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PubMed1985

[Experimental studies on regeneration of the pancreas--morphological and functional restoration of the remnant pancreas after major pancreatectomy].

In order to elucidate a regeneration of the pancreas, morphological and functional changes after major pancreatic resection were sequentially investigated in dogs. Within the first week after major pancreatectomy, the acinar cell division occurred, followed by hypertrophy resulting in an increase of the weight of the remnant pancreas. The regeneration rate correlated with the resection rate, glucose tolerance test, and insulin secretion of the remnant pancreas. Immediately after resection of more than 92% of the pancreas, severe diabetes and diarrhea developed. The regeneration rate was 29.9 +/- 6.03% (mean +/- SD) three to six weeks after surgery, without any recovery of the exocrine function. After twelve weeks following resection of 74 to 92% of the pancreas, so-called Sandmeyer's diabetes developed. The regeneration rate was 45.3 +/- 4.22% in the nondiabetic group, accompanied with a good recovery of the exocrine function, but in the diabetic group it revealed regeneration rate of 15.4 +/- 2.39% with less recovery of the exocrine function. When less than 74% of the pancreas was resected, no significant changes were observed in both morphological and functional studies in the remnant pancreas with regeneration rate of 5.5 +/- 6.62%.

Amylases↗
PubMed1989

[Oncological bases and limits in the indications for total pancreatectomy in the treatment of pancreatic ductal cancer. Retrospective evaluation through a review of the literature].

Nowadays, pancreatic ductal cancer shows an increasing incidence, either absolute or relative, moreover in economically advanced countries: it needs a very early diagnosis and a surgical strategy both aimed to project a cure, also if at the price of a generally high operative mortality. The selection of the right operation must be deduced from a careful analysis of results of collective reviews of more numerically wide and pathologically definite cases. It is necessary above all to consider operative mortality, morbidity and late survival, both for conservative and resectional surgery (Whipple, TP), and confront it with the natural history of this cancer. The late survival is not yet satisfactory. Therefore revisiting and rationalizing the oncologic basis and the surgical issues of this deadly tumor, total pancreatectomy assumes an imposing meaning, provided the diagnosis is early, and the pre- and intra-operative staging is precise. In such a way it is possible to obtain a reasonable percentage of better immediate and late results.

Humans↗
PubMed1989

Pylorus-preserving total pancreatectomy and segmental pancreas autotransplantation.

12 patients affected by periampullary neoplasms underwent surgery consisting of modified pylorus-preserving total pancreatectomy. In 8 of these patients, a segmental pancreas autotransplantation was performed by anastomosing the splenic to the femoral vessels in the Scarpa's triangle. The pancreas was treated by irradiation to inhibit the exocrine function. Gastric emptying was studied in 9 survivors by upper gastrointestinal barium series. In 6 patients gastric emptying and pyloric function were also evaluated by radionuclide studies. In 3 patients the transplanted pancreas had to be removed within the second postoperative week because of graft thrombosis, infection or hemorrhage. In a mean follow-up of 16 months (range: 6-20 months) the remaining 5 transplants showed a good endocrine activity until the beginning of antiblastic treatment for hepatic metastasis (3 cases), pancreatic fibrosis (1 case) or the patient's death (2 case). At present no graft is still functioning.

Adult↗
PubMed1978

Treatment of hyperinsulinism after partial pancreatectomy: medical or surgical?

A 21 year old male patient with hypoglycemia secondary to hyperinsulinism had no palpable adenoma at surgery, and failed to respond to a partial (75%) pancreatectomy. Subsequently, he was begun on oral Diazoxide. Soon after initiation of Diazoxide he developed a viral pneumonitis, and because of hyperglycemia, the Diazoxide was temporarily discontinued. He has been treated since June of 1975 with Diazoxide, 100 mg, three times daily. He is asymptomatic, completely rehabilitated, and physically active at work for 10 hours daily. Diazoxide therapy may be an option worth considering even in benign states of hyperinsulinism when surgery has failed to correct the process.

Adult↗
PubMed1988

[Pancreatic fistula after left pancreatectomy. Frequency and severity].

