RESUMEN
A 28-year-old woman was hospitalized because of the third episode of acute pancreatitis. No hint for an extrinsic cause was evident. Under conservative treatment pancreatitis and signs of intestinal obstruction were persisting. Imaging procedures showed an undefinite mass in the neighbourhood of the pancreatic caput. Endoscopy revealed a phytobezoar in a wind sock web, a special form of congenital duodenal atresia. Obstructing the papilla of Vater the bezoar had caused acute pancreatitis. After endoscopical removal the symptoms of pancreatitis disappeared immediately. Web excision and duodenoduodenostomy were performed. At operation further anomalies of the gastrointestinal tract frequently associated with duodenenal atresia were found.
Asunto(s)
Bezoares/complicaciones , Divertículo/complicaciones , Obstrucción Duodenal/congénito , Atresia Intestinal/complicaciones , Páncreas/anomalías , Pancreatitis/etiología , Enfermedad Aguda , Adulto , Ampolla Hepatopancreática , Colestasis Extrahepática/complicaciones , Colestasis Extrahepática/cirugía , Divertículo/cirugía , Obstrucción Duodenal/complicaciones , Obstrucción Duodenal/cirugía , Duodenostomía , Femenino , Humanos , Atresia Intestinal/cirugía , Pancreatitis/cirugía , Esfinterotomía EndoscópicaRESUMEN
BACKGROUND: There is a discrepancy between the incidence of gastrointestinal involvement by malignant lymphomas, as established in postmortem studies, and the rareness of the corresponding clinical diagnosis. METHODS: Therefore, the authors performed routine upper gastrointestinal endoscopic examination, within the framework of the usual staging examinations, in 103 consecutive patients with newly diagnosed Hodgkin disease (n = 21) and non-Hodgkin lymphoma (n = 82). RESULTS: One patient with Hodgkin disease (4.8%), 11 of 40 patients (27.5%) with non-Hodgkin lymphoma of low-grade malignancy, and 11 of 42 (26.2%) of those with highly malignant non-Hodgkin lymphoma showed involvement of the gastric and/or duodenal mucosa, as diagnosed with esophagogastroduodenoscopy. Of the 22 patients with non-Hodgkin lymphoma, 9 had involvement of other mucosa-associated lymphoid or epithelial tissue. In two patients with Stage III, two with Stage II, and two patients with presumptive Stage I disease, the disease was reclassified as Stage IV. Because of gastrointestinal involvement, treatment for two patients was changed from radiation therapy to chemotherapy and another two patients had gastric resections so that possible treatment-related complications could be avoided. CONCLUSIONS: In light of these results and the fact that a major basis for the therapeutic strategy for malignant lymphomas is tumor stage, routine esophagogastroduodenoscopic examination within the framework of the usual staging examinations is recommended. In individual cases, this procedure may be of decisive importance in the therapeutic approach to and prevention of complications.
