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PubMed2000

Reversal of left ventricular diastolic dysfunction after kidney-pancreas transplantation in type 1 diabetic uremic patients.

OBJECTIVE: Diastolic function is frequently impaired in diabetic patients. Our aim was to evaluate the effects of glycometabolic control achieved by pancreas transplantation on left ventricular function in uremic type 1 diabetic patients. RESEARCH DESIGN AND METHODS: Left ventricular systolic and diastolic functions were evaluated using radionuclide ventriculography in 42 kidney-pancreas transplant patients and 26 kidney-alone recipients who had similar clinical characteristics before transplantation. Patients were grouped according to 6, 24, and 48 months of follow-up. Control subjects consisted of 20 type 1 diabetic patients. RESULTS: The left ventricular ejection fraction was normal in all of the patients. However, kidney-pancreas transplant patients with 4 years of graft function had a higher ejection fraction (75.7 +/- 1.8%) than kidney-alone patients with 4 years of graft function (65.3 +/- 2.8%, P = 0.02) and type 1 diabetic patients (61.3 +/- 3.7%, P = 0.004). In patients with 4 years of graft function, normal diastolic parameters were evident in kidney-pancreas but not in kidney-alone or in type 1 diabetic patients (peak filling rate: 4.46 +/- 0.15 end diastolic volume (EDV)/s in kidney-pancreas patients vs. 2.73 +/- 0.24 EDV/s [P < 0.01] and 3.39 +/- 0.30 EDV/s [P < 0.01] in kidney-alone and type 1 diabetic patients, respectively; time-to-peak filling rate: 141.9 +/- 7.8 ms in kidney-alone patients vs. 209.4 +/- 13.5 ms in kidney-alone patients [P < 0.01]; peak filling rate/peak ejection rate ratio: 1.10 +/- 0.04 in kidney-pancreas patients vs. 0.81 +/- 0.08 in kidney-alone patients [P < 0.01]). A significant reduction in diastolic dysfunction rate was observed only in kidney-pancreas patients. CONCLUSIONS: Kidney-pancreas transplantation results in complete insulin independence, a better glycometabolic pattern and blood pressure control, an improvement of left ventricular function, and a reversal of diastolic dysfunction.

Adult↗
PubMed1989

Pancreas transplantation in the rat using Lee's technique: a reliable model in experimental microsurgery.

Numerous unresolved problems, both technical and immunological, in pancreas transplantation stimulate experimental studies. Dogs have been routinely used in experimental studies but today rats are more commonly used. However, pancreas transplantation in the rat presents complex technical problems and requires a good knowledge of microsurgical techniques. In 1983 Squifflet undertook an experimental study aimed at evaluating the technical aspects of pancreas transplantation in the rat and calculating the success rates using different methods. The comparison of four methods revealed to our surprise that 100% of the rats operated on using Lee's technique had complications, with a 0% survival rate. In our study we report our experience using Lee's technique which we had the opportunity of mastering directly under the supervision of Professor Lee. We performed 100 pancreas transplantations using Lee's technique and divided our study in two phases. In the first phase we performed 70 pancreas transplantations and overall survival, after 1 week, was 42 rats (60%). In the second phase on 30 rats diabetes was induced by administering 70 mg/kg of streptozotocin. These 30 diabetic rats underwent pancreas transplantation and overall survival, after 1 week, was 25 (83.3%). We believe that our successful survival rates could probably be explained by the close collaboration between Lee and our department. Moreover, we noted the importance of constant training in obtaining better results, and in our opinion Lee's technique of pancreas transplantation is a reliable experimental model which can be used to resolve problems linked to pancreas transplantation.

Animals↗
PubMed2003

Localization of TRAIL/TRAILR in fetal pancreas.

AIM: To observe the localization of TRAIL/TRAIR (DR4, DR5, DcR1, DcR2) in the fetal pancreas. METHODS: Fetal pancreas of 32 weeks of pregnancy were obtained from induced abortions, embedded in paraffin, and 4-microm sections were prepared. The localization of TRAIL/TRAILR in fetal pancreas was investigated by fluorescence immunohistochemical method combined with laser scanning confocal microscopy. RESULTS: TRAIL immunoreactive cells were mainly located on the periphery of the pancreas islets. There were a few DcR1 and DcR2 positive cells whereas there were no immunoreactive cells of DR4 and DR5 in the pancreas islets. In the acini and the ducts of the exocrine pancreas there were no TRAIL/TRAILR immunoreactive cells. CONCLUSION: This study not only describes the distribution of TRAIL/TRAILR in the fetal pancreas, but also provides a morphological basis for deducing the function of TRAIL/TRAILR in pancreas, suggesting that in normal pancreatic islets, the pancreatic cells are resistant towards apoptosis too.

