Biomedical subjects
Publications and source records attributed to H D Becker.
Infusions of GIP in man with innervated stomach is only a potent inhibitor of gastric secretion in high pharmacological doses. Cholinergic mechanisms seem to have an influence on the inhibitory effect of GIP on gastric secretion.
A case report is given of a patient with an accessory choledochus duct opening into the gastric antrum. This is the fifth case reported in the literature. A short review is given about incidence of malformations of extrahepatic bile ducts, ontogenetic background and clinical relevance.
Different types of vagotomy have been widely used in the treatment of peptic ulcer disease. A close relationship between the vagus nerve and the release or action of gastrointestinal hormones is necessary for the optimal activation of the gastrointestinal tract. The serum concentrations of the antral hormone gastrin are elevated after all types of vagotomy. The postvagotomy hypergastrinemia is due to the change in pH in the antral lumen or the gastric motility changes, both of which may lead to a proliferation of G cells. The reduction in pancreatic secretion after vagotomy is not due to changes in intestinal hormone release, but may be caused by the interruption of a postulated enteropancreatic reflex. Postprandial GIP release and serum insulin levels are not affected by vagotomy, but basal GIP levels are increased after vagotomy. Postprandial pancreatic polypeptide release is nearly abolished by vagotomy, but seems to normalize in the later postoperative course. These findings may be important for the interpretation of pathophysiologic changes after vagotomy.
After major abdominal surgery 32 patients received a parenteral nutrition for 6 days with 360 g of a carbohydrate mixture (levulose:glucose:xylitol = 2:1:1) and 100 g of an L-amino acid mixture/24 h. 16 patients with benign disease showed positive nitrogen balances, 16 patients with malignant diseases balanced or slightly negative nitrogen balances. Postoperatively, blood glucose levels did not require insulin. Less than 1.5% of the infused levulose, 2.0% of glucose and 2.4-4.1% of xylitol were found in urine. C3- and C4- complement levels in serum were below normal, transferrin showed a pathological decrease in carcinoma patients.
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In patients with bleeding esophageal varices the main purpose of the treatment is to stop the bleeding at a justifiable risk. The so-called blocking procedures reach this purpose most consistently. We report the results on transmural variceal ligation plus fundoplication in 16 patients in whom the bleeding esophageal varices were not stopped by conservative means. 75% of these patients belonged to group B and C in Child's classification. Postoperative lethality was 18,7%, in all cases bleeding was stopped. These results favour trasmural varices ligation as an emergency procedure in bleeding esophageal varices.
In a prospective study 67 patients with bleeding from acute gastric mucosal lesions were treated by intravenous infusion of secretin. In 64 of the 67 patients bleeding stopped during secretin infusion. In 16 of these 64, bleeding recurred after cessation of the secretin infusion; all recurrences were stopped by secretin. Severe side effects were not observed. Secretin seems to be an effective drug in the treatment of stress ulcer bleeding.
The gastric secretion of hydrochloric acid, total proteolytic activity, and especially pepsin were studied before and 6 months after selective proximal vagotomy in 15 patients suffering from recurrent duodenal ulcer, and compared with that of ten sound volunteers. The patients with duodenal ulcer showed a significantly increased secretion of acid and proteolytic enzymes. After vagotomy, the basal acid output was reduced by 70%, the secretion of the total proteolytic activity by 54%, and that of pepsin by 45%. The concentration of the total proteolytic activity and of pepsin in the gastric juice was increased after vagotomy. Although the total basal proteolytic activity after vagotomy was still increased by 15% as compared with that in the volunteers, due to the drastically reduced basal acid output the actual intragastric basal proteolytic activity was expected to be reduced after vagotomy.
