Acta hepato-gastroenterologica最新文献

A case of hepatocellular carcinoma associated with erythrocytosis is described. The patient was successfully treated with a combination chemotherapy of 5-fluorouracil, mitomycin C, cyclophosphamide and chromomycin A3, which was followed by a left lateral hepatectomy, and has survived for more than 9 years after the operation without any signs of recurrence. With the regression of hepatic tumor by the anticancer chemotherapy, the remission of erythrocytosis was observed, indicating that the tumor was producing erythropoietin. The data suggest also that erythrocytosis could be a marker for evaluation of chemotherapeutic effects in some patients with hepatocellular carcinoma.

The clinical presentation and subsequent treatment of 160 consecutive patients with proven diverticular disease of the colon from the Auckland Hospital, New Zealand were compared with 182 consecutive patients admitted to St. Bartholomew's Hospital, London. There were significant differences in sex incidence, in the ages of the male patients at presentation, patient symptoms, extent of disease and methods of surgical treatment. These probably reflect differences in the types of National Health Services of the two countries, rather than differences in the natural history of diverticular disease of the colon. Overall, the 342 patients studied show a very good correlation with other large series published over the last 10 years. This study confirms the previously reported association between diverticular disease of the colon and gallstones. It confirms that gallstones are more common in female patients with or without diverticular disease. It suggests that Auckland patients with gallstones are more likely to have had a cholecystectomy than London patients. The possible role of dietary fiber in the aetiology of both gallstones and diverticular disease of the colon is discussed.

Concentrations of numerous sulfate steroids were checked in the plasma of 10 women in normal pregnancy (NP), 21 women with intrahepatic cholestasis of pregnancy (ICP) and 10 pregnant women suffering from viral hepatitis with jaundice (VHP). A considerable increase in 5 alpha pregnane and 5 beta pregnane 3 alpha, 20 alpha diols, mono- and disulfates and in 5 alpha pregnane 3 beta, 20 alpha diols disulfates was observed only in ICP and not in VHP. This observation permits us to hypothesize that these hormone changes can have a causative role in the pathogenesis of ICP.

Fasting gastrinemia in cirrhotics (48.35 +/- 2.77 pg/ml) was higher than in normal controls (32.93 +/- 0.75 pg/ml; P less than 0.001). After insulin-induced hypoglycemia, the mean increase of gastrin above basal level was 42.29 +/- 1.92 pg/ml in controls and 10.85 +/- 5.05 pg/ml in cirrhosis (P less than 0.001). BAO was 2.53 +/- 0.36 mEq/h in controls and 0.42 +/- 0.004 mEq/h in cirrhotics (P less than 0.001). After i.v. insulin, TAO was 8.42 +/- 0.72 mEq/h in controls and 3.06 +/- 0.26 mEq/h in cirrhotics (P less than 0.001). The authors suggest that the lack of an adequate gastrin and acid response to the hypoglycemic stimulus in cirrhotics might be accounted for by a decreased insulin sensitivity.

Serum angiotensin I converting enzyme, identical with kininase II, was measured fluorometrically in patients with acute viral hepatitis (n=18), liver cirrhosis without (n=44) and with (n=19) ascites. In all groups of patients the enzyme was significantly elevated as compared to 44 healthy controls (p less than 0.001). No correlation could be found between angiotensin I converting enzyme activity and liver function tests (serum glutamic oxalacetic transaminase, serum glutamic pyruvic transaminase, total protein, albumin, bilirubin) or other parameters (serum potassium, serum sodium). High serum converting enzyme activity in chronic liver diseases might originate primarily from an altered pulmonary circulation and indicates higher conversion rate of angiotensin I by passage through the lungs as well as increased bradykinin degradation. The reason for the enzyme liberation in acute viral hepatitis is as yet uncertain.

In vitro experiments were carried out to examine the enzymatic activity in various organ homogenates of the dog, which inactivates the biological activity of the synthetic cholecystokinin-octapeptide (CCK-OP). The highest splitting activity was found in the renal cortex; substantially lower activities were registered in the lung, pancreas and small intestine. It seems interesting that neither the gallbladder nor the saliva and the serum contained measurable amount of the CCK-OP splitting activity. An effort was made to characterize the CCK-OP inactivating principle found in the renal cortex. It was ascertained that the CCK-OP was inactivated by a peptidase which is heat sensitive, has a pH optimum of 7,4 and could be inhibited by chelating agents (EDTA) and epsilon-aminocaproic acid. The fact that most of the enzyme function is associated with the sediment obtained at 12 000 g speaks in favour of its mitochondrial origin.

The effect of gastric distension on pancreatic secretion of bicarbonate and trypsin was studied in 10 individuals in the basal state or during stimulation with low and high doses of secretin or secretin plus cholecystokinin (CCK). Gastric distension augmented the pancreatic response to secretin but had no consistent effect on the pancreatic response to combination of secretin and CCK. We conclude that gastropancratic reflexes do not have much functional significance in man.

The authors presented a patient with primary gastric cancer and liver metastases. They permanently observed the AFP concentrations before, during and after cytostatic therapy. At the same time they examined possible sites of AFP production. It is supposed that AFP neo-synthesis takes place in the secondary site with participation of altered liver cells. In such cases it is important to watch the AFP values, and this is also necessary when the primary source of the secondary liver cancer is not known. Cytostatic drugs act only in a palliative way i.e. AFP concentrations drop to a lower level and the patient feels temporarily better.