Schenk Wg

Clinical, pathologic, and therapeutic aspects of carcinoma of the pancreas

Summary The records of 121 cases of pancreatic carcinoma recorded over a ten year period (1962 through 1971) at a 600 bed county hospital were analyzed. In 109 cases, the tumor was visualized at either laparotomy or autopsy. The most frequent presenting symptoms were weight loss, jaundice, and abdominal pain. Laboratory studies showed evidence of obstructive jaundice, anemia, hypoproteinemia, and a reversed albumin/globulin ratio. An upper gastrointestinal series was a helpful diagnostic tool. The prognosis was uniformly poor, with a resectability rate of only 2.5 per cent. Reasonable palliation was obtained with bypass surgery. It is concluded that both biliary and duodenal bypass procedures should be used routinely to avoid having patients return for additional operation in the terminal stages. Recent developments in diagnosis and treatment are reviewed.

Evaluation of insulin secretion after pancreas autotransplantation by oral or intravenous glucose challenge

Segmental pancreatic autotransplantation is accompanied by surgical alterations to the pancreas that may have consequences for carbohydrate metabolism. Four mongrel dogs were evaluated before operation and sequentially until 40 weeks after total pancreatectomy and autotransplantation of the splenic lobe of the pancreas with bolus intravenous and oral administration. Intravenous glucose tolerance test (IVGTT) (0.5 g/kg) revealed maintenance of fasting euglycemia for as long as 40 weeks after operation. Peak glucose and integrated glucose values did not show significant changes as a result of autotransplantation. Following transplantation, a delayed peak insulin response was seen; however, basal, peak, and integrated insulin values were largely unaltered. Only K values, a measure of glucose disposal, showed severe alterations (2.44 +/- 0.21 before operation to 1.24 +/- 0.30 at 40 weeks after operation). Oral glucose tolerance tests (OGTT) (2.0 g/kg) demonstrated an increased peak hyperglycemic response after autotransplantation with increased integrated glucose responses. Insulin levels remained at those levels seen before operation, and glucose-dependent insulinotropic polypeptide (GIP) responses were unchanged during the OGTT as late as 20 weeks after operation. In conclusion, pancreas autotransplantation after total pancreatectomy results in significant metabolic alterations that the IVGTT fails to detect with absolute glucose or insulin levels. However, K values are significantly lowered, which indicates alterations in cellular glucose transport. The OGTT demonstrates hyperglycemia without increased insulin or GIP levels, which suggests an altered beta cell response to the enteric stimulus of insulin release. These changes are nonetheless well tolerated by animals that have remained clinically healthy and euglycemic in the basal state.