摘要:

Periampullary cancers are a group of tumours with similarities in symptoms and treatment, the prognoses of which are better than that of proper ductal pancreatic carcinoma. They are still sometimes diagnosed unexpectedly at operations for other reasons, such as gallstone disease and they are best diagnosed with the triad of duodenoscopy, endoscopic retrograde cholangiopancreatography and endoscopic biopsy, but one should never rely on a negative biopsy. For evaluation of resectability chest X-ray, ultrasonography and angio-CT currently are recommended for routine use and patients with resectable tumours should be offered a Whipple operation unless their general condition and/or tumour stage contradict attempted curative surgery. Long-term survival is gratifying after resection of tumours originating in the papilla, ampulla and bile duct. This is also true for those high-risk, fragile patients undergoing local excision of the tumour with free resection margins. The obstructive jaundice in patients who are pre-operatively deemed to have incurable disease or in the very frail and old patients is preferably relieved endoscopically. In those selected for laparotomy but in whom the tumour is found to be irresectable surgical biliary bypass nowadays can be done with low hospital mortality and morbidity. We feel that prophylactic gastrojejunostomy should be done selectively. If it is not possible to control pain pharmacologically palliation can often be adequately achieved by a percutaneous coeliac bloc. Additionally, the initial results of thoracoscopic sympathectomy seem promising.

ISSN:0253-4886    

DOI:10.1159/000172293

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Recent improvements in the operative mortality and survival in patients undergoing resection for pancreatic cancer have led to a renewed interest in the role of adjuvant therapy. The roles of neoadjuvant radiotherapy, intra-operative radiotherapy, postoperative external beam radiotherapy and adjuvant chemotherapy alone are reviewed. More recently, combined multimodality adjuvant therapy has been used following ‘curative resection’ for pancreatic cancer, and the current status concerning the use of such treatment is addressed. There is insufficient evidence at present to recommend the use of routine adjuvant therapy. Nevertheless, there are sufficient encouraging data to advocate entering patients in large adjuvant therapy tri

ISSN:0253-4886    

DOI:10.1159/000172294

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Thirty-two patients with advanced nonresectable pancreatic cancer of UICC stages III (17 patients) and IV (15 patients; palliative group) received regional chemotherapy with mitoxantrone, 5-FU + folinic acid, and cisplatin via celiac axis infusion with the Seldinger technique. Twenty patients received this treatment after resection of their primary tumors (adjuvant group). Overall 202 cycles [4(1-11)/patient] were applied. Toxicities in all cycles were as follows: gastrointestinal ulcers 6%, gastritis 5%, severe stomatitis 0.5%, nausea/vomiting WHO I+ 11 44%, leukopenia WHO I+ II 11% and WHO III 0.5%. A false aneurysm and a hematoma developed in 1 patient each. The median survival times were 7.5 months in the palliative group (UICC III 12 months, UICC IV 4 months) and 15.1 months in the adjuvant group. Pain decreased significantly in the palliative group.

ISSN:0253-4886    

DOI:10.1159/000172295

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The results of pancreas transplantation have improved markedly over the last decade, owing equally to improvement in proper patient selection, organ preservation, refinements in surgical technique, early diagnosis and treatment of rejection, and management of potential complications. Among all pancreas transplants reported to the International Pancreas Transplant Registry, simultaneous transplantation of the pancreas and kidney with bladder drainage is the technique associated with the best graft survival rates. Graft and patient 5-year survival rates of 80 and 86%, respectively, can be achieved and are now comparable to those of other organ transplants. Objective improvement in diabetic neuropathy, vasculopathy, and retinopathy, as well as in prevention of recurrent diabetic nephropathy, has now been demonstrated. Simultaneous pancreas-kidney transplantation is now considered the procedure of choice for selected uremic diabetic patients.

ISSN:0253-4886    

DOI:10.1159/000172296

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The important advances made in islet separation techniques, in understanding the immunological mechanism of islet rejection, in immunosuppression strategies made it possible to start clinical trials of islet transplantation in diabetic patients. Preliminary results showed that islet transplantation is a safe procedure able to restore the pancreatic endocrine function in diabetic patients. Potentialities of islet transplantation and future development in this field are analyzed in this review.

ISSN:0253-4886    

DOI:10.1159/000172297

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Somatostatin is found in the pancreas and gastrointestinal tract, including the visceral autonomic nervous system, the endocrine D cells and the gut lumen. Somatostatin peptides may act differently at different sites as hormones, as paracrine substrances or neurotransmitters. So far not much is known on the physiological effects of somatostatin in the gastrointestinal tract. Somatostatin and octreotide, a synthetic analogue with a longer half-life and higher potency, inhibit the neuroendocrine and exocrine gastrointestinal secretion, intestinal glucose, fat and amino acid transport, intestinal propulsive and gallbladder motility, splanchnic blood flow in volunteers and hepatic venous pressure in cirrhotic patients. The inhibition occurs to various extents depending on the target organ. This review deals with the pharmacological effects of octreotide on different gastrointestinal functions and describes its possible therapeutic role in different gastrointestinal disorders.

