Solid and Papillary epithelial neoplasm. Ultrasound and CT features of an unusual pancreatic tumour

The ultrasonographic and computed tomography features of four cases of solid and papillary epithelial neoplasm (SPEN) - a rare pancreatic tumour - are described. Although not diagnostic, the presence of these imaging features in the typical clinical setting may permit pre-operative radiological diagnosis and facilitate planning for curative surgery for this malignant tumour which has an excellent prognosis even without further adjuvant therapy.(Au)

The hyperglycaemic effect of S-nitroso-glutathione via the release of nitric oxide

Nitric oxide is a pathogenic factor of inflammatoryislet cell death in Type I diabetes. Insulin-Dependent Diabetes Mellitus (IDDM) is mediated by an autoimmune mechanism or inflammatory process that is characterized by destruction of beta cells. Incubation of pancreatic islet cells with activated macrophages, which release large amounts of nitric oxide, causes the death of the islet cells. When the cells are exposed to the nitric oxide donor, sodium nitroprusside, lysis of the cells occur in a concentration and time-dependent manner. In this study we investigated the pharmacological activity of S-nitroso-glutathione (GSNO), a carrier of nitric oxide on blood glucose levels in dogs, and measured the plasma nitrate/nitrite concentration in the dog serum after the administration of GSNO using an automated method. The blood glucose level was measured using the glucose oxidase assay. S-nitroso-glutathione elicited a dose-dependent increase in blood glucose levels which was paralleled with an increase in nitrate/nitrite production. The blood glucose levels at 2.0 hrs and 2.5 hrs of the Oral Glucose Tolerance Test (OGTT) were significantly higher in dogs administered with GSNO than those of the controls (p<0.05). Post-prandial blood glucose levels in dogs administered with 35 mg per kg body weight of GSNO were 7.2 + 0.9mmol/l and 7.1 + 0.7mmol/l, compared with 4.8 + 0.2mmol/l and 4.6 + 0.2mmol/l in controls. The hyperglycaemic effect was more pronounced on adminstration of 35 mg per kg body weight of GSNO and ascorbic acid. Post-prandial blood glucose levels in the dogs after administration of 50 mg per body weight, at 2.0 hrs and 2.5 hrs were 9.2 + 0.7mmol/l and 9.3 + 0.3mmol/l, respectively. The basal nitrate/nitrite concentration was 12.4 + 0.4umol. On administration of 35 mg per kg body weight of GSNO, there was a 35 - 60 percent increase in the plasma nitrate/nitrite concentration. The plasma nitrate/nitrite concentration at 2.0 hrs to 2.5 hrs ranged from 16.8 + 1.0umol. The plasma nitrate/nitrite concentration increase by 100 percent on administration of 50 mg per kg of GSNO. This study confirms that S-nitroso-glutathione is a hyperglycaemic compound which affects the blood glucose levels in dogs. The hyperglycaemic effects can be caused by the nitric oxide action on the pancreatic islet cells (AU).

J type diabetes revisited

J type diabetis is grouped as a subtype of type III or malnutrition-related diabetes, known as protein deficient pancreatic diabetis, (PDPD). J type diabetes has not been reported recently, but a clinical picture called phasic insulin-dependent diabetes mellitus (PIDDM) has been elaborated in Jamaica, the same home country of PDRD and appears to be a "formes frustes" syndrome. The following comparative studies were performed on a group of diabetic patients and normal controls: insulin receptor binding; renal, hepatic, and pancreatic function; and abdominal ultrasonography. The results show a considerbaly decreased white and red blood cell binding to insulin (P<0.05), extensive kidney damage (P<0.05), and increased pancreatic echogenicity in PIDDM, supporting a separate identity of this latter syndrome from types I and II diabetes mellitus. Also, the features of relative insulin resistance, absence of ketosis even in the presence of severe hyperglycemia, and intermittent insulin requirement suggests that PIDDM, J type diabetes, and PDPD are one and the same syndrome. (AU)

Papillary cystic tumors of the pancreas

Papillary cystic tumor is an uncommon neoplasm of the pancreas which has only been described recently. This report describes five such cases seen at the University Hospital of the West Indies (UHWI). The clinico-pathological features were typical in all these cases. The literature of this condition is also reviewed. (AU)

