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Biomedical subjects

J A Gregg

Publications and source records attributed to J A Gregg.

At least 19 recordsLinked to original sources
PubMed1985

Effects of exogenous secretin on pancreatic and biliary ductal and sphincteric pressures in man demonstrated by endoscopic manometry and correlation with plasma secretin levels.

An endoscopic manometric technique was used to investigate the effects of exogenous secretin on pancreatic duct, common bile duct, pancreatic duct sphincter, and bile duct sphincter pressures in 20 healthy volunteers. Synthetic secretin was infused intravenously at rates of 8.05, 16.1, 32.2, 64.4, 129, 258, and 516 ng/kg/hr, and plasma secretin concentrations were measured by a radioimmunoassay. Secretin produced a significant fall in peak and trough pancreatic duct sphincter pressures from basal values of 48.2 +/- 7.9 mm Hg (mean +/- SD) and 16.9 +/- 7.7 mm Hg, respectively, to 34.4 +/- 6.8 mm Hg and 11.2 +/- 5.8 mm Hg (P less 0.005), respectively, at a mean plasma secretin concentration of 16 pg/ml (during an infusion rate of 32.2 ng/kg/hr). Higher infusion rates had no additional effect. Pancreatic duct pressure became significantly elevated above basal (11.5 +/- 4.0 mm Hg) at the two highest secretin rates. Secretin had no effect on common bile duct or bile duct sphincter pressures. Plasma secretin concentrations were within the postprandial range during the lowest four secretin infusion rates. We conclude that secretin produces selective physiological relaxation of the pancreatic duct sphincter.

Adult↗
PubMed1985

Secretion of beta-lactam antibiotics in pure human pancreatic juice.

The secretion of cephalothin and cefoxitin in stimulated pure pancreatic juice was studied in 13 persons after intravenous administration of antibiotics. Of all these studied, three had acute relapsing pancreatitis, five chronic pancreatitis, and five were control subjects. Antibiotic levels were measured in paired pure pancreatic juice and serum samples at fixed time intervals after administration. Cephalothin was detected in very low levels (1 to 1.8 micrograms/ml) in the pure pancreatic juice of four of the six persons studied (3 micrograms/ml). Although therapeutic levels were not obtained in stimulated pure pancreatic juice with either antibiotic, additional studies evaluating antibiotic levels in unstimulated pure pancreatic juice and in pancreatic tissue would be helpful in assessing the role of antibiotic therapy in the treatment of pancreatitis.

Acute Disease↗
PubMed1985

Effects of sphincteroplasty and endoscopic sphincterotomy on the bacteriologic characteristics of the common bile duct.

Forty-five patients with sphincter of Oddi stenosis had specimens of common bile duct cultured during ERCP before either sphincteroplasty or endoscopic sphincterotomy. All had sterile bile before sphincter ablation. Bile was recultured 6 to 36 months later during endoscopy at which time 70 percent of the sphincterotomy and 76 percent of the sphincteroplasty patients had bile colonized principally by enteric organisms. Growth was heavy to moderate in most of the patients and contained few nasopharyngeal organisms. Despite bactobilia, no patient had symptomatic cholangitis, presumably due to excellent drainage of bile. The most likely source of the bactobilia is from direct extension of duodenal organisms into the common bile duct.

Adult↗
PubMed1985

Sphincter of Oddi stenosis: diagnosis using hepatobiliary scintigraphy and endoscopic manometry.

To determine the role of radionuclide imaging in diagnosing sphincter of Oddi stenosis, 21 patients with symptoms suggesting this disorder underwent endoscopic retrograde cholangiopancreatography, cholescintigraphy, and, when possible, endoscopic manometry. Those patients with abnormal hepatobiliary scintigraphy results--based on our criteria of delayed biliary intestinal transit, abnormal duct size, and abnormal time-activity dynamics and obstruction--had a mean basal sphincter pressure of 38.5 mm Hg. Sphincter pressures could not be measured in six patients with sphincters too tight to cannulate. Ten patients who underwent hepatobiliary scanning both before and after sphincter surgery had normal scan results on the repeat study. Hepatobiliary imaging appears useful for diagnosis of sphincter of Oddi stenosis in selected patients in whom manometry cannot be performed and for objective assessment of response to therapy.

