Visual field defects in optic neuritis and anterior ischemic optic neuropathy: distinctive features

BACKGROUND

We analyzed the value of visual-field defects in the differential diagnosis of optic neuritis (ON) and non-arteritic anterior ischemic optic neuropathy (AION).

METHODS

Ninety-nine consecutive patients with acute-onset optic neuropathy formed the basis for this study. Compressive and vasculitic neuropathies were excluded. Eighty-six patients fulfilled the criteria for either ON (50 patients): < or = 35 years, normal disk, recovery of visual function, or AION (36 patients): > or = 60 years, swelling of the disk, no recovery of visual function. Without knowledge of other clinical data, visual fields obtained by Gold-mann perimetry were classified into five types of defects (forced choice). With the correct diagnosis at hand, fields were reviewed for characteristic features.

RESULTS

Forced-choice classification into defect types [%]: Central scotoma ON 68, AION 18; superior altitudinal defect ON 13 AION 7; inferior altitudinal defect ON 8, AION 52; peripheral defect ON 1, AION 5; diffuse defect ON 10, AION 18. Search for pathognomonic defects: a scotoma centered on the fixation point with a sloping border occurred exclusively in ON (25 of 50 patients). An inferior altitudinal defect with a sharp border along the horizontal meridian, particularly in the nasal periphery, occurred only in AION (10 of 36 patients). A steep centrocecal scotoma occurred in 3 of the 36 AION cases and not at all in the ON cases. Scotomas in the center breaking through to the periphery, superior altitudinal defects (with a sloping border along the horizontal meridian) and diffuse depressions verging on blindness occurred in both ON and AION.

CONCLUSION

A sctoma centered on the fixation point with a sloping border is highly characteristic of ON, while an inferior altitudinal defect with a sharp border along the horizontal meridian, particularly in the nasal periphery, is highly characteristic of AION. To identify these diagnostic criteria, it can be necessary to examine full fields. With restriction of perimetry to 30 degrees a large central scotoma can be mistaken for a diffuse defect and the border in the nasal periphery can be missed.

Effect of aclacinomycin A on in vitro cultures of porcine lens epithelial cells

As a potential drug for the prevention of secondary cataract formation (SCF), we investigated the effect of Aclacinomycin A (ACM) on the growth of cultures of porcine lens epithelial cells in vitro. ACM is an anthracycline that has been used in the treatment of acute myeloid leukemia in the human for many years. It has been shown to be non-mutagenic and non-carcinogenic in in vitro and in animal models. Subconfluent cell cultures were exposed to different concentrations of ACM for 5 minutes. The drug effect was evaluated by cell counts after various lengths of culture time (between 1 and 10 weeks). No cells survived the treatment with 12 or 16 microg ml-1. Cultures treated with concentrations between 0.5 and 8 microg ml-1 showed a marked decrease in cell number when compared to controls. However, reproliferation occurred at concentration up to 8 microg ml-1 after 2-6 weeks. Intraocular application of ACM might be suitable in the prevention of SCF. However, with regard to reproliferation, long-term cultures (or long-term animal models, respectively) have to be used in further evaluating the appropriate dosage for this purpose.

Mismatch of duodenal deliveries of dietary fat and pancreatin from enterically coated microspheres

