Patient quality of life and pain improve after autologous islet transplantation (AIT) for treatment of chronic pancreatitis: 53 patient series at the University of Arizona

BACKGROUND/OBJECTIVES

Pancreatectomy with autologous islet transplantation has slowly been proving to be an effective way of treating chronic pancreatitis while lessening the effects of the concomitant surgical diabetes of pancreatectomy alone. Assessing patient quality of life and pain after the procedure is particularly important as intractable pain is the main complaint for which patients undergo total pancreatectomy.

METHODS

We used the Rand SF-36 and McGill pain questionnaires, and Visual Analogue Scale to assess patients preoperatively for quality of life and pain resulting from life with chronic pancreatitis. After undergoing total pancreatectomy with autologous islet transplantation (TPAIT), patients were followed with surveys administered at 1 month, 6 months, and 1 year to evaluate changes in their quality of life and pain experienced.

RESULTS

Significant improvement was reported in all components of every questionnaire within a year after surgery. Furthermore, patient reported mean scores on quality of life were found to fall within the range of the general population.

CONCLUSIONS

From our experience with 53 patients at the University of Arizona, after pancreatectomy with autologous islet transplantation patients reported a higher quality of life when compared to preoperative values, as well as reduced levels of pain.

P3-11-03: A Phase I Trial of D-Limonene in Newly Diagnosed Breast Cancer Patients: A Chemoprevention Study

Background: D-limonene (DL) is a highly lipophilic monoterpene found naturally in citrus that has been demonstrated in preclinical studies to have anticancer properties. Early phase clinical trials support the investigation of DL in the chemoprevention of breast cancer. We sought to evaluate whether DL and its presumed active metabolite perillic acid (PA) would distribute extensively to the breast tissue and reach an effective drug concentration. We hypothesized that the mechanism of DL is related to the induction of apoptosis in cancer cells.

Materials and Methods: We enrolled 40 patients with newly diagnosed Stage 0–2 breast cancer to take 2 grams daily of oral DL for 2–6 weeks prior to planned surgical intervention. Blood was drawn pre/post intervention to assess for toxicity and plasma concentration of DL and PA. Adverse effects related or possibly related to the study drug were noted. A small piece of breast tissue adjacent to the tumor mass was used to measure drug concentration for each patient. DL and PA levels in breast tissue were analyzed by gas chromatography and liquid chromatography, respectively, in tandem with mass spectrometry. Analysis of variance testing was used to determine if DL or PA preferentially concentrated in the breast tissue compared to plasma. We tested for a possible modulation of the biomarkers estrogen receptor (ER), progesterone receptor, HER2, Ki67 or grade pre/post treatment by comparing results from the core biopsy to the surgical pathology and applying pairwise Student's T tests. The caspase 3 and the annexin V assays were performed by plating 10,000 cells per well for the cell lines MCF7, MDA-231, BT474, and T47D and separately administering DL and PA acid in serial dilutions in their treatment concentration ranges in triplicate and read by microplate. Results: DL was found to preferentially concentrate in breast tissue versus plasma (tissue/plasma concentration ratio (TPCR) of 1297, p<0.001) while PA did not concentrate (TPCR of 1.4, p=0.9). 20 patients (50%) reported Grade 1 eructation, which was the most common adverse effect. A slight decrease in white count from a mean of 7.1 to 6.6 (p=0.03) and a slight increase in ALT from a mean of 22.5 to 26.9 (p=0.03) were noted. No other statistically significant changes in laboratory values related to serum complete blood count, renal, hepatic or other studies were noted. No change in tissue biomarkers were noted post-treatment. DL produced a dose dependent increase in the apoptotic markers cleaved caspase 3 and annexin V for the ER positive cell lines MCF7, BT474, and T47D, however, no such response was noted for the triple negative cell line MDA-231. A PA dose response trend was noted with the annexin V but not the caspase 3 assay for each cell line.

Discussion: D-limonene preferentially concentrates in the breast tissue and is a candidate chemopreventive agent based on its favorable side effect profile. PA does not readily concentrate in the breast when administered as oral DL. Our correlative studies establish that DL induces apoptosis in ER positive breast cancer cell lines; no definite relationship between PA and apoptosis was found. Further clinical trials of DL are necessary to establish its potential role as a chemopreventive agent in breast cancer.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-11-03.

Ischaemic rest pain of the head: a case report

A 54-year-old man presented with a 3-year history of rest pain of an ischaemic scalp ulcer. Angiography demonstrated that the only blood supply to his head was the left internal carotid artery. Stenting the left subclavian artery and subsequently allowing flow into his left vertebral artery alleviated his symptoms.

