Plasma secretin levels in total pancreatectomy and pancreaticoduodenectomy

The secretory response of plasma secretin to intrajejunal acid was measured in 11 patients who underwent total pancreatectomy and eight with pancreaticoduodenectomy. In cases of pancreaticoduodenectomy, the secretory response of plasma secretin was well maintained, but in those with total pancreatectomy there was a significantly impaired secretory response of plasma secretin. Among patients with total pancreatectomy, those with Billroth II type anastomosis showed a significantly impaired response compared with those with Billroth I type anastomosis. Thus biliary secretion is more impaired in patients with total pancreatectomy than in those with pancreaticoduodenectomy. To improve the impaired biliary secretion after total pancreatectomy, Billroth I type anastomosis for reconstruction procedure of the alimentary tract appears to be more feasible. In the case of the major pancreatectomy, much attention should be given biliary secretion and such may decrease the possibility of occurrence of ulcer at the anastomosis and improve the digestion-absorption of fat.

A prospective study of the antisecretory and therapeutic effects of cimetidine and glucagon in human acute pancreatitis

Nasogastric suction, glucagon, and cimetidine are proposed treatments for human acute pancreatic because they may reduce gastric acid and exocrine pancreatic secretion. However, the functional status of gastric and pancreatic secretion during human acute pancreatitis is unknown. Thus, we compared the effects of nasogastric suction, intravenous glucagon (5 microgram/kg per hour), and cimetidine (2 mg/kg per hour) on the output of acid and pancreatic enzymes and the clinical course of human acute pancreatitis. In three subjects with acute alcoholic pancreatitis, gastric acid secretion was increased above normal and was decreased by glucagon and cimetidine used alone and in combination. In two of the three patients, duodenal output of trypsin and lipase was normal or increased and was reduced by glucagon and cimetidine given alone or in combination. Twenty patients with documented acute pancreatitis randomly received treatment with nasogastric suction, cimetidine alone, or the combination of cimetidine and glucagon. Four of the five complications observed during the trial occurred in the combination-treatment group (P less than 0.05). Administration of cimetidine alone or with glucagon did not improve the outcome when compared with nasogastric suction.

Transport of protons and hydrochloric acid through lipid bilayer membranes

Transport of protons and hydrochloric acid through lipid bilayer membranes was studied by a combination of electrical conductance and pH electrode techniques. In the presence of large pH gradients, proton transport occurs primarily by diffusion of molecular HCl. The permeability of egg phosphatidylcholine/decane bilayers to HCl is about 3 cm . s-1, seven to nine order of magnitude higher than the permeability to H+, OH- or Cl-. The HCl permeability of phosphatidylserine or egg phosphatidylcholine/cholesterol (1 : 1) bilayers is about 50% lower than the permeability of egg phosphatidylcholine bilayers. Diffusion of molecular HCl may be an important process in tissues exposed to high HCl concentrations, e.g., gastric mucosa. However, at neutral pH the diffusion of molecular HCl is too slow to contribute significantly to net movements of H+ or Cl-.

Experimental analysis of hydrogen ion diffusion in gastrointestinal mucus glycoprotein

Experiments were undertaken to test the hypothesis that mucus glycoproteins retard the diffusion of hydrogen ions, a possible protective action of gastric mucus. Mucus and mucus glycoproteins (visible mucus, crude mucin, mucus glycoprotein fractions) were evaluated in two devices designed for this test, a linear diffusion chamber and a hydrogen ion flux chamber. The linear diffusion chamber assessed ion diffusion from a point source through mucus glycoproteins to a H+ detector. A mathematical model of diffusion, based on Fick's law, was adapted to characterize diffusion in this chamber. The H+ flux chamber assessed H+ flux rates across a steep concentration gradient through controlled amounts of mucus glycoprotein. With the exception of human sulfomucin, tested only at dilute concentrations and only in the flux chamber, both procedures indicated that mucosubstances retarded, in a dose-related manner, diffusion of hydrogen ions. Experiments on buffering by crude porcine gastric mucin did not demonstrate significant buffering under physiological conditions. Thus, the present experimental data, the principles of which should be extrapolative to the mucous barrier at the biological level, suggest that mucus glycoproteins can in fact inhibit the diffusion of hydrogen ions.

