Biomedical subjects

R A Prinz

Publications and source records attributed to R A Prinz.

At least 109 records · Page 6Linked to original sources

PubMed1986

Myocardial depression during acute pancreatitis: fact or fiction?

Clinical and experimental evidence suggests that myocardial depression occurs during severe pancreatitis, but this evidence is derived from techniques that are not optimal for assessing myocardial contractility (e.g., rate of rise in ventricular pressure [dP/dt]). The slope of the left ventricular (LV) and systolic pressure dimension relationship (Ees), a better indicator of myocardial function, has not been measured in pancreatitis. Ten mongrel dogs underwent surgical instrumentation to monitor systemic arterial and LV pressure, cardiac output, LV dP/dt, and anterior LV wall thickness. End of systole was defined by the peak negative dP/dt. The end-systolic points used to calculate Ees were obtained by aortic and vena caval occlusion. After surgical recovery, pancreatitis was induced via cannulation of the pancreatic duct and injection of autologous bile (1 ml/kg) at 200 mm Hg perfusion pressure. All measurements were taken during a control period and daily after pancreatitis was induced. Pancreatitis was confirmed by a significant increase in serum amylase throughout the study and by autopsy finding of hemorrhagic necrosis. Ees was increased throughout the experimental protocol (1 to 7 days) (p less than 0.05). Myocardial performance as assessed by Ees was significantly increased and myocardial depression did not occur in untreated, conscious dogs with severe pancreatitis. Peak positive LV dP/dt was a poor index of contractility during pancreatitis since it decreased while myocardial contractility was increased. Cardiac depression in pancreatitis noted in other reports was likely due to decreased preload and not to intrinsic cardiac dysfunction.

Acute Disease↗

PubMed1985

Combined pancreatic duct and upper gastrointestinal and biliary tract drainage in chronic pancreatitis.

In 55 patients undergoing pancreaticojejunostomy for intractable abdominal pain, common bile duct obstruction occurred in 29% (16/55) and duodenal obstruction occurred in 15% (8/55). Serum alkaline phosphatase and total and direct serum bilirubin levels were significantly higher in patients with intrapancreatic common bile duct stenosis. Transient upper gastrointestinal (UGI) tract obstruction was common with chronic pancreatitis; however, if symptoms persisted beyond 2 weeks, fixed duodenal obstruction was likely. Endoscopic retrograde cholangiopancreatography and UGI roentgenograms and endoscopy were useful in confirming mechanical obstruction to the biliary and UGI tracts, respectively. There was no difference in operative mortality and morbidity from combined drainage procedures compared with pancreaticojejunostomy alone. The biliary and UGI tracts should be investigated in symptomatic patients both before and after pancreaticojejunostomy. Combined drainage of the pancreatic duct and UGI and biliary tract is safe and effective treatment for obstructing complications of chronic pancreatitis.

Adult↗

PubMed1985

Serum calcium metabolism in acute experimental pancreatitis.

Serum calcium changes in severe pancreatitis were studied in 23 dogs. Twelve dogs underwent duodenotomy and served as controls. Pancreatitis was induced in the other 11 by autologous bile injection (1 ml/kg) into the pancreatic duct. Serum amylase, total calcium, ionized calcium, albumin, magnesium, chloride, phosphorous, parathyroid hormone (PTH), and calcitonin were measured at 0, 1/2, 1, 3, 6, 24, 48, and 72 hours after duodenotomy or bile injection. Serum amylase levels became significantly elevated in all dogs with pancreatitis at 30 minutes (p less than 0.01) and remained so throughout the entire experiment. Total calcium levels dropped significantly 30 minutes after pancreatitis was induced from 10.0 +/- 0.3 mg/dl compared with 8.8 +/- 0.4 mg/dl in control dogs (p less than 0.05) and remained statistically lower for as long as 1 hour. Ionized calcium levels were significantly lower than were those of control dogs at 1/2, 1, 3, and 6 hours (p less than 0.05). Serum magnesium and chloride levels showed no significant changes between both groups. The only significant difference in phosphorus values was at 6 hours when they were higher in dogs with pancreatitis than in controls (6.2 +/- 0.3 mg/dl versus 4.8 +/- 0.4 mg/dl; p less than 0.05). Serum albumin levels remained unchanged throughout the study except for 48 hours when they were significantly lower in animals with pancreatitis (p less than 0.02). PTH levels were significantly greater in dogs with pancreatitis than in controls at 1, 3, 6, and 24 hours (p less than 0.05). There was no significant difference in calcitonin levels between both groups. Ionized calcium is a more reliable indicator of calcium fluxes in acute experimental pancreatitis since it remains depressed longer than total serum calcium. The time course of PTH elevation indicates a reaction to hypocalcemia, and failure of PTH secretion is not the cause of hypocalcemia in pancreatitis. This study does not support elevation of calcitonin as a cause of hypocalcemia in acute pancreatitis.

