作者： 刊期： 2014年第06期

BACKGROUND: There is a growing evidence that matrix metalloproteinase (MMP)-2 and MMP-9 (gelatinases) play an important role in the pathogenesis of numerous disorders, especially with inflammatory etiology and extracellular matrix (ECM) remodeling. Despite the fact that gelatinases involve in liver cirrhosis is provided in the literature, their role in the pathogenesis of chronic pancreatitis and non-specific inflammatory bowel diseases is still under investigation.DATA SOURCES: We carried out a PubMed search of Englishlanguage articles relevant to the involvement of gelatinases in the pathogenesis of liver fibrosis, pancreatitis, and non-specific inflammatory bowel diseases.RESULTS: The decreased activity of gelatinases, especially MMP-2, is related to the development of liver fibrosis, probably due to the decrease of capability for ECM remodeling. Similar situation can be found in chronic pancreatitis; however, reports on this matter are rare. The presence of non-specific inflammatory bowel diseases results in MMP-9 activity elevation.CONCLUSION: The fluctuation of gelatinases activity during liver fibrosis, chronic pancreatitis and non-specific inflammatorybowel?diseases?is?observed,?but?the?exact?role?of?these?enzymes?demands?further?studies.

作者： 刊期： 2014年第06期

BACKGROUND:?Autoimmune?pancreatitis?(AIP)?is?increasingly?recognized?as?a?unique?subtype?of?pancreatitis.?This?study?aimed?to?analyze?the?diagnosis?and?treatment?of?AIP?patients?from?a?tertiary?care?center?in?China.METHODS:?One?hundred?patients?with?AIP?who?had?been?treated?from?January?2005?to?December?2012?in?our?hospital?were?enrolled?in?this?study.?We?retrospectively?reviewed?the?data?of?clinical?manifestations,?laboratory?tests,?imaging?examinations,?pathological?examinations,?treatment?and?outcomes?of?the?patients.RESULTS:?The?median?age?of?the?patients?at?onset?was?57?years?(range?23-82)?with?a?male?to?female?ratio?of?8.1:1.?The?common?manifestations?of?the?patients?included?obstructive?jaundice?(49?patients,?49.0%),?abdominal?pain?(30,?30.0%),?and?acute?pancreatitis?(11,?11.0%).?Biliary?involvement?was?one?of?the?most? extrapancreatic? manifestations? (64,? 64.0%).? Fifty-six?(56.0%)?and?43?(43.0%)?patients?were?classiifed?into?focal-type?and?diffuse-type?respectively?according?to?the?imaging?examinations.?The?levels?of?serum?IgG?and?IgG4?were?elevated?in?69.4%?(43/62)?and?92.0%?(69/75)?patients.?Pathological?analysis?of?specimens?from?27?patients?supported?the?diagnosis?of?lymphoplasmacytic?sclerosing?pancreatitis,?and?marked?(>10?cells/HPF)?IgG4?positive?cells?were?found?in?20?(74.1%)?patients.?Steroid?treatment?and?surgery?as?the?main?initial?treatments?were?given?to?41?(41.0%)?and?28?(28.0%)?patients,?respectively.?The?remission?rate?after?the?initial?treatment?was?85.0%.?Steroid?was?given?as?the?treatment?after?relapse?in?most?of?the?patients?and?the?total?remission?rate?at?the?end?of?follow-up?was?96.0%. CONCLUSIONS:?Clinical?manifestations,?laboratory?tests,?imaging?and?pathology?examinations?in?combination?could?increase?the?diagnostic?accuracy?of?AIP.?Steroid?treatment?with?an?initial?dose?of?30?or?40?mg?prednisone?is?effective?and?safe?in?most?patients?with?AIP.

