Volume 14,Issue 5,2005 Table of Contents

1 Effect of the spleen on intestinal barrier function in rats with acute pancreatitis

LU Zheng , ZHU YanLiang , HE ChangLin , LIU JinXin

2005, 14(5):4. DOI: 10.7659/j.issn.1005-6947.2005.05.003

[Abstract](925) [HTML](0) [PDF 952.07 K](621)

Abstract:
Abstract:Objective
To investigate the effect of the spleen on the function of intestinal barrier during the course of acute pancreatitis in rats.
Methods Rats were randomly divided into four groups: sham operation group; actue pancreatitis group; splenectomy group;splenectomy plus acute pancreatitis group.The serum levels of TNFα,IL1,IL6 and IL10 in each group were examined 24 hours after operation.Two days after operation,the rate of bacterial translocation(BT) was determined and the terminal ileum was excised and examined by transmission electron microscopy to detect the injury of intestinal mucosa.
Results The serum levels of TNFα,IL1β,IL6 and IL10 in splenectomy plus acute pancreatitis group were 3.06±3.61,16.46±5.52,19.90±6.89,6.94±3.93,and in acute pancreatitis group were 19.93±2.38, 42.79±4.31, 20.19±3.35, 39.28±12.69 respectively. The values of TNFα, IL1β and IL10 were significantly lower in splenectomy plus acute pancreatitis group than those in acute pancreatitis group(P<0.05).The rate of bacterial translocation was 40 percent in splenectomy plus acute pancreatitis group,but 93.3 percent in acute pancreatitis group,and the difference was statistically significant(P<0.05).Histologic examination revealed mild edema of intestinal mucosal epithelium and normally appearing intact mucosa in splenectomy plus acute pancreatitis group,whereas in acute pancreatitis group revealed severe injuries of intestinal mucosa,including apparent edema,necrosis of intestinal villi,degeneration of epithelial cells,infiltration of neutrophils and bacterial translocation. 〖WTHZ〗Conclusions The spleen can exacerbate the inflammatory response of acute pancreatitis by markedly promoting the production and release of inflammatory mediators. Splenectomy can reduce the production and release of inflammatory mediators, and thus decrease the damage of intestinal mucosa and the rate of BT.

2 Effect of ectogenic lysolethcin choline on bloodbrain barrier permeability in rats with acute pancreatitis

LIU XiaoFeng , QIAN ZhuYin , Miao Yi

2005, 14(5):5. DOI: 10.7659/j.issn.1005-6947.2005.05.004

[Abstract](847) [HTML](0) [PDF 944.78 K](705)

Abstract:
Abstract:Objective To explore the effect of lysolecithin choline (LPC) on bloodbrain barrier(BBB) permeability in rats with acute pancreatitis.
Methods Acute pancreatitis rat model was produced and rats were randomly divided into:(1)Test groupAP, rats received LPC by tail vein injection; (2)control group I, AP rats were given normal saline by tail vein injection; (3)control group II, sham operation without AP, but LPC was given by tail vein injection.Horseradish peroxidase(HRP) was used as a tracer to determine BBB permeability 7~10 days later.
Results The test group showed local extravascular effusion of HRP,indicating that BBB permeability was markedly increased,while both control groups showed no apparent increase of BBB permeability,which were statistically significant(P<0.01,P<0.05).
ConclusionsLPC can increase BBB permeability of rats with acute pancreatitis,and this may be related to the development of pancreatic encephalopathy.

3 Treatment of severe acute pancreatitis: a review of 217 cases

FENG Chao , TANG Huihuan , CHEN Zihua , LU Xinsheng

2005, 14(5):6. DOI: 10.7659/j.issn.1005-6947.2005.05.005

[Abstract](728) [HTML](0) [PDF 946.94 K](598)

Abstract:
Abstract:Objective
To investigate the principles of treatment for severe acute pancreatitis(SAP). Methods A retrospective analysis of the data of 217 cases of SAP with regards to clinical features,mortality rate and conversion to surgical operation.In this group,66 cases received early operation and 24 cases were converted to operation after initial conservative treatment.
Results The overall cure rate was 80.2%(174/217).Among them,90 cases underwent operative treatment,with a cure rate of 72.2%(65/90),and 127 cases underwent conservative treatment with a cure rate of 85.8%(109/127).
Conclusions The initial treatment of SAP should be conservative. Operation should be performed if there is a specific indication for early surgical intervention,or for conversion to operation.