Apoptosis Regulatory Proteins↗
PubMed1999

[Gastrointestinal surgery and gastroenterology. II. Transplantation of pancreas].

In patients with type I diabetes mellitus, adequate blood glucose control prevents the development or aggravation of late complications. Apart from administration of insulin, transplantation of insulin-producing tissue is also a possibility. Transplantation of Langerhans islets which contain the insulin-producing beta cells is still in its initial phase. Transplantation of the entire pancreas received a boost in the mid-eighties when it became possible to drain the secretion of the exocrine part of the pancreas to the bladder using the duodenum. Other important steps forward were prevention and treatment of rejection and improvement of the preservation fluid. Because pancreas transplantation makes lifelong immunosuppression necessary, it is performed mainly in patients subjected to kidney transplantation because of terminal renal failure. The one-year survival of the patients after simultaneous pancreas and kidney transplantation increased to over 90%, that of the grafted pancreas to 82% and that of the grafted kidney to 86-90%. The one-year survival after transplantation of the pancreas alone increased to 62%. A successful pancreas transplantation leads to independence from insulin treatment and to normal glucose and HbA1c values. Pancreas transplantation also reduces diabetes nephropathy and progression of coronary sclerosis.

Diabetes Mellitus, Type 1↗
PubMed1999

[Pancreas transplantation--a review].

According to the International Pancreas Transplant Registry, more than 1,000 pancreas transplantations are now performed annually. When performed simultaneously with a kidney transplant, pancreas transplantation is a generally accepted treatment for type 1 diabetic patients with end stage renal disease, and the pancreas graft survival in this setting is equivalent to that of the kidney graft. The reported results of solitary pancreatic transplantation in non-uraemic diabetic patients have been less favourable due to a high rejection rate in combination with difficulties in rejection diagnosis and treatment. However, the introduction of new immunosuppressive drugs over the last few years has drastically improved the survival of solitary pancreatic grafts and allows for a rising enthusiasm. The majority of the 122 transplantations performed in Oslo so far were simultaneous kidney and pancreas transplantations. Duct occluded segmental grafts were used until 1988 when the pancreatico-duodenal technique with bladder drainage was introduced. In March 1998 we changed to enteric drainage of the exocrine pancreas due to a high percentage of lower urinary tract problems and bicarbonate loss associated with the bladder drainage technique. The positive impact of a functioning pancreas transplant on the recipient's quality of life is well recognised, whereas long-term beneficial effects on the secondary complications of diabetes are not well documented. A short overview of various aspects of pancreas transplantation is given, including experience with the 122 transplantations performed at the National Hospital, Oslo, Norway.

Adult↗
PubMed2000

Role of the basic helix-loop-helix transcription factor p48 in the differentiation phenotype of exocrine pancreas cancer cells.

The majority of human pancreatic adenocarcinomas display a ductal phenotype; experimental studies indicate that tumors with this phenotype can arise from both acinar and ductal cells. In normal pancreas acinar cells, the pancreas transcription factor 1 transcriptional complex is required for gene expression. Pancreas transcription factor 1 is a heterooligomer of pancreas-specific (p48) and ubiquitous (p75/E2A and p64/HEB) basic helix-loop-helix proteins. We have examined the role of p48 in the phenotype of azaserine-induced rat DSL6 tumors and cancers of the human exocrine pancreas. Serially transplanted acinar DSL6 tumors express p48 whereas DSL6-derived cell lines, and the tumors induced by them, display a ductal phenotype and lack p48. In human pancreas cancer cell lines and tissues, p48 is present in acinar tumors but not in ductal tumors. Transfection of ductal pancreas cancers with p48 cDNA did not activate the expression of amylase nor a reporter gene under the control of the rat elastase promoter. In some cell lines, p48 was detected in the nucleus whereas in others it was cytoplasmic, as in one human acinar tumor. Together with prior work, our findings indicate that p48 is associated with the acinar phenotype of exocrine pancreas cancers and it is necessary, but not sufficient, for the expression of the acinar phenotype.

