The imbalance of peripheral interleukin-18 and transforming growth factor-ß1 levels in patients with cirrhosis and esophageal varices.

INTRODUCTION: The presence of esophageal varices in liver cirrhosis indicates clinically significant portal hypertension (PH), that results from structural and dynamic changes in the liver and systemic circulation including the activation of several fibrotic and inflammatory pathways. We assessed if interleukin-18 (IL-18) and transforming growth factor-ß1 (TGF-ß1) serum levels can be used as PH markers and reflect its severity. MATERIAL AND METHODS: IL-18 and TGF-ß1 peripheral blood levels were analyzed in 83 cirrhotic patients with esophageal varices compared to healthy individuals, in relation to MELD and Child-Pugh scores, laboratory and Doppler ultrasound parameters, and non-selective beta-blocker therapy (NSBB). RESULTS: IL-18 concentration was significantly higher in cirrhotic patients, while TGF-ß1 concentration was lower than in controls. MELD score correlated positively with IL-18 levels and negatively with TGF-ß1 levels. IL-18 levels correlated positively with bilirubin, INR, ALT and AST levels, and negatively with albumin levels and erythrocyte count. TGF-ß1 levels correlated positively with platelet count, leukocyte, and erythrocyte count, and negatively with bilirubin levels and prothrombin time. Moreover, significant correlations were found: between IL and 18 levels and portal, mesenteric superior, and splenic vein velocity, and between TGF-ß1 levels and splenic vein diameter and spleen size. In a subgroup of patients, IL-18 levels significantly decreased after NSBB. CONCLUSION: The observed imbalance of peripheral IL-18 and TGF-ß1 levels indicates clinically significant PH associated with the presence of esophageal varices in cirrhosis. The correlation of IL-18 levels with liver failure indicators and decrease with NSBB suggest an important role of IL-18 in disease progression and its potential use as noninvasive test for PH assessment.

Management of acute pancreatitis (AP) - Polish Pancreatic Club recommendations.

The presented recommendations concern the current management of acute pancreatitis. The recommendations relate to the diagnostics and treatment of early and late phases of acute pancreatitis and complications of the disease taking into consideration surgical and endoscopic methods. All the recommendations were subjected to voting by the members of the Working Group of the Polish Pancreatic Club, who evaluated them every single time on a five-point scale, where A means full acceptance, B means acceptance with a certain reservation, C means acceptance with a serious reservation, D means rejection with a certain reservation and E means full rejection. The results of the vote, together with commentary, are provided for each recommendation.

Circulating endothelial mediators in human pancreatitis-associated lung injury.

OBJECTIVES: To investigate the role of endothelial cell mediators, E-selectin (ES), intercellular adhesion molecule-1 (ICAM-1), tissue factor (TF), and von Willebrand factor (vWF), in the early phase of severe acute pancreatitis (SAP) complicated with respiratory failure [pancreatitis-associated lung injury (PALI)]. PATIENTS AND METHODS: This study included 30 patients with SAP and 39 patients with PALI. Blood samples were taken from SAP and PALI patients on presenting to the hospital (day 1), and days 2, 3, 5, and 10. The relationship between blood concentrations of the studied endothelial mediators and lung function tests was analyzed. RESULTS: PALI patients had significantly higher ES, ICAM-1, TF, and vWF blood levels than those with SAP as early as at admission and throughout the period studied. We found the highest concentration of ES on the second day, ICAM-1 and TF at admission, and vWF level on the fifth day. There were adverse correlations between ES, ICAM-1, TF, vWF concentrations, and the index of oxygenation--PaO2/FiO2 ratio (Rs=-0.385, Rs=-0.523, Rs=-0.505, Rs=-0.408, P<0.001, respectively). The most accurate prediction of PALI was provided by ICAM-1 and TF levels on the day of admission [areas under curve (AUCs): ES, 0.704; ICAM-1, 0.787; TF, 0.757; and vWF, 0.686]. CONCLUSION: Endothelium-related mediators ES, ICAM-1, TF, and vWF appear to participate in pancreatitis-associated lung injury. In SAP, the measurement of endothelial mediator levels (especially ICAM-1 and TF) may be used as an early prognostic indicator that would predict the development of respiratory failure and to monitor the severity of lung dysfunction.

Increased expression of the intercellular adhesion molecule-1 (ICAM-1) on peripheral blood neutrophils in acute pancreatitis.

