Volume 15,Issue 11,2006 Table of Contents

1 Extended pancreaticoduodenectomy combined with resection of the involved portal vein(PV) and superior mesenteric vein(SMV)

LI Bin-sheng , ZHONG De-wu , MIAO Xiong-yin , ZHOU Jun

2006, 15(11):1-803. DOI: 10.7659/j.issn.1005-6947.2006.11.001

[Abstract](727) [HTML](0) [PDF 864.30 K](653)

Abstract:
Abstract:Objective ：To explore the feasibilityof the radical resectionof cancer of head of pancreas with involving PV and SMV.
Methods ：The data of 16 cases who underwent extended pancreaticoduodenectomy for tumors with involvement of PV/SMV were analysed retrospectively. The 16 cases all underwent extended pancreaticoduodenectomy. In 9 of the 16 cases partial resection of the wall of blood vessels was performed,5 cases mnderwent segmental resection of the blood vessel and end-end anastomosis,2 cases had segmental resection of the blood vessel and homologous vein transplantation.
Results ：No cases of embolization,intestinal necrosis or hepatic failure were found in the whole group. One case died of mutiple organ failure was days after operation,and all the others were survival after operation and were followed up.Survival time was more than 3 years in 3 cases, and more than 5 years in 1 case,and 3~26 minths in 4 cases.
Conclusions ：It is feasible to perform extended pancreaticoduodenectomy for cases of pancreatic head carcinoma with involvement of PV/SMV.

2 The diagnosis and treatment of solid-pseudopapillary tumor of pancreas: a report of 11 cases

SU Zhong-xue , LU Jun , XU Jian , WU Ya-guang , WU Tai-huang

2006, 15(11):2-806. DOI: 10.7659/j.issn.1005-6947.2006.11.002

[Abstract](825) [HTML](0) [PDF 784.02 K](631)

Abstract:
Abstract:Objective ：To explore the diagnosis and treatment of solid-pseudopapillary tumor of(SPT) pancreas. Methods ：The clinical dada of 11 patients with SPT of pancreas treated in our hospital from 2000 to 2006 were studied retrospectively. There were 10 females, one was male, the average age was 26.2(range 11~53) years in this series. The location of the tumors was:8 in the head, 1 in the neck, and 2 in the tail of pancreas. Results ：Two patient underwent distal pancreatectomy and splenectomy, and simple tumor resection was performed in the other patients. All patients were followed up, and no recurrence or metastsis was found. Conclusions ：Solid-pseudopapillary tumor of pancreas is a rare type neoplasm of pancreas. SPT of pancreas is affecting primarily young women. Complete resection resulted in excellent prognosis.

3 The diagnosis and treatment of pancreatic duct stones

HUANG Dong-hang , YOU Zhen-hui , CHEN Zhi-jiang , LI Jiang-dang

2006, 15(11):3-809. DOI: 10.7659/j.issn.1005-6947.2006.11.003

[Abstract](1051) [HTML](0) [PDF 782.95 K](690)

Abstract:
Abstract:Objective ：To explore the diagnosis and surgical treatment of pancreatic duct stones.Methods ：The clinical data of 24 cases of pancreatic duct stones who underwent operation from 1985 to 2005 were analyzed retrospectively. Results ：The diagnosis of all cases was confirmed by imaging examinations such as B ultrasonography, abdominal X-ray film, CT， endoscopic retrograde cholangiopancreatography or magnetic resonance cholangiopancreatography . The operative methods were pancreatolithotomy with Roux-en-Y side-to-side pancreaticojejunostomy in 19 cases, distal pancreatectomy with pancreatojejunostomy in 4 cases and pancreatoduodenectomy in 1 case. No operative complication was found. Tweenty-four cases were followed for 2 months to 4 years after operation.Among 23 cases with upper abdominal pain before operation, the abdominal pain disappeared in 19 cases and was alleviated in 4 cases postoperatively. Among 8 cases with diabetes mellitus before operation, blood glucose returned to normal in 4 cases postoperatively. Among 5 cases with steatorrhea before operation, the steatorrhea disappeared in 2 cases and was alleviated in 1 case postoperatively. Conclusions ：Imaging examinations are the main methods for diagnosis of pancreatic duct stones. The main operative method is pancreatolithotomy with Roux-en-y side-to-side pancreaticojejunostomy.

