Functional assessments for decision-making regarding return to sports following ACL reconstruction. Part II: clinical application of a new test battery

PURPOSE

The purpose of this study was to utilize a novel functional test system to facilitate determining the time of return to sports following ACL reconstruction.

METHODS

Sixty-nine patients with unilateral ACL reconstruction were included in this pilot study. All the patients performed a standardized test battery consisting of one- and two-legged stability tests, counter movement jumps, speedy jumps, plyometric jumps and a quick feed test. The first test was administered on average 170.7 ± 75.1 days post-operatively, and the retest was administered on average 239.1 ± 79.7 days post-operatively. The values of the subtests were compared with the normative data of healthy gender- and age-matched controls to determine the functional capacities of patients following ACL reconstruction.

RESULTS

After the first and second test, 15.9 and 17.4 % of the patients met the criteria for a "return to non-competitive sports". One patient fulfilled the criteria for a "return to competitive sports" after the second test battery. The most limiting factor was a poor LSI value of <90 % if the dominant leg was involved and <80 % if the non-dominant leg was involved.

CONCLUSION

This test battery demonstrates that, in terms of neuromuscular abilities, most patients, compared to healthy controls, are most likely not ready for a safe return to sports, even 8 months post-operatively. This should be considered in the future to determine when it is safe to return to sports and should avoid a premature return to competitive sports.

LEVEL OF EVIDENCE

III.

Anticytokeratins are a potential source of false-positive indirect immunofluorescence assays for C-ANCA

Antibodies to neutrophil cytoplasmic antigens (ANCA) targeted toward granule enzymes have been recognized as a valuable diagnostic tool in the detection of Wegener's granulomatosis and systemic vasculitides. However, the most commonly used method of detection, the indirect immunofluorescence assay, is prone to false-positive results due to antibodies of different pathological significance either targeted to, or cross-reacting with, similarly distributed epitopes. Using double immunofluorescence, the present study demonstrates that anticytokeratin antibodies are able to produce false-positive C-ANCA immunofluorescence assays. In addition, a case of natural appearance of cytokeratin-reactive antibodies causing a false-positive "pseudo-ANCA" staining pattern in a patient presenting with sepsis is reported. Since the expression of cytokeratins is almost exclusively confined to epithelial cells, the most plausible explanation for both phenomena is a crossreaction of anticytokeratin antibodies with granule associated epitopes. Due to the natural appearance of anticytokeratin antibodies in association with a variety of other pathologic entities, it is of crucial importance for the diagnostic significance of the C-ANCA immunofluorescence assay to exclude anticytokeratin caused false-positive results. It is shown that supplementary indirect immunofluorescence tests performed on cultured human epithelial cells readily distinguish anticytokeratin caused "pseudo-ANCA" from true C-ANCA.

Antimitochondrial antibody profiles in primary biliary cirrhosis distinguish at early stages between a benign and a progressive course: a prospective study on 200 patients followed for 10 years

In recent retrospective studies, it was shown that subtypes of antimitochondrial antibodies (AMA) can help to discriminate between a benign [only anti-M9 and/or anti-M2 positive by enzyme-linked immunosorbent assay (ELISA)] and a rather progressive course (anti-M2, -M4 and/or -M8 positive). According to different constellations of these AMA subspecificities in ELISA and complement fixation test (CFT), four AMA profiles (A-D) were defined. In 1984 we started a prospective study based on 200 PBC patients with known AMA profiles in order to correlate the antibody pattern with the clinical outcome. Progression was defined primarily as the necessity of liver transplantation and death due to hepatic failure or variceal bleeding. At entry, 18 (9%) of the 200 patients had AMA profile A (only anti-M9), 57 (29%) profile B (only anti-M2 with or without anti-M9), 74 (37%) profile C (anti-M2 in association with anti-M4/-M8 by ELISA), and 51 (26%) profile D (anti-M2/-M4/-M8 by ELISA and CFT). At the beginning of the study, 177 patients had PBC stage I/II. During the observation period of ten years, ten patients died and in 18 orthotopic liver transplantation (OLT) was performed; all these patients belonged to profile C/D. Furthermore, 44% of the patients with profile C and 31% of the patients with profile D progressed to late stages, as defined by histology and clinical manifestations such as portal hypertension and increase of bilirubin, while only one of the patients with profile B and none of the profile A-patients developed late stage PBC. A significant increase of bilirubin was observed only in C/D-patients. AMA profiles did not change during the follow-up. In conclusion, AMA profiles discriminate between a benign and a progressive course of PBC already at early stages.

