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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

It is suggested that the early-morning growth-hormone release associated with slow-wave sleep is due to inhibition of somatostatin secretion from the hypothalamus. It is also associated with inhibition of gastrointestinal somatostatin, causing a release of gastrin and insulin. Because the levels of glucocorticoid hormones are concurrently low, the insulin effect is unopposed and increases gut motility through augmented vagal tone. This results in an increased delivery of acid to the duodenum. In duodenal-ulcer patients, whose duodenal buffering capacity is reduced because of a relative deficiency of secretin response, this leads to pain.
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PMID:Nocturnal ulcer pain associated with slow-wave sleep. 7 1

Endoscopic retrograde pancreaticocholangiography (ERPC) has been performed in 140 patients, mainly Blacks and Indians. The first 100 patients have been analysed. The greatest diagnostic yield in this series is in (suspected) obstructive jaundice, where 26 diagnoses were made in 35 patients. In 40 patients with pancreatitis, the widest ducts were seen in 12 patients with calcific pancreatitis, but the procedure was of less help than expected. This was because no patients with continual pain after cessation of alcohol intake were found with operable strictures of the main pancreatic duct. The pancreatic function test with secretin and cholecystokinin-pancreozymin correctly diagnosed 4 patients with non-calcific pancreatitis in whom the ERPC was normal. There was a useful diagnostic yield in patients with unexplained upper gastrointestinal symptoms (15 diagnoses were made in 23 patients).
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PMID:Technique and results of endoscopic retrograde pancreaticocholangiography. A preliminary report on 140 patients. 16 2

Hospitalized male patients with endoscopically verified duodenal ulcer were studied to determine the effect of secretin on the clinical course of their disease. Seven patients received synthetic porcine secretin, 333 mug subcutaneously every 4 hr for 10 days, and 6 patients received placebo injections on the same schedule. Repeat endoscopy was performed within 48 hr of completing the 10-day treatment period. The trial was discontinued because of transient, asymptomatic, hyperamylasemia in secretin-treated patients. Although significant gastric alkalinization could be reproducibly demonstrated in secretin-treated patients, secretin was not more effective than placebo in relieving pain or healing duodenal ulcer. However, because the number of patients was small, definitive conclusions regarding efficacy of secretin in ulcer treatment could not be drawn.
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PMID:Experience with synthetic secretin in the treatment of duodenal ulcer. 79 Sep 43

Endoscopic retrograde cholangiopancreatography (ERCP) was carried out in 98 patients with unexplained abdominal pain or known pancreatitis with recurrent pain. Patients with jaundice were excluded from the study. In 38 patients with a clinical diagnosis of pancreatitis, the radiological findings on ERCP were graded according to the criteria of Kasugai et al. Advanced pancreatitis was found in 20 patients (52,5%), moderate changes in 7 (18,4%) and minimal-change pancreatitis in 6 (15,8%). ERCP had normal pancreatic function tests. In 35 patients investigated for unexplained abdominal pain, changes consistent with pancreatitis were found in 7, pancreatic carcinoma in 5, a duodenal ulcer in 2, gallstones in 1 and a duodenal tumour in 1. ERCP was normal in 19 patients. A comparison of the findings on ERCP and the standard secretin-cholecystokinin pancreatic function test was available in 52 patients. There was a good agreement between the two tests in the patients with advanced or moderate pancreatitis as revealed by ERCP, but less agreement in the patients with minimal-change pancreatitis. A few patients with clinical pancreatitis and abnormal ERCP had normal pancreatic function tests. ERCP increases the diagnostic yield in patients suspected of having pancreatitis and is at present the only reliable method of diagnosing pancreatic carcinoma which is not evident by other non-operative techniques. ERCP is also of value in the assessment of the severity of pancreatitis and is a necessary investigation before pancreatic surgery to confirm or exclude cyst formation or the site of duct obstruction. The finding of an unsuspected cyst at ERCP necessitates early operation because of the danger of introducing infection during the procedure.
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PMID:Endoscopic retrograde cholangiopancreatography in the evaluation of pancreatic disease. 98 98

Studies were undertaken in 40 patients with chronic pancreatitis six months to seven and a half years (mean 25 months) after operation, results being compared with pre-operative findings. Measurements included: exercise capacity, absence of pain, body weight, endocrine (36) and exocrine (25) pancreatic function. Almost all patients returned to full or only slightly impaired activity, were free of pain or had less pain and weight increase. Exocrine pancreatic function (secretin-pancreozymin test and faecal fat) was noted in 11 of 25 patients. In another 11 pre-operative progression was arrested. But endocrine function improved in only three of 36 and worsened in 13 (manifestation of subclinical diabetes in eight, worse glucose tolerance in five). The results justify a more active surgical approach in the treatment of chronic pancreatitis in order to save the patients from an often long and painful "burning out" of the disease on purely conservative treatment. Furthermore, exocrine pancreatic function, at least, is maintained or improved.
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PMID:[Results of operative treatment of chronic pancreatitis, especially exocrine and endocrine functions (author's transl)]. 112 91

