Impairment Of Endocrine Function Research Articles

The association between exocrine pancreatic dysfunction and insulin resistance in an insulin-resistant population in Turkey: A cross-sectional study.

In insulin resistance (IR), it is thought that pancreatic fat accumulation may decrease pancreatic volume, cause an impaired endocrine function, and simultaneously lead to an exocrine dysfunction before diabetes develops. The association between pancreatic exocrine function and insulin resistance (IR) was assessed in a population with insulin resistance. This was a descriptive cross-sectional study that included 43 IR cases with no other comorbid diseases or pregnancy and 41 healthy controls. Fasting blood adiponectin, leptin, pancreatic amylase, lipase, and stool fecal elastase-1 (FE-1) were studied and compared in both groups. The IR group consisted of 38 females (88.3%) and five males (11.6%), while the control group consisted of 31 females (75.6%) and ten males (24.3%). FE-1 levels were significantly lower in the IR group (P-value <0.01). Blood glucose, insulin, and HbA1c levels were significantly higher in the IR group than in the control (P-value of <0.01, <0.01, <0.01, respectively). Leptin levels were significantly higher in the IR group compared to the controls (P-value = 0.013). After dividing the whole group (n: 84) into two groups as FE-1 <200 μg/g (n: 61) and FE-1 ≥200 μg/g (n: 23), logistic regression analysis was performed; the significant predictor of low FE-1 was HOMA-IR (ODD ratio: 4.27, P-value <0.01, 95% confidence interval for ODD ratio: 1.95-9.30). This study showed that IR is associated with pancreatic exocrine dysfunction.

An Overview of Essential Microelements and Common Metallic Nanoparticles and Their Effects on Male Fertility.

Numerous factors affect reproduction, including stress, diet, obesity, the use of stimulants, or exposure to toxins, along with heavy elements (lead, silver, cadmium, uranium, vanadium, mercury, arsenic). Metals, like other xenotoxins, can cause infertility through, e.g., impairment of endocrine function and gametogenesis or excess production of reactive oxygen species (ROS). The advancement of nanotechnology has created another hazard to human safety through exposure to metals in the form of nanomaterials (NMs). Nanoparticles (NPs) exhibit a specific ability to penetrate cell membranes and biological barriers in the human body. These ultra-fine particles (<100 nm) can enter the human body through the respiratory tract, food, skin, injection, or implantation. Once absorbed, NPs are transported to various organs through the blood or lymph. Absorbed NPs, thanks to ultrahigh reactivity compared to bulk materials in microscale size, disrupt the homeostasis of the body as a result of interaction with biological molecules such as DNA, lipids, and proteins; interfering with the functioning of cells, organs, and physiological systems; and leading to severe pathological dysfunctions. Over the past decades, much research has been performed on the reproductive effects of essential trace elements. The research hypothesis that disturbances in the metabolism of trace elements are one of the many causes of infertility has been unquestionably confirmed. This review examines the complex reproductive risks for men regarding the exposure to potentially harmless xenobiotics based on a series of 298 articles over the past 30 years. The research was conducted using PubMed, Web of Science, and Scopus databases searching for papers devoted to in vivo and in vitro studies related to the influence of essential elements (iron, selenium, manganese, cobalt, zinc, copper, and molybdenum) and widely used metallic NPs on male reproduction potential.

The effect of zinc deficiency and iron overload on endocrine and exocrine pancreatic function in children with transfusion-dependent thalassemia: a cross-sectional study

BackgroundChildren with transfusion-dependent thalassemia (TDT) suffer from secondary hemosiderosis and the delirious effects this iron overload has on their different body organs, including the pancreas. They are also more prone to develop zinc deficiency than the general pediatric population. This study aimed to determine the effect of zinc deficiency and iron overload on the endocrine and exocrine pancreas in TDT children.MethodsEighty children, already diagnosed with TDT, were included in this study. We assessed the following in the participant children: serum ferritin, serum zinc, endocrine pancreatic function (oral glucose tolerance test (OGTT), fasting insulin level and from them, HOMA-IR was calculated), and exocrine pancreatic function (serum lipase and serum amylase).ResultsForty-four TDT children had a subnormal zinc level, while 36 of them had a normal serum zinc level. TDT children with low serum zinc had significantly more impaired endocrine pancreatic function and an abnormally high serum lipase than children with normal serum zinc, p < 0.05 in all. Serum zinc was significantly lower in TDT children with serum ferritin above the ferritin threshold (≥2500 ng/ml) than those below (59.1 ± 20.2 vs. 77.5 ± 28.13), p = 0.02. TDT children, having a serum ferritin ≥2500 ng/ml, had significantly more frequently impaired endocrine pancreatic function and abnormally high serum lipase than TDT children below the ferritin threshold, p < 0.05 in all.ConclusionIn children with transfusion-dependent thalassemia, zinc deficiency aggravates iron-induced pancreatic exocrine and endocrine dysfunction.

