ceruletide and Biliary-Tract-Diseases

Topics: Biliary Tract Diseases; Ceruletide; Cholangiography; Cholelithiasis; Duodenal Ulcer; Endoscopy; Gastrins; Gastrointestinal Diseases; Gastrointestinal Hemorrhage; Gastrointestinal Hormones; Humans; Intestinal Absorption; Lactose Intolerance; Pancreatic Diseases; Peptic Ulcer; Radionuclide Imaging; Secretin; Stomach Neoplasms

Topics: Adult; Aged; Biliary Tract Diseases; Ceruletide; Clinical Trials as Topic; Colic; Female; Humans; Kidney Diseases; Male; Middle Aged; Random Allocation

A randomized controlled study has been carried out in order to check the activity of caerulein in the treatment of biliary and renal colic. In 88% out of 107 patients caerulein, 1 ng/kg IV, relieved biliary colic and had no side effects. To elucidate the mechanism of action of the peptide, 22 cholecystectomized patients, showing a dilation of the common bile duct (CBD), were submitted to caerulein treatment under echo-control. Reduction of CBD caliber was noticed when the dilatation was due to functional obstruction, whereas an organic obstruction of the terminal tract of CBD was found in the non-responding patients. Caerulein appears to be an effective agent in relieving biliary colic through a relaxation of Oddi's sphincter, and may be used in ultrasound differential diagnostics of terminal bile duct obstruction. Caerulein, 75 ng/kg intramuscularly, relieved renal colic in 75% of the examined patients; it is suggested that the effect of caerulein in this syndrome is due to central analgesic action.

Topics: Adolescent; Aged; Biliary Tract Diseases; Ceruletide; Colic; Double-Blind Method; Female; Humans; Kidney Diseases; Male; Middle Aged

A prospective clinical trial of 100 patients receiving either intramuscular ceruletide or a fatty meal to contract the gallbladder after oral cholecystography is described. The percentage reduction of the gallbladder area after 30 min of stimulation was not significantly greater with ceruletide (49%) than with a fatty meal (44%) (t-test: p greater than 0.3). Ceruletide caused significantly more adverse reactions than a fatty meal (Fisher test, p less than 0.01). The diagnostic value of routine cholecystokinetic stimulation is doubtful, since the diagnosis changed after the contraction in only 1 patient.

Topics: Biliary Tract Diseases; Ceruletide; Cholecystography; Clinical Trials as Topic; Dietary Fats; Female; Gallbladder; Humans; Male; Middle Aged; Random Allocation

The analgesic effect of ceruletide in biliary and renal colic was evaluated by a randomized, double-blind study in 82 patients. Ceruletide was compared with pentazocine, a well-established analgetic agent. Rapid and effective analgesia was obtained by intramuscular injection of ceruletide 0.5 micrograms/kg in 56 patients with biliary colic. The analgesic effect of ceruletide compared well with pentazocine 0.5 mg/kg im, and was associated with remarkably fewer side effects. In 26 patients with renal colic, ceruletide was significantly inferior to pentazocine. These data support the recommendation of ceruletide as a first-choice analgetic agent for biliary colic.

Topics: Adult; Biliary Tract Diseases; Ceruletide; Clinical Trials as Topic; Colic; Double-Blind Method; Female; Humans; Kidney Diseases; Male; Middle Aged; Pentazocine; Random Allocation; Time Factors

A randomized placebo-controlled double-blind trial was carried out in 24 patients with biliary colic pain in order to evaluate the analgesic effect of caerulein (CRL). Caerulein (1 ng/kg . min infused intravenously over 15 min) showed an analgesic effect that was significantly higher than placebo (p less than 0.001). The analgesic action of CRL was not inhibited by naloxone (0.4 mg intravenously, administered two times). Further, the effect of i.v. CRL or saline on artificially induced biliary tree hypertension was studied in 7 patients with a T-tube common bile duct drainage. During saline intravenous administration, increasing biliary tree pressure resulted in pain in 5 patients, with the threshold for pain being 40 cmH2O. During CRL intravenous infusion, significantly higher perfusion pressures were required to achieve a given common bile duct pressure and the pressure threshold for pain was not reached. Consequently, pain was prevented in all patients. These data suggest that CRL relieves biliary colic pain by reducing biliary tract pressure.

