Turnover and excretion of copper in rats as measured with 67Cu

We have examined the whole-body turnover and excretion of copper in rats, using 67Cu. Female Fischer rats, 3-4 mo of age, were injected intraperitoneally with tracer doses of 67CuCl2, and whole-body radioactivity was monitored over the next 3-6 days. The rate of loss was exponential and biphasic, with a half-life of 67 h for the first 70 h, followed by a much slower rate over the following days. A small percentage (2-7%) of the early loss was in the urine, the rest in the feces. In sexually immature animals, turnover was slower in the first and faster in the second phases. Pretreatment of rats with a large dose of copper had no significant effect on the initial turnover rate. Ligation of the common bile duct cut the rate in half, but did not block turnover. It is concluded that there are at least two pools of copper in the rat that turn over at different rates and that excretion of copper occurs via the bile and also by other intestinal routes.

Biochemical changes in liver, kidney and blood associated with common bile duct ligation

Common bile duct ligation (CBDL) in rats was used to induce liver disease and secondary kidney damage. The biochemical changes in the liver, kidney and plasma were studied at 3, 6, 10 and 21 days post CBDL. The observed alterations climaxed at the 6th day following ligation. Renal, activities of aldolase (ALD), lactic dehydrogenase (LDH), isocitric dehydrogenase (ICDH), sorbitol dehydrogenase (SDH), and alkaline phosphatase (ALP), were lowered in CBDL rats. Further, microsomal Na,K-ATPase and Mg-ATPase and mitochondrial oxidative-phosphorylation were inhibited. In the liver from CBDL rats the activities of aspartate aminotransferase (AST), Mg-ATPase and ALP were elevated, while SDH, ALD, malic dehydrogenase (MDH), LDH, malic enzyme (ME) and Na,K-ATPase were lowered. Plasma enzymes, AST, ALP, MDH, LDH, ALD, acid phosphatase (ACP) and ICDH and the metabolites bile acids, bilirubin, creatinine and urea were elevated. Addition of bile acids or bilirubin at concentrations comparable to those found in the plasma of CBDL rats, to the reaction mixture of the various enzymes strongly inhibited most, particularly mitochondrial oxidative phosphorylation. High concentrations of these substances in the blood may explain the development of renal failure during liver disease and its reversibility when liver function returns to normal.

Effects of alfentanil and fentanyl on common bile duct pressure

The effects of alfentanil (7.5 or 15 micrograms/kg) and fentanyl (1.5 micrograms/kg) on common bile duct pressure were examined by using an indwelling postoperative T-tube in 36 conscious, unpremedicated patients. All opiate doses significantly (P less than 0.001) increased the pressure. There was no significant difference among the groups in the peak pressures nor in the times to peak pressures. Fentanyl had a significantly longer duration of effect on pressure.

Inhibition of the biosynthesis of uroporphyrinogen and heme in rat liver during obstructive jaundice produced by bile duct ligation

Altered hepatic microsomal drug metabolism has been reported to occur in afflicted with hyperbilirubinemia. Similarities of the chemical structures of hydroxymethylbilane, an intermediate in the biosynthesis of uroporphyrinogen, to bilirubin prompted investigations of the effect of bilirubin on the activity of uroporphyrinogen I synthase (porphobilinogen deaminase, EC 4.3.1.8) and the biosynthesis of heme. Bilirubin was found to be a reversible, noncompetitive inhibitor of uroporphyrinogen I synthase. The inhibition constant (Ki) for bilirubin was 1.5 microM. Bile acids had no effect on rat hepatic uroporphyrinogen I synthase activity. Hyperbilirubinemia was achieved in rats by biliary ligation in order to investigate whether elevated levels of bilirubin impair the biosynthesis of hepatic heme in vivo. The relative rate of heme biosynthesis, as measured by the rate of incorporation of delta-[4-14C]aminolevulinic acid into heme, was decreased 59% 24 h after biliary obstruction. The levels of hepatic microsomal heme and cytochrome P-450 were decreased by 43 and 40%, respectively, 72 h after biliary obstruction. The activities of hepatic delta-aminolevulinic acid synthase and uroporphyrinogen I synthase were increased by 39 and 46%, respectively, 72 h after biliary obstruction. During the 48- to 72-h period following biliary obstruction, the urinary excretion of porphobilinogen and uroporphyrin was increased 3.0- and 3.5-fold, respectively, whereas, the urinary excretion of delta-aminolevulinic acid was not altered. During this 48-to 72-h time interval following biliary obstruction, 100% of the uroporphyrin was excreted as isomer I. These results indicate that bilirubin is capable of depressing the biosynthesis of rat hepatic heme and thus cytochrome P-450-mediated drug metabolism by inhibition of the formation of uroporphyrinogen. These findings are a plausible mechanism for reports of impaired clearance of various drugs in patients afflicted with hyperbilirubinemic disease states.

