Herbert Weisberg

FAILURE OF ENDOGENOUS STIMULATION OF SECRETIN AND PANCREOZYMIN RELEASE TO INFLUENCE SERUM-INSULIN

Abstract The effect of endogenously stimulated and exogenously administered secretin and pancreozymin on blood-glucose and serum-immunoreactive-insulin was studied in healthy controls and in patients with histamine-fast anacidity. When the release of secretin was stimulated by duodenal acidification in three patients with histamine-fast anacidity, the serum-immunoreactive-insulin response and the blood clearance of an intravenous glucose load were not enhanced. In the absence of a glucose load, in five anacid patients duodenal acidification did not lower fasting blood-glucose or raise serum-immunoreactive-insulin. Intravenous administration of either secretin or pancreozymin to four fasting healthy controls caused a small rise in serum-immunoreactive-insulin, which was associated with a slight fall in blood-sugar in the case of pancreozymin but not of secretin. These results indicate that the effect of intra-venously administered secretin and pancreozymin on serum-insulin is not duplicated by the stimulation of their endogenous release of the hormones does not normally influence the utilisation of ingested carbohydrate.

Sources of bleeding in upper gastrointestinal hemorrhage: A re-evaluation

SummaryTwo hundred fifty consecutive patients admitted for upper gastrointestinal hemorrhage were examined by endoscopy within 24 hr. of admission. The technic proved safe and was tolerated well. One hundred twenty-seven diagnoses (50.8%) were established by endoscopy alone. The incidence of duodenal ulcer (20%) as the bleeding source was strikingly below the figure usually quoted. Erosive gastritis and esophageal varices were the bleeding sources in 20% and 17.2% respectively, while 22% remained undiagnosed.

EVALUATION OF ESOPHAGEAL VARICES IN LIVER DISEASE BY SPLENIC-PULP MANOMETRY, SPLENOPORTOGRAPHY, AND ESOPHAGOGASTROSCOPY; DIAGNOSTIC DISCREPANCIES.

Summary and ConclusionEsophagogastroscopy, splenic-pulp manometry, and splenoportography were combined in a prospective study of 60 patients with documented liver disease and suspected portal hypertension. All three procedures were performed on each of the patients within a 6-day period. Twenty patients were actively bleeding at the time of endoscopic examination.Esophagogastroscopy demonstrated varices in 90% of the patients studied. Splenoportography, however, demonstrated collateral circulation in only 50% of the patients with endoscopically demonstrated varices. In no instance did splenoportography demonstrate collateral circulation not previously seen on endoscopy. Splenoportography failed to demonstrate collateral circulation in all patients whose splenic-pulp pressure was less than 270 mm. water.In 20 patients with upper gastrointestinal bleeding, the height of the splenic-pulp pressure was a poor index of the site of bleeding. Eight patients with portal hypertension and esophageal varices were found to be bleeding from nonvariceal sites. Conversely, 5 patients with active bleeding from endoscopically demonstrated varices had no collateral circulation revealed by splenoportography.It is evident from this study that splenic-pulp manometry, splenoportography, and esophagogastroscopy will frequently yield divergent results in the evaluation of portal hypertension and portosystemic collateral circulation in patients with liver disease. While splenoportography may be useful in determining the patency of the portal vein and demonstrating large spontaneous or surgical portosystemic shunts, esophagogastroscopy is a better method for detecting esophageal varices and determining whether they are bleeding. The height of the splenic-pulp pressure is of little value in indicating the site of upper gastrointestinal bleeding.

Hydroxocobalamin. VI. Comparison of Intestinal Absorption in Man Of Large Doses of Hydroxocobalamin and Cyanocobalamin.

Summary Intestinal absorption of large oral doses of hydroxocobalamin and cyanocobalamin (100,. 500 and 1000 μg) was compared and quantitated in 17 normal subjects using a double label isotope technique. In 3 pairs of normal individuals, Co57-labeled cyanocobalamin and Co60-labeled hydroxocobalamin were administered simultaneously in oral doses of 100, 500 and 1000 μg and the ratio of the 2 isotopes in whole stool specimens was compared with that in the administered dose. No significant differences were found between the ratios administered and excreted at each dosage level. In 11 subjects intestinal absorption was quantitated by a modification of the double label hepatic uptake test in which the hepatic uptake of orally administered cyanocobalamin Co57 and hydroxocobalamin Co57 was given simultaneously with the first oral dose. At oral doses of 100, 500 and 1000 μg, mean hydroxocobalamin and cyanocobalamin absorption were not significantly different.

Intestinal vitamin B12 absorption in the dog: I. Evidence against an intrinsic factor mechanism for vitamin B12 absorption

Summary The aim of this study was to determine whether the intestinal absorption of vitamin B 12 in the dog is mediated by intrinsic factor. Dog gastric juice and duodenal mucosal extracts were tested for their ability to promote intestinal absorption of radioactive vitamin B 12 in vitro on guinea pig and dog intestinal mucosa homogenates and everted dog jejunal and ileal sacs. The absorption by in situ dog ileal sacs of radio B 12 alone and radio-B 12 bound to dog gastric juice or duodenal mucosal extracts into blood and liver was further studied in vivo by means of a double label isotope technique. In all systems the absorption of B 12 alone was higher than that of B 12 bound to dog gastric juice or duodenal mucosal extracts, which rather inhibited B 12 absorption. These studies do not support the notion that dog gastric juice and duodenal mucosal extracts are endowed with intrinsic factor activity and that, in the dog, physiological B 12 absorption in the intestine is mediated by intrinsic factor.

Hepatic uptake and blood clearance of free Co57B12 and of Co57B12 bound to gastric juice after intravenous injection in man

SummaryIn 9 normal subjects, hepatic uptake and blood clearance of radioactivity were measured for 7–10 days after the intravenous administration of a tracer dose of Co57B12 alone. In 5 of these subjects, the measurements were repeated after intravenous administration of Co57B12 bound to normal human gastric juice (NHGJ). Administration of B12 bound to NHGJ resulted in an augmented hepatic uptake of the vitamin at 1 hr. significantly greater than that for B12 alone. This difference became less marked with time and was not significant at the end of 1 week. Blood clearance during the first 24 hr. following administration was significantly slower for NHGJ-bound B12 than for B12 injected alone.These and other findings from our laboratory suggest that IF-related gastric B12 binders and some non-IF-related binders may function in the hepatic uptake of vitamin B12, if administered intravenously in man.