Limited usefulness of histopathological features in identification of a clinically aggressive solid-pseudopapillary neoplasm of the pancreas.

Solid-pseudopapillary neoplasms (SPN) are rare tumours of the pancreas. Distant metastases and/or local recurrence following surgical resection occur in 10% to 15% of patients with SPN. In the present study, we aimed to systematically examine the usefulness of virtually all histopathological features of SPN which were previously considered potential risk factors of clinically aggressive behaviour of SPN following surgical resection. Seventeen SPN were included. None of the cases had an undifferentiated component. Follow-up data were available for 14 patients (median 52 months). One patient developed liver metastasis 17 months after resection of the primary tumour and fulfilled the criteria of a clinically aggressive disease. None of the histopathological features allowed identification of that case with an adequate diagnostic yield. At present, histopathological examination cannot identify patients who may develop tumour recurrence following resection of the primary lesion. A close follow-up should be offered to all patients treated for SPN.

The assessment of serum and diagnostic peritoneal lavage concentration of matrix metalloproteinase-2, matrix metalloproteinase-9, carbohydrate antigen 19-9, and carcinoembryonic antigen in patients with pancreatic cancer and chronic pancreatitis.

Pancreatic cancer and chronic pancreatitis are still significant diagnostic and clinical problems. A tumor marker that would eliminate the imperfection of preoperative serum carbohydrate antigen 19-9 (CA19-9) concentration is still being sought. This study aimed to conduct a comparative analysis of the concentrations in serum and peritoneal cavity of matrix metalloproteinases: metalloproteinase-2 (MMP-2), metalloproteinase-9 (MMP-9), CA19-9, and carcinoembryonic antigen (CEA) in patients with pancreatic cancer (PC), chronic pancreatitis (CP) and a control group (CG). The study was performed in a group of 90 patients. Group 1 consisted of 30 patients with PC, group 2 consisted of 30 patients with CP. There was no case of pancreatic cancer in the CP group. Group 3 (CG) consisted of 30 individuals, who were recruited among patients operated for non-inflammatory cholelithiasis. The serum samples and intraperitoneal fluid, when present or samples of peritoneal lavage were taken from patients and the concentration of MMP-2, MMP-9, and CA19-9 were evaluated. The revealed intraperitoneal fluid concentrations of the MMP-2, MMP-9, and CA19-9 were significantly higher in both PC and CP groups in comparison to CG. There were no statistically significant differences between intraperitoneal fluid concentrations of the MMP2, MMP9, and CA19-9 in PC and CP groups. The revealed serum concentration of the MMP-2 and MMP-9 in the PC, CP, and CG were significantly higher compared to the intraperitoneal fluid. There was no significant correlation between serum and intraperitoneal fluid concentration of the MMP-2, MMP-9, and CA19-9 and the presence of cancer cells in the intraperitoneal fluid conventional cytological examination. The elevated preoperative intraperitoneal fluid concentration of MMP-2 and MMP-9 and serum concentration of CA19-9 and CEA showed significant sensitivity and specificity in PC prediction. The preoperative serum concentrations of MMP-2 and MMP-9, serum, and intraperitoneal fluid concentrations of CA19-9 and CEA have been shown to have a statistically significant effect on predicting cancer progression and the presence of distant metastases. Presented findings suggest the usefulness of MMP-2 and MMP-9 as a potential predictor of PC and marker of dissemination but its usefulness in the differential diagnosis between PC and CP is limited, however more studies on a large population are needed to support our result. To our knowledge, this was the first study evaluating not only MMP-2 and MMP-9 concentrations in serum but also the concentration of these metalloproteinases in peritoneal fluid in patients with PC and CP.

[Manometric examinations in esophageal peristalsis disorders]. / Manometryczne badania w zaburzeniach motoryki przelyku i wpustu.

Many centers besides radiography and endoscopy, perform manometric measurements in the diagnostics of diseases concerning esophagus and cardia. They which allow to determine esophageal body peristalsis, LES length with spatial distribution of pressures (Vector Volume). The aim of our study was the estimation of usefulness the esophageal and cardial computed manometry in disorders concerning motor activity of the upper part of gastrointestinal tract. In our hospital between March 1997 and March 1998 we examined 12 patients with cardial achalasia, 9 patients with hiatal hernia, 2 ones with features of gastroesophageal reflux without hernia and 1 patient with diffuse esophageal spasm. All patients were examined preoperatively, on the 7th postoperative day and postoperatively--after a month. Computer recording of pressures was made. In postoperative examination we revealed favourable improvement in gastroesophageal passage with marked decrease of LES pressures in patients after dilation. However in patients after Nissen's operation LES pressures exceeded upper normal range on the 7th day postoperatively, but they came back to normal range within a month after operation.

