Photodynamic therapy can be an effective treatment of patients with pancreatic cancer, but more extensive preclinical and clinical trials are needed for further improvement in the clinical application of PDT, especially in avoidance of complications during PDT.

PN can be expected to obtain a longer survival for the patient with GI tract obstruction caused by advanced cancer.

after one year of persistent epigastric distention and acid regurgitation, which were uninfl uenced by ingesting food. There were no obvious symptoms of gastrointestinal obstruction, e.g., nausea or vomiting. The patient had a long history of overindulgence of bitter persimmons from childhood without the history of gastric surgery.On physical examination, a solid, movable ellipse mass could be palpated in the left epigastrium and the abdomen was soft. Gastroscopical examination showed a giant brown solid gastric bezoar of 15 cm × 7 cm in size (Figure 1), chronic superficial gastritis as well as two erosions at the corner of the stomach, which were pathologically proven to be chronic superficial active membraneous inflammation. Abdominal computerized tomography revealed a mass-like occupational lesion within the stomach (18 cm long and 7 cm in diameter) with air bubbles retained in its interstices and mottled appearance, compatible with the features of bezoars (Figure 2). The patient was then admitted to the department of gastroenterology of our hospital.On the 3 rd day after admission to hospital, endoscopy (Fujinon EG 250 WR 5, Fuji Photo Optical Company Ltd, Tokyo, Japan) was used to fragment the huge bezoar with a mouse-teeth clamp and snare, but it was unsuccessful to extract the bezoar despite the help of gastric lavage using sodium bicarbonate (NaHCO3) because the bezoar was too hard and big. On the 4 th d, another attempt of endoscopical fragmentation and extraction procedure also failed. On the 5 th day, the patient was transferred to the department of general surgery for operation after two failed attempts in endoscopic fragmentation and removal of the gastric bezoar.Gastrotomy was performed on the patient and a huge grey ellipse bezoar (18 cm × 7.5 cm × 7 cm) was removed from the gastric lumen (Figure 3). A piece of the bezoar obtained during endoscopy was analyzed by infrared spectroscopy, which revealed that 85% of them was composed of tannin and 10% was cellulose, therefore, the bezoar was considered as disopyrobezoar derived from bitter persimmon. The patient was discharged on the 7 th postoperative day. During the 6-month follow-up, the patient did not complain of any discomfort and the two concomitant erosions healed uneventfully on medical therapy shown by another gastroscopy. DISCUSSIONBezoars are classifi ed according to their composition into phytobezoar, trichobezoar (hair), lactobezoar (concentrated AbstractWe reported a case of huge gastric phytobezoar. The gastric phytobezoar was successfully removed through gastrotomy after two failed attempts in endoscopic fragmentation and removal. Disopyrobezoars could be treated either conservatively or surgically. Gastrotomy or laparoscopical management is recommended for the treatment of huge disopyrobezoars.

We examined the relation between nutrient-stimulated insulin secretion and the islet lysosome acid glucan-1,4-alpha-glucosidase system in rats undergoing total parenteral nutrition (TPN). During TPN treatment, serum glucose was normal, but free fatty acids, triglycerides, and cholesterol were elevated. Islets from TPN-infused rats showed increased basal insulin release, a normal insulin response to cholinergic stimulation but a greatly impaired response when stimulated by glucose or alpha-ketoisocaproic acid. This impairment of glucose-stimulated insulin release was only slightly ameliorated by the carnitine palmitoyltransferase 1 inhibitor etomoxir. However, in parallel with the impaired insulin response to glucose, islets from TPN-infused animals displayed reduced activities of islet lysosomal enzymes including the acid glucan-1,4-alpha-glucosidase, a putative key enzyme in nutrient-stimulated insulin release. By comparison, the same lysosomal enzymes were increased in liver tissue. Furthermore, in intact control islets, the pseudotetrasaccharide acarbose, a selective inhibitor of acid alpha-glucosidehydrolases, dose dependently suppressed islet acid glucan-1,4-alpha-glucosidase and acid alpha-glucosidase activities in parallel with an inhibitory action on glucose-stimulated insulin secretion. By contrast, when incubated with intact TPN islets, acarbose had no effect on either enzyme activity or glucose-induced insulin release. Moreover, when acarbose was added directly to TPN islet homogenates, the dose-response effect on the catalytic activity of the acid alpha-glucosidehydrolases was shifted to the right compared with control homogenates. We suggest that a general dysfunction of the islet lysosomal/vacuolar system and reduced catalytic activities of acid glucan-1,4-alpha-glucosidase and acid alpha-glucosidase may be important defects behind the impairment of the transduction mechanisms for nutrient-stimulated insulin release in islets from TPN-infused rats.

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