摘要:

A case of malignant somatostatinoma is reported in a patient with long-standing dermatitis herpetiformis and coeliac disease. The patient had non-specific abdominal pain of several years duration and came to attention because of weight loss despite strict adherence to a gluten-free diet. Plasma somatostatin levels were raised, and laparotomy showed a pancreatic tumour with metastases, which on histology, electron microscopy and immunohistochemistry proved to be a somatostatinoma. After a promising initial response to streptozotocin, she died 30 months later. This is the first reported occurrence of a somatostatinoma in a patient with coeliac disease, adding to the growing list of neoplastic complications in this condition.

ISSN:0012-2823    

DOI:10.1159/000199601

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

A prospective study was undertaken to establish the role of individualized diet counselling in the management of 137 outpatients with Crohn’s disease. Individualized dietary counselling for 6 months was associated with a significant decrease in the Crohn’s disease activity index, an increased incidence of disease remission, a decreased need for prednisone and Salazopyrin® therapy, a reduction in the number of days spent in hospital, and a reduction in the amount of time lost from work due to Crohn’s disease, when compared with control patients who did not receive dietary counselling but who were seen regularly in follow-up under similar circumstances. Improvement with diet counselling was more likely to occur in patients who had not previously been subjected to small bowel resection, and occurred in patients with active or inactive disease. The effect of counselling 58 patients was assessed over a further 6 months (for a total 12-month period); there was a persistently reduced Crohn’s disease activity index and a continued decreased number of lost days of work. The mechanism for these beneficial effects of diet counselling was not established. It is suggested that individualized diet counselling, aimed at optimizing the patient’s nutritional status, may play a role in the management of patients with Crohn

ISSN:0012-2823    

DOI:10.1159/000199602

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

Hereditary α1-antitrypsin (α1-AT) deficiency has been suggested to be associated with peptic ulcer disease. Since the serum concentration of the enzyme is the result of both hereditary and nonhereditary factors, we have studied not only the serum levels but also the α1-AT electrophoretic variants in 177 Dutch patients with duodenal ulcer disease and compared with 357 healthy blood donors. No relation was found between any of the α1-antitrypsin phenotypes and duodenal ulcer disease. Serum levels of α1-AT were significantly higher than in the controls in the patients. This study does not support an association between hereditary α1-AT deficiency and duodenal ulcer disease, and makes therefore a possible role of such a deficiency in the etiology of peptic ulcer disease highly unl

ISSN:0012-2823    

DOI:10.1159/000199603

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

Natural killer cell (NK) activity and antibody-dependent cellular cytotoxicity (ADCC) exerted by peripheral blood mononuclear cells (PMNC) were investigated in 53 patients with Crohn’s disease (CD). NK activity and ADCC were found to be significantly reduced in patients with CD (p < 0.0005) as compared to healthy controls. Both effector cell functions increased after in vitro treatment of PMNC with n-interferon, but did not reach the levels found in controls (p < 0.0005). Neither NK activity nor ADCC was significantly influenced by therapy with corticosteroids. Moreover, the reduced serum zinc levels in patients with CD, which have been shown to be associated with impaired immune function, did not influence the lytic effector cell mechanism assayed either. Finally, no association could be found between NK cell activity or ADCC and CD activity index, the extent of the disease and several laboratory parameters of inflammation. We conclude that patients with CD have a reduced lytic effector cell function which remains uninfluenced by corticosteroid treatment and seems to be present independently of disease activit

ISSN:0012-2823    

DOI:10.1159/000199604

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

Antibodies to gliadin (AGA), detected in jejunal juice by immunofluorescence and enzyme-linked immunosorbent assay, have been found in 13 of 15 (87%) children with untreated coeliac disease. Jejunal AGA were also positive in 6 of the 9 (67%) coeliac children on gluten challenge, while they were consistently negative in coeliac children on a gluten-free diet and in controls. Jejunal AGA were always of immunoglobulin A (IgA) class, associated with IgM in some cases. Moreover, the presence of IgA AGA in jejunal juice was strictly related to the severity of intestinal damage. These data suggest that IgA AGA, detected in jejunal juice, are synthesized from gut mucosa and are markers of its abnormal function. Like AGA, antibodies to milk and egg proteins were only found in jejunal juice of coeliac patients with flat inestinal mucosa, but their prevalence was significantly lower than that of AGA.

