The solid-pseudopapillary neoplasm of the pancreas is a rare disease, although since 2000, it has been often identified. The current study aims to present a 10-case series of solid-pseudopapillary neoplasm of the pancreas and a literature review on the topic. The cohort consisted of nine female patients and one male. The mean age in the group was 31.2 year-old. These patients underwent surgical treatment at the University Hospital between May 2007 and July 2014. Since there was a previous systematic literature review on solid-pseudopapillary neoplasm of the pancreas (prior to September 20 th , 2012), a complementary review was done after this period using PubMed’s data base. The search identified 225 studies on this subject, but only 13 were selected for detailed analysis, after applying the inclusion and exclusion criteria. As a result, most of the information about the disease’s epidemiology, clinical manifestations, malignity risk factors, metastasis and relapse were gathered, however, early diagnosis remained a challenge. Radical surgical resection is established as the standard treatment protocol for the disease, it is also recommended to perform metastasectomy, vascular resections and/or resections of other compromised organs in order to ensure therapeutic success in 95% of the cases. However, a post-operative follow up of at least 5 years is required to identify the possibility of relapses. Further studies are still needed mainly to define this disease’s true prevalence among men, protocols for early diagnosis and the possible role of adjuvant therapies. Image: Intraoperative picture demonstrating a SPN in pancreatic head attached to the portal vein.
{"title":"Solid-Pseudopapillary Neoplasm of the Pancreas: Case Series and Literature Review","authors":"José Roberto Alves, E. Amico","doi":"10.6092/1590-8577/2986","DOIUrl":"https://doi.org/10.6092/1590-8577/2986","url":null,"abstract":"The solid-pseudopapillary neoplasm of the pancreas is a rare disease, although since 2000, it has been often identified. The current study aims to present a 10-case series of solid-pseudopapillary neoplasm of the pancreas and a literature review on the topic. The cohort consisted of nine female patients and one male. The mean age in the group was 31.2 year-old. These patients underwent surgical treatment at the University Hospital between May 2007 and July 2014. Since there was a previous systematic literature review on solid-pseudopapillary neoplasm of the pancreas (prior to September 20 th , 2012), a complementary review was done after this period using PubMed’s data base. The search identified 225 studies on this subject, but only 13 were selected for detailed analysis, after applying the inclusion and exclusion criteria. As a result, most of the information about the disease’s epidemiology, clinical manifestations, malignity risk factors, metastasis and relapse were gathered, however, early diagnosis remained a challenge. Radical surgical resection is established as the standard treatment protocol for the disease, it is also recommended to perform metastasectomy, vascular resections and/or resections of other compromised organs in order to ensure therapeutic success in 95% of the cases. However, a post-operative follow up of at least 5 years is required to identify the possibility of relapses. Further studies are still needed mainly to define this disease’s true prevalence among men, protocols for early diagnosis and the possible role of adjuvant therapies. Image: Intraoperative picture demonstrating a SPN in pancreatic head attached to the portal vein.","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"71 1","pages":"218-226"},"PeriodicalIF":0.2,"publicationDate":"2015-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71234429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Balakrishnan, S. Rinkoff, P. Goldsmith, S. Harper, N. Jamieson, E. Huguet, A. Jah, R. Praseedom
Context Post-operative haemorrhage is a known complication of hepatopancreatobiliary surgery. Prompt treatment minimizes mortality and morbidity; however, there is currently little uniformity in the management of this complication. Objective The total numbers of pancreatectomies or liver resections were identified using hospital episode statistic data. Methods Patients who experienced post-operative bleeding were identified with keyword searches of all discharge letters, imaging reports and the theatre-coding database for the period between January 2005 and December 2011. Treatment modalities for control of haemorrhage as well as morbidity, mortality, length of stay and survival were examined. Results Thirty-four of the 768 pancreatic and liver resections performed experienced post-operative haemorrhage. More patients bled following pancreatectomies (6.1%) compared to hepatectomies (2.5%). Bleeding was controlled using endoscopic, interventional radiological or surgical methods; re-laparotomy provided definitive management in the majority of patients. Post-pancreatectomy haemorrhage was associated with significantly increased mortality (P=0.004). Length of stay was increased following haemorrhage post-pancreatectomy or hepatectomy (P<0.05). Conclusions Our study highlights the substantial increase in mortality and length of stay following post-pancreatectomy and post-hepatectomy haemorrhage. Re-laparotomy was frequently required for control of bleeding. Our proposed management algorithm based on the timing and site of bleeding may standardize treatment in this heterogeneous group. Image: Algorithm for the management of late post-resectional haemorrhage.
