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

The pathogenetic mechanism underlying glucose intolerance in pancreatic cancer is still unclear. We studied the pattern of three glucose regulating hormones (C-peptide, glucagon and GH) in pancreatic cancer patients with (N = 34) and without (N = 8) hyperglycemia, and compared the findings made with those from subjects with other hyperglycemic conditions of well-known origin [type I diabetes mellitus (8 cases) and diabetes mellitus secondary to chronic pancreatitis (13 cases) or liver cirrhosis (4 cases)]. In hyperglycemic pancreatic cancer patients, C-peptide was absent in 26% of the cases, reduced in 24%, elevated in 29% and within the normal range in the remaining 21%. In normoglycemic pancreatic cancer this hormone was reduced in two cases (25%) and within the normal range in all the others. GH was within the normal range in all cases: glucagon was below the normal range in some hyperglycemic pancreatic cancer patients (41%) or within the normal range in all the remaining patients. No correlations were found between the three hormones when findings from subjects were considered all together. However, in pancreatic cancer C-peptide and glucagon presented consensual variations. C-peptide, glucagon and GH levels were not related to tumor volume; glucagon was found to be associated with liver metastases. C-peptide was correlated with serum ALT and ALP. We may conclude that hyperglycemia associated with pancreatic cancer may be caused by different mechanisms. In some cases a reduced secretion of both insulin and glucagon was observed, as occurs in chronic pancreatitis. In the majority of patients, beta cell function appears normal, and the hyperglycemic state may depend on an altered peripheral sensitivity to insulin due to the pancreatic pathology itself or to consensual liver involvement.
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PMID:C-peptide pattern in patients with pancreatic cancer. 813 97

Whether having diabetes predisposes an individual to developing pancreatic cancer continues to be studied. At present, the greater challenge for diabetes educators is to help those individuals who have had surgical resection for pancreatic cancer and now have resultant IGT or frank diabetes to manage their condition to the best of their ability and make their quality of life the best it can be, given the circumstances.
Diabetes Educ
PMID:Pancreatic cancer and diabetes. 813

Very early detection of pancreas cancer is most desirable, since it permits less invasive surgery which has a correspondingly greater chance of success. The present study investigated both surgical outcome and postsurgical quality of life in 8 patients whose occult neoplasms were successfully treated. In all 8 patients, cytology of the pancreatic secretion obtained during endoscopic retrograde pancreatography (ERP) was positive, although no pancreatic tumor was detected by ERP, other examinations or intraoperative inspection. In these 8 patients, our method of intraoperative cytodiagnosis to locate occult neoplasms of the pancreas (Surgery 1992; 111: 294-300) was used (1). Using this method of cytodiagnosis, we were able to avoid total pancreatectomy in 6 patients (75%; 3 pancreatoduodenectomies and 3 caudal pancreatectomies), but not in the other 2 patients. Histopathological study of the resected specimens indicated that the extent of pancreatic resection was quite appropriate in all 8 patients. There were 6 minimally invasive carcinomas, one carcinoma in situ and one borderline lesion. Neither nodal involvement nor severe invasion was found on microscopic inspection, and all have been disease-free for 23 +/- 13 months after surgery. In the 6 patients with partial pancreatectomies, both postoperative quality of life and general health were good, with no insulin-dependent diabetes developing. Thus, our cytology-guided surgical technique is very useful not only for locating occult and potentially curable neoplasms, but also for avoiding blind resection of the entire pancreas, permitting better preservation of pancreatic endocrine function.
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PMID:Surgical resection of potentially curable pancreatic cancer with improved preservation of endocrine function--further evaluation of intraoperative cytodiagnosis. 827 Feb 33

A hospital-based case-control study of pancreatic cancer was conducted in Athens in 1991-92. One hundred and eighty-one patients operated on for cancer of the exocrine pancreas in eight teaching hospitals formed the case series, whereas hospital patient controls and hospital visitor controls formed two independent comparison series. Cases and controls were matched by hospital, gender, and age in a 1:1:1 ratio, and every matched triplet was interviewed in person by the same researcher. Results indicate that tobacco smoking increased the risk of pancreatic cancer, whereas neither coffee drinking nor consumption of alcoholic beverages were associated with the disease. Diabetes mellitus, cholelithiasis, and pancreatitis were associated positively with risk of pancreatic cancer, whereas allergic asthma was inversely (but not significantly) related to the disease. There was a suggestion that earlier age at menarche was associated with increased risk of pancreatic cancer and that parous women were at lower risk. No consistent associations were noted with respect to gastrectomy, other medical conditions or operations, birth order, height, weight, broad occupational groups, or other reproductive variables. The two comparison series were remarkably similar with respect to the whole spectrum of the study variables.
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PMID:Tobacco, ethanol, coffee, pancreatitis, diabetes mellitus, and cholelithiasis as risk factors for pancreatic carcinoma. 834 87

Diabetes in patients with pancreatic cancer occurs in 70% to 80% of the patients and is characterized by high plasma levels of insulin. In type II diabetes that is not associated with pancreatic cancer, peripheral insulin resistance and impaired muscle glycogen synthesis are major pathogenic factors. We investigated peripheral insulin sensitivity in patients with pancreatic cancer before and after tumor removal. The effects of pancreatic tumor extracts on glycogen synthesis in skeletal muscle in vitro and the tumor content of pancreatic islet hormones were also investigated. Marked peripheral insulin resistance was found in the patients with pancreatic cancer and was more pronounced in the diabetic patients than in the nondiabetic patients. Insulin sensitivity was not correlated with weight loss, tumor size, or bilirubin levels but improved after surgery. Tumor extracts from diabetic patients with pancreatic cancer caused a marked reduction of glycogen synthesis in skeletal muscle in vitro. All tumors contained islet hormones but not in concentrations sufficient to explain the effect on glycogen synthesis. These findings indicate that a diabetogenic factor associated with pancreatic adenocarcinomas could be involved in the development of the profound peripheral insulin resistance and thereby could contribute to the high incidence of diabetes observed in patients with pancreatic cancer.
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PMID:Is profound peripheral insulin resistance in patients with pancreatic cancer caused by a tumor-associated factor? 838 Mar 14

