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PubMed1985

Nutritional considerations in the patient with disabling brain disease.

Increased nutritional requirements are now recognized as the typical sequellae of head injury. Whether similar nutritional demands routinely accompany nontraumatic, disabling brain diseases is uncertain. Experience with patients suffering from head injury indicates that clinical criteria for differentiating the severity of neurological impairments categorize rather poorly the levels of nutritional need. Based on available data, "nutritional risk" can only be assigned to broad patient categories. Head-injured patients seem to be at nutritional risk and, by virtue of increased caloric and protein requirements, may benefit, in terms of reduced mortality, from early, intensive nutritional intervention. Because the nutritional risk cannot be established, the indications for aggressive nutritional support in the noninjured patient are even less clear than those for the trauma patient. Parenteral nutrition is often required to meet the goals of nutritional support because inadequacies in gastrointestinal function frequently mitigate successful enteral nutrition. Selective nutritional therapies involving the branched chain amino acids may reduce the attrition of the body cell mass seen in head injury patients. Furthermore, improvements in energy nutrient utilization in other than head-injured patients have been suggested when fat is provided in addition to glucose as a caloric source. When clinically feasible, enteral nutrition offers significant economic and physiological benefits over parenteral nutrition. In this regard, increasing attention has been focused on newer techniques of enteral access. These include percutaneous gastrostomies and nasally inserted small bore feeding tubes. The latter achieve duodenal intubation with a high success rate, and they offer the prospects of improved feeding tolerance and reduced tracheobronchial aspiration by allowing the administration of nutrients distal to the pylorus.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acids↗

PubMed2003

A long-term porcine model for measurement of gastrointestinal motility.

Animal models have become an essential tool in the investigations of gut motility under experimental conditions. To determine the influence of various anaesthetic drugs on the motility pattern of the gastroduodenal tract, a new long-term model has had to be developed for allowing measurements in conscious and unrestrained as well as in sedated and analgosedated pigs. Since mechanical ventilation influences gut motility, it was necessary that this animal model enabled the investigation of the effect of drugs causing sedation and analgosedation during spontaneous breathing. Seven male, castrated pigs, German landrace, 32-40 kg bodyweight (BW) were investigated in this study. After habituation of the pigs to local housing conditions over 5 days, the animals were trained over 4 days to prepare for experimental situations and investigators. Pigs were inserted with a central venous catheter and with percutaneous enterogastrostomy (PEG) under general anaesthesia. Intestinal motility was measured by intraluminal impedancometry. The catheter was introduced over the PEG into the stomach and positioned into the duodenum by duodenoscopy. Measurements were done in conscious, unrestrained pigs and with sedated, and analgosedated animals on subsequent days. The habituation and training of the pigs to the investigators and for the laboratory conditions took between 7 and 9 days. The initial anaesthesia protocol for the instrumentation using remifentanil/propofol led to pyloric spasm and was thus unsuitable for duodenal intubation with an endoscope. In contrast, a combination of ketamine/propofol enabled this procedure. It was practicable to measure gut motility in conscious, unrestrained pigs. Spontaneous breathing was sufficient under propofol sedation and analgosedation using fentanyl-propofol. Systematically local application of polividon iodine in the area of the subcutaneous catheters avoided the necessity of using systemic prophylactic antibiotics. In conclusion, the habituation and training for 9 days enabled the measurement of gut motility by intraluminal impedancometry in conscious pigs. The insertion of the catheter was done during general anaesthesia using a combination of propofol and ketamine. For the future determination of gut motility performed under general anaesthesia, each sedation and analgosedation concept has to be evaluated to see whether it allows spontaneous breathing or whether mechanical ventilation is necessary.

Animals↗

PubMed1976

The small bowel enema: description and experience of a technique.

