Huge gastric disopyrobezoar: a case report and review of literatures.

We reported a case of huge gastric phytobezoar. The gastric phytobezoar was successfully removed through gastrotomy after two failed attempts in endoscopic fragmentation and removal. Disopyrobezoars could be treated either conservatively or surgically. Gastrotomy or laparoscopical management is recommended for the treatment of huge disopyrobezoars.

Effects of parenteral nutrition on the exocrine pancreas in response to cholecystokinin.

BACKGROUND: Clinical and experimental data have revealed that parenteral nutrition (PN) can lead to hypotrophy and dysfunction in the morphology and physiology of the pancreas. These adverse alterations appear to be related to many different factors. One important factor is the absence of a gastrointestinal hormone, such as cholecystokinin, which is the most important stimulator for the integrity of the pancreas. The level of cholecystokinin is decreased during absent enteral feeding, and the stimulatory effect of cholecystokinin is significantly reduced during PN. METHODS: Original and review articles, editorials, and case reports published primarily in English and listed in MEDLINE/ISI up to September 2006 or identified by a manual search have been reviewed in an attempt to provide a comprehensive overview of the effects of PN on the exocrine pancreas in response to cholecystokinin. RESULTS: When hypercholecystokininemia, produced by endogenous and exogenous procedures, is present during PN, the morphology and functions of the pancreas are still unable to be fully reversed. CONCLUSIONS: Other growth factors besides cholecystokinin are probably involved in the pancreatic regulation, and enteral feeding seems to be important for the full expression of the trophic effects of cholecystokinin on the pancreas.

Parenteral nutrition prolongs the survival of patients associated with malignant gastrointestinal obstruction.

BACKGROUND: Many patients with advanced cancers have associated gastrointestinal (GI) obstruction. Parenteral nutrition (PN) is indicated in patients with a dysfunctional GI tract, but the role of PN in patients' survival is still controversial. The present study was retrospectively conducted to verify if there are any long-term survivors living for more than 1 year after initiation of PN without food or drink in patients with malignant GI tract obstruction resulting from advanced cancers. METHODS: One hundred fifteen adult patients with malignant GI obstruction were identified over a 6-year period at a palliative-care setting. Their median age was 51 years (range, 31-74 years), and 62 (54%) were women and 53 men (46%). All selected patients had malignant GI tract obstruction and started PN treatment after cessation of energy intake to time of death. Survival expectancy as a criterion was analyzed in all patients. RESULTS: The median time from initiation of PN to death was 6.5 months. Eleven patients survived >or=1 year and 2 patients have been alive for almost 4 years later after cessation of energy intake. CONCLUSIONS: PN can be expected to obtain a longer survival for the patient with GI tract obstruction caused by advanced cancer.

Painful Leg Ulcers: A Misdiagnosed Case Report With Literature Review.

A 56-year-old man presented with painful leg ulcers located on the left malleolus, tibia, the dorsal aspect of the feet and calves. He was initially treated with wound dressings, antibiotics, and other surgical debridement-'but these treatments were not effective. The results from laboratory and image examinations did not support the diagnosis of vascular and diabetic ulcerations or any specific infectious diseases. Subsequently, the patient confessed that he has been on medication with hydroxyurea for his granulocytic leukemia. The leg ulcers were fully cured after discontinuation of hydroxyurea. This case suggests that any medication the patient might be taking is always considered when evaluating a chronic ulcer.

I.v. hypertonic glucose stimulates the exocrine pancreas in rat.

BACKGROUND: Pancreatic atrophy and dysfunction resulting from parenteral nutrition (PN) may be explained by several mechanisms; one of the important factors is the nutrient in the circulation, which affects the pancreatic growth and secretion. The effect of nutrients on the pancreatic exocrine still has controversies. The aim of the present study is to better understand the effect of i.v. glucose on the exocrine pancreas stimulated by cholecystokinin during the parenterally fed condition. METHODS: Two mixed solutions consisting of 30% and 50% glucose, respectively, were used. Thirty male Sprague-Dawley rats were randomly divided into 5 groups, including a control group; a freely fed group received cholecystokinin; 2 groups were infused with 30% and 50% glucose, and a group was infused with 50% glucose with cholecystokinin. The body weight and pancreatic contents were measured after 10 days. RESULTS: The body weight in all groups was increased but lower than in the freely fed rats. I.v. glucose caused a decrease in the pancreatic weight, the amount of the pancreatic protein and DNA, and the level of amylase but elevated the level of trypsin in all treated groups. The enzymes were elevated after infusion of cholecystokinin with glucose, but they were lower than in freely fed animals with cholecystokinin. Compared with 30% glucose, 50% glucose elevated the level of amylase but did not affect the level of trypsin. CONCLUSIONS: I.v. glucose results in atrophy of the exocrine pancreas, elevates the amylase in pancreas, but suppresses the stimulatory effect of cholecystokinin on the exocrine pancreas.

