Chronic pancreatitis is a debilitating disease affecting millions worldwide. These patients suffer from bouts of severe pain that are minimally relieved by pain medications and may necessitate major surgeries with high morbidity and mortality. Previously, we demonstrated that “chemical pancreatectomy,” a pancreatic intraductal infusion of dilute acetic acid solution, ablated the exocrine pancreas while preserving the endocrine pancreas. Notably, chemical pancreatectomy resolved chronic inflammation, alleviated allodynia in the cerulein pancreatitis model, and improved glucose homeostasis. Herein, we extensively tested the feasibility of a chemical pancreatectomy in NHPs and validated our previously published pilot study. We did serial computed tomography (CT) scans of the abdomen and pelvis, analyzed dorsal root ganglia, measured serum enzymes, and performed histological and ultrastructural assessments and pancreatic endocrine function assays. Based on serial CT scans, chemical pancreatectomy led to the loss of pancreatic volume. Immunohistochemistry and transmission electron microscopy demonstrated exocrine pancreatic ablation with endocrine islet preservation. Importantly, chemical pancreatectomy did not increase pro-nociceptive markers in harvested dorsal root ganglia. Also, chemical pancreatectomy improved insulin secretion to supranormal levels in vivo and in vitro. Thus, this study may provide a foundation for translating this procedure to patients with chronic pancreatitis or other conditions requiring a pancreatectomy.
Chronic pancreatitis is a debilitating disease affecting millions worldwide. These patients suffer from bouts of severe pain that are minimally relieved by pain medications and may necessitate major surgeries with high morbidity and mortality. Previously, we demonstrated that “chemical pancreatectomy,” a pancreatic intraductal infusion of dilute acetic acid solution, ablated the exocrine pancreas while preserving the endocrine pancreas. Notably, chemical pancreatectomy resolved chronic inflammation, alleviated allodynia in the cerulein pancreatitis model, and improved glucose homeostasis. Herein, we extensively tested the feasibility of a chemical pancreatectomy in NHPs and validated our previously published pilot study. We did serial computed tomography (CT) scans of the abdomen and pelvis, analyzed dorsal root ganglia, measured serum enzymes, and performed histological and ultrastructural assessments and pancreatic endocrine function assays. Based on serial CT scans, chemical pancreatectomy led to the loss of pancreatic volume. Immunohistochemistry and transmission electron microscopy demonstrated exocrine pancreatic ablation with endocrine islet preservation. Importantly, chemical pancreatectomy did not increase pro-nociceptive markers in harvested dorsal root ganglia. Also, chemical pancreatectomy improved insulin secretion to supranormal levels in vivo and in vitro. Thus, this study may provide a foundation for translating this procedure to patients with chronic pancreatitis or other conditions requiring a pancreatectomy.
A 30-year-old male presented with swelling in lower abdomen for three years. The swelling was painless and accompanied by voiding urinary symptoms like straining during micturition, thinning of urinary stream and feeling of incomplete bladder evacuation. There was a previous history of pelvic fracture and open suprapubic cystostomy for urethral injury, followed by urethroplasty in childhood. On examination, there was a swelling in the lower abdomen reaching up to base of scrotum, which was partly compressible but non reducible [Table/ Fig-1].The patient underwent ultrasonography of abdomen including inguinoscrotal region which revealed right cystocele and bilateral hydrouretronephrosis. Since the biochemical investigations were deranged (serum creatinine -2.8mg/dl), patient underwent Non Contrast Computed Tomography (NCCT) of the abdomen which depicted herniation of antero inferior wall of urinary bladder, through a defect in the linea alba at the site of previous surgical scar, which reached upto base of right scrotum with displacement of right testis to opposite side 3]. The bladder had thick walls and sacculations. Old healed fracture of right inferior pubic rami and bilateral superior pubic rami, without any pubic diastasis, was also seen. Further uroflowmetry depicted low maximum and average flow rates with prolonged voiding time. A pan cystourethroscopy revealed normal urethra. Per urethral catheterisation was done for four weeks for optimization of renal parameters, as the herniated urinary bladder impinging upon bladder neck was considered a cause for obstructive uropathy. A diagnosis of incisional hernia with herniation of bladder into right scrotum was made and the patient was taken up for exploration under anaesthesia. Intraoperatively, there was a large bladder diverticulum which was herniating into the right scrotum along the penile corpora [Table /Fig-4]. The bladder diverticula was densely adhered to the penile corpora and the undersurface of pubic arch from which it was separated by a combination of sharp and blunt dissection. The diverticula was seen herniating through a 1.5x0.5cm defect in linea alba, which was opened vertically to indentify the bladder. Diverticulectomy was done with widening of the diverticular neck. A Supra Pubic Catheter (SPC), Retropubic Drain (RPD) insertion and primary herniorraphy with closure of linea alba with prolene was done. Postoperatively, patient had uneventful recovery except for penile oedema which subsided over a week. DISCUSSIONIncisional hernia is a very common surgical disease and usually contains intra-peritoneal viscera as its content. An extra peritoneal organ such as the bladder usually doesn't form a content of the hernia sac. Inguinal and femoral hernias sometimes contain herniated bladder diverticulum [1,2]. However the same is not usually seen in incisional hernia.Hernias usually result from weakness of musculoaponeurotic layer of abdominal wall, often compounded by an increased intra-abdominal pressure [1]. Herniation of urinary bladder or its div...
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