作者： 刊期： 2014年第06期

BACKGROUND:?Pancreaticoduodenectomy? is? a? high? risk,?complex,? technically? challenging? operation? associated? with?signiifcant?perioperative?morbidity?and?mortality.?This?study?on?the?surgical?management?of?periampullary?cancer?patients?is?based?on?our?experience?in?a?period?of?nearly?13?years.METHODS:?The? study? was? conducted? on? two? groups? of?patients:?group?A?included?42?patients?who?were?treated?between?January?2000?and?September?2005?and?group?B?included?134?patients?who?were?treated?between?October?2005?to?October?2012.?Preoperative,?intraoperative?and?postoperative?details?of?all?these?patients?were?collected,?tabulated?and?analyzed?to?assess?the?impact?of?the?selective?approach?introduced?in?the?department?with?effect?from?October?2005.RESULTS:?Intraoperative? details? revealed? highly? signiifcant?differences?in?the?management?of?the?two?groups?of?patients?in?respect?of?operative?time?(250.4?vs?126.6?minutes;?P<0.001),?operative? blood? loss? (1070.2? vs? 414.9? mL;? P<0.001)? and?intraoperative?blood?transfusion?(1.4?vs?0.2?units;?P<0.001).?Variations? between? the? two? groups? in? the? frequency? of?complications? were? found? to? be? statistically? insigniifcant.?However,?the?difference?between?the?two?groups?in?the?overall?morbidity?of?patients?(47.6%?vs?26.1%;?P=0.009)?and?the?length?of?their?hospital?stay?(11.8?vs?7.8?days;?P<0.001)?were?signiifcant. CONCLUSION:?A?selective?approach?applied?to?the?surgical?management?of?periampullary?cancer?patients?is?a?step?in?the?right?direction.

作者： 刊期： 2014年第06期

BACKGROUND:?Ectopic?pancreatic?tissue?is?relatively?uncommon,?and?is?characterized?as?pancreatic?tissue?with?no?contact?with?the?normal?pancreas,?and?with?its?own?ductal?system?and?blood?supply.?It?is?usually?asymptomatic,?and?can?be?incidentally?diagnosed?by?conventional?imaging?studies. METHOD:?A? 69-year-old? woman? with? a? prior? history? of?bilateral?breast?carcinoma?presented?with?ectopic?pancreatic?intraepithelial?neoplasia?(PanIN)?that?was?identiifed?incidentally?in? the? small? bowel? during? an? oncological? resection? of? a?synchronous?primary?pancreatic?adenocarcinoma,?and?renal?cell?carcinoma. RESULTS:?The?patient?underwent?subtotal?pancreatectomy?with?splenectomy,?regional?lymphadenectomy,?radical?left?nephrectomy,?and?small?bowel?resection?with?primary?anastomosis?of?ectopic?PanIN-2.? She? had? an? uneventful? hospitalization? and? was?discharged?home?on?postoperative?day?7. CONCLUSIONS:?The?occurrence?of?ectopic?PanIN?is?extremely?unusual?with?only?few?cases?previously?reported?in?the?literature.?The?need?for?negative?margins?after?surgical?resection?of?ectopic?PanIN?lesions?remains?controversial.

作者： 刊期： 2014年第06期

BACKGROUND: Postoperative pancreatic fistula remains the most common complication of pancreaticoduodenectomy (PD) and is potentially lethal. It contributes significantly to prolonged hospitalization and mortality. In this study, we introduced a new technical approach, a modified Roux-en-Y reconstruction and evaluated its safety and feasibility.METHODS: We retrospectively reviewed the patients who had undergone PD with the modified Roux-en-Y reconstructive technique for periampullary malignancies from January 2011 to June 2012. The data on complications, hospital stay and outcomes after the modified Roux-en-Y reconstruction were analyzed.RESULTS: The reconstruction was performed in 171 patients, of whom 92 received pancreaticogastrostomy and 79 received pancreaticojejunostomy. The median duration of surgery was 4.0 hours (range 3.1-6.9) in all patients, and the median blood loss was 530 mL (range 200-2000). Sixty-nine patients were subjected to transfusions, with a median transfusion volume of 430 mL (range 200-1400). The median hospital stay of the patients was 14 days (range 11-38). Their operative mortality was zero and overall morbidity was 18.1% (31 patients). Only four patients (2.3%) developed pancreatic fistulas (grade A fistulas in two patients and grade B in two patients); no patients developed grade C fistula. None of the patients developed bile reflux gastritis.CONCLUSIONS: The modified Roux-en-Y reconstruction, which isolates biliary anastomosis from pancreatic, gastric or jejunal anastomosis,?is?a?safe,?reliable,?and?favorable?technique.?But?it?needs?further?investigation?in?randomized?controlled?trials.

