Deutsche Zeitschrift fur Verdauungs- und Stoffwechselkrankheiten最新文献

Between 1981 and 1986 we have investigated 143 outpatients with symptoms of G.M.S. Analysis of the different diagnostic procedures aimed at standardization of diagnostic measures in patients with mild unconjugated hyperbilirubinaemia without other abnormal physical findings. In these patients and in persons with only anamnestic disorder, diagnosis was ensured by oral application of nicotine acid. The principles of the specific diagnostic procedure are described. In general, diagnosis of G. M. S. is possible without histological investigation of liver tissue.

Inflammatory liver diseases display higher levels in serum ADA activity compared to non-inflammatory ones. The most pronounced increases in activity are found in acute virus-induced hepatitis, in active liver cirrhoses, extremely high levels in some liver tumours. Due to correlative relations, the ADA is mainly attributed to the mesenchymal parameters by factor analysis. This can be validated by assessment of histological criteria. The highest correlation coefficient could be demonstrated for ADA in relation to all parameters under investigation by means of the semi-quantitatively evaluated mesenchymal reaction within the histological section. The determination of the serum ADA is valuable in assessing the inflammatory reaction of the liver and for diagnosing active cirrhosis in particular. Increases in activity based on an elevated nucleic acid metabolism in tumours and regenerative processes have to be taken into consideration. This interpretation is evidenced by correlative relations between the activity of ADA in liver biopsy homogenate specimen and the hepatic inflammatory reaction.

For investigations of cell injury during pathogenesis of acute pancreatitis antisera to pancreatic acinar cells were used as experimental tool. Within one hour after intraductal injection of antiserum a strong pancreatic edema was developed. Within 24 h this edema receded to a large extent but at this time there were inflammatory cells scattered in the intra- and periductal region. As a sequel of application of antiserum pancreatic enzymes were released. At 24 h after this application serum activities of alpha-amylase and lipase were significantly increased in comparison to the control and reached that level which was found in a model of acute pancreatitis provoked by pancreatic edema plus short-term ischemia.

After partial duodenopancreatectomy the authors performed a pancreatogastrostomy with splinting the anastomosis. This method has some advantages vice versa the pancreatojejunostomy. Experiments with animals show that the beneficial effects of pancreatogastral-and pancreatojejunal anastomoses are of limited duration.

By the aid of continuous flow culture of microbial populations it is possible to answer specific micro_ecological questions even under anaerobic conditions. We present some findings from a continuous flow model of human duodenal juice with microbial overgrowth. Germ counts and species were reproducible in a steady state over several days. Metabolic activity was very high. For example, this model allows the in vitro study of therapeutic possibilities against overgrowth syndrome, microbial fermentation of food, metabolism of drugs and the growth of microorganisms on surfaces in gastrointestinal tract.

1013 ALAT-attacks--in addition to the frequent asymptomatic onset of the disease and the high tendency of chronicity a typical symptom of the non-A, non-B hepatitis--were statistically analysed on 333 patients (of these 216 with uniform parenteral source of infection). 52% of the patients showed a multiphasic course. The aim of the analysis was the exact mathematical description of the attack-behaviour and the discovery of presumed regularities. The investigation of the periodicity of the attacks showed a maxima of spectral density corresponding to a 7-day-rhythm. The trend function of the ALAT-amplitudes in the time-course was assessed as an exponential function. Between mono- and multiphasic ALAT-courses no significant differences existed concerning the clinical picture (icteric--anicteric--subclinical), but as regards the late prognosis the multiphasic courses exhibited highly-significantly more transitions into chronic hepatitis. From the time-serial analysis of the attacks can be deduced for practical application that the reliable detection of non-A, non-B hepatitis cannot be guaranteed with weekly screenings. Screenings at 2-day-intervals which take into consideration the attack-behaviour and the ascertained time of incubation are recommended.

920 determinations of alpha 1-fetoprotein were performed in 564 patients with mainly hepatological diseases. For AFP determination double antibody sandwich technique with 10 microliter final volume was used. The ultramicro-ELISA-method, which meets all criteria of a screening parameter, is simple and far more economic than RIA or a commercial enzyme immunoassay. The 3s limit was determined to be 23.2 for men and 29.8 ng/ml for women. 24/26 (= 92.0%) hepatocellular carcinomas (HCC) showed elevated serum AFP concentrations. The serum AFP concentrations in the hepatocellular carcinoma showed different constellations of the findings: 1. AFP below 215 ng/ml (= range suspicious of hepatome, according to Poltenauer); 2. AFP moderately exceeds 215 ng/ml; 3. AFP weeks before death excessively increasing from moderately elevated ranges; 4. AFP decreasing prior to death; 5. AFP course fluctuating; 6. AFP within normal range. 231 liver cirrhoses showed elevated values in 28.1%. Active liver cirrhoses had significantly more often AFP concentrations above 30 ng/ml than inactive had (31.9% as opposed to 10.8%). Active liver cirrhoses and cirrhoses with decompensation of the portal vein had significantly more often (34.9% of 83 probands) increased AFP values than inactive, compensated cirrhoses had (11.9% of 42 probands). Various pathomechanisms of the neosynthesis of AFP in HCC, in liver metastases and in benign liver diseases are discussed. Increases in AFP above 500 ng/ml are practically indicative of hepatocellular carcinoma. Low-grade elevations of AFP in benign liver diseases and liver metastases can be categorized by considering other criteria (persistent or transitory AFP?/trend - increase?/serum concentration) including clinical/paraclinical features. The determination of AFP by the above-mentioned method allows to make a better hepatologic diagnosis. It ist suitable for the still improvable early diagnosis of HCC. AFP screening should be employed in risk groups (liver cirrhoses, HBsAg carriers, chronic HV-B patients).

Up to now the results of drug treatment are unsatisfying. Treatment of more than 1-2 years did not decrease the occurrence of relapses. Thyroid suppression test and TRH test give the same indications concerning the outcome in cases with Graves' disease and disseminated autonomy (short-time prognosis). The relapse rate is distinctly higher in Graves' disease than in cases with disseminated autonomy (goitre class 3 excluded).

The enteric absorption of oxalic acid with 14C-labelled oxalic acid was determined in patients with small bowel resection, jejunoileal bypass, Crohn's disease and chronic pancreatitis in comparison to the control group. Extreme hyperoxaluria were found in small bowel resections above 100 cm, after bypass operations and in ileocolitis Crohn with signs of clinical activity. Small bowel resections and relapses of Crohn's disease increase the absorption of oxalic acid. The significance of 14C-oxalic acid absorption test is the recognition of enteric hyperoxaluria.

Although bleedings in the part of the jejunoileum only amount to about 1% of bleedings of the whole gastrointestinal tract, they can raise outstanding problems because of the difficulties in discovering the sources of bleeding and their localization. The importance of intraoperative endoscopy will be emphasized by example of 5 patients who suffered from recurrent bleedings. All of the other diagnostic procedures like x-ray examinations (angiography included), endoscopy and scintigraphy were fruitless.