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Biomedical subjects

T N Pappas

Publications and source records attributed to T N Pappas.

At least 73 records · Page 4Linked to original sources

Intracerebroventricular neuropeptide Y increases gastric acid secretion by decreasing tonic adrenergic inhibition of acid in dogs.

Neuropeptide Y (NPY) has been shown to increase basal gastric acid secretion in dogs. We examined the hypothesis that NPY might increase gastric acid secretion by interaction with central catecholaminergic control of acid secretion in dogs. Studies were performed in awake canines with gastric fistulas and cerebroventricular guides which allowed injection into the lateral cerebral ventricle. Intracerebroventricular (i.c.v.) injection of yohimbine (5 micrograms/kg) increased acid secretion compared to control (yohimbine: 9.1 +/- 3.3 mmol/h; control: 1.8 +/- 1.0 mmol/2 h P < 0.05), whereas prazosin and propranolol (both 5 micrograms/kg i.c.v.) had no effect, suggesting that there is tonic central alpha 2-adrenergic inhibition of acid secretion. NPY13-36 significantly increased acid secretion compared to control (NPY13-36 1000 pmol/kg i.c.v.: 5.6 +/- 1.9 mmol/2 h; control: 1.3 +/- 0.8 mmol/2 h, P < 0.05), whereas [Leu31,Pro34]-NPY had no effect, suggesting that the central effect of NPY is mediated at a Y2, probably pre-synaptic receptor. Finally, i.c.v. desmethylimipramine (DMI) inhibited the acid response to i.c.v. NPY when injected before but not after NPY (i.c.v. DMI then i.c.v. NPY: control, 15.2 +/- 6.6 mmol/2 h; DMI, 3.5 +/- 1.2 mmol/2 h, P < 0.05; i.c.v. NPY followed by i.c.v. DMI: control, 8.9 +/- 4.0 mmol/2 h; DMI, 9.9 +/- 2.9 mmol/2 h, P > 0.05). This suggests that NPY acts by decreasing noradrenaline release. These findings are compatible with the hypothesis that i.c.v. NPY increases acid secretion by decreasing tonic central adrenergic inhibition of acid by decreasing release of noradrenaline at a pre-synaptic level.

Adrenergic Antagonists↗

Stimulation of gastric secretion and enhanced gastric mucosal damage following central administration of pancreatic polypeptide (PP) in rats.

The present study was carried out to investigate the central effects of pancreatic polypeptide on gastric secretion and gastric ulcer formation in conscious rats. Intracisternal injection of rat pancreatic polypeptide (62.5, 250, and 1000 ng/rat) into pylorus-ligated rats resulted in a dose-dependent stimulation of gastric acid and pepsin secretion. In contrast, intraperitoneal injection of even higher doses of pancreatic polypeptide (250, 1000, and 2500 ng/rat) failed to increase gastric secretion. This stimulatory effect of centrally administered pancreatic polypeptide was completely blocked by vagotomy and by pretreatment with atropine. Intracisternal injection of PP (500-2000 ng/rat) dose-dependently increased the severity of gastric lesions induced by 2-deoxy-D-glucose or indomethacin. In contrast, intraperitoneal injection of PP failed to increase the severity of the gastric lesions induced by 2-deoxy-D-glucose or indomethacin. These results indicate that pancreatic polypeptide is capable of acting centrally in the brain to stimulate gastric acid and pepsin secretion through a vagal, muscarinic pathway and in so doing exerts an ulcerogenic action on the gastric mucosa.

Animals↗

Effect of CGRP antagonist, alpha-CGRP 8-37, on acid secretion in the dog.

The recently synthesized calcitonin gene-related peptide (CGRP) antagonist, human alpha-CGRP 8-37, was used to study its effects on gastric acid secretion. Four dogs with gastric fistula were used to measure the antagonist's physiologic effects in the stomach. All dogs received a bactopeptone dextrose meal (intragastric titration to pH 5.5) with either continuous CGRP 8-37 (1000 pmol/kg/hr) or saline (control). Additionally, intravenous bombesin (75-600 ng/kg/hr) and bethanechol (12.5-100 micrograms/kg/hr) was tested in the presence of the antagonist. Plasma gastrin levels also were measured via radioimmunoassay (RIA) in control and CGRP 8-37-stimulated animals. Gastric acid secretion increased by 100% with infusion of 1000 pmol/kg/hr CGRP 8-37 when compared to the control. Acid output increased 98% with both intravenous antagonist and 600 ng/kg/hr bombesin when compared to bombesin alone. However, no augmentation of acid secretion by CGRP 8-37 was shown with 25 micrograms/kg/hr bethanechol. RIA of plasma gastrin demonstrated no effect with the antagonist when given alone and did not increase bombesin-stimulated gastrin release. We conclude that CGRP 8-37 blocks native CGRP inhibitory effects on gastric acid secretion. Our findings of potentiation of acid secretion by bombesin as well as no change in gastrin levels in the presence of the antagonist is likely due to a blockage in a noncholinergic neuron to the somatostatin cell. Furthermore, CGRP 8-37 did not increase bethanechol-stimulated acid secretion, most likely due to bethanechol's (acetylcholine) nearly ubiquitous positive effects on acid secretion.

