No abstract

The function of the choledocho-duodenal sphincter was studied in 16 patients, 8 with juxta-papillary duodenal diverticula. All patients had calculi in the gallbladder. The common bile duct was normal. At cholecystectomy two catheters were introduced into the common bile duct through the stump of the cystic duct and fixed in place. The examinations were performed when the patients had recovered from the operation. One catheter was connected to a pressure transducer, the other was used for saline infusions. Pressure in the common duct was recorded before infusion and at constant infusion rates of 3,6, and 12 ml/min. The muscular tone, the contractile activity, and the total rhythmic variations of the sphincter during infusions were all significantly less in patients with diverticula than in the controls without diverticula. The findings indicate that there is a dysfunction of the choledochoduodenal sphincter in patients with juxta-papillary duodenal diverticula. This may in part be responsible for the high incidence of biliary calculi in patients with duodenal diverticula.

Pancreatic blood flow was studied in dogs by measuring local hydrogen gas clearance. External pancreatic secretion was collected by cannulation for volume measurements. In 16 expts. (15 dogs), recordings were obtained in pentobarbital (Nembutal) anesthesia. The mean value of 115 observations was 42.8 (S.E. 4.3) ml/min. 100 g pancreas. In 3 dogs, measurements were made in the awake, fasted state by means of chronically implanted electrodes, which proved effective for about two weeks. Mean of 33 observations was 76 ml/min. 100 g. The correlation between pancreatic blood flow and external secretion was studied by means of secretin (Boots, Jorpes) and pancreozymin (Boots). A variable response occurred, which proved to be time‐dependent and not correlated to the state of secretion or stimulation. An acute rise in blood flow was seen when hormone administration was started or increased. This effect was immediate but transient; blood flow returned to pre‐stimulatory level after 20 min, whereas the external secretion continued unchanged. No effect was noticed on gastric hydrogen clearance recorded in 4 of the dogs, indicating an organ specificity of the hormonal influence.

Acute pancreatitis was induced in pigs by retrograde injection of Na-taurocholate into the pancreatic duct. By means of chromogenic peptide substrate assays, increased plasma kallikrein activity, parallel with a reduction of plasma prekallikrein and functional kallikrein inhibition values, was found in peritoneal exudate. In plasma, however, no changes in the kallikrein-kinin system were found during the 6-h observation time. The study demonstrates the presence of components of the plasma kallikrein-kinin system in peritoneal fluid and suggests that the peritoneal cavity to a great extent is a functionally separate compartment from plasma. Activation of the plasma kallikrein-kinin system in peritoneal exudate during acute experimental pancreatitis appears to be of importance for the initial symptoms and the development of shock seen during this condition.