Endotoxin temporarily impairs canine jejunal absorption of water, electrolytes, and glucose

OBJECTIVE: To evaluate the usefulness of a portable, computer-based, oscillometric, noninvasive blood pressure monitor for the automatic surveillance of postoperative infrainguinal bypasses. DESIGN: Prospective unblinded study. SETTING: Regional tertiary care Veterans Affairs medical center. PATIENTS: A total of 60 limbs were examined in 3 groups (n = 20 in each group): normal, asymptomatic volunteers; older patients with symptomatic peripheral vascular disease; and patients who had undergone infrainguinal bypass procedures. INTERVENTIONS: Noninvasive blood pressure monitor pressures, complete lower extremity arterial studies with Doppler ankle-brachial index (ABI), segmental pressures, and pulse volume recordings were performed in all groups. The patients who had undergone surgery also had hourly noninvasive blood pressure measurements taken. MAIN OUTCOME MEASURES: Ankle-brachial indices obtained with the noninvasive blood pressure monitor were compared with simultaneous manual Doppler ABIs and pulse volume recordings. RESULTS: There was a significant overall correlation between the Doppler-derived ABIs and automatic oscillometric values (r = 0.89, P < .001). Although there was a slight difference in absolute values (+/-SEM) (0.90 +/- 0.03 vs 0.84 +/- 0.03, respectively), an excellent correlation was found between the 2 methods in the clinically relevant range of ABI values between 0.60 and 1.10. The oscillometric method, however, overestimated the ABI when it was less than 0.60 by the Doppler method (0.61 +/- 0.02 vs 0.44 +/- 0.03, P < .001) and underestimated it when it was more than 1.10 (1.05 +/- 0.02 vs 1.16 +/- 0.01, P < .001). (All values given as +/-SEM.) Oscillometric overestimation correlated with depressed pulse volume recording waveforms (P < .001) or diminished pulse volume recording amplitudes of less than 10 mm (P < .001). CONCLUSION: The automatic oscillometric monitor provides a useful, accurate, objective, and quantitative method for postoperative bypass graft surveillance.     

Sodium balance and jejunal ion and water absorption in Dahl salt-sensitive and salt-resistant rats

1. Apparent Na+ absorption and jejunal water, Na+, Cl- and K+ absorption in vivo was evaluated in young (prepubertal) and adult Dahl salt-sensitive (DS) and Dahl salt-resistant (DR) rats kept on a low-salt (low-salt rat chow + distilled water) or a high-salt diet (HS1 diet: NaCl-enriched rat chow + distilled water; HS2 diet: standard rat chow + 1% saline as drinking fluid). These two high-salt diets were chosen because the HS1 regimen has been shown to increase blood pressure (BP) in DS rats and the HS2 regimen decreases jejunal water and ion absorption in normotensive Wistar rats. 2. The HS1 or HS2 diet increased BP in young and adult DS rats but had no effect on the BP of young and adult DR rats. 3. Irrespective of dietary Na+ intake, no significant difference of apparent Na+ absorption (dietary Na+ intake minus faecal Na+ output) was observed between DS and DR rats both in prepuberty and in adulthood. Young DS rats kept on a low-salt diet had increased faecal Na+ output in comparison with young DR rats. This difference disappeared with increasing dietary Na+ intake. 4. There were no interstrain differences on the effect of a high-salt diet on jejunal Na+ and K+ absorption in young and adult DS and DR rats. However, high-salt diets stimulated jejunal water and Cl- absorption in young DS rats, but not in adult DS rats and young and adult DR rats. Interstrain differences of water and Cl- absorption were observed only in adulthood. Adult DR rats kept on an HS2 diet absorbed more water and Cl- than their DS counterparts. 5. Our results do not indicate any abnormalities of apparent Na+ absorption and jejunal water and electrolyte transport in DS and DR rats. We conclude that there is no relationship between intestinal Na+ absorption and sensitivity or resistance to induction of experimental salt hypertension.     

A case of biliary cystadenoma with obstructive jaundice

Biliary cystadenoma is a rare cause of obstructive jaundice. We report a case of a 78-year-old Japanese man with biliary cystadenoma presenting repetitive abdominal pain and jaundice. Ultrasound sonography revealed a hyperechoic mass in the left lateral lobe of the liver. Histological examination revealed a biliary cystadenoma. Intracystic hemorrhage was assumed to be the cause of obstruction of the bile ducts.     

