FT3 to FT4 Conversion Ratio May Be an Independent Prognostic Factor in Pancreatic Cancer Patients.

Preclinical evidence suggests that T4 can promote tumor growth while T3 can act conversely; therefore, the fT3 and fT4 concentrations should affect overall survival (OS) in cancer patients. The objective of the study was to look for an association between thyroid hormone concentrations in peripheral blood and OS in the pancreatic adenocarcinoma (PDAC) patients group. We included, retrospectively, 15 PDAC patients, without thyroid dysfunction under treatment, who underwent radical surgery, with no prior history of anticancer therapy. TSH, fT3, and fT4 concentrations were determined in blood samples taken preoperatively. We found that the fT3/fT4 ratio categorized into two groups (<0.22 vs. ≥0.22) dichotomized the study population into poor and good prognosis subgroups (log-rank p = 0.03; OS medians, respectively: 3 and 14 months), being a statistically significant predictor both in uni- and multivariate Cox regression analysis. We conclude that the importance of fT4 into fT3 conversion means not just its standard metabolic effects as the final products of thyroid gland activity. We hypothesize that it is linked to the progression of pancreatic malignancies, either via thyroid hormone receptors or indirectly, by interaction with cancer cells product.

[Paliative procedures in cholangiocarcinomas--experience of 5 centers]. / Zabiegi paliatywne w raku pecherzyka i/lub dróg zólciowych--doswiadczenia 5 osrodków.

UNLABELLED: Cholangiocarcinomas have been often met in daily practice. Biliar tract neoplasmas are the most important group in adenomas and papillomas. There is the medical and social problem with cancer patients because they call doctor too late when cancer changes reach a high level and only paliative procedures are recommended. In the most cases the prothesis implanted by ERCP and surgical digestive bypasses are applied. AIM OF THE STUDY: was to evaluate some therapeutic methods in paliative treatment applied in patients with biliary tract cancer. MATERIAL AND METHODS: From 01.2003 to 12.2007 (5 years experience) in 4 departments of general surgery and departments of digestive tract diseases the medical treatment of 430 patients with biliary tract cancer was analyzed. All patients were divided into 3 groups: G1--prosthesis by ERCP; G2--percutaneously, transhepatic drainage of biliary tract; G3--surgical digestive bypass. RESULTS: G1 techniques were applied in 75 patients, G2 in 14 cases and G3 in 74 cases. In the last group of patients the following procedures have been performed: triple bypass (TB) in 45 cases (62%), choledochoduodenostomy (ChD) in 7 cases (9%), gastroenterostomy (GE) in 10 patients (13%) and laparotomy with Kehr drainage in 12 patients (16%). The number of complications in G1 group was observed in 31%, in G2--42%, and in G3--63%. 30 days death rate was 14% in G1, 28% in G2 and 18% in G3. Over 12 months survival rate was in G1, 3 months in G2 and 15 months in G3. Differences are statistically sagnificant (p < 0.05). CONCLUSIONS: From all applied methods of paliative treatment the best results were noticed in surgical digestive bypass and implantation of prosthesis by ERCP. After surgical treatment survival rate was higher, but the number of complications was higher in relation to another methods.

[A symptomatic ectopic pancreas in the stomach--a case report]. / Objawowa ektopowa tkanka trzustkowa w zolqdku--opis przypadku.

Ectopic pancreas (heterotopic pancreas) is a congenital anomaly and the most common type of ectopic tissue in the gastrointestinal tract. It is typically located in the stomach, duodenum and jejunum. Ectopic pancreas is usually an asymptomatic and benign lesion, in a majority of cases found incidentally during endoscopy or surgery. Generally appears as submucosal lesion with characteristic central umbilication. Complications of heterotopic pancreas are secondary to pathologic changes occurring in the normal pancreatic tissue or caused by ,,mass effect". Asymptomatic cases of ectopic pancreatic tissue are seldom recognized at a preoperative stage. In this paper we reported a case of symptomatic heterotopic pancreatic tissue in a young man, requiring surgical treatment.

[The role of selected enzymes and acute phase proteins in necrotizing pancreatitis]. / Zachowanie sie wybranych enzymów i bialek ostrej fazy w martwiczej postaci ostrego zapalenia trzustki.

THE AIM: Despite potent clinical manifestation of acute necrotizing pancreatitis symptoms, its severity estimation and prognosis based on laboratory tests proves to be difficult. In general, the key role in disease diagnostics is attributed to enzymes secreted by this organ. However, this opinion doesn't find confirmation in all cases. MATERIAL AND METHODS: A-amylase, C-reactive protein, and lipoprotein (a) serum concentration changes were evaluated in 60 patients treated in our department because of necrotizing pancreatitis. Observation period was 30 days and the severity of disease was taken into account. All patients were divided onto 2 groups. Group 1 contained 42 individuals who survived the 30 day observation period. Group 2 consisted of 18 patients with poor prognoses, who died. All patients were operated on between 15th and 30th day of treatment. Overall condition was monitored by means of Ranson and APACHE II scores. RESULTS: The decrease in alpha-amylase activity was noted in both groups; however the differences between groups lost its significance from the 5th day on. Initially, the pancreatic lipase activity was increased in both groups, but the differences showed no significance. In subsequent days of study those differences became statistically significant. On the contrary, differences between subsequent measurements appeared as late as in the fourth time point. C-reactive protein serum concentrations were significantly higher in poorly prognosing patients. In group 1 patients these concentrations underwent a gradual normalization. In Group 2 lipoprotein (a) serum concentration increased reaching 100 mg/dL at the end of observation. CONCLUSIONS: The study shows lack of feasibility of alpha-amylase serum concentration assessment as a method of pancreatic necrosis extent determination in patients with necrotizing pancreatitis. High level of lipase proves the existence of inflammatory reaction, but unspecific one regarding acute pancreatitis. Although CRP levels change non-specifically during acute pancreatitis, they are extremely high at the early stage of pancreas necrosis. Serum level of Lp (a) increases in necrotizing pancreatitis along with overall patient standing deterioration. Low levels of mentioned parameters do not exclude the diagnosis of most severe form of acute pancreatitis.