bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pathologic aspects of gastrinomas in patients with Zollinger‐Ellison syndrome with and without multiple endocrine neoplasia type I
Authors: Pipeleers‐Marichal Miriam , Donow Christian , Heitz Philipp U. , Klöppel Günter 
Published: May 2005

AbstractDuring the three decades since the recognition of the Zollinger‐Ellison syndrome (ZES), major progress has been made in the diagnosis and treatment of this disease. However, the many failed operations in patients with ZES, the existence of primary lymph node gastrinomas, and the surgical approach of patients with ZES and multiple endocrine neoplasia type I (MEN‐I) have remained controversial issues. In this review, our experience with the pathology of immunocytochemically identified gastrinomas in 44 patients with ZES is presented and related to the relevant literature. (1) Gastrinomas occur frequently in the duodenum (> 40%) and are commonly small (< 1 cm). They can therefore easily be missed at surgical exploration; lymph node metastases from such occult gastrinomas may be mistaken for primary tumors. (2) Most pancreatic gastrinomas reside in the head of the gland and have a diameter of 1 to 3 cm. (3) Gastrinomas associated with MEN‐I are predominantly of duodenal origin and frequently multicentric; sporadic gastrinomas are single and more often pancreatic. Because MEN‐I associated pancreatic tumors seldom contain gastrin, ZES in MEN‐I patients is almost never cured by resection of the pancreatic tumors. (4) The metastatic potential of most small duodenal gastrinomas seems to be restricted to the regional lymph nodes.
Current approach to the management of gastrinoma and insulinoma in adults with multiple endocrine neoplasia type I
Authors: Mignon Michel , Ruszniewski Philippe , Podevin Philippe , Sabbagh Luis , Cadiot Guillaume , Rigaud Daniel , Bonfils Serge 
Published: May 2005

AbstractThe difficult and controversial diagnostic and therapeutic management of patients having gastrinoma or insulinoma with multiple endocrine neoplasia type I (MEN‐I) has been discussed by reference to the literature and a personal series of 45 gastrinoma/MEN‐I patients followed consecutively at Bichat Hospital. In both gastrinoma/ and insulinoma/MEN‐I patients, anatomic distribution and morphology of tumoral process(es) are usually multiple, diffuse, of small size, and associated with endocrine cell hyperplasia and even nesidioblastosis. These features enhance the difficulty of tumor localization and eradication. Despite the dramatic development of modern medical imagery and surgical experience, the real possibility, on a long‐term basis, of curing the patients from their disease remains limited, especially in the gastrinoma/MEN‐I patients. In the latter group, according to our experience, persistence or recurrence of the disease after surgery is usual, and metachronous hepatic metastasis development is frequently observed when the follow‐up is long enough. Patients with liver metastases, however, seem to undergo a more indolent course than sporadic gastrinoma cases. In insulinoma/MEN‐I patients, removal of the functionally dominant islet cell area(s) is essential. Various preoperative and intraoperative localization techniques allow efficacious selective pancreatic surgery in many cases. The latter refinements and the promises of long‐acting somatostatin analogs, if confirmed, might restrict to exceptional circumstances the indication of near‐total or total pancreatectomy.
Use of octreotide acetate for control of symptoms in patients with islet cell tumors
Authors: Maton Paul N. 
Published: May 2005

AbstractGut tumor syndromes are rare, occurring in less than two cases per million population per year: Insulinomas are most common and gastrinomas are less common; all the others are extremely rare. Conventional treatment of the symptoms caused by these tumors has included surgery, hepatic arterial embolization, and chemotherapy; some patients with Zollinger‐Ellison syndrome (ZES) have been treated with specific agents such as gastric antisecretory drugs. The development of octreotide, a synthetic, long‐acting analogue of the natural peptide somatostatin, has offered an alternative to such therapies. Octreotide has a half life of >100 minutes and inhibits both physiological‐ and tumor release of many peptides. It also has direct effects on the gut that modify secretion and motility. Octreotide has been shown to be particularly useful for the symptoms of tumors producing vasoactive intestinal peptide (VIP), and of the carcinoid syndrome. It is also useful in patients with glucagonomas, with growth hormone‐releasing hormone producing tumors, and in some patients with Cushing's syndrome and unresectable insulinomas. Octreotide is effective in patients with ZES, but alternative therapies such as omeprazole are more effective, safer, and more convenient for those patients. Side effects of octreotide have not been troublesome in these patients, but the incidence of long term effects is still not entirely clear. Octreotide has proved to be a significant advance in the treatment of patients with islet cell tumors.
Somatostatin analog Sandostatin and inhibition of tumor growth in patients with metastatic endocrine gastroenteropancreatic tumors
Authors: Arnold Rudolf , Neuhaus Christian , Benning Ralph , Schwerk Wolf B. , Trautmann Michael E. , Joseph Klaus , Bruns Christian 
Published: May 2005

