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Biomedical subjects

M Büchler

Publications and source records attributed to M Büchler.

At least 217 records · Page 12Linked to original sources
PubMed1987

Adaptive changes of the exocrine pancreas and plasma cholecystokinin release following subtotal gastric resection in rats.

This study was performed to investigate adaptive changes of the exocrine pancreas occurring after distal gastric resection by different procedures: Billroth I (BI) and Billroth II (BII). Sixty-four male Wistar rats were used and divided into four groups: controls (n = 16), sham-operated (n = 16), BI (n = 16) and BII (n = 16) subtotal gastric resection. Both procedures of subtotal gastric resection showed an organotrophic effect on the pancreas after 2 weeks: pancreatic weight in BI- and BII-operated rats increased by 23 and 35% and DNA content by 36 and 27%, respectively, compared to controls (p less than 0.001). After 4 weeks a further increase in pancreatic weight (46%), DNA content (52%) and protein content (58%) was found in BII rats. Trypsin and amylase content were increased in BI rats after 2 weeks (p less than 0.01). No parallel changes were observed in the enzyme content of BII rats as trypsin increased by over 200%, amylase by over 100% and lipase remained unaffected. Hormonal studies were carried out in 36 rats divided into groups as above. Basal and stimulated plasma levels of gastrin were reduced (p less than 0.01) following both types of subtotal gastric resection (p less than 0.01). Basal cholecystokinin (CCK) plasma levels did not differ between operated and control rats. Following the test meal CCK plasma levels were significantly increased after BII gastric resection (p less than 0.001) and BI gastric resection (p less than 0.01) compared to controls.

Amylases↗
PubMed1987

Improved method for the determination of phospholipase A2 catalytic activity concentration in human serum and ascites.

An improved radiochemical method is presented for the selective determination of phospholipase A2 activity in human serum and ascites, using only commercially available reagents. The method can be applied to large quantities of samples. As substrate we used 1,2-dipalmitoyl-sn-glycero(3)phosphorylcholine and phosphatidylcholine containing tritiated palmitic acid in position 2 (1-palmitoyl,2-[9,10-3H]palmitoyl-sn-glycero(3)phosphorylcholine). The liberated fatty acids are extracted and radioactivity is detected in a liquid scintillation spectrometer. A preliminary reference range of human serum samples was established ranging up to 1.0 U/l. In sera of patients with acute pancreatitis we found activities up to 20 U/l. The correlation of phospholipase A2 activity with that of other enzymes and with the severity and complications of acute pancreatitis was investigated. A possible relationship between phospholipase A2 activities and pulmonary complications is discussed.

Ascites↗
PubMed1987

[The fluorescein dilaurate serum test following metoclopramide and secretin stimulation for evaluating pancreatic function. Contribution to the diagnosis of chronic pancreatitis].

A new method of exocrine pancreatic function testing is described. After oral administration of a standard meal containing fluorescein dilaurate (FDL) metoclopramide (10 mg) and secretin (1 U/kg) are given as intravenous bolus injection. The best discrimination between normal and abnormal pancreatic function was found to be the individual peak serum fluorescein concentration within 180 minutes. 184 patients were studied and divided into 4 groups according to the final diagnosis: group 1: 44 healthy controls; group 2: 87 patients with chronic pancreatitis; group 3: 21 patients with different pancreatic diseases; group 4: 32 patients with different gastrointestinal disorders. Sensitivity of the FDL serum-test in detecting chronic pancreatitis was 87%, specificity was 97%. Considering patients with different gastrointestinal disorders specificity dropped to 77%. FDL serum-test revealed superior as compared to the FDL urine test. Correlation between FDL serum-test and secretin ceruletide test was significant (r = 0.72, p less than 0.001).

Chronic Disease↗
PubMed1987

[Peptic ulcer: status of resecting stomach surgery].

In gastric ulcer disease the operative procedure of choice is still partial gastrectomy, mostly carried out as Billroth I reconstruction with preservation of the duodenal passage. Indications for gastric resection are as follows: suspicion of malignancy, non-healing ulcers under conservative therapy, recurrent ulcer following conservative treatment, multiple and giant ulcers and ulcer complications like penetration, perforation, or bleeding. In duodenal ulcer gastric resection represents the exception. The routine operation is selective proximal vagotomy. The indication for partial gastrectomy in duodenal ulcer disease is: Recurrent ulcer after selective vagotomy (refractory to drugs), gastrin cell hyperplasia (hyper-function) and in rare cases of technical problems during surgery.

