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STUDY DESIGN: Cross-sectional study. OBJECTIVES: To describe participation in activities and explore the relationship with secondary complications among persons aging with a traumatic spinal cord injury (SCI). SETTING: A regional SCI outpatient center in Sweden. METHODS: Data were collected through a phone survey, which included 10 activities from the instrument PARTS/M-v3 (PARTicipation Survey/Mobility version-3) together with data from the participants' medical records. Cross-tabulation and χ2 were used for data analysis. RESULTS: In this study, 121 persons matched the inclusion criteria and the final study sample comprised 73 participants (60% response rate): 55 men and 18 women. Mean age was 63.7±9.4 years, and mean time since injury was 36.3±9.2 years. Regardless of duration of SCI, all 73 participated in dressing, bathing and leisure activities. Women reported better health than men. Particularly for those who lived 36-55 years after injury; increasing pain, fatigue, spasticity and decreased muscle strength were negatively affecting participation in activities, especially exercise and active recreation. Additionally, a need to save strength/energy was also a reason for not participating in the activities. Perceived future support and concerns in relation to personal assistance, assistive devices and rehabilitation was also reported. CONCLUSION: Increasing secondary health complications and a need to save strength/energy influenced participation in activities. Laws and/or governmental policies regarding personal assistance and assistive devices did not always support participation in activities. Interventions should aim to create a balance among activities in everyday life.

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AIM: We hypothesized that in normal rats in metabolic steady state, (i) the plasma renin concentration (PRC) is log-linearly related to Na(+) intake (NaI), (ii) the concurrent changes in mean arterial pressure (MABP) and glomerular filtration rate (GFR) are negligible and (iii) the function PRC = f(NaI) is altered by ß1-adrenoceptor blockade (metoprolol) and surgical renal denervation (DNX). METHODS: In catheterized, conscious rats on low-Na(+) diet (0.004% Na(+)), NaI was increased by up to 120-fold, in four 3-day steps, by intravenous saline infusion. MABP was recorded continuously, PRC measured in arterial blood, and GFR estimated by inulin clearance. RESULTS: Steady states were achieved within 3 days. PRC [mIU L(-1)] was log-linearly related to NaI [mmol kg(-1) day(-1)]: PRC = -9.9 log (NaI) + 22. Set point (22 mIU L(-1) at NaI = 1) and slope (9.9 mIU per decade NaI) were independent of metoprolol administration and DNX. MABP and GFR were markedly salt-sensitive: MABP [mmHg] = 4.9 log (NaI) + 99 (P < 0.01), and GFR [mL min(-1)] = 1.4 log (NaI) + 8.3 (P < 0.01). MABP increased similarly (approx. 10%, P < 0.001) irrespective of pre-treatment. Metoprolol, but not DNX, reduced MABP, HR, and GFR (all P < 0.01). Salt sensitivity of GFR was not observed in DNX rats. CONCLUSION: Log-linear relations to sodium intake exist not only for PRC, but also for MABP and GFR, which per 10-fold increase in sodium intake rose by 5 mmHg and 1.4 mL min(-1) respectively. Steady-state levels of PRC appear independent of renal nerves. MABP and GFR seem markedly salt sensitive in normal rats.

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Fifty-one consecutive pancreaticojejunostomies for pain in chronic pancreatitis performed during the years 1964 to 1983 have been reviewed. Mean observation time was 8.2 years. Information on alcohol consumption, pain intensity and clinical signs of pancreatic dysfunction was recorded at regular intervals. Operative mortality was nil. Analysis showed no difference between alcohol abusers and other patients with regard to calcification, ductal dilation or exocrine and endocrine insufficiency. Good to excellent pain relief was achieved in 65 per cent of abusers and 88 per cent of nonabusers and was stable for at least five years. Patients who are heavy and unremitting abusers did not get much pain relief as a result of the operation. Patency of the anastomosis does not seem to be crucial for pain relief after pancreaticojejunostomy.