Gastric emptying of dietary fat is affected by both chemical and physical factors; but when ingested as a free oil or an aqueous emulsion, fat may empty most rapidly immediately after the meal. In contrast, gastric transit of 1- to 3-mm spheres (like those of enterically coated pancreatins) is known to vary inversely with sphere diameter; and spheres leave the stomach initially slowly, if their diameter is > or = 1.6 mm. Our objective was to determine whether 2-mm microspheres of Pancrease would empty much more slowly than free or emulsified oil and whether 1.2-mm microspheres of Creon would empty as fast as free oil. We used a gamma camera to track the concurrent gastric emptying of 123I-labeled oil and 113mIn-labeled spheres of Pancrease or Creon in pancreatic-insufficient subjects with cystic fibrosis who ingested 20 g of free oil in spaghetti meals or 20 g of oil emulsified in a milk meal. We found that either type of oil emptied rapidly initially but slowed later, whereas either dosage form emptied slowly initially but rapidly later. Unexpectedly, the smaller spheres of Creon emptied about the same as Pancrease did after the spaghetti meal. For example, 50% of oil but < 25% of either dosage form had left the stomach by 90 min after the meals. Both dosage forms were lipophilic, forming aggregates in vitro. We concluded that the gastric emptying of either dosage form frequently lagged behind the emptying of oil from ordinary meals. We speculated that the similar transits of the 1.2-mm Creon and the 2-mm Pancrease resulted from aggregation of these microspheres in the presence of free oil.

[Does the fundus perimetry determined edge of the blind spot depend on the superficial form of the papilla?]

BACKGROUND

We wanted to find out whether the borders of the blind spot depend on the surface topography of the optic disc and its surrounding area.

PATIENTS AND METHODS

We therefore examined ten eyes with parapapillary atrophy adjacent to the temporal side of the disc. Fundus perimetry was performed under direct fundus control using a Rodenstock scanning laser ophthalmoscope. We examined the horizontal meridian of the optic discs in 0.5 degree steps using Goldmann IV-stimuli with 10 different degrees of brightness and the Goldmann stimulus 1, 0 dB (greatest luminance). Six eyes with symmetric, "normal" excavation served as controls. Optic disc topography was measured with the Heidelberg Retina Tomograph (HRT).

RESULTS

Stimuli with a large luminance power (Goldmann IV, 4 dB) were seen up to 0.8 degree centrally (i.e., towards the optic disc center) from the temporal edge of the parapapillary atrophy, but up to 1.9 degrees centrally from the nasal optic disc border (P < 0.01). Horizontal HRT section profiles of the optic disc consistently showed prominent nasal disc borders contrasting with a shallow excavation within the temporal parapapillary atrophy. In all six subjects with a normally shaped disc there was no such "nasotemporal asymmetry."

CONCLUSIONS

The size of scotomas depends on the surface topography of the tested area. The prominent nasal part of the optic disc appears less "blind" than the shallow temporal part, probably due to more intensive light scattering by the prominent nasal part of the disc.

Blind spot size depends on the optic disc topography: a study using SLO controlled scotometry and the Heidelberg retina tomograph

AIMS

To find out whether the size of the blind spot area, determined by static perimetry, depends on the surface topography of the optic disc and its surrounding area.

METHODS

Ten eyes were examined; all had a parapapillary atrophy adjacent to the temporal side of the disc. Microperimetry was performed under direct fundus control using a Rodenstock scanning laser ophthalmoscope. The horizontal meridian of the optic discs was examined in 0.5 degree steps using five stimulus sizes (Goldmann I to V), each with 10 different degrees of brightness. Optic disc topography was measured with the Heidelberg retina tomograph (HRT).

RESULTS

Stimuli with a high luminance level (Goldmann IV, 4 dB), presented on the horizontal meridian, were seen up to 0.75 degree centrally (that is, towards the optic disc centre) from the temporal edge of the parapapillary atrophy but up to 1.85 degrees centrally from the nasal optic disc border (p < 0.01). Horizontal HRT section profiles of the optic disc consistently showed prominent nasal disc borders contrasting with a shallow excavation within the temporal parapapillary atrophy.

CONCLUSIONS

The size of scotomas depends on the surface topography of the tested area. The prominent nasal part of the optic disc appears less 'blind' than the shallow temporal part, probably because of more intensive light scattering by the prominent nasal part of the disc. These considerations should also apply to other scotomas.

[How successful is the filtering bleb "needling"?]

BACKGROUND

"Needling" may become necessary when filtering blebs fail due to scarring or encapsulation. Our goal was to calculate the medium term success rate of the needling procedure.