{"title":"Diagnosis and Management of Haemorrhagic Complications Following Hepatopancreatobiliary Surgery","authors":"A. Balakrishnan, S. Rinkoff, P. Goldsmith, S. Harper, N. Jamieson, E. Huguet, A. Jah, R. Praseedom","doi":"10.6092/1590-8577/2996","DOIUrl":"https://doi.org/10.6092/1590-8577/2996","url":null,"abstract":"Context Post-operative haemorrhage is a known complication of hepatopancreatobiliary surgery. Prompt treatment minimizes mortality and morbidity; however, there is currently little uniformity in the management of this complication. Objective The total numbers of pancreatectomies or liver resections were identified using hospital episode statistic data. Methods Patients who experienced post-operative bleeding were identified with keyword searches of all discharge letters, imaging reports and the theatre-coding database for the period between January 2005 and December 2011. Treatment modalities for control of haemorrhage as well as morbidity, mortality, length of stay and survival were examined. Results Thirty-four of the 768 pancreatic and liver resections performed experienced post-operative haemorrhage. More patients bled following pancreatectomies (6.1%) compared to hepatectomies (2.5%). Bleeding was controlled using endoscopic, interventional radiological or surgical methods; re-laparotomy provided definitive management in the majority of patients. Post-pancreatectomy haemorrhage was associated with significantly increased mortality (P=0.004). Length of stay was increased following haemorrhage post-pancreatectomy or hepatectomy (P<0.05). Conclusions Our study highlights the substantial increase in mortality and length of stay following post-pancreatectomy and post-hepatectomy haemorrhage. Re-laparotomy was frequently required for control of bleeding. Our proposed management algorithm based on the timing and site of bleeding may standardize treatment in this heterogeneous group. Image: Algorithm for the management of late post-resectional haemorrhage.","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"16 1","pages":"283-289"},"PeriodicalIF":0.2,"publicationDate":"2015-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71235007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Autoimmune pancreatitis is a rare type of chronic pancreatitis with characteristic clinical, radiologic, and histopathologic findings. Diagnosis of autoimmune pancreatitis is often challenging due to its low incidence and nonspecific clinical and radiologic findings. Patients with autoimmune pancreatitis and pancreatic cancer share similar clinical presentations, including obstructive jaundice, abdominal pain and weight loss. Due to these overlapping features, autoimmune pancreatitis patients are often misdiagnosed with pancreatic cancer and undergo unnecessary surgery. International consensus diagnostic criteria for autoimmune pancreatitis lists 5 cardinal features to establish the diagnosis of autoimmune pancreatitis. These features include imaging, serology, other organ involvement, histopathology of the pancreas, and response to steroid therapy. Endoscopic ultrasound-guided fine needle aspiration is a routine diagnostic tool for pancreatic lesions. It is usually utilized to exclude a malignant process in autoimmune pancreatitis patients, since its role to establish a definitive diagnosis of autoimmune pancreatitis is often limited. Endoscopic ultrasound-guided-tru-cut biopsy and endoscopic ultrasound-guided fine needle using a large gauge needle (19 to 22 gauges) have been the preferred methods to obtain tissue samples for histologic evaluation. Lymphoplasmacytic infiltrates, fibrotic stroma, mildly atypical epithelial cells, periphlebitis, and obliterative periphlebitis are the common histologic findings of type 1 autoimmune pancreatitis. Meanwhile, granulocytic pancreatic ductal epithelial damage and ductal obliteration are the histologic characteristics of type 2 autoimmune pancreatitis. Immunohistochemical and molecular studies may be helpful to support the diagnosis of AIP in biopsy materials. Image: Permanent section of the fine needle aspirate showing venulitis.