The role of bile and bile acids in bacterial translocation in obstructive jaundice in rats

Eight independent chl (chromosome loss) mutants were isolated using yeast haploid strain disomic for chromosome III. In these mutants, chromosome III is lost during mitosis 50-fold more frequently than in the wild-type strains. chl mutants are also incapable of stable maintenance of circular and linear artificial chromosomes. Seven of the eight mutations are recessive, and one is semidominant. Complementation tests placed these mutants into six complementation groups (chl11 through chl16). Based on tetrad analysis, chl12, chl14 and chl15 correspond to mutations in single nuclear genes. Tetrad analysis of the other mutants was not possible due to poor spore viability. Complementation analysis was also carried out between collection of chl mutants and ctf mutants (chromosome transmission fidelity) (Spencer et al., 1990). The chl3, chl4, chl8, chl12 and chl15 mutants were unable to complement ctf3, ctf17, ctf12, ctf18 and ctf4, respectively. Three CHL genes were mapped by tetrad analysis. The CHL3 gene is placed on the right arm of chromosome XII, between the ILV5 (33.3 cM) and URA4 (21.8 cM) loci. The CHL10 gene is located on the left arm of chromosome VI, 12.5 cM from the centromere. The CHL15 gene is tightly linked to the KAR3 marker of the right arm of chromosome XVI (8.8 cM). The mapping data indicate that these three genes differ from other genes known to affect chromosome stability in mitosis. Therefore, the total number of the CHL genes identified (including those described by us earlier) is 13 (CHL1-CHL10, CHL12, CHL14 and CHL15).     

Inhibitory mechanisms of oleanolic acid 3-O-monodesmosides on glucose absorption in rats

We examined the action mechanism of oleanolic acid 3-O-monodesmoside, momordin Ic (1), and oleanolic acid 3-O-glucuronide (2) for the inhibitory effect on the increase in serum glucose levels in oral glucose-loaded rats. Although 1 and 2 dose-dependently inhibited the increase in serum glucose levels in oral glucose-loaded rats, these compounds showed no significant effects on serum glucose levels in normal rats, intraperitoneal glucose-loaded rats, and alloxane-induced diabetic mice. Furthermore, 1 and 2 were found to suppress gastric emptying in rats, and also to inhibit the glucose uptake in rat small intestine concentration dependently in vitro. These results indicate that 1 and 2 given orally have neither insulin-like activity nor insulin releasing-activity. 1 and 2 apparently inhibited glucose absorption by suppressing the transfer of glucose from the stomach to the small intestine and by inhibiting the glucose transport system at the small intestinal brush border.     

A rare cause of obstructive jaundice: peripancreatic pseudoaneurysm

We report the case of a 54-year-old-man with alcoholic calcified chronic pancreatitis complicated by jaundice and abdominal pain. Investigations (Doppler ultrasonography examination and computed tomography scan) showed peripancreatic pseudoaneurysm of the posterior and inferior pancreatico-duodenal artery and a dilatation of the common bile duct. Selective embolization of the pseudoaneurysm resulted in rapid regression of both jaundice and abdominal pain. Common bile diet compression is a rare complication of peripancreatic pseudoaneurysm. Selective embolization seems to be the first line treatment in this indication.     

A controlled trial of choleretic and hepatoprotective actions of Livzon and dehydrocholic acid in a model of obstructive jaundice in albino rats

Ascites becomes refractory to medical treatment in nearly 10% of cirrhotic patients, who then require repeated large-volume paracentesis. In this prospective study we evaluated the use of transjugular intrahepatic portosystemic shunt (TIPS) in 30 patients with refractory ascites. TIPS was successful in all and resulted in a 54% reduction in portacaval gradient (from 22.8 +/- 0.8 to 10.4 +/- 0.6 mm Hg). Ascites became easily controlled with diuretics in 26 patients following TIPS. Ascites recurrence associated with shunt stenosis was observed during follow-up in eight patients; revision could be undertaken in five of them and resulted in good control of ascites. In responders, a marked decrease in plasma aldosterone and renin activity, a reduction in serum creatinine, and a rise in urinary sodium excretion were observed. Creatinine and inulin clearances improved significantly; PAH clearance remained unchanged. However, new-onset or worsening hepatic encephalopathy was seen in 14 patients. Severe disabling chronic encephalopathy occurred in five patients; it could be reversed successfully by balloon occlusion of the shunt in three. The cumulative survival rate was 41 and 34% at 1 and 2 years, respectively. In summary, TIPS can control refractory ascites in a majority of patients but is associated with a high rate of chronic disabling HE. In addition, the survival rate is poor. Randomized trials are needed to evaluate the exact role of TIPS in the management of refractory ascites. It is unlikely to improve survival but can ameliorate quality of life in nontransplant candidates and be useful as a bridge to transplantation, in particular, to improve denutrition associated with longstanding tense ascites.     

