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Pancreatic cystic neoplasms: a review of preoperative diagnosis and management*  

PubMed Central

Pancreatic cystic neoplasms (PCNs) are a diverse group of neoplasms in the pancreas, and are more increasingly encountered with widespread abdominal screening and improved imaging techniques. The most common types of PCNs are serous cystic neoplasms (SCNs), mucinous cystic neoplasms (MCNs), and intraductal papillary mucinous neoplasms (IPMNs). Clinicians frequently feel bewildered in the differential diagnosis and subsequent management among the various types of lesions in the pancreas, which may lead to overtreatment or delayed treatment. The current review provides recent developments in the understanding of the three most common types of PCNs, the latest modalities used in preoperative diagnosis and differential diagnosis, as well as the most up to date management. Suggestions for diagnosis and differential diagnosis of SCNs, MCNs, and IPMNs are also provided for young surgeons. Better understanding of these neoplasms is essential for clinicians to make accurate diagnosis and to provide the best management for patients.

Bai, Xue-li; Zhang, Qi; Masood, Noman; Masood, Waqas; Zhang, Yun; Liang, Ting-bo



"Sugar" tumor of the pancreas: a rare entity that is diagnosable on preoperative fine-needle biopsies.  


This study is the second to report a pancreatic "sugar" tumor (ST) case. This ST was incidentally discovered in a 31-year-old woman using computed tomography scan (CT scan) for work-up of a hepatic focal nodular hyperplasia. Both CT scan and endoluminal ultrasonography (EUS) features evoked a 15-mm large benign endocrine tumor. Pathological examination of EUS-guided fine-needle aspiration biopsies could not confirm this diagnosis. Laparoscopic corporeo-caudal pancreatectomy was performed. The tumor was intrapancreatic, well circumscribed, and organized in sheets of epithelioid cells. The tumor cells expressed HMB-45 but did not express epithelial or endocrine immunohistochemical markers. These histophenotypic features are those of an extra pulmonary ST, which belong to the PEComa family of tumors. Retrospective examination of preoperative biopsies evidenced the same histophenotypic features. This observation highlights that STs should be considered in preoperative differential diagnosis of pancreas tumors, since they may be treated by limited surgical resection. PMID:15821930

Ramuz, Olivier; Lelong, Bernard; Giovannini, Marc; Delpero, Jean-Robert; Rochaix, Philippe; Xerri, Luc; Hassoun, Jacques; Flejou, Jean-François; Monges, Geneviève



The preoperative diagnosis of primary ovarian pregnancy.  

PubMed Central

BACKGROUND: Ovarian pregnancies comprise 0.15% of all pregnancies and 0.15-3% of ectopic gestations, with an incidence of up to 1/7,000 deliveries. CASE: A single case of an ovarian gestation consistent with Spieglberg's four criteria in a primigravida without prior gynecological, medical, or surgical history is presented. Presumptive diagnosis was by thorough clinical examination with a single, palpable, adnexal mass in a patient with BMI of 19, supported with serial ultrasound and quantitative betaHCG-enabled preoperative diagnosis. CONCLUSION: Primary ovarian pregnancy may occur without any classical antecedent risk factors. Ultrasonography can be a useful adjunct to clinical presentation and physical examination in allowing the preoperative diagnosis of ovarian gestation. Images Figure 1 Figure 2 Figure 3

Nwanodi, Oroma; Khulpateea, Neekiaund



Solid pseudopapillary tumor of pancreas in a male child: a diagnosis by fine needle aspiration cytology.  


Solid pseudopapillary tumor (SPT) is an uncommon pancreatic neoplasm with low malignant potential. It occurs predominantly in young women. It is very rare in males and nonrelated pediatrics. In children, SPT commonly present as abdominal mass and pain. A 10-year-old male presented with progressively growing palpable tumor in upper abdomen. SPT of pancreas is diagnosed on preoperative fine needle aspiration cytology. This was subsequently confirmed by histopathology and immunohistochemistry. Due to rarity, SPT is not the first option to rule out, especially in children. Preoperative cytological diagnosis of SPT helps in management of this surgically curable neoplasm with good prognosis. PMID:23301913

Nasit, Jitendra Gordhanbhai; Jetly, Dhaval; Shah, Manoj



Amyloid goiter: preoperative scintigraphic diagnosis using Tc-99m pyrophosphate  

SciTech Connect

Amyloid goiter is a rare clinical entity. The diagnosis is rarely made preoperatively because clinical and laboratory findings are nonspecific. The authors report two cases of amyloid goiter in whom the diagnosis was made preoperatively using Tc-99m pyrophosphate scintigraphy.

Lee, V.W.; Rubinow, A.; Pehrson, J.; Skinner, M.; Cohen, A.S.



Preoperative indications for extended pancreatectomy for locally advanced pancreas cancer involving the portal vein.  

PubMed Central

This retrospective study attempted to determine the indications for extended pancreatectomy for locally advanced carcinoma of the pancreas, in terms of postoperative prognosis. An extended pancreatectomy with portal vein or superior mesenteric vein (PV/SMV) resection and regional lymphadenectomy was performed in 35 of 50 consecutive cancers that extended into the retroperitoneal spaces and involved the PV or SMV. Among the many background factors in the 35 resected specimens, the degree of PV/SMV invasion by the cancer was most closely associated with prognosis, despite resection of all involved PV/SMV. This factor generally correlated with the preoperative findings on the portal phase of superior mesenteric arteriograph. In 17 selected patients in whom PV/SMV invasion had been angiographically both semicircular or less and 1.2 cm (1.4 cm on the film) or less in length, the 3-year survival rate was 59%. This survival rate was significantly higher than the 29% 3-year survival rate in all 35 patients (p less than 0.05). Conversely, among the 18 patients in whom invasion was angiographically either beyond semicircular or more than 1.2 cm (1.4 cm on the film) in length, there were no 1.5-year survivors, and this result was even worse than that of 15 nonresectable cases. Based on postoperative survival, the degrees of PV/SMV invasion on preoperative angiography (narrowing pattern and length) are good indicators for aggressive pancreatectomy for locally advanced pancreatic cancer. Images FIG. 2.

Ishikawa, O; Ohigashi, H; Imaoka, S; Furukawa, H; Sasaki, Y; Fujita, M; Kuroda, C; Iwanaga, T



An unexpected pre-operative diagnosis.  


This is a case report of a patient presenting with breathlessness who was thought to have suspected systemic lupus erythematosus, but was actually diagnosed with an atrial myxoma. It shows how cardiac pathology can be easily misdiagnosed as suspected pulmonary pathology and serves as a reminder to clinicians when investigating a patient with breathlessness. It also raises the question as to which patients should undergo routine pre-operative echocardiography before thoracic surgery. PMID:19939813

Hallward, G; Valchanov, K



Pancreas-Protocol Imaging at a High-Volume Center Leads to Improved Preoperative Staging of Pancreatic Ductal Adenocarcinoma  

PubMed Central

Background High-quality preoperative cross-sectional imaging is vital to accurately stage patients with pancreatic ductal adenocarcinoma (PDAC). We hypothesized that imaging performed at a high-volume pancreatic cancer center with pancreatic imaging protocols more accurately stages patients compared with pre-referral imaging. Methods We retrospectively reviewed data from all patients with PDAC who presented to the surgical oncology clinic at our institution between June 2005 and August 2009. Detailed preoperative imaging, staging, and operative data were collected for each patient. Results A total of 230 patients with PDAC were identified, of which 169 had pre-referral imaging. Patients were selectively reimaged at our institution based on the quality and timing of imaging at the outside facility: 108 (47%) patients were deemed resectable, 54 (23.5%) were deemed borderline-resectable, and 68 (29.5%) were deemed unresectable. Of the resectable patients, 99 opted for resection. Eighty-two of those 99 patients underwent preoperative imaging at our institution, and of these 27% had unresectable disease at the time of surgery compared with 47% of patients who only had pre-referral imaging (p = 0.14). Reimaging altered staging and changed management in 56% of patients. Among that group were 55 patients, categorized as resectable on pre-referral imaging, who on repeat imaging were deemed to be borderline resectable (n = 27) or unresectable (n = 28). Conclusions Pancreas-protocol imaging at a high-volume center improves preoperative staging and alters management in a significant proportion of patients with PDAC who undergo pre-referral imaging. Thus, repeat imaging with pancreas protocols and dedicated radiologists is justified at high-volume centers.

Walters, Dustin M.; LaPar, Damien J.; de Lange, Eduard E.; Sarti, Marc; Stokes, Jayme B.; Adams, Reid B.; Bauer, Todd W.



Preoperative diagnosis of pelvic actinomycosis by clinical cytology  

PubMed Central

Background The purpose of this work was to investigate whether clinical cytology could be useful in the preoperative diagnosis of pelvic actinomycosis. Methods This study involved the prospective collection of samples derived from the endometrium and the uterine cervix, and retrospective data analysis. Nine patients with clinically diagnosed pelvic actinomycosis were enrolled. The clinical and hematological characteristics of patients were recorded, and detection of actinomyces was performed by cytology, pathology, and bacteriological culture of samples and by imprint intrauterine contraceptive device (IUD) cytology. Results The detection rate of actinomyces was 77.7% by combined cervical and endometrial cytology, 50.0% by pathology, and 11.1% by bacterial culture. Conclusion The higher detection rate of actinomyces by cytology than by pathology or bacteriology suggests that careful cytological examination may be clinically useful in the preoperative diagnosis of pelvic actinomycosis.

Matsuda, Katsuya; Nakajima, Hisayoshi; Khan, Khaleque N; Tanigawa, Terumi; Hamaguchi, Daisuke; Kitajima, Michio; Hiraki, Koichi; Moriyama, Shingo; Masuzaki, Hideaki



Preoperative biliary drainage for cancer of the head of the pancreas  

Microsoft Academic Search

BACKGROUND: The benefits of preoperative biliary drainage, which was introduced to improve the postoperative outcome in patients with obstructive jaundice caused by a tumor of the pancreatic head, are unclear. METHODS: In this multicenter, randomized trial, we compared preoperative biliary drainage with surgery alone for patients with cancer of the pancreatic head. Patients with obstructive jaundice and a bilirubin level

Gaag van der N. A; Erik A. J. Rauws; Eijck van C. H. J; Marco J. Bruno; Erwin van der Harst; Frank J. G. M. Kubben; Josephus J. G. M. Gerritsen; Jan Willem Greve; Michael F. Gerhards; Hingh de I. H. J. T; Jean H. Klinkenbijl; Chung Y. Nio; Castro de S. M. M; Olivier R. C. Busch; Gulik van T. M; Patrick M. M. Bossuyt; Dirk J. Gouma



Enhanced CT and CT virtual endoscopy in diagnosis of heterotopic pancreas  

PubMed Central

AIM: To improve the diagnosis of heterotopic pancreas by the use of contrast-enhanced computed tomography (CT) imaging and CT virtual endoscopy (CTVE). METHODS: A total of six patients with heterotopic pancreas, as confirmed by clinical pathology and immunohistochemistry in the Sixth Affiliated People’s Hospital of Shanghai Jiao Tong University, Shanghai, China, were included. Non-enhanced CT and enhanced CT scanning were performed, and the resulting images were reviewed and analyzed using three-dimensional post-processing software, including CTVE. RESULTS: Four males and two females were enrolled. Several heterotopic pancreas sites were involved; three occurred in the stomach, including the gastric antrum (n = 2) and lesser curvature (n = 1), and two were in the duodenal bulb. Only one case of heterotopic pancreas lesion occurred in the mesentery. Four cases had a solid yet soft tissue density that had a homogeneous pattern when viewed by enhanced CT. Additionally, their CT values were similar to that of the pancreas. The ducts of the heterotopic pancreas tissue, one of the characteristic CT features of heterotopic pancreas tissue, were detected in the CT images of two patients. CTVE images showed normal mucosa around the tissue, which is also an important indicator of a heterotopic pancreas. However, none of the CTVE images showed the typical signs of central dimpling or umbilication. CONCLUSION: CT, enhanced CT and CTVE techniques provide useful information about the location, growth pattern, vascularity, and condition of the gastrointestinal wall around heterotopic pancreatic tissue.

Wang, Dan; Wei, Xiao-Er; Yan, Lei; Zhang, Yu-Zhen; Li, Wen-Bin



Optimising preoperative diagnosis in phyllodes tumour of the breast  

PubMed Central

The role of the pathologist in the preoperative diagnosis of phyllodes tumours of the breast is critical to appropriate surgical planning. However, reliable differentiation of phyllodes tumour from cellular fibroadenoma remains difficult. Preoperative diagnostic accuracy allows correct surgical treatment, avoiding the pitfalls of reoperation because of inadequate excision, or surgical overtreatment. Specific clinical indices may arouse diagnostic suspicion but are unreliable for confirmation, as with current imaging modes. Fine needle aspiration cytology has a high false negative rate. Few studies have evaluated the role of core needle biopsy, but it may prove a useful adjunct. Both diagnostic and prognostic information may in future be gained from application of immunohistochemical and other techniques assessing the expression of proliferative markers including p53, Ki?67, and others.

Jacklin, R K; Ridgway, P F; Ziprin, P; Healy, V; Hadjiminas, D; Darzi, A



Increasing security in an artificial pancreas: diagnosis of actuator faults  

Microsoft Academic Search

The current and incoming technology for the treatment of type 1 diabetes mellitus (T1DM) suggests that the concept of an artificial pancreas is a feasible goal [1]. Many engineering areas have key roles in the development of such system since they are involved in every part of the process (monitoring, dosing algorithms and delivering). Control engineering has presented many advances

O. Vega-Hernandez; F. Campos-Cornejo; D. U. Campos-Delgado; D. R. Espinoza-Trejo



Accurate Preoperative Diagnosis of Ovarian Pregnancy with Transvaginal Scan  

PubMed Central

Ovarian pregnancy is a rare variant of ectopic pregnancy, and an accurate preoperative diagnosis is very challenging. Dr. Saint Monnissey described the first reported case of ovarian pregnancy in 17th century. Transvaginal ultrasonography is a valuable tool in identifying an ovarian pregnancy from other types of ectopic pregnancies. Management with laparoscopy or laparotomy is required in all cases, and in almost all cases, ovary can be preserved since implantation is usually superficial (Koo et al.; 2011). A single case of an ovarian pregnancy, consistent with Spiegelberg's criteria is presented here. This case history demonstrates the use of ultrasonography (USG) and surgery in the diagnosis and treatment, respectively, of the ovarian pregnancy. As we step into an era where in vitro fertilization rate is on its hike, one should be aware that incidence of ovarian pregnancy is also increasing, necessitating a high index of suspicion.

Gupta, Natasha; Gupta, Anu; Onyema, Godwin; Pantofel, Yelena; Ying, Shan-Ching; Garon, Jack E.; Lampley, Charles; Blankstein, Josef



Diagnosis and surgical treatment of solid pseudopapillary neoplasm of the pancreas: analysis of 24 cases  

PubMed Central

Background Our aim was to summarize our experience with the diagnosis and surgical treatment of solid pseudopapillary neoplasm (SPN) of the pancreas to provide a reference for the management of this rare condition. Methods We collected and analyzed retrospective data on the clinical presentation, laboratory investigations, radiologic imaging, pathology and operative details of patients with SPN of the pancreas diagnosed between February 2001 and December 2009. Results In all, 23 of 24 patients were women, and the mean age of all patients was 31 years. The most common clinical presentation was vague abdominal pain. Abdominal imaging showed solid or solid cystic masses in the pancreas, mostly in the tail or head of the gland. All patients were treated surgically. There were no postoperative deaths. After follow-up ranging from 4 to 109 months (median 68 mo), 20 of 22 patients who underwent curative resection were alive with no evidence of disease recurrence. Of the 2 patients with R1 resections, 1 died 42 months after surgery, whereas the other underwent a second operation and was alive after 36 months’ follow-up. Conclusion Solid pseudopapillary neoplasm of the pancreas is a relatively indolent tumour. The initial diagnosis of SPN of the pancreas is suggested by radiologic imaging findings but should be considered in the context of clinical and histopathologic characteristics. We advocate for complete surgical resection once SPN is diagnosed.

Guo, Ning; Zhou, Quan B.; Chen, Ru F.; Zou, Sheng Q.; Li, Zhi H.; Lin, Qing; Wang, Jie; Chen, Ji S.



Newer imaging modalities for the preoperative diagnosis of choledochal cyst. A case report  

SciTech Connect

Many new radiographic procedures have recently been widely introduced which should make the diagnosis of cystic of the biliary tree a preoperative rather than an operative diagnosis. A case is presented emphasizing the value of these procedures.

Klein, G.M.; Frost, S.S.



Prenatal Diagnosis of Annular Pancreas: Reliability of the Double Bubble Sign with Periduodenal Hyperechogenic Band  

PubMed Central

Objective To evaluate the power of prenatal 2-D ultrasound examination in the 2nd trimester as a method of choice for accurate diagnosis of annular pancreas. Methods Co-incidence of the double bubble sign (often accompanying gastroduodenal dilatation) together with a hyperechogenic band around the duodenum (corresponding with the tissue of annular pancreas) was used as a diagnostic criterion. Findings from postnatal surgery served for verification. Results From 7,897 screened pregnancies, annular pancreas was proven in the cases where both signs were present, but never without the hyperechogenic band (N1 = 3, N2 = 3, p ? 0.05). Sensitivity and specificity were 100%. Conclusions More multicentric studies are required to test this approach. The following diagnostic strategy is reasonable at the present time: when the double bubble sign is discovered, always suspect annular pancreas and look for the second sign: hyperechogenic bands around the duodenum. Also look for known associated anomalies, and vice versa, if any of associated anomalies are noted, also search specifically for the signs of annular pancreas.

Dankovcik, Robert; Jirasek, Jan E.; Kucera, Eduard; Feyereisl, Jaroslav; Radonak, Jozef; Dudas, Marek



Duodenal Duplication Cyst with Profound Elevation of Intracystic Carbohydrate Antigen (CA 19-9) and Carcinoembryonic Antigen (CEA): A Rare but Important Differential in the Diagnosis of Cystic Tumours of the Pancreas  

Microsoft Academic Search

Context Enteric duplication cysts are rare lesions of uncertain incidence and natural history. Pre-operative confirmation of diagnosis can be difficult. This case reports an adult duodenal duplication cyst presenting with grossly elevated intra-lesional levels of tumour markers. Case report A 57-year-old female was found to have a complex cystic lesion of the head of the pancreas. Intra-lesional fluid analysis revealed

Kant J Shah; Giuseppe Malleo; Jee Low; Kassiani Skordilis; Alistair J Makin; Ajith K Siriwardena


Preoperative aspiration culture for preoperative diagnosis of infection in total hip or knee arthroplasty.  


This meta-analysis evaluated preoperative aspiration culture for diagnosing prosthetic joint infection (PJI) in total hip arthroplasty (THA) and total knee arthroplasty (TKA). The pooled sensitivity and specificity were 0.72 (95% confidence interval, 0.65 to 0.78) and 0.95 (0.93 to 0.97), respectively. Subgroup analyses revealed nonsignificant worse diagnostic performance for THA than for TKA (sensitivity, 0.70 versus 0.78; specificity, 0.94 versus 0.96). Preoperative aspiration culture has moderate to high sensitivity and very high specificity for diagnosing PJI. PMID:23946521

Qu, Xinhua; Zhai, Zanjing; Wu, Chuanlong; Jin, Fangchun; Li, Haowei; Wang, Lei; Liu, Guangwang; Liu, Xuqiang; Wang, Wengang; Li, Huiwu; Zhang, Xiaoyu; Zhu, Zhenan; Dai, Kerong



Solitary fibrous tumor of the pancreas  

Microsoft Academic Search

A 67-year-old woman was found to have an incidental pancreatic mass on computed tomographic examination of her abdomen in the course of investigation of hematuria. The radiologic features were of a hypervascular mass in the uncinate process of the head of the pancreas, and a preoperative diagnosis of a neuroendocrine tumor was favored. A Whipple procedure was performed. The uncinate

Runjan Chetty; Richa Jain; Stefano Serra



Preoperative Diagnosis of Long QT Syndrome in an Infant With Tetralogy of Fallot  

Microsoft Academic Search

Long QT syndrome is a well-described entity in infants. Its presentation in the context of congenital heart disease is rare\\u000a and is almost exclusively diagnosed postoperatively. For patients undergoing surgical intervention, preoperative knowledge\\u000a of the diagnosis and appropriate perioperative management can be life-saving. We present the rare case of an infant with tetralogy\\u000a of Fallot who was preoperatively diagnosed with

Christoph P. Hornik; Michael J. Campbell; Michael P. Carboni; Andrew J. Lodge; John F. Rhodes; Ronald J. Kanter



[Preoperative biopsy diagnosis in suspicion of breast cancer].  


The golden standard in non-operative breast cancer diagnosis is the triple test, a combination of clinical evaluation, mammography/ultrasound and needle biopsy, either fine needle aspiration cytology (FNAC) or histological core biopsy. FNAC and core biopsy both have advantages and disadvantages but neither of them can act as a decisive diagnostic procedure on its own. The final diagnosis should always be a consensus between the three diagnostic modalities in the triple test. Quality assurance of the pathological diagnosis is a must. The number of uncertain diagnoses i.e. atypia or suspicion of malignancy should be kept at a minimum. These diagnostic categories call for additional diagnostic procedures and thereby cause a delay in reaching the final diagnosis leading to definitive treatment. PMID:17953876

Rasmussen, Birgitte Bruun; Bak, Martin; Rank, Fritz E



Preoperative sonographic diagnosis of sealed-off perforated gastric ulcer.  


Perforated peptic ulcer (PPU) is a common surgical emergency. Early diagnosis and intervention are necessary to reduce the morbidity and mortality. Radiographic or sonographic detection of free air is neither sensitive nor specific for PPU. We report a case of sealed-off PPU with direct sonographic demonstration of the perforation tract within the anterior wall of the gastric antrum. The diagnosis was confirmed at laparotomy. PMID:9608372

Tsai, K C; Wang, H P; Huang, G T; Wang, S M



Preoperative assessment of basal cell carcinoma using conventional fluorescence diagnosis  

Microsoft Academic Search

Fluorescence diagnosis (FD) seems to be a promising method for the non-invasive detection of tumour boundaries. We aimed to\\u000a investigate the diagnostic performance of conventional FD of basal cell carcinoma (BCC). Patients were included in this study\\u000a when they had a skin lesion on the head which was clinically consistent with the diagnosis of BCC. FD was performed using\\u000a a

Susanne Neuß; Thilo Gambichler; Falk G. Bechara; Stephan Wöhl; Percy Lehmann



Laparoscopic omentectomy for preoperative diagnosis of torsion of the greater omentum  

PubMed Central

Introduction Torsion of the greater omentum is unusual. In most cases, the preoperative diagnosis was difficult due to the non-specific clinical presentation. Presentation of case We present a case of greater omental torsion in a 28-year-old man with an untreated right inguinal hernia since childhood. Computed tomography (CT) revealed characteristic signs of omental torsion, which was important in making correct diagnosis. We made correct preoperative diagnosis and performed laparoscopic omentecomy. The greater omentum distal to the twisted part was dark red and showed necrotic change. This case was secondary omental torsion associated with a right inguinal hernia. Discussion Omental torsion should always be included in the differential diagnosis of acute abdomen. Conclusion CT multi-planar reconstruction (MPR) imaging played a particularly important role in making a precise diagnosis. Laparoscopic approach could be useful in both diagnostic and therapeutic intervention. A successful laparoscopic omentectomy was performed in the present case.

Abe, Tomoyuki; Kajiyama, Kiyoshi; Harimoto, Norifumi; Gion, Tomonobu; Nagaie, Takashi



Omental torsion with left-sided inguinal hernia: a rare preoperative diagnosis.  


Omental torsion is a rare disease. It can be difficult to identify if it is not clinically considered in the preoperative period, and this pathology may lead to an acute abdomen. We present the characteristic computed tomography findings and clinical particulars in a 34-year-old male patient with longstanding left inguinal hernia associated with an extraordinary diagnosis. PMID:23206629

Kayan, Mustafa; Sabuncuoglu, Mehmet Zafer; Çetin, Meltem; Çetin, Recep; Benzin, Mehmet Fatih; Benzin, ?eyma; Ya?ar, Selçuk; ?bi?o?lu, Seda



Preoperative assessment of basal cell carcinoma using conventional fluorescence diagnosis.  


Fluorescence diagnosis (FD) seems to be a promising method for the non-invasive detection of tumour boundaries. We aimed to investigate the diagnostic performance of conventional FD of basal cell carcinoma (BCC). Patients were included in this study when they had a skin lesion on the head which was clinically consistent with the diagnosis of BCC. FD was performed using a 20% 5-aminolaevulinic acid (ALA) cream. The FD tumour area was determined 3.5 h after the ALA application using the naked eye and a Wood lamp. The tumour margins were marked on the basis of FD. The lesions were then excised according to the FD-defined tumour margin. On histology, the tumour margins were checked whether the lesion was completely excised in accordance with FD. Twenty-eight BCCs were finally included into the statistical analysis. In six BCCs, the FD-defined BCC margin did not correlate with the histopathologically assessed tumour borders. Four of these lesions were incompletely excised; two tumours were excised in toto indicating that the tumour was beyond the FD-defined margin but not at the excision margin. Hence, the rate of incompletely excised BCCs was 14.3% (4/28). The sensitivity and specificity rates of FD were 79 and 100%, respectively. FD is pretty sensitive and highly specific in regard to the demarcation of BCC margins. When compared to clinically based BCC excision, however, FD does not appear to be substantially superior to simple clinical assessment of tumour margins. PMID:18979108

Neus, Susanne; Gambichler, Thilo; Bechara, Falk G; Wöhl, Stephan; Lehmann, Percy



Difficult preoperative diagnosis of a patient with sclerosing splenic hemangioma  

SciTech Connect

We present a young asymptomatic woman with splenomegaly and a large isolated splenic mass demonstrated by ultrasonography, /sup 99m/Tc sulfur colloid, and gallium scintigraphy studies. Computerized tomography (CT) and three-phase 99mTc-labeled red blood cell imaging suggested a malignant lesion. Repeated sonographically guided fine needle aspiration (FNA) obtained only blood, suggesting the possible vascular nature of the tumor. Splenectomy established the diagnosis of splenic hemangioma (SH) with marked sclerotic changes. We conclude from this case that (1) the sclerotic and cystic changes in the SH and the abdominal lymphadenopathy could explain why the three-phase red blood cell and CT scanning, respectively, suggested that the lesion was malignant rather than benign; (2) guided FNA of a splenic mass suspected to be hemangioma may be an additional safe and useful diagnostic procedure. Multiple aspirations yielding blood alone suggest hemangioma and may prevent an unnecessary operation. To the best of our knowledge, this is the first reported case in the literature of FNA of splenic hemangioma.

Edoute, Y.; Ben-Haim, S.A.; Ben-Arie, Y.; Fishman, A.; Barzilai, D.



Pre-operative diagnosis of an unusual complication of abdominal aortic aneurysm on multidetector computed tomography: a case report  

PubMed Central

Spontaneous fistulation of an abdominal aortic aneurysm (AAA) into the inferior vena cava (IVC) is an unusual and infrequently encountered complication in clinical practice. In the majority of cases, it is a diagnosis made on the operating table, during surgical repair of AAA. We report a patient with an aortocaval fistula diagnosed preoperatively on multidetector computed tomography (MDCT). Preoperative diagnosis of this rare complication is important as it allows appropriate anaesthetic and surgical planning thereby reducing morbidity and mortality.

Jakanani, George C; Chong, Peter Lee



FNA diagnosis of osteoclast-like giant cell tumor of the pancreas  

PubMed Central

Osteoclast-like giant cell tumor of the pancreas is a rare non-endocrine neoplasm composed of reactive multinucleated giant cells admixed with mononuclear stromal cells. We report a case of osteoclast-like giant cell tumor of the pancreas in a 58-year-old female with vague clinical symptoms. Endoscopic ultrasound-guided aspirate from the mass revealed numerous characteristic osteoclast-like giant cells.

Sivanandham, Shanthakumari; Subashchandrabose, Priya; Muthusamy, K Rajeshwari



Role of preoperative sonography in the diagnosis and pathologic staging of pseudomyxoma peritonei.  


Objectives- The purpose of this study was to analyze the sonographic features of pseudomyxoma peritonei and the ability of preoperative sonography to assess the pathologic grades of this disease. Methods- Nineteen patients with pseudomyxoma peritonei who underwent preoperative sonographic examinations were included (9 male and 10 female; age range, 31-70 years). Four patients presented with disseminated peritoneal adenomucinosis, 7 with peritoneal mucinous carcinomatosis with intermediate or discordant features (intermediate-grade disease), and 8 with peritoneal mucinous carcinomatosis. The sonographic characteristics, clinical features, and serum tumor marker levels were recorded and compared among the 3 grades. Results- Clinical symptoms and carcinoembryonic antigen, cancer antigen 125 (CA-125), CA-19-9, CA-724, and CA-153 levels were not significantly different among the 3 pathologic grades (P > .05). Ascites, scalloping of the visceral margin, invasive parenchymal nodules, and peritoneal masses were detected in all grades. Disseminated peritoneal adenomucinosis occurred without the finding of an omental cake. The presence of enlarged lymph nodes was more common in peritoneal mucinous carcinomatosis. The diagnosis of pseudomyxoma peritonei was made by preoperative sonography in 1 case. Four cases were diagnosed as ovarian mucinous cystadenoma with rupture. One case was diagnosed as a mucinous appendiceal cyst. Four cases were diagnosed as ascites or encapsulated effusion. One case was misdiagnosed as lymphoma. The others were diagnosed as celiac masses. Conclusions- Preoperative sonography can be used to diagnose pseudomyxoma peritonei as long as radiologists are familiar with the imaging features. Although there are overlaps in the sonographic findings among the different grades, some features may aid in separating them. PMID:23980216

Li, Yanmi; Guo, Aitao; Tang, Jie; Wang, Longxia; Wang, Junyan; Yu, Dejiang



The value of endoscopic diagnosis and the treatment of pancreas injuries following blunt abdominal trauma  

Microsoft Academic Search

Background: Injuries to the pancreas following blunt abdominal trauma are rare due to its protected retroperitoneal position. Many pancreatic lesions remain unnoticed at first and only become apparent when complications arise or during treatment of other injuries. The mortality rate is between 12 and 30%, and if treatment is delayed it is as high as 60%. Methods: Using medical records

A. Wolf; J. Bernhardt; M. Patrzyk; C.-D. Heidecke



MDCT of Intraductal Papillary Mucinous Neoplasm of the Pancreas: Evaluation of Features Predictive of Invasive Carcinoma  

Microsoft Academic Search

OBJECTIVE. The purpose of our study was to evaluate factors predictive of the presence of invasive carcinoma associated with intraductal papillary mucinous neoplasm (IPMN) of the pancreas on MDCT. MATERIALS AND METHODS. Preoperative MDCT of 36 consecutive patients (23 men, 13 women; mean age, 66.6 years) who had undergone surgical resection and had a patho- logic diagnosis of IPMN were

Satomi Kawamoto; Leo P. Lawler; Karen M. Horton; John Eng; Ralph H. Hruban; Elliot K. Fishman; Lawler LP; Hruban RH; Fishman EK



Pancreas Transplantation  


... 1 diabetes have experienced positive results from pancreas transplants. Typically, part or all of a new pancreas is surgically implanted. The old pancreas is left alone; it still makes digestive enzymes, even though it ...


Solitary fibrous tumor of the pancreas.  


A 67-year-old woman was found to have an incidental pancreatic mass on computed tomographic examination of her abdomen in the course of investigation of hematuria. The radiologic features were of a hypervascular mass in the uncinate process of the head of the pancreas, and a preoperative diagnosis of a neuroendocrine tumor was favored. A Whipple procedure was performed. The uncinate process contained a 2.6-cm well-circumscribed mass. Histologic evaluation showed a lesion composed of alternating hypercellular areas made up of spindle-shaped cells and hypocellular areas with hyalinized, keloidal-like fibrous tissue. Occasional dilated vascular channels and entrapped pancreatic tissue were present within the lesion. Immunohistochemistry showed the lesion to be CD34, CD99, and bcl-2 positive. No evidence of atypia was noted, and the overall impression was of a benign solitary fibrous tumor of the pancreas. This is an unusual primary spindle cell neoplasm of the pancreas and should be considered in the differential diagnosis of all spindle cell lesions that occur in the pancreas. PMID:19751911

Chetty, Runjan; Jain, Richa; Serra, Stefano



Diagnosis of infection by preoperative scintigraphy with indium-labeled white blood cells  

SciTech Connect

Scintigraphy with indium-labeled white blood cells has been reported to be sensitive and specific in the diagnosis of low-grade sepsis of the musculoskeletal system. We reviewed the records of fifty patients who had suspected osteomyelitis or suspected infection about a total joint prosthesis and who underwent scintigraphy with technetium-99m methylene diphosphonate and scintigraphy with indium-111 oxine-labeled white blood cells before an open surgical procedure. Any patient who received preoperative antibiotics was not included in the study. For all of the patients, gram-stain examination of smears, evaluation of a culture of material from the operative site, and histological examination were done. The patients were divided into two groups. Group I was composed of twenty-four patients, each of whom had a prosthesis in place and complained of pain. Group II was composed of twenty-six patients for whom a diagnosis of chronic osteomyelitis had to be considered. With the indium scans alone, there was only one false-negative result (in Group II), but there were eighteen false-positive results (eight patients in Group II and ten patients in Group I). Although scintigraphy with indium-labeled white blood cells is quite sensitive, it is not specific in detecting chronic osteomyelitis; a negative scan should be considered highly suggestive that osteomyelitis is not present. Specificity can be increased by interpreting the indium scan in conjunction with the technetium scan.

Wukich, D.K.; Abreu, S.H.; Callaghan, J.J.; Van Nostrand, D.; Savory, C.G.; Eggli, D.F.; Garcia, J.E.; Berrey, B.H.



Hydatid cyst of head of pancreas mimicking choledochal cyst  

PubMed Central

A 5-year-old girl presented with abdominal pain, intermittent jaundice and a gall bladder lump. Clinical examination and preoperative imaging suggested the diagnosis of a type I choledochal cyst (CDC). During surgery, this was found to be a hydatid cyst (HC) occupying the head of pancreas causing obstruction to the common bile duct (CBD). A pancreatic HC mimicking a CDC and presenting with CBD obstruction is unusual.

Agrawal, Sanwar; Parag, Pulak



Intraductal Papillary Mucinous Tumors of the Pancreas: Biology, Diagnosis, and Treatment  

PubMed Central

Pancreatic intraductal papillary mucinous neoplasms (IPMNs) rank among the most common cystic tumors of the pancreas. For a long time they were misdiagnosed as mucinous cystadenocarcinoma, ductal adenocarcinoma in situ, or chronic pancreatitis. Only in recent years have IPMNs been fully recognized as clinical and pathological entities, although their origin and molecular pathogenesis remain poorly understood. IPMNs are precursors of invasive carcinomas. When resected in a preinvasive state patient prognosis is excellent, and even when they are already invasive, patient prognosis is more favorable than with ductal adenocarcinomas. Subdivision into macroscopic and microscopic subtypes facilitates further patient risk stratification and directly impacts treatment. There are main duct and branch duct IPMNs, with the main duct type including the intestinal, pancreatobiliary, and oncocytic types and the branch duct type solely harboring the gastric type. Whereas main duct IPMNs have a high risk for malignant progression, demanding their resection, branch duct IPMNs have a much lower risk for harboring malignancy. Patients with small branch duct/gastric-type IPMNs (<2 cm) without symptoms or mural nodules can be managed by periodic surveillance.

Niedergethmann, Marco; Pilarsky, Christian; Kloppel, Gunter; Saeger, Hans D.



Use of fractional anisotropy value by diffusion tensor MRI for preoperative diagnosis of astrocytic tumors: case report  

Microsoft Academic Search

The fractional anisotropy (FA) value calculated by diffusion tensor MRI can indicate the degree of directionality of water diffusion in astrocytic tumors. Here, we report a case of anaplastic astrocytoma in which FA proved invaluable for the preoperative differential diagnosis. A 60-year-old man complained of headache, and underwent routine neuroimaging and DTI. The routine images suggested a low-grade glioma in

Toshinari Misaki; Takaaki Beppu; Takashi Inoue; Kuniaki Ogasawara; Akira Ogawa; Hiroyuki Kabasawa



Diagnosis and preoperative predictive value of serum HE4 concentrations for optimal debulking in epithelial ovarian cancer  

PubMed Central

The aim of this study was to evaluate serum human epididymis protein 4 (HE4) concentrations for the diagnosis and preoperative prediction of optimal debulking in epithelial ovarian cancer. The concentrations of serum HE4 and CA125 in 180 epithelial ovarian cancer patients, 40 benign ovarian tumor patients and 40 healthy female subjects were determined using enzyme-linked immunosorbent assays (ELISAs). The value of determining the serum HE4 concentrations for the diagnosis and preoperative prediction of optimal debulking in epithelial ovarian cancer was also analyzed. The concentration of serum HE4 was 355.2±221.29 pmol/l in ovarian cancer, 43.86±20.87 pmol/l in benign ovarian tumors and 30.22±9.64 pmol/l in healthy individuals, respectively. The serum HE4 levels of patients with ovarian cancer were significantly higher compared with those in the other two groups (P<0.01), although there were no statistically significant differences (P>0.05) between the benign ovarian tumors and healthy individuals. The maximum diagnostic value was identified at an HE4 serum concentration of 67.52 pmol/l and the sensitivity and specificity were 84 and 96%, respectively. The area under the ROC curve was 0.944 (95% CI, 0.912–0.976; P<0.001) and the ? value of the diagnosis of epithelial ovarian cancer according to HE4 was 0.814 (P=0.000). The demarcation criterion was 600 pmol/l, where a value >600 mol/l indicates a lower possibility of optimal debulking. HE4 predicted that the sensitivity of the incomplete cytoreductive surgery was 77% and specificity was 32%. The concentration of serum HE4 is a useful marker for diagnosis and preoperative prediction for the ideal tumor cytoreductive surgery in epithelial ovarian cancer.




Gastric heterotopic pancreas: an unusual case and review of the literature.  


Heterotopic pancreas is a rare condition and its preoperative diagnosis is difficult. It is generally asymptomatic, but it may become clinically evident depending on the size, location and the pathological changes. Heterotopic pancreas can occur anywhere in the gastrointestinal tract, but most commonly is found in the antrum of the stomach. We report an unusual case of a 31-year-old male patient with gastric outlet obstruction and chronic pancreatitis caused by a submucosal tumor at the pre-pyloric area revealed at endoscopy. Distal gastrectomy was performed and a histological diagnosis of heterotopic pancreas was established. The patient had an uneventful postoperative course and remained symptom free in the follow-up of six months. The difficulty of making an accurate preoperative diagnosis is highlighted and a review of the literature on this pathology is hereby presented. Although heterotopic pancreas is rare, it should be considered in the differential diagnosis of pancreatitis and gastric outlet obstruction caused by a submucosal gastric tumor. PMID:22720312

Trifan, Anca; Târcoveanu, Eugen; Danciu, Mihai; Hu?ana?u, C?t?lin; Cojocariu, Camelia; Stanciu, Carol



Dermoid cyst of the pancreas: A case report with literature review  

PubMed Central

Pancreatic dermoid cysts represent a rare entity with 35 cases described in the world literature, including the present one. Pre-operative diagnosis is difficult, with definitive diagnosis usually taking place intra-operatively. We report the case of a 63 year old male with a symptomatic, 6 cm cystic mass in the body of the pancreas. The pre-operative evaluation suggested a cystic neoplasm, but was indeterminate as to whether the lesion was benign or malignant. The diagnosis of dermoid cyst was made intra-operatively with frozen section. Although the diagnosis could not be made pre-operatively this retrospective report highlights the difficulty in evaluating cystic pancreatic lesions by imaging and summarizes the current body of knowledge on this rare entity.

Lane, Jason; Vance, Ansar; Finelli, Daniel; Williams, Gary; Ravichandran, Pars



Pancreas Transplantation  

Microsoft Academic Search

The world's first clinical pancreas transplant was performed at the University of Minnesota on December 16, 1966, to treat\\u000a a uremic diabetic patient. Since that time, nearly 15,000 pancreas transplants have been performed around the world, the major\\u000a ity in the United States.\\u000a \\u000a A successful pancreas transplant can establish normoglycemia and insulin independ ence in diabetic recipients. It also has

Abhinav Humar; Khalid O. Khwaja; David E. R. Sutherland


Preoperative diagnosis of hydatid cyst of the breast: a case report  

PubMed Central

Hydatid cyst of the breast is endemic in some areas like sheep-raising countries. The location of the disease is mostly in the liver and lungs. We presents a case of 66-year-old female with hydatid cyst of the breast diagnosed pre-operatively by core needle biopsy. Complete radiology workup are also provided which includes mammography, ultrasound, and computed tomography images. Hydatid cyst of the breast is extremely rare even in endemic areas, its only accounts for 0.27% of all cases. Only few reports are published in the literatures about breast hydatid cyst and majority of cases have been diagnosed post-operatively with no complete radiology workup.

Alamer, Ali; Aldhilan, Asim; Makanjuola, Dorothy; Alkushi, Abdulmohsen



Pancreas, Duodenum, Small Bowel  

Microsoft Academic Search

\\u000a Multiple perforations of the small bowel are common after penetrating abdominal trauma. Small bowel perforation after blunt\\u000a trauma is less common and the diagnosis is challenging but recent advances in radiological imaging have improved the diagnostic\\u000a accuracy. Because of the retroperitoneal location of the pancreas, it is rarely injured, and the pre- and intraoperative diagnosis\\u000a relies on high index of

Ari K. Leppäniemi


Artifical Pancreas  

NASA Astrophysics Data System (ADS)

In 2006, JDRF launched the Artificial Pancreas Project (APP) to accelerate the development of a commercially-viable artificial pancreas system to closely mimic the biological function of the pancreas individuals with insulin-dependent diabetes, particularly type 1 diabetes. By automating detection of blood sugar levels and delivery of insulin in response to those levels, an artificial pancreas has the potential to transform the lives of people with type 1 diabetes. The 6-step APP development pathway serves as JDRF's APP strategic funding plan and defines the priorities of product research and development. Each step in the plan represents incremental advances in automation beginning with devices that shut off insulin delivery to prevent episodes of low blood sugar and progressing ultimately to a fully automated ``closed loop'' system that maintains blood glucose at a target level without the need to bolus for meals or adjust for exercise.

Fei, Jiangfeng



[Usefulness of computed tomography and magnetic resonance in the preoperative diagnosis for hyperparathyroidism].  


Sonnography and Tc-99m sestamibi scintigraphy are the most requested preoperative imaging tests nowdays in the surgery of hyperparathyroidism. The aim of our article is to know if Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) are useful as a location study and in which cases it would be more justified to ask these radiologic techniques. For that we report our results with 29 patients at all diagnosed as hyperparathyroidism (26 primary forms and 3 secondary ones) and operated by our E.N.T. Department later. On 20 of them a cervical CT was asked before the parathyroidectomy and on the rest 9, a MRI with sensitivities of 65% and 88.9% respectively. We think both complementary explorations must not be solicited by routine but they can represent a help in the cases in that sonnography and scintigraphy are not able to show the possible adenoma or hiperplasia, particularly in recurrent hyperparathyroidisms, reinterventions or suspect of parathyroid glands in an atypical location. PMID:16318093

Pino Rivero, V; Pantoja Hernández, C G; González Palomino, A; Trinidad Ruíz, G; Marcos García, M; Keituqwa Yáñez, T; Pardo Romero, G; Blasco Huelva, A



[Imaging diagnosis of locally advanced rectal cancer: tumor staging before and after preoperative chemoradiotherapy].  


Recently, treatment strategy of rectal cancer has changed dramatically. The application of total mesorectal excision (TME) and preoperative chemoradiation therapy (PCRT) has become standard procedure for locoregional and locally advanced rectal cancer, respectively. For the planning of patient-specific therapy, both functional and morphological radiologic evaluation as well as multidisciplinary approach is essential. In other words, the needs for more accurate T- and N-staging and assessment of circumferential resection margin, both before and after PCRT, are increasing rapidly. Although so far there is no consensus on the role of diagnostic imaging (endorectal ultrasound, CT, MRI) in the evaluation of rectal cancer patient, MRI with diffusion-weighted image is emerging as an essential imaging modality, especially in the assessment of tumor response and depiction of complete remission after PCRT. In this review, we intended to demonstrate the present diagnostic role of various imaging modalities in tumor assessment of locally advanced rectal cancer before and after PCRT, with the introduction of new emerging imaging tool. PMID:23354343

Kim, Ah Young



Pancreas Transplantation  

Microsoft Academic Search

In summary, solitary pancreas transplants (alone in non-uremics—PTA; or after a kidney—PAK) should be done, as well as simultaneous\\u000a pancreas-kidney (SPK) transplants in uremic diabetics who cannot get a kidney transplant first (to preempt or shorten the\\u000a time on dialysis). The approach depends on the recipient candidate characteristics and on living or deceased donor availability\\u000a and suitability. It is regressive

David E. R. Sutherland; Angelika C. Gruessner


Intraductal papillary adenoma: Usefulness of magnetic resonance cholangiopancreatography in the diagnosis of cystic branch-duct dilatation of the pancreas  

Microsoft Academic Search

A 70-year-old woman with gastric cancer was referred to our hospital for further evaluation of a cystic mass in the head of\\u000a the pancreas. Endoscopic ultrasonography (EUS) showed a mural nodule in the cystic mass. Endoscopic retrograde cholangio pancreatography\\u000a (ERCP) revealed a cystic lesion with a filling defect caused by obstruction with mucus. Magnetic resonance cholangiopancreatography\\u000a (MRCP) allowed visualization of

Shugo Mizuno; Takashi Yano; Shuji Isaji; Shunichi Nakagawa; Hajime Yokoi; Yoshifumi Kawarada



Fish bone penetration of the duodenum extending into the pancreas: report of a case.  


We report a case of fish bone penetration of the duodenum extending into the pancreatic head, which was successfully treated by surgery. A 73-year-old woman was admitted with upper abdominal dull pain that had persisted for 3 days. Computed tomography showed a linear calcified body, which appeared to penetrate the posterior wall of the duodenal bulb into the pancreatic head. A laparotomy was performed based on the preoperative diagnosis of localized peritonitis caused by penetration of the duodenum into the pancreas by an ingested foreign body. The foreign body was safely removed from both the pancreas and duodenum and was found to be a fish bone, measuring 4 cm in length. Neither an abscess nor hematoma was detected at the site of the pancreatic head. The postoperative course was uneventful. This case demonstrates an unusual presentation of fish bone penetration of the duodenum with a migration to the pancreas. PMID:20582523

Yasuda, Takashi; Kawamura, Shiro; Shimada, Etsuji; Okumura, Shuichi



A molecular computational model improves the preoperative diagnosis of thyroid nodules  

PubMed Central

Background Thyroid nodules with indeterminate cytological features on fine needle aspiration (FNA) cytology have a 20% risk of thyroid cancer. The aim of the current study was to determine the diagnostic utility of an 8-gene assay to distinguish benign from malignant thyroid neoplasm. Methods The mRNA expression level of 9 genes (KIT, SYNGR2, C21orf4, Hs.296031, DDI2, CDH1, LSM7, TC1, NATH) was analysed by quantitative PCR (q-PCR) in 93 FNA cytological samples. To evaluate the diagnostic utility of all the genes analysed, we assessed the area under the curve (AUC) for each gene individually and in combination. BRAF exon 15 status was determined by pyrosequencing. An 8-gene computational model (Neural Network Bayesian Classifier) was built and a multiple-variable analysis was then performed to assess the correlation between the markers. Results The AUC for each significant marker ranged between 0.625 and 0.900, thus all the significant markers, alone and in combination, can be used to distinguish between malignant and benign FNA samples. The classifier made up of KIT, CDH1, LSM7, C21orf4, DDI2, TC1, Hs.296031 and BRAF had a predictive power of 88.8%. It proved to be useful for risk stratification of the most critical cytological group of the indeterminate lesions for which there is the greatest need of accurate diagnostic markers. Conclusion The genetic classification obtained with this model is highly accurate at differentiating malignant from benign thyroid lesions and might be a useful adjunct in the preoperative management of patients with thyroid nodules.



Relationship between the diagnosis, preoperative evaluation, and prognosis after orthotopic liver transplantation.  

PubMed Central

The purpose of this study was to identify which of the biochemical, immunological, or functional parameters derived before surgery as part of a systemic evaluation were helpful in predicting the frequency of rejection episodes, the chance of survival, and the cause risk of death (should death occur) of patients after orthotopic liver transplantation (OLTx). Ninety-eight adult patients who had an extensive preoperative protocol evaluation were studied before OLTx. The biochemical parameters assessed were albumin, prothrombin time, bilirubin, and ICG clearance. The immunologic parameters assessed included total lymphocytes, T3 cells, T4 cells, T8 cells, and the T4/T8 ratio. The degree of histocompatibility antigen (HLA) matching between the donor and the recipient was also evaluated in 80 of the 98 patients studied. Most postoperative deaths occurred within 12 weeks of the procedure (24%; 24 of 98 patients); 13 patients (13%) died within the first 6 postoperative weeks, of either bacterial or fungal sepsis. An additional 14 patients (14%) died after the initial 6 postoperative weeks due, primarily of an acquired viral and/or protozoan infection (p less than 0.01). During the first 6 weeks, survival was better for patients with cholestatic liver disease (ChLD, 93%, n = 45) and miscellaneous liver diseases (MISC, 100%, n = 10) than it was for those with parenchymal liver diseases (PLD, 77%, n = 43). Although albumin, prothrombin time, T4/T8 ratios, and per cent T8 cells were statistically different in patients with PLD as compared with those with ChLD, these parameters, as well as the per cent T4 cells, serum bilirubin level, per cent retention of ICG at 15 minutes, and the plasma ICG disappearance rate were not found to be of substantial help in predicting patient survival or non-survival. Moreover, neither the degree of HLA matching nor the number of rejection episodes differed between surviving and nonsurviving patients. The results of this study suggest that patients with PLD are at increased risk of early postoperative death after OLTx because of bacterial and/or fungal sepsis, as compared with patients operated upon for ChLD. Better pre-, intra-, and postoperative predictors of risk of death and complications are needed to reduce the early mortality observed after orthotopic liver transplantation.

Adler, M; Gavaler, J S; Duquesnoy, R; Fung, J J; Svanas, G; Starzl, T E; van Thiel, D H



Presepsin (sCD14-ST) in preoperative diagnosis of abdominal sepsis.  