Duodenal Ulcer↗
PubMed1986

Diagnostic and prognostic value of serum elastase 1 in acute pancreatitis.

Serum elastase 1 was determined in the serum of 38 patients with acute pancreatitis, using specific radioimmunoassay technique. Serving as controls were 36 healthy people, 33 patients with chronic pancreatitis, 49 patients with various GI-tract diseases, and 6 patients with pancreatic carcinoma. Sensitivity of elastase 1 for the diagnosis "acute pancreatitis" was 97% after admission to the hospital and 100% within 48 h after onset of acute pancreatitis. The determination of elastase 1 is clearly superior to that of trypsin, pancreatic lipase, or pancreatic amylase, if diagnosis has to be made more than 48 h after the onset of the disease. The specificity is restricted, because there are some cases with chronic pancreatitis and GI-diseases with raised values. There is no possibility to estimate the severity of acute pancreatitis by measuring serum elastase 1.

Acute Disease↗
PubMed1986

CA 19-9 and pancreatic adenocarcinoma.

The diagnostic place value of CA 19-9, a tumor-associated antigen, was tested in 611 patients. This group of patients included 273 patients who suffered from a malignant disease (48 patients with pancreatic carcinomas and 225 patients with extrapancreatic malignant growths) and 338 patients with benign diseases (66 patients with chronic pancreatitis, 36 patients with acute pancreatitis, and 236 patients with general surgical diseases). In 93% of the patients with pancreatic carcinoma (media value, 528 U/ml), in 37% and 19% of the patients with carcinoma of the stomach and colorectal carcinomas (median value 8 U/ml), respectively, the CA 19-9 value was estimated as being above the normal limits of 6 to 37 U/ml. A sensitivity of 93% and a specificity of 85%, as well as a total accuracy of 82%, were established in pancreatic carcinoma during preoperative observation. The preoperatively raised CA 19-9 concentration in patients with pancreatic carcinomas dropped after curative resection of the carcinoma to within normal limits. However, a serum concentration of less than 37 U/ml was not recorded in any CA 19-9 estimation after a palliative surgical intervention, or in any case of inoperable carcinomas.

Adenocarcinoma↗
PubMed1986

Ultrastructure of human acute pancreatitis.

Few studies have been published on the ultrastructural changes which accompany human acute pancreatitis, and these have concentrated primarily on parenchyma. The present study concentrates on extraparenchymal changes, compares acute pancreatitis occurring alone with that on a background of chronic pancreatitis, and tests for similarity with observations made previously in an experimental model. Pancreatic tissue came from 16 patients undergoing surgery for pancreatic disease and five subjects without pancreatic disease. Regressive changes in parenchymal cells were consistent with ischemia, and with previously described studies. Polymorphonuclear leukocytes infiltrated into stroma and parenchyma. Platelets accumulated intra- and extravascularly. Fibrin deposits were common in the connective tissue, and could be observed in intercellular spaces at the base of acini, mingled with degenerating acinar cells and secretion product. Microthrombi occurred in blood vessels. These alterations were consistent with those in experimental acute pancreatitis. Similar changes were observed whether or not acute pancreatitis occurred on a background of chronic pancreatitis. The vascular component is important in acute pancreatitis, and altered epithelial barriers allow interaction between blood-borne material and pancreatic exocrine secretions.

Acute Disease↗
PubMed1986

Structure and function of specialized cilia in the exocrine pancreas.

Cilia are found in acinar and ductular lumina. Most descriptions of human or dog pancreatic tissue have indicated that these are probably motile structures which move and/or mix pancreatic secretion. A recent study interpreted arrangements of microtubules within cilia which deviated from the classic 9 + 2 pattern as indicating pathological change. There have been suggestions, however, from studies on nonmammalian and human pancreas, that the structure of pancreatic cilia suggests a sensory function. The present paper reports studies on the ultrastructural organization of the specialized cilia in human and canine pancreatic tissue. The pattern of microtubular organization resembles that of cilia modified for chemoreception rather than that of classic kinocilia. It is concluded that pancreatic ductular cilia are sensory rather than motile, providing a mechanism for monitoring general or specific molecular concentrations.

Animals↗
PubMed1986

Presence of two distinct acinar cell populations in human pancreas based on their antigenicity.

