Gastrin: a new branch of the gastropancreatic axis that can explain the effect of sleeve gastrectomy on glucose metabolism.

BACKGROUND: Among bariatric techniques, sleeve gastrectomy (SG) stands out owing to its efficiency. The role of the stomach as a secretory organ of many substances, such as gastrin, related to insulin secretion is well known. Gastrin induces insulin release in isolated pancreatic islets, limiting somatostatin-14 intraislet release, and has been associated with blood glucose level improvement in diabetic models after SG. SG involves gastric resection along the greater curvature. This study aimed to determine the role of gastrin in glucose metabolism improvement after SG with the aid of the gastrin antagonist netazepide. METHODS: In 12 sham-operated, 12 SG-operated, and 12 SG-operated/netazepide-treated Wistar rats, we compared medium- and long-term plasma insulin, oral glucose tolerance test (OGTT) results, and plasma gastrin levels. In addition, gastrin expression was assessed in the gastric remnant, and the beta-cell mass was measured. RESULTS: SG induced a medium-term elevation of the insulin response and plasma gastrin levels without modification of the OGTT results. However, long-term depletion of the insulin response with elevated OGTT areas under the curve and plasma gastrin levels appeared after SG. Netazepide prevented the SG effect on these parameters. Gastrin tissue expression was greater in SG animals than in SG/netazepide-treated or control animals. The beta-cell mass was lower in the SG group than in the control or SG/netazepide group. CONCLUSION: Gastrin plays a central role in glucose improvement after SG. It stimulates a medium-term strong insulin response but also causes long-term beta-cell mass depletion and a loss of insulin response. These effects are prevented by gastrin antagonists such as netazepide.

Lymphoepithelial cyst of the pancreas.

Within pancreatic cysts, the lymphoepithelial variant is considered a highly atypical condition with few reported cases in the literature. Following a case managed in our hospital, we aim to shed more light on this entity as an incidental finding, providing a temporal description until its excision, along with radiological, surgical, and histological images.

Malignant degeneration in pilonidal disease.

BACKGROUND: Pilonidal disease is one of the most frequent entities in our daily surgical activity. Although it is a benign disease, malignant degeneration is likely to occur in pilonidal disease. We reviewed surgical interventions for pilonidal diseases performed from January 1, 1995 to December 31, 2008. CLINICAL CASE: We reviewed all 3729 histology reports obtained after surgical removal of pilonidal disease. There were three cases of squamous cell carcinoma and one case of basal cell carcinoma. Patients affected by squamous cell carcinoma had a mean age of 54.2 years and a mean time of evolution of the lesions of 20.6 years. We found local recurrence and lymph node recurrence. Mean follow-up period was 5 years and there was no mortality. The patient with basal cell carcinoma had 1 year of pilonidal disease evolution. There were no recurrences. CONCLUSIONS: Malignancy can arise in pilonidal diseases with a long evolution time. There is a high rate of recurrence and morbimortality in cases of squamous cell carcinomas. Adjuvant radiotherapy in addition to complete local excision has demonstrated a decrease in the rate of local recurrence.

[Pancreatic ascariasis mimicking a pancreatic tumor]. / Ascariasis pancreática que simula un tumor pancreático.

BACKGROUND AND AIM: Ascaris lumbricoides infection in Spain is anecdotal and is usually associated with travel to areas with high endemicity such as India and South America. Biliopancreatic disease caused by this parasite is both rare and one of the most feared complications. There are few publications in the literature about pancreatic involvement in ascariasis. We describe a case of pancreatic ascariasis diagnosed after a pancreaticoduodenectomy was performed for a suspected pancreatic adenocarcinoma. PATIENT: A 58-year-old man consulted for longstanding abdominal pain and diarrhea. Computed tomography and magnetic resonance scans, endoscopy, and endoscopic ultrasound-guided fine-needle cytology were performed. The pathological diagnosis was moderately differentiated adenocarcinoma of the pancreatic head. RESULTS: Cephalic pancreaticoduodenectomy was performed. The postoperative course was favorable. A pancreatic fistula type B (ISGPF classification) developed and was resolved with conservative treatment. Analysis of the surgical specimen revealed the presence of a pancreatic pseudotumor due to Ascaris lumbricoides. After these findings, treatment was completed with oral albendazole. CONCLUSIONS: Pancreatic ascariasis in our environment is unusual, but should be included in the differential diagnosis of tumors and inflammatory processes of the pancreas.