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Introduction: Not much is known about the significance of nutritional status and support in transplant surgery, least of all in simultaneous pancreatic and kidney transplantation. Malnutrition in the context of simultaneous pancreatic–kidney transplantation seems to be complex and a still poorly investigated problem. Since SPKTX is highly qualified and also has a small volume procedure, it is difficult to obtain data from large cohorts of patients. The aim of this article is to gather existing evidence and information about the subject, as well as to elicit some questions and goals for the future. Methods: We searched through the Pub-Med database using the keywords "pancreas and kidney transplantation" combined with "nutritional risk", "nutritional status", "malnutrition", "nutritional intervention", and "frailty", finding a total of 4103 matching results. We then narrowed it down to articles written in English with the full text available. We also researched through the references of articles most accurately matching our researched terms. Results: There are numerous tools that have been investigated for the screening of malnutrition, such as the NRI index, PNI index, NLR, SGA scale, and NRS-2002 scale, each of which proved to be of some use in predicting patient outcomes in different surgical settings. Since all of them differed in components and assessed parameters and, in the absence of more sensitive or infallible indicators, the most reasonable approach seems to evaluate them jointly. Conclusion: It is important to underline the necessity of nutritional screening and the subsequent introduction of adequate therapy while awaiting transplantation in an attempt to improve results. Considering the complexity of surgical procedures and the severity of underlying diseases with their intense metabolic components, the patient's nutritional status seems to significantly influence results. Consequently, nutritional risk assessments should be a part of the routine care of patients qualified for transplantation. [ABSTRACT FROM AUTHOR]

Aim: Ophthalmic evaluation of patients after simultaneous pancreas-kidney transplantation (SPK) due to complications of type 1 diabetes mellitus, and type 1 diabetic patients assessed for eligibility for SPK. Material and methods: We performed an ophthalmic evaluation in 37 patients after SPK and 49 patients assessed for eligibility for SPK in the Central Clinical Hospital of the Ministry of Interior in Warsaw between January 2016 and March 2020. Ophthalmic evaluation included measurements of best corrected visual acuity, anterior and posterior eye segment examinations, fundus digital photography, and OCT. Results: In the patients after SPK, we found a statistically significant correlation between atrophy in the photoreceptor inner segment/outer segment junction (IS/OS line) on OCT and the pre-transplant HbA1 level. In the group of patients evaluated before and within one year after SPK, we confirmed activation of retinopathy in 66.7% of examined eyes. OCT performed during the assessment of eligibility for SPK revealed atrophy in the IS/OS line in 47% of examined eyes. Conclusions: Changes in the retina associated with poor pretransplant diabetes control determine the best achievable visual acuity even after long-term normalization of glycemia following SPK. Patients after SPK require frequent comprehensive ophthalmological follow-up examinations during the first year after transplantation because of the risk of diabetic retinopathy progression. Despite the limitations resulting from their baseline status, more than half of all patients after SPK (51%) have a visual acuity of > 0.6 at least in one eye, which is sufficient for independent functioning. Patients eligible for SPK exhibit macular changes on OCT, hypoperfusion on angio-OCT, and 47% atrophy in the IS/OS line. [ABSTRACT FROM AUTHOR]

Simple Summary: The aim of this study is to describe the prevalence of diabetes mellitus (DM) among patients with the diagnosis of pancreatic ductal adenocarcinoma (PDAC), analyse the association between the occurrence of DM and clinicopathological factors, and detect variables influencing overall survival. Diabetes mellitus is prevalent among patients with pancreatic cancer. In our study, patients with diabetes mellitus receiving palliative chemotherapy had significantly higher median OS than those without. Among variables influencing survival, TNM stage, nodal involvement, tumour site, levels of CEA and CRP were confirmed. Background: pancreatic ductal adenocarcinoma (PDAC) is the seventh leading cause of cancer-related deaths with increasing incidence and link to the onset of diabetes mellitus (DM). The aim of this study is to describe the prevalence of DM among patients with the diagnosis of PDAC, analyse the association between the occurrence of DM and clinicopathological factors, and detect variables influencing overall survival. Methods: a retrospective analysis of medical records was performed. The patients were divided into non-DM (n = 101) and DM (n = 74) groups. Statistical analysis with the usage of appropriate tests was conducted. Results: Patients in the groups of DM and NODM had significantly longer median OS than the non-DM group. Nodal involvement, tumour location, level of CEA, CRP and CRP/lymphocytes ratio were significantly associated with OS among patients with any type of DM. Neutropenia was less frequently observed in the DM group. Conclusions: DM is prevalent among patients with pancreatic cancer. In our study, patients with DM receiving palliative chemotherapy had significantly higher median OS than those without DM. The increased comprehension of the mechanisms of the relationship between DM and pancreatic cancer needs further research, which might provide avenues for the development of novel preventive and therapeutic strategies. [ABSTRACT FROM AUTHOR]