Abstract Background: The aim of the study was to identify the diagnostic significance of presepsin in acute abdominal conditions and also to examine the correlation between presepsin, procalcitonin (PCT) and other parameters. Methods: To detect presepsin we used a new rapid method based on a chemiluminescent enzyme immunoassay. The clinical usefulness of presepsin to differentiate bacterial and non-bacterial infection [including systemic inflammation response syndrome (SIRS)] was studied and compared with PCT, C-reactive protein (CRP) and white blood cells (WBC). Results: The presepsin values in different conditions were (mean±standard deviation): healthy group (n=70) 258.7±92.53 pg/mL; SIRS (n=30) 430.0±141.33 pg/mL; sepsis (n=30) 1508.3±866.6 pg/mL. The presepsin values were significantly higher in patients with sepsis than the SIRS group (p<0.0001, Mann-Whitney U-test). The area under the receiver operating characteristics (ROC) curve (AUC) for discriminating of the SIRS from the sepsis patients was 0.996 for presepsin and it was greater than the AUC of PCT (0.912), CRP (0.857) or WBC (0.777). Conclusions: The ROC curve of the SIRS patient without infection and the sepsis patient showed that the presepsin concentration was a significantly sensitive indicator of sepsis and useful marker for the rapid diagnosis of sepsis. PMID:23740685

Vodnik, Tatjana; Kaljevic, Goran; Tadic, Tanja; Majkic-Singh, Nada



Management of mucinous cystic neoplasms of the pancreas  

PubMed Central

The purpose of this study was to investigate the actual management of mucinous cystic neoplasm (MCN) of the pancreas. A systematic review was performed in December 2009 by consulting PubMed MEDLINE for publications and matching the key words “pancreatic mucinous cystic neoplasm”, “pancreatic mucinous cystic tumour”, “pancreatic mucinous cystic mass”, “pancreatic cyst”, and “pancreatic cystic neoplasm” to identify English language articles describing the diagnosis and treatment of the mucinous cystic neoplasm of the pancreas. In total, 16 322 references ranging from January 1969 to December 2009 were analysed and 77 articles were identified. No articles published before 1996 were selected because MCNs were not previously considered to be a completely autonomous disease. Definition, epidemiology, anatomopathological findings, clinical presentation, preoperative evaluation, treatment and prognosis were reviewed. MCNs are pancreatic mucin-producing cysts with a distinctive ovarian-type stroma localized in the body-tail of the gland and occurring in middle-aged females. The majority of MCNs are slow growing and asymptomatic. The prevalence of invasive carcinoma varies between 6% and 55%. Preoperative diagnosis depends on a combination of clinical features, tumor markers, computed tomography (CT), magnetic resonance imaging, endoscopic ultrasound with cyst fluid analysis, and positron emission tomography-CT. Surgery is indicated for all MCNs.

Testini, Mario; Gurrado, Angela; Lissidini, Germana; Venezia, Pietro; Greco, Luigi; Piccinni, Giuseppe



Hypoglycemia following pancreas transplantation  

Microsoft Academic Search

Mild symptoms of hypoglycemia in individuals with type 1 diabetes who have undergone pancreas transplantation are common,\\u000a but biochemical evidence of hypoglycemia in these individuals often remains scant. Rarely, more overt cases with profound\\u000a neuroglycopenic symptoms and documented hypoglycemia after transplantation have been described. Although the diagnosis of\\u000a hypoglycemia in most cases of adrenergic symptoms alone, without documented hypoglycemia, remains

Joy Shen; Jason Gaglia



CD 99 immunocytochemistry in solid pseudopapillary tumor of pancreas: A study on fine-needle aspiration cytology smears  

PubMed Central

Background: Solid pseudopapillary tumor of pancreas (SPTP) is a rare pancreatic tumor of uncertain histogenesis usually affecting young women. Though these tumors have characteristic cytomorphology, it is sometimes difficult to differentiate them from neuroendocrine tumors of the pancreas. We reviewed cases of SPTP to delineate the diagnostic cytological features and also observed utility of CD 99 (MIC 2) immunostaining to aid in the diagnosis of this tumor. Aims: This study was designed to demonstrate the utility of CD 99 immunostaining along with cytological features for making a pre-operative diagnosis and delineating it from the neuroendocrine tumor of pancreas which is a close mimic. Materials and Methods: Cytomorphological features of 11 cases of solid pseudopapillary neoplasm diagnosed by pre-operative fine-needle aspiration cytology (FNAC) at our institute were reviewed. Immunocytochemistry for CD 99 was also performed on the smears. Results: All the cases had cellular smears with monomorphic cells lying singly, as loosely cohesive clusters as well as forming delicate pseudopapillae. Presence of intra and extra-cellular basement membrane material, background foamy macrophages and nuclear grooves were the other salient features. Immunocytochemistry for CD 99 could be performed on eight cases and demonstrated typical paranuclear dot-like positivity. Conclusions: Pre-operative early diagnosis of SPTP can be made by FNAC which can further be aided by CD 99 immunocytochemistry.

Ghosh, Ranajoy; Mallik, Saumya R.; Mathur, Sandeep R.; Iyer, Venkateswaran K.



Pancreas transplantation  

Microsoft Academic Search

Pancreas transplantation is now the standard of care for selected patients with diabetes and end-stage renal failure, with clear benefits in duration and quality of life. The indication for transplantation in patients with other severe diabetic complications are less clearly defined and the benefits less certain. The criteria for donor selection are more rigorous than for kidney and liver transplantation;

Thomas Vogel; Peter Friend



Routine measurement of serum calcitonin in nodular thyroid diseases allows the preoperative diagnosis of unsuspected sporadic medullary thyroid carcinoma.  


To assess whether routine measurement of serum calcitonin (CT) could improve the preoperative diagnosis of sporadic medullary thyroid carcinoma (MTC), 1385 consecutive patients presenting for nodular thyroid disease during the year 1991 were submitted to serum CT determination and fine needle aspiration cytology (FNAC). The clinical diagnosis was nontoxic nodular goiter in 1197 (86.4%) patients, toxic multinodular goiter in 65 (4.7%), autonomously functioning thyroid nodule (AFTN) in 64 (4.6%), and autoimmune thyroid disease (Graves' disease or Hashimoto's thyroiditis) with nodule(s) in 59 (4.3%). As controls, 177 patients with nonnodular thyroid disease and 32 normal subjects were also studied. Patients with FNAC suspicious of any kind of thyroid carcinoma and patients with elevated basal and pentagastrin-stimulated serum CT, regardless of the results of FNAC, were submitted to surgery. Eight (0.57%) patients (7 with nontoxic nodular goiter and 1 with AFTN) had elevated basal serum CT levels, ranging between 55-10,000 pg/mL. The pentagastrin test was abnormal in all of them. FNAC was suggestive of MTC in 2, thyroid carcinoma in 1, benign nodule in 3, and inadequate in 2. By histology, immunohistochemistry, and Northern blot analysis of total tumor RNAs, MTC was confirmed in all patients, including the 1 with AFTN, who had the association of microfollicular adenoma and a small MTC in the same lobe. After surgery, serum CT decreased to undetectable levels in 7 patients and remained undetectable in 6 of them during a mean follow-up of 22 months, although 1 of them had a positive response to pentagastrin. Forty-four patients in the group with normal serum CT levels had FNAC suspicious for differentiated thyroid carcinoma and were treated by surgery. Differentiated thyroid carcinoma, mostly papillary, was confirmed at histology in 43 subjects (3.1% of all thyroid nodules). In conclusion, the results of our study indicate that serum CT measurement is useful for the screening of sporadic MTC in patients with thyroid nodule(s). The prevalence of MTC, diagnosed by serum CT measurement in a 12-month period, among an unselected series of 1385 patients with nodular thyroid disease was surprisingly high: 0.57% of all thyroid nodules and 15.7% of all thyroid carcinomas. Serum CT measurement was superior to FNAC in suggesting the diagnosis of MTC and was devoid of falsely positive results. Increasing the diagnostic accuracy helped the surgeon to perform more radical treatment of MTC, thus achieving frequent normalization of postoperative serum CT levels. Whether this result indicates definitive cure remains to be established on the basis of longer follow-up.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:8157706

Pacini, F; Fontanelli, M; Fugazzola, L; Elisei, R; Romei, C; Di Coscio, G; Miccoli, P; Pinchera, A



Polysplenia syndrome with congenital agenesis of dorsal pancreas presenting as acute pancreatitis and the role of endoscopic ultrasonography in its diagnosis.  


A 49-year-old female was admitted to our hospital for acute pancreatitis. The abdomen CT scan incidentally showed midline liver with hepatomegaly, centrally located gallbladder, pancreas truncation, right sided small bowel, left sided large bowel, interruption of the inferior vena cava with azygos continuation, preduodenal portal vein, and multiple spleens in the left upper quadrant. In MRCP, the head of pancreas was enlarged and short main pancreatic duct without accessory duct was showed. EUS revealed enlarged ventral pancreas with a main pancreatic duct of normal caliber, absence of the accessory pancreatic duct and the dorsal pancreas. She was diagnosed as polysplenia syndrome with agenesis of dorsal pancreas. It is a rare congenital anomaly frequently associated with various visceral anomalies including multiple spleens, impaired visceral lateralization, congenital heart diseases, gastrointestinal abnormalities and azygos continuation of the inferior vena cava. We report a case of polysplenia syndrome with agenesis of dorsal pancreas presenting acute pancreatitis. PMID:22832800

Jeong, Jae Hoon; Kim, Gwang Ha; Song, Geun Am; Lee, Dong Gun; Moon, Ji Yoon; Cheong, Jae Hoon; Kim, Suk



An aggressive resectional approach to cystic neoplasms of the pancreas  

Microsoft Academic Search

Background: Prognosis is good after curative resection for serous and mucinous cystic neoplasms of the pancreas. There has been a recent trend to resect all cystic neoplasms, without attempts to preoperatively determine the exact histologic subtype. Our purpose is to report on the results of such an aggressive surgical approach to all cystic neoplasms of the pancreas.Methods: This is a

Karen D Horvath; John A Chabot



Pancreas transplantation.  


SPK transplant is the definitive treatment of type 1 diabetes combined with end-stage renal disease. Long-term graft function can lead to improvement in diabetes-related complications and, in patients younger than 50 years, can lead to improved overall survival. PAK transplant and PA transplant do not result in similar improvements in patient survival, but with appropriate patient selection, they can improve quality of life by rendering patients insulin-free. Pancreas transplant is associated with more surgical complications and higher perioperative morbidity and mortality than KTA. Therefore, careful donor and recipient selection along with meticulous surgical technique are mandatory for optimal outcomes. PMID:22341254

Dhanireddy, Kiran K



Prenatal Diagnosis and Risk Factors for Preoperative Death in Neonates with Single Right Ventricle and Systemic Outflow Obstruction: Screening Data from the Pediatric Heart Network Single Ventricle Reconstruction Trial  

PubMed Central

Objectives The purpose of this analysis was to assess preoperative risk factors prior to the first-stage Norwood surgery in infants with hypoplastic left heart syndrome and related single ventricle lesions, and to evaluate practice patterns in prenatal diagnosis as well as the role of prenatal diagnosis in outcome. Methods Data from all live births with morphologic single right ventricle and systemic outflow obstruction screened for the Pediatric Heart Network Single Ventricle Reconstruction Trial were used to investigate prenatal diagnosis and preoperative risk factors. Demographics, gestational age, prenatal diagnosis status, presence of major extracardiac congenital abnormalities and preoperative mortality rates were recorded. Results Of 906 infants, 677 (75%) had prenatal diagnosis, 15% were preterm (<37 weeks), and 16% were low birth weight (<2500 g). Rates of prenatal diagnosis varied by study site (59%-85%, p<0.0001). Major extracardiac congenital abnormalities were less prevalent in those born after prenatal diagnosis (6% vs. 10%, p=0.03). There were 26 (3%) deaths prior to Norwood palliation; preoperative mortality did not differ by prenatal diagnosis status (p=0.49). In multiple logistic regression models, preterm birth (p=0.02), major extracardiac congenital abnormalities (p<0.0001), and obstructed pulmonary venous return (p=0.02) were independently associated with preoperative mortality. Conclusions Prenatal diagnosis occurred in 75%. Preoperative death was independently associated with preterm birth, obstructed pulmonary venous return and major extracardiac congenital abnormalities. Adjusted for gestational age and the presence of obstructed pulmonary venous return, the estimated odds of preoperative mortality were 10 times greater for subjects with a major extracardiac congenital abnormality.

Atz, Andrew M.; Travison, Thomas G.; Williams, Ismee A.; Pearson, Gail D.; Laussen, Peter C.; Mahle, William T.; Cook, Amanda L.; Kirsh, Joel A.; Sklansky, Mark; Khaikin, Svetlana; Goldberg, Caren; Frommelt, Michele; Krawczeski, Catherine; Puchalski, Michael D.; Jacobs, Jeffrey P.; Baffa, Jeanne M.; Rychik, Jack; Ohye, Richard G.



Pancreas divisum.  


We review important new clinical observations in pancreas divisum (PD) made since 2007. PD is common and has the same prevalence in the general population and idiopathic pancreatitis (IP). Up to 53% of patients with PD and IP have underlying idiopathic chronic pancreatitis (CP), and in rigorous prospective clinical follow-up and/or natural history studies, many with idiopathic recurrent acute pancreatitis (IRAP) have idiopathic CP. According to retrospective studies, PD does not modify the natural course of nonalcoholic or alcoholic CP. CFTR and/or SPINK1 gene mutations associate with IP (idiopathic CP and IRAP) independently of the presence of PD. More than one third of patients with pancreatitis or presumed pancreaticobiliary pain respond to placebo. Authors of uncontrolled studies report a significant symptomatic response to surgery and endotherapy in patients with IP and PD, but the response remains unproven and is largely limited to those with IRAP and not idiopathic CP or chronic pain. PMID:21222060

DiMagno, Matthew J; Wamsteker, Erik-Jan



Agenesis of the dorsal pancreas  

PubMed Central

Developmental anomalies of the pancreas have been reported but dorsal pancreatic agenesis is an extremely rare entity. We report an asymptomatic 62-year-old woman with complete agenesis of the dorsal pancreas. Abdominal computed tomography (CT) revealed a normal pancreatic head, but pancreatic body and tail were not visualized. Magnetic resonance imaging (MRI) findings were similar to CT. At magnetic resonance cholangiopancreatography (MRCP), the major pancreatic duct was short and the dorsal pancreatic duct was not visualized. The final diagnosis was dorsal pancreatic agenesis.

Pasaoglu, Lale; Vural, Murat; Hatipoglu, Hatice Gul; Tereklioglu, Gokce; Koparal, Suha



Two cases of portal annular pancreas.  


Portal annular pancreas is one of the pancreatic fusion anomalies in which the uncinate process of the pancreas extends to fuse with the dorsal pancreas by encircling the portal vein or superior mesenteric vein. We report two consecutive patients with portal annular pancreas. The first case is a 71-year-old male patient who underwent a pancreaticoduodenectomy for intraductal papillary mucinous neoplasm in the head of pancreas. His preoperative computed tomography scan showed the suprasplenic type portal annular pancreas. The second case is a 74-year-old female patient who underwent a laparoscopic anterior radical antegrade modular pancreatosplenectomy (RAMPS) for pancreatic body cancer. In operative finding, portal confluence (superior mesenteric vein-splenic vein-portal vein) was encased with the uncinate process of pancreas in both cases. Therefore, they required pancreatic division at the pancreatic neck portion twice. During the postoperative period, grade B and A, respectively, postoperative pancreatic fistulas occurred and were controlled by conservative management. Surgeons need to know about this rare pancreatic condition prior to surgical intervention to avoid complications, and to provide patients with well-designed, case-specific pancreatic surgery. PMID:22832801

Jang, Ji Young; Chung, Young Eun; Kang, Chang Moo; Choi, Sung Hoon; Hwang, Ho Kyoung; Lee, Woo Jung



Preoperative detection of insulinomas: two case reports  

PubMed Central

Background Insulinoma is the most common endocrine tumor of the pancreas. Accurate preoperative detection and localization of insulinomas is essential for the appropriate selection of candidates for surgery. We present two cases with benign pancreatic insulinoma. Case presentation Preoperative evaluation for patients with suspected insulinomas has been controversial. Endoscopic ultrasonography (EUS) has a sensitivity of 95% in well skilled operators and well tolerated preoperative imaging method. Conclusion We have detected the insulinomas with EUS before surgery in our patients but other imaging modalities did not help us for localization of them. Patients have been asymptomatic postoperatively with no hypoglycemia on repeat fasting. We reviewed here the different modalities for preoperative localization of insulinoma.

Ozkaya, Mesut; Yuzbasioglu, Mehmet Fatih; Koruk, Irfan; Cakal, Erman; Sahin, Mustafa; Cakal, Basak



Cor triatriatum sinister, not mitral stenosis, in an adult with previous Sydenham's chorea: diagnosis and preoperative assessment by cross sectional echocardiography  

PubMed Central

In cor triatriatum sinister, one of the rarest congenital cardiac anomalies, a membrane divides the left atrium into a pulmonary venous component above and the vestibule below. The importance of the anomaly lies in the effects of the resultant pulmonary venous obstruction that usually present in the first year of life and can mimic obstructed total anomalous venous drainage or congenital mitral stenosis. A case presented as mitral stenosis in the third decade of life, ten years after a well documented episode of Sydenham's chorea. The diagnosis was made rapidly by transthoracic echocardiography and transoesophageal echocardiography was used for complete assessment. Cardiac catheterisation added nothing to the non-invasive diagnosis or the preoperative assessment. Uncomplicated corrective surgery was undertaken.

De Belder, Mark A; Argano, Vincenzo; Burrell, Christopher J



Solid-pseudopapillary neoplasm (SPN) of the pancreas: case series and literature review on an enigmatic entity  

PubMed Central

Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare tumor which typically affects young women without significant clinical symptoms. SPN usually shows an indolent behavior and only rare cases recur and/or metastasize after complete resection. We report our experience with four cases of SPN of the pancreas. All four patients were female with an age range of 15-42 years (mean age: 24.5 years). Two patients presented with abdominal pain, one with abdominal mass and one with acute abdominal signs following blunt trauma. Tumor’s size ranged from 1 to 16 cm (mean size: 5.5 cm). Two tumors were diagnosed preoperatively through percutaneous core needle biopsy and two underwent surgery without preoperative diagnosis because of high suspicion of SPN based on clinical and radiological findings. By immunohistochemistry, all cases stained strongly for vimentin, progesterone-receptor and beta-catenin (nuclear) and variably with pankeratin and neuroendocrine markers. The proliferation index (Ki-67) was <2% in all cases. After a median follow-up of 40 months (range: 24-57 months), all patients were alive with no evidence of recurrence or metastatic disease. In conclusion, SPN of the pancreas should be considered in the differential diagnosis of any solid and partly cystic pancreatic or upper abdominal mass, particularly in young females. SPN possesses a low malignant potential and complete surgical resection with clear margins is the treatment of choice. Following R0 resection, SPN has an excellent prognosis.

Vassos, Nikolaos; Agaimy, Abbas; Klein, Peter; Hohenberger, Werner; Croner, Roland S



A decade of breast cancer screening in The Netherlands: trends in the preoperative diagnosis of breast cancer  

Microsoft Academic Search

Purpose  In a prospective, multi-institutional follow-up study we describe the trends in the preoperative pathologic confirmation of\\u000a breast cancer of women who underwent breast cancer screening between 1995 and 2005.\\u000a \\u000a \\u000a \\u000a Methods  We included all women aged 50–75 years who underwent biennial screening mammography in the southern breast cancer screening\\u000a region of the Netherlands between February 13, 1995 and December 22, 2004. Clinical data,

Lucien E. M. Duijm; Johanna H. Groenewoud; Rudi M. H. Roumen; Harry J. de Koning; Menno L. Plaisier; Jacques Fracheboud



Pre-operative assessment enables early diagnosis and recovery of shoulder function in patients with breast cancer.  


In order to determine the extent and time course of upper limb impairment and dysfunction in women being treated for breast cancer (BC), and followed prospectively, a novel physical therapy surveillance model post-treatment was used. Subjects included adult women with newly diagnosed, untreated, unilateral, Stage I to III BC, and normal physiological and biomechanical shoulder function. Subjects were excluded if they had a previous history of BC, or prior injury or surgery of the affected upper limb. Measurements included body weight, shoulder ranges of motion (ROM), manual muscle tests, pain levels, upper limb volume, and an upper limb disability questionnaire (ULDQ). Measurements were taken at baseline (pre-surgery), and 1, 3-6, and 12 months post-surgery. All subjects received pre-operative education and exercise instruction and specific physical therapy (PT) protocol after surgery including ROM and strengthening exercises. All measures of function were significantly reduced 1 month post-surgery, but most recovered to baseline levels by 1-year post-surgery. Some subjects developed signs of lymphedema 3-12 months post-surgery, but this did not compromise function. Shoulder abduction, flexion, and external rotation, but not internal rotation ROM, were associated with the ULDQ. Most women in this cohort undergoing surgery for BC who receive PT intervention may expect a return to baseline ROM and strength by 3 months. Those who do not reach baseline, often continue to improve and reach their pre-operative levels by 1-year post-surgery. Lymphedema develops independently of shoulder function 3-12 months post-surgery, necessitating continued monitoring. A prospective physical therapy model of surveillance allows for detection of early and later onset of impairment following surgery for BC in this specific cohort of patients. PMID:20054643

Springer, Barbara A; Levy, Ellen; McGarvey, Charles; Pfalzer, Lucinda A; Stout, Nicole L; Gerber, Lynn H; Soballe, Peter W; Danoff, Jerome



Pre-operative Assessment Enables Early Diagnosis and Recovery of Shoulder Function in Patients with Breast Cancer  

PubMed Central

Purpose To determine the extent and time course of upper limb impairment and dysfunction in women being treated for breast cancer, and followed prospectively, using a novel physical therapy surveillance model post-treatment. Patients and Methods Subjects included adult women with newly diagnosed, untreated, unilateral, Stage I to III BC and normal physiological and biomechanical shoulder function. Subjects were excluded if they had a previous history of BC, or prior injury or surgery of the affected upper limb. Measurements included body weight, shoulder ranges of motion (ROM), manual muscle tests, pain levels, upper limb volume, and an upper limb disability questionnaire (ULDQ). Measurements were taken at baseline (pre surgery), and one, three-six, and 12 months post surgery. All subjects received pre-operative education and exercise instruction and specific physical therapy (PT) protocol after surgery including ROM and strengthening exercises. Results All measures of function were significantly reduced one month post surgery, but most recovered to baseline levels by one year post surgery. Some subjects developed signs of lymphedema 3–12 months post surgery, but this did not compromise function. Shoulder abduction, flexion, and external rotation, but not internal rotation ROM, were associated with the ULDQ. Conclusion Most women in this cohort undergoing surgery for BC who receive PT intervention may expect a return to baseline ROM and strength by three months. Those who do not reach baseline, often continue to improve and reach their pre-operative levels by one year post surgery. Lymphedema develops independently of shoulder function three to 12 months post surgery, necessitating continued monitoring. A prospective physical therapy model of surveillance allows for detection of early and later onset of impairment following surgery for BC in this specific cohort of patients.

Springer, Barbara A.; Levy, Ellen; McGarvey, Charles; Pfalzer, Lucinda A.; Stout, Nicole L; Gerber, Lynn H.; Soballe, Peter W.; Danoff, Jerome



Factors affecting surgical margin positivity in invasive ductal breast cancer patients who underwent breast-conserving surgery after preoperative core biopsy diagnosis  

PubMed Central

Purpose The aim of our study is to evaluate the factors affecting surgical margin positivity among patients with invasive ductal breast cancer who underwent breast-conserving surgery (BCS) after preoperative diagnostic core biopsy. Methods Two hundred sixteen patients with stage I, II invasive ductal breast carcinoma who had histological diagnosis with preoperative tru-cut biopsy and underwent BCS were included in the present study. Potential factors that affect the positive surgical margin were analyzed. In univariate analysis, the comparisons of the factors affecting the surgical margin positivity were made by chi-square test. Logistic regression test was used to detect the independent factors affecting the surgical margin positivity. Results Positive axillary lymph node (odds ratio [OR], 8.2; 95% confidence interval [CI], 3.01 to 22.12), lymphovascular invasion (LVI; OR, 3.9; 95% CI, 1.62 to 9.24), extensive intraductal component (EIC; OR, 6.1; 95% CI, 2.30 to 16.00), presence of spiculation (OR, 5.1; 95% CI, 2.00 to 13.10) or presence of microcalcification in the mammography (OR, 13.7; 95% CI, 4.04 to 46.71) have been found to be the independent and adverse factors affecting surgical margin positivity. Conclusion Considering decision making for the extent of the excision and for achieving negative surgical margin before BCS, positive axillary lymph node, LVI, EIC, spiculation or microcalcification in mammography are related as predictor factors for positive surgical margin.

Kuru, Bekir; Yuruker, Savas; Gokgul, Bar?s; Ozen, Necati



Gastric heterotopic pancreas can be identified by endoscopic direct imaging with submucosal endoscopy.  


Heterotopic pancreas (HP) is pancreatic tissue found outside the usual anatomical location of the pancreas, typically in the upper gastrointestinal tract. Asymptomatic HP is considered a benign submucosal tumor (SMT) that can be followed without intervention. However, invasive surgery or endoscopic resection is often inappropriately applied in cases of HP due to the difficulty of preoperative diagnosis by endoscopic ultrasonography (EUS) and tissue sampling error. Therefore, it is very important to distinguish HP from neoplastic SMTs, such as gastrointestinal stromal tumor (GIST), preoperatively. Herein, we describe two asymptomatic gastric HP cases that were distinguished by endoscopic direct imaging (EDI) on submucosal endoscopy with a mucosal flap method (SEMF). In the two patients, EUS-guided fine needle aspiration (FNA) biopsy failed to accurately diagnose two SMTs, consistent with the suspicion of a GIST on EUS. Accordingly, we attempted to perform bloc biopsy using SEMF as a novel method for obtaining tissue samples for two indefinite SMTs. Direct endoscopic imaging via a dissected submucosal tunnel revealed a yellowish, multi-nodular mass identified as pancreatic tissue. Histopathology of the bloc biopsy confirmed the diagnosis of HP. Our findings indicate that the characteristic EDI findings of gastric HP may distinguish these lesions from neoplastic SMTs. Additional evaluations of this approach are warranted. PMID:24078995

Kobara, Hideki; Mori, Hirohito; Fujihara, Shintaro; Nishiyama, Noriko; Tsutsui, Kunihiko; Masaki, Tsutomu



Pancreas transplant alone  

Microsoft Academic Search

Pancreas transplant alone (PTA) represents a growing proportion of overall pancreas transplantations, with 1-year patient and graft survivals of almost 100% and higher than 80%, respectively. PTA can restore normoglycemia without exogenous insulin administration and eliminate acute diabetic complications. In our series of 28 PTA, performed with portal-enteric drainage, 2-year patient and pancreas survivals were 100% and 87%, respectively. In

P. Marchetti; U. Boggi; A. Coppelli; R. Giannarelli; F. Vistoli; M. Aragona; S. Del Prato; F. Mosca



Pre-operative diagnosis and successful surgery of a strangulated internal hernia through a defect in the falciform ligament: a case report  

PubMed Central

Introduction Internal hernia within the falciform ligament is exceedingly rare. A literature search revealed only 14 cases of internal herniation of the small bowel through a congenital defect of the falciform ligament, most of which were found intra-operatively. Case presentation A 77-year-old Japanese woman presented to our emergency department with sudden hematemesis, occurring at least four to five times over a 12-hour period. No ulcer or gastrointestinal bleeding was detected on gastroendoscopy. A 40mm mass in the inferior lobe of the right lung was found on a chest X-ray, and our patient’s symptoms were therefore initially ascribed to aspirated blood from lung tumor-associated hemoptysis. However, our patient continued to show signs of severe abdominal pain and decreased urine output despite aggressive hydration, leading her examining physicians to search for a possibly severe, occult abdominal pathology. On emergent computed tomography imaging, we found an acute strangulated internal hernia within the falciform ligament. Diagnosis was made by helical computed tomography, permitting rapid surgical intervention. Conclusions Our findings on computed tomography imaging assisted with the pre-operative diagnosis and enabled us to make a rapid surgical intervention. Early diagnosis may help preclude significant strangulation with unnecessary resection.



Peroperative transduodenal biopsy of the pancreas.  

PubMed Central

Peroperative transduodenal biopsy of the pancreas was performed in 65 patients with the disposable Trucut needle. The technique described is simple, effective, and may reveal unsuspected malignancy. A histological diagnosis of malignancy is reliable but false negative diagnosis may arise because of failure to obtain representative samples. Images Figure

Tweedle, D E



Epithelioid hemangioendothelioma of the liver: The role of hepatobiliary phase imaging for the preoperative diagnosis and qualification of patients for liver transplantation - preliminary experience.  


Background The aim of this study was to determine if the appearance of hepatic epithelioid hemangioendothelioma (HEHE) on state-of-the-art MRI including hepatocyte phase after administration of hepatobiliary contrast agent can facilitate preoperative diagnosis and identification of potential candidates for liver transplantation. Material and Methods The study group comprised 6 patients with pathologically confirmed HEHE. Analysis included signal characteristics of 55 tumor nodules (maximum of 10 lesions per patient) on T2-weighted images, dynamic contrast-enhanced, 5-minute delayed, and hepatobiliary phase images. Results The most common feature of HEHE, observed in 84% of lesions, was progressive contrast-enhancement, followed by subcapsular location (66%), confluent appearance (60%) and hyper- or isointensity on hepatobiliary phase images (53%). In 5 of 6 patients, capsular retraction was observed. Conclusions The appearance of HEHE on hepatobiliary phase images was variable, but examined tumors often demonstrated hyper- or isointensity, most probably due to prolonged retention of contrast material. These features, along with typical morphology (subcapsular, confluent nodules, with progressive enhancement and capsular retraction), may contribute to correct diagnosis and recognition of potential candidates for liver transplantation. PMID:23965576

Cieszanowski, Andrzej; Pacho, Ryszard; Anysz-Grodzicka, Agnieszka; Gornicka, Barbara; Remiszewski, Piotr; Maj, Edyta; Grudzinski, Ireneusz P; Zieniewicz, Krzysztof; Oldakowska-Jedynak, Urszula; Rowinski, Olgierd; Krawczyk, Marek



Use of radionuclide method in preoperative and intraoperative diagnosis of osteoid osteoma of the spine. Case report  

SciTech Connect

A 24-year-old man with persistent low back pain and right sciatica, was found to have an osteoid osteoma of the right pedicle of the second lumbar vertebra. /sup 99m/Tc-MDP bone scan and CAT scan produced an early diagnosis of the lesion. Intraoperative /sup 99m/Tc-MDP in vitro combined with imaging and quantitative activity measurements were useful for accurate localization and complete removal. The method is simple and can be performed in every nuclear medicine department, with no need for special operating room facilities.

Israeli, A.; Zwas, S.T.; Horoszowski, H.; Farine, I.



Pancreas Transplantation for Diabetes Mellitus  

Microsoft Academic Search

Pancreas transplantation has become a viable option for the patient with insulin-dependent diabetes mellitus with progressive renal failure. The most common type of pancreas transplantation is a simultaneous pancreas and kidney transplantation performed from a single cadaver donor (SPK). The next most common is pancreas transplantation after successful kidney transplantation (PAK). A few centers are performing pancreas transplantation alone (PTA)

John D. Pirsch; Charles Andrews; Donald E. Hricik; Michelle A. Josephson; Alan B. Leichtman; Christopher Y. Lu; Larry B. Melton; Venkateswara K. Rao; Robert R. Riggio; Robert J. Stratta; Matthew R. Weir



Pancreas and islet transplantation  

Microsoft Academic Search

Considerable evidence supports the hypothesis that the microangiopathic lesions of diabetes are secondary to disordered metabolism. This hypothesis underlies the rationale for whole pancreas and islet transplantation. Whole pancreas transplantation has had limited clinical success—only 1 of 47 recipients reported to the ACS\\/NIH Transplant Registry is currently alive. Major problems have been allograft rejection and complications related to either the

David E. R. Sutherland; Arthur J. Matas; John S. Najarian



Primary monophasic synovial sarcoma of the pancreas.  


We report a case of synovial sarcoma of the pancreas in a 44-year-old male who presented with multiple episodes of retroperitoneal hemorrhage; the diagnosis was confirmed by histology. The patient underwent distal pancreatectomy without complication, and the hospital stay was nine days. No adjuvant treatment was administered. The patient is alive at 1 year. PMID:23491856

Luc, G; Collet, D; Reich, S; Stanislas, S; Sa-Cunha, A



Human pancreas-specific protein  

Microsoft Academic Search

Summary\\u000a Conclusion  Human pancreas-specific protein (hPASP) is a very sensitive reflector of the extent of pancreatic necrosis on the cellular\\u000a level, and is of both diagnostic and prognostic value in acute pancreatitis. Furthermore, it allows the estimation of the\\u000a severity of graft pancreatitis soon after simultaneous renal and pancreatic transplantation.\\u000a \\u000a \\u000a \\u000a Background  Diagnosis of acute pancreatitis (AP) has been improved in the past

Stefan W. Schmid; Waldemar Uhl; Anne Steinle; Bettina Rau; Christian Seiler; Markus W. Biichler



Preoperative Systems  

Microsoft Academic Search

The preoperative period is the time during which critical patient data are gathered, processed, and disseminated. This information\\u000a is used to plan for and schedule personnel, equipment, and a myriad of subtasks to ensure a smooth day in the OR. The level\\u000a and the thoroughness of planning determine the efficient utilization of personnel and facilities, which impacts actual costs\\u000a and,

David Young; Gordon Gibby


Relation of preoperative sialographic findings with histopathological diagnosis in cases of obstructive sialadenitis of the parotid and submandibular glands: retrospective study  

Microsoft Academic Search

The clinical records, preoperative sialograms and histopathological slides of 33 patients who had been operated on for symptoms of obstructive salivary gland disease were reviewed. Twenty patients had had superficial parotidectomy and 13 excision of the submandibular gland.Among those who had required parotidectomy, preoperative sialograms tended to suggest more architectural damage than was actually noted on definitive histopathological examination. Patients

J. V. P. Tighe; B. M. W. Bailey; M. Z. Khan; M. Stavrou; C. E. C. Todd



The value of ultrasound examination in preoperative neck assessment and in early diagnosis of nodal recurrences in the follow-up of patients operated for laryngeal cancer.  


The purpose of this study was to prove the superiority of ultrasound (US) examination of the neck in comparison to palpation, to reveal unpalpable nodes (pN0) before surgery, and to allow for the early detection of nodal recurrences in patients with laryngeal cancers. In all, 1,120 patients with laryngeal cancers were operated on between 1990 and 1997. All underwent palpation and neck US before surgery. In the pN0 group US revealed enlarged lymph nodes in 261/505 cases, of which 63 (24.14%) were confirmed as metastatic by histology. All 1,120 patients underwent regular postoperative US follow-up. Nearly 5,000 US examinations were performed; 136 patients who developed nodal recurrences had surgical salvage procedures. In this group 61 patients had small, nonpalpable lesions, and 46 patients discrete and slight changes in scarred necks. In this latter group of 117 patients with nonpalpable lesions, 105 cases were histologically confirmed as metastatic. In postoperative check-ups, metastases were suspected in sonographically detected subclinical nodes, but the US scans obtained were difficult to interpret. In these cases, because of the dynamics of lesion changes, US was repeated two to three times at 10- to 14-day intervals. This reappraisal enabled us to exclude malignancy in regressing nodes, as well as to obtain the stable picture of scar, and support a diagnosis while the lesion grew larger or a central area of low attenuation or hypoechogenic echos appeared in the nodal capsule. Successful radical reoperation for tumor was done on110 patients; 78 patients underwent successful salvage surgery after an early US diagnosis. The sonographic-surgical correlation was nearly 95% and the sonographic-histological correlation was 90%. The follow-up period was 1-49 months. In all preoperative assessments US was found to be a valuable tool in the staging of laryngeal cancer and planning the extent of surgery. Close follow-up with US after radiotherapy and initial operation was essential for the early detection of tumor recurrences, making surgical salvage still feasible. PMID:10525948

Szmeja, Z; Wierzbicka, M; Kordylewska, M



Organ Facts: Kidney / Pancreas  


... the kidneys is to remove waste from the body through the production of urine. They also help to regulate blood pressure, blood volume and the chemical (electrolyte) composition of the blood. The pancreas is a five ...


An implantable artificial pancreas  

Microsoft Academic Search

The artificial implantable pancreas is seen as the optimal means of therapy in patients with severe diabetes mellitus. The\\u000a implantable pancreas consists of three modules; (i) the dosing unit, (ii) the control circuit and (iii) a glucose sensor for\\u000a the realisation of a feedback system. Intensive research has been devoted to essential items, such as a dosing valve with\\u000a only

W. Schubert; P. Baurschmidt; J. Nagel; R. Thull; M. Schaldach



Annular pancreas associated with duodenal carcinoma  

PubMed Central

Annular pancreas (AP) is a rare congenital anomaly. Coexisting malignancy has been reported only in a few cases. We report what is, to the best of our knowledge, the first case in the English literature of duodenal adenocarcinoma in a patient with AP. In a 55-year old woman with duodenal outlet stenosis magnetic resonance cholangiopancreatography showed an aberrant pancreatic duct encircling the duodenum. Duodenojejunostomy was performed. Eight weeks later she presented with painless jaundice. Duodenopancreatectomy revealed a duodenal adenocarcinoma, surrounded by an incomplete AP. Thus, co-existent malignancy with AP can be present without obstructive jaundice and without being visible through preoperative diagnostics.

Bronnimann, Enrico; Potthast, Silke; Vlajnic, Tatjana; Oertli, Daniel; Heizmann, Oleg



Agenesis of the Dorsal Pancreas with Chronic Calcific Pancreatitis. Case Report, Review of the Literature and Genetic Basis  

Microsoft Academic Search

Context Agenesis of the dorsal pancreas is a rare developmental anomaly. This anomaly may be complicated by recurrent acute and chronic pancreatitis. Case report We report the case of a 28-year- old female with agenesis of the dorsal pancreas and chronic calcific pancreatitis. The diagnosis of agenesis of the dorsal pancreas is discussed and the genetic changes leading to it

Vallath Balakrishnan; Vekateswara A Narayanan; Ismail Siyad; Lakshmi Radhakrishnan; Prem Nair



Acinar cell carcinoma arising from an ectopic pancreas.  


We herein report a rare case of ectopic pancreatic acinar cell carcinoma (ACC) which presented as a submucosal tumor of the pylorus. A 73-year-old man came to our hospital presenting with epigastralgia. Esophago-gastroduodenal endoscopy showed no mucosal lesions, but a submucosal tumor was observed around the pylorus. Abdominal computed tomography revealed two round masses. One was located in the pylorus, while the other was found between the portal vein and the inferior vena cava. An examination of a biopsy specimen was inconclusive. We diagnosed a gastrointestinal stromal tumor or malignant lymphoma preoperatively, and decided to perform an operation in order to confirm the diagnosis and select the optimal treatment. Intraoperatively, the mass in the pylorus invaded the pancreatic head, and the lymph node in the hepatoduodenal ligament was swollen. We performed a pancreaticoduodenectomy as a radical excision. The resected specimen showed the 7.6 x 4.9-cm size tumor to mainly originate from the pylorus. Histopathologically, the tumor was identified as pancreatic ACC with lymph node metastasis. The tumor cells were labeled by immunohistochemical staining for alpha1-antitrypsin. Because of the tumor location, we considered the tumor to have originated from the ectopic pancreatic tissue in the stomach. This is only the second case of ACC originating from an ectopic pancreas reported in the literature. PMID:17643220

Mizuno, Yoshimasa; Sumi, Yasuhiro; Nachi, Sho; Ito, Yoshihiro; Marui, Tsutomu; Saji, Shigetoyo; Matsutomo, Hirokazu



[Preoperative plasmapheresis].  


Plasmapheresis is performed during the preoperative patient preparation phase of the Ulm Autologous Transfusion Concept (ATU). On an outpatient basis, weeks or months before the operation, 900 ml autologous plasma is donated per visit using the one needle technique, shock frozen, and stored at -30 degrees C or lower. During a period of approximately 1 1/4 years, 813 patients were studied in order to obtain information (in addition to the observation of the usual vital statistics) concerning the effect of plasmapheresis on homeostasis and coagulation factors directly before, directly after, 2 h after, and 24 h after (in-patients only). A complete electrolyte solution of the Ringer-lactate type was used as volume substitution (1000 ml or 1500 ml). Arterial blood pressure and heart rate showed no significant change. The transient decrease in various laboratory parameters was within tolerable limits. The parameters for blood protein, anti-thrombin III, and immunoglobulin G had already normalized within 24 h. Our more than three year experience with more than 2600 patients and the collective data indicate no reason not to perform plasmapheresis on non-fasting outpatient patients. The for the most part postoperatively transfused autologous fresh frozen plasma represents an ideal, long acting volume substitution which contains such blood components as antithrombin III, immunoglobulins, and factor XIII. These blood components could be a contributing factor for a decreased danger of thrombosis, embolie, and infection, as well as provide for better wound healing. PMID:3184786

Schleinzer, W; Mehrkens, H H; von Bormann, B; Weindler, M; Wollinsky, K H



Genes controlling pancreas ontogeny.  


The pancreas develops from two separate and independent endodermal primordia. The molecular events supporting the early morphological changes that give rise to the formation of the dorsal and ventral pancreatic buds result from coordinated responses to extrinsic and intrinsic signals. The extrinsic signals are involved in processes dictating whether progenitor cells remain as immature or as committed precursors. After specification, the sequential activation of transcription factors determines cell autonomously the commitment and differentiation of these progenitors. During pancreas development, the roles of extrinsic and intrinsic signals are variable, depending on the particular competence of each progenitor cell. We summarize in this review the main events, at the level of gene expression, which are involved in the early stages of pancreas development. PMID:18956314

Bonal, Claire; Herrera, Pedro L



Plasmacytoma of the pancreas: an unusual manifestation of multiple myeloma.  


Extramedullary plasmacytoma of the pancreas is a rare entity. Although this condition is uncommon, it should be considered in the differential diagnosis of solid mass in the pancreas, especially in patients with underlying multiple myeloma. We report a case of pancreatic plasmacytoma in a 56-year-old woman with newly diagnosed multiple myeloma. We highlight this rare manifestation of multiple myeloma among other better recognised presentations. PMID:23716161

Hue, Susan Swee Shan; Azhar, Rafay



Cystic Neoplasms of the Pancreas  

Microsoft Academic Search

Cystic neoplasms of the pancreas are an important entity for gastroenterologists and endoscopists because these lesions represent\\u000a the best example of an early malignancy of the pancreas. In the past, cystic neoplasms of the pancreas were thought to be\\u000a relatively rare, composing less than 10% of cancers of the pancreas. With the increasing use of cross-sectional imaging, an\\u000a increasing number

William R. Brugge


Preoperative chemoradiation strategies for localized adenocarcinoma of the pancreas  

Microsoft Academic Search

:   Patients who undergo pancreaticoduodenectomy alone for adenocarcinoma of the pancreatic head or uncinate process have a median\\u000a survival of 12 months, and a high incidence of local tumor recurrence (50%–80%) due to the common finding of positive margins\\u000a following pathologic evaluation of pancreaticoduodenectomy specimens. The available prospective and retrospective data suggest\\u000a improved survival duration and local-regional tumor control when

Douglas B. Evans; Peter W. T. Pisters; Jeffrey E. Lee; Richard J. Bold; C. Charnsangavej; Nora A. Janjan; Robert A. Wolff; James L. Abbruzzese



Solid pseudopapillary tumor of the pancreas.  


Solid pseudopapillary tumor of the pancreas is considered to be a rare pancreatic tumor. These tumors are typically present in women in their third decade of life. The tumors have a low malignant potential. We report a case of 22-year-old female who presented with intermittent abdominal pain of 3 years duration. Distal pancreatectomy with splenectomy was done as a definitive treatment. The importance of accurate diagnosis and treatment is emphasized. PMID:18603707

Kamat, Rima N; Naik, Leena D; Joshi, Rajeev M; Amrapurkar, Anjali D; Shetty, T S


Anatomy of the pancreas  

Microsoft Academic Search

The pancreas comprises the head, uncinate process, neck, body and tail. The head lies within, and closely attached to, the ‘C’ of the duodenum. The main pancreatic duct (Wirsung) runs the length of the gland. It usually joins the common bile duct at the ampulla of Vater to enter the second part of the duodenum at the duodenal papilla. The

Harold Ellis



Mucin-Producing Neoplasms of the Pancreas: An Analysis of Distinguishing Clinical and Epidemiologic Characteristics  

PubMed Central

BACKGROUND & AIMS Mucin-producing neoplasms (MPNs) of the pancreas include mucinous cystic neoplasms (MCNs) and main-duct, branch-duct, and combined intraductal papillary mucinous neoplasms (IPMNs). MCNs and branch-duct IPMNs are frequently confused; it is unclear whether main-duct, combined, and branch-duct IPMNs are a different spectrum of the same disease. We evaluated their clinical and epidemiologic characteristics. METHODS Patients who underwent resection for histologically confirmed MPNs were identified (N = 557); specimens were reviewed and eventually re-classified. RESULTS One hundred sixty-eight patients (30%) had MCNs, 159 (28.5%) had branch-duct IPMNs, 149 (27%) had combined IPMNs, and 81 (14.5%) had main-duct IPMNs. Patients with MCNs were significantly younger and almost exclusively women; 44% of patients with main-duct or combined IPMNs and 57% of those with branch-duct IPMNs were women. MCNs were single lesions located in the distal pancreas (95%); 11% were invasive. IPMNs were more frequently found in the proximal pancreas; invasive cancer was found in 11%, 42%, and 48% of branch-duct, combined, and main-duct IPMNs, respectively (P =.001). Patients with invasive MCN and those with combined and main-duct IPMNs were older than those with noninvasive tumors. The 5-year disease-specific survival rate approached 100% for patients with noninvasive MPNs. The rates for those with invasive cancer were 58%, 56%, 51%, and 64% for invasive MCNs, branch-duct IPMNs, main-duct IPMNs, and combined IPMNs, respectively. CONCLUSIONS MPNs comprise 3 different neoplasms: MCNs, branch-duct IPMNs, and main-duct IPMNs, including the combined type. These tumors have specific clinical, epidemiologic, and morphologic features that allow a reasonable degree of accuracy in preoperative diagnosis.




Preoperative Diagnosis of Thyroid Papillary and Anaplastic Carcinomas by Real-Time Quantitative Reverse Transcription-Polymerase Chain Reaction of Oncofetal Fibronectin Messenger RNA1  

Microsoft Academic Search

The restricted expression of oncofetal fibronectin (onfFN) mRNA in thyroid papillary and anaplastic carcinomas was recently reported. In this study, we measured the copy number of onfFN mRNA in RNAs extracted from fine needle aspiration biopsies by real-time quantitative reverse transcription-PCR using thyroglobulin mRNA as an internal control. By measuring the onfFN:thyroglobulin mRNA ratio, preoperative aspirates from 31 papillary carcinomas

Toru Takano; Akira Miyauchi; Tamotsu Yokozawa; Fumio Matsuzuka; Ikuhiro Maeda; Kanji Kum; Nobuyuki Amino



Diagnosis and management of insulinoma  

PubMed Central

Insulinomas, the most common cause of hypoglycemia related to endogenous hyperinsulinism, occur in 1-4 people per million of the general population. Common autonomic symptoms of insulinoma include diaphroresis, tremor, and palpitations, whereas neuroglycopenenic symptoms include confusion, behavioural changes, personality changes, visual disturbances, seizure, and coma. Diagnosis of suspected cases is based on standard endocrine tests, especially the prolonged fasting test. Non-invasive imaging procedures, such as computed tomography and magnetic resonance imaging, are used when a diagnosis of insulinoma has been made to localize the source of pathological insulin secretion. Invasive modalities, such as endoscopic ultrasonography and arterial stimulation venous sampling, are highly accurate in the preoperative localization of insulinomas and have frequently been shown to be superior to non-invasive localization techniques. The range of techniques available for the localization of insulinomas means that blind resection can be avoided. Intraoperative manual palpation of the pancreas by an experienced surgeon and intraoperative ultrasonography are both sensitive methods with which to finalize the location of insulinomas. A high proportion of patients with insulinomas can be cured with surgery. In patients with malignant insulinomas, an aggressive medical approach, including extended pancreatic resection, liver resection, liver transplantation, chemoembolization, or radiofrequency ablation, is recommended to improve both survival and quality of life. In patients with unresectable or uncontrollable insulinomas, such as malignant insulinoma of the pancreas, several techniques should be considered, including administration of ocreotide and/or continuous glucose monitoring, to prevent hypoglycemic episodes and to improve quality of life.

Okabayashi, Takehiro; Shima, Yasuo; Sumiyoshi, Tatsuaki; Kozuki, Akihito; Ito, Satoshi; Ogawa, Yasuhiro; Kobayashi, Michiya; Hanazaki, Kazuhiro



Additional Resection of the Pancreas Body Prevents Postoperative Pancreas Fistula in Patients with Portal Annular Pancreas Who Undergo Pancreaticoduodenectomy  

Microsoft Academic Search

Portal annular pancreas (PAP) is a rare variant in which the uncinate process of the pancreas extends to the dorsal surface of the pancreas body and surrounds the portal vein or superior mesenteric vein.Upon pancreaticoduodenectomy (PD), when the pancreas is cut at the neck, two cut surfaces are created. Thus, the cut surface of the pancreas becomes larger than usual

Jun Muto; Yohei Mano; Noboru Harada; Hideaki Uchiyama; Tomoharu Yoshizumi; Akinobu Taketomi; Ken Shirabe; Yoshihiko Maehara



Islet and Pancreas Transplantation  

Microsoft Academic Search

\\u000a Transplantation of whole pancreas or of purified pancreatic islets can restore insulin secretion in patients with insulin-dependent,\\u000a type 1 diabetes (T1D). Both procedures reverse diabetes in most patients, improving chronic complications and quality of life,\\u000a but require chronic, systemic immunosuppression. Given the side effects and health risks associated with immunosuppression,\\u000a exogenous insulin therapy remains the mainstay of treatment for most

Gaetano Ciancio; Alberto Pugliese; George W. Burke; Camillo Ricordi


Unusual, Metastatic, or Neuroendocrine Tumor of the Pancreas: A Diagnosis with Endoscopic Ultrasound-guided Fine-needle Aspiration and Immunohistochemistry  

PubMed Central

Background/Aim: To determine the yield of endoscopic ultrasound–guided fine-needle aspiration (EUS–FNA) in combination with immunostains in diagnosing unusual solid pancreatic masses (USPM) in comparison with pancreatic adenocarcinoma (ACP). Patients and Methods: All EUS–FNA of solid pancreatic masses performed with a 22-gauge needle were included. Data on clinical presentations, mass characteristics, presence of pancreatitis, yield of tissue, and final diagnosis were compared between the two groups. On site cytopathology was provided and additional passes were requested to perform immunostains. Results: Two hundred and twenty-nine cases with either adenocarcinoma or USPM were included. The median age of the cohort was 65 years. ACP (210/229, 92%) accounted for the majority of the cases. The USPM included neuroendocrine (NET) masses (n=13), metastatic renal carcinoma (n=3), metastatic melanoma (n=1), lymphoma (n=1), and malignant fibrous histiocytoma (n=1). Subjects with ACP were significantly more likely to present with loss of weight (P=0.02) or obstructive jaundice (P<0.001). Subjects with ACP were more likely to have suspicious/atypical FNA biopsy results as compared with USPM (10% vs 0%). The sensitivity of EUS–FNA with immunostains was 93% in ACP as compared with 100% in USPM. Diagnostic accuracy was higher in USPM as compared with ACP (100% vs 93%). Conclusions: EUS–FNA using a 22-gauge needle with immunostains has excellent diagnostic yield in patients with USPMs, which is comparable if not superior to the yield in pancreatic adenocarcinoma.

Eloubeidi, Mohamad A.; Tamhane, Ashutosh R.; Buxbaum, James L.



Long-Term Results After Pancreas Transplantation  

Microsoft Academic Search

With the advances in technique and immunosupression, not only the short- but the long-term outcomes of pancreas transplantation have improved significantly. This retrospective study describes the long-term outcomes of simultaneous pancreas and kidney (SPK) transplants, pancreas after kidney (PAK), and pancreas transplants alone (PTA). An overall analysis was performed for all deceased donor (DD) primary pancreas transplants performed in the

D. E. R. Sutherland; A. C. Gruessner



Carcinoma of the uncinate process of the pancreas presenting with deep vein thrombosis: a case report.  


