High doses of neutralizing antacid (Maalox 60ml) or sucralfate (2.0g) was orally given each to five healthy males together with oral ranitidine (150mg) after fasting, and their effects on the blood concentration of ranitidine were investigated. The blood concentration of ranitidine was decreased either by Maalox or by sucralfate, compared to that after the administration of ranitidine alone. The area under the plasma concentration curve (AUC0→∞) was also decreased significantly: by 27% after ranitidine plus Maalox and 40% after ranitidine plus sucralfate, suggesting decrease in ranitidine absorption. When ranitidine is taken together with large amount of antacids (e.g. in cases of UGIT bleeding) or with sucralfate (e.g. in the usual treatment of peptic ulcer), the dosing schedule should be considered in order to avoid possible decrease in ranitidine absorption.
Contact pH value of the rectal mucosa in 91 patients with ulcerative colitis was measured and was correlated with the activity of the disease and the inflammatory grade by Matts. The mean value of contact pH on mucosal surface of rectum in healthy controls was 7.31±0.17 (mean±1SD), whereas that in patients with active ulcerative colitis was 7.05±0.14, which was significantly lower than that in healthy controls (p<0.01). The contact pH value of the rectal mucosa in patients with ulcerative colitis was inversely correlated with the grade of inflammation. The contact pH value of rectal mucosa in patients with ulcerative colitis will be one of useful indices for objective evaluation of inflammatory grade of the rectal mucosa.
Responses of plasma c-AMP to exogenous glucagon were studied in 48 patients, including 29 with liver cirrhosis (LC) and 19 with hepatocellular carcinoma (HCC), in order to investigate whether or not this response to glucagon has clinical significance for assessment of total functioning hepatic mass and prognosis of LC and HCC. Compensated liver cirrhosis (LC-C) showed significantly higher responses of plasma c-AMP than decompensated liver cirrhosis (LC-D) did (p<0.001). Furthermore, in LC-D, the patients only with ascites (an ascites group) showed better responses than other groups did, the prognosis being relatively good. On the other hand, the patients with jaundice and/or with encephalopathy showed lower responses, as compared with those complicating only ascites, and the prognosis was poor. In addition, in the group with encephalopathy, those with terminal coma showed significantly lower responses than those with chronic recurrent encephalopathy, the prognosis being extremly poor. A significant correlation between the responses of plasma c-AMP and survival time was observed. Thus, plasma c-AMP response to exogenous glucagon was proved to be useful for evaluation of prognosis in patients with LC. Many of HCC with compensated liver cirrhosis showed relatively high responses compared with LC-C without HCC. This result suggests that HCC tends to arise in well compensated liver cirrhosis. However, the responses in HCC with decompensated liver cirrhosis or largely occupied HCC showed as low as those of LC-D, the prognosis being extremly poor.
We devised a new system for simultaneous monitoring of tissue perfusion and oxygenation of the same lobe of rat liver. The tissue perfusion was monitored by measuring the clearance of electrochemically generated hydrogen, and calculating its blood flow. The tissue oxygenation was monitored by measuring the tissue oxygen tension using a polarographic microelectrode. This system was then applied to investigate the effects of intravenously infused liver extract and FAD on hepatic perfusion and oxygenation in the rat. Normal saline was used as control. When normal saline was infused, the mean blood flow (under the constant generating current of 5μA, 20sec) and the mean oxygen tension were 47.4ml/min/100g and 18.1mmHg, respectively. The infusion of liver extract increased both the blood flow and oxygen tension, whereas only oxygen tension increased when FAD was infused. In both cases, the increase of oxygen tension was statistically significant when compared with that of normal saline. The analysis using this system is useful in obtaining the indices of hepatic microcirculation, and it can be applied to study the effects of drugs on liver.
Under percutaneous transhepatic cholangioscopy (PTCS), operative cholangioscopy or stereoscopy, the mucosa of the common bile duct was observed on 87 patients with biliary tract, pancreatic or miscellaneous disease. Cholesterosis was found in 15 cases (17%). It was located in the lower part of the common bile duct in almost all cases. Foamy cells were histologically demonstrated in 6 of 15 cases. It is noteworthy that cholesterosis of the common bile duct was found in 7 cases (64%) in 11 cases of congenital dilatation of the bile duct, in which cholesterosis spots outnumbered those in other diseases. Cholesterosis of the common bile duct has been regarded as a rare finding. The present study, however, shows that this is not so rare on PTCS or stereoscopy. Cholesterosis may be one of the important and interesting findings of the common bile duct.
In order to investigate the effect of surgery in the biliary tract and pancreas upon the release of gastric inhibitory polypeptide (GIP) and insulin, a test-meal loading was performed on patients who underwent biliary tract reconstructions (jejunal interposition choledochoduodenostomy and Roux-Y choledochojunostomy) or pancreaticoduodenectomy. Although the fasting levels of plasma GIP were almost the same in both the interposition group and the Roux-Y group, the loading of the test-meal elicited a smaller response of GIP in the latter than in the former. The response of plasma insulin to the test-meal was scarcely altered in the interposition group, but was significantly diminished in the Roux-Y group, as compared with preoperative studies. In patients who undenwent pancreaticoduodenectomy, the fasting levels of plasma GIP and insulin were close to those in the control, not only before surgery but after surgery. After feeding, the preoperative levels of both GIP and insulin were similar to those of the control, while the levels of these hormones were markedly reduced after surgery. These results suggest that the release of GIP and insulin is mainly affected by the massive resection of the upper small intestine together with the head of the pancreas and the diversion of the stream of food or bile away from the proximal portion of the small intestine.
This study was conducted to clarify whether synthetic porcine gastrin-releasing peptide (pGRP) can stimulate pancreatic exocrine secretion and whether the effect is direct or CCK-mediated in rabbits. pGRP infused intravenously in anesthetized rabbits with pyloric ligation elicited a potent increase in pancreatic protein and enzyme secretion without a significant change in juice flow and bicarbonate secretion. The protein and enzyme response was correlated with the dose of pGRP from 0.1 to 2mcg/kg-hr. The effect of pGRP on pancreatic secretion was not affected by either the resection of the small intestine to exclude CCK or the resection of the small intestine with a truncal vagotomy. Furthermore, the in vitro study showed that pGRP in KHB solution significantly stimulated the liberation of amylase and lipase from the pancreatic tissue. Therefore, it was suggested that pGRP had a potent and direct stimulatory effect on pancreatic enxyme secretion without the mediation of CCK.