Lajos Flautner

Effect of enteral nutrition on exocrine pancreatic function

Twelve patients with chronic pancreatitis underwent a pancreatoduodenectomy in which the pylorus was preserved. The effects of parenteral and enteral nutrition on pancreatic secretion were compared. Postoperative nutrition was administered by needle-catheter jejunostomy in seven patients and by total parenteral nutrition in five patients. Pancreatic juice, drained directly from the pancreatic duct, was collected in 4-hour fractions. Volume, bicarbonate, protein, amylase, and chymotrypsin were measured. In the first two postoperative days, there was a slow increase in all measured indices. On the third postoperative day, an abrupt rise occurred, after which pancreatic secretion stabilized. No differences in exocrine pancreatic secretion were observed between the enteral and parenteral methods of feeding.

Pancreatogastrostomy: An ideal complement to pancreatic head resection with preservation of the pylorus in the treatment of chronic pancreatitis

We have reported our experience with pancreatoduodenectomy with preservation of the pylorus performed in 37 patients for the treatment of chronic pancreatitis and its complications. The remaining pancreatic tail duct was occluded in 12 patients without anastomosis. Eight complications were observed and reoperation was necessary in two patients. Three complications and one reoperation occurred in the 25 patients who underwent pancreatogastrostomy. There was no operative mortality in the 37 patients. Six to 30 months postoperatively, 23 patients were free of complaints, the average weight gain was 7.6 kg, and so far no marginal ulcers have developed. Technically, pancreatogastrostomy is easy and complications may be identified early. According to our results, this type of anastomosis is the most favorable so far and is particularly suitable for the significant reduction of complications and deaths related to partial pancreatoduodenectomy.

GRP-receptor-mediated signal transduction, gene expression and DNA synthesis in the human pancreatic adenocarcinoma cell line HPAF

Bombesin-like peptides have been implicated as growth factors in various human cancers. Human adenocarcinoma cell lines (Capan-1, Capan-2, MiaPaCa-2 and HPAF) were tested to determine whether they express the gastrin-releasing peptide-preferring bombesin receptor (GRPR) and neuromedin B-preferring bombesin receptor (NMBR). Using RT-PCR the highest level of GRP receptor mRNA was found in HPAF cells. NMB receptor mRNA expression moderate in all cell lines investigated. We therefore selected the HPAF cell line to investigate whether bombesin treatment affects intracellular Ca(2+) ([Ca(2+)](i)), cAMP level, DNA synthesis as a measure of cell proliferation, and expression of three transcription factors: c-fos, c-myc and high mobility group protein IY (HMG-I(Y)).Bombesin administration led to an immediate increase in free intracellular Ca(2+) concentration ([Ca(2+)](i)) but did not change cAMP levels. The peptide also enhanced [(3)H]thymidine incorporation in HPAF cells (but not in the other cell lines), an effect that was concentration dependent, reaching 36 +/- 5% stimulation over control values at 24 h with an EC(50) of 2.27 x 10(-12) M. Furthermore, bombesin stimulated c-fos, c-myc and HMG-I(Y) expression in a time-dependent manner: the c-fos mRNA level increased dramatically in the first 30 min of exposure, then returned to basal level within 2 h, while the c-myc and HMG-I(Y) mRNA levels peaked at 2 h and 4h, respectively. All actions of bombesin were blocked by BME (D-Phe(6)-bombesin-(6-13)-methylester), a selective GRP receptor antagonist, but not by the NMB receptor antagonist BIM-23127 (D-Nal-cyclo[Cys-Tyr-D-Trp-Orn-Val-Cys]-Nal-NH(2)). We conclude that HPAF cells express mRNA for GRP receptors and that functional receptors are present in the cell membrane. The occupation of these receptors leads to a sequence of intracellular events involving rapid mobilization of intracellular Ca(2+), expression of c-fos, c-myc and HMG-I(Y) mRNA, and stimulation of cell proliferation. Conversely, although NMB receptor mRNA can be detected, its actual translation to functional receptors does not reach a detectable level.