Animals↗

Laparoscopic Nissen fundoplication: operative results and short-term follow-up.

The operative results, outcome, and short-term follow-up after laparoscopic exploration for Nissen fundoplication were evaluated in 35 patients with symptomatic gastroesophageal reflux and reflux-induced pulmonary disease. There were 19 female and 16 male patients, ranging in age from 17 to 72 years (mean: 42 years, SD: 11.6 years). In 20 patients, the symptoms were predominantly of regurgitation and heartburn; the remaining 15 patients had mixed regurgitation/heartburn and pulmonary symptoms. All patients underwent 24-hour pH monitoring, upper endoscopy, and manometry. The indication for surgery was medical failure or the need for long-term medical management with omeprazole. The operation, which was performed laparoscopically, is identical to the conventional Nissen fundoplication. There was a mortality rate of 0% and a morbidity rate of 25.7%. Five patients required conversion to open Nissen fundoplication, which was due to hemodynamic instability secondary to presumed pneumothorax in three patients and colotomy and a distal esophageal perforation in the other two patients. Thirty patients underwent laparoscopic Nissen fundoplication. Three patients developed early dysphagia, and one patient experienced a perforation of the piriform sinus due to nasogastric tube manipulation under anesthesia. All these patients had an uncomplicated postoperative course, and there was no long-term disability. The total surgical time of laparoscopic Nissen fundoplication was on average 107 minutes (SD: 35.3 minutes). Discharge usually occurred on the evening of postoperative day 2 (mean: 3.3 days; SD: 1.5 days). Twenty-six of the 30 patients who underwent laparoscopic Nissen fundoplication described the outcome as excellent and good (87%); however, 4 patients (13%) were unsatisfied. Fifteen patients (50%) had difficulty belching or vomiting, and moderate dysphagia was described by 7 patients (24%) in follow-up. Regurgitation and heartburn were cured in 96%, whereas reflux-induced pulmonary disease was cured in 50%. The results of laparoscopic Nissen fundoplication compare favorably with those of conventional Nissen fundoplication with respect to mortality, complications, and outcome.

Adult↗

Localization of cholecystokinin A and cholecystokinin B/gastrin receptors in the canine upper gastrointestinal tract.

BACKGROUND/AIMS: Cholecystokinin (CCK) is a neuropeptide that exerts numerous effects in the gut. To determine the sites of action of CCK, the distribution and properties of CCK receptor subtypes were studied. METHODS: CCK receptors were localized by autoradiographic analysis of 125I-CCK binding to frozen sections of the canine upper gastrointestinal tract. RESULTS: In the cardiac and fundic stomach, CCK-B/gastrin receptors were found in the mucosa and in a subpopulation of neuronal elements in the circular muscle. The antrum expressed CCK-B/gastrin receptors in a few neurons in the circular muscle and in the entire myenteric plexus; no receptors were observed in the antral mucosa or esophagus. The duodenum showed a high concentration of CCK-B/gastrin receptors in the myenteric plexus. The cardiac and fundic basal mucosae expressed CCK-A receptors. Two nonpeptide CCK receptor antagonists were unable to differentiate between the receptor subtypes. CONCLUSIONS: The differential expression of CCK receptor subtypes in the gastric mucosa provides a morphological basis for the separate regulatory roles of CCK and gastrin in gastric function. CCK-B/gastrin receptor expression in a subset of neurons in gastric circular muscle suggests a novel site of action for CCK and/or gastrin.

Animals↗

Intracisternal injection of apolipoprotein A-IV inhibits gastric secretion in pylorus-ligated conscious rats.

