The distribution of epidermal growth factor (EGF) binding sites in the mouse digestive system was investigated by in vivo whole-body autoradiography.Male mice were injected intravenously with 125I-EGF in both the absence and the presence of excess unlabeled EGF. The animals were perfused and subjected to autoradiographic procedures 3, 5, 15, and 30 min after injection. Our study provides the first quantitative data on the binding levels of digestive system tissues under in vivo conditions with intact experimental mice.Specific EGF binding was observed in the liver, pancreas, stomach, and intestinal mucosae at 3, 5, and 15 min post-injection, but at 30 minutes the bindings were not lowered by the presence of excess unlabeled EGF. Very high specific EGF binding was noted in the liver, where distribution of the binding sites was heterogeneous, and the density of the binding was higher around the branches of the portal vein than around the central vein. In the stomach, relatively high specific binding was seen in the glandular part, but the non-glandular portion showed no significant binding. There was low specific binding in the pancreas and distribution of that binding was homogeneous according to macroscopic observation. Low specific binding was observed in the intestinal tract from duodenum to rectum, and level of the binding was quite similar throughout the tract. The esophagus evinced no substantial EGF binding. Submandibular and sublingual glands showed relatively high radioactivity during the experimental period, but most of it was nonspecific in nature.
A cytological study of pure pancreatic juice obtained endoscopically after brushing the lesion of the pancreatic duct urns performed in 10 patients with mucin producing tumors of the pancreas. In 6 of these 10 patients, biopsies from the lesion in the pancreatic duct were also carried out endoscopically.
The brushing cytology in all 6 patients with mucin producing carcinoma of the pancreas, except for the sidebranch type, showed cellular atypism and the cytological diagnoses were Class IV or Class V. The results of the brushing cytology in the patients assumed clinically benign were Class I ˜ Class III.
Biopsy results in 4 patients with mucin producing carcinoma of the pancreas indicated that one of them had adenocarcinoma, and the other 3 had atypical hyperplasia which suggests the existence of malignancy. In the patient with adenoma, diagnosis of the biopsy specimen revealed hyperplasia only.
It was concluded that cytology and biopsy of lesions in the pancreatic duct are a valuable way of assessing mucin producing tumors of the pancreas before surgery.
We attempted endoscopic retrograde cholangiopancreatography (ERCP) using guidewires on 32 patients: 16 with main pancreatic duct (MPD) stricture and 16 with MPD obstruction which had been detected by ordinary ERCP. We also performed brushing cytology for pancreatic ductal lesions in 24 of these patients. In 15 of the 16 patients with a MPD stricture, an ERCP catheter was inserted up to the stricture and then the catheter was passed into the proximal MPD through the stricture using a guidewire (recanalization method). In 14 of the 16 patients with a MPD obstruction, the lesion was reached using guidewires. In addition, the recanalization method was possible in 12 of these 14 patients and the pancreatic ductal system proximal to the obstruction was visualized.
ERCP using guidewires, especially using the recanalization method, allowed us to obtain detailed information, not only about the lesion itself but also on the pancreatic ductal system proximal to the lesion. Employing these methods, we obtained pancreatograms cliaracteristic of chronic pancreatitis or pancreatic cancer with a high detection rate and could evaluate whether the lesion was benign or malignant even in cases difficult to diagnose using ordinary ERCP. Furthermore, an assessment of the lesion expansion was possible to some degree with the recanalization method. The diagnostic accuracy of brushing cytology of the ductal lesion using guidewires was 79%. Although one subject experienced acute pancreatitis after these procedures, she recovered following conservative treatment. No other serious complications were observed.
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