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Management of hypersplenism in non-cirrhotic portal hypertension:a surgical series

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Hepatobiliary & pancreatic Diseases International 2012年第2期11卷 165-171页

作者： Rajesh Rajalingam Amit Javed Dharmanjay Sharma Puja Sakhuja Shivendra Singh Hirdaya H Nag Anil K Agarwal Department of Gastrointestinal surgery G. B. Pant Hospital and Maulana Azad Medical College Delhi University New Delhi India Department of Pathology G. B. Pant Hospital and Maulana Azad Medical College Delhi University New Delhi India

BACKGROUND:Hypersplenism is commonly seen in patients with non-cirrhotic portal hypertension(NCPH).While a splenectomy alone can effectively relieve the hypersplenism,it does not address the underlying portal *** present study was undertaken to analyze the impact of shunt and non-shunt operations on the resolution of hypersplenism in patients with *** relationship of symptomatic hypersplenism,severe hypersplenism and number of peripheral cell line defects to the severity of portal hypertension and outcome was also ***:A retrospective analysis of NCPH patients with hypersplenism managed surgically between 1999 and 2009 at our center was *** 252 patients with NCPH,64(45 with extrahepatic portal vein obstruction and 19 with non-cirrhotic portal fibrosis) had hypersplenism and constituted the study *** analysis was done using GraphPad *** and continuous variables were compared using the chi-square test,ANOVA,and Student’s t *** MannWhitney U test and Kruskal-Wallis test were used to compare non-parametric ***:The mean age of patients in the study group was 21.81±6.1 *** was symptomatic in 70.3% with an incidence of spontaneous bleeding at 26.5%,recurrent anemia at 34.4%,and recurrent infection at 29.7%.The mean duration of surgery was 4.16±1.9 hours,intraoperative blood loss was 457±126(50-2000) mL,and postoperative hospital stay 5.5±1.9 *** surgery,normalization of hypersplenism occurred in all *** long-term followup,none of the patients developed hepatic encephalopathy and 4 had a variceal re-bleeding(2 after a splenectomy alone,1 each after an esophago-gastric devascularization and proximal splenorenal shunt).Patients with severe hypersplenism and those with defects in all three peripheral blood cell lineages were older,had a longer duration of symptoms,and a higher incidence of variceal bleeding and postoperative *** addition,patients with t

关键词： portal hypertension hypersplenism splenorenal shunt lienorenal shunt

Autophagy in 5-Fluorouracil Therapy in Gastrointestinal Cancer： Trends and Challenges

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Chinese Medical Journal 2016年第4期129卷 456-463页

作者： Jia-Cheng Tang Yi-Li Feng Xiao Liang Xiu-Jun Cai Department of General surgery Zhejiang Province Key Laboratory of Laparosopic Technology Sir Run Run Shaw Hospital Zhejiang University Hangzhou Zhejiang 310016 China

Objective： 5-Fluorouracil （5-FU）-based combination therapies are standard treatments for gastrointestinal cancer, where the modulation of autophagy is becoming increasingly important in offering effective treatment for patients in clinical *** review focuses on the role of autophagy in 5-FU-induced tumor suppression and cancer therapy in the digestive *** Sources： All articles published in English from 1996 to date those assess the synergistic effect ofautophagy and 5-FU in gastrointestinal cancer therapy were identified through a systematic online search by use of *** search terms were ＆quot;autophagy＆quot; and ＆quot;5-FU＆quot; and （＆quot;colorectal cancer＆quot; or＆quot;hepatocellular carcinoma＆quot; or＆quot;pancreatic adenocarcinoma＆quot; or＆quot;esophageal cancer＆quot; or＆quot;gallbladder carcinoma＆quot; or ＆quot;gastric cancer＆quot;）.Study Selection： Critical reviews on relevant aspects and original articles reporting in vitro and/or in vivo results regarding the efficiency ofautophagy and 5-FU in gastrointestinal cancer therapy were reviewed, analyzed, and *** exclusion criteria for the articles were as follows：（1） new materials （e.g., nanomaterial）-induced autophagy;（2） clinical and experimental studies on diagnostic and/or prognostic biomarkers in digestive system cancers;and （3） immunogenic cell death for anticancer ***： Most cell and animal experiments showed inhibition ofautophagy by either pharmacological approaches or via genetic silencing of autophagy regulatory gene, resulting in a promotion of 5-FU-induced cancer cells ***, autophagy also plays a pro-death role and may mediate cell death in certain cancer cells where apoptosis is defective or difficult to *** dual role of autophagy complicates the use of autophagy inhibitor or inducer in cancer chemotherapy and generates inconsistency to an extent in clinic ***： Autophagy might be a therapeutic target that sensitize

