The effect of gastric secretory inhibitors, vasoactive agents and gastrointestinal peptide hormones were investigated on gastric mucosal blood flow (MBF) and HCl secretion in 197 subjects. Changes in MBF were estimated by a new clearance substance, 99mTc-4-methyl-aminophenazone originally described by the authors. The procedure seemed to be suitable for characterizing changes in MBF without any toxic side effect or considerable radioactive loading of the patient or its surroundings. The studies were performed after a secretory steady state had been achieved by continuous pentagastrin infusion. Some experiments were done in the fasting stomach instilled with 0.160 N HCl. Secretory inhibition following atropine, pirenzepine, ranitidine and somatostatin was a primary effect of these substances, the observed MBF decrease being a secondary one. In contrast, vasopressin caused a fall in mucosal blood supply through vasoconstriction, the concomitant secretory inhibition being a secondary phenomenon. Certain doses of dopamine and terbutaline increased MBF without influencing HCl secretion. Glucagon in the dose used did not influence either mucosal blood flow or acid secretion. Synthetic secretin in the fasting stomach increased MBF without affecting HCl production; during pentagastrin stimulation it inhibited acid production while MBF remained unchanged. Cholecystokinin-octapeptide proved to be a direct vasodilating agent with a slight acid output increasing effect. Divergent effects of some drugs on mucosal blood flow and HCl production may be important in the pathology of hypoxic ulcerative damage and in the reparative processes of gastric ulceration. The 99mTc-4-methyl-aminophenazone clearance technique proved to be a reliable method for screening of drugs possessing vasoactive or secretion influencing properties.
The pathophysiology, diagnosis and therapy of biliary motility disorders are surveyed on the basis of the literature and own experience. Bile duct dyskinesia is clinically characterised by pain of biliary and sometimes pancreatic type evoked by meal or psychogenic influence. A prerequisite of the diagnosis is the exclusion of any organic origin of the complaints. In the routine clinical practice Oddi's sphincter dyskinesia can be diagnosed by the simultaneous assessment of the response to a provocation test and the therapeutic effect of a sphincter-relaxant, e.g. nitroglycerine. For differentiating between papillary stenosis and dismotility the endoscopic manometry and radiopharmacological methods are of greatest value. The cystic duct dyskinesia can be recognized with the help of cholecystokinetic provocation test and on the basis of therapeutic response to nitrite derivates. The therapy of the biliary dyskinesia includes influence on the evoking dietetic and psychic factors and administration of long-acting sphincter relaxants as well. In failure of the conservative therapy the complaints caused by Oddi's sphincter dyskinesia and cystic duct dyskinesia can be abolished by endoscopic or surgical sphincterotomy and cholecystectomy, respectively.
To investigate the effectiveness of rectally administered indomethacin in the prophylaxis of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis and hyperamylasaemia in a multicentre study.
Introduction: Autoimmune pancreatitis (AIP) is a rare and uncommon form of pancreatitis, characterized by chronic inflammation. It's pathomechanism is still not clear. Elevated serum IgG4 immunoglobulin concentrations, some autoantibodies and the presence of IgG4 positive immune cells were observed. The clinical picture of AIP is not characteristic, abdominal pain, weight loss and obstructive jaundice can be observed. AIP is sometimes associated with other autoimmune disorders, such as Sjögren's syndrome, Riedel thyroiditis, sclerosing cholangitis, and inflammatory bowel disease. The clinical relevance is that it can be mistakenly diagnosed as pancreatic cancer. Both have similar signs and symptoms, but need very different treatments, so it is very important to distinguish one from the other. On the other hand in contrast with the majority of chronic pancreatitis it can be efficiently treated, even complete remission can be achieved on steroid therapy. Aim: Through the case of our 42- year old patient we would like to present the characteristics of this heterogeneous and fibroinflammatory disorder of the pancreas.
Recently the oesophageal metallic stenting has become a new palliative treatment of inoperable malignant stenoses and broncho-oesophageal fistulas. Our initial experiences in this field are demonstrating.
The effect of PG-E2, 16-16-DMPGE2, PG-F2 alpha and PG-I2 was investigated on histamine stimulated and resting canine gastric mucosa. PG-F2 alpha had no effect on mucosal circulation or acid secretion. PG-E2 and 16-16-DMPGE2 showed an increasing effect on blood flow of the resting mucosa. PG-E2, 16-16-DMPGE2 and PG-I2 decreased of acid secretion; the effect seemed to be due to a direct action on the parietal cells.
Pentagastrin-stimulated mucosal blood flow and acid secretion were studied in duodenal ulcer patients by means of the 99mTc-4-methylaminophenazone clearance method in the active and inactive phases of the disease, and before and after proximal selective vagotomy. The results suggest that the mucosal blood flow--acid secretion ratio in the patients differs from that found in normosecretory subjects. In duodenal ulcer patients in the inactive phase, the secretory capacity of the gastric mucosa was found to be significantly elevated as compared with the mucosal blood flow. In the active phase of the disease the mucosal blood flow increased in parallel with acid secretion. Following proximal selective vagotomy the normal blood flow-secretion ratio was restored. Comparison of the pre- and postoperative gastric mucosal blood flow and secretion values via the 99mTc-methylaminophenazone clearance technique proved useful for the evaluation of the effectiveness of vagotomy.
The diagnostic possibility of hypertonic Oddi's sphincter dysfunction was evaluated in 100 cholecystectomized and 28 noncholecystectomized patients. An organic lesion interfering with free bile flow was ruled out in every case. The existence of the syndrome, i.e., the dysfunction of the Oddi's musculature, was verified using the morphine-choleretic test combined with either dynamic hepatobiliary scintigraphy or (in selected cases) percutaneous transhepatic cholangiography. Hypertonic Oddi's sphincter dyskinesia can be regarded as an independent clinical syndrome.
Between 1983 and 1992, 44 patients with early gastric cancer underwent operative treatment. This group comprised 13.3 percent of all patients with gastric cancer operated on during this period. Every patient underwent oesophago-gastro-duodenoscopy before operation. The indication for surgery was histologically confirmed carcinoma in 37 patients, gastric haemorrhage in 2 patients and gastric ulcer unresponsive to medical treatment in 5 patients. The gastric carcinoma was limited to the mucosa in 28 cases and involved the submucosa in 16. Five patients, one with mucosal and four with submucosal early gastric cancer had regional metastatic lymph node involvement. Life-table calculated patient survival rate at 5 years, excluding the perioperative mortality, was 79.4 percent.1. The prevalence of early gastric cancer proved to be similar to previously published in West-Europe and United States. 2. If early gastric cancer is limited only to the mucosa, regional metastatic lymph node is relatively rare. 3. Gastrointestinal bleeding can be the first clinical sign of early gastric cancer. 4. Therapy resistant gastric ulcer requires surgery irrespective of the histological examination of the biopsy specimen.
