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PubMed1987

Quantitative immunocytochemical analysis of the endocrine pancreas of the Nile crocodile.

Four major pancreatic hormones were immunolocalized at the light and electron microscopic levels in the pancreas of the Nile crocodile, Crocodilus niloticus. Immunogold was used for electron microscopy, and peroxidase-antiperoxidase was used for light microscopy. Somatostatin-positive D-cells and pancreatic polypeptide-containing F-cells accounted for about 60% of the immunoreactive cells in the ventral pancreas. Glucagon-positive A-cells were the least frequent cell type in the ventral pancreas, about 15%, but were the predominant cell type, about 40%, in the pancreas that was dorsal in character. An expanded population of D-cells (relative to mammals and other higher vertebrates) in association with two very different numbers of A-cells can be expected to have important consequences for the homotropic control of secretory activity of the endocrine pancreas as well as for the function of the acinar pancreas. F-cells were absent from the dorsal part of the pancreas, whereas insulin-containing B-cells were slightly more abundant in this portion of the pancreas. The regional character of the endocrine pancreas was related to the complex looping of the proximal small intestine. Without immunolabeling, only B-granules were morphognomonic in electron micrographs. The insulin-reactive B-granules were the smallest (370 nm) of the secretory granules and were followed in size by somatostatin-positive D-granules (380 nm). The pancreatic polypeptide-containing secretory granules were the largest (580 nm). Glucagon-reactive A-granules (430 nm) sometimes exhibited a protuberance or extension of secretory granule matrix and limiting membrane. Such a morphological feature has previously been associated with secretion of glucagon and the initiation of insulin secretion. Taken together these studies indicate that protuberances have a significant, but as yet undefined, role in pancreatic endocrine cells.

Alligators and Crocodiles↗

PubMed2003

[Laparoscopic segmental pancreas resection and pancreatic cystadenoma].

Aside from location, the complex anatomic relationships and advanced laparoscopic skills needed in selected cases of laparoscopic pancreas surgery have increased. We report a 55-year-old woman with cystic adenoma in the area of the corpus who was treated with complete laparoscopic corpus resection while preserving the head and tail of the pancreas and the spleen. The patient was placed in lithotomy position. Four trocars were placed. After opening the bursa, the pancreas showed a 6x6x6-cm, well-bordered, cystic tumor in the corpus. Tail and head of the pancreas were free of tumor and seemed inconspicuous. After exploration of the v. porte and v. lienalis, the healthy tissue in the head area of the pancreas was divided with the linear stapler. Preparation continued in the direction of the pancreatic tail while preserving the v. lienalis. After reaching the healthy pancreas in the tail region, the tumorous segment was resected. The resected pancreas segment was placed in an endobag until removal over a slightly widened trocar incision above the symphysis. The tail segment was anastomized in situ end-to- side with the first jejunum loop behind the Treitz's ligament. There was no postoperative complication, and the postoperative course was observed. The patient returned to normal activity within 10 days after operation. Retaining high surgical standards and preserving the healthy pancreas tissue and laparoscopic anastomosis, laparoscopic surgery in cases of benign tumors of the distal pancreas is possible with all the patient benefits of minimally invasive surgery.

Anastomosis, Surgical↗

PubMed1984

Preganglionic innervation of the pancreas islet cells in the rat.

The position and number of preganglionic somata innervating the insulin-secreting beta-cells of the endocrine pancreas were investigated in Wistar rats. This question was approached by comparing the innervation of the pancreas of normal rats with the innervation of the pancreas in alloxan-induced diabetic animals. The presumption was made that alloxan treatment destroys the beta-cells of the islet of Langerhans and results in a selective degeneration of the beta-cells innervation. Cell bodies of preganglionic fibers innervating the pancreas were identified by retrograde transport of horseradish peroxidase following pancreas injections. It was found that 25% of the cells innervating the pancreas in the left dorsal vagal motor nucleus, 50% of the cells in the ambiguous nucleus and 50% of the cells innervating the pancreas, that originate in segments C3-C4 of the spinal cord, fail to become labeled after alloxan treatment. The position and distribution of these cell groups are described in detail and are assumed to be involved in preganglionic beta-cell innervation. A second cell population in the ventral horn and intermediolateral column of the segments T3-L2 of the cord also was labeled in normal rats and was not affected by the alloxan treatment. These thoracic cell groups are thus considered as sympathetic preganglionic somata that maintain direct connections to the pancreas. Additional preliminary information is presented dealing with the general aspects of sympathetic and parasympathetic organization of the pancreas innervation.

