Prolonged Survival in an Aged Labrador Retriever with a Metastatic Insulinoma

2013 ◽  
Vol 49 (3) ◽  
pp. 224-229 ◽  
Author(s):  
Jessica Rychel ◽  
Deanna R. Worley ◽  
Christine S. Hardy ◽  
Brett T. Webb
Keyword(s):  
Serum Insulin ◽  
Pancreatic Insufficiency ◽  
Exocrine Pancreatic Insufficiency ◽  
Labrador Retriever ◽  
Hypoglycemic Episode ◽  
Partial Pancreatectomy ◽  
Reference Limit ◽  
Glucose Levels ◽  
Initial Surgery ◽  
Upper Reference Limit

This case report highlights an unusually prolonged, asymptomatic, disease-free interval in an aged male Labrador retriever that underwent partial pancreatectomy for a functionally active pancreatic insulinoma with histologically confirmed hepatic metastasis. The patient developed pancreatitis and nonseptic suppurative peritonitis 24 hr after surgical resection of the insulinoma and was managed medically until discharge. Three mo after surgery, the dog was diagnosed with exocrine pancreatic insufficiency (EPI) that was effectively managed with parenteral pancreatic enzymes. Due to normal glucose levels 3 mo postsurgically, liver samples from the initial surgery were resubmitted for immunohistochemistry. Results confirmed insulinoma metastasis with insulin expression. Ten mo postsurgically, the blood glucose was normal and serum insulin levels were slightly above the upper reference limit. The first hypoglycemic episode was documented 23 mo postoperatively, which was effectively managed with prednisone. The cause for the prolonged disease remission and survival was unknown, but was possibly a result of pancreatitis and peritonitis, partial spontaneous regression of metastatic lesions, or idiopathic. Despite life-threatening postoperative complications, this patient enjoyed a profoundly longer than expected survival. This case highlights the importance of removing the primary tumor (insulinoma) despite the presence of metastatic disease.

Juvenile Diabetes Mellitus and Concurrent Exocrine Pancreatic Insufficiency in a Labrador Retriever: Long-Term Management

2015 ◽  
Vol 51 (6) ◽  
pp. 419-423 ◽  
Author(s):  
Maria Saiz Alvarez ◽  
Vicente Herrería-Bustillo ◽  
Artur Font Utset ◽  
Jorge Martínez
Keyword(s):  
Diabetes Mellitus ◽  
Pancreatic Insufficiency ◽  
Juvenile Diabetes ◽  
Term Treatment ◽  
Exocrine Pancreatic Insufficiency ◽  
Labrador Retriever ◽  
Juvenile Diabetes Mellitus ◽  
Stunted Growth ◽  
Long Term Treatment

A 3 mo old, female, entire Labrador retriever presented with vomiting, diarrhea, polyuria, polydipsia, polyphagia, and stunted growth. Diagnostics revealed the presence of juvenile diabetes mellitus and concurrent exocrine pancreatic insufficiency. Pancreatic histopathology showed severe pancreatic atrophy. Successful treatment was achieved with a combination of insulin and pancreatic enzymes. This report describes successful long-term treatment of juvenile diabetes mellitus and concurrent exocrine pancreatic insufficiency in a dog.

scholarly journals The influence of sampling time on indirect reference limits, decision limits, and the estimation of biological variation of random plasma glucose concentrations

2021 ◽  
Vol 45 (2) ◽  
pp. 111-119 ◽  
Author(s):  
Mustafa Özcürümez ◽  
Farhad Arzideh ◽  
Antje Torge ◽  
Anja Figge ◽  
Rainer Haeckel ◽  
...  
Keyword(s):  
Plasma Glucose ◽  
Large Scale ◽  
Laboratory Data ◽  
Sample Collection ◽  
University Hospitals ◽  
Reference Limit ◽  
Average Decrease ◽  
Glucose Levels ◽  
Reference Limits ◽  
Upper Reference Limit

Abstract Objectives Plasma glucose concentrations exhibit a pronounced daytime-dependent variation. The oscillations responsible for this are currently not considered in the determination of reference limits (RL) and decision limits. Methods We characterized the daily variation inherent in large-scale laboratory data from two different university hospitals (site 1 n=513,682, site 2 n=204,001). Continuous and distinct RL for daytime and night were estimated. Diurnal characteristics of glucose concentrations were further investigated by quantile regression analyses introducing age and cosinor-functions as predictors in the model. Results Diurnal variations expressed as amplitude/Midline Estimating Statistic of Rhythm (MESOR) ratio, averaged 7.7% (range 5.9–9.3%). The amplitude of glucose levels decreased with increasing concentrations. Between 06:00 and 10:00 h an average decrease of 4% has to be considered. Nocturnal glucose samples accounted for only 5% of the total amount but contributed to 19.5% of all findings over 11.1 mmol/L. Partitioning of RL between day and night is merely justified for the upper reference limit. The nocturnal upper RLs for both genders differed from those obtained during the day by 11.0 and 10.6% at site 1 and by 7.6 and 7.5% at site 2. Conclusions We conclude that indirect approaches to estimate upper RL of random plasma glucose concentrations require stratification concerning the time of sample collection.

