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1

Preoperative chemoradiation for marginally resectable adenocarcinoma of the pancreas.  

PubMed

Only 10% to 20% of patients with pancreatic cancer are considered candidates for curative resection at the time of diagnosis. We postulated that preoperative chemoradiation therapy might promote tumor regression, eradicate nodal metastases, and allow for definitive surgical resection in marginally resectable patients. The objective of this study was to evaluate the effect of a preoperative chemoradiation therapy regimen on tumor response, resectability, and local control among patients with marginally resectable adenocarcinoma of the pancreas and to report potential treatment-related toxicity. Patients with marginally resectable adenocarcinoma of the pancreas (defined as portal vein, superior mesenteric vein, or artery involvement) were eligible for this protocol. Patients received 50.4 to 56 Gy in 1.8 to 2.0 Gy/day fractions with concurrent protracted venous infusion of 5-fluorouracil (250 mg/m2/day). Reevaluation for surgical resection occurred 4 to 6 weeks after therapy. Fifteen patients (9 men and 6 women) completed preoperative chemoradiation without interruption. One patient required a reduction in the dosage of 5-fluorouracil because of stomatitis. Acute toxicity from chemoradiation consisted of grade 1 or 2 nausea, vomiting, diarrhea, stomatitis, palmar and plantar erythrodysesthesia, and hematologic suppression. CA 19-9 levels declined in all nine of the patients with elevated pretreatment levels. Nine of the 15 patients underwent a pancreaticoduodenectomy, and all had uninvolved surgical margins. Two of these patients had a complete pathologic response, and two had microscopic involvement of a single lymph node. With a median follow-up of 30 months, the median survival for resected patients was 30 months, whereas in the unresected group median survival was 8 months. Six of the nine patients who underwent resection remain alive and disease free with follow-up of 12, 30, 30, 34, 39, and 72 months, respectively. Preoperative chemoradiation therapy is well tolerated. It may downstage tumors, sterilize regional lymph nodes, and improve resectability in patients with marginally resectable pancreatic cancer. Greater patient accrual and longer follow-up are needed to more accurately assess its future role in therapy. PMID:11309645

Mehta, V K; Fisher, G; Ford, J A; Poen, J C; Vierra, M A; Oberhelman, H; Niederhuber, J; Bastidas, J A

2001-01-01

2

Primary gastric malignant melanoma: challenge in preoperative diagnosis  

PubMed Central

Primary gastric melanoma is an extremely rare clinical entity. The clinical manifestation is not specific and usually similar with other common malignancies at this site, such as gastric cancer and lymphoma. And there are no specific radiological features either. Preoperative diagnosis via biopsy is usually difficult, since melanoma pigment could be absent in the biopsy tissue. Here, we report a case of a 50-year-old woman with a mass in the stomach found by gastroscopy. Biopsy was taken twice preoperatively under gastroscope and it was diagnosed as gastric carcinoma and neuroendocrine tumor respectively. Radical surgery was performed with gastrectomy and D2 lymph node dissection. Postoperative pathological examination finally made a definite diagnosis of gastric melanoma by immunohistochemistry. We summarize the reasons for preoperative misdiagnosis and discuss the difficulty in diagnosing gastric melanoma according to literature. PMID:25400765

Song, Wu; Liu, Fakeng; Wang, Shaochuan; Shi, Huijuan; He, Weiling; He, Yulong

2014-01-01

3

Preoperative diagnosis of carcinoma within fibroadenoma on screening mammograms.  

PubMed

Three cases of fibroadenoma associated with carcinoma are reported. These cases were diagnosed within a screening programme as a result of suspicious mammographic findings, and the diagnosis of malignancy was confirmed preoperatively by core biopsy in all cases. The mammographic findings suggestive of carcinoma within fibroadenoma were irregularity of margins in one case and associated new suspicious pleomorphic and linear calcifications in the two other cases. The preoperative diagnosis of carcinoma within fibroadenoma was provided by ultrasound-guided core biopsy in two cases and core biopsy under stereotactic guidance in one case. Whereas asymptomatic fibroadenoma with benign imaging appearances usually does not require further investigation, fibroadenoma with atypical imaging features requires a triple test investigation. PMID:18373829

Borecky, N; Rickard, M

2008-02-01

4

Preoperative Diagnosis of Adult Intussusception Caused by Small Bowel Lipoma  

PubMed Central

Adult intussusception is rare, accounting for only 5% of all intussusceptions, for which preoperative diagnosis is difficult. We herein report a preoperatively diagnosed case of adult intussusception caused by a small bowel lipoma. A 33-year-old man was admitted to our hospital with three weeks history of colicky epigastric pain. Computed tomography revealed thickening of the ileal wall suggestive of intussusception. Colonoscopy revealed an ileocolic intussusception. Barium enema for reduction of ileocolic intussusception demonstrated a small bowel tumor in the ileum 15 cm proximal to the ileocecal valve. The intussusception was reduced, and the patient underwent partial resection of the ileum encompassing the small bowel tumor. Histological findings confirmed the diagnosis of lipoma of the small bowel. The patient made a satisfactory recovery and remains well. PMID:21103257

Shiba, Hiroaki; Mitsuyama, Yoshinobu; Hanyu, Ken; Ikeuchi, Kenji; Hayashi, Hirotaka; Yanaga, Katsuhiko

2009-01-01

5

MRI diagnosis and preoperative evaluation for pure epidural cavernous hemangiomas  

Microsoft Academic Search

Introduction  The aims of the study were to summarize the characteristics of the spinal epidural cavernous hemangioma, especially for the\\u000a MRI, and to improve the accurate rate of the preoperative diagnosis.\\u000a \\u000a \\u000a \\u000a Methods  The clinical and medical imaging data of six patients with pure spinal epidural cavernous hemangioma proved by operation and\\u000a pathology were analyzed retrospectively.\\u000a \\u000a \\u000a \\u000a Results  The level was thoracic (n?=?2), thoracolumbar (n?=?1),

Jie Feng; Yi-Kai Xu; Long Li; Rui-Meng Yang; Xiang-Hua Ye; Nan Zhang; Tian Yu; Bing-Quan Lin

2009-01-01

6

The Role of Volume Perfusion CT in the Diagnosis of Pathologies of the Pancreas.  

PubMed

The review discusses the potential role of volume perfusion CT (VPCT) in the diagnosis and follow-up of different pathologies of the pancreas. VPCT enables a differentiation of different pancreatic tumors like adenocarcinoma or neuroendocrine tumors based on functional parameters like blood flow, blood volume and permeability. Furthermore, the article discusses the potential indications for VPCT imaging of inflammatory diseases of the pancreas such as acute or chronic pancreatitis and autoimmune pancreatitis. Key Points: •?VPCT may help to diagnose even small pancreatic tumors based on functional parameters •?Functional perfusion parameters can help to characterize pancreatic neoplasms •?In acute pancreatitis VPCT can evaluate the perfusion status of the organ Citation Format: •?Grözinger G., Grözinger A., Horger M. The Role of Volume Perfusion CT in the Diagnosis of Pathologies of the Pancreas. Fortschr Röntgenstr 2014; 186: 1082?-?1093. PMID:25122172

Grözinger, G; Grözinger, A; Horger, M

2014-12-01

7

Preoperative diagnosis of colonic angiolipoma: A case report  

PubMed Central

Angiolipoma, a common benign tumor mostly seen in the subcutaneous tissue, is a rare pathological condition in the gastrointestinal tract that is usually diagnosed postoperatively. In this case report, an angiolipoma was diagnosed preoperatively by imaging (including CT scans, abdominal echo, barium enema, and colonoscopy). This pathology was confirmed postoperatively. Computed tomography scan, abdominal echo, and barium enema images were presented. PMID:16124075

Chen, Yang-Yuan; Soon, Maw-Soan

2005-01-01

8

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. PMID:22288058

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

2011-01-01

9

Diagnosis and management of relapsing pancreatitis associated with cystic neoplasms of the pancreas  

PubMed Central

One of the most important causes of relapsing pancreatitis is a cystic neoplasm of the pancreas. These low grade malignancies may cause pancreatitis by obstructing or communicating with a pancreatic duct. Patients with relapsing pancreatitis and a focal fluid fluid collection should be investigated for the possibility of a mucinous cystic neoplasm. Cross sectional imaging can provide a diagnosis with the imaging findings of a low attenuation cystic lesion containing mural calcification (CT scanning) or a lobular T2 enhancing lesion (MRCP). Endoscopic ultrasound can provide more detailed imaging with the ability to guide fine needle aspiration of the cyst fluid. Cyst fluid analysis can provide a diagnosis of a mucinous cystic lesion with the combination of cytology (mucinous epithelium), elevated carcinoembryonic antigen (CEA), and the presence of DNA mutations. Management of these patients consists of surgical resection and monitoring in patients not able to withstand surgery. PMID:18286685

Brugge, William R

2008-01-01

10

Pathological features and diagnosis of intraductal papillary mucinous neoplasm of the pancreas.  