Acetylcholinesterase↗

PubMed2004

Zebrafish mnx genes in endocrine and exocrine pancreas formation.

The pancreas consists of two components, which exert distinct homeostatic function, an endocrine part that secretes hormones including insulin and an exocrine part that produces digestive enzymes. In mouse, one of the factors essential for development of the pancreas is the Mnx-class homeobox transcription factor Hb9. Genetic studies showed that Hb9 is required for both initial morphogenesis of the pancreas as well as subsequent differentiation of insulin-producing beta-cells [Nat. Genet. 23 (1999) 71; Nat. Genet. 23 (1999) 67]. To get a better understanding of what role mnx genes play in pancreas development, we isolated and characterized mnx genes in the model organism zebrafish. We found one gene with homology to hb9 orthologs and two that display homology to the related chicken mnr2. Embryonic expression of the zebrafish mnx genes is very dynamic and is detected in derivatives of all three germ layers. Endodermal expression of hb9 takes place in the early gut endoderm and, later, in the endocrine pancreas and the swim bladder. In addition, one of the mnr2 genes, mnr2a, shows expression in an endodermal cell population that is initially intermingled with insulin-positive cells and that later becomes restricted to the exocrine pancreas. In knockdown studies using antisense morpholinos, we show that hb9 is essential for differentiation of the insulin-producing beta-cells but unlike mouse Hb9 is not needed for early morphogenesis of the pancreas. In contrast, mnr2a is required during late morphogenesis of the exocrine pancreas. In summary, our data suggest a tissue-specific mnx-expression code in the zebrafish pancreas and they reveal a novel role of an mnr2-related gene.

Air Sacs↗

PubMed1998

Pleomorphic carcinoma of the pancreas: reappraisal of surgical resection.

Pleomorphic carcinoma is a rare variant of pancreatic exocrine carcinoma. The aim of this communication is to reappraise surgical resection of pleomorphic carcinoma of the pancreas. Clinicopathological findings of four Japanese patients with pleomorphic carcinoma of the pancreas were reviewed and compared with those of 24 Japanese patients with adenocarcinoma of the pancreas to clarify possible surgical implications of pleomorphic carcinoma. Of the four patients, three were female and one male, aged 64, 65, 66, and 74 yr, respectively. Two carcinomas were located in the head of the pancreas, one in the body, and the other in the tail. Ultrasonography demonstrated a well defined hypoechoic mass measuring 5-10 cm, with central necrotic area in all of the patients. Computed tomography showed a low density tumor with sharp margin and heterogeneous internal structure in all. On angiography, three tumors were hypervascular and another was hypovascular. Extensive vascular encasement was observed in all. Pancreatoduodenectomy was done in two patients and distal pancreatectomy in the other two. Multiple liver metastases occurred 1 month after surgical resection in two patients and local recurrence 1 month in one and 2 months in the other, leading to death either 2 (2 patients) or 3 months (2 patients) after pancreatectomy. Significantly differentiating features of the four pleomorphic carcinomas of the pancreas and the 24 adenocarcinomas of the pancreas were the mean diameter (6.6 +/- 1.3 cm vs 3.5 +/- 0.3 cm, p = 0.0007), margin of the tumor (expansive in the four pleomorphic carcinomas versus infiltrative in 21 of the 24 adenocarcinomas, p = 0.003) and vascularity on angiography (hypervascular in three of the four pleomorphic carcinomas versus hypovascular in 21 of the 23 adenocarcinomas, p = 0.013). The 1-yr and 3-yr survival rates of the four patients with pleomorphic carcinoma were 0% and 0%, whereas those of the 24 patients with adenocarcinoma of the pancreas were 42% and 13%, respectively (p < 0.0001). These findings suggest that the clinical course of patients with pleomorphic carcinoma of the pancreas is so poor even after surgical resection that pleomorphic carcinoma of the pancreas is not a candidate for pancreatectomy despite its locally expansive growth.

