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Baekdal M, Nielsen SW, Hansen CP, Storkholm JH, van Hall G, Hartmann B, Holst JJ, Vilsbøll T, Lund A, Knop FK. Empagliflozin Normalizes Fasting Hyperglycemia and Improves Postprandial Glucose Tolerance in Totally Pancreatectomized Patients: A Randomized, Double-Blind, Placebo-Controlled Crossover Study. Diabetes Care 2024; 47:71-80. [PMID: 37703527 DOI: 10.2337/dc23-0645] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/20/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE Insulin remains the only glucose-lowering treatment modality recommended for totally pancreatectomized patients. We investigated the effects of the sodium-glucose cotransporter 2 inhibitor empagliflozin on fasting and postprandial glucose concentrations in pancreatectomized patients and matched healthy control participants. RESEARCH DESIGN AND METHODS In a randomized, double-blind, placebo-controlled crossover study, 10 pancreatectomized patients and 10 matched control participants underwent two 3-h liquid mixed meal tests preceded by two doses of 25 mg empagliflozin (administered the night before and in the morning of the meal test) or placebo, respectively. Basal insulin was administered as usual, but bolus insulin was omitted before the meal test during experimental days. RESULTS Compared with placebo, empagliflozin lowered fasting plasma glucose (5.0 ± 0.4 vs. 7.9 ± 0.9 mmol/L [mean ± SEM], P = 0.007) and postprandial plasma glucose excursions as assessed by baseline-subtracted area under the curve (1,080 [733; 1,231] vs. 1,169 [1,036; 1,417] pmol/L × min [median (25th and 75th percentiles)], P = 0.014) in the pancreatectomized patients. In the control participants, empagliflozin lowered fasting plasma glucose compared with placebo (5.1 ± 0.1 vs. 5.5 ± 0.1 mmol/L, P = 0.008) without affecting postprandial glucose excursions significantly. The pancreatomy group exhibited greater postprandial glucagon excursions compared with the control group on both experimental days (P ≤ 0.015); no within-group differences between days were observed. CONCLUSIONS Empagliflozin administered the day before and immediately before a standardized liquid mixed meal test normalized fasting hyperglycemia and improved postprandial glucose tolerance in pancreatectomized patients.
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Affiliation(s)
- Mille Baekdal
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sophie W Nielsen
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Carsten P Hansen
- Department of Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jan H Storkholm
- Department of Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Gerrit van Hall
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Clinical Metabolomics Core Facility, Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Bolette Hartmann
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens J Holst
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tina Vilsbøll
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Asger Lund
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Filip K Knop
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
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Storkholm JH, Burgdorf SK, Larsen PN, Hansen CP. Pancreaticoduodenectomy with preoperative total embolization of the hepatic arteries (PD-HAE)-a novel treatment with sacrifice of the hepatic arterial blood supply without the need for arterial reconstruction. Langenbecks Arch Surg 2023; 408:310. [PMID: 37580555 PMCID: PMC10425295 DOI: 10.1007/s00423-023-03054-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 08/08/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE Tumors with involvement of common hepatic and gastroduodenal arteries (CHA and GDA) or GDA and the proper hepatic artery (PHA) are traditionally considered nonresectable. We have devised a new procedure that includes pancreaticoduodenectomy with preoperative hepatic artery embolization (PD-HAE) to facilitate an R0 resection of tumors involving the hepatic arteries without vascular anastomoses and complete sacrifice of normal hepatic arterial blood supply. METHODS To allow resection of the hepatic arteries, preoperative embolization of the PHA was performed to induce an increased collateral arterial blood flow from the periphery of the liver, far from the hepatic hilum 10-14 days prior to the operation. Between May 1, 2017 and December 31, 2019, eight patients with ductal adenocarcinoma were operated with the PD-HAE procedure. RESULTS The embolizations were uneventful apart from a transient marginal elevation of alanine aminotransferase in three patients. All patients had N disease with perineural invasion of tumor cells around the adventitia of the artery and severe perivascular inflammation. An R0 resection (> 1.0 mm to all resection margins) was obtained in six patients (75%). Mean hospital stay was 12 days. Median survival was 23 months (95% CI: 19.5-26.5 months). Six patients (75%) are still alive 11 to 36 months after the operation. There was perioperative fatality, and morbidity was comparable to standard pancreaticoduodenectomy. CONCLUSION PD-HAE is a safe procedure and may provide the opportunity for curative resection in otherwise unresectable patients. However, larger studies are needed to evaluate this procedure.
