Paraplegia following intraoperative celiac plexus injection

The technique for percutaneous and open neurolytic celiac plexus injection, using ethanol or phenol, for relief of intractable pancreatic cancer pain has been well described. Prospective randomized studies, demonstrating safety and efficacy with few complications, have led to widespread acceptance and use of this palliative procedure. The complications of neurolytic celiac plexus injection are rare, and are usually minor. However, transient or permanent paraplegia has been reported previously in 10 cases. The case described herein represents the third reported case of permanent paraplegia following open intraoperative neurolytic celiac plexus injection using 50% ethanol. The literature surveying the indications for this procedure, routes of administration, known complications, and their pathophysiology are reviewed.     

Magnetic resonance imaging with magnetic resonance cholangiopancreatography accurately predicts resectability of pancreatic carcinoma

Accurate preoperative staging of pancreatic malignancy aids in directing appropriate therapy and avoids unnecessary invasive procedures. We evaluated the accuracy of magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP) in determining resectability of pancreatic malignancy. Twenty-one patients with suspected pancreatic malignancy underwent dynamic, contrast-en-hanced breath-hold MRI with MRCP prior to surgical evaluation. Results of this study were correlated with operative results and pathologic findings. The sensitivity, specificity, and accuracy of MRI with MRCP in detecting a mass, determining the nature of the mass, and predicting lymph node involvement and resectability were determined. MRI with MRCP correctly identified the presence of a pancreatic mass in all 21 of these patients. Following pathologic correlation, it was determined that MRI with MRCP was 81 % accurate in determining the benign or malignant nature of the pancreatic mass and 43% accurate in predicting lymph node involvement. In predicting resectability, MRI with MRCP had a sensitivity of 100%, specificity of 83%, positive predictive value of 94%, negative predictive value of 100%, and accuracy of 95%. MRI with MRCP is an accurate, noninvasive technique in the preoperative evaluation of pancreatic malignancy. Information obtained from MRI with MRCP including identification of a mass and predicting tumor resectability may be of value in staging and avoiding unnecessary invasive diagnostic procedures in patients with pancreatic cancer. Presented at the Thirty-Ninth Annual Meeting of The Society for Surgery of the Alimentary Tract, New Orleans, La., May 17–20, 1998.     

Economic evaluation of the use of octreotide for prevention of complications following pancreatic resection

Recent studies have concluded that octreotide can prevent complications in patients undergoing pancreatic resections. Given the acquisition cost of octreotide, a cost-effectiveness analysis was performed to establish whether if the additional cost associated with its use was justified by a decrease in the consumption of other resources. To evaluate success rates and complication rates, a meta-analysis of double-blind, randomized, controlled clinical trials was conducted. The rates for pancreatic fistula and fluid collection were 10.7% (95% confidence interval [CI] 7.9 to 13.4) and 3.6% (95% CI 1.9 to 5.2) for octreotide vs. 23.4% (95% CI 19.7 to 27.1) and 8.8% (95% CI 6.2 to 11.3) for placebo. In a second phase we evaluated the treatment cost for patients with and without complications using two different models of cost savings. In the first model the cost to treat a pancreatic fistula was calculated as the per diem rate (as determined by Statistics Canada) multiplied by the incremental length of stay associated with the complication. In the second model we used data from institutions participating in the Ontario Case Costing Project. In model 1 the estimated incremental length of hospital stay attributed to a pancreatic fistula was 7 days, based on a review of the literature, and the per diem was $552. In model 2 the average cost of care for patients with or without complication was $32, 347 (n = 17; 95% CI $20, 882 to $43, 812) and $11, 169 (n = 18; 95% CI $7558 to $14, 779), respectively. The data suggest that when compared to placebo, octreotide is a dominant treatment strategy. In model 1, in a cohort of 100 patients, octreotide saved an average of $853 per patient while allowing 16 incremental patients to avoid complications. In model 2 use of octreotide resulted in an average savings of $1642 per patient while still allowing 16 patients to avoid complications. Detailed one-way and two-way sensitivity analyses suggest that both models were robust. The use of octreotide is a cost-effective strategy in patients undergoing elective pancreatic resection. Consideration should be given to extending its use to patients who are at high risk for development of complications following pancreatic surgery and who do not have any contraindications to the use of this drug. Supported in part by Novartis Pharmaceuticals Canada Inc. Presented at the Thirty-Eighth Annual Meeting of The Society for Surgery of the Alimentary Tract, Washington, D.C., May 11–14, 1997.     

