Colon cancer may invade the adjacent organ in the absence of distant metastasis, which is called stage T4bM0 colon cancer according to the 7th edition of TNM staging system. It is not rare in clinical setting, and usually recognized intraoperatively. How to deal with this situation is a big challenge for the surgeons. It is difficult to distinguish between dense adhesion and cancerous invasion. Intraoperative biopsy should be avoided because of the risk of tumor cell dissemination and frozen often gives false-negative results. After evaluating the resectability of the tumor sufficiently, the surgeon should make every effort to do an en bloc multivisceral resection and to achieve a margin-free (R0) resection if there is no absolute contraindication. This effort will bring long-term prognosis benefit for the patients with stage cT4bM0 colon cancer.
Colonic Neoplasms ; surgery ; Humans ; Neoplasm Staging

OBJECTIVETo study the characters of chronic pancreatitis complicated by non-calculous obstructive jaundice, and discuss the methods for differentiation and treatment.

METHODTwenty cases selected from January 1985 to December 2004 were analysed in the fields of differentiation and treatment.

RESULTSAll cases didn't present with typical clinical presentations and radiological features. Jaundice was presented as the main complaint. Stricture of the intra-pancreatic common bile duct was the symbolic radiological feature. Pancreatic disseminated inflammation was verified pathologically in these cases. CT, ultrasound, EUS, ERCP, MRCP and antigen-marker of neoplasm failed to offer the data for differentiation. The diagnosis could only be determined by pathological exam. The obstructive jaundice could be solved by biliary-enteric anastomoses successfully.

CONCLUSIONSThe patients with sole complaint of obstructive jaundice account for 15% of all inpatients with chronic pancreatitis. There exists a direct relationship between the jaundice and the pancreatic inflammation. This disorder should be differentiated from total pancreatic carcinoma, but few differentiated material could be offered by preoperative studies. Pathological result derived from the tissue sample obtained within the exploration would be reliable for diagnosis. The bypass between biliary tract and intestine would be a safe and economical treatment method.

Adult ; Aged ; Anastomosis, Roux-en-Y ; Biopsy, Needle ; Cholangiopancreatography, Endoscopic Retrograde ; Choledochostomy ; methods ; Chronic Disease ; Endosonography ; Female ; Humans ; Jaundice, Obstructive ; diagnosis ; etiology ; surgery ; Male ; Middle Aged ; Pancreaticoduodenectomy ; Pancreatitis ; complications ; diagnosis ; surgery ; Retrospective Studies ; Tomography, X-Ray Computed

BACKGROUNDTissue factor (TF) is overexpressed in many malignant tumours and is linked to the pathogenesis and prognosis of such malignancies. In vitro studies have proved that reduced expression of TF has inhibitory effect on the angiogenesis and cell proliferation of the malignant tumour. Therefore, TF suppression has been raised as a possible treatment for malignant tumours. Here we investigated the effect of celecoxib on TF expression induced by tumour necrosis factor alpha (TNFalpha) in PANC-1 cells and a possible molecular mechanism underlying the celecoxib effect.

METHODSVarious doses of celecoxib solution were added to standard cell numbers of PANC-1 cells mixed with equal dose of TNFalpha for 6 hours. The expression of tissue factor was detected quantitatively by Western blot, whilst the activation of nuclear factor kappaB was tested by electromobility shift assay.

RESULTSAs the doses of celecoxib increased, the tissue factor expression was decreased in PANC-1 cells and so was the activation of nuclear factor kappaB.

CONCLUSIONSCelecoxib can downregulate the expression of tissue factor induced by TNFalpha in PANC-1 cells. This antitumour effect of celecoxib can be explained indirectly via its suppressive role in activation of nuclear factor kappaB.

Celecoxib ; Cell Line, Tumor ; Cyclooxygenase 2 Inhibitors ; pharmacology ; Gene Expression Regulation ; drug effects ; Humans ; NF-kappa B ; metabolism ; Pancreatic Neoplasms ; metabolism ; pathology ; Pyrazoles ; pharmacology ; Sulfonamides ; pharmacology ; Thromboplastin ; genetics ; Tumor Necrosis Factor-alpha ; antagonists & inhibitors

OBJECTIVETo study the combined effect of gestational age and birth weight on metabolites related to inherited metabolic diseases (IMD).

