Róbert Papp

Pancreatic Cancer: Multicenter Prospective Data Collection and Analysis by the Hungarian Pancreatic Study Group.

BACKGROUND AND AIMS Pancreatic cancer is a devastating disease with poor prognosis. There is very limited information available regarding the epidemiology and treatment strategies of pancreatic cancer in Central Europe. The purpose of the study was to prospectively collect and analyze data of pancreatic cancer in the Hungarian population. METHODS The Hungarian Pancreatic Study Group (HPSG) organized prospective, uniform data collection. Altogether 354 patients were enrolled from 14 Hungarian centers. RESULTS Chronic pancreatitis was present in 3.7% of the cases, while 33.7% of the patients had diabetes. Family history for pancreatic cancer was positive in 4.8%. The most frequent presenting symptoms included pain (63.8%), weight loss (63%) and jaundice (52.5%). The reported frequency of smoking and alcohol consumption was lower than expected (28.5% and 27.4%, respectively). The majority of patients (75.6%) were diagnosed with advanced disease. Most patients (83.6%) had a primary tumor located in the pancreatic head. The histological diagnosis was ductal adenocarcinoma in 90.7% of the cases, while neuroendocrine tumor was present in 5.3%. Biliary stent implantation was performed in 166 patients, 59.2% of them received metal stents. Primary tumor resection was performed in 60 (16.9%) patients. Enteral or biliary bypass was done in 35 and 49 patients, respectively. In a multivariate Cox-regression model, smoking status and presence of gemcitabine-based chemotherapy were identified as independent predictors for overall survival. CONCLUSION We report the first data from a large cohort of Hungarian pancreatic cancer patients. We identified smoking status and chemotherapy as independent predictors in this cohort.

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.

Ganglioneuroma in the papilla of Vater with neurofibromatosis type 1: report of a case.

Ganglioneuromas (GNs) are rare benign tumors and their association with neurofibromatosis type 1 (NF-1) is especially uncommon. We report in this article the case of a young woman, subjected to diagnostic work-up because of abdominal pain. Endoscopy and histology revealed not only a GN in the papilla of Vater, but also NF-1. Because of the size and macroscopic features of the lesion, we performed pancreatoduodenectomy, from which she recovered uneventfully. Histological examination of the resected tumor confirmed a diagnosis of GN.

High versus low energy administration in the early phase of acute pancreatitis (GOULASH trial): protocol of a multicentre randomised double-blind clinical trial

Introduction Acute pancreatitis (AP) is an inflammatory disease with no specific treatment. Mitochondrial injury followed by ATP depletion in both acinar and ductal cells is a recently discovered early event in its pathogenesis. Importantly, preclinical research has shown that intracellular ATP delivery restores the physiological function of the cells and protects from cell injury, suggesting that restoration of energy levels in the pancreas is therapeutically beneficial. Despite several high quality experimental observations in this area, no randomised trials have been conducted to date to address the requirements for energy intake in the early phase of AP. Methods/design This is a randomised controlled two-arm double-blind multicentre trial. Patients with AP will be randomly assigned to groups A (30 kcal/kg/day energy administration starting within 24 hours of hospital admission) or B (low energy administration during the first 72 hours of hospital admission). Energy will be delivered by nasoenteric tube feeding with additional intravenous glucose supplementation or total parenteral nutrition if necessary. A combination of multiorgan failure for more than 48 hours and mortality is defined as the primary endpoint, whereas several secondary endpoints such as length of hospitalisation or pain will be determined to elucidate more detailed differences between the groups. The general feasibility, safety and quality checks required for high quality evidence will be adhered to. Ethics and dissemination The study has been approved by the relevant organisation, the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (55961-2/2016/EKU). This study will provide evidence as to whether early high energy nutritional support is beneficial in the clinical management of AP. The results of this trial will be published in an open access way and disseminated among medical doctors. Trial registration The trial has been registered at the ISRCTN (ISRTCN 63827758).

[Pancreatojejunostomy--with purse-string suture].

INTRODUCTION Pancreatic fistula is one of the most relevant complications following pancreatoduodenectomies. Significant effort has been made to decrease it. The aim of the authors was to show a pancreatojejunal anastomosis combined with purse-string suture, and report the first experiences, as well. MATERIAL AND METHODS The implantation pancreatojejunostomy - which has been applied by the authors since 2003 - was modified, that the remnant of the pancreas was fixed in the jejunum with one purse-string and two mattress sutures. In case of a soft pancreas the Wirsungian duct was stented, then the vein canule was pulled out to the outside throught the afferent jejunal limb. The method was applied in seven patients during pylorus-preserving pancreatoduodenectomy performed for neoplasm. RESULTS In the postoperative period there were two complications in two patients noted (a bleeding ulcer developed in the region of the duodenojejunostomy and a transient confusion). However there was no pancreatic fistula, reoperation or early mortality detected. CONCLUSIONS While major conclusions can not be drawn due to the relatively small number of cases, this method seems promising and it is worth to carry out further trials.