关键词： 5-Fluorouracil Autophagy Gastrointestinal Cancer Tumor

Is There Comparable Morbidity in Pylorus-preserving and Pylorus-resecting pancreaticoduodenectomy? A Meta-analysis

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2015年第6期35卷 793-800页

作者：陈琦军何志强杨艳张宇舜陈星霖杨洪吉朱世凯钟平勇杨冲吴河水 pancreatic Disease Institute Union Hospital Tongji Medical College Huazhong University of Science and Technology Community Health Service Center the 9th Hospital of Wuhan Key Laboratory of Geriatrics of Health Ministry Department of Geriatrics Union Hospital Tongji Medical College Huazhong University of Science and Technology Organ Transplantation Center Hospital of the University of Electronic Science and Technology of China and Sichuan Provincial People’s Hospital

Summary： pancreaticoduodenectomy （PD） is the most effective treatment for patients with pancreatic head or periampullary lesions. Two major strategies exist： pylorus-preserving pancreaticoduodenectomy （PPPD） and pylorus-resecting pancreaticoduodenectomy （PRPD）. However, it is yet unclear regarding the morbidity after PPPD and PRPD. This study analyzed the morbidity after PPPD and PRPD to de- termine the optimal surgical treatment of masses in the pancreatic head or periampullary region. A sys- tematic search of databases identifying randomized controlled trials （RCTs） from the Cochrane Library, PubMed, EMBASE and Web of Science was performed. Outcome was compared by postoperative mor- bidity including overall morbidity, pancreatic fistulas, wound infections, postoperative bleeding, biliary leakage, ascites and delayed gastric emptying （DGE） rate between PPPD and PRPD. The DGE rate in the PRPD subgroups （conventional PD [CPD] and subtotal stomach-preserving PD [SSPPD], respec- tively） was also analyzed. The results showed that 9 RCTs including 722 participants were included for meta-analysis. Among these RCTs, 7 manuscripts described PRPD as CPD, and 2 manuscripts described PRPD as SSPPD. There were no significant differences in the overall morbidity, pancreatic fistulas, wound infections, postoperative bleeding, or biliary leakage between PPPD and PRPD. There was a lower rate of DGE with PRPD than that with PPPD （RR=2.15, P=0.03, 95% CI, 1.09-4.23）. Further subgroup analysis indicated a comparable DGE rate for the CPD but a lower DGE rate for the SSPPD group than the PPPD group. However, the result did not indicate any difference between CPD and SSPPD regarding the DGE rate （P=-0.92）. It is suggested that PPPD is comparable to PRPD in overall morbidity, pancreatic fistulas, wound infections, postoperative bleeding and biliary leakage. The current data are not sufficient to draw a conclusion regarding which surgical procedure is associated with a lower postoperative

关键词： pancreaticoduodenectomy pylorus morbidity meta-analysis

Serum biomarkers in evaluation and management of idiopathic pulmonary fibrosis

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Precision Medicine Research 2020年第3期2卷 127-135页

作者： Xiao-Yan Ji Peng Jin Guang Yu Qing-Quan Wang Pei Yu Department of emergency ward First Teaching Hospital of Tianjin University of Traditional Chinese MedicineTianjin 300193China Department of pancreatic and gastric surgery National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China NHC Key Laboratory of Hormones and Development(Tianjn Medical University) Tianjin Key Laboratory of Metabolic DiseasesTianjn Medical University Chu Hsien-I Memorial Hospital&Tianjin Institute of EndocrinologyTianjin 300134China

Despite there has greater understanding of the pathophysiology in idiopathic pulmonary fibrosis,idiopathic pulmonary fibrosis still remains a challenge in clinical practice and translational research due to its *** in molecular techniques have identified potential pathways and targets for diagnosis and therapeutic *** types of idiopathic pulmonary fibrosis biomarkers such as KL-6,SP-A,SP-D,MMP7 and other potential ones have been studied *** addition,many studies have confirmed that levels of some tumor markers such as CA 19-9,CA 15-3,CEA,CA 125,CYFRA 21-1 are useful for idiopathic pulmonary *** present study focuses on serum biomarkers including tumor markers to provide an overview on the current roles of these biomarkers in the setting of diagnosis,prediction as well as response to therapy in idiopathic pulmonary fibrosis.

