Neopterin--a potential factor for differentiation between pancreatic cancer and chronic pancreatitis.

BACKGROUND/AIMS: Pancreatic cancer constitutes a difficult diagnostic and therapeutic problem. It remains the fourth cause of death among gastrointestinal malignancies. The present study aimed to investigate whether neopterin can be used as a significant marker in pancreatic cancer and to establish any possible relationships between serum neopterin levels and the differentiation between chronic pancreatitis, pancreatic cancer, and acute pancreatitis. METHODOLOGY: The research was done on a group of 65 patients with a diagnosed pancreatic tumor and on a group of 21 patients with a diagnosed acute pancreatitis. Serum neopterin concentration was determined in all patients on the first day of hospitalization. RESULTS: Based on intraoperative and postoperative histopathological findings, pancreatic cancer was diagnosed in 42 patients and chronic pancreatitis in 23 patients. Neopterin concentrations in pancreatic cancer patients, chronic pancreatitis patients, and acute pancreatitis patients were 13.01-29.64 nmol/L (mean 18.16), 0.95-11.81 nmol/L (mean 6.52), and 9.64-25.0 nmol/L (mean 13.61), respectively. Mean neopterin levels in pancreatic cancer and acute pancreatitis patients were higher than the accepted norm (norm<10 nmol/L). Serum neopterin concentrations in patients with chronic pancreatitis remained within the norm. CONCLUSIONS: In our opinion, neopterin might be a promising factor of differentiation between pancreatic tumors. However, the use of neopterin as a nonspecific tumor marker requires further studies.

Liver regeneration following portal blood arterialization and splenectomy in acute hepatic failure.

BACKGROUND/AIMS: The purpose of the experiment was to estimate an influence of portal blood arterialization in animals with tetrachloromethane-induced acute hepatic failure. METHODOLOGY: Thirty-five pigs were divided into four groups: three groups of 10 and a control group of 5 animals. On day 1 of the experiment an intraperitoneal dose of 477 mg CCl4//kg body wt. in a suspension of corn oil was given to the trial groups to induce an acute hepatic failure. On day 3 after the intoxication all animals were operated on. Aortovenous splenic anastomosis without splenectomy, aorto-venous splenic anastomosis with splenectomy, and splenectomy procedure alone, were performed in groups I, II, and III, respectively. In the control group only laparotomy was performed. Histopathologic estimation of hematoxylin- and eosin-stained specimens and immunohistochemical analysis of regenerating hepatocytes by applying monoclonal serum for CK19, CD56, CD117 were carried out. RESULTS: Liver biopsies demonstrated no quantitative differences concerning the surface of damaged lobules between groups I, II, and III. The phenomenon of parenchyma regeneration was observed in both groups (with and without splenectomy procedure performed). Small stem cells could be observed mainly in the central part of lobules. The immunohistochemical analysis showed that part of the regenerating cells had CD56 and CD117 antigens' receptors, demonstrating no expression of antigen CK19. In the third group of animals (splenectomy without blood arterialization) neither the phenomenon of parenchyma regeneration nor the presence of cells of hepatoblast phenotype were observed. CONCLUSIONS: The arterialization of portal blood in pigs with acute hepatic failure triggered off the regeneration of damaged parenchyma through the colonization of impaired areas of lobules by small stem cells. The lack of the receptor for antigen CK19 could mean that the cells do not originate in bile duct epithelium.

Endovascular gamma irradiation of the iliac arteries: 1-year results from a clinical safety and feasibility study.

