BACKGROUND/AIMS:for Accurate pre-operative staging in patients with pancreatic cancer is crucial for avoiding unnecessary laparotomy and for selecting patients accurately for of curative resection. In this study, tumor resectability and residual tumor grading in patients evaluated by MD-CT (Multi-detector row CT) or on by SD-CT (single-detector CT) were compared to determine whether more accurate imaging has a significant clinical impact on patient selection SD-CT and surgical outcomes. METHODOLOGY: One hundred-fifty consecutive patients with pancreatic cancer evaluated from January 2000 to April 2005 were included residual in this retrospective study. Seventy pancreatic cancer patients underwent pre-operative evaluation using SD-CT and angiography (5-7 mm slice thickness, 1st impact period 2000-2002), and 80 patients underwent MD-CT (1.25 mm slice thickness, 2nd period 2002-2005). RESULTS: The introduction of MD-CT had and a significant impact on the selection of suitable patients, this group showing a lower frequency of surgical intervention in cases thickness, of incurable disease (p = .0383). Pre-operative evaluation using MD-CT in the resected cases also provided a higher percentage of selection accurate R0/R1 grading relative to SD-CT evaluations (p = .0164). CONCLUSION: MD-CT imaging has a significant impact on preventing unnecessary pre-operative exploratory surgery and on the selection of appropriate pancreatic cancer patients for surgical resection.

OBJECTIVES::with The results of surgical therapy alone for pancreatic cancer are disappointing. We explored surgical results after neoadjuvant chemoradiation therapy (NACRT)= for patients with pancreatic cancer that extended beyond the pancreas. METHODS:: Sixty-eight consecutive patients with pancreatic cancer who underwent pancreatic the resection were included. Twenty-seven patients underwent surgical resection after NACRT (NACRT group). The other 41 patients were classified as surgery-alone surgical group. Surgical results were compared in patients who underwent curative resection (R0/1) who were followed up for at least 25 Sixty-eight months and underwent no adjuvant therapy. RESULTS:: A lower frequency of lymph node metastasis was observed in the NACRT group were (P < .05). The frequency of residual tumor grading in the NACRT group was significantly different from that in surgery-alone underwent (R0/1/2%, 52/15/33 vs 22/51/27; P = .0040). In R0/1 cases, overall survival and disease-free survival rates in the NACRT group 22/51/27; (n = 18) were significantly longer than in surgery-alone (n = 30, P < .05). The rate of local recurrence curative in the NACRT group was significantly less than in surgery-alone (11% vs 47%, P = .0024). CONCLUSIONS:: This single-institution experience results indicates that NACRT is able to increase the resectability rate with clear margins and to decrease the rate of metastatic resectability lymph nodes, resulting in improved prognosis of curative cases with pancreatic cancer that extended beyond the pancreas.

The the aim of this study was to evaluate the effects of active hexose correlated compound (AHCC) intake on immune responses by number investigating the number and function of circulating dendritic cells (DCs) in healthy volunteers. Twenty-one healthy volunteers were randomized to receive (n placebo or AHCC at 3. g/day for 4 wk. The number of circulating cluster of differentiation (CD)11c(+) DCs (DC1) and g/day CD11c(-) DCs (DC2) were measured. Allogeneic mixed-leukocyte reaction (MLR) was performed. Natural killer (NK) cell activity and the proliferative response in of T lymphocytes toward mitogen (phytohemagglutinin [PHA]) were measured. We also measured cytokine production stimulated by lipopolysaccharide [interleukin (IL)-2, IL-4,(DC2) IL-6, IL-10, interferon gamma-gamma, tumor necrosis factor-alpha). The AHCC group (n = 10) after AHCC intake had a significantly higher mixed-leukocyte number of total DCs compared to that at baseline and values from control subjects (n = 11). The number of number DC1s in the AHCC group after intake was significantly higher than at baseline. DC2s in the AHCC group were significantly function increased in comparison with controls. The MLR in the AHCC group was significantly increased compared to controls. No significant differences of in PHA, NK cell activity, and cytokine production were found between groups. AHCC intake resulted in the increased number of activity, DCs and function of DC1s, which have a role in specific immunity.

