The efficacy of wrist protectors in preventing snowboarding injuries

Injuries of the wrist are common among snowboarders and in-line skaters. Wrist protectors have been developed to protect against injury. Some studies support the use of such wrist protection, but others emphasize the fact that wrist protectors may transfer the injury to other locations in the forearm. We conducted a prospective, randomized, clinical study of 5,029 snowboarders, 2,515 in a braced group and 2,514 in a control group. The primary endpoint was fracture or sprain of the wrist with loss of range of motion and pain of at least a 3-day duration. Concomitant injuries were also recorded. Eight wrist injuries occurred in the braced group and 29 occurred in the control group. This was a significant difference. Beginners (first 5 days on a snowboard) and snowboarders with rented equipment were more prone to injury than others. No injuries could be related to the use of the wrist brace. We conclude that wrist braces are effective in protecting snowboarders against wrist injury. Beginners are a high-risk group.

Risk of injury during alpine and telemark skiing and snowboarding. The equipment-specific distance-correlated injury index

Estimation of injury risk in alpine sports is difficult. We present a new method of calculating an injury index related to the distance traveled on ski or snowboard. The distance-correlated injury index equals the number of injuries per 100,000 km traveled distance. This injury index can also be correlated to the type of equipment used. The equipment-specific distance-correlated injury index is the same as the distance-correlated injury index, but it is sport-specific. We found the distance-correlated injury index for alpine skiing to be 3.9 (95% Cl = 2.8 to 5.4); for snowboarding, 13.5 (95% Cl = 8.3 to 22.0); and for telemark skiing, 3.0 (95% Cl = 1.0 to 9.4), suggesting a three- to four-times higher incidence of injuries requiring hospital treatment among snowboarders than among alpine and telemark skiers.

[Follow up after potential curative surgery of colorectal cancer. Guidelines from the Norwegian Gastrointestinal Cancer Group]

In Norway, about 2,800 cases of colorectal cancer are diagnosed every year. Two-thirds of the patients undergo potentially curative surgery and almost half of them develop local or distant metastases. The follow-up of colorectal cancer patients involves four strategies: Educating the patients about the disease, symptoms of relapse, and risk of hereditariness; Early diagnosis of relapse, to make curative re-surgery possible; Diagnosis of metachronous/synchronous cancer(s); Recording the results of current surgical techniques. The Norwegian Gastrointestinal Cancer Group recommend a four-year follow-up programme (every third month for two years and then twice a year) of colorectal cancer patients. It is suggested that patients treated with low anterior resection are followed regularly by means of rectoscopy and local examination (digital or by ultrasound) undertaken by specialist (surgeon or gastroenterologist). The others should be followed up mainly by general practitioners. Carcinoembryonic antigen (CEA)-monitoring is suggested every third month for two years, and then every sixth month. Colonoscopy is recommended at one and four year follow-up. Patients with normal CEA levels prior to surgery should be evaluated by ultrasound of the liver every sixth month for four years.

Characterization of 'winners' to enoxaparin in the prevention of postoperative venous thromboembolism in digestive surgery

BACKGROUND

A total of 826 patients were included in three 'play-the-winner' studies to investigate the safety of prophylaxis against venous thromboembolism in digestive surgery. To characterize patients benefiting from prophylaxis with low-molecular heparin, the 445 patients allocated to enoxaparin were investigated.

METHODS

A training set consisting of 292 patients from 2 of the studies was analysed by using a linear discriminant model. The reliability of the results was verified on a test set consisting of 153 patients from the third study.

RESULTS

A typical 'winner' was a young patient, preferably female, with serum bilirubin in the lower normal range, combined with body temperature, serum sodium, creatinine, and albumin in the upper normal ranges. By using the discriminant function on the test set, 81.7% of the 'winners' and 21.1% of the "losers' were correctly classified.

CONCLUSION

The discriminant function for characterization of winners to enoxaparin was found adequate. No rule was acceptable for characterization of losers.

