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Severe acute pancreatitis (SAP) is an acute abdominal disease and a critical illness commonly seen in clinical practice. Infection complications in the middle and late stages of SAP have a great impact on the prognosis of SAP and are often difficult to avoid. This article introduces the pathogenesis of secondary pancreatic and extra-pancreatic infections and summarizes the pathogen spectrum of infections secondary to SAP in the past 10 years. This article also summarizes and evaluates the current strategies for preventing secondary infections and briefly describes the advances in surgical interventions for SAP secondary infections. These analyses show that the pathogenesis, pathogenic features, and immunological features of SAP secondary infection remain unclear. There are various control strategies for such infection, but there are still no effective measures to prevent infection except early enteral nutrition. Conclusions will be achieved on the issues including the timing of percutaneous catheter drainage, and surgical interventions have developed rapidly on the basis of the STEP-UP approach. Endoscopic STEP-UP approach is slightly superior to conventional STEP-UP approach in the treatment of critically ill patients with SAP.
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Objective To explore the diagnosis and treatment of bronchogenic cyst in the abdomen.Methods Clinical data of 7 cases with abdominal bronchogenic cyst in the First Affiliated Hospital of China Medical University from October 2001 to February 2016 were retrospectively analyzed.Results Of the 7 patients,5 were male and 2 were female aging from 36 to 50 years with a median age of 37 years.Two cases were complaining for upper abdominal pain,5 cases were asymptomatic.Ultrasonography revealed hypoechoic or anechoic mass.Color doppler flow imaging showed no blood flow.Contrast-enhanced CT scans showed no obvious enhancement in 6 out of 7 cases,all patients underwent cystectomy successfully.Cysts were of unilocular in 6 cases and multilocular in one.Bronchogenic cysts were diagnosed by pathology in all 7 cases.Six patients were followed up from 1 month to 6 years with no recurrence.Conclusions Abdominal bronchogenic cyst is benign and postoperative prognosis is very good.
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Background and purpose:The prognosis of pancreatic cancer is poor. This study aimed to evaluate the value of pancreatic CT perfusion on biological behavior assessment in pancreatic cancer. Methods:This study collected 78 cases of pancreatic cancer which diagnosed by the method of pancreatic CT perfusion, and detected the differences of the values of blood lfow (BF), blood volume (BV), permeability (per), peak value (PE) and time to peak (TTP) between normal pancreatic tissues and tumor tissues. Combined with clinical and pathological data. Besides, this study evaluated the relationship between perfusion parameters of tumor tissues and tumor size, lymph node metastasis, distant metastasis, preoperative serum CA199 level, Ki-67, p53, CEA, CA199, CD34 expression of tumor tissues. Results:The values of BF, BV, per and PE in pancreatic tumor tissue were signiifcantly lower than those in normal pancreatic tissue. The BF values of cases with high levels of serum CA199 and with CA199 positively expressed tissues were signiifcantly higher than those with negative expression. The PE values of cases with positive tissue expression of Ki-67 were significantly higher than those with negative expression. The TTP values of cases with positive tissue expression of CEA were signiifcantly lower than those with negative expression. The per values of well differentiated cases was signiifcantly higher than those of moderately/poorly differentiated cases. Conclusion:CT perfusion may have its value on assessment of tumor biological behavior in pancreatic cancer.
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Objective To detect the expression of MSI2 protein and mRNA in pancreatic ductal adenocarcinoma (PDAC) tissue,and investigate the correlation between the expression of MSI2 protein and the clinicopathological parameters.Methods The expression of MSI2 protein in 61 PDAC specimens and paired adjacent non-cancerous pancreatic tissues were detected by immunohistochemistry.Western blot and quantitative real-time PCR (QRT-PCR) were used to examine the expression of MSI2 protein and mRNA level in 10 PDAC specimens and adjacent non-cancerous pancreatic tissues.Then the relationship between MSI2 expression in cancerous tissues and clinicopathological parameters was analyzed.Results In 61 patients with PDAC,the expression rate of MSI2 protein was higher in cancerous tissues (63.9％) compared with that in paired non-cancerous pancreatic tissues (41.0％),and the difference between the two groups was statistically significant (t =2.809,P =0.007).The expression levels of MSI2 protein in 10 fresh PDAC specimens and adjacent non-cancerous pancreatic tissues were 0.748 ± 0.195 and 0.420 ± 0.171,and the expression level of MSI2 mRNA in PDAC specimens was as 2.507 ± 2.981 times as much of adjacent non-cancerous pancreatic tissues,and the difference between the two groups was statistically significant (t =3.689,P=0.005;t =2.660,P =0.026).The expression of MSI2 in cancerous tissues was only positively associated with the size of the tumor (x2 =5.096,P =0.024),but it was not associated with other parameters.The median survival of patients with high MSI2 expression was 321 d,and it was 730 d for patients with low MSI2 expression,and the median survival of patients with high MSI2 expression was significantly shorter than that of low MSI2 expression (x2 =6.706,P =0.010).Conclusions The expression MSI2 is up-regulated in PDAC and related to the tumor size.The patients with high expression of MSI2 protein have poor prognosis.
