The pentagastrin test in the diagnosis of the carcinoid syndrome. Blockade of gastrointestinal symptoms by ketanserin.

The levels of 5-hydroxytryptamine (serotonin, 5-HT) and substance P (SP) were assayed (using high performance liquid chromatography-electron capture and radioimmunoassay methods) in the peripheral blood of 17 patients with known mid-gut carcinoids, 16 of whom had hepatic metastases. All patients had supranormal basal levels of 5-HT and SP. The clinical and hormonal changes induced by two provocation tests, intravenous pentagastrin (PG) and calcium infusion, were compared.

The effect of carcinoid levels of serotonin and substance P on hemodynamics.

Serotonin and substance P circulate in high concentrations in patients with the carcinoid syndrome. These studies were performed to evaluate the effects of intravenous infusions of serotonin and substance P to reproduce carcinoid levels of these agents on central hemodynamics, regional blood flow (using the radioactive microsphere technique), and endogenous hormone release. Serotonin did not affect mean arterial pressure but it significantly increased cardiac output, decreased systematic vascular resistance, and redistributed regional blood flow, increasing blood flow to the heart, adrenals, fundus, and antrum.

The effects of intravenous substance P infusion on hemodynamics and regional blood flow in conscious dogs.

substance P concentrations in plasma increase in response to a meal. The effects of intravenous substance P infusions were investigated in seven conscious dogs with doses of peptide (7 ng/kg/min) designed to reproduce the normal postprandial circulating increase in substance P. Substance P levels measured by radioimmunoassay increased 8.

Endoluminal substance P as a cause of mucosal hyperemia in the feline gut by a nonneural mechanism.

Exogenous substance P (SP) was perfused into the lumen of the proximal jejunum in 16 fasted cats at a rate of 6.04 +/- 1.96 ng/min.

The hemodynamic effects of intravenous infusions of serotonin in conscious dogs.

The effects of exogenously infused serotonin on central and regional hemodynamics were investigated in 14 dogs. Using intravenous doses that mimic postprandial levels of serotonin, we were able to demonstrate no changes in cardiac output or mean arterial pressure. However, there were region-specific changes in blood flow.

Common bile duct complications of pancreatitis evaluation and treatment.

Five cases that illustrate the spectrum of biliary complications of pancreatitis and pancreatic pseudocyst are discussed. Obstructive jaundice, hemobilia, and bilious ascites were the major problems in these five patients. Sonography, transhepatic cholangiogram, endoscopic retrograde cholangiopancreatography, operative cholangiography, and arteriography are important in establishing the diagnosis and planning the treatment.

Local regulation of blood flow in the feline jejunum. A possible role for endoluminally released substance P.

Serotonin and substance P of gastrointestinal origin have been measured by radioimmunoassay in the bowel lumen under basal and stimulated conditions. To investigate the possibility that local blood flow may be influenced by these endoluminal hormones, 26 cats were studied with exogenous serotonin and substance P infused endoluminally into isolated proximal jejunal segments in vivo. Regional blood flow was measured by using the radioactive microsphere technique before, during, and after the endoluminal instillation of two doses of substance P (3.

Effect of xenopsin on blood flow, hormone release, and acid secretion.

We investigated the effects of the neurotensin analogue xenopsin on regional blood flow, central hemodynamics, and stimulated acid secretion in awake conscious dogs. Organ blood flow, estimated using the radioactive microsphere technique, was significantly increased during the xenopsin infusion to the adrenals, pancreas, and ileum. There was no change in mean arterial pressure or cardiac output (measured by thermodilution).

Effect of cervical and thoracic vagal stimulation on luminal serotonin release and regional blood flow in cats.

In acute experiments on 14 cats, the transected vagus nerves were stimulated at two levels (10 V, 5 ms, 10 Hz, 10 mA, 15 min). Fifteen-centimeter proximal jejunal segments were perfused with saline (1.0 ml/min).

A clinical trial of cimetidine in acute pancreatitis.

A prospective randomized clinical trial was carried out to evaluate the efficacy of cimetidine in the treatment of acute pancreatitis. One hundred and sixteen patients with a clinical diagnosis of acute pancreatitis and an elevated serum amylase level were included in the study. All patients were treated with fluids, given intravenously, analgesia and nasogastric tube suction, if required.

Release of immunoreactive serotonin into the lumen of the feline gut in response to vagal nerve stimulation.

Immunoreactive serotonin was detected in the lumen of the proximal jejunum of food-deprived cats. During perfusion of this intestinal segment in vivo, there was a constant basal rate of intraluminal secretion of this amine. The rate of secretion was significantly increased during efferent electrical stimulation of the cut cervical vagal nerves.

