[Bismuth preparations--encephalopathy].
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Biomedical subjects
Publications and source records attributed to J Myren.
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The effect of a small dose of somatostatin (0.05 mg/h) on the gastric secretion of acid, pepsin and Intrinsic Factor (IF) after stepwise increases in the dose of pentagastrin was examined in six healthy volunteers. The gastric secretion of acid, pepsin and IF in response to pentagastrin was significantly reduced by a continuous infusion of somatostatin. The pattern of inhibition indicates that somatostatin is a competitive inhibitor of pentagastrin in the stimulation of gastric secretion of both acid, pepsin and IF. This finding supports the hypothesis of a direct effect of somatostatin on the exocrine secretory cells of the stomach.
Six subjects with a normal endoscopic pancreatogram were investigated after an overnight fast by means of a side-viewing duodenoscope. After cannulation of the main pancreatic duct, juice was collected in five-minute samples for 20 minutes. An iso-osmolar solution of 6 g cattle bile was then infused into the duodenum through a separate catheter attached to the outside of the duodenoscope, and pancreatic juice collected in five-minute samples for another 20 minutes. Blood was frequently drawn from an arm vein through an indwelling catheter for estimation of immunoreactive secretin (IRS) by radioimmunassay. The flow rate of pancreatic juice and outputs of bicarbonate, amylase, and protein increased significantly after intraduodenal infusion of bile. A significant rise in plasma IRS was also found after instillation of bile in the duodenum.
Sera from 3 allergic patients with specific IgE antibodies as shown by RAST were used to sensitize jejunal mucosa obtained from surgical patients. The sensitized specimens were challenged with the appropriate antigens to the specific IgE shown in the sera, Non-challenged sensitized specimens were used as controls to determine mast cell degranulation. The mast cells were counted in a defined area in the mucosa immediately adjacent to the muscularis mucosa. Mast cell degranulation was 47 percent in a timothy pollen system, 40 percent in an eggwhite system, and 33 percent in a codfish system. The results of the investigation indicates that mast cells in the human jejunal mucosa are able to react in the same manner as mast cells in the human lung. The experimental model described appears suitable for studying the allergic reaction in the gastrointestinal tract and the effect of pharmacotherapy in this respect.
The distribution of parietal cells in the body mucosa, and of G cells in the antral mucosa, was quantitatively mapped in resected stomachs from 42 patients (12 with gastric ulcer, 11 with duodenal ucler, 14 with duodenal ulcer and uremia, and 5 with gastric cancer) who preoperatively had had their gastric acid secretion measured. In the material as a whole there was a significant positive correlation between the parietal-cell density and maximal acid output (MAO), and a significant negative correlation between the parietal-cell density and patient age. A significant positive correlation was found between the antral G-cell mass and basal acid output (BAO). When the individual patient categories were analyzed, the correlation between parietal-cell density and MAO were significant in the group with duodenal ulcer and uremia, and in the group with gastric cancer. Correlation between parietal-cell density and age was found only in the group with duodenal ulcer and uremia. There was no correlation between the parietal-cell density and various parameters of the antral G-cell population in the material as a whole or in any of the individual groups.
The main pancreatic duct was cannulated in 12 individuals with a teflon catheter by means of a side-viewing duodenscope. Six individuals received a duodenal infusion of 40 ml 100 mmol/l HCl over 5 min, while the other six served as controls for basal pancreatic secretion. Pancreatic juice was collected in 5-min samples, and blood was frequently drawn for radioimmunoassay of immunoreactive secretin (IRS). In the control group, during 20-min cannulation of the main pancreatic duct, no effect was seen on basal secretion of water, bicarbonate, or alpha-amylase--nor did the IRS levels change. After duodenal acidification there was a significant increase in IRS (p less than 0.02), reaching the highest level at 7 min. The mean flow rate, bicarbonate concentration, and bicarbonate output showed a significant increase as compared to the control group (p less than 0.02), the highest levels being reached in the third 5-min period after the start of the duodenal acidification. The alpha-amylase output was also significantly higher after acidification (p less than 0.02) than in the control group, but the mean alpha-amylase concentration decreased after acidification, reaching its nadir in the third 5-min sample (p less than 0.02). The present results demonstrate a basal and HCl-stimulated pancreatic secretion collected by endoscopic cannulation of the main pancreatic duct in man together with plasma IRS levels.
