Search

Introduction: Neuroendocrine tumors (NETs) are tumors of the interface between the endocrine and nervous system. They are characterized by the presence of secretory granules, as well as the ability to produce biogenic amines and polypeptide hormones. The clinical behavior of NETs is extremely variable; they may be functioning or non-functioning, ranging from very slow-growing tumors, which are the majority, to highly aggressive and very malignant tumors. Many case reports of rare sites of primary NETs outside the gastrointestinal tract have been described, as tumors with neuroendocrine characteristics can occur in virtually any organ or tissue. Nevertheless, this is the first case of a metastatic coccygeal carcinoid tumor ever described. Aim(s): To describe the clinical presentation, diagnosis and treatment of a patient with a carcinoid tumor of the coccyx and with liver metastases. Materials and methods: Clinical history, laboratory tests, magnetic resonance imaging studies and light microscope micrographs are reviewed. Results: A coccygeal mass was detected in a 67-year-old woman with fever and coccygeal pain that was proved to be of neuroendocrine origin. She has been treated with a somatostatin analogue and subsequently Everolimus, with regression of her symptoms. Conclusion: Coccyxeal carcinoid tumors are extremely rare tumors. Somatostatin analogues and mTOR inhibitors offer effective treatment options in cases where surgery is not indicated. [ABSTRACT FROM AUTHOR]

Objectives: To clinically evaluate the outcomes following surgical coverage of single peri-implant mucosal recessions in the aesthetic maxillary area by means of the modified coronally advanced tunnel (MCAT) and subepithelial connective tissue graft (SCTG)., Materials and Methods: Eleven systemically healthy non-smoking patients (8 females) each presenting a single peri-implant mucosal recession in the anterior maxillary region were consecutively treated with MCAT in conjunction with SCTG. In all cases, the facial recession was associated with an impaired aesthetic appearance. Before reconstructive surgery and at 12 months postoperatively, clinical and aesthetic parameters were assessed. The primary outcome variable was the mean mucosal recession coverage (MRC)., Results: Healing was uneventful in all cases. At 12 months, statistically significant (p < 0.05) recession coverage (MRC 94.71%) and improvement of aesthetics (pink aesthetic score) was obtained at all implants. Complete RC was obtained in 10 out of the 11 patients (90.9%). The treatment was associated with a statistically significant gain of keratinized and attached mucosa (p < 0.05)., Conclusion: The present results demonstrate that single peri-implant mucosal recessions in the maxillary aesthetic area can be successfully treated with MCAT and SCTG., (© 2025 Wiley Periodicals LLC.)

The e-Prescription systems are modern and efficient prescribing tools which can affect the quality of the healthcare services. The aim of this study is to evaluate the e-Prescription systems in Greece based the users' opinions. The survey was conducted in 2019 among 157 randomly selected healthcare profesionals through an on-line survey tool. The 51.2% of the sample were pharmacists and 48.8% physicians. 80.7% believe that the e-Prescription systems are reliable. More than the half of the professionals has the view that the e-Prescription systems are useful. Regarding to the ease of use, the e-Prescription systems, seem to can not fulfill sufficiently the participants' requirements.

Objective: To systematically review the available histologic evidence on periodontal regeneration in class II and III furcations in animals and humans., Materials and Methods: A protocol including all aspects of a systematic review methodology was developed including definition of the focused question, defined search strategy, study inclusion criteria, determination of outcome measures, screening methods, data extraction and analysis, and data synthesis. The focused question was defined as follows: "What is the regenerative effect obtained by using or not several biomaterials as adjuncts to open flap surgery in the treatment of periodontal furcation defects as evaluated in animal and human histological studies?", Search Strategy: Using the MEDLINE database, the literature was searched for articles published up to and including September 2018: combinations of several search terms were applied to identify appropriate studies. Reference lists of review articles and of the included articles in the present review were screened. A hand search of the most important dental journals was also performed., Criteria for Study Selection and Inclusion: Only articles published in English describing animal and human histological studies evaluating the effect of surgical treatment, with or without the adjunctive use of potentially regenerative materials (i.e., barrier membranes, grafting materials, growth factors/proteins, and combinations thereof) for the treatment of periodontal furcation defects were considered. Only studies reporting a minimum of 8 weeks healing following reconstructive surgery were included. The primary outcome variable was formation of periodontal supporting tissues [e.g., periodontal ligament, root cementum, and alveolar bone, given as linear measurements (in mm) or as a percentage of the instrumented root length (%)] following surgical treatment with or without regenerative materials, as determined histologically/histomorphometrically. Healing type and defect resolution (i.e., complete regeneration, long junctional epithelium, connective tissue attachment, connective tissue adhesion, or osseous repair) were also recorded., Results: In animals, periodontal regeneration was reported in class II and III defects with open flap debridement alone or combined with various types of bone grafts/bone substitues, biological factors, guided tissue regeneration, and different combinations thereof. The use of biological factors and combination approaches provided the best outcomes for class II defects whereas in class III defects, the combination approaches seem to offer the highest regenerative outcomes. In human class II furcations, the best outcomes were obtained with DFDBA combined with rhPDGF-BB and with GTR. In class III furcations, evidence from two case reports indicated very limited to no periodontal regeneration., Conclusions: Within their limits, the present results suggest that (a) in animals, complete periodontal regeneration has been demonstrated in class II and class III furcation defects, and (b) in humans, the evidence for substantial periodontal regeneration is limited to class II furcations., Clinical Relevance: At present, regenerative periodontal surgery represents a valuable treatment option only for human class II furcation defects but not for class III furcations.

