25 mmHg) had no response to conservative management, and,therefore,had to be decompressed by invasive procedure,including 6 patients performed by decompression laparotomy,2 patients by laparoscopic decompression and 5 patients by ultrasound/computed tomography location and needle paracentesis drainage.These 13 ACS patients had obvious amelioration in physiological variables (hemodynamic,respiratory and tissue perfusion) after 24 hour post-decompression (P

Humans ; Liver Failure ; mortality ; Portasystemic Shunt, Transjugular Intrahepatic ; mortality ; Survival Rate

OBJECTIVETo compare the outcomes of patients undergoing surgical treatment for pancreatic head carcinomas during different time course over 40 years in one hospital.

METHODSTotally 346 cases of pancreatic head carcinoma in one hospital were retrospectively analyzed during the periods of 1958-1976, 1977-1987, 1988-1998, and 1999-2003.

RESULTSDuring the period of 1958-1976, 79 patients with pancreatic head carcinoma were diagnosed and the rate of pancreaticoduodenectomy (PD) was 20.6% (21/79). During the period of 1977-1987, 60 patients with pancreatic head carcinoma were diagnosed and the PD rate was 26.7% (16/60). During the period of 1988-1998, 109 patients with pancreatic head carcinoma were diagnosed and the resection rate was 20.18% (22/109). During the period of 1999-2003, 98 patients with pancreatic head carcinoma were diagnosed and the resection rate was 22.4% (20/98). The total resection rate of pancreatic head carcinomas was 22.8% (79/346). The complication rate of the operation was 42.3% (9/21) during 1958-1976, 37.5% (6/16) during 1977-1987, 27.3% (6/22) during 1988-1998, and 10.0% (2/20) during 1998-2003. The perioperative mortality was 19.0% (4/21) during 1958-1976 (2 cases of pancreatic fistula and 1 case of liver and renal failure), 12.5% (2/16) during 1977-1987 (1 case of multiple organ failure and 1 case of bleeding), and 4.5% (1/22) during 1988-1998 (1 case of multiple organ failure). One patient with bile duct fistula during 1977-1987 and one patient with pancreatic fistula during 1988-1998 were cured by non-operative treatment. There was no perioperative death during 1999-2003. During the period of 1958-1976, the survival rate of patients undergoing PD was 55.5% by 1 year, 23.1% by 3 year, and 11.0% by 5 year. During 1977-1987, it was 56.3% by 1 year, 25.0% by 3 year, and 12.5% by 5 year. During 1988-1998, it was 59.1% by 1 year, 27.2% by 3 year, and 13.6% by 5 year.

CONCLUSIONSRemarkable improvement have been achieved in perioperative preparation and care after surgical treatment of pancreatic head cancer in the past decades. However, the resection rate and prognosis of PC were still poor, although the accuracy of early diagnosis is increasing, and the complications and perioperative mortality of PD are decreasing.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Pancreatic Neoplasms ; mortality ; pathology ; surgery ; Pancreaticoduodenectomy ; adverse effects ; methods ; Retrospective Studies ; Survival Analysis ; Survival Rate

OBJECTIVETo observe the growth effect of somatostapin on human pancreas cancer lines Bxpc-3.

METHODSThe Bxpc-3 pancreas cancer cells were treated with Somatotropin. The cells hyperplasia were detected by MTT and were observed apoptosis cells determinated quantitatively by TUNEL, quantify immune fluoresence double marked the proliferation cells and apoptosis cells, the expression of Cyclin D1 detected by immunohistochemical.

RESULTSThe growth effect of pancrea cancer cells were limited by 10(-7) M, 10(-8) M, 10(-9) M Somatotropin on 2 day. The limited effect was decreased from 3 day. The cells proliferation were increased by somotostapin on 4day to 5day. The relationship between the expression of Cyclin D1 and apoptosis was negative correlation and the cells hyperplasia was positive correlation in Bxpc-3 cell line.

CONCLUSIONFrom the cell study we knew the expression of Cyclin D1 reflected the prolefiration of pancreas cancer cells.

Apoptosis ; drug effects ; Cell Division ; drug effects ; Cell Line, Tumor ; Cyclin D1 ; biosynthesis ; Dose-Response Relationship, Drug ; Growth Hormone ; pharmacology ; Humans ; Immunohistochemistry ; In Situ Nick-End Labeling ; Pancreatic Neoplasms ; metabolism ; pathology ; Time Factors

BACKGROUNDTraditional Chinese medicine has been used widely for many years in China to treat acute pancreatitis. We have investigated the effects of Dachengqi decoction on intestinal mucosal permeability and outcome in patients with severe acute pancreatitis (SAP).

