Glucagon in Acute Medicine: Pharmacological, clinical and therapeutic implications

177 Pages·1993·3.86 MB·English

by  Prof. Pierre J. Lefèbvre (auth.)

Glucagon in
Acute Medicine
Glucagon in
Acute Medicine
Pharmacological, clinical and
therapeutic implications
EDITED BY
J. Picazo, MD
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The Proceedings of an International Workshop
held in Barcelona on 23 October, 1992,
under the auspices of the
Escuela de ţ'atologia Digestiva, Barcelona
....
••
SPRINGER-SCIENCE+BUSINESS MEDIA, B.V.
A catalogue record for this book is available from the British Library
ISBN 978-94-010-4984-9 ISBN 978-94-011-2220-7 (eBook)
DOI 10.1007/978-94-011-2220-7
Copyright
© 1993 Springer Science+Business Media Dordrecht
Originally published by Kluwer Academic Publishers in 1993
AII rights reserved. No part of this publication may be reproduced. stored in a retrieval system. or
trasmitted in any form or by any means. electronic. mechanical. photocopying. recording or otherwise.
without prior permission from the publishers. Springer-Science+Business Media, B.V.
Typeset by Lasertext Ud. . Stretford. Manchester M32 OIP.
Contents
List of Participants vii
Preface
F. Vilardell ix
1 An introduction to glucagon
P. ]. Lejebvre 1
2 Cardiovascular emergencies
G. P. Zaloga 11
3 Glucagon for the treatment of respiratory emergencies
]. E. Wilson and P. B. Fontanarosa 27
4 Genitourinary emergencies and glucagon
s. P. Ros 37
5 Glucagon for metabolic/endocrinologic emergencies:
hypoglycaemia
M. B. Heller and R. B. Vukmir 47
6 Acute poisoning and glucagon
]. A. Henry 67
7 Acute mesenteric ischaemia
]. L. Cronenwett 83
8 Intestinal strangulation
A. Oshima and M. Kitajima 107
v
GLUCAGON IN ACUTE MEDICINE
9 Glucagon in gastrointestinal radiology emergencies
]. Skucas 119
10 Glucagon for the management of hepatic emergencies
A. L. Baker 131
11 Biliary and pancreatic emergencies
D. L. Carr-Locke 141
Final discussion ISS
From the Chairmen
P. ]. Lejebvre and F. Vi/ardell 167
Index 169
vi
List of Participants
A. L. BAKER P. J. LEFEBVRE
Liver Study Unit Diabetes, Nutrition and Metabolic Disorders
University of Chicago Unit
Chicago, Illinois 60637 C.H.U. Sart Tilman
USA University of Liege
Liege
D. L. CARR-LOCKE Belgium
Endoscopy Center
Brigham & Women's Hospital A.OSHIMA
Harvard Medical School Department of Surgery
Boston, Massachusetts 02115 Tokyo Adventist Hospital
USA Tokyo 167
Japan
J. L. CRONENWETT
Section of Vascular Surgery S. P. ROS
Darmouth-Hitchcock Medical Center Department of Pediatrics
Lebanon, New Hampshire 03756 Loyola University Medical Center
USA Maywood, Illinois 60153
USA
M. B. HELLER
Division of Emergency Medicine J. SKU CAS
University of Pittsburgh Department of Radiology
School of Medicine University of Rochester Medical Center
Pittsburgh, Pennsylvania 25213 Rochester, New York 14262
USA USA
J. A. HENRY F. VILARDELL
National Poisons Unit Escuela de Patologia Digestiva
Guy's Hospital Universidad Aut6noma
London, SE1 9RT Barcelona
UK Spain
vii
GLUCAGON IN ACUTE MEDICINE
J. E. WILSON G. P. ZALOGA
Department of Emergency Medicine Department of Anesthesia and Medicine
Akron City Hospital Section on Critical Care
Northeastern Ohio Universities College of Bowman Gray School of Medicine
Medicine Wake Forest University
Akron, Ohio 44309 Winston-Salem, North Carolina 27157-1009
USA USA
viii
Preface
The fourth international workshop on glucagon of this series (Barcelona,
1992), which focused on the use of glucagon in emergency medicine, departed
from the main topic of diagnosis and treatment in hepatogastroenterology
dealt with in the previous three meetings. This most recent workshop
concentrated on the use of glucagon in acute, critical care medicine.
The interest in glucagon as a therapeutic agent is not new. The first
workshop on glucagon (Madrid, 1978) defined the physiological role of
glucagon and discussed its uses in clinical gastroenterology, particularly as
an aid to diagnosis in the areas of endoscopy and radiology. Also examined
were the spasmolytic effects of glucagon and its value in the treatment of
biliary colic, as well as the management of biliary tract disease and that of
liver failure.
After the first workshop, new developments occurred and research
continued. The usefulness of glucagon as an aid to gastro-duodenoscopy and
ERCP became well-established; assessment was undertaken on the inhibitory
effects of glucagon on gastric acid; and research was done on glucagon
analogues and fragments, the action of glucagon on the sphincter of Oddi,
and the effect of glucagon in certain liver diseases. These advances led to the
organization of a second workshop (Madrid, 1981) in which the subjects of
