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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The aim of this study was to develop a model for pancreatic transplantation in the primate in order to test a new immunosuppressive drug. Initially, streptozotocin was used to induce insulin-dependent diabetes mellitus, but it was found to be ineffective and associated with a high morbidity. Furthermore, streptozotocin-induced insulin-dependent diabetes mellitus did not always persist, thus invalidating the evaluation of pancreatic graft function. Therefore, total pancreatectomy was introduced and combined with the pancreatic allotransplantation as a single procedure. Enteric diversion of the pancreatic juice was chosen since this avoids exocrine pancreatic insufficiency and facilitates the oral administration of the test drug. Intra-arterial monitoring of blood pressure and blood gases during the operation and avoidance of hypothermia in the animal were found to be the most important factors contributing to a successful outcome from the operative procedure.
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PMID:Diabetes induction and pancreatic transplantation in the cynomolgus monkey: methodological considerations. 183 63

Treatment of the adolescent diabetic continues to be a challenge for the physician. Ninety-five diabetic patients aged from 12-18 years were treated according to several therapeutic regimens. Principally the Spanish school time-table and, in some cases, life-style or brittle diabetes, determined the adoption of one of five proposed routines. The degree of control achieved assessed by the mean levels of HbA1 (10.6-10.3%), and the frequency and severity of hypoglycaemic accidents ("mild" variety in 25-30% of patients) were similar in all groups with total pancreatic insufficiency. The switch to a four-daily injection regimen (routine 5) with a pen-injector failed to improve metabolic control but patients had more flexibility in meal size and timing. These results suggest that even in teenagers diabetes can be acceptably treated.
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PMID:Insulin treatment in adolescence. 268 42

A many-year prospective follow-up of patients with chronic pancreatitis has shown that the development of carbohydrate metabolism disorders in such patients is always preceded by exo-secretory pancreatic insufficiency of varying severity. Considerable enzyme-secretory pancreatic insufficiency is much more often in patients with secondary diabetes than in those with chronic pancreatitis without diabetes. Insulinemia and blood C-peptide level are regularly reduced in chronic pancreatitis with secondary diabetes but are normal in the patients with less manifest disturbances of carbohydrate metabolism, detectable by the double glucose tolerance test. Blood glucagon is increased in both groups of patients, but more so in those with secondary diabetes. A high direct correlation of the beta-cell activity and the pancreatic enzymes debit are characteristic of patients suffering from chronic pancreatitis with secondary diabetes, as well as a negative correlation, equally high, between the blood glucagon level and the pancreatic enzymes debit in the duodenal contents.
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PMID:[Exocrine and endocrine pancreatic disorders in chronic pancreatitis]. 281 62

To evaluate the influence of chronic alcoholism on clinical features of chronic pancreatitis in Japan, pain evolution, pancreatic insufficiency, and long-term prognosis were studied by comparing chronic alcoholic pancreatitis (N = 88) with idiopathic pancreatitis (N = 67). The 155 patients with known course of the disease over three years were followed-up further for five more years, and pain evolution was evaluated once at the start and once at the end of the follow-up period. At the time of diagnosis, severe pain (59 vs 33%, P less than 0.001), pancreatic calcification (63 vs 31%, P less than 0.001), advanced exocrine pancreatic insufficiency (72 vs 60%, NS), and overt diabetes (48 vs 17%, P less than 0.001) were more common in alcoholic than in idiopathic pancreatitis, respectively. Pain evolution was similar in both pancreatitis, and the pain decreased with time. The rate of abstinence was higher in groups with pain relief than without in alcoholic pancreatitis. Cumulative mortality rate during the five years was higher in alcoholic than idiopathic pancreatitis (26 vs 10%, P less than 0.01). These results suggest more favorable evolution of the disease can be expected by abstinence from alcohol.
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PMID:Chronic alcoholism and evolution of pain and prognosis in chronic pancreatitis. 291 Jun 80

Fat replacement of the exocrine pancreas is a rare cause of exocrine pancreatic failure. We report two adult patients (a 25-year-old woman and a 63-year-old man) with weight loss and massive steatorrhea in whom abdominal computed tomograms were diagnostic of pancreatic lipomatosis. In both patients, oral pancreatic enzyme replacement in association with cimetidine led to a marked reduction of steatorrhea and weight gain. Pancreatic lipomatosis should be suspected in cases of severe exocrine pancreatic insufficiency in the absence of abdominal pain and diabetes. Computed tomogram scanning should lead to an increasing detection rate of this unusual condition.
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PMID:Lipomatosis of the pancreas: an unusual cause of massive steatorrhea. 318 86