作者： 刊期： 2014年第06期

作者： 刊期： 2014年第06期

ABSTRACT:?CD98?has?been?described?to?play?a?crucial?role?in?tumor?progression?and?survival.?However,?the?role?of?CD98?in?biliary?tract?cancer?remains?unclear.?We?found?that?36.7%?of?all?patients?with?biliary?tract?cancer?had?a?high?CD98?expression.?Statistical?analysis?using?Spearman's?rank?correlation?showed?that?CD98?was?signiifcantly?correlated?with?L-type?amino?acid?transporter?1?(LAT1,?r=0.562,?P<0.001),?Ki-67?(r=0.230,?P=0.006)?and?CD34?(r=0.290,?P=0.005).?Multivariate?analysis?conifrmed?that?a?high?CD98?expression?was?an?independent?prognostic?factor?for?predicting?poor?outcome.?CD98?is?closely?associated?with?tumor?growth,?biological?aggressiveness,?and?survival?of?patients.?With?these?data?we?proposed?that?CD98?expression?is?necessary?for?the?development?and?pathogenesis?of?biliary?tract?cancer.

作者： 刊期： 2014年第06期

作者： 刊期： 2014年第06期

BACKGROUND:?Fibrolamellar? hepatocellular? carcinoma?(FLHCC)? is? a? rare? disease? with? an? indolent? behavior.? Its?prognosis?is?better?than?that?of?patients?with?hepatocellular?carcinoma.?The?authors?present?their?experience?with?resection?of?FLHCC.METHODS:?Twenty-one?patients?with?FLHCC?were?treated?at?our?institution?between?1990?and?2012.?Of?these?patients,?14?were?subjected?to?resection?of?the?tumor.?Patient?demographics,?medical?history,?results?of?imaging?studies?and?laboratory?tests,?surgical?data,?and?pathologic?ifndings?were?evaluated.RESULTS:?The?median?age?of?the?patients?at?the?diagnosis?of?the?tumor?was?20?years?and?14?patients?were?female.?None?of?the?patients?had?tumor-associated?chronic?liver?disease?or?cirrhosis.?The?mean?tumor?size?was?12.8?cm?(range?6-19)?and?18?patients?had?a?single?liver?nodule.?Fourteen?patients?were?subjected?to?hepatectomy?and?six?of?them?had?lymph?node?metastases?resected.?Pathologic?evaluation?revealed?that?5?(35.7%)?patients?had?major?vascular?invasion.?Tumor?recurrence?was?seen?in?8?patients?(66.7%),?during?a?follow-up.?The?median?survival?time?for?patients?who?were?subjected?to?resection?was?36?months.?The?5-year?overall?survival?rate?and?disease?free?survival?rate?were?28.0%?and?8.5%,?respectively.?Univariate?analysis?showed?that?vascular?invasion?was?the?only?variable?associated?with?the?disease?free?survival?rate.CONCLUSIONS:?Despite? an? aggressive? treatment,? patients?with?FLHCC?presented?unexpected?low?survival?rates.?It?seems?that?an?underestimated?malignant?behavior?is?attributed?to?this?disease,?and?that?the?forms?of?adjuvant?treatment?should?be?urgently?evaluated.

