L—盐酸赖氨酸对脑损伤大鼠胰高血糖素和血糖含量的影响

目的　研究 Ｌ盐酸赖氨酸对脑损伤后大鼠的胰高血糖素、胰岛素及血糖含量的影响。方法　采用落体法致大鼠脑损伤;伤后立刻一次腹腔注射 Ｌ盐酸赖氨酸,２４ｈ 后断头处死,用免疫组织化学 Ａ Ｂ Ｃ 法结合图像分析技术,观察 Ｌ盐酸赖氨酸（６２１ ．５ｍｇ·ｋｇ － １ 及３１０ ．８ｍｇ·ｋｇ － １） 对脑损伤后大鼠胰岛 Ａ 细胞内胰高血糖素（ Ｇｌｕ） 及 Ｂ 细胞内胰岛素（ Ｉｎｓ） 免疫反应强度和光密度值的影响;用生化分析仪测定血糖含量。结果　 Ｌ盐酸赖氨酸能显著增强 Ａ 细胞内 Ｇｌｕ 免疫反应强度,提高平均光密度值,增加 Ｇｌｕ 的含量,并降低血糖水平,但对 Ｂ 细胞内 Ｉｎｓ 的免疫反应强度及光密度值无明显影响。结论　 Ｌ盐酸赖氨酸可抑制 Ｇｌｕ 的释放并产生显著的降血糖作用。     

内窥镜十二指肠乳头切开术的应用解剖

目的：为临床经内窥镜十二指肠乳头括约肌切开术（Ｅｎｄｏｓｃｏｐｉｃｓｐｈｉｎｃｔｅｒｏｔｏｍｙ,ＥＳＴ）提供形态学的依据。方法：３０例正常成人腹部标本,解剖观测胆总管、胰管、肝胰壶腹和乳头区长度、宽度,胆总管与胰管的夹角,肝胰壶腹区的血管分布。结果：肝胰壶腹及十二指肠乳头区的营养动脉平均为２．１支,均来源于胰十二指肠上动脉、胰十二指肠下动脉,其中肝胰壶腹区及十二指肠乳头区９～１２点钟处营养动脉的出现率为４６．１％（２９支）。测量胆总管、胰管、壶腹末端的长度分别为３２．１±８．９ｍｍ、９．９±３．９ｍｍ、１２．８±２．９ｍｍ;宽度分别为７．２±２．２ｍｍ、３．１±０．６ｍｍ、７．１±１．４ｍｍ。胆总管和胰管间的夹角７０％为２０°至４５°,平均３５．４°。结论：本实验的结果为临床在ＥＳＴ中选择切开部位和切开的深度等提供了理论依据,对防止术后并发症具有重要的临床意义。     

5-氟尿嘧啶在胰十二指肠切除术患者血液和胰液中的动态分布

探讨５－氟尿嘧啶能否通过胰十二指肠切除术后的残留胰腺组织进入胰液中,并达有效的治疗浓度,为胰腺为临床合理化疗提供理论依据。方法通过观察胰十二指肠切除术患者胰快速推注５－氟尿嘧啶后血液和胰液中药物动态分布及相关性,术后静脉一次性快速推注５－氟尿嘧啶１．０ｇ／ｍ＾２,在给药前后按设计时间点分别采集静脉血和胰液,采用高效液相色谱法测定血浆和胰液５－氟尿嘧啶药物浓度,应用ＰＣＮＯＮＬＩＮ程序程序计算共动态     

胰腺假性囊肿治疗方法的选择

该文报告２３例胰腺假性囊肿,根据病期、囊肿大小、部位选择治疗方法,其中非手术治疗５例,外引流１例,内引流１４例,囊肿切除术３例。结果：无手术死亡,非手术治愈５例,外引流术后胰瘘１例,囊肿切除术后复发１例,内引流术后无严重并发症出现。我们认为急性囊肿应观察６周,有些病例有自行消散的可能,慢性囊肿一经确诊即可行内引流治疗,内引流是目前较理想的有效手术方式     