The multiple sequential distal bypass graft: improving nature's alternatives.

Sequential femoral-distal bypass grafts were employed to revascularize 21 ischemic limbs. An end-to-side distal anastomosis plus an additional side-to-side anastomosis to an isolated popliteal segment or an additional distal tibial vessel were employed. If one graft that underwent successful early revision is included, the initial patency rate was 100%.

The extended retroperitoneal approach for treatment of extensive atherosclerosis of the aorta and renal vessels.

The aorta was exposed by a standard "nephrectomy" incision through the eleventh interspace in 53 patients with aneurysmal or occlusive disease. The plane posterior to the kidney and ureter was developed easily, enabling exposure of the aorta above the level of the celiac axis to its bifurcation by dividing only the crus of the diaphragm and the lumbar branch of the left renal vein. Twenty-five patients with abdominal aortic aneurysms were treated in this fashion.

Effect of altered intestinal water transport on rabbit ileal blood flow.

A method is described for measuring ileal blood flow in the anesthetized (pentobarbital sodium) rabbit by the intraventricular injection of microspheres (15 micrometer) labeled with cerium-141 or chromium-51; with this method the amount of labeled microspheres lodging in the tissue is proportional to the blood flow. Blood flow to the ileal mucosa plus submucosa could be separated from flow to the ileal muscularis propria plus serosa by this technique. Simultaneous and sequential injections of radiolabeled microspheres gave similar measurements of ileal blood flow and did not affect ileal water absorption.

Vasodilation, fibrinolysis, and thrombolysis with intraarterial infusion of urokinase in the canine superior mesenteric artery.

Urokinase, the plasminogen activator from human urine, produces a dose-dependent increase in blood flow in the canine superior mesenteric artery when injected intraarterially at doses from 10(-1) to 10(3) units kg-1. This vasodilation persists despite blockade of beta-adrenergic and histamine H1 and H2 receptors as well as inhibition of plasminogen activation, suggesting that these mechanisms are not involved. Infusion of urokinase at 10(2) CTA (Committee on Thrombolytic Agents) units kg-1 min-1 does not produce a sustained vasodilation, but is effective in achieving complete lysis of thrombi within 100 min in the superior mesenteric arterial circulation.

Acute supravalvular stenosis following replacement of the aortic valve and ascending aorta in a patient with Marfan's syndrome: report of a case.

A case report of a patient with Marfan's syndrome who developed acute supravalvular aortic stenosis following aortic valve replacement and reconstruction of the ascending aorta is presented. Early recognition of this complication permitted reoperation and successful repair. One similar case has been reported previously.

Regional gastric blood flow in cynomolgus monkeys with hemorrhagic shock and resuscitation.

Five anesthetized cynomolgus monkeys were subjected to hemorrhagic shock (42 +/- 3 mm Hg) for four hours and then resuscitated with shed blood and intravenous fluids to restore mean arterial pressure and arterial pH to control levels. Regional gastric blood flow was measured by radioactive microspheres. Responses were similar in all regions, except mucosal blood flow increased significantly (from 20.

Microvascular architecture of anthropoid primate intestine.

Microvascular architecture of the small intestine of New World monkey, ape, and man was examined with the silicone rubber injection technique and the results compared to previous observations in dogs and Old World monkeys. In man, chimpanzee, and New World monkey the small intestine villus contains a single centrally located vein draining a subepithelial capillary plexus converging at the apex of the villus. These villi also contain a single eccentrically located artery rising to the midlevel of the villus, where it branches into subepithelial capillaries over the rest of its length.

Effect of histamine H2 antagonism by metiamide on the response of the canine gastric mucosa to acid and bile salt.

Prevention of acute gastric erosions with histamine H2-receptor blocking agents suggests that these drugs may improve the ability of the gastric mucosa to maintain electrical, ionic, and protein concentration gradients. In 5 awake mongrel dogs, transmural potential difference, ion fluxes, and protein loss were measured across Heidenhain pouches topically exposed to isotonic solutions containing either 80 mM HCl or 80 mM HCl plus 20 mM sodium taurocholate (BS). The dogs received an intravenous infusion of either saline (as a control) or the H2 antagonist metiamide, 10 mumoles per kg-hr.

Vasodilation due to urokinase in the canine femoral circulation.

Based upon clinical observations, we hypothesize that the plasminogen activator urokinase is vasoactive in addition to being fibrinolytic and thrombolytic. The effects of intra-arterial injections and infusions of urokinase were investigated in the canine femoral circulation. Injections of human urine urokinase increased femoral artery blood flow in a dose-related fashion that was not significantly attenuated by beta adrenergic blockade, antihistamine treatment, heating, atropine treatment or kallikrein inactivation.