Clinical and Variant Anatomy of the Blood Supply to the Body and Tail of the Human Pancreas

The aim of the study was to specify peculiarities of the blood supply to the body and tail of the human pancreas determining topographic variants and vascular bed of the splenic artery.Material and methods. The artery basin of the pancreas body and tail was studied in 46 native and 42 organ complexes consisting of the pancreas, duodenum, spleen, retropancreatic tissue, celiac trunk with the main branches, a section of the superior mesenteric artery up to the entrance into the root of the small intestine mesentery with the preliminary artery injection by gelatin mass. The organ complexes were fixed in 10% formalin solution.Results. The study revealed two variants of the splenic artery topography in relation to the pancreas and determined the degree of tortuosity of the artery. In 31.7% of cases the vessel passed retro-pancreatically and in 68.3% suprapancreatically. Moderate tortuosity of the splenic artery was detected most frequently (44.82%); in 34.48% of cases severe tortuosity was detected; in 17.24% of cases there was no tortuosity in the artery. The correlation between area/convolution and the number of pancreatic arteries was found to be 0.864 (p=0.05), which is considered to be a high parameter according to the Cheddock scale. In severe tortuosity of the splenic artery 3.16±0.37 pancreatic arteries on average closed to the corpus caudal segment of the pancreas, in moderate tortuosity – 5.09±1.24, in straight passage – 9±1.22.Conclusion. The regularities revealed in the spleen artery topography, blood supply of the pancreas body and tail allow determining operational risks and tactics of surgical interventions on the corpus caudal segment of the pancreas.

Influence of simethicone and fasting on the quality of abdominal ultrasonography in dogs

The presence of a significant quantity of gas in the gastrointestinal tract may hinder a proper ultrasonographic examination of the abdominal organs. The objective of this study was to investigate the influence of simethicone and fasting on the quality of ultrasonographic examinations of the gastrointestinal tract and the small organs in the abdominal cavity. Fourteen clinically healthy dogs were examined repeatedly after four different preparation protocols. The visualisation of the organs was assessed subjectively with a 3-point scoring system. The administration of simethicone is superior in the visualisation of the ileum, the ileocolic junction, the pancreas (body and right lobe), the jejunal lymph nodes, and both adrenal glands when compared to no preparation. The combination of the oral administration of simethicone and fasting is superior in the visualisation of the pylorus, the duodenum, the jejunum, the ileum, the ileocolic junction, the pancreas (body, right and left lobe), the jejunal lymph nodes, and both adrenal glands when compared to no preparation. The conclusion and clinical relevance from this exploratory study suggest that the oral administration of simethicone and fasting before an ultrasonographic examination significantly improve the visualisation of some abdominal organs.

A cystic lesion mimicking pancreatic neoplasm

A 54-year old male patient was admitted with complaints of periodical pain in the upper abdomen, CA- 19.9-51 U/ml (reference range < 37 U/ml). Blood tests were normal. However, ultrasound scan results revealed growth of a pancreatic tumor over 52×38 mm. A CT scan was performed for further characterization of the lesion. A tumor mass of 54 mm in diameter of the pancreatic body was found. There was no differentiation of lesion border with pancreas body (Fig. 1). Surgical resection was performed without preoperative biopsy following the consensus of the International Study Group of Pancreatic Surgery which states that in the presence of a solid mass suspicious for malignancy, a biopsy proof is not required before proceeding with resection (1). A soft consistence pancreas cyst with pus-like content was resected during surgical operation....

