Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Endoscopic placement of Wallstents was thought to be a less invasive procedure, and in previous publications serious complications were infrequent. We report here on the case of a 58-year-old man with unresectable pancreatic cancer who developed emphysematous cholecystitis after endoscopic placement of a Wallstent, which was further complicated by distal migration of the stent. A second stent had to be placed into the first to fully bridge the malignant stricture. Three days later, the patient developed cholecystitis and septic complications, and he finally died of septic shock with disseminated intravascular coagulation. This previously unreported complication should be considered if abdominal pain and high fever develop after Wallstent placement.
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PMID:Emphysematous cholecystitis after endoscopic wallstent placement complicated by distal migration of the stent. 890 88

An effective local-regional therapy is needed for adenocarcinomas of the pancreas. Paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton NJ) may enhance the effect of radiation therapy. Paclitaxel synchronizes cells at G2/M, a relatively radiosensitive phase of the cell cycle. We have shown that response to paclitaxel and concurrent radiation (paclitaxel/RT) was not affected by p53 mutations in non-small cell lung cancer (NSCLC). This suggested that paclitaxel/RT was a rationale treatment approach for other malignancies which frequently harbor p53 mutations such as upper gastrointestinal malignancies. We have completed a phase I study of paclitaxel/RT for locally advanced pancreatic and gastric cancers. The maximum tolerated dose (MTD) of paclitaxel was 50 mg/m2/week for 6 weeks with abdominal radiation. The dose limiting toxicities were abdominal pain within the radiation field, nausea and anorexia. Twenty-five patients with locally advanced pancreatic cancer have now completed treatment at the phase II dose level of paclitaxel 50 mg/m2/week with 50 Gy concurrent RT. Thus far, the only grade 3/4 toxicities have been hypersensitivity reactions in 2 patients, asymptomatic grade 4 neutropenia in 3 patients, and non-neutropenic biliary sepsis in 1 patient. Of the first 22 assessable patients treated at the phase II study, 8 obtained a partial response (PR) for a preliminary response rate of 36%. These findings demonstrate that paclitaxel/RT is well tolerated with substantial activity for locally advanced pancreatic cancer.
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PMID:Paclitaxel and concurrent radiation for locally advanced pancreatic carcinoma. 979 3

Two cases of unresectable pancreatic cancer underwent percutaneous ethanol injection (PEI). The first was a 65-year-old man with a 43 x 39 mm mass in the head of the pancreas. He received PEI (total 38.5 ml of ethanol) 6 times. Serum CA19-9 decreased from 3,800 U/ml to 1,700 U/ml. The patient was dead 6 months after PEI. Autopsy revealed coagulative necrosis at the site of ethanol injection. The second case was a 66-year-old man with a 70 x 50 mm mass in the body of the pancreas. He was treated by PEI (total 10 ml). After PEI, his abdominal pain was relieved considerably. He died 4 months after PEI treatment. These findings suggest that PEI may be useful not only for pain control but also for tumor reduction of unresectable pancreatic cancer.
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PMID:[Percutaneous ethanol injection for unresectable pancreatic cancer-report of two cases]. 979 22

A 66-year-old woman was admitted to our hospital complaining of abdominal pain and jaundice. Upper gastrointestinal series and computed tomography revealed pancreatic cancer. Pancreatectomy could not be performed because of portal invasion and multiple liver metastasis. Cholecystectomy, choledochojejunostomy and gastrojejunostomy were performed. The patient was treated with methotrexate (MTX) 100 mg/m2 i.v. followed one hour later with 5-fluorouracil (5-FU) 700 mg/m2. Leucovorin rescue of 10 mg po was given 24 hours after MTX administration. Treatment was repeated every 14 days. As a result, the size of a primary tumor of the pancreas was reduced (42%) on computed tomography, and the CEA level decreased to 27.8 ng/ml from 84 ng/ml. No side effects were observed. The patient continued to receive chemotherapy at our outpatient clinic for 20 months. She died of exacerbation of carcinomatous peritonitis 23 months after initial admission. Therefore, we conclude that MTX/5-FU sequential therapy seems beneficial to manage advanced pancreatic carcinoma from the viewpoint of antineoplastic activity as well as quality of life.
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PMID:[A case of unresectable pancreatic cancer responding to MTX/5-FU sequential therapy]. 998 14

