Showing papers in "Zeitschrift Fur Gastroenterologie in 1986"

Therapy of pancreatogenic steatorrhoea: does acid protection of pancreatic enzymes offer any advantage?

Abstract: Pancreatic enzyme replacement may fail to achieve a beneficial effect because of enzyme inactivation by gastric acid. In this controlled randomized study, 8 hospitalized patients with severe exocrine pancreatic insufficiency and considerable steatorrhoea (greater than 15 g faecal fat/day) were treated with a conventional pancreatic enzyme preparation (Pankreon 700; 3 X 3 dragees daily), with (300 mg) and without cimetidine before meals, and with a new pH-sensitive enzyme preparation (Kreon; 3 X 6 capsules daily) comprising acid-protected granules. Both conventional enzyme replacement plus cimetidine, and acid-protected pancreatin were significantly (p less than 0.05) more effective than conventional enzyme therapy alone. Since both regimens are equally potent in overcoming gastric acid-induced enzyme inactivation, it is concluded that therapy with acid-protected pancreatin may simplify and improve treatment of exocrine pancreatic insufficiency in the presence of gastric hyper- or normo-acidity.

[Value of biochemical and imaging procedures for the diagnosis and prognosis of acute pancreatitis--results of a prospective clinical study].

Abstract: For a period of 14 days we carried out measurements for alpha-1-protease inhibitor, alpha-2-macroglobulin, complement C 3, complement C 4, and C-reactive protein in two different groups of patients with acute pancreatitis. Group I consisted of 13 patients with edematous-interstitial pancreatitis and group II of 22 patients with necrotizing pancreatitis. Diagnosis of acute pancreatitis was established by clinical signs and symptoms, by specific pancreatic enzymes determined in the serum, by imaging procedures, and by laparotomy in 24 cases. The overall detection rate for pancreatic necrosis was 90% for the contrast enhanced CT and 33% for ultrasonography respectively. There were significant differences as to all measured serum parameters between the two morphologically defined pancreatitis groups. The necrosis detection rate was 95% for CRP and 85% for alpha-2-macroglobulin. The combined determination of CRP and alpha-2-macroglobulin is recommended in patients with acute pancreatitis to stage the severity of the disease and to probably replace the CT investigation.

Effects of an enkephalin analog on motility of the small and large intestine in the cat.

Abstract: In order to study the effects of naturally occurring opioids on intestinal motility we exposed the unanesthetized cat to different doses of methionine (Met)-enkephalin analog DAMME. DAMME 10(-10) and 10(-9) M/kg body weight inhibited spike activity in the small intestine 20-50 min after injection, whereas in the colon doses as low as 10(-11) M/kg stimulated spiking. Transit of a radiopaque marker infused into duodenal and cecal catheters was delayed both in the small and large bowel. The enkephalin effect was inhibited by the opiate antagonist naloxone 10(-8) and 10(-7) M/kg in the colon, but only at 10(-7) M/kg in the small intestine. Atropine suppressed the enkephalin effect in the small, but not in the large bowel. DAMME caused central nervous side effects. It is concluded that the Met-enkephalin analog suppresses myoelectrical activity in the small intestine probably via cholinergic nervous pathways, and it stimulates spiking and segmenting contractions in the colon probably via a myogenic action. Opiate antagonists may be useful in the treatment of constipation if endogenous opioids are involved.

[Gabexate mesilate in the treatment of acute pancreatitis. Results of a Hannover multicenter double-blind study with 50 patients].

