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Biomedical subjects

H Friess

Publications and source records attributed to H Friess.

At least 271 records · Page 15Linked to original sources
PubMed1996

[Pancreas transplantation--indication, technique and results].

Pancreas transplantation is the only therapeutic measure currently available to achieve long term normoglycemia and normal HbA1 levels in diabetic patients. A live long immunosuppression with it's side effects is the price payed for that treatment. Like in renal transplantation an alternative treatment is available for potential pancreas transplant recipients so that most transplant centers are willing to perform pancreas transplantation as a combined kidney pancreas transplantation in patients with diabetic nephropathy only. This article reviews indications, technique, results and complications of simultaneous kidney pancreas transplantation and pancreas after kidney transplantation.

Diabetes Mellitus, Type 1↗
PubMed1996

The risk of pancreaticointestinal anastomosis can be predicted preoperatively.

The risk of developing postoperative complications following pancreatic resection depends mainly on how difficult it is to perform a proper pancreaticointestinal anastomosis. We have evaluated the serum pancreolauryl test, a rapid tubeless pancreatic function test, as a simple preoperative predictor of the degree of pancreatic fibrosis. Degree of fibrosis in turn provides an indirect parameter for the difficulties of performing a proper and safe pancreaticointestinal anastomosis. In 35 patients (21 chronic pancreatitis, 14 pancreatic tumors) undergoing major pancreatic resection, we found a negative correlation (r = -0.75, p < 0.001) between the degree of fibrosis at the resection margin and the serum pancreolauryl test results. Patients with chronic pancreatitis had a significantly higher degree of fibrosis at the resection margin (59 +/- 22 vs. 34 +/- 25%; X +/- SD; p < 0.01) and lower fluorescein serum concentrations (2.6 +/- 1.9 vs. 4.3 +/- 2.1 micrograms/ml; X +/- SD; p < 0.01) in comparison with patients with pancreatic tumors. These findings indicate that the degree of pancreatic fibrosis, the difficulties of performing a proper pancreaticointestinal anastomosis, and subsequently the potential risk of postoperative complications can easily be predicted preoperatively.

Adult↗
PubMed1996

[Inhibition of secretion in pancreas surgery reduces postoperative complication rate: a meta analysis of 4 multicenter studies].

We report on a meta-analysis of four randomized, placebo-controlled, double-blind multicenter trials evaluating the role of perioperative octreotide treatment in the prevention of postoperative complications following elective pancreatic surgery. From a total of 963 patients (483 placebo, 480 octreotide), the postoperative complication rate (329 placebo, 206 octreotide) and the number of patients with postoperative complications (placebo 38%, octreotide 22%) were significantly higher in the placebo groups compared with the octreotide groups. Postoperative morality was comparable between the placebo (3.9%) and the octreotide (3.5%) groups. These data indicate that perioperative application of octreotide can prevent postoperative complications following pancreatic surgery.

Double-Blind Method↗
PubMed1995

Increased expression of keratinocyte growth factor in human pancreatic cancer.

Keratinocyte growth factor (KGF) is a member of the fibroblast growth factor (FGF) group of heparin-binding polypeptides. In the present study we sought to determine whether KGF is expressed in human pancreatic cancers. Using reverse transcriptase polymerase chain reaction (RT-PCR), a cDNA fragment of KGF was cloned and used to analyze Northern blots of RNA isolated from normal and cancerous human pancreatic tissues. Seven of 16 (44%) pancreatic cancer samples revealed significant overexpression of the 2.4 kilobase KGF mRNA transcript by comparison with the normal pancreas. Northern blot analysis failed to reveal the KGF transcript in several cultured human pancreatic cancer cell lines. However, by PCR analysis, some of the cell lines expressed KGF mRNA. Furthermore, 5 of 7 tested cell lines expressed the KGF receptor, and the growth of one cell line was enhanced by human recombinant KGF. These results suggest that KGF may participate in aberrant paracrine and autocrine pathways in human pancreatic cancer.

Base Sequence↗
PubMed1995

Induction of platelet-derived growth factor A and B chains and over-expression of their receptors in human pancreatic cancer.

