Background: Injuries to the pancreaticoduodenal complex present a significant challenge both in diagnosis and management. The retroperitoneal location of the pancreas means that it is not a common site of injury, but this also contributes to the difficulty in diagnosis. Objective: To evaluate changes of serum amylase level before the operation of pancreaticoduodenal injuries. Subjects and method: Prospective analysis of 156 patients with pancreaticoduodenal injuries from January 2000 to December 2006 was measured serum amylase level at admission. The factors analyzed in the study included age, gender, time elapsed from injury to admission, type of pancreaticoduodenal injuries according to The American Association for the Surgery of Trauma 1990. Results: The serum amylase level was found to be abnormal in all patients admitted more than 3 hours after trauma. Various comparisons between patients with elevated (78.2%) and nonelevated (26.3%) serum amylase levels showed the statistical significance solely of the time elapsed from injury to admission. The major factor that influenced the serum amylase level on admission appeared to be the time elapsed from injury to admission. Determination of the serum amylase level was no diagnosis within 3 hours or less after trauma, irrespective of the type of injury. Conclusions: To avoid failure in the detection of pancreaticoduodenal injuries, the authors advocate determination of serum amylase levels more than 3 hours after trauma.
Amylases/ diagnostic use ; Duodenal Diseases/ diagnosis ; Pancreatic Ducts/ injuries

Identifying a target molecule that is crucially involved in pancreatic tumor growth and metastasis is necessary in developing an effective treatment. The study aimed to investigate the role of the eukaryotic translation initiation factor 3a (eIF3a) in the cell proliferation and motility in pancreatic cancer. Our data showed that the expression of eIF3a was upregulated in pancreatic ductal adenocarcinoma as compared with its expression in normal pancreatic tissues. Knockdown of eIF3a by a specific shRNA caused significant decreases in cell proliferation and clonogenic abilities in pancreatic cancer SW1990 and Capan-1 cells. Consistently, the pancreatic cancer cell growth rates were also impaired in xenotransplanted mice. Moreover, wound-healing assay showed that depletion of eIF3a significantly slowed down the wound recovery processes in SW1990 and Capan-1 cells. Transwell migration and invasion assays further showed that cell migration and invasion abilities were significantly inhibited by knockdown of eIF3a in SW1990 and Capan-1 cells. Statistical analysis of eIF3a expression in 140 cases of pancreatic ductal adenocarcinoma samples revealed that eIF3a expression was significantly associated with tumor metastasis and TNM staging. These analyses suggest that eIF3a contributes to cell proliferation and motility in pancreatic ductal adenocarcinoma.
Adenocarcinoma ; Animals ; Cell Movement ; Cell Proliferation* ; Mice ; Neoplasm Metastasis ; Neoplasm Staging ; Pancreatic Ducts ; Pancreatic Neoplasms* ; Peptide Initiation Factors* ; RNA, Small Interfering ; Wounds and Injuries

PURPOSE: The surgical morbidity and mortality after a pancreaticoduodenectomy has been decreasing but still remains high. The most serious complications are pancreatic leakage, gastrointestinal or intra-abdominal hemorrhage, and an intraabdominal abscess. The less serious complications are delayed gastric emptying and wound problems. The aim of this study was to evaluate the risk factors for morbidity and mortality after a pancreaticoduodenectomy. METHODS: Among 90 patients who underwent pancreaticoduodenectomy from Feb. 1992 to Dec, 2000. 68 patients whose hospital records could be reviewed thoroughly were enrolled in this study. The postoperative morbidity and mortality after a pancreaticoduodenal resection were evaluated in terms of the patient's age, combined disease, laboratory values, biliary drainage, transfusion, types of pancreaticojejunostomy, pancreatic duct size, consistency, and the administration of octreotide. Univariate and multivariate analysis were performed with a chi-square test and multiple logistic regression test. RESULTS: Postoperative complications were observed in 43 cases (63.2%). Wound complications were noted in 13 cases (19.1%), gastric emptying disturbance in 10 cases (14.7%), bleeding in 9 cases (13.2%), an abscess in 4 cases (5.9%), and leakage in 22 cases (32.4%). Nine cases (13.2%) had died. The causes of death were sepsis due to leakage in 3 cases, bleeding in 3 cases, and others causes in 3 cases. Univariate analysis showed that diabetes mellitus was significantly (P<0.05) related to delayed gastric emptying. In multivariate analysis, transfusion was significantly (P<0.05) related to wound infections and mortality. Old age ( 65 years) was significantly related to leakage and delayed gastric emptying. CONCLUSION: Pancreaticoduodenectomy is still associated with a high mortality and morbidity rate even though there has been significant progress in the field of pancreatic surgery and postoperative follow-up. Old age and transfusions appeared to be the main risk factors for morbidity and mortality after a pancreaticoduodenectomy in this study. In addition to these factors, better anticipation and management of the postoperative complications is essential for improving the surgical outcome.
Abscess ; Cause of Death ; Diabetes Mellitus ; Drainage ; Follow-Up Studies ; Gastric Emptying ; Hemorrhage ; Hospital Records ; Humans ; Logistic Models ; Mortality* ; Multivariate Analysis ; Octreotide ; Pancreatic Ducts ; Pancreaticoduodenectomy* ; Pancreaticojejunostomy ; Postoperative Complications ; Risk Factors ; Sepsis ; Wound Infection ; Wounds and Injuries