用于人体局部微循环监测的便携式近红外检测仪

近红外技术在生物医学中应用越来越广泛,已涉及到指述的诊断和治疗.本文针对更年期妇女经常出现的潮热、局部充血等症状,研发了一套用于人体局部微循环状态监测的便携式近红外检测装置,能够同步监测人体体温和局部血容量的变化.系统由便携式监护仪和配套的PC机及相应软件组成.便携式监护仪采用腰带式设计,温度测量精度为0.2℃,在人体体温区段(35～40 ℃)精度可达到0.1℃;所测血容量的变化与体温变化一致,即体温升高,局部血液循环加快,血容量增加.配套PC机及软件主要完成对监护仪的控制、数据的传输、处理、存储等任务.     

Thrombospondin-1 and transforming growth factor beta-1 upregulate plasminogen activator inhibitor type 1 in pancreatic cancer

Controlled degradation of the extracellular matrix by proteases is crucial in tumor cell invasion. We have shown that thrombospondin-1 (TSP-1), through activation of transforming growth factor beta-1 (TGF-β1), regulates the plasminogen/plasmin protease system in breast cancer. To determine whether this occurred in other epithelial neoplasms, we studied the role of TSP-1 and TGF-β1 in the regulation of the plasminogen/plasmin system in pancreatic cancer. ASPC-1 and COLO-3S7 pancreatic cancer cells were treated with TSP-1 or TGF-β1 at varying concentrations. The TSP-1 and TGF-β1-treated cells were also treated with either anti-TSP-1, anti-TSP-1 receptor, or anti-TGF-β1 antibodies. Urokinase plasminogen activator (uPA) and plasminogen activator inhibitor-1 (PAI-1) expression was determined by enzyme-linked immunosorbent assay. TSP-1 and TGF-β1 promoted a dose-dependent upregulation of ASPC-1 and COLO-3S7 PAI-1 expression. The TSP-1 effect could be blocked with anti-TSP-1 or anti-TGF-β1 antibodies. The TGF-β1 effect could be blocked only with anti-TGF-β1 antibody. Anti-TSP-1 receptor antibody blocked the TSP-1 effect on PAI-1 expression but had no effect on TGF-β1-mediated PAI-1 expression. Neither TSP-1 nor TGF-β1 had an effect on uPA production. We conclude that TSP-1, in a receptor-mediated process that involves the activation of TGF-β1, upregulates PAI-1 expression in pancreatic cancer without an effect on uPA production. Supported in part by National Institutes of Health grants CA65675 and CA69722 (Dr. Tuszysnki). Dr. Berger is the recipient of an American Cancer Society Clinical Career Development Award 96-09. Presented at the Thirty-Eighth Annual Meeting of The Society for Surgery of the Alimentary Tract, Washington, D.C., May 11–14,1997.     

模拟失重时兔微循环的动态变化

用家兔以头低位－２０°方法模拟失重时体液头向分布和运动减退生理效应的模型。用兔耳不开窗微循环观察方法，动态地研究机体在模拟失重量表浅微血管中血液流动状态以及内脏主要脏器微循环功能状态以及调节变化规律；用非常规的血液流变学测量方法，观察血液流变学性特点。     

Is there a role for staging laparoscopy in patients with locally advanced,unresectable pancreatic adenocarcinoma?

