[Gastrointestinal manifestations of Henoch-Schoenlein purpura. Apropos of 7 cases].
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Biomedical subjects
Publications and source records attributed to E Loizeau.
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Perspectives in nutrition suggest a greater use of single-cell proteins in the future. The problems of a high purine content and of potential allergens have been solved by technology. The single-cell proteins may contain trehalose, the absorption of which by the human intestine necessitates prior hydrolysis by trehalase, a specific brush-border disaccharidase. The enzymatic analysis of 100 intestinal biopsies discovered 2 cases of very low trehalase level, with an expected clinical intolerance to even small doses of trehalose. It is concluded that tolerance to high doses of trehalose should be excellent in about 98% of healthy people.
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Basal and stimulated (secretin/CCK pancreozymin) duodenal aspirates were analyzed for flow rate and the protein and bicarbonate concentrations in 7 non-alcoholic controls and in 7 subjects with type IV hyperlipoproteinemia. Basal volume and bicarbonate concentration did not differ in the two groups. In the hyperlipoproteinemia patients, basal protein concentration and flow rates were significantly different from controls (p = 0.0143 and p = 0.0182 respectively). The bicarbonate flow rate is also increased in hyperlipoproteinemia. The data obtained after stimulation were similar for protein and HCO3 in both groups. These findings are identical to those observed by SARLES in alcoholic and hypercalcemic animals and in man. It is possible, but not yet proven, that hyperlipoproteinemia pancreatitis is due to protein precipitates in the pancreatic canaliculi.
The incidence of the cancer of the pancreas is particulary high in Geneva. To determine the possible effects of tobacco, alcohol and/or food, the consumption habits of patients with digestive diseases have been studied at the University Hospital of Geneva since 1977. The present contribution deals with pancreatic patients only. These patients' consumption of tobacco, alcohol and food has been compared with that of standardized controls randomly selected from the Geneva population. A relationship between pancreatic cancer and lifetime tobacco consumption was found on the one hand, and on the other a relationship between chronic pancreatitis and lifetime alcohol consumption.
Glucagon secretion has been tested in 12 cirrhotic patients and the results have been compared with those obtained in 10 normal subjects. Two antisera reputed to be specific for glucagon (antiserum 30-K and antiserum RCS5) were used. The patients with cirrhosis exhibited significantly higher levels of plasma immunoreactivity for glucagon, suggesting hyperglucagonemia when using antiserum 30-K but not when using antiserum RCS 5. A positive correlation (r = 0.527, p less than 0.001) was found between plasma immunoreactive glucagon measured by antiserum 30-K and IgG. With antiserum RCS 5 there was no such correlation. These data suggest that hyperglucagonemia may be wrongly suspected when glucagon is measured with antiserum 30-K, due to cross-reaction with IgG. Cirrhotic patients exhibit only a slight increase of glucagon.
In German the consumption of food among cirrhotic patients, whether male or female and among male patients with primary liver cancer (PLC), is virtually the same as in normals. Alcohol consumption is very high in all three groups. The heaviest drinkers are the cirrhotic males, but the highest patient/control ratio is found among cirrhotic females (X 5.4). Total alcohol ingestion during life appears to be higher in patients with PLC plus cirrhosis than in those with PLC without cirrhosis. Tobacco consumption by male cirrhotic and PLC patients is the same as in controls. Conversely, cirrhotic females smoke seven times as much as their standardized controls.
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Glucagon immunoreactivity (IRG) was measured in plasma of 8 duodenopancreatectomized patients with antiserum 30-K. Arginine infusions failed to raise plasma IRG, whereas in control subjects IRG rose 3-fold. Column chromatography revealed that the basal IRG measured in these plasmas was not due to glucagon (molecular weight 3485) but to other plasma factors, mainly of high molecular weight. This suggests that diabetes mellitus does not require the presence of glucagon to produce the clinical picture, as suggested by other authors. Plasma levels of the amino acids alanine, serine, ornithine, and arginine were significantly (p less than 0.05) elevated, the former two being gluconeogenic substrates and the latter two constituents of the urea cycle. This amino acid abnormality may be a consequence of glucagon deficiency.
A study has been conducted to determine the accuracy of breath-H2 measurements for quantitating the malabsorption of small amounts of carbohydrate. H2 pulmonary excretion was measured after an overnight fast at 30-min intervals for 4 h in 7 healthy subjects after ingestion of 4 doses of lactulose (2.5,5,10 and 50 g). In 3 subjects the test was repeated without lactulose. The volume of H2 excreted was directly proportional to the amount of ingested lactulose: mean cumulative H2 excretion over a 2-h period after 5, 10 and 50 g was 2.9, 6.6 and 37.6 ml H2 respectively; H2 response after the 2.5-g dose was not perceptible. Individual H2 excretion before lactulose ingestion was highly variable: 0.096 +/- 0.075 mlH2 (mean +/- 1 SD); the individual base line rate over a fasting period showed marked fluctuations. It is concluded that the inter- and intraindividual variations of H2 excretion limit the accuracy of the H2 breath test for quantitating malabsorption of small amounts of carbohydrate.
The differential diagnosis of chronic diarrhea is often difficult and necessitates a two-step evaluation: (1) classification as to the clinical type of diarrhea (accelerated transit time, lesional, metabolic); (2) once the type of diarrhea is ascertained, search for the causative factor. The clinical classification is within the general practitioner's capability, whereas step two is more a matter for the specialist.
D-xylose pharmacokinetics has been studied in 6 healthy subjects by serial measurement of blood and urinary levels following oral and intravenous administration of two doses of D-xylose (5 and 25 g successively). Furthermore, patients with obesity, renal or hepatic insufficiency, or with a T-drain after cholecystectomy, are also investigated. Both the rate and completeness of D-xylose absorption and the apparent distribution volume of D-xylose present noteworthy interindividual variations, so that the time and value of the peak blood level are highly variable as between healthy subjects. Renal insufficiency increases the apparent elimination half-life of D-xylose and notably reduces D-xylose renal excretion. This study provides pharmacokinetic evidence of the very wide range of blood and urinary levels observed in the D-xylose tolerance test, and emphasizes the fact that D-xylose urinary excretion alone is not a reliable index of intestinal absorption.
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