Preface

Chapter 7 **Contrast‐Enhanced Ultrasound for the Assessment of**

Christopher Riley, Nicole Villafane and George Van Buren

Yoshinobu Sato, Yoshiaki Hara, Naruhiko Sawada, Shoji Shimada, Kenta Nakahara, Daisuke Takayanagi, Fumio Ishida, Shin-EI Kudo

**Pancreatic Lesions 141** Roxana Șirli and Alina Popescu

**VI** Contents

and Junichi Tanaka

**Treatment 195**

**Section 5 New Procedures in Diabetes 217**

**Protective Biomaterials 219**

Chapter 8 **The Improvement of Care in Patients with Pancreatic Cancer 159**

Chapter 9 **New Surgical Procedure for Pancreas Head 181**

Chapter 10 **The Role of Vascular Resection in Pancreatic Cancer**

Vos, Elliot Botvinick and Jonathan Lakey

Nikola Vladov, Ivelin Takorov and Tsonka Lukanova

Chapter 11 **Avoiding Immunosuppression for Islet Transplantation: Use of**

Michael Alexander, Huy Nguyen, Antonio Flores, Shiri Li, Paul De

The assessment of the pancreas is a challenging problem because it is a "deep" organ that often presents difficulties in diagnosis and treatment. Despite many efforts in dealing with pancreatic diseases, the pathogenesis is not completely understood, the symptoms and imaging methods are unspecific, and the treatment possibilities are sometimes very limited.

The major purpose of this book is to offer the reader a better understanding of the challeng‐ ing aspects in pancreatic pathology, starting with anatomy and following with the main pancreatic pathology.

The first section discusses the very close interaction between the nervous system and the endocrine cells within the pancreas, details about pancreas anatomy, and the physiology of the exocrine pancreas.

The second section reviews the surgical resection strategies in chronic pancreatitis.

The third section includes chapters concerning the cystic lesions of the pancreas, such as precancerous conditions, including the current opinion on intraductal papillary mucinous neoplasms and mucinous cystadenoma. The improvement of imaging, endoscopic modali‐ ties, and cyst fluid studies that allow the differential diagnosis of these lesions and the selec‐ tion of high-risk factors for malignant progression are largely discussed.

The fourth section includes the majority of data in this book. Hereditary pancreatic cancer and the risk factors associated with pancreatic cancer development are presented extensive‐ ly. The new method of contrast-enhanced ultrasound represents a valuable method for eval‐ uation of the solid and liquid pancreatic lesions, and the selection of the subsequent imaging method needed is facilitated. New surgical methods for pancreatic resection and vascular resection represent challenging problems in the treatment of the pancreatic cancer, and they are also presented here.

The last section focuses on the discussion of the difficult issue of islet autotransplantation for the treatment of type I diabetes, related to the inflammatory response generated after trans‐ plant. The technologies to avoid immune rejection or immediate contact with cytotoxic in‐ flammatory response are revealed in detail.

This book is meant to provide a thorough guide in pancreatology. The information offered will be useful for the clinicians, students, and patients, as well. The contributing authors to this volume are well-known scientists in the field of their expertise, and we are indebted to their efforts for dissemination of knowledge in pancreatology.

#### **Andrada Seicean, MD, PhD**

Professor of Gastroenterology and Internal Medicine Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca University of Medicine and Pharmacy Cluj-Napoca, Romania

**Normal Anatomy and Physiology of the Pancreas**

#### **Neuro-Insular Complexes in the Human Pancreas Neuro-Insular Complexes in the Human Pancreas**

Yuliya S. Krivova, Alexandra E. Proshchina, Valeriy M. Barabanov and Sergey V. Saveliev Yuliya S. Krivova, Alexandra E. Proshchina, Valeriy M. Barabanov and Sergey V. Saveliev

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/65059

#### **Abstract**

It is well known that pancreatic islets are complex structures composed of endodermally derived endocrine cells, integrated with endothelial cells and other cells, originating from the mesoderm, and innervated by nerve fibers that have a neuroectodermal origin. In our studies, we focused on the interactions between the structures of the nervous system and endocrine cells, the so-called neuro-insular complexes, in the human pancreas. In this chapter, we present our results and literature data concerning the morphological organization of neuro-insular complexes in humans and other mammals. We also discuss the possible functional role of neuro-insular complexes, such as the involvement of the nervous system in the regulation and synchronization of islet hormone secretion and the morphogenetic plasticity of the endocrine pancreas in adults, as well as in the regulation of endocrine cell proliferation and maturation during prenatal development of the pancreas.

**Keywords:** pancreas, islets of Langerhans, neuro-insular complex, human development

#### **1. Introduction**

Pancreatic innervation is of interest due its role in the pathogenesis of some diseases, including chronic pancreatitis [1], pancreatic cancer [2] and type 1 diabetes [3–5]. The pancreas is well innervated by the autonomic nervous system [6–10]. In histological studies on the mammalian pancreas, the abundant innervation of the blood vessels, exocrine and endocrine part of the glandhas beenidentified[11, 12].Later,nerve endingswere foundaroundbloodvessels, aswell as pancreatic acinar, ductal and endocrine cells using immunohistochemistry and electron microscopy[13,14].Fourtypesofplexuses(perivascular,periductal,periacinarandperi-insular)

© 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

have been identified in the mouse pancreas [14]. Similar data were obtained in studies on the pancreas of the rat [15] and nutria [16].

Since the classical study by Claude Bernard, which showed that an injury to the floor of the fourth cerebral ventricle caused hyperglycemia, the involvement of the nervous system in the regulation of pancreatic endocrine function and metabolic control has been shown in many studies [17–19]. At the same time, the precise innervation patterns of islets were unknown, particularly in humans [9]. Single nerve cells and nerve ganglia, as myelinated and demyelinated nerve fibers, have been identified in the human pancreas [1, 20–22]. However, the literature data indicate poor innervation of adult human pancreatic islets in comparison with rodents [1, 9, 20, 23].

One of the most interesting features of the mammalian pancreas is that endocrine cells may form highly organized complexes with structures of the nervous system, so-called neuroinsular complexes (NIC). The structure of NIC in the human pancreas has not been studied in detail since their first description by Van Campenhout [24] and Simard [25].

In this chapter, we summarize the literature data and our previous results concerning the morphological organization of NIC in the human fetal and adult pancreas. We also discuss the possible role of the close integration between the nervous system and endocrine cells in the development of the endocrine pancreas.
