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At least 217 records · Page 12Linked to original sources

PubMed1987

Kaluresis independent K homeostasis in dogs: activity after ureter ligation and pancreatectomy.

In ureter ligated dogs intravenous administration of KCl stimulates both insulin secretion and activity of a kaluresis independent K homeostatic mechanism (K transfer capacity) that retards the development of hyperkalemia by transferring K to intracellular fluid. If the preparation is K loaded by infusion with 2 mEq KCl/kg/hr until prelethal ECG changes of hyperkalemic cardiotoxicity appear, about 50% of administered K is transferred. An increased proportion--70%--is transferred if the animal is K loaded 70 minutes after pancreatectomy--when serum immunoreactive insulin is fixed at less than 4 uU/ml. That proportion (70%) is unchanged by simultaneous adrenalectomy, but is reduced to less than 40% by propranolol blockade of B receptors. Increased post pancreatectomy K transfer capacity apparently involves K transfer mediated by B receptors that are activated by an extra-adrenomedullary B agonist(s). Findings also indicate that residual post pancreatectomy insulin biological activity mediates K transfer.

Animals↗

PubMed1999

Subtotal pancreatectomy for cancer can be safe in the elderly.

OBJECTIVES: Evaluation of safety of subtotal pancreatectomy for cancer in elderly patients (70 years of age or more) and of long term survival compared with younger patients. DESIGN: Retrospective study of information recorded prospectively in the departmental database. SETTING: University hospital, Sweden. SUBJECTS: 74 consecutive patients who underwent subtotal pancreatectomy for cancer between 1985 and 1993. MAIN OUTCOME MEASURES: Postoperative mortality and morbidity, and long term survival. RESULTS: The diagnosis was pancreatic cancer in 41, cancer of the papilla of Vater in 17, cancer of the bile duct in 7, juxtapapillary duodenal cancer in 5, and 4 other pancreatic head tumours. There were no differences in sex, first symptom, preoperative weight loss, radicality according to the pathology report, tumour size, grade of differentiation or presence of lymph node metastases between the two groups. The rate of postoperative complications was the same for both groups, as was the amount of intraoperative bleeding, operation time, and length of hospital stay including stay at the intensive care unit (ICU). Hospital mortality was 4% for the younger and 7% for the elderly (p = 0.61). The long term survival was the same in the two age groups both when all patients were included and when patients with pancreatic cancer were analysed separately. CONCLUSION: Subtotal pancreatectomy for cancer can be done safely in the elderly which is why chronological age alone is not a contradiction to resection of a periampullary or pancreatic head malignancy provided that the patients are carefully selected.

Adult↗

PubMed1975

Effect of pancreatectomy or adrenalectomy on the responses of rats to meal-feeding.

The effects of partial pancreatectomy or adrenalectomy and insulin or corticosterone replacement on the responses of rats to meal-feeding were studied. Partial pancreatectomy lowered glucose-6-phosphate dehydrogenase (G6PD) and malic enzyme (ME) activities and resulted in higher blood glucose levels. Partial pancreatectomy did not affect the ability of the animals to adapt to meal-feeding. Insulin supplementation of the pancreatectomized rats restored G6PD and ME activities to those observed in the intact animals and normalized the blood glucose levels in the ad libitum-fed rats. Adrenalectomy decresed the survival of rats subjected to meal-feeding. Eighty percent of the rats died when meal-fed a high glucose diet. Survival was improved when either a 66.5% starch diet or a 40.5% fat diet was substituted for the 66.5% glucose diet. Adrenalectomized meal-fed animals fed 66.5% glucose had higher G6PD and ME activities and higher liver lipid levels than both the adrenalectomized ad libitum-fed and the sham-operated meal-fed rats. Glucocorticoid supplementation lowered G6PD activity in the adrenalectomized meal-fed rats but had no effect on ME activity or liver lipid. Meal-fed adrenalectomized rats had lower liver and serum cholesterol levels than meal-fed intact rats and ad libitum-fed adrenalectomized rats. These cholesterol levels were increased with glucocorticoid supplementation. It was concluded that adaptation to meal-feeding involves an adrenal response to the periodic absence of dietary energy intake, and that the degree of involvement of this response is determined by the composition of the diet.

Adrenal Glands↗

PubMed1979

Anastomotic ulceration following subtotal and total pancreatectomy.