Adenocarcinoma↗
PubMedDate not supplied

Practical guidelines for the preservation of the pancreaticoduodenal arteries during duodenum-preserving resection of the head of the pancreas: clinical experience and a study using resected specimens from pancreaticoduodenectomy.

BACKGROUND/AIMS: The purpose of this study was to create a practical guideline for vascular preservation during duodenum-preserving resection of the head of the pancreas. METHODOLOGY: We examined the anatomy of pancreaticoduodenal arteries by specimen angiography and dissection using 12 pancreaticoduodenectomy specimens. We also reviewed our experiences with duodenum-preserving resection of the head of the pancreas. RESULTS: In the specimens, the posterior pancreaticoduodenal artery and its duodenal branches were easily separated from the posterior surface of the pancreas, and its papillary branch was identified in two-thirds of the cases. It was difficult to dissect the anterior superior pancreaticoduodenal arteries from the pancreas because they were partially buried in the pancreatic parenchyma. The anterior inferior pancreaticoduodenal artery located in the posterior and inferior surface of the pancreas could be safely dissected in two-thirds of the cases. Duodenum-preserving resection of the head of the pancreas was performed in 7 patients. In every case, the anterior superior pancreaticoduodenal artery was sacrificed and the anterior inferior pancreaticoduodenal artery was preserved. In 3 cases, the entire posterior pancreaticoduodenal artery was preserved and in 4 cases a short segment of the posterior pancreaticoduodenal artery was removed accidentally. The pancreatic head was totally removed and the intrapancreatic common bile duct was preserved. There were 3 postoperative complications, pancreatic leakage, intraabdominal fluid collection and bile duct stricture. They improved with conservative management. CONCLUSIONS: To safely perform duodenum-preserving resection of the head of the pancreas, preservation of the whole posterior pancreaticoduodenal artery and anterior inferior pancreaticoduodenal artery is recommended because they can be safely dissected from the pancreas, and the posterior pancreaticoduodenal artery provides the major blood supply to the papilla and distal bile duct. However, removal of a short segment of posterior pancreaticoduodenal artery does not preclude a good blood supply to the duodenum because of bidirectional blood flow.

Adult↗
PubMed1992

Analysis of United Network for Organ Sharing (UNOS) United States of America (USA) Pancreas Transplant Registry data according to multiple variables.

As of 1992, more than 4,200 pancreas transplants were reported to the International Pancreas Transplant Registry. Of these, more than 2,600 were performed in the United States, and of these, more than 2,100 have been transplanted since the inception of the UNOS Registry in October 1987. The analyses here are only of the UNOS data. Pancreas transplants performed in conjunction with a liver (either cluster or noncluster) or a heart were excluded from the analysis, and only those performed as a solitary procedure or in conjunction with a kidney were included. Emphasis was placed on those performed with the bladder drainage (BD) technique (96%). In the overall analysis of BD cadaveric pancreas transplants (n = 1,879), 1-year patient survival and pancreas graft function survival rates were 91% and 71%, respectively, 87% and 66% at 2 years, and 81% and 59% at 3 years. There were no differences according to gender, but 1-year graft survival rates were significantly higher in recipients 45 years or younger (72%) (n = 1,679) than in those older than 45 (64%) (n = 200). There were no significant differences according to graft preservation times of less than 12 (n = 749), 12-24 (n = 940), 24-30 (n = 79), and more than 30 (n = 9) hours, function rates at 1 year being 71%, 72%, 72%, and 44%, respectively. When analyzed according to the 3 major recipient categories (simultaneous pancreas/kidney transplants [SPK] [n = 1604]; pancreas after kidney transplants [PAK] [n = 166]; and pancreas transplants alone [PTA] [n = 109]), patient survival rates were no different (91%, 92%, and 92% at 1 year, respectively), but pancreas graft survival rates were significantly higher in the SPK than in the PAK and PTA categories (75%, 48%, and 49%, at 1 year, respectively). In the SPK group, kidney graft survival rates at 1 year were 84%. Outcomes were also compared according to whether induction immunotherapy included ALG, OKT3, or neither. In the SPK category, there was no difference among the protocols, with 1-year graft survival rates being 76% in the ALG (n = 838), 76% in the OKT3 (n = 416), and 72% in the Neither (n = 299) group.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMedDate not supplied

Pancreas-sparing duodenectomy in duodenal pathology: indications and results.