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Objective To investigate the diagnosis and treatment of serous cystadenoma of the pancreas. Methods The clinical data of 18 patients with serous cystadenoma of the pancreas which were admitted into the First Affiliated Hospital of China Medical University from October 1999 to October 2010 were retrospectively analyzed. Results There were 15 females(83.3%) and 3 males (16.7%).Tumors were present in the pancreatic body and tail in 12 cases ( 66. 7% ), in the pancreatic head in 3 cases ( 16. 7% ) and in the pancreatic neck in 3 cases( 16. 7% ). The mean maximum diameter of the tumor was 6. 5 cm. No specific clinical features were indentified. The size of the tumor was significantly correlated with clinical symptoms. CT was main examination with correct diagnosing rate of 61.1%. All 18 patients received surgical resection. Pancreaticoduodenectomy was performed in 3 patients, distal pancreatectomy in 5 cases,spleen-preserving distal pancreatectomy in 5 cases, middle pancreatectomy in 3 cases, and tumor enucleation in 2 cases. Postoperative pancreatic fistula developed in 10 cases (55.6%);Fistula was healed by conservative therapy in all these 10 cases. Postoperative followed up from 6 to 125 months (mean,48. 3months) found no recurrence or metastasis. Conclusions CT was main imaging examination for serous cystadenoma of the pancreas. Surgical resection should be adopted for serous cystadenoma of the pancreas with clinical symptoms but uncertain malignancy.
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Objective To investigate the expression of TMPRSS4 mRNA,protein in human pancreatic cancer tissues and to explore the relationship between the expression of TMPRSS4 protein and the clinicopathologic parameters.Methods Real-time PCR and Western blotting were used to detect the expressions of TMPRSS4 mRNA and protein in 16 samples of pancreatic cancer tissues and adjacent normal pancreatic tissues.The expression of TMPRSS4 protein in 61 samples of pancreatic cancer tissues and 26 samples of adjacent pancreatic tissues and 4 samples of normal pancreatic tissues was detected by using immunohistochemistry and its relationship with clinicopathological features was analyzed.Results The expression of TMPRSS4 mRNA and protein of pancreatic cancer tissues were significantly higher than those in adjacent pancreatic tissues (9.09 ± 7.01 vs.1.27 ± 0.72; 1.223 ± 0.125 vs.0.667 ± 0.106,P ＜ 0.01 ) ;the expression rate of TMPRSS4 protein of pancreatic cancer tissues was 67.2％ (41/61),which were significantly higher than that in adjacent pancreatic tissues[3.8％ (1/26),P ＜ 0.01].There was no TMPRSS4 protein expression in normal pancreatic tissues.There was no significant correlation between the expression of TMPRSS4 protein and the age,gender,tumor location or tumor size was found.There was significant correlation between the expression of TMPRSS4 protein and the degree of differentiation,lymph node metastasis,and clinical staging (P ＜ 0.05 ).Conclusions TMPRSS4 protein is highly expressed in pancreatic cancer tissues,and the expression of TMPRSS4 is associated with the degree of malignancy of pancreatic cancer.
