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At least 37 records · Page 2Linked to original sources
PubMed1997

The cystic fibrosis transmembrane conductance regulator as a marker of human pancreatic duct development.

BACKGROUND & AIMS: The cystic fibrosis transmembrane conductance regulator (CFTR) protein is a small conductance adenosine 3',5'-cyclic monophosphate (cAMP)-activated chloride ion channel found in the apical membranes of epithelia within the pancreas, airway, intestine, bile duct, sweat gland, and male genital ducts. Pancreatic insufficiency is a feature of about 85% of patients with cystic fibrosis and is believed to be caused by pancreatic autolysis after pancreatic duct obstruction. The aim of this study was to investigate the expression of CFTR in the pancreas from early development to postnatal life to establish whether the CFTR plays a key role in development of the pancreatic duct epithelium. METHODS: Expression of CFTR from the start of the mid-trimester of human development through term to adult life by messenger RNA (mRNA) in situ hybridization was examined. RESULTS: CFTR mRNA is detected throughout the pancreatic duct epithelium and its pattern of expression follows the differentiation of the duct system. CONCLUSIONS: CFTR is a valuable marker of human pancreatic duct cell development and differentiation.

Aging↗
PubMed1987

Presence of endocrine cells in pancreatic ducts.

Pancreatic endocrine cells were found in close contact with epithelial cells (either the centro-acinar or those lining the ducts). Junctional specializations were present between both cell types, demonstrating that they are structurally associated. In some instances, the endocrine cells present in the wall of the ducts reached the luminal space having direct contact with the pancreatic juice. These cells may well be responsible for the secretion of islet hormones directly in the duct lumen. The islet hormones present in the pancreatic juice as reported previously, seems to play a significant role in the interactions between the gut and the pancreas for optimal regulation of digestive activity.

Animals↗
PubMed2006

Acute suppuration of the pancreatic duct associated with pancreatic ductal obstruction due to pancreas carcinoma.

Acute obstructive suppurative cholangitis is a well-known clinical entity; however, acute suppuration of the pancreatic duct in the setting of pancreatic ductal obstruction is an uncommon pancreatic disorder. We report a case of acute suppuration of the pancreatic duct without either a concomitant pancreatic abscess or an infected pseudocyst, presenting as acute relapsing pancreatitis. In this case, the underlying cause of suppuration of the pancreatic duct was pancreatic ductal obstruction and chronic pancreatitis secondary to pancreas head carcinoma along with infection of Escherichia coli. Endoscopic placement of a pancreatic stent resulted in an evacuation of grayish thick pus from the distal pancreatic duct with a dramatic improvement of the disease. This case proposes the concept that acute suppuration of the pancreatic duct is a complex process involving the chronically damaged pancreas, pancreatic outflow obstruction, and subsequent bacterial infection. Antibiotic treatment is effective but temporary; therefore, the immediate drainage of the infected pancreatic duct is mandatory.

Aged↗
PubMed1977

Detection of bacterial infection of the pancreatic ducts in patients with pancreatitis and pancreatic cancer during endoscopic cannulation of the pancreatic duct.

Bacterial infections of the pancreas and bacteremia may occur during episodes of pancreatitis. Detection of bacterial infections of the pancreas in the past has required laparotomy. The present study was undertaken to determine whether bacterial infection of the pancreas occurred during nonsuppurative pancreatitis. During endoscopic cannulation of the main pancreatic duct, secretin was administered intravenously and pancreatic juice aspirated from within the duct was cultured. Bacterial infections were detected in 11 of 35 patients with pancreatitis and 3 of 5 with pancreatic cancer. The pancreatic juice was sterile in 25 controls. Cultures from the common bile duct in 9 controls were also sterile whereas 4 of 6 with pancreatitis showed infected bile. The infecting organisms were principally gram-negative and the infections were usually polymicrobial. Antibiotics, where used, successfully eradicated the infecting organisms but did not appear to affect the patient's clinical course.

Adult↗
PubMed2003

Wall stent-enhanced lateral pancreaticojejunostomy for small-duct pancreatitis.