Investigation of the pathogenesis of massive hemolysis in a case of Clostridium perfringens septicemia

Massive hemolysis is a rare, usually fatal complication of Clostridium perfringens septicemia. Of all toxins produced by the bacterium, phospholipase C (PLC) is believed to be the most likely cause of hemolysis. An influence of neuraminidase has often been suspected. In the present study, a case of C. perfringens septicemia with acute massive intravascular hemolysis is described. It led to death within 4 h of admission to the hospital. While the course of events was comparable to previously reported cases, we succeeded in gaining deeper insight into the pathogenesis by monitoring serum anti-T titer and quantifying serum PLC activity during the course of the disease. We excluded an effect of neuraminidase by a negative direct antiglobulin test, a negative anti-T lectin test, and a steady serum anti-T titer of 1 in 32. Serum PLC activity, on the other hand, showed a nearly fivefold increase (6.0 to 27.3 U/l), which is consistent with the hypothesized dominant role of this enzyme.

Progressive cerebellar syndrome in adult coeliac disease

A case of slowly progressing cerebellar syndrome and pathologically confirmed adult coeliac disease is presented. Neurological symptoms progressed although the patient had no enteric complaints. This case seems to be identical with 18 previously reported cases of encephalopathy and adult coeliac disease. However, the aetiology and pathogenesis of the encephalopathy are still not known.

Influence of verapamil on gastric acid secretion and gastrin release in dogs

Gastric secretion is supposed to be calcium-dependent. The effect of verapamil (0.3 mg/kg/h i.v.), a calcium channel-blocking agent, on stimulated gastric acid secretion and gastrin release was investigated in 8 mongrel dogs. Stimulation was either performed by bombesin (1.0 microgram/kg/h i.v.) or by insulin (0.3 U/kg i.v.). Verapamil significantly inhibited both the bombesin- and the insulin-stimulated gastric acid secretion. Mean total gastric acid output over a 120-min period was 9.5 +/- (SEM) 2.2 mmol after bombesin stimulation and 6.3 +/- 2.0 mmol after bombesin and verapamil (p less than 0.01). The respective values were 15.3 +/- 2.0 mmol for insulin stimulation and 7.0 +/- 1.6 mmol for insulin and verapamil (p less than 0.01). There was no significant influence of verapamil on plasma gastrin concentrations. Thus, the impairment of acid secretion by verapamil is not due to an inhibition of gastrin release in intact dogs.

Influence of long-term anticonvulsant treatment on liver ultrastructure in man

In 35 patients on long-term anticonvulsant treatment (7-35 years, means = 19.6 years), various liver enzymes were measured. In 32 cases (91.4%), elevated levels of serum-gamma-glutamyl-transpeptidase (GGT) were found. Liver biopsy was performed in five of 13 patients with GGT levels of greater than 60 U/l (75-257, means = 123 U/l). Light microscopy showed a minimal steatosis and fine granular appearance of hepatocytes in two cases, and a slight portal fibrosis in one case. Two cases showed an unremarkable histology. Electron microscopy revealed signs of enzyme induction as overall swelling of the smooth endoplasmic reticulum and additionally a dilatation of the rough endoplasmic reticulum in all five specimens. No signs of liver damage or disturbance of liver function could be observed.

[Sarcoidosis of the nervous system. Clinical and diagnostic synopsis based on two cases]

This paper reports two cases of neurosarcoidosis . Initially the clinical picture involved only the nervous system. Later on manifestations pertaining to other systems were detected by interdisciplinary investigations. The resulting diagnostic problems, the value of additional investigations and the therapeutic management are discussed on the basis of the two presented cases.