Adult↗
PubMed1984

Rhythm abnormalities of the biliary and pancreatic sphincters: diagnosis by endoscopic manometry.

Abnormal phasic wave activity was noted in the biliary duct sphincter, pancreatic duct sphincter, or both in 43 patients. This abnormality consisted of a tachyrhythmia in 40 patients and absent phasic wave activity in 3 patients. Tachyrhythmia was encountered in patients with elevated basal sphincter pressures. In four patients with tachyrhythmia, administration of intravenous naloxone failed to modify phasic wave activity. Three patients with normal basal sphincter pressures had absent phasic wave activity. This abnormality occurred in two patients with cirrhosis and in one patient with suspected cirrhosis. In one patient with cirrhosis, administration of intravenous morphine did not induce phasic wave activity.

Adult↗
PubMed1984

Endoscopic pancreatic and biliary manometry in pancreatic, biliary, and papillary disease, and after endoscopic sphincterotomy and surgical sphincteroplasty.

Endoscopic manometry was used to measure pancreatic duct, common bile duct, pancreatic duct sphincter and bile duct sphincter pressures in 43 healthy volunteers and 162 patients with a variety of papillary, pancreatic and biliary disorders. Common bile duct pressure was significantly raised after cholecystectomy, with common bile duct stones and papillary stenosis but pancreatic duct pressure only in papillary stenosis. After endoscopic sphincterotomy mean common bile duct pressure fell from 11.2 to 1.1 mmHg and pancreatic duct pressure from 18.0 to 11.2 mmHg. Distinct pancreatic duct sphincter and bile duct sphincter zones were identified as phasic pressures of 3-12 waves/minute on pull-through from pancreatic duct and common bile duct to duodenum. Pancreatic duct sphincter pressures were higher with common bile duct stones and stenosis whereas bile duct sphincter pressures were higher in pancreatitis and stenosis. Bile duct sphincter activity was present in 60% of patients after surgical sphincteroplasty but 21% of patients after endoscopic sphincterotomy. Endoscopic manometry facilitated the diagnosis of papillary stenosis, has allowed study of papillary pathophysiology and has shown a functional inter-relationship between the two sphincteric zones.

Adult↗
PubMed1979

Endoscopic retrograde cholangiopancreatography and gray-scale abdominal ultrasound in the diagnosis of jaundice.

Fifty-five patients with suspected obstructive jaundice were studied with both ERCP and abdominal ultrasound. Biliary tract obstruction was documented in 49 patients and parenchymal liver disease in 7. A definite cause of jaundice was demonstrated by ERCP in 45 of 49 patients with biliary tract obstruction but in only 28 of 49 patients by ultrasound. Bile duct dilatation, where present, was detected by ERCP in only 33 of 42 patients. ERCP was particularly effective in patients with common duct stones; common duct calculi and a dilated common duct were detected in 15 of 16 such patients. Dilated bile ducts where present were detected by ultrasound in 22 of 42 patients. Ultrasound was particularly helpful in patients with pancreatic cancer in whom a dilated common duct could not be opacified during ERCP. ERCP and abdominal ultrasound together provide a rapid and safe method of diagnosis in the jaundiced patient with suspected bile duct obstruction.

Adolescent↗
PubMed1978

Pancreatic hypersecretion in liver disease.

Abnormally large duodenal aspirates have been reported in a large percentage of patients with cirrhosis of the liver. The source of this fluid has been variously ascribed to the liver and/or pancreas. The present study was undertaken to clarify its source. Eleven patients with cirrhosis of the liver and one with cholestatic hepatitis underwent an intraductal secretin test during endoscopic cannulation of the pancreatic duct. Six patients with cirrhosis had pancreatic hypersecretion ranging from 7.8 to 26.0 ml/min, while three patients demonstrated low secretory flow rates. Bile flow was negligible or nonexistent in ten patients, while in two others, larger but unmeasurable amounts of bile secretion were present. This study conclusively demonstrates that pancreatic hypersecretion may occur in patients with cirrhosis during secretin stimulation. Impaired metabolism of secretin or the associated pancreatic hypersecretion of early pancreatitis may be responsible for this finding.

