EFFECTS OF A SYNTHESIZED PHOSPHODIESTERASE INHIBITOR, ZSY-27, ON PANCREATIC EXOCRINE SECRETION OF THE DOG

The effects of a synthesized phosphodiesterase inhibitor, ZSY-27, on the secretion of pancreatic juice were investigated in dog isolated and blood-perfused pancreas, and compared with those of secretin and dopamine. Intravenous administration of ZSY-27 (0.3-1 mg/kg) elicited increases in pancreatic secretion. Intra-arterial (i.a.) administration of ZSY-27 (0.1-1 mg) also elicited increased secretion. The secretory activity of ZSY-27 (1 mg) was approximately equal to that of 0.1 units of secretin and 2.5 micrograms of dopamine. The concentration of bicarbonate in the pancreatic juice induced by ZSY-27 i.a. was increased, but the protein concentration was not increased significantly. These effects are analogous to those of secretin and dopamine. ZSY-27-induced pancreatic secretion was not modified by pretreatment with phentolamine, propranolol, atropine, sulpiride and cimetidine. Secretin-induced secretion was significantly potentiated by infusion of ZSY-27 (25 micrograms/min) but dopamine-induced one was not. These results suggest that ZSY-27 increases pancreatic secretion acting directly on the ductular cells of the dog pancreas, at least in part, through the increase of intracellular cyclic AMP concentration by inhibiting phosphodiesterase activity.     

Regulation of major histocompatibility complex (MHC) products in fresh and cultured human fetal pancreata aged 9–16 gestational weeks by gamma-interferon

Immunological data on the human fetal pancreas (HFP) are mainly confined to its constitutive expression of the MHC antigens. However, cytokines, such as gamma-interferon (g-IFN), released by lymphocytes during immune reactions, can induce or upregulate the expression of MHC products in allografts and alter their immunological behaviour. We investigated the effects of g-IFN on fresh and cultured HFPs aged 9–16 gestational weeks (gw). Following g-IFN stimulation of fresh HFPs, there was class I hyperexpression by the ductal cells, and some of the ductal, endothelial and islet cells also became class II⁺. Conventional tissue culture (5% CO₂ in air at 37°C) reduced the number of interstitial class II⁺ cells within the HFP after 1 week but was associated with de novo class I expression by some of the ductal cells. Remarkably, the changes in major histocompatibility complex (MHC) antigen expression by the ductal cells occurred earlier and were markedly enhanced when the HFPs were cultured beforehand. The number of interstitial class II⁺ cells in fresh and cultured HFPs was not influenced by g-IFN. The significance of these observations with regard to clinical HFP transplantation is discussed.     

The pancreas in acute graft versus host disease in man

Twenty-six bone marrow transplant recipients, 14 of whom had evidence of acute graft versus host disease at autopsy, were studied. The pancreas in four of these patients exhibited changes thought to be due to acute graft versus host disease. Pathognomonic findings were in exocrine ducts which showed marked epithelial cellular atypia associated with a mild lymphocytic infiltrate. This was accompanied by ulceration and intraluminal haemorrhage in severe cases. In three of these four cases ductal epithelium showed marked hyperexpression of class I and class II major histocompatibility complex molecules. By contrast islets were not inflamed, showed no evidence of endocrine cell damage and no abnormalities of major histocompatibility complex expression were seen.     

Effects of long-term parenteral nutrition on the course of pancreatic pseudocyst

The benefit of total parenteral nutrition (TPN) for the non-operative treatment of acute pancreatic pseudocyst remains hypothetical benefit. We reviewed results for 40 patients with pancreatic pseudocyst treated with TPN who had had serial imaging studies. On presentation, mean cyst size was 7.4 cm and after non-operative treatment with TPN (mean 32.5 days) the cyst had decreased to 5.6 cm. After the non-operative period, 68% of the pseudocysts had regressed, completely in 14% and partially in 54% of the patients. Except for 1 patient with cyst-related obstructive jaundice, there were no complicated pseudocysts. Only 12 (28%) of the patients underwent cyst drainage. Fifteen patients (35%) sustained catheter-related complications, which included sepsis (26%), pneumothorax (9%), hydropneumothorax (2%), and septic right atrial thrombosis (2%), during the course of hospitalization. Most of the patients treated with TPN showed both clinical and radiographic regression of their pseudocysts. However, the risk of catheter-related complications in this group suggests that this therapy should be limited to those patients who are unable to sustain enteral nutrition.     