METHODS

The results of 90 needling procedures performed on 58 eyes were analyzed, 52 eyes required one single needling (group 1) after simple trabeculectomy, whereas 19 eyes had to have double needling (group 2) and 3 eyes had to be needled 3 times (group 3). These figures do not include a 4th group of 16 eyes which had been needled after repeated and complicated surgery. Success rates were calculated at t1 = 0 - 1 day, t2 = 1 - 4 weeks, t3 = 4 - 8 weeks, t4 = 3 - 5 months and t5 = > 6 months after the treatment.

RESULTS

The mean IOP (n = 90) was 29 +/- 6 mm Hg preoperatively, 15 +/- 10 mm Hg at t1, 23 +/- 9 mm Hg at t2, 20 +/- 7 mm Hg at t3, 17 +/- 5 at t4 and 17 +/- 3 at t5. The overall success rates were 80% (t1), 45% (t2), 37% (t3), 35% (t4) and 31% (t5). The corresponding success rates were 74%, 36%, 32%, 28% and 26% for group 1.89%, 52%, 37%, 37% and 31% for group 2.67% at all times for group 3 and 100%, 69%, 54%, 54% and 45% for group 4.

CONCLUSIONS

In one third of all cases the needling is effective for more than 6 months. A complicated pressure lowering surgery does not necessarily diminish the effectiveness of a needling procedure. Re-needlings are as successful as the first one.

[Success and complications of rTPA treatment of the anterior eye segment]

Recombinant tissue plasminogen activator (rTPA) is commonly used in patients with myocardial infarction. Recently, it has also been applied intraocularly to dissolve postoperative fibrin with no serious complications being reported so far. In this study we describe our own experience with rTPA in 25 patients with persisting fibrinous membranes in the anterior segment. rTPA (Actilyse, Dr. Karl Thomae GmbH) was given in a single dose of 25 micrograms and injected into the anterior chamber via a paracentesis. We did not encounter any complications during the injection of rTPA. In 21 eyes fibrin could be reduced significantly, albeit sometimes only slowly. In 13 patients, the membrane had dissolved almost completely by the following day. In contrast, no success was observed after glaucoma surgery (2 eyes) and in chronic iritis (1 eye), or when fibrin mixed with blood was treated (1 eye). There were two (controllable) post-operative hemorrhages (rTPA after vitrectomy, and for fibrin/blood after cataract surgery). In addition, we noted 2 cases of irreversible superficial corneal clouding (rTPA after cataract surgery). We conclude that injection of rTPA can be a useful addition to steroid treatment in selective cases of persisting fibrin in the anterior segment. Long-standing membranes, however, are unlikely to be dissolved. Care should also be taken and rTPA be avoided when there is evidence of recent bleeding. Most worrying to us were the corneal complications that we cannot explain to date. With regard to the definite time correlation we feel that rTPA or one of the solution components might be the cause of this unusual feature.

Twenty four hour blood pressure monitoring in normal tension glaucoma

BACKGROUND

The few investigations that used continuous 24 hour blood pressure monitoring to investigate whether blood pressure in patients with normal tension glaucoma is lower than in normal subjects yielded conflicting results. Therefore, a prospective controlled trial was carried out.

METHODS

Systemic blood pressure was recorded continuously over a 24 hour period in 20 patients with normal tension glaucoma (IOP < or = 21 mm Hg). Eight of them showed a localised loss of the neuroretinal rim area and, in addition, optic disc haemorrhages-that is, focal ischaemic signs. Twenty healthy patients without glaucoma, who were hospitalised for cataract or retinal surgery, served as controls. Blood pressure was automatically measured every 20 minutes during the day and every 40 minutes at night.