METHODSA total of 3 381 samples ruled out of IMD by follow-up were randomly selected from 38 931 newborns who participated in the neonatal IMD screening during 2014-2016. The 3 381 neonates were categorized into seven groups according to their gestational age and birth weight: extremely preterm appropriate-for-gestational age (AGA) group (n=12), preterm small-for-gestational age (SGA) group (n=18), preterm AGA group (n=219), preterm large-for-gestational age (LGA) group (n=18), full-term SGA group (n=206), full-term AGA group (n=2 677), and full-term LGA group (n=231). Heel blood samples were collected from each group on postnatal days 3-7 after adequate breastfeeding. Levels of 17 key IMD-related metabolic indices in dried blood spots were measured using tandem mass spectrometry. Spearman′s correlation analysis was used to investigate the relationships between 17 IMD-related metabolic indices and their influencing factors, while covariance analysis was used to compare the metabolic indices between these groups.

RESULTSAfter adjusting the influencing factors such as physiological and pathological status, compared with the full-term AGA group, the extremely preterm AGA, preterm SGA, and preterm AGA groups had significantly reduced levels of leucine\isoleucine\hydroxyproline and valine (P<0.05); the preterm AGA group had a significantly decreased ornithine level (P<0.05); the extremely preterm AGA and preterm AGA groups had a significantly reduced proline level (P<0.05). Besides, the phenylalanine level in the extremely preterm AGA and preterm AGA groups, the methionine level in the preterm SGA group, and the tyrosine level in the preterm AGA group all significantly increased (P<0.05). The increased levels of free carnitine, acetylcarnitine, and propionylcarnitine were found in the preterm SGA and preterm AGA groups. The oleylcarnitine level also significantly increased in the preterm SGA group (P<0.05). Most carnitine indices showed significant differences between the SGA group and the AGA/LGA group in both preterm and full-term infants (P<0.05).

CONCLUSIONSLow gestational age and low birth weight may result in abnormal results in IMD screening. Therefore, gestational age and birth weight should be considered to comprehensively judge the abnormal results in IMD screening.

Birth Weight ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Small for Gestational Age ; Male ; Metabolic Diseases ; metabolism

OBJECTIVETo evaluate the frequency and nature of E-cadherin gene (CDH1) germline mutations in familial gastric cancer kindreds of china.

METHODSFive familial gastric cancer kindreds of Chinese origin were screened for germline CDH1 mutations, all of them meeting the clinical criteria for hereditary diffuse gastric cancer (HDGC), by PCR-DHPLC and direct sequencing.

RESULTSA new truncating mutation in exon 10 in B family was identified, producing a stop codon at position 503 (Q503X), resulting in a truncated protein. The proband of this family had metachronous development of lobular breast and diffuse type gastric carcinoma. No protein expression was detected in the lobular breast carcinoma, indicating complete inactivation of the gene.

CONCLUSIONSA Chinese gastric cancer family with CDH1 germline truncating mutation is described for the first time, and our findings suggest that lobular breast carcinoma might be part of the tumor spectrum of HDGC.

Adult ; Breast Neoplasms ; genetics ; Cadherins ; genetics ; Female ; Humans ; Male ; Middle Aged ; Mutation ; Neoplasms, Multiple Primary ; genetics ; Neoplastic Syndromes, Hereditary ; genetics ; Pedigree ; Polymerase Chain Reaction ; Stomach Neoplasms ; genetics

OBJECTIVETo analyze the clinicopathological characteristics of gastric gastrointestinal stromal tumors (gastric GISTs) and to explore the diagnosis, treatment and prognosis of gastric GISTs.

METHODSClinical data of 63 cases with gastric GISTs from January 1997 to May 2007 were analyzed retrospectively. All patients were treated by surgery. All the 63 cases were grouped according to the Fletcher 4-tier system for predicting the aggressiveness of GISTs. Survival was calculated by Kaplan-Meier method. Univariate and multivariate analyses were performed using log-rank analysis and Cox regression model respectively to evaluate the prognostic factors.

RESULTSThe accuracy of preoperative ultrasonography, CT and EUS was 72.2%, 81.0% and 94.3% respectively. The diagnostic accuracy of EUS was significantly higher than those of ultrasonography and CT(chi(2)=6.065, P<0.05). Of the 63 gastric GISTs, 31 cases(49.20%) were at fundus. Immunohistochemistry staining revealed that the positive rates of CD117 and CD34 were 88.9% and 95.1% respectively. The 1-, 3- and 5-year total survival rates of 63 patients were 96.4%, 84.7% and 71.7% respectively. Univariate analysis revealed that the differences of Fletcher classification and tumor size were significant. No significant differences in gender, age, mitotic index, immunohistochemistry expression and multi-organ resection existed among the groups. Multivariate analysis demonstrated that Fletcher classification was the independent poor prognostic factor for survival.

