Studies on Segmental Pancreatic Autotransplants in Dogs

Munda, Rino; Berlatzky, Yacov; Jonung, Majvi; Murphy, Richard F.; Brackett, Kim A.; Joffe, Stephen N.; Alexander, J. Wesley

doi:10.1001/archsurg.1983.01390110058013

Cited by 11 publications

(4 citation statements)

References 11 publications

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“…Interestingly, they did not find exaggerated elevated insulin levels after transplantation. This is in contrast with the data we report and the experience of other investigators studying dogs (12)(13)(14).…”

Section: Discussioncontrasting

confidence: 99%

Glucose Homeostasis and Insulin Secretion in Human Recipients of Pancreas Transplantation

et al. 1989

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To ascertain the consequences of pancreas transplantation with systemic venous drainage on glucose homeostasis and insulin secretion, glucose and insulin responses to intravenous glucose were compared in 10 recipients and 15 normal control subjects. There were no differences in fasting glucose levels or intravenous glucose disappearance rates. However, basal insulin levels and acute insulin responses to glucose were threefold greater in the recipients. It is not clear whether this consequence of hyperinsulinemia in the recipients is due to the abnormal circulatory drainage, the lack of autonomic input, or concurrent immunosuppressive drug therapy.

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Section: Discussioncontrasting

confidence: 99%

Glucose Homeostasis and Insulin Secretion in Human Recipients of Pancreas Transplantation

et al. 1989

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“…Florack et al showed lowered serum insulin levels in segmental pancreas transplants [3]. Munda et al [11] reported normal fasting but enhanced arginine-stimulated insulin levels, and Cutfield et al [12] reported fasting hyperinsulinemia with a lowered integrated insulin response to intravenous glucose stimulation.…”

Section: Transplantation (Denervation)mentioning

confidence: 99%

Whole Organ Transplantation and Glucose Regulation

2001

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Abstract:Pancreas transplantation has gained clinical acceptance since its initial application more than 30 years ago. A constellation of surgical, pharmacologic, and metabolic alterations occur with transplantation, particularly if pancreatic transplantation is performed in addition to renal transplantation in a uremic diabetic. Increasingly sophisticated studies have allowed analysis of the performance of the transplanted organ and have enhanced our basic understanding of insulin's complex interplay in peripheral glucoregulatory processes. Article:Clinical experience with pancreas transplantation was not overwhelmingly successful during the late 1960s and early 1970s [1]. Over the next 20 years a period of constant reevaluation and reassessment of early clinical failures resulted in the development of animal models of transplantation. These models ultimately led to advances in surgical techniques and immunosuppression therapy and provided a better understanding of the impact of surgically induced alterations to the pancreas on carbohydrate metabolism. As pancreas transplantation enjoyed an increasing success rate and longer patient survival, posttransplant graft physiology and the metabolic response to the new insulin source became an interesting area of research.EARLY MODELS OF TRANSPLANTATION Surgical alterations of the pancreas that occur during transplantation include (1) reduction of the beta cell mass (by resection, immunologic loss, or preservation ischemic loss); (2) systemic venous drainage versus portal venous drainage of the pancreatic venous effluent; and (3) denervation. Surgical alterations per se should lead to an altered insulin source. What effect, if any, might this have on peripheral levels of insulin or insulin's glucoregulatory properties? Would it ultimately affect the function of the transplanted pancreas? To address these questions and attempt to delineate the role of surgical alterations of the pancreas on longterm glucose homeostasis in transplanted patients, studies were performed using primarily dog or rat models. Reduction of Beta Cell MassThe complex interplay between insulin secretion and insulin action was suggested nearly 50 years ago by Dragstedt et al.'s observation that the amount of insulin required to control glucosuria after partial pancreatectomy exceeded the amount needed after complete pancreatectomy [2]. Subsequently, it became evident that surgical models of partial pancreatectomy might result in alterations of alpha and beta cell ratios, which could explain earlier observations. Studies evaluating a dog model of 60% to 80% partial pancreatectomy showed that these animals have a reduced insulin response to the intravenous glucose tolerance test (IVGTT) and altered potassium values, indicating altered glucose metabolism [3]. It was suggested that

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“…Recent clinical experience with living related pancreatic transplantation [8] and the necessity for refining the technique of total pancreatectomy with duodenal preservation in chronic pancreatitis has led to the development of contact laser surgery. This operative technique reduces operating time, blood loss, and associated morbidity and mortality [9].…”

Section: Introductionmentioning

confidence: 99%

Contact yag laser system in abdominal surgery, in particular hepatic and pancreatic surgery

Joffe

1989

Seminars in Surgical Oncology

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The SLT contact Nd:YAG laser system offers a new method of obtaining a hemostatic incision through the anterior abdominal wall and a surgical tool for performing various intraabdominal resectional procedures. Advantages include reduction in intraoperative bleeding, reduced tissue damage, and tactile sensation with a reduction in laser power requirements. Sterile disposable laser scalpels, fibers, synthetic sapphire probes, and a user friendly laser system offer a new dimension in intraabdominal surgery, especially relating to liver and pancreatic surgery. Potentially, all general surgical procedures could use the SLT contact laser, which may, in the future, replace conventional electrocautery and the surgical steel scalpel. Cost containment and improved quality of care will probably be the driving forces for its acceptance.

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Studies on Segmental Pancreatic Autotransplants in Dogs

Cited by 11 publications

References 11 publications

Glucose Homeostasis and Insulin Secretion in Human Recipients of Pancreas Transplantation

Glucose Homeostasis and Insulin Secretion in Human Recipients of Pancreas Transplantation

Whole Organ Transplantation and Glucose Regulation

Contact yag laser system in abdominal surgery, in particular hepatic and pancreatic surgery

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