Gastroenterologisches Journal : Organ der Gesellschaft fur Gastroenterologie der DDR最新文献

The aim of the present study was to investigate frequency and distribution of granulomas in resected specimens of patients with well known Crohn's disease. Granulomas were observed in 57% (8/14) of all cases. Their distribution varied remarkably between different sections of the same resectional sample as well as between the patients. 11.6% of all granulomas were found within the lamina propria, 42.9% within the submucosa, and 45.5% within the muscularis propria. The mean value per cm muscularis mucosae was 0.85 +/- 0.82 granulomas. Caused by the heterogeneity in frequency and distribution there is no guarantee for a successful identification of this helpful parameter. During the last years the diagnosis Crohn's disease became more and more certain even in absence of granulomas. Therefore they are an useful but dispensable feature.

Relationship between acromegaly and occurrence of colonic cancer and polyps is well-known. A rare case of gastric and duodenal polyps in a patient with hypophyseal adenoma is described. After selective hypophysectomy a regression of the polyps was observed. Probable mechanisms of the development and the regression of polyposis are explained. The diagnostic value of gastroscopy in the screening for polyps in patients with acromegaly is discussed.

Methemalbumin was estimated by means of electrophoresis and the method of Walberg, respectively in 59 patients (25 pat. with edematous, 34 patients with hemorrhagic pancreatitis) partially over three days. In addition the estimation of free hemoglobin in ascites has been carried out. By both approaches of methemalbumin estimation there was no differentiation of the two pancreatitis forms possible. Though the method of Walberg was much more sensitive especially in the serum its specificity was correspondingly lower. The tendency to a correlation of the methemalbumin-concentration to the severity of the course of the disease could be observed. Such a correlation has been proved statistically for the free hemoglobin.

40 women, average age 52.5 years, with varying stages of primary biliary cirrhosis, were observed. One third of them suffered from a mild anaemia, mean plasma concentrations of ALAT were increased four times and those of AP six times. Despite the hepatocellular damage products of the liver synthesis such as transport proteins or coagulation factors were found to be normal or enhanced. 60% of the patients had a hypercholesterolaemia. The risk factors low density lipoprotein (LDL)- and very low density lipoprotein (VLDL)-cholesterol showed normal levels, but the protective factor high density lipoprotein (HDL)-cholesterol was clearly increased. Apart from the low blood pressure in most of the patients and the absence of other risk factors these observations explain, why patients with PBC and hypercholesterolaemia don't usually develop arteriosclerotic complications. Only in case of severe cholestasis a lipid constellation comes into being accompanied by high risk for the blood vessels, but in these cases the terminal stage of PBC limits the survival. Positive correlations between markers of cholestasis and lipid parameters let an enhanced production and simultaneous impaired excretion of cholesterol be assumed.

Circulating lymphocytes were enumerated in 25 patients with Crohn's disease and in 43 healthy donors by immunofluorescent staining using monoclonal antibodies for T cell surface phenotypic markers (CD 3, CD 4, CD 8) or for surface immunoglobulin of B cells (mu-chain). Proportions of peripheral T cells and percentages of T cell subsets in Crohn's disease were not significantly different from those in controls. For analyzing the lymphocytes for the expression of activation associated antigens (HLA-DR, CD 25) we found increased numbers of activated lymphocytes during acute exacerbation, whereas, in remission, the population of activated lymphocytes was in the upper normal range. The results leads to the conclusion that the assessment of activated lymphocytes may serve as a parameter in the evaluation of the activity of Crohn's disease.

Under normal conditions a "physiologic malabsorption" and thus nutrients in the lower small intestine in the late postprandial state can be observed in humans. To study the effects of "physiologic" quantities of nutrients in the distal small intestine on upper gastrointestinal motor functions, 9 healthy subjects were intubated with an oro-ileal multi-lumen tube. The continuous perfusion of the duodenum with essential amino acids induced a fed motility pattern. In 12 out of 14 cases additional ileal perfusion with carbohydrates (60 kcal), but not with saline, converted the fed motility pattern to a pattern characteristic of the interdigestive state. These findings suggest that the ileum takes part in the late postprandial regulation of proximal gastrointestinal motor functions in humans.

From 1979 to 1988 in the GDR the number of patients with alcoholic liver cirrhosis increased from 2,387 to 3,958 (61.2%). An evident decrease of patients with acute virus hepatitis was observed (from 7,037 in 1979 to 1,578 in 1989). In future a further increase of alcoholic liver diseases with the resulting complications (e.g. coma, bleeding varices and withdrawal symptoms) has to be expected.

The aim of our study is to prove whether the development of the low-T3-syndrome in patients with liver cirrhosis is associated with their prognosis. For this purpose we determined the peripheral thyroid hormone levels in 28 patients with liver cirrhosis. For prognosis assessment we calculated the Prognostic Index (PI) on the basis of Cox's regression model as recently described by us. Calculating this index we used 11 parameters: liver morphology, consciousness, spider naevi, PCV, thrombocytes, gamma-GT, cholesterol, albumin, Quick's value, IgA, and potassium. It is demonstrated that there is an inverse correlation between T3-serum levels and PI (p = 0.03). An association could not be detected neither between reverse T3 and PI nor between T3 and rT3. On the other hand basal TSH was also inversely associated with PI. Thus, the low T3-serum levels did not induce a rise of basal TSH in cirrhotics. Moreover, the mean serum-T3-concentration differed significantly from that of 6 decreased patients and from that of the surviving (p = 0.00076). It seems to be true that low T3-serum levels are a very sensitive parameter for prognosis prediction in patients with liver cirrhosis.

The treatment of aging rats with 100 or 300 mg/kg "essential" phospholipids (EPL) for 10 weeks significantly changed the microsomal concentration of phosphatidyl serine plus phosphatidyl inositol. The most marked alterations of the phospholipid fatty acid pattern predominantly observed with unsaturated fatty acids were detectable even 7 days after cessation of EPL application. Ultrastructurally, an enrichment in the hepatocytes with rough endoplasmic reticulum was visible which was more prominent in acinus zone 3. The changes after EPL administration are regarded as the expression of an increased membrane fluidity.