In the present study the effect of metastatic liver disease on hepatic drug metabolism has been examined by studying the pharmacokinetics of antipyrine and the urinary excretion of antipyrine and its three major metabolites (4-hydroxyantipyrine, norantipyrine, and 3-hydroxymethylantipyrine) in 12 patients with extensive metastatic liver disease, and in 12 matched healthy controls. In the patients total liver volume, the volume of the liver parenchyma, and the volume of the liver metastases were determined by computed tomography. The volume of liver metastases always exceeded 35% of the total liver volume. There were no significant differences between the patients and controls in plasma half-life, plasma clearance, or apparent volume of distribution of antipyrine. The cumulative urinary excretion of antipyrine and its three major metabolites was significantly lower in patients [44 (18) %] than in controls [71 (8) %]. The excretion of antipyrine itself was unchanged and the decrease in cumulative excretion was due to reduced excretion of the three metabolites. The results show that the activity of the hepatic mixed function oxidases was not impaired even in patients with extensive metastatic liver disease. This may be because liver metastases do not cause a corresponding reduction in the volume of normal hepatic parenchyma. The decreased urinary excretion of the three major metabolites of antipyrine, which are mainly glucuronidated, may have been due to an alteration in the process of conjugation.

No abstract

Beim Speiseröhrenersatz durch den isoperistaltischen, intrathorakalen Schlauchmagen erfolgt die Erstellung des Ersatzorgans durch die Resektion der kleinen Magenkurvatur, etwa drei Querfinger oberhalb des Pylorus bis zur Funduskuppe. Die Durchblutung des schlauchförmig umgestalteten Restmagens erfolgt über die A. gastroepiloica dextra und ihre Ausläufer zur A. gastroepiploica sinistra sowie eines Restes der A. gastrica dextra. In Ausnahmefällen reicht eine alleinige Gefäβversorgung über die A. gastroepiploica dextra aus. Gefäβdarstellungen an vier Leichenpräparaten demonstrieren die ausreichende arterielle Blutversorgung des Schlauchmagens als Ösophagusersatzorgan.

In 20 patients the esophagus was replaced by an isoperistaltic gastric tube. Cervical esophagogastrostomy was performed. Postoperatively motility, histology, gastric secretion, and emptying time of the gastric tube were investigated. The esophageal replacement showed residual motility, pyloric motility, atrophic gastritis, decreased basal and stimulated secretion and normal emptying time, except in two patients. There were no essential drawbacks in function of the intrathoracic gastric tube. Patients with esophagectomy are comparable to patients with partial gastrectomy.

43 patients with complicated gastric, duodenal or anastomotic ulcers resected according to Billroth II-Roux were controlled clinically, by endoscopy and X-ray. Little amounts of bile acid were found in only one case. Two groups with different pH-values were verified: 6 patients with pH from 1.2 to 2.2; three of them had recurrent ulcers. In the other group of the remaining 37 patients pH was higher than 5.5; there was only one recurrence in a patient with HPT. According to the Visick grading system results were good or excellent in 86%. The study shows that under conditions of no bile reflux and maintained vagal stimulation recurrence of ulcer is probable. In the acid ulcer type (Johnson II and III), duodenal ulcer and anastomotic ulcer supplementary vagotomy is recommendable.