In contrast to L-glutamine, lipid emulsions are routinely administered to patients receiving nutritional support. The provision of fat during intravenous feeding is essential, but the potentially toxic byproducts of fatty acid oxidation may have adverse metabolic consequences. In the present study, we have examined the effect of L-glutamine, an inhibitor of fatty acid oxidation, on the development of defective blood glucose regulation caused by a 48-hour infusion of 10% intralipid in rats. Male Sprague-Dawley rats (200-290 g) were anesthetized with sodium pentobarbital, the right femoral vein cannulated, and baseline blood samples were taken. Each rat was placed in a metabolic cage with access to water, in the presence or absence of rodent chow. Two hours after waking, the rats were infused with 10% intralipid with either saline (control), 2% L-glutamine, or 2% L-alanine. After 48 hours, all animals were sacrificed and blood samples were again obtained. The mean +/- SEM plasma glucose levels before and after lipid infusion at the rate of 1 mL/hr in control rats fed ad libitum, were 125 +/- 13 and 170 +/- 5 mg/dL (p < 0.01, n = 7). Similarly, plasma free fatty acids (FFA) in these animals rose from 0.74 +/- 0.11 to 1.34 +/- 0.32 mmol/L (p < 0.05). Plasma insulin levels also increased from 337 +/- 44 to 1278 +/- 88 pg/mL (p < 0.01). Reduction of intralipid dose infusion did not prevent insulin resistance characterized by hyperglycemia and hyperinsulinemia. However, addition of L-glutamine to the high-dose lipid infusion with chow feeding prevented changes in plasma glucose, insulin levels, and FFA but not triglyceride levels. Also, glutamine but not alanine supplementation in intralipid infused rats without chow feeding prevented changes in plasma glucose, insulin, and malondialdehyde levels. In conclusion, these data show that glutamine supplementation during intravenous lipid administration in rats prevents the development of impaired glucose regulation associated with hyperlipidemia.

Authors

Ballard, TC; Farag, A; Branum, GD; Akwari, OE; Opara, EC

MLA Citation

Ballard, TC, Farag, A, Branum, GD, Akwari, OE, and Opara, EC. "Effect of L-glutamine supplementation on impaired glucose regulation during intravenous lipid administration." Nutrition 12.5 (May 1996): 349-354.

PMID

8875520

Source

pubmed

Published In

Nutrition

Volume

12

Issue

5

Publish Date

1996

Start Page

349

End Page

354

It has been shown that myocardial tissue function may be better preserved if antioxidants are incorporated into the reoxygenation medium at the end of the ischemic period following isolation of the organ. Although isolated pancreatic islets are prone to ischemic-reperfusion injury, it is not clear if antioxidants have a role in the preservation of their function. The purpose of the present study, therefore, was to examine the effect of the addition of glutathione (GSH) to a physiologic incubation medium on pancreatic islet response to glucose stimulation. Islets isolated by microdissection were preperifused at the rate of 1 ml/min for 1 hr at 37 degrees C, with Krebs-Ringer bicarbonate (KRB) buffer containing 1% albumin, 5.5 mM (basal) glucose without (control) or with 10 mM glutamine or 10 mN GSH and maintained at pH 7.4 by continuous gassing with 95/5% O2/CO2. After preperifusion, basal effluent samples were taken on ice for 20 min. The perifusion was then continued for 20 min with the KRB containing 27.7 mM glucose alone, followed by another 20 min of basal glucose washout. Solutions were changed using a stopcock and all effluent perifusate samples obtained were stored frozen at -20 degrees C until radioimmunoassay for insulin. Total insulin output in the control group increased from a basal 11.45 +/- 3.18 to 29.23 +/- 7.08 ng/6 islets/20 min (P < 0.001, n = 5) when the glucose concentration was raised to 27.7 mM. During a 20-min washout, insulin secretion was still significantly raised and did not return to the prestimulation basal rate. In the glutamine-treated islets, insulin output increased from 7.23 +/- 0.94 to 16.83 +/- 2.25 ng/6 islets/20 min (P < 0.001, n = 5) with 27.7 mM glucose stimulation and the significantly raised washout basal rate of secretion did not return to the prestimulation level. GSH treatment not only caused an enhanced 27.7 mM glucose stimulation (8.46 +/- 1.99 to 38.72 +/- 11.51 ng/6 islets/20 min, P < 0.001, n = 6) of insulin output but also completely restored the basal rate of insulin secretion to the prestimulation level within the 20-min washout perifusion. In conclusion, these data show that incubation of isolated islets with GSH enhanced their secretory response to glucose stimulation and preserved their functional integrity.

Authors

Littman, ED; Opara, EC; Akwari, OE

MLA Citation

Littman, ED, Opara, EC, and Akwari, OE. "Glutathione-mediated preservation and enhancement of isolated perifused islet function." The Journal of Surgical Research 59.6 (December 1995): 694-698.

PMID

8538167

Source

epmc

Published In

Journal of Surgical Research

Volume

59

Issue

6

Publish Date

1995

Start Page

694

End Page

698

DOI

10.1006/jsre.1995.1225

Previous work has shown that the C57BL/6J (BL/6) mouse strain develops type 2 diabetes after being fed a high-fat, high-simple carbohydrate (HFHSC) diet. In contrast, the AJ mouse strain does not. The aim of the present study was to determine if differences in the insulin secretory characteristics of isolated perifused islets of these animals could help explain why the BL/6 mouse develops diet-induced diabetes. Insulin secretion was assessed as mean integrated area under the curve during 20 min of stimulation with 27.7 mM glucose or 5 mM lauric acid. We found that both glucose- and laurate-stimulated insulin secretions were significantly less in euglycemic BL/6 mice than in the euglycemic AJ mice. The defect in insulin response to glucose, but not laurate, in islets from the BL/6 mouse was exacerbated when the animals were fed the HFHSC diet. These data suggest that the BL/6 mouse has a defective insulin response to glucose, which is exacerbated by a diabetogenic diet.

Authors

Lee, SK; Opara, EC; Surwit, RS; Feinglos, MN; Akwari, OE

MLA Citation

Lee, SK, Opara, EC, Surwit, RS, Feinglos, MN, and Akwari, OE. "Defective glucose-stimulated insulin release from perifused islets of C57BL/6J mice." Pancreas 11.2 (August 1995): 206-211.

PMID

7479681

Source

epmc

Published In

Pancreas

Volume

11

Issue

2

Publish Date

1995

Start Page

206

End Page

211

Authors

FARAG, A; BRIDGES, S; OPARA, EC; AKWARI, OE

MLA Citation

FARAG, A, BRIDGES, S, OPARA, EC, and AKWARI, OE. "ASSOCIATION OF INSULIN-RESISTANCE WITH INTRAVENOUS LIPID ADMINISTRATION." GASTROENTEROLOGY 108.4 (April 1995): A725-A725.

Source

wos-lite

Published In

Gastroenterology

Volume

108

Issue

4

Publish Date

1995

Start Page

A725

End Page

A725

The purpose of the present study was to examine the role played by structural differences among fatty acids in their effect on insulin secretion by isolated perifused murine islets. Insulin secretion measured by radioimmunoassay was assessed either as total insulin output (ng.6 islets-1.20 min-1) or as percent of basal insulin secretion. Raising the glucose concentration from a basal 5.5 to 27.7 mM caused an increase of insulin output from 6.69 +/- 1.59 to 19.92 +/- 4.99 ng.6 islets-1.20 min-1 (P < 0.05) in control (untreated) islets. However, after 20-min exposure of islets to 5 mM 16:0 or 18:2, the effect of 27.7 mM glucose was enhanced or diminished, respectively. Basal insulin output (100% basal) changed to 44 +/- 10% basal (P < 0.005) with the addition of 5 mM 4:0 but was not altered when 4:0 was replaced by 6:0. Insulin output increased modestly with 5 mM 8:0 but significantly (P < 0.05) with 10:0 until a maximal of 280 +/- 24% basal with 12:0 (P < 0.01), then fell to 110 +/- 18 and 93 +/- 15% basal (P < 0.05) with 14:0 and 16:0, respectively. The addition of 5 mM 18:0 inhibited insulin secretion to 30 +/- 10% of basal (P < 0.003), and this effect was not caused by fatty acid interference with insulin assay.(ABSTRACT TRUNCATED AT 250 WORDS)

Authors

Opara, EC; Garfinkel, M; Hubbard, VS; Burch, WM; Akwari, OE

MLA Citation

Opara, EC, Garfinkel, M, Hubbard, VS, Burch, WM, and Akwari, OE. "Effect of fatty acids on insulin release: role of chain length and degree of unsaturation." The American Journal of Physiology 266.4 Pt 1 (April 1994): E635-E639.

PMID

8178984

Source

epmc

Published In

The American Journal of Physiology

Volume

266

Issue

4 Pt 1

Publish Date

1994

Start Page

E635

End Page

E639

DOI

10.1152/ajpendo.1994.266.4.e635

Authors

LITTMAN, E; OPARA, EC; AKWARI, OE

MLA Citation

LITTMAN, E, OPARA, EC, and AKWARI, OE. "PRESERVATION AND ENHANCEMENT OF ISOLATED-PERFUSED ISLET FUNCTION BY GLUTATHIONE." CLINICAL RESEARCH 42.2 (April 1994): A212-A212.

Source

wos-lite

Published In

Clinical Research

Volume

42

Issue

2

Publish Date

1994

Start Page

A212

End Page

A212

Authors

OPARA, EC; BALLARD, T; AKWARI, OE

MLA Citation

OPARA, EC, BALLARD, T, and AKWARI, OE. "EFFICACY OF L-GLUTAMINE IN METABOLIC-REGULATION DURING TOTAL PARENTERAL-NUTRITION (TPN)." GASTROENTEROLOGY 106.4 (April 1994): A625-A625.

Source

wos-lite

Published In

Gastroenterology

Volume

106

Issue

4

Publish Date

1994

Start Page

A625

End Page

A625

Authors

OPARA, EC; GARFINKEL, M; HUBBARD, VS; BURCH, WM; AKWARI, OE

MLA Citation

OPARA, EC, GARFINKEL, M, HUBBARD, VS, BURCH, WM, and AKWARI, OE. "EFFECT OF FATTY-ACIDS ON INSULIN RELEASE - ROLE OF CHAIN-LENGTH AND DEGREE OF UNSATURATION." AMERICAN JOURNAL OF PHYSIOLOGY 266.4 (April 1994): E635-E639.