The duodenal pressure activity was studied by means of an intraluminal electrical transducer, and the recordings were compared to those of a traditional open-tip tube. The physiological significance of different pressure waves was studied by means of combined pressure and cineradiographic recordings. The recordings obtained by the intraluminal transducer were found to be essentially similar to those obtained by the open-tip tube. Most pressure waves observed in this study were found to cause a propulsive, mixed, or retropulsive movement of the intraluminal contents, and no significant displacement of the contents could be observed without simultaneous pressure waves. A difference in physiological significance of single and complex waves could not be detected. Rhythmic activity caused a rapid propulsion of intraluminal contents. It is concluded that the pressure recordings obtained by the intraluminal transducer are reliable in the study of duodenal motility.
Forty patients with endoscopically confirmed gastric ulcers, completed a double-blind study comparing trimipramine with placebo during 4 weeks' treatment. The daily dose of trimipramine was 50 mg given before bedtime. No serious side-effects occurred. After four weeks' treatment 12 of the 20 patients receiving trimipramine had endoscopically completely healed ulcers, while in the placebo group only 4 of the 20 ulcers were healed (P = 0.025). With regard to the patients' complaints, a distinct and statistically significant improvement was also observed in the patients receiving trimipramine (P = 0.025). It is assumed that the previously shown antisecretory effect of the drug, together with the sedative and anti-depressive effect, make trimipramine a valuable drug in the treatment of peptic ulcer disease.
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Out of 421 patients who had partial gastrectomy 20-25 years ago for gastric or duodenal ulcer, 108 were examined by endoscopy with multiple biopsy. In no case were the endoscopic appearances of the mucosae interpreted as malignant, though in 2 patients the clinical history suggest malignant disease. Histological examination revealed infiltrating carcinoma in 4 patients, 3 of whom had intramucosal carcinoma only. 3 further patients had severe dysplasia (carcinoma-in-situ). Only 1 patient had a near-normal mucosa close to the anastomosis; in the remainder the gastric remnant showed various degress of dysplasia, metaplasia, or chronic atrophic gastritis. In the patients with carcinoma only 28 (12%) of the 226 biopsy specimens revealed the malignant lesion. Patients who have had partial gastrectomy for benign lesions are at high risk of gastric-stump carcinoma. If, 20 years after operation, they have an endoscopy with multiple biopsy, stump carcinoma may be detected early when the prognosis after operation is probably good.
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In a consecutive series of 830 routine gastroscopies a total of 43 patients was found with gastric carcinomas, Thirteen of these were patients with a previous Billroth-II operation for ulcer disease. Early cancers were found in ten patients (23%), and four of these ten (3 men, 1 woman, aged 49 to 76 years), had been operated on 20-33 years previosuly with a Billroth II partial gastrectomy. All patients had symptoms indicating gastro-intestinal disease. We conclude that a high number of gastric stump carcinomas may be detected at an early stage, and that endoscopy of the whole gastric stump, with multiple biopsies and brush cytology from the entire gastro-jejunal anastomosis, is of crucial importance in detecting such carcinomas.
In a double blind study 30 male patients subjected to peroral endoscopy were given 0.5 mg glucagon (G) and 50 mg pethidine plus 0.5 mg atropine (PA) intravenously for premedication. The results showed that the PA group of patients had less discomfort, vomiting, salivary and gastric secretion during the examination than the G group. The arrestment of motility was significantly more prolonged in the G group of patients; otherwise no difference was found regarding the relaxation of the antrum, pylorus and duodenal bulb. This suggests glucagon to be superior to pethidine plus atropine when examinating these regions except in anxious patients which probably should have a sedative in addition to glucagon as premendication for peroral endoscopy.