Dezso Kelemen

Clinical Experience with Different Techniques of Pancreatic Head Resection for Chronic Pancreatitis

Background/Aims: Recently organ-saving procedures have become popular in the treatment of chronic pancreatitis with head enlargement. The purpose of this study is to compare the results of three different procedures. Methods: Between 1991 and 1998, 32 Beger operations, 13 Frey procedures and 21 pylorus-preserving pancreatoduodenectomies (PPPDs) were performed. The pre-, intra- and postoperative data were detailed. During the follow-up examination the quality of life, body weight, consumption of alcohol and enzymes, as well as the carbohydrate metabolism were checked. Results: Considering the operative and late mortality and reoperation rate, there was no difference between the procedures. The postoperative hospitalization time was the shortest after the duodenum-preserving pancreatic head resections (Beger and Frey). While the rate of early morbidity was higher after PPPDs, there was no difference in late morbidity between the groups. The condition of the patients was better and the development rate of diabetes was lower after the Beger procedure than after PPPDs. Conclusion: Consequently duodenum-preserving pancreatic head resections seem to be more advantageous than PPPD. Nevertheless the latter operation is the only possibility in some situations.

The NANC relaxation of the human ileal longitudinal and circular muscles is inhibited by MRS 2179, a P2 purinoceptor antagonist

AIMS Functional innervation of the human small intestine may be different from that of experimental animals. These experiments set out to assess the mediating roles of P(2) purinoceptors in the non-adrenergic, non-cholinergic (NANC) relaxation of the human ileum longitudinal and circular muscles. MAIN METHODS In organ bath experiments NANC relaxations were evoked by electrical field stimulation (EFS). The relaxant effects of ATP and sodium nitroprusside were also examined. KEY FINDINGS In the longitudinal muscle, relaxation in response to EFS (2 or 10 Hz for 30 s) or the relaxant effect of exogenous ATP were strongly inhibited or abolished, respectively, by the P(2) purinoceptor antagonist MRS 2179 (10 microM). MRS 2179 had a smaller effect at 3 microM. The NANC relaxation was also inhibited by apamin (3 microM), but not by N(G)-nitro-L-arginine (100 microM), an inhibitor of nitric oxide synthesis. Both apamin (3 microM) and MRS 2179 (3 microM, a concentration below the effective range if administered alone) strongly inhibited the NANC response in preparations pretreated with the nitric oxide synthase inhibitor. NANC relaxations of the circular muscle were also inhibited by MRS 2179 (3-10 microM). SIGNIFICANCE MRS 2179-sensitive P(2) purinoceptors play a mediating role the NANC relaxation in the ileal longitudinal and circular muscle. There seems to be a supra-additive relationship between the purinergic and nitrergic mechanisms in the longitudinal muscle.

Oncogene and tumor suppressor gene expression changes in the peripheral blood leukocytes of patients with colorectal cancer

Aims and background The mortality of colorectal cancer continues to stagnate despite the development of new therapeutic approaches. Therefore, identifying high-risk population groups could contribute to the prevention of a considerable part of deaths caused by colorectal tumors. Methods Fifty patients with colon cancer and 50 patients with other, nonmalignant diseases were selected for the study. Expression of the c-myc, Ha-ras and p53 genes was determined in the peripheral leukocytes of the participants. Results Marked elevations of the expression of all three investigated genes were seen in the colon cancer patients when compared to the controls. Conclusions Our investigations showed that increases in the expression of c-myc, Ha-ras and p53 genes can be demonstrated in the peripheral leukocytes of colon cancer patients. By applying our method to clinical investigations, individuals with a high risk of having developed colon cancer may be identified and early diagnosis may be established.

Unexpected Insensitivity of the Cholinergic Motor Responses to Morphine in the Human Small Intestine

Background/Aims: Morphine is known to inhibit cholinergic contractions of the guinea pig small intestine. This has been compared to the human small intestinal innervated longitudinal muscle in the current study. Methods: Cholinergic primary contractions of human small intestinal longitudinal strips were evoked by electrical field stimulation (EFS; 0.5– 5 Hz in the presence of purinergic and nitrergic blockers or 5 Hz without pretreatment) and recorded isotonically in organ bath experiments. Guinea pig small intestinal segments were also studied. Results and Conclusion: Neurogenic cholinergic contractions of human preparations were unaffected by morphine (1, 2 or 10 µmol/l). Longitudinal contractions of the guinea pig ileum were concentration-dependently suppressed by morphine (0.1–10 µmol/l). It is concluded that myenteric neurons supplying the longitudinal muscle of the human small intestine are much less sensitive to morphine than those of the guinea pig.

Smooth Muscle-Depressant Activity of AP-18, a Putative TRPA1 Antagonist in the Guinea Pig Intestine

AP-18, a putative antagonist at TRPA1 receptor/ion channel, caused smooth muscle relaxation at 10-100 µmol/l. It inhibited cholinergic twitch responses evoked by electrical field stimulation of cholinergic nerves as well as contractions in response to acetylcholine and histamine in the guinea pig small intestine. AP-18 (30 µmol/l) blocked spontaneous contractions of longitudinal strips of human jejunum. It is concluded that AP-18 may have limited value in studying TRPA1-mediated responses in smooth muscles and should probably be used with care in other preparations because of possible nonspecific effects.