ISSN:0012-2823    

DOI:10.1159/000199605

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

Gastro-intestinal transit of a mixed solid-liquid meal containing wheat bread, scrambled eggs, coffee labelled with 99mTc, orange juice with lactulose and indigocarmine was evaluated in 21 young control (mean age 33.5 years) and 25 elderly subjects (mean age 81.7 years) without gastro-intestinal complaints or severe medical illness. The rate of gastric emptying was determined by an anterior gamma camera technique, mouth-to-caecum transit by the hydrogen breath test and whole-gut transit by the first stool passage of indigocarmine. Gastric emptying was significantly prolonged in older subjects: t½ = 136 ± (SEM) 13 versus 81 ± 4 min; p < 0.001. Concerning mouth-to-caecum or whole-gut transit time, significant differences between the two study groups were not detect

ISSN:0012-2823    

DOI:10.1159/000199606

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

This study investigates whether ‘gastric diversion’, collecting gastric secretion from just distal to the pyloric sphincter into a plastic bag, provides an alternative to pylorus ligation to determine the rat basal acid output over 6 h. Gastric diversion did not produce distension, lesions visible through the serosa, or mucosal injury in any stomach, and all bags were found to be intact and to have completely drained their stomachs. The acid output (mean ± SEM) was reproducible on the following day (59.7 ± 2.8 vs. 60.4 ± 2.4 μmol; n = 10) and a week later (62 ± 3.2 μmol; n = 10). Atropine (5 mg/kg) or cimetidine (40 mg/kg) significantly (p < 0.001) depressed this output (16.2 ± 1.3 and 20.6 ± 1.7 μmol, respectively, vs. 62 ± 3.2 μmol; n ≈ 10).The results illustrate that gastric diversion is accurate and suitable for basal acid output estimation and it is suggested as a valuable substitute for the classical Shay rat procedure, allowing gastric secretion collection over 6 h without gastri

ISSN:0012-2823    

DOI:10.1159/000199607

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

Biliary and fecal bile acid composition was studied in 13 patients 3–12 years after a partial ileal bypass operation and in 10 unoperated controls, all with heterozygous familial hypercholesterolemia. Three operated patients were taking cholestyramine. The relative amount of cholic acid in the bile was decreased at the expense of chenodeoxycholic acid in the operated subjects. Chenodeoxycholic acid content of the bile correlated negatively with the fractional cholesterol absorption, suggesting that in compromised absorption chenodeoxycholic acid is absorbed more efficiently than cholic acid. Despite a ninefold increase in total bile acid synthesis the cholic/chenodeoxycholic acid synthesis ratio was not significantly different in the operated and control subjects. However, the lower the chenodeoxycholic acid synthesis the higher was the proportion of deoxycholic acid in the bile and feces, suggesting regulation of chenodeoxycholic acid synthesis by deoxycholic acid. Ileal exclusion had increased the proportion of primary bile acids in the feces from below 10 to over 50%. Despite increased fecal water excretion the concentration of fecal total and dihydroxy bile acids was higher in the operated than in control subjects. However, the fecal concentration of the potentially cancer-promoting bile acids, deoxycholic acid and lithocholic acid, was not increased in the operated subjects. In the operated subjects, fecal water output was positively correlated with total bile acid and chenodeoxycholic acid synthesis. It is concluded that the severe bile acid malabsorption caused by ileal exclusion activates the synthesis of both primary bile acids in similar amount. However, after ileal exclusion the relative amount of cholic acid in the bile is decreased, obviously because loss of ileal absorption predominantly affects the absorption of cholic aci

ISSN:0012-2823    

DOI:10.1159/000199608

出版商:S. Karger AG    

年代:1988

数据来源: Karger