METHODSForty patients with sustained SAP that required admission to the surgical intensive care unit were enrolled prospectively in the study. All of these patients were divided randomly into the Dachengqi decoction group (n = 20) and control group (n = 20) on admission. Intestinal permeability was assessed by measuring absorption of two metabolically inert markers, lactulose (L) and mannitol (M), which were administered orally. Serum concentrations of endotoxin (lipopolysaccharide, LPS) and the ratio of lactulose to mannitol in urine (L/M) were detected in all patients.

RESULTSCompared with those in the control group, urinary L/M ratio decreased significantly in the Dachengqi decoction group on the 7th day after admission (P = 0.001). Also, serum concentrations of LPS were reduced on the 5th and 7th day after admission (P = 0.006, P = 0.008, respectively). Incidence of multiple organ dysfunction syndrome (MODS) and pancreatic infection was significantly lower in the Dachengqi decoction group compared with those in the control group (P = 0.038,P = 0.025, respectively).

CONCLUSIONDachengqi decoction may promote the recovery of intestinal mucosal permeability and decrease the incidence of MODS and pancreatic infection in patients with SAP.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Interleukin-6 ; metabolism ; Intestinal Mucosa ; drug effects ; metabolism ; pathology ; Male ; Medicine, Chinese Traditional ; methods ; Middle Aged ; Pancreatitis ; drug therapy ; metabolism ; pathology ; Tumor Necrosis Factor-alpha ; metabolism ; Young Adult

BACKGROUNDCathespin-B (cath-B) is an important proteolytic enzyme involved in the disease course of invasion in many types of cancer. Cath-B expression in subcutaneous heteroplastic pancreatic carcinoma in nude mice has not been studied. We investigated the role of cath-B in a model of heteroplastic pancreatic carcinoma in BALB/c nude mice.

METHODSThirty-two six-week-old female BALB/c nude mice were equally divided into four groups. PANC-1 cells were inoculated subcutaneously in the left axillary region. Besides volume, weight of subcutaneous tumor, and change in body weight, cath-B expression in each group was measured by immunohistochemical staining, PCR and Western blotting. Its relationship to microvessel density (MVD), CD44v6, and placenta growth factor (PLGF) was also examined. CA-074Me, a specific inhibitor of cath-B, was injected intraperitoneally (i.p.) at different stages of tumor growth in group B and C. Gemcitabine (GEM), was also injected (i.p.) in group D to compare anti-tumor efficacy with CA-074Me.

RESULTSExpression of cath-B at different levels was related to tumor growth, MVD, and PLGF expression. In group A (control group), cath-B expression was enhanced more than that seen in other groups. CA-074Me clearly inhibited cath-B expression and tumor growth in group B. There was no difference between group C and D with respect to anti-tumor effect.

CONCLUSIONSCath-B correlates with the growth and angiogenesis of tumors, but not with the adhesion induced by CD44v6. CA-074Me clearly inhibited cath-B expression and demonstrated an anti-neoplastic and anti-angiogenesis effect.

Animals ; Antineoplastic Agents ; therapeutic use ; Blotting, Western ; Body Weight ; Cathepsin B ; antagonists & inhibitors ; genetics ; metabolism ; physiology ; Cell Line, Tumor ; Dipeptides ; therapeutic use ; Female ; Humans ; In Vitro Techniques ; Mice ; Mice, Nude ; Pancreatic Neoplasms ; drug therapy ; metabolism ; Placenta Growth Factor ; Pregnancy Proteins ; genetics ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Transplantation, Heterologous

The complications of injection sclerotherapy for hemorrhoid are always local. Herein, we report a case in which a female patient with abdominal compartment syndrome developed after receiving a local injection of a sclerosing agent for hemorrhoid.
Abdomen ; Aged ; Compartment Syndromes ; etiology ; Female ; Hemorrhoids ; therapy ; Humans ; Sclerotherapy ; adverse effects

OBJECTIVETo explore the feasibility of using plasma trypsinogen activation peptides (TAP) and serum interleukin-6(IL-6) as early markers for predicting the severity of experimental acute pancreatitis.

METHODSNinety male adult Sprague-Dawley rats were equally randomized into five groups: edema pancreatitis group, treated with retrograde ductal infusion of 3% sodium taurocholate solution; necrosis pancreatitis group, treated with retrograde ductal infusion of 5% sodium taurocholate solution; treatment pancreatitis group, treated with retrograde ductal infusion of 3% sodium taurocholate solution and ulinastatin intravenous infusion half an hour later; control pancreatitis group, treated with 0.9% normal saline retrograde ductal infusion; and sham operation group, treated with sham operation. Rats in each group were equally randomized into three subgroups, which were killed by exsanguination 3, 6, or 24 hours after infusion, and blood specimens were obtained. Serum amylase, plasma TAP, and serum IL-6 were determined. The severity of pancreatitis was scored by two blinded pathologists under microscope.

