[Carbohydrate infusion in internal diseases. A comparative study in metabolically health, liver diseased and diabetic patients. VII. Infusions of a glucose-fructose-xylitol mixture (relationship 1:2:1) over 48 hours]

3 groups (6 control persons, 6 patients with liver cirrhosis, 6 patients with diabetes mellitus) were infused with 20% (w/v) carbohydrate mixture (glucose/fructose/xylitol, 1:2:1) for 48 hours. The metabolical status was controlled in defined intervals by means of 39 different laboratory parameters. The infusion rate was supposed to be 0.25 g carbohydrates/kg B. W. and hour. There were no significant changes in blood glucose levels in any of the 3 groups. However we could observe a slight but constant increase in lactate and triglyceride concentrations. Free fatty acids and keton bodies were suppressed on a low level. Only the diabetics showed a significant renal carbohydrate loss with up to 15% of the amount administered. No clinically relevant side effects were observed.

[Carbohydrate infusion in internal diseases. A comparative study in metabolically healthy, liver diseased and diabetic patients. VI. Infusions of a glucose/xylitol mixture (1:1 ratio) over a 48-hour period]

By central venous catheterization, 6 control persons, 7 patients with liver cirrhosis and 6 patients with diabetes mellitus were infused for 48 h with a 20% (w/v) mixture of glucose/xylitol (1:1). The infusion 48 h with a 20% (w/v) mixture of glucose/xylitol (1:1). The infusion rate of 0.125 g monosaccharide/kg/h could be maintained with minor deviations. There were no significant changes in blood glucose levels using this infusion regimen. Lactate levels, however, did increase constantly during the whole infusion period. In the liver group as well as in the diabetic group we could measure values between 1.5 and 3.9 mmol/l. Triglycerides increased solely in the diabetic group. Uric acid concentrations were elevated in all 3 groups. Clinically significant side effects were not observed.

[The radiological and endoscopic appearances of Crohn's disease of the upper gastro-intestinal tract (author's transl)]

Involvement of the upper gastrointestinal tract (oesophagus, stomach, duodenum, jejunum) accounted for 13% of endoscopically proven Crohn's disease in patients at the University Clinic, Tübingen between 1973 and 1980. The basis for the diagnosis was the presence of epitheloid granulomas. The diagnosis was suspected in 26% of patients on endoscopic appearances alone. In these two groups, the appearances were similar, consisting of atypical or linear ulcers, cobble-stone lesions, chronic erosions, aphthous ulcers, stenoses, coarsening of the mucosa and areas of engorgement and granularity. Most patients were also examined radiologically. The radiological findings correspond with the endoscopic observations. Using a double contrast technique, mucosal changes could be demonstrated which, up to now, were only seen by endoscopy. If these findings are observed either radiologically or endoscopically, it is essential to examine the distal portions of the gut.

[Carbohydrate infusions in internal diseases. A comparative study in metabolically normal subjects, patients with liver diseases and diabetics. V. Infusion of a glucose-sorbitol mixture (ratio 1:1) for 48 hours]

Three groups (6 patients with liver cirrhosis, 6 patients with diabetes mellitus, 6 controls) have been infused for 48 h with a 20% (w/v) glucose/sorbitol-solution (1:1). The only group where the infusion rate of 0,25 g carbohydrates/kg/h could not be reached was the control group with 0,232 g carbohydrates/kg/h. We could not see any significant changes in blood glucose levels during the total infusion period. Sorbitol levels dropped very slowly after the end of the infusion, a time when sorbitol was still excreted in the urine. The concentration of triglycerides was steadily increasing. Besides there were no further changes compared to equicaloric glucose or glucose/fructose infusions.

Kohlenhydratinfusion bei internistischen Erkrankungen. Eine vergleichende Studie bei stoffwechselgesunden, leberkranken und diabetischen Patienten

Je 6 Kontrollpersonen, Leberkranke und Patienten mit Diabetes mellitus erhalten eine 20%ige Mischlösung (Glukose : Fruktose : Xylit = 1:2:1) über eine Periode von 48 Stunden infundiert. 39 Stoffwech-selkenngrößen werden in regelmäßigen Intervallen kontrolliert. Die Sollzufuhr des Gesamtgemisches ist mit 0,25 g/kg KG und Stunde vorgegeben. Die Blutglukosekonzentrationen ändern sich in keiner der 3 Gruppen wesentlich. Laktat- und Triglyceridwerte tendieren zu einem geringen, kontinuierlichen Anstieg. Freie Fettsäuren und Ketonkörper werden auf niedrige Werte supprimiert. Nur bei den Diabetikern kommt es mit 15% zu erheblichen Kohlenhydratverlusten über die Niere. Klinisch relevante Nebenwirkungen sind nicht aufgefallen.