4 Nonsurgical treatment in the early stage of severe acute pancreatitis

HUANG Jianxian , CHEN Xiaoling , SHI Lizhi , CAI Xiang wu

2005, 14(5):7. DOI: 10.7659/j.issn.1005-6947.2005.05.006

[Abstract](766) [HTML](0) [PDF 945.65 K](665)

Abstract:
Abstract:Objective To explore a rational treatment program for the nonsurgical treatment of severe acute pancreatitis (SAP) in the early stage. Methods The data of 123 cases of SAP treated from 1986 to 2004 were collected and divided into two groups according to admission time and treatment procedure. Group A:53 cases admitted from 1986 to 1992,treated mainly by operation. Group B :70 cases admitted from 1992 to 2004 ,treated mainly by nonsurgical procedures.
Results The mortality rate in group A and B was 33.9%(18/53) and 7.1% (5/70),respectively,while the incidence rate of complications such as ARDS,shock,renal failure,pancreatic abscess,cardiac failure in group A was 28.3%(15/53),16.9%(9/53),20.8%(11/53),16.9%(9/53),24.5%(13/53),and in group B was 14.3%(10/70),7.1%(5/70),7.1%(5/70),2.8%(2/70), 4.2%(3/70),respectively. There was significant difference between the two groups (P<0.0 01 ).
Conclusions Conservative treatment for the early stage of SAP can effectively decrease morbidity and mortality rates.The majority of cases of SAP can be cured with conservative treatment.

5 Acute pancreatitis complicated with pancreatic encephalopathy：a report of 19 cases

JIN Zhouxiang , LI Yongguo , HUANG Shengfu , ZHANG Wei

2005, 14(5):8. DOI: 10.7659/j.issn.1005-6947.2005.05.007

[Abstract](862) [HTML](0) [PDF 947.21 K](699)

Abstract:
Abstract:Objective
To discuss the predisposing factors,prognosis and treatment of pancreatic encephalopathy(PE) in acute pancreatitis(AP).
Methods Nineteen cases of AP complicated with PE were retrospectively studied.
Results The occurrence rate of PE was 12.0%. PE often occurred in association with such factors as hyperpyrexia, waterelectrolyte disturbance, and hypoxemia. Among the 19 patients,11 patients received surgical operation and 8 were treated conservatively.The total fatality rate reached 52.6%(10/19),significantly higher than other concurrently treated cases of severe acute pancreatits(SAP) (20.7%,P<0.05).
Conclusions PE may result from the combined effect of several factors upon an underlying cerebral injury due to pancreatic enzymes.AP complicated with PE carried a poor prognosis.PE should be treated according to the "individualized therapy"principle of SAP,and operative indications should be the same as that of SAP.Operation should be simple and effective.PE should not be independently considered as an operative indication of SAP.

6 The protective effect of ischemic preconditioning on pancreas transplantation in rats

HE Tingting , LIU Xiaonan , WANG Weizhong , LI Kaizong , GUAN Wenxian , CHEN Dongli

2005, 14(5):9. DOI: 10.7659/j.issn.1005-6947.2005.05.008

[Abstract](837) [HTML](0) [PDF 959.57 K](614)