Acute Disease↗

PubMed1985

The association of primary hyperparathyroidism and pancreatitis.

The long-held tenet that a cause and effect relation exists between primary hyperparathyroidism and pancreatitis has recently been questioned. To clarify this association, records of 1475 patients seen with pancreatitis during a 10-year period were reviewed. Five patients (0.4%) were identified with primary hyperparathyroidism. The four men and one woman ranged in age from 31 to 57 years. Four had recurrent pancreatitis over a 2-10 yr period before hyperparathyroidism was diagnosed. One patient had hypercalcemia noted 1 year prior to developing pancreatitis. Four patients had associated potential causes of pancreatitis including alcohol abuse, gallstones, and hypotension. Pancreatitis was severe in each patient. Two patients had more than four admissions for acute pancreatitis, one patient underwent pseudocyst drainage and distal pancreatectomy for chronic pancreatitis, one patient underwent pancreaticojejunostomy for chronic pancreatitis, and one patient died from hemorrhagic pancreatitis. Four patients have undergone successful parathyroidectomy and have had no further attacks of pancreatitis on follow-up ranging from 1 to 4 years. Hyperparathyroidism is rarely associated with pancreatitis, but when this combination occurs, the pancreatitis is likely to be severe. Despite its rarity, a cause and effect relationship is still suggested by the fact that parathyroidectomy seems to prevent recurrence of pancreatitis.

Adult↗

PubMed1985

Spectrum of catecholamine-secreting tumors of the organ of Zuckerkandl.

In a series of 24 pheochromocytomas, four were tumors in the organ of Zuckerkandl. Their presenting symptoms of headache, palpitation, diaphoresis, and anxiety were similar to symptoms of adrenal pheochromocytomas. Two patients had paroxysmal and two patients sustained hypertension. All four had elevated urinary vanillylmandelic acid, metanephrine or catecholamine levels. Two of the tumors were localized with angiography before the availability of computerized tomography. Two patients underwent initial computerized tomography, which was nondiagnostic. Later scans looking specifically for organ of Zuckerkandl tumors were positive. Organ of Zuckerkandl tumors, like other ectopic pheochromocytomas, have a higher rate of malignancy. Two of the four were malignant tumors. One patient died 4 years after operation, but the other patient remains stable despite metastatic disease 8 years after operation. The two patients with benign tumors remain well 2 and 3 years after resection and treatment with alpha-blockade.

Adult↗

PubMed1984

The spectrum of biliary tract obstruction from chronic pancreatitis.

Fifty-one patients with chronic pancreatitis manifested distal common duct obstruction from fibrosis of pancreatitis. The cause of the pancreatitis was alcohol in most patients. An elevated serum alkaline phosphatase level was the most frequent abnormal laboratory finding. The serum bilirubin level elevation was never progressive; a rising and falling pattern was most often encountered. Percutaneous transhepatic cholangiography and endoscopic retrograde cholangiopancreatography are the most useful diagnostic tests. An operation was performed on 47 patients and included choledochoduodenostomy in 16 patients, choledochojejunostomy in 19 patients, cholecystenteric anastomosis in seven patients, common bile duct exploration with T-tube drainage in three patients, and sphincteroplasty in two patients. Abdominal pain was lessened after operation in 40 of 44 patients who survived surgery. Two patients with T-tube drainage and two with cholecystenteric anastomosis required conversion operations to choledochoduodenostomies. Identification of associated pancreatic duct obstruction and dilatation, pseudocysts, and duodenal obstruction is important.

