Aberrant pancreas is not susceptible to alcoholic pancreatitis
T KondoTetsuo HayakawaTokimune ShibataMotoji KitagawaYuzo SakaiHiroshi SobajimaYuji NimuraSatoshi KondoToyoharu Yokoi
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Abstract:
Three cases of chronic alcoholic pancreatitis associated with aberrant pancreas are reported. All three patients underwent laparotomy, and an aberrant pancreas was found in the jejunum of each of the three patients. Microscopic examination of the aberrant pancreas did not show any changes suggestive of chronic pancreatitis, despite severe chronic pancreatitis in the main pancreas.Keywords:
Pancreatic Disease
Chronic alcoholic
Jejunum
Exocrine pancreas
As an orally administered, locally acting gastrointestinal drug, mesalamine products are designed to achieve high local drug concentration in the gastrointestinal (GI) tract for the treatment of ulcerative colitis. The aim of this study was to directly measure and compare drug dissolution of three mesalamine formulations in human GI tract and to correlate their GI concentration with drug concentration in plasma. Healthy human subjects were orally administered Pentasa, Apriso, or Lialda. GI fluids were aspirated from stomach, duodenum, proximal jejunum, mid jejunum, and distal jejunum regions. Mesalamine (5-ASA) and its primary metabolite acetyl-5-mesalamine (Ac-5-ASA) were measured using LC–MS/MS. GI tract pH was measured from each GI fluid sample, which averaged 1.82, 4.97, 5.67, 6.17, and 6.62 in the stomach, duodenum, proximal jejunum, middle jejunum, and distal jejunum, respectively. For Pentasa, high levels of 5-ASA in solution were observed in the stomach, duodenum, proximal jejunum, mid jejunum, and distal jejunum from 1 to 7 h. Apriso had minimal 5-ASA levels in stomach, low to medium levels of 5-ASA in duodenum and proximal jejunum from 4 to 7 h, and high levels of 5-ASA in distal jejunum from 3 to 7 h. In contrast, Lialda had minimal 5-ASA levels from stomach and early small intestine. A composite appearance rate (CAR) was calculated from the deconvolution of individual plasma concentration to reflect drug release, dissolution, transit, and absorption in the GI tract. Individuals dosed with Pentasa had high levels of CAR from 1 to 10 h; individuals dosed with Apriso had low levels of CAR from 1 to 4 h and high levels of CAR from 5 to 10 h; Lialda showed minimal levels of CAR from 0 to 5 h, then increased to medium levels from 5 to 12 h, and then decreased to further lower levels after 12 h. In the colon region, Pentasa and Apriso showed similar levels of accumulated 5-ASA excreted in the feces, while Lialda showed slightly higher 5-ASA accumulation in feces. However, all three formulations showed similar levels of metabolite Ac-5-ASA in the feces. These results provide direct measurement of drug dissolution in the GI tract, which can serve as a basis for investigation of bioequivalence for locally acting drug products.
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Eight groups of Alpine Fine-wool lambs were used to study the development of pH and five enzyme activities in duodenum, proximal jejunum, middle jejunum, distal jejunum, and ileum mucosa or digesta from birth to d56.From duodenum to ileum the acdity of intestinal mucosa and digesta decreased. pH changed in a very little range in all small intestine with age.The trypsin,chymotrypsin, lipase, lactase, and α-amylase activities were observed at birth but decreased at d3.Thereafter they showed a non-uniform change pattern in different parts. From d 3 to 21 the trypsin activity tended to increase and reached peak at d21,thereafter it began to decrease In duodenum, proximal jejunum and middle jejunum. In distal jejunum and ileum it reached peak at d 7. From d 14 to 28 the chymotrypsin activity increased charply and reached peak at d 28 in duodenum.The gradual nonsignificant increases were abserved from d 3 to 56 in proximal jejunum.From d 3 to 21 the chymotrypsin activity increased and reached peak at d 21 in middle jejunum digesta,thereafter it tended to decrease.In distal jejunum the chymotrypsin activity increased from d 3 to 14 ,d 28 to 56 and decreased from d 14 to 28.And reached peak at d 14 and 56 respectively.In ileum it tended to increase with age and at d21 it had a sharply increase. The chymotrypsin activity in duodenum and proximal jejunum digesta was lower than that in other parts,and it was the highest in middle jejunum. The lipase activity of small intestinal mucosa changed little with age.In duodenum mucosa lipase activity was the highest and pre-jejunum was lowest.In all small intestinal mucosa α-amylase activity was near at birth. Duodenum and proximal jejunum was a little low.At 3d α-amylase activity in the two parts mucosa was close to birth, and increased at 7d or 14d respectively.After 21d α-amylase activity in duodenum mucosa was the highest,followed middle jejunum mucosa, and in ileum mucosa it seemed to be the lowest.The lactase activity was high at birth and decreased at 21d.It was the highest in proximal- and midddle-jejunum mucaosa,but lowest in ileum mucosa.The activity changed little in duodenum mucosa,but decreased with age in other parts.
