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Biomedical subjects

J Hotz

Publications and source records attributed to J Hotz.

At least 109 records · Page 6Linked to original sources

[Review: cimetidine: mode of action and clinical efficacy in various gastrointestinal diseases (author's transl)].

The development of the histamine-H2-receptor-antagonist cimetidine has led to a better understanding in the physiological control of gastric secretion and to a new approach in the management of various lesions of the upper gastrointestinal tract. Numerous world-wide controlled clinical trials have shown that the new drug is more efficient in diseases which are accompanied by hyperchlorhydria. This is especially true in the acute therapy and long-term prophylaxis of duodenal ulcer and in Zollinger-Ellison-syndrome. In contrast, at the present, the therapeutic benefit of cimetidine is less proven in gastric ulcer, in reflux oesophagitis and in acute hemorrhage of the upper gastrointestinal tract. Even under long-term administration no severe organic side effect occured with the drug which generally is well tolerated. Cimetidine appears as a valuable and safe agent, when the range of application is limited to defined gastrointestinal disorders.

Acute Disease↗

[Theoretical and practical implications of calcitonin therapy in gastroduodenal ulcer].

Calcitonin (CT) inhibits basal and pentagastrin stimulated gastric acid and pepsin secretion by 60 to 70% when CT is infused over a short period of time. Vagal and histamine-mediated stimulations are less diminished. A long-term infusion of CT inhibits persitently basal and pentagastrin-stimulated acid and pepsin secretion over more than 24 hours in patients with duodenal ulcer, stress bleeding and Zollinger-Ellison-Syndrome. To date, the therapeutic efficiency of CT in gastroduodenal bleeding has not been evaluated in a controlled trial. CT inhibits gastric secretion also after oral application. In an endoscopically controlled double blind trial we were not able to demonstrate a significant benefit of oral CT in patients with gastric ulcer. In ulcer bleeding CT does not apear reasonable in comparison with histamine-H2-receptor antagonists which apparently is more efficient and less costly.

Calcitonin↗

[Eosinophilia as a diagnostic clue to primary sclerosing cholangitis (author's transl)].

The history of a 38-year-old, asymptomatic man with primary sclerosing cholangitis is reported. The diagnosis has been suggested by eosinophilia (66%, 27 X 10(9)/l leucocytes) and markedly elevated serum alkaline phosphatase levels (1860 U/l) and has been established by endoscopic retrograde cholangiography. Report of a therapeutic approach with D-Penicillamin. Documentation of follow-up by endoscopic retrograde cholangiography.

Adult↗

Hypercaloric nutrition as aetiological factor in chronic pancreatitis.

Nutritional habits were evaluated in 31 patients with confirmed chronic calcifying pancreatitis (CCP) (n = 11, mean age 43,9 years) and chronic non-calcified pancreatitis (CP) (n = 20, mean age 44,5 years). Each patient was matched with two healthy persons of same age, sex and social class. In the patients with CCP before onset of the clinical disease the daily intake of fat (156 g versus 89 g), of carbohydrates (325 g versus 262 g, of alcohol (124 g versus 19 g) and of total calories (4110 versus 2250) was significantly higher than in the control persons. In the patients with CP likewise the daily intake of fat, alcohol and total calories (3598 versus 2069) was significantly higher than in the controls. After onset of the clinical signs of pancreatitis, the intake of nutrients was significantly reduced, mainly due to a lower intake of fat and alcohol.

Adult↗

Similar modes of action of calcitonin and glucagon in inhibiting pancreatic enzyme secretion in man.

The inhibitory action of both calcitonin (CT) and glucagon (GK) on human pancreatic secretion has been evaluated in detail. The reduction of enzyme secretion expressed as percentage corresponded to 60--80% of the initial values in response to both CT and GK when the hormones were given as single infusions during background stimulation with secretin or with secretin plus cholecystokinin-pancreozymin (CCK-PZ). After withdrawal of GK-infusion the return to normal values of enzyme secretion was distinctly faster than after CT, thus reflecting a more rapid degradation of circulating GK than of CT. In the presence of stimulation with secretin plus CCK-PZ, the combined administration of CT and GK did not enhance the inhibitory actions of CT and GK. Fluid and bicarbonate secretions were not affected by either CT or GK. The results suggest that CT and GK inhibit human pancreatic enzyme secretion by similar modes of action. Therefore, the combined administration of both CT and GK does not offer a reasonable approach to the treatment of acute pancreatitis.

