Chromosomal instability in in vivo radiation exposed subjects

OBJECTIVE: To analyze the efficacy of extended drainage--that is, longitudinal pancreaticojejunostomy combined with local pancreatic head excision (LPJ-LPHE)-and pylorus-preserving pancreatoduodenectomy (PPPD) in terms of pain relief, control of complications arising from adjacent organs, and quality of life. SUMMARY BACKGROUND DATA: Based on the hypotheses of pain origin (ductal hypertension and perineural inflammatory infiltration), drainage and resection constitute the main principles of surgery for chronic pancreatitis. METHODS: Sixty-one patients were randomly allocated to either LPJ-LPHE (n = 31) or PPPD (n = 30). The interval between symptoms and surgery ranged from 12 months to 10 years (mean 5.1 years). In addition to routine pancreatic diagnostic workup, a multidimensional psychometric quality-of-life questionnaire and a pain score were used. Endocrine and exocrine functions were assessed in terms of oral glucose tolerance and serum concentrations of insulin, C-peptide, and HbA1c, as well as fecal chymotrypsin and pancreolauryl testing. During a median follow-up of 24 months (range 12 to 36), patients were reassessed in the outpatient clinic. RESULTS: One patient died of cardiovascular failure in the LPJ-LPHE group (3.2%); there were no deaths in the PPPD group. Overall, the rate of in-hospital complications was 19.4% in the LPJ-LPHE group and 53.3% in the PPPD group, including delayed gastric emptying in 9 of 30 patients (30%; p < 0.05). Complications of adjacent organs were definitively resolved in 93.5% in the LPJ-LPHE group and in 100% in the PPPD group. The pain score decreased by 94% after LPJ-LPHE and by 95% after PPPD. Global quality of life improved by 71% in the LPJ-LPHE group and by 43% in the PPPD group (p < 0.01). CONCLUSIONS: Both procedures are equally effective in terms of pain relief and definitive control of complications affecting adjacent organs, but extended drainage by LPJ-LPHE provides a better quality of life.     

Changes in lymph node dissection for pancreatic cancer

Two step pancreatoduodenectomy for periampullary carcinoma was first reported in 1912 by Kausch. Pancreatoduodenectomy performed for carcinoma of the head of the pancreas was first reported in 1937 by Brunschwig. Before this report, all previous pancreatoduodenectomy had been performed for other periampullary tumors. By the 1960's, pancreatoduodenectomy was performed for pancreatic cancer without lymph node dissection. However, Fortner advocated regional pancreatectomy for pancreatic cancer in 1973. In our institute, also, extended radical pancreatectomy by translateral retroperitoneal approach has been performed during the past 2 decades. Many Japanese surgeons also adopted extend pancreatectomy. In the 1980's, extended radical pancreatectomy consisted of paraaortic lymph node dissection, total pancreatectomy, and complete resection of extrapancreatic nerve plexus. However, based on the many clinicopathologic studies, pancreatoduodenectomy was better operative procedure than total pancreatectomy. Although extended radical pancreatectomy has the advantage of long-time survival, disadvantage of nutritional status and quality of life was produced by this operative procedure. Tarverso and Longmire reported new operative procedure of pylorus preserving pancreatoduodenectomy (PPPD) in 1978. Recently, this operative procedure was indicated for pancreatic cancer. However, there is a question whether PPPD is the best operative procedure for pancreatic cancer or not.     

Left ventricular shape analysis from three-dimensional echocardiograms

Cystic fibrosis patients require pancreatic enzyme supplements to aid food digestion. It is suspected that incorrect delivery of this enzyme may result in both significant malabsorption and the development of strictures in the proximal colon caused by the high-dose supplement reaching this region before the food. Investigations into the drug's delivery were performed using dual-isotope imaging; a method was developed to directly label the enteric-coated enzyme pellets with 111In, re-applying the enteric coating afterwards, and this was then ingested with a pancake meal labelled with 99Tcm-tin colloid. Consecutive image data, acquired over a period of > or = 4 h using a dual-headed gamma camera, were analysed to assess intestinal transit. In-vitro stability checks on these labelling techniques were encouraging, showing < 2% 99Tcm and < 7% 111In elution over 90 min in hydrochloric acid. In 5 of the 12 patients studied to date, the pellets were seen to pass through significantly faster than the food, with a mean difference in 50% gastric emptying time of greater than 93 min. The mean absolute difference in emptying time for all 12 patients was > 67 min. Thus, a technique has been developed to effectively radiolabel pancreatic enzyme pellets, and analysis of dual-isotope images using this preparation, together with radiolabelled solid food, has demonstrated significant differences in the transit of these two substances through the gastrointestinal tract of some cystic fibrosis patients.     