The basic and with pentagastrin stimulated (dose response) secretion of acid and proteolytic activity of the stomach were estimated at five healthy volunteers before and after a six-week-antacid-therapy as well as at ten patients with duodenal ulcer disease. After a six-week-antacid-therapy the BAO and the basic proteolytic activity were reduced for 50% as compared to the healthy volunteers without it while the maximal stimulated secretion of acid and proteolytic enzymes was not altered. After a three-day-antacid-therapy these changes did not occur. The basic acid output (BAO) was increased for 60% and the basic secretion of proteolytic enzymes was increased for 50% at duodenal ulcer patients. The changes of the gastric juice volumes at the different steps of stimulation and within the three groups of patients do not seem to be correlated constantly to the changes of secretion of acid and proteolytic activity. After a three-day-antacid-therapy, however, the volume of the basic and stimulated gastric juice turned out to be identically reduced as after a longtime antacid therapy. These results suggest that the secretion of acid, proteolytic activity and gastric juice occur independently.
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A liver cyst was detected during a routine ultrasonographic examination. Needle biopsy of the cyst was performed using ultrasound as a guidance device during puncture. Malignant cells could be demonstrated on cytological examination. Needle biopsy of circumscribed lesions of the liver is a low risk procedure, causing no strain for the patient. Needle biopsy should be done, when a hepatic cyst is detected by ultrasound, when there is suspicion of malignancy, and when a parasitic lesion has been excluded.
Previous investigations show that calcium infusion stimulates gastrin output in healthy volunteers, whereas after antrectomy calcium does not cause any significant change of IRG levels. Both healthy volunteers and antrectomized patients (B II) show a continuous increase of LESP, reaching a maximum after 120 minutes. These results suggest a direct interaction of Ca++-ions and gastrointestinal smooth muscle cells.
Truncal and selective proximal vagotomy cause in an increase of basal GIP-levels. There was no difference between the postprandial GIP release before and after vagotomy. However after extragastric vagotomy in dogs postprandial GIP-levels showed a significant increase in comparison to intact animals.
The question has been risen whether "pancreatic polypeptide" (PP) determination is a suitable index for a successful vagotomy. Three months after truncal vagotomy (TV) there was only a slight postprandial increase of PP levels whereas five years after TV a normal PP response was found compared to controls. Vagal induced PP release was completely abolished after TV. Selective proximal vagotomy did not influence vagal and food stimulated PP release significantly. It can be concluded that PP determination does not prove to be a suitable index for a successful vagotomy.
Antrectomy or truncal vagotomy with pyloroplasty induces an abnormal alimentary hyperglycemia after ingestion of oral glucose. Low doses of secretin normalize the glucose homeostasis in dogs after antrectomy and truncal vagotomy.
It has been postulated that resection therapy for peptic ulcer disease will result in an increased frequency of gastric stump cancer depending on the ulcer type and type of operation (Billroth I, Billroth II, gastroenterostomy). However, an extensive review of the literature shows that after Billroth II resection for gastric ulcer without enteroanastomosis the frequency of primary gastric stump cancer is not greater than in the case of medically treated benign gastric ulcers. The frequency of cancer of the gastric stump seems lower after resection for duodenal ulcer disease. It is possible that the combination of the Billroth II resection with an enteroanastomosis decreases the frequency of cancer of the gastric remnant. Clinical and experimental studies do not allow final statements on cancer frequency after Billroth I resection or simple gastroenterostomy.
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Serum immunoreactive gastric inhibitory polypeptide (IR-GIP), gastrin (IRG), and insulin (IRI) were estimated in 41 normal weight patients with duodenal ulcer (DU) and 25 age-matched controls in response to a high calorie liquid test meal. 28 out of 41 DU patients had a hyperglycaemic glucose response during the test meal, and 15 had a pathological oral glucose tolerance test. Fasting and food-stimulated IR-GIP and IRG levels were significantly elevated in the DU patients. Serum IRI also increased to significantly higher levels in DU patients after the test meal. The degree of the greater hormone response was dependent on the glucose increase after the test meal in the case of insulin and GIP, but not in the case of gastrin. It is concluded: firstly, that a faster glucose absorption (possibly due to rapid initial gastric emptying or increased intestinal motility) is responsible for the high and short-lasting glucose peak and the increased GIP and insulin secretion; secondly, that the GIP response could well be causally related to the insulin response; thirdly, that hyposcretion of GIP is ruled out as a possible factor in the pathogenesis of gastric acid hypersecretion of duodenal ulcer patients.