Eishi Miyashita

Pancreatic function and rehabilitation after pancreaticoduodenectomy

Postoperative pancreatic function and rehabilitation were monitored in 149 patients who had had reconstruction of the digestive tract by Childs method, out of a total 151 patients who had undergone pancreaticoduodenectomy. The occurrence of peptic ulcer following Childs method may be prevented by the resection of a wider area of the stomach. Because the source of gut hormone secretion is removed by the pancreaticoduodenectomy, the secretion of this hormone is subsequently reduced and thus metabolic abnormalities also occur. If careful attention however, is paid to the maintenance of residual pancreatic function most patients who undergo pancreaticoduodenectomy can be expected to lead reasonably normal lives.

Effects of Intravenous Fat Emulsion Administration on Exocrine and Endocrine Pancreatic Function

A study was made of alterations in exocrine and endocrine function of the pancreas following infusion of a 10% fat emulsion preparation (Intralipid) into 5 patients after pancreaticoduodenectomy and in 5 dogs with a chronic pancreatic fistula. Pancreatic exocrine secretion was significantly increased by 18.3% in the volume, 27.5% in the output of bicarbonate in humans and 8.9% in the volume, 26.1% in the output of amylase, 7.6% in the output of bicarbonate in dogs, by intravenous administration of the fat emulsion. The administration of the fat emulsion was followed by slight to minimal changes in blood sugar, amylase and IRI. The blood IRG level was significantly elevated but showed small fluctuations. The increase in pancreatic exocrine secretion induced by the fat emulsion was considered not to be mediated by intrinsic hormones but rather to be due to other humoral mechanisms.

Malignant insulinoma with metastasis to gallbladder and bone, accompanied by past history of peptic ulcer and hyperthyroidism

SummaryA case of a malignant insulinoma in a 53-year-old female is presented. In 1973, the patient underwent caudal pancreatectomy for a malignant insulinoma. Ten years later, it was discovered that the insulinoma had spread to the bones. On admission for cholecystectomy because of a gallbladder polyp and gallstones, she often experienced hypoglycemic attacks, and both calcium and glucagon provocation tests elicited marked release of insulin. Selective angiography of the common hepatic artery showed a tumor blush near the hilum of the liver. Immunohistochemical staining of the gallbladder polyp and the bone tumors proved positive for insulin. Plasma levels of insulin and prolactin were abnormally high. The patient had also been treated for a perforated duodenal ulcer and hyperthyroidism. It is concluded that this may have been a case of a multiple endocrine neoplasia.

Abstracts of selected papers presented at the 29th annual meeting of the japanese society of gastroenterology

S OF SELECTED PAPERS PRESENTED AT THE 29TH A N N U A L MEETING OF THE JAPANESE SOCIETY OF GASTROENTEROLOGY K0fu, Japan, November 5--7, 1987 Chairman: Katsuhiko SUGAHARA, M.D.