PURPOSE: Considering the important role of neutrophils' activation in the pathogenesis of acute pancreatitis (AP), the aim of our study was to evaluate the expression of leukocytes' adhesion molecules in patients with AP. PATIENTS/METHODS: Thirty-five patients (16 women and 19 men; age 32-77 years, median 56 years) with AP were prospectively included into our study. The absolute number of leukocytes was estimated by haematologic analyser. Surface neutrophils antigens (CD) were assayed by the direct fluorescence method for whole blood, using a flow cytometer. RESULTS: At the day 1, significant increase of ICAM-1 expression was found in patients with severe AP (S-AP) (7280 mm(-3) vs 2850 mm(-3) in healthy control; p<0.05). In the days 2, 3 and 5 it sharply decreased and peaked again to 4860 mm(-3) at the day 10. In patients with mild AP (M-AP), not significant elevation of ICAM-1 quickly returned to normal level. In both forms of AP, neutrophil CD62L (L-selectin) expression reached the highest level at the day 1 (8800 mm(-3) and 9020 mm(-3), respectively in M-AP and S-AP, in comparison to 3400 mm(-3) in control; p<0.05). Expression of CD69 (neutrophils' marker of early activation) significantly increased in both M-AP and S-AP. CONCLUSIONS: We have found an early and significant increase of peripheral blood neutrophil CD54/ICAM-1 expression, specific for S-AP but not for M-AP. It may provide a good marker predicting severe course of pancreatitis.

Early enteral nutrition is superior to delayed enteral nutrition for the prevention of infected necrosis and mortality in acute pancreatitis.

OBJECTIVES: The exact time of initiation of total enteral nutrition (TEN) in severe acute pancreatitis (SAP) and its influence on the disease outcome are not well known. METHODS: An analysis of 197 cases with predicted SAP allocated to: group A (n = 97), early TEN (started within the first 48 hours after admission to hospital); and group B (n = 100), delayed TEN (started after 48 hours). RESULTS: Infection of necrosis/fluid collections occurred in 4 patients in group A and 18 patients in group B (P < 0.05). Respiratory failure and transfer to intensive care unit occurred more frequently in group B than in group A (15 vs 5 and 15 vs 3 patients; P < 0.05). Multiple-organ failure was observed in 9 patients in group A and 16 patients in group B (P > 0.05). Seven patients in group A and 11 patients in group B underwent surgery (P > 0.05). All 9 reported deaths occurred in group B (P < 0.05). The time to start TEN was a predictor of infected necrosis/fluid collection (odds ratio, 4.09; P = 0.028). CONCLUSIONS: Delayed compared to early TEN is associated with higher mortality, increased frequency of infected necrosis/fluid collections, respiratory failure, and a need for intensive care unit hospitalization. Enteral nutrition in SAP should be started within 48 hours after admission to hospital.

Platelet activation in acute pancreatitis.

OBJECTIVES: The aim of this study was to assess the functional state of platelets in patients with mild acute pancreatitis and severe acute pancreatitis (S-AP). METHODS: The number of platelets and their morphological parameters were measured with Advia 2120. ß-Thromboglobulin and platelet factor 4 concentrations were determined by enzyme-linked immunosorbent assay method. To evaluate the expression of platelet glycoproteins, flow cytometry method was used. RESULTS: At the time of admission, a multiparameter evaluation of the platelets' function in AP patients showed enhanced platelet activation, which was reflected by an increase in the number of large platelets, concentration of degranulation markers (platelet factor 4 and ß-thromboglobulin), expression of glycoprotein (Gp) IIb/IIIa, and decreased mean platelet component. Only in S-AP patients at day 1 a decreased number of platelets and high expression of P-selectin and GpIa were observed, which may suggest their prognostic value. At day 30, the procoagulation state was still present in S-AP patients, because of increased platelets and number of large platelets as well as high GpIIb/IIIa expression. CONCLUSIONS: These results may indicate an important role of platelet activation in the pathogenesis of acute pancreatitis and the development of complications in S-AP.

Clinical significance of the measurements of serum matrix metalloproteinase-9 and its inhibitor (tissue inhibitor of metalloproteinase-1) in patients with pancreatic cancer: metalloproteinase-9 as an independent prognostic factor.