Several COVID-19 convalescents suffer from the post-acute COVID-syndrome (PACS)/long COVID, with symptoms that include fatigue, dyspnea, pulmonary fibrosis, cognitive dysfunctions or even stroke. Given the scale of the worldwide infections, the long-term recovery and the integrative health-care in the nearest future, it is critical to understand the cellular and molecular mechanisms as well as possible predictors of the longitudinal post-COVID-19 responses in convalescent individuals. The immune system and T cell alterations are proposed as drivers of post-acute COVID syndrome. However, despite the number of studies on COVID-19, many of them addressed only the severe convalescents or the short-term responses. Here, we performed longitudinal studies of mild, moderate and severe COVID-19-convalescent patients, at two time points (3 and 6 months from the infection), to assess the dynamics of T cells immune landscape, integrated with patients-reported symptoms. We show that alterations among T cell subsets exhibit different, severity- and time-dependent dynamics, that in severe convalescents result in a polarization towards an exhausted/senescent state of CD4+ and CD8+ T cells and perturbances in CD4+ Tregs. In particular, CD8+ T cells exhibit a high proportion of CD57+ terminal effector cells, together with significant decrease of naïve cell population, augmented granzyme B and IFN-γ production and unresolved inflammation 6 months after infection. Mild convalescents showed increased naïve, and decreased central memory and effector memory CD4+ Treg subsets. Patients from all severity groups can be predisposed to the long COVID symptoms, and fatigue and cognitive dysfunctions are not necessarily related to exhausted/senescent state and T cell dysfunctions, as well as unresolved inflammation that was found only in severe convalescents. In conclusion, the post-COVID-19 functional remodeling of T cells could be seen as a two-step process, leading to distinct convalescent immune states at 6 months after infection. Our data imply that attenuation of the functional polarization together with blocking granzyme B and IFN-γ in CD8+ cells might influence post-COVID alterations in severe convalescents. However, either the search for long COVID predictors or any treatment to prevent PACS and further complications is mandatory in all patients with SARS-CoV-2 infection, and not only in those suffering from severe COVID-19. [ABSTRACT FROM AUTHOR]

Background. A total of 148 surgeries were performed in our center on patients with pancreatic cancer in 2020. In 2019, 263 such procedures were performed (77.7% more) in this facility. Objectives. To analyze the impact of coronavirus disease 2019 (COVID-19) on pancreatic cancer surgery type, number and outcome in our center. Materials and methods. Retrospective data analysis of medical documentation in a hospital database from January 2019 till December 2020. Results. In 2020, we observed an increase of tumors localized in the tail of the pancreas (P) -- 29 cases (19.9%) in 2020 compared to 26 cases (9.9%) in 2019 (p = 0.005). In 2020, our patients presented with much greater advancement of the disease illustrated by the increased tumor size (median 3.5 cm in 2020 compared to 3.0 cm in 2019), although it did not reach statistical significance (p = 0.073). In 2020, we performed more palliative procedures, e.g., bypassing anastomoses (17 (11.6%) in 2020 compared to 8 (3%) in 2019 (p < 0.001)), more open biopsies of P (21 (14.4%) in 2020 compared to 21 (7.9%) in 2019 (p = 0.041)), and more percutaneous biopsies of P (7 (4.8%) in 2020 and 0 in 2019 (p = 0.001)). We observed a significant decrease in the number of Whipple procedures (53 (36.3%) in 2020 and 125 (47.5%) in 2019 (p = 0.037)). The most common histopathological finding was adenocarcinoma of the P, accounting for 50% in 2020 and almost 52% of all tumor cases in 2019. In a group of 148 patients operated on due to a P tumor during the COVID-19 pandemic, only 6 patients died, which resulted in a mortality rate of 4.1% compared to 13.4% mortality rate in 2019 (34 deaths/263 patients; p = 0.005). We observed less leakage of gastrointestinal anastomosis (0/148 in 2020 and 10/263 in 2019 (p = 0.038)). Conclusions. Particular attention should be paid to patients with an aggressive type of cancer who have completed neoadjuvant therapy, as they are unable to undergo other therapeutic options. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive cancer patients should be postponed until recovery. Relatively few postoperative complications and low all-cause mortality are the result of a more careful selection of oncological patients before the admission to the surgical ward, as well as a ompliance with the principles of planning the procedure and organization of the operating theater during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Perianal fistulas in Crohn’s disease (CD) are a major problem. In majority of patient, inflammation involves the rectum. Perianal fistulas in CD pose a diagnostic and therapeutic challenge due to severe symptoms and worse prognosis compared to cryptogenic fistulas. The accurate diagnosis is crucial for an effective treatment of CD-related perianal fistulas, and the following should be determined: anatomy of the fistula, possible strictures and inflammation of the alimentary tract, including the rectum and the anal canal. Treatment of fistulas might be challenging and requires cooperation between the colorectal surgeon and the gastroenterologist. The combination of surgical and pharmacological therapy is more effective than surgical or pharmacological therapy alone. In conservative treatment, aminosalicylates or steroids have little significance. In everyday practice, antibacterial chemotherapeutics, antibiotics and thiopurines are applied. The most effective are TNF-neutralizing antibodies, i.e. infliximab (IFX), adalimumab (ADA) and certolizumab (CER). Surgical management can be urgent including drainage. Elective procedures include dissection of the fistula (simple fistula) or more complex interventions such as mucosal flap or ligation of the intersphincteric portion of the fistula. Surgical interventions can be enhanced using the video-assisted anal fistula treatment (VAAFT) or negative-pressure therapy. In extreme cases, creation of a stoma may be necessary. Also, tissue glues or so-called plugs may be applied in managing perianal fistulas. The use of stem cells seems promising, i.e. application of multipotent non-hematopoietic stem cells around the fistula in order to induce immunomodulation and wound healing. [ABSTRACT FROM AUTHOR]