Abstract: We investigated the effect of a new synthetic protease- and phospholipase A2-inhibitor gabexate mesilate (FOY) in a multicenter (6 hospitals in Hannover and vicinity) double-blind study on the clinical course of acute pancreatitis. 50 patients were randomized into two subgroups. One group was treated with 3 X 300 mgs of gabexate mesilate per day for 9 days as a continuous intravenous infusion, the control group received placebo. There was no difference in these two groups regarding age and sex, but there was a discrepancy concerning the severity (stage I-IV) of the acute pancreatitis at the onset of treatment. More of the patients in the gabexate mesilate-group had severe disease on admission to hospital. Of the 7 patients (14%) who died, 5 were in the gabexate mesilate-group whereas only 2 were in the placebo group. This difference in the mortality rate is not significant. There was, however, a significant difference at the 5% level between the verum-group and the control group concerning the decline in alpha-amylase activity in serum and the number of complications. The difference was greatest in alcohol induced acute pancreatitis. A non-parametric test showed a significant reduction in hospitalisation time in the gabexate mesilate-group. Due to the small number of patients and the inhomogeneous clinical course of the acute pancreatitis a definite conclusion concerning the effect of gabexate mesilate on the clinical course of acute pancreatitis is not possible. Further studies with a much greater number of patients and more homogeneous groups with respect to the severity of the acute pancreatitis at the onset of the therapy with gabexate mesilate or placebo are necessary.

[Therapy and prevention of reflux esophagitis. Results of a multicenter study with cimetidine. I: Epidemiology and results of acute therapy].

Abstract: In a sequential observational study efficacy and safety of two dosage regimens of cimetidine for the treatment of reflux-oesophagitis (RE) were examined. 22 office-based specialists took part in the trial. 187 patients received 1600 mg cimetidine (400 mg q.i.d.) daily and 136 patients received 800 mg cimetidine (400 mg b.i.d.) daily, over twelve weeks. The two dosages proved to be equally effective. In the group of patients with RE of stage I at the beginning of the trial, the healing rates were 82% under 1600 mg cimetidine/die and 86% under 800 mg cimetidine/die. In the group of those patients, who entered the study with RE of stage II, in both dosage groups the lesions of 87% of the patients were healed completely or had decreased to stage I. The severity of the mucosal lesions was judged endoscopically, based on a classification scheme modified according to Savary and Miller. The incidence of unwanted symptoms was not significantly different in both dosage groups (1600 mg: 5.3%, 800 mg: 3.4%); none of the symptoms which occurred was judged as definitely caused by cimetidine. The patient collective of the trial was characterized epidemiologically; out of the risk factors examined, only duration of RE history and number of previous RE episodes correlated with the severity of the disease, smoking and alcohol consumption showed no influence.

Cholecystokinin--gene structure, and molecular forms in tissue and blood.

Abstract: The gene structure of human cholecystokinin (CCK) is known and the cDNA structures are known for pig and rat. However, the molecular forms of CCK produced, stored and released from neural or endocrine cells cannot be predicted from the known structures of preprocholecystokinin derived from cDNA. It is well recognized that gastrin and CCK share carboxyl-terminal homology and similar processing to form the biologic active peptides. Comparisons of the structures of preprogastrin and preprocholecystokinin reveal a similar degree of homology in the midregion of the precursors (the structure of preprogastrin 55-59 and preprocholecystokinin 39-42 is His-Arg-Arg-Gln-Leu). Gastrin-34 (whose amino terminus corresponds to position 58 of preprogastrin) is formed by cyclization of glutamine to pyrrolidone carboxylic acid subsequent to cleavage at the double basis site. Identical posttranslational processing in this region would yield CCK-61. However, CCK-58 is the largest biologically active peptide so far isolated and chemically characterized. CCK can be found in high concentrations in gut and brain but the molecular forms differ in the two tissues. Thus, the most abundant forms in the intestine are CCK-58, followed by CCK-39, CCK-33, and CCK-8, whereas in the brain CCK-8 is the most abundant form, followed by CCK-58 and CCK-5. The brain contains in contrast to the intestine little or no CCK-39 and CCK-33. Therefore differences in posttranslational processing between gut and brain are assumed. The predominant small CCK forms in the brain act presumably as neurotransmitters. Large and small molecular forms are released from the endocrine cell of the gut and act as circulating hormones. Several problems have hindered the characterization and quantitation of CCK forms in tissue and blood. The large forms (CCK-58, CCK-39, CCK-33) are easily lost because they are more basic and bind to glass and plastic surfaces. In addition to recovery problems, CCK-58 can be readily degraded into smaller forms at neutral or basic pH in tissue extracts and in blood or plasma. When special care is taken to prevent these problems, we have shown that, in the dog, CCK-58 is not only the most abundant molecular form in the intestinal mucosa but also in the circulating blood. The physiology and pathophysiology of circulating CCK (regulation of pancreatic secretion, of the motility of the gallbladder and the bowel, and involvement in satiety mechanisms) has to be studied further.