Abstract:
Abstract:Objective
To investigate the effect of ischemic preconditioning (IPC) on pancreas transplantation(PT) in rats.
Methods Steptozozininduced diabetic SD rats were randomly assigned to 2 groups: group I/R(ischemia/reperfusion), consisted of 30 diabetic rats which received PT; group IPC, consisted of 30 diabetic rats which received pancreas transplantation and IPC. Six rats in each group were randomly sacrificed at 2 days before PT, and 3 days and 7days after PT, to detect the level of blood sugar and amylase,and pancreatic sections were stained with HE simultaneously; 6 rats were used to observe various metabolic indexes, and other 6 rats were used to observe the rat survival rate. Results The rats of group IPC had a higher 1 month survival rate than group I/R (5/6 vs 3/6, P<0.01). The blood sugar and amylase activity,food intake, water intake and urine volume in group IPC were lower than group I/R at each time period after transplantation(P<0.01, P<0.01, P<0.05 ,P<0.05, P<0.01,respectively). The degree of injury of pancreas graft in group I/R was more serious than that in group IPC. Conclusions IPC can improve the survival rate, reduce amylase activity, alleviate the degree of injury of pancreas graft, and protect the pancreas graft after PT in rats.

7 Immunedeficient dendritic cells can induce tolerance to transplantation of xenogenic islet cells〖STBZ〗

ZHAO Gang , Wang Fang , WANG Chunyou

2005, 14(5):10. DOI: 10.7659/j.issn.1005-6947.2005.05.009

[Abstract](572) [HTML](0) [PDF 955.16 K](719)

Abstract:
Abstract:Objective
To investigate whether host derived immunedeficient dendritic cells (DC) were capable of inducing immunological tolerance to islet xenografts and to ascertain its mechanism.
MethodsImmunedeficient DC were obtained from marrow of BALB/C mice by inductive differentiation,and loaded with MHC antigen of Wistar rat. The loaded DC were injected into diabetic model mice through tail vein,and,7 days later, islet of Wistar or SD rats were implanted beneath the renal capsule. Survival time of grafts was monitored. Mixed lymphocyte culture and TH1/TH2 cytokine expression were observed.
Results Compared to the untreated mice, the survival time of Wistar islets was significantly prolonged in the pretreated mice(P<0.05), but the survival time of SD islets was not significantly prolonged. T lymphocytes of immunedeficient DC pretreated mice showed mild proliferative reaction, and the expression of TH1/TH2 cytokine was significantly lower.
Conclusions Immunedeficient DC pretreated with donor MHC antigen can induce antigenspecific nonfunction of T cells and low expression of TH1/TH2 cytokines, and thus can effectively prolong the survival time of islet xenografts.

8 Experimental study on the protective effects of adenosine on reperfusion injury following pancreaticoduodenal transplantation in rats

YUAN Chunhui , LIU Yongfeng , ZHAO Ning , LI Guichen , Cheng Ying , He Sanguang

2005, 14(5):11. DOI: 10.7659/j.issn.1005-6947.2005.05.010

[Abstract](648) [HTML](0) [PDF 1013.69 K](654)

Abstract:
Abstract:Objective
To study the protective effects of adenosine（ADO） on reperfusion injury following pancreaticoduodenal transplantation in rats.
Methods The homologous male Wistar rat model of heterotopic total pancreaticoduodenal transplantation was made. The rats received IV injection of either ADO,8PT(1,3dimethyl 8phenylxanthine) or ADO+8PT at 5 min before or 5 min after operation,and then were divided into 6 groups:(1)blank control(C group);(2)transplant control group;(3)transplant +ADO group(ADO);(4)transplant +8PT group(8PT);(5)transplant+ADO+8PT group(ADO+8PT),and (6) transplant+［α32P］ ADO(radiationvisible group).AT 24h after transplantation,the pancreatic tissue concentration of adenosine triphosphate（ATP） and total adenine nucleotides (TAN) were determined, blood sugar (BG) and serum concentration of amylase and lipase were examined, the activity of myeloperoxidase (MPO) in pancreatic graft tissue was measured, and histological observation was made. ［α32P］ADO was used to radiologically identify the content of ADO in pancreatic tissue.
Results Pancreatic tissue concentration of ATP and TAN［（5.72±0.47）μmol/g, （8.71±0.91）μmol/g］in ADO group> transplant control group［（3.39±0.58）μmol/g, （5.01±0.78）μmol/g］>(ADO+8PT)group［（2.92±0.24）μmol/g, （4.84±0.41）μmol/g］>8PT group［（2.05±0.66）μmol/g, （3.98±0.41）μmol/g］ 24h after transplantation（P<0.05）.The value of BG and serum lipase and MPO in ADO group< transplant control group < (ADO+8PT)group < 8PT group(P<0.05). Lightmicroscopic studies showed that histomorphological changes of pancreas in experimental group were muchless than that in other groups.Radioactive ［α32P］ADO was found that the radiactive meteria can enter the pancreatic acinar cells.〖WTHZ〗Conclusions〓〖WTBZ〗Exogenous ADO can increase the amount of ATP and TAN in pancreatic graft tissue,while 8PT reduces it. ADO has protective effects on the ischemia/reperfusion injury of pancreaticoduodenal graft.