Obesity and Diabetes Mediated Chronic Inflammation: A Potential Biomarker in Alzheimer’s Disease

Alzheimer’s disease (AD) is the sixth leading cause of death and is correlated with obesity, which is the second leading cause of preventable diseases in the United States. Obesity, diabetes, and AD share several common features, and inflammation emerges as the central link. High-calorie intake, elevated free fatty acids, and impaired endocrine function leads to insulin resistance and systemic inflammation. Systemic inflammation triggers neuro-inflammation, which eventually hinders the metabolic and regulatory function of the brain mitochondria leading to neuronal damage and subsequent AD-related cognitive decline. As an early event in the pathogenesis of AD, chronic inflammation could be considered as a potential biomarker in the treatment strategies for AD.

Estrogen therapy offsets thermal impairment of vitellogenesis, but not zonagenesis, in maiden spawning female Atlantic salmon (Salmo salar).

In female Atlantic salmon (Salmo salar), exposure to warm summer temperatures causes a reduction in plasma 17β-estradiol (E2), which impairs downstream vitellogenesis and zonagenesis, and reduces egg fertility and embryo survival. The aim of the present study was to determine whether E2-treatment could offset thermal impairment of endocrine function and maintain egg quality in maiden (first-time-spawning) S. salar reared at 22 °C. Treatment with E2 at 22 °C stimulated vitellogenin (vtg) gene expression and subsequent protein synthesis which promoted oocyte growth and increased egg size relative to untreated fish at 14 and 22 °C. However, E2-treatment at 22 °C was not associated with an increase in egg fertility and embryo survival relative to untreated fish at 22 °C, despite the positive effects of E2-treatment on vitellogenesis and oocyte growth. As there was no evidence to suggest that the estrogen receptor alpha expression was suppressed by high temperature, this could be due to the lack of stimulation on zonagenesis by E2-treatment observed at high temperature during oocyte development. Our results demonstrate that treatment with E2 is not able to maintain zonagenesis or egg quality in maiden S. salar at high temperature, even when vtg gene expression, protein synthesis and subsequent oocyte growth is promoted. This implies that the mechanisms regulating zonagenesis, but not vitellogenesis are impaired at elevated temperature in female S. salar broodstock, and highlights the remarkable complexity of thermally induced endocrine disruption in fish.

Partington-Rochelle Pancreaticojejunostomy for Chronic Pancreatitis Combined with Cholangioenterostomy Treatment of Chronic Pancreatitis and Biliary Strictures: Case Report and Review of the Literature

Chronic pancreatitis (CP) is a kind of pancreatic disease with irreversible morphological changes, can lead to impaired endocrine and exocrine function of the inflammatory process. CP simultaneously accompanied with bile duct stricture (BDS) is a rare condition. At present, the treatment of CP tend to be individualized by the surgeons.Here, we reported the case of a plastic stent inserted two times into the main pancreatic duct and common bile duct. During the last 5 years, the patient hospitalized several times due to recurrent abdominal pain, till Partington-Rochelle pancreatojejunostomy(PRP) procedure combined with cholangioenterostomy was treated without complications. After 4 years of follow-up, the patient showed abnormal glucose metabolism without the need for additional enzymes, and he was in good condition without pain. Partington-Rochelle procedure combined with cholangioenterostomy provided a promising result of pancreatitis with BDS endoscopic papillary and stent failure

Secretin-stimulated MRI characterization of pancreatic morphology and function in patients with chronic pancreatitis