The immunohistochemical localization of ABH- and Lewis (Le)-related blood group antigens, including CA 19-9, a sialylated Lea antigen, was examined using monoclonal antibodies (MoAbs) in 18 normal human pancreases and compared with ABH blood group antigenicity of the individuals. Acinar cells expressed ABH, Leb, Ley, and in some cases, Lex antigen in various proportions, but not Lea and CA 19-9. The reactivity of Leb and Ley was similar with regard to cellular localization and specificity. In all specimens but one, the distribution of Leb (and Ley) and H antigens on the one hand, and of A or B antigens on the other, showed a reciprocal relationship, in that one group of acini expressed Leb (and Ley) and H antigens, but lacked any A or B antigens (type 1 acinar cell); another group of acinar cells had A or B antigens, but expressed neither Leb (Ley) or H antigens (type 2 acinar cell). In ductal cells, four of eight individuals with blood group A, two of three with blood group B, and five of six with blood group O expressed the appropriate antigen, while the remainder did not. Lea antigen was expressed primarily by centroacinar and terminal ductular and ductal cells of medium-sized ducts of all specimens, whereas Leb was present in the cells of small and large ducts in all but four cases. The reactivity of ductal and ductular cells to Lex was negative, except for one case. MoAb-Ley and MoAb 19-9 reacted only with a few ductal cells in six (33%) and 12 cases (67%), respectively. There was no relationship in the expression of Le-related antigens between acinar and ductal/ductular cells; nor were there any sex difference with regard to the binding patterns of any antibodies. However, age appeared to influence the reactivity of some antibodies with acinar cells. Islet cells did not react with any of the antibodies. The results indicate that, although the antigenicity of epithelial cells can be affected by the host blood group types, there might be several regulatory systems for expression of blood group antigens in a cell-specific pattern.

Adolescent↗
PubMed1986

Sensitivity of antiproteases, complement factors and C-reactive protein in detecting pancreatic necrosis. Results of a prospective clinical study.

Thirty-five patients with acute pancreatitis underwent serum monitoring of alpha-1-protease inhibitor, alpha-2-macroglobulin, complement factors C3 + C4, and C-reactive protein (CRP). Edematous interstitial pancreatitis was shown to be present in 13 patients by contrast-enhanced computed tomography (CT) and laparotomy (n = 3). Necrotizing pancreatitis was confirmed by laparotomy (n = 21) and contrast-enhanced CT. There were significant differences between the serum values of all measured parameters in the two morphologically defined pancreatitis groups. The best discriminating factors were CRP and alpha-2-macroglobulin, showing 95% and 85% overall detection rates for pancreatic necrosis, respectively.

Acute Disease↗
PubMed1986

Rat exocrine pancreas following total gastrectomy.

Sixteen rats underwent a total gastrectomy with an end-to-end anastomosis between the esophagus and duodenum. After either two or four weeks, the entire pancreas was excised and isolated lobules were incubated for 60 min in Krebs-Ringer-Hepes solution either with or without addition of ceruletide (5 X 10(-10) g/ml). Amylase was determined every 15 min in the supernatant medium. Measurements of amylase, lipase, trypsin, DNA and total protein were carried out in the homogenized pancreatic tissue. Morphometry was performed via light microscopic analysis. Two weeks following gastrectomy there was an increase in pancreatic wet weight, DNA, total protein and enzyme content (except lipase). Four weeks after surgery, pancreatic weight, amylase and trypsin increased further, whereas DNA content and lipase content remained stable. The DNA concentration decreased, and the size of exocrine pancreatic cells increased. In vitro, amylase discharge increased only after four weeks. The experiments demonstrate a short-term adaptation of the rat exocrine pancreas following total gastrectomy in the form of cellular hyperplasia (after 2 weeks), and hypertrophy (after 4 weeks), and enzyme dissociation.

Amylases↗
PubMed1986

Hemodynamic data pattern in patients with acute pancreatitis.

In 16 patients with necrotizing pancreatitis and in 6 patients with edematous-interstitial pancreatitis, hemodynamic studies were conducted between the first and the 12th day after the onset of illness. Patients with necrotizing pancreatitis had a high cardiac index of 4.47 +/- 0.75 L/min X m2 and a low total peripheral vascular resistance of 884 +/- 180 dyn X s/cm5, a low mean pulmonary vascular resistance of 84.3 +/- 25.7 dyn X s/cm5, and a high pulmonary shunt fraction of 24.2% +/- 6.6% of the cardiac output. This hyperdynamic vascular pattern was not found in patients with edematous-interstitial pancreatitis associated with gallstone disease. The group of patients with edematous-interstitial pancreatitis had a cardiac index of 3.21 +/- 0.8 L/min X m2, a total peripheral vascular resistance of 1337.8 +/- 248.2 dyn X s/cm5, a mean pulmonary vascular resistance of 130.7 +/- 48.2 dyn X s/cm5, and a pulmonary shunt fraction of 13.6% +/- 3.5% of the cardiac output. There was a significant difference between the patients with necrotizing pancreatitis and those with edematous-interstitial pancreatitis in the following hemodynamic parameters: heart rate (p less than 0.02), cardiac index (p less than 0.01), total peripheral vascular resistance (p less than 0.001), arteriovenous oxygen difference (p less than 0.02), and pulmonary shunt fraction (p less than 0.01). These findings in patients with necrotizing pancreatitis demonstrate an opening of intrapulmonary shunts and peripheral vasodilatation probably due to the release of pancreatitis-associated toxic agents in the early phase of the disease.

