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Diagnosis and treatment of the periampullary carcinoma in the pre-jaundice stage

Shaowu HE ; Gang JIN ; Xiangui HU ; Junsheng KANG

Chinese Journal of Pancreatology.2010;10(6):398-400. doi:10.3760/cma.j.issn.1674-1935.2010.06.006

Objective To explore the clinical characteristics of periampullary carcinoma in the prejaundice stage and improve early diagnosis rate and operative effects.Methods Clinical data of 27 cases with periampullary carcinoma in the prejaundice stage in our institute during the period of Jan 1998 to Dec 2005were analyzed retrospectively.Results The clinical symptom was mostly nonspecific, mainly included abdominal discomfort ( 92.6% ), abdominal pain ( 55.6% ), and irregular fever ( 29.6% ).The positive diagnosis rate with US, CT, MRCP, ERCP and EUS was 75.6%, 85.2%, 83.3%, 84.6%, and 88.9%,respectively, and they were helpful for early diagnosis.Among these 27 patients, 19 cases received regional pancreaticoduodenectomy, and 5 cases received pancreaticoduodenectomy in combination with vessel resection,3 cases received bile duct or gallbladder jejunal Roux-en-Y anastomosis, the overall resection rate was 88.9% with no operative mortality, and the post-operation complication rate was 7.4%.The 1,3, and 5 year survival rates were 100%, 70.8% and 41.7%, respectively.Conclusions The periampullary carcinoma in the prejaundice stage has its own clinical characteristics and abnormal image changes.If the diagnosis can be confirmed in the prejaundice stage, it is still an important method to improve the resection rate and prognosis.

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Diagnosis and treatment of 21 blunt pancreatic trauma patients

Zhiyuan JIAN ; Mingyin LAN ; Meng ZHOU ; Yanmei ZHAO

Chinese Journal of Pancreatology.2010;10(6):395-397. doi:10.3760/cma.j.issn.1674-1935.2010.06.005

Objective To investigate the diagnosis and treatment of the blunt pancreatic injury.Methods The clinical data of 21 blunt pancreatic trauma patients admitted to our hospital in the past 5 years were analyzed retrospectively.Results 3 of 21 patients were simple blunt pancreatic injury, while the other 18 patients were complicated with other abdominal organs injuries.According to the grading criteria, the number of Ⅰ , Ⅱ, Ⅲ, Ⅳ, Ⅴ grade injury were 4, 7, 5, 3 and 2 cases, respectively, and only 9 patients were diagnosed by CT before operation, and the diagnosis was confirmed during the operation in 11 patients, and 1 was miediagnosed in the first operation.Single drainage or debridement and drainage were performed in 8 cases and distal pancreatectomy with and without spleen were performed in 5 and 3 cases, respectively, and 3patients received pancreaticojejunostomy, 1 received Whipple operation, the other 1 case underwent duodenorrhahy and diverticulation.The mortality rate was 9.5% (2/21), and the complications of pancreatic pseudocyst and fistula developed in 2 (9.5%, 2/21 ) and 5 (23.8%, 5/21 ) cases respectively, and they were cured by drainage, while the other 12 were cured completely.Conclusions The preoperative misdiagnosis rate of pancreatic trauma is high;CT scan should be used to confirm the diagnosis.Careful pancreatic exploration is mandatory and simple and effective surgical procedures with effective drainage is important for treatment success.