Topics: Adult; Bile Ducts; Biliary Tract Diseases; Ceruletide; Cholelithiasis; Clinical Trials as Topic; Colic; Double-Blind Method; Female; Humans; Infusions, Parenteral; Male; Middle Aged; Naloxone; Pressure; Random Allocation; Time Factors

Pancreatic acinar cells express proteinase-activated receptor-2 (PAR2) that is activated by trypsin-like serine proteases and has been shown to exert model-specific effects on the severity of experimental pancreatitis, i.e., PAR2(-/-) mice are protected from experimental acute biliary pancreatitis but develop more severe secretagogue-induced pancreatitis. P2pal-18S is a novel pepducin lipopeptide that targets and inhibits PAR2. In studies monitoring PAR2-stimulated intracellular Ca(2+) concentration changes, we show that P2pal-18S is a full PAR2 inhibitor in acinar cells. Our in vivo studies show that P2pal-18S significantly reduces the severity of experimental biliary pancreatitis induced by retrograde intraductal bile acid infusion, which mimics injury induced by endoscopic retrograde cholangiopancreatography (ERCP). This reduction in pancreatitis severity is observed when the pepducin is given before or 2 h after bile acid infusion but not when it is given 5 h after bile acid infusion. Conversely, P2pal-18S increases the severity of secretagogue-induced pancreatitis. In vitro studies indicate that P2pal-18S protects acinar cells against bile acid-induced injury/death, but it does not alter bile acid-induced intracellular zymogen activation. These studies are the first to report the effects of an effective PAR2 pharmacological inhibitor on pancreatic acinar cells and on the severity of experimental pancreatitis. They raise the possibility that a pepducin such as P2pal-18S might prove useful in the clinical management of patients at risk for developing severe biliary pancreatitis such as occurs following ERCP.

Topics: Acinar Cells; Animals; Bile Acids and Salts; Biliary Tract Diseases; Calcium; Calcium Signaling; Ceruletide; Cholangiopancreatography, Endoscopic Retrograde; Chymotrypsinogen; Coloring Agents; Enzyme Activation; Enzyme Precursors; Gallstones; Indicators and Reagents; Lipopeptides; Mice; Mice, Inbred C57BL; Mice, Knockout; Pancreatitis; Propidium; Receptor, PAR-2; Trypsinogen

This study reviewed 25 patients with the reflux sign in cholescintigraphy to assess its diagnostic value in evaluating biliary passage. After at least 4-hour fasting 5 mCi of 99mTcPMT or p-butyl IDA was injected intravenously and serial images were recorded before and after intramuscular injection of 10 micrograms of ceruletide diethylamine (caerulein). The reflux sign was determined positive when increased radioactivities in the left hepatic duct (minor reflux; MIR) or more peripheral intrahepatic ducts (major reflux; MAR) were recognized after injection of caerulein. The reflux sign was found in 28 of 237 (12%) studies. Direct and/or indirect X-ray cholangiograms were available in 25 (MIR; 15, MAR; 10). They included common bile duct (CBD) stone in 4, dilated CBD in 4, biliary dyskinesia (BD) in 4, chronic pancreatitis (CP) in 4, gallbladder (GB) stone in 3, duodenal ulcer (DU) in 2, CBD adenoma, pancreatic pseudocyst (PP), duodenal diverticle (DD), and acute cholangitis (AC) in 1 each. Their serum bilirubin levels were within normal limit in all but 2 at the time of cholescintigraphy. Transit time of radionuclides to the duodenum was found prolonged more than 60 min in 17 (68%) patients and persistent pooling in the CBD was found in 8 (28%) patients on scintigrams. The diameter of the CBD on X-ray cholangiogram was ranged 4 to 17 mm. Dilated CBD of more than 10 mm was found in 13 (52%) patients and apparent stenosis of the CBD in 6 (24%) patients. MAR seemed to correspond to increased diameter of the common hepatic more than 2 mm after caerulein injection in DIC. No abnormal findings in X-ray cholangiography was found in 10 (40%) patients including 3 with BD, 2 with GB stone, 2 with DU, 1 each with CP, PP, and AC. All those patients demonstrated MIR. We concluded that major reflux (MAR) sign was helpful in detecting an incomplete obstruction of the CBD, especially in patients with slightly to mildly dilated CBD.

Topics: Adult; Aged; Biliary Tract Diseases; Ceruletide; Cholangiography; Female; Gallbladder; Humans; Male; Middle Aged; Organometallic Compounds; Organotechnetium Compounds; Pyridoxal; Radionuclide Imaging; Technetium; Tryptophan

This study reviewed 12 patients with the reflux sign in cholescintigraphy to assess its diagnostic usefulness in evaluating biliary passage. The reflux sign was determined by appearance or increase of the radioactivity in peripheral intrahepatic bile ducts after intramuscular injection of 10 micrograms of ceruletide diethylamine (caerulein). Of the 12 patients, there were common bile duct (CBD) stone in four, chronic pancreatitis in two, biliary dyskinesia in two, papillary adenoma of the CBD, dilated CBD, papillitis, and juxtapapillary duodenal diverticulum in one each. Cholangiographically, dilated caliber of the CBD more than or equal to 12 mm was found in five and equivocal caliber of 8 to 11 mm was in the remaining seven. Apparent stenosis of the CBD was found in four with dilated CBD. There were two patients who had CBD stone with equivocal caliber of the CBD. The reflux sign seems to be a sensitive finding indicating the presence of biliary dysfunction, and would be helpful for the detection of incomplete obstruction of the CBD or CBD stone, especially in a patient with equivocal caliber of the CBD.