[Excretion of lead in the gastric and duodenal juice of persons with occupational lead poisoning and normal subjects]

Lead was measured in the gastric and duodenal juice of three patients with lead poisoning (blood concentrations of lead: 4.30; 5.16; 5.50 mumol/l). The lead excretion into the gastric juice was 94.6; 29.9 and 18.3 nmol Pb X h-1 for the poisoned persons and 57.9 +/- 38.1 nmol Pb X h-1 for healthy persons (n = 20). Pentagastrin (6 microgram/kg, i.m.) stimulated lead excretion in both groups (normal + 109%, lead poisoned persons: + 180%; + 187%; + 311%). The lead excretion was correlated with an increase of HCl-secretion and volume in healthy persons. The lead excretion into the duodenal juice after secretion (1 unit/kg) amounted to 14.2 +/- 8.8 nmol Ph X h-1 in healthy persons, whereas after secretion plus caerulein 18.8 +/- 7.2 nmol Pb X h-1 were found. In the duodenal juice of the lead poisoned persons 27.5 and 474.9 nmol Ph X h-1 respec. were found after secretion and 58.9 and 491.8 nmol Pb X h-1 respec. after secretion plus caerulein. Lead excretion was correlated with enzyme secretion (trypsin and chymotrypsin).

Modulation of jejunal flow by solutions of varying osmolality and acidity in the intact canine jejunum

Because gastric emptying is modulated by the osmolality or hydrogen ion concentration of intraduodenal solutions, we hypothesized that similar mechanisms exist to regulate flow within the small intestine and that the altered flow is associated with changes in intestinal motility. Sodium chloride solutions with higher and lower osmolality than plasma and both isotonic and hypotonic hydrochloric acid solutions flowed more slowly into segments of jejunum in conscious dogs than isotonic neutral salt solutions. The altered flow was associated with increased frequency of spike bursts in the segment with the salt solutions of varied osmolality, but with only increased force of contractions with both isotonic and hypotonic acid solutions. Some evidence exists to suggest that the changes in motility are mediated by a neural mechanism. If similar mechanisms exist in the duodenum, they may play a role in the regulation of gastric emptying.

[Synthesis of polyamine hydrochlorides and their oxidative deamination by diamine oxidase from rapidly growing tissues]

A simple, highly effective and economical method is developed for conversion of polyamines/putrescine, spermidine and spermine into their chlorhyndrates with a yield about 100%. The melting points of the preparations obtained and those available from "Serva" /FRG/ were identical; all the preparations were oxidized by diamine oxidase from rat liver tissue at the same rate. Tissues of transplanted hepatomas and malignant liver exhibited an absolute inability to oxidative deamination. The diamine oxidase activity in regenerating liver tissue was similar to the rate of deamination, estimated in liver tissue of sham-operated animals.

Impaired acid neutralization in the duodenum in pancreatic insufficiency

The influence of severe exocrine pancreatic disease on the acid-neutralizing capacity of the duodenum was studied in five patients with pancreatic insufficiency (PI) and six control subjects using duodenal perfusion-marker technique. Hydrochloric acid (0.1 N containing 1% PEG) was infused at constant rates (1.2, 4.5 and 7.0 ml/min) into the duodenum just distal to the duodenal bulb. Samples were aspirated from the tip of the duodenal perfusion tube located at the ligament of Treitz. All samples were analyzed for volume, pH, titrable acidity, PEG and [14C]PEG (gastric marker) determination. Patients with PI demonstrated significantly diminished ability to neutralize various acid loads as compared to controls who virtually completely neutralized acid loads in the range of maximal gastric acid secretion. Exogenous secretin did not significantly improve percent acid neutralized in PI. These data clearly indicate that patients with PI have significantly impaired ability to neutralize even small loads of acid in the duodenum.

Clinically significant vitamin B12 deficiency secondary to malabsorption of protein-bound vitamin B12

Protein- (chicken serum) bound [57Co]cyanocobalamin absorption was evaluated in five hypochlorhydric patients who had developed B12 deficiency despite having normal absorption of unbound crystalline vitamin B12. All five patients had decreased urinary excretion of protein-bound B12 (0.06--0.34%) as compared to twelve normal controls (0.61--5.6%), P less than .001. Improvement in protein-bound B12 absorption in four of the five patients occurred with the exogenous administration of hydrochloric acid, pepsin, gastric intrinsic factor, or a combination thereof. Vitamin B12 deficiency developing in the setting of hypochlorhydria may result from deficiency of acid-peptic digestion of B12 bound to protein and/or a relative deficiency of intrinsic factor. This digestive defect is not detected with tests which measure the absorption of unbound crystalline B12 but is detected by a simple test which employs B12 bound to chicken serum as the form of protein-bound B12.

