Arteriovenous malformation of the pancreatic head--difficulties in diagnosis and treatment.

A patient with pancreatic arteriovenous malformation who presented diagnostic and therapeutic difficulties is presented. The initial tests appeared to suggest inflammatory bowel disease, but the diagnosis was clinched by the finding of blood issuing from the ampulla of Vater. Repeated angiographic embolization did not obliterate the vascular malformation, and the symptoms eventually resolved after Whipple's pancreaticoduodenectomy.

CA 19-9 to differentiate benign and malignant masses in chronic pancreatitis: is there any benefit?

BACKGROUND: The role of the tumor marker CA 19-9 in differentiating benign from malignant masses in chronic pancreatitis has not been extensively studied. AIM: This study aims at assessing the accuracy of CA 19-9 in differentiating inflammatory head masses in chronic pancreatitis from superimposed carcinomas on chronic pancreatitis. METHODS: The data of 84 consecutive patients who had mass lesions in chronic pancreatitis were analyzed to determine the sensitivity, specificity and predictive values at cut-off values of 37, 100, 200 and 300 U/mL. Receiver operating characteristic (ROC) curves were used to assess the sensitivity and specificity. RESULTS: There were 50 benign masses and 34 malignancies. The overall sensitivity and specificity of CA 19-9 for cancer was 68% and 70%, respectively. There was a higher positivity of CA 19-9 in cancers than in benign masses (23/34; 68% versus 15/50; 30%, P<0.01) with cut-off values of 37 U/mL. Higher positivity rates were obtained in cancers using other cut-off values such as 100, 200 and 300 U/mL. Values over 300 U/mL were 100% specific for malignancy, but occurred in only 5 (of whom had distant metastases) of 34 patients. CONCLUSION: CA 19-9 level in excess of 300 U/mL in mass lesions in chronic pancreatitis was always indicative of malignancy.

Intussusception due to ileal metastases from renal cell carcinoma.

Small bowel secondaries from renal cell carcinoma are rare. Patients usually present with features of intestinal obstruction or GI bleeding. Management should be aggressive since metastasectomy can improve the quality of life and survival.

Intestinal absorption and biodistribution of cosalane and its amino acid conjugates: novel anti-HIV agents.

Cosalane and its amino acid conjugates are potent inhibitors of HIV replication. The purpose of this study was to investigate: (1) the pharmacokinetic disposition of the diglycine (GC) and the diaspartic acid (ASPC) conjugates of cosalane in male Sprague-Dawley rats; (2) intestinal absorption of cosalane and its amino acid conjugates using in vitro (small intestinal segments), in situ (closed loop); and (3) biodistribution of GC and its absolute oral bioavailability in rat. Cosalane and its conjugates exhibited biexponential disposition with very long half-lives upon intravenous dosing. However, these compounds failed to permeate the small intestine unless sodium desoxycholate (5-20 mM) was used as an intestinal permeation enhancer. A rank order correlation in terms of permeation enhancement in a descending order is as follows: GC>Cosalane>ASPC. In situ studies revealed that although the bile salt enhanced the permeation of cosalane across the enterocyte, its hepatic uptake was extensive. However, 66% of the absorbed dose of GC escaped uptake by the reticuloendothelial system (RES) and its biodistribution studies showed that the uptake by the RES was significantly lower compared to the parent compound. GC had an absolute oral bioavailability of 5.10+/-1.51%. Therefore, GC appears to be a favorable candidate for further development.

Milk hypersensitivity. II. Practical aspects of diagnosis, treatment and prevention.

To date the most reliable procedure for the diagnosis of milk hypersensitivity is a properly conducted elimination-challenge test. Several in vitro tests have been developed but because of the diverse underlying mechanisms of hypersensitivity reactions to milk developing a single laboratory test that can be universally positive in every patient would be rather difficult. However, with a better categorization of milk-sensitive patients, together with the development of relevant, standardized and practical tests, the laboratory diagnosis of milk allergy should become more reliable. Milk hypersensitivity can be effectively treated and is largely preventable. Avoidance is the most effective mode of treatment and results in a good prognosis. In instances where the desired degree of avoidance cannot be attained pharmacologic agents may be of help. The need still exists for developing an effective procedure of hyposensitization. For prevention, prolonged breast feeding should be recommended, especially in infants of atopic families.

Milk hypersensitivity. I. Pathogenesis and symptomatology.

Milk hypersensitivity is a problem that can have substantial health, financial and social implications. The condition is underdiagnosed by some physicians and overdiagnosed by others probably because its symptoms are varied and shared with many other diseases. The gap in our knowledge on the pathogenesis of various manifestations of CMA has been only partly bridged by the information accumulated in recent years. It has become clear that milk-sensitive patients are heterogeneous, both regarding symptomatology and underlying pathogenic mechanisms.