L. A. Scuro

Long-Term Outcome of Acute Necrohemorrhagic Pancreatitis

This long-term follow-up of 27 patients treated with conservative surgery for necrohemorrhagic pancreatitis (NHP) showed that an almost complete recovery of the exocrine function is achieved within 4

Glucose tolerance and blood lipids in bran-fed patients with impaired glucose tolerance.

Thirty-eight patients (13 men and 25 women) with impaired glucose tolerance, aged 33–70 yr, underwent a dietary program adding 20 g of raw bran to their usual diet without changing their dietary habits. After 1 mo of treatment, the areas under the curves for glucose and insulin were reduced from 26,214 ± 5618 to 24,529 ± 5207 g/min (P < 0.001) and from 15,893 ± 9714 to 12,440 ± 7377 mU/min (P < 0.001), respectively, cholesterol was reduced from 234 ± 40 to 212 ± 29 mg/dl (P < 0.001), and triglycerides were reduced from 108 ± 56 to 97 ± 50 mg/dl (P < 0.05). Body weight (initially 128.44% relative body weight) decrease 0.8% (P < 0.02). After the first month, 14 subjects were studied for a further 2 mo. Six patients continued bran feeding, and eight, who stopped bran, were used as controls. Patients who took bran maintained metabolic improvement over the 3-mo treatment period, while those who stopped bran did not.

Fasting serum insulin in relation to fat distribution, serum lipid profile, and blood pressure in European women: The European fat distribution study

Samples of 38-year-old women were randomly selected from five European centers: Ede (The Netherlands), Warsaw (Poland), Gothenburg (Sweden), Verona (northern Italy), and Afragola (Naples-southern Italy). In total, 452 healthy women were studied. Anthropometric measurements were taken by one operator in each country after common training of all operators and blood parameters of all women were determined in one laboratory. Body mass index (BMI) was different among centers, mainly due to the higher values in southern Italy. Women from southern Europe had more central fat distribution than women from north European centers. Fasting serum insulin was higher in women from Poland and The Netherlands than in the other three centers. After adjustment for BMI, fasting insulin was significantly related to subscapular skinfold, subscapular to triceps skinfold ratio, waist circumference, and waist to thigh circumference ratio, although the partial correlations varied somewhat between the centers. In the pooled data, waist circumference showed the highest correlations with fasting serum insulin when adjusted for BMI. Fasting serum insulin showed significant partial correlations, adjusted for BMI, with lipid profile and blood pressure only in women from the two Italian centers. In the pooled data, fasting serum insulin was significantly positively correlated with serum triglycerides and total cholesterol and negatively to high-density lipoprotein (HDL) cholesterol and HDL/total cholesterol, independently of BMI and waist circumference. While blood pressure was not related to insulin in the pooled women, when adjusted for BMI and waist circumference; here as well, there were some differences in relationships between the centers.(ABSTRACT TRUNCATED AT 250 WORDS)

The Role of Caerulein in Tests of Exocrine Pancreatic Function

Secretin (1 CU/Kg) plus Caerulein (100 ng/Kg) or Cholecystokinin (1 or 2 IvyU/Kg) were given by rapid intravenous injection (Schedule 1) or by continuous infusion (Schedule 2) to 63 control subjects (C) and 69 patients affected by chronic pancreatitis (CP). Duodenal juice was collected for two and four 30-minute periods in schedule 1 and schedule 2, respectively. Volume, bicarbonate, and enzyme content were measured. Secretin-Daerulein, by rapid intravenous injection, showed a strong overlapping between C and CP values and led to some side-effects. Secretin-Caerulein by continuous intravenous infusion gave almost identical results as the Secretin-Cholecystokinin.

Is the 14C-triolein breath test useful in the assessment of malabsorption in clinical practice?