Source

wos-lite

Published In

The American Journal of Physiology

Volume

266

Issue

4

Publish Date

1994

Start Page

E635

End Page

E639

The purpose of the present study was to examine the role played by structural differences among fatty acids in their effect on insulin secretion by isolated perifused murine islets. Insulin secretion measured by radioimmunoassay was assessed either as total insulin output (ng · 6 islets-1 · 20 min-1) or as percent of basal insulin secretion. Raising the glucose concentration from a basal 5.5 to 27.7 mM caused an increase of insulin output from 6.69 ± 1.59 to 19.92 ± 4.99 ng · 6 islets-1 · 20 min-1 (P < 0.05) in control (untreated) islets. However, after 20-min exposure of islets to 5 mM 16:0 or 18:2, the effect of 27.7 mM glucose was enhanced or diminished, respectively. Basal insulin output (100% basal) changed to 44 ± 10% basal (P < 0.005) with the addition of 5 mM 4:0 but was not altered when 4:0 was replaced by 6:0. Insulin output increased modestly with 5 mM 8:0 but significantly (P < 0.05) with 10:0 until a maximal of 280 ± 24% basal with 12:0 (P < 0.01), then fell to 110 ± 18 and 93 ± 15% basal (P < 0.05) with 14:0 and 16:0, respectively. The addition of 5 mM 18:0 inhibited insulin secretion to 30 ± 10% of basal (P < 0.003), and this effect was not caused by fatty acid interference with insulin assay. In the presence of 2 mM of each fatty acid, insulin secretion was unaffected by 18:0 but increased to 137 ± 29, 156 ± 12 (P < 0.05), and 206 ± 16% (P < 0.01) basal, with 18:1, 18:2, and 18:3, respectively. The 18:3 and 20:4 (2 mM each) were equipotent. In conclusion, the effect of fatty acids on insulin release is dependent both on their chain length and degree of unsaturation.

Authors

Opara, EC; Garfinkel, M; Hubbard, VS; Burch, WM; Akwari, OE

MLA Citation

Opara, EC, Garfinkel, M, Hubbard, VS, Burch, WM, and Akwari, OE. "Effect of fatty acids on insulin release: Role of chain length and degree of unsaturation." American Journal of Physiology Endocrinology and Metabolism 266.4 29-4 (January 1, 1994).

Source

scopus

Published In

The American Journal of Physiology

Volume

266

Issue

4 29-4

Publish Date

1994

Authors

Opara, EC; Garfinkel, M; Hubbard, VS; Burch, WM; Akwari, OE

MLA Citation

Opara, EC, Garfinkel, M, Hubbard, VS, Burch, WM, and Akwari, OE. "Effect of fatty acids on insulin release: Role of chain length and degree of unsaturation." AM.J.PHYSIOL. 266.4 part 1 (1994): E635-E639.

Source

scival

Published In

AM.J.PHYSIOL.

Volume

266

Issue

4 part 1

Publish Date

1994

Start Page

E635

End Page

E639

The present study was designed to determine whether extravaginal torsion of the spermatic cord (EVT) can be distinguished from intravaginal torsion (IVT) on the basis of gross and histologic examination of the testis. It is traditionally believed that EVT, postulated to occur only in neonates, can be grossly distinguished from IVT, which occurs in older patients, on the basis of adherence between testis and tunica vaginalis. Such adherence is felt to be present in EVT but not IVT. This concept that the two types of torsion can be distinguished in the operating room has important clinical ramifications. In cases of EVT, contralateral orchidopexy theoretically need not be performed, since adhesions develop between tunica vaginalis and dartos by a few weeks of age. This is in contrast to IVT, in which contralateral orchidopexy is necessary due to the bilateral nature of the bell clapper deformity. Using a rat model, we first demonstrated that IVT could produce adherence of the tunica vaginalis to testis. Then, eight rats were operated on, producing right IVT and left EVT. Animals were then sacrificed at intervals of up to one month. Gross and histologic examination showed involvement of the tunica vaginalis in an ischemic and inflammatory response in a majority of testes, regardless of the type of torsion. Attempts to distinguish EVT from IVT on the basis of grossly evident adhesions between tunica vaginalis and testis are of questionable validity. Early contralateral orchidopexy is therefore recommended in all cases of neonatal torsion.

Authors

Friedman, RM; Flashner, SC; Akwari, OE; King, LR

MLA Citation

Friedman, RM, Flashner, SC, Akwari, OE, and King, LR. "An experimental model of neonatal testicular torsion: evidence against an exclusively extravaginal etiology." J Urol 150.1 (July 1993): 246-248.

PMID

8510265

Source

pubmed

Published In

The Journal of Urology

Volume

150

Issue

1

Publish Date

1993

Start Page

246

End Page

248

Authors

OPARA, EC; BRANUM, GD; CUCCHIARO, G; AKWARI, OE

MLA Citation

OPARA, EC, BRANUM, GD, CUCCHIARO, G, and AKWARI, OE. "EFFECT OF L-GLUTAMINE ON DEFECTIVE GLUCOSE-HOMEOSTASIS IN LIPID-INFUSED RATS." GASTROENTEROLOGY 104.4 (April 1993): A639-A639.

Source

wos-lite

Published In

Gastroenterology

Volume

104

Issue

4

Publish Date

1993

Start Page

A639

End Page

A639

Previous studies showed that exposure of pancreatic islets to polyunsaturated fatty acids (PUFA) can render the beta cells unresponsive to glucose, thus suggesting the possibility that prolonged obligatory use of lipid preparations containing high concentrations of essential fatty acids during total parenteral nutrition may adversely affect glucose tolerance. In the present study we examined the effect of pretreatment of isolated murine islets with 10 mmol/L linoleate (18:2, ω6) alone or in the presence of 20 mmol/L-glutamine on the response of both alpha and beta cells to 27.7 mmol/L glucose perifusion at 37° C. The incremental areas under the curve/20 mins (AUC/20 mins) for insulin output stimulated by 27.7 mmol/L glucose were 1552.8 ± 276.3 pg and 220.4 ± 163.9 pg (P < 0.001), (n = 6), respectively, before and after treatment with linoleic acid alone. In experiments in which the islets were treated with linoleate in the presence of L-glutamine there was no difference in the incremental insulin AUC/20 mins, in response to 27.7 mmol/L glucose before and after the fatty acid treatment (2051.8 ± 420.5 pg versus 2159.2 ± 317.6 pg, respectively, n = 6). Glucose-induced suppression of glucagon secretion, which was lost after perifusion of islets with the fatty acid alone, was observed when glutamine was added to the linoleate perifusate. In conclusion, the addition of L-glutamine to linoleic acid perifusion of isolated islets completely blocked the PUFA-induced desensitization of both pancreatic alpha and beta cells to glucose effect. © 1993.

Authors

Opara, EC; Hubbard, VS; Burch, WM; Akwari, OE

MLA Citation

Opara, EC, Hubbard, VS, Burch, WM, and Akwari, OE. "Addition of L-glutamine to a linoleic acid perifusate prevents the fatty acid-induced desensitization of pancreatic islet response to glucose." The Journal of Nutritional Biochemistry 4.6 (January 1, 1993): 357-361.

Source

scopus

Published In

The Journal of Nutritional Biochemistry

Volume

4

Issue

6

Publish Date

1993

Start Page

357

End Page

361

DOI

10.1016/0955-2863(93)90082-8

The role of cholecystokinin (CCK) as a central and peripheral satiety factor was studied using the CCK-B (L-365,260) and CCK-A (MK-329) receptor antagonists in esophageal-fistula dogs. Suppression of feeding was induced by either balloon gastric distension or small bowel nutrient infusion and was measured as the volume sham fed. Intracerebroventricular L-365,260 abolished satiety behavior from gastric distension (volume sham fed 2,667 ± 211 ml vs. vehicle alone 1,217 ± 446 ml, P < 0.05) but not small bowel infusion. Intravenous MK-329 abolished satiety behavior from small bowel infusion (volume sham fed 1,900 ± 521 ml vs. vehicle alone 210 ± 198 ml, P < 0.05) but not from gastric distension. The volume sham fed after intracerebroventricular MK-329 with balloon gastric distension or small bowel infusion did not differ from control. These results suggest that, in the brain, CCK is a physiological mediator of satiety behavior from gastric distension but not small bowel nutrients and, in the periphery, CCK is a physiological mediator of satiety behavior from small bowel nutrients but not gastric distension.

Authors

Cheng, CA; Geoghegan, JG; Lawson, DC; Berlangieri, SU; Akwari, O; Pappas, TN

MLA Citation

Cheng, CA, Geoghegan, JG, Lawson, DC, Berlangieri, SU, Akwari, O, and Pappas, TN. "Central and peripheral effects of CCK receptor antagonists on satiety in dogs." American Journal of Physiology Gastrointestinal and Liver Physiology 265.2 28-2 (January 1, 1993).

Source

scopus

Published In

The American Journal of Physiology

Volume

265

Issue

2 28-2

Publish Date

1993

Postoperative adhesions are a major cause of bowel obstruction and infertility. Since mast cells in the intestinal wall have been shown to degranulate after bowel manipulation, we investigated a possible role for these cells in peritoneal adhesion formation. Adhesions were created in weanling rats using cecal scraping and the application of 95% ethanol. The rats were treated with saline or one of two mast cell stabilizers, disodium cromoglycate (DSCG) or nedocromil sodium (NED), intraperitoneally 30 minutes before laparotomy and at the time of abdominal closure. The adhesions were assessed blindly 1 week later using a standardized scale. When the results in rats treated with DSCG were compared with those in rats treated with saline, the DSCG rats had significant attenuation of adhesion formation at 2 mg/kg (1.05 ± 1.0 versus 2.15 ± 0.8) and 10 mg/kg (1.2 ± 0.9 versus 2.71 ± 0.5). The application of NED decreased adhesions at a dose of 100 mg/kg (1.33 ± 1.2 versus 2.4 ± 0.8) but not at 10 mg/kg (2.4 ± 0.8 versus 2.4 ± 0.8). Histologic analysis using toluidine blue staining was done to assess the effect of DSCG on mast cell degranulation in the same adhesion model. DSCG significantly decreased the number of degranulated mast cells in the bowel wall when compared with saline (7.16 ± 0.6 mast cells/high-power field [hpf] versus 12.4 ± 1.9 mast cells/hpf). These data suggest that mast cells play an important role in the initial stages of peritoneal adhesion formation. In the future, pharmacologic inhibition of mast cell degranulation may be a useful adjunct for the prevention of postoperative adhesions.

