Maximal Bicarbonate Concentration Research Articles

Role of Endoscopic Retrograde CholangioPancreatography (ERCP) and Intraductal Secretin Test (IDST) in the Diagnosis of Chronic Pancreatitis (CP)

Background: 
 CP may be difficult to diagnose in the early stages when imaging may be normal. An IDST performed at ERCP may further evaluate for CP, with determination of pure pancreatic juice (PPJ) volume and bicarbonate concentration (BC). The optimal collection time for IDST is unknown. We report our experience with the IDST in 447 patients with suspected CP. 
 Experimental Design: 
 IDSTs performed from 2006-2018 were reviewed, with fluid collected at 5-min intervals for 20-60 minutes. Parameters evaluated were PPJ volume, Secretory Flow Rate (SFR), time of peak SFR, maximum BC and time to maximum BC. 
 Results: 
 Maximum BC was reached by 10-min in 59 patients (13.2%); 15-min: 207 patients (46.3%); 20 min: 340 patients (76.1%); 25-min: 384 patients (85.9%); 30-min: 421 patients (94.1%). Peak SFR was reached by 10-min in 92 patients (20.6%); 15-min: 177 patients (39.6%); 20-min: 240 patients (53.7%); 25-min: 284 patients (63.5%); 30-min: 323 patients (72.3%). Final diagnosis (normal vs. CP) for both SFR and BC was determined by 20-min (i.e. in CP pts, either the SFR or BC was low (SFR <3ml/min, BC <105mEq/L) and remained low throughout collection, or normal (>3ml/min and >105mEq/L) within the first 20-min. Further collection did not change the diagnosis. 
 Conclusion: 
 At IDST, a 20-minute collection period is necessary to categorize patients into normal or suspected CP groups. A study in control patients (no suspicion of CP) to validate these data is currently underway.

Evaluation of Pancreatic Endocrine and Exocrine Function in Patients With Autoimmune Pancreatitis

Up to now, the characteristics of pancreatic endocrine and exocrine functions in autoimmune pancreatitis (AIP) are still unclear. The aim of this study is to evaluate pancreatic functions in AIP compared with those of chronic pancreatitis (CP). Twelve patients with AIP and 25 patients with CP were examined for exocrine and endocrine pancreas. Exocrine function was evaluated by a secretin test. Concerning endocrine function, insulin secretion (C-peptide response) was examined with the glucagon tolerance test and glucagon secretion was examined with the arginine tolerance test. Pathological examination of pancreatic tissues was done on the operative specimens of AIP and CP that could not be clinically excluded from pancreatic cancer. For the secretin test, 8.3% of patients with AIP showed 1-factor abnormality, which was a reduction in volume, and 41.7% showed 2-factor abnormalities, which were a reduction in volume and amylase output. On the other hand, 44.0% of patients with CP showed only 1-factor abnormality, which was the reduction in the maximum bicarbonate concentration. Autoimmune pancreatitis accompanied with diabetes mellitus showed a reduction both in DeltaC-peptide response (beta-cell response) and Deltaglucagon (alpha-cell response). Histologically, AIP showed lymphoplasmatic cells infiltration surrounding the pancreatic ducts, but basement membranes were intact. Moreover, basement membranes of the duct were injured in CP. Furthermore, islet cells in AIP were revealed as almost intact even though they were surrounded by fibrosis. These findings indicate that exocrine dysfunction with AIP is different from CP because AIP induces stenosis of the pancreatic ducts, but ductal cells that possess the function of bicarbonate secretion are intact, and that endocrine dysfunction with AIP was secondary pancreatic diabetes.

