Exocrine pancreatic function in diabetic rats treated with intraportal islet transplantation

Streptozotocin-diabetic rats with chronic pancreatic fistula show severe impairment of secretin-stimulated pancreatic secretion while the action of pancreozymin remains unchanged. Intrahepatic transplantation of islets of Langerhans restores the response of ductal cells to secretin; physiological control of insulin secretion appears to be essential for exocrine function.

[Tuberculosis of the breast. Presentation of 3 clinical cases]

Tuberculosis of the breast is quite rare. Three cases, histologically proved, are reported; one of them was associated with a carcinoma. Clinical and radiological tools can hardly differentiate tubercular from tumoral nodules.

[Immunologic changes in chronic pancreatitis]

In 35 patients with chronic pancreatitis, C3, C4, s-immunoglobulins, circulating immunocomplexes and T-lymphocytes were assessed in order to verify whether an immunological role may be postulated in the pathogenesis and/or in the maintenance of the disease. A significant increase of serum IgM together with normal values of C3 and C4 and without circulating immunocomplexes was found. A significant decrease in the total number of lymphocytes as well as in the number and percentage of T-lymphocytes was also documented. These results suggest a possible involvement of immunological (humoral and cellular) processes in maintaining the chronic pancreatic damage.

[Chronic pancreatitis and diabetes]

Chronic pancreatitis appears to be increasing likely because increase in alcohol consumption and improved diagnostic tools. So the diabetes due to chronic pancreatitis is gaining importance. In order to obtain a better understanding of that particular secondary diabetes, 179 patients with chronic pancreatitis were studied from 1970 to 1981. 154 patients were male and 25 female. Average admission age was 45, ranging from 25 to 86. All the patients underwent medical therapy, based on diet, pancreatic enzymes, pain control. 99 of them underwent even to surgery. The follow-up is ranging from 6 months to 10 years: during this period 18 patients died, 41 went lost. 120 patients are still under observation. Diabetes was found in the family history of 27 patients (15%). At hospital admission 41 patients (23%) had high fasting glycemia, 23 of them even glycosuria. Other 74 showed diabetic oral glucose tolerance test. During the follow-up time 27 became clinically diabetic, 3 died because hyperosmolar coma and 8 had to be readmitted more than once because diabetic metabolic decompensation. Among the 120 patients at the moment under control, 66 (55%) show abnormal fasting glycemia, 10 developed high blood pressure, 12 inferior limbs vasculopathy with paresthesias and intermittent claudication, 2 myocardiosclerosis and atrial fibrillation, 1 myocardial infarction, 2 chronic nephropathy, 1 diabetic retinopathy. Whereas surgery or medic therapy may relieve chronic pancreatitis typical symptoms, they appear to be useless remedy against the under lying diabetes. As the time goes on more and more patients develop glucose intolerance, quite early became insulin-dependent, are disposed to severe diabetic metabolic decompensation and can show vascular, cardiac or renal complication.

Hepatic artery aneurysms

Four patients with hepatic artery aneurysm are reported. Two patients presented with abdominal pain, initially considered a consequence of pancreatic disease. A third patient had a sudden onset with hemoperitoneum and shock. In the fourth patient the aneurysm burst into the common bile duct causing hemobilia and jaundice. All were successfully treated with hepatic artery ligation, which left the patient free of symptoms during long-term follow-up. Arteriography should facilitate diagnosis and artery ligation appears the best treatment.

Serum ferritin in pancreatic disease. An accurate test of malignancy?

Serum ferritin, described as increased in patients with pancreatic cancer, was studied in 109 subjects by an immunoradiometric technique in order to assess its reliability in detecting pancreatic malignancy. A significant increase of serum ferritin was found in pancreatic cancer as compared to controls (p less than 0.01), to calcifying (p less than 0.05), non-calcifying (p less than 0.05), and recurrent (p less than 0.01) chronic pancreatitis. Nevertheless, high levels of serum ferritin were found in 10 out of the 36 chronic pancreatitis patients and in 10 out of the 26 patients with non-pancreatic diseases, whilst values within the normal range were detected in 6 out of the 22 pancreatic cancer patients. These data suggest that serum ferritin, although frequently increased in pancreatic cancer, cannot be considered a marker of pancreatic malignancy.

Role of trypsin/creatinine clearance ratio in the differential diagnosis of chronic pancreatic disease

Trypsin/creatinine clearance ratio--a recently proposed screening test for pancreatic cancer--was assessed in 45 subjects (17 control subjects, 15 patients with pancreatic cancer, and 13 with chronic pancreatitis). A statistically significant increase of the ratio was detected not only in pancreatic cancer, but also in chronic calcifying pancreatitis. Thus, the previously reported clinical usefulness of the test in pancreatic cancer diagnosis was not substantiated by the present data. Although not fully investigated as yet, reasons for an abnormal ratio are probably independent of the neoplastic or inflammatory nature of the pancreatic disease. Science renal enzyme excretion (alpha-glucosidase, gamma-glutamyltranspeptidase, leucine aminopeptidase) was not found to be invariably elevated when trypsin/creatinine clearance ratio was increased, tubular damage cannot be assumed as constituting the only reason for an altered clearance ratio.

