Biomedical subjects

E Kivilaakso

Publications and source records attributed to E Kivilaakso.

At least 109 records · Page 6Linked to original sources

PubMed1987

Papillary cystic tumor of the pancreas. An analysis of cellular differentiation by electron microscopy and immunohistochemistry.

Three cases of clinically benign pancreatic papillary cystic tumors in young female patients were studied by immunohistochemistry and electron microscopy in order to define the cellular nature of this type of neoplasm. Two of the tumors showed focal cytokeratin- and desmoplakin-positivity as evidence of focal epithelial differentiation, while the tumor cells were in all cases positive for vimentin--the intermediate filament protein typical of (but not specific for) mesenchymal cells. Electron microscopy showed some cell-cell junctions, but there was no evidence of acinar or islet cell differentiation. The tumors were at least focally positive for neuron-specific enolase, and small clusters of polypeptide hormone immunoreactive cells were present in all cases (glucagon 3/3, somatostatin 2/3, insulin 2/3). However, the tumors were negative for synaptophysin and neurofilament proteins, unlike most islet cell tumors. Trypsin and chymotrypsin immunoreactivity was found in all tumors, but because many nonpancreatic carcinomas were also positive, we doubt whether these two enzyme proteins can act as specific markers for pancreatic acinar cell differentiation. Two of the tumors that were studied immunohistochemically for the presence of nuclear estrogen receptors, were negative. Therefore no proof of the suggested hormone dependence of this tumor could be obtained. We conclude that papillary cystic tumor is a neoplasm of primitive pancreatic epithelial cells, that may exhibit focal endocrine cell differentiation.

Adult↗

PubMed1986

Results of sphincteroplasty in patients with spastic sphincter of Oddi. Predictive value of operative biliary manometry and provocation tests.

The predictive value of different preoperative provocation tests and operative biliary manometry was studied in a series of 22 patients undergoing sphincteroplasty for suspected spastic sphincter of Oddi (SPO). The result of the operation was good in 59%, 54%, and 71% of patients in groups with a positive codein test, a positive endoscopic retrograde cholangiopancreatography filling pain sign, and positive fentanyl test, respectively. Common bile duct pressure (CBDP) did not differ significantly between the SPO spasm group and control patients, but in the fentanyl test the CBDP elevation was significantly higher (p less than 0.01) than in controls (7.7 versus 3.3 mm Hg). It was concluded that the operative fentanyl test seems to be useful in predicting the response to surgery (sphincteroplasty) in patients with post-cholecystectomy biliary-type pain and suspected SPO spasm.

Adult↗

PubMed1986

Effects of dextran 70 versus crystalloids in the microcirculation of porcine hemorrhagic pancreatitis.

The cause of hemodynamic changes occurring during acute pancreatitis remains obscure. Using a pig model of acute hemorrhagic pancreatitis and the reference sample method with 113Tin and 46 Scandium labelled microspheres, blood flow to organs was determined before and five hours after the induction of pancreatitis. Blood pressure, pulse rate and cardiac output were measured hourly. There were two treatment groups. The first group received dextran 70 (5.7 milliliters per kilogram per hour) and saline solution (7.5 milliliters per kilogram per hour) in sufficient amounts to maintain cardiac output at the initial (prepancreatic) level. The second group received saline solution (26 milliliters per kilogram per hour) only and during the experiment the cardiac output was allowed to decrease to approximately one-half of the initial level. In the dextran 70 group, blood flow in various organs stayed at the initial level or was slightly increased. However, in the saline solution group there was a marked and significant decrease in the blood flow in all organs except the antral mucosa, gallbladder and adrenal glands. The changes in the pancreatic fraction of the cardiac output during the experiment were similar to those of other organs in respective treatment groups. In conclusion, adequate infusion of dextran maintains cardiac output and organ microcirculation at the initial level during the early phase of acute hemorrhagic pancreatitis. It is suggested that the hemodynamic changes which develop during acute pancreatitis are mainly secondary to the ensuing hypovolemia and not direct consequences of the pancreatic inflammatory process.

Animals↗

PubMed1986

Gastroduodenal mucosal secretion of bicarbonate and mucus: physiological control and role in protection.