A method of examining the small bowel, involving duodenal intubation is described. Good visualization of all parts of the small bowel is obtained using an air-barium double contrast technique. The technique is compared and contrasted with the more conventional methods of small bowel examination, and its advantages and disadvantages discussed. The authors relate their experience with the technique, indicating the abnormalities which can be shown, and list the type of clinical problems where the technique may be most usefully employed.

Barium Sulfate↗

PubMed1995

Exocrine pancreatic function in the early phase of human acute pancreatitis.

BACKGROUND: Little is known about exocrine pancreatic function during human acute pancreatitis. We aimed to evaluate interdigestive exocrine pancreatic secretion and pancreatic polypeptide (PP) release during the early phase of acute pancreatitis in humans. METHODS: Eight patients with acute pancreatitis (six biliary, one alcoholic, and one idiopathic acute pancreatitis) were studied within 72 h from the onset of symptoms. Four patients had necrotizing and four had edematous acute pancreatitis. Normal values were obtained from 26 normal subjects matched by sex and age. Interdigestive pancreatic secretion was studied by a duodenal intubation perfusion technique. Enzyme output was calculated for consecutive 15-min periods over 3-4 h and expressed as units per hour within a secretion cycle and units per hour around a secretion peak. Plasma PP concentrations were measured by radioimmunoassay in 15-min intervals. RESULTS: All variables studied were similar in patients with acute pancreatitis and in controls. PP release in acute pancreatitis was maintained in a normal cyclical pattern closely related to the secretory cycles. CONCLUSIONS: Interdigestive exocrine pancreatic secretion in the early phase of mild to moderate acute pancreatitis in humans remains within the normal range. This finding provides a rational basis for early therapeutic inhibition of pancreatic secretion in human acute pancreatitis.

Acute Disease↗

PubMedDate not supplied

"Mixed" triglyceride breath test: methodological problems and clinical applications.

Laboratory assessment of pancreatic function is unpleasant for the patient and time-consuming for the investigator since it requires duodenal intubation and measurement of maximal pancreatic enzyme output by means of perfusion techniques. Non-invasive indirect tests such as bentiromide test, pancreolauryl test and faecal fat measurement have been introduced in clinical practice but their results depend on the collaboration of the patient in collecting urine or stool. Moreover, faecal fat reflects fat malabsorption but it is neither sensitive nor specific to evaluate exocrine pancreatic function. With the aim to determine whether steatorrhea is due to pancreatic insufficiency, several 14C- (or 13C) breath tests have been developed in which triolein, trioctanoin, tripalmitin, and cholesteryl-octanoate are used as marker substances. In 1989, G. Vantrappen and its group in Leuven developed a breath test in which a new substrate was used: the [1,3-distearyl, 2[carboxyl-13C]octanoyl glycerol] or 13C-"mixed"-triglyceride (MT). The "mixed triglyceride breath test" (MTBT) was shown to be an excellent test of exocrine pancreatic insufficiency when compared with the maximal lipase output after CCK-pancreozymin stimulation. Aim of this paper is to review the methodology of the MTBT and its actual and future applications in clinical practice.

Breath Tests↗

PubMed1975

Determination of bile acid pool size in man: a simplified method with advantages of increases precision, shortened analysis time, and decreased isotope exposure.

A simplified isotope dilution method for measurement of the bile acid pool size in normal subjects is described and compared with the traditional method of Lindstedt (Acta Physiol. Scand. 40: 1-9, 1957). Advantages of this simplified method include a four- to eightfold reduction of isotope dose, facilitation of analytical procedures, and a reduction in the required number of duodenal intubations. In 15 human subjects who had two separate estimates of pool size by this method, precision averaged 2.6 percent. In 16 comparisons, pool size measured by this method averaged 13.7 percent higher than simultaneous estimates by the Lindstedt method. Factors affecting accuracy (as opposed to precision) in both methods are discussed.

Adult↗

PubMed2000

[Clinical features of gastrointestinal diseases in patients with primary mitral prolapse].