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In totally pancreatectomized patients breath 14CO2 excretion after ingestion of 14C-labeled triolein was significantly increased by a granulated pancreatic enzyme preparation and was reduced when pectin was added to the enzyme supplement. In the same patients pectin reduced trypsin, lipase, and amylase activities of jejunal aspirates after a test meal supplemented with pancreatic enzyme substitution, which was shown to give good enzyme activities in the intestine. In patients with chronic pancreatitis, breath 14CO2 excretion was reduced by wheat bran, which also caused a reduction in lipase and amylase activities of duodenal aspirates after a test meal. The findings demonstrate the efficiency of treatment with a granulated pancreatic enzyme preparation in restoring intraluminal enzyme activities and fat absorption in patients with pancreatic insufficiency. They also show that pectin and wheat bran may induce fat malabsorption and inhibit digestive enzyme activities in vivo.

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In normal rats, and in rats with reduced intraluminal amylolytic activity, acute administration of low methoxyl pectin with soluble starch via an oro-gastric tube was found to delay starch digestion. In normal rats pectin slightly lowered plasma glucose levels after a starch load. In pancreatic duct-occluded rats, in which intestinal pancreatic digestive enzyme activities are markedly reduced, an increased insulin secretion and a reduced glucose response were seen after starch loading even without the addition of pectin, when compared to normal control rats. In these duct-occluded rats pectin was found to further reduce starch digestion, and markedly suppress plasma glucose levels after a starch load without changing plasma insulin levels. In moderately alloxan diabetic rats, in which intestinal amylase activity also was substantially reduced, pectin reduced the glucose response to starch to a similar extent (about 30%) as in duct-occluded rats without changing the impaired insulin response. The results suggest that pancreatic insufficiency accompanied by reduced intraluminal activities of pancreatic digestive enzyme activities may be associated with a decreased glucose and an increased insulin response to starch loading and that the ability of dietary fibre to reduce postprandial glycaemia may, inter alia, involve an inhibiting action by fibre on starch digestion, especially manifested in conditions of amylolytic insufficiency.

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Ileostomized rats were fed diets with different fiber content. The addition of 5% pectin to the diet caused an increase in the wet weight, fat content, amylase activity per gram, and lipase output of the ileostomy evacuates. Twenty percent wheat bran in the diet increased weight, fat and nitrogen content, and trypsin output of the evacuates. In normal rats pectin added to a meal containing 3H-labeled triolein increased the isotope activity of the feces, indicating an impaired fat absorption. In rats operated on with occlusion of the pancreatic ducts with a tissue glue, the fat absorption was, however, not significantly affected by pectin. The results of the study show that fiber can cause a change in the intestinal enzymatic milieu of ileostomized rats and can cause steatorrhea, which can be explained, at least partly, by malabsorption.

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A parallel investigation into endocrine and exocrine pancreatic function, after duct-ligation in the rat, was performed to study the effect of reduced intestinal trypsin levels on insulin secretion and glucose tolerance. Animals with only a slight exocrine insufficiency displayed a normal insulin secretion and a normal glucose tolerance 4 weeks after operation. At 4-5 month s these animals showed a slight increase in glucose-induced insulin release when compared with control rats. However, animals operated on with a more complete ligation of the pancreatic ducts, who showed a marked exocrine insufficiency accompanied by decreased levels of intestinal trypsin, displayed a markedly increased insulin secretory response to intravenous glucose and an increased glucose tolerance. The results lend further support to our previous suggestion that, in the rat, the levels of intestinal trypsin may influence insulin secretory processes via complex feed-back mechanisms which may involve cholecystokinin and/or other intestinal hormones.

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In a double-blind study on 19 patients with the diagnosis of chronic pancreatitis, the effects of treatment with a granulated pancreatic enzyme preparation (Pankreon) were compared with those of placebo administration. One week of treatment with each preparation was preceded by one week without any medication. The patients kept daily records of their symptoms, plotting the severity of pain on an analog scale. Weekly assessments of the mean pain level were also made by an examiner questioning the patients. Recordings of body weights and pancreas and liver laboratory tests were done weekly. Fifteen of 19 patients noted less pain during the week of treatment with pancreatic enzymes as compared to that of placebo treatment (P less than 0.05). The average reduction of pain, as calculated for all patients, was 30% as evaluated by both patients (P less than 0.01) and the examiner (P less than 0.05). No differences were found in other parameters examined. A possible explanation of the findings could be an effect on the intraductal pressure by intraluminal trypsin.

