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Biomedical subjects

R L Goodale

Publications and source records attributed to R L Goodale.

At least 55 records · Page 3Linked to original sources
PubMed1981

Clinical and secretory differences in pancreatic cancer and chronic pancreatitis.

The differential diagnosis between chronic pancreatitis and pancreatic cancer can be very difficult. In 60 patients with either of these conditions, who had satisfactory ERCP study, clinical features were correctly matched with the final diagnosis by discriminant analysis in 44 (73%). The sensitivity of ERCP radiographic findings in pancreatic cancer was 80% and sensitivity of cytology was 54%. To see if exocrine function was specific for cancer, fresh pancreatic secretions were aspirated in 27 patients at the time of ERCP. By isoelectric focusing, a pattern of extreme zymogen depletion was observed in chronic alcoholic pancreatitis (Group 1), pancreatic cancer (Group 2), and chronic nonalcoholic pancreatitis (Group 3). The three groups were not distinguishable. By contrast, significant changes in albumin, IgG and IgA concentrations were seen in Group 2. The albumin level was over ten-fold greater than in Groups 1 and 3 (p less than 0.02 and less than 0.05). The IgG was seven-fold and two-fold greater (p less than 0.01 and greater than 0.2) and the IgA was 15-fold and six-fold greater (p less than 0.002 and less than 0.05) than in Groups 1 and 3, respectively. The two groups of pancreatitis had similar concentrations of albumin and IgA. The ratio of albumin to IgG was also different in Group 2 from the other groups, suggesting different mechanisms for the appearance of proteins in pancreatic secretions. Nonzymogen protein levels can distinguish chronic pancreatitis from pancreatic cancer, and further study of them may identify useful tumor-specific markers.

Albumins↗
PubMed1980

Ulcer perforation rate and pepsin. A study of the perfused cat esophagus.

The perforation rate of the cat esophagus varies as the log of the pepsin concentration when the esophagus is perfused in vivo with canine gastric juice at constant acidity, temperature, and pressure. The esophagus is extremely sensitive to gastric juice, frequently perforating before 60 minutes of perfusion. The maximal response is achieved with pepsin concentrations of 0.3 mg/mL, although the canine stomach is capable of concentrations as high as 1.3 mg/mL after vagal stimulation with 2 deoxy-D-glucose. These findings emphasize that peptic activity contributes significantly to initial acute esophageal ulceration induced by gastric secretions.

Animals↗
PubMed1980

A study of the cholinesterases of the canine pancreatic sphincters and the relationship between reduced butyrylcholinesterase activity and pancreatic ductal hypertension.

Previous work from this laboratory revealed in increased canine pancreatic intraductal pressure following cholinesterase inhibitor intoxication. The pressure was negatively correlated with serum butyrylcholinesterase (BChE) activity, suggesting that BChE activity mediated the pressure rise. This study uses a histochemical technique to investigate the tissue cholinesterase activity of the canine pancreatic sphincters and the effect of a cholinesterase inhibitor (ChEI) on tissue cholinesterase activity. In five control dogs, serial sections of the major and minor spincters were stained for acetylcholinesterase (AChE) and BChE activity. Four treated dogs were given the ChEI, O,O-diethyl-O- (2-isopropyl-6-methyl-4-pyrimidinyl) phosphoro-thioate, 25 mg/kg, one hour prior to excising the ampullae. In the control dogs, BChE activity is present in the periampullary nerves and the pancreatic smooth muscle sphincters. AChE activity is present in nerves but not in smooth muscle. In the treated group, following a dose of ChEI known to cause ductal hypertension, BChE activity was absent in the pancreatic sphincters but AChE activity was preserved in the periampullary nerves. These data suggest that the pancreatic ductal hypertension that occurs following ChEI administration is due to a selective reduction in pancreatic smooth muscle BChE activity.

Acetylcholinesterase↗
PubMed1979

Pancreatitis as a complication of anticholinesterase insecticide intoxication.