Asunto(s)
Neoplasias Gastrointestinales/patología , Linfoma/patología , Adolescente , Adulto , Anciano , Endoscopía del Sistema Digestivo , Femenino , Neoplasias Gastrointestinales/epidemiología , Enfermedad de Hodgkin/epidemiología , Enfermedad de Hodgkin/patología , Humanos , Linfoma/epidemiología , Linfoma no Hodgkin/epidemiología , Linfoma no Hodgkin/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias/métodos , Estudios ProspectivosRESUMEN
The existence of negative feedback inhibition of human pancreatic enzyme secretion by proteases is controversially discussed. We have recently demonstrated that jejunal application of porcine pancreatic extracts, in a dose commonly used to treat digestive insufficiency, stimulated rather than inhibited, human pancreatic enzyme secretion. We have now studied the influence of duodenal application of high concentrations of either pure trypsin or porcine pancreatic extracts with trypsin-equivalent activity, on human pancreatic enzyme secretion. Twenty-three male volunteers were intubated with a gastric tube and a two-lumen jejunal tube to collect secretions separately via the first and third tubes and to perfuse either pure trypsin or porcine pancreatic extracts distal to the pylorus via the second tube. PEG-4.000 was continuously perfused via the second tube to correct for losses of volume. Volunteers received PEG alone during the first hour, phenylalanine during the second, PEG alone again during the third, and either phenylalanine together with trypsin or porcine pancreatic extracts during the fourth h. Activities of lipase, amylase, and chymotrypsin were measured in 15-min fractions. In addition, human lipase secretion was measured with an enzyme immunoassay, which does not crossreact with porcine lipase. Plasma cholecystokinin (CCK) was measured using a sensitive bioassay, which utilizes amylase release by isolated rat pancreatic acini. Perfusion of the duodenum with phenylalanine caused a statistically significant stimulation of enzyme secretion. This stimulation could be inhibited by high concentrations of pure trypsin. In contrast, application of porcine pancreatic extracts, which contained the equivalent activity of trypsin, caused further increases of lipase secretion when compared to phenylalanine alone.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Páncreas/enzimología , Extractos Pancreáticos/farmacología , Adulto , Amilasas/metabolismo , Colecistoquinina/sangre , Quimotripsina/metabolismo , Duodeno , Retroalimentación , Humanos , Lipasa/metabolismo , Masculino , Páncreas/efectos de los fármacos , Páncreas/metabolismo , Extractos Pancreáticos/administración & dosificación , Fenilalanina/administración & dosificación , Fenilalanina/farmacología , Tripsina/administración & dosificación , Tripsina/farmacologíaRESUMEN
In view of the discrepancy between the incidence of gastrointestinal involvement by malignant lymphomas, as established in postmortem studies, and the rareness of the corresponding clinical diagnosis, we carried out routine upper gastrointestinal endoscopy in 82 consecutive patients with newly diagnosed non-Hodgkin's lymphoma. 11/40 patients (27.5%) with non-Hodgkin's lymphoma of low-grade malignancy, and 11/42 (26.2%) of those with highly malignant non-Hodgkin's lymphoma revealed involvement of the gastric and/or duodenal mucosa, as diagnosed by oesophagogastroduodenoscopy. Two patients in stage III, two in stage II, and two further patients with presumptive stage I had to be reclassified as stage IV. Due to gastrointestinal involvement, two patients changed from radiation to chemotherapy, and another two patients underwent gastric resections to avoid possible treatment related complications. In the light of these results and the fact that a major basis for the therapeutic strategy in non-Hodgkin's lymphomas represents tumor stage, routine oesophagogastroduodenscopy within the framework of the usual staging examinations should be discussed. In the individual case, this procedure may be of decisive importance for the therapeutic approach and the prevention of complications.
