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

Four pharmacons were tested on an acute portal pressure lowering effect in an experimental animal model with 25 normal and 25 rats with Thioacetamide-toxic liver cirrhosis. Invasive measurements of arterial and portal pressure were made under Hexobarbital-Sodium anaesthesia during 30 minutes after pharmacon application. The portal pressure of cirrhotic rats was under basic conditions 9.5 +/- 1.5 mm Hg and significant higher as in normal animals (5.3 +/- 0.9 mm Hg, p less than 0.01). After 10 mg/kg body mass Propranolol the portal pressure decreased in both animal groups small but not significantly over the whole measurement time. 1 mg/kg Verapamil lowered arterial middle pressure significantly, but increased portal pressure at all 15-20% in both animal groups. Application of 0.1 mg/kg Prazosin decreased the arterial middle pressure at all 5-15% and the portal pressure at all 20-30% in both study groups (both significantly). For Canrenoat-Potassium (20 mg/kg) no clear effect could by evaluated on portal pressure. The model of Thioacetamide-toxic cirrhosis of the rat offers conditions like cirrhosis in human medicine in order to study the effects of portal pressure lowering pharmacons. Propranolol and Prazosin decrease portal pressure and should by further investigated.

Tendency of peptic ulcer to frequent recurrence and spontaneous healing as to life-threatening complications are apart of the natural history of ulcer disease. In a retrospective study of 7 years, we examined 27 simple factors for their prognostic value by 218 patients suffering from ulcer disease which were diagnosed by fibroscopy. The interpretation with help multi analysis, the variant and discriminant analysis showed by patients with stomach ulcer that, the prognosis of the combination between renunciation of nicotine the begin of the disease until 30th years of the people, more than three foods daily, stomach cancer in the family, blood group A and left finger position would be suitable. The prognosis was better for patients with duodenal ulcer who have nicotine abstinence, childlessness negative history of the family with view to ulcer disease, blood group 0, positive Rh-factor and the working time.

A sonographically demonstrated vermicular structure in the region of the gall bladder was suspected to be an ascaris, which is to find in the biliary system occasionally. However under cholecystectomy there was not to detect a worm, only a stone in the cystic duct. In accordance to anamnesis we think it being the caudal part of a ventriculo-peritoneal drain implanted for hydrocephalus therapy.

The diagnostic and therapeutic management is described in four cases with foreign bodies of the biliary tract: ball of thread, T-bougie, shell splinter, peel of greens. The possibilities of therapeutic endoscopy are emphasized.

The diagnostic value of secretin provoked abdominal ultrasound was studied on 34 patients with pancreas divisum and on 20 control subjects. The patients received a 1.0 unit/kg body weight dose of secretin. The degree of ductal expansion and the time required to return to the initial state were registered and these values were compared to the clinical diagnosis. The control subject's ductal diameters prior to secretin administration were 1 mm in all cases (maximum expansion 2 mm, return to the initial value within 10 minutes). The pancreas divisum patients could be placed in two groups based on their initial ductal diameter. Fourteen patients had initial ductal diameters of 2 mm or greater (A group mean +/- SD: 2.4 +/- 0.3) while 21 patients had an initial value of less than 2 mm (B group; 1.7 +/- 0.3). Following secretin administration the ductal diameter of the A group's patients increased on average +/- SD to 1.3 +/- 0.5 times the initial value and in the B group 3.2 +/- 1.1 times the initial value (p less than 0.01). In the A group the ductal diameter returned to it's initial value within 10 minutes while it took 35 minutes for the same to occur in the B group. A relationship can be observed between the clinical diagnosis, the initial ductal diameter, the degree of expansion following secretin administration and the time required to return to the initial state.

In the liver biopsy of 100 patients with chronic liver diseases, the activity of 7-ethoxycoumarin O-deethylase (ECOD) was determined as a parameter of hepatic monooxygenase system and was compared with some markers of fibrosis e.g. collagen peptidase and hydroxyproline. ECOD was significantly different in healthy liver, fatty liver, chronic active hepatitis (CAH) and cirrhosis. The importance of the fibrotic process was shown by the significant correlations between ECOD and the signs of fibrosis in the liver biopsy. A connection between ECOD and the markers of fibrosis was not found. Further research is necessary to clarify this difference.

With laser it's possible to produce a radiation of definite wave length which is rich in energy. This energy is changed into heat during its impinge on tissue. Different effects (coagulation, vaporization) can be produced in dependence on wave length, the technical features of laser and the different interaction of laser light. In 8 patients with obstructive polypous carcinomas of rectosigmoid a complete passage-recovery could be achieved. The therapy was effective in 8 out of 11 patients with villous adenomas. One patient had a relapse into adenoma after half a year. With laser a distal rectostenosis at high degree could be widened at Morbus Crohn. Complications didn't appear. Indications of laser-therapy are explained. The laser-therapy is effective, not very risky but not cheap. Therefore it requires an application of overlapping subjects.

In a prospective study the routine endoscopy of the upper gastrointestinal tract was carried out in 100 patients before they underwent elective cholecystectomy for gallstones. In 31/100 patients we detected abnormalities which changed the plan of therapy. In 18/100 patients the cholecystectomy was performed 4 to 8 weeks later, after additional medical treatment. 7 patients were discharged from the cholecystectomy. The preoperative endoscopy of the upper gastrointestinal tract should be used in patients undergoing cholecystectomy to exclude other gastrointestinal disorders.

Plasma concentrations of atrial natriuretic peptide (ANP), aldosterone (PA), vasopressin (AVP) and plasma renin activity (PRA) were measured in 15 patients with decompensated cirrhosis of the liver during a control period and subsequently during intravenous administration of albumin. Infusion of hyperoncotic albumin increased diuresis, natriuresis, stimulated ANP secretion and tended to normalize other vasoactive hormone levels in 9 patients (responders), whereas it had no effect in 6 other patients (non-responders). Responders had significantly lower basal levels of ANP and higher ones of PRA, and AVP than non-responders, suggesting that responders had decreased effective intravascular volume. Our data suggest that cirrhotic patients with ascites formation do not represent a homogenous group. In some patients with decompensated cirrhosis a compromised circulatory state with decreased effective circulatory volume induces compensatory changes in several regulatory hormones. It appears that secondary alterations in the plasma concentrations of ANP of cirrhotic patients may occur according to the suspected change of intravascular fluid volume.

In an overview of the history of gastric intubation, the first use of a stomach tube in 1790 is reported, and the importance of the works of Kussmaul and his assistants as well as of Leube, Ewald, Boas, and Einhorn are specially stressed. With the development of new possibilities of investigation by means of the gastric tube gastroenterology began to emerge as a special field.