Az akut pancreatitis pathomechanizmusának és terápiájának a vizsgálata = Pathomechanism and therapy of acute pancreatitis

Choleszterin gazdag diétával kiváltott hyperlipidemia nem befolyásolta az enyhe, ödémás pancreatitist, de súlyosbította a nekrotizáló pancreatitist. Hyperlipidemia csökkentette az endogén gyökfogók és a cNOS szintjét, iNOS és NF-kB aktivációt idézett elő és fokozta az ONOO- képződést a pancreasban. Ezen eltérések lehetnek felelősek a nekrotizáló pancreatitis súlyosbodásáért. Akut pancreatitis esetén az enterális táplálás az állatok súlyvesztését, a mortalitást, a pancreatitis súlyosságát és a pancreas bakteriális felülfertőződését mérsékelte, a pancreas regenerációját gyorsította. Ezen hatásokért a bélbe jutó táplálék trophicus hatása és a bélnyálkahártya integritásáért felelős nitrogén oxid anyagcserében bekövetkező kedvező változások tehetők felelőssé. A biopsziás mintavétel nem teljesen megbízható a sessilis nyálkahártya léziók azonosításában. Ezért egy adott léziónál, a méretétől és a típusától függően a teljes, endoszkópos eltávolításra kell törekedni, hogy biztos diagnózist lehessen felállítani, ill. így egyben végleges terápiát is lehet nyújtani. Szteroid terápia klinikai, morfológiai és funkcionális regressziót eredményez autoimmun pancreatitisben. Az MR képalkotás a morfológiai és a funkcionális változásokat egyaránt képes detektálni a hasnyálmirigyben. Ez növeli a vizsgálómódszer diagnosztikus hatékonyságát a krónikus pancreatitis korai felismerésében. | Hyperlipidemia induced with cholesterol-enriched diet did not worsen edematous, but aggravated necrotizing pancreatitis. Hyperlipidemia leads to decreases in endogenous scavenger and cNOS activities, results in iNOS and NF-?B activation and stimulates ONOO- generation in the pancreas, which may be responsible for the aggravation of acute necrotizing pancreatitis. Enteral feeding reduces the weight loss, mortality, the severity of acute pancreatitis, and the bacterial superinfection of pancreas, fasten the regeneration of pancreas in experimental acute pancreatitis. The trophic effects of nutriments in the gut, and the favorable modification in nitric oxide metabolism are responsible for these changes. Forceps biopsy is insufficiently reliable for the identification of gastric polyps. These lesions should be fully resected by endoscopic mucosal resection for a final diagnosis and (depending on the lesion size and type) possibly definitive treatment. Steroid therapy is clinically, morphologically, and functionally effective in patients with autoimmun pancreatitis. MRCP permits visualization of the ductal changes and furnishes functional information on the pancreas; this combination may enhance its diagnostic accuracy so that MRCP can become a valuable diagnostic means in early-stage chronic pancreatitis

The Effects of Hypokalaemia on the Hormone Exocytosis in Adenohypophysis and Prolactinoma Cell Culture Model Systems

The extracellular ion milieu determines the exocytosis mechanism that is coupled to spontaneous electrical activity. The K+ ion plays crucial role in this mechanism: as the potassium current is associated with membrane hyperpolarization and hormone release through protein cascade activation. The primary aim of this study was to investigate the response mechanisms of normal adenohypophysis and adenohypophyseal prolactinoma cell populations at different extracellular K+ levels with an otherwise isoionic milieu of all other essential ions. We focused on prolactin (PRL) and adrenocorticotrophic hormone (ACTH) release.In our experimental study, female Wistar rats (n=20) were treated with estrone-acetate (150 mug/kg b.w./week) for 6 months to induce prolactinomas in the adenohypophysis. Primary, monolayer cell cultures were prepared by enzymatic and mechanical digestion. PRL and ACTH hormone presence was measured by radioimmunoassay or immuno-chemiluminescence assay. Immunocytochemistry was used to assess the apoptotic cells.Differences between the effects of hypokalaemia on normal adenohypophysis cultures and prolactinoma cell populations were investigated. Significant alteration (p<0.001, n=10) in hormone exocytosis was detected in K+ treated adenohypophyseal and prolactinoma cell cultures compared to untreated groups. Immunocyto-chemistry showed that Bcl-2 expression was reduced under hypokalaemic conditions.The decrease in hormone exocytosis was tightly correlated to the extracellular K+ in both cell types, leading to the conclusion that external K+ may be the major factor for the inhibition of hormone release. The significant increase in hormone content in supernatant media suggests that hypokalaemia may play important role in apoptosis

Visceral pleural infiltration as a negative prognostic factor in lung metastasis

The prognostic value of visceral pleural infiltration in lung metastasis was analysed. Fifty-two patients (32 males and 20 females) were operated on for lung metastases. The locations of the primary tumours were as follows: 19 colon, 10 kidneys, 8 melanomas, 3 breast, 3 bladder, 2 uterus, 2 osteosarcomas, 1 testis, and 1 parotid, 1 haemangiopericytoma, 1 thyroid gland and 1 larynx. Explorative thoracotomies and incomplete resections were excluded from the study. Visceral pleural infiltration was present in 20 of the 52 cases. There was a significant correlation between the occurrence of pleural infiltration and multiple lesions (P=0.019). The overall five-year survival rate was 33.6%. In a subgroup of 38 patients with N0 and single metastases, the five-year survival rate was 73% and 12% in the cases without and with visceral pleural infiltration, respectively (P=0.003). Multivariate analysis of pleural infiltration, lymph node metastasis, multiple lesions and DFI revealed that only pleural infiltration (P=0.003) had a significant impact on survival. In one-third of the pulmonary metastases, visceral pleural infiltration appeared. There was a significant correlation between the occurrence of visceral pleural infiltration and multiple lesions. Visceral pleural infiltration in lung metastasis is a negative prognostic factor, and in these cases, survival was significantly reduced