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Biomedical subjects

L Gullo

Publications and source records attributed to L Gullo.

At least 91 records · Page 5Linked to original sources
PubMed1988

Maximal effective dose of cerulein in the secretin-cerulein test.

In order to determine whether the doses of cerulein generally used in the secretin-cerulein test are supramaximal, the pancreatic secretion of enzymes and bicarbonate in response to intravenous infusion of cerulein plus secretin was studied in 6 subjects on two separate days at the respective doses of 50 ng/kg/h and 0.5 CU/kg/h on one day, and 100 ng/kg/h and 1 CU/kg/h on the other. In all subjects studied, the infusion of cerulein at the dose of 100 ng/kg/h caused a pancreatic enzyme response significantly higher than that produced by 50 ng/kg/h, demonstrating that the doses of cerulein generally used in clinical practice to explore the exocrine pancreatic function are not supramaximal.

Adult↗
PubMed1988

Pancreatic function tests in the diagnosis of pancreatic cancer.

Based on the relevant literature data and on personal experience, the author discusses the mechanisms of pancreatic function impairment in patients with pancreatic cancer, and the role of pancreatic function tests in the diagnosis of this disease. Although pancreatic function is reduced in the vast majority of patients with pancreatic cancer, at present pancreatic function tests are of limited value in the diagnostic approach to this tumor. This is mainly due to the fact that in most cases, patients with pancreatic cancer are seen when the cancer is in an advanced stage, and it can be rather easily diagnosed with currently available imaging techniques.

Humans↗
PubMed1987

Diagnostic value of serum elastase 1 in pancreatic disease.

We studied serum elastase 1 concentrations in patients with pancreatic disease to assess its diagnostic value and compare its sensitivity and specificity with that of amylase and pancreatic isoamylase. Markedly raised concentrations of elastase 1 were found in all twenty-nine patients with acute pancreatitis (amylase was elevated in all but three and pancreatic isoamylase in all but one). Serial measurements of the three enzymes in acute pancreatitis showed that elastase remained elevated longer than amylase and pancreatic isoamylase. The majority of chronic pancreatitis patients studied during a painful relapse (16 out of 21, 76 per cent) had elastase concentrations above the upper normal limit. Amylase and pancreatic isoamylase were elevated in 11 (52 per cent) and in 13 (62 per cent), respectively. Most patients with chronic pancreatitis studied during clinical remission (39 out of 43) had serum elastase levels either within (n = 24) or below (n = 15) the control range. The latter had severe exocrine pancreatic insufficiency and steatorrhoea. In carcinoma of the pancrease, 20 out of 32 (63 per cent) had abnormal serum elastase concentrations; 16 were higher and 4 lower than the control range. Amylase was abnormal in 10 (31 per cent) (8 high, 2 low), and pancreatic isoamylase was abnormal in 16 (50 per cent) (11 high, 5 low). In 46 control patients with non-pancreatic abdominal pain, serum elastase concentrations were not significantly different from those in healthy controls. Elastase was slightly raised in two, whereas amylase and pancreatic isoamylase were elevated in seven and eight, respectively. We conclude that serum elastase 1 is a highly sensitive and specific indicator of pancreatic disease.

Acute Disease↗
PubMed1987

Effect of somatostatin 14 on pure human pancreatic secretion.

While it is well known that large doses of somatostatin inhibit human pancreatic enzyme secretion, it is still unknown whether low doses are also effective and whether the peptide is able to inhibit bicarbonate production. Eight subjects with external transduodenal drainage of the main pancreatic duct performed after biliary tract surgery were studied. Somatostatin was infused at progressively increasing rates of 0.05, 0.15, 0.45, and 1.35 micrograms/kg/hr, for 30 min/dose, during pancreatic stimulation with secretin, 25 ng/kg/hr, and cerulein, 10 ng/kg/hr. Somatostatin, at the dose of 0.05 microgram/kg/hr (shown to produce blood levels similar to those measured after a meal) did not affect pancreatic secretion in any of the subjects. The successive three higher doses caused a significant and dose-dependent inhibition of protein concentration and output and of bicarbonate output. Bicarbonate concentration was slightly but significantly reduced only by the two highest doses of somatostatin. At each dose level, the inhibition of protein output was much more marked than the inhibition of bicarbonate output. The maximal inhibition of protein output (at 1.35 micrograms/kg/hr somatostatin) was 73.9 +/- 5.4%, and that of bicarbonate output was 55.9 +/- 6.4%. The results demonstrate that: (1) the administration of somatostatin at a low dose level does not affect human exocrine pancreatic secretion, at least under the experimental conditions of this study; and (2) the administration of larger doses of somatostatin inhibits pancreatic secretion of both protein and bicarbonate dose-dependently. The inhibitory effect on protein output is significantly greater than that on water and bicarbonate production.