OBJECTIVE: Pancreatic cancer (PC) is a malignant tumor with high mortality. Aggressive growth and metastases of PC are the result of basement membrane degradation that may be attributed to the action of matrix metalloproteinase-9 (MMP-9). The aim of the study was to determine the diagnostic and prognostic significance of the measurements of serum MMP-9 and tissue inhibitor of metalloproteinase-1 (TIMP-1) in patients with PC. METHODS: The study involved 78 patients with PC, 45 with chronic pancreatitis, and 70 healthy subjects. We assayed the serum concentrations of MMP-9, TIMP-1, and classic tumor markers (carbohydrate antigen 19-9 and carcinoembryonic antigen) and defined the prognostic value and the diagnostic criteria for all the proteins tested. RESULTS: In the patients with PC, the serum levels of MMP-9, TIMP-1, and the tumor markers were higher as compared with those in the patients with chronic pancreatitis and the healthy subjects. The diagnostic sensitivity and the area under the receiver operating characteristic curve for TIMP-1 were higher than for MMP-9 and the tumor markers. The elevated preoperative concentration of MMP-9 was a significant independent prognostic factor for the patients' survival. CONCLUSIONS: These findings indicate a potential clinical significance of serum TIMP-1 and MMP-9 measurements in the diagnosis and prognosis of patients with PC, respectively.

Serum interleukin 6 (IL-6) and C-reactive protein (CRP) levels in colorectal adenoma and cancer patients.

BACKGROUND: Colorectal cancer is one of the most common cancers of the gastrointestinal tract and the fourth cause of cancer death in the world. It has been shown that local chronic inflammation may lead to colorectal carcinogenesis via adenomatous polyps. Interleukin-6 and C-reactive protein are biomarkers of inflammation and indicators of the immune response to tumors. METHODS: Serum levels of interleukin-6, carcinoembryonic antigen and carbohydrate antigen 19-9 were determined using immunoenzymatic assays, and C-reactive protein concentrations by immunoturbidimetric kits in 76 colorectal cancer patients before surgery, in 38 colorectal adenoma patients and in 35 healthy controls. RESULTS: Serum levels of interleukin-6, C-reactive protein and carcinoembryonic antigen were significantly higher in cancer patients when compared to adenoma patients and healthy subjects, and increased in more advanced stages of disease and in patients with non-resectable tumors. Based on Cox's analysis, the elevated preoperative serum level of C-reactive protein was an independent significant prognostic factor for patients' survival. CONCLUSIONS: Our findings suggest the usefulness of interleukin-6 in the diagnosis of colorectal cancer patients and C-reactive protein in the survival prognosis.

Monocyte subsets and natural killer cells in acute pancreatitis.

BACKGROUND: Alteration of the immune system is one of the major mechanisms responsible for complications in severe acute pancreatitis (AP). The aim of our study was to provide a complex evaluation of peripheral blood monocyte subsets, natural killer cells (NK cells) and cytotoxic T lymphocytes in patients with different severity forms of AP. METHODS: 20 patients with mild AP and 15 with severe AP (S-AP) were included in our study. Peripheral blood mononuclear cells were studied on days 1-3, 5, 10 and 30, by means of flow cytometry. RESULTS: In peripheral blood of patients with pancreatitis, we found a marked increase in total monocyte count. In S-AP, circulating monocytes were significantly activated, which was presumed from increased expression of HLA-DR, CD54, CD69 and CD25. Concurrent increased expression of CD95 (FasR) may indicate enhanced susceptibility of these cells to apoptosis. In patients with S-AP, a dramatic depletion of circulating NK cells (CD16/56 and CD3- CD8+) was found along with a reduction of circulating CD3+ CD8+ lymphocytes (cytotoxic T lymphocytes). CONCLUSION: Our findings suggest profound disturbances of innate cellular immunity in patients with S-AP.

Serum macrophage-colony stimulating factor levels in colorectal cancer patients correlate with lymph node metastasis and poor prognosis.

BACKGROUND: Elevated serum concentrations of macrophage-colony stimulating factor (M-CSF) have been found in a variety of malignant diseases. The aim of our study was to assess correlations between serum levels of M-CSF and clinicopathological features and survival rates in patients with colorectal cancer (CRC). PATIENTS/METHODS: M-CSF and the established tumor markers (carcinoembryonic antigen - CEA and carbohydrate antigen - CA 19-9) were investigated in the sera of 116 colorectal cancer patients and correlated with the clinical parameters of the disease and with the survival of patients. We compared M-CSF serum levels in CRC with colorectal adenoma patients. M-CSF was determined using enzyme-linked immunosorbent assay (ELISA). Tumor markers were measured by microparticle enzyme immunoassays (MEIA). RESULTS: CRC patients had significantly higher M-CSF and tumor markers levels compared to healthy controls and colorectal adenoma patients, with a significant association between M-CSF levels, disease stage and lymph node metastasis. Serum levels of M-CSF and CEA decreased significantly after radical resection of the tumor. Moreover, the multivariate analysis showed that the serum level of M-CSF in CRC patients was an independent prognostic factor. CONCLUSION: These findings suggest the potential clinical use of circulating M-CSF measurements, particularly in estimating prognosis for patients with CRC.