The uncinate process is a hook-like projection of the inferior aspect of the head of the pancreas. Carcinoma of the uncinate process of the pancreas is considered to be rare, difficult to diagnose and particularly devastating. The current method of detection is computed tomography. We report a case of carcinoma of the uncinate process of the pancreas in a patient who initially presented with deep vein thrombosis. The diagnosis of carcinoma of the uncinate process of the pancreas should be considered in patients who present with primary thromboembolic disease and other nonspecific signs. PMID:20184696

Shanmugarajah, Kumaran; Hui, Elaine; Vergis, Nikhil; Schelvan, Chris; Robinson, Stephen



Preoperative serum TA90IC as an adjunct to serum CA 19-9 in the diagnosis of pancreatic malignancy: A pilot study  

Microsoft Academic Search

PurposeBecause TA90, a 90-kDa immunogenic tumor-associated antigen, is expressed by pancreatic cancer cells, we hypothesized that the serum level of its immune complex with IgG (TA90-IC) might be a useful marker for diagnosis of pancreatic malignancy. We also wanted to compare TA90-IC with CA 19-9 in the diagnosis of pancreatic cancer.

Mathew H. Chung; Rishab K. Gupta; Anton J. Bilchik; Wei. Ye; Reynold Yee; Donald L. Morton



Acute cellular and antibody-mediated rejection of the pancreas allograft: incidence, risk factors and outcomes.  


Antibody-mediated rejection (AMR) after pancreas transplantation is a recently identified entity. We describe the incidence of, risk factors for, and outcomes after AMR, and the correlation of C4d immunostaining and donor-specific antibody (DSA) in the diagnosis of AMR. We retrospectively analyzed 162 pancreas transplants in 159 patients who underwent 94 pancreas allograft biopsies between 2006 and 2009. Univariate and multivariate analyses were performed to evaluate risk factors for pancreas graft AMR. One-year rejection rates and survival after rejection were calculated by Kaplan-Meier methods. AMR occurred in 10% of patients by 1-year posttransplant. Multivariate risk factors identified for AMR include nonprimary simultaneous pancreas-kidney (SPK) transplant, primary solitary pancreas (PAN) transplant and race mismatch. After pancreas rejection, patient survival was 100% but 20% (8 of 41) of pancreas grafts failed within 1 year. Graft survival after acute cellular rejection (ACR), AMR and mixed rejection was similar. Of biopsies that stained >5% C4d, 80% were associated with increased Class I DSA. In summary, AMR occurs at a measurable rate after pancreas transplantation, and the diagnosis should be actively sought using C4d staining and DSA levels in patients with graft dysfunction, especially after nonprimary SPK and primary PAN transplantation. PMID:24102905

Niederhaus, S V; Leverson, G E; Lorentzen, D F; Robillard, D J; Sollinger, H W; Pirsch, J D; Torrealba, J R; Odorico, J S



Cystic lesions of the pancreas: radiologic-endosonographic correlation.  


Cystic lesions of the pancreas are relatively common findings at cross-sectional imaging; however, classification of these lesions on the basis of imaging features alone can sometimes be difficult. Complementary evaluation with endoscopic ultrasonography and fine-needle aspiration may be helpful in the diagnosis of these lesions. Cystic lesions of the pancreas may range from benign to malignant and include both primary cystic lesions of the pancreas (including intraductal papillary mucinous neoplasms, mucinous cystic neoplasms, serous cystadenomas, pseudocysts, and true epithelial cysts) and solid neoplasms undergoing cystic degeneration (including neuroendocrine tumors, solid pseudopapillary neoplasms, and, rarely, adenocarcinoma and its variants). Familiarity with the imaging features of these lesions and the basic treatment algorithms is essential for radiologists, as collaboration with gastroenterologists and surgeons is often necessary to obtain an early and accurate diagnosis. PMID:23150863

Kucera, Jennifer N; Kucera, Stephen; Perrin, Scott D; Caracciolo, Jamie T; Schmulewitz, Nathan; Kedar, Rajendra P


Pancreas Transplantation: Indications and Consequences  

Microsoft Academic Search

Pancreas transplantation continues to evolve as a strategy in the management of diabetes mellitus. The first combined pan- creas-kidney transplant was reported in 1967, but pancreas transplant now represents a number of procedures, each with different indications, risks, benefits, and outcomes. This re- view will summarize these procedures, including their risks and outcomes in comparison to kidney transplantation alone, and




Pancreas transplantation: indications and outcomes  

Microsoft Academic Search

Nearly all uraemic diabetic candidates for kidney transplants are candidates for a pancreas transplant. The best treatment option is to receive a living related donor kidney transplant first, followed later by a pancreas transplant from either a living related (segmental graft) or cadaver (whole organ or segmental) donor [22, 28]. For those without a living related donor for a kidney,

David E. R. Sutherland



Metastases to the pancreas diagnosed by fine-needle aspiration.  


Background: Metastatic cancer infrequently involves the pancreas. When the pancreas hosts a metastatic tumor, cytopathological evaluation of fine-needle aspirate material is a crucial part of the diagnostic process. In this study, we show two institutions' experience with cytopathological diagnosis of pancreatic metastasis. Methods: Databases of institutional experience at The Johns Hopkins Hospital and Ohio State University Medical Center were queried for cases of metastatic tumors in the pancreas that underwent fine-needle aspiration. Demographic and pathological features were compiled and the cytomorphology was reviewed. Results: Forty-two cases of tumor metastasis to the pancreas were found. Over the time of this review, 5,495 aspirates were performed, and 43% (2,389/5,495) had malignant cytological findings. Thus, the 42 cases of metastatic disease to the pancreas comprised 0.8% of all pancreas aspirates and 1.8% of the malignant ones. Renal cell carcinoma was the most common metastasis, followed by melanoma and non-small cell lung carcinoma. Among the other tumors in this series, 2 cases each of rare metastases such as the fibrolamellar variant of hepatocellular carcinoma and solitary fibrous tumor were also seen. Conclusion: The pancreas is rarely involved with metastatic disease, but when it is involved the most common tumor is renal cell carcinoma followed by melanoma and non-small cell lung cancer. Clinical history and awareness of the primary pancreatic mimickers are necessary for arriving at the correct diagnosis. As conventional pancreatic adenocarcinoma is uncommon in children and young adults, history of other tumors - even ones that usually follow an indolent course - is essential. © 2013 S. Karger AG, Basel. PMID:24021904

Olson, Matthew T; Wakely, Paul E; Ali, Syed Z



Annular pancreas in adults: embryological development, morphology and clinical significance  

Microsoft Academic Search

: Three cases (two male, one female) of annular pancreas are presented, which were found and operated on within the last three decades. Diagnosis was made using imaging techniques, especially ultrasonography and computed tomography. In two cases there was incomplete obstruction, while in the other obstruction was complete. It is characteristic that in the case of complete obstruction the annular

G. Paraskevas; B. Papaziogas; C. Lazaridis; P. Gigis; T. Papaziogas



Preoperative Diagnosis of Medullary Thyroid Carcinoma by RT-PCR Using RNA Extracted from Leftover Cells within a Needle Used for Fine Needle Aspiration Biopsy  

Microsoft Academic Search

Fine needle aspiration Biopsy (FNAB) is commonly used to diag- nose thyroid tumors. In some clinical situations, however, accurate diagnosis requires a more objective method than cytological exami- nation alone. Medullary thyroid carcinomas (MTC) derive from C cells in the thyroid and express some specific messenger RNAs (mRNA), such as those transcribed from the RET proto-oncogene, the calcitonin gene, and




Pancreaticoduodenectomy in portal annular pancreas: report of a case.  


Portal annular pancreas (PAP) is a rare anatomical anomaly in which the pancreatic parenchyma surrounds the superior mesenteric vein and portal vein (PV) annularly. This anomaly requires careful consideration in pancreatic resection. A case is presented and the technical issues are discussed. A 61-year-old female was referred to the hospital for suspected papilla Vater adenocarcinoma. Preoperative computed tomography showed that the PV was annularly surrounded by pancreatic parenchyma. Surgery revealed the uncinate process extended extensively behind the PV and fused with the pancreatic body. The pancreas was first divided above the PV, and it was divided again in the body after liberating the PV from pancreatic annulation. The postoperative course was uneventful without pancreatic fistula. It is safer to divide the pancreatic body on the left of the fusion between the uncinate process and the pancreatic body to reduce the risk of pancreatic fistula in pancreaticoduodenectomy for PAP. PMID:22855010

Kobayashi, Shin; Honda, Goro; Kurata, Masanao; Okuda, Yukihiro; Tsuruta, Koji



Use of Balloon Enteroscopy in Preoperative Diagnosis of Neurofibromatosis-Associated Gastrointestinal Stromal Tumours of the Small Bowel: A Case Report  

PubMed Central

Neurofibromatosis type I (NF1) is one of the most common inheritable disorders and is associated with an increased risk of gastrointestinal stromal tumours (GISTs). However, the predominant location of these lesions in the small bowel makes them difficult to diagnose. We report the successful use of balloon enteroscopy in conjunction with conventional methods for clinical diagnosis of jejunal GISTs in a 70-year-old man with NF1 who presented with melaena. The importance of screening NF1 patients for GISTs and the complementary role of balloon enteroscopy with capsule endoscopy in such diagnoses is discussed.

Takakura, Kazuki; Kajihara, Mikio; Sasaki, Shigemasa; Nagano, Tomohisa; Ohta, Arihito; Ikegami, Masahiro; Eto, Ken; Kashiwagi, Hideyuki; Yanaga, Katsuhiko; Arihiro, Seiji; Kato, Tomohiro; Tajiri, Hisao



Experience with OKT3 in vascularized pancreas transplantation.  


With refinements in technical aspects of whole organ pancreas transplantation, allograft rejection is currently the major cause of graft failure. The monoclonal antibody OKT3 has emerged as a highly effective antirejection therapy in renal and hepatic allograft recipients, but its efficacy in pancreas transplantation remains to be determined. During a 12-month period, 28 vascularized whole organ pancreas transplants were performed with pancreatico-cystostomy. Sixteen episodes of allograft rejection were treated with monoclonal antibody OKT3. Indications for OKT3 use included steroid- or antilymphocyte globulin (ALG)-resistant allograft rejection in isolated pancreas (n = 8) or simultaneous kidney-pancreas (n = 8) transplants. A total of 34 rejection episodes occurred in the 16 patients (mean, 2.1; range, one to five). The diagnosis of rejection was based on clinical criteria, a reduction in urinary amylase clearance, radionuclide scanning, hyperglycemia, or associated renal allograft dysfunction in combined engraftments. Postoperative immunosuppression consisted of cyclosporine, prednisone, azathioprine, and prophylactic ALG. OKT3 was administered for a full 14-day course concomitant with low-dose steroids, azathioprine, and cyclosporine. The mean age of the patient population was 32.1 years (range 24 to 39) with a mean duration of insulin-dependent diabetes mellitus (IDDM) of 20.9 years. Monoclonal antibody therapy was instituted in two clinical settings: early rejection (within 3 months of transplant, n = 10); and late rejection (after 3 months, n = 6). OKT3 successfully reversed allograft rejection in ten (62.5%) cases, including six early (60%) and four late (66.7%) episodes. In isolated pancreas transplants, OKT3 therapy reversed pancreas allograft rejection in only two patients (25%).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3277405

Sollinger, H W; Stratta, R J



Emerging therapies in pancreas cancer.  


Pancreas cancer has a grave prognosis and treatment options remain limited despite advancement in anti-cancer chemotherapeutics. This review provides an overview of the emerging therapies for pancreas cancer, focusing on novel signal transduction inhibitors (insulin-like growth factor receptor, hedgehog/Smo, PI3k/Akt/mTOR) and cytotoxics (nab-paclitaxel) that are currently in clinical development. Despite the impact molecularly targeted agents have on other tumor types, their application without cytotoxics in pancreas cancer remains limited. In addition, recent report of the superiority of an intensive cytotoxic regimen using fluorouracil, irinotecan and oxaliplatin (FOLFIRINOX) over gemcitabine reminded us of the importance of cytotoxics in this disease. As such, the future of pancreas cancer therapy may be combination regimens consisting of cytotoxics and molecularly targeted agents. PMID:22811835

Kotowski, Adam; Ma, Wen W



Epidemiology of pancreas cancer (1988)  

Microsoft Academic Search

Summary  This article reviews the epidemiology of cancer of the pancreas, both descriptive and analytical, at all times cognizant of\\u000a the problems of misdiagnosis, particularly underdiagnosis, of this lethal disease that continue to hinder epidemiological\\u000a studies. Pancreas cancer is consistently reported to occur more frequently in men than in women, in blacks than in whites,\\u000a and in urban rather than rural

P. Boyle; C.-C Hsieh; P. Maisonneuve; C. La Vecchia; G. J. Macfarlane; A. M. Walker; D. Trichopoulos



Induction therapy in pancreas transplantation.  


Induction therapy, the initial high-dose bolus of immunosuppression given perioperatively to transplant patients, is almost ubiquitous in pancreas transplantation. Despite the frequent use, scientific data on the risks and benefits of induction therapy are scarce, especially as it concerns use specifically for pancreas transplantation. Indeed, none of the currently used induction agents are approved as induction therapy for pancreas transplantation, yet potential benefit is largely extrapolated from trials in kidney transplant recipients. This review summarizes which induction therapy agents are available both now and historically, their mechanisms of action, and provides an overview of the published literature describing the use of these agents in simultaneous pancreas-kidney transplant and solitary pancreas transplant recipients. In summary, there are two multicenter randomized trials, several single-center randomized trials, and many other single-center descriptive reports. Overall, the main benefit of induction therapy is the ability to wean steroids earlier, and the main downside is a higher risk of opportunistic infections. Despite a lack of solid evidence, over 90% of pancreas transplants performed annually in the United States receive some type of induction immunosuppression. PMID:23672537

Niederhaus, Silke V; Kaufman, Dixon B; Odorico, Jon S



Colonic duplication in an adult mimicking a tumor of pancreas  

PubMed Central

Duplications of the alimentary tract are uncommon congenital malformations that can present diagnostic difficulties. We report a rare case of a cystic colonic duplication in a female adult. Preoperative investigations were suggestive of pancreatic tumor. The diagnosis was established based on the histopathological examination of the resected specimen. We concluded that, though uncommon, intestinal duplication should be considered in differential diagnosis of abdominal mass.

Carneiro, Fabiana Pirani; de Nazareth Sobreira, Maria; de Azevedo, Ana Emilia B; Alves, Andrea Pedrosa Ribeiro; Campos, Karina Martins



Two rare cases of a solid pseudopapillary neoplasm of the pancreas  

PubMed Central

A solid pseudopapillary neoplasm (SPN) of the pancreas has distinct histopathological features. A solid pattern of growth with pseudopapillary structures that result from degeneration is observed. On rare occasions, the tumor may vary from being entirely solid to completely cystic. The present study describes two unique cases of SPN. A 25-year-old male presented with a pancreatic tumor showing a predominantly solid pattern with no degenerative change, although the pre-operative cytological specimens that were obtained by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) revealed pseudopapillary structures. The second case was of an 11-year-old female who presented with a pancreatic tumor with prominent degeneration. Nests and cords of the remaining neoplastic cells were located only at the periphery, with perineural invasion. An immunohistochemical analysis revealed that the tumor cells in the two cases were positive for CD10 and ?-catenin and negative for trypsin. An awareness of the broad morphological variability of SPN and an immunohistochemical panel that includes CD10, ?-catenin and trypsin are useful for establishing an accurate diagnosis.




A case of long survival in poorly differentiated small cell carcinoma of the pancreas  

PubMed Central

Small cell carcinoma (SCC) of the pancreas is rare. It has similar histological features to pulmonary small cell carcinoma and is equally aggressive. Most patients with SCC in the pancreas reported in case studies died within 1 year after diagnosis. We present a case of unusually long-term survival after surgery and combined chemotherapy for SCC of the pancreas. A 62-year-old woman presented with epigastric pain and jaundice. Computed tomography revealed dilated common bile duct caused by external compression of the mass in the pancreatic head. Exploratory laparotomy and pancreaticoduodenectomy (PPPD) was performed with histopathological analysis confirming a primary small cell carcinoma of the pancreas. After an uneventful postoperative recovery, the patient was treated with 6 cycles of combined chemotherapy consisting of cisplatin and ectoposide. During the follow-up, there was no evidence of recurrence and the patient has remained in a good health condition for 36 mo since the diagnosis.

Chung, Min Sung; Ha, Tae Kyung; Lee, Kyeong Geun; Paik, Seung Sam



Additional Resection of the Pancreas Body Prevents Postoperative Pancreas Fistula in Patients with Portal Annular Pancreas Who Undergo Pancreaticoduodenectomy  

PubMed Central

Portal annular pancreas (PAP) is a rare variant in which the uncinate process of the pancreas extends to the dorsal surface of the pancreas body and surrounds the portal vein or superior mesenteric vein. Upon pancreaticoduodenectomy (PD), when the pancreas is cut at the neck, two cut surfaces are created. Thus, the cut surface of the pancreas becomes larger than usual and the dorsal cut surface is behind the portal vein, therefore pancreatic fistula after PD has been reported frequently. We planned subtotal stomach-preserving PD in a 45-year-old woman with underlying insulinoma of the pancreas head. When the pancreas head was dissected, the uncinate process was extended and fused to the dorsal surface of the pancreas body. Additional resection of the pancreas body 1 cm distal to the pancreas tail to the left side of the original resection line was performed. The new cut surface became one and pancreaticojejunostomy was performed as usual. No postoperative complications such as pancreatic fistula occurred. Additional resection of the pancreas body may be a standardized procedure in patients with PAP in cases of pancreas cut surface reconstruction.

Muto, Jun; Mano, Yohei; Harada, Noboru; Uchiyama, Hideaki; Yoshizumi, Tomoharu; Taketomi, Akinobu; Shirabe, Ken; Maehara, Yoshihiko



Additional resection of the pancreas body prevents postoperative pancreas fistula in patients with portal annular pancreas who undergo pancreaticoduodenectomy.  


Portal annular pancreas (PAP) is a rare variant in which the uncinate process of the pancreas extends to the dorsal surface of the pancreas body and surrounds the portal vein or superior mesenteric vein. Upon pancreaticoduodenectomy (PD), when the pancreas is cut at the neck, two cut surfaces are created. Thus, the cut surface of the pancreas becomes larger than usual and the dorsal cut surface is behind the portal vein, therefore pancreatic fistula after PD has been reported frequently. We planned subtotal stomach-preserving PD in a 45-year-old woman with underlying insulinoma of the pancreas head. When the pancreas head was dissected, the uncinate process was extended and fused to the dorsal surface of the pancreas body. Additional resection of the pancreas body 1 cm distal to the pancreas tail to the left side of the original resection line was performed. The new cut surface became one and pancreaticojejunostomy was performed as usual. No postoperative complications such as pancreatic fistula occurred. Additional resection of the pancreas body may be a standardized procedure in patients with PAP in cases of pancreas cut surface reconstruction. PMID:22532811

Muto, Jun; Mano, Yohei; Harada, Noboru; Uchiyama, Hideaki; Yoshizumi, Tomoharu; Taketomi, Akinobu; Shirabe, Ken; Maehara, Yoshihiko



Complication Rate of Pancreas Retransplantation After Simultaneous Pancreas–Kidney Transplantation Compared With Pancreas After Kidney Transplantation  

Microsoft Academic Search

Simultaneous pancreas kidney transplantation is currently the state of the art therapy for patients with type 1 diabetes mellitus and diabetic nephropathy. Up to 30% of patients loose the pancreas with a kidney graft that continues to function. Under those conditions, isolated pancreas retransplantation can be indicated. We compared the outcome of these patients with the outcome of patients undergoing

P. Fellmer; K. Lanzenberger; F. Ulrich; A. Pascher; J. Langrehr; S. Jonas; A. Kahl; U. Frei; P. Neuhaus; J. Pratschke



Sonographic features of agenesis of dorsal pancreas  

PubMed Central

Agenesis of dorsal pancreas is an extremely rare congenital anomaly that occurs due to failure of the dorsal pancreatic bud to form the body and tail of the pancreas. We report the sonographic appearance of this condition in six cases.

Vijayaraghavan, S Boopathy; Gouru, Swapna; Senthil, Sathiya



The role of transrectal ultrasound-guided biopsy-based staging, preoperative serum prostate-specific antigen, and biopsy gleason score in prediction of final pathologic diagnosis in prostate cancer  

Microsoft Academic Search

ObjectivesTo evaluate the role of ultrasound-guided systematic and lesion-directed biopsies, biopsy Gleason score, and preoperative serum prostate-specific antigen (PSA) as three objective and reproducible variables to provide a reliable combination in preoperative identification of risk of extraprostatic extension in patients with clinically localized prostate cancer.

Perinchery Narayan; Viswanathan Gajendran; Stephen P. Taylor; Ashutosh Tewari; Joseph C. Presti; Raymond Leidich; Richard Lo; Keith Palmer; Katsuto Shinohara; Joseph t. Spaulding



Antithrombin therapy in pancreas retransplantation and pancreas-after-kidney/pancreas-transplantation-alone patients.  


Antithrombin (AT) is a coagulatory inhibitor with pleiotropic activities. AT reduces ischemia/reperfusion injury and has been successfully used in patients with simultaneous pancreas kidney transplantation. This study retrospectively analyzes prophylactic high-dose AT application in patients with solitary pancreas transplantation traditionally related to suboptimal results. In our center, 31 patients received solitary pancreas transplantation between 7/1994 and 7/2005 (pancreas retransplantation, PAK/PTA). The perioperative treatment protocol was modified in 5/2002 now including application of 3000?IU. AT was given intravenously before pancreatic reperfusion (AT, n?=?18). Patients receiving standard therapy served as controls (n?=?13). Daily blood sampling was performed during five postoperative days. Standard coagulatory parameters and number of transfused red blood cell units were not altered by AT. In AT patients serum amylase (p?pancreas transplantation reduced postoperative liberation of pancreatic enzymes in this pilot study. Prophylactic AT application should deserve further clinical testing in a randomized controlled trial. PMID:21999781

Fertmann, Jan M; Arbogast, Helmut P; Illner, Wolf-Dieter; Tarabichi, Anwar; Dieterle, Christoph; Land, Walter; Jauch, Karl-Walter; Hoffmann, Johannes N


Accuracy of PET/CT Scan in the diagnosis of the focal form of congenital hyperinsulinism  

PubMed Central

Purpose The purpose of the study was to determine the sensitivity of the 18fluoro-dihydroxyphenylalanine positron emission tomography/computed tomography scan (18 F-PET/CT) in the diagnosis of focal congenital hyperinsulinism (HI). Methods A retrospective review of children with HI who underwent a preoperative 18 F-PET/CT scan was performed. Results Between 1/2008 and 2/2012 we performed 105 consecutive 18 F-PET/CT scans on infants with HI. Fifty-three patients had focal HI. Of those fifty-three patients, eight had a preoperative 18 F-PET/CT scan read as “diffuse disease”. The sensitivity of the study in the diagnosis of focal HI was 85%. The location of the eight missed focal lesions was: head (3), body (2), and tail (3). The 18 F-PET/ CT of the missed head lesions showed homogeneous tracer uptake (n =2) or heterogeneous uptake throughout the pancreas (n=1). The 18 F-PET/CT of the 2 missed body lesions and 1 missed tail lesion showed heterogeneous uptake throughout the pancreas. The 18 F-PET/CT of the other 2 missed tail lesions showed lesions adjacent to and obscured by the signal of the upper renal pole, identified retrospectively by closer observation. Fifty-two of the 105 patients had diffuse HI. Two of them had 18 F-PET/CT studies read as “focal disease”. Therefore, the specificity of the study was 96%. Of the forty-seven 18 F-PET/CT studies read as “focal disease”, forty-five had true focal HI. Therefore, the positive predictive value of the study in the diagnosis of focal HI was 96%. Conclusion The sensitivity and specificity of 18 F-PET/CT can be affected by certain anatomic features of the pancreas, by the location of the lesion, and by the reader’s experience.

Laje, Pablo; States, Lisa J.; Zhuang, Hongming; Becker, Susan A.; Palladino, Andrew A.; Stanley, Charles A.; Adzick, N. Scott



Collection protocol for human pancreas.  


This dissection and sampling procedure was developed for the Network for Pancreatic Organ Donors with Diabetes (nPOD) program to standardize preparation of pancreas recovered from cadaveric organ donors. The pancreas is divided into 3 main regions (head, body, tail) followed by serial transverse sections throughout the medial to lateral axis. Alternating sections are used for fixed paraffin and fresh frozen blocks and remnant samples are minced for snap frozen sample preparations, either with or without RNAse inhibitors, for DNA, RNA, or protein isolation. The overall goal of the pancreas dissection procedure is to sample the entire pancreas while maintaining anatomical orientation. Endocrine cell heterogeneity in terms of islet composition, size, and numbers is reported for human islets compared to rodent islets. The majority of human islets from the pancreas head, body and tail regions are composed of insulin-containing ?-cells followed by lower proportions of glucagon-containing ?-cells and somatostatin-containing ?-cells. Pancreatic polypeptide-containing PP cells and ghrelin-containing epsilon cells are also present but in small numbers. In contrast, the uncinate region contains islets that are primarily composed of pancreatic polypeptide-containing PP cells. These regional islet variations arise from developmental differences. The pancreas develops from the ventral and dorsal pancreatic buds in the foregut and after rotation of the stomach and duodenum, the ventral lobe moves and fuses with the dorsal. The ventral lobe forms the posterior portion of the head including the uncinate process while the dorsal lobe gives rise to the rest of the organ. Regional pancreatic variation is also reported with the tail region having higher islet density compared to other regions and the dorsal lobe-derived components undergoing selective atrophy in type 1 diabetes. Additional organs and tissues are often recovered from the organ donors and include pancreatic lymph nodes, spleen and non-pancreatic lymph nodes. These samples are recovered with similar formats as for the pancreas with the addition of isolation of cryopreserved cells. When the proximal duodenum is included with the pancreas, duodenal mucosa may be collected for paraffin and frozen blocks and minced snap frozen preparations. PMID:22665046

Campbell-Thompson, Martha L; Montgomery, Emily L; Foss, Robin M; Kolheffer, Kerwin M; Phipps, Gerald; Schneider, Lynda; Atkinson, Mark A



Pancreas transplantation — Indications and outcomes  

Microsoft Academic Search

Background: Pancreas transplantation is the only treatment of Type I diabetes that establishes an insulin-independent, constant normoglycemic\\u000a state. The penalty for this benefit is the need for immunosuppression in the recipients. Thus, most pancreas transplants are\\u000a performed in patients with advanced diabetic nephropathy who receive kidney transplants to treat uremia, and who are obligated\\u000a to immunosuppression for this reason.\\u000a \\u000a \\u000a Methods:

D. E. R. Sutherland



CT differentiation of distal pancreas fat replacement and distal pancreas agenesis  

Microsoft Academic Search

We aimed to describe CT signs useful for differentiation of distal agenesis from distal or dorsal pancreas lipomatosis. Multidetector\\u000a CT (MDCT) studies of five patients with distal pancreas agenesis (n = 2), distal lipomatosis (n = 1), distal short pancreas (n = 1), and distal pancreatectomy (n = 1) were retrospectively reviewed. Agenesis of dorsal pancreas can be diagnosed by the absence of body and tail of pancreas.

Musturay Karcaaltincaba



Roadmap to the artificial pancreas  

Microsoft Academic Search

Objective: To outline a roadmap to the artificial pancreas (AP) comprising a subcutaneous (sc) glucose monitor, a control algorithm, and an insulin pump delivering sc insulin.Research design and methods: A literature review, personal views, and material from the Juvenile Diabetes Research Foundation have been used to prepare the roadmap.Results: The roadmap identifies sensor reliability but not sensor accuracy as the

Roman Hovorka; Malgorzata E. Wilinska; Ludovic J. Chassin; David B. Dunger



Mortality after vascularized pancreas transplantation  

Microsoft Academic Search

Background: Previous studies have questioned the safety of vascularized pancreas transplantation (PTX), particularly because diabetes is an independent risk factor for coronary artery disease and cardiac death. Methods: A retrospective analysis of the timing and causes of death after PTX was performed. From April 1989 through December 1995, 196 PTXs were performed in 186 diabetic patients including 134 simultaneous kidney-PTXs,

Robert J Stratta



Diagnosis and Prognostication of Ductal Adenocarcinomas of the Pancreas Based on Genome-Wide DNA Methylation Profiling by Bacterial Artificial Chromosome Array-Based Methylated CpG Island Amplification  

PubMed Central

To establish diagnostic criteria for ductal adenocarcinomas of the pancreas (PCs), bacterial artificial chromosome (BAC) array-based methylated CpG island amplification was performed using 139 tissue samples. Twelve BAC clones, for which DNA methylation status was able to discriminate cancerous tissue (T) from noncancerous pancreatic tissue in the learning cohort with a specificity of 100%, were identified. Using criteria that combined the 12 BAC clones, T-samples were diagnosed as cancers with 100% sensitivity and specificity in both the learning and validation cohorts. DNA methylation status on 11 of the BAC clones, which was able to discriminate patients showing early relapse from those with no relapse in the learning cohort with 100% specificity, was correlated with the recurrence-free and overall survival rates in the validation cohort and was an independent prognostic factor by multivariate analysis. Genome-wide DNA methylation profiling may provide optimal diagnostic markers and prognostic indicators for patients with PCs.

Gotoh, Masahiro; Arai, Eri; Wakai-Ushijima, Saori; Hiraoka, Nobuyoshi; Kosuge, Tomoo; Hosoda, Fumie; Shibata, Tatsuhiro; Kondo, Tadashi; Yokoi, Sana; Imoto, Issei; Inazawa, Johji; Kanai, Yae



The spectrum of hematologic malignancies involving the pancreas: potential clinical mimics of pancreatic adenocarcinoma.  


Hematologic malignancies often involve the pancreas, causing potential diagnostic pitfalls and, rarely, potentially avoidable surgical resection. We review the spectrum of hematologic malignancies involving the pancreas and describe features useful in preoperative distinction from adenocarcinoma. Archived clinical, pathologic, and radiologic data (1965 to present) for hematologic malignancies involving the pancreas were reviewed and compared with the data for 157 surgically resected pancreatic adenocarcinomas. Of 42 cases, 27 (64%) were clinically "suspicious" for hematologic malignancies. Of the remaining 15 cases, 4 patients underwent resection for presumed pancreatic adenocarcinoma. Isolated pancreatic masses proved most difficult to identify clinically. Significant factors in distinguishing hematologic malignancies from adenocarcinoma included history of hematologic malignancy, young age, large tumor size, low CA19-9 level, B symptoms, and lack of jaundice or diabetes mellitus. Various hematologic malignancies involve the pancreas, most commonly diffuse large B-cell lymphoma. Pancreatic masses are usually correctly identified clinically. Preoperative and operative sampling is strongly recommended when hematologic malignancies cannot be excluded. PMID:22338053

Rock, Jonathan; Bloomston, Mark; Lozanski, Gerard; Frankel, Wendy L



Accurate localization of an insulinoma by preoperative selective intra-arterial calcium injection and intraoperative glucose monitoring  

Microsoft Academic Search

The role of pre- and intraoperative procedures for the localization of insulinomas has been extensively debated. We report\\u000a a case of successful treatment using preoperative selective intra-arterial calcium injection and intraoperative glucose monitoring.\\u000a A 12-year-old boy with hypoglycemic attacks had a large insulinoma in the head of the pancreas on computed tomography. Preoperative\\u000a selective angiography combined with arterial stimulation-venous sampling

Tadashi Iwanaka; Masatomo Matsumoto; Yoshinobu Yoshikawa; Naoya Koda; Hiroshi Mochizuki; Toshinori Aihara; Satohiko Imaizumi



Vascular instruction of pancreas development.  


Blood vessels course through organs, providing them with essential nutrient and gaseous exchange. However, the vasculature has also been shown to provide non-nutritional signals that play key roles in the control of organ growth, morphogenesis and homeostasis. Here, we examine a decade of work on the contribution of vascular paracrine signals to developing tissues, with a focus on pancreatic ?-cells. During the early stages of embryonic development, blood vessels are required for pancreas specification. Later, the vasculature constrains pancreas branching, differentiation and growth. During adult life, capillaries provide a vascular niche for the maintenance of ?-cell function and survival. We explore the possibility that the vasculature constitutes a dynamic and regionalized signaling system that carries out multiple and changing functions as it coordinately grows with the pancreatic epithelial tree. PMID:22833471

Cleaver, Ondine; Dor, Yuval



Vascular instruction of pancreas development  

PubMed Central

Blood vessels course through organs, providing them with essential nutrient and gaseous exchange. However, the vasculature has also been shown to provide non-nutritional signals that play key roles in the control of organ growth, morphogenesis and homeostasis. Here, we examine a decade of work on the contribution of vascular paracrine signals to developing tissues, with a focus on pancreatic ?-cells. During the early stages of embryonic development, blood vessels are required for pancreas specification. Later, the vasculature constrains pancreas branching, differentiation and growth. During adult life, capillaries provide a vascular niche for the maintenance of ?-cell function and survival. We explore the possibility that the vasculature constitutes a dynamic and regionalized signaling system that carries out multiple and changing functions as it coordinately grows with the pancreatic epithelial tree.

Cleaver, Ondine; Dor, Yuval



Cystic tumours of the pancreas  

PubMed Central

Pancreatic carcinoma accounts for the most dismal survival among all malignancies with 5-year survival rates approaching 5%. The reason for this, besides the inherent biologic nature of the disease, is the fact that the patients tend to present late in the disease. We present a review of the current published data on cystic neoplasms of the pancreas, which though rare, constitute an important subgroup of pancreatic neoplasms that have a better prognosis and are potentially curable lesions.

Barreto, George; Shukla, Parul J.; Ramadwar, Mukta; Arya, Supreeta



Development of the Endocrine Pancreas  

Microsoft Academic Search

Ke yW ords. islet, ?-cell, ?-cell, GLP-1, IGF, regeneration Insulin availability is a key factor in embryonic and fetal growth, and infants born with nesidioblastosis or the Beckwith-Wiedemann syndrome, conditions associated with hyper-secretion of insulin, exhibit enhanced fetal somatic growth. Conversely, transient neonatal diabetes or pancreatic agenesis results in growth retardation. The temporal and structural development of the endocrine pancreas

David J. Hill



Ghrelin and the endocrine pancreas  

Microsoft Academic Search

Ghrelin is a 28-amino-acid peptide predominantly produced by the stomach, while substantially lower amounts derive from other\\u000a tissues including the pancreas. It is a natural ligand of the GH secretagogue (GHS) receptor (GHS-R1a) and strongly stimulates\\u000a GH secretion, but acylation in serine 3 is needed for its activity. Ghrelin also possesses other endocrine and nonendocrine\\u000a actions reflecting central and peripheral

Fabio Broglio; Cristina Gottero; Andrea Benso; Flavia Prodam; Marco Volante; Silvia Destefanis; Carlotta Gauna; Giampiero Muccioli; Mauro Papotti; Aart Jan van der Lely; Ezio Ghigo



Wearable and implantable pancreas substitutes.  


A lifelong-implanted and completely automated artificial or bioartificial pancreas (BAP) is the holy grail for type 1 diabetes treatment, and could be a definitive solution even for other severe pathologies, such as pancreatitis and pancreas cancer. Technology has made several important steps forward in the last years, providing new hope for the realization of such devices, whose feasibility is strictly connected to advances in glucose sensor technology, subcutaneous and intraperitoneal insulin pump development, the design of closed-loop control algorithms for mechatronic pancreases, as well as cell and tissue engineering and cell encapsulation for biohybrid pancreases. Furthermore, smart integration of the mentioned components and biocompatibility issues must be addressed, bearing in mind that, for mechatronic pancreases, it is most important to consider how to recharge implanted batteries and refill implanted insulin reservoirs without requiring periodic surgical interventions. This review describes recent advancements in technologies and concepts related to artificial and bioartificial pancreases, and assesses how far we are from a lifelong-implanted and self-working pancreas substitute that can fully restore the quality of life of a diabetic (or other type of) patient. PMID:22990986

Ricotti, Leonardo; Assaf, Tareq; Dario, Paolo; Menciassi, Arianna



[Desmoplastic small round cell tumour of the pancreas with breast metastasis].  


Desmoplastic small round cell tumour (DSRCT) is a very rare, highly aggressive neoplasm. Most cases have been reported in adolescent and young male patients. These tumours occur mainly in the peritoneal cavity, with peritoneal and lymphatic dissemination. Their histologic features are unspecific and immunohistochemistry and cytogenetic or biomolecular techniques are required for their diagnosis. Involvement of the pancreas is exceptional and is difficult to differentiate from other pancreatic primary tumours. We report here the case of a 49-year-old woman who had a DSRCT of the pancreas with metastasis to the breast. She died within one year after the diagnosis despite an aggressive surgical strategy. PMID:19268512

Neuzillet, C; Hammel, P; Couvelard, A; Msika, S; Felce-Dachez, M; Laé, M; Lévy, P; Ruszniewski, P



Incidence, timing and site of infections among pancreas transplant recipients  

Microsoft Academic Search

The incidence, timing and site of infections among the different categories of pancreas transplant recipients were investigated. Patients were divided into three groups: pancreas transplant alone (PTA), pancreas after kidney transplant (PAK), or simultaneous pancreas and kidney (SPK) transplants. Length of follow-up, time to death, pancreas graft survival, incidence, timing and site of bacterial infections were noted. Our study showed

M Bassetti; P. R. O Salvalaggio; J Topal; M. I Lorber; A. L Friedman; V. T Andriole; G. P Basadonna



Quality of life of pancreas transplant recipients  

Microsoft Academic Search

Summary  The quality of life outcome of 131 pancreas transplant recipients who were 1 to 11 years post-transplant were studied. Patients with a functioning pancreas graft (n=65) described their current quality of life and rated their health significantly more favourably than those with non-functioning grafts (n=66). For example, of those patients with a functioning pancreas graft, 68% expressed overall satisfaction with

C. L. Zehrer; C. R. Gross



Imaging in Pancreas and Intestinal Transplantation  

Microsoft Academic Search

Successful pancreas transplantation is currently the only known therapy that establishes an insulin-independent euglycemic\\u000a state with normalization of glycosylated hemoglobin levels. Insulin-secreting cells are part of the pancreatic islets, which\\u000a are predominantly located in the tail (Williams 1995). In the majority of cases, pancreas transplantation is performed together with the kidney from the same donor as simultaneous\\u000a pancreas-kidney transplantation in

Martin C. Freund; Karin M. Unsinn


[Solid pseudopapillary tumor of the pancreas. A report of 3 cases and a review of the literature].  


Solid pseudopapillary tumours of the pancreas (SPTP) are a distinct clinico-pathological entity that differs from the other cystic pancreatic neoplasms in the young age of onset, the almost exclusive incidence in the female sex and the low degree of malignancy. SPTP is a rare neoplasm that has shown a progressive increase of incidence, passing from 0.17%-2.7% of all exocrine tumours of the pancreas in the 1980's, to 6% in recent reports in 2003. In addition, it accounts for about 5% of cystic neoplasms of the pancreas. With the present paper, in the world literature, updated to August 2005, 887 cases have been described in 248 articles. The histogenesis of these epithelial neoplasms remains uncertain though it is likely that they originate from pluripotent immature pancreatic cells. The tumour is generally of large size and invariably presents a capsule. The diagnosis in most cases is based on compressive symptoms, pain or finding of a palpable mass, while in about 20% of the patients the finding is occasional during abdominal imaging performed for other pathologies. CT and MR are not always sufficient to differentiate with certainty between this type of tumour and other cystic neoplasms of the pancreas such as pseudocysts, parasitic cysts and congenital cysts. Cytological examination in most cases permits the diagnosis of SPTP. The malignancy of these neoplasms is attenuated and local with capsular invasion, lymp-node spread and, only rarely, liver and peritoneal metastases. The surgical treatment has to be radical since the malignancy can only be defined by postoperative histological examination. The treatment consists of three possible options: duodenocephalopancreatectomy, intermediate pancreatectomy, and distal pancreatectomy with or without splenectomy. Intraoperative histological examination is mandatory for the diagnostic confirmation and for the evaluation of negativity of the pancreatic resection margins. Survival after radical resection is excellent. Moreover, in forma metastasizing to the liver an aggressive attitude may be still curative and assure longer survival. The Authors report their experience with three female patients with an average age 18 years (28,19 and 8 years) operated on between 1995 and 2000 for SPTP. Two of the patients were asymptomatic and the finding of the tumour was occasional. The third patient presented jaundice and abdominal pain. The average diameter of the tumours was 6 cm (4, 7 and 7 cm). In all three cases tumour marker values (CEA, Ca19-9, alphaFP) were normal. Only in one case was the preoperative diagnosis correct. The surgical treatment depended on the location of the neoplasms: for the two tumours in the head, in one case an enucleoresection was performed in relation to an exophytic location, while, in the other, a duodenocephalopancreatectomy was performed. In the somatopancreatic tumour a distal splenopancreatectomy was performed. Only in one case (the DCP) the capsule and the surrounding parenchyma were infiltreted by neoplasm. In all cases there was immunohistochemical positivity for alpha1-antitrypsin and for neuron-specific enolase. Neither mortality nor operative morbidity were observed. Follow-up with CT found no relapses in any of the three patients after 5, 7 and 10 years, respectively, after the operation. PMID:16734174

Siquini, Walter; Marmorale, Cristina; Guercioni, Gianluca; Stortoni, Pierpaolo; Bearzi, Italo; Fianchini, Aroldo; Landia, Eduardo


Arteriovenous Malformation of the Pancreas  

PubMed Central

Pancreatic arteriovenous malformation (PAVM) is a very rare and mostly congenital lesion, with less than 80 cases described in the English-published literature. It is defined as a tumorous vascular abnormality that is constructed between an anomalous bypass anastomosis of the arterial and venous networks within the pancreas. It represents about 5% of all arteriovenous malformations found in the gastrointestinal tract. Herein, we present a 64-year-old patient with symptomatic PAVM involving the body and tail of the organ, which was successfully treated by transcatheter arterial embolization. The disease spectrum and review of the literature are also presented.

Charalabopoulos, Alexandros; Macheras, Nikolas; Krivan, Sylvia; Petropoulos, Konstantinos; Misiakos, Evangelos; Macheras, Anastasios



Sclerosing mesenteritis involving the pancreas: A mimicker of pancreatic cancer  

PubMed Central

Sclerosing mesenteritis (SM), also known as mesenteric lipodystrophy, rarely involves the parenchyma of the pancreas. When sclerosing mesenteritis does involve the pancreas, it can mimic pancreatic carcinoma both clinically and radiographically with pain, obstructive jaundice, a mass lesion and even the appearance of vascular invasion. We report 6 patients with sclerosing mesenteritis involving the pancreas (mean age 43.2 years, 5 female), and review their clinical presentation, radiographic findings, pathology, and outcome. Five of these 6 patients were originally thought to have a primary pancreatic neoplasm. Initial presenting clinical information was available for each patient: all 6 reported abdominal or epigastric pain, 3 reported weight loss, and 2 reported one or more of the following: back pain, fever, abdominal bloating/distention, nausea with/without vomiting, and anorexia. The lesions formed masses with an infiltrative pattern, and all had three key histologic features: fibrosis, chronic inflammation, and fat necrosis—without a known etiology. The inflammatory infiltrate was composed of a mixture of lymphocytes, plasma cells, and scattered eosinophils. Of the five patients with post-treatment clinical information available, four had at least a partial response to treatment with steroids, tamoxifen, azathioprine, resection, or a combination of these, and 1 did not respond. A dramatic response to immunosuppressive therapy is illustrated by the case of a 46-year-old woman who presented with the presumptive diagnosis of an unresectable pancreatic cancer. Distinguishing sclerosing mesenteritis from pancreatic carcinoma is crucial to appropriate management, as patients with sclerosing mesenteritis may benefit from immunosuppressive therapy.

Scudiere, Jennifer R.; Shi, Chanjuan; Hruban, Ralph H.; Herman, Joseph; Fishman, Elliot K.; Schulick, Richard D.; Wolfgang, Christopher L.; Makary, Martin A.; Thornton, Katherine; Montgomery, Elizabeth; Horton, Karen M.



Pathology of Kidney and Pancreas Transplants  

Microsoft Academic Search

\\u000a A thorough understanding of the pathology of renal and pancreas allograft is an indispensable skill set for the practicing\\u000a transplant physician. This chapter provides an overview of the processing and interpretation of kidney and pancreas transplant\\u000a biopsies. A summary of current classification schema is presented. Where applicable, clinicopathologic correlations are provided.

Lillian Gaber; Byron P. Croker


Mycophenolate Mofetil Immunosuppression in Rat Pancreas Allotransplantation  

Microsoft Academic Search

Prolongation of pancreas allograft survival has been difficult to achieve in rodent models despite use of immunosuppression regimens that successfully increase graft survival of other organs. The purpose of this study was to evaluate a new immunosuppressive agent, mycophenolate mofetil (MM), for its ability to prevent rejection in a rat pancreas transplant model. In addition, using congenic strains of rats,

James A. Schulak; Ravi Masih; Venkatesh Krishnamurthi; Ann Robinson



Environmental Factors and Diseases of Pancreas.  

National Technical Information Service (NTIS)

The aggregate impact of 5 major diseases of the pancreas on mortality and morbidity in the U.S. is major. These diseases are diabetes, cystic fibrosis, acute and chronic pancreatitis, and carcinoma of the exocrine pancreas. The last of these is clearly in...

D. S. Longnecker



Preoperative Assessment of Risk  

Microsoft Academic Search

\\u000a Preoperative risk assessment for geriatric patients must include an acknowledgment of the hazards of iatrogenic events associated\\u000a with hospitalization of elderly persons. These include adverse drug events, bowel and bladder dysfunction, delirium, falls,\\u000a malnutrition, nosocomial infections, and pressure sores. Evaluation includes individual assessment of risk for each adverse\\u000a outcome and strategies for avoiding each.\\u000a \\u000a \\u000a The consultant should provide:\\u000a \\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a \\u000a Systematic

Joan Weinryb


Pancreas transplantation after bariatric surgery.  


Obese transplant candidates are at increased risk for perioperative and postoperative complications. In many transplant programs, morbid obesity is considered to be an exclusion criterion for transplantation. The only potential option that would grant these patients access to transplant is weight loss. Non-operative weight loss strategies such as behavioral modifications, exercise, diet, or medication have only very limited success in achieving long-term weight loss. In contrast, bariatric surgery was shown to achieve not only more excessive weight loss, but more importantly, this weight loss can be sustained for longer periods of time. Therefore, bariatric surgery presents an attractive option for weight loss for morbidly obese transplant candidates. We report our experience with four patients who underwent bariatric surgery prior to successful pancreas transplantation. Even though gastric bypass and laparoscopic adjustable gastric band present as equivalent alternatives for weight reduction, we believe that in the population of morbidly obese diabetic patients who are possible candidates for pancreas transplantation, laparoscopic adjustable gastric band placement is the more suitable procedure. PMID:22050266

Porubsky, Marian; Powelson, John A; Selzer, Don J; Mujtaba, Muhammad A; Taber, Tim; Carnes, Katerine L; Fridell, Jonathan A



Impact of preoperative chemoradiotherapy on survival in patients with resectable pancreatic cancer  

Microsoft Academic Search

AIM: To explore whether preoperative chemoradiation therapy improves survival of patients with pancreatic cancer undergoing resectional surgery. METHODS: Forty-seven patients with a malignant pancreatic tumor localized in the head or uncinate process of the pancreas underwent radical pancreatico- duodenectomy. Twenty-two received chemoradiation therapy (gemcitabine and radiation dose 50.4 Gy) before surgery (CRR) and 25 patients underwent surgery only (RO). The

Pälvi Vento; Harri Mustonen; Timo Joensuu; Päivi Kärkkäinen; Eero Kivilaakso; Tuula Kiviluoto


Desmoplastic small round cell tumor of the pancreas: An unusual primary site for an uncommon tumor  

PubMed Central

Pancreas is a rare location for desmoplastic small round cell tumor. The present case highlights the dilemma in diagnosis and ascertaining the site of tumor origin. Morphologic and immunohistochemical features were complemented with the molecular markers and tumor origin which was initially nebulous was subsequently confirmed on exploratory laparotomy.

Qureshi, Sajid S.; Shrikhande, Shailesh; Ramadwar, Mukta; Desai, Saral; Visvanathan, Seethalakhsmi; Medhi, Seema S.; Laskar, Siddharth; Muckaden, Mary A.; Pai, Suresh K.; Desai, Sangeeta; Kurkure, Purna A.



Extraosseous Ewing's sarcoma of the pancreas.  


The Ewing's family of tumors (EFT) comprises a molecularly defined group of "small round blue cell tumors", consisting of Ewing's sarcoma of bone (ESB), extraosseous Ewing's sarcoma (EES), peripheral primitive neuroectodermal tumor (pPNET), and Askin's tumor. Characteristic translocations that disrupt the EWSR1 gene located at 22q12 create novel fusion genes that are central to the pathogenesis. The EFT also shares certain clinical characteristics, such as a peak incidence during the teenage years, a tendency to spread rapidly, and responsiveness to the same chemotherapeutic regimens and radiation therapy. Nearly all patients have occult disseminated disease at diagnosis; hence, chemotherapy is routinely used. Improvements in multimodality treatment have had a dramatic impact on outcomes. EES/pPNET has been reported in a variety of sites, including the pancreas, though this is extremely rare. We describe a case of pancreatic EES/pPNET in a 35-year-old woman and provide a brief review of the relevant literature. PMID:21892669

Bose, Prithviraj; Murugan, Paari; Gillies, Elizabeth; Holter, Jennifer L




The Est. Annual PC is the Estimated Annual Percent Change (EAPC) over the time interval. SEER Program. NCHS public use tape. The EAPC is significantly different from zero (p<.05). The EAPC for 1991-95 is significantly different from the EAPC for


72-hour preservation of the canine pancreas.  


A new flushout solution for preservation of the pancreas was tested in the dog model of segmental pancreas autotransplantation. The solution osmolality was 320 mOsm/L, K+ = 120 mM, Na+ = 30 mM, and it contained the anion, lactobionate, and raffinose as impermeants to the cell. Preservation times studied were 48 and 72 hr. The pancreas was flushed out with about 250 ml of the new solution and stored at 0 degrees C. Dogs were monitored postoperatively for blood glucose and intravenous glucose tolerance (IVGTT). Results were compared with control (no preservation) segmental pancreas autotransplants. Dogs receiving pancreases stored for 48 or 72 hr were normoglycemic on day one and remained normoglycemic for at least 28 days, or until time of sacrifice. Two of four dogs with pancreases stored for 48 hr were sacrificed on day 14 with normal IVGTT for histology. The remaining two dogs had normal pancreatic function for 28 days. Two of eight dogs receiving pancreas grafts after 72-hr cold storage died of causes unrelated to the pancreas graft, which was still functioning at the time of death. Six dogs remained normoglycemic and had a normal IVGTT at least for 28 days. This study demonstrates the feasibility of preserving the pancreas for three days for transplantation. PMID:3541322

Wahlberg, J A; Love, R; Landegaard, L; Southard, J H; Belzer, F O



Ultrasound examination of the normal pancreas.  


