Diagnosis and management of gastrinoma (Zollinger-Ellison Syndrome)
Explore the source record for details and available documents.
Cimetidine↗
Biomedical subjects
J E Clain
Publications and source records attributed to J E Clain.
Human endoscopic ultrasonography.
Conventional transcutaneous ultrasound examinations are often compromised by intervening pulmonary or bowel gas and have limited resolution. Ultrasonic probes of frequencies greater than 5 MHz, which enhance resolution, cannot be used successfully on the skin surface, because they do not penetrate deeply enough to view intraabdominal organs in most adults. To overcome these problems, we tested an ultrasonic endoscope which had a 10-MHz, 64-element linear assay, generated real-time images at resolutions of less than 1 mm, and was an integral part of a 35-mm-long and 13-mm-wide endoscopic rigid tip. Thirty-two studies were performed in 15 healthy subjects, 4 patients with pancreatic cancer and 6 patients with chronic pancreatitis, and 1 patient each with a gastric ulcer and a suspected pancreatic abscess. We demonstrated that this procedure is safe, provides high resolution real-time ultrasound visualization of the heart, aorta, spleen, pancreas, liver, gallbladder, kidneys, and gastrointestinal mucosa and can detect moderate-sized pancreatic tumors and hepatic metastases less than 1 cm in diameter. Because endoscopic visualization of gastrointestinal mucosa and ultrasound examination of extraluminal organs can be obtained during a single procedure, rapid differentiation among mucosal and intramural disease of the hollow gut and disease of extraluminal organs should be possible with this diagnostic technique.
Digestive System↗
A comparison between simple aspiration, marker correction, and marker perfusion techniques in the estimation of pancreatic function.
Results of pancreatic function tests, using simple aspiration, simple aspiration with marker correction and marker perfusion methods were compared. With simple aspiration alone, approximately one-third of the marker was not recovered. Yet with the marker correction method the volume (and consequently other measurements), appeared to be greatly overcorrected, probably owing to poor mixing of marker and endogenous secretions. In contrast, the marker perfusion method yielded data which were 8-24% higher than those for simple aspiration for the various outputs; this difference was not statistically significant. It is concluded, firstly, that marker correction of a simple aspiration technique is inaccurate because of poor mixing; secondly, that because marker perfusion methods yield arithmetically but not statistically greater outputs than simple aspirations tests, the latter are probably adequate for diagnostic tests of pancreatic function.
Carbon Radioisotopes↗
Exocrine pancreatic enzyme and calcium secretion in health and pancreatitis.
Calcium, enzyme, and total protein secretion were measured in secretin stimulated pancreatic juice in health, "early" chronic pancreatitis, and in chronic calcific pancreatitis. Increased concentrations of trypsin, total protein, and calcium, and increased outputs of calcium and protein were shown to be present in the "early" stages of the disease, indicating that an environment conducive to the formation of protein plugs and possibly later calcification already exists.
Calcium↗
In vitro neutralizing capacity of commercially available antacid mixtures, and their role in the treatment of peptic ulcer.
An in vitro technique has been used to determine the neutralizing capacity of liquid antacids. Many locally available preparations have been tested, and the results indicate that they vary strikingly in both neutralizing capacity and cost. This study re-emphasizes the place of antacids in peptic ulcer therapy.
Antacids↗
Is pancreatic duct obstruction or stricture a major cause of pain in calcific pancreatitis?
Forty-seven patients with calcific pancreatitis were submitted to ERCP, 24 of whom were designated 'painless' and 23 'painful', according to whether or not pain had occurred during the previous year. The pancreatic duct was cannulated in 39 of these patients. The incidence of pancreatic duct obstruction or stricture was of the same order in the painless (13/20, 65 per cent) and painful (15/19, 79 per cent) groups. Alcohol was the aetiological factor in 46 patients. Twenty-four (52 per cent) continued to drink, and were equally divided between the painless (12) and painful (12) groups. Four out of 13 in the painless and 7 out of 14 in the painful groups, with a stricture or obstruction, continued to drink. The difference was statistically not significant. These results suggest that ERCP findings of pancreatic duct obstruction or stricture need not necessarily be pertinent to the pain in patients with chronic pancreatitis.