Validation of direct intraabdominal pressure measurement using a continuous indwelling compartment pressure monitor

BACKGROUND

According to recommendations, intraabdominal pressure should be monitored every 8 hours for patients at high risk of abdominal compartment syndrome. Continuous intraabdominal pressure monitoring may be valuable for these patients.

METHODS

For 15 patients undergoing laparoscopic surgery, a pressure monitor was introduced after formation of pneumoperitoneum. During the procedure, the laparoscopic insufflator pressure was varied. The pressure monitor values and the time to equilibrium were recorded.

RESULTS

Altogether, 152 pressure recordings were taken for the patients studied. The measurements from the insufflator and pressure monitor were compared using a Bland-Altman plot. The mean difference between the techniques was 0.04 +/- 3.8, and 95% of the points from the pressure monitor were within two standard deviations of the mean difference. Pressure changes were essentially "real time."

CONCLUSIONS

The intracompartmental pressure monitor provides accurate, rapid, and direct measurement of intraabdominal pressure, and may be a useful tool for continuous intraabdominal pressure measurement among patients at risk of abdominal compartment syndrome.

Cloning and mapping of platypus SOX2 and SOX14: insights into SOX group B evolution

Group B SOX genes, the closest relatives to the sex-determining gene SRY, are thought to have evolved from a single ancestral SOX B by a series of duplications and translocations. The two SOX B genes SOX2 and SOX14 co-localize to chromosome 3q in humans. SOX2 and SOX14 homologues were cloned and characterized in the platypus, a monotreme mammal distantly related to man. The two genes were found to co-localize to chromosome 1q in this species. Proximity of the two related genes has therefore been conserved for 170 Myr, since humans and platypus diverged. The sequence similarity and conserved synteny of these group B genes provide clues to their origin. A simple model of SOX group B gene evolution is proposed.

Ruptured abdominal aortic aneurysm: a novel method of outcome prediction using neural network technology

BACKGROUND

reported survival following emergency surgery for ruptured abdominal aortic aneurysm (RAAA) varies widely between institutions. This is largely attributable to differences in case mix. The aim of this study was to identify and evaluate a set of prognostic variables that would accurately predict outcome for individual patients from perioperative indices.

METHODS

perioperative factors associated with subsequent mortality at our institution were identified by retrospective review of 102 consecutive operations for RAAA over a 7-year period (January 1990 to January 1997). Logistic regression analysis was used to select the most significant variables associated with subsequent mortality. These were used to construct, train, and validate a neural network designed to predict survival from surgery in individual cases on a prospective basis.

RESULTS

the 30-day mortality rate was 53%. Multivariate analysis identified four highly significant independent predictors of mortality; preoperative hypotension, intraperitoneal rupture, preoperative coagulopathy, and preoperative cardiac arrest. Using these inputs, the neural network correctly predicted outcome in 82.5% of individual cases.

CONCLUSION

a neural network based on just four perioperative variables can accurately predict outcome of RAAA. Prognostic variables should be reported in studies as a measure of the effect of case mix on survival data. Neural networks have potential to aid decision-making relating to outcome for individual cases.

Identification of a gene family from Drosophila melanogaster encoding proteins with homology to invertebrate sarcoplasmic calcium-binding proteins (SCPS)

Using antibodies raised against the Drosophila Ca(2+)-binding protein DCABP-23, we have isolated two distinct cDNA clones that encode Ca(2+)-binding proteins of the invertebrate sarcoplasmic calcium-binding protein (SCP) family. Southern blot analysis of whole genomic DNA has shown that one of the clones, Dcabp-A.1, is present in more than one copy in the genome of the fly, and is located in the beta-heterochromatic region at cytological division 80 on chromosome III. The expression pattern of this transcript shows that it is present in the tubular but not the fibrillar muscles of the adult thorax. This expression pattern is consistent with this being a true SCP. In contrast, the expression pattern of the transcript corresponding to the second cDNA clone is exclusive to neural tissue. This transcript derives from a single copy gene, and is located at cytological position 89 D on chromosome III. Comparative analysis of the amino acid sequences from the proteins encoded by the two cDNAs with that of the original DCABP-23 protein indicates that the purified DCABP-23 contained mainly the DCABP-A.1 protein. The identification of members of the SCP family of proteins in Drosophila, will allow for a future genetic investigation of the function of these ubiquitous proteins.