Adaptation of intestinal secretomotor function and nutrient absorption in response to diet-induced obesity.

BACKGROUND: The gut plays a significant role in the development of obesity, notably through peptide signaling to the brain. However, few studies have investigated intestinal function per se in a rodent model of diet-induced obesity (DIO). Our aim was to investigate intestinal secretomotor function and glucose transport in DIO and diet-resistant (DR) rat jejunum. METHODS: Male outbred Sprague-Dawley rats were maintained on a medium high fat diet for 9-10 weeks and split into DIO and DR groups based on weight gain. Mucosal-submucosal preparations of the proximal jejunum were mounted in Ussing chambers and voltage-clamped at 0 mV. Glucose (10 mmol L(-1)), 2-deoxy-D-glucose (10 mmol L(-1)), and leptin (10 nmol L(-1)) were added to the luminal side of the tissue and veratridine (30 micromol L(-1)), bethanechol (100 micromol L(-1)), and forskolin (10 micromol L(-1)) were added to the basolateral side of the tissue. KEY RESULTS: Secretomotor responses were significantly decreased in DIO jejunum compared to DR tissues. Glucose-stimulated increases in I(sc) in DR animals, that were sensitive to leptin inhibition, were significantly reduced in DIO rats. Decreased sodium glucose transporter-1 mediated glucose transport was accompanied by a concomitant increase in the expression of jejunal glucose transporter-2. CONCLUSIONS & INFERENCES: These data suggest that submucosal nerve function is compromised in DIO rats and electrogenic glucose transport is significantly decreased. The latter may represent an adaptive response to limit nutrient absorption in the jejunum from DIO rats. However, the loss of secretomotor control may lead to an altered host defense with a resultant change in intestinal flora contributing to the maintenance of obesity.

[Results of treatment of lupus nephritis in children. Own experience]. / Wyniki leczenia toczniowego zapalenia nerek u dzieci. Doswiadczenia wlasne.

The study aims at assessing the results of treating lupus nephritis in 31 children, aged 4-16 years at the diagnosis of the disease. Renal biopsy was performed in 29 patients. Patients were divided into 2 groups. Group 1 included 15 children treated in 1980-92 and group 2 included 16 children treated in 1993-98. The average age, sex and follow-up were similar in both groups. All children were treated with corticosteroids. Alkylating agents were administered to 12 patients in group 1 and in 14 in group 2. Group 2 patients were given cyclophosphamide in monthly intravenous pulses, and methylprednisolone according to the Mendoza regime. In Group 1, 8 remissions (53%) were observed. Better results with more aggressive treatment were obtained in group 2--13 remissions (81%).

[Vascular changes of colonic mucosa as a cause of lower gastrointestinal bleeding in patients with liver cirrhosis]. / Zmiany naczyniowe blony sluzowej jelita grubego jako przyczyna krwawienia z dolnego odcinka przewodu pokarmowego u chorego z marskoscia watroby.

Gastrointestinal bleeding is the common complication of the portal hypertension. Endoscopy is the most accessible diagnostic technique, but the investigation is often limited to the endoscopy of upper gastrointestinal tract. Colonoscopy in the case of bleeding from the colon is often limited by the possibility of good bowel preparation to that procedure. However diagnostic colonoscopy in these cases increases chances for correct diagnosis and application of adequate treatment. Increasing number of gastrointestinal bleeding cases in the last decade causes the necessity of focusing on this problem.

[Angiographic findings in hereditary hemorrhagic teleangiectasia: a case study of Rendu-Osler-Weber disease]. / Diagnostyka angiograficzna nawracajacych krwawien z przewodu pokarmowego; opis przypadku choroby Rendu-Osler-Webera.

A case of Rendu-Osler-Weber disease in 48 year old male was described. Selective arteriography of superior mesenteric artery revealed its widening (including intestine branches), numerous anastomoses in the form of microhaemangioma and fast venous return with broad superior mesenteric and portal vein.

Long-term Cyclosporine A (Sandimmun) therapy for steroid resistant nephrotic syndrome in children.

The aim of the paper was to evaluate Cyclosporine A (CsA) treatment in children with steroid resistant nephrotic syndrome (diagnosed according to criteria established by ISKDC), in whom numerous attempts at other types of therapy had failed. CsA was used in 23 children aged 2-16 years. Renal biopsies revealed minimal changes (MCD) in 7 children, focal segmental glomerulosclerosis (FGS) in 11, mesangial glomerulonephritis (MES) in 4, and membrano-proliferative glomerulonephritis (MPGN) in 1. CsA was administered for a period of 6-41 months at a daily dose of 6 mg/kg, gradually decreased to 2.5 mg/kg. Blood CsA level was 40-200 ng/ml. In the course of the treatment, proteinuria disappeared or diminished and clinical improvement was seen in 21 patients. 13 children had relapses of nephrotic syndrome, showing very low blood CsA levels. Complete remissions were achieved in 16 children, partial remissions in 5, no remission in 2. Throughout the treatment and after its cessation 22 patients manifested no deterioration of renal function. In 1 child, repeated renal biopsies revealed some lesions that could suggest a nephrotoxic effect of CsA. Secondary steroid sensitivity observed in 3 children should be emphasized. Concluding, CsA is an effective and well tolerated agent in children with steroid resistant nephrotic syndrome, and the improvement noted in patients with FGS may reduce the risk of early terminal failure. The treatment requires monitoring blood CsA levels.