Effect of luminal somatostatin on pentagastrin-stimulated gastric acid secretion in the rat

The perfused rat stomach was used to investigate the effect of intragastrically administered somatostatin (S-14) on basal and pentagastrin-stimulated gastric acid secretion. Intravenous injection of pentagastrin (10 micrograms/kg body wt) induced a peak acid output (PAO) of 6.3 +/- 0.45 mu eq H+. With luminal perfusion of the stomach by S-14 (100 micrograms X kg-1 X min-1), no significant inhibition of gastric acid secretion was observed (PAO: 5.9 +/- 0.6 mu eq H+). The same dose of S-14 administered intravenously significantly inhibited acid secretion (PAO: 1.7 +/- 0.4 mu eq H+) as did intravenous injection of neutralized S-14-containing gastric perfusate obtained by perfusion from a different rat stomach (PAO: 1.9 +/- 0.5 mu eq H+). Intravenous injection of a saline gastric perfusate containing no S-14 did not alter gastric acid secretion (PAO: 6.3 +/- 0.7 mu eq H+). It is concluded that S-14 does inhibit gastric acid secretion when administered systemically but not by intraluminal application.

Effect of gut lavage on phenobarbital elimination in rats

In the management of intoxications, the major goals are enhanced elimination of the toxin from the organism and prevention of further absorption. Absorption of an orally administered substance from the gastrointestinal tract can be decreased by adequate washing of the stomach. Delayed absorption of the substance from the small intestine cannot be avoided by this procedure and after the gastric lavage, a nonspecific absorbent must be administered and diarrhea induced (1). This study demonstrates that iatrogenic diarrhea via gut lavage can also eliminate toxins already absorbed by the body.

[(Influence of somatostatin (SS-14) on early dumping reaction in patients after partial gastrectomy) ]

In seven patients suffering from early dumping syndrome after partial gastrectomy (Billroth II operation) an early dumping reaction was provoked by 100 g dextrose per os and the influence of somatostatin-14 (SS-14) infusion on clinical appearance of dumping syndrome was evaluated. SS-14 in contrast to the control trial resulted in total suppression of insulin release and slightly delayed and lowered increase of blood glucose which was not statistically significant, but with SS-14 there was no change in clinical symptoms of dumping reaction and compared to the control test no significant difference was found between the decrease of blood pressure, the increase of pulse frequency, the small increase of hematocrit and plasma free fatty acids.

[Inhibition of glucose and leucin absorption by somatostatin in the dog (author's transl)]

Small bowel absorption of glucose and leucin was investigated under the influence of somatostatin (SST) using an isolated Thiry Vella loop in the unrestrained dog. SST infusion significantly reduced glucose and leucin absorption, inhibiting glucose absorption more than that of leucin.

Failure of somatostatin to influence experimental tumor cell growth in vivo and in vitro

The influence of somatostatin on tumor cell growth was studied in vivo in mice (sarcoma 180 ascites tumor and Lewis lung tumor) and in vitro on nontransformed and polyoma-transformed cell lines. 4 or 20 micrograms/100 g of cyclic somatostatin and 4 micrograms/100 g of linear protamin Zn-bound somatostatin were injected s.c. twice daily in the in vivo study. Cyclic somatostatin (1, 4 or 10 micrograms/ml) was added twice daily to the cell cultures. Somatostatin administration influenced neither the survival of animals nor the growth rate of cultured cell lines.

[Diagnosis of pancreatic function. Simplified screening with fluorescein dilaurate using serum concentration determinations]

Fluorescein-dilaurate has been recommended as a screening test for the assessment of exocrine pancreatic function. In this test fluorescein excretion in the urine is measured for an 8--10 hour period. To avoid urine collection the present study reports on serum fluorescein determinations following oral administration of fluorescein-dilaurate-ester. According to the results of a standard secretin-pancreozymin-test 24 subjects were classified as 10 persons with normal pancreatic function, 7 patients with mild and 7 patients with severe exocrine pancreatic insufficiency. Fluorescein concentrations were measured photometrically after TCA-precipitation. In the normal persons maximal fluorescein levels were observed 4--6 hours after oral load of the test substance. Patients with mild pancreatic insufficiency showed the same pattern and only in patients with severe pancreatic insufficiency much lower serum fluorescein concentrations were found. They were statistically significantly different from normal subjects 3--6 hours after administration of fluorescein-dilaurate.