AbstractA prospective study was performed to determine the efficacy of octreotide (Sandostatin®; SMS 201–995) 200 μg tid in controlling tumor growth. The study included 21 patients with metastasized endocrine GEP tumors: 6 gastrinomas, 8 carcinoid syndromes, 7 nonfunctioning tumors. Treatment was performed for 3 to 59 months (median 15 months). Evaluation of the response to octreotide was facilitated in 12 patients by a pretreatment observation period of 3 to 47 months (median 17 months) during which the natural growth behavior was determined. Based on the presence or absence of a control period prior to treatment, 5 patients were considered to be responders, 7 as questionable responders (no pretreatment phase available), and 9 as nonresponders. None of the 21 patients had documented shrinkage of the tumor mass. The most favorable response was tumor standstill. In all but one responder an escape to an initially favorable response occurred after 6 to 28 months (median 14 months). Proved inhibition of growth was paralleled by a reduction of serum and urine hormone parameters, whereas unaltered progression of tumor growth was observed also in the presence of hormone suppression. Tumor growth and hormone release was inhibited in the absence and presence of somatostatin receptors on the tumor. It is concluded that octreotide exerts a limited effect on metastatic GEP tumor growth. The evaluation of a response to octreotide is facilitated by an observation period prior to the drug that provides information on growth characteristics of the tumor. The presence of octreotide receptors does not predict the success of therapy.
Percutaneous transhepatic portal embolization using newly devised catheters: Preliminary report
Authors: Nagino Masato , Nimura Yuji , Hayakawa Naokazu 
Published: May 2005

AbstractTwo 5.5 French triple‐lumen balloon catheters were devised to improve percutaneous transhepatic portal embolization (PTPE) as preoperative management of patients undergoing extensive liver resection. Using these catheters, an ipsilateral approach for embolization is achieved through a portal branch of the liver using fibrin glue mixed with Lipiodol as the embolic material. This approach proved safer and more reliable than the traditional contralateral approach: (1) The portal branch to be resected is punctured; (2) the left and right anterior portal embolization is conducted simultaneously through a single portal puncture; and (3) the catheter sheath can consequentially be removed soon after PTPE without requiring further treatment.
Experimental study of pylorus and pyloric vagus preserving gastrectomy
Authors: Yunfu Lu , Yiding Hou , Shouren Jia , Cuiying Guo 
Published: May 2005

AbstractIn an attempt to prevent the sequelae of conventional gastrectomy, such as rapid gastric emptying, dumping syndrome, intestinal content reflux, indigestion, and poor absorption, we have devised the pylorus and pyloric vagus preserving gastrectomy (PPVPG). Experimenting on 48 dogs, we found theoretic grounds for using our design and obtained the desired effects‐retaining the merits of conventional subtotal resection of the stomach, with acidity reduction, while avoiding the above‐mentioned complications.
Exogenous growth hormone: Effects on the catabolic response to surgically produced acute stress and on postoperative immune function
Authors: Vara‐Thorbeck R. , Guerrero J. A. , Rosell J. , Ruiz‐Requena E. , Capitán J. M. 
Published: May 2005

