Pancreatic sarcoidosis

Pancreatic involvement in sarco?dosis is exceptional. We report a case of pancreatic sarco?dosis diagnosed during the etiologic work-up done for a pancreatic mass associated to a polyadenopathy. Under corticotherapy evolution is favorable with regression of the pancreatic lesions.     

Pancreatic transplant

Diabetes mellitus is a health concern of the first order, given the high level of associated morbidity and mortality. The objective, in order to slow down the advance of its complications before they become irreversible, is based on correct metabolic control. The high rate of morbidity associated with the surgery of the vascularized pancreas transplant and the high index of rejection have for three decades formed an obstacle to this being considered a valid alternative in the treatment of these patients. Nowadays the pancreas transplant has come to occupy a key position, thanks to the new regimes of immunosuppression and to the perfection of surgical techniques. In this article we review the evolution of the pancreas transplant from its beginnings to its present state.     

Pancreatic ascites

Pancreatic ascites is an unusual yet increasingly more often recognized complication of inflammatory pancreatic disease. The gradual onset of abdominal distension in a debilitated patient who may not have marked abdominal pain is often misdiagnosed and commonly attributed to cirrhotic ascites or malignant ascites. Analysis of ascitic fluid enables the diagnosis to be made, even in the presence of a normal serum amylase. Treatment should be initially conservative, moving onto surgery after 4-6 weeks if no improvement has occurred. When the conditions has been diagnosed the prognosis is surprisingly good despite the poor presenting condition of most patients.     

Pancreatic transplantation.

In the last few years there has been considerable improvement in results with pancreatic transplantation. Several centers now report a 1-year graft survival rate of 50%-60%. Patients with well-functioning grafts become insulin independent and have normal or near normal fasting ans post-prandial glucose levels and normal glycosylated hemoglobin values. The glucose tolerance as measured by oral and intravenous glucose tolerance tests is normal in 50%-80% of the patients but subnormal in the others. One important reason for subnormal glucose tolerance is medication with cyclosporin and prednisolone. In most cases an improvement in neuropathy is found and retinopathy seems to be stabilized. Preliminary data indicate that the provision of a pancreatic graft prevents the occurrence of diabetic nephropathy in a simultaneously or previously transplanted kidney.     

Pancreatic abscess.

Three cases of pancreatic abscess are described to show the difficulties in diagnosis and that inadequate treatment is invariably fatal. Early recognition and prompt surgical drainage, together with biliary decompression if indicated, are advised.     

Pancreatic pseudocysts in children

Pancreas pseudocysts in childhood. On the basis of experience obtained with 9 patients treated over 31 years the authors publish the first comprehensive study in Hungary on the pancreas pseudocyst in childhood. Having reviewed their series and the medical literature main features and the possible prevention and management of this disease is outlined. Review of these patients with ultrasonography and chemistry tests is advised in order to follow-up the recovery and to screen the error in the glucose metabolism.