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Biomedical subjects

B Andersen

Publications and source records attributed to B Andersen.

At least 127 records · Page 7Linked to original sources

Perinatal development of the distributions of phosphoenolpyruvate carboxykinase and succinate dehydrogenase in rat liver parenchyma.

Parenchymal distributions and activities of mitochondrial succinate dehydrogenase and cytosolic phosphoenolpyruvate carboxy-kinase were studied during perinatal development of rat liver. 1. Succinate dehydrogenase activity increased almost linearly from day 5 before to day 5 after birth. Hepatocytes with higher enzyme activities were disseminated heterogeneously, zonal heterogeneity developed during the second week. 2. Cytosolic phosphoenolpyruvate carboxykinase was not detectable before birth; it was induced to high levels during day 1 and increased further to a maximum during days 5 to 10. It decreased again to adult levels at the end of the third week. The enzyme distribution already showed signs of a zonal heterogeneity at day 1, which became fully developed during the second week. The results indicate that the zonal heterogeneity typical of adult liver was established for the two enzymes during the second week of life. They revealed in addition that the two enzymes, representing two different subcellular compartments, had an individual development towards the zonal heterogeneity.

Age Factors

Precision in measuring shunt length in jejunoileostomy for morbid obesity.

We performed a prospective assessment of intraoperative precision in determination of shunt length in 138 patients. The variations were slight and of the same order of magnitude in the jejunum and ileum. Precision in per cent of measured length was independent of the actual length and of the surgeons who performed the operations. The results indicate that factors other than error in the measurements are responsible for variations in weight loss after jejunoileostomy.

Body Weight

Portographic findings and coagulopathy in cirrhosis.

Percutaneous transhepatic portography was performed in 57 patients with cirrhosis and portal hypertension. The portographic findings, the free portal pressure and the coagulation tests were analyzed. Moderate or severe abnormality of the coagulation system was significantly associated with extrahepatic shunting, large gastric varices and collaterals from the splenic vein and splenic hilum. Reduced levels of prothrombin, factor X and thrombocyte counts were the factors mainly accounting for this association. As severe variceal bleeding is associated with these changes in the portal circulation, identification of patients at high risk may be based on portography combined with examination of the coagulation system.

Adult

Plasma cholesterol fractions after jejunoileal bypass with 3:1 or 1:3 jejunoileal ratio.

Jejunoileal bypass results in a 40% reduction in total plasma cholesterol both with a 3:1 and with a 1:3 jejunoileal ratio of the segments left in continuity, in spite of a lower rate of cholesterol degradation to bile salts with a 1:3 jejunoileal ratio. We measured total cholesterol, total triglycerides, and high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol in plasma from 34 patients who either were waiting for or had had bypass surgery with 3:1 or 1:3 jejunoileal ratio 3, 9, or 15 months earlier. Total cholesterol and triglycerides were significantly reduced after bypass surgery but showed no significant difference between 3:1 and 1:3 bypass and no significant changes with time after surgery. The HDL cholesterol showed no significant differences between the groups except for a moderately decreased level in the 1:3 bypass group 3 months after surgery. LDL cholesterol was pronouncedly reduced in the bypass groups compared with the unoperated group and was not significantly related to the jejunoileal ratio of the bypass or to the time since surgery.

Bile Acids and Salts

Bypass revision in unsatisfactory weight loss after jejunoileal bypass for morbid obesity.

Sixteen patients with unsatisfactory weight loss after end-to-side jejunoileal bypass were treated with either simple resection of the elongated segment of the shunt (10 patients) or resection combined with conversion to an end-to-end anastomosis (Scott) (6 patients). This led to an additional median weight loss of 13.5 kg (range, 3-25 kg) after 1 year. Scott's procedure yielded the greatest weight loss, but the price was bypass enteritis, arthritis, or electrolyte disturbances in all but one patient. Two of these patients required conversion to gastroplasty. After simple resection of the shunt less than half of the patients required electrolyte supplementation. Most of these patients, however, had unsatisfactory weight loss, which necessitated further surgery in five patients. Only 6 of the 16 patients had good results. In consequence, we have for the past 2 years used conversion to gastroplasty in patients with unsatisfactory weight loss after jejunoileal bypass.

Adult

Bile acid malabsorption after jejunoileal bypass is less compensated for with a 1:3 than with a 3:1 jejunoileal ratio.