Adult↗

PubMed1984

Gastric outlet and duodenal obstruction from inflammatory pancreatic disease.

During a ten-year period, 16 patients with gastric outlet and duodenal obstruction due to inflammatory pancreatic disease were seen. The cause of obstruction was chronic pancreatitis in ten patients, pseudocysts with associated pancreatitis in five patients, and pancreatic abscess in one patient. All patients had nausea and vomiting, 14 had abdominal pain, and five had weight loss greater than 4.5 kg. Diagnosis was made by plain abdominal film in one case, upper gastrointestinal tract roentgenographic series in 15 cases, and endoscopy in 11 cases. Mobilization of the duodenum relieved the obstruction in two patients. Fixed obstruction remained in 14 patients. This was relieved by gastrojejunostomy in 12 patients. Gastrojejunostomy was combined with drainage of a pseudocyst in three patients, a dilated pancreatic duct in three patients, and a dilated common bile duct in four patients. Obstruction was relieved by pseudocyst drainage in two patients. Associated common duct and pancreatic duct obstruction must be identified preoperatively.

Abscess↗

PubMed1984

Comparative study of protease inhibitors on coagulation abnormalities in canine pancreatitis.

Coagulation abnormalities induced by pancreatitis were studied in 36 dogs. The 12 dogs in group I underwent a duodenotomy alone. The six dogs in groups II, III, IV, and V had pancreatitis induced by bile injection (1 cc/kg) into the pancreatic duct. Twenty minutes after bile-induced pancreatitis, group III was given 1.0 mg/kg aprotinin (trasylol), group IV was given 10 mg/kg S-2441, a new synthetic protease inhibitor, and group V was given 0.5 mg/kg alpha 2-antitrypsin by intravenous infusion over 10 min. Blood was drawn for amylase, protime (PT), partial thromboplastin time (PTT), fibrinogen, and platelets, in addition to markers of hypercoagulation, fibrinopeptide A, and antithrombin III, and markers of fibrinolysis, B beta 15-42 immunoreactive peptide (IP), and alpha 2-antiplasmin at baseline, 1/2, 1, 3, 6, 24, 48, and 72 hr after duodenotomy or bile injection. There was no significant difference in PT, platelets, antithrombin III, and fibrinopeptide A among the five groups. With the induction of pancreatitis (group II), serum amylase was significantly elevated but fibrinogen only became elevated at 24 hr and PTT at 48 hr. The increase in B beta 15-42 IP seen 30 min after induction of pancreatitis and the decrease in alpha 2-antiplasmin were blunted by aprotinin, alpha 1-antitrypsin, and S-2441, but inhibition of the rise in amylase and B beta 15-42 IP only reached significance with S-2441 (P less than 0.05). Pancreatitis-induced fibrinolysis was inhibited by S-2441 suggesting that synthetic protease inhibitors may play a therapeutic role in pancreatitis.

Acute Disease↗

PubMed1984

Platelet activation by human pancreatic fluid.