[Carbohydrate infusion in internal diseases. A comparative study of metabolically healthy persons and liver disease and diabetic patients. IV. Infusion of a glucose-fructose mixture (1:1 ratio) over a 48-hour period]

6 patients with liver cirrhosis, 6 patients with diabetes and 6 control persons were infused for 48 h with a mixed carbohydrate solution (glucose/fructose, 1:1). The infusion rate was supposed to be 0,25 g carbohydrates/kg and hour. The metabolical status was surveilled by 39 different laboratory values. The results showed that compared to a pure glucose solution blood glucose levels where decreased. Basic blood glucose levels were passed only in patients with diabetes mellitus. However, the glucose values were not as much elevated that permanent insulin administration would have been necessary. The antilipolytic, antiketogenic and anticatabolic efficacy was comparable to an equicaloric glucose infusion.

[Carbohydrate infusion in internal diseases. A comparative study of metabolically healthy persons and liver disease and diabetic patients. III. Glucose infusion over a 48-hour period]

6 metabolically healthy control persons, 6 patients with liver cirrhosis, and 6 patients with diabetes were infused for 48 hours with a 20 % (w/v) glucose solution. The infusion rate was 0,25 g glucose/kg body weight and hour. A constant surveillance of the metabolical status was performed by control of 39 different laboratory values. In all 3 groups, glucose infusion alone was sufficient for basal metabolic rate. This was shown by the inhibition of lipolysis as well as in the decreased catabolism. Only the diabetic group exhibited high blood-sugar values and an energy loss up to 10 % of the administered glucose. We could not observe any side effects.

[Carbohydrate infusions in internal diseases. A comparative study on metabolically normal patients, patients with liver diseases and diabetics. Aims, execution and statistics of the studies in long-term infusion of carbohydrates]

We present the problems, methodology and statistics of a large scale clinical trial concerning biochemical events and compatibility of carbohydrate infusions. The presented work serves as introduction to understand the following publications from this study. More specifically we show the results of 48-hour infusion of the following solutions: 1. Glucose, 2. Glucose/Fructose, 3. Glucose/Sorbitol, 4. Glucose/Xylitol, 5. Glucose/Fructose/Xylitol. Each of the infusion series was applicated to patients with liver cirrhosis; diabetes mellitus, and a metabolically healthy control group.

Comparative study with ranitidine and cimetidine on gastric secretion

The inihibitory effect of various doses of ranitidine and cimetidine on pentagastrin stimulated volume, acid, and pepsin secretion was studied in 8 healthy volunteers. Both compounds inhibited all three variables in a dose dependent manner with an average ID50 of approximately 5 mg for ranitidine and of approximately 41 mg for cimetidine. On a molar basis ranitidine is about 11 times more potent than cimetidine. The duration of action of both compounds appears to be equally long.

Adrenaline sensitive adenylate cyclase in human gastric mucosa

Basal and adrenaline-stimulated adenylate cyclase (AC) was studied in biopsy specimens of the gastric and duodenal mucosa from 112 individuals. AC activities were log normally distributed. AC of fundic and antral gastric mucosa responded to adrenaline in a concentration-dependent manner, that of the duodenal mucosa did not respond to adrenaline. The degree of activation in biopsies of normal gastric mucosa was similar to that of patients with chronic atrophic gastritis or patients antrectomized according to the Billroth method. AC in biopsies from cimetidine-treated peptic ulcer patients was less sensitive to adrenaline than AC in biopsies from untreated patients. The threshold concentration of cimetidine to inhibit adrenaline-stimulated AC in vitro was 10(-6) mol/l. The data provide evidence of an adrenaline-sensitive AC in cells other than parietal cells and show an inhibitory action of cimetidine on the catecholamine-sensitive AC in the human gastric mucosa.

Kohlenhydratinfusion bei internistischen Erkrankungen. Eine vergleichende Studie bei stoffwechselgesunden, leberkranken und diabetischen Patienten

6 stoffwechselgesunden Kontrollpersonen, 6 Patienten mit Leber-zirrhose und 6 Patienten mit Diabetes mellitus werden über einen Zeitraum von 48 h mit einer 20%igen Glukoselösung infundiert. Die Infusionsrate beträgt 0,25 g/kg Körpergewicht und Stunde. 39 Stoff-wechselkenngröβen werden in regelmäβigen Abständen kontrolliert. In den drei Kollektiven reicht die alleinige Glukosezufuhr zur Deckung des Grundumsatzes aus, was durch die gehemmte Lipolyse sowie die Abnahme des Katabolismus gezeigt werden kann. Nur bei den Diabetikern kommt es zu hohen Blutzuckerspitzen und zu Energieverlusten bis zu 10 % der zugeführten Glukose. Nebenwirkungen werden nicht beobachtet.