Although pyloric preservation can be performed during pancreaticoduodenectomy without increased morbidity or mortality or decreased survival, the long-term benefit of this technique remains unproven. In this study, the functional status of patients recovered from pyloric-preserving pancreaticoduodenectomy was evaluated by comparing 6 long-term survivors of the standard Whipple procedure (1-7 years postoperative; mean. 4.7 yr) to a similar group of 6 patients recovered from pylorus preservation pancreaticoduodenectomy (1-7 years postoperative: mean. 3.0 yr/. All patients completed a questionnaire evaluating postgastrectomy symptoms. Fasting blood specimens were obtained for hematologic and biochemical analysis. Ten of the 12 patients then underwent endoscopy; perianastomotic and midgastric biopsies were graded for inflammation. Gastric emptying of both liquid and solid phases was measured with an isotopically-labeled meal. Gastric emptying data were compared between groups and also to a group of 7 normal controls studied previously using the same methodology. Analysis of questionnaire results and mean laboratory values revealed no significant differences between the 2 surgical groups. Serum carotene levels were low in most patients. Several patients demonstrated abnormal indices of iron homeostasis. No significant abnormalities were noted on endoscopic examinations and biopsy results did not differ between the 2 surgical groups. Liquid gastric emptying was significantly prolonged in patients following standard pancreaticoduodenectomy (h/2 = 98.3 -+ 26.2 min) as compared to pylorus preservation patients (h/2 = 37.5 _+ 10.9 min) or normal controls (tl/2 = 33.1 -+ 2.8 min~. We conclude that. in the long-term, pylorus preservation appears to be at least functionally equivalent to the standard pancreaticoduodenectomy. As such. we believe that pyloric preservation. obviating vagotomy and gastric resection, deserves consideration during pancreaticoduodenectomy.

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The effects of cis-diamminedichloroplatinum (CDDP) on lymphoid organs and the immune response of young and older adult mice were studied histologically and by functionally assessing the activity of various subpopulations of immune cells. Young adult mice (6-8 weeks old) treated with 2 mg/kg CDDP mounted an enhanced splenic plaque-forming cell (PFC) response to both sheep erythrocytes, a helper T-cell-dependent antigen (HD), and pneumococcal polysaccharide type III a helper T-cell-independent antigen (HI). Older adult mice (18-22 weeks old) treated in the same way exhibited an equally enhanced PFC response to HD antigen and even a more pronounced response to HI antigen. Treatment of mice with 12 mg/kg CDDP resulted in immunosuppression. Thymus, lymph nodes, and spleen of animals treated with the higher dose of CDDP showed a marked cell depletion from both T and B areas, confirming that the immunosuppression was due to an indiscriminate elimination of both T and B lymphocytes. The immunosuppression and the cell depletion from lymphoid organs were more pronounced in younger mice. Thus, the effects of CDDP on the lymphoid organs and the immune response depend both on the age of the animals and on the dose of the drug. CDDP given in small doses enhances the PFC response, whereas a reduced PFC response is obtained following high-dose treatment.