CONCLUSIONSThe preoperative diagnostic accuracy of EUS is significantly higher than those of ultrasonography and CT. Fletcher classification is reasonable and feasible to evaluate the prognosis of gastric GISTs.

Adult ; Aged ; Female ; Gastrointestinal Stromal Tumors ; diagnosis ; pathology ; surgery ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Prognosis ; Stomach Neoplasms ; diagnosis ; pathology ; surgery

OBJECTIVETo explore the classification, choice of surgical procedures and the clinical outcome of surgical management for chronic pancreatitis.

METHODS54 patients with chronic pancreatitis undergoing operation in our hospital from 1983 to 2004 were analyzed retrospectively, who were divided into chronic calcifying pancreatitis and chronic obstructive pancreatitis according to the clinical manifestations.

RESULTSThere were 41 men (76%) and 13 women (24%) with a mean age of 54 years. The cause of chronic pancreatitis was alcohol related in 25 cases (46%), cholelithiasis in 21 (39%), and previous episodes of acute pancreatitis in 18 (33%). Clinical manifestations included abdominal pain in 38 cases (70%), obstructive jaundice in 27 cases (50%). There existed a significant difference in some clinical materials between the two groups of chronic calcifying pancreatitis and chronic obstructive pancreatitis, which might mean the different pathologic basis in the two kinds of chronic pancreatitis. A total of 34 patients underwent nine different operations without perioperative deaths. Both the Puestow procedure and the pancreatoduodenectomy was safe and achieved pain relief in a large percentage of patients, which could also improve the exocrine function whereas the endocrine function remained unchanged. Addition of biliary bypass to the Puestow procedure was suitable for the patients with stenosis of common bile duct. Jaundice was the main manifestation in the patients with the inflammatory mass in the head of the pancreas and Whipple's procedure or other resectional procedures should be performed for them. Only drainage of bile duct had a better outcome for the relief of jaundice, but its effect to pancreas need to be further evaluated.

CONCLUSIONThe clinicopathologic characteristics of obstructive chronic pancreatitis was more variable and the surgical management should be also different for individuals.

Adolescent ; Adult ; Aged ; Chronic Disease ; Female ; Humans ; Male ; Middle Aged ; Pancreatectomy ; methods ; Pancreaticoduodenectomy ; Pancreaticojejunostomy ; Pancreatitis ; classification ; pathology ; surgery ; Retrospective Studies

OBJECTIVETo evaluate the clinical outcome of extended retroperitoneal lymphadenectomy as surgical therapy for adenocarcinoma of the head of the pancreas.

METHODSTwenty patients with adenocarcinoma of the head of the pancreas were treated by standard pancreatoduodenectomy (standard group) between 1994 and 1997, and 46 patients with the same disease underwent extended retroperitoneal lymphadenectomy associated with standard pancreatoduodenectomy (radical group) between 1998 and 2002. Clinical and pathological parameters in both groups were reviewed. The postoperative morbidity, mortality, and survival data were compared.

RESULTSThe mean total number of lymph nodes resected was significantly higher in the radical group than in the standard group (P < 0.05). Of the 46 patients in the radical group, 26.09% (12/46) had metastatic adenocarcinoma in the resected retroperitoneal lymph nodes. There was one perioperative death in the standard group and two in the radical group. Postoperative diarrhea and lymphatic leakage were only observed in the radical group. Transfusion requirements and postoperative morbidity did not differ between the two groups. The 1-, 2-, and 3-year survival rates were 63.16%, 31.58%, and 21.05% in the standard group, and 65.91%, 37.71%, and 21.21% in the radical group (P > 0.05). When the subgroups of patients with positive lymph nodes were analyzed, the 1-, 2-, and 3-year survival rates were 41.67%, 16.67%, and 8.33% in the standard group, and 64.52%, 32.26%, and 12.9% in the radical group (P < 0.05). A trend toward a better survival was observed in the first 2 years after operation in the radical group, but with no significant differences 2 years later.

CONCLUSIONThe addition of an extended lymphadenectomy may improve the early survival without increasing the morbidity, but has no significant effect on long-term survival.

Adenocarcinoma ; mortality ; pathology ; surgery ; Adult ; Aged ; Female ; Humans ; Lymph Node Excision ; methods ; Male ; Middle Aged ; Pancreatic Neoplasms ; mortality ; pathology ; surgery ; Pancreaticoduodenectomy ; Postoperative Complications ; Retroperitoneal Space ; Retrospective Studies ; Survival Rate

BACKGROUNDIt is a challenge for the surgeons to accurately diagnose the pancreatic masses preoperatively, which decides the choice of surgical managements and subsequently results in different survivor outcomes, operative complications, and mortality rates. The purposes of this study were to evaluate the diagnostic role that intra-operative puncture biopsy may play in pancreatic masses and to explore the relevant factors influencing the diagnosis.