Surgical treatment of pancreatic head and periampullary tumors

The aim of this study was the comparison of the postoperative results of standard Whipple pancreatoduodenectomy (WP), pylorus preserving pancreatoduodenectomy (PPPD) and palliative bypass operation performed for treatment of pancreatic head and periampullary tumors. In the period from Jan. 1992 to 1996 106 patients had tumors located in the head of pancreas and 21 patients had periampullary tumors. The diagnosis was established by ERCP, transabdominal ultrasonography and computer tomography. We assessed the morbidity, mortality, prognostical data of the surgery of pancreatic head and periampullary tumors. Tumor markers such as CEA, CA 19-9 and CA 125 were also studied. The operability rate was 26% in case of pancreatic head tumors and 69% in peri ampullary tumors. The mortality rate was 6%. Postoperative complications were in 23 patients(18.1%). There was no significant difference between the survival of WP and PPPD group, but we found much better survival in patients with periampullary tumor. After palliative operation the survival rate was 6.1 months in case of pancreatic head carcinoma and 11 months in case of periampullary tumors. Our data provided many evidences about the advantage of PPPD in the patients with malignant periampullary and pancreas head tumors and the long-term results and quality of life is much better after PPPD.     

Prospective, randomized trial on the effect of cyclic versus continuous enteral nutrition on postoperative gastric function after pylorus-preserving pancreatoduodenectomy

OBJECTIVE: The effect of a cyclic versus a continuous enteral feeding protocol on postoperative delayed gastric emptying, start of normal diet, and hospital stay was assessed in patients undergoing pylorus-preserving pancreatoduodenectomy (PPPD). SUMMARY BACKGROUND DATA: Delayed gastric emptying occurs in approximately 30% of patients after PPPD and causes prolonged hospital stay. Enteral nutrition through a catheter jejunostomy is used to provide postoperative nutritional support. Enteral infusion of fats and proteins activates neurohumoral feedback mechanisms and therefore can potentially impair gastric emptying and prolong postoperative gastroparesis. METHODS: From September 1995 to December 1996, 72 consecutive patients underwent PPPD at the Academic Medical Center, Amsterdam. Fifty-seven patients were included and randomized for either continuous (CON) jejunal nutrition (0-24 hr; 1500 kCal/24 hr) or cyclic (CYC) enteral nutrition (6-24 hr; 1125 kCal/18 hr). Both groups had an equal caloric load of 1 kCal/min. The following parameters were assessed: days of nasogastric intubation, days of enteral nutrition, days until normal diet was tolerated orally, and hospital stay. On postoperative day 10, plasma cholecystokinin (CCK) levels were measured during both feeding protocols. RESULTS: Nasogastric intubation was 9.1 days in the CON group (n = 30) and 6.7 days in the CYC group (n = 27) (not statistically significant). First day of normal diet was earlier for the CYC group (15.7 vs. 12.2 days, p < 0.05). Hospital stay was shorter in the CYC group (21.4 vs. 17.5 days, p < 0.05). CCK levels were lower in CYC patients, before and after feeding, compared with CON patients (p < 0.05). CONCLUSIONS: Cyclic enteral feeding after PPPD is associated with a shorter period of enteral nutrition, a faster return to a normal diet, and a shorter hospital stay. Continuously high CCK levels could be a cause of prolonged time until normal diet is tolerated in patients on continuous enteral nutrition. Cyclic enteral nutrition is therefore the feeding regimen of choice in patients after PPPD.     