The effects of human pancreatic fluid (HPF) on platelet aggregation and activation were studied. HPF, obtained at operation from nine patients with chronic pancreatitis and two with pancreas cancer, was pooled, lyophilized, and adjusted to a concentration of 1 mg protein/cc of 0.9% saline after dialysis. Platelet aggregation was evaluated by measuring platelet count after iv administration of HPF to five rabbits in concentrations ranging from 0.2 to 2.0 mg/kg. Platelet activation was evaluated by adding 0.1-ml aliquots of pooled HPF in various concentrations to 0.9 ml of human platelet-rich plasma. After a 15-min incubation at 37 degrees C, the platelets were removed by centrifugation and the supernatant examined for platelet-release products. Serotonin was measured by high-performance liquid chromatography (HPLC) and platelet factor 4 and thromboxane B2 were measured by radioimmunoassay. A significant decrease in rabbit platelet count signifying platelet aggregation was seen after iv administration of 1.0 mg/kg (P less than 0.05) and 2.0 mg/kg (P less than 0.001) HPF. Platelet activation was confirmed by a significant increase (P less than 0.05) in serotonin, platelet factor 4, and thromboxane B2 at almost all concentrations of HPF. This study indicates that HPF induces platelet aggregation and activation and suggests that platelet contact with pancreatic exocrine fluid may have both local and systemic effects that are important in the pathophysiology of acute pancreatitis.

Adult↗

PubMed1984

Serum levels of alpha-1-antitrypsin in pancreatic islet cell tumors.

To evaluate the usefulness of alpha-1-antitrypsin as a tumor marker for pancreatic islet cell tumors, serum levels were measured in 16 patients including 4 with gastrinomas, 4 with glucagonomas, 1 with a malignant somatostatinoma 1 with a malignant insulinoma, and 6 with "nonfunctioning" islet cell carcinoma and in 10 controls. Serum alpha-1-antitrypsin ranged from 190-420 mg/dl in controls (normal serum values with this method range between 200-450 mg/dl). Serum levels of alpha-1-antitrypsin ranged from 150-900 mg/dl in the 16 patients with islet cell tumors. Only 3 of the 16 patients had elevated levels of alpha-1-antitrypsin. In this group of patients with advanced disease, serum alpha-1-antitrypsin was not a sensitive marker, and it is not likely to be useful for diagnostic screening or for monitoring tumor growth in patients with pancreatic islet cell tumors.

Adenoma, Islet Cell↗

PubMed1984

Carcinoma masquerading as a pancreatic pseudocyst on ultrasound.

Ultrasound has proven invaluable in detecting and evaluating pancreatic pseudocysts, and it is now a standard test to rule out complications of pancreatitis. In reviewing the authors' experience with 122 patients treated surgically for a pancreatic pseudocyst, five patients were identified in whom an ultrasound demonstrated a pseudocyst that was associated with an unexpected cancer at the time of operation. A sixth patient, with a pseudocyst documented by ultrasound, died prior to surgery and was found at autopsy to have metastatic common bile duct carcinoma. There was little difference in presenting symptoms, age, frequency of alcoholism, or physical findings compared with patients with pseudocysts secondary to pancreatitis. In two patients, pseudocysts were found in the tail of the pancreas at operation, in addition to carcinoma. In the other three patients, no pseudocyst was found; however, a subcapsular splenic hematoma was present in one. Five patients had metastatic disease, three from pancreatic adenocarcinoma, one from islet cell carcinoma, and one from a common bile duct carcinoma. One patient with a pancreatic adenocarcinoma confined to the head underwent a Whipple procedure and has no evidence of disease 6 months later. Malignancy may cause or coexist with pancreatic pseudocysts. Ultrasound is often not helpful in distinguishing pseudocysts associated with malignancy from those associated with pancreatitis. Biopsy should be performed to rule out malignancy when operating for pancreatic pseudocysts.

Adenocarcinoma↗

PubMed1984

Successful adrenal autotransplantation in Cushing's disease.

Since Cushing's disease was delineated as a distinct entity, a wide array of therapeutic modalities has been employed to treat its symptoms, which are primarily the result of hypercortisolism. With the advent of pituitary polytomography and the concept of microadenomas, a wave of enthusiasm has developed in recent years in favor of transsphenoidal microdissection. In a recent national survey, however, one third of 30 endocrinologists reported cure rates below 60% and, according to several respondents, recurrence was a serious problem at 50% or greater incidence. We report on four patients treated by bilateral adrenalectomy and autotransplantation. They were weaned off all corticosteroid medication for up to 6 years. Two of the four patients have demonstrable iodocholesterol uptake at the site of autotransplantation. We also report on three additional patients who are taking reduced doses of cortisone. All seven patients have no demonstrable iodocholesterol uptake in the adrenal fossae or other possible ectopic sites. We believe that bilateral adrenalectomy with autotransplantation is a worthy alternative in the long-term treatment of Cushing's disease.

