Curative Chemoradiotherapy of Primary Pancreatic Lymphoma with Vertebral Metastasis: Palliation of Persistent Biliary Stricture by Roux-en-Y Hepaticojejunostomy

Primary pancreatic lymphoma (PPL) is a rare tumor that usually presents with the clinical picture of advanced adenocarcinoma but has a much better prognosis. A 38-year-old man was referred after percutaneous transhepatic external biliary drainage for obstructive jaundice. Abdominal magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography had revealed a 5-cm pancreatic head mass that caused biliary tract dilation. Computed tomography angiography showed that the mass encased the celiac trunk as well as the common hepatic and splenic arteries. MRI also revealed a metastatic lesion at the third lumbar vertebra. Serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels were within normal range. The initial diagnosis was inoperable pancreatic adenocarcinoma; however, Tru-Cut pancreatic biopsy showed a large B cell lymphoma. After 6 sessions of chemotherapy and 21 sessions of radiotherapy, both the pancreatic mass and the vertebral metastasis had disappeared. However, he had persistent distal common bile duct stricture that could not be negotiated by either the endoscopic or percutaneous route. A Roux-en-Y hepaticojejunostomy was performed. The patient stayed alive without recurrence for 52 months after the initial diagnosis and 45 months after completion of oncologic treatment. In conclusion, a large pancreatic mass with grossly involved peripancreatic lymph nodes, without ascites, liver or splenic metastasis, should alert the clinician to the possibility of PPL. Cure is possible by chemoradiotherapy even in the presence of vertebral metastasis. Persistent stricture in the distal common bile duct may require a biliodigestive anastomosis

Effects of the Starch Types and the Grafting Conditions on the In Vitro Mucoadhesiveness of the Starch-graft-Poly(Methacrylic Acid) Hydrogels

In the present study, grafting of poly(methacrylic acid) (PMAA) onto various types of starches (maize; rice; wheat; potato) is realized in the aqueous media for the first time using methacrylic acid as monomer and ammonium cerium-IV-nitrate as initiator system. The effects of the gelatinization pretreatment and the use of a crosslinker in the grafting reactions are investigated. The formation of the starch-graft-poly(methacrylic acid) (S-g-PMAA) is confirmed by Fourier transform infrared spectroscopy analysis. The grafting amounts (GA%) of the S-g-PMAAs are determined. The swelling and the erosion characteristics of the S-g-PMAAs are examined in deionized water and pH = 5 lactate buffer solution as an in vitro vaginal medium. Mechanical and in vitro mucoadhesiveness of the S-g-PMAAs are also investigated using ewe vaginal mucosa. The results demonstrate that the gelatinization pretreatment and crosslinking significantly affect the GA% values, swelling, erosion, mechanical, and mucoadhesive characteristics of the S-g-PMAAs depending on the types of starches. S-g-PMAAs with different mechanical and reasonable mucoadhesiveness can be obtained by manipulating the grafting conditions and using various types of starches. It is concluded that S-g-PMAAs could be appropriate candidates for applications as vaginal drug delivery systems