To inquiry into clinical-pathological factors influencing cytological accuracy of pancreatic head lesions / 中华外科杂志

<p><b>OBJECTIVE</b>To inquiry into clinical-pathological factors influencing cytological accuracy of pancreatic head lesions.</p><p><b>METHODS</b>Cytology was retrospectively evaluated in 94 inpatients with a mass in head of pancreas existing with chronic pancreatitis in the past decade, the results of cytology were compared with clinical pathology or clinical follow-up to estimate the value and accuracy of cytology in detecting pancreatic cancer. Pancreatic clinical-pathology includes size of mass and component of mass which was composed of cancerous mode of development including shape of conglomeration, nest and pervasion, and pancreatic ductal epithelium inside the vicinity of 1 cm around the mass. Pancreatic ductal epithelium were divided into PanIN1, PanIN2 and PanIN3 three types according to classified criterion of pancreatic intraepithelial neoplasia (PanIN).</p><p><b>RESULT</b>Forty-six patients were pathologically diagnosed as pancreatic cancer and five patients as chronic pancreatitis, accordingly, 29 malignant, 5 suspicious, 10 atypical hyperplasia among of them 5 malignant, 3 hyperplastic ductal epithelium, 1 nondiagnostic results due to interfered by blood and 3 insufficient specimens. 43 patients were clinically diagnosed as chronic pancreatitis. Cytologic evaluation of pancreatic cancer has an 84.2% accuracy less than or equal to 2.5 cm and 71.9% larger than 2.5 cm. Shape of conglomeration, and nest have more accurate than pervasion in cytological diagnosis.</p><p><b>CONCLUSIONS</b>Cancerous mode of development is a vital factor influencing accuracy of cytology, cytological estimation of atypical hyperplasia and is still waiting for further investigation.</p>

Significance of the mitochondrial D-loop alterations in hyperplastic pancreatic ductal cells in the vicinity of pancreatic cancer coexisting with chronic pancreatitis / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the significance of mitochondrial D-loop alterations in hyperplastic pancreatic ductal cells in vicinity of pancreatic cancer coexisting with chronic pancreatitis.</p><p><b>METHODS</b>Malignant lesions and foci of pancreatic ductal intraepithelial neoplasia of the pancreas and paired normal gastric mucosal epithelial cells from the same patients, respectively, were assessed by polymerase chain reaction. Somatic point mutations and sequence variants of D-loop were searched by direct sequencing of the mitochondrial genome. D-loops were sequenced by BLAST to identify their mutations.</p><p><b>RESULTS</b>Eleven of 12 pancreatic cancers displayed at least one D-loop variants and one tumor presented heteroplasmy. There was an apparent increase in incidence of D-loop mutational rate from PanIN1 (33.3%) to PanIN3 (75%, P < 0.01).</p><p><b>CONCLUSION</b>Mitochondrial D-loop alterations in the pancreas occur in the earliest premalignant lesions and exhibite an increasing occurence that parallels histological severity. These alterations may serve as a valuable marker to follow the histopathological progression of the lesions. Large number of further studies are required to clarify clinical implications of the mitochondrial DNA alterations.</p>

Significance of extended radical resection for cancer of pancreatic head / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the significance of extended radical resection in the treatment of pancreatic head cancer and its indication.</p><p><b>METHODS</b>Between Jan. 1995 and Dec. 1998, 56 patients with pancreatic head cancer were retrospectively reviewed, among whom 35 were treated by the Whipple operation and 21 received the extended radical resection during the same interval.</p><p><b>RESULTS</b>There was no significant difference between the mortality and morbidity rate of complication, though with more patients having higher clinical stages in the extended radical resection group. The 1-, 2- and 3-year survival rates were 84.8%, 62.8%, 39.9% in the extended radical resection group and 70.8%, 47.6%, 17.2% in the Whipple operation group with significant difference between the two groups. The total mortality rate was 51.4% in Whipple group and 42.9% in extended radical resection group with significant difference between the two. The 3-year cumulative rate of death from local recurrence decreased from 37.4% in the Whipple group to 23.8% in the extended radical operation group. Patients who survived for more than 3 years were only those in clinical stage (SC)1 in the Whipple group whereas they were found both in patients who had had CS1, CS2 lesions and also in some who had CS3 lesions in the extended radical resection group.</p><p><b>CONCLUSION</b>The extended radical operation does benefit patients with pancreatic head carcinoma in CS1, CS2 and in a part of CS3 without too extensive exrtra-pancreatic invasion.</p>

Surgical management of transected injury to the pancreatic neck / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To present a batch of data of transected pancreatic neck injuries and to sum up the experience in surgical interventions for the injuries.</p><p><b>METHODS</b>We analysed 13 patients with a transected injury to the pancreatic neck from Jan. 1995 to Dec. 2000. External drainage was performed in all patients. Pancreatoduodenectomy was conducted in 2 patients with a transected injury to the pancreatic neck associated with duodenal ruptures, and TPN was administered immediately after operation. Proximal closure of the transected margin and distal pancreaticojejunostomy was performed in 4 patients. Proximal closure of the transected margin and distal pancreaticojejunostomy plus splenectomy was performed in 7 patients associated with contusion of pancreatic body or tail plus spleen rupture.</p><p><b>RESULTS</b>12 patients healed and one patient died of anesthetic accident during the course of restoration of the dislocation of his right hip joint. Complications occurred in 7 patients.</p><p><b>CONCLUSIONS</b>The operation should be performed according to the degree of the injuries and associated duodenal injuries. Routine drainage and nutrient support should be recommended.</p>