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Query: UMLS:C0011849 (diabetes)
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In summary, at the University of Minnesota we perform pancreas transplants from both living-related and cadaver donors. Living-related donors must meet strict criteria indicating that they are not at risk for diabetes. Segmental grafts are procured from living-related donors. We currently procure whole pancreas grafts from most cadaver donors, including those in whom a liver is procured. We will accept preservation times up to 24 hours using hyperosmolar silica-gel-filtered plasma as the preservation solution. In regard to recipient selection, we have several categories of patients, including nonuremic individuals with early secondary lesions of diabetes affecting the eyes, nerves, and kidneys. Pancreas transplants are also performed in patients with end-stage diabetic nephropathy, either simultaneous with or after a kidney transplant. The potential benefit from pancreas transplantation is greatest in patients who have early diabetic complications which in the absence of this intervention would progress to a severity more serious than the possible side effects of chronic immunosuppression. A careful pretransplant evaluation is necessary in order to select nonuremic, nonkidney recipients in whom pancreas transplantation is appropriate. The selection process is much easier in kidney transplant recipients; virtually any person who can withstand the additional surgery is a candidate, the risks associated with immunosuppression having already been accepted in lieu of the unsatisfactory alternative of chronic dialysis. The results we have obtained in the 3 categories of recipients since November 1984 in patients managed by our currently preferred surgical techniques and immunosuppressive protocols are shown in Figure 6. One-year pancreas survival rates in nonuremic, nonkidney transplant recipients are 63%, in recipients of a previous kidney 46%, and in recipients of simultaneous kidneys 75%. With respect to surgical technique, our current preference is the bladder drainage method because the ability to monitor exocrine function leads to earlier diagnosis and treatment of rejection episodes. With related donor transplant, we have continued to use enteric drainage. Because the rejection rate is much lower than with cadaver donors, the one-year functional survival rate has been relatively high for technically successful enteric-drained related donor grafts. Nevertheless, rejection does occur, and related donor segmental grafts are being performed with bladder drainage. Our current immunosuppressive protocol of quadruple drug therapy has been associated with the highest graft survival rates, particularly in the bladder-drained group where early diagnosis and treatment of rejection has been facilitated. In our experience, UAA monitoring results have had a high correlation with rejection episodes, and we have never seen loss of endocrine function with retention of high UAA levels.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Pancreas transplant protocols at the University of Minnesota: recipient and donor selection, operative and postoperative management, and outcome. 315 73

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.
Pancreas 1988
PMID:Lipomatosis of the pancreas: an unusual cause of massive steatorrhea. 318 86

The beta-cell function in the perfused pancreas, the total pancreatic insulin content, and the weights of pancreas, kidney, spleen, and total body fat were compared at the age of 30 and 45 days in diabetes-prone and body weight-matched diabetes-resistant male BB rats. These inbred rats had an incidence rate of diabetes at 90 days of age of 80 and 0%, respectively. At day 30, the pancreatic insulin content was reduced in the diabetes-prone (n = 10) rats to 15 micrograms (range 7.7-31.8) compared with 32 micrograms (range 23.3-52.9) in the diabetes-resistant (n = 10) rats (p less than 0.01). Although the kinetics of insulin release in response to glucose was maintained, the amount of insulin released in the diabetes-prone rats was decreased (p less than 0.05) including the first peak (p less than 0.05). The weight of the spleen was less (p less than 0.05); whereas the weights of the pancreas, kidney, and total body fat did not differ from those observed in the diabetes-resistant control rats. At 45 days of age, the weight of the pancreas in the diabetes-prone rats (n = 8) was reduced to 159 mg (range 100-190) from 202 mg (range 185-214) (p less than 0.01). The body weight and body fat were identical to those observed in the diabetes-resistant controls (n = 8) and their kidney (p less than 0.05) and spleen (p less than 0.01) were larger. The insulin content was reduced to the same magnitude as the reduction of pancreatic weight.
Pancreas 1988
PMID:Reduced pancreatic insulin is associated with retarded growth of the pancreas in young prediabetic BB rats. 328 68

Pancreatic lipase was revealed by immunocytochemistry and analyzed biochemically in pancreatic tissue from control, diabetic, and insulin-treated diabetic rats. In the three groups of animals, lipase antigenic sites were detected with high resolution in the acinar cells in the compartments involved in protein secretion: rough endoplasmic reticulum, Golgi apparatus, and secretory zymogen granules. The quantitative evaluation of the intensities of labeling has demonstrated that, in contrast to other pancreatic proteins, lipase is concentrated only at the transition between the Golgi apparatus and the condensing vacuoles. This indicates that, although sharing the same secretory pathway as amylase and chymotrypsinogen, lipase may in fact be processed differently. On the other hand, when compared with controls, lipase immunolabelings in tissues with diabetic condition were higher in all the cellular compartments. Treatment of diabetic animals with insulin was found to restore these levels to those obtained in control condition. The biochemical determination of lipase activities in pancreatic tissues confirmed the immunocytochemical data. These results, together with those obtained previously for amylase and chymotrypsinogen, indicate that in diabetic condition secretion from the acinar cells is significantly altered, which may influence intestinal digestion and absorption processes. These modifications, and the enhancement of lipase in particular, could play a role in the pathogenesis of the hyperlipidemic condition present in diabetes.
Pancreas 1988
PMID:Immunocytochemical and biochemical evaluation of pancreatic lipase in acinar cells of control and streptozotocin-induced diabetic rats. 329 Aug 94