Expression of platelet-derived growth factor (PDGF) and PDGF receptors was examined in cultured human pancreatic cancer cells, in the normal human pancreas and in pancreatic adenocarcinomas. mRNA transcripts encoding PDGF A and B chains, and PDGF receptor beta (PDGFR beta) were present in PANC-I and HPAF human pancreatic cancer cells. Transforming growth factor beta I (TGF-beta I), but not PDGF-AA or -BB, enhanced PDGF A and B chain mRNA levels in both cell lines. In the normal human pancreas PDGF A chain mRNA levels were relatively abundant, whereas PDGF B chain mRNA levels were not detected and PDGF receptor alpha (PDGFR alpha) and beta mRNA transcripts were present at low levels. PDGF immunoreactivity was present in islet cells, and PDGFR alpha was present in acinar cells, whereas PDGFR beta was present in acinar cells and in the connective tissue. In the pancreatic cancers, PDGF A chain mRNA transcripts were also abundant, and 6 of 13 samples exhibited the PDGF B chain mRNA transcript. In addition, there was a 7-fold increase in the levels of PDGFR alpha and PDGFR beta in the cancer samples by comparison with the normal pancreas. By immunohistochemistry, PDGF and both PDGF receptors were present in the cancer cells, and PDGFR beta was abundant in fibroblasts and endothelial cells within the connective tissue.

Base Sequence↗
PubMed1995

Expression and in-situ localization of genes coding for extracellular matrix proteins and extracellular matrix degrading proteases in pancreatic cancer.

Pancreatic cancer shows a strong desmoplastic reaction characterized by a remarkable proliferation of interstitial connective tissue (collagens type I and III, fibronectin). In this study we have analyzed the balance of expression of mRNAs encoding extracellular matrix components (collagens I, III and IV, laminin, fibronectin), extracellular matrix-degrading metalloproteinases (MMP-1, -2, -3 and -9) and tissue inhibitors of metalloproteinases (TIMP-1 and -2) in pancreatic cancer and control pancreatic tissue by Northern-blot analysis and mRNA in situ hybridization. Transcripts for MMP-1 (interstitial collagenase) and MMP-3 (stromelysin-1) were not detectable in pancreatic cancer and control tissues. Steady-state levels of transcripts encoding extracellular matrix proteins, MMP-2 (72-kDa collagenase IV), MMP-9 (92-kDa collagenase type IV), TIMP-1 and TIMP-2 were elevated in the majority of pancreatic-cancer tissue samples as compared to control pancreatic tissue. A good correlation was seen between overexpression of these MMPs and TIMPs and the steady-state levels of transcripts coding for extracellular matrix proteins, the amount of collagen protein and the severity of the desmoplastic reaction. In situ hybridization studies localized transcripts coding for collagens type I and III to spindle-shaped stromal cells, whereas transcripts for MMP-2, MMP-9, TIMP-1 and TIMP-2 were found in both stromal and tumor cells. However, MMP-2 transcripts appeared to be more abundant in stromal cells, TIMP-1 and TIMP-2 transcripts were evenly distributed over tumor and stromal cells and relatively more MMP-9 transcripts were found in tumor cells. We conclude that, in human pancreatic cancer, MMP-2, MMP-9, TIMP-1 and TIMP-2 may be involved in processes leading to the strong desmoplastic reaction observed in these tumors. Both stromal and tumor cells appear to be the source of MMPs and TIMPs in human pancreatic cancer.

Blotting, Northern↗
PubMed1995

Randomized controlled multicentre study of the prevention of complications by octreotide in patients undergoing surgery for chronic pancreatitis.

A randomized double-blind placebo-controlled multicentre trial was carried out in 247 patients undergoing major elective surgery for chronic pancreatitis to clarify whether the perioperative application of octreotide prevents postoperative complications. Eleven complications were defined, including death, anastomotic leakage, pancreatic fistula, abscess, fluid collection, shock, sepsis, bleeding, pulmonary insufficiency, renal insufficiency and postoperative pancreatitis. A total of 124 patients underwent pancreatic head resection, 55 left resection, 61 pancreaticojejunostomy and seven had other procedures. The overall mortality rate was 1.2 per cent (octreotide group 1.6 per cent, placebo group 0.8 per cent [corrected] (P not significant)). The postoperative complication rate in the octreotide group was 16.4 per cent (20 of 122 patients) and in the placebo group 29.6 per cent (37 of 125) (P < 0.007). The perioperative application of octreotide substantially reduces the risk of postoperative complications in patients undergoing major pancreatic surgery for chronic pancreatitis.

