Albrecht Holle

Microencapsulated cell-mediated treatment of inoperable pancreatic carcinoma

Pancreatic cancer can seldom be resected, and chemotherapy has only a limited effect on survival or tumour load. We did a phase I/II trial in 14 patients with pancreatic cancer to assess the safety of local activation of low-dose ifosfamide. We encapsulated genetically modified allogeneic cells, which expressed a cytochrome P450 enzyme, in cellulose sulphate and delivered them by supraselective angiography to the tumour vasculature. These cells locally activated systemically administered ifosfamide. The tumours of four patients regressed after treatment, and those of the other ten individuals who completed the study remained stable. Median survival was doubled in the treatment group by comparison with historic controls, and 1-year survival rate was three times better. Further studies of this cell-therapy-based treatment combined with chemotherapy for inoperable pancreatic cancer are warranted.

T1196 Reduced Clinical Activity During the Course of Ulcerative Colitis

Background: There are limited data available concerning the course of ulcerative colitis (UC) beyond a 10 year history. Clinical experience shows decreased disease activity of UC over time. Therefore, the aim of the study was to obtain data from a 15-year UC period to verify this clinical observation. Methods: 49 adult patients suffering from UC at least 15 years were included in the study. They were evaluated for age, gender, disease extension, the frequency of acute flares, surgical interventions, the highest clinical activity index (CAI according to Rachmilewitz), medication, and the number of hospitalizations. Assessment was performed comparing 5-year episodes of disease history. The patients were treated using 5-aminosalicylates, glucocorticoids and azathioprin. Results: We found a highly significant (p= 0.001) reduction of acute flare number during the course of UC. In the first 5 years 86.4% of the patients had 1-5 acute flares, 11.4% had more than 5 episodes. In the time period of 11-15 years 57.1% of pats. had 1-5 acute flares, but 32.7% of pats. were in remission without acute flares. Moreover, there was a significant (p=0.001) reduction of the highest CAI during the course of disease. 88.9 % of the patients had an CAI>4 in the first 5 years. In contrast, only 41.5% of the patients had a CAI>4 in the years 11-15 after diagnosis. Furthermore, the number of patients without hospitalization was increased significantly from 28.9% (year 1-5) to 83.0% (year 11-15). There was no relation of these data to age, gender, disease extension, and the medication. Conclusion: During the long time course of UC disease activity was reduced independent of the other investigated disease parameters.

Hämorrhagische Verlaufsform einer hereditären Pankreatitis

ZusammenfassungFall. Die vorliegende Kasuistik stellt den klinischen Verlauf bei einem 7-jährigen Knaben mit hereditärer Pankreatitis dar. Die Symptomatik war von Meläna mit häufiger Transfusionsbedürftigkeit und heftigen Bauchschmerzattacken bei relativ geringer Erhöhung der Plasmalipase- und -amylasewerte dominiert. Die Diagnose “hereditäre Pankreatitis” wurde durch Nachweis der Mutation R122H des kationischen Trypsinogens gestellt. Die Familienanamnese konnte erst später ergänzt werden, wobei die Erkrankung des Großonkels mütterlicherseits an einem Pankreaskarzinom bekannt wurde. Die Quelle für die ständigen gastrointestinalen Blutverluste ließ sich zwar nicht definitiv sichern. Viele Indizien und die 1-malige endoskopische Beobachtung einer Blutung aus dem Pankreasgang sprechen jedoch für eine intrapankreatische Blutungsquelle. Nach einem halbjährigen, schwierigen Verlauf kam dem Entschluss zur longitudinalen Pankreatikojejunostomie eine spontane Remission mit völliger Beschwerdefreiheit des Patienten zuvor. Schlussfolgerung. Die hereditäre Pankreatitis kann einen hämorrhagischen Verlauf mit gastrointestinalen Blutverlusten nehmen. Auch bei primär negativer Familienanamnese darf die Differenzialdiagnose “hereditäre Pankreatitis” aufgrund der unvollständigen Penetranz der Erkrankung nicht verworfen werden.AbstractCase report. This case-report presents the clinical course in a 7 year old boy with hereditary pancreatitis who was suffering from melaena requiring frequent transfusions and severe abdominal pain correlated with slightly elevated serum lipase and amylase. The diagnosis hereditary pancreatitis was established by detection of the mutation R122H in the cationic trypsinogen gene. Later on, the family history could be completed and revealed a pancreatic carcinoma in a grand uncle of the patient. Although identification of the source of the gastrointestinal bleeding was inconclusive various signs and one occasion with observable bleeding from the pancreatic duct during duodenoscopy lead to the assumption of pancreatic bleeding. Following a period of continued seriousness in the patients condition over half-a-year a decision to carry out a longitudinal pancreaticojejunostomy was pre-empted by spontaneous remission with a complete absence of clinical symptoms. Conclusion. Hereditary pancreatitis may have a hemorrhagic course with gastrointestinal blood losses. Owing to the incomplete penetrance of the illness the differential diagnosis hereditary pancreatitis cannot be discounted even in a patient with a negative family history.