Serum levels of granulocyte colony-stimulating factor (G-CSF) and macrophage colony-stimulating factor (M-CSF) in pancreatic cancer patients.

BACKGROUND: Pancreatic cancer is an aggressive malignancy of the gastrointestinal tract and one of the most lethal human cancers. It has been shown that endogenous cytokines, produced aberrantly in many malignancies, including pancreatic cancer, may act as autocrine growth factors or as indicators of the immune response to tumors. Granulocyte-colony stimulating factor (G-CSF) and macrophage-colony stimulating factor (M-CSF) are hematopoietic growth factors (HGFs), i.e., cytokines that induce proliferation of hematopoietic and cancer cells. METHODS: Serum levels of G-CSF, M-CSF, carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9) were determined using immunoenzymatic assays in 62 patients with pancreatic cancer before and 30 days after surgery, and in 65 healthy controls. RESULTS: Cancer patients had significantly higher levels of all parameters measured compared to healthy subjects, especially in non-resectable tumors. Higher values of diagnostic parameters [specificity, sensitivity and area under receiver operating characteristic (ROC) curve] were observed for M-CSF than G-CSF, and for combined use of M-CSF with CA 19-9. Based on Cox analysis, elevated preoperative serum M-CSF was a significant prognostic factor for patient survival, although not independent of tumor stage. CONCLUSIONS: Our findings suggest the usefulness of M-CSF as a tumor marker for pancreatic cancer, especially in combination with CA 19-9.

Pretreatment serum levels of hematopoietic cytokines in patients with colorectal adenomas and cancer.

BACKGROUND AND AIM: Hematopoietic cytokines (HCs) regulate the proliferation and differentiation of hematopoietic progenitor cells, and it was proved that HCs can promote cancer growth. The aim of this study is to determine whether HCs might be useful in the diagnosis of colorectal cancer. MATERIALS AND METHODS: We compared the serum levels of stem cell factor (SCF), interleukin 3 (IL-3), granulocyte-macrophage colony-stimulating factor (GM-CSF), and macrophage colony-stimulating factor (M-CSF) in 97 colorectal cancer patients with those in 35 patients with colorectal adenomas and 65 healthy subjects (control group). Additionally, we investigated commonly accepted tumor markers, such as carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9). HCs were determined using enzyme linked immunosorbent assay (ELISA). CEA and CA 19-9 were measured by microparticle enzyme immunoassay. RESULTS: Serum levels of GM-CSF, M-CSF, and tumor markers were significantly higher in cancer patients as compared to the control group and adenomas patients. Of these, hematopoietic cytokines were found elevated in the higher proportion of patients than CEA and CA 19-9. The sensitivity of SCF was higher than the sensitivity of other cytokines, but diagnostic specificity and predictive value were highest for M-CSF. Moreover, the M-CSF area under the receiver operating characteristic curve was larger than the areas of other cytokines. The highest values of diagnostic parameters were observed for the combined use of M-CSF with CEA. CONCLUSION: The obtained data support the M-CSF usefulness as a tumor marker for colorectal cancer, especially in combination with CEA.

Alteration of peripheral blood lymphocyte subsets in acute pancreatitis.

AIM: To evaluate peripheral blood lymphocyte subsets in patients with acute pancreatitis (AP). METHODS: Twenty patients with mild AP (M-AP) and 15 with severe AP (S-AP) were included in our study. Peripheral blood lymphocytes were examined at d 1-3, 5, 10 and 30 by means of flow cytometry. RESULTS: A significant depletion of circulating lymphocytes was found in AP. In the early AP, the magnitude of depletion was similar for T- and B- lymphocytes. In the late course of S-AP, B-lymphocytes were much more depleted than T-lymphocytes. At d 10, strong shift in the CD7+/CD19+ ratio implicating predominance of T- over B-lymphocytes in S-AP was found. Among T-lymphocytes, the significant depletion of the CD4+ population was observed in M-AP and S-AP, while CD8+ cells were in the normal range. Lymphocytes were found to strongly express activation markers: CD69, CD25, CD28, CD38 and CD122. Serum interleukin-2 (IL-2), IL-4, IL-5, IL-10, interferon-gamma (IFN-gamma) and tumor necrosis factor-alpha (TNF-alpha) levels were significantly increased in both forms of AP. The magnitude of elevation of cytokines known to be produced by Th2 was much higher than cytokines produced by Th1 cells. CONCLUSION: AP in humans is characterized by significant reduction of peripheral blood T- and B-lymphocytes.