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Objective To investigate the risk factors associated with acute renal failure (ARF)after surgery in patients with simple abdominal trauma. Methods A retrospective case-control study was carried out in patients with simple abdominal trauma after surgery from January 2003 through May 2008 in our hospital. Twenty patients with ARF were set as study group and 68 patients without ARF as control group. Clinical data including age, gender, injury type, number of injured organs, blood transfusion volume, intra-abdominal pressure, abdominal infection, shock and related factors were analyzed by using univariate and Logistic regression to identify the independent risk factors of ARF after surgery in patients with simple abdominal trauma. Results Univariate analysis revealed statistical difference in aspects of blood transfusion volume ( ＞ 1 600 ml), operation timing ( interval between trauma and operation ＞12 h), preoperative shock duration ( ＞6 h), postoperative abdominal infection and intra-abdominal hypertension ( ＞ 12 mm Hg) between two groups ( P ＜ 0. 05 ). Logistic regression analysis showed that these five indices were the independent risk factors of ARF after surgery in patients with simple abdominal trauma ( P ＜ 0. 05 ). Conclusions Massive blood transfusion, delayed operation, long preoperative duration of shock, postoperative abdominal infection or intra-abdominal hypertension are the risk factors of ARF after surgery in patients with simple abdominal trauma. We should pay attention to these factors and take effective measures to prevent occurrence of ARF.
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Objective To investigate the expression and clinical significance of intergrin linked kinase (ILK) in pancreatic carcinoma.Methods ILK protein was detected by immunohistochemistry and Western blotting in 60 cases of pancreatic carcinoma and 32 cases of normal pancreatic tissue,and the relationship with the clinicopathological characteristics were analyzed.Results Immunohistochemistry showed ILK was expressed in cytoplasm and membrane of pancreatic carcinoma cells and the positive rate was 65% (39/60),which was significantly higher than 18.75% (6/32) of normal pancreatic tissue(P ＜0.05 ).Western blotting showed the expression of ILK in pancreatic carcinoma tissue was 303933±195116,which was significantly higher than 144613±30074 of normal pancreatic tissue(P＜0.05 ).In pancreatic carcinoma,the expression of ILK was correlated with clinical stage and lymph metastasis(P＜0.05 ),but not correlated with tumor cell differentiation(P＞0.05 ).Conclusions ILK protein was highly expressed in pancreatic carcinoma tissue and it was correlated with the degree of malignancy.
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Objective To investigate the role of peroxynitrite in induction of apoptosis in non-heart-beating donor (NHBD) liver grafts. Methods Rat livers were harvested and perfused via the portal vein with 60 ml of cold 4℃ HTK solution from heart beating donors (HB) or 60 min after car-diac arrest from NHBD. A third group consisted of NHBD livers which were perfused with HTK con-taining 7500 IU of superoxide dismutase (SOD) (n=6, resp.). After cold storage for 24 h, the func-tional integrity of the liver was evaluated by isolated reperfusion with Krebs-Henseleit Buffer in a re-circulating system at 37℃ for 45 min. Results Compared to the NHBD livers, HB and SOD groups were characterized by a significantly reduced hepatic enzyme leakage(P<0. 05) as well as decreased portal venous pressure(P<0.01). Bile production upon reperfusion was increased significantly (P< 0.01). Prominent decreasing nitrite oxide(NO) (P<0.05), nitrotyrosine(P<0.01, P<0.05) and apoptosis(P<0.05) in effluent perfusate was encountered. Slight nitrotyrosine staining was concen-trated on the endothelial cells. Conclusion Peroxynitrite may play a fundamental role in the apoptosis caused by enhanced oxygen free radical production in NHBD livers.
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Objective To study the relationship between the expression of cytochrome c ( Cyt c) and programmed cell death 4 (PDCD4) in pancreatic cancer, and investigate the pathway of PDCD4 inducing the apoptosis of pancreatic cancer cells. Methods Pancreatic cancer specimens from 69 patients who received pancreatic resection from 1990 to 2002 in First Affiliated Hospital of China Medical University were collected. The expression of Cyt c in the 69 paraffin specimens of pancreatic cancer was detected by immunohistochemistry, and the expression of Cyt c in 8 samples of cold-preserved fresh pancreatic cancer and normal pancreatic tissues were detected by Western blot. The expression of PDCD4 and Cyt c in pancreatic cancer was analyzed by paired t test and chi-square test. Results Compared with normal pancreatic tissues, the expression of Cyt c in pancreatic cancer was significantly decreased. The positive expression rate of Cyt c in 69 samples of pancreatic cancer was 41% (28/69). The expression of Cyt c was positive in most patients with positive expression of PDCD4, and the expression of PDCD4 was negative in most patients with negative expression of Cyt c. The expression of PDCD4 and Cyt c was closely correlated with each other (χ2= 10.52, P < 0.05). Conclusions There is a close relationship between the expression of PDCD4 and Cyt c in pancreatic cancer. PDCD4 may induce the apoptosis of pancreatic cancer cells through mitochondrial pathway.
