Earl E. Gambill

Pancreatitis Associated with Pancreatic Carcinoma: A Study of 26 Patients.

Excerpt To determine the prevalence and significance of pancreatitis in the presence of pancreatic carcinoma the records of 255 consecutive patients with pancreatic carcinoma were studied. Of the 2...

Pancreatic Volume and Bicarbonate Output with Augmented Doses of Secretin

Summary With augmented doses of secretin from the same batch, the maximal secretory response of the pancreas in 10 healthy individuals under defined test circumstances was found with doses of 2 or 3 units/kg of body weight. The former dose was more reliable since apparent depression of pancreatic function occurred in some individuals with the larger dose. Of the various measurements of pancreatic exocrine function, total (60 min) volume output per kilogram of body weight and total (60 min) bicarbonate output per kilogram of body weight showed the largest differences associated with change of dose.

Pancreatic exocrine function: Comparison of responses to augmented secretin stimulus, augmented pancreozymin stimulus, and test meal in health and disease

SummaryThe relative value of certain tests of pancreatic exocrine function was assessed by the sequential administration of (1) an augmented dose of secretin, (2) an augmented dose of pancreozymin, and (3) a test meal. Eighty-one individuals were studied—namely, the control group of 47 persons (24 healthy volunteers and 23 patients with nonpancreatic disease) and a group of 34 patients with pancreatic disease. The latter group included 17 patients with chronic pancreatitis: 2 with subacute relapsing pancreatitis and 15 with carcinoma of the pancreas. Measurements of volume, bicarbonate output (peak and total), and bicarbonate concentration (maximal and 60-min.) were made with and without reference to body weight, after administration of secretin. Concentrations and outputs of trypsin and amylase were measured after the administration of pancreozymin and the test meal.The augmented secretin test yielded the most reliable results, both in indicating pancreatic disease and in differentiating between chronic pancreatitis and pancreatic carcinoma; measurements of volume output per kilogram of body weight, peak or total bicarbonate output, and maximal bicarbonate concentration were the most appropriate data for these purposes. Satisfactory, but less reliable, results were those of secretion that followed the administration of an augmented dose of pancreozymin or a test meal; the findings after these two tests were comparable. Mayo Clinic Rochester, Minn. 55902

Confirmation of presence of a gastric secretory depressant in gastric juice of humans.

Summary By use of a quantitative method for the determination of gastric secretory inhibitors the observation of Brunschwig and co-workers that the intravenous injection of alcoholic precipitates of achlorhydric gastric juice from patients with pernicious anemia depresses gastric secretion in dogs has been confirmed. The secretory depressant activity in such juice was shown by Brunschwig and his collaborators to reduce the secretion induced by feeding a meal. In this study it was found to be effective in inhibiting secretion provoked by histamine. The gastric secretory inhibitor was found in high concentration in achlorhydric gastric juice of persons without other demonstrable abnormalities in the gastro-intestinal tract or disease of the hemopoietic system. The gastric secretory inhibitor was absent or present in lower concentrations in gastric juice from normal individuals.

Blood pressure in the arm and thigh of man

Abstract Blood pressure, pulse pressure, the difference of blood pressure in thigh and arm, and the pulse rate in 112 subjects in the horizontal posture showed great variability from person to person. The tendency of the diastolic blood pressure to increase while the systolic blood pressure remained essentially the same on changing from the horizontal to the standing position is in agreement with the results reported by others. Fifty-nine and five-tenths per cent of all blood pressures fell within 10 per cent, and 86.5 per cent fell within 20 per cent, of the average for the group. These results are almost identical with those of Strang. 16 Differential blood pressures between thigh and arm revealed a wide range of values; the average was 35 mm., systolic, and 27 mm., diastolic, for the horizontal posture. Assumption of the standing posture resulted in a differential pressure of 78 mm., systolic, and 66 mm., diastolic. No apparent correlation was noted between differential pressures and factors such as age, sex, or occupation. No significant differences were found between blood pressures in the left and right thighs of normal subjects. Knowledge of the range of blood pressure in the normal, nonhyperreacting subject, as contrasted to that in the normal, hyperreacting, or hypertensive, hyperreacting subject, is particularly important for those who are trying to evaluate therapeutic attempts to lower or raise the blood pressure.

Comparison of Urinary and Serum Amylase Values Following Pancreatic Stimulation in Patients with and without Pancreatic Disease

Summary Serum amylase concentrations and urinary amylase excretion rates were studied before and after pancreatic stimulation in 23 controls and 31 patients with pancreatic disease. The urinary amylase excretion rate increased substantially after stimulation in 20 of 31 patients with pancreatic disease, or 65%, while serum amylase increases were found in only 6 of the 31, or 19%.

The circulation in man in certain postures before and after extensive sympathectomy for essential hypertension

Abstract In a previous paper 1 we reported some of the physiologic effects on the circulation of extensive splanchnic sympathectomy and postural change in cases of essential hypertension. The studies to be reported in this paper were made on the same ten patients (Cases 1 to 10). In general, the same air-conditioned room and basic procedure, including the same dates of study, were employed in both instances. This part of the investigation was concerned with modifications of blood pressure and pulse rate by (1) a tight abdominal binder, (2) bilaterally inflated cuffs around the thighs, (3) an abdominal binder plus cuffs around the thighs, (4) exercise of the legs, and (5) the administration of paredrinol sulfate. The blood-pressure-raising effects of some of these agents were compared to similar effects of the cold-pressor test. Controlled observations preceded each of the investigations. Each study was done before and after extensive sympathectomy, and, in most instances, while the patients were in the horizontal and in the 60-degree head-up postures.

Polycystic Disease of the Liver, with Unusual Cholecystographic Manifestations: Report of a Case

Summary A case is presented in which polycystic disease of the liver produced extrinsic pressure on the gall bladder, causing distortion and irregularity of its outline.

Blood pressure in the arm and thigh of man: II. Hydrostatic influences

Abstract Placing a cuff around the thigh and inflating it above the level of systolic blood pressure before subjects assumed the standing posture resulted in a significant, but rather transient, lowering of blood pressure in that thigh when the blood pressure was measured during the period of deflation of the cuff. Possible explanations for this observation are suggested. It appears that most of the increase which occurs in the blood pressure in the thigh when one stands is due to the influence of hydrostatic pressure. There is, however, in a few subjects a homeostatic component in such increases; this is variable, and is distinct from that due to hydrostatic pressure. This homeostatic component may be of considerable magnitude. Elevation of the arm or thigh above the horizontal position resulted in a decrease of blood pressure in the limb; this is apparently also largely related to hydrostatic factors. The posture of a limb in which the blood pressure is measured should be stated, particularly when the limb is not in the horizontal position. For obvious reasons, the horizontal position of the limb is the one in which blood pressure should be measured.

ATYPICAL CLINICAL SYNDROMES OF DUODENAL ULCER.

Observations on 10 less common clinical forms of duodenal ulcer are presented, eight of which include illustrative cases. The dominant feature of these forms is used to designate each type.The physician may avoid pitfalls in the diagnosis of duodenal ulcer by realizing that atypical forms do occur and that an active ulcer may be the cause of almost any type of dyspepsia or upper abdominal distress or backache, and by obtaining an accurate, detailed history during the first interview, keeping these atypical manifestations in mind.