RESUMO
We tested the efficacy of the hypoxic cell sensitizer misonidazole in conjunction with intraoperative electron beam radiation therapy (IORT) and external beam irradiation in patients with locally advanced, nonmetastatic adenocarcinoma of the pancreas. Misonidazole was delivered intravenously (IV) at a dose of 3.5 g/m2 in conjunction with IORT of 1,500 to 2,000 cGy to the pancreas. Additional external beam radiation as administered to 4,960 cGy. The study was based on the premise that the effect of misonidazole would be maximized when a high dose of the drug was administered and, thus, high hypoxic cell sensitization could be obtained when using a high single dose of radiation where the hypoxic fraction would be expected to dominate in the survivors. In a nonrandomized study of 41 patients treated with misonidazole and 22 without, the 1-year local control was 67% and 55%, and 1-year survival was 50% and 77%, respectively. Although there was a bias towards larger tumors in the patients treated with the sensitizer, we were unable to demonstrate an advantage to misonidazole in this clinical situation.
Assuntos
Adenocarcinoma/cirurgia , Misonidazol/uso terapêutico , Neoplasias Pancreáticas/cirurgia , Análise Atuarial , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Terapia Combinada , Seguimentos , Humanos , Período Intraoperatório , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/radioterapia , Tomografia Computadorizada por Raios XRESUMO
Hereditary pancreatitis appears in many different ways and in a variety of age groups, spanning both pediatric and adult medicine. The variable expression of hereditary pancreatitis is emphasized by the difficulty in diagnosing it in a patient obviously at risk because of a severely affected father and son. The morphine prostigmine test and hypotonic duodenogram were most helpful. Aminoaciduria previously associated with this disorder is coincidental or nonspecifically related to acute pancreatic inflammation. The increased risk for pancreatic carcinoma (about 20%) is emphasized by the concern for that complication in the proband's grandfather.
Assuntos
Aminoácidos/urina , Pancreatite/genética , Adulto , Feminino , Genes Dominantes , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Morfina , Neostigmina , Neoplasias Pancreáticas/genética , Pancreatite/diagnóstico por imagem , Pancreatite/urina , Linhagem , Fenótipo , Radiografia , RiscoAssuntos
Ampola Hepatopancreática , Doenças Biliares/complicações , Colangite/etiologia , Abdome Agudo/etiologia , Abdome Agudo/cirurgia , Doenças Biliares/cirurgia , Colangite/cirurgia , Colecistectomia , Ducto Colédoco , Duodeno , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas , Supuração/etiologiaAssuntos
Ampola Hepatopancreática , Doenças Biliares , Pancreatite/etiologia , Ampola Hepatopancreática/cirurgia , Ensaios Enzimáticos Clínicos , Ducto Colédoco/cirurgia , Humanos , Morfina , Neostigmina , Pâncreas/diagnóstico por imagem , Ductos Pancreáticos/efeitos dos fármacos , Pancreatite/diagnóstico , Cuidados Pós-Operatórios , RadiografiaAssuntos
Pancreatite , Alcoolismo/complicações , Fosfatase Alcalina/sangue , Amilases/sangue , Colangiografia , Colecistectomia , Doença Crônica , Fezes/análise , Feminino , Seguimentos , Humanos , Lipase/sangue , Masculino , Pâncreas/diagnóstico por imagem , Ductos Pancreáticos , Pancreatite/classificação , Pancreatite/complicações , Pancreatite/diagnóstico , Pancreatite/diagnóstico por imagem , Pancreatite/enzimologia , Pancreatite/etiologia , Pancreatite/cirurgia , Cintilografia , Fatores SexuaisAssuntos
Adenoma de Células das Ilhotas Pancreáticas , Hiperinsulinismo/etiologia , Neoplasias Pancreáticas , Adenoma de Células das Ilhotas Pancreáticas/diagnóstico , Adenoma de Células das Ilhotas Pancreáticas/tratamento farmacológico , Adenoma de Células das Ilhotas Pancreáticas/cirurgia , Glicemia/análise , Dano Encefálico Crônico/etiologia , Criança , Jejum , Feminino , Humanos , Hipoglicemia/complicações , Insulina/metabolismo , Secreção de Insulina , Masculino , Pâncreas/metabolismo , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/tratamento farmacológico , Neoplasias Pancreáticas/cirurgia , TolbutamidaAssuntos
Hiperparatireoidismo/diagnóstico , Adenoma/complicações , Adulto , Fosfatase Alcalina/metabolismo , Cálcio/metabolismo , Feminino , Suco Gástrico/metabolismo , Hemostasia , Humanos , Hipercalcemia/complicações , Hiperparatireoidismo/etiologia , Hiperparatireoidismo/fisiopatologia , Cálculos Renais/complicações , Masculino , Neoplasias das Paratireoides/complicações , Fósforo/metabolismo , Fatores SexuaisRESUMO