4 Diagnosis and treatment of chronic pancreatitis with mass in the head ofpancreas

SHI Quan , CHEN Jing-fan , LON Chen-meng

2006, 15(11):4-812. DOI: 10.7659/j.issn.1005-6947.2006.11.004

[Abstract](750) [HTML](0) [PDF 785.30 K](645)

Abstract:
Abstract:Objective ：To study the diagnosis and treatment of chronic pancreatitis with mass in the head of pancreas (CPMHP ). Methods ：The clinical material of 29 patients of CPMHP confirmed by operation and pathology were analyzed. Results ：In the 29 cases, habitual alcohol consumption accounted for 16 cases, cholelithiasis for 12 cases and idiopathic pancreatitis for 1 case. The diagnostic methods included laboratory examination, CT or helical CT, PTC or ERCP. Before operation, 21 cases were diagnosed as CPMHP and 8 cases were diagnosed as carcinoma of pancreatic head (PhCa), but all of the patients were diagnosed as CPMHP by intraoperative biopsy. All of the 29 patients received operation, including Whipple′s operation in 11 cases, Beger′s operation in 6 cases, and choledochotomy in 12 cases. After operation, the pancreatic fistula rate was 5.9%, and there was no operative death in this series. All of the patients were followed up for a mean of 5 years. One case was found to have PhCa at re-operation 5 years later, and one case died of diabetetic complication after 7 years. Conclusions ：It is very difficult to differentiate between PhCa and CPMHP, but the clinical features in combination with CT and ERCP findings are helpful, while intraoperative biopsy is the most sensitive method of differentiation. Since CPMHP can undergo cancerous change, it is advised that a mass in the head of pancreas should be removed by surgery.

5 Diagnosis and treatment of hyperlipidemic pancreatitis: a report of 46 cases

WU He-shui , ZHANG Lei , WANG Chun-you , HUANG Peng , GUO Xing-jun , XIONG Jiong-xin

2006, 15(11):5-815. DOI: 10.7659/j.issn.1005-6947.2006.11.005

[Abstract](1108) [HTML](0) [PDF 786.42 K](647)

Abstract:
Abstract:Objective ：To elucidate the clinical features, and the principles in diagnosis and treatment of hyperlipidemic pancreatitis.Methods ：The clinical data of 262 cases with acute pancreatitis from January, 2004 to April, 2006, were studied. Results ：Among 262 cases, 46 cases were diagnosed as hyperlipidemic pancreatitis(17.5%,46/262), that included 32 cases with mild acute pancreatitis(69.0%) and 14 cases with severe acute pancreatitis(31.0%). Depending on the severity of pancreatitis, different treatments were adopted. Among the 46 cases, 10 were treated operatively. As a result, 43 cases were cured, accountingfor 93.5% of all cases, and3 cases died, accounting for 21.4% of cases with severe acute pancreatitis. Conclusions ：Hyperlipidemia can induce acute pancreatitis, and many may have severe pancreatitis. Treatment is mainly by nonoperative management but different therapeutic measures should be adopted according to the severity of pancreatitis.

6 Suppression of pancreatic cancer cell eypression ofXIAP by RNAi and its effect on sensitivily to chemotherapeutics

JIAN Zhi-yuan , LI Yi-xiong , LU Xin-sheng , LI Xiao-gang , LAN Ming-yin

2006, 15(11):6-820. DOI: 10.7659/j.issn.1005-6947.2006.11.006

[Abstract](1067) [HTML](0) [PDF 803.18 K](700)