The pancreas is a challenge for the beginner in ultrasonography, but patience, perseverance and experience will lead to a complete and correct evaluation of the organ in almost all cases. A correct examination of the pancreas requires the patient's fasting 7 to 8 hours before the examination. Transverse and longitudinal upper epigastric sections are used to visualize the pancreas, as well as oblique intercostal and subcostal sections (especially for the head and tail). The best ultrasound windows are obtained by using high epigastric sections (that avoid the colon), also by using transgastric sections and sections that use the left liver lobe as an acoustic window. In order to better visualize the pancreas, it is useful to invite the patient to drink 500-700 ml of still water 10-15 minutes before the examination. To highlight the pancreas, we will start by viewing the landmarks: posterior--the porto-splenic axis and anterior--the gastric antrum and/or the left liver lobe. The echogeneity of the normal pancreas can vary, from hypoechoic to hyperechoic, all normal, provided that the pancreatic parenchyma structure is fine and homogeneous. The Wirsung duct can be visualized in some of the cases, especially in thin patients, its normal maximum diameter should be < 2 mm. For a correct evaluation of the pancreas all its segments must be visualized: head, uncinate process, body, and tail - the latter being the most difficult to visualize. PMID:21165455

Sirli, Roxana; Sporea, Ioan



Therapeutic Laparoscopy of the Pancreas  

PubMed Central

Objective To communicate results of laparoscopic treatment of pancreatic pseudocyst (PP) and resection of benign lesions of the pancreas. Perioperative data, surgical outcomes, techniques and insights from 54 cases are presented. Summary Background Data Although laparoscopic therapy for other solid organs has been widely adopted, reports of therapeutic laparoscopy of the pancreas have been few and of limited numbers, and its role in pancreatic disease is still unclear. Methods Eighteen men and 11 women were selected for laparoscopic PP surgery. Four distinct laparoscopic approaches were used. An additional 9 men and 16 women underwent laparoscopic distal pancreatectomy (LDP) using a technique similar to the lesser sac approach. Results Laparoscopic PP surgery was completed successfully in 28 of 29 patients. The overall mean operative time was 2.8 hours and the mean postoperative length of stay was 4.4 days. Of the techniques described, the authors prefer cyst gastrostomy by the lesser sac approach or the minilaparoscopic cystic gastrostomy. LDP was attempted in 25 patients and completed successfully in 23. One underwent a successful hand-assisted enucleation of an insulinoma. In 12 cases the spleen was preserved. Mean operative time was 3.7 hours, and mean postoperative length of stay was 4.1 days. Conclusions In the authors’ experience, minimally invasive treatment of PP produces good results and avoids difficulties linked with percutaneous drainage or endoscopic internal procedures. However, combining upper endoscopy with intragastric laparoscopic surgery offers advantages of both. LDP compares well to open procedures and often allows preservation of the spleen.

Park, Adrian E.; Heniford, B. Todd



The Artificial Pancreas: How Sweet Engineering Will Solve Bitter Problems  

Microsoft Academic Search

An artificial pancreas is a closed-loop system containing only synthetic materials which substitutes for an endocrine pancreas. No artificial pancreas system is currently approved; however, devices that could become components of such a system are now becoming commercially available. An artificial pancreas will consist of functionally integrated components that will continuously sense glucose levels, determine appropriate insulin dosages, and deliver

David C. Klonoff



One Hundred Pancreas Transplants Performed in a Brazilian Institution  

Microsoft Academic Search

After decades of controversy surrounding the therapeutic validity of pancreas transplantation, the procedure has become accepted as the preferred treatment for selected patients with type 1 diabetes mellitus. Between January 2001 and January 2008, 100 patients underwent pancreatic transplantation at our center: 88 simultaneous pancreas-kidney transplantation and 12 pancreas transplantations alone. Pancreas graft management of the exocrine drainage technique involved

J. Nicoluzzi; F. Silveira; F. Porto; M. Macri



New tools for laparoscopic division of the pancreas: a comparative animal study.  


We tested the hypothesis that the pancreas can be safely divided laparoscopically using non-suture devices. Twelve pigs were randomized into 4 groups: 1) laparoscopic distal pancreatectomy (LDP) using an ultrasonic scalpel; 2) LDP using an ultrasonic scalpel with pancreatic stump suture reinforcement; 3) LDP using a 35-mm laparoscopic linear vascular stapler; 4) LDP using a prototype 35-mm radio-frequency laparoscopic linear vascular stapler. There were no serious complications related to distal pancreatectomy. All groups gained weight by postoperative day (POD) 14. Serum amylase, glucose, electrolytes and total bilirubin levels were measured preoperatively and on POD 1, 3, 7, and 14, and peripancreatic peritoneal fluid amylase levels were measured on POD 7 and 14; all remained normal in all groups. Fewer adhesions to the pancreatic stump were found in the ultrasonic scalpel groups as compared with the stapler groups. Ultrasonic dissection may be the superior means oflaparoscopic transection of the pancreas. PMID:15287601

Hanly, Eric J; Mendoza-Sagaon, Mario; Hardacre, Jeffrey M; Murata, Kazunori; Bunton, Tracie E; Herreman-Suquet, Karen; Poulose, Benjamin K; Talamini, Mark A



Endoscopic ultrasound fine-needle aspiration characteristics of primary adenocarcinoma versus other malignant neoplasms of the pancreas  

PubMed Central

BACKGROUND: Endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) is often used to assist in the evaluation of pancreatic lesions and may help to diagnose benign versus malignant neoplasms. However, there is a paucity of literature regarding comparative EUS characteristics of various malignant pancreatic neoplasms (primary and metastatic). OBJECTIVE: To compare and characterize primary pancreatic adenocarcinoma versus other malignant neoplasms, hereafter referred to as nonprimary pancreatic adenocarcinoma (NPPA), diagnosed by EUS-guided FNA. METHODS: The present study was a retrospective analysis of a prospectively maintained database. The setting was a tertiary care, academic medical centre. Patients referred for suspected pancreatic neoplasms were evaluated. Based on EUS-FNA characteristics, primary pancreatic adenocarcinoma was differentiated from other malignant neoplasms. The subset of other neoplasms was defined as malignant lesions that were ‘NPPAs’ (ie, predominantly solid or solid/cystic based on EUS appearance and primary malignant lesions or metastatic lesions to the pancreas). Pancreatic masses that were benign cystic lesions (pseudocyst, simple cyst, serous cystadenoma) and focal inflammatory lesions (acute, chronic and autoimmune pancreatitis) were excluded. RESULTS: A total of 230 patients were evaluated using EUS-FNA for suspected pancreatic mass lesions. Thirty-eight patients were excluded because they were diagnosed with inflammatory lesions or had purely benign cysts. One hundred ninety-two patients had confirmed malignant pancreatic neoplasms (ie, pancreatic adenocarcinoma [n=144], NPPA [n=48]). When comparing adenocarcinoma with NPPA lesions, there was no significant difference in mean age (P=0.0675), sex (P=0.3595) or average lesion size (P=0.3801). On average, four FNA passes were necessary to establish a cytological diagnosis in both lesion subtypes (P=0.396). Adenocarcinomas were more likely to be located in the pancreatic head (P=0.0198), whereas masses in the tail were more likely to be NPPAs (P=0.0006). Adenocarcinomas were also more likely to exhibit vascular invasion (OR 4.37; P=0.0011), malignant lymphadenopathy (P=0.0006), pancreatic duct dilation (OR 2.4; P=0.022) and common bile duct dilation (OR 2.87; P=0.039). CONCLUSIONS: Adenocarcinoma was more likely to be present in the head of the pancreas, have lymph node and vascular involvement, as well as evidence of pancreatic duct and common bile duct obstruction. Of all malignant pancreatic lesions analyzed by EUS-FNA, 25% were NPPA, suggesting that FNA is crucial in establishing a diagnosis and may be helpful in preoperative planning.

Gagovic, Veronika; Spier, Bret J; DeLee, Ryan J; Barancin, Courtney; Lindstrom, Mary; Einstein, Michael; Byrne, Siobhan; Harter, Josephine; Agni, Rashmi; Pfau, Patrick R; Frick, Terrence J; Soni, Anurag; Gopal, Deepak V



Living donor pancreas transplantation in Japan  

Microsoft Academic Search

Background\\/purpose  Living-donor pancreas transplants (LDPs) were introduced at Chiba-East National Hospital in 2004, and 12 LDPs have been performed\\u000a at this institution to date. Based on the outcome of these 12 LDPs, the efficacy and safety of LDPs are herein discussed.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Twelve diabetic patients underwent LDPs; ten had simultaneous pancreas and kidney transplants from living donors, one had\\u000a pancreas transplant after

Takashi Kenmochi; Takehide Asano; Michihiro Maruyama; Kenichi Saigo; Naotake Akutsu; Chikara Iwashita; Kazunori Ohtsuki; Akiko Suzuki; Mariko Miyazaki



Immunosuppression in pancreas transplantation: progress, problems and perspective  

Microsoft Academic Search

Through 1997, over 10 000 pancreas transplants have been performed world-wide, with 88% being simultaneous kidney-pancreas transplants (SKPTs). Current 1-year patient survival exceeds 90% and pancreas graft survival (complete insulin independence) exceeds 80% for SKPT, 70% for sequential pancreas after kidney transplant (PAKT), and 65% for pancreas transplant alone (PTA). According to Registry data, rejection account for 32% of graft

Robert J Stratta



Pancreas-sparing duodenectomy for trauma.  


The application of pancreas sparing duodenectomy (PSD) in extensive duodenal trauma has not been fully explored. We report 3 caes of duodenal trauma in whom PSD was performed successfully and with good results. PMID:15303470

Yadav, T D; Kaushik, R


Molecular and clinical markers of pancreas cancer.  


Pancreas cancer has the worst prognosis of any solid tumor but is potentially treatable if it is diagnosed at an early stage. Thus there is critical interest in delineating clinical and molecular markers of incipient disease. The currently available biomarker, CA 19-9, has an inadequate sensitivity and specificity to achieve this objective. Diabetes mellitus, tobacco use, and chronic pancreatitis are associated with pancreas cancer. However, screening is currently only recommended in those with hereditary pancreatitis and genetic syndromes which predispose to cancer. Ongoing work to identify early markers of pancreas cancer consists of high throughput discovery methods including gene arrays and proteomics as well as hypothesis driven methods. While several promising candidates have been identified none has yet been convincingly proven to be better than CA 19-9. New methods including endoscopic ultrasound are improving detection of pancreas cancer and are being used to acquire tissue for biomarker discovery. PMID:21068484

Buxbaum, James L; Eloubeidi, Mohamad A



Ferritin as an independent mortality predictor in patients with pancreas cancer. Results of a pilot study.  


Prognosis of patients with pancreas cancer is very poor. The aim of the study was to test the significance of laboratory parameters in the prognosis of patients with pancreas cancer. The studied group included 57 patients (31 men, 26 women, mean age 65 ± 9 years). Blood was collected at the time of diagnosis of pancreas cancer and basic laboratory parameters, including nutritional and inflammatory markers and tumour markers were measured. Patients were followed up until death (median survival 147 days). Ferritin, iron, albumin, prealbumin, cholinesterase, haemoglobin, C-reactive protein, alkaline phosphatase and carcinoembryonic antigen were significant for patients' prognosis in univariate analysis while CA 19-9, bilirubin, liver, pancreas and kidney tests and lipids were not. Multivariate Cox regression demonstrated ferritin, iron and albumin as independent mortality predictors (RR (95%CI), per standard deviation: ferritin 1.497(1.215-2.241), p = 0.002; albumin, 0.716(0.521-0.977), p = 0.035; iron, 0.678(0.504-0.915), p = 0.010). Iron correlated significantly with albumin (r = 0.397, p = 0.002) but neither iron nor albumin correlated with ferritin. Patients who survived 100 days had significantly lower ferritin (median 239 ?g/l vs. non-survivors 435 ?g/l, p = 0.014), significantly higher albumin but the difference in serum iron was not quite significant. ROC analysis for ferritin revealed AUC for 100 days survival of 0.710, p = 0.007 (and 0.725, p = 0.004 for 200 days survival). AUC for albumin for 100 days survival was not significant (p = 0.073). This study points out ferritin as an independent mortality predictor in patients with pancreas cancer. High serum levels of ferritin at the time of diagnosis of pancreas cancer indicate bad prognosis of the patient. PMID:22875781

Kalousová, Marta; Krechler, Tomáš; Jáchymová, Marie; Kub?na, Aleš A; Zák, Aleš; Zima, Tomáš




Microsoft Academic Search

There had been few if any study for second pancreas transplant outcome and consequences in patients with simultaneous kidney pancreas transplant after failure of the first pancreas allograft. The aim of this study was to compare the patient and graft survival and clinical outcomes and complication of the second pancreas transplant in patients with simultaneous kidney pancreas, compared with pancreas

R. Hekmat; S. Gareh; E. Morelon; N. Lefrancois; L. Badet


Imaging findings of localized lymphoid hyperplasia of the pancreas: a case report.  


We report here on a case of localized lymphoid hyperplasia of the pancreas in a 70-year-old man which manifested as double lesions (uncinate process and tail) in the organ. The lesions were incidentally detected as hypoechoic lesions on ultrasonography and they appeared as delayed enhancing lesions on the contrast-enhanced dynamic CT and MRI. Total pancreatectomy was performed, because malignant tumor could not be excluded according to the preoperative imaging studies and the endoscopic ultrasound-guided biopsy failed. Pathology revealed localized lymphoid hyperplasia. The patient had an uneventful postoperative course. He has been alive for 18 months after surgery. PMID:21852913

Kim, Jin Woong; Shin, Sang Soo; Heo, Suk Hee; Jeong, Yong Yeon; Kang, Heoung Keun; Choi, Yoo Duk



Preoperative instrumented testing of anterior and posterior knee laxity  

Microsoft Academic Search

A prospective study was performed on 50 patients who were thought or suspected to have cruciate ligament tears. Each patient had a clinical examination preoper atively and under anesthesia and instrumented exami nation using the MedMetric KT-1000 arthrometer, Stry ker knee laxity tester, and Genucom knee analysis. The diagnosis was confirmed by arthrotomy or arthroscopy. Thirty had acute knee injuries

Allen F. Anderson; A. Brant Lipscomb



Estimation of operative line of resection using preoperative image and nonrigid registration  

Microsoft Academic Search

Even though accurate diagnosis of organs is done using preoperative images such as CT or MRI, these information are not directly used in the operating room, because organs are nonrigid and their shapes change with time. In this paper, we propose to obtain an intraoperative image of an open organ and fuse the image with a preoperative image. The intraoperative

Jong-Ha Lee; Chang-Hee Won; Seong-Gon Kong



Long-term pancreas allograft survival in simultaneous pancreas-kidney transplantation by era.  


Data collected by UNOS from all approved US transplant programs were analyzed. The analysis was based on data for 22,075 diabetic patients who received a pancreas transplant between January 1995 and December 2011. Simultaneous pancreas-kidney (SPK) transplantation was the major therapeutic option for diabetes patients. SPK had better survival than pancreas transplantation alone (PTA) or pancreas-after-kidney (PAK) transplantation. The 5-year pancreas graft survival rate for SPK, PAK, and PTA was 71.3%, 56.6%, and 53.0%, respectively. When long-term SPK pancreas graft survival was examined by transplant era, there was no survival improvement after 1995. The effect of year of transplant was estimated using Cox proportional hazard models. The 5-year pancreas graft survival rate in the eras 1995-1998, 1999-2002 and 2003-2006 were 69.2%, 69.8%, and 72.4%, respectively. For those whose graft survived over one year, the 5-year graft survival rate in those eras was 83.5%, 83.4%, and 85.2%, respectively. The adjusted hazard ratio for overall graft loss by year of transplant for the grafts that survived more than one year in the eras 1999-2002 and 2003-2006 was 1.08 (95% confidence interval [CI], 0.94-1.24) and 0.95 (95% CI, 0.82-1.11), respectively. The survival rate of long-term pancreas grafts remained almost unchanged over time. PMID:23721007

Waki, Kayo; Sugawara, Yasuhiko; Kokudo, Norihiro; Kadowaki, Takashi



Current state of pancreas preservation and implications for DCD pancreas transplantation.  


One of the main factors limiting potential uptake of pancreas transplantation, particularly in the United Kingdom, is the shortage of grafts. There has therefore been a recent expansion, particularly in the United Kingdom, in the utilization of grafts from donation after cardiac death (DCD) donors. These grafts are subjected to a greater ischemic insult and are arguably at higher risk of poor functional outcome. Although conventional preservation techniques may be adequate for donation after brain death (DBD) and low-risk DCD pancreases, as the number of DCD pancreas transplants increase and the threshold for rejecting organs decreases, the importance of optimal preservation techniques is going to increase. Over recent years, there have been significant advances in preservation techniques for DCD kidneys, improving the outcome of these marginal grafts. However, the use of such techniques for pancreas preservation is extremely limited and mainly historical. This overview describes the background and results of the established method of pancreas preservation for DBD, namely, cold static storage, and describes the use of the two-layer method. It also reviews pulsatile machine perfusion and normothermic perfusion for pancreas preservation techniques, which have shown promise in the preservation of DCD kidney grafts. The use of these techniques in pancreas preservation is predominantly historical but warrants reevaluation as to the feasibility of applying these techniques to DCD pancreas grafts not only for preservation but also for viability assessment. Further areas for development of pancreas preservation are discussed. PMID:23579769

Barlow, Adam D; Hosgood, Sarah A; Nicholson, Michael L



Porcine pancreas extracellular matrix as a platform for endocrine pancreas bioengineering.  


Emergent technologies of regenerative medicine have the potential to overcome the limitations of organ transplantation by supplying tissues and organs bioengineered in the laboratory. Pancreas bioengineering requires a scaffold that approximates the biochemical, spatial and vascular relationships of the native extracellular matrix (ECM). We describe the generation of a whole organ, three-dimensional pancreas scaffold using acellular porcine pancreas. Imaging studies confirm that our protocol effectively removes cellular material while preserving ECM proteins and the native vascular tree. The scaffold was seeded with human stem cells and porcine pancreatic islets, demonstrating that the decellularized pancreas can support cellular adhesion and maintenance of cell functions. These findings advance the field of regenerative medicine towards the development of a fully functional, bioengineered pancreas capable of establishing and sustaining euglycemia and may be used for transplantation to cure diabetes mellitus. PMID:23583038

Mirmalek-Sani, Sayed-Hadi; Orlando, Giuseppe; McQuilling, John P; Pareta, Rajesh; Mack, David L; Salvatori, Marcus; Farney, Alan C; Stratta, Robert J; Atala, Anthony; Opara, Emmanuel C; Soker, Shay



Hyperinsulinaemic hypoglycaemia: genetic mechanisms, diagnosis and management.  


Hyperinsulinaemic hypoglycaemia (HH) is due to the unregulated secretion of insulin from pancreatic ?-cells. A rapid diagnosis and appropriate management of these patients is essential to prevent the potentially associated complications like epilepsy, cerebral palsy and neurological impairment. The molecular basis of HH involves defects in key genes (ABCC8, KCNJ11, GLUD1, GCK, HADH, SLC16A1, HNF4A and UCP2) which regulate insulin secretion. The most severe forms of HH are due to loss of function mutations in ABCC8/KCNJ11 which encode the SUR1 and KIR6.2 components respectively of the pancreatic ?-cell K(ATP) channel. At a histological level there are two major forms (diffuse and focal) each with a different genetic aetiology. The diffuse form is inherited in an autosomal recessive (or dominant) manner whereas the focal form is sporadic in inheritance and is localised to a small region of the pancreas. The focal form can now be accurately localised pre-operatively using a specialised positron emission tomography scan with the isotope Fluroine-18L-3, 4-dihydroxyphenyalanine (18F-DOPA-PET). Focal lesionectomy can provide cure from the hypoglycaemia. However the diffuse form is managed medically or by near total pancreatectomy (with high risk of diabetes mellitus). Recent advances in molecular genetics, imaging with 18F-DOPA-PET/CT and novel surgical techniques have changed the clinical approach to patients with HH. PMID:22231386

Senniappan, Senthil; Shanti, Balasubramaniam; James, Chela; Hussain, Khalid



Pancreas-Specific Deletion of Prox1 Affects Development and Disrupts Homeostasis of the Exocrine Pancreas  

PubMed Central

BACKGROUND & AIMS The exocrine portion of the pancreas functions in digestion and preserves pancreatic homeostasis. Learning how this tissue forms during embryogenesis could improve our understanding of human pancreatic diseases. Expression of the homeo-box gene Prox1 in the exocrine pancreas changes throughout development in mice. We investigated the role of Prox1 in development of the exocrine pancreas in mice. METHODS Mice with pancreas-specific deletion of Prox1 (Prox1?Panc) were generated and their pancreatic tissues were analyzed using immunohistochemistry, transmission electron microscopy, histologic techniques, quantitative real-time polymerase chain reaction, immunoblotting, and morphometric analysis. RESULTS Loss of Prox1 from the pancreas led to multiple exocrine alterations, most notably premature acinar cell differentiation, increased ductal cell proliferation, altered duct morphogenesis, and imbalanced expression of claudin proteins. Prox1?Panc mice also had some minor alterations in islet cells, but beta-cell development was not affected. The exocrine congenital defects of Prox1?Panc pancreata appeared to initiate a gradual process of deterioration that resulted in extensive loss of acinar cells, lipomatosis, and damage to ductal tissue in adult mice. CONCLUSIONS Pancreas-specific deletion of Prox1 causes premature differentiation of acinar cells and poor elongation of epithelial branches; these defects indicate that Prox1 controls the expansion of tip progenitors in the early developing pancreas. During later stages of embryogenesis, Prox1 appears to regulate duct cell proliferation and morphogenesis. These findings identify Prox1 as an important regulator of pancreatic exocrine development.




Bringing the Artificial Pancreas Home: Telemedicine Aspects  

PubMed Central

The design and implementation of telemedicine systems able to support the artificial pancreas need careful choices to cope with technological requirements while preserving performance and decision support capabilities. This article addresses the issue of designing a general architecture for the telemedicine components of an artificial pancreas and illustrates a viable solution that is able to deal with different use cases and is amenable to support mobile-health implementations. The goal is to enforce interoperability among the components of the architecture and guarantee maximum flexibility for the ensuing implementations. Thus, the design stresses modularity and separation of concerns along with adoption of clearly defined protocols for interconnecting the necessary components. This accounts for the implementation of integrated telemedicine systems suitable as short-term monitoring devices for supporting validation of closed-loop algorithms as well as devices meant to provide a lifelong tighter control on the patient state once the artificial pancreas has become the preferred treatment for patients with diabetes.

Lanzola, Giordano; Capozzi, Davide; Serina, Nadia; Magni, Lalo; Bellazzi, Riccardo



Congenital short pancreas: a report of two cases  

Microsoft Academic Search

We report two adult cases with partial agenesis of the pancreas. Their radiological features, including endoscopic retrograde pancreatography are demonstrated. The significance of developmental anomalies involving the pancreas is emphasised.

N H Gilinsky; G Del Favero; P B Cotton; W R Lees



Use of Small Donors (<28 kg) for Pancreas Transplantation  

Microsoft Academic Search

ObjectiveSmall donors have long been considered a potential source of organs for simultaneous pancreas-kidney transplantation (SPK) and pancreas transplantation alone (PTA). Our aim was to analyze our experience with SPK and PTA using small donors weighing

H. G. Illanes; C. M. Quarin; R. Maurette; N. G. Sánchez; L. Reniero; D. H. Casadei



Stenting of the Superior Mesenteric Artery as a Preoperative Treatment for Total Pancreatectomy  

SciTech Connect

The patient was a 58-year-old male with mucinous cyst adenocarcinoma of the pancreas. Prior to total pancreatectomy, preoperative CT and angiography showed a high-grade arteriosclerotic stenosis of about 1.0 cm in length in the ostium of the superior mesenteric artery (SMA), as well as the development of collateral vessels in the area around the head of the pancreas. A stent was placed in the SMA stenosis to preserve the intestinal blood flow in the SMA region after total pancreatectomy, which was performed 25 days after stent placement. The postoperative SMA blood flow was favorable, with no postoperative intestinal ischemia, and the patient had an uneventful postoperative course.

Tanigawa, Noboru, E-mail:; Kariya, Shuji; Komemushi, Atsushi [Kansai Medical University, Department of Radiology (Japan); Satoi, Sohei; Kamiyama, Yasuo [Kansai Medical University, 1st Department of Surgery (Japan); Sawada, Satoshi; Kojima, Hiroyuki; Sougawa, Mitsuharu [Kansai Medical University, Department of Radiology (Japan); Takai, Yuichirou [Kansai Medical University, 1st Department of Surgery (Japan)



The Solution to Hyperglucagonemia after Pancreas Transplantation in Inbred Rats  

Microsoft Academic Search

Background: We studied the possible role of the diseased host pancreas and site of venous graft drainage in the development of hyperglucagonemia after pancreas transplantation, to identify the crucial steps of the technique capable of eliminating hyperglucagonemia and its possible diabetogenic effect. Methods: Therefore, we compared 4 groups of inbred rats: (1) heterotopic pancreas transplantation with either systemic (n =

H. J. Kissler; R. Hennig; H. Gepp; W. Hohenberger; P. O. Schwille



A Solution to Organ Shortage: Vascular Reconstructions for Pancreas Transplantation  

Microsoft Academic Search

Multiorgan harvesting (MOH) accounts for approximately 40% of all organ procurements in Poland. Simultaneous procurement of the pancreas and liver necessitates division of the vessels supplying both organs. Therefore, reconstruction of the pancreas vasculature is mandatory for proper function of the transplanted organ. The aim of this study was to present various methods of vascular reconstruction to prepare the pancreas

Z. Ga??zka; T. Grochowiecki; S. Nazarewski; O. Rowi?ski; W. Chudzi?ski; K. Pietrasik; T. Jakimowicz; B. Solonynko; I. Nawrot; A. Ka?ski; J. Szmidt



Increased serum concentration of carbohydrate- deficient transferrin in patients with combined pancreas and kidney transplantation  

Microsoft Academic Search

Serum concentration of carbohydrate-deficient trans- ferrin (cCDT) is used for laboratory diagnosis and follow-up of chronic alcohol abuse. In analyzing by CDTect-RIA (Pharmacia) sera from outpatients with combined pancreas and kidney transplantation and no excessive alcohol consumption, we found above-normal values for cCDT and CDT\\/transferrin ratios (CDT\\/Tf) in more than half of the samples. Isoelectric focusing of these samples showed

Torsten Arndt; Rolf Hackler; Thomas Muller; Tilman O. Kleine; Axel M. Gressner


A case of mixed ductal-endocrine carcinoma of the pancreas  

Microsoft Academic Search

A 66-year-old male patient underwent a stomach-preserving pancreatoduodenectomy procedure because of a tumor located around\\u000a the lower bile duct under the diagnosis of carcinoma of the lower bile duct. The tumor (3.5 × 2.5 cm) was found at the head\\u000a of the pancreas and had invaded the papillae of Vater at the duodenum. Histology findings indicated both ductal adenocarcinoma\\u000a and

Hiroshi Hirano; Nobuyuki Terada; Naoko Yamada; Yasushi Yamanegi; Hideki Oyama; Takashi Nishigami; Keiji Nakasho



Neuroendocrine tumors of the pancreas  

Microsoft Academic Search

Pancreatic endocrine tumors are rare neoplasms accounting for less than 5% of pancreatic malignancies. They are broadly classified\\u000a into either functioning tumors (insulinomas, gastrinomas, glucagonomas, VIPomas, and somatostatinomas) or nonfunctioning tumors.\\u000a The diagnosis of these tumors is difficult and requires a careful history and examination combined with laboratory tests and\\u000a radiologic imaging. Signs and symptoms are usually related to hormone

Karen Davies; Kevin C. Conlon



Kidney-pancreas transplantation: assessment of key imaging findings in the acute setting.  


For patients with diabetes, insulin therapy can be an effective treatment for years. However, many diabetics eventually develop complications from the disease, including neuropathy, amputations, atherosclerosis, and kidney failure. While kidney failure can be managed with dialysis, difficulties with monitoring fluid intake and diet, bone loss, anemia, and venous access can be problematic for the patient. Due to the decreased life expectancy and difficulties of medical management of patients with diabetes and renal failure, combined renal-pancreas transplantation is an increasingly used option available to type 1 diabetics with concurrent renal failure due to refinements of surgical technique and immunosuppressive therapy. Due to the increasing number of kidney-pancreas transplant patients, longer post-transplant survival, and increasing number of hospitals performing the procedure, more transplant patients are having their care increasingly shifted away from the major transplant centers to general community hospitals. In many kidney-pancreas transplants patients who present to the emergency department for suspected transplant dysfunction, imaging plays a critical initial role in their diagnosis and management. Therefore, it has become increasingly important that community and emergency department radiologists be able to recognize the normal imaging appearance of renal-pancreas transplants and to identify acute findings. PMID:22644061

Heller, Matthew T; Hattoum, Alexander



Biohybrid artificial pancreas based on macrocapsule device  

Microsoft Academic Search

On the basis of an overview of the current methodologies used for biohybrid artificial pancreas (BAP) and a critical analysis of the problems in designing the BAP devices, especially macrocapsule systems, a new type of refillable BAP is proposed. The following highlights the unique features of this design: (1) use of a thermally reversible synthetic hydrogel made of N-isopropylacrylamide based

Q. P Hou; Y. H Bae



Ductal Adenocarcinoma Arising in Duodenopyloric Heterotopic Pancreas  

Microsoft Academic Search

The occurrence of heterotopic pancreatic tissue in the abdomen has been well described and is of more than occasional frequency. It has further been noted that this tissue may be subject to most of the pathologic changes ascribed to the pancreas itself; however, malignant transformation in pancreatic heterotopia has only rarely been described. We encountered such a case occurring in

Steven J. Brotman; Wayne Pan; Jason Pozner; Marshall Weiss; Ira J. Bleiweiss




EPA Science Inventory

Eight cases of acinar cell carcinoma of the exocrine pancreas were diagnosed in Japanese medaka (Oryzias latipes) from a pool of approximately 10,000 specimens used in a variety of carcinogenesis bioassays. hree cases occurred in specimens from control groups and one case in a sp...


Report from the International Pancreas Transplant Registry  

Microsoft Academic Search

Summary  From December, 1966 through 1990, 3082 pancreas transplants were reported to the International Registry. A detailed analysis was performed on the 2087 transplants in the 1986–90 data base; during this time the overall one year recipient and graft functional survival rates were 89% and 62%. Univariate analyses showed graft survival rates to be significantly higher with bladder drainage than with

D. E. R. Sutherland



New variant for whole pancreas grafting  

SciTech Connect

A new variant for whole pancreas grafting is described in which a segment of the duodenum and the spleen is included in the graft. The graft is placed extraperitoneally as in kidney transplantation. The exocrine drainage is with side-to-side anastomosis between duodenum and bladder. The spleen is irradiated to prevent the occurrence of GVHD, as is reported in splenic transplantation.

Kootstra, G.; van Hooff, J.P.; Joerning, P.J.L.; Leunissen, K.M.; van der Linden, C.J.; Beukers, E.; Buurman, W.A.



Kidney Function After Solitary Pancreas Transplantation  

Microsoft Academic Search

Preserving kidney function in patients after solitary pancreas transplantation (SPTx) is an important consideration, yet various factors may negatively impact long-term function of the native kidneys or kidney allograft. To determine changes in kidney function over time in a series of patients receiving SPTx, we conducted a retrospective analysis and tracked changes in serum creatinine (SCr) and calculated glomerular filtration

J. S. Odorico; B. Voss; A. Munoz del Rio; G. Leverson; Y. T. Becker; J. D. Pirsch; R. M. Hoffman; H. W. Sollinger



Glucose Sensing Issues for the Artificial Pancreas  

Microsoft Academic Search

The first retrospective continuous glucose monitor entered the market in 1999. Now that this tool gives online data, the question arises whether it is ready to be incorporated into a closed-loop system. The author discusses the following questions: (1) Is the accuracy of current continuous glucose monitoring (CGM) systems good enough for use in a prototype artificial pancreas system?; (2)

J. Hans DeVries


Remarkable Adrenergic Nerves in the Exocrine Pancreas.  

National Technical Information Service (NTIS)

The adrenergic nerves in the pancreas of mice, rats, guinea-pigs, rabbits, and cats were investigated with the fluorescence method of Falck and Hillarp. The relations between the adrenergic fibres and the vessels were studied by the injection of india ink...

P. Alm L. Cegrell B. Ehinger B. Falck



Treatment of cancer of the exocrine pancreas  

Microsoft Academic Search

Background: The incidence of cancer of the exocrine pancreas varies among populations, being the fourth or fifth cause of cancer death in the West. Outcome remains poor and opinions remain divided over the optimal management of the condition.Method: A computer literature search was made of the MEDLINE database from January 1990 to December 1997 and selected other studies.Results: Indications and

Michel Huguier; Nicholas P Mason



Assessment of the usefulness of the standardized uptake values and the radioactivity levels for the preoperative diagnosis of thyroid cancer measured by using 18F-FDG PET/CT dual-time-point imaging  

NASA Astrophysics Data System (ADS)

The purpose of this study was to assess and compare the changes in the SUV (standardized uptake value), the 18F-FDG (18F-fluorodeoxyglucose) uptake pattern, and the radioactivity level for the diagnosis of thyroid cancer via dual-time-point 18F-FDG PET/CT (positron emission tomographycomputed tomography) imaging. Moreover, the study aimed to verify the usefulness and significance of SUV values and radioactivity levels to discriminate tumor malignancy. A retrospective analysis was performed on 40 patients who received 18F-FDG PET/CT for thyroid cancer as a primary tumor. To set the background, we compared changes in values by calculating the dispersion of scattered rays in the neck area and the lung apex, and by comparing the mean and SD (standard deviation) values of the maxSUV and the radioactivity levels. According to the statistical analysis of the changes in 18F-FDG uptake for the diagnosis of thyroid cancer, a high similarity was observed with the coefficient of determination being R2 = 0.939, in the SUVs and the radioactivity levels. Moreover, similar results were observed in the assessment of tumor malignancy using dual-time-point. The quantitative analysis method for assessing tumor malignancy using radioactivity levels was neither specific nor discriminative compared to the semi-quantitative analysis method.

Lee, Hyeon-Guck; Hong, Seong-Jong; Cho, Jae-Hwan; Han, Man-Seok; Kim, Tae-Hyung; Lee, Ik-Han



Laparoscopic removal of a needle from the pancreas.  


Foreign bodies inside the pancreas are rare and usually occur after the ingestion of sharp objects like fish bone, sewing needle and toothpick. Most of the ingested foreign bodies pass spontaneously through the anus without being noticed but about 1% of them can perforate through the wall of stomach or duodenum to reach solid organs like pancreas or liver. Once inside the pancreas they can produce complications like abscess, pseudoaneurysm or pancreatits. Foreign bodies of pancreas should be removed by endoscopic or surgical methods. We hereby report our experience of successful removal one a sewing needle from pancreas. PMID:23741114

Jain, Amit; Nag, Hirdaya Hulas; Goel, Neeraj; Gupta, Nikhil; Agarwal, Anil Kumar



Laparoscopic removal of a needle from the pancreas  

PubMed Central

Foreign bodies inside the pancreas are rare and usually occur after the ingestion of sharp objects like fish bone, sewing needle and toothpick. Most of the ingested foreign bodies pass spontaneously through the anus without being noticed but about 1% of them can perforate through the wall of stomach or duodenum to reach solid organs like pancreas or liver. Once inside the pancreas they can produce complications like abscess, pseudoaneurysm or pancreatits. Foreign bodies of pancreas should be removed by endoscopic or surgical methods. We hereby report our experience of successful removal one a sewing needle from pancreas.

Jain, Amit; Nag, Hirdaya Hulas; Goel, Neeraj; Gupta, Nikhil; Agarwal, Anil Kumar



Preoperative Hyperoxyradiotherapy of Colorectal Carcinoma  

Microsoft Academic Search

Aim: The article focuses on the radioprotective effect of acute hypoxia on healthy tissues during preoperative accelerated hypoxyradiotherapy of colorectal carcinoma performed as locoregional irradiation including the common iliac lymph nodes. Analysis of early and late side effects and complications. Patients and Methods: In this prospective study, early and late complications were assessed in 50 patients as a function of

Ta?o Ta?ev; Tomáš Sk?i?ka; Jan Žaloudík; Zden?k Pa?ovský



Preoperative fasting guidelines: an update  

Microsoft Academic Search

Liberal pre-operative fasting routines have been implemented in most countries. In general, clear fluids are allowed up to 2 h before anaesthesia, and light meals up to 6 h. The same recom- mendations apply for children and pregnant women not in labour. In children <6 months, most recommendations now allow breast- or formula milk feeding up to 4 h before

E. Soreide; L. I. Eriksson; G. Hirlekar; H. Eriksson; S. W. Henneberg; R. Sandin; J. Raeder



Preoperative fasting: a clinical audit.  


This clinical audit examines the adherence to guidelines suggested by the Royal College of Nursing (2005); the results uphold previous studies of a preoperative starving period for patients undergoing elective surgical procedures. Patients excessively starved of food or fluids report problems relating to their health. These include hunger, distress and complaints of nausea. PMID:23413526

Roberts, Stuart


Preoperative Autologous Blood Donation (PABD).  

National Technical Information Service (NTIS)

Since the mid 1980s, when concerns over the safety of the U.S. blood supply arose, preoperative autologous blood donation (PABD) has been utilized by patients undergoing elective surgery for which blood transfusion was anticipated. However, the risk of ac...



Isolated and complete traumatic rupture of the pancreas: A case report and a review of the literature  

PubMed Central

INTRODUCTION Pancreatic trauma without injuries to other organs is uncommon, as reported in the reviewed literature. Diagnosis of pancreatic trauma might be difficult, due to unspecific signs and symptoms. The integrity of the main pancreatic duct is the crucial point in the management and outcome of patients with pancreatic trauma. PRESENTATION OF CASE The authors report a case of delayed diagnosis after a complete traumatic rupture of the main pancreatic duct, successfully managed by surgical treatment. The authors performed a laparotomy with complete removal of necrotic pancreatic tissue at the site of rupture. The proximal pancreatic stump was hand-sewn with detached stitches and a disposable catheter was positioned into Wirsung's duct, a diversion of the distal stump with a Roux-en-y pancreato-jejunal anastomosis was performed. The postoperative course was uneventful. DISCUSSION Traumatic injuries of the pancreas occur after blunt abdominal traumas or penetrating wounds with a ratio of 3:1. Isolated traumatic injuries of the pancreas are uncommon; and they are usually associated with injuries to other organs. Surgical solutions for the treatment of pancreas lesions vary and it is well known that a surgical procedure performed after a delayed diagnosis is associated with high mortality and morbidity, especially in pancreatic duct rupture. CONCLUSION Pancreatic trauma is a diagnostic and therapeutic challenge for the trauma surgeon. The integrity of the main pancreatic duct is the most important determinant of outcome after injury to the pancreas and, in Wirsung's duct rupture, early surgery may improve it.

Viti, M.; Papis, D.; Ferraris, V.; Fiori, F.; D'Urbano, C.



Local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy in the management of patients with chronic pancreatitis.  

PubMed Central

OPERATION: Local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy of the body and tail of the pancreas (LR-LPJ) was designed to improve decompression of the head of the pancreas, which often was not drained well by standard longitudinal pancreaticojejunostomy. This was achieved by excising the head of the pancreas overlying the ducts of Wirsung and Santorini, and duct to the uncinate, along with their tributary ducts. PATIENT MATERIAL: The operation has been performed on 50 patients. There were five late deaths among the 50 patients; two at 6 months, and one each at 24, 26, and 91 months. Eighty percent of the patients were alcoholics, 50% had pseudocysts, and 80% had calcification. ASSESSMENT: Pain was assessed on a scale of 1 to 10, with 10 being most severe. Narcotic intake was considered minimal-Vicodin equivalent (hydrocodone bitartate, 5 mg, acetaminophen, 500 mg; Vicodin, Knoll Pharmaceuticals, Whippany, NJ) once or twice/month; moderate--Vicodin weekly daily; and major--meperidine hydrochloride (Demerol, Winthrop Pharmaceuticals, New York, NY) weekly or daily. RESULTS: Pain relief in 47 patients was excellent (74.5%), improved in 12.75%, and unimproved in 12.75%. Endocrine status in 45 patients was as follows: 69% were not diabetic, and 20% were diabetic preoperatively and postoperatively. Postoperatively, 11% had progression of their diabetes. Exocrine function was not worsened and may have been improved in some patients. Sixty-four percent of 39 patients gained an average of 15.3 pounds. Fifty-nine percent of patients were not working preoperatively or postoperatively. CONCLUSIONS: The LR-LPJ provides good pain relief with a modest increase in endocrine and exocrine insufficiency and a significant increase in weight. Even when relieved of pain, patients seldom return to the work force.

Frey, C F; Amikura, K



Concomitant intraductal papillary mucinous neoplasm and neuroendocrine tumor of the pancreas.  


Intraductal papillary mucinous neoplasm (IPMN) and neuroendocrine tumor (NET) of the pancreas are rare tumors and their association is not expected to be frequent. However, certain studies have suggested that the concomitant occurence of these tumors may be more frequent than previously thought. In the current study, we describe a case of concomitant occurrence of IPMN and NET of the pancreas and review the clinicopathological features of previously published cases and the current one. A 68-year-old female was incidentally found to have dilatation of the main pancreatic duct. A distal pancreatectomy was performed under the clinical diagnosis of IPMN. Histopathological analysis revealed concomitant IPMN (low-grade) and NET G1 of the pancreas. Review of the clinicopathological features of the 15 previously reported cases of concomitant IPMN and NET of the pancreas as well as the present one indicated that: i) this condition mainly affects middle-aged females; ii) the main symptom is abdominal or back pain, or no symptoms; iii) a hormone production symptom was observed in only one case; iv) the most common degree of dysplasia of IPMN is low grade; and v) the size of the NET is not particularly large (average 15.1 mm), although the clinical behavior is not always indolent (metastasis was observed in 3 cases). It is well known that IPMNs are associated with a high incidence of extrapancreatic malignancies, including colorectal and gastric carcinomas. Concomitant pancreatic NET and extrapancreatic malignancies may occur, therefore, systemic surveillance of extrapancreatic neoplasms and detection of concomitant NETs of the pancreas are necessary for patients with IPMN. PMID:23255895

Ishida, Mitsuaki; Shiomi, Hisanori; Naka, Shigeyuki; Tani, Tohru; Okabe, Hidetoshi



Cystic neoplasia of the pancreas: pathology and biology.  


In contrast with solid tumors, most of which are invasive ductal adenocarcinoma with dismal prognosis, cystic lesions of the pancreas are often either benign or low-grade indolent neoplasia. Those that are mucinous, namely, intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs), constitute the most important category, not only because they are the most common, but more importantly because they have well-established malignant potential, representing an adenomacarcinoma sequence. While many are innocuous adenomas--in particular, those that are small and less complex, and in the case of IPMN, those that are branch-duct type are more commonly benign, some harbor or progress into in situ or invasive carcinomas. For this reason, pancreatic cysts with mucinous differentiation ought to be evaluated carefully, preferably by experts familiar with subtle evidences of malignancy in these tumors. In the past few years, the definition of IPMNs and MCNs has become more refined. The presence of ovarian-type stroma has now almost become a requirement for the diagnosis of MCN, and when defined as such, MCN is seen almost exclusively in women of perimenopausal age group as thick-walled multilocular cystic mass in the tail of the pancreas in contrast with IPMN which afflicts an elder population, both genders in almost equal numbers, and occur predominantly in the head of the organ. While mucinous lesions have well-established pre-malignant properties, most of the entities that fall into the nonmucinous true cyst category such as serous tumors, lymphoepithelial cysts, congenital cysts, and squamoid cyst of ducts have virtually no malignant potential. In contrast, the rare cystic tumors that occur as a result of degenerative/necrotic changes in otherwise solid neoplasia such as the rare cystic ductal adenocarcinomas, cystic endocrine neoplasia, and most importantly, solid-pseudopapillary tumor (SPT) in which cystic change is so common that it used to be incorporated into its name ("solid-cystic," "papillary-cystic") are malignant neoplasia, albeit variable degrees of aggressiveness. SPT holds a distinctive place among pancreatic neoplasia because of its highly peculiar characteristics, undetermined cell lineage, occurrence almost exclusively in young females, association with beta-catenin pathway, and also by being a very low-grade curable malignancy. In conclusion, cystic lesions in the pancreas constitute a biologically and pathologically diverse category most (but not all) of which are either benign or treatable diseases; however, a substantial subset, especially mucinous ones, has malignant potential that requires careful analysis. PMID:17957438

Adsay, N Volkan



[Current situation of pancreas transplantation in Japan].  


Pancreas transplantation has been recognized as the best treatment for advanced type 1 diabetic patients. In Japan, we have performed 64 SPK, PAK or PTA from 62 brain-dead donors and two non-heart beating donors since the enforcement of Organ Transplant Act in 1997. In addition, 18 cases have been performed from living related donors. The patient survival, pancreas graft survival and kidney graft survival rate of the cadaveric transplantation at five years are 97.5%, 73.9% and 71.0%, respectively. The QOL of the recipients in both mental and physical aspects has been wonderfully improved leading to the happy second life. In front of the revised low in this year, the number of the donor and the transplantation are expected to increase. PMID:21174693

Sugitani, Atsushi; Yoshida, Junichi; Hoshinaga, Kiyotaka; Okabe, Yasuhiro; Kitada, Hidehisa; Tanaka, Masao



Preoperative assessment of alternative veins.  


Duplex ultrasonography, with or without color flow, has replaced phlebography as the technique of choice to select veins for autogenous bypass grafts. Although anatomic location and length are well-defined by ultrasound, evaluation of the venous wall itself is still imperfect. In situ diameters are less than those of arterialized veins. Ultrasonic search is most valuable in the examination of patients with good veins obscured by a layer of fat. Preoperative knowledge of variant anatomy and location of major veins and their branches facilitates bypass surgery. The preoperative vein mapping should be available in the operating room to guide the placement of incisions for unroofing and exploration directly over veins and vein segments that have a high likelihood of being usable. The finding of a useful vein when none is apparent on physical examination may enable the construction of an autogenous bypass in lieu of a less desirable prosthetic graft or leg amputation. PMID:8564029

Salles-Cunha, S X; Beebe, H G; Andros, G



Preoperative localization of parathyroid adenomas  

SciTech Connect

During a 12-month period, 64 patients were operated on for primary hyperparathyroidism. Sixty-one had single adenomas and 3 had double adenomas. Preoperative imaging was used to localize the adenomas. Half of the patients (32 of 64) had magnetic resonance, thallium-201/technetium-99m subtraction scintigraphy, and high-resolution ultrasonography; the other 32 patients had 1 or 2 of the imaging modalities. Sensitivity and specificity of magnetic resonance imaging was 82 percent and 97 percent, respectively; the sensitivity and specificity of the other two modalities was 59 and 98 percent for subtraction scintigraphy and 73 and 98 percent for ultrasonography. The use of preoperative imaging facilitated surgical exploration, reduced operating time, and resulted in an increased number of successful operations. There were no negative explorations in this series as compared with 19 negative explorations (2.6 percent) in our prior experience with 720 operations.

Attie, J.N.; Khan, A.; Rumancik, W.M.; Moskowitz, G.W.; Hirsch, M.A.; Herman, P.G.



Acute pancreas allograft rejection is associated with increased risk of graft failure in pancreas transplantation.  


The effect of acute allograft rejection (AR) on long-term pancreas allograft function is unclear. We retrospectively studied 227 consecutive pancreas transplants performed at our institution between January 1, 998 and December 31, 2009 including: 56 simultaneous pancreas and kidney (SPK), 69 pancreas transplantation alone (PTA); and 102 pancreas after kidney (PAK) transplants. With a median follow-up of 6.1 (IQR 3-9) years, 57 patients developed 79 episodes of AR, and 19 experienced more than one episode. The cumulative incidence for AR was 14.7%, 19.7%, 26.6% and 29.1% at 1, 2, 5 and 10 years. PTA transplant (hazards ratio [HR]=2.28, p=0.001) and donor age (per 10 years) (HR=1.34, p=0.006) were associated with higher risk for AR. The first AR episode after 3 months post PT was associated with increased risk for complete loss (CL) (HR 3.79, p<0.001), and the first AR episode occurring during 3- to 12-month and 12- to 24-month periods after PT were associated with significantly increased risk for at least partial loss (PL) (HR 2.84, p=0.014; and HR 6.25, p<0.001, respectively). We conclude that AR is associated with increased risk for CL and at least PL. The time that the first AR is observed may influence subsequent graft failure. PMID:23432918

Dong, M; Parsaik, A K; Kremers, W; Sun, A; Dean, P; Prieto, M; Cosio, F G; Gandhi, M J; Zhang, L; Smyrk, T C; Stegall, M D; Kudva, Y C



Preoperative assessment for pituitary surgery  

Microsoft Academic Search

Evaluation of pituitary function is essential before pituitary surgery. In hyperprolactinaemic patients with a pituitary macrolesion,\\u000a tumoral secretion of prolactin must be distinguished from ‘disconnection’ hyperprolactinaemia; serum prolactin >200 mcg\\/l\\u000a is virtually diagnostic of a macroprolactinoma whereas levels <80 mcg\\/l usually indicate ‘disconnection’. The prolactin ‘hook\\u000a effect’ should be excluded. A minimum set of pre-operative endocrine tests should include serum electrolytes, cortisol

Olivia Pereira; John S. Bevan



The pancreas and oxygen consumption (Part 2)  

Microsoft Academic Search

Summary  In order to evaluate the effect of methylprednisolone sodium succinate (MPSS) on the alteration of pancreatic oxygen consumption\\u000a (VO2) in hypovolemic shock, MPSS was administered to four normal canines and three hypovolemic animals. All were treated according\\u000a to the protocol used in the initial report. (The Pancreas and Oxygen Consumption 1: Pancreatic Oxygen Consumption in Normo-\\u000a and Hypovolemic Dogs.) All

John H. Robert; Aholeab E. Toledano; Gang Huang; Lewis S. Toth; Giuliano Premus; Miklos Papp; David A. Dreiling



The pancreas and oxygen consumption 1  

Microsoft Academic Search

Summary  Pancreatic oxygen consumption (VO2) was studied in hypovolemic shock: 4 dogs served as controls and 4 others were kept at 50 mm Hg of mean arterial blood pressure.\\u000a All 8 were studied for a period of 3 h. Pancreatic VO2 was obtained by adding up VO2 for the head (minus the uncinate process) and tail of the pancreas both equal

John H. Robert; Aholeab E. Toledano; Gang Huang; Lewis S. Toth; Giuliano Premus; Miklos Papp; David A. Dreiling



Stimulation of nerves innervating the dog's pancreas.  