A 14C-triolein breath test was carried out on 49 subjects suffering from chronic pancreatitis or from other digestive diseases, and its results were compared with the daily fecal fat excretion. The 14CO2 peak excretion was abnormal in all the subjects with a fecal fat excretion above 14 g/day, whereas individual values of 14CO2 peak excretion in subjects without steatorrhea and with a fecal fat excretion ranging from 7.1 to 14 g overlapped. The lowest value observed in patients not suffering from steatorrhea was chosen as the lower normal limit of 14CO2 peak excretion. A test sensitivity as high as 64% was attained. The correlation between fecal fat and 14CO2 peak excretion was highly significant (r = 0.802; p less than 0.0001), and it followed a negative exponential function. Therefore, small variations in the 14CO2 peak excretion can be associated with a wide range of fecal fat excretion. Well-compensated diabetes secondary to pancreatitis did not interfere with the results of the test. In conclusion, in our experience this test proved to be a qualitative diagnostic tool with a low sensitivity.

Suppressive effect of chronic glucocorticoid treatment on circulating calcitonin in man.

INTRODUCTION Many factors contribute to glucocorticoid-in deced osteopenia.Corticosteroid excess leads to in testinal malabsorption of calcium through a direct inhibition of the intestinal absorptive process(l, 2) or through an impaired vitamin D metabolism (3, 4). A direct action of the corticosteroid on bone tissue has also suggested (5). On the other hand an impaired calcitonin (CT) secretion has been suggested to be a factor in the pathogenesis of some forms of decreased bone mass (6,7) . To explore a possible relationship between CT secretion and steroid induced bone loss we studied the secretion of this hormone before and during long term treatment with eorticosteroids.

Somatostatin inhibition of insulin secretion in insulin-producing tumors.

Abstract Synthetic linear somatostatin infused in two patients with insulin producing tumors lowered slightly basal insulin and a little less basal glucose levels; above all it inhibited insulin release induced by glucose, glucagon, and tolbutamide.

Duodenal Ulcer in Chronic Relapsing Pancreatitis

Frequency of duodenal ulcer in patients with chronic pancreatitis is still controversial. This study aims to prospectively investigate the frequency of duodenal ulcer in a group of 190 patients (162 males and 28 females) affected by chronic relapsing pancreatitis admitted to our department between 1970 and 1979. 41 cases (21.5%) were endoscopically observed (22% of the males and 17.9% of the females; male:female ratio 1.2:1). Drinking habits, cigarette consumption, presence of pancreatic calcifications and surgery did not affect the frequency of duodenal ulcer. Exocrine pancreatic insufficiency, as fecal fat excretion higher than 7 g/day, seems to be linked with an increased frequency of duodenal ulcer (exact Fishers test: p = 0.0586). Moreover, duodenal ulcer was present in about one third of the patients who afterwards died, but it was the cause of death in only 1 case. Even if a prospective control population is lacking, the male:female ratio of duodenal ulcer in chronic pancreatitis seems to be different from that observed in a comparable hospitalized group (1.2:1 vs. 2.4:1) and from that reported in literature in the general adult population.

Discriminant analysis in the differential diagnosis of hypercalcaemia.

Linear discriminant analysis, a multivariate statistical procedure, applied to serum calcium, phosphate, alkaline phosphatase, bicarbonate, chloride, creatinine and tubular reabsorption of phosphate, proved to be effective in distinguishing patients with Primary Hyperparathyroidism from other hypercalcaemic patients in eighty‐four retrospective cases. The application of the model to thirty‐four prospective cases enabled us to separate correctly, hyperparathyroid patients from non‐parathyroid hypercalcaemic patients.

Lactoferrin concentration in the parotid saliva of patients with chronic pancreatitis.

Lactoferrin is present in pancreatic juice, and greatly increased concentrations are found in the pancreatic juice of patients with chronic pancreatitis. It is not known whether these high levels of lactoferrin represent a genetically determined defect predisposing to the later development of chronic pancreatitis or are simply a consequence of the disease. In view of the morphological and functional similarities between the pancreatic and parotid glands, we have measured the immunoreactive lactoferrin concentration in pure parotid saliva of 30 patients with chronic calcific pancreatitis, 26 controls, 5 patients with proven pancreatic cancer, 2 patients with Sjögrens disease and 2 patients with chronic recurrent parotitis. No difference in the lactoferrin concentration was detected between control subjects and patients with chronic pancreatitis or pancreatic cancer. Raised levels were found in the 4 patients with parotid gland disease. These findings suggest that increased lactoferrin secretion is confined to the exocrine pancreas in patients with chronic pancreatitis and is thus probably a phenomenon secondary to the disease.