Abstract:
Abstract:Objective ：To investigate the possibility of XIAP inhibition by RNA interference (RNAi) vectors, and the chemotherapeutic sensitivity change of pancreatic carcinoma cells of SW1990 after XIAP inhibition. Methods ：RNA interference vectors against XIAP was constructed and transfected into the pancreatic carcinoma cell line SW1990, the expression of XIAP was determined by RT-PCR and Western blot, while flow cytometry and Hoechst 33258 stain were employed to examine the apoptosis index of SW1990 induced by gemcitabine. The relationship between XIAP and apoptosis index was analyzed by linear regression. Results ：Four RNAi vectors against XIAP were constructed, two of the four RNAi vectors could instantaneous inhibit XIAP expression more than 50%, The sensitivity of SW1990 to gemcitabine increased after XIAP was inhibited ( P <0.05), and the expression level of XIAP was negatively related to the apoptosis index ( P <0.05). Conclusions ：RNAi vectors could effectively suppress the expression of XIAP, and enhance the sensitivety of pancreatic cancer cells to chemtherapentic drygs.

7 Antitumor effect of tumor necrosis factor-related apoptosis-inducing ligand gene transfection mediated by adenovirus in human pancreatic carcinoma cell

TIAN Rui , QIN Ren-yi , DU Zhi-yong , XIA Wei

2006, 15(11):7-825. DOI: 10.7659/j.issn.1005-6947.2006.11.007

[Abstract](830) [HTML](0) [PDF 805.01 K](631)

Abstract:
Abstract:Objective ：To investigate the antitumor effect of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) gene transfection mediated by adenovirus into human pancreatic carcinoma cell line Panc-1, and the mechanisms involved in this effect. Methods ：TRAIL gene was transfected into pancreatic cancer cell line Panc-1 by an adenovirus vector (Ad-TRAIL). Level of TRAIL mRNA expression was determined using RT-PCR, and TRAIL protein synthesis was evaluated with Western blot. Cell-growth activities were determined by MTT assay. The bystander effect was observed by co-culturing the Panc-1 cells with and without the transfected TRAIL gene at different ratios. Apoptosis in pancreatic cancer cells was detected by flow cytometry. Proaspase-8 and procaspase-3 proteins were determined by Western blot. Results ：The stable overexpression of TRAIL was detected in Panc-1 cells transfected by Ad-TRAIL. Ad-TRAIL significantly inhibited cell viability of Panc-1 cells. Furthermore, co-culture of cancer cells transfected with TRAIL resulted in the nontransfected cell inhibition by bystander effect. Moreover, the percentage of apoptotic cells was significantly higher in the Ad-TRAIL-treatment group compared to the control groups ( P <0.01), and there was a diminished amount of procaspase-8 and procaspase-3 after infection with Ad-TRAIL transfection. Conclusions ：The overexpression of TRAIL gene in Panc-1 cells by Ad-TRAIL exerts a marked antitumor effect, and the mechanisms involved in this effect may be related to proapoptosis and bystander effect.

8 Reexpression of somatostatin receptor type2 gene can enhance the effect of5-FU on pancreatic carcinoma in vivo

DU Zhi-yong , CHENG Li-mo , QIN Ren-yi

2006, 15(11):8-830. DOI: 10.7659/j.issn.1005-6947.2006.11.008

[Abstract](683) [HTML](0) [PDF 804.90 K](645)

Abstract:
Abstract:Objective ：To observe the therapeutic effect of 5-FU on pancreatic carcinoma after xenografts transfected with SSTR2 in vivo. Methods ：Human pancreatic cancer cells (panc-1) were inoculated subcutaneously to the back of nude mice. The animals were then divided into 4 groups randomly( n =6/group) when tumor nodules grew to about 5mm×5mm seven days later. Group I served as an untreated control, group II received 5-FU via intraperitoneal injection, group III received an intratumoral injection of a combination of pCMV-6C-SSTR2 and lipofectamine 2000; Group IV recieved 5-FU via intraperitoneal injection and intratumoral injection of SSTR2. Finally, the animals were anesthetized and the tumors were excised and weighed. The result of transfection was detected by immunohistochemistry and Western-blot. A quantification of apoptosis rate was then performed using Tunel method. Results ：The expression of SSTR2 was detected in pancreatic xenografts of group III and IV transfected by pCMV-6C-SSTR2-lipofectamine2000. Combination of SSTR2 gene therapy and 5-FU chemotherapy resulted in a significant effect. The tumor group rate of group IV was slower than that of the other three groups （ P <0.01），the final size and weight of tumor was smaller than that of the other three groups（ P <0.01）, but the apoptosis rate of pancreatic cancer cells was higher than that of the other three groups （ P <0.01）. Conclusions ：Reexpression of SSTR2 can ehance the sensitivity of pancreatic carcinoma cells to 5-FU; combination SSTR2 gene therapy and 5-FU chemotherapy may be a new upproach for therapy of pancreatic carcinoma.