Our aim was to modulate secretion of insulin and glucagon into the blood of a diabetic but otherwise healthy dog with stimulation of nerves innervating the pancreas. The 33 electrode spiral cuffs were implanted in an adult beagle canine. The first cuff was installed on the vagus nerve, the second one on the splanchnic nerve, and the last one on the pancreatic nerve. To cause insulin-dependent Type I diabetes, partial dysfunction of the pancreas was induced. Nerves were stimulated using biphasic, rectangular current pulses (10 mA, 200 micros, 20 Hz). Samples from the femoral artery were drawn before the experiment, after 5 min, and 5 min after the stimulation stopped. The results of radioimmunological assay of blood samples showed that in the intact pancreas, stimulation of the vagus nerve caused a considerable increase in insulin secretion, no significant change in glucagon secretion, and a decrease in C-peptide secretion. Splanchnic nerve stimulation did not cause considerable change in insulin and C-peptide secretion while considerable increase in glucagon secretion was noticed. Pancreatic nerve stimulation did not considerably change the secretion of any of the three hormones. In the dysfunctioned pancreas, vagal nerve stimulation caused an increase in insulin and glucagon secretion and a minor increase in C-peptide secretion. Splanchnic nerve stimulation caused a minor decrease in insulin secretion, a considerable increase in glucagon secretion, and a small increase in C-peptide secretion. Pancreatic nerve stimulation did not cause a considerable change in insulin secretion while a minor increase in glucagon and C-peptide secretion was observed. PMID:11940023

Rozman, Janez; Zorko, Bojan; Bunc, Matjaz; Zitko, Mojca



Outcomes of Kidney and Pancreas Transplantation  

Microsoft Academic Search

\\u000a The transplant physician and surgeon need to have a sound understanding of transplant outcomes. The authors review various\\u000a factors that impact survival of kidney and pancreas transplantation. Also discussed are the implications of outcomes data\\u000a on patient and regimen selection. The basic premises of survival analysis and relevant terminology are presented in the context\\u000a of a framework for clinical practice.

Titte R. Srinivas; Herwig-Ulf Meier-Kriesche; Jesse D. Schold


Evolving surgical strategies for pancreas transplantation  

Microsoft Academic Search

Pancreas transplant has become a reliably predictable treatment and cure for patients with type 1 diabetes mellitus and hypoglycemic\\u000a unawareness or renal failure. During the past 2 years, the use of enteric drainage has been shown to decrease morbidity over\\u000a traditional bladder drainage, and the use of the portal system for venous drainage continues to be explored. Technically,\\u000a the use

David B. Leeser; Stephen T. Bartlett



Immobilization and characterization of porcine pancreas lipase  

Microsoft Academic Search

Porcine pancreas lipase (triacylglycerol ester hydrolase, EC was immobilized with the highest activity (2,187 U g?1 solid) on polyacrylamide beads possessing carboxylic functional groups activated by a water-soluble carbodiimide. The optimum pH for catalytic activity was pH 8.9. The apparent optimum temperature for the immobilized enzyme was about 7°C higher than that for the soluble enzyme. The immobilization stabilized

K. Bagi; L. M. Simon; B. Szajáni



Duodenal segment complications in vascularized pancreas transplantation  

Microsoft Academic Search

Bladder drainage by the duodenal segment (DS) technique is currently the preferred method of pancreas transplantation (PTX)\\u000a but is associated with unique complications. Over a 7-year period, 191 diabetic patients underwent 201 whole-organ PTXs with\\u000a bladder drainage using a 6 to 8 cm length of DS as an exocrine conduit. A retrospective chart review was performed to document\\u000a all DS

Robert J. Stratta; Rakesh Sindhi; Debra Sudan; John T. Jerius; Stanley J. Radio



Intra-abdominal complications after pancreas transplantation  

Microsoft Academic Search

Pancreas transplantation is the treatment of choice for patients with end-stage renal disease (ESRD) secondary to type 1 insulin-dependent diabetes mellitus (IDDM), either simultaneously with a cadaver kidney transplant or after a living donor kidney transplant. Recent advances in immunosuppression and surgical technique have encouraged extension of this procedure to selected pre-uremic diabetics with poor glucose control as well. Currently,

David Shaffer



Pancreas transplantation: indications, clinical management, and outcomes.  


Although many advances have been made, pancreas transplantation still poses several challenges to the surgeon, internist and patient. With success rates now above 80% and improving yearly, diabetic patients must make a major life-style decision when considering a pancreas transplant. The main concerns are will the benefits of insulin-independence off-set the risks of surgery and immunosuppression. For diabetics near dialysis and considering a kidney transplant, the decision may not be as difficult. However, for those patients who are failing insulin therapy (brittle control) and remain with good renal function, the options are limited. As the success of pancreas transplantation improves, the procedure may become routine at more centers and become accepted by more third-party carriers. However, as with other solid organs, the availability of pancreases is limited and the supply soon to be exhausted. Thus, further advances are required for the prevention and treatment of Type 1 diabetes. Hopefully, the new frontiers of the next century will allow physicians to identify and preventively treat those at risk for the development of diabetes. Thus, the population of patients suffering from the consequences of this dreadful disease will be greatly reduced. With new developments in immunosuppression and islet transplantation, diabetic patients of the future may be offered the option of a procedure with reduced risks, less morbidity, and improved long-term cure rates. PMID:9230065

Leone, J P; Humar, A; Gruessner, R W; Sutherland, D E



Serous adenoma of the pancreas with multiple microcysts communicating with the pancreatic duct.  


The rare neoplastic cystic adenomas of the pancreas form two groups of tumors: macrocystic mucinous and microcystic serous adenomas. Both entities show specific radiologic and histologic features. Several recent case reports, however, suggest some diversity within the group of microcystic serous adenomas. We present the case of a young man operated because of epigastric pain for 12 months and a palpable microcystic tumor of the pancreatic head. Multiple cysts communicating with branches of the pancreatic duct in an alveolar-like pattern were demonstrated on endoscopic retrograde cholangiopancreatography. Histologic examination of the specimen confirmed the diagnosis of a serous adenoma of the pancreas. The tumor morphology in this case may suggest a ductal origin of microcystic serous adenomas. PMID:9830581

Samel, S; Horst, F; Becker, H; Brinck, U; Schwörer, H; Ramadori, G; Oestmann, J W



Serous Adenoma of the Pancreas With Multiple Microcysts Communicating With the Pancreatic Duct  

PubMed Central

The rare neoplastic cystic adenomas of the pancreas form two groups of tumors: macrocystic mucinous and microcystic serous adenomas. Both entities show specific radiologic and histologic features. Several recent case reports, however, suggest some diversity within the group of microcystic serous adenomas. We present the case of a young man operated because of epigastric pain for 12 months and a palpable microcystic tumor of the pancreatic head. Multiple cysts communicating with branches of the pancreatic duct in an alveolar-like pattern were demonstrated on endoscopic retrograde cholangiopancreatography. Histologic examination of the specimen confirmed the diagnosis of a serous adenoma of the pancreas. The tumor morphology in this case may suggest a ductal origin of microcystic serous adenomas.

Horst, F.; Becker, H.; Brinck, U.; Schworer, H.; Ramadori, G.; Oestmann, J.-W.



Pancreas as Delayed Site of Metastasis from Papillary Thyroid Carcinoma  

PubMed Central

Introduction. Follicular variant (FV) papillary thyroid carcinoma (PTC) has aggressive biologic behavior as compared to classic variant (CV) of PTC and frequently metastasizes to the lungs and bones. However, metastasis to the pancreas is extremely rare manifestation of FV-PTC. To date, only 9 cases of PTC have been reported in the literature. Pancreatic metastases from PTC usually remain asymptomatic or manifest as repeated abdominal aches. Associated obstructive jaundice is rare. Prognosis is variable with reported median survival from 16 to 46 months. Case Presentation. Herein we present a 67-year-old Saudi woman, who developed pancreatic metastases seven years after total thyroidectomy and neck dissection followed by radioactive iodine ablation (RAI) for FV-PTC. Metastasectomy was performed by pancreaticoduodenectomy followed by sorafenib as genetic testing revealed a BRAF V600E mutation. She survived 32 months after the pancreatic metastasis diagnosis. Conclusion. Pancreatic metastases are rare manifestation of FV-PTC and are usually sign of extensive disease and conventional diagnostic tools may remain to reach the diagnosis.

Tunio, Mutahir A.; AlAsiri, Mushabbab; Riaz, Khalid; AlShakweer, Wafa



Assessment of islet function following islet and pancreas transplantation  

Microsoft Academic Search

Pancreas and islet transplant recipients are monitored using various metabolic and imaging methods. The inaccessibility of\\u000a the transplanted whole pancreas and of the isolated islets poses specific problems (eg, all assessment techniques are indirect).\\u000a Although successful pancreas transplantation typically restores normal glucose homeostasis, islet transplantation into the\\u000a liver does not completely normalize islet hormone secretion and glucose metabolism. Development of

Emily C. Dy; David M. Harlan; Kristina I. Rother



Pancreas divisum. A cause of chronic relapsing pancreatitis.  


A 36-year-old man, followed for 14 years with recurrent abdominal pain, developed chronic calcific pancreatitis and was found to have pancreas divisum on endoscopic retrograde pancreatography. An intraoperative biopsy showed normal acinar tissue in the head of the pancreas, while the body and tail were replaced by fibrous tissue. His pain resolved following surgical drainage of the dorsal pancreatic duct. Evaluation of the clinical course of this patient and critical review of other such cases in the literature support the role of compromised ductal drainage of the dorsal pancreas in the pathogenesis of chronic pancreatitis in pancreas divisum. PMID:3996162

Marshall, J B; Eckhauser, M L



The molecular mechanisms, diagnosis and management of congenital hyperinsulinism  

PubMed Central

Congenital hyperinsulinism (CHI) is the result of unregulated insulin secretion from the pancreatic ?-cells leading to severe hypoglycaemia. In these patients it is important to make an accurate diagnosis and initiate the appropriate management so as to avoid hypoglycemic episodes and prevent the potentially associated complications like epilepsy, neurological impairment and cerebral palsy. At a genetic level abnormalities in eight different genes (ABCC8, KCNJ11, GLUD1, GCK, HADH, SLC16A1, HNF4A and UCP2) have been reported with CHI. Loss of function mutations in ABCC8/KCNJ11 lead to the most severe forms of CHI which are usually medically unresponsive. At a histological level there are two major subgroups, diffuse and focal, each with a different genetic etiology. The focal form is sporadic in inheritance and is localized to a small region of the pancreas whereas the diffuse form is inherited in an autosomal recessive (or dominant) manner. Imaging using a specialized positron emission tomography scan with the isotope fluroine-18 L-3, 4-dihydroxyphenyalanine (18F-DOPA-PET-CT) is used to accurately locate the focal lesion pre-operatively and if removed can cure the patient from hypoglycemia. Understanding the molecular mechanisms, the histological basis, improvements in imaging modalities and surgical techniques have all improved the management of patients with CHI.

Senniappan, Senthil; Arya, Ved Bhushan; Hussain, Khalid



The molecular mechanisms, diagnosis and management of congenital hyperinsulinism.  


Congenital hyperinsulinism (CHI) is the result of unregulated insulin secretion from the pancreatic ?-cells leading to severe hypoglycaemia. In these patients it is important to make an accurate diagnosis and initiate the appropriate management so as to avoid hypoglycemic episodes and prevent the potentially associated complications like epilepsy, neurological impairment and cerebral palsy. At a genetic level abnormalities in eight different genes (ABCC8, KCNJ11, GLUD1, GCK, HADH, SLC16A1, HNF4A and UCP2) have been reported with CHI. Loss of function mutations in ABCC8/KCNJ11 lead to the most severe forms of CHI which are usually medically unresponsive. At a histological level there are two major subgroups, diffuse and focal, each with a different genetic etiology. The focal form is sporadic in inheritance and is localized to a small region of the pancreas whereas the diffuse form is inherited in an autosomal recessive (or dominant) manner. Imaging using a specialized positron emission tomography scan with the isotope fluroine-18 L-3, 4-dihydroxyphenyalanine (18F-DOPA-PET-CT) is used to accurately locate the focal lesion pre-operatively and if removed can cure the patient from hypoglycemia. Understanding the molecular mechanisms, the histological basis, improvements in imaging modalities and surgical techniques have all improved the management of patients with CHI. PMID:23776849

Senniappan, Senthil; Arya, Ved Bhushan; Hussain, Khalid



Current Perspectives on Laparoscopic Robot-Assisted Pancreas and Pancreas-Kidney Transplantation  

PubMed Central

Pancreas transplant recipients continue to suffer high surgical morbidity. Current robotic technology provides a unique opportunity to test whether laparoscopy can improve the post-operative course of pancreas transplantation (PT). Current knowledge on robotic pancreas and renal transplantation was reviewed to determine feasibility and safety of robotic PT. Information available from literature was included in this review, together with personal experience including three PT, and two renal allotransplants. As of April 2011, the relevant literature provides two case reports on robotic renal transplantation. The author’s experience consists of one further renal allotransplantation, two solitary PT, and one simultaneous pancreas-kidney transplantation. Information obtained at international conferences include several other renal allotransplants, but no additional PT. Preliminary data show that PT is feasible laparoscopically under robotic assistance, but raises concerns regarding the effects of increased warm ischemia time on graft viability. Indeed, during construction of vascular anastomoses, graft temperature progressively increases, since maintenance of a stable graft temperature is difficult to achieve laparoscopically. There is no proof that progressive graft warming produces actual damage to transplanted organs, unless exceedingly long. However, this important question is likely to elicit a vibrant discussion in the transplant community.

Boggi, Ugo; Signori, Stefano; Vistoli, Fabio; Amorese, Gabriella; Consani, Giovanni; De Lio, Nelide; Perrone, Vittorio; Croce, Chiara; Marchetti, Piero; Cantarovich, Diego; Mosca, Franco



Photodynamic therapy for cancer of the pancreas  

PubMed Central

Background: Few pancreatic cancers are suitable for surgery and few respond to chemoradiation. Photodynamic therapy produces local necrosis of tissue with light after prior administration of a photosensitising agent, and in experimental studies can be tolerated by the pancreas and surrounding normal tissue. Aims: To undertake a phase I study of photodynamic therapy for cancer of the pancreas. Patients: Sixteen patients with inoperable adenocarcinomas (2.5–6 cm in diameter) localised to the region of the head of the pancreas were studied. All presented with obstructive jaundice which was relieved by biliary stenting prior to further treatment. Methods: Patients were photosensitised with 0.15 mg/kg meso-tetrahydroxyphenyl chlorin intravenously. Three days later, light was delivered to the cancer percutaneously using fibres positioned under computerised tomographic guidance. Three had subsequent chemotherapy. Results: All patients had substantial tumour necrosis on scans after treatment. Fourteen of 16 left hospital within 10 days. Eleven had a Karnofsky performance status of 100 prior to treatment. In 10 it returned to 100 at one month. Two patients with tumour involving the gastroduodenal artery had significant gastrointestinal bleeds (controlled without surgery). Three patients developed duodenal obstruction during follow up that may have been related to treatment. There was no treatment related mortality. The median survival time after photodynamic therapy was 9.5 months (range 4–30). Seven of 16 patients (44%) were alive one year after photodynamic therapy. Conclusions: Photodynamic therapy can produce necrosis in pancreatic cancers with an acceptable morbidity although care is required for tumours invading the duodenal wall or involving the gastroduodenal artery. Further studies are indicated to assess its influence on the course of the disease, alone or in combination with chemoradiation.

Bown, S G; Rogowska, A Z; Whitelaw, D E; Lees, W R; Lovat, L B; Ripley, P; Jones, L; Wyld, P; Gillams, A; Hatfield, A W R



[Islet function of the pancreas following irradiation].  


Function of islets of Langerhans of Wistar male rats was studied after irradiation of animals with different doses. The pancreas function was determined with regard to the incorporation of 65Zn into the gland tissues. Total-body irradiation (60Co) with the dose of 4.0 Gy somewhat increased the function of islets; at the dose of 8.0 Gy their function was transiently blocked, and at the dose of 15 Gy the function of islets of Langerhans was blocked completely. PMID:6359249

Sheianov, G G; Filatov, P P; Letova, A N


Why are levels of maternal microchimerism higher in type 1 diabetes pancreas?  

PubMed Central

Maternal microchimerism (MMc) results from transfer of maternal cells to the fetus in pregnancy. These cells have been shown to persist into adulthood in healthy individuals and an increased frequency of MMc has been associated with autoimmune disease. Female (presumed maternal) islet beta cells have recently been identified at higher levels in pancreas from a child with T1D compared to three controls. There was, however, no evidence that these cells were the targets of autoimmune attack. The aim of this study was to analyze well-characterized T1D pancreases encompassing a spectrum in age at diagnosis, and duration of diabetes, for the presence of maternal microchimerism compared to control pancreases. Pancreas samples were available from six males with T1D and four male controls. Fluorescent-labeled probes were used to detect X and Y chromosomes. At least 1,000 cells, usually 4,000–8,000 cells underwent confocal imaging for each pancreas. The frequency of MMc was higher in T1D pancreases (range 0.31–0.80%, mean 0.58%) than in controls (0.24–0.50%, mean 0.38%) (p = 0.05). Intriguingly, clusters of 2–3 MMc were occasionally found in the pancreases, particularly T1D pancreases, suggesting replication of these cells. Concomitant FISH and immunofluorescence staining for insulin or CD45 was performed to phenotype cells of maternal origin. Insulin positive and insulin negative MMc were identified indicating that MMc contribute to the exocrine and endocrine compartments. No CD45 positive MMc were observed. These data confirm the presence of maternal cells in human pancreas and support previous observations that levels of MMc are higher in T1D pancreas compared to controls. MMc do not appear to be immune effector cells and those that stain positive for insulin within intact islets in T1D tissue appear healthy with no evidence that they are the focus of immune attack. This study adds support to the hypothesis that maternal stem cells have the capacity to cross the placental barrier and differentiate into both endocrine and exocrine cells but more detailed characterization of MMc in the pancreas is required.

vanZyl, Berendine; Planas, Raquel; Ye, Yi; Foulis, Alan; de Krijger, Ronald R; Vives-Pi, Marta



Resection of the uncinate process of the pancreas due to a ganglioneuroma.  


A 33-year-old woman who presented with epigastric discomfort and diarrhea underwent an abdominal ultrasound (US). This investigation and subsequent contrast-enhanced computed tomography, magnetic resonance imaging and endoscopic US with fine needle aspiration (FNA) revealed a 40 mm well-circumscribed mass in the uncinate process of the pancreas. Findings were suggestive of a mucinous or solid-cystic pseudopapillary tumor of the pancreas, although other lesions such as a non-functioning neuroendocrine tumor could not be ruled out. FNA samples were negative for malignant cells, but of limited value due to poor cellularity. It was decided to surgically remove the tumor because malignancy could not be discounted. Multiple intraoperative biopsies were suggestive of mesenchymal tumor and consequently a conservative resection (uncinatectomy) was performed. The postoperative course was uneventful. The definitive diagnosis was ganglioneuroma. Immunocytochemistry showed positive staining with vimentin, S-100 protein, neurofilament and neuron-specific enolase. Ganglioneuroma is a rare benign tumor that can also present as a pancreatic tumor. Uncinatectomy is feasible, safe and a good surgical technique for the treatment of non-malignant tumors located in the uncinate process of the pancreas. PMID:19750580

Poves, Ignasi; Burdío, Fernando; Iglesias, Mar; Martínez-Serrano, María de los Angeles; Aguilar, Guadalupe; Grande, Luís



What is artificial endocrine pancreas? Mechanism and history  

Microsoft Academic Search

The artificial endocrine pancreas is a feedback control instrument that regulates insulin delivery on a minute-by-minute basis according to measured blood glucose levels. Only one type of bedside- type artificial endocrine pancreas is now available in Japan: STG-22 (Nikkiso Co. Ltd., Japan). In the insulin infusion algorithm, insulin is infused on the basis of its proportional and derivative actions, to

Kenro Nishida; Seiya Shimoda; Kenshi Ichinose; Eiichi Araki; Motoaki Shichiri



Automatic control issues in the development of an artificial pancreas  

Microsoft Academic Search

Concerns the development, for the treatment of diabetes mellitus, of prototype robust control methodologies for an artificial pancreas that provides quantitative bounds on the required performance of sensors\\/actuators to be used in an artificial pancreas system. Such a system must address the following four issues: (1) The subject dynamic systems (a patient's glucose\\/insulin kinematics) are inherently nonlinear and poorly modeled

Jennifer S. Naylor; A. Scottedward Hodel; B. Morton; D. Schumacher



Update Lecture: Benign Diseases of the Exocrine Pancreas  

Microsoft Academic Search

A brief overview on the physiology and regulation of digestive enzyme secretion by the exocrine pancreas is presented. Knowledge about the physiology of the exocrine pancreas should help for a better understanding of the pathophysiology of both acute and chronic pancreatitis. In the pathophysiology of acute pancreatitis, fusion of zymogen granules with lysosomes, which leads to intracellular activation of trypsinogen,

Joachim Mössner



Anesthesia for pancreas transplantation alone or simultaneous with kidney  

Microsoft Academic Search

Improvements in perioperative care, namely, organ preservation solutions, immunosuppression, and increased experience of surgical, anesthetic, and intensive care teams, have contributed to the success of pancreas transplantation. The objective of this study was to present data on anesthesia for pancreas transplantation alone (PTA) or simultaneous with kidney (SPKT), evaluating crystalloid, albumin and blood component infusions, graft ischemic times, and weights

H. Halpern; E. Miyoshi; L. M. Kataoka; R. A. Khouri Fo; S. B. P. Miranda; C. K. Marumo; O. Omati; T. Genzini; M. P. Miranda



Optimizing the program-specific reporting of pancreas transplant outcomes.  


The Scientific Registry of Transplant Recipients is charged with providing program-specific reports for organ transplant programs in the United States. Monitoring graft survival for pancreas transplant programs has been problematic as there are three different pancreas transplant procedures that may have different outcomes, and analyzing them separately reduces events and statistical power. We combined two consecutive 2.5-year cohorts of transplant recipients to develop Cox proportional hazards models predicting outcomes, and tested these models in the second 2.5-year cohort. We used separate models for 1- and 3-year graft and patient survival for each transplant type: simultaneous pancreas-kidney (SPK), pancreas after kidney (PAK) and pancreas transplant alone (PTA). We first built a predictive model for each pancreas transplant type, and then pooled the transplant types within centers to compare total observed events with total predicted events. Models for 1-year pancreas graft and patient survival yielded C statistics of 0.65 (95% confidence interval, 0.63-0.68) and 0.66 (0.61-0.72), respectively, comparable to C statistics for 1-year patient and graft survival for other organ transplants. Model calibration (Hosmer-Lemeshow method) was also acceptable. We conclude that pooling the results of SPK, PAK and PTA can produce potentially useful models for reporting program-specific pancreas transplant outcomes. PMID:23289524

Kasiske, B L; Gustafson, S; Salkowski, N; Stock, P G; Axelrod, D A; Kandaswamy, R; Sleeman, E F; Wainright, J; Israni, A K; Snyder, J J



Trasplante de pancreas en Espana, mas vale tarde quey  

Microsoft Academic Search

Pancreas transplant is the only method that enables diabetic patients to have a normal carbohydrate metabolism in the long-term. Its application in selected patients has shown to have patient survival rates, at one year of the graft, similar to those transplanted with other solid organs, such as kidney, heart, liver, etc. The indications are currently well established, with combined pancreas-kidney



Glycosaminoglycans from Ateroid ® and bovine duodenal mucosa and pancreas  

Microsoft Academic Search

Summary Glycosaminoglycans (GG) were isolated from commercial Ateroid® and compared with those from bovine duodenal mucosa and pancreas. The major GG in Ateroid® is heparin. Heparan sulfate (HS) and dermatan sulfate were also found. HS, chondroitin sulfates, and heparin were isolated from duodenal mucosa after papain digestion, but a residue, non-digestible, was mostly heparin. Pancreas contains very little GG, and

Parakkat Seethanathan; Edward Dalferes; B. S. Bhandaru Radhakrishnamurthy; Ronald Victor; Gerald S. Berenson



Comparison of Celsior and UW Solution in Experimental Pancreas Preservation  

Microsoft Academic Search

Background. The University of Wisconsin solution (UW) is the gold standard for pancreas preservation. Celsior (CEL) was formulated specifically for heart preservation. Recently, experimental and clinical experience has been reported on the application of CEL to abdominal organs. In this animal study, pancreas preservation with CEL was compared with that in UW solution.Patients and Materials. Heterotopic, allogeneic pancreaticoduodenal transplantation was

Dirk Uhlmann; Barbara Armann; Stefan Ludwig; Evelyn Escher; Uta-Carolin Pietsch; Andrea Tannapfel; Daniel Teupser; Johann Hauss; Helmut Witzigmann



Necrotizing fasciitis: unreliable MRI findings in the preoperative diagnosis  

Microsoft Academic Search

The authors present two cases of necrotizing fasciitis (NF), one case of dermatomyositis and one case of posttraumatic muscle injury, which have similar magnetic resonance imaging findings in terms of skin, subcutaneous fat, superficial and deep fasciae and muscle involvement. These cases highlight the need for cautious interpretation of magnetic resonance imaging (MRI) findings, for they are nonspecific and the

Arzu Arslan; Claude Pierre-Jerome; Arne Borthne



Total pancreatectomy for recurrent intraductal papillary mucinous carcinoma in remnant pancreas of pancreaticoduodenectomy for intraductal papillary mucinous adenocarcinoma.  


A 62-year-old man underwent pancreaticoduodenectomy (PD) for intraductal papillary mucinous carcinoma (IPMC) in 2006. No signs of adenocarcinoma at the resection margin were found by intraoperative pathological examination of frozen sections. The postoperative pathological diagnosis was invasive carcinoma derived from IPMC and moderately differentiated tubular adenocarcinoma. A blood analysis in 2011 showed serum (CA19-9) to be increased since the initial resection. Imaging test showed a recurrent tumour at the site of the pancreaticogastrostomy (PG) in the remnant pancreas. We conducted total remnant pancreatectomy for recurrent IPMC and partial gastrectomy. Because both lesions had a histopathological resemblance, the pathological diagnosis was recurrent invasive IPMC. Based on this experience, it is important to facilitate early detection by annual check-up. And also, we recommend PG as a reconstructive intervention in patients at high risk of IPMC recurrence in the remnant pancreas following PD as it is grossly visible on upper gastrointestinal endoscopy. PMID:23709152

Ohkura, Yu; Sasaki, Kazunari; Matsuda, Masamichi; Hashimoto, Masaji



Recovery of Endocrine Function After Islet and Pancreas Transplantation  

PubMed Central

Long-standing type 1 diabetes (T1D) is associated with an absolute loss of endogenous insulin secretion (circulating C-peptide is undetectable) and a related defect in glucose counterregulation that is often complicated by hypoglycemia unawareness, markedly increasing the risk for severe hypoglycemia. Both the transplantation of isolated islets and a whole pancreas can restore ?-cell secretory capacity, improve glucose counterregulation, and return hypoglycemia awareness, thus alleviating severe hypoglycemia. The transplantation of islets may require more than one donor pancreas, and the recovery of endocrine function for now appears more durable with a whole pancreas; however, islet transplantation outcomes are steadily improving. Because not all patients with T1D experiencing severe hypoglycemia are candidates to receive a whole pancreas, and since not all pancreata are technically suitable for whole organ transplantation, islet and pancreas transplantation are evolving as complementary approaches for the recovery of endocrine function in patients with the most problematic T1D.

Rickels, Michael R.



Variability of Preoperative Breast MRI Utilization among Older Women with Newly Diagnosed Early-stage Breast Cancer.  


While magnetic resonance imaging (MRI) is frequently used following breast cancer diagnosis, routine use of breast MRI for preoperative evaluation remains contentious. We identified factors associated with preoperative breast MRI utilization and investigated the variation among physicians. We used the surveillance, epidemiology, and end Results (SEER)-Medicare linked database to analyze the preoperative breast MRI utilization among patients with stage 0, I, or II breast cancer diagnosed between 2002 and 2007. Multilevel logistic regression models were used to identify patient- and physician-level predictors of preoperative MRI utilization. Of 56,743 women with early-stage breast cancer who were treated with surgery and evaluated by a preoperative mammogram and/or ultrasound during the study period, 8.7% (n = 4,913) received preoperative breast MRI. While patient and tumor characteristics did predict preoperative breast MRI utilization, they explained only 15.4% of the variation in utilization rates. Differences in preoperative breast MRI utilization across physicians were large, after controlling patient-level factors and physicians' volumes. Accounting for clustering of patients within individual physicians (n = 3,144), the multilevel logistic regression models explained 36.4% of variation. The median odds ratio of 3.2, corresponding with the median value of the relative odds of receiving preoperative breast MRI between two randomly chosen physicians, indicated a large individual physician effect. Our study found that preoperative breast MRI has been adopted rapidly and variably. Although patient characteristics were associated with preoperative breast MRI utilization, physician practice was a major determinant of whether women received preoperative breast MRI. Future studies should evaluate whether routine use of preoperative breast MRI in newly diagnosed early-stage breast cancer improves clinical outcomes. PMID:24011145

Wang, Shi-Yi; Virnig, Beth A; Tuttle, Todd M; Jacobs, David R; Kuntz, Karen M; Kane, Robert L



[Metastasis of uterine leiomyosarcoma to the pancreas--usefulness and limitations of EUS-FNA].  


A woman in her 60's presented with a tumor of the pancreatic body. Pan-hysterectomy had been performed under a diagnosis of uterine leiomyoma 11 years previously. A sample obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) revealed the histopathological proliferation of spindle-shaped bundles of atypical cells, and immunohistochemical staining demonstrated that these cells were positive for KIT. Therefore, distal pancreatectomy was performed under a diagnosis of pancreatic gastrointestinal stromal tumor (GIST). Immunohistochemical staining of surgical specimens demonstrated that the tumor cells were positive for desmin and negative for KIT and CD34. The low-grade leiomyosarcoma in pathological specimens of the uterine myoma obtained 11 years previously histologically resembled the pathological findings of the pancreatic specimens except for atypical nuclei and mitotic cells. Therefore, the final diagnosis was extremely rare metastatic leiomyosarcoma of the pancreas. Herein, we report metastasis of uterine leiomyosarcoma to the pancreas and discuss the usefulness and limitations of EUS-FNA. PMID:21646767

Ogura, Takeshi; Yamao, Kenji; Hijioka, Susumu; Hara, Kazuo; Sawaki, Akira; Mizuno, Nobumasa; Niwa, Yasumasa; Tajika, Masahiro; Kawai, Hiroki; Kondo, Shinya; Saeki, Akira; Akabane, Asana; Haba, Shin; Tomono, Teruko; Shimizu, Satoshi; Shimizu, Yasuhiro; Hosoda, Kazuki; Yatabe, Yasushi



Use of Ultrasound and Cystoscopically Guided Pancreatic Allograft Biopsies and Transabdominal Renal Allograft Biopsies: Safety and Efficacy in Kidney-Pancreas Transplant Recipients  

Microsoft Academic Search

The use of allograft biopsies to guide treatment after solid organ transplantation is a valuable tool in the detection and treatment of rejection. Prior development and use of the cystoscopically guided pancreatic allograft biopsy have allowed for more accurate and timely diagnosis of pancreatic allograft dysfunction, possibly contributing to our 1-year pancreas graft, renal allograft and patient survival rates of

Christian S. Kuhr; Connie L. Davis; Darlene Barr; John P. McVicar; James D. Perkins; Carlos E. Bachi; Charles E. Alpers; Christopher L. Marsh



Paucity of intrahepatic bile ducts, solitary kidney and atrophic pancreas with diabetes mellitus: Atypical Alagille syndrome?  

Microsoft Academic Search

Abstract  A child with the tentative diagnosis of Alagille syndrome is reported. Additional renal abnormalities are unilateral kidney\\u000a agenesis and a kidney with subcortical cysts with decreased function. At the age of 5 years, insulin-dependent diabetes mellitus\\u000a developed, with the pancreas being atrophic and negative pancreatic islet cell antibodies.\\u000a \\u000a \\u000a \\u000a Conclusion  This observation extends the picture of Alagille syndrome and suggests an overlap

K. Devriendt; L. Dooms; W. Proesmans; F. de Zegher; E. Eggermont; V. Desmet



Pleomorphic carcinoma of the pancreas: computed-tomographic, sonographic, and pathologic findings  

SciTech Connect

The authors present a series of eight cases of pleomorphic carcinoma of the pancreas, an uncommon lesion that contains bizarre giant cells and resembles sarcoma histologically. To our knowledge, this entity has not been described in the radiological literature. Clinical symptoms are similar to those of the usual pancreatic ductal cell carcinoma, but at presentation the primary tumor mass is usually large, and widespread metastatic disease is present. The most striking finding is massive lymphadenopathy, which may mimic lymphoma. A combination of clinical history, imaging findings, and results of percutaneous biopsy should lead to the proper diagnosis and may help to differentiate this entity from others that may affect lymph nodes.

Wolfman, N.T.; Karstaedt, N.; Kawamoto, E.H.



Chronic pancreatitis presenting with pseudocyst of pancreas and pseudo-aneurysm of hepatic artery.  


A 2-y-old girl presented with recurrent abdominal pain and hematemesis. The patient was diagnosed to have chronic calcific pancreatitis complicated by pseudocyst of the head of pancreas and pseudo-aneurysm of the common hepatic artery. Diagnosis was made using abdominal ultrasonography and CT angiography. The rarity of the presentation of pseudocyst with pseudo-aneurysm formation in a pediatric patient is noted. The pseudo-aneurysm was treated by embolization of the artery and the pain being refractory to analgesics was managed by celiac plexus blockade. PMID:22438095

Janarthanan, Krishnaveni; Balalakshmoji, Devanand; Sanathkumar, Harshavardhan T; Suthakaran, Prasanna Karthik



Noninvasive preoperative localization of an intracardiac bullet.  


A 40-year-old patient with intracardiac gunshot injury is reported. The bullet was localized preoperatively within the pericardium at the junction of the right atrium and the inferior caval vein and was removed successfully at surgery. The role of various imaging techniques in the preoperative localization of intracardiac missiles is discussed. PMID:1761338

Karak, P K; Sharma, S; Rajani, M



Preoperative Imaging Staging of Rectal Cancer  

Microsoft Academic Search

Carcinomas of the rectum are associated with a significant local and distant recurrence rate. Not all patients are appropriate candidates for preoperative radiation therapy. Preoperative identification of those most likely to benefit from neoadjuvant therapy is important. There is no general consensus on the role of endorectal ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) in staging patients with

A. H. Karantanas; S. Yarmenitis; N. Papanikolaou; N. Gourtsoyiannis



OPTN/SRTR 2011 Annual Data Report: pancreas.  


Numbers of pancreas transplants have been decreasing over the past decade, but outcomes continue to improve for all types: simultaneous pancreas-kidney transplant, pancreas after kidney transplant (PAK), and pancreas transplant alone (PTA). The most notable decrease occurred for PAK transplants, possibly due in part to decreases in numbers of living donor kidney transplants. The number of new candidates on the pancreas transplant waiting list has decreased steadily since 2000; only 1005 active candidates were added in 2011. Transplant rates for all pancreas transplant types reached a low in 2011 of 34.9 transplants per 100 wait-list years. Deceased donation rates have also been decreasing since 2005, but use of donation after circulatory death has been gradually increasing. The discard rate in 2011 was 27.7%, and higher for pancreata recovered from older donors. Improved outcomes during the early posttransplant period largely reflect improved donor and recipient selection and improved technical strategies. Inconsistent definitions of graft failure across reporting centers creates an ongoing challenge in the interpretation of outcome data for pancreas transplants. Rates of posttransplant re-hospitalization are high, most occurring in the first 6 months. Rejection rates are highest for PTA recipients, who also experience higher incidence of posttransplant lymphoproliferative disorder. PMID:23237696

Kandaswamy, R; Stock, P G; Skeans, M A; Gustafson, S K; Sleeman, E F; Wainright, J L; Carrico, R J; Ghimire, V; Snyder, J J; Israni, A K; Kasiske, B L



Progress in development of an artificial pancreas.  


This issue of Journal of Diabetes Science and Technology contains a collection of 12 original articles describing the latest advances in the development of algorithms for controlling insulin delivery in an artificial pancreas. Algorithms presented in this issue are affected by numerous quantifiable factors, including insulin pharmaco-kinetics, timing of meal carbohydrate appearance, meal size, amount of exercise, presence of stress, day-to-day variations in insulin sensitivity, insulin time-activity profiles, accuracy of glucose monitor calibration, metabolic profiles of both adults and neonates, and risks of hypoglycemia/hyperglycemia. These articles present theoretical advances in insulin delivery algorithms from modeled in silico patients, as well as clinical data from actual patients who have used closed loop systems. The novel approaches described in these articles are expected to bring us much closer to realization of a commercially available closed loop system for controlling glucose levels in patients with diabetes. PMID:20144412

Klonoff, David C; Cobelli, Claudio; Kovatchev, Boris; Zisser, Howard C




PubMed Central

The regulation of protein synthesis in the pigeon has been studied by comparing the capability of cell-free amino acid incorporating systems of membrane-bound and membrane-free polysomes prepared from fasted and fed birds. New methods were developed for isolating polysomes since techniques used for other tissues did not provide quantitative recovery of polysomal RNA. The sucrose gradient profile of polysomes from pigeon pancreas showed a predominance of trisome species. Although initiation factors are present on polysomes, it was found that polysomes in cell-free systems would not initiate protein synthesis without exogenous initiation factors. This suggested the presence of an inhibitor or regulator of protein synthesis. These studies show that fasting resulted in: (a) decreased amounts of polysomes; (b) disaggregation of polysomes to monosomes; (c) decreased capability of polysomes to synthesize nascent peptides and to initiate additional synthesis, apparently not related to concentration of initiation factors.

Black, Owen; Webster, Paul D.



The Association between Nonalcoholic Fatty Pancreas Disease and Diabetes  

PubMed Central

Background Fatty infiltration of the pancreas has been shown to interfere with insulin secretion. Both insulin sensitivity and secretion are important in the pathogenesis of diabetes and prediabetes. However, the relationship between diabetes, prediabetes, and fatty pancreas remains unknown. We aim to investigate the relationships that fatty pancreas and nonalcoholic fatty liver disease (NAFLD) have with prediabetes and diabetes in a Chinese population. Patients and Methods This was a cross-sectional study. A total of 7,464 subjects were recruited. NAFLD and fatty pancreas were assessed by sonography. Clinico-metabolic parameters were compared among subjects with normoglycemia, prediabetes, and diabetes. Multinomial logistic regression was used to evaluate the relationship between fatty pancreas and NAFLD and diabetes or prediabetes with adjustment for cardiometabolic risk factors. Results With an increase in glycemia, a significantly greater proportion of subjects had NAFLD and fatty pancreas (test for trend p<0.05). Similar trends were also found for hypertension, general and central obesity, low-HDL cholesterol, and hypertriglyceridemia. In the logistic regression analysis, age, hypertension, male gender, hypertriglyceridemia, and central obesity were significantly associated with prediabetes and diabetes. Furthermore, the ORs of prediabetes and diabetes for NAFLD were 1.798 (95% CI 1.544–2.094) and 2.578 (95% CI 2.024–3.284), respectively. In addition, fatty pancreas was independently related to diabetes (OR, 1.379; 95% CI, 1.047–1.816) and prediabetes (OR, 1.222; 95% CI, 1.002–1.491) in male subjects. Conclusions Both NAFLD and fatty pancreas were associated with diabetes independent of age, gender, adiposity, and other cardiometabolic risk factors. Fatty pancreas was also related to prediabetes in males.

Yang, Yi-Ching; Chen, Ming-Fong; Chang, Chih-Jen



MD-Logic Artificial Pancreas System  

PubMed Central

OBJECTIVE Current state-of-the-art artificial pancreas systems are either based on traditional linear control theory or rely on mathematical models of glucose-insulin dynamics. Blood glucose control using these methods is limited due to the complexity of the biological system. The aim of this study was to describe the principles and clinical performance of the novel MD-Logic Artificial Pancreas (MDLAP) System. RESEARCH DESIGN AND METHODS The MDLAP applies fuzzy logic theory to imitate lines of reasoning of diabetes caregivers. It uses a combination of control-to-range and control-to-target strategies to automatically regulate individual glucose levels. Feasibility clinical studies were conducted in seven adults with type 1 diabetes (aged 19–30 years, mean diabetes duration 10 ± 4 years, mean A1C 6.6 ± 0.7%). All underwent 14 full, closed-loop control sessions of 8 h (fasting and meal challenge conditions) and 24 h. RESULTS The mean peak postprandial (overall sessions) glucose level was 224 ± 22 mg/dl. Postprandial glucose levels returned to <180 mg/dl within 2.6 ± 0.6 h and remained stable in the normal range for at least 1 h. During 24-h closed-loop control, 73% of the sensor values ranged between 70 and 180 mg/dl, 27% were >180 mg/dl, and none were <70 mg/dl. There were no events of symptomatic hypoglycemia during any of the trials. CONCLUSIONS The MDLAP system is a promising tool for individualized glucose control in patients with type 1 diabetes. It is designed to minimize high glucose peaks while preventing hypoglycemia. Further studies are planned in the broad population under daily-life conditions.

Atlas, Eran; Nimri, Revital; Miller, Shahar; Grunberg, Eli A.; Phillip, Moshe



Ectopic pancreas bleeding in the jejunum revealed by capsule endoscopy.  


Ectopic pancreas is defined as pancreatic tissue found outside the usual anatomic location. It is often found incidentally at different sites in the gastrointestinal (GI) tract. The incidence of ectopic pancreatic tissue in autopsy series is 1% to 2%, with 70% of the ectopic lesions found in the stomach, duodenum and jejunum. Although it is usually a silent anomaly, an ectopic pancreas may become clinically evident when complicated by inflammation, bleeding, obstruction or malignant transformation. We report a case of ectopic pancreas located in the jejunum and presenting as an obscure GI bleeding, which was diagnosed by capsule endoscopy. PMID:22977800

Lee, Mi-Jeong; Chang, Jae Hyuck; Maeng, Il Ho; Park, Jin Young; Im, Yun Sun; Kim, Tae Ho; Han, Sok-Won; Lee, Do Sang



Simultaneous pancreas kidney transplantation in the HIV-positive patient.  


HIV is no longer an absolute contraindication to solid organ transplantation. However, few reports have been published with regards to pancreas or simultaneous pancreas kidney transplantation in the HIV-positive recipient. We report, to our knowledge, the first simultaneous pancreas kidney transplantation (SPK) performed in an HIV-positive patient in the United Kingdom. We reflect on the article recently published by Miro et al in Transplantation Proceedings and highlight strategies used by our department to prevent drug interactions in these complex patients. PMID:22172869

Akhtar, M Z; Patel, N; Devaney, A; Sinha, S; Shankar, S; Vaidya, A; Friend, P J



[The role of screening for carcinoma of the pancreas].  


We discussed the possibility of the screening programs for the early detection in carcinoma of the pancreas. Several trials of screening have been conducted for the outpatients with diabetes mellitus, jaundice or upper abdominal pain by means of serum erastase-1, amylase and CA19-9 levels and the ultrasonography. The trials could detect 37 patients of 4250 (1.3%), 47 of 423,905 (0.011%) and 89 of 3585 (2.4%) with carcinoma of the pancreas. Despite effective screening program is not available, the screening carries the potential for improvement of the resectability and the mortality in the patients with carcinoma of the pancreas. PMID:8965380

Amikura, K; Kobari, M; Matsuno, S



Preoperative evaluation of patients with suspected ovarian cancer.  


A diagnosis of ovarian cancer should be suspected when a postmenopausal woman presents with a pelvic mass. The presence of ascites, which can be detected clinically or by ultrasound, increases the accuracy of the diagnosis. CA 125, although nonspecific in the premenopausal patient population, is very sensitive in postmenopausal patients when used in combination with clinical impression and an abnormal ultrasound. CAT scan is more sensitive than ultrasound, but may not alter surgical management. Preoperative preparation of the bowels should consist of a polyethylene glycol lavage in combination with oral and systemic antibiotics and is indicated for any woman with a mass adherent to the cul de sac. Preoperative total parenteral nutrition should be reserved for severely malnourished patients as determined by objective criteria. Early surgical intervention is a key component for the treatment of these patients, and extensive diagnostic testing should be used temperately in order to ensure expeditious treatment of these patients. In the future, the most significant impact on the survival of patients with ovarian cancer will be in the development of improved methods of screening and early detection. It is hopeful that clinical trials currently being conducted will bring us closer to that goal. PMID:7835814

Brooks, S E



Preoperative assessment and premedication in paediatrics.  


Preoperative assessment and premedication represent important preparatory steps to ensuring a smooth and effective induction of anaesthesia. A thorough review of the child's medical history, previous anaesthetics, medications, allergies and family history is essential to design the optimal anaesthetic for the child and his/her surgery. Risks must be addressed with the parents as appropriate based on the local standards. Preoperative anxiolysis may assume several strategies, with premedication with a pharmacologic agent very common and most successful. This review focuses on the preoperative assessment and premedication for children undergoing elective surgery. PMID:24022595

Lerman, Jerrold



Extramedullary Plasmacytoma of the Pancreas: A Rare Entity  

PubMed Central

Extramedullary plasmacytomas are plasma cell neoplasms in organs other than the bone marrow. Most are found in the upper respiratory tract. Involvement of the pancreas is rare. We report a case of pancreatic plasmacytoma in association with advanced multiple myeloma.

Smith, Alexis; Hal, Hassan; Frauenhoffer, Elizabeth



Endourologic Management of Duodenal Calculi in Pancreas-Kidney Transplantation  

Microsoft Academic Search

Duodenal stones formed during pancreas-kidney transplantation are usually associated with nonabsorbable sutures or staples. We report on the delayed formation of a struvite duodenal stone not attributed to foreign material, managed successfully with intracorporeal electrohydraulic lithotripsy.

Koon H. Rha; Ioannis M. Varkarakis; Albert M. Ong; Peter A. Pinto; Ernesto P. Molmenti; Thomas W. Jarrett



Transcriptional Program of the Endocrine Pancreas in Mice and Humans  

Microsoft Academic Search

The Endocrine Pancreas Consortium was formed in late 1999 to derive and sequence cDNA libraries enriched for rare transcripts expressed in the mammalian endo- crine pancreas. Over the past 3 years, the Consortium has generated 20 cDNA libraries from mouse and human pancreatic tissues and deposited >150,000 sequences into the public expressed sequence tag databases. A special effort was made

Klaus H. Kaestner; Catherine S. Lee; L. Marie Scearce; John E. Brestelli; Athanasios Arsenlis; Kristen A. Lantz; Jonathan Crabtree; Angel Pizarro; Joan Mazzarelli; Deborah Pinney; Steve Fischer; Elisabetta Manduchi; Christian J. Stoeckert; Gerard Gradwohl; Sandra W. Clifton; Juliana R. Brown; Hiroshi Inoue; Corentin Cras-Meneur; M. Alan Permutt



Intraductal mucinous tumors occurring simultaneously in the liver and pancreas  

Microsoft Academic Search

  A case of simultaneous intraductal mucinous tumors of the liver and pancreas in a 67-year-old man is described. Abdominal\\u000a ultrasonography and computed tomography (CT) revealed the presence of cystic lesions with intraluminal septae both in the\\u000a caudate lobe of the liver and in the uncinate process of the pancreas; these cystic lesions communicated with the hepatic\\u000a duct and pancreatic duct,

Makoto Ishida; Kenichiro Seki; Kei Honda; Toshihisa Kimura; Kanji Katayama; Kazuo Hirose; Manabu Dojo; Takeshi Azuma; Yoshiaki Imamura; Robert R Hutchins; Akio Yamaguchi



Laparoscopic resection of uncinate process of the pancreas  

Microsoft Academic Search

Background  Solid pseudopapillary neoplasm of the pancreas is an uncommon but distinctive pancreatic neoplasm with low metastatic potential\\u000a [1]. Therefore, whenever feasible, an organ-preserving operation should be performed. As previously reported, women with solid\\u000a pseudopapillary neoplasm of the pancreas may be best treated by more conservative procedures [2]. Recently, laparoscopic pancreatic resections became more common and are being performed in highly

M. A. Machado; F. F. Makdissi; R. C. Surjan; M. C. Machado



Current State of Combined Kidney and Pancreas Transplantation  

Microsoft Academic Search

Glycemic control via the use of exogenous insulin injections in diabetic patients is incomplete, resulting in multiple long-term complications, such as retinopathy, neuropathy, vasculopathy, and nephropathy. The goal of whole-pancreas and kidney transplantation is to achieve long-term insulin independence and correct uremia. The proposed benefits of pancreas and kidney transplantation are improved quality of life, prevention of recurrent diabetic nephropathy,

Anja Richter; Susan Lerner; Bernd Schröppel



Glycemic control during pancreas transplantation: continous infusion versus bolus  

Microsoft Academic Search

Pancreas transplantation is a method to restore endogenous insulin secretion in insulin-dependent diabetic patients. Because glycemia >150 mg\\/dL may harm pancreatic graft beta cells, early glucose control using insulin administration is recommended during transplantation. The aim of this study was to evaluate the benefits of strict glycemic control during pancreas transplantation by comparing two types of insulin and glucose administration:

H Halpern; E Miyoshi; L. M Kataoka; R. A Khouri Fo; S. B. P Miranda; C. K Marumo; P. P. P Caravatto; T Genzini; M. P Miranda



Endovascular Management of Acute Enteric Bleeding from Pancreas Transplant  

SciTech Connect

Arterioenteric fistula is a rare but serious complication of enteric drained pancreas transplant, which may lead to massive gastrointestinal bleeding. We present 3 patients with failed enteric drained pancreas transplants and massive gastrointestinal bleeding secondary to arterioenteric fistula. One patient was treated by embolization and the 2 others by stent graft placement. Bleeding was successfully controlled in all cases, at follow up of 5 days, 8 months, and 12 months, respectively. One patient died 24 days after embolization, of unknown causes.

Semiz-Oysu, Aslihan; Cwikiel, Wojciech [University of Michigan Hospital, Vascular and Interventional Radiology (United States)], E-mail:



Reversal of diabetic nephropathy: lessons from pancreas transplantation.  


Pancreas transplantation is the only therapeutic intervention able to achieve and maintain long-term euglycemia, without risks of hypoglycemia; this makes it possible to test the impact of normoglycemia in the different stages of diabetic nephropathy. Pancreas and islet transplantation in animal models prevent the development of diabetic nephropathy lesions and ameliorate or reverse established glomerular lesions. In type 1 diabetic patients, pancreas transplantation, performed simultaneously or after kidney transplantation, has been shown to prevent the recurrence of diabetic glomerulopathy lesions. The established lesions of diabetic nephropathy have been considered to be irreversible; pancreas transplantation alone allows us to test whether this is true. To this end, we studied renal structure before and 5 and 10 years after pancreas transplantation in 8 nonuremic type 1 diabetic patients. These patients, with a long diabetes duration, had established diabetic nephropathy lesions at the time of transplantation. We report that diabetic glomerulopathy lesions, unchanged at 5 years post pancreas transplantation, significantly improved after 10 years, with complete normalization of glomerular structure in most patients. Thus this study demonstrates that the lesions of diabetic nephropathy are reversed by long-term normoglycemia and that the human kidney has the potential in humans to obtain a substantial architectural remodeling of the glomerular and tubular structures toward healing. PMID:22241641

Fioretto, Paola; Mauer, Michael


A fresh look at preoperative body washing.  


National guidelines do not support preoperative body washing to reduce surgical site infections, instead recommending bathing or showering with soap. Yet preoperative body washing continues to be widely used in many hospitals across Europe. This paper suggests that existing trials of preoperative body washing, upon which guidelines are based, are dated and proposes a new investigation of preoperative body washing using modern definitions of surgical site infection with standardised patient follow up, modern surgical techniques and well designed trials. This paper provides a critique of existing guidelines and describes a randomised trial with 60 participants to compare the effect of soap and two antiseptic washing products on colony forming units (CFUs) for up to six hours. Chlorhexidine gluconate and octenidine were significantly more effective than soap in reducing CFUs in the underarm, and chlorhexidine was significantly more effective than soap in reducing CFUs in the groin. PMID:22448182

Tanner, Judith; Gould, Dinah; Jenkins, Philip; Hilliam, Rachel; Mistry, Neetesh; Walsh, Susannah



A fresh look at preoperative body washing  

PubMed Central

National guidelines do not support preoperative body washing to reduce surgical site infections, instead recommending bathing or showering with soap. Yet preoperative body washing continues to be widely used in many hospitals across Europe. This paper suggests that existing trials of preoperative body washing, upon which guidelines are based, are dated and proposes a new investigation of preoperative body washing using modern definitions of surgical site infection with standardised patient follow up, modern surgical techniques and well designed trials. This paper provides a critique of existing guidelines and describes a randomised trial with 60 participants to compare the effect of soap and two antiseptic washing products on colony forming units (CFUs) for up to six hours. Chlorhexidine gluconate and octenidine were significantly more effective than soap in reducing CFUs in the underarm, and chlorhexidine was significantly more effective than soap in reducing CFUs in the groin.