Aim of the study: To determine the correlation of protein serum levels of two cytokines and their polymorphisms, which have an influence on their expression. Material and methods: The study group consisted of 65 patients (33 men, 31 women) who met the criteria for inclusion and exclusion of pancreatic cancer, and 41 patients (25 men, 16 women) with colorectal cancer. The control group consisted of 100 healthy volunteers (63 men, 37 women). Detection of polymorphisms was performed using TaqMan probes, and concentration of proteins by ELISA method. Results: The mean TNF-a concentration in patients with colorectal cancer was significantly higher compared to the control group, p < 0.0001. A statistically significant difference was noted when comparing both study groups, p = 0.0009. The analyses show that the occurrence of the polymorphic genotype -308AA of the TNF-a gene was not correlated with the increased concentration of the examined protein in patients with both pancreatic and colorectal cancer. It was also noted that the concentration of TGF-ß protein was significantly higher in patients with colorectal cancer than in patients with pancreatic cancer. These results also proved to be statistically significant, p = 0.0353. Conclusions: The only statistically significant effects were the correlations between patients belonging to a specific group (pancreatic cancer/colorectal cancer/control) and average protein levels. There was no effect of sex or genotype on the occurrence of elevated levels of TNF-a and TGF-ß protein control, despite their variability in particular types of cancer. [ABSTRACT FROM AUTHOR]

Perirectal fistulas in the course of Crohn's disease (CD) constitute an important problem in this group of patients. They are observed in a vast majority of patients with involvement through colorectal inflammation. Perirectal fistulas in CD present a great diagnostic and therapeutic challenge due to the intensified clinical symptoms and worse prognosis than in the case of crypt originating fistulas. The condition for implementation of effective treatment of perirectal fistulas in the course of CD is correct diagnosis, defining the anatomy of fistulas, presence of potential stenoses and inflammation in the gastrointestinal tract. Treatment of these fistulas is difficult and requires close cooperation between the colorectal surgeon and the gastroenterologist. The combination of surgical and pharmacological treatment has higher efficacy compared to surgical treatment or pharmacotherapy alone. In conservative treatment, aminosalicylates and steroids are of minor importance, while chemotherapeutics, antibiotics and thiopurines find application in daily clinical practice. TNF-a neutralizing antibodies such as infliximab (IFX), adalimumab (ADA) or certolizumab (CER) prove to be the most effective. Surgical treatment may be provided as ad hoc; in this case drainage procedures are recommended, usually with leaving a loose seton. Planned procedures consist in the excision of fistulas (simple fistulas) or performing more complex procedures, such as advancement flaps or ligation of the intersphincteric fistula tract Surgical measures can be complemented by the use of video technology (video-assisted anal fistula treatment VAAFT) or vacuum therapy. In extreme cases, it may be necessary to create the stoma. Treatment of perirectal fistulas includes adhesives or so-called plugs. High hopes may be associated with the introduction of stem cells into clinical practice, which is the administration of non-hematopoietic multipotent cells to the fistulas to induce the phenomenon of immunomodulation and tissue healing. [ABSTRACT FROM AUTHOR]

