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

In the catchment area of two Pathological Institutes in Saxony with a population of approximately 1.3 million people all autopsies with the diagnosis of exocrine pancreatic cancer were evaluated with respect to age and the number of autopsies carried out in the period of the past ten years (1979-1988). The trend of this type of cancer within this group of all dissected cancer patients was followed. Absolute increase rates of 48% for males and 32% females could be calculated. An increasing incidence of pancreatic cancer was observed not only in the 7th and 8th decade of live--as was typical so far--but also from the age of 50 years onwards. Rates of increase were also found with regard to all cancer autopsies: 6% for males and 34% for females. The data agree with other observations of an increased pancreatic cancer incidence in all industrialized countries.

Autonomic neuropathy has been evaluated by various cardiovascular bedside tests in 99 patients with chronic alcoholism (33 alcoholics without liver disease, 33 patients with fatty liver and 33 with cirrhosis), in 10 patients with primary biliary cirrhosis, in 12 patients with cirrhosis of other origin, and in 40 healthy controls. Parasympathetic integrity was evaluated by beat-to-beat variation during deep breathing (6 min), Valsalva manouver and standing up, sympathetic function by blood pressure response to standing up and to sustained handgrip test. Autonomic reflex damage was found in all groups examined. Patients with alcoholic cirrhosis exhibited the most severe alterations. Our results suggest, that chronic hepatopathy itself presents a pathogenetic factor of autonomic neuropathy. Autonomic failure has to be considered as a possible cause of symptoms in liver diseases with all its prognostic consequences.

In CF-patients physical development is an important prognostic factor. Therefore, maldigestion in consequence of an exocrine pancreatic insufficiency must be payed special attention to. Only the acid-protected microsphere pancreatin preparations should be used for enzyme substitution. In estimating of effectiveness both subjective (pains, tolerance) and particularly objective parameters (balance investigations, stool-weight and -frequency, physical development) should be considered. Referring to this the determination of fecal chymotrypsin-concentration is unsuitable. There are further possibilities for increasing the enzyme efficiency, which could soon become applicable.

This is an overview about the work of the Central Scientific Research Institute of Gastroenterology, Moscow, with special attention of hepatology. The speak goes about Delta hepatitis in Soviet Union, results of hepatoprotective treatment in experimental animals and in patients, and others.

The results obtained by the examination of the post-operative bile viscosity behaviour sampled by T-drainages of 29 patients (investigations of the relative viscosity with the help of a modified horizontal capillary viscometer from the day of operation until the 9th postoperative day) confirm the importance of the biorheological classification of bile fluid as a Maxwell fluid (investigations of the absolute dynamic viscosity of 33 bile specimens with a Contraves-Low-Shear-Viscometer and representation of flow curves for rheological characterization). The Maxwell flow behaviour is characterized--among other things--by an exponential increase in the case of prestasis. This fact is important in all "low-flow-states" of different pathophysiological genesis and offers a concept with respect to a pathogenetically orientated cholelithiasis prophylaxis.

In a 28 year-old man with epigastric pain endoscopy detected giant gastric folds and multiple superficial erosions. Histologically a mixed form of glandular and foveolar hyper plasia of the gastric mucosa was suggested (Ming's type III). Basal and pentagastrin stimulated secretion volume and acid output were moderately elevated, hypersecretion of protein was not found. Serum levels of calcium and gastrin were normal, also after secretin stimulation. The mucosa of the corpus was extensively infested with Campylobacter pylori. Therapy with cimetidine, antacids, pirenzepine and metronidazol resulted in relief of symptoms but not of histological findings. Bismuth (JatroxR) was successful in eradicating Campylobacter pylori and decreasing inflammation of the mucosa. Cause and prognosis of this mixed hyperplasia are not known.

Relations between porphyrias (porphyria cutanea tarda, variegate porphyria) and HLA- or protease inhibitor (Pi-) system were repeatedly found or supposed. Corresponding investigations do not exist for erythropoietic protoporphyria (EP), for which an autosomal dominant mode of inheritance with highly varying expressiveness (additional genes?) is being discussed. Three families with five EP-patients were examined for possible relations between the manifestations of this disease (skin - and liver changes) and the above-mentioned genetic markers. It was remarkable that three of the patients had the HLA A 3, but nobody of the obvious gene-carriers of this disease without clinical manifestations. On the other hand, two ill couples of siblings were genetically different as to HLA A 3. One couple with liver morphological changes each were different as Pi M-carrier and Pi MS-carrier respectively. Thus, relations between the disease and the genetic markers examined could not be proved.

The authors searched for Campylobacter pylori (CP) in gastric biopsies from 180 patients by means of microbiological culture. Warthin-Starry staining and urease activity determination. 50 patients with CP-positive antral gastritis were treated with bismuthsubsalicylate 2.4 g per day for 3 weeks, followed by a therapy-free interval of 7-10 days and then a control biopsy was performed. Combined results of bacterial culture and histology proved to be mostly reliable. The prevalence of CP in Hungary is similar to other European countries. CP-positivity was found at the following rates: endoscopically normal patients 30%; stump gastritis 30%; antral gastritis 75%; duodenal ulcer 89%. In all CP-positive cases chronic antral gastritis was seen, whereas normal antral mucosa was never CP-positive. There was no correlation between dyspeptic complaints and CP-positive chronic antral gastritis. Both decreased after bismuth therapy independently on the elimination of CP. CP-positivity in 2/3 of the control investigations points to fast recolonization. The clinical relevance of the CP-infection seems to be questionable.

Extensive drug-induced hepatic injury leading up to jaundice occurs relatively rarely. Generally it is not predictable, independent on dosage and irreproductible in animals. As a rule you find it in less than 0.1% of the patients taking the drug, whereas the degree may range up to heavy or lethal (e.g. for isoniazid, methyldopa, halothane). Pathogenetically reactive metabolites capable of producing cytotoxic and/or immune reactions may play a role. Obviously higher age, female sex and endogenous or exogenous alterations in hepatocellular drug metabolism are disposing factors. Drugs, to which our patients most frequently reacted, were dihydralazine alone or in combination with propranolol, and ketophenylbutazone. The lymphocyte transformation test proved diagnostically valuable although it cannot be considered to represent a generally reliable testing method for drug-induced liver disease. Clinical, laboratory and histological findings are typical with a wider range of drugs, but liver biopsy provides the most reliable criteria. Clinical suspicion and stopping the intake of potentially noxious drugs are of importance. The reexposition test should be reserved to exceptional cases.