In order to study the frequency and complications related to pancreatic fistula following distal pancreatectomy we have reviewed 19 patients operated on between January 1st 1981 and February 28 1986. There was no mortality but the incidence of pancreatic fistula was 52%. 40% of these cases developed a subphrenic abscess (21% of the total number of cases). These fistulas closed after an average post-operative period of 42 days. Reoperation for an infected collection was required in 4 cases. The incidence of pancreatic fistula was not related to the initial pancreatic pathology. Splenectomy did not influence the incidence of subphrenic abscess. Different techniques of closure of the distal pancreas after resection have not changed the incidence of this complication. The use of somatostatin appears to favourably influence the course of the fistula. These conclusions tend to confirm the results of other reported series.

Adolescent↗
PubMed1989

Is proximal pancreatoduodenectomy with pyloric preservation superior to total pancreatectomy?

The records of all patients who underwent pylorus-preserving pancreatic resection (29 subtotal and 4 total pancreatectomies) during a 10-year period at the Mayo Clinic were reviewed. Thirty-day operative mortality was 6%. Early postoperative morbidity occurred in 45% of patients and necessitated reoperation in four patients. One patient had a hemorrhage from a marginal ulcer in the early postoperative period. The incidence of late postoperative morbidity was 18%. Marginal ulcers developed in the late postoperative period in three additional patients, for an overall incidence of 13%. One patient underwent vagotomy and pyloroplasty because of intractable bleeding 2 years after initial operation. The 29 patients who underwent pylorus-preserving pancreatoduodenectomy (PPW) were compared (retrospectively) with 200 patients who had undergone standard pancreatoduodenectomy (Whipple operation) during the same 10-year period. The overall incidences of marginal ulcer were 10% in the PPW group and 5% in the Whipple group; the incidences of delayed gastric emptying were similar in these groups. We believe that caution is warranted in the use of PPW, as yet an unproved procedure.

Adult↗
PubMed1988

[Clinical and experimental study on reconstruction after pancreatectomy--Part I. Cholangitis and its relationship to reconstruction].

The purpose of the present study is to clarify pathogenesis of cholangitis after pancreatectomy. The clinical study consisted of follow-up survey and hepatobiliary scintigraphy for the patients with type-I reconstruction (e.g. Imanaga procedure) and type-II reconstruction (e.g. Child procedure) after pancreatoduodenectomy. The experimental study was performed in dogs by creating three types of biliary reconstruction, namely, cholecystoduodenostomy (C-D), cholecystojejunostomy (C-J) and Roux-Y cholecystojejunostomy (R-Y). In the follow-up survey, cholangitis occurred in 19.0% of 21 type-I patients and in 33.3% of 18 type-II patients. In the hepatobiliary scintigraphy, type-I demonstrated smooth transit of bile along the reestablishing intestine. Type-II, on the other hand, showed marked stagnation of bile in the excluded loop, which could even trigger cholangitis. The experimental study showed that the results obtained from R-Y were no better than those obtained from C-D and C-J with respect to prevention of cholangitis based on histological, biochemical and bacteriological point of view. These studies suggest that type-I reconstruction carries little risk of causing cholangitis, whereas type-II reconstruction is not effective in preventing cholangitis.

Anastomosis, Roux-en-Y↗
PubMed1987

The effects of pancreatectomy on the plasma concentrations of insulin-like growth factors 1 and 2 in the sheep fetus.

The effects of hypoinsulinaemia and altered metabolite concentrations on the fetal plasma concentrations of insulin-like growth factors (IGF) have been investigated in chronically catheterized fetal sheep made insulin deficient by pancreatic ablation. Fetal pancreatectomy reduced significantly the plasma IGF-1 concentration and increased plasma IGF-2 activity in comparison with the values observed in sham operated fetuses. Mean plasma IGF-1 concentrations in the sham operated and pancreatectomized fetuses were 18.6 +/- 3.1 ng/ml (n = 7) and 13.4 +/- 1.4 ng/ml (n = 13) respectively. When all the data were combined, there was a significant positive correlation between the plasma concentrations of IGF-1 and insulin in utero. The mean IGF-2 activity was 2349 +/- 83 ng/ml (n = 7) in the sham operated fetuses and 3800 +/- 532 ng/ml in the pancreatectomized animals (n = 13). Plasma IGF-2 activity was correlated positively with plasma glucose, fructose and alpha-amino nitrogen levels and inversely related to the plasma insulin concentration in utero. These observations demonstrate that the fetal pancreas is essential for normal IGF production in the fetus and suggest that insulin, substrate availability and the IGFs may interact in the regulation of fetal growth.

