Multiple pancreatic metastases from clear cell renal carcinoma: Diagnosis with chemical shift magnetic resonance imaging before surgery

We present a case in which multiple pancreatic tumours were diagnosed as metastatic clear cell renal carcinomas with chemical shift MRI (CSI) before surgery. Radiologists may be unable to recognize the loss of intensity on CSI macroscopically. We believe that it is useful to make subtraction images and calculate signal intensity on CSI, even if the lesions are multiple metastatic tumours.     

Cancer risk due to occupational exposure to polycyclic aromatic hydrocarbons

Polycyclic aromatic hydrocarbons (PAHs) demonstrate carcinogenic activity in animal models. Although some epidemiologic studies have implicated PAHs as risk factors for human cancer, the evidence reported to date has not been consistent. The purpose of this report is to describe the associations between occupational exposure to PAHs in the workplace and each of 14 types of cancer. A population-based, case-control study was carried out in Montreal to investigate associations between a large variety of environmental and occupational exposures on the one hand, and several types of cancer on the other. A detailed job history was obtained from each subject along with information on a number of potential confounders. Each job history was reviewed by a team of experts, who used this information to construct a corresponding history of occupational exposures. Among the PAH exposures considered were benzo(a)pyrene (B(a)P) and five categories of PAHs defined on the basis of the source material, namely, wood, petroleum, coal, other sources, and any source. Altogether, 3,730 cancer patients and 533 population controls were interviewed and their job exposure histories coded. For each of 14 types of cancer analyzed, three control groups were available: other cancer patients, population controls, and the pooled set of cancer and population controls. The associations between 14 cancer types and 6 PAH exposures were analyzed using logistic regression methods. For most types of cancer evaluated, there was no evidence of excess risk due to PAHs at the levels encountered in the occupations in which PAH exposure has been prevalent in the Montreal area. For a few cancer sites–the esophagus, the pancreas, and the prostate gland–there were suggestions of excess risk; these observations are noteworthy hypotheses for further investigation. For lung cancer, there appeared to be an increased risk due to PAHs among nonsmokers and light smokers, but not among heavy smokers.     

Normothermic cardiopulmonary bypass: effect on the incidence of persistent postoperative neurological dysfunction following coronary artery bypass graft surgery

We retrospectively reviewed the records of 250 consecutive patients undergoing coronary artery bypass graft surgery (CABG) from January 1994 through January 1996 to determine the incidence of persistent postoperative neurological dysfunction after CABG and to compare normothermic and moderate hypothermic cardiopulmonary bypass (CPB). Normothermic CPB was used in 128 patients (36°–37°C) and hypothermic CPB (27°–28°C) in 122 patients. Postoperative neurological dysfunction included focal motor deficits, delayed recovery of consciousness (>24h) after surgery, and seizures within 1 week postoperatively. Persistent neurological dysfunction was diagnosed if complete resolution had not occurred within 10 days of surgery. The incidence of persistent postoperative neurological dysfunction was 4.1% in the hypothermic CPB group and 2.3% in the normothermic CPB group. There were no statistically significant differences between the two groups (P=NS). These results suggest that normothermic CPB did not increase the incidence of persistent postoperative neurological dysfunction compared to hypothermic CPB.     

Expression of the cell surface antigen detected by the monoclonal antibody A7 in pancreatic carcinoma cell lines

In a previous study, we used a murine monoclonal antibody, A7, against human colon carcinoma as a drug-carrier to treat colorectal cancer.¹ In the present study, we found that MAb A7 also reacted immunohistochemically with 73% of human pancreatic carcinoma cell lines, with the A7 antigen mainly being detected on the cell surface. However, the A7 antigen was found in only 9% of the spent media of these human pancreatic carcinoma cell lines by ELISA. On the other hand, the positive incidence of CA19-9, POA, ferritin, CEA, DU-PAN-2 and SLX in those spent media was 100%, 64%, 64%, 55%, 55% and 36%, respectively. These results suggest that the A7 antigen may only rarely be shed into the sera of pancreatic cancer patients, in which case MAb A7 could be a suitable drug-carrier in targeting chemotherapy for pancreatic cancer patients.     

Primate endocrine function after pancreatico-duodenal-splenic allotransplantation

In this study the endocrine function following intraperitoneal hetero- and orthotopic pancreatico-duodenal-splenic allotransplantation (PDS) in hemipancreatectomized, non-immune-suppressed chacma baboons was assessed. Significantly reduced K-values and insulin release together with glucose intolerance during IVGTT were observed in hemipancreatectomized recipients (HPS) without grafts. Orthotopic and heterotopic PDS transplantation improved the glucose intolerance of HPS recipients; orthotopically sited grafts rendering the best curves. Normal glucose tolerance was not achieved. Both orthotopic and heterotopic PDS transplantation rendered suboptimal insulin release during IVGTT; heterotopically draining grafts released significantly more insulin than orthotopic grafts. Hyperglucagonaemia during IVGTT was a constant feature in both groups, heterotopic grafts releasing the most glucagon during stimulation. C-peptide release was significantly lower in orthotopic grafts compared to normal animals or heterotopically drained insulin. It is concluded that glucose tolerance was not directly related to insulin or glucagon release in this study as orthotopic grafts rendered near-normal IVGTT curves in the presence of hypoinsulinaemia, hyperglucagonaemia, and reduced C-peptide values. The hormonal response after PDS transplantation was variable and the advantages of portal vs systemic insulin drainage remain to be defined.     

