[Comparative studies of in-vivo and in-vitro contraction behavior of gallbladders with impaired function]. / Vergleichende Untersuchungen des Kontraktionsverhaltens funktionsgestörter Gallenblasen in vivo und in vitro.

The contractility of human gallbladders without calculi of 10 patients with typical biliary pain was investigated in vivo (n = 7; pharmacosonography) and in vitro (n = 10; isometric registration). In 6 out of 7 cases, investigated in vivo as well as in vitro, the contractility was identical--therefore the smooth-muscle-preparation in the organ-bath could be an interesting model for studies with CCK-antagonists. 3 of the in-vitro-preparations showed hypomotility consecutive to acetylcholine- and CCK-stimulation. Histologically, the destruction of the normal gallbladder wall structure by scars, chronic inflammation and the evidence of so-called Rokitansky-Aschoff-sinuses could be proved. The importance of these findings probably causal to the process of cholelithogenesis is discussed.

[Diagnosis of biliary dyskinesia after cholecystectomy]. / Diagnostik biliärer Dyskinesien nach Cholezystektomie.

In patients with upper abdominal complaints after cholecystectomy the normal and disordered bile flow was evaluated using quantitative scintigraphy after initially excluding organic etiology. A continuous intravenous infusion of cholecystokinin and secretin for one hour resulted in an accelerated bile flow in the majority of these patients, which is the normal reaction of the biliary system under stimulation. On the contrary, a bolus injection of these hormones led to marked delay of flow in a group of the study population, a condition taken as a paradoxical reaction to cholecystokinin. Although all of the patients with this paradoxical reaction did complain of typical biliary pain, a causal association is, however, yet to be proved. Nitrates can be helpful in the differential diagnosis of impeded bile flow, a lack of response being a possible sign of organic hindrance at the papilla of Vater.

[Isoelectric focusing of pure human pancreatic juice. 1. Examination of patients with and without pancreatic diseases]. / Isoelektrische Fokussierung von reinem menschlichen Pankreassaft. 1. Mitteilung: Untersuchungen des Pankreassaftes von Patienten mit und ohne Pankreaserkrankungen.

Thin layer urea isoelectric focusing is a powerful tool for a rapid and reproducible high resolution separation of cholecystokinin stimulated human pancreatic proteins. In pancreatic juice of patients without pancreatic disease, 11 main protein bands were separated and distinguished by Coomassie Blue-R 250 staining. A number of faint protein bands divided among the whole pH range demonstrate a wide microheterogeneity of exocrine pancreatic proteins. Secretory protein patterns of patients with chronic pancreatitis are shown to be different from those of patients without pancreatic disease. Significant alterations were found at the acidic protein band region of pI 4.4 to 4.7. In two cases of chronic pancreatitis the IEF pattern was very similar to that obtained by a short time enteropeptidase incubation of pure pancreatic juice from patients without pancreatic disease.

[Isoelectric focusing of pure human pancreatic juice. 2. Identification of enzymes and proenzymes and characterization of glycoproteins]. / Isoelektrische Fokussierung von reinem menschlichen Pankreassaft. 2. Mitteilung: Identifizierung von Enzymen und Porenzymen und Charakterisierung von Glykoproteinen.

After isoelectric focusing of proteins of human pure pancreatic juice following digestive enzymes and zymogens were identified by substrate specific detection methods: in the anodic range trypsinogen 1, and acidic form of proelastase and procarboxypeptidase A; in the pH--range of 5.0-6.0 a trypsinogen--like protein and the secretory trypsin inhibitor; in the pH--range of 6.0-7.0 one form of each of procarboxypeptidase B, trypsinogen 2, lipase, chymotrypsinogen and two forms of alpha-amylase and in the cathodic range an activated form of procarboxypeptidase B, one form of prophospholipase A2 and an additional form of proelastase. In order to characterize glycoproteins the IEF separated pancreatic proteins were transferred onto nitrocellulose membranes. Using the periodic acid/Schiff's reagent (PAS) procedure five PAS-positive proteins (pl s 4.5; 6.0; 6.6; 6.9 and 7.3) were detected. Three Con A-binding proteins (pl s 6.0; 6.6 and 6.9) were identified by incubating the blot in Con A followed by peroxidase and o-phenylendiamin as a chromogenic peroxidase substrat.