scholarly journals Signalment and Clinical Data of Cats with Exocrine Pancreatic Insufficiency Diagnosed Using Feline Trypsin-like Immunoreactivity in Routine Diagnostics

2021 ◽  
Vol 8 (8) ◽  
pp. 155
Author(s):  
Katrin Törner ◽  
Julia Maria Grassinger ◽  
Corinna N. Weber ◽  
Heike Aupperle-Lellbach ◽  
Argine Cerezo-Echevarria ◽  
...  
Keyword(s):  
Treatment Response ◽  
Clinical Data ◽  
Pancreatic Insufficiency ◽  
Clinical Signs ◽  
Clinical Information ◽  
Reference Interval ◽  
Exocrine Pancreatic Insufficiency ◽  
Reference Limit ◽  
Good Treatment Response ◽  
Group 3

Serum feline trypsin-like immunoreactivity (fTLI) is commonly used to diagnose feline exocrine pancreatic insufficiency (EPI). This study aimed to describe signalment and clinical data of cats with EPI. Determination of TLI was performed using an in-house ELISA; the reference interval was defined using a Reference Limit Estimator. Groups were formed from 4813 cats (2019–2020), based on their fTLI concentration: 1 (<8 µg/L; decreased; n = 275), 2 (8–88 µg/L; reference interval; n = 4256), and 3 (>88 µg/L; increased; n = 282). Males and Domestic Shorthairs were most common in all groups. Group 3 had the highest (13 years), and group 1 had the lowest (9 years), median age. Clinical information was available for 200 cats (decreased fTLI: n = 87, lower reference interval (8–12 µg/L): n = 113). Treatment response was observed in 83% (decreased fTLI) and 66% (lower reference interval). EPI cats displayed weight loss (69%), diarrhoea (68%), vomiting (41%), anorexia (39%), poor hair coat (35%), lethargy (33%), and/or polyphagia (21%). The lower the serum fTLI concentration, the more often good treatment response was reported (p = 0.022) but there were no statistically significant clinical signs. In conclusion, fTLI is a helpful parameter to diagnose EPI but predicting treatment response based on signalment or clinical signs is not possible.

scholarly journals Long - term follow up of a simplified and less burdened pancreatic duct ligation model of exocrine pancreatic insufficiency in Goettingen Minipigs

2020 ◽  
Author(s):  
Andreas Minh Luu ◽  
Alexander Brock ◽  
Sabrina Ritz ◽  
Sandra Junghänel ◽  
Ingo Aldag ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Pancreatic Insufficiency ◽  
Exocrine Pancreatic Insufficiency ◽  
Pancreatic Ducts ◽  
Fat Absorption ◽  
Glucose Levels ◽  
Pancreatic Duct Ligation ◽  
Duct Ligation

Abstract BackgroundPancreatic duct ligation in a minipig model leads to exocrine pancreatic insufficiency (EPI). This allows studies of digestive processes and pancreatic enzyme replacement therapies (PERT). However, detailed descriptions of the surgical procedure, perioperative management, and determination of exocrine pancreatic insufficiency are scarce in literature. To date, data of long-term health status of minipigs after induction of EPI are not available. This study describes in detail the experimental approach of EPI-induction via pancreatic duct ligation in minipigs and long-term results of the animal’s health state.Methods14 Goettingen minipigs underwent pancreatic duct ligation via midline laparotomy for the induction of exocrine pancreatic insufficiency. Fecal fat content, fat absorption, body weight, chymotrypsin levels, blood vitamin levels and glucose levels were determined. Follow-up data was gathered for a period of 180 weeks postoperatively.ResultsExocrine pancreatic insufficiency was successfully induced in 12 Goettingen minipigs. Fecal fat content increased from 9.0% to 30.9% (p < 0.001). Mean coefficient of fat absorption decreased from 90% (± 2.8) to 24.2% (± 8.3). PERT led to a significant increase of fat absorption. Two minipigs failed to develop exocrine insufficiency most likely due to undetected accessory pancreatic ducts. All animals tolerated the procedure very well and gained weight within 6 weeks past surgery. Follow up for 180 weeks showed a stable body weight and health state of the animals with normal blood glucose levels. Vitamin E and B12 levels dropped significantly between post-op week 125 and 134 requiring vitamin supplementation. ConclusionsPancreatic duct ligation in minipigs is an excellent method to induce exocrine pancreatic insufficiency. It is important to identify and ligate accessory pancreatic ducts since persistence of accessory ducts will lead to maintenance of exocrine pancreatic function. The EPI model caused no persistent side effects in the animals and can be applied in long-term EPI studies. However, it is important to substitute Vitamin B12 and E as their concentration drops in the long-term period.