[Liver injuries]

We report on a series of 193 patients with traumatic liver injuries treated at our Trauma Centre I during the period 1983-94; i.e. about 13 patients per year. The centre has a catchment population of 850,000. Most of the patients were severely injured, with 3.2 injured organs per patient among the 151 patients with multiple injuries. The clinical diagnostic work was supplemented with peritoneal lavage, ultrasonography and computer tomography. 38 patients were not operated on, of whom 25 survived. Exploratory laparotomy with or without liver suturing was used in 125 patients and liver resection in 18 seriously injured patients, with more than 50% mortality. Perihepatic packing was used in 12 patients, all with other serious injuries and with a high rate of mortality from these injuries. Liver injuries can be divided into two groups. A few injured patients are admitted in severe shock, and may be treated with immediate thoracotomy and clamping of the aorta, followed by urgent laparotomy to control bleeding by means of packing. The rest of the abdomen is examined quickly and closed, to avoid well known complications of bleeding and multitransfusions, i.e. hypoxaemia, acidosis and hypothermia. Repeat laparotomy follows in 2-3 days, to remove the packing. A stable patient should be referred for computer tomography, and may be treated without operation, but must be followed closely clinically.

[Thromboembolic complications in ambulatory surgery. A retrospective study of 1691 patients]

The risk of thromboembolic complications in outpatient surgery is regarded as being low. Thromboembolic prophylaxis is seldom administered as a routine. A retrospective study in our outpatient department, based upon patients readmitted for clinical thromboembolism, showed an incidence of deep vein thrombosis of 0.05% (8/1 691) and of pulmonary embolism 0.0006% (1/1 691). None of the patients received prophylaxis for thrombosis, and all operations were performed under regional anaesthesia of the lower extremity. 50% of the operations were performed using a tourniquet. 2/3 of the patients were women and 2/3 were over the age of 50. Operation time was usually 30-45 minutes. Our study indicates that patients undergoing knee arthroscopy, and operations for varicose veins and hallux valgus are at risk of thromboembolism. Prospective studies of these risk groups are necessary to figure out the need for thrombosis prophylaxis.

[Spontaneous retroperitoneal hemorrhage]

Spontaneous retroperitoneal haemorrhage is most frequently due to rupture of an abdominal aortic aneurysm. Pathology in other retroperitoneal organs, most often the kidney and the adrenal gland, may cause retroperitoneal haemorrhage. Spontaneous rupture of veins, especially the iliac vein, and haemorrhage secondary to anticoagulant therapy, are less common causes. The symptoms are variable and non-specific, but most often include acute abdominal pain, hypotension, peritoneal irritation and a palpable abdominal mass. The diagnosis is confirmed by ultrasonography, computerized tomography, and if relevant angiography or scintigraphy. We discuss three patients with spontaneous retroperitoneal haemorrhage, examine the clinical approach and the role of the various diagnostic aids, and consider how the various conditions should be dealt with.

[Chemotherapy in colorectal cancer. Recommendations of the Norwegian Gastrointestinal Cancer Group]

The scientific documentation for fluorouracil-based chemotherapy in patients with colorectal cancer has increased during recent years, both for the adjuvant primary situation and in recurrent and metastatic disease. In the case of operable colorectal cancer (stage Dukes B and C), the patients should be included in the ongoing randomized trial on use of fluorouracil and levamisol. In advanced disease, fluorouracil combined with calcium folinate may have palliative effects in terms of relief of symptoms, improved quality of life, delay of onset of symptoms and probably also prolonged survival in 40-50% of the patients, without serious toxicity. In many cases, however, the patient should not be given chemotherapy.

[Treatment of fixed, primarily non-resected rectal cancer. Recommendations from Norwegian Gastrointestinal Cancer Group]

In most cases (70%), fixed rectal cancers are primarily non-resectable, and of the ones that are resected, local recurrence will occur in 50-70%. The same trend, but less pronounced, is also seen for partly fixed or tethered tumours. High-dose irradiation (45-60 Gy) has been reported to yield resectability rates up to 70%, with 17% local recurrences and a 5-year disease-free survival of up to 60-70%. Combined chemotherapy and sequential radiation therapy, hyperthermia or addition of intra-operative radiotherapy, have shown promising results, but no randomized studies have been published comparing the different treatment modalities. Surgery should be performed 4-6 weeks after preoperative treatment. Resectability can only be determined by exploratory laparotomy and serious attempts to remove the tumour-bearing segment by anatomic dissection.