Duodenal varices. Report of 13 cases.

Abstract: Only a few cases of Duodenal Varices (DV) have been reported in the world literature mostly by radiological studies, at operations, or autopsies. Alberti described DV for the first time in 1931. The visualisation of DV by fiberoptic endoscope was first made in 1973 by Kunisaki et al. (one case) and later by Kunert and Ottenjann in 1976 (one case). In this study we present 13 cases of DV diagnosed in the period from June 1979 to May 1983 out of 5664 endoscopic examinations performed in the Endoscopy Unit of Riyadh Central Hospital and giving a prevalence of 1:435. 598 cases of Oesophageal Varices (OV) were found in these series, so that the relation DV:OV is 1:46 in this study. The etiology of DV is mostly liver fibrosis due to schistosomiasis (9 cases). In the rest of the cases we found av-malformation (one case), cancer of the head of pancreas (one case) and Hodgkin's disease with enlarged lymph-nodes and ascites in association with chronic duodenal ulcer (one case). In one case the etiology remained unknown. 4 patients had no oesophageal involvement (isolated DV). The cases will be discussed in detail.

Computer analysis of intestinal motility: effects of cholecystokinin and neurotensin on jejunal contraction patterns.

Abstract: The motility of the intestine consists of various contractile patterns which have either segmenting or propulsive function. To differentiate and quantify intestinal contractile patterns the temporal and spatial relation of several closely spaced transducers have to be analysed. For this purpose a special computer method was developed. The system consists of a subsystem for data acquisition and on-line peak detection and a personal computer for data storage and off-line analysis. The subsystem identifies each contraction on the basis of preestablished threshold and timing criteria. Economical and appropriate processing of signals from multichannel recordings requires data reduction which is performed by storing only the voltage and time characteristics of the contraction minimum and maximum. Subsequent analysis of the stored data, especially the measurement of the length of spread of contractions yields a more detailed analysis than commonly obtained. This method enables a rapid detection and exact numerical analysis of signals independent of their wave shapes. Intravenous infusion of neurotensin after administration of a non-caloric cellulose meal decreased the length of spread of contraction waves and slowed the transit rate of luminal contents. Cholecystokinin had a powerful stimulating effect by increasing the length of spread of contraction waves and by accelerating the transit rate.

Lactase deficiency and lactose malabsorption. A review.

Abstract: The results of previous investigations of lactase deficiency and lactose malabsorption are reviewed. It showed that lactase activity and its decline in animals and humans is controlled genetically, but also that its phenotypic expression as lactose malabsorption is influenced by nongenetic factors: adaptation, biological (circadian) rhythmicity, hormones, gastrointestinal functions, and nutritional components can alter the response to lactose intake.

Insulin resistance in liver diseases

Abstract: Coexistence of hyperinsulinemia and normal or impaired carbohydrate tolerance indicates insulin resistance which is frequently observed in patients with liver diseases such as liver cirrhosis, fatty liver, acute and chronic hepatitis and idiopathic haemochromatosis. Insulin resistance in liver diseases can be due to circulating insulin antagonists or a target tissue defect in insulin action, either due to changes in the state of the insulin receptor or due to a postreceptor defect, that means any abnormality in the insulin action sequence following the initial binding step. High insulin levels in liver diseases are caused by diminished degradation of insulin by the liver whereas hypersecretion only plays a minor role under basal conditions. High levels of glucagon, free fatty acids and growth hormone are well known in liver diseases but until now there is no evidence of the pathogenetic importance of these factors. Conflicting results on insulin binding, methodological criticism on binding data and the question whether or not diminished insulin binding on peripheral blood cells plays any physiological role make it unlikely that studies on insulin receptors of peripheral blood cells contribute to the revelation of insulin resistance in liver diseases. The clamp technique allows to quantify the sensitivity of the body to exogenous insulin. The results on liver cirrhosis in connection with studies on glucose metabolism show that under basal conditions insulin insensitivity is due to peripheral resistance (primarily muscle) according to a postreceptor defect. Finally the causes of insulin resistance in liver diseases are still not known.