RESULTS

Both groups showed a significant (physiological) blood pressure drop at night, which was significantly (p < 0.001, ANOVA) more pronounced in the group with normal tension glaucoma than in the control group. There was a weak trend towards lower blood pressure values in the normal tension glaucoma group. Minima, maxima, and mean values of the systolic, diastolic, and mean arterial pressures did not differ significantly between the group with normal tension glaucoma and the control group. The greatest differences occurred with nocturnal systolic and diurnal diastolic values. There were no significant differences between the subgroup with focal lesions and the other patients with normal tension glaucoma.

CONCLUSIONS

Patients with normal tension glaucoma tend to have lower blood pressure values (p > 0.05, ANOVA) than normals; this difference is probably much smaller than formerly assumed. Patients with normal tension glaucoma, however, have significantly greater nocturnal blood pressure drops (p < 0.001, ANOVA) than normal controls. Nocturnal blood pressure drops (relative day-night differences) may play a more important role in the pathogenesis of normal tension glaucoma than the absolute height of the blood pressure.

Gastric emptying of oil from solid and liquid meals. Effect of human pancreatic insufficiency

Digestion of fat in pancreatic insufficiency (PI) is strongly affected by how rapidly fat enters the duodenum. We postulated that: (1) oil empties faster in PI than in normals and (2) in both, it empties in a load-dependent fashion. We used a gamma camera to test these ideas by comparing gastric emptying of iodine-123 iodinated oil in normal and pancreatic-insufficient subjects after 15 g of free oil were ingested in a small spaghetti meal and 60 g of oil were ingested in a large spaghetti meal and in a milk emulsion. Indium-113m marked gastric emptying of water in the milk. In both groups after all meals, oil emptied fastest initially, slowing later; and oil emptied three to four times faster when 60 g vs 15 g were ingested. There were no significant differences between the groups of subjects with respect to gastric emptying of the spaghetti meals, but the pancreatic-insufficient subjects emptied both oil and water faster from the milk emulsion than did the normal subjects. The slower emptying of oil in the normal subjects was associated with significantly more layering of oil to the top of the intragastric milk emulsion.

A comparison of oral and intravenous iron supplementation in preterm infants receiving recombinant erythropoietin

OBJECTIVE

To determine whether intravenously administered iron supplements would improve the hematologic response to recombinant erythropoietin in stable preterm infants.

METHODS

Forty-two preterm infants (<33 weeks' gestation, birth weight < 1500 gm, hematocrit <38%) were treated with recombinant human erythropoietin (Eprex), 600 U/kg per week, and randomly assigned to receive either an oral preparation of ferrous lactate (elemental iron, 12 mg/kg per day) or an intravenous preparation of iron sucrose (6 mg/kg per week).

RESULTS

Hematocrits, reticulocyte counts, and transfusions were similar in the oral group (OG) and the intravenous group (IVG). However, markedly higher serum ferritin concentrations were noted in the IVG (p <0.001), and by completion of the study the arithmetic mean values were 265 +/- 127 microg/L versus 137 +/- 65 microg/L in the IVG and the OG, respectively. The numbers of hypochromic erythrocytes increased in both groups during the study but were significantly higher in the OG (p = 0.04). Mean daily weight gain in the IVG (27 +/- 6.4 gm/day) was greater than in the OG (22.9 +/- 4.78 gm/day; p = 0.04).

CONCLUSIONS

High doses of both orally administered iron and intravenously administered iron sucrose appear to supply sufficient iron for erythropoiesis in stable infants. Storage iron may become depleted after oral supplementation. The intravenous preparation appears to be safe and maintains serum ferritin concentrations, and it may be indicated for patients with low ferritin levels and for those not established on enteral feedings.

