Pancreas divisum and acute pancreatitis: romancing the stone?
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Acute Disease↗
Biomedical subjects
J T Cunningham
Publications and source records attributed to J T Cunningham.
Endoscopic stent placement for obstructive jaundice secondary to metastatic malignancy.
In patients with malignancy, jaundice may result from hepatic infiltration or metastatic lymph nodal compression along the bile duct. We attempted endoscopic stent placement on 31 consecutive patients with biliary obstruction from malignant adenopathy, with and without computerized tomographic (CT) scan evidence of hepatic parenchymal metastases. Endoscopic or combined endoscopic-percutaneous decompression was accomplished in 28 patients. Fifteen patients (53.6%) had CT evidence of concomitant metastatic disease to the liver. Thirteen patients had obstructing adenopathy only. Mean survival for patients with hepatic metastases after relief of extrahepatic obstruction was 117.4 days (range 9-386 days). Mean survival after biliary decompression in patients without hepatic involvement was significantly longer at 364.3 days (range 52-1098 days; p = 0.0087). Bilirubin levels fell in all patients in this group. No patient died from complications of obstruction or stent placement. Our data support the conclusion that patients with extrahepatic metastatic biliary obstruction without hepatic metastases have improved survival, compared with patients with both obstruction and hepatic involvement. In the absence of hepatic parenchymal involvement, endoscopic stent placement can safely and effectively palliate metastatic extrahepatic obstruction. Controlled trials are needed to assess the effect of such stenting on survival.
Adult↗
The effects of central norepinephrine infusions on drinking behavior induced by angiotensin after 6-hydroxydopamine injections into the anteroventral region of the third ventricle (AV3V).
Adult male Sprague-Dawley rats were injected with either 6-hydroxydopamine (6-OHDA) or vehicle in the median preoptic nucleus and the organum vasculosum of the lamina terminalis. The subjects were tested for drinking responses to intraventricular angiotensin II (ANG II) or saline during either saline or norepinephrine intraventricular infusions. Rats injected with 6-OHDA into the ventral lamina terminalis initially failed to show drinking responses to ANG II injections. However, norepinephrine infusion in combination with ANG II injection restored the drinking response to ANG II in rats with catecholamine depletions of the lamina terminalis region.
Angiotensin II↗
Dissociation of experimentally induced drinking behavior by ibotenate injection into the median preoptic nucleus.
Adult male Sprague-Dawley rats were injected with either ibotenic acid (5 micrograms/1 microliter) or vehicle in the ventral median preoptic nucleus. The injections were given during either methoxyflurane or ketamine anesthesia. None of the rats injected with ibotenic acid were adipsic after surgery. After at least one week of recovery, all rats were tested for drinking responses to angiotensin II (1.5 and 3 mg/kg s.c.) and hypertonic saline (3% and 12% 1 ml/100 g b.wt.). Rats injected with ibotenic acid during methoxyflurane anesthesia drank significantly less than the vehicle injected control group in tests with both doses of angiotensin II and both concentrations of hypertonic saline. The rats that were injected with ibotenic acid during ketamine anesthesia drank significantly less than the control group when tested with 3% hypertonic saline but not when tested with angiotensin II. Histological examination of the injection sites indicated significant reductions in the volume of the median preoptic nucleus only in rats that had been injected with ibotenic acid during methoxyflurane anesthesia. The results are consistent with the interpretation that the drinking response to angiotensin II is dependent upon the integrity of neurons with postsynaptic N-methyl-D-aspartate receptors within the median preoptic nucleus.
Analysis of Variance↗
Occupational and industrial toxin exposures and the gastrointestinal tract. Gastrointestinal Toxicology Subcommittee of the American College of Gastroenterology Patient Care Committee.
The subcommittee on Gastrointestinal Toxicology of the Patient Care Committee of the American College of Gastroenterology has reviewed potential effects of exposures to occupational and industrial hazards on the gastrointestinal tract, liver and pancreas. This review is presented to 1) share clinical data concerning gastrointestinal toxicology, 2) emphasize the paucity of available information to the practicing clinician, and 3) stimulate basic research interest in this field.
Digestive System Diseases↗
Primary peritoneal sarcoidosis.
A 14-year-old male was admitted for the evaluation of tense exudative ascites. Despite thorough evaluation, the diagnosis remained cryptic until peritoneoscopy revealed diffuse studding of the entire visualized peritoneum with multiple miliary nodules, and peritoneal biopsy demonstrated multiple noncaseating epithelioid granulomas. After other causes were excluded, a diagnosis of sarcoidosis was considered and confirmed with classic endobronchial findings at bronchoscopy. Involvement of the peritoneum with sarcoidosis is rare and, to our knowledge, only one other case describes this as the initial manifestation of this disease.
