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

Out of 88 carcinomas of the pancreas observed from 1973 through 1981, 41 regional total (19 patients) or subtotal (22 patients) pancreatectomies were performed. Routine histological examination of 12 lymph nodes areas and pancreatic peritoneal involvement were used to determine three stages: 1) stage I without metastatic lymph nodes involvement (18 patients), 2) stage II with peripancreatic metastatic lymph node involvement (14 patients), 3) stage III with pedicular and/or retroperitoneal metastatic lymph node and/or peritoneal involvement. Six patients died in the postoperative period (14.6 p. 100). Complications were infections (11 patients), pancreatic anastomotic leakage after subtotal pancreatectomy (11 patients), digestive bleeding (8 patients). No patients need insulin two months after subtotal pancreatectomy. After total pancreatectomy diabetes mellitus was controlled by 0.30 UI/kg/day of insulin (mean). The three years survival was 38 p. 100 (Kaplan-Meier). In the author's experience, regional pancreatectomy seems to be the best surgical procedure in patients with carcinoma of the pancreas except in patients with poor general condition, age over 75, and stage III.
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PMID:[Regional pancreatectomy in the treatment of pancreatic adenocarcinoma. Apropos of 41 cases]. 669 35

A series of 85 patients with carcinoma of the pancreas seen in South India has been analysed. The median age was 50 years, 20% of patients being below years of age, and the male to female ratio was 4:1. Diabetes mellitus and smoking were more prevalent among males than in a control group, but this was not the case with alcoholism. Distribution of blood groups was the same as in controls. Clinical features of these patients are reviewed. Operative mortality in jaundiced patients was similar whether simple laparotomy, a biliary bypass procedure or a pancreaticoduodectomy was done. This mortality was related to the depth of jaundice and to the degree of abnormality in serum transaminase levels, but it was not related to the age of the patient, the stage of the disease, ECG evidence of ischaemic heart disease, or abnormalities in either serum albumin concentration or blood urea level. Following biliary bypass procedures 50% of patients were dead within eight months; after pancreatoduodenectomy this interval was increased to 18 months, but differences in the stage of the disease between the two groups would account for the difference in survival to some extent.
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PMID:Operative mortality following surgery for carcinoma of the pancreas. 677 69

340 autopsy cases of pancreatic carcinoma from hospitals of St. Petersburg (1990-1991) and Petrozavodsk (1981-1990) have been studied (male/female proportion 1.1:1). The pancreatic head was involved in 75% of cases, including the head only in 61.3%, head and body in 12%, total organ involvement in 2.7%. Pancreatic carcinoma was combined with other tumors in 7 cases, including 4 cases of simultaneous combination. Histological types of carcinoma were represented by: adenocarcinoma (75.2%), undifferentiated carcinoma (10.9%), solid cancer (5.8%), mucosal (4.1%), squamous cell carcinoma (1.7%), glandular-squamous cell carcinoma (0.6%). Metastases occurred most frequently in the liver (52.6%) and lymph nodes (44.7%). Jaundice was registered in 39.1% of cases, primarily in cases of carcinomatous head involvement, and in 12.8% without such involvement (most frequently with metastases to the portal lymph nodes of the liver). Diabetes mellitus was diagnosed in 18 (5.3%) patients, but only in 4 of them as a consequence of pancreatic carcinoma. The diagnosis was found missed in 48% of patients.
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PMID:[Clinico-anatomic characteristics of pancreatic cancer]. 767 87

A retrospective study was performed of 113 patients who underwent surgical resection of carcinoma of the pancreas from 1970 to 1992. The postoperative mortality rate was 15 per cent (5 per cent in the last 11 years). The actuarial 5-year survival rate was 12 per cent. Survival was significantly influenced by age (P = 0.03), vascular resection (P = 0.02), radicality of operation (P = 0.01), number of transfused blood units (P = 0.01), tumour differentiation (P = 0.002), lymph node status (P = 0.001), perineural invasion (P = 0.01), tumour size (P = 0.008), preoperative diabetes (P = 0.001) and stage (P = 0.0001). Multivariate analysis showed that stage, diabetes, age and grade were independent predictors of long-term survival. The type of pancreatic resection (Whipple, subtotal, total or distal pancreatectomy) did not influence prognosis. The 5-year survival rate was 14 per cent in the period 1970-1981 and 11 per cent in the period 1982-1992, with no statistical difference. These results suggest that patient characteristics and tumour findings rather than operative procedures affect long-term survival after resection for pancreatic carcinoma.
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PMID:Survival after resection for ductal adenocarcinoma of the pancreas. 868 3

We discussed the possibility of the screening programs for the early detection in carcinoma of the pancreas. Several trials of screening have been conducted for the outpatients with diabetes mellitus, jaundice or upper abdominal pain by means of serum erastase-1, amylase and CA19-9 levels and the ultrasonography. The trials could detect 37 patients of 4250 (1.3%), 47 of 423,905 (0.011%) and 89 of 3585 (2.4%) with carcinoma of the pancreas. Despite effective screening program is not available, the screening carries the potential for improvement of the resectability and the mortality in the patients with carcinoma of the pancreas.
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PMID:[The role of screening for carcinoma of the pancreas]. 896 80