Authors

Liebman, SM; Langer, JC; Marshall, JS; Collins, SM; Cameron, JL; Kral, JG; Akwari, OE; Samuel, I

MLA Citation

Liebman, SM, Langer, JC, Marshall, JS, Collins, SM, Cameron, JL, Kral, JG, Akwari, OE, and Samuel, I. "Role of mast cells in peritoneal adhesion formation." American Journal of Surgery 165.1 (1993): 127-130.

Source

scival

Published In

American Journal of Surgery

Volume

165

Issue

1

Publish Date

1993

Start Page

127

End Page

130

Fasting and postprandial plasma levels of the gut hormones gastrin, cholecystokinin (CCK), secretin, glucose-dependent insulinotropic polypeptide, motilin, neurotensin, peptide YY (PYY), enteroglucagon, glucagon, insulin, and pancreatic polypeptide were measured in 11 patients with alkaline gastritis associated with excessive duodenogastric reflux not related to previous gastric surgery (primary DGR), 12 primary DGR patients after pancreatico-biliary diversion ('duodenal switch' procedure), and in 10 age-matched healthy controls. Gastric emptying of a semisolid oatmeal was also measured in patients with primary DGR and in patients after bile diversion. Fasting plasma levels of the distal gut hormone neurotensin and the pancreatic islet hormone insulin were significantly greater in patients with primary DGR compared with controls. Neurotensin levels were normal in patients studied after bile diversion. Postprandial plasma levels, incremental integrated and total integrated responses for CCK, secretin, insulin, neurotensin, PYY, and enteroglucagon, were significantly greater in patients with primary DGR compared with controls. The majority of these responses normalized after bile diversion; however, the postprandial response for insulin and enteroglucagon remained elevated. Patients with primary DGR had a rapid early postprandial phase of gastric emptying of solids, which showed a significant correlation with plasma neurotensin levels. Bile diversion produced a significant delay in this lag-phase of gastric emptying. These abnormalities in gut regulatory hormones appear to be adaptive changes to rapid early postprandial gastric emptying, probably related to antropyloric dysmotility, which has been implicated in the pathogenesis of this condition. Measurement of these gastrointestinal hormones may become useful in the diagnosis of primary DGR.

Authors

Wilson, P; Welch, NT; Hinder, RA; Anselmino, M; Herrington, MK; DeMeester, TR; Adrian, TE; Akwari, OE; Kellum, JM; Larson, GM; al, E

MLA Citation

Wilson, P, Welch, NT, Hinder, RA, Anselmino, M, Herrington, MK, DeMeester, TR, Adrian, TE, Akwari, OE, Kellum, JM, Larson, GM, and al, E. "Abnormal plasma gut hormones in pathologic duodenogastric reflux and their response to surgery." American Journal of Surgery 165.1 (1993): 169-177.

Source

scival

Published In

American Journal of Surgery

Volume

165

Issue

1

Publish Date

1993

Start Page

169

End Page

177

Authors

LEE, SK; OPARA, EC; SURWIT, R; AKWARI, OE

MLA Citation

LEE, SK, OPARA, EC, SURWIT, R, and AKWARI, OE. "GENETIC-CONTROL OF INSULIN-RESPONSE TO SECRETAGOGUES IN DIET-INDUCED DIABETES OF C57BL/6J (BL/6) MOUSE STRAIN." CLINICAL RESEARCH 40.4 (December 1992): A789-A789.

Source

wos-lite

Published In

Clinical Research

Volume

40

Issue

4

Publish Date

1992

Start Page

A789

End Page

A789

The need for a better lipid system to satisfy the fuel requirements of patients while avoiding the adverse effects of current systems has led to suggestions that medium chain fatty acids (MCFs) be incorporated into TPN-lipid emulsions. Since clinical situations requiring TPN are associated with metabolic processes mediated by insulin, in the present study we have therefore examined the effects of a variety of medium chain fatty acids on insulin release. Using an isolated perifused mouse islet model, various doses of medium chain fatty acids and the essential fatty acid, linoleic acid, were tested and compared. The possibility of an additive effect of an insulinotropic MCF and linoleate when both are provided together was also examined. Effluent perifusate samples collected on ice during these experiments were assayed for insulin by radioimmunoassay. It was found that the ability of 5 mM of a given MCF to stimulate insulin secretion was dependent upon its chain length. Thus, while adipic acid (C6) had no effect, Caprylic acid (C8) had a minimal effect that was not statistically significant, but capric acid (C10) and lauric acid had very potent effects that were of the same magnitude to the effect of linoleate on insulin secretion. When insulin output was assessed as the mean integrated area under the curve during a 20-min perifusion, 5 mM lauric acid enhanced insulin secretion from a basal 7351 +/- 666 pg to 15,756 +/- 1680 pg (P less than 0.01, n = 5). In the same experiments, 5 mM linoleic acid stimulated insulin release to 11,260 +/- 867 pg (P less than 0.05). When C12 and linoleate were added together, each at a submaximally effective concentration of 2.5 mM, insulin output was 12,712 +/- 1011 pg (P less than 0.05, n = 5), which was not statistically different from the values obtained when the islets were perifused with 5 mM of each fatty acid alone.(ABSTRACT TRUNCATED AT 250 WORDS)

Authors

Garfinkel, M; Lee, S; Opara, EC; Akwari, OE

MLA Citation

Garfinkel, M, Lee, S, Opara, EC, and Akwari, OE. "Insulinotropic potency of lauric acid: a metabolic rationale for medium chain fatty acids (MCF) in TPN formulation." The Journal of Surgical Research 52.4 (April 1992): 328-333.

PMID

1593871

Source

epmc

Published In

Journal of Surgical Research

Volume

52

Issue

4

Publish Date

1992

Start Page

328

End Page

333

DOI

10.1016/0022-4804(92)90111-c

In this study we have assessed the individual abilities of the essential fatty acids, linoleic and linolenic acids, to release insulin and compared their insulinotropic potencies with those of the more established nutrient insulin secretagogues, glucose and arginine. In each experiment, a total of six islets microdissected from three mice were preperifused at the rate of 1 ml/min with Krebs-Ringer bicarbonate buffer, pH 7.4, containing 2% bovine albumin and 5.5 mM glucose (basal) with a continuous supply of 95% O2-5% CO2 at 37 C for 1 h. After collecting basal samples, the effects of 27.7 mM glucose, 20 mM arginine, 10 mM linoleic acid (18:2, omega 6), and 5 mM linolenic acid (18:3, omega 3) were tested using a sandwich protocol that entails 20-min alternating periods of stimulation with a secretagogue and a washout with basal perifusion. These nutrient concentrations were selected from initial experiments performed to characterize their dose-response effects on insulin secretion. Effluent samples were collected throughout each experiment for measurement of insulin by RIA. In one series of experiments, islets were challenged three times with 27.7 mM glucose, 10 mM linoleic acid, and 5 mM linolenic acid. In another set of experiments, islets were perifused with 20 mM arginine, 27.7 mM glucose, and 10 mM linoleic acid. All of these nutrients stimulated insulin release in a dose-dependent manner. In comparing the insulinotropic potencies of these secretagogues, we assessed insulin secretion as the integrated areas under the curve during 20 min of perifusion with a given nutrient. Thus, the mean integrated area under the curve per 20 min above basal in the presence of 27.7 mM glucose was 6,516 +/- 1,435 pg, which was not significantly different from the value of 4,772 +/- 866 pg obtained during arginine perifusion. However, the area under the curve during 20 min above basal obtained in the presence of linoleate and linolenic acid (8,712 +/- 1,949 and 10,506 +/- 1,490 pg, respectively) were significantly different (P less than 0.05) from those calculated during arginine and glucose perifusions. There was no statistically significant difference between the effects of these two fatty acids at the concentrations tested. In conclusion, our data suggest that linoleic acid and linolenic acid may be, at least in this murine islet preparation, as effective in stimulating insulin release as glucose and arginine, hitherto used to assess the abilities of nutrients to stimulate insulin secretion. However, it remains to be seen whether the efficacy of these polyunsaturated fatty acids in insulin release by murine islets will be obtained in experiments performed on human islets.

Authors

Opara, EC; Hubbard, VS; Burch, WM; Akwari, OE

MLA Citation

Opara, EC, Hubbard, VS, Burch, WM, and Akwari, OE. "Characterization of the insulinotropic potency of polyunsaturated fatty acids." Endocrinology 130.2 (February 1992): 657-662.

PMID

1733714

Source

epmc

Published In

Endocrinology

Volume

130

Issue

2

Publish Date

1992

Start Page

657

End Page

662

DOI

10.1210/endo.130.2.1733714

Available data on the effect of neuropeptide Y (NPY) on insulin release are conflicting and little data exist regarding the effect of NPY on glucagon secretion. The purpose of the present study, therefore, was to characterize the direct effect of NPY on the release of these pancreatic hormones and to examine the role of glucose on these interactions. Using a perifused mouse islet system, we found that NPY suppressed both basal and glucose-stimulated insulin secretion. Thus, basal insulin release assessed as mean integrated area under the curve/20 min (AUC/20 min) decreased from 1446 +/- 143 pg to 651 +/- 112 pg (P less than 0.05) with the addition of 2 x 10(-8) M NPY and the AUC/20 min for glucose stimulated insulin output decreased from 1973 +/- 248 pg to 1426 +/- 199 pg (P less than 0.05). In both cases, this inhibitory effect was followed after removing NPY by a stimulation of insulin secretion which was typical of a 'rebound off-response'. In contrast, NPY exerted a stimulatory effect on basal glucagon release and significantly reversed the suppressive effect of high glucose on glucagon output. The basal glucagon AUC/20 min increased from 212 +/- 103 pg to 579 +/- 316 pg (P less than 0.05), while glucagon secretion in the presence of 27.7 mM glucose increased from 75 +/- 26 pg to 255 +/- 28 pg (P less than 0.01). In conclusion, we have shown that the direct effect of NPY on the endocrine pancreas is to suppress insulin but stimulate glucagon secretion. These data are compatible with a role for NPY in the regulation of pancreatic hormone output.

Authors

Opara, EC; Burch, WM; Taylor, IL; Akwari, OE

MLA Citation

Opara, EC, Burch, WM, Taylor, IL, and Akwari, OE. "Pancreatic hormone response to neuropeptide Y (NPY) perifusion in vitro." Regul Pept 34.3 (July 9, 1991): 225-233.

PMID

1924890

Source

pubmed

Published In

Regulatory Peptides

Volume

34

Issue

3

Publish Date

1991

Start Page

225

End Page

233

Authors

OPARA, EC; HUBBARD, VS; BURCH, WM; AKWARI, OE

MLA Citation

OPARA, EC, HUBBARD, VS, BURCH, WM, and AKWARI, OE. "LINOLEATE BUT NOT PALMITATE STIMULATES GLUCAGON-SECRETION BY ISOLATED PERIFUSED ISLETS." CLINICAL RESEARCH 39.2 (April 1991): A449-A449.