Molecular diagnosis of exocrine pancreatic cancer using a percutaneous technique

Background: The K-ras oncogene is activated by point mutations at codon 12 in most patients with exocrine pancreatic cancer. Mutant-enriched polymerase chain reaction (PCR) amplification can enhance the detection of mutated K-ras. This technique was applied to patients undergoing percutaneous fine-needle aspiration (FNA) biopsy of suspect pancreatic lesions. Methods: Twenty-five patients underwent percutaneous FNA of the pancreas for cytologic and molecular analysis. After preparing cytologic smears, the 22-gauge needle and syringe used for FNA were rinsed in RPMI-1640. The specimen was centrifuged, and DNA was extracted from the supernatant and subjected to mutant-enriched PCR using appropriate mismatched primers that introduce a BstNI restriction endonuclease cleavage site at codon 12 of wild-type, but not mutant, K-ras. After digestion with BstNI, the DNA was reamplified. To increase assay sensitivity, the final five PCR cycles were completed incorporating 5 μCi of (α-32P)dCTP. The DNA was then redigested and subjected to gel electrophoresis and autoradiography. Results: The median amount of DNA retrieved per specimen was 3.33 μg. Mutant K-ras was detected as a band of 143 bps; residual wild-type DNA was seen as a 114-bp fragment. Twenty-one of 25 specimens demonstrated mutated K-ras DNA. Two patients with nondiagnostic cytology results had mutated K-ras DNA; adenocarcinoma of pancreatic origin was confirmed in both cases after pancreatectomy. Conclusion: The molecular diagnosis of pancreatic cancer through identification of mutations in K-ras can be readily performed on specimens obtained by percutaneous FNA. As aggressive multimodality management of this disease becomes more common, pretreatment analysis of molecular determinants may have greater clinical significance. Presented at the 48th Cancer Symposium of The Society of Surgical Oncology, Boston, Massachusetts, March 23–26, 1995.     

Phosphate and thiophosphate group donating adenine and guanine nucleotides inhibit glibenclamide binding to membranes from pancreatic islets

Summary In microsomes obtained from mouse pancreatic islets, the Mg complex of adenosine 5-triphosphate (MgATP) increased the dissociation constant (K _D) for binding of [³H]glibenclamide by sixfold. In the presence of Mg²⁺, not only ATP but also adenosine 5-0-(3-thiotriphosphate) (ATPS), adenosine 5-diphosphate (ADP), guanosine 5-triphosphate (GTP), guanosine 5-diphosphate (GDP), guanosine 5-0-(3-thiotriphosphate) (GTPTS) and guanosine 5-0-(2-thiodiphosphate) (GDP S) inhibited binding of [³H]glibenclamide. These effects were not observed in the absence of Mg²⁺. Half maximally effective concentrations of the Mg complexes of ATP, ADP, ATPS and GDP were 11.6, 19.0, 62.3 and 90.1 mol/l, respectively. The non-hydrolyzable analogues adenosine 5-(,-imidotriphosphate) (AMP-PNP) and guanosine 5-(,-imidotriphosphate) (GMP-PNP) did not alter [³H]glibenclamide binding in the presence of Mg²⁺. MgADP acted much more slowly than MgATP and both MgADP and MgADP did not inhibit [³H]glibenclamide binding when the concentrations of MgATP and MgATP were kept low by the hexokinase reaction. Development of MgATP-induced inhibition of [³H]glibenclamide binding and dissociation of [³H]-glibenclamide binding occurred at similar rates. However, the reversal of MgATP-induced inhibition of [³H]glibenclamide binding was slower than the association of [³H]glibenclamide with its binding site. Exogenous alkaline phosphatase accelerated the reversal of MgATP-induced inhibition of [³H]glibenclamide binding. MgATP enhanced displacement of [³H]glibenclamide binding by diazoxide. The data suggest that sulfonylureas and diazoxide exert their effects by interaction with the same binding site at the sulfonylurea receptor and that protein phosphorylation modulates the affinity of the receptor.Some of the results described here are part of the medical theses of S. Löser and I. Rietze Send offprint requests to M. Schwanstecher at the above address     

胰腺囊实性肿瘤8例临床病理学分析

目的 观察胰腺囊实性肿瘤(CSTP)的临床病理及免疫组化特点。方法 组织学HE、PAS法，免疫组化SP法。结果 8例CSTP中，女性7例，男性1例；年龄19～32岁，平均26岁。手术后均无复发；肿瘤平均直径9cm，有包膜、囊实性相问。镜检：肿瘤由乳头和囊实性区混合而成，细胞大小形态较一致，核圆、卵圆，异形不明显，核分裂罕见。免疫组化8例al抗胰蛋白酶、VIMENTIN弥漫阳性，2例CK阳性，3例CgA、Syn局灶阳性；Insulin、EMA阴性。结论 胰腺囊实性肿瘤多发生于年轻女性，具有独特临床病理特点。预后好，应视为低度恶性肿瘤。     