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Affiliation(s)
- J H Storkholm
- Department of Gastroenterological Surgery and Transplantation CTx, Rigshospitalet, Copenhagen, Denmark.
- Department of HPB Surgery, Imperial College, Hammersmith Hospital, London, UK.
| | - S K Burgdorf
- Department of Gastroenterological Surgery and Transplantation CTx, Rigshospitalet, Copenhagen, Denmark
| | - P N Larsen
- Department of Gastroenterological Surgery and Transplantation CTx, Rigshospitalet, Copenhagen, Denmark
| | - C P Hansen
- Department of Gastroenterological Surgery and Transplantation CTx, Rigshospitalet, Copenhagen, Denmark
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Jensen KK, Storkholm JH, Chen I, Burgdorf SK, Hansen CP. Long-term results after resection of primary duodenal adenocarcinoma: A retrospective cohort study. Int J Surg 2022; 100:106599. [DOI: 10.1016/j.ijsu.2022.106599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/16/2022] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
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Juel CTB, Dejgaard TF, Hansen CP, Storkholm JH, Vilsbøll T, Lund A, Knop FK. Response to Letter to the Editor from McKee and McGill: "Glycemic Control and Variability of Diabetes Secondary to Total Pancreatectomy Assessed by Continuous Glucose Monitoring". J Clin Endocrinol Metab 2021; 106:e4307-e4308. [PMID: 33822975 PMCID: PMC8475207 DOI: 10.1210/clinem/dgab221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Caroline T B Juel
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Thomas F Dejgaard
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Carsten P Hansen
- Department of Surgery and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jan H Storkholm
- Department of Surgery and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Tina Vilsbøll
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Asger Lund
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Filip K Knop
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Correspondence: Prof. Filip K. Knop, MD, PhD, Gentofte Hospital, University of Copenhagen, Gentofte Hospitalsvej 7, 3rd floor, DK-2900 Hellerup, Denmark.
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Burgdorf SK, Storkholm JH, Chen IM, Hansen CP. Postoperative and long-term survival in relation to life-expectancy after pancreatic surgery in elderly patients (cohort study). Ann Med Surg (Lond) 2021; 69:102724. [PMID: 34457257 PMCID: PMC8379474 DOI: 10.1016/j.amsu.2021.102724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 11/06/2022] Open
Abstract
Background An evaluation of the outcome after pancreatic surgery with focus on post-operative and late survival in elderly patients was performed. Methods The study included 1.556 patients from a single HBP unit operated from 1. January 2010 to 31. December 2019. Patients were divided into two cohorts, < 75 years (n = 1.296) and ≥75 years (n = 260). Post-operative outcome was evaluated in all patients and late outcome in patients with adenocarcinoma in the pancreas (n = 765) and the duodenum (n = 117). The follow-up of patients with benign disease and adenocarcinoma was 57.95 (12.1–132.7) and 39.85 (12.0–131.7) months, respectively. Results Length of hospital-stay and surgical complications were not significantly different in the two cohorts, but in-hospital death was 1.1% (<75 years) and 3.5% (≥75 years) (p = 0.008). The median overall survival of adenocarcinoma was 29.7 (<75 years) and 24.3 months (≥75 years) (p = 0.3228) with a one, two, and five-years survival of 74.5%, 56.6% and 28.6% vs. 73.6%, 51.1%, and 25.5%. Median time to relapse (46.2% of patients <75 years and 40.5% of patients ≥75 years) was 9 (1 - 51) and 8 (1 - 78) months (p = 0.534), respectively. Adjuvant chemotherapy did not have impact on the survival of the old cohort. Patients who died during the observation period had lost 94% (<75 years) and 87% (≥75 years) of expected remnant life. Estimated years lost in the old cohort was 4.2 in males and 4.9 in females (p = 0.025) Conclusion Elderly patients may undergo pancreatic surgery with a low mortality and for adenocarcinoma with an acceptable long-term survival. Surgery is the only potentially curable treatment to pancreatic cancer. Elderly patients may tolerate pancreatic surgery with low mortality. Radical pancreatic surgery improves long-term survival, also in elderly patients. Operability should be evaluated from morbidity and biological age. Pancreatic surgery in elderly should only be performed in high volume centers.