Background/ObjectivesChronic pancreatitis (CP) is characterized by abnormal pancreatic morphology and impaired endocrine and exocrine function. However, little is known about the relationship between pancreatic morphology and function, and also the association with the etiology and clinical manifestations of CP. The aim was to explore pancreatic morphology and function with advanced MRI in patients with CP and healthy controls (HC) MethodsEighty-two patients with CP and 22 HC were enrolled in the study. Morphological imaging parameters included pancreatic main duct diameter, gland volume, fat signal fraction and apparent diffusion coefficient (ADC) values. Functional secretin-stimulated MRI (s-MRI) parameters included pancreatic secretion (bowel fluid volume) and changes in pancreatic ADC value before and after secretin stimulation. Patients were classified according to the modified Cambridge and M-ANNHEIM classification system and fecal elastase was collected. ResultsAll imaging parameters differentiated CP patients from HC; however, correlations between morphological and functional parameters in CP were weak. Patients with alcoholic and non-alcoholic etiology had comparable s-MRI findings. Fecal elastase was positively correlated to pancreatic gland volume (r = 0.68, P = 0.0016) and negatively correlated to Cambridge classification (r = −0.35, P < 0.001). Additionally, gland volume was negatively correlated to the duration of CP (r = −0.39, P < 0.001) and baseline ADC (r = −0.35, P = 0.027). When stratified by clinical stage (M-ANNHEIM), the pancreatic gland volume was significantly decreased in the severe stages of CP (P = 0.001). ConclusionsS-MRI provides detailed information about pancreatic morphology and function and represents a promising non-invasive imaging method to characterize pancreatic pathophysiology and may enable monitoring of disease progression in patients with CP.

Testicular function during puberty and young adulthood in patients with Klinefelter's syndrome with and without spermatozoa in seminal fluid.

Patients with Klinefelter's syndrome experience progressive testicular degeneration resulting in impaired endocrine function and azoospermia. What proportion of adolescents develop testosterone deficiency during puberty and how many have spermatozoa in their semen is unclear to date. We aimed to investigate testicular function during puberty and young adulthood in patients with Klinefelter's syndrome and to assess testosterone effects in target tissues. The clinical data of 281 patients with non-mosaic Klinefelter's syndrome aged 10-25years without previous testosterone replacement were reviewed. In late pubertal adolescents, semen analyses were evaluated, and testicular volumes, hormone and haemoglobin (Hb) levels, the number of CAG repeats and final height data were compared to those of 233 age-matched controls with pubertal gynaecomastia. Spontaneous pubertal virilisation to Tanner stages IV-V occurred. Serum T levels ≥10nmol/L were reached in 62% of patients with Klinefelter's syndrome and in 85% of controls at ages 15-25 (TKFS : 12.2±5.4 vs. TC : 16.6±7.2nmol/L). LHKFS levels were elevated >10U/L in 84%, and normal in all controls (LHKFS : 18.6±12.2 vs. LHC : 3.5±1.6U/L). In nine of 130 (7%) adolescents with Klinefelter's syndrome, spermatozoa (oligozoospermia) were found in semen; all had T levels >7nmol/L and eight of nine had LH levels ≤18U/L, while their hormone levels, number of CAG repeats and testicular volumes were not different from those of adolescents with azoospermia. Controls had normal sperm concentrations in 73% (46/63). Semen volumesKFS were normal in 55% vs. 78% in controls; HbKFS was normal in 89% (HbC : 97%). Mean final heightKFS was 185±8 cm vs. 181±7cm in controls. Hypergonadotropic hypogonadism develops during early puberty in adolescents with Klinefelter's syndrome and remains compensated in over 60% during ages 15-25, with sufficient testosterone secretion for spontaneous accomplishment of pubertal development. Spermatozoa in semen are rare and associated with T levels >7nmol/L. Parameters reflecting androgen deficiency in target tissues may help to optimise timing of testosterone substitution, which should preferably not be initiated before fertility status has been clarified.

Spontaneous intratumoural and intraventricular haemorrhage associated with a pilomyxoid astrocytoma in the hypothalamic/chiasmatic region

Pilomyxoid astrocytoma (PMA) is a rare, low-grade glioma that is recognised as a variant of pilocytic astrocytoma. There have been few reports on this pathologic entity presenting with spontaneous haemorrhage. In this study, we report a rare case of PMA in the hypothalamic/chiasmatic region presenting with intratumoural and intraventricular haemorrhage. An external ventricular drain was urgently inserted. A ventriculo-peritoneal shunt (VP) was undergone 4weeks thereafter. The patient received fractionated Gamma Knife radiosurgery in another hospital 3weeks after the VP shunt. Three months later, subtotal resection of the tumour was performed in our hospital via a pterional approach. The pathological diagnosis was PMA. Postoperatively, no adjuvant therapy was given, and the neurologic deficits were improved. However, the presentation of endocrine deficits remained. Notably, PMAs in the hypothalamic/chiasmatic region presenting with massive intratumoural and intraventricular haemorrhage may result in a severe condition and long-term impairment of endocrine function. Long-term follow-up is required to monitor the recurrence of the tumour and endocrinopathy.