9 Experimental study of kansui root and LMWH combined therapy for severe acute pancreatitis

PAN Xiao-ji , LU Xin-sheng , DUAN Lian , CHEN Shan-zheng , REN Xue-qun , CHEN Jian-yun , LI Yi-xiong

2006, 15(11):9-835. DOI: 10.7659/j.issn.1005-6947.2006.11.009

[Abstract](1083) [HTML](0) [PDF 808.83 K](742)

Abstract:
Abstract:Objective ：To investigate if there is a synergism of kansui root and low molecular weight heparin(LMWH) in combined treatment of SAP in rats. Methods ：SD rats were randomly divided into 5 groups:Sham group(A group), severe acute pancreatitis group(B group), kansui root treatment group(C group), LMWH treatment group(D group), combined treatment group(E group). The serum TNF-α,IL-6 level and the ratio of TXB2/6-keto-PGF1α in pancreatic tissue, and the histological examination were evaluated. Results ：The values ofTNF-α、IL-6 and the ratio ofTXB2/6-keto-PGF1α in C，D，E group were significantly lower than those in B group at the time point of6,12,24h. But there were no significant differences in C，D，E group at all the time points. The histological examination showed that the pancreas was normal in group A; the pathological changes were milder in C，D，E group than that in B group.Conclusions ：Combined treatment of kansui root and LMWH was effective in SAP, but there was no synergism, and also no side effects.

10 The effect of gadolinium chloride on inflammatory mediators secreted byalveolar macrophages in acute necrotizing pancreatitis rats

CHENG Shi , SONG Mao-min , SHI Jing-dong

2006, 15(11):10-839. DOI: 10.7659/j.issn.1005-6947.2006.11.010

[Abstract](1018) [HTML](0) [PDF 798.03 K](713)

Abstract:
Abstract:Objective ：To explore the effect of gadolinium chloride(Gdcl3) on inflammatory mediators secreted by alveolar macrophages（AMs）in acute necrotizing pancreatitis(ANP) rats. Methods ：Ninty SD rats were randomly into five groups( n =18 in each group): normal control(C) group, ANP group, C+Gdcl3 treatment(C+A) group, ANPGdcl3 pretreatment(AP) group, ANPGdcl3 treatment(AT) group. AMs were obtained by bronchoalveolar lavage. The blood gas the weight ratio of wet/dry lung tissue, the protein content of bronchoalveolar lavage fluids(BALF), the myeloperoxidase(MPO) of lung tissue and secretion of TNFa and NO by AMs were evaluated; histologic examination of lung tissue was performed. Results ：The parameters mentioned above in C+A group compared with C group showed no statistical significance ( P >0.05). Except the blood gas, the indicators mentioned above in AP group and AT treatment group were significantly elevated compared with normal control group( P <0.05); but lewer significantly compared to the ANP group( P <0.05).Conclusions ：Gdcl3 can inhibit the secretion of inflammatory mediators of AMs and ameliorate lung injury of ANP.