the first workshop were treated in much more depth, and the use of glucagon
in the therapy of colonic disorders, fulminant liver failure and alcoholic
hepatitis was discussed. I was impressed at that time by the huge amount of
literature devoted to these subjects and especially by the potential therapeutic
effects of glucagon on a number of conditions. Two years later, Professor
Lefebvre edited his work on the physiological and clinical features of glucagon.
ix
GLUCAGON IN ACUTE MEDICINE
In 1987, a third workshop on glucagon took place in Barcelona. The
meeting was divided in two sessions. One covered glucagon physiology,
glucagon receptors, and an updating of the diagnostic and therapeutic uses
of this hormone in the gastrointestinal and biliary tracts. The second session
was devoted to glucagon in hepatology, particularly its hepatotrophic effects
when coupled with insulin, its possible role in fulminant hepatitis, and its role
in acute alcoholic liver disease.
The fourth and most recent workshop, the proceedings of which are
gathered in this current volume, dealt with a rather different and more
complicated subject, that of glucagon in emergency medicine. Critical care
medicine has become a fully recognized specialty in many countries. Whether
for good or for bad, intensive care medicine is growing in importance due
to the increasing application of advanced technologies to saving or prolonging
lives. Emergency medicine is expected to assume an increasingly larger role,
both technically and scientifically, within the field of medicine. Emergency
medicine provides a new forum for the open discussion of previously
unrecognized problems related to the management of a constellation of
conditions arising from a common denominator-saving lives. This new field
is ideal for the analysis of glucagon with its large variety of multi-targeted
actions.
In the following proceedings from the fourth workshop on glucagon,
we examine glucagon in relation to conditions such as respiratory and
cardiovascular problems, genitourinary disorders, metabolic and endocrine
acute diseases, as well as acute poisoning. The gastrointestinal tract is included
in presentations on the effects of glucagon on biliary acute conditions and
its use in emergency gastrointestinal radiology.
Given that so much is happening in the study of glucagon, the format of
the workshop was particularly attractive. A distinguished group of scientists
from different parts of the world participated in a working event. The program
had been carefully planned to ensure that all aspects of the subject of glucagon
in acute medicine were covered. A very tight schedule was drawn up for we
had to treat a wide range of interrelated topics in just one day. The
concentrated program permitted that an international group of highly occupied
professionals could participate and share their knowledge in a multi-disciplinary
framework. One of the great advantages of this context, remarked upon by
more than one of the participants, was that one was drawn out of working
in one's own particular field and introduced to others working in different
fields only to find that they were working on similar topics.
It was a pleasure for me to welcome discussants attending the workshop
for the first time. Other speakers were veterans of previous workshops,
ensuring a desirable continuity. This fourth meeting continued the "freedom
of speech" tradition established in previous workshops as we believe that by
x
PREFACE
far the most important aspect and contribution to the success of the workshop
is the possibility of ample, relaxed and even belligerent discussion and
criticism.
I would like to thank most heartily all the workshop participants for their
contributions and cooperation, not only during the meeting, but also before
and after. Without them it would not have been possible to present and to
disseminate so much information, nor would this book exist in its current
form. I also extend my thanks to Dr. Jose Picazo who brilliantly organized
the event and made it possible for all of us to meet. I congratulate him, Mari
Carmen Hernandez and Alice Gail Bier on the publication of this book, for
it was they who had to gather the manuscripts together from different corners
of the world and pull our far-ranging discussions into shape. Finally, I would
like to thank our publishers for working so professionally and cooperatively
to produce this book. In short, to everyone involved I extend my thanks for
their contributions to what was a most interesting and worth while project.
Barcelona F. VlLARDELL
June, 1993
Address for correspondence:
Prof. D. Francisco Vilardell
Director
Escuela de Patologia Digestiva
Hospital San Pablo
Avda. S. Antonia Ma Claret 167
08025 BARCELONA
Spain
xi