Source

wos-lite

Published In

Clinical Research

Volume

39

Issue

2

Publish Date

1991

Start Page

A449

End Page

A449

Authors

GARFINKEL, M; OPARA, EC; AKWARI, OE

MLA Citation

GARFINKEL, M, OPARA, EC, and AKWARI, OE. "EFFECT OF LONG-CHAIN SATURATED FATTY-ACIDS ON INSULIN RELEASE FROM ISLETS." CLINICAL RESEARCH 39.2 (April 1991): A177-A177.

Source

wos-lite

Published In

Clinical Research

Volume

39

Issue

2

Publish Date

1991

Start Page

A177

End Page

A177

Authors

AKWARI, OE

MLA Citation

AKWARI, OE. "HONORING JOHNSON,CHARLES." JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION 83.4 (April 1991): 297-298.

Source

wos-lite

Published In

Journal of the National Medical Association

Volume

83

Issue

4

Publish Date

1991

Start Page

297

End Page

298

We have shown recently that a mixture of 10 mM linoleic acid (18:2,ω6) and 5 mM linoleic acid (18:3,ω3) enhanced insulin secretion by microdissected islets. In the present study, our aim was to examine the effect of a prestimulus with this mixture of 10 mM linoleic acid and 5 mM linoleic acid on glucose and arginine-stimulated insulin response, by perifused isolated islets. Insulin secretion by untreated (control) islets estimated as integrated area under the curve (AUC/ 20 mins) above basal during three pulses of 27.7 mM glucose separated by 20 min periods of basal (washout) perifusions were 2950 ± 585 pg, 5185 ± 1258 pg, and 2410 ± 921 pg, a greater response (P < 0.03) being obtained during the second glucose challenge. The insulin response of the islets to the glucose challenge was blunted profoundly if the islets were first exposed to a 20 min period of perifusion with the fatty acid mixture followed by a 20 min washout. Thus, the insulin AUC/20 min decreased from a control value of 2410 ± 921 pg to 337 ± 201 pg (P < 0.03) after prestimulus with the fatty acids. In contrast, fatty acid exposed islets were still responsive to 10 mM arginine. These data suggest that (1) a mixture of 10 mM linoleic acid and 5 mM linolenic acid can desensitize isolated perifused islets to glucose but not arginine; and (2) glucose intolerance associated with lipemia may result, at least in part, from a direct effect on the islets of Langerhans. © 1991.

Authors

Opara, EC; Hubbard, VS; Burch, WM; Akwari, OE

MLA Citation

Opara, EC, Hubbard, VS, Burch, WM, and Akwari, OE. "Homologous desensitization of pancreatic beta cells to glucose response by polyunsaturated fatty acids." The Journal of Nutritional Biochemistry 2.8 (January 1, 1991): 424-429.

Source

scopus

Published In

The Journal of Nutritional Biochemistry

Volume

2

Issue

8

Publish Date

1991

Start Page

424

End Page

429

DOI

10.1016/0955-2863(91)90111-H

Authors

Opara, EC; Burch, WM; Akwari, OE

MLA Citation

Opara, EC, Burch, WM, and Akwari, OE. "Characterization of glutamine-regulated pancreatic islet hormone release." Surgical Forum 41 (December 1, 1990): 16-19.

Source

scopus

Published In

Surgical Forum

Volume

41

Publish Date

1990

Start Page

16

End Page

19

Analysis of 100 consecutive patients with pyloric outlet obstruction revealed that 37% of the obstructions were secondary to peptic ulcer disease and 42% were caused by malignant neoplasm. Only a single patient with primary hypertrophic pyloric stenosis was identified, and whether this lesion is a cause or effect of peptic ulcer disease remains unclear. Similarly, the association of this entity with congenital pyloric stenosis is unknown.

Authors

Quigley, RL; Pruitt, SK; Pappas, TN; Akwari, O

MLA Citation

Quigley, RL, Pruitt, SK, Pappas, TN, and Akwari, O. "Primary hypertrophic pyloric stenosis in the adult." Arch Surg 125.9 (September 1990): 1219-1221.

PMID

2400314

Source

pubmed

Published In

Archives of Surgery (Chicago, Ill. : 1960)

Volume

125

Issue

9

Publish Date

1990

Start Page

1219

End Page

1221

Recent studies have suggested the beneficial effects of essential fatty acids in postoperative patients receiving total parenteral nutrition. While there is abundant information on the role of glucose and amino acids on insulin release, the effect of essential fatty acids on endocrine pancreatic secretions is not clear. Since linoleic and linolenic acids are constituents of TPN solutions as well as dietary fat, our aim was to examine their effect on the endocrine pancreatic function, using isolated islets. In each experiment, six islets microdissected from three mice were preperifused at the rate of 1 ml/min with Krebs-Ringer bicarbonate (KRB) buffer pH 7.4 containing 2% bovine albumin and 5.5 mM glucose (basal) with continuous supply of 95%/5%, O2/CO2 for 1 hr, after which basal samples were collected on ice every minute. The perifusion was continued for 20 min after the addition of a mixture of 10 mM linoleic acid and 5 mM linolenic acid to the KRB. During each perifusion phase, effluent samples were also collected for insulin and glucagon assay. The mean integrated area under the curve/20 min showed an increase in both insulin and glucagon secretions with the addition of fatty acids. Hence insulin increased from a basal 3154.8 +/- 953.7 to 8393.0 +/- 2073.1 pg (P less than 0.025, n = 6) and glucagon increased from 193.7 +/- 46.9 to 1566.1 +/- 411.2 pg (P less than 0.0025, n = 5). The fatty-acid-induced insulin but not glucagon secretion was blocked by the addition of 2 mM palmoxirate an inhibitor of fatty acid oxidation.(ABSTRACT TRUNCATED AT 250 WORDS)

Authors

Opara, EC; Burch, WM; Hubbard, VS; Akwari, OE

MLA Citation

Opara, EC, Burch, WM, Hubbard, VS, and Akwari, OE. "Enhancement of endocrine pancreatic secretions by essential fatty acids." The Journal of Surgical Research 48.4 (April 1990): 329-332.

PMID

2187112

Source

epmc

Published In

Journal of Surgical Research

Volume

48

Issue

4

Publish Date

1990

Start Page

329

End Page

332

DOI

10.1016/0022-4804(90)90068-d

Authors

OPARA, EC; BURCH, W; TAYLOR, IL; AKWARI, OE

MLA Citation

OPARA, EC, BURCH, W, TAYLOR, IL, and AKWARI, OE. "NEUROPEPTIDE-Y (NPY) SUPPRESSES INSULIN (I) BUT STIMULATES GLUCAGON (G) SECRETION." CLINICAL RESEARCH 38.2 (April 1990): A342-A342.

Source

wos-lite

Published In

Clinical Research

Volume

38

Issue

2

Publish Date

1990

Start Page

A342

End Page

A342

In a detailed review of cystic hepatobiliary neoplasms, we identified a subset of 50 cases in which tumors were characterized by the presence of a mesenchymal cell layer interposed between an inner epithelial lining and an outer connective tissue layer. We have recently seen three such patients, making a total of 53 patients reported in the English literature. All of the patients were female, 44 of whom, with an average age of 41 years, had benign tumors. The average age of the remaining nine patients was 57 years and these patients had malignant tumors. In seven patients, the malignancy arose from the epithelial layer, but in two patients sarcomatous changes were identified in the mesenchymal tissues. The older age of the patients with malignant tumors with adequate serial biopsies in two cases supported the thesis that malignant transformation may occur in the benign tumors. Moreover the location of the tumor in one of our patients in whom the resected tumor was associated with anomalous right hepatic ducts and portal veins supported the theory that these tumors develop embryologically from nests of primitive hepatobiliary endodermal and mesodermal cells. Although surgical treatment was performed in all patients, 25% of the patients with benign hepatobiliary cystadenoma with mesenchymal stroma (CMS), and 33% of the patients with malignant CMS had tumor recurrence after primary resection. Ninety per cent of these patients had an incomplete resection at the time of their initial operations. Forty-four per cent of the patients with malignant CMS died after a mean follow-up of 17 months. We conclude that CMS (Edmonson's tumor) occurs uniquely in young female patients, develops from nests of primitive embryonal cells, has the potential for malignant transformation, and should be completely resected at primary operation to avoid recurrence.

Authors

Akwari, OE; Tucker, A; Seigler, HF; Itani, KM

MLA Citation

Akwari, OE, Tucker, A, Seigler, HF, and Itani, KM. "Hepatobiliary cystadenoma with mesenchymal stroma." Annals of Surgery 211.1 (January 1990): 18-27. (Review)

PMID

2403772

Source

epmc

Published In

Annals of Surgery

Volume

211

Issue

1

Publish Date

1990

Start Page

18

End Page

27

DOI

10.1097/00000658-199001000-00004

Totally implantable catheters (TICs) have recently been employed for long-term central venous access in patients with sickle cell disease (SCD). We have reviewed our experience with 10 TICs inserted in patients with SCD. These were compared to 33 TICs inserted in patients without SCD (controls). The primary diagnosis was malignancy in most of the controls. The SCD patients experienced a marked increase in total complications (70 vs. 24%), as well as in complications requiring catheter removal (50 vs. 3%). No variable explained these differences except the presence of SCD. The complications requiring catheter removal from SCD patients were infections, catheter thrombosis, and venous thrombosis. The increased risk of these complications must be considered before a catheter is inserted; however, the average useful life of these catheters exceeded 12 months. They remained useful in the care of patients with poor venous access and multiple complications of SCD.

Authors

Phillips, G; Slingluff, C; Hartman, J; Thomas, P; Akwari, O

MLA Citation

Phillips, G, Slingluff, C, Hartman, J, Thomas, P, and Akwari, O. "Totally implantable intravenous catheters in the management of sickle cell anemia." American Journal of Hematology 29.3 (1988): 134-138.

