Objective To establish the model of pancreatoduodenal allotransplantation in pigs with enteric drainage (ED) and portal venous drainage (PVD). Methods Forty-six hybrid landraces were divided into two groups (donor and recipient groups) randomly, for pancreatoduodenal allotransplantation. Donors were perfused via abdomial aorta without clamping the portal venous outflow with UW solution after heparinization. Whole pancreatoduodenal graft was arvested with segments of abdomial aorta and portal vein and shaped under cold UW solution. Then, the end-to-end nastomosis was performed with the donor iliac artery bifurcation “Y” graft to the recipient superior mesenteric arteries and celiac artery. Furthermore, type Ⅰdiabete model was made by removal of the recipient pancreas. The venous anastomosis was reconstructed between the donor portal vein and the recipient superior mesenteric vein. Meanwhile, the end-to-side anastomosis was performed with the donor common iliac artery bifurcation “Y” graft to the recipient abdomial aorta and the side-to-side intestinal anastomosis was performed between the donor duodenum and the recipient jejunum. External jugular vein was intubated for transfusion. The levels of blood glucose， insulin and glucagon in blood were measured before and during the operation and 1， 3， 5， 7 d after operation. Results Twenty-three cases of pancreatoduodenal allotranplantations were performed on pigs. One died from complication of anesthesia. Success rate of operation was 95.7％.Complications of operation happened in 2 cases in which one was phlebothrombosis, incidence 4.5％and the other was duodenojejunal anastomotic leak, incidence 4.5％. The level of blood glucose increased within 30 min and recovered on the 2nd day after removal of pancreas. The levels of insulin and glucagon decreased within 30 min and recovered on the 2nd day after removal of pancreas. Rejection curred at the 1st day and reached the worst level on the 9th day after transplantation without the change of insulin and glucagon in blood and clinical symptoms of rejection. Conclusion Pancreatoduodenal transplantation in pigs can treat type Ⅰ diabete. ED and PVD can keep the function of endocrine in normal. The technique of duodenal transplantation with ED and PVD may pave the way for the further development of pancreas transplantation in clinic.
Objective To investigate the CT imaging features of pancreatic fatty replacement and its clinical significance. Methods Three patients with pancreatic fatty replacement detected by CT were retrospectively analyzed. CT examination included plain scan and contrast-enhanced scanning at the arterial and portal venous phases. The shape, size, density, pancreatic lobulation and interlobular spaces, course of the pancreatic duct were carefully observed. The clinic and laboratory data were also analyzed to determine the clinical significance of pancreatic fatty replacement. Results ①Imaging features: Two patients had complete fatty replacement involving the entire pancreas, another one had most fatty replacement sparing the posterior aspect of head and tail. Two patients had regular configuration of pancreas. The size of pancreas was slightly enlarged in 2 patients. Lobular atrophy and widening of interlobular spaces were present in all 3 patients. The pancreatic duct was normal in 3 patients. ②Clinic findings: Chronic diarrhea was present in 3 patients. Two patiens had diabetes （one had chronic cholangitis with choledochal lithiasis）， another one had small stone in the common bile duct. Serum lipase was low in 3 patients, of which one had low serum amylase. Conclusion Pancreatic fatty replacement demonstrates certain characteristic CT appearances, and is usually associated with disturbances of both the endocrine and exocrine functions of the pancreas.
ObjectiveTo analyze the CT features of solid pseudopapillary tumor of pancreas (SPTP). MethodsEight patients with SPTP received triple phasic contrast-enhanced CT, and its consistency with pathological findings was analyzed. ResultsSPTP manifested as a solitary and exogenous mass, with a heterogeneous pattern composed of solid and polycystic parts. The shape of SPTP was spherical in four patients, oval in two patients, and shallow lobulation in another two patients. In contrast-enhanced phase images, the solid parts showed mild to moderate enhancement in both arterial and portal phases. Complete capsule was showed in seven patients, and nodules were found in the wall of mass in five patients. Hemorrhage was seen in two patients and calcification was showed in five patients. The dilation of pancreatic duct was found in one patient, liver metastases was showed in one patient, and the invasion of tumor to posterior gastric wall was found in one patient. Pseudopapillary structure, hemorrhage, necrosis, and cystic degeneration were showed in all patients by histological study. ConclusionSPTP has certain characteristic CT imaging manifestations consistent with histological features, which is helpful for the diagnosis and differential diagnosis of SPTP.
