Evaluation of perioperative cholangiography in one thousand laparoscopic cholecystectomies.

We analyzed a teaching institution's experience with intra-operative cholangiography (IOCG) and endoscopic retrograde cholangiopancreatography (ERCP) and established an algorithm for their timing and use. The records of all patients undergoing LC during a five year period were reviewed. Patients with a history of jaundice or pancreatitis, abnormal bilirubin, alkaline phosphatase, serum glutamic-oxaloacetic transaminase, or radiographic evidence suggestive of choledocholithiasis were considered "at risk" for common bile duct stones (CBDS). The remaining patients were considered to be at low "risk." LC was attempted on 1002 patients during the study period and successfully completed on 941 (94% of the time). The major complication rate was 3.1% and the common bile duct injury rate 0.1%. Eighty eight (9.5%) patients underwent ERCP, 67 in the preoperative period and 19 in the postoperative period. IOCG was attempted in 272 (24%) patients and completed in 234 for a success rate of 86%. Intraoperative cholangiography (IOCG) and preoperative endoscopic retrograde cholangiopancreatography (ERCP) were equivalent in the detection of CBDSs Twelve of the 21 patients (57%) with IOCG positive for stones underwent successful laparoscopic clearance of the common duct, and did not require postop. ERCP. No patients were converted to an open procedure for common bile duct exploration. Because postoperative ERCP was 100% successful in clearing the common duct, reoperation for retained common bile duct stones was not necessary. IOCG is an alternative procedure to ERCP for patients at risk with biochemical, radiological, or clinical evidence of choledocholithiasis. The incidence of CBDS in low-risk patients is 1.7%, a risk that does not warrant routine cholangiography. Preoperative ERCP is recommended in cases of cholangitis unresponsive to antibiotics, suspicion of carcinoma, and biliary pancreatitis unresponsive to supportive care. Although IOCG leads to a similar percentage of nontherapeutic studies as preoperative ERCP, it often allows for one procedure therapy.

Effects of interleukin-11 and epidermal growth factor on residual small intestine after experimental massive small bowel resection.

Interleukin 11 (IL-11) is a multifunctional cytokine derived from bone marrow, which has a trophic effect on small bowel epithelium. This study compares the effects of IL-11 with epidermal growth factor (EGF), a growth factor known to enhance small bowel adaptation. Forty Sprague-Dawley rats (90-100g) underwent an 85% mid-small bowel resection with primary anastomosis on day 0. Rats were divided into four treatment groups: controls (group I) received bovine serum albumin (BSA), group II received IL-11, 125 microg/kg subcutaneously (SC) twice daily, group III received EGF, 0,10 microg/g SC bid, and group IV received EGF and IL-11 in the above doses. Half of the animals (five per group) were killed on day 4 of therapy, and the rest on day 8. Animals were evaluated for weight, mucosal length, and bowel wall muscle thickness on days 4 and 8, and expression of proliferating cell nuclear antigen (PCNA) in intestinal crypt and smooth muscle cells on day 8. Body weight was similar at day 4 and 8. Mucosal thickness in groups 11 (IL-11) and IV (IL-11 and EGF) was significantly increased at day 4 and 8 compared with controls (group I) and EGF (group III, P<.001). Muscle thickness was significantly increased in the EGF and combined group IV compared with the BSA controls and IL-11 groups (P < .001). Thirty-two percent of the mucosal crypt cells in group I stained positive for PCNA, whereas 51%, 53%, and 60% stained positive in groups II (IL-11), III (EGF), and IV (IL-11 and EGF), respectively. In groups I and II, 2% and 1.7% of the myocytes stained positive for PCNA, whereas 11.2% and 5.2% in group III and IV. These data suggest that IL-11 has a trophic effect on small intestinal enterocytes, causing cell proliferation and increased mucosal thickness. EGF has a more generalized effect causing proliferation of both enterocytes and myocytes. IL-11, with or without EGF may be a useful adjunct in treatment of short bowel syndrome.

Gastrointestinal stromal tumors (GIST).