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Affiliation(s)
- S K Burgdorf
- Department of Surgery Rigshospitalet, University of Copenhagen, Denmark
| | - J H Storkholm
- Department of Surgery Rigshospitalet, University of Copenhagen, Denmark
| | - I M Chen
- Department of Oncology, Herlev Hospital, University of Copenhagen, Denmark
| | - C P Hansen
- Department of Surgery Rigshospitalet, University of Copenhagen, Denmark
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Juel CTB, Dejgaard TF, Hansen CP, Storkholm JH, Vilsbøll T, Lund A, Knop FK. Glycemic Control and Variability of Diabetes Secondary to Total Pancreatectomy Assessed by Continuous Glucose Monitoring. J Clin Endocrinol Metab 2021; 106:168-173. [PMID: 33053154 DOI: 10.1210/clinem/dgaa731] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT The extent of the glycemic variability in diabetes secondary to total pancreatectomy is not fully understood. OBJECTIVE To evaluate glycemic variability in totally pancreatectomized (PX) patients and compare it to glycemic variability in hemoglobin A1c (HbA1c)-matched patients with long-standing type 1 diabetes (T1D). DESIGN A case-control study was performed. SETTING Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark. PATIENTS OR OTHER PARTICIPANTS Ten PX patients (mean [SEM]: age 64.3 [9.8] years; body mass index (BMI) 34.4 [5.0] kg/m2; duration of diabetes 3 [2.8] years), 10 HbA1c-matched patients with T1D (63.9 [8.6] years; 24.6 [3.1] kg/m2; 22 [4] years), and 10 gender-, age-, and BMI-matched healthy controls. All patients were managed on multiple daily injections of insulin. INTERVENTION Continuous glucose monitoring (CGM) (Medtronic MiniMed iPro 2) during 12 consecutive days. MAIN OUTCOME MEASURES Glycemic variability. RESULTS HbA1c levels were similar in the PX group and the T1D group. The PX group had greater continuous overall net glycemic action per 60 minutes (CONGA60 min) compared with the T1D group (mean [SEM]: 9.5 [0.3] vs 8.3 [0.2] mmol/L, P < 0.003) and mean plasma glucose values were higher in the PX group (10.6 [0.9] vs 9.0 [0.9] mmol/L, P < 0.001), whereas coefficient of variation for plasma glucose and standard deviation of mean plasma glucose, respectively, were similar in the 2 groups. Time spent below range was not different between the PX and the T1D group (2.3 [0.8] vs 4.5 [0.8]%, P = 0.065), whereas time spent above range was higher in the PX group (51.4 [3.3] vs 37.6 [1.9]%, P < 0.001). CONCLUSIONS CGM-assessed glycemic variability showed higher CONGA60 min and time spent above range in our PX patients compared with HbA1c-matched T1D patients. This study is registered at www.ClinicalTrials.gov (NCT02944110).
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Affiliation(s)
- Caroline T B Juel
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Thomas F Dejgaard
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Carsten P Hansen
- Department of Surgery and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jan H Storkholm
- Department of Surgery and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Tina Vilsbøll
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Asger Lund
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Filip K Knop
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Jensen KK, Bonde P, Storkholm JH, Heerwagen ST, Larsen PN, Eiberg J. Spontaneous intestinal bleeding due to pseudoaneurism of the gastroduodenal artery: case report of a rare complication to median arcuate ligament syndrome. J Surg Case Rep 2020; 2020:rjaa507. [PMID: 33365121 PMCID: PMC7748124 DOI: 10.1093/jscr/rjaa507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Abstract
Median arcuate ligament syndrome (MALS) is the compression of the celiac artery (CA) by the median arcuate ligament. MALS can cause pseudoaneurysm of the gastroduodenal artery, which can lead to fatal bleeding. A 40-year-old male with no prior medical history presented with symptoms of upper gastrointestinal hemorrhage (UGIH). Severe duodenal bleeding was confirmed although endoscopic hemostasis was impossible and final hemostasis was achieved following a subsequent open duodenotomy. A postoperative computed tomographic angiography (CTA) visualized a significant CA stenosis, post-stenotic dilatation and an aneurysm on a jejunal branch artery. The patient underwent coiling of the gastroduodenal artery, gastroepiploic artery and two pancreaticoduodenal arterial branches. The patient was diagnosed with MALS and 6 months later underwent open resection of the median arcuate ligament. MALS should be considered as a rare cause of upper gastrointestinal bleeding. The literature and proposed treatments are discussed.