Aim: In patients with progressive, metastatic neuroendocrine tumors (NET), intra-arterial radionuclide infusions with high activities of In-[DTPA]-octreotide and more recently with non-carrier added (nca) Lu-[DOTA,Tyr]-octreotate have been performed with encouraging results. However, the affinity profiles (IC50) of these radiopeptides for human sst2 receptors are markedly different (In-[DTPA]-octreotide, 22 ± 3.6 nM and nca Lu-[DOTA,Tyr]-octreotate, 1.5 ± 4.0 nM). The total administered activity is determined by organ dose limits (kidneys and bone marrow), and our aim therefore was to compare and evaluate the therapeutic efficacy of both radiopeptides in metastatic NETs., Methods: Thirty patients with gastroenteropancreatic (GEP) somatostatin-positive NETs with liver metastases confirmed on biopsy and In-pentetreotide scan were included. They were treated with In-[DTPA]-octreotide (n = 17) or nca Lu-[DOTA,Tyr]-octreotate (n = 13). Blood samples were collected 2, 4, 8, and 24 hours postadministration to calculate residence time in blood and in red marrow. The maximum percentage uptake in organs and tumors was estimated by region of interest analysis, and tumor dosimetry calculations were performed using OLINDA/EXM/ 1.0 software., Results: ncaLu-[DOTA,Tyr3]-octreotate blood radioactivity, expressed as a percentage of the injected dose, was significantly lower than In-[DTPA]-octreotide (P < 0.05), as clearly depicted from the time-activity curves; the background-corrected tumor uptake was significantly higher than In-[DTPA]-octreotide but without any significant difference in other organs (spleen, kidneys, and liver)., Conclusions: Using Lu-[DOTA,Tyr]-octreotate, a 3-fold higher absorbed dose to tumor tissue was achieved compared with In-[DTPA] octreotide. Residence time of nca Lu-[DOTA,Tyr]-octreotate results in a significantly higher absorbed dose to bone marrow compared with In-[DTPA]-octreotide. However, a drawback of In-[DTPA]-octreotide therapy is that the number of administrations would need to be almost doubled to achieve an equal therapeutic outcome as compared with Lu-[DOTA,Tyr]-octreotate.

