The cephalogastric phase of the pancreatic response to food in the dog

We studied post-meal pancreatic secretion and gastrin release in conscious dogs with duodenal Thomas cannulas. Normal dogs were tested in physiological conditions and with an i.v. infusion of atropine 20 micrograms/kg/h or secretin 0.5 CU/kg/h. The responses were also studied after antral and truncal vagotomy. In the early phase (0-20 min) of the response, before gastric emptying started, antral vagotomy reduced fluid and protein outputs, and truncal vagotomy reduced them still more. Atropine reduced only the protein response. Gastrin release reached a peak after 20-25 min. After antral and truncal vagotomy, gastrin release was reduced within 10 min after the meal. Late-phase (greater than 20 min) pancreatic secretion depended on the presence of chyme in the duodenum. The effects of atropine and antral vagotomy in the cephalogastric phase could be explained by antropancreatic reflexes stimulating fluid secretion (atropine-resistant pathway) and protein output (atropine-sensitive pathway).     

Gracilis muscle transposition in the treatment of faecal incontinence

Between 1965 and 1994 eight selected patients with faecal incontinence for solid stool (Grade 4) were operated on by the original procedure described by Pickrell (1952), combined with biofeedback training postoperatively. No postoperative complication occurred. All patients were improved by this procedure. Five had normal continence and there were 3 incontinence for flatus. Anal manometry showed an increase in postoperative squeeze pressure (p<0.05). Long term results (48.5 months) remained the same in five cases. One patient became incontinent following an anal dilatation at 108 months, and two required excision of mucosal ectropion at 7 and 78 months with restoration of continence. One patient died of unrelated disease at 31 months.

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Résumé Les résultats du traitement de l'incontinence anale par transposition du muscle droit interne sont diversement appréciés dans la littérature. Entre 1965 et 1994, 8 malades ayant une incontinence anale totale (stade D) ont été opérés selon la technique originale décrite par KL. Pickrell. La morbidité postopératoire a été nulle. Le degré de la continence a été amélioré dans tous les cas: 5 stades A (continence normale) et 3 stades B (incontinence aux gaz) postopératoires. Les pressions de contraction ont toujours été améliorées par l'intervention (p<0,05). La rééducation postopératoire par biofeedback semble jouer un rôle important dans la qualité des résultats. Les résultats à long terme (48,5 mois) restent stables dans la plupart des cas. La transposition du muscle droit interne peut donc être utilisée avec succès dans le traitement de l'incontinence anale chez des malades soigneusement sélectionnés.

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Correspondence to: J.-C. Sarles     

Action of oleic acid on the exocrine pancreatic secretion of the conscious rat: evidence for an anticholecystokinin-pancreozymin factor

The effects on exocrine pancreatic secretion of an intraduodenal infusion of oleic acid (2 ml in 60 min) has been assessed in conscious rats provided with a new type of duodenal cannula permitting the normal flow of pancreatic juice, but not of bile, between experiments.

1. Intraduodenal oleic acid infusion induces an increased secretion of water and bicarbonate which is still significantly above basal values 90 min after the end of infusion. Protein output increased during the infusion, but protein concentration and output significantly decreased under basal levels 120 min and 150 min after infusion (respectively -63 and -57% of basal values at 150 min).

2. No inhibition was found when oleic acid was introduced into the caecum or into the first 20 cm of ileum isolated from the rest of small intestine. On the contrary, inhibition of protein secretion was induced immediately by intra-ileal oleic acid infusion.

3. Inhibition of protein secretion secondary to intra-ileal oleic acid infusion was transmitted from a donor rat to a receiver rat by means of a cross-circulation.

4. It is concluded that oleic acid induces an immediate and long lasting increase in water and bicarbonate secretion. During the infusion of oleic acid, protein output is increased, followed by an inhibition. This delayed inhibition stems from the second part of the small intestine and was transferred from one rat to another by cross-circulation: it is speculated that oleic acid releases in the conscious rat (from the distal part of the small intestine) a hormonal factor inhibiting pancreatic secretion.

     

Albumin, IgG and IgA in normal adult human pancreatic juice

Normal human pancreatic juice was collected by catheterisation of the main pancreatic duct in 5 adult subjects of two sexes. On these samples containing proteolytic enzymes in the zymogen form, we found and quantitated albumin, IgG and IgA by the single radial immunodiffusion technique. Albumin represents 1.26 ± 0.36% (at p< 0.05) of total proteins of pancreatic juice; IgG 0.23 ± 0.039 and IgA 0.18 ± 0.034. The albumin/IgG ratio is not significantly different from that in human serum while the albumin/IgA and IgG/IgA ratios significantly differ. This fact favours the hypothesis of a local synthesis of IgA and/or a specific excretory mechanism, however this latter seems less likely.     

Effet chez l'homme de l'interruption partielle du cycle entéro-hépatique sur les concentrations biliaires du cholestérol et des sels biliairesEffect of the partial interruption of the enterohepatic cycle on the biliary concentration of cholesterol and bile salts

The concentration of bile cholesterol (Sperry and Webb), cholic and dihydroxy-cholanic acids (reversed phase partition chromatography) was studied in 14 cholecystectomized patients with a T-tube in the common bile duct, during 9 to 23 days (9 patients with gallstones, 5 without stones). The patients were classified in:

Group 1: daily volume of drained bile 230 ml;

Group 2: daily volume of drained bile 450 ml. The age, sex distribution, duration of drainage, and daily alimentary intake were not statistically different between the two groups.

The bile cholesterol concentration (14 patients, 196 daily bile samples), the total bile salts concentration and the ratio dihydroxycholanic acids/cholic acid (8 patients, 110 daily bile samples) were very highly significantly lower in group 2 (p < 0.0005). The dihydroxycholanic acid decrease is due to a decrease of desoxycholic acid.

The ratio cholesterol/bile salts (8 patients, 186 bile samples) was very significantly higher (p < 0.0005) in group 2.

In group 1, the bile cholesterol concentration (9 patients, 119 daily bile samples) was very significantly higher (p < 0.0005) in patients with gallstones than in patients without gallstones.

In group 2, the hepatic synthesis of bile salts was increased.     

A familial form of congenital hypopituitarism due to a PROP1 mutation in a large kindred: phenotypic and in vitro functional studies

We report the natural history of a hypopituitarism in a large Tunisian kindred including 29 subjects from the same consanguineous family. The index case was a 9-yr-old girl with severe growth retardation due to complete GH deficiency and partial corticotroph, lactotroph, and thyrotroph deficiencies. Magnetic resonance imaging showed a hyperplastic anterior pituitary. Thirteen of the 28 relatives examined (10 female subjects) had hypopituitarism. In the 14 patients, previously untreated (aged 6-53 yr), height was -5.7 +/- 1.7 sd score, and puberty was spontaneously initiated in only two females. Complete GH deficiency was found in all 12 patients investigated, of whom 11 had thyrotroph and eight of 10 had corticotroph deficiency. A homozygous R73C mutation of PROP1 was present in all 10 patients studied, and a heterozygous mutation was found in six unaffected parents or siblings. In vitro the mutant had 11.5% of the transactivation capacity of the wild type and was unable to bind to a high-affinity DNA sequence. This report showed the deleterious effect of the recessive R73C mutation that affects a hot spot of the PROP1 gene and was associated with severe dwarfism, a lack of spontaneous puberty, and a high incidence of early onset of corticotroph deficiency.