Effects of exogenous secretin on pancreatic and biliary ductal and sphincteric pressures in man demonstrated by endoscopic manometry and correlation with plasma secretin levels

An endoscopic manometric technique was used to investigate the effects of exogenous secretin on pancreatic duct, common bile duct, pancreatic duct sphincter, and bile duct sphincter pressures in 20 healthy volunteers. Synthetic secretin was infused intravenously at rates of 8.05, 16.1, 32.2, 64.4, 129, 258, and 516 ng/kg/hr, and plasma secretin concentrations were measured by a radioimmunoassay. Secretin produced a significant fall in peak and trough pancreatic duct sphincter pressures from basal values of 48.2 +/- 7.9 mm Hg (mean +/- SD) and 16.9 +/- 7.7 mm Hg, respectively, to 34.4 +/- 6.8 mm Hg and 11.2 +/- 5.8 mm Hg (P less 0.005), respectively, at a mean plasma secretin concentration of 16 pg/ml (during an infusion rate of 32.2 ng/kg/hr). Higher infusion rates had no additional effect. Pancreatic duct pressure became significantly elevated above basal (11.5 +/- 4.0 mm Hg) at the two highest secretin rates. Secretin had no effect on common bile duct or bile duct sphincter pressures. Plasma secretin concentrations were within the postprandial range during the lowest four secretin infusion rates. We conclude that secretin produces selective physiological relaxation of the pancreatic duct sphincter.

[Dynamic test in the echographic evaluation of the common bile duct]

Common bile duct (CBD) diameter was measured with ultrasonography in 396 patients (131 had previous cholecystectomy) before and 40 minutes after the ingestion of a fatty meal. CBD diameter reduced in 177 cases, remained unchanged in 175, increased in 44. The increasing of CBD diameter always means obstructive choledochal pathology, caused by stones or other pathologic conditions. Caliber reduction or other pathologic conditions. Caliber reduction is physiologic. When CBD remains unchanged, in 10% of the cases there are stones in the duct.

Effects of gastrointestinal hormones on Oddi's sphincter and duodenal myoelectric activity and pancreatobiliary pressure. Studies in the opossum

Myoelectric activity of Oddi's sphincter and duodenum was correlated with common duct and pancreatic duct pressures in conscious opossums after infusion of the following substances: cholecystokinin, pentagastrin, glucagon, secretin, and acetylcholine. Cholecystokinin and pentagastrin increased and glucagon and secretin decreased the frequency of spike potentials in Oddi's sphincter and the duodenum. Acetylcholine was associated with the largest increase in spike potentials in both Oddi's sphincter and the duodenum. Although there was variation in the number of pressure elevations related to Oddi's sphincter spike potentials, the baseline pressure remained constant during administration of the hormones. Acetylcholine infusion increased the biliary and pancreatic pressures to 29 and 31 mm Hg, respectively. We conclude that gastrointestinal hormones may have an important role in regulating the excretion of bile and pancreatic juice into the duodenum.

Two approaches for electrohydraulic lithotripsy in the common bile duct

Electrohydraulic lithotripsy is a method used to break up a stone by electric discharge in the presence of liquid medium. After the effect of crushing gallstones was tested in vitro, efficacy and safety of this method were investigated with 11 mongrel dogs. When the electrode was in touch with or close to the bile duct wall, the discharge caused perforation or potentially serious mucosal injury. However, a stone held in a basket catheter combined with the lithotripsy probe was fragmented safely in the bile duct in all the animals. Bile duct manometry showed a transient fall, which was followed by a slight increase, of the pressure on crushing the stone. After these studies in animals, three patients with stones in the common bile duct were treated successfully with the device via the percutaneous transhepatic route (one patient) or through the duodenoscopic route (two patients). Two approaches are now available for electrohydraulic lithotripsy in the common bile duct.