Adult↗
PubMed1987

Relationship between morphological changes detected by ultrasonography and pancreatic exocrine function in chronic pancreatitis.

We have studied the degree of pancreatic secretory alterations assessed by secretin-cerulein test (S-C) in relation to various morphological changes detected by real-time ultrasonography (US) in 42 patients affected by chronic pancreatitis. Exocrine insufficiency was found in 41 patients (97.6%), while morphological alterations were detected in 32 (76.1%). In the 10 patients with normal US, a mild or moderate exocrine insufficiency was present. Significant negative linear correlations of decreasing volumes of duodenal aspirate (r = 0.528, p less than 0.001) and output of bicarbonate (r = 0.635, p less than 0.001), lipase (r = 0.583, p less than 0.001), and chymotrypsin (r = 0.592, p less than 0.001) were found with increasing ultrasonographic alterations. However, a wide overlap was found in the secretory behavior in the various categories of change as determined by ultrasound. Hence, the attempt to predict exocrine function on the basis of morphological alterations proved unsuccessful.

Adult↗
PubMed1987

Serum pancreatic enzyme behavior during the course of acute pancreatitis.

The variations of serum levels of amylase, pancreatic isoamylase, lipase, trypsinogen, and elastase 1 were evaluated in 21 patients with acute pancreatitis. The patients were studied for a mean period of 7 consecutive days (range 5-12 days) after admission to the hospital. On the day of onset of acute pancreatitis, all enzyme levels were abnormally high; pancreatic isoamylase showed the greatest increase compared with its upper normal limit, whereas the increase increment for elastase 1 was the lowest. Subsequently, all enzyme levels except elastase 1 decreased in a parallel fashion. On the eighth day of the study only elastase 1 levels were above normal values in all patients examined, while abnormally high values of lipase were found in 85% of the patients, trypsinogen in 58% of the patients, pancreatic isoamylase in 43%, and total amylase in 23%. These results indicate that, for the early diagnosis of acute pancreatitis, the determination of any of these enzymes is equally efficient, but that elastase 1 is the most sensitive marker of acute pancreatic damage in later stages of the disease.

Acute Disease↗
PubMed1987

Pure pancreatic juice collection over 24 consecutive hours.

We collected pure pancreatic juice during an entire day and examined pancreatic secretory changes induced by ordinary meals in a male patient having an external drainage of the main pancreatic duct. The ingestion of breakfast, lunch, and dinner each caused a marked increase in pancreatic secretion above basal levels. The increase in both bicarbonate and protein output was very prolonged. The highest secretory outputs induced by meals were slightly higher than those produced by exogenous administration of submaximal doses of secretin and cerulein. The profile and magnitude of bicarbonate and protein secretion were similar.

Bicarbonates↗
PubMed1987

The effect of neurotensin on pure pancreatic secretion in man.