An effective locoregional therapy is needed for adenocarcinomas of the pancreas, stomach, and gastroesophageal junction. Paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) may enhance the effect of radiation therapy (RT). Paclitaxel synchronizes cells at G2/M, a relatively radiosensitive phase of the cell cycle. We have shown that response to paclitaxel and concurrent RT (paclitaxel/RT) was not affected by p53 mutations in non-small cell lung cancer. This finding suggested that paclitaxel/RT was a rational treatment approach for other malignancies that frequently harbor p53 mutations, such as upper gastrointestinal malignancies. We completed a phase I study of paclitaxel/RT for locally advanced pancreatic and gastric cancer. The maximum tolerated dose of paclitaxel was 50 mg/m2/wk for 6 weeks with abdominal RT. The dose-limiting toxicities were abdominal pain within the radiation field, nausea, and anorexia. Phase II studies are now under way. Twenty-five patients with locally advanced pancreatic cancer have been entered at the phase II dose level of paclitaxel 50 mg/m2/wk with concurrent RT (total dose, 50 Gy). Thus far, the only grade 3/4 toxicities have been hypersensitivity reactions (n = 2), asymptomatic grade 4 neutropenia (n = 3), and nonneutropenic biliary sepsis (n = 1). Of the first 18 assessable patients with pancreatic cancer treated on the phase II study, six obtained a partial response, for a preliminary response rate of 33%. In the phase II study for locally advanced gastric cancer, 20 patients have been enrolled. Of the first 19 patients who have completed treatment, nine (47%) had grade 3/4 toxicities, including nausea, anorexia, esophagitis, and gastritis. Of the first 16 patients with gastric cancer, complete and partial responses have been observed in one and eight patients, respectively, for a preliminary response rate of 56%. We have also completed treatment on 24 patients with potentially resectable adenocarcinomas of the gastroesophageal junction with neoadjuvant paclitaxel 60 mg/m2 and cisplatin 25 mg/m2, weekly for 4 weeks, with concurrent RT (total dose, 40 Gy) followed by surgical resection. Ten patients (41%) had grade 3/4 toxicities, including neutropenia, nausea, and dehydration. Of 24 patients, four complete responses (17%) and 14 partial responses (58%) were observed, for an overall response rate of 75%. Severe esophagitis was uncommon, making this a well-tolerated outpatient regimen for adenocarcinomas of the distal esophagus. These findings demonstrate that paclitaxel-based chemoradiation for locally advanced upper gastrointestinal malignancies is well-tolerated with substantial activity.
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PMID:Paclitaxel and concurrent radiation therapy for locally advanced adenocarcinomas of the pancreas, stomach, and gastroesophageal junction. 1021 May 40

The difficulty in an early diagnosis of pancreatic cancer is in the absence of early symptoms due to lower limit of detection of the actual imaging techniques. Clinical symptoms like weight loss, abdominal pain and jaundice indicate an advanced cancer stage. Today 50% of pancreatic tumors are diagnosed in advanced metastatic stage and only 20-30% show resectable cancer. Ultrasound and determination of a mucine like antigen as CA 19-9, CA 50 and CA 195 seem to allow an earlier diagnosis with a higher rate of resective surgery and a prolonged survival for these patients. The mucines are high molecular weight glycoproteins consistent of a backbone protein to which oligosaccarides are attached. The linkage of carbohydrate to the peptide is termed O-glycosidic and involves the hydroxylic groups of serine or threonine with N-acetylglucosamine. Only the backbone proteins are genetically determined (genes MUC). The gangliosides are the same or derivative of Lewis antigen. CA 19-9, CA 50 and CA 195 are assays directed to different epitopes probably present on the same mucinous antigen. These epitopes are not present in different mucines as CA 15-3, CA 125 and TAG 72. Recently other two mucines are emploied CA 242 and CAM 17.1 but they are not better than CA 19-9. The use of a "triplet" of tumor markers as CA 19-9, CA 125 and CEA is the best diagnostic tool for cancer of pancreas in an "integrated" use with ultrasonographic evaluation of the lesion. CA 19-9 permits differential diagnosis from neuroendocrine tumor or pancreatitis, the values of CA 125 and CEA are useful in the evaluation of the stage, resectability and prognosis of pancreatic cancer. The recent use of CA19-9 for the evaluation of radiochemotherapy in preoperative management of the patient is a mode of a well known application of tumor markers in a kinetic evaluation of the tumor for the radicality of therapy, follow-up, recurrence and the effectiveness of the palliative therapy.
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PMID:[Tumor markers in the diagnosis of pancreatic cancer]. 1023 75