PubMed

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a noninvasive epithelial neoplasm of mucin-producing cells arising in the main duct (MD) and/or branch ducts (BD) of the pancreas. Involved ducts are dilated and filled with neoplastic papillae and mucus in variable intensity. IPMN lacks ovarian-type stroma, unlike mucinous cystic neoplasm, and is defined as a grossly visible entity (? 5 mm), unlike pancreatic intraepithelial neoplasm. With the use of high-resolution imaging techniques, very small IPMNs are increasingly being identified. Most IPMNs are solitary and located in the pancreatic head, although 20%-40% are multifocal. Macroscopic classification in MD type, BD type and mixed or combined type reflects biological differences with important prognostic and preoperative clinical management implications. Based on cytoarchitectural atypia, IPMN is classified into low-grade, intermediate-grade and high-grade dysplasia. Based on histological features and mucin (MUC) immunophenotype, IPMNs are classified into gastric, intestinal, pancreatobiliary and oncocytic types. These different phenotypes can be observed together, with the IPMN classified according to the predominant type. Two pathways have been suggested: gastric phenotype corresponds to less aggressive uncommitted cells (MUC1 -, MUC2 -, MUC5AC +, MUC6 +) with the capacity to evolve to intestinal phenotype (intestinal pathway) (MUC1 -, MUC2 +, MUC5AC +, MUC6 - or weak +) or pancreatobiliary /oncocytic phenotypes (pyloropancreatic pathway) (MUC1 +, MUC 2-, MUC5AC +, MUC 6 +) becoming more aggressive. Prognosis of IPMN is excellent but critically worsens when invasive carcinoma arises (about 40% of IPMNs), except in some cases of minimal invasion. The clinical challenge is to establish which IPMNs should be removed because of their higher risk of developing invasive cancer. Once resected, they must be extensively sampled or, much better, submitted in its entirety for microscopic study to completely rule out associated invasive carcinoma. PMID:25232456

Castellano-Megías, Víctor M; Andrés, Carolina Ibarrola-de; López-Alonso, Guadalupe; Colina-Ruizdelgado, Francisco

2014-09-15

11

Breast hemangioma with difficulty in preoperative diagnosis: a case report.  

PubMed

We report a rare case of breast hemangioma found in a 70-year-old Japanese female. Before seeking medical attention, the patient noticed a hard mass in her right breast but denied associated symptoms. A mammography revealed a well-circumscribed, highly dense, lobular nodule located in the middle inter portion of the right breast. To verify this finding, we used ultrasonography which revealed an irregular, iso-echoic nodule measuring 10 mm in the same portion. Based on these findings, we suspected a malignancy and performed a core needle biopsy. Unexpectedly, a histological examination of the biopsy displayed normal vasculature, adipose, and mammary tissues. In order to make an accurate diagnosis, the mass was surgically excised under general anesthesia and sent to pathology. Pathological findings of the mass were positive for breast hemangioma, and the patient has had no recurrence of the disease for the past 24 months. PMID:25312096

Funamizu, Naotake; Tabei, Isao; Sekine, Chikako; Fuke, Azusa; Yabe, Mitsuo; Takeyama, Hiroshi; Okamoto, Tomoyoshi

2014-01-01

12

Fine-needle aspiration diagnosis of high grade adenoid cystic carcinoma metastatic to the pancreas.  

PubMed

Pancreatic tumors are mostly primary tumors, with only rare metastatic tumors described in the literature. Here we report an unusual case of fine-needle aspiration (FNA) diagnosis of high grade adenoid cystic carcinoma of the parotid gland metastatic to the pancreas. The aspirate smears were moderately cellular and revealed numerous basaloid neoplastic cells. The cytomorphologic differential diagnosis included primary pancreatic tumor with small cell morphology as well as metastatic tumors. By immunocytochemistry, the tumor cells were positive for cytokeratins (AE1/AE3, CAM5.2, and CK7), and CD117 (C-KIT), and negative for CD45, WT1, synaptophysin, chromogranin, CD56, TTF-1, and CK20. The cytomorphologic features and immunoprofile in our case were consistent with high-grade carcinoma metastases from patient's known salivary gland primary. To the best of our knowledge, this case is the first reported encounter of FNA diagnosis of pancreatic metastasis with small cell morphology from a salivary gland neoplasm as primary site. Diagn. Cytopathol. 2015;43:117-120. © 2014 Wiley Periodicals, Inc. PMID:24554389

David, Doina; Masineni, Sreeharsha N; Giorgadze, Tamar

2015-02-01

13

Preoperative diagnosis and intraoperative protection of nonrecurrent laryngeal nerve: A review of 5 cases  

PubMed Central

Background Nonrecurrent laryngeal nerve (NRLN) is a risk factor for nerve injury during thyroidectomy or parathyroidectomy. It is usually associated with abnormal vasculature that can be identified by several imaging methods. The aim of this study was to retrospectively analyze the preoperative diagnosis and intraoperative protection of NRLN. Material/Methods Of the 7169 patients who underwent thyroid surgery at our hospital between August 2008 and January 2013, 5 patients with NRLN were identified. Preoperative chest X-rays, neck ultrasonography (US), and computed tomography (CT) findings were reviewed. NRLNs were carefully and systematically searched for in surgery. Results Preoperative CT predicted NRLN in all 5 cases (100% accuracy). The detection rate of NRLN by CT was 0.4% (5/1170). NRLNs were confirmed in surgery. All of them were right-sided NRLN with type IIA variant. The CT scans clearly revealed the vascular anomalies. The review of US images suggested that vascular anomalies could be identified on the images in 1 patient. No postoperative complications occurred in any patient. Conclusions The preoperative CT scan was a reliable and effective method for identifying abnormal vasculature to indirectly predict NRLN. Combining the CT and US findings with adequate surgical technique may help to reduce the risk of nerve damage, in addition to preventing nerve palsy. PMID:24518037

Wang, Zhihong; Zhang, Hao; Zhang, Ping; He, Liang; Dong, Wenwu

2014-01-01

14

First Report of Preoperative Imaging Diagnosis of a Surgically Confirmed Case of Valentino's Syndrome.  

PubMed

Perforation of a duodenal ulcer (DU) into the retroperitoneal space presenting with clinical features of acute appendicitis is known as Valentino's syndrome. Post duodenal perforation, the gastric and duodenal fluids tend to settle in the right paracolic gutter causing peritonitis and clinically mimicking acute appendicitis. Only three cases of Valentino's syndrome have been reported till date in the published literature and there is only one previous report of its preoperative imaging diagnosis. To our knowledge, this is the first reported case of preoperative imaging diagnosis in a surgically confirmed case of Valentino's syndrome. In most cases, patients with undiagnosed Valentino's syndrome are operated for acute appendicitis, and on finding a normal appendix, search is made for the cause of peritonitis, which then leads to retroperitoneal perforation of duodenum. The diagnosis of Valentino's syndrome by computed tomography (CT) imaging is easy and can help in avoiding the surgery or directing the surgeon directly to the repair of the duodenal perforation. It is, therefore, essential for emergency physicians, surgeons, and radiologists to know about this entity and consider it in the differential diagnosis. PMID:24991479

Mahajan, Parag Suresh; Abdalla, Mohammed Fahmy; Purayil, Nishan K

2014-01-01

15

[Diagnosis and treatment of pancreas ectopy in the gastric wall in children].  

PubMed

The authors describe 6 children with pancreas ectopy to the gastric wall. Their age was between 8 and 14 years. The main clinical and endoscopic signs were: prolonged pain, dyspepsia and a "polyp" in pyloroantral part of the stomach. In 4 of 6 children the pancreas ectopy to the gastric wall was suspected. All patients had been operated on. The indications for surgery were the following: severe pain with no effect of conservative therapy, suspicion for "polyp" malignancy and ulceration, bleeding. In one patient Bilroth-1 resection has been performed and in 2 cases sectoral dissection of the gastric wall pancreatic ectopy has been done. In 3 patients enucleation of the ectopic pancreas was performed. All patients had ineventful postoperative period. The pancreas ectopy in children is an indication for the surgery because of severe pain and possibility of severe complications. The surgery relieves pain and provides recovery. PMID:8926667

Odinak, V M; Trubitsina, I A; Roshke, E V; Borodulin, I V

1996-01-01

16

Immunoglobulin subclass 4 for the diagnosis of immunoglobulin subclass 4-associated diseases in an unselected liver and pancreas clinic population  

PubMed Central

Aims The diagnosis of autoimmune pancreatitis (AIP) and immunoglobulin subclass 4 (IgG4)-associated cholangitis (IAC) is based on imaging studies, serology, histology and a response to steroid therapy. The major serological finding is an elevation of the serum IgG4 concentration. Previous studies have shown that its sensitivity is about 70% and its specificity exceeds 90% at a cut-off of 140 mg/dl in selected patient populations. The aim of the present study was to assess the performance of serum IgG4 as a diagnostic parameter in an unselected liver and pancreas clinic population. Methods and results IgG4 was prospectively determined in 1412 patients and clinical diagnoses were recorded from a review of patient charts. The prevalence of AIP or IAC in the entire cohort was 1.1% (n = 15). The sensitivity of IgG4 for the diagnosis of AIP and IAC was 80% and the specificity was 86% at a cut-off value of ?135 mg/dl. The positive predictive value and the negative predictive value were 6% and 99.7%, respectively. The most common differential diagnosis in patients with elevated IgG4 was liver cirrhosis. Conclusion IgG4 has a reasonable sensitivity and specificity in a liver and pancreas clinic population, where liver cirrhosis appears to be the most frequent differential diagnosis for elevated IgG4 concentrations. PMID:22221573

Dorn, Livia; Finkenstedt, Armin; Schranz, Melanie; Prokop, Wolfgang; Griesmacher, Andrea; Vogel, Wolfgang; Zoller, Heinz

2012-01-01

17

The role of core needle biopsy in the preoperative diagnosis of follicular neoplasm of the thyroid.  