The effect of neurotensin on human pancreatic secretion and its role in the control of pancreatic function are not well defined. In the present investigation I have studied the effect of low doses of neurotensin on pure pancreatic secretion in six subjects with external transduodenal drainage of the main pancreatic duct performed after biliary tract surgery. Intravenous infusion of neurotensin at doses of 0.5 and 2.5 pmol X kg-1 X min-1, administered during submaximal pancreatic stimulation with secretin and cerulein, caused a significant and dose-dependent stimulation of pancreatic secretion (volume, bicarbonate, and protein). The effect of neurotensin was rapid, persisted for the duration of neurotensin infusions, and ceased immediately when the administration of the peptide was discontinued. Compared with control values, the increase in bicarbonate output averaged 24.8% and 44.8% and the increase in protein output 29.2% and 54% for the two different doses of neurotensin used, respectively. The clear effectiveness of the small doses of neurotensin used in the present study strongly suggests that the stimulatory effect of the peptide on pancreatic secretion may be of physiologic significance.

Adult↗
PubMed1986

Effect of somatostatin and thyrotropin-releasing hormone on cholecystokinin-induced gallbladder emptying.

The effect of somatostatin (0.05 and 1.5 micrograms/kg/hr) and of thyrotropin-releasing hormone (0.1 and 1.0 microgram/kg/hr) on cholecystokinin-induced gallbladder emptying was studied in healthy volunteers by means of real-time ultrasonography. In addition, the action of increasing doses (0.05, 0.15, 0.45, and 1.35 micrograms/kg/hr) of somatostatin on resting gallbladder volume was also evaluated. Somatostatin, at the dose of 0.05 microgram/kg/hr (shown to produce blood levels similar to those measured after a meal) significantly inhibited the gallbladder contraction in response to cholecystokinin. Kinetic analysis showed that the interaction of somatostatin and cholecystokinin is of the noncompetitive type. The higher dose of the peptide (1.5 microgram/kg/hr) completely suppressed cholecystokinin-induced gallbladder contraction. In experiments carried out using somatostatin alone, a progressive increase in gallbladder volume in response to increasing doses of peptide was observed. The administration of either dose of thyrotropin-releasing hormone did not affect gallbladder emptying in any of the subjects studied. It is concluded that somatostatin is a potent inhibitor of cholecystokinin action on the gallbladder. The clear effectiveness of a very low, presumably physiological, dose indicates that somatostatin may play a physiological role in the regulation of gallbladder motor activity and provides further evidence that the peptide may act as a true hormone in man. Thyrotropin-releasing hormone does not seem to affect gallbladder motility, at least under the experimental conditions of the present study.

Adult↗
PubMed1986

A rapid assay for serum immunoreactive lipase as a screening test for acute pancreatitis.

In 134 consecutive patients with acute abdominal pain, we evaluated the clinical role of a new rapid test for serum lipase based on latex agglutination. The results were compared with those obtained with a widely used lipase immunoassay as well as with serum amylase and pancreatic isoamylase measurements. Fifty-five healthy subjects were studied as controls. In 174 cases (121 patients and 53 controls) the results of the two lipase assays were in agreement. A positive lipase latex test was found in 10 of 12 patients with acute pancreatitis, in eight of 24 patients with other pancreatic diseases, and in 14 of 98 with nonpancreatic diseases. The sensitivity and specificity of this test were similar to those of the other pancreatic enzyme assays performed. The results indicate that the lipase latex agglutination test is useful for emergency screening for acute pancreatitis in patients with acute abdominal pain.

Acute Disease↗
PubMed1986

Aging and exocrine pancreatic function.

In view of the limited information concerning the influence of aging on exocrine pancreatic function, the authors undertook the present study. To examine a large number of elderly persons, including people of very advanced age (80 years and over), pancreatic function was studied by using the fluorescein dilaurate test (pancreolauryl test), one of the most recent tubeless, noninvasive pancreatic function tests. Sixty healthy noninstitutionalized elderly individuals (35 women and 25 men, aged 66 to 88 years, mean 78) participated in the study. Thirty-six healthy younger subjects (16 women and 20 men, aged 21 to 57 years, mean 36) were also studied as controls. All elderly subjects showed a strictly normal fluorescein dilaurate test. No significant differences in the pancreatic function test results were observed between the elderly under 80 years old and those over 80 years old. The authors conclude that the aging process per se does not significantly affect exocrine pancreatic function and, more particularly, does not impair the digestive capacity of the elderly person.