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Kansui root therapy for severe acute pancreatitis with high intra-abdominal pressure

Junming HE ; Shixia CAI ; Xiaosheng ZHONG ; Chengjiang QIU ; Youxing HUANG ; Song WANG ; Xianfeng LIU ; Zhijian TAN ; Bingqin CAI

Chinese Journal of Pancreatology.2010;10(6):392-394. doi:10.3760/cma.j.issn.1674-1935.2010.06.004

Objective To investigate the treatment effects of Kansui root on severe acute pancreatitis (SAP) with abdominal compartment syndrome (ACS).Methods 16 cases of SAP were randomly divided into kansui root treatment group and control group according to random number table.Patients in control group received routine treatment including fasting, anti-shock, antibiotics and nutritional support.And the patients in kansui root group received routine treatment plus kansui root therapy.The clinical and laboratory parameters were determined and compared between the two groups.Results The relieving time of abdominal pain, bowel sound, the recovery time of hyperamylasemia, body temperature and leukocyte count in treatment group was (7.6±2.3)d, (6.1 ±3.1)d, (5.9±3.3)d, (5.2 ±3.2) d, (6.3 ±2.1)d, which were significantly shorter than those in control group [ ( 11.7 ± 2.1 ) d, ( 11.2 ± 2.3d, ( 10.2 ± 2.7) d, (9.2 ± 3.5 ) d, ( 11.1 ±3.3)d, P＜0.01 ) ].At the 3rd, 4th and 5th day, the intra-abdominal pressure in treatment group were also significantly lower than those in control group[ ( 19.8 ±3.1 )cmH2O vs(23.7 ±2.9) cmH2O, ( 12.3 ±2.7) cmH2O vs (21.3±1.5)cmH2O,(8.2±3.1)cmH2O vs (17.3 ±2.3)cmH2O,P＜0.05].Conclusions Severe acute pancreatitis has close relationship with Jiexiong syndrome in traditional chinese medicine.Kansui root is an effective therapy for alleviating high intra-abdominal pressure.

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Dynamic changes and significance of serum IL-1β and sE-selectin in patients with acute pancreatitis

Duanmin HU ; Chunhua ZHOU ; Shaofeng WANG

Chinese Journal of Pancreatology.2010;10(6):386-388. doi:10.3760/cma.j.issn.1674-1935.2010.06.002

Objective To investigate the dynamic changes and relationship between the serum levels of IL-1 β and sE-selectin in acute pancreatitis (AP) patients, and to study the predicative value for severity of AP.Methods Forty one patients with AP were divided into severe acute pancreatitis (SAP, 19 cases) group and mild acute pancreatitis (MAP, 22 cases) group.Their serum were collected at the 1st, 3rd, 7th, and 14th day after admission and the serum concentrations of IL-1 β and sE-selectin were detected by ELISA.Another 20healthy volunteers were selected as controls.Results The serum concentration of IL-1 β in control group was ( 18.71 ±2.43)ng/L, while they were (61.18 ±7.47)ng/L, (33.03 ±5.85)ng/L, (20.73 ±4.07)ng/L in MAP group at the 1st, 3rd, 7th day;and they were (86.91 ± 13.32) rng/L, (81.35 ± 12.71) ng/L,(64.93 ±5.99)ng/L, (21.40±49.13) ng/L at the 1st, 3rd, 7th and 14th day in SAP group.The serum concentration of IL - 1β of patients with SAP were markedly higher than those with MAP and normal controls on the 1st, 3rd, 7th day (P ＜0.05) and they decreased almost to normal on the 14th day.The serum concentration of sE-selectin was ( 10.69 ± 2.51 ) ng/ml, while they were ( 41.60 ± 6.85 ) ng/ml, ( 14.90 ±3.51)ng/ml, (9.85 ±2.88)ng/ml in MAP group at the 1st, 3rd, 7th day;and they were (84.73 ±15.37)ng/ml, ( 95.65 ± 13.06 ) ng/ml, ( 39.41 ± 3.73 ) ng/ml, ( 12.25 ± 2.29 ) ng/mlon the 1st, 3rd, 7 th and 14th day.The serum concentration of sE-selectin of patients with SAP were significantly higher than those with MAP and normal controls on the 1st, 3rd, 7th day (P ＜0.05 ) and there was no significant difference between SAP and control group on the 14th day.There was a positive correlation between the serum level of IL-1 β and sE-selectin in AP on the 1 st day after admission ( r = 0.851, P ＜ 0.01 ).Conclusions The serum concentrations of IL-1 β and sE-selectin are useful for AP severity predication.

