イショセイ シボウ ト 2ガタ トウニョウビョウ シンゾウ ケッカンビョウ

There is evidence supporting the notion that excess abdominal fat is predictive of insulin resistance and the presence of related metabolic abnormalities currently referred to as the metabolic syndrome (MetS). Despite the fact that abdominal obesity is a highly prevalent feature of MetS, the mechanisms by which abdominal obesity is causally related to MetS are not fully elucidated. Besides visceral fat accumulation, ectopic lipid deposition, especially in the liver and skeletal muscle, has been implicated in the pathophysiology of diabetes, insulin resistance and obesity-related disorders. In addition, ectopic fat deposition play a critical role in the heart components such as (1) circulatory and locally recruited fat, (2) intra-and extra-myocellular fat, (3) perivascular fat, and (4) pericardial fat. In this review, the contribution of ectopic lipid deposition to global cardiometabolic risk is discussed via possible mechanisms including adipocytokine, insulin resistance and lipotoxicity

Effect of Glucagon on Plasma Amino Acid and Glucose Levels in a Patient Who Had Undergone Total Pancreatectomy

The plasma glucose and amino acid levels of a patient who had undergone total gastrectomy and total pancreatectomy 15 years previously were examined under 4 conditions determined by the method of exogenous glucagon injection. Glucagon was not injected in the first period, and 1mg of glucagon was injected twice a day in the second period. Twice a day 1mg of zinc glucagon was injected in the third period, and 2mg/day of glucagon by continuous subcutaneous glucagon infusion (CSGI) was given in the fourth period. The plasma pancreatic glucagon levels were within the normal range during CSGI. The effect of glucagon on plasma amino acid levels was greatest with CSGI. The effect became less in the order of zinc glucagon injection and twice-a-day injection of 1mg of glucagon. Furthermore, afternoon hyperglycemia and nocturnal hypoglycemia were suppressed with CSGI. Urinary nitrogen excretion was increased with glucagon injection. However, excretion of 3-methylhistidine did not show any significant increase. From these results we consider that exogenous glucagon injection has significant effects on the metabolism of glucose and amino acids after total pancreatectomy. We also conclude that both continuous subcutaneous glucagon infusion and zinc glucagon are useful in the postoperative management of total pancreatectomy

Pancreatic Exocrine Insufficiency after Pancreatic Surgery Detected by Tubeless Testing

The pancreatic function diagnostant (PFD test) and fecal chymotrypsin test were performed simultaneously in patients after pancreatic surgery, and findings for both tests were analyzed. The p-aminobenzoic acid recovery rate in the PFD test and the chymotrypsin activity in stools decreased after pancreatectomy, particularly after extended radical pancreaticoduodenectomy. Chymotrypsin activity in stools, measured by the fecal chymotrypsin test after extended radical pancreaticoduodenectomy, was significantly lower than the normal level. The D-xylose output in the extended radical group was significantly (p<0.05) lower than that following conventional pancreaticoduodenectomy. The results allow the conclusion that the absorption factor must be taken into account when evaluating the pancreatic exocrine function by the PFD test

Effect of Glutamine-Enriched, Elemental Diet on Regeneration of Residual Small Bowel Mucosa and Hepatic Steatosis Following Massive Bowel Resection

The effect of an orally administered, glutamine-enriched, elemental diet on the regeneration of small bowel mucosa and hepatic steatosis following massive small bowel resection was examined by determination of the levels of the bromodeoxyuridine labelling indices, alkaline phosphatase activity in the residual jejunal mucosa, and histological change of the liver. The serum glutamine level was significantly higher in the glutamine-enriched diet group than in the glutamine-free diet group, as were the alkaline phosphatase activity in the homogenate of the residual jejunal mucosa and the bromodeoxyuridine labelling index in the residual jejunal mucosa. The histological findings showed that the fat infiltration in the liver was more severe in the glutamine-free diet group than in the glutamine-enriched diet group. These findings suggest that an orally administered, glutamine-enriched, elemental diet promotes the regeneration of the intestinal mucosa and prevents the liver from fat infiltration following a massive small bowel resection