Effect of cisapride on symptoms and biliary drainage in patients with postcholecystectomy syndrome.

The study evaluates the effect of 20 mg cisapride twice daily on symptoms and biliary drainage in patients with the postcholecystectomy syndrome. Nineteen patients, all female, went through a randomized, double-blind, placebo-controlled, crossover trial with two 4-week treatment periods separated by a 2-week washout period. Symptoms were registered on diary cards. Biliary drainage was studied with dynamic cholescintigraphy. The down slope of the time-activity curve (T1/2 and elimination index) was used as a measure of the biliary drainage. More symptoms were registered during cisapride therapy than with placebo. This unfavourable effect of cisapride was statistically significant in a subgroup of patients with postcholecystectomy complaints identical to the biliary pain they experienced during injection of contrast at the endoscopic retrograde cholangiopancreatographic examination. Cisapride statistically significantly hastened biliary drainage. The median T1/2 values were 24 and 28 min after cisapride and placebo, respectively (p less than 0.01). In conclusion, cisapride promoted biliary drainage in patients with the postcholecystectomy syndrome but had an unfavourable symptomatic effect in those with bile duct-triggered postcholecystectomy complaints.

Sphincter of Oddi dysfunction. Dynamic cholescintigraphy and endoscopic retrograde cholangiopancreatography with papillotomy in diagnosis, treatment, and follow-up study.

The study compares dynamic cholescintigraphy with traditional methods in diagnosing sphincter of Oddi dysfunction. Five patients with dysfunction of the sphincter, in accordance with traditional diagnostic criteria, are compared with 25 patients with postcholecystectomy syndrome. Dynamic cholescintigraphy showed complete separation of the two groups, T1/2 distinguishing better than Tmax. The patients with sphincter dysfunction were treated with endoscopic papillotomy (EPT) for symptomatic relief. Three had early complications. At follow-up study the courses were uneventful. Their symptoms had disappeared or markedly improved, and dynamic cholescintigraphy was normalized. In conclusion, dynamic cholescintigraphy seems to be a reliable noninvasive method for identification and control of patients with sphincter of Oddi dysfunction suitable for treatment with EPT.

Lactate dehydrogenase isoenzymes in mucosal biopsy specimens from patients with ulcerative colitis.

Biopsy specimens from long-standing ulcerative colitis were frozen shortly after resection and homogenized before measurement of lactate dehydrogenase (LD) isoenzymes by agar electrophoresis. Results were related to histological changes in inflammation or dysplasia. The percentage of total LD M monomers was significantly higher in homogenates of specimens with dysplastic changes than in homogenates of specimens with only inflammatory changes. A positive correlation was found between total LD M monomers and LD5 monomers (isoenzyme) for the whole material, for each of the histological subgroups of ulcerative colitis, and for the control specimens of adenomas, carcinomas, and normal mucosa. A positive correlation between total LD activity and total percentage of LD5 monomers was only seen for dysplastic, adenomatous, and malignant tissues. The results support the use of dysplasia as a marker for premalignant changes in mucosal specimens and indicate a possible role for LD isoenzyme measurements in specimens from patients with long-standing ulcerative colitis.

Enzymatic characteristics of tubular adenomas and carcinomas of the large intestine.

Enzymes activities in homogenates of the large intestine were measured in biopsies from 11 tubular adenomas and six carcinomas and from the corresponding normal mucosa of each individual. A similar and significant increase was found in the total activities of glucose-6-phosphate dehydrogenase (G 6 PD), pyruvate kinase, and lactate dehydrogenase in adenomas and carcinomas as compared with the levels of normal mucosa. The lactate dehydrogenase isoenzyme patterns showed also a marked and similar change in the adenomas and carcinomas with a significant increase of lactate dehydrogenase M-monomers. Most of the adenomas showed slight to moderate dysplasia. The results indicate that the measurement of total G 6 PD, pyruvate kinase and lactate dehydrogenase activities for screening purposes has no predictive value in separating non-premalignant from premalignant adenomas. Moreover, it seems that the enzymatic characteristics of malignancy are present even in tubular adenomas. This is in agreement with the theory of a polyp-cancer sequence.

Mixed bullous disease with labile erythrocyte sedimentation rate.

A woman, aged 66, fulfilled all the usual criteria of dermatitis herpetiformis. Subsequently, she developed circulating IgA and IgM basement membrane zone antibodies, a labile erythrocyte sedimentation rate (ESR), and the clinical picture changed to one of bullous pemphigoid. Her labile ESR was obviously caused by a factor related to the erythrocytes. Direct Coombs test was positive.