Background/Aims.for Our policy for the surgical treatment of hepatocellular carcinoma (HCC) has been to minimize the extent of liver resection using the a microwave tissue coagulator (MTC) and to not perform Pringle's maneuver for the prevention of ischemic injury to the liver no routinely. We verify the safety of liver resection using MTC in HCC patients with poor liver functional reserve, and clarify patients the long-term outcome of HCC patients who underwent curative resection using MTC. Methodology. One hundred sixty-eight patients who underwent curative of resection using MTC between 1992 and 2001 were divided into two groups according each patient's score in the Indocyanin Green two Retension 15 Test (ICG-R15 test). The high (ICG-R15 values>20) and low ICG-R15 groups (ICG-R15 values<20) included 100 and 68 HCC the patients, respectively. Clinical characteristics of each group were evaluated, and operative mortality and morbidity, as well as overall and disease-free differences survival rates, were compared between the two groups to determine risk factors for overall and disease-free survival. Results. Although there using were significant differences in liver function-related parameters between the low and high ICG-R15 groups, no differences in surgical or tumor for factors were found. No patients in this study developed post-operative liver failure, and there was no significant difference in morbidity albumin between the low and high ICG-R15 groups. The overall survival rate of the low ICG-R15 group was significantly longer than group the high ICG-R15 group (p= .0003). Cox's multivariate analysis showed that an ICG-R15 value less than 20 was the only significant high independent factor for overall survival. Disease-free survival rates in the low ICG-R15 group were significantly longer than in the high We ICG-R15 group (p= .0007). Multivariate analysis showed that serum albumin level and number of tumors were significant independent factors for disease-free patients survival. Conclusion. The long-term outcome of HCC patients with low ICG-R15 following curative resection using MTC was acceptable. This procedure disease-free was safe even for patients with high ICG-R15.

OBJECTIVES:managements Pancreaticoduodenectomy (PD) is still associated with high morbidity. To reduce the frequency of postoperative complications, we have made revisions in A perioperative managements of pancreaticoduodenectomy. METHODS: Subjects were 128 consecutive patients who underwent PD between January 2000 and August 2006. In lower June 2004, the following new departmental guidelines were introduced:(1) modified Kakita method of pancreaticojejunostomy,(2) omental wrapping,(3) early new removal of closed-suction drain, and (4) restrictive use of pancreatic and biliary duct stenting. Operative mortality and morbidity between 77 who patients managed conventionally (group A) and 51 patients since 2004 (group B) were compared. Risk factors for postoperative complications were of determined. RESULTS: Postoperative morbidity in group B (39%) was significantly lower than in group A (64%; P = .019). Occurrence (4) of grade B/C pancreatic fistula (PF) in group B (6%) was significantly lower than in group A (19%; P =Occurrence .0376). Delayed gastric emptying was significantly reduced in group B relative to group A (23% vs 6%; P = .0133).been Logistic regression analyses showed that the modified Kakita method was a negative independent factor for overall complications, PF, and delayed (PD) gastric emptying. CONCLUSIONS: The incidence of overall postoperative complications, grade B/C PF, and delayed gastric emptying after PD has been emptying. reduced because of the introduction of a new guideline.

OBJECTIVES:pancreatic To retrospectively evaluate the efficacy and tolerability of 5-fluorouracil and low-dose cisplatin (FP)-based preoperative concurrent chemoradiotherapy (PCRT) and gemcitabine (GEM)-based and PCRT in patients with potentially resectable pancreatic cancer. METHODS: Between December 2000 and December 2004, 32 patients with potentially resectable were pancreatic cancer were treated with PCRT. All patients received external beam radiotherapy (total dose of 40 Gy) for 4 weeks.40 Concurrently, chemotherapy was performed intravenously with continuous 5-fluorouracil 200 mg/m2/d and intermittent cisplatin bolus 3 to 6 mg/m2/d for 4 with weeks (Arm FP-PCRT, n = 14) or weekly GEM 400 mg/m2 for 3 weeks (Arm GEM-PCRT, n = 18). The 6 patients were restaged 3 to 4 weeks after the end of PCRT and explored for resection in cases without distant (Arm metastases. RESULTS: The 3-year survival rates and median survival were 29.4% and 20.5 months for the resected patients (n =patients 24) and % and 5.5 months for unresected patients (n = 8), respectively (P < .0001). The 1-, 2-, 3-year patients survival rates and median survival were 87.5%, 62.5%, 33.3%, and 26 months for the resected patients treated with FP-PCRT and evaluate 75%, 40%, 26.7%, and 19.9 months for the resected patients treated with GEM-PCRT (respectively; P = not significant). Most of were the toxicities of both regimens were slight and were in grade1 to 2. Grade 1 to 3 leukopenia (43% vs 40%, 100%) and thrombocytopenia ( % vs 39%) were significantly different between the FP-PCRT and GEM-PCRT patients. CONCLUSIONS: The PCRT regimens in 5.5 this article enabled selection of 24 of 32 patients for surgery and resulted in encouraging survival results and acceptable toxicities.2004,