The Effect of Moderate Sedation on Exocrine Pancreas Function in Normal Healthy Subjects: A Prospective, Randomized, Cross-Over Trial Using the Synthetic Porcine Secretin Stimulated Endoscopic Pancreatic Function Test (ePFT)

We have developed a purely endoscopic collection method for the assessment of pancreatic secretory function (ePFT). The pancreatic secretory effects of sedation medications utilized during endoscopic procedures are not completely known. To study the effect of moderate sedation on the exocrine pancreas gland in a prospective, randomized trial. Healthy volunteers were randomized by computers to one of two treatments (A-no sedation, B-sedation) in period 1 and crossed-over to the other treatment in period 2 with a minimal washout interval of 7 days. Sedation dosage was standardized for each patient based on age, gender and weight from a previously published dosing nomogram. Synthetic porcine secretin (ChiRhoClin, Inc., Burtonsville, Maryland) was used as the pancreatic stimulant. Duodenal fluid samples were aspirated via the endoscope every 5 min for 1 h and sent on ice to our hospital laboratory for the measurement of pancreatic secretory electrolyte concentrations by autoanalyzer. A total of 17 healthy volunteers were enrolled. Sixteen subjects (8 males and 8 females) completed the randomized prospective trial. Median intravenous meperidine and midazolam sedation dose was 62.5 mg and 2.5 mg, respectively. Maximum pancreatic juice flow occurred during the early phase of secretion and maximum bicarbonate concentration occurred during the late phase of secretion. Analysis of the electrolyte composition of the endoscopically collected duodenal drainage fluid revealed a constant cation concentration for both sodium and potassium over the 1 h collection period. The anions, chloride and bicarbonate, exhibited a reciprocal relationship identical to that seen in traditional gastroduodenal tube collection studies. There was no statistical difference observed between the sedation and no sedation groups. The estimated total bicarbonate output (area under curve, AUC) for the sedated and non-sedated groups were 5,017 meq + 724 (range 3,663-6,173) and 5,364 meq +/- 583 (range 4,323-6563) respectively (p= 0.0656). The mean peak bicarbonate concentrations for sedated (n = 8) versus non-sedated (n = 8) groups were 103 +/- 11 meq/L (range 78-125) and 106 +/- 11 meq/L (range 87-138), respectively (p= 0.1346). There was excellent correlation of peak bicarbonate concentrations when sedation and no sedation groups were compared (r= 0.744, p < 0.05; Spearman rank correlation). There were no episodes of pancreatitis. (a) Moderate sedation used for upper endoscopy does not effect the clinical diagnostic parameters (peak bicarbonate concentration or total bicarbonate output) utilized to diagnose pancreatic insufficiency. (b) Analysis of duodenal drainage fluid collected endoscopically after synthetic secretin stimulation produces an identical pancreatic secretory curve described with traditional gastroduodenal tube collection methods.

Pancreatic Duct Abnormalities and Pancreatic Function in Patients with Chronic Inflammatory Bowel Disease

We performed a cross-sectional study to estimate the prevalence of duct abnormalities and exocrine pancreatic dysfunction in an unselected group of patients with inflammatory bowel disease (IBD) and to correlated the findings with clinical, endoscopic, and histologic variables. A total of 237 IBD patients were screened for pancreatic enzymes and with a PABA test. Seventy-one (30%) patients with values more than twice the upper normal limit in biochemical tests or with a PABA test < 40% were further evaluated. The pancreatic evaluation included endoscopic retrograde pancreatography, ultrasonography, and a secretin test. The endoscopic and histologic findings were systematically evaluated. The secretin test was completed in 54 patients, and in 10 (19%) it showed a decreased maximal bicarbonate concentration, corresponding to 4% of the whole study group. The pancreatograms of 59 patients were studied. In 20 (34%) patients unequivocal duct abnormalities were found. The prevalence of pancreatic duct abnormalities in IBD was 8.4%. Our results show the presence of pancreatic duct abnormalities and exocrine pancreatic insufficiency in some patients with IBD.