Pancreas-preserving surgical management of grade-C pancreatic fistulas after pancreatic head resection by external wirsungostomy.

Completion pancreatectomy for grade-C pancreatic fistula is associated with unacceptably high mortality and therefore this strategy should be reassessed. This study presents an update of our experience with a pancreas-preserving technique in the course of salvage re-laparotomy in terms of closure of the open jejunum via segmental resection and external drainage of the pancreas. Between April 2004 and January 2015, 292 pancreaticoduodenectomies (PD) with pancreaticojejunostomy (PJ) were performed. Thirteen patients (5%) underwent salvage re-laparotomy for symptomatic grade-C fistulas, and clinical data were retrospectively analyzed. In all patients, the preservation of the pancreas remnant and external drainage of the pancreatic juice was feasible. Median hospital stay was 58days (range, 21-142days). In 4/13 patients (31%), further reoperations were necessary. In-hospital mortality was 15% (2/13). 3/13 patients (23%) were readmitted and two received inpatient non-surgical treatment. To date re-pancreaticojejunostomy was performed in seven of the remaining 11 patients (63%) after 168days in median. In 1/7 patients (14%), a re-operation after re-PJ was necessary. In one patient, externalization of the pancreas juice was chosen as a definite option. In another patient, secretion ceased spontaneously without stasis and normal endocrine function. Neither before nor after re-anastomosis impairment of endocrine function was observed. Closure of the intestinum and preservation of the pancreas remnant in grade-C pancreatic fistula is easy to perform and can be categorized as a life-saving procedure. Prevention of total pancreatectomy associated with high morbidity and mortality was achieved in all cases.

Endocrine function impairment after distal pancreatectomy: incidence and related factors

Endocrine function impairment after distal pancreatectomy: incidence and related factors

Endocrine Function Impairment After Distal Pancreatectomy: Incidence and Related Factors.

Little is known about the incidence of and risk factors for glucose intolerance after distal pancreatectomy. This study investigated the clinicopathologic factors associated with the development of glucose intolerance or overt diabetes mellitus (DM) after distal pancreatectomy, and the correlation between resected pancreas volume and endocrine function impairment. After excluding patients with preoperative DM, 101 patients who underwent distal pancreatectomy with a minimum of 1-year postoperative follow-up were enrolled in this prospective cohort. Patients were assessed preoperatively and 1 week and 12 months postoperatively by oral glucose tolerance tests and by measures of HbA1c and pancreatic volume. Mean patient age was 54.1 years, mean body mass index (BMI) was 23.3 kg/m(2), and the male-to-female ratio was 1:1.8. Of the 101 patients, 21 (20.8 %) had pancreatic ductal adenocarcinoma. The median percent resected pancreas volume was 28.0 % (range 5.0-71.3 %). One year after distal pancreatectomy, 51 patients (50.5 %) had glucose intolerance, including 26 with impaired fasting glucose and 25 with DM. ROC curve analysis showed that a resected pancreas volume of 25 % showed maximum diagnostic value for development of glucose intolerance. Univariate analysis showed that female sex (58.5 vs. 36.1 %, P = 0.031), BMI (24.1 vs. 22.5 kg/m(2), P = 0.010), larger resected volume (36.5 vs. 28.0 %, P = 0.026), and lower remnant volume relative to BMI (1.7 × 10(-3) vs. 2.1 × 10(-3) m(5)/kg, P = 0.021) were risk factors for postoperative endocrine function impairment. Multivariate analysis revealed that female sex (odds ratio [OR] 5.818, P = 0.003), higher BMI (OR 10.556, P = 0.006), and resected pancreatic volume (OR 3.192, P = 0.035) were independent risk factors for endocrine impairment. About 50 % of patients without preoperative DM developed impaired glucose tolerance or overt DM following distal pancreatectomy. Female sex, higher BMI, and resection of pancreatic volume >25 % were risk factors for endocrine function impairment, indicating the need for preoperative evaluation and careful perioperative glucose monitoring in these patients.

The long-term effects of FSH and triiodothyronine administration during the pubertal period on Connexin 43 expression and spermatogenesis efficiency in adult rats.