[Should oral contraceptives and postmenopausal hormonal substitution be withdrawn prior to surgery? A questionnaire study in departments of surgery and gynecology]

We conducted a survey among the surgical and gynaecological departments of all Norwegian hospitals, about today's practice concerning oral contraceptives and surgery. Most of the surgical and gynaecological departments recommend discontinuance of the pill two and four weeks prior to surgery, and reintroduction upon mobilisation postoperatively. In surgical emergencies amongst women who use the pill, 4/5 surgical and 2/3 gynaecological departments would prefer to give thrombosis prophylaxis. Low molecular weight heparin was recommended most. Surgical departments especially recommend stopping the use of the progestogene only contraceptive pill, and post menopausal oestrogen substitution, before elective surgery. Both gynaecological and surgical departments give inadequate information about the use of alternative birth control during the period when the pill is not taken. The survey did not show any difference between university and central/county hospitals.

[Abdominal injuries after blunt trauma]

We present a series of 331 patients admitted to hospital in 1980-87 with abdominal injuries after blunt trauma. The patients included 230 males and 101 females. The median age was 29 years. More than half of the patients were injured in traffic accidents. 11% were transferred to our Trauma Center from other hospitals, median five hours after the accident. A doctor-manned helicopter transported 52 patients (18%) directly to our hospital. 70% had extra-abdominal injuries as well. A minimum of 20% were intoxicated by alcohol and/or drugs. Severe injuries (AIS greater than 3) were present in 46%. 168 patients underwent laparotomy, in 56% within two hours of admission. In 27 of the 168 laparotomized patients (16%) no intraabdominal injury was encountered that needed repair.

[Grading and prognosis of blunt abdominal injuries]

From 1 January 1980 to 31 December 1987, 297 patients were admitted to Ullevål Hospital, Dept. of Surgery, with abdominal injury after blunt trauma. The Injury Severity Score (ISS) was determined in retrospect, and correlated to mortality, morbidity and use of resources. 50 patients (16.8%) died. Mortality increased with increasing ISS, until ISS was above 34. In this group, mortality was 75%. In the survivors, hospital costs (days in the hospital, in the intensive care unit, on mechanical respiration, and number of blood units transfused) increased with increasing ISS. The likelihood of developing septicaemia adult respiratory distress syndrome (ARDS) or multiple organ failure also increased with increasing ISS. Those who died were older and had a higher ISS than the survivors. In patients over 55 years old, the mortality increased significantly. The ISS is well suited for identification of seriously injured patients after blunt abdominal trauma. The ISS can be used to predict mortality, morbidity and cost of treatment in groups of patients.

[Delayed surgery in blunt abdominal trauma]

Abdominal organ injuries caused by blunt trauma are notoriously difficult to diagnose, and for this reason an operation may be dangerously delayed. 426 abdominal organ injuries were registered in a series of 331 patients admitted after blunt abdominal trauma. 151 of these patients had 199 abdominal organ injuries which required surgical repair. In 31 patients (20%) with 44 organ injuries, operation was delayed for more than six hours after admission, in most cases because of missed diagnosis. One of these patients died as a result. Hollow viscus injuries were the most commonly missed. In addition to repeated clinical evaluation, peritoneal lavage, repeated if necessary, and diagnostic imaging must be used as valuable tools of diagnosis, especially in comatous patients, in patients with multiple injuries, and in intoxicated patients.

[Diagnostic peritoneal lavage in blunt abdominal trauma]

Peritoneal lavage was performed in 142 of 331 patients submitted to hospital after blunt abdominal trauma. The lavage catheter was introduced through a short infra-umbilical longitudinal incision with surgically controlled access to the peritoneal cavity. First time lavage was positive in 58 out of 68 patients in demand of laparotomy, and after repeated lavages in 66 of 68. In 12 patients there was a false positive lavage. The sensitivity was 97% and the specificity 84%. Negative lavage strongly indicates that laparotomy is not necessary. A positive test as an indication for laparotomy should be regarded with reservation. The method is simple to perform and represents a valuable supplement to clinical evaluation in patients with blunt abdominal trauma.