Adolescent↗
Endoscopic management of biliary fistulas with small caliber stents.
Biliary fistulas have in the past been managed by a variety of methods, including surgical correction or endoscopic sphincterotomy. From 1984 to 1989, we used endoscopic indwelling biliary stents in seven consecutive patients with and without sphincterotomy and have attained fistula closure in all patients studied. The etiologies of the fistulous tracts varied, as did the type and number of stents used. The duration of time between stent placement and observed closure of the fistulous tracts ranged from 3 days to 5 months. Of note, all patients had a dramatic reduction of drainage within the first week. From our study we conclude that surgical correction of biliary fistulas is not required, that sphincterotomy is not mandatory for stent placement or fistula management in patients without distal obstruction, and that a single, small caliber stent alone may be effective.
Biliary Fistula↗
Neuropeptide Y-immunoreactive cells in the caudal medulla project to the median preoptic nucleus.
The region surrounding the anteroventral third ventricle, particularly the median preoptic nucleus, has been implicated in the control of fluid balance and blood pressure. Previous studies indicate that catecholaminergic inputs from the caudal medulla are important in these controls. In this study we report that neuropeptide Y-immunoreactive cells in the caudal medulla project to the median preoptic nucleus in the basal forebrain. Notably these cells are found in the caudal ventral lateral medulla and the nucleus of the solitary tract. Since catecholaminergic projections to the median preoptic nucleus also arise from these regions the possibility of interactions between NPY and catecholamines exists, particularly in the control of fluid balance and blood pressure.
Animals↗
Decreased norepinephrine in the ventral lamina terminalis region is associated with angiotensin II drinking response deficits following local 6-hydroxydopamine injections.
Previous studies have demonstrated that punctate injections of 6-hydroxydopamine (6-OHDA) into structures along the ventral lamina terminalis reduce drinking responses elicited by angiotensin II (ANG II). The purpose of the present study was to extend these findings by quantifying the catecholamine depletions that are associated with the drinking response deficits. Male Sprague-Dawley rats were given injections of 6-OHDA into the median preoptic nucleus (MnPO) and the organum vasculosum of the lamina terminalis (OVLT) after pretreatment with pargyline. Controls were injected with vehicle and a third group received 6-OHDA after pretreatment with desmethylimipramine (DMI). All subjects were tested for drinking responses to centrally injected ANG II and carbachol. Changes in catecholamine content of the MnPO, OVLT, supraoptic nucleus, paraventricular nucleus, caudate and cortex were determined using HPLC with electrochemical detection after behavioral testing. Only rats injected with 6-OHDA without DMI pretreatment showed a significant reduction in ANG II-induced drinking responses. This behavioral deficit was associated with a significant norepinephrine decrease in the ventral lamina terminalis region. All 3 groups showed comparable drinking responses to carbachol. These data support the hypothesis that noradrenergic innervation of the ventral lamina terminalis region is necessary for ANG II-induced drinking responses.
Angiotensin II↗
Central oxytocin systems may mediate a cardiovascular response to acute stress in rats.
The role of central nervous system arginine vasopressin (AVP) and oxytocin (OXY) in the cardiovascular response to acute stress was examined using three experimental models: pharmacological antagonism of central AVP-OXY receptors; lesions of the paraventricular nucleus (PVN); and rats genetically lacking in AVP synthesis, i.e., the Brattleboro strain. Central administration of an AVP-OXY antagonist abolished the increase in heart rate (HR) seen following acute footshock stress. The group receiving centrally administered antagonist increased HR 15 +/- 17 (SE) beats/min, whereas, in contrast, the group receiving intravenous administration of the antagonist showed a 66 +/- 17 beats/min increase, and the group receiving intraventricular antagonist vehicle showed a 101 +/- 14 beats/min increase in response to stress. In a second study, electrolytic lesions of the PVN also blocked the increase in HR seen following stress, 20 +/- 12 beats/min for PVN-lesioned rats, 74 +/- 25 beats/min for sham lesion rats, and 93 +/- 7 beats/min for rats with a lesion not destroying the PVN. In the final study, the responses of Brattleboro rats, i.e., rats genetically deficient in vasopressin synthesis, were equivalent to their Long-Evans controls (131 +/- 13 and 147 +/- 12 beats/min, respectively). In each of these studies, the blood pressure responses to the stressor were equivalent for control and experimental groups. The results of these studies suggest that a neuropeptide system originating in or passing through the PVN may play an important role in the cardiovascular responses to stress and further suggest that the central OXY system may be one pathway mediating this response.