BACKGROUND/AIMS: Gastrointestinal stromal tumors (GIST) are the most frequent non-epithelial tumors of the alimentary tract. The interstitial cells of Cajal or more primitive progenitor mesenchymal cells are suggested as their cells of origin. GIST's occur throughout the gastrointestinal tract but are generally located in the stomach and the intestine. About 70% of GIST's are immunohistochemically positive for CD34 and more than 90% for c-kit protein (CD117). About two thirds of GIST's are malignant. The tumor size, mitotic rate, cellularity and nuclear pleomorphism are the most important parameters characterizing the biological behavior of tumors. The diagnostic procedures are similar to those of other gastrointestinal neoplasms but only a half of the patients will have correct preoperative histological diagnosis. GIST's can be cured only by surgery. The procedure of choice, if possible, is resection without extended lymphadenectomy. Radiation and chemotherapy are generally ineffective. METHODOLOGY: 22 patients were operated on for GISTs in our department between 1996 and 2003. RESULTS: All but one proved to be benign. The patients were all asymptomatic after the operation except the malignant case. In his case an irresectable local recurrence developed later. CONCLUSIONS: GIST is a rare neoplasm of the GI tract. The only possibility for treatment of GISTs is surgical removal.

Urinary excretion of retinol-binding protein in type 1 (insulin-dependent) diabetic patients with microalbuminuria and clinical diabetic nephropathy.

The urinary excretion of retinol-binding protein (RBP) was studied in 101 insulin-dependent diabetic patients allocated to three groups according to 24-h urinary albumin excretion rate (UAE) (median of three urine collections): group 1 (n = 45), normal UAE less than 30 mg/24 h; group 2 (n = 27), microalbuminuria (UAE 30-300 mg/24 h); and group 3 (n = 29), clinical diabetic nephropathy (UAE greater than 300 mg/24 h). We used 23 healthy subjects as controls. Fractional clearance of RBP (FC-RBP) and its 24-h urinary excretion rate (URBP) were higher in each diabetic group than in healthy subjects, the highest values being found in group 3. Groups 1 and 2 did not differ in URBP and FC-RBP. There was a correlation between FC-RBP and haemoglobin A1c in both the total diabetic cohort (P less than 0.001) and in diabetic patients in groups 1 and 2 with a glomerular filtration rate of more than 90 ml/min (P less than 0.05). No correlation was found between FC-RBP and UAE and/or duration of diabetes in any of the diabetic groups. We conclude that the increased urinary excretion of RBP, indicating proximal tubular dysfunction, is already present in normoalbuminuric insulin-dependent diabetic patients and correlates with metabolic control. Further deterioration in proximal tubular function was not observed in microalbuminuric patients, but is a late event in clinical diabetic nephropathy.

Prevalence of echinococcosis in pigs and sheep in the Slovak Republic.

The prevalence of echinococcosis in slaughtered animals has been monitored in the Slovak Republic between 1971 and 1990. In pigs, the prevalence dropped almost constantly from 3.85% to 0.13%, by as much as 15% per year. The dynamics of prevalence in sheep differs substantially from that in pigs. Significant 12 year, 6 year and 3 year periodicities predominate over a nonsignificant and slight decrease of prevalence by only 1% per year. Therefore, the prevalence fluctuates in the period of observations between 0.49 and 3.72%. No significant correlations or cross-correlations have been found between the prevalences in the two groups of animals.

Circadian rhythmicity of plasma somatostatin, gastrin and cortisol in colon cancer patients.

BACKGROUND/AIMS: The aim of the study was to compare somatostatin, gastrin and cortisol levels over a 24 hour period in patients suffering from large bowel cancer and to compare this group with healthy subjects and patients suffering from other large bowel diseases (ulcerative colitis, large bowel polyps). MATERIALS AND METHODS: There were 11 cancer patients (8 men and 3 women). The plasma levels of somatostatin, gastrin and cortisol were determined by radioimmunoassay. Fisher's periodogram and Halberg's cosinor analysis were used for statistical evaluation. RESULTS: We confirmed 24-hour rhythm of somatostatin, gastrin and cortisol secretion in patients with colon cancer. The most important findings were a higher mesor (p < 0.01) of gastrin compared to all other groups and a lower 24-hour amplitude (p < 0.05) and a shorter 12-hour acrophase (p < 0.05) of cortisol compared to all other groups were found. CONCLUSION: Chrono-abnormalities in gastrin and cortisol secretion may reflect the role of gastrin in the etiopathogenesis of colon cancer and a reduced responsiveness to stimulus in patients with malignant diseases. Somatostatin blood levels probably do not reflect its antitrophic effect at cellular and subcellular level.

