[Three cases of severe chronic diarrhea with a rare cause and a simple therapy]. / Drei Fälle von schwerer chronischer Diarrhö mit seltener Ursache und einfacher Therapie.

We report three cases of severe olmesartan-associated chronic diarrhea with weight loss and malassimilation syndrome. Histologically, a sprue-like enteropathy was diagnosed in each case, while serological tests for celiac disease were negative. After stopping the medication, symptoms improved within a few days. Histologically, remission was documented after 3 months. Olmesartan-associated enteropathy is an underestimated entity and an important differential diagnosis in patients with chronic diarrhea.

Prognostic significance and relationship of worst lead residual ST segment elevation with myocardial damage assessed by cardiovascular MRI in myocardial infarction.

OBJECTIVE: To investigate the relation of residual worst lead ST segment elevation (WL-STE) after ST segment myocardial infarction (STEMI) with infarct size and microvascular injury assessed by cardiovascular magnetic resonance (CMR) imaging. BACKGROUND: WL-STE in patients with acute reperfused STEMI has been shown to identify high risk patients for major adverse cardiovascular events (MACE). However, the relation of WL-STE with myocardial damage is unknown. METHODS: In this multicentre study we analysed ECG data 90 min after primary percutaneous coronary intervention (PCI) in 763 STEMI patients. WL-STE was defined as the absolute magnitude of STE in the most affected lead on the post-PCI ECG. Patients were categorised into three groups (<1 mm, 1-2 mm, and ≥2 mm). CMR was performed within 1 week after infarction for comprehensive assessment of myocardial damage using a standardised protocol. The primary clinical endpoint was MACE defined as death, reinfarction, and new congestive heart failure within 12 months after infarction. RESULTS: WL-STE <1 mm, 1-2 mm, and ≥2 mm was present in 155 (20%), 328 (43%), and 280 (37%) patients, respectively. Myocardial damage determined by CMR demonstrated a graded relationship of infarct size (median (IQR) 13.3 (6.2-20.3)%LV vs 13.7 (7.6-21.3)%LV vs 22.5 (15.6-31.2)%LV, p<0.001), the myocardial salvage index (60.8 (37.0-84.5) vs 55.0 (36.6-73.9) vs 42.7 (26.2-58.2), p<0.001), and microvascular obstruction (0.0 (0.0-0.9)%LV vs 0.0 (0-1.0)%LV vs 1.2 (0.0-3.6)%LV, p<0.001) across the three groups. WL-STE ≥2 mm was strongly associated with MACE 12 month after infarction (HR 1.93, 95% CI 1.11 to 3.37; p=0.02). CONCLUSIONS: This largest CMR study to date correlating post-PCI WL-STE with markers of myocardial damage demonstrates that WL-STE is significantly associated with infarct size, myocardial salvage, microvascular obstruction, and MACE in a high risk STEMI population. TRIAL REGISTRATION NUMBER: NCT00712101.

Prevalence of dural ectasia in 63 gene-mutation-positive patients with features of Marfan syndrome type 1 and Loeys-Dietz syndrome and report of 22 novel FBN1 mutations.

Marfan syndrome is an autosomal dominant disorder involving different organ systems. Marfan syndrome type 1 (MFS1) is caused by mutations in the FBN1 gene. Heterozygosity for mutations in the TGFBR1 or TGFBR2 genes cause Loeys-Dietz syndrome (LDS) types 2A and 2B that overlap with MFS1 in their clinical features. The phenotype of MFS1 is defined by the Ghent nosology, which classifies the clinical manifestations in major and minor criteria. Dural ectasia is one of the major criteria for Marfan syndrome but it is rarely tested for. We here report 22 novel and 9 recurrent mutations in the FBN1 gene in 36 patients with clinical features of Marfan syndrome. Sixty patients with identified mutations in the FBN1 gene and three patients with mutations in the TGFBR1 or TGFBR2 genes were examined for dural ectasia. Forty-seven of the 60 patients (78%) with MFS1 showed the dural ectasia criterion and 13 (22%) did not. Thirty-three (55%) patients were suspected of having Marfan syndrome and 24 (73%) of them had dural ectasia. Two of the three patients with LDS had dural ectasia.