Adult↗

Electrolyte secretion by the isolated cat pancreas during replacement of extracellular bicarbonate by organic anions and chloride by inorganic anions.

1. The effect of replacing extracellular bicarbonate and chloride by other anions on the volume and composition of secretin-stimulated pancreatic juice has been analysed in the isolated, perfused cat pancreas. 2. The anions of some aliphatic carboxylic acids were able partially to substitute for bicarbonate in sustaining pancreatic secretion. The order of effectiveness was: acetate greater than proprionate greater than butyrate greater than formate. 3. The rate of secretion in the presence of 25 mM-acetate was 42% of that achieved with 25 mM-bicarbonate. The concentration of acetate in the secretion varied with flow rate, reaching a maximum of 120 mM at high flow rates and declining at lower flow rates, with reciprocal changes in chloride concentration. Bicarbonate was always present in the secretion at a concentration of 5--7 mM. 4. Inorganic anions were able totally or partially to substitute for chloride in sustaining secretion. In relation to chloride, their degree of effectiveness was: chloride = bromide = or greater than nitrate greater than iodide greater than sulphate greater than methyl sulphate greater than isethionate. Those anions which had no effect on secretion rate (i.e. bromide and nitrate) also had no effect on the bicarbonate concentration of the secretion and themselves appeared in the secretion in place of chloride. Those anions which inhibited secretion increased the bicarbonate concentration in the secretion in proportion to the degree of inhibition they caused (i.e. the increase was greatest with isethionate). 5. When perfusate chloride was only partially replaced by bromide or iodide the ratios of chloride: bromide and chloride: iodide in the secretion were approximately equal to those in the perfusate. 6. The carbonic anhydrase inhibitor acetazolamide reduced secretory rate and bicarbonate concentration when added to normal perfusion fluid or chloride-substituted fluids, but had no effect following replacement of perfusate bicarbonate by acetate. 7. These observations illustrate that an extracellular source of permeant anions is required for optimal pancreatic bicarbonate secretion to occur. This may indicate the participation of an anion exchange carrier in the transport events responsible for this secretory process.

Acetazolamide↗

A double-blind trial of synthetic salmon calcitonin in the treatment of acute pancreatitis.

A multicenter randomized double-blind trial on the use of synthetic salmon calcitonin (SCT) was carried out in 94 patients with acute pancreatitis. In addition to strict standard treatment--without aprotinin, atropine, or antacids--50 patients received daily 3 x 20 micrograms = 300 MRCU SCT intravenously and 44 patients received placebo for 6 days. Mortality rate was not influenced, overall mortality being 5.3%. The number of patients without pain and with normalized serum amylase on a given day was significantly higher in the group treated with SCT. Other parameters such as doses of analgesics, leukocyte count, and normalization of seven defined clinical and laboratory criteria within 6 days showed a positive trend without reaching significance.

Acute Disease↗

[The conservative treatment of acute pancreatitis in the Federal Republic of Germany in 1977 (author's transl)].

A questionnaire on the conservative treatment of acute pancreatitis was answered by 312 surgical [n = 139] and medical [n = 173] departments from all over Western Germany and from West-Berlin. Nearly total positive agreement was found about routine administration of parenteral fluids and on the prohibition of oral food and fluids. The application of glucocorticoids, glucagon, heparin in small doses and of a carboanhydrase inhibitor [Diamox] is rejected by most of the departments. Renal failure is treated in 63% by hemodialysis and in 37% by peritoneal dialysis. There is great disagreement between the answers about the administration of atropine, antacids and aprotinin [Trasylol]. Antibiotics are applied routinely by 63% of the surgical and 70% of the medical departments.

Acute Disease↗

[Clinical experiences with a disposable biopsy set according to Menghini for percutaneous liver biopsy (author's transl)].

The handling and reliability of a new disposable biopsy set (Hepafix) have been evaluated in 170 percutaneous liver biopsies according to the technique of Menghini. In comparison with the conventional multiple biopsy set the new set provides several advantages discussed in the paper. The wider use of the disposable liver biopsy set may contribute to the prevention of transmission of hepatitis.

