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31.
2003年12月30日一辆装载7.28t苯胺的槽车从宁波开往温州的路上在甬台温高速公路温岭市境内翻车,造成5.3t左右的苯胺泄漏在高速公路旁的环境中,除少量的液体被清除外,绝大部分渗入地下,造成了水井污染.从12月31日开始我们对周围的水井开展了监测,现将监测结果分析如下: 相似文献
32.
目的 探讨术中氩靶向冷冻治疗系统(即氩氦刀)治疗晚期胰腺癌的安全性及疗效。方法 2001-2002年期间8例晚期胰腺癌使用了术中氩氦刀治疗。结果 8例晚期胰腺癌病人中,平均生存期为8.6个月,1例目前仍然存活。5例腹痛病人,3例完全缓解,2例部分缓解;1例腰背痛病人,疼痛部分缓解。结论 术中氩氦刀治疗尽管不能明显延长晚期胰腺癌病人的平均生存期,但能明显缓解病人的疼痛,提高病人的生活质量,仍不失为一种有效的晚期胰腺癌的姑息治疗方法。 相似文献
33.
Traditionally the drainage of pancreatic pseudocysts has been carried out operatively, forming a cystenterostomy. A simple endoscopic method of forming a pancreatic cystogastrostomy with laser is presented. This procedure does not require a general anesthetic, is safe, and allows resolution of symptoms. 相似文献
34.
S. Rosewicz E. O. Riecken Priv.-Doz. Dr. med B. Wiedenmann 《Journal of molecular medicine (Berlin, Germany)》1992,70(3-4):205-209
Summary Secretory vesicles of both the exocrine and the endocrine pancreas have been isolated and characterized in molecular terms from pancreatic tissue and primary cell cultures. Studies on pancreatic secretory processes could be further facilitated by the use of permanent cell lines that respond to secretory stimuli with a regulated secretory response. We now present biochemical, morphological and secretory studies on the rat pancreatic acinar cell line AR42J. This cell line is characterized by the presence of digestive enzyme-containing dense core vesicles, which are released in response to cholecystokinin. In addition, we present evidence that these cells also contain small neuroendocrine-specific vesicles, as evidenced by the expression of the neuroendocrine-specific vesicle proteins synaptophysin and S.V.2. Corresponding to these mixed exocrine-neuroendocrine features, we also found considerable amounts of the neurotransmitters glycine, glutamine and gammaaminobutyric acid (GABA), as well as the rate-limiting enzyme in GABA synthesis, glutamic acid decarboxylase (GAD) (EC 4.1.1.15) expressed in these cells. We demonstrated a specific uptake mechanism for radioactively-labelled GABA by these cells. In addition, GABA was released from intracellular storage pools by nicotinic receptor stimulation or membrane depolarization. In summary, AR42J cells represent the first amphicrine pancreatic cell line with the combined expression of exocrine and neuroendocrine secretory organelles, both of which follow a regulated secretory pathway in response to various secretory stimuli.Abbreviations DCV
dense core vesicles
- GABA
gammaaminobutyric acid
- SDS-PAGE
sodium dodecyl sulphate polyacrylamide gel electrophoresis 相似文献
35.
VEGF-C和VEGF-D蛋白表达在胰腺癌淋巴转移中的意义 总被引:1,自引:1,他引:0
目的探讨胰腺癌中VEGF-C、VEGF-D蛋白表达与淋巴结转移之间的相关关系,阐明癌周淋巴管增生在胰腺癌淋巴转移中的作用及意义。方法免疫组化检测30例胰腺癌组织中VEGF-C、VEGF-D的表达及其与临床病理、淋巴结转移的关系。结果胰腺癌VEGF-C、VEGF-D蛋白表达阳性率分别为73%(22/30)、57%(17/30),肿瘤周边部位显著高于肿瘤中心部位,其表达与肿瘤的部位、分化程度、组织学类型无关,与肿瘤的TNM分期有关,Ⅲ~Ⅳ期显著高于Ⅰ~Ⅱ期。在VEGF-C、VEGF-D蛋白阳性组,淋巴结转移均显著增多。结论VEGF-C和VEGF-D与诱导胰腺癌淋巴管生成,促进肿瘤细胞淋巴道转移有关。 相似文献
36.