The study objective was to determine the incidence of laparoscopically detected metastasis in patients with radiographically staged locally advanced adenocarcinoma of the pancreas. Patients with locally advanced pancreatic cancer are considered candidates for novel treatment protocols. Stratification of patients into locally advanced disease versus metastatic disease is imperative to accurately evaluate treatment outcome. Between 1994 and 2000, 100 consecutive patients undergoing staging laparoscopy with radiologic evidence of unresectable locally advanced pancreatic cancer were identified from a prospective database. All patients had preoperative contrast-enhanced, thin-cut computed tomography scanning or magnetic resonance imaging and had no evidence of detectable metastatic disease. There were 53 men and 47 women, with a median age of 64 years. The disease site was the pancreatic head in 69 cases and the body or tail in 31. Radiographic assessment of nonresectability was due to encasement of the celiac or hepatic artery in 37 patients, of the portal vein and superior mesenteric vessels in 56, and extrapancreatic extension in 7. Laparoscopy identified metastatic disease in 37% of patients, not seen on preoperative imaging. Peritoneal disease was noted in 12 cases and liver metastasis in 18 cases, and 7 patients had both. Neither the primary tumor size nor location influenced the incidence of metastatic disease. Standard imaging modalities failed to detect metastatic disease in 37% of patients who were considered to have locally advanced pancreatic cancer. Patients considered for treatment protocols for locally unresectable pancreatic cancer should be staged laparoscopically before initiation of therapy. Presented at the Forty-Third Annual Meeting of The Society for Surgery of the Alimentary Tract, San Francisco, California, May 19–22, 2002.     

胰腺巨大假性囊肿超声内镜引导下胃内支架引流1例报告——附文献复习

为探讨胰腺假性囊肿内镜治疗的操作技术和临床疗效，在超声内镜引导下对1例巨大胰腺假性囊肿行超声内镜引导下经胃壁穿刺置管引流。术后当天患者症状缓解，1周后囊肿缩小50%，随访6个月，囊肿消失无复发，未发生出血、穿孔等并发症。超声内镜引导下囊肿胃置管引流术安全、可靠，并发症少，是一种有效的微创介入治疗方法。     

CD/5-FC自杀基因系统治疗胰腺癌的实验研究

为探讨自杀基因CD/5-FC系统对胰腺癌的杀伤作用及作用机制,应用细菌内同源重组法构建含大肠杆菌胞嘧啶脱氨酶（cytosine deaminase, CD）基因的腺病毒载体,经293细胞包装、扩增,氯化铯密度梯度离心制备纯化CD腺病毒液,体外转染人胰腺癌细胞,并给予前药5-FC,观察其体外杀伤效果;并建立胰腺癌裸鼠皮下移植瘤模型,瘤内直接注入CD腺病毒液,随后腹腔内注入5-FC,观察CD基因的原位治疗效应。含CD基因腺病毒载体经酶切鉴定正确,包装纯化后,检测病毒滴度为2×1011pfu/ml,将重组腺病毒转染胰腺癌细胞株后,可见5-FC对转导入CD基因的胰腺癌细胞有明显细胞毒性作用,而对未导入CD基因的人胰腺癌细胞毒性较低,体内实验显示CD基因原位转导对裸鼠胰腺癌疗效较明显。腺病毒介导CD基因,不仅转染效果强,而且加用5-FC后,可直接或通过旁观者效应杀伤胰腺癌细胞或抑制移植瘤的生长,可作为胰腺癌基因治疗的有效方法。     

超声导向胰腺假性囊肿穿刺治疗术

目的探讨超声引导下对胰腺假性囊肿进行穿刺的诊断和治疗价值. 方法对35例胰腺假性囊肿患者实行超声引导下诊断性穿刺(7例)和治疗性穿刺(28例),后者抽出囊液后注药冲洗. 结果 35例患者共52个囊肿均明确诊断并予相应治疗,总成功率100%.随访期间27例胰腺假性囊肿消失,8例复发. 结论超声引导下胰腺假性囊肿穿刺是一种有效而可靠的诊断与非手术治疗方法.