ISSN:0253-4886    

DOI:10.1159/000172298

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Bleeding from esophageal varices has a high mortality rate. Sclerotherapy is the most appropriate treatment, but is not always available. Alternatively, somatostatin and octreotide may be used for the treatment of variceal bleeding. They seem to be as effective as vasopressin but have fewer adverse effects. Their role as adjuvant treatment to emergency sclerotherapy for active variceal bleeding must be further investigated. Somatostatin and octreotide reduce symptoms of the early and late dumping syndrome. Their therapeutic benefit is probably associated with a slower gastric emptying and small bowel transit time and inhibition of the release of peptide hormones mediating vasomotor symptoms. In refractory diarrhea, octreotide is able to promote intestinal absorption and inhibit gastric, pancreatic and intestinal secretion. Octreotide positively affects short bowel syndrome, secretory diarrhea resulting from neuroendocrine tumors, intestinal infections in AIDS patients, and motility disorders in diabetes mellitus and systemic sclerosis.

ISSN:0253-4886    

DOI:10.1159/000172299

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Major pancreatic resection is still accompanied by considerable morbidity (35%) and even mortality (10%). Typical complications such as pancreatic fistula and abscess are chiefly associated with exocrine pancreatic secretion. Therefore, the perioperative inhibition of exocrine pancreatic secretion is a promising concept in the prevention of complications. The hormone somatostatin and its analogue octreotide is well known as a potent inhibitor of exocrine pancreatic secretion. In two randomized, double-blind, placebo-controlled multicenter trials we assessed the prophylactic effect of the perioperative inhibition of exocrine pancreatic secretion by octreotide, a long-acting somatostatin analogue, to prevent postoperative complications. Each patient received 3 × 100 µg/day octreotide or placebo subcutaneously. A significant reduction of complications such as fistula, abscess, fluid collection, sepsis and postoperative pancreatitis could be demonstrated in the study with patients undergoing Whipple resection for cancer. In a second study, using the same study protocol recruiting only patients with chronic pancreatitis a significant reduction in the postoperative complication rate was also present in the octreotide group in comparison with the placebo group. In acute pancreatitis activation of digestive enzymes in the pancreas may play an important role. Therefore, inhibition of enzyme secretion also seems to be a useful concept in treating acute pancreatitis. However, it is not clear whether exocrine pancreatic secretion continues in acute pancreatitis. Recently we have started a randomized, controlled multicenter trial in which 300 patients will be treated with or without octreotide in a double-blind fashion. The results of this study will clarify the influence of the inhibition of the exocrine pancreatic secretion by octreotide on the course of acute pancreatiti

ISSN:0253-4886    

DOI:10.1159/000172300

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Naturally occurring somatostatin and, even more so, its analogue, octreotide, by virtue of its greater manageability, are used extensively today in various pancreatic and gastrointestinal disorders, where their potent secretion-inhibiting capacity is exploited. In a number of conditions such as pancreatic fistulas the beneficial efficacy of the hormone is now definitely established both for therapeutic and for prophylactic purposes, whereas, in the other disease areas analyzed here, its use appears to be as an adjuvant to more specific and more radical procedures. Future clarification as to indications, dosage regimens and treatment times may reveal more strictly curative uses of octreotide in its own right, though, even as things stand at present, its efficacy as a complementary measure is so self-evident as to prompt its inclusion in treatment schedules both for enterocutaneous fistulas and for ascites and pancreatic pseudocysts.

ISSN:0253-4886    

DOI:10.1159/000172301

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

In a European multicenter trial, a combination of conventional imaging methods (CIM) detected tumor sites in 88% of patients with gastroenteropancreatic endocrine tumors, whereas [111In-DTPA-D-Phe1]-octreotide scintigraphy was positive in 80% of the patients. The highest success rates of [111In-DTPA-D-Phe1]-octreotide scintigraphy were observed in patients with glucagonomas (100%), vipomas (88%), carcinoids (87%) and nonfunctioning islet cell tumors (82%). In addition to 297 out of 388 localizations found with CIM [111In-DTPA-D-Phe1]-octreotide scintigraphy revealed another 166 unsuspected lesions of which 40% were subsequently confirmed as true-positive findings based on the results of additional imaging procedures or histology obtained during a follow-up period. Overall, the scintigraphic findings led to management changes in 40% of the 235 patients for whom these data were available.

ISSN:0253-4886    

DOI:10.1159/000172302

出版商:S. Karger AG    

年代:1994

数据来源: Karger