In vivo absorption and phosphorylation of pyridoxine . HCl in rat jejunum

The absorption and phosphorylation of 3H-pyridoxine . HCl were studied in vivo in isolated loops of rat jejunum. Uptake was rapid and linear over the concentration range of 0.2-1 mM; tissue content of absorbed vitamin was saturable and consisted primarily of phosphorylated forms of vitamin B6. Phosphorylation was saturable with a Km of 11.6 micronM and a Vmax of 1.65 nmol/5 min/g wet tissue. Inhibition of phosphorylation changed neither the t 1/2 of 3H-pyridoxine . HCl disappearance from the lumen nor the calculated uptake after either 5-min or 30-min absorption periods. Inhibition of phosphorylation, however, significantly decreased the t 1/2 for transmural absorption and significantly increased the calculated transmural absorption after a 5-min absorption period. These studies indicate that (a) pyridoxine absorption, over the concentration range tested, is nonsaturable and consistent with passive diffusion; (b) jejunal phosphorylation of pyridoxine occurs in vivo, is saturable, and results in saturation of tissue content of the absorbed vitamin; and (c) phosphorylation has no significant effect on the uptake of pyridoxine but significantly delays the transmural absorption of a finite amount of the vitamin.

Acid elution of blood group antibodies from intact erythrocytes

Human IgM and IgG antibodies against blood group antigens (A, B, D, C, c, E, e, Fya, K), autoantibodies and mouse IgM and IgG antibodies against sheep erythrocytes have been eluted from intact human and sheep red cells by glycine-HCl buffer, pH 3.0. The yield of human antibodies was higher with acid than with heat and ether elution, and the contamination of hemoglobin in the eluate was negligible. The acid elution method is very simple and rapid and, therefore, highly suitable for experimental as well as routine immunohematological work.

Acid-base relationships in the different body compartments: the basis for a simplified diagnostic approach

Special characteristics of cellular buffering must be taken into account in order to describe accurately acid-base relationships in the whole body. In particular, tissues other than blood are able to neutralize mineral acid independent of changes in Pco(2) and hence independent of large changes in extra- and intracellular pH. Although mechanistic details remain to be clarified, relationships that describe this tissue buffering in quantitative terms are well established. In this report, emphasis is placed on quantitative relationships that stress the need for diagnostic interpretation derived from acid-base changes within the whole body rather than simply within the blood compartment. Theoreticalproblems with respect ot buffering mechanisms in various body compartments are reviewed and analyzed.

Acid absorption in the canine duodenum

Alterations in composition of isosmotic acid solutions were studied in exteriorized segments of the proximal (Brunner's gland area) and distal canine duodenum, mounted in lucite chambers. Varying concentrations of HCl (40, 80, 120, 160 mEq/l) made isotonic by the addition of NaCl were instilled into the chamber, removed in 15 minutes and analyzed for volume, electrolytes, protein content and osmolality. Both proximal and distal duodenal mucosa modified the instilled solution with a loss of H+ and a gain in Na+ and K+, which occurred at similar rates independent of the acid concentration of the instilled solution. The rate of ionic movement was twice that for the antrum, and 30-100 times that of the fundus. Calculated H+ loss across the entire duodenal mucosa at these rates could account for 17.5% of the peak acid output from the canine stomach. The loss of H+ could not be accounted for on the basis of neutralization and probably represented transmucosal insorption. In addition to the neutralization of gastric acid by pancreatic juice and bile, duodenal mucosa thus plays an important role in the maintenance of intraluminal pH. Duodenal mucosal permeability to H+ may be related to the vulnerability of the duodenal mucosa to acid-peptic ulceration.