19-Iodocholesterol↗

PubMed1984

Androgen receptors in human thyroid tissue.

To evaluate the potential effect of androgens on human thyroid tumors, the incidence and distribution of cytosolic receptors for androgens were analyzed in thyroidectomy specimens from 31 patients. Fourteen specimens were from male and 17 from female patients. The specimens included five papillary carcinomas, five follicular adenomas, 15 colloid goiters, and six relatively normal thyroid tissues. All assays were performed by a protamine sulfate precipitation technique and analyzed by the method of Scatchard. Selected specimens were analyzed by sucrose density gradient. A receptor content greater than 1 fmol/mg cytosol protein was taken as positive if the dissociation constant was less than 1 nm. Seventeen of 31 specimens were positive for androgen receptors, with a dissociation constant of 0.26 +/- 0.09 X 10(-10) M and a receptor content of 11.20 +/- 4.77 fmol/mg cytosol protein. Four of five carcinomas, four of five adenomas, and nine of 21 benign thyroid tissues were positive for androgens. These androgen receptors are a single class with high affinity that are saturable and precipitate at the 6S (Svedberg unit) region similar to receptors in other androgen-dependent tissue. The data suggest that physiologic androgenic milieu may influence the growth of thyroid tumors.

Adenoma↗

PubMed1983

The nature and course of cystic pancreatic lesions diagnosed by ultrasound.

To determine the nature and course of cystic pancreatic lesions, we reviewed the records of 93 patients who were followed up with serial ultrasound until resolution occurred or definitive therapy was given. Initially, 105 cystic lesions were seen. Single cysts occurred in 83 patients and multiple cysts in ten. Eight patients had two cysts and two patients had three. Twenty-one patients had a single ultrasound examination and 72 had two or more examinations. Spontaneous resolution occurred in 29 of (28%) 105 cysts in 24 patients. In 46 patients, 53 pseudocysts were found at operation or autopsy. Five patients had pancreatic abscesses. Two patients became unavailable for follow-up and three refused surgery. The results of one examination were false negative. Twelve patients had false-positive ultrasound results. Factors influencing the likelihood of spontaneous resolution included initial cyst size, subsequent increase in size, multiple cysts, and the presence of calcifications. This study confirms the usefulness of serial ultrasound scans in determining the nature and necessity for treatment of cystic lesions of the pancreas.

Abscess↗

PubMed1983

A serotonin and beta HCG-producing islet cell carcinoma associated with focal nodular hyperplasia of the liver.

A 48-year-old woman is described with a pancreatic islet cell carcinoma that had no clinical evidence of hormone production. This neoplasm was removed by radical distal pancreatectomy. Immunohistochemical and extraction studies performed on the tumor tissue revealed that it was producing serotonin and beta HCG. Circulating levels of these hormones were elevated in preoperative serum samples that had been frozen. Beta HCG, a known tumor marker, has remained normal following operation, and this mirrors her clinical course since she has no evidence of disease 1.5 yr after operation. This patient also had focal nodular hyperplasia of the liver. It is possible that the trophoblastic hormone, beta HCG, which was being produced in excess by the islet tumor, may have directly or indirectly caused or facilitated the development of focal nodular hyperplasia.

Adenoma, Islet Cell↗

PubMed1983

Serum neuron-specific enolase: a serum marker for nonfunctioning pancreatic islet cell carcinoma.

