[XXXI. Congress of the Bavarian Society of Gastroenterology e.V.--23 to 25 October 2003 Herzogenaurach/Forchheim].
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Biomedical subjects
Publications and source records attributed to D Belohlavek.
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The measurement of the gastric transmucosal potential difference (PD) in healthy volunteers under endoscopic control revealed: 1. The local PD can be observed also in regions where oxyntic cells are rare or absent. 2. When the gastric mucosa ist irritated mechanically by the tip of the electrolyte bridge, the local PD is declining and becomes poorly reproducible. 3. The reduction of the PD by pentagastrin can be observed even after blockade of the HCl-secretion by cimetidine. It has two components, a rapid and a slower one. Our results are questioning the concept of an electrogenic HCl-transport as the source of the PD and the interpretation of the PD as a quantitative indicator for the functional integrity of the mucosa barrier.
Twenty-two severely ill patients with multiple injuries and sepsis were treated with IV pirenzepin or placebo 3 x 10 mg per day in the frame of the double-blind study. All the patients were examined three times with endoscopy during the 14-day observation period. In 100% of cases without prophylactic treatment, stress lesions were observed, 60% of these cases had bleeding. A prophylactic IV pirenzepin application had an unmistakable protective effect regarding the stress bleeding, number and degree of stress lesions.
In polytraumatised or septic patients without adequate medical prophylaxis the incidence-rate of postoperative complications is very high. The incidence-rate of acute mucosal stress lesions is to be expected 100 per cent. The parenteral application of pirenzepine shows in comparison to placebo a clear protective effect measured as incidence-rate of stress lesion (p greater than 0,05) and occurrence of bleeding (p greater than 0,01).
The study comprises 56 patients, who underwent transduodenal papilloplasty. More than 15% were symptom-free at least 4 years following surgery. All the symptoms the patients suffered from were nonspecific and the pathological findings of the blood samples were not correlated with the width of the orificium of the papilla of Vater or the diameter of the common bile duct. In 49 patients the ERCP was performed. In 48 cases the retrograde cholangiography was successful, in 1 case only the retrograde pancreatography was possible. In all patients we found normal efflux of contrastmedium out of the papilla. Bile stones, one localized in the common bile duct and the other in the cyst remnant were the most important findings. The diameters of the common bile ducts varied considerably and were not dependent on the velocity of the efflux of the contrast medium. Contrary to the observations of other authors, in only 15% of our patients free air bubbles were found in the bile tree. Peripapillary diverticula of the duodenum were detected in 15% of our patients, but did not lead to compression or obstruction of the common bile duct. Even without histologic examination of the liver, we believe that a broad papilloplasty of the papilla prevents an ascending cholangitis or other related complications.
Zolimidine, a derivate of imidazopyridine, has a gastroprotective effect. Encouraged by the good results with zolimidine therapy in the literature we initiated a clinical study of zolimidine in duodenal ulcer healing.
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4--9 years after transduodenal papillotomy an endoscopic-manometric and clinical control of the surgical result was done in 49 patients. The pressure difference of common bile duct and duodenum was of great interest. There existed a correlation between the pressure difference and other parameters so far, as air was frequently seen in those patients without pressure gradient between common bile duct and duodenum. Pathological activity of gamma-GT and a decrease of Prothrombine-time was found after a high pressure difference. It may be possible that anatomical variations of the biliary system and the duodenum have some importance for the formation of stones.
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As a result of several retrospective and prospective studies, there have been remarkable changes in surgery for portal hypertension, namely the limitation of surgical interventions to an asymptomatic time interval (without bleeding), and the preference for distal shunt operations, aiming at a lasting reduction of the portal hypertension with minimal reduction of portal liver perfusion. These requirements are best met by the mesocaval (H-) shunt, using a vascular prosthesis with sufficient wall stability and a negatively charged inner surface, such as, for example, the expanded PTFE graft (Gore-TEX). In contrast to several types of splenorenal shunt, the H-shunt in mesocaval position is characterized by the following advantages: (a) minimal operative stress, even in high-risk patients, (b) technical ease of use, (c) reduced operative mortality, especially for interval operations, (d) minimal risk of recurrent bleeding and encephalopathy. From this preliminary report it may be expected that the technique of mesocaval expanded PTFE shunt here presented is likely to become the method of choice in both elective and emergency interventions.
The case history of a 40 year old male with septical temperatures and ascites is presented. Because of skin-pigmentation, hypotension, low rate of electrolytes, augmented renin-activity, and septical temperatures there was a suspicion of Addison's disease. A protein-rich ascites without tumor cells and erythrocytes, but with lymphocytes gives the diagnosis of peritonitis tuberculosa. Addison's disease and peritonitis tuberculosa are late manifestations of an organ tuberculosis, about 20 years after pulmonal tuberculosis.
The dose response of duodenal bicarbonate production during synthetic porcine secretin infusions was studied in six healthy volunteers and related to plasma secretin immunoreactivity. Secretin was infused in each individual at four different doses from 0-1 to 2-7 CU/kg/h, each infusion lasting for 60 minutes. Mean maximal bicarbonate secretion was 33 +/- 4 mEq/h. The secretin plasma level for half maximal bicarbonate response was estimated to be 22 pmol/l. As this level is reported to be achieved by intraduodenal acidification in man, it is concluded that secretin may well play a part in the control of duodenal pH.
Graded doses of 0-1, 0-3, 0-9, and 2-7 clinical units/kg/h of pure synthetic secretin were infused over 60 minute periods in six healthy volunteers. Duodenal bicarbonate output and pH were recorded and plasma secretin and motilin levels were measured by radioimmunoassay. During the infusions plasma motilin fell in a dose dependent manner to a nadir of 35%. This fall was linearly correlated with pancreatic bicarbonate output, whereas a non-linear correlation was observed between plasma motilin and both plasma secretin level and duodenal pH. It is suggested that plasma motilin levels are decreased by secretin-induced pancreatic bicarbonate juice flow. This may be important for the control of motilin secretion initiated by duodenal acidification and the concomitant delay in gastric emptying.
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