Value of pylorus preserving partial duodenopancreatectomy in ductal pancreatic carcinoma]

In a study compiling the data in a prospective manner, the value of the pylorus-preserving duodenopancreatectomy (PPPD) compared to partial duodenopancreatectomy (PD) in patients suffering from ductal pancreatic carcinoma was assessed. Postoperative morbidity, mortality and overall prognosis were analysed. From May 1990 to April 1995 130 patients entered the study; 61 underwent PD, 69 patients had PPPD. The patients were regularly followed up every 6 months and the median follow-up period for all patients was 36 months. PPPD in patients with ductal pancreatic head carcinoma without infiltration of the duodenum is the technically simpler and faster operation method with significantly less blood loss. Moreover, PPPD did not lead to increased postoperative complications. The median survival rate of patients in the PD group was 10.8 months, in the PPPD group 21 months. This significant difference derives from the fact that the tumor stages were unevenly distributed. Regarding the most common stage (stage III according to UICC) the median survival times were almost identical (PD group 10.1 months, PPPD group 11.2 months). The PPPD operation seems to be a sufficiently radical procedure which does not worsen the prognosis of the disease.     

The role of pancreatogastrostomy following pancreatoduodenectomy for trauma

The records of all patients undergoing pancreatogastrostomy after pancreatoduodenal resection at the University of Kansas Medical Center were reviewed. Five patients with a mean age of 26 years (range, 20-32 years) and severe penetrating (n = 3) or blunt (n = 2) traumatic injuries have required pancreatoduodenectomy followed by pancreatogastrostomy (n = 4) or pancreatogastrostomy alone (n = 1) since 1975. Their mean Trauma Score was 12 (range, 9-16). All five patients had soft, previously normal pancreatic glands without induration or ductal dilatation. The mean duration of surgery was 6 hours (range, 5-7 hours), mean blood loss was 7200 mL (range, 1,000-17,500 mL), mean transfusion requirements were 14 units of blood (range, 2-32 units), and mean hospital stay was 37 days (range, 11-90 days). Two patients developed right upper quadrant abscesses that required a second procedure. There were no pancreatic anastomotic leaks, fistulas, or other complications related to the pancreatogastrostomy. At last examination, all five patients were alive and well and had not developed endocrine or exocrine pancreatic insufficiency after a mean follow-up of 4 years (range, 1-9 months). Pancreatogastrostomy following pancreatoduodenectomy for trauma has not been previously reported. Our experience demonstrates that pancreatogastrostomy is a safe and expeditious method for handling the pancreatic remnant following pancreatoduodenectomy. Furthermore, the results of this study suggest that pancreatogastrostomy has several advantages over pancreatojejunostomy for restoring pancreato-intestinal continuity in trauma patients.     

Pancreatic exocrine function

Stimulation of the pancreatic secretion of water, electrolytes, and enzymes is under neurohumoral control sensitive to the ingestion and digestion of food. Hormones interact to maximize physiologic responses to a meal and to autoregulate pancreatic secretion. Clinical manifestations of pancreatic exocrine insufficiency may result from obstruction to pancreatic flow through the major duct or to destructive disease of the exocrine cells; this insufficiency is a consequence of reduced volume, electrolytes, and enzyme output.     

The effect of octreotide on gastric emptying at a dosage used to prevent complications after pancreatic surgery: a randomised, placebo controlled study in volunteers