加齢によるすい外分泌機能の変化 新しく提案されたセクレチン静注法を用いて

The authors studied the relationship between aging and exocrine pancreatic function by the secretin test which was recently standardized by the Japanese Society of Gastroenterology. Pancreatic juice was collected at 10 min intervals for 60 minutes after a bolus intravenous injection of secretin (Secrepan, Eisai Co., Ltd., 100 U/body) through a quadruple-lumen doudenal tube equipped with double balloons. Exocrine pancreatic function was evaluated by three parameters: secretory volume, maximal bicarbonate concentration or bicarbonate output, and enzyme (amylase and lipase) output. Control subjects consisted of 65 outpatients presenting with mild vague abdominal symptoms who fulfilled the following three criteria: 1) good general condition with no known diseases; 2) no abnormality in the liver, bile duct, pancreas, kidney and metabolism judged from blood chemistry, urine and stool analysis, upper GI series, abdominal ultrasonography (US), and endoscopic retrograde cholangiopancreatography (ERCP); 3) alcohol consumption less than 25 g/day. Control subjects were divided into three groups: 15 subjects below 40 years of age (group A), 32 subjects from 40 to 65 years (group B), and 18 subjects of 65 years and above (group C). Nineteen patient with chronic pancreatitis were also studied. The group C showed significantly lower values in secretory volume, bicarbonate output, and enzyme output than group A and B. Enzyme output showed a gradual decrease with aging. However, secretory volume and bicarbonate output showed a gentle convex curve with a peak around age 40 and a rather steep down-slope after late 50s. The degree of the decrease was significantly more marked in volume and bicarbonate output than in enzyme output in group C.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Usefulness of Dual-Label Schilling Test for Pancreatic Exocrine Function

The usefulness of the pancreatic dual-label Schilling test as an indirect test of pancreatic exocrine function was evaluated. This dual-label Schilling test was based on the difference of absorption for [58Co]cobalamin bound to hog R protein and [57Co]cobalamin bound to intrinsic factor. In this study, the test was performed in 7 normal subjects, 5 patients with pancreatectomy, 12 patients with chronic pancreatitis, 10 patients with suspicion of chronic pancreatitis, and 13 patients without chronic pancreatitis. The normal lower limit (mean -2 SD) of excretion ratio for [58Co]/[57Co] in 24-h urine was 0.68. Of the 26 patients on whom endoscopic retrograde pancreatography was performed, none of the 9 patients with normal pancreatogram, 4 of the 9 patients with mild to moderate pancreatitic changes in pancreatogram, and 7 of the 8 patients with advanced pancreatitic changes in pancreatogram showed a positive value lower than the ratio of 0.68 in this test. In 28 patients examined with the direct test of pancreatic secretory capacity, 2 of the 13 patients with normal function, 6 of the 9 patients with mild dysfunction, and 5 of the 6 patients with definite dysfunction were positive in this test. The results of the pancreatic dual-label Schilling test significantly correlated with those of a direct test of pancreatic secretory capacity and the findings of pancreatitic changes in pancreatogram (p less than 0.01, chi 2 test). The ratio for [58Co]/[57Co] correlated (r = 0.73) with the maximal bicarbonate concentration in duodenal juice of the direct test of pancreatic secretory capacity. The impairment of bicarbonate output by the pancreas may adversely affect the transfer of cobalamin from R protein to intrinsic factor. It suggested that the pancreatic dual-label Schilling test is useful for detecting not only patients with severe pancreatic insufficiency but also the relatively early stage of chronic pancreatitis with bicarbonate secretory dysfunction of the pancreas.

Exocrine pancreatic function test by endoscopic retrograde aspiration of pure pancreatic juice.

The validity of endoscopic retrograde aspiration of pure pancreatic juice (PPJ) as an exocrine pancreatic function test was evaluated in terms of coefficients of variation in control subjects, reproducibility on repeated examinations, and sensitivity for detecting patients with chronic pancreatitis (CP). PPJ was obtained from, nine control subjects, four patients with suspected CP and 13 with CP. PPJ was collected from within the pancreatic duct by endoscopic retrograde catheterization of the papilla at 2-min intervals for 20 minutes after a bolus intravenous injection of secretin (1U/kg) and then for further 20 minutes after a bolus intravenous injection of CCK-PZ (1U/kg). It was recognized that endoscopic aspiration of PPJ was at least as useful and reliable as the traditional pancreozymin secretin test. Useful parameters included 10-min secretory volume and 10-min bicarbonate output after secretin stimulation, and 10-min enzyme output after CCK-PZ stimulation (lipase output showed higher sensitivity than amylase output). Maximal bicarbonate concentration showed poorer reproducibility and sensitivity despite better coefficients of variation. Lower limits in controls (mean-1.5SD) were 22.5ml for 10-min secretory volume, 2.7mEq for 10-min bicarbonate output, 24.5 x 10(3)U for 10-min amylase output and 3.4 x 10(3)IU for 10-min lipase output.

