Deutsche Zeitschrift fur Verdauungs- und Stoffwechselkrankheiten最新文献

Prostanoids are important for the pathogenesis of chronic inflammatory bowel diseases as mediators of inflammatory, immune and allergic reactions. The levels of thromboxane B2(TXB2), the stable hydrolysis product of thromboxane A2(TXA2) were determined in blood plasma of patients with chronic inflammatory bowel diseases. The platelet malondialdehyde (MDA) formation was determined as an indicator of the TXA2 synthetase activity. The TXB2 concentrations were measured radioimmunologically. The platelet MDA formation induced by N-ethylmaleimide was investigated with the thiobarbituric acid reaction. The investigated patients (n = 10) suffering from ulcerative colitis had a significant increasing (p less than 0.02) of the platelet MDA formation (mean = 4.39 nmol/10(9) platelets) in comparison to the normal group (n = 20; mean = 2.87; nmol/10(9) platelets). The increasing of TXB2 levels was not significantly different than in normal control subjects. The plasma concentrations of 6-keto-PGF1 were situated on the limit of detection.

The contribution of immunologic noxae to the damage of the cells and the induction of autodigestion in the course of acute pancreatitis in rats should be regarded. The isolation of intact acinar cells from rat pancreas offers a new approach to a more specific antiserum being directed against antigens at the outside of the cell membrane. Proof of circulating antibodies was performed using the indirect immunofluorescence reaction method (IFAR). A defined membrane fluorescence was observed at the surface of the acinar cells in vitro and a fluorescence at the septa of lobules marking the borders of acini in vivo.

In the years 1957-1975 we found out of 13336 autopsies in a medium-sized urban general hospital 912 cases of cirrhosis of the liver. In comparison these persons with sections of non-cirrhotic controls the frequency of gallstones was neither for the total group (33.9%) nor for the males (27.1%) significantly raised. Only in the female subgroup of cirrhotic patients we could demonstrate a significantly increased frequency of gallstones (43.5%) in comparison to the female control group (38.3%). With regards to all kinds of predominantly lithogenous alterations of the gallbladder (concrements, chronic cholecystitis, cholecystectomy) we found for the cirrhotic group and its subgroups a significant positive coincidence of both diseases. The female to male ratio for the frequency of cholelithiasis and for all kinds of lithogenous alterations of the gallbladder was 1.6:1 for the cirrhotic group and the controls.

The study covered 25 patients with acute alcoholic hepatitis mean age of 48 years 25 patients with alcoholic liver steatosis (mean age of 49 years), and 41 clinically healthy persons - controls (mean age of 42 years). Plasma levels of individual free fatty acids (FFA) were determined in any case. There was a statistically significant decrease of palmitinc, stearinic, oleinic, linolic and arachidonic acid and of total FFA in the patients with acute alcoholic hepatitis (AAH) as compared with the controls (p less than 0.001). Similar changes were found in patients with liver steatosis but they were slightlier expressed. In AAH patients serious disorders of FFA metabolism set in which are manifested mainly by total FFA level reduction that is on the account of the polyunsaturated fatty acids combined with significant increase of the saturated ones.

The activities of enteropeptidase, alanine aminopeptidase, sucrase, and leucine aminopeptidase were determined in mucosa biopsies taken from three defined places of the duodenum and in duodenal juice. We examined 23 adults with a histological proven normal mucosa and 10 patients suffering from duodenitis grade I. Using multivariate evaluation of all the four enzyme activities of the three mucosa sites, we could differentiate duodenitis from normal mucosa with an efficiency of 88%.

The most important pathophysiological mechanism of functional disorders of colon is motility disturbance. The best term for these disturbances is considered to be "colon dyskinesia". Dyskinesia can be classified as primary and secondary, and as hyperand hypokinetic. The following clinical forms are distinguished: with constipation, painless diarrhea, isolated pain syndrome, colica mucosa. Inflammatory diseases of colon are accompanied by chemical changes in feaces: the increase of enterokinase and alkalien phosphatase activity (enzymorrhea), the increase of feacal excretion of protein (proteinorrhea). Both enzymorrhea and proteinorrhea are absent in colon dyskinesia. The investigation of enzymes and protein in faeces can be of great help in differential diagnostics of functional and inflammatory colon diseases. In treating colon dyskinesia psychopharmacological, cholinolytical, spasmolytical and antidiarrrheal preparations are used, as well as some drugs with purgative effect. Clinical and instrumental methods make it possible to determine which type of the motility disturbances predominates. The latter is important for differential prescription of drugs correcting colon motility in colon dyskinesia. Colon motility in man ist actively affected by adrenergic drugs: it is inhibited by adrenomimetics and stimulated by adrenolytics which justifies their prescription in colon dyskinesia. Diazepam and phenobarbital inhibit colon motility. Diphenoxylate and metoclopramide have a normalizing effect.

For studying the postulated relationship between prior cholecystectomy, cholelithiasis, and occurrence of subsequent colorectal cancer, we examined in a retrospective study autopsy cases to get information about the frequency of them. The material consisted of 10,000 cases (female:male = 1,08:1) with an age maximum in the 8. decennium. Among them were 2457 (902 male and 1555 female) cases of cholelithiasis and 646 (211 male and 435 female) cases of cholecystectomy. 449 colorectal cancer were found, altogether. The incidence of cancer in cases without gallbladder disease amounts to 4.13%, in cases with cholelithiasis 5.37%, and after cholecystectomy 4.95%, respectively. The results must be discussed with care because Berkon's Fallacy. Further exploratory investigations are necessary.

In 14 cholecystectomized patients with recurrent attacks of pain endoscopic manometry of the c.b.d. was carried through after thorough exclusion of organic diseases. Two different conspicuous types of pressure behaviour became evident: In 8 pat. the pressure in the c. b. d. increased steadily during perfusion and finally triggered pain, identical to the spontaneous one according to localization and character. In 6 pat. even after prolonged perfusion no pain emerged and the c. b. d.-pressure remained unchanged. As the increase in c. b. d.-pressure connected with provocation of pain was reproducible, perfusion manometry in the c. b. d. seems to be a mean of delimitating and objectifying functional disturbances of the bile duct.

In the pancreas of female rats (180 g body mass) mast cells were seen with histological and histochemical methods in the periductular and perivasal connective tissue in a less number; they were absent in the interacinar region totally. Compared to it they were relatively numerous in the peripancreatic investing tissue. Under calciphylactic conditions (H. Selye) i. e. after sensitization with Vitamin D2 and infiltration of Ferric dextran only calcifies the interstitium of the pancreatic gland, but not the peripancreatic tissue. It is concluded that mast cells in the calciphylactic reaction of the pancreas are of an inferior importance, a mastocalciphylaxis does not exist, but in the sense of a simple calciphylaxis the collagenous connective tissue undergoes a calcifying reaction.

To quantify the dynamics of acute pancreatitis in a prospective clinical study on 108 patients, clinical and computed tomographic classifications were performed at days 1, 3 and 6 after admission. Sixty-two percent of the patients revealed a variable clinical staging at the times considered. Progredience of pancreatic necrosis was found in 20 of the 55 patients subjected to radiomorphologic investigations. Comparison between clinical and CT findings showed an increase in the agreement of both assessments from 69 percent (day 1) to 85 percent (day 6). Despite this high-level agreement in some patients both findings diverged remarkably. Acute pancreatitis is discussed as an interplay of necrobiosis and the "compensatory capacity" of the organism, with clinical findings acting as an indicator of the overall state of this struggle.