Ultrastructure of the Islets of Langerhans in protein-energy malnutrition

Significant hormonal changes have been reported in childhood malnutrition, including high serum levels of growth hormone and cortisol, and low levels of circulating insulin. The ultrastructure of the endocrine pancreas in such patients has hitherto not been reported. A light microscopy survey of the pancreatic islets was carried out on 69 malnourished children dying from protein-energy malnutrition. In seven of these cases, a rapid autopsy protocol allowed tissues to be fixed for electron microscopy within 75 minutes of death. This paper presents the first ultrastuctural observations on the Islets of Langerhans in childhood protein-energy malnutrition. In all cases, there was a variable degree of degereration of all cell types with membrane damage, loss of ribosomes, vesiculation and mitochondrial swelling. In addition, the B-cells showed a high proportion of precursor granules compared to crystal forms, possibly accounting for low insulin serum levels reported by other workers. It is suggested that islet cell changes may be related to free radical damage secondary to depletion of glutathione and other antioxidants, as well as relative deficiencies of cysteine and zinc. In addition, the effects of agonal anoxia, and a short fixation delay after death must be considered. (AU)

Toxicity of the hyperglycaemic-inducing extract of the Annatto (Bixa orellana) in the dog

The Annatto seed coat extract, which is commonly used in folklore in treating diabetes mellitus, has been investigated for its effects on blood sugar levels in the dog. An alkali-soluble hyperglycaemia-inducing fraction was detected, and detailed studies revealed toxic effects in the pancreas and liver accompanied by hyperglycaemia and apparent tendency to increased insulin levels. The toxicity was diminished by feeding riboflavin. The relevance of this finding points to a possible aetiological role in the development of malnutrition-related diabetes mellitus and also to the potential toxicity inherent in the widespread use of folklore medicines (AU)

Fasting pancreatic glucagon in Jamaican children during malnutrition and subsequent recovery

Fasting pancreatic glucagon was observed in Jamaican infants during malnutrition and subsequent recovery. Rehabilitation in two groups of children with isocaloric diets rich either in carbohydrate or fat produced no differences in the rate of weight gain. During malnutrition, plasma pancreatic glucagon concentration was 104ñ11 (n=20) pg/ml (meanñS.E.) significantly lower than during recovery when the maximum value was 180ñ24 (n=13) pg/ml during the later recovery phase. After clinical recovery glucagon levels declined to 127ñ13 (n=15) pg/ml. Plasma insulin followed a similar pattern, increasing significantly during catch-up growth and declining after recovery. Slower rates of growth were associated with the simultaneous decline in the concentrations of both hormones after clinical recovery. (Summary)

The relationship of the pancreatic part of the common bile duct to the head of the pancreas in Jamaicans - abstract

There is little conformity in the descriptions of the relationship of the common bile duct to the head of the pancreas in textbooks of Anatomy. It has also been suggested that there might be racial differences in the topographical relation of these structures. The pancreatic part of the common bile duct is of primary importance to the biliary surgeon, since it is often necessary to explore it during operations. In view of this it would seem useful to the biliary surgeon in the Caribbean to have basic data on its topographical relations. Duodenum-pancreas specimens of 234 persons of both sexes between the ages of 15 and 97 years were obtained from the postmortem cases in the Department of Pathology, UWI, Jamaica. The common bile duct (CBD) was carefully dissected under the dissecting microscope. The relationship of the CBD to the head of the pancreas could be classified into the following three types: (Type I) the CBD was situated entirely in a groove of the posterior surface of the head of the pancreas and its posterior surface was not covered by pancreatic tissue: 45 cases (19.2 percent); (Type II) The CBD lies in a deep groove, entirely or partially covered on its posterior side by a lingula of pancreatic tissue: 170 cases (72.7 percent) and (Type III) The CBD is surrounded by pancreatic tissue: 19 cases (8.1 percent). It would seem that in about 20 percent of cases (Type I) exploration of the pancreatic part of the CBD would not give problems. However, in the remaining 80 percent (Type II and III) pancreatic tissue was covering this part of the CBD. Although the CBD in Type II (72.7 percent) could easily be reached because of the presence of a cleavage plane filled with loose connective tissue, blood vessels of variable size were overbridging these cleavage planes. Cutting too many of these vessels would interfere with the blood circulation of the pancreatic lobule in that area with the possible consequence of the development of a postoperative pancreatitis. In Type III (8.1 percent of cases) it would be pratically impossible to expose the CBD without disturbing surrounding pancreatic tissue. Comparison with data from the literature revealed that for Type I there was no statistically significant difference, while for Type II and III, respectively there were marked differences. Although factors related to racial differences could have contributed to these differences, differences in the methods of investigation could not be excluded (AU)

Light microscopic and ultrastructural changes of the exocrine pancreas in magnesium deficient rats