[Incidence of pathologic ammonia concentrations in the plasma in children with seizure disorders treated with Convulsofin/Convulex and other anticonvulsants in comparison with children with brain damage and healthy children]. / Untersuchungen zur Häufigkeit pathologischer Ammoniakkonzentrationen im Plasma bei Kindern mit Anfallsleiden unter der Behandlung mit Convulsofin/Convulex und anderer Antikonvulsiva im Vergleich zu Kindern mit Zerebralschäden und gesunden Kindern.

In healthy children plasma ammonia concentrations show values from 12.3 to 57.2 mumol/l (80%-range) (group I). We also measured plasma ammonia in epilepsy patients with valproate therapy (group II) and epilepsy patients treated with other anticonvulsiva (group III). In a fourth group there were children with various cerebral lesions without episodes and without anticonvulsiva therapy. There were significant differences between group I and group II and group II and group IV respectively. But no significant differences were found between the patients who were treated with valproate and the patients with cerebral lesions. The data does not allow the plasma ammonia concentration to be taken as a control parameter in children treated with valproate. Ammonia estimation at the beginning of therapy, however, may be used as risk indicator.

Effects of secretin and cholecystokinin-pancreocymin on water, electrolyte and glucose absorption in human jejunum. A comparison between different hormone preparations.

The effects of natural secretin (90%) and synthetic secretin as well as impure (10%) and pure (99%) cholecystokinin-pancreozymin (CCK) on net absorption of water, electrolytes, and glucose in human jejunum were studied in 31 normal subjects. An intestinal perfusion technique with a triple-lumen tube was used. Net absorption of water and solute was significantly inhibited by both hormones only with larger doses, pure CCK being less active than impure CCK. A dose-dependent response of water and electrolyte absorption to graded doses of pure CCK was observed, without concomitant inhibition of glucose absorption with lower doses. The findings suggest that secretin and CCK may not be of physiologic importance regarding intestinal absorption in man. The definite changes in intestinal motility and transit rate caused by these hormones seem more likely to result in a reduction of intestinal absorption and an increase in the secretion of water and electrolytes along the proximal small bowel.

Synthetic human gastrin I and gastrin-like pentapeptide in studies of intestinal absorption in man. Role of gastrin in human intestinal absorption.

The effects of synthetic human gastric I (SHG I) and gastrin-like pentapeptide (PG) on jejunal water, electrolyte, and glucose absorption were studied in 11 normal subjects. The i.v. administration of graded doses of SHG I increased plasma gastrin levels similar to those after food intake and in the Zollinger-Ellison syndrome. SHG I and PG caused no significant changes in the net movement of water and solute. The findings indicate that gastrin has no direct effect on intestinal absorption in normal man, and does not account for the mechanism of diarrhea in the Zollinger-Ellison syndrome.

[Amylase in serum, amylase excretion and the amylase-creatinine-ratio. Individual variation and diagnostic specifity (author's transl)]. / Diagnostische Wertigkeit der individuellen Langzeitvariation der Amylaseaktivität im Serum und Urin.

The amylase activity in serum, the amylase excretion and the amylase-creatinine-ratio was investigated in 25 volunteers monthly for one year and daily for two weeks. The intraindividual variation of the amylase-activity in serum showed only small oscillations. The large refernce value of the group and the need to use individual reference values prefer the 24 hour amylase excretion as a diagnostic tool. The amylase-creatinine-ratio showed individual and seasonal large variations. Therefore the ratio is not suitable for diagnostic questions.

Elimination of low molecular weight polyethylene glycol 400 in the urine following an oral load, as a measure of intestinal permeability.

After an oral load of 10 g polyethylene glycol, its concentration in the urine was measured by gas chromatography. The coefficient of variation of the imprecision between run was about 11%. The urinary excretion was 25% of the administered dose with a coefficient of variation of the interindividual variation 26% and the intraindividual variation between 13% and 29%.

