Risk and genetic factors in pancreatic cancer.
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Beverages↗
Biomedical subjects
L Gullo
Publications and source records attributed to L Gullo.
Plasma cholecystokinin and neurotensin after an ordinary meal in humans. A prolonged time study.
BACKGROUND/AIM: Ingestion of a meal causes the release of cholecystokinin and neurotensin into the circulation, but little is known about the duration of this release. METHODS: Six healthy volunteers were studied. Blood samples for cholecystokinin, neurotensin and gastrin assessment were drawn before and after consumption of a typical Italian lunch. Postprandial samples were obtained every hour for a total of 10 hours. All peptides were measured using previously validated radioimmunoassays. RESULTS: Ingestion of the meal caused a prompt and significant increase in plasma levels of all three peptides. Cholecystokinin remained elevated for about 7 hours and then tended to return towards basal values, whereas the increase of neurotensin persisted for the entire period of the study (10 hours). Gastrin remained elevated for about 5 hours and then declined. The integrated CCK and gastrin responses during the initial postprandial hours were greater than those in the late hours, whereas the integrated neurotensin response during the initial hours was lower than that in the late hours. CONCLUSIONS: The results indicate that, after an ordinary meal, cholecystokinin is released into the circulation for about 7 hours, much longer than previously reported (3-4 hours). The release of neurotensin begins soon after the meal and persists even longer, for at least 10 hours. Possible physiological implications of these findings are discussed.
Adult↗
Serum pancreatic enzymes in patients with coma due to head injury or acute stroke.
Serum amylase and lipase were measured in 32 patients with cerebral ischemia, 19 with spontaneous cerebral hemorrhage, 15 with head injury and intracranial bleeding, and 22 with head injury without intracranial bleeding; 20 healthy subjects were also studied as controls. Serum pancreatic isoamylase concentrations were assayed in hyperamylasemic sera. The overall incidence of hyperamylasemia was 14% (12 of 88 patients: 4 with cerebral ischemia, 4 with spontaneous cerebral hemorrhage, 1 with head injury and intracranial bleeding, and 3 with head injury without intracranial bleeding). In 4 of the 12 patients the hyperamylasemia was of pancreatic origin: 1 patient with cerebral ischemia, 1 patient with spontaneous cerebral hemorrhage, 1 patient with head injury and intracranial bleeding, and 1 patient with head injury without intracranial bleeding. The incidence of hyperlipasemia was 7% (6 of the 88 patients: 1 patient with cerebral ischemia, 2 with spontaneous cerebral hemorrhage, and 3 with head injury without intracranial bleeding). We conclude that hyperamylasemia is more frequent than hyperlipasemia in patients with an altered state of consciousness due to head injury or stroke and is usually of non-pancreatic origin. This knowledge may save these patients from invasive and costly examinations.
Acute Disease↗
Faecal elastase 1 in children with cystic fibrosis.
UNLABELLED: Recently, a new ELISA kit for determination of elastase 1 in faeces has become commercially available. Studies in patients with chronic pancreatitis have indicated that it is a simple and sensitive test of exocrine pancreatic function. The aim of this study was to assess the clinical value of this new test in cystic fibrosis. A total of 72 children were studied: 27 who were healthy, 22 with cystic fibrosis and 23 with non-pancreatic disorders. Oral pancreatic extracts were not discontinued in the children with cystic fibrosis. A small sample of faeces was collected from each subject for elastase 1 concentration and chymotrypsin activity determination. In all of the healthy children and most of those with non-pancreatic disorders (20/23), elastase 1 concentrations were greater than 500 microg/g; in contrast, the vast majority (20/22) of children with cystic fibrosis had very low values (less than 20 microg/g). The differences between children with cystic fibrosis and the other two groups were highly significant (P < 0.001). With a cut-off level of 132 microg/g, the sensitivity and specificity of faecal elastase 1 for the determination of exocrine pancreatic insufficiency were 96% and 100%, respectively. The specificity of faecal chymotrypsin was 96%, but its sensitivity was not calculated since the children with cystic fibrosis continued to take pancreatic extracts during the study. CONCLUSION: The determination of faecal elastase 1 concentration is a simple and reliable means of assessing exocrine pancreatic function in children with cystic fibrosis. Results are not influenced by non-pancreatic disorders or by enzyme supplementation.
Adolescent↗
Pancreatitis and the risk of pancreatic cancer.
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Humans↗
Tolerability and safety of the long-term administration of pancreatic extracts.