Age and sex dependency of bile duct diameter and bile duct pressure--an ERC manometry study

Using ERC-manometry diameters of the common bile duct (CBD) the common hepatic duct (CHD) as well as CBD pressure before and after opacification were determined in 35 non-cholecystectomized patients without extrahepatic cholestasis. We found a significant rise of both CBD and CHD diameters as well as CBD pressure recorded before the injection of contrast medium with increasing age. (p less than 0.005, less than 0.001 and less than 0.05 respectively). Following the opacification CBD pressure became elevated. Again this increase tended to be more pronounced in older patients although this association was lacking statistical significance. In the presence of comparable age female patients (n = 16) exhibited higher CBD and CHD diameters (n.s.) as well as CBD pressure values (p less than 0.05) than male patients (n = 19). We conclude that in the absence of extrahepatic cholestasis bile duct diameter as well as bile duct pressure rise significantly with increasing age. Furthermore women tend to have higher diameters and pressure values than men.

[Vasoactive hormones and mediators in the mechanism of the development of an aphthous process in the oral mucosa]

Experiments on dogs were made to simulate aphthous process on the oral mucosa by occlusion of the common bile duct. The content of adrenaline, noradrenaline, serotonin, histamine and ascorbic acid was measured during the development of pathological process in the areas of oral mucosa tissue characterized by most frequent appearance of aphthas and in the tissue of the duodenal, small and large intestine mucosa. The magnitude of the characteristics indicated was determined 2, 6 and 12 h and 1, 3, 7 and 10 days after operation. Aphthas appeared on the 3d day. Within the first hours of the experiment there was a considerable increase in the content of noradrenaline, adrenaline and serotonin in the oral mucosa accompanied by a reduction in the histamine and ascorbic acid content. In the intestinal mucosa, shifts in the correlations between the hormones and transmitters were less pronounced. During aphthas appearance, the histamine content rose whereas other parameters decreased. The period of the reverse development was characterized by the recovery of the correlations of the hormones under study and transmitters.

Effect of glyceryl trinitrate on the sphincter of Oddi motility and baseline pressure

It is widely accepted that glyceryl trinitrate (GTN) effectively dilates the smooth muscles of blood vessels. A similar effect has been postulated on the smooth muscles in the gastrointestinal tract. In this study the motility of the sphincter of Oddi and the common bile duct pressure as determined by endoscopic manometry was investigated in nine patients before and after sublingual application of 1.2 mg GTN (nitro group). Eight untreated patients served as controls. Three minutes after application of GTN the papillary contraction amplitude decreased from 69.3 +/- 4.3 mmHg to 36.8 +/- 5.1 mmHg (p less than 0.005) and the papillary baseline pressure fell from 8.9 +/- 0.6 mmHg to 2.9 +/- 0.2 mmHg (p less than 0.005) respectively. The contraction frequency in the nitro group and all motility parameters in the control group remained unchanged. These results indicate that GTN does not influence the sphincter of Oddi motility, but it relaxes very effectively the sphincter of Oddi muscle. Thus, GTN should be taken into account for the treatment of biliary colic. In our endoscopic unit GTN proved to be useful as premedication for endoscopic examinations, particularly for the removal of small and medium size common bile duct stones through the intact papilla.

Effect of the artificially elevated common bile duct pressure on the motor activity and function of the papilla of Vater. A study by endoscopic manometry

In 10 patients without disease of the pancreatico-biliary system, the common bile duct pressure was artificially elevated by endoscopic retrograde feeding with saline under manometric control. The motor activity of the papilla of Vater was recorded by endoscopic manometry using the hydraulic capillary perfusion system according to Arndorfer. Compared to the baseline motility, a mild pressure elevation (from 9.75 +/- 1.8 to 13.5 +/- 0.26 mm Hg) had no effect. After the following strong pressure elevation (to 32 +/- 0.9 mm Hg), however, the papillary residual pressure and the wave duration of the papillary contractions increased significantly (p less than 0.001) from 5.5 +/- 0.5 s and 6.3 +/- 0.16 mm Hg to 10.7 +/- 0.75 s and 8.6 +/- 0.64 mm Hg, whereas the papillary contraction frequency and amplitude were not affected. These data indicate several clinically important speculations.

Absorption of heparin injected into various parts of the rat intestinal tract: a bile-dependent mechanism?

Heparin sodium, dissolved in water, causes plasma clearing activity (PC) and appreciable heparinemia (HE) when directly delivered into the duodenum, the jejunum, the ileum or the large intestine of rats, as well as when administered through an esophageal tube to distal duodenum-ligated animals. However, choledochus occlusion significantly decreases both PC and HE produced by intraesophageal heparin application. It is suggested that, in rats, bile flow participates in intestinal heparin absorption.