Acute Disease↗
Role of the anteroventral third ventricle (AV3V) region of the rat brain in the pressor response to gamma 2-melanocyte-stimulating hormone (gamma 2-MSH).
We have examined the role of the anteroventral third ventricle (AV3V) region of the forebrain on the pressor responses to intravenous injections of the pituitary pressor agent, gamma 2-melanocyte-stimulating hormone (gamma 2-MSH) and the direct acting alpha 1-adrenergic agonist, phenylephrine in unanesthetized rats. Lesions of the AV3V region produce a parallel shift to the right in the dose response curve to gamma 2-MSH, with no effect on the pressor response to phenylephrine. The lesion had no effect on the heart rate response to either agent. These experiments indicate that the forebrain region surrounding the anterior third ventricle area is important to some of the cardiovascular actions of gamma 2-MSH.
Animals↗
Dieulafoy's cirsoid aneurysm of the duodenum.
Dieulafoy's lesion or cirsoid aneurysm is a rare cause of massive upper gastrointestinal hemorrhage. Historically cirsoid aneurysm most often occurs in the stomach, but has been reported to occur in the jejunum. In this paper, four cases are presented that are felt to represent the first documented cases of cirsoid aneurysm involving the duodenum. At endoscopy, the appearance of Dieulafoy's lesion may range from a pinpoint dot, clot, or tortuous vessel, to blood oozing or spurting from normal mucosa. A shallow defect may be present that can give the appearance of a partially healed peptic ulcer. Previous histologic studies have shown a wide-caliber-persistent artery with intimal thickening, sclerosis, and medial muscular hypertrophy. Once the diagnosis is made, surgical intervention utilizing simple ligation of the involved vessel results in cessation of recurrent hemorrhage. Dieulafoy's lesion is probably more common than the previous literature would suggest. The lesion needs to be considered in the clinical setting of the patient with massive upper gastrointestinal hemorrhage, a paucity of symptoms, and negative findings on barium studies, endoscopy, and exploratory laparotomy.
Adolescent↗
Brain mechanisms and drinking: the role of lamina terminalis-associated systems in extracellular thirst.
Concomitants associated with alterations in body fluid balance serve as stimuli to appraise the brain of the momentary status of body salt and water. Extracellular fluid osmolality and the peptide ANG II have been identified as the humoral components that act as stimuli to trigger central receptors related to cellular and extracellular thirst, respectively. In the case of extracellular thirst, information about pressure/volume status is also obtained from systemic vascular receptors. It is proposed that peripherally-derived neural information is integrated with ANG II-related input within structures located in periventricular tissue of the AV3V.
Angiotensin II↗
A biliary cannulation sleeve.
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Catheterization↗
Estrogen-progesterone therapy for bleeding gastrointestinal telangiectasias in chronic renal failure. An uncontrolled trial.
Gastrointestinal telangiectasias cause hemorrhage in patients with chronic renal failure. Therapies using vasoconstrictors, endoscopic application of heat, and surgery have had limited efficacy. Because several reports have suggested that estrogen or estrogen-progesterone therapy may control mucosal bleeding from telangiectasias in patients with hereditary hemorrhagic telangiectasia, we treated seven patients with chronic renal failure and bleeding gastrointestinal telangiectasias with systemic estrogen or estrogen-progesterone in an uncontrolled trial. Bleeding ceased in all patients. Blood transfusion requirements decreased from a mean of 1.2 U/month before treatment to 0.21 U/month after treatment. No significant side effects were noted. Results of this trial indicate the need for controlled investigations of this type of hormonal therapy.
Aged↗
Endoscopic palliation for jaundice associated with malignant biliary obstruction.
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Adenocarcinoma↗
Circadian rhythms in food intake and activity in domestic cats.
Daily patterns of food intake and activity were determined for normal cats and cats with pontile lesions. Food intake in the dark and in the light of LD (light/dark) cycles were determined separately by weighing the food, and a "percentage nocturnal" score was calculated. The measure of activity was infrared photobeam interruptions, with the photobeam placed in front of the cages, over the food bowl. No differences between normal cats and cats with pontile lesions were detected for any of the measures. Food intake of cats was influenced by simulated starlight and moonlight conditions and by the presence of humans. Cats in isolation from humans and human noises exhibited random patterns of activity in constant light and free-running circadian rhythms in constant dark. Idiosyncratic differences in entrainment to LD cycles were found among cats, and the relevance of this variability is noted for studies of photoperiodic phenomena in this species.
Animals↗
Computed tomographic demonstration of hemobilia.
A patient with hemobilia presumably due to a small hemangioma in the liver is presented. The condition was diagnosed by computed tomography (CT) done immediately following hepatic arteriography and confirmed by hem-positive duodenal aspirates on two occasions.
Aged↗