Asunto(s)
Endoscopía del Sistema Digestivo/métodos , Neoplasias Gastrointestinales/patología , Linfoma no Hodgkin/patología , Adolescente , Adulto , Anciano , Terapia Combinada , Femenino , Neoplasias Gastrointestinales/terapia , Humanos , Linfoma no Hodgkin/terapia , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Planificación de Atención al PacienteRESUMEN
A new synthetic analogue of cholecystokinin, Thr28Nle31CCK25-33(CCK9) is compared with caerulein with regards to plasma bioactivity, degradation rate, side effects, and stimulation of pancreatic secretion. 24 healthy male volunteers were intubated with a double lumen Lagerlöf-tube. 30 min after correct positioning of the tube subjects received a continuous intravenous infusion of synthetic secretin (1 U/kg) together with either ceruletide (61.5 pM/kg) or CCK9 (30 pM/kg) both for 45 min. 30 pM/kg of CCK9 have been shown by others to cause maximal enzyme secretion (1). 61.5 pM/kg (= 100 ng) of caerulein are probably supramaximal but used by many centers for direct pancreatic function tests. Plasma CCK was measured by bioassay which compares amylase release of isolated rat pancreatic acini stimulated by plasma extracts with known standards of CCK8. Lipase, amylase, trypsin, chymotrypsin, and bicarbonate were measured in 15 min fractions after the onset of CCK infusion. Both drugs caused a similar stimulation of pancreatic enzyme secretion during infusion of the respective analogue which declined after termination. After the onset of CCK9 infusion plasma bioactivity reached a plateau around 20 pM at 15 min. Values declined after 30 min. After termination of infusion bioactivity rapidly declined within 3 min but still remained slightly elevated after further 15 min as compared to basal values (3.9 vs 0.6 pM). Plasma kinetics of caerulein were quite similar. However, despite a dose which was only twice as high as compared to CCK9, plasma bioactivity was six times higher with plateau values of about 120 pM.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Ceruletida/farmacocinética , Colecistoquinina/farmacocinética , Páncreas/efectos de los fármacos , Pruebas de Función Pancreática , Fragmentos de Péptidos/farmacocinética , Adulto , Amilasas/sangre , Animales , Bicarbonatos/sangre , Disponibilidad Biológica , Ceruletida/farmacología , Colecistoquinina/farmacología , Quimotripsina/sangre , Técnicas de Cultivo , Humanos , Infusiones Intravenosas , Secreciones Intestinales/efectos de los fármacos , Lipasa/sangre , Masculino , Fragmentos de Péptidos/farmacología , Ratas , Ratas Endogámicas , Tripsina/sangreRESUMEN
We have evaluated the effects of porcine pancreatic extracts on human pancreatic secretion. Ten male volunteers were intubated with a 4-lumen jejunal tube to collect gastric and duodenal secretions separately via the first and third tube, to infuse PEG 4000 distal the pylorus via the second tube and to apply porcine pancreatic extracts via the fourth tube distal the ligament of Treitz. Pancreatic extracts were given four times at 40 minute intervals; the first two as active enzymes and subsequently as heat denatured proportions. Secretin was continuously infused intravenously (0.5 E/kg bw/h) to achieve minimal pancreatic flow. Lipase, amylase, trypsin, chymotrypsin, volume, and bicarbonate were measured in duodenal contents in eight pooled 15 minute fractions. Three subjects who received HEPES-Ringer buffer instead of pancreatic enzymes served as controls. Plasma cholecystokinin (CCK) was measured using a sensitive bioassay. Both active and heat denatured pancreatic extracts caused a small but significant increase in amylase and chymotrypsin secretion. Basal plasma CCK values were 0.85 (0.05) pM. After intrajejunal instillation of either active or heat denatured pancreatic extracts plasma CCK rose to 3.25 (0.30) pM and to 3.28 (0.36) pM respectively. In a second group of five volunteers, plasma CCK concentrations were measured after a test meal. On day 1, volunteers received a liquid fat and protein rich meal and on day 2, the same test meal containing porcine pancreatic extracts. In both cases, a similar increase in plasma CCK was observed. We conclude that therapy with pancreatic extracts stimulate pancreatic enzyme secretion. This may be mediated through release of CCK.
Asunto(s)
Páncreas/efectos de los fármacos , Extractos Pancreáticos/farmacología , Adulto , Colecistoquinina/sangre , Alimentos , Humanos , Masculino , Páncreas/enzimología , Páncreas/metabolismoRESUMEN
Intestinal absorption of folic acid, glucose, water and sodium in 10 patients with chronic pancreatitis who have abstained from alcohol for at least 2 months is compared with 18 agematched outpatients without gastrointestinal disorders and a daily alcohol intake less than 30 g. Intestinal absorption was measured by segmental perfusion of the jejunum using a triple lumen tube. Patients with chronic pancreatitis showed a significantly decreased absorption of folic acid and glucose, whereas the net absorption of water and sodium was not disturbed.