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PubMed2003

Severity of acute gallstone pancreatitis in patients with pancreas divisum.

BACKGROUND AND STUDY AIMS: The presence of pancreas divisum may reduce the severity of acute gallstone pancreatitis (AGP), as stone impaction at the major papilla only affects the ventral pancreas. PATIENTS AND METHODS: The severity of AGP was compared retrospectively in patients with and without pancreas divisum. Acute gallstone pancreatitis was defined by clinical, biological, radiological, and endoscopic features. Thirteen patients with AGP and pancreas divisum were identified among those presenting with AGP between 1989 and 2000. Pancreas divisum patients were compared to 39 control individuals with AGP and conjugate pancreas. All patients underwent biliary sphincterotomy. Levels of serum amylases, lipases, C-reactive protein (CRP), and white blood cells (WBC) were compared in patients with AGP and pancreas divisum and in control individuals before sphincterotomy. The severity of pancreatitis was assessed on the basis of CRP, Ranson's score, computed tomography, the need for intensive care and drainage of collections or necrosis, duration of hospitalization, and mortality. RESULTS: Patients with AGP and pancreas divisum had a lower severity grade at CT scanning than control individuals ( P = 0.005), a shorter hospitalization period (5 +/- 1.9 vs. 11.6 +/- 1.6 nights; P = 0.032), and lower mortality (none of 13 vs. four of 39; P = 0.048). Serum amylases and lipases, WBC, and Ranson's score tended to be lower in patients with AGP and pancreas divisum, but the difference was not significant in comparison with control individuals. CONCLUSIONS: Acute gallstone pancreatitis is less severe in patients with pancreas divisum than in those with a conjugate pancreas.

Acute Disease↗
PubMed2000

Imaging changes in the pancreas in cystic fibrosis: a retrospective evaluation of 55 cases seen over a period of 9 years.

BACKGROUND: Pathologic changes of the pancreas have been observed as early as the recognition of the disease termed initially "cystic fibrosis of the pancreas". Atrophy of the gland and its fatty infiltration were considered as usual features. The aim of this study was to follow-up the evolution of cystic fibrosis pancreas and to define its successive stages in correlation with the clinical, biochemical, and imaging findings. METHODS: Fifty-five patients were followed up during 9 years. The patients' genetic backgrounds were systematically performed. Blood lipase levels were analyzed systematically at each consultation of the patients and in the event of bouts of abdominal pains. Imaging using mainly echograms and tomodensitometric scans were regularly performed: echograms every 6 months, and tomodensitometric scans every 1 to 2 years. Magnetic resonance imaging was performed in four patients. RESULTS: Five groups of patients were identified on the basis of tomodensitometric scan findings: normal pancreas (n = 4), incomplete lipomatosis of the pancreas (n = 9), complete lipomatosis of the pancreas (n = 23), cystic pancreas (n = 5), macrocystic pancreas (n = 1), atrophic pancreas (n = 13). Pancreas exocrine function was not correlated with findings. Forty episodes of pancreatitis were observed in seven patients. They had bouts of abdominal pain and elevation of lipase levels. Five of these patients were composite heterozygotes (D508/other). Incomplete lipomatosis represents an intermediate stage leading toward complete lipomatosis or toward atrophy after pancreatitis. CONCLUSIONS: Studies of pancreatic function should be performed routinely in cystic fibrosis, especially in pancreatic sufficiency or in patients with normal pancreas images. Acute pancreatitis should be diagnosed and properly identified to be differentiated from other acute abdominal syndromes occurring in cystic fibrosis.

Adolescent↗
PubMed1992

Differential response of kidney and pancreas rejection to cyclosporine immunosuppression.