ObjectiveTo explore the effect of endotoxin on insulin secretion from islet βcell of rat pancreas.MethodsAfter the model of endotoxemia was established in rats with intraperitoneal injection of LPS (2 mg/kg),the changes of insulin level in the serum and pancreas were dynamically determined, the expression of inducible nitric oxide synthase (iNOS) by situ hybridization and DNA damage in islet cells were also observed, the effect of sodium nitroprusside (exogenous NO) on synthesis and secretion of insulin from isolated islet βcell of normal rat pancreas under high glucose stimulation was also evaluated.ResultsThe level of glucose and insulin in plasma were significantly increased at 12th and 6th h, respectively and kept on 3 d after injection of LPS,but the insulin level in pancreas was not remarkably altered.The expression of iNOS and DNA damaged significantly enhanced at 6 d after endotoxemia. The high glucosestimulated insulin synthesis and secretion were bly inhibited by exogenous NO.ConclusionThese findings suggest that LPS be stimulate the expression of iNOS and NO product,which inhibites synthesis and secretion of insulin in islet βcells,but it stimulates insulin secretion by another mechanism,and results in dysfunction and destruction of the rat pancreas.
Objective To explore the value of pathologic diagnosis for pancreatic head mass by using recise Tru-cut biopsy under intraoperative ultrasound guided. Methods Twenty-eight patients with solid pancreatic masses in People’s Hospital of Suqian，Affiliated Hospital Xuzhou Medical College from August 2010 to August 2011 were performed precise Tru-cut biopsy under intraoperative ultrasound guided. In all patients of 28 cases, male 20 cases and female 8 cases, the male-to-female ratio was 5∶2. The patients’ age was 34-78 years old（mean age： 64 years old）. Twenty-eight patients were divided into three groups based upon the greatest dimension of the masses as follows：equal or less than 1.5 cm （group S, 5 cases）, 1.5-3.0cm （group M, 7 cases）, and greater than 3.0cm （group L, 16 cases）. Three needlepasses in each mass were performed. The results of postoperative pathologic findings were compared with specimens in paraffin sections. Results In all cases of 28, the diagnostic coincidence rate was 100%, there were no false positive finding and false negative. The coincidence ratio for pathological diagnosis of tissues with only 1 strip sample （1/3）, only 2 strip samples （2/3）, and with 3 strip samples （3/3） were 3/5, 2/5, and 0/0, respectivly in S group, 0/0, 5/7, and 2/7, respectivly in M group, and 0/0, 4/16, and 12/16, respectivly in L group. The false negative rate of single strip sample in S group and M group was higher than that in L group （χ2=9.833，P=0.002）. There was false negative finding with master single test in small focus of infection. Conclusion Precise Tru-cut biopsy under intraoperative ultrasound guided is a safe and highly accurate method for pathological diagnosis of patients with solid pancreatic lesions, especially in small lesions，it is worthy of clinical application..
ObjectiveTo investigate the imaging findings of carcinoma of body and tail of the pancreas. MethodsTotally twentythree patients with carcinoma of body and tail of the pancreas were studied. The diagnosis was proven by surgery and pathological findings. The imaging features of twentythree cases were reviewed including the location, size, shape, texture, and enhancement patterns of the tumor masses. Five cases underwent enhanced MRI examination, 18 cases underwent enhanced spiral CT examination. ResultsThe tumors located in the pancreatic body in 5 cases, located in the tail in 7 cases, and located in the body and tail of pancreas in 11 cases. The tumor masses were irregular in shape and heterogeneously hypointense from CT scan. From MR, the masses were slightly hypointense on T1WI, and slightly or mixed hyperintense on T2WI. Nineteen cases showed heterogeneous slight enhancement and four cases had no enhancement. The tumors were well demarcated in five cases, while those were poorly defined in the other 18 cases. Metastatic lymphadenopathy was shown in 16 cases, vascular invasion in 8 cases, and metastatic lesions of other organs in 3 cases. ConclusionThe carcinoma of body and tail of the pancreas shows certain characteristic imaging. CT and MRI examination can reflect the morphologic features, the hemodynamic alterations, and the involvement of adjacent structures and organs.
Objective To approach the recent advances in diagnosis and surgical treatment of pancreatic endocrine tumors （PETs）. Methods Articles relevant to diagnosis and treatment of PETs were collected and reviewed. Results PETs are characterized by their ability to over-produce peptides and hormones， which cause specific clinical syndromes. Because of rare incidence and complex clinical syndromes， there are still impediments to early diagnosis of these tumors. Monitoring of serum hormones and imaging method allow early tumor detection. PETs have been investigated for the past several decades. With the great knowledge of these tumors in molecular genetic level， clinical managements have been greatly changed. Conclusions Avoiding misdiagnosis is important for treatment of PETs. Surgical approach is still considered as the preferred option for curtailing the malignant progression of PETs and controlling the associated biochemical syndromes.