Ulcerogenic potential exists after subtotal gastrectomy, pancreatic resection and separation of the pancreatic and bile ducts from the gastric outlet. Collectively, as with radical pancreatoduodenectomy or total pancreatectomy, a substantial risk of an anastomotic ulcer developing can be expected. To elucidate this, we reviewed the records of 297 patients who had undergone either radical pancreatoduodenectomy (Whipple procedure) or total pancreatectomy. We found that 18 patients (6%) had developed an anastomotic ulcer and that total pancreatectomy was statistically more ulcerogenic than a Whipple procedure. An anastomotic ulcer a virulent complication; two-thirds of the patients had bleeding, and it was a contributing cause of death in 22% of patients in whom ulcer developed. In patients who have a favorable prognosis, the addition of vagectomy to either procedure should be considered.

Adult↗

PubMed1979

Histopathology in the evaluation of total pancreatectomy for ductal carcinoma.

Whipple resections for pancreatic head carcinoma are often inadequate because tumor is left behind in the body and tail. Thirty-six patients have undergone total pancreatectomy for various conditions, of which 25 have undergone total pancreatectomy, for ductal carcinoma. Thirty-seven per cent of these 25 patients have shown histologic evidence that a Whipple resection would not have adequately removed tumor-bearing pancreatic tissue. Three patients had carcinoma spreading up and along the common bile duct from a primary ductal carcinoma in the head of the pancreas. Four patients had tumor infiltrating in continuity into the pancreatic body and tail at a distance from the palpable tumore in the head well to the left of a Whipple transection site. Five patients had widespread multifocal autonomous tumor involving other areas in the gland but with tumor palpable only in the head of the pancreas. Three patients (12%) died postoperatively. The two year survival rate is 32%, and the five year survival, 19%. Histological factors affecting the survival prognosis include 1) positive nodes, 2) tumor extension up the common duct, and 3) intrapancreatic extension and multicentricity of tumor mandating total pancreatectomy for hope of cure in at least 38% of cases.

Humans↗

PubMed1992

Preoperative indications for extended pancreatectomy for locally advanced pancreas cancer involving the portal vein.

This retrospective study attempted to determine the indications for extended pancreatectomy for locally advanced carcinoma of the pancreas, in terms of postoperative prognosis. An extended pancreatectomy with portal vein or superior mesenteric vein (PV/SMV) resection and regional lymphadenectomy was performed in 35 of 50 consecutive cancers that extended into the retroperitoneal spaces and involved the PV or SMV. Among the many background factors in the 35 resected specimens, the degree of PV/SMV invasion by the cancer was most closely associated with prognosis, despite resection of all involved PV/SMV. This factor generally correlated with the preoperative findings on the portal phase of superior mesenteric arteriograph. In 17 selected patients in whom PV/SMV invasion had been angiographically both semicircular or less and 1.2 cm (1.4 cm on the film) or less in length, the 3-year survival rate was 59%. This survival rate was significantly higher than the 29% 3-year survival rate in all 35 patients (p less than 0.05). Conversely, among the 18 patients in whom invasion was angiographically either beyond semicircular or more than 1.2 cm (1.4 cm on the film) in length, there were no 1.5-year survivors, and this result was even worse than that of 15 nonresectable cases. Based on postoperative survival, the degrees of PV/SMV invasion on preoperative angiography (narrowing pattern and length) are good indicators for aggressive pancreatectomy for locally advanced pancreatic cancer.

Adenocarcinoma↗

PubMed1995

Segmental occlusion of the pancreatic duct with prolamine to prevent fistula formation after distal pancreatectomy.

OBJECTIVE: The authors used prolamine (Ethibloc, Ethicon GmBH, Norderstedt, Germany) for segmental obstruction of the pancreatic duct to prevent pancreatic fistula development after distal pancreatectomy combined with total gastrectomy for gastric malignancies. SUMMARY BACKGROUND DATA: Although the initial clinical application of prolamine was pancreatic duct obstruction for patients with pancreatitis and undergoing pancreatic transplantation and pancreaticoduodenectomy for pancreatic cancer, there are no reports on prevention of pancreatic fistula formation after distal pancreatectomy. METHODS: Prolamine (0.2 mL) was injected into the distal segment of the main duct in the remaining pancreata of 51 patients. Small pancreatic ducts on the cut surface, from which prolamine extravasates, were closed by ligation, the main duct was ligated doubly, and the transected pancreatic margin was closed 15 minutes after phenylpropanolamine hydrochloride injection. RESULTS: No patient developed a pancreatic fistula or the complication of arterial bleeding due to prolonged infection. CONCLUSION: Segmental obstruction of the pancreatic duct with prolamine is useful for preventing pancreatic fistula development after distal pancreatectomy.

