B. Andersen

Plasma Enteroglucagon after Jejunoileal Bypass with 3:1 or 1:3 Jejunoileal Ratio

Enteroglucagon concentration in peripheral blood was determined before and after a test meal in 24 morbidly obese patients. Eighteen had jejunoileal bypass, 6 with a 3:1 and 12 with a 1:3 jejunoileal ratio of the functioning segment, and 6 were unoperated. All three groups exhibited an increment of enteroglucagon concentration after the meal. Both the fasting values and the postprandial integrated increments were higher in operated patients than in unoperated patients and higher after 1:3 bypass than after 3:1 bypass. The findings agree with the hypothesis that enteroglucagon secretion is stimulated by exposure of the lower bowel to upper-bowel content, and that the effect of enteroglucagon is, as seen after bypass operation, stimulation of growth and reduction of motility of the intestine.

A Randomized Trial of Fistulotomy in Perianal Abscess

In a randomized trial we compared the treatment of perianal abscess by incision only (18 patients) with that by incision followed by fistulotomy 3 days later (20 patients). All patients were observed for 12 months. There were no differences between the two groups with regard to recurrent abscess/fistula, but the fistulotomy group had a statistically significantly higher prevalence of flatus incontinence. Further, fistulotomy was followed by significantly longer duration of hospitalization and by delayed healing. We recommend that fistulotomy is used only in patients with recurrent abscess.

An improved glucoseoxidase-peroxidase-coupled assay for β-fructofuranosidase activity

Abstract An improved glucoseoxidase-peroxidase-coupled assay for the determination of β-fructofuranosidase activity is described. The method makes use of the double effect of Tris (2-amino-2-hydroxymethylpropane-1,3-diol) as an inhibitor of both invertase and contaminating glucosidases. The method is very sensitive and is suitable for routine determinations. The total time needed for a single analysis is less than half an hour.

Food Intake before and after Gastroplasty for Morbid Obesity

Preoperatively, the energy intake was high, the protein intake was sufficient, whereas the relative contribution of fat was greater than and of carbohydrate less than the recommended values. After gastroplasty a dramatic fall occurred in the intake of energy and all nutrients, and a relative reduction in the contribution of fat at 3 months and of carbohydrate at 12 months was observed. Preoperatively, the intake of vitamins D, B6, folacin, biotin, magnesium, iron, zinc, manganese, copper, and fluoride was deficient. Twelve months after operation the intake of these components and of vitamin E and iodine was less than half of the values recommended.

Gut and pancreatic hormones after jejunoileal bypass with 3:1 or 1:3 jejunoileal ratio.

The aim of the study was to elucidate the differential role of the jejunum and ileum in the regulation of secretion of the gut hormones, gastrin, gastric inhibitory polypeptide, and enteroglucagon, and the pancreatic hormones, insulin, glucagon, and pancreatic polypeptide, in man. We measured the plasma levels of the hormones (and glucose) during fasting and after a test meal in 34 obese patients, of whom 5 were waiting for bypass surgery and 29 had had a jejunoileal bypass with a 3:1 or 1:3 jejunoileal ratio between the functioning segments 3, 9, or 15 months earlier. The major findings were that surgery bypass (1) has no important influence on the levels of gastrin and pancreatic polypeptide, (2) reduces the level of gastric inhibitory polypeptide, insulin (and glucose), and enhances the pancreatic glucagon level, independently of the jejunoileal ratio, and (3) increases enteroglucagon secretion, most effectively so with a short jejunal and long ileal segment left in continuity. These findings suggest that the upper jejunum and terminal ileum has no important role in regulation of secretion of these hormones apart from that in secretion in enteroglucagon which is related to the length of functioning ileum.

Gastric emptying of liquid before and after gastroplasty for morbid obesity.

