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1.
Kazuyuki Nagai Ryuichiro Doi Tatsuo Ito Atsushi Kida Masayuki Koizumi Toshihiko Masui Yoshiya Kawaguchi Kohei Ogawa Shinji Uemoto 《Journal of hepato-biliary-pancreatic sciences》2009,16(3):353-358
Background
The international consensus guidelines (the guidelines) for management of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas recommend surgical resection of branch duct IPMNs with any of the following features: cyst size >30 mm, mural nodules, main pancreatic duct diameter >6 mm, positive cytology, and symptoms. The aim of this study was to evaluate the usefulness of these guidelines for resection of branch duct IPMNs.Methods
We reviewed 84 consecutive patients with branch duct IPMNs who underwent surgical resection at our hospital between January 1984 and December 2007.Results
Sixty-nine patients had indications for resection according to the guidelines. Malignant IPMNs had significantly larger cysts than benign tumors (P = 0.026). Patients with malignant IPMNs had significantly more indications for resection than those with benign IPMNs (2.6 ± 1.0 vs. 1.7 ± 0.9, P < 0.001), and 36 of the 37 patients with malignant IPMNs had indications. The sensitivity of the guidelines for predicting malignancy was 97.3%. One of 15 patients without indications had malignancy, and the specificity was low (29.8%).Conclusions
The guidelines show a high sensitivity for predicting malignancy of branch duct IPMNs, but the specificity is low. The cyst size and the total number of indications in each patient should be taken into account when predicting the risk of malignancy for branch duct IPMNs. 相似文献2.
Noritoshi Kobayashi Masahiko Inamori Koji Fujita Toshio Fujisawa Nobutaka Fujisawa Hirokazu Takahashi Masato Yoneda Yasunobu Abe Harunobu Kawamura Takeshi Shimamura Hiroyuki Kirikoshi Kensuke Kubota Takashi Sakaguchi Satoru Saito Lawrence J. Saubermann Atsushi Nakajima 《Journal of hepato-biliary-pancreatic sciences》2008,15(2):169-177
Background/Purpose
Intraductal papillary-mucinous neoplasms (IPMNs) of the pancreas have a favorable prognosis. However, invasive ductal carcinomas of the pancreas show a rapid progression. The aim of this study was to investigate gene mutations in pure pancreatic juice from IPMN patients and to define these genetic mutations in relation to the histopathological and clinical features of IPMNs.Methods
Twenty-two patients with IPMN, 21 patients with ductal carcinoma, and 20 patients with normal pancreas or chronic pancreatitis were recruited for this study. We measured the main pancreatic duct’s largest diameter and the maximum size of a dilated branch was assessed by ultrasonography or endoscopic ultrasonography. Pure pancreatic juice was collected and was investigated for K-ras, p16, and p53 mutations.Results
Mutant K-ras gene was detected in 13 of the 22 patients (59.1%) with IPMNs. Different kinds of mutations were detected in the same patient in 4 cases. In the 13 patients with mutant K-ras gene, the diameter of the most dilated part of the main pancreatic duct was 2–8 mm (average, 4.5 mm) and in 7 patients with wild-type K-ras gene, the diameter was 2–5 mm (average, 2.7 mm). There was a significant difference in the diameter of the main pancreatic duct between patients with and without the mutant K-ras gene (P = 0.0323).Conclusions
The incidence of K-ras mutation may be associated with the hypersecretion of mucin. 相似文献3.