Intrabony periodontal defects are a frequent complication of periodontitis and, if left untreated, may negatively affect long-term tooth prognosis. The optimal outcome of treatment in intrabony defects is considered to be the absence of bleeding on probing, the presence of shallow pockets associated with periodontal regeneration (i.e. formation of new root cementum with functionally orientated inserting periodontal ligament fibers connected to new alveolar bone) and no soft-tissue recession. A plethora of different surgical techniques, often including implantation of various types of bone graft and/or bone substitutes, root surface demineralization, guided tissue regeneration, growth and differentiation factors, enamel matrix proteins or various combinations thereof, have been employed to achieve periodontal regeneration. Despite positive observations in animal models and successful outcomes reported for many of the available regenerative techniques and materials in patients, including histologic reports, robust information on the degree to which reported clinical improvements reflect true periodontal regeneration does not exist. Thus, the aim of this review was to summarize, in a systematic manner, the available histologic evidence on the effect of reconstructive periodontal surgery using various types of biomaterials to enhance periodontal wound healing/regeneration in human intrabony defects. In addition, the inherent problems associated with performing human histologic studies and in interpreting the results, as well as certain ethical considerations, are discussed. The results of the present systematic review indicate that periodontal regeneration in human intrabony defects can be achieved to a variable extent using a range of methods and materials. Periodontal regeneration has been observed following the use of a variety of bone grafts and substitutes, guided tissue regeneration, biological factors and combinations thereof. Combination approaches appear to provide the best outcomes, whilst implantation of alloplastic material alone demonstrated limited, to no, periodontal regeneration., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To systematically analyze the regenerative effect of the available biomaterials either alone or in various combinations for the treatment of periodontal intrabony defects as evaluated in preclinical histologic studies., Data Sources: A protocol covered all aspects of the systematic review methodology. A literature search was performed in Medline, including hand searching. Combinations of searching terms and several criteria were applied for study identification, selection, and inclusion. The preliminary outcome variable was periodontal regeneration after reconstructive surgery obtained with the various regenerative materials, as demonstrated through histologic/ histomorphometric analysis. New periodontal ligament, new cementum, and new bone formation as a linear measurement in mm or as a percentage of the instrumented root length were recorded. Data were extracted based on the general characteristics, study characteristics, methodologic characteristics, and conclusions. Study selection was limited to preclinical studies involving histologic analysis, evaluating the use of potential regenerative materials (ie, barrier membranes, grafting materials, or growth factors/proteins) for the treatment of periodontal intrabony defects. Any type of biomaterial alone or in various combinations was considered. All studies reporting histologic outcome measures with a healing period of at least 6 weeks were included. A meta-analysis was not possible due to the heterogeneity of the data., Conclusion: Flap surgery in conjunction with most of the evaluated biomaterials used either alone or in various combinations has been shown to promote periodontal regeneration to a greater extent than control therapy (flap surgery without biomaterials). Among the used biomaterials, autografts revealed the most favorable outcomes, whereas the use of most biologic factors showed inferior results compared to flap surgery.

Aim: Aim of this study was to evaluate the effectiveness of non-carrier added (n. c. a.) [177Lu]DOTA-TATE in inoperable liver metastases, positive for sst2 receptor overexpression (verified by Octreoscan and confirmed by biopsy) due to neuroendocrine gastroenteropancreatic (GEP) tumors. [177Lu]DOTA-TATE has been infused after selective catheterization of the hepatic artery, minimising in parallel the toxicity of non-target tissues., Methods: The dose per session administered to each patient (12 cases in total) was 7400 MBq (200 mCi). Repetitions did not exceed 6-fold with treatment intervals of 5-8 weeks. Response assessment was classified according to the therapeutic benefit. Absorbed doses delivered to metastases, kidneys and red marrow were calculated according to OLINDA 1.1 program and the derived values were correlated to the Response Evaluating Criteria in Solid Tumors (RECIST). CT/MRI scans were performed as baseline before, during and after the end of treatment and monthly ultrasound images for follow-up estimation and measurements. Toxicity (World Health Organization criteria) was measured using blood and urine tests of renal, hepatic and bone marrow function., Results: None of the patients resulted complete response (0.0%); partial response was assessed in 8 (66.7%), disease stabilization in 3 (25%) and progressive disease in 1(8.3%). A 14-month median survival time was estimated for all patients, so far. Eight of 12 (66.7%) showed a mean target diameter shrinkage ranging from 33% to 45%. The organ average radiation dose estimation was found as follows: a) liver tumor 20.8 mGy/MBq; b) liver 0.14 mGy/MBq; c) kidneys 0.41 mGy/MBq; d) spleen 1.4 mGy/MBq; and f) bone marrow 0.022 mGy/MBq. The average absorbed dose per session to a tumor for a spherical mass of 20 g was estimated to be 20.8 mGy/MBq, depending on the histotype of the tumor. WHO toxicity grade 2 to 3 erythro-, leuko- and thrombo-cytopenia occurred in 9 (75%) cases observed about after the third session., Conclusion: In unresectable metastatic liver lesions positive for somatostatin receptors repeated, trans-hepatic high doses of [177Lu]DOTA-TATE resulted in a more than promising therapeutic outcome with a partial response in 75% of the treated patients. Given the loco-regional modality character of the administration technique, no nephro-toxicity has been so far observed whereas a remarkable myelotoxicity was noticed.

Cervical external root resorption can be present in natural teeth, involving one or more teeth in the same patient. The incidence of these lesions appears random and the etiology remains unclear. Cervical external root resorption has been considered a difficult clinical situation, and its diagnosis and treatment of the defect challenging. The present report describes a case of multiple external cervical resorption lesions involving four teeth, including the history, and the clinical and radiographic findings. The treatment included surgical intervention and restoration of the defect without sacrificing the pulp. A 3-year re-evaluation of the case confirmed a stable, uneventful clinical recovery.