Amylases↗

PubMed1997

Transcontinental shipping of pancreatic islets for autotransplantation after total pancreatectomy.

Islet autotransplantation prevents diabetes in some patients after total pancreatectomy. Pancreatectomy is done at most hospitals but islets are prepared at only a few centers. We report a case in which the pancreas was sent to a laboratory half a continent distant from the operative site, and islets were prepared and returned to the original hospital for autotransplantation 16 h after resection. At 10 months posttransplantation, the patient is normoglycemic and insulin independent, with an appropriate insulin secretion in response to glucose. Endocrine function can be retained after pancreatectomy even if the islets are isolated at a remote laboratory, and autotransplantation could be offered to patients without the need to travel. This outcome implies that the typical handling and processing of a pancreas destined to yield an islet allograft should not prevent the recovery of a sufficient number of viable beta cells to establish insulin independence in type 1 diabetic recipients.

Adult↗

PubMed2000

Pancreatic inflammation, apoptosis, and growth: sequential events after partial pancreatectomy in pigs.

Positive signs of pancreas regeneration were observed in rats after induced pancreatitis and partial pancreatectomy (1,2). Although the human pancreas did not regenerate after partial anatomic resection (3), the pig pancreas exhibited growth responses to bombesin after partial pancreatectomy (4). This study was undertaken to establish the time course of pancreatic inflammation, apoptosis, and hypertrophy and/or hyperplasia after partial pancreatectomy in pigs.

Animals↗

PubMed2004

Spleen-preserving total pancreatectomy with conservation of the spleen vessels:: operative technique and possible indications.

Conventional distal pancreatectomy (cDP) and total pancreatectomy (cTP) also involve removal of the spleen. The spleen, however, is an important organ in the immunologic defense of the host and is worthy of preservation if this can be safely achieved. We performed a spleen-preserving total pancreatectomy (SPTP), with good results, in a Caucasian woman, 66-year-old, affected by pancreatic metastases of renal clear cell carcinoma. This is the first report of a SPTP for pancreatic metastases to our knowledge, and we therefore wish to describe the surgical technique and to suggest the possible indications for this new technique.

Adenocarcinoma, Clear Cell↗

PubMed1991

Total pancreatectomy in the pig for islet transplantation. Technical alternatives.

Pigs appear to be a suitable biological and logistical animal donor of islets for xenotransplantation in human diabetic type I recipients. To improve the islet isolation technique in this species, to evaluate the islet function in vivo, and to assess the toxic effects of various immunosuppressive regiments on transplanted islets will necessitate a model of the pancreatectomized pig suitable for islet autotransplantation. We describe three techniques of total pancreatectomy in pigs. The first removed the pancreas in order to study postoperative management and pig survival; no attempt was made to preserve the pancreas for islet isolation. The second consisted of a pancreatectomy in a surviving pig, with careful preservation of the whole pancreas for subsequent islet isolation. The third was rapid en bloc procurement of the pancreas and duodenum, to obtain a pancreas solely for the purpose of islet isolation. We conclude that pigs tolerate and survive a total pancreatectomy--they are suitable animals for islet isolation and possible autotransplantation. The result of islet isolation does not appear related to the pancreas procurement technique; however, the islet yield must be improved before autotransplantation can be functionally successful.

Animals↗

PubMed2006

Central pancreatectomy for benign pancreatic pathology/trauma: is it a reasonable pancreas-preserving conservative surgical strategy alternative to standard major pancreatic resection?

