Postprandial cholecystokinin secretion in elderly with protein-energy undernutrition.

OBJECTIVE: Malnutrition is currently observed in aged people, and cholecystokinin is an important peripheral satiety signal. The aim of this study was to examine the effect of aging and protein-energy malnutrition on postprandial cholecystokinin (CCK) release. DESIGN: Non-randomized, cross-sectional comparison by age group. SETTING: Gastroenterology section of a teaching hospital. PARTICIPANTS: Twenty-one human volunteers divided into three groups: young healthy subjects (Group 1: mean 29 years, n = 7), aged healthy subjects (Group 2, mean 80 years, n = 7), and aged subjects with an important degree of malnutrition (Group 3, mean 84.6 years, n = 7). INTERVENTION: Each subject ingested a standardized liquid meal after an overnight fast. MAIN OUTCOME MEASURES: Plasma cholecystokinin was measured using a sensitive bioassay before and after the ingestion of the liquid meal. RESULTS: Basal cholecystokinin levels were similar (0.9 to 1 pM equivalent CCK-8) in the three groups. Postprandial levels were significantly increased over basal (P less than 0.05). The maximal cholecystokinin value was lower in Group 1 (3.5 +/- 0.8 pM equivalent CCK-8) and Group 2 (3.3 +/- 0.77 pM equivalent CCK-8) than in Group 3 (8.3 +/- 2 pM equivalent CCK-8) (P less than 0.05). Integrated plasma cholecystokinin was also similar in Group 1 (171 +/- 38 pM.60 min), (P less than 0.05). CONCLUSION: The increase of postprandial maximal levels of cholecystokinin is more related to malnutrition than to aging.

Etiologies of acute, persistent, and dysenteric diarrheas in adults in Bangui, Central African Republic, in relation to human immunodeficiency virus serostatus.

A study of the etiologies of diarrhea in adults in relation to their human immunodeficiency virus (HIV) serostatus and number of CD4+ cells was carried out in the Central African Republic. In cases and controls, multi-parasitism was observed. Salmonella spp. were identified mainly during acute diarrhea, with 50% of the S. enteritidis isolated during the study being responsible for septicemia and/or urinary tract infection in immunodeficient patients. Enteroaggregative Escherichia coli (EAggEC) were the most frequently identified agent in HIV+ patients with persistent diarrhea; 42.8% of the patients with EAggEC as sole pathogens had bloody diarrhea, and these strains were negative for the presence of a virulence plasmid. Coccidia were found in those with acute and persistent diarrhea. Blood was observed in 53.3% of infections involving coccidia as the sole pathogen. Microsporidium spp. and Blastocystis hominis were found only in HIV+ patients with persistent diarrhea. Shigella spp., Campylobacter spp., and Entamoeba histolytica were found in HIV+ and HIV- dysenteric patients; bacteria resembling spirochetes that could not be cultivated were identified only in HIV+ cases with dysentery. Shiga-like toxin-producing E. coli O157:H- was isolated from two cases with hemolytic-uremic syndrome. Fungi were identified as the sole pathogen in 6.4% of the HIV+ patients with persistent diarrhea. Most of enteropathogenic bacteria identified were resistant to ampicillin and trimethoprim-sulfamethoxazole, remained susceptible to ampicillin plus clavulanic acid, and were susceptible to amikacin, gentamicin, and ciprofloxacin.

[Helicobacter heilmannii ulceronecrotic acute gastritis: apropos of 5 cases ]. / Gastrite aiguë ulcéronécrotique à Helicobacter heilmannii: à propos de 5 cas.

We report 5 cases of Helicobacter heilmannii associated ulceronecrotic gastritis in patients presenting with acute epigastric pain. These bacteria were known to be associated with chronic active gastritis, less severe than those associated with Helicobacter pylori. Helicobacter heilmannii appears as spiral shaped organisms larger and longer but less numerous than Helicobacter pylori. Our five patients were cured by 4 weeks treatment with proton-pomp inhibitors without antibiotics. Endoscopic control, done in 4 patients, showed a complete cure and eradication of the germ. No ulcer relapse had occurred.

[Case of bilateral pulmonary dystrophy operated on at the Dakar General Hospital]. / A propos d'un cas de dystrophie pulmonaire bilatérale opéré a l'Hôpital Principal de Dakar.

The authors report one case of large bullous dystrophia of both lungs. It was operated in two phases at the hospital Principal, Dakar, Senegal. They emphasize the technics of anesthesia by thoracic high epidural block, surgical technics. They also point out the clinical improvement, as results of respiratory functional exploration did prove it.