PMID

3189307

Source

scival

Published In

American Journal of Hematology

Volume

29

Issue

3

Publish Date

1988

Start Page

134

End Page

138

Of 565 patients with thrombocytopenia admitted to Duke University Hospital between 1975 and 1985, 100 had splenectomy. Ninety-eight patients had failed chronic immunosuppressive therapy and three patients had acute intracranial bleeding or total absence of platelets in the peripheral blood smear, and had urgent splenectomy. At primary splenectomy, accessory spleens were identified and resected in 18% of patients. There was no operative mortality. Fifty-eight patients had an excellent response to splenectomy and their steroids were tapered off within 3 weeks. Thirteen patients had a poor response to primary splenectomy of whom eight remitted spontaneously and five required accessory splenectomy resulting in complete remission in three patients. Twenty-nine patients were considered nonresponders, 25 of whom had radionuclide scanning for accessory spleens. Seven of these patients had accessory spleens identified but only four consented to accessory splenectomy. In three of the four patients, a complete remission was achieved. Neither platelet antibody titers nor measurements of platelet survival or turnover predicted platelet response to splenectomy. However, immune thrombocytopenic purpura (ITP) in older patients was significantly less likely to respond to splenectomy. These data support continuing use of splenectomy in selected patients with ITP and an aggressive search for accessory spleens in patients who relapse since they are easily localized at operation by hand-held isotope detector probe.

Authors

Akwari, OE; Itani, KM; Coleman, RE; Rosse, WF

MLA Citation

Akwari, OE, Itani, KM, Coleman, RE, and Rosse, WF. "Splenectomy for primary and recurrent immune thrombocytopenic purpura (ITP). Current criteria for patient selection and results." Annals of Surgery 206.4 (October 1987): 529-541.

PMID

3662662

Source

epmc

Published In

Annals of Surgery

Volume

206

Issue

4

Publish Date

1987

Start Page

529

End Page

541

DOI

10.1097/00000658-198710000-00014

Authors

ITANI, KMF; COLEMAN, RE; AKWARI, OE

MLA Citation

ITANI, KMF, COLEMAN, RE, and AKWARI, OE. "OSMOCALORIC REGULATION OF GASTRIC-EMPTYING (GE) AFTER DUODENOJEJUNOSTOMY (DJ)." DIGESTIVE DISEASES AND SCIENCES 32.8 (August 1987): 915-915.

Source

wos-lite

Published In

Digestive Diseases and Sciences

Volume

32

Issue

8

Publish Date

1987

Start Page

915

End Page

915

Painful palmar and plantar erythema is an uncommon systemic complication of chemotherapy and has been reported in association with methotrexate, cystosine arabinoside, doxorubicin, and 5-fluorouracil. The authors report a case in which the syndrome was precipitated by hepatic artery infusion of 5-FUdR. The previous recommendation that treatment of patients developing painful palmar-plantar erythema from other drugs may be successfully resumed using intrahepatic arterial infusion of FUdR must be reconsidered in light of the present report.

Authors

Neuss, MN; Akwari, OE; Stevenson, DF; Goodwin, BJ

MLA Citation

Neuss, MN, Akwari, OE, Stevenson, DF, and Goodwin, BJ. "Painful palmar and plantar erythema associated with hepatic artery infusion of 5-fluoro-2'deoxyuridine." J Natl Med Assoc 79.6 (June 1987): 669-671.

PMID

2956430

Source

pubmed

Published In

Journal of the National Medical Association

Volume

79

Issue

6

Publish Date

1987

Start Page

669

End Page

671

We investigated the impact of direct jejunal delivery of various meals on gastric emptying, glucose tolerance, and insulin response in a chronic dog model following duodenojejunostomy. Ten beagle dogs underwent duodenal transection 2 cm distal to the pylorus and end-to-side duodenojejunostomy 20 cm distal to the ligament of Treitz. Three months after operation each dog underwent gastric emptying studies using radiolabeled normal saline, 20% glucose solution, and standardized mixed solid meal. Glucose tolerance tests with plasma insulin determinations were obtained using the glucose meal. After duodenojejunostomy both the rapid exponential pattern of emptying of normal saline and the slower linear pattern of glucose emptying seen in intact dogs were preserved. The linear gastric emptying of the solid meal which was slower than gastric emptying of either of the liquid meals was also preserved. Although integrated plasma glucose levels over 2 hr were 484.8 +/- 40.4 and 456.6 +/- 30.4 mg X hr/dl in intact and duodenojejunostomy dogs, respectively (P greater than 0.05), the initial rate of rise of plasma glucose was significantly delayed in the duodenojejunostomy dogs. But integrated plasma insulin levels over 2 hr differed significantly (P less than 0.05) between the intact (71.6 +/- 9.2 microU X hr/nl) and duodenojejunostomy (48.3 +/- 6.2 microU X hr/nl) dogs. We conclude that duodenojejunostomy (jejunal delivery) preserved the patterns of gastric emptying of saline, glucose, and mixed solid meals; retarded initial plasma glucose response to the glucose meal; and blunted plasma insulin response to the glucose load.

Authors

Itani, KM; Akwari, OE; Burch, W; Watters, CR; Coleman, RE

MLA Citation

Itani, KM, Akwari, OE, Burch, W, Watters, CR, and Coleman, RE. "Gastric emptying, glucose tolerance, and insulin response after duodenojejunostomy." J Surg Res 42.5 (May 1987): 521-527.

PMID

3295389

Source

pubmed

Published In

Journal of Surgical Research

Volume

42

Issue

5

Publish Date

1987

Start Page

521

End Page

527

Authors

Itani, KMF; Coleman, RE; Akwari, OE

MLA Citation

Itani, KMF, Coleman, RE, and Akwari, OE. "Osmocaloric regulation of gastric emptying after duodenojejunostomy: Interplay with the gastric fundus." Surgical Forum 38 (January 1, 1987): 131-135.

Source

scopus

Published In

Surgical Forum

Volume

38

Publish Date

1987

Start Page

131

End Page

135

Of 565 patients with thrombocytopenia admitted to Duke University Hospital between 1975 and 1985, 100 had splenectomy. Ninety-eight patients had failed chronic immunosuppressive therapy and three patients had acute intracranial bleeding or total absence of platelets in the peripheral blood smear, and had urgent splenectomy. At primary splenectomy, accessory spleens were identified and resected in 18% of patients. There was no operative mortality. Fifty-eight patients had an excellent response to splenectomy and their steroids were tapered off within 3 weeks. Thirteen patients had a poor response to primary splenectomy of whom eight remitted spontaneously and five required accessory splenectomy resulting in complete remission in three patients. Twenty-nine patients were considered nonresponders, 25 of whom had radionuclide scanning for accessory spleens. Seven of these patients had accessory spleens identified but only four consented to accessory splenectomy. In three of the four patients, a complete remission was achieved. Neither platelet antibody titers nor measurements of platelet survival or turnover predicted platelet response to splenectomy. However, immune thrombocytopenic purpura (ITP) in older patients was significantly less likely to respond to splenectomy. These data support continuing use of splenectomy in selected patients with ITP and an aggressive search for accessory spleens in patients who relapse since they are easily localized at operation by hand-held isotope detector probe.

Authors

Akwari, OE; Itani, KMF; Coleman, RE; Rosse, WF

MLA Citation

Akwari, OE, Itani, KMF, Coleman, RE, and Rosse, WF. "Splenectomy for primary and recurrent immune thrombocytopenic purpura (ITP)." Annals of Surgery 206.4 (January 1, 1987): 529-541.

Source

scopus

Published In

Annals of Surgery

Volume

206

Issue

4

Publish Date

1987

Start Page

529

End Page

541

DOI

10.1097/00000658-198710000-00014

Authors

AKWARI, O

MLA Citation

AKWARI, O. "Splenectomy for primary and recurrent immune thrombocytopenic purpura (ITP). Current criteria for patient selection and results." Ann Surg 206 (1987): 529-541.

Source

cinii-english

Published In

Ann Surg

Volume

206

Publish Date

1987

Start Page

529

End Page

541

DOI

10.1097/00000658-198710000-00014

Since 1978, 252 patients from different centers in the world have undergone pylorus-preserving pancreatoduodenectomy. Fifty-five per cent of the patients had malignant tumors in the region of the head of the pancreas. The overall operative mortality rate was 2.8%. Anastomotic leakage and fistulae occurred in 19% of the patients. Pancreatic, biliary, and enteric fistulae represented 11%, 4%, and 4%, respectively. Peptic ulcers were subsequently diagnosed in seven patients (3%), two of whom required vagotomy and antrectomy. Delayed recovery of gastric function was the most common complication of this operation, with an overall incidence of 30%. Although the cause of this gastric dysfunction is unknown, its transient nature in most patients makes expectant therapy with gastric tube drainage the best remedy when the problem is encountered. Pylorus-preserving pancreatoduodenectomy decreased the incidence of postgastric surgery syndromes that are commonly associated with the standard Whipple operation. The existing data support the continued use of the operation and the need for future laboratory and clinical investigation of its physiologic impact.

Authors

Itani, KM; Coleman, RE; Meyers, WC; Akwari, OE

MLA Citation

Itani, KM, Coleman, RE, Meyers, WC, and Akwari, OE. "Pylorus-preserving pancreatoduodenectomy. A clinical and physiologic appraisal." Ann Surg 204.6 (December 1986): 655-664.

PMID

3024595

Source

pubmed

Published In

Annals of Surgery

Volume

204

Issue

6

Publish Date

1986

Start Page

655

End Page

664

Authors

ITANI, KMF; AKWARI, OE

MLA Citation

ITANI, KMF, and AKWARI, OE. "EFFECT OF PROXIMAL DUODENOJEJUNOSTOMY (DJ) ON MYOELECTRIC ACTIVITY IN DOGS." GASTROENTEROLOGY 90.5 (May 1986): 1472-1472.

Source

wos-lite

Published In

Gastroenterology

Volume

90

Issue

5

Publish Date

1986

Start Page

1472

End Page

1472

Authors

ITANI, KMF; COLEMAN, RE; AKWARI, OE

MLA Citation

ITANI, KMF, COLEMAN, RE, and AKWARI, OE. "EFFECTS OF DUODENOJEJUNOSTOMY (DJ) ON MOTILITY AND GASTRIC-EMPTYING (GE)." CLINICAL AND INVESTIGATIVE MEDICINE-MEDECINE CLINIQUE ET EXPERIMENTALE 9.3 (1986): A68-A68.

Source

wos-lite

Published In

Clinical and Investigative Medicine. Medecine Clinique Et Experimentale

Volume

9

Issue

3

Publish Date

1986

Start Page

A68

End Page

A68

This article describes two patients with hepatic metastases from colorectal cancer in whom a reversible enteropathy developed during the administration of hepatic artery infusion chemotherapy with 5-fluoro-2-deoxyuridine (5-FUdR) via an Infusaid Series 400 pump (Infusaid Corp., Sharon, MA). Both patients had severe diarrhea and signs that suggested small bowel obstruction. Barium studies revealed a distinctive radiologic appearance of severe narrowing of the ileum associated with complete loss of normal mucosal patterns. Results of an extensive evaluation for an infectious or toxin-related enterocolitis were negative. Perfusion studies confirmed the appropriate position of the catheters and revealed no extrahepatic perfusion. Systemic shunting of the 5-FUdR through the liver or tumor bed is postulated as the primary event, with the small bowel manifesting the major toxicity.

