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Pancreatic endocrine function after total gastrectomy and truncal vagotomy

Oral and intravenous glucose tolerance tests were performed in four groups: (1) preoperative patients, (2) patients with interposition reconstruction after total gastrectomy, (3) patients with Roux-Y reconstruction after total gastrectomy, and (4) patients with intrathoracic replacement after esophagectomy. We obtained the following results: (1) Hyperglucagonemia in response to orally administered glucose occurred after truncal vagotomy and occurred in the presence and absence of gastric tissue. (2) compared wtih the preoperative study, all postoperative groups demonstrated glucose intolerance. (3) The glucose intolerance was due to increased glucagon, insulinopenia, and possibly nutritional factors. (4) The insulin response to intravenous glucose suggests an impairment in the first phase of insulin secretion in the surgically treated group, demonstrating a role for the vagus in insulin secretion. (5) The glucose tolerance curve shows that the interposition operation is superior the the Roux-Y operation.

Change of glucagon reacting to 30 K antibody in totally depancreatized dogs.

SummaryTotal pancreatectomy was performed in dogs; an arginine test was conducted at the first, second and third weeks after surgery, and measurement was made of blood glucose, glucagon and insulin on a time-course basis for a comparative study with normal dogs.1)After total pancreatectomy, glucagon reacting to 30 K antibody decreased once but increased with the lapse of time when no insulin was administered.2)In the arginine test, glucagon showed a biphasic reaction in normal dogs, but a monophasic reaction in totally depancreatized dogs. This reaction declined three weeks after surgery.3)When blood samples were taken from the pancreaticoduodenal vein, the left-gastroepiploic and mesenteric veins, during and after arginine was infused for 30 minutes. Glucagon in the pancreaticoduodenal vein increased markedly, but there were no such prominent changes in the left-gastroepiploic or mesenteric veins, Meanwhile, the level of glucagon in the left-gastroepiploic vein increased remarkably in dogs one week after total pancreatectomy.

Effect of exogenously administered glucagon on plasma glucose levels in totally depancreatized dogs

SummaryGlucagon was administered exogenously via a subcutaneous route to totally depancreatized adult mongrel dogs and studies were made with major emphasis on glucagon effect on the plasma glucose levels.1.In the totally depancreatized dogs, the plasma glucose levels determined 90 minutes after glucagon injection (40µg/kg s.c.) were compared with the pretreatment fasting plasma glucose levels. The rate of increase in the plasma glucose levels was 5.13±0.48 times (M±SEM) in dogs with low pretreatment levels (lower than 100 mg/dl). In dogs with higher pretreatment levels (100–400mg/dl), the increase was 1.62±0.40 times. And in dogs with the pretreatment levels higher than 400mg/dl, the value was 0.90±.07 times.2.Ninety minutes after regular insulin injection (0.25U/kg i.v.), glucagon was administered (40/smg/kg s.c), and the changes in the plasma glucose levels were determined.3.In totally depancreatized dogs, a transient increase in the plasma insulin level was noted when glucagon was administered (40/smg/kg s.c.) under infusion of a mixture of glucose and insulin.4.There was no significant difference in the rate of disappearance of glucagon from the blood between normal and totally depancreatized dogs.5.It is considered that glucagon would be useful for the treatment of hypoglycemia encountered after total pancreatectomy.