[Penetrating abdominal injuries]

We have reviewed the medical records of 111 patients treated for abdominal stab wounds during the period 1980-87. Our two hospitals serve a catchment area of about 450,000 people. Exploratory laparotomy was performed in 89 patients with suspected peritoneal penetration. In 16 patients the laparotomy was negative, and in 15 patients only minor injuries were noted. There were no serious complications in these 31 patients. Twenty-seven patients had thoracic wounds below the fourth intercostal space, 15 with intraabdominal injuries. The most common injuries were lacerations of the liver, the small bowel and the diaphragm. The mortality in the series was 2%. Stab wounds are infrequent in Norway, and most surgeons have limited experience of such injuries. We discuss whether to employ immediate exploratory laparotomy or selective management when the peritoneum has been penetrated. When there is no evidence of evisceration or omental protrusion, local exploration of the wound should be performed in order to confirm or exclude peritoneal penetration. Injury to the diaphragm and intraabdominal viscera should always be suspected in thoracic stab wounds below the fourth intercostal space.

Missed diagnosis and delayed laparotomy in blunt abdominal trauma

Abdominal organ injuries caused by blunt trauma are notoriously difficult to diagnose and a vital operation may as a result be dangerously delayed. In a series of 331 patients admitted after blunt abdominal trauma, 426 abdominal organ injuries were registered. 152 of these patients had 199 abdominal organ injuries requiring surgical repair. In 31 of these patients (20%) with 44 organ injuries operation was delayed for more than 6 hours after admission, in most instances because the diagnosis had been missed. One of these patients died as a consequence. Hollow organ injuries were the most commonly missed. Peritoneal lavage, repeated if necessary, and diagnostic imaging must be used as valuable tools in addition to repeated clinical evaluation, especially in comatose patients, in patients with multiple injuries, and in intoxicated patients.

Serotonin--a possible transmitter for the gastric adaptive relaxation. Interaction with histamine and prostaglandin F2 alpha on pressure responses in the isolated stomach

Serotonin, or 5-hydroxytryptamine (5-HT), relaxes upper guinea pig stomach, and its possible role as a transmitter in the vagally induced upper gastric adaptive relaxation has been discussed. Such a transmitter is expected to act via other mechanisms than crude muscle depression. To test whether the relaxation response to serotonin is compatible with a putative role as transmitter in gastric adaptive relaxation, we wanted to evaluate whether serotonin acts by crude muscle depression and whether it selectively inhibits histamine or prostaglandin F2 alpha (PGF2 alpha). The study shows that 5-HT, in addition to its relaxatory effect on fundic spontaneous activity, selectively inhibits histamine, whereas PGF2 alpha is not inhibited. It is then concluded that the relaxatory effect of 5-HT is provided through other mechanisms than crude muscle depression and that selective inhibition of intramural agonists, like histamine, is a possible effect mechanism.

[Duodenal injuries due to blunt trauma]

During the last ten years we have seen fourteen patients with duodenal injury after blunt trauma. Five patients with intramural hematomas received no treatment. Nine patients had a perforated duodenal wall, and in four of these the diagnosis was delayed for more than 24 hours. Revision and primary suture were carried out in seven patients, with no complications. In one patient, where the diagnosis was delayed for three days, the perforation was closed around a Pezzer catheter for external drainage. She developed an intraabdominal abscess which required reoperation. One patient died from liver injury with profuse bleeding; the others survived without sequelae from the duodenal injury.

CONCLUSIONS

Duodenal injuries are rare and early diagnosis is difficult. We think that frequently repeated physical examinations, liberal use of diagnostic peritoneal lavage, and careful peroperative exploration of the entire duodenum when performing laparotomy after abdominal injuries, are important for early diagnosis and treatment.

Antibiotic prophylaxis in colorectal surgery. Combined doxycycline-tinidazole vs. doxycycline alone

Single-dose doxycycline was compared with single-dose doxycycline + tinidazole in regard to prevention of septic complications after colorectal surgery, taking into account the type and level of surgery--right or left hemicolectomy, rectal operations and others. The study was performed as a prospective double-blind trial, with randomization in blocks. In colorectal surgery as a whole the combination was found to be more effective than doxycycline alone. When the four surgical blocks were separately considered, however, the difference between the two regimens was found to be mainly due to rectal operations, following which the incidence of abdominal and of perineal wound infections was significantly lower with the combined regimen than with doxycycline alone. The subgroups composed of right-sided or left-sided hemicolectomy or other operations were too small to permit definite conclusions.