PubMed

Follicular neoplasm/suspicious for follicular neoplasm (FN/SFN) can often be challenging to diagnose using core needle biopsy (CNB) specimens. We have developed the histologic criteria for the CNB diagnosis of FN and validated the usefulness of CNB. We retrospectively reviewed 184 CNBs and 224 FNACs diagnosed with FN/SFN. CNBs were histologically classified into four subgroups, based on the histologic features of follicular proliferation, fibrous capsulation, and surrounding parenchyma. Among 184 CNBs, 103 (55.9%) had previous FNAC results of non-diagnostic or indeterminate. Overall malignancy rates in FNAC (48%) and CNB (46%) were nearly identical (p > 0.05), and the neoplasm rate was higher in CNB (88%) than FNAC (74%) (p = 0.007). There was no significant difference in the malignancy rates among the four histologic subgroups. Among the 40 nodules with simultaneous CNB and FNAC, only nine had the FNAC diagnosis of FN/SFN, and others were non-diagnostic, benign, or atypia of undetermined significance. Overall, CNB improved specimen adequacy and achieved better sensitivity of the FN/SFN diagnosis in thyroid nodules that were inconclusive by FNAC. In the preoperative diagnosis of FN/SFN, CNB has no advantage over FNAC in predicting the likelihood of malignancy, but helps to reduce the need for repeat biopsy. PMID:24673498

Min, Hye Sook; Kim, Ji-Hoon; Ryoo, Inseon; Jung, So Lyung; Jung, Chan Kwon

2014-10-01

18

Preoperative diagnosis of lymphocytic hypophysitis (adenohypophysitis) unresponsive to short course dexamethasone: case report.  

PubMed

Lymphocytic hypophysitis (adenohypophysitis) is a rare lymphocytic infiltration of the pituitary gland that usually occurs during pregnancy. Because of its rarity, it has seldom been diagnosed preoperatively, and no trials of therapeutic treatment have been reported to date. We describe a 29-year-old woman with a pituitary mass and visual-field defects during pregnancy. The patient's pituitary profile revealed an abnormal thyroid axis and relatively low prolactin for her stage of pregnancy. This finding suggested adenohypophysitis, and the patient was given a trial course of dexamethasone. The progression of the visual-field defects, however, indicated that the steroids, both in dosage and duration, were not effective. Thus, the patient underwent a partial hypophysectomy for decompression. The pathology report confirmed adenohypophysitis, and steroids were continued for the remainder of the pregnancy, with slow resolution of the visual-field defects to normal. This report is the first case of adenohypophysitis where the diagnosis was suspected preoperatively, and a trial course of steroids was given. The steroids at the dosage and duration used were not effective. Further evaluation of the use of steroids in this disease is warranted. PMID:1545900

Reusch, J E; Kleinschmidt-DeMasters, B K; Lillehei, K O; Rappe, D; Gutierrez-Hartmann, A

1992-02-01

19

Preoperative diagnosis of gastrointestinal stromal tumor by endoscopic ultrasound-guided fine needle aspiration  

PubMed Central

AIM: To evaluate the role of endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) in the preoperative diagnosis of gastrointestinal stromal tumor (GIST). METHODS: From September 2002 to June 2006, Fifty-three consecutive EUS-FNAs of GI tract subepithelial hypoechoic tumors with continuity to proper muscle layer suspected as GIST by standard EUS were evaluated prospectively. The reference standards for the final diagnosis were surgery (n = 31), or clinical follow-up (n = 22). Additionally, immunophenotyping of specimens obtained by EUS-FNA and surgical resection specimens were compared. RESULTS: In 2 cases puncture was not performed because of anatomical problems. The collection rate of adequate specimens from the GI tract subepithelial hypoechoic tumor with continuity to proper muscle layer was 82% (42/51). The diagnostic rate for the tumor less than 2 cm, 2 to 4 cm, and 4 cm or more were 71% (15/21), 86% (18/21), and 100% (9/9), respectively. In 29 surgically resected cases, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of EUS-FNA using immunohistochemical analysis of GIST were 100% (24/24), 80% (4/5), 96% (24/25), 100% (4/4), and 97% (28/29), respectively. No major complications were encountered. CONCLUSION: EUS-FNA with immunohistochemical analysis is a safe and accurate method in the prethera-peutic diagnosis of GIST. It should be taken into consideration in decision making, especially in early diagnosis following minimal invasive surgery for GIST. PMID:17465451

Akahoshi, Kazuya; Sumida, Yorinobu; Matsui, Noriaki; Oya, Masafumi; Akinaga, Rie; Kubokawa, Masaru; Motomura, Yasuaki; Honda, Kuniomi; Watanabe, Masayuki; Nagaie, Takashi

2007-01-01

20

Practical significance of utilizing fine needle aspiration cytology as an adjunct diagnostic aid in the preoperative presumptive diagnosis of ameloblastoma  

PubMed Central

Background: Cytological reports of ameloblastoma are relatively rare in the literature. Appropriate cytologic diagnosis may play a significant role in its preoperative presumptive diagnosis, especially when incisional biopsy findings are inadequate. Aim: To systematically study the detailed cytomorphologic features of ameloblastoma and to evaluate the role of fine needle aspiration cytology (FNAC) in its preoperative diagnosis. Materials and Methods: In this study, FNAC was done on 26 cases of intra-osseous jaw lesion, clinically diagnosed as odontogenic tumor or developmental odontogenic cysts and detailed cytopathological interpretation was carried out and the results were correlated with the corresponding histopathology. Results: Of the 26 cases, 15 were found to be ameloblastoma and sensitivity of FNAC in the diagnosis of ameloblastoma was found to be 86.6%. None of the intra-osseous jaw lesion was false positively diagnosed as ameloblastoma in FNAC and hence the specificity was found to be 100%. Conclusion: Presence of cohesive epithelial cell clusters exhibiting smaller basaloid cells with peripherally placed tall columnar cells and occasional large squamous cells either adjoining the basaloid epithelial clusters or in isolated group aids in the specific cytological diagnosis of ameloblastoma and FNAC offers an excellent diagnostic aid that may play a significant role in preoperative presumptive diagnosis of ameloblastoma along with incisional biopsy. PMID:24648668

Kaliamoorthy, Sriram; Venkatapathy, Ramesh; Babu, Premalatha; Veeran, Veeravarmal

2013-01-01

21

Pancreas Transplantation  

MedlinePLUS

The pancreas is a gland behind your stomach and in front of your spine. It produces the juices that ... hormones that help control blood sugar levels. A pancreas transplant is surgery to place a healthy pancreas ...

22

Clinical value of magnetic resonance imaging in preoperative T staging of gastric cancer and postoperative pathological diagnosis  

PubMed Central

The aim of the present study was to evaluate the clinical value of magnetic resonance imaging (MRI) in the preoperative T staging of gastric cancer and in the postoperative pathological diagnosis. In total, 30 patients with gastric cancer were investigated, including 19 males and 11 females (age, 50–69 years; mean age, 60 years). The preoperative depth of invasion (T stage) was evaluated according to the characteristics of the imaging performance. The evaluation results for the MRI T staging were as follows: T1 stage accuracy, 90% with a specificity of 96% and sensitivity of 60% (? value=0.61; P<0.05); T2 stage accuracy, 86.7% with a specificity of 87.5% and sensitivity of 83.3% (? value=0.71; P<0.05); T3 stage accuracy, 90% with a specificity and sensitivity of 90% (? value=0.78; P<0.05); and T4 stage accuracy, 96.7% with a specificity of 100% and sensitivity of 87.5% (? value=0.91; P<0.05). The results demonstrated that, with reference to pathological diagnosis, the MRI method exhibited high accuracy, specificity and sensitivity in determining the preoperative T stage in gastric cancer patients. PMID:24959260

HUO, XIANYING; YUAN, KUANGSHENG; SHEN, YUEXIA; LI, MIN; WANG, QI; XING, LINGXIAO; SHI, GAOFENG

2014-01-01

23

An evaluation of the preoperative diagnosis and management of cystosarcoma phyllodes.  

PubMed Central

Cystosarcoma phyllodes is a rare tumour of the breast which is notoriously difficult to diagnose accurately preoperatively. In this review we report the clinical, imaging and histopathological features of 20 patients who have presented in our Centre over a 10-year period. Images fig. 1 fig. 2 fig. 3 fig. 4 PMID:2552895

Umpleby, H. C.; Moore, I.; Royle, G. T.; Guyer, P. B.; Taylor, I.

1989-01-01

24

Annular pancreas  

MedlinePLUS

An annular pancreas is a ring of pancreatic tissue that encircles the duodenum (the first part of the small intestine). The normal position of the pancreas is next to, but not surrounding the duodenum.

25

Sonographic biometry in obstructive uropathy of children: Preoperative diagnosis and postoperative monitoring  

Microsoft Academic Search

Renal sonography was performed in 92 children with obstructive uropathy or vesicoureteral reflux preoperatively and at follow-up.\\u000a Renal volume and the anteroposterior diameter of the renal pelvis proved to be the most reliable morphometric criteria for\\u000a objective sonographic staging and follow-up of urinary tract obstruction. If transient obstruction occurred after uncomplicated\\u000a antireflux ureterovesico-plasties (n=41), it lasted at most 4 weeks.

