Clinical assessment of hyperlipidemic pancreatitis.

OBJECTIVE: This study addresses three questions: 1) What are the clinical presentations of pancreatitis secondary to hyperlipidemia? 2) What is the role of alcohol, diabetes, or known causes of hypertriglyceridemia? and 3) Does the course of pancreatitis secondary to hypertriglyceridemia differ from that of other etiologies? METHODS: We reviewed patients between 1982 and 1994 with a diagnosis of pancreatitis (577.0) and hypertriglyceridemia (272.0). Four hospitals participated. Seventy patients had a clinical presentation consistent with pancreatitis, that is elevated amylase and lipase or evidence of pancreatitis by ultrasound or CT imaging and serum triglyceride levels greater than 500 mg/dl or lactescent serum. Clinical data were derived from hospital admissions. RESULTS: Hypertriglyceridemia was the etiology in 1.3-3.8% of patients discharged with a diagnosis of pancreatitis. A history of diabetes mellitus was present in 72%, hypertriglyceridemia in 77%, alcohol use 23%, and gallstones in 7%. Lipemic serum was described on admission in 45%. Mean triglyceride levels were 4587 +/- 3616 ml/dl. Amylase was elevated two times normal in 54%, and lipase was elevated two times normal in 67%. CT scans were abnormal in 82%, with peripancreatic fluid in 34%, pseudocyst 37%, and necrosis in 15%. Abscess occurred in 13%, death in 6%. CONCLUSION: Acute pancreatitis secondary to hyperlipidemia is characterized by three presentations. All patients present with abdominal pain, nausea, and vomiting of hours to days duration. The most common presentation is a poorly controlled diabetic with a history of hypertriglyceridemia. The second presentation is the alcoholic found to have hypertriglyceridemia or lactescent serum on admission. The third, about 15-20% of patients, is the nondiabetic, nonalcoholic, nonobese patient with drug- or diet-induced hypertriglyceridemia.

Origin of tubular complexes developing during induction of pancreatic adenocarcinoma by 7,12-dimethylbenz(a)anthracene.

Implantation of 7,12-dimethylbenz(a)anthracene (DMBA) into the pancreas of rats has been shown to induce adenocarcinoma. Complexes of tubules, which have the appearance of proliferated intralobular ducts, frequently appear during tumor development. These complexes were studied by light and electron microscopy to determine their method of formation. In addition, a tubular complex was reconstructed from serial sections to determine its three-dimensional configuration. Although tubular complexes have been thought by others to result from ductal proliferation, the following observation indicate that they originate from zymogen-granule-containing cells: a) there is a continuum of transitional stages between acini and tubules, b) most tubules decrease in size and are replaced by connective tissue (evidence of regression rather than proliferation), c) few mitotic figures are seen in tubular complexes, d) the tubules comprise many cells which have an abundance of rough endoplasmic reticulum, an organelle which is sparce in ducts, and e) the three-dimensional arrangement of tubules appears identical to the branching, anastomosing arrangement of zymogen-granule-containing cells of the normal rat pancreas. Control animals in which only sutures were placed in the pancreas showed minimal reaction. It is concluded that "acini" become recognized as tubules when loss of zymogen granules accompanies tumor induction by DMBA. Transformation of these cells could be erroneously interpreted as transformation from proliferating ducts.

Neurohormonal control of pancreatic secretion. A review.

This is a review of current information concerning the role of hormones and the autonomic nervous system in the control of exocrine secretions of the pancreas. A greater emphasis has been placed on the role of hormones because of information accumulated during the last several years. With the development of radioimmunoassay techniques, it is now possible to correlate circulating hormone concentrations with biological function. The role of hormones has been discussed with the framework of the secretin-glucagon family, the cholecystokinin-gastrin family, and other proposed gastrointestinal hormones and related peptides. Gastrin, secretin and cholecystokinin-pancreozymin are three prime gut hormones that regulate pancreatic secretion. Other hormones that may have a role in pancreatic secretion include glucagon, vasoactive intestinal polypeptide, chymodenin, somatostatin, pancreatic polypeptide, motilin, and bombesin. Neural mechanisms play an important although not so succinct a role in the over-all control of exocrine secretion. A complex relationship exists between the parasympathetic nervous system and the release of the hormones and their effect on pancreatic acinar and duct cells.

Pancreatic acinar cell metabolism and function.

This review outlines progress made during the past 11 years in research related to pancreatic acinar cell metabolism and function. We have reviewed information gained at the cellular level concerning structural and functional relationships, and effects of fasting and feeding, as well as the action of gastrointestinal hormones and cholinergic agonists on acinar cells. In toto, this information outlines a significant role for gastrointestinal hormones as mediators of secretion, synthesis, and control of trophism. This information provides a basis for more sophisticated inquiries as to the mechanisms of injury of alcohol and drugs. The information may prove helpful in developing diagnostic modalities for pancreatic disease, as well as understanding the processes involved in neoplastic transformation.

A study of synthesis of DNA, RNA, protein, and oxygen uptake in segments of the rat pancreas.

The determination of whether metabolic homogeneity exists in an organ is of importance to both the clinician and investigator. These studies examine synthesis of DNA, RNA, protein, and oxygen uptake in the three anatomical segments of the rat pancreas. There was rather close agreement among the three segments insofar as these metabolic measurements were concerned. We concluded that there is metabolic uniformity in the rat pancreas and that measurements obtained in one segment reflect activities in the other two segments.

