Tumors of the endocrine pancreas

37 patients suffering from apudomas of the pancreas are reported (18 insulinomas, 6 isletcell-hyperplasias, 9 Zollinger-Ellison syndroms, 1 glucagonoma, 3 without hormone production). In preoperative localization computerized tomography and angiography were the best with 65% positive findings. Insulinomas were enucleated, all free of recidives. 50% of operated isletcell hyperplasias had a postoperative resisting hyperinsulinism. Either gastrectomy or tumour enucleation was performed in the Zollinger-Ellison syndrome. The five-years survival rate was 43%.     

Organogenesis of the endocrine pancreas

Organogenesis of the endocrine pancreas. Embryonic pancreatic primordia transplanted into diabetic animal hosts undergo selective endocrine differentiation in situ and normalize glucose tolerance. Pancreatic primordia can be transplanted across isogeneic, allogeneic, and both concordant (rat to mouse) and highly disparate (pig to rodent) xenogeneic barriers. This review explores the therapeutic potential for pancreatic organogenesis posttransplantation of embryonic primordia.     

Functional genomics in osteoarthritis: Past,present, and future

Osteoarthritis (OA) is a common complex disease of high public health burden. OA is characterized by the degeneration of affected joints leading to pain and reduced mobility. Over the last few years, several studies have focused on the genomic changes underpinning OA. Here, we provide a comprehensive overview of genome‐wide, non‐hypothesis‐driven functional genomics (methylation, gene, and protein expression) studies of knee and hip OA in humans. Individual studies have generally been limited in sample size and hence power, and have differed in their approaches; nonetheless, some common themes have started to emerge, notably the role played by biological processes related to the extracellular matrix, immune response, the WNT pathway, angiogenesis, and skeletal development. Larger‐scale studies and streamlined, robust methodologies will be needed to further elucidate the biological etiology of OA going forward. © 2016 The Authors. Journal of Orthopaedic Research Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 34:1105–1110, 2016.     

Pathogenesis of endocrine tumors of the pancreas

Precise pathohistologic and immunohistochemical investigations of the pancreas in elderly autopsy cases revealed that endocrine tumors are found very frequently. Some endocrine tumors of the pancreas may originate from Langerhans islets, although other endocrine tumors may develop from endocrine cells or stem cells with multiple differentiation ability and occur in the duct cells or acinar cells. This possibility may be supported by the evidence that ductular or tubular structures were found in or adjacent to tumors in about 60% of minute tumors and that hormone production was found in both duct cells and acinar cells based on immunohistochemical findings. The occurrence of ductuloinsular tumors, acinar endocrine cell tumors, and duct-acinar-islet cell tumors may also support these observations. Islets of Langerhans with diameter of 500 microm or greater, or islets with a mean +/- 2 SD or greater, were found around the tumors, suggesting the presence of factors that promote the growth of islets of Langerhans. Molecular biological investigations will further analyze the pathogenesis of endocrine tumors of the pancreas. There are three possible origins of endocrine tumors of the pancreas: Langerhans islets cells, ductular cells, and acinar cells.     

Non-functioning tumors of the endocrine pancreas. Concept, diagnosis, treatment

Five cases of nonfunctioning islet cell tumors of the pancreas are reported. There were 3 males and 2 females aged from 34 to 83 years (Average: 55.8 years). Two tumors were malignant since already metastatic, one tumor was probably malignant and two tumors were judged as benign. One patient died post-operatively. The four remaining patients are alive without recurrence after from 1.4 to 7.3 years. The concepts of nonfunctioning tumors of the pancreas and APUD system are discussed in view of these 5 cases and the relevant literature. The value of tumor markers as well as the radiographic appearances of these tumors are reported. Having a better prognosis than the adenocarcinoma of the exocrine pancreas, the nonfunctioning tumors of the endocrine pancreas are best managed by surgery. The indications and the results of surgery and chemotherapy are discussed.     

Bioartificial pancreas for the treatment of diabetes

Recent advances in islet transplantation using highly purified islets and effective immunosuppression strategies have resulted in substantial improvement in achieving insulin independence in type 1 diabetes patients. However, there are side effects from long-term immunosuppression, and transplant rejection and/or the recurrence of autoimmune attack of the transplanted islets cannot be completely prevented, even with immunosuppressive treatment. Therefore, construction of a safe and functional bioartificial pancreas (BAP) that provides an adequate environment for islet cells may be an important approach to treat diabetic patients. Various types of BAP devices have been developed and examined in animals. In this review, I introduce the previous BAP studies and our approach of BAP development.     

