Über die maximale osmotische Konzentrierung des Magensaftes

Zusammenfassung 1. An gastrobioptisch kontrollierten 16 Männern und 3 Frauen werden Veränderungen von Osmolalität, ionaler Zusammensetzung und Sekretionsraten des Magensaftes während tatsächlicher maximaler Säurestimulation und zusätzlicher Wirkung von Atropin über 2 Std beobachtet. Dazu werden durch intravenöse Dauerinfusion pro Stunde 2 mg Histalog/kg Körpergewicht zugeführt und bei 12 Personen während maximaler Histalogwirkung 0,5 mg Atropinsulfat intravenös injiziert.2. Das osmotische Konzentrationsverhältnis zwischen Magensekret und Plasma (G/P _osm) beträgt am nicht stimulierten Magen 0,66±0,10. Mit zunehmender Stimulation nähert sichG/P _osm dem Grenzwert 1 (0,98±0,07). Obwohl der Säureausstoß wegen des wesentlich stärkeren Reizes der Belegzellen weit über demjenigen vonKay als maximal angegebenen Wert liegt, kann in keinem Falle hypertoner Magensaft nachgewiesen werden (G/P _osm maximal 1,03).3. Der Effekt einer kontinuierlichen maximalen Säurestimulation ändert sich in 2stündiger Beobachtungszeit nicht. Magengesunde Personen sezernieren pro Stunde 286,8±75,6 ml Sekret, 34,8±9,6 mval H⁺ und 42,6±10,8 mval Cl^–. Gegenüber dem Nüchternsekret nehmen die Konzentrationen von H⁺ und Cl^– im Magensaft während maximaler Histalogwirkung hochsignifikant zu, diejenigen von Na⁺, Ca⁺⁺ und Mg⁺⁺ signifikant ab. Die Konzentration von K⁺ zeigt eine insignifikante Tendenz zum Abfall.4. Zusätzliche Applikation von Atropin ruft eine signifikante Abnahme des Ausstoßes von Na⁺ und Ca⁺⁺, vor allem aber eine hochsignifikante Erhöhung der Konzentration von H⁺ und Cl^– im Magensaft hervor. Dadurch nimmt der osmotische Druck des Magensaftes in allen Fällen zu, so daß ein vorher isotoner Magensaft deutlich hyperton wird (G/P _osm maximal 1,12).5. Diese Befunde sind mit der Diffusionstheorie vonTeorell nicht zu vereinbaren, dürften jedoch direkter Beweis für die Gültigkeit der Zweikomponententheorie vonHollander sein. Gegenüber ihrer ursprünglichen Fassung ist damit jedoch unter anderem die Einschränkung verbunden, daß die Elektrolytzusammensetzung der alkalischen Nichtparietalkomponente keineswegs nahezu identisch mit derjenigen der interstitiellen Flüssigkeit ist.

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Summary 1. The effects of histalog and in addition of atropine on osmolality, ionic composition and secretory rates of gastric juice were studied in gastrobioptically controlled 16 males and 3 females. The primary stimulus was a continous intravenous infusion of histalog at a dose of 2 mg per kg per hour. During maximal stimulation with histalog 0,5 mg atropine sulfate was intravenously injected in 12 persons.2. In resting stomach the osmotic concentration ratio between gastric secretion and plasma (G/P _osm) was 0,66±0,10. Upon stimulationG/P _osm increased and in the normal stomach at maximum came up to the limiting value of 1,0. Because of the stronger stimulation acid output was considerably higher than in the augmented histamine test ofKay. Hyperosmotic gastric juice, however, could not be obtained in any case (G/P _osm at maximum 1,03).3. Over a test period of 2 hours constant histalog infusion produced a steady state of maximal acid secretion. In healthy persons we found the following values per hour: volume secretion 286,8±75,6 ml, secretory rate of H⁺ 34,8±9,6 mval, Cl^– output 42,6±10,8 mval. In comparison with the basal secretion histalog provoked a highly significant increase of the concentrations both of H⁺ and Cl^– in the gastric juice. On the other hand the concentrations of Na⁺, Ca⁺⁺ and Mg⁺⁺ diminished, whereas the concentration of K⁺ decreased insignificantly.4. The effect of histalog on the concentrations both of H⁺ and Cl^– in gastric juice was enhanced by combining it with atropine. Inspite of a significant diminution of the secretory rates of both Na⁺ and Ca⁺⁺ there was a consistent increase of the osmotic pressure of gastric juice. As a result, previously obtained isotonic secretion became hypertonic to plasma (G/P _osm at maximum 1,12).5. These findings are not compatible with the back-diffusion theory ofTeorell, but may be considered as an important basis and strong evidence of the two-component hypothesis ofHollander. In contrast to the original text of this theory there are several implications. For instance, we cannot support the estimate ofMakhlouf et al., that the composition of the nonparietal component approximates very closely that of interstitial fluid.

     

The influence of in-pregnancy smoking cessation programmes on partner quitting and women's social support mobilization: a randomized controlled trial [ISRCTN89131885]

Background  

Smoking cessation interventions in pregnancy could influence a woman's social behaviour and her partner's smoking behaviour, but this has not been examined in any published randomized trials.     