A previous study surprisingly showed that after jejunoileal bypass a ratio of 1:3 compared with 3:1 between the jejunal and ileal segment left in continuity resulted in a smaller synthesis rate, pool size, and postcibal jejunal levels of bile acids. These findings are reevaluated in the present study of 34 patients who either were waiting for or 3, 9, or 15 months earlier, had undergone bypass surgery with a 3:1 or 1:3 jejunoileal ratio. Compared with 3:1 bypass, the 1:3 bypass resulted in (i) greater reduction of the fasting bile acid pool, significant for chenodeoxycholic acid but not for cholic adic, (ii) less increase in synthesis rate of both bile acids, (iii) less decrease in relative content of taurine-conjugated bile acids in bile, and (iv) equal reduction of postcibal levels of bile acids in jejunum. We conclude that the increase in synthesis of bile acids compensates insufficiently for the excess fecal loss; the lower synthesis rate after bypass with a short jejunum relative to ileum in function may be due to an impaired stumulation of bile acid synthesis, the mechanism of which is unexplained.

Bile Acids and Salts

Heterogeneous distribution of phosphoenolpyruvate carboxykinase in rat liver parenchyma, isolated, and cultured hepatocytes.

Phosphoenolpyruvate carboxykinase was localized in rat liver parenchyma, as well as isolated and cultured hepatocytes by indirect immunofluorescence microscopy using antibodies against the enzyme raised in rabbits and purified by antigen-affinity-chromatography. 1. In fed and fasted rats the enzyme was heterogeneously distributed over the parenchyma. It was predominantly located in the periportal zone. 2. In hepatocytes shortly after isolation or cultured for 1 h the heterogeneity with respect to the enzyme content was maintained. 3. In hepatocytes cultured for 24 h and treated with glucagon the heterogeneity was lost. The results indicate that the heterogeneity of hepatocytes as to phosphoenolpyruvate carboxykinase content is due to a different expression of the genome.

Animals

Diarrhoea following jejuno-ileostomy for morbid obesity. A randomised trial of loperamide and diphenoxylate.

The effect of loperamide and diphenoxylate on diarrhoea following jejuno-ileostomy for morbid obesity was investigated in 27 patients by means of a randomized fixed sample size, three-period cross-over trial. Both loperamide and diphenoxylate had significant effect on the diarrhoeas when compared with no treatment, but no significant difference was found between the two drugs. Loperamide is an acceptable alternative in the treatment of diarrhoea following jejuno-ileostomy.

Adult

Metronidazole treatment of bypass-enteropathy after jejunoileal shunt-operation for obesity.

In 5 patients with bypass-enteropathy following jejunoileal shunt-operation for morbid obesity, bacterial overgrowth was demonstrated in the functioning small bowel. The symptoms were effectively relieved during treatment with metronidazole in the 3 patients, who completed the treatment. Bacterial cultures revealed no anaerobic growth during 3 of 4 periods of treatment. Anaerobic overgrowth in the small bowel is probably the cause of bypass-enteropathy following jejunoileal shunt-operation.

Adult

Serum levels and clearance of bile acids are unaffected by jejunoileal bypass with 3:1 or 1:3 jejunoileal ratio.

Jejunoileal bypass may impair liver function. The hypothesis of the present study was that this may depend on the jejunoileal ratio of the segment left in continuity in a manner that affects the transport of bile acids from blood to bile. We investigated five extremely obese patients before and 29 patients 3, 9 and 15 months after bypass surgery with a 3:1 or 1:3 jejunoileal ratio of the functioning segment. Routine liver function tests, plasma disappearance rate of intravenously administered 3H-cholic acid and 14C-24-chenodeoxycholic acid, and fasting and postprandial serum concentrations of total 3-alpha-hydroxy bile acids showed no appreciable significant relationship with bypass surgery as such, time after surgery, or the jejunoileal ratio of the functioning segment.

Adult

Cholesterol saturation of bile after jejunoileal bypass increases more with a 1:3 than with a 3:1 jejunoileal ratio.

Previous suggested, surprisingly, that after jejunoileal bypass surgery the lithogenicity of the bile, assessed by its cholesterol saturation and rate of gallstone formation, increases more with a 1:3 than with a 3:1 jejunoileal ratio of the functioning segment. The present study re-evaluates this by examining fasting bile samples drawn from duodenum after cholecystokinin stimulation in 34 obese patients without gallstones, who either were waiting for or had had bypass surgery, with a 1:3 or 3:1 jejunoileal ratio, 3,9, or 15 months earlier. In all groups, the cholesterol content exceeded the solubilizing capacity of the bile as determined on the basis of total lipid concentration and content of phospholipid relative to bile acids. The cholesterol supersaturation increased with bypass surgery as such, increased more with a 1:3 than with a 3:1 jejunoileal ratio, decreased with time after surgery, and reached the preoperative level at 15 months. Assuming a total lipid concentration of 10 g/dl in the bile did not change this pattern. Our results indicate that during the period of weight loss after bypass surgery the lithogenicity of gallbladder bile increases more with a 1:3 than with a 3:1 jejunoileal ratio.

Bile