| 1. |
- Grama, D, et al.
(författare)
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Clinical characteristics, treatment and survival of pancreatic tumors causing hormonal syndromes
- 1992
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Ingår i: World Journal of Surgery. - 0364-2313 .- 1432-2323. ; 16:4, s. 632-639
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Tidskriftsartikel (refereegranskat)abstract
- Eighty-five patients with endocrine pancreatic tumors associated with clinical syndromes of hormone excess were retrospectively analyzed regarding symptomatology, means of diagnosis, and results of surgical and medical treatment during follow-up of 3-18 years (median 8 years). The combination of angiography and computed tomography was most successful in pre-operative localization of both primary tumors and metastases. Surgery provided long term cure in 39 of 44 patients with benign islet cell lesions, the majority having insulinomas. Forty-one patients had malignant tumors, which at the time of diagnosis or operation were associated with liver and/or regional lymph gland metastases in 56% and 24%, respectively. Sixteen patients with metastatic disease and/or very large tumors were considered inoperable, 5 patients underwent palliative resection of their malignant tumors, while grossly radical tumor removal was accomplished in 20 patients. Long-term cure was achieved in 5 patients by excision of primary tumors and localized liver or lymph gland metastases. Half of the patients, particularly those with insulinoma, gastrinoma, or vipoma, showed response to streptozotocin, in combination with other cytostatics, for a median of 24 months or a response to interferon for a median of 10 months. The overall 5-year and 10-year survival among the patients with malignant islet cells tumors was 54% and 28%, respectively. Absence of liver metastases at time of operation/diagnosis, smaller size of the primary tumor, grossly radical tumor resection as well as response to medical therapy predicted the more favorable survival.
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| 2. |
- Grama, D, et al.
(författare)
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Pancreatic tumors in multiple endocrine neoplasia type 1 : clinical presentation and surgical treatment
- 1992
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Ingår i: World Journal of Surgery. - 0364-2313 .- 1432-2323. ; 16:4, s. 611-618
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Tidskriftsartikel (refereegranskat)abstract
- Among 33 patients with endocrine pancreatic tumors due to multiple endocrine neoplasia type 1 (MEN-1), 19 (58%) patients had hypergastrinemia, 7 (21%) patients had hyperinsulinism, and 7 (21%) patients had clinically non-functioning lesions. At least one gross tumor was found in all patients undergoing pancreatic surgery, including those with negative localization studies prior to operation. The patients also had additional macroscopic tumors as well as numerous microadenomas, and the lesions frequently were positive for immunostaining with multiple hormones, mainly pancreatic polypeptide, insulin, glucagon, and somatostatin. Duodenal endocrine lesions were found in 4 of 5 investigated patients and stained with gastrin and somatostatin antibodies. Distal, mainly subtotal pancreatic resection, was performed in 18 patients, eventually combined with caput tumor enucleation or duodenotomy, while a few patients underwent only tumor enucleation or a Whipple procedure. The long-term outcome of operation was most favorable in patients with hyperinsulinism; only 1 patient had clinical recurrence. Patients with hypergastrinemia experienced only transitory lowering of serum gastrin values after pancreatic surgery and 47% of them had or developed metastases. Such tumor spread was seen in 57% of the patients with non-functioning lesions. Nine patients died from progressive tumor disease during follow-up. Consistent with previous studies, we found that surgery is indicated in MEN-1 patients with hyperinsulinism even if a lesion is not visualized by radiology. In addition, these indications should be extended to also include patients with only biochemical markers of disease, including elevations of gastrin, as these indicate the presence of gross tumors.
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| 3. |
- Lepistö, J, et al.
(författare)
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Stimulation of wound healing by the immunomodulator LS-2616 (Linomide).
- 1994
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Ingår i: World Journal of Surgery. - 0364-2313 .- 1432-2323. ; 18:6, s. 818-20; discussion 821
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Tidskriftsartikel (refereegranskat)abstract
- LS-2616 (Linomide), a quinoline-3-carboxamide, is an immunomodulator that has been suggested to act on macrophage-like cells. Based on a hypothesis that LS-2616 would stimulate macrophages in the wound and affect the healing process, the effects of LS-2616 on developing granulation tissue were evaluated using a wound model in rats. Subcutaneously implanted cylindrical cellulose sponges were used as an inductive matrix for the ingrowth of granulation tissue. LS-2616 was continuously present at a concentration of 1.2 mg/ml in the drinking water either for 7 days before implantation or starting at the implantation of sponges. Seven days after implantation LS-2616 treatment increased the mean amounts of nitrogen and collagen hydroxyproline over the control level [+20% (p < 0.05) and +59% (p < 0.05), respectively]. The effect was less pronounced in the rats receiving LS-2616 in advance [+7% (NS) and +38% (p < 0.05), respectively]. The mean amounts of nucleic acids and proteoglycans tended to decrease in the rats receiving LS-2616 in advance compared to the control rats [-12% to 13% (NS) and -25% (p < 0.05), respectively]. It was concluded that continuous oral administration of LS-2616 enhanced wound repair in the rat. This immunoenhancement of wound healing results in increased accumulation of collagen.
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| 4. |
- Bergenfelz, A, et al.
(författare)
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Suppressibility of serum levels of PTH by calcium in the immediate postoperative period after surgery for primary hyperparathyroidism
- 1993
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Ingår i: World Journal of Surgery. - 0364-2313. ; 17:6, s. 10-806
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Tidskriftsartikel (refereegranskat)abstract
- The ability of calcium to suppress the secretion of parathyroid hormone (PTH) is impaired in primary hyperparathyroidism (pHPT). Whether the nonadenomatous glands in pHPT also exhibit altered calcium/PTH homeostasis is not known, but this may be the case since in the immediate postoperative period after surgery for pHPT, hypocalcemia often evolves in spite of a rapid normalization of serum levels of PTH. In this study, therefore, the suppression of serum levels of PTH by an oral calcium load was investigated pre- and postoperatively in 12 patients operated on for parathyroid adenoma. There was no difference in the calcemic response during the calcium load pre- and postoperatively. We found that the suppression of serum levels of PTH by calcium was increased already on the first postoperative day. However, postoperatively, the suppression of serum levels of PTH correlated positively to serum levels of ionized calcium and, furthermore, negatively to the weight of the excised parathyroid adenoma and the preoperative serum levels of ionized calcium. The results indicate that the function of the remaining parathyroid glands in patients with parathyroid adenoma could have been altered during the hyperparathyroid state and that postoperative hypocalcemia more readily evolves in patients with severe pHPT and impaired suppressibility of PTH (by calcium) in the remaining parathyroid glands.
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