Evidence for an effect of exorphins on plasma insulin and glucagon levels in dogs.

Recently, peptides with opioid-like activity have been demonstrated in peptic digests of dietary protein. The present study was designed to determine the effect of digested and undigested gluten on postprandial insulin and glucagon levels in conscious dogs. The intragastric instillation of digested gluten (25 g) elicited a more rapid and a significantly greater rise in postprandial peripheral vein insulin and glucagon levels compared with the effect of 25 g undigested gluten. The incremental insulin level was 104 +/- 20 microU/ml after digested gluten and only 58 +/- 7 microU/ml (P less than 0.01) after undigested gluten; the respective values for glucagon are 426 +/- 25 pg/ml versus 302 +/- 20 pg/ml (P less than 0.01). The intragastric administration of naloxone (4 mg), a specific opiate receptor antagonist, reduced the insulin response and augmented the glucagon response to the digested gluten test meal, whereas the response of both hormones to the undigested gluten meal was not affected by naloxone. Intravenously infused naloxone during the digested gluten meal did not influence insulin or glucagon levels. The present data suggest that in dogs the peptic digest of gluten contains an opioid-like material that stimulates postprandial insulin and glucagon release.

Effect of solid and liquid carbohydrates upon postprandial pancreatic endocrine function.

The present study was designed to determine the effect of sucrose-containing liquids upon postprandial pancreatic endocrine function in comparison to an identical quantity of sucrose contained in the solid part of the test meal. In 10 normal subjects, the ingestion of a solid-liquid meal with sucrose in the liquid part elicited a significantly greater increase in the plasma insulin and glucose levels during the first 20 min than did the ingestion of the same meal in homogenized form. Plasma glucagon levels fell below baseline during the early phase of the meal in response to the solid-liquid meal, whereas values increased immediately upon ingestion of the homogenized meal. To determine the effect of repeated ingestion of sucrose-containing liquids, 6 subjects ingested a meal containing sucrose in solid form together with water (solid sucrose); on another occasion, the same subjects ingested the sucrose in liquid form. In response to the liquid-sucrose meal, mean postprandial plasma insulin levels were significantly higher than those observed in response to the solid-sucrose meal (110 +/- 11.3 vs. 80 +/- 8.5 microunits/ml; P less than 0.01) as were plasma glucagon levels (284 +/- 12.2 vs. 198 +/- 8.2 pg/ml; P less than 0.001). Mean postprandial plasma glucose levels and the insulin to glucagon ratio were not different. The present data demonstrate that the ingestion of sucrose in the liquid part of a meal results in a significant elevation of plasma insulin concentrations compared to the ingestion of sucrose in the solid part of the meal.

Gastrin concentration in plasma of the neonate at birth and after the first feeding.

Plasma gastrin was determined simultaneously in 19 newborn infants and their respective mothers shortly after birth and in ten neonates before and after the first feeding. The gastrin concentrations in the umbilical vein plasma of the newborn infants were significantly higher than in the peripheral vein plasma of their mothers. The values were statistically not different from those obtained in the neonates before the first feeding. There was an increase in gastrin concentrations after the first feeding. From these results it is suggested that gastrin is produced in the neonate independently from the mother. It is already secreted after the first feeding. Experiments in rats showed that 125I-gastrin is not transported through the placenta. From these findings we assume that most likely the gastrin measured in plasma of newborn infants is of neonatal origin.

Pathophysiology of gastrointestinal hormones. Implications for paediatrics.

Gastrointestinal hormones (GI hormones) have received growing interest in endocrinology, gastroenterology and neuroendocrinology. Because of new methodological techniques, they can be measured in plasma and therefore be related to different pathophysiological conditions. In childhood, our present knowledge is as yet limited to the physiological rôle of gastrin at different ages and in some diseases (gastrinoma; Verner-Morrison syndrome) caused by humoral dysfunction. The present review relates the clinical important GI hormones to chemically classified families. The diagnostic value of determining endogenous hormone concentration in plasma and the validity of function tests carried out by administration of exogenous hormones are pointed out. Particular emphasis is given to the trophic action of GI hormones in the development and function of the gastrointestinal tract during childhood. More speculatively, GI hormones are involved in the complex function of the central nervous system, thus making food intake a trophotropic action in a broader sense.

Treatment of septicaemia in the newborn infant: choice of initial antimicrobial drugs and the role of exchange transfusion.

The therapeutic success of antibiotics used at the beginning of treatment and the effect of exchange transfusion in cases of septicaemia were tested in 22 newborn infants. The clinical course of these patients was compared with the outcome of 11 newborn infants who received antibiotic treatment without exchange transfusion. The following results were obtained: 1) All 6 patients initially receiving antibiotics, which were ineffective in vitro, died. In this group of patients the incidence of septic organ involvements (meningitis, ventriculitis, peritonitis) was significantly increased. 2) Following exchange transfusion, an impressive clinical improvement was consistently observed. 3) In patients who had initially received effective antibiotics and exchange transfusion, the lethality was significantly lower than in patients without exchange transfusion. 4) Our bacteriological findings show that continuous monitoring of cultures from blood, CSF and stool is necessary to choose the most effective antibiotic in the prevailing nosocomical circumstances.

[Stomach rupture as a sequela of child abuse]. / Magenruptur als Folge einer Kindsmisshandlung.

Rupture of the stomach was found in a case of child-battering. The victim, a 10-month-old boy was injured by his father, a U.S. soldier. The traumatic mechanism is discussed.

Human nasal septal cartilage: analysis of intracellular enzyme activities, glycogen content, cell density and clonal proliferation of septal chondrocytes of healthy adults and acromegalic patients.

