[Lateral anastomosis techniques: Partington-Rochelle and V-shaped excision]

Characteristic symptoms of chronic pancreatitis are difficult to manage conservatively. They include severe pain and endocrine and exocrine insufficiency. Surgical treatment with simple and extended draining procedures addresses pain relief and the management of chronic pancreatitis-associated complications of adjacent organs. Following the assumption that pancreatic duct changes with intraductal hypertension are the reason for pain, simple drainage procedures have reduced pain in up to 80% of patients, with low morbidity and mortality. In case of complications involving adjacent organs with inflammatory pancreatic head tumor and stenosis of the distal bile duct, extended drainage procedures with limited pancreatic head resection according to Frey and V-shaped excision of the ventral aspect of the pancreas have been performed successfully.

Late morbidity after duodenum-preserving pancreatic head resection with bile duct reinsertion into the resection cavity

BACKGROUND

Reinsertion of the distal common bile duct (CBD) into the pancreatic resection cavity during duodenum-preserving pancreatic head excision (DPPHE) may be an alternative option to Whipple resection or bilioenteric anastomosis when chronic pancreatitis is associated with CBD stenosis.

METHODS

Outcome in 82 patients with chronic pancreatitis who underwent DPPHE with CBD reinsertion was compared with that in 432 who had DPPHE without reinsertion and 50 who had a Whipple procedure or pylorus-preserving pancreatoduodenectomy (PPPD).

RESULTS

There were no deaths after DPPHE with CBD reinsertion, compared with four (0.9 per cent) after DPPHE without reinsertion and three (6 per cent) after classical resection. Overall morbidity rates were 30, 28.9 and 36 per cent respectively. Fifteen patients (18 per cent) who had DPPHE with CBD reinsertion developed a stricture at the reinsertion site, compared with a long-term stricture rate of 2.3 per cent (ten patients) after DPPHE without CBD reinsertion and 4 per cent (two patients) after PPPD/Whipple resection.

CONCLUSION

Although associated with a high incidence of anastomotic stricture, reinsertion of the CBD into the resection cavity as part of DPPHE can be used to preserve duodenal passage and offers an alternative to extended resection for chronic pancreatitis.

[Native magnetic resonance tomography imaging of the Morris hepatoma (MH-7777A) in the rat]

Goal of the study presented was to establish an oncological animal model for implantable and differentiated hepatoma in the rat and to evaluate imaging of the tumor induced using MRI.

MATERIAL AND METHODS

20 male buffalo rats underwent tumor cell implantation of 150,000 MH7777-A cells via laparotomy. After 12 days MRI was performed T1w SE, T2w TSE fs, TIRM) for tumor detection and measurement of size. Immediately there after all rats were killed and macroscopic and histological examination performed. Pathological findings were correlated with MRI.

RESULTS

In 5 out of 20 animals no tumor was found. Mean size of the hepatomas in 15 animals was 3.1 mm (+/- 1.7 mm). On MRI 14 out of 15 tumors were detectable. Mean diameter in MRI was 2.7 mm (+/- 1.5 mm; 1-5 mm). T2w TSE was superior for tumor detection compared with the TIRM, while the best anatomic depiction was offered by T1w SE.

CONCLUSIONS

The MH7777-A tumor model presents with a rate of 75% even with the small tumor cell amount of 150,000 cells. With MRI using T2 weighted sequences with fat saturation a detection of tumors with diameters of 1 mm is reliably possible in 93% of the cases.

Receptor for advanced glycation end products mediates inflammation and enhanced expression of tissue factor in vasculature of diabetic apolipoprotein E-null mice

Advanced glycation end products (AGEs) and their cell surface receptor, RAGE, have been implicated in the pathogenesis of diabetic complications. Here, we studied the role of RAGE and expression of its proinflammatory ligands, EN-RAGEs (S100/calgranulins), in inflammatory events mediating cellular activation in diabetic tissue. Apolipoprotein E-null mice were rendered diabetic with streptozotocin at 6 weeks of age. Compared with nondiabetic aortas and kidneys, diabetic aortas and kidneys displayed increased expression of RAGE, EN-RAGEs, and 2 key markers of vascular inflammation, vascular cell adhesion molecule (VCAM)-1 and tissue factor. Administration of soluble RAGE, the extracellular domain of the receptor, or vehicle to diabetic mice for 6 weeks suppressed levels of VCAM-1 and tissue factor in the aorta, in parallel with decreased expression of RAGE and EN-RAGEs. Diabetic kidney demonstrated increased numbers of EN-RAGE-expressing inflammatory cells infiltrating the glomerulus and enhanced mRNA for transforming growth factor-beta, fibronectin, and alpha(1) (IV) collagen. In mice treated with soluble RAGE, the numbers of infiltrating inflammatory cells and mRNA levels for these glomerular cytokines and components of extracellular matrix were decreased. These data suggest that activation of RAGE primes cells targeted for perturbation in diabetic tissues by the induction of proinflammatory mediators.