[Massive bleeding from the upper digestive tract in patients with pseudoaneurysm of splenic artery]. / Masywne krwawienie z górnego odcinka przewodu pokarmowego u chorego z tetniakiem rzekomym tetnicy sledzionowej--opis przypadku.

Pancreatic pseudocysts are common complication of both chronic and acute pancreatitis. Sanguination from damaged peripancreatic vessels into the lumen of pseudocyst results in pseudoaneurysm. The rupture of pancreatic pseudoaneurysm into the lumen of digestive tract causes massive bleeding witch source is often difficult to find during endoscopic examination. We present a case of patient with chronic alcohol pancreatitis, with pancreatic pseudocyst and of acute bleeding from upper digestive tract. In the endoscopy we found gastric ulcer with visible vessel. During hospitalization we observed increase the diameter of pseudocyst and circulation of it's liquid contence. Second-look endoscopy showed gastric fundic varices. Surgical operation revealed pseudoaneurysm of splenic artery inserting pressure on gastric wall.

The diagnostic value of G-CSF measurement in the sera of colorectal cancer and adenoma patients.

BACKGROUND: Granulocyte-colony stimulating factor (G-CSF) regulates the growth of hematopoietic progenitor cells. Cancer cells, including colorectal cancer, can produce this cytokine. The aim of this study was to compare the diagnostic value of measurement of G-CSF and classic tumor markers--carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9) in the sera of colorectal cancer with adenoma patients and to determine its usefulness in the diagnosis of colorectal cancer and polyps. PATIENTS AND METHODS: The serum levels of G-CSF and tumor markers were assayed in 76 colorectal cancer, 35 colorectal adenoma patients and in 65 healthy subjects. We defined the diagnostic sensitivity, specificity and areas under ROC curves for the measurands. RESULTS: Median values of G-CSF and tumor markers were significantly higher in colorectal cancer patients than those in healthy subjects. There were significant differences in the serum levels of G-CSF between adenoma patients and healthy subjects. The concentrations of tumor markers in colorectal cancer patients were higher than those in polyps. Combined use of G-CSF with CEA improved their diagnostic sensitivity in colorectal cancer. CONCLUSIONS: Measurement of G-CSF might be useful in the diagnosis of colorectal cancer patients, but not in the differentiation between colorectal cancer and polyps.

[The laryngological complications of the Gastroesophageal Reflux Diseases]. / Powiklania laryngologiczne choroby refluksowej przelyku.

UNLABELLED: The aim of the study was the quantitative and qualitative assessment of the pathological reflux episodes present in laryngological diseases in relation to GERD. These findings allowed for outlining the relationship between the reported subjective ailments and the disturbances of function and acidic refluxes diagnosed in pH-metric measurements. The study included 40 patients (23 women, 17 men) with clinical laryngological symptoms of GERD (aged 19-63 years, median 42.2): chronic persistent cough, laryngitis, pharyngitis, ulceration of vocal cords, hacking. The patients underwent laryngological check-up (direct laryngoscopy), gastroscopy, 24-hour pH-metry and manometry of the oesophagus. The analysis of the subjective symptoms reported by the patients was done according to the DeMeester's and Likert's scale. The 24-hour abdominal pH-metry was carried out with the use of microDigitrappr MARK III (Synecpol) pH-meter and antymon probe with the reference epidermal electrode. The manometric analysis of the pressure in lower oesophagal sphincter (LES) and the antral function was done with the use of Köenisberg probe integrated with microDigitrapper. RESULTS: In 80% of the patients we observed the presence of pathological acid refluxes and so called high pharyngeal refluxes (the total number of reflux episodes--91 +/- 8.2, the number of reflux episodes lasting longer than 5 minutes--19.6 +/- 4.6, "fraction time" the percentage of pH < 4.0-7.1 +/- 2.9). In this group of patients chronic laryngitis was observed in 50% of cases, chronic hacking--in 31%, persistent pain in the pharynx--in 28.1%, strong cough--in 59.4%. In 18.7% of the patients with the pathological recurrent reflux of gastro-intestinal content to the oesophagus we observed inflammatory changes of various extent in gastroscopy. We found a strong causal relationship between cough and hacking and the pathological GERD (time interval 5 min, Wiener's indicator SI > or = 75%). CONCLUSIONS: 1. The achieved results confirm the significant role of pathological GERDS in the pathogenesis of many laryngological symptoms. 2. On the basis of the achieved data it seems purposeful that the diagnosis should be much more detailed with the use of 24-hour gastroesophageal pH-metry in the patients with persistent laryngological (mainly cough and hacking) symptoms, especially in case of the patients in whom the reported symptoms are not relieved after routine laryngological treatment. 3. Our findings create the possibility for the modification of the so far diagnostic and therapeutical procedures in this group of patients and the relief of the reported subjective ailments.