Topics: Adult; Aged; Bile Reflux; Biliary Tract; Biliary Tract Diseases; Ceruletide; Cholangiography; Cholestasis; Common Bile Duct; Common Bile Duct Diseases; Female; Gallbladder; Humans; Male; Middle Aged; Muscle Contraction; Radionuclide Imaging; Retrospective Studies

Topics: Biliary Tract Diseases; Ceruletide; Colic; Common Bile Duct; Humans; Pain; Pressure

A dose of 0.3 micrograms/kg body weight of ceruletide was assessed for its effect on gallbladder contraction and bile duct delineation following oral cholecystography. Nausea, vomiting, and abdominal pain sometimes occurred after ceruletide. No relationship was found after ceruletide administration between the radiologic appearances of the biliary tract and reproduction of the patients' biliary-type symptoms. Ceruletide cholecystography is regarded as an inaccurate investigation of biliary tract function.

Topics: Adult; Aged; Biliary Tract Diseases; Ceruletide; Cholecystography; Female; Gallbladder; Humans; Male; Middle Aged

Ceruletide is a decapeptide isolated from the skin of an Australian frog. Its chemical and biologic relationship to cholecystokinin and its potent relaxant effect on the sphincter of Oddi makes it useful in biliary colic. In this double-blind placebo-controlled experiment, 60 subjects with moderate to severe pain caused by biliary colic were injected with ceruletide, 1 ng/kg iv or with an equal volume of saline solution. Pain in the right hypochondrium, referred pain, and Murphy's sign were scored before and after treatment. Data indicate that ceruletide is effective in biliary colic.

Topics: Adult; Aged; Analgesics; Biliary Tract Diseases; Ceruletide; Colic; Double-Blind Method; Drug Evaluation; Female; Humans; Injections, Intravenous; Male; Middle Aged; Pain; Random Allocation

We have compared responsiveness of serum lipase and amylase activity to the pancreatic exocrine stimulation with cerulein and secretin (CS test) in normal subjects and patients with pancreas-related and other diseases. The lipase and amylase activities were measured by a sensitive colorimetric method, the BALB-DTNB method and the Caraway method, respectively. The percentage of positive lipase and amylase response cases was as follows: confirmed chronic pancreatitis (N = 22), 27 and 14%; suspected chronic pancreatitis (N = 37), 46 and 32%; pancreatic cancer (N = 16), 44 and 25%; biliary tract diseases (N = 11), 14 and 14%; miscellaneous (N = 11), 0 and 18%; normal subjects (N = 13), and partial pancreatectomy (N = 5), 0 and 0%, respectively. The serum lipase response cannot be regarded as specific for pancreatic diseases because the lipase response cases were found in biliary tract diseases as well. However, in view of frequent, fast, and intense responsiveness to the CS test, the serum lipase activity measured by the BALB-DTNB method may be more useful than the serum amylase as an auxiliary diagnostic aid for suspected pancreatitis which might develop into confirmed chronic pancreatitis or cancer of the head or body of the pancreas.

Topics: Adolescent; Adult; Aged; alpha-Amylases; Biliary Tract Diseases; Ceruletide; Clinical Enzyme Tests; Colorimetry; Female; Humans; Lipase; Male; Middle Aged; Pancreas; Pancreatic Diseases; Pancreatic Function Tests; Pancreatic Neoplasms; Secretin

Topics: Adult; Animals; Biliary Tract Diseases; Ceruletide; Cholecystokinin; Female; Humans; Male; Rats

Topics: Adult; Aged; Biliary Tract Diseases; Ceruletide; Colic; Female; Humans; Male; Middle Aged

The role of caerulein in differentiating functional narrowing of the distal common bile duct from organic stenosis was studied in 146 patients. Caerulein caused a generalized contraction of the extrahepatic biliary tract and a contraction of the sphincter of Oddi. It therefore improved opacification of the tract, particularly of the terminal portion, which is often not demonstrated by traditional techniques. The appearance of the duodenographic effect allowed for the evaluation of functional factors, which often play a role in stenosis of the sphincter of Oddi. Also, the reduction of bile-duct caliber revealed previously undetected filling defects.

Topics: Adult; Aged; Biliary Tract Diseases; Ceruletide; Cholangiography; Common Bile Duct; Diagnosis, Differential; Female; Humans; Male; Middle Aged

Topics: Adult; Aged; Bile Ducts; Biliary Tract Diseases; Ceruletide; Cholangiography; Female; Humans; Male; Middle Aged; Postoperative Complications

Topics: Biliary Dyskinesia; Biliary Tract Diseases; Ceruletide; Cholangiography; Cholecystography; Cholecystokinin; Digestive System; Humans