The incidence of pancreatic cancer continues to increase and, although improving of diagnostic techniques, the prognosis is very poor with 5-year survival less than 5% and high mortality cancer rate. Neural and lymphatic micrometastases appear in early stages and curative resection is possible in few selected cases; in these patients there is a high local recurrence rate and a low median survival. Most patients with pancreatic cancer need palliative care of the obstructive jaundice (90%), duodenal stenosis and abdominal pain; endoscopic procedures have an important role in the treatment of these patients. Endoscopic placement of plastic biliary stents is a safe and efficient technique to perform a biliary drainage with a short hospital stay. The use of metal stent, instead of plastic prosthesis, improve median patency of the prosthesis with a low incidence of cholangitis, but they should be used only in patients with a life expectancy of more than six months, because of their high costs. Laparoscopic gastro-entero-anastomosis is a valid alternative to laparotomic procedure in the treatment of the duodenal stenosis, with a shorter hospital stay and a lower morbidity rate. The endoscopic treatment of abdominal pain with pancreatic endoprosthesis placement or with endosonography-guided celiac plexus neurolysis is an alternative approach to radiotherapy and analgesic drugs.
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PMID:[Role of endoscopy in the palliative therapy of pancreatic cancer]. 1023 83

Acute pancreatitis is a rare finding in childhood but probably more common than is generally realized. This condition should be considered in the evaluation of children with vomiting and abdominal pain, because it can cause significant morbidity and mortality. Clinical suspicion is required to make the diagnosis, especially when the serum amylase concentration is normal. Recurrent pancreatitis may be familial as a result of inherited biochemical or anatomic abnormalities. Patients with hereditary pancreatitis are at high risk for pancreatic cancer.
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PMID:Childhood pancreatitis. 1032 57

Congenital variants of the pancreaticobiliary junction are rare anomalies that are usually diagnosed in childhood because of recurrent abdominal pain and jaundice. These lesions are associated with several pancreaticobiliary diseases including pancreatitis and malignancy. We observed a rare anomaly of the pancreaticobiliary tract with a combination of several ductal malformations, i.e., choledochal cyst, long common channel and incomplete pancreas divisum in a patient with pancreatic cancer.
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PMID:A rare malformation of the pancreaticobiliary junction long common channel choledochal cyst and pancreas divisum in a patient with pancreatic cancer. 1043 Mar 13

Most of the successful serological markers used in pancreatic cancer diagnosis detect circulating mucins which are back-secreted into the blood circulation. These markers have sensitivities (70-95%) and specificities (70-95%) which compare well with those achieved by imaging tests yet they have been subjected to very critical review and are still not widely used. There seem to be two main reasons for this: firstly, they are biochemical tests and clinicians tend to expect and demand 100% accuracy for such tests: secondly, the failure of serological tests to prove adequate for screening seems to have deterred clinicians from using them in more appropriate situations. It should have been realised that screening of asymptomatic cases was never going to be achievable until methods could be found for defining a high risk population. With a prevalence of about 10 per 100,000, say 20 per 100,000 adults, a test with 99% specificity (far in excess of that achievable by any current imaging or biochemical tests) would produce 1,000 false positive results for every 20 true positives, a hopelessly unacceptable ratio. In symptomatic patients the odds are very different. The prevalence of pancreatic cancer may be as high as about 15% in patients over 40 years old who have unexplained upper abdominal pain or weight loss and in whom upper G-I endoscopy is negative. In these patients serological tests (with a false positive rate of about 15%) will fare at least as well as imaging tests. Combination of the two modalities i.e. an imaging test such as ultrasound or CT scanning together with a biochemical test such as CA19.9, DuPan2 or CAM17.1 seems both logical and highly practical and has been shown to enhance diagnostic accuracy. The best established pancreatic tumour marker assays all detect mucins. Pancreatic cancers have a particular propensity to secrete mucin into the blood either because of mechanical blockage of the pancreatic duct, loss of polarity of pancreatic cells or early blood vessel invasion. Other mucin secreting cancers e.g. colon and ovary can also cause increased concentrations of the same serological markers albeit less frequently but this is not usually a major cause of confusion since the clinical features are usually distinguishable. Serological markers correlate with tumour staging but are nevertheless still effective in resectable cancer. They may also have a useful role in monitoring after surgical resection or chemotherapy. A serological mucin assay such as CA19.9, CAM17.1, DuPan2 or SPan-1 should be used in conjunction with a scanning test in the diagnosis of patients over 40 with endoscopy-negative abdominal pain, in the investigation of patients with a known pancreatic mass or cyst, and for monitoring following resection or chemotherapy for pancreatic cancer.
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PMID:Usefulness of novel tumour markers. 1043 1


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