Improved detection of human pancreatic proteins separated by two-dimensional isoelectric focusing/sodium dodecyl sulphate gel electrophoresis using a combined staining procedure.

In order to assess secretory pancreatic proteins in a two-dimensional isoelectric focusing/sodium dodecyl sulphate electrophoresis gel, a highly sensitive double-staining method with Coomassie Brilliant Blue followed by silver stain was used. This combined procedure afforded more distinct spots and additional bands, particularly glycoproteins, than either silver or Coomassie Blue staining alone. As measurements of dye volumes by densitometry have shown, double staining of two-dimensional separated pancreatic proteins is up to twenty times more sensitive than the usual Coomassie Brilliant Blue staining.

[Endoscopic implantation of endoprostheses in incurable esophageal and cardia cancer]. / Endoskopische Implantation von Endoprothesen beim inkurablen Osophagus- und Kadiakarzinom.

The palliative treatment of tumorous stenosis of the esophagus and cardio-esophageal region by intubation with an endoprosthesis leads to an improved quality of life. The used endoscopic positioning provides better results than the surgical procedure. This method is easy in handling and has only few complications. The endoscopic positioning of endoprosthesis is also a really alternative of alimentary fistula. The positioning of plastic prosthesis under endoscopic control should be given preference in the palliative treatment of obstructing cardio-esophageal malignancy.

[Duodenal bile acid output in gastroenterologic diseases]. / Duodenaler Gallensäurenoutput bei gastroenterologischen Erkrankungen.

The biliary secretion of bile acids was measured with the modified secretin-pancreozymin test in 50 patients with various gastroenterological diseases and in a control group. In the control group the highest bile acid output and the lowest G/T quotient was estimated. In comparison to the control group, the bile acid output in the patients with gastroenterological disorders was reduced significantly to a varying degree. Except in postcholecystectomy patients, it was proved that the G/T quotient was significantly increased compared to that in the control group. The estimation of bile acid output and the G/T quotient presented here shows an easier extension of the validity of the secretin-pancreozymin test which does not indice any additional burden to the patients.

[Effect of physical training on the aerobic-anaerobic transition in chronic liver diseases]. / Die Wirkung körperlichen Trainings im aerob-anaeroben Ubergangsbereich bei chronisch Leberkranken.

7 males, aged 30 to 60 years, with bioptically ascertained chronic liver diseases underwent a four-week preservance training programme on the bicycle ergometer in the aerobic-anaerobic transitional area (performance at 2-4 mmol 1(-1) lactate). The training caused a significant amelioration of the aerobic functional capacity of the test persons. The hypothesis of a liver-protective effect of the perserverance training was confirmed. The inclusion of a dosed physical training in the therapy and rehabilitation programme, respectively, of patients with chronic liver diseases can be recommended, particularly, since there is no causal medicamentous therapy of chronic liver diseases possible at present.

[Pancreatico-biliary secretion in enteral hyperoxaluria]. / Die pankreatobiliäre Sekretion bei enteraler Hyperoxalurie.

The increased oxalic acid absorption is a well documented finding in gastroenterological diseases. The malabsorption of bile acids and fat is important in the pathogenesis of the hyperoxaluria. The enteric absorption of 14C-labelled oxalic acid was measured in 49 patients with different diseases. The dihydroxy-trihydroxy-ratio of bile acids is significantly decreased in patients with hyperoxaluria over 20% of the ingested dosage. We didn't find any correlation between the excretion of oxalic acid and the intraduodenal pancreatic lipase activity.

Analysis of human exocrine pancreatic proteins by means of pore gradient polyacrylamide gel electrophoresis.