11 The effect of the Extract of Ginkgo biloba on intestinal mucosal barrier after pancreas transplantation in rats

LIU Xiao-nan , HUO Ting-ting , WANG Wei-zhong , DONG Guang-long , ZHANG Hong-wei ，CHEN Dong-li

2006, 15(11):11-844. DOI: 10.7659/j.issn.1005-6947.2006.11.011

[Abstract](640) [HTML](0) [PDF 811.43 K](617)

Abstract:
Abstract:Objective ：To investigate the protective effect of extract of Ginkgo biloba (EGb) on intestinal mucosal barrier after rats pancreas transplantation(PT), and analyze the possible mechanism. Methods ：In the control group, 12 normal rats received sham operation, and 24 steptozozin-induced diabetic SD rats were randomly assigned to 2 groups: Group PT consisted of 12 diabetic rats which received pancreas transplantation, group EGb consisted of 12 diabetic rats that received EGb（1.5 mg/kg） injected intravenously 1 day and 30min respectively before pancreas transplantation. The intestinal permeability, absorptional function and morphology, the TNF-α, NO, SOD and amylase activity in serum, and MDA, SOD and MPO in interstitial tissue were monitored 5 days after PT. Simultaneously, bacteria translocation in the superior mesenteric vein, mesenteric lymph node, liver and spleen was observed. Results ：(1)The mean TNF-α level( P <0.01) and amylase activity in serum( P <0.01), the mean intestinal permeability ( P <0.01), the mean bacteria translocation rate( P <0.01), the mean degree of MDA level and MPO activity( P <0.05) in intestinal mucous, and intestinal mucosal injury of group EGb were lower than those in Group PT. (2)The mean NO level ( P <0.01) and SOD activity ( P <0.01) in serum and the intestinal absorption function of group EGb were higher than those in Group PT. Conclusions ：EGb can protect the intestinal mucosal barrier of pancreas transplant recipient, and decrease the rate of bacteria translocation. The mechanism may be related to antioxidation and elimination of free radicals, decrease synthesis of TNF-α, decrease of adhesion and aggregation of PMNs, and increase production of endogenous NO.

12 Study in the effect of endothelin-1 on the contraction of Oddi sphincter

GE Chun-lin , LUO Xiao-guang , LI Zhi , SUN Shu

2006, 15(11):12-848. DOI: 10.7659/j.issn.1005-6947.2006.11.012

[Abstract](644) [HTML](0) [PDF 795.46 K](684)

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Abstract:Objective ：To investigate the direct effect of endothelin-1 on the contraction of Oddi sphincter, and study its signal transduction pathway. Methods ：By cumulative increase method, ET-1 was given in K-H solution up to the final concentration （0.1～100.0nmol/L）, and the contraction amplitude and frequency of Oddi sphincter were observed. Anti-ET serum,nicardipine, and BQ-123 were added to detect their effects on the contraction of Oddi sphincter,and PKC activity in Oddi sphincter were also detected. Results ：ET addition resulted in the contraction of resting Oddis sphincter,and the contraction intensity increased with the rising ET concentration. No obvious inhibition effect on Oddis sphincter contraction was induced by nicardipine, while anti-ET serum and ET receptor antagonist reduced the Oddi sphincter contraction significantly.The PKC activity in cytoplasm of Oddi sphincter enhanced with the rising ET-1 concentration, and the contraction of Oddis sphincter increased at the same time. Conclusions ：ET-1 results in the significant contraction of the vivo Oddi sphincter, and the magnitude of contraction is dose-effect related to ET concentration. Anti-ET serum and ET receptor antagonistsstrongly offset the function of ET. PKC is involved in the signal transduction pathway of the Oddi sphincter contraction induced by ET-1.

13 Adenovirus mediated MDA-7/IL-24 gene transfer selectively killshepatocellular carcinoma lines HepG2

WANG Cong-jun , XU Xin-bo , YI Ji-lin , CHEN Kun , ZHEN Jian-wei , ZENG Jian-ping , XU Rong-hua , WANG Wei-yu , WU Zai-de

2006, 15(11):13-854. DOI: 10.7659/j.issn.1005-6947.2006.11.013

[Abstract](888) [HTML](0) [PDF 812.90 K](676)