{"title":"Autoimmune Pancreatitis: A Succinct Overview","authors":"J. Putra, Xiaoying Liu","doi":"10.6092/1590-8577/2989","DOIUrl":"https://doi.org/10.6092/1590-8577/2989","url":null,"abstract":"Autoimmune pancreatitis is a rare type of chronic pancreatitis with characteristic clinical, radiologic, and histopathologic findings. Diagnosis of autoimmune pancreatitis is often challenging due to its low incidence and nonspecific clinical and radiologic findings. Patients with autoimmune pancreatitis and pancreatic cancer share similar clinical presentations, including obstructive jaundice, abdominal pain and weight loss. Due to these overlapping features, autoimmune pancreatitis patients are often misdiagnosed with pancreatic cancer and undergo unnecessary surgery. International consensus diagnostic criteria for autoimmune pancreatitis lists 5 cardinal features to establish the diagnosis of autoimmune pancreatitis. These features include imaging, serology, other organ involvement, histopathology of the pancreas, and response to steroid therapy. Endoscopic ultrasound-guided fine needle aspiration is a routine diagnostic tool for pancreatic lesions. It is usually utilized to exclude a malignant process in autoimmune pancreatitis patients, since its role to establish a definitive diagnosis of autoimmune pancreatitis is often limited. Endoscopic ultrasound-guided-tru-cut biopsy and endoscopic ultrasound-guided fine needle using a large gauge needle (19 to 22 gauges) have been the preferred methods to obtain tissue samples for histologic evaluation. Lymphoplasmacytic infiltrates, fibrotic stroma, mildly atypical epithelial cells, periphlebitis, and obliterative periphlebitis are the common histologic findings of type 1 autoimmune pancreatitis. Meanwhile, granulocytic pancreatic ductal epithelial damage and ductal obliteration are the histologic characteristics of type 2 autoimmune pancreatitis. Immunohistochemical and molecular studies may be helpful to support the diagnosis of AIP in biopsy materials. Image: Permanent section of the fine needle aspirate showing venulitis.","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"16 1","pages":"239-243"},"PeriodicalIF":0.2,"publicationDate":"2015-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71234521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Context Acinar cell cystadenoma of pancreas is a very rare pancreatic cystic lesion. It is also a benign lesion without malignant potential. Because it is normal tissue with abnormal figuration, acinar cell transformation is also named. Case report We reported a thirty-seven-year-old female noticed to have a cystic lesion closely in contact with the pancreatic tail by abdominal CT scan. After operation, the cystic lesion was analyzed and acinar cell cystadenoma arising from retroperitoneum was confirmed. Conclusion Literature review revealed only one case of retroperitoneal acinar cell cystadenoma was reported before and the pathogenesis is still unknown. Image: Loculated cystic lesion with watery clear fluid over retroperitoneum.
{"title":"Acinar Cell Cystadenoma of Retroperitoneum: A Case Report and the Literature Review","authors":"Ming-Zhang Song, C. Su, C. Hsiao","doi":"10.6092/1590-8577/3002","DOIUrl":"https://doi.org/10.6092/1590-8577/3002","url":null,"abstract":"Context Acinar cell cystadenoma of pancreas is a very rare pancreatic cystic lesion. It is also a benign lesion without malignant potential. Because it is normal tissue with abnormal figuration, acinar cell transformation is also named. Case report We reported a thirty-seven-year-old female noticed to have a cystic lesion closely in contact with the pancreatic tail by abdominal CT scan. After operation, the cystic lesion was analyzed and acinar cell cystadenoma arising from retroperitoneum was confirmed. Conclusion Literature review revealed only one case of retroperitoneal acinar cell cystadenoma was reported before and the pathogenesis is still unknown. Image: Loculated cystic lesion with watery clear fluid over retroperitoneum.","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"16 1","pages":"307-309"},"PeriodicalIF":0.2,"publicationDate":"2015-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71234985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hongyi Chen, Julie A. Teague, L. Weinberg, M. Nikfarjam
Context Multifocal or diffuse mucinous cystic neoplasm are uncommon and may be difficult to distinguish from multifocal intra-ducal mucinous neoplasm or diffuse serous cystadenoma. Case report A forty-seven-year old lady with vague abdominal pain was noted to have cystic lesions ranging from 5 to 20 mm throughout her pancreas. The cysts had enlarged over several years of observation. There was no evidence of pancreatic duct dilatation or communication with the pancreatic duct on magnetic resonance imaging. Cyst fluid analysis for carcinoembryonic antigen and amylase were non-diagnostic. A total pancreatectomy was performed, with histology confirming numerous cysts lined by mucus producing cells, without obvious ovarian-like stroma. The stroma did however demonstrate positive staining for oestrogen receptor and smooth muscle actin. These findings were most consistent with a mucinous cystic neoplasm, despite the apparent absence of typical ovarian like stroma. Conclusion Multifocal or diffuse pancreatic mucinous cystic neoplasm are uncommon and may be suspected when imaging demonstrates multiple pancreatic cysts without communication with the pancreatic duct or pancreatic duct dilation. Surgical resection is indicated due to the increased risk of malignancy. Image: Sectioning of the pancreas demonstrates multiple cysts without any clear communication with the pancreatic duct and no evidence of pancreatic duct dilatation.
