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Biomedical subjects

K Gyr

Publications and source records attributed to K Gyr.

At least 19 recordsLinked to original sources
PubMed1992

[Percutaneous endoscopic gastrostomy (PEG) for long-term nutrition--comparison of 2 different caliber tubes].

Percutaneous endoscopic gastrostomy (PEG) is often used nowadays for long-term enteral nutrition in patients with swallowing disorders and severely altered esophageal-duodenal transit. The most common indications for gastrostomy tubes were neurological disturbances and malignancies of the oropharynx and esophagus. We compared in a prospective sequential trial PEG-tubes of two different sizes (2.9 mm [CH-9] vs. 4.8 mm [CH-15]) with respect to placement, complications, durability and handling. The tube was successfully placed in 51 of 52 patients (98%). In 1 patient placement was impossible due to missing diaphanoscopy. The mean observation period was 22 weeks for the CH-9-tubes (n = 28) and 14 weeks for the CH-15-tubes (n = 23). The only early complication was 1 case with a hemorrhage at the site of implantation (CH-15). In both groups 2 cases of local infection were noted. In the CH-9-group 2 PEG-tubes disappeared into the stomach and in 1 case a cicatricial granuloma developed. In the CH-15-group a leak occurred 10 days after implantation. All complications were treated conservatively. There was no causal relationship between the size of tube and the complications. The period of implantation was mostly limited by the death due to the underlying disease of the patient and was not related to the type of PEG-tube. We conclude the both PEG-tubes were easy to place, safe and effective means of providing enteral nutrition. We would, however, recommend CH-15-tubes for long-term nutrition, since in our experience they were less frequently obstructed and handling for the nurses was easier.

Adult↗
PubMed1992

Role of cholecystokinin in mediating GRP-stimulated gastric, biliary and pancreatic functions in man.

To explore the mechanisms of gastrin-releasing peptide (GRP)-induced gut functions in man, we investigated the effect on gallbladder contraction, exocrine pancreatic secretion and gastric acid secretion of a recently developed CCK receptor antagonist, loxiglumide, on GRP-stimulated effects in six healthy human subjects. Intravenous infusion of graded doses of synthetic human GRP (1-27 pmol/kg per h) caused significant and dose-dependent increases in pancreatic enzyme and gastric acid secretions and in gallbladder contraction. Intravenous administration of loxiglumide (10 mg/kg per h) abolished GRP-stimulated gallbladder contraction, augmented gastric acid secretion, but did not affect exocrine pancreatic secretion. The results suggest that endogenously released CCK is (1) responsible for GRP-stimulated gallbladder contraction, and (2) involved in regulating gastric acid secretion. The results further suggest that GRP-stimulated pancreatic secretion is not mediated by CCK, but has a direct response of GRP on the exocrine pancreas.

Adult↗
PubMed1992

Evidence for hormonal inhibition of exocrine pancreatic function by somatostatin 28 in humans.

Somatostatin 28 (S-28), originating in gastrointestinal cells, is secreted into the circulation and increases in humans after ingestion of a mixed meal. To evaluate the possibility that the increased levels of S-28 post cibum might modulate the release of enzymes and bicarbonate from the exocrine pancreas, S-28 was infused intravenously into healthy volunteers to levels seen after food intake. During S-28 infusion, the output of lipase, trypsin, amylase, and bicarbonate stimulated by either exogenous cholecystokinin octapeptide or endogenous signals from intraduodenal administration of tryptophan or a mixture of amino acids was significantly reduced. It is concluded that S-28 released from the gut during food intake modulates pancreatic exocrine function in humans.

Adult↗
PubMed1992

Postprandial control of gallbladder contraction and exocrine pancreatic secretion in man.