Immunological interferences between kidney and pancreas transplants were investigated in a genetically defined rat model of combined kidney and pancreas transplantation. Kidney and whole-pancreas grafts were transplanted microsurgically either as individual grafts or in a combined technique. Whole pancreas grafts were grafted into streptozotocin diabetic recipients (55 mg/kg bodyweight i.v.) three days after induction of diabetes. The exocrine secretion was suppressed by duct ligation. Rejection of the grafts was defined by recurrence of diabetes in pancreas-grafted recipients and renal failure after kidney transplantation. There were marked differences in the efficacy of identical short-term cyclosporine immunosuppression (15 mg/kg intramuscularly for 14 days): DA kidneys survived indefinitely in LEW rats (MST greater than 100 days), while DA pancreas allografts underwent prolonged but not permanent survival (P less than 0.01) either as individual grafts (MST 27.3 +/- 1,9 days) or when transplanted simultaneously together with the kidney (44 +/- 16 days) (P less than 0.01). LEW rats carrying a DA kidney for 100 days also rejected a subsequent donor-specific pancreas transplant within 30 days. The histological alterations in the kidney were more pronounced than after cyclosporine-induced DA kidney long-term survival alone. By contrast to the rejecting subsequently transferred pancreas, a metachronous second DA kidney was permanently accepted (greater than 100 days) without further immunosuppression after removal of the first graft, while unrelated LEW. 1U kidneys were acutely rejected. In summary, the results indicate that there are not only quantitative differences of kidney and pancreas allograft survival but also differences concerning the state of immunological unresponsiveness induced by identical cyclosporine immunosuppression. While CsA induces donor-specific immunological unresponsiveness after kidney transplantation, pancreas transplants are all eventually rejected after some differential prolongation of survival. Further investigations on the effects of different MHC and minor alloantigens may provide more insight into the complex immunological situation of individual and combined kidney and pancreas transplantation.

Animals↗
PubMed1997

Simultaneous pancreas and kidney transplant rejection: separate or synchronous events?

The results of simultaneous pancreas and kidney transplantation (SPK) cannot be matched by pancreas transplantation alone (PTA), in part because an independent diagnosis of pancreas graft rejection remains difficult. The relationship between rejection of the pancreas and rejection of the kidney is poorly understood, and it is not known whether simultaneous transplantation of both organs confers true protection to either graft. To study these questions, reliable canine allotransplant models of kidney transplantation alone (KTA), PTA, and SPK were established. Sixty-seven mongrel dogs received KTA (n=21), PTA (n=23), or SPK (n=23) with either no immunosuppression, low-dose cyclosporine (CsA)-based immunosuppression, or high-dose CsA-based immunosuppression. Needle core biopsy (NCB) and fine needle aspiration biopsy (FNAB) were performed at 0, 2, 4, 7, 9, 11, 14, 21, and 30 days or at the time of graft failure. Pancreas and kidney graft survival after SPK was significantly shorter in dogs given low-dose CsA than in dogs given high-dose CsA (pancreas, P<0.04; kidney, P<0.03). Concurrent NCBs and FNABs were performed on 227 occasions in pancreas grafts and 229 occasions in kidney grafts. The time to initial evidence of rejection by NCB was not different in any immunosuppressed group. Synchronous rejection occurred in 73% of immunosuppressed SPK biopsies. Kidney-only rejection occurred in 23% of biopsies and pancreas-only rejection occurred in only 3% after SPK. All markers of pancreas graft rejection were poor, with the most sensitive being NCB of the simultaneously transplanted kidney. In summary, recipients of SPK required more immunosuppression than recipients of PTA, and improved PTA survival should be achievable with more sensitive markers of rejection. Markers of kidney rejection were the most sensitive indicators of pancreas rejection, and independent pancreas rejection was uncommon after SPK.

Animals↗
PubMed2000

Estimating the benefits of solitary pancreas transplantation in nonuremic patients with type 1 diabetes mellitus: a theoretical analysis.