9 Experimental and clinical study on intratumor injection of slowrelease 5FU to treat pancreatic carcinoma

DU weidong , YUAN Zurong , NI Quanxing , HUA Luchun , SHEN Daming , TANG Jianxiong , ZHANG Qunhua , ZHU Yue

2005, 14(5):12. DOI: 10.7659/j.issn.1005-6947.2005.05.011

[Abstract](857) [HTML](0) [PDF 975.58 K](648)

Abstract:
Abstract:Objective
To study the effect of intratumor injection of slowrelease 5FU on pancreatic carcinoma cells in nude mice,and on changes in serum tumor markers and cellular immunity of patients with pancreatic carcinoma.
Methods 1) In vitro experiments, the releasing action and antitumor effect of slowrelease 5FU were studied. Measurement of the concentration of effused fluid,calculation of amount of drug released,and observation of the inhibitory effects of effused fluid on PC3 strains of pancreatic cancer cellswere perfomed.(2) Human pancreatic carcinoma strain PC3 cells were cultured and inoculated into 60 nude mice,and were randomly divided into 5 groups according to various treatments received: NS injection as control group(A group), 5FU (10 mg/kg)IV injection group(B group), stroma implant group(C group), intratumor injection of high dose slowrelease 5FU (4mg/kg) group(D group) and intratumor injection of low dose slowrelease 5FU (1mg/kg) group(E group). Tumor size were measured before and 14 days after treatment. On week 2, histological changes of the tumors were examined. The apoptotic index (AI) of the tumor cells was detected by terminaldeoxynucleotide transferase mediated dUTP nick end labeling(TUNEL) and expression of bcl2 and Bax by immunohistochemistry.(3) 69 cases of unresectable pancreatic carcinoma were divided into 3 groups randomly:intratumor injection of slowrelease 5FU treated group(treatment group), intravenous injection of 5FU group(chemotherapy group), and control group. The serum values of CD3+, CD4+, CD8+, CD4+/ CD8+, NK cells, CEA, CA50, CA199, CA125 and CA242 were measured in all patients 1 day before and 14 days after operation.
Results 1) There was 0.85 mg 5FU released in the 1st day and 0.45 mg 5FU released in the 3rd day. The release remained constant at 0.25 mg and continued for about 14 days. (2) The tumor growth suppression rate on the 1st day by effusion fluid of slowrelease 5FU was 60.27% and on the 3rd day was 34.25%. Later, it remained at about 25.00%. The tumor growth rate was slower in D and E group than in other groups (P<0.05). The expression of bcl2 was markedly decreased but that of Bax remarked increased in D and E group than in the other groups (P<0.05). The extent of local inflammation and degree of thickness of blood vessel endothelium was more pronounced in D and E groups than in other groups (P<0.05).AI was significantly higher in D and E group than in other groups(P<0.05). In patients of intravenous injection of 5FU treated group, the serum levels of CD4+/ CD8+ and NK cells were much lower than in H patients of treatment group and the control group（P<0.05）;and the serum values of CEA, CA50, CA199, CA125 and CA242 in patients of treatment group were much lower than in patients the intravenous injection of 5FU group and the control group（P<0.05）.
Conclusions Slowrelease 5FU can constantly maintain drugrelease during 2 weeks of in vitro experment and has inhibitory action against human pancreatic cancer cell strain PC 3.Intratumor injection of slowrelease 5FU can inhibit the growth of pancreatic carcinoma by inducing local inflammation and thickening of blood vessel endothelium and upregulating apoptosis of pancreatic cancer cells. Intratumor embedding of slowrelease 5FU into the pancreatic cancer tissue of palients causes minimal damage of cellular immunity, but can decrease the serum values of CEA, CA50, CA199, CA125 and CA242, and might become an useful method for treating patients with unresectable pancreatic cancinoma.