Abstract Background The aim of this prospective study was to investigate mitochondrial DNA (mtDNA) copy number in a group of resectable pancreatic cancer (PC) tumor tissues and adjacent normal pancreatic tissues, and to explore the correlation between the mtDNA content in tissues and the clinicopathological parameters and the overall survival. Methods Relative mtDNA copy number was measured by the quantitative PCR-based assay. The tumors specimens (n = 43) originated from the patients with pathologically confirmed pancreatic ductal adenocarcinoma who did not receive any neoadjuvant systemic therapy. The adjacent normal pancreatic tissue samples (n = 31) were obtained from surgical margins. Results mtDNA copy number was significantly lower in PC tissue (P < 0.001) compared to adjacent normal pancreatic tissue. Jonckheere-Terpstra trend testing indicated a statistically significant decrease in median mtDNA copy number across the differentiation (adjacent normal pancreatic tissue, low-grade, intermediate-grade, high-grade cancer), P < 0.001. However, the survival analyses failed to show a significant difference in survival between patients with high and low mtDNA copy number. Conclusions To the best of our knowledge, we provided the first evidence that mitochondrial DNA copy number was significantly lower in pancreatic cancer tissue (P < 0.001) compared to adjacent normal pancreatic tissue. Also, we demonstrated that mitochondrial copy number was not a significant marker for predicting prognosis in resectable pancreatic cancer. [ABSTRACT FROM AUTHOR]

Introduction: Neuroma (Schwannoma in Latin) is an encapsulated, mesenchymal tumor arising from Schwann cells surrounded by nerves. Hence it can be located in any area in the body with passing peripheral nerves. The most common location is the head, neck, and extremities. The tumor arising from Schwannoma cells was first described by Stout and Carson in 1935. Pancreatic schwannomas are extremely rare tumors. Until 2017, in English literature 68 cases have been described. Surgical treatment is the most common way of treating pancreatic schwannomas, and postoperative prognoses are good. case report: A 63-year-old patient was admitted to the Clinical Department of Gastroenterological Surgery and Transplantation of the Central Clinical Hospital at the Ministry of Interior and Administration in Warsaw due to pancreatic head cancer. Needle biopsy--both ultrasound-guided and CT-guided as well as open biopsy for lesions in the pancreas did not show tumor cells in any of the collected samples. Abdominal CT in a projection of the uncinate process of the pancreas revealed an oval lesion highly suspected of neoplastic process. Next, diagnostics was extended by abdominal MRI which revealed a retroperitoneal tumorous thick-walled cystic mass filled with fluid. The patient was qualified for surgical treatment. Pancreaticoduodenectomy (Whipple Procedure) was done on August 22, 2017. Material sent for histopathological examination revealed Schwannoma capitis pancreatis. In surgical practice, pancreatic schwannoma occurs extremely rare, but in centers which conduct large numbers of surgical procedures in the pancreas, a case like this may occur. [ABSTRACT FROM AUTHOR]

Background. Periodontitis is a major risk factor of systemic diseases with inflammatory etiology. Numerous studies have established the connection between periodontal condition and diabetes, but there are no reports in the literature on the relationship between periodontitis and other pancreas conditions. The activity of pancreatic enzymes is an important parameter of pancreatic damage, and is also a diagnostic marker of acute and chronic pancreatitis, and the bleeding index determines the periodontitis activity. To date, the periodontal status in both of the above-mentioned conditions has not been examined. Objectives. The objective of the study was to provide a clinical evaluation of oral cavity hygiene and the condition of periodontal tissues in patients diagnosed with pancreatic adenocarcinoma or chronic pancreatitis and in the control group, and to assess the correlation between the activity of periodontitis and the concentration of glycated hemoglobin HbA1c, lipase activity and pancreatic amylase in serum from the examined groups. Material and methods. The serum activity levels of amylase, lipase and HbA1c concentration were correlated with periodontitis activity markers in patients diagnosed with chronic pancreatitis (n = 41), pancreatic cancer (n = 29) and in the control group (n = 50). Results. In the group with chronic pancreatitis, we have found a positive association between the bleeding on probing (BOP) and the amylase activity (r = 0.64) as well as the lipase (r = 0.62; p < 0.05). The patients diagnosed with pancreatic cancer evinced a higher value of the inflammatory response index, namely 1.51, than the other studied groups (H = 24.94; p = 0.01). Patients diagnosed with chronic pancreatitis evinced the highest periodontitis activity indices: BOP: 62.53% (H = 61.31; p = 0.01) and probing depth (PD): 4.14 ±0.89 mm (H = 22.43; p < 0.0001). Conclusions. The study showed that periodontitis in patients with pancreatic cancer is independent of the state of oral hygiene. In the group of patients with chronic pancreatitis, the observed positive correlation between the bleeding index and the enzyme activity suggests interaction between the examined diseases. [ABSTRACT FROM AUTHOR]

