Gall bladder contraction induced by cholecystokinin: bolus injection or infusion?
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Biomedical subjects
Publications and source records attributed to G Rosenbusch.
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In 31 of 33 patients with polyps of the stomach who underwent gastroscopy and x-ray examination the polyps could be diagnosed roentgenologically. 11 patients had multiple polyps, which were in 8 cases hyperplastic polyps, in 3 "other polyps", whereas in 20 patients with solitary polyps 11 cases showed hyperplastic, in 5 cases adenomatous and in 4 cases "other" polyps. After x-ray analysis it can be stated that in our cases the premalignant adenomatous polyp always occurred solitary.
A 30-year-old man returning from a trip through India complained of epigastric pain, diarrhea, loss of weight, and jaundice. Stool examination was positive for Strongyloides stercoralis. On ultrasonographic investigation, intravenous cholangiography, and endoscopic retrograde cholangiopancreaticography, stenosis of the distal common bile duct and enlargement of the pancreatic head were observed. The patient was treated for the Strongyloides infection. The jaundice disappeared within days, the laboratory finding normalized, and the patient recovered rapidly. However, the ultrasonographic examination showed a complete recovery in the course of about 2 years. From this report we conclude that in patients with obstructive jaundice and Strongyloides stercoralis infection, serious abnormalities resembling pancreatic tumour or pancreatitis can be found on ultrasonographic and radiological investigations, and this should be considered in the differential diagnosis of pancreatic mass in patients living in or returning from endemic areas.
Two cases are reported in which rupture of the renal artery occurred many hours after renal percutaneous transluminal angioplasty. Delayed rupture can be recognized by the angiographic appearance and by the presence of persistent flank pain. The typical angiographic finding is a poorly defined zone of contrast medium at the site of perforation.
The clinical and radiographic findings of 11 patients with a chronic traumatic aneurysm were reviewed. Each patient had been under medical care at the time of injury but acute aortic rupture was not recognized in any, although several signs of mediastinal hemorrhage were present on the immediate posttraumatic radiographs. The average time between the initial trauma and the detection of the aneurysm was 5.3 years. Seven patients showed no or minimal specific complaints. Four patients showed more or less severe complaints of dysphagia, severe thoracic pain, hoarseness, and dyspnea. In all patients the chest radiograph was abnormal: Four patients showed a mass lesion at the level of the aortic knob. The other seven patients showed contour deformities of the descending aorta, sometimes subtle, with (five) or without (two) calcification. Esophagography and CT were useful in several patients. In the light of the unpredictable course of a chronic traumatic aneurysm and the low operative mortality, early operation after detection is recommended. Preoperative angiography is usually desirable.
In 4 out of 190 patients, who underwent a cholecystectomy, stones were only found in the common bile duct and none in the gallbladder. The radiological data of these 4 patients were retrospectively analysed. In 2/3 patients sonography showed a dilatation of the common bile duct, whereas stones in the common bile duct were shown by IVC in 2/2 patients, ERCP in 3/3 patients and PTC in 1/1 patients. In 1/3 patients also, in whom an ERCP had been performed, stones were suspected in the gallbladder, but could not be verified during cholecystectomy.
A double-contrast examination of the colon was performed during diarrheal illness in 5 patients with Campylobacter infection. The findings in these 5 patients were aphthoid ulcers and stippled appearance. In 1 patient with stool culture positive for Campylobacter, double-contrast study of the colon 9 days later showed no abnormalities. In a 12-year-old boy lymphoid hyperplasia could be observed as well as the aphthoid ulcers. All the abnormalities were segmental, more often localized in the rectosigmoid. No changes were found in the ascending colon. Histopathologic studies of the biopsy specimens taken endoscopically in 3 patients showed a nonspecific inflammatory reaction.
This study was undertaken to determine in healthy humans the effect of graded physiologic doses of cholecystokinin (CCK) on gallbladder size as assessed by ultrasonography and to analyze the relations between the doses of CCK infused, the plasma CCK increments, the decreases in gallbladder volume, and the cumulative intraduodenal bilirubin output. Infusion of stepwise-increasing doses of CCK, ranging from 0.2 to 6.4 pmol/kg X h, induced dose-related increases in plasma CCK (r = 0.99; p less than 0.001), decreases in gallbladder volume (r = 0.99; p less than 0.001), and increases in intraduodenal bilirubin output (r = 0.96; p less than 0.01). There was a highly significant correlation between the decreases in gallbladder volume and the cumulative intraduodenal bilirubin outputs (r = 0.98; p less than 0.001). Infusion of 0.8 pmol/kg X h of CCK, resulting in an increase in plasma CCK of 1.3 +/- 0.5 pmol/L, was the threshold for stimulating gallbladder contraction as assessed by both ultrasonography and measurement of intraduodenal bilirubin output. It is concluded that ultrasonography is a sensitive method for the quantitation of gallbladder contraction and that physiologic plasma CCK concentrations do stimulate gallbladder contraction.
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Gastrostomy is performed in patients with obstructive carcinoma of the esophagus. As in this operation the peritoneal cavity has to be opened we tried to find in experiments with 11 rabbits whether the percutaneous gastrostomy is a possible alternative.
In the fifties and sixties pregnant women with a history of habitual abortions or premature deliveries were treated with DES (diethylstilboestrol). This treatment can lead to certain pathognomonic uterine changes in the daughters, that are recognizable on hysterosalpingographs. Because of the obstetric consequences, it is important to interpret these changes correctly. The findings in 7 patients are described. As most of the DES-daughters are now coming into reproductive age, gynecologists and radiologists will be confronted more frequently with their specific problems.
Retrospectively the sonographic findings of 11 patients with proven empyema of the gallbladder were analysed. In one patient sonography only showed signs of cholelithiasis, whereas the other ten patients showed one or more signs of cholecystitis. Echogenic bile was established nine times, always connected with layering.
A computerized method that requires only 1-2 minutes to quantify gallbladder volume from real-time sonograms is described. This time is considerably shorter than that required using the hand-calculation method. There was a highly significant correlation between gallbladder volumes calculated by computer and hand (r = 0.97; P less than .001).
Gallbladder contraction and hormone release were measured in six healthy volunteers after their ingestion of two commercially available fatty meals (Biloptin Fatty Meal and Sorbitract) and intravenous bolus injection of 1 Ivy Dog Unit/kg body weight cholecystokinin (CCK) to compare the effectiveness of fatty meals to CCK. Differences in gallbladder volumes, rate constants of emptying, and times of maximal contractions, as measured by real-time sonography, were not statistically significant. Peak levels of CCK, a potent stimulant of gallbladder contraction, and of pancreatic polypeptide, an inhibitor of gallbladder contraction, were significantly higher (P less than .05-P less than .005) after administration of CCK than after ingestion of each fatty meal, but this did not significantly affect emptying rate or maximal contraction. We conclude that the use of intravenous CCK does not offer any advantage over the ingestion of fatty meals in radiographic studies of gallbladder involving induced contractions.
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In 7 kidneys of 6 dogs one of the main stem of the renal artery was ligated. The development of the renorenal collaterals could be followed in 5, as two dogs died after the operation. In all cases intrarenal collaterals could be demonstrated, even in the postoperative dead dogs. The vessels responsible for the collateral circulation are performed interarterial anastomoses, belonging to the extra-glomerular arterial system. From the results of these and former experimental studies it can be concluded, that the renal artery of the dog when entering the renal sinus cannot be regarded as an anatomic, but at most as a functional end artery.