Adenocarcinoma↗

PubMed2002

Radical resection of gastric carcinoma with pancreas and spleen preservation and functional cleaning of lymph nodes.

OBJECTIVE: To study the clinical value of radical resection of gastric carcinoma with pancreas and spleen preservation (PSP) and functional cleaning of lymph nodes (LNs) of the spleen hillus and along the splenic artery. METHODS: Pancreas and spleen involvement was retrospectively reviewed among 439 cases of resectable carcinoma of the gastric cardia, gastric corpus and total stomach. During gastric surgery, 2 ml of methylene blue was injected into the subserosal space of the gastric cardia or corpus to observe the spread of lymphatic flow in 54 cases of gastric carcinoma. The metastatic rate of LNs in splenic hillus and along the trunk of the splenic artery (No10, No11), postoperative complications and survival rates were investigated in 63 gastric carcinoma patients that had received gastrectomy with pancreas and spleen preservation (PSP). These were compared with the pancreas preservation (PP) group and pancreas and spleen combined resection (PSR) group. RESULTS: Among these 439 cases, only 25 cases were observed with direct invasion to the pancreas (5.7%), and 10 cases with direct invasion to the spleen (2.3%). After pathological examination of the pancreatic body and tail, we found 22 cases with pancreas and spleen combined resection, 4 cases (18.2%, 4/22) with direct invasion of the capsule and 2 with invasion to the superficial parenchyma (9.1%, 2/22), without metastasis to the lymph nodes within the pancreas and spleen. The metastatic rate of No10, No11 lymph nodes were 17.5% (11/63) and 19.1% (12/63) in the PSP group, 20.8% (45/216) and 25% (54/216) in the PP group, and 20% (6/30) and 23.3% (7/30) in the PSR group. There were no statistically significant differences (P > 0.05). Injection of methylene blue into the subserosal space of the stomach did not diffuse into the spleen or pancreatic parenchyma. Postoperative complications, diabetes and mortality in PSP (0%, 0%, 0%) were lower than in PP (4.2%, 0.9%, 0.9%) or PSR (40%, 10%, 3.3%). The 5-year survival rate (5-YSR) and 10-YSR in PSP (57.5%, 52.0%) were higher than in PSR (37.5%, 30.0%). Those patients with stage II and III(a) treated by PSP, improved markedly. CONCLUSIONS: The surgical procedure of pancreas and spleen preservation for gastric cancer is a safe and organ function protected method. Postoperative complications were lower and survival rates were higher, the radicality was not reduced. These results indicate that PSP is preferred in patients with gastric carcinoma of stage II or III(a).

Adult↗

PubMed2004

[A case of patient with insulinoma of the pancreas anl infammatory tumor of the sigmoid colon-one-step operation treatment].

The paper presents the case of a 61 year-old man on with a rare disease--insulinoma of the pancreas. The tumor was discovered accidentally and it displayed no hormonal symptoms. The abdominal pain that the patient had suffered from was probably caused by the inflammatory tumor localized in the sigmoid as the result of diverticulitis. As the patient had no defecation problems, concentration was placed preoperatively on pancreas tumor diagnosis. During the operation the pancreas tumor as well as the sigmoid tumor were resected. Implantation of the whole profile of pancreas tail to the stomach was performed. This method permits for further diagnostics (gastroscopy, ERCP). The man had no diabetes, the blood glucose level was normal. The alimentary tract from the stomach to the duodenum was kept and the pancreas secretory function was acceptable. Colonoscopy in 2002 did not show any pathological changes. One month after the operation the patient suffered from pancreatitis which was localized in the head of the pancreas. Medical treatment relieved all symptoms, but then the cyst in the pancreas head appeared as a sequela. The patient would not agree to its puncture. The inflammatory process in the head of the pancreas may have resulted from surgical treatment, although ERCP showed no passage obstruction between this part of the pancreas and the duodenum. The patient is still on follow-up.

Diverticulitis↗

PubMed1992

Overexpression of cholecystokinin receptors in azaserine-induced neoplasms of the rat pancreas.

