[The post-cholecystectomy syndrome].
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Biomedical subjects
Publications and source records attributed to K Gyr.
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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.
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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.
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.
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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.
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.
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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.
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.
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.
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Plasma secretin and pancreatic polypeptide has been measured in 10 normal volunteers before and after intraduodenal acidification. Secretin rose rapidly from 1,4 +/- 0,44 to 11,2 +/- 1,24 pmol/l (+/- SEM). PP also rose significantly from 39,0 +/- 3,0 to 52.3 +/- 5,8 pmol (paired p less than 0.01) but much slower and to a lesser extent than seen after a meal. This supports the conclusion that acid plays no important role in control of postprandial PP release.
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