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Background: Long-term insulin independence after islet transplantation depends on engraftment of a large number of islets. However, the yield of pancreatic islets from brain-dead donors is negatively affected by the up-regulation of inflammatory mediators. Brain death is also believed to increase tissue factor (TF) expression, contributing to a low rate of engraftment., Methods: We conducted a case-control study to assess brain death-induced inflammatory effects in human pancreas. Seventeen brain-dead patients and 20 control patients undergoing pancreatectomy were studied. Serum tumor necrosis factor (TNF), interleukin (IL) 6, IL-1β, interferon (IFN) γ, and TF were measured using enzyme-linked immunosorbent assay kits. Gene expressions of these cytokines and TF were evaluated by reverse transcriptase quantitative polymerase chain reaction. Protein quantification was performed by immunohistochemistry in paraffin-embedded pancreas sections., Results: Brain-dead patients had higher serum concentrations of TNF and IL-6 and increased TNF protein levels compared to controls. The groups had similar TNF, IL-6, IL-1β, and IFN-γ messenger RNA levels in pancreatic tissue. Reverse transcriptase quantitative polymerase chain reaction revealed TF messenger RNA up-regulation in controls. Immunohistochemical analyses showed that brain-dead patients had increased TNF protein levels compared to controls., Conclusions: Brain death induces inflammation evidenced by the up-regulation of TNF in serum and pancreatic tissue. Blocking the expression of key inflammatory mediators in brain-dead donors should be evaluated as a new approach to improve the outcomes of islet transplantation.

Purpose: To present the authors experience managing anular pancreas and to compare the results found by the authors with the ones found in the literature., Methods: A retrospective review of four patients treated at the Departamento de Cirurgia da Faculdade de Medicina da Universidade Federal do Rio Grande do Sul with anular pancreas. The disease was present in three different ages: one in the neonatal age, one in childhood and two in the adulthood. Gastroduodenal obstructive symptoms were the most common. Abdominal pain was present in adult patients. The diagnostic investigation began with radiological studies such as upper gastrointestinal barium series, upper endoscopy and abdominal computed tomographic scan, although all the diagnoses required surgery for confirmation. The duodenoduodenostomy was the treatment of choice in the pediatric patients, and division of the anulus was carried out in the adults., Results: All patients had symptomatic relief and postoperative recovery. The hospital stay ranged from 9 to 12 days (median 10.5 days). There were no postoperative complications. All patients remain asymptomatic up to now., Conclusion: The rare condition of anular pancreas does not allow a more detailed and comparative study. The results of the authors showed that both gastrointestinal by-pass and division of the pancreas are effective and safe treatments.