Follicle-stimulating hormone (FSH) and triiodothyronine (T3) are known regulatory factors of spermatogenesis initiation. Hyperstimulation of both hormones evokes regressional changes in connexin 43 expression and the seminiferous epithelium in young rats during testicular maturation. However, separate treatments with T3 reduce Sertoli cell number, which seems to be closely connected with the maturation of connexin 43 gap junctions. FSH elevates Sertoli cell number and function, but this effect may take place regardless of the presence of connexin 43-dependent intercellular communication. The aim of the study was to evaluate the later effects of such treatments. Newborn, male Wistar rats were divided randomly into experimental groups receiving daily subcutaneous injections of either 7.5 IU/animal FSH, or 100 mg/kg b.w. T3, or both substances or the same volume of vehicle (control group) until day 15 of life. The animals were sacrificed on day 50. Morphometric analysis and immunohistochemical reactions were performed using antibodies against Vimentin, Proliferating Cell Nuclear Antigen and Connexin 43 in the testis. Sertoli cell count, efficiency of spermatogenesis, and hormonal pattern were examined. Disturbances in the connexin 43 expression reduced the number of Sertoli cells, the efficiency of spermatogenesis and impaired endocrine function of testes in adult rats treated with FSH and T3 during puberty. Stimulation with FSH alone increased Sertoli cell number, but was associated with a negative effect on cell-to-cell connexin 43-dependent communication, with a consequential reduction of spermatogenesis efficiency. J. Exp. Zool. 323A: 256-265, 2015. © 2015 Wiley Periodicals, Inc.

Influence of bile duct obstruction on the results of Frey's procedure for chronic pancreatitis

ObjectivesTo evaluate the influence of a biliary obstruction (BO) requiring biliary bypass on both short and long-term outcomes of patients undergoing Frey's procedure for chronic pancreatitis (CP). MethodsFrom 1999 to 2010, 33 consecutive patients underwent Frey's procedure for CP in two centers. Seventeen (54%) patients underwent biliary bypass to treat an associated BO. Characteristics and outcomes of these patients were compared to those of 16 others without BO. ResultsPatients with BO had more severe disease including lower BMI and larger pancreatic head (4 cm vs. 6 cm, p = 0.021). The operative mortality was nil. Patients with BO experienced more overall postoperative complications (71% vs. 31%, p = 0.024) but similar major complication rates (18% vs. 6%, p = 0.316) compared to those without BO. After a median follow-up of 51 (1–96) months, 91% of the patients experienced either partial or complete relief of their symptoms and 36% exhibited deterioration of their endocrine function. Multivariate analysis revealed preoperative BO to be associated with long-term impairment of endocrine function (OR: 43.249; 95% CI 2.221–84.277; p = 0.013). ConclusionIn patients undergoing Frey's procedure for CP, associated BO can be safely managed using biliary bypass. However, the severity of CP in these patients is responsible for a higher risk of long-term endocrine insufficiency.

Effects of pancreatectomy on nutritional state, pancreatic function and quality of life

There are concerns about the extent of impaired endocrine and exocrine pancreatic function and poor quality of life (QoL) after pancreatectomy, but there is little information from large prospective follow-up studies. Consecutive patients undergoing pancreaticoduodenectomy or distal pancreatectomy between 2007 and 2011 were included. Relative bodyweight (RBW), triceps skinfold thickness (TSFT), serum protein, albumin, transferrin, fasting blood glucose, postprandial 2-h glucose (PP2), glycosylated haemoglobin A1c and stool elastase measurements, and European Organization for Research and Treatment of Cancer QLQ-C30 questionnaires were collected serially for 1 year. Some 136 patients undergoing pancreatic resection completed the study. RBW and TSFT recovered to over 90 per cent of the preoperative value by 12 months, whereas transferrin, albumin and protein had returned to preoperative levels by 3 months. Diabetes mellitus, impaired fasting glucose or raised PP2 was present in 42 of 76 patients at 6 months and 36 of 76 at 12 months. Although steatorrhoea and diarrhoea had mainly resolved by 3 months, stool elastase level decreased after operation and showed no recovery. Nutritional status, pancreatic endocrine function and QoL returned to preoperative levels in 63 (46·3 per cent), 72 (52·9 per cent) and 77 (56·6 per cent) of 136 patients within 6 months of pancreatectomy. Multivariable analysis revealed that age 60 years or more, operation type, chronic pancreatitis and malignant disease had a significant impact on nutritional index, pancreatic function and QoL. About half of all patients can expect recovery from pancreatectomy after 6 months, but those with risk factors need more careful follow-up and supportive management.