HYPOTHESIS: The purpose of this study was to see if a small (<7 mm) pancreatic duct could be dilated to an acceptable diameter, allowing lateral pancreaticojejunostomy to decompress the pancreatic duct and relieve pain, while preserving pancreatic endocrine and exocrine function. DESIGN: Patients with chronic pancreatitis who had a small main pancreatic duct underwent progressive trans-ampullary dilation of the duct and subsequent placement of an expandable metallic wall stent (wallstent; Boston Scientific Microvasive Division, Natick, Mass). Approximately 14 days later, a lateral pancreaticojejunostomy was done. SETTING: A 400-bed university referral center hospital in an urban setting. PATIENTS: Thirty-five patients were selected from a large group with chronic pancreatitis. Thirty-one had pancreas divisum. All patients had undergone transendoscopic sphincterotomies and stenting before being accepted into the study. All had endoscopic retrograde cholangiopancreatography-proven chronic pancreatitis, and all ducts were observed to be 7 mm or smaller. INTERVENTIONS: Patients were selected after endoscopic sphincterotomy and stenting failed. Progressive transendoscopic duct dilation with plastic stents was carried out, and a 10-mm expandable metallic wall stent was placed prior to surgical decompression. Lateral pancreaticojejunostomy was performed. MAIN OUTCOME MEASURES: Patients were observed for pain relief, postoperative symptoms, analgesic use, glucose intolerance, and quality of life. All patients were seen or contacted by telephone, and their results were recorded. RESULTS: There were no operative deaths, but 26% of patients had complications. Seventy-one percent of patients reported that their pain was better than preoperatively. Three patients had subsequent pancreatic surgery. No new cases of diabetes occurred except in the 2 patients who underwent total pancreatectomy. CONCLUSIONS: In general, most patients feel that their lives were improved by the procedure. A quarter of the patients no longer take narcotics, and many have been able to resume a relatively normal lifestyle. Although this procedure is not a panacea for all patients with chronic pancreatitis and a nondilated duct, it is a reasonable alternative to resection.

Adult↗
PubMed2006

Clearance of irretrievable bile duct and pancreatic duct stones by extracorporeal shockwave lithotripsy, using a transportable device: effectiveness and medium-term results.

BACKGROUND AND GOALS: Extracorporeal shockwave lithotripsy (ESWL) is an established treatment of irretrievable biliary and pancreatic stones, but the cost of the shockwave generators limits its widespread use. We revised data about the effectiveness of our treatment for refractory stones using a transportable shockwave generator. STUDY: We retrospectively evaluated the short and medium-term outcomes of patients who underwent ESWL using a transportable electromagnetic shockwave generator between 1998 and 2003 at our unit, for the treatment of irretrievable bile duct or pancreatic duct stones. All patients received intravenous conscious sedation and antibiotic prophylaxis. RESULTS: Complete stone clearance was achieved in 70/82 patients (85.4%), in 66 of the patients (94.2%) with 1 session of ESWL. Despite the insertion of a stent in the bile duct, 2 patients had moderate cholangitis, while they waited for the next ESWL session. We did not record any moderate-severe complication of ESWL, but 2 patients underwent surgery owing to perforation/bleeding during endoscopic removal of residual fragments. A symptomatic recurrence of stones was recorded in 10/69 (14.5%) patients, who had been previously cleared and whose follow-up data (median follow-up 29 mo; range 7 to 66) were available. CONCLUSIONS: We obtained satisfactory stone clearance by using a transportable shockwave generator. Most patients required 1 session. Our experience confirmed the safety of the treatment, even though patients may experience cholangitis while awaiting definitive treatment. The use of a transportable ESWL generator may be a valuable option in centers, while ensuring a sufficient proficiency in biliary endoscopy.

Adult↗
PubMed1988

Acute hypercalcemia, pancreatic duct permeability, and pancreatitis in cats.

We investigated the effects of hypercalcemia on pancreatic duct permeability and pancreatitis in cats. Acute hypercalcemia was maintained by an infusion of calcium gluconate; controls received saline solution. Chronic hypercalcemia was maintained by diet and by vitamin D and dihydrotachysterol injections. Portal venous blood was analyzed for large dextran molecules that had been perfused through the pancreatic duct. In a separate group of hypercalcemic animals, we perfused the duct with activated pancreatic enzymes to induce acute pancreatitis. After 24 hours of hypercalcemia, dextrans were detected in the portal venous blood of 6 of 11 hypercalcemic and none of the 6 control animals (p less than 0.05). After 12 hours of hypercalcemia, dextrans were detected in all 7 hypercalcemic and 1 of 7 control animals (p less than 0.001). The degree of pancreatic inflammation was greater in the 12-hour animals than in the controls (p less than 0.001). After 14 days of hypercalcemia, however, there were no differences in dextran permeability or pancreatitis in experimental or control animals. Our results indicate that acute hypercalcemia increases the permeability of the pancreatic duct to molecules the size of pancreatic enzymes. This could be important in the pathogenesis of acute pancreatitis associated with hypercalcemic states.

