ABSTRACT
A general characteristic of GEP endocrine tumours is that vast majority produce and secrete a multitude of peptide hormones and amines. The rarity of these types of tumours, their possible episodic expression and the variable clinical symptoms, are the reasons why patients are often diagnosed late in the advanced stages of the disease. For these reasons, the patients with advanced metastatic disease should be treated aggressively with medical and surgical therapies aimed at reducing both symptoms and complications through strategies that reduce tumour bulk and block hormonal effects. The medical treatment of functioning endocrine tumours of the gastrointestinal tract must be based on the growth properties of the tumour and includes chemotherapy, somatostatin analogs, alpha-interferon alone and associated with somatostatin analogs, chemoembolization and radiolabelled somatostatin analogs. Even if chemotherapy has been basis of therapy for these types of tumours for a long time, it is currently reserved for progressive disease and anaplastic tumours. Biotherapy, with interferon and somatostatin analogs has been demonstrated to have a significant antitumor effect and causes an improvement of symptoms in patients with functioning neuroendocrine tumours. Furthermore, these drugs produce a notable improvement in the quality of life. Radioactive targeting therapy is the most promising new treatment modality for patients who have SST receptor positive tumours.
Subject(s)
Gastrointestinal Neoplasms/therapy , Neuroendocrine Tumors/therapy , Pancreatic Neoplasms/therapy , Humans , Quality of Life , Rare DiseasesABSTRACT
This study investigated the clinical relevance of acute pancreatitis in allogeneic hemopoietic stem cell (bone marrow or peripheral blood) transplants (BMT). We studied 26 patients undergoing BMT. The preparative regimen was busulfan and cyclophosphamide in 17 patients and total body irradiation and cyclophosphamide in 9 patients. Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporin A and short-term methotrexate in all 26 patients. The pancreas was studied using amylase and lipase serum levels, abdominal contrast-enhanced tomography, and/or ultrasound. Clinical and laboratory signs of acute pancreatitis were found in two patients with acute hepatointestinal GVHD, and in one patient with acute hepatic GVHD and cytomegalovirus infection. This patient died of multiorgan failure, with interstitial acute pancreatitis at autopsy; the other two patients recovered with general supportive care and GVHD therapy. We suggest that in the patients with complications after BMT, particularly acute hepatic/hepatointestinal GVHD, and cytomegalovirus infection, the possibility of acute pancreatitis should be considered.
Subject(s)
Bone Marrow Transplantation/adverse effects , Hematopoietic Stem Cell Transplantation/adverse effects , Pancreatitis/etiology , Transplantation Conditioning/adverse effects , Acute Disease , Adult , Amylases/blood , Bone Marrow Transplantation/methods , Clinical Enzyme Tests , Female , Graft vs Host Disease/epidemiology , Graft vs Host Disease/etiology , Graft vs Host Disease/prevention & control , Hematopoietic Stem Cell Transplantation/methods , Humans , Incidence , Lipase/blood , Male , Middle Aged , Pancreas/diagnostic imaging , Pancreatitis/diagnosis , Pancreatitis/epidemiology , Radiography , Time Factors , Transplantation Conditioning/methods , Transplantation, Homologous , UltrasonographyABSTRACT
CONCLUSION: In acute pancreatitis (AP), the peripheral blood analysis, including reticulocytes (RC) and RC fractions, and its relationship to the changes of the levels of the soluble interleukin 2 receptor (sIL-2R) can provide useful information about the involvement of the immunoinflammatory system in AP and can indicate the severity of the disease. BACKGROUND: In the disease clinical assessment, we correlated the sIL-2R serum levels to the peripheral blood components (including RC and RC fractions) to serum albumin and C-reactive protein (CRP) during AP. METHODS: In 21 patients with AP, sIL-2R, the total and differential white blood cell (WBC) counts, red blood cell (RBC) counts, RC, RC fractions, hemoglobin (Hb), hematocrit (Ht), platelets (PLT), albumin, and CRP were evaluated from the onset to the sixth day of illness. RESULTS: sIL-2R increased in all the patients. The increase was directly related to eosinophils, monocytes, and to middle-aged (MFR) RC, and inversely related to neutrophils and the old (LFR) RC. MFR-RC were directly related to the total WBC count, eosinophils, and basophils, and inversely related to Hb and albumin. LFR-RC behaved in the opposite manner. CRP increased in 16 patients; this rise was directly related to WBC, RC, and MFR-RC, and inversely related to Hb, LFR-RC, and albumin. sIL-2R and CRP values were not statistically interrelated, but when the CRP levels were higher, the increase in sIL-2R was greater and more sustained.