[Surgical treatment of pancreatic injuries]

Major pancreatic traumas are not frequent, and diagnosis often difficult. In a retrospective study we found 11 verified cases of pancreatic trauma treated in the period 1977-86. Three were penetrating and eight blunt trauma victims. Five patients suffered serious lesions in other organs. Laparotomy was performed in nine patients. One patient died, due to other lesions. The patients can be separated clinically into two groups. In the first group emergency laparotomy is indicated because of bleeding or peritonitis, most often due to lesions in other abdominal organs. In the other group the initial symptoms and clinical signs are sparse, and the diagnosis is based on repeated clinical examinations, ultrasound CT, peritoneal lavage and repeated amylase determinations. Contusions and minor lacerations without injury to the duct are treated with revision and canalization. Resection and pancreatico-jejunostomy should be considered when the pancreas is heavily lacerated with damage to the duct system.

[Diathermy in surgery]

Unskilled handling of surgical diathermia units exposes patients, operators and assistants to unnecessary risks. This article briefly reviews the equipment's technical potential, possible risks of complication, and how risk factors can be eliminated by proper handling. Important issues are risk of local accidental burns and of unintended stimulation of muscles and nerves, precautions when treating patients with a pacemaker or metallic implant, and specific problems connected to endoscopy.

Human immunodeficiency virus and hepatitis B virus in injured patients and victims of violence

Of a total number of 643 injured patients admitted during 1986 and 1987, 113 were tested for antibodies against the human immunodeficiency virus (HIV) and hepatitis B surface antigen HBsAg and the concentration of hepatitis B surface antibodies (HBsAb) was determined. Nine patients were HIV positive while HBsAg was detected in two patients and increased levels of HBsAb were found in 19 patients. HIV antibodies were found in 6 (4.8 per cent) of 124 victims of violence, in 3.3 per cent of the patients with penetrating injuries and 1.1 per cent of the patients with multiple, closed injuries. The estimated prevalence for HIV infection in the Norwegian population is 0.08 per cent, thus indicating an over-representation of infected patients among injured patients and victims of violence.

Persistent sciatic artery. Case report

In a man with ischemia of the right leg due to embolism of popliteal artery, arteriography following failure of embolectomy via the common femoral artery revealed the internal iliac artery continuing as an aneurysmally dilated sciatic artery distally to the popliteal artery. The aneurysm was ligated and bypass established from the common femoral to the popliteal artery.

Inhibitory effects of dopamine and isoprenaline on antral motor activity stimulated by acetylcholine or physostigmine in vitro

Continuous pressure recordings were made in guinea-pig antral pouches in vitro. The antral phasic activity was stimulated by acetylcholine and by the cholinesterase inhibitory agent physostigmine. Dopamine and isoprenaline both significantly impaired antral pressure responses to physostigmine, whereas the acetylcholine-induced response was not significantly reduced. This suggests that both dopamine and isoprenaline to some extent act by reducing the spontaneously released acetylcholine, suggesting that both drugs act on intramural cholinergic neural pathways.

Premedication in upper gastrointestinal endoscopy. A comparison of glucagon and atropine given in combination with diazepam and pethidine

The effects of four premedication regimes on clinical variables regarded as important in upper gastrointestinal endoscopy were evaluated in a double-blind randomized study. The drug combinations were diazepam/glucagon, diazepam/atropine, pethidine/glucagon, and pethidine/atropine. No significant difference was observed among the combinations of regimes or between diazepam and pethidine or between glucagon and atropine with regard to the variables duration of examination, vomiting, secretion and maximal pyloric opening. Pethidine was more effective than diazepam in reducing salivation and pyloric reflux. Glucagon was more effective than atropine in reducing motility and reflux and was also superior to atropine with regard to diagnostic accuracy. Glucagon caused less subjective discomfort than atropine 2 h and 1 day after the investigation.

