• 한국간담췌외과학회지
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• 제28권1호
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• pp.99-103
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• 2024

Pancreatic resections, depending on the location of the tumor, usually require division of the vasculature of either the distal or proximal part of the stomach. In certain situations, such as total pancreatectomy and/or with splenic vein occlusion, viability of the stomach may be threatened due to inadequate venous drainage. We discuss three cases of complex pancreatic surgeries performed for carcinoma of the pancreas at a tertiary care center in India, wherein the stomach was salvaged by reimplanting the veins in two patients and preserving the only draining collateral in one case after the gastric venous drainage was compromised. The perioperative and postoperative course in these patients and the complications were analyzed. None of these 3 patients developed any complication related to gastric venous congestion, and additional gastrectomy was avoided in all these patients. Re-establishment of the Gastric venous outflow after extensive pancreatic resections helps to avoid additional gastric resection secondary to venous congestive changes.

• 한국발생생물학회지:발생과생식
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• 제10권3호
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• pp.185-192
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• 2006

산모의 당뇨병은 조산과 함께 광범한 선천성 기형을 야기한다고 알려져 있다. 고혈당이 원인으로 제시되었지만 알려진 것은 별로 없다. 당뇨병의 모델로서 췌장을 부분절제한 동물의 배아와 신생자를 조사하였다. 1) 췌장을 90% 절제한 어미로부터 태어난 신생자는 정상 신생자보다 생존률이 낮았지만, 살아남은 신생자의 경우에 생후 6주까지 체중을 조사하였을 때 암수 모두 정상적인 신생자와 비슷하였다. 간 조직을 조사하였을 때, 췌장을 절제한 어미로부터 태어난 신생자는 암수 모두에서 간의 이상이 발견되었다. 간에서 합성되고 소변으로 분비되는 major urinary protein(MUP)도 암컷 수컷 모두에서 그 양이 감소하였는데, 간조직의 이상을 뒷받침하고 있다. 2) 췌장을 부분절제한 어미에서 남아있는 췌장내의 랑게르한스 섬이 커져 있었으며, 간조직도 이상이 생긴 것으로 나타났다. 그러나 췌장을 부분절제한 어미의 경우에 혈당 수준은 대조군과 차이를 보이지 않았다. $Inhibin-{\alpha}$가 과발현된 생쥐에서 태어난 신생자의 경우에 저체중과 생존률 저하가 나타나고 있는데, 당뇨병 신생자와 유사한 점이 매우 많다. 이에 DNA 주사법으로 $inhibin-{\alpha}$의 과발현을 유도한 후에 어미 자신의 변화를 조사하였는데, $inhibin-{\alpha}$를 과발현시킨 생쥐에서 랑게르한스 섬이 작아졌지만, 혈당 수준은 대조군과 차이를 보이지 않았다. 종합하면, 췌장의 부분절제는 신생자와 배아 모두에게 영향을 미치고 있었고, 어미 자체에도 심각한 영향을 주고 있었다. 그렇지만 조사한 기간 내에서 산모의 혈당 수준은 변하지 않은 것으로 나타났다. 당뇨병 산모와 배아 및 신생자와의 관계는 매우 복잡한 것으로 추정된다.

• BMB Reports
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• 제53권2호
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• pp.100-105
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• 2020

While liver histopathology is heterogeneous in diabetes, the underlying mechanisms remain unclear. We investigated whether glycemic variation resulting from differential diets can induce heterogeneity in diabetic liver and the underlying molecular mechanisms. We generated end-stage non-obese diabetic model rats by subtotal-pancreatectomy in male Sprague-Dawley rats and ad libitum diet for 7 weeks (n = 33). The rats were then divided into three groups, and fed a standard- or a low-protein diet (18 or 6 kcal%, respectively), for another 7 weeks: to maintain hyperglycemia, 11 rats were fed ad libitum (18AL group); to achieve euglycemia, 11 were calorie-restricted (18R group), and 11 were both calorie- and protein-restricted with the low-protein diet (6R group). Overnight-fasted liver samples were collected after the differential diets together with sham-control (18S group), and histology and molecular changes were compared. Hyperglycemic-18AL showed glycogenic hepatopathy (GH) without steatosis, with the highest GSK-3β inactivation because of Akt activation during hyperglycemia; mitochondrial function was not impaired, compared to the 18S group. Euglycemic-18R showed neither GH nor steatosis, with intermediate GSK-3β activation and mitochondrial dysfunction. However, euglycemic-6R showed both GH and steatosis despite the highest GSK-3β activity and no molecular evidence of increased lipogenesis or decreased ApoB expression, where mitochondrial dysfunction was highest among the groups. In conclusion, heterogeneous liver histopathology developed in end-stage non-obese diabetic rats as the glycemic levels varied with differential diets, in which protein content in the diets as well as glycemic levels differentially influenced GSK-3β activity and mitochondrial function in insulin-deficient state.