{"title":"Diffuse Pancreatic Mucinous Cystic Neoplasm Treated by Total Pancreatectomy","authors":"Hongyi Chen, Julie A. Teague, L. Weinberg, M. Nikfarjam","doi":"10.6092/1590-8577/2999","DOIUrl":"https://doi.org/10.6092/1590-8577/2999","url":null,"abstract":"Context Multifocal or diffuse mucinous cystic neoplasm are uncommon and may be difficult to distinguish from multifocal intra-ducal mucinous neoplasm or diffuse serous cystadenoma. Case report A forty-seven-year old lady with vague abdominal pain was noted to have cystic lesions ranging from 5 to 20 mm throughout her pancreas. The cysts had enlarged over several years of observation. There was no evidence of pancreatic duct dilatation or communication with the pancreatic duct on magnetic resonance imaging. Cyst fluid analysis for carcinoembryonic antigen and amylase were non-diagnostic. A total pancreatectomy was performed, with histology confirming numerous cysts lined by mucus producing cells, without obvious ovarian-like stroma. The stroma did however demonstrate positive staining for oestrogen receptor and smooth muscle actin. These findings were most consistent with a mucinous cystic neoplasm, despite the apparent absence of typical ovarian like stroma. Conclusion Multifocal or diffuse pancreatic mucinous cystic neoplasm are uncommon and may be suspected when imaging demonstrates multiple pancreatic cysts without communication with the pancreatic duct or pancreatic duct dilation. Surgical resection is indicated due to the increased risk of malignancy. Image: Sectioning of the pancreas demonstrates multiple cysts without any clear communication with the pancreatic duct and no evidence of pancreatic duct dilatation.","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"16 1","pages":"295-298"},"PeriodicalIF":0.2,"publicationDate":"2015-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71235175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Today, almost half of the patients who are on chronic kidney replacement therapy have diabetes. The enormous worldwide rise in these cases pose potential economic burden for every country and therefore monitoring kidney function should be a practice provided in outpatient settings. Poorly controlled diabetes will not only result in chronic renal failure, but also patients with chronic renal disease will have some metabolic abnormalities that will increase both morbidity and mortality of the patients. While hypertension may associate with most of the diabetic cases, those people with diabetes who have no rise in blood pressure will eventually develop hypertension at later stage of the chronic kidney disease. Many inflammation markers present in case of diabetes, may contribute somehow further to the deterioration of the kidney function especially in those who do not have a properly controlled glucose excursions during day and night. Increased serum creatinine level is considered a definite marker of very late stage chronic renal failure that should be kept in mind. In order to avert increasing the rate of waiting list for kidney transplantation, monitorizing the level of microalbuminuria should be a routine practice delivered in general practitioner’s offices.