Background/aims: Non-functioning pancreatic endocrine tumours (NFPET) constitute the largest component (35-50%) of pancreatic endocrine tumours. They are characterized by the absence of symptoms of hormone hypersecretion and frequently have clinical manifestations similar to the more common exocrine pancreatic adenocarcinoma. The present studyaims toevaluate the clinical features, diagnostic approach and, in particular, the significance of serum chromogranin A levels (CgA) in the management and outcome of 42 patients with NFPET (from a series of 121 patients with pancreatic endocrine tumours)., Methods: Twenty-five males and 17 females were included, and the mean age at diagnosis was 52.3 years (range: 26-68 years). The diagnosis for each patient was established by histopathological examination and immunohistochemistry. After the histopathological confirmation of diagnosis and during the follow-up period, patients were evaluated clinically and radiologically (including OctreoScan), whilst fasting gut hormones (including CgA) were also estimated. At diagnosis, all patients were checked for the presence of multiple endocrine neoplasia type I syndrome. The follow-up was complete and ranged from 12 to 86 months (mean: 49 months)., Results: Dyspepsia (66.5%) and weight loss (47.6%) were the most common symptoms at diagnosis, while in 21.4% of patients tumour lesions were revealed incidentally. Plasma CgA levels were significantly or moderately elevated in all patients with liver metastases at diagnosis (64.3%). The levels also reflected tumour progression or response to treatment during the follow-up period. OctreoScan showed avid uptake in 77.8% of patients with hepatic metastases. Moreover, in 2 patients OctreoScan revealed unexpected metastatic mesenteric deposits, which had not been found by the other studies. However, it was negative in 6 patients with liver metastases, in whom tumours were proved to be poorly differentiated (high-grade)., Conclusions: (1) NFPET may present with clinical manifestations similar to those of an exocrine pancreatic tumour; (2) plasma CgA levels reflect tumour load, and also seem to correlate with tumour progression or response to treatment; (3) surgeryin patients with localized disease at presentation can be curative, while it can also reduce tumour burden in patients with metastases; (4) long-acting somatostatin analogues provide good quality of life and temporary disease stabilization in patients with low-grade tumours; (5) systemic chemotherapy or chemoembolization seem to be beneficial in high-grade and progressive tumours., (Copyright 2008 S. Karger AG, Basel.)

Background: Neuroendocrine tumors of the thymus are rare neoplasms. Four patients with this tumor who underwent multimodality treatment are presented and the literature is briefly reviewed., Methods: The medical records of all patients treated for neuroendocrine tumors of the thymus from 1979 to 2002 were reviewed. Tumors were classified using a slight modification of the World Health Organization criteria., Results: The patients' median age was 38 years. All patients underwent extensive excision of the tumor. Histological diagnosis was atypical carcinoid (2), typical carcinoid (1), and small cell carcinoma (1). All patients developed recurrence(s). One patient died 132 months after diagnosis. The remaining three patients are alive with no symptoms at 135, 99, and 35 months, respectively, after diagnosis. Two patients with recurrences have been on treatment with Octreotide LAR with satisfactory results. One patient is free of disease., Conclusions: Neuroendocrine tumors of the thymus are potentially aggressive tumors. Radical resection is the treatment of choice. The encouraging results obtained by administration of Octreotide LAR in two of our patients warrant further investigation.