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Affiliation(s)
- Kristian K Jensen
- Department of Surgical Gastroeneterology and Transplantation, Rigshospitalet, Copenhagen, Denmark
| | - Peter Bonde
- Department of Surgery, Bispebjerg Hospital, Copenhagen, Denmark
| | - Jan H Storkholm
- Department of Surgical Gastroeneterology and Transplantation, Rigshospitalet, Copenhagen, Denmark
| | | | - Peter N Larsen
- Department of Surgical Gastroeneterology and Transplantation, Rigshospitalet, Copenhagen, Denmark
| | - Jonas Eiberg
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
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Jensen KK, Krohn PS, Storkholm JH, Burgdorf SK. [Minimally invasive surgery for malignant diseases in pancreas]. Ugeskr Laeger 2020; 182:V12190694. [PMID: 33000731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Unlike most other abdominal procedures, pancreatic resection for malignant tumours is still predominantly performed as open surgery. However, recent published randomised trials suggest that a laparoscopic approach is safe and may offer advantages in the early postoperative period. Likewise, early reports of robot-assisted pancreatic resection suggest advantages. This reveiw describes the current status of minimally invasive pancreatic surgery for malignant tumours, including both laparoscopic and robot-assisted approaches for pancreaticoduodenectomy and distal pancreatectomy.
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Aasvang EK, Pitter S, Hansen CP, Storkholm JH, Krohn PS, Burgdorf SK, Von Stemann JH, Lundgren JD, Nielsen SD, Kehlet H, Ostrowski SR. Preoperative TruCulture® whole blood cytokine response predicts post-operative inflammation in pancreaticoduodenectomy patients-A pilot cohort study. Scand J Immunol 2020; 92:e12930. [PMID: 32640052 DOI: 10.1111/sji.12930] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/24/2020] [Accepted: 07/02/2020] [Indexed: 01/21/2023]
Abstract
Major surgery is associated with substantial morbidity and mortality with early post-operative adverse events (POAE) occurring in 30% of patients within the first 30 days. The underlying pathogenesis is multifactorial, including immune dysfunction and increased inflammatory response to surgery. We investigated preoperative immune function by the TruCulture® whole blood technique in a cohort of patients undergoing pancreaticoduodenectomy (PD), hypothesizing that patients developing inflammatory POAE defined as leucocytosis, fever or high (above median) area under the curve (AUC) C-reactive protein (CRP) the first post-operative week would display perturbed preoperative immune function. Sixty-two adult patients were screened, 30 included and 11 excluded post-inclusion due to other surgical procedures than PD and post-operative complications directly attributed to surgery, leaving 19 patients for analysis of preoperative immune function. Patients developing leucocytosis (n = 5, 26%) had lower Toll-like receptor (TLR)-3-stimulated IL-12p40 and higher Candida Albicans (TLR1/2/4/6, Dectin-1)-stimulated TNF-α, compared to patients without leucocytosis (all P < .05). Patients developing fever (n = 7, 37%) had lower TLR7/8-stimulated IFN-γ and patients with high AUC CRP (n = 9, 47%) had lower TLR3-stimulated IFN-γ and IL-6 and lower TLR7/8-stimulated IL-10 (all P < .05), compared to patients without fever or low CRP, respectively. In conclusion, patients with inflammatory POAE displayed lower preoperative stimulated IL-12p40, IFN-γ, IL-6 and IL-10 and higher TNF-α response, compared to patients without inflammatory POAE. This finding suggests that TruCulture is a feasible immunologic screening tool in surgical patients, with a potential for preoperative identification of patients at increased risk for inflammatory POAE, allowing for risk-based intervention trials.