AbstractThe first purpose of the present prospective randomized study was to determine if the protein catabolic response after operation could be restrained by administration of hypocaloric parenteral nutrition (HPN) plus human growth hormone (hGH). Our second aim was to determine if the administration of hGH could improve the systemic host defenses, thereby reducing the risk of infection. We performed a placebo‐controlled randomized double‐blind trial in 180 patients after elective cholecystectomy with or without choledochoduodenostomy (placebo=control group,n=93; hGH‐treated group,n=87). The results obtained in this study show that positive nitrogen balance can be achieved during the postoperative period from the first 24 hours onward, with a combination of HPN support (1.0–1.5 g protein/kg/day and 900 kcal/day) together with the administration of small doses (8 IU) of hGH. The potassium balance tended to follow the same positive balance as the nitrogen balance. Our study shows that in the control group, treated only with HPN, a significant decrease in serum levels of some acute‐phase proteins (retinol‐binding protein, transferrin, prealbumin), albumin, total proteins, and immunoglobulins occurs by the 5th postoperative day. In the GH group the values of all the above‐mentioned proteins do not change or tend to rise if compared to preoperative levels. In the GH‐treated group liver function appeared to improve at the start of the study. GH and somatomedin C levels were similar in the two groups and had not changed significantly in the control group by the 5th postoperative day. In the GH‐treated group a significant increase in serum levels of GH and somatomedin C on postoperative day 5 was observed. Glucose levels in the control group were unaltered, but in the GH‐treated group a clear increase in glucose concentration was observed. On the other hand, insulin values on postoperative day 5 in the GH group rose to almost twice those of the control group. After operation the number of normoergic patients in the control group fell from 56 to 40; in the GH‐treated group the opposite was the case: the number of normoergic patients increased from 59 to 81. The number of anergic patients remained constant (n=11) in the control group and disappeared in the GH‐treated group. Wound infection was found in 16 patients (17.2%) of the control group but in only 3 (3.4%) of the GH‐treated group. Hospitalization averaged 12.5 ±7.1 days in the control group versus 9.6 ±3.6 days in the GH‐treated group (p < 0.05). With moderate surgical injury (cholecystectomy with or without choledochoduodenostomy) hGH can optimize utilization of adjuvant HPN and overcome the protein catabolic effects of the trauma response. As a result, body cell mass is preserved, wound healing is promoted, and immunologic function is enhanced.
Laparoscopic cholecystectomy: A minor abdominal trauma?
Authors: Schippers Ekkehard , Öttinger Alexander P. , Anurov Michael , Polivoda Michael , Schumpelick Volker 
Published: May 2005

AbstractClinical observations following laparoscopic surgery indicate a shorter period of postoperative ileus than after conventional surgery. The aim of our study was to verify disorders of postoperative motility of the small intestine by means of implanted electrodes after laparoscopic and conventional cholecystectomy (CHE) in an animal model. Four weeks after implantation of three electrodes on the jejunum, CHE was performed laparoscopically in 5 dogs and in an additional 5 dogs by laparotomy. Independent of the type of operation, normal motility (especially the migrating motility complex) was abolished during the early postoperative period. Electrical activity was characterized by the basic electrical rhythm. Time to the occurrence of the first postoperative activity front, indicating restoration of motility, varied significantly depending on the type of operation: It was 5.5 ±1.0 hours after laparoscopic CHE and 46 ±5 hours after conventional CHE. These results support the hypothesis that small peritoneal incisions and less manipulation of the intestine during laparoscopic surgery result in reduced abdominal trauma.
Management of bile duct injuries and strictures following cholecystectomy
Authors: Raute M. , Podlech P. , Jaschke W. , Manegold B. C. , Trede M. , Chir B. 
Published: May 2005