Putrescine and spermidine uptake is regulated by proliferation and dexamethasone treatment in AR4-2J cells.

Polyamines are essential for cell growth and differentiation. Their specific uptake contributes to the regulation of intracellular polyamine levels. In this study, we describe the modulation of this transport mechanism in a rat tumoral pancreatic acinar cell line (AR4-2J) and analyze the transport system characteristics of the normal rat pancreatic acini. Normal acini had a common carrier for spermidine and spermine, like AR4-2J cells, but not a specific putrescine carrier. Intracellular polyamine deprivation enhanced putrescine and spermidine uptake of AR4-2J cells with no modification of polyamine carrier affinity. Uptake was modulated during growth and decreased for both polymaines at confluence. AR4-2J cell differentiation with dexamethasone prevented cell proliferation and diminished uptake of both putrescine and spermidine without affecting their respective carrier affinities. Our data show, first, that the polyamine transport system could be modulated by polyamine metabolism with no change in its affinity characteristics. Second, in rat pancreatic acinar cells, neoplastic transformation was partly characterized by induction of a high-affinity putrescine carrier. This phenotype was not reversed by dexamethasone-induced cell differentiation.

Role of EUS in the management of pancreatic and ampullary carcinoma: a prospective study assessing resectability and prognosis.

BACKGROUND: Endoscopic ultrasonography (EUS) is highly accurate for the staging of tumors, but its role in the management of periampullary carcinoma is still being defined. METHODS: Seventy-nine patients with pancreatic (n = 73) or ampullary (n = 6) carcinoma underwent prospective evaluation by means of assessment of resectability and survival according to the following three-step staging algorithm: (1) ultrasonography and computed tomography; (2) if tumor appears resectable, EUS; (3) if criteria of resectability are found at EUS, laparotomy for curative resection. RESULTS: The first step of the algorithm helped predict unresectability of tumors and need for palliative treatment for 36 patients. Among the other 43 patients EUS revealed signs of unresectability in 20 additional patients who then underwent palliative surgical or medical treatment (median survival time 7 to 8 months). Twenty-three carcinomas were considered resectable according to EUS findings: Palliative surgery was performed in 9 cases (survival time 6 months), and 14 tumors could be resected in a curative way with a median survival period of 15 (pancreatic) to 16 months (ampullary). In evaluation of resectability, EUS had a 50% sensitivity (positive examination), 100% specificity, 100% positive predictive value, 61% negative predictive value, and 72% accuracy. CONCLUSIONS: EUS is accurate for evaluating resectability of ampullary and pancreatic cancer. EUS staging can prevent unnecessary surgery, and the findings correlate well with prognosis. The management of ampullary and pancreatic cancer could be improved with EUS.

Identification of K-ras mutations in pancreatic juice in the early diagnosis of pancreatic cancer.

OBJECTIVE: To develop an early diagnostic test for pancreatic cancer based on the identification of K-ras mutations in pure pancreatic juice collected during endoscopic retrograde pancreatography. DESIGN: Prospective study with masked comparison. The standard criteria for the diagnosis of pancreatic cancer were pancreatography or surgery (or both) and histopathology, with follow-up ranging from 6 to 40 months. SETTING: Referral center. PATIENTS: 24 patients with no pancreatic disease (group 1); 29 patients with nontumoral pancreatic disease (group 2); and 22 patients with pancreatic tumor (group 3). Endoscopic ductal aspiration of cells or brush cytology was done on patients having endoscopic retrograde pancreatography for diagnostic or therapeutic reasons. MAIN OUTCOME MEASURE: Confirmation of mutation rates in patients with pancreatic cancer. RESULTS: K-ras gene analysis was done by polymerase chain reaction-mediated restriction fragment length polymorphism analysis and direct sequencing. All patients from groups 1 and 2 (n = 53) had a normal sequence for the K-ras 12th codon (group 1, 0% [95% CI, 0% to 14%]; group 2, 0% [CI, 0% to 12%]). Mutations were seen in 17 of the 22 patients in group 3 (77% [CI, 55% to 92%]). Two of the 17 had no evidence of pancreatic cancer when K-ras was first studied. One had chronic abdominal pain and the other presented with acute pancreatitis. Both were initially free of any pancreatic mass, but they developed tumors 18 and 40 months, respectively, after the K-ras mutations were identified. CONCLUSION: Identification of K-ras mutations in samples of pancreatic juice may be useful in differentiating between pancreatic cancer and noncancerous pancreatic diseases. K-ras mutation can precede clinical evidence of pancreatic cancer, but the clinical implications of this finding need further study.