2 or 1 daily doses of ranitidine in the treatment of reflux esophagitis

Abstract: In a randomized multicentre study 96 patients with mild to moderate types of reflux esophagitis (stages I and II according to Savary-Miller) the effect of 150 mg ranitidine b.i.d. (49 patients) was compared to that of 300 mg ranitidine nocte (47 patients). In both patient groups similar healing rates were observed. 81.6% and 74.5%, respectively, of the patients with esophagitis healed within 6 weeks, and 95.9% and 93.6%, respectively, within 12 weeks. Reflux symptoms disappeared in both treatment groups in 91.8% and 80.9%, respectively, within 6 weeks, and 98.0% and 100%, respectively, within 12 weeks. Drug safety was good. Thus, in mild to moderate types of reflux esophagitis treatment with ranitidine can be reduced to one single dose of 300 mg at night.

Local fibrinolytic therapy in thrombotic complications of peritoneovenous shunt

Abstract: Since 1981 in the University Hospital of Freiburg 41 patients with ascites have been treated by installation of a peritoneo-venous shunt system. In 9 patients thrombotic complications occurred. Two patients had to undergo a second surgical treatment. Seven patients have been treated by local fibrinolysis. In 6 patients local fibrinolytic therapy was partly or completely successful, in one patient local fibrinolysis was of no therapeutic effect.

Effect of various sclerosing drugs on the rat esophagus

Abstract: The sclerosing effect of injections of ethoxysklerol, phenol-almondoil, and 10% NaCl-solution into the esophageal walls of 64 wistar-rats was histologically investigated after 2 days, 1 week, 3 weeks, and 4 months. Inflammatory reaction and subsequent sclerosis were of the same kind with all substances. Nevertheless ethoxysklerol showed a slight dependence on concentration. Injection of phenol-almondoil resulted in a less diffuse inflammation than the aqueous solutions. But after 4 months all cases exhibited the same patchy sclerosis despite of the solution used. Our findings and those of the literature allow the conclusion that the sclerosing effect is less dependent from the inflammation-inducing substance itself but from its concentration and localization.

Ultrastructure of the islets of Langerhans after long-term occlusion of the pancreatic duct system.

Abstract: The long-term effect of surgically induced atrophy and fribrosis of the exocrine parenchyma of the pancreas on the islets of Langerhans was examined electron-microscopically in animal experiments in mini-pigs. Ligature of the pancreatic duct, occlusion of the pancreatic duct system with an alcoholic solution of amino acids and the combination of this occlusion with ligature of the pancreatic duct were compared. A largely similar result was found in all three experimental groups 9 months post-operatively: The islets of Langerhans are mostly subdivided into predominantly small and apparently intact islet cell complexes by peri- and intra-insular fibrosis, and, where larger islet cell complexes are found, these are, in places, also destroyed in the peripheral region. The diffusion distance between the capillaries and the endocrine cells is, in part, considerably dilated by the interposition of collagen fibres. In the capillaries, thickenings and duplications of the basement membrane, as well as swelling of the endothelial cells can be found. There are rarely signs of atrophy in the islet cells lying in clusters. Only the granular structure of the B-cells diverges from the norm. From our morphological findings a delayed and diminished hormone output after pancreatic duct occlusion can be deduced, whereby, compared to earlier short-term experiments of our own, no significant progression of the peri- and intra-insular fibrosis can be determined.

Further evidence for gastroprotection induced by aluminium hydroxide in the rat.