Functional regeneration of ischemic myocardium by transplanted cells overexpressing stromal cell-derived factor-1 (SDF-1): intramyocardial injection versus scaffold-based application

Objective: Stromal cell-derived factor-1 (SDF-1) is a potent chemotaxin. Increased SDF-1 levels can be found in ischemic myocardium and might protect against ischemia-reperfusion injury. We hypothesized that transplantation of stem cells overexpressing SDF-1 might improve cardiac function after myocardial infarction (MI). We compared intramyocardial injection with a scaffold-based application of SDF-1-transfected cells. Methods: Skeletal myoblasts (SkMs) were isolated and expanded from newborn Lewis rats. Cells were transfected with pcDNA3-huSDF-1 and seeded on polyurethane (PU) scaffolds or diluted in medium for cell injection. Two weeks after myocardial infarction, seeded scaffolds were implanted epicardially into rats (group: PU-SDF-1-SkM) or the injection solution was applied intramyocardially (Inj-SDF-1-SkM). Additional groups were treated with non-transfected myoblasts either by injection (Inj-SkM) or by scaffold-based application (PU-SkM) or received a sham operation (Sham). Before this intervention and 6 weeks later, hemodynamic parameters were measured. Infarction size and neovascularization were assessed by histology at study end. Results: In sham animals, we detected a clear decrease in systolic function from intervention to study end. In group Inj-SkM and PU-SkM, all hemodynamic parameters that were assessed remained unchanged during observation time. Systolic function as measured by dP/dt_max and SB-Emax was significantly improved in groups Inj-SDF-1-SkM and PU-SDF-1-SkM at study end without a difference between the two SDF-1 groups. Diastolic function measured by post-interventional dP/dt_min was also increased in group Inj-SDF-1-SkM but not in PU-SDF-1-SkM. Histological analysis revealed a reduced infarction size in all treatment groups at study end but enhanced neovascularization was not observable. Conclusions: Transplantation of myoblasts overexpressing SDF-1 improves cardiac function after MI. The restoration of hemodynamic parameters is accompanied by a reduction in infarction size. This reverse remodeling capacity is independent of a scaffold-based application of the SDF-1-transfected cells.     

Peri-operative outcomes for pancreatoduodenectomy in India: a multi-centric study

Background:

There have been an increasing number of reports world-wide relating improved outcomes after pancreatic resections to high volumes thereby supporting the idea of centralization of pancreatic resectional surgery. To date there has been no collective attempt from India at addressing this issue. This cohort study analysed peri-operative outcomes after pancreatoduodenectomy (PD) at seven major Indian centres.

Materials and Methods:

Between January 2005 and December 2007, retrospective data on PDs, including intra-operative and post-operative factors, were obtained from seven major centres for pancreatic surgery in India.

Results:

Between January 2005 and December 2007, a total of 718 PDs were performed in India at the seven centres. The median number of PDs performed per year was 34 (range 9–54). The median number of PDs per surgeon per year was 16 (range 7–38). Ninety-four per cent of surgeries were performed for suspected malignancy in the pancreatic head and periampullary region. The median mortality rate per centre was four (range 2–5%). Wound infections were the commonest complication with a median incidence per centre of 18% (range 9.3–32.2%), and the median post-operative duration of hospital stay was 16 days (range 4–100 days).

Conclusions:

This is the first multi-centric report of peri-operative outcomes of PD from India. The results from these specialist centers are very acceptable, and appear to support the thrust towards centralization.     

Resident approaches to advance care planning on the day of hospital admission

BACKGROUND: Advance care planning is the process of establishing a patient's goals and preferences for future care. Previous research has demonstrated a need to improve patient-physician communication around advance care planning. A critical time for advance care planning conversations is the day of admission to the hospital. METHODS: A survey of internal medicine residents was administered at Duke University Medical Center and the Brigham and Women's Hospital, 2 major academic teaching centers. Residents were questioned about their approaches to advance care planning on their last on-call admitting day. RESULTS: Of 347 residents solicited, 292 (84.1%) participated in the survey. Residents reported that they established preferences for cardiopulmonary resuscitation (CPR) with 70.5% of patients, established a health care proxy with 33.7% of patients, discussed goals and values concerning end-of-life care with 32.0% of patients, and asked 35.6% of patients if they had an advance directive. Although 89.0% of residents had observed an advance care planning discussion model, only 66.4% had received teaching and 36.6% had received feedback about advance care planning conversations. In multivariable analysis, having received feedback about advance care planning conversations was associated with a higher percentage of conversations about health care proxy and goals and values related to the end of life. CONCLUSIONS: Residents discuss patient preferences for CPR on the day of admission with most patients. Preparing residents, particularly through feedback, may improve communication around other elements of advance care planning.     

Peripheral blood stem cell collection in allogeneic donors: impact of venous access

BACKGROUND: Peripheral blood stem cell (PBSC) collection is accepted as a routine procedure in related and unrelated healthy donors worldwide. Venous access can be accomplished by peripheral veins or a central venous catheter (CVC). STUDY DESING AND METHODS: We compared efficacy and tolerability of 40 PBSC collections via CVC with 6267 PBSC collections via peripheral veins in healthy allogeneic donors. Results of the leukapheresis procedures and side effects in the donors were evaluated. RESULTS: The median CD34+ cell counts on Day 5 and the results of the stem cell collection were not significantly different between the two groups of allogeneic donors. Pain or problems at the site of puncture or catheter insertion occurred in 58.6% of the donors with a CVC versus 37.8% of the donors with peripheral venous access (p = 0.03). The incidence and severity of paresthesia during the leukapheresis was not significantly different in both groups of donors (p = 0.09). During follow‐up no major adverse events related to CVC were reported. CONCLUSION: Central femoral lines proved to be safe and tolerable in healthy allogeneic donors but peripheral venous access should be preferred, whenever possible.     

Subtypes of Irritable Bowel Syndrome Based on Abdominal Pain/Discomfort Severity and Bowel Pattern

Introduction  

Irritable bowel syndrome (IBS) has traditionally been classified by stooling pattern (e.g., diarrhea-predominant). However, other patterns of symptoms have long been recognized, e.g., pain severity. Our objective was to examine the utility of subtyping women with IBS based on pain/discomfort severity as well as predominant bowel pattern.