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Affiliation(s)
- Eske K Aasvang
- Deptartment of Anesthesiology, Centre for Cancer and Organ Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Deptartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sandra Pitter
- Deptartment of Anesthesiology, Centre for Cancer and Organ Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Deptartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Carsten P Hansen
- Deptartment of Surgical Gastroenterology, Centre for Cancer and Organ Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jan H Storkholm
- Deptartment of Surgical Gastroenterology, Centre for Cancer and Organ Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Paul S Krohn
- Deptartment of Surgical Gastroenterology, Centre for Cancer and Organ Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Stefan K Burgdorf
- Deptartment of Surgical Gastroenterology, Centre for Cancer and Organ Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jakob H Von Stemann
- Deptartment of Clinical Immunology, Centre for Diagnostic Investigation, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jens D Lundgren
- Deptartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Deptartment of Infectious Diseases, Centre for Cancer and Organ Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,PERSIMUNE, Centre of Excellence for Personalized Medicine of Infections Complications in Immune Deficiency and CHIP, Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Section 2100, Copenhagen University Hospital, Copenhagen, Denmark
| | - Susanne D Nielsen
- Deptartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Deptartment of Infectious Diseases, Centre for Cancer and Organ Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henrik Kehlet
- Deptartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Section for Surgical Pathophysiology, Juliane Marie Centre, Rigshospitalet, , Copenhagen University Hospital, Copenhagen, Denmark
| | - Sisse R Ostrowski
- Deptartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Deptartment of Clinical Immunology, Centre for Diagnostic Investigation, Copenhagen University Hospital, Copenhagen, Denmark
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Juel CTB, Lund A, Andersen MM, Hansen CP, Storkholm JH, Rehfeld JF, van Hall G, Hartmann B, Wewer Albrechtsen NJ, Holst JJ, Vilsbøll T, Knop FK. The GLP-1 receptor agonist lixisenatide reduces postprandial glucose in patients with diabetes secondary to total pancreatectomy: a randomised, placebo-controlled, double-blinded crossover trial. Diabetologia 2020; 63:1285-1298. [PMID: 32394228 DOI: 10.1007/s00125-020-05158-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/11/2020] [Indexed: 12/25/2022]
Abstract
AIMS/HYPOTHESIS Treatment of diabetes secondary to total pancreatectomy remains a challenge and insulin constitutes the only glucose-lowering treatment for these patients. We hypothesised that the glucagon-like peptide 1 (GLP-1) receptor agonist lixisenatide would improve postprandial glucose tolerance in totally pancreatectomised patients. METHODS In a double-blinded, randomised, crossover study, 12 totally pancreatectomised individuals (age: 65.0 ± 9.5 mean±SD years; BMI: 22.9 ± 3.9 kg/m2) and 12 healthy control individuals (age 66.1 ± 7.6 years; BMI: 24.0 ± 2.9 kg/m2) underwent two 3 h liquid mixed-meal tests (with paracetamol for assessment of gastric emptying) after single-dose injection of 20 μg of lixisenatide or placebo. Basal insulin was given the night before each experimental day; no insulin was given during study days. RESULTS Compared with placebo, lixisenatide reduced postprandial plasma glucose excursions in the pancreatectomy group (baseline-subtracted AUC [bsAUC] [mean±SEM]: 548 ± 125 vs 1447 ± 95 mmol/l × min, p < 0.001) and in the control group (-126 ± 12 vs 222 ± 51 mmol/l × min, p < 0.001). In the pancreatectomy group a mean peak glucose concentration of 23.3 ± 1.0 mmol/l was reached at time point 134 ± 11 min with placebo, compared with a mean peak glucose concentration of 18 ± 1.4 mmol/l (p = 0.008) at time point 148 ± 13 min (p = 0.375) with lixisenatide. In the control group a mean peak concentration of 8.2 ± 0.4 mmol/l was reached at time point 70 ± 13 min with placebo, compared with a mean peak concentration of 5.5 ± 0.1 mmol/l (p < 0.001) at time point 8 ± 25 min (p = 0.054) with lixisenatide. Lixisenatide also reduced gastric emptying and postprandial glucagon responses in the pancreatectomy group (66 ± 84 vs 1190 ± 311 pmol/l × min, p = 0.008) and in the control group (141 ± 100 vs 190 ± 100 pmol/l × min, p = 0.034). In the pancreatectomy group, C-peptide was undetectable in plasma. In the control group, postprandial plasma C-peptide responses were reduced with lixisenatide (18 ± 17 vs 189 ± 31 nmol/l × min, p < 0.001). CONCLUSIONS/INTERPRETATION The GLP-1 receptor agonist lixisenatide reduces postprandial plasma glucose excursions in totally pancreatectomised patients. The mode of action seems to involve deceleration of gastric emptying and reduced postprandial responses of gut-derived glucagon. TRIAL REGISTRATION ClinicalTrials.gov NCT02640118. FUNDING This study was funded by an unrestricted investigator-initiated study grant from Sanofi. Support was also received from from the Novo Nordisk Foundation Center for Basic Metabolic Research, the A.P. Møller Foundation for the Advancement of Medical Science and the Faculty of Health and Medical Sciences, University of Copenhagen.
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Affiliation(s)
- Caroline T B Juel
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Gentofte Hospitalsvej 7, 3rd floor, DK-2900, Hellerup, Denmark
| | - Asger Lund
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Gentofte Hospitalsvej 7, 3rd floor, DK-2900, Hellerup, Denmark
| | - Maria M Andersen
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Gentofte Hospitalsvej 7, 3rd floor, DK-2900, Hellerup, Denmark
| | - Carsten P Hansen
- Department of Surgery and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jan H Storkholm
- Department of Surgery and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jens F Rehfeld
- Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Gerrit van Hall
- Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Clinical Metabolomics Core Facility, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Bolette Hartmann
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nicolai J Wewer Albrechtsen
- Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens J Holst
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tina Vilsbøll
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Gentofte Hospitalsvej 7, 3rd floor, DK-2900, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Filip K Knop
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Gentofte Hospitalsvej 7, 3rd floor, DK-2900, Hellerup, Denmark.
