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Query: UMLS:C0149521 (chronic pancreatitis)
 7,199 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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

The aim of this study was an assessment of the usefulness of indirect test NBT-PABA in evaluation of pancreatic exocrine function in patients from our department treated for chronic pancreatitis. The study was carried out on 67 persons divided in three groups: I - healthy controls (n = 23), II - patients with non-pancreatic diseases (n = 17), III - patients with chronic pancreatitis (n = 27). On the basis of degree of impairment of exocrine function in the secretin-pancreozymin test (SPT), group III was divided in three subgroups: with mild (A), moderate (B), severe (C) exocrine insufficiency. NBT-PABA test was performed using reagents (firm's Hoffman-La Roche) in accordance with the added instructions. In healthy persons (I) average PABA excretion in urine was 62% and lower normal limit was 30%. In patients with non-pancreatic diseases (II) mean urinary PABA excretion was 52% and in the group with chronic pancreatitis (III) markedly lower results were obtained (mean = 26%), p less than 0.05. In order to evaluate diagnostic sensitivity in relation to the degree of pancreatic insufficiency, results of NBT-PABA test were compared with the results of SPT. The results of both tests completely coincided in subgroups III B, and III C, but in subgroups III A, in only 43% of cases it was observed. The specificity of NBT-PABA test (i.e. frequency of normal results in controls and patients with non-pancreatic diseases) was 87%. Our results suggest that NBT-PABA test may be a useful procedure in diagnosis of chronic pancreatitis with severe and moderate exocrine insufficiency. In cases of mild exocrine dysfunction its value is limited.
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PMID:[Diagnostic value of the NBT-PABA test in chronic pancreatitis]. 209 25

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

We measured total plasma amino acid concentrations before and during pancreatic stimulation with secretin (1 clinical unit/kg/h) and caerulein (50 ng/kg/h) in 28 healthy volunteers, 60 patients with chronic pancreatitis (25 mild to moderate, 35 severe), and 22 patients with non-pancreatic digestive disease. In the healthy volunteers and patients with non-pancreatic digestive disease pancreatic stimulation caused a significant decrease (p less than 0.001) in plasma amino acid concentration, whereas in patients with chronic pancreatitis the decrease did not occur or was only slight. In six healthy volunteers and 24 patients with chronic pancreatitis (nine mild to moderate, 15 severe) repetition of the test using caerulein alone showed no significant differences from combined stimulation. Using the maximal per cent decrease in plasma amino acid concentration as an index of pancreatic function (lower normal limit 14%), 20 of the 25 patients with mild to moderate pancreatitis (80%) and 32 of the 35 with severe pancreatitis (91.4%) had values clearly below normal. The overall sensitivity of the test (86.7%) was significantly greater than that of the pancreolauryl test (64.2%) (p less than 0.02) and that of faecal chymotrypsin (66%) (p less than 0.05). None of the patients with non-pancreatic digestive disease had abnormal values. We conclude that the assessment of the decrease in the plasma amino acid concentration during pancreatic stimulation with secretin and caerulein is a simple, sensitive, and highly specific test of pancreatic function. The data obtained using caerulein stimulation alone suggest that the test can be further simplified, and made less costly, by eliminating the use of secretin.
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PMID:Caerulein induced plasma amino acid decrease: a simple, sensitive, and specific test of pancreatic function. 220 84

Radioimmunoassay (RIA) was used to measure the response of serum trypsin to intravenous secretin and pancreozymin in 16 subjects with adrenocortical hyperfunction (group I) versus 6 subjects with hypercorticism (group II). In group I the enzyme reaction to the peptides was active and long-term. A similar rise in trypsin level occurred equally in patients free of chronic pancreatitis often present in Itsenko++ -Cushing syndrome. In group II patients RIA trypsin values comply with normal levels. The data obtained suggest an affected pancreatic status in adrenal hyperfunction both in the presence and absence of chronic pancreatitis which minimizes the informative value of the test in identification of chronic pancreatitis in endogenic hypercorticism.
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PMID:[Immunoreactive trypsin in the blood serum of patients with endogenous hypercorticism]. 221 19

A well known in physiology fact is that stimulation with enterohormones (secretin, cholecystokinin) causes a steep increase in the synthesis of pancreatic enzymes, and this might affect the plasma level of amino acids. In view of this, this level was studied in healthy subjects and patients with chronic pancreatitis. Hormonal stimulation was observed to cause in healthy subjects a significant rapid fall of the levels of all amino acids, which was greatest in the 20th minute. A less evident fall of the amino acid level was observed in chronic pancreatitis. A high correlation was noted (r = 0.9) between the value of amino acid fall in plasma and the degree of failure of the exocrine pancreatic function measured with the NBT-PABA test. All results are an encouraging indication that plasma amino acid level fall may be used for the assessment of the pancreatic exocrine potential. In the analysis of individual amino acids the most significant fall was noted of methionine, serine, valine, isoleucine, glutamine and tyrosine.
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PMID:[Level of amino acids in blood plasma as a test for exocrine pancreatic function]. 221 24