BACKGROUND: The aim of this study was to assess the technical feasibility, safety and outcome of central pancreatectomy (CP) with pancreaticogastrostomy or pancreaticojejunostomy in appropriately selected patients with benign central pancreatic pathology/trauma. Benign lesions/trauma of the pancreatic neck and proximal body pose an interesting surgical challenge. CP is an operation that allows resection of benign tumours located in the pancreatic isthmus that are not suitable for enucleation. METHODS: Between January 2000 and December 2005, eight central pancreatectomies were carried out. There were six women and two men with a mean age of 35.7 years. The cephalic pancreatic stump is oversewn and the distal stump is anastomosed end-to-end with a Roux-en-Y jejunal loop in two and with the stomach in six patients. The indications for CP were: non-functional islet cell tumours in two patients, traumatic pancreatic neck transection in two and one each for insulinoma, solid pseudopapillary tumour, splenic artery pseudoaneurysm and pseudocyst. Pancreatic exocrine function was evaluated by a questionnaire method. Endocrine function was evaluated by blood glucose level. RESULTS: Morbidity rate was 37.5% with no operative mortality. Mean postoperative hospital stay was 10.5 days. Neither of the patients developed pancreatic fistula nor required reoperations or interventional radiological procedures. At a mean follow up of 26.4 months, no patient had evidence of endocrine or exocrine pancreatic insufficiency, all the patients were alive and well without clinical and imaging evidence of disease recurrence. CONCLUSION: When technically feasible, CP is a safe, pancreas-preserving pancreatectomy for non-enucleable benign pancreatic pathology/trauma confined to pancreatic isthmus that allows for cure of the disease without loss of substantial amount of normal pancreatic parenchyma with preservation of exocrine/endocrine function and without interruption of enteric continuity.

Abdominal Injuries↗

PubMed1986

The effect of pancreatectomy on the uptake of metabolites by the sheep fetus.

The effects of fetal pancreatectomy on the uptake of oxygen, glucose and lactate by the fetus, uterus and uteroplacental tissues were investigated in chronically catheterized sheep during the last third of gestation. Pancreatectomy reduced the uptake of glucose by the fetus but had little apparent effect on glucose uptake by the uterus or uteroplacental tissues. The mean umbilical uptake of glucose by the pancreatectomized fetuses was 10.4 +/- 1.1 mumol/kg . min (n = 4) which was significantly less than the value observed in the intact fetuses (24.5 +/- 2.7 mumol/kg . min, n = 4, P less than 0.01). When all the data from the pancreatectomized and intact fetuses were combined, there was a significant positive correlation between the plasma insulin concentration in utero and the umbilical uptake of glucose (r = 0.95, n = 14, P less than 0.01). The glucose/oxygen quotient in the pancreatectomized fetuses (0.32 +/- 0.02, n = 9) was significantly less than the value observed in the intact fetuses (0.59 +/- 0.04, n = 6, P less than 0.01). There was also a significant positive correlation between the glucose/oxygen quotient and the plasma concentration of insulin in the fetus (r = 0.73, n = 59, P less than 0.01). Pancreatectomy had no significant effect on the fetal lactate/oxygen quotient or on the uptake of oxygen or lactate by any of the tissues. These observations demonstrate that the endogenous concentration of insulin is a physiological regulator of glucose uptake by the fetal tissues.

Animals↗

PubMed1984

Management of secondary diabetes mellitus after total pancreatectomy in infancy.

We report five children who required total pancreatectomy in the neonatal period for life threatening hypoglycaemia. Subsequent diabetes was managed with once daily subcutaneous insulin, oral pancreatic extract, and a controlled carbohydrate diet. Daily home blood glucose profiles in four of these children were different from those of 14 C-peptide negative children with type 1 insulin dependent diabetes--in the pancreatectomy group there was less variation in blood glucose throughout the day with a fall after breakfast as against a rise after breakfast in the type 1 group. Hyperglycaemia (greater than 10 mmol/l) with or without ketonaemia was extremely rare in the pancreatectomy group. Despite neonatal convulsions, physical growth and development have been normal. Hypoglycaemia, usually after food refusal, has been a major problem. In addition, there have been considerable emotional and family disturbances despite the excellent metabolic control, which presumably reflect the cumulative difficulties in managing such young children with diabetes.

Blood Glucose↗

PubMed1998

Pancreatic exocrine and endocrine function after pancreatectomy for persistent hyperinsulinaemic hypoglycaemia of infancy.