Alcoholism↗
Colonoscopy in lower gastro-intestinal haemorrhage.
The value of colonoscopy in the diagnosis and management of lower gastro-intestinal haemorrhage was assessed in 107 patients who were examined during a 2-year period. The main indications were to define uncertain radiological findings, to further investigate the cause of bleeding in patients with normal barium studies and to carry out polypectomy. Radiological lesions were confirmed in 27, defined in 12, and refuted in 14 patients. Twenty-eight lesions were demonstrated on colonoscopy which were not diagnosed by barium enema or sigmoidoscopy. A diagnosis was made by colonoscopy in more than two-thirds of the patients with frank blood loss and normal radiographs. In cases of occult bleeding it was farless helpful. Colonoscopy significantly improved diagnosis and management of gastro-intestinal bleeding when the cause was in doubt after standard investigations. In addition, 37 polyps were removed through the colonoscope from 30 patients.
Gastrointestinal Hemorrhage↗
Diabetic diarrhoea and steatorrhoea. A case report and review of the literature.
A case of severe diabetic steatorrhoea is presented in a young Black male with poorly controlled diabetes, symptomatic peripheral neuropathy, evidence of autonomic neuropathy with gastroparesis and raised faecal fat excretion. A pancreatic function test was negative as were tests of small-bowel structure and function. There was resistance to all therapy. The literature on diabetic diarrhoea and steatorrhoea has been reviewed, and it is concluded that they are expressions of the same entity which remains a clinical problem for which there is at present no effective management.
Adult↗
A double-blind trial of loperamide in the treatment of chronic diarrhoea.
A new antidiarrhoeal compound, loperamide (Imodium; (Janssen) Ethnor) has been evaluated in the treatment of patients with chronic nonspecific diarrhoea. In a double-blind trial its effect was compared with that of a placebo. The results of this trial indicate that loperamide is an effective antidiarrhoeal compound.
Adolescent↗
Control of human postprandial pancreatic exocrine secretion: a function of the gastroduodenal region.
Regulation of the exocrine pancreatic secretion elicited by a meal in man is incompletely understood. In this study, we attempted to localize in the gastrointestinal tract areas that control postprandial trypsin secretion and to determine the effects of individual components of jejunal chyme on the meal-stimulated trypsin secretion. Trypsin outputs elicited by ingesting a mixed-nutrient meal and diverting it at the ligament of Treitz proximal to an occlusive balloon were compared with those occurring when the same meal was ingested, diverted at the ligament of Treitz, and immediately reinfused distal to the balloon, a procedure that exposed the entire gastrointestinal tract to chyme. Two different meals, one of semielemental and one of complex nutrients, were used with similar results. Trypsin outputs were similar whether or not jejunal chyme was diverted. In addition, no component--exogenous nutrients or endogenous secretions--of chyme reaching the jejunum after a meal further modified the trypsin secretion elicited by the gastroduodenal segment. This finding suggests that the gastroduodenal segment is sufficient to elicit the entire postprandial trypsin output and is the physiologic determinant of meal-stimulated trypsin secretion.
Adult↗
Jejunal secretion in response to a duodenal mixed nutrient perfusion.
A multilumen balloon tube constructed to separate duodenal and jejunal perfusion segments was placed in the proximal small bowel of 6 healthy volunteers. The effect of nutrient mixture in the duodenum on net jejunal water and electrolyte flux was then determined. The duodenum was perfused with a balanced electrolyte solution before and after the nutrient perfusion. Net water flux in the perfused jejunum changed from absorption 27.0 +/- 6.0 microliter/min/cm, (mean +/- SEM) to secretion 7.7 +/- 7.3 microliter/min/cm (P less than 0.025) during nutrient perfusion. There was also net chloride secretion and decreased net absorption of Na, K, and HCO3 (P less than 0.05). The jejunal absorption of water and electrolytes before and after the duodenal nutrient perfusion was the same. Results indicate that intestinal secretion may occur under physiologic conditions at sites remote to the application of food in humans.