Tanner, Judith; Gould, Dinah; Jenkins, Philip; Hilliam, Rachel; Mistry, Neetesh; Walsh, Susannah



Preoperative radiotherapy in operable rectal cancer  

Microsoft Academic Search

The effect of preoperative radiotherapy (31.5 Gy in 3.5 weeks) in operable rectal cancer was examined with respect to resectability and prognosis after two surgical procedures, abdominoperineal resection, or low anterior resection. Preoperative radiation did not influence the surgeon's selection of low anterior resection, which was similar (40 percent) in each group. Radiation improved five-year survival probability and decreased the

Arild Horn; Jan F. Halvorsen; Olav Dahl



Preoperative therapy for soft tissue sarcoma.  


Soft tissue sarcomas appear to be an ideal tumor type for delivering preoperative therapy. The rationale for preoperative therapy is that it is delivered to undisturbed tissue planes with well-oxygenated tissue. This is of great benefit for radiation therapy, because with new computed tomography scan treatment planning it is possible to completely delineate the tumor without surgical clips or postoperative hematoma (or both) obscuring the tumor margin. PMID:7490243

Eilber, F; Eckardt, J; Rosen, G; Forscher, C; Selch, M; Fu, Y S



Analyses of pancreas development by generation of gfp transgenic zebrafish using an exocrine pancreas-specific elastaseA gene promoter  

Microsoft Academic Search

In contrast to what we know on development of endocrine pancreas, the formation of exocrine pancreas remains poorly understood. To create an animal model that allows observation of exocrine cell differentiation, proliferation, and morphogenesis in living animals, we used the zebrafish elastaseA (elaA) regulatory sequence to develop transgenic zebrafish that display highly specific exocrine pancreas expression of GFP in both

Haiyan Wan; Svitlana Korzh; Zhen Li; Sudha Puttur Mudumana; Vladimir Korzh; Yun-Jin Jiang; Shuo Lin; Zhiyuan Gong



Interleukin10 Gene Transfection of Donor Pancreas Grafts Protects against Rejection after Heterotopic Pancreas Transplantation in a Rat Model  

Microsoft Academic Search

Objective: The aim of this study was to assess the effect of immunoregulatory cytokine interleukin-10 (IL-10) gene therapy on pancreas tissue rejection in a heterotopic pancreas transplantation model. Background: Modulation of inflammatory responses by anti-inflammatory cytokines (e.g., IL-10) has been suggested to minimize organ rejection. In this context, modulation of cytokines using gene therapy could be a new therapeutic modality

H. Özden; B. Kabay; G. Guven; M. F. Acikalin; H. Erbis; O. Alatas



Epidemiology of pancreas cancer in Los Angeles  

SciTech Connect

The characteristics of the 3614 Los Angeles County residents in whom cancer of the exocrine pancreas was diagnosed during the period 1972-1977 were compared with those of all county residents and patients in whom any cancer was diagnosed during the same period. Seventy-nine percent of the diagnoses had been pathologically verified. This disease still preferentially afflicts the old, the black, and men, although the differences in risk with factors other than age are modest. The disease is not evenly distributed by social class, or over time, although it is not clear that the observed differences reflect etiology. The distributions with respect to important categories of occupation and industry, religion, marital status, geography of residence, and birthplace were rather uniform. Although there is no obvious explanation for any of several unexpected minor inequities in the pattern of incidence, there is no compelling evidence to support any specific environmental cause. There is substantial evidence which is inconsistent with those environmental hypotheses that have been proposed previously.

Mack, T.M.; Paganini-Hill, A.



Recent progress in mechanical artificial pancreas.  


Strict blood glucose (BG) control is proved to improve the outcome in patients with glucose intolerance both in acute and chronic phases, irrespective of whether the patient has diabetes mellitus. However, strict BG control by conventional methods is so complicated that it cannot be performed easily in normal clinical situations. Furthermore, it is sometimes inadequate. Therefore, a clinically applicable, reliable artificial pancreas (AP) has long been sought after for more than 40 years. Considering the present important situations concerning AP, a survey of recent progress in AP is highly desirable. In this review, recent progress in mechanical AP (MAP) and in MAP-related items is presented. MAP is composed of three major components: a BG control algorithm, a drug administration system, and a glucose sensor. Recent progress in development of these components is presented, followed by descriptions of representative MAPs. Although significant progress in the development of MAP has been made, its use in clinical situations is limited or for research purposes at present. The main limiting factor is the slow progress in the development of glucose sensors. However, more widespread clinical application of the MAP will occur in the near future, considering the number of reliable long-life intravenous glucose sensors under development. Another factor is the worldwide recognition of the importance of BG control in acutely ill patients, in whom the period of strict BG control is usually for several days to a few weeks. PMID:19894087

Hoshino, Masami; Haraguchi, Yoshikura; Mizushima, Iwanori; Sakai, Motohiro



Carcinoma of the pancreas and periampullary region.  

PubMed Central

Over a 21 year period, 245 cases of cancer of the pancreas were operated upon and followed-up at UCLA Hospital. A further 34 cases of periampullary tumor were treated by partial or total pancreatectomy. Apparent clearance of tumors at the time of pancreaticoduodenectomy that was confirmed by subsequent histopathology resulted in a patient survival time of 20.3 months as compared with a figure of 12.9 months when the pathological examination revealed tumor in a resection margin, although the surgeon believed that excision had been complete at the time of operation. Frozen section examination of resection margins is therefore mandatory. The result of performing a pancreaticoduodenectomy in which tumor was seen to be left behind was a survival time of only 6.8 months, which is similar to the survival time of 6.2 months following a palliative biliary bypass. Pancreaticoduodenectomy in patients over the age of 70 resulted in an average survival of only 7.6 months. Of patients having a palliative biliary bypass alone, 13% required subsequent reoperation to bypass distressing duodenal obstruction. A duodenal bypass should therefore be a routine concomitant of a biliary bypass. Total pancreatectomy with duodenectomy for pancreatic cancer gave an increased average survival of 26 months, and it is likely that the frequency of performance of this operation will increase.

Forrest, J F; Longmire, W P



Pancreas Transplant Venous Thrombosis: Role of Endovascular Interventions for Graft Salvage  

SciTech Connect

Venous thrombosis of pancreas transplant allografts often leads to graft loss. We evaluated the efficacy of emergent endovascular techniques to salvage thrombosed pancreatic allografts in a series of six patients. Of the 76 pancreas transplants performed between 2002 and 2006, six patients were diagnosed with venous thrombosis on MRI between 2 and 28 days posttransplant (mean, 9 days). Five patients were systemic-enteric (donor portal vein anastomosis to recipient iliac vein) and one patient was portal-enteric (donor portal vein anastomosis to recipient superior mesenteric vein). Conventional venography confirmed the diagnosis of venous thrombosis in all patients. One patient was treated with catheter-directed venous thrombolysis and balloon thrombectomy. Another patient was treated with rheolytic thrombectomy alone. The remaining four patients were treated with a combination of these mechanical and thrombolytic techniques. Completion venography revealed >50% clot reduction and resumption of venous drainage in all patients. One patient required additional intervention 16 days later for recurrent thrombosis. Two patients required metal stent placement for anastomotic stenoses or kinks. One patient required pancreatectomy 36 h after attempted salvage secondary to a major hemorrhage and graft necrosis. Two patients recovered pancreatic function initially but lost graft function at 8 and 14 months, respectively, from severe chronic rejection. Patient survival was 100%, long-term graft survival was 50%, rethrombosis rate was 16.6%, and graft loss from rejection was 33%. In conclusion, early recognition and treatment of venous thrombosis after pancreas transplantation has acceptable morbidity and no mortality using short-term endovascular pharmacomechanical therapy.

Stockland, Andrew H. [Mayo Clinic, Department of Radiology (United States); Willingham, Darrin L. [Mayo Clinic, Department of Transplantation (United States); Paz-Fumagalli, Ricardo [Mayo Clinic, Department of Radiology (United States); Grewal, Hani P. [Mayo Clinic, Department of Transplantation (United States); McKinney, J. Mark [Mayo Clinic, Department of Radiology (United States); Hughes, Christopher B. [Mayo Clinic, Department of Transplantation (United States); Walser, Eric M., E-mail: Walser.eric@mayo.ed [Mayo Clinic, Department of Radiology (United States)



Beneficial effects of ischemic preconditioning on pancreas cold preservation.  


Ischemic preconditioning (IPC) confers tissue resistance to subsequent ischemia in several organs. The protective effects are obtained by applying short periods of warm ischemia followed by reperfusion prior to extended ischemic insults to the organs. In the present study, we evaluated whether IPC can reduce pancreatic tissue injury following cold ischemic preservation. Rat pancreata were exposed to IPC (10 min of warm ischemia followed by 10 min of reperfusion) prior to ~18 h of cold preservation before assessment of organ injury or islet isolation. Pancreas IPC improved islet yields (964 ± 336 vs. 711 ± 204 IEQ/pancreas; p = 0.004) and lowered islet loss after culture (33 ± 10% vs. 51 ± 14%; p = 0.0005). Islet potency in vivo was well preserved with diabetes reversal and improved glucose clearance. Pancreas IPC reduced levels of NADPH-dependent oxidase, a source of reactive oxygen species, in pancreas homogenates versus controls (78.4 ± 45.9 vs. 216.2 ± 53.8 RLU/?g; p = 0.002). Microarray genomic analysis of pancreata revealed upregulation of 81 genes and downregulation of 454 genes (greater than twofold change) when comparing IPC-treated glands to controls, respectively, and showing a decrease in markers of apoptosis and oxidative stress. Collectively, our study demonstrates beneficial effects of IPC of the pancreas prior to cold organ preservation and provides evidence of the key role of IPC-mediated modulation of oxidative stress pathways. The use of IPC of the pancreas may contribute to increasing the quality of donor pancreas for transplantation and to improving organ utilization. PMID:22305457

Hogan, Anthony R; Doni, Marco; Molano, R Damaris; Ribeiro, Melina M; Szeto, Angela; Cobianchi, Lorenzo; Zahr-Akrawi, Elsie; Molina, Judith; Fornoni, Alessia; Mendez, Armando J; Ricordi, Camillo; Pastori, Ricardo L; Pileggi, Antonello



GATA4 and GATA6 control mouse pancreas organogenesis  

PubMed Central

Recently, heterozygous mutations in GATA6 have been found in neonatal diabetic patients with failed pancreatic organogenesis. To investigate the roles of GATA4 and GATA6 in mouse pancreas organogenesis, we conditionally inactivated these genes within the pancreas. Single inactivation of either gene did not have a major impact on pancreas formation, indicating functional redundancy. However, double Gata4/Gata6 mutant mice failed to develop pancreata, died shortly after birth, and displayed hyperglycemia. Morphological defects in Gata4/Gata6 mutant pancreata were apparent during embryonic development, and the epithelium failed to expand as a result of defects in cell proliferation and differentiation. The number of multipotent pancreatic progenitors, including PDX1+ cells, was reduced in the Gata4/Gata6 mutant pancreatic epithelium. Remarkably, deletion of only 1 Gata6 allele on a Gata4 conditional knockout background severely reduced pancreatic mass. In contrast, a single WT allele of Gata4 in Gata6 conditional knockout mice was sufficient for normal pancreatic development, indicating differential contributions of GATA factors to pancreas formation. Our results place GATA factors at the top of the transcriptional network hierarchy controlling pancreas organogenesis.

Carrasco, Manuel; Delgado, Irene; Soria, Bernat; Martin, Francisco; Rojas, Anabel



Amyand's Hernia: A Serendipitous Diagnosis.  


An Amyand's hernia refers to the presence of an appendix within an inguinal hernia sac. This uncommon finding occurs in less than 1% of all right side inguinal hernias; to date, this finding has been reported in only 14 patients with left side inguinal hernias. The preoperative diagnosis of this condition is uncommon. We report the 15th case of a left side Amyand's hernia that was diagnosed preoperatively on a contrast enema study as well as the relatively more common right-sided Amyand's hernia diagnosed serendipitously at surgery. PMID:23691419

Mewa Kinoo, S; Aboobakar, M R; Singh, B



Patients Postoperatively Forget Aspects of Preoperative Patient Education  

Microsoft Academic Search

Background: Preoperative patient education is critically important to the success of any bariatric operation. In our clinic,\\u000a we perform extensive preoperative education and informed consent. Part of the informed consent process includes a preoperative\\u000a true\\/false quiz. This study tests the hypothesis that postoperative patients do not recall key components of their preoperative\\u000a education. Methods: Preoperatively, all patients were required to

Atul K. Madan; David S. Tichansky



Acinar Cell Carcinoma of the Pancreas: New Genetic and Treatment Insights into a Rare Malignancy  

PubMed Central

Background. Acinar cell carcinoma (ACC) of the pancreas is a rare neoplasm, accounting for 1% of all pancreatic neoplasms. There remains a lack of data regarding the use of systemic therapy in this disease. We present a series of 40 consecutive cases of ACC of the pancreas treated at Memorial Sloan-Kettering Cancer Center, with an emphasis on evaluation of activity of new therapeutic agents. Methods. Patients reviewed at our institution from January 2000 through January 2011 were identified from an institutional database with prior institutional review board approval. Pathology was confirmed in all cases as ACC or a closely related entity. Results. Forty patients were identified; 29 were male (73%). The median age at diagnosis was 65 years (range, 16–87 years). The median overall survival (OS) time for patients with localized, resectable disease was 56.9 months and the OS time for patients with metastatic ACC (n = 18) was 19.6 months. Six patients with metastatic or recurrent ACC had a partial response to chemotherapy and five patients had stable disease for ?6 months on systemic chemotherapy. Clinical observation was made of a patient with ACC and hereditary nonpolyposis colorectal cancer and a patient with ACC and a BRCA1 germline mutation. Conclusions. ACC is moderately chemoresponsive to agents that have activity in pancreatic adenocarcinoma and colorectal carcinoma. A potential association between germline mutations in DNA mismatch repair genes and ACC warrants further evaluation.

Lowery, Maeve A.; Klimstra, David S.; Shia, Jinru; Yu, Kenneth H.; Allen, Peter J.; Brennan, Murray F.



BK virus nephropathy in simultaneous pancreas kidney transplant: a potentially preventable cause of kidney allograft loss.  


More than half of the simultaneous pancreas kidney transplant (SPK) patients afflicted with BK virus nephropathy (BKVN) lose their kidney allograft. Fear of pancreatic rejection limits the ability to reduce immunosuppression; this may result in inadequate treatment of BKVN. This single-center retrospective review included 138 SPK patients who underwent periodic BKV screening and were managed with IS reduction alone as a treatment of choice for BKVN. All patients underwent rabbit anti-thymocyte globulin (rATG) induction and were maintained on tacrolimus/sirolimus or mycophenolate. The incidence of BKVN was 4.4%. BKVN was diagnosed at a median of 11 months; mean serum creatinine 2.1 mg/dL and the geometric mean BK serum viral load at diagnosis 1,758,000 DNA copies/mL. Median time to BKV clearance was 5.6 months; there was 96% reduction in the mycophenolate dose, 100% reduction in sirolimus, and 40% reduction in the tacrolimus blood level at BKVN clearance. No BKVN-related kidney failure was noted, and patients retained excellent kidney and pancreatic allograft function till last follow-up (43 months). BKVN in SPK is a potentially preventable cause of end-stage kidney disease, and IS reduction alone is an acceptable treatment modality in SPK without a higher risk of kidney/pancreas allograft loss as long as close monitoring can be ensured. PMID:22448973

Mujtaba, Muhammad; Fridell, Jonathan; Sharfuddin, Asif; Kandula, Praveen; Yaqub, Muhammad S; Phillips, Carrie L; Mishler, Dennis; Taber, Tim



Clinical target volume delineation including elective nodal irradiation in preoperative and definitive radiotherapy of pancreatic cancer  

PubMed Central

Background Radiotherapy (RT) is widely used in the treatment of pancreatic cancer. Currently, recommendation has been given for the delineation of the clinical target volume (CTV) in adjuvant RT. Based on recently reviewed pathologic data, the aim of this study is to propose criteria for the CTV definition and delineation including elective nodal irradiation (ENI) in the preoperative and definitive treatment of pancreatic cancer. Methods The anatomical structures of interest, as well as the abdominal vasculature were identified on intravenous contrast-enhanced CT scans of two different patients with pancreatic cancer of the head and the body. To delineate the lymph node area, a margin of 10?mm was added to the arteries. Results We proposed a set of guidelines for elective treatment of high-risk nodal areas and CTV delineation. Reference CT images were provided. Conclusions The proposed guidelines could be used for preoperative or definitive RT for carcinoma of the head and body of the pancreas. Further clinical investigations are needed to validate the defined CTVs.



Microangiography of the pancreas in experimental hemorrhagic pancreatitis.  


In experimental hemorrhagic pancreatitis induced with sodium-taurocholate-trypsin, contrast enhancement of the pancreas in computed tomography (CT) has been shown to be decreased in spite of normal pancreatic blood flow. The contrast enhancement in CT depends on blood flow to the organ, capillary permeability and the amount of extracellular fluid in the organ. For further evaluation of the role of microcirculatory changes in our model of hemorrhagic pancreatitis, microangiography was performed in five normal piglets and in ten piglets with acute hemorrhagic pancreatitis. In this experimental model histological studies showed focal necroses, hemorrhages and leucocyte accumulation. In the affected areas microangiography revealed unfilled capillaries and extravasation of contrast medium. Arteries and arterioles were well filled, as in the normal control animals. These severe disturbances in the capillary circulation of the pancreas may explain the decreased contrast enhancement of the pancreas in CT during acute hemorrhagic pancreatitis. PMID:3769941

Nuutinen, P; Kivisaari, L; Standertskjöld-Nordenstam, C G; Lempinen, M; Schröder, T



Microangiography of the pancreas in experimental oedemic and haemorrhagic pancreatitis.  


Microangiography of the pancreas was performed in five normal piglets and in 10 piglets with oedemic and haemorrhagic pancreatitis in order to evaluate the role of microcirculatory changes in experimental pancreatitis. Acute haemorrhagic pancreatitis was induced by intraductal infusion of trypsin-taurocholate and oedematous pancreatitis correspondingly by infusion of autologous diluted bile. Both types of pancreatitis were confirmed by histological examination. Microangiography of the control animals revealed well-filled arteries, arterioles and capillaries, which formed a dense capillary network. In the areas of histologically documented haemorrhagic pancreatitis, unfilled capillary nets were observed as empty areas in the microangiography. Other areas of focal extravasation of the contrast material could be seen. Arteries and arterioles were well filled. In oedematous pancreatitis, the microangiography was unchanged compared with the control. Conclusion: Acute experimental haemorrhagic pancreatitis is associated with severe disturbances in the capillary circulation of the pancreas, whereas in oedematous pancreatitis the microangiography of the pancreas is normal. PMID:3494299

Nuutinen, P; Kivisaari, L; Standertskjöld-Nordenstam, C G; Lempinen, M; Schröder, T



[Preoperative selective embolization of intracranial meningiomas].  


The authors report preliminary experiences with preoperative embolization of intracranial meningiomas describing the technique using a specially prepared gelfoam as embolizing material. Embolization was done in 3 cases, in 2 of them transient facial nerve paresis appeared as complication. The effectiveness of embolization was assessed by means of selective control intraoperative angiography and histological examination. In the conclusions the authors stress the effectiveness of preoperative embolization for reducing intraoperative bleeding and indicate the usefulness of the procedure in selected cases of other brain tumours. PMID:3226479

Marchel, A; Sadowski, Z; Dowzenko, A


Case report: gastrointestinal hemorrhage caused by a pancreas transplant arteriovenous fistula with large psuedoanuerysm 9 years after transplantation.  


Reported cases of arteriovenous fistulae in transplant recipients are uncommon. We present a case of an arteriovenous fistula associated with a large pseudoaneurysm in the root of the small bowel mesentery of a pancreas transplant. Uniquely, in our case, the arteriovenous fistula presented with an episode of gastrointestinal (GI) hemorrhage 9 years postoperatively. Radiographic imaging including coronal computed tomography angiogram and conventional angiogram demonstrated an arteriovenous fistula in the patient's pancreas transplant between the distal superior mesenteric artery (SMA) and superior mesenteric vein (SMV) with 6 cm aneurysmal dilatation. The tremendous flow in the fistula in the root of the graft small intestine mesentery led to graft duodenal mucosal congestion and lower GI hemorrhage. After successful embolization of the SMA-SMV fistula and pseudoaneurysm using interventional radiographic techniques, the arteriovenous fistula remained thrombosed. The patient had no further episodes of GI bleeding and her endoscopic evaluation was otherwise negative. The presence of arteriovenous fistulae and pseudoaneurysms in pancreas transplant recipients is uncommon, but has been previously documented. This case is further distinguished from previous reports by the notable 9-year interval between transplantation and the onset of hemorrhage. Historically, symptomatic vascular malformations have been associated with significant patient morbidity and mortality. Successful patient management involves timely and accurate diagnosis and intervention. PMID:22172898

Bratton, C F; Hamid, A; Selby, J B; Baliga, P K



The Artificial Pancreas: How Sweet Engineering Will Solve Bitter Problems  

PubMed Central

An artificial pancreas is a closed-loop system containing only synthetic materials which substitutes for an endocrine pancreas. No artificial pancreas system is currently approved; however, devices that could become components of such a system are now becoming commercially available. An artificial pancreas will consist of functionally integrated components that will continuously sense glucose levels, determine appropriate insulin dosages, and deliver the insulin. Any proposed closed loop system will be closely scrutinized for its safety, efficacy, and economic impact. Closed loop control utilizes models of glucose homeostasis which account for the influences of feeding, stress, insulin, exercise, and other factors on blood glucose levels. Models are necessary for understanding the relationship between blood glucose levels and insulin dosing; developing algorithms to control insulin dosing; and customizing each user's system based on individual responses to factors that influence glycemia. Components of an artificial pancreas are now being developed, including continuous glucose sensors; insulin pumps for parenteral delivery; and control software, all linked through wireless communication systems. Although a closed-loop system providing glucagon has not been reported in 40 years, the use of glucagon to prevent hypoglycemia is physiologically attractive and future devices might utilize this hormone. No demonstration of long-term closed loop control of glucose in a free-living human with diabetes has been reported to date, but many centers around the world are working on closed loop control systems. It is expected that many types of artificial pancreas systems will eventually be available, and they will greatly benefit patients with diabetes.

Klonoff, David C.



Microencapsulation of pancreatic islets for use in a bioartificial pancreas.  


Islet transplantation is the most exciting treatment option for individuals afflicted with Type 1 diabetes. However, the severe shortage of human pancreas and the need to use risky immunosuppressive drugs to prevent transplant rejection remain two major obstacles for the routine use of islet transplantation in diabetic patients. Successful development of a bioartificial pancreas using the approach of microencapsulation with perm-selective coating of islets with biopolymers for graft immunoisolation holds tremendous promise for diabetic patients because it has great potential to overcome these two barriers. In this chapter, we provide a detailed description of the microencapsulation process. PMID:23494435

Opara, Emmanuel C; McQuilling, John P; Farney, Alan C



[Diagnosis and treatment of mediastinal tumors].  


The analysis of treatment of 103 patients with sizable mediastinal formations is adduced. In 50 patients the disease was revealed during prophylactic photoroentgenography. In 44 (42.7%) patients malignant tumor was revealed, in 37 (84.1%) of them the diagnosis was confirmed according to morphological investigation data before beginning of the treatment, in 7--while the operation performance. Of 32 patients with malignant tumor operated on in 25 preoperative irradiation therapy was conducted, in 19 the tumor was excised entirely and in 4--partially, in 9 it was not possible to excise it at all. In 13 patients postoperative complications occurred and 2 (2.3%) died. The authors propose to confirm the mediastinal formation diagnosis by preoperative morphological investigation data. In absence of possibility of morphological diagnosis conduction it is necessary to perform operative intervention. In the case of malignant solid tumor present preoperative irradiation therapy in the middle fractioning regimen is expedient. PMID:12833618

Palamarchuk, I D



CT Diagnosis of Blunt Pancreatic Trauma: Importance of Detecting Fluid  

Microsoft Academic Search

OBJECTIVE. The purpose of this study was to determine the value of detecting fluid between the splenic vein and the pancreas on CT scans in the diagnosis of pancreatic Injury after blunt abdominal trauma. MATERIALS AND METHODS. We retrospectively reviewed the abdominal CT scans of 10 patients with surgical- or autopsy-proved pancreatic injury after blunt abdomi- nal trauma. The finding

Robert E. Mindelzun; Jeet S. Sandhu; Vincent D. McCormick; R. Brooke Jeffrey


Diagnosis and management of endocrine gland neoplasmas. Revision 1  

SciTech Connect

Functional and nonfunctional neoplasms of the endocrine glands constitute some of the more challenging diagnostic and therapeutic problems in veterinary cancer medicine. This discussion will focus on the clinical signs and syndromes associated with neoplasms of the thyroid, adrenal, and parathyroid glands, and pancreas in companion animals and will concentrate on the mechanisms producing the clinical signs, diagnosis, staging, therapy and prognosis.

Weller, R.E.



The Amsterdam preoperative anxiety and information scale provides a simple and reliable measure of preoperative anxiety  

Microsoft Academic Search

Purpose  To compare three anxiety scales; the anxiety visual analogue scale (VAS), the anxiety component of the Amsterdam preoperative\\u000a anxiety and information scale (APAIS), and the state portion of the Spielburger state-trait anxiety inventory (STAI), for\\u000a assessment of preoperative anxiety levels in same day admission patients.\\u000a \\u000a \\u000a \\u000a Methods  Patients completed the three anxiety assessment scales both before and after seeing the anesthesiologist preoperatively.

Abdulaziz Boker; Laurence Brownell; Neil Donen



Preliminary Study on Glucose Control with an Artificial Pancreas in Postoperative Sepsis Patients  

Microsoft Academic Search

Background: Glucose control is essential to avoid hypoglycemia in postoperative patients. Aim: To conduct a preliminary examination to evaluate the feasibility of the use of an artificial pancreas for glucose control as well as the accuracy of assessment by the artificial pancreas of the insulin dose required. Subjects and Methods: Glucose control using an artificial pancreas was undertaken in 8

G. Takahashi; N. Sato; N. Matsumoto; T. Shozushima; K. Hoshikawa; S. Akitomi; T. Kikkawa; C. Onodera; M. Kojika; Y. Inoue; K. Suzuki; G. Wakabayashi; S. Endo



Outcome of Endoscopic Minor Papillotomy in Patients with Symptomatic Pancreas Divisum  

Microsoft Academic Search

Context Pancreas divisum has been associated with recurrent acute pancreatitis, chronic abdominal pain without elevated pancreatic enzymes, and chronic pancreatitis. Prior studies suggest that endoscopic minor papillotomy benefits certain symptomatic pancreas divisum patients. However, the data are quite limited and there is a lack of long- term follow-up. Objective To describe a retrospective study of endoscopic minor papillotomy for pancreas

Henning Gerke; Michael F Byrne; Helen L Stiffler; Jorge V Obando; Robert M Mitchell; Paul S Jowell; Malcolm S Branch; John Baillie


Local Resection of the Head of the Pancreas Combined with Longitudinal Pancreaticojejunostomy  

Microsoft Academic Search

The steps in the performance of local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy are described. These include a wide Kocher maneuver freeing up the superior mesenteric vein below the neck of the pancreas from the anterior surface of the head of the pancreas and uncinate process, opening the lesser sac, measurements of pressure in the

Charles F. Frey; Hung S. Ho



Carcinoma of the uncinate process of the pancreas presenting with deep vein thrombosis: a case report  

Microsoft Academic Search

The uncinate process is a hook-like projection of the inferior aspect of the head of the pancreas. Carcinoma of the uncinate process of the pancreas is considered to be rare, difficult to diagnose and particularly devastating. The current method of detection is computed tomography. We report a case of carcinoma of the uncinate process of the pancreas in a patient

Kumaran Shanmugarajah; Elaine Hui; Nikhil Vergis; Chris Schelvan; Stephen Robinson



Serial Peripheral Blood Cytotoxic Lymphocyte Gene Expression Measurements for Prediction of Pancreas Transplant Rejection  

Microsoft Academic Search

Acute rejection after pancreas transplantation remains a significant problem and contributes to immunological graft loss. No clinical markers of pancreas rejection have been universally accepted. The purpose of this study was to investigate the use of genetic markers; granzyme B, perforin, and HLA-DRA in the peripheral blood of pancreas transplant recipients. These genes have been identified in renal and islet

A. K. Cashion; O. M. Sabek; C. J. Driscoll; L. W. Gaber; A. O. Gaber



Congenital anomaly of pancreas divisum as cause of obstructive pain and pancreatitis  

Microsoft Academic Search

Pancreas divisum occurs when the embryological ventral and dorsal parts of the pancreas fail to fuse, so that pancreatic drainage is mainly through the accessory papilla. In 169 patients with primary biliary tract disease who underwent pancreatography incidental to endoscopic cholangiography, the incidence of pancreas divisum was 3.6%. Among 78 patients with unexplained recurrent pancreatitis, the incidence was 25.6%. The

P B Cotton



Sarcomatoid carcinoma of the bladder after simultaneous kidney-pancreas transplant: a case report and review of the literature.  


Carcinosarcoma and sarcomatoid carcinoma of the bladder after organ transplantation is higher in comparison to the general population but overall occurrence is still very uncommon. Due to the decreased immunitary response effects of antirejection drugs, these cancers have aggressive course and respond poorly to treatment. Bladder drained pancreatic transplants are associated with a number of urologic challenges that can delay the diagnosis and the treatment of malignancies of the genito-urinary system. The authors present a case of a rare sarcomatoid carcinoma of the bladder following bladder drained simultaneous kidney and pancreas transplant and discuss its pathogenesis and clinical management. PMID:22605000

McCrea, Patrick H; Chang, Michelle; Bailley, Gregory; Molinari, Michele



Cystic glucagonoma: A rare variant of an uncommon neuroendocrine pancreas tumor.  


Glucagon-producing neuroendocrine tumors typically present with a characteristic constellation of symptoms including necrolytic migratory erythema, non-insulin-dependent diabetes, weight loss, anemia, glossitis, and an increased thrombotic tendency. Most glucagonomas are solid and arise in the body or tail of the pancreas. We report two cases of cystic glucagonoma, one found incidentally in an asymptomatic patient and one in a patient with weight loss and diabetes but no rash. In the first patient, distal pancreatectomy and splenectomy were curative, whereas the second patient continued to exhibit elevated serum glucagon levels and symptoms of glucose intolerance in the absence of demonstrable metastases. Cystic glucagonoma is a unique variant of classic glucagonoma and should be considered in the differential diagnosis of cystic pancreatic neoplasms. PMID:10457311

Brown, K; Kristopaitis, T; Yong, S; Chejfec, G; Pickleman, J


Hypnosis Reduces Preoperative Anxiety in Adult Patients  

Microsoft Academic Search

In this study we examined the effect of hypnosis on preoperative anxiety. Subjects were randomized into 3 groups, a hypnosis group (n 26) who received suggestionsofwell-being;anattention-controlgroup (n 26) who received attentive listening and support without any specific hypnotic suggestions and a \\

Haleh Saadat; Jacqueline Drummond-Lewis; Inna Maranets; Deborah Kaplan; Anusha Saadat; Shu-Ming Wang; Zeev N. Kain



Preoperative Cardiac Evaluation for Elective Noncardiac Surgery  

Microsoft Academic Search

e reviewed the approach to preoperative cardiac risk assessment, incorporating new information regarding the pathophysiologic features of perioperative myo- cardial ischemia and recent clinical trials. Relevant articles were identified from a MEDLINE search, followed by bibliography review of the articles identified. The multifactorial risk indexes are valuable in stratifying risks among unselected patients under- going noncardiac surgery, but they underestimate

Darryl Potyk; Peter Raudaskoski



Preoperative cardiac risk assessment for noncardiac surgery  

Microsoft Academic Search

Coronary artery disease (CAD) represents an important risk in patients undergoing elective noncardiac surgical procedures, in whom the stress of surgery and postoperative recovery can represent a significant ischemic burden. Population considerations: Preoperative cardiac assessment should be based on the prevalence of CAD (if known) in the population undergoing the procedure and the institutional event rate for the procedure. Procedures

Jeffrey A. Leppo



Preoperational test, vent building ventilation system  

SciTech Connect

Preoperational Test Procedure for Vent Building Ventilation System, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The Vent Building ventilation system provides ventilation, heating, cooling, and zone confinement control for the W-030 Project Vent Building. The tests verify correct System operation and correct indications displayed by the central Monitor and Control system.

Clifton, F.T., Westinghouse Hanford



Preoperative Doppler Assessment for Transmetatarsal Amputation  

Microsoft Academic Search

A thorough preoperative vascular evaluation should be performed before the initiation of any lower extremity surgical intervention, but particularly in situations of diabetic foot reconstruction with compromised blood flow. The intended emphasis of this brief report is to provide the foot and ankle surgeon with an appreciation for the clinical vascular anatomy of the transmetatarsal amputation through a handheld Doppler

Christopher E. Attinger; Andrew J. Meyr; Sarah Fitzgerald; John S. Steinberg



Preoperative considerations and creation of normal ostomies.  


Stomas provide fecal diversion in emergent and elective settings. Preoperative planning and counseling are extremely important to the creation of an acceptable and functional ostomy for the surgeon and patient. Proper site selection will help decrease the incidence of postoperative complications. Ileostomy, colostomy, and cecostomy indications and techniques are discussed. PMID:20011391

Brand, Marc I; Dujovny, Nadav



Maturity onset diabetes of the young: clinical characteristics and outcome after kidney and pancreas transplantation in MODY3 and RCAD patients: a single center experience.  


The diabetes and renal phenotype of patients with maturity-onset diabetes of the young (MODY) on a transplantation waiting list is not known; neither is their outcome after pancreas (PT) and/or kidney transplantation (KT). Between 2002 and 2009, we screened 50 of 150 patients referred for kidney and pancreas transplantation to the Kremlin-Bicêtre center for HNF1B and HNF1A mutations if one or more of the following criteria was present (i) an atypical history of diabetes (ii) diabetes with at least one affected parent or two affected relatives, (iii) an absence of auto-antibodies at diagnosis (iv) a persistent secretion of fasting C peptide (v) a personal or a family history of renal cysts or dysplasia. Their phenotype and their outcome were analyzed. Four HNF1A (MODY3) and eight HNF1B mutations [renal cysts and diabetes (RCAD)] were identified. All MODY3 patients had diabetic nephropathy, but only 50% of RCAD patients. Four patients underwent a kidney and pancreas transplantation and two a kidney transplant alone. After 4.1 ± 1.1 years of follow-up, 83% of patients still have a functioning kidney and 75% a functioning pancreas. PT can be proposed with good results for MODY3 and RCAD patients. PMID:22432796

Poitou, Caroline; Francois, Hélène; Bellanne-Chantelot, Christine; Noel, Christian; Jacquet, Antoine; Clauin, Séverine; Beaudreuil, Séverine; Damieri, Hani; Hebibi, Hadia; Hammoudi, Yacine; Benoit, Gérard; Charpentier, Bernard; Durrbach, Antoine



Pancreas transplantation in type 1 diabetes: hope vs reality.  


Pancreas transplantation can improve quality of life for patients with type 1 diabetes by eliminating hypoglycemic and hyperglycemic episodes, the need for insulin injections, frequent self-monitoring of blood glucose levels, and dietary restrictions. Increasing evidence suggests that it may slow the progression of long-term diabetic complications. On the other hand, patients risk the adverse effects of lifelong immunosuppression. PMID:10780100

Mayes, J T; Dennis, V W; Hoogwerf, B J



Quest for the Artificial Pancreas: Combining Technology with Treatment  

Microsoft Academic Search

The various components of the artificial pancreas puzzle are being put into place. Features such as communication, control, modeling, and learning are being realized presently. Steps have been set in motion to carry the conceptual design through simulation to clinical implementation. The challenging pieces still to be addressed include stress and exercise; as integral parts of the ultimate goal, effort

REBECCA A. HARVEY; Youqing Wang; Benyamin Grosman; MATTHEW W. PERCIVAL; Wendy Bevier; DANIEL A. FINAN; Howard Zisser; DALE E. SEBORG; Lois Jovanovic; FRANCIS J. DOYLE; Eyal Dassau



A novel strategy for long-term implantable artificial pancreas  

Microsoft Academic Search

Technology has recently changed type 1 diabetes treatment by introducing several advancements able to improve patients' quality of life. However, despite of several decades of research efforts, the dream of a fully-automated implanted artificial pancreas is quite far from its realization. The need for periodically restoring the implanted battery charge and refilling the implanted insulin reservoir are the main issues,

Leonardo Ricotti; Tareq Assaf; Arianna Menciassi; Paolo Dario



The Next Generation of Artificial Pancreas Control Algorithms  

Microsoft Academic Search

Creating a wearable artificial pancreas (AP) by closing the loop between a glucose sensor and an insulin infusion pump has the potential to significantly impact the complications associated with and improve the quality of life of diabetic individuals. Despite recent progress on glucose sensor and insulin infusion technologies, control algorithms built on the simple glucose value efferent and insulin dose

Rodrigo E. Teixeira; Stephen Malin



Very early steroid withdrawal in simultaneous pancreas-kidney transplants  

Microsoft Academic Search

Background. Simultaneous pancreas-kidney (SPK) transplantation is an effective treatment for patients suffering from type 1 diabetes mellitus. Conventional immunosuppressive treatments include steroids that may induce insulin resistance and are responsible for many side effects. In de novo SPK, early withdrawal of corticosteroids may be an important issue. Methods. A total of 24 consecutive patients with type 1 diabetes mellitus had

Mabel Aoun; Pascal Eschewege; Yacine Hamoudi; Severine Beaudreuil; Jacques Duranteau; Gaelle Cheisson; Christian Noel; Gerard Benoit; Bernard Charpentier; Antoine Durrbach



Agenesis and pseudo-agenesis of the dorsal pancreas  

Microsoft Academic Search

Agenesis of the dorsal pancreatic anlage is a very unusual congenital anomaly. The case reported appears to be accompanied by hypertrophy of the ventral gland. Atrophy of the pancreas following an episode of acute pancreatitis is also very unusual. When the atrophy spares the uncinate process, it may also resemble agenesis of the dorsal gland.

Richard Palmer Gold



Immunohistochemical studies of endocrine cells in heterotopic pancreas  

Microsoft Academic Search

Twenty-one specimens of heterotopic pancreas were investigated using the indirect immunoperoxidase method for insulin, somatostatin, glucagon, pancreatic polypeptide (PP) and gastrin. Ten specimens showed ducts, acini and islets, seven showed ducts and acini, and four showed a ductal component alone. Pyloric gland-like mucous glands were occasionally identified in association with the ductal component. In eight of ten lesions containing islets,

Masafumi Hara; Yutaka Tsutsumi



Influence of Pancreas Transplantation Alone on Native Renal Function  

Microsoft Academic Search

Pancreas transplantation alone (PTA) has become an accepted treatment of nonuremic diabetic patients, when the risks of secondary complications of diabetes mellitus are greater than those of the surgical procedure and the posttransplant immunosuppression. As a decrease in native renal function is expected, we followed this parameter among patients who underwent PTA. From January 1997 through January 2005, we performed

T. Genzini; G. S. Marchini; A. J. B. A. Chang; I. Antunes; A. Hayashi; H. Abensur; L. Kataoka; F. Crescentini; J. Eg??dio Romão; E. B. Rangel; M. Perosa



Abnormal endocrine pancreas function at birth in cystic fibrosis ferrets  

PubMed Central

Diabetes is a common comorbidity in cystic fibrosis (CF) that worsens prognosis. The lack of an animal model for CF-related diabetes (CFRD) has made it difficult to dissect how the onset of pancreatic pathology influences the emergence of CFRD. We evaluated the structure and function of the neonatal CF endocrine pancreas using a new CFTR-knockout ferret model. Although CF kits are born with only mild exocrine pancreas disease, progressive exocrine and endocrine pancreatic loss during the first months of life was associated with pancreatic inflammation, spontaneous hyperglycemia, and glucose intolerance. Interestingly, prior to major exocrine pancreas disease, CF kits demonstrated significant abnormalities in blood glucose and insulin regulation, including diminished first-phase and accentuated peak insulin secretion in response to glucose, elevated peak glucose levels following glucose challenge, and variably elevated insulin and C-peptide levels in the nonfasted state. Although there was no difference in lobular insulin and glucagon expression between genotypes at birth, significant alterations in the frequencies of small and large islets were observed. Newborn cultured CF islets demonstrated dysregulated glucose-dependent insulin secretion in comparison to controls, suggesting intrinsic abnormalities in CF islets. These findings demonstrate that early abnormalities exist in the regulation of insulin secretion by the CF endocrine pancreas.

Olivier, Alicia K.; Yi, Yaling; Sun, Xingshen; Sui, Hongshu; Liang, Bo; Hu, Shanming; Xie, Weiliang; Fisher, John T.; Keiser, Nicholas W.; Lei, Diana; Zhou, Weihong; Yan, Ziying; Li, Guiying; Evans, Turan I.A.; Meyerholz, David K.; Wang, Kai; Stewart, Zoe A.; Norris, Andrew W.; Engelhardt, John F.



A Solid Pseudopapillary Tumour Arising from Mesocolon without Ectopic Pancreas  

PubMed Central

A solid pseudopapillary tumour (SPT) is an uncommon pancreatic tumour. Very rarely it has also been described outside the pancreas, usually arising from heterotopic pancreatic tissue. In this paper, we described a case arising from the transverse mesocolon without heterotopic pancreatic tissue in an 18-year-old girl.

Tez, Mesut; Ozalp, Necdet; Zulfikaroglu, Bar?s; Koc, Mahmut



Effect of parental malnutrition on enzyme content of rat pancreas.  


The aim of this study was to assess in rat pups the influence of protein diets ingested by their mothers during gestation and lactation on the enzyme content of the pancreas of the offspring. Rat pups born of either well-nourished mothers or of mothers fed a diet moderately restricted in protein (9% casein w/w) were studied. After weaning, the pups were fed on one of three diets: a well-balanced diet, a 5% casein diet (protein restricted), or a well-balanced diet of a similar caloric value as the protein-restricted diet (pair-fed rat pups). The pups were sacrificed after intervals of one to 25 weeks after weaning. The results showed that the enzyme content of the pancreas increased progressively with time in pups born of malnourished mothers, particularly in pups fed the protein-restricted diet. This suggests prolonged maturation of the pancreas. Pups fed the 5% casein diet had a decreased amylase content per milligram of DNA but not of other enzymes. Malnutrition in the mother increased the ratio of enzymes to DNA and the total pancreatic enzyme content at different times after weaning, indicating that maternal malnutrition had a prolonged effect on the pancreatic enzyme content of the pups' pancreas. This mechanism could play a role in the pathogenesis of tropical chronic calcific pancreatitis in man and explain some of the geographic differences in the incidence of the disease. PMID:2436866

Sarles, H; LaHaie, R; Dollet, J M; Beck, B; Michel, R; Debry, G



Ischemic preconditioning improves islet recovery after pancreas cold preservation.  


Increasing evidence supports the beneficial effects of ischemic preconditioning (IPC) of organs on subsequent ischemia. The aim of this study was to assess the effects of IPC of the pancreas on islet cell recovery after cold preservation using a rat model. The pancreas was deprived of perfusion (celiac artery and superior mesenteric artery occlusion) for 10 minutes followed by 10 minutes of reperfusion. Islet isolation was performed after 18 hours of cold ischemia. Glands undergoing IPC yielded significantly greater numbers of islets than controls. Following overnight culture, a significantly greater proportion of islets was recovered from IPC-treated pancreata. Microarray genomic analysis of pancreatic tissue revealed a significant differential expression of approximately 600 unique mRNA strands within IPC pancreata compared to only <100 unique mRNA strands within non-IPC pancreata (>2-fold change; P < .05). Proteomic analysis revealed significant differential expression of at least 5 proteins >1.5-fold change; P < .05) within the IPC vs control group. Our data indicated that IPC of the pancreas prior to cold preservation was associated with improved islet cell recovery after cold ischemia. IPC of the pancreas may represent a viable therapeutic intervention to increase islet transplantation success from a single donor and to maximize organ utilization. PMID:19249556

Hogan, A R; Doni, M; Ribeiro, M M; Molano, R D; Cobianchi, L; Molina, J; Zahr, E; Ricordi, C; Pastori, R L; Pileggi, A


Neuroendocrine neoplasms of the gut and pancreas: new insights  

Microsoft Academic Search

Neuroendocrine neoplasms arise in almost every organ of the body and are variably defined according to the site of origin. This Review focuses on neuroendocrine neoplasms of the digestive tract and pancreas. The 2010 WHO classification of tumors of the digestive system introduces grading and staging tools for neuroendocrine neoplasms. A carcinoid is now defined as a grade 1 or

Bertram Wiedenmann; Guido Rindi



Pancreas transplantation in African American patients using basiliximab induction.  


The long-term outcome of pancreas transplant (PT) in African Americans (AA) using interleukin-2 receptor antibody induction has not been well documented. We retrospectively analyzed the 7-year outcomes of 45 AA and 73 white recipients of primary PT at our center. All PT were performed with enteric-systemic drainage. Basiliximab induction, tacrolimus, mycophenolic acid, and steroid maintenance were used as the primary immunotherapy. There was no difference by Kaplan-Meier analysis in patient (P = 0.94), pancreas graft (P = 0.76), or death-censored graft survival (P = 0.71) over 7 years between the AA and white groups. Clinically treated pancreas rejection episodes were slightly higher in AA than in white patients. Similarly, cytomegalovirus infection rates and comparable quality of graft function were noted in both groups over 7 years. Excellent long-term patient and pancreas graft survivals can be achieved in AA recipients of PT by using interleukin-2 receptor antibody induction and combination of tacrolimus, mycophenolic acid, and steroid maintenance. PMID:19295415

Zhang, Rubin; Florman, Sander; Paramesh, Anil; Islam, Tareq; Zarifian, April; Simon, Eric; Hamm, L Lee; Slakey, Douglas



Characteristics of pancreas transplantation currently performed in japan  

Microsoft Academic Search

The Pancreas Transplantation (tx) Program under the Japanese Organ Transplant Act was started in 2000. PTx is indicated for type 1 diabetic patients on hemodialysis therapy. As of April 2003 93 patients are listed as candidates. Ten cases of PTx with enteric or bladder-drained technique were performed during the last 3 years as well as nine SPK and one PAK.

M Ishibashi; T Ito; A Sugitani; K Nakajima; T Abe; N Matsuno; Y Hirao; M Gotoh; M Tanaka; S Teraoka; H Matsuda; H Taniguchi; T Fukao; R Kikkawa; Y Idezuki; Y Kanazawa



Minnesota experience with 85 pancreas transplants between 1978 and 1983  

Microsoft Academic Search

We have performed 85 pancreas transplants in 79 diabetic patients since 1978 in a new clinical trial. Fifty grafts were from cadaver donors (32 segmental, 18 whole organ) and 35 (segmental) were from related donors (4 parent, 17 HLA identical and 7 non-identical siblings, 6 identical twins, 1 cousin). All the grafts from the living related donors were immediately transplanted,

David E. R. Sutherland; Patricia L. Chinn; Frederick C. Goetz; Barbara A. Elick; John S. Najarian



Organogenesis of endocrine pancreas from transplanted embryonic anlagen  

Microsoft Academic Search

The number of donor human pancreas organs that can be transplanted directly or used for islet of Langerhans isolation is limited. We and others have shown that it is possible to ‘grow’ new pancreatic tissue in situ by transplanting embryonic organ-specific pancreatic precursor cells. This technology takes advantage of the fact that selective development of islets takes place post transplantation

Marc R Hammerman



Diurnal blood pressure variation in kidney-pancreas transplant recipients  

Microsoft Academic Search

Blood pressure normally follows a characteristic pattern throughout the 24 h cycle with daytime pressures higher than nighttime pressures. Patients lacking a nocturnal decrease in pressure have a higher incidence of end organ damage. This investigation was designed to characterize the diurnal pattern of blood pressure and to evaluate blood pressure load in patients who have received a combined kidney-pancreas

Michael A. Marx; Stephanie F. Gardner; Beverley L. Ketel



Occupational exposure and cancer of the pancreas: a review  

Microsoft Academic Search

Many hypotheses have been proposed about the aetiology of cancer of the pancreas, especially concerning the effects of tobacco, coffee, alcohol, diet, and pancreatic pathology. Results of numerous epidemiological studies are, however, inconsistent. Chemical carcinogens have been implicated as possible risk factors. Animal studies have been carried out to determine the role of these chemical factors but, except for nitrosamines

F Pietri; F Clavel



Islet tumours of the pancreas with intractable diarrhoea  

PubMed Central

This paper reports the association between severe, prolonged, watery diarrhoea and islet cell tumours of the pancreas. There appear to be significant differences between patients with these symptoms and those with the classical Zollinger-Ellison syndrome. ImagesFIG. 1

Telling, M.; Smiddy, F. G.



Chronic ethanol administration causes oxidative stress in the rat pancreas  

Microsoft Academic Search

There is increasing evidence implicating oxidative stress in the pathogenesis of both acute and chronic pancreatitis. Because ethanol is a major cause of pancreatitis in Western society, the aim of this study was to determine whether chronic ethanol administration results in oxidative stress in the pancreas. Twelve pairs of rats were fed a diet containing ethanol as 36% of calories

I. D. Norton; M. V. Apte; O. Lux; P. S. Haber; R. C. Pirola; J. S. Wilson



Acinar cell carcinoma with fatty change arising from the pancreas  

PubMed Central

Acinar cell carcinoma of the pancreas is a rare malignant tumour developing from acinar cells, accounting for approximately 1% of pancreatic exocrine tumours. We experienced a case of an acinar cell carcinoma with fatty change. To the best of our knowledge, this is the first case report of an acinar cell carcinoma with fatty change in the clinical literature.

Chung, W-S; Park, M-S; Kim, D W; Kim, K W



The electrical properties of resting and secreting pancreas  

PubMed Central

1. The electrical properties of the resting and stimulated pancreas have been studied in the anaesthetized cat. There is an inverse relationship between the frequency of applied alternating current and the resistivity and dielectric constant of the resting pancreas. The resistivity is also affected by the fat content of the gland. The impedance locus of the pancreas is similar to that of other tissues. 2. On intravenous injection of secretin there is a brief increase, followed by a more marked decrease, in conductance and capacitance of the pancreas. The phase of decreased conductance is related to the flow of pancreatic juice. The decrease in conductance and the flow rate can be characterized by two closely related empirical equations. 3. During secretin stimulation the sodium concentration in pancreatic tissue increases, and the potassium concentration falls. 4. It is tentatively suggested that the decreased conductance across the secreting gland is mostly due to swelling of the secretory cells and to a minor degree is the result of changes in the composition of the secretion in the pancreatic ducts. 5. In the anaesthetized cat the mean half life of the secretory action of secretin is 199 sec.