BACKGROUND: The goal of early pancreas transplantation in type 1 diabetes mellitus is to achieve euglycemia and thereby prevent the renal, retinal, and vascular complications of this disease. The purpose of this analysis was to examine the conditions and assumptions that would make early solitary pancreas a viable therapeutic option. METHODS: A Markov model was constructed to compare outcomes for patients with type 1 diabetes mellitus and early overt nephropathy assigned to either standard insulin therapy or solitary pancreas transplantation. Probabilities for development of end stage renal disease (ESRD), blindness, mortality, and direct health care costs were taken from the literature. Utility scores for the relevant health states were determined by the standard gamble method on 16 type 1 diabetic patients suitable for pancreas transplantation. RESULTS: Assuming a baseline graft life expectancy for the pancreas of 10 years, early pancreas transplantation could provide 0.42 more life years and 2.2 more quality adjusted life years (discounted at 3%) to patients above standard insulin therapy. The model was sensitive to estimates of pancreas graft life expectancy (<8 years being inadequate to extend patient life), timing of pancreas transplantation with respect to rate of progression to ESRD, and drug nephrotoxicity rates. The incremental costs (charges) for early pancreas transplantation over standard therapy were estimated to be modestly high (about $56,600/quality adjusted life year for the baseline case). Pancreas transplant costs were also a very sensitive parameter in the cost utility analysis. CONCLUSIONS: The success of early solitary pancreas transplantation may well be at the stage to consider a trial in selected type 1 diabetic patients at risk for renal and retinal disease.

Costs and Cost Analysis↗
PubMed2001

A bipotential precursor population for pancreas and liver within the embryonic endoderm.

The pancreas emerges independently from dorsal and ventral domains of embryonic gut endoderm. Gene inactivation experiments in mice have identified factors required for dorsal pancreas development, but factors that initiate the ventral pancreas have remained elusive. In this study, we investigated the hypothesis that the emergence of the ventral pancreas is related to the emergence of the liver. We find that the liver and ventral pancreas are specified at the same time and in the same general domain of cells. Using embryo tissue explantation experiments, we find that the default fate of the ventral foregut endoderm is to activate the pancreas gene program. FGF signalling from the cardiac mesoderm diverts this endoderm to express genes for liver instead of those for pancreas. No evidence was found to indicate that the cell type choice for pancreas or liver involves a selection for growth or viability. Cardiac mesoderm or FGF induces the local expression of sonic hedgehog, which in turn is inhibitory to pancreas but not to liver. The bipotential precursor cell population for pancreas and liver in embryonic development and its fate selection by FGF has features that appear to be recapitulated in the adult pancreas and are reflected in the evolution of these organs.

Animals↗
PubMed1989

OKT3 rescue therapy in pancreas-allograft rejection.

OKT3 has emerged as a highly effective antirejection therapy, but its efficacy in pancreas transplantation remains to be determined. During a 26-mo period, 46 vascularized pancreas transplants were performed with pancreaticoduodenocystostomy. Twenty-one patients (45.7%) were treated with OKT3. Indications for OKT3 use included steroid- and/or antilymphoblast globulin-resistant rejection in isolated-pancreas transplant (n = 8) or simultaneous pancreas-kidney-transplant (n = 13) recipients. A total of 46 rejection episodes occurred (mean 2.2). OKT3 was administered for a 14-day course concomitant with pulsed corticosteroids, azathioprine, and cyclosporin. OKT3 rescue therapy was successful in 13 cases (61.9%). The mean time to rejection reversal was 8.8 days (range 5-14 days). In isolated-pancreas transplants, OKT3 reversed only 1 episode of rejection (12.5%). In contrast, 12 episodes (92.3%) of allograft rejection were responsive to OKT3 in simultaneous pancreas-kidney recipients (P less than .05). Graft loss from rejection occurred at a mean 5.5 mo posttransplantation. OKT3 therapy was more successful in the setting of early rejection, rejection in combined pancreas-kidney transplants, and rejection not associated with hyperglycemia. No graft loss due to infection or patient death has occurred after OKT3 therapy. After a mean follow-up of 17.3 mo, patient survival was 89.1%, and allograft survival was 26.3% in isolated-pancreas and 85.2% in simultaneous pancreas-kidney transplants (P less than .05). Salvage therapy with OKT3 is a safe and effective means of reversing rejection in pancreas-allograft recipients. OKT3 is more effective in simultaneous pancreas-kidney recipients due to the earlier diagnosis of rejection.