The human septal cartilage is of ectodermal origin and contributes to midfacial growth and development. Acromegaly is an endocrine disease due to growth hormone (Gh) excess originating from a somatotrophic adenoma of the pituitary gland. Excessive Gh levels lead to high insulin-like growth factor I (IGF I) concentrations, which are known to stimulate cartilage growth in vivo and in vitro. One of the salient clinical pictures is coarsening of the midface and enlargement of the septal cartilage. Septal cartilage was obtained from 8 acromegalic patients during transnasal hypophysectomy and from 10 healthy adults during septoplasty to analyse the following aspects of cartilage biochemistry, metabolism and growth. 1. Intracellular glycogen, the major source of energy of chondrocytes, was determined enzymatically and found to be drastically reduced in acromegaly. 2. Several intracellular enzymes, related to biomatrix degradation, showed a strict local pattern of distribution. Cathepsin B activity, a neutral proteinase degrading both the helical and nonhelical region of the collagen molecule was significantly increased in acromegaly, whereas alkaline phosphatase activity, an enzyme related to mineralization of the cartilage at the chondroosseous junction was depressed in acromegaly. 3. The cell density in some areas of the septal cartilage was increased in acromegaly, whereas the clonal proliferation rate of its chondrocytes in response to serum and growth factors was decreased. Chondrocytes both of healthy adults and acromegalic patients could be effectively stimulated by insulin-like growth factor I and II and to a lesser extent by epidermal growth factor.

Congenital nephrogenic diabetes insipidus-vasopressin and prostaglandins in response to treatment with hydrochlorothiazide and indomethacin.

In four boys with congenital nephrogenic diabetes insipidus, plasma arginine-vasopressin (AVP) and urinary excretion of prostaglandins were studied in response to treatment with hydrochlorothiazide and indomethacin. An abnormal relationship between AVP and urine osmolality was demonstrated in all patients. In the first patient, treatment with indomethacin (3 mg/kg per day) resulted in a drop of the insulin and paraminohippurate clearances. In the other three patients urinary excretion of PGE2 was raised, and fell during treatment with hydrochlorothiazide (2 mg/kg per day) and indomethacin (2 mg/kg per day). Urine flow, free water clearance and osmolar clearance decreased during treatment. A combination of both drugs is more effective than hydrochlorothiazide alone and the effect appears to be additive.

Analysis of banding patterns and mosaic configurations in a case of ring chromosome 15.

Cytogenetic studies on lymphocytes from a 14-year-old mentally retarded girl with somatic anomalies suggestive of a chromosomal abnormality revealed a ring chromosome 15. The long arm of the defective chromosome is broken at band q24 or q25. The silver staining technique for nucleolus organizer regions showed that the ring had lost the achromatic stalk and the satellite. The chromosomal mosaicism resulting from the structural instability of the ring chromosome was analyzed and compared with 6 cases reported in the literature. It is proposed that the clinical manifestations in the different patients with ring chromosome 15 result from both the deficiency in the long arm and the mosaic configurations.

Rate dependent stimulation of insulin and glucagon but not gastrin and somatostatin release during the intestinal phase of a meal.

Previous studies have indicated a possible influence of gastric emptying on postprandial pancreatic endocrine function and the present study was designed to determine if the rate at which nutrients enter the small intestine may play a role in the postprandial regulation of insulin, glucagon, somatostatin and gastrin release in conscious dogs. In response to an intraduodenal instillation of a liver extract--sucrose test meal postprandial insulin and glucagon levels increased significantly with increasing infusion rates of the test meal, whereas somatostatin and gastrin levels did not change. The rise of the endocrine factors preceded any increase of peripheral vein plasma glucose levels. The present data demonstrate that during the intestinal phase of a meal the rate of nutrient entry into the duodenum favours insulin and glucagon but not somatostatin and gastrin release. This mechanism could be of importance in the regulation of nutrient homeostasis during the ingestion of certain carbohydrate containing meals.

Fanconi anemia complementation group E: clinical and cytogenetic data of the first patient.

The clinical and cytogenetic data of the first patient proven to belong to the fifth Fanconi anemia complementation group are described. The Turkish boy presented with psychomotoric retardation, growth retardation, retarded bone age, brachycephaly, hypotelorism, epicanthus, syndactyly, brachydactyly, renal dystopia, and cryptorchism. In addition, an asymmetrical skeletal anomaly was seen with a double distal phalanx of the left thumb and hypoplasia of the right thumb. Typical hematological features of the disorder developed, at the age of 2.5 years, about 1 year after diagnosis. Cytogenetic studies confirmed the clinical diagnosis and revealed a spontaneous chromosomal instability and hypersensitivity to the cross-linking agents diepoxybutane and Trenimon. The findings in the patient, who is considered to be the standard for the fifth Fanconi anemia complementation group, are compared with data reported for other patients affected with Fanconi anemia.

Placental transfer of parathyroid hormone.

We investigated the in vitro transfer of three parathyroid hormone (PTH) fragments (amino acids 35-84, 44-68 and 65-84) through human placenta at term. The perfused and transferred fragments were measured radioimmunologically and identified by three different methods: high-pressure-liquid chromatography (HPLC), preparative flat-bed electrofocusing (PEGG), and gel filtration (GF). The study demonstrated that PTH fragments traverse the human placenta. The transferred and perfused fragments were identical. We observed a significant degradation of the perfused hormone during the passage through the placenta in both fetal and maternal directions. In addition, we measured the PTH concentrations on forty samples of maternal and umbilical cord artery and vein plasma obtained immediately after delivery. A highly significant correlation of PTH concentrations in the maternal and umbilical cord vessels was observed. These findings support the contention that human placenta at term is permeable for PTH fragments.