Ernst Dinkel; Matthias Dittrich; Helmut Peters; Gerhard Alzen; Peter Walz; Christine Ney; Hermann Schulte-Wissermann; Dieter Weitzel

1985-01-01

26

Optimizing of preoperative computed tomography for diagnosis in patients with peritoneal carcinomatosis  

PubMed Central

Background and Objective This study evaluates whether Computer Tomography is an effective procedure for preoperative staging of patients with Peritoneal Carcinomatosis. Method A sample of 37 patients was analyzed with contrast enhanced abdominal Computer Tomography, followed by surgical staging. All Computer Tomography scans were evaluated 3 times by 2 radiologists with one radiologist reviewing 2 times. The efficacy of Computer Tomography was evaluated using the Spearman correlation coefficient. Correlations were analyzed by abdominopelvic region to assess results of the Peritoneal Carcinomatosis Index (PCI) aggregating the 13 regions. Surgical findings were compared to radiological findings. Results Results indicate high correlations between the surgical and radiological Peritoneal Carcinomatosis Indices. Analyses of the intra-class correlation between the first and second reading of one radiologist suggest high intra-observer reliability. Correlations by abdominopelvic region show higher values in the upper and middle regions and relatively lower values in the lower regions and the small bowel (correlation coefficients range between 0.418 and 0.726, p < 0.010; sensitivities range between 50% and 96%; and specificities range between 62% and 100%). Conclusion Computer Tomography represents an effective procedure in the preoperative staging of patients with PC. However, results by abdominopelvic region show lower correlation, therefore suggest lower efficacy. These results are supported by analyses of sensitivity and accuracy by lesion size. This suggests that Computer Tomography is an effective procedure for pre-operative staging but less for determining a tumor's accurate extent. PMID:22188796

2011-01-01

27

Portal Annular Pancreas  

PubMed Central

Abstract Portal annular pancreas (PAP) is an asymptomatic congenital pancreas anomaly, in which portal and/or mesenteric veins are encased by pancreas tissue. The aim of the study was to determine the role of PAP in pancreatic surgery as well as its management and potential complication, specifically, postoperative pancreatic fistula (POPF). On the basis of a case report, the MEDLINE and ISI Web of Science databases were systematically reviewed up to September 2012. All articles describing a case of PAP were considered. In summary, 21 studies with 59 cases were included. The overall prevalence of PAP was 2.4% and the patients' mean (SD) age was 55.9 (16.2) years. The POPF rate in patients with PAP (12 pancreaticoduodenectomies and 3 distal pancreatectomies) was 46.7% (in accordance with the definition of the International Study Group of Pancreatic Surgery). Portal annular pancreas is a quite unattended pancreatic variant with high prevalence and therefore still remains a clinical challenge to avoid postoperative complications. To decrease the risk for POPF, attentive preoperative diagnostics should also focus on PAP. In pancreaticoduodenectomy, a shift of the resection plane to the pancreas tail should be considered; in extensive pancreatectomy, coverage of the pancreatic remnant by the falciform ligament could be a treatment option. PMID:25207658

Harnoss, Jonathan M.; Harnoss, Julian C.; Diener, Markus K.; Contin, Pietro; Ulrich, Alexis B.; Büchler, Markus W.; Schmitz-Winnenthal, Friedrich H.

2014-01-01

28

Pancreas Transplantation  

PubMed Central

Diabetes mellitus is generally treated with oral diabetic drugs and/or insulin. However, the morbidity and mortality associated with this condition increases over time, even in patients receiving intensive insulin treatment, and this is largely attributable to diabetic complications or the insulin therapy itself. Pancreas transplantation in humans was first conducted in 1966, since when there has been much debate regarding the legitimacy of this procedure. Technical refinements and the development of better immunosuppressants and better postoperative care have brought about marked improvements in patient and graft survival and a reduction in postoperative morbidity. Consequently, pancreas transplantation has become the curative treatment modality for diabetes, particularly for type I diabetes. An overview of pancreas transplantation is provided herein, covering the history of pancreas transplantation, indications for transplantation, cadaveric and living donors, surgical techniques, immunosuppressants, and outcome following pancreas transplantation. The impact of successful pancreas transplantation on the complications of diabetes will also be reviewed briefly. PMID:21253293

Sutherland, David ER

2010-01-01

29

A case of myxofibrosarcoma of the maxilla with difficulty in preoperative diagnosis.  

PubMed

Myxofibrosarcoma (MFS) is a very rare fibroblast-derived sarcoma that occurs in the head and neck region. Here, we report the case of a 52-year-old man in whom MFS generated from the maxilla and whose beginning of treatment was considerably delayed because he was initially diagnosed as having a benign inflammatory lesion. Because a definite diagnosis was not obtained via 2 independent biopsies, total maxillectomy was used for both diagnosis and treatment. Histopathological and immunohistochemical analyses suggested that the tumor was a low-grade MFS. Because soft tissue tumors in the head and neck region are rare and a definite diagnosis is relatively difficult, surgical excision is indispensable if malignancy of the tumor is suspected. PMID:21830085

Nakahara, Susumu; Uemura, Hirokazu; Kurita, Tomoyuki; Suzuki, Motoyuki; Fujii, Takashi; Tomita, Yasuhiko; Yoshino, Kunitoshi

2012-08-01

30

Preoperative diagnosis of ductal carcinoma in situ arising within a mammary fibroadenoma: a case report.  

PubMed

Fibroadenoma is the most common form of benign breast tumor and the most common breast tumor in women under 30 years of age. However, carcinoma arising within a fibroadenoma is unusual, with over 100 cases reported in the literature. Histological diagnosis is typically unexpected. A 46-year-old female with no family history of breast malignancies was admitted for an elastic hard lump in the upper-outer quadrant of her right breast. At a clinic that she visited previously, her condition was diagnosed by core needle biopsy with four specimens showing fibroadenoma with borderline atypical ductal hyperplasia at pathology. Excisional biopsy was recommended for pathological diagnosis. The patient requested a definitive diagnosis and alternative treatment to tumorectomy. More biopsy specimens were needed for pathological diagnosis; therefore, ultrasonography-guided vacuum-assisted core needle biopsies were obtained, confirming ductal carcinoma in situ with questionable microinvasion of intracanalicular- and pericanalicular-type fibroadenoma. Right breast-conserving surgery and sentinel lymph node biopsy were immediately performed for radical therapy. We present this case to increase awareness of this entity and stress the need for histological evaluation of some breast masses. PMID:21693482

Ooe, Asako; Takahara, Sachiko; Sumiyoshi, Kazuhiro; Yamamoto, Hitoshi; Shiba, Eiichi; Kawai, Jun

2011-07-01

31

Organ Facts: Pancreas  

MedlinePLUS

... Heart/Lung Kidney Pancreas Kidney/Pancreas Liver Intestine Pancreas Facts The pancreas is a five to six inch gland located behind the stomach. The pancreas produces enzymes that are used for digestion, and ...

32

Incidental cystic endocrine tumor of the pancreas: a case report with immunohistochemical study.  

PubMed

A large cystic lesion in the pancreatic tail was found incidentally in a 20-year-old female during laparoscopic cholecystectomy. Pre-operative work up had revealed calculi in gall bladder and in addition, a cystic lesion in pancreas suggesting the possibility of a pseudocyst. A laparoscopic enucleation of the cyst was performed along with the removal of gallbladder. Microscopic examination of the resected specimen revealed a pancreatic cystic endocrine tumor; however, this tumor had produced no symptoms. Immunohistochemical studies of the tumor cells showed positivity for neuron-specific enolase, chromogranin A, and synaptophysin indicating their neuroendocrine nature. Prognostic markers (CK19, CD10 and Ki67) indicated good prognosis. Although endocrine tumors of the pancreas are usually solid, cystic change occurs only rarely and such tumors should be considered in the differential diagnosis of patients who have a cystic lesion in the pancreas in view of their rare transformation into a malignant tumor. PMID:22842378

Deshmukh, Sanjay D; Gulati, Harveen K; Gaopande, Vandana; Purandare, Snehal; Anand, Mani

2012-01-01

33

Role of FNAC in the Preoperative Diagnosis of Salivary Gland Lesions  

PubMed Central

Background: The characteristic cytologic features of the common salivary gland lesions have been well-delineated in literature. However, there also exist cytologic pitfalls and overlapping features that make an accurate diagnosis difficult in few cases. The present study was designed to compare the cytologic findings of salivary gland lesions with the histologic diagnoses, in order to assess the sensitivity, specificity and diagnostic accuracy of FNAC, with an emphasis on discordant cases. Materials and Methods: Patients with suspected salivary gland enlargements, who were referred for FNAC, were included in this study, which was done over a 3 year period in a medical college hospital. FNAC was performed by using the standard procedure. Smears were stained by using Papanicolaou’s and MGG stains. Cytologic diagnosis was compared with histopathologic diagnosis wherever it was available. Results: Eighty eight patients with salivary gland swellings were included in the study. The ages of the patients ranged from 15 to 82 years, with the M:F ratio being 1.6:1. Out of 88 cases, 68 had swellings in parotid gland, 19 had them in submandibular gland and one had them in hard palate. Pleomorphic adenoma was the commonest neoplasm which was seen in our study. Mucoepidermoid carcinoma (MEC) was the only malignant lesion seen in our study. One each of Warthin’s tumour (WT) and MEC were overdiagnosed and underdiagnosed respectively, the reason being squamous metaplasia in WT and subtle nature of malignant cells in low-grade MEC. Conclusion: WT and MEC can pose problems in cytologicdiagnosis. Sampling errors and interpretational errors can lead todiscordant diagnoses. PMID:25386436