Bicarbonate secretion by the surface epithelium in the stomach and duodenum maintains a near neutral pH in the mucus gel adherent to the surface in spite of acidities as high as pH 2.0-3.0 in the gastric and pH 1.5-2.0 in the duodenal lumen. This strongly suggests that the alkaline secretion together with the mucus gel provides a first line of protection in the stomach and this may be the main mechanism of defense in the duodenum. The secretion is increased by physiological stimuli such as sham-feeding or the presence of acid in the lumen. Mucosal endogenous production of prostaglandins as well as humoral and neural mechanisms are involved in the control of the secretion.

Animals↗

PubMed1985

Partial gastrectomy with Roux-en-Y reconstruction in the treatment of persistent or recurrent oesophagitis after Nissen fundoplication.

The results of partial gastrectomy with Roux-en-Y reconstruction in the treatment of persistent or recurrent oesophagitis after failed Nissen fundoplication in six patients were analysed. There were no postoperative deaths. Postoperative complications (pneumonia and atelectases, postoperative ileus) developed in three patients. The results were evaluated by clinical and endoscopic examination 1 to 3.5 years after the operation. Clear clinical and endoscopic improvement was observed in five of the six patients. In the remaining patient the procedure failed to prevent progression of the oesophagitis with development of a Barrett's oesophagus. The results suggest that a partial gastrectomy with Roux-en-Y reconstruction is an effective and safe procedure in the treatment of persistent or recurrent oesophagitis after failed Nissen fundoplication.

Aged↗

PubMed1985

Gastroduodenal bicarbonate secretion in mucosal protection. Possible role of vasoactive intestinal peptide and opiates.

HCO3- secretion by surface epithelium in duodenum devoid of Brunner's glands was titrated in situ in anesthetized rats. Intravenous injection of small amounts (20 ng/kg) of the endogenous opioid peptide beta-endorphin significantly increased secretion. Naloxone prevented this effect, suggesting that stimulation is mediated by mu-opiate receptors. Morphine 50 microgram/kg had a similar stimulatory action. Vasoactive intestinal peptide (VIP) 0.5-100 microgram/kg dose-dependently increased secretion and this response was independent of simultaneous cholinergic stimulation. The HCO3- secretion maintained pH in the mucus gel adherent to the luminal surface at neutrality for long periods of time (greater than or equal to 60 min); even when the pH in the terminal bulk solution was as low as 2.0. Mucosal HCO3- secretion is thus very probably important in mucosal protection and VIP and endogenous opioid peptides may have a role in its control.

Animals↗

PubMed1985

Cysteamine and propionitrile inhibit the rise of duodenal mucosal alkaline secretion in response to luminal acid in rats.

Effects of subulcerogenic doses of cysteamine (100 mg/kg s.c.) and propionitrile (5 mg/kg) on alkaline secretion by duodenal surface epithelium and pH at the surface of this mucosa were assessed in duodenum of anesthetized rats. Alkaline secretion was titrated in situ, using segments of duodenum just distal to the Brunner's glands area and devoid of pancreatic HCO3-. Surface pH was measured by advancing pH-sensitive microelectrodes from the luminal solution to the epithelial cell surface. Proximal duodenum from bullfrogs was used to study effects of cysteamine on alkaline secretion in vitro. Cysteamine caused an increase in alkaline secretion in the rat during the first hour after administration, but rates after 5 and 20 h were the same as in controls and cysteamine (1 mg/ml) had no effect on secretion in vitro. Neither in vitro nor in vivo did cysteamine affect the rise in alkaline secretion in response to exogenous prostaglandin E2 (and dibutyryl-cyclic adenosine monophosphate). Luminal acid is a potent stimulant of duodenal mucosal alkaline secretion. By delayed (5 h) actions, both cysteamine and propionitrile inhibited the rise in alkaline secretion in response to a 5-min exposure to luminal acid with pH 2.00 in the rat. Cysteamine also depressed the ability of this mucosa to maintain a high rate of alkaline secretion during sustained exposure at pH 2.00 but had no such effect at pH 5.00. The former resulted in acidification of the pH gradient at the mucosal surface. Cysteamine is thus probably without effect on the HCO3- secretory process itself but impairs the ability of the duodenal mucosa to respond to acid. Inhibition of mechanisms mediating this response may contribute to the duodenal ulcerogenic actions of cysteamine and propionitrile.