{"title":"Complications of Diabetes: Chronic Kidney Disease (CKD) and Diabetic Nephropathy","authors":"M. A. Büyükbeşe","doi":"10.6092/1590-8577/2787","DOIUrl":"https://doi.org/10.6092/1590-8577/2787","url":null,"abstract":"Today, almost half of the patients who are on chronic kidney replacement therapy have diabetes. The enormous worldwide rise in these cases pose potential economic burden for every country and therefore monitoring kidney function should be a practice provided in outpatient settings. Poorly controlled diabetes will not only result in chronic renal failure, but also patients with chronic renal disease will have some metabolic abnormalities that will increase both morbidity and mortality of the patients. While hypertension may associate with most of the diabetic cases, those people with diabetes who have no rise in blood pressure will eventually develop hypertension at later stage of the chronic kidney disease. Many inflammation markers present in case of diabetes, may contribute somehow further to the deterioration of the kidney function especially in those who do not have a properly controlled glucose excursions during day and night. Increased serum creatinine level is considered a definite marker of very late stage chronic renal failure that should be kept in mind. In order to avert increasing the rate of waiting list for kidney transplantation, monitorizing the level of microalbuminuria should be a routine practice delivered in general practitioner’s offices.","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"15 1","pages":"537-537"},"PeriodicalIF":0.2,"publicationDate":"2014-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71234363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Despite incredible effort on understanding and awareness of diabetes, management procedure is becoming more challenging since the complications of the disease as well as the newly discovered or yet put on market drugs that may have a suspicious association with cancer. This metabolic disorder itself does already have high prevalence of cancer such as pancreas and colon. Thyroid cancer itself is also increasing and thyroid disorders associated with diabetes is well known endocrinological problem. Rise in thyroid cancer patients in diabetics are also emphasized in meta-analyses. Obesity does seem to be another factor for thyroid cancer; however, it is also commonly associated with patients who have type 2 diabetes. GLP-1 based therapy does not only help diminish blood glucose but help satiety and lose weight as well which is a desired effect of diabetes therapy since losing weight corrects many other cardiovascular risk factors. Thyroid cancer and its connectivity to GLP-1 analogue therapy is a concern, yet not proven; although may diminish the rate of prescription by some diabetologists, although some suggest outweigh the clinical positive effect. Image: Thyroid gland.
{"title":"GLP-1 Based Therapy for Diabetes and Potential of Thyroid Cancer","authors":"M. A. Büyükbeşe","doi":"10.6092/1590-8577/2788","DOIUrl":"https://doi.org/10.6092/1590-8577/2788","url":null,"abstract":"Despite incredible effort on understanding and awareness of diabetes, management procedure is becoming more challenging since the complications of the disease as well as the newly discovered or yet put on market drugs that may have a suspicious association with cancer. This metabolic disorder itself does already have high prevalence of cancer such as pancreas and colon. Thyroid cancer itself is also increasing and thyroid disorders associated with diabetes is well known endocrinological problem. Rise in thyroid cancer patients in diabetics are also emphasized in meta-analyses. Obesity does seem to be another factor for thyroid cancer; however, it is also commonly associated with patients who have type 2 diabetes. GLP-1 based therapy does not only help diminish blood glucose but help satiety and lose weight as well which is a desired effect of diabetes therapy since losing weight corrects many other cardiovascular risk factors. Thyroid cancer and its connectivity to GLP-1 analogue therapy is a concern, yet not proven; although may diminish the rate of prescription by some diabetologists, although some suggest outweigh the clinical positive effect. Image: Thyroid gland.","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"15 1","pages":"538-538"},"PeriodicalIF":0.2,"publicationDate":"2014-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71234370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gentle touch is sensed in the nematode Caenorhabditis elegans by six touch receptor neurons (TRNs). Transduction requires a heterotrimeric channel comprised of two DEG/ENaC proteins, MEC-4 and MEC-10, in a 2:1 ratio. Touch sensitivity is modulated by several different factors and on at least two different time scales. In the short term repeated stimuli result in two forms of habituation, one involving intrinsic regulation and the other requiring synaptic regulation. In addition long-term affects (resulting after several hours) are produced by vibration, which acts through integrins and other focal adhesion molecules in the TRNs to increase sensitivity and low oxygen, high salt, and entry into the dauer state, which affect neurohormonal regulation by the products of two different insulin genes of the TRNs to reduce sensitivity. These long-term modifications act through the transcription factor DAF-16 to change the amount of surface MEC-4. These changes, which are integrated at several levels within the animal and in the TRNS, allow the animals to respond differently to touch under various environmental conditions and to prioritize sensory signals. Image: Caenorhabditis elegans , adult hermaphrodite (Author: Bob Goldstein , University of North Carolina (UNC), Chapel Hill, NC, USA. Wikimedia Commons )