[A case of large size adrenal pseudocyst coexisting with cyst like changes in other organs clinical implications and diagnostic problems]. / Przypadek znacznych rozmiarów torbieli rzekomej nadnercza, wspólistniejacej ze zmianami o charakterze torbieli w innych narzadach--implikacje kliniczne oraz trudnosci diagnostyczne.

The work presents a case of large size adrenal pseudocyst coexisting with cyst like changes in other organs (transparent septum of the brain, liver, right kidney). Diagnostic problems and often atypical course have been highlighted.

[Biostatic endoprosthesis of the esophagus for prevention of leakage and stenosis at the site of anastomosis]. / Biostatyczna endoproteza przelyku w zapobieganiu nieszczelnosci oraz zwezeniu w miejscu zespolenia.

The authors present the results of using endoprosthesis made of bowine fascia which was conserved in special way. The endoprosthesis was used to cure salivary fistula in the place of anastomosis oesophagus with its replacement of the neck. The endoprosthesis was used to prevent leakness or stenosis in difficult operative circumstances and to pass the substitutive oesophagus in non-anatomical way. Prophylactic using of the endoprosthesis in technical difficulties caused by operative circumstances prevents leakness and stenosis in the place of anastomosis.

[Duodenojejunostomy in the symptomatic treatment of neoplastic obstruction of the duodenum--clinical observations]. / Zespolenie dwunastniczo-czcze w objawowym leczeniu nowotworowych niedroznosci dwunastnicy--spostrzezenia kliniczne.

The aim of the study was to evaluate the value of duodenojejunostomy and gastrojejunostomy in the treatment of neoplastic obstruction in the distal part of the duodenum. From 1992-1996, 37 patients (15 women, 22 men, aged 31-76 years) underwent a palliative operation for pancreatic cancer infiltrating the distal part of duodenum. Roux-en-Y procedure was used to create anastomoses between the duodenal bulb and jejunal loop. In 13 patients only alimentary by-pass was made whereas in the remaining 24 biliary decompression was also performed. The results were compared with the outcome in 26 patients in whom gastrojejunal side-to-side anastomosis been made. The advantage of Roux-en-Y duodenojejunostomy is that it does not interfere with gastric emptying and thus prevents jejuno biliary reflux and the consequent complications. Improvement of nutrition and quality of life in patients with inoperable pancreatic cancer, were noticed with this method.

[Evaluation of stomach emptying under extreme obstruction of gastrointestinal transit treated with gastro-intestinal or duodenal-intestinal anastomosis]. / Ocena oprózniania zoladkowego w warunkach wysokiej niedroznosci przewodu pokarmowego leczonej zespoleniem zoladkowo-jelitowym lub dwunastniczo-jelitowym.

The purpose of the present study was to compare gastric emptying in two groups of dogs in which a gastrojejunal or duodenojejunal Roux-en-Y anastomosis was performed over the site of an experimental obstruction in the distal duodenum. The experiment was carried out on 10 mongrel dogs. Gastric emptying was assessed twice in each dog before the experiment (control examination); the solid phase of the test meal was labelled with 99mTc. Following a control examination, the dogs were divided into two groups of 5 animals each, and subjected to the above mentioned surgical procedures. Postoperative gastric emptying was carried out 3 weeks after the operation, and then at 3 and 6 months following the procedure. The following parameters describing quantitatively gastric emptying were determined: mean transit time MTT0-60. MTT0-120 and total mean transit time MTT0-180. The comparison of these parameters revealed statistically significant differences confirming delay of gastric emptying in dogs with a gastrojejunal anastomosis.

Two cases of lymphoepithelial cyst of the pancreas: first - a cyst coexisting with a primary gastric lymphoma, second - incidentally found pancreatic cyst.

BACKGROUND/AIMS: The aim of this report is to describe two cases of lymphoepithelial cysts (LEC) of the pancreas: 1. LEC coexisting with primary gastric lymphoma, 2. an incidental finding of LEC during imaging examination. RESULTS: 1. A 47-year old man complaining of epigastric pain showed a 2 x 1.5 cm cyst of the pancreatic head on computed tomography (CT) scan. Endoscopic biopsy revealed infiltration by a poorly differentiated neoplasm, probably carcinoma. The patient underwent gastrectomy with lymphadenectomy D 2. The pancreatic lesion was excised. Diffuse large B-cell lymphoma (pT4N1 M0BX) and LEC were diagnosed. Patient refused adjuvant therapy. No symptoms of recurrence were observed during 24-months follow-up period. 2. 50-year-old male with non-specific urinary complaints revealed a 4.2 x 3.5 cm cyst in the body of pancreas on CT scan. The cyst was excised and LEC was diagnosed. Patient had not reported any complaints during 42 months follow-up period. CONCLUSIONS: To the best of the authors' knowledge, the first of two presented cases is the first described case of coexistence of LEC of the pancreas and gastrointestinal lymphoma. It is difficult to ascertain if there is any causative relationship or if this coexistence is purely incidental. Incidental pancreatic cysts are more and more common finding in surgical practice.