Impaired response of gastric vessels to prostaglandin E2 in rats with persistent obstructive jaundice

Osteogenesis imperfecta (OI) is an inheritable disorder characterized by bone fragility with various symptoms of connective tissue disorders. OI is commonly classified by Sillence's classification into four types according to the clinical features. The cardinal symptom is pathologic fracture, which is often recognized before birth, is frequent during infancy and childhood, then decreases at puberty. Bone mineral density is markedly decreased in OI, especially of the lumbar spine. Bone deformities are frequently observed in the long bones of the extremities, and spinal deformities and compression fractures are also common. Growth retardation is extremely severe, especially in type III. Calcitonin has been the most common therapy for OI. Recently, bisphosphonates have been found to be potent drugs that increase bone mass in OI patients. To prevent further fracture or bone deformity, appropriate orthopedic managements, including intramedullary rodding, are critically important. Growth hormone is effective in stimulating bone growth during childhood. The pathogenesis of OI is quantitative or qualitative abnormalities of type I collagen. The clinical features of each type usually correspond to the type of mutation. Several possibilities for gene therapy have been proposed.     

Influence of pyridoxine supplementation on vitamin B-6 levels in milk of rats deficient in the vitamin

Levels of vitamin B-6 in milk from pyridoxine deficient dams were used as an indicator of the ability of pyridoxine to protect offspring against the effects of the deficiency. Sprague Dawley rats were fed a basal diet containing 30.0 (control) or 1.2 (deficient) mg pyridoxine-HC1/kg diet from weaning throughout growth, gestation and until 5 days postpartum. At this time, deficient dams were supplemented by a single intraperitoneal injection of 600 mug pyridoxine-HC1, or by adding 30 or 60 mg pyridoxine-HC1/kg to the diet. The vitamin B-6 content in milk form the group supplemented by injection exceeded the control level of 38.8 mug/100 ml milk 30 minutes after the injection, and reached a peak level of 110.7 mug/100 ml at 4 hours with a subsequent decline to 27mug/100 ml at 20 hours. In rats supplemented orally with 30 or 60 mg pyridoxine-HC1/kg diet, the vitamin B-6 level in the milk reached the control value in 24 and 6 hours, respectively. At 120 hours, orally supplemented dams had significantly higher levels of vitamin B-6 in the milk than control animals. Vitamin supplementation of dams by a single injection of pyridoxine-HC1 was sufficient to overcome the pyridoxine deficiency syndrome in the pups, but was not adequate for optimum growth.     

Immune dysfunction in patients with obstructive jaundice, mediators and implications for treatments

Patients with obstructive jaundice have an increased perioperative complication rate. Sepsis, bleeding, wound problems, renal and liver malfunction are all seen in these patients. Assessment of immune function has been an active research area in these patients. This review will examine various aspects of immune functions in obstructive jaundice, discuss the recent research results and controversies and then go on to discuss the relevant mediators of immune function and some possible implications for treatment.     

Polyethylene glycol-modified bilirubin oxidase improves hepatic energy charge and urinary prostaglandin levels in rats with obstructive jaundice

BACKGROUNDS/AIMS: No study has so far been conducted to clarify whether the presence of hyperbilirubinemia is detrimental to liver and renal functions. In the present study, the effects of polyethylene glycol-modified bilirubin oxidase (PEG-BOX) therapy on liver and renal function tests, hepatic energy charge and urinary prostaglandin levels were evaluated in a rat model of obstructive jaundice. METHODS: Sprague-Dawley rats were used in the experimental model of obstructive jaundice. PEG-BOX or an equivalent amount of PEG alone was intravenously injected into the animals and sampling of blood and urine, and liver harvesting were done sequentially after bile duct ligation. RESULTS: Conventional liver function tests showed no difference between PEG-BOX and control groups. However, bilirubin concentrations in the peripheral blood and liver tissue specimens markedly decreased, and the hepatic energy charge significantly increased in the PEG-BOX group as compared to controls. The blood concentration of bile acid was lower, but its urinary excretion was higher in the PEG-BOX group than in the control group. In vitro incubation of PEG-BOX with serum from rats with obstructive jaundice decreased the concentration of bilirubin but not that of bile acid. The urinary levels of prostaglandin E2 and the thromboxane B2/6-keto-prostaglandin Fla ratio were significantly lower in the PEG-BOX group than in the control group. CONCLUSIONS: The systemic reduction of bilirubin concentration may contribute to normalization of the urinary levels of prostaglandins and thromboxane B2, to decrease in serum bile acid levels, and to improvement of the hepatic energy charge in obstructive jaundice. These findings suggest that preoperative improvement of jaundice may be beneficial to patients with obstructive jaundice.     