Acute Disease↗
PubMed1986

Bacterial contamination of pancreatic necrosis. A prospective clinical study.

In a prospective clinical study including 114 patients with acute necrotizing pancreatitis, but excluding patients with a pancreatic abscess, necrotic material obtained at surgery was tested bacteriologically. Intestinal microorganisms were cultured in 39.4% of the cases. The contamination rate was 23.8% in patients operated on during the first 7 days of the attack; it rose to 71.4% in the third week and decreased to 32.5% after the fourth week. Intra- and extrapancreatic necrosis was more widespread and pancreatitis-associated ascites was more frequent in patients with proven contamination. The number of objective signs was 4.5 (median) and postoperative mortality was 37.8% in bacteriologically positive subjects, whereas the number was 3.5 (median) and mortality was 8.7% in bacteriologically negative patients. Morphologic and clinical alterations were more severe, and the mortality rate was significantly elevated, in patients with a short history of disease and bacterial contamination of necrotic tissue. All 5 patients with pancreatic sepsis who were operated on in the first 7 days of the disease, as compared with 2 of 16 patients with sterile necrosis, died. Thus, it is demonstrated that bacterial contamination of pancreatic necrosis occurs early and frequently, causing a significant increase in morbidity and mortality, particularly when it develops in the initial stages of the attack.

Abscess↗
PubMed1986

Identification of pancreas necrosis in severe acute pancreatitis: imaging procedures versus clinical staging.

One hundred and five of 395 patients with acute pancreatitis were surgically treated in our clinic from 1981 to 1984. Ninety three of these patients were examined with contrast enhanced computed tomography and/or ultrasound and were clinically assessed according to Ranson's objective criteria before operation. At operation, 77 patients showed necrotising pancreatitis and 16 showed biliary acute interstitial pancreatitis. Ninety per cent of the cases with extensive and 79% of those with minor necroses of the pancreas had been demonstrated with contrast enhanced computed tomography. Ultrasound failed to be diagnostic in 24% of the patients due to meteorism; the sensitivity of the diagnostic studies for pancreatic necrosis was 73% regardless of the extent of the process. Using the early objective signs, seven patients with acute interstitial pancreatitis were classified as having a severe attack, whereas 30 patients with necrotising pancreatitis were categorised as mild attacks. We conclude that the contrast enhanced computed tomography is an aid in deciding on conservative or surgical treatment in a case of acute pancreatitis. Ultrasound does not appear to be an adequate method for determining pancreatic necrosis. The early objective signs fail to sufficiently identify the necrotising form of acute pancreatitis.

Acute Disease↗
PubMed1986

[Value of biochemical and imaging procedures for the diagnosis and prognosis of acute pancreatitis--results of a prospective clinical study].

For a period of 14 days we carried out measurements for alpha-1-protease inhibitor, alpha-2-macroglobulin, complement C 3, complement C 4, and C-reactive protein in two different groups of patients with acute pancreatitis. Group I consisted of 13 patients with edematous-interstitial pancreatitis and group II of 22 patients with necrotizing pancreatitis. Diagnosis of acute pancreatitis was established by clinical signs and symptoms, by specific pancreatic enzymes determined in the serum, by imaging procedures, and by laparotomy in 24 cases. The overall detection rate for pancreatic necrosis was 90% for the contrast enhanced CT and 33% for ultrasonography respectively. There were significant differences as to all measured serum parameters between the two morphologically defined pancreatitis groups. The necrosis detection rate was 95% for CRP and 85% for alpha-2-macroglobulin. The combined determination of CRP and alpha-2-macroglobulin is recommended in patients with acute pancreatitis to stage the severity of the disease and to probably replace the CT investigation.

Acute Disease↗