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.
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11
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Lund A, Bagger JI, Wewer Albrechtsen NJ, Christensen M, Grøndahl M, Hartmann B, Mathiesen ER, Hansen CP, Storkholm JH, van Hall G, Rehfeld JF, Hornburg D, Meissner F, Mann M, Larsen S, Holst JJ, Vilsbøll T, Knop FK. Erratum. Evidence of Extrapancreatic Glucagon Secretion in Man. Diabetes 2016;65:585-597. Diabetes 2016; 65:1752. [PMID: 27222398 DOI: 10.2337/db16-er06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lund A, Bagger JI, Wewer Albrechtsen NJ, Christensen M, Grøndahl M, Hartmann B, Mathiesen ER, Hansen CP, Storkholm JH, van Hall G, Rehfeld JF, Hornburg D, Meissner F, Mann M, Larsen S, Holst JJ, Vilsbøll T, Knop FK. Evidence of Extrapancreatic Glucagon Secretion in Man. Diabetes 2016; 65:585-97. [PMID: 26672094 DOI: 10.2337/db15-1541] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 12/06/2015] [Indexed: 12/27/2022]
Abstract
Glucagon is believed to be a pancreas-specific hormone, and hyperglucagonemia has been shown to contribute significantly to the hyperglycemic state of patients with diabetes. This hyperglucagonemia has been thought to arise from α-cell insensitivity to suppressive effects of glucose and insulin combined with reduced insulin secretion. We hypothesized that postabsorptive hyperglucagonemia represents a gut-dependent phenomenon and subjected 10 totally pancreatectomized patients and 10 healthy control subjects to a 75-g oral glucose tolerance test and a corresponding isoglycemic intravenous glucose infusion. We applied novel analytical methods of plasma glucagon (sandwich ELISA and mass spectrometry-based proteomics) and show that 29-amino acid glucagon circulates in patients without a pancreas and that glucose stimulation of the gastrointestinal tract elicits significant hyperglucagonemia in these patients. These findings emphasize the existence of extrapancreatic glucagon (perhaps originating from the gut) in man and suggest that it may play a role in diabetes secondary to total pancreatectomy.
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Affiliation(s)
- Asger Lund
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark The Novo Nordisk Foundation Center for Basic Metabolic Research and Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jonatan I Bagger
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark The Novo Nordisk Foundation Center for Basic Metabolic Research and Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nicolai J Wewer Albrechtsen
- The Novo Nordisk Foundation Center for Basic Metabolic Research and Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Mikkel Christensen
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark The Novo Nordisk Foundation Center for Basic Metabolic Research and Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Magnus Grøndahl
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Bolette Hartmann
- The Novo Nordisk Foundation Center for Basic Metabolic Research and Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Department of Endocrinology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Carsten P Hansen
- Department of Gastrointestinal Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jan H Storkholm
- Department of Gastrointestinal Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Gerrit van Hall
- Clinical Metabolomics Core Facility, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jens F Rehfeld
- Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Daniel Hornburg
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Felix Meissner
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Matthias Mann
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany The Novo Nordisk Foundation Center for Protein Research, Proteomics Program, University of Copenhagen, Copenhagen, Denmark
| | - Steen Larsen
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Jens J Holst
- The Novo Nordisk Foundation Center for Basic Metabolic Research and Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tina Vilsbøll
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Filip K Knop
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark The Novo Nordisk Foundation Center for Basic Metabolic Research and Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Storkholm JH, Villadsen GE, Jensen SL, Gregersen H. Mechanical properties and collagen content differ between isolated guinea pig duodenum, jejunum, and distal ileum. Dig Dis Sci 1998; 43:2034-41. [PMID: 9753270 DOI: 10.1023/a:1018855113849] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
We compared the stress-strain distributions obtained from isolated segments of the guinea pig duodenum, jejunum, and distal ileum, and the relation between the elastic properties and the collagen content. The segments were immersed in Krebs-Ringer solution containing 10(-2) M MgCl2 to abolish contractile activity. Stepwise inflation of an intraluminal balloon in which the cross-sectional area (CSA) was measured provided the luminal pressure-loading stimulus. The wall thickness was measured by means of 20-MHz A-mode ultrasound. The stress-strain and the incremental elastic modulus-strain distributions were derived from the steady-state values of wall thickness, internal radius, and applied pressure. The CSA-pressure relations and the wall thickness-pressure relations were nonlinear and both differed between the segments (P < 0.01). The stress-strain distributions showed an exponential behavior that fitted well to the equation Y = a x Exp(b x X) (r2 = 0.97 +/- 0.01). The intercept with they axis (a) and the slope of the curves (b) differed between the segments (P < 0.01 and P < 0.05). The collagen contents were 3.99 +/- 0.18 microg/mg, 2.51 +/- 0.13 microg/mg, and 2.10 +/- 0.11 microg/mg in the duodenum, jejunum, and distal ileum, respectively. This difference was significant among all three locations (P > 0.05). An association was found between the collagen content and the incremental elastic modulus (stiffness) at a stress level of 70 kPa (P < 0.05).