In magnesium deficient rats with a clinical picture of protein malnutrition, pancreatic changes typical of protein malnutrition were expected. However, in rats fed for four weeks on a low magnesium diet (protein content 25 percent), light and electron microscopic studies revealed that the ascinar cells of the pancreas were packed with zymogen granules, suggesting a disturbance in the discharge (rather than in the production) of the pancreatic enzymes. The mitochondria and the lumina of the RER were swollen. The nuclei had an irregular outline, the chromatin was aggregated into irregular granules and the nucleolemma of the nucleolus was fibrillar. It was suggested that the disturbance in the release of pancreatic enzymes might cause a maldigestion of the dietary protein, which eventually would lead to the condition of protein malnutrition in the magnesium deficient rats. The disturbance of exocytosis in the pancreas of magnesium deficient rats might be due to the preferential use of all the available magnesium for protein (enzymes) synthesis so that there were no magnesium ions left for the energy dependent discharge of the zymogen granules (AU).

A review of the aetiology and pathogenesis of acute pancreatitis Part II: Obstruction with hyper-secretion theory, alcoholism, vascular factors and trauma

Acute pancreatitis is generally accepted as being due to obstruction of the pancreatic duct and hyper-section but the activation of trypsinogen into trypsin is not fully understood. The value of trasylol in pancreatitis is debatable. The roles of alcoholism, circulatory disturbances and trauma in the aetiology of pancreatitis are discussed (AU)

Exocrine pancreatic response to the venom of the scorpion, Tityus trinitatis

This paper records for the first time the exocrine pancreatic response to scorpion venom, in this case that of Tityus trinitatia, a scorpion endemic in Trinidad. The crude venom injected intravenously into fasting anaethetised dogs induced a secretion of the exocrine pancreas. The secretion evoked was rich in enzyme (AU)

Functional status of the pancreas in malnutrition and on recovery

Intravenous glucose tolerance tests with early repeated sampling were done on twenty children nutritionally recovered from protein energy malnutrition (PEM). Three (15 percent) of the children had fasting plasma glucose levels which were below normal. All showed maximal plasma glucose levels one minute after intravenous load, and (25 percent) showed delayed removal of glucose. Rate of removal of plasma glucose, KG, was positively correlated with age. All fasting plasma insulin levels were normal. Maximum insulin response peaks were normal and occurred between 2 and 5 minutes in seventeen (85 percent) of the babies. Three (15 percent) children had maximal insulin peaks at 1, 7, and 10 minutes respectively. Suppressibility of growth hormone by glucose was shown by 6 out of 15 (38 percent) of the children for whom GH levels were determined. Protein deprived and protein-energy deprived rat models were developed for in vivo and in vitro studies of insulin release. In vivo, these models showed lowered fasting insulin levels. PED models showed reduced insulin release in response to intravenous glucose and impaired glucose tolerance. Insulin content of the pancreas was not reduced int eh malnourished rat models. In vitro, there was no difference in insulin responsiveness to increasing concentrations of glucose in malnourished and control rats. Caffeine (2mM) was an effective potentiator of insulin release in the control rat pancreas. However caffeine inhibited insulin release from the malnourished rat pancreas. Theophylline did not potentiate insulin release in either control or malnourished rats. PEM led to significant reduction in leucine-induced insulin release. This defect was corrected after refeeding malnourished rats for 21 days. Arginine alone stimulated insulin realease in vitro to the same extent in both control and protein-energy deprived rats, suggesting that the ability to phosphorylate glucose had not been impaired by pem. Epinephrine inhibited the in vitro response to both basal and stimulatory levels of glucose to the same degree in control and malnourished rats. This suggested that responsiveness of alpha-receptors had not been altered by PEM (AU)

Experimental studies on the aetiology of acute scorpion pancreatitis

This study examined the action of the venom of the scorpion Tityus trinitatis on the pancreas and gastrointestinal tract in anaesthetized dogs, on the isolated extracorporeal haemoperfused canine pancreas and on the isolated canine sphincter of Oddi. The venom induces exocrine secretion in both the isoslated and intact pancreas and causes contraction of the isolated sphincter of Oddi. These results are discussed in relation to the pathogenesis of acute scorpion pancreatitis and possibly of some other forms of acute pancreatitis. (Summary)

Carcinoid tumor and cystadenoma of the pancreas

A nonfunctioning carcinoid tumor of the pancreas coexistent with a cystadenoma was found in a 29-year-old woman. The carcinoid tumor appears to have originated in the wall of the cystademona. To our knowledge, the association of these two tumors has not been previously reported (AU)

Stimulation of insulin secretion in vitro by essential aminoacids

Leucine was the only essential aminoacid to stimulate insulin release from rabbit pancreas in vitri in the absence of extracellular glucose. In the presence of 1.5 mg glucose, per ml leucine, arginine, lysine and isoleucine were effective stimuli of insulin release (Summary)