Clark, D. G.; Greenwell, J. R.; Harper, A. A.; Sankey, Alison M.; Scratcherd, T.



Preoperative Chemotherapy in Patients with Malignant Ovarian Tumors.  

National Technical Information Service (NTIS)

Preoperative drug therapy has allowed for a 75% increase in surgical treatment of patients with malignant ovarian tumors. It was found that the survival rates for patients who were administered preoperative drug therapy was considerably higher than those ...

A. K. Pankov G. A. Nerodo E. G. Ilinskaya R. I. Shtirmer



New surgical technique for pediatric en-bloc kidney and pancreas transplantation: the pancreas piggy-back.  


Combined pancreas and kidney transplantation is the therapy of choice for type I diabetes patients with associated end-stage renal disease. To counterbalance increasing waiting lists, there is a clear need to extend the organ donor pool. Although results following simultaneous pancreas and kidney transplantation (SPK) using pediatric organs are encouraging, there is still reluctance in accepting them. This reflects the fear of graft thrombosis and graft failure because of small vessels and little absolute islet cell mass. Simpler transplant techniques for pediatric SPK might lower this threshold. In this article, a novel technique using a "piggy-back" implantation of the pancreas onto the conduits of en-bloc grafted kidneys, performed in two consecutive cases, is presented. This technique is associated with less vascular manipulation, requiring only one arterial anastomosis onto the frequently arteriosclerotic arteries of the recipient for all three organs. One-year follow-up (14 and 12 months) proved excellent graft function of kidneys and pancreas. PMID:23072376

Waldner, Matthias; Bächler, Thomas; Schadde, Erik; Schiesser, Marc; Immer, Franz; Clavien, Pierre-Alain; Brockmann, Jens Gunther



Effect of chronic unpredictable mild stress on brain–pancreas relative protein in rat brain and pancreas  

Microsoft Academic Search

Brain–pancreas relative protein (BPRP) is a novel protein whose biological function remains unknown. Here, we report a possible role of BPRP in male rats exposed to chronic unpredictable mild stress (CUMS) to induce depression for 3 weeks. Compared to unstressed rats, those exposed to CUMS showed significantly less weight gain with age, decreased consumption of (and preference for) sucrose without

Yan-Hua Lin; Ai-Hua Liu; Ying Xu; Lu Tie; He-Ming Yu; Xue-Jun Li



Agenesis of the dorsal pancreas and its association with pancreatic tumors.  


Morphogenesis of the pancreas is a complex process; nevertheless, congenital anomalies are rare. At embryogenesis, the pancreas develops from the endoderm-lined dorsal and ventral buds of the duodenum. The ventral bud gives rise to the lower head and uncinate process of the pancreas; whereas, the dorsal bud gives rise to the upper head, isthmus, body, and tail of the pancreas. Rarely, developmental failure of the dorsal pancreatic bud at embryogenesis results in the agenesis of the dorsal pancreas--neck, body, and tail. Even rarer is the association of pancreatic tumors with agenesis of the dorsal pancreas. In addition to citing our case, we provide a comprehensive review on agenesis of the dorsal pancreas and its association with pancreatic tumors. PMID:19390403

Sakpal, Sujit Vijay; Sexcius, Lucretia; Babel, Nitin; Chamberlain, Ronald Scott



Preoperative Embolization of Cervical Spine Tumors  

SciTech Connect

Purpose: To assess the technical success rate, complications, and effect on intraoperative blood loss of preoperative transarterial embolization of cervical spine tumors. Methods: A retrospective analysis was performed on 38 patients with tumors of the cervical spine; 69 vertebrae were affected. Polyvinyl alcohol particles, coils, gelfoam particles, either alone or in combination, were used for preoperative tumor embolization. After embolization a total of 57 corporectomies with titanium basket implantation were performed. Results: In 36 of 38 patients, complete (n= 27) or partial (n= 9) embolization was achieved. In 23 patients one vertebral artery was completely occluded by coil placement, and in one patient the ipsilateral internal and external carotid arteries were occluded in addition. No neurological complications could be directly related to the embolization, but two postoperative brain stem infarctions occurred. The mean intraoperative blood loss was 2.4 L. Conclusion: Transarterial embolization of cervical spine tumors is a safe and effective procedure to facilitate extensive surgery.

Vetter, Sylvia C.; Strecker, Ernst-Peter [Department of Radiology and Nuclear Medicine, Diakonissenkrankenhaus, Diakonissenstrasse 28, D-76199 Karlsruhe (Germany); Ackermann, Ludwig W.; Harms, Juergen [Department of Orthopedic Surgery, Klinikum Karlsbad-Langensteinbach Guttmannstrasse 1, D-76307 Karlsbad (Germany)



Assistive Communication Robot for Preoperative Health Care  

Microsoft Academic Search

\\u000a Health care costs and ageing population are two factors which are of major concern to western governments in the 21st century.\\u000a Existing work in affective health care is primary focused on developing avatars in the tele-health space. This paper reports\\u000a on the modeling of emotions (anxiety level) of patients in pre-operative stage using communication robots to assist nurses\\u000a in providing

Rajiv Khosla; Mei-Tai Chu; Kerstin Denecke; K. G. Yamada; T. Yamaguchi



[Analyzing and tracking preoperative and intraoperative astigmatism].  


Precise evaluation of preoperative astigmatism is the first step optimizing outcomes. This begins with office-based evaluation of astigmatism; corneal astigmatism is evaluated by keratometry, traditionally by Javal keratometry, but now including topography, whether Placido- or elevation-based, which allows for detailed analysis of even irregular astigmatism, including the corneal periphery, which is invaluable. Aberrometers, essentially "super-auto refractors", allow the incorporation of additional data into the qualitative analysis of astigmatism. The correlation between these multiple preoperative data helps to differentiate between corneal and total astigmatism, to infer the lenticular astigmatism, and to integrate all of these data into the clinical decision-making process. Immediately preoperatively, the 0 and 180° axes are marked; then, with the aid of a special marker, the axis of alignment for the toric IOL is also marked. Once the cataract is removed, the toric IOL is injected and pre-aligned; the viscoelastic is carefully removed, particularly from between the IOL and posterior capsule, with the toric IOL being definitively aligned at this point. These alignment techniques represent a major advance, soon to be indispensible for toric IOL surgery, which will certainly continue to grow in the future. PMID:22382128

Perez, M



A Case of a Metastatic Disease to the Pancreas from a Small-Cell Lung Carcinoma Documented by a CT-Scan-Guided Trucut Biopsy: The Diagnostic Role of Cytomorphology and Immunohistochemistry  

PubMed Central

Unlike primary pancreatic carcinoma, metastatic lesions of the pancreas are uncommon and account for approximately 2% of pancreatic malignancies. Small-cell lung carcinoma (SCLC) represents a group of highly malignant tumors giving rise to early and widespread metastasis at the time of diagnosis. However, the pancreas is a relatively infrequent site of metastasis by this neoplasm, and reports on metastatic small-cell carcinoma (SCC) in the pancreas, either of pulmonary or extrapulmonary origin, to be diagnosed by CT-scan-guided trucut biopsy (CT-TCB) are very rare. A 56-year-old man presented with a laterocervical lymphadenopathy associated to a mixed-density lung mass and a mass in the pancreatic body. CT-TCB slides from the pancreatic mass contained small, round tumor cells with extensive nuclear molding. The cytomorphological and histological diagnosis was metastatic SCC. Immunocytochemical staining showed that a variable number of neoplastic cells were positive for cytokeratin 7, TTF1, chromogranin A, and synaptophysin but negative for leukocyte common antigen and cytokeratin 20 with a very high expression of KI67. The transbronchial needle biopsy confirmed the diagnosis of an SCC. This case represents a rare metastatic lesion in the pancreas from SCLC, diagnosed by CT-TCB histological and immunohistochemical studies.

Bouyahia, N.; Daoudi, K.; Moumna, K.; Hijri, F. Z.; Benhammane, H.; Brahmi, S. A.; Arifi, S.; Mellas, N.; Amarti, A.; El Mesbahi, O.



A Case of a Metastatic Disease to the Pancreas from a Small-Cell Lung Carcinoma Documented by a CT-Scan-Guided Trucut Biopsy: The Diagnostic Role of Cytomorphology and Immunohistochemistry.  


Unlike primary pancreatic carcinoma, metastatic lesions of the pancreas are uncommon and account for approximately 2% of pancreatic malignancies. Small-cell lung carcinoma (SCLC) represents a group of highly malignant tumors giving rise to early and widespread metastasis at the time of diagnosis. However, the pancreas is a relatively infrequent site of metastasis by this neoplasm, and reports on metastatic small-cell carcinoma (SCC) in the pancreas, either of pulmonary or extrapulmonary origin, to be diagnosed by CT-scan-guided trucut biopsy (CT-TCB) are very rare. A 56-year-old man presented with a laterocervical lymphadenopathy associated to a mixed-density lung mass and a mass in the pancreatic body. CT-TCB slides from the pancreatic mass contained small, round tumor cells with extensive nuclear molding. The cytomorphological and histological diagnosis was metastatic SCC. Immunocytochemical staining showed that a variable number of neoplastic cells were positive for cytokeratin 7, TTF1, chromogranin A, and synaptophysin but negative for leukocyte common antigen and cytokeratin 20 with a very high expression of KI67. The transbronchial needle biopsy confirmed the diagnosis of an SCC. This case represents a rare metastatic lesion in the pancreas from SCLC, diagnosed by CT-TCB histological and immunohistochemical studies. PMID:23119202

Bouyahia, N; Daoudi, K; Moumna, K; Hijri, F Z; Benhammane, H; Brahmi, S A; Arifi, S; Mellas, N; Amarti, A; El Mesbahi, O



Identification of Accessory Spleens During Laparoscopic Splenectomy Is Superior to Preoperative Computed Tomography for Detection of Accessory Spleens  

PubMed Central

Background: Missed accessory spleen (AcS) can cause recurrence of hematologic disease after splenectomy. The objective of the study was to determine whether detection of AcS is more accurate with preoperative computed tomography (CT) scan or with exploration during laparoscopic splenectomy. Methods: A retrospective chart review was performed for 75 adult patients who underwent laparoscopic splenectomy for various hematologic disorders from 1999 to 2009. Preoperative CT scans were performed in all patients. Patients were followed for recurrence of disease, and a scintigraphy scan was performed in those with suspected missed AcS. Results: The most common diagnosis was idiopathic thrombocytopenic purpura in 29 patients (39%), followed by non-Hodgkin's lymphoma in 22 patients (29%). Sixteen AcSs were found during surgery in 15 patients (20%), and preoperative CT scan identified 2 of these. Twelve AcSs were located at the splenic hilum (75%). Nine patients experienced recurrence of their disease, and none had a missed AcS on subsequent scintigraphy. Sensitivity of exploratory laparoscopy for detection of AcS was 100%, and for preoperative CT scan was 12.5% (P = .005). Conclusion: Exploratory laparoscopy during splenectomy is more accurate than preoperative imaging with CT scan for detection of AcS. Preoperative CT scan misses AcS frequently and should not be obtained for the purpose of its identification.

Pahuja, Anil K.; Nemeth, Zoltan H.; Abkin, Alexander; Carter, Mitchel S.



One hundred pancreas transplants at a single institution.  

PubMed Central

Clinical pancreas transplantation at the University of Minnesota began in 1966. An initial series of 14 whole pancreas grafts was reported in part to the American Surgical Association in 1970. Only one patient survived for more than 1 year with a functioning graft. Twenty attempts at islet allotransplantation in the mid-1970s were unsuccessful. In 1978 we resumed performing pancreas transplants by the segmental technique, allowing the use of related donors. The current series (July 25, 1978 to December 20, 1983) includes 86 pancreas transplants (51 cadaver, 35 related) in 75 patients (41 with and 34 without previous kidney grafts). Variations in management of the pancreatic duct include three ligated, 15 duct-open, 39 duct-injected, and 29 pancreaticojejunostomies. The latter technique is currently preferred. Currently (April 1984) 61 patients are alive (81%), 24 have functioning grafts (32%), and 21 are insulin-independent (28%), three with open-duct grafts for 4.4 to 5.7 years, seven with silicone-injected grafts from 10 to 39 months, and 14 with pancreaticojejunostomies for 3 to 31 months; 15 of the grafts have functioned for greater than 1 year. Twenty-two of the grafts (25%) failed for technical reasons (thrombosis, infection, or ascites); 35 grafts functioned for 1 to 13 months before totally failing from either rejection, fibrosis, or recurrent disease; five patients died with functioning grafts. The graft survival rate has been higher for pancreases from related (15/35, 43% functioning) than from cadaver (9/51, 18% functioning) donors. The success rate has increased, e.g., 11/22 recipients of pancreas transplants in 1983 currently have functioning grafts (50%). Metabolic studies show most patients with functioning grafts to be euglycemic; however, three of 24 have chronic hyperglycemia unless supplemented with insulin, but they are no longer ketosis-prone. Glucose tolerance test results are normal or nearly normal in 12 and abnormal in 12 of the recipients with currently functioning grafts. Regression of diabetic nephropathy has been documented in two long-term recipients. Pancreas transplantation is currently applicable as treatment for selected diabetics who have demonstrated their propensity to develop serious secondary complications.

Sutherland, D E; Goetz, F C; Najarian, J S



Locoregional Recurrence of Breast Conserving Surgery after Preoperative Chemotherapy in Korean Women with Locally Advanced Breast Cancer  

PubMed Central

Purpose Preoperative chemotherapy has been used to increase the rate of breast conserving surgery (BCS) in Caucasian women. However, whether it would also increase the rate of BCS in Korean women has not been verified. The aim of this study was to determine the effectiveness of preoperative chemotherapy to make BCS possible in Korean women who have locally advanced cancer without any increase of locoregional recurrence according to operation methods (BCS vs. mastectomy). Methods From August 2002 to April 2005, 205 patients with stage II or III breast cancer were enrolled in a phase III randomized trial of preoperative chemotherapy. Surgeons decided on the type of surgery (mastectomy or BCS) at initial diagnosis. By randomization, patients received four cycles of either docetaxel/capecitabine or doxorubicin/cyclophosphamide followed by surgery and crossover to the other treatment as postoperative chemotherapy. Results The mean tumor size was 3.29 cm and the mean breast volume was 489 cc at diagnosis. After preoperative chemotherapy, clinical response was shown in 76.0% of the patients. Of the 71 patients planned for a mastectomy at initial diagnosis, 27 patients underwent BCS (38.0%). Clinical T stage after preoperative chemotherapy, pathologic T size and lymphatic invasion were correlated with conversion to BCS. In multivariate analysis, only lymphatic invasion showed statistical significance. Locoregional disease-free survival did not statistically differ between the two operation methods for the patients who were planned for a mastectomy at the initial exam. Conclusion This study showed that preoperative chemotherapy also increased the rate of BCS, while avoiding any increase of locoregional recurrence in Korean women with locally advanced breast cancer.

Lee, Seeyoun; Kim, Seok Won; Kim, Seok-Ki; Lee, Keun Seok; Kim, Eun A; Kwon, Youngmee; Shin, Kyung Hwan; Kang, Han-Sung; Ro, Jungsil



Successful Pregnancy after Simultaneous Pancreas-Kidney Transplantation  

PubMed Central

The effect of pregnancy on simultaneous pancreas-kidney transplant recipients has previously been described, but experience is limited. We describe the case of a thirty-five-year-old female who previously underwent simultaneous pancreas-kidney transplant for type 1 diabetes mellitus-complicated nephropathy. An integrated multidisciplinary team including the transplant team, nephrologist, endocrinologist, and obstetrician closely followed progress during pregnancy. Blood glucose levels and HbA1c remained within normal limits, and she did not require insulin treatment at any point. She experienced deterioration in renal indices and underwent an uncomplicated, elective Caesarean section at thirty-week gestation. She delivered a male infant of 1.18?kg, appropriate for gestational age, who had hypothermia and respiratory distress, which required intubation and ventilation and an eleven-week stay in the special care baby unit. At eighteen-month followup the infant shows normal development, and there has been no deterioration in either grafts' function.

Smyth, A.; Gaffney, G.; Hickey, D.; Lappin, D.; Reddan, D.; Dunne, F.



A novel strategy for long-term implantable artificial pancreas.  


Technology has recently changed type 1 diabetes treatment by introducing several advancements able to improve patients' quality of life. However, despite of several decades of research efforts, the dream of a fully-automated implanted artificial pancreas is quite far from its realization. The need for periodically restoring the implanted battery charge and refilling the implanted insulin reservoir are the main issues, for which invasive surgery, transcutaneous catheters or external portable devices are presently the only solutions. In this paper we propose a novel approach to these issues, describing a totally implanted closed-loop artificial pancreas with a wireless battery charger and a non-invasive strategy for insulin refilling, based on sensorized swallowable "insulin carrier" capsules. Such system has the potential to represent a final solution for diabetes treatment, by fully restoring patients' quality of life. PMID:22254935

Ricotti, Leonardo; Assaf, Tareq; Menciassi, Arianna; Dario, Paolo



Artificial pancreas: an emerging approach to treat Type 1 diabetes.  


Intensive insulin therapy aimed at achieving normal glucose levels significantly reduces the complications that are associated with diabetes but is also associated with an increased risk of low glucose levels (hypoglycemia). The growing use of continuous glucose monitors has stimulated the development of the artificial pancreas, a closed-loop insulin-delivery system aimed at restoring near-normal glucose levels while reducing the risk of hypoglycemia. The artificial pancreas comprises three components: a continuous glucose monitor, an insulin infusion pump and a control algorithm delivering insulin according to real-time glucose readings. In this article, we review closed-loop glucose control, including its components, development, testing and clinical application. PMID:19572795

Kumareswaran, Kavita; Evans, Mark L; Hovorka, Roman



[3 case reports of unsuccessful cadaveric pancreas transplantation].  


Pancreas transplantation, according to the experiences of USA and Europe, must be done persistently, as only in this way can be acquired the precious experiences. By the gradual preparation one can acquire criticism for this more complicated explantation of graft than its implantation. Three our cases, two of which ended with exitus letalis and one with the successful kidney transplantation only, speaks in favor of the fact that the experiences must permanently be enlarged on the own casuistics, with the readiness, that in the beginning results can also be discourageous, what, unfortunately has happened in our case. In the paper was presented the clinical flow, surgical technique, immunobiological monitoring and some important complications of our first transplantations of the whole pancreas. PMID:8701689

Boskovi?, S



[Pancreas divisum--a rare cause of chronic pancreatitis].  


Pancreas divisum (P.D.) is a congenital anatomic variant, characterized by the nonunion of dorsal and ventral pancreatic ducts. A 20 years old man followed for 8 years with reccurent abdominal pain and relapsing acute pancreatitis develope chronic calcific pancreatitis. He was diagnosed with P.D. on endoscopic retrograde pancreatography and operative pancreatography. The patient was treated with longitudinal pancreatico-jejunostomy (PUESTOW-GILLESBY procedure). His pain resolved following surgical drainage of the pancreatic duct. Evaluation of the clinical course of this patient and critical review of other such cases in the literature support the role of compromised ductal drainage of the pancreas in the pathogenesis of chronic pancreatitis in P.D. PMID:17410736

Vasile, D; Grigoriu, M; Turcu, Fl; Ilco, Al; Tenovici, G; Vasile, Raluca


Induction Gemcitabine and Stereotactic Body Radiotherapy for Locally Advanced Nonmetastatic Pancreas Cancer  

SciTech Connect

Purpose: Stereotactic body radiotherapy (SBRT) has been used successfully to treat patients with locally advanced pancreas cancer. However, many patients develop metastatic disease soon after diagnosis and may receive little benefit from such therapy. We therefore retrospectively analyzed a planned strategy of initial chemotherapy with restaging and then treatment for those patients with no evidence of metastatic progression with SBRT. Methods and Materials: Forty-seven patients received gemcitabine (1,000 mg/m{sup 2} per week for 3 weeks then 1 week off) until tolerance, at least six cycles, or progression. Patients without metastases after two cycles were treated with SBRT (tolerance-based dose of 24-36 Gy in 3 fractions) between the third and fourth cycles without interrupting the chemotherapy cycles. Results: Eight of the 47 patients (17%) were found to have metastatic disease after two cycles of gemcitabine; the remaining 39 patients received SBRT. The median follow-up for survivors was 21 months (range, 6-36 months). The median overall survival for all patients who received SBRT was 20 months, and the median progression-free survival was 15 months. The local control rate was 85% (33 of 39 patients); and 54% of patients (21 of 39) developed metastases. Late Grade III toxicities such as GI bleeding and obstruction were observed in 9% (3/39) of patients. Conclusion: For patients with locally advanced pancreas cancer, this strategy uses local therapy for those who are most likely to benefit from it and spares those patients with early metastatic progression from treatment. SBRT delivers such local therapy safely with minimal interruption to systemic chemotherapy, thereby potentially improving the outcome in these patients.

Mahadevan, Anand, E-mail: [Department of Radiation Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts (United States); Miksad, Rebecca; Goldstein, Michael; Sullivan, Ryan; Bullock, Andrea; Buchbinder, Elizabeth [Department of Medical Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts (United States); Pleskow, Douglas; Sawhney, Mandeep [Department of Interventional Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts (United States); Kent, Tara; Vollmer, Charles; Callery, Mark [Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts (United States)



Operative Management of Papillary Cystic Neoplasms of the Pancreas  

Microsoft Academic Search

Background: Papillary cystic neoplasm (PCN) is a rare malignant tumor of the pancreas that typically occurs in young females and has an excellent prognosis.Study Design: We report a retrospective review of 12 patients treated during a 16-year period. Pre-, intra-, and postoperative data were evaluated in all patients to determine optimal management with specific reference to surgical strategy.Results: All 12

Eugenio Panieri; Jake E. J Krige; Philippus C Bornman; Scott M Graham; John Terblanche; John P Cruse



Staging of carcinoma of the pancreas and ampulla of Vater  

Microsoft Academic Search

Summary  Between 1984 and 1987, 472 Norwegian patients with histologically or cytologically verified carcinoma of the pancreas (N=442) and ampulla of Vater (N=30) were accrued and TNM staged according to UICC. The influence of the T, N, and M categories on long-term survival was\\u000a evaluated. The T1a and T1b tumors of stage I pancreatic carcinoma had a comparable survival (p=0.68–0.95). A

Kåre E. Bakkevold; Brit Kambestad



Biocompatible polymer alloy membrane for implantable artificial pancreas  

Microsoft Academic Search

The preparation of a novel polymer alloy membrane with both biocompatibility and permeability for fabrication of an implantable artificial pancreas was carried out. The polymer alloy was composed of a segmented polyurethane (SPU) and phospholipid polymer with 2-methacryloyloxyethyl phosphorylcholine (MPC) units. The MPC polymer was poly(MPC-co-2-ethylhexyl methacrylate) (PMEH), which can be dissolved in the same solvent for SPU. The SPU\\/PMEH

Tomoaki Uchiyama; Junji Watanabe; Kazuhiko Ishihara



Proceedings of the 47th annual pancreas club meeting.  


The 47th annual Pancreas Club meeting was held on 17 and 18 May 2013 at the Walt Disney World Swan and Dolphin Hotel, Lake Buena Vista, FL, USA. Two hundred fifty-eight attendees comprised a remarkably international congress, with 92 international pancreatologists contributing to the meeting. Two hundred eleven abstracts were submitted from which 54 oral presentations and 140 posters were presented. PMID:23979638

Zyromski, Nicholas J; Baker, Marshall S



Transforming Growth Factor-? Signaling in Pancreas Development and Pancreatic Disease  

Microsoft Academic Search

Transforming growth factor-? (TGF-?) proteins have key roles in development of the pancreas, which is a complex exocrine and\\u000a endocrine gland that controls many homeostatic functions. Expression levels of several components of the TGF-? signaling pathway\\u000a are altered during pancreatic cancer progression, including that of the TGF-? ligands, TGF-? receptors and the inhibitory\\u000a Smads, Smad6 and Smad7. Mutations in a

Sushil G. Rane; Huei-Min Lin; Ji-Hyeon Lee


Pancreas divisum: Evaluation with secretin-enhanced magnetic resonance cholangiopancreatography  

Microsoft Academic Search

Background: The clinical significance of pancreas divisum (PD) remains controversial. Secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) is a noninvasive diagnostic procedure that relies on the dynamic response of the main pancreatic duct (MPD) to secretin stimulation. The aim of this study was to determine the frequency of PD and to analyze the dynamic changes of the MPD by using S-MRCP in

Celso Matos; Thierry Metens; Jacques Devière; Myriam Delhaye; Olivier Le Moine; Michel Cremer



Regimens of IGF-I Treatment in Fetal Pancreas Transplantation  

Microsoft Academic Search

Transplantation of fetal pancreas (FP) is a potential treatment for diabetes mellitus. FP has remarkable proliferative capacity and may be induced to expand sufficiently to provide a functional ? cell mass in adult recipients. We have demonstrated that local delivery of recombinant insulin-like growth factor-I (IGF-I) onto FP isografts is sufficient to reverse streptozotocin-induced diabetes in animals receiving as few

Gregg A. Adams; Elizabeth C. Squiers; Marcello Maestri; Larisse Lee; Edward J. Alfrey; Donald C. Dafoe



Selection and Preparation of the Pancreas Transplant Recipient  

Microsoft Academic Search

\\u000a Careful selection of appropriate pancreas transplant candidates is essential in order to maintain good patient and graft survival.\\u000a As more complex patients are referred with increasing acceptance of this procedure, meticulous evaluation of potential candidates\\u000a and their careful preparation prior to transplantation will also become increasingly necessary to maintain excellent outcomes.\\u000a This chapter is devoted to the identification of candidates

Ho-Yee Tiong; Venkatesh Krishnamurthi


Purinergic receptors in the endocrine and exocrine pancreas  

Microsoft Academic Search

The pancreas is a complex gland performing both endocrine and exocrine functions. In recent years there has been increasing\\u000a evidence that both endocrine and exocrine cells possess purinergic receptors, which influence processes such as insulin secretion\\u000a and epithelial ion transport. Most commonly, these processes have been viewed separately. In ? cells, stimulation of P2Y1 receptors amplifies secretion of insulin in

I. Novak



Ontogeny of glucagon messenger RNA in the rat pancreas  

Microsoft Academic Search

The synthesis of proglucagon mRNA was studied in rat pancreas from day 11 of fetal gestation (E11) to maturity. Proglucagon mRNA was first detected on E11, the time that the pancreatic bud forms in developing rats. The synthesis of proglucagon mRNA and its translation product at this early time point in pancreatic development suggests an early differentiation of A cell

S.-L. C. Jin; M. A. Hynes; J. G. Simmons; J. M. Lauder; P. K. Lund



Dorsal Pancreas Agenesis in N-Cadherin- Deficient Mice  

Microsoft Academic Search

Members of the cadherin family of cell adhesion molecules are thought to be crucial regulators of tissue patterning and organogenesis. During pancreatic ontogeny N-cadherin is initially expressed in the pancreatic mesenchyme and later in pancreatic endoderm. Analysis of N-cadherin-deficient mice revealed that these mice suffer from selective agenesis of the dorsal pancreas. Further analysis demonstrated that the mechanism for the

Farzad Esni; Bengt R. Johansson; Glenn L. Radice; Henrik Semb



Cystic fibrosis in the pancreas: Recent advances provide new insights  

Microsoft Academic Search

Idiopathic chronic pancreatitis accounts for up to one third of chronic pancreatitis cases. The most common inherited disease\\u000a of the exocrine pancreas is cystic fibrosis, which is caused by mutations of a gene encoding an ion transport protein. It\\u000a was discovered during the past year that many patients with idiopathic chronic pancreatitis have mutations of the gene that\\u000a causes cystic

Jeffrey D. Bornstein; Jonathan A. Cohn



Carcinoma of the Gallbladder: Diagnosis, Treatment, Prognosis  

Microsoft Academic Search

Despite modern imaging techniques, the majority of gallbladder cancers are recognized at the time of laparotomy, when curative procedures are rarely possible. Predisposing factors include old age, female sex and cholelithiasis. Abdominal pain, vomiting, anorexia, weight loss and jaundice are the most prevalent signs and symptoms. The nonspecific clinical picture combined with low sonographic diagnostic value make preoperative diagnosis unlikely.

Shalom Watemberg; Ram Avrahami; Ofer Landau; Itamar Kott; Alexander A. Deutsch



Extrahepatic biliary atresia: preoperative assessment and surgical results in 47 consecutive cases.  

PubMed Central

Of 47 consecutive infants with extrahepatic biliary atresia, effective bile drainage with the return of the serum bilirubin concentration to normal, was achieved in 17 (38%). Direct bile duct-to-bowl anastomosis, attempted in 15 infants, produced bile drainage in only those 4 (9%) in whom bile could be seen within the bile duct remnants at laparotomy. 13 (45%) of 29 infants subjected to portoenterostomy (direct liver-to-bowel anastomosis) had satisfactory prolonged bile drainage with normal serum bilirubin values. Although a correct preoperative diagnosis was made in each case, in 3 (6%) the 72-hour faecal rose bengal 131I excretion was greater than 10% of the injected dose, and in 5 (11%) the hepatic histology did not indicate bile duct obstruction, showing that both investigations are necessary for preoperative diagnosis. Preoperative clinical, laboratory, and hepatic histological features in the 16 jaundice-free survivors showed no significant difference when compared with the 31 infants in whom surgery was successful. Cholangitis occurred in only 7 (43%) of 16 infants with satisfactory bile drainage and was easily controlled with antibiotic treatment. No cutaneous enterostomies were performed. In most survivors liver function tests remain abnormal, but the patients are symptom-free. While it is too early to predict a long-term prognosis for these children, our eldest survivors are healthy and show normal development.

Psacharopoulos, H T; Howard, E R; Portmann, B; Mowat, A P



Development of the human pancreas from foregut to endocrine commitment.  


Knowledge of human pancreas development underpins our interpretation and exploitation of human pluripotent stem cell (PSC) differentiation toward a ?-cell fate. However, almost no information exists on the early events of human pancreatic specification in the distal foregut, bud formation, and early development. Here, we have studied the expression profiles of key lineage-specific markers to understand differentiation and morphogenetic events during human pancreas development. The notochord was adjacent to the dorsal foregut endoderm during the fourth week of development before pancreatic duodenal homeobox-1 detection. In contrast to the published data from mouse embryos, during human pancreas development, we detected only a single-phase of Neurogenin 3 (NEUROG3) expression and endocrine differentiation from approximately 8 weeks, before which Nirenberg and Kim homeobox 2.2 (NKX2.2) was not observed in the pancreatic progenitor cell population. In addition to revealing a number of disparities in timing between human and mouse development, these data, directly assembled from human tissue, allow combinations of transcription factors to define sequential stages and differentiating pancreatic cell types. The data are anticipated to provide a useful reference point for stem cell researchers looking to differentiate human PSCs in vitro toward the pancreatic ?-cell so as to model human development or enable drug discovery and potential cell therapy. PMID:23630303

Jennings, Rachel E; Berry, Andrew A; Kirkwood-Wilson, Rebecca; Roberts, Neil A; Hearn, Thomas; Salisbury, Rachel J; Blaylock, Jennifer; Piper Hanley, Karen; Hanley, Neil A



No evidence for ? cell neogenesis in murine adult pancreas.  


Whether facultative ? cell progenitors exist in the adult pancreas is a major unsolved question. To date, lineage-tracing studies have provided conflicting results. To track ? cell neogenesis in vivo, we generated transgenic mice that transiently coexpress mTomato and GFP in a time-sensitive, nonconditional Cre-mediated manner, so that insulin-producing cells express GFP under control of the insulin promoter, while all other cells express mTomato (INSCremTmG mice). Newly differentiated ? cells were detected by flow cytometry and fluorescence microscopy, taking advantage of their transient coexpression of GFP and mTomato fluorescent proteins. We found that ? cell neogenesis predominantly occurs during embryogenesis, decreases dramatically shortly after birth, and is completely absent in adults across various models of ? cell loss, ? cell growth and regeneration, and inflammation. Moreover, we demonstrated upregulation of neurogenin 3 (NGN3) in both proliferating ducts and preexisting ? cells in the ligated pancreatic tail after pancreatic ductal ligation. These results are consistent with some recent reports, but argue against the widely held belief that NGN3 marks cells undergoing endocrine neogenesis in the pancreas. Our data suggest that ? cell neogenesis in the adult pancreas occurs rarely, if ever, under either normal or pathological conditions. PMID:23619362

Xiao, Xiangwei; Chen, Zean; Shiota, Chiyo; Prasadan, Krishna; Guo, Ping; El-Gohary, Yousef; Paredes, Jose; Welsh, Carey; Wiersch, John; Gittes, George K



What is artificial endocrine pancreas? Mechanism and history.  


The artificial endocrine pancreas is a feedback control instrument that regulates insulin delivery on a minute-by-minute basis according to measured blood glucose levels. Only one type of bedside-type artificial endocrine pancreas is now available in Japan: STG-22 (Nikkiso Co. Ltd., Japan). In the insulin infusion algorithm, insulin is infused on the basis of its proportional and derivative actions, to blood glucose concentrations with a constant time delay. The bedside-type artificial endocrine pancreas has been proven to be useful not only as a therapeutic tool for diabetes mellitus, but also as an elegant research tool for investigating the pathophysiology of the disease, by using the euglycemic hyperinsulinemic glucose clamp technique. The wearable type of closed-loop system has been developed recently. The breakthrough is the establishment of a needle-type glucose sensor. The development of closed-loop glycemic control systems that enable long-term physiological regulation has focused on implantable devices. Much effort has been expended to realize these devices. PMID:19725141

Nishida, Kenro; Shimoda, Seiya; Ichinose, Kenshi; Araki, Eiichi; Shichiri, Motoaki



Quercetin Aglycone Is Bioavailable in Murine Pancreas and Pancreatic Xenografts  

PubMed Central

Quercetin is a potential chemopreventive and chemotherapeutic agent for pancreatic and other cancers. This study was to examine the distribution of quercetin in plasma, lung, liver, pancreas and pancreatic cancer xenografts in a murine in vivo model and the uptake of quercetin in pancreatic cancer MiaPaCa-2 cells in cellular in vitro model. Mice were randomly allocated to control diet, 0.2 and 1% quercetin diet groups utilizing the AIN93G-based diet (n=12 per group) for 6 weeks. In addition, 6 mice from each group were injected weekly with chemotherapeutic drug gemcitabine (120 mg/kg mouse, i.p.). MiaPaCa cells were collected from culture medium after cells were exposed to 30 µM of quercetin for 0.5, 1, 2, 4, 8, and 24 hrs. Levels of quercetin and 3-O’-methyl-quercetin in mice tissues and MiaPaCa-2 cells were measured by high-pressure liquid chromatography following enzymatic hydrolysis and then extraction. Our study showed that quercetin is accumulated in pancreatic cancer cells, and is absorbed in the circulating system, tumors and tissues of pancreas, liver and lung in vivo. A higher proportion of total quercetin found in tumors and pancreas are aglycones. Gemcitabine co-treatment with quercetin reduced absorption of quercetin in mice circulatory system and liver. Results from the study provide important information on the interpretation of chemo-therapeutic efficacy of quercetin.

Zhang, Lifeng; Angst, Eliane; Park, Jenny L.; Moro, Aune; Dawson, David W.; Reber, Howard A.; Eibl, Guido; Hines, O. Joe; Go, Vay-Liang W.; Lu, Qing-Yi



Canine pancreas and kidney transplantation following total-lymphoid irradiation  

SciTech Connect

The effect of total-lymphoid irradiation on survival of canine pancreas and kidney allografts was studied. TLI had a marked immunosuppressive effect as measured by in vitro immune responses and reduced circulating leukocytes. Despite the changes, median graft survival times for animals treated with 800 cGy (9 days) or 1800 cGy (9.5 days) were not significantly different from untreated control animals (7 days). The addition of low-dose antithymocyte globulin (10 mg/kg/day) on post-transplant days 0, 2, 4, 6, 8, and 10 had no measurable synergistic effect. Similarly, median segmental pancreas allograft survival times after 1700-2200 cGy of TLI treatment (16.5 days) were only marginally longer than those of untreated controls (9 days). The only animal to maintain a graft for greater than 200 days was matched to the donor in mixed lymphocyte culture (MLC). This animal was able to reject a third-party skin graft after 8 days while a graft from the original donor was still surviving after 21 days when the pancreas graft failed from a chronic-type rejection. These results indicate that TLI alone or in combination with ATG will not be predictably effective as a method of prolonging allograft survival. The role of matching major histocompatibility complex antigens in TLI treatment requires clarification.

Williamson, P.; Allen, R.D.; Deane, S.A.; Ekberg, H.; Grierson, J.M.; Hawthorne, W.J.; Mears, D.C.; Tiver, K.; Little, J.M.; Stewart, G.J. (Westmead Hospital, Sydney, New South Wales (Australia))



Current concepts in the simultaneous transplantation of kidney and pancreas.  


Diabetes mellitus (DM) represents an enormous health care concern for the United States and other countries. According to the American Diabetes Association in 2007, there were more than 23 million Americans living with diabetes. This is a 13.5% increase from 2005, likely representing increases in Type II DM (DMII). Diabetes mellitus results when the beta cells of the pancreas are unable to produce sufficient insulin to prevent hyperglycemia. Simultaneous pancreas and kidney transplantation, or SPK, may be indicated for patients that have experienced renal failure as a complication of DM (either type I or type II). Until recently, technical failure represented a significant impediment to the success of pancreas transplantation. At the turn of the century, however, both renal and pancreatic graft survival dramatically improved. Immunologic and nonimmunologic causes of graft failure continue to challenge inpatient and outpatient management. With vigilance in the ICU postoperatively and in the clinic, SPK can provide significant benefit both in patient survival and quality of life. PMID:21576190

Scalea, Joseph R; Cooper, Matthew



Pancreas++: Automated Quantification of Pancreatic Islet Cells in Microscopy Images  

PubMed Central

The microscopic image analysis of pancreatic Islet of Langerhans morphology is crucial for the investigation of diabetes and metabolic diseases. Besides the general size of the islet, the percentage and relative position of glucagon-containing alpha-, and insulin-containing beta-cells is also important for pathophysiological analyses, especially in rodents. Hence, the ability to identify, quantify and spatially locate peripheral, and “involuted” alpha-cells in the islet core is an important analytical goal. There is a dearth of software available for the automated and sophisticated positional quantification of multiple cell types in the islet core. Manual analytical methods for these analyses, while relatively accurate, can suffer from a slow throughput rate as well as user-based biases. Here we describe a newly developed pancreatic islet analytical software program, Pancreas++, which facilitates the fully automated, non-biased, and highly reproducible investigation of islet area and alpha- and beta-cell quantity as well as position within the islet for either single or large batches of fluorescent images. We demonstrate the utility and accuracy of Pancreas++ by comparing its performance to other pancreatic islet size and cell type (alpha, beta) quantification methods. Our Pancreas++ analysis was significantly faster than other methods, while still retaining low error rates and a high degree of result correlation with the manually generated reference standard.

Chen, Hongyu; Martin, Bronwen; Cai, Huan; Fiori, Jennifer L.; Egan, Josephine M.; Siddiqui, Sana; Maudsley, Stuart



The value of standard serum tumor markers in differentiating mucinous from serous cystic tumors of the pancreas: CEA, Ca 19-9, Ca 125, Ca 15-3  

Microsoft Academic Search

Background. Differentiating between mucinous cystic tumors (MCTs) and serous cystic tumors (SCTs) can be a troubling diagnostic dilemma in pancreatology: when SCTs present in their macro-oligocystic form they must be resected because MCT cannot be ruled out, and some tumors considered benign are actually MCTs, which delays diagnosis and places patients at increased risk. Examination of preoperative serum tumor markers

Claudio Bassi; Roberto Salvia; Andrew A. Gumbs; Giovanni Butturini; Massimo Falconi; Paolo Pederzoli



[Preoperative and postoperative management of adrenal masses].  


The surgical approach of adrenal masses requires a careful preoperative and postoperative management. In order to avoid iatrogenic hypocortisolism, Cushing patients have to be treated, before adrenal surgery and then every eight hours, with hydrocortisone 100 mg iv. The therapy should be gradually reduced to 10-20 mg/die by mouth for six-twelve months. In primary hyperaldosteronism the target of medical treatment is to control blood pressure and serum potassium values as well as to normalize the circulating aldosterone levels or to obtain mineralocorticoid receptor blockade. Epleronone and spironolactone are the most common used drugs. Spironolactone has long been the drug of choice while epleronone represents a newer more expensive alternative with fewer side effects. Postoperative management generally does not require steroid replacement therapy. The management of pheochromocytoma requires a careful medical preparation for surgery: in fact, the surgical removal of a pheochromocytoma is a high-risk procedure and an experienced surgeon/anesthesiologist team is required. The preoperative medical therapy is aimed at controlling hypertension (including preventing a hypertensive crisis during surgery) and at avoiding cardiac arrhythmia. The most common used drugs are alpha-adrenergic blockade: phenoxybenzamine is an irreversible, long-acting, nonspecific alpha-adrenergic blocking agent. Doxazosine is a selective alpha1-adrenergic blocking agent with a more favorable side-effect profile, being less related to postoperative hypotension. Postsurgical management is aimed at expanding plasma volume: a copious hydration is required while the use of dopamine in hemodynamin support is not effective because of the preoperative use of alpha-blocking agents. PMID:20646386

Paragliola, R M; Ricciato, M P; Gallo, F; De Rosa, A; Ianni, F; Locantore, P; Senes, P; Pontecorvi, A; Corsello, S M


Intraductal papillary mucinous tumours of the pancreas. Clinical and therapeutic issues in 32 patients.  

PubMed Central

BACKGROUND/AIM: The clinical presentation, pancreatographic findings, and outcome of patients with intraductal papillary mucinous tumours have not been reported in a large patient series in the English literature. This study reviewed 32 patients diagnosed between 1980 and 1994, with special attention to these features. PATIENTS/METHOD: Data on 24 operated and eight non-operated patients were abstracted from inpatient, outpatient, and procedure records. RESULTS: Acute pancreatitis was the most common presentation seen in 56% of patients. Relapses occurred during an average of 43 months before diagnosis. A patulous papilla was observed in 55% of the cases. Endoscopic pancreatography showed communicating cysts, a diffusely dilated main pancreatic duct, and amorphous defects in 42, 71, and 97% respectively. An invasive carcinoma was found in nine of 24 (37.5%) of operated patients: six of the patients (66%) died or developed metastases within three years after surgery. No mortality was related to the tumour in absence of invasive carcinoma. Benign recurrence on the remaining pancreas was unusual and occurred late after surgery. CONCLUSIONS: Intraductal papillary mucinous tumours must be considered in the differential diagnosis of relapsing pancreatitis. Despite slow growing, these tumours have an obvious malignant potential and a very poor prognosis when invasive carcinoma has developed. Early recognition and resection are the cornerstones of treatment. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9

Azar, C; Van de Stadt, J; Rickaert, F; Deviere, M; Baize, M; Kloppel, G; Gelin, M; Cremer, M



Preoperational test report, raw water system  

SciTech Connect

This represents the preoperational test report for the Raw Water System, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system supplies makeup water to the W-030 recirculation evaporative cooling towers for tanks AY1O1, AY102, AZ1O1, AZ102. The Raw Water pipe riser and associated strainer and valving is located in the W-030 diesel generator building. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

Clifton, F.T.



Anesthesiologic preoperative evaluation of drug addicted patient.  


Even if there are few scientific data about preoperative management of drug addict patients, a careful anesthesiology evaluation facilitates the prevention of interactions between drugs and anaesthetics and avoids intraoperative and postoperative complications. Moreover it is important to earn the confidence of patient in order to know the abuse substances consumed and the frequency of consumption. This knowledge is necessary to the anaesthetist in order to manage possible withdrawal syndromes or overdose, which are the two greatest dangers for a drug addict patient during the hospital stay. PMID:15886603

Cavaliere, F; Iacobone, E; Gorgoglione, M; Pellegrini, A; Tafani, C; Volpe, C; Conti, G



Magnetic resonance diagnosis of intramedullary tumors of the spinal cord  

Microsoft Academic Search

Fifty patients with intramedullary space occupying lesions were studied with MR from October 1983. Of these 32 were operated on and histological diagnosis together with gross morphological description was available. MR findings were reviewed in search for morphological and signal characteristics capable of providing a better preoperative diagnosis. There were 11 astrocytomas, 10 ependymomas, 5 vascular lesions and 6 “gliomas”.

G. Scotti; G. Scialfa; N. Colombo; L. Landoni



A giant retention cyst of the pancreas (cystic dilatation of dorsal pancreatic duct) associated with pancreas divisum  

Microsoft Academic Search

  We describe a rare case of pancreas divisum associated with a giant retention cyst (cystic dilatation of the dorsal pancreatic\\u000a duct), presumably formed following obstruction of the minor papilla. The patient was treated by pancreatico(cysto)jejunostomy.\\u000a A 50-year-old man was admitted with complaints of increasing upper abdominal distension and body weight loss. There was no\\u000a previous history of pancreatitis, gallstones, drinking,

Zenichi Morise; Kazuo Yamafuji; Tadao Tsuji; Atsunori Asami; Kaoru Takeshima; Noritaka Hayashi; Hideo Baba; Fumiko Yoshida; Yuta Abe; Yasuyuki Tokura



Association of Preoperative Biliary Drainage With Postoperative Outcome Following Pancreaticoduodenectomy  

PubMed Central

Objective To determine whether preoperative biliary instrumentation and preoperative biliary drainage are associated with increased morbidity and mortality rates after pancreaticoduodenectomy. Summary Background Data Pancreaticoduodenectomy is accompanied by a considerable rate of postoperative complications and potential death. Controversy exists regarding the impact of preoperative biliary instrumentation and preoperative biliary drainage on morbidity and mortality rates after pancreaticoduodenectomy. Methods Two hundred forty consecutive cases of pancreaticoduodenectomy performed between January 1994 and January 1997 were analyzed. Multiple preoperative, intraoperative, and postoperative variables were examined. Pearson chi square analysis or Fisher’s exact test, when appropriate, was used for univariate comparison of all variables. Logistic regression was used for multivariate analysis. Results One hundred seventy-five patients (73%) underwent preoperative biliary instrumentation (endoscopic, percutaneous, or surgical instrumentation). One hundred twenty-six patients (53%) underwent preoperative biliary drainage (endoscopic stents, percutaneous drains/stents, or surgical drainage). The overall postoperative morbidity rate after pancreaticoduodenectomy was 48% (114/240). Infectious complications occurred in 34% (81/240) of patients. Intraabdominal abscess occurred in 14% (33/240) of patients. The postoperative mortality rate was 5% (12/240). Preoperative biliary drainage was determined to be the only statistically significant variable associated with complications (p = 0.025), infectious complications (p = 0.014), intraabdominal abscess (p = 0.022), and postoperative death (p = 0.037). Preoperative biliary instrumentation alone was not associated with complications, infectious complications, intraabdominal abscess, or postoperative death. Conclusions Preoperative biliary drainage, but not preoperative biliary instrumentation alone, is associated with increased morbidity and mortality rates in patients undergoing pancreaticoduodenectomy. This suggests that preoperative biliary drainage should be avoided whenever possible in patients with potentially resectable pancreatic and peripancreatic lesions. Such a change in current preoperative management may improve patient outcome after pancreaticoduodenectomy.

Povoski, Stephen P.; Karpeh, Martin S.; Conlon, Kevin C.; Blumgart, Leslie H.; Brennan, Murray F.



Resection of the inferior head of the pancreas: Report of a case  

Microsoft Academic Search

We developed a new technique for partial resection of the head of the pancreas with an end-to-side pancreaticoduodenostomy, while preserving the duodenum, the common bile duct, and the upper part of the head of the pancreas around the duct of Santorini. A resection of the inferior head of the pancreas was performed in a patient with an intraductal mucin-producing tumor

Toshio Nakagohri; Takehide Asano; Wataru Takayama; Takeshi Uematsu; Masayuki Hasegawa; Hideaki Miyauchi; Michihiro Maruyama; Chikara Iwashita; Kaichi Isono



A prospective comparison of systemic-bladder versus portal-enteric drainage in vascularized pancreas transplantation  

Microsoft Academic Search

Background: Most pancreas transplants are performed with systemic venous delivery of insulin and bladder drainage of the exocrine secretions (systemic-bladder [S-B]). To develop a more physiologic procedure, we performed pancreas transplantations with portal venous delivery of insulin and enteric drainage of the exocrine secretions (portal-enteric [P-E]). Methods: During an 11-month period, we prospectively alternated 32 consecutive pancreas transplant recipients to

Robert J Stratta; A. Osama Gaber; M. Hosein Shokouh-Amiri; K. Sudhakar Reddy; M. Francesca Egidi; Hani P Grewal; Lillian W Gaber



The surgical risk of pancreas transplantation in the cyclosporine era: an overview  

Microsoft Academic Search

Background:Pancreas transplants are still associated with the highest surgical complication rate of all routinely performed solid organ transplants. To date, the impact of serious surgical complications in the cyclosporine era on perioperative patient morbidity, graft and patient survival, and hospital costs has not been analyzed in detail.Study Design:We retrospectively studied surgical complications after 445 consecutive pancreas transplants (45% simultaneous pancreas-kidney

Rainer W. G Gruessner; David E. R Sutherland; Christoph Troppmann; Enrico Benedetti; Nadey Hakim; David L Dunn; Angelika C Gruessner



Preoperative predictors of malignant gastric submucosal tumor  

PubMed Central

Purpose The preoperative prediction of malignant potential in patients with gastric submucosal tumors (SMTs) plays an important role in decisions regarding their surgical management. Methods We evaluated the predictors of malignant gastric SMTs in 314 patients with gastric SMTs who underwent surgery in Chonnam National University Hospital. Results The malignant SMTs were significantly associated with age (odds ratio [OR], 1.067; 95% confidence interval [CI], 1.042 to 1.091; P < 0.0001), presence of central ulceration (OR, 2.690; 95% CI, 1.224 to 5.909; P = 0.014), and tumor size (OR, 1.791; 95% CI, 1.483 to 2.164; P < 0.0001). Receiver operating characteristic curve analysis showed that tumor size was a good predictor of malignant potential. The most relevant predictor of malignant gastric SMT was tumor size with cut-offs of 4.05 and 6.40 cm. Conclusion Our findings indicated that age, central ulceration, and tumor size were significant preoperative predictors of malignant SMTs. We suggest that 4 cm be selected as a threshold value for malignant gastric SMTs. In patients with a gastric SMT larger than 4 cm with ulceration, wide resection of the full thickness of the gastric wall or gastrectomy with adequate margins should be performed because of its malignant potential.

Kim, Ho Goon; Ryu, Seong Yeob; Yun, Sang Kwon; Joo, Jae Kyoon; Lee, Jae Hyuk



Esophageal atresia. Prognostic factors and contribution of preoperative telescopic endoscopy.  

