[Multiple stenoses of the gastro-intestinal tract and upper leg calcification associated with scirrhous stomach cancer (author's transl)].
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Biomedical subjects
Publications and source records attributed to L Kayasseh.
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A simple direct radioimmunoassay for human secretin has been developed by immunizing rabbits with synthetic human secretin. After 1-2 injections antisera with titers up to 1:52000 could be induced. In a dysequilibrium system secretin levels in plasma can be measured down to a concentration of 25 pg/ml plasma. Extraction methods gave unreproducible recoveries. Direct estimation in plasma provides only relative values because of a "non-specific" effect of secretin free plasma which is difficult to control. A simple assay based on iodination with chloramin-T and charcoal dextran separation produces at least reliable relative values, as shown by the pattern of secretin concentrations in response to intraduodenal stimulation with HC1.
In 4 dogs with pancreatic and gastric fistulae the effect of somatostatin (SST) on the pancreas was investigated during stimulation by pancreozymin-secretin or by a test meal. The pancreozymin-secretin-induced enzyme output and bile flow, as well as the enzyme concentration and duodenal volume during test meal stimulation were significantly reduced by SST. SST caused a less marked decrease in bicarbonate concentration, while volume and bicarbonate output did not change.
Exocrine pancreatic function was investigated by means of the Lundh test model in dogs with chronic duodenal and gastric fistulas. The test was standardized and the effect of glucagon on exocrine pancreatic secretion was evaluated. The mean tryptic activity detected in 18 tests in 6 dogs was 32.25 +/- 5.25 muEqH+/minute/ml, which is considerably higher than that observed in man. The administration of glucagon was followed by a significant decrease (30.8%) in the volume of the duodenal contents and a more pronounced depression of the enzyme concentrations (trypsin 59%, chymotrypsin 53.3%). It is concluded that the Lundh test affords a valuable experimental model for the investigation of exocrine pancreatic function in dogs.
6 patients who have had a duodeno-pancreatectomy were starved and then given a test meal, to stimulate the serumgastrin which was measured by RIA. The fasting gastrin values were, by all the patients, in the lower range of the normal level (25-50 pg/ml). The stimulation with the meat-extract (25 g with 400 ml of water) did not lead to any significant raising of the fasting serum gastrin.
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Administration of 2-DG accompanied by simultaneous neutralization of gastric contents with sodium bicarbonate resulted in a rise in serum gastrin in 4 patients without gastric disease, 4 with duodenal ulcer and 4 with gastric ulcer. The rise in gastrin equals that observed on stimulation with meat extract. Patients with gastric ulcers display a low PAO and a small rise in gastrin compared with normals and patients with duodenal ulcers. This finding correlates well with the chronic atrophic changes of the antral mucosa in patients with gastric ulcer.
The results of 611 Lundh-tests performed on 546 patients over a period of 4 1/2 years have been evaluated. The test was highly reliable in the diagnosis of exocrine pancreatic deficiency. False-normal results were seen in 2.04% and false-abnormal in 3%. The test does not differentiate between chronic pancreatitis and carcinoma. Extrapancreatic factors depressing duodenal tryptic activity are discussed.
The Lundh test for exocrine pancreatic function was performed on 376 patients. An increased trypsin concentration in duodenal secretion (greater than 28.9 IU/ml) was measured in eight. Seven of them had symptoms of pancreatic disease, six of them with acute episodes. Eight further cases have been reported in the literature, at least two of them definitely having pancreatic disease. Both in the reported cases and in the authors' study the proportion of patients with abnormally raised enzyme concentrations among the group of patients with acute or subacute pancreatitis was significantly greater than in a control group. It is possible that abnormally raised enzyme concentration is due to subacute pancreatic disease and may at times be the only finding. An abnormally raised enzyme concentration in the Lundh test should therefore simply be classified as such and not be taken as the expression of normal or even "excellent" pancreatic function.
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