Adult↗
PubMed1986

Stimulation of exocrine pancreatic secretion by met-enkephalin.

The effect of met-enkephalin on pure exocrine pancreatic secretion was studied in five subjects with external transduodenal drainage of the main pancreatic duct carried out after biliary tract surgery. Intravenous infusion of a low dose of met-enkephalin (0.15 micrograms/kg/h) during submaximal pancreatic stimulation with secretin (25 ng/kg/h) and cerulein (10 ng/kg/h) significantly increased pancreatic outputs. Bicarbonate secretion increased 50% above control values, a more marked effect than the increase in enzyme secretion (maximal rise averaged 22%). The effect of the peptide was rapid, persisted for the duration of met-enkephalin infusion and then tended gradually to diminish.

Bicarbonates↗
PubMed1985

Inhibition of pancreatic exocrine secretion and bile entry into the duodenum by isometheptene, a sympathomimetic agent.

We have studied the effect of isometheptene, an indirectly acting sympathomimetic with analgesic and antispastic properties, on secretin-cholecystokinin-stimulated pancreatic and biliary outputs. Isometheptene, infused intravenously at a dose of 100 mg in 30 min, significantly inhibited bicarbonate, enzyme, and bilirubin output in eight healthy subjects (compared to control values, the maximum percent inhibition was 34% for bicarbonate, 57% for lipase, 61% for chymotrypsin, and 86% for bilirubin). In four cholecystectomized subjects, the drug inhibited only pancreatic outputs. The inhibitory effect on pancreatic secretion, coupled with the analgesic action, suggest a potential benefit of this drug in acute pancreatic pathology.

Adult↗
PubMed1984

Secretin administration induces a dilatation of main pancreatic duct.

In this study we evaluated the effect of secretin administration on the caliber of the Wirsung duct visualized by real-time ultrasonography. A maximal dose [75 clinical units (CU)] of secretin was intravenously injected in 1 min into 18 normal subjects. The duct was continuously monitored from the beginning of injection for a period of 20 min and measured at the level of the body using a calibrated optical lens. The mean caliber of the duct (basal value +/- SD = 1.2 +/- 0.4 mm) markedly increased after secretin stimulation (mean value +/- SD at 3 min = 2.9 +/- 0.8 mm). No dilatation was observed in five of these subjects after administration of 2 ml of saline. In a further four subjects a dose of 0.25 CU/kg/hr of secretin caused a much less marked dilatation of the main pancreatic duct. During dilatation a longer segment of duct is more clearly visualized; furthermore the pancreatic juice within the duodenum improves ultrasonographic imaging of the head of the pancreas.

Adolescent↗
PubMed1984

Action of secretin on pancreatic enzyme secretion in man. Studies on pure pancreatic juice.

The action of pure, natural secretin on the pancreatic secretion of enzymes was investigated in six patients with external transduodenal drainage of the main pancreatic duct performed after biliary tract surgery. Secretin infused for five successive 50 minute periods at increasing doses of 0.03, 0.1, 0.3, 0.9 and 2.7 clinical units (CU)/kg/h, produce a dose dependent increase in protein and lipase output. A weak but significant (p less than 0.02) increase of enzyme output above the fasting level was already observed with the lowest dose. The maximal output of protein and lipase, observed with the highest dose of secretin infused, corresponded to about 50% of that induced by maximal doses of cerulein (100 ng/kg/h) plus secretin (1 CU/kg/h). As far as bicarbonate is concerned, the lowest dose of secretin (0.03 CU/kg/h) significantly (p less than 0.001) stimulated bicarbonate output. The dose of 0.9 CU/kg/h of secretin evoked a bicarbonate output of 526 +/- 49 micromol/min; trebling the dose of secretin did not significantly increase the output of bicarbonate above this value. Increasing doses of secretin induced a dose related increase in calcium output. There was a close parallel between calcium and protein outputs, suggesting that the increase in calcium output reflected primarily an increase in the enzyme-associated fraction of pancreatic juice calcium. It is concluded that secretin stimulates pancreatic enzyme secretion in man probably by a direct action on the acinar cells.

Adult↗