Serum amino-terminal propeptide of type III procollagen levels in chronic pancreatitis

The severity of pancreatic fibrosis, a characteristic feature of patients with chronic pancreatitis (CP), can be assessed only by direct histologic analysis of pancreatic tissue. Since serum levels of the amino-terminal type III procollagen propeptide (PIIIP) can reflect the degree of fibrogenic activity in several diseases associated with fibrosis, the current study was aimed at investigating whether PIIIP are increased in chronic pancreatitis, the relationship between PIIIP and pancreatic fibrogenic activity, and the influence of pancreatectomy, pancreatic exocrine function, and duration of disease on PIIIP levels. Serum PIIIP was measured in 18 patients with CP (15 without liver disease and three with cholestasis) and in 21 healthy controls. The effect of pancreatectomy on PIIIP was evaluated in seven patients, in whom PIIIP was measured immediately before and 2 months after surgery. Prolylhydroxylase (PHase) activity as an index of pancreatic fibrogenesis was evaluated in pancreatic tissue from 11 patients who had undergone subtotal pancreatectomy and from 11 organ donors. The bentiromide (BT)-PABA test as an index of exocrine pancreatic function was measured in all patients. PIIIP was significantly higher in patients who had or had not undergone pancreatectomy (17.3 +/- 4.0 and 25 +/- 11.4 ng/ml, respectively) than in controls (12.3 +/- 3.1 ng/ml) (p < 0.001). PIIIP decreased significantly after pancreatectomy (before, 32.0 +/- 9.3 ng/ml; after, 18.4 +/- 4.8 ng/ml; p = 0.005). PHase was significantly higher in patients (773 +/- 250 cpm/mg protein) than in controls (405 +/- 121 cpm/mg protein) (p < 0.001). PIIIP was correlated with pancreatic PHase (r = 0.7, p = 0.001) but not with BT-PABA or with the duration of the disease. In conclusion, serum PIIIP levels are increased in patients with CP and reflect the severity of pancreatic fibrogenic activity. No relationship between the serum PIIIP levels and the pancreatic exocrine function and duration of disease was found.

Quantitative morphological studies of aging changes in the kidney of the Lewis rat

Spontaneous aging changes in the kidneys of the rat have been previously described. In the Lewis strain, we performed semiquantitative studies of kidney histology and quantitative studies of glomerular basement membrane thickness and mesangial area in animals aged 6-30 months. There is a progressive increase in glomerular basement membrane thickness and mesangial area throughout the life of the rat. Spontaneous glomerulosclerosis in the Lewis rat does not appear to be as extensive as in other strains. The importance of spontaneous glomerulosclerosis in studies of induced kidney disease is emphasized.

Effect of fusidic acid on pancreatic islet allograft rejection

We examined in fully mismatched rats, the survival of pancreatic islet allografts in recipients treated with either fusidic acid (FA), an antistaphyllococcal antibiotic that has been shown to possess an immunosuppressive effect in vitro and in vivo, or cyclosporin-A (CsA). Islets were isolated by collagenase digestion, separated from acinar tissue by handpicking under a dissecting microscope and transplanted into the liver by portal vein injection of streptozotocin(STZ)-induced diabetic rats. The results indicated that while a temporary immunosuppression with CsA achieved an indefinite islet allograft survival, FA administered to recipients daily was not able to prevent islet allograft rejection across a major histocompatibility barrier. We conclude that despite the fact that fusidic acid has been claimed to act as an-immunosuppressant drug in vitro with effects similar to those of CsA, unlike CsA, FA given either orally or by s.c. injection was not effective to prolong islet allograft survival in vivo.

Effect of Fusidic Acid on Pancreatic Islet Allograft Rejection

We examined in fully mismatched rats, the survival of pancreatic islet allografts in recipients treated with either fusidic acid (FA), an antistaphyllococcal antibiotic that has been shown to possess an immunosuppressive effect in vitro and in vivo, or cyclosporin-A (CsA). Islets were isolated by collagenase digestion, separated from acinar tissue by handpicking under a dissecting microscope and transplanted into the liver by portal vein injection of streptozotocin(STZ)-induced diabetic rats. The results indicated that while a temporary immunosuppression with CsA achieved an indefinite islet allograft survival, FA administered to recipients daily was not able to prevent islet allograft rejection across a major histocompatibility barrier. We conclude that despite the fact that fusidic acid has been claimed to act as an immunosuppressant drug in vitro with effects similar to those of CsA, unlike CsA, FA given either orally or by s.c. injection was not effective to prolong islet allograft survival in vivo. Copyright © 1997 Elsevier Science Inc.

