Chronic pancreatitis: relation to acute pancreatitis and pancreatic cancer

The relationship between chronic pancreatitis (CP) and other pancreatic diseases, such as acute pancreatitis (AP) and pancreatic cancer (PK), remains a fairly debated question. The progression from alcoholic AP to CP is controversial, and some long-term epidemiological studies suggest that alcoholic CP might be the result of recurrent alcoholic AP (necrosis-fibrosis sequence) and a subgroup of alcoholics may present recurrent AP without progression to CP. Other predisposing factors (genetic, nutritional, environmental) seems to be important in inducing different outcomes of pancreatic damage due to alcohol. However, recurrent episodes of AP are clearly involved in pathophysiology of CP in patients with hereditary pancreatitis. A relationship between CP and subsequent PK development has long been suspected, but we actually don't know whether this association is direct or is the result of confounding factors, such as alcohol intake or cigarette smoking. Many issues should be considered as indicators of a causal association, and several of them are not fulfilled. Nonetheless, epidemiological studies (case-control or cohort studies) showed that the risk of PK is increased in patients with CP; the risk is significantly higher in tropical calcifying CP and hereditary pancreatitis. Studies on growth factors, oncogenes, tumor-suppressor genes, and angiogenesis suggest that the sequence PC-KP is plausible from the biological standpoint.     

慢性胰腺炎胰,胆管梗阻的处理：附6例报告

在３７例慢性胰腺炎病人中，８例合并胆道梗阻（２２％），４例合并主胰管梗阻（１１％）；６列同时或异时合并胰、胆管梗阻（１９％）。其中１例在发现胰管扩张１年后，出现胆管梗阻；２例同时发现胰、胆管梗阻。３例因黄疸在外院先行胆道手术，术后腹痛持续，影像检查证实尚伴有胰管梗阻，而再次行胰管减压手术。未合并胆石和（或）胆管炎的单纯胆道梗阻一般不引起严重的腹痛。对腹痛症状较重，而又无胆管结石的慢性胰腺炎病人应特别警惕是否同时合并胰管梗阻。     

MicroRNA 与胰腺癌关系的研究进展

胰腺癌是恶性程度最高、预后最差的恶性肿瘤之一,其相关的分子机制的研究具有重要的临床意义。微小RNA（microRNA,miRNA）通过调节基因的表达参与多种生物医学过程,其异常表达与肿瘤的发生发展及预后密切相关。笔者就miRNA与胰腺癌的诊断、治疗和预后关系的研究进展做一综述。     

纳米药物在胰腺癌治疗上的进展

胰腺癌恶性度高,预后差,常规治疗药物及靶向药物对其治疗效果不佳.其中,胰腺癌的肿瘤微环境对其耐药性的形成有重要作用.纳米药物因合适的粒径、在外周循环中的高稳定性以及高渗透长滞留效应,再结合如光敏、pH敏感等策略控制药物的释放,从而有效地通过肿瘤微环境靶向癌细胞,是治疗胰腺癌的新思路.笔者回顾了目前胰腺癌治疗中纳米药物的...     

Evidence-based pancreatic head resection for pancreatic cancer and chronic pancreatitis

OBJECTIVE: To review the current status of pancreatoduodenectomy for pancreatic cancer and chronic pancreatitis using evidence-based methodology. SUMMARY BACKGROUND DATA: Despite improved results of pancreatoduodenectomy over the recent years, the reputation of the Whipple procedure and its main modifications has remained poor. In addition, the current status of newer modifications of standard pancreatoduodenectomy is still under debate. METHODS: Medline search and manual cross-referencing were performed to identify all relevant articles for classification and analysis according to their quality of evidence. The search was limited to articles published between 1990 and 2001. RESULTS: The mortality rate of pancreatoduodenectomy has declined to less than 5% for chronic pancreatitis and 3% to 8% for pancreatic cancer. In contrast, overall morbidity rates remain high, ranging between 20% and 70%. Delayed gastric emptying represents almost half of all complications. The overall 5-year survival rate for patients with pancreatic cancer remains poor, ranging between 5% and 15%, with a median survival of 13 to 17 months. Mortality and morbidity are not related to the type of pancreatoduodenectomy; however, patients with pancreatic cancer tend to be at increased risk for complications. Extended lymph node dissection and portal vein resection can be performed with similar mortality and morbidity rates as standard procedures, but without apparent survival benefits in the long term. Major relief of pain is achieved in 70% to 100% of patients with chronic pancreatitis. CONCLUSIONS: Pancreatoduodenectomy and its main modifications are safe and effective treatment modalities, especially in experienced centers with a high patient volume. For chronic pancreatitis, surgical resection provides major relief of pain and thus increased quality of life. Overall survival for patients with pancreatic cancer is determined predominantly by the pathology within the resected specimen.     