Everson L. A. Artifon Airton Z. Rodrigues Sergio Marques Bhawna Halwan Paulo Sakai Claudio Bresciani Atul Kumar 《Journal of gastrointestinal surgery》2007,11(12):1686-1691
Background Exploratory laparoscopy is commonly undertaken in patients with highly suspicious biliary and pancreatic lesions to facilitate
diagnosis and staging cancer is present. If an unresectable tumor is identified, a second endoscopic procedure may be required
do deploy a self-expandable metal stent (SEMS) for palliation. As endoscopic retrograde cholangio pancreatography (ERCP) may
be unsuccessful in up to 20% of patients, we evaluated the feasibility and safety of deployment of self-expandable metal stents
at the same time as the initial laparoscopy.
Patients and Methods A total of 23 eligible patients (8 male and 15 female) with malignant obstruction of the common bile duct underwent deployment
of SEMS at laparoscopy. Primary outcome measure was the successful laparoscopic deployment of stent and secondary outcome
measure was complications rates.
Results Indications for stent deployment were unresectable pancreatic cancer in 18, cholangiocarcinoma in two, neuroendocrine tumor
in one and ampullary adenocarcinoma in two patients. The median age was 73 years (range 49–93). Twenty-two of 23 stents were
deployed successfully: 17 stents were deployed transcystically and five via a choledochotomy. Median times for laparoscopic
exploration and SEMS deployment were 165 min (range 105–230) and 20 min (range 10–50), respectively. Pre- and post-procedures
median total bilirubin were 9.4 mg/dl (range 5.4–17.5) and 4.0 (range 2.6–7.1). The median size of the pancreatic mass was
3 cm (range 2–5 cm) and that of the common bile duct (CBD) from 9.2 mm (range 7.2–17.4). The mean duration of laparoscopy
was 170 min (range 120–230 min) and that for stent deployment 23 min (range 10–50 min). Complications included bleeding, obstruction,
and wound infection. Bleeding occurred on day 7 in two patients and on day 30 in one patient; bleeding occurred at the gastrojejunal
anastomosis site and was successfully treated with endoscopic hemostasis. A total of three stent obstructions were identified:
one each at 60, 90, and 120 days follow-up. All complications were successfully managed endoscopically. There were a total
of seven deaths, six as a result of progressive cancer and one of surgical wound infection and ensuing complications.
Conclusion This study demonstrates that laparoscopic deployment of self-expandable metal bile duct stents is feasible and safe. This
option appears to be a reasonable option in patients with inoperable malignant obstruction of the distal common bile duct. 相似文献
37.
P. O. Berberat H. Ingold A. Gulbinas J. Kleeff M. W. Müller C. Gutt M. Weigand H. Friess M. W. Büchler 《Journal of gastrointestinal surgery》2007,11(7):880-887
Concepts in “fast-track” surgery, which provide optimal perioperative care, have been proven to significantly reduce complication
rates and decrease hospital stay. This study explores whether fast-track concepts can also be safely applied and improve the
outcomes of major pancreatic resections. Perioperative data from 255 consecutive patients, who underwent pancreatic resection
by means of fast-track surgery in a high-volume medical center, were analyzed using univariate and multivariate models. Of
the 255 patients, 180 received a pancreatic head resection and 51 received distal, 15 received total, and 9 received segmental
pancreatectomies. The patients were discharged on median day 10 with a 30-day readmission rate of 3.5%. The in-hospital mortality
was 2%, whereas medical and surgical morbidities were 17 and 25%, respectively. Fast-track parameters, such as first stools,
normal food, complete mobilization, and return to normal ward, correlated significantly with early discharge (p < 0.05). Patients’ age, operation time, and early extubation proved to be independent factors of early discharge, shown through
multivariate analysis (odds ratio: 4.0, 2.0, and 2.8, respectively; p < 0.05). Low readmission, mortality, and morbidity rates demonstrate that fast-track surgery is in fact feasible and safe
and promotes earlier discharge without compromising patient outcomes. 相似文献
38.