Takashi Hatori Akira Kimijima Izumi Fujita Toru Furukawa Masakazu Yamamoto 《Journal of hepato-biliary-pancreatic sciences》2010,17(6):824-830
Background/Purpose
Total pancreatectomy (TP) is sometimes performed to treat low-grade malignant neoplasms that are spreading to the entire pancreas. However, TP impairs quality of life, due to the resulting loss of pancreatic exocrine and endocrine function, and an organ-preserving procedure should be chosen to minimize the impact of pancreatic dysfunction. Recently, we performed four duodenum-preserving TPs (DPTPs) on patients with low-grade malignant neoplasms of the entire pancreas and we introduce our operative technique and results herein.Methods
DPTP is performed with the objective of preserving the arterial arcade of the posterior pancreas so as to maintain good blood flow in the duodenum and common bile duct. Care must also be taken to preserve the splenic artery and vein to protect the spleen. When patients are also undergoing a bile duct resection, an end-to-side choledochoduodenostomy is also performed to reconstruct the biliary tract.Results
Patient 1: DPTP with preservation of the spleen, conserving splenic vessels, was performed on a patient with hereditary pancreatic carcinoma with pancreatic intraepithelial neoplasia-3 (PanIN-3). Patient 2: DPTP with splenectomy was performed on a patient with multiple metastases of the entire pancreas from renal cell carcinoma. Patient 3: DPTP with preservation of the common bile duct and the spleen, conserving splenic vessels, was performed on a patient with minimally invasive carcinoma derived from intraductal papillary mucinous neoplasm (IPMN). Patient 4: DPTP with preservation of the spleen, conserving splenic vessels, was performed on a patient with minimally invasive carcinoma derived from IPMN. No deaths or morbidity occurred. All patients were placed on pancreatic enzyme replacement therapy and given a daily dose of insulin of approximately 30 U. Complete professional rehabiliation was achieved in all patients. All patients except one gained weight, and the hemoglobin A1c (HbA1c) levels have been maintained at around 7%.Conclusions
DPTP is a useful organ-preserving procedure for low-grade malignant neoplasms spreading within the entire pancreas. This procedure minimizes the impact of pancreatic dysfunction and allows the patient to maintain good nutrition after surgery. 相似文献4.
Song C. Kim Kwan T. Park Young J. Lee Sang S. Lee Dong W. Seo Seong K. Lee Myung H. Kim Se J. Jang Jae H. Byun Duck J. Han 《Journal of hepato-biliary-pancreatic sciences》2008,15(2):183-188
Background/Purpose
Appropriate surgical treatment strategies based on clinicopathological findings are unavailable for intraductal papillary mucinous neoplasm (IPMN) of the pancreas. We investigated the clinical features of pancreatic IPMN in a single-center database in order to design an optimal surgical strategy.Methods
The medical records of 118 consecutive patients who had undergone surgical resection between August 1994 and December 2004, in whom IPMN was histologically confirmed, were reviewed retrospectively for radiological and pathological findings.Results
Most of the invasive carcinomas in these patients were detected as the main-duct type (88.5%). The type of tumor (main-duct type vs branched-duct type), the tumor size, and the dilated duct size were significant predictive factors associated with malignancy. The relative risk of malignancy was greatest at 13-mm or more ductal dilation in the main-duct type (Odds ratio, 4.1), at 35-mm or more tumor size (Odds ratio, 7.6), and for main-duct type (Odds ratio, 3.9). Major pancreatic resections such as total pancreatectomy and pancreatoduodenectomy were performed in 14.5% and 69% of the patients, respectively. There was a 19.5% rate of incomplete resection, with these patients having a positive resection margin. However, significant recurrence did not occur in patients with a benign IPMN lesion which remained at the resection margin. The overall postoperative survival rate at 5 years was 98.2% for benign IPMN and 65.3% for malignant IPMN.Conclusions
Function-preserving strategies, based on the clinical status of the patient, are necessary in order to avoid possible severe metabolic complications following extended pancreatectomy in patients with benign IPMN because of the low recurrence rate and good prognosis of this entity, irrespective of margin status.5.