Prospective analysis of pancreatic grafts with duplex-Doppler ultrasound: value of resistive index in the diagnosis of rejection

The diagnosis of rejection and its differentiation from other causes of pancreatic graft dysfunction remain the basic problem in pancreas transplantation. A previous study with pulsed Doppler (PD) done at our institution demonstrated an increase of the resistive index (RI) during pancreatic graft rejection episodes. The aim of the study was to determine prospectively the utility of duplex-Doppler (DD) ultrasound (US) in identifying the cause of pancreatic graft dysfunction. The major clinical categories were graft rejection and graft pancreatitis.

[Thoracoscopic splanchnicectomy for intractable pancreatic pain]

Intractable pain is the most distressing symptom in nonresectable pancreatic carcinoma and in chronic pancreatitis. Recently, thoracoscopic splanchnicectomy has been advocated as a minimally invasive method of pain control in these patients. Between May 1995 and April 1998, 24 patients with nonresectable pancreatic cancer and 4 with chronic pancreatitis, underwent 43 thoracoscopic splanchnicectomies. All suffered from intractable pain, were opiate-dependent and unable to perform normal daily activities. Unilateral left splanchnicectomy was done in 13 and bilateral in 15. All procedures were completed thoracoscopically. Operative time ranged from 25 to 60 min and mean hospital stay was 3 days. Median pain intensity was reduced by 50% in 24 and no further narcotics or analgesics were required. We found thoracoscopic splanchnicectomy a safe and effective procedure for intractable pancreatic pain.

Pheochromocytoma: laparoscopic approach with CO2 and helium pneumoperitoneum

A number of different surgical approaches have been devised for adrenalectomy in patients with pheochromocytoma. The anterior transabdominal approach was at one time considered a source of postoperative morbidity; the advent of laparoscopy however, may result in a resurgence in its use. The laparoscopic approach was used with a CO2 pneumoperitoneum in one patient with a left pheochromocytoma, and using a helium pneumoperitoneum in another with bilateral pheochromocytoma. The left adrenalectomy took 135 minutes to perform and the total bilateral adrenalectomy 330 minutes. No transfusion was necessary. The postoperative stay was 4 days for both patients. To prevent the risk of CO2 retention during extended laparoscopic procedures, helium can serve as an alternative gas, as was documented in the patient who underwent total adrenalectomy. Unilateral or bilateral resection of pheochromocytoma can safely be performed laparoscopically and has the advantage of avoiding both the muscular trauma related to laparotomy and the rib resection necessary for the extraperitoneal approach.

[Preliminary experiences with endoscopic parathyroidectomy]

Since the advent of extraperitoneal approaches for laparoscopic surgery, the creation of extraperitoneal virtual spaces has spread rapidly. We describe our preliminary experience with selective neck exploration and endoscopic parathyroidectomy in 4 women, aged 57-74, with primary hyperparathyroidism. Preoperative localization of parathyroid adenoma was assessed by technetium-sestamibi scanning and cervical ultrasonography. A cervical work space was created by the introduction of a trocar with an inflatable balloon-tip and maintained with low-pressure CO2 insufflation. All procedures were completed endoscopically. There were no intraoperative complications. Mean operative time was 40 minutes and cosmetic results were very satisfactory. We found endoscopic parathyroidectomy a feasible and safe option and particularly appropriate for the surgical treatment of primary hyperparathyroidism. Further refinements in technique will enhance its practicability in exploring the mediastinum for ectopic parathyroid glands and in those with secondary hyperparathyroidism.

DNA ploidy and S + G2M fraction (proliferative index) as prognostic determinants in human periampullary cancer

BACKGROUND/AIMS

The aim of the present study was to investigate the relationship between pathological factors, DNA ploidy patterns, proliferative index and survival in a population of patients undergoing resection for adenocarcinoma of periampullary region.