Authors

Gluck, WL; Akwari, OE; Kelvin, FM; Goodwin, BJ

MLA Citation

Gluck, WL, Akwari, OE, Kelvin, FM, and Goodwin, BJ. "A reversible enteropathy complicating continuous hepatic artery infusion chemotherapy with 5-fluoro-2-deoxyuridine." Cancer 56.10 (November 1985): 2424-2427.

PMID

2931170

Source

epmc

Published In

Cancer

Volume

56

Issue

10

Publish Date

1985

Start Page

2424

End Page

2427

DOI

10.1002/1097-0142(19851115)56:10<2424::aid-cncr2820561015>3.0.co;2-z

Authors

AKWARI, OE; FRIEDMAN, AH; FAWCETT, T

MLA Citation

AKWARI, OE, FRIEDMAN, AH, and FAWCETT, T. "ABLATION OF THE AREA POSTREMA ALTERS GASTROINTESTINAL MYOELECTRIC RESPONSE TO APOMORPHINE AND CISPLATIN." Gastroenterology 88.5 (January 1, 1985): 1301-1301.

Source

wos

Published In

Gastroenterology

Volume

88

Issue

5

Publish Date

1985

Start Page

1301

End Page

1301

Authors

AKWARI, OE; FRIEDMAN, AH; FAWCETT, T

MLA Citation

AKWARI, OE, FRIEDMAN, AH, and FAWCETT, T. "ABLATION OF THE AREA POSTREMA ALTERS GASTROINTESTINAL MYOELECTRIC RESPONSE TO APOMORPHINE AND CISPLATIN." Gastroenterology 88.5 (January 1, 1985): 1301-1301.

Source

wos

Published In

Gastroenterology

Volume

88

Issue

5

Publish Date

1985

Start Page

1301

End Page

1301

Computed tomography (CT) is a widely accepted modality for the detection, localization, and potential therapeutic drainage of abdominal abscesses. The CT demonstration of extraluminal gas within the abdomen usually signifies the presence of an abscess. We report two cases of nonpurulent spontaneous tissue necrosis which simulated a gas containing abscess on CT. The significance of a gas-containing mass detected by CT must be interpreted cautiously since this appearance is not necessarily pathognomonic of a drainable abscess. Confirmation of purulent material within a suspected abscess collection requires documentation by percutaneous aspiration or surgery.

Authors

Silverman, PM; Korobkin, M; Halvorsen, RA; Heaston, DK; Akwari, OE

MLA Citation

Silverman, PM, Korobkin, M, Halvorsen, RA, Heaston, DK, and Akwari, OE. "Computed tomographic detection of gas within spontaneously necrotic tissue." Comput Radiol 9.1 (January 1985): 51-55.

PMID

2985328

Source

pubmed

Published In

Computerized Radiology : Official Journal of the Computerized Tomography Society

Volume

9

Issue

1

Publish Date

1985

Start Page

51

End Page

55

Authors

Enterline, DS; Rauch, RE; Silverman, PM; Korobkin, M; Akwari, OE

MLA Citation

Enterline, DS, Rauch, RE, Silverman, PM, Korobkin, M, and Akwari, OE. "Cyst of the falciform ligament of the liver." AJR Am J Roentgenol 142.2 (February 1984): 327-328.

PMID

6607601

Source

pubmed

Published In

Ajr. American Journal of Roentgenology

Volume

142

Issue

2

Publish Date

1984

Start Page

327

End Page

328

DOI

10.2214/ajr.142.2.327

Authors

AKWARI, OE

MLA Citation

AKWARI, OE. "DIAZOPRIDE(AHR-5531) - GASTRODUODENAL MYOELECTRIC ACTIVITY ASSOCIATED WITH ITS ANTI-EMETIC EFFECT." GASTROENTEROLOGY 86.5 (1984): 1012-1012.

Source

wos-lite

Published In

Gastroenterology

Volume

86

Issue

5

Publish Date

1984

Start Page

1012

End Page

1012

Ten asymptomatic patients who had undergone resection of rectal carcinoma were evaluated prospectively by at least three serial computed tomographic (CT) examinations of the pelvis within 24 months of surgery. Of the seven patients who had undergone abdominoperineal resection, five were found to have a presacral mass due to normal postoperative changes within the first 4 months. The mass showed a variable diminution between 4 and 9 months after operation and developed a more distinct outline, partial separation from the sacrum, or a change in configuration to a thin transverse sliver. These changes indicate the possibility of CT differentiation of a normal postoperative mass from local recurrence. In the other five patients, no postoperative mass was observed. In one patient CT demonstrated a solitary 1.5 cm lymph node metastasis. This patient was asymptomatic and had a normal carcinoembryonic antigen level. From these observations, a baseline CT study of the pelvis within 2-4 months of resection of rectal carcinoma, followed by serial CT examinations at about 6-month intervals is recommended for the detection of early asymptomatic pelvic recurrence and to facilitate differentiation from persistent postoperative changes.

Authors

Kelvin, FM; Korobkin, M; Heaston, DK; Grant, JP; Akwari, O

MLA Citation

Kelvin, FM, Korobkin, M, Heaston, DK, Grant, JP, and Akwari, O. "The pelvis after surgery for rectal carcinoma: serial CT observations with emphasis on nonneoplastic features." Ajr. American Journal of Roentgenology 141.5 (November 1983): 959-964.

PMID

6605069

Source

epmc

Published In

Ajr. American Journal of Roentgenology

Volume

141

Issue

5

Publish Date

1983

Start Page

959

End Page

964

DOI

10.2214/ajr.141.5.959

Although it is well known that neural control of gastric motility occurs via sympathetic, parasympathetic, noncholinergic, and nonadrenergic fibers contained in the vagus nerve, the central sites of origin of these influences are largely unknown. Recent experiments in our laboratory indicate that noncholinergic neural pathways originating in the posterior hypothalamus can markedly influence gastric motility. At least 2 weeks prior to the experiment, mongrel dogs were surgically prepared with bipolar recording electrodes fixed to the serosal surface of the stomach. This prevented violation of the abdominal cavity on the day of testing. Experiments were performed with the animals under alpha-chloralose anesthesia (100 mg kg-1) in temperature-controlled settings. Under stereotactic guidance, bipolar stimulation of the posterior periventricular hypothalamus produced profound reproducible excitatory or inhibitory effects on gastric myoelectric and motor activity. Changes in the frequency and amplitude of pacesetter potentials (PPs) and in the incidence of action potentials associated with them were observed. Stimulation of various loci in 14 dogs resulted in a 71 +/- 7.5% increase in the incidence of action potentials associated with gastric PPs in "excitatory" areas (n = 7) and a 69.1 +/- 4% decrease in this ratio in "inhibitory" areas (n = 19). In general, more lateral stimulation produced greater inhibitory effects. Responses were frequency dependent, with a threshold greater than 25 Hz in most cases. Excitatory gastric responses to hypothalamic stimulation occurred despite full systemic atropinization (0.1 mg kg-1). The physiologic significance of these noncholinergic excitatory pathways influencing distal gastric motility and the neurotransmitters they employ are as yet unknown.

Authors

Schirmer, BD; Iacono, RP; Nashold, BS; Jones, RS; Akwari, OE

MLA Citation

Schirmer, BD, Iacono, RP, Nashold, BS, Jones, RS, and Akwari, OE. "Neural control of gastrointestinal motility: evidence for noncholinergic regulatory influences." Surgery 94.2 (August 1983): 191-198.

PMID

6308841

Source

pubmed

Published In

Surgery

Volume

94

Issue

2

Publish Date

1983

Start Page

191

End Page

198

Authors

Akwari, OE

MLA Citation

Akwari, OE. "The gastrointestinal tract in chemotherapy-induced emesis. A final common pathway." Drugs 25 Suppl 1 (February 1983): 18-34.

PMID

6840018

Source

pubmed

Published In

Drugs

Volume

25 Suppl 1

Publish Date

1983

Start Page

18

End Page

34

Authors

BOLARINWA, AF; SCHIRMER, BJ; KORTZ, WJ; AKWARI, OE

MLA Citation

BOLARINWA, AF, SCHIRMER, BJ, KORTZ, WJ, and AKWARI, OE. "PATTERN OF INTERDIGESTIVE BILIARY FLOW IN FASTED DOGS - THE EFFECT OF MOTILIN IN CHOLECYSTECTOMIZED AND INTACT ANIMALS." GASTROENTEROLOGY 84.5 (1983): 1110-1110.

Source

wos-lite

Published In

Gastroenterology

Volume

84

Issue

5

Publish Date

1983

Start Page

1110

End Page

1110

Authors

AKWARI, OE; LUCAS, VS

MLA Citation

AKWARI, OE, and LUCAS, VS. "A PHYSIOLOGIC MODEL OF CHEMOTHERAPY-INDUCED EMESIS IN DOGS." AMERICAN JOURNAL OF GASTROENTEROLOGY 78.10 (1983): 670-670.

Source

wos-lite

Published In

American Journal of Gastroenterology

Volume

78

Issue

10

Publish Date

1983

Start Page

670

End Page

670

Authors

AKWARI, OE; ZHANG, RG; POSTLETHWAIT, R

MLA Citation

AKWARI, OE, ZHANG, RG, and POSTLETHWAIT, R. "ELECTRICAL-ACTIVITY OF GREATER CURVATURE TUBES OF CANINE STOMACH." GASTROENTEROLOGY 84.5 (1983): 1089-1089.

Source

wos-lite

Published In

Gastroenterology

Volume

84

Issue

5

Publish Date

1983

Start Page

1089

End Page

1089

Computed tomography potentially offers the most accurate noninvasive means of estimating in vivo volumes. Contiguous 1-cm-thick CT scans were obtained through phantoms, dog kidneys in vivo, and human spleens before splenectomy. Cross-sectional areas were calculated for each individual scan and volumes then determined with each of four mathematical integration techniques. Volume estimations were compared to volumes determined by water displacement. The simplest, most practical means of calculating volumes, using the summation-of-areas technique with scans obtained at 2 cm intervals, was similar in accuracy to more complex methods. The mean percentage error of volume calculations using the sum-of-areas technique was 4.95% for five immobile phantoms, 3.86% for eight dog kidneys, 3.59% for eight human spleens in vivo at 1 cm scan spacing, and 3.65% for the same human spleens at 2 cm scan spacings. Difficulties in visual recognition and manual tracking of object boundaries seem to be more significant sources of error than patient-related factors.

