Endocrine pancreatic secretion in patients after acute pancreatitis.

In 14 nonobese patients after acute pancreatitis and with normal oral glucose tolerance, the response of insulin, C-peptide, and pancreatic glucagon after 100 g of oral glucose was assessed. The curves of insulin and C-peptide were significantly raised compared with those of controls, and no difference was found between the response of patients with a negative (n = 8) and a positive (n = 6) family history of type II diabetes. The curves of pancreatic glucagon did not differ from those found in controls. Our results indicate that a normal response to glucose after recovery from an attack of acute pancreatitis is maintained at the cost of increased insulin secretion.

The effect of some N solutions for parenteral nutrition on gastric and pancreatic secretion.

In patients without pancreatic disease Aminofusin L forte infused for 1 h did not stimulate gastric or pancreatic secretion. On the other hand, infusion of casein by hydrolysate led to a significant increase in the concentration and total output of HCl. 4 h intravenous infusion of Aminofusin L forte caused a transient but significant rise of the bicarbonate concentration, amylase activity and above all trypsin activity and output. The results show that N solutions used for parenteral protein nutrition influence in a different way both gastric and pancreatic secretion.

Influence of protein intake and renal function on plasma amino acids in patients with renal impairment and after kidney transplantation.

A group of 17 patients with chronic renal impairment and a group of 11 patients surviving for 3--7 years after kidney transplantation were examined. In all patients plasma amino acids were analyzed. The ratio of essential/nonessential amino acids, the valine/glycine ratio and Whitehead's quotient are influenced above all by the dietary protein intake. Raised citrulline and 3-methylhistidine values were not influenced by the protein intake, while they correlate with indicators of renal function. Changes detected after kidney transplantation are analogous.

The effect of a low-protein diet on serum levels of ceruloplasmin and transferrin in patients with chronic renal failure.

In patients with chronic renal failure the administration of a diet providing 20 g protein per day for five weeks caused a significant rise in the serum ceruloplasmin level. A low dietary copper content (0.8 mg/day) may have been the limiting factor for any further rise of the ceruloplasmin level. The rise of ceruloplasmin was associated with a continuous decline of total iron binding capacity. The temporarily raised serum iron levels and the continuous decline of unsaturated iron binding capacity suggested enhanced iron mobilization caused by the raised ceruloplasmin level. The rise of ceruloplasmin correlated with the decline of UIBC.

Primary sclerosing cholangitis. Light and electron microscopy of hepatic tissue in two cases.

In an 18 year-old woman presenting with an intra- and extrahepatic form of sclerosing cholangitis needle biopsy of the liver revealed, in addition to a conspicuous proliferation of biliary ductules and mild inflammatory infiltrations of the portal tract, piece-meal necroses and focal intralobular inflammatory changes. In the second case - a 49-year-old man - presenting with an extrahepatic location of stenoses there were infrequent proliferating biliary ductules in the enlarged fibrotic portal tracts. Ultrastructural investigations revealed in both patients adverse regressive changes in the epithelium of proliferating biliary ductules, seen as microvillous damage on the luminal surface, dilation of the endoplasmic reticulum and mitochondrial swelling; in the second patient there was, moreover, electrondense material in epithelial cytoplasm, probably corresponding to bile components. In the first patient predominated among ultrastructural changes increase of cytoskeletal filaments in some epithelia and pronounced reduplication of the basement membranes of small biliary ducts. These "cholestatic" modifications, expressed in different form in the two patients, were accompanied by dilatation and damage, sometimes total disappearance of microvilli of biliary canaliculi.

Plasma beta-endorphin immunoreactivity (PL-beta-ED-ir) in patients with ulcer disease and its management by acute and chronic administration of gastrozepin.

The initial level of PL-beta-ED-ir was significantly lowered in a group of 14 patients with gastroduodenal ulcer disease as compared with healthy volunteers (P less than 0.05). Immediately after i.m. administration of 20 mg gastrozepin (G) the PL-beta-ED-ir level increased but not significantly. Given orally over two weeks, G (50 mg/day) led to a more than doubling of the initial level (P less than 0.05). Controls showed no significant changes. A further meaningful change represented the time relationship of PL-beta-ED-ir during 5-hour observation to i.m. administration of 20 mg G before the start and after the end of the 2-week oral therapy. The placebo character of the above findings rules out the absence of any deviations of PL-beta-ED-ir in the diseased and healthy group after i.m. injection of saline. The study deals with the findings in relation to the pathophysiology of ulcer disease, and with a potential interference of G in the interrelation of the cholinergic and endogenous opiate systems.