BACKGROUND/AIMS: Pancreas sparing-duodenectomy is an organ-preserving surgical procedure suitable for patients with premalignant or early malignant lesions of the duodenum. The surgical technique is challenging due to the close anatomical relationship between the pancreas and the duodenum. METHODOLOGY: All patients undergoing pancreas-sparing duodenectomy for benign or premalignant condition of the duodenum operated on between 1998 and 2001 were analyzed prospectively. The surgical technique, the hospital course, and complications are described. RESULTS: A total of four patients underwent pancreas sparing-duodenectomy. Two patients experienced an uncomplicated postoperative course. In one patient, after completing the pancreas sparing-duodenectomy, the operation was converted to a Whipple procedure after the intraoperative diagnosis of malignant disease in the fresh frozen section. One patient had a complicated postoperative course with postoperative pancreatitis requiring several reoperations. At follow-up all patients are well, free of recurrence and alive. CONCLUSIONS: Pancreas-sparing duodenectomy is a challenging surgical technique and requires excellent knowledge of the anatomy. Intraoperative fresh-frozen section is mandatory to exclude malignant disease. If performed for appropriate indications, pancreas sparing-duodenectomy offers the potential to preserve the anatomical gastrointestinal passage and the integrity of the pancreas.

Digestive System Surgical Procedures↗
PubMed2001

[Resection of gastric carcinoma with preserving of the spleen and pancreas and functional clearance lymph nodes of the spleen hillus and splenic artery].

OBJECTIVE: To study the practical effects of the preserved spleen and pancreas and functional, clearance of lymph nodes of the spleen hillus and splenic artery for gastric carcinoma. METHODS: Spleen and pancreatic involvement was retrospectively reviewed in 439 cases of resectable carcinoma of the gastric cardia, gastric corpus and total stomach. During gastric operation, 2 ml methylene blue was injected into the subserosal space of the gastric cardia or corpus to observe the spreading of lymphatic flow of the stomach in 54 cases. The No10, No11 lymph node metastasis rates, postoperative complications and survival rates were observed in 63 case of gastric carcinoma that had received gastrectomy with preservation of the spleen and pancreas (PSP) and functional clearance of lymph nodes of the spleen hillus and splenic artery. RESULTS: Invasion of gastric cancer into the pancreas and spleen occurred in 5.7% (25/439) and 2.3% (10/439) respectively. Methylence blue was injected into the subserosal space of the stomach without diffusion into the spleen and pancreas. The No10, No11 lymph node metastasis rates of PSP, pancreas preservation (PR) and pancreas and spleen resection (PSR) were 17.5% (11/63), 19.1% (12/63); 20.8% (45/216), 25% (54/216); 20% (6/30), 23% (7/30), respectively (P > 0.05). The occurrence of postoperative complications and mortality was lower in patients with PSP than those with spleen and parts of pancreas resected, whereas the survival rate was higher in patients with PSP. The 5-year and 10-year survival rates of gastric carcinoma in stage II, III a were markedly improved in patients with PSP. CONCLUSIONS: PSP for patients with gastric cancer is safe and functional resectable. The occurrence of postoperative complications is lower and the survival rates are higher in patients with PSP than those with spleen and part of pancreas resected. PSP is beneficial to those with gastric carcinoma in stage II, IIIa.

Adult↗
PubMed1990

Innervation of the pancreas by neurons in the gut.

