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

A total of 58 patients with histologically confirmed chronic viral hepatitis B and presence of HBsAg and HBV-DNA in the serum were randomized in a prospectively controlled trial. 30 patients were treated with 3 megaunits of rIFN a-2b s.c. thrice weekly for 4 months. 28 controls received no treatment. The post-treatment follow-up period consisted of 6 months. 28 patients treated and 27 controls completed the protocol. One female patient of the treatment group showed a complete response (loss of HBsAg, HBeAg and HBV-DNA), 8 other patients (32%) revealed a partial response to therapy (loss of HBeAg and HBV-DNA). Three patients of the control-group (11%) lost HBeAg and HBV-DNA spontaneously. This finding is statistically significant (p less than 0.05). The elimination of HBV-markers from the serum was associated with a normalization of aminotransferase activities in the serum. A reactivation of hepatitis was not observed after seroconversion.

About 15% of children with alpha-1-antitrypsin-deficiency with proteinase inhibitor type ZZ develop hepatopathy, uninfluenceable in its course. These children already show symptoms of severe cholestatic hepatitis in early infancy as became obvious from data of 13 children being patients in the authors care and suffering from hepatic cirrhosis with alpha-1-antitrypsin-deficiency. At present liver transplantation is the only causal possibility of therapy. Even without highly specialized laboratory the non-laboratory assistant will recognize at least the homozygous alpha-1-antitrypsin-deficiency (PI-ZZ). The therapeutic approach must be directed on treating the patients in such a way that liver transplantation will be possible at a favourable moment and under good conditions. Since PI-ZZ family members suffer similar course of hepatopathy, genetic counsel is of special significance.

Xenobiotics may produce liver damages. Vice versa primary liver diseases influence metabolism and elimination of drugs. The activity of the isoenzymes of the monooxygenase system which catalyze biotransformation reactions in the liver can be tested by model substances (Cyt P-450Pb: Metamizol, Cyt P-450MC: Caffeine, Cyt P-450db1: Debrisoquine). It can be influenced by estrogens, gestagens, smoking, alcohol. Only severe stages of liver diseases reduce the biotransformation of drugs. Thus in liver cirrhosis the excretion of unchanged furosemide is increased. The bioavailability of propranolol is changed by a reduced first pass effect in liver cirrhosis. In patients with drug hepatitis after dihydralazine 15 out of 17 patients are genetically slow acetylators and they show also a lower activity of phase I cytochrom P-450 catalyzed biotransformation reactions. The same holds true for patients with haemochromatosis. Determination of the 7-ethoxycoumarin-O-deethylase (ECOD) in liver biopsy samples allows the correlation of the decrease in biotransformation with the increase of liver cell necrosis, intraacinous fibrosis and structural changes. Possibly the changes in biotransformation caused by liver diseases are connected with a disturbed regeneration of the liver corresponding to the concept of the "streaming liver".

Inflammatory and cicatrical alterations are the morphological basis of papillary stenosis in most cases due to canalicular or lymphatic spreading of bacterial infection in gallstone disease. The consequences of papillary stenosis are elevated pressure in the ducts and reduced bile flow. At surgery you find dilatation of the bile ducts, increase of residual pressure, decrease of outflow, and--in cicatrical stenosis--stop for the probe. Only the inflammatory stenosis is reversible, but permanent alteration is not to determine. Therefore therapy is necessary, at first instrumental dilation to 4-6 mm. Impossibility of dilatation indicates transduodenal sphincterotomy. Recurrencies are best treated by endoscopic sphincterotomy and exceptionally by choledochoduodenostomy.

Esophageal varices nearly always rupture at or just above the gastro-esophageal junction. Mucosal changes on top of the varices, the so-called red colour sign, are found in the majority of patients with a positive bleeding history. An increase of intraabdominal pressure and consequently a sudden pressure rise in the varices is thought of as a trigger cause. The larger the esophageal varices the higher the intravariceal and the transmural varix pressures. The portal pressure in patients with portal hypertension is subjected to considerable changes. Therefore, hemodynamic measurements at rest may have a prognostic value with regard to predisposition to hemorrhage, but they are less significant than endoscopic parameters. Disturbances of blood hemostasis and ascites indicating an impaired liver function are essential predisponable factors for the onset of bleedings. A peptic lesion caused by acid gastric-esophageal reflux is of less importance for the occurrence of variceal hemorrhage.