Appleby-műtét − lehetőség truncus coeliacust infiltráló pancreastest tumor sebészi kezelésére

Absztrakt: Esetismertetes: Esetunkben neoadjuvans onkologiai kezelest kovetően egy olyan pancreas baloldali tumor sebeszi eltavolitasat ismertettuk, ami infiltralta a truncus coeliacus oszlast es a gyomort is. A beavatkozas soran a truncust resecaltuk, distalis pancreatectomiat, splenectomiat, total gastrectomiat, bal mellekvese-resectiot es cholecystectomiat vegeztunk. Betegunk zavartalanul gyogyult, csupan atmeneti majfunkcios laborelterest tapasztaltunk. A histologiai feldolgozas R1 resectiot mutatott, ezert adjuvans onkologiai kezelesre kerul sor. Megbeszeles: A pancreas distalis tumorai gyakran inoperabilisak. Ilyennek szamitott sokaig a truncus coeliacus oszlasat involvalo elvaltozas is, azonban van lehetőseg radikalis műtetre a truncus resectiojaval, ami utan a maj arterias verellatasat a pancreaticoduodenalis arkad biztositja. Egy esetunk kapcsan ismertettuk a műteti technikat es az ezzel kapcsolatosan felmerulő kerdeseket. Arterias infiltraciot mutato pancreastumor eseten feltetlenul ajanlott a p...

Evidence Supports Tradition: The in Vitro Effects of Roman Chamomile on Smooth Muscles

The dried flowers of Chamaemelum nobile (L.) All. have been used in traditional medicine for different conditions related to the spasm of the gastrointestinal system. However, there have been no experimental studies to support the smooth muscle relaxant effect of this plant. The aim of our research was to assess the effects of the hydroethanolic extract of Roman chamomile, its fractions, four of its flavonoids (apigenin, luteolin, hispidulin, and eupafolin), and its essential oil on smooth muscles. The phytochemical compositions of the extract and its fractions were characterized and quantified by HPLC-DAD, the essential oil was characterized by GC and GC-MS. Neuronally mediated and smooth muscle effects were tested in isolated organ bath experiments on guinea pig, rat, and human smooth muscle preparations. The crude herbal extract induced an immediate, moderate, and transient contraction of guinea pig ileum via the activation of cholinergic neurons of the gut wall. Purinoceptor and serotonin receptor antagonists did not influence this effect. The more sustained relaxant effect of the extract, measured after pre-contraction of the preparations, was remarkable and was not affected by an adrenergic beta receptor antagonist. The smooth muscle-relaxant activity was found to be associated with the flavonoid content of the fractions. The essential oil showed only the relaxant effect, but no contracting activity. The smooth muscle-relaxant effect was also detected on rat gastrointestinal tissues, as well as on strip preparations of human small intestine. These results suggest that Roman chamomile extract has a direct and prolonged smooth muscle-relaxant effect on guinea pig ileum which is related to its flavonoid content. In some preparations, a transient stimulation of enteric cholinergic motoneurons was also detected. The essential oil also had a remarkable smooth muscle relaxant effect in this setting. Similar relaxant effects were also detected on other visceral preparations, including human jejunum. This is the first report on the activity of Roman chamomile on smooth muscles that may reassure the rationale of the traditional use of this plant in spasmodic gastrointestinal disorders.

Metasztázis miatt végzett máj- és hasfalreszekció 11 évvel a pancreatoduodenectomia után

Absztrakt: A pancreasrak prognozisa kedvezőtlen. A betegseg kiujulasa tipusosan főleg a posztoperativ első ket evben tortenik. A kesői es szoliter metasztazis azonban ritka. Esetunkben egy ferfi beteg kortortenetet mutatjuk be, aki hasnyalmirigyrak miatt radikalis műteten esett at. A betegnel 11 evvel kesőbb egy szoliter majmetasztazist diagnosztizaltak, amelyet az epben reszekaltunk. Egy evvel a műtet utan betegunk jo altalanos allapotban van. Esetunk demonstralja, hogy pancreastumor miatt reszekcioban reszesitett betegeknel indokolt lehet ismetelt műtet kesői, izolalt metasztazis eseten. Orv Hetil. 2017; 158(28): 1109–1111.

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.

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.