Adult↗
PubMed1997

Pancreas transplantation restores epinephrine response and symptom recognition during hypoglycemia in patients with long-standing type I diabetes and autonomic neuropathy.

Impaired epinephrine secretion and symptom unawareness are characteristic of severe hypoglycemia in individuals with long-standing type I diabetes. Recently, the avoidance of clinical hypoglycemia has been reported to improve epinephrine and symptom responses to hypoglycemia in type I patients. However, the extent to which these defects can be restored in individuals with long-standing type I diabetes and autonomic neuropathy has not been assessed, nor has it been determined whether pancreas transplantation, which not only obviates hypoglycemia but also prevents hyperglycemia, results in the complete recovery of either epinephrine response or symptom awareness during insulin-induced hypoglycemia. We performed stepped hypoglycemic clamp studies in successful pancreas transplantation recipients to assess epinephrine and other counterregulatory hormone responses during hypoglycemia and to determine the degree to which hypoglycemic symptom recognition could be restored. Thirteen pancreas transplant recipients and matched control subjects were studied utilizing stepped hypoglycemic clamp protocol to achieve target glucose levels of 3.9, 3.3, 2.8, and 2.2 mmol/l (70, 60, 50, and 40 mg/dl, respectively). Plasma epinephrine response was significantly greater in healthy control subjects and pancreas transplant patients compared with type I subjects at the glucose plateaus of 3.9, 3.3, and 2.8 mmol/l. However, epinephrine response in pancreas transplant recipients was significantly less than that seen in either healthy control subjects or nondiabetic kidney transplant recipients at each of these glucose plateaus. The magnitude of the epinephrine response in pancreas transplant type I patients did not correlate with either the duration of diabetes, the duration of transplantation, or the measures of autonomic nerve function. Hypoglycemic symptom recognition was significantly greater in pancreas transplant subjects than type I patients and did not differ between pancreas transplant and control groups. No improvement in norepinephrine response was observed after pancreas transplantation, while glucagon responses to hypoglycemia were normalized in pancreas transplant patients. In conclusion, these studies uniquely demonstrate that successful pancreas transplantation improves epinephrine response and normalizes hypoglycemia symptom recognition in patients with long-standing diabetes and established autonomic neuropathy. No correlation was observed between the severity of autonomic neuropathy or the duration of diabetes and the recovery of either the epinephrine or symptom responses to hypoglycemia.

Adult↗
PubMed1998

[Current status and future of pancreas transplantation].

The results of pancreas transplantation have improved in the ciclosporin A era. Success rates are now similar to those in other types of organ transplantation, and the number of cases has increased concomitantly. As of December 1997, 10,283 pancreas transplantation procedures had been reported to the International Pancreas Transplant Registry. Since 1995, over 1,000 have been reported annually, 75% of which have been performed in the USA. The majority (88%) of those carried out in the USA consist of simultaneous pancreas and kidney (SPK) transplantations, followed by pancreas transplantation after kidney transplantation (10%) and pancreas transplantation alone (PTA) (2%). From 1994 to 1997, the overall one-year patient survival rate was 94%. The graft survival rate for SPK was the highest, with one- and three-year graft survival rates of 82% and nearly 80%, respectively. The administration of FK506 and mycophenolate mofetil has improved the results in patients undergoing pancreas transplantation. Althought the technical failure rate has decreased, graft thrombosis remains the most frequent cause of technical failure (5.5% for SPK with exocrine bladder drainage and 11% for SPK with enteric drainage). The standard surgical procedure has included pancreas-exocrine bladder drainage, but the current trend is to perform physiological enteric drainage. It has been reported that the portal venous and enteric exocrine drainage methods are safe, with outcomes similar to those of the standard technique. It appears that these will become the standard methods in the near future. The primary objective of improved quality of life is achieved in patients with functioning pancreas grafts, and transplantation results in modest reductions in secondary diabetes mellitus complications. However, it must still be confirmed whether the long-term quality-of-life benefits outweigh the potential risks. The secondary objective of pancreas transplantation is to prevent complications of diabetes mellitus. It is necessary to develop methods for the early detection of rejection, which will lead to significant improvements in the results of PTA. Although 15 pancreas transplantation surgeries have been carried out in Japan, they ceased after 1994. Currently, social debate to determine the rules governing such procedures is ongoing.

