N). The absorption of 15N ranged between 87.1 and 98.1% of the administered dose, and the retention in the protein pool ranged between 81.0 and 95.7%. The incorporation of 15N in the plasma proteins was demonstrated by 15N-excess values between 0.01 and 0.10 atom-%, the TCA soluble fraction contained 15N-excess values of 0.04 to 0.19 atom-%. The results suggest that the colon can assimilate proteins when insufficient absorption of protein nitrogen in the small intestine occurs. The breakdown of protein is thought to result from the action of the colonic flora.

An analysis of 287 (1.42%) exocrine pancreatic carcinomas of an 18 years post-mortem examination includes pathomorphological and histological findings of the tumors, causes of death, important concomitant diseases, and relevant clinical details. The tumor prefers the old age. We found a medium age of 68.2 years and a nearly balanced sex ratio, but some age dependent differences in this ratio. Localization, histological type, staging and dependent findings of the tumours do not differ essentially from wellknown statements. Among the causes of death there was in the first position the tumour itself (48.5%), followed by general tumour associated (39%) and local complications (11.5%). We found no foregoing diseases respectively endogenous risk factors of pancreatic cancer. This statement concerns particularly the chronic pancreatitis, diseases of the biliary tract or the gastroenteron, and diabetes mellitus. The role of a particular blood group was to exclude. Special findings are discussed. The results rather support the significance of exogenous risk factors, especially of nicotine and ethanol, which, in conjunction with other in relation to the exocrine pancreas weak carcinogenic agents and hyperplasiogenic factors may contribute to the increasing incidence of the exocrine pancreatic cancer.

Hypersomatotropism causes not only the typical acromegalic symptoms but also very often a splanchnomegaly with participation of the enteron. We performed a colonoscopy in 16 patients with a persistent active acromegaly in spite of full used therapy possibilities. Only in four cases (25%) we could find a polyp. They were distributed on the colon transversum (one), descendens (one) and sigmoideum (two). Three of them (histology: tubular adenoma) had a diameter of less than 5 mm. Only one adenoma had an extent of 3.5 x 3 x 2.5 cm (histology: tubular-villous adenoma). Not any polyp showed signs of malignity. There existed no relations between the coloscopic findings, the degree of activity and the duration of illness. Localisation, histology, frequency and age distribution of the found out polyps of our patients were in the range of real frequency of the occurrence of colorectalic neoplasms. We conclude: Acromegaly is correlated not more than accidentally with colorectalic neoplasms (benign, malignant). Therefore preventive medical examinations of acromegalic patients are not rich in meaning.

Several prospective studies on the efficiency and technique of endoscopic sclerotherapy (EST) were performed among 300 patients with bleeding esophageal varices, 173 of which had been treated by EST. Contrasted with a comparable control group (n = 80), EST (n = 100) reduced the incidence of rebleedings (40% vs 13.3%; p less than 0.0005) and the lethality (46.7% vs 30.6%; p less than 0.05) during the observation period of 21 months. The paravariceal and the intravariceal injection techniques were compared in 20 patients each. A higher number of initial and repeated treatment sessions argued against the paravaricel technique (mean follow up: 4 years). In a randomized study on prophylactic EST we found a lower bleeding frequency (13% vs 39%) in 16 patients treated by EST compared to 18 controls.

The study gives a survey of the causes of death of 106 patients suffering from acute pancreatitis and of 125 chronic pancreatitis cases. They account for 1.41% and 1.69% respectively of the autopsies performed by us. In 76.4% of the 106 cases of acute pancreatitis the disease was the main cause directly responsible for the death. Chronic pancreatitis was the main underlying disease or a significant secondary condition in the chronic group. The results of etiologic analysis are in acute pancreatitis: 67.9% biliary tract changes, 7.5% alcohol abuses and 20.8% postoperative damages. Alcoholism (44 cases) was important by patients with chronic pancreatitis.