Abstract. 1. Activities of phosphoglucomutase, hexokinase, glucose‐6‐phosphate dehydrogenase, triosephosphate dehydrogenase, mitochondrial glycerophosphate dehydrogenase, hexosediphosphatase and phosphoenolpyruvate‐carboxykinase, of enzymes involved in the citric acid cycle and connected pathways, of hydroxyacyl‐CoA dehydrogenase and carnitine acetyltransferase were determined in biopsy specimens of liver and of tibialis anterior muscle from thyrotoxic and hypothyroid patients and from controls. The results are compared with data obtained from liver and red and white muscle of thyrotoxic rats and guinea pigs. 2. Concomitant with diminished glucose tolerance, the glucokinase activity is decreased in thyrotoxic human liver. The decrease of rat liver glucokinase activity as a response to administered thyroid hormones is found to be dose‐dependent. A relationship between the diminished glucose tolerance in thyrotoxicosis and the decrease of glucokinase activity is discussed. The increase of hexokinase activity (isozyme II) is the most interesting finding in thyrotoxic human muscle because of its possible significance with respect to the elevated metabolic rate. The activity of triosephosphate dehydrogenase, (NADP) malate dehydrogenase, phosphoenolpyruvate carboxykinase and carnitine acetyltransferase is markedly enhanced in human thyrotoxic liver, whereas that of phosphoglucomutase is diminished. 3. Mitochondrial glycerophosphate dehydrogenase, which is known to be markedly increased in the liver and red muscle of thyrotoxic rats, is not increased in the liver and tibialis anterior muscle of thyrotoxic patients, nor in the liver and white muscle of thyrotoxic guinea pigs. The enzyme responses to thyrotoxicosis in human liver and muscle are more similar to those of the guinea pig than of the rat.
Present conventional surgical therapy of obstructive colon cancers of the right colon is primary resection, whereas in the left colon it is a two-stage or three-stage operation with a temporary colostomy. Morbidity and mortality rates in staged operations are still as high as 40% and 24%, respectively. Preoperative recanalization of obstructive cancers by neodymium-YAG laser vaporization will tend to relieve the symptoms of ileus and will permit preoperative peroral bowel lavage. For this reason primary resection with primary anastomosis is practicable in patients who have recovered from symptoms of ileus. In 27 cases who had been operated on with left-side hemicolectomy or anterior resection, the mortality rate was 3.7% (1/27). The total inpatient mortality rate of all laser-treated patients who had been operated on by different operative procedures, or who had not been surgically treated, was 8.8% (5/57).
For the first time it was possible to transmit a powerful laser beam (6 watt argon laser) through the biopsy channel of a conventional endoscope. This was achieved by the development of a special quartz fiberoptic transmission system, consisting of a single very flexible fiber with a diameter of 150 p. A strong absorption effect on liver tissue was observed with the argon laser, due to selective colour absorption of hemoglobin in the green-blue spectral region. The effect on the intact liver surface was studied using different power levels and exposure times. The size of the burned areas and the depth of affected tissue can be exactly controlled by variation of both power and exposure time. After performance of a liver biopsy with the Menghini needle, arrest of hemorrhage was successful in cases with slight and more intense bleedings. Furthermore, the diameter of a diaphragmatical vein shrinked markedly after exposure to a low power beam without getting leakage.
The aim of a resolute, endoscopic treatment in acute gastrointestinal hemorrhage by a neodymium:YAG laser is to prevent massive loss of blood and to avoid transformation of the hemorrhagic shock event into an irreversible state. Parallel to endoscopic procedure treatment of coagulopathies is necessary. 1,029 (94%) out of 1,092 acute bleeding episodes of 852 unselected patients were treated successfully. In bleeding esophageal varices, reduction of mortality from 70% to 36.2% has been achieved by sclerotherapy following laser coagulation of the acute bleeding. Compared with the results of surgery the mortality rate of bleeding acute ulcers has been reduced from 58% to 23.4%, and of bleeding chronic ulcers from 25% for resection and 15% for vagotomy to 0%. For optimal treatment of the patients close cooperation with surgeons is also desirable.
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