Biomedical subjects

N Thorsgaard Pedersen

Publications and source records attributed to N Thorsgaard Pedersen.

9 recordsLinked to original sources

PubMed1991

Short report: lipid and vitamin B12 malassimilation in pancreatic insufficiency.

Patients with exocrine pancreatic insufficiency have steatorrhoea as well as vitamin B12 malassimilation. To investigate whether this is caused by the pancreatic insufficiency per se or whether intestinal bacterial overgrowth contributes to the condition, 10 patients with pancreatic steatorrhoea were studied. Intestinal culture was done. Lipid and vitamin B12 assimilation was estimated from faecal spot tests, using 14C-triolein and 58Co-vitamin B12 as tracers and 51CrCl3 as marker. Out of the 10 patients, 9 had either vitamin B12 malassimilation (n = 8), and/or bacterial overgrowth (n = 5). These 9 patients were retested with pancreatic enzyme therapy, with and without addition of the antibiotics metronidazole and cefalexin. The lipid assimilation was significantly increased by enzyme therapy but did not improve further on additional antibiotic treatment. The vitamin B12 assimilation did not improve significantly on enzyme therapy nor with additional antibiotic treatment.

Cephalexin↗

PubMed1987

Fat digestion tests.

Estimation of the fat assimilation is one of the keystones when examining a patient with diarrhoea. Three fat assimilation tests, using 14C- and/or 3H-labelled long chain fatty acids as test substance, have been investigated: the 14C-triglyceride breath test is not sufficiently effective in diagnosing malassimilation, and two tests on alternative days are needed to establish lipid digestion. The serum 14C-triolein/3H-oleic acid test estimates lipid assimilation from blood samples and may discriminate between lipid malabsorption and lipid maldigestion from the ratio between 3H (from oleic acid) and 14C (from triolein). The test is, however, not sufficiently effective to be useful in clinical practice. The faecal 14C-triolein/3H-oleic acid test estimates lipid assimilation correctly in approximately 90% of the patients with diarrhoea from samples of faeces and discriminates between malabsorption and maldigestion with an efficiency of approximately 100% from the ratio between 14C and 3H in faeces. The traditionally used estimation of the 3-day faecal fat excretion classifies lipid assimilation correctly in approximately 85% of the patients, even when performed as simple out-patient collections. Furthermore, the faecal fat concentration is often useful in discriminating between normal lipid assimilation, malabsorption and maldigestion, even when only a single-day collection is done. The so-called fat balance studies do not seem to improve the usefulness of the faecal fat measurement. When quantitative data about the magnitude of malassimilation are sought, none of the fat assimilation tests are optimal, all of the tests having coefficients of variation of approximately 30%.

Breath Tests↗

PubMed1985

Simultaneous assessment of fat maldigestion and fat malabsorption by a double-isotope method using fecal radioactivity.

[14C]Triolein and [3H]oleic acid are useful tracers of dietary triglycerides and free fatty acids. The combustion/liquid scintillation counting technique was found a practicable method of estimating the fecal activity of these tracers. When ingested with the nonabsorbable marker 51CrCl3, the fecal excretion of 14C and 3H could be estimated accurately from samples of two stools. This technique was investigated as a test of lipid assimilation in a prospective, blind study of 84 consecutive patients suspected of malassimilation. The fecal excretion of 14C was a useful alternative to fecal fat: the patients with "normal lipid assimilation" excreted less than or equal to 10.4% of the dose ingested, whereas 25 of the 26 patients with steatorrhea ("unequivocal malassimilation") excreted greater than 10.4%. Fecal fat was normal in 18 patients who exhibited other signs of malassimilation ("equivocal malassimilation"); in 5 of these patients fecal excretion of 14C was greater than 10.4%. Lastly, there was a significant correlation between fecal 14C and fecal fat (r = 0.82, p less than 0.001). The fecal 14C/3H ratio was found useful as an index of pancreatic digestive function, being less than 1.3 in patients with "normal" lipid digestion and greater than or equal to 1.3 in 18 of the 19 patients with pancreatic steatorrhea and in 19 of the 27 patients with severely reduced exocrine pancreatic function. The test result was found widely independent either of the amount of carrier fat or the quality of the fecal collections and was therefore useful as an outpatient test. As it provided information about the pathogenesis of malassimilation and was at least as sensitive and specific as a fat "balance study," the test may be a useful alternative to fecal fat measurement.

Carbon Radioisotopes↗

PubMed1985

The serum 14C-triolein/3H-oleic acid assimilation test for differential diagnosis of maldigestion and malabsorption.

In 125 consecutive patients the measurement of serum radioactivities after simultaneous ingestion of 14C-triolein and 3H-oleic acid was investigated as a test of lipid assimilation. The sum of the 2-h and 4-h concentrations of 14C in serum (se(2 + 4)14C) was most useful as an index of lipid assimilation, and the 2-h serum 3H/14C ratio (se-3H/14C) reflected lipid digestion. Normal values were se(2 + 4)14C greater than or equal to 1.0% of the dose ingested per litre serum and se-3H/14C less than 1.3. Se(2 + 4)14C correlated significantly with faecal fat (r = -0.56, P less than 0.001) and indicated malassimilation in 26 of the 50 patients with a faecal fat excretion greater than 7 g/day. False-negative values appeared mainly in the patients with moderate steatorrhoea and gastrointestinal anastomoses. Only one false-positive se(2 + 4)14C value was found. Se-3H/14C was abnormal in 24 of the 34 patients with maldigestion with 2 false-positive results. When the results of se(2 + 4)14C and se-3H/14C were combined, the predictive value of the test result 'normal lipid assimilation' was 0.75, that of the test result 'maldigestion' was 0.93, and that of 'malabsorption' was 0.71. It is concluded that the serum 14C-triolein/3H-oleic acid assimilation test is convenient and inexpensive and may be useful when quantitative faecal collections are not available.