10 Study on the expressions of chemotactic proteins and their significance in pancreatic carcinoma and chronic pancreatitis

LIU Dongcai , YANG Zhulin , ZHUO Jianpin , YUAN Lianwen , SHU Guoshun , ZHOU Jiapeng , LI Yongguo

2005, 14(5):13. DOI: 10.7659/j.issn.1005-6947.2005.05.012

[Abstract](1187) [HTML](0) [PDF 958.82 K](624)

Abstract:
Abstract:Objective To investigate the expressions of IL8,MCP1 and MIP1α and their biological significance in pancreatic carcinoma and chronic pancreatitis, and investigate the relationships of their expressions in pancreatic cancer tissues.
Methods Immunohistochemical method of avidinbiotin complex was used to examine surgically removed specimens from 51 cases of pancreatic carcinoma and 10 cases of chronic pancreatitis.
Results The positive rates of expression and the scorings of IL8,MCP1,MIP1α were significantly higher in pancreatic carcinoma than that in chronic pancreatitis(P<0.01). IL8 expression was significantly higher in welldifferentiated adenocarcinoma than that in poorlydifferentiated ones(P<0.05). Also the positive expression rate and the scorings of the three factors were significantly lower in cases without metastasis than in those with metastasis(P<0.05 or P<0.01).
Conclusions The expressions of IL8,mcpI and MIPIα might be three important chemotactic factors in reflecting the carcinogenesis,progression,biological behavior,metastatic potential and prognosis of pancreatic carcinoma.The three factors might have mutual effect and common regulatory pathways of action.

11 An experimental novel microcapsular system for in vitro culture of primary generation hepatocytes

WANG Xianwei , LU Xinsheng , TANG Huihuan , MA Na

2005, 14(5):14. DOI: 10.7659/j.issn.1005-6947.2005.05.013

[Abstract](559) [HTML](0) [PDF 953.49 K](704)

Abstract:
Abstract:Objective To investigate a new microcapsular system for culture of primary generation hepatocytes in vitro.
Methods A novel microcapsular system was used for in vitro culture of primary generation rat hepatocytes.The various characteristics of the microcapsular system were examined. The survival rate of hepatocytes and the functions of urea and albumin synthesis were observed.
Results The microcapsule had good permeability,a certain degree of mechanical stability and favorable immunological protective ability.Hepatocytes within the microcapsule maintained a high degree of viability and function, and the synthesis of urea and albumin was 1~3 times higher than that of controls.
Conclusions This microcapsule has excellent biological and mechanical properties.This system can be of great benefit for use in bioartificial liver and cell transplantation.