To explore the interactions between cholecystokinin (CCK) and the cholinergic system, we compared the effect of cholinergic or peptidergic CCK blockade on gallbladder contraction and pancreatic enzyme secretion using atropine and loxiglumide (a specific CCK antagonist) as pharmacological tools. Gallbladder contraction was measured by sonography and pancreatic secretion by a marker perfusion and aspiration technique. Graded doses of exogenous CCK8 induced dose-dependent contractions of the gallbladder and increasing enzyme outputs. Loxiglumide (10 mg kg-1 h-1) abolished the gallbladder response and prevented an increase in pancreatic enzyme secretion to CCK8. Atropine (5 micrograms kg-1 h-1), however, only reduced gallbladder contraction and enzyme output to CCK8. Gallbladder volumes decreased maximally to 12 +/- 4% after oral food, whereas enzyme output and plasma CCK levels increased 6- to 8-fold. Loxiglumide completely abolished gallbladder contraction and inhibited enzyme secretion by 30%. Atropine caused a small reduction in gallbladder volumes, but essentially blocked postprandial enzyme secretion. The results indicate that CCK is the major regulator of gallbladder contraction with the cholinergic system modulating the response, while the exocrine pancreas is crucially dependent on a cholinergic background with CCK modulating the secretory response.

Adult↗
PubMed1992

Antimicrobial therapy of bacterial diarrhea in adult residents of Mexico--lack of an effect.

Two clinical trials in adults in Mexico are reported. In the first trial, long-term residents of Mexico with acute fecal leukocyte-positive diarrhea were randomized to receive trimethoprim/sulfamethoxazole (TMP/SMX), clioquinol or a placebo. Neither antimicrobial shortened the illness for all cases or for those with shigellosis or enterotoxigenic Escherichia coli diarrhea. In a second study, US and Mexican students received enoxacin, TMP/SMX or a placebo on a blind random basis. While the placebo-treated subjects with bacterial diarrhea tended to be more ill after treatment than other groups, no statistical differences were seen in treatment groups. These studies cast doubts on the value of antimicrobial drugs for 'invasive' and other forms of bacterial diarrhea in adults living in endemic areas and indicate the importance of a placebo control group when conducting clinical trials in these populations.

Adult↗
PubMed1992

Perfusion studies in cholera: methods and procedures.

This paper reviews the characteristics of perfusion techniques in the study of intestinal functions by specifically examining the methods and procedures of perfusion in patients with diarrhoea due to infection with V. cholerae 01. Because of abundant jejunal secretion of water and electrolytes in cholera, perfusion studies require special approaches with regard to patient preparation, use of tubing material, selection of markers, and rate of perfusion. A discussion on specific problems involved in marker perfusion techniques in cholera and on the interpretation of the results is followed by practical recommendations.

Cholera↗
PubMed1979

Immunological blocking of exogenous and endogenous secretin in the dog.

In mongrel dogs with chronic gastric and duodenal fistula the biological activity of secretin on exocrine pancreatic secretion could be blocked by preincubating the secretin injected with rabbit antisecretin antibody. In addition, the activity of endogenous secretin released by acid was markedly reduced by application of antibody. Since no such effect was observed after testmeal stimulation, secretin is most probably not released in a significant amount by the liquid meal used in this experiment.

Animals↗
PubMed1979

[Dosage dependence of the effect of somatostatin on human splanchnic blood flow].

The effect of three different doses of somatostatin on splanchnic blood flow (SBF) and on arterial plasma insulin, glucagon and glucose was determined. 125, 250 and 500 microgram/h of somatostatin was infused during 60 minutes in 3 groups of 6 patients undergoing arterial-hepatic-venous catheterization; no patient had clinical evidence of metabolitic or hepatic disease. Continuous infusion of 125 microgram/h somatostatin was without significant effect on SBF, whereas 250 microgram/h resulted in a mean 28% reduction of SBF (p less than 0.05). Doubling the dose to 500 microgram/h affected SBF similarly (21% reduction of SBF). In contrast, administration of all three doses of somatostatin suppressed the circulating insulin and glucagon levels significantly. In a recent report somatostatin had been administered in a dose of 250 microgram/h to control gastric ulcer hemorrhage. The present studies demonstrate that this dose results in a significant reduction of SBF which cannot be further depressed by increasing the dose.

Adult↗
PubMed1979

[Caerulein and the test meal: a comparison of their effects on pancreatic exocrine secretion in the dog].

Relatively small doses of caerulein (10, 20, 40, 100 ng/kg/h) were given to conscious dogs with chronic duodenal and gastric fistulas and the exocrine pancreatic response was compared with that obtained by a test meal. Test meal stimulated pancreatic secretion was nearly equivalent to that achieved with 10 ng caerulein/kg/h. Plasma secretin levels did not significantly change during test meal stimulation.