Pancreatic juice collected by endoscopic retrograde cannulation of the pancreatic duct after administration of secretin and pancreozymin was analyzed by pore gradient polyacrylamide gel electrophoresis. Two electrophoretic systems, an alkaline (pH 8.9) and an acidic (pH 5.0), were elaborated to obtain optimal separation of exocrine proteins. 13 bands under alkaline conditions and 17 bands by running in the acidic system were separated and distinguished by Coomassie-Brilliant Blue G 250 staining. Fourteen proteins were identified using enzymatic and immunological methods: one form of each of lipase, chymotrypsinogen, prophospholipase A2, procarboxypeptidase A and trypsin inhibitor, two forms of each of procarboxypeptidase B and proelastase, three forms of each of trypsinogen and amylase. An additional band was identified as albumin.

[Simultaneous registration of pancreatic secretion profiles in endoscopic secretion sampling in patients with and without pancreatic diseases]. / Simultane Registrierung von Pankreassekretionsprofilen während der endoskopischen Sekretentnahme bei Patienten mit und ohne Pankreaserkrankungen.

A method for the continuous detection of secretory profiles of human pure pancreatic juice is described. After retrograde cannulation of the D. pancreaticus the exocrine pancreas was stimulated by an intravenous infusion of secretin and a bolus injection of pancreozymin additionally. The absorbance of pancreatic juice at 280 nm was measured continuously using an Uvicord-UV-Photometer which was connected directly with a Teflon catheter localised in the main pancreatic duct. The secretory profiles obtained from patients without pancreatic diseases (n = 12) indicated a first maximum of absorbance after secretin infusion and a second one in response to pancreozymin bolus injection. Alterations of secretory profiles in patients with chronic pancreatitis (n = 10) were evident after pancreozymin administration principally.

[Secretin-pancreozymin test with volume correction in the functional diagnosis of pancreatobiliary secretion]. / Der Sekretin-Pankreozymin-Test mit Volumenkorrektur zur Funktionsdiagnostik der pankreatobiliären Sekretion.

A modified secretin-pancreozymin test was performed for the quantitative determination of both the pancreatic exocrine function and the biliary secretion of total bile acids followed by exogenous (secretin and pancreozymin) and endogenous (L-phenylalanine) stimulation of the pancreatic and biliary secretion. The outputs of lipase, alpha-amylase, trypsin, bicarbonate and total bile acids were estimated and the ratio of glycine to taurine conjugated bile acids was measured by thin layer chromatography. Polyethylene glycol 4,000 was used as a nonabsorbable marker for the correction of aspirated volumes. 40 patients were studied: 10 control subjects; 10 control subjects with previous cholecystectomy; 10 patients with chronic pancreatitis and 10 cholecystectomized patients with chronic pancreatitis. In cholecystectomized probands, not only the total bile acid output but also the output of bicarbonate, trypsin and lipase were diminished compared to the control subjects with a intact gallbladder. In noncholecystectomized and cholecystectomized patients with chronic pancreatitis both, the pancreatic secretion and the biliary bile acid secretion were significantly decreased. The ratio of glycine/taurine conjugated bile acids was found to be significantly higher in these patients compared to the controls.

[Oxalic acid resorption in patients with resection of the small intestine, jejunoileal bypass, Crohn disease and chronic pancreatitis]. / Oxalsäureresorption bei Patienten mit Dünndarmresektion, jejunoilealem Bypass, Morbus Crohn und chronischer Pankreatitis.

The enteric absorption of oxalic acid with 14C-labelled oxalic acid was determined in patients with small bowel resection, jejunoileal bypass, Crohn's disease and chronic pancreatitis in comparison to the control group. Extreme hyperoxaluria were found in small bowel resections above 100 cm, after bypass operations and in ileocolitis Crohn with signs of clinical activity. Small bowel resections and relapses of Crohn's disease increase the absorption of oxalic acid. The significance of 14C-oxalic acid absorption test is the recognition of enteric hyperoxaluria.

[Diagnostic value of direct and indirect cholangiography - a comparative study]. / Die Aussagefähigkeit der direkten und indirekten Cholegraphie - eine vergleichende Untersuchung.