BACKGROUND/AIMS: Fat feeding increases not only serum but also cerebrospinal fluid concentration of apolipoprotein (apo) A-IV, a protein produced mainly by the small intestine in the rat. We hypothesized that apo A-IV may have a central effect on gastric secretion. METHODS: Gastric juice was collected by the pylorus ligation method. Rats underwent pylorus ligation and received intracisternal injection of apo A-IV under brief isoflurane anesthesia. Two hours after the injection, gastric juice was collected and gastric acid output determined. RESULTS: Intracisternal injection of 0.5 microgram apo A-IV had no effect on gastric secretion. However, gastric acid secretion was significantly inhibited by intracisternal injection of 1 microgram apo A-IV. Furthermore, intracisternal administration of higher doses of apo A-IV (2.0 and 4.0 microgram) resulted in greater inhibition of gastric acid secretion in a dose-dependent manner. On the contrary, 4 micrograms of apo A-I intracisternally injected failed to inhibit gastric acid secretion. Intraperitoneal administration of 15 micrograms of apo A-IV did not alter gastric secretion. CONCLUSIONS: These results suggest that apo A-IV may act in the brain to inhibit gastric acid secretion. Apo A-IV might be a central enterogastrone, which is a gastric inhibitor produced by the small intestine in response to fat feeding.

Animals↗

Role of neuropeptides in the regulation of feeding behavior: a review of cholecystokinin, bombesin, neuropeptide Y, and galanin.

The purpose of this report is to provide a review of four peptides (cholecystokinin, bombesin, neuropeptide Y, galanin) and their role in feeding behavior. Cholecystokinin (CCK) and bombesin (BBS) are considered satiety peptides, and neuropeptide Y (NPY) and galanin (GAL) have been proposed as appetite peptides. For the purposes of this review, satiety refers to the physiological cessation of feeding, and appetite refers to the drive to eat and exists in gradations.

Animals↗

Balloon dilatation of the sphincter of Oddi facilitates passage of glass beads from the canine biliary tract.

Laparoscopic management of common duct stones is increasing. The most widely used technique involves trans-cystic duct scope placement and stone extraction. Occasionally, stones cannot be retrieved and are allowed to pass spontaneously after manipulation of the sphincter of Oddi. This study examines a model of sphincter of Oddi dilatation in the dog to facilitate passage of glass beads simulating gallstones. In 24 dogs, glass beads of varying sizes (3-8 mm) were implanted in the gallbladder and allowed to pass spontaneously over 1 month. In three separate groups, these animals underwent (1) sham instrumentation of the sphincter of Oddi (control), (2) sphincter dilatation with balloon catheters, or (3) transduodenal sphincterotomy. At the end of 1 month, all the animals were autopsied, and the glass beads were retrieved. Histologic sections of the pancreas were examined for possible pancreatitis. The results of this study show that no animal experienced pancreatitis from sphincter manipulation or the passage of glass beads. The control animals who underwent sham manipulation of the sphincter passed 10% of their glass beads. In contrast, after sphincter dilatation, 52.5% of the 3-mm glass beads passed or 22% of all size beads. Animals with sphincterotomy passed a similar amount of glass beads as those with balloon dilatation. These studies suggest that balloon dilatation is as efficacious as sphincterotomy in facilitating the passage of glass beads from the canine biliary tract.

Animals↗

Directed enzyme pro-drug gene therapy for pancreatic cancer in vivo.

BACKGROUND: Directed enzyme pro-drug therapy incorporates the delivery of a gene to a cancer cell that will be specifically expressed and will confer sensitivity to a therapeutic agent. Tumor-specific gene expression can be achieved by coupling the promoter for the carcinoembryonic antigen (CEA) to a gene such as herpes simplex virus thymidine kinase (HSV-tk), which phosphorylates ganciclovir to a potent DNA synthesis inhibitor. METHODS: Retroviral vectors were constructed to contain the CEA promoter coupled to HSV-tk (LN-CEA-TK) and were used to transduce the CEA-expressing pancreatic carcinoma cell line BXPC3. Recombinant pancreatic carcinoma cell lines expressing HSV-tk (BXPC3CEA-TK) were then tested for sensitivity to the toxic effects on ganciclovir after engraftment into severe combined immunodeficient mice. Tumors were generated by subcutaneous inoculation of 20 x 10(6) tumor cells consisting of BXPC3 and/or BXPC3CEA-TK cells in ratios of 100:0, 90:10, 50:50, 10:90, and 0:100. After 3 days mice received daily ganciclovir (0.1 mg/kg) or phosphate-buffered saline solution by intraperitoneal injection and were monitored for tumor growth. RESULTS: All severe combined immunodeficient mice inoculated with BXPC3 or BXPC3CEA-TK cells in any proportion developed large pancreatic tumors. As expected, a significant reduction in tumor size was seen in the BXPC3CEA-TK engrafted mice receiving ganciclovir compared with mice receiving phosphate-buffered saline solution or mice engrafted with only BXPC3. In addition, all animals with any fraction of cells expressing HSV-tk exhibited a significant reduction in tumor growth, including animals with only 10% of cells expressing HSV-tk. CONCLUSIONS: These results suggest the potential utility of directed enzyme pro-drug therapy in patients with CEA-expressing pancreatic carcinoma.