Nobuyuki Ozaki Masaki Ohmuraya Satoshi Ida Daisuke Hashimoto Yoshiaki Ikuta Akira Chikamoto Masahiko Hirota Hideo Baba 《Journal of hepato-biliary-pancreatic sciences》2013,20(6):620-627
Background
Serine protease inhibitor Kazal type 1 (SPINK1) is expressed in normal human pancreatic acinar cells and in a variety of tumors, and binds to the epidermal growth factor receptor (EGFR), mediating cell proliferation through the mitogen-activated protein kinase cascade in pancreatic cancer cell lines. Here, we aimed to assess SPINK1 and EGFR expression in various neoplastic lesions, including tissues demonstrating precancerous changes.Methods
Surgical specimens of pancreatic ductal adenocarcinoma (n = 23), intraductal papillary mucinous neoplasm (IPMN; n = 21), pancreatic neoplasms other than ductal adenocarcinoma (n = 8), chronic pancreatitis (n = 11), and pancreatic intraepithelial neoplasia (PanIN) lesions within the resected specimens were analyzed immunohistochemically for SPINK1 and EGFR expression.Results
Sixty-five PanIN-1A, 32 PanIN-1B, 17 PanIN-2, and 6 PanIN-3 were identified. Both SPINK1 and EGFR were expressed in almost all PanIN lesions. All tubular ductal adenocarcinoma, IPMN, and mucinous cystadenocarcinoma samples (neoplasms of ductal origin) expressed SPINK1, whereas acinar cell carcinoma, anaplastic carcinoma, adenosquamous carcinoma, insulinoma, and islet cell carcinoma did not. EGFR was expressed in 87 % of tubular adenocarcinoma and 48 % of IPMN lesions. Among IPMN lesions, malignant lesions (IPMC) expressed EGFR more often than benign lesions (IPMA) did. Scattered expression of EGFR was observed in normal pancreatic ducts and within the tubular complex within chronic pancreatitis lesions.Conclusions
These results indicate that SPINK1 plays a role as a growth factor, signaling through the EGFR pathway in pancreatic ductal adenocarcinoma and neoplasms, and that the EGFR is involved in the malignant transformation of IPMN. 相似文献6.
Uehara H Ishikawa O Katayama K Kawada N Ikezawa K Fukutake N Takakura R Takano Y Tanaka S Takenaka A 《Journal of gastroenterology》2011,46(5):657-663
Background
A mural nodule is a strong predictive factor for malignancy in branch duct intraductal papillary mucinous neoplasm (IPMN) of the pancreas, but the nodule size has hardly been considered. The aim of this study was to investigate whether a mural nodule of 10?mm was appropriate as an indicator of surgery for IPMN during follow-up.Methods
The follow-up outcomes of 100 patients who had branch duct IPMN without mural nodules or who had branch duct IPMN with mural nodules of less than 9?mm in a tertiary care setting were investigated retrospectively. The patients underwent abdominal ultrasound (US) every 3?months and additional imaging examinations or cytologic examination of pancreatic juice when necessary. Surgery was recommended to them when a mural nodule developed or when a nodule enlarged and reached 10?mm.Results
During an average follow-up period of 97?months, branch duct IPMNs developed mural nodules that reached 10?mm in 5 patients (0.62% per year). In one patient the IPMN was revealed to be non-invasive carcinoma by resection, 1 IPMN was shown to be malignant by further follow-up, and 3 were not resected because of refusal or the patient??s age. In 7 patients, mural nodules stayed within 9?mm. The remaining 88 patients lacked mural nodules in their branch duct IPMNs throughout the follow-up. The occurrence of invasive carcinoma around the IPMN was not indicated by imaging examinations in any patient. Univariate analysis showed that the size of the cyst at baseline significantly predicted the development of a mural nodule that reached 10?mm during follow-up (P?=?0.05).Conclusions
A mural nodule of 10?mm is appropriate as an indicator of surgery in the follow-up of branch duct IPMN. 相似文献7.