Humans↗
PubMed2003

[Pancreas transplantation: multislice computed tomography follow-up].

PURPOSE: Solitary pancreas or combined kidney-pancreas transplantation is currently the only therapeutic procedure for complete resolution of diabetes mellitus type I. The aim of the present study is to investigate the role of multislice computed tomography (MSCT) in the follow-up of patients subjected to solitary pancreas or combined kidney-pancreas transplantation. MATERIALS AND METHODS: Sixteen patients who had undergone solitary pancreas (n=8) or combined kidney-pancreas (n=8) transplantation, with systemic-bladder (n=6) or portal-enteric (n=10) pancreatic drainage were evaluated with MSCT (Light Speed Plus, GE Medical System). In solitary pancreas follow-up the MSCT study included arterial and portal phases; in combined kidney-pancreas transplanted patients the urographic phase was included. The acquisition was performed with 1.25 mm collimation, 0.6 mm reconstruction interval and a pitch of 6. An MSCT scan of the thorax was included in patients suspected of having lung complications. RESULTS: In all cases MSCT allowed identification of the surgical technique performed, evaluation of the transplanted pancreas, and assessment of complications, if present. The following major complications were identified: thrombosis or stenosis of the arterial graft, pancreatic infarction, ectasia of the common iliac artery and arterial graft, dehiscence of the duodenocystostomy, infected abdominal collections, pulmonary infections. CONCLUSIONS: MSCT is able to detect complications arising in the transplanted organs and those related to immunosuppressive therapy, and confirms its usefulness in the follow-up of solitary pancreas or combined kidney-pancreas transplanted patients.

Adult↗
PubMed1996

Pancreas transplantation: a treatment option for insulin-dependent diabetes mellitus.

The success with which pancreas transplantation normalizes glucose concentration in patients with Type I diabetes mellitus has made it an important treatment option. Most pancreas transplant operations are performed in combination with a kidney transplant, and neither overall patient survival nor renal graft survival is compromised by the addition of a pancreas graft. Pancreas after kidney transplantation and isolated pancreas transplantation are performed less frequently since the pancreas graft success rate remains lower in these operations compared to combined pancreas-kidney transplantation. Pancreas transplantation improves the quality of life and stabilizes or reverses some diabetic microvascular complications, but its impact on the risk of atherosclerotic vascular disease is still unknown. The relative risks and benefits of pancreas transplantation need to be carefully assessed for each candidate through a thorough screening process, regardless of which type of graft is being considered. However, patient counseling and selection will be greatly aided by further research assessing the long-term risks and benefits of all types of pancreas transplantation. Pancreas transplantation will probably remain an important treatment option for some patients with Type I diabetes mellitus until this disease can either be successfully prevented or alternative treatment strategies are developed that provide equal glycaemic control with less or no associated immunosuppression.

Arteriosclerosis↗
PubMed1998

Patterns of acute rejection in portal-enteric versus systemic-bladder pancreas-kidney transplantation.