Cholecystokinin (CCK) is a growth factor for normal pancreas. Numerous studies also suggest that CCK promotes pancreatic carcinogenesis in the rat. Our previous studies suggested that growth of preneoplastic pancreatic foci was stimulated by CCK more than that of normal pancreas. We hypothesized that such differential growth might be due to increased numbers of CCK receptors in neoplastic tissue. Azaserine-induced pancreatic carcinoma (DSL6) had an increased high-affinity CCK receptor binding capacity of 122 +/- 23 (SD) fmol/mg protein compared to 12 +/- 2 fmol/mg protein in normal pancreas (P less than 0.001). The Kd of the high-affinity site was 0.33 +/- 0.04 nM for carcinoma and 0.46 +/- 0.08 nM for normal pancreas (P less than 0.01). The amount of cholecystokinin octapeptide (CCK-8) bound to high-affinity receptor was 8.6 +/- 1.9 fmol/mg protein for DSL6 compared to 0.6 +/- 0.2 fmol/mg protein in normal pancreas (P less than 0.001). Azaserine-induced premalignant nodules were compared to remaining internodular pancreas. Nodules demonstrated a mean high-affinity CCK receptor binding capacity of 38 +/- 9 fmol/mg protein compared to 6 +/- 3 fmol/mg protein in internodular pancreas (P less than 0.001). The amount of CCK-8 bound to high-affinity receptor was 3.1 +/- 0.8 fmol/mg protein in nodules compared to 0.6 +/- 0.3 fmol/mg protein in internodular pancreas (P less than 0.001). Overexpression of high-affinity CCK-8 receptor in premalignant and malignant azaserine-induced tumors may result in a growth advantage relative to normal pancreas.

Animals↗

PubMed1975

Morphological patterns of primary nonendocrine human pancreas carcinoma.

The study of histological sections of 406 cases of nonendocrine pancreas carcinoma at Memorial Hospital indicated that morphological patterns of pancreas carcinoma could be delineated as follows: duct cell adenocarcinoma (76%), giant-cell carcinoma (5%), microadenocarcinoma (4%), adenosquamous cancinoma (4%), mucinous adenocarcinoma (2%), anaplastic carcinoma (2%), cystadenocarcinoma (1%), acinar cell carcinoma (1%), carcinoma in childhood (under 1%), unclassified (7%). In 195 cases of patients with pancreas carcinoma, search was made for changes in the pancreas duct epithelium and these were compared to duct epithelium in a control group of 100 pancreases from autopsies of patients with nonpancreatic cancer. The following incidences were found for pancreas cancer and nonpancreatic cancer, respectively: mucous cell hypertrophy, 39 versus 28%; pyloric gland metaplasia, 28 and 17%; epidermoid metaplasia, 6 and 12%; papillary hyperplasia, 42 and 12%; atypical duct hyperplasia, 14% and none; cancinoma in situ in 19% and none in the control group. Mucin in the majority of pancreas cancers suggested that the cell type of origin of the common pancreas cancer is the mucin-producing duct epithelium. The association of atypias and carcinomas in situ in the patients with pancreas carcinoma implies, by analogy to other organs, that there may be a significant latent period between the appearance of carcinoma in situ and the grossly recognizable pancreas cancer.

Adenocarcinoma↗

PubMed1990

Human pancreas scintigraphy using iodine-123-labeled HIPDM and SPECT.

The pancreatic affinity of iodine-123-labeled HIPDM (N,N,N'-trimethyl-N'-(2-hydroxy-3-methyl-5-iodobenzyl)-1,3-propane diamine) ([123I]HIPDM) was studied in 18 cases (5 normal volunteers, 7 cases with pancreas cancer, and 6 with chronic pancreatitis). In the normal cases, the pancreas was visualized in the planar images as early as 3 hr, and again at 20 hr postinjection. Single-photon emission computed tomography (SPECT) performed following 3-hr planar scintigraphy, provided excellent pancreas images without an overlap of activity in the liver or spleen. The mean pancreas-to-liver (P/L) ratio was 1.26 +/- 0.22 in normal controls. With the exception of one case of massive calcification in the pancreas, the entire pancreas could be observed in the cases with chronic pancreatitis, but the P/L ratio was 0.74 +/- 0.15, significantly lower than that of normal cases. Defective areas of the distal portion of the pancreas were clearly seen in those with cancer of the pancreas. The results of our study indicate that [123I] HIPDM may have clinical potential as a human pancreas imaging agent.

