ABSTRACT
We report the case of a middle-aged man with a 6-month history of diabetes treated with insulin. He was referred for diabetes control and education. Six weeks after we saw him, he was euglycemic (hemoglobin, Hgb A1C 5.9%), but returned because of weight loss, diarrhea, and abdominal cramps. Pancreatic adenocarcinoma was diagnosed. We review the literature on the relationship between diabetes mellitus and pancreatic carcinoma with particular emphasis on situations in which recent-onset diabetes may be a harbinger of pancreatic carcinoma. Several reports are cited in which the onset of diabetes mellitus in middle-aged patients antedated by a short time the onset of clinically recognizable pancreatic carcinoma. An otherwise silent pancreatic carcinoma may present as new-onset diabetes. Although rare, pancreatic carcinoma should be considered in a recently diagnosed middle-aged diabetic person with unusual manifestations, e.g., abdominal symptoms and continuous weight loss despite euglycemia.
Subject(s)
Adenocarcinoma/complications , Diabetes Mellitus, Type 1/etiology , Pancreatic Neoplasms/complications , Humans , Male , Middle Aged , Risk Factors , Time FactorsABSTRACT
Intestinal obstruction inhibits amino acid absorption. The inhibition, being dependent on the pathological changes of the absorptive epithelium, was considered as an index of injury and measured after varying periods of obstruction and after pretreatment with clindamycin, indomethacin, 16,16-dimethyl-PGE2 or arachidonic acid. A reduction in amino acid uptake was apparent after 2h of obstruction and was increasingly evident after 4, 6 and 18 h. During the late phase (after 6 h), inhibition was partly prevented by pretreatment with clindamycin, but the antibiotic was ineffective during the early phase (within the first 2 h). Bacterial colony counts of luminal contents of rats obstructed for 2 h, were not different from counts obtained in controls, but significantly lower than counts in rats that have been obstructed for 6 h. Pretreatment of rats with 16,16-dimethyl-PGE2 or with arachidonic acid prevented the early inhibitory effects of the obstruction. The findings suggest that the early inhibition in amino acid uptake may be related to metabolic changes that are correctable by the administration of 16,16-dimethyl-PGE2 or of arachidonic acid. The inhibition, during the late phase, is mainly related to an overgrowth of the enteric bacteria.
Subject(s)
Alanine/metabolism , Ileum/metabolism , Intestinal Absorption , Intestinal Obstruction/metabolism , Prostaglandin Antagonists/pharmacology , Prostaglandins/metabolism , 16,16-Dimethylprostaglandin E2/pharmacology , Animals , Arachidonic Acid , Arachidonic Acids/pharmacology , Clindamycin/pharmacology , Ileum/drug effects , In Vitro Techniques , Indomethacin/pharmacology , Intestinal Absorption/drug effects , Inulin/metabolism , Male , Rats , Rats, Inbred StrainsABSTRACT
Choledochoduodenal fistula is an uncommon complication of choledocholithiasis. Five patients with this entity were treated by endoscopic enlargement of the choledochoduodenal fistula without complication. Choledochoduodenal fistula complicating choledocholithiasis seem to arise either from stone erosion through the bile duct into the duodenum or as a complication of vigorous instrumentation at the time of common duct exploration. In patients in whom endoscopic sphincterotomy cannot be performed because of inability to cannulate the ampullary orifice, endoscopic enlargement of the choledochoduodenal fistula can be performed safely.