Calcium chemoprevention in colorectal cancer.

BACKGROUND/AIMS: There are genetic, endoengenous, and exogenous factors responsible for colorectal cancer. Calcium may play a chemopreventive role in high risk groups. Binding fatty and biliary acids and their reduced absorbtion, with a consequent decrease of proliferative stimulation and reduction of secondary carcinogenic compounds, may explain this role. MATERIAL AND METHODS: 175 patients with adenomatous polyps after polypectomy and with calcium chemoprevention were evaluated for polyps recurrence. Another three groups of patients with colorectal cancer without chemoprevention (A,B) and with chemoprevention (group C) were followed concerning survival after surgery. RESULTS: The cumulative survival rate of patients after surgery due to colorectal carcinoma is significantly higher in a calcium chemopreventive group. Adenomatous polyps recurrences after polypectomy are lower (12.9%) in the chemoprevention group than in the group without prevention (55%) with a mean time of follow-up 3.1 yrs. CONCLUSIONS: Calcium is an important chemopreventive agent in adenomatous polyps after polypectomy and after colorectal surgery for colorectal cancer.

Plasma cholecystokinin and somatostatin levels in chronic pancreatitis patients.

BACKGROUND/AIMS: The existence of a negative-feedback mechanism between pancreatic enzyme secretion and intraduodenal proteases and the role of cholecystokinin in its mediation in humans is debatable. The presence of such a feedback mechanism in chronic pancreatitis patients with exocrine enzyme deficiency possibly leads to an increase in cholecystokinin plasma levels. Somatostatin has been used in many studies in the therapy of pain in chronic pancreatitis and plays a role in the regulation of cholecystokinin levels, however data on its plasma levels are still lacking. METHODOLOGY: Basal and the postprandial cholecystokinin and somatostatin levels in 30 patients with chronic pancreatitis (11 with severe chronic pancreatitis and 19 with mild chronic pancreatitis) were measured 14 days after discontinuation of enzymatic substitution therapy and then were compared with the levels taken from 25 healthy subjects. RESULTS: The cholecystokinin postprandial plasma levels were significantly higher in patients with chronic pancreatitis when compared with those of healthy individuals (P < 0.01). Basal, somatostatin, cholecystokinin and postprandial somatostatin levels were not significantly higher than those in healthy subjects. There was no correlation between basal and postprandial levels of cholecystokinin and somatostatin in our study. CONCLUSIONS: The cholecystokinin postprandial plasma levels were significantly higher in all patients with chronic pancreatitis when compared with healthy individuals, which suggests the role of cholecystokinin in the feedback control of pancreatic secretion.

Circadian rhythmicity and cross correlation of plasma gastrin, cortisol and somatostatin levels in ulcerative colitis patients and healthy subjects.

Gastrin, somatostatin and cortisol circadian (24 hours) rhythmicity was confirmed in healthy subjects. Gastrin and cortisol circadian rhythmicity was studied and also established in patients with ulcerative colitis (UC). UC patients were found to have a lower 24-hour amplitude of plasma cortisol and a shorter acrophase of plasma gastrin. Gastrin correlated positively with somatostatin and negatively with cortisol.

Plasma somatostatin levels in ulcerative colitis.

The circadian (24 hour) rhythmicity of somatostatin in healthy subjects and patients with ulcerative colitis (UC) was studied and established. UC patients were found to have a higher 24-hour amplitude, a higher average level and a longer peak level phase of plasma somatostatin. This finding may indicate a defensive role of somatostatin in inflammatory bowel disease.

Somatostatin and large bowel polyps.