Adult↗

PubMed1989

[Urinary tract involvement from pancreas carcinoma].

Pancreas carcinoma is sometimes notoriously difficult to diagnosis. It is well known that pancreas carcinoma can invade contiguous organs, but no attention for urinary tract involvement is paid. Urinary tract is involved at a late stage but may represent the first symptomatic evidence of disease. In such case, pancreas carcinoma can be presented initially as urologic disease and patients' symptom may not be differentiated from urinary tract disease. Computed tomographic (CT) images and medical records of 50 patients with histologically proved pancreas carcinoma were reviewed. There were 10 cases with urinary tract involvement. Those of 8 were male and 2 were female. There was a high incidence of left urinary tract involvement (left:right:bilateral = 7:2:1). Although 9 cases were pancreas body and tail carcinoma, 1 case was pancreas head carcinoma. And those stages were all in IV. All cases have confirmed evidence of urinary tract involvement at autopsy within 4 months following CT studies. IVP study was performed in 8 of these cases. We compared those IVP, CT images and findings of autopsy. In those patients, 4 cases showed direct invasion of the kidney, 5 cases showed ureteral involvement and 1 case showed metastasis to the urinary bladder and ureters. IVP showed inferior displacement of the kidney and/or ureteral displacement on the affected side. And also, collecting system distortion was demonstrated, including hydronephrosis secondary to ureteral compression. CT scan showed abnormal mass which is contiguous to the pancreas, showing compression the kidney and/or retroperitoneal extension with ureteral involvement. Metastasis to the urinary bladder is also identified. The findings of autopsy were almost the same of the CT findings. Pancreas carcinoma characteristically remains silent until little chance for cure. Although urinary tract involvement is rare, it can mimic renal and ureteral pathology. In differential diagnosis of urinary tract lesion, the disease process originated from pancreas should be included as well as from contiguous structures.

Aged↗

PubMed1993

[Cystic tumors and endocrine tumor of the pancreas. An unusual association].

Cystadenomas and cystadenocarcinomas are the most common cystic tumors of the pancreas. Their inner lining contains neuroendocrine cells that may, in rare cases, produce a systemic syndrome. Similarly, digestive or pancreatic endocrine tumors have been reported in association with cystic tumors of the pancreas. We report a case of cystadenocarcinoma of the pancreas head, associated with a serous cystadenoma and an endocrine tumor of the body of the pancreas. In a 70 year old patient, jaundiced due to obstruction of the extra-hepatic bile ducts, the abdominal ultrasound and CT scan showed a hypoechogenic hypodense lesion of the pancreas head resulting in an enlargement of the common bile duct and pancreatic duct. Echoendoscopy confirmed the diagnosis and gave additional information; it showed that the cephalic lesion was heterogeneous, with anechogene spaces separated by coarse echogenic septae associated to a solid contingent. Also detected by echoendoscopy was a cystic lesion containing thin septae and a contiguous hypoechogenic nodule of the body of the pancreas. Histology of the specimen following total pancreatectomy revealed a cephalic cystadenocarcinoma associated with a serous cystadenoma and a non-secreting endocrine tumor of the body region. This observation highlights the usefulness of echoendoscopy in the work-up of cystic lesions of the pancreas; indeed, the tumors of the body of the pancreas were not detected by others methods. Furthermore, there are reports in literature on endocrine secretion syndromes secondary to digestive endocrine tumors or neuroendocrine cells in the lining of cystic tumors of the pancreas.

Aged↗

PubMed1989

Function of pancreas allografts more than 1 year following transplantation.