Gastric emptying of a liquid meal was investigated with a radionuclide method before and 1 week and 3 and 12 months after gastroplasty operation for morbid obesity. Gastroplasty results in a small proximal pouch with a narrow stoma to the remaining stomach. The total gastric emptying was delayed 3 months after gastroplasty (p less than 0.01). Twelve months after gastroplasty, emptying of the proximal pouch was faster than at 3 months (p less than 0.01). This may indicate dilatation of the stoma between the two gastric pouches during this period. Surprisingly, the total gastric emptying 12 months after gastroplasty was not only faster than at 3 months but also faster than before surgery. The explanation, therefore, cannot only be attributed to a dilated stoma, and hormonal mechanisms may be involved. A lack of correlation between preoperative weight and emptying was observed, but because the material consists of only obese subjects, no conclusion can be drawn about the postulated role of gastric emptying in developing obesity. Emptying of the total stomach and of the proximal pouch failed to correlate with postoperative weight losses. The weight loss after gastroplasty evidently bears little, if any, relation to the postoperative changes in gastric emptying of liquids.

Pancreatic Secretion of Zinc and Copper in Normal Subjects and in Patients with Chronic Pancreatitis

Pancreatic secretion of zinc and copper in duodenal juice were measured in 7 healthy persons and in 9 patients with chronic pancreatitis. Stimulation with cholecystokinin and secretin increased secretion of zinc in healthy persons but not in patients. Copper secretion was not influenced. In patients with chronic pancreatitis, the correlations between zinc secretion, and amylase and trypsin secretion were significant while in healthy subjects they were not. Possibly pancreatic zinc secretion in the duodenal juice might be used as a measure of exogenic pancreatic function, and determination of zinc in duodenal juice may replace enzyme determinations in the diagnosis of chronic pancreatitis.

Risk of gallstone formation after jejunoileal bypass increases more with a 1:3 than with a 3:1 jejunoileal ratio.

The rate of gallstone formation after jejunoileal bypass and the influence on the rate of the jejunoileal ratio of the functioning segment were assessed in 265 obese patients without stones in the gallbladder. After on the average 20.1 months of observation 231 patients were adequately examined for gallstones, which had developed in 2 (4%) out of 46 unoperated patients, in 9 (9%) out of 100 with a 3:1 jejunoileal ratio, and in 17 (20%) out of 85 with a 1:3 jejunoileal ratio of the functioning segment of the bypass. This result suggests that the association of ileal dysfunction and gallstone formation depends on the length of the functioning jejunum, which, according to previous studies, may reduce bile lithogenicity by stimulating bile salt synthesis.

ABDOMINAL SCINTIPHOTOGRAPHY WITH 99mTECHNETIUM-LABELLED ALBUMIN IN ACUTE GASTROINTESTINAL BLEEDING: An Experimental Study and a Case-report

In a new diagnostic method in acute gastrointestinal bleeding, after an intravenous injection of 99mtechnetium-labelled albumin, the distribution of radioactivity in the abdomen is followed for 40-60 minutes by sequential scintiphotography. The site of simulated gastrointestinal bleeding could be identified in all five volunteers. In a patient with severe bleeding from diverticula in the sigmoid colon the method gave a correct estimate of the site of the bleeding and of its rate.

Meal stimulated levels of pancreatic polypeptide (PP) and vasoactive intestinal polypeptide (VIP) in gastroplasty for morbid obesity

Plasma concentrations of pancreatic polypeptide (PP) and vasoactive intestinal polypeptide (VIP) were measured after a meal consisting of 11 ml meat extract and 40 ml of 20% soya oil in 11 patients before and 3 months after gastroplasty for morbid obesity. Gastroplasty results in a small proximal pouch with a narrow stoma allowing delayed emptying into the distal pouch, and consequently postprandial distension of the proximal pouch. Postprandial plasma PP increased significantly (P less than 0.01) independent of gastroplasty. PP is therefore not involved in the early satiety after gastroplasty. Postprandial plasma VIP increased significantly from fasting levels both before and after gastroplasty (P less than 0.05). Only 10 min after a meal, the median value of VIP was significantly higher after than before gastroplasty (P less than 0.02) and may be caused by distension of the proximal pouch.