Malignant obstruction of the bile duct from cholan-giocarcinoma,pancreatic adenocarcinoma,or other tumors is a common problem which may cause debilitating symptoms and increase the risk of subsequent surgery.The optim...Malignant obstruction of the bile duct from cholan-giocarcinoma,pancreatic adenocarcinoma,or other tumors is a common problem which may cause debilitating symptoms and increase the risk of subsequent surgery.The optimal treatment-including the decision whether to treat prior to resection-depends on the type of malignancy,as well as the stage of disease.Preoperative biliary drainage is generally discouraged due to the risk of infectious complications,though some situations may benefit.Patients who require neoadjuvant therapy will require decompression for the prolonged period until attempted surgical cure.For pancreatic cancer patients,self-expanding metallic stents are superior to plastic stents for achieving lasting decompression without stent occlusion.For cholangiocarcinoma patients,treatment with percutaneous methods or nasobiliary drainage may be superior to endoscopic stent placement,with less risk of infectious complications or failure.For patients of either malignancy who have advanced disease with palliative goals only,the choice of stent for endoscopic decompression depends on estimated survival,with plastic stents favored for survival of < 4 mo.New endoscopic techniques may actually extend stent patency and patient survival for these patients by achieving local control of the obstructing tumor.Both photodynamic therapy and radiofrequency ablation may play a role in extending survival of patients with malignant biliary obstruction.展开更多
Prehepatic portal hypertension induces a splanchnic low-grade inflammatory response that could switch to high-grade inflammation with the development of severe and life-threatening complications when associated with c...Prehepatic portal hypertension induces a splanchnic low-grade inflammatory response that could switch to high-grade inflammation with the development of severe and life-threatening complications when associated with chronic liver disease. The extraembryonic origin of the portal system maybe determines the regression to an extraembryonic phenotype, i.e., vitellogenic and amniotic, during the evolution of both types of portal hypertension. Thus, prehepatic portal hypertension, or compensated hypertension by portal vein ligation in the rat, is associated with molecular mechanisms related to vitellogenesis, where hepatic steatosis and splanchnic angiogenesis stand out. In turn, extrahepatic cholestasis in the rat induces intrahepatic portal hypertension, or decompensated hypertension, with ascites and hepatorenal syndrome. The splanchnic interstitium, the mesenteric lymphatic system, and the peritoneal mesothelium seem to create an inflammatory pathway that could have a key pathophysiological relevance in the production of ascites. The hypothetical comparison between the ascitic and the amniotic fluid also allows for translational investigation. The induced regression of the splanchnic system to extraembryonic functions by portal hypertension highlights the great relevance of the extraem-bryonic structures even during postnatal life.展开更多
Objective To identify effects of bile acids on pancreatic cancer, The ultrastructure and growth of PANC-1 and MIA PaCa-2 cell lines in crude bile modified medium were studied. Methods The growth of PANC-1 and MIA PaCa...Objective To identify effects of bile acids on pancreatic cancer, The ultrastructure and growth of PANC-1 and MIA PaCa-2 cell lines in crude bile modified medium were studied. Methods The growth of PANC-1 and MIA PaCa-2 cells in RPMI 164o with or without 1%, 2% and 4% of the purified crude bile (containing total bile acids 1o. 17mmol/L) was assessed for 2, 4, 6, 8d by using MTT assay to determine inhibitory rate- The cell surface and intracellular ultrastructure of PANC-1 cells was investigated by SEM and TEM at 24h and 48h, respectively. Results The proliferation of both cell lines in bile treated medium were greatly retarded (P <o. oo1). The inhibitory rate of 1 %, 2% and 4% bile on Panc-1 cells in 4d were 38%, 6o% and 66%, respectively (P <o. o5), on MIA PaCa-2 cells at 4d were 28%, 39% and 52%, respectively (P <o. o5). The ceIls grown in bile for 48h lost their microvilli, their mitochondria and other organelles became vacuolated. Conclusion The bile acids in bile has cytotoxicity on PANC-1 and MIAPACA-2 cells, which may inhiblt pancreatic cancer progress in patients clinically.展开更多
文摘Malignant obstruction of the bile duct from cholan-giocarcinoma,pancreatic adenocarcinoma,or other tumors is a common problem which may cause debilitating symptoms and increase the risk of subsequent surgery.The optimal treatment-including the decision whether to treat prior to resection-depends on the type of malignancy,as well as the stage of disease.Preoperative biliary drainage is generally discouraged due to the risk of infectious complications,though some situations may benefit.Patients who require neoadjuvant therapy will require decompression for the prolonged period until attempted surgical cure.For pancreatic cancer patients,self-expanding metallic stents are superior to plastic stents for achieving lasting decompression without stent occlusion.For cholangiocarcinoma patients,treatment with percutaneous methods or nasobiliary drainage may be superior to endoscopic stent placement,with less risk of infectious complications or failure.For patients of either malignancy who have advanced disease with palliative goals only,the choice of stent for endoscopic decompression depends on estimated survival,with plastic stents favored for survival of < 4 mo.New endoscopic techniques may actually extend stent patency and patient survival for these patients by achieving local control of the obstructing tumor.Both photodynamic therapy and radiofrequency ablation may play a role in extending survival of patients with malignant biliary obstruction.
文摘Prehepatic portal hypertension induces a splanchnic low-grade inflammatory response that could switch to high-grade inflammation with the development of severe and life-threatening complications when associated with chronic liver disease. The extraembryonic origin of the portal system maybe determines the regression to an extraembryonic phenotype, i.e., vitellogenic and amniotic, during the evolution of both types of portal hypertension. Thus, prehepatic portal hypertension, or compensated hypertension by portal vein ligation in the rat, is associated with molecular mechanisms related to vitellogenesis, where hepatic steatosis and splanchnic angiogenesis stand out. In turn, extrahepatic cholestasis in the rat induces intrahepatic portal hypertension, or decompensated hypertension, with ascites and hepatorenal syndrome. The splanchnic interstitium, the mesenteric lymphatic system, and the peritoneal mesothelium seem to create an inflammatory pathway that could have a key pathophysiological relevance in the production of ascites. The hypothetical comparison between the ascitic and the amniotic fluid also allows for translational investigation. The induced regression of the splanchnic system to extraembryonic functions by portal hypertension highlights the great relevance of the extraem-bryonic structures even during postnatal life.
文摘Objective To identify effects of bile acids on pancreatic cancer, The ultrastructure and growth of PANC-1 and MIA PaCa-2 cell lines in crude bile modified medium were studied. Methods The growth of PANC-1 and MIA PaCa-2 cells in RPMI 164o with or without 1%, 2% and 4% of the purified crude bile (containing total bile acids 1o. 17mmol/L) was assessed for 2, 4, 6, 8d by using MTT assay to determine inhibitory rate- The cell surface and intracellular ultrastructure of PANC-1 cells was investigated by SEM and TEM at 24h and 48h, respectively. Results The proliferation of both cell lines in bile treated medium were greatly retarded (P <o. oo1). The inhibitory rate of 1 %, 2% and 4% bile on Panc-1 cells in 4d were 38%, 6o% and 66%, respectively (P <o. o5), on MIA PaCa-2 cells at 4d were 28%, 39% and 52%, respectively (P <o. o5). The ceIls grown in bile for 48h lost their microvilli, their mitochondria and other organelles became vacuolated. Conclusion The bile acids in bile has cytotoxicity on PANC-1 and MIAPACA-2 cells, which may inhiblt pancreatic cancer progress in patients clinically.