Adult↗

PubMed1984

Estimation of assimilation of simultaneously ingested 14C-triolein and 3H-oleic acid as a test of pancreatic digestive function.

The ratio between assimilation of simultaneously ingested 14C-triolein and 3H-oleic acid was investigated as a test of pancreatic digestive function in 48 consecutive patients suspected of malassimilation. Faecal excretion of 14C-triolein and 3H-oleic acid was measured by means of a combustion/liquid scintillation counting technique. Compared with the patients in whom the clinical investigation showed normal lipid assimilation (no. = 31) the assimilation of both 14C-triolein and 3H-oleic acid was significantly reduced in the patients with malabsorption (no. = 6) and maldigestion (no. = 11). However, in all except one patient with maldigestion the assimilation of 14C-triolein was more reduced than that of 3H-oleic acid, whereas there was no difference in 14C-triolein and 3H-oleic acid assimilation in the patients with malabsorption and normal lipid assimilation. Measurement of the postprandial serum radioactivities of 14C and 3H, like the faecal measurements, indicated more severely reduced assimilation of 14C-triolein than of 3H-oleic acid in the patients with maldigestion than in the other patient groups. In fact, the 2-h postprandial 3H/14C ratio at a level of 1.3 correctly classified digestive function in 47 of the 48 patients.

Digestion↗

PubMed1983

Association between duodenal bulb ulceration and reduced exocrine pancreatic function.

Seventy two patients admitted to a medical department with dyspepsia but without a previous diagnosis of peptic ulcer disease or chronic pancreatitis were studied consecutively. A pancreatic function test (Lundh meal test) and an upper endoscopy was made in all patients. There was no difference in age, sex ratio, occurrence of upper abdominal pain or chronic alcoholism between the groups of patients with reduced pancreatic function (20) and the group with normal function (52). Seven duodenal ulcers were found, two in patients with normal pancreatic function (2/52 = 3.8%; 95% conf lim: 0.5-13.2) and five in patients with reduced pancreatic function (5/20 = 25%; 95% conf lim: 8.7-49.1). This difference was statistically significant (p less than 0.01). Duodenitis occurred with equal frequency in the two groups.

Adult↗

PubMed1983

Estimation of lipid assimilation from faecal samples using 14C-triolein as tracer and 51CrCl3 as non-absorbable marker.

14C-triolein was investigated as tracer of dietary lipids from faecal measurements in 48 consecutive gastrointestinal patients. Simultaneously, 51CrCl3 was investigated as non-absorbable marker. Faecal 51Cr was measured in a whole-body scintillation counter and faecal 14C by means of a combustion technique. This technique permitted accurate measurement of faecal 51Cr and faecal 14C in each stool collected over a 6-day period. The investigation showed that the transit time of 51Cr was slightly shorter than the transit time of 14C-triolein in patients with high faecal excretion of 14C. Nevertheless, total faecal 14C, estimated from the ratio between 14C and 51Cr in two stools, correlated very closely with measured, cumulative faecal 14C (r = 0.99, P less than 0.001). 51CrCl3 was therefore considered useful as a non-absorbable marker. The 14C-labelling of triolein was stable during gastrointestinal transit. Qualitatively, estimated faecal 14C agreed with faecal fat diagnosing steatorrhoea in 97% (95% confidence limits 90-100%) of the patients with quantitative faecal collections. Quantitatively, a significant correlation with faecal fat was found (r = 0.82, P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1982

Chronic pancreatitis in Copenhagen. A retrospective study of 64 consecutive patients.

A longitudinal study of 64 patients with chronic pancreatitis is presented. The patients were followed up for a median period of 4 years. Pain was the dominant symptom in 43 of the patients, but only 5 patients had pancreatic resection because of pain. Alcoholism was the etiology in 45 patients. Complications were common: 34 patients developed steatorrhea and 29 diabetes. Two major groups of associated diseases contributed to a high morbidity in chronic pancreatitis: 24 patients presented with duodenal ulcer, and 8 developed malignant tumors. This number is significantly higher than expected in a matched population (P less than 0.01). Twenty-six of the patients died within the observation period from complications of chronic pancreatitis (38%), from malignant neoplasms (15%), or from other causes (46%). The calculated mortality rate after 7 years of observation was close to 50%. Most patients were recruited from the lower social classes, and most were unemployed. We conclude that chronic pancreatitis in Copenhagen is associated with a high morbidity, a high mortality, and a poor social prognosis.

Adolescent↗

PubMed1982

Estimation of 14C-triolein assimilation as a test of lipid assimilation. Breath test or measurement of serum radioactivity?

Two tests of lipid assimilation based on estimation of 14C-triolein assimilation from expiratory 14CO2 (breath test) and from serum radioactivity of 14C, respectively, were investigated in 48 consecutive patients suspected of having malassimilation. Patients with proven malassimilation had significantly lower expiration of 14CO2 and lower serum radioactivity of 14C than patients with normal lipid assimilation. The se-14C test correctly diagnosed significantly more patients with malassimilation than the breath test; the diagnostic efficiencies were 0.87 and 0.74, respectively. The results of both tests correlated with measurement of faecal fat. However, within the group of patients with proven malassimilation the results of the breath test correlated poorly with faecal fat, whereas a significant correlation was found between the se-14C test and faecal fat within this group. Correspondingly, the correlation between the results of the breath test and the se-14C test was poor, indicating that intermediate metabolism influences the results.

Adult↗