摘要:

In a prospectively randomized trial evaluating pancreatic resection with adjuvant radiotherapy (intraoperative radiotherapy [IORT] vs. external beam radiotherapy (EBRT]), lymph nodal involvement was examined and correlated with outcome. Twenty-six patients underwent pancreatic resection and received either IORT or EBRT (Stages 11-IV). Patients who were stage I received surgery alone. Regional nodal metastases were present in 15 of 26 (57%) patients. Seven patients suffered treatment-related mortality. Survival, mortality, and morbidity were unaffected by the type of radiotherapy. The survival of patients with negative nodes (median survival 24 months, range 10 to >109) appeared superior to the survival of patients with nodal involvement (median survival 11.5 months; range 4–39). Even in patients with locally advanced disease extending into extrapancreatic tissues, two node-negative patients appeared to survive longer (12 and 53 months) than 10 node-positive patients with similarly extensive local disease (median survival 11.5 months; range 639). Local disease control, however, appeared to be independent of nodal involvement, with eventual local recurrences in 6 of 8 node-negative patients and in 4 of 7 node-positive patients who were evaluable for local disease control by autopsy or by antemortem laparotomy.

ISSN:0885-3177    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Octreotide (SMS 201–999, a long-acting somatostatin analogue, has been shown to decelerate growth of human pancreatic cancer in vitro and in vivo. We analyzed the efficacy of octreotide treatment in 22 patients (14 men, 8 women) with histologically verified ductal pancreatic cancer. All patients had advanced tumor stages (stage 111: 13 patients; stage IV: 9 patients). Octreotide was given by self-administered subcutaneous injection (3 × 100 kg/day). When there was evidence of tumor progression, the dose of octreotide was increased to 3 × 200 μg/day. A monthly follow-up, including clinical status, CT scan or ultrasonography, and tumor marker carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19–9 determination was carried out. There were no severe side effects apart from slight burning sensation at the injection site. No partial or complete remission was seen. Eighteen patients showed tumor progression with a median survival time of 17 weeks (range 3–42 weeks). In three patients a “no change” evaluation with a median survival time of 46 weeks (range 40–68 weeks) was registered. In these three patients the serum tumor markers CA 19–9 and CEA did not show an increase to more than twice the baseline value during this time. One patient discontinued the octreotide treatment because of tumor progression. The results of the analysis indicate that lowdose octreotide treatment is not effective in patients suffering from advanced tumor stages of pancreatic cancer.

ISSN:0885-3177    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

A comparative study of antibacterial activity of pancreatic juice was conduced on six mammalian species. Pancreatic juice collections were conducted as acute (rabbit, guinea pig, rat) and chronic (pig, sheep, cattle) experiments, in the former before and after stimulation [cholecystokinin (CCK) and secretin] and in the latter under basal conditions alone. Antibacterial activity was tested onMicrococcus pyogenesand compared with that of neomycin. The samples were tested under normal conditions and after heating and dilution. The pancreatic juice of rat showed no activity againstMicrococcus pyogenes. The antibacterial activity of rabbit and guinea pig pancreatic juice under basal conditions was similar within the group but significantly higher than that of pig, sheep and cattle which also did not differ significantly within the group. On stimulation with CCK and secretin, no significant change could be observed in the potency of antimicrobial activity of pancreatic juice in the rabbit and guinea pig. The antibacterial activity remained unchanged after heating to 65°C and upon dilution to 1:10.

ISSN:0885-3177    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Infections from enteric bacteria are a major cause of morbidity and mortality during acute pancreatitis (AP), but the pathways by which these organisms reach distant organs remains speculative. Experiments were conducted to determine if bacterial translocation could be a mechanism for infection during this disease. AP was induced in Lewis rats by i.v. infusion of caerulein (experiment I) or ligation of the head of the pancreas (experiment 11). In a third experiment, rats were gavaged with 1 × 10814C-radiolabeledEscherichia coliand pancreatitis was induced with caerulein. Results in all three experiments showed that AP increased the number of viable bacteria recovered in peritoneal fluid, mesenteric lymph nodes (MLN), liver, lungs, and pancreas. Radionuclide counting indicated that AP enhanced the gut permeability to14C E. coli. To estimate the impact of AP on the magnitude of translocation and on the ability of the host to clear bacteria, the nuclide and colony-forming units (CFU) ratios were calculated between animals with and without AP. Blood, peritoneal fluid, and MLN had the highest nuclide ratio. During AP, these tissues may be the principal routes for bacterial spreading from the gut lumen. Peritoneal fluid, pancreas, and lung were the tissues with the highest CFU ratio. Bacterial killing ability of these tissues is likely impaired during AP.