Study of Chronic Alcoholic Pancreatitis by Means of Serial Pancreozymin-Secretin Tests

Fourteen patients with suspected chronic alcoholic pancreatitis (CAP) and 21 patients who had been shown to have the disease were followed up by the pancreozymin-secretin test in order to clarify the serial changes in exocrine pancreatic function in alcoholic pancreatitis. The initial and final test data for secretory volume, maximal bicarbonate concentration, bicarbonate output (BO), and amylase output (AmO) of exocrine secretion were compared in these two groups. Patients with suspected CAP showed a significant serial decrease only in AmO; definite CAP developed in 3 of them during the follow-up period. In definite CAP, a significantly progressive decrease in BO as well as AMO was observed. It is suggested that in the earlier stage of CAP, AMO is initially affected, whereas decreased secretion of both bicarbonate and enzyme becomes apparent in the later stage.

Pancreatic function tests in tropical sprue is pancreas involved?

Pancreatic functions were studied in 15 patients with tropical sprue. The diagnosis of tropical sprue was made on accepted criteria of demonstrating malabsorption of at least two unrelated food substances in the absence of any other cause for malabsorption in patients residing in a tropical zone. Exogenous secretion (Boots) in a dose of one clinical unit per kg was employed for direct stimulation of exocrine pancreatic secretion. Of the 15 patients, 12 showed normal pancreatic functions. In two patients, volume output was marginally low i.e. 1.6 and 1.6 ml/kg/hr respectively (Normal value greater than 1.8 ml/kg/hr). In the third patient, volume output was normal but maximum bicarbonate concentration in pancreatic juice was 61.6 mEq/litre (Normal value greater than 80 mEq/litre). None of these three patients, however, had abnormalities in both the parameters of exocrine pancreatic function. Although pancreatic hyposecretion has been reported in patient with tropical sprue when indirect stimulation with Lundh meal was applied to pancreas, yet on direct stimulation with secretin, we found pancreatic functions to be normal. It is therefore concluded that the pancreas is not primarily involved in tropical sprue.

加令と膵

There have been many reports on aging of the pancreas; decrease in weight, atrophy and fatty degeneration of the acinal cells, increase of the interacinar connective tissue, arteriosclerosis and so on. However, only a limited number of reports have been published on changes in the exocrine pancreatic function as related to aging and these results are controversial. Furthermore reports on morphological changes of the pancreas, especially of the pancreatic duct, have been limited to a small number of studies with histological evaluation.The purpose of the present study is to elucidate morphological as well as functional changes of the aging pancreas in the light of recent developments in thinking of: (1) functional changes of the exocrine pancreas as evaluated with the pancreozymin-secretin test; (2) morphological changes of the pancreatic duct as evaluated with endoscopic retrograde cholangiopancreatography; (3) correlation between functional and morphological changes.The present paper is concerned with studies on changes of the exocrine function of the aging pancreas as evaluated with the panceozymin-secretin test according to the modified Sun-Shay method.The material was taken from healthy controls accommodated in an old-age home, healthy controls hospitalized for routine annual check-ups, and patients who had no abdominal or metabolic disease. The 60 controls were subdivided into three groups according to age for comparative studies: 21 to 40 years of age; 41 to 60 years of age; older than 60 years of age.The following conclusions were made:(1) A significant decrease in the exocrine pancreatic function was observed with aging.(2) The decrease of exocrine pancreatic function with aging was unrelated to the body weight of controls, the doses of pancreozymin and secretin determined according to the body weight, sex, or the history of alcohol ingestion in cases where daily intake was limited to less than 33 g of ethanol.(3) Because of the decrease in exocrine pancreatic function, physiological ranges of secretory volume, maximal bicarbonate concentration, bicarbonate output and amylase output on the pancreozymin-secretin test were determined for each age group.