Little Evidence of Low Bone Mass in Acute Lymphoblastic Leukemia Survivors

Childhood acute lymphoblastic leukemia (ALL) survivors represent a specific group at risk for many health problems, including skeletal complications and osteoporosis. The objective of this study was to assess the risk of osteoporosis associated with the prevalence of low bone mass (according to the guidelines of the Pediatric Official Positions of the International Society for Clinical Densitometry 2007) in survivors of childhood ALL. The cross-sectional study was conducted in a cohort of 69 Caucasian children and adolescents (46 boys and 23 girls) aged 12.15±0.5yr diagnosed with ALL and screened up to 5yr after cessation of the treatment. Total body bone mineral content (TB BMC, g), total body bone mineral density (TB BMD, g/cm2), and lumbar spine BMD (LS BMD, g/cm2) were determined using dual-energy X-ray absorptiometry. Time interval from the completion of the treatment to the beginning of this study (subgroup I<2yr or subgroup II>2yr after treatment), methotrexate (MTX) doses (subgroup I—MTX ranging from 0.5 to 1.0g/m2; subgroup II—MTX>2.0g/m2), cranial irradiation (subgroup I—without radiotherapy (RTX) and subgroup II receiving RTX of 12–18Gy), cumulative steroid dose, and impaired endocrine function were considered as potential factors affecting bone metabolism and included in the analysis. No differences were found in bone traits (BMC, TB BMD, LS BMD) in relation to examined risk factors. In multiple regression model that included therapeutical factors, a risk group and central nervous system irradiation were of an important influence on bone mass, and risk group predicted TB BMD in small degree. Risk group and irradiation status lost their significance after the inclusion of anthropometric, age-connected, and time-connected factors. This study suggests that ALL survivors are not at increased risk for low bone mass. However, from the clinical perspective all patients after childhood ALL should be screened for clinical signs, fracture history, and lifestyle risk factors for low bone mass and osteoporosis. They should be referred to bone density evaluation only as often as may be necessary from the clinical evaluation.

Diane-35 combined with insulin sensitizer for polycystic ovary dyndrome

Objective To explore the efficacy of cyproterone acetate (CPA) combined with metformin or rosiglitazone for polycystic ovary syndrome (PCOS). Methods 45 women with PCOS were randomized to receive CPA plus either metformin (25 patients, group A) or rosiglitazone (20 patients, group B) for 3 months.Body weight, plasma levels of glucose, insulin, and sex homones, ovulation, and menstruation were compared after treatment. Results As compared with group B, body weight significantly decreased in group A (P 0.05). The ovulation rate was higher in group B than in group A (P<0.05). Conclusions Insulin sensitizer combined with Diane-35 can markedly improve insulin resistance and impaired endocrine and metabolic function. Metformin has a slight weight lowering effect is less expansive; where as rosiglitazone has a better therapeutic effect on insulin resistance and ovulation rate. Metformin is used as the first-line agent because, rosiglitazone is expensive and has more side effects. Key words: Polycystic ovary syndrome; Diane-35; Metformin; Rosiglitazone