Acute Disease↗
PubMed1991

[Histopathological study on branches of the pancreatic duct in obstructive pancreatic disorders].

Branches of the pancreatic duct in obstructive pancreatic disorders were studied histopathologically. Obstructive pancreatic disorders were observed in 25 out of 32 patients with pancreatic carcinoma. The main pancreatic duct was dilated in all 25 cases. Luminal conditions in the branches of the pancreatic duct were divided as follows: dilated, obstructed and unchanged. The dilated duct was found in all 25 cases and showed mainly cystic dilatation with flat epithelia. The obstructed duct was found in 10 cases and revealed granulation tissue in the lumen, disappearance of epithelia and increase in the number of elastic fibers in the periductal space. The pancreatic tissue distal to the tumor frequently showed isolated islets of Langerhans with elastosis. Morphogenesis of elastosis was interpreted as follows: during the process of shortening or disappearance of the duct, elastic fibers increased in number and remained in the fibrous tissue. Hence, the elastosis was considered to be a remnant in which the pancreatic duct had once existed. Therefore, the branches of the pancreatic duct in obstructive pancreatic disorder were classified into four types as follows: dilated, obstructed, remnant and unchanged.

Adult↗
PubMedDate not supplied

Endoscopically placed pancreatic stent in a patient with concomitant two locations of main pancreatic duct disruption following pancreatic trauma.

Severe pancreatic trauma involving disruption of the main pancreatic duct usually requires operative management. Recently, the successful non-operative treatment of proximal main pancreatic duct injuries by pancreatic stent has been described as having good results. Computed tomography of a 36-year-old man who sustained a blunt abdominal trauma in a motor vehicle accident disclosed a large amount of fluid in the cavity of the lesser sac, as well as a laceration of the pancreatic parenchyma at the pancreatic neck. Without definite evidence of pancreatic duct injury during laparotomy, no pancreatic resection was performed. However, postoperative endoscopic retrograde cholangiopancreatography showed 2 sites of main pancreatic duct disruption at the pancreatic neck and body, respectively. The first attempt for endoscopic pancreatic drainage failed with the endoscopic nasopancreatic drainage tube penetrating into the peritoneal cavity through the distal disruption site. A 5-French pancreatic stent was used for another attempt and successfully passed through the proximal disruption site with its tip located just proximal to distal disruption site. The patient improved steadily and was discharged uneventfully. The presenting case demonstrated that the endoscopically placed pancreatic stent was highly effective for the management of severe pancreatic trauma even though there were 2 sites of main pancreatic duct disruption, and pancreatic resection could be avoided.

Adult↗
PubMed1997

Expression of Bcl-2 and PCNA in duct cells after pancreatic duct ligation in rats.

Obstruction of the pancreatic duct induces acinar cell deletion followed by duct proliferation and interstitial fibrosis. Apoptosis has been reported to be involved in the induction of acinar cell deletion after pancreatic duct ligation (PDL) in rats, however, the mechanism of pancreatic duct cell proliferation is still unknown. We hypothesized that Bcl-2 (antiapoptosis protein) and PCNA (cell cycle-related protein) could be involved in the mechanism of pancreatic duct cell proliferation after PDL. In PDL, rats, acinar cells decreased in number and disappeared completely after duct ligation and duct-lining cells increased in number and formed duct-tubular complexes. Immunohistochemical study showed that PCNA expression appeared in the ductules and centroacinar cells from early stages after duct ligation and that Bcl-2 expression in duct cells, which was faint in normal pancreas, increased significantly when acinar cells were diminishing. Western blotting demonstrated that Bcl-2 was detected as a single band at 26 kDa, and the intensity of Bcl-2 in PDL rats was approximately ninefold stronger than in normal pancreas. Expression of Bcl-2 and PCNA after pancreatic duct ligation may be related to the prevention of apoptosis and cell proliferation of pancreatic duct cells in rats.

Animals↗