Related titles. Carousel Previous Carousel Next. Jump to Page. Search inside document. Aris Nur Azhar. Monika Werdiningsih. Ionel-florin Hritcu. Haleema Sultan. Arpit Jain. Rigotti Br. Revalia Dwisari Nusantara. Hugo Alberto C F. Anas Tasya. Ryok Days. Raees Ali Khan. Tvisha Patel. Siti Anisa. Transplanting the kidney first also decreases the pressure on the pan- creas allograft during implantation of the kidney. Tacrolimus, mycophenolate mofetil, and steroids were used for maintenance immunosuppression.
All patients also received prophylactic therapy for Pneumocystis jiroveci, cytomegalovirus CMV , and fungi for three months after transplantation. Upper endoscopy was performed for every patient Figure 1: Schematic drawing of the portal-endocrine and gastric-exocrine with possible pancreatic dysfunction to study the technique of pancreatic transplantation. Pancreatic dysfunction was defined as elevated serum levels of of pancreas transplantation.
Pancreas allograft rejection was treated by anti-thymo- All patients who had pancreas transplantation with the cyte globulin, pulse steroid therapy, and increasing the dose technique of portal-endocrine and gastric-exocrine drainage of maintenance immunosuppressive medications.
CMV at our center from October to November were duodenitis was treated by valganciclovir and decreasing included in this retrospective study. Demographics, clini- the dose of maintenance immunosuppression. RESULTS All transplant recipient candidates were informed on this new technique of pancreas transplantation and signed From October to November , 40 pancreas the consent form to undergo transplantation with this transplants were done at our center.
Among them, 38 pa- technique. First, anastomosis with systemic enteric technique. This case was reconstructed arterial supply of pancreas, which was done transplanted with portal enteric technique. Panel A: Site of gastroduodenal anastomosis. Panel B: Transplanted duodenum. Seven patients died during follow- dysfunction, such as pancreas allograft rejection and CMV up five due to cardiovascular causes [all SKP], one due to infection, while eliminating the risk of major complications donor duodenal perforation [SKP], and one due to unknown secondary to a more invasive diagnostic procedure.
Three more cases all PTA had vascular throm- tory markers of insulin production, such as blood glucose, bosis of the transplanted pancreas within eight days post- HbA1C, or C-peptide levels, become abnormal. These three patients were later diagnosed serum enzymes like amylase is neither sensitive nor specific to have antithrombin-3 deficiency, protein S deficiency, and for detection of rejection and could happen due to several high levels of lupus anticoagulant antibodies, respectively.
Moreover, two patients were ous complications, such as bowel perforation, hemorrhage, found to have peptic ulcer at the site of the duodenogastric or pancreatic leak. No patient developed any complication due transplant technique that could provide an easy access for to the upper endoscopy. By evaluating the donor duodenum as a surrogate marker for the trans- planted pancreas, our technique could facilitate early detection and differentiation of acute pancreas Figure 3: Panel A: Photomicrograph image of a biopsy from normal transplanted allograft rejection and CMV infec- duodenum.
Note the normal villous architecture and lack of significant inflammatory tion. Moreover, through upper en- changes. Hematoxylin and Eosin stain, x original magnification. Panel B: doscopy of the donor duodenum, Photomicrograph image of a biopsy from a patient with acute rejection. The biopsy endoscopic ultrasound-facilitated demonstrated areas of neutrophilic inflammation thin arrows , erosive change, and biopsy of transplanted pancreas numerous apoptotic bodies thick arrows.
Hematoxylin and Eosin stain, x original could be potentially achieved. Panel C: Photomicrograph image of a biopsy from a patient with The site of anastomosis of enteric Cytomegalovirus duodenitis involving the transplanted duodenum.
Arrow denoted cells drainage is also prone to develop- with viral cytopathic effect. Panel ment of ulcers and bleeding. Arrow denoted cell with positive reaction with CMV access to the site of enteric drainage immunohistochemical stain. CMV immunohistochemical stain, x original magnification. Additional hormones produced and secreted include amylin, somatostatin, pancreatic polypeptide and ghrelin.
Skip to content Chapter Endocrine system. Ryan Jennings Pancreas. The pancreas is surrounded by a thin fibrovascular capsule C that coalesces with septa that divide the exocrine pancreas into discrete lobules L; also outlined by red-dashed lines. The pancreatic secretions collect into an increasingly larger duct system that, terminally, empties into the proximal duodenum.
Larger interlobular ducts ID are surrounded and supported by a collagenous tissue stroma. Here, collagen stains blue. The fine interlobular septa and connective tissue surrounding interlobular ducts are most prominent.
Pancreatic lobules are predominantly composed of exocrine pancreatic acini, apparent here due to their brightly eosinophilic cytoplasmic granules zymogen granules. Need an account? Click here to sign up. Download Free PDF. Anatomia y fisiologia de pancreas. Rafael Rodriguez. A short summary of this paper.
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