Stanley H. Lorber

Effect of secretin and cholecystokinin on gastric emptying and gastric secretion in man.

The effects of secretin and cholecystokinin on gastric emptying and gastric secretion of acid were studied in man. The intravenous administration of secretin in a dose of 1 U per kg of body weight caused a significant decrease in gastric emptying measured 15 min after the intragastric instillation of 500 ml of normal saline solution in 10 subjects. The mean percentage of gastric emptying following the administration of secretin was 40.7% as compared with a control value of 85.2%. A decrease in gastric emptying of similar magnitude was observed in 9 subjects following the intravenous administration of cholecystokinin in a dose of 0.5 Ivy dog unit per kg. Gastric secretion of acid was stimulated by a continuous intravenous infusion of pentagastrin or histamine acid phosphate and both gastric and duodenal contents were collected simultaneously. The intravenous administration of secretin in a dose of 1 U per kg resulted in marked inhibition of acid secretion stimulated by either pentagastrin in a dose of 0.12 μg per kg per hr or histamine acid phosphate in a dose of 0.02 mg per kg per hr in 10 subjects. Secretin appeared to have a greater inhibitory effect on acid secretion stimulated by pentagastrin than on histamine-stimulated secretion. Inhibition of acid secretion similar in magnitude to that produced by secretin was observed following the administration of cholecystokinin in a dose of 1 U per kg. Gastric secretion of acid stimulated by pentagastrin in a dose of 6 μg per kg per hr or histamine acid phosphate in a dose of 0.04 mg per kg per hr, however, was not influenced by the same dose of secretin in a dose similar to that which inhibited smaller doses of these stimuli.

Controlled trial of medical therapy for active upper gastrointestinal bleeding and prevention of rebleeding

UNLABELLED This multicentered, placebo-controlled trial evaluated the efficacy of medical therapy to stop bleeding in 285 patients with active upper gastrointestinal bleeding (bleeding phase) and 194 patients who had ceased gastrointestinal bleeding and in whom therapy was instituted to prevent rebleeding during the same hospitalization (prevention phase). Patients in the bleeding phase were given cimetidine (300 mg every six hours) or intravenous placebo. There was no significant overall difference between intravenous cimetidine (71 percent) and placebo (77 percent) in stopping acute upper gastrointestinal bleeding. There was also no significant difference noted between intravenous cimetidine and placebo when specific bleeding lesions were evaluated. Once gastrointestinal bleeding had stopped, recurrence of bleeding while receiving prevention therapy (cimetidine tablets 300 mg one three times a day and at bedtime, or Mylanta II liquid 30 ml every hour, or cimetidine plus hourly antacids, or placebo) was evaluated in 194 of the patients in the bleeding phase. Twenty-four percent (12 of 51 patients) rebled while receiving cimetidine, 13 percent (five of 39 patients) rebled while receiving hourly antacids, 11 percent (six of 54 patients) rebled while receiving cimetidine plus hourly antacids, and 26 percent (13 of 50 patients) rebled while receiving placebo. None of these prevention regimens reached statistical significance (p = 0.13). Evaluation of specific bleeding lesions within this group also failed to show any significant value of prevention therapy. IN CONCLUSION (1) intravenous cimetidine offers no advantage over placebo in stopping active upper gastrointestinal bleeding; (2) the occurrence of rebleeding during the same hospitalization does not appear to be significantly affected by any of the medical regimens used for prevention. These findings would suggest that the cessation of active bleeding and the prevention of recurrent upper gastrointestinal bleeding during a single hospitalization appear to be unaffected by therapy directed at acid neutralization or reduction.

Characterization of a Hyperactive Segment at the Rectosigmoid Junction

During a study of intraluminal motor patterns of the colon and rectum, spontaneous wave activity of a continuous complex type was observed at the rectosigmoid junction in constipated subjects. To assess the frequency and characteristics of this hyperactive segment, 36 subjects with colonic motor disorders and 12 healthy controls were studied. Eighteen of 24 patients with constipation (75%) and 1 of 7 subjects with asymptomatic diverticulosis exhibited a persistent hyperactive segment at the rectosigmoid junction. Neither secretin nor cholecystokinin influenced the wave activity of the hyperactive segment. In contrast, atropine and glucagon inhibited markedly all wave activity and decreased the motility index of this segment significantly, suggesting overactivity of the muscarinic effector cells. It is concluded that a segmental area of overactivity exists at the rectosigmoid junction in most constipated subjects regardless of their underlying disorders.

Effects of ethanol on the gastric mucosa of the Heidenhain pouch of dogs.

The effect of ethanol on the mucosa of the Heidenhain pouch in dogs was studied by instilling ethanol in concentrations of 10, 20 and 40% using changes in ionic fluxes of an acid solution and mucosal alterations to measure the effects of ethanol. The instillation of 20 or 40% ethanol resulted in increased insorption of H+ and increased exorption of Na+ into the pouch lumen. Following the administration of 20 and 40% ethanol, the mucous layer and mucin content of the lining epithelial cells decreased markedly. Hourly bathing with the acid test solution aggravated the injury and induced bleeding, but hourly instillation of a buffer solution minimized the damage. Ionic fluxes returned to pre-ethanol levels 2 hr after 20% ethanol and 3–4 hr after 40% ethanol. Partial restoration of mucosal damage occurred in 4–6 hr and was complete in 24 hr.