Pancreatic carcinoid in childhood.

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First experiences with duodenum-preserving resection of the head of the pancreas in the treatment of chronic pancreatitis

A new procedure, duodenum-preserving resection of the head of the pancreas, has been developed for the surgical treatment of chronic pancreatitis with inflammatory enlargement of the pancreatic head.

The TRPA1 Activator Allyl Isothiocyanate (AITC) Contracts Human Jejunal Muscle: Pharmacological Analysis.

The contractile effect of AITC (300 μM) on human jejunal longitudinal strips was inhibited by the TRPA1 antagonist HC 030031 and atropine or scopolamine, but was insensitive to tetrodotoxin, purinoceptor antagonists or capsaicin desensitization. It is concluded that TRPA1 activation stimulates a cholinergic mechanism in a tetrodotoxin-resistant manner.

Pancreasrák. A Magyar Hasnyálmirigy Munkacsoport bizonyítékon alapuló kezelési irányelvei

A pancreasrak gyakran kesőn diagnosztizalt korkep, amely a legrosszabb korlefolyasu betegsegek csoportjaba sorolhato, ezert a szűrese, diagnosztikaja, kezelese es palliacioja korszerű es bizonyitekokon alapulo utmutatot igenyel. A Magyar Hasnyalmirigy Munkacsoport celul tűzte ki, hogy a jelenleg elerhető nemzetkozi iranyvonalakat, illetve evidenciakat alapul veve a pancreasrak kezelesenek kulcskerdesei vonatkozasaban bizonyitek alapu iranyelveket fogalmazzon meg. A Magyar Hasnyalmirigy Munkacsoport altal kijelolt előkeszitő es konzulens munkacsoport leforditotta, es ahol szuksegesnek talalta, kiegeszitette es/vagy modositotta a nemzetkozi iranyelveket. Osszesen 10 temakorben (Rizikofaktorok es genetika, Szűres, Diagnozis, Staging, Sebeszi kezeles, Patologiai feldolgozas, Szisztemas kezeles, Sugarterapia, Palliacio es szupportiv kezeles, Utankovetes es rekurrencia) 37 relevans iranyelv kerult osszeallitasra. Az evidencia osztalyozasa a National Comprehensive Cancer Network (NCCN) rendszere alapjan kerult meghatarozasra. Az osszeallitott iranyelvek a 2014. szeptember 12-ei konszenzustalalkozon kerultek bemutatasra es megvitatasra. A resztvevők 15 iranyelvet teljes (95% feletti) egyetertessel, mig 22 iranyelvet erős (70% feletti) egyetertessel fogadtak el. A Magyar Hasnyalmirigy Munkacsoport kezelesi iranyelvei az első, bizonyitek alapjan keszult pancreasrak-kezelesi utmutato hazankban. Az iranyelv komoly segitseget nyujthat a pancreasrak oktatasahoz, a mindennapi betegellatashoz es a megfelelő finanszirozas kialakitasahoz. Ezert a szerzők biznak abban, hogy ezen iranyelvek minel szelesebb korben alapreferenciakent fognak szolgalni Magyarorszagon. Orv. Hetil., 2015, 156(8), 326–339.Pancreatic cancer is a disease with a poor prognosis usually diagnosed at a late stage. Therefore, screening, diagnosis, treatment and palliation of pancreatic cancer patients require up-to-date and evidence based management guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available scientific evidence and international guidelines. The preparatory and consultation board appointed by the Hungarian Pancreatic Study Group translated and complemented/modified the recent international guidelines. 37 clinical statements in 10 major topics were defined (Risk factors and genetics, Screening, Diagnosis, Staging, Surgical care, Pathology, Systemic treatment, Radiation therapy, Palliation and supportive care, Follow-up and recurrence). Evidence was graded according to the National Comprehensive Cancer Network (NCCN) grading system. The draft of the guideline was presented and discussed at the consensus meeting in September 12, 2014. Statements were accepted with either total (more than 95% of votes, n = 15) or strong agreement (more than 70% of votes, n = 22). The present guideline is the first evidence-based pancreatic cancer guideline in Hungary that provides a solid ground for teaching purposes, offers quick reference for daily patient care and guides financing options. The authors strongly believe that these guidelines will become a standard reference for pancreatic cancer treatment in Hungary.

Rupture of pseudoaneurysm into hepaticojejunal anastomosis: report of three cases.

Bleeding complications are less common after major pancreatic resections. They are more often associated with pancreatic fistula. The authors present three cases of a unique situation, when pseudoaneurysm of the common hepatic artery ruptured into the hepaticojejunal anastomosis, causing massive upper gastrointestinal haemorrhage. The basic operations were pancreatic resections for malignancy. In two out of the three cases intra-abdominal infection developed postoperatively. Computer tomographic angiography was a useful tool to reveal the source of bleeding. A re-do surgery was carried out whereby bleeding control was achieved with haemostatic sutures and the biliodigestive anastomoses were also repaired. Re-bleeding did not occur postoperatively and the liver function remained normal. The authors emphasize that in case of severe gastrointestinal bleeding after pancreatic resection, this rare entity ought to be taken into account in the differential diagnosis.