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Adolescent↗
Clinical value of pancreatitis-associated protein in acute pancreatitis.
OBJECTIVES: Pancreatitis-associated protein (PAP) is a secretory protein that is overexpressed by the pancreas during acute pancreatitis. This study was carried out to assess the clinical value of PAP in acute pancreatitis, particularly its ability to indicate the severity of the disease. METHODS: Twenty-one healthy subjects, 58 patients with acute pancreatitis, and 20 patients with nonpancreatic acute abdomen were studied. In addition to serum PAP concentration, serum concentrations of amylase, lipase, and C-reactive protein (CRP) were measured at admission and, in patients with acute pancreatitis, during the following 5 days. RESULTS: On admission, serum PAP concentrations were abnormally high in 46 of the 58 patients with acute pancreatitis (79%); serum amylase, in 57 patients (98%); serum lipase, in all patients (100%); and serum CRP, in 40 patients (69%). During the subsequent days of the study, PAP and CRP tended to increase, whereas amylase and lipase decreased. No significant differences in PAP or amylase and lipase concentrations were found between patients with mild pancreatitis and those with severe pancreatitis during the entire study period, whereas from the third day to the sixth day, CRP concentrations were significantly higher in patients with severe pancreatitis than in those with mild pancreatitis. Among the 20 patients with nonpancreatic acute abdomen, PAP concentrations were abnormally high in 10 (50%), whereas amylase concentrations were abnormally high in five (25%), and lipase concentrations were high in two (10%). CONCLUSIONS: Our results indicate that the clinical value of PAP in acute pancreatitis is quite limited and, in particular, that PAP is not a useful marker for determining the severity of the disease.
Abdomen, Acute↗
Risk of pancreatic cancer associated with cholelithiasis, cholecystectomy, or gastrectomy.
Current data regarding an association between cholelithiasis, cholecystectomy, or gastrectomy and pancreatic cancer are conflicting. We evaluated the frequency with which these factors were present in 720 patients with newly diagnosed pancreatic cancer and in 720 matched controls. All subjects were interviewed personally and in detail about their clinical history. Cholelithiasis was present in 126 patients with pancreatic cancer (17.5%) and in 95 controls (13.2%), constituting a statistically significant association (odds ratio, 1.39; 95% confidence interval, 1.04-1.86); however, considering only the patients and controls in whom the diagnosis of cholelithiasis was made more than one year before cancer diagnosis or interview, the association was no longer significant (odds ratio, 1.04; 95% confidence interval, 0.75-1.44). Cholecystectomy had been performed in 93 patients with pancreatic cancer (12.9%) and in 71 controls (9.9%). When all subjects were considered, the odds ratio was mildly, although not significantly, increased (odds ratio, 1.35; 95% confidence interval, 0.97-1.87); when only subjects who underwent cholecystectomy one year or more before the cancer diagnosis or interview were considered, the odds ratio fell to unity. Gastrectomy had been performed in 28 patients with pancreatic cancer (3.9%) and in 25 controls (3.5%); analysis revealed no significant association between these two factors (odds ratio, 1.14; 95% confidence interval, 0.64-2.05). In conclusion, our study, one of the largest on this topic, has found no evidence for an association between cholelithiasis, cholecystectomy, or gastrectomy and pancreatic cancer.
Adult↗
Effects of ischemia on the human pancreas.
BACKGROUND & AIMS: Patients undergoing cardiac surgery frequently have pancreatic damage; several factors, including tissue hypoperfusion, have been implicated. The aim of this study is to better understand the effects of decreased blood supply on human pancreas. METHODS: Twenty-one consecutive patients undergoing surgery for thoracic or thoracoabdominal aortic aneurysm were studied. During surgery, the descending thoracic aorta was cross-clamped for a mean of 44 minutes (range, 15-85 minutes). Effects of the resultant pancreatic ischemia were assessed by examining the patients daily for evidence of acute pancreatitis for at least 20 days after surgery and by determining serum concentrations of amylase, pancreatic isoamylase, and lipase before clamping the aorta and at varying intervals after its release (1, 2, and 6 hours during the first day and once daily for the following 6 days). RESULTS: One patient died of acute necrotizing pancreatitis. None of the others had symptoms of pancreatitis postoperatively, but all showed a significant increase in serum pancreatic enzyme concentrations soon after declamping; this peaked about 24 hours later and persisted for all 7 days of the study. A significant relationship was found between the increase in pancreatic enzyme concentrations and the aortic clamping time. CONCLUSIONS: Acinar cell injury is a constant, rapidly appearing consequence of severe pancreatic ischemia, even that of brief duration; acinar cell injury is usually subclinical but may also present as severe acute pancreatitis.