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Expression of MCP-1 in the pancreas of piglet with chronic obstructive pancreatitis and its significance

Yang BIAN ; Na TA ; Lin LI ; Qiao ZHENG ; Shunmin ZHANG ; Jianming ZHENG ; Changjing ZUO

Chinese Journal of Pancreatology.2010;10(6):412-414. doi:10.3760/cma.j.issn.1674-1935.2010.06.011

Objective To determine the serum concentration of MCP-1 and the expression of MCP-1 protein in the pancreas in the piglet with chronic obstructive pancreatitis and to explore the role of MCP-1 protein in pancreatic fibrosisits.Methods The piglet model of chronic obstructive pancreatitis was established by incomplete ligation of the pancreatic duct.The piglets were sacrificed at 4, 6, 8 weeks after induction.Pathological changes of pancreas were examined.Pancreatic fibrosis was assessed by VG staining.Serum MCP-1 concentrations were detected by ELISA method.MCP-1 and α-SMA, PDGF, TGF-β1 and NF-κB protein expression were detected by immunohistochemistry.Results The induction was successful in 14 piglets ( 58.3% ).Mild atrophic changes, interstitial fibrosis, chronic inflammatory cell infiltration could be observed in the body and tail of pancreas from the 4th week in the experimental group.The most obvious changes occurred in the 8th week.Stage Ⅰ pancreatic fibrosis occurred in 5 piglets (35.7%), stage Ⅱ in 4 piglets (28.6%), stage Ⅲ in 5 rats ( 35.7% ).Seurm MCP-1 at 4, 6, 8 weeks was ( 102.44 ± 36.25 ) pg/ml,(97.84 ± 28.67) pg/ml, ( 94.32 ± 28.42 ) pg/ml, respectively, and was significantly higher than that in control group [ ( 10.42 ±5.86) pg/ml, (8.58 ±4.86) pg/ml, (8.22 ±4.58) pg/ml, P ＜0.01 ].There was no MCP-1 protein expression in the control group;MCP-1 protein was detected in the successful induction group, and MCP-1 expression was positively correlated with expressions of the PDGF, TGF-β1, α-SMA and NF-κB.Conclusions MCP-1 may play an important role in the course of pancreatic fibrosis in chronic obstructive pancreatitis.

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Effect of PIAS1 gene silencing on inflammatory response of pancreatic acinar cell

Ping CHEN ; Wenjie DONG ; Yunwei SUN ; Weiyan YAO ; Yongping ZHANG ; Minmin QIAO ; Yaozong YUAN

Chinese Journal of Pancreatology.2010;10(6):404-407. doi:10.3760/cma.j.issn.1674-1935.2010.06.008

Objective To investigate the effect of protein inhibitor of activated signal transducer and activator of transcription 1 ( PIAS1 ) gene silencing on the inflammatory response of rat pancreatic acinar cell lines AR42J with cerulein stimulation, to study its role in the pathogenesis of acute pancreatitis.Methods The siRNA targeting PIASI was designed, synthesized, transfected into AR42J cells by lipofectmine 2000.24 h later, cerulean was added and cultured for another 24 h.Subsequent AR42J cells with cerulein stimulation were divided into 4 groups: cerulein, liposome, negative-siRNA and PIAS1-siRNA groups.In addition, a group with PBS was as control group.The activity of p38 mitogen- activated protein kinase (p38MAPK) was detected by western blotting.TNF-α, IL-1β, IL-6, matrix metalloproteinase (MMP) 9 expression were analyzed by RT-PCR and western blotting, respectively.Results The expression of p38MAPK in PIAS1-siRNA, negative-siRNA, liposome, cerulein,and control group was 1.93 ±0.11, 1.22 ±0.10, 1.30 ±0.17,1.32 ± 0.21, 0.12 ± 0.02;while the expression of phosphorylated p38MAPK was 2.10 ± 0.25, 1.36 ± 0.20,1.26 ±0.15, 1.23 ±0.25, 0.58 ±0.48, the expression in PIAS1-siRNA group was significantly increased when compared with other groups (P＜0.05).The levels of TNF-α, IL-1β, IL-6, MMP-9 mRNA were 1.66 ±0.15,1.66 ± 0.15,1.90 ±0.01, 1.56 ±0.20 in PIAS1-siRNA group, while the expression of protein was 2.06 ±0.37,2.20 ±0.34, 1.80 ±0.10, 1.17 ±0.05, which was markedly higher than those in other group (P ＜0.05).Conclusions PIAS1 gene silencing could enhance p38MAPK activity, and improve inflammatory mediator expression in pancreatic acinar cells with cerulein stimulation.