Background: The meaning of viral nucleic acids in the myocardium in many cases is difficult for clinical interpretation, whereas the presence of viral nucleic acids in the serum is a marker of active infection. We determined the diagnostic value of viral nucleic acids in ventricular serum and peripheral serum samples in comparison with endomyocardial biopsy (EMB) specimens in patients with clinically suspected myocarditis. Methods: The viral nucleic acid evaluation was performed in serum samples and EMB specimens by realtime PCR in 70 patients (age: 47 ± 16 years). The biopsy specimens were examined by histo- and immunohistochemistry to detect inflammatory response. Results: The viral nucleic acids were detected in ventricular and peripheral serum, and EMB samples of 10 (14%), 14 (20%), and 32 (46%) patients, respectively. Notably, viral nucleic acids of the same virus as in the EMB sample were present more often in ventricular than in peripheral serum (60 vs. 7%, p = 0.01). A significant concurrence was observed between the positive and the negative results of viral nucleic acids present in EMB and ventricular serum (p = 0.0001). Conclusions: The detection of the same viral nucleic acid type in the myocardium and in ventricular serum being significantly more frequent than in the peripheral serum may suggest that the site of the blood collection is important for more precise and reliable confirmation of the active viral replication in the heart. [ABSTRACT FROM AUTHOR]

Background: Surgery-related mortality depends on a number of factors including the type of surgical procedure, quality of healthcare, co-morbidities, and age of patient. The objective of the study was to assess the in-hospital mortality in the elderly undergoing surgical treatment. Methods: This was a national data-based retrospective cohort study. Data were extracted from the National Health Fund, a public organization financing medical procedures in Poland. Adult citizens who underwent 9,344,384 surgical interventions (including 3,093,254 cases in seniors who were above 65 years old) between 2009 and 2012 were included in this study. Overall, surgery type-dependent, age-stratified in-hospital mortality related to surgery was assessed. Results: Overall in-hospital surgery-related mortality rate in seniors was stable (approximately 2 % annually, P for trend = 0.104). It doubled with each successive decade of life (1.2, 2.3, 5.6, and 13 % in 65-74, 75-84, 85-94 and ≥95 years old groups, respectively, in 2012). In ≥75-year-old mortality exceeded 10 % only after neurological surgeries, in ≥85-year-old after neurological, vascular, gastrointestinal, and endocrinological surgeries, and in ≥95-year-old also after heart and circulation, bones and muscles, liver, pancreas, and spleen operations. However, even in the oldest individuals it was low after genitourinary, female genital tract, head and neck, and eye surgeries. Conclusions: The overall rate of in-hospital mortality after surgery, although increasing with age, is rather low up to the ninth decade of life. Whereas some surgeries pose a significant risk, others may be relatively safe even in the oldest subjects. [ABSTRACT FROM AUTHOR]

The aim of this study was to establish the correlation between the occurrence of Q705K and F359L polymorphisms in patients diagnosed with pancreatic diseases and periodontal conditions of various degrees of severity. The above-mentioned genetic markers were assessed in patients with pancreatic cancer ( n = 18) and chronic pancreatitis ( n = 39) as well as in a healthy control group ( n = 115). The established inclusion criteria were the following: Caucasian descent, non-smoking, and age range 20-80, with different levels of periodontitis activity according to S. Offenbacher's scale. The genotyping reactions were performed by means of an RT-PCR with the use of TaqMan genotyping assay. Results of the study revealed that the state of periodontium was significantly worse in patients with chronic pancreatitis. The Q705K and F359L polymorphisms were associated with more advanced cases of periodontitis measured by clinical attachment level, whereas the Q705K was associated with intensified bleeding index. Furthermore, the F359L single-nucleotide polymorphism was significantly higher in the group with chronic pancreatitis ( p < 0.0001; OR = 6.8571). Whereas, the prevalence of Q705K polymorphism was higher in the group of pancreatic cancer ( p = 0.107; OR = 3.3939). This study suggests that the exaggerated inflammatory response provoked by Q705K and F359L might be the common denominator for periodontitis, pancreatic cancer, and chronic pancreatitis. These findings might constitute the basis for a new diagnostic and therapeutic approach. [ABSTRACT FROM AUTHOR]

