After intubation of Bartelheimer's tube into the duodenum, caerulein in dose of 0.1 μg/kg was injected intramuscularly, followed by intravenous admistration of secretin in dose of 1unit/kg. Duodenal aspirates were collected at the interval of 10minutes during 40 minutes after caerulein and 60minutes after secretin administration. In 70 patients, involving 24 patients with gallstone, 10 patients with pacreatic disease, 7 patients with peptic ulcer and 12 normal persons, caerulein-secretin test was carried out, and results obtained in this test were compared and discussed with that of pancreozymin-secretin test. Icteric index and bicarbonate concentration of duodenal aspirates in caerulein-secretin test were higher than in pancreozymin-secretin test, but no significant differences were observed in total volume and amylase output between both tests. These findings were observed not only in normal persons but in patients with various digestive diseases. Thus, caerulein seemed to be a potent stimulant for the contraction of gall bladder and exocrine pancreatic secretion, so caerulein-secretin test is available for diagnosing biliary dysfunction and pancreatic impairment.
Analysis of bile acids using thin-layer chromatography was conducted to evaluatepathological changes in diseases of the biliary tract system. Studies were performed on 108 patients with cholelithiasis and/or cholecystitis, 22cases with cancer of the biliary tract, 2 cases with stricture of the common bile duct and 10 control patients. Hepatic bile or gall-bladder bile were obtained at the time of percutaneous transhepatic cholangiography or operation, or from T-tube drainage. Glycocholic, glycodihydroxycholic, taurocholic and taurodihydroxycholic acids were determined separetely by Gänshirt's method.(Dihydroxycholic acid was calculated as deoxycholic acid). The following results were obtained. 1) In biliary tract diseases there were some cases with lower ratio of glycine conjugated bile acids to taurine conjugated bile acids (G/T ratio) than control; i. e. the G/T ratio was slightly diminished in cholelithiasis, while remarkable decrease was noted in cancer of the biliary tract and benign stricture of the bile duct. 2) In cholelithiasis, the decrease of G/T ratio corresponded with the severity of inflammatory changes of the gall-bladder wall. 3) The G/T ratio decreased when there were abnormalities in serum transaminase and alkaline phosphatase or liver histology. These findings suggest that the lower G/T ratio indicates abnormality of function and structure of the liver. 4) In a study of the biliary excretion of bile acids in 35 patients with choledochotomy drainage, it was found that the mode of postoperative change of the G/T ratio could be classified into 3 types as follows: i) Type I: In this group, the G/T ratio increased and reached a plateau (G/T>4) after the fourth to fifth postoperative day. Prognosis for this group was excellent. ii) Type II: In this group, the G/T ratio increased very slowly and remained low. iii) Type III: In this group, the G/T ratio increased very slowly and was not more than 1.5 after the 14th postoperative day. 5) It is concluded that morphological and functional disturbance of the liver is not seen in Type I, whereas structural and functional derangement of the liver is seen in Type II and noted remarkably in Type III. These findings can be applied to ascertain the course of recovery of liver function and to aid in determining when to withdraw drainage after operation of the biliary tract.
1. The actions of caerulein and cholecystokinin-pancreozymin (CCK-Pz) on the secretion of pancreatic protein and amylase, were compared in the in situ rat pancreas or the isolated and perfused rat pancreas. 2. Caerulein displayed a potent stimulant action on the release of pancreatic enzymes. The threshold dose in situ was 3ng/rat by rapid intravenous injection. In proportion to the logarithmic increase in dose up to 96ng/rat, the secretory response was enhanced linearly. However, further increasing the dose, lesser release rather than greater release was evoked. In the isolated and perfused pancreas, the threshold concentration of caerulein was estimated to be 0.01ng/ml. In proportion to the logarithmic increase in dose up to 0.1ng/ml, the amylase output was increased linearly. Further increase in dose evoked lesser output. Thus, the secretory activity of 20-24ng of caerulein is equivalent to that of 1 Crick, Harper and Raper unit of CCK-Pz. 3. The effect of caerulein was partially inhibited after administration of atropine (1.5 mg/kg b. w.), but the effect of CCK-Pz was not altered after atropinization in the in situ rat pancreas. 4. The effect of both caerulein and CCK-Pz on the protein release was greater when the drugs were injected into the femoral veins than when injected into the portal veins. These observations indicate that both caerulein and CCK-Pz seem to be partially inactivated by the liver. 5. The effect of caerulein on the release of pancreatic amylase depended on Ca2+-in the medium perfusing the blood vessels of the pancreas. 6. Observation of the surface of acinar lumen by scanning electron microscopy supported the views that caerulein induces the extrusion of zymogen granules at the luminar surface of the pancreatic acinar cells by the process of Ca2+-dependent exocytosis. 7. Caerulein and CCK-Pz are shown to have a similar effect on the release of pancreatic enzymes except that caerulein seems to act on the pancreas partially by activating the vagal nerve.