A 52-year-old-woman with non-insulin-dependent diabetes mellitus developed carcinoma of the pancreas and had a Whipple's resection performed. She required pancreatic exocrine supplements and insulin post-operatively. Five years later metastatic disease became apparent, and was accompanied by episodic spontaneous hypoglycaemia necessitating the cessation of insulin therapy. Hormonal analysis was performed, off insulin, at a time of hypoglycaemia (glucose 0.9 mmol l-1) and showed negligible insulin concentrations (< 2 mU l-1) but raised IGF-II together with low IGF-I concentrations (1.85 and 0.1 U ml-1, respectively). The association between diabetes and pancreatic carcinoma, and the pathogenesis of non-islet cell tumour induced hypoglycaemia (NICTH) are discussed.
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PMID:Spontaneous hypoglycaemia in a noninsulin-dependent diabetes mellitus patient with disseminated pancreatic carcinoma. 911 88

A review of recent data from the literature on the pathophysiology and clinical aspects of pancreatogenic diabetes, carcinoma of the pancreas and conditions after pancreatectomy. It deals with the secretion of insular hormones, insulin sensitivity and contraregulatory mechanisms. On these findings, not always complete, adequate treatment should be based.
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PMID:[Pancreatic diabetes]. 960 44

There are very few benign or malignant diseases which arise in the remnant pancreas after pancreatectomy. Pancreatic carcinoma in the remnant pancreas after pylorus preserving pancreatoduodenectomy (PpPD) for mucinous cystadenoma in a 66-year-old Japanese man is reported in this paper. The patient underwent PpPD for a mucinous cystadenoma in the pancreatic head 39 months prior to the present operation. The surgical margins of the PpPD specimen were free from atypical cells. Follow-up ultrasonography revealed a hypoechoic lesion in the body of the remnant pancreas. Magnetic resonance cholangiopancreatography (MRCP) revealed a stenosis of the main pancreatic duct, with upstream dilatation in the remnant pancreas. Segmental resection of the remnant pancreas, splenectomy, pancreaticojejunostomy and intraoperative radiotherapy were performed under the diagnosis of pancreatic carcinoma of the remnant pancreas. Final histopathological diagnosis was adenocarcinoma of the pancreas. There were no malignant cystic components. The present pancreatic carcinoma was regarded as independent of the previous mucinous cystadenoma. Postoperative radiation therapy and chemotherapy were added. He is doing well 20 months after the second operation although diabetes mellitus has slightly deteriorated. In this communication, we would like to recommend that clinicians should constantly be on guard against the development of pancreatic carcinoma even in the remnant pancreas after pancreatectomy for mucinous cystadenoma.
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PMID:Pancreatic carcinoma in remnant pancreas after pancreatectomy for mucinous cystadenoma. 974 1

We report on a resected case of spindle cell carcinoma of the pancreas in a 73 year-old Japanese male who has a history of diabetes mellitus. The patient visited his neighborhood hospital complaining of abdominal pain and was referred to our hospital for further examination of a pancreatic tumor discovered by abdominal ultrasonography. Upon the diagnosis of ductal carcinoma, a distal pancreatectomy with splenectomy was performed. Microscopically, the tumor was composed of spindle cells arranged in interlacing bundles with frequent mitotic figures. The diagnosis of spindle cell carcinoma of the pancreas was confirmed by immunohistochemical studies. To our knowledge, our case is the first resected case of spindle cell carcinoma arising from the pancreas in the English literature.
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PMID:Spindle cell carcinoma of the pancreas: a case report. 1043 Mar 87

Biliopancreatic malignancy is one of the leading causes of cancer death in the Western world. Defining at risk groups has been difficult. Diabetes mellitus and pancreatitis increase the risk of pancreatic carcinoma, and inflammatory bowel disease and associated sclerosing colangitis increase the risk of biliary tract malignancy. Pancreatic carcinoma has also been described in pedigrees with inherited cancer predisposition. Extensive molecular profiling of pancreatic carcinomas has been accomplished over the past few years, but similar knowledge in other biliopancreatic malignancies is lacking. In almost all pancreas cancers at least one alteration will occur out of a combination of K-ras mutations and inactivation of the tumor suppressor genes p16/MTS1/ink4a, p53 and DPC4/Smad4. Mutations of K-ras and p16 have been described in hyperplastic and dysplastic pancreatic ductal lesions believed to be the non-malignant precursors of pancreatic carcinoma. Detection of K-ras mutations in clinical samples (biliopancreatic secretions, stool, duodenal aspirates, and blood) identical to ones present in primary pancreatic cancers and/or their precursor ductal lesions has been reported in pilot studies. Recently detection of 18q deletions (at the DPC4 locus) in pancreatic secretions from early pancreatic cancers was also reported. These advances raise the possibility that within well defined at risk groups it will be possible to use a combined set of molecular markers to screen clinical samples and detect early pancreatic cancer or even pre-malignant lesions. The fulfillment of this promise will depend on proving the role of molecular screening in decreasing morbidity and mortality, which will require well designed clinical studies.
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PMID:Biliopancreatic malignancy: screening the at risk patient with molecular markers. 1043 11


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