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The i.p. administration of a single dose (10 kg) of lead chloride (PbClJ to male adult rats significantly decreased (P < 0.05) liver ight after 72 h. Lead significantly increaT sed the concentration of total thiols (ToThi) in duodenum and jejunum as well as that of non-protein thiols (NpThi) in jejunum 30 mih after its administration. However, as early as 10 min after administration, lead significantly decreased the activities of the following: a) y-glutamyl transpeptidase (GTP) in liver (60 2 7%), kidneys (26 +- 4%) and jejunum (61 +- 6%); b) alanylaminopeptidase (AAP) in kidneys (27 2 5%) and jejunum (64 2 5%); c) carboxylesterases/amidases (CE/A) in liver (32 ? 3%) and jejunum (47 2 5%); d) glutathione-S-transferase (GST) in liver (49 2 3%), kidneys (51 2 5%) and jejunum (54 2 3%); and d) butyrylcholinesterase (BChE) in jejunum (67 + 4%). Some of lead's effects on the enzymes studied were not detected after 30 min but reappeared 24 and 72 h after lead administration. When taken together, these results indicate that jejunum and liver are the organs in adult rats most susceptible to a single, low dose of PbC1, when it is i.p. administered.
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Our aim was to determine the role of the extrinsic and intrinsic nerves in the regulation of the small intestinal interdigestive myoelectric complex (IMC). In five dogs, the extrinsic nerves of the jejunoileum were divided, but the bowel was left in situ with its wall intact. After recovery, IMCs were detected in the duodenum (mean IMC period +/- SE = 188 +/- 19 min), from where most migrated distally into and through the jejunum (84%). In addition, extra IMCs appeared in the jejunum. Thus, the mean period of the IMCs in the jejunum (134 +/- 10 min) was shorter than in the duodenum (P less than 0.05). In contrast, after enteric transection and reanastomosis at the ligament of Treitz and at a site 75 cm distal to the ligament, fewer duodenal IMCs migrated into the jejunum (only 61%). However, extra IMCs still arose in the jejunum, so that the mean period of IMCs in the jejunum (111 +/- 5 min) was now similar to that in the duodenum (128 +/- 4 min, P greater than 0.05). Our data were consistent with the hypothesis that extrinsic nerves regulate the frequency of the small intestinal IMCs, while an intact enteric wall aids in their distal propagation.
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Abstract
Objective: To estimate the usefulness of serum concentrations of the complex of trypsin 2 and (alpha)1 antitrypsin in diagnosing and assessing the severity of acute pancreatitis in comparison with serum C reactive protein, amylase, and trypsinogen 2 concentrations (reference markers). Design: Markers were measured in consecutive patients admitted with acute abdominal pain that was either due to pancreatitis or to other disease unrelated to the pancreas (controls). Setting: Department of surgery of a teaching hospital in Helsinki. Subjects: 110 patients with acute pancreatitis and 66 with acute abdominal diseases of extrapancreatic origin. On the basis of the clinical course, acute pancreatitis was classified as mild (82 patients) or severe (28 patients). Main outcome measures: Clinical diagnosis of acute pancreatitis and severity of the disease. Results: At admission all patients with acute pancreatitis had clearly raised concentrations of trypsin 2-(alpha)1 antitrypsin complex (32 μg/l), whereas only three of the controls had such values. Of the markers studied, trypsin 2-(alpha)1 antitrypsin complex had the largest area under the receiver operating curve, both in differentiating acute pancreatitis from extrapancreatic disease and in differentiating mild from severe disease. Conclusions: Of the markers studied, trypsin 2-(alpha)1 antitrypsin complex was the most accurate in differentiating between acute pancreatitis and extrapancreatic disease and in predicting a severe course for acute pancreatitis.Key messages
This complex can be accurately measured in a sensitive immunoassay In this study the diagnostic and prognostic accuracy of serum concentrations of trypsin 2-(alpha)1 antitrypsin complex was determined in acute pancreatitis The complex was more accurate than trypsinogen 2, C reactive protein, and amylase in differentiating between acute pancreatitis and extrapancreatic disease and in predicting a severe course for the disease If the immunoassay could be automated determination of concentrations of trypsin 2-(alpha)1 antitrypsin complex could greatly improve the diagnosis of this common and potentially lethal diseasePancreatic Disease
Alpha (finance)
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Etiology
Exocrine pancreas
Chronic alcoholic
Pancreatic juice
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In order to study the physiological changes in the intestinal movement after total gastrectomy with jejunal interposition, electromyography was taken from different sites of small intestine of the dogs with and without gastrectomy.Both 6 and 12 months after surgery, the frequency of the basic electric rhythm (BER) of interposed jejunum was lower and that of distal jejunum was much lower than that of duodenum. Most of the interdigestive migrating electric complexes (IMEC) was originated in the oral side of the interposed jejunum; the rate of occurence increased after the operation further and reached to 91.5% one year after the operation. Most of the dogs showed the propagation pattern from interposed jejunumto duodenum and to distal jejunum; this tendency increased afer the operation and 80.8% of the dogs showed this pattern one year after the operation.Thus, the IMEC, conducted usual intestinal order disappeared after the operation and those originated from oral to anal side, regardless of their original order. These results suggest that the order of the propagation of IMEC were determined bythe order of the portion of intestine after operation and the parietal continuity, rather than extrinsic nerves, is involved in the propagation. It is also suggested that the propagation of IMEC is not always correlated with the gradient in the difference of the BER between the replaced jejunum and duodenum.
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Migrating motor complex
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