Ole Vagn Nielsen

Vagal, Cholinergic Regulation of Pancreatic Polypeptide Secretion

THE EFFECT OF EFFERENT, PARASYMPATHETIC STIMULATION UPON PANCREATIC POLYPEPTIDE (PP) SECRETION WAS STUDIED IN THREE WAYS: (a) Plasma PP concentrations increased in response to insulin-induced hypoglycemia in both normal subjects, from 11 pM (9.5-12.5) to 136 pM (118-147), n = 8 (median and interquartile range) and in duodenal ulcer patients, from 33 pM (21-52) to 213 pM (157-233), n = 7. The PP response to hypoglycemia was diminished by atropine in normal subjects (P < 0.005) and completely abolished by vagotomy in the duodenal ulcer patients. (b) Electrical stimulation, 8 Hz, of the vagal nerves in anesthetized pigs induced an increase in portal PP concentrations within 30 s from 32 pM (28-39) to 285 pM (248-294), n = 12. Minimal stimulatory frequency was 0.5 Hz and maximal stimulatory frequency 8-12 Hz. Atropine inhibited the PP response to electrical stimulation. Median inhibition with 0.5 mg of atropine/kg body wt was 74%, range 31-90%, n = 6. The response was eliminated by hexamethonium. Adrenergic alpha and beta blockade did not influence the release of PP in response to vagal stimulation. (c) Acetylcholine stimulated, in a dose-dependent manner, the secretion of PP from the isolated perfused porcine pancreas, half-maximal effective dose being 0.19 muM; maximal PP output in response to 5 min stimulation was 228 pmol, range 140-342 pmol, n = 5. Atropine completely abolished this response.The results of the present study together with the previously demonstrated poor PP response to food in vagotomized patients, indicate that vagal, cholinergic stimulation is a major regulator of PP secretion.

Diseases of the urachus simulating intra-abdominal disorders

Abstract The urachus forms in early embryonic life as a tubular communication between the bladder lumen and the allantois. After birth the bladder descends and the urachus undergoes varying degrees of regression during which its lumen normally closes. Various diseases may affect the urachus. Their symptoms, signs, and pathologic anatomy are reviewed. A common feature of these conditions is partial reopening of the lumen of the regressive urachus. The distinction between congenital and acquired urachal diseases is made. Five cases of acquired urachal disease, observed in a department of abdominal surgery, are reported. It is emphasized that the symptoms and signs were suggestive of acute abdominal conditions caused by intra-abdominal diseases. Acquired urachal disease, causing a true acute abdominal condition, elicited by supervening complications, is described on the basis of the literature and the present series. Therapeutic principles are discussed, taking into account the possibility of malignant degeneration of the urachus and the high recurrence rate in acquired urachal disease.

Oxyntomodulin (glicentin-(33-69)): pharmacokinetics, binding to liver cell membranes, effects on isolated perfused pig pancreas, and secretion from isolated perfused lower small intestine of pigs

The pharmacokinetics of purified synthetic oxyntomodulin were studied after infusing it into euglycaemic pigs at two rates. The elimination of the peptide from plasma was characterized by two components, a fast one (t1/2 7.2 +/- 0.6 min) and a slow one (t1/2 20.4 +/- 3.8 min) (mean +/- S.E.M., n = 7). The metabolic clearance rate was independent of infusion rate (6.96 +/- 0.99 vs 7.44 +/- 0.98 ml/kg . min (mean +/- S.E.M., n = 7). The synthetic peptide bound to pig hepatic glucagon receptors, but with approximately 2% of the affinity of glucagon, and showed insulinotropic and somatostatinotropic effects when infused into isolated perfused pig pancreases at concentrations higher than 10(-10) M. A dose-dependent increase was also shown for pancreatic glucagon output. A naturally occurring peptide, identified as oxyntomodulin by gel filtration and HPLC, was released into the circulation from the pig lower small intestinal mucosa upon intraluminal administration of glucose, and represented 25 +/- 3.8% of the secreted glucagon-like immunoreactivity. 11 +/- 2.3% of the secreted glucagon-like immunoreactivity was indistinguishable from glucagon itself upon gel filtration; thus at least 36% of the glucagon-like immunoreactivity secreted from the intestinal mucosa is already in an active form.

Lateral subcutaneous sphincterotomy versus anal dilatation in the treatment of fissure in ano in outpatients: a prospective randomised study.

Fifty eight patients with idiopathic chronic anal fissure were included in a randomised prospective trial of lateral subcutaneous sphincterotomy versus simple anal dilatation carried out as outpatient procedures. Operations were performed under local anaesthesia and the patients reviewed 10-30 months later (median follow up time 18 months). Altogether 30 patients were treated by lateral subcutaneous sphincterotomy and 28 by anal dilatation. No serious complications were observed in either group. One recurrence was observed in the group treated by sphincterotomy, whereas eight occurred in the other group (p less than 0.05). Functional results with respect to impaired control of flatus and soiling of underwear were significantly better after sphincterotomy (p less than 0.002). It is concluded that lateral subcutaneous sphincterotomy is the treatment of choice for idiopathic chronic anal fissure resistant to conservative measures.