Healing of the bile duct anastomosis after transverse choledochotomy or transplantation of the liver in the pig

A comparison was made in pigs of the tensile strength of the bile duct anastomosis after simple dochotomy and after hepatic autograft or allograft. It appears that tensile strength returned to normal levels within 15 days of simple dochotomy and indeed rose past normal at 50 days, but that after either form of hepatic grafting, tensile strength did not reach normal levels even by 50 days postoperation.

The etiology of "white bile" in the biliary tree

"White bile" is the colorless fluid occasionally found in occluded biliary systems. The absence of pigments in this "bile" was not satisfactorily explained. The objectives of this study were to assess its etiology. In dogs, "white bile" developed whenever both the common bile duct and the cystic duct were ligated. In comparison, dark green ("black") bile occurred when only the common bile duct was ligated leaving the gallbladder in communication with the obstructed ducts. The pressure in extrahepatic ducts containing "white bile" was significantly higher than in those filled with "black bile." Flow in the extrahepatic ducts was assessed by the aid of radioiodinated human serum albumin (RIHSA). When "black bile" was present, the direction of flow was from the extrahepatic ducts into the gallbladder. Whenever "white bile" developed, a reverse flow from the extrahepatic ducts into the liver was observed. Thus, the role of the gallbladder appears to be decompression of the biliary system allowing bile flow from the liver even in obstruction. In the absence of the gallbladder water absorption activity, the colorless secretion of the bile ducts seems to "back wash" into the liver and replace the bile present in the ducts at the time of occlusion.

Common bile duct pressure in dogs after opiate injection--epidural versus intravenous route

The effect on the common bile duct pressure of epidurally injected morphine and fentanyl, was compared with that of intravenous injections of the same drugs in 12 mongrel dogs. Intravenous injection of morphine (0.1 mg X kg-1) or fentanyl (0.01 mg X kg-1) significantly elevated the common bile duct pressure from 10.48 +/- 0.37 to 21.68 +/- 0.33 cm H2O and from 9.66 +/- 0.33 to 14.14 +/- 0.21 cm H2O respectively. These increases occurred within 4-15 minutes after injection and lasted for about 2-3 hours. When the narcotics in identical dosages were injected epidurally, the common bile duct pressures were unchanged during the four hours of investigation. Further studies are planned to determine whether this beneficial effect of epidural narcotics applies also in the human clinical situation.

Fasting canine biliary secretion and the sphincter of Oddi

This study correlates duodenal bile acid delivery with motility of the sphincter of Oddi during the fasting state. Dogs were prepared with a functional cholecystectomy, a duodenal cannula for direct vision cannulation of the common bile duct, and 12 bipolar electrodes serosally implanted from stomach to terminal ileum. In one set of experiments, the bile acid pool was depleted, and during a continuous i.v. infusion of sodium taurocholate (20 mumol/min), duodenal bile acid delivery was assessed over 6 h by a marker perfusion technique. In other experiments, a double-lumen continuously perfused manometry catheter was placed to record motility in the bile duct and sphincter of Oddi for a period of 6 h. Station pull-throughs of the sphincter of Oddi were performed in each phase of the migrating motor complex. Bile acid secretion rates fluctuated about the i.v. infusion rate during duodenal phase I and II, peaked in late phase II, and then fell to barely detectable levels during duodenal phase III. There was no peristaltic contractile activity in the common bile duct in any phase of the migrating motor complex. The sphincter of Oddi maintained a baseline pressure above common bile duct pressure. It was highest during phase III. Phasic contractions of the sphincter of Oddi were intermittent during phase I, increasingly frequent during phase II, and continuous during duodenal phase III of the migrating motor complex. Contractions were frequently peristaltic. We concluded that the occurrence and amplitude of phasic peristaltic contractions of the sphincter of Oddi are cyclically coordinated with the fasting intestinal motor pattern (migrating motor complex), and with cyclical variations in the delivery of bile acids into the duodenum. Both resting pressure and phasic contractions of the sphincter appear to play a role in coordinating the cyclic delivery of bile acids into the duodenum with the migrating motor complex. Intense phasic motor activity appears to impede bile flow, and less intense activity allows or facilitates flow.