Adult↗
PubMed1995

Cellular and subcellular localization of transforming growth factor-alpha and epidermal growth factor receptor in normal and diseased human and hamster pancreas.

Four normal pancreas, 8 chronic pancreatitis specimens, and 30 non-endocrine pancreatic tumors from humans and 6 normal and 6 induced pancreatic cancers in hamsters were examined immunohistochemically by antibodies against human transforming growth factor-alpha (TGF-alpha) and epidermal growth factor receptor (EGFR). Two normal pancreas and two pancreatic cancer specimens from each species were also studied immunoelectron microscopically by the immunogold method. In chronic pancreatitis, the reactivity and intensity of the staining with both antibodies were much greater in ductal/ductular cells than in the normal pancreas. All 30 pancreatic cancers reacted with both antibodies with a variable degree of reactivity and staining intensity. No correlation was found between the histological type of tumors, the degree of tumor differentiation, and the incidence and patterns of reactivity of either antibody. Immunoelectron microscopically, both EGFR and TGF-alpha were demonstrated primarily on the basal membrane. In the normal hamster pancreas, TGF-alpha was overexpressed in the alpha-cells but not in any other islet cells. Both TGF-alpha and EGFR were marginally detectable in the exocrine pancreas and in induced pancreatic lesions. This is the first demonstration of subcellular localization of TGF-alpha and EGFR in the normal and diseased human and hamster pancreas.

Adult↗
PubMed1995

Changes of protein gene product 9.5 (PGP 9.5) immunoreactive nerves in inflamed appendix.

The existence of chronic appendicitis is controversial. In this prospective study, we investigated possible changes in the innervation of the appendix under different pathological conditions and correlated histological findings with clinical observation. Thirty appendectomy specimens and 14 appendices obtained from organ donors or patients who underwent right hemicolectomy were immediately fixed in Bouin's solution and processed for immunocytochemistry using an antiserum directed against the panneuronal marker protein gene product 9.5 (PGP 9.5). The density of PGP 9.5 immunostaining was evaluated by digitized morphometry. Significant differences in the density of the PGP 9.5-immunoreactive area were detected in the mucosal layer. In the nonacute appendicitis group, PGP 9.5 was increased (10.99 +/- 3.15%) as compared to acute appendicitis (3.89 +/- 1.77%) and controls (4.98 +/- 1.25%). The significant increase of PGP 9.5 in nonacute appendicitis may suggest axonal sprouting leading to hyperinnervation of the mucosa. This may be a neuronal factor in the pathophysiology of the disease and pain symptoms.

Abdominal Pain↗
PubMed1995

Differential distribution of human epidermal growth factor receptor family in acute pancreatitis.

Using northern blot analysis and immunohistochemistry, we assessed the expression and distribution of human epidermal growth factor receptor-1 (HER-1), HER-2, and HER-3 in pancreatic tissues obtained from patients with acute pancreatitis (AP). Overall, HER-1, HER-2, and HER-3 mRNA levels were similar in the normal pancreas and in the pancreas of AP patients. However, three patients exhibited a significant increase in HER-1 mRNA levels. Furthermore, the distribution of the receptors differed with respect to the various cell types in the human pancreas. In the normal pancreas, moderate HER-1 and strong HER-3 immunoreactivity was present predominantly in the cytoplasm of acinar cells and to a lesser extent in the ductal cells, whereas strong HER-2 immunoreactivity was present in the islet cells. In the AP tissues, there was a marked increase in HER-1 immunoreactivity in acinar and ductal-like cells, whereas HER-3 immunoreactivity was less prominent in acini and increased in ductal-like cells. HER-2 immunoreactivity was again mainly evident in islet cells, but was also present in the ductal-like cells. These findings indicate that there is altered distribution of HERs in the pancreas following AP and raise the possibility that HERs may be involved in the process of pancreatic regeneration during recovery from AP.

Acute Disease↗
PubMed1995

Randomized trial of duodenum-preserving pancreatic head resection versus pylorus-preserving Whipple in chronic pancreatitis.