Usefulness of transhepatic portal catheterization in the treatment of insulinomas

Twenty-four per cent of beta-cell tumours require more than one operation to control the hypoglycaemic syndrome. Almost all of them are small insulinomas undetectable by palpation of the pancreas. Arteriography is too insensitive to detect non-palpable tumours. Transhepatic catheterization of the splenic and portal veins (TPC) can detect the position at which there is an abrupt increase in insulin level indicating the site of the tumour. Routine use of TPC allowed us to locate all 9 insulinomas in which this technique was employed, whereas of 15 patients not studied by TPC only 12 tumours were located at first operation, 2 of which were found by blind resection of the tail of the pancreas. We believe that routine application of TPC to all cases of suspected insulinoma would reduce the incidence of surgical failures, unsuccessful blind resections and lengthy trials of medical therapy before laparotomy.

Effects of sodium DL-lactate on insulin secretion in anesthetized dogs

The effect of sodium DL-lactate administration on insulin release in anesthetized dogs has been studied. Eleven mongrel dogs were infused with sodium DL-lactate for 20 min at the rate of 20 mg/kg . min. Lactate infusion produced simultaneous increases in blood glucose and plasma insulin levels in the pancreaticoduodenal vein. To determine whether lactate stimulated insulin secretion directly, sodium DL-lactate was rapidly injected into the pancreatic artery of six dogs; this pulse induced a significant increase in insulin release from pancreatic B-cells, even in the absence of a measurable change in blood glucose. Diazoxide, when infused in six dogs, blocked lactate-induced insulin secretion. These findings indicate that lactate, as do other circulating energy fuels, may play a role in the physiologic control of insulin secretion.

[Value and limitations of exfoliative cytological study of the pancreatico-duodenal juice collected during the secretin and pancreozymin test in the diagnosis of pancreatic carcinoma]

Studies on exfoliative cytology of the pancreatic-duodenal juice in the diagnosis of pancreas neoplasia are not numerous and the data reported are not uniform. The present study examines 176 patients, 18 of them suffering from carcinoma of the pancreas. In these latter patients there were no advanced signs of the disease. Cytology gave a correctly negative result in 46.8% of the normal subjects and in those with non-neoplastic pancreatic or digestive conditions, correctly positive in 66.6% of the pancreas neoplasias, falsely negative in 2,2% of the total series and in 33.3% of the pancreatic cancers, and falsely positive in 1,1% of the series. In 47.7% of cases, the study proved useless owing to the absence of material in the collected juice.

Effect of cimetidine on steroid experimental peptic ulcers

Cimetidine, a H2-receptor inhibitor was able to prevent the development of gastric ulcers induced in rats by chronic administration of prednisolone and hydrocortisone associated to fasting. The results suggest that cimetidine may be used in patients under long term steroid treatment.

[Current value of diagnostic laparatomy with splenectomy in Hodgkin's disease (critical evaluation of 188 cases)]

Diagnostic laparotomy with splenectomy was performed in 188 patients with Hodgkin's disease. Preoperative assessment by means of conventional methods of examination was confirmed in 118 cases (62.9%) and had to be modified in the remainder. Post-operative complications were observed in 12 cases (6.5%). One subject died of myocardial infarct. It is felt that the procedure is useful in establishing the stage of the disease and in planning treatment. It must not be applied indiscriminately, however, and is primarily useful insofar as it results in a modification of the therapeutic programme.

Inhibition of secretin-stimulated exocrine pancreatic secretion by diazoxide in the rat

Diazoxide, a known insulin inhibitor, inhibits the pancreatic exocrine response to secretin in unanesthetized rats and does not modify the CCK-PZ-stimulated secretion. These results suggest that insulin may have a role on the stimulation of exocrine pancreas through secretin.

Comparison between bolus injection and infusion of secretin and pancreozymin in the diagnosis of chronic pancreatic disease (one hour test)

There is no agreement in the literature as regards the carrying out of the Secretin-Pancreozymin test in order to achieve the greatest accuracy in the diagnosis of pancreatic insufficiency. In this study the results obtained by bolus i.v. injection of Secretin and Pancreozymin GIH are compared with those obtained by i.v. infusion of the hormones. The test - always prolonged for one hour - was done in 125 subjects, divided into two groups matched for sex, age and pancreatic or digestive disease. Volume, pH, bicarbonates, calcium and amylase were measured in the juice collected. The results showed that bolus i.v. injection of Secretin and Pancreozymin has greater diagnostic sensitivity (94%) than the infusion method (84%). If infusion is used, it is necessary to protract the test for more than one hour.