D’souza, Clement R S; Khosla, Charu; George, Lovely; Katte, Namitha Hegde

2014-01-01

34

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

2013-03-01

35

Laparoscopy-Assisted Billroth I Gastrectomy for Ectopic Pancreas in the Prepyloric Region  

PubMed Central

Ectopic pancreatic tissue is an uncommon developmental anomaly. The condition mostly occurs in the gastrointestinal tract and is usually asymptomatic. It rarely causes symptoms of inflammation, bleeding and perforation, and has potential for malignant change. Though it is an uncommon condition, cases of ectopic pancreas have been reported worldwide. Preoperative diagnosis of ectopic pancreas is challenging because of its nonspecific symptoms and signs. Owing to the revolution of minimally invasive surgery, submucosal tumors of the stomach can be resected by laparoscopic techniques. We have earlier reported on a case of ectopic pancreas in the stomach treated by robotics-assisted laparoscopic wedge resection. Herein, we report a case of ectopic pancreas in the prepyloric region of the stomach. A 44-year-old female presented with a two-week history of epigastralgia with radiation to the back. She received endoscopy check-up which disclosed a mass in the stomach. By endoscopic findings, a submucosal lesion in the prepyloric region with umbilical folding on the mucosa was identified. The umbilical folding on the mucosa hint the orifice of the duct of ectopic pancreas into the gastric mucosa suggestive of ectopic pancreas. Contrast-enhanced abdominal computed tomography showed a 5 cm cystic mass with heterogeneous content. To sum it up, the patient was diagnosed as ectopic pancreas in the stomach. She underwent laparoscopy-assisted antrectomy with Billroth I anastomosis (excision of the antrum and prepyloric region with reconstruction of gastrointestinal continuity by gastroduodenostomy) and had an uneventful hospitalization course. The histopathology of the resected tumor demonstrated ectopic pancreatic tissue in the gastric wall. To the best of our knowledge, excision of gastric ectopic pancreas using laparoscopy-assisted antrectomy with Billroth I anastomosis has never been reported in the literature. PMID:23185154

Lee, Yueh-Tsung; Lin, Ho; Guo, Jen-Chang; Yan, Sheng-Lei; Hou, Hsiang-Jen; Lai, Yih-Shyong; Liu, Yi-Hsiang; Wu, Hurng-Sheng; Hwang, Min-Ho

2012-01-01

36

Annular Pancreas: A Cause of Gastric Outlet Obstruction in a 20-Year-Old Patient  

PubMed Central

Patient: Female, 20 Final Diagnosis: Annular pancreas Symptoms: Food intolerance • vomiting Medication:— Clinical Procedure: — Specialty: Gastroenterology and Hepatology Objective: Congenital defects/diseases Background: Annular pancreas is a congenital anomaly that consists of a ring of pancreatic tissue partially or completely encircling the descending portion of the duodenum. It is formed due to the failure of the ventral bud to rotate, thus it elongates and encircles the upper part of the duodenum. It can present in a wide range of clinical severities, and can affect neonates to the elderly, making it difficult to diagnosis. Although diagnosis of annular pancreas can be made pre-operatively by upper GI series, upper GI endoscopy, or CT scan, 40% of diagnoses require surgery for confirmation. Case Report: We report the case of a 20-year-old woman presenting with history of vomiting and weight loss since childhood. We present the clinical characteristics, surgical management in the form of bypass procedure done through a duodenojujenostomy, and follow-up of the patient. Conclusions: Annular pancreas occasionally presents in adults. Variable presentations have been described in the literature, including pancreatic neoplasm, pancreatitis, obstructive jaundice, duodenal obstruction, and peptic ulcer diseases. Most studies of these lesions are single case reports or small series, which do not allow a surgeon to accumulate extensive experience; therefore, reliance on the combined experience of others in recognition and appropriate management has been the norm. PMID:25300027

Alahmadi, Raha; Almuhammadi, Saud

2014-01-01

37

What Is the Pancreas?  

MedlinePLUS

... Our Blog Patient Education Pancreas News Basics of Pancreatic Cancer FAQs The Pancreas Types of Tumors Causes Hereditary ... Goldman Center Discussion Board Patient Education / Basics of Pancreatic Cancer The Pancreas Parts of the Pancreas Function of ...

38

Huge Cystic Lymphangioma of the Pancreas Mimicking Pancreatic Cystic Neoplasm  

PubMed Central

Lymphangiomas of the pancreas are very rare benign tumors of lymphatic origin, accounting for less than 1% of these neoplasms. We report a case of a 55-year-old woman who presented with a palpable mass in the left abdomen. Abdominal sonography and computed tomography showed a lobulated, hypodense mass extending from the left diaphragm to the pelvis, measuring 10 × 25?cm. A preoperative diagnosis of mucinous cystadenoma of the pancreas was suggested and the patient underwent laparotomy. Distal pancreatectomy with splenectomy was performed, encompassing a segment of descending colon because of close relationship to the mass. The cystic mass was histologically diagnosed as lymphangioma of the pancreas. The patient is well and free of disease 12 months after surgery. Pancreatic lymphangioma should be kept in mind when a huge, multiloculated mass is encountered in the abdomen, especially in adult women. Although lymphangioma is considered a benign tumor, involvement of adjacent organs sometimes occurs and extended resection is required to obtain a radical treatment. PMID:23197988

Dalla Bona, Enrico; Beltrame, Valentina; Blandamura, Stella; Liessi, Federica; Sperti, Cosimo

2012-01-01

39

Cystic lymphangioma of the pancreas  

PubMed Central

Lymphangioma is a benign form of neoplasm arising from the lymphatic system. It occurs as a result of congenital malformations of the lymphatics leading to the obstruction of local lymph flow and the development of lymphangiectasia. Lymphangiomas are common in pediatric patients, in the soft tissues of the neck and the axillae, but lymphangioma of the pancreas is extremely rare, accounting for less than 1% of these tumors. It occurs more frequently in females and is often located in the distal pancreas. Although extremely rare, cystic lymphangioma of the pancreas should be taken into consideration as a differential diagnosis of pancreatic cystic or retroperitoneal lesions, especially in women. Herein, we report on a case of cystic lymphangioma of the distal pancreas in a 37-year-old woman who was treated with complete surgical resection with a review of the literature. PMID:22066114

Sohn, Bok-Kyung; Cho, Chang-Ho

2011-01-01

40

Adenocarcinoma arising in a heterotopic pancreas (Heinrich type III): a case report  

PubMed Central

Introduction Heterotopic pancreatic cancer in the duodenum is a very rare disease. Only twelve cases have been reported worldwide to date. We report a rare case of malignant transformation of heterotopic pancreas (Heinrich type III) in the duodenum with long-term survival of the patient, and review the 12 cases in the literature. Case presentation A 75-year-old Japanese man was admitted to our hospital complaining of nausea and vomiting. Endoscopy and upper gastrointestinal contrast study showed marked duodenal stenosis. A pylorus-preserving pancreaticoduodenectomy was performed. Histopathological examination of the surgically resected specimen showed malignant transformation of heterotopic pancreas (Heinrich type III) in the duodenum. The postoperative course was uneventful, and the patient was discharged from the hospital on postoperative day 30. He is well and shows no signs of recurrence at the time of writing, six years after the surgery. Conclusion Adenocarcinoma arising within the heterotopic pancreas appears to be rare. It is difficult to obtain a correct diagnosis preoperatively. The management of heterotopic pancreas depends on the presence or absence of symptoms. If the patient is asymptomatic or benign, conservative treatment with regular follow-up is recommended. When the patient is symptomatic or there is a suspicion of malignancy, surgical management with intra-operative frozen section diagnosis is indicated. PMID:20205891

2010-01-01

41

Adenocarcinoma of the pancreas  

PubMed Central

Infiltrating ductal adenocarcinoma of the pancreas is a real enigma. On one hand, it is one of the most deadly of all of the solid malignancies. On the other hand, the neoplastic glands can be remarkably well-differentiated, and it can be difficult to distinguish between a reactive non-neoplastic gland and a gland of invasive adenocarcinoma. In this review, we will present diagnostic criteria that one can “hang your hat on” when establishing the diagnosis of infiltrating ductal adenocarcinoma of the pancreas. We will also review clinically important features of the disease, and, with the impending incorporation of molecular genetics into everyday practice, we will emphasize clinical applications of cancer genetics. PMID:25441308

Hruban, Ralph H.; Klimstra, David S.

2015-01-01

42

Preoperative diagnosis of fallopian tube malignancy with transvaginal color doppler ultrasonography and magnetic resonance imaging after negative hysteroscopy for postmenopausal bleeding.  