BACKGROUND/AIMS: Somatostatin, a polypeptide hormone, inhibits cellular proliferation of the mucosa. As this cellular proliferation has been observed in large bowel polyps and cancer, the exact pattern of secretion may be of importance to the understanding of such diseases. MATERIALS AND METHODS: The circadian (24 hours rhythmicity) of plasma somatostatin was studied and established in patients suffering from large bowel polyps. Blood was drawn from the study subjects at regular intervals and the plasma somatostatin levels were determined by radioimmunoassay. RESULTS: In both groups, a circadian rhythm of somatostatin was confirmed. In patients with P higher mesor (p < 0.05), higher 24 hour amplitude (p < 0.05) and longer acrophase (p < 0.05) were found. CONCLUSION: These findings may indicate the defense antiproliferative role of somatostatin in malignant and premalignant states. Somatostatin may prove beneficial as one of the treatment possibilities for large bowel polyps.

Vitamin 1,25-(OH)2 D3 concentrations in patients hospitalized long-term.

Vitamin D deficiency may be one reason for the onset and development of osteoporosis. The aim of the present study was to determine the occurrence rates of hypovitaminosis D in an unselected group of individuals presenting with common medical conditions and hospitalized for long periods. Concentrations of 1,25-(OH)2 D3 were measured in 89 patients (38 males and 51 females). Mean age was 70 years. Thirty-eight patients were tested in the spring and the remaining 51 patients in the autumn. Vitamin D3 levels were significantly reduced in patients tested in the autumn (p < 0.001). The reason for this surprising observation may have been the small number of sunny days and the long hospital stays during the study period, differences in the composition of both groups and the fact that 1,25-(OH)2 D3 reflects the actual vitamin D3 levels rather than those of its reserve in the human body. The results obtained suggesting hypovitaminosis D in an unselected group of elderly patients hospitalized with common diseases, even after the summer season, suggest the need for general supplementation of this vitamin throughout the year, regardless of the risk factors.

Plasma gastrin levels in alcoholic and idiopathic chronic pancreatitis patients free from Helicobacter pylori infection.

BACKGROUND: Previous studies on gastrin levels in chronic pancreatitis (CP) patients have given conflicting results. These studies did not take into consideration the influence of Helicobacter pylori (H. pylori) infection on gastrin release. Also, there is no previous study that compared alcoholic CP patients to patients with idiopathic pancreatitis. Our aim was to measure basal and postprandial plasma gastrin levels in all CP patients, including subgroups of alcoholic, idiopathic, severe and mild CP patients, and compare them with healthy subjects after the eradication of H. pylori infection. PATIENTS AND METHODS: Basal and postprandial gastrin levels were measured in 30 patients with CP (10 patients with alcoholic and 20 patients with idiopathic CP) and in 25 healthy subjects. RESULTS: A significant increase in basal gastrin levels was found only in a subgroup of alcoholic CP (P<0.05) in comparison to healthy subjects. A significant increase in postprandial plasma gastrin levels (P<0.01) was found in all chronic pancreatitis compared to healthy subjects. CONCLUSION: In the absence of H. pylori infection, plasma gastrin levels were significantly higher in chronic pancreatitis patients than in healthy subjects. Chronic alcoholism, however, does not appear to be the only factor responsible for the increased plasma gastrin levels in these patients.

Changes in levels of thyroid hormones and TSH in acute myocardial infarction.

The changes in levels of total serum thyroxine (T4), total serum triiodothyronine (T3), effective thyroxine ratio (ETR), and serum TSH were investigated in 88 patients with acute myocardial infarction (AMI). The T4 and T3 values decreased significantly on the third day of hospitalization to return to starting values on the 7th day. ETR values were significantly reduced on the 3rd day and remained so also on the 7th day. Compared to starting values, serum TSH levels were increased on the 7th day of hospitalization, yet not significantly. In the group of 16 patients who died within 96 hours, ETR values were significantly increased on the 1st day of hospitalization (immediately after admission) in comparison with the group of AMI surviving patients. The highest frequency rate of abnormally low T3 values was found in patients who died within 96 hours. With respect to thyroid function evaluation, ETR proved to be the most satisfactory parameter with the lowest percentage of abnormal values.

Carcinoid tumors--somatostatine in the diagnosis and therapy.