Neurotoxicity of Cyclosporine A in therapy of steroid resistant nephrotic syndrome in a 10-year old boy.

A 10-year old boy with steroid resistant nephrotic syndrome developed neurological symptoms during the combined therapy with Cyclosporine A, prednisone and ketonazole. These symptoms might be caused by Cyclosporine because the clinical course and laboratory data revealed neither inflammatory nor other causative factors.

[Manometric evaluation of the effects of intravenous administration of glucagon, buscopan and papaverine on the contractile activity of the sphincter of Oddi]. / Manometryczna ocena wplywu dozylnego podania glukagonu, buskopanu i papaweryny na czynnosc skurczowa zwieracza Oddiego.

Endoscopic manometric technique was used to investigate the effects of spasmolytic drugs on the sphincter of Oddi (s.O.) motility. 41 patients were randomly divided into 4 groups. In every patient the characteristics of the s.O. was monitored before and during 5 min. period after i.v. administration of: 20 mg buscopan, 1 mg glucagon, 40 mg papaverine or 2 ml of 0.9% NaCl solution. After buscopan administration the amplitude and frequency of phasic contractions of the s.O. were decreased as well as a baseline pressure in the s.O. Glucagon reduced frequency and amplitude of phasic contractions of the s.O. without influencing the baseline pressure. Papaverine reduced only frequency of phasic contractions. Physiological saline caused no change in pressure characteristics of the s.O.

[Difficulties in the diagnosis of pancreatic cancer using endoscopic retrograde cholangiopancreatography]. / Trudnosci rozpoznawania raka trzustki w obrazie endoskopowej pankreatocholangiografii wstecznej.

Difficulties are presented which the authors met on ERCP-evaluation of the pancreatic cancer. 64 cases were analyzed of the diagnosed cancer, then confirmed on surgery, histopathologically+ and post mortem. Differentiation of the cancer from chronic pancreatitis was most difficult with the false positive results being 20.3.

Patency of the Santorini duct and acute biliary pancreatitis. A prospective ERCP study.

Disturbance of outflow of the pancreatic juice is considered to be a pathogenic factor in the development of acute biliary pancreatitis (ABP). In the years 1984-1988 sixty-seven patients admitted with ABP were prospectively allocated to urgent ERCP and endoscopic sphincterotomy. Diagnostic criteria of acute biliary pancreatitis were as follows: epigastric pain, an elevated serum amylase concentration, biochemical prediction of gallstones, positive pattern of pancreatitis in US and CT-scan and ERCP performed within 24 h of admission. At ERCP the anatomy of the pancreatic duct was evaluated and special attention was paid to the patency of the accessory (Santorini) duct as a potential outflow route of the pancreatic juice. The control group comprised 100 consecutive patients in whom a pancreatogram was obtained during ERCP performed because of expected biliary pathology. Patency of the Santorini duct was found merely in 17% patients with ABP. In contrast, this duct was patent in 69% of the patients in the control group (p less than 0.001). The absence of this additional possibility of draining pancreatic juice might be an important pathogenic factor in acute biliary pancreatitis.

Seasonal occurrence of abdominal pain and endoscopic findings in patients with gastric and duodenal ulcer disease.

Fifty patients with peptic ulcer disease were followed up to 1 to 5 years. Panendoscopy was repeated on the average of 5.6 times a year, also in patients who were actually well. The pattern of changes during on calendar year was a substantial comparative unit. The incidence and intensity of pain, erosions, and ulcers were registered in yearly charts, and the results were calculated per month from 100 yearly cycles. Pain appeared to be the most frequent symptom, being reported in 50% to 100% of visits in particular months. Its decrease in springtime and in August was significant at the level of p less than 0.5, whereas the increase in early autumn was more significant, with p less than 0.01, as was also the next decrease in December. Although pain appeared more often than ulcer niches, and although 4% of patients never felt pain, the only positive correlation found (p less than 0.05) was that between incidence of pain and of ulcer. Erosions occurring in 10% to 30% seemed to be the most constant feature in these cases, whereas the appearance of ulcers ranged from 15% to 60%. The lower ulcer incidence in August and in December was highly significant (in both, p less than 0.001).