Between 1957 and 1977, 95 patients underwent transduodenal pancreatic sphincteroplasty (TPS) for a diagnosis of recurrent pancreatitis. Five to twenty-five year follow-up was obtained for 89 patients (94%) and was analyzed by life-table method. Short-term successful outcome was defined as relief of symptoms (e.g., pain) for one to three years; long-term successful outcome was defined as those patients who remained symptom-free at time of last follow-up. Operative mortality was 4.2% (4 patients). Fifty-six patients (66%) had a successful short-term outcome. Of these, 13 patients had recurrence of symptoms: 7 occurred at 4 years, 5 at 5 years and 1 at 6 years. Preoperative factors associated with poor short-term outcome were previous upper abdominal surgery (X2 = 5.67, p less than 0.05) and frequent diarrhea (X2 = 6.18, p less than 0.05). Preoperative factors associated with poor long-term outcome were previous upper abdominal surgery (X2 = 7.82, p less than 0.01), heavy alcohol intake (X2 = 4.71, p less than 0.05), narcotic use (X2 = 5.68, p less than 0.05) and frequent diarrhea (X2 = 4.8, p less than 0.05). Morphine Prostigmin Test (MPT) was performed preoperatively in 78 patients (82%). A significantly greater proportion of patients with a rise in serum pancreatic enzymes secondary to MPT (MPT+) had a successful long-term outcome compared with those without such a rise (MPT-) (61% v 41%, X2 = 5.13, p less than 0.05). Furthermore, of the patients with a successful short-term outcome, 88% with MPT+ remained long-term symptom-free compared to 38.5% with MPT- (X2 = 8.36, p less than 0.01). We conclude that TPS can be a successful operation for acute recurrent pancreatitis. Previous upper abdominal operations, signs of more advanced pancreatic disease, preoperative narcotic use and alcohol abuse, were associated with a worse outcome and probably associated with chronic recurrent pancreatitis. Preoperative use of MPT, coupled with accurate clinical history, defined groups with different short- and long-term prognosis after TPS.
Assuntos
Ampola Hepatopancreática/cirurgia , Pancreatite/cirurgia , Esfíncter da Ampola Hepatopancreática/cirurgia , Abdome/cirurgia , Alcoolismo/complicações , Diarreia/complicações , Seguimentos , Humanos , Métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Pancreatite/complicações , Complicações Pós-Operatórias , Prognóstico , Recidiva , Fatores de TempoRESUMO
The present report considers the conscious perception of passive horizontal rotations of the trunk, the head, or both, by human observers. It examines in particular how this perception depends on the interaction of canal and neck afferents. Three sets of sinusoidal stimulations (0.2 Hz) were applied to subjects (Ss): Rotations of (1) whole body (pure labyrinthine stimuli, lambda), of (2) only the trunk with the head stationary in space (pure neck stimuli, nu), and of (3) both head and trunk, each with an amplitude and a direction of its own, giving rise to various in-phase and counter phase combinations of lambda and nu.--The Ss were to estimate the magnitude of their turning sensations (psi). In doing so, they were to concentrate either on the rotation of their trunk in space (TS) or of their head in space (HS), or of the head relative to the trunk (HT). The TS and HS turning sensations induced by pure lambda-stimuli were essentially the same as to magnitude and direction. Pure nu-stimulation also led to TS and HS turning sensations. However, the former had the direction of the trunk-to-head (T delta S) deflection, the latter that of the head-to-trunk deflection. The nu-induced HS turning sensation represented an illusion, since the head remained stationary in space. When the lambda- and nu-stimuli were combined, the interaction could be described by a linear summation of their effects. The estimates of TS turning followed the equation psi HS approximately lambda-nu, thus well reflecting the actual TS rotation. The estimates of HS could be described by psi HS approximately lambda+k nu; the term k nu represents the "nu-illusion" contaminating the HS turning sensation. The estimates of HT turning were roughly proportional to nu alone and, therefore, close to the actual HT rotation. We conclude that humans may derive a rather faithful information about trunk rotation from the combined activation of canal and neck afferents, but that the sensation of passive head rotation is contaminated by an (illusionary) contribution from neck afferents. These additive and subtractive modes of interaction have parallels in postural reflexes as well as in neuronal responses that are known from cat.