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SURGICAL TREATMENT OF CARCINOMA OF HEAD OF PANCREAS

Diagnosis and Treatment of Pancreatic Vasoactive Intestinal Peptide Tumor (Report of 3 Cases)

目的總結胰腺血管活性腸肽瘤（VIPoma）的臨床特點并探討其診治方法。 方法回顧性分析1991年11月至2010年2月期間我院收治的3例VIPoma患者的臨床資料。 結果3例均有周期性發作水樣瀉、低鉀血癥和低或無胃酸。有2例血漿血管活性腸肽值顯著升高。B超及CT發現3例腫瘤均位于胰腺內，其中1例肝轉移，1例懷疑肝轉移。3例均行手術治療。1例腫瘤位于胰頭部行胰十二指腸切除術，隨訪3年無腫瘤復發；1例腫瘤位于胰頭頸部及肝臟多發轉移灶，行胰腺頭頸部切除及肝臟轉移結節摘除術，術后4個月腹瀉癥狀復發，證實肝臟多發轉移灶，又先后3次手術，于第1次手術后3.5年死于電解質紊亂；另1例術中發現腫瘤位于胰頭部無法切除，肝臟多發轉移灶，摘除1枚肝臟結節病理確認為轉移癌，術后間斷應用奧曲肽，術后2.5年仍在隨訪中。 結論VIPoma首選的治療方法是手術切除腫瘤。惡性腫瘤即使無法根治手術，也應該姑息性切除和間斷應用奧曲肽，以改善患者生活質量。

Comparative Study on Mutations at Codon 12 of Ki-ras Gene Between Chinese and Western Patients with Pancreatic Cancer

【Abstract】　Objective　To explore the features of Ki-ras mutations at codon 12 in Chinese patients of pancreatic cancer and to compare these features with those in Western countries. Methods　Fifty-nine samples were collected during operations for pancreatic adenocarcinoma in our hospital from December 1989 to November 1997. The patients, age ranged from 30 to 73 years 〔(55.5±10.4) years〕,with 38 males and 21 female. TNM staging of the patients: stage Ⅰ(n=4); stage Ⅱ(n=8), stage Ⅲ(n=42),stage Ⅳ(n=5). PCR was used to amplify target gene and Dot blot hybridization for detecting Ki-ras mutations at codon 12 was performed in fifty-nine specimens of Chinese pancreatic cancer. The data of Ki-ras mutations at codon 12 from Western countries were gotten by Medline system. Results　Ki-ras mutation at codon 12 was detected in 76.3% of the patients in this group. The frequency of double mutation of Ki-ras at codon 12 in this group (15.6%) was highest than that in western countries. Our results were compared with those reported in Western countries. The results suggested that there were the significant differences in the substitution of Ki-ras mutations at codon 12 and in the ratio of transition to transversion in pancreatic cancer among various countries. Conclusion　Ki-ras mutations at codon 12 is frequent in Chinese pancreatic cancer, and a gene component to pancreatic cancer may be different among various countries. In addition, the effect of Ki-ras mutations at codon 12 on prognosis of patients with pancreatic cancer is different in various countries.

Study about the Relationships Between the Formation of Cholesterol Calculus and the Transporters of BSEP， MRP2 and MDR3

【Abstract】ObjectiveTo evaluate the relationships between the transporters BSEP， MRP2， MDR3 and cholesterol calculus formation. MethodsTwenty hepatic tissue specimens were taken from consented patients with cholesterol calculus during intraoperative liver biopsy, of which ten were taken from patients without cholesterol calculus. RNA of liver tissue from all the samples was extracted and ultraviolet spectrophotometry was used to measure the content and purity of it. The mRNA and protein expressions of BSEP, MRP2 and MDR3 were determined by reverse transcriptionpolymerase chain reaction (RTPCR) and Western blot analysis, respectively. ResultsRTPCR showed that the mRNA expressions of BSEP, MRP2 and MDR3 in liver were significantly lower in patients with cholesterol calculus （0.47±0.18, 1.12±0.39 and 1.02±0.24） than those in the liver of patients without calculus （0.90±0.42, 2.48±0.89 and 1.94±0.80）,P＜0.01. And Western blot also showed the protein expressions of these transporters were significantly lower in patients with cholesterol calculus （90.16±18.82, 45.43±22.77 and 61.08±14.77） than those in the liver of patients without calculus (186.17±4.34, 160.47±30.19 and 100.84±15.44). ConclusionThe decreased expression of BSEP, MRP2 and MDR3 may correlate with the formation of cholesterol calculus.