PubMed

Primary fallopian tube carcinoma is a rare malignancy and is not often diagnosed preoperatively. We present a case of a 67-year-old woman who complained of postmenopausal vaginal bleeding. After a negative hysteroscopy, transvaginal ultrasound showed a well vascularized solid-cystic tumor in the adnexal region separate from the ovary. The presence of an adnexal mass was confirmed by MR imaging. Total abdominal hysterectomy with bilateral salpingoophorectomy, omentectomy and appendectomy, as well as pelvic and paraaortic lymphadenectomy was performed. The pathohistological diagnosis was poorly differentiated serous adenocarcinoma of the fallopian tube, FIGO stage IA. The patient was subsequently treated with platinum based adjuvant chemotherapy. PMID:25507377

Arko, Darja; Žegura, Branka; Virag, Mirjana; Dovnik, Nina Fokter; Taka?, Iztok

2014-09-01

43

Preoperative diagnosis of a breast hydatid cyst using fine-needle aspiration cytology: a case report and review of the literature  

PubMed Central

Introduction A hydatid cyst of the breast is rare and often goes unnoticed by mammography and ultrasound. Preoperative diagnosis may be performed using fine-needle aspiration cytology, which also minimizes the risk of intraoperative rupture. Case presentation We report the case of a 70-year-old Spanish woman who was diagnosed with a hydatid cyst using fine-needle aspiration cytology before surgery. Conclusion Fine-needle aspiration cytology is an accurate and safe technique that can allow surgery to be avoided, especially in older patients or patients with high surgical risk. PMID:22973941

2012-01-01

44

An unusual presentation of pancreatic pseudocyst mimicking cystic neoplasm of the pancreas: a case report  

PubMed Central

In spite of their rarity, cystic neoplasms of the pancreas are characterized by existing or potential malignancy that cannot be ignored during decisive process with regard to the choice of treatment. Diagnostic difficulties in the differentiation of pancreatic pseudocyst and cystic pancreatic neoplasm can lead to misdiagnosis and inappropriate treatment, since clinical symptoms, preoperative imaging tests and even endoscopic retrograde cholangiopancreatography are often not sufficient to establish the correct diagnosis. We present a case of pancreatic cyst with no typical features of pseudocyst in the medical interview, treated by Child's subtotal pancreatectomy by reason of the high risk of neoplasia suggested by radiological and endoscopic examinations. PMID:20062655

2009-01-01

45

Normal Pancreas Anatomy  

MedlinePLUS

... Browse Search Quick Search Image Details Normal Pancreas Anatomy View/Download: Small: 761x736 View Download Add to My Pictures Title: Normal Pancreas Anatomy Description: Anatomy of the pancreas; drawing shows the ...

46

Enlarged pancreas: not always a cancer.  

PubMed

Pancreatic fat accumulation has been described with various terms including pancreatic lipomatosis, pancreatic steatosis, fatty replacement, fatty infiltration, fatty pancreas, lipomatous pseudohypertrophy and nonalcoholic fatty pancreas disease. It has been reported to be associated with type 2 diabetes mellitus, acute pancreatitis, pancreatic cancer and the formation of pancreatic fistula. The real incidence of this condition is still unknown. We report a case of pancreatic steatosis in a non-obese female patient initially diagnosed with a mass in the head of the pancreas. Magnetic resonance imaging (MRI) was carried out to define the characteristics of the pancreatic mass. MRI confirmed the diagnosis of fat pancreas. Enlarged pancreas is not always a cancer, but pancreatic steatosis is characterized by pancreatic enlargement. MRI could give a definite diagnosis of pancreatic steatosis or cancer. PMID:25655299

Calculli, Lucia; Festi, Davide; Pezzilli, Raffaele

2015-02-01

47

Mature cystic teratoma of the pancreas.  

PubMed

The pancreatic teratoma is a congenital tumor which results from abnormal embryonic development of totipotent cells. The preoperative diagnosis is challenging. We report, to our knowledge, the 26th case in a 64-year-old man in whom the diagnosis was made preoperatively on imaging. PMID:21983876

Ben Ameur, Hazem; Boujelbene, Salah; Abdelhedi, Cherif; Gheriani, Olfa; Beyrouti, Mohamed Issam

2012-12-01

48

Pancreas transplant - series (image)  

MedlinePLUS

The pancreas resides in the back of the abdomen. It functions to produce digestive enzymes which are delivered to ... of the most important hormones produced by the pancreas is insulin. Insulin is produced by specialized cells ...

49

Annular pancreas (image)  

MedlinePLUS

Annular pancreas is an abnormal ring or collar of pancreatic tissue that encircles the duodenum (the part of the ... intestine that connects to stomach). This portion of pancreas can constrict the duodenum and block or impair ...

50

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.

1983-05-01

51

Controversies in pancreas transplantation.  

PubMed

Pancreas transplants are now highly effective for patients with diabetes mellitus. Improvements in outcomes have primarily been due to significant reductions in technical failures and immunological graft loss. In this short review we discuss three areas of controversy in the field of pancreas transplantation. Notwithstanding the controversies we have highlighted, in line with the American Diabetic Association position statement, simultaneous pancreas-kidney transplants and pancreas after kidney transplants should be routine for diabetic kidney recipients, and a pancreas transplant alone is appropriate for non-uremic labile diabetic patients. PMID:25584826

Chinnakotla, S; Majumder, K; Sutherland, D E

2015-02-01

52

The tail of neuroendocrine tumors from lung to pancreas: Two rare case reports  

PubMed Central

INTRODUCTION Primary pancreatic neuroendocrine tumors are a well-established disease entity, however, neuroendocrine metastases to the pancreas from other sites have been scarcely documented. Specifically, pancreatic metastases from a pulmonary carcinoid tumor have only previously been described in a single case report. PRESENTATION OF CASE We sought to outline our institutional experience of two patients with pulmonary neuroendocrine tumors that developed metastases to the pancreas, confirmed by gross pathology and immunohistochemistry. In both cases, the pancreatic metastases were surgically resected and their pulmonary origin were discovered post-operatively. DISCUSSION Our findings should raise awareness to the possibility of metastatic disease when evaluating a pancreatic mass in a patient with a clinical history of pulmonary carcinoid tumor. Expert opinion on immunohistochemically differentiating a primary pancreatic neuroendocrine malignancy from a metastasis should be employed in these cases. CONCLUSION Establishing this diagnosis pre-operatively could affect the decision to proceed with surgical resection, given the morbidity of pancreatectomy and the unknown long-term clinical outcome of patients with pulmonary carcinoid tumors metastatic to the pancreas. PMID:25016081

Soni, Ashwin; Dogeas, Epameinondas; Juluri, Krishna R.; Wolfgang, Christopher L.; Hruban, Ralph H.; Weiss, Matthew J.

2014-01-01

53

Getting a New Pancreas: Facts about Pancreas Transplants  

MedlinePLUS

... Revised December 2006 Revised March 2012 Getting A New Pancreas Facts About Pancreas Transplants American Society of ... will work together to keep you and your new organ healthy. What Does a Pancreas do? The ...

54

Ectopic pancreas presenting with pancreatitis and a mesenteric mass.  

PubMed

Ectopic pancreas is defined by the presence of abnormally situated pancreatic tissue that lacks contact with normal pancreas and possesses its own duct system and vascular supply. Ectopic pancreas in the gastrointestinal tract is not uncommon. Moreover, there are several reported cases of adult ectopic pancreatitis in the literature, but to date, only two cases of pediatric ectopic pancreatitis have been reported. We describe a 15-year-old female with acute right upper quadrant pain and elevated serum lipase and amylase, in whom the radiological diagnosis was mesenteric soft tissue mass with adjacent inflammatory changes. The surgical pathology diagnosis, however, was mesenteric ectopic pancreas complicated by pancreatitis. We advocate for ectopic pancreatitis to be considered in a pediatric patient with acute abdominal pain, laboratory findings consistent with pancreatitis, and imaging findings of a mesenteric mass and normal orthotopic pancreas. PMID:23331836

Ginsburg, Michael; Ahmed, Osman; Rana, Kuntal A; Boumendjel, Redouane; Dachman, Abraham H; Zaritzky, Mario

2013-01-01

55

Assessment of pancreas cells  

NASA Technical Reports Server (NTRS)

Pancreatic islets were obtained from guinea pig pancreas by the collagenase method and kept alive in tissue culture prior to further studies. Pancreas cell morphology was studied by standard histochemical techniques using light microscopy. Preparative vertical electrophoresis-levitation of dispersed fetal guinea pig pancreas cells was conducted in phosphate buffer containing a heavy water (D20) gradient which does not cause clumping of cells or alter the osmolarity of the buffers. The faster migrating fractions tended to be enriched in beta-cell content. Alpha and delta cells were found to some degree in most fractions. A histogram showing the cell count distribution is included.

Vanoss, C. J.

1978-01-01

56

Symptoms of annular pancreas exacerbated by pregnancy.  