Pancreas transplantation. Combined kidney and pancreas transplantation is one valuable treatment of patients with type I diabetes who developed the long-term secondary complications of the diabetes, with pre-end or end-stage renal disease. Thirteen patients underwent that procedure in our Institution. Technical modifications - such as whole pancreas transplantation with urinary drainage of the exocrine secretion by a pancreatico-duodenocystostomy - allow the monitoring of the exocrine secretion which is a pertinent immunological parameter. In the next future, pancreas transplantation alone should be considered safely using the same procedure, in non uremic diabetic recipients in whom secondary complications would predictably otherwise be more serious than the potential side effects of chronic immunosuppression.
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PMID:[Pancreatic transplantation]. 329 14

The effects of fasting, refeeding, and streptozotocin-induced experimental diabetes on free amino acid concentrations in the rat exocrine pancreas were investigated. Extracts of pancreatic tissue and plasma were analyzed using high-performance liquid chromatography (HPLC). Pancreatic and plasma concentrations of alanine were reduced in animals fasted for 24 to 72 h. Pancreatic concentrations of leucine, arginine, and glutamine were increased after fasting for 48 h, and concentrations of all essential amino acids plus the nonessential amino acids glycine, serine, taurine, and glutamine were elevated after fasting for 72 h. Refeeding 72 h fasted animals for 3 h or 24 h had a negligible effect on the plasma amino acid concentrations, but markedly lowered the concentration of essential amino acids within the pancreatic tissue. Diabetes lowered the total plasma amino acid concentration from 4.9 mM to 3.1 mM but increased the total pancreatic tissue amino acid level from 16.4 mM to 18.3 mM. Efflux of intracellular amino acids into the circulation of the isolated perfused pancreas was assessed under basal conditions and in response to a vascular amino acid challenge using HPLC. L-serine transstimulated efflux of a large number of amino acids, whereas cellular efflux was only minimally affected by L-phenylalanine. Fasting and diabetes-induced increases in essential amino acid concentrations within the pancreas may reflect decreased protein synthesis, accelerated protein catabolism, or a change in membrane transport. Altered intracellular amino acid levels may directly regulate exchange diffusion of intracellular for extracellular amino acid(s).
Pancreas 1988
PMID:Fasting, refeeding and diabetes modulate free amino acid concentrations in the rat exocrine pancreas: role of transstimulation in amino acid efflux. 336 44

Serum trypsin-like immunoreactivity and pancreatic isoamylase were measured in 302 insulin-dependent diabetic patients (166 men) using radioimmunoassay for the former and a photocolorimetric method for the latter. There was a significant correlation between the two enzymes (r = 0.67, p less than 0.0001) with lower concentrations of both trypsin-like immunoreactivity (208.8 micrograms/L) and pancreatic isoamylase (67.5 U/L) in diabetic patients as compared to controls (p less than 0.0001). Using multiple regression analysis, a statistically significant association was only apparent between enzyme concentrations and age at onset of diabetes (r = 0.31, p less than 0.0001). The results suggest that impaired exocrine pancreatic function may occur in an appreciable proportion of diabetic patients and also that a primary insult to the exocrine pancreas occurring at the time of endocrine injury may be a contributory factor.
Pancreas 1988
PMID:Serum concentrations of trypsin-like immunoreactivity and pancreatic isoamylase in insulin dependent diabetic patients. 337 27

The frequency of Ia antigen bearing W3/13 positive lymphocytes from the blood of 68 bio-breeding (BB) diabetes-prone rats was analyzed with monoclonal antibodies to determine whether elevated levels of these cells could predict which animals would subsequently become hyperglycemic. Selecting a value of greater than or equal to 4.00% as elevated, the sensitivity of this assay in predicting diabetes was 85%, while the specificity was 83%. We believe that elevated levels of Ia antigen bearing W3/13 positive lymphocytes reflect an ongoing immune process and accurately predict the likelihood of developing spontaneous hyperglycemia when obtained from a high risk population.
Pancreas 1987
PMID:Elevated levels of a lymphocyte subset accurately predict the diabetic state in the BB rat. 349 61

Pancreas was examined in 136 patients who died at the age of 7 to 89 years of various diseases including 22 with diabetes mellitus. Amyloidosis of its islands was observed in 9 patients (aged 49 and over); 6 out of them suffered from diabetes mellitus. Number of islands with amyloidosis and amyloid quantity were determined morphometrically. Glucagon-producing A-cells and insulin-producing B-cells in the islands not involved in amyloidosis were counted in sections impregnated by Grimelius. It is found that the development of diabetes is determined not only by the islands amyloidosis but by the quantitative domination of A-cells over B-cells in the islands without amyloidosis as well being the manifestation of aging processes.
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PMID:[Amyloidosis of the pancreatic islets and diabetes mellitus]. 352 15

Amyloid was isolated from islets of amyloidotic pancreata of monkey and human beings by solubilization of non-amyloid materials from the pancreas and digestion of contaminating collagen and elastin. The resulting pellet was estimated to be greater than 90% pure islet amyloid. Antibodies specific for monkey islet amyloid and for monkey and human liver amyloid A (AA) were raised in rabbits. Immunohistochemical reaction using the peroxidase antiperoxidase method demonstrated that amyloidotic pancreas reacted with both anti-AA and anti-islet amyloid antibodies. Although the antibodies are specific toward antigens, they cross-react with tissues from human and monkeys. The immunochemical results suggest the possibility that more than one kind of amyloid is associated with islet amyloidosis, but that a significant portion of the islet amyloid is related to AA. Preliminary chemical analysis indicated that islet amyloid is enriched with hexosamines while AA contains both hexosamines and hexoses. Establishment of the islet amyloid composition(s) can give insight into its source and its role in diabetes in Macaca nigra and human beings.
Pancreas 1986
PMID:Immunohistochemical study of islet amyloid in diabetes mellitus. 355 Jul 80


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