[Variability of findings in light sense and ring perimetry]

The variability of the interpretation of visual fields by physicians has so far been thoroughly examined only with reference to light sense perimetry. Therefore, we studied the variability in assigning visual fields to topical diagnoses of the visual pathway with the ring perimeter. For this purpose we examined the proportion of correct assignments of physicians and the reproducibility of their assignments. Two experienced ophthalmologists had to assign 76 selected pairs of right and left visual fields to one of the following diagnosis without any information about further clinical findings: (1) normal (n = 5), (2) media opacity (n = 5), (3) retinal lesion (n = 5), (4) optic disc lesion (n = 6), (5) optic nerve lesion (n = 6), (6) lesion of the chiasma (n = 5) and (7) retrochiasmal lesion (n = 6). The assignment was repeated after intervals of 6 weeks and 10 months. Our statistical analysis of the number of correct assignments revealed no significant differences between the perimeters or between the physicians. The amount of correct assignments with both perimeters decreased from 75% and 66% during the first run through 60% and 70% during the second run to 58% and 60% during the third. Neither perimeter showed any major differences in the reproducibility of the assignments (Fig. 4). During the three runs only 47% (physician 1) and 58% (physician 2) of the cases were assigned three times to the same diagnoses with the octopus. The corresponding figures for the ring perimeter were 58% and 60%. This is regarded as an indicator of the unreliability in the interpretation of visual fields.

[Band-like keratopathy after treatment of postoperative fibrin reaction with tissue plasminogen activator]

BACKGROUND

In recent years TPA (tissue-plasminogen activator) has been increasingly and successfully used for the treatment of severe, postoperative fibrin reaction in the anterior chamber. So far no serious side effects of this treatment have been reported.

PATIENTS AND METHODS

Altogether, 32 patients received 0.2 ml solution with 20 micrograms TPA intracamerally. In 2 cases a dense corneal opacity was observed 12-24 hours after the injection of TPA which was resistant to treatment with local dexamethasone and lubricants. Therefore it was removed by superficial keratectomy. In one case the keratectomy specimen could be examined by light- and electronmicroscopy.

RESULTS

In the keratectomy specimen a selective, fine-granular calcification of Bowman's membrane could be demonstrated.

CONCLUSIONS

The intracameral TPA treatment for postoperative fibrin reaction can cause a rapid band keratopathy. Therefore the application of TPA should be restricted to severe therapy-resistant cases of intracameral fibrin reaction. In cases with the development of a band keratopathy EDTA-treatment is recommended.

Bilateral combined hamartoma of the retina and the retinal pigment epithelium

Images

Neuromodulation of frontal and temporal cortex by intravenous d-fenfluramine: an [15O]H2O PET study in humans

This study assessed the modulatory effect of a serotonergic agonist, d-fenfluramine, on localized neuronal firing as indexed by changes in regional cerebral blood flow (rCBF). Previously, we reported the effect of oral d, l-fenfluramine on neuronal activity as measured by change in [18F]fluorodeoxyglucose uptake. Improvements in the current study include: a more specific serotonin agonist, d-fenfluramine; a more reliable administration route, intravenous; and a one session paradigm made possible with the radiotracer [15O]H2O. Changes in relative rCBF (P < 0.001) were observed: increases within the frontal cortex bilaterally and decreases within the temporal cortex bilaterally, and left thalamus. Other significant findings were elevated cortisol and growth hormone; increased euphoria and panic symptoms and decreased tiredness. These results support further investigation with intravenous d-fenfluramine to study the net functional effects of serotonergic stimulation in health and illness.

Midline granuloma presenting as orbital cellulitis

BACKGROUND

Lethal midline granuloma usually presents with rhinorrhoea and redness of the skin above the nose. Early ocular symptoms are very rare. We here describe a patient who presented with acute orbital cellulitis.

PATIENT

A 73-year-old woman had a 24-h history of severe pain around her left eye. We saw the typical clinical picture of orbital cellulitis. A CT scan revealed a diffuse infiltration of the left upper and lower lid, the anterior orbit and the ethmoidal sinuses.

RESULT

On surgical exploration we found a granular, partly necrotic tumour. Histological examination revealed an angiocentric nasal T-cell lymphoma (midline granuloma).

CONCLUSION

Midline granuloma should be included in the differential diagnosis of acute orbital cellulitis.

Wide-spread myelinated nerve fibers of the optic disc: do they influence the development of myopia?