Experiments were done in order to test the hypothesis that neurons in the bowel send axonal projections to the pancreas and can modify pancreatic activity. pancreatic injections of the retrograde tracer, Fluoro-Gold, labeled neurons in the myenteric plexus of the antrum of the stomach and in the first 6 cm of the duodenum. this labeling was not due to the diffusion of Fluoro-Gold from the pancreas, because the injections did not label longitudinal muscle cells overlying labeled ganglia in the bowel or neurons in the phrenic nerve nucleus or nucleus ambiguous; nor were enteric neurons labeled if insufficient time was allotted for retrograde transport. More Fluoro-Gold labeled neurons were found in the stomach (9.2 +/- 0.9/ganglion) than in the duodenum (3.8 +/- 0.3/ganglion; p less than 0.001). Neurons were found in myenteric ganglia of both duodenum and stomach that were doubly labeled by retrograde transport of Fluoro-Gold and anti-serotonin (5-HT) sera. In addition, thick bundles of 5-HT immunoreactive nerve trunks were found to run between the duodenum and the pancreas. Most 5-HT immunoreactive axons in the pancreas terminated in ganglia, although some fibers were also observed near acini, ducts, vessels, and islet cells. The B subunit of cholera toxin (B-CT) was microinjected into single myenteric ganglia in order to determine if axon terminals in the pancreas would become labeled by anterograde transport in the pancreas. B-CT labeled bundles of axons in the pancreatic stroma. Branches of these bundles entered the pancreatic parenchyma and varicose B-CT labeled terminal axons were found in pancreatic ganglia and in proximity to acinar and insulin immunoreactive cells. The intercalating fluorochrome 1, 1', dioctadecyl-3,3,3',3'-tetramethylcarbocyanine perchlorate (Dil), which moves by lateral diffusion to outline entire cells, was introduced by microinjection into individual myenteric ganglia of fixed preparations. Fluorescence was seen in sequential observations to move away from the injected ganglion along connectives of the myenteric plexus. After about a month, neurons in ganglia at some distance from the injection site displayed Dil fluorescence as did nerve bundles that exited from the myenteric plexus and pierced the longitudinal muscle in the direction of the pancreas. Varicose Dil fluorescent terminal varicosities were also observed int he pancreas. These observations indicate that there is an extensive entero-pancreatic innervation.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1989

Annular pancreas. Etiology, classification and diagnostic imaging.

A rare type of annular pancreas, in which the tail of the annular duct is fused with the dorsal pancreatic duct to form the main duct, and its diagnostic imagings of endoscopic retrograde cholangiopancreatography, hypotonic duodenography, computed tomography and ultrasound are described. Annular pancreas is an anomaly embryologically formed by the ventral anlage of the pancreas as the duodenum rotates, mainly due to hypertrophy of the left ventral bud. According to the fusion pattern of the ventral and dorsal pancreatic ducts, annular pancreas can be divided into three types: type I, divisional annular pancreas; type II, branch annular pancreas; and type III, main duct annular pancreas. Endoscopic retrograde cholangiopancreatography, hypotonic duodenography, computed tomography and ultrasound can show the imagings of annular pancreas from different aspects, but the final diagnosis must be based on the evidence of endoscopic retrograde cholangiopancreatography or hypotonic duodenography combined with computed tomography or ultrasound.

Aged↗
PubMed1989

Clinical pancreas transplantation. Complete review of eight years experience.

In the eight years since the initiation of pancreas transplantation at our center, 36 patients have received either segmental or whole pancreas grafts. Seventeen patients had segmental pancreas allografts, with eight of these receiving simultaneous kidney allografts from the same donor. Nineteen patients received whole pancreas and kidney allografts. Thirty five of the pancreases were preserved using hypothermic storage for up to 43 hours and 45 minutes, using either albumin-augmented crystalloid or hyperosmolar colloid preservation solution. The one-year actuarial graft survival was 12 per cent for segmental pancreas transplants and 42 per cent for whole pancreas grafts. The use of cyclosporine after whole pancreas transplantation as well as improved surgical techniques for exocrine drainage contributed to the improvement in graft survival in the whole pancreas graft group.

Adult↗
PubMed1986

[Status of clinical pancreas transplantation].

