Plasma cholecystokinin and pancreatic polypeptide response after radical pancreatoduodenectomy with Billroth I and Billroth II type of reconstruction

This study was conducted to elucidate plasma cholecystokinin (CCK) and pancreatic polypeptide (PP) response after pancreatoduodenectomy and to compare response of CCK and PP in patients who had pancreatoduodenectomy with Billroth I and Billroth II type of reconstruction. Basal levels of plasma CCK were significantly lower in patients who had pancreatoduodenectomy (9.6 +/- 0.8 pmol/L) than in the control (preoperative patients: 14.6 +/- 2.0 pmol/L) probably because of the removal of the entire duodenum due to pancreatoduodenectomy, since vagotomy, which is concomitantly brought about by pancreatoduodenectomy, does not appear to interfere with release of CCK. Significant amounts of CCK (integrated CCK: 497 +/- 111 pmol-120 min/L), although less amounts than in the preoperative patients (integrated CCK: 901 +/- 167 pmol-120 min/L), were still released in response to oral fatty meal after pancreatoduodenectomy. Plasma CCK response to oral fatty meal was significantly greater in patients who had pancreatoduodenectomy with Billroth I type of reconstruction (integrated CCK: 705 +/- 153 pmol-120 min/L) than in patients who had pancreatoduodenectomy with Billroth II type of reconstruction (248 +/- 63 pmol-120 min/L). Simultaneous measurement of plasma levels of PP revealed complete abolishment of PP response by pancreatoduodenectomy. Since PP secretion can be produced by vagal stimulation, it is most likely that the decreased PP secretion is due to vagotomy rather than removal of the duodenum and pancreas. Significant amounts of CCK released after pancreatoduodenectomy, in which the main sources of release of CCK are removed, may suggest the compensatory mechanism of the remnant upper small intestine. This study also suggests the necessity of re-evaluating Billroth I type of anastomosis as a physiologic reconstruction procedure for the remnant alimentary tract after pancreatoduodenectomy.

Expression of the c-myc gene in human gastrointestinal malignancies

We have examined the level of the c-myc transcript in 6 esophageal, 16 gastric, 19 colorectal and 1 anal cancer tissue samples; these included four lymph nodes and six hepatic metastases obtained surgically. The esophageal cancer tissues were without an increase of the c-myc transcript, some of the gastric cancer samples showed a two to three fold increase and most of the colorectal and the one anal cancer samples showed a two to ten fold increase when compared with a normal mucosal layer. Therefore, the level of the c-myc transcript in human gastrointestinal malignancies shows organ dependency. Local, lymphatic, and hepatic metastases showed little difference in the level of c-myc mRNA from that of the primary tumor.

Synthetic neuromedin C stimulates exocrine pancreatic secretion in dogs and rats

We have examined the effect of neuromedin C on exocrine pancreatic secretion both in vivo and in vitro, and compared its bioactivity with those of related peptides. In anesthetized dogs, neuromedin C caused a dose-dependent initial reduction of pancreatic blood flow and an increase in secretin-stimulated exocrine pancreatic secretion, and had almost the same potency as gastrin-releasing peptide (GRP) in decreasing pancreatic blood flow. A potent stimulatory effect on exocrine pancreatic secretion was found in conscious dogs accompanied by a significant elevation in the circulating cholecystokinin (CCK) levels. In isolated rat pancreatic acini, amylase was released dose-dependently in response to neuromedin C. This study demonstrates that neuromedin C (a smaller molecular form of GRP) possesses potent bioactivity on exocrine pancreas and suggests that two factors may be involved in the mechanism by which this peptide effects exocrine secretion, namely; direct stimulation on acinar cells and stimulation of CCK release.

[An immunohistochemical study on esophageal carcinomas with various kinds of antikeratin antibodies]

Fifty five formalin-fixed, paraffin-embedded, pronase-pretreated esophageal carcinomas and their metastatic nodes were studied immunohistochemically with peroxidase-antiperoxidase technique for keratins using polyclonal antibody (DAKO), antibody against keratins of keratinocyte (KL1), against high molecular weight-keratin (EY904), and against low molecular weight-keratins (EY902, PKK1). The suprabasal layer of the esophageal epithelium was stained diffusely with DAKO, KL1 and EY902 and faintly or locally with EY904 and PKK1. Esophageal ducts were positive with any antibodies. We classified staining pattern of the esophageal carcinoma according to the localization and proportion of the positive cells in the cancer nests. No significant correlation of the staining pattern was found between the primary lesions and metastatic nodes. The proportion of the EY904-positive cells correlated significantly with the degree of lymph node metastasis, histologic stage, and prognosis by rank correlation method and generalized Wilcoxon test, but not with the depth of invasion nor histologic degree of differentiation. The proportion of DAKO-positive cells correlated significantly only with histologic degree of differentiation. It was supposed that esophageal carcinomas with high molecular weight-keratin had less tendency to metastasize to nodes.