At the University of Iowa, Iowa City, 75 pancreas transplant procedures were performed for type I diabetes mellitus from March 1984 to September 1988. Forty-seven of these transplants were performed simultaneously with kidney transplants from the same donor; 23 followed previous kidney transplants, and 5 were preuremic pancreas-only transplants. The 1-year patient survival rate is 85% and pancreas graft survival rate is 54%. The simultaneous kidney and pancrease group had a 1-year patient survival rate of 82%, a pancreas graft survival rate of 59%, and a renal graft survival rate of 73%. Thirty-one of 70 kidney and pancreas recipients had a functioning pancreas 1 year post transplantation and 26 of 31 currently have a functioning pancreas and are insulin free. Patient symptoms of neuropathy and gastroenteropathy are improved with long-term graft function. Some patients may develop type II diabetes post transplantation with impaired glucose tolerance despite high insulin production by the graft. Pancreas transplantation is the only therapy that achieves a euglycemic state as indicated by glycosylated hemoglobin and glucose tolerance testing. Centers must continue to follow up patients on a long-term basis to determine the final effects on the secondary complications of diabetes.

Diabetes Mellitus, Type 1↗

PubMed1997

Amelioration of nerve conduction velocity following simultaneous kidney/pancreas transplantation is due to the glycaemic control provided by the pancreas.

Diabetic polyneuropathy is a common, disabling chronic complication of diabetes mellitus. Previous studies have suggested that combined pancreas-kidney transplantation can ameliorate nerve conduction. The relative contribution of the correction of hyperglycaemia and uraemia on nerve function is still a matter of debate. Nerve conduction velocity (NCV) was assessed before and after simultaneous pancreas and kidney transplantation, and before and after pancreas graft failure in five insulin-dependent diabetic (IDDM) patients affected by severe diabetic polyneuropathy. Sensory and motor NCV were recorded in five nerves and expressed as a cumulative index for each patient. Metabolic control was evaluated by fasting blood glucose and glycosylated haemoglobin levels. NCV index was below normal values before transplant: -3.8 +/- 0.7 (normal value: 0.89), improved 1 and 2 years after transplant: -3.1 +/- 1.3 and -2.6 +/- 0.9 (p = 0.0019), stabilised until pancreas failure and deteriorated to pre-transplant values 2 years after pancreas graft failure: -3.6 +/- 1.0 (p = 0.034). Fasting blood glucose levels worsened after pancreas graft failure. HbA1c levels, in the normal range during functioning pancreas graft (6.6 +/- 0.6%), deteriorated after its failure (8.0 +/- 0.6%, p = 0.04). Kidney function was preserved. These data support a positive effect of pancreas transplantation per se on NCV in IDDM subjects with diabetic polyneuropathy, thus demonstrating that metabolic control provided by a self-regulated source of insulin not only halts but also ameliorates nerve function, even if polyneuropathy is advanced.

Adult↗

PubMed2004

Multirow CT in the follow-up of pancreas transplantation.

PURPOSE: Isolated pancreas or combined kidney-pancreas transplantation represents the only therapeutic weapon for complete resolution of type I diabetes mellitus. The purpose of the present study was to investigate the role of multirow CT in the follow-up of these patients. MATERIALS AND METHODS: Thirty patients who underwent isolated (n = 13) or combined kidney-pancreas (n = 17) transplantation, using systemic-bladder (n = 7) or enteric-portal (n = 23) drainage, were evaluated with multirow CT (Light Speed Plus, GE Medical System). The CT study included unenhanced, arterial, and portal phases of the isolated pancreas, and a urographic phase for combined kidney-pancreas transplants. The acquisition was done with 1.25-mm collimation, 0.6-mm reconstruction interval, and a pitch of 6. A CT scan of the thorax was included if patients were suspected to have pulmonary complications. RESULTS: In all cases it was possible to recognize the surgical technique performed for endocrine and exocrine pancreatic drainage, to evaluate the transplanted pancreas, and to identify possible complications. For example, CT identified thrombosis or stenosis of the arterial graft, partial thrombosis of the venous graft, ectasia of the common iliac artery and arterial graft, dehiscence of the duodenal-bladder anastomosis, infected abdominal collections, thrombosis of the internal iliac vein, and pulmonary infections. CONCLUSIONS: Because multirow CT detects complications it is useful to follow isolated pancreas or combined kidney-pancreas transplants.

Diabetes Mellitus, Type 1↗

PubMed2005

Follow-up experience using histidine-tryptophan ketoglutarate solution in clinical pancreas transplantation.