ISSN:0885-3177    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The bacterial flora from the jejunum and colon of 19 dogs with naturally occurring exocrine pancreatic insufficiency (EPI) was examined. In six dogs with EPI that did not receive any treatment the bacterial count in the small intestine was >106colony-forming units (CFU)/g. This was consistent with bacterial overgrowth (BOG) (control dogs: <105CFU/g). Six dogs with EPI that received pancreatic enzyme supplementation and were in good condition had bacterial counts (>106CFU/g) that were non significantly different from the untreated group. The remaining seven dogs with EPI that received both pancreatic enzyme supplementation and oral antibiotic therapy (tylosin), had bacterial flora counts that were significantly lower than the values in the other two groups of EPI dogs, and did not differ significantly from those of the control group. There were no statistical differences between the number of bacteria in the colon among the different groups of dogs with EPI and the control dogs. We conclude that the prevalence of BOG in dogs with EPI is high. Pancreatic enzyme supplementation did not affect the microflora of dogs with naturally occurring EPI. Oral antibiotic therapy with tylosin, however, effectively decreased BOG in these dogs.

ISSN:0885-3177    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The aim of this study was to assess the prevalence, presentation, cause, and location of symptomatic duodenal stenosis, and its relation to the natural course of chronic pancreatitis in a medical-surgical series of 306 patients (86% alcoholics). Mean follow-up of the series was 7.9 years. Symptomatic duodenal stenosis occurred in 17 patients (5.6%). Diagnosis was confirmed by a barium series. The cause of stenosis was compression by the pancreatic head in all patients, associated with a pancreatic abscess in two. No pseudocysts were found at the time of diagnosis. The location was the 1st and 2nd part of the duodenum or the entire duodenal loop in 4, 6, and 7 patients, respectively. Cholestasis due to common bile duct stenosis occurred in association with duodenal stenosis in 9 patients. Fifteen patients were treated surgically; 11 for gastroenterostomy, and 4 for duodenopancreatectomy. Two patients were not treated surgically. We conclude that during the course of chronic pancreatitis, symptomatic duodenal stenosis occurred in 5.6% of patients, mainly during the first years of the clinical course of chronic pancreatitis, was due to pancreatic head compression and not pseudocysts, usually involved the 2nd part of the duodenum and, was associated with biliary stenosis in half of the cases. Since these two complications require surgery, common bile duct stenosis should be investigated when symptomatic duodenal stenosis is diagnosed.

ISSN:0885-3177    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Only a small minority of alcoholics develop clinical evidence of pancreatitis. The reasons for this variation in individual susceptibility have not yet been defined. Recent studies have suggested that smoking may be a risk factor for the development of pancreatitis. However, there have been methodological problems with these studies regarding choice of controls and assessment of tobacco consumption. The present study was designed to determine whether smoking is a risk factor for pancreatitis in alcoholics. Tobacco consumption in alcoholics with pancreatitis was compared to that of alcoholics without pancreatitis (controls). Of 52 subjects with alcoholic pancreatitis, 86.5% were smokers compared with 87.2% of 47 alcoholic controls. Both daily and lifetime tobacco consumption in subjects with pancreatitis were less than those of alcoholic controls. Thus, there was no association between smoking and pancreatitis in this study. The previously described association between smoking and pancreatitis may be related to the high prevalence of smoking among alcoholics.