Effect of Secretin and Cholecystokinin on the Transport of Electrolyte and Water in Human Jejunum

The effect of natural porcine secretin and cholecystokinin on the transport of electrolytes and water in human jejunum was studied in eight normal volunteers utilizing a triple lumen tube technique of perfusion. These hormones were observed to inhibit significantly (P

Effects of glucagon and secretin on food- or morphine-induced motor activity of the distal colon, rectum, and anal sphincter

The effects of glucagon and secretin on food- or morphine-induced motor activity of the distal colon, rectum, and internal anal sphincter were investigated in 12 healthy subjects. Intraluminal pressure changes were measured using a triple-lumen polyvinyl tube assembly with 3 side orifices. Glucagon, administered intravenously, caused significant inhibition of food- or morphine-induced motor activity of both the distal colon and rectum. In contrast, secretin did not suppress morphine-induced motor activity but did significantly inhibit food-stimulated motor activity of the distal colon. The inhibitory effect of secretin on motor activity of the rectum was insignificant. Morphine, but not food, elevated the pressure of the anal sphincter which was not effected by glucagon or secretin. Hyperglycemia, produced by the infusion of 5% glucose, had no effect on motor activity. These studies demonstrate that glucagon but not secretin, in the doses employed, inhibits morphine-induced motor wave activity of both the distal colon and rectum and that this inhibitory effect is not secondary to hyperglycemia. Furthermore, the rise in anal sphincter pressure is not affected by glucagon or secretin.

Effect of intraduodenal administration of essential amino acids and sodium oleate on motor activity of the sigmoid colon.

The effects of the intraduodenal administration of solutions of essential amino acids and 5% sodium oleate on motor activity of the sigmoid colon was studied in 11 normal subjects and in 1 patient with a previous antrectomy. A marked increase in motor activity was observed during administration of both solutions in all subjects, including the patient with antrectomy. Intravenous infusion of pentagastrin, in a dose of 0.6 μg per kg per hr, in 6 subjects did not influence motor activity of the sigmoid colon significantly. These observations suggest that the increased motor activity of the sigmoid colon, observed in response to exposure of the duodenum to essential amino acids and sodium oleate, could result from release of endogenous cholecystokinin.

Effects of chronic administration of ethanol on gastric secretion of acid in dogs.

The effects of an excessive intake of ethanol on gastric acid secretion was investigated up to 14 months in 6 dogs. After the daily administration of 4.4 g/kg of ethanol as a 40% solution through the esophagostomy was initiated, mean daily secretion of acid from a Heidenhain pouch increased from 5.22 to 12.55 mEq during the first month and remained elevated throughout the entire period of observation. The mean maximal acid output (MAO) increased also from 19.54 to 26.3 mEq within 1 month after the daily administration of ethanol began. The increased MAO, however, tended to decrease with the passage of time and at the end of 6 months, it was no different, statistically, from that of the pre-ethanol level. Factors possibly responsible for the increase in acid secretion are discussed.

Roentgen Studies of Esophageal Transport in Patients with Dysphagia Due to Abnormal Motor Function

Summary Esophageal transport of a water-barium mixture was studied in 40 patients with dysphagia. From the changes produced in transport by parasympathetic stimulation or depression, we can divide these patients into two groups: one with cardiospasm and a second group which we propose to call dysrhythmia of the esophagus. Characteristic of cardiospasm was esophageal dilatation and retention of the water-barium mixture in the esophagus during the control period. Spasm of the lower esophagus, frequently associated with substernal pain and vomiting, occurred in this group after the administration of Urecholine. Dibuline relaxed the Urecholine-induced spasm and resulted in slightly better esophageal emptying. Xitroglycerin was the most effective drug in promoting esophageal evacuation in the cardiospasm group. The patients with dysrhythmia had greater intermittency of symptoms, and dilatation of esophagus was not found in this group. Hiatal hernia and/or constriction ring of the lower esophagus were found in 16 of 23 in this group, and esophagitis occurred in approximately 25 per cent. Characteristic of patients with dysrhythmia was the disorganization of esophageal motor waves. Urecholine administration resulted in improvement in esophageal emptying but Dibuline increased the esophageal retention. In conclusion, our results indicate that abnormal esophageal transport may result, aside from anatomical obstructive lesions, from one of two disturbances: one, cardiospasm, the result of damaged or absent parasympathetic plexuses of the lower esophagus including the sphincters and/or vestibule; the other due to disorganized motor function of the esophagus which we suggest be called dysrhythmia of the esophagus. These two varieties may be separated by their respective pharmacologic responses to parasympathomimetic and parasympatholytic drugs. The response to these drugs not only enables a differential diagnosis of the type of abnormal esophageal transport but also supplies a basis for therapy.

Hemangioendotheliomaitosis of the Liver: A 12-year follow-up

Hemangioendothelioma of the liver is a rare tumor. A case is reported of a middle-aged woman who presented with hepatomegaly and ascites, and who has been followed for over 12 years. The clinical features, pathological, radiographic, portal hemodynamic, and metabolic changes are presented.