The effects of in utero exposure to teratogens on organ size: a prospective paediatric study

In low-income countries, prospective data on combined effects of in utero teratogen exposure are lacking and necessitates new research. The aim of the present study was to explore the effect of in utero teratogen exposure on the size of the kidneys and pancreas 5 years after birth in a low-income paediatric population. Data was collected from 500 mother–child pairs from a low-income setting. Anthropometric measurements included body weight, (BW) body height, mid-upper arm and waist circumference (WC). Clinical measurements included blood pressure (BP), mean arterial pressure and heart rate. Ultrasound measurements included pancreas, and kidney measurements at age 5 years. The main outcome of interest was the effect of maternal smoking and alcohol consumption on ultrasound measurements of organ size at age 5 years. Left and right kidney length measurements were significantly lower in smoking exposed children compared to controls (p = 0.04 and p = 0.03). Pancreas body measurements were significantly lower in smoking exposed children (p = 0.04). Multiple regression analyses were used to examine the associations between the independent variables (IDVs), maternal age, body mass index (BMI), mid-upper arm circumference (MUAC) and BW of the child, on the dependent variables (DVs) kidney lengths and kidney volumes. Also, the association between in utero exposure to alcohol and nicotine and pancreas size. WC was strongest (r = 0.28; p < 0.01) associated with pancreas head [F (4, 454) = 13.44; R2 = 0.11; p < 0.01] and tail (r = 0.30; p < 0.01) measurements at age 5 years, with in utero exposure, sex of the child and BMI as covariates. Kidney length and pancreas body measurements are affected by in utero exposure to nicotine at age 5 years and might contribute to cardiometabolic risk in later life. Also, findings from this study report on ultrasound reference values for kidney and pancreas measurements of children at age 5 years from a low-income setting.

Mitchell-Riley syndrome iPSCs exhibit reduced pancreatic endoderm differentiation due to a mutation in RFX6

ABSTRACTMitchell-Riley syndrome (MRS) is caused by recessive mutations in the regulatory factor X6 gene (RFX6) and is characterised by pancreatic hypoplasia and neonatal diabetes. To determine why individuals with MRS specifically lack pancreatic endocrine cells, we micro-CT imaged a 12-week-old foetus homozygous for the nonsense mutation RFX6 c.1129C>T, which revealed loss of the pancreas body and tail. From this foetus, we derived iPSCs and show that differentiation of these cells in vitro proceeds normally until generation of pancreatic endoderm, which is significantly reduced. We additionally generated an RFX6HA reporter allele by gene targeting in wild-type H9 cells to precisely define RFX6 expression and in parallel performed in situ hybridisation for RFX6 in the dorsal pancreatic bud of a Carnegie stage 14 human embryo. Both in vitro and in vivo, we find that RFX6 specifically labels a subset of PDX1-expressing pancreatic endoderm. In summary, RFX6 is essential for efficient differentiation of pancreatic endoderm, and its absence in individuals with MRS specifically impairs formation of endocrine cells of the pancreas head and tail.

Сlinical case of pancreatic cancer

Description of a rare case of pancreas body tumor, which was grown into celiac trunk, is presented. The patient was saved due toanftomy of right hepatic artery, which was a branch of superior mesenteric artery. Patient Z.V, 60 years old, came to the clinic with such complaints as pain, heaviness in abdomen and waist area,weakness.4–5 cm tumor of pancreas body was detectedduring surgery. The tumor had grown into celiac trunk and into left adrenal gland. The friable tissue of hepato-duodenal ligament was dissected duringthe surgery.Thesurgeons mobilized duodenum usingKoxertechnique. As a result of this manipulation, the followingblood vesselswere visualized:inferior vena cava and abdominal aorta, celiac trunk, superior mesentericartery. Surgical team opened ligament of Treitz and excisedpancreas body2.5 cm away from thetumor proximally. The stump was sewed with “mattress stich”, celiac trunk was sectioned and entangled, surgeons also dissected common hepatic artery. After section they checked blood supply of liver. The pressure of blood flowing from gastro-duodenal and pancreato-duodenal artery was enough for providing normal blood flow in the left hepatic artery. Morphological result of the excisedtissue — Ductal adenocarcinoma (No 672). The patient’sstate was satisfactory when he left the clinic. He underwent medical check-up three times next year. He feels well, his state of health is normal. Patient is capable of working. This case is interesting due to the anatomy of right hepatic artery (which was a branch of superior mesenteric artery) that saved patient’s life.