[Study of the correlation of sonographic and scintigraphic results in measuring stomach emptying]. / Korrelationsstudie der sonographischen mit den szintigraphischen Messergebnissen der Magenentleerung.

"Stomach cockade" can be readily imaged sonographically, so that it has also been possible to carry out studies of gastric motility or measurements of gastric emptying times of fluids. However, the results of measurements should be verified by reference methods using new investigation techniques. For this reason, we measured synchronously by sonography and scintigraphy the emptying of test fluids from the stomach in patients with diabetes mellitus and suspected gastroparesis. We found a correlation of the two methods of measurement, so that sonographic measurement can be regarded as confirmed by scintigraphy as a reference method.

The treatment of chronic recurrent pancreatitis with depot secretin--a preliminary report.

Increased viscosity and raised lactoferrin, trypsin and protein concentrations in selectively aspirated pancreatic secretion, prompted us to try depot secretin therapy in patients with advanced chronic recurrent pancreatitis without pancreatic duct obstruction or pancreatic pseudocysts. The idea behind this approach was that it might "wash out" the sticky, protease-rich secretion. In a randomized double-blind trial we administered depot secretin at doses of 800 CU by subcutaneous injection twice daily for 7 days. Pancreatic secretion from the treatment group had significantly lower viscosities and lactoferrin and trypsin concentrations than in the placebo group. There was also significant pain relief. Depot secretin therapy appears to offer an alternative approach to the management of advanced chronic recurrent pancreatitis without pancreatic duct obstruction or pseudocysts.

[Sonography of gallbladder kinetics during cholagogue therapy]. / Sonographie der Gallenblasenkinetik unter Cholagogum-Medikation.

Sonography of gallbladder kinetics shows that a cholagogue exercising a spasmolytic action counteracts the periodic voiding of the gallbladder or even induces an increase in volume of the gallbladder in healthy persons and in patients with cholecystolithiasis. This effect cannot be seen in chronic cholecystitis.

[Effect of secretin and gabexate-mesilate (synthetic protease inhibitor) on serum amylase level after ERCP]. / Einfluss von Sekretin und Gabexat-mesilat (synthetischer Proteaseninhibitor) auf die Serumamylase-Spiegel nach ERCP.

Complication rate of ERCP is about 2%, mortality rate 0,2%. In about 1% acute pancreatitis or recurrency of chronic pancreatitis occurs. In 20 to 73% a rise of serum amylase is noted without clinical symptoms. In a randomized trial the influence of secretin and gabexate-mesilate (synthetic protease inhibitor) on ERCP-correlated complications was analyzed. Gabexate-mesilate caused a significant decrease of ERCP-induced hyperamylasemias, whereas secretin showed no effect.

[Ultrasound measurement of gastric emptying time values]. / Sonographische Messung der Magenentleerungszeit.

Sonography, as a non-invasive procedure, may be used also for studying the gastric emptying time. After 250 ml of a liquid test meal the gastric emptying time was determined in 20 subjects. In each subject the applied test meal could be traced in the prepyloric antrum. When examined at 8.00 a.m. the fluid had left the stomach after an average time of 8.3 min. During the day the emptying time increased to 10.8 min. A second examination on another day after application of 30 mg metoclopramide revealed significantly lower gastric emptying time. Ultrasonography may therefore be used as a sensitive non-invasive method for studying the gastric emptying rate in the fasting state and under pharmacological stimulation.

[Sonographic measurement of gastric emptying time]. / Sonographische Messung der Magenentleerungszeit.

Sonography, as a non-invasive procedure, may be used also for studying the gastric emptying time. After 250 ml of a liquid test meal the gastric emptying time was determined in 20 subjects. In each subject the applied test meal could be traced in the prepyloric antrum. When examined at 8.00 a.m. the fluid had left the stomach after an average time of 8.3 min. During the day the emptying time increased to 10.8 min. A second examination on another day after application of 30 mg metoclopramide revealed significantly lower gastric emptying time. Ultrasonography may therefore be used as a sensitive non-invasive method for studying the gastric emptying rate in the fasting state and under pharmacological stimulation.