2,4-Dinitrophenol↗

PubMed1985

Pancreatic blood flow and contrast enhancement in computed tomography during experimental pancreatitis.

The pancreatic blood flow and contrast enhancement in computed tomography (CT) were studied in 10 piglets weighing 17-25 kg with experimental pancreatitis. Each animal served as its own control. CT and blood flow measurements were made both before induction of pancreatitis and 5-6 h after the onset of the disease. Cardiac output was measured by thermodilution, and was kept constant throughout the study by infusion of dextran and saline. Although the pancreatic blood flow remained constant in this experiment, CT showed a significant decrease in contrast enhancement.

Animals↗

PubMed1985

Pathogenetic mechanisms in experimental gastric stress ulceration.

The studies reviewed suggest that the presence of luminal acid is essential for acute gastric stress ulceration to occur and that acid promotes ulceration by diffusing into the mucosa in an ulcerogenic situation. Disruption of the mucosal barrier by the presence of e.g. intragastric bile salts, aspirin, or ethanol increases the hydrogen ion back diffusion, thereby increasing the susceptibility of the mucosa to ulceration. Such a disruption is presumably needed for development of ulcerations in species with a "tight" gastric mucosa, such as the dog, the pig and man, whereas in species with a "leaky" mucosa, such as the rabbit or rat, ulceration occurs even without these agents. However, the response of the mucosa to hydrogen ions is not uniform. Luminal acidities and rates of hydrogen ion back diffusion that are normally harmless may in certain situations cause severe damage to the mucosa. Thus, the ability of the mucosa to withstand the influxing hydrogen ions is as important as the absolute amount of hydrogen ions diffusing into the mucosa. If the rate of hydrogen ion back diffusion exceeds the ability of the mucosa to dispose of hydrogen ions, acidification of the mucosa occurs, with resultant breakdown of the tissue. The main factors modulating the response of the mucosa to hydrogen ions are availability of bicarbonate in the mucosa and the mucosal blood flow. Bicarbonate contributes to mucosal protection through secretion by the epithelium to form an "alkaline" buffer layer at the epithelial surface, which seems to act as a "firstline" defence mechanism against the influxing hydrogen ions.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1985

Significance of extrapancreatic findings in computed tomography (CT) of acute pancreatitis.

Computed tomography (CT) has proven reliable in the early detection of acute haemorrhagic pancreatitis. In the present study the extrapancreatic changes at CT were studied in 60 patients with acute pancreatitis. The CT findings were correlated to the early "prognostic signs" by Ranson and the clinical course of the disease. All the patients with minor extrapancreatic changes recovered without complications. When moderate to severe extrapancreatic changes were seen the incidence of haemorrhagic pancreatitis and the risk of development of pseudocyst or abscess was high. In these patients a dynamic contrast enhanced CT should be done in order to select the patients with haemorrhagic pancreatitis.

Acute Disease↗

PubMed1984

A new method for the diagnosis of acute hemorrhagic-necrotizing pancreatitis using contrast-enhanced CT.

Twenty-eight consecutive patients with a first attack of alcohol-induced pancreatitis were studied using contrast-enhanced CT. The findings on CT were then related to the course of the disease. The patients with acute hemorrhagic-necrotizing pancreatitis showed significantly lower enhancement values of the pancreatic parenchyma than those with milder forms of the disease. The next 20 patients with severe pancreatitis were scanned using a slightly modified procedure. The enhancement values were calculated and plotted on the graphs for the 2 former groups. Two categories of pancreatic enhancement were found: "low enhancement" and "high enhancement." In all 10 patients with "low-enhancement" values surgery revealed hemorrhagic-necrotizing pancreatitis. In the 10 patients with "high-enhancement" values conservative treatment was continued, and the clinical course was nonfulminant in all of them.

Acute Disease↗

PubMed1984

Pancreatic resection versus peritoneal lavation for acute fulminant pancreatitis. A randomized prospective study.