Bile↗
PubMed1978

Endoscopic measurement of pancreatic juice secretory flow rates and pancreatic secretory pressures after secretin administration in human controls and in patients with acute relapsing pancreatitis, chronic pancreatitis, and pancreatic cancer.

Secretory flow rates were measured inside the main pancreatic duct during endoscopic retrograde cholangiopancreatography (ERCP) in patients with acute relapsing pancreatitis, chronic pancreatitis, and pancreatic cancer and in controls after intravenous administration of secretin. Peak secretory flow rates in these groups were 5.04 +/- 1.74, 0.71 +/-1.28, 0.60 +/- 1.37, and 4.13 +/- 0.88 ml/min, respectively. Peak secretory pressures were also measured intraductally in patients with acute relapsing pancreatitis and pancreatic cancer and in controls and were 402 +/- 69, 75 +/- 161, and 403 +/- 99 mm pancreatic juice, respectively. Peak secretory flow rates and pressures measured in controls during constant administration of secretin were similar to those measured when secretin was administered as a bolus.

Endoscopy↗
PubMed1977

Problems in the diagnosis of pancreatic carcinoma by endoscopic retrograde cholangiopancreatography.

Diagnostic problems occurred in five out of 55 patients undergoing endoscopic retrograde cholangiopancreatography who subsequently proved to have carcinoma of the pancreas. In one patient the pancreatic duct was normal, two had non-specific ductal abnormalities, one had pancreas divisum, and one had ductal ectasia. Two patients with non-specific changes on retrograde pancreatography had evidence of tumor on their retrograde cholangiogram. Two patients had ductal obstruction simulating pancreatic cancer, in one due to compression by the thoracic spine, in the other by inflammatory changes.

Aged↗
PubMed1977

Percutaneous fine needle aspiration biopsy of pancreatic carcinoma.

Carcinoma of the pancreas was diagnosed in 13 patients by percutaneous fine needle aspiration. The tumor was localized by angiography in eight, ultrasound in five, and endoscopic retrograde pancreatography in three patients. In four patients aspiration was performed using two of the three localizing techniques. Cytological diagnosis of carcinoma of the pancreas can be made accurately by percutaneous fine needle aspiration of the tumor and operative intervention avoided in those patients who do not require operative bypass procedures. Percutaneous fine needle aspiration can be used with equal facility with arteriography, ultrasound, or endoscopic retrograde pancreatography. There have not been complications due to fine needle biopsy, and one can expect a 77-86% positive diagnostic yield.

Angiography↗
PubMed1977

Duodenoscopy and endoscopic pancreatography in patients with postive morphine prostigmine tests.

Twenty-three patients with abdominal pain and positive morphine prostigmine tests underwent duodenoscopy and endoscopic retrograde cholangiopancreatography (ERCP). Sixteen demonstrated marked or moderate ampullary stenosis. The pancreatic duct was dilated in three and stenotic in four. Ampullary stenosis was confirmed in all patients who subsequently underwent sphincteroplasty. Only six patients had pancreatitis demonstrated by appropriate laboratory studies or at surgery. Relief of pain after sphincteroplasty was complete in ten patients during follow-up.

Adolescent↗
PubMed1977

Pancreas divisum: its association with pancreatitis.

Thirty-three patients with pancreas divisum studied by endoscopic retrograde cholangiopancreatography (ERCP) are described. Documented pancreatitis was present in fifteen patients, and another eleven had recurrent episodes of pain typical of pancreatitis. The major papilla was cannulated in all patients, but the duct of Wirsung was opacified in only twenty-eight and showed changes of pancreatitis in one. Attempts were made to cannulate the minor papilla in fifteen of the thirty-three patients and were successful in four. The duct of Santorini showed typical changes of pancreatitis in one. One patient had pancreatic cancer, and the duct of Wirsung demonstrated only nonspecific abnormalities. In only two cases was pancreatitis due to alcohol abuse. The high incidence of pancreatitis and pancreatic-like pain in patients with pancreas divisum, may be due to the very small ampulla of the duct of Santorini which in these patients drains the majority of the pancreas, creating a marked relative stenosis of the ampulla. Surgery for relief of pain was required in five patients. The operation of choice, when pancreatitis involves the dorsal pancreas, appears to be distal resection with drainage.