Severe pancreatitis and a pseudocyst occurred in a patient following accidental ingestion of an anticholinesterase insecticide, a substance not previously known to produce pancreatitis. Experiments were done to elucidate the mechanism. In one group of dogs the pancreatic duct was perfused and intraductal pressures were measured. The cholinesterase inhibitor 0,0-diethyl-0-(2-isopropyl-6-methyl-4-pyrimidinyl)phosphorothioate (25 mg/kg) caused a significant increase in the mean intraductal pressure from 12 +/- 2.4 to 27.8 +/- 5.9 cm saline. In a second group of dogs pancreatic secretory rates were measured. Anticholinesterase (75 mg/kg) in combination with secretin infusion (1 U/kg/hr) caused a significant increase in the secretin stimulated flow rate from 0.13 to 0.56 cc/min. Atropine (75 microgram/kg) abolished the anticholinesterase induced pressure and secretory rate increases. In a third group of dogs administration of cholinesterase inhibitor 75 mg/kg and secretin infusion 2 U/kg/hr resulted in acute pancreatic interstitial edema, acinar cell vacuolization, hyperamylasemia and hyperlipasemia. These results suggest that occurrence of pancreatitis as a complication of anticholinesterase insecticide intoxication is the result of hypersecretion and pharmacologic ductal obstruction.

Adult↗
PubMed1979

A study of secretory proteins, cytology and tumor site in pancreatic cancer.

Pure pancreatic fluid was aspirated at the time of endoscopic retrograde cholangiopancreatography (ERCP), after Secretin stimulation, and was analyzed for protein in eight patients with proven adenocarcinoma of the pancreas and in 16 subjects of the same sex ratio and approximately matching ages, who had normal pancreatograms and pancreatic cytology, who served as controls. The albumin concentration, IgA, IgG, were all significantly greater in the pancreatic fluid of the cancer group, and the IgM and transferrin increase was of borderline significance. Many zymogen bands present in controls were either faintly present or absent in the cancer group at matching zymogen concentration. Cytology was positive or suspicious in eight of 11 cancer patients. The secretory protein abnormalities and cytology results in the cancer group did not depend on a particular tumor site or size, the smallest being 3 cm lesions. Hence, secretory abnormalities and gross tumor size and location are independent entities to a certain extent. It is possible that secretion changes may precede the development of gross tumor. Further study will be necessary before the actual significance of these findings for early diagnosis is known.

Adenocarcinoma↗
PubMed1979

Sensitivity of the canine pancreatic intraductal pressure to subclinical reduction in cholinesterase acitivity.

As a continuation of work from this laboratory on anticholinesterase induced pancreatitis, a study of the relationship between reduced serum cholinesterase activity and changes in pancreatic intraductal pressure was undertaken. Pharmakokinetic studies in three dogs revealed rapid reduction in serum cholinesterase activity following an IV bolus dose of the cholinesterase inhibitor 0,0-diethyl-0-(2-isopropyl-6-methyl-4-pyrimidinyl)phosphorothioate. Following each dose of cholinesterase inhibitor, stable levels of cholinesterase inhibition were reached in 30 minutes. In four dogs the pancreatic duct was perfused from the tail of the ventral pancreas and intraductal pressures measured. A total of 25 mg/kg of the cholinesterase inhibitor was given in 5 mg/kg doses 30 minutes apart, and serum cholinesterase measured 30 minutes after each dose. Mean pressures were established over a 15 minute interval. Linear regression analysis of 23 data points revealed a significant (p < 0.001) cumulative dose-related increase in pancreatic intraductal pressure [Pressure (cm saline) = 14.2 + 1.03 x Cumulative Dose (mg/kg)] and significant (p< 0.001) negative correlation between serum cholinesterase activity and intraductal pressure [Pressure (cm saline) = 48.0 - 0.057 x Esterase Activity (mU/ml)]. These data suggest that, in dogs, reduced cholinesterase activity is directly related to increased pancreatic intraductal pressure, and it may be a factor in the pathogenesis of pancreatitis.

