Antral reactivity: effect of vagal innervation on antral gastrin release by various stimuli

We have demonstrated that temporary vagal blockade does not decrease gastrin release from an isolated antral pouch when gastrin is stimulated by local factors in the pouch. At the same time this sort of temporary vagal blockade decreases the responsiveness of the Heidenhain pouch to endogenous stimuli from the antral pouch but not to exogenous stimuli. These findings suggest that truncal vagotomy may be more efficient and might achieve a greater degree of gastric secretory reduction than does parietal cell vagotomy. The implications of these findings with regard to parietal cell vagotomy in the treatment of duodenal ulcer are discussed.     

Neural control of blood flow in gastric mucosa.

The innervation of the small vessels in the fundic mucosa of the rat and the effects of vagotomy on this innervation were studied ultrastructurally. The capillaries and arterioles, but not the venules, were found to receive direct innervation. Vagotomy causes degeneration of the nerve endings that innervate these vessels, confirming their vagal origin. This finding, and the fact that some morphologic changes in the capillaries were observed after vagotomy, provides morphologic evidence for the neural control of blood flow in the rodent gastric mucosa.     

Giant insulinoma.

A patient with an extremely large insulinoma but short duration of symptoms is reported on. Fasting hypoglycemia, hyperinsulinism, and angiography were the modalities used to diagnose and locate the tumor.     

New approaches to the management of severe acute pancreatitis.

A recent experience with seventy-seven patients admitted to Boston City Hospital for acute pancreatitis permitted us to identify thirteen patients (17 per cent) whom we diagnosed as having severe protracted acute pancreatitis. These alcoholic patients obviously had fulminant pancreatitis similar to that reported by others in two instances and pancreatic abscesses in two additional instances, but nine of the patients did not fulfill the criteria usually used by others as a basic for surgical intervention. Specific preoperative diagnosis was obtained in these patients by the aggressive use of endoscopic cannulation of the pancreatic ducts, which documented the presence of surgically correctable lesions. These patients had sustained significant malnutrition, which was corrected only by protracted therapy extending an average of two months and involving all modalities currently available for nutritional support of the severely ill patient. After proper preoperative identification of a specific lesion and correction of the malnutrition, the eleven patients without fulminant disease were operated on with no deaths or significant complication. Nine of the patients had elective procedures, which included six distal pancreatectomies and one total pancreatectomy. Thus, severe protracted acute pancreatitis can be identified, and once categrorized, it can have therapeutic implications.     

Neurohumoral observations and the gastrointestinal tract

Vagal interrelationships with the gastric antrum have been studied in depth. A special experimental model, antroneurolysis, demonstrated that the function of the gastric mucosa is maintained after removal of central neural control, that is, vagotomy. A series of experiments are reported which demonstrate the importance of the sympathetic nervous system in the local control of gastrointestinal function. The concept of local neural control of the endocrine and secretory function of the epithelial cells of the intestinal mucosa (internal brain) is proposed.     

Diagnosis of traumatic rupture of the gallbladder

Possible gallbladder rupture should be considered in any patient with blunt abdominal trauma and vague symptoms who has been inebriated. Peritoneal lavage and endoscopic or percutaneous cholangiography, if feasible, are the preferred diagnostic methods during the initial period after the gallbladder rupture. Later, when encapsulation occurs, ultrasonic examination of the mass together with guided aspiration of the bilious pseudocyst may provide the most useful diagnostic information.     

Diagnostic considerations in acute alcoholic and gallstone pancreatitis

Comparison of a group of patients with acute alcoholic pancreatitis with a group with gallstone pancreatitis has established the serum amylase level on admission as one of the most useful laboratory tests in aiding to differentiate the two entities. A serum amylase level greater than 1,500 IU was most often due to gallstone pancreatitis, as was elevation of the serum bilirubin and alkaline phosphatase levels.     

Mesenteric vascular disease

In a patient with acute abdominal pain, the diagnosis of acute mesenteric vascular disease should be suspected immediately if there is a history of previous embolization, atrial fibrillation, or generalized atherosclerosis. Supportive therapy should be instituted promptly and should include treatment for congestive heart failure, hypotension, and dehydration. Heparin should be given intravenously to prevent extension of the occlusion. Angiography is essential in selecting those patients with superior mesenteric artery occlusion who should undergo immediate operation. At surgery, scanning of the revascularized intestine after aortic injection of ⁹⁹Te-labeled microspheres permits immediate determination of intestinal viability. If angiography demonstrates patency of the superior mesenteric artery, nonocclusive arteriosclerotic disease, venous thrombosis, or inferior mesenteric ischemic colitis is suspected and further supportive therapy and close observation are given. If abdominal findings progress to include peritonitis, laparotomy with intestinal resection is performed in any of these groups. Patients found to have an embolus are carefully evaluated for later corrective cardiac surgery. Patients with extensive atherosclerosis who recover from an acute episode are considered for subsequent elective bypass to avoid future ischemic episodes. This program is clinically practical and offers the hope of greater salvage of patients with decreased operative risk in a disease that has thus far yielded poor clinical results.     

Intracellular demonstration of growth hormone in human mammary carcinoma cells.

Intracellular growth hormone has been demonstrated in human mammary carcinoma cells by using an unlabeled antibody enzyme technic with horseradish peroxidase and antihorseradish peroxidase complex. Intense reaction was seen in both male and female mammary carcinoma cells. Positive staining was observed in nuclei and cytoplasm and on cytoplasmic membranes.     

Impotence therapy and cancer of the prostate.

Prostate cancer developed in two male patients being treated with fluoxymesterone for erectile impotence. It is suggested that the current increased interest in and therapy for sexual dysfunction be accompanied by an awareness of a possible causal relationship between exogenous androgens and prostrate cancer.     

Pathophysiology of acute pancreatitis: Evaluation of the effects and mode of action of indomethacin in experimental pancreatitis in dogs

Prostaglandins are known to affect vascular flow and the inflammatory response. Since acute pancreatitis involves both of these phenomena, we undertook studies using anesthetized mongrel dogs to investigate changes in blood pressure, cardiac output and pancreatic arterial flow for 6 hr in both normal animals (10 dogs) and following induction of acute pancreatitis (15 dogs). Indomethacin (5 mg/kg), which inhibits synthesis of prostaglandins, was then injected intravenously, and the animals were subsequently monitored for 2 hr. Results showed: (1) A significant fall in pancreatic arterial flow, relative to cardiac output, over the first 6 hr of the disease in the acute pancreatitis animals (P < 0.001). (2) A further significant decrease in relative pancreatic arterial flow following indomethacin in these animals (P < 0.001). A similar reduction in pancreatic arterial flow was observed following indomethacin administration in the control animals (P < 0.001). Conclusions: (1) Relative pancreatic arterial flow falls during experimental acute pancreatitis. (2) Indomethacin reduces both basal and compromised pancreatic arterial flow in the anesthetized dog; this suggests that prostaglandins may participate in the maintainance of basal acid-compromised pancreatic blood flow in the anesthetized dog.