Cholangiography↗
PubMed1977

Detection of bacterial infection of the pancreatic ducts in patients with pancreatitis and pancreatic cancer during endoscopic cannulation of the pancreatic duct.

Bacterial infections of the pancreas and bacteremia may occur during episodes of pancreatitis. Detection of bacterial infections of the pancreas in the past has required laparotomy. The present study was undertaken to determine whether bacterial infection of the pancreas occurred during nonsuppurative pancreatitis. During endoscopic cannulation of the main pancreatic duct, secretin was administered intravenously and pancreatic juice aspirated from within the duct was cultured. Bacterial infections were detected in 11 of 35 patients with pancreatitis and 3 of 5 with pancreatic cancer. The pancreatic juice was sterile in 25 controls. Cultures from the common bile duct in 9 controls were also sterile whereas 4 of 6 with pancreatitis showed infected bile. The infecting organisms were principally gram-negative and the infections were usually polymicrobial. Antibiotics, where used, successfully eradicated the infecting organisms but did not appear to affect the patient's clinical course.

Adult↗
PubMed1976

Carcinoembryonic antigen (CEA) activity in pancreatic juice of patients with pancreatic carcinoma and pancreatitis.

Carcinoembryonic antigen (CEA) activity was assayed in plasma and in pure pancreatic juice from eight patients with carcinoma of the pancreas, 28 patients with pancreatitis, and 13 controls with no demonstrable pancreatic disease. Juice specimens were obtained via direct transduodenal cannulation of the pancreatic duct. The mean pancreatic juice CEA activities in controls, pancreatitis, and pancreatic carcinoma were 8.1 ng/ml, 18.6 ng/ml, and 309 ng/ml, respectively. Pancreatic juice CEA activity in patients with cancer of that organ was significantly higher than in those with pancreatitis or in controls. None of the 32 subjects with both pancreatic juice CEA activity less than 30 ng/ml and plasma CEA less than 2.5 ng/ml had pancreatic cancer. Three of the four patients with CEA elevations in both fluids above these levels harbored this malignancy. These findings suggest that combined measurement of CEA activity in plasma and pancreatic juice may help in diagnosing pancreatic disease.

Carcinoembryonic Antigen↗
PubMed1976

Demonstration and immunochemical characterization of carcinoembryonic antigen in human pancreatic juice.

Pancreatic juice collected from 10 patients without evidence of malignant disease of the pancreas or other organs was pooled, extracted, and fractionated by Sepharose 6-B and Sephadex G-200 gel filtration. The carcinoembryonic antigen (CEA) activity in the material was demonstrated and studied by: a) radioimmunoassay, b) competitive binding to antibodies against CEA, c) precipitin inhibition, and d) Ouchterlony analysis. The immunochemical identity of the active material to CEA purified from liver metastases of colon cancer was demonstrated.

Binding, Competitive↗
PubMed1975

Angiography vs. pancreatography in diagnosis of carcinoma of the pancreas.

Relative efficacy of angiography and pancreatography in the diagnosis of pancreatic carcinoma was assessed in 13 patients. Pancreatography provided a correct preoperative diagnosis in 10 patients. In 3 patients the duct could not be cannulated. Twelve patients underwent angiography and a correct diagnosis was made in 10. Preoperative diagnosis was not made by either technique in 1 patient. Pancreatography did not detect carcinoma of the pancreas at an earlier stage than did angiography. These procedures should be considered complementary to each other. Angiography defines the size, extension and resectability of the tumor. Pancreatography outlines the internal architecture of the gland and duct system.

Aged↗