Chronic pancreatitis and extrapancreatic cancer A retrospective study among 181 patients with chronic pancreatitis

Summary The relationship between chronic pancreatitis (CP) and extrapancreatic cancer has been debated in the recent years. In prospective studies, it has been found that pancreatic cancer develops in 0–5% of patients with chronic pancreatitis. Many papers describe an increased relative risk for developing extrapancreatic cancer in patients suffering from chronic pancreatitis. In this study including 181 patients with CP, we found 14 patients with extrapancreatic cancer (three of these had two different types of cancer). No patient had pancreatic cancer. It was found that the respiratory airways and upper gastrointestinal tract were the dominating locations (five and four cases, respectively), but also genital and hemolymphopoietic cancers were represented (four and two cases, respectively). Two patients had metastatic cancer with unknown primary tumor. The patients with cancer tended to be older than those without cancer. The patients with CP had a 2.43 times greater risk of developing cancer than the general Danish population (age and sex standardized comparison). The relatively large number of cancers in the upper gastrointestinal tract and respiratory airways suggest that tobacco and alcohol may be responsible, as these organs have the highest exposure to these compounds, which are well known carcinogens.     

慢性阻塞性肺疾病与凝血-纤溶功能异常

慢性阻塞性肺疾病（COPD）是以气道、肺实质和肺血管的慢性炎症为特征。因肺内通气血流比例失调致慢性缺氧，可继发红细胞增多和血黏滞度增高，引起血流高黏、高聚、高凝及微血栓形成。COPD急性加重期凝血-纤溶功能异常进一步恶化，对病情进展的影响已经为临床高度关注。研究同时发现COPD与静脉血栓栓塞症（VTE）关系密切，其合并深静脉血栓（DVT）甚至肺血栓栓塞症（PTE）已成为重要的医疗保健问题。     

慢性阻塞性肺疾病患者撤机方式的探讨

目的探讨慢性阻塞性肺疾病并发呼吸衰竭患者无创通气撤机方式是否改善预后。方法选择COPD并发急性高碳酸血症呼吸衰竭插管上机患者51例,在插管机械通气24~48 h后,尝试T型管自主呼吸试验,若失败则对比两种撤机方式:①拔管后通过口鼻面罩接无创通气(治疗组n=26例);②不拔管,经气管插管给予PSV方式通气(对照组n=25例)。观察并比较两组患者动脉血气、机械通气时间、住ICU时间、呼吸机相关性肺炎及60 d生存率。结果住院时所有患者均有严重高碳酸血症呼吸衰竭,治疗组n=26:pH 7.21±0.06;PaCO2(95.4±18.9)mm Hg;对照组n=25:pH 7.21±0.07,PaCO2(93.7±17.7)mm Hg(P均>0.1),两组患者临床特征类似。治疗组平均机械通气时间(10.8±3.87)d,而对照组为(9±3.4)d(P>0.05);治疗组住ICU时间比对照组短(P<0.05),住院费用明显低于对照组(P<0.001),呼吸机相关性肺炎(VAP)发生率低于对照组(P<0.05),但60 d生存率两组无差异。结论无创通气可缩短住ICU时间,减少住院花费,降低VAP发生率。但对60 d生存率无影响。     

Survey of implementation of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines in nine Asian countries

After the release of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines in 2001 and update in 2003, its implementation in nine Asian countries was investigated. Questionnaire surveys involving thoraco-pulmonary physicians or internists investigated the awareness and consensus of the GOLD guidelines including the care and management of chronic obstructive pulmonary disease (COPD) patients in Asian. Two surveys were conducted, in June 2002 and March 2004, through questionnaires by direct mail in Japan and face-to-face interviews in the other countries. Approximately 600 questionnaires were returned with approximately 84% awareness of the publication and its update and nearly 90% appreciated the globalization efforts. The survey revealed great variances concerning the definition of COPD, its diagnosis, and use of computed tomography. As for the implementation, the majority answered the use of the combined local and GOLD guidelines in five of nine countries surveyed, while the GOLD guidelines were implemented mainly in Korea, suggesting the influence in daily practice for care and management of COPD patients. Implication of rehabilitation in clinical practice has not been standardized despite high evidence of its advantages. Most respondents stated the necessity of developing a local or regional guideline for best practice. Our survey revealed: (i) awareness of the GOLD guidelines was high and well accepted; (ii) the possibility of developing a uniform or standard guideline in Asia is low due to local characteristics; (iii) modifications of the GOLD guidelines may be more practical; and (iv) that the multidisciplinary pulmonary rehabilitation program needs to be further activated in GOLD implementation for the Asia–Pacific region.     

