The objective of this study was to investigate the effects of high and low inhibitor soybean meals on the duodenal enzyme activities and on the possible regulatory role of gastrointestinal hormones in the pancreatic response. After an overnight fast, 11 healthy volunteers received an intraduodenal infusion of saline for 60 min. This was followed by infusion of either of three test meals: extract of raw soybeans (RS), a low inhibitor soy protein isolate (SPI) or bovine serum albumin (BSA), 10 g/h for 60 min. Then saline was again given intraduodenally for 30 min. Gastric juice was collected continuously and duodenal juice and peripheral blood samples were collected every 10 min. Duodenal chymotryptic activity was severely inhibited by RS, whereas SPI and BSA increased the chymotryptic activity. Tryptic activity showed a transient reduction (55%) during RS infusion, whereas BSA and in particular SPI increased the tryptic activity. No change was seen in amylase activity. The lack of total inhibition of tryptic activity has been studied further and is the subject of the accompanying paper. The peripheral plasma levels of cholecystokinin (CCK) increased significantly during BSA but not during SPI or RS infusions. Thus, CCK levels were not increased by the inhibition of the proteolytic activity by RS in duodenal juice.
Recombinant human interferon-alpha has been used in the treatment of several cancers, but there have been several reports that it may exacerbate psoriasis or trigger off its onset. We report four patients, three of whom first developed psoriasis and one who had an aggravation of the condition during treatment with interferon-alpha. Three of the patients had the carcinoid syndrome and one a renal carcinoma, and all were treated with interferon-alpha 2b or 2a (IFN-alpha 2b, 2a) with doses ranging from 1.5 x 10(6) U daily to 18 x 10(6) U three times weekly. In two of the patients there appeared to be a correlation between the severity of the psoriasis and the dosage of interferon.
Nineteen patients with histologically verified midgut carcinoid tumours and liver metastases were included in a prospective study with daily recombinant human alpha 2b interferon injections of 5 million IU subcutaneously for 1 year. All had as much as possible of the primary tumour removed at laparotomy. Whenever technically possible (in seven cases), an embolization of the hepatic arteries was performed before interferon start. The response rate of the combined embolization and interferon treatment (n = 7) was 86% after 1 year, as judged from either a 50% reduction in excretion of 5-hydroxy-3-indoleacetic acid in the urine or a 50% reduction in the area of the largest liver metastasis as evaluated by computed tomography. All patients experienced an improvement in diarrhoea and/or flushing. When interferon was given alone (n = 12), 40% responded on the basis of objective criteria (50% after 6 months), whereas an improvement in either diarrhoea or flushing was experienced by 70% (75% after 6 months). In this group one patient had died and one had decided to withdraw after 6 months, at which time both were responders. We conclude that interferon seems to be an effective treatment of malignant metastatic midgut carcinoid tumours and that embolization of the liver arteries seems to increase the response rate, as judged after 1 year.
Interferon induced an objective response in mid-gut carcinoid patients as judged by the 24-h urinary 5-HIAA excretion. Patients receiving continuous interferon therapy showed improved response and survival compared with patients who stopped the treatment. Regardless of medical therapy, more survivors and more responders, as evaluated from CT measurements, were found among the embolized patients than among the non-embolized. Embolization could, however, not be shown to have a significant effect on survival.
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