Introduction Pancreaticoduodenectomy with vascular resection remains a controversial approach for patients with local advanced pancreatic
head cancer for the lack of evidences of survival and quality of life benefits. The aim of this study was to evaluate whether
patients of pancreatic head cancer benefit on quality of life, survival, and treatment cost from pancreaticoduodenectomy with
vascular resection compared with palliative therapy.
Materials and Methods Two hundred fourteen patients of pancreatic head cancer whose pancreatic head could not be dissected free from adjacent vascular
were involved in this study. Eighty of these patients underwent pancreaticoduodenectomy with vascular resection, whereas other
patients underwent palliative therapy.
Results Pancreaticoduodenectomy with artery resection offered worse outcomes on almost all aspects of quality of life and survival
compared with palliative therapy. Pancreaticoduodenectomy with vein resection offered better 5-year survival compared with
palliative therapy, whereas palliative therapy offered better quality of life after surgery.
Conclusion Pancreaticoduodenectomy with artery resection is nonsensical on treatment of pancreatic head cancer with artery adhesion/invasion.
As for patients with vein adhesion/invasion, pancreaticoduodenectomy with vein resection should be performed cautiously. When
actual vein invasion is very possible to have taken place, the choice of treatment strategy should be considered carefully
by the pancreatic surgeons. 相似文献
Concurrent chemoradiotherapy begins to be more and more widely accepted as a standard adjuvant treatment in gastric cancer. And oxaliplatin, leucovorin, and 5-fluorouracil (FOLFOX) also reveals to be a very effective regimen in gastric cancer. But the safety and the dosages of FOLFOX combining with radiotherapy are still unknown. This study was to determine the maximum-tolerated dose and the dose-limiting toxicity of FOLFOX with higher-dose concurrent radiotherapy (RT) as adjuvant treatment in patients with gastric cancer. Patients with Stage II/III gastric cancer after surgery were recruited. They received one cycle of induction chemotherapy (standard FOLFOX4). Then, they received 50.4 Gy in 1.8-Gy fractions in combination with two cycles of concurrent FOLFOX, and oxaliplatin among this regimen was administered with escalating doses. Dose-limiting toxicity including grade 3 or grade 4 hematologic and nonhematologic toxicities was investigated. Fifteen patients were enrolled at the following dose levels: oxaliplatin 55 mg/m2 (3 patients), 65 mg/m2 (6 patients), and 75 mg/m2 (6 patients). Dose-limiting toxicity was observed in 1 patient at 65 mg/m2 (grade 4 leukopenia) and in 3 patients at 75 mg/m2 (1 patient had grade 4 leukopenia, 1 had grade 3 thrombocytopenia, and 1 had grade 3 stomatitis). Combination chemotherapy FOLFOX with oxaliplatin 65 mg/m2, d 1; leucovorin 200 mg/m2, 2 h, d1–2; 5-fluorouracil 400 mg/m2, iv, d 1–2 and 600 mg/m2 civ, 22 h, d 1–2 given concurrently with RT (50.4 Gy) can be recommended as a safer and preferable regimen for the adjuvant treatment of patients with gastric cancer.
Gallstone ileus is a rare but important cause of small bowel obstruction in the geriatric population. A 65-year-old man with a twenty year history of cholecystolithiasis was admitted to our hospital with abdominal pain and vomiting. Physical exams showed abdominal defence and rebound tenderness. A plain abdominal X-ray suggested a small bowel obstruction and pneumobilia. CT scan revealed a 2.5-cm gallstone at the jejunum and air in the biliary tree. The patient underwent a emergency laparotomy based on a diagnosis of panperitonitis with a perforation associated with gallstone ileus. Operative findings revealed a jejunal perforation and a impacted stone on the anal side of perforation. Enterolithotomy and jejunal resection were performed with cholecystectomy and repairment of the cholecystoduodenal fistula. 相似文献
Grb2-associated binder (Gab) family of scaffolding adaptor proteins coordinate signaling cascades downstream of growth factor and cytokine receptors. In the heart, among EGF family members, neuregulin-1beta (NRG-1beta, a paracrine factor produced from endothelium) induced remarkable tyrosine phosphorylation of Gab1 and Gab2 via erythroblastic leukemia viral oncogene (ErbB) receptors. We examined the role of Gab family proteins in NRG-1beta/ErbB-mediated signal in the heart by creating cardiomyocyte-specific Gab1/Gab2 double knockout mice (DKO mice). Although DKO mice were viable, they exhibited marked ventricular dilatation and reduced contractility with aging. DKO mice showed high mortality after birth because of heart failure. In addition, we noticed remarkable endocardial fibroelastosis and increase of abnormally dilated vessels in the ventricles of DKO mice. NRG-1beta induced activation of both ERK and AKT in the hearts of control mice but not in those of DKO mice. Using DNA microarray analysis, we found that stimulation with NRG-1beta upregulated expression of an endothelium-stabilizing factor, angiopoietin 1, in the hearts of control mice but not in those of DKO mice, which accounted for the pathological abnormalities in the DKO hearts. Taken together, our observations indicated that in the NRG-1beta/ErbB signaling, Gab1 and Gab2 of the myocardium are essential for both maintenance of myocardial function and stabilization of cardiac capillary and endocardial endothelium in the postnatal heart. 相似文献