MATERIALS AND METHODS

DNA ploidy and proliferative index of periampullary cancer tissue was measured by flow cytometry in 73 patients who had undergone pancreatoduodenectomy.

RESULTS

Seventy-four percent (n = 54) of cancers were diploid and 26% (n = 19) were aneuploid. The median survival time of patients with diploid cancers was 30.1 (s.d. 5.1) months and with aneuploid cancers was 16.0 (s.d. 2.9) months (p = 0.02). Kaplan-Meier survival curves showed that the patients with aneuploid cancers succumbed to recurrent disease within 40 months after surgery whereas 20% of patients with diploid cancers survived longer than 40 months. In patients with long survival (3 years) there was a significant difference between aneuploid and diploid cancers (p < 0.001). In the multivariate analysis, tumor location and tumor size are independent prognostic variables for the length of survival after resection of periampullary cancer.

CONCLUSIONS

DNA ploidy pattern appears to be one important prognostic predictor in patients with "long term" survival after successful pancreatoduodenectomy for periampullary cancers.

Prevention by whole pancreas transplantation of glomerular basement membrane thickening in alloxan diabetes

Serial thickness measurements of the glomerular basement membrane were performed over a 24-month period in four groups of inbred male Lewis rats. Group I consisted of normal animals age-matched to the remaining experimental groups. In groups II, III, and IV, diabetes was induced by intravenous alloxan (42 to 44 mg/kg). Group II was subsequently untreated. One week after induction of diabetes, groups III and IV received vascularized isografts of the pancreas and duodenum or duct-ligated pancreas alone, respectively. Animals in all groups were killed monthly and X 11,000 electron photomicrographs prepared of the kidney. The thickness of the glomerular basement membrane was measured by a quantitative morphometric technique. Untreated diabetic animals developed significant thickening of the basement membrane when compared to normal animals and the differences remained significant throughout life. Animals undergoing pancreas transplantation were completely protected from the diabetic changes in the basement membrane and showed no increase in basement membrane thickness when compared to normal animals. Pancreaticoduodenal and duct-ligated isografts offered equal protection against changes in the basement membrane. All groups showed age-related thickening of the basement membrane; this change was accelerated in the untreated diabetic group and normalized in the transplanted rats.

Correlates of cognitive impairment in elderly residents of long term care institutions in the metropolitan area of Guadalajara, Mexico

AIM

To determine the prevalence of cognitive impairment and to examine the correlation between demographic and social factors, the activities of daily living (ADL), and depression with cognitive function in elderly Mexicans living in nursing homes.

DESIGN

Cross-sectional.

SETTING

Fourteen nursing homes in Guadalajara.

PARTICIPANTS

Data were drawn from a random sample of 451 elderly, aged 60-104 years.

MEASUREMENTS

The Spanish versions of MMSE (Folstein), ADL index (Barthel), and the Geriatric Depression Screening (GDS) (Yesavage); demographic factors were obtained.

RESULTS

The prevalence of cognitive impairment was 52.3%, with a cut-off of 19/20 (Bohnstedt). Cognitive impairment was significantly related to gender, educational level, activity participation, pension, ADL, and depression.

CONCLUSION

The results indicate a higher prevalence of cognitive impairment than in other Mexican studies. The data are consistent with previous findings that cognitive impairment in the elderly is more common among females, those with a low level of education, the lack of participation in social/leisure activities, ADL dependencies, and depression.

[Extraperitoneal laparoscopic adrenalectomy]

Laparoscopic adrenalectomy has recently been shown to be safe and effective for a variety of benign adrenal tumors, such as aldosterone adenoma, pheochromocytoma, nonfunctioning adenoma, Cushing's adenoma and Cushing's syndrome. Recently, laparoscopic surgeons adopted an extraperitoneal approach in which a space is created by the introduction of a trocar with an inflatable balloon tip. This technique with a minimal access procedure provides direct access to the adrenal glands without interfering with intraperitoneal organs. Laparoscopic adrenalectomy using the extraperitoneal approach was completed in 18/20 consecutive patients. Mean operative time was 95 min (range 80-120) and median hospital stay 3 days. Blood transfusion was not required, and there were no postoperative complications.