关键词： Idiopathic pulmonary fibrosis Biomarkers Serum tumor makers

Malignant transformation of ectopic pancreatic cells in the duodenal wall

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World Journal of Gastroenterology 2010年第10期16卷 1293-1295页

作者： Roberto Bini Paolo Voghera Alberto Tapparo Raffaele Nunziata Andrea Demarchi Matteo Capocefalo Renzo Leli Department of General and Emergency surgery San Giovanni Bosco Hospital Department of Pathology San Giovanni Bosco Hospital Department of Microbiology and Bio-chemistry The University of Leeds

Ectopic pancreas (EP) is the relatively uncommon presence of pancreatic tissue outside the normal location of the pancreas. This condition is usually asymptomatic and rarely complicated by pancreatitis and malignant transformation. A few cases of neoplastic phenomena that developed from EP into the duodenal wall are described in the literature. Herein we report a case of gastric outlet obstruction due to adenocarcinoma arising from EP of the duodenal wall. The patient underwent a Whipple's procedure and had an uneventful post-operative recovery. Traditional imaging studies are often inconclusive in the definitive diagnosis, whilst endoscopic ultrasonography and guided biopsy may aid accurate pre-operative diagnosis. Diagnostic uncertainty warrants surgical exploration and if necessary extended resection is indicated.

关键词： Ectopic pancreas Duodenum Gastrointestinal obstruction Neoplasm pancreaticoduodenectomy

Novel endoscopic management for pancreatic pseudocyst with fistula to the common bile duct

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World Journal of Gastrointestinal Endoscopy 2014年第12期6卷 620-624页

作者： Stefano Francesco Crinò Giuseppe Scalisi Pierluigi Consolo Doriana Varvara Antonio Bottari Sebastiano Pantè Socrate Pallio Digestive Endoscopy Unit University Hospital Radiological Sciences University Hospital General surgery Unit University Hospital

pancreatic pseudocyst formation is a well-known complication of pancreatitis. It represents about 75% of the cystic lesions of the pancreas and might be located within or surrounding the pancreatic tissue. Sixty percent of the occurrences resolve spontaneously and only persistent, symptomatic or complicated cysts need to be treated. Complications include infection, hemorrhage, gastric outlet obstruction, splenic infarction and rupture. The formation of fistulas to other viscera is rare and most commonly occurs within the stomach, duodenum or colon. We report a case of a patient with a pancreatic pseudocyst in communication with the common bile duct. There have been only few cases reported in the literature. We successfully managed our case by performing an endoscopicultrasound-guided drainage of the pancreatic collection and a contemporaneous stenting of the common bile duct. Performed independently, both drainages are effective, safe and well-coded and the expertise on these procedures is widespread. By our knowledge this therapeutic approach was never reported in literature but we retain this is the most correct treatment for this very rare condition.

关键词： pancreatic pseudocyst Fistula Common bile duct Endoscopic retrograde cholangiopancreatography Endoscopic ultrasound

Perforated jejunal ulcer associated with gastric mucosa in a jejunal diverticulum

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World Journal of Clinical Cases 2014年第6期2卷 209-210页

作者： John Bunni Helen L Barrett Tim A Cook Department of surgery Gloucester-shire Royal Hospital Department of Pathology Gloucestershire Royal Hospital

Jejunal diverticula are rare and subsequent complications even more so. The usual small bowel diverticulum encountered by general surgeons is a Meckel's. These are embryological remnants of the vitello-intestinal duct and are on the anti-mesenteric surface of the terminal ileum. They may contain heterotopic gastric or pancreatic mucosa. Herein we explore the case of a young girl who presented with features of peritonitis secondary to a complication from a jejunal diverticulum. The case, pathology, complications and treatment of jejunal diverticulosis and heterotopic gastric mucosa in the jejunum are explored.