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CT and MRI features of autoimmune pancreatitis

Mingzhi LU ; Maoheng ZU ; Chengwei SHAO ; Changjing ZUO ; Jianping LU

Chinese Journal of Pancreatology.2010;10(6):401-403. doi:10.3760/cma.j.issn.1674-1935.2010.06.007

Objective To investigate the CT and MRI features of the autoimmune pancreatitis (ALP).Methods CT and MRI data of fourteen patients with AIP who were confirmed by histology and/or steroid therapy were retrospectively analyzed.Ten patients underwent CT examination, and seven patients underwent MRI, while three patients underwent both CT and MRI examinations.Results It was showed that diffuse (n =11 ) or local ( n = 3 ) enlargement of pancreas.CT features showed that the hypoattenuation pancreatic lesions on unenhanced CT (n = 10);segmental pancreatic duct could be seen in five patients;stenosis of common bile duct in the head of pancreas was observed in 5 patients;the capsule-like structure around lesions was seen in seven patients.Delayed homogeneous enhancement was showed on enhanced CT.MRI features included homogeneous ( n = 3) and heterogeneous ( n = 4) hyperintense on T1 WI with fat-suppression images and homogeneous ( n = 3 )and heterogeneous (n =4) hyperintense on T2WI with fat-suppression images.Pancreatic duct could be seen in four patients.MRCP showed pancreatic duct stenosis in the head of pancreas ( n = 1 ) and segmental pancreatic duct (n = 2).Stenosis of common bile duct in the head of pancreas was showed in 5 cases.The capsule-like structure around lesions was showed in seven patients.No pancreatic calcification was revealed, and no significant pancreatic duct dilation was detected ( ＞3 mm) in all 14 patients.Conclusions The CT and MRI manifestations of AIP had characteristic features such as sausage-like changes of the pancreas, capsule-like structure around the lesions, diffuse or local pancreatic duct stricture, and stenosis of common bile duct in the bead of pancreas.

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Imaging and pathologic diagnosis of adenosquamous carcinoma of pancreas

Qi SUN ; Yilin WANG

Chinese Journal of Pancreatology.2010;10(6):427-429. doi:10.3760/cma.j.issn.1674-1935.2010.06.016

Objective To explore the pathological and imaging features of adenosquamous carcinoma (ASC) of pancreas.Methods Both clinical data and imaging findings in seven cases with pathologically proved ASC of pancreas were analyzed retrospectively.Imaging features were compared with pathological results.Results 1 )The disease mainly occurred in people around 55 years, among the 7 cases ,5 located in the pancreatic head, 2 in the body and tail, with abdominal pain and jaundice as the chief complaint.2)Pathologically, the solid part of the tumor was made up of ductal adenocarcinoma and squamous carcinoma components, with a different rate, while the cystic part was made up of necrosis, liquefaction.3) the imaging of 5 cases with ASC of pancreas in which squamous carcinoma components predominate shows solid and cystic tumors of pancreas, furthermore the ratio of central cystic diameter and the whole tumor diameter increase with the the volum of the tumor.4) There is no partitioning in the cystic part of the tumor, with a few irregular microcyst around it.5 ) The tumor shows a pattern of infiltrative growth, associated dilatation of the common bileduct or pancreatic duct in all cases, pancreatic atrophy in part.6) Squamous carcinoma components of the tumor was the pathologic basis for the formation of the solid and cystic structure in imaging.Conclusions ASC of pancreas is a rare aggressive subtype of pancreatic adenocarcinoma with a worse prognosis than the usual type of ductal adenocarcinoma, although symptoms similar to pancreatic ductal carcinoma.Cases of ASC of pancreas in which squamous carcinoma components predominate have certain characteristic imaging and pathologic features,which is important to early diagnosis.