AbstractDuring 7057 conventional cholecystectomies (1972–1991), 16 bile duct injuries occurred, amounting to a risk of 0.22%. A total of 1022 laparoscopic cholecystectomies were performed without such a complication since April 1990. In a retrospective study, 64 patients (16 of our patients and 48 referrals) with an injury or stricture due to conventional cholecystectomy were investigated. In 14 of our 16 patients the injury was recognized and immediately repaired with a good long‐term result of 93%, including one successful repair of a subsequent stricture. Two cases of unrecognized injury were managed by nonoperative means. The group of 48 referred patients comprised 10 early postoperative complications (21%) and 38 strictures after an “uneventful” cholecystectomy. Of the 64 total patients, 10 (16%) underwent nonoperative treatment, and 54 required surgery. The mean follow‐up period after surgery was 7.4 ±4.9 years. Most cases (93%) were repaired by bilioenteric anastomosis (i.e., foremost hepaticojejunostomy) with an 18% restricture rate. Including second and third repairs for restricture, a total of 60 operations (14 primary and 46 secondary reconstructions) were performed without hospital mortality. A good long‐term result after stricture repair was achieved in 75% of the patients, whereas 17% had a poor outcome owing to restricture or death (10% had related mortality within 10 years). The other 8% had a moderate result due to recurrent cholangitis. Thus immediate repair of a bile duct injury offers the better chance of a favorable prognosis compared to secondary stricture repair.
Historical review of pancreatic islet transplantation
Authors: Downing Richard 
Published: May 2005

AbstractThis historical perspective attempts to document the origin and early work of islet tissue transplantation. In the final analysis, most of these early experiments were failures. However, the ideas were clearly appropriate and in place at a very early phase. The first islet tissue transplantation was done in 1893; that is 29 years prior to the Banting's and Best's discovery of insulin therapy. Most of our current active approaches have been tried in the past. As is the case in many areas in science, the problems were defined with ideas and solutions outlined long ago. Yet, the problems were not solvable because of inadequate technology. The insight behind these early experiments must be admired, knowing the limited knowledge that was available. Keeping this historical perspective in mind as we work through our technologic opportunities may be of assistance as we approach our goal of clinical islet transplantation.
Fetal pancreas as a donor organ
Authors: Brown Josiah , Danilovs John A. , Clark William R. , Mullen Yoko S. 
Published: May 2005

AbstractThe use of the fetal pancreas as a donor organ for the treatment of diabetes has been explored in the rat and currently is being tried in minipigs. Growth and development of a fetal pancreas under the kidney capsule of a diabetic rat is sufficient to completely reverse streptozotocin diabetes; the organ contains 20–25% of the insulin content of a normal adult pancreas. The fetal pancreas grows and develops most fully in normoglycemic environment. Cryopreservation results in nearly complete survival of the pancreas and provides time for tissue and blood typing and testing for compatibility of donor and recipient lymphocytes using the Mixed Leucocyte Reaction. These methods have been developed in human systems. Removal of the pancreas from the fetus and transplantation prior to a critical period of exocrine development (18 days in the rat, 55 in the pig) are followed by atrophy of exocrine elements and a pure endocrine organ results. This obviates the problem of exocrine enzymes. Venous drainage of insulin from the transplanted pancreas into the liver provides the most effective response when the supply of insulin is limited. Metabolic studies in successfully‐transplanted rats indicate complete reversal of the diabetic state to normal. These include blood glucose and insulin levels and responses to stimuli, the activity levels of 6 enzymes in the liver, glucagon levels, and the response to arginine stimulation and glucose metabolism during and after pregnancy.Methods that have been used to prevent rejection, all of which have been partially effective, include donor liver pretreatment and short‐term immunosuppression, total lymphoid irradiation combined with donor bone marrow, and treatment of the donor organ to eliminate immune cells by digestion and culture. Additional research will be required to develop an effective and safe method for prevention of allograft rejection in the minipig prior to application to diabetic humans.
Transplantation of organ‐cultured fetal pancreas: Experimental studies and potential clinical application in diabetes mellitus
Authors: Mandel T. E. 
Published: May 2005

AbstractTransplantation of organ‐cultured fetal islets of Langer‐hans may be one way of overcoming the dual difficulties of finding a suitable source of tissue and controlling graft rejection. Experiments in mice have clearly shown that fetal pancreas is an excellent source of islets. Tissue from one donor can be used to treat one or more recipients and provides excellent control of drug‐induced diabetes, including prevention of diabetic renal microangiopathy. The fetal islets display selective survival in vitro and organ culture can be used to obtain large amounts of tissue for transplantation. In addition, growth in “normoglycemic” media results in functional maturation of the fetal tissue.Culture conditions can be modified to eliminate from the putative graft immunogenic “passenger leukocytes,” the cells responsible for initiating graft rejection. Such immunogenic cell—depleted grafts can be transplanted across histocompatibility barriers without the need for recipient immunosuppression.Fetal human pancreas shares many properties in common with fetal mouse pancreas. Continuing growth and differentiation occur in vitro and following xenotransplantation into athymic mice. However, fetal human pancreas is frequently damaged by ischemia before it can be used, and also appears to be more susceptible to oxygen toxicity than is fetal mouse pancreas. Nevertheless, when fresh human tissue is available, it may be a suitable source of islets for transplantation in type I diabetics.
Theory and practice of immunoregulation by tissue treatment prior to transplantation
Authors: Lafferty Kevin J. , Prowse Stephen J. 
Published: May 2005