In May 2003, at Indiana University, the standard cold preservation solution University of Wisconsin (UW) solution was replaced by histidine-tryptophan ketogluatarate (HTK) solution. Earlier, we presented our initial experience with HTK in pancreas preservation with an analysis of the first 10 pancreas transplants. Here we report updated results with HTK in pancreas transplantation over the past 18 months. Between May 2003 and March 2005, a total of 87 pancreas transplants were performed with 78 of these organs utilizing HTK. Seventy five patients received 78 organ transplants. Surgical procedures performed were: simultaneous kidney pancreas transplantation (n = 50, 64%), pancreas after kidney transplantation (n = 19, 24%), solitary pancreas transplantation (n = 9, 12%). Donor and recipient data were collected with primary outcomes as primary nonfunction and 30-day graft and patient survivals, and compared to the UW cohort from our original report. Donor and recipient demographics were similar. Mean follow-up time is 12 +/- 6 months. The mean cold ischemia time was 9 +/- 3 hours. There were no cases of primary graft nonfunction. Thirty-day and 1-year patient survivals were 99% and 93%. The 30-day and 1-year graft survivals were 96% and 93%. There were five grafts lost, including three within the first month (two venous and one arterial thrombosis). There was one case of chronic rejection and one noncompliance. All other patients were insulin-independent by discharge. Serum fasting blood glucose and serial amylase remained comparable at all intervals posttransplantation. Within this range of cold ischemia time, HTK appears to provide effective pancreas preservation.

Adult↗

PubMed2000

A prospective comparison of systemic-bladder versus portal-enteric drainage in vascularized pancreas transplantation.

BACKGROUND: Most pancreas transplants are performed with systemic venous delivery of insulin and bladder drainage of the exocrine secretions (systemic-bladder [S-B]). To develop a more physiologic procedure, we performed pancreas transplantations with portal venous delivery of insulin and enteric drainage of the exocrine secretions (portal-enteric [P-E]). METHODS: During an 11-month period, we prospectively alternated 32 consecutive pancreas transplant recipients to either S-B (n = 16) or P-E (n = 16) drainage with standardized immunosuppression. RESULTS: Patient, kidney, and pancreas graft survival rates after simultaneous kidney-pancreas transplantation were 91% S-B versus 92% P-E, 91% S-B versus 92% P-E, and 82% S-B versus 92% P-E, respectively. Pancreas graft survival rates after solitary pancreas transplantation were 80% S-B versus 75% P-E. There were no graft losses either to immunologic or infectious complications in either group, but the incidence of acute rejection was slightly higher in the S-B group (44% S-B vs 31% P-E, P = NS). The cost and length of the initial hospital stay were similar between groups. The incidence of operative complications, major infections, and cytomegalovirus infections were likewise comparable. However, the S-B group was characterized by a slight increase in the number of readmissions, urinary tract infections, and urologic complications. Furthermore, metabolic acidosis and dehydration were more common in the S-B group. CONCLUSIONS: Pancreas transplantation with P-E drainage can be performed with short-term results comparable to those of transplantation with S-B drainage.

Adult↗

PubMed1987

Exocrine pancreatic function in dogs with denervated pancreas.

There is strong evidence that the vagus nerve plays an important role in exocrine pancreatic secretion. In the present study we examined the effect of total extrinsic denervation of the pancreas on exocrine pancreatic secretion to different stimuli in dogs. In the experiments we used the model of the orthotopic autotransplanted dog pancreas as described by Debas et al. Denervation of the gland did not significantly alter water and bicarbonate response to secretin. The dose-response curve of caerulein showed the denervated pancreas as sensitive as the intact gland. However, autotransplantation of the pancreas caused a significant decrease (p less than 0.05) in protein secretion during intraintestinal L-tryptophan in increasing doses. Furthermore, bicarbonate and protein secretion after food intake was significantly decreased in the denervated pancreas (protein: peak levels 380 mg/15 min and 135 mg/15 min; bicarbonate: 3.2 mEq/15 min and 1.4 mEq/15 min) (p less than 0.02). From our data we conclude that the denervated pancreas is as sensitive as the intact pancreas to stimulation by exogenous secretin and caerulein, whereas denervation of the pancreas causes an important influence in the intestinal phase of pancreatic secretion.

Animals↗