The improvement of laparoscopic techniques that we witnessed over the last decade, also applied to pancreatic surgery. Both worldwide and in Poland, increasingly more patients with lesions located within the body and tail of the pancreas are treated using laparoscopic distal pancreatectomy. The aim of the study was to compare the outcomes of laparoscopic and open distal pancreatectomy. Material and method. Between January 2009 and March 2013, 107 patients underwent distal pancreatectomy at a single institution: 39 using laparoscopic technique and 68 using open technique. This was a retrospective study. Results. There were no significance differences with regard to duration of the surgical procedure, duration of hospitalization and complication rate between both groups. Statistically significant difference was found for the incidence of spleen preservation in patients undergoing laparoscopy, due to better visualization of the structures. In the group of patients with pancreatic cancer there was no significance difference in the incidence of malignancy found in the surgical margin. Our results are similar to that presented in the literature. Conclusions. Laparoscopic distal pancreatectomy is a safe method, with a higher rate of spleen preservation among the patients with the lesion located in the body and tail of the pancreas. [ABSTRACT FROM AUTHOR]

Introduction. In spite of intensive research during many years, pancreatic adenocarcinoma remains one of the deadliest cancers. The surgical intervention remains main possibility of treatment because chemotherapy and radiotherapy has a minimal impact on long-term survival. We are still looking for the weak points of this devastating disease. Materials and Methods. Pancreatic tumor tissue samples were collected from 36 patients. Immunohistochemistry staining was used to evaluate expression of growth factors and immune infiltrates. Activity of MMP2 and MMP9 was assessed by gelatin zymography on 7.5% SDS-PAGE gel with 0.1% gelatin. Results. All growth factors were strongly expressed in pancreatic tumor tissue. We found that level of expression of c-Met receptor was higher for G3 tumors than for G2 tumors. Also we found that active MMP2 was present at all stages of tumor while active MMP9 just at more advanced tumors. Abundant immune cells infiltration was distinctive for tumor tissue, especially macrophages were infiltrating tumor tissue. We found that amount of macrophages was associated with lymph nodes metastases. Conclusion. In our research we demonstrated that among many factors influencing tumor microenvironment c-Met receptor, infiltrating macrophages and MMP2 have significant influence on development and invasion of pancreatic cancer. [ABSTRACT FROM AUTHOR]

Chronic pancreatitis is an inflammatory disease that may require surgical intervention. In some patients a total pancreatectomy is necessary. Such patients develop diabetes, which in some cases may be difficult to control. When standard insulin treatment is unsuccessful and the patient has frequent blood glucose swings with life-threatening hiper- and hypoglycemic episodes, a pancreas transplant should be considered. [ABSTRACT FROM AUTHOR]

Confocal laser endomicroscopy (CLE) is a new technique, which allows subsurface histological diagnosis at a cellular and subcellular level in vivo and could provide histological diagnosis during endoscopic examination. Up to now histological examination of the tissue sample is the only definitive way of diagnosis and monitoring organ rejection after transplantation. In case of pancreas transplantation percutaneous pancreas biopsy under imaging control is still the method of choice for obtaining tissue samples. However in 73–89% of biopsy attempts, it was shown that the duodenal histology predicts the initial diagnosis of rejection of the pancreas, usefulness of transplanted duodenum biopsies for graft rejection monitoring was also described. The histology technique is time consuming, and the therapeutic decision could not be made quickly, in spite of clinical necessity. In this paper we described feasibility of visualization and biopsy of donor duodenum and detection of microscopic changes in 2 cases of transplanted duodenum, expressed as destruction of the villi and dispersed goblet cells in comparison to a microscopic view of their own healthy duodenum No or only small, endoscopically non-significant macroscopic changes in transplanted duodenum in those patients were observed. In both cases, the histological examination confirmed acute organ rejection. We demonstrated for the first time that CLE is promising and effective method to detect acute phase of organ rejection and also for follow up in those patients. [ABSTRACT FROM AUTHOR]