AbstractAccording to the classical view of allograft rejection, the transplanted tissue is the source of antigen that stimulates a T‐cell response, which in turn sets up the rejection process. Research now indicates that two signals are required for lymphocyte activation. The first signal is provided by antigen binding by the T‐cell receptor. A stimulator cell provides an inductive molecule, costimulator activity, which is the second signal. The stimulator cell model of lymphocyte activation has resulted in a new passenger leukocyte concept, in which these passenger cells are seen to play a central role in graft rejection. Appropriate treatment of a tissue prior to transplantation can afford a marked reduction in its immunogenicity for the host. It is now possible to eliminate or at least reduce tissue immuno‐genicity by removal of leukocytes from the transplant prior to grafting. This phenomenon has been demonstrated to be effective with both endocrine tissue and larger organs, such as the kidney. There is some variation in the effectiveness of the technique with different tissues which can be related to the degree of leukocyte contamination. Allografts of pretreated tissue can induce a state of specific unresponsiveness in the adult recipient. Although the mechanism of this tolerance is not fully understood, the existence of the phenomenon is one of the most encouraging recent developments in transplantation biology.
Immunogenetic considerations in islet transplantation: The role of Ia antigens in graft rejection
Authors: Bach Fritz H. , Morrow Charles E. , Sutherland David E. R. 
Published: May 2005

AbstractAs demonstrated by Faustman et al., islets that are pretreated with Ia antibodies and complement show markedly prolonged survival as compared with islets, with the same immunogenetic disparity, without antibody pretreatment. In order to test whether it is simply the absence of an allo‐Ia disparity that accounts for this finding, we have transplanted islets across class I disparities alone; in certain cases, such islets are rapidly rejected. Yet, even though there is no allo‐Ia difference on such islets, pretreatment of the islets with anti‐Ia monoclonal antibody also results in markedly prolonged survival. We suggest that the presence of Ia antigens may serve as a differentiation marker for cells that can present class I antigens in an immunogenic manner; further, allo‐Ia antigens can lead to a stronger anti‐class I rejection response.
Immunologic factors in pathogenesis and treatment of human and animal diabetes
Authors: Naji Ali , Silvers Willys K. , Bartlett Stephen T. , Francfort John , Barker Clyde F. 
Published: May 2005

AbstractRecent evidence suggests that the pathogenesis of insulindependent (type I, juvenile onset) diabetes mellitus may have an important autoimmune component, possibly triggered by a viral infection. This evidence includes mononuclear infiltration of the endocrine pancreas, circulating islet cell antibodies, and a strong association with certain HLA alleles (DR3 and DR4). The biologic response (apart from allograft rejection) of diabetic hosts to transplanted islets has been examined in an animal model of spontaneous diabetes which closely resembles the human condition (the BB rat). In this syndrome, MHC‐compatible islet allografts suffered autoimmune destruction even when rejection was excluded by experimental design. Implications of this finding with respect to human islet and/or pancreas transplantation are discussed.
Cyclosporine and pancreas transplantation
Authors: Gray D. W. R. , Morris P. J. 
Published: May 2005

AbstractA variety of experiments have thus far shown cyclosporine to be not nearly as successful in preventing rejection of pancreas allografts (islets, fetal, vascularized segmental) in experimental animals as it is with other tissues. Clinical experience has also been relatively disappointing, although surgeons at most centers have the impression that it is marginally better than azathioprine and steroids. The role of cyclosporine in pancreas transplantation, and indeed the place of pancreas transplantation, remains uncertain at this time.