[Case report of a patient with intermittent fever, leucopenia and terminal fungal sepsis (author's transl)]

A fatal case of disseminated candidiasis with deep organ involvement is reported. The patient was employed as a radiologist for several decades and already showed X-ray-induced bone marrow damage at the onset of the disease. He suffered for several years from an unknown granulomatous systemic bacterial infection and had been treated with antimicrobial agents with varying degrees of success. Regarding prophylaxis of systemic Candida infections it is concluded that prolonged medication with glucocorticoids and antibiotics should be combined with the oral administration of antimycotic drugs in order to prevent invasion by potentially pathogenic fungi.

The effect of SST, glucagon, calcitonin and PGE1 on exocrine pancreatic secretion in the unrestrained dog in long-term experiments

Using a new model of a reversible pancreatic fistula which allows the long-term-investigation under nearly physiological conditions on the unrestrained dog, we tested the effect of somatostatin (50 micrograms), calcitonin (4 micrograms), glucagon (1 microgram), and prostaglandin E1 (150 micrograms) on the exocrine pancreatic function in 45 experiments over a period of 13 h: SST inhibits the basal as well as the secretin or CCK-stimulated secretion: calcitonin shows inhibition of the stimulated secretion only; glucagon blocks the secretin-stimulated pancreatic function; and PGE1 reduces the bicarbonate concentration and trypsin output in secretin stimulation, but in one of the two series it stimulates the basal secretion.

The action of somatostatin on intestinal alkaline phosphatase stimulated by secretin and cholecystokinin-pancreozymin

The action of somatostatin on intestinal alkaline phosphatase activity (IAP) in the duodenal juice was examined in 22 subjects undergoing diagnostic secretin-CCK-PZ-tests. Under continuous secretin-CCK-PZ-stimulation there is an increase of IAP which is followed by a period of exhaustion after 1 h of stimulation. The intravenous administration of somatostatin induces a distinct inhibition of IAP which cannot be due to the exhaustion of the enzyme synthesis. As there is a functional relationship between fat absorption and alkaline phosphatase, it is suggested that this inhibition of IAP is one of the mechanisms of the somatostatin-induced inhibition of intestinal fat absorption.

[The value of laboratory tests (author's transl)]

The diagnostic significance of various laboratory tests was studied at a Medical University Clinic and a regional hospital. Requests for such tests were graded on admission according to the criteria: (a) necessary for differential diagnostic decision; (b) part of routine admission programme. Results were assessed according to the criteria: (a) clinical "proof"; (b) of value in differential diagnosis; (c) pointing to another diagnosis; (d) unhelpful. Analysis of the results provided an interesting agreement: all doctors graded seven to ten tests as necessary. Those with the highest information content were the classical tests--erythrocyte sedimentation rate, serum-electrophoresis and blood sugar levels. 45.6% of those graded as necessary proved informative; 7.2% of routinely ordered tests provided pointers to another diagnosis. This percentage is the contribution of laboratory tests beyond what doctors consider as necessary for diagnosis. This additional value of laboratory tests is relatively high so that a reasonably extensive programme of laboratory tests on admission appears justified, especially if one adds the time factor to cost-effectiveness.

[Serum gastrin following renal transplantation]

Basal and postprandial serum gastrin concentrations were determined in 26 renal transplant patients and compared with the values found in 5 normal subjects. All subjects received a solid test meal consisting of 25 g protein, 47 g fat and 58 g carbohydrates. All patients were in a non-uraemic state and received combined prednisolone-azathioprine treatment. 5 patients had a peptic ulcer. There was no significant difference in the mean serum gastrin concentrations of the two groups, either with respect to basal or postprandial values. On calculating mean gastrin concentrations of patients given high (over 20 mg daily) or low (under 20 mg daily) prednisolone dosage, again no difference was found in comparison with the normal subjects. Similarly, no difference was observed in the mean serum gastrin levels between ulcer patients and normal controls. We conclude from these results that, in contrast to the findings in chronic uraemic patients, gastrin metabolism is normal in renal transplant recipients and that the high indicence of gastrointestinal complications, especially peptic ulcer, cannot be due to a disturbed gastrin metabolism in these patients.