The role of ERCP in management of biliary complications after liver transplantation.

Biliary complications remain to pose a serious problem in patients after liver transplantation. In the past, they occurred in as many as 50% of patients, and were associated with a height mortality. This has changed and at present the incidence of this complications is lower. The authors present their own series and discuss the role of ERCP in the management of complications.

Residual kidney function and plasma urea concentration in patients with chronic renal failure.

The relationships between the plasma levels of urea (P(urea)), renal clearance of urea (C(urea)) and creatinine (Ccr) at an intake of 0.5 g protein/kg body weight/day were followed in 10 patients with chronic renal failure (CRF) under balance conditions. Under these conditions, P(urea) attained a value of 30 mmol/l when C(urea) had decreased below 3.8 ml/min. By contrast, no correlation could be demonstrated between P(urea) and Ccr under these conditions. The same relationships were followed in another group of 30 outpatients with CRF. Even in patients not followed under balance conditions, C(urea) determination makes it possible to establish whether the high increase in P(urea) is due to the decrease in residual renal function below the critical level or whether extrarenal factors are involved. Likewise, no significant correlation between P(urea) and Ccr could be demonstrated under these conditions. The findings suggest that C(urea) measurement in CRF patients helps to assess residual renal function in terms of P(urea) regulation and provides information that cannot be obtained by Ccr measurement.

[Helicobacter (Campylobacter) pylori in stomach and duodenal biopsies]. / Helicobacter (Campylobacter) pylori v biopsii zaludku a duodena.

In bioptic specimens of the gastric mucosa of 57 patients with dyspeptic complaints and/or a duodenal ulcer Helicobacter pylori was detected under the microscope in 82,4% of chronic active gastritis and in 28,6% and 61,5% resp. of chronic gastritis grade I and II. The finding of helicobacteria depended on the number of collected specimens. They were never found at sites with intestinal metaplasia and their numbers did not correspond to the intensity and character of the inflammatory changes. As compared with the antrum, in the corpus of the stomach helicobacteria were found more frequently not only in mild forms of the inflammation but also in the normal mucosa. In the duodenum the finding was negative and the inflammatory changes were only mild. In all patients with a duodenal ulcer and a scar after ulceration in the antrum chronic active or inactive gastritis grade II was found with helicobacteria in 84,6% of the observations. Cultivation was consistent with microscopic evidence in 50 patients (87,7%).

[The critical value of residual kidney function in patients with chronic kidney failure from the viewpoint of the concentration of urea and potassium in the plasma]. / Kriticheskaia velichina ostatochnoi funktsii pochek u bol'nykh s khronicheskoi pochechnoi nedostatochnost'iu s tochki zreniia kontsentratsii mocheviny i kaliia v plazme.

Residual kidney function was examined in 10 patients with chronic renal insufficiency under balance conditions and in 30 outpatients on the basis of urea clearance (Curea) and potassium clearance (CK). Protein intake was 35-40 g/day (0.5 g/kg/day) and potassium intake was 30-40 mmol/day. Under these conditions the critical values of residual kidney function were as follows: 1) plasma urea concentration (Purea) did not exceed 30 mmol/l if Curea did not drop below 3.8 ml/min; 2) plasma potassium concentration (PK) did not exceed 5 mmol/l if CK did not decrease below 4.1 ml/min. Clinical examination of Curea and CK provides additional information to the examination of creatinine clearance (Ccr) or its plasma concentration (Pcr). Our results suggest that the critical value of residual kidney function cannot be defined only on the basis of examination of Ccr or Pcr. Examination of Curea and CK can help in the interpretation of very high Purea and hyperkalemia in patients with chronic renal insufficiency.

[Diet therapy in renal insufficiency]. / Dietoterapiia pri pochechnoi nedostatochnosti.

In renal insufficiency the low-protein diet should be considered of reduction and temporary type. After clinical improvement it is advisable to place the patients on diet with a higher protein content and in this way to avert any further fall in the concentration of essential amino acids in the plasma and thus keep down the progressive protein-caloric fasting. The disturbance of the protein metabolism is, however, provoked not only by the protein-caloric deprivation, but by the disease itself. In this way, the developing upsets distort the picture of the protein-calorie deficiency, which finds its expression in the appearance of the anemic syndrome, disturbed electrolytes metabolism, imbalance of the acid-base equilibrium, etc. Therefore, one should look for other ways for their compensation, not believing that this can be achieved through the dietotherapy alone.