加令と膵

The previous reports revealed that the aging pancreas showed a significant decrease in the exocrine function as evaluated by the pancreozymin-secretin test and that dilatation, totuosity and irregularity of the margin of the pancreatic duct were more frequently observed with aging.The present report is concerned with studies on the correlationship between changes in exocrine pancreatic function and pancreatogrms with aging.The material was taken from 117 patients hospitalized for routine annual check-ups and those with no abdominal or metabolic diseases on whom pancreozyminsecretin tests and endoscopic retrograde cholangio-pancreatography were performed after a short timelag. Evaluated were 4 factors by the pancreozyminsecretin test (secretory volume, maximal bicarbonate concentration, bicarbonate output, and amylase output) and 4 factors on pancreatograms (diameters of the main pancreatic duct in the head, the body and the tail of the pancreas and the presence or absence of irregularity of the margin of the pancreatic duct).The following conclusions were made:(1) The exocrine pancreatic function decreased significantly with aging. The main pancreatic duct also showed significant dilatation with aging. A clear-cut correlation was observed among aging, decrease in exocrine pancreatic function and increase in the diameter of the pancreatic duct.(2) Cases with a decrease in exocrine pancreatic function as well as irregularity of the margin of the main pancreatic duct were observed in an increasing frequency with aging.(3) It was concluded that aging, exocrine pancreatic function and pancreatographic findings are closely related and that there is a clear-cut parallelism between aging in the exocrine pancreatic function and that in the pancreatic duct as revealed on pancreatograms.

Biochemical and clinical studies on human pancreatic deoxyribonuclease I inhibitor.

Human pancreatic Deoxyribonuclease I (DNase I), inhibitor was partially purified from duodenal juice of healthy subjects collected in the Pancreozymin-Secretin test, by a procedure which included ammonium sulfate fractionation, DEAE cellulose fractionation, Sepharose 4B affinity chromatography, and gel filtration. The final preparation inhibited DNase I only, and had no inhibitory activity on pancreatic RNase, and trypsin. The inhibitor had a molecular weight of approximately 40,000, as determined by gel filtration, and showed the same mobility as skeletal muscle actin on SDS gel electrophoresis. Then clinical studies were made on the DNase I inhibitor in duodenal juice obtained after administration of Pancreozymin and Secretin to patients with various pancreatic diseases. In patients with suspected chronic pancreatitis with whom the ordinary test, containing the assay of the total volume, amylase output and maximum bicarbonate concentration of duodenal juice had produced normal results, the DNase I inhibitor output was observed to be higher than that in control subjects. While it was lower in patients with confirmed chronic pancreatitis than in control subjects. There results imply that DNase I inhibitor output may be an indicator of the pancreatic inflammation state and be useful for the early detection of pancreatic diseases.

Analysis of pure pancreatic juice in patients with chronic alcoholism.

To elucidate early biochemical changes of pancreatic juice and their reversibility in chronic alcoholics, pure pancreatic juice was collected from 23 chronic alcoholics by endoscopic retrograde catheterization of the papilla. Samples were collected at 1 minute intervals for 20 minutes after intravenous injection of secretin (Eisai, 1 U/kg) and for 10 minutes after CCK-PZ injection (Boots, 1 U/kg). Volume, bicarbonate concentration, protein concentration and three hydrolases were determined. Following results were obtained. (1) Five patients showed hypersecretory state. Four of the five patients showed hyperconcentration of protein. (2) Seventeen patients showed hyposecretory state. Lipase secretion was most frequently affected (94%). Maximal bicarbonate concentration was the next to be affected (82%). Amylase and chymotrypsinogen secretion were less frequently affected (65%). Flow rate was least frequently affected (24%). (3) It was suggested that exocrine dysfunction in chronic alcoholics is reversible in an early stage and that sequence of events with advancement of the stage is hypersecretion, hyperconcentration of protein, normalization of water secretion with a decrease in lipase secretion and maximal bicarbonate concentration, a decrease in amylase and chymotrypsinogen output, and finally a decrease in flow rate.