The influence of an angiogenesis stimulating dipeptide (Lys-Pro-derivative) on the blood flow rate of the stomach was tested in rats suffering from ulcus ventriculi by microspheres technique. 21 days after operation (acetic acid model by Takagi) the ulcers in the group treated with the dipeptide were healed completely, but not in the control group. The higher blood flow in the ulcer area of the dipeptide group radiometrically gained, was not changed significantly (U-test by Man-Whitney). These results demonstrate, that the process of rapid wound healing promoted by the dipeptide cannot entirely be explained by a higher blood flow of the stomach.

Lymphocytic dipeptidylaminopeptidase IV (DP-IV; E.C.3.4.14.5.) is described as a marker enzyme of immunostimulant T-lymphocytes as well as functional characteristic of IL-2-producing cells. Mononuclear cells of periphere blood (MNC) were isolated by density gradient centrifugation followed by enzymcytochemical staining of DP-IV positive cells and measuring of DP-IV enzyme activity using chromogenic substrates. As relative sign of single cell DP-IV activity we calculated average DP-IV activities of DP-IV positive cells. Blood samples from 14 patients with acute virus hepatitis, 30 cases of chronic active liver disease, 61 cases with liver cirrhosis of various kind and 19 patients with fatty liver and toxic hepatitis were investigated. As standard of comparison we used a group of healthy blood donors. By this way significant differences of described DP-IV parameters between some groups of liver disease were evident. Using an aetiologic classification of investigated liver diseases we found highly significant increased single cell activities in hepatitis-B associated cases in comparison to remarkable lower lower values in autoimmune cases. Different hypothesis about changes of lymphocytic dipeptidylaminopeptidase IV as a part of disturbed immunoregulation in chronic liver diseases were discussed.

The abdominal clinical staging in malignant lymphomas should be started from sonography. The size of detectable lymph nodes and focal lesions in liver and spleen (to 0.5 cm on favourable conditions of examination) reflects a comparable position of ultrasound, computed tomography and magnetic resonance imaging. The last called method seems to be advantageous only in the pelvic region. Involved lymph nodes in malignant lymphomas on the contrary to metastatic infiltration in carcinomas appear for the most part hypoechoic. The sonographic findings in liver, spleen, pancreas and kidneys infiltrated by lymphomas and other malignant diseases do not differ significantly. The involvement of gastrointestinal tract can be associated with the so called "bull's eye"-, "target"- or "pseudokidney"-sign. The endoscopic sonography could improve the preoperative staging by measuring thickened gastrointestinal wall structures and by detecting infiltrated neighbouring organs. Ultrasound-assisted needle biopsies are useful. However the favourable results reported (sensitivity, positive correlation, concordance-100%) seems to be connected with low number of cases involved. Remarkable proportion of false negative results should be expected. Laparotomy with splenectomy remains the most accurate staging method in Hodgkin's disease and non-Hodgkin's lymphomas.

In 148 patients (medium of 59, 1 years) we investigated the natural history of chronic gastritis within 1-7 years (average of 5.9 years). We performed two biopsies, but in 35 cases 3 or 4 biopsies. In most patients the histological picture was not changed. In superficial gastritis of the body we observed a regression more often than a progression. Regression of atrophic gastritis was see in body and antrum. The rate of regression was higher in cases with 3 or 4 biopsies and with a longer interval of observation. The frequency of regression was higher than awaited according to simultaneous biopsies (criticism of method). There was no difference of rate of regression in various age groups and in various diagnosis (gastric or duodenal ulcer). In gastritis Type B the regression was more seldom than in gastritis Type a or type AB. For spontaneous regression no cause was found.

The Gastroenterological Society of the GDR was founded on May 19th, 1965. A survey is given of the number of its members, its presidents, the meetings organized by it, and the awards presented by it.