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Objective To investigate the diagnosis and therapeutic methods of primary tumors of the duedenum(PTD). Methods Clinical data of 124 patients with primary duodenal tumors who were hospitalized in the First Affiliated Hospital of China Medical University from 2001 to 2007 were analyzed retrospectively. Of all the tumors,10 cases were of benign tumors and 114 cases were malignant tumors. Diagnosis was established on endoscopy and radiography. Results Common clinical manifestations included upper abdominal pain, jaundice, weight loss and poor appetite. Lesion located in the superior portion of the duodenum in 9 cases, in the descending portion in 107 cases, in the horizontal portion in 7 cases, and in the ascending portion in 1 case. The correct preoperative diagnostic rate by endoscopy was 90.5%, by ERCP was 94.1%, by ultra-endoscopy was 100%, by air barium double radiography was 78.6%, by MRI was 80.5%, and by BUS was 40.6%. Among the 10 benign PTD cases, 5 cases underwent simple tumor resection, 2 cases underwent standard pancreaticoduedenectomy, 1 case received segmental duodenectomy and 2 cases didn't receive operation, the 5-year survival rate was 100%. Among the 114 malignant PTD cases, 47 cases underwent standard pancreaticoduodenectomy, 3 cases received pylorus preserving pancreaticoduodenectomy, 3 cases underwent pancreaticeduodenectomy in other hospitals, with the 5-year survival rate of 35.8%. Six cases underwent simple tumor resection, and 12 case received segmental duodenectomy, with the 5-year survival rate of 16.7%. Twenty-two cases treated by bypass operation died in 5-16 months after operation. 2 cases treated by stent-intervention, and 2 cases by PTCD (percutancous transhepatic cholangiodrainage) died in 3-11 months. Those not treated surgically died in 1-11 months. Conclusions Patients with PTD usually lack specific clinical manifestations, but combination of endoscopy, ultra-endoscopy, ERCP and other eximinations can improve the preoperative positive diagnosis rate. simple tumor resection and segmental duodenectomy are curable for PBTDs (primary benign tumors of the duodenum), while for PMTDs (primary malignant tumors of duodenum), pancreaticoduodenectomy should be done, and bypass operation is suitable for late-stage patients to improve survival rate and life-quality.
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Objective To evaluate the diagnosis and treatment of vipoma based on our experience on 4 cases.Method Clinical manifestations,laboratory examination,imaging features,surgical findings,and pathology of 4 patients with vipoma admitted in our hospital from 1991 were discussed.Results Watery diarrhea and hypokalemia were the main clinical manifestations.Hepatic metastasis OCCurred in two patients.Tumor located in the head of the pancreas in one case.Two tumors were shown in the pancreatic body and one tumor was in the pancreatic tail.Resection of tumor and hepatic metastatic lesions with repeat resection of metastases Was performed in 1 patient.Resection of the pancreatic body and tail was done in one patient.Pancreatoduodenectomy Was performed in one patient.Laparotomy only was done in one patient because of invasion of the superior mesenteric vein and duodenum.Conclusion Typical symptoms play an important role in the diagnosis of vipoma.Hepatic metastasis is common.Surgery is the most effective means for treatment.
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Objective To sum up the harvesting and trimming (bench surgery) experience of simultaneous pancreas-kidney (SPK) transplantation.Methods Retrospectively analysis of the methods of harvesting and skill of trimming in 19 cases of SPK transplantation was made.Results No injury of allograft occurred. Exogenous insulin was discontinued within 9 day after operation in 18 patients, and their fasting blood sugar was normal, and urine sugar was negative or(+). Serum creatinine and urea nitrogen became normal at 2-4 d postoperatively. Three transplanted kidney and 2 transplanted pancreas had acute rejection (AR), and all the AR were disappeared after anti-rejection therapy. The SPK grafts in 1 patient was excised on 11 d postoperatively due to accelerated rejection. Conclusions The skill of procurement and bench surgery trimming of allograft in one of the key factors for successful SPK.