[Further examinations of the influence of somatostatin on triglyceride absorption (author's transl)]

7 healthy subjects received an oral fat load containing 100 g neutral fat on two test days. The test meal was followed by an infusion of somatostatin (500 micrograms/h) over three hours. On the first test day 150,000 E of an active fungal lipase (extracted from Rhizopus arrhizus) were given with the fat meal. On the second day placebo capsules were administered instead of lipase. No postprandial increase of serum triglyceride levels could be found in both examinations. These results suggest, that the influence of somatostatin on triglyceride absorption cannot be due to the inhibition of pancreatic lipase secretion.

Evaluation of the 75Se-l-selenomethionine test for pancreatic disease. Studies on gel filtration

Radioselenium-secretin-pancreozymin tests have been performed in 22 normal subjects and in 23 patients with pancreatic exocrine insufficiency. Each subject received an intravenous injection of 40-100 mu Ci 75Se-l-selenomethionine as a bolus which was followed by an intravenous infusion of secretin-CCK-PZ (1 CU/kg/h) for 2 h. Duodenal juice was collected from a double-lumen Lagerlöf tube and the 75Se radioactivity measured. Gel filtrations on Sephadex G-50 were performed from samples of duodenal juice. Total duodenal radioactivity in pancreatic insufficient patients was significantly lower than in normal subjects 60-120 min after the start of the examination. When regarding the individual values of each subject an important overlap of normal and pancreatic insufficient persons could be observed. No difference in the gel filtration pattern was demonstrable between the two groups. From these results the use of 75Se-l-selenomethionine for diagnostic purposes in pancreatic diseases cannot be recommended.

The influence of somatostatin on the absorption of triglycerides in partially gastrectomized subjects

Serum triglyceride levels were measured in 10 partially gastrectomized patients after an oral fat load of 100 g. Postprandial triglyceride elevation was completely blocked by somatostatin infusion. This depression cannot be an effect of delayed gastric emptying, because all our patients were Billroth-II operated, but is considered to be due to a direct effect of somatostatin of intestinal absorption.

Somatostatin reduces the release of colony-stimulating activity (CSA) from PHA-activated mouse spleen lymphocytes

PHA-activated lymphocytes release colony-stimulating activity (CSA) for macrophage-granulocyte precursor cells (colony forming units, CFUc) in the culture medium. Somatostatin, known to interfer with ribosomal protein synthesis, was demonstrated to reduce the release of CSA from PHA-treated mouse spleen lymphocytes.

[Exocrine pancreatic function in chronic alcoholics in Austria (author's transl)]

97 chronic alcoholic patients were investigated with regard to exocrine pancreatic function. Chronic calcifying pancreatitis was radiologically established in 7.2% of the cases. Secretin-pancreozymin tests were performed in 30 patients. Pancreatic insufficiency was found in 8 patients, while 8 patients showed marked hypersection. The daily faecal fat excretion in 10 other patients with partial gastrectomy and Billroth II operation was 5.3 g. Pancreatic disorders were, thus, detected in 53.2% cases of chronic alcoholism. This is higher than expected for Austria.

[Inhibition of postprandial increase in serum triglycerides by somatostatin in man (author's transl)]

A test meal containing 100 g neutral fat was administered to 10 healthy subjects. Serum concentrations of triglycerides, cholesterol, free fatty acids and gastrin were determined during an infusion of 1000 microng somatostatin/h over 3 hours. In comparison with a control group (infusion of normal saline solution), somatostatin caused almost complete suppression of the triglyceride increase. The free fatty acids showed a slight increase under somatostatin while there was no change in the cholesterol levels. Gastrin release was also completely blocked by somatostatin. The suppression of the serum triglycerides may be explained by the inhibition of digestion and absorption of fat in the small intestine under the influence of somatostatin which suppresses exocrine pancreatic secretion.

[Long-term results after therapeutic starvation (author's transl)]

19 Persons with gross refractory obesity (7 men and 12 women) were treated by therapeutic starvation. The patients were controlled after 32 months, on average (range: 7 to 58 months), following completion of treatment. The study shows that 8 of the females gained weight, one of these attaining her pretreatment weight and another even exceeding the pretreatment figure. None of the males had regained his pretreatment weight but 4 showed an increase in comparison with the weight at the time of hospital discharge. During starvation the serum lipids showed a marked decrease, which was statistically significant in the case of cholesterol, but not triglycerides. At the time of follow-up examination the serum lipid values were about the same as before treatment. It is concluded that the long-term results of therapeutic starvation are beter in men than in women and yet this method of treatment should be attempted, when indicated according to strict criteria, in refractory cases of extreme obesity.