Animals↗
PubMed1977

Role of pepsin in species differences in erosive gastritis.

This controlled study shows that the rabbit is more vulnerable to erosive gastritis after stress of operation, weight loss, and hypersecretion or acute ischemia than is the cat. Rabbit gastric juice also produces more erosions in the Shay rat preparation after four hours than does cat gastric juice (P less than .05). In vitro, rabbit pepsin has 1.5 times greater specific activity and possesses other kinetic differences. The deleterious effect of these qualitative differences on gastric mucosa may also be augmented by quantitative differences. Hypersecretion of pepsin has been reported once the mucosa is damaged. We conclude that demonstration of species-related differences in pepsin activity helps to explain an apparent discrepancy noted by others--namely, why the rabbit is so much more susceptible to stress-produced erosions than the cat or other experimental animals.

Animals↗
PubMed1977

Endoscopic dilation of a gastric anastomotic stricture.

A stricture developed in a patient two months after undergoind a Billroth I gastroduodenal anastomosis. His mechanical gastric obstruction was relieved by dilation up to 37 F caliber under direct vision using a fiberendoscope. The patient became, and has remained, symptom free. Visualization of the area two months after dilation showed an adequately patent anastomosis.

Adult↗
PubMed1977

Electrical potential of gastroduodenal mucosa measured by endoscopy.

The gastroduodenal mucosa has a negative electrical potential with regard to the blood stream, as measured by a potentiometer connected to an intravenous and an intragastric electrode. The intragastric electrode can be positioned on various points of the gastroduodenal surface under direct vision through the forceps channel of the gastroduodenoscope. The values of potential differences were determined in various areas of the stomach and duodenum of normal humans and also over gastric ulcers, duodenal ulcers, gastritis and gastric erosions. A deflection of the potential difference value toward zero characterizes any disruption of the normal mucosa, even if only a few millimeters in diameter. Localized reproduce localized potential difference deflections. Atrophic lesions are represented by larger areas of abnormal potential difference levels. The direct multiple determinations of potential differences over mucosal areas in which lesions are suspected is a useful, simple tool for more objective gastroduodenoscopic diagnoses.

Adult↗
PubMed1976

Rapid long tube intubation of the jejunum by a new endoscopic device.

Despite the advantages of aseptic nonoperative intubation of the small intestine for decompression of obstructed loops, 48% of the attempts lead to failure to pass the tube through the pylorus. The difficulty and inconvenience of passage beyond the stomach have been overcome by the development of a special tube attachment adapted to a fiberoptic duodenoscope (Olympus Model GIF-K). Under direct endoscopic vision the tube can be carried into the second and third portion of the duodenum, released from the scope, and then further prodded into the jejunum. The entire procedure takes less than 15 minutes. Rapid intubation has now been easily carried out in five patients. Three patients had mechanical bowel obstruction. Rapid and effective decompression allowed adequate time for stabilization of concomitant serious problems such as (1) marked cardiopulmonary dysfunction secondary to a near fatal pulmonary embolus, (2) severe peritonitis post appendectomy, and (3) acidosis and dehydration. Surgical correction of the obstructing lesions was safely deferred for up to one week until the concomitant problems improved. The fourth patient, who was a renal transplant recipient, had chronic gastric ileus secondary to duodenal ulcer. Rapid passage of the long tube into the jejunum allowed restoration of nutrition and avoidance of gastrostomy. The fifth patient, with an ileus secondary to an infected abdominal aortic graft, underwent successful decompression but died of sepsis. He represents the only mortality. We propose that jejunal intubation using our technic is not only rapid but relatively easy and should encourage the wider acceptance of aseptic long tube intestinal decompression.

Adult↗