Portal-enteric (PE) transplantation of the pancreas allograft provides maintained physiologic drainage, and theoretically the portal delivery of transplantation antigens may have beneficial effects on the graft acceptance leading to improved graft survival. To determine whether the technique of pancreas placement affects the incidence of acute rejection we reviewed our experience in technically successful PE and systemic-bladder (SB) drained simultaneous pancreas and kidney (SPK) transplants performed between 1989 and 1994. Forty-seven recipients were included (SB = 30, PE = 17). All patients received cyclosporine based quadruple immunosuppression and survived at least 1 month. The two groups were comparable in HLA mismatches, cold ischemia time and level of immunosuppression at time of rejection. In the SB group the incidence of rejection was 1.04 kidney rejection/patient and 0.90 pancreas rejection/patient whereas the PE group experienced 0.53 kidney rejection/patient and 0.47 pancreas rejection/patient. The two groups were compared using incidence density statistics due to great variation in follow-up time. The SB group had a significant higher density of both kidney and pancreas rejections (p < or = 0.037 for kidney rejection and 0.058 for pancreas rejection). In addition, while 6 of 30 (20%) pancreas grafts and 4 of 30 (13%) kidney grafts were lost to irreversible rejection in the SB group, only 1 of 17 (6%) pancreas graft and 1 of 17 (6%) kidney graft were lost in the PE group. These data demonstrate, that the PE placement of pancreas allograft affects the rates of acute rejection and graft loss, and imply that there exist some important immunological advantages when the pancreas graft is drained into the portal circulation.

Adult↗
PubMed1988

Significance of 2-3 and 2-6 sialylation of Lewis a antigen in pancreas cancer.

Distributions of sialylated derivatives of Lewis a (Lea) antigen in cancer tissue of the human pancreas and in the sera of patients with pancreas diseases have been studied; the significance of 2-3 and 2-6 sialylation of Lea antigens in pancreas cancer have been investigated using specific monoclonal antibodies. In most pancreas cancer tissue the 2-3 sialylated Lea antigen was found to be specifically distributed in cancer cells as determined by immunohistologic techniques, while a significantly smaller amount of the antigen was detected in surrounding nonmalignant pancreas tissue, which was infiltrated by cancer cells. Conversely, the 2-6 sialylated Lea antigen was abundantly present in nonmalignant pancreas tissue, while it was less frequently present in pancreas cancer cells. When the sera of 66 patients with pancreas diseases were examined for these sialylated Lea antigens, correlation studies showed that the levels of 2-3 sialylated Lea tended to be 44.1 times more than the levels of 2-6 sialylated Lea in the sera of cancer patients. The average ratio of 2-3 sialylated Lea to 2-6 sialylated Lea was 0.23 in the sera of patients with pancreatitis. These data collectively indicate that the 2-3 sialylation of Lea is remarkably enhanced, and the 2-6 sialylation of Lea antigen is suppressed in pancreas cancer. The determination of the 2-3 sialylated Lea to 2-6 sialylated Lea ratio in patients with pancreas diseases may be helpful for the differential diagnosis of pancreas cancer and nonmalignant pancreatic disorders.

Antibodies, Monoclonal↗
PubMed1997

Pancreatic cyst as a sentinel of in situ carcinoma of the pancreas. Report of two cases.