METHODSA retrospective study was performed on 94 in-patients admitted to Peking University First Hospital for pancreatic masses during the period from June 1994 to December 2007. They all underwent intra-operative puncture biopsy during exploratory laparotomy. The sensitivity and specificity of intra-operative puncture biopsy were calculated and the relevant factors to the diagnosis of biopsy were selected for the statistical analysis.

RESULTSThe overall sensitivity, specificity, positive predictive value, and negative predictive value of intra-operative puncture biopsy were 76.0%, 94.7%, 98.3% and 50.0%, respectively. The analysis of bivariate correlations showed that the size of the pancreatic masses (P = 0.000), the number of puncture biopsies (P = 0.000), and the presence of pancreatic fibrosis (P = 0.012) had statistic significance for the diagnosis. But the multivariate analysis identified the size of the pancreatic masses (P = 0.004) and the number of puncture biopsies (P = 0.000) as independent predictive factors for intra-operative puncture biopsy. In addition, as the number of puncture biopsies increased, the sensitivity and specificity of diagnosis was improved (P = 0.000). The sensitivity and specificity of intra-operative puncture biopsy were found to be lower for the pancreatic masses less than 25 mm compared with the masses larger than 25 mm (P = 0.000). It was noted, however, that even if the masses were less than 25 mm, the sensitivity and specificity could be improved significantly as the number of puncture biopsies reached 3 to 6 (P = 0.007).

CONCLUSIONSIntra-operative puncture biopsy is simple and accurate for qualitatively differentiating various types of pancreatic masses. Three to 4 biopsies could significantly improve the diagnostic effect for pancreatic masses, even if the masses are less than 25 mm in size.

Aged ; Biopsy, Needle ; methods ; Female ; Humans ; Male ; Middle Aged ; Pancreas ; surgery ; Pancreatic Diseases ; diagnosis ; Pancreatic Neoplasms ; diagnosis ; Retrospective Studies ; Sensitivity and Specificity

OBJECTIVETo investigate the effects of Hic-5/ARA55 on the growth of the human colorectal cancer cells (Lovo cells) and its mechanism.

METHODFlow cytometry (FCM) was used to study the cell cycle of Lovo cells (Lovo group), Lovo cells stably transfected with empty vector (Lovo-Vector group) and the Lovo cells stably transfected with vector containing Hic-5/ARA55 (Lovo-Hic-5/ARA55 group). Western blot assay was used to detect the principal cyclins in the three groups, and Luciferase assay was used to study the mechanism between Hic-5/ARA55 and the only target cyclin. The cells from the three groups were inoculated subcutaneously into 7 nude mice (Balb/c nu/nu) respectively to observe the effects of Hic-5/ARA55 on the growth of the cells in vivo. Seven weeks later, the subcutaneous tumors were harvested and weighed. Then immunohistochemistry assay was used to detect Hic-5/ARA55 and the target cyclin in the tumors.

RESULTSThe cell cycle was obviously delayed from G0/G1 to S stage in Lovo-Hic-5/ARA55 cells. A significantly higher expression of P27 was found in Lovo-Hic-5/ARA55 cells than in the other two groups. The weight of the subcutaneous tumors of Lovo-Hic-5/ARA55 cells, Lovo cells and Lovo-Vector cells were (0.33 +/- 0.23) g, (1.20 +/- 0.39) g and (1.30 +/- 0.49) g, respectively; the tumors of Lovo-Hic-5/ARA55 cells was significantly lighter than those of the other two groups (P<0.05). Hic-5/ARA55 and P27 were both over-expressed in implanted tumors of Lovo-Hic-5/ARA55 cells, while were both expressed lower or not expressed in the other two groups. And the expressions of Hic-5/ARA55 and P27 were highly positive correlated (r=0.816, P<0.05).

CONCLUSIONHic-5/ARA55 could inhibit the growth of Lovo cells both in vitro and in vivo by up-regulating the transcription of P27.

Animals ; Cell Cycle ; Cell Line, Tumor ; Colorectal Neoplasms ; genetics ; metabolism ; pathology ; Cyclin-Dependent Kinase Inhibitor p27 ; metabolism ; Gene Expression Regulation, Neoplastic ; Genetic Vectors ; Humans ; Intracellular Signaling Peptides and Proteins ; genetics ; metabolism ; Male ; Mice ; Mice, Nude ; Plasmids ; genetics ; RNA, Messenger ; genetics ; Transfection ; Xenograft Model Antitumor Assays