Hormone-producing serous cystadenoma of the pancreas.

The clinical and histochemical examination of hormone-producing serous cystadenomas of the pancreas are presented. The study material was obtained from five female patients. The patients underwent diagnostic examinations, including ultrasonography, computer tomography (CT), magnetic resonance imaging (MRI) and Doppler ultrasonography examination of abdomen. In all cases the presence of serous cystadenoma of pancreas was detected in the histopathologically verified sections. The test applied to immunohistochemically localize paraffin-embedded sections of neoplastic tissues of the pancreas was the LSAB2-HRP test using monoclonal antibodies against epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), synaptophysin, p53 and polyclonal antibodies against insulin, glucagon, somatostatin and pancreatic polypeptide. In one patient, ultrasonography revealed an irregular space filled with fluid resembling a multicellular cystic lesion. The Doppler ultrasonography examination showed a pathologically vascularized focus in the pancreatic head. In the adenoma sections of this patient, the immunohistochemical techniques revealed a strong positive somatostatin, pancreatic polypeptide and synaptophysin expression in the lining epithelium of neoplastic cysts.

TPS and CA 19-9 measurements in the follow-up of patients with pancreatic cancer and chronic pancreatitis.

The aim of this study was to assess the value of TPS and CA 19-9 in a long-term follow-up analysis of 11 patients with chronic pancreatitis (CP) and 15 patients with pancreatic cancer (PC). In all monitored patients with chronic pancreatitis the initial TPS level was below 200 U/L, whereas CA 19-9 was elevated in two of them. In one patient a dramatic increase in the TPS concentration (820 U/L) was measured at the last follow-up visit (after 8.6 months), which led to the detection of PC. In all patients with PC the preoperative TPS level exceeded 200 U/L, whereas CA 19-9 was elevated in only nine patients. After the Kausch-Whipple operation 11 patients showed no evidence of disease and in eight of these patients both TPS and CA 19-9 were within the reference range; however, in three patients liver metastases were detected after 8-24 months from the last tumor marker measurement. In four of the 15 patients both markers were elevated at the end of the follow-up period and distant metastases were clinically confirmed. Our results indicate that in patients with CP and PC undergoing long-term follow-up, TPS reflects the clinical status of patients more accurately than CA 19-9.

Surgical treatment of patients with multiple carcinomas.

BACKGROUND: Primary multiple carcinomas are not observed very frequently. Research has been focused mainly on such issues as the frequency of occurrence of primary multiple carcinomas, the identification of high-risk groups, early diagnosis, treatment methods, and prognosis. The purpose of this article is to present our own experience in the surgical treatment of patients with multiple cancers. MATERIAL AND METHODS: The paper presents 13 patients of both sexes with primary multiple carcinomas. Four of these patients were diagnosed with synchronous carcinomas, the remaining patients with metachronous. The malignant tumors were variously localized. In the group with synchronous carcinomas, the malignant tumors were located in esophagus, stomach and rectum, pancreas and right ovary, esophagus and palatine tonsil. In the group with metachronous carcinomas, another cancer was diagnosed 12 months to 24 years after the treatment of the first carcinoma was completed. The other cancers were located in esophagus, stomach, pancreas, lung, and the skin of the cheek. Nine patients were qualified for surgical treatment on the basis of the preoperative TNM classification. Various surgical procedures were used. In cases of synchronous multiple carcinomas one-stage operations were preferred. RESULTS: Significant postoperative complications were noted in 2 cases. In the first case, a recto-sigmoid anastomotic leak resulted in increased circulatory and renal insufficiency, leading to the patient's decease. In the second case, a massive gastric hemorrhage after ileocoloesophagoplasty led to respiratory insufficiency, which was the cause of the patient's decease. Two patients died within 12 months after surgical treatment. In the first case cancer recurrence was the cause of death; in the second, myocardial infarction. Long-term follow-up was focused on 5 patients with no cancer recurrence during the period from 12 months to 4 years after surgical treatment. CONCLUSIONS: The results of this study suggest that patients who have had a first cancer successfully treated are at higher risk of developing a subsequent cancer, and that regular follow-up with thorough examination in patients successfully treated for cancer may lead to the early detection of a subsequent cancer when it is still at a curable stage.

Tissue polypeptide specific antigen (TPS), a marker for differentiation between pancreatic carcinoma and chronic pancreatitis. A comparative study with CA 19-9.

BACKGROUND: The value of serum tissue polypeptide specific antigen (TPS) as a complement to CA 19-9 in the detection of pancreatic carcinoma was determined prospectively. TPS and CA 19-9 levels obtained at the time of diagnosis in patients suspected of having chronic pancreatitis or pancreatic carcinoma were evaluated in receiver operating characteristic (ROC) curve analysis. METHODS: Serum TPS and CA 19-9 levels were measured by immunoassays in 122 subjects, 48 with pancreatic carcinoma and 74 with chronic pancreatitis. RESULTS: Elevated levels of CA 19-9 were detected preoperatively in 70% of pancreatic carcinoma patients and in 19% of chronic pancreatitis patients. Elevated levels of TPS were detected in 100% of patients with pancreatic carcinoma and in 22% of patients with chronic pancreatitis. The median levels of TPS and CA 19-9 for pancreatic carcinoma were significantly higher than those for chronic pancreatitis (P < 0.0001). Increasing the upper reference value of TPS allowed for better discrimination between chronic pancreatitis and pancreatic carcinoma. ROC curve analysis showed that the introduction of 200 U/L as a decision criterion for TPS did not reduce its sensitivity but significantly improved its specificity. At a specificity of 98% for TPS, discrimination between pancreatic carcinoma and chronic pancreatitis was found to be 97%. Increasing the upper reference level for CA 19-9 to attain a specificity of 98% decreased its sensitivity from 70% to 33%. CONCLUSIONS: At an elevated cut-off level for TPS (200 U/L), almost complete discrimination between pancreatic carcinoma and chronic pancreatitis was obtained. TPS will be more useful than CA 19-9 in the differential diagnosis of pancreatic carcinoma and chronic pancreatitis.