Stimulated by Goodman's paper and the discussion evoked by this we, too, compared the valency of the intravenous cholography with the evidence of the direct cholography. Among our selected patients (95 patients) in 60% we did not find an accordance of the two methods. The intravenous cholography were with Goodman' criteria judged by a radiologist at 42% as optimal, at 24% as suboptimal and at 34% without evidence. Also a control group of 50 intravenous cholographies in accidental order were to be estimated as optimal only in 56%. In 39 cases only the direct cholography could bring the definitive diagnosis, the intravenous cholographies, no doubt, were pathologically sufficient, but not for the final clarification. 16% falsely positive and 10% falsely negative judged intravenous cholographies are particularly aggravating in our study. Mainly the explanation of a dilated choledochus and changes near the papilla, the finding of the calculus in the duct system and the possibility to estimate the intrahepatic bile ducts were the weak points in the evidence of the intravenous cholography. According to our results only the direct cholography brings the exact and for therapy guiding diagnostics, particularly before reinterventions on the bile ducts with the increased risk of operation. This and the justifiably small complications vindicate the invasive diagnostics.

[The behavior of lipid metabolism parameters in liver cirrhosis and fatty liver during glucose load]. / Zum Verhalten von Fettstoffwechselparametern bei der Leberzirrhose und Fettleber unter Glukosebelastung.

In altogether 31 patients with liver cirrhosis, fatty degeneration of the liver or a morphologically normal liver the free fatty acids, glycerin, ketone bodies and triglycerides were examined as parameters of the fat metabolism after nocturnal alimentary abstinence and under 2-hour glucose infusion. Parallel to this estimations of the immune-reactive insulin and of the blood glucose were performed. In liver cirrhoses increased levels of free fatty acids, low ketone body levels, the absent correlation between ketone bodies and immune-reactive insulin under basis conditions as well as the relatively smaller reduction of the TG-values in hyperinsulinaemia were to be established. They may be explained as an expression of restricted metabolic functions of the cirrhotic liver. On the other hand from the prompt decrease of free fatty acids and glycerin under glucose-induced hyperinsulinaemia was concluded to an unrestricted efficacy of the insulin in the fatty tissue in the sense of the furthering of lipogenesis and inhibition of the lipolysis.

[Changes in carbohydrate metabolism in liver cirrhosis during glucose infusion tests]. / Veränderungen des Kohlenhydratstoffwechsels bei der Leberzirrhose unter Glukoseinfusionstest.

In 31 patients with normal liver findings, fatty degeneration of the liver and liver cirrhosis the behaviour of parameters of the carbohydrate metabolism (blood glucose, IRI, lactate, glycogen of liver and muscle) was tested under a two-hour glucose infusion. Accumulation of pathological carbohydrate tolerance and hyperinsulinaemia and the reduced content of liver glycogen in liver cirrhoses are traced back to a decreased functional reserve of the diseased liver. On the other hand, the reduction of lactate was normal as a criterion of the gluconeogenesis. Lactacidoses did not appear despite advanced liver cirrhoses. The increase of the reduced reserves of glycogen in liver and muscle after the offer of glucose refers to preserved regulation mechanisms in supply of substrates despite peripheral insulin resistance.

[Percutaneous antegrade pyelography with a fine needle]. / Perkutane antegrade Pyelographie mit dünner Nadel.

In 15 patients the percutaneous antegrade pyelography with thin needle was performed for the clarification of a mute kidney and a urinary stasis kidney. The two groups of diseases could not be clarified by means of the methods of the conventional urography. The retrograde pyelography was intentionally given up. By means of the percutaneous antegrade pyelography we could clarify a mute kidney in 8 cases and in 4 cases a urinary stasis kidney. In 3 cases with mute kidney we did not succeed in the demonstration of the renal calyces. No complications appeared. In strong indication the percutaneous antegrade pyelography is an evident diagnostic measure by great security, little stress for the patient and little cost. Despite modern investigation methods including sonography and computer tomography is referred to the fields of application of the percutaneous antegrade pyelography.