Purpose: To investigate the efficacy and toxicity of gemcitabine, in combination with 5-fluorouracil (5-FU) biologically modulated by folinic acid (FA) plus a somatostatin analogue (octreotide acetate-long acting formulation-LAR) that can both inhibit the action of several growth factors and angiogenesis, in patients with advanced pancreatic cancer., Patients and Methods: Thirty-two patients with advanced symptomatic pancreatic cancer with measurable disease and median age 64 years (range 50-72) received the following combination: 5-FU, given at 350 mg/m(2) i.v. bolus, biologically modulated by FA 350 mg/m(2) on days 1, 2, 8 and 9; and gemcitabine, given by short i.v. infusion at 1000 mg/m(2) on days 1 and 8. The regimen was administered every 3 weeks. LAR 30 mg was given intramuscularly every 4 weeks., Results: Objective tumor response was documented in 7 out of 32 evaluable patients (all partial responses-PR), yielding a 22% response rate (RR) (95% CI 10.5-35). Sixteen (50%) patients (95% CI 31.4-60.8) remained with stable disease (SD), while 9 (28%) patients (95% CI 20.4-48.4) progressed while on chemotherapy. The median response duration (RD) was 7 months (range 4-18). The median time to tumor progression (TTP) was 7 months (range 2-20), while the median survival was 7 months (range 4-29). The probability of surviving beyond 12 months was 20%. Of the 32 patients with tumor-related symptoms who were considered evaluable for clinical benefit response, 25 (78%) had pain improvement, while 14 (44%) experienced weight gain during treatment. In general, performance status improved in 16 (50%) patients during treatment. Serum concentrations of Ca 19-9 were decreased by more than 50% in 14 (44%) of the 32 assessable patients. Chemotherapy was well tolerated with mild myelotoxicity. Gastrointestinal toxicity was moderate with mild mucositis., Conclusion: The combination of gemcitabine and 5-FU/FA plus LAR 30 was well tolerated and showed a moderate antitumor activity and a significant palliative effect on tumor-related symptoms. It would be interesting to evaluate in a randomized study the impact of octreotide administration on the palliative effect of the regimen.

Background/aims: Carcinoid tumors of the appendix are thought to be the most common type of appendiceal neoplasms. Although the vast majority of appendiceal carcinoids behave in a benign fashion, they are considered malignant because they all have the potential for invasion, metastasis and production of physiologically active substances. The aim of our study is to evaluate the gravity of the prognostic factors and the indications for extended surgical treatment., Methodology: Twenty-four patients, six male (aged from 18 to 59 years) and eighteen female (aged from 16 to 27 years) are included in our study. All these patients were managed and followed-up in our section during the last 17 years (follow-up range 10-17 years). Following confirmation of the diagnosis, secretion of 5-HLAA (5-Hydroxy-Inndole-Acetic Acid) was measured after a 24-hour collection of urine. Moreover, ultrasound (US) examination of the liver and computerized tomography (CT) scanning of the upper abdomen were performed after the operation in all patients. Also, patients with tumor size more than 1cm underwent a Somatostatin Receptor Scintigraphy (Octreoscan). The follow-up data of all patients included measurement of 5-HLAA and US examination every six months., Results: The most common site for the tumors was the tip of the appendix (18/22). In the rest of the cases, the neoplasms were located in the base (4/22) and in the body (2/22), while in one patient the mesoappendix was invaded. In sixteen patients the tumor size was less than 1cm, in seven patients the tumor diameter was measured to be 1 to 2cm and in one patient the tumor was 3cm. Most of our patients (16/22) underwent only an appendicectomy, while in the rest of them (in the patients with tumor size between 1-2cm and in the patient with invasion of mesoappendix) a right hemicolectomy was performed. No patient was found to have metastatic disease during the operation, while the patient with invasion of the mesoappendix developed metastases in the lung, two years after the operation., Conclusions: Carcinoid tumors of the appendix, in most cases, are found incidentally during appendicectomies, especially in young females and usually are less than 1cm in size, which is probably the reason of the absence of metastases in all cases. Histological examination and size of the tumor are important factors that contribute to the selection of the surgical treatment and both must be estimated by the surgeons to make the final choice.

Objective: To investigate the efficacy and toxicity of gemcitabine administration followed by the combination of fluorouracil (5-FU) modulated by folinic acid in patients with advanced, symptomatic pancreatic cancer. The main objective was to estimate tumour response and any improvement in patients' quality of life., Patients: The study included 48 evaluable patients with metastatic disease with no prior chemotherapy. The study duration was 3 years., Interventions: Gemcitabine 1000 mg/m(2) intravenously was given on days 1 and 8 followed by fluorouracil 350 mg/m(2) intravenously as a bolus biologically modulated by folinic acid 350 mg/m(2) intravenously given on days 1, 2, 8 and 9 in order to develop the conditions for any potential drug synergism. The regimen was administered every 3 weeks for 1 year or until disease progression., Results: Objective partial responses were documented in ten (21%) patients (95% CI 10.5, 35). Twenty-two (46%) patients had stable disease while 16 (33%) patients had progressive disease. The median response duration was 8 months (range 4-20). The median time to progression was 6 months (range 2-24), while the median survival of the group was 7 months (range 3-36) and the probability of surviving beyond 12 months was 20%. Of the 44 patients with tumour-related symptoms who were considered evaluable for clinical-benefit response, 28 (70%) patients had pain improvement, 25 (52%) patients had improvement of their performance status, and nine (28%) patients experienced weight gain during treatment. Serum concentrations of cancer antigen (Ca-19-9) were decreased by more than 50% in 14 (37%) of the 38 assessable patients. Chemotherapy was well tolerated, with mild myelotoxicity. Gastrointestinal toxicity was moderate with mild mucositis., Conclusion: The regimen of gemcitabine and fluorouracil administered in this study was well tolerated and showed a moderate antitumour activity and a significant palliative effect on tumour-related symptoms. Because fluorouracil is a low toxicity combination agent for gemcitabine, other forms of the two-drug combination warrant further investigation.