胰十二指肠切除术近期合并症及技术改进

目的:探讨如何提高壶腹周围肿瘤的切除率以及降低胰十二指肠切除术后的主要并发症-胰漏的发生.方法:1995年3月～2000年12月本院行胰十二指肠术126例,除经典的手术步骤,作者对手术方法进行了改进,完整切除胰腺钩突,在门静脉与胰头粘连时应仔细分离,受到浸润时可合并门静脉侧壁或部分切除,胰肠端侧吻合时,将胰腺残端确切地套入空肠,并在吻合口两角危险区及前壁覆盖一束大网膜.结果:胰十二肠切除技术的改进,提高了切除率和生存率,而且并发症并未增加,本组患者1、3年生存率分别为71.4%、48.6%;胰肠端端吻合胰漏的发生率为4.8%,端侧吻合加吻合口周围附以带蒂大网膜无胰漏发生.结论:随着外科学的进步,胰十二指肠切除及合并门静脉部分切除已是安全有效的手术方式,胰肠端侧吻合加吻合口周围覆盖大网膜能有效地避免胰漏的发生.     

经PCS区域动脉灌注健择和5-氟尿嘧啶治疗中晚期胰腺癌的疗效观察

 目的　评价经PCS区域动脉灌注健择和 5 氟尿嘧啶治疗中晚期胰腺癌的疗效和安全性。方法　 36例中晚期胰腺癌患者分为 2组 ,16例行经PCS区域动脉灌注化疗 (B组 ) ,另 2 0例行外周静脉全身化疗 (A组 )。结果　B组临床受益反应有效率为 75 .0 % (12 / 16 ) ,A组为 4 5 .0 % (9/ 2 0 ) (P <0 .0 5 ) ,A组和B组 6个月、1年生存率和中位生存期分别为 35 .0 %、15 .0 %、6 .8个月和 6 8.7%、37.5 %、11.4个月 ,P<0 .0 5。结论　经PCS区域动脉灌注化疗较外周静脉化疗能提高中晚期胰腺癌的临床受益反应、改善生活质量 ,提高远期生存率。     

吉西他滨联合顺铂或氟尿嘧啶治疗晚期胰腺癌临床疗效的比较

目的　比较GP方案 (吉西他滨 顺铂 )与GF方案 (吉西他滨 氟尿嘧啶 )治疗晚期胰腺癌的近期疗效和毒副作用。方法　经病理组织学或细胞学检查证实的 60例胰腺癌患者 ,随机分为GP组和GF组 ,各 3 0例。GP组给予吉西他滨 10 0 0mg/m2加生理盐水 10 0ml,静脉滴注 3 0min ,第 1、8、15天 ;顺铂 40mg ,静脉滴注 ,第 15、16、17天。GF组给予吉西他滨 10 0 0mg/m2 加生理盐水 10 0ml ,静脉点滴 3 0min ,第 1、8、15天 ;氟尿嘧啶 5 0 0mg/m2 加 5 %GS 5 0 0ml ,静脉滴注时间超过 6h ,第 1～ 5天。结果　GP组PR 3例 ,MR 5例 ,NC 12例 ,PD 5例 ,PR MR为 3 2 .0 % ,中位生存期为 8.7个月 ,临床受益反应率 (CBR )为 5 7.7% (15 /2 6) ,CA 19 9水平下降超过 5 0 %者达 48.1% (13 /2 7)。GF组PR 3例 ,MR 8例 ,NC 9例 ,PD 4例 ,PR MR为 45 .8% ,中位生存期为 10 .1个月 ,CBR 82 .1% (2 3 /2 8) ,CA19 9水平下降超过 5 0 %者达 5 3 .6% (15 /2 8)。 2组比较 ,CBR有显著性差异 (P <0 .0 5 ) ,GF疗效较佳。不良反应主要为白细胞减少和血小板减少 ,2组无显著性差异。结论　含吉西他滨的联合化疗方案与以往单药方案比较 ,疗效高、副作用小、患者中位生存期长 ,临床受益反应率 (CBR )高 ;GP方案和GF方案比较 ,后者CBR更高 (5