CONCLUSION: We would like to recommend detailed examination of the pancreas including cytology of the pancreatic juice in patients with pancreatic cyst to find possible concomitant early pancreatic carcinoma. Further study is necessary to determine whether there is a rational relationship between mucinous cystadenoma of the pancreas and pancreatic adenocarcinoma. BACKGROUND: Two cases of in situ carcinoma of the pancreas first detected with pancreatic cyst as a diagnostic clue are reported. Cytologic examination of the pancreatic juice was positive for malignancy in both cases, and pancreatic cyst and in situ carcinoma were located independently. METHODS AND RESULTS: Case 1: Ultrasonography (US) and computed tomography (CT) in a 54-yr-old Japanese man with a known gastric cancer revealed a pancreatic cyst. Endoscopic retrograde cholangiopancreatography (ERCP) showed a cyst in the tail of the pancreas, and cytology of the pure pancreatic juice revealed adenocarcinoma. Intraoperatively, the pancreas was cut along the portal vein, and cytology of the pancreatic juice from the pancreas distal to the cutting line showed adenocarcinoma. Resection of the body and tail of the pancreas was performed together with total gastrectomy. Histopathologically, the cyst was mucinous cystadenoma, and the surrounding pancreatic ducts and ductules showed epithelial dysplasia of moderate-to-severe degree having foci of unequivocal in situ carcinoma. No stromal invasion was seen. Case 2: A 55-yr-old Japanese man with known hepatocellular carcinoma was diagnosed as having pancreatic cyst in the tail of the pancreas on US and CT. ERCP showed a pancreatic cyst, and cytology of the pancreatic juice highly suggested adenocarcinoma. Distal pancreatectomy and splenectomy were performed. Histopathologic diagnosis of pancreatic cyst was mucinous cystadenoma. The pancreatic ductule 2 cm proximal to the pancreatic cyst showed carcinoma in situ. The diagnostic clue of in situ carcinoma of the pancreas in these two cases was a cystic lesion of the pancreas detected by check-up US and CT of known carcinoma of the stomach and liver. Cytology of the pancreatic juice was also positive for malignancy. In situ carcinoma of the pancreas was found to be independent of the cysts because of the different locations and divergent histopathologic natures of the two lesions.

Biomarkers↗
PubMed1998

Chronic asymptomatic pseudocyst with sludge aggregates masquerading as mucinous cystic neoplasm of the pancreas.

Pseudocyst of the pancreas is sometimes difficult to distinguish from mucinous cystic neoplasm of the pancreas. A 37-year-old asymptomatic Japanese man was diagnosed with hypertension. He had a 20-years history of habitual drinking of alcohol, but no history of pancreatitis or abdominal trauma. During examinations to ascertain the cause of hypertension, ultrasonography and computed tomography incidentally demonstrated a huge cyst in the head of the pancreas. Laboratory data were within normal limits, including serum levels of amylase, carcinoembryonic antigen, and carbohydrate antigen 19-9. Imaging studies showed a huge unilocular cyst, measuring 7 cm, in the head-to-body of the pancreas, and two small unilocular cysts, measuring 1.4 and 1.5 cm, in the tail and head of the pancreas, respectively. A mural nodule was suspected in the largest cyst. Endoscopic retrograde cholangiopancreatography demonstrated communication of the main pancreatic duct with the two small cysts in the head and tail of the pancreas but not with the huge cyst. There were no ductal changes suggesting chronic pancreatitis. Laparotomy was performed under the tentative diagnosis of potentially malignant mucinous cystic neoplasms of the pancreas. However, inflammatory adhesion was dense around the pancreas and the mural nodule suspected preoperatively was found to be sludge aggregates in a pseudocyst. The diagnosis of an intraoperative frozen section of the cyst wall was pseudocyst of the pancreas. Cystojejunostomy was performed. We report this case because the preoperative diagnosis was mucinous cystic neoplasm of the pancreas, but the diagnosis changed with careful intraoperative examinations, to pseudocyst of the pancreas. We discuss the differential diagnosis of the two conditions.

Adult↗
PubMed1987

Expression of cytoplasmic islet cell antigens by rat pancreas.

A major problem in standardization of the islet cell cytoplasmic antibody (ICA) assay is variation in sensitivity of the different human pancreas substrates used in individual laboratories. To circumvent this problem, we have developed an assay that utilizes Wistar-Furth rat pancreas as substrate, an anti-islet monoclonal antibody (A2B5) to identify islets and fluorescein-conjugated protein A to identify patient autoantibodies. Sera from 85 control subjects, 27 type I diabetics, and 17 subjects at high risk for developing type I diabetes were assayed in parallel with our standard ICA assay on human pancreas substrate and with Wistar-Furth rat pancreas as substrate. Two sera from control subjects (2 of 85) were ICA positive with rat pancreas compared to 1 of 85 with human pancreas substrate. Sera from 11 of 27 type I diabetics and 15 of 17 sera from high-risk subjects were ICA positive with either rat or human pancreas substrate. A correlation between the specific islet fluorescence readings on human and rat pancreas sections was found with sera from high-risk and control subjects. Furthermore, end-point titers of an ICA-positive serum were identical with both assays. Finally, incubation of an ICA-positive serum with glycolipids, extracted from either human or Wistar-Furth rat pancreas, blocked subsequent ICA binding. These findings suggest that Wistar-Furth rat pancreas expresses an identical or similar autoantigen to human pancreas.