Authors

Breiman, RS; Beck, JW; Korobkin, M; Glenny, R; Akwari, OE; Heaston, DK; Moore, AV; Ram, PC

MLA Citation

Breiman, RS, Beck, JW, Korobkin, M, Glenny, R, Akwari, OE, Heaston, DK, Moore, AV, and Ram, PC. "Volume determinations using computed tomography." AJR Am J Roentgenol 138.2 (February 1982): 329-333.

PMID

6976739

Source

pubmed

Published In

Ajr. American Journal of Roentgenology

Volume

138

Issue

2

Publish Date

1982

Start Page

329

End Page

333

DOI

10.2214/ajr.138.2.329

Six patients with Clostridium septicum sepsis seen at Duke University Medical Center over a two-year period also had other abnormalities, consisting of hematologic disorders in 3 and colon tumors in 3. Three patients died of sepsis; 2 survived following disarticulation of the arm to control gas gangrene, while the sixth patient survived the sepsis but died of metastatic disease. When anaerobic cultures are positive for C. septicum, antibiotics should be given immediately. The high incidence of underlying colon tumor, especially in the cecum, should prompt consideration of a barium-enema examination.

Authors

Schaaf, RE; Jacobs, N; Kelvin, FM; Gallis, HA; Akwari, O; Thompson, WM

MLA Citation

Schaaf, RE, Jacobs, N, Kelvin, FM, Gallis, HA, Akwari, O, and Thompson, WM. "Clostridium septicum infection associated with colonic carcinoma and hematologic abnormality." Radiology 137.3 (December 1980): 625-627.

PMID

6934562

Source

epmc

Published In

Radiology

Volume

137

Issue

3

Publish Date

1980

Start Page

625

End Page

627

DOI

10.1148/radiology.137.3.6934562

A case of carcinoma of the prostate causing fistulous communication between the rectum and the prostatic ducts is presented. The patient's initial symptoms included gradual onset of inability to ejaculate and the complaint of ejaculation per rectum. Appropriate urologic studies demonstrated a fistulous connection between the area of the ejaculatory duct and the rectum. Microscopic studies of rectal discharge confirmed that semen was exiting through his rectum. All genitourinary symptoms in patients with carcinoma of the prostate warrant thorough investigation.

Authors

Carson, CC; Akwari, OE

MLA Citation

Carson, CC, and Akwari, OE. "Rectal ejaculation and prostatic carcinoma." Urology 16.2 (August 1980): 188-189.

PMID

7404917

Source

pubmed

Published In

Urology

Volume

16

Issue

2

Publish Date

1980

Start Page

188

End Page

189

Our aim was to compare the myoelectrical and motor properties of the continent ileal pouch of 19 patients with those of the terminal ileum of six patients with Brooke ileostomy. The undistended ileum in both types of ileostomy exhibited pacesetter potentials at a mean frequency of 9.1 cycles per minute during fasting upon which were superimposed the cyclic bursts of action potentials and attendant contractions characteristic of the interdigestive state. Both types of ileostomy also accommodated to distention, with intraluminal pressure being kept low as the ileum filled. However, the amplitudes of the changes in intraluminal pressure present in the pouch were less than those present in the Brooke ileum both before and during distention, and the volumes to which the ileum could be distended were far greater in the patients with ileal pouches than in those with the Brooke ileostomy. Feeding did not alter the responses to distention of either type of ileostomy. We conclude that the electrical and motor patterns of the undistended ileum are similar in both types of ileostomy, but that the anatomic and motor properties of the pouch allow it to accept far larger intraluminal volumes both during fasting and after feeding.

Authors

Akwari, OE; Kelly, KA; Phillips, SF

MLA Citation

Akwari, OE, Kelly, KA, and Phillips, SF. "Myoelectric and motor patterns of continent pouch and conventional ileostomy." Surg Gynecol Obstet 150.3 (March 1980): 363-371.

PMID

7355362

Source

pubmed

Published In

Surgery, Gynecology & Obstetrics

Volume

150

Issue

3

Publish Date

1980

Start Page

363

End Page

371

Among 400 patients with adenocarcinoma of the distal large bowel, anterior resection resulted in more anastomotic leaks, postoperative urinary retention and diarrhea when used for lesions of the mid-rectum than when used for lesions of the proximal rectum or sigmoid colon. However, the operative mortality, long-term morbidity and 2 year survival were similar among patients with lesions at all three locations.

Authors

Akwari, OE; Kelly, KA

MLA Citation

Akwari, OE, and Kelly, KA. "Anterior resection for adenocarcinoma of the distal large bowel." Am J Surg 139.1 (January 1980): 88-94.

PMID

7350850

Source

pubmed

Published In

American Journal of Surgery

Volume

139

Issue

1

Publish Date

1980

Start Page

88

End Page

94

The postoperative function of "free" jejunal autotransplants for replacement of the pharyngoesophagus after palliative resection was evaluated in nine patients using clinical assessment, cinefluoroscopy, manometry, and electrical studies. After an initial period of adjustment, all patients swallowed solids and liquids with minimal difficulty, gained weight appropriately and were satisfied with their operations. Cinefluoroscopy and esophageal manometry demonstrated normal function of the intact distal esophagus, which correlated with the absence of reflux symptoms. The grafts were capable of contraction in response to local distension and maintained an intrinsic myoelectrical activity. These results indicate that jejunal autotransplantation may provide excellent palliation with restoration of a near normal swallowing mechanism for patients with large resectable lesions of the pharyngoesophagus. An additional observation was that the instillation of food directly into the gastric antrum caused a change in the motor activity in the transplantd jejunum, indicating physiological hormonal control of intestinal motility.

Authors

Meyers, WC; Seigler, HF; Hanks, JB; Thompson, WM; Postlethwait, R; Jones, RS; Akwari, OK; Cole, TB

MLA Citation

Meyers, WC, Seigler, HF, Hanks, JB, Thompson, WM, Postlethwait, R, Jones, RS, Akwari, OK, and Cole, TB. "Postoperative function of "free" jejunal transplants for replacement of the cervical esophagus." Ann Surg 192.4 (1980): 439-450.

PMID

6158920

Source

pubmed

Published In

Annals of Surgery

Volume

192

Issue

4

Publish Date

1980

Start Page

439

End Page

450

Authors

Thomas, PA; Akwari, OE; Kelly, KA

MLA Citation

Thomas, PA, Akwari, OE, and Kelly, KA. "Hormonal control of gastrointestinal motility." World Journal of Surgery 3.5 (September 1979): 545-552. (Review)

PMID

390898

Source

epmc

Published In

World Journal of Surgery

Volume

3

Issue

5

Publish Date

1979

Start Page

545

End Page

552

DOI

10.1007/bf01654757

Thirty-eight patients with primary adenocarcinoma arising at the junction of the right, left, and common hepatic biliary ducts were seen at the Mayo Clinic, Rochester, Minn, between 1950 and 1976. Prompt and lasting relief of jaundice and cholangitis occurred in four patients undergoing resection of the tumor combined with left hepatic lobectomy, and their mean survival was 33 months. Relief of symptoms was only temporary in 26 patients treated with drainage of the biliary tree, and their mean survival was only ten months. Eight patients undergoing exploration only had no relief of symptoms, and none survived beyond four months. We conclude that resection of these tumors in selected patients gives good palliation and offers the chance of long-term cure. If resection is not possible, biliary decompression results in satisfactory palliation, whereas exploration only does not.

Authors

Akwari, OE; Kelly, KA

MLA Citation

Akwari, OE, and Kelly, KA. "Surgical treatment of adenocarcinoma. Location: junction of the right, left, and common hepatic biliary ducts." Arch Surg 114.1 (January 1979): 22-25.

PMID

83129

Source

pubmed

Published In

Archives of Surgery (Chicago, Ill. : 1960)

Volume

114

Issue

1

Publish Date

1979

Start Page

22

End Page

25

From 1950 through 1974, a total of 108 cases of primary intestinal leiomyosarcoma were seen at the Mayo Clinic. Most of these uncommon tumors occurred in the fifth and sixth decades of life, and more of them in men than in women (2.6:1). There were 73% in the small bowel, 25% in the large bowel, and 2% in the anus. Gastrointestinal bleeding and pain were the two most common signs at presentation, and they led to surgical exploration in all cases where they appeared. By the time surgery was performed, only 48% of the tumors could be resected with hope of cure. Within that group of cases, 50% of the patients survived 5 years, but only 35% survived 10 years, late recurrence being common. The histologic grade of the tumor affected survival to erroneous early optimism in prognosis.

Authors

Akwari, OE; Dozois, RR; Weiland, LH; Beahrs, OH

MLA Citation

Akwari, OE, Dozois, RR, Weiland, LH, and Beahrs, OH. "Leiomyosarcoma of the small and large bowel." Cancer 42.3 (September 1978): 1375-1384.

PMID

81101

Source

pubmed

Published In

Cancer

Volume

42

Issue

3

Publish Date

1978

Start Page

1375

End Page

1384

Among 706 collected cases of mediastinal neurogenic tumors were 69 patients (9.8%) with extension through an intervertebral foramen, so that the composite neoplastic mass was dumbbell-shaped. Although only 10% of these dumbbell tumors were malignant, the majority of the patients presented with neurologic symptoms of spinal cord compression. In about 40% of reported cases, the intraspinal component, although present, was not clinically apparent. Such cases of asymptomatic intraspinal extension should be suspected when special roentgenologic views of the spine demonstrate erosion of the vertebral pedicle or enlargement of the intervertebral foramen adjacent to the posterior mediastinal mass. Workup of these patients should include myelographic studies to determine whether a dumbbell tumor is indeed present; if it is, surgery should be carried out by a team of thoracic surgeons and neurosurgeons in a one-stage combined resection of both the intraspinal and the mediastinal component of the tumor. With early diagnosis and surgical intervention, long-term survival is the rule. When the patient is in the pediatric age bracket, an orthopedic surgeon should be included on the team to help minimize subsequent skeletal growth deformity.

Authors

Akwari, OE; Payne, WS; Onofrio, BM; Dines, DE; Muhm, JR

MLA Citation

Akwari, OE, Payne, WS, Onofrio, BM, Dines, DE, and Muhm, JR. "Dumbbell neurogenic tumors of the mediastinum. Diagnosis and management." Mayo Clin Proc 53.6 (June 1978): 353-358.

