c-peptide and Common-Bile-Duct-Neoplasms

The authors studied carbohydrate metabolism 4 weeks to 12 months after pancreatoduodenal resection (PDR) in 21 patients whose ages ranged from 40 to 55 years. Seven of them had been operated on for carcinoma of the major duodenal papillas and the other patients for carcinoma of the major duodenal papillas and the other patients for carcinoma of tree pancreas. The control group was formed of 10 healthy volunteers of the same age as the patients of the two groups under study; 10 patients who were subjected to PDR with pancreatojejunostomy and 11 patients in whom resection of the pancreatic stump was completed by intraductal occlusion of the formed stump. None of them had disorders of carbohydrate metabolism before the operation. The patients were examined by the oral test for glucose tolerance (OTGT, 75 g of glucose) with glycemia determination and by intravenous glucose tolerance test (i.v. GTT) with determination of glycemia and C-peptide. It was found that the glycemia curves obtained during OTGT did not have a diabetic character according to the WHO criteria. In performing TTG, the coefficient K was diabetic in both groups. Study of the C-peptide level during the i.v. GTT showed that in the group with occluded ducts the level of the C-peptide and the nature of its secretion differed obviously from those in the other groups under study, which testified to disturbances in the homeostai mechanisms.

Topics: Adenocarcinoma; Adult; Ampulla of Vater; Blood Glucose; C-Peptide; Common Bile Duct Neoplasms; Glucose Tolerance Test; Humans; Middle Aged; Pancreatic Neoplasms; Pancreaticoduodenectomy; Pancreaticojejunostomy; Postoperative Care; Time Factors

A radioimmunological analysis of the changes in concentration of tumour markers CA 19-9, REA, beta 2-microglobulin, trypsin and C-peptide was carried out in 53 patients with pancreatic cancer and in 14 patients with cancer of the major duodenal papilla before and 7-10 days after the treatment. A control group was comprised of 116 volunteers. The levels of the tumour markers decreased after the combined use of remote radiotherapy and pancreaticoduodenal resection (PDR). After creation of cholecysto-enteroanastomosis and performance of radiotherapy they remained without changes. Exocrine pancreatic function after remote radiotherapy, especially in combination with PDR, was sharply suppressed.

Topics: Ampulla of Vater; beta 2-Microglobulin; Biomarkers, Tumor; C-Peptide; CA-19-9 Antigen; Combined Modality Therapy; Common Bile Duct Neoplasms; Humans; Lewis X Antigen; Pancreatic Neoplasms; Prohibitins; Radioimmunoassay; Surgical Procedures, Operative; Time Factors; Treatment Outcome; Trypsin

Diabetes mellitus (DM) is prevalent in patients with pancreatic cancer and tends to improve after tumor resection. However, the glycemic response of non-pancreatic cancer patients after surgery has not been examined in detail. We aimed to investigate the changes in glucose metabolism in patients with pancreatic cancer or non-pancreatic cancer after pancreatoduodenectomy (PD).We prospectively enrolled 48 patients with pancreatic cancer and 56 patients with non-pancreatic cancer, who underwent PD. Glucose metabolism was assessed with fasting glucose, glycated hemoglobin (HbA1c), plasma C-peptide and insulin, quantitative insulin check index (QUICKI), and a homeostatic model assessment of insulin resistance (HOMA-IR) and β cell (HOMA-β) before surgery and 6 months after surgery. Patients were divided into 2 groups: "improved" and "worsened" postoperative glycemic response, according to the changes in HbA1c and anti-diabetic medication. New-onset DM was defined as diagnosis of DM ≤ 2 years before PD, and cases with DM diagnosis >2 years preceding PD were described as long-standing DM.After PD, insulin resistance (IR), as measured by insulin, HOMA-IR and QUICKI, improved significantly, although C-peptide and HOMA-β decreased. At 6 months after PD, new-onset DM patients showed improved glycemic control in both pancreatic cancer patients (75%) and non-pancreatic cancer patients (63%). Multivariate analysis showed that long-standing DM was a significant predictor for worsening glucose control (odds ratio = 4.01, P = .017).Favorable glycemic control was frequently observed in both pancreatic cancer and non-pancreatic cancer after PD. PD seems to contribute improved glucose control through the decreased IR. New-onset DM showed better glycemic control than long-standing DM.

Topics: Aged; Ampulla of Vater; Blood Glucose; C-Peptide; Common Bile Duct Neoplasms; Diabetes Mellitus; Duodenal Neoplasms; Female; Glycated Hemoglobin; Humans; Insulin; Insulin Resistance; Male; Middle Aged; Pancreatic Neoplasms; Pancreaticoduodenectomy