Motor responses to serotonin in isolated guinea pig fundus and antrum

The effects of serotonin on gut motility have been both excitatory and inhibitory. The purpose of the present study was to elucidate how serotonin influences motor activity in two functionally different parts of the stomach. Pressure recordings were made from fundic and antral pouches of isolated guinea pig whole stomach preparations. In the fundus serotonin induced relaxation, which developed gradually within 3 min. In the antrum serotonin initiated phasic contractions, which culminated within 3 min and then returned to near or below prestimulatory values. Whereas tetrodotoxin did not significantly reduce the fundic relaxation, the antral excitation was strongly inhibited by both atropine and tetrodotoxin, indicating different effect mechanisms in fundus and antrum.

Motor responses to prostaglandin F2 alpha in isolated guinea pig fundus and antrum

While guinea-pig stomachs were isolated and oxygenated in organ baths. Continuous pressure recordings were made from separate fundic and antral pouches. Prostaglandin F2 alpha stimulated motor activity in both fundus and antrum mainly by elevation of wall tension, whereas the amplitude or frequency of the rhythmic activity was not significantly affected. The responses were dose-dependent and not significantly inhibited by atropine, mepyramine, or cimetidine. A direct effect mechanism of PGF2 alpha, independent of intramural cholinergic or histaminergic pathways, is indicated for both fundus and antrum.

Pressure responses to OP-CCK compared to CCK-PZ in the antrum and fundus of isolated guinea-pig stomachs

To document that the previously demonstrated excitatory effects of cholecystokinin-pancreozymin--about 20% purified and containing approximately 500 U/mg (CCK-PZ 20%)--on isolated guinea-pig antrum and fundus are caused by the hormone itself, and not by impurities, the effect of the synthetic C-terminal octapeptide (OP-CCK) was tested and compared with that of CCK-PZ 20%. The qualitative effects were similar for the two hormones, characterized by increased amplitudes of rhythmic activity in the antrum and by elevated basal tension in the fundus. The calculated maximal responses were about the same for the two substances, but OP-CCK was 3--6 times more potent than CCK-PZ 20%. Atropine and tetrodotoxin markedly reduced the antral response to OP-CCK, while the fundal response was only slightly, but significantly, reduced. This indicates that the antral response to OP-CCK is mediated mainly through local neural cholinergic pathways, while the fundal response is less dependent on these, corresponding to our previous results for CCK-PZ 20%. While previous reports indicate that OP-CCK shares the pharmacological characteristics of partially purified CCK-PZ with regard to its effect on other organs, the present study confirms a corresponding relationship between OP-CCK and CCK-PZ 20% on gastric motility in guinea-pigs, suggesting that the actions of CCK-PZ 20% are displayed by the hormone itself, and not by impurities.

The effects of mepyramine and cimetidine on the motor responses to histamine, cholecystokinin, and gastrin in the fundus and antrum of isolated guinea-pig stomachs

Guinea-pig stomachs were isolated in organ baths, and recordings made of fundal and antral responses. Cholecystokinin (CCK-PZ), 0.38 U/ml, gastrin, 0.05 microgram/ml, and acetylcholine, 10(-4)M, produced typical responses: raised base line in the fundus and increased amplitudes of rhythmic contractions in the antrum. The antral responses to gastrin were too small to quantitate. Both fundal and antral responses to 5 x 10(-4)M histamine consisted of an increase in base line without an alteration in amplitudes. Mepyramine, 3.2 x 10(-5)M, reduced the spontaneous activity in the fundus. It also inhibited fundal responses to gastrin and responses to histamine and CCK-PZ in both pouches. The fundal response to acetylcholine was unaffected by mepyramine, but the antral response seemed to be partially reduced (p less than 0.06). Cimetidine affected neither spontaneous activity nor motor responses. The results indicate that the motor response to histamine is mediated via H1-receptors and that these receptors may also be involved in the fundal response to CCK-PZ and gastrin. The inhibition of the antral responses by mepyramine may be due to unspecific anticholinergic action.