Takahashi S Kinoshita T Konishi M Gotohda N Kato Y Kinoshita T Kobayashi T Mitsunaga S Nakachi K Ikeda M 《Journal of hepato-biliary-pancreatic sciences》2011,18(4):567-574
Background
Borderline resectable pancreatic cancer (BRPC) appears to be most frequently related to a positive surgical margin and has a poor prognosis after resection. However, few reports are available on differences in tumor characteristics and prognoses among resectable pancreatic cancer (PC), BRPC, and unresectable PC.Methods
Records of 133 patients resected for pancreatic ductal adenocarcinoma and 185 patients treated as locally advanced PC (LAPC) were reviewed.Results
Twenty-four patients who initially underwent resection (BRPC-s) and 10 patients who were initially treated as LAPC (BRPC-n) met the criteria for BRPC. Prognosis of BRPC was significantly better than that of unresectable PC, but was significantly worse than that of resectable PC. BRPC-s showed more frequent nerve plexus invasion (P < 0.01), portal vein invasion (P < 0.01), and loco-regional recurrence (P = 0.03) than resectable PC. The positive surgical margin rate was not significantly higher in BRPC-s (29%) than in resectable PC (19%) (P = 0.41).Conclusions
BRPC had a poorer prognosis with more local failure than resectable PC although prognosis of BRPC was significantly better than that of unresectable PC. Considering the tumor and treatment characteristics, multidisciplinary treatment including resection is required for BRPC. 相似文献8.
Masahiko Hirota Atsushi Ichihara Satoshi Furuhashi Hiroshi Tanaka Hiroshi Takamori Hideo Baba 《Journal of hepato-biliary-pancreatic sciences》2009,16(6):792-795
Background
As a modification of hand-assisted laparoscopic pancreatectomy, we devised a method of spleen and gastrosplenic ligament preserving distal pancreatectomy, in which pancreatic resection is performed under direct vision extracorporeally.Methods
The distal pancreas and spleen are pulled out of the peritoneal cavity through the minilaparotomy at the epigastrium following hand-assisted laparoscopic dissection of the distal pancreas. Spleen-preserving pancreatectomy is performed safely under direct vision. The gastrosplenic ligament is also preserved to prevent splenic volvulus after the operation. The transected main pancreatic duct is doubly ligated, and the transected pancreatic stump is sewn manually. The preserved spleen and splenic vessels are placed back in the peritoneal cavity after resection.Results
In the current study (n = 3), overall morbidity rate, including splenic volvulus and pancreatic fistula, was 0%.Conclusion
Preservation of the gastrosplenic ligament and extracorporeal preparation of the transected pancreatic stump under direct vision are useful measures in spleen-preserving distal pancreatectomy under a minimum incision approach assisted by laparoscopy. 相似文献9.
Timothy L Frankel Jennifer LaFemina Zubin M Bamboat Michael I D'Angelica Ronald P DeMatteo Yuman Fong T Peter Kingham William R Jarnagin Peter J Allen 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2013,15(10):814-821
Background
The significance of a positive margin in resected non-invasive pancreatic intraductal papillary mucinous neoplasms (IPMN) remains controversial. The aim of this study was to determine recurrence rates when dysplasia was present at the final surgical margin.Methods
A prospectively maintained database identified 192 patients undergoing resection of non-invasive IPMN. Pathological, peri-operative and recurrence data were analysed.Results
Ductal dysplasia was identified at the final surgical margin in 86 patients (45%) and defined as IPMN or Pancreatic Intraepithelial Neoplasia PanIN in 38 (20%) and 54 (28%) patients, respectively. At a median follow-up of 46 months, 40 (21%) patients recurred with 31 developing radiographical evidence of new cysts, 6 re-resected for IPMN and 3 diagnosed with pancreatic cancer within the remnant. Of those with margin dysplasia, 31% developed recurrent disease compared with 13% in those without dysplasia (P = 0.002). On multivariate analysis, margin dysplasia was associated with a three-fold increased risk of recurrence (P = 0.02). No relationship between dysplasia and development of pancreatic cancer was found.Discussion
In this study, dysplasia at the margin after a pancreatectomy for non-invasive IPMN was associated with recurrence in the remnant gland, but not at the resection margin. While this finding may warrant closer follow-up, it does not identify a gland at higher risk for the subsequent development of invasive disease. 相似文献10.