BACKGROUND: Carcinoid tumors have a neuroendocrine origin and endocrine activity is typical for them. OBJECTIVES: The main objective of the present study was to determine differences in the levels of an endogenous somatostatin, a neuron specific enolase in serum and excretion of 5-HIAA in the urine in patients with carcinoid tumors and also to determine the changes of these parameters during the treatment with long acting somatostatin analogue--lanreotide. SUBJECTS AND METHODS: 30 pts with carcinoid tumors (20 pts with metastatic disease, 10 pts after resection of the primary tumor without known metastases at the time of the investigation) and 12 healthy probands were included in the study. Circadian rhythm of endogenous somatostatin in all groups was performed. Levels of neuron specific enolase in the serum and the excretion of 5-HIAA in the urine in pts with carcinoid tumors were done. The estimation of these parameters were repeated in the group of pts with advanced metastatic disease during the treatment with the lanreotide. RESULTS: We confirmed the existence of the circadian rhythm of endogenous somatostatin in all groups. Chronogram of somatostatin in pts without known metastases shows the same characteristics as the chronogram of healthy volunteers. The chronogram of pts with metastatic carcinoid disease shows a statistically significant differences in comparison with healthy volunteers--higher mesor and later acrophase of 24-hour rhythm (p < 0.05). During the therapy with lanreotide lower mesor was observed (p < 0.05). The amount of the 5-hydroxyindolacetate acid in urine in pts with metastatic carcinoid was statistically significant higher than in the pts without metastases (p < 0.001). During therapy with the lanreotide the decrease in the 5-HIAA in the urine (p < 0.05) was observed. Neuron specific enolase in the serum was higher in group with the metastatic disease (p < 0.001). CONCLUSION: Abnormalities in the somatostatin secretion and the concentration of the neuron specific enolase in serum are useful markers for the differential diagnosis and might distinguish the carcinoid patients with and without metastases. Urine excretion of 5-HIAA is a good marker of endocrine activity of the carcinoid tumor. (Fig. 4, Tab. 3, Ref. 22.)

[The circadian cycle of endothelin-1 in healthy persons]. / Cirkadiánny cyklus endotelínu-1 u zdravých osôb.

The possible circadian rhythmicity of endothelin-1 was investigated. Radioimmunoassay method was used in 5 clinically healthy male subjects aged 24-32 years. Blood samples were collected at 4-hour intervals over a period of 24 hours. Data for ET-1 were fitted to a 24-hour cosine curve. Statistically significant curves were found in two subjects (maximum at 4 p.m. and minimum at 10 p.m.), one did not yield a statistically significant curve and in two subjects despite the fact that the curves were not presented. Nevertheless, the circadian rhythmicity in our study was not confirmed according to our results it could not be excluded. (Fig. 2, Tab. 2, Ref. 23.)

[Bioenergetics of liver mitochondria after administration of ramipril in experimental diabetes mellitus]. / Bioenergetika pecenových mitochondrií pri experimentálnom diabetes mellitus po podávaní ramiprilu.

BACKGROUND: Diabetes mellitus represents an intense metabolic strain for the liver. Inhibitors of angiotensin-converting enzymes (ACEI) are drugs of choice in the therapy of hypertension in coincidence with diabetes mellitus. The effect of ACEI is complex. The attention is drawn to the study of metabolic effects of ACEI. OBJECTIVES: The aim of the study was to investigate whether the administration of ramipril affects the levels of glycated hemoglobin and fructoseamine in the blood of rats with insulin-dependent diabetes mellitus (IDDM), and whether bioenergetics of mitochondria in the liver undergo changes. METHODS: In our experiments, we used rats of the Wistar strain. The control group was composed of healthy animals. The experimental groups were formed by rats with IDDM evoked by streptozotocine (45 mg/kg) and rats with IDDM + ramipril (10 mg/KG). Both, insulin MONO-ID in the doses of 6 U/kg administered subcutaneously, and water solution of ramipril administered by gastric probe were applied for the period of 8 weeks. We have assessed blood levels of glucose, glycated hemoglobin, fructoseamine and the concentration of cholesterol and triacylglycerols have been assessed also in the liver. Oxidative phosphorylation in mitochondria of the liver were measured polarographically. RESULTS: In the group with IDDM + ramipril, the glycated haemoglobin (M 6.85 CI 5.7-7.0%) and fructoseamine (M 1.45 CI 1.2-1.6 mmol/l) have significantly dropped in comparison with the group with IDDM glycated haemoglobin (M 8.8 7.7-10.7%) and fructoseamine (M 2.04 CI 1.69-2.4 mmol/l). Ramipril did not affect the concentration of cholesterol and triacylglycerols in the blood and liver in rats with IDDM. Ramipril has positively affected oxidative phosphorylation in mitochondria of the liver in coincidence with IDDM. The group with IDDM + ramipril has yielded an increase in the velocity of oxygen consumption in coincidence with stimulated breathing with ADP, the state 3 (M 107.97 CI 96.78-134.51 n AtO/mg of proteins/min.) and phosphorylation velocity (M 232.67 CI 209.38-284.97 nmolATP/protein/min) in contrast to the group with IDDM: the state 3 (M 76.71 CI 66.81-85.99 nAtO/mg of proteins/min and the velocity of phosphorylation (M 161.84 CI 143.55-189.99 nmol ATP/mg of proteins/min) in coincidence with substrate glutamate. A similar trend is present also in coincidence with FAD succinate substrate. CONCLUSIONS: After the administration of ramipril to rats with IDDM, the indicators have improved, and they express the rate of compensation of diabetes mellitus. An increased capacity of the respiratory chain and an increased origin of energy in mitochondria in the livers of rats with IDDM after administration of ramipril indicates an improvement in the metabolic capacity of the liver. (Tab. 4. Ref. 47.)

