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Biomedical subjects

A Bruusgaard

Publications and source records attributed to A Bruusgaard.

At least 19 recordsLinked to original sources

Sucralfate versus placebo treatment in duodenal and prepyloric ulcer: a clinical endoscopic, double-blind controlled investigation.

Sucralfate, which has cytoprotective, pepsinostatic, antacid and bile acid-binding properties, was studied in a therapeutic trial against a placebo in patients with duodenal and prepyloric ulcer. The investigation was designed as a double-blind controlled study. Thirty-five patients with endoscopically verified ulcers were observed during 8 weeks of treatment. In 14 out of 17 (82%) patients treated with sucralfate the ulcers healed, as compared with 7 out of 18 (39%) in the placebo group, as compared with 7 out of 18 (39%) in the placebo group. In approximately 60% of sucralfate-treated patients all symptoms disappeared, as compared with approximately 30% in the placebo group. No significant side effects were detected, and compliance was good. Consequently, sucralfate represents as effective and safe treatment for duodenal ulcer.

Adult↗

Bile acid malabsorption after jejunoileal bypass is less compensated for with a 1:3 than with a 3:1 jejunoileal ratio.

A previous study surprisingly showed that after jejunoileal bypass a ratio of 1:3 compared with 3:1 between the jejunal and ileal segment left in continuity resulted in a smaller synthesis rate, pool size, and postcibal jejunal levels of bile acids. These findings are reevaluated in the present study of 34 patients who either were waiting for or 3, 9, or 15 months earlier, had undergone bypass surgery with a 3:1 or 1:3 jejunoileal ratio. Compared with 3:1 bypass, the 1:3 bypass resulted in (i) greater reduction of the fasting bile acid pool, significant for chenodeoxycholic acid but not for cholic adic, (ii) less increase in synthesis rate of both bile acids, (iii) less decrease in relative content of taurine-conjugated bile acids in bile, and (iv) equal reduction of postcibal levels of bile acids in jejunum. We conclude that the increase in synthesis of bile acids compensates insufficiently for the excess fecal loss; the lower synthesis rate after bypass with a short jejunum relative to ileum in function may be due to an impaired stumulation of bile acid synthesis, the mechanism of which is unexplained.

Bile Acids and Salts↗

Serum levels and clearance of bile acids are unaffected by jejunoileal bypass with 3:1 or 1:3 jejunoileal ratio.

Jejunoileal bypass may impair liver function. The hypothesis of the present study was that this may depend on the jejunoileal ratio of the segment left in continuity in a manner that affects the transport of bile acids from blood to bile. We investigated five extremely obese patients before and 29 patients 3, 9 and 15 months after bypass surgery with a 3:1 or 1:3 jejunoileal ratio of the functioning segment. Routine liver function tests, plasma disappearance rate of intravenously administered 3H-cholic acid and 14C-24-chenodeoxycholic acid, and fasting and postprandial serum concentrations of total 3-alpha-hydroxy bile acids showed no appreciable significant relationship with bypass surgery as such, time after surgery, or the jejunoileal ratio of the functioning segment.

Adult↗

Endoscopic retrograde pancreatography and the exocrine pancreatic function in chronic alcoholism.

In a consecutive study of chronic alcoholics admitted for X-ray-negative dyspepsia, endoscopic retrograde pancreatography (ERP) showed pancreatographic changes in 47% of the patients, whereas exocrine pancreatic dysfunction was found in 19%. Only patients with severe parenchymatous damage on ERP had subnormal output of pancreas lipase. In patients with less severe pancreatographic changes the pancreas function test was normal. It was suggested that ERP is a more sensitive method for detection of minor and moderate duct abnormalities in pancreatic inflammatory disease. A clinical diagnosis of pancreatitis had been made in only 22% of the patients before the present investigation. Thus subclinical pancreatitis may be more frequent among alcoholics than previously recognized and should be suspected in cases of unclarified dyspepsia in patients with long-standing abuse of alcohol.

Adult↗

Cholesterol saturation of bile after jejunoileal bypass increases more with a 1:3 than with a 3:1 jejunoileal ratio.