急性胰腺炎腺泡细胞损伤机制研究进展

急性胰腺炎（AP）是胰腺的炎症性疾病,由于发病机制尚未完全阐明,临床对重症AP仍缺乏有效的治疗方法。目前认为,钙超载、酶原异常活化、内质网应激、自噬、线粒体损伤及炎症反应与胰腺腺泡细胞损伤关系密切,现就其研究进展进行综述。     

自身免疫性胰腺炎与胰腺癌的鉴别诊断

自身免疫性胰腺炎(AIP)是全身炎症-纤维化的胰腺表现,亦是免疫球蛋白G4相关的硬化性疾病.AIP具有独特的临床症状、影像学、血清学、病理组织学及胰腺外症状特点.AIP的临床特征与胰腺癌有相似之处,但也有区别.特别要强调的是仅以临床表现不能明确鉴别两者.对于AIP的诊断目前有两个不同的诊断标准:美国Mayo中心的临床HISORt诊断标准,以及日本胰腺学会和韩国医学中心提出的亚洲诊断标准.AIP确诊后,主要治疗手段为类固醇类药物治疗,治疗效果较好;但在患者良好反应后类固醇类药物是否作为维持治疗尚有争议.     

长链非编码RNA 在胰腺癌中的研究进展

长链非编码RNA(lncRNAs)是一类转录本长度超过200nt、不具备蛋白编码功能的RNA分子。LncRNAs能够在表观遗传、基因转录水平以及转录后水平等不同层面发挥作用。此外,新近发现的微小RNA、环状RNA等可与lnc RNAs交互作用,参与恶性肿瘤的发生与发展过程。近年来,研究发现大量的lncRNAs异常表达于胰腺癌组织和细胞中,在胰腺癌的发生发展中也起着重要作用。因此,笔者就多种异常表达的lncRNAs在胰腺癌中的作用及机制进行综述。     

胰腺癌诊治现状和进展(近2年国内文献回顾)

2000年杭州第八届全国胰腺外科学术研讨会以后，胰腺外科在全国又有了长足的发展，胰腺癌的诊治在国内越来越得到重视，许多医院组织专业技术队伍在临床和基础研究方面对胰腺癌诊治展开了重点攻关，并取得了良好的效果，发表了许多有价值的文章。我们通过中国医学科学院医学信息研究所     

Tobacco and the risk of pancreatic cancer: a review and meta-analysis

Background/Aim Smoking is a recognized risk factor for pancreatic cancer. The aim of this study was to perform a meta-analysis to provide a robust estimate of the strength of the association between smoking and pancreatic cancer, to determine the risk of pipe and cigar smoking, and to estimate the duration of an elevated risk after smoking cessation. Methods We performed a meta-analysis of 82 published studies containing epidemiologic information about smoking and pancreatic cancer. Information on studies published between 1950 and 2007 was abstracted and prepared for analysis using standard meta-analytic procedures. Results The overall risk of pancreatic cancer estimated from the combined results for current and former smokers was, respectively, 1.74 (95% CI 1.61–1.87) and 1.2 (95% CI 1.11–1.29). The risk of pancreatic cancer for current and former pipe and/or cigar smokers was respectively 1.47 (95% CI 1.17–1.83) and 1.29 (95% CI 0.68–2.45). For former cigarette smokers, the risk remains elevated for a minimum of 10 years after cessation. Conclusions Based on estimates from four continents, smoking cigarettes causes a 75% increase in the risk of pancreatic cancer compared to non-smokers, and the risk persists for a minimum of 10 years after smoking cessation. This implies that in a population where the prevalence of smoking is 30%, the population’s attributable risk (the proportion of pancreatic cancer explained by smoking) is estimated to be 20%. Supported by grants from the Italian Association for Cancer Research (AIRC), Solvay Pharmaceuticals, and the C.D. Smithers Foundation.     