Abstract:
Abstract:Objective ：To investigate the selective killing effect of MDA/IL-24 on human hepatocellular carcinoma line HepG2 in vitro and provide a theoretical basis for gene therapy of hepatocellular carcinoma. Methods ：The MDA-7/IL-24 gene was transfected into human hepatocullular carcinoma cell line HepG2 and normal liver cell line L02 with a replication-incompetent adenovirus vector. The mRNA and protein expression of MDA7/IL-24 in HepG2 and L02 cells was examined by RT-PCR and ELISA assay respectively. MTT assay and flow cytometry were used to study tumor cell proliferation and cell cycle in vitro. Hoechst and Annexin-V and PI staining were studied to indicate the apoptosis.Results ：RT-PCR confirmed that the exogenous MDA-7/IL-24 gene was expressed in HepG2 and L02 cells. The protein product was confirmed by assay of the supernatant with ELISA. MTT and apoptosis test indicated MDA-7/IL-24 induced growth suppression and cell apoptosis of the HepG2 cell in vitro but not in cell line L02, and cell cycle test revealed MDA-7/IL-24 could block HepG2 cell in G2/M but not in L02. Conclusions ：MDA-7/IL-24 selectively induces growth suppression and apoptosis in lines HepG2 in vitro but not in L02 cell, which indicates that adenovirus mediated MDA-7/IL-24 can be an excellent tool for gene therapy in hepatocellular carcinoma.

14 Nonoperative management strategy to prevent the conversion of mild intosevere acute pancreatitis

PU Qing-fan , REN Rui-fang , CAO Gao-jian , CAI Yu , JIN Kai

2006, 15(11):14-857. DOI: 10.7659/j.issn.1005-6947.2006.11.014

[Abstract](875) [HTML](0) [PDF 790.76 K](649)

Abstract:
Abstract:Objective ：To discuss the nonoperative management strategy to prevent the conversion of acute pancreatitis to the severe form. Methods ：In recent 4 years, 286 patients withmild acute pancreatitis admitted to our hospital were divided into control group and treatment observation group;routine conservative management was performed in control group, and the strategy of improving pancreatic microcirculation and preventing cell Ca 2+ overload and inhibiting pancreatic protease was added to the treatment observation group. Results ：Among the 144 patients with mild acute pancreatitis in control group, conversion to severe acute pancreatitis occurredin 20 patients, and 14 of the 20 patients with severe acute pancreatitis developed systemic complications. Among the 142 cases in treatment observation group, the conversion of mild to severe acute pancreatitis occurred in 8 patients, and 2 of the 8 patients developed systemic complications. Serum C-reactive protein levels and Balthazar CT severity index were significantly decreased at each time point in treatment observation group compared to control group. Conclusions ：In addition to routine management, improving pancreatic microcirculation, preventing cell Ca 2+ overload and inhibiting pancreatic protease might serve as a benificial strategy for preventing the progression of mild acute pancreatitis to the severe form.

15 The clinical significance of detecting amylase level of bile during ERCP

ZOU Shu , TIAN Fu-zhou , CUI Jian-feng

2006, 15(11):15-860. DOI: 10.7659/j.issn.1005-6947.2006.11.015

[Abstract](714) [HTML](0) [PDF 786.71 K](627)

Abstract:
Abstract:Objective ：To elucidate the clinical significance of detecting amylase level of bile during ERCP. Methods ：Bile samples for amylase measurement were taken from selected patients who underwent ERCP. According to their radiological and clinical manifestations, these patients were divided into abnormal junction of pancreatic and bile ducts(AJPB), short common channel(SCC) and long common channel(LCC) groups. Results ：The amylase level of bile of AJPB group was significantly higher than that of SCC and LCC groups, and the amylase level of bile of LCC group was much higher than that of SCC group. Furthermore, in AJPB group, the amylase level of bile was significantly higher than serum level. Conclusions ：Amylase level of bile is partly dependent on the length of pancreaticobiliary common channel, and a longer common channel usually is accompanied with a higher amylase level of bile. An unusually high amylase level of bile is a reliable evidence for diagnosing pancreaticobiliaryreflux, and measuring amylase content of bile provides an important and adjunctive tool for diagnosing pancreaticobiliary maljunction, especially for those with a common channel shorter than 15 mm, and these patients should be treated as AJPB.

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Volume 15,Issue 11,2006 Table of Contents

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