RESULTSAt 3 and 6 hours after infusion, plasma TAP concentration of necrosis pancreatitis group [(4.798±0.169) and (3.999±0.299)nmol/L, respectively]were significantly higher than those of edema pancreatitis group [(2.416±0.148) and (3.356±0.211)nmol/L, respectively] (P<0.01); at 6 hours after infusion, serum IL-6 level of necrosis pancreatitis group [(1339.51±56.43)pg/ml]was significantly higher than that of edema pancreatitis group [(619.07±42.25)pg/ml] (P<0.01).

CONCLUSIONSIn this acute pancreatitis model, the peak levels of plasma TAP and serum IL-6 may appear earlier in rats with severer disease. Serum TAP level may be used as a marker for the accurate early prediction of the severity of acute pancreatitis.

Animals ; Biomarkers ; blood ; Disease Models, Animal ; Interleukin-6 ; blood ; Male ; Oligopeptides ; blood ; Pancreatitis, Acute Necrotizing ; blood ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo report the experience in diagnosis and management of bleeding pseudoaneurysms associated with severe acute pancreatitis (SAP).

METHODSThe medical records of 12 patients with bleeding pseudoaneurysms associated with SAP treated between October 1990 and October 2006 were retrospectively reviewed. The etiologies of the 12 patients were gallstones in 6 patients, hyperlipidemia in 3 patients, hyperparathyroidism in 1 patient and the other 2 patients had no definitive causes.

RESULTSAbdominal computed tomography revealed bleeding pseudoaneurysms in 6 of 9 patients. Angiography determined correct diagnosis in 12 patients (12/12). The most involved vessels were peripancreatic arteries. Eight patients were managed by trans-catheter arterial embolization (TAE) as "one point" (a proximal point of the pseudo-aneurysm). Two patients were treated by TAE as "two points" (both distal and proximal to the pseudo-aneurysm). The last two cases were treated by surgery as suture and ligation. Four of the "one point" TAE patients were re-bleeding 4 to 7 days later, and 2 of them were treated with surgery, the other 2 patients were controlled with "two points" TAE. Three patients were died of infection and multiple organ dysfunction syndromes. Overall mortality rate was 25% (3/12).

CONCLUSIONSAngiography is the main diagnostic methods for bleeding pseudoaneurysms in SAP patients. "Two points" embolization and emergency surgery are an effective treatment options in these patients.

Adult ; Aged ; Aneurysm, False ; diagnosis ; etiology ; therapy ; Aneurysm, Ruptured ; diagnosis ; etiology ; therapy ; Angiography ; Embolization, Therapeutic ; Female ; Hemorrhage ; diagnosis ; etiology ; therapy ; Humans ; Ligation ; Male ; Middle Aged ; Pancreatitis, Acute Necrotizing ; complications ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo compare primary anastomosis after intraoperative colonic defecation and Hartmann procedure for obstructive left colon cancer.

METHODSClinical data of 68 patients who underwent emergent laparotomy for left colon cancer with acute bowel obstruction between January 2000 and January 2008 were analyzed retrospectively.

RESULTSPrimary resection and anastomosis with intraoperative defecation was performed in 43 patients and Hartmann's procedure in 25 cases. Patients in both groups were comparable in terms of age, gender, nutritional status, underlying diseases, tumor location and stage, etc. The morbidity and mortality in the two groups were 25.6% vs 28.0% (P=0.761) and 2.3% vs 4.0% (P=0.369), respectively, and the differences were not statistically significant. The length of hospital stay (including first resection operation and second admission for colostomy closure) was (16.6+/-7.8) d in the primary anastomosis group and (24.6+/-9.4) d in the Hartmann procedure group, and the difference was statistically significant (P=0.002). The costs of hospitalization in the two groups were CNY 50,192.8+/-39,727.4 and CNY 58,382.1+/-30,304.9 (P=0.020).

CONCLUSIONPrimary resection with intraoperative colonic defecation is safe and effective, and should be considered as an alternative to Hartmann procedure for obstructive left colon cancer in selected patients.

Aged ; Anastomosis, Surgical ; methods ; Colectomy ; methods ; Colon ; surgery ; Colonic Neoplasms ; surgery ; Defecation ; Female ; Humans ; Intestinal Obstruction ; etiology ; surgery ; Male ; Middle Aged ; Proctocolectomy, Restorative ; Retrospective Studies