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Affiliation(s)
- J H Storkholm
- Department of Surgical Gastroenterology L, and Centre of Gastrointestinal Motility and Biomechanics, Aarhus University Hospital, Denmark
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Villadsen GE, Storkholm JH, Hendel L, Vilstrup H, Gregersen H. Impedance planimetric characterization of esophagus in systemic sclerosis patients with severe involvement of esophagus. Dig Dis Sci 1997; 42:2317-26. [PMID: 9398812 DOI: 10.1023/a:1018831104549] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study was designed to evaluate the distensibility and secondary peristalsis of the esophagus in patients suffering from systemic sclerosis with severe esophageal involvement. Balloon distension with impedance planimetric measurement of luminal cross-sectional area was done 7 and 15 cm above the lower esophageal sphincter in 13 patients and nine healthy controls. The controls were studied both with and without receiving the anticholinergic drug butylscopolamine. The cross-sectional area--pressure relations were nonlinear with the largest cross-sectional area in patients at both measuring sites when compared to controls (P < 0.001). The anticholinergic drug butylscopolamine increased the cross-sectional area in controls (P < 0.001). The cross-sectional area distensibility, defined as CSA0(-1) delta CSA delta P-1 did not differ between patients and controls. Balloon distensions elicited contractions proximal to the distension site. The amplitude and frequency of contractions at the distal distension site were significantly reduced in the patients when compared to the controls (P < 0.05). In conclusion, the distal esophagus is most severely affected in patients with systemic sclerosis with increased cross-sectional area and impaired peristalsis.
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Affiliation(s)
- G E Villadsen
- Department of Medicine V, Center of Biomechanics and Gastrointestinal Motility, Aarhus C, Denmark
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15
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Storkholm JH, Villadsen GE, Krogh K, Jørgensen CS, Gregersen H. Dimensions and mechanical properties of porcine aortic segments determined by combined impedance planimetry and high-frequency ultrasound. Med Biol Eng Comput 1997; 35:21-6. [PMID: 9136186 DOI: 10.1007/bf02510387] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The aim of the study is to devise a method for direct measurements of pressure, cross-sectional area (CSA) and wall thickness of a vessel when pressurised. Segments of porcine descending thoracic aorta from 22 and 35 kg pigs (in groups 1 and 2, respectively) and of abdominal aorta from 35 kg pigs are studied in vitro. Impedance planimetry provides measurements of the luminal pressure and CSA of the aorta. The wall thickness is measured simultaneously by means of 20 MHz A-mode ultrasound. The pressure, CSA and wall thickness are registered at different pressure at steady state. At maximum pressure, the CSAs are 107 +/- 10, 215 +/- 19 and 257 +/- 17 mm2 in the abdominal, group 1 and 2 segments, respectively. There is a difference between the abdominal group and groups 1 and 2 (p < 0.05), but not between group 1 and 2 segments (p > 0.2). At maximum pressure, the wall thickness is 0.52 +/- 0.04, 0.79 +/- 0.07 and 1.07 +/- 0.02 mm, in the abdominal group 1 and 2 segments, respectively (p < 0.05). The circumferential stress-strain relationship accorded well with stress = a x exp(b x strain). The stress-strain curve of the abdominal aortas is shifted to the left, indicating an increase (p < 0.05).
