Gastroenterology
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Intraduodenal infusion of 0.05-0.5 N hydrochloric acid dose-dependently increases serum levels of immunoreactive gastric inhibitory polypeptide (GIP) in rats. Immunoreactive GIP released by duodenal acidification is biologically active because it augments the glucose-induced release of immunoreactive insulin (IRI). This augmentation of glucose-induced IRI release by intraduodenal acid can be abolished for 30 min by simultaneous intravenous infusion of GIP-antiserum. ⋯ The GIP release is a direct effect of intraduodenal acid and is not mediated via secretin release. Injection of secretin in supraphysiologic doses does not change serum levels of immunoreactive GIP. However, such secretin injections induce a short-term insulin release and a decrease in serum glucose concentration.
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Randomized Controlled Trial Clinical Trial
Esophageal tamponade for bleeding varices. Controlled trial between the Sengstaken-Blakemore tube and the Linton-Nachlas tube.
To investigate the effectiveness and safety of the Sengstaken-Blakemore (SB) tube compared with the Linton-Nachlas (LN) tube, a randomized clinical trial was carried out between both types of balloon. Seventy-nine patients suffering from gastrointestinal bleeding attributed to esophagogastric varices were included in the study. ⋯ Better tolerance and greater effectiveness were obtained when the SB tube was applied without external traction. The usefulness of esophageal tamponade for bleeding varices was higher when performed within 6 hr of the onset of hemorrhage.
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In an effort to avoid the potentially dangerous side effects of vasopressin infusions, we attempted to reproduce mechanically the splanchnic hemodynamic changes induced by vasopressin without its systemic effects. Superior mesenteric arterial pressure was reduced to 50 to 70 mm Hg for 30 to 60 min in 10 normal dogs by partial balloon obstruction of the superior mesenteric artery. ⋯ Partial balloon obstruction caused an increase in cardiac output (1950 +/- 203 versus 2317 +/- 376 ml per min) and mean arterial pressure 138 +/- 6 versus 151 +/- 7 mm Hg), whereas heart rate did not change. Partial balloon obstruction of the superior mesenteric artery caused similar changes in splanchnic hemodynamics to those of vasopressin infusions into the superior mesenteric artery, but without the potential deleterious effects of vasopressin on systemic hemodynamics.
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A cirrhotic patient with hemoperitoneum was found, at laparotomy, to be bleeding from variceal vessels in the peritoneum lateral to the ascending colon. Radiological in vestigations before surgery did not identify the source of blood loss. Despite hemostasis being obtained, the patient died postoperatively. The 5 previously reported cases of intraabdominal bleeding from variceal vessels are reviewed.
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Comparative Study
Elevations in skin tissue levels of bile acids in human cholestasis: relation to serum levels and topruritus.
To define the relationship of bile acid retention to the pruritus of cholestasis, we quantified individual bile acids in serum, acetone swabs of skin, and skin tissue in 13 patients with cholestasis undergoing laparotomy and in 8 controls. There was no consistent relationship between pruritus and concentrations of either total or individual bile acids in serum. ⋯ Concentrations of bile acids on the skin surface, which were lower than those reported by others, did not correlate with pruritus, and were decreased by simple soap and water washing. These data indicate that the pruritus of cholestasis is not directly related to the skin tissue concentration of any of the major bile acids, although a relationship to a particular molecular form of bile acids could not be excluded.