Whether patients with mitral prolapse (MP) have specific features in the course of their gastrointestinal diseases (GD) was studied in 420 MP patients with various GD. Echocardiography and examination of the vegetative status were conducted in all the patients. On demand, esophagogastroduodenoscopy, ultrasonic investigation of the abdominal organs, multistage fraction duodenal intubation were made. The findings evidence of more severe course of GD in MP patients. This manifests in early onset, severe pain and dispeptic syndromes, marked mucosal inflammation and is explained by dysfunction of the vegetative nervous system and generalized dysplasia of the connective tissue.

Adult↗

PubMed1975

A case of severe human coccidiosis in Israel.

A 51-year-old woman presented with intermittent diarrhea and marked loss of weight. Stool examination and duodenal intubation both yielded coccidian oocytes of Isospora belli. The patient responded to treatment with Septrin (trimethoprim and sulfamethoxazole), 2 g daily for three weeks. This is the first reported case of severe human coccidiosis in Israel.

Animals↗

PubMed1975

Kinetics and pool size of chenodeoxycholic acid in cholesterol gallstone patients.

The pool size, half life, and daily production rate of chenodeoxycholic acid (CDCA) was determined by the isotope dilution method upon intravenous injections of about 10 muCI OF 24-14C-CDCA in 7 patients with radiolucent gallstones in functioning gallbladders, and 9 healthy controls. Bile was obtained by duodenal intubation. The method also allowed measurement of the CDCA percentage of total bile acids (TBA) and an indirect calculation of the TBA pool size. The pool size and daily production rate of CDCA were slightly, but not significantly, diminished in the gallstone patients. The half life of CDCA was almost equal in the 2 groups. The CDCA percentage of TBA was significantly higher in the gallstone patients (0.02 less than P less than 0.05), and the TBA pool size was significantly reduced (P less than 0.01) in the gallstone patients. It is concluded that the CDCA metabolism is similar to that of cholic acid in gallstone patients. Thus the formation of gallstones is hardly due to specific alterations in CDCA metabolism, suspected on account of the specific cholelitholytic effect of CDCA ingestion. The significance of increased CDCA percentage in bile is discussed in relation to the results from other study groups, and it is pointed out that a relative increase in the bile content of dihydroxy bile acids may lead to reduced cholesterol holding capacity of bile, and thus favor the formation of gallstones.

Adult↗

PubMed2003

[Morphofunctional status of the gastric mucosa in acalculous diseases of the biliary tract].

AIM: To study morphofunctional peculiarities of gastric mucosa in native and migrant rural population of North Siberia. MATERIAL AND METHODS: A comprehensive clinicomorphological examination including physical examination, ultrasonic scanning, cholecystography, duodenal intubation, intragastric pH-metry, esophagogastroduodenoscopy, quantitative and qualitative investigations of gastric mucosa was conducted in 148 migrants (Russians, Ukrainians) and 165 evenks living in Evenkia. RESULTS: In both population groups, more often in the migrants, in cholecystitis vs dyskinesia patients frequency of atrophic changes in gastric mucosa was higher while acid production in the stomach was lower, antral gastritis more active. CONCLUSION: Morphofunctional condition of the stomach influences the condition of the bile tract in native and migrant population of North Siberia.

Adult↗

PubMed1992

[Fascioliasis in populations of rural areas with high prevalence of animal infection].