PubMed

Annular pancreas is a rare embryonal abnormality. Its manifestation in adulthood is often pinpointed with a substantial delay, which is most often attributed to pancreatitis, biliary pathology or dyspepsia. We present a case of a 28-year-old woman who had exacerbating symptoms of high bowel obstruction from 20th week of pregnancy, progressing after premature delivery. Diagnostic work-up revealed partial annular pancreas compressing the duodenum. Despite attempts of conservative treatment, her state deteriorated to such an extent that surgery was indicated and gastrojejunal bypass created. Her postoperative recovery was uneventful. In cases in which symptoms of high bowel obstruction in pregnancy persist and prostration occurs, we suggest close monitoring and a more thorough diagnostic approach. The question remains whether annular pancreas presents a cause of pathologic findings, a cofactor, or a mere accidental diagnosis in the development of superposed pathologies. PMID:19623872

Ledinsky, Mario; Sui?, Ivan; Babi?, Nenad; Kujundzi?, Stipan

2009-03-01

57

Giant mucinous cystic adenoma with pancreatic atrophy mimicking dorsal agenesis of the pancreas  

PubMed Central

Mucinous cystic adenoma (MCA) of the pancreas is a rare benign cystic tumor with ovarian-like stroma and lack of communication with the pancreatic ductal system. The ovarian tissue is incorporated from the left gonad within the dorsal pancreas during embryogenesis. Consequently, congenital dorsal agenesis of the pancreas (DAP) cannot be associated with MCA. We report the case of a giant MCA associated with atrophy of the dorsal pancreas mimicking complete DAP. Pancreato-magnetic resonance imaging failed to identify the dorsal pancreas but the absence of diabetes mellitus and compression of the splenic vein with major tributaries rectified the diagnosis of secondary atrophy of the distal pancreas. Unusual proximal location of the cyst in the pancreas may have induced chronic obstruction of both the dorsal pancreatic duct and the splenic vein, with secondary atrophy of the distal pancreas. PMID:24672649

Gagnière, Johan; Dupré, Aurélien; Ines, David Da; Tixier, Lucie; Pezet, Denis; Buc, Emmanuel

2014-01-01

58

Deconstructing Pancreas Developmental Biology  

PubMed Central

The relentless nature and increasing prevalence of human pancreatic diseases, in particular, diabetes mellitus and adenocarcinoma, has motivated further understanding of pancreas organogenesis. The pancreas is a multifunctional organ whose epithelial cells govern a diversity of physiologically vital endocrine and exocrine functions. The mechanisms governing the birth, differentiation, morphogenesis, growth, maturation, and maintenance of the endocrine and exocrine components in the pancreas have been discovered recently with increasing tempo. This includes recent studies unveiling mechanisms permitting unexpected flexibility in the developmental potential of immature and mature pancreatic cell subsets, including the ability to interconvert fates. In this article, we describe how classical cell biology, genetic analysis, lineage tracing, and embryological investigations are being complemented by powerful modern methods including epigenetic analysis, time-lapse imaging, and flow cytometry-based cell purification to dissect fundamental processes of pancreas development. PMID:22587935

Benitez, Cecil M.; Goodyer, William R.

2012-01-01

59

[Pancreas and islet transplantation].  

PubMed

Pancreas transplantation is a successful and effective procedure resulting in tight glucose control. Due to the postoperative morbidity and the need for immunosuppression pancreas transplantation should be considered in patients with type I diabetes at the time of kidney transplantation. Besides this pancreas transplantation alone can be taken into consideration for patients with very poor metabolic control and quality of life despite optimal medical treatment. Recently, islet transplantation became a less invasive alternative to pancreas transplantation. Due to the lack of long-term follow-up and due to the need of multiple donor grafts for one recipient, islet transplantation should be performed under experimental settings in experienced centers. New developments in protecting transplanted islets and in the induction of donor-specific tolerance could increase the indication to perform the procedure. Therefore alternative sources of beta-cells have to be identified. PMID:19390835

Jaeckel, E; Lehner, F

2009-05-01

60

Pancreas.org  

NSDL National Science Digital Library

Developed by Dr. David Whitcomb (the current president of the American Pancreatic Association) in collaboration with the University of Pittsburgh Medical School, this site offers a host of material on the pancreas for those persons dealing with diseases associated with this organ, as well as for doctors and scientists. Much of this material can be easily accessed from the site's homepage, which also features a helpful three-dimensional visual rendering of the pancreas and related structures for quick reference. The sections for patients contains background information on some of the more common conditions associated with the pancreas, such as acute pancreatitis, hereditary pancreatitis, and pancreatic cancer, which is the fourth leading cause of death due to cancer in almost every industrialized country. The sections for physicians and scientists is also well-developed, as both of them contain information on genetic testing, clinical trials, and research groups with a keen interest in the pancreas.

Whitcomb, David

61

Diagnosis and management of insulinoma.  

PubMed

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. PMID:23430217

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

2013-02-14

62

Borderline Ovarian Tumors and Diagnostic Dilemma of Intraoperative Diagnosis: Could Preoperative He4 Assay and ROMA Score Assessment Increase the Frozen Section Accuracy? A Multicenter Case-Control Study  

PubMed Central

The aim of our study was to assess the value of a preoperative He4-serum-assay and ROMA-score assessment in improving the accuracy of frozen section histology in the diagnosis of borderline ovarian tumors (BOT). 113 women presenting with a unilateral ovarian mass diagnosed as serous/mucinous BOT at frozen-section-histology (FS) and/or confirmed on final pathology were recruited. Pathologists were informed of the results of preoperative clinical/instrumental assessment of all patients. For Group_A patients, additional information regarding He4, CA125, and ROMA score was available (in Group_B only CA125 was known). The comparison between Group A and Group B in terms of FS accuracy, demonstrated a consensual diagnosis in 62.8% versus 58.6% (P: n.s.), underdiagnosis in 25.6% versus 41.4% (P < 0.05), and overdiagnosis in 11.6% versus 0% (P < 0.01). Low FS diagnostic accuracy was associated with menopausal status (OR: 2.13), laparoscopic approach (OR: 2.18), mucinous histotype (OR: 2.23), low grading (OR: 1.30), and FIGO stage I (OR: 2.53). Ultrasound detection of papillae (OR: 0.29), septa (OR: 0.39), atypical vascularization (OR: 0.34), serum He4 assay (OR: 0.39), and ROMA score assessment (OR: 0.44) decreased the probability of underdiagnosis. A combined preoperative assessment through serum markers and ultrasonographic features may potentially reduce the risk of underdiagnosis of BOTs on FS while likely increasing the concomitant incidence of false-positive events. PMID:25431767

Gizzo, Salvatore; Berretta, Roberto; Di Gangi, Stefania; Guido, Maria; Zanni, Giuliano Carlo; Franceschetti, Ilaria; Quaranta, Michela; Plebani, Mario; Nardelli, Giovanni Battista; Patrelli, Tito Silvio

2014-01-01

63

Imaging Spectrum after Pancreas Transplantation with Enteric Drainage  

PubMed Central

Since the introduction of pancreas transplantation more than 40 years ago, surgical techniques and immunosuppressive regiments have improved and both have contributed to increase the number and success rate of this procedure. However, graft survival corresponds to early diagnosis of organ-related complications. Thus, knowledge of the transplantation procedure and postoperative image anatomy are basic requirements for radiologists. In this article, we demonstrate the imaging spectrum of pancreas transplantation with enteric exocrine drainage. PMID:24497791

Chen, Jian-Ling; Shyr, Yi-Ming; Wang, Sing-E; Tseng, Hsiuo-Shan; Wang, Hsin-Kai; Huang, Shan-Su; Chang, Cheng-Yen

2014-01-01

64

Portal annular pancreas: a systematic review of a clinical challenge.  

PubMed

Portal annular pancreas (PAP) is an asymptomatic congenital pancreas anomaly, in which portal and/or mesenteric veins are encased by pancreas tissue. The aim of the study was to determine the role of PAP in pancreatic surgery as well as its management and potential complication, specifically, postoperative pancreatic fistula (POPF).On the basis of a case report, the MEDLINE and ISI Web of Science databases were systematically reviewed up to September 2012. All articles describing a case of PAP were considered.In summary, 21 studies with 59 cases were included. The overall prevalence of PAP was 2.4% and the patients' mean (SD) age was 55.9 (16.2) years. The POPF rate in patients with PAP (12 pancreaticoduodenectomies and 3 distal pancreatectomies) was 46.7% (in accordance with the definition of the International Study Group of Pancreatic Surgery).Portal annular pancreas is a quite unattended pancreatic variant with high prevalence and therefore still remains a clinical challenge to avoid postoperative complications. To decrease the risk for POPF, attentive preoperative diagnostics should also focus on PAP. In pancreaticoduodenectomy, a shift of the resection plane to the pancreas tail should be considered; in extensive pancreatectomy, coverage of the pancreatic remnant by the falciform ligament could be a treatment option. PMID:25207658

Harnoss, Jonathan M; Harnoss, Julian C; Diener, Markus K; Contin, Pietro; Ulrich, Alexis B; Büchler, Markus W; Schmitz-Winnenthal, Friedrich H

2014-10-01

65

Heterotopic Pancreas: A Rare Cause of Ileo-Ileal Intussusception  

PubMed Central

Background Heterotopic pancreas is a rare developmental anomaly defined as pancreatic tissue found on ectopic sites without contiguity with the main pancreas. An isolated heterotopic pancreas as a cause of bowel intussusception is extremely rare. Case Report A case of 47-year old male with multiple episodes of melena, constipation and abdominal pain for one year duration is presented. CT eneterography revealed a large circumferential lesion involving the terminal ileum that acted as a leading point to an ileo-ileal intussusception. The resection of the lesion and related bowel segment was carried out. The histopathological examination confirmed the excised lesion as a heterotopic pancreatic tissue. Conclusions Though a rare entity, heterotopic pancreas should be considered in the differential diagnosis of bowel intussusception. PMID:25302087

Monier, Ahmed; Awad, Ahmed; Szmigielski, Wojciech; Muneer, Mohamed; Alrashid, Amal; Darweesh, Adham; Hassan, Heba

2014-01-01

66

MR imaging of the pancreas.  

