Expression of estrogen (ER) and progesterone receptors, c-erbB-2 oncogene, mutant p53 antioncogene (mp53), e-cadherin adhesion, and apoptotic caspase-8 antigens in tumor relative to matched normal tissue specimens from 102 unselected patients with primary ductal breast carcinoma of various tumor grades was assessed by immunohistochemistry and correlated with patient's biologic and clinical features, such as age, menstrual status, age of menarche, tumor grade and diameter, the presence or absence of metastases, and number of infiltrated lymph nodes. We observed association of e-cadherin adhesion, ER and progesterone antigen marker expression with low histologic grade tumors and limited number of lymph node metastases and of c-erbB-2, mp53, and casp-8 antigen marker expression with high histologic grade tumors and increased number of lymph node metastases. We also observed strong correlation (P<0.05) between 4 of the 6 biomarkers and 4 of the 7 patient/tumor parameters examined. Our findings support the hypothesis of independent expression of these 4 strong biomarkers and reveal that nearly 40% of all breast tumor cases studied express similar proportions of 2 major phenotypic combinations [ER/c-erbB-2/mp53/casp-8: +/+/-/+ (19.6%) & +/-/-/+ (17.8%)]. We conclude that, in agreement with earlier reports, our findings support the diagnostic and potential prognostic value of these markers in the clinical assessment of breast cancer.

Expression of 6 common antigenic markers in invasive ductal breast carcinoma: potential clinical implications.

Introduction: The poor prognosis seen after the Whipple procedure greatly depends on leaks from pancreatic-duodenal anastomosis. Objective: To evaluate ligation of the pancreatic duct without reconstruction of the gastrointestinal tract continuity to prevent pancreatic postoperative fistula occurrence and to reduce surgical time. Methods: An experimental study was carried out on New Zealand adult rabbits who underwent pancreatic duct ligation without pancreatic-duodenal anastomosis. Pancreatic enzyme was administered orally to one operated group; another group of animals was operated on and monitored without enzyme replacement. Results: The groups were compared, and variations in weight and metabolic profiles were assessed. No significant differences were found between both operated groups in terms of postoperative mortality or reoperations. Discussion/Conclusion: The morbidity associated with pancreatic duct ligation is low, the procedure is well tolerated, and endocrine insufficiency does not seem to be a problem in the animal model.

/pdf/occlusion-of-the-main-pancreatic-duct-as-a-method-to-avoid-a-588a5kcmjm.pdf

Occlusion of the Main Pancreatic Duct as a Method to Avoid a Pancreatojejunal Anastomosis: Metabolic Consequences

"Duct tape:" Management strategies for the pancreatic anastomosis during pancreatoduodenectomy.

In an effort to avoid the morbidity and mortality related to pancreaticojejunal anastomosis after pancreaticoduodenectomy (PPD), we report on the treatment of the pancreatic stump by pancreatic duct ligation (PDL) following Whipple procedure. We studied a series of 9 consecutive unselected patients (8 with pancreatic cancer and 1 with chronic pancreatitis). Of those, pancreatic fistula occurred in 4 patients and persisted for 14 to 58 days (mean 35.4 days). Two patients died within 30 days after surgery from causes not related to PDL. None of our patients developed diabetes mellitus following PDL surgery, nor any of the other frequently mentioned postoperative complications such as acute pancreatitis or pancreatic insufficiency. In conclusion, PDL may occasionally lead to a controlled pancreaticocutaneous fistula with fading inactive contents over time not causing further metabolic complications but is a safe, simple and fast alternative to pancreaticojejunostomy.

Reevaluating pancreatic duct ligation in Whipple procedure.

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Reevaluating pancreatic duct ligation in Whipple procedure.