Genetics of pancreatic cancer: recent advances in molecular diagnosis

Pancreatic cancer is an important cause of death from cancer throughout the world. Until recently, pancreatic cancer was a poorly understood disease. Research in the past decade has shown conclusively, however, that pancreatic cancer is primarily genetic in nature. Inactivation with a variety of tumor-suppressor genes such as p53, p16, and DPC4, and genome-maintenance genes such as BRCA2, coupled with the activation of oncogenes such as K-ras, are a few of the mutations that trigger the growth of cancerous cells. The genetic profile of pancreatic cancer has reshaped the nomenclature describing histological progression in pancreatic ductal tumorigenesis. K-ras mutations frequently occur early, whereas changes in the expression and genetic integrity of the p16 gene appear in intermediate lesions, and the inactivation of the p53 and DPC4 genes and activation of telomerase occur late in the neoplastic progression. Although the majority of pancreatic cancers occur sporadically, a minority has been shown to aggregate in families and has aided our understanding of pancreatic tumorigenesis. An improved understanding of the genetics of pancreatic cancer should lead to the development of gene-based screening tests and novel rational therapies.     

Diagnosis and management of isolated pancreatic tuberculosis: recent experience and literature review

The increased reporting of tuberculosis of the pancreas is related to a worldwide increase in tuberculosis and an increase in emigration from countries where tuberculosis is endemic into countries where more sophisticated healthcare and radiological imaging are available. Three recent cases of pancreatic tuberculosis in Auckland, New Zealand, emphasize that tuberculosis should now be included in the differential diagnosis of a pancreatic mass. Diagnostic indicators include emigration from, or recent travel to, a country where tuberculosis is endemic, the association of a pancreatic mass with fever, the presence of abdominal pain and a cystic pancreatic mass in a younger male. Radiological appearances might be similar to a mucinous cystic neoplasm or could show a pancreatic mass with involvement of peripancreatic lymph nodes or a mass centred in a peripancreatic lymph node. When the diagnosis is suspected an human immunodeficiency virus test and a comprehensive screening for tuberculosis at other sites should be performed. If tuberculosis is unable to be diagnosed then pancreatic biopsy and culture is indicated. Endoscopic ultrasound with fine needle aspiration for cytology is likely to become the preferred technique. Most patients have an excellent clinical response to standard antituberculosis regimens.     

Acute pancreatitis due to pancreatic hydatid cyst: a case report and review of the literature

Non-occlusive colonic ischaemia is a recognized albeit rare entity related to low blood flow within the visceral circulation and in most reported cases the right colon was affected. This is the second case report in the literature of extensive colonic necrosis following cardiac arrest and cardiopulmonary resuscitation (CPR). A 83-year-old Caucasian woman was admitted to our hospital due to a low energy hip fracture. On her way to the radiology department she sustained a cardiac arrest. CPR started immediately and was successful. A few hours later, the patient developed increasing abdominal distension and severe metabolic acidocis. An abdominal multidetector computed tomography (MDCT) scan was suggestive of intestinal ischaemia. At laparotomy, the terminal ileum was ischaemic and extensive colonic necrosis was found, sparing only the proximal third of the transverse colon. The rectum was also spared. The terminal ileum and the entire colon were resected and an end ileostomy was fashioned. Although the patient exhibited a transient improvement during the immediate postoperative period, she eventually died 24h later from multiple organ failure. Histology showed transmural colonic necrosis with no evidence of a thromboembolic process or vasculitis. Therefore, this entity was attributed to a low flow state within the intestinal circulation secondary to the cardiac arrest.     

Acute pancreatitis due to pancreatic hydatid cyst: a case report and review of the literature

ABSTRACT: Hydatid disease is a major health problem worldwide. Primary hydatid disease of the pancreas is very rare and acute pancreatitis secondary to hydatid cyst has rarely been reported. We report the case of a 38-year-old man who presented acute pancreatitis. A diagnosis of hydatid cyst of the pancreas, measuring 10 cm, was established by abdominal computed tomography before surgery. The treatment consisted of a distal pancreatectomy. The postoperative period was uneventful. Additionally, a review of the literature regarding case reports of acute pancreatitis due to pancreatic hydatid cyst is presented.     