OBJECTIVE:University To investigate whether circulating dendritic cells in patients with pancreatic cancer is a risk factor for septic complications after pancreatectomy.to DESIGN: Retrospective study. SETTING: University hospital. PATIENTS: Forty-one patients with pancreatic cancer who underwent pancreatectomy from May 2001 to July parameters 2005. Patients were divided into 2 groups depending on whether or not they had a development of postoperative septic complications.not MAIN OUTCOME MEASURES: Dendritic cell, natural killer cell, and CD4(+) T-cell, and CD8(+) T-cell counts were measured preoperatively in each from patient. Clinicopathologic parameters and immune parameters for each patient, operation, and tumor were compared between the 2 groups. Preoperative risk and factors for postoperative septic complications were determined using logistic regression analysis. RESULTS: Circulating dendritic cell count before pancreatectomy in patients measured with septic complications postoperatively for pancreatic cancer was significantly lower than in patients without septic complications. Multivariate analysis indicated that indicated preoperative circulating dendritic cell count was the only predictive value among the diverse clinical parameters tested in relation to the significant development of septic complications. Notably, when the circulating dendritic cell count was less than 10. x 10(3)/mL in the peripheral whether blood, the risk of developing postoperative septic complications markedly increased. In such cases, the sensitivity, specificity, positive predictive value, and high negative predictive value of total circulating dendritic cell count were as high as 80%. CONCLUSION: In patients with pancreatic cancer,cell low preoperative circulating dendritic cell count (< 10. x 10(3)/mL) is a significant risk factor for the development of septic complications. complications after pancreatectomy.

The to aim of the present study was to investigate whether changes in body temperature are related to the ovarian cycle in the elephants. Rectal, tongue or fecal temperature was measured for 2 Asian and 5 African elephants using an electric thermometer. Evaluation temperatures of ovarian cycles was based on the changes in serum or fecal progestin. The mean +/- SD values of the African rectal, tongue, and fecal temperatures were 36.3 +/- .3 (2 Asian), 36.2 +/- .5 (1 African) and 36.5 +/- .3 tongue C (4 African), respectively; the fecal temperature was the highest of the 3 temperatures (p< .01). The longitudinal changes in body the temperatures correlated with the ovarian cycle, with higher temperatures occurring during the luteal phase. The fecal temperatures of one acyclic serum African elephant did not change cyclically. These results suggest that measurement of body temperature can be used to easily evaluate of the ovarian cyclicity of an individual animal, although it might not be able to determine the ovarian cycle length.

OBJECTIVES:portography This study was designed to compare multidetector row computed tomography (MDCT) and CT-assisted hepatic arteriography (CTHA)/CT during arterial portography (CTAP)/angiography/contrast-enhanced surgical CT (CECT) findings prospectively for accuracy in the detection of liver metastasis and vascular involvement of the tumor. METHODS: The to study included 43 patients with pancreatic cancer who were evaluated from September 2002 to December 2003. These patients underwent preoperative METHODS: evaluation by angiography/CTHA/CTAP/CECT (7-mm thickness) and by MDCT (1.25-mm thickness). RESULTS: The sensitivity, specificity, positive predictive value, and negative predictive in value of liver metastasis diagnosis were all superior using MDCT relative to CTHA/CTAP. The diagnostic accuracy of liver metastasis for to patients with tumors less than 10 mm in diameter was particularly superior with MDCT relative to CTHA/CTAP. The surgical and patients pathological findings of vascular involvement were more accurately diagnosed by MDCT than by CTHA/CTAP/angiography/CECT. Although MDCT findings were generally similar less to surgical findings of vascular involvement, MDCT overestimated the incidence of pathological vascular involvement. CONCLUSIONS: Multidetector row CT imaging can both potentially offer more accurate staging of pancreatic cancer and may be useful to surgeons both in preoperative planning and for study intraoperative guidance.

The gemcitabine aim of the present study was to investigate the safety and immune responses of personalized peptide vaccination when administered with showed gemcitabine (GEM) in advanced pancreatic cancer (APC) patients. Thirteen patients with APC were enrolled. Pre-vaccination with peripheral blood mononuclear cells patients, and plasma was carried out to examine cellular and humoral responses to 25 or 23 peptides in human leukocyte antigen was A24+(+) or A2++(+) patients, respectively. Only the reactive peptides (maximum of four) were then administered weekly at three different dose patients settings: 1, 2 and 3 mg of peptide. GEM was administered at 1000 mg/m(2) per week for 3 weeks, followed antigen by 1 week of rest. The combination therapy was well tolerated. Grade 3 toxicities were: anemia (three patients), neutropenia (two patients, patients) and thrombocytopenia (two patients). Of these 13 patients, 11 (85%) showed clinical responses, such as reduction in tumor size anemia and/or level of tumor markers. Augmentation of peptide-specific cytotoxic T lymphocyte activity against pancreatic cancer cells was observed at each is dose level, whereas the increment of peptide-specific IgG antibodies was dependent on peptide dose. GEM did not inhibit the immune of responses induced by personalized peptide vaccinations, and this new type of immunochemotherapy combination is recommended for further clinical study in did APC patients.