KL-6 is an antigen of the sialylated sugar chain expressed on MUC1. We examined the usefulness of measuring the level of KL-6 in pancreatic juice for the diagnosis of malignant IPMN of the pancreas and pancreatic cancer. The values of KL-6 in pancreatic juice were 670±894U/ml in the malignant IPMN group and 26±42U/ml in the pancreatic cancer group, which were significantly higher than the values in the benign IPMN and control groups. Sensitivity, specificity and accuracy for diagnosis were all 100% for malignant IPMN and 38%, 100% and 69% for pancreatic cancer, under a cut-off value of KL-6 in the pancreatic juice of 20U/ml, respectively. The results showed that measuring the level of KL-6 in pancreatic juice is useful for the diagnosis of malignant IPMN and pancreatic cancer.

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Objective: The aim of this study was to determine the maximum-tolerated dose (MTD) of S-1, an oral fluoropyrimidine derivative, with concurrent gemcitabine and radiotherapy in patients with unresectable locally advanced pancreatic cancer.
Methods: Patients with histopathologically-confirmed unresectable locally advanced pancreatic cancer were eligible. Radiotherapy was delivered in 1.8Gy daily fractions to a total dose of 50.4Gy over 5.5 weeks. Gemcitabine (200mg/m²) was given once a week for 6 weeks. S-1 was administered orally twice a day from Day 1 to 14 and 22 to 35 at an escalating dose from 50 to 80mg/m²/day.
Results: Fifteen patients were enrolled in this study. Three patients received S-1 at 50mg/m²/day, 3 at 60mg/m²/day, 3 at 70mg/m²/day, and 6 at 80mg/m²/day. Though 1 patient at the final dose level (80mg/m²/day) experienced a dose limiting toxicity (Grade 3 thrombocytopenia), an MTD was not reached in this study.
Conclusion: The recommended dose of S-1 with concurrent gemcitabine and radiotherapy was determined to be 80mg/m²/day from Day 1 to 14 and 22 to 35 in patients with locally advanced pancreatic cancer. Oral S-1, gemcitabine, and radiotherapy are well tolerated and feasible and should be further investigated.

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We investigated the usefulness of contrast-enhanced ultrasonography(CEUS) in the diagnosis of autoimmune pancreatitis(AIP). We examined 7 AIP patients (5 males and 2 females) with an average age of 67 years (range: 57-74 years). Ultrasonic diagnostic equipment used consisted of a Toshiba SSA-370A (PowerVision 6000) and an SSA-770A (Aplio). A galactose/palmitic acid mixture (Levovist^®) was employed as the contrast agent. The contrast enhancement effect was investigated by advanced dynamic flow(ADF) -flash echo imaging(FEI). 1) Enlargement of the pancreas was seen in all patients. Affected regions of the pancreas included the entire pancreas (3 patients), head of the pancreas (3 patients; 2 of whom had already undergone caudal resection), and body of the pancreas (1 patient). Internal echo images showed low-echo regions. One patient with an enlarged tail of the pancreas showed a low echo region similar to the circle in the head of the pancreas. 2) Contrast-enhancement patterns were classified into two types: Type I (5 patients) showed uniform contrast enhancement, and Type II (2 patients) showed non-contrast enhancement. 3) The degree of enlargement of the pancreas was reduced post-therapy in all patients. 4) In 4 of the 5 Type I patients, contrast enhancement was attenuated post-therapy, and 1 patient showed continued contrast enhancement. All Type II patients showed non-contrast enhancement both pre- and post-therapy. Type II CEUS patterns allowed classification of AIP. The possibility of being able to make an effective judgment for treatment was suggested in the case of a Type I pattern. Differential diagnosis and the effects from treatment were difficult to determine in patients with Type II patterns. Therefore it was thought necessary to perform an endoscopic retrograde cholangiopancreatography(ERCP) along with a self-immunological search to acquire additional diagnostic information.

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A 70-year-old man presented with a chief complaint of abdominal pain and was diagnosed with resectable pancreatic cancer. Adjuvant chemotherapy with gemcitabine hydrochloride was started after a partial pancreatic resection and D2 dissection. On day 1 of his fifth course of therapy, his serum creatinine was 2.05mg/dl, his urine tested positive for protein, and bilateral kidney enlargement was found on abdominal computed tomography. Gemcitabine hydrochloride was stopped. The condition was diagnosed as a drug-induced renal disorder and hemolytic uremic syndrome after kidney biopsy. Serum creatinine levels fell after treatment with prednisolone, and no relapse of pancreatic cancer has occurred 13 months after the administration of prednisolone.

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This is the first report of impacted papilla minor stone in pancreas divisum successfully treated with endoscopic minor papillotomy.
A 50-year-old male with a complaint of sudden upper abdominal pain was seen at a local hospital, and he had had no history of pancreatitis. He was referred to our hospital and was diagnosed as having pancreas divisum and dorsal pancreatitis with impacted papilla minor stone based on multidetector-row computed tomography. Endoscopic retrograde pancreatography via the accessory papilla showed diffuse dilatation of the isolated dorsal pancreatic duct and filling defect. He was treated with endoscopic minor papillotomy and endoscopic nasopancreatic drainage and was discharged on the 36th day of his hospital stay. There were no further episodes of abdominal pain or pancreatitis after a follow-up period of 16 months.
This case report suggests that endoscopic minor papillotomy is one of the effective treatments for dorsal pancreatitis resulting from an impacted papilla minor stone in pancreas divisum.

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Reported herein is a unique case of pancreatic serous cystadenoma extend into the main pancreatic duct (MPD). The patient was a 82-year-old man with history of acute pancreatitis. Laboratory data including tumour markers showed within almost normal lange. Abdominal ultrasonography demonstrated a solid tumor (2cm in diameter) in the pancreas head. The solid tumor showed a hypervascular pattern but had no obvious cystic component in dynamic CT. Curved planar reformatted images obtained by CT and MRCP images revealed local stenosis of MPD at the head of pancreas. EUS and IDUS images showed that the tumor with increased level of internal echo extended into MPD.
A pylorus-preserving pancreatoduodenectomy was preformed. In Macroscopical inspection of the surgical specimen, the tumor measured 30×25×20mm had numerous and various sized cystic components. Histopathologically, the epithelium columular cells of the cysts were glycogen-rich and positive for PAS staining, and the tumor cells partially compressed and extended into the MPD.

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