Rintaro Mikata Takeshi Ishihara Motohisa Tada Katsunobu Tawada Masayoshi Saito Joe Kurosawa Harutoshi Sugiyama Yuji Sakai Toshio Tsuyuguchi Masaru Miyazaki Osamu Yokosuka 《Journal of gastroenterology》2013,48(7):866-873
Background
Cytological examination of pancreatic juice obtained during endoscopic retrograde cholangiopancreatography (ERCP) is well established, but its sensitivity for pancreatic cancer has not been satisfactory. The aim of this study was to evaluate the usefulness of repeated pancreatic juice cytology (PJC) via the endoscopic naso-pancreatic drainage (ENPD) tube in patients with pancreatic cancer compared with conventional PJC.Methods
We retrospectively investigated 139 patients with pancreatic disease. Between April 2004 and November 2007, conventional PJC was performed in 56 patients with pancreatic cancer and 23 with benign pancreatic stricture. Between January 2008 and November 2010, ENPD was used in 40 patients with pancreatic cancer and 20 with benign pancreatic stricture. The ENPD tube was placed into the main pancreatic duct for up to 3 days, and cytological samples of pancreatic juice were collected up to 6 times in total.Results
Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of the ENPD method for pancreatic cancer were 80, 100, 100, 71, and 87 %, respectively, revealing significantly higher sensitivity than the conventional method (p = 0.0001). Sensitivities according to tumor location and size were 90 % (19/21), 69 % (9/13), and 67 % (4/6) in the head, body, and tail of the pancreas, 88 % (7/8), 79 % (19/24), and 75 % (6/8) in tumors with a diameter less than 20 mm including carcinoma in situ, 21–40, and greater than 41 mm, respectively.Conclusions
The ENPD method was found to have high diagnostic yield, especially for tumors less than 20 mm or located in the pancreatic head, and might be useful for the diagnosis of early-stage pancreatic cancer. 相似文献11.
Asad Kutup Yogesh Vashist Jussuf T. Kaifi Emre F. Yekebas Jakob R. Izbicki 《Journal of hepato-biliary-pancreatic sciences》2010,17(6):758-762
Background
A pancreatic duct diameter (PDD) ranging from 4 to 5 mm is regarded as “normal”. The “large duct” form of chronic pancreatitis (CP) with a PDD > 7 mm is considered a classical indication for drainage procedures. In contrast, in patients with so-called “small duct pancreatitis” (SDP) with a PDD < 3 mm, extended resectional procedures are suggested including, as an “ultima ratio”, even total pancreatectomy.Methods
Between 1992 and 2008, among a total of 978 patients who were treated for CP, 51 suffered from SDP and underwent longitudinal “V-shaped excision” of the anterior aspect of the pancreas. The interval between symptoms and surgery varied from 12 to 123 months. Median follow-up was 87 months (range 32–131 months). A pain score was used as well as a multidimensional psychometric quality-of-life questionnaire.Results
Hospital mortality was 0%. The perioperative morbidity (30 days) was 19.1%. Median pain score decreased by 95.5%. Global quality of life index increased in median by 53.6% (range 37.5–80%). In 35 patients (75%), complete pain relief was achieved. The impairment of exocrine and endocrine pancreatic function after surgery was statistically not significant.Conclusions
Longitudinal “V-shaped excision” of the ventral pancreas is a secure and effective approach for SDP, achieving significant improvement in quality of life and pain relief. While sparing patients from unnecessary, extended resectional procedures, it appears not to result in substantial deterioration of exocrine and endocrine pancreatic function. 相似文献12.
