ABSTRACT
OBJECTIVE: To summarize the experience of diagnosis and treatment of autoimmune pancreatitis(AIP)and to investigate the value of surgery in the management of AIP.METHODS: The clinical data of 17 patients with AIP who were admitted to Fujian Medical University Union Hospital between January 2013 and June 2017 were analyzed retrospectively. Observed indexes included clinical manifestations,blood test results,imaging findings,diagnosis and treatment and follow-up status. RESULTS:(1)Clinical manifestations:of the 17 patients,7 demonstrated obstructive jaundice,8 had upper abdominal pain,1 had recurrent diarrhea and 1 was found a pancreatic tumor by health checkup. Extrapancreatic organ involvement was detected in 11 of the 17 patients.(2)Blood test results:13 patients underwent serum IgG4 detection and increased expression of IgG4 was found in 13 patients.Increased expression of serum CA199 was detected in 4 patients. Elevated level of serum amylase was found in 3 patients.(3)Imaging findings:all the 17 patients underwent enhanced computed tomography(CT)scan of pancreas.Diffused enlargement of pancreas was observed in 12 patients and localized pancreatic enlargement was observed in 5 patients.(4)Diagnosis and treatment:All of the 17 patients were diagnosed as type 1 AIP. Three of the 17 patients underwent operation due to suspicion of pancreatic cancer and were diagnosed as AIP based on postoperative pathological examinations, including 2 pancreaticoduodenctomy and 1 distal pancreatectomy with splenectomy.Fourteen patients received initial steroid treatment. After steroid treatment,11 patients achieved remission, 1 underwent distal pancreatectomy with splenectomy due to continuous elevation of serum CA199,1 underwent pancreaticoduodenctomy because of a continuous enlarged pancreatic pseudocyst in the head of pancreas with obstructive jaundice,and 1 underwent cystjejunostomy due to a pancreatic pseudocyst in the body of pancreas with abdominal pain.(5)Follow-up status:All of the 17 patients were followed up for an average time of 29 months(range,12-66 months). Three patients who initially underwent pancreatectomy achieved remission after operation and no recurrence was observed. Of the 14 patients who received initial steroid treatment,11 got remission and the other three patients received maintenance steroid treatment for 3 months after operation and no recurrence was observed. CONCLUSION: The diagnosis of AIP should be based on the clinical manifestations,blood test results,imaging findings and pathological examinations. Steroid is the most critical therapy for AIP,but surgery is still important for the management of AIP,especially for localized AIP which is difficultly distinguished from pancreatic cancer and AIP with pancreatic pseudocyst which is refractory to steroid treatment.
ABSTRACT
<p><b>OBJECTIVE</b>To observe the effects of cucurmosin (CUS) on the cell proliferation and apoptosis in pancreatic PANC-1 cells.</p><p><b>METHODS</b>The inhibition of CUS on the PANC-1 cell growth was observed using MTT assay. The inhibition ratio of CUS on the pancreatic orthotopic transplantation was in vivo observed in the NOD/SCID mouse model. The changes of microstructure of the apoptosis-inducing effect of CUS on PANC-1 was observed under electron microscope. The cell cycle and apoptosis after CUS intervention was detected using flow cytometry. The Caspase-3 activity after CUS treatment was detected using enzyme linked immunospecific assay (ELISA).</p><p><b>RESULTS</b>Treatment with CUS at the dose of 0.125, 0.25, and 0.5 mg/kg inhibited the growth of pancreatic carcinoma PANC-1 xenografs with the ratio of 45.2%, 50.0%, and 59.7%, respectively (P < 0.05). After exposure to 10 microg/mL CUS for 24 h, most cells presented typical morphologic changes of apoptosis such as chromatin condensation and shrunken nucleus. The apoptotic cells increased. Some nuclear shrinkage and fragmentation, as well as the apoptotic body were observed when cells were exposed to CUS for 72 h. Being exposed to 0, 2.5, 10.0, and 40.0 microg/mL of the CUS for 72 h, the percentage of G0/G1 phase cells was 46.56% +/- 5.08%, 53.33% +/- 5.05%, 67.50% +/- 6.50%, and 77.00% +/- 6.73%, respectively (P < 0.05). The apoptosis ratio was 2.50% +/- 0.13%, 8.30% +/- 1.23%, 23.40% +/- 2.45%, and 48.50% +/- 3.65% shown by Annexin V/PI (P < 0.05). The Caspase-3 activity (unit) was 0.009 +/- 0.002, 0.011 +/- 0.003, 0.035 +/- 0.009, and 0.065 +/- 0.009, respectively (P < 0.05). These data showed that CUS induced the apoptosis of PANC-1 cells in a dose-dependent maner. Being exposed to 40.0 microg/mL of the CUS for 24, 48, and 72 h, the percentage of G0/ G1 phase cells was 56.60% +/- 6.65%, 67.83% +/- 6.76%, and 77.00% +/- 6.73%, respectively (P < 0.05), the apoptosis ratio was 16.51% +/- 2.97%, 38.51% +/- 2.38%, and 48.50% +/- 3.65% shown by Annexin V/PI (P < 0.05). These data showed that CUS induced apoptosis of PANC-1 cells in the G0/G1 phase of the cell cycle in a time-dependent maner.</p><p><b>CONCLUSION</b>CUS significantly inhibited the growth of PANC-1 cells possibly through the G0/G1 cell cycle arrest and apoptosis.</p>
Subject(s)
Animals , Female , Humans , Male , Mice , Apoptosis , Cell Line, Tumor , Cell Proliferation , Cucurbita , Mice, Inbred NOD , Mice, SCID , Pancreatic Neoplasms , Pathology , Plant Proteins , PharmacologyABSTRACT
<p><b>OBJECTIVE</b>To investigate the short-term therapeutic effectiveness of body gamma-knife in patients with advanced pancreatic carcinoma.</p><p><b>METHODS</b>Forty-eight patients with advanced pancreatic carcinoma were treated by body gamma-knife therapy. The dosage distribution and other radiotherapeutic plans were established on the basis of the carcinoma position, clinical target volume, and patient health condition. The isodose curve was 50%-60% and covered about 95% of the target volume. The single dose was 350-450cGy. The radiation was performed once every one or two days for 10-12 times.</p><p><b>RESULTS</b>There were 33 patients with back pain. 63.6% of the patients got completely controlled, 30.3% pain remitted, and 6.1% ineffective after 2 to 18 months of therapy. The analgesic effective rate was 93.9%. Among 28 patients with obstructive jaundice, 21 patients (75.0%) recovered. Among 42 patients who received CT, tumor disappeared in 5 patients (11.9%), tumor size decreased in 30 patients (71.4%), remained unchanged in 5 patients (11.9%), and enlarged in 2 patients (4.8%). The 6-month, 12-month, and 18-month overall survival rates were 77.1%, 37.5%, and 10.4%, respectively. The whole process was tolerable for all patients and no severe side-effect was observed.</p><p><b>CONCLUSIONS</b>Body gamma-knife can achieve a high local control rate and survival rate. Its short-term therapeutic effectiveness is satisfactory. Body gamma-knife is a safe and reliable treatment option for patients with locally advanced pancreatic carcinoma.</p>