Influence of an intravenous infusion of amino acids and glucose on the pancreatic exocrine in rats.

BACKGROUND: A number of reports based on both animal experiments and clinical investigations have pointed out that total parenteral nutrition (TPN) suppresses the function of the exocrine pancreas. Even though pancreatic hypotrophy and dysfunction resulting from TPN may be explained by several mechanisms, the clinically most important cause is that nutrients in circulation affect pancreatic secretion. The effect of nutrients on the exocrine pancreas is still controversial. The aim of the present study was, therefore, to clarify the influence of intravenous amino acids and hypertonic glucose in TPN solution on the exocrine pancreas. METHODS: Three mixed TPN solutions, consisting of 30% or 50% glucose or of 14% amino acids, were employed. Twenty-four male Sprague-Dawley rats were randomly divided into four groups, six rats in each group, including a control group and one group receiving each of the three TPN solutions. All animals were killed after 10 days of TPN. Body weight, pancreatic content, and enzyme levels in the pancreas were measured. RESULTS: Compared with the control group, pancreatic wet weight was lower in all TPN groups. Glucose significantly decreased the content and concentration of pancreatic protein, but amino acids did not alter the concentration of protein. The level of amylase was lower in all parenterally fed groups, with a greater decrease in the groups treated with amino acids and 30% glucose than with 50% glucose. Trypsin levels in all groups receiving TPN were markedly higher than in the control group. CONCLUSION: TPN results in atrophy of the pancreas, but trypsin levels increase with TPN treatment. Glucose elevates the amylase level in the pancreas, while amino acids suppress pancreatic amylase. Amino acids used as a source of protein maintain normal pancreatic protein levels.

Acute pancreatitis.

BACKGROUND: Acute pancreatitis continues to be a serious illness, and the patients with acute pancreatitis are at risk to develop different complications from ongoing pancreatic inflammation. AIMS: The present review is to highlight the classification, treatment and prognosis of acute pancreatitis. MATERIAL #ENTITYSTARTX00026; METHODS: We reviewed the English-language literature (Medline) addressing pancreatitis. RESULTS: Acute pancreatitis is frequently caused by gallstone disease or excess alcohol ingestion. There are a number of important issues regarding clinical highlights in the classification, treatment and prognosis of acute pancreatitis, and treatment options for complications of acute pancreatitis including pancreatic pseudocysts. CONCLUSIONS: Multidisciplinary approach should be used for the management of the patient with acute pancreatitis.

Autoimmune pancreatitis.

Since the autoimmune pancreatitis was introduced in 1995, it has been recognized as a form of chronic pancreatitis, which is always associated with autoimmune manifestations. As the improvement of technical and instrumental made in ultrasonography, computed tomography and magnetic resonance imaging, the diagnoses of autoimmune pancreatitis is no longer such difficult. Even though the treatment of autoimmune pancreatitis is available with a conservative therapy, there are many points that are still unclearly. These have stimulated widespread interest in this disease from gastroenterologists, endoscopists, pathologists, and prevalent research. The present article provides with our better understanding of the diagnosis and treatment of autoimmune pancreatitis.

Photodynamic therapy for pancreatic cancer.

OBJECTIVES: This study examined the status of photodynamic therapy (PDT) in the treatment of cancers of the pancreas. METHODS: Original and review articles, editorials, and case reports published primarily in English and listed in Medline/ISI up to October 2006 or identified by a manual search have been reviewed in an attempt to provide a comprehensive overview of the mechanisms of PDT action and clinical application of PDT in the treatment of pancreatic cancers. RESULTS: Photodynamic therapy represents a novel treatment of pancreatic malignancy; it produces local necrosis of tissue with light after administration of a photosensitizing agent. Evidences from in vivo and in vitro results have shown that PDT significantly decreases pancreatic cancer cell growth, destroys pancreatic carcinoma, and prolongs the survival of patients with unresectable pancreatic malignancy, and also show that PDT has disadvantages and limitations for the treatment of pancreatic cancer. CONCLUSIONS: Photodynamic therapy can be an effective treatment of patients with pancreatic cancer, but more extensive preclinical and clinical trials are needed for further improvement in the clinical application of PDT, especially in avoidance of complications during PDT.