Nerve conduction velocity in man: influence of glucose, somatostatin and electrolytes

Insufficient metabolic control in diabetes mellitus is associated with a reversible reduction in nerve conduction velocity, but the mechanism behind this phenomenon is unknown. To examine the effect of acute hyperglycaemia on nerve conduction eight non-diabetic men (20-49 years of age) with no signs of peripheral neuropathy were studied before and after 3 h of hyperglycaemic clamping (plasma glucose approximately 15 mmol/l), while insulin secretion was suppressed by somatostatin [Study 1]. Nerve conduction velocity, as determined in the proximal part of the median nerve, fell by 2.8 +/- 3.0 m/s (2p-value: 0.033). However, during euglycaemic clamping (plasma glucose approximately 5 mmol/l) in five non-diabetic men (19-38 years of age) infused solely with somatostatin [Study 2], a comparable decrement in nerve conduction velocity was found (1.7 +/- 1.3 m/s, 2p-value: 0.043). In both studies relative hypoinsulinaemia was present. Serum-sodium decreased significantly (143 +/- 1 mmol/l vs 137 +/- 1 mmol/l [Study 1] and 143 +/- 1 mmol/l vs 142 +/- 2 mmol/l [Study 2]), while serum-potassium increased. In conclusion, the slight but significant reduction in nerve conduction velocity observed in both studies appears to be correlated to electrolyte changes. However, an effect of hypersomatostatinaemia or the hormonal changes associated with this cannot be excluded, while short-term hyperglycaemia per se seems to be without effect on nerve conduction velocity.     

Influence of beta carotene, vitamin E, and vitamin C on endogenous antioxidant defenses in erythrocytes

OBJECTIVE: To evaluate the in vivo radical scavenger activity of vitamin E, vitamin C, and beta carotene on erythrocyte membranes. DESIGN: A prospective, open trial without placebo. SETTING: Department of Clinical Pharmacy. PATIENTS: Ten healthy volunteers being supplemented with beta carotene, vitamin E, and vitamin C. MEASUREMENTS: Erythrocytes were incubated in water bath with 2,2' azobis (2 amidinopropane) hydrochloride (AAPH). AAPH decomposes spontaneously at 37 degrees C to generate free radicals inducing membrane cellular damage and hemolysis. The absorbance was measured at 405 nm at 0, 30, and 60 min, and then every 20 minutes for four hours. The time for 50 percent of maximal hemolysis (T50%), which expresses the radical scavenger activity of erythrocytes, was determined. RESULTS: The physiologic T50% value determined in 52 healthy volunteers is 117 +/- 12 min. Patients receiving these supplements have a higher value of T50% (143.2 +/- 11.6 min at 30 d and 145.7 +/- 10.5 min at 60 d) than the physiologic value (p < 0.001). CONCLUSIONS: These data suggest that vitamin C, vitamin E, and beta carotene stimulate the radical scavenger activity of erythrocyte membranes after 30 days.     

A rare case of severe acute pancreatitis complicated with pancreatic pseudocysts, obstructive jaundice and intraperitoneal hemorrhage

A 58-year-old man visited our hospital because of back pain. Blood examinations revealed the presence of acute inflammation and an increase of pancreatic enzymes. Abdominal computed tomography indicated pseudocysts in the pancreas. The patient was diagnosed as having acute pancreatitis with pseudocysts formation. During the course of the disease, a newly formed pseudocyst in the pancreatic head compressed the common bile duct, leading to the obstructive jaundice. In addition, the rupture of a pseudocyst in the pancreatic tail caused intraperitoneal hemorrhage. This is an interesting case of acute pancreatitis with pseudocysts in which two rare complications developed.     

Relative merits of ultrasonography, computed tomography and cholangiography in patients of surgical obstructive jaundice

Fifty consecutive patients with surgical obstructive jaundice were evaluated prospectively with ultrasonography (US), computed tomographic scans (CT scan) and cholangiography-percutaneous transhepatic cholangiography (PTC) or endoscopic retrograde cholangio-pancreaticography (ERCP). The diagnostic accuracy of ultrasound in defining the level of obstruction was 86% as compared to 86% and 94.8% for CT scan and cholangiography, respectively. To measure the etiology of the obstruction, the accuracy of ultrasound, CT scan and cholangiography were 84%, 86% and 75%, respectively. The sensitivity of CT scans and cholangiography in the diagnosis of choledocholithiasis was 100%, 81.8% and 90%, respectively, whereas specificity was 97%, 100% and 100%, respectively. Sensitivity for a diagnosis of malignant disease was 100% for both US and CT scans whereas specificity was 90% and 81%, respectively. Ultrasonography as a single radiological investigation is sufficient in the evaluation of the majority of patients with surgical obstructive jaundice. CT scan and cholangiography should be done only when US gives equivocal findings or if concomitant therapeutic procedures like basketing and stenting are also planned.