Björn-Christian Link Emre F. Yekebas Dean Bogoevski Asad Kutup Gerhard Adam Jakob R. Izbicki Gerrit Krupski 《Journal of gastrointestinal surgery》2007,11(2):166-170
Symptomatic biliary leakage following major upper abdominal surgery is a severe complication resulting in increased morbidity
and mortality. Treatment options usually include either endoscopic intervention or surgical revision. These options may be
burdened by a high perioperative risk for the patient (e.g., patients with severe disease) or simply may not be possible (e.g.,
nonpreserved gastroduodenal passage). In the past, percutaneous transhepatic cholangiodrainage did only seem to be a viable
option for patients with dilated bile ducts. Here, we present our experience in a consecutive series of patients with symptomatic
biliary leakage following major upper abdominal surgery and without dilation of the biliary system that underwent percutaneous
transhepatic cholangiodrainage. Percutaneous transhepatic cholangiodrainage was feasible in 15 of 18 patients (83.3%). The
procedure was technically not possible in three patients (16.7%). In 10 of the 15 patients (66.6%) with feasible percutaneous
transhepatic cholangiodrainage, biliary leakage was definitely controlled without the need for surgical revision. Depending
on the experience with the interventional procedure, percutaneous transhepatic cholangiodrainage should be considered as an
alternative for treatment of symptomatic biliary leakage instead of immediate reoperation.
Presented at the Digestive Disease Week 2005 (DDW), Chicago, IL, May 14–19, 2005 (poster presentation). 相似文献
39.
Michael B. Farnell Gerard V. Aranha Yuji Nimura Fabrizio Michelassi 《Journal of gastrointestinal surgery》2008,12(4):651-656
With improvements in the safety of Whipple resection in recent decades, surgeons have continued to explore the role of more
extensive lymphadenectomy in hope of improving long-term survival. A systematic literature search of level I evidence addressing
the role of the extent of lymphadenectomy was undertaken. Only reports of prospective, randomized controlled trials comparing
pancreaticoduodenectomy with standard lymphadenectomy to pancreaticoduodenectomy with extended lymphadenectomy where information
regarding survival, morbidity, mortality, the number of resected lymph nodes in each group and detailed operative technique
were included. Four prospective, randomized trials comprising some 424 patients and one meta-analysis were identified. In
aggregate, these studies confirmed that the number of resected lymph nodes was significantly higher in the pancreaticoduodenectomy
with extended lymphadenectomy group. Morbidity and mortality rates were comparable. Postoperative diarrhea in the early months
after operation was problematic in patients undergoing extended lymphadenectomy. In none of the studies was a benefit in long-term
survival demonstrated. Standard pancreaticoduodenectomy continues to be the operation of choice for adenocarcinoma of the
head of the pancreas.
Presented at The Society for Surgery of the Alimentary Tract Postgraduate Course “Systematic Reviews of Pancreaticobiliary
Disease Customized for the Gastroenterologist and Gastrointestinal Surgeon” on May 20, 2007, Washington, D.C. 相似文献
40.
Jürgen Treckmann Andreas Paul Georgios C. Sotiropoulos Hauke Lang Arzu Özcelik Fuat Saner Christoph E. Broelsch 《Journal of gastrointestinal surgery》2008,12(2):313-318
Introduction Delayed massive hemorrhage induced by pancreatic fistula after pancreaticoduodenectomy is a rare but life-threatening complication.
The purpose of this study was to analyze the clinical course of patients with late hemorrhage, with or without sentinel bleeding,
to better define treatment options in the future.
Material and Methods From April 1998 to December 2006, 189 pancreaticoduodenectomies were performed. Eleven patients, including two patients referred
from other hospitals, were treated with delayed massive hemorrhage occurring 5 days or more after pancreaticoduodenectomy.
Sentinel bleeding was defined as minor blood loss via surgical drains or the gastrointestinal tract with an asymptomatic interval
until development of hemorrhagic shock. The clinical data of patients with bleeding episodes were analyzed retrospectively.
Results Eight of the 11 patients had sentinel bleeding, and seven of them had it at least 6 h before acute deterioration. Seven out
of 11 patients died, five out of eight with sentinel bleeding. No differences could be detected between patients with or without
sentinel bleeding before delayed massive hemorrhage. The only difference found was that non-surviving patients were significantly
older than surviving patients. Delayed massive hemorrhage is a common cause of death after pancreaticoduodenostomy complicated
by pancreatic fistula formation. The observation of sentinel bleeding should lead to emergency angiography and dependent from
the result to emergency relaparotomy to increase the likelihood of survival. 相似文献