慢性胰腺炎糖尿病的发生率及其风险因素分析

Objective To investigate the incidence of diabetes mellitus and risk factors for the disease in chronic pancreatitis (CP) patients.Methods A historical cohort study on subjects with painful CP who were admitted to hospital from Jan.1997 to July 2007 were conducted.A life-table method was used to estimate the cumulative probability of the development of diabetes mellitus once clinical onset of abdominal pain.Cox proportional-hazards model was used for multivariate analysis of the variables including age,sex,drinking and smoking habits,etiological factor,presence of pancreatic masses,pancreatic calcifications,measure of intervention,diarrhea,weight loss and degree of pain.Results Data were obtained from 354 patients (239 males,mean age at onset of pain (38.1±17.6) years;alcoholic origin 18.1%) with painful CP.The mean follow-up period was (45.2±32.9)months.The rate of diabetes mellitus in CP patients was 16.1%.There was a high incidence (29.8%)of diabetes mellitus 1 year before the episodes of abdominal pain.The cumulative risk of diabetes mellitus in subjects 5 and 10 years after the episodes of pain was 9.3% and 20.7%,respectively.Cox proportional-hazards model selected smoking (＞10 pack years) (hazard rate (HR)= 3.3),mild abdominal pain (HR=5.2),weight loss (HR = 2.6) and pancreatic calcifications (HR = 2.2) as variables identifying subjects with diabetes mellitus in patients with painful CP before they were performed therapeutic endoscopy or surgical intervention.Smoking (＞10 pack years) (HR = 3.0),weight loss (HR= 2.8) and distal pancreatectomy (HR =7.3) were identified with an increased risk of diabetes mellitus in these cases after they received therapeutic endoscopy or surgical intervention.Conclusion The risk factors of diabetes mellitus for CP appears to be independent of smoking (＞10 pack years),mild abdominal pain,weight loss,pancreatic calcifications and distal pancreatectomy.     

胃黏膜脱垂与慢性胃炎关系探讨

目的研究胃黏膜脱垂(prolapseofgastricmucosa ,GMP)与慢性胃炎的关系。方法选取二组接受胃镜检查的患者①慢性胃炎组,均符合1996年悉尼慢性胃炎诊断标准,并除外胃、十二指肠溃疡性疾病及十二指肠球部变形者。共10 3例,男5 7例,女46例。年龄2 2～74岁,平均年龄48 9岁。②对照组同期接受胃镜检查的患者,未发现胃、十二指肠存在活动性炎症、溃疡等病变表现,亦为10 3名,男60名,女43名。年龄2 0～76岁,平均年龄47 3岁。结果①共69例( 3 3 .5 % )存在GMP ,其中慢性胃炎患者及对照组中分别为43例( 4 1.7% )及2 6例( 2 5 .2 % ) ,慢性胃炎组中GMP检出率显著高于对照组(P <0 .0 5 )。②GMP在各年龄组,男女间发病率无显著性差异(P >0 .0 5 )。③GMP患者中Helicobecterpylori检测阳性率( 10 7% )显著低于GMP阴性患者H .pylori检出率( 2 6.2 % ) (P <0 .0 5 )。④43例伴GMP的慢性胃炎中胃窦条状红斑( 3 0 .2 % )、食管炎( 16.3 % )均高于60例不伴GMP中相应比例( 10 .0 % ,P <0 .0 1;3 .3 % ,P <0 .1)。结论GMP与慢性胃炎相关,胃窦条状红斑为特征性表现,GMP患者易合并食管炎;GMP发生与性别年龄无关;GMP患者H .pylori感染率较低。     

Up-regulation of transferrin receptor 1 in chronic hepatitis C: Implication in excess hepatic iron accumulation.

BACKGROUND/AIMS:: To clarify the mechanism of excess hepatic iron accumulation in chronic hepatitis C, we investigated the expressions of transferrin receptor 1 and divalent metal transporter 1 in hepatocytes, both of which are involved in cellular iron uptake, in relation to the degree of hepatic iron accumulation and hepatic fibrosis by immunohistochemistrical study. METHODS:: Forty-six hepatic tissues with chronic hepatitis C and five normal hepatic tissues were examined. Chemical detection of hepatic iron accumulation was performed by Perl's Prussian blue stain. The immunohistochemistrical study was performed by avidin-biotin complex method with alkaline phosphatase. RESULTS:: In chronic hepatitis C: (1) Hepatic iron accumulation was significantly increased in relation to the advance of the fibrosis. (2) Divalent metal transporter 1 decreased significantly in relation to the advance of hepatic fibrosis. (3) Transferrin receptor 1 expression was always detected, although not in normal hepatic tissues; there was no relation between expression levels and the degree of hepatic fibrosis. CONCLUSIONS:: These data demonstrated that the transferrin receptor 1 expression was up-regulated irrespective of the degree of hepatic iron accumulation, suggesting that the up-regulation of transferrin receptor 1 might act as one of the key mechanisms implicated in the accumulation of hepatic iron in chronic hepatitis C.     

Safety and effi cacy of hepatitis A vaccine in children with chronic liver disease

INTRODUCTION Hepatitis A virus (HAV) infection is common. In general, hepatitis A is a self-limited illness with a recovery time measured in months[1]. Young children are often asymptomatic, whereas adults are more likely to be symptomatic and may present…