Between January 1986 and December 1990 the prevalence of F. hepatica infection was studied in 5861 rural inhabitants of the provinces of Curico, Talca and Linares, VII Region, an hyperendemic zone of animal fascioliasis. Every one was screened by intradermal (IDR), complement fixation (CF), double diffusion (DD) counterelectrophoresis (CIEF), immunoelectrophoresis (IEP) and enzyme-linked immunoabsorbent assay (ELISA) tests. 366/1881 (9.3%) had positive IDR; 61 (1.04%) positive CF; 14 (0.24%) positive DD and 105/3838 (2.73%) positive ELISA and thus considered under suspicion to be infected. F. hepatica eggs were searched in stool in 241 of these persons. 37 cases were thus confirmed. Another 4 individuals with positive immunobiological tests and absence of the parasite eggs in stools were confirmed by duodenal intubation. 21 of the confirmed cases (51.2%) had less than 15 years of age. Women were more frequently infected than men (73.2% vs 26.8%). The 41 cases represent 0.7% of the surveyed population predicting 2000 cases among the total rural population of these provinces (300,000 persons). These results indicate that human fascioliasis is an important problem in the zone, perhaps much higher if family contacts of the index cases and symptomatic persons are included.

Adolescent↗

PubMed1958

Biliary tract anomalies: the utilization of modern techniques in differential diagnosis.

The diagnostic aids used in dealing with biliary disease in adults were applied to the study in infants of the principal congenital anomalies of the biliary tract such as choledochal cyst, biliary atresia and biliary stenosis. Choledochal cysts were distinguished from other upper abdominal masses occurring in childhood by the use of intravenous cholecystography. Since the clinical manifestations in infants with biliary atresia or stenosis are almost identical to those associated with the obstructive phase of neonatal hepatitis, the problem of differentiation is difficult. The serial total serum bilirubin curve, a careful analysis of the pigment content of feces and urine and duodenal intubation for bilirubin determinations were found to be useful in making the distinction. Operative cholangiograms were helpful in some cases. Frozen section examinations of liver tissue during operation were of little value except to demonstrate certain unusual cases of intrahepatic biliary atresia. Routine liver function studies, including serum transaminase determination in a limited number of cases, did not help in differentiation.

Biliary Atresia↗

PubMed1998

[Diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in patients with Billroth II gastrectomy].

BACKGROUND: Diagnostic and therapeutic endoscopic cholangiopancreatography (ERCP) is more difficult in patients with Billroth II gastrectomy. METHODS: Personal experience in the last 28 months with 38 ERCP regarding 33 Billroth II patients representing the 5.4% of total number of ERCP performed in the same period is reported. RESULTS: Choledochal lithiasis could be treated in all cases observed also if two observed patients necessitated of two ERCP procedure. Only one patient with biliary stenosis could not be treated because of failed sphincterotomy and deep incannulation. The most difficult step in the procedure was duodenal intubation. A final ERCP success rate was 79%. EST could be performed in most cases (16 out of 17 patients=94%). No complications are reported. The use of the lateral viewing duodenoscope is emphasized. CONCLUSIONS: Today, ERCP and endoscopic sphincterotomy (EST) give similar results and no higher risk in patients with regular anatomy or in patients with Billroth II gastrectomy.

English Abstract↗

PubMed2002

[Strongyloidosis. Part VIII. Parasitological diagnosis].

The effectiveness and safety of the methods of detecting Strongyloides stercoralis, by passing larvae from the faeces to water, in duodenal fluid (duodenal intubation, Enterotest), in sputum and other body fluids, have been estimated. The author recommend Baermann technique for detecting S. stercoralis in individual examinations and Dancescu technique in mass field examinations. The detection of S. stercoralis larvae by the two methods ought to be checked by Fülleborn agar Petri dish technique in order to identify parasite to the species level.

Animals↗

PubMed1991

[Effects of biliary lithogenesis in acromegalic patients with long-term octreotide (SMS 201-995) treatment].