[Influence of various non-steroid antirheumatic drugs on the electric potential between the gastric serosa and mucosa (author's transl)]. / Einfluss verschiedener nicht-steroidaler Antirheumatika auf die elektrische Potentialdifferenz der Magenschleimhaut.

Non-steroid antirheumatic drugs inhibit the synthesis of prostaglandin, which results in a reduction in the efficacy of the gastric mucosal barrier. The transmural electric potential difference of the stomach wall would appear to be a useful criterion for mucosal barrier function. After 4 weeks of treatment with Indomethacin, Azapropazpone, Diclofenac or Phenylbutazone, a significant reduction in the gastric potential difference as compared with the pre-treatment measurement was observed. Accordingly, non-steroid antirheumatics give rise to a reduction in the functional efficacy of the mucosal barrier.

Gastroscopic findings after therapy with non-steroid antirheumatic drugs.

Non-steroid antirheumatic drugs inhibit synthesis of prostaglandins, which gives rise to a reduction in gastric mucosal perfusion and the limitation of cytoprotective factors. Thus, pan-endoscopic follow-up examinations performed after four weeks of treatment with various non-steroid antirheumatic agents also revealed a significantly increased incidence of erosions, ulcers and reflux oesophagitis. After therapy of at least 18 months with non-steroid antirheumatics, incomplete erosions were verified in 35% of the cases, complete erosions in 7.5%, and reflux oesophagitis in 22.5%. Signs of gastro-intestinal intolerance occurred in 70% of the patients treated with antirheumatics drugs.

Selectively aspirated pure pancreatic secretion. Viscosity, trypsin activity, protein concentration and lactoferrin content of pancreatic juice in chronic pancreatitis.

The viscosity, trypsin activity, protein concentration and lactoferrin concentration in selectively aspirated, pure pancreatic secretion uncontaminated by bile, were determined in 46 patients with chronic pancreatitis and compared with the values obtained in 39 control subjects. The viscosity was measured using a modified capillary viscosimeter, the trypsin activity and the protein concentration using photometry, and the concentration of lactoferrin employing a new standard. It was found that in chronic pancreatitis, viscosity, trypsin activity and lactoferrin concentration was also found to be increased, but the differences were not significant. The results of this examination support the hypothesis that precipitation of protein-containing material in the pancreatic ducts, delayed outflow of secretion and premature activation of trypsin are pathogenically important factors in chronic pancreatitis.

[Therapy of gastrointestinal disorders due to oral rheumatism therapy. Effect of bromopride on antirheumatic agent-induced functional reduction in the gastric mucosa barrier]. / Zur Therapie gastrointestinaler Beschwerden bei oraler Rheuma- Behandlung. Einfluss von Bromoprid auf die Antirheumatika-induzierte Funktionseinschränkung der Magenmukosa-Schranke.

Non-steroid antirheumatic agents inhibit the synthesis of prostaglandins to an extent which depends upon their respective chemical composition. The result of this inhibition is a reduction in gastric mucosal perfusion, a limitation of cytoprotective factors, and an enhanced back diffusion of H+-ions into the mucosal cell. The function of the gastric mucosal barrier is restricted and a reduction in the measurable electric potential between the gastric serosa and mucosa ensues. Adjunctive therapy with bromopride (Cascapride) improves this reduction in gastric potential difference induced by the antirheumatic agent, and alleviates the gastrointestinal symptoms brought on by the antirheumatic drug.

[Lactoferrin levels in pure pancreatic secretion of chronic pancreatitis (author's transl)]. / Lactoferrinkonzentration im reinen Pankreassekret bei chronischer Pankreatitis.

As compared to 20 controls, 14 patients with chronic pancreatitis showed a significantly higher lactoferrin level in pure pancreatic secretion. The determination of lactoferrin levels in pure pancreatic secretion is an important parameter in the diagnosis of chronic pancreatitis.