• Journal of Trauma and Injury
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• 제24권2호
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• pp.68-74
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• 2011

Purpose: Although pancreas injury is rare in abdominal trauma, it poses a challenge to the surgeon because its clinical features are not prominent and the presence of main duct injury cannot be easily identified by imaging studies. Furthermore, severe pancreas injuries require a distal pancreatectomy or a pancreaticoduodnectomy which are associated considerable morbidity and mortality. We reviewed the clinical features of and outcomes for patients with pancreas injury. Methods: For 10 years from Jan. 2001 to Dec. 2010, thirty-four patients were diagnosed as having pancreas injury by using an explo-laparotomy. Patients successfully treated by non-operative management were excluded. Patients were divided into early (n=18) and delayed surgery groups (n=11) based on an interval of 24hours between injury and surgery. The clinical features of and the outcomes for the patients in both groups were compared. Results: Males were more commonly injured (82.4% vs.17.6%). The mean age was 37.2 years. The injury mechanisms included vehicle accidents (62.9%, 22/34), assaults (20%, 7/34), and falls (11.4%, 3/34). The head and neck of the pancreas was most commonly injured, followed by the body and the tail (16, 12, and 6 cases).Of the 34 patients, 26 (76.5%) patients had accompanying injuries. Grade 1 and 2 occurred in 14 (5 and 9) patients, and grade 3, 4, and 5 occurred in 20 (16, 3, and 1) patients. The early and delayed surgery groups showed no difference in surgical outcomes. Two patients with grade 3 in the early surgery group died after surgery,one due to massive hemorrhage and the other due to septic shock. Of the five patients initially managed non-operatively, three developed peripancreatic necrosis and two developed pseudocyst. All five patients were successfully cured by surgery. Conclusion: All cases of pancreas injury in this study involved blunt injury, and accompanying injury to major vessels or the bowel was the major cause of mortality. Surgery delayed for longer than 24 hours after was not associated with adverse outcomes.

• Journal of Trauma and Injury
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• 제24권1호
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• pp.1-6
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• 2011

Purpose: Even though traumatic pancreatic injuries occur in only 0.2% to 4% of all abdominal injuries, the morbidity and the mortality rates associated with pancreatic injuries remain high. The aim of this study was to evaluate the clinical outcomes of traumatic pancreatic injuries and to identify predictors of mortality and morbidity. Methods: We retrospectively reviewed the medical records of 26 consecutive patients with a pancreatic injury who underwent a laparotomy from January 2000 to December 2010. The data collected included demographic data, the mechanism of injury, the initial vital signs, the grade of pancreatic injury, the injury severity score (ISS), the revised trauma score (RTS), the Glasgow Coma Scale (GCS), the number of abbreviated injury scales (AIS), the number of associated injuries, the initial laboratory findings, the amount of blood transfusion, the type of operation, the mortality, the morbidity, and others. Results: The overall mortality rate in our series was 23.0%, and the morbidity rate was 76.9%. Twenty patients (76.9%) had associated injuries to either intra-abdominal organs or extra-abdominal organs. Two patients (7.7%) underwent external drainage, and 18 patients (69.3%) underwent a distal pancreatectomy. Pancreaticoduodenectomies were performed in 6 patients (23.0%). Three patients underwent a re-laparotomy due to anastomosis leakage or postoperative bleeding, and all patients died. The univariate analysis revealed 11 factors (amount of transfusion, AAST grade, re-laparotomy, associated duodenal injury, base excess, APACHE 11 score, type of operation, operation time, RTS, associated colon injury, GCS) to be significantly associated with mortality (p<0.05). Conclusion: Whenever a surgeon manages a patient with traumatic pancreatic injury, the surgeon needs to consider the predictive risk factors. And, if possible, the patient should undergo a proper and meticulous, less invasive surgical procedure.

• Advances in pediatric surgery
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• 제16권1호
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• pp.11-17
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• 2010

Pancreatic tumors in children are relatively rare, and their prognosis differs from that in adults. The purpose of this study is to examine the clinical characteristics, treatment, and prognosis for children with pancreatic tumors. We retrospectively reviewed the medical records of children under 15 years of age with pancreatic tumors who were treated surgically at Asan Medical Center between January 1992 and November 2009. There were 16 patients, fourteen of whom were pathologically diagnosed with solid pseudopapillary tumor. The other two patients were diagnosed with pancreatoblastoma and acinar cell carcinoma, respectively. Six patients of the 16 patients (38 %) were male, and there was a male-to-female ratio of 1:1.6. The initial presentations were upper abdominal pain in eight patients (50 %), palpable abdominal mass in three, and vomiting in one. Four patients were diagnosed incidentally. Six patients' tumors were located in the pancreatic head, six in the pancreatic body, and four in the pancreatic tail, respectively. The surgical procedures performed included distal pancreatectomy (n=7, 44 %), median segmentectomy (n=3), enucleation (n=3), pancreaticoduodenectomy (n=2), and pylorus-preserving pancreaticoduodenectomy (n=1). Three patients underwent laparoscopic surgery. The median tumor size was 6.5 cm (1.8~20 cm). Early surgical complications included pancreatic fistula (n=4), bile leakage (n=1), and delayed gastric emptying (n=1). A late complication in one patient was diabetes. The median follow-up period was five years and four months, and all patients survived without recurrence. While pancreatic tumors in adults have a poor prognosis, pancreatic tumors of childhood are usually curative with complete resection and thus have a favorable prognosis.

• Journal of Digestive Cancer Research
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• 제2권1호
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• pp.28-31
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• 2014

췌장암은 예후가 매우 불량한 암으로 gemcitabine을 근간으로 하는 항암화학요법이 진행성 췌장암에 대한 표준치료이지만, 이러한 일차 항암화학요법에 반응이 없을 경우의 이차 항암화학요법에 대해서는 아직까지 정립된 것이 없는 상태이다. FOLFIRINOX 병합용법은 최근 여러 연구에서 일차 항암화학요법으로서의 치료 효과가 보고되고 있고, gemcitabine 항암화학요법에 반응이 없는 진행성 췌장암에 대한 이차 항암화학요법으로도 시도되어 양호한 치료 효과가 보고되고 있다. 저자들은 gemcitabine을 근간으로 하는 병합요법에 대해 반응이 없는 진행성 췌장암 환자에 대한 이차 항암화학요법으로 FOLFIRINOX 병합요법을 시행하여 완전 관해를 획득한 증례를 문헌고찰과 함께 보고하는 바이다.