Animals↗
PubMed1987

Liver trophism in dogs made diabetic by total pancreatectomy or alloxan administration.

1. In order to evaluate hepatic trophism in diabetic dogs, an experimental study was carried out on 30 adult mongrel dogs of both sexes weighing 11.9 +/- 1.6 kg, divided into three groups: 1) Controls (C) (N = 10), submitted to partial (30%) hepatectomy; 2) PD Animals (N = 10), submitted to partial hepatectomy plus total pancreatectomy with preservation of the duodenum during the same surgical intervention; 3) and AD Animals (N = 10), submitted to partial and simultaneously made diabetic with alloxan. 2. The animals were submitted to an oral glucose tolerance test (OGTT) one day before and on the 7th day after partial hepatectomy to evaluate the severity of diabetes. During the post-hepatectomy period the fasting glycemia values were similar for both diabetic groups (greater than 200 mg%). During OGTT, blood glucose levels of the diabetic groups peaked at 60 min but were significantly higher for the AD than for the PD group. The difference persisted at 120 and 180 min, but was no longer statistically significant. 3. Liver trophism was evaluated by measuring liver RNA content and the nuclear volume of hepatocytes. Both diabetic groups showed significantly lower RNA contents and absence of nuclear hypertrophy compared to partially hepatectomized controls probably because of the severe diabetes induced in these animals.

Alloxan↗
PubMed1985

Total pancreatectomy for chronic pancreatitis.

Ten instances of total pancreatectomy performed for chronic alcohol induced pancreatitis are reported. There was no hospital mortality, and all of the patients were free of pain. The most difficult problem was labile insulin sensitive diabetes in these patients who were chronic alcoholics. In addition, steatorrhea with weight loss, bleeding marginal ulcers and general weakness diminished working ability. The present data suggest that this procedure should be considered as the last resort in the treatment of severe instances of chronic pancreatitis.

Adult↗
PubMed1985

[Effect of simultaneous partial pancreatectomy on liver regeneration in domestic chickens].

Simultaneous partial pancreatectomy does not change the fundamental mechanisms of reparative regeneration of the chick liver, taking the course of regeneration hypertrophy. Nevertheless it introduces some temporary and quantitative alterations into this process. Later on the connective tissue is formed on the wound surface and infiltration of the resected organ lobe with eosinophilic leukocytes takes place. The wound healing and scar formation are slightly retarded, with the processes of hypertrophy and hyperplasia of the cells being more significant. These events govern more continuous and more intense processes of the regeneration of epithelial structures and the growth of the secretory tubes. The liver weight completely returns to normal toward the end of experiment. Stereological analysis of the regenerating organ shows that this happens largely due to the regeneration growth of the glandular parenchyma because of the activation of proliferative processes and cell hypertrophy.

Animals↗
PubMed1985

Glycemic control and serum lipoproteins after total pancreatectomy.

Carbohydrate and lipid metabolism were studied in 10 patients who had undergone total pancreatectomy. The results were compared with Type I diabetic patients and normal subjects, all of whom were matched for age, sex and weight. At the same level of glycemic control, the daily need for insulin was significantly lower in the patients with pancreatogenic diabetes than in those with Type I diabetes. Concentrations of serum total VLDL and HDL triglyceride were higher in the pancreatectomized patients than in the diabetic or normal controls, whereas concentrations of serum total and LDL cholesterol were significantly lower. The composition of the VLDL, LDL and HDL particles was abnormal in the totally pancreatectomized patients as all three lipoprotein fractions were enriched in triglyceride. HDL2 cholesterol was similar in the totally pancreatectomized patients to that in the other two groups but HDL3 cholesterol was lower. Postheparin plasma lipoprotein lipase and hepatic lipase activities were normal. It is concluded that in totally pancreatectomized patients the changes in the lipoprotein profile on reflect more the action of various confounding factors, i.e. malabsorption, continuance of alcohol abuse and dietary changes than the impact of the diabetes itself.