BACKGROUND: Octreotide is used in many centres to prevent complications after pancreatic surgery. Delayed gastric emptying is a another complication occurring in around 30% of patients after pancreatoduodenectomy (PD) and causes prolonged hospital stay. The influence of octreotide on this complication is doubtful. AIMS: To assess the effect of octreotide, at the clinical dosage used after pancreatic surgery, on gastric emptying in healthy volunteers. SUBJECTS AND METHODS: Eight healthy male volunteers (mean age 22.5 years) participated in this double blind, placebo controlled study. On day 1 subjects received 100 micrograms of octreotide or placebo subcutaneously, three times daily and on day 2, one hour after the fourth injection, gastric emptying, postprandial cholecystokinin (CCK) release, and mouth to caecum transit time (MCTT) were measured. This protocol was repeated after one week, in a crossover design. On the test day subjects received a liquid test meal (1.57 MJ/300 ml) and gastric emptying measurements were performed with applied potential tomography, an non-invasive, validated technique which measures gastric emptying through impedance differences. From the gastric emptying curves, lag time, t50, and postlag emptying rate were measured. MCTT was measured using the hydrogen breath test. RESULTS: Lag time decreased from 29.6 (6.3) (mean (SEM)) to 12.2 (4.6) minutes (p < 0.05) during octretide treatment; t50 decreased from 87.8 (12.0) to 47.5 (8.2) minutes (p < 0.02) and there was a trend towards an increased postlag emptying rate (0.8 to 1.6% per minute; p = 0.07). MCTT increased from 150 (12.7) to 229 (17.9) minutes during octreotide treatment (p < 0.01). Octreotide suppressed postprandial CCK release (p < 0.05). CONCLUSIONS: MCTT was delayed by octreotide, suggesting impairment of small bowl treatment. Octreotide administered at the clinical dosage for pancreatic surgery accelerates gastric emptying, mainly by shortening the lag time. Suppression of postprandial CCK release may be involved in this process. Octreotide administration is therefore not a contributing factor in the pathogenesis of delayed postoperative gastric emptying after PD and might even play a role in preventing this complication.     

Gas in the temporomandibular joint: computed tomography findings. Report of 3 cases

BACKGROUND: The advantages of pancreatogastrostomy over pancreatojejunostomy after pancreaticoduodenectomy are still debated. This study analyses the results of pancreatogastrostomy to identify factors that could influence immediate outcome. METHODS: During a 10-year period, 160 consecutive patients underwent a pancreatogastrostomy. There were 109 men (68 per cent) and 51 women (32 per cent) with a mean(s.d.) age of 59(10) (range 22-82) years; 27 patients were older than 70 years. The following parameters were assessed: mortality rate, morbidity, reasons for reoperation, length of hospital stay, duration of nasogastric tube and drainage. RESULTS: Hospital mortality rate was 3 per cent; overall morbidity rate was 30 per cent. The reoperation rate was 12 per cent, mainly because of bleeding at the pancreatic margin. Delayed gastric emptying occurred in 36 patients. The overall rate of pancreatic fistula was 2.5 per cent. Age, sex, indications for pancreatoduodenectomy, and the texture of the pancreatic remnant did not influence the occurrence of pancreatic fistula or delayed gastric emptying. CONCLUSION: This study confirmed that pancreatogastrostomy is a safe procedure with low mortality and morbidity rates.     

Lack of dose-response with Pancrease MT for the treatment of exocrine pancreatic insufficiency in adults

BACKGROUND: Choosing the optimum pancreatic enzyme replacement therapy for patients with exocrine insufficiency remains a problem. An enteric coated enzyme microsphere pancreatic enzyme preparation (Pancrease) has been marketed with several levels of lipase activity, implying that there is a dose-response relationship between dose and effectiveness such that the high potency form appears to be the most cost effective. METHODS: In a randomized, single-blind, cross-over study, we evaluated the effectiveness of a commercial enzyme preparation with different amounts of lipase per dosage unit in adults with exocrine pancreatic insufficiency. Patients received a diet comprising 100 g fat each day for 6 days. With each meal (three per day) they received two capsules of either Pancrease MT4 (8000 unit lipase), Pancrease MT10 (20,000 units lipase), Pancrease MT16 (32,000 units lipase) or placebo. A 72-h quantitative faecal collection was carried out for the last 3 days of the 6-day period. RESULTS: There was a reduction in faecal fat excretion with each of the preparations compared to placebo. The difference failed to reach significance with the 8000 units lipase preparation (P > 0.05) but was significant (P = 0.02) with the 20,000 units lipase and the 32,000 units lipase preparations (faecal fat excretion: placebo = 42.1 +/- 29 g, lipase 8000 = 22.1 +/- 7.3 g, lipase 20,000 = 10.2 +/- 4.5 g and lipase 32,000 = 15.8 +/- 12.5 g, P < for 20,000 units and 32,000 units lipase compared to placebo). CONCLUSION: A dose-response relationship between the amount of lipase administered with each meal and a reduction in faecal fat was not evident. The most potent preparation did not provide additional benefits compared to the less expensive lower potency dosage form.     