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Affiliation(s)
- J H Storkholm
- Core Centre of Gastrointestinal Motility and Biomechanics, Aarhus University Hospital, Skejby Sygehus, Denmark
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Abstract
OBJECTIVES To characterise possible differences in vascular mechanics between in vitro and in vivo settings. DESIGN Experimental animal study. MATERIAL Segments of abdominal aorta from five 30kg pigs were studied in vitro and five porcine abdominal aortas were investigated in vivo. METHODS Vessel luminal cross-sectional area (CSA) was assessed in vitro and in vivo by measuring the electrical impedance of fluid inside a distensible balloon mounted on a catheter. Wall thickness was measured in vitro by means of 20 MHz A-mode ultrasound. The obtained values in vitro were used to calculate wall thickness in vivo. RESULTS The CSAs were larger in vitro than in vivo (p < 0.05). All segments showed stress-strain relations that accorded well with the exponential equation: Stress = a.exp(b. Strain). The y-axis intercepts (a) and the slope of the curves (b) were different in vitro and in vivo (p < 0.05). Differences were found between the aorta in vivo and in vitro regarding the circumferential stress-strain relations, i.e. the stiffest abdominal aorta was found in vivo. CONCLUSIONS The differences in dimensions and wall stiffness may be attributed to the tethering to the surrounding tissues in vivo. Impedance planimetry combined with high frequency ultrasound is an accurate way of measuring segmental vascular elasticity in vivo.
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Affiliation(s)
- J H Storkholm
- Institute of Experimental Clinical Research, Aarhus University Hospital, Denmark
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Frøbert O, Storkholm JH, Gregersen H, Bagger JP. In vivo assessment of luminal cross-sectional areas and circumferential tension-strain relations of the porcine aorta. Scand J Thorac Cardiovasc Surg 1996; 30:11-9. [PMID: 8727852 DOI: 10.3109/14017439609107235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
UNLABELLED The objectives were to measure the pressure--cross-sectional area relations and intrinsic stiffness of the porcine aorta in vivo. METHODS Measurements were made in 12 pigs, weight 30, 50 or 75 kg, proximal and distal to the bifurcation of the renal arteries, using an electrical impedance system which was located inside a balloon mounted on a catheter. Vessel cross-sectional area (CSA) was assessed by measuring impedance of the fluid inside the balloon during distension. RESULTS In vitro testing demonstrated the accuracy and reproducibility of impedance planimetry. In vivo steady-state CSA values showed non-linear relationship with rising distension pressures. Mean CSA values rose with increasing weight of the pigs. the suprarenal aorta was larger than the infrarenal only in 75 kg pigs (p < 0.05). At three measurements the within-subject variation was 0.89% and the between-subject variation 99.11%. Nitroglycerine infusion produced only minor, insignificant CSA increase, indicating negligible tone in the abdominal aorta. All segments showed circumferential wall strain-tension relations with exponential behaviour uninfluenced by weight class or site in the aorta. CONCLUSION Information of vascular mechanics in vivo is obtainable by catheterization of the abdominal aorta.
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Affiliation(s)
- O Frøbert
- Skejby Hospital, Department of Cardiology, Aarhus University Hospital, Denmark
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18
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Abstract
The aim was to study and compare the passive biomechanical wall properties in the isolated duodenum and distal ileum of the guinea pig in vitro. The organ bath contained a Krebs-Ringer solution with 10(-2) M MgCl2 to abolish smooth muscle contractile activity. Stepwise inflation of an intraluminal balloon, in which the cross-sectional area (CSA) was measured, provided the distension stimulus. The circumferential wall tension-strain distributions and wall stiffness-strain relations were computed from steady-state values of these measurements in order to evaluate the passive elastic properties. The CSA always reached equilibrium within the 2-min distension period. The CSAs obtained in the distal ileum were higher than those in the duodenum (P < 0.001). The basal CSA was 17.31 +/- 1.14 mm2 and 12.96 +/- 0.42 mm2 for the distal ileum and the duodenum, respectively (P < 0.01). At a maximum pressure of 6 kPa, the CSA of the ileum was 56.63 +/- 1.81 mm2 and 36.86 +/- 1.76 mm2 for the duodenum (P < 0.01). The circumferential wall tension-strain distributions showed an exponential behavior that accorded well with the equation Y = exp(a+bX) with determination coefficients of 0.96 +/- 0.01 and 0.99 +/- 0.00 in the duodenal segments in the distal ileal segments, respectively. The values of a (intercept with the y-axis) were 0.54 +/- 0.11 and -0.35 +/- 0.19 for the duodenal and ileal segments, respectively (P < 0.001). The slope of the curves (b values) were 4.34 +/- 0.35 in the duodenal and 5.23 +/- 0.37 in the ileal segments (0.1 > P > 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J H Storkholm
- Core Center of Gastrointestinal Motility and Biomechanics, Aarhus University Hospital, Denmark
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