Cystic endocrine tumors of the pancreas: clinical, radiologic, and histopathologic features in 13 cases

Cystic endocrine tumors of the pancreas are rare and raise difficult clinical problems. Our aims were to reevaluate the diagnostic and therapeutic strategy and to assess their histopathologic characteristics. Thirteen cystic endocrine tumors diagnosed in 10 patients were included. Clinical, radiologic, and pathologic data were reviewed. There were 6 male and 4 female patients (median age, 46 yrs). Six patients had evidence of multiple endocrine neoplasia type 1 (MEN1) disease. Four had a functional endocrine syndrome. Ten tumors were visible on imaging studies. The most suggestive radiologic features were the existence of a peripheral hypervascular rim (10 cases) and images of cyst into cyst (two cases). On gross and histologic examinations, two distinct types were present. Macrocystic tumors (six cases) were unilocular and limited by a thick wall containing nests of tumor cells. Microcystic tumors (seven cases) were characterized by the presence of multiple cystic spaces directly lined by tumor cells. Surgical resection was performed in all cases. Three patients had lymph node metastases at the time of diagnosis. One patient is dead with metastatic dissemination. The others are alive without recurrence or metastasis. The diagnosis of endocrine tumor must be considered for any pancreatic cyst discovered in a patient with a history of MEN1 syndrome or with clinical features suggestive of this syndrome. Cystic pancreatic endocrine tumors must be treated by surgical resection because of their possible malignant evolution.     

重视胰腺内分泌肿瘤的诊断和治疗

胰腺内分泌肿瘤来源于胰腺多能神经内分泌干细胞,有内分泌功能的肿瘤根据其分泌的主要激素进行命名,常见的有胰岛素瘤和胃泌素瘤.血清激素正常且不伴有明确临床症状的肿瘤,称为无功能内分泌肿瘤.总体来讲,胰腺内分泌肿瘤是一种少见病,容易误诊;另一方面,多数手术治疗效果好,即使是恶性胰腺内分泌肿瘤,由于生长缓慢,积极治疗也可获得长期存活.因此,在诊断和治疗上与胰腺外分泌肿瘤有较大区别,必须加以重视,从而达到减少误诊、及时处理、获得满意治疗效果的目的.     

Functional genomics: clinical effect and the evolving role of the surgeon.

The genetic and molecular revolution that has occurred over the last 2 decades has dramatically increased our understanding of basic disease processes and will undoubtedly lead to improved detection methods and treatment. This will occur at an even more rapid rate after the completion of the Human Genome Project in the next 2 to 3 years. While these remarkable technological advances offer great hopes for novel therapeutic modalities, complicated medical, ethical, and legal issues will need to be addressed. This article briefly describes the advances that have occurred and their future ramifications for the field of surgery. Most assuredly, we will all be affected by these changes. Surgeons have the opportunity to be active participants and real leaders in the research and complex decisions regarding the optimal treatment of patients. However, formal training in these techniques and their potential applications will be required. Surgeons, as well as all physicians, must rise to the occasion or, otherwise, we will be relegated to a bystander status with clinical and moral decisions being made by nonclinicians.     

Bisphenol-A disruption of the endocrine pancreas and blood glucose homeostasis

The link between endocrine disruptors and altered blood glucose homeostasis has been recently suggested. Epidemiological studies have correlated levels of phthalates, dioxins and persistent organic pollutants with alterations of blood glucose homeostasis in humans. Environmentally relevant doses of the ubiquitous endocrine disruptor bisphenol-A (BPA) have profound effects on mice endocrine pancreas--an essential tissue involved in glucose metabolism. BPA exerts rapid non-genomic effects on insulin releasing beta-cells and glucagon releasing alpha-cells within freshly isolated islets of Langerhans. In vivo, a single BPA injection of 10 microg/kg rapidly increases plasma insulin and concomitantly decreases glycaemia. When mice were treated with BPA 100 microg/kg/day for 4 days, the environmental oestrogen produced an increase in beta-cell insulin content along with a post-prandial hyperinsulinaemia and insulin resistance. The results reviewed here demonstrate that doses well below the current lowest observed adverse effect level considered by the US-EPA, disrupt pancreatic beta-cell function producing insulin resistance in male mice. Therefore, this altered blood glucose homeostasis by BPA exposure may enhance the risk of developing type II diabetes.     

Malignant endocrine tumor of the pancreas and ensuing clinical syndromes

We report the observation of an endocrine tumor of the pancreas with metastasis to the liver which was apparently non-secreting. The evolution after resection by distal pancreatectomy was remarkable for the successive occurrence of a Zollinger-Ellison syndrome which was resistant to a gastric resection, then a hyperglycemia coma with ketoacidosis and finally a glucagonoma syndrome. This observation is the basis of a discussion on the multisecretory aspect of endocrine tumors of the pancreas.