[Salmon calcitonin in the treatment of osteoporosis]. / Lososí kalcitonín v liecbe osteoporózy.

Salmon calcitonin is frequently used in the treatment of osteoporosis. Via specific receptors on osteoclasts it reduces bone absorption and has also an osteogenic effect. Treatment with calcitonin leads to an increase in bone density, drop of markers of bone turnover and reduction of risk fractures. In the submitted trial the authors investigated the influence of nasal calcitonin administered in amounts of 100 IU in three-month intervals, on bone density. The group comprised 59 patients, mean age 64 years. The mean period of treatment was 2.5 years. Treatment led to a significant increase of bone density in the region of the lumbar spine and neck of the femur. Treatment was well tolerated and the authors did not record new manifest fractures or side-effects of treatment.

[Coronary score and risk indicators]. / Koronárne skóre a rizikové ukazovatele.

Using the method of multi-dimensional statistical analysis in the evaluation of relations between the coronary score and risk factors in 120 men with ischaemic heart disease type stable angine, and in 30 men in a control group the authors revealed: age is a significant negative discriminator of the presence and indicator of the severity of atherosclerotic narrowing of the coronary arteries, cholesterol is a statistically significant positive independent discriminator of the presence and indicator of the severity of atherosclerotic narrowing of the coronary arteries, HDL-cholesterol is a significant negative independent indicator of the severity of the atherosclerotic narrowing of the coronary arteries, triacylglycerols are a positive indicator of the severity of the atherosclerotic narrowing of the coronary arteries only at the borderline of statistical significance, Broca's index of relative body weight is a positive discriminator of atherosclerotic narrowing of the coronary arteries only at the borderline of significance, there is a statistically significant positive additive relationship of quantitative risk factors with the atherosclerotic narrowing of coronary arteries, physical activity is a significant positive discriminator of the presence of atherosclerotic narrowing of the coronary arteries, the oral glucose tolerance test is a positive discriminator of the presence of the atherosclerotic narrowing of the coronary arteries.

[Sibutramin in obesity treatment (multicenter, open, prospective 12-month-long study)]. / Sibutramín v liecbe obezity (multicentrická, otvorená, prospektívna 12-mesacná stúdia).

Obesity presents a significant medical and socio-economic problem due its prevalence exceeding 20% of adult population. Body weight reduction significantly decreases both morbidity from numerous complications and total mortality. Nonpharmacological measures are the first step in weight reduction, however an effective pharmacotherapy is also needed in some of the patients. In a 12-month-long study 50 obese female patients were treated with Sibutramin doses of 10 mg or 15 mg. Sibutramin is a drug with a dual effect: it reduces intake of energy by simultaneous bringing on a sense of satiety and inhibiting reduction of the energy release which usually accompanies low energy diets. Medication accompanied with a diet therapy and physical activity led to a reduction of body weight by 14.9 kg and an important weight loss by 5% have reached nearly 95% of patients. The treatment was well tolerated and no significant side effects have been indicated.