Diabetes occurs frequently in patients with pancreatic cancer. To investigate the impact to tumour removal, seven patients were studied before and after 85 per cent subtotal pancreatectomy for adenocarcinoma of the pancreas. The frequency of diabetes was determined by the oral glucose tolerance test. Fasting levels of C peptide and insulin were measured in plasma, and insulin secretion was investigated by hyperglycaemic glucose clamp and glucagon stimulation. Six of the seven patients were diabetic before surgery and four required insulin treatment. Improvements in diabetic status and glucose metabolism were found in all seven patients after operation, as demonstrated by increased glucose metabolic capacity during hyperglycaemia. This occurred despite a postoperative reduction in insulin secretion and is explained by the observed augmentation of whole-body insulin sensitivity after surgery. A diabetogenic factor may be produced by pancreatic adenocarcinoma that may be responsible, directly or indirectly, for the high frequency of diabetes in patients with pancreatic cancer.
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PMID:Improved glucose metabolism after subtotal pancreatectomy for pancreatic cancer. 840 64

In 59 patients with ductal pancreatic cancer the monoclonal antibody (MAb) BW 494, which detects the CA 494 glycoprotein antigen, was analyzed in comparison with the reference tumor markers CA 19-9 and CEA. Eighty-one patients with non-pancreatic malignancies of the gastrointestinal (GI) tract, 95 with chronic pancreatitis, 124 with benign non-pancreatic GI diseases, 30 with diabetes mellitus (type I or type II) and 114 healthy blood donors served as controls. The sensitivity of pancreatic cancer was 90%, 44% and 90% for CA 19-9, CEA and CA 494, respectively. In chronic pancreatitis, as the most important control population for pancreatic cancer, the specificity was 85%, 72% and 94% for CA 19-9, CEA and CA 494, respectively.
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PMID:CA 494--a new tumor marker for the diagnosis of pancreatic cancer. 844 99

An exploratory case-control study to detect risk factors for pancreatic cancer was conducted within a large cohort of people who had received multiphasic health checkups in the San Francisco Bay Area. Four hundred and fifty who later developed pancreatic cancer were compared with 2687 who did not with respect to 779 characteristics recorded at the checkups. There was strong confirmation that cigarette smoking and diabetes mellitus were associated with risk of subsequent pancreatic cancer. Higher levels of serum iron, iron saturation and body weight were also predictive. Less striking associations of interest were with the leukocyte count, pulse rate and certain questionnaire items suggesting non-specific health impairment. Past concerns about alcohol and coffee consumption were not confirmed.
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PMID:Risk factors for pancreatic cancer: an exploratory study. 844 44

One thousand twenty patients consecutively admitted because of a clinical suspicion of pancreatic cancer were investigated to evaluate the accuracy of simple clinical, laboratory, and ultrasonographic data in the diagnosis of pancreatic cancer. Age, weight loss, recent-onset diabetes mellitus, palpable abdominal mass or gallbladder, elevated serum bilirubin or alkaline phosphatase levels, and ultrasonography were significant criteria in discriminating 80 pancreatic cancers from 940 controls. The most sensitive criteria were ultrasonography (83%), weight loss (66%), and bilirubin level of > 3 mg/dl (61%); the most specific were ultrasonography (99%), recent-onset diabetes (97%), and a distended palpable gallbladder (94%). Only ultrasonography demonstrated an elevated positive predictive value (86%), while weight loss, elevated bilirubin and alkaline phosphatase, besides ultrasonography had an elevated negative predictive value (95%). These results show that advanced pancreatic cancer may be excluded with simple clinical and laboratory data; ultrasonography can confirm the diagnosis with a high degree of accuracy. We suggest that the results of any new diagnostic tests for pancreatic cancer be compared with these clinical findings.
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PMID:Clinical presentation and ultrasonography in the diagnosis of pancreatic cancer. 846 88

Serum pancreatic stone protein (PSP) was determined in sera of pancreatic and nonpancreatic diseases using enzyme immunoassay specific to human PSP to study the diagnostic and pathophysiological significance of PSP. Serum PSP in acute pancreatitis (mean +/- SD = 1075.4 +/- 2849.1 ng/mL, n = 33) was significantly higher than that in controls (78.6 +/- 31.8 ng/mL, n = 37, p < 0.01), chronic pancreatitis (156.8 +/- 82.8 ng/mL, n = 32, p < 0.05), and pancreatic cancer (148.468.8 ng/mL, n = 26, p < 0.05). No significant difference was found between noncalcified and calcified chronic pancreatitis. Serum PSP levels were significantly higher in chronic renal failure under hemodialysis (1796.0 +/- 1492.9 ng/mL) than in other diseases such as peptic ulcer, liver cirrhosis, gallstone, and diabetes mellitus. Low but significant correlation was obtained between serum PSP and serum immunoreactive trypsin (r = 0.22, p < 0.05). Increased serum PSP levels in acute pancreatitis and chronic renal failure suggest that serum PSP levels reflect reflex from pancreatic secretion, release from damaged pancreatic acinar cells, or retention in circulation, and can be useful for diagnosis of acute pancreatitis, but not chronic calcified pancreatitis.
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PMID:Serum pancreatic stone protein in pancreatic diseases. 850 56


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