Novis Bh

Fibreoptic endoscopy and the use of the Sengstaken tube in acute gastrointestinal haemorrhage in patients with portal hypertension and varices.

The value of emergency upper gastrointestinal fibre-endoscopy, followed where required by the use of a modified Sengstaken tube, was studied during 84 episodes of acute bleeding in 75 patients who had evidence of portal hypertension with varices. The portal hypertension was due to alcoholic cirrhosis in 80% and to cryptogenic cirrhosis in 9% of the patients. By definition, varices were present in all patients, but in only 66% of episodes were the varices the cause of the bleed. The correct diagnosis of the source of bleeding was made at endoscopy in 89%. A Boyce modification of the Sengstaken-Blakemore tube was passed in 73% of the episodes of variceal bleeding. It effectively stopped the bleeding primarily in 85% of patients but was successful as a final definitive measure only in 46%. Furthermore, only 40% of the patients in whom the tube was passed, survived. Mortality rate could be related to the severity of the bleed and to hepatocellular dysfunction. Survival increased from 23% in those patients with jaundice, ascites, and encephalopathy on admission to 92% in those without these manifestations. The in-hospital survival rate was 52% in patients bleeding from varices and 64% in those bleeding from other causes, with an overall survival rate of 56%, indicating the poor prognosis in cirrhotic patients with gastrointestinal bleeding, irrespective of the cause.

The radiology of tuberculosis of the gastro-intestinal tract.

Abstract The radiological appearances of tuberculosis of the gastro-intestinal tract are presented. One hundred and seventeen cases were seen at the Groote Schuur Hospital over the period 1962–71. In only 44 cases was there evidence of pulmonary tuberculosis. The series included three cases of oesophageal, two of gastric, three of pyloroduodenal, and ten of mesenteric lymph-node tuberculosis, 17 cases of malabsorption or protein losing enteropathy, three of small bowel strictures, 11 ileocaecal lesions, 10 colonic tubercle and 58 of tuberculous peritonitis. The appearance of tuberculosis of the gastro-intestinal tract radiologically depends on the presence of ulceration, fibrosis, enlarged lymph nodes, or caseous lesions with abscess formation. The differentation of tuberculosis from neoplasms or Crohns disease is discussed and the difficulty and limitations of radiology in this condition is stressed.

The Cephalic Phase of Pancreatic Secretion in Man

Five cases with achlorhydria have been investigated by sham-feeding to establish the existence of a cephalic phase of pancreatic secretion in man. The results of the study showed that as far as the individual enzymes were concerned, the most consistent and greatest response to sham-feeding was found in the concentration and output of trypsin and lipase. A rise in chymotrypsin concentration and output was also found but the amylase response was more variable. Basal volume and bicarbonate concentration was maintained. Sham-feeding would appear to produce a highly concentrated pancreatic juice. The mechanism of the cephalic phase of pancreatic secretion is discussed.

Serum immunoglobulins in calcific pancreatitis

Serum immunoglobulin concentrations were measured in 40 patients with calcific pancreatitis. A significant elevation of the mean serum IgA and IgG concentration when compared with a control group was found. The IgA was raised in 50% and the IgG in 27·5% when the individual results were assessed. The IgA did not appear to be of the secretory type. The possible significance of the raised IgA and IgG is discussed with reference to local pancreatic IgA production, autoimmune factors in chronic pancreatitis, and the ductal protein plugs in this disease.

The relation between gastric acid secretion and body habitus, blood groups, smoking, and the subsequent development of dyspepsia and duodenal ulcer

One hundred and seventy-six students free of gastrointestinal disease were studied to establish normal acid secretion values for healthy male and female students by the augmented histamine test and to re-examine the relationship between gastric acid secretion and ABO blood groups, body weight, fat-free body mass, height, degree of ectomorphy and mesomorphy, the number of cigarettes smoked per day, and serum cholesterol. A prospective study was then carried out on gastric acid secretion and the subsequent development after 10 years of duodenal ulcers or dyspepsia. Young, healthy medical students have a fairly high mean basal and maximal acid output. There was very little difference in the mean acid outputs of the various ABO blood groups. A significant correlation was shown between acid output and body weight and fat-free body mass, but not with the other measurements of body build. Basal acid output was also related to the number of cigarettes smoked per day. Three students who subsequently developed duodenal ulcers all had a preexistent high level of acid secretion. The acid output was, however, similar in the groups who developed significant or minor dyspepsia or who remained asymptomatic.

Exocrine pancreatic function in intestinal malabsorption and small bowel disease

Exocrine pancreatic function was studied by means of secretin/pancreozymin stimulation in 50 patients with small bowel disease. Forty-five patients had clinical and biochemical evidence of malabsorption. In none of the patients was there evidence of primary pancreatic disease. Impaired amylase or bicarbonate concentration was found in 62% of the patients; however, in only 6 was there gross pancreatic insufficiency and in only 2 of these was the volume output also decreased. Insufficient dietary protein intake, malabsorption and protein loss in the bowel, with subsequent amino acid and albumin deficiency, are suggested as major causes of pancreatic dysfunction in small bowel disease. In some cases a combination of factors, including folic acid deficiency and chronic malnutrition secondary to intestinal disease with weight loss, are likely causes. In this series, pancreatic function was abnormal in 78% of patients with low serum albumin and 52% of patients with normal serum albumin. The pancreatic insufficiency in intestinal disease is rarely as pronounced as that found in pancreatic steatorrhea; there is usually little difficulty in distinguishing the two, although the secretin/pancreozymin test is not completely discriminatory.Exocrine pancreatic function was studied by means of secretin/pancreozymin stimulation in 50 patients with small bowel disease. Forty-five patients had clinical and biochemical evidence of malabsorption. In none of the patients was there evidence of primary pancreatic disease. Impaired amylase or bicarbonate concentration was found in 62% of the patients; however, in only 6 was there gross pancreatic insufficiency and in only 2 of these was the volume output also decreased. Insufficient dietary protein intake, malabsorption and protein loss in the bowel, with subsequent amino acid and albumin deficiency, are suggested as major causes of pancreatic dysfunction in small bowel disease. In some cases a combination of factors, including folic acid deficiency and chronic malnutrition secondary to intestinal disease with weight loss, are likely causes. In this series, pancreatic function was abnormal in 78% of patients with low serum albumin and 52% of patients with normal serum albumin. The pancreatic insufficiency in intestinal disease is rarely as pronounced as that found in pancreatic steatorrhea; there is usually little difficulty in distinguishing the two, although the secretin/pancreozymin test is not completely discriminatory.

A comparison between secretin alone and sequential and simultaneous secretin and cholecystokinin administration in the assessment of pancreatic function

Pancreatic volume, bicarbonate and enzyme secretion were studied after sequential and after simultaneous secretin and cholecystokinin (CCK) stimulation and the results compared. No statistical difference between sequential or simultaneous stimulation was noted. A comparison of secretin alone with simultaneous secretin plus cholecystokinin stimulation showed that the combination yielded a significantly higher trypsin concentration. Volume and bicarbonate were unchanged.