Galperin Surgery For Diabetes Mellitus

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SCALPEL AGAINST THE DIABETES The unique surgical method of treating the heavy ailment is created in Russia

Diabetes - a treacherous disease. It is caused not so much by deficiency in the organism of insulin, but appearing as a result of this unbalance between insulin and one additional hormone - glucagon. Both hormones are manufactured by the pancreas, both straight from there enter the liver, where they actively participate in the metabolism . Only the action of them is directly opposite: insulin is responsible for the assimilation of incoming glucose into the body, , and Glucagon - the fact that at the right time to extract it from the "store" and send to those cells , which most of all need nourishment (it has the name which says : glucagon - “glucose carrier ”). In a healthy person, this "sweet couple" works well, providing an internal equilibrium. Patients with diabetes mellitus own little or no insulin at all. But glucagon is manufactured even more than usual. And the failure begins in the work of system : “excess” sugar ( glucose ) is constantly ejected in the blood flow . In the course of time , all this produces changes in organs and tissues of patients and severe complications: blindness, the ischemic disease of heart, the kidney deficiency… If we balance a quantity of insulin and glucagons , the state of patient will be improved considerably . But to make this possible , if we lead the flow of glucagon from the liver into the common blood stream - there, where the conditions for “sugar production ” are not so favorable At the beginning of XX century, physicians have noticed that , if people with diabetes develop cirrhosis of the liver, the period of diabetes is markedly easier. But cirrhosis exactly also disrupts blood flow. Later American Thomas Starlz and Soviet hepatologist Edward Galperin in experiments on animals have confirmed these observations. Professor Galperin created in dogs the experimental model of diabetes mellitus, and then operated them - the “switching” of blood flow. As a result , animals got better. At the All-Russian Congress of Surgeons , Dr. Edward Galperin proposed to treat diabetes mellitus this way in humans. Most colleagues reacted to this suggestion with the distrust . But doctors from Kemerovo estimated it on the merit , since already they themselves performed operations taking into account the influence of the liver on the metabolic processes in the organism . In March 1985, in the Kemerovo Oblast Hospital , Professor Theodore Shraer operated on five patients who failed to adjust blood sugar levels through medication. After six months, the surgeons were convinced of the fact that the complete recovery of diabetes did not begin not in one of that operated patient , but in 4 of 5 were presently a noticeable improvement in the state: a number of symptoms disappeared, the need

for insulin decreased , fitness for work increased. Endocrinologists were skeptical about the intrusion of associates with the scalpel into their field . They insisted that they needed to see longterm results of operations. After operating more than two hundred patients, surgeons stopped in order to conduct prolonged observations. Three years after operation the improvement was noted in 88% of patients: the level of sugar in the blood was stabilized , some of them recovered from the retinopathy and kidney failure, muscle weakness disappeared, recovered sexual potency . However , in the next two years , patients with satisfactory results became less - for a part of them , after the lapse of time, the effect of operation has decreased. To trace even the more distant results proved to be complex. With the beginning of economic reforms , to go on inspections of operated patients became too expensive. So doctors have developed a questionnaire to assess the comparative quality of life. The results of these studies formed the basis for the thesis of surgery clinic employee Lyubovi Chekhlovoy. She managed to prove that a large group of patients significantly improved during the operation of diabetes, including those in the distant time frame. Quality of a life of the operated patients - ability to work, physical and social activity - was considerably above even through 10-14 years after operation. Analysis at the same time showed that not all patients then it was worthwhile to operate. “ Today we consider possibility of the revival of operations from strict medical indications “ Professor Theodore Shraer comments on data. Moreover , in itself , heavy flow of patients with diabetic indications did not existed , as we assumed at the beginning ( in the mid-1980s ). Surely , “our” those patients, in whom already for the second- third year from the beginning of disease - has developed the complications and who lose the sensation of sugar, the feeling of either its high level or a sharp decrease . Specifically, in this group , we obtained the best results. Kemerovo surgeons are ready to join with colleagues from other cities to further improve the method that would help tens of thousands of patients.

Excerpt from the article " An operation - according to Galperin " appeared in the magazine " Science in the USSR " issue no. 2 ( March-April ) The point is that in such cases one of the internal secretion glands , namely , the pancreas , ceases to produce insulin , an extremely vital hormone for the organism . The lacking insulin is periodically introduced into blood from outside , by injections . All the tissues of the organism are sensitive to insulin except the nerves and erythrocytes in which glucose is utilized in the absence of insulin . Without insulin the liver , muscles and other tissues fail to absorb glucose coming to them from the blood , and glucose is a source of energy for a living cell . Just imagine a car at an crude oil well . There is plenty of fuel around , but there is nothing to fill the tank with , for crude oil is not yet gasoline . When the organism need energy - a signal is sent to the pancreas -

as much as possible glucagon to produce glucose . and as much as possible insulin to get this glucose to " burn " and produce energy . In normal conditions the insulin of a healthy man produced by the pancreas first of all gets into the liver and already from there is carried to various tissues with the blood flow . Its antagonist , glucagon , another hormone of pancreas , also gets into the liver . Thus , since two hormones with opposite properties function in the organism , they must be present in a certain proportion which may change depending on the demand for energy at the given time . A diabetic patient has no insulin , but the pancreas continue to secrete glucagon and precisely due to the absence of its antagonist , insulin , even in larger quantities than in a healthy person . Glucagon goes straight to the liver , And insulin from the a syringe first gets into peripheral tissues . True , it is carried all over the organism with the blood flow later . However , only about 20% of insulin gets into the liver playing the chief role in regulating the contents of the antagonistic hormones. This leads to an imbalance of hormones and causes sharp changes in organs and tissues resulting in the grave complications of diabetes , in particular , disruptions in the function of heart , kidneys , and the weakening of eyesight . Surgeon E. Gaperin has found a way of creating conditions conductive to normalizing the ratio of hormones in the patient's organism . Glucagon is let into the general circuit of the blood flow by connecting the vein carrying it from the pancreas into the liver with another in which blood flows past the liver . In this situation the " meeting " of the antagonist hormones will occur close to the place where insulin is injected and their imbalance will be considerably reduced . The first successes in the operative corrections of hormonal metabolism to relieve patients of an excruciating disease enabled surgeons to put the operation into practice on a large scale . More than 80% of the patients operated on show a considerable improvement in their health . It means that the operation manages to block the slipping to a catastrophe , for example , to blindness or the worsening of the kidney functions , pains in the legs pass , weakness disappears , the capacity for work increases sharply , and the sugar level in the blood becomes stabilized , which makes it possible to reduce the dosage of the injected insulin . The state of the other 20% of patients remains the same . After all , physicians are not gods , the human organism is sophisticated , and the disease is not limited to an insulin-glucagon disproportion .