PURPOSE

To find correlations between the extent of myelinated nerve fibers with refraction anomalies.

METHOD

Searching for myelinated nerve fibers in the slide collection of the University Eye Hospital Freiburg we found 13 patients. We distinguished between eyes with wide-spread myelinated nerve fibers located on and around the optic disc which extended to the midperiphery of the retina (6 patients; Group A) and eyes with circumscribed myelinated nerve fibers, localized merely around the optic disc (7 patients, Group B). In Group A myelinated nerve fibers spared the macula area, but were localized very close to the macula. Color fundus photographs were taken by the Zeiss Fundus camera SK50 (30 degrees and 50 degrees picture size) and by the Olympus Fundus camera GRC-W (same picture size).

RESULTS

The myelinated nerve fibers were found to be unilateral in all 13 patients. In all 6 patients of Group A, a strabismus was present. The affected eye had a severe amblyopia and a unilateral myopia (-5.75 to -25.0 D). The nonaffected fellow eye showed a normal visual acuity with no or only a slight refractive error. In the 7 patients of the Group B, no strabismus was present and a normal or a slightly decreased visual acuity of the affected eye was found. No distinct refractive error was present in the affected and non-affected eyes of this group.

CONCLUSIONS

Myopia only occurred in eyes with wide-spread myelinated nerve fibers but not in eyes with circumscribed myelinated nerve fibers. We assume that myelinated nerve fibers, if wide-spread, cause myopia.

Pattern electroretinogram and computerized optic nerve-head analysis in ocular hypertension--interim results after 2.5 years

Evidence exists that both the pattern electroretinogram (PERG) as a parameter of ganglion-cell function and computerized morphometric disc analysis (ONHA) predict subsequent glaucomatous visual field defects in ocular hypertensive eyes. Since November 1991 we have conducted a prospective longitudinal study to evaluate the suitability of PERG and ONHA for detecting incipient glaucoma damage. Inclusion criteria were: an intraocular pressure of > or = 25 mmHG (at least two measurements taken on different days) or, in eyes with additional risk factors, > or = 23 mmHG; a normal Octopus visual field (mean defect < or = 2 dB, no local defect); and no definite glaucomatous disc cupping. After a mean follow-up period of 14.6 +/- 8.8 (range 1-33) months and with a mean intraocular pressure of 24.4 (range 18-42) mmHg, none of the 66 patients (115 eyes) converted to glaucoma. Furthermore, PERG and ONHA do not agree in their estimation of the glaucoma risk at this stage.

Acute alcohol blocks neurosteroid modulation of synaptic transmission and long-term potentiation in the rat hippocampal slice

Effects of ethanol (22 mM) on the modulation of synaptic transmission and long-term potentiation (LTP) by the neurosteroid dehydroepiandrosterone sulfate (DHEAS; 10 microM) was examined in the in vitro rat hippocampal slice preparation. The synaptic responses were elicited by Schaffer collateral stimulation and recorded extracellularly in the somatic and dendritic regions of CA1 pyramidal neurons. LTP induction produced an increase (approximately 55% to 75%) in the amplitude of synaptic responses in ethanol and ethanol plus DHEAS (ethanol/DHEAS) treated slices. These increases were significantly smaller than the approximately 130% increase observed previously in slices treated with DHEAS, but were not significantly different from the approximately 82% increase observed in control slices. These results indicate that an ethanol/DHEAS interaction prevents the enhancement of LTP normally observed with DHEAS treatment of hippocampal slices. An ethanol/DHEAS interaction also altered DHEAS's effects on individual synaptic components of the synaptic response to Schaffer collateral stimulation. Ethanol applied before but not after DHEAS prevented DHEAS's enhancement of the NMDA receptor-mediated synaptic component. DHEAS's depression of the GABAA receptor-mediated synaptic component was also blocked by ethanol. Ethanol or DHEAS individually had no effect on the AMPA receptor-mediated synaptic component, but application of ethanol after DHEAS resulted in a small enhancement of this synaptic component, an effect that was not observed if ethanol was applied before DHEAS. These results show that ethanol and DHEAS interact, altering DHEAS's effects on synaptic transmission and LTP in the hippocampus. Such an interaction may be involved in ethanol's actions on the CNS and raises the possibility that ethanol and DHEAS may act via a common site or pathway.