Biopsy, Needle↗

Interactions of calcium, magnesium and atropine on exocrine pancreatic secretion in man.

The effects of the intravenous administration of atropine or magnesium on pancreatic secretion which has been stimulated by secretin and induced hypercalcaemia have been studied in man. In the presence of secretin (0.5 CU/kg.h) the infusion of Ca2+ (0.3 mmol/kg.105 min) resulted in an increase in secretion of enzymes by 100-200%, and in that of Ca2+ and Mg2+ by 50-100% without affecting fluid and bicarbonate secretion. The additional injection of atropine (0.5 mg i.v. and 0.5 mg s.c.) were followed by a prompt fall in enzymes but not in Ca2+ and Mg2+ to the secretin-stimulated values. The additional infusion of Mg2+ (0.12 mmol/kg.45 min) to the Ca2+-infusion did not alter the secretion of enzymes, Ca2+ or Mg2+ compared with the calcium infusion alone. It is suggested that the hypercalcaemic stimulus depends on an intact innervation of the acinar cells. In these experiments the secretion of Ca2+ and Mg2+ seem to originate mainly from extracellular fluxes.

Adolescent↗

[Gastric and exocrine pancreatic function in patients with medullary thyroid carcinoma and with bone diseases under treatment with calcitonin (author's transl)].

Calcitonin (CT) inhibits gastric acid and pancreatic enzyme secretion when infused intravenously. Therefore, in two patients showing excessively elevated CT-blood levels due to medullary thyroid carcinoma and in two patients with bone diseases before and under CT-treatment, gastric and pancreatic secretion were measured. Spontaneous (BAO) and pentagastrin stimulated acid as well as hormonally stimulated pancreatic enzyme secretion revealed normal in all subjects and tests. The findings are in favour of adaptation mechanisms of gastric parietal and pancreatic acinar cells against the inhibitory action of chronically elevated CT. Therefore, long term treatment with CT is no likely to induce impaired acidity or exocrine pancreatic insufficiency.

Adaptation, Physiological↗

Calcitonin and exocrine pancreatic secretion in man: inhibition of enzymes stimulated by CCK-pancreozymin, caerulein, or calcium--no response to vagal stimulation.

The effect of calcitonin on human pancreatic secretion was studied under various conditions of stimulation. During administration of both secretin plus cholecystokinin-pancreozymin (CCK-PZ) or secretin plus caerulein, enzyme secretion was promptly reduced by an infusion of calcitonin of more than 50%. In contrast, vagally stimulated enzyme secretion induced by insulin-hypoglycaemia or carbamyl-choline was not altered against a background infusion of calcitonin in comparison with control experiments. Calcium-induced enzyme secretion was abolished by additional calcitonin infusion which also prevented an increase in serum calcium. On the other hand, additional high grade calcium infusion did not modify the inhibitory action of calcitonin on enzyme output stimulated by secretin and CCK-PZ. Secretion of fluids and bicarbonate remained unaffected by calcitonin in all experimental conditions, whereas the outputs of calcium and magnesium paralleled generally the changes in enzymes. It is suggested that calcitonin interferes with hormonemediated stimulation of the acinar cells without influencing cholinergic mechanisms. The inhibitory action of calcitonin on enzyme secretion does not appear to be mediated by a depletion of extracellular calcium in the pancreatic tissue by calcitonin.

Adult↗

Massive pancreatic ascites without carcinoma. Report of three cases.

Three cases of benign pancreatic ascites have been added to 94 cases reviewed from the literature. Common characteristic of this syndrome were chronic alcoholism, intermittent abdominal pain, nausea, vomiting and considerable weight loss which occurred despite fluid accumulation. Markedly elevated protein and amylase levels in the ascitic fluid, hyperamylasemia and hypoalbuminemia were the major diagnostic clues as to the pancreatic origin of ascites. Predominant pathological findings were chronic pancreatitis with or without pseudocysts, pancreatic duct disruption, lesion which were considered to be the major pathogenic factor besides lymphatic obstruction by leaking pancreatic juice into the peritoneal cavity. Early laparotomy for diagnosis and treatment is essential. ERP might be of great value in diagnosis.

Adult↗