作者： 刊期： 2014年第06期

作者： 刊期： 2014年第06期

作者： 刊期： 2014年第06期

作者： 刊期： 2014年第06期

BACKGROUND:?A?previous?report?has?identiifed?a?signiifcantly?higher?sensitivity?of?cancer?detection?for?dedicated?grasping?basket?than?brushing?at?endoscopic?retrograde?cholangiopancreato- graphy?(ERCP).?This?study?aimed?to?compare?the?diagnostic?accuracy?of?Geenen?brush?and?Dormia?basket?cytology?in?the?differential?diagnosis?of?bile?duct?stricture.METHOD:? The? current? study? enrolled? one? hundred? and?fourteen?patients?who?underwent?ERCP?with?both?Geenen?brush?and?Dormia?basket?cytology?for?the?differential?diagnosis?of?bile?duct?stricture?at?our?institution?between?January?2008?and?December?2012.RESULTS:?We?adopted?sequential?performances?of?cytologic?samplings? by? using? initial? Geenen? brush? and? subsequent?Dormia?basket?cytology?in?59?patients?and?initial?Dormia?basket?and?subsequent?Geenen?brush?cytology?in?55?patients.?Presampling?balloon?dilatations?and?biliary?stentings?for?the?stricture?were?performed?in?17?(14.9%)?and?107?patients?(93.9%),?respectively.?The?sensitivity,?speciifcity,?positive?predictive?value,?negative?predictive?value,?and?accuracy?of?Geenen?brush?cytology?for?the?diagnosis?of?malignant?bile?duct?stricture?were?75.0%,?100.0%,?100.0%,?66.7%?and?83.3%,?respectively,?and?those?of?Dormia?basket?cytology?were?64.5%,?100.0%,?100.0%,?58.5%?and?76.3%,?respectively?(P=0.347?and?0.827?for?sensitivity?and?accuracy,?respectively).?The?good?and?excellent?cellular?yields?(≥?grade?2)?were?obtained?by?Geenen?brush?and?Dormia?basket?cytology?in?88?(77.2%)?and?79?(69.3%)?patients,?respectively.CONCLUSION:?The? sensitivity,? speciifcity? and? accuracy? of?biliary?sampling?with?a?Dormia?basket?are?comparable?to?those?with?conventional?Geenen?brush?cytology?in?the?detection?of?malignant?bile?duct?stricture.

作者： 刊期： 2014年第06期

BACKGROUND:?The?peripheral?morphologic?characteristics?of?hepatocellular?carcinoma?(HCC)?relfect?tumor?growth?patterns.?Computed?tomography?(CT)?perfusion?is?a?new?method?to?analyze?hemodynamic?changes?in?tissues.?We?assessed?the?relationship?between?CT?perfusion?and?histopathologic?ifndings?in?the?periphery?of?HCC?lesions.METHODS:?Non-contrast?CT,?enhanced?dual-phase?CT,?and?CT?perfusion?were?performed?on?77?subjects?(47?patients?and?30?controls).?Based?on?the?imaging?ifndings?of?enhanced?dual-phase?CT,?the?tumor?edges?were?classiifed?into?three?types:?type?I?(sharp);?type?II?(blurry);?and?type?III?(mixed).?The?CT?perfusion? parameters? included? hepatic? blood? lfow,? hepatic?arterial?fraction,?hepatic?arterial?perfusion,?and?hepatic?portal?perfusion.?The?tissue?sections?from?resected?specimens?were?subjected? to? routine? hematoxylin? and? eosin? staining? and?immunohistochemical? staining? for? CD34.? The? correlations?between?microvessel?density?(MVD)?and?the?CT?perfusion?parameters?were?analyzed?using?Pearson's?product-moment?correlation?coefifcient.?Changes?in?the?perfusion?parameters?in?tumor?edges?of?different?tumor?types?were?evaluated.RESULTS:?Type?I?(sharp):?the?pathologic?ifndings?showed?ifbrous?connective?tissue?capsules?in?the?tumor?edges,?and?an?MVD?≤?30/mm2.?Type?II?(blurry):?the?histology?showed?that?the?edges?were?clear?with?no?capsules?and?an?MVD?>30/mm2.?Type?III(mixed):?the?pathology?was?similar?to?that?of?types?I?and?II,?and?an?MVD?>30/mm2.?Hepatic?blood?lfow,?hepatic?arterial?fraction,?hepatic?arterial?perfusion,?and?hepatic?portal?perfusion?were?signiifcantly?increased?in?the?tumor?edges?of?HCC?patients?compared?to?those?of?the?controls?(P<0.05).?The?correlation?between?CT?perfusion?parameters?and?MVD?was?higher?in?blurry?tumor?edges?of?type?II?than?in?those?of?types?I?or?III.CONCLUSION:?CT?perfusion?imaging?of?tumor?edges?may?be?helpful?in?revealing?histopathological?features,?and?indirectly?relfect?angiogenic?changes?of?HCCs.

作者： 刊期： 2014年第06期