Interactions of cholecystokinin (CCK-PZ) and gastrin on motor activity of isolated guinea-pig antrum and fundus

Pressure responses to cholecystokinin (CCK-PZ, approximately 500 U/mg) and gastrin (human synthetic gastrin) were investigated in isolated guinea-pig antral and fundal pouches. Both drugs stimulated motor activity, in the antrum mainly by increasing amplitudes and rhythmic activity, in the fundus by increasing basal tension. Antral responses to gastrin were markedly smaller than to CCK-PZ, while the differences were less pronounced in the fundus. Prestimulation with gastrin, being an agonist by itself, significantly reduced the antral responses to submaximal doses of CCK-PZ, while no inhibition was found in the fundus. When pre-exposed to gastrin, the antral dose-response curve to CCK-PZ was flattened, with reduced maximal response, simulating a non-competitive interaction. It seems that gastrin behaves like a partial agonist to CCK-PZ on guinea-pig antral smooth muscle.

The inhibitory effect of secretin and glucagon on pressure responses to cholecystokinin-pancreozymin in isolated guinea-pig stomach

Pressure responses in guinea-pig antral and fundal pouches were investigated in vitro. Secretin and glucagon in concentrations that did not significantly alter spontaneous activity significantly reduced antral responses to cholecystokinin, but had no depressive effect on the fundal responses. The antral inhibition of CCK-PZ may be specific, since responses to acetylcholine were unaffected by secretin and glucagon. The changes produced by secretin and glucagon in the antral dose-response curve to CCK-PZ suggest that the inhibition might be of a non-competitive type.

The role of local cholinergic pathways in the motor response to cholecystokinin and gastrin in isolated guinea-pig fundus and antrum

Both cholecystokinin (CCK-PZ) and gastrin stimulated antral rhythmic activity and raised fundal basal pressure. The antral motor effects were significantly blocked by pretreatment with atropine or tetrodotoxin. The fundal motor responses were almost unaffected. It is concluded that CCK-PZ and gastrin exert their antral motor effects essentially through local cholinergic neural pathways, while the motor responses in the fundus are almost entirely independent of these pathways.

The influence of graded distension and carbachol on the motor response to cholecystokinin in isolated guinea-pig antrum and fundus

Graded distension increased the motor response to cholecystokinin and acetylcholine both in antral and fundal pouches. The increase became even more obvious when the pressure responses were converted into changes in wall tension. The responses to cholecystokinin were additive with low doses (10(-7)M) of carbachol, but diminished or abolished by prestimulation with higher doses. The results indicate that the increased response to cholecystokinin after distension is due to increased smooth muscle stretch.

Pressure-responses to cholecystokinin in the fundus and antrum of isolated guinea-pig stomachs

Cholecystokinin produced dose-dependent increases in motor activity in antral and fundal pouches of isolated guinea-pig stomachs. The response was immediate; the motor activity increased to a peak within 2 min, then decreased somewhat, but stabilized within 5 min at a value that was higher than before addition of cholecystokinin. In the antral pouches the response consisted of an increase in the amplitude of the rhythmic contractins; in the fundal pouch it was seen as an increase in basal pressure. The antral response was significantly greater in pouches distended to an initial basal pressure of 15-25 cm H2O than in undistended pouches. The fundal reponse was not enhanced by distension.

The heterogeneity of the serum activity of gamma-glutamyl transpeptidase in hepatobiliary diseases as studied by agarose gel electrophoresis

Using electrophoresis on agarose gel, the serum activity of gamma-GT in various hepatobiliary diseases has been separated into several electrophoretic fractions. Predominance of activity was always found in fractions corresponding to either alpha1-, alpha2- or beta-globulins. The predominant activity fractions have been related to the various disease states and to the zymogram patterns of gamma-GT found in bile and tissue homogenates of liver, bile duct and pancreas. Bile disclosed activity in the beta-region, tissue homogenates of liver mostly in the alpha1- and alpha2- areas, bile dict showed very faint activity in the alpha1- position, while extracts of pancreas revealed activity in the regions of alpha2, alpha2-beta and beta-gamma. In serum, dominance of alpha1-activity was found in all cases associated with alcoholism and alcoholic cirrhosis, this activity also appeared as the most frequent dominant one in biliary obstruction. Predominance of alpha2 and/or the beta-fraction in most cases occurred associated with malignant processes involving liver and/or pancreas.