[Intrahepatic cholestasis and aplastic anemia following administration of prajmaline]. / Intrahepatische Cholestase und aplastische Anämie nach Prajmalin-Einnahme.

Intrahepatic cholestasis and aplastic anemia after N-propylajmaline. A 43 year old female patient taking oral contraceptives for more than five years received the antiarrhythmic drug N-propylajmaline for treatment of ventricular arrhythmia. After twelve days (total dosage 510 mg N-propyl-ajmaline) acute severe intrahepatic cholestasis and aplastic anemia developed. The erythropoeisis improved after three weeks of treatment with corticosteroids. However, despite treatment with phenobarbital the jaundice receded very slowly. Even after nine years of follow-up cholestatic enzymes are still significantly elevated although serum bilirubin levels are in the normal range. This case report demonstrates that antiarrhythmic drugs may induce nearly irreversible intrahepatic cholestasis and severe hematological disturbances.

[Small intestinal biopsy--technique and diagnostic value (author's transl)]. / Die Dünndarmbiopsie--Methodik und diagnostische Aussage.

The commonly used instruments for obtaining small bowel biopsies, their use and the examination of the biopsy particles by magnifying lens, light microscopy and histochemistry are presented. Based on biopsy findings, diseases of the small intestine are classified as follows: 1) diseases with diagnostic biopsy abnormalities which are excluded by a normal biopsy; 2) diseases which can be diagnosed by positive biopsy findings but cannot be excluded by a normal biopsy; 3) nonspecific mucosal abnormalities; and 4) diseases with normal architecture of the intestinal mucosa.

Structural and functional studies on the transformation of the intestinal mucosa in rats with experimental diabetes.

Twenty days after the onset of alloxan-induced diabetes, a villous hyperplasia has developed in the intestines of rats having free access to food. The transformation is characterised by a considerable increase in the area of the villous surface, caused by an enhanced mitotic activity in the crypts. The absorption of glucose or methionine by jejunal loops, whether expressed in terms of serosal area or villous area, is unchanged at this stage. On the other hand, the specific activity of certain disaccharidases and dipeptidases in crude mucosal homogenates is greater in diabetic animals, but quantitative histochemistry revealed no changes in the activities of alkaline phosphatase, leucine amino-peptidase and non-specific esterase in the individual enterocytes. Thus the biochemical changes may simply reflect the hyperplasia of the mucosa. The blood sugar level does not appear to be directly responsible for the mucosal transformation; however, the positive correlation between the daily food intake and the villus height suggests a role of hyperphagia and consequent increased luminal nutrition in the development of the hyperplasia.

[Diabetes mellitus in idiopathic haemochromatosis (author's transl)]. / Diabetes mellitus bei idiopathischer Hämochromatose

In 28 out of 40 patients with idiopathic haemochromatosis manifest diabetes mellitus could be demonstrated 19 patients required insulin. Treatment of diabetes with or without insulin was problem-free. In only two patients there was an insulin resistance which required high doses of insulin some of the time. There was a family history of diabetes in eleven patients. Minimal diabetic retinopathy in two patients was the only typical complication specific to diabetes. Severe forms of microangiopathy are seldom seen in haemochromatosis diabetes. This form of diabetes is probably mainly of genetic origin. Liver cirrhosis and fibrosis and possibly pancreatic siderosis are additional factors to be considered. A sufficiently long and intensive venesection treatment leads to clinical improvement in the diabetes in only a small fraction of the haemochromatosis patients.