The pancreas and duodenum of 24 beagle dogs were given intraoperative irradiation (IORT) with 6 MeV electrons. The dose range was 17.5 Gy to 40 Gy. Billroth II gastrojejunostomy was performed on all dogs prior to irradiation. Six control dogs received only Billroth II surgery. Starting 2 weeks after surgery, dogs in the irradiation groups were given 50 Gy 6 MV X rays external beam radiation therapy (EBRT) to the pancreas and duodenum. The total dose of 50 Gy was given in 2 Gy fractions over 5 weeks. Dogs were monitored for 135 days then necropsied. Gross and histopathologic changes in the pancreas and duodenum were evaluated and quantitative analysis of pancreatic lesions done. Duodenal ulcers were found following 32.5 Gy and 40 Gy IORT. The pancreases were atrophic in irradiated dogs and exocrine pancreatic insufficiency occurred in one dog given 25 Gy. Gross pancreatic atrophy correlated with IORT dose. Histopathologic evidence of radiation damage to the pancreas was observed in acinar cells. Islet cell lesions were not apparent. There was pancreatic fibrosis and damage to blood vessels and ducts. Dose-response relationships were observed for the index of damage to the pancreas as a whole, for pancreatic fibrosis and a decrease in normal acinar cells. Although 25 Gy IORT plus 50 Gy EBRT was tolerated by the duodenum to 135 days, these doses may cause later pancreatic injury as an expression of damage to blood vessels and ducts. Exocrine pancreatic insufficiency and diabetes mellitus may thus represent potential late complications of IORT following 25 Gy or higher doses.
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PMID:Pathologic response of the pancreas and duodenum to experimental intraoperative irradiation. 338 21

We determined by the ninhydrin method the plasma amino acid (AA) levels prior to, during and following, a 1-hour i.v. infusion of 1 U/kg body weight each of secretin and pancreozymin in patients with normal (n = 74) or reduced (n = 39) exocrine pancreatic function, as assessed by the duodenal aspiration test. The results of the two tests correlated significantly with each other (p less than 0.001). A maximum AA decrease of greater than or equal to 12% was observed in all patients with a normally functioning pancreas (specificity 100%), and of less than 12% in all patients with medium to high-grade impairment of pancreatic function (sensitivity 100%). Since, however, low-grade pancreas insufficiency (20-40% of the mean normal enzyme output) is recognized in fewer than one-half of the cases, the overall sensitivity of the AA-consumption test decreases to 69%. The results can, however, be improved by: 1) Calculating the mean percentage AA decrease with a limit value of 5% (sensitivity 90%); 2) determining individual AA with pancreas-specific absorption, such as serine (sensitivity 92%); 3) dropping the lower normal value of exocrine pancreatic function to 25% of the normal mean enzyme output (sensitivity 96%). Diseases that may be associated with the most common condition that causes pancreatic insufficiency--chronic pancreatitis--and which have an influence on AA metabolism, such as cirrhosis of the liver and diabetes mellitus, have no influence on the accuracy of the AA consumption test, which, considered overall, represents a competitive alternative to other tubeless tests of pancreatic function.
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PMID:[Amino acid level in plasma--expressed as alpha-amino-nitrogen--reaction to stimulation of the exocrine pancreas: approaches to a new pancreatic function test]. 343 Oct 32

A 39-year-old man with severe diabetes mellitus, chronic pancreatic insufficiency, intrapancreatic choledochal stricture, and secondary biliary cirrhosis developed postsurgical fungemia and large hepatic abscesses due to Torulopsis glabrata. These were treated successfully with a combination of amphotericin B and percutaneous drainage of the liver abscesses. We believe this is the first reported case of such infection due to this normally saprophytic agent.
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PMID:Hepatic abscesses and fungemia from Torulopsis glabrata. Successful treatment with percutaneous drainage and amphotericin B. 344 38

Early pancreatic carcinoma is defined as a tumor of less than 2 cm in diameter, limited to the pancreas without extension to adjacent structures or organs and without lymph-node and distant metastasis (T1a, N0, M0). In analysing 693 pancreatic cancer patients seen at the Surgical Clinic of Erlangen since 1969 we found only 3 early lesions (0.4%). There is a variety of diagnostic signs like unexplained abdominal pain, the development of pancreatic insufficiency, weight loss in excess of 10%, sudden onset of diabetes and elevation of serum and urine amylase. These early symptoms should be clarified by special pancreatic screening tests (ERCP, CT, US, angiography). CT and US alterations may be missing, because of the small tumor size. The proof of a pancreatic duct stenosis indicates laparotomy and resection. One of three of our patients survived longer than 6 years without recurrence. As reported, the 5-year-survival rate of early pancreatic cancer is 86%.
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PMID:[Early cancer of the exocrine pancreas: diagnosis and prognosis]. 356 19

Pain relief and compensatory therapy of exocrine and endocrine pancreatic insufficiency is the aim of conservative treatment of chronic pancreatitis. Pain relief may be achieved by analgetics, dietary restrictions, alcohol abstinence, enzyme substitution, and operative procedures. Decompensated exocrine pancreatic insufficiency, i.e. steatorrhea, is a late complication of chronic pancreatitis. It requires diet, vitamin, and enzyme replacement. Failure of the latter may be due to inactivation of the enzymes by gastric acid. Finally, diabetes mellitus, secondary to chronic pancreatitis, is managed with diet and insulin. Pancreatogenic diabetes responds only for a short period, if at all, to oral antidiabetics.
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PMID:Conservative treatment of chronic pancreatitis. 365 Jan 83


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