Thirty-five patients with acute fulminant (hemorrhagic) pancreatitis, verified at laparotomy, were allocated to either pancreatic resection (18 patients) or peritoneal lavation (17 patients) therapy groups. Pancreatic resection was carried out by removing the distal pancreas well cephalad to the portal vein. For peritoneal lavation, two inlet silicone catheters were inserted at laparotomy around the pancreas and an outlet catheter was inserted in the lower abdomen, and the peritoneal cavity was thereafter lavated (1000 ml/hr) with a standard peritoneal dialysis fluid for 7 to 12 days (or until death if met earlier). In other respects, the postoperative care was similar, including intravenous fluids with total parenteral nutrition until oral intake of food was resumed, prophylactic antibiotics (tobramycin and clindamycin) and stress ulcer prophylaxis (cimetidine and antacids). In the resection group, four of the 18 patients (22.2%) died, while in the lavation group eight of the 17 patients (47.1%) died. The most common cause of death was septic complications with multiple organ failure, but one patient in each group died accidentally of airway complications. There was no difference in the incidence of septic complications (sepsis and/or intra-abdominal abscesses), but the incidence and severity of pulmonary and renal complications were greater in the lavation group. However, these complications accumulated to patients who ultimately died. Also, the need for reoperation was greater in the lavation group (20 reoperations/10 patients versus 12 reoperation/eight patients). Yet, the length of overall hospital stay was equal in the two groups. Six of the 14 survivors in the resection group developed diabetes, whereas none of the nine survivors in the lavation group got this complication. The results suggest that pancreatic resection is superior to peritoneal lavation in the management of acute fulminant (hemorrhagic) pancreatitis, decreasing mortality and affording smoother postoperative course. However, these benefits are gained at the expense of higher incidence of postoperative diabetes.

Acute Disease↗

PubMed1984

Endotoxaemia and acute pancreatitis: correlation between the severity of the disease and the anti-enterobacterial common antigen antibody titre.

Enterobacterial common antigen is a highly immunogenic component of the Gram negative bacterial cell wall that is common to all enteric bacteria. In the present study, the humoral antibody response against enteric bacteria was investigated by measuring antibodies to enterobacterial common antigen in paired serum samples in 38 patients with acute pancreatitis and in 31 healthy subjects. In mild pancreatitis (11 patients), no changes in anti-enterobacterial common antigen titres were observed as compared with healthy controls. Nine of the 10 patients had a significant increase (greater than or equal to 8 times) in anti-enterobacterial common antigen titres during the disease. Similarly, in patients with fulminant (haemorrhagic) pancreatitis who survived, a significant increase in anti-enterobacterial common antigen titres occurred during the course of the disease (in nine of the 11 patients). Paradoxically, only one of the six patients with fulminant pancreatitis with fatal outcome showed a significant increase in his anti-enterobacterial common antigen titre. The results suggest that Gram negative bacterial components escape into the systemic circulation in acute pancreatitis. This may have pathophysiologic significance in this disease.

Abscess↗

PubMed1984

Acute haemorrhage associated with pancreatic pseudocyst and chronic pancreatitis.

The present study reports 18 patients operated on for chronic pancreatitis complicated by bleeding in the upper gastrointestinal tract, the peritoneal cavity or the retroperitoneal space. Damage to the splenic artery by a pancreatic pseudocyst was the most common reason for the bleeding (10 patients, 56%) and the most common site was the duodenum (10 patients, 56%). Eleven patients were treated by transcystic multiple suture ligations combined with external drainage of the pseudocyst, and seven by pancreatic resection or total pancreatectomy. Hospital mortality was 33% (6 patients); two patients had undergone transcystic suture ligation, and four pancreatic resection. Five patients needed a reoperation because of further bleeding, four of them having been treated initially by transcystic suture ligation. Our results suggest that haemostasis by suture ligation is a method to be recommended if the patient's condition has been exacerbated by severe haemorrhage.

Adult↗

PubMed1984

Stimulation by BW755C and inhibition by cysteamine of duodenal epithelial alkaline secretion suggest a role of endogenous prostaglandin in mucosal protection.