Motility of the canine pyloric ring following a pylorus-preserving pancreatoduodenectomy

Recently, function-preserving operations have become popular, and pylorus-preserving pancreatoduodenectomy (PPPD) is frequently performed for diseases of the head of the pancreas. However, there are only a few basic studies on the pyloric function after PPPD. Using strain gauge force transducers (SGTs), we studied the pyloric motility of normal and PPPD dogs. We prepared three normal and three PPPD dogs in which the SGTs were implanted onto the antrum and pyloric ring, etc. In conscious dogs, the spontaneous gastrointestinal motility was recorded, and the plasma motilin concentration was measured during the interdigestive state. Following the administration of exogenous Leu13-motilin, the motility was again recorded. The relaxation and opening of the pyloric ring was observed synchronously with intense contractions of the antrum during the phase III of normal dogs. Phase III-like motility was recorded in the PPPD dogs, which was not a typical periodic motility. The plasma motilin concentration of one PPPD dog could be measured, and the motilin levels during the phase III-like motility were higher than during phase I. The phase III-like motility was induced by Leu13-motilin in both normal and PPPD dogs. The phase III-like motility recorded in the PPPD dogs was not a typical periodic one, and this aberrant motility was considered to be one of the causes of delayed gastric emptying. Phase III-like motility was induced by the administration of Leu13-motilin; therefore, it is possible that Leu13-motilin improved the motility of the pyloric ring after PPPD.     

Effect of ammonia on the anaerobic degradation of protein by a mesophilic and thermophilic biowaste population

The purpose of this study was to assess the effect of gastrointestinal proteins on the in vitro release of zidovudine (AZT) from ethylcellulose microspheres, and to investigate protein adsorption as a possible mechanism that mediates this effect. AZT release from ethylcellulose microspheres was tested in the presence of different gastrointestinal proteins, both dietary (casein and albumin) and endogenous (pepsin, pancreatin, and mucin) in simulated gastric fluid and/or simulated intestinal fluid. The resulting release profiles were compared with those produced in the corresponding release media without the presence of proteins. Protein adsorption on AZT-loaded ethylcellulose microspheres was studied for the five proteins under investigation. The amounts of adsorbed proteins were determined by fluorescent spectrometry after the protein solution was reacted with fluoraldehyde reagent. All of the investigated proteins were found to slow the release of AZT from ethylcellulose microspheres. At gastric pH, ovalbumin and casein had the maximum effect on AZT release. Mucin exerted a more pronounced effect at gastric pH compared with that at intestinal pH. The negative effect of pancreatin on AZT release increased when its concentration was increased. The five proteins were found to adsorb on AZT-loaded ethylcellulose microspheres with varying quantities. The observed protein adsorption is believed to cause blockage of the small pores and channels in the microsphere structure, and consequently slow the release of AZT.     

Rapid distal small bowel transit associated with sympathetic denervation in type I diabetes mellitus

BACKGROUND: The pattern of progression of a meal from the stomach to the caecum in diabetes mellitus is controversial and the differential roles of transit through the jejunum and the ileum have not been investigated in diabetes. AIMS: To determine gastric emptying and transit rates through proximal and distal regions of the small bowel in type I diabetic patients. SUBJECTS: The study included six diabetic patients with evidence of autonomic neuropathy (DM-AN group), 11 diabetics without autonomic dysfunction (DM group), and 15 control volunteers. METHODS: Gastric emptying and small bowel transit of a liquid meal were evaluated scintigraphically in these subjects. Transit through regions of interest corresponding to the proximal and distal small intestine up to the caecum was determined and correlated with gastric emptying rates, cardiovascular measurements of autonomic function, and the occurrence of diarrhoea. RESULTS: Gastric emptying and transit through the proximal small bowel were similar in the three groups. The meal arrived to the caecum significantly earlier in DM-AN patients (median; range: 55 min; 22-->180 min) than in the DM group (100 min; 44-->180 min, p < 0.05) or in controls (120 min; 80-->180 min, p < 0.02). Accumulation of chyme in the distal small bowel was decreased in DM-AN patients, who showed values for peak activity (30%; 10-55%) significantly lower than in the DM group (49%; 25-77%, p = 0.02) and controls (50%; 30-81%, p = 0.02). In DM patients (n = 17), the time of meal arrival to the caecum was significantly correlated with both orthostatic hypotension (coefficient of contingency, C = 0.53, p < 0.01) and diarrhoea (C = 0.47, p < 0.05), but not with gastric emptying rates. CONCLUSIONS: Patients with type I diabetes mellitus and sympathetic denervation have abnormally rapid transit of a liquid meal through the distal small bowel, which may play a part in diarrhoea production.     