Yoshitsugu Tajima Tamotsu Kuroki Amane Kitasato Tomohiko Adachi Ichiro Isomoto Masataka Uetani Takashi Kanematsu 《Journal of hepato-biliary-pancreatic sciences》2010,17(6):831-838
Background
A fragile or non-fibrotic pancreas increases the risk of postoperative pancreatic fistula (POPF) after pancreatic head resection, whereas pancreatic fibrosis decreases the risk. The degree of pancreatic fibrosis can be estimated using the time-signal intensity curve (TIC) of the pancreas, obtained with dynamic magnetic resonance imaging (MRI). We have investigated whether trainee surgeons can perform pancreatic anastomosis safely, without the occurrence of POPF, when patients are selected carefully based on a preoperative assessment of pancreatic fibrosis.Methods
Seventy-two consecutive patients who underwent pancreatic head resection were enrolled in this prospective trial. Dynamic contrast-enhanced MRI of the pancreas was performed preoperatively in all patients who, based on their pancreatic TIC profile, were then allocated to one of two groups: Group A comprised patients with type I pancreatic TIC, signifying a normal pancreas without fibrosis (n = 46); Group B comprised patients with type II or III pancreatic TIC, signifying a fibrotic pancreas (n = 26). An end-to-side duct-to-mucosa pancreaticojejunostomy was performed in all patients, with all patients in Group A operated on by two experienced surgeons, and all patients in Group B operated on by one of eight trainee surgeons at various stages of training.Results
There was no operative mortality. POPF developed in 19 patients: 12 patients with grade A POPF and seven with grade B. All except one of the POPF occurred in Group A patients. The POPF in the one patient from Group B was grade A (p < 0.001).Conclusions
A trainee surgeon can perform a secure pancreatic anastomosis without the occurrence of POPF in patients with a pancreas displaying a fibrotic pancreatic TIC on dynamic MRI scans. 相似文献13.
Yohei Minato Terumi Kamisawa Taku Tabata Seiichi Hara Sawako Kuruma Kazuro Chiba Go Kuwata Takashi Fujiwara Hideto Egashira Koichi Koizumi Itaru Saito Yuka Endo Satomi Koizumi Junko Fujiwara Takeo Arakawa Kumiko Momma Masanao Kurata Goro Honda 《Journal of hepato-biliary-pancreatic sciences》2013,20(6):628-633
Background/purpose
Although pancreatic cancer produces upstream obstructive pancreatitis, acute pancreatitis is a less common manifestation of pancreatic cancer. This study aimed to clarify the subgroup of pancreatic cancer patients who present with an episode of acute pancreatitis (Group I) in comparison with a matched group of pancreatic cancer patients without pancreatitis (Group II) and another group of acute pancreatitis patients without pancreatic cancer (Group III).Methods
This was a retrospective comparative study of 18 patients in Group I, 300 patients in Group II and 141 patients in Group III.Results
The mean age of Group I was 63.7 years and the male to female ration was 1:0.3. Serum CA 19-9 levels were elevated in 80 %. The main pancreatic duct was incompletely obstructed in 7 patients. There were no significant differences in location of tumor, clinical stage, resection rate and survival months between Group I and II. Acute pancreatitis secondary to pancreatic cancer was more likely to be mild (94 vs. 72 %, p < 0.05) and relapsed (39 vs. 16 %, p < 0.05) compared with Group III.Conclusions
Anatomic evaluation of the pancreas should be performed in patients with acute pancreatitis with no obvious etiology, even if the pancreatitis is mild, to search for underlying malignancy. 相似文献14.
A. E. Butler R. Galasso A. Matveyenko R. A. Rizza S. Dry P. C. Butler 《Diabetologia》2010,53(1):21-26
Aims/hypothesis
In a high-fat-fed rat model of type 2 diabetes we noted increased exocrine duct replication. This is a predisposing factor for pancreatitis and pancreatic cancer, both of which are more common in type 2 diabetes. The aim of the study reported here was to establish if obesity and/or type 2 diabetes are associated with increased pancreatic ductal replication in humans.Methods
We obtained pancreas at autopsy from 45 humans, divided into four groups: lean (BMI <25 kg/m2); obese (BMI >27 kg/m2); non-diabetic; and with type 2 diabetes. Pancreases were evaluated after immunostaining for the duct cell marker cytokeratin and Ki67 for replication.Results
We show for the first time that both obesity and type 2 diabetes in humans are associated with increased pancreatic ductal replication. Specifically, we report that (1) replication of pancreatic duct cells is increased tenfold by obesity, and (2) lean subjects with type 2 diabetes demonstrate a fourfold increase in replication of pancreatic duct cells compared with their lean non-diabetic controls.Conclusions/interpretation
Pancreatic duct cell replication is increased in humans in response to both obesity and type 2 diabetes, potentially providing a mechanism for the increased risk of pancreatitis and pancreatic cancer in those with obesity and/or type 2 diabetes. 相似文献15.