Abstract: The effect of aluminium hydroxide on the development of gastric mucosal lesions induced by microcirculatory disturbances was investigated in the rat. Aluminium hydroxide dose-dependently inhibited the serotonin-induced gastric damages. Carbachol give subcutaneously intensified the development both of ethanol-produced gastric erosions and of indometacin-induced lesions. Al(OH)3 was able to counteract the damaging effect of the compounds mentioned. The gastroprotective effect of Al(OH)3 may be explained by the release of vasodilating prostaglandins into the submucosa; and by the slight spasmolytic effect of aluminium that also contributes to the improvement of the mucosal blood supply.

[Metabolic interaction between cimetidine, ranitidine and amitriptyline/chlordiazepoxide].

Abstract: The effects of cimetidine and ranitidine on plasma levels of amitriptyline and chlordiazepoxide were examined in a biphasic study with 12 young male volunteers. During the first phase all subjects received a fixed combination of 2 X amitriptyline (25 mg) and chlordiazepoxide (10 mg) daily for one week. After the last dose blood samples were drawn up to 72 hours in order to detect plasma levels of the drugs and their main metabolites. Following a wash-out-period of 7 days two groups of 6 subjects, each were formed in a randomized order. In addition to the mentioned medication 3 X 200 mg plus 1 X 400 mg of cimetidine daily or 2 X 150 mg of ranitidine daily were administered for one week. After discontinuation of amitriptyline/chlordiazepoxide the medication with H2-blockers was kept and blood samples were collected again for plasma analysis. Plasma level detections were carried out employing HPLC. The change of the area under the plasma level-time curve (AUC), total clearance and terminal half-life served as parameters indicating interaction. Under treatment with cimetidine plasma levels of amitriptyline and chlordiazepoxide were significantly (5%) increased, whereas such effects could not be observed with ranitidine. Due to these interactions under the conditions of coadministration of H2-blockers and amitriptyline and/or chlordiazepoxide the use of ranitidine is recommended.

Dose comparative study with ranitidine in the therapy and prevention of duodenal ulcer

Abstract: The clinical value of ranitidine, 75 b. d. versus 175 mg b. d. in 48 patients with endoscopically proven duodenal ulcer was evaluated in a randomised double-blind study. In the two groups of patients there was no significant difference of ulcer healing. After 4 weeks of treatment in each group healing of 79% and after 6 weeks of 92% of the ulcers was observed. After 8 weeks the healing rate was 96% in patients who received 75 mg b. d. and 100% in those receiving 150 mg of ranitidine b. d. Smoking prolonged ulcer healing in both groups. Upon ulcer healing in 34 patients a ranitidine dosis of 75 mg nocte for prophylaxis of ulcer recurrence was compared with a 150 mg dosis nocte. Within 12 months in the two groups recurrence of duodenal ulcer was found by endoscopy in 21% and 20% of the patients. 7 out of 8 patients with ulcer recurrence were smokers. According to the results of these studies it appears that the recommended standard dosis of ranitidine for treatment of duodenal ulcer could be reduced by one half. To confirm our conclusions, further studies with a greater number of duodenal ulcer cases are necessary.

[Seasonal incidence of duodenal ulcer--a myth?].

Abstract: A retrospective study was performed on 1091 acute duodenal ulcers found by endoscopy from 1973-1983. The chi 2-test verified statistically a maximum of ulcers in autumn. The vectorial analysis by means of the Rayleigh-Test showed a maximum of observed ulcers in November for all of the patients as well as for subjects with a duodenal ulcer seen only once, or with one relapse found endoscopically. Patients with three or more successive duodenal ulcers showed an individual pattern with or without seasonal periodicity. In chronic duodenal ulcer disease the individual long-time follow-up might be useful in prophylactic anti-ulcer therapy.

[1,000 pancreolauryl tests: evaluation of sensitivity, specificity and use in clinical routine].