PMID

651379

Source

pubmed

Published In

Mayo Clinic Proceedings

Volume

53

Issue

6

Publish Date

1978

Start Page

353

End Page

358

Authors

AKWARI, O

MLA Citation

AKWARI, O. "Leiomyosarcoma of the small and large bowel." Cancer 42 (1978): 1375-1384.

Source

cinii-english

Published In

Cancer

Volume

42

Publish Date

1978

Start Page

1375

End Page

1384

Authors

AKWARI, O

MLA Citation

AKWARI, O. "Dumbbell neurogenic tumors of the mediastinum : diagnosis and management." Mayo Clin Proc 53 (1978): 353-358.

Source

cinii-english

Published In

Mayo Clin Proc

Volume

53

Publish Date

1978

Start Page

353

End Page

358

Authors

AKWARI, OE; KELLY, KA; PHILLIPS, SF

MLA Citation

AKWARI, OE, KELLY, KA, and PHILLIPS, SF. "MYOELECTRIC AND MOTOR PATTERNS OF CONTINENT ILEAL POUCH - RESPONSES TO DISTENTION AND FEEDING." GASTROENTEROLOGY 74.5 (1978): 1002-1002.

Source

wos-lite

Published In

Gastroenterology

Volume

74

Issue

5

Publish Date

1978

Start Page

1002

End Page

1002

Is the recent trend toward more radical parathyroid surgery justified? Surgical outcomes in three groups of 50 patients undergoing operation for primary hyperparathyroidism at the Mayo Clinic between January, 1974, and May, 1976, were compared. One group of patients was operated on by Surgeon A who used a "conservative" approach (removal of grossly enlarged glands only, with or without biopsy of one normal-sized gland). A second group was operated on by a Surgeon B, who used a more "liberal" approach (almost routine removal of at least two glands, removal of three and one-half glands when more than one gland was enlarged, and liberal use of biopsy identification). Symptomatic hypocalcemia requiring treatment occurred in 24% of patients after liberal neck exploration, as compared with 4% in the conservatively treated group. The liberal approach did not yield any higher cure rate. A third group of 50 patients was operated on by Surgeon B using the conservative approach. The incidence of postoperative hypocalcemia was reduced to 2%; one patient remained hypercalcemic. Symptomatic hypocalcemia, even if temporary, represents significant morbidity. A conservative approach to neck exploration in patients with primary hyperparathyroidism is recommended because it is associated with a very low incidence of temporary postoperative hypoparathyroidism (2 to 4%) and a high cure rate (99% in this series).

Authors

Edis, AJ; Beahrs, OH; van Heerden, JA; Akwari, OE

MLA Citation

Edis, AJ, Beahrs, OH, van Heerden, JA, and Akwari, OE. ""Conservative" versus "liberal" approach to parathyroid neck exploration." Surgery 82.4 (October 1977): 466-473.

PMID

898024

Source

pubmed

Published In

Surgery

Volume

82

Issue

4

Publish Date

1977

Start Page

466

End Page

473

Over a 22-year span, 87 patients with carcinoma of the papilla of Vater underwent radical pancreatoduodenectomy. No patient was lost to follow-up, and extended observation was possible in most cases: the definitive operation was at least five years earlier than this study in 87% and at least ten years earlier in 73%. Operative mortality was 11.5% among patients who had a single definitive operative procedure and 15.4% among those whose treatment involved reoperation after prior exploration elsewhere. Overall survival rates at two, five, and ten years were 56%, 34%, and 20% respectively. Factors associated with favorable survival were histologic differentiation (Broders grades 1 and 2), absence of nodal metastasis, and papillary histologic characteristics. Noteworthy is the fact that no patient having resection of an undifferentiated carcinoma (Broders grade 3 or 4) survived four years.

Authors

Akwari, OE; van Heerden, JA; Adson, MA; Baggenstoss, AH

MLA Citation

Akwari, OE, van Heerden, JA, Adson, MA, and Baggenstoss, AH. "Radical pancreatoduodenectomy for cancer of the papilla of Vater." Arch Surg 112.4 (April 1977): 451-456.

PMID

192176

Source

pubmed

Published In

Archives of Surgery (Chicago, Ill. : 1960)

Volume

112

Issue

4

Publish Date

1977

Start Page

451

End Page

456

Authors

Akwari, OE; van Heerden, JA; Adson, MA; Foulk, WT; Baggenstoss, AH

MLA Citation

Akwari, OE, van Heerden, JA, Adson, MA, Foulk, WT, and Baggenstoss, AH. "Bile duct carcinoma associated with ulcerative colitis." Rev Surg 33.4 (July 1976): 289-293.

PMID

940978

Source

pubmed

Published In

Review of Surgery

Volume

33

Issue

4

Publish Date

1976

Start Page

289

End Page

293

Of 957 patients undergoing operation for benign gastric ulcer and its complications from 1965 through June 1975, 90 had perforated ulcers. Among these were four patients in whom a gastrocolic fistula had formed. Although two of the four patients had symptoms due to peptic ulcer dating back 12 and 68 months, symptoms of a gastrocolic fistula were the initial presentation of ulcer disease in the other two. All four patients had watery diarrhea and weight loss, and barium enema examination was diagnostic in each case. The perforating ulcers were located in the distal stomach on the greater curvature in all four patients. Although enterostasis was not present in these cases, regurgitation of colonic contents probably results in bacterial overgrowth in the small intestine, causing structural and functional damage to the mucosal cells by bacterial products, manifested clinically by diarrhea in 75% of the patients. Surgery should be advised in all cases after adequate preparation of the patient; bowel preparation with cathartics, enemas, and oral antibiotics is mandatory. The preferred operation is one-stage enbloc hemigastrectomy and resection of the involved segment of colon along with the fistulous tract. The present series brings to 43 the total number of cases of gastrocolic fistulas complicating benign, previously unoperated gastric or duodenal ulcers. There is an appreciable mortality associated with this condition - 7 of these 43 patients (16%) died as a direct consequence of their fistula.

Authors

Akwari, OE; Edis, AJ; Wollaeger, EE

MLA Citation

Akwari, OE, Edis, AJ, and Wollaeger, EE. "Gastrocolic fistula complicating benign unoperated gastric ulcer. Report of four cases and review of the literature." Mayo Clin Proc 51.4 (April 1976): 223-230.

PMID

1263593

Source

pubmed

Published In

Mayo Clinic Proceedings

Volume

51

Issue

4

Publish Date

1976

Start Page

223

End Page

230

In 10 conscious, fasted dogs with electrodes chronically implanted on the intestine, current pulses (8 mA, 50 ms) at frequencies the same as, or faster than, that of the natural intestinal pacemaker always entrained pacesetter potentials (PP) along the proximal frequency plateau, but not along the distal frequency gradient. As duodenal PP's were paced faster, the proximal plateau shortened by orad extension of the distal gradient. Entrained PP's propagated orally and aborally. Their velocity slowed caudally while varying inversely with their frequency. After midduodenal transection had reduced the frequency of the natural PP's distal to the cut, pacing entrained PP's in all areas of the bowel and restored the proximal plateau and distal gradient. But no area could be paced faster than before transection. PP's were not propagated across sites of transection. A digital computer model of coupled relaxation oscillators gave similar results. We conclude that the frequency of the natural pacemaker and the declining gradient of maximal driven frequency determine the frequency pattern of the small intestinal PP.

Authors

Akwari, OE; Kelley, KA; Steinbach, JH; Code, CF

MLA Citation

Akwari, OE, Kelley, KA, Steinbach, JH, and Code, CF. "Electric pacing of intact and transected canine small intestine and its computer model." The American Journal of Physiology 229.5 (November 1975): 1188-1197.

PMID

1200137

Source

epmc

Published In

The American Journal of Physiology

Volume

229

Issue

5

Publish Date

1975

Start Page

1188

End Page

1197

DOI

10.1152/ajplegacy.1975.229.5.1188

Thirteen patients with bile duct cancer (excluding gallbladder) and associated chronic ulcerative colitis (CUC) were seen at the Mayo Clinic from 1935 through 1973. Most patients had initial symptoms of severe diarrhea and bleeding, followed by a pattern of mild-to-moderate disease with exacerbations and remissions. Three patients had especially severe symptoms and underwent total colectomy (1 patient) or proctocolectomy (2 patients) an average of 15.7 years from onset of CUC symptoms. Anorexia, followed rapidly by the development of progressive jaundice (or a sudden deterioration when liver disease was already present), marked the onset of symptoms of bile duct cancer in the 13 patients. The overall mean duration from onset of CUC to development of symptoms of bile duct cancer was 19 years. The patients in whom colitis was managed by proctocolectomy or total abdominal colectomy developed symptoms of bile duct cancer an average of 9.4 years after colectomy. When cancer was diagnosed, the tumor had spread beyond the bile ducts in 10 patients. The tumors were difficult to identify and often infiltrated the hepatic hilus. The present series and review of the literature suggest that the relationship between CUC and bile duct cancer is more than a chance occurrence. The carcinoma has an onset approximately 3 decades earlier than does carcinoma of the bile ducts without CUC. Surgical removal of the diseased colon and mode of medical management of the unresected colon have no relationship to the subsequent development of carcinoma of the bile ducts; neither does the extent or severity of the colonic disease. The prognosis of carcinoma of the bile ducts unfortunately continues to be dismal.

Authors

Akwari, OE; Van Heerden, JA; Foulk, WT; Baggenstoss, AH

MLA Citation

Akwari, OE, Van Heerden, JA, Foulk, WT, and Baggenstoss, AH. "Cancer of the bile ducts associated with ulcerative colitis." Annals of Surgery 181.3 (March 1975): 303-309.

PMID

165791

Source

epmc

Published In

Annals of Surgery

Volume

181

Issue

3

Publish Date

1975

Start Page

303

End Page

309

DOI

10.1097/00000658-197503000-00010

Authors

AKWARI, O

MLA Citation

AKWARI, O. "Cancer of the bile ducts associated with ulcerative colitis." Ann. Surg. 181 (1975): 303-309.

Source

cinii-english

Published In

Ann. Surg.

Volume

181

Publish Date

1975

Start Page

303

End Page

309

DOI

10.1097/00000658-197503000-00010

Authors

Adson, MA; Akwari, OE

MLA Citation

Adson, MA, and Akwari, OE. "Management of gastrointestinal dysfunction after gastric surgery." The Surgical Clinics of North America 51.4 (August 1971): 915-926. (Review)

PMID

4939428

Source

epmc

Published In

The Surgical Clinics of North America

Volume

51

Issue

4

Publish Date

1971

Start Page

915

End Page

926

DOI

10.1016/s0039-6109(16)39487-7