EditorVitiligo is a common dermatologic condition that affects 1% of the population worldwide, with no sexual predilection. Several co-morbidities have been described in association with this disorder: thyroidopathies, pernicious anaemia, diabetes, etc. 1 However, no cardiovascular (CV) risk profile has been related so far. Several studies have analysed the relationship between other common dermatological conditions like psoriasis, lichen planus (LP) or androgenetic alopecia and CV disease or metabolic syndrome, showing a possible association 2-5 based on a convergent mechanism of T-cell mediated chronic inflammation in cutaneous conditions, atherosclerosis or dyslipemia. 6,7
The effect of oral dissolution therapy for pancreatic stones was evaluated in patients with chronic calcific pancreatitis. The anti-epileptic agent trimethadione was given orally to 30 outpatients at a dose of 0.9-1.5 g daily. On plain X-ray films and CT scans of the abdomen, pancreatic stones began to be dissolved around 8 months of treatment, and diminished in size and number or disappeared in 21 patients (70%) during the mean follow-up period of 32 months. The effect of trimethadione treatment on dissolution of stones was not closely related to the aetiology of the disease, distribution and size of stones, previous history of surgical interventions, or the degree of pancreatic dysfunctions. In three patients who stopped this medication of their own accord, pancreatic stones re-increased or reappeared about 6 months later. During trimethadione treatment, impaired exocrine pancreatic function returned to normal in four of nine patients examined, and diabetes mellitus was well controlled by either diet therapy alone or oral hypoglycaemic agents in eight of 10 patients who did not need insulin before trimethadione treatment. Complete relief of pain was noted in 73% of patients during the treatment. Overall gains and no change in bodyweight were observed in 83% of patients. Mild photophobia was the most common side effect, but could be easily overcome by wearing sunglasses. No severe side effects were observed in the liver, kidney, blood or the eyeground. Pancreatic stones in 30 patients not treated with trimethadione neither disappeared nor diminished spontaneously. Trimethadione treatment may be a useful tool for chemical dissolution of pancreatic stones.
Pancreatic cancer was subsequently identified in 27 patients. Positive in disease, negative in health, and area under receiver operating characteristic curve were significantly higher by CAMPAS-PX2 (89, 87, 91%) than by CA 19-9 (78, 82, 84%), the most sensitive marker among the 23 markers.
Summary. In an attempt to study pancreatic A cell function at an early stage of pancreatic diabetes secondary to chronic pancreatitis, both intravenous glucose (0.5 g/kg) and insulin (0.5 U/kg) tolerance tests were performed on seven dogs with pancreatolithiasis and seven normal control dogs. Experimental pancreatolithiasis was produced 12 months after incomplete ligation of the greater pancreatic duct. Impaired glucose tolerance and reduced plasma insulin response to an intravenous glucose load were observed in the calcified group. Pancreatic release of glucagon to insulin-induced hypoglycaemia was diminished, but suppressive response of the hormone to glucose-induced hyperglycaemia was well preserved. These data suggest that the A cell response to hypoglycaemia may be impaired earlier than that to hyperglycaemia in pancreatic diabetes secondary to pancreatolithiasis. Key words:Experimental pancreatolithiasis, pancreatic diabetes, chronic pancreatitis, immunoreactive glucagon, intravenous glucose tolerance test, intravenous insulin tolerance test.Pancreatic lithiasis is a common late complication of long-standing chronic pancreatitis. Pancreatic diabetes occurs more often in patients with calcified than those with non-calcified pancreatitis [1,2]. Little is known about pancreatic endocrine function at an early stage of diabetes associated with pancreatic lithiasis [3].In the present study an attempt was made to investigate the response of plasma pancreatic glucagon to glucose and insulin in dogs with pancreatolithiasis. Materials and Methods Animal PreparationThe 14 dogs were divided into two weight-matched groups; t 8+ 3 kg (range 14-24 kg) in the control group and 18_ r kg (range 14-25 kg) in other group. Details of the operative procedures for producing experimental pancreatolithiasis have been reported previously [4,5]. The greater pancreatic duct was incompletely ligated with stainless steel wire. The lesser duct was ligated and then cut separately. The dogs were fed commercial dog food and the mean weight was not significantly changed during the 12months. Pancreatic calculi were identified by autopsy 12 months after the operation. The gland was indurated, nodular and atrophic. Acinar alterations including atrophy, disorganization and interlobular replacement of fibrous connective tissue were present in moderate degree. In the control dogs neither calculi nor histological abnormalities were found at autopsy. Protocols of Pancreatic Endocrine Function TestsPancreatic endocrine function was studied by intravenous injection of glucose or insulin in the conscious state. In seven dogs with pancreatic calcification, the test was carried out 12 months after the surgical intervention.
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