Abstract: 1115 examinations with the Pancreolauryl-Test (PLT) were carried out and assessed on 918 non-selected patients with various gastro-enterologic diseases. Depending on the severity of the exocrine insufficiency, sensitivity varied in confirmed chronic pancreatitis (n = 54). Overall sensitivity was 69%, in chronic pancreatitis with steatorrhoe 100%, and 54% in moderate insufficiency. In all patients not suffering from pancreatic diseases (n = 789) specificity was 77%. Since the PLT was frequently pathological in patients with subtotal gastrectomy (gastric resection) and active peptic lesion, specificity was also determined excluding these cases (29% of all patients without pancreatic disease). This resulted in a specificity of 86%. Gastric hyperacidity should be taken into consideration as a possible source of errors (for example, in the condition following an ulcer). Age, weight and alcohol consumption as well as diseases of the bile duct and liver, had no influence on specificity. Urine collection errors, occurring in 10% of the patients investigated, could be avoided by determination of fluorescein in the serum. Our results from a series of examinations on non-selected patients with a 6% prevalence of chronic pancreatitis indicated that PLT is likely to increase predictive value in selected application. If the oesophagus-gastro-duodenoscopy is non-pathological but the PLT gives a pathological result, further pancreatic investigative procedures should be carried out.

[Galactosamine-induced acute liver failure in the guinea pig--spontaneous course and controlled study conditions].

Abstract: The spontaneous course of the galactosamine-hepatitis in the guinea-pig (750 and 1000 mg/kg GalN iv respectively) is characterized by a terminal hypoglycemia together with hypothermia and arterial hypotension fifty-nine hours on average after GalN-application. Preventing hypoglycemia and hypothermia by continuous intravenous infusion of a glucose solution and by increasing room temperature, the animals do not develop hepatic coma, but show an increasing disturbance of the righting reflex and survive at least seventy-two hours. Plasma biochemical tests and liver histology reflect severe hepatic damage. A twofold increase of the liver weight is caused by raised water and lipid content combined with a concomitant depletion of liver glycogen. Pharmacological studies with 14C-Pentobarbital result in a distinctly diminished clearance and in a prolonged half life while the cytochrome P-450 content of the liver shows a moderate decrease. In animal models of acute liver failure the possible incidence of hypoglycemia, arterial hypotension and hypothermia should be considered.

Choledochal cyst type I: successful endoscopic balloon dilatation of the distal common bile duct and sphincter of Oddi: a case report.

Abstract: A 12-year-old boy with a choledochal cyst type I is reported with clinical features of abdominal pain, postprandial vomiting, weight loss and fatigue since 3 months. Diagnosis was made by ultrasound and confirmed by computer-assisted tomography (CAT) and endoscopic retrograde cholangiography (ERC). Instead of the usual surgical treatment balloon dilatation of the sphincter of Oddi and the distal common bile duct was performed by endoscopic means. The patient was relieved from his complaints, gained weight and felt healthy again. Sonographic and endoscopic reexamination had proven that the diameter of the common bile duct had diminished from 3,0 to 2,6 cm. Endoscopic balloon dilatation of choledochal cysts type I may be a valuable alternative to surgical treatment.

[Dose-dependent telenzepine inhibition of the secretion of human gastric acid stimulated by sham feeding and saliva].

Abstract: The effect of graded doses of the new antimuscarinic agent telenzepine on human gastric secretion has been studied in a double-blind placebo-controlled trial in nine healthy volunteers. Over a period of 60 minutes basal acid output as well as acid response to sham feeding was examined. Telenzepine reduced dose-dependently basal acid secretion: This parameter was inhibited with 1 mg by 2%, with 2 mg by 37%, with 3 mg by 53% and with 5 mg by 76%, respectively. The corresponding values for stimulated acid secretion were 16%, 34%, 40% and 57%, respectively. The reduction of basal and stimulated acid secretion was statistically significant (p less than 0.05) following the two larger telenzepine doses. Production of saliva was inhibited by 9%, 21%, 28% and 48%, respectively. The latter reaching statistical significance (p less than 0.05).

[Rioprostil 600 micrograms at night: marked inhibition of nocturnal intragastric acidity in man].