{"title":"Modulation of Sensory Mechanoreceptor Neurons in Caenorhabditis elegans by Insulin and Other Signals","authors":"M. Chalfie","doi":"10.6092/1590-8577/2782","DOIUrl":"https://doi.org/10.6092/1590-8577/2782","url":null,"abstract":"Gentle touch is sensed in the nematode Caenorhabditis elegans by six touch receptor neurons (TRNs). Transduction requires a heterotrimeric channel comprised of two DEG/ENaC proteins, MEC-4 and MEC-10, in a 2:1 ratio. Touch sensitivity is modulated by several different factors and on at least two different time scales. In the short term repeated stimuli result in two forms of habituation, one involving intrinsic regulation and the other requiring synaptic regulation. In addition long-term affects (resulting after several hours) are produced by vibration, which acts through integrins and other focal adhesion molecules in the TRNs to increase sensitivity and low oxygen, high salt, and entry into the dauer state, which affect neurohormonal regulation by the products of two different insulin genes of the TRNs to reduce sensitivity. These long-term modifications act through the transcription factor DAF-16 to change the amount of surface MEC-4. These changes, which are integrated at several levels within the animal and in the TRNS, allow the animals to respond differently to touch under various environmental conditions and to prioritize sensory signals. Image: Caenorhabditis elegans , adult hermaphrodite (Author: Bob Goldstein , University of North Carolina (UNC), Chapel Hill, NC, USA. Wikimedia Commons )","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"15 1","pages":"533-533"},"PeriodicalIF":0.2,"publicationDate":"2014-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71234815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
About half of all patients with chronic pancreatitis (CP) develop diabetes mellitus (DM) due to the loss of islet cell mass, not just beta cells as in Type 1 DM (T1DM), or due to insulin resistance, as in Type 2 DM (T2DM). Patients with DM from loss of islets due to pancreatic disease or resection are diagnosed with pancreatogenic or Type 3c DM (T3cDM). Patients with T3cDM also lose counter-regulatory hormones, such as glucagon and pancreatic polypeptide, and experience maldigestion associated with pancreatic exocrine insufficiency. Patients with T3cDM are therefore more susceptible to hypoglycemia and a mismatch (asynchrony) between food ingestion and nutrient absorption. At the same time, the use of incretin therapy is likely useless, since maldigestion leads to the release of higher levels of hind gut hormones, including GLP1. Thus, T3cDM caused by CP or destruction of the islets involves a special class of potential risks and comorbidity that may be overlooked if the CP has not been diagnosed. Further, because CP is also associated with pancreatic ductal adenocarcinoma, better classification of patients with DM is needed to determine if PDAC is associated with DM or with undetected CP that gave rise to T3cDM that was previously misclassified as T1DM to T2DM. Image: Cathedral of Learning at University of Pittsburgh. Pittsburgh, PA, USA. (Author: Kevin Albright, Wikimedia Commons )
{"title":"Chronic Pancreatitis, Type 3c Diabetes, and Pancreatic Cancer Risk","authors":"D. Whitcomb","doi":"10.6092/1590-8577/2773","DOIUrl":"https://doi.org/10.6092/1590-8577/2773","url":null,"abstract":"About half of all patients with chronic pancreatitis (CP) develop diabetes mellitus (DM) due to the loss of islet cell mass, not just beta cells as in Type 1 DM (T1DM), or due to insulin resistance, as in Type 2 DM (T2DM). Patients with DM from loss of islets due to pancreatic disease or resection are diagnosed with pancreatogenic or Type 3c DM (T3cDM). Patients with T3cDM also lose counter-regulatory hormones, such as glucagon and pancreatic polypeptide, and experience maldigestion associated with pancreatic exocrine insufficiency. Patients with T3cDM are therefore more susceptible to hypoglycemia and a mismatch (asynchrony) between food ingestion and nutrient absorption. At the same time, the use of incretin therapy is likely useless, since maldigestion leads to the release of higher levels of hind gut hormones, including GLP1. Thus, T3cDM caused by CP or destruction of the islets involves a special class of potential risks and comorbidity that may be overlooked if the CP has not been diagnosed. Further, because CP is also associated with pancreatic ductal adenocarcinoma, better classification of patients with DM is needed to determine if PDAC is associated with DM or with undetected CP that gave rise to T3cDM that was previously misclassified as T1DM to T2DM. Image: Cathedral of Learning at University of Pittsburgh. Pittsburgh, PA, USA. (Author: Kevin Albright, Wikimedia Commons )","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"28 1","pages":"525-525"},"PeriodicalIF":0.2,"publicationDate":"2014-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71234330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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