Local Institutional Review Boards.
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Biomedical subjects
Publications and source records attributed to T R Hendrix.
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Cholera enterotoxin (CT) produces intestinal secretion associated with an elevation of intestinal cyclic AMP (cAMP). Indomethacin, a potent inhibitor of prostaglandin (PG) synthesis, decreases CT-induced secretion, although a role for PG in this process has not been demonstrated. The purpose of this study was to measure the effects of indomethacin on net fluid movement and unidirectional Na fluxes in rabbit jejunal loops exposed to CT and to correlate these findings with intestinal cAMP levels. In untreated animals (no indomethacin), CT loops secreted 0.37 ml per cm per 4 hr compared to absorption in control loops of 0.23 ml per cm per 4 hr (P less than 0.001). In indomethacin-treated animals, there was a striking reduction of secretion in CT loops (0.07 ml per cm per 4 hr, P less than 0.001). Absorption in control loops in indomethacin animals was greater than in untreated animals (0.42 ml per cm per 4 hr, P less than 0.02). Unidirectional Na fluxes were greatly depressed in indomethacin animals at 1 h in both CT and control loops. This effect disappeared by 4 hr. Intestinal cAMP levels in CT loops, although not elevated at 1 hr despite the onset of secretion, were significantly elevated at 4 hr. Indomethacin did not alter cAMP levels at 1 and 4 hr in either cholera or control loops. These studies support the view that PG synthesis is not involved in CT-induced elevation of intestinal cAMP. Indomethacin may depress intestinal secretion by inhibiting a PG-mediated step beyond the generation of cAMP or by acting on some other, as yet unidentified, biological mechanism involved in intestinal secretion.
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The effect of distention on levels of intestinal cyclic AMP has been examined in rabbit jejunal loops under conditions of distention causing fluid secretion. Cyclic AMP levels were not significantly changed when compared with control loops. Histologic examination of the distended loops showed no significant changes from normal. The data indicate that the secretion in response to distention can occur in absence of morphological alteration and is not mediated by the cyclic AMP system.
A patient is presented with the short bowel syndrome who because of massive diarrhea was unable to maintain fluid and electrolyte balance with the aid of the usual antidiarrhea drugs. Her bowel remnant consisted of approximately 155 cm of proximal jejunum. Intramuscular propantheline has allowed this patient to function normally for the past 36 months. Balance studies are presented to document the benefit of this drug. Propantheline's effectiveness is probably secondary to its marked slowing of intestinal motility.
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The purpose of this study was to compare the actions of shigella toxin and cholera toxin to determine if mucosal damage is a prerequisite for shigella toxin-induced secretion. The secretory response to maximal doses of cholera toxin and shigella toxin were compared. The maximal rate of secretion and the electrolyte and protein concentration of the intestinal fluid were similar for both toxins. On the other hand, the time of onset after exposure to the toxin was 105 min for shigella toxin and 15 to 30 min for cholera toxin. In addition, cholera toxin-induced secretion was associated with depletion of goblet cell mucus, whereas no change was seen in association with the response to shigella toxin. Other than goblet cell depletion, there were no histological differences between loops secreting in response to cholera toxin and to shigella toxin. Finally, the secretory effect of the toxins are not additive. These studies suggest that, in spite of apparent differences in the patterns of secretory response to the two toxins, they may share a rate-limiting step in the secretory process.
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