Retinopathy of pancreatitis indicates multiple-organ failure and poor prognosis in severe acute pancreatitis

Abstract. During hospitalization for severe acute necro‐tizing pancreatitis, a connection between the onset of re‐tinopathy of pancreatitis and multiple‐organ failure was studied. Ophthalmoscopy was repeated every second day and continuous staging for multiple‐organ failure was performed in 38 patients. Typical retinopathy of pancreatitis developed in 7 of 10 patients with multiple‐organ failure and only in 4 of the 28 patients without multiple‐organ failure. Retinopathy of pancreatitis was observed in 7 of the 18 cases leading to lethal outcome and only in 4 of the 20 surviving patients. No correlation was observed between the development of retinopathy of pancreatitis and hemodialysis, pre‐existing diabetes mellitus, abnormal platelet count, result of hemoculture, c reactive protein value, fraction of inspired oxygen and adult respiratory distress syndrome. In the 21 control patients in grave general state but without acute pancreatitis, retinopathy of pancreatitis was never observed. In our prospective study the onset of retinopathy of pancreatitis had clinical prognostic value and indicated multiple‐organ failure and poor prognosis in severe acute necrotizing pancreatitis.

Inhibitory effect of a long-acting somatostatin analogue on EGF-stimulated cell proliferation in Capan-2 cells.

Numerous studies have reported diverse effects of gut-derived regulatory peptides on growth of the normal pancreas, pancreatic neoplasms induced experimentally in animals, and pancreatic cancer cell lines, but the results of these investigations are rather controversial. The stimulatory effect of epidermal growth factor (EGF) on cell proliferation of pancreatic cell lines is well established. Whether this action can be modulated by somatostatin is not clear. Furthermore, it is not certain whether another regulatory peptide, cholecystokinin (CCK), affects the proliferation of these cells. In the present study we investigated the presence of CCK-A and CCK-B, as well as somatostatin-2 (SSTR2) receptors by RT-PCR, and studied the actions of EGF, CCK and octreotide on DNA synthesis in the human pancreatic adenocarcinoma cell line Capan-2. Octreotide, a long-acting somatostatin analogue was used as somatostatin agonist. Cells were cultured in RPMI-1640 medium. They were incubated in serum free medium containing 0.2% BSA in the absence (control) or the presence of the peptides. [3H]-thymidine incorporation into DNA was measured after 48 h of incubation. By means of RT-PCR analysis we were able to demonstrate SSTR2 expression, but not CCK-A or CCK-B receptor mRNA in Capan-2 cells. DNA synthesis evaluated by [3H]-thymidine incorporation was found to be increased by 45.2 +/- 5.6% in response to EGF (10(-8) M) and decreased by 11.7 +/- 2.6% to octreotide (10(-8) M) compared to controls (P < 0.01). The increase in [3H]-thymidine incorporation was significantly lower when EGF treatment was combined with octreotide administration (10.1 +/- 2.5% over control). In the concentration range of 10(-11)-10(-8) M, CCK did not alter significantly the incorporation of [3H]-thymidine into DNA in Capan-2 cells. In conclusion, these data support a role for EGF as a growth factor for the human pancreatic cancer cell Capan-2. Somatostatin may play an important role in regulating cell proliferation in Capan-2 cells both under basal, and growth factor-stimulated conditions. Our results suggest, however, that CCK receptors are not expressed, and CCK does not affect cell proliferation in this transformed pancreatic cell line.

Ano-rectal physiological changes after rubber band ligation and closed haemorrhoidectomy.

Objective  The effect of treatment for haemorrhoids on ano‐rectal physiology was studied in a prospective longitudinal follow‐up study.

NEW TECHNIQUES IN THE MANAGEMENT OF PANCREATIC PSEUDOCYSTS

The results of an analysis on the mortality-morbidity data of 1698 operations performed for the treatment of chronic pancreatitis and/or its complications at the First Department of Surgery of Semmelweis University Medical School between 1975 and 1995 are presented herein. Special attention was focused on the effectiveness of such recently introduced techniques as posterior cystogastrostomy, cysto-Wirsungo gastrostomy, modified pylorus-preserving pancreatoduodenectomy, and blunt transparenchymal cystoduodenostomy. The posterior cystogastrostomy is technically easier to perform than the traditional Juras operation, as only the posterior ventricular wall needs to be cut open, and it can be combined with decompression-type operations. On the other hand, the cysto-Wirsungo gastrostomy achieves a long-lasting effect, and the cyst drainage in this operation ensures decompression. Moreover, if this operation is performed at an early stage, the progression of chronic pancreatitis is slowed down. The modified pylorus-preserving pancreatoduodenectomy eliminates the disadvantages of the Whipple operation and is a commonly performed operation for chronic pancreatitis localized within the head of the pancreas. However, since the introduction of the blunt transparenchymal cystoduodenostomy, the number of pancreatoduodenectomies has been reduced by 60%. This is an effective method with long-lasting results for the treatment of smaller cysts localized deeply in the head of the pancreas. The findings of this study strongly suggest that that these procedures give significantly better results for certain pathological conditions such as pancreatic pesudocysts than traditional methods.