Five-year follow-up of a prospective randomised multi-centre trial of weekly chemotherapy (CAPOMEt) versus cyclical chemotherapy (CHOP-Mtx) in the treatment of aggressive non-Hodgkin''s lymphoma. Central Lymphoma Group

Benign tumors of the pancreatic head are normally treated by a partial duodenopancreatectomy. This operation has been developed for the treatment of malignant alterations in the pancreatic head and includes resection of the gastric bowel, duodenum and common bile duct. The aim of this study was to evaluate whether the less radical duodenum-preserving pancreatic head resection is a suitable surgical procedure in the treatment of benign pancreatic head tumors. From May 1982 to December 1996, seven patients underwent surgical treatment for benign pancreatic head tumors. Two patients suffered from gastrinoma of the pancreatic head, four exhibited a serous or mucinous cystadenoma, and one patient suffered from an intraductal papillary-mucinous tumor in this region. All patients were treated by duodenum-preserving pancreatic head resection. The operation was easily performed with little blood loss and a low rate of complications. None of the patients had to be reoperated upon due to postoperative surgical complications. After a follow-up period of a median 3 years, six of seven patients were had no recurrence of the disease and were symptom-free. One patient who had initially been operated on for gastrinoma still exhibited high gastrin values postoperatively. The endocrine and exocrine pancreatic function was not impaired in the early and late postoperative phase as compared to the preoperative assessment. From our results, it is concluded that duodenum-preserving pancreatic head resection is an adequately radical, yet organ-preserving procedure for the treatment of benign tumors of the pancreatic head without compromising endocrine and exocrine function.     

Subclinical chronic pancreatitis in type I hyperlipoproteinemia

Severe pancreatic exocrine insufficiency was demonstrated in a 41 year old man with familial type I hyperlipoproteinemia (fat-induced hyperlipemia). Plasma triglyceride concentration failed to increase significantly with increased dietary fat intake, and fecal fat excretion was markedly increased. Indices of intestinal function were normal. Pancreatic enzyme therapy resulted in reduced fat excretion and increased plasma triglyceride concentration. Secretin stimulation tests revealed impaired duodenal fluid volume, bicarbonate and pancreatic enzyme responses. Insulin-dependent diabetes mellitus had been diagnosed three years earlier. No attacks of acute pancreatitis had occurred in the preceding 20 years, and it is suggested that pancreatic damage may have resulted from repeated subclinical pancreatic insults due to elevated plasma lipid levels. This report is the first to indicate that pancreatic exocrine insufficiency may occur as a late complication of hyperlipemic disorders in the absence of recurrent acute pancreatitis. Steatorrhea may not be apparent because of therapeutic restriction of dietary fat, and the first manifestation of pancreatic exocrine disease may be an amelioration of fat-induced hyperlipemia.     

Jejunitis with malaborption. A quantitative study of the gastric and intestinal handling of a meal during malabsorption and after recovery

The gastric and intestinal response to a standard meal was examined with a quantitative multiple indicator dilution technique in a patient with jejunitis and malabsorption. Examinations were made during and after recovery from disease. The malabsorptive state was associated with a marked delay of the gastric emptying paralleled by a low gastric secretion rate. Despite the low delivery rate from the stomach, large fluid volumes passed at the investigated level 70 cm distal to the pyloric sphincter. This was due to a reduced absorption of nutrients and water during a rapid transit of the proximal intestine and to persistently high pancreatic and intestinal secretion rates. A comparison with data from the healthy experiment suggests that the strong gastric inhibition during malabsorption works as an effective compensation for the decreased absorptive capacity after the second hour from meal intake and onwards.     