Adult↗
The Mallory-Weiss syndrome. A prospective study in 130 patients.
The clinical features of the Mallory-Weiss syndrome were prospectively documented in 130 of 1 667 patients submitted to endoscopy for gastro-intestinal haemorrhage, an incidence of 7,8%. The important clinical features found in these patients were: alcohol abuse (21%); retching or vomiting (38%); salicylate ingestion (36%); dyspepsia (39%). The correct clinical diagnosis was therefore often difficult to make. Additional lesions were found in 40% of patients at endoscopy. Blood loss was relatively small, and surgery was not required in any patient. The 2 deaths that occurred were not attributable to haemorrhage. A high index of suspicion and early endoscopy are required to establish the diagnosis.
Adolescent↗
In vitro enzyme activity of commercially available pancreatic enzyme extracts.
An in vitro study was performed to measure the enzyme activity in commerically available preparations of pancreatic enzyme extracts. Particular attention was paid to lipase content, because lipase deficiency is the most clinically relevant enzyme deficiency. Individual preparations varied greatly with regard to enzyme content, and Cotazym and Viokase proved the most effective preparations of those tested.
Celiac Disease↗
The effect of calcitonin on secretin-stimulated pancreatic secretion in man.
The effect of calcitonin on pancreatic secretion was studied in man. After steady-state secretion had been achieved with a constant intravenous infusion of secretin (2 microgram/kg/h), either calcitonin (0,16 and 0,32 microgram/kg/h) or 0,15M NaCl was infused over a period of 80 minutes. Calcitonin did not affect pancreatic volume output or bicarbonate concentration, but amylase concentration and output were significantly inhibited (P less than 0.025). The colour index in the duodenal juice was unchanged by calcitonin. No changes were observed in blood glucose or serum calcium concentrations.
Adult↗
Glucagon inhibition of secretin and combined secretin and cholecystokinin stimulated pancreatic exocrine secretion in health and disease.
The effect of glucagon infusion on secretin and combined secretin and cholecystokinin stimulated exocrine pancreatic secretion was studied in normal subjects and in patients after acute and with chronic pancreatic disease. Glucagon inhibited pancreatic protein secretion and had no inhibitory effect on volume or bicarbonate secretion.
Acute Disease↗
Inhibitory role of the distal small intestine on the gastric secretory response to meals in man.
The role of the distal small intestine on postprandial gastric function was determined in 6 healthy volunteers by diverting chyme from the intestine at a site 100 cm distal to the ligament of Treitz and comparing the results with those observed in the same subjects when chyme was exposed to the entire gut. Diversion of chyme increased the gastric secretory response, which suggests that the distal small intestine has an inhibitory role in postprandial gastric secretion.
Adult↗
Binding properties in vitro of antacids for conjugated bile acids.
The binding properties of various commercial antacids for pure conjugated bile acids in an aqueous solution or the bile acids present in human gallbladder bile were characterized. Aluminum hydroxide was a potent binding agent, similar in affinity and capacity to cholestyramine. With aluminum hydroxide, dihydroxy bile acid conjugates were bound more strongly than trihydroxy bile acid conjugates, and glycine conjugates were bound more strongly than taurine conjugates; pH had no effect per se on binding. Magnesium hydroxide and aluminum phosphate bound bile acids much more weakly. Aluminum hydroxide warrants exploration in therapeutic situations in which bile acid binding is sought.
Aluminum↗
Participation of the jejunum and ileum in postprandial gastric secretion in man.
The role of the small intestine in postprandial gastric secretory function was determined in 6 normal volunteers by diverting chyme at the ligament of Treitz and comparing the results with those obtained in the same individuals when chyme was exposed to the entire small intestine. Because diversion of chyme caused a lesser gastric secretory response, it is concluded that the small intestine contributes appreciably to the magnitude of gastric secretory responses to meals.
Adult↗