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[Pancreas head resection combined with resection of the superior mesenteric vein: extensive procedure for tumors of the pancreas head].

Surgical treatment for locally advanced cancer of the pancreas head with vascular invasion is controversial. It is regarded as a contraindication for resection by most surgeons, others perform resection involving the vessel. We performed pancreaticoduodenectomy with vascular resection in a 61 year old patient. The vascular reconstruction was performed using reversed saphenous vein. We review and analyse clinical, and operative data and results.

Female↗

[Hormon producing tumors of the pancreas. Verner-Morrison like symptomatology of a non-serotonin-producing, metastasizing carcinoid of the pancreas (author's transl)].

A case of Verner-Morrison like symptomatology of an histological identified, metastasizing, non-serotonin-producing carcinoid of the pancreas is described. The likeness of symptomatology to courses of disease by islet-cell tumors is pointed out, the coincidence of carcinoid and islet-cell-tumors and their common origin are discussed.

Carcinoid Tumor↗

[Solid and papillary epithelial neoplasm of the pancreas--a rare malignant tumor of pancreas].

The paper presents two cases of solid and papillary epithelial neoplasm of the pancreas (SPENP)--a rare pancreatic neoplasm in a 45-year-old woman admitted to the hospital with the diagnosis of pancreatic tail tumor and 22-year-old woman with the diagnosis of pancreatic head tumor. First patient was subjected to peripheral pancreatic resection; the second patient was subjected to Whipple pancreatoduodenectomy. Histopathological examination confirmed SPENP. The authors present cases and review of the literature on SPENP.

Carcinoma, Papillary↗

[Pathological anatomy of neoplasms of the pancreas. I. Tumors of the exocrine pancreas].

The authors make a review of the exocrine pancreas tumors describing the main clinical, pathological and histogenetic features. The benign neoplasms develop generally from the ductal epithelium and may be cystic or mucinous, the last type suffering some times a malignant transformation. The malignant tumors are very common; histogenetically they may be ductal, acinar or of uncertain origin. Tumor localization, size and invasion are to be taken into consideration for the prognosis.

Adenoma↗

[Pancreatic function and quality of life after resection of the head of the pancreas in chronic pancreatitis. A prospective, randomized comparative study after duodenum preserving resection of the head of the pancreas versus Whipple's operation].

Given an indication for surgery in patients with chronic pancreatitis, such as distal common bile duct obstruction, duodenal stenosis, or dilated pancreatic duct with stones and congestion, the surgeon must decide the type of operation to perform. A duodenopancreatectomy, the Whipple procedure, is widely considered to be the gold standard. It is highly effective in relieving pain and eliminating the structural abnormalities noted above. Duodenum-preserving resection of the head of the pancreas (DPRHP) seems to be an attractive alternative to pancreaticoduodenectomy (PD) in the treatment of chronic pancreatitis. In a clinical prospective randomized trial the efficiency of both operative methods was investigated. Between 7/1987 and 12/1993 43 patients were randomly assigned to undergo either a Whipple procedure (n = 21) or DPRHP (n = 22). Data on postoperative course, mortality, and postoperative morbidity were compiled. As concerns long-term results, postoperative hormonal status (insulin, neurotensin, cholecystokinin, gastrin) was checked, basal and stimulated with a standardized meal, using standard hormonal assay kits. All patients with PD survived, whereas one with DPRHP died from peritonitis. Patients with DPRHP had a significant more rapid convalescence (16.5 vs. 21.7 days). The range for postoperative follow-up is from 36 months to 5.5 years. In the DPRHP group 18 patients are in good condition. Two had diabetes and one developed carcinoma. In the PD group one died from hepatic coma, 14 are in good condition and 6 developed diabetes. All gained body weight with an average of 6.4 vs. 4.9 kg, DPRHP vs. PD. A difference between DPRHP and PD was obvious for the postoperative hormonal status. Results are satisfactory in both groups. For patients with DPRHP however, we see a quicker convalescence and a significant benefit as concerns postoperative hormonal status.

Adult↗

An in situ evaluation of distal splenic arteriovenous fistula on pancreas function in an isolated pancreas segment.

To determine the effects of a distal splenic arteriovenous fistula on endocrine function and pancreatic blood flow, 25 dogs underwent proximal pancreatectomy with the pancreatic tail left in situ and free intraperitoneal drainage of the pancreatic duct. Group A served as controls. In groups B through E, ligation of all nonpancreatic splenic vessels was accomplished. In group B, no further manipulations were performed. In group C, an arteriovenous fistula was created. Groups D and E were identical to groups B and C, respectively, except for the induction of bile pancreatitis. During intravenous glucose tolerance testing, the mean (+/- SEM) basal-to-peak insulin difference was 10.1 +/- 3.5 microU/mL in group A, 16.3 +/- 3.6 microU/mL in group B, 14.8 +/- 5.1 microU/mL in group C, 16.4 +/- 3.1 microU/mL in group D, and 13.0 +/- 4.4 microU/mL in group E. Corresponding mean (+/- SEM) glucose clearance values were as follows: -0.907% +/- 0.24%/min, -0.867% +/- 0.14%/min, -1.056% +/- 0.21%/min, -1.365% +/- 0.26%/min, and -0.887% +/- 0.20%/min. These values were not significantly different. Ligation of all splenic arterial and venous branches resulted in a 64.8% to 78.3% reduction in splenic artery blood flow that was restored to 60.9% to 84.9% of basal flow by an arteriovenous fistula (groups C and E). In conclusion, the creation of a splenic arteriovenous fistula was not beneficial in this model and other factors (rejection or technical) should be considered in vascular thrombosis following segmental pancreatic transplantation.

Amylases↗

Liposoluble antioxidants are not consumed in the pancreas after reperfusion in human simultaneous pancreas-kidney transplantation.

There is considerable evidence that under experimental conditions, oxygen free radicals (OFRs) are decisive in the pathogenesis of ischemia-reperfusion injury. Normally OFRs are scavenged by antioxidants such as alpha-tocopherol. Thus, in the following study we investigated whether antioxidants are consumed locally in human pancreatic grafts after reperfusion. A series of ten patients receiving bladder-drained pancreaticoduodenal and renal allografts were studied. Sequential blood samples were drawn locally from the venous outflow of the graft and simultaneously from the radial artery after reperfusion. alpha-Tocopherol, retinol, lycopene, and alpha- and beta-carotene levels were determined. After reperfusion these levels remained largely unchanged. Hence, in our study a consumption of antioxidants locally in the pancreatic graft after transplantation was not demonstrated. Therefore, the antioxidant capacity seems not to be exhausted at that time. This suggests that in clinical pancreatic transplantation oxidant stress in the initial reperfusion period might not have the relevance suggested by animal models.

Antioxidants↗