Chlorpromazine treatment of acute necrotizing pancreatitis in rats / 中华胰腺病杂志

Objective To investigate the therapeutic effect of ehlorpromazine in rats with acute necrotizing pancreatitis (ANP). Methods 120 healthy female SD rats were randomly divided into three groups: normal control group (NC group, n=30); acute necrotizing pancreatitis group (ANP group, n=45) and chlorpromazine treatment group (CPZ group, n=45). ANP was induced by the injection of 5% sodium taurocholate (1 ml/kg) into pancreatic duct, NC group were injected with same amount of saline. 0.4% chlorpromazine (0.25 ml/100 g) was intraperitoneally administered in CPZ group at 0 h, 24 h, 48 h after ANP was established. Same amount of normal saline was given to ANP group and NC group in the same way and at the same time points. The rats were sacrificed at 24, 48, 72 h after ANP was induced. The blood samples were collected for analysis of serum amylase (AMY), phospholipase A2 (PLA2), interleukin-6 (IL-6). Pancreas was harvested for evaluation of pathologic changes. Results The pathologic changes in ANP group were compatible with pathologic changes of ANP. The pathologic scores in CPZ group was 3.57±0.73 at 72 hours after ANP induced, which was significantly lower than 13.29±1.03 in ANP group. The serum amylase and PLA2 levels in CPZ group at 72 hours after ANP induced were (1658.0±277.0) U/L and ( 12.26±1.40) ng/ml respectively, the corresponding values of ANP group were (3666.7±1233.0) U/L and (16.81±1.13)ng/ml, respectively. The difference was statistically significantly (P＜0.01). The serum IL-6 levels of CPZ group at 24,48 72 hours were (116.27±14.49) pg/ml, (75.35±6.17) pg/ml, (82.75± 8.86) pg/ml respectively, the corresponding values of CPZ group were (160.88±27.19) pg/ml, (111.77± 19.10)pg/ml, (125.51±30.71) pg/ml respectively. There was a significant difference between the two groups (P＜0.01). Conclusions Chlorpromazine may have a therapeutic effect on ANP.

Study on the expression of neuron-specific enolase,chromogranin and synaptophysin in functional islet cell tumors / 中国现代普通外科进展

Objective:To study the expression and clinical significance of neuron-specific enolase,chromogranin and synaptophysin in islet cell tumors.Methods:Twenty-one paraffin-embedded specimens with islet tumors and 3 cases cholangiocarcinoma and tissue nearby the tumor were recruited from Jan 1988 to Jun 2001.The S-P method was used for the detection of chromogranin,synaptophysin and neuron-specific enolase.Results:There were positive expressions of neuron-specific enolase,chromogranin and synaptophysin in 19,15 and 18 cases respectively,while negative results were observed in 3 cases of cholangiocarcinoma and the para-cancer tissue.Conclusion:CG,SYN and NSE may be specific tumor markers of islet cell tumors and combined detection can help to enhance the sensitivity.

Clinical experience on the therapy of pancreatic encephalopathy / 中国现代普通外科进展

Objective: To discuss the treatment of pancreatic encephalopathy(PE).Methods: Recombinant human growth hormone (rhGH)(Saizen)were applied in patients of severe acute pancreatitis(SAP) with suspicious early PE that presented with mental disorders. rhGH was also used in combination with somatostatin as the therapeutic method for SAP and its complication.Dosage and administration: Saizen 4U was injected intramuscularly twice a day for 5～7 days.Results: In 7 patients of this group, all of them showed improvement in the aspect of mental dysfunction and the symptoms disappeared after 48～72 hours. In 13 SAP cases underwent combined application of rhGH and somatostatin, no PE was observed.Conclusion: Application of rhGH showed therapeutic effect on the early manifestations of PE. It also suggested that combined use of rhGH and somatostatin could decrease the occurance of PE.

Early endoscopic treatment in 92 patients with acute biliary pancreatitis / 中华消化内镜杂志

Objective To study on the value and safety of early endoscopic retrograde cholangiopan-creatography (ERCP)and endoscopic sphincterotomy (EST) in acute biliary pancreatitis. Methods Ninety-two patients with acute biliary pancreatitis underwent early ERCP (within 72 hours) and received endoscopic therapy (ERCP group). Another 40 patients with acute biliary pancreatitis were treated conservatively without ERCP (control group). The disappearance of abdominal pain, decrease of serum amylase level, the mean days and costs of hospitalization and complications were observed in all patients. Results In ERCP group, all patients were performed EST, stones in 72 choledocholithiasis patients had been removed with net-basket or air pocket. Ten cases of severe acute biliary pancreatitis received endoscopic pancreatic duct stents drainage. Ninety two cases of acute biliary pancreatitis received endoscopic nasal catheter bile drainage. The days of the disappearance of abdominal pain, the decrease of serum amylase levels, the cost of the hospitalization and the days of the hospitalization were significantly shorter in the early ERCP group than in the control group. The mortalities in ERCP and control group were 8. 3% and 33. 3% respectively. Conclusion Early ERCP endoscopic therapy is a safe procedure has the superiorities in lowering the mortality, hospital days and expense.

Pull-through Welch procedure for the lower rectal carcinoma: a report of 28 cases / 中国普通外科杂志

Objective To find a novel operative modality with sphincter preservation in the treatment of middle and low rectal carcinoma. Methods Pull through lower resection was performed on 28 rectal cancer patients. The distance between the anal verge and the lower margin of the tumor was 6～8cm(20 patients) or 8～10cm(8 patients), including 8 patients in Dukes A stage, 16 Dukes B and 4 Dukes C. The resected line from tumor distal margin was 2cm, 3cm, and 4cm, respectively. Results There was no operative death, anastomotic fistula or anastomotic stenosis in these cases. Mean follow up period was 30 months. Local recurrence was found in two cases (7.1%) 18 months after the operation, and 26 cases were cancer free till the end of the follow up. Defecation was satisfactorily controlled 8～12 weeks after the operation. Conclusions Pull through Welch procedure could meet the criterion of the radical resection of rectal carcinoma,and keep the internal and external sphincter muscles intact in the superior lower anterior resection. The normal defecationcan can maintain after the operation due to the preservation of internal and external sphincter muscles.