Severe pancreatitis and a pseudocyst occurred in a patient following accidental ingestion of an anticholinesterase insecticide, a substance not previously known to produce pancreatitis. Experiments were done to elucidate the mechanism. In one group of dogs the pancreatic duct was perfused and intraductal pressures were measured. The cholinesterase inhibitor 0,0-diethyl-0-(2-isopropyl-6-methyl-4-pyrimidinyl)phosphorothioate (25 mg/kg) caused a significant increase in the mean intraductal pressure from 12 +/- 2.4 to 27.8 +/- 5.9 cm saline. In a second group of dogs pancreatic secretory rates were measured. Anticholinesterase (75 mg/kg) in combination with secretin infusion (1 U/kg/hr) caused a significant increase in the secretin stimulated flow rate from 0.13 to 0.56 cc/min. Atropine (75 microgram/kg) abolished the anticholinesterase induced pressure and secretory rate increases. In a third group of dogs administration of cholinesterase inhibitor 75 mg/kg and secretin infusion 2 U/kg/hr resulted in acute pancreatic interstitial edema, acinar cell vacuolization, hyperamylasemia and hyperlipasemia. These results suggest that occurrence of pancreatitis as a complication of anticholinesterase insecticide intoxication is the result of hypersecretion and pharmacologic ductal obstruction.
In a kindred with a mild, recessively inherited variant of the Ehlers-Danlos syndrome (EDS), a platelet aggregation defect segregated concordantly with skin and joint abnormalities. This defect was partially corrected in vitro by addition of normal plasma or cryoprecipitate. The plasma of the patients with EDS failed to support the aggregation of normal gel-filtered platelets in response to collagen; this defect was completely corrected by the addition of normal human fibronectin. Since fibronectin is an important adhesive glycoprotein in connective tissue and is required for normal platelet interactions with collagen, we propose that both platelet malfunction and joint hypermobility in this kindred are likely explained by a defective fibronectin.
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