714 EFFECT OF GHRELIN ON PRESERVATION OF ENDOCRINE AND SPERMATOGENIC FUNCTION OF SURGICALLY CRYPTORCHID MICE

INTRODUCTION AND OBJECTIVES: Cryptorchidism is associated with progressive germ cell loss and impaired spermatogenesis. Effective approaches to protect or improve testis function after cryptorchidism are not known. We demonstrated that the orexigenic hormone ghrelin can help prevent endocrine impairment and spermatic function loss from cisplatin mediated testicular injury in mice. We asked if ghrelin could prevent testicular damage from surgically-induced cryptorchidism in mice. METHODS: 8–10 week old C57BL6 male mice were isolated from females for two weeks prior to undergoing laparotomy and suture fixation of the testicles to the abdominal wall. Starting post-operative day 3 twice daily injections of ghrelin or phosphate buffered saline were administered to the mice. After six weeks the mice were sacrificed and hormone levels evaluated. Testes were evaluated using light microscopy of hematoxylin and eosin-stained paraffin sections. Quantitative PCR was used to evaluate gene expression for specific endocrine and spermatogenic markers. Flow cytometry of Annexin-FITC signaling with single cell preparations were used to evaluate the relative proportions of viable and apopototic cell populations between the saline and ghrelin groups. RESULTS: Post-operatively weight loss was greater in the control group with the ghrelin-treated mice recovering their body weight more quickly. After six weeks testicular weights in the control and ghrelin group were 35.1 mg and 52.3 mg (p 0.02). Testosterone concentration was 1.5 fold higher in the ghrelin group compared to control while LH was 3.8 fold higher in the ghrelin group and FSH was similar in both groups. Hematoxylin and eosin-stained paraffin sections demonstrated a disruption of spermatogenesis with vacuolization and decreased cellularity in the PBS group with preservation of spermatogenesis and improved seminiferous tubular architecture in the ghrelin treated group. Quantitative PCR revealed relative gene expression of steroidogenic marker (StAR) and Sertoli cell marker (GDNF) to be similar between treatment groups. Flow cytometry showed a larger proportion of late apopototic cells in the saline group in comparison to the ghrelin group. CONCLUSIONS: Experimentally cryptorchid mice exhibit a dramatic loss of spermatogenesis and impairment of endocrine function. Ghrelin administration to surgically cryptorchid mice increased testosterone production. This suggests a possible mechanism by which ghrelin may limit the testicular damage from cryptorchidism.

Predictive Factors for Exocrine Pancreatic Insufficiency After Pancreatoduodenectomy with Pancreaticogastrostomy

IntroductionThe aim of this study was to determine risk factors for exocrine pancreatic insufficiency after pancreatoduodenectomy (PD) with pancreaticogastrostomy (PG). Material and MethodsA 13C-labeled mixed triglyceride breath test was performed in 61 patients after PD to assess exocrine pancreatic function. Percent 13CO2 cumulative dose at 7 h <5% was considered diagnostic of exocrine pancreatic insufficiency. Abdominal computed tomography scans were utilized to assess the dilatation of the main pancreatic duct (MPD dilatation) in the remnant. ResultsThirty-eight of 61 patients (62.3%) were diagnosed with exocrine pancreatic insufficiency. Univariate analysis identified significant associations between two preoperative factors (preoperative impaired endocrine function and a hard pancreatic texture induced by preexisting obstructive pancreatitis), plus one postoperative factor (MPD dilatation caused by PG stricture) and exocrine pancreatic insufficiency (P < 0.05). Multivariate analysis determined that all three of these factors were independent factors (P < 0.05). ConclusionsAlthough exocrine pancreatic insufficiency after PD may be partly explainable by preexisting obstructive pancreatitis prior to surgery, surgeons desiring to obtain better postoperative exocrine pancreatic function after PD would be well-advised to devote considerable attention to preventing PG stricture.

NUTRITIVE PERFUSION OF PANCREATIC ENDOCRINE TISSUE DURING HEMORRHAGIC HYPOTENSION

Although the exocrine gland frequently has I/R-associated complications such as posttransplant pancreatitis, hypoxia-induced dysfunction of pancreatic endocrine tissue is rarely observed. However, sympathetic hypersensitivity is accused of impaired endocrine function observed in human pancreatic grafts. These tissue-confined differences in susceptibility might be attributed to a distinct islet-specific regulatory control of blood flow (BF). To investigate this hypothesis, intravital microscopy was used for visualization of islets in situ and revascularized islet isografts in Syrian golden hamsters. Blood withdrawal was performed to induce sympathetic stimulation and to evoke an appropriate stress response of the tissue under investigation. Hypotension resulted in a perfusion pressure-dependent reduction of perfusion in both islets in situ and islet isografts. This was associated with comparable microhemodynamics of the tissues in direct vicinity, that is, pancreatic exocrine and host muscle tissue. There was a progressive decrease in functional capillary density of islets in situ and islet isografts that significantly correlated with the stepwise reduction of arterial blood pressure and did not differ in the hypotension-induced perfusion pattern in the neighboring exocrine and host skeletal muscle tissue. Concomitantly, capillary BF in islets in situ and islet isografts and in pancreatic exocrine and host muscle tissue was found to be reduced due to hypotension-associated decreases in capillary diameters and BF velocity. Microvascular perfusion of pancreatic islets and islet isografts is not preserved but strongly parallels perfusion pattern of the neighboring tissue under hemorrhagic stress. This disproves the existence of an individual islet-specific regulatory control of blood flow.