Animals↗

Intracerebroventricular neuropeptide Y increases gastric and pancreatic secretion in the dog.

BACKGROUND: Neuropeptide Y (NPY), a centrally located neurotransmitter, is known to increase appetite in fasted and satiated animals. In addition to evaluating NPY's effect on eating behavior, this study was intended to determine whether intracerebroventricular (ICV) NPY would have an effect on canine gastric and pancreatic secretion. METHODS: Four dogs were prepared with cerebroventricular guides and gastric and pancreatic fistulas. ICV and intravenous NPY was administered during intragastric titration of a glucose and peptone meal. During this study, gastric and pancreatic secretion was measured, as well as insulin levels and pancreatic polypeptide (PP). An additional set of four dogs were prepared with esophageal fistulas and cerebroventricular guides, and the effect of ICV NPY on sham feeding was studied. RESULTS: ICV NPY significantly increased sham feeding, meal-stimulated gastric and pancreatic secretion, basal gastric acid, pancreatic bicarbonate, insulin levels, and PP. Vagotomy blocked the effect of ICV NPY on gastric acid secretion in a urethane-anesthetized rat model with acute gastric fistula. CONCLUSIONS: ICV NPY increased sham feeding, gastric and pancreatic secretion, insulin levels, and PP in the dogs. NPY's effect on gastric secretion was blocked by vagotomy in a rat model. NPY should be considered a candidate mediator of cephalic phase secretion.

Analysis of Variance↗

Taste and smell sensations enhance the satiating effect of both a high-carbohydrate and a high-fat meal in humans.

The effects of meal sensory properties (tasty vs. bland) and nutrient composition [high-CHO (carbohydrate) vs. high-FAT] on hunger ratings, blood glucose and free fatty acids (FFA), taste perception, and subsequent food intake, were studied in human subjects. Aspartame and vanilla were used to augment meal palatability, yielding four isocaloric liquid meals: bland-FAT, tasty-FAT, bland-CHO, tasty-CHO. Normal-weight, nondieting young adults consumed each of the meals for breakfast on separate days. The main finding was that tasty versions of high-FAT and high-CHO meals were more satiating than nutritionally identical bland meals, as indicated by a greater decrease in hunger ratings following the tasty meals. Changes in blood glucose and FFA were related to meal nutrient composition, but not to meal sensory properties. High-CHO meals tended to be more satiating than high-FAT meals. Consumption of each of the meals produced a similar decrease in pleasantness ratings of food-related tastes. Intake of carbohydrates was significantly higher at a self-selected lunch 5.25 h following a tasty breakfast. These findings indicate that hunger is decreased to a greater extent by meals flavored with aspartame and vanilla relative to nutritionally identical, unflavored meals. The satiety-enhancing effect of oral stimulation was found for both high-FAT and high-CHO meals.

Adult↗

Short-term oral sensory deprivation: possible cause of binge eating in sham-feeding dogs.

Six mongrel dogs (18-20 kg) were prepared with gastric and esophageal fistulas. All dogs were studied under four experimental conditions. In conditions 1 and 3 the dogs were allowed to sham feed either a high-palatable or low-palatable meal on days 1-5 followed by a sham feed of a high-palatable or low-palatable meal on day 6. In conditions 2 and 4 the dogs were not sham fed (oral sensory deprived) on days 1-5 but were allowed to sham feed either a high-palatable or low-palatable meal on day 6. Total caloric requirement during each 6-day study was given by infusion of a liquid diet (Isocal) through the gastric fistula following the experiment. In condition 4, dogs deprived of oral sensation on days 1-5, significantly overconsumed their low-palatable meal on day 6. In condition 2, dogs deprived of oral sensation on days 1-5 also overconsumed their high-palatable meal on day 6, although this did not reach statistical significance. Dogs that received oral stimulation days 1-5 (conditions 1 and 3) did not overconsume their high- and low-palatable meals on day 6, suggesting that binge eating following short-term oral deprivation may be avoided if the diet provides adequate oral sensory stimulation. Body weights were well maintained throughout each study period and no changes were observed.

Animals↗

Central and peripheral effects of CCK receptor antagonists on satiety in dogs.