Background/aims: Octreotide is a novel semisynthetic analogue of somatostatin mainly indicated for acute necrotizing pancreatitis. The aim of the present study was to define its role in the treatment of acute pancreatitis of moderate severity., Methodology: One hundred and twenty patients were randomly assigned to three groups of treatment receiving octreotide subcutaneously 100, 200 or 300 micrograms t.i.d. for seven days. Physical examination and biochemical monitoring were performed daily., Results: No differences were found between the three groups of patients regarding the rate of rebound of leukocytosis and of the elevated serum and urine amylase levels within normal limits. Patients receiving 300 micrograms t.i.d. presented an earlier relief of pain than all others whereas patients receiving octreotide at a dose of either 200 micrograms or 300 micrograms t.i.d. had a shorter duration of hospitalization (12 days) than those receiving octreotide at 100 micrograms t.i.d. (19 days)., Conclusions: The subcutaneous administration of octreotide in acute pancreatitis of moderate severity might be of little benefit only at a dose of 200 micrograms t.i.d. or 300 micrograms t.i.d. for at least seven days.

The appendix is the most common location for carcinoid tumors within the gastrointestinal tract. Carcinoid tumors of the ampulla of Vater is an extremely rare entity; only 71 cases of carcinoid of the ampulla of Vater have been reported in the literature to date. The clinical picture is non-specific, and endoscopy is the main diagnostic procedure; but large and deep biopsies are often needed to verify the histological nature of the tumor. Surgery is the treatment of choice. We report a new case of this rare tumor, and a review of the literature concerning the clinical findings, diagnosis, therapeutic challenge and results.

Glucagon-like peptide (GLP)-1 (7-36)-NH2 is a peptide found in the mucosal endocrine cells of the intestine, and plasma levels of GLP-1 (7-36)-NH2 immunoreactivity show a rise after the ingestion of a fat or mixed-component meal. We investigated the effects of physiological infusion of GLP-1 (7-36)-NH2 on a submaximal gastric acid secretion in healthy volunteers at a rate known to mimic the observed postprandial rise in plasma concentrations. Corrected gastric acid output decreased to less than 50% and volume output to 33% of stimulated values. After the infusion, the secretion of gastric acid recovered immediately to preinhibition values. These results suggest a novel role for GLP-1 (7-36)-NH2 as a physiological inhibitor of gastric acid secretion in man.

Tumors associated with the Verner Morrison syndrome secrete peptide histidine methionine, its C-terminally extended variant peptide histidine valine, and vasoactive intestinal peptide. There is evidence that vasoactive intestinal peptide mediates diarrhea, but recent evidence suggested that peptide histidine methionine and peptide histidine valine may be at least as important. Infusion of vasoactive intestinal peptide, peptide histidine methionine, and peptide histidine valine into patients with ileostomies produced mean plateau plasma levels of 163, 1301, and 2106 pM, respectively, which are within the range seen in the Verner Morrison syndrome. Vasoactive intestinal peptide produced an integrated ileal output of 174 (53) g (mean [SEM]), compared with only 20 (7) g with peptide histidine methionine and 10 (3) g with peptide histidine valine. These results suggest that vasoactive intestinal peptide is substantially more important than peptide histidine methionine or peptide histidine valine in mediating diarrhea in the Verner Morrison syndrome.

Digoxin levels were measured perspectively in the serum of 12 patients subjected to cholecystectomy and in serum and bile (Kehr) of 15 patients who underwent cholecystectomy plus choledochostomy in order to assess adequate digitalization. All patients were volunteers with no cardiac problems. In the cholecystectomy group serum digoxin levels increased in all patients from the second to the fourth postoperative day (P = 0.0001), while in patients with choledochostomy both serum and bile digoxin levels displayed wide variations. This last finding was associated with signs reflecting inadequate digitalization, probably due to significant digoxin losses through the choledochostomy.