Jiarun Mo Aimin Yang Zilong Chen Tingji Shao Yang Zhang Qiang Chen 《Digestive diseases and sciences》2013,58(10):2903-2907
Background and Aims
Neuronostatin is encoded in the preprosomatostatin gene and exerts important physiological actions on neuronal and cardiovascular regulation and metabolism in diverse tissues. An intraperitoneal injection of neuronostatin can induce c-Jun expression in the periphery of pancreatic islets. Because of the relatively high amount of neuronostatin present in the pancreas, it is necessary to investigate the effects of neuronostatin on pancreas. Furthermore, little is known about the effect of neuronostatin on acute pancreatitis.Methods
Neuronostatin (30, 60, and 120 nmol) was injected in to the external jugular vein 30 min before retrograde infusion of 2 % sodium taurocholate into the pancreaticobiliary duct. After 6 h, histological damage of the pancreas was evaluated by pancreas weight and paraffin section. A blood sample was collected to determine the serum amylase and lipase activities.Results
In our findings, neuronostatin groups had a reduction in interstitial edema, acinar cell vacuolization, and inflammatory infiltration of the pancreas compared with the model group. Biochemical data showed that serum amylase and lipase activities were significantly decreased in neuronostatin-pretreated groups by comparison with the model group.Conclusions
Histopathologic examination suggests that neuronostatin ameliorated the histological damage of sodium taurocholate-induced acute pancreatitis in rats. The biochemical analysis was consistent with that obtained from histopathologic examination, which was toward a trend of attenuating acute pancreatitis. In summary, neuronostatin might be potentially capable of ameliorating pancreatic damage in acute pancreatitis in rats. 相似文献16.
Koichi Aiura Masahiro Shinoda Ryo Nishiyama 《Journal of hepato-biliary-pancreatic sciences》2011,18(2):276-281
Background
Ampullary tumors have to be completely resected, but substantial morbidity and mortality rates are associated with pancreaticoduodenectomy (PD). Local resection can be the procedure of choice in selected ampullary lesions for high-risk patients.Methods
Preoperative examination indicated that the ampullary tumor extended into the common bile duct without evidence of pancreatic duct involvement and no definite invasion into either the duodenum or the pancreas. We performed a complete resection of the extrahepatic bile duct and the ampulla of Vater, including the tumor, without performing PD by dissecting the intrapancreatic bile duct from the pancreas both downward towards the ampulla of Vater and upward using a transduodenal approach.Results
The operation was successfully completed, and the postoperative course was uneventful, with the exception of a minor pancreatic fistula from retropancreatic dissection. The final pathological examination demonstrated well-differentiated tubular adenocarcinoma limited to the mucosa with negative surgical margins.Conclusion
Complete resection of the extrahepatic bile duct and the ampulla of Vater through a transduodenal approach can be a feasible and safe surgical procedure for selected ampullary tumors in high-risk patients. 相似文献17.