BACKGROUND: In about 30% of patients, chronic pancreatitis leads to an inflammatory enlargement of the pancreatic head with subsequent obstruction of the pancreatic duct, common bile duct, and duodenum. METHODS: In a prospective, randomized controlled trial, we compared duodenum-preserving pancreatic head resection (DPPHR) with pylorus-preserving Whipple (PPW) operation to define the advantages of each operation with regard to (1) postoperative complications, (2) glucose tolerance and induction of diabetes mellitus, and (3) postoperative pain and quality of life up to 6 months after operation for chronic pancreatitis. RESULTS: The two study groups of 20 patients were both well balanced with regard to sex, age, history of chronic pancreatitis, and indication for surgery. Postoperative mortality was zero. After duodenum-preserving and pylorus-preserving resection, morbidity was 15% and 20%, respectively. After 6 months, patients who underwent the duodenum-preserving resection had less pain, greater weight gain, a better glucose tolerance, and a higher insulin secretion capacity. CONCLUSION: The DPPHR compares favorably with the standard PPW operation and should be considered as an alternative procedure in the treatment of chronic pancreatitis.

Adult↗
PubMed1995

Diagnosis of pancreatic cancer by 2[18F]-fluoro-2-deoxy-D-glucose positron emission tomography.

The detection of pancreatic cancer or the discrimination between pancreatic cancer and chronic pancreatitis remains an important diagnostic problem. The increased glucose metabolism in malignant tumours formed the basis for this investigation, which focused on the role of positron emission tomography (PET) with 2[18F]-fluoro-2-deoxy-D-glucose (FDG) in the detection of pancreatic cancer and its differentiation from chronic pancreatitis. Eighty patients admitted for elective pancreatic surgery received preoperatively 250-350 mBq FDG intravenously and emission scans were recorded 45 minutes later. Intense focal activity in the pancreatic region was taken at the time of scanning as showing the presence of pancreatic cancer. The presence of cancer was later confirmed by histological examination of the surgical specimens and histological findings were compared with the preoperative PET results. Forty one patients with pancreatic cancer (group I: n = 42) had a focally increased FDG uptake in the pancreatic region. Two patients with a periampullary carcinoma (group II: n = 6) failed to develop FDG accumulation. In 28 patients with chronic pancreatitis (group III: n = 32) no FDG accumulation occurred. Overall sensitivity and specificity of PET for malignancy (group I + II) were 94% (45 of 48) and 88% (28 of 32), respectively. The standard uptake value of the patients with pancreatic carcinoma was significantly higher than in patients with chronic pancreatitis (3.09 (2.18) v 0.87 (0.56); p < 0.001; median (interquartile range)). These findings show that FDG-PET represents a new and non-invasive diagnostic procedure for the diagnosis of pancreatic cancer and to differentiate pancreatic cancer from chronic pancreatitis. However, the diagnostic potential of this technique requires further evaluation.

Adult↗
PubMed1995

2-(fluorine-18)-fluoro-2-deoxy-D-glucose PET in detection of pancreatic cancer: value of quantitative image interpretation.

PURPOSE: To evaluate use of positron emission tomography (PET) versus computed tomography (CT) in detection of pancreatic cancer and determine the value of quantitative and visual image interpretation of these techniques. MATERIALS AND METHODS: Within 8 weeks before surgery, 73 patients with suspected pancreatic cancer or chronic pancreatitis underwent imaging with CT and with static PET after injection of 250-350 MBq of 2-(fluorine-18)-fluoro-2-deoxy-D-glucose (FDG). Focal FDG uptake, considered a sign of malignancy, was calculated with standardized uptake values (SUVs) 60 minutes after injection. RESULTS: With FDG PET, pancreatic carcinoma was correctly diagnosed in 41 (95%) of 43 patients, and chronic pancreatitis in 27 (90%) of 30 patients. With an SUV cutoff value of 1.53, both sensitivity and specificity for detection of malignancy were 93%. With CT, pancreatic cancer was correctly diagnosed in 33 (80%) of 41 patients, whereas results in seven (26%) of 27 patients with chronic pancreatitis were false-positive (specificity, 74%). CONCLUSION: FDG PET enabled reliable differentiation of pancreatic adenocarcinoma from chronic pancreatitis. The sensitivity and specificity of visual image interpretation with FDG PET was statistically significantly higher (P < .05) than with CT.

Adenocarcinoma↗