Since 1977 and especially within the latest 5 years there was a volatile development in the pancreas transplantation. If we had only 60 transplants between 1966-1977, prevalent duodeno-pancreas-transplants, the cases rose to 215 up to 1982 and to 447 transplantations between 1983 to 1985. Altogether there were 722 pancreas transplants, up to November, 15, 1985 registered. Before 1977 only 2 patients had a 1 year function rate of the transplant and of the 447 transplantations within the latest 3 years 201 transplants functioned more than 12 months. That was a 1-year function rate of 45% in contrast to 3% before 1977. The clear improvement of the results in pancreas transplantation can be attributed to operative aspects and to the employment of Cyclosporine A. The segmental pancreas transplantation with duct occlusion and intestinal or external drainage of the duct system were the most sure operative procedures. The combination of Azathioprine and Cyclosporin A brought with a 1-year function rate of 54% better results in comparison to the singular application of Azathioprine (22%) and Cyclosporin A (41%). The simultaneous pancreas-kidney transplantation had a 1-year function rate of 39%, the pancreas transplantation after kidney of 31% and the pancreas transplantation alone of 20%.

Azathioprine↗
PubMed1984

Immunohistochemical localization of carcinogen-metabolizing enzymes within the rat and hamster exocrine pancreas.

The P-450 cytochromes, reduced nicotinamide adenine dinucleotide phosphate-cytochrome P-450 reductase, epoxide hydrolase, and glutathione S-transferases all play important roles in the bioactivation and detoxication of various classes of chemical mutagens and carcinogens. The present investigation was undertaken to determine if and where these enzymes are located within the exocrine pancreas, a tissue that is a target for chemically induced neoplasia. In this study, reduced nicotinamide adenine dinucleotide phosphate-cytochrome P-450 reductase, two isozymes of cytochrome P-450 (cytochromes P-450 PB-B and BNF-B), epoxide hydrolase, and glutathione S-transferases B, C/A, and E were each localized at the light microscopic level within exocrine pancreases of untreated rats and hamsters utilizing the unlabeled antibody peroxidase-antiperoxidase staining technique. Immunohistochemical staining for each of these enzymes was apparent within acinar cells in pancreases of Holtzman, Sprague-Dawley, Wistar, and Fischer 344 rats. Staining for the reductase, the epoxide hydrolase, and the glutathione S-transferases was also observed within the epithelia of both interlobular and intralobular ducts in the exocrine pancreases of these rat strains, whereas staining for cytochromes P-450 PB-B and BNF-B was not readily detectable within epithelial cells of the rat pancreatic duct system. In the exocrine pancreas of the Syrian golden hamster, immunohistochemical staining for reduced nicotinamide adenine dinucleotide phosphate-cytochrome P-450 reductase, epoxide hydrolase, and glutathione S-transferases B and C/A was similar to that observed within the rat exocrine pancreas. In contrast, acinar and duct cells in the hamster pancreas both appeared to be stained for cytochrome P-450 PB-B, whereas staining for cytochrome P-450 BNF-B could not be readily detected within either acinar or duct cells, and staining for glutathione S-transferases E did not appear to be present within duct cells in the hamster pancreas. The results of this investigation therefore suggest that highly reactive and toxic electrophilic metabolites of procarcinogens may be generated to the greatest extent within acinar cells in the rat pancreas, whereas these metabolites may be produced within both acinar and duct cells in the hamster pancreas. Regardless of where they are formed, reactive metabolites may be enzymatically detoxicated within both acinar and duct cells in the rat and hamster exocrine pancreas.

Animals↗
PubMed1980

Acute hemorrhagic pancreatic necrosis in mice: the activity of lysosomal enzymes in the pancreas and the liver.

The activity of lysosomal enzymes of the pancreas and the liver has been studied during induction and onset of acute hemorrhagic pancreatic necrosis with fat necrosis (AHPN) in mice. We induced AHPN by feeding the animals a choline-deficient (CD) diet containing 0.5% DL-ethionine (CDE). Control animals were fed either laboratory chow or a plain CD DIET. Increased total activities of cathespin B1, beta-galactosidase, and acid phosphatase were found to occur in pancreas homogenates of mice fed the CDE diet for 2 and 3 days. Release of cathespin B1 into pancreas cytosol was observed after 1 day of feeding. beta-galactosidase and acid phosphatase were increased in pancreas cytosol after 2 and 3 days of feeding. Changes in total activity and location of the lysosomal enzymes did not occur in the liver. Feeding the CD and CDE diets resulted in an increase in the free activity of lysosomal enzymes of both the pancreas and the liver, suggesting the existence of alterations in the lysosomal membrane. Pancreas and liver homogenates were stored on ice up to 3 hours, and the free activity of acid phosphatase and beta-galactosidase were determined at various time intervals. The free activity of both enzymes increased progressively for 3 hours in the pancreas but not in the liver. It is concluded that: 1) induction of AHPN in mice is accompanied by an increase in the activity of lysosomal enzymes of the acinar cells of the pancreas; 2) cathepsin B1 may be responsible for triggering an intraparenchymal activation of zymogens, and 3) pancreatic lysosomes are labilized more easily than liver lysosomes.