Adolescent↗
PubMedDate not supplied

A new method of duodenum-preserving subtotal resection of the head of the pancreas based on the surgical anatomy.

BACKGROUND/AIMS: Duodenum-preserving resection of the head of the pancreas has been performed for benign and, sometimes, malignant diseases of the pancreas. We propose a new procedure of duodenum-preserving subtotal pancreatectomy of the pancreas according to the precise anatomy of the pancreatoduodenal region, especially of the pancreaticoduodenal arteries which provide blood to the duodenum. MATERIAL AND METHODS: After a complete Kocher's maneuver is performed, the pancreas is cut above the portal vein and removed from the third portion of the duodenum, followed by the removal of the posterior surface of the pancreas head from a connective tissue membrane. The main pancreatic duct is identified at its junction with the terminal portion of the bile duct from the posterior surface of the head of the pancreas and is cut at the junction. The pancreas is cut in the line of the ASPD. This line is almost the same as the left side of the common bile duct. The ASPD and the common bile duct should be preserved in this procedure. RESULTS: The reason for leaving part of the pancreas between the duodenum and the anterior superior pancreaticoduodenal artery and the common bile duct is that the artery toward the papilla of Vater runs along the right side of the common bile duct and would be difficult to be preserved with the removal of this part of the pancreas. The most important technique of this procedure is in keeping the connective tissue membrane of the posterior surface of the pancreas intact so as to preserve pancreaticoduodenal arteries and veins, because all the pancreaticoduodenal arteries and veins are situated on this membrane. Complete Kocher's maneuver should cause no problem in this procedure. CONCLUSIONS: Benign lesions as well as low-grade malignancy of the head of the pancreas may possibly be the indication of this procedure.

Adenocarcinoma, Mucinous↗
PubMed1993

Thromboxane and prostacyclin synthesis in experimental pancreas transplantation. Changes in parenchymal and vascular prostanoids.

The principal causes of failure of a pancreas transplant are rejection and vascular thrombosis. There is an unusually high attrition rate for pancreas transplants, but study models have been difficult to develop. In a rat model that allows study of acute rejection to the exclusion of nonspecific effects of transplant surgery on the pancreas, in vitro synthesis of prostacyclin (PGI2) and thromboxane A2 (TXA2) by transplanted pancreas and the blood vessels transplanted with it was measured using an RIA for their stable hydrolysis products 6-keto-prostaglandin F1 alpha and thromboxane B2 (TXB2). TXB2 synthesis was significantly greater in allotransplanted pancreas than isotransplanted pancreas from the 5th day after transplantation. Rejection was complete in the allografted group 7-9 days after transplantation. 6-Keto-prostaglandin F1 alpha synthesis was similar in the pancreas for both allografts and isografts. Similar changes were seen in aorta, celiac artery, superior mesenteric artery, and portal vein transplanted with the pancreas. In the transplanted aorta, TXB2 was significantly greater in the allograft group from the third posttransplant day. A group of CsA-treated allografts sampled after 9 days had transplanted pancreatic parenchymal and vascular prostanoid synthesis in the isograft range. The changes in PGI2 and TXA2 synthesis that accompany cellular rejection may mediate vascular failure in rejecting pancreas transplants, and changes in PGI2 and TXA2 synthesis in blood vessels transplanted with the pancreas could promote early vascular thrombosis.

6-Ketoprostaglandin F1 alpha↗