To confirm the respective influence of chronic alcoholism and liver disease on exocrine pancreatic function in cholecystokinin secretin (CS), tests were performed on patients with chronic liver cirrhosis (LC) and non-cirrhotic (nLC) disease of alcoholic (A) and nonalcoholic (nA) etiology. Results were compared in four subgroups (ALC, N = 26; AnLC, N = 45; nALC, N = 18; and nAnLC, N = 43). Volume of duodenal juice and bicarbonate output (BO) were increased and maximal bicarbonate concentration was decreased in ALC, compared with those in normal controls. Comparison of LC and nLC indicated that the volume, BO, and amylase output (AO) were greater in LC than in nLC of alcoholic etiology, but not in those of nonalcoholic etiology. The initial disappearance rate (KICG) of indocyanine green (ICG) excretion correlated with a parameter of CS test in alcoholic liver disease (vs. volume: r = -0.51, p less than 0.01 vs BO: r = -0.40, p less than 0.01), but not in nonalcoholic liver disease. Concurrent chronic pancreatitis with pain and definite exocrine insufficiency was observed in only one ALC patient and in four AnLC patients, but in none of the nonalcoholics. In alcoholic liver disease, exocrine pancreatic secretion tends to increase with severity of liver damage, but concurrence of definite chronic pancreatitis is not correlated with the severity.
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PMID:Exocrine pancreatic function in chronic liver diseases. 170 82

In patients with upper abdominal complaints after cholecystectomy the normal and disordered bile flow was evaluated using quantitative scintigraphy after initially excluding organic etiology. A continuous intravenous infusion of cholecystokinin and secretin for one hour resulted in an accelerated bile flow in the majority of these patients, which is the normal reaction of the biliary system under stimulation. On the contrary, a bolus injection of these hormones led to marked delay of flow in a group of the study population, a condition taken as a paradoxical reaction to cholecystokinin. Although all of the patients with this paradoxical reaction did complain of typical biliary pain, a causal association is, however, yet to be proved. Nitrates can be helpful in the differential diagnosis of impeded bile flow, a lack of response being a possible sign of organic hindrance at the papilla of Vater.
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PMID:[Diagnosis of biliary dyskinesia after cholecystectomy]. 192 52

Pancreatic secretion is involved in circadian regulation of the whole organism. This observation was obtained in animals and humans with pancreatic fistulas. We report on three patients in whom the pancreas was removed totally or subtotally because of chronic pancreatitis with severe pain. A segment of the removed gland was transplanted into the thigh in order to preserve endocrine function. The pancreatic duct was drained by a polyethylene tube until pancreatic duct occlusion. Postoperatively juice volume increased within 3 days and remained constant afterwards with 300 ml in 24 hours. Secretin, cholecystokinin and food intake are able to stimulate the transplanted segment in a typical manner. The secretion showed circadian changes. In all patients the pancreatic juice content of protein, amylase, trypsinogen, calcium, and zink decreased till 11 p.m. After 11 p.m. the content of all substances increased and reached maximal values at 6 a.m. Flow rates and therefore output per minute decreased greatly till 6 a.m. The large juice volume of 300 ml in 24 hours is perhaps the consequence of a break down of the feedback mechanism between intraduodenal trypsin activity and CCK-release. The changes during the night may be of pathogenetic relevance. In the early morning pancreatic juice is highly concentrated and the flow rate is very low. High protein concentrations, high calcium concentrations, and reduced flow rates may lead to protein and calcium carbonate precipitates. This mechanism is under discussion in the pathogenesis of chronic pancreatitis.
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PMID:[Exocrine function of a heterotopically transplanted pancreas segment in humans]. 195 40

This chapter focuses on studies dealing with the feedback mechanism of pancreatic exocrine secretion in animal and man. Clear evidence is presented that this feedback mechanism is working in the rat and the pig and that this feedback is mediated in the rat by the gastrointestinal hormones pancreozymin (enzyme secretion) and secretin (volume and bicarbonate secretion). Two novel peptides have been described--the 'CCK-releasing peptide' originating from the small intestinal mucosa, and the 'monitor peptide' cosecreted together with the enzymes in the pancreatic juice--to account for the stimulation of pancreatic enzyme secretion by the release of CCK. A similar feedback regulation of pancreatic secretion is working in man. It remains as yet controversial whether the feedback in humans is regulated via hormonal or neural pathways. It is also a matter of debate whether this feedback regulation of pancreatic enzyme secretion could be utilized for therapeutic aims in the treatment of pain in patients with chronic pancreatitis.
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PMID:Feedback regulation of pancreatic exocrine secretion in animal and man. 212 96

Three markers of free radical oxidation of lipids--9 cis, 11 trans isomer of linoleic acid, conjugated dienes and ultraviolet fluorescence products--were measured in the phospholipid fraction of duodenal juice collected in the first 10 min after an intravenous injection of secretin. The volume of aspirate was similar in 11 controls and in 25 patients who had sustained an attack of pancreatitis 6 weeks earlier--acute pancreatitis (AP) 10, chronic pancreatitis (CP) 15. The concentration of each marker was very significantly higher in the patients; the output of the isomer gave the best discrimination from controls; and ultraviolet fluorescence products were substantially higher in the subgroup with CP than with AP. The serum % molar ratio of the isomer to linoleic acid was measured in 25 controls, 14 AP and 17 CP patients: the highest levels were found in the CP group. Heightened hepatic free radical activity involving lipid isomerization as well as lipid peroxidation pathways is a feature of pancreatitis--probably antedating the attack and persisting well after clinical recovery--the difference between CP and AP being in the degree of abnormality. We argue that these hepatic changes mirror changes in pancreatic-acinar cells and that increased free radical activity in both organs is due to a shortfall of antioxidants in the face of cytochromes P450 induction by xenobiotics. Therefore, a combination of preventive and chain-breaking antioxidants may be useful in preventing further attacks of pancreatitis and controlling background pain in chronic disease.
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PMID:Heightened free radical activity in pancreatitis. 237 63


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