Previous suggested, surprisingly, that after jejunoileal bypass surgery the lithogenicity of the bile, assessed by its cholesterol saturation and rate of gallstone formation, increases more with a 1:3 than with a 3:1 jejunoileal ratio of the functioning segment. The present study re-evaluates this by examining fasting bile samples drawn from duodenum after cholecystokinin stimulation in 34 obese patients without gallstones, who either were waiting for or had had bypass surgery, with a 1:3 or 3:1 jejunoileal ratio, 3,9, or 15 months earlier. In all groups, the cholesterol content exceeded the solubilizing capacity of the bile as determined on the basis of total lipid concentration and content of phospholipid relative to bile acids. The cholesterol supersaturation increased with bypass surgery as such, increased more with a 1:3 than with a 3:1 jejunoileal ratio, decreased with time after surgery, and reached the preoperative level at 15 months. Assuming a total lipid concentration of 10 g/dl in the bile did not change this pattern. Our results indicate that during the period of weight loss after bypass surgery the lithogenicity of gallbladder bile increases more with a 1:3 than with a 3:1 jejunoileal ratio.

Bile↗

An easy procedure for determination of molar activity (or specific activity) of bile acids in bile.

An easy procedure is described for determination of the molar activity of the major bile acids, labelled with 14C, in bile. The procedure involves initial enzymatic hydrolysis, by which the amino acid moieties are removed from the glycine and taurine conjugated bile acids by means of choloylglycine hydrolase, followed by thin-layer chromatographic separation of the unconjugated bile acids, cholic acid, chenodeoxycholic acid, and deoxycholic acid. Then the bile acids are eluted from the individual silica gel spots concerned. Finally, determination of the radioactivity by liquid scintillation counting and of the amount of substance by an enzymatic method using 3 alpha-hydroxysteroid dehydrogenase is performed in the eluates. The method requires only a small volume of sample and allows of separate determination of the molar activity of cholic acid and chenodeoxycholic acid, labelled with the same isotope, in the same sample.

3-Hydroxysteroid Dehydrogenases↗

Determination of total 3 alpha-hydroxy bile acids in serum.

The usual techniques for determination to total 3 alpha-hydroxy bile acids in serum involving liquid-solid extraction of the bile acids with the adsorbent XAD-2 and fluorimetric measurement of NADH generated from the reaction with a NAD-linked 3 alpha-hydroxysteroid dehydrogenase are evaluated and improved. The influence of different types of enzyme preparations on the results is examined. The results with the improved technique are compared to the results obtained with another method, avoiding extraction of the bile acids before the enzymatic reaction which is followed by fluorimetric measurement of resorufin, produced by transfer of the hydrogen of the generated NADH by diaphorase to resazurin. No significant difference between the results with the two types of methods was found. The concentration of total 3 alpha-hydroxy bile acids in serum of 46 fasting 'healthy' individuals aged 17 to 82 years is estimated. 30 were females, of whom 10 were taking estrogen-containing oral contraceptives, and 16 were males. Mean +/- standard deviation in all the females was 3.0 +/- 1.1 micromol/l, and in the males 4.0 +/- 1.9 micromol/l. There was no significant difference between any of the groups.

3-Hydroxysteroid Dehydrogenases↗

Treatment of retained bile duct calculi with T-tube infusion of sodium cholate and heparin.

A series of 26 patients with retained radiolucent bile duct calculi diagnosed at postoperative cholangiagrophy through the T-tube is presented. All patients were treated with infusion of 15-20 g sodium cholate in 1000 ml saline and 20,000 units of heparin in 1000 ml saline per 24 hours. In 19 of 26 patients (73 per cent) the calculi disappeared. No complications were encountered. This treatment is recommended prior to reoperation in all patients with retained radiolucent bile duct calculi diagnosed by postoperative cholangiography through the T-tube.

Adult↗

Lithogenic index of bile after jejunoileal bypass operation for obesity.

Lithogenic index of cholecystokinin-stimulated, fasting, duodenal bile was determined in 12 obese patients before and 1-2 months after end-to-side jejunoileal bypass operation, either including 37.5 cm jejunum and 12.5 cm jejunum and 12.5 cm ileum or 12.5 cm jejunum and 37.5 ileum. The index did not change significantly after bypass with short ileum, whereas a four-fold, significant increase was found after bypass with long ileum. Surprisingly, the results may suggest that the lithogenicity of gallbladder bile increases when the length of the functioning ileal, relative to the functioning jejunal, segment in jejunoileal bypass is increased.

Bile↗

Criteria for selection of patients for medical treatment (chenodeoxycholic acid therapy) of gallstones.

With the introduction of medical treatment (chenodeoxycholic acid therapy) of cholesterol gallstones, the prediction of the gallstone type, cholesterol--non-cholesterol stones, (i.e. cholesterol predominating or not), has become important. In 24 consecutive patients admitted for surgery because of gallstones, the value of various criteria for differentiation between the two types of stones was assessed. It is concluded that the combined requirements of radiolucency of the stones and a cholesterol saturation index in duodenal bile above 1.00 constitutes a fairly reliable method for selection of patients for dissolution therapy with chenodeoxycholic acid.

Adult↗