Yoshiki Naito Koichi Suda Bunsei Nobukawa Hisafumi Kinoshita Masamichi Kojiro 《Journal of hepato-biliary-pancreatic sciences》2006,13(6):556-561
Backgroud/Purpose
Invasive ductal carcinoma (IDC) of the pancreas may be associated with cancerous occlusion of the main pancreatic duct (MPD) in its growth process, but at quite low a frequency; there are patients who do not develop this occlusion.Methods
This study examined the histological features of surgical specimens from 8 patients with IDC without MPD occlusion, in comparison to 32 patients with IDC with this occlusion (controls). The pancreatic duct was identified by confirming the presence of mural elastic fibers on the wall of the pancreatic duct. Immunohistochemical staining was done with Ki-67 antibody.Results
The frequency of IDC without MPD occlusion was very low (5.0% [2/40] patients at Kurume University and 3.1% [4/126] patients at Juntendo University). The number of intraductal carcinoma components was 1.5 ± 1.1 per specimen in the IDCs without occlusion and 5.9 ± 2.4 in the controls (P < 0.001). The Ki-67 labeling index was 18.0 ± 11.7% in the IDCs without occlusion and 30.0 ± 12.1% in the controls (P < 0.05). The number of intraductal carcinoma components and the Ki-67 labeling index were significantly lower in the IDCs without occlusion than in the controls.Conclusions
Our findings suggested that these two types of IDC could have different biological features. 相似文献18.
Jin-Young Jang Yoon-Chan Park Yoon Sup Song Seung Eun Lee Dae Wook Hwang Chang-Sup Lim Hee Eun Lee Woo Ho Kim Sun-Whe Kim 《Journal of hepato-biliary-pancreatic sciences》2009,16(5):668-674
Purpose
The purpose of this study was to document the biological changes during the progression of intraductal papillary mucinous neoplasm of the pancreas (IPMN) and to identify biological markers capable of differentiating benign and malignant IPMN.Methods
Forty-one patients with IPMN who underwent resection between 1994 and 2003 were enrolled in this study. The paraffin-embedded tumors from 27 with benign IPMNs and from 14 with IPMCs were subjected to immunohistochemical staining and DNA extraction. Direct DNA sequencing analysis for K-ras mutation and immunohistochemical staining using 17 biological markers was performed.Results
K-ras mutations at codon 12 and 13 were detected in 13 of 37 (38.2%) of the IPMNs: in 5 of 24 (20.8%) of benign IPMNs, and in 8 of 13 (61.5%) of malignant IPMNs (p = 0.028). The expression of S100A4 and MUC2 were increased in malignant IPMNs. S100A4 was expressed in 2 (7.4%) of 27 benign IPMNs, and 6 (42.9%) of 14 malignant IPMNs (p = 0.007). MUC2 was expressed in 2 (7.4%) benign IPMNs, and in 9 (64.3%) malignant IPMNs (p < 0.001).Conclusion
K-ras mutation and the expression of S100A4 and MUC2 (especially in intestinal subtype) were found to be related to malignancy in IPMN, and may be useful for the diagnosis and for assessing the biological behavior of IPMN. 相似文献19.
Savio G. Barreto Sanjay Pandanaboyana Natasha Ironside John A. Windsor 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(7):573-579
Background
Margin status is the main surgical determinant of long-term outcome in pancreatic cancer. Intraoperative frozen section (IOFS) detects microscopic positive margins at a stage when margin revision is possible. The aim of this study was to determine if IOFS driven-revision of pancreatic resection margin(s) improves overall survival (OS) in pancreatic cancer.Methods
A systematic review of major reference databases was undertaken. Patients were divided into 3 groups based on initial FS (FSR0 for negative margin and FSR1 for positive microscopic margin) and final Permanent Section report (PSR0 for negative margin and PSR1 for positive microscopic margin): Group 1 (FSR0 → PSR0), Group 2 (FSR1 → PSR0), and Group 3 (FSR1 → PSR1). Patients in Groups 2 and 3 had surgical revision of the FSR1 margin. Data was meta-analysed.Results
4 studies included in the final analysis. No difference in OS and incidence of lymph node metastases between Groups 2 and 3 (P = 0.590 and P = 0.410).Conclusions
IOFS-based revision of R1 pancreatic resection margin does not improve OS, even when it results in an R0 margin. This suggests that any benefit of margin revision based on FS is over-ridden by markers of more advanced or aggressive disease. 相似文献20.
Mahmud Baghbanian Hasan Salmanroghani Ali Baghbanian Mohsen Bakhtpour Bijan Shabazkhani 《Indian journal of gastroenterology》2013,32(6):376-380