Alkaline secretion by 12 mm segments of duodenum just distal to the Brunner's glands area was titrated in situ in anesthetized rats. Intravenous injection of the lipoxygenase inhibitor BW755C (10-20 mg/kg) increased the surface epithelial HCO3- secretion and pretreatment with indomethacin prevented this effect. This supports the view that endogenous production of prostaglandins is important in control of duodenal epithelial HCO3- secretion and ulceroprotection . Pretreatment with cysteamine (100 mg/kg) inhibited the ability of the duodenal surface epithelium to respond to luminal acid with a compensatory rise in alkaline secretion. Measurement of pH at the mucosal surface with microelectrodes revealed that acidification of this surface occurred simultaneously with the decline in alkaline secretion.

4,5-Dihydro-1-(3-(trifluoromethyl)phenyl)-1H-pyraz↗

PubMed1984

The clinical significance of contrast enhanced computed tomography in acute pancreatitis.

58 patients with alcohol-induced acute pancreatitis were studied by contrast enhanced computed tomography (CT). The patients were divided into groups both on the basis of the clinical course and the prognostic signs. The contrast enhancement curves were then plotted for these patients. All patients with uncomplicated pancreatitis had increased or normal contrast enhancement, whereas all those with fulminant pancreatitis had decreased contrast enhancement of the pancreas. The patients with three, or more prognostic signs had lower enhancement values than those with fewer prognostic signs, but the prognostic signs did not correlate as well with the clinical course as did the contrast enhancement.

Acute Disease↗

PubMed1984

Contribution of trypsin and cholate to the pathogenesis of experimental alkaline reflux esophagitis.

Previous studies suggest that trypsin and bile salts are the causative agents in alkaline reflux esophagitis. However, their individual effects on the esophageal mucosa is relatively weak when used alone. Since these agents seem to have different sites of action in the esophageal mucosa, we have investigated whether they might have a synergic action when used in combination. Rabbit esophagus was perfused in situ with a test solution containing trypsin and cholate, alone or in combination, at pH 7.0. The severity of mucosal damage was assessed, using as indicators of mucosal integrity transmucosal potential difference, net flux of Na+, and mucosal permeability to two neutral molecules of different sizes, 3H-H2O and 14C-erythritol. Cholate (in its conjugated and deconjugated form) was chosen as the bile salt test agent, because it is quantitatively important but almost inert on the esophageal mucosa when used alone. The results indicate that trypsin significantly decreased potential difference and increased mucosal permeability to Na+, 3H-H2O and 14C-erythritol. Cholate and taurocholate had no influence on the mucosa when used alone, but cholate, especially in its deconjugated form, increased significantly mucosal damage caused by trypsin. The findings suggest that trypsin and bile salts do have a synergic effect on esophageal mucosa, which may have pathogenetic significance in clinical alkaline reflux esophagitis.

Animals↗

PubMed1984

Effect of cimetidine on HCl-taurocholate-induced esophageal mucosal injury.

The effect of the histamine H2-receptor antagonist, cimetidine, on the resistance of esophageal mucosa was investigated in an experimental model of acute esophagitis. Esophagitis was induced by perfusing an isolated segment of rabbit esophagus in situ with a solution containing HCl and taurocholate, with or without pretreatment with cimetidine (10 mg/kg and 100 mg/kg i.m.). The degree of esophageal mucosal integrity changes in transmucosal potential difference as well as mucosal permeability to H+, Na+ and two neutral molecules of different sizes, 3H-H2O and 14C-erythritol. The gross mucosal damage was also estimated. The results indicated that cimetidine in the larger dose (100 mg/kg) significantly diminished the permeability changes in esophageal mucosa induced by exposure to HCl-taurocholate, thus seeming to enhance the resistance of that mucosa against damage. In contrast, the smaller dose (10 mg/kg) did not significantly modulate the permeability changes induced by HCl-taurocholate. It is concluded that, although high doses of cimetidine seem to have a direct protective action on esophageal mucosa, the beneficial influence of therapeutic cimetidine dose given for clinical esophagitis is mainly mediated by its antisecretory action.

Animals↗