PURPOSE: To estimate safety and feasibility of vascular brachytherapy in iliac arteries. METHODS: Fourteen patients (11 men; mean age 56.7+/-9.9 years, range 44-81) with occlusive disease in 15 iliac arteries (7 external, 8 common) were treated with balloon dilation followed by irradiation from an iridium 192 source (15 Gy at 3 mm from the inner surface of the artery wall) applied with a PARIS centering catheter and bilateral 10-mm margins. Patients receiving stents for suboptimal angioplasty were prescribed a 6-month course of antiplatelet treatment with ticlopidine. Angiography was routinely scheduled for 6 months after intervention. RESULTS: There were no complications of the angioplasty procedure or EVBT treatment; 7 patients received stents for dissection or residual stenosis. Mean follow-up was 12.4+/-6.0 months. At 6-month angiography, 1 (6.7%) restenosis in a common iliac artery stent was found. Another patient with a common iliac artery stent developed transient lower limb ischemia at 4 months, probably due to temporary suspension of antiplatelet treatment and distal disease. CONCLUSIONS: Brachytherapy in the iliac arteries appears to be feasible and safe; longer follow-up in more patients is needed to determine its clinical utility in the prevention of restenosis.

[Analysis of causes of mechanical jaundice and treatment methods in a group of 103 hospitalized patients]. / Analiza przyczyn zóltaczki mechanicznej oraz metod leczenia w grupie 103 kolejno hospitalizowanych chorych.

103 consecutive hospitalized patients at the age from 23 to 87 years with mechanical jaundice are presented in this study. In 58 patients, a cause of the jaundice was ductal calculosis, in four, a damage to bile duct after cholecystectomy. In 43 patients (74%), a calculus was removed through endoscopy, in 2 patients (4%) through Kehr's drain, 13 patients required an operation, in 41 patients, jaundice resulted from a neoplasm including 22 patients with a tumor of the head of pancreas, in 9 neoplasm of gall bladder, in 4 tumor of liver invagination, in 4 tumor of distal part of bile duct, in 2 neoplasm of Vater's papilla. 8 patients out of 28 with neoplastic tumor of pancreatoduodenal field had proximal pancreatoduodenectomy performed (29%). 1 patient out of 4 with a tumor of liver invagination had a tumor removed together with II and III segment of liver with the following right side hepatoenterostomy. No perioperational deaths were noted. In two patients after pancreatoduodenectomy (25%), a fistula in pancreatoenterostomy occurred. Due to the advanced stage of the neoplastic disease, resections in tumors of pancreatoduodenal fields and of liver invagination were only possible respectively in 29 and 25%. In most case of ductal calculosis or residual ductal calculosis, a removal of calculi was possible through endoscopy.

Vascular brachytherapy after percutaneous transluminal angioplasty of superficial femoral arteries-Polish pilot group.

PURPOSE: The article presents the results of treatment with vascular brachytherapy (VBT) in superficial femoral arteries. This method aims to minimize frequency of restenosis after percutaneous transluminal angioplasty (PTA). METHOD: Treatment was carried out in 20 cases. The patients with severe stenoses or total occlusions verified in angiography were selected. In the group of 19 patients, two were women (the average age of the patients was 58.7 years). VBT was performed immediately after PTA. A 15-Gy dose, with high dose rate, was applied. The dose was calculated based on individually chosen distance from the internal surface of the artery wall, which varied from 2 to 3 mm. The mean observation time after treatment was 8 months. The shortest time was 1 month and the longest 14 months. At the end of the observation time, the control DSA angiography was performed on every patient. RESULTS: During the first 2 months, in three cases, an acute thrombosis in treated artery was observed. In the third month, one treated artery occluded. In the sixth month of observation, one case of acute thrombosis was observed. The rest of the patients were free of restenoses. CONCLUSIONS: (1) In superficial femoral arteries, a low value of ankle brachial pressure index (ABPI; below 0.4) is very probably responsible for acute thrombosis after PTA with or without stent implantation followed by VBT. (2) Diabetes, rest ischaemia before treatment, poor vessel status confirmed in angiography may also be responsible for acute thrombosis after VBT. (3) Anticoagulants or antiplatelet (ticlipidine) treatment must be ordered for 6 months after VBT in patients with implanted stents.