高能聚焦超声刀联合氟脲嘧啶、四氢叶酸治疗晚期胰腺癌临床疗效观察

目的探讨高能聚焦超声刀加氟脲嘧啶、四氢叶酸治疗晚期胰腺癌临床疗效及毒副作用。方法30例经病理学或细胞学确诊的晚期胰腺癌病人先用高能聚焦超声刀(HIFU)治疗，再予氟脲嘧啶、四氢叶酸联合化疗。氟脲嘧啶500mg／m^2加入5％GNS500ml静滴持续6小时以每天1次连用5天，CF(四氢叶酸)100mg／m^2加入生理盐水250ml静滴每天1次连用5天，28天为1周期，至少治疗2个周期。结果CR1例；PR9例；MR9例；NC5例；PD6例。总有效率63％。毒副作用主要消化道反应，其他副作用轻微。结论应用HIFU局部治疗胰腺癌同时合用四氢叶酸加氟脲嘧啶全身化疗近期疗效提高明显，止痛明显达75％，副反应小，值得应用。     

EUS AND PANCREATIC CYST DRAINAGE: AN UPDATE

Endoscopic drainage has become the primary therapy for pancreatic pseudocysts. Diagnostic endoscopic ultrasound (EUS) has added safety to the procedure and interventional EUS has broadened the indications to non‐bulging lesions. At the same time, more aggressive endoscopic treatment has also made it possible to treat infected pseudocysts and organized pancreatic necrosis. The indications and technique are reviewed in this paper.     

手助腹腔镜胆肠、胃肠内引流术联合125I粒子置入术治疗晚期胰腺癌

目的探讨手助腹腔镜胆肠、胃肠内引流术联合125I粒子置入术治疗晚期胰腺癌的可行性和临床疗效. 方法2002年2月～2004年8月,我院行手助腹腔镜胆肠、胃肠内引流术联合125I粒子置入术治疗晚期胰腺癌12例(胰头癌10例,胰体癌2例). 结果 12例手术均获成功.手术时间104～181 min,(122±29) min.术中出血量45～152 ml,(60±18) ml.住院时间6～17 d,(8.5±1.3) d.术后病人黄疸逐渐减退,术后7～10 d肝功能恢复正常.腹痛消失3例,明显缓解7例.2例出现胃肠功能障碍,治疗后缓解.10例术后随访6个月复查CT肿瘤明显缩小(PR)4例,无变化(NC)4例,肿瘤进展(PD) 2例. 结论手助腹腔镜内引流术联合癌组织间125I粒子置入术是治疗晚期胰腺癌,使其缓解症状的有效方法,具有创伤小、恢复快、能改善病人生活质量.     

Tetrahydrobiopterin Attenuates Microvascular Reperfusion Injury Following Murine Pancreas Transplantation

In this study we investigated the effect of tetrahydrobiopterin (BH4), an essential cofactor for nitric oxide synthases, on ischemia-reperfusion injury (IRI) following murine pancreas transplantation. Pancreatic grafts were exposed to prolonged cold ischemia times (CIT) and different treatment regimens: normal saline (S), S + 16 h CIT, BH4 50 mg/kg + 16 h CIT. Nontransplanted animals served as controls. Graft microcirculation was analyzed by means of functional capillary density (FCD) and capillary diameters (CD) after 2 h reperfusion using intravital microscopy. Quantification of inflammatory responses (mononuclear infiltration) and endothelial disintegration (edema formation) was done by histology (hematoxylin and eosin), and peroxynitrite formation assessed by nitrotyrosine immunostaining. FCD was significantly reduced after prolonged CIT, paralleled by increased peroxynitrite formation as compared with controls (all p < 0.05). Microcirculatory changes correlated significantly with intragraft peroxynitrite generation (Spearman: r = -0.56; p < 0.01). Pancreatic grafts treated with BH4 displayed markedly higher FCD values (p < 0.01) and abrogated nitrotyrosine staining (p = 0.03). CD were not significantly different in any group. Histology showed increased inflammation, interstitial edema, hemorrhage, acinar vacuolization and focal areas of necrosis after 16 h CIT, which was diminished by BH4 administration (p < 0.01). BH4 treatment significantly reduces post-ischemic deterioration of microcirculation as well as histologic damage and might be a promising novel strategy in attenuating IRI following pancreas transplantation.     

PRIMARY LYMPHOMA OF THE PANCREAS

Lymphoma of the pancreas is uncommon. Secondary invasion from contiguous, retroperitoneal lymph node disease is the predominant mode of involvement. Lymphoma originating in and remaining localized to the pancreas is very rare. A case of primary lymphoma confined to the pancreas, in a 35 year old man, is described. Only two other similar cases could be found in the English literature.