[The influence of somatostatin on serum gastrin concentrations in patients after total duodenopancreatectomy (author's transl)]

Serum gastrin concentrations were measured in insulin-dependent diabetics and in patients who had undergone total duodenopancreatectomy and gastrectomy. Administration of somatostatin markedly inhibited gastrin release in the diabetic patients with an intact gastrointestinal tract. This inhibitory effect of somatostatin, however, is not detectable in the group of operated patients, who display basically low plasma gastrin levels. A marked increase in the plasma gastrin level after withdrawal of somatostatin was observed in patients with a normal gastrointestinal tract. This rebound effect was only slight in the operated patients.

[ Somatostatin in insulin-dependent diabetics and in pancreatectomized patients (author's transl)]

The inhibitory effect of somatostatin on the secretion of glucagon permits the examination of the effect of glucagon on some metabolic parameters in the insulin-dependent diabetic patient. The results obtained in 5 insulin-dependent diabetics and in 4 pancreatectomized patients revealed an inhibitory effect of somatostatin on blood glucose in the juvenile-type diabetics, but failed to show this influence of somatostatin in the pancreatectomized patients. These observations indicate a participation of glucagon in the generation of hyperglycaemia in diabetes mellitus. However, the failure of somatostatin to influence the blood glucose level in pancreatectomized patients contrasts with the results obtained in dogs and emphasizes the difficulty and pit falls in the application of animal experiments with somatostatin to humans.

Effect of alterations of blood glucose levels on gastric acid secretion, plasma gastrin, and plasma osmolality in man

In 16 experiments on 4 healthy subjects, the effect of procedures which alter blood glucose, ie, infusion of 0.2 units/kg body wt/hr insulin and/or 0.66 g/kg body wt/hr glucose, on gastric acid secretion, plasma gastrin, and plasma osmolality was studied, Each subject underwent four different experimental procedures, each lasting 4 hr. All had in common one basal hour and the infusion of insulin in the second hour, but differed in the time of infusion of glucose or isotonic saline. To control for order effects, the four procedures were applied to the subjects in the form of a Latin square. Acid output was measured continuously be means of intragastric titration and a telemetering capsule; blood glucose, plasma gastrin, and plasma osmolaity were determined in 15-min intervals. An inverse relationship between blood glucose and acid output was found: Low glucose levels were associated with high rates of acid secretion, high glucose levels with low acid secretion. No noticeable changes occurred in either plasma gastrin or plasma osmolality. These results reveal a determining influence of blood glucose levels on acid secretion. On the basis of earlier work in animals it is concluded that this influence is exerted via the reciprocal activities of the hypothalamic satiety and feeding centers.

Extraction of gastrin from normal porcine pancreas

Gastrin was extracted from normal porcine pancreas by the method used by Gregory and Tracy for the extraction of gastrin from the antrum. Radioimmuno-assay was used for identification at all stages of the extraction procedure. Gastrin of pancreatic origin was eluted from a sephadex G 50 and a DEAE-collulose column at the soma position as porcine antral gastrin. In disc electrophoresis (7.5% polyacrylamide in tris-glycin buffer) we found a single band which migrated the same distance from the origin as reference gastrin (synthetic human gastrin I). Densitometircally there was also a single band. The eluate of this electrophoretic band produced an increase in gastric acid secretion after intravenous injection in the rat. A dilution series was made from the extracted fraction and radioimmunologically tested with gastrin antibodies. The individual points of the dilution curve corresponded well with the standard calibration curve of gastrin. A certain discrepancy between the small amount of gastrin found by radioimmunoassay (500 pg/g fresh pancreas) and biochemical and biological findings could probably be explained by a different sensitivity of the gastrin antibody of the radioimmunological system to pancreatic gastrin. Our results prove that there is gastrin in the normal porcine pancreas.