Renal tubular dysfunction in pancreatic cancer and chronic pancreatitis

Urinary excretion of alpha-glucosidase (AGL), gamma-glutamyltransferase (GGT) and ribonuclease (RNase), and serum amylase and immunoreactive trypsin (IRT) were determined in 38 control subjects, 48 patients with pancreatic cancer, 77 with chronic pancreatitis and 47 with extrapancreatic diseases in order to ascertain the presence of a renal tubular damage and to investigate its etiology. A significantly increased frequency of pathological results for all urinary enzymes was documented in the various groups of patients as compared to controls. Significant correlations were detected among AGL, GGT and RNase. Considering the subjects as a whole, GGT and RNase excretions correlated with serum IRT and amylase; the two urinary enzymes were found to be higher when jaundice was present. In chronic pancreatic disease enzymuria was related to increased serum pancreatic enzymes; in extrapancreatic diseases it was associated to hyperbilirubinemia. The vast majority of patients with pancreatic cancer and elevated urinary enzymes presented hepatic metastases and/or jaundice. We can conclude that an anatomical and functional tubular impairment is detectable in some patients with chronic pancreatic and extrapancreatic diseases. Tubular damage seems to least in part to be related to pancreatic inflammation and necrosis in chronic pancreatic disease, while jaundice may be found to play an important role in diseases of the hepatobiliary tract. In pancreatic cancer, liver dysfunction (presence of liver metastases and/or extrahepatic cholestasis) also appears to be involved in altering tubular cells.     

Non-operative differentiation between pancreatic cancer and chronic pancreatitis.

Eighty-five of 186 patients investigated for suspected pancreatic cancer had an unequivocal final diagnosis of either pancreatic cancer (58 patients) or chronic pancreatitis (27 patients). They had been studied prospectively using ultrasonography, computerized tomography, radionuclide scanning, endoscopic retrograde cholangiopancreatography (ERCP), selective celiac and superior mesenteric angiography, duodenal drainage studies, cytologic studies, serum carcinoembryonic antigen assay, and pancreatic oncofetal antigen assay, The results were compared to determine which test would most frequently and reliably differentiate between pancreatic cancer and pancreatitis in a patient believed to have one or other disease. Criteria for interpreting results, first for highest rate of correct diagnoses, and second for highest accuracy were derived. Applying these criteria, ultrasonography achieved the highest rate of correct diagnoses (97% of patients diagnosed with 84% accuracy). ERCP, duodenal drainage studies, and cytology were the most accurate tests ((86% accuracy each test) but, with this accuracy, ERCP most frequently gave a diagnosis (diagnosis rate: ERCP--70%, duodenal drainage--32%, cytology--35%). The results suggest that ultrasonography is the best noninvasive test, and that a combination of ERCP, pancreatic juice assay and cytology in a single procedure may prove to be the best discriminating investigation.     

胰腺炎误诊胰腺癌CT及MRI征像分析

目的 从误诊为胰腺癌病例中寻找胰腺炎的影像特征。 方法 回顾性分析2001-2010年第二军医大学附属长征医院22例误诊为胰腺癌的胰腺炎CT、MRI影像学资料。 结果 误为局限性胰腺癌的胰腺炎有5种表现：胰腺局限性增大,胰腺内坏死、假性囊肿,胰腺不均匀脂肪沉积,继发于胰腺分裂的胰管潴留性扩张或胰管积血。误为弥漫性胰腺癌的胰腺炎有3种表现：胰腺弥漫肿大,胰腺广泛乏血供病变,胰腺周围没有渗出。误为胰腺外转移的胰腺炎有2种表现：胰旁假性囊肿、炎性结节误认为转移淋巴结,局部静脉血栓、动脉狭窄误认为血管侵犯。 结论 对表现不典型的胰腺癌均应想到胰腺炎或合并胰腺炎可能,应完整了解病史,仔细分析影像学特点和变化规律,密切随访。