Evidence that alterations in distal sodium delivery and distal sodium avidity affect the rate of excretion of an acute HCl load

In these experiments, two groups of animals were studies to evaluate the effect of altering renal tubular sodium-handling on the excretion of acute HCl load. In group, I, normal salt animals hypotonically expanded with antidiuretic hormone (ADH) (using a protocol known to stimulate aldosterone) presented large amounts of sodium to the distal tubule and excreted an acute HCl load much more efficiently than did animals pretreated with either a normal (NL) or low (LO) salt diet alone. In group II, 24 hr after acid-loading, the plasma bicarbonate concentrations were significantly lower in animals pretreated with sodium restriction plus furosemide (F) than in those maintained on a normal (NL) or high (HI) salt diet alone. Acid excretion was maximized (ADH) when distal sodium avidity was stimulated in the presence of adequate distal sodium delivery and minimized (F) when distal sodium delivery was limited (despite possible augmentation of distal sodium avidity). Alterations in urinary sodium excretion alone (LO, NL, HI) did not affect the rate of acid excretion. These data are compatible with the hypothesis that the excretion of an acute HCl load is mediated by existing levels of distal sodium delivery and distal sodium avidity.

Action of glucagon and aspirin on ionic flux, mucosal blood flow and bleeding in the fundic pouch of dogs

Into vagally denervated (Heidenhain) pouches of 4 dogs 25 ml of 0.1 M HCl was instilled and removed at 30 min intervals for 6 hours. During the 4th, 5th, and 6th 30 min periods the acid instillate contained 5 mg/ml of aspirin. Aspirin significantly increased gastric-mucosal clearance of aminopyrine (mucosal blood flow), outputs of Na+, Ca++, Mg++, hemoglobin, and plasma transferrin-Cr51 into the pouch contents, and disappearance of H+ from lumen to mucosa. Glucagon, 50 mug/kg subcutaneously was given during irrigation with aspirin and again 1 hour later. Glucagon did not significantly affect loss of acid from lumen to mucosa or the increase in Na+, K+, Ca++, and Mg++ effluxes caused by aspirin. Glucagon significantly decreased mucosal blood flow and the hemorrhage and loss of plasma protein into the instillate induced by aspirin.

[Morphology and physiopathology of Billroth I gastroduodenostomy]

97 patients subjected from 1 to 7 years previously to partial gastric resection by gastroduodenostomy (Billroth I) have been studied endoscopically and radiologically. Acid secretion after pentagastrin injection has also been determined. The most frequent mucous alterations identified by endoscopy were erosions in the stomach residue with inflammatory granulation in the anastomosis region. Recurrent ulcers were observed in 3% of cases. Acid secretion was reduced in 87% by comparison with the preoperative picture. The quantity of residual recretion depended on the greater curvature of the residual stomach. Radiological studies highlighted functional modifications indicative of organized motility in the residual stomach and pseudopyloric function at anastomosis level making coordinated draining possible.

The effect of 16,16-dimethyl prostaglandin E2 on meal-stimulated gastric acid secretion and serum gastrin in duodenal ulcer patients

The effect of intragastric and intraduodenal 16,16-dimethyl prostaglandin E2 (dm PGE2) on meal-stimulated gastric acid secretion and gastrin release was studied in patients with inactive duodenal ulcer. Compared to placebo, doses of 0.75, 1.00, 1.33, and 1.77 mug per kg of dm PGE2 instilled into the stomach inhibited meal-stimulated gastric acid secretion by 61 to 94% (P less than 0.01). The 1.00, 1.33, and 1.77 mug per kg doses inhibited acid secretion significantly (P less than 0.05) more than an optimal dose of propantheline bromide. Intragastric dm PGE2 (1 mug per kg) was significantly (P less than 0.05) more effective than intraduodenal dm PGE2 (1 mug per kg) in inhibiting both gastric acid secretion and gastrin release. After 1.33 and 1.77 mug per kg, some patients experienced abdominal cramps, or diarrhea, or both, but at doses of 1.00 mug per kg or less no apparent untoward side effects were observed. It is concluded that 16,16-dm PGE2 significantly inhibits meal-stimulated gastric acid secretion and gastrin release, and may be of therapeutic value in patients with peptic ulcer provided it is free of untoward side-effects with chronic administration.

Polyvinyl chloride toxicity in fires. Hydrogen chloride toxicity in fire fighters

Polyvinyl chloride, of all the plastic polymers, has been implicated primarily in causing the most serious problem in fire fighting today because it releases hydrogen chloride gas when burning. One hundred seventy fire fighters who experienced symptoms from its toxicity have been studied from 1970 to 1975. One died.