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The management of pancreatic pseudocysts was reviewed in 41 patients, 28 of whom were treated surgically, 9 by non-surgical percutaneous drainage and 4 expectantly. In 20 patients an internal drainage was created and in 15 an external drainage. Hospital mortality was 2% (1/41) and postoperative mortality 4% (1/28). External drainage was associated with 40% early complications and 33% recurrent cysts or chronic internal or external fistulas; the corresponding figures for internal drainage were 15% and 5%, respectively. The 4 patients who were managed expectantly with disappearance of the cysts had an uneventful course. The advent of ultrasound and computerized tomography (CT) has been of great diagnostic value. As external drainage proved inferior to internal drainage in the present study, percutaneous puncture guided by ultrasound or CT and creation of non-operative external drainage is not a recommended treatment. Expectant management with repeated ultrasound examinations may be chosen in selected cases.

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Dietary fiber inhibits pancreatic enzyme activity--i.e., trypsin, lipase and amylase--in buffer solutions and in human duodenal juice in vitro. It is well established that oral administration of trypsin inhibitor stimulates the secretion and growth of the rat pancreas. In the present study, trypsin inhibitor (Trasylol) as well as dietary fiber such as pectin of low (37%) methoxylic esterification and wheat bran were found to stimulate pancreatic enzyme secretion in acute experiments in conscious rats with bile-pancreatic fistulae. Feeding for 10 days with wheat bran resulted in increased pancreatic weight and in increased protein and trypsinogen content. Administration of pectin of high (73%) methylic esterification caused increased pancreatic protein content and that of low methylic esterification increased pancreatic trypsinogen activity/milligram tissue. The results suggest that pectin and wheat bran may interfere with the feedback regulation of pancreatic enzyme secretion exerted by intraluminal trypsin, and, like trypsin inhibitor, have a secretagogue and trophic effect on the pancreas.

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Exocrine and endocrine pancreatic function was studied in the rat after occlusion of the pancreatic ducts with acrylate or prolamine, respectively. After 5 months the effect of these procedures was a clear-cut exocrine insufficiency as evidenced by reduced enzyme activities in pancreatic tissue and in intestinal content, while the endocrine function was not impaired. The insulin secretory response to an intravenous glucose load was rather increased in duct-occluded rats, and the glucose tolerance was improved. The liver glycogen levels in duct occluded rats were decreased. As judged from the present investigation there was no striking difference between the effects of acrylate and prolamine on either exocrine or endocrine pancreas. The results suggest that long-term duct occlusion in the rat by acrylate or prolamine is harmless to the endocrine pancreas. The improvement of the glucose-induced insulin response and the glucose tolerance is probably due to an enteropancreatic feedback mechanism elicited by low levels of intestinal trypsin.

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The importance of various factors for dietary fiber effects on pancreatic enzyme activities was studied in vitro. Pectin of high methylic esterification and guar gum, which reduced enzyme activities, particularly lipase activity, increased the viscosity of duodenal juice. Increasing duodenal juice viscosity by polyethlene glycol also caused a reduction particularly of lipase activity. Pectin of low methylic esterification, which reduced especially amylase and lipase activities, significantly lowered duodenal juice pH. Lowering duodenal juice pH by hydrochloric acid caused a reduction especially of amylase and lipase activities. Pretreating fiber at acid pH tended to increase its enzyme-inhibiting properties. Trypsin adsorption to wheat bran was partly reversible by buffer washings. Changing ionic strength and incubation time appeared relatively unimportant for the effects of the fiber on enzymes. It is assumed that the inhibitory effects of the fiber on enzymes are attributed inter alia to effects on viscosity, pH, and adsorption, and further that gastric acidification of fiber and conditions lowering intestinal pH may enhance these effects.

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