[Circadian variation of intestinal sucrose and water absorption in rats (author's transl)]. / Tageszeitabhängige Schwankungen der Saccharose- und Wasserabsorption im Dünndarm der Ratte.

A rat jejunal segment of 15 cm length was perfused single pass with a 3 mmol/l sucrose solution 4 times daily at 8.00, 14.00, 20.00 and 2.00. One group of rats was fed ad libitum, a second group was "meal fed" between 14.00 and 18.00. Sucrose absorption reached its maximum at 8.00 in the rats fed ad libitum whereas it was spread over a period of six hours (20.00-2.00) in the meal fed rats. The activity of sucrase in mucosal scrapings reached its peak at feeding time.

[Urea and creatinine levels and clearances: observations in 25 healthy subjects for one year (author's transl)]. / Harnstoff, Kreatinin, Harnstoff- und Kreatinin-Clearance: Untersuchungen an 25 gesunden Probanden über ein Jahr.

The seasonal, intra- und interindividual variation of the creatinine and urea concentrations in serum and urine and the clearances of these compounds were examined monthly for one year in 25 healthy volunteers. In contrast to the other parameters (serum urea, clearance and excretion of creatinine and urea), the variations in serum-creatinine concentration were small and statistically unsignificant. The variations of the urinary excretion and the clearance of creatinine and urea is due to seasonal variations in the output of the kidney.

[Concept of reliable laboratory test procedures (author's transl)]. / Gesichtspunkte für die Erstellung eines verlässlichen klinisch-chemischen Befundes.

Considering the multitude of tests in clinical chemistry and hematology, their low diagnositc sensitivity and specifity, and the low incidence of the diseases in a non selected population it is not possible presently to recommend a general screening procedure based on the definition of the reference, the methodological reproducibility and the diagnostic information of a test procedure it is possible to calculate the number of requests necessary to get any desired number of pathological results. "Tell me how many pathological results you want and I'll tell you how many requests you need". In order to get an optimal diagnostic information for clinical chemistry and hematological tests, it is necessary to increase the prevalence by proper selection of the patients and then to order test procedures specific for the suspected disease.

[Absorption in the human small intestine relative to the intraluminal milieu]. / Das Absorptionsverhalten des menschlichen Dünndarms in Abhängigkeit von dem intraluminalen Milieu.

The bulk of water and electrolyte absorption takes place in the human jejunum from isotonic solutions, and is determined largely by special transport mechanisms for different monosaccharides, amino acids and dipeptides. This is of considerable significance for regaining the large volumes of fluid delivered to the small intestine during the digestion of food. Small changes in intraluminal pH do not significantly influence the absorptive function of the jejunum and are rapidly compensated by the buffering capacity of the gut. The maintenance of an isotonic as well as neutral intraluminal milieu seems to be essential to the physiological processes of intestinal absorption.

[Diagnostic value of the lipoprotein-X determination (author's transl)]. / Zur diagnostischen Aussagekraft der Lipoprotein-X-Bestimmung.

LP-X was investigated in the serum of 221 patients with and without cholestasis. The diagnostic sensitivity and the diagnostic specificity of the test were 0.9 and 0.88, respectively. When this test is used on a non-selected collective, however, the predictive value of the positive test is very low, whereas negative results have a high diagnostic value. Thus, in practice, LP-X is more suitable for the exclusion, rather than the detection of cholestasis.

Reproducibility of the intravenous galactose tolerance test.

The reproducibility of the intravenous galactose tolerance test was investigated in eight healthy volunteers by performing the test five times under identical conditions in each individual. The results show that the interindividual scattering is much greater than the intraindividual variation. Therefore, and in connexion with the results of a previous investigation, the conclusion can be drawn that the intravenous galactose tolerance test is more suitable for the longitudinal course of patients than for the detection of an impaired liver function. A simplification of the test is possible by measuring the fasting galactose concentration and the blood galactose concentration 40 minutes after the galactose load.