Demethylation of the progesterone receptor CpG island is not required for progesterone receptor gene expression

In a previous study we have shown that an intravenous infusion of pramlintide (an analogue of human amylin) delayed gastric emptying, but the dose of pramlintide was supraphysiological in relation to the amylin response to food in non-diabetic subjects. The purpose of this study was to examine the dose response relationship of subcutaneous injections of pramlintide on gastric emptying and to determine whether administration of the drug before one meal has an impact on the subsequent meal. Eleven men with insulin-dependent diabetes mellitus were studied in a double-blind, randomised, four-way crossover design. None had autonomic neuropathy. Euglycaemia was maintained overnight before the study day. At -30 min the patients self-injected their usual morning insulin and at -15 min they injected the study drug (either placebo or 30, 60 or 90 microg pramlintide) subcutaneously. At 0 min they ate a standard meal consisting of a pancake, labelled with 99mTc, and a milkshake containing 3-ortho-methylglucose (3-OMG). Gastric emptying images were obtained for the next 8 h. At 240 min the subjects ate a similar meal, but on this occasion the pancake was labelled with (111)In. All three doses of pramlintide delayed emptying of the solid component of the first meal (p < 0.004) with no significant difference between the drug doses. There were no differences between placebo and pramlintide after the second meal. All three doses of pramlintide resulted in a prolongation in the time to peak plasma 3-OMG level (p < 0.0001) after the first meal but there was no difference after the second meal.     

Exocrine pancreatic function in hepatic cirrhosis

Exocrine pancreatic function was assessed by the standard test meal method of Lundh in a control group, and 13 patients with nonalcoholic, postnecrotic cirrhosis of the liver. In six of these patients, splenorenal shunts were performed and exocrine pancreatic function was assessed before and three months after operation. In three of the six, the secretin-pancreozymin stimulation test was also performed. An increased volume but normal trypsin output was observed in the unoperated cirrhotic patients. An increase both in volume and in trypsin was found in the cirrhotic patients after shunting using the test meal stimulation. There was no appreciable difference, however, when tested with secretin and pancreozymin. Hypersecretion in cirrhotics, with or without shunts, is probably due to a by-pass of the hepatic degradation of normal pancreatic secretogogues produced by the intestine.     

Ultrasonographic findings of diseases in peripheral lung fields using transtracheobronchial endoscopic ultrasonography (TUS)

Cystic neoplasms of the pancreas constitute about 9% of all cystic lesions of the pancreas and less than 1% of all pancreatic neoplasms. The case of a 70 years-old woman with microcystic cystadenoma is reported. CT-scan of the abdomen diagnosed a 5 cm multilocular septated cyst, with calcifications in the context, localized in the head-uncinate process of the pancreas. The mass was well separated by a sharp cleavage plane with portal vein and superior mesenteric vessels. An ERCP showed cephalic symmetrical stenosis (diameter 3 mm) of the main pancreatic duct (MPD), mildly dilated in the remaining tract (diameter 6 mm). An intraoperative biopsy of the cystic wall was performed. Therefore, it was decided to proceed with a duodenum-preserving resection of the head of the pancreas (DPPHR), including the stenosis tract of the MPD in the surgical specimen. The reconstructive procedure consisted, by i.v. jejunal loop transposition, in a side-to-side pancreatico-jejunostomy, including in the anastomosis both corpocaudal stump and the resection cavity of the pancreatic head, and an end-to-side Roux-en-Y jejuno-jejunostomy. With respect to long-lasting pain relief and preservation of the endocrine and exocrine functions of the pancreas, DPPHR is a highly effective surgical procedure with a low early and late morbidity and mortality due to limited surgical resection. This technique, introduced into surgical practice by Beger, is indicated in patients with chronic pancreatitis with an inflammatory mass in the head of the pancreas. The authors conclude that this procedure can be performed also in case of pancreatic benign tumors, as microcystic cystadenoma. Advantages of this technique makes DPPHR an attractive alternative to Pylorus-Preserving-Pancreatico-Duodenectomy (PPPD).