Abstract: Antisecretory doses of prostaglandin analogues of the E1 and E2 series have been shown to promote peptic ulcer healing. In this double blind randomized cross-over study we investigated the effect of oral Rioprostil 300 micrograms b.i.d., 600 micrograms hs and placebo on 24 h intragastric H+ activity in 9 healthy male volunteers (age 20-37 years). 5-10 ml of gastric contents were aspirated hourly via a nasogastric tube. The pH of the samples was determined using a glass electrode . The results were expressed in terms of H+ activity (mmol/l). Night acidity (AUC/h, 2400-0800) is decreased by rioprostil in a dose related fashion (300 micrograms: 52%, 600 micrograms: 74%). The effect on day-time (0900-1800) H+ activity is much less. Rioprostil 300 micrograms given at breakfast reduce day-time acidity by 33%. Our results suggest that 600 micrograms Rioprostil in a single bedtime dose is effective in peptic ulcer treatment.

[Stomach ulcer healing with enprostil, an orally effective prostaglandin E2 analog: direct comparative study with ranitidine].

Abstract: In a randomized, endoscopically controlled double-blind trial the effectiveness of a twice daily dose of the prostaglandin E2-analogue enprostil was compared with ranitidine given to 93 ambulatory patients with benign gastric ulcers. Under 35 micrograms b.i.d. enprostil the ulcer healing rates after 2, 4, 6 and 8 weeks averaged 22% (10/46), 58% (26/45), 80% (35/44) and 86% (37/43). The corresponding values for ranitidine 150 mg b.i.d. were 22% (10/46), 66% (29/44), 84% (38/45) and 89% (41/46). The differences were not statistically significant. Both drugs had a similar influence on the ulcer symptoms and were well tolerated. The findings suggest that enprostil can be given in a twice daily dosage in the treatment of benign gastric ulcers.

Bedeutung der gestörten Magenentleerung

Abstract: In the last ten years we have learnt much about the pathophysiology of gastric motility and emptying, the study of which has been stimulated by the development of new classes of drugs. Radionuclide methods to measure gastric emptying are now generally accepted as reliable and non-invasive diagnostic tools. Too rapid gastric emptying, especially of liquids, may occur after partial resection of the stomach or after vagotomy. Early satiety, epigastric fullness, nausea and vomiting are its manifestations. 'Classical' dumping symptoms only occur in a minority of cases. Delayed gastric emptying can be brought about by many causes, many of which are transient. Chronic forms of gastric stasis can be caused by several metabolic disturbances, by a number of diseases that affect gastric smooth muscle and by many types of drugs. Abnormalities of the innervation of the stomach as in diabetics with autonomic neuropathy and after truncal vagotomy can give rise to seriously delayed emptying of solid food. These conditions can cause impairment of interdigestive motility that may lead to the development of bezoars. Delayed gastric emptying can also be found in otherwise healthy persons (idiopathic gastroparesis). In a proportion of the patients with idiopathic gastroparesis abnormalities of the electrical control activity of the stomach are found; tachyarrhythmias and tachygastrias. In the treatment of gastric emptying disorders dopamine receptor antagonists (metoclopramide, domperidone) play an important role. These drugs have been found to be both effective and safe. The recently developed substance cisapride enhances gastric motility and emptying, probably through a direct effect on the myenteric plexus in the gut wall

Bile duct surgery in the light of modern endoscopic and radiologic technics

Abstract: Biliary surgery and interventional endoscopy and radiology are not competitors but supplement and enlarge their capacities mutually. This holds true for improved diagnostic capabilities and differentiated indication settings as well as for therapeutic splitting by combining surgical and non-surgical methods. Promising reports from the newer literature and increasing own experiences in favour of these concepts form the basis of this topical review.

[Effect of penicillamine therapy on the concentration of zinc, copper, iron, calcium and magnesium in the serum and their excretion in urine].

Abstract: The application of Penicillamine (750 mg per day) for one year resulted in the expected increase of urinary copper excretion (8-10 fold). The increase of Zinc excretion was only moderate (2 fold). The application of Penicillamine did not influence the excretion of Ca, Mg and Fe. We did not find a decrease of Zinc content in the hair of patients after one year treatment. The serum concentration of Zn, Cu, Fe, Ca and Mg was not influence by the application of Penicillamine. Thus, a treatment with Penicillamine is not a probable cause of zinc deficiency in liver disease.