关键词： Jejunum Perforation Heterotopic gastric mucosa Meckel’s gastrointestinal diverticulum

Helicobacter species ribosomal DNA in the pancreas, stomach and duodenum of pancreatic cancer patients

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World Journal of Gastroenterology 2006年第19期12卷 3038-3043页

作者： Hans-Olof Nilsson Unne Stenram Ingemar Ihse Torkel Wadstr(o|¨)m Department of Laboratory Medicine Division of Medical Microbiology Lund UniversityLundSweden Department of Pathology Lund University LundSweden Department of surgery Lund University LundSweden

AIM： To determine whether gastric and enteric Helicobacter species are associated with pancreatic cancer. METHODS： Patients with exocrine pancreatic cancer （n = 40）, neuroendocrine cancer （n = 14）, multiple endocrine neoplasia type 1 （n = 8）, and chronic pan- creatitis （n = 5） were studied. Other benign pancreatic diseases （n = 10） and specimens of normal pancreas （n = 7） were included as controls. pancreatic tissue specimens were analyzed by Helicobacter-specific PCR-assay and products were characterized by denaturing gradient electrophoresis and DNA-sequencing. From a subset of the pancreatic cancer patients, gastric and/or duodenal tissue as well as gallbladder and ductus choledochus tissue were analyzed. Gallbladder and choledochus samples were included as controls. Stomach and duodenum samples were investigated to analyze whether a gastric helicobacter might disseminate to the pancreas in pancreatic cancer patients. pancreatic specimens were analyzed by Bacteroidesspecific PCR for detecting the translocation of indigenous gut microbes to the diseased pancreas. RESULTS： He/icobacter DNA was detected in pancreas （tumor and/or surrounding tissue） of 75% of patients with exocrine cancer, 57% of patients with neuroendocrine cancer, 38% of patients with multiple endocrine neoplasia, and 60% of patients with chronic pancreatitis. All samples from other benign pancreatic diseases and normal pancreas were negative. Thirtythree percent of the patients were helicobacterpositive in gastroduodenal specimens. Surprisingly, H. bilis was identified in 60% of the positive gastroduodenal samples. All gallbladder and ductus choledochus specimens were negative for helicobacter. Bacteroides PCR-assay was negative for all pancreatic samples. CONCLUSION： Helicobacter DNA commonly detected in pancreatic cancer suggests a possible role of the emerging pathogens in the development of chronic pancreatitis and pancreatic cancer.

关键词： pancreatic cancer Helicobacter species Polymerase chain reaction DNA-sequence analysis

Raf kinase inhibitor protein combined with phosphorylated extracellular signal-regulated kinase offers valuable prognosis in gastrointestinal stromal tumor

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World Journal of Gastroenterology 2023年第26期29卷 4200-4213页

作者： Wen-Zhi Qu Luan Wang Juan-Juan Chen Yang Wang Department of General surgery The 4^(th)Affiliated Hospital of China Medical UniversityShenyang 110032Liaoning ProvinceChina Department of Emergency Shengjing Hospital of China Medical UniversityShenyang 110004Liaoning ProvinceChina Department of Medical Service Shengjing Hospital of China Medical UniversityShenyang 110004Liaoning ProvinceChina

BACKGROUND Gastrointestinal stromal tumors(GISTs)are the most common mesenchymal tumors of the gastrointestinal *** kinase inhibitors,such as imatinib,have been used as first-line therapy for the treatment of *** these drugs have achieved considerable efficacy in some patients,reports of resistance and recurrence have *** signal-regulated kinase 1/2(ERK1/2)protein,as a member of the mitogen-activated protein kinase(MAPK)family,is a core molecule of this signaling ***,research reports on the important clinical and prognostic value of phosphorylated-ERK(P-ERK)and phosphorylated-MAPK/ERK kinase(P-MEK)proteins closely related to raf kinase inhibitor protein(RKIP)have gradually emerged in digestive tract tumors such as gastric cancer,colon cancer,and pancreatic ***,literature on the expression of these downstream proteins combined with RKIP in GIST is *** study will focus on this aspect and search for answers to the *** To detect the expression of RKIP,P-ERK,and P-MEK protein in GIST and to analyze their relationship with clinicopathological characteristics and prognosis of this *** to establish a new prognosis evaluation model using RKIP and PERK in combination with analysis and its prognosis evaluation *** The research object of our experiment was 66 pathologically diagnosed GIST patients with complete clinical and follow-up *** patients received surgical treatment at China Medical University Affiliated Hospital from January 2015 to January *** method was used to detect the expression of RKIP,PERK,and P-MEK proteins in GIST tissue samples from these ***-Meier method was used to calculate the survival rate of 63 patients with complete follow-up data.A Nomogram was used to represent the new prognostic evaluation *** Cox multivariate regression analysis was conducted separately for each set of risk evaluation factors,bas

关键词： Raf kinase inhibitory protein Phosphorylated extracellular-signal-regulated kinase Gastrointestinal stromal tumors Immunohistochemistry Survival analysis Risk grade model