Clinical studies on human pancreaticdeoxyribonuclease I

Duodenal juice collected after administration of Boot's pancreozymin and secretin to patients with various pancreatic diseases was subjected to deoxyribonuclease I (DNase I) assay, as well as measurements of total volume, amylase output and maximum bicarbonate concentration. It was observed that the DNase I output is well correlated with each of three factors. The DNase I output was much lower in patients with chronic pancreatitis or pancreatic cancer than in control subjects, and DNase I output was even found to be low in patients suspected of having chronic pancreatitis, who did not give abnormal resulsts with other assay methods. These results imply that DNase I output may be a good indicator of exocrine function of the pancreas, and thus may be useful for early detection of pancreatic diseases.

Studies on human pure pancreatic juice collected by endoscopic retrograde catheterization of the papilla.

Pure pancreatic juice was collected from 8 subjects by endoscopic retrograde cannulation of the papilla. Samples were collected at 1 minute intervals for 20 minutes after rapid intravenous injection of secretin (Eisai, 1u/kg) and for 10 to 15 minutes after rapid intravenous injection of CCK-PZ (1 U/kg). Three hydrolases (amylase, chymotrypsinogen and lipase) showed nonparallel secretory pattern. Lipase was proportionally more stimulated than chymotrypsinogen and chymotrypsinogen was more stimulated than amylase by CCK-PZ stimulation. However, in one subject the secretion of three hydrolases was parallel and in another subject lipase and chymotrypsinogen showed parallelism. Samples collected at "wash out" period showed quite high enzyme and protein concentration with specific activity and enzyme ratio not different from those of samples collected at peak period of CCK-PZ stimulation. Normal ranges were estimated in peak flow rate per minute, peak enzyme concentration, specific activity of enzymes, maximal enzyme output per minute and maximal bicarbonate concentration.

Studies on intestinal malabsorption in chronic pancreatitis.

Pancreozymin-secretin test (PS test) and intestinal absorption tests were performed in 21 patients with chronic calcific pancreatitis and 32 patients with chronic noncalcific pancreatitis to evaluate exocrine functions of the pancreas. And the following results were confirmed. (1) Fecal fat excretion increased in 33% of chronic pancreatitis (47% of calcific pancreatitis and 25% of noncalcific pancreatitis). Serum carotene leves showed significantly low levels in 44% of chronic pancreatitis (67% of calcific pancreatitis and 27% of noncalcific pancreatitis). (2) D-xylose tolerance test was abnormally low in only 6% of chronic pancreatitis, but Schilling test was evaluated abnormally low in 29% of chronic pancreatitis (50% of calcific pancreatitis and 11% of noncalcific pancreatitis). (3) Fecal fat excretion increased in cases of severe exocrine insufficiency of the pancreas with decreased amylase output and decreased maximum bicarbonate concentration in PS test. (4) Correlation of fecal fat excretion to maximum bicarbonate concentration was statistically significant, but those to amylase output or volume of pancreatic juice were not significant. (5) Antacid drugs combined with pancreatic extracts seems to be indispensable in the treatment of chronic pancreatitis as far as malabsorption in chronic pancreatitis is concerned.