Animal Feed↗
PubMed1979

The effect of oral pancreatic enzymes on the intestinal flora of protein-deficient vervet monkeys challenged with Vibrio cholerae.

Jejunal bacterial flora in 11 protein deficient vervet monkeys (Cercopithecus aethiops) and four controls was studied. These were the same animals from an investigation previously reported in which it was shown that pancreatic extract modified the course of cholera infection in protein-deficient monkeys. The present study reports in addition that these animals the fluid in the upper jejunum contained significantly increased numbers of bacteria including Enterobacteriaceae compared to its predietary state and to that of the controls. After challenge to these animals with Vibrio cholerae, the jejunal bacterial flora in the protein-deficient animals given placebo remained unchanged, whereas pancreatic extract-treated animals showed a quantitative and qualitative recovery of their jejunal bacterial flora. Pancreatic extract hastened the return of altered intestinal flora to predietary levels.

Animals↗
PubMed1979

[Benign symmetric lipomatosis: a symptom of alcoholic liver disease?].

Benign symmetric lipomatosis (BSL) leads to characteristic multiple lipomas of the neck and submandibular region. BSL is easily diagnosed by its typical feature, "Madelung's neck". However, the early stages are often missed or lead to futile diagnostic endeavours. A report is presented on 7 men with BSL aged 36--65 years who were investigated with regard to alcohol consumption, clinical findings and liver histology. This is the first time that liver histology has been systematically worked up in patients with BSL. All admitted long standing ethanol intake (x = 111 ml/day) prior to the development of BSL. The growth of the lipomas was irregular and occurred over a period of months. There was no correlation with overweight or hyperlipidemia. However, liver biopsy revealed features consistent with alcoholic liver disease in all subjects. It is suggested that BSL is a symptom of alcoholic liver disease mainly affecting middle-aged men.

Adult↗
PubMed1979

The effect of oral pancreatic extract on jejunal bactericidal activity in protein-deficient vervet monkeys challenged with Vibrio cholerae.

Eleven vervet monkeys (Cercopithecus aethiops) were fed with an "O" protein diet. After the serum albumin level fell below 2.5 g/100 ml the animals and 4 controls, which received regular monkey chow, were orally infected with a monkey-adapted strain of Vibrio cholerae. The total bactericidal activity of the jejunal fluid decreased during feeding with "O" protein diet, but increased after challenge with V. cholerae in all groups. The non-immunoglobulin-bound bactericidal activity, which also decreased during protein depletion, remained less in those animals receiving placebo instead of pancreatic extract after challenge.

Animals↗
PubMed1979

[Necrosis of the lesser curve of the stomach after proximal selective vagotomy].

Necrosis of lesser curve of stomach after proximal selective vagotomy is a specific but rare hazard of this operation. Anatomical and pathophysiological findings speak in favour of ischaemic pathogenesis, even if a peptic factor may exceptionally play a role in some cases. Local tissue trauma enhances the risk of later sloughing of lesser curve. Three own reported cases without fatality point out the importance of previous massive ulcer bleeding with hypovolemic shock and severe anaemia. Early recognition and immediate reoperation only may avoid an otherwise fatal course. Simple oversewing has proved successful in treating even large lesions. Careful, atraumatic technique of skeletonization and reperitonealization of lesser curve help to prevent this life threatening complication.

Humans↗
PubMed1979

[Papillotomy or papilloplasty? Clinical and endoscopic follow-up after papillary surgery].

We controlled patients after surgical incision of the papilla for papillary stone or papillary stenosis. 131 were examined clinically, 39 of them additionally with ERCP. The endoscopy showed that simple cutting of the papilla (i.e. papillotomy) often resulted in a restenosis because of accretion of the incised duodenal mucosa. This was prevented by the additional suture of the choledochal and duodenal mucosa (i.e. papilloplasty). The clinical results, however, were equally good with both surgical techniques. This rises the question in view of the striking endoscopical results, whether the clinical examination alone is an adequate criterion to detect stasis disorders of the liver and the pancreas. The results confirm us to perform, when surgical incision of the papilla is necessary, rather a papilloplasty than a papillotomy.

Ampulla of Vater↗