Aged↗
Chronic pancreatitis and pancreatic cancer.
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Chronic Disease↗
Chronic nonpathological hyperamylasemia of pancreatic origin.
BACKGROUND & AIMS: Pancreatic hyperamylasemia is usually an expression of pancreatic disease. This study describes pancreatic hyperamylasemia in the absence of pancreatic disease. METHODS: Eighteen subjects with this form of hyperamylasemia were referred to our unit from January 1987 to June 1991. Amylase and pancreatic isoamylase as well as serum lipase and trypsin concentrations were determined, and ultrasonography and computed tomography were performed in all patients. After initial evaluation, they were seen annually for clinical assessment, ultrasonography, and serum enzyme determination until December 1995. At the final evaluation, all underwent a pancreatic function study. RESULTS: In 14 of the 18 subjects, all enzyme levels assessed were abnormally elevated; in 3 subjects, all but the lipase level were abnormally elevated, and in the remaining subject, all but the trypsin level were abnormally elevated. The increase over the upper normal limit was in the range of 1.4-4.1-fold for amylase, 1.8-6-fold for pancreatic isoamylase, 1.5-7.7-fold for lipase, and 1.6-13.9-fold for trypsin. During follow-up, enzyme concentrations remained elevated, although wide fluctuations and occasional transient normalization were observed. No subjects had evidence of pancreatic disease either at initial evaluation or during follow-up. CONCLUSIONS: This is the first detailed description of chronic nonpathological pancreatic hyperamylasemia as a distinct entity. The reasons for this enzyme alteration are unknown.
Adult↗
Diagnostic value of the amino acid consumption test in pancreatic diseases.
The amino acid consumption test (AACT) has been proposed as a simple tubeless test of pancreatic function, but studies of its diagnostic accuracy have produced conflicting results. Eighty-three consecutive patients with clinical suspicion of pancreatic disease underwent pancreatic stimulation for 1 h with an intravenous infusion of cerulein (50 ng/kg/h); the total plasma amino acid concentration was measured at -15, 0, 30, 45, and 60 min of infusion. The maximal percentage decrease in plasma amino acid concentration during cerulein infusion was taken as an index of pancreatic function. In addition, patients had pancreatic function assessed with the pancreolauryl test (PLT). Of the 83 patients studied, 24 were found to have chronic pancreatitis and four pancreatic cancer; the remaining 55 had various nonpancreatic digestive disorders. Pancreatic function, as assessed by the PLT, was impaired in 22 of the 28 patients with pancreatic diseases, and it was normal in all but four patients with nonpancreatic disorders. Cerulein infusion caused a decrease in total plasma amino acid concentration that was generally more pronounced in patients with nonpancreatic diseases (maximal percentage decrease: median, 14%; range, 4-28%) than in those with pancreatic diseases (maximal percentage decrease: median, 9%; range, 0-21%) (p < 0.001). Using a cutoff of a 14% amino acid decrease, the sensitivity of the AACT was 89% and the specificity 53% (diagnostic accuracy, 65%); with a cutoff of 12%, the sensitivity was 75% and the specificity 69% (diagnostic accuracy, 71%). The sensitivity of the PLT was 79% and the specificity 93% (diagnostic accuracy, 88%). The results indicate that the sensitivity of the AACT is relatively high, but they show that the specificity is low, making the test unsuitable for clinical use, at least in its present form.
Amino Acids↗
An unusual case of chronic pancreatitis of possible immune origin.
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Adult↗
Somatostatin analogues and exocrine pancreatic secretion.
Subcutaneous injection of 50 micrograms octreotide before a meal can almost totally prevent the increase in exocrine pancreatic secretions caused by the meal. Octreotide inhibits plasma amino acid uptake by pancreatic acinar cells, and thus synthesis of pancreatic enzymes. This effect has clinical potential.
Animals↗
Pericardial effusion and left ventricular function in acute pancreatitis.