The intestinal mucosa preferentially releases somatostatin-28 in pigs

We studied the molecular forms of somatostatin-like immunoreactivity (SLI), newly released from isolated perfused preparations of the porcine antrum, stomach, pancreas and upper small intestine: Perfusion effluents were concentrated by Sep-Pak C-18 adsorption, eluted with ethanol, dessicated, and subjected to gel filtration with subsequent radioimmunoassays for somatostatin-14 and N-terminal somatostatin-28 immunoreactivity. All the SLI newly released from the stomach and antrum eluted at the position of somatostatin-14, and such was also the case for more than 95% of the SLI newly released from the pancreas, while 68 -/+ 7% and 75 -/+ 8% of the SLI newly released from the isolated perfused jejunum and ileum, respectively, corresponded to somatostatin-28. By reverse phase HPLC the identity of these peptides with synhetic somatostatin-14 and -28 was established.

Ceruletide reduces postoperative intestinal paralysis. A double-blind placebo-controlled trial.

Sequential analysis of a placebo-controlled double-blind clinical trial involving 18 patients demonstrated that ceruletide had a statistically significant effect on restoration of peristalsis in intestinal paralysis after abdominal surgery (P<0.05).

Secretin release from the isolated, vascularly perfused pig duodenum.

1. A method for the isolation and vascular perfusion of the porcine pancreas and duodenum was developed. 2. The oxygen consumption of the whole preparation was similar to that of the pancreas alone, and since the duodenal arteriovenous oxygen deficit was similar to that of the total preparation, it was concluded that the duodenum respired adequately. 3. The duodenum rapidly absorbed luminally administered radioactive glucose, and this absorption was strongly inhibited by ouabain and phloridzin. 4. The duodenum secreted secretin rapidly in response to hydrochloric acid, but did not respond to any other luminal stimuli, including lipids, proteins, carbohydrates and bile. Neither was secretin release stimulated by intra‐arterially injected acetylcholine. 5. By gel permeation chromatography the release immunoreactive secretin behaved identically to pure natural secretin, indicating that the tissue form and the circulating form have identical molecular size. 6. It is concluded that this model offers an unique opportunity to study the endocrine secretion of the duodenum.

Effect of Sulfation of CCK-8 on Its Stimulation of the Endocrine and Exocrine Secretion from the Isolated Perfused Porcine Pancreas

The secretory effect of sulfated and nonsulfated cholecystokinin octapeptide (CCK-8) was studied on the isolated perfused porcine pancreas. Both CCKs in concentrations from 10(-11) to 10(-8) mol/l in the presence of glucose (7.5, 5.0 or 3.5 mmol/l) were without effect on insulin and glucagon release. The exocrine secretion was stimulated by both CCKs in a dose-dependent manner, but sulfated CCK-8 was considerably more potent. The study shows that CCK-8, a major constituent of endogenous CCK, does not contribute to the incretin mechanism, irrespective of degree of sulfation. In contrast, CCK-8 is a potent stimulator of exocrine pancreatic secretion. For this effect sulfation is crucial.

Results of hepatic lobectomy for primary epithelial cancer in 31 adults

Hepatic lobectomy for primary epithelial cancer was performed in 31 adults from 1964 through 1977 in the surgical departments of six Scandinavian hospitals. Twenty-three patients were discharged and had a 2 year survival rate of 62 per cent and a 5 year survival rate of 16 per cent. Alternatives to surgery have not yet emerged. Further progress requires centralization.

Role of gastrin-releasing peptide in neural control of pancreatic exocrine secretion

We studied the effect of electrical stimulation of the vagus nerves on the exocrine secretion of isolated perfused porcine pancreas before and after procedures that almost completely blocked the effects elicited by infusions of gastrin-releasing peptide (GRP): desensitization of the pancreas for GRP (by perfusion with high concentrations of GRP); administration of an antagonist of GRP action [D-Arg1, D-PrO2, D-Trp7,9, Leu11)-substance PI; and perfusion with Fab fragments of antibodies against GRP. Both desensitization and antagonist administration significantly (p < 0.01) inhibited the effect of vagus stimulation on pancreatic protein secretion (by 42.1 and 33%). The inhibitory effect of anti-GRP perfusion was less pronounced (22% inhibition, 0.05 >p < 0.1). The results support the notion that pancreatic, GRP-producing nerve fibers are involved in the neural control of pancreatic enzyme secretion.