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Expression and clinical implications of RADIL gene in pancreatic cancer

Haojie HUANG ; Jun GAO ; Yiqi DU ; Yanfang GONG ; Shunli LV ; Xiaowei WANG ; Aiping XU ; Fei GAO ; Zhaoshen LI

Chinese Journal of Pancreatology.2010;10(6):424-426. doi:10.3760/cma.j.issn.1674-1935.2010.06.015

Objective To investigate the RADIL mRNA expression in pancreatic carcinoma and to evaluate its clinical significance.Methods Fluoesecent quantitative PCR (FQ-PCR) was used to detect the RADIL mRNA expression in 40 patients with pancreatic carcinoma and adjacent tissue and in 5 healthy adult with normal pancreatic tissue and to observe its relationship with clinicopathologic parameters.Results RADIL mRNA was expressed in pancreatic carcinoma and adjacent tissue, as well as normal pancreatic tissue, and the relative expression was 2.263 ± 3.826, 5.425 ± 8.858 and 8.559 ± 4.214, respectively.There was statistically significant difference among the three groups (P ＜0.05 ).RADIL mRNA expression was closely related with the metastasis and differentiation grade ( r = -0.312 and -0.294, P ＜ 0.05 ), however, it was not significantly related to tumor site, tumor size, CA19-9, TNM staging, sex and age.Conclusions RADIL gene may have an inhibitory effect on the pancreatic cancer.

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Effects of zerumbone on the proliferation and apoptosis of human pancreatic cancer cell line PANC1

Xiaoyan CHEN ; Weixing WANG ; Youming DING ; Tao YIN ; Ablikim ABLIZ

Chinese Journal of Pancreatology.2010;10(6):421-423. doi:10.3760/cma.j.issn.1674-1935.2010.06.014

Objective To investigate the effect of zerumbone on the proliferation and apoptosis of human pancreatic cancer cell line PANC1 and its possible mechanism.Methods Zerumbone of various concentrations (3.75, 7.5, 15, 30, 60 μg/ml) were used to treat PANC1, and cells without treatment were used as control.CCK-8 assay was used to detect the inhibitory rate of cell proliferation.Cell apoptosis analysis was determined by using Hoechst 33342 staining and flow cytometry.Western blotting was performed to evaluate the phosphorylation Statl ( p-STAT1 ), and Bax and Bcl2 protein expression.Results Zerumbone caused a time- and dose-dependent reduction of cell viability in PANC1 cells.After 48h treatment of Zerumbone of 15 μg/ml, cells inhibitory rate was increased to (72.8 ± 2.72 )%, and classic apoptosis morphology was observed, with apoptosis rate was 14.2%.At the same time, p-STAT1, and Bax protein expression was significantly increased (0.654 ±0.048 vs 0.074 ±0.011, 0.577 ±0.044 vs 0.218 ±0.027,P＜0.05);Bcl-2 protein expression was significantly decreased (0.162 ± 0.029 vs 0.459 ± 0.034, P＜0.05).Conclusions Zerumbone may inhibit the proliferation of PANC1 cells and inducing cell apoptosis,which may be related to the up-regulation of STAT1's activity and Bcl-2/Bax ratio.

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