[Chronic pancreatitis: diagnostic value of endoscopic retrograde pancreaticography, of pancreatic sonography, and of secretin-pancreozymin test corrected for volume losses (author's transl)]. / Wertigkeit der endoskopischen retrograden Pankreatikografie, des volumenverlustkorrigierten Sekretin-Pankreozymin-Tests und der Sonografie in der Diagnostik der chronischen Pankreatitis.

Endoscopic retrograde pancreaticography (ERP) and secretin-pancreozymin test corrected for losses (SP test) were performed in 153 patients suspected to have pancreatic disorders in order to evaluate diagnostic significance of these procedures. Pancreatic sonography was done in addition in 110 of these patients. If pancreatic excretion was normal, ERP results turned out to be normal in the same patients as well. SP test involves rather extensive laboratory work-up, but it does yield the most precise results as far as diagnosis of chronic pancreatitis is concerned. For this reason, and because of the possible complications caused by ERP, ERP should be applied only, when surgery is considered. Results of SP test and sonography coincided rather well. Therefore, sonography, not doing any harm to the patient, does have its place in the diagnosis of chronic pancreatitis.

[Viscosity of pure pancreatic juice in chronic pancreatitis (author's transl)]. / Viskosität des reinen Pankreassekretes bei chronischer Pankreatitis.

In patients with chronic pancreatitis viscosity is significantly increasesed compared to controls when pure pancreatic juice aspirated in the course of duodenoscopy is analysed. This parameter may represent a simple method for the diagnosis of chronic pancreatitis.

Viscosity and trypsin activity of pure pancreatic juice in chronic pancreatitis.

In patients with chronic pancreatitis, the viscosity and trypsin activity of the pure pancreatic juice obtained endoscopically are significantly higher than in healthy subjects. These two parameters may thus represent a simple method for the diagnosis of chronic pancreatitis.

[Analysis of pancreatic function. Determination of fecal chymotrypsin and the secretin-pancreozymin test. Comparative study]. / Pankreas-Funktionsanalyse. Chymotrypsin-Bestimmung im Stuhl und Sekretin-Pankreozymin-Test. Eine vergleichende Untersuchung.

Fecal chymotrypsin determination and secretin-pancreozymin test with volume-loss corrected were carried out intra-individually on 57 clinically normal test subjects and 51 patients with chronic pancreatic disease. A good correlation could be established in every case between the chymotrypsin activity in stool and the chymotrypsin output in the duodenal aspirate. False-positive chymotrypsin activity was not to be found in healthy subjects. On the other hand, however, the chymotrypsin activity in stool compared with the result of the secretin-pancreozymin test was found to be false negative in 21% of all patients with chronic pancreatic disease (some or all parameters pathological). In patients with a clear deficiency in the exocrine function of pancreas (all parameters pathological) the chymotrypsin activity was nevertheless seen to be false-negative in only 9.9% of the cases. Thus the fecal chymotrypsin determination can be used as screening test for the clearly reduced pancreatic exocrine insufficiency.

[The function of the hydrokinetic and ekbolic pancreas after acute pancreatitis]. / Verlauf der hydrokinetischen und ekbolen Pankreasfunktion nach akuter Pankreatitis

Thirteen patients were investigated 3-4 weeks (I. examination) and 3-5 months (II. examination) after the ceasing of the signs symptoms of an acute pancreatitis concerning their hydrokinetic and ekbolic pancreas-functions. In addition, the pancreatic ducts were demonstrated by ERCP. Reduction of the secretion were shown in 31% at the I. examination and in 23% at the II. examination. There were significant differences in the outputs of bicarbonate, trypsine and chymotrypsine compared to healthy test persons at the I. examination. At the II. examination, however, no significant differences could be observed compared to healthy test persons. The exocrine function of the pancreas was getting worse during the interval between the I. and II. examination in 2 cases but it became normal in 5 cases. Pathological alterations at the pancreativ-duct-system were not demonstrable shown at all.