Changes in glucose metabolism and the Langerhans islet in the remnant pancreas after major pancreatectomy, with special reference to D cells in the islet in Sandmeyer's diabetes (author's transl)

Abstract

Recently major resection of the pancreas has been employed for radical treatment of not only pancreatic carcinoma but also benign pancreas disease, such as chronic pancreatitis. Because it is reported that the amount of insulin required to control glycosuria after partial pancreatectomy is much greater than that needed after total pancreatectomy, it is believed that the pathophysiology of diabetes developed after partial pancreatectomy is considerably different from that following total pancreatectomy. However, metabolic changes have not been investigated in detail after partial pancreatectomy, although they have been widely investigated after total pancreatectomy.In the present experiment, changes in glucose tolerance and the Langerhans islet were investigated after major resection of the pancreas in dogs to elucidate the pathophysiology of carbohydrate metabolism.Immediately after a 90% or more pancreatectomy, diabetes developed, and the size and volume density of the islet was markedly decreased, accompanyied by severe degeneration of B, A and D cells, which was dominant seven weeks or more after the pancreatectomy.During the early periods after 70-90% pancreatectomy, glucose tolerance was maintained within the normal range. Six to nineteen weeks later, so-called Sandmeyer's diabetes developed. Within five weeks after the diabetes developed, the size and volume density of the islet slightly increased. B cells in the remnant pancreas decreased in number and showed moderate degeneration, but both A and D cells were observed in the central part of the islet and increased in number. Five weeks or more after the diabetes developed, the size and volume density of the islet slightly decreased, with marked hydropic degeneration of B cells, similar to findings within seven weeks after 90% or more pancreatectomy.After resection of less than 70% of the entire pancreas, diabetes did not develop, glucose tolerance was maintained well, and the islet was maintained at almost normal size and the volume density of the islet moderately increased, without any significant changes of B, A and D cells.