ceruletide and Calcinosis

Seventeen Indian patients from Kerala State and 13 Indian controls were submitted to a dietary inquiry. Indian patients and controls had a low fat intake (40.8 g +/- 12.1 and 34.5 g +/- 11.0 per day, respectively) and a moderately low protein intake (52.8 +/- 9.5 and 47.8 +/- 11.3 g per day); 11 patients and 6 controls did not consume cassava. Pure nonactivated pancreatic juice was collected at endoscopy in 10 Indian patients who presented with tropical calcific diabetes, 12 apparently normal controls from the same area, and 23 apparently normal French controls. The only significant differences between Indian and French controls was a decreased pancreatic protein response to cerulein and an increased calcium concentration in the Indian subjects. The pancreatic juice of Indian patients was characterized by decreased volume, normal bicarbonate concentration, increased protein concentration when the acinar cells were not stimulated, with no response to cerulein, increased calcium concentration, and normal citrate concentration. These changes are very similar to the changes observed in French patients with chronic alcoholic pancreatitis. The lesions of 14 surgical resection pancreatic specimens from South Indian patients presenting with tropical pancreatitis were compared to pancreata from French patients presenting with chronic alcoholic pancreatitis. The only difference was that intraductal plugs, lesions of the duct epithelium, and retention cysts or pseudocysts were less frequent in Indians. These results show that the two nutritional forms of pancreatic lithiasis, alcoholic and tropical, have similar histological lesions and biochemical modifications of pancreatic juice.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Alcoholism; Calcinosis; Calcium; Ceruletide; Chronic Disease; Citrates; Diet; Female; Humans; India; Lipase; Male; Pancreatic Juice; Pancreatitis; Proteins

A prospective investigation of the diagnostic value of imaging procedures, computed tomography (CT) and endoscopic retrograde pancreatography (ERP) in comparison with the exocrine pancreatic function test, was done in 109 patients with chronic pancreatitis. The sensitivity of the secretin-ceruletide test (SC) proved to be 87% as compared with 89% for ERP and 78% for CT. The severity of morphological lesions noted in ERP and CT, shows a significant correlation to the degree of the exocrine functional impairment (p less than 0.001). 75% of patients with chronic pancreatitis had corresponding functional and ductal changes in advanced-stage disease, while only 47% of the patients with severe pancreatic insufficiency had CT changes of a corresponding degree. ERP lesions such as ductal obstruction and marked duct dilatation, and CT alterations such as atrophy and ductal dilatation, are almost always coupled with severe pancreatic insufficiency in chronic pancreatitis. Calcific lesions demonstrated by CT are also found in less advanced stages of exocrine insufficiency. Discrepancies between functional and morphological alterations were remarkable in "early" stages of the disease.

Topics: Adult; Aged; Calcinosis; Ceruletide; Cholangiopancreatography, Endoscopic Retrograde; Chronic Disease; Female; Humans; Male; Middle Aged; Pancreatic Ducts; Pancreatic Function Tests; Pancreatitis; Prospective Studies; Secretin; Tomography, X-Ray Computed