DIAGNOSIS OF PANCREATIC DISEASE BY A SYNTHETIC PEPTIDE: A New Test of Exocrine Pancreatic Function

N-benzoyl-L-tyrosyl- p-aminobenzoic acid, a synthetic peptide, is specifically cleaved by the pancreatic endopeptidase chymotrypsin; the released p-aminobenzoic acid (P.A.B.A.) is absorbed and excreted in the urine. To evaluate its diagnostic value, the urinary excretion of P.A.B.A. after oral administration of this peptide was examined in patients with pancreatic disease (chronic pancreatitis with pancreatic insufficiency and pancreatic carcinoma). Recovery of P.A.B.A. in the urine was significantly lower in patients with pancreatitis (40%) and pancreatic carcinoma (56%) than in the control group (75%) (P<0·001 and P<0·05 respectively). A good correlation was obtained comparing 8-hour cumulative recovery of P.A.B.A. with maximal bicarbonate concentration during secretin cholecystokinin/pancreozymin (C.C.K./P.Z.) test (P<0·001), mean intraduodenal concentration of trypsin (P<0·01), and 72-hour fæcal fat determination (p<0·05). These data indicate that urinary excretion of a tracer marker (P.A.B.A.) of a synthetic peptide (1) correlates well with other parameters of exocrine pancreatic function and (2) may prove a useful, practical, and accurate diagnostic test in chronic pancreatitis with pancreatic insufficiency.

Further Studies of Parotid Saliva Test as a Diagnostic Means for Pancreatic Disorders

The parotid saliva test was made on 89 subjects in total, consisting of 54 patients with non-pancreatic disorders, 27 with pancreatic disorders, and 8 remote postoperative cases of pancreatolithiasis, and the following results were obtained: 1) The salivary output as well as the maximum bicarbonate concentration and amylase content in the parotid saliva of patients with pancreatic disorders were significantly less than those of patients with non-pancreatic disorders. 2) Three of the 8 remote postoperative cases of pancreatolithiasis and a case with cancer of the head of the pancreas showed abnormally high salivary output and amylase con-tent. 3) The positive saliva test was found in 85% of patients with pancreatic disorders. 4) Histological changes of the parotid glands were atrophic and degenerative in patients with hypofunction on the saliva test, and hypertrophic in patients with hyperfunction on the saliva test.

Clinicopathological studies on the relationship between cholelithiasis and chronic pancreatitis.

In order to investigate the relationship between cholelithiasis and chronic pancreatitis, biopsy of the pancreas was performed Iat laparotomy in 151 cases with cholelithiasis, and the pancreatic exocrine function test using secretin was applied in 119 out of them. Thirty-one cases with gastric lesion were served as controls. The disturbance of the pancreatic exocrine function was demonstrated in 30 (25%) of the 119 cases; mildly disturbed in 25, moderately in 4, and markedly in one. Of a total of 30 cases with disturbed pancreatic exocrine function, there were 10 cases with decreased volume of the duodenal aspirate, 17 with decreased maximum bicarbonate concentration and 9 with decreased output of amylase. Thus, cases with reduced maximum bicarbonate concentration were most frequently observed. In the majority of the cases with bacteria in bile, with common bile duct dilatation and with hypercholesterolemia, the disturbance of the pancreatic exocrine function of moderate and marked degree was observed. A significant correlation was indicated between the histology of the pancreas and the result of the secretin test in the cases with moderately and markedly disturbed exocrine function. However, no significant difference was demonstrated between the controls and the group of cholelithiasis in morphological features. Only 5 cases (3%) of 151 cases with cholelithiasis were regarded as chronic pancreatitis.

Laboratory diagnostic test for pancreatic disorders by examination of parotid saliva.

Laboratory diagnostic tests for pancreatic diseases were carried out by examination of samples of parotid saliva in 22 patients, of whom 9 were with pancreatic disorders and 13 with disorders of other organs or systems. Trend analyses of the data thereby obtained revealed the approximate borderline values (lower for pancreatic diseases and higher for non-pancreatic disorders) for the rate of salivary secretion, its maximum bicarbonate concentration and amylase secretion to be 0.6ml per minute, 20 mEq/L, and 1, 000 units per kg of body weight, respectively. The results of the present study emphasize potential usefulness of the examination of parotid saliva as a reliable diagnostic means for diseases of the pancreas.