Resection of the pancreas for acute hemorrhagic and necrotizing pancreatitis

Autio, Ville; Juusela, E; Lauslahti, K; Markkula, H; Pessi, T.

doi:10.1007/bf01654774

Cited by 27 publications

(13 citation statements)

References 13 publications

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“…Pancreatectomy has certainly been related to the development of diabetes in humans, but the degree of pancreatectomy necessary for subsequent development of diabetes has been unclear, both because of an imprecise documentation of the extent of pancreatic resections, and because of the coexistence of pancreatic disease in patients undergoing surgery (46,47). Hemipancreatectomy is now being performed in normal individuals who are donating tissue to diabetic relatives (48).…”

Section: Discussionmentioning

confidence: 99%

Modulation of proinsulin messenger RNA after partial pancreatectomy in rats. Relationships to glucose homeostasis.

Orland¹,

Chyn²,

Permutt³

1985

J. Clin. Invest.

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These studies of partial pancreatectomy assess pancreatic proinsulin messenger RNA (mRNA) levels as an index of in vivo insulin biosynthesis, and show relationships to glucose homeostasis. Rats were subjected to sham operation, 50% pancreatectomy (Px), or 90% Px, and were examined after 1, 3, or 14 wk. Proinsulin mRNA was measured by dot hybridization to complementary DNA. After 50% Px there was a nearly complete adaptation of proinsulin mRNA. After 90% Px a marked increase of proinsulin mRNA occurred, but it was insufficient and it was not maintained with time. The deficit in insulin production is related to development of hyperglycemia.Sham-operated controls showed no worsening of fasting or fed blood glucose or of intraperitoneal glucose tolerance within the period of observation. Total proinsulin mRNA and pancreatic insulin content rose in proportion to body weight. 50% PN produced no change from controls in body weight or blood glucose. The concentration of proinsulin mRNA in the 50% pancreatic remnant paralleled that of controls after 1 and 3 wk, but then increased after 14 wk, such that total proinsulin mRNA approached control levels. This adaptive response was reflected by changes in serum insulin, but not by pancreatic insulin content, which was only 30% of control after 14 wk. Intraperitoneal glucose tolerance was impaired mildly, and did not worsen with time after pancreatectomy.90% Px led to elevated fed blood glucose and reduced serum insulin after 3 wk, and fasting hyperglycemia was seen after 14 wk. Proinsulin mRNA concentration in the 10% pancreatic remnant showed an adaptive increase after 1 and 3 wk, such that total proinsulin mRNA reached 40% of control. After 14 wk, however, remnant proinsulin mRNA concentration was no longer increased; total proinsulin mRNA and pancreatic insulin content were severely reduced. Intraperitoneal glucose tolerance was impaired more dramatically than with the 50% Px animals, and worsened with time after operation.These observations indicate ability to increase proinsulin mRNA levels as an adaptation to pancreatectomy. Insufficiency of this adaptation is associated with the development of hyperglycemia, and the loss of this adaptation correlates with a worsening of glucose tolerance.

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Section: Discussionmentioning

confidence: 99%

Modulation of proinsulin messenger RNA after partial pancreatectomy in rats. Relationships to glucose homeostasis.

Orland¹,

Chyn²,

Permutt³

1985

J. Clin. Invest.

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“…There were groups, mostly surgeons, advocating debridement of sterile pancreatic necrosis in the early phase. Others favored later interventions when signs of infected necrosis appeared [7,9,10,12,13]. The advantages of delayed intervention soon became clear.…”

Section: Timing Of Interventionmentioning

confidence: 99%

“…The medical and surgical management of necrotizing pancreatitis has been the subject of debate over the past decades. Traditionally, extensive resection played an important role in approaching severe acute pancreatitis [7,8,9,10]. In the 1980s, based upon new technological advances such as the improvement of different diagnostic tools, a new surgical approach was developed which targeted debridement of necrotic tissue rather than extensive resection [11].…”

Section: Therapeutic Strategies In Acute Pancreatitismentioning

confidence: 99%

Severe Acute Pancreatitis - How Conservative Can We Be?

Alberts

Alsfasser

2018

Visc Med

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Background: Acute pancreatitis still is a disease with overall high mortality. Continuously improved understanding of the pathophysiology, however, led to changes in treatment algorithms within the last decades, thus resulting in decreased mortality. This knowledge of acute pancreatitis enabled a new classification system introduced by an international expert panel. This classification system is helpful in initiating treatment strategies which are adapted to the course of acute pancreatitis. Especially the role of surgery experienced a paradigm shift towards a more conservative approach. Methods: A specific literature search regarding the treatment of acute pancreatitis was performed in the PubMed database, and the results of key studies were compared. Results of these studies are discussed in the context of the most recent international classification system. Results and Conclusion: Based upon the available data, we can summarize that conservative treatment of acute pancreatitis with pancreatic necrosis is a valid treatment option for selected cases and is associated with reduced mortality compared to more aggressive therapy. However, patients with acute pancreatitis should be treated in experienced centers.

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“…Pancreatic resection has been mostly abandoned. Because of the diffi culties to correctly assess the amount of necrotic tissue the loss of viable pancreatic tissue was often considerable and the morbidity and mortality rate associated with the procedure were high [89][90][91][92] . Organ-preserving extensive debridement of necrotic tissue combined with postoperative continuous lavage through drains placed in the retroperitoneal cavities that occurred as a result of removal of necrotic tissue has provided better results in several series [4,93,94] ( table 4 ).…”

Section: Surgical Techniquementioning

confidence: 99%