ISSN:0885-3177    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

This study was undertaken to establish if a correlation exists between chronic elevated pancreatic secretion and growth of the pancreas. Rats provided with jugular, pancreatic, biliary, duodenal, or ileal cannulas were fed throughout the experiment with a liquid diet continuously infused into the duodenum. Four days after surgery, control rats and those infused with cerulein (CE) 0.45 pgkg/h had their pancreatic juice returned into the duodenum. Two other groups had their pancreatic juice either totally diverted outside (DO) or returned into the ileum (DI). In all groups, bile was returned into the duodenum. Pancreatic juice was collected every 4 h for 4 days with volume and protein determined. After 4 days, rats were killed and their pancreata were evaluated for weight and contents of DNA, RNA, protein, amylase, and chymotrypsinogen. The average volumes/4 h were significantly increased by 259, 241, and 270% in DO, DI, and CE rats, respectively. Protein output remained at control levels in DO rats, whereas increases of 200 and 90% above control values were observed in DI and CE rats, respectively, during the last periods of collection. Constant drainage of pancreatic juice outside (DO) had no effect on pancreatic growth; on the contrary, its reinfusion into the ileum and constant cerulein infusion were associated with impressive growth of the pancreas, with cerulein being the most potent stimulus. In conclusion these data support the hypothesis that increased protein output is associated with pancreatic growth, a phenomenon mediated by endogenous cholecystokinin.

ISSN:0885-3177    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The diagnostic value of bile salt-dependent lipase for pancreatic diseases was tested in sera of 187 patients. Of these patients, 76 suffered from pancreatic carcinoma, 43 from nonmalignant liver diseases (cirrhosis and chronic hepatitis), 18 from acute pancreatitis, and 20 from chronic pancreatitis. The remaining subjects were controls without pancreatic pathology. Bile salt-dependent lipase was determined by a sandwich enzyme-linked immunosorbent assay using polyclonal antibodies. Amylase and CA 19–9 antigen were also determined. In sera from control patients, the mean level of bile salt dependent lipase was 1.5 μg/L. This level is quite similar to that of patients with benign liver diseases (1.1 μg/L) and with chronic pancreatitis (1.4 μg/L), but it was raised to 3.5 μg/L in patients with acute pancreatitis and decreased to 0.5 μg/L in subjects with pancreatic adenocarcinoma. Thirty percent of control subjects and 73% of cancer patients had a bile salt-dependent lipase serum level below the cutoff value of 0.5 μg/L. In acute pancreatitis, 11 of 16 subjects had levels above 1.5 μg/L. Amylase level largely increased in acute pancreatitis but was normal in all other groups. Concerning CA 19–9 antigen, 65% of control patients and >SO% of patients with nonmalignant pancreatic or liver diseases had normal levels. In sera from cancer patients, 80% presented with high levels. Accordingly, 36 of 38 patients with pancreatic cancer had either low serum levels of bile salt-dependent lipase (< 0.5 μg/L) or high values of CA 19–9 antigen (>37 U/ml; sensitivity 95%). In control patients 2 of 30 had low levels of enzyme or elevated levels of CA 19–9 (specificity 94%). Therefore, assay of the serum level of bile salt dependent lipase, alone or more usefully in conjunction with CA 19–9 antigen, helps to diagnose pancreatic carcinoma and to discriminate malignant diseases from either chronic or acute pancreatitis.

ISSN:0885-3177    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Sodium butyrate is widely used to differentiate insulinoma cell lines. However, sodium has been shown to decrease glucose phosphorylation in the liver and heart and decrease the expression of glucose transporter. Since these mechanisms are essential for glucose induced insulin secretion, the ultimate function of the pancreatic β-cell, we investigated the effect of sodium butyrate on both glucose-phosphorylating enzymes as well as glucose transport in the pancreatic cell line RINm5F. Treatment of RIN-m5F cells with 2.5 mMsodium butyrate for 72 h increased by twofold both hexokinase and glucokinase (GK) activities, as well as the gene expression of GK. Sodium butyrate treatment had no effect on GLUT-1 mRNA levels but increased the GLUT-2 mRNA 3.7-fold. Kinetic analysis of 2-deoxyglucose transport displayed a single curve with Km= 1.2 mMand Vmax= 10.9 pmol/μg protein/min in the untreated cells, values similar to the low Kmglucose transport reported in the pancreatic β-cells. This low Kmtransport component markedly decreased with sodium butyrate treatment, and interestingly a second component with a higher Kmappeared, consistent with the increase in GLUT-2 mRNA. We conclude that the differentiating action of sodium butyrate involves increases in GK and GLUT-2 gene expression, which characterizes the differentiated state of the pancreatic p-cell. However, the inhibitory effect of sodium butyrate on low K, glucose transport needs to be considered in the use of this compound to promote differentiation.

ISSN:0885-3177    

出版商:OVID    

年代:1993

数据来源: OVID