The role of cholecystokinin (CCK) as a central and peripheral satiety factor was studied using the CCK-B (L-365,260) and CCK-A (MK-329) receptor antagonists in esophageal-fistula dogs. Suppression of feeding was induced by either balloon gastric distension or small bowel nutrient infusion and was measured as the volume sham fed. Intracerebroventricular L-365,260 abolished satiety behavior from gastric distension (volume sham fed 2,667 +/- 211 ml vs. vehicle alone 1,217 +/- 446 ml, P < 0.05) but not small bowel infusion. Intravenous MK-329 abolished satiety behavior from small bowel infusion (volume sham fed 1,900 +/- 521 ml vs. vehicle alone 210 +/- 198 ml, P < 0.05) but not from gastric distension. The volume sham fed after intracerebroventricular MK-329 with balloon gastric distension or small bowel infusion did not differ from control. These results suggest that, in the brain, CCK is a physiological mediator of satiety behavior from gastric distension but not small bowel nutrients and, in the periphery, CCK is a physiological mediator of satiety behavior from small bowel nutrients but not gastric distension.

Animals↗

Exogenous neuropeptide Y blocks myoelectric activity in the upper gastrointestinal tract of starved dogs. Brain neuropeptide Y converts a fasting pattern of myoelectric activity to a fed pattern.

The effect of intracerebroventricular (ICV) neuropeptide Y (NPY) on the migrating motor complex (MMC) was examined in five starved dogs. Myoelectric activity was recorded using gastric, duodenal, and jejunal electrodes. Intragastric pressure was monitored via a gastric fistula, and ICV injections were given through a cerebroventricular guide. Recordings were made with no ICV injection and before and after 250-microliters bolus injections of vehicle as control (0.1% dog serum albumin in saline) or 500 pmol/kg NPY. The mean interval between MMCs was 98 +/- 10 min without ICV injection and 96 +/- 7 min after control solution. After ICV injection of NPY no further MMCs were recorded in any dog, even though the study was continued for a minimum of 3.5 h. Instead, the myoelectric pattern became indistinguishable from that in fed dogs. We conclude that central NPY plays a role in modulation of upper gastrointestinal myoelectric activity. This may reflect a central regulatory role for NPY in the coordination of feeding.

Animals↗

An endoscopic retrograde cholangiopancreatography (ERCP)-based algorithm for the management of pancreatic pseudocysts.

In the treatment of pancreatic pseudocysts, percutaneous and endoscopic drainage have, in certain cases, become alternatives to surgery. However, each treatment modality carries risks of complications and recurrences that may be minimized by the appropriate allocation of therapy. This article proposes the use of an endoscopic retrograde cholangiopancreatography (ERCP)-based algorithm as a means to allocate pseudocyst therapy based on the findings of pancreatic duct obstruction or pseudocyst communication. To evaluate this algorithm, the records of a series of patients with pancreatic pseudocysts seen at Duke University Medical Center from 1984 to 1990 were reviewed. Of 102 patients, 73 had symptomatic pseudocysts that required treatment. Forty of the 69 elective interventions were preceded by ERCPs and retrospectively applied to the algorithm. The number of adverse outcomes (treatment failures + complications) of the group that followed the algorithm was 3 of 26 (12%), while the number of adverse outcomes of the group that did not follow the algorithm was 6 of 14 (43%) (p less than 0.04 by Fisher's exact test). These two subgroups were similar in all other characteristics examined. Therefore, this ERCP-based algorithm may be used to allocate pseudocyst treatment; however, a prospective trial is necessary to prove its efficacy.

Algorithms↗

Laparoscopic cholecystectomy in young patients with sickle hemoglobinopathies.

Nine young patients with sickle hemoglobinopathies successfully underwent laparoscopic cholecystectomy; no complications resulted from the procedure. The mean postoperative hospital stay was 1.6 days. This technique appears to be a safe and efficacious procedure in children with sickle hemoglobinopathies who require cholecystectomy for cholelithiasis.

Adolescent↗

Physiological satiety implications of gastrointestinal antiobesity surgery.

This manuscript reviews the known satiety signals and the impact of antiobesity surgery on these physiological satiety mechanisms. Satiety signals originate from the stomach and small bowel to stop eating behavior. Stomach signals (gastric distension) produce early satiety by releasing hypothalamic cholecystokinin (CCK). The intermeal interval is probably mediated by peripheral CCK released by a threshold level of intraluminal calories. Anti-obesity operations probably rely little on these physiological satiety signals. Gastric balloons and gastroplasty produce nonphysiological gastric distension whereas intestinal bypass causes malabsorption. Gastric bypass combines supramaximal gastric distension with taste aversion from dumping. Future physiological manipulation of the satiety cascade will lead to improve obesity intervention.

Humans↗