[Comparative evaluation of postoperative complication in the reconstructive surgery of the esophagus]. / Porównawcza ocena wczesnych powiklan pooperacyjnych po zabiegach wytwórczych przelyku.

The paper presents 78 patients with stenosis of the middle thoracic segment of the esophagus. The substitute, being pedunculated intestinal graft, was brought to the neck through the retrosternal space. Early post-operative complications occurred in 8.9% of patients. Post-operative mortality rate was 7.6%. The most dangerous complication after esophageal plastic surgery is blood supply insufficiency. It was observed in 2 cases. Other complications included anastomotic leaks and respiratory distress syndrome. The authors emphasize that frequency of post-operative complications and mortality are related with the patient general condition and extent of the surgery.

[Postop complication of pancreatic resection]. / Powiklania po czesciowych resekcjach trzustki.

Early complications after partial pancreatic resections and benign pancreatic tumours were analysed. 276 patients with pancreatic tumours were treated in the years 1979-1997. In 77 cases radical operation was performed. 65 patients underwent Whipple and 12--Traverso-Longmire pancreatoduodenectomy. Malignant tumour was found in 55 cases and 22 were benign. In 4 patients tumour's resection along with invaded portal vessels and portal confluence reconstruction was performed. These were the first cases with vessels resection operated in Poland. There were 2 post-operative deaths observed in that group. Complications in our material were as follows: pancreatico-jejunal anastomosis fistulae, haemorrhage from ulcers in gastro-jejunal anastomosis, diffuse peritonitis, haemorrhage from pancreatic stump vessels, ileus, acute renal insufficiency, pneumonia and myocardial infarct. Mortality in whole group was 11%. In the last 5 years due to our growing experience and some technical modifications mortality fell to 4.4%.

[Iatrogenic injuries of the cardia antireflux system]. / Jatrogenne uszkodzenia mechanizmu antyrefluksowego wpustu.

Among presented 18 patients with iatrogenic injury of the cardia antireflux system, 5 were females and 13 males aged 35-62 years of life. 13 cases were operated before for cardiospasmus, 5 had gastric resection B2 for duodenal ulcer. In consequence all the patients presented stricture of the thoracic lower and abdomen part of oesophagus. 16 patients required reoperations, 2 had dilatation. In 2 cases stricture were located in middle and lower part of oesophagus. In 4 cases in abdominal and supradiaphragmatic part of oesophagus, in 5 cases in abdominal part of oesophagus, and in 7 cases in the cardia. 11 patients required one corrective surgery, 4-two operations, and 1-three operations. As a final procedure: in 2 cases artificial oesophagus was formed with intestinal graft, in 8 cases the cicatrical part of the oesophagus was excised and replaced by a pedunculated graft by Merendino method, in 3 cases esophagogastric anastomosis were done using Heyrowsky method, in 2 cases bypass was made from pedunculated part of jejunum which connect the part of oesophagus above the narrowing with the prepyloric part of the stomach by the own method, in 1 case intrathoracic esophagogastric anastomosis was performed. The best results were obtained by oesophagogastric bypass.

[Gastroesophageal reflux after reconstruction of the esophagus with colon interposition]. / Refluks zoladkowo-przelykowy po zabiegach wytwórczych przelyku z jelita grubego.

In this study 113 cases were analysed; in which colon interposition was used for the reconstruction od the esophagus. The function od the esophageal grafts was evaluated 2 to 36 years after the reconstruction. Massive reflux was observed mainly when the anastomosis had been made to the gastric fundus. Reflux to isoperistaltic grafts was found in 21% of cases in children and in 27% od cases in adults, whereas for antiperistaltic grafts is was found in 33% od cases in children and in 61% od cases in adults. 4 children and 7 adult patients required a a reoperation.

[Surgical methods of protecting grafts from the colon against gastric reflux]. / Chirurgiczne sposoby zabezpieczenia przeszczepu z jelita grubego przed refluksem tresci zoladkowej.

The authors presented their methods of protecting esophageal grafts made of colon intestine from the gastric reflux to the graft; the methods were invented in their Department and verified in clinical practice. 51 patients had anti-reflux interpositions of jejunal or ileo-cecal segments made during the initial reconstruction or as a reoperation. Despite this, reflux was found on control examination in 12 cases, 8 of which had esophagitis confirmed by histology.

[Intraoperative portography in operations for resection of pancreas neoplasms]. / Portografia sródoperacyjna w operacjach resekcyjnych guzów trzustki.

Since 1993 during pancreatic resection routine intraoperative portography has been employed. Thus we are able to establish infiltration engaging portal vein and its branches. Facilitating decision making about resectability of the tumor. 29 portographies were performed. In eight cases malignant infiltration on portal vein was established. Because of that in seven cases no radical resection was undertaken.

[Tumor in Vater's ampulla--local excision or Whipple's resection]. / Rak brodawki Vatera--miejscowe wyciecie czy operacja Whipple'a.

Results of the operative treatment of Vater's papilla carcinoma in fifteen cases were analysed. Eleven patients had pancreatoduodenectomy according to Whipple, four had only local excision of Vater's papilla along with the tumour. All four had early recurrence and were re-operated by Whipple method. In our experience only radical pancreatoduodenectomy with regional lymphadenectomy, preferably Whipple type, gives chance of achieving the radical cure.