[Peptic lesions of the upper digestive tract and drugs. Prospective study]. / Atteintes peptiques du tractus digestif supérieur et médicaments. Etude prospective.

The association between drugs and diseases of the gastrointestinal tract is well known but has always been evaluated qualitatively and not quantitatively. To study the importance of this association, a prospective study was undertaken at the University of Geneva Hospital in 456 subjects. A statistically significant (p less than 0.05) correlation was found in the following associations: aspirin and multiple gastric ulcers, aspirin and severe erosive gastritis; non-steroidal antiinflammatory drugs and multiple duodenal ulcers, non-steroidal antiinflammatory drugs and mild erosive gastritis. On the other hand, no correlation was found between any of the observed gastrointestinal diseases and prednisone, alcohol or tobacco.

[Dissolution of gallstones based on 6 months treatment with a single daily dose of ursodeoxycholic acid]. / Dissolution de lithiase vésiculaire après 6 mois de traitement par dose journalière unique d'acide ursodésoxycholique.

51 patients with radiolucent gallstones of diameter less than or equal to 15 mm were treated for 6 months with a new form of ursodeoxycholic acid (UDCA) in a single dose of 450 mg at bedtime. This new form has 3 components with fractionate liberation. The rate of partial and complete dissolution after 6 months was 63.4%, reaching 85% for gallstones of less than 5 mm diameter. The results show that a single dose of 450 mg UDCA at bedtime is as effective as UDCA at mealtimes in the dissolution of radiolucent gallstones. Administration of the drug once a day should be more acceptable to patients.

[Disturbance of exocrine secretion by the human pancreas in hyperlipoproteinemia]. / Perturbation de la sécrétion exocrine du pancréas humaine lors d'hyperlipoprotéinémie.

Basal and stimulated (secretin/CCK pancreozymin) duodenal aspirates were analyzed for flow rate and the protein and bicarbonate concentrations in 7 non-alcoholic controls and in 7 subjects with type IV hyperlipoproteinemia. Basal volume and bicarbonate concentration did not differ in the two groups. In the hyperlipoproteinemia patients, basal protein concentration and flow rates were significantly different from controls (p = 0.0143 and p = 0.0182 respectively). The bicarbonate flow rate is also increased in hyperlipoproteinemia. The data obtained after stimulation were similar for protein and HCO3 in both groups. These findings are identical to those observed by SARLES in alcoholic and hypercalcemic animals and in man. It is possible, but not yet proven, that hyperlipoproteinemia pancreatitis is due to protein precipitates in the pancreatic canaliculi.

[Indications for medical dissolution of biliary lithiasis and value of the determination of the lithogenic index]. / Indication à la dissolution médicale de la lithiase biliaire et valeur de la détermination de i'index lithogène.

The conventional selection criteria for chemical dissolution of cholesterol gallstones provide poor results. Thirty patients have been reviewed with reference to factors with which to predict possible success. The lithogenic index was found to be discriminatory in only 3 patients out of a total of 19 (16%). On the other hand, diluted bile (which evidences dysfunction of the gallbladder) was found in a third of patients with no radiological sign of gallbladder dysfunction. Analysis of gallbladder function may be a good criterion for selection of patients who will respond to medical treatment.

[Clinical application of the radiolabeled bile salt tolerance test]. / Applications cliniques du test de tolérance aux sels biliaires radiomarqués.

The labeled bile salt tolerance test is the measure of the decrease in plasmatic radioactivity after intravenous injection of carboxyl-14C-labeled chenic acid. The label is distributed in the blood, taken up by hepatocytes and then secreted in the bile. The decrease in plasmatic radioactivity during the 4 h following the injection follows a bi-exponential curve. It has been studied in 6 normal subjects, 4 patients equipped with "T tube", 3 cases of acute viral hepatitis, 4 cases of hepatic steatosis, and 6 cases of hepatic cirrhosis. The first slope (b1) represents the hepatic uptake of the label. It is lowered in cases of viral hepatitis and in cirrhosis. The second slope (b2) represents hepato-biliary secretion of the label. It is lowered in patients equipped with a "T tube". From 100 min after the injection, the plasma concentration of radioactivity remains constant. This is the residual value (R), and it is very low in normal subjects. It is increased in cases of acute viral hepatitis and cirrhosis, indicating displacement of a fraction of the bile salt pool into peripheral blood. After a standard meal, the R value is not modified in the normal subject. In cases of steatosis and cirrhosis, a temporary peak may be seen, indicating recirculation of the label towards the periphery due to a porto-systemic shunt or a hepatocyte lesion.

Cholesterol in acute cholestasis induced by taurolithocholic acid. A cytochemical study in transmission and scanning electron microscopy.

Rats were given intravenous injections of a single dose of sodium taurolithocholate, and an almost total cholestasis appeared after 10 minutes and lasted for 3 hours after the injection; then the choleresis began again and 24 hours after the injection, normal values of bile flow were restored. Ultrastructural analysis of the liver during the acute cholestasis and the restoration phase showed, beside usual modifications found in most cases of cholestasis, the "characteristic" alterations of sodium taurolithocholate-induced cholestasis. Cytochemical procedures were used, both in transmission and in scanning electron microscopy, in order to delineate the possible participation of free cholesterol in these cellular modifications. After Williamson's reaction procedure (Williamson JR:J Ultrastruct Res 27:118, 1969), not only were cholesterol-digitonin complexes found in large numbers, both in the hepatocytic cytoplasm and in the biliary canaliculi, but also their morphologic appearance revealed several new features: dark sticks and dark lamellae, frequently adsorbed on the outer surface of crystalline clear material were observed by transmission electron microscopy, and plugs, obliterating parts of biliary canaliculi, were observed using scanning electron microscopy. These observations seem to indicate that a significant amount of free cholesterol is released into the hepatocyte cytoplasm and into canalicular lumina within a few minutes after the infection of sodium taurolithocholate, probably originating from the hepatocytic membranes, especially from those limiting the canalicular lumen. Such a drastic modification in the chemical constitution of these membranes should coincide with a marked modification of their active and passive transport ability.

[The effect of flavonoid compounds (+)-cyanidanol-3 in acute viral hepatitis]. / Wirksamkeit der Flavonoidverbindung (+)-cyanidanol-3 bei der akuten Virushepatitis

A double blind study was carried out with 14 pairs of patients suffering from acute virus hepatitis in order to determine the action of (+)-cyanidol-3 (2 g daily, administered orally). Among these few patients no significant differences were observed between the two groups. This also holds true for the liver function test with the exception of total serum bilirubin. In the treated patients hyperbilirubinemia decreased significantly faster than in the untreated group (p smaller than 0.05). The values registered with a daily dosis of 1 g (+)-cyanidol-3 did not differ from those recorded in the groups of untreated patients.