The isoenzyme, neuron-specific enolase (NSE) was evaluated as a serum marker for nonfunctioning pancreatic islet cell carcinoma. Serum NSE was measured by radioimmunoassay in 6 patients with islet cell cancer and in 22 healthy adults. Mean serum NSE in control subjects was 5 ng/ml (range 3.2 to 8.4 ng/ml). Three of six patients had clearly elevated serum NSE with values that ranged from 22 to 44 ng/ml. One patient had an equivocally elevated serum NSE of 9.2 ng/ml while receiving chemotherapy. When relapse occurred, the NSE level increased to 44 ng/ml. One of two patients with normal serum NSE had undergone radical pancreatectomy and had no evidence of disease when studied. Elevated serum NSE returned to normal limits after removal of all gross tumor in the only patient from whom a preoperative measurement was obtained. Results of this preliminary study suggest that serum NSE levels can aid in the diagnosis and monitoring of the course of nonfunctining islet cell carcinoma.

Adenoma, Islet Cell↗

PubMed1983

Fine needle aspiration biopsy of thyroid nodules.

The clinical value of the fine needle aspiration of thyroid nodules was evaluated by comparing preoperative cytology to subsequent pathology in 109 patients undergoing thyroidectomy. Preoperative cytology was reported as insufficient cellular material (31 patients), benign goiter (27 patients), follicular neoplasm (22 patients), thyroiditis (12 patients), suspicious for papillary carcinoma (nine patients), Hurthle cell neoplasm (five patients), medullary carcinoma (one patient), lymphoma (one patient), and metastatic adenocarcinoma (one patient). Operative findings demonstrated that the overall sensitivity of fine needle aspiration in diagnosing thyroid neoplasia (carcinoma or adenoma) was 88% and its specificity was 80%. Operation verified the cytologic diagnosis of medullary carcinoma, lymphoma, metastatic adenocarcinoma, and seven of nine papillary carcinomas. Of the five patients with an aspiration biopsy diagnosis of Hurthle cell neoplasm, three patients had carcinoma and one had an adenoma. Four carcinomas and 12 follicular adenomas were found in patients with a cytologic diagnosis of follicular neoplasm. Thyroiditis was confirmed at operation in all 12 patients with this diagnosis on fine needle aspiration. One carcinoma was found in the 27 patients with benign goiter diagnosed on cytology. Fine needle aspiration is a valuable tool that can lead to earlier diagnosis and treatment of thyroid cancer. However, a negative aspiration does not supplant good clinical judgement in determining the need for thyroidectomy.

Adenocarcinoma↗

PubMed1983

Serum markers for pancreatic islet cell and intestinal carcinoid tumors: a comparison of neuron-specific enolase, beta-human chorionic gonadotropin and pancreatic polypeptide.

Neuron-specific enolase (NSE) (a glycolytic enzyme that occurs only in neuroendocrine cells), human pancreatic polypeptide (hPP) (a probable peptide hormone), and the beta-subunit of human chorionic gonadotropin (beta hCG) (a glycoprotein hormone), have been suggested as serum markers for the diagnosis and management of apudomas of the pancreas and intestinal tract. Serum levels of NSE, hPP, and beta hCG were measured in 21 patients with pancreatic islet cell cancer (including nine "nonfunctioning" tumors, six gastrinomas, three glucagonomas, two insulinomas, and one somatostatinoma) and in five patients with intestinal carcinoid tumors. Sixteen of the 26 patients (62%) had elevated circulating levels of at least one tumor marker. All three markers were elevated in only one patient, a woman with a "nonfunctioning" islet cell carcinoma. Five patients had increased levels of two serum markers. In three patients both NSE and hPP levels were above normal and in two patients both NSE and beta hCG levels were above normal. In nine patients only one marker was elevated. These included six with elevated NSE levels, two with elevated hPP levels, and one with elevated beta hCG levels. Thus NSE levels were elevated in 12, hPP levels in six, and beta hCG levels in four of the 26 patients. While no single marker was elevated in all patients, each of the three can be elevated in an individual case. When elevated, these markers may be valuable to estimate prognosis or monitor response to therapy.

Adenoma, Islet Cell↗