scholarly journals Digestive enzyme replacement relieves growth failure in preterm infants with poor exocrine pancreatic function: a retrospective case series

2021 ◽  
Author(s):  
Annette Münch ◽  
Christoph Bührer ◽  
Ann Carolin Longardt
Keyword(s):  
Weight Gain ◽  
Preterm Infants ◽  
Digestive Enzyme ◽  
Pancreatic Insufficiency ◽  
Growth Failure ◽  
Exocrine Pancreatic Function ◽  
Exocrine Pancreatic Insufficiency ◽  
Very Preterm Infants ◽  
Enzyme Replacement ◽  
Fecal Pancreatic Elastase

AbstractIn orally fed preterm infants, poor weight gain may be linked to low fecal pancreatic elastase-1 (FPE-1) activity, indicative of exocrine pancreatic insufficiency. The objective of this study was the retrospective assessment of the effect of exogenous digestive enzyme replacement by gavage in preterm infants with growth failure and low FPE-1 (<200 μg/g). We analyzed weight gain relative to baseline and caloric intake during 14-day periods before and after institution of digestive enzyme replacement containing 6000 U lipase and 240 U protease kg−1 d−1. Among 46 of 132 preterm infants < 1250g birth weight surviving to at least 14 days in whom FPE-1 was determined, 38 infants had low FPE-1 (< 200 μg/g), and 33 infants received exogenous digestive enzyme replacement. Average daily weight gain significantly increased from 14.4 [range 2.6–22.4] g kg−1 d−1 to 17.4 [8.4–29.0] g kg−1 d−1 (P = 0.001), as did weight gain per kcal, from 0.08 [0.02–0.13] g kcal−1 d−1 to 0.11 [0.05–0.18] g kcal−1 d−1.Conclusion: In preterm infants with signs and symptoms of exocrine pancreatic insufficiency, exogenous digestive enzyme replacement is associated with improved growth. What is Known:• Very preterm infants on full enteral nutrition may display growth failure linked to transient poor exocrine pancreatic function.• Porcine pancreatic enzymes covered with an acid-resistant coating are too large to pass the internal diameter of most gavage tubes used in very preterm infants.What is New:• Administration of a liquid formulation of acid-resistant microbial digestive enzymes in preterm infants with growth failure and low fecal pancreatic elastase-1 values was associated with improved weight gain.• Response to exogenous digestive enzyme replacement was associated with the prior extent of growth failure.

scholarly journals Increased canine pancreatic lipase immunoreactivity (cPLI) and 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6′-methylresorufin) ester (DGGR) lipase in dogs with evidence of portal hypertension and normal pancreatic histology: a pilot study

2021 ◽  
pp. 104063872110039
Author(s):  
Gonçalo Serrano ◽  
Dominique Paepe ◽  
Tim Williams ◽  
Penny Watson
Keyword(s):  
Portal Hypertension ◽  
Liver Disease ◽  
Pilot Study ◽  
Pancreatic Lipase ◽  
Glutaric Acid ◽  
Inclusion Criteria ◽  
Reference Limit ◽  
Clinical Presentations ◽  
Upper Reference Limit

The clinical presentations of both liver disease and pancreatitis are nonspecific and overlapping, which may cause difficulty in diagnosis. In our retrospective pilot study, we assessed whether dogs with evidence of portal hypertension and absence of pancreatitis on pancreatic histology have increases in canine pancreatic lipase immunoreactivity (cPLI) and 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6′-methylresorufin) ester (DGGR) lipase. We included dogs that had been presented between 2008 and 2019 if they had normal pancreatic histology, histologically confirmed hepatopathy, and if canine pancreas-specific lipase (Spec cPL; Idexx) or DGGR lipase had been measured. Only dogs with portal hypertension were included. Six dogs fulfilled the inclusion criteria. Four of 6 and 2 of 6 dogs had Spec cPL and DGGR lipase exceeding the upper reference limit, respectively. From the 4 dogs with increased Spec cPL, 2 had concentrations of 200–400 µg/L and 2 had concentrations ≥ 400 µg/L. Our results suggest that canine portal hypertension might lead to increased Spec cPL and DGGR lipase values in the absence of pancreatitis on histology. Until more evidence in a larger number of dogs with portal hypertension is available, both tests should be interpreted cautiously in the presence of portal hypertension.

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