High-pass resolution perimetry and light-sense perimetry in open-angle glaucoma

To determine the correlation between the results obtained with light-sense and ring perimetry in glaucoma, we examined 201 eyes of 107 patients with ocular hypertension or different stages of glaucoma using Octopus 1-2-3 and the Ophthimus ring perimeter. Statistical parameters describing the mean visual field defect ["global defect, GD," or "neural capacity, NC" (Ophthimus)] were significantly correlated (P < 0.0001). Statistical parameters describing the local deviations were significantly correlated as well ["loss of variance, LV" (Octopus) and "local defect, LD" (Ophthimus), P < 0.0001]. Correlation between the MD and the LV or LD was somewhat less significant. As compared with the MD or LV (Octopus) the Ophthimus parameters GD, NC, and LD were less often pathological. We conclude from our data that due to the good correlation between light-sense and resolution perimetry results, both perimeters are equally suited for the follow-up of glaucoma patients. Sensitivity to early glaucomatous damage seems to be higher in light-sense perimetry (Octopus 1-2-3).

Gastric emptying of oil and aqueous meal components in pancreatic insufficiency: effects of posture and on appetite

The aims of this study were to evaluate the effects of posture on gastric emptying, intragastric distribution, and satiation after a meal containing oil and aqueous phases in patients with exocrine pancreatic insufficiency. Five patients with cystic fibrosis (CF) consumed 60 ml 99mTc-labeled (V)-thiocyanate olive oil and 290 ml 113mIn-labeled diethylenetriaminepentaacetic acid soup while sitting and while lying in the left lateral decubitus position. Hunger and fullness before and after the meal were recorded. Results were compared with those obtained in 11 normal volunteers. In both postures emptying of oil was faster (P < 0.01) in CF patients. Emptying of the aqueous phase was faster (P < 0.01) in CF patients in the decubitus position. In normal subjects there was no overall difference in emptying of oil between the two postures, whereas emptying of the aqueous phase was delayed (P < 0.01) in the decubitus position. In CF patients emptying of oil was faster (P < 0.01) in the decubitus position, and emptying of the aqueous phase was only slightly faster (P < 0.05) in the sitting position. For both postures there was greater retention (P < 0.05) of oil in the proximal stomach in normal subjects than CF patients. Hunger decreased (P < 0.05) after the meal in the control subjects, but there was no change in CF patients. These results indicate that in CF patients with pancreatic exocrine insufficiency 1) gastric emptying of nonhomogenized fat is faster than normal, 2) gravity affects gastric emptying of oil, and 3) effects of a fatty meal on hunger are reduced.

Preduodenal mechanisms compensate completely for absent pancreatic enzymes to stimulate gallbladder after meals

We studied gallbladder emptying with gamma scintigraphy in nine dogs prepared with chronic pancreatic fistulas, so that pancreatic enzymes could be either completely excluded from the duodenum or supplied in normal amounts. During duodenal perfusion of the fasted dogs with fat emulsions, gallbladder emptying was significantly less rapid when the emulsion contained inactive vs active enzymes, confirming the potency of lipolytic products in the intestine as stimuli of gallbladder emptying. However, after feeding either a 115-g or a 460-g meal, each 18% fat, the gallbladders emptied identically whether or not pancreatic enzymes were excluded from the duodenum. We concluded that while products of pancreatic lipolysis in the small intestine are potent stimuli of gallbladder contraction, preduodenal mechanisms can compensate completely for the absence of pancreatic hydrolysis in stimulating gallbladder emptying after a meal.