[Digestion of fat and protein and its relation to the activity of faecal enzymes in mucoviscidosis infants under substitution therapy with pancreatic enzymes (author's transl)]. / Fett- und Eiweissverdauung und ihre Beziehung zur Aktivität von Stuhlenzymen bei Mucoviscidosis-kranken Kindern unter Substitutionstherapie mit Pankreasenzymen.

The article reports on a study to determine the influence of different dosage schedules of a pancreas enzyme preparation on the digestion of fat and protein and on the lipolytic, tryptic and chymotryptic activity of the faeces in children suffering from mucoviscidose. After administration of the pancreatin preparation at the low dose level, the quantity of faeces, the excretion of fatty acids and of nitrogen are reduced and the absorption coefficient is improved. The faecal tryptic and chymotryptic activity increases, whereas the lipase activity in the faeces merely shows a tendency to rise. Increasing the pancreatin dose up to a still tolerable value by doubling the dosage does not result in further reduction of the excretion of fat and nitrogen although it enhances the proteolytic activity of the faeces while the lipase activity remains unaffected. Determination of the lipolytic, tryptic or chymotryptic activity is, therefore, unsuitable for assessing the fat and protein digestion and for estimating the required dose of pancreatic enzyme. No increase in uric acid excretion was seen in the urine collected for 24 hours after administration of both enzyme doses.

Viscosity and electrolyte concentrations in gastric juice from cystic fibrosis children compared to healthy children.

The viscosity of gastric juice and the concentrations of sodium, potassium, calcium, magnesium and chloride ions were measured before and after stimulation with pentagastrin in 10 children with cystic fibrosis and compared to those in 10 healthy children of corresponding ages. The viscosity values followed the same patterns as those for the sodium and calcium ion concentrations and were higher in the cystic fibrosis group. The electrolyte concentrations in the basal and different post-stimulation fractions of the gastric juice were higher in the cystic fibrosis group. Significant differences between both groups could only be found in the electrolyte concentrations. The total secretion of each of the electrolytes was the same in both groups because along with the increased electrolyte concentration in the cystic fibrosis group there was a reduced volume of gastric juice. The dependence of viscosity on the individual electrolyte concentration is discussed. The differences in the viscosity and the electrolyte concentrations in gastric juice from the cystic fibrosis children seems to be due to changes in the process of gastric secretion and not due to the influence of swallowed saliva.

[Enzymic determination of acetoacetate and D(--)-3-hydroxybutyrate in urine (author's transl)]. / Enzymatische Bestimmung von Acetacetat und D(--)-3-Hydroxybutyrat im Harn.

The enzymic methods for the quantitative determination of acetoacetate and D(--)-3-hydroxybutyrate in blood were modified for the routine determination of these compounds in urine for clinical purposes. Preliminary normal values are reported for children.

[Comparative examinations of gastric juice in healthy infants and in infants suffering from enteritis (author's transl)]. / Vergleichende Magensaftuntersuchungen bei gesunden und Enteritis-kranken Säuglingen.

There are significant differences between the shapes of curves of gastric juice volume, acid quantity, pH levels, and peptic activity, in the three age groups of healthy infants under examination. Significant differences are also seen in all three age groups with regard to the quantity of acid calculated in relation to 1 ml gastric juice, as well as the relative peptic activity (volume activity). The amount of gastric juice is proportional to the bodyweight and body surface of the infants, whereas acid concentration and peptic volume activity show a relatively steeper increase.

[Studies on the value of fecal tryptic and chymotryptic activity in the diagnosis and therapy of cystic fibrosis (author's transl)]. / Untersuchungen über die Anwendbarkeit tryptischer und chymotryptischer Aktivitätsmessung im Stuhl in Diagnostik und Therapie der Mucoviscidosis

Under certain conditions the determination of the tryptic activity, especially of the chymotryptic activity in the feces mostly of infants in the first 4-6 weeks of life is considered to be an important step in the diagnosis of cystic fibrosis. The tryptic anc chymotryptic activity in the feces of children with cystic fibrosis declines when the substitution of pancreatic enzymes is stopped. On resubstitution, the activity rises in relation to the dose and attains the activity related to age as found in healthy children. A comparison of the proteolytic activity with the fat content of the feces during the study period without the enzyme substitution and during the period when the enzyme dosage varied showed no significant correlation. It is not possible to postulate a poor excretion of fats merely from the high proteolytic activity of the feces because the fecal proteolytic activity and the fat excretion are not inversely proportional to one another. For this reason, one cannot conclude that the grade of the proteolytic activity in the feces of patients with cystic fibrosis is a yardstick for the total digestive process when they are under pancreatic enzyme substitution.

[Tryptic and chymotryptic activity in the faeces of children of different age groups (author's transl)]. / Tryptische und chymotryptische Aktivität im Stuhl von Kindern verschiedener Altersgruppen

Measurement of tryptic and chymotryptic activity in the faeces was not disturbed by bacterial proteolytic activity of different bacteria such as proteus, pseudomonas, coli, enterococci, bacteroides. Both activities within a group follow a logarithmic normal distribution. Lower limit of the standard deviation is 51% upper limit 129% for tryptic activity, respectively 60 and 170% for chymotryptic activity. There were no differences in chymotryptic activity between the 10 age groups comprising 157 healthy children, whereas a significant difference could be found for tryptic activity between premature and older children. Daily fluctuations of the enzyme activities are quite high in the same individual, and only reduced in "bottlefed" infants with constant nutrition. In prematures and very young infants chymotryptic activity predominates, later tryptic activity. Influence of increased and decreased bowel movements on deviation of the data was tested. There was, however, no real alteration of enzyme activity due to the bowel dysfunction beyond the standard deviation of the control groups. But passage time and nutrition have to be considered beside other factors in the wide distribution of the enzyme activities and the latter limits the value of this method.

[The acidity and peptic activity of gastric juice in healthy children and in children suffering from cystic fibrosis (author's transl)]. / Acidität und peptische Aktivität des Magensafts bei gesunden und Mucoviscidosis-kranken Kindern

The acid concentration and quantity, the pH and the peptic activity of the gastric juice were measured after stimulation with pentagastrin in 10 children with cystic fibrosis between the ages 2 and 12 years and in 20 healthy children of the same age group. Furthermore, the basal, maximal and peak volume outputs (BVO, MVO and PVO), the basal, maximal and peak acid outputs (BAO, MAO and PAO) and the basal, maximal and peak pepsin output (BPO, MPO and PPO) were determined. The statistical calculations were carried out with the help of partial hierarchical analysis of variance, comparison of regression curves, simple analysis of covariance and the t test. After stimulation with pentagastrin, the volume of the gastric juice, the acid quantity and the peptic activity were found to be dependent on age in healthy children as well as in children with cystic fibrosis. The maximal volume of secretion in children with cystic fibrosis is less than that of healthy children; however, the acid quantity and peptic activity show no significant difference in both groups. The volume of the gastric juice, acid quantity and peptic activity in basal and stimulated secretions, expressed in kilograms per body weight or surface area in square meters, are independent of age and show no significant difference between the two groups. In the two groups the curves for the three parameters differ significantly from one to another. There is a significant shift in the time course of the curves that depict the acid secretion and peptic activity. Contrary to the accepted views, the acid and enzyme secretions are not closely interrelated. Based on the acidity and peptic activity, the digestive capacity of the stomach is the same for healthy children and children with cystic fibrosis. In contrast to the pancreas, there is no impairment in the exocrine function of the stomach. The gastric secretions of children with cystic fibrosis are not completely the same as in healthy children.