吉西他滨联合5-氟尿嘧啶和四氢叶酸治疗晚期胰腺癌的临床研究

目的　评价 5 氟尿嘧啶和四氢叶酸联合化疗与加用吉西他滨后治疗晚期胰腺癌的疗效和不良反应 ;以及 5 氟尿嘧啶药物代谢动力学指标的改变。方法　 43例晚期胰腺癌患者分为实验组 ( 2 2例 )和对照组 ( 2 1例 )。实验组 :吉西他滨 10 0 0mg/m2 ,第 1,8,16天静脉滴注 ,5 氟尿嘧啶 40 0mg/m2 和四氢叶酸 10 0mg/m2 于第 1～ 5天静脉滴注 ;对照组 :5 氟尿嘧啶 40 0mg/m2 和四氢叶酸 10 0mg/m2 在第 1～ 5天静脉滴注 ,均以每 4周为 1疗程 ,持续 4个疗程。结果　实验组完全缓解 (CR) 1例 ( 4 .5 %) ,部分缓解 (PR) 6例 ( 2 7.3 %) ,临床受益反应率 (CBR)为 68.2 %;对照组无CR ,PR3例 ( 14 .3 %) ,CBR有效率 3 3 .3 %。实验组出现不良反应的数量和严重程度较对照组提高且差异具有显著性。实验组 5 氟尿嘧啶血浆药物浓度、血浆峰值提高 ,血浆半衰期延长。结论　吉西他滨与 5 FU、四氢叶酸联合应用治疗晚期胰腺癌有一定的客观疗效 ,可明显改善患者的生存质量 ,但不良反应也随之提高。上述变化与吉西他滨改变 5 FU的药物代谢动力学有关     

胰腺实性-假乳头状瘤影像与病理诊断分析

目的 探讨胰腺实性-假乳头状瘤的影像及病理学的诊断要点。资料与方法 回顾分析11例经手术切除、病理学和免疫组织化学证实的胰腺实性一假乳头状瘤患者的临床资料，以比较其影像和病理学特点。结果 (1)本病多发于30岁以下女性，临床主要表现为腹痛。(2)CT、MRI表现为肿瘤内有实性和囊性结构，可分为3型；特征性表现为“浮云征”。(3)肿瘤大部分位于胰腺，多有完整包膜，不伴有胆总管扩张。(4)病理学特点为肿瘤实性部分由实性区、假乳头区及两者过渡区以不同比例混合而成。囊性区由坏死、液化、陈旧性出血组成。(5)肿瘤的囊实性结构是形成“浮云征”的病理基础。结论 胰腺实性-假乳头状瘤有相对特征性的影像和病理学表现，术后预后较好。     

腹部器官移植术后并发症的磁共振检查

目的探讨磁共振在腹部器官移植并发症中的诊断价值。方法对4例肝移植、5例胰肾联合移植及2例肾移植患者进行磁共振检查，检查时间在术后28d至2年，采用GE1．5TMR机型，成像技术包括常规平扫及增强扫描。结果4例肝移植，1例发生肝动脉狭窄伴肝坏死，1例发生下腔静脉血栓形成，1例为肝静脉与下腔静脉吻合口明显狭窄，1例为左右肝管明显狭窄；5例胰、肾联合移植中，1例并发急性排斥反应，1例为移植胰慢性排斥反应伴纤维化，1例为迟发性胰腺炎，移植肾4例正常，1例并发急性排斥反应伴肾梗死；2例单纯肾移植者，1例为肾动脉局限性中度狭窄，1例为肾动脉与髂内动脉吻合口处动脉瘤形成。上述病理改变均经组织病理检查和数字减影血管造影证实。结论磁共振可作为腹部器官移植并发症的一种无损伤检查手段，对于血管并发症，有其独有的优势。     

思他宁对人胰腺癌细胞株ASPC-1的生长调控

目的:观察思他宁对人胰腺癌细胞ASPC-1的生长作用.方法:细胞培养,分别加入不同浓度的思他宁.应用MTT法来观察细胞增殖程度;放免法测定细胞内cAMP含量;荧光法测定[Ca2 ]i.结果:不同浓度的思他宁(10-11～10-6mol/L)均能有效地抑制ASPC-1的生长,能抑制ASPC-1细胞内cAMP生成和细胞内钙离子水平,cAMP生成量和细胞内钙离子水平与思他宁浓度呈负相关.结论:思他宁能抑制ASPC-1细胞的生长,经过特异性受体调节.     

术后恶心呕吐的危险因素分析及防治

恶心呕吐是术后常见的并发症，而且可引起切口裂开、吸入性肺炎、水电解质紊乱等严重后果。近年来，虽然对术后恶心呕吐(PONV)的发生机制进行了大量的研究，也出现了很多新型的抗呕吐药，但PONV发生率依然较高。PONV的治疗可分为非药物疗法和药物疗法，作者对药物疗法进行综述。