Objective To investigate the roles of cell apoptosis and the gene expressions of Fas, FasL, bcl-2 and bax in acute rejection of pancreaticoduodenal transplantation and to evaluate the function of duodenum biopsy for early detection of rejection in rats. Methods Wistar and SD rats were divided into two groups: ①Wistar rats that underwent allogenic pancreaticoduodenal transplantation from the organs of SD rats; ②Wistar rats that received homogenic transplantation. The grafts were then harvested on day 3, 5 and 7 after the transplantation, and all graft samples were observed with HE staining and TUNEL was also used to detect apoptotic cells. The expressions of Fas, FasL, bcl-2 and bax were measured by immunochemical method. According to Nakhleh’s score, pathologic features of transplanted pancreas and duodenum were ranged from one to three scores in order. Results The percentage of same or different scores between the pathological scores of pancreas and duodenum in allogenic pancreaticoduodenal transplantation group were 61.1% (11/18) and 38.9% (7/18) respectively, and there were 6 specimens of pancreatic tissue got higher scores with only one higher score for duodenum. There were significant differences of histopathologic rejection scores and apoptotic indices between the two groups, respectively (P＜0.05， P＜0.01). Apoptotic indices of pancreas and duodenum both showed positive correlations with histopathologic rejection scores (r=0.965， P＜0.01; r=0.942, P＜0.01). The rejection score and apoptotic index elevated, the expression of FasL increased, bcl-2 decreased, and Fas and bax changed over time after operation. Conclusion Apoptosis maybe significantly positive correlated with the degrees of damage of the acute pancreaticoduodenal allograft rejection, and the apoptotic index maybe valuable to estimate the damage. FasL and bcl-2 were significantly related to the impairment of acute pancreatic allograft rejection as well. Duodenum biopsy may contribute to the early diagnosis of the rejecting transplanted tissues.
【Abstract】 Objective To investigate the effect of verapamil on apoptosis, calcium and expressions of bcl-2 and c-myc of pancreatic cells in ischemia-reperfusion rat model. Methods Wistar rats were randomly divided into three groups: control group （n=10）; ischemia-reperfusion group （n=10）; verapamil treatment group （n=10）. The anterior mesenteric artery and the celiac artery of rats in both ischemia-reperfusion group and verapamil treatment group were occluded for 15 min followed by 12-hour reperfusion. Verapamil （1 mg／kg） was injected via caudal vein to the rats in verapamil treatment group 15 min before occlusion and 1 hour after the initiation of reperfusion, respectively; and ischemia-reperfusion group was given the same volume of salient twice intravenously. Pancreatic tissues were collected from the dead rats after twelve hours since the reperfusion. The pathologic characters of pancreatic tissue were observed under light microscope; The level of calcium in the tissue was measured by atomic absorption spectrometer; TUNEL was used to detect apoptosis of pancreatic cells; and the expressions of c-myc and bcl-2 in the cells were also analyzed by immunohistochemistry technique and flow cytometry. Results The pathologic change in verapamil treatment group was less conspicuous than that of ischemia-reperfusion group. Both the calcium level and the number of apoptotic cells in verapamil treatment group were less than those of ischemia-reperfusion group 〔（411.1±55.8） μg/g dry weight vs （470.9±31.9） μg/g dry weight, P＜0.05 and （9.5±2.9）% vs （18.4±3.1）% 〕, P＜0.05. After taking verapamil, the number of apoptotic cells decreased, whereas the expressions of bcl-2 and c-myc increased. The fluorescent indexes of bcl-2 and c-myc in verapamil treatment group were significantly higher than those of ischemia-reperfusion group (1.72±0.11 vs 1.41±0.07, P＜0.05; 1.76±0.19 vs 1.55±0.13, P＜0.05. Conclusion Ischemia-reperfusion injury can induce apoptosis of pancreatic cells. Verapamil could protect the injured pancreatic tissue by reducing the level of calcium, stimulating the expressions of bcl-2 and c-myc and inhibiting apoptosis of pancreatic cells.
【Abstract】Objective To investigate the effect of ischemia on the treatment of advanced body and tail carcinoma of pancreas. Methods In operation the proximal spleen artery was ligated, a chemotherapy pump was installed to connect the distal spleenic artery and urea solution (40%) was injected through the device during and after operation. The pathology and pathophysiology change in dogs were observed. Results All the eight dogs studied were alive after operation, no serious complication appeared, pancreatic cells were replaced by fibrosis. Conclusion Infusion of 40% urea solution is a safe and effective ischemic method, it can lead to all sorts of pancreatic cell necrosis and fibrosis. It may be a good madality in the treatment of advanced pancreatic carcinoma.