Measurement of liver blood flow by galactose clearance

Low-dose galactose clearance is a new method for measuring functional (nutrient) liver blood flow. In 22 healthy beagle dogs, the mean (+/- SD) blood galactose clearance rate of 311 +/- 93 mL/min was not significantly different from the mean measurement obtained using electromagnetic flow probes (322 +/- 37 mL/min). This shows that galactose clearance can be used to measure liver blood flow in healthy dogs. The 22 dogs were divided into two groups of 11. The first group underwent portacaval shunting and weekly galactose clearance rates were measured until death an average of 6 weeks later. The anticipated fall in liver blood flow was successfully detected by the second week after shunting. This suggests that long-term (week-to-week) changes in liver blood flow can be detected by this method. In the second group, ligation of the common bile duct was used to induce secondary biliary cirrhosis. Galactose clearance was measured weekly for 6 weeks and showed a significant decrease by 6 weeks. At 7 weeks, laparotomy was performed in order to take flow-probe measurements; the galactose clearance rate was also measured. Whereas the two methods were similar at the time of the original operation, 7 weeks after ligation there was a significant difference (p = 0.02) with the rate of liver blood flow as measured by galactose clearance being much lower than the flow rate measured by the electromagnetic flow probes. These findings suggest that in cirrhotic dogs, galactose clearance measures functional or effective (nutrient) liver blood flow whereas the electromagnetic flow probe measures anatomic flow. The effective flow gives a more accurate reflection of perfusion of the hepatocyte by blood.

Importance of renal prostaglandins in control of renal function after chronic ligation of the common bile duct in dogs

To explore the possible vasoregulatory role of renal prostaglandins during liver disease, excretory rates of PGE2, PGF2 alpha, and a metabolite of PGI2, 6k-PGF1 alpha, were determined before and after chronic ligation of the common bile duct in 23 dogs. Bile duct ligation for 50 +/- 3.7 days (mean +/- SEM) significantly increased serum bilirubin and alkaline phosphatase. PGE2, PGF2 alpha, and 6k-PGF1 alpha excretion rates were significantly (p less than 0.01) increased following chronic bile duct ligation, by approximately 100%, 80%, and 500%, respectively, with similar increments in both ascitic and nonascitic animals. In 10 sham-ligated animals, PGE2, PGF2 alpha, and 6k-PGF1 alpha excretion rates were unchanged. In 6 dogs sequential measurements of urine prostaglandins indicated that PGE2 and 6k-PGF1 alpha excretion were significantly increased at 2, 4, and 6 weeks after ligation, whereas the increase in PGF2 alpha excretion was not significant until 6 weeks. Indomethacin (2 mg/kg) reduced prostaglandin excretion by 65% to 90% and significantly increased arterial pressure, decreased glomerular filtration rate and renal blood flow, and increased renal vascular resistance from 0.53 +/- 0.09 to 0.90 +/- 0.13 mm Hg/ml/min. Fractional renal blood flow, assessed by microspheres, was disproportionately reduced in the inner cortex after prostaglandin inhibition in the chronic bile duct ligation group. Indomethacin did not significantly alter renal function in sham animals, despite comparable reductions in prostaglandin excretion. These data demonstrate that, in dogs with experimental liver disease produced by chronic bile duct ligation, renal prostaglandin synthesis is increased, and the enhanced synthesis of vasodilatory prostaglandins serves to maintain renal blood flow and glomerular filtration rate.

Effects of butorphanol, nalbuphine, and fentanyl on intrabiliary tract dynamics

The effects of equianalgesic doses of fentanyl citrate (100 micrograms; n = 20), butorphanol tartrate (2 mg; n = 20), and nalbuphine hydrochloride (10 mg; n = 16) on biliary tract dynamics were examined in patients anesthetized with enflurane-nitrous oxide. After removal of the gall bladder, the common bile duct or cystic duct remnant was cannulated with an 18-gauge catheter. Using a modified Caroli apparatus, control measurements of flow through the common bile duct into the duodenum over 60 sec and resting intrabiliary tract pressure were obtained. Patients then were given one of the drugs intravenously and measurements were repeated 5 min later. Flow rates decreased 35%, 21%, and 13% after fentanyl, butorphanol, and nalbuphine, respectively. Similarly, resting intrabiliary tract pressures increased by 23%, 12%, and 6%, respectively. All changes were statistically significant (P less than 0.05) except for the increase in intrabiliary tract pressure after nalbuphine. Likewise, the incidence of decreases in flow rate or increases in intrabiliary tract pressure more than 20% was greater after fentanyl than after either butorphanol or nalbuphine. Agonist-antagonist analgesics may be advantageous in patients with known or suspected biliary tract disease.