The Experts below are selected from a list of 258 Experts worldwide ranked by ideXlab platform
Hans G Beger - One of the best experts on this subject based on the ideXlab platform.
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randomized trial of Duodenum preserving pancreatic head resection versus pylorus preserving whipple in chronic pancreatitis
American Journal of Surgery, 1995Co-Authors: Markus W Buchler, Helmut Friess, Michael Muller, Antony M Wheatley, Hans G BegerAbstract:Background In about 30% of patients, chronic pancreatitis leads to an inflammatory enlargement of the pancreatic head with subsequent obstruction of the pancreatic duct, common bile duct, and Duodenum. Methods In a prospective, randomized controlled trial, we compared Duodenum-preserving pancreatic head resection (DPPHR) with pylorus-preserving Whipple (PPW) operation to define the advantages of each operation with regard to (1) postoperative complications, (2) glucose tolerance and induction of diabetes mellitus, and (3) postoperative pain and quality of life up to 6 months after operation for chronic pancreatitis. Results The two study groups of 20 patients were both well balanced with regard to sex, age, history of chronic pancreatitis, and indication for surgery. Postoperative mortality was zero. After Duodenum-preserving and pylorus-preserving resection, morbidity was 15% and 20%, respectively. After 6 months, patients who underwent the Duodenum-preserving resection had less pain, greater weight gain, a better glucose tolerance, and a higher insulin secretion capacity. Conclusion The DPPHR compares favorably with the standard PPW operation and should be considered as an alternative procedure in the treatment of chronic pancreatitis.
Tadahiro Takada - One of the best experts on this subject based on the ideXlab platform.
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Duodenum preservation in pancreatic head resection to maintain pancreatic exocrine function determined by pancreatic function diagnostant test and cholecystokinin secretion
Journal of Hepato-biliary-pancreatic Surgery, 2005Co-Authors: Tadahiro TakadaAbstract:Background/Purpose Organ-preserving surgery, such as pylorus-preserving pancreatoduodenectomy (PPPD), Duodenum-preserving pancreatic head resection (DPPHR), or medial pancreatectomy (MP), is one of the recent advances in pancreatic surgery. There was a previous report that preservation of the Duodenum maintained pancreatic function. However, concerning the resected pancreas, patients were divided into two groups; one group included pancreatic head resections such as Whipple, PPPD, and complete DPPHR, and the other group included MP that removed only the pancreatic neck and preserved the pancreatic head and distal pancreas. The present study was designed to clarify the significance of Duodenum preservation, in comparison with Duodenum removal, in patients with pancreatic head resection, in terms of pancreatic function, determined by a pancreatic function diagnostant (PFD) test and cholecystokinin (CCK) secretion.
Stefan Pierzynowski - One of the best experts on this subject based on the ideXlab platform.
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cck b receptor antagonist yf476 inhibits pancreatic enzyme secretion at a duodenal level in pigs
Scandinavian Journal of Gastroenterology, 2004Co-Authors: Lena Evilevitch, Bjorn Westrom, Stefan PierzynowskiAbstract:Background: To evaluate the mechanisms by which cholecystokinin (CCK) regulates the exocrine pancreas, the role and location of CCK receptors in the pig were investigated using the CCK‐B receptor antagonist YF476 and different administration routes of CCK. Methods: In 11 anaesthetized pigs, catheters were surgically implanted in the pancreatic duct for juice collection, and in the gastric arteries and jugular vein, so that infusions of CCK‐33 could be directed to the duodenal/gastric, duodenal/pancreatic or general circulations, respectively. Experiments were performed under control conditions, and after pretreatment by gavage feeding with YF476, using either a single, low dose of 0.3 μmol kg −1 , which would block the CCK‐B receptors, or a 1000 times higher dose (300 μmol kg −1 ), which would also block the CCK‐A receptors. Results: The increase in the pancreatic output of protein and the enzymes trypsin and amylase observed after the infusion of CCK‐33 at 13 pmol kg −1 to the Duodenum/stomach or duodenu...