OBJECTIVES: To establish the prevalence of pericardial effusion and to evaluate left ventricular function in patients with acute pancreatitis. METHODS: Twenty-one consecutive acute pancreatitis patients were studied. In 15 patients, the pancreatitis was of biliary origin and was attributable to other causes in the remaining six; eight patients had severe pancreatitis and 13 a mild disease. Using M-mode and B-mode echocardiography, pericardial effusion and left ventricular function were evaluated in all of the patients within 48 h of pain onset. All patients underwent an electrocardiogram and a standard chest x-ray. In 12 patients, the same parameters were evaluated 1 month after clinical recovery. Twenty healthy subjects, comparable for sex and age, have been studied as controls. RESULTS: Left ventricular function was similar in patients with acute pancreatitis and in healthy subjects; it was also similar both in patients with biliary and nonbiliary pancreatitis as well as in patients with severe pancreatitis and in those with mild disease. In the 12 patients in whom echocardiography was performed on hospital admission and one month after clinical recovery, no changes of left ventricular function were observed. Two patients with a mild form and one with a severe disease had pericardial effusion. One patient had negative T waves at electrocardiogram and an apical asynergy at echocardiography; these alterations disappeared after recovery. Chest x-ray revealed pleural effusion in seven patients with severe pancreatitis, whereas no alterations of cardiac silhouette were found. Acute abdominal fluid collections were also detected in seven of eight patients with severe pancreatitis, by contrast-enhanced computed tomography. CONCLUSIONS: The presence of pericardial effusion or left ventricular asynergy may be observed occasionally at echocardiography in acute pancreatitis patients; these findings, in contrast to the presence of pleural and abdominal effusions, seem to be unrelated to the severity of the disease.
Acute Disease↗
Increased prevalence of aortic calcification in chronic pancreatitis.
OBJECTIVES: The seemingly frequent radiological observation of aortic calcification in patients with chronic pancreatitis seen in our clinic prompted us to assess the prevalence of this lesion in this disease. METHODS: Fifty-seven consecutive patients with chronic pancreatitis (52 male, five female; mean age 44.2 yr, range 26-59 yr), and 66 healthy controls, matched for sex and age, were studied. Of the 66 controls, 40 were both smokers and drinkers, as were most of the patients. The presence of aortic calcification was determined by performing anteroposterior and lateral radiograms of the prelumbar region. RESULTS: Radiological evidence of aortic calcification was found in 35 of the 57 patients with chronic pancreatitis (61.4%) and in 12 of the 40 smoker control (30.0%) (p < 0.005); none of the nonsmoker controls had aortic calcification. The increased frequency was more pronounced among the patients under 50 yr of age (40.0% vs. 0% and 70.4% vs. 35.3% in the 30-39 and 40-49 yr age groups, respectively). No significant differences in serum levels of cholesterol and triglycerides, blood pressure, alcohol, and smoking habits were observed between chronic pancreatitis patients with aortic calcification and those without, or between patients with aortic calcification and controls. CONCLUSIONS: The results indicate that patients with chronic pancreatitis have a significantly higher prevalence of aortic calcification than controls. The reason for the increased prevalence of this advanced atherosclerotic lesion is nuclear.
Adult↗
[The risk factors for pancreatic cancer].
This review summarises the current state of knowledge regarding the risk factors for pancreatic cancer. Of all the factors studied, only smoking is well established. Excessive dietary fat and protein may increase the risk, but this has not been proven conclusively. Fruits and vegetables, on the other hand, may offer a protective effect. The role of coffee remains controversial. There is no concrete evidence that alcohol, tea, occupational exposure, diabetes, gallstones, cholecystectomy or gastrectomy are significantly associated with this tumour. A possible predisposing role for chronic pancreatitis cannot be excluded.
Adult↗
Unusual association of macroamylasemia and hyperlipasemia: report of two cases.
OBJECTIVE: To describe two cases of macroamylasemia associated with hyperlipasemia. METHODS AND RESULTS: The patients were a young male soccer player who had sustained a kick in the groin during a match and a woman with a specific dyspeptic complaints. In both the macroamylasemia had been previously undetected; when admitted with the above complaints, serum pancreatic isoamylase levels, as determined by the inhibitor method, were markedly increased, as were serum lipase levels. In both cases these findings led to the erroneous diagnosis of pancreatitis and consequent multiple diagnostic and therapeutic procedures. The cause of the hyperlipasemia was not clear in either case, although the possibility that it was due to the presence of macrolipase cannot be excluded. CONCLUSION: The possibility of macroamylasemia associated with hyperlipasemia should be kept in mind to avoid unnecessary diagnostic and therapeutic efforts.
Adolescent↗