Stem cell factor (SCF) and interleukin 3 (IL-3) in the sera of patients with colorectal cancer.

For a long time markers that can detect a malignant cell transformation as early as possible have been sought. Substances which have been discovered are known as tumor markers. Stem cell factor (SCF) and interleukin 3 (IL-3) are members of a group of glycoprotein growth factors called hematopoietic cytokines (HCs). These factors take part in the regulation of developmental processes of hematopoietic progenitor cells and it was proved that HCs can be produced by different cancer cells, including colorectal cancer. The aim of this study was to investigate a potential role for SCF and IL-3 as tumor markers for colorectal cancer. We compared the serum levels of SCF and IL-3 in colorectal cancer patients with those in healthy subjects (control group) and commonly accepted tumor markers, such as carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9). We defined the diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and receiver-operating characteristics (ROC) curve of tested substances. SCF and IL-3 were determined using enzyme-linked immunosorbent assay (ELISA). CEA and CA 19-9 were measured by microparticle enzyme immunoassay. The serum levels of HCs and tumor markers were investigated in 75 patients with colorectal cancer and in 40 healthy subjects. There were significant differences in the level of circulating SCF and IL-3 in the colorectal cancer patients compared to the control group. Moreover, the diagnostic sensitivity of SCF was higher than the sensitivity of CEA and CA 19-9. The SCF area under the ROC curve was larger than the IL-3 area but smaller than the CEA and CA 19-9 areas. The diagnostic specificities of cytokines were lower than those of tumor markers, but the combined use of cytokines and tumor markers increased the diagnostic values. The highest values of diagnostic parameters were observed for the combined use of SCF and CA 19-9. These results suggest a potential role for SCF and IL-3 as tumor markers for colorectal cancer, especially in combination with CEA or CA 19-9.

Hematopoietic cytokines in the sera of patients with pancreatic cancer.

Hematopoietic cytokines (HCs) can affect the growth and spread of cancer. Therefore, in the present study, we investigated in pancreatic cancer patients the serum levels of selected HCs, such as stem cell factor (SCF), interleukin 3 (IL-3), granulocyte-macrophage-colony stimulating factor (GM-CSF), granulocyte-colony stimulating factor (G-CSF) and macrophage-colony stimulating factor (M-CSF) in relation to a control group and to a group of patients with chronic pancreatitis. Classical tumor markers such as carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9) were also tested. We compared the serum level of cytokines with the tumor stage. The diagnostic sensitivity, specificity, positive and negative predictive values and receiver-operating characteristics (ROC) curve for cytokines and classical tumor markers were defined. The cytokines were measured in 48 patients with pancreatic cancer, in 23 patients with chronic pancreatitis and in 40 healthy subjects. HCs were determined using ELISA. CEA and CA 19-9 were measured by microparticle enzyme immunoassay. There were significant differences in the levels of circulating SCF, IL-3, GM-CSF, M-CSF, CEA and CA 19-9 in the pancreatic cancer patients compared to the control group. The serum levels of M-CSF and tumor markers were significantly higher in pancreatic cancer patients compared to the pancreatitis group. The levels of SCF, M-CSF and tumor markers were higher in patients with a more advanced tumor stage. The M-CSF serum levels in the pancreatitis group correlated positively with the tumor markers tested--CEA and CA 19-9. The diagnostic sensitivity of SCF and specificity of M-CSF and tumor markers were the highest. The SCF and M-CSF areas under the ROC curve were greater than the areas for other cytokines. These results suggest the potential usefulness of HCs in pancreatic cancer detection; however, further investigations of early-stage pancreatic cancer patients and confirmation by a prospective study are necessary.