AIM: To evaluate long term detailed pancreatic endocrine and exocrine function in children with persistent hyperinsulinaemic hypoglycaemia of infancy (PHHI) after 85-95% pancreatectomy. METHODS: Six children with PHHI between 0.9 and 12.7 years after pancreatic resection underwent clinical and investigative follow up at 1.0 to 14.9 years of age. One child with PHHI who had not had pancreatectomy was also assessed. Standard endocrine assessment, pancreatic magnetic resonance imaging (MRI), and detailed direct and indirect tests of exocrine pancreatic function were performed. RESULTS: Pancreozymin-secretin stimulation test results were normal in only one child, borderline in two, and deficient in four, one of whom requires daily pancreatic enzyme supplements. Pancreolauryl tests performed in three children were borderline in two and abnormal in the other. Only one child had low faecal chymotrypsin values. One child developed insulin dependent diabetes at 9 years and two children at 1.0 and 13.3 years require diazoxide to maintain normoglycaemia. MRI showed no major regrowth of the pancreatic remnant after resection (n = 5). CONCLUSIONS: Clinical evidence of endocrine or exocrine dysfunction has developed in only two patients to date, but detailed pancreatic function testing suggests subclinical deficiency in all but one of our patients with PHHI. Although 95% pancreatectomy results in postoperative control of blood glucose, subclinical pancreatic insufficiency is present on long term follow up and development of diabetes mellitus and exocrine failure remain ongoing risks.

Child↗

PubMed2006

Laparoscopic distal pancreatectomy with splenic preservation for serous cystadenoma: a case report and literature review.

A minimally invasive approach can be beneficial in a spleen-preserving distal pancreatectomy. This article reports a 71-year-old woman who presented to her internist with hypertension and persistent hypokalemia. A computed tomography scan to rule out a functional adrenal mass incidentally revealed a 4 cm x 3 cm x 2 cm serous cystadenoma of the distal pancreas and normal adrenal glands. The patient was referred to the general surgery service for resection of the distal pancreatic lesion. A laparoscopic spleen-preserving distal pancreatectomy was performed. The lesion was completely excised, and the pathology revealed serous cystadenoma with focal fibrosis and atrophic acini. The postoperative advantages of this approach were the early return of bowel function, minimal narcotic requirements, and early resumption of normal activities. This case illustrates the advantages of minimally invasive surgery in the performance of a spleen-preserving distal pancreatectomy.

Aged↗

PubMed1980

[Changes in glucose metabolism and endocrine function in the remnant pancreas after major pancreatectomy, with special reference to the function of the anti-insulin system in Sandmeyer's diabetes (author's transl)].

Changes in glucose tolerance and the function of the anti-insulin system after a major resection of the canine pancreas were divided into three types. Immediately after the removal of 90 per cent or more of the pancreas, diabetes developed, and the function of the anti-insulin system was depressed, showing a poor response of glucagon secretion to hypoglycemia after insulin load and degeneration or destruction of the islet cells and both A and B cells, and the dosage of insulin required to control blood sugar was close to that of a total pancreatectomy. 6 to 24 weeks after the removal of 70 to 90 per cent of the pancreas, so-called Sandmeyer's diabetes occurred, in which glucose tolerance and the function of the anti-insulin system were within the normal range during the early postoperative periods, but the function of the anti-insulin system was highly activated later, showing a high response of pancreatic glucagon secretion to hypoglycemia after insulin load, accompanied by degeneration of B cells, but not A cells. These results could well explain the fact that the insulin dosage needed to control blood sugar in Sandmeyer's diabetes was 3 to 4 times more than it was in total pancreatectomy. After the removal of 70 per cent or less of the pancreas, diabetes did not occur, and glucose tolerance and the function of the anti-insulin system were maintained well, without any significant change in the islets of the remnant pancreas. Insulin therapy relieved the disturbed function of the anti-insulin system in diabetes following pancreatectomy.

Animals↗

PubMed1977

Decrease of non-suppressible insulin-like activity after pancreatectomy and normalization by insulin therapy.

Non-suppressible insulin-like activity (NSILA-S) was determined in 5 dogs before and after pancreatectomy and again during insulin therapy. All NSILA-S determinations were carried out on serum samples which were passed over Sephadex G-50 columns equilibrated with 1 M acetic acid. The levels of NSILA-S decreased drastically shortly after pancreatectomy and rose slowly after institution of insulin therapy, to normal levels. During the period of severe diabetes after pancreatectomy the concentration of growth hormone was elevated. These findings indicate that 1) the pancreas cannot be the site of synthesis and release of NSILA-S, 2) NSILA-S levels do not always parallel growth hormone levels and 3) the synthesis and secretion of NSILA-S among other factors is under the control of insulin.

Animals↗