Pancreatic calcifications are particularly frequent in patients with severe pancreatic insufficiency and long-lasting chronic pancreatitis. To clarify whether calcifications point to a more severe form of the disease, irrespective of its duration, we have retrospectively analyzed patients with chronic pancreatitis submitted to the secretin-cerulein test in our center over a six-year period. Out of 120 patients, calcifications were found in 55. Higher alcohol intake and longer duration of the disease were found in patients with calcifications, compared with patients without calcifications (p less than 0.001). In both groups, lipase and chymotrypsin were more severely impaired than bicarbonate; a greater reduction of pancreatic exocrine function was found in patients with calcifications, compared to those without (p less than 0.001, Mann-Whitney U-test). When the patients were classified according to the duration of the disease or the severity of exocrine function impairment, higher percentages of patients with calcifications were found in the classes with more advanced disease. A log-linear analysis showed that the prevalence of calcifications was associated with pancreatic function impairment, even within the same class of duration of the disease. It is likely that calcifications mark more severe forms of chronic pancreatitis, even in the early phases of the disease.
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PMID:Pancreatic calcifications in patients with chronic pancreatitis. A sign of long-lasting or severe disease? 223 Mar 61

The fasting carcinoembryonal antigen (CEA) concentrations in the serum and duodenal juice and after venous stimulation of the exocrine pancreas with the hormones CCK and secretin (Boots) were studied. Radioimmunologic test with a kit of the firm "Labimex"--PPR was used. 28 patients with clinically proved chronic pancreatitis and a control group of 27 healthy persons were examined. The fasting CEA serum concentrations in the patients with chronic pancreatitis were statistically significantly higher than those of the healthy persons--mean--16.5 ng/ml vs mean--8.2 ng/ml (p less than 0.001). In 14% of the healthy persons and 57% of of the patients with chronic pancreatitis the basic CEA concentrations were significantly increased. After stimulation with CCK and secretin the serum CEA concentration did not change substantially. The duodenal juice CEA concentrations after CCK and secretin stimulation were about 11 times higher than those in the serum--mean--113 ng/ml and mean--104 ng/ml for the control group vs mean--118 ng/ml and mean--110 ng/ml for the patients with chronic pancreatitis. No statistically significant difference between the patients with chronic pancreatitis and the control group of healthy persons was established. The results reveal the low specificity of the CEA as a "tumor marker".
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PMID:[The carcinoembryonic antigen in chronic pancreatitis]. 223 19

Investigations of pancreatic juice revealed new insights into the pathogenesis of chronic pancreatitis (cP). But many results are contradictory. In this paper pure human pancreatic juice from patients with cP (n = 14) was compared with results obtained from normal subjects (n = 22). The pancreatic juice was obtained endoscopically recording the absorption (280 nm) simultaneously. By means of this special technique 4 fractions could be exactly distinguished: 1. wash-out-period, 2. phase of secretin action, 3. phase of pancreozymin (CCK) action, and 4. post-CCK-phase. Total protein, trypsinogen, zinc sodium, and potassium were determined. In fraction 1 (wash-out-period) mean values of protein, trypsinogen and zinc are lower in patients with cP compared with control subjects. In case of zinc the difference is statistically significant. In fraction 2 (secretin-phase) no differences could be detected between cP and control subjects. In contrast in fraction 3 (CCK-phase) mean values of protein and trypsinogen are lower in control subjects than in patients with cP. But the standard deviations are so high that all differences are not statistically significant. The results indicate that under fasting conditions the pancreatic juice content of protein, trypsinogen and zinc is lower in patients with cP. But patients with cP can be stimulated much better with CCK than control subjects. Till now such a different behaviour during wash-out-period and CCK-stimulation is not reported in the literature.
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PMID:[Changes in pure human pancreatic juice in chronic pancreatitis]. 228 54

By means of consecutive pancreatic stimulation, we have investigated the presence of changes of pancreatic function in alcoholic patients, with and without alcoholic liver disease, in order to detect functional alterations and possible association of hepatic and pancreatic disease. The patients were 49 chronic alcoholics (8 patients without liver disease, 11 hepatic steatosis, 9 alcoholic hepatitis and 21 alcoholic cirrhosis) and 15 non alcoholic subjects (8 normal controls and 7 cases of non alcoholic cirrhosis). In all the cases two consecutive stimulations were carried out: first with secretin and cholecystokinin (CCK) and second with CCK alone. The total volume and concentration as well as the output of bicarbonate, trypsin, amylase and total proteins were measured in the duodenal juice. Patients with alcoholic cirrhosis had larger volumes of duodenal juice and lower concentrations of bicarbonate, enzymes and proteins. There was also a tendency to larger volume and lower bicarbonate concentration as the hepatic lesion was more severe. Bicarbonate output was significatively higher in patients with alcoholic cirrhosis but for the remaining parameters the outputs were similar in all the groups. In conclusion, the alterations in pancreatic function parallel the severity of the liver disease. None of the patients had changes consistent with chronic pancreatitis.
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PMID:[Changes in pancreatic secretion in alcoholic liver disease]. 237 59


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