Multimodality Treatment in Pancreatic and Periampullary Cancer

__Abstract__ Pancreatic cancer is the eight most common form of cancer in Europe with 96.000 new cases yearly. This incidence closely matches the mortality rate, thus revealing the aggressive behaviour of this tumour. Five-year survival after diagnosis is only 5% with a median overall survival of 2-8 months. For the patients undergoing surgery, the 5 year survival rate increases to 5% to 25% with a median survival of 12- 15 months. At presentation only 15-20% of the patients have a resectable, and thus possibly curative disease, while the majority of the patients already has locally advanced (i.e. unresectable) or even metastasized pancreatic cancer. The retroperitoneal location of the pancreas plays an important role in the absence of specific complaints. Obstructive jaundice, caused by obstruction of the distal common bile duct by tumours located in the pancreatic head, is a late symptom. This lack of evident clinical manifestations frequently results in a delayed diagnosis and is one of the reasons why pancreatic cancer is usually detected in late stages where curation is no longer an option. In the pancreatic head a variety of tumours can be found, all with its own biological behaviour. Pancreatic ductal adenocarcinoma originating in the pancreatic ducts is the most common and most aggressive tumour resulting in the shortest survival. Periampullary tumour

A Single-Lumen Central Venous Catheter for Continuous and Direct Intra-abdominal Pressure Measurement

Background: Abdominal compartment syndrome (ACS) is associated with high morbidity and mortality rates. Therefore, the need for a good diagnostic tool to predict intra-abdominal hypertension (IAH) and progression to ACS is paramount. Bladder pressure (BP) has been used for several years for intra-abdominal pressure (IAP) measurement but has the disadvantage that it is not a continuous measurement. In this study, a single-lumen central venous catheter (CVC) is placed through the abdominal wall into the abdominal cavity to continuously and directly monitor the intra-abdominal pressure (CDIAP). The aim of this study was to evaluate the use of CDIAP to measure BP as a representative of the true IAP. Methods: Both BP and CDIAP were prospectively recorded on a variety of surgical patients admitted to the intensive care unit (ICU) from March 2003 up to December 2004. At the end of the surgical procedure, the CVC was placed through the abdominal wall and connected to a pressure transducer. In addition, the BP was measured through the urine drainage port after clamping the catheter and filling the bladder with 50 ml of 0.9% saline. At least three paired measurements (BP and CDIAP) were performed for at least one day on the ICU in a standardized manner at preset time intervals on each patient. The paired measurements were compared using the Bland-Altman (B-A) method. Data are presented as mean ± standard deviation. Results: Over a period of 22 months (March 2003 until December 2004), 125 paired measurements of both BP and CDIAP were recorded on 25 patients. The mean age was 72.4 ± 6.6 years. Eighteen patients underwent central vascular surgery, and seven patients with peritonitis received laparotomy. The mean CDIAP was 11.4 ± 4.8 (range 2-30) mmHg, and the BP was 12.9 ± 5.3 (range 3-37) mmHg. The mean difference between CDIAP and BP was 1.6 ± 2.7 mmHg. There was an acceptable level of agreement (intraclass correlation 0.82) between IAP measured by BP and IAP measured via CDIAP. Conclusion: Continuous direct intra-abdominal pressure measurement proved that the BP measurement approach of Kron is representative of the IAP. CDIAP measurement is accurate and makes it easier for the nursing staff to be informed of the IAP

Ischemic acute necrotizing pancreatitis in a marathon runner

Context: Acute pancreatitis due to pancreatic ischemia is a rare condition. Case report: In this case report we describe a 57-year-old male who developed an acute necrotizing pancreatitis after running a marathon and visiting a sauna the same evening, with an inadequate fluid and food consumption during both events. Conclusions: Pancreatic ischemia imposed by mechanical and physical stress and dehydration can induce the development of acute pancreatitis. Separately, these factors are rare causes of ischemic acute pancreatitis. But when combined, as in this particular case, the risk of an acute necrotizing pancreatitis cannot be neglected.</p

Ischemic acute necrotizing pancreatitis in a marathon runner

Context: Acute pancreatitis due to pancreatic ischemia is a rare condition. Case report: In this case report we describe a 57-year-old male who developed an acute necrotizing pancreatitis after running a marathon and visiting a sauna the same evening, with an inadequate fluid and food consumption during both events. Conclusions: Pancreatic ischemia imposed by mechanical and physical stress and dehydration can induce the development of acute pancreatitis. Separately, these factors are rare causes of ischemic acute pancreatitis. But when combined, as in this particular case, the risk of an acute necrotizing pancreatitis cannot be neglected.</p

Type I interferons as radiosensitisers for pancreatic cancer

Background: Radiotherapy is an established treatment for malignant localised disease. Pancreatic cancer however seems relatively insensitive to this form of therapy. Methods: Pancreatic cancer cell lines MiaPaca-2 and Panc-1 were pre-treated with 3000 IU/ml IFN alpha or 100 IU/ml IFN beta followed by 0, 2, 4, or 6 Gray (Gy) irradiation. Colony forming assay was used to assess the effects on cellgrowth. To measure the surviving fraction at the clinically relevant dose of 2 Gy (SF2), cells were pre-treated with 1000-10.000 IU/ml IFN alpha or 50-500 IU/ml IFN beta followed by 2 Gy irradiation. Results: The plating efficiency was 49% for MiaPaca-2 and 22% for Panc-1. MiaPaca-2 was more radiosensitive than Panc-1 (surviving fraction of 0.28 versus 0.50 at 4 Gray). The SF2 of MiaPaca-2 was 0.77 while the SF2 of Panc-1 was 0.70. The SF2 significantly decreased after pretreatment with IFN alpha 1000 IU/ml (p < 0.001) and IFN beta 100 IU/ml (p < 0.001) in MiaPaca-2 and with IFN alpha 5000 IU/ml (p < 0.001) and IFN beta 100 IU/ml (p < 0.01) in Panc-1. The sensitising enhancement ratio (SER) for IFN alpha 3000 IU/ml was 2.15 in MiaPaca-2 and 1.90 in Panc-1. For IFN beta 100 IU/ml the SER was 1.72 for in MiaPaca-2 and 1.51 in Panc-1. Conclusions: Type I interferons have radiosensitising effects in pancreatic cancer cell lines. This radiosensitising property might lead to an improved response to treatment in pancreatic cancer. Interferon beta is the most promising drug due to its effect in clinically obtainable doses. (C) 2011 Elsevier Ltd. All rights reserved