Fine structure of pancreatic adenocarcinoma induced in rats by 7,12-dimethylbenz(a)anthracene.

We induced pancreatic adenocarcinomas in Long-Evans rats by placing crystals, 2-3 mg, of 7,12-dimethylbenz[a]anthracene (DMBA) in a 2- to 3-mm incision in the "head" of the pancreas approximately 1 cm from the duodenum. The incisions were closed with one or two silk sutures. The animals were killed 4-10 months after DMBA implantation, and nodules were removed and routinely prepared for light and/or electron microscopic study. Histologic organization varied from normal, through areas of tubule-like structures, to sheets of pleomorphic tumor cells. Electron microscopic study of tumor cells revealed large electron-lucent nuclei that frequently had irregular outlines and prominent nucleoli. The predominant feature of the cytoplasm was abundant rough endoplasmic reticulum. Zymogen granules were rare. Adjacent cells sometimes were jointed by an apical junctional complex to form a lumen into which projected irregular microvilli. A basal lamina sometimes occurred at the bases of the tumor cells. The fine structural similarity of these tumor cells to acinar cells was noted.

Malignancies in blood-forming organs following diagnostic and therapeutic procedures: a review.

Ionizing radiation used for diagnosis or therapy has been associated with an increased incidence of malignancies of blood-forming organs. The increased incidence of hematopoietic malignancies following exposure to ionizing radiation obtained in the course of occupation, diagnosis and therapy of disease, or as a weapon of war is documented. The natural occurrence and the induced progression to acute leukemia of polycythemia rubra vera, Hodgkin's disease, multiple myeloma, Di Guglielmo's disease, and reticuloendothelial malignancies are discussed. The status of transplantation and immunodeficiency states and their relationship to acute leukemia is reviewed. Finally, drugs, toxins, and the use of cytotoxic radiomimetic agents for nonmalignant purposes are shown to lead to the development of acute leukemia. Background information relevant to the proper use of future diagnostic and therapeutic modalities is provided.

Hepatocellular carcinoma: a clinical study.

The clinical course of 40 patients with histologically proven hepatocellular carcinoma was reviewed. The majority had symptoms and signs suggesting abdominal malignancy; these included abdominal pain, weight loss, tenderness in the right upper quadrant, hepatomegaly, and fever. The most useful diagnostic tests were determination of serum alkaline phosphatase level, sodium sulfobromophthalein (Bromsulphalein) excretion, and liver scan. Prothrombin time and bilirubin levels were normal or only slightly elevated. Celiac angiography was helpful in determining the extent of the disease. Surgical exploration was done in 25% of the cases, but in only 5% was resection attempted. The grim prognosis is indicated by the fact that only 10% of patients were alive six months after admission to the hospital.

Experimental induction of pancreatic adenocarcinoma in rats.

Adenocarcinomas of the pancreas were experimentally induced in rats after the implantation of 7,12-dimethylbenz[alpha]anthracene (DMBA). Rats were anesthetized with Nembutal, the pancreas was exposed, and a 2- to 3-mm incision was made in the "head" of the pancreas approximately 1 cm from the duodenum. Crystalline DMBA (2-3 mg) was implanted and the incision was closed with silk suture. Eight % of animals developed tumors in the pancreas from 119 to 363 days after implantation (mean, 194 days). Ten animals developed tumors in less than 180 days. The adenocarcinomas were invasive, metastasized, and had pronounced ductal cell characteristics. The light-microscopic morphology of these pancreatic tumors was presented.

Effect of hormones on pancreatic macromolecular transport.

The role of subcellular organelles in the synthesis, transport, and secretion of pancreatic digestive proteins has been well documented. This study was designed to examine effects of pentagastrin, secretin, and acute and chronic administration of cholecystokinin-pancreozymin (CCK-PZ) on pancreatic macromolecular transport and secretion. Pooled rat pancreas slices were pulse-labeled with L-[14-C]phenylalanine and migration of 14-C-labeled proteins studied by "chase" incubation for 15, 30, 60, and 120 min. After in vitro incubation of control and drug-treated pancreatic slices, subcellular particles were isolated by differential centrifugation; Specific activity of radioactive labeled proteins was determined in subcellular fractions involved in transport and secretion of digestive proteins. These studies indicate that pentagastrin and acute and chronic stimulation with CCK-PZ did not alter the rate of transport of labeled proteins from ribosomes to the zymogen granules. Pentagastrin and CCK-PZ stimulated secretion of labeled proteins from the zymogen granules into the medium in the concentrations used as evidenced by significant increase in the amount of labeled proteins in the medium and significant decrease in the specific activity of the zymogen granule fractions after 60- and 120-min periods of incubation. Secretin did not alter the rate of transport or secretion of the pulse-labeled proteins.

Amebic colitis mistaken for inflammatory bowel disease.

In ten patients, amebic colitis was mistakenly diagnosed as ulcerative colitis or Crohn disease of the colon because of the similarity of history, physical examination, and routine laboratory studies as well as findings on proctoscopic and barium enema examination. Multiple stool examinations failed to demonstrate ova or trophozoites of Entamoeba histolytica. Routine examinations of stools for ova and parasites are inadequate and even a meticulous search for amebas in fresh stool, in scrapings from bowel ulcer, or in biopsy material may give negative results. The indirect hemagglutination test was shown to be a reliable diagnostic test in the evaluation of these cases. Because corticosteroid treatment of patients with amebic colitis may lead to undesirable complications the indirect hemagglutination test results should be obtained in patients in whom such diagnostic confusion is likely.