PubMed Central

In recent years, the surgical correction of esophageal atresia with distal tracheoesophageal fistula (TEF) has become increasingly successful. However, there remains a group of high-risk patients with specific anatomical abnormalities in whom the mortality remains appreciable. These associated disorders include cardiac, renal, and chromosomal anomalies as well as severe respiratory distress syndrome. These factors, rather than low birth weight or early gestational age, are primarily responsible for surgical mortality. Preoperative telescopic bronchoscopy has been a useful adjuvant confirming the diagnosis, identifying unusual variants, and permitting the proper anatomic placement of the endotracheal tube. A Fogarty balloon catheter can be passed bronchoscopically into the distal TEF in patients with severe respiratory distress syndrome to occlude the fistula and facilitate effective positive pressure ventilation. Thirty-two patients were treated for esophageal atresia among whom 28 had esophageal atresia with distal TEF, three had esophageal atresia alone, and one had esophageal atresia with proximal TEF. The higher-risk group comprised those with severe respiratory insufficiency as evidenced by a room air paO2 of less than 60 mmHg; this group accounted for nine of the ten deaths in the total series. There was one late death following surgical correction. In summary, in the absence of severe respiratory insufficiency or associated life-threatening congenital anomalies, the results of surgical correction for esophageal atresia are remarkably good and survival in this group approximates 100%. Images Fig. 1A, 1B.

Filston, H C; Rankin, J S; Grimm, J K



Adverse effects of preoperative steroid use on surgical outcomes  

Microsoft Academic Search

BackgroundPreoperative steroid use has been associated with increased postoperative complications. We sought to establish these risks using data from the National Surgical Quality Improvement Program (NSQIP).

Hishaam Ismael; Mathilda Horst; Maria Farooq; Jack Jordon; Joe H. Patton; Ilan S. Rubinfeld



Evaluation of clinical diagnosis by knee arthroscopy.  


This prospective study was carried out in the orthopaedic department of a medical college to evaluate the accuracy of clinical diagnosis by knee arthroscopy. The reliability of clinical assessment (history and physical examination) was determined by comparing the initial pre-operative diagnosis with the postoperative diagnosis as determined by arthroscopy. The study group included 50 patients (50 knees) scheduled for arthroscopic surgery for suspected internal derangements of knees. The primary pre-operative diagnosis was fully correct in 16 cases (32%), partially correct in 16 cases (32%), and incorrect in 18 cases (36%), with an overall accuracy of 81%, sensitivity 82% and specificity 62%. The most common pre-operative diagnosis was medial meniscal tear and anterior cruciate ligament tear. The results of clinical assessment were comparable to the published reports. Though the present study suggests that the diagnostic value of arthroscopy is higher than clinical examination but it also makes it apparent that the two techniques complement each other and are more accurate when taken together than individually. PMID:24003563

Juyal, Anil; Variyani, Amber; Sharma, Sansar Chand; Chauhan, Vijendra; Maheshwari, Rajesh



Solid pseudopapillary tumor of the pancreas: 'experiences' and 'lessons' at a tertiary-care oncology center.  


Solid pseudopapillary tumor of the pancreas (SPT) is a rare and fascinating entity of elusive histogenesis and unpredictable biology. It has a peculiar proclivity to afflict young females and involve the pancreatic body-tail region. Cytology diagnosis of these rare neoplasms remains a challenge. We analyzed the cytology features of all SPT cases diagnosed on fine needle aspiration cytology (FNAC) from 2003 to 2009 along with their histopathology slides. Nineteen consecutive cases were diagnosed as SPT on FNAC. Fifteen out of nineteen cases were confirmed as true SPT on histopathology. Amongst the true SPT, all except one occurred in females. Age ranged from 14 to 50 years. Pseudopapillae bearing stout branches terminating in bulbous tips and enclosing transgressing vessels, separated from a collar of tumor cells by a clear zone of myxohyaline coat were pathognomonic of SPT. Singly dispersed monomorphic tumor cells with bland chromatin formed the second diagnostic component of SPT. Nuclear grooves and hyaline globules were in addition helpful in segregating SPT from its close differentials. In four cases diagnosed as SPT on FNAC, histopathology revealed a different final diagnosis (one case each of paraganglioma, extragastrointestinal stromal tumor, metastatic papillary renal cell carcinoma and inflammatory myofibroblastic tumor). Conversely, one case of SPT had been erroneously diagnosed as neuroendocrine tumor on FNAC. Six cases (40%) developed metastasis; commonest site being liver. In conclusion, cytology in conjunction with clinico-radiologic findings plays a key role in making a correct diagnosis. Awareness of unique cytomorphological features is important in distinguishing this tumor from its diverse mimics. PMID:23008277

Bal, Munita Meenu; Deodhar, Kedar; Shrikhande, Shailesh; Shukla, Parul; Arya, Supreeta; Ramadwar, Mukta



Robot-Assisted Subtotal Pancreas-Preserving Duodenectomy  

PubMed Central

Background: Angiodysplasia of the duodenum is a rare disorder, often requiring surgical resection. Technical difficulties have made the use of the minimally invasive approach uncommon. Herein, we present a subtotal pancreas-preserving duodenectomy using robotic assistance. Methods: The patient is a 60-y-old female with a long medical history including chronic gastrointestinal bleeding due to angiodysplasia with intermittent melena, and requiring multiples blood transfusions. A capsule endoscopy and double-balloon upper endoscopy showed angiectasis, which appeared to be limited to the third and fourth portion of the duodenum and the proximal loops of the jejunum. Despite multiple endoscopic cauterizations, the patient continued to require blood transfusion for several years. The patient underwent a robot-assisted subtotal pancreas-preserving duodenectomy. Results: The operation lasted 420 min with minimal blood loss. The postoperative course was uneventful. The pathology report showed multiple small bowel mucosal and submucosal distorted and dilated vasculature, consistent with angiodysplasia. At 2-mo follow-up, the patient was totally asymptomatic. A barium swallow study showed contrast passed antegrade through the duodenojejunostomy with no evidence of obstruction, stricture, or leakage. Conclusion: The use of robotic assistance to perform a subtotal pancreas-preserving duodenectomy for the treatment of benign duodenal disease, such as angiodysplasia, is feasible and safe. The technical advantages include a high degree of freedom offered by the robotic instruments, as well as enhanced visualization, which allows for precise microdissection and microsuture, thereby preserving the benefits of minimally invasive surgery. The use of robotic technology allows for a wider range of indications for minimally invasive surgery.

Gheza, Federico; Raimondi, Paolo; D'Ugo, Stefano; Calatayud, David; Giulianotti, Pier C.



Preoperative psychosocial evaluation of penile prosthesis candidates.  


Penile prosthesis surgery is a recommended treatment option for a subset of patients who present with erectile dysfunction (ED). Although treatment outcome research indicates that patients are generally satisfied with this intervention, it remains an invasive procedure with risk for complications. A review of the literature reveals general agreement for the importance of a thorough preoperative evaluation to determine appropriateness for a penile implant; however, there are no known descriptions of such an evaluation in the literature. This article provides an introduction to the domains that are most relevant to assess in a patient who is considering penile implant surgery: sexual history (including organic and psychogenic causes of ED), success and utilization of other treatment interventions, relationship functioning, and patient expectations for and knowledge of the procedure. The advantages to this approach are presented, particularly in enhancing patient satisfaction with treatment outcomes. PMID:19477771

Ulloa, Erin Winters; Silberbogen, Amy K; Brown, Kirstin



Preoperational test report, recirculation condenser cooling systems  

SciTech Connect

This represents a preoperational test report for Recirculation Condenser Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The four system provide condenser cooling water for vapor space cooling of tanks AY1O1, AY102, AZ1O1, AZ102. Each system consists of a valved piping loop, a pair of redundant recirculation pumps, a closed-loop evaporative cooling tower, and supporting instrumentation; equipment is located outside the farm on concrete slabs. Piping is routed to the each ventilation condenser inside the farm via below-grade concrete trenches. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

Clifton, F.T.



Preoperative preparation for patients with nutritional disorders.  


Eating disorders are very common today. An increasing number of patients that undergo anesthesia and surgery have some nutritional disorder. These disorders are very versatile starting from obesity to anorexia. Significant changes in all organ systems are present. These pathophysiological changes are increased with the duration of the disease. There are many changes in the functioning of the cardiovascular system in all these diseases and there are significant. Respiratory and ventilatory functions are changed too. There are also many endocrine disorders. As a final result, there are many serious biochemical and coagulation disorders. These patients are often under some drug treatment. Patients could be under psychiatric therapy (psychiatric drugs) and/or could take drugs for relieving symptoms related to the pathophysiological changes in different organ systems. Preoperative preparation of patients must be detailed. All changes must be improved to optimal condition. In addition, it is necessary to think about the possible influence of used drugs on the anesthesia. PMID:21879667

Palibrk, Ivan; Velickovi?, Jelena; Panti?-Palibrk, Vesna; Arsenijevi?, Vladimir; Tanovi?, Biljana; Ugrinovi?, Djordje



Preoperative pulmonary assessment of the older adult.  


Postoperative pulmonary complications in the elderly are common and are a significant source of morbidity, mortality, and prolonged length of stay. Risk factors differ from the well-known risk factors for cardiac complications and can be divided into patient- and procedure-related factors. Patient-related factors include COPD, recent cigarette use, poor general health status as defined by Goldman or ASA class, dependent functional status, and laboratory parameters including abnormal chest radiograph, renal insufficiency, and low serum albumin. Age is a minor risk factor when adjusted for comorbidities and confers approximately a two-fold increase in risk. Elderly patients who are otherwise acceptable surgical candidates should not be denied surgery based solely on age and concern for postoperative pulmonary complications. The surgical site is the single most important predictor of pulmonary complications. High-risk surgeries include thoracic, upper abdominal, aortic, neurosurgery, and peripheral vascular. Other procedure-related risk factors include surgery lasting longer than 3 hours, the use of general anesthesia, pancuronium use, and emergency surgery. Clinicians should not recommend routine preoperative spirometry before high-risk surgery because it is no more accurate in predicting risk than clinical evaluation. Patients who might benefit from preoperative spirometry include those who have unexplained dyspnea or exercise intolerance and those who have COPD or asthma in whom uncertainty exists as to the status of airflow obstruction when compared with baseline. After identifying patients at risk for postoperative pulmonary complications, clinicians can recommend strategies to reduce risk throughout the operative period. In addition to minimizing or avoiding the above risk factors, optimization of COPD or asthma, deep breathing exercises, incentive spirometry, and epidural local anesthetics reduce the risk of postoperative pulmonary complications in elderly surgical patients. PMID:12735114

Smetana, Gerald W



Pre-operative nutrition and carbohydrate loading.  


An optimal nutritional state is an important consideration in providing successful operative outcomes. Unfortunately, many aspects of surgery are not constructive to providing this. In addition, the metabolic and immune response to injury induces a catabolic state and insulin resistance, a known risk factor of post-operative complications. Aggressive insulin therapy post-operatively has been shown to reduce morbidity and mortality but similar results can be achieved when insulin resistance is lessened by the use of pre-operative carbohydrate loading. Consuming carbohydrate-containing drinks up to 2 h before surgery has been found to be an effective way to attenuate insulin resistance, minimise protein losses, reduce hospital stays and improve patient comfort without adversely affecting gastric emptying. Enhanced recovery programmes have employed carbohydrate loading as one of several strategies aimed at reducing post-operative stress and improving the recovery process. Studies examining the benefits of these programmes have demonstrated significantly shorter post-operative hospital stays, faster return to normal functions and lower occurrences of surgical complications. As a consequence of the favourable evidence they are now being implemented in many surgical units. Further benefit to post-operative recovery may be found with the use of immune-enhancing diets, i.e. supplementation with n-3 fatty acids, arginine, glutamine and/or nucleotides. These have the potential to boost the immune system, improve wound healing and reduce inflammatory markers. Research exploring the benefits of immunonutrition and solidifying the use of carbohydrate loading is ongoing; however, there is strong evidence to link good pre-operative nutrition and improved surgical outcomes. PMID:21781358

Kratzing, Caroline



Intraductal growing acinar cell carcinoma of the pancreas.  


Acinar cell carcinoma (ACC) is a rare pancreatic exocrine neoplasm characterized by a huge, exophytic well-circumscribed hypovascular mass. There has been several reports describing intraductal and papillary variant of ACC and they showed different radiologic features from usual ACC. We present histologically confirmed cases of intraductal and papillary variant of ACC that had been found in two patients, who underwent CT and MRI. This report provides CT and MRI features of intraductal and papillary variant of ACC in pancreas with pathologic correlation after surgical excision. PMID:23515859

Kim, Hae Jin; Kim, Young Kon; Jang, Kee Taek; Lim, Jae Hoon



Laparoscopic pancreas-preserving subtotal duodenectomy for gastrointestinal stromal tumor.  


Gastrointestinal stromal tumors (GISTs) of the duodenum are rare neoplasms. The optimal surgical procedure is debated and several options ranging from limited resections to pancreaticoduodenectomy have been reported. The laparoscopic approach has been validated for gastric GISTs, but it does not yet represent a standard technique for tumors of the duodenum. We report the case of a localized duodenal GIST that was successfully treated by totally laparoscopic pancreas-preserving subtotal duodenectomy. This procedure may represent a feasible and effective treatment option for localized GISTs of the duodenum. Large series with long-term follow-up are needed. PMID:22732015

Corcione, Francesco; Pirozzi, Felice; Sciuto, Antonio; Galante, Francesco; Bracale, Umberto; Andreoli, Federica



Santorinicele without pancreas divisum pathophysiology: initial clinical and radiographic investigations  

PubMed Central

Background Only one case of santorinicele without pancreas divisum pathophysiology (SWOPP) was previously reported. The purpose of the study was to determine the gross prevalence of SWOPP and santorinicele with pancreas divisum (SWPD) in community and patient populations, and investigate their clinical and radiographic features. Methods This cross-sectional study was performed at a tertiary referral centre. The Patient group comprised 2035 consecutive patients enrolled in the study who underwent magnetic resonance cholangiopancreatography (MRCP) studies. The Community group comprised 2905 consecutive subjects who participated in our whole-body medical check-up program that routinely includes MRCP studies. SWOPP was diagnosed when a saccular dilatation of the terminal portion of the dorsal pancreatic duct was observed unaccompanied by pancreas divisum or dominant dorsal duct. The prevalence of SWOPP and SWPD, and the clinical and radiological features were assessed in each group. Results Five cases of SWOPP were found in the Patient group (age range, 67–85 years; mean age, 73.6 years) (5/2035?=?0.25%; 95% confidence interval, 0.07–0.57); there were no cases of SWOPP in the Community group (0/2905?=?0.00%; 95% confidence interval, 0.00–0.10) (P?=?0.01). Previous history of pancreatitis (4/5) and chronic pancreatitis (3/5) was more common in patients with SWOPP than in other subjects in the Patient or Community groups (both P?pancreas divisum.



Ultrasound study of acute appendicitis in children with emphasis upon the diagnosis of retrocecal appendicitis  

Microsoft Academic Search

Acute appendicitis in children frequently presents equivocal clinical manifestations. Delay of the proper diagnosis and unnecessary laparotomies are common. Abdominal ultrasound has proved to be useful in the diagnosis of acute appendicitis in adults. We have performed a preoperative ultrasound study in 368 children with acute appendicitis. Among them, 92 had a retrocecal appendicitis. Ultrasound established the correct diagnosis in

L. Ceres; I. Alonso; P. López; G. Parra; J. Echeverry



A resected case of multiple intraductal papillary mucinous tumors of the pancreas with US-guided ductal branch-oriented partial pancreatectomy.  


A 69-year-old man with epigastralgia was admitted on August 26, 2002 and diagnosed with multiple intraductal papillary mucinous tumors by various imagings. The cystic tumor of pancreas head had a diameter of 2 cm, and the mural nodule of the cystic tumor measured only 3 mm. In the pancreas body the cystic tumor was measured at 1.5 cm with the mural nodule of the cystic tumor measuring 3 mm. It was believed that the tumors were benign. However, a mural nodule of the cystic lesion was recognized, thus, the possibility of malignancy could not be completely ruled out. The reduction operation for preservation of pancreatic parenchyma should be selected for these circumstances. Ductal branch-oriented partial pancreatectomy was performed on September 6, 2002 with intraoperative ultrasonography and a Cavitron Ultrasonic Aspirator, preserving the main pancreatic duct and normal pancreatic parenchyma. The operation was successful, and the histopathological diagnosis of the tumors was intraductal papillary adenoma of the pancreas. PMID:15985773

Hayashibe, Akira; Sakamoto, Kazuki; Shinbo, Masaya; Makimoto, Shinitiro; Nakamoto, Takeshi



Effects of ethanol feeding and malnutrition on collagen synthesizing and degrading enzymes in rat pancreas  

Microsoft Academic Search

This study was performed to delineate the combined effects of a low-fat diet and chronic ethanol ingestion on collagen metabolism in rat pancreas. Rats fed a very low-fat diet (5% of total calories as lipid) for 12 weeks developed malnutrition as judged by weight loss (?33% of the initial body weight) and low serum albumin and amylase levels. The pancreas

JoséManuel López; Santiago Imperial; Rodrigo Valderrama; América Giménez; Albert Parés; Joan Caballería; Salvador Navarro



Heterotopic pancreas as a rare cause of gastrointestinal hemorrhage in the newborn: Report of a case  

Microsoft Academic Search

We report herein a female infant in whom a heterotopic pancreas in the stomach caused gastrointestinal hemorrhage during the newborn period. Endoscopy was essential for ruling out other causes of hemorrhage and to follow the patient until the time of elective surgery at 6 months of age. Heterotopic pancreas should be borne in mind as a rare cause of gastrointestinal

Shigeru Ueno; Haruo Ishida; Akira Hayashi; Shoichiro Kamagata; Masahiko Morikawa



Regulation and expression of a renin-angiotensin system in human pancreas and pancreatic endocrine tumours  

Microsoft Academic Search

Objective: Evidence exists for the presence of a renin - angiotensin system (RAS) in the pancreas. The aims of this study were to prove the presence of an intrinsic RAS in the human pancreas and to ana- lyse the role of such an RAS in pancreatic endocrine tumours (PETs). Methods: Gene expression of key RAS components (angiotensinogen and angiotensin II

King Yin Lam



Inflammation increases cells expressing ZSCAN4 and progenitor cell markers in the adult pancreas.  


We have recently identified the zinc finger and SCAN domain containing 4 (Zscan4), which is transiently expressed and regulates telomere elongation and genome stability in mouse embryonic stem (ES) cells. The aim of this study was to examine the expression of ZSCAN4 in the adult pancreas and elucidate the role of ZSCAN4 in tissue inflammation and subsequent regeneration. The expression of ZSCAN4 and other progenitor or differentiated cell markers in the human pancreas was immunohistochemically examined. Pancreas sections of alcoholic or autoimmune pancreatitis patients before and under maintenance corticosteroid treatment were used in this study. In the adult human pancreas a small number of ZSCAN4-positive (ZSCAN4?) cells are present among cells located in the islets of Langerhans, acini, ducts, and oval-shaped cells. These cells not only express differentiated cell markers for each compartment of the pancreas but also express other tissue stem/progenitor cell markers. Furthermore, the number of ZSCAN4? cells dramatically increased in patients with chronic pancreatitis, especially in the pancreatic tissues of autoimmune pancreatitis actively regenerating under corticosteroid treatment. Interestingly, a number of ZSCAN4? cells in the pancreas of autoimmune pancreatitis returned to the basal level after 1 yr of maintenance corticosteroid treatment. In conclusion, coexpression of progenitor cell markers and differentiated cell markers with ZSCAN4 in each compartment of the pancreas may indicate the presence of facultative progenitors for both exocrine and endocrine cells in the adult pancreas. PMID:23599043

Ko, Shigeru B H; Azuma, Sakiko; Yokoyama, Yukihiro; Yamamoto, Akiko; Kyokane, Kazuhiro; Niida, Shumpei; Ishiguro, Hiroshi; Ko, Minoru S H



Beta amyloid and hyperphosphorylated tau deposits in the pancreas in type 2 diabetes  

Microsoft Academic Search

Strong epidemiologic evidence suggests an association between Alzheimer disease (AD) and type 2 diabetes. To determine if amyloid beta (A?) and hyperphosphorylated tau occurs in type 2 diabetes, pancreas tissues from 21 autopsy cases (10 type 2 diabetes and 11 controls) were analyzed. APP and tau mRNAs were identified in human pancreas and in cultured insulinoma beta cells (INS-1) by

Judith Miklossy; Hong Qing; Aleksandra Radenovic; Andras Kis; Bertrand Vileno; Forró Làszló; Lisa Miller; Ralph N. Martins; Gerard Waeber; Vincent Mooser; Fred Bosman; Kamel Khalili; Nune Darbinian; Patrick L. McGeer



Beta amyloid and hyperphosphorylated tau deposits in the pancreas in type 2 diabetes  

Microsoft Academic Search

Strong epidemiologic evidence suggests an association between Alzheimer disease (AD) and type 2 diabetes. To determine if amyloid beta (A) and hyperphosphorylated tau occurs in type 2 diabetes, pancreas tissues from 21 autopsy cases (10 type 2 diabetes and 11 controls) were analyzed. APP and tau mRNAs were identified in human pancreas and in cultured insulinoma beta cells (INS-1) by

J. Miklossy; L. Miller; H. Qing; A. Radenovic; A. Kis; B. Vileno; F. Laszlo; R. N. Martins; G. Waeber; V. Mooser; F. Bosman; K. Khalili; N. Darbinian; P. L. McGeer



Simultaneous pancreas-kidney transplant versus kidney transplant alone in diabetic patients  

Microsoft Academic Search

Simultaneous pancreas-kidney transplant versus kidney transplant alone in diabetic patients. The decision for simultaneous pancreas-kidney (SPK) versus kidney transplant alone (KTA) in diabetic patients with renal failure depends on the potential risks and benefits for each procedure. The purpose of this study was to compare the morbidity, mortality, and renal allograft survival in diabetic patients who underwent SPK versus KTA,

Alan H S Cheung; David E R Sutherland; Kristen J Gillingham; Lois E McHugh; Kay C Moudry-Munns; David L Dunn; John S Najarian; Arthur J Matas



Pancreas Transplant Venous Thrombosis: Role of Endovascular Interventions for Graft Salvage  

Microsoft Academic Search

Venous thrombosis of pancreas transplant allografts often leads to graft loss. We evaluated the efficacy of emergent endovascular techniques to salvage thrombosed pancreatic allografts in a series of six patients. Of the 76 pancreas transplants performed between 2002 and 2006, six patients were diagnosed with venous thrombosis on MRI between 2 and 28 days posttransplant (mean, 9 days). Five patients

Andrew H. Stockland; Darrin L. Willingham; Ricardo Paz-Fumagalli; Hani P. Grewal; J. Mark McKinney; Christopher B. Hughes; Eric M. Walser



Pancreas transplantation: differences in activity between Europe and the United States  

Microsoft Academic Search

Background. Although pancreas transplantation (PT) is the treatment of choice in selected diabetic patients, the In- ternational Pancreas Transplant Registry (IPTR) has re- ported important differences in activity between USA and Europe. Of all cases reported, 75% are from USA and only 23% from Europe. Therefore, an analysis of PT activity in selected European countries (SEC) and USA was performed.

José Manuel González-Posada; Domingo Marrero; Domingo Hernández; Elisabeth Coll; Lourdes Pérez Tamajón; Pedro Gutiérrez; Eduardo Martín; Alberto Bravo; Antonio Alarcó; Rafael Matesanz


Pancreas Transplantation Inside Emilia-Romagna, Italy: Referral Pattern, Demand Forecasting, and Organ Availability  

Microsoft Academic Search

In Italy, referral of diabetic patients for pancreas transplantation (PT) is an unstructured process, resulting in a low rate of activity and late referrals, often when the patient has already undergone dialysis. In addition, the continuous improvement in pancreas transplant alone, offering the opportunity to reduce cardiovascular risk due to proteinuria and reduced glomerular filtration rate (GFR), is rarely appreciated.

D. Bonucchi; E. Longhitano; G. Gerunda; A. Baldini; M. Masetti; F. Ravera; S. De Amicis; V. Albertazzi; G. Mori; A. Savazzi; A. Albertazzi



Posttransplant donor-specific anti-HLA antibodies negatively impact pancreas transplantation outcome.  


During a 9-year follow-up, 167 consecutive pancreas transplant recipients (152 simultaneous pancreas-kidney [SPK]) were followed for the detection of posttransplant anti-HLA antibodies. Forty patients (24%) developed anti-HLA antibodies, 26 (65%) had donor-specific antibodies (DSA; 61% anticlass 2) and 14 (35%) non-DSA (78.6% anticlass 1). More rejection episodes were observed in patients with positive anti-HLA antibodies than in patients without antibodies (42.5% vs. 11%; p = 0.001), with the highest incidence observed in DSA patients (53.8%). More severe rejections (according to rescue therapy) were observed in DSA patients compared to non-DSA (p < 0.05) or to negative patients (p < 0.001). Contrasting with the kidney, pancreas graft survival did not differ between patients with or without anti-HLA antibodies. On the contrary, pancreas and kidney survivals were significantly lower in DSA positive patients (75% for both organs) as compared to non-DSA positive patients (100% for pancreas and 92% for kidney) or to HLA-negative patients (91% for pancreas and 89% for kidney). Nontechnical pancreas and kidney graft failures were significantly higher in positive than in negative anti-HLA patients (32.5% vs. 11%; p < 0.01). Occurrence of posttransplant DSA was an independent risk factor for both pancreas and kidney survival (HR 3.2; p = 0.039) in diabetic transplant recipients. PMID:21906255

Cantarovich, D; De Amicis, S; Akl, A; Devys, A; Vistoli, F; Karam, G; Soulillou, J-P



Sacral neuromodulation enabling simultaneous pancreas and kidney transplantation: a first case  

PubMed Central

We report a case where simultaneous pancreas and kidney transplantation was precluded because of recurrent urinary tract infections due to non-obstructive chronic urinary retention requiring clean intermittent self catheterisation in a diabetic woman with end stage renal disease. Sacral neuromodulation restored voiding and cured recurrent urinary tract infections, enabling her to undergo simultaneous pancreas and kidney transplantation.

Pistolesi, Donatella; Barsotti, Massimiliano; Giannarini, Gianluca; Mantovani, Mauro; Boggi, Ugo; Kessler, Thomas M; Selli, Cesare



Pancreas Versus Islet Transplantation in Diabetes Mellitus: How to Allocate Deceased Donor Pancreata?  

Microsoft Academic Search

Transplant options for the diabetic recipient include pancreas and islet transplantation. Pancreas transplantation has been increasingly performed in the last 3 decades with increasing success rates. Nevertheless, islet transplantation offers the advantage of being less invasive with fewer complications. However, current experience shows that multiple transplants are required to achieve and maintain insulin-independence in the intermediate term, and long-term function

R. Kandaswamy; D. E. R. Sutherland



The pattern of rejection after combined stomach, small bowel, and pancreas transplantation in the rat  

Microsoft Academic Search

This study was designed to investigate whetherin combined stomach, small bowel, and pancreas transplantation allograft rejection occurs in the individual organs concomitantly and with the same intensity. Heterotopic enbloc transplantation of the stomach, small bowel, and pancreas was performed in a Lewis-to-Brown Norway rat combination. Group 1 animals received no immunosuppressive therapy while animals in group, 2 were treated with

G. Oberhuber; T. Schmid; W. Thaler; G. Klima; R. Margreiter



Protective effect of inducible nitric oxide synthase inhibitor on pancreas transplantation in rats  

Microsoft Academic Search

AIM: To investigate the effect of inducible nitric oxide synthase inhibitor, aminoguanidine, on pancreas transplantation in rats. METHODS: A model of pancreas transplantation was established in rats. Streptozotocin-induced diabetic male Wistar rats were randomly assigned to sham-operation control group (n = 6), transplant control group (n = 6), and aminoguanidine (AG) treatment group (n = 18). In the AG group,

Bai-Feng Li; Yong-Feng Liu; Ying Cheng; Ke-Zhong Zhang; Tie-Min Li; Ning Zhao



Effects of Age and Weaning on Enzyme Activities of Abomasum and Pancreas of the Lamb  

Microsoft Academic Search

The effect of age and weaning on enzyme activities of abomasum and pancreas of the lamb was studied. Sixty- nine lambs were either maintained at the preruminant stage until 42 days of age or weaned between 20 and 30 days. They were slaughtered between birth and 100 days, and the mucosa of their abomasum and their pancreas were collected. At

P. Guilloteau; T. Corring; Pascaline Garnot; P. Martin; R. Toullec; G. Durand



Single incision laparoscopic distal pancreatectomy with splenectomy for neuroendocrine tumor of the tail of pancreas.  


Laparoscopic resection is becoming the standard of care for tumors located in the body and tail of pancreas. We herein report a patient with neuroendocrine tumor in the tail of pancreas who underwent single incision laparoscopic distal pancreatectomy with splenectomy without the use of a commercial port device. PMID:24019693

Srikanth, Gadiyaram; Shetty, Neel; Dubey, Deepak



Pancreas transplantation: lessons learned from a decade of experience at Wake Forest Baptist Medical Center.  


This article reviews the outcome of pancreas transplantations in diabetic recipients according to risk factors, surgical techniques, and immunosuppression management that evolved over the course of a decade at Wake Forest Baptist Medical Center. A randomized trial of alemtuzumab versus rabbit anti-thymocyte globulin (rATG) induction in simultaneous kidney-pancreas transplantation (SKPT) at our institution demonstrated lower rates of acute rejection and infection in the alemtuzumab group. Consequently, alemtuzumab induction has been used exclusively in all pancreas transplantations since February 2009. Early steroid elimination has been feasible in the majority of patients. Extensive experience with surveillance pancreas biopsies in solitary pancreas transplantation (SPT) is described. Surveillance pancreas biopsy-directed immunosuppression has contributed to equivalent long-term pancreas graft survival rates in SKPT and SPT recipients at our center, in contrast to recent registry reports of persistently higher rates of immunologic pancreas graft loss in SPT. Furthermore, the impact of donor and recipient selection on outcomes is explored. Excellent results have been achieved with older (extended) donors and recipients, in recipients of organs from donation after cardiac death donors managed with extracorporeal support, and in African-American patients. Type 2 diabetics with detectable C-peptide levels have been transplanted successfully with outcomes comparable to those of insulinopenic diabetics. Our experiences are discussed in the light of findings reported in the literature. PMID:21720669

Rogers, Jeffrey; Farney, Alan C; Al-Geizawi, Samer; Iskandar, Samy S; Doares, William; Gautreaux, Michael D; Hart, Lois; Kaczmorski, Scott; Reeves-Daniel, Amber; Winfrey, Stephanie; Ghanta, Mythili; Adams, Patricia L; Stratta, Robert J



The Amsterdam Preoperative Anxiety and Information Scale (APAIS)  

Microsoft Academic Search

The purpose of the present study was to assess patients' anxiety level and information requirement in the pre- operative phase. During routine preoperative screen- ing, 320 patients were asked to assess their anxiety and information requirement on a six-item questionnaire, the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Two hundred patients also completed Spielberger's State-Trait Anxiety Inventory (STAI- State). Patients

Nelly Moerman; Martin J. Muller; Hans Oosting



Evaluating a Revised Self-efficacy Scale for Preoperative Patients  

Microsoft Academic Search

Nurses conduct preoperative teaching to help patients cope with the adversities of surgery. Self-efficacy can predict an individual's behavior in aversive situations (eg, surgery); therefore, assessing patients' self-efficacy is one way perioperative nurses can plan patient care and help patients through the surgical experience. This study expands on the results of a previous evaluation of a preoperative selfefficacy scale. The

Sharon L. Oetker-Black; Charistine Kauth



Multifactorial index of preoperative risk factors in colon resections  

Microsoft Academic Search

Our aim was to analyze the predictive value of a variety of preoperative risk factors on operative outcomes. We reviewed all colorectal resections performed in a single hospital between January 1985 and May 1990. Nine hundred seventy-two resections were performed on 825 patients. We studied 17 preoperative risk factors generated from various medical risk categories. Using the multivariate discriminant function

D. P. Ondrula; R. L. Nelson; M. L. Prasad; B. W. Coyle; H. Abcarian



Prevention and Intervention Strategies to Alleviate Preoperative Anxiety in Children  

ERIC Educational Resources Information Center

|Preoperative anxiety (anxiety regarding impending surgical experience) in children is a common phenomenon that has been associated with a number of negative behaviors during the surgery experience (e.g., agitation, crying, spontaneous urination, and the need for physical restraint during anesthetic induction). Preoperative anxiety has also been…

Wright, Kristi D.; Stewart, Sherry H.; Finley, G. Allen; Buffett-Jerrott, Susan E.



Effect of Music on Ambulatory Surgery Patients' Preoperative Anxiety  

Microsoft Academic Search

The authors investigated music as a method to reduce ambulatory surgery patients' preoperative anxiety. They assigned 42 patients to either an experimental or a control group and compared the patients' vital signs and self-reports of anxiety, which were measured using the state portion of the State-Trait Anxiety Inventory. The study results indicate that music can be more beneficial than preoperative

Penny Augustin; Anthony A. Hains



Pre-operative localization of 25 consecutive parathyroid adenomas: a prospective imaging/surgical correlative study.  


The successful diagnosis and surgical treatment of primary hyperparathyroidism due to parathyroid adenoma benefits significantly, in our experience, from a process of pre-operative imaging localization of the parathyroid adenoma. This prospective study evaluates a window of 25 consecutive patients who underwent pre-operative imaging localization prior to successful unilateral parathyroidectomy for parathyroid adenoma. All parathyroid adenomas were successfully localized by imaging, and subsequently documented photographically in surgical correlation, and pathologically confirmed. All patients were cured biochemically. Ultrasound accurately localized 92% of adenomas (100% in the neck and extrathyroidal) while radionuclide subtraction scanning identified 60% of a smaller subset. Both DSA and CT were successful in the two cases utilized, and MRI demonstrated four of five adenomas. The high yield of these pre-operative localization studies should make them an important consideration in the routine evaluation of patients undergoing surgery for possible parathyroid adenoma. Their usefulness in directing a conservative unilateral operation may result in time and cost savings, as well as reduced surgical exposure. PMID:8230382

Pearl, A J; Chapnik, J S; Freeman, J L; Bain, J; Salem, S; Kirsh, J; Noyek, A M



Simultaneous pancreas and kidney (SPK) retransplantation in prior SPK recipients  

PubMed Central

Introduction We have performed 113 renal and 28 isolated pancreas retransplants in our cohort of more than 1200 prior simultaneous pancreas and kidney (SPK) recipients. On the basis of these experiences, we began performing repeat SPK in prior SPK recipients (n = 9). Methods This retrospective review summarizes our experience with repeat SPK transplantation in prior SPK recipients. Mean age at retransplant was 39 yr; mean interval to retransplant was 7.8 yr. Thirty-three percent were pre-dialysis. Eighty-nine percent of patients underwent transplant nephrectomy (five during the repeat SPK and three prior to it), and 78% underwent transplant pancreatectomy (four during the repeat SPK and three prior to it). Enteric drainage was performed in all repeat SPKs. Results Median length of stay was 11 d. Perioperative complications included the following: renal artery thrombosis (1), pancreatic portal venous thrombosis (1), enteric leak (1), and hematoma (2). Overall pancreatic allograft survival was 78% at one yr and 67% at two yr. Overall renal allograft survival was 89% at one yr and 78% at two yr. Patient survival at one and three yr was 100%. Conclusions Survival of repeat SPK allografts is acceptable despite the increased technical and immunologic demands of retransplantation. Graftectomy prior to or at the time of retransplantation is often necessary.

LaMattina, John C.; Sollinger, Hans W.; Becker, Yolanda T.; Mezrich, Joshua D.; Pirsch, John D.; Odorico, Jon S.



RBM4 Promotes Pancreas Cell Differentiation and Insulin Expression  

PubMed Central

The RNA-binding protein RNA-binding motif protein 4 (RBM4) modulates alternative splicing of muscle-specific mRNA isoforms during muscle cell differentiation. To better understand the physiological function of RBM4, we exploited a gene knockout strategy in the present study. Mice with targeted disruption of one of the two Rbm4 genes exhibited hyperglycemia coincident with reduced levels of serum insulin and reduced size of pancreatic islets. The embryonic pancreases of Rbm4-deficient mice showed reduced expression or aberrant splicing of many transcripts encoding factors required for pancreas cell differentiation and function. Using pancreatic acinar AR42J cells, we demonstrated that RBM4 promoted insulin gene expression by altering the isoform balance of the transcription factors Isl1 and Pax4 via alternative splicing control. RBM4 overexpression was sufficient to convert AR42J cells into insulin-producing cells. Moreover, RBM4 may mediate glucose-induced insulin expression and insulin receptor isoform switches. These results suggest that RBM4 may have role in promoting pancreas cell differentiation and endocrine function, essentially via alternative splicing regulation.

Lin, Jung-Chun; Yan, Yu-Ting; Hsieh, Wen-Kou; Peng, Pey-Jey; Su, Chun-Hao



Tight perioperative glycemic control using an artificial endocrine pancreas.  


Van den Berghe et al. reported in 2001 that tight glycemic control (maintaining blood glucose levels at 80-110 mg/dl) improved morbidity and mortality in the surgical intensive care unit. This method was termed intensive insulin therapy (IIT), and it is now being adopted worldwide for perioperative care. Recent evidence has suggested that perioperative hyperglycemia significantly contributes to the development of postoperative infection (POI). Many professional societies therefore now recommend IIT over conventional standard glycemic control measures for critically ill adult patients to minimize infectious complications. However, IIT carries a risk of inducing hypoglycemia, which is linked to serious neurological events. We recently demonstrated that achieving perioperative tight glycemic control using an artificial endocrine pancreas for surgical patients was a safe and effective method for decreasing the incidence of POI without increasing the risk of hypoglycemia. We herein review the benefits and requirements of tight glycemic control in surgery, with a focus on infection control. Strict perioperative glycemic control using a closed-loop artificial endocrine pancreas system is recommended for safe and effective performance of IIT. PMID:20037833

Hanazaki, Kazuhiro; Maeda, Hiromichi; Okabayashi, Takehiro



Phosphorus nuclear magnetic resonance in isolated perfused rat pancreas  

SciTech Connect

Phosphorus nuclear magnetic resonance spectroscopy was applied to measure phosphorus energy metabolites in isolated perfused rat pancreas. The gland was perfused with a modified Krebs-Henseleit solution at room temperature (25{degree}C). {sup 31}P resonances of creatine phosphate (PCr), ATP, ADP, inorganic phosphate (P{sub i}) and phosphomonoesters (PMEs) were observed in all the preparations of pancreas. In different individual preparations, the resonance of PCr varied, but those of ATP were almost the same. The initial levels of PCr and ATP in individual preparations, however, remained almost unchanged during perfusion with the standard solution for 2 h. When the perfusion was stopped, the levels of ATP and PCr decreased, while the levels of PME and P{sub i} increased. At that time, the P{sub i} resonance shfted to a higher magnetic field, indicating that the tissue pH decreased. On reperfusion, the tissue levels of phosphorus compounds and the tissue pH were restored to their initial resting levels. Continuous infusion of 0.1 {mu}M acetylcholine caused marked and sustained increases in the flow of pancreatic juice and protein output. During the stimulation the tissue levels of phosphorus compounds remained unchanged, while the tissue pH was decreased slightly.

Matsumoto, Takehisa; Kanno, Tomio; Seo, Yoshiteru; Murakami, Masataka; Watari, Hiroshi (Hokkaido Univ., Sapporo (Japan) National Institute for Physiological Sciences, Okazaki (Japan))



Effects of pancreas cold ischemia on islet function and quality.  


We used a rat model of pancreas cold preservation to assess its effects on islets. Glands were surgically retrieved and stored in University of Wisconsin (UW) solution for 3 hours (Short) or 18 hours (Long) cold ischemia time (CIT). Islet yield was significantly lower in the Long-CIT than the Short-CIT group, as well as islet recovery after overnight culture (P < .01). Islet cell viability after isolation was significantly reduced in the Long-CIT group (P < .05). Reversal of diabetes following transplantation of suboptimal islet grafts occurred earlier in the Short-CIT group than the Long-CIT. All animals in the Short-CIT group and 80% in the Long-CIT group achieved euglycemia. Freshly isolated islets showed a significant increase of JNK and p38 (P < .05) phosphorylation in Long-CIT compared with Short-CIT. Histopathological assessment of the pancreas showed a significantly higher injury score. Proteomic analysis of pancreatic tissue led to identification of 5 proteins consistently differentially expressed between Short-CIT and Long-CIT. Better understanding of the molecular pathways involved in this phenomenon will be of assistance in defining targeted interventions to improve organ use in the clinical arena. PMID:19545733

Pileggi, A; Ribeiro, M M; Hogan, A R; Molano, R D; Embury, J E; Ichii, H; Cobianchi, L; Fornoni, A; Ricordi, C; Pastori, R L



Pancreas transplantation. An immunohistologic and histopathologic examination of 100 grafts.  

PubMed Central

The authors examined tissues obtained by biopsy, pancreatectomy, and autopsy from 100 pancreas grafts to determine the cause of dysfunction or failure of the graft. Immunohistologic examination of 42 tissues to determine the mononuclear cell phenotypes and Class I and II antigen expression was performed as well. Technical factors--infections, thrombosis, obstruction--accounted for a large number of graft losses, but immunologic-mediated mechanisms resulted in graft dysfunction and failure as well. Pleomorphic inflammatory infiltrates were present in grafts with acute rejection, as well as Silastic and Prolamine duct-obstructed grafts. Criteria useful in the identification of acute rejection from pancreatitis included a more intense, predominantly mononuclear cell infiltration of transformed lymphocytes in the exocrine pancreas and evidence of vascular rejection--endovasculitis or fibrinoid necrosis. Increased expression and/or induction of Class I and II antigens on pancreatic constituents occurred in grafts with evidence of acute rejection, but also with Silastic and prolamine duct-obstructed pancreatitis. An isletitis occurred in 25% of the grafts. Nine of the 25 grafts (36%) with isletitis also had selective loss of beta cells from the islets. Recurrent diabetes mellitus appeared to have developed in these cases, which accounted for loss of graft function. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 Figure 14

Sibley, R. K.; Sutherland, D. E.



Differentiating neoplastic from benign lesions of the pancreas: translational techniques.  


There has been substantial recent progress in our ability to image and sample the pancreas leading to the improved recognition of benign and premalignant conditions of the pancreas such as autoimmune pancreatitis (AIP) and mucinous lesions (mucinous cystic neoplasms [MCN] and intraductal papillary mucinous neoplasms [IPMN]), respectively. Clinically relevant and difficult situations that continue to be faced in this context include differentiating MCN and IPMN from nonmucinous pancreatic cysts, the early detection of malignant degeneration in MCN and IPMN, and accurate differentiation between pancreatic cancer and inflammatory masses, especially AIP. These challenges arise primarily due to the less than perfect sensitivity for malignancy utilizing cytological samples obtained via EUS and ERCP. Aspirates from pancreatic cysts are often paucicellular further limiting the accuracy of cytology. One approach to improve the diagnostic yield from these very small samples is through the use of molecular techniques. Because the development of pancreatic cancer and malignant degeneration in MCN and IPMN is associated with well studied genetic insults including oncogene activation (eg, k-ras), tumor suppressor gene losses (eg, p53, p16, and DPC4), and genome maintenance gene mutations (eg, BRCA2 and telomerase), detecting these molecular abnormalities may aid in improving our diagnostic accuracy. A number of studies have shown the utility of testing clinical samples from pancreatic lesions and bile duct strictures for these molecular markers of malignancy to differentiate between cancer and inflammation. The information from these studies will be discussed with emphasis on how to use this information in clinical practice. PMID:19896100

Khalid, Asif



Stressful pre-operative preparation procedures. The routine removal of dentures during pre-operative preparation contributes to pre-operative distress.  


One hundred and twenty-four patients (76 women and 48 men) were interviewed within the first 36 hours after operation. Fifty per cent of those studied were denture wearers. They were asked to fill in a questionnaire which registered their levels of distress about the various pre-operative preparation procedures. The most common factors contributing to pre-operative distress were waiting for transfer to the operating theatre, the prohibition of fluids and the removal of dentures. PMID:1781525

Cobley, M; Dunne, J A; Sanders, L D



Pancreas transplantation from donors after circulatory death from the United Kingdom.  


This study reports the comparative short-term results of pancreas transplantation from donors after circulatory death (DCD) (Maastricht III & IV), and pancreases from brainstem deceased donors (DBD). Between January 2006 and December 2010, 1009 pancreas transplants were performed in the United Kingdom, with 134 grafts from DCD and 875 from DBD. DCD grafts had no premortem pharmacological interventions performed. One-year pancreas and patient survival was similar between DCD and DBD, with pancreas graft survival significantly better in the DCD cohort if performed as an SPK. Early graft loss due to thrombosis (8% vs. 4%) was mainly responsible for early graft loss in the DCD cohort. These results from donors with broader acceptance criteria in age, body mass index, premortem interventions, etc. suggest that DCD pancreas grafts may have a larger application potential than previously recognized. PMID:22845910

Muthusamy, A S R; Mumford, L; Hudson, A; Fuggle, S V; Friend, P J



Analyses of pancreas development by generation of gfp transgenic zebrafish using an exocrine pancreas-specific elastaseA gene promoter  

SciTech Connect

In contrast to what we know on development of endocrine pancreas, the formation of exocrine pancreas remains poorly understood. To create an animal model that allows observation of exocrine cell differentiation, proliferation, and morphogenesis in living animals, we used the zebrafish elastaseA (elaA) regulatory sequence to develop transgenic zebrafish that display highly specific exocrine pancreas expression of GFP in both larvae and adult. By following GFP expression, we found that the pancreas in early development was a relatively compact organ and later extended posterior along the intestine. By transferring the elaA:gfp transgene into slow muscle omitted mutant that is deficient in receiving Hedgehog signals, we further showed that Hedgehog signaling is required for exocrine morphogenesis but not for cell differentiation. We also applied the morpholino knockdown and toxin-mediated cell ablation approaches to this transgenic line. We showed that the development of exocrine pancreas is Islet-1 dependent. Injection of the diphtheria toxin A (DTA) construct under the elastaseA promoter resulted in selective ablation of exocrine cells while the endocrine cells and other endodermal derivatives (liver and intestine) were not affected. Thus, our works demonstrated the new transgenic line provided a useful experimental tool in analyzing exocrine pancreas development.

Wan Haiyan [Department of Biological Sciences, National University of Singapore (Singapore); Korzh, Svitlana [Department of Biological Sciences, National University of Singapore (Singapore); Li Zhen [Department of Biological Sciences, National University of Singapore (Singapore); Mudumana, Sudha Puttur [Department of Biological Sciences, National University of Singapore (Singapore); Korzh, Vladimir [Department of Biological Sciences, National University of Singapore (Singapore); Laboratory of Fish Developmental Biology, Institute of Molecular and Cell Biology (Singapore); Jiang Yunjin [Laboratory of Developmental Signaling and Patterning, Institute of Molecular and Cell Biology (Singapore); Lin Shuo [Department of Molecular, Cell and Developmental Biology, University of California at Los Angeles, CA 90024 (United States); Gong Zhiyuan [Department of Biological Sciences, National University of Singapore (Singapore) and Department of Molecular, Cell and Developmental Biology, University of California at Los Angeles, CA 90024 (United States)]. E-mail:



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Burkitt's Lymphoma Presenting as Late-Onset Posttransplant Lymphoproliferative Disorder following Kidney and Pancreas Transplantation: Case Report and Review of the Literature.  


Posttransplant lymphoproliferative disorders (PTLD) are a rare, but serious complication following transplantation. Late-onset PTLD are often associated with more monoclonal lesions and consequently have a worse prognosis. There are only isolated case reports of Burkitt's lymphoma presenting as PTLD. We present an extremely rare, aggressive Burkitt's lymphoma years after kidney and pancreas transplantation which was successfully treated with combination chemotherapy along with withdrawal of immunosuppression. The patient remains in complete remission more than 2 years after his diagnosis. We also provide a succinct review of treatment of various PTLD and discuss the role of Epstein-Barr virus infection in the pathogenesis of PTLD. PMID:23466659

Naik, Seema; Tayapongsak, Kristy; Robbins, Katherine; Manavi, Cyrus Koresh; Pettenati, Mark J; Grier, David D



Burkitt's Lymphoma Presenting as Late-Onset Posttransplant Lymphoproliferative Disorder following Kidney and Pancreas Transplantation: Case Report and Review of the Literature  

PubMed Central

Posttransplant lymphoproliferative disorders (PTLD) are a rare, but serious complication following transplantation. Late-onset PTLD are often associated with more monoclonal lesions and consequently have a worse prognosis. There are only isolated case reports of Burkitt's lymphoma presenting as PTLD. We present an extremely rare, aggressive Burkitt's lymphoma years after kidney and pancreas transplantation which was successfully treated with combination chemotherapy along with withdrawal of immunosuppression. The patient remains in complete remission more than 2 years after his diagnosis. We also provide a succinct review of treatment of various PTLD and discuss the role of Epstein-Barr virus infection in the pathogenesis of PTLD.

Naik, Seema; Tayapongsak, Kristy; Robbins, Katherine; Manavi, Cyrus Koresh; Pettenati, Mark J.; Grier, David D.



Poorly differentiated endocrine carcinoma of the pancreas responded to gemcitabine: Case report  

PubMed Central

Poorly differentiated endocrine carcinoma (PDEC) of the pancreas is a rare and aggressive tumor. First-line treatment is commonly a combination of etoposide and cisplatin, but there is no consensus regarding further treatment recommendations. In this report, we describe a case of pancreatic PDEC treated with gemcitabine as third-line chemotherapy. A 62-year-old man with pancreatic PDEC was administered etoposide plus cisplatin as first-line treatment; he then received irinotecan for tumor relapse. However, because irinotecan induced ileus in this patient, we chose gemcitabine as third-line chemotherapy. After two cycles of gemcitabine (1000 mg/m2 on days 1, 8 and 15 every 4 wk), a partial tumor response was noted by computed tomography (approximately 68% reduction in tumor size). Our patient survived for 15 mo after diagnosis. This is a rare case of unresectable pancreatic PDEC, which showed a partial response to gemcitabine after the failure of two other regimens. Gemcitabine could be an effective treatment option for pancreatic PDEC that is resistant to other treatments.

Nakazuru, Shoichi; Yoshio, Toshiyuki; Suemura, Shigeki; Itoh, Mari; Araki, Manabu; Yoshioka, Chiaki; Ohta, Makiyo; Sueyoshi, Yuka; Ohta, Takashi; Hasegawa, Hiroko; Morita, Kaori; Toyama, Takashi; Kuzushita, Noriyoshi; Kodama, Yoshinori; Mano, Masayuki; Mita, Eiji



Calculating life years from transplant (LYFT): methods for kidney and kidney-pancreas candidates.  


The Organ Procurement and Transplantation Network (OPTN) Kidney Committee is considering a proposal for a new deceased donor kidney allocation system. Among the components under consideration is a strategy to rank candidates in part by the estimated incremental years of life that are expected to be achieved with a transplant from a specific available deceased donor, computed as the difference in expected median lifespan with that transplant compared with remaining on dialysis. This concept has been termed life years from transplant or LYFT. Median lifespans could be calculated, based on objective medical criteria, for each candidate when a deceased donor kidney becomes available, based on Cox regression models using current candidate and donor medical information. The distribution of the calculated LYFT scores for an average nonexpanded criteria donor kidney is similar across candidate sex, race/ethnicity, insurance status and, with the exception of diabetes, diagnosis. LYFT scores tend to be higher for younger candidates and lower for diabetics receiving a kidney-alone rather than a simultaneous kidney-pancreas transplant. Prioritizing candidates with higher LYFT scores for each available kidney could substantially increase total years of life among both transplant candidates and recipients. LYFT is also a powerful metric for assessing trends in allocation outcomes and for comparing alternative allocation systems. PMID:18336702

Wolfe, R A; McCullough, K P; Schaubel, D E; Kalbfleisch, J D; Murray, S; Stegall, M D; Leichtman, A B