Acid Phosphatase↗
PubMed1994

Differences in rejection grading after simultaneous pancreas and kidney transplantation in pigs.

Clinical observations suggest that recipients of multiorgan transplants from the same donor can have disparate immunological reactions to each organ. We studied this phenomenon in 36 diabetic (streptozotocin-induced), bilaterally nephrectomized, immunosuppressed (cyclosporine, azathioprine, prednisone) pig recipients of simultaneous (same donor) pancreas (bladder drained) and kidney allografts by grading the histological intensity of rejection in biopsies of each organ at defined intervals posttransplant. Graft function was monitored by plasma glucose (PG) and urine amylase (UA) for the pancreas and serum creatinine (Cr) for the kidney. Interstitial rejection was graded as absent, mild, moderate, and severe in, respectively, 8%, 25%, 42%, and 25% of pancreas vs. 4%, 12%, 27%, and 57% of kidney biopsies at 1 week; and 0%, 43%, 29%, and 29% of pancreases vs. 10%, 0%, 30%, and 60% of kidneys at two weeks. Although the distribution of grades was similar in the two organs (P > 0.1), the grade of rejection for each pair at 1 week (n = 24) was discordant in 75% (42% differed by one and 33% by > or = 2 grades) and at 2 weeks (n = 7) in 57% (29% by 1 and 29% by > or = 2 grades). The inability to use the severity of interstitial rejection in one organ to predict the findings in the other is exemplified by the fact that for the two pancreases without interstitial rejection at one week, the corresponding kidney showed moderate or severe rejection, and for the 1 kidney without rejection the corresponding pancreas showed moderate rejection. Vascular rejection grades (absent, mild, moderate, severe) also showed a similar distribution for the pancreas (57%, 30%, 9%, 4%) vs. kidney (50%, 38%, 0%, 12%) at 1 week, and at 2 weeks (57%, 29%, 0%, and 14% for the pancreas vs. 78%, 11%, 0%, and 11 for the kidney) (P > or = 0.64). However, the grading of vascular rejection in organ pairs was dyssynchronous in 54% at 1 week (n = 22) and 29% at 2 weeks (n = 7). No vascular rejection in the pancreas with rejection in the kidney was seen in 5 pairs at 1 week (23%) and 0 at 2 weeks (0%), while no rejection in the kidney with rejection in the pancreas was seen in 5 pairs at 1 week (23%) and 2 pairs at 2 weeks (29%).(ABSTRACT TRUNCATED AT 400 WORDS)

Amylases↗
PubMed1994

[Technics and results of pancreas transplantation].

Long-term normoglycaemia cannot be achieved in patients with insulin dependent diabetes mellitus neither with conventional nor with intensified insulin therapy. The only ideal method to obtain this seems the islet cell or pancreas transplantation. The number of pancreas transplantation approaches 5000 all over the world. The first simultaneous pancreas-kidney transplantation in Germany was performed in 1979 by the Munich group. Till 1991 in Grosshadern 141 pancreas transplantations have been performed. At the beginning duct occlusion (n = 106) later bladder drainage (n = 35) were used as a standard procedure. The authors discuss in detail the indications and contraindications, the types of pancreas transplantation, the different diversions of exocrine secretion. They analyse the effect of pancreas transplantation upon diabetic metabolism, retinopathy, neuropathy, nephropathy and quality of life, based on own experiences and literary data. At present the indication for pancreas transplantation is the stadium of late complications in IDDM. Because of the definitive lesions its beneficial effect is limited. After successful transplantation the peripheral (and autonomic?) neuropathy improves, the retinopathy seems to remain stabile, and the pancreas protects the transplanted kidney against recurrent diabetic nephropathy. Most patients will become insulin independent with tight metabolic control, but the complications of immunosuppressive therapy must be taken into consideration. The working ability and the quality of life seem to improve considerably.

Contraindications↗