This study was performed to evaluate the risk of gallstone formation during long-term treatment with the long-acting somatostatin analog octreotide (SMS 201-995). Twelve patients (8 men, 4 women--mean age 43 years) treated with continuous subcutaneous octreotide infusion for acromegaly (mean duration 26.5 months, mean dose 541 micrograms/day) were included. Bile collection by duodenal intubation was performed before, during, and 45 days after octreotide treatment in 3, 12, and 8 patients, respectively. Abdominal ultrasonography and/or oral cholecystrography were also performed before (n = 9 patients), during (n = 12), and after treatment (n = 10). Bile examination was normal in the 3 patients controlled before treatment but showed that 58.3 percent of the treated patients had cholesterol monohydrate crystals. After discontinuation of octreotide only 25 percent of patients had cholesterol crystals. In 3 patients (25 percent) treated longer than 6 months, cholesterol crystals occurred prior to the occurrence of small radiolucent gallstones: one patient underwent cholecystectomy because of biliary colic, while in the two others, complete dissolution of stones was obtained after 10 months of treatment with ursodeoxycholic acid given in association with octreotide. None of the 9 other acromegalic patients (including 7 treated more than 20 months) developed stones. Cholesterol gallstone formation seems to be increased in acromegalic patients during long-term octreotide treatment but the exact incidence remains to be determined in larger series of patients.

Acromegaly↗

PubMed1991

Influence of the thyroid on exocrine pancreatic function.

Exocrine pancreatic function was studied in 15 patients with hypothyroidism and 15 healthy subjects by means of the amino acid consumption test, a new tubeless test based on the measurement of plasma amino acid uptake by the pancreas during pancreatic enzyme synthesis stimulation. Nine of the 15 patients were also studied after they had become euthyroid following thyroxine treatment. Pancreatic function was significantly reduced in patients with hypothyroidism compared with healthy subjects. Treatment with thyroxine restored pancreatic function to normal. In two additional hypothyroid patients studied by means of duodenal intubation, pancreatic secretion of both bicarbonate and enzymes was found to be significantly decreased. It was concluded that the thyroid gland plays an essential role in maintaining the functional integrity of the exocrine pancreas in humans.

Adult↗

PubMed1991

A simple method for the determination of lipid composition of human bile.

The Entero-Test, a device for easy sampling of gastrointestinal contents, including bile, has been used for determination of biliary lipid composition. The device consists of a weighted gelatin capsule containing 140 cm of a highly absorbent nylon line. The capsule is swallowed while one end of the string is taped to the face. After 3.5 h, when the line has reached the duodenum, gallbladder contraction is stimulated by intramuscular administration of ceruletide. The line is pulled out, and the last 15 cm are eluted four times in methanol. Total bile acids (by 3 alpha-hydroxysteroid-dehydrogenase assay), individual bile acids (by high performance liquid chromatography), phospholipids (by assay of lipid-soluble phosphorus), and cholesterol (by gas-liquid chromatography) are determined in the eluate. Tests in vitro demonstrated no preferential binding and a good recovery of biliary lipids from the thread. Similar values of biliary cholesterol saturation were obtained by means of duodenal intubation and of the Entero-Test in a series of 12 subjects (r = 0.952). In 5 subjects, individual bile acids were also measured and were found to be similar with both techniques (r = 0.948). When the test was repeated over 3 days in a series of 7 subjects, biliary cholesterol saturation was found to be remarkably reproducible (CV = 7.6%). Thus, the Entero-Test is a convenient technique for the determination of biliary lipid composition, which can be particularly useful in longitudinal studies.

Bile↗

PubMed1990

Villous adenoma of the main pancreatic duct: a potentially malignant tumor?

This report deals with two cases of villous adenoma of the Wirsung duct. The two patients presented with upper abdominal pain, diarrhea, and weight loss. Duodenal intubation showed a complete failure of exocrine pancreatic function. Ultrasound scan, computed tomography, and endoscopic retrograde cholangiopancreatography disclosed marked dilatation of the head portion of the main pancreatic duct. A proximal duodenopancreatectomy was performed. Pathological examination revealed a papillary polyp expanding the pancreatic head and filling the main duct lumen. Histological pattern consisted of a villous adenoma without any feature of malignant change. Previously reported cases exhibit many similarities to our two cases. The putative likelihood of malignant change and the relationship between villous tumors of the Wirsung duct and of other origin remain unclear.

Adenoma↗