Effect of synthetic neuromedin-N, a novel neurotensin-like peptide, on exocrine pancreatic secretion and splanchnic blood flow in dogs

Neuromedin-N, a novel neurotensin-like peptide, has recently been identified from porcine spinal cord by using a bioassay for a stimulatory effect on guinea pig ileum. The amino acid sequence of the peptide has been determined to be Lys-Ile-Pro-Tyr-Ile-Leu, which is quite homologous to the COOH-terminal sequence of neurotensin. In this study, the effect of neuromedin-N on pancreas and splanchnic blood flow was investigated in eight dogs. Intravenous injections of graded doses of synthetic neuromedin-N caused a dose-dependent decrease of systemic arterial pressure and a dose-dependent increase in both portal and superior mesenteric arterial blood flow, which were measured with transit time ultrasonic flow meter. Volume and protein output of the pancreatic juice were also increased significantly by Neuromedin-N. Pancreatic capillary blood flow measured with laser Doppler flowmetry was increased in a dose-related manner. The present study first demonstrated that neuromedin-N retains a potent stimulatory effect on the pancreas and splanchnic circulation, indicating that this peptide is one of the biological active forms of neurotensin-like peptide in mammals. This study also leads to the suggestion that this peptide possesses physiological significance as a novel neuropeptide.

Synthesis of porcine neuropeptide Y(NPY) in solution

The porcine neuropeptide Y (NPY), a 36-residue peptide amide, was synthesized by assembling six peptide fragments followed by thioanisole-mediated deprotection with trifluoromethanesulfonic acid in trifluoroacetic acid. beta-Cycloheptyl aspartate, Asp(OChp), was employed to suppress base-catalyzed succinimide formation. When administered to dogs, the purified peptide (10 micrograms/kg) caused prolonged increase of systemic arterial blood pressure and decreased pancreatic blood flow.

Retrosternal esophagogastrostomy with the EEA stapler

We performed an anastomosis of the cervical esophagus to the retrosternally shifted gastric tube with a new technique. The technique was applied successively to ten patients undergoing distal subtotal esophagectomy for carcinoma of the esophagus. In every patient, the technique was done easily and anastomoses were completed without any leakage, bleeding or stricture.

Usefulness of selective arterial secretin injection test for localization of gastrinoma in the Zollinger-Ellison syndrome

Secretin was injected into a feeding or nonfeeding artery of a gastrinoma and blood samples were taken from the hepatic vein (HV) or a peripheral artery (PA) to measure the changes of serum immunoreactive gastrin concentration (IRG). The IRG in the HV rose within 40 seconds and in the PA rose within 60 seconds after the injection of secretin into a feeding artery, but not after secretin was injected into a nonfeeder. These results indicated that secretin directly stimulates a gastrinoma to release gastrin in vivo. The selective arterial secretin injection test (SASI test) was applied in three patients in whom gastrinomas could not be located by computed tomography, ultrasonography, or arteriography, and functioning gastrinomas were located in all three patients. In one patient, malignant gastrinomas in the head of the pancreas and in the duodenum could be resected radically with the help of this test.

High levels of anti-mitochondrial antibodies in MRL mice. Influence of anti-DNA antibodies on anti-mitochondrial antibodies measured by an enzyme-linked immunosorbent assay

We developed an easy enzyme-linked immunosorbent assay (ELISA) for anti-mitochondrial antibodies, and detected high levels of anti-mitochondrial antibodies in MRL/Mp-lpr/lpr (MRL1/l) mice. The influence of the presence of anti-DNA antibodies in the tested sera on this assay was also evaluated. The monoclonal anti-DNA antibodies, which were made from non-immunized MRL1/l mice, did not react with the mitochondrial antigens adhering to polystyrene plates. Absorption with DNA had little effect on the levels of mitochondrial antibodies in MRL1/l sera. Our assay for mitochondria-binding antibody was very easy and sensitive, although it could not differentiate among heterogeneous anti-mitochondrial antibodies.

Influence of obstructive jaundice on pancreatic growth and on basal plasma levels of cholecystokinin and gastrin in rats

Obstructive jaundice was produced in rats by ligation and transection of bile duct outside the liver; the control group underwent laparotomy alone. Pancreatic wet weight, amylase, lipase, protein, DNA, RNA, RNA/DNA ratio, and weight/100 micrograms DNA were significantly increased in jaundiced rats when compared to control rats. Histologic evaluation of pancreatic tissue obtained from jaundiced rats revealed the appearance of large or multiple nuclei in pancreatic acinar cells. Basal plasma levels of immunoreactive CCK were significantly increased in jaundiced rats at two weeks and four weeks but, when compared to the levels obtained in laparotomized controls at those time intervals, CCK levels were not significantly different. In jaundiced rats, plasma immunoreactive gastrin was found to be significantly decreased at two and four weeks. Plasma gastrin levels were also found significantly decreased when the jaundiced group was compared with laparotomized control group. The results suggest that obstructive jaundice induced enlargement of the pancreas, probably due to hyperplasia and hypertrophy of pancreatic cells. Whether or not this phenomenon is related to changes in gastrin and CCK is not known.

A secured technique for pancreatojejunal anastomosis in pancreaticoduodenectomy

In order to avoid complications after pancreaticoduodenectomy, a simple and safe technique for pancreatojejunal anastomosis was developed. After resection of the pancreas, a vinyl chloride tube with a circumferential knot is inserted into the pancreatic duct and tied with a Dexon suture. Pancreatojejunal anastomosis is performed by approximating the seromuscular layer of the jejunum around the opening to the parenchymal tissue of the pancreas with interrupted nylon sutures, eliminating the need for direct anastomosis between the duct and jejunum. The knot on the tube prevents the tube from dislodging, and pancreatic juice is completely drained until the tube is safely removed two to three weeks after the operation.