Adult↗
PubMed1979

Immunoreactive secretin release in patients after duodenectomy and partial or total pancreatectomy.

Seven patients were investigated 8--22 months after duodenectomy and pancreatectomy for chronic pancreatitis or cancer. Seven other patients, admitted for minor surgery, served as controls. 40 ml 100 mmol/l HCl was infused over 5 min into the jejunum 10 cm beyond the gastrojejunal stoma in the duodenectomized patients and 10 cm beyond the pylorus in the controls. Plasma immunoreactive secretin (IRS) increased from 3.0 +/- 0.8 pmol/l (mean +/- S.E.M.) to 9.8 +/- 0.5 pmol/l (p less than 0.01) in the duodenectomized patients. In the controls the increase was significantly higher than in the patients (p less than 0.01)--from 1.5 +/- 0.3 pmol/l to 19.5 +/- 3.3 pmol/l (p less than 0.01). The study shows that the jejunum is able to release IRS after acid infusion in duodenectomized patients.

Adult↗
PubMed1979

[X-ray diagnosis and the clinical aspects after pancreatectomy].

11 patients (three women) were examined 7 month to 12 years after total pancreatectomy. There were found differences of--34% to +23% between bodyweight and ideaweight. Three patients with a bodyweight less than 75% of the idealweight died, steatorrhea (8--19 g/die), bloodsugar oscillation in the 24 h-profile (40--820 mg%) and an intrinsic-factor-non-responsive vitamin B12-malabsorption without megaloblastic anemia. The roentgenexamination permitted a classification of the upper gastrointestinaltract in a type similar to B II or B I resection and a type with Y- Roux anastomosis for bilarydrainage.

Adenocarcinoma↗
PubMed1977

[Serum gastrins after duodeno-pancreatectomy].

6 patients who have had a duodeno-pancreatectomy were starved and then given a test meal, to stimulate the serumgastrin which was measured by RIA. The fasting gastrin values were, by all the patients, in the lower range of the normal level (25-50 pg/ml). The stimulation with the meat-extract (25 g with 400 ml of water) did not lead to any significant raising of the fasting serum gastrin.

Adult↗
PubMed1982

Low dose streptozotocin diabetes after partial pancreatectomy in dogs. Histological findings in a new type of experimental diabetes.

Permanent diabetes was produced in 16 out of 55 dogs by partial pancreatectomy (77% of the calculated organ weight) and simultaneous infusion of 2 mg/kg streptozotocin into the superior pancreaticoduodenal artery. The animals exhibited hyperglycemia, absolute lack of endogenous B-cell function, and ketosis, but no exocrine pancreatic insufficiency. 21 animals needed up to 7 additional subsequent intravenous streptozotocin injections (15 mg/kg each at intervals of 3 days). In 18 animals the procedure failed to render them diabetic; they died mainly from toxic effects of the drug. There were severe pathohistological changes in all streptozotocin-treated animals. Besides the well known alterations of the islets of Langerhans, lymphocytic inflammations were found in numerous organs including the exocrine pancreas. In most cases they were combined with degenerative changes of the organ parenchyma, particularly in kidney and liver. These findings were not correlated to the sex of the animals, to the occurrence and severity if diabetes, to the time of survival, or to the streptozotocin dose applied. But they were obviously related to the clinical picture existing besides diabetes. It is concluded that the model of experimental diabetes presented might be useful in a carnivorous big animal species but that toxic streptozotocin effects are to be expected when the dose administered exceeds 2 mg/kg.

Animals↗
PubMedDate not supplied

[Subtotal pancreatectomy as treatment of acute hypoglycemia of the newborn].

The most frequent causes of hypoglycemia in the newborn are reviewed and the pertinent diagnosis procedures in order to establish its etiology are discussed apropose of a case of nesidioblastosis. Physiological considerations are made around the pancreatic insulin response to two stimuli: I.V. glucose and glucagon, used in the present case. The indication of subtotal pancreatectomy in the cases of severe hypoglycemia is re-examined.

Acute Disease↗