[GSP--a polypeptide from the pancreas with gastrin-like effect]

A peptide has been extracted from porcine pancreas which is capable to stimulate gastric acid secretion in the rat. This peptide consists of 13 aminoacids, it's molecular weight is about 1300. In comparison with antral gastrin there are several biochemical differences: GSP (gastrosecretagogue pancreatic polypeptide) reacts differently in gel filtration, ion exchange chromatography and electrophoreses and has a different aminoacid composition. The 4 amino acids of the C-terminal tetrapeptide of gastrin are not all present. GSP does not react with gastrin antibodies in radioimmunoassay. GSP may be a new gastrointestinal hormone by means of which the pancreas takes part in the regulation of gastric acid secretion.

[Is there a feed-back mechanism between serum gastrin concentration and gastrin release (author's transl)]

The dialysability of gastrin heptadecapeptide was investigated in a model arrangement. The amounts of gastrin passing through the dialysis membrane during a 6-hour dialysis procedure are very small. Furthermore, the serum gastrin concentrations were measured during a 6-hour haemodialysis session with and without simultaneous pentagastrin infusion (0.003 mug/kg/h) in 8 patients on intermittent haemodialysis. There is a continuous decrease in the serum gastrin concentration during the 6-hour dialysis period with simultaneous pentagastrin infusion, while in the investigation without pentagastrin infusion phases of increase in serum gastrin levels are observed. In view of this different response of the serum gastrin curve it is suggested that a direct feed-back mechanism exists between the serum gastrin concentration and gastrin release, a mechanism which was interrupted by the pentagastrin infusion in the present investigation.

[Treatment of exocrine pancreatic insufficiency with fungal lipase (author's transl)]

7 patients suffering from severe exocrine pancreatic insufficiency have been treated with a lipolytic enzyme extracted from Rhizopus arrhizus. Comparing the fungal lipase with a placebo the drug lowered the daily stool weight from 809 g to 443 g on an average, i.e. by 45.2%. The steatorrhea was reduced from 75.6 g/24 h to 32.9 g, i.e. by 56.5%. When incubating the enzyme in vitro in saline solutions of different pH for 1 h the loss of lipolytic activity is 13% at pH 5, 15% at pH 4, and 19% at pH 3. So the enzyme, like fungal proteases, is almost not altered by hydrochloric acid at concentrations found physiologically in the stomach.

[The measurement of 75selenium in duodenal juice--an advance in the diagnosis of pancreatic function (author's transl)]

The radioactivity in the duodenal juice following the intravenous injection of 75Se-1-selenomethionine was measured in 17 normal subjects and in 14 patients with exocrine pancreatic insufficiency. The mean values of radioactivity were significantly lower during certain periods of the investigation in the patients with pancreatic insufficiency as compared with the normal subjects. The individual values, however, scattered widely and the standard deviations were large. There was a highly significant correlation between the volume of duodenal juice and the 75Se radioactivity, but no significant correlation was established between the duodenal juice radioactivity and bicarbonate or enzyme concentration i.e. specific parameters of exocrine pancreatic function. It is possible that observation period may bring less equivocal results, but this appears of doubtful practicability. Measurement of the 75Se-1-selenomethione radioactivity in the duodenal juice is only an indirect indicator of exocrine pancreatic function. It does not appear to represent any significant advance in the diagnosis of pancreatic insufficiency, since the information provided by these older-established methods is more reliable and is obtained within a similar space of time.

Hormone-induced diarrhea in man

In a healthy subject infusions of either secretion or glucagon caused no diarrhea. A combinations of gastrin and glucagon induced severe watery diarrhea immediately after the end of the 3 hour infusion. No diarrhea occurred from the combination of secretin and gastrin.

Normal serum gastrin levels in patients with liver cirrhosis

In 28 patients with cirrhosis of the liver, histologically confirmed by liver biopsy, serum gastrin concentrations were determined radioimmunologically afer an overnight fast. Mean value and standard deviation in the patients with cirrhosis (30.1 +/- 19.3 pg/ml) was not found to be significantly different from the mean value established in 275 normal subjects (39.7 +/- 21.3 pg/ml).

75Se-selenomethionine excretion in bile and pancreatic juice

The radioactivity in the bile and pancreatic juice of two patients was measured after intravenous injection of 75Se-l-selenomethionine. The concentration of radioactivity in both fluids is almost equal. Thin-layer chromatography shows that the main part of radioactivity in pancreatic juice is due to unbound 75Se-selenomethionine, while free 75Se-selenomethionine is only a minor part of the total radioactivity appearing in the bile.