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cck regulates pancreatic enzyme secretion via short duodenal pancreatic reflexes in pigs
Scandinavian Journal of Gastroenterology, 2003Co-Authors: Lena Evilevitch, Bjorn Westrom, Stefan PierzynowskiAbstract:Background: Different routes of administration of CCK-33 and blockage of CCK-A and muscarinic (m 3 ) receptors are used in this study to evaluate the mechanisms by which cholecystokinin can stimulate the exocrine pancreas. Methods: The experiment was performed on eight anaesthetized pigs during control conditions and after administration of the CCK-A and m 3 receptor antagonists, Tarazepide and 4-DAMP, respectively. Catheters were surgically implanted in the pancreatic duct for juice collection and in the gastric and right gastro-epipoic arteries and in the jugular vein, so that infusions of CCK-33 could be made exclusively to the Duodenum/stomach, Duodenum/pancreas or general circulation, respectively. Results: Infusion of a low dose of CCK-33 (13 pmol kg −1 ) to the general circulation did not affect pancreatic protein or trypsin output. When the same dose was given directly to the Duodenum/stomach or the Duodenum/pancreas, pancreatic output increased during both control conditions and after Tarazepide ...
Markus W Buchler - One of the best experts on this subject based on the ideXlab platform.
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randomized trial of Duodenum preserving pancreatic head resection versus pylorus preserving whipple in chronic pancreatitis
American Journal of Surgery, 1995Co-Authors: Markus W Buchler, Helmut Friess, Michael Muller, Antony M Wheatley, Hans G BegerAbstract:Background In about 30% of patients, chronic pancreatitis leads to an inflammatory enlargement of the pancreatic head with subsequent obstruction of the pancreatic duct, common bile duct, and Duodenum. Methods In a prospective, randomized controlled trial, we compared Duodenum-preserving pancreatic head resection (DPPHR) with pylorus-preserving Whipple (PPW) operation to define the advantages of each operation with regard to (1) postoperative complications, (2) glucose tolerance and induction of diabetes mellitus, and (3) postoperative pain and quality of life up to 6 months after operation for chronic pancreatitis. Results The two study groups of 20 patients were both well balanced with regard to sex, age, history of chronic pancreatitis, and indication for surgery. Postoperative mortality was zero. After Duodenum-preserving and pylorus-preserving resection, morbidity was 15% and 20%, respectively. After 6 months, patients who underwent the Duodenum-preserving resection had less pain, greater weight gain, a better glucose tolerance, and a higher insulin secretion capacity. Conclusion The DPPHR compares favorably with the standard PPW operation and should be considered as an alternative procedure in the treatment of chronic pancreatitis.
Hideo Nagai - One of the best experts on this subject based on the ideXlab platform.
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study of surgical anatomy for Duodenum preserving resection of the head of the pancreas
Annals of Surgery, 1995Co-Authors: Wataru Kimura, Hideo NagaiAbstract:OBJECTIVE: The authors precisely examined the topography of the Duodenum, pancreas, bile duct, and supplying vessels from the perspective of performing Duodenum-preserving resection of the pancreatic head. SUMMARY BACKGROUND DATA: Little has been reported regarding the detailed surgical anatomy that is crucial in this procedure. METHODS: The authors precisely examined the local anatomy of the pancreas head and Duodenum, using materials from 40 autopsy cases. RESULTS: Arcade formation between the anterior superior pancreaticoduodenal (ASPD) artery and the anterior inferior pancreaticoduodenal (AIPD) artery was found in all of the cases. After departing from the gastroduodenal artery, the ASPD ran toward a point 1.5 cm below the papilla of Vater, then turned to the posterior aspect of the pancreas to joint the AIPD. In 88% of the cases, an arcade was found between the posterior superior pancreaticoduodenal (PSPD) artery and the posterior inferior pancreaticoduodenal (PIPD) artery. The ASPD, AIPD, PSPD, PIPD, or their branches to the Duodenum, the bile duct, and the papilla of Vater were not completely buried in the pancreatic parenchyma in any of these cases. Generally, it was easy to dissect the pancreas from the Duodenum because of the loose connection. Near the accessory papilla, however, dissection of the vessels was difficult, and the pancreatic parenchyma sometimes was found in the wall of the Duodenum. Dissection of the pancreas from the common bile duct and identification of the main pancreatic duct at the junction with the terminal portion of the bile duct were straightforward in all cases. CONCLUSIONS: It may be possible to remove the head of the pancreas while preserving of the vascular arcades and their branches to the Duodenum, the bile duct, and the papilla of Vater.