12 Simultaneous pancreaskidney transplantation:a report of 19 cases

YANG Lei , WU Gang , LIU Shurong , LIU Yongfeng

2005, 14(5):15. DOI: 10.7659/j.issn.1005-6947.2005.05.014

[Abstract](876) [HTML](0) [PDF 944.74 K](699)

Abstract:
摘要：
目的探讨胰肾联合移植术中药物的应用方法，以取得良好的术后效果。
方法 19例胰肾联合移植受者，术中用药如下；以白蛋白（清蛋白）作为主要血管扩容剂，平均用量为1.5~2.0g/kg；电解质溶液输注量为30~50mL/kg；用异搏定（5mg/12h）、前列腺素E1 （100μg/12h）以减少移植器官的保存损伤；用生长抑素（3mg/12h）抑制移植胰腺外分泌功能。
结果 19例受者移植胰腺通血后5~10min分泌含高淀粉酶（平均为20 800U/L）的胰液，供肾血管开放后2~10min，输尿管有尿液流出。术后2~4d肾功恢复，术后1.5h至9d停用胰岛素。
结论胰、肾联合移植术中合理应用白蛋白、血管扩张剂和生长抑素对移植胰、肾功能有良好作用。

13 Surgical excision of tumors in the body and tail of pancreas

MA Lilin , SHEN Hongxun , ZHU Jianwei , LIU Jianmin , YU Xiu , XU Qing , LI houxiang , CHEN Yuquan

2005, 14(5):16. DOI: 10.7659/j.issn.1005-6947.2005.05.015

[Abstract](1159) [HTML](0) [PDF 945.12 K](779)

Abstract:
Abstract:Objective
To explore the methods of surgical treatment of patients with tumors in the body and tail of pancreas.
Methods We analyzed the clinical data from 45 patients with tumors in the body and tail of pancreas who underwent surgical excision between 1984 and 2002 in our hospital. The 45 cases consisted of malignant tumors(n=33) and benign tumors(n=12). Operations performed included resection of the body and tail of pancreas(17 cases), combinedorgan excision (24 cases) and local tumor resection(4 cases).
Results Pathological classification:carcinoma (33 cases), islet cell tumors (8 cases), cystic adenoma(8 cases), epithelioid fibroma (1 case) and cystic teratoma (1 case). The average diametersize of excised tumor was determined as follows: carcinoma in the body or tail of pancreas was(8.0±2.6)cm, and that of islet cell tumors was(6.5±2.4)cm. There were no operative deaths, but operation resulted in the following complications: pancreatic fistula (2 cases), subdiaphragmatic abscess (2 cases), pancreatic pseudocyst (1 case ), upper gastrointestinal bleeding(1 case) and infection or poor healing of incisional wound (3 cases). All of the complications were cured with conservative therapy.
ConclusionsExcision of the body and tail of pancreas is an effective method for the treatment of patients with tumors in the distal half of pancreas.Before operation, it is necessary to be routinely prepared to perform combined organ excision. Regarding the surgical handling of pancreatic stump, we select the use of ligation of main pancreatic duct plus mattress suture, which we believe could effectively prevent pancreatic fistula.

14 Analysis of risk factors associated with mortality after pancreatoduodenectomy

WANG Zhijun , WU Yang , XIE Zhizheng , WANG Lulin

2005, 14(5):17. DOI: 10.7659/j.issn.1005-6947.2005.05.016

[Abstract](837) [HTML](0) [PDF 951.41 K](729)

Abstract:
Abstract:Objective To evaluate the risk factors associated with operative death after pancreatoduodenectomy(PD) and thus be able to decrease mortality.
Methods The data of 123 consecutive patients undergoing PD during 9 years were reviewed. The variables analyzed were clinical data, laboratory data, operative factors, pathological diagnosis, and complications.
Results The 30day postoperative mortality rate was 7.3 percent. Postoperative intraabdominal hemorrhage(OR=17.954), diabetes(OR=7.097), gastrointestinal hemorrhage (OR=7.789), preoperative serum albumin concentration(OR=10.689) and amount of operative blood loss(OR=5.473) were independent risk factors.
Conclusions The chief risk factors associated with operative death after PD are low concentration of preoperative serum albumin, diabetes, large amount of operative blood loss, and postoperative intraabdominal and gastrointestinal hemorrhage. These risk factors should be specifically considered in the perioperative management of the patients.

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Volume 14,Issue 5,2005 Table of Contents

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