PubMed

Magnetic resonance (MR) imaging of the pancreas is useful as both a problem-solving tool and an initial imaging examination of choice. With newer imaging sequences such as diffusion-weighted imaging, MR offers improved ability to detect and characterize lesions and identify and stage tumors and inflammation. MR cholangiopancreatography can be used to visualize the pancreatic and biliary ductal system. In this article, the use of MR to evaluate the pancreas, including recent advances, is reviewed and the normal appearance of the pancreas on different imaging sequences, as well as inflammatory diseases, congenital abnormalities, and neoplasms of the pancreas, are discussed. PMID:24889170

O'Neill, Erin; Hammond, Nancy; Miller, Frank H

2014-07-01

67

Endosonographic Features of Histologically Proven Gastric Ectopic Pancreas  

PubMed Central

Gastric ectopic pancreas is an uncommon developmental anomaly and its histological diagnosis is usually difficult by using a conventional biopsy forceps. In the literature, most cases of gastric ectopic pancreas were usually diagnosed by gross pattern during endoscopic examination or features of endoscopic ultrasound. In contrast, this disease was seldom diagnosed by histology in clinical practice. Although the typical endoscopic ultrasonographic features of ectopic pancreas include heterogeneous echogenicity, indistinct borders, and a location within 2 or more layers, it can also exhibit hypoechoic homogeneous echogenicity and a distinct border within the fourth sonographic layer (muscularis propria) similar to the endoscopic ultrasonographic features of gastrointestinal stromal tumors. In our study, we found that 53% of gastric ectopic pancreas originated within the fourth sonographic layer, demonstrating hypoechoic, homogeneous echogenicity, and distinct borders. Therefore, recognizing endoscopic ultrasonographic features, combining with deep biopsy, endoscopic ultrasound-guided fine needle aspiration/core needle biopsy can prevent conducting unnecessary resection. Surgical resection is the mainstay treatment for symptomatic gastric ectopic pancreas, but endoscopic resection using endoscopic mucosal resection or endoscopic submucosal dissection technique provides an alternative method of removing superficial-type and deep-type gastric ectopic pancreas. PMID:25371670

Cheng, Ken-Sheng; Ting, Chun-Fu; Feng, Chun-Lung; Huang, Wen-Hsin

2014-01-01

68

Automatic segmentation of abdominal vessels for improved pancreas localization  

NASA Astrophysics Data System (ADS)

Accurate automatic detection and segmentation of abdominal organs from CT images is important for quantitative and qualitative organ tissue analysis as well as computer-aided diagnosis. The large variability of organ locations, the spatial interaction between organs that appear similar in medical scans and orientation and size variations are among the major challenges making the task very difficult. The pancreas poses these challenges in addition to its flexibility which allows for the shape of the tissue to vastly change. Due to the close proximity of the pancreas to numerous surrounding organs within the abdominal cavity the organ shifts according to the conditions of the organs within the abdomen, as such the pancreas is constantly changing. Combining these challenges with typically found patient-to-patient variations and scanning conditions the pancreas becomes harder to localize. In this paper we focus on three abdominal vessels that almost always abut the pancreas tissue and as such useful landmarks to identify the relative location of the pancreas. The splenic and portal veins extend from the hila of the spleen and liver, respectively, travel through the abdominal cavity and join at a position close to the head of the pancreas known as the portal confluence. A third vein, the superior mesenteric vein, anastomoses with the other two veins at the portal confluence. An automatic segmentation framework for obtaining the splenic vein, portal confluence and superior mesenteric vein is proposed using 17 contrast enhanced computed-tomography datasets. The proposed method uses outputs from the multi-organ multi-atlas label fusion and Frangi vesselness filter to obtain automatic seed points for vessel tracking and generation of statistical models of the desired vessels. The approach shows ability to identify the vessels and improve localization of the pancreas within the abdomen.

Farag, Amal; Liu, Jiamin; Summers, Ronald M.

2014-03-01

69

Pancreas transplantation in type II diabetes mellitus  

PubMed Central

Although the diagnosis of type 2 diabetes mellitus was once considered a contraindication to simultaneous pancreas-kidney transplantation, a growing body of evidence has revealed that similar graft and patient survival can be achieved when compared to type 1 diabetes mellitus recipients. A cautious strategy regarding candidate selection may limit appropriate candidates from additional benefits in terms of quality of life and potential amelioration of secondary side effects of the disease process. Although our current understanding of the disease has changed, uniform listing characteristics to better define and study this population have limited available data and must be established.

Weems, Phillip; Cooper, Matthew

2014-01-01

70

TFTR preoperational test plan  

Microsoft Academic Search

A preoperation test program is outlined for the TFTR (Tokamak Fusion Test Reactor), including test description, test objectives, documentation, test prerequisites, and special precautions. The preoperational test program is intended to establish a machine performance baseline for TFTR prior to the start of experimental operations. The manpower requirements for testing and startup purposes are also discussed.

W. J. Byron; N. S. Youssef; T. J. Carpenter; D. E. Lee

1979-01-01

71

Cystic lesions of the pancreas.  

PubMed

Although cystic tumors of the pancreas are relatively rare, they constitute an increasingly important category. Advances in imaging and interventional techniques and the sharp drop in the mortality rate of pancreatic surgery have rendered pancreatic biopsies and resections commonplace specimens. Consequently, in the past two decades, the nature of many cystic tumors in this organ has been better characterized. The names of some existing entities were revised; for example, what was known as papillary-cystic tumor is now regarded as solid-pseudopapillary tumor. New entities, in particular, intraductal papillary mucinous neoplasm and its variants, such as oncocytic and intestinal subtypes were recognized. The importance of clinical and pathologic correlation in the evaluation of these lesions was appreciated, in particular, with regards to the multifocality of these lesions, their association with invasive carcinomas, and thus their 'preinvasive' nature. Consensus criteria for the distinction of these from the ordinary precursors of adenocarcinoma, the pancreatic intraepithelial neoplasia, were established. The definition of mucinous cystic neoplasms was refined; ovarian-like stroma has now become almost a requirement for the diagnosis of mucinous cystic neoplasia, and defined as such, the propensity of these tumors to occur in perimenopausal women became even more striking. The validity and clinical value of classifying the pancreatic cysts of mucinous type as adenoma, borderline, CIS and invasive have been established. Related to this, the importance of thorough sampling in accurate classification of these mucinous lesions was recognized. Greater accessibility of the pancreas afforded by improved invasive as well as noninvasive modalities has also increased the detection of otherwise clinically silent cystic tumors, which has led to the recognition of more innocuous entities such as acinar cell cystadenoma and squamoid cyst of pancreatic ducts. As the significance of the cystic lesions emerged, cystic forms of otherwise typically solid tumors were also better characterized. Thus, significant developments have taken place in the classification and our understanding of pancreatic cystic tumors in the past few years, and experience with these lesions is likely to grow exponentially in the coming years. PMID:17486054

Volkan Adsay, N

2007-02-01

72

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. PMID:23414871

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

2013-01-01

73

Ectopic pancreas: a rare cause of abdominal pain.  

PubMed

We present a case of recurrent abdominal pain due to an ectopic or heterotopic pancreas. Heterotopic pancreas (HP) is the presence of histologic pancreatic tissue outside its normal location without any anatomic or vascular continuity with the pancreas. The frequency of HP has been estimated as 0.6-13.7%. Most are found in the duodenum, stomach, andjejunum. The exact mechanism remains controversial but it has been theorized that it most likely arises congenitally during embryonic development. The elevations of amylase and lipase levels are modest due to the small volume of pancreatic tissue in the HP. Therefore, diagnostic modalities including barium swallow, upper-gastrointestinal series, CT, EUS, and MRCP can be used when suspecting HP. The need for treatment is based on symptoms and definitive diagnosis, especially when the possibility of malignancy exists. Asymptomatic causes need not require treatment. PMID:25314887

Habibi, Hamid; Devuni, Deepika; Rossi, Lisa

2014-09-01

74

Pre-operative fasting.  

PubMed

This descriptive research study replicates that of Hamilton-Smith and investigates the current practice of pre-operative fasting. It was found that, 20 years on, the management of pre-operative fasting was still largely unchanged. Despite the recognition of vast potential complications of prolonged fasting, most patients were deprived of food and fluid for considerable lengths of time before general anaesthesia--far beyond the acceptable maximum fasting time of 12 hours. However, a small number of experienced nurses challenged the tradition and successfully reduced pre-operative fasting near to the accepted minimum and thereby provided adequate nutrition for patients. PMID:1454610

Hung, P

75

Emerging therapies in pancreas cancer  

PubMed Central

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

2011-01-01

76

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

1989-01-01

77

Evolution in Pancreas Transplantation Techniques: Simultaneous Kidney-Pancreas Transplantation Using Portal-Enteric Drainage Without Antilymphocyte Induction  

PubMed Central

Objective To report initial experience with the combination of a novel technique of portal-enteric pancreas transplantation with newer immunosuppressive strategies that eliminate antilymphocyte induction therapy. Background A new surgical technique of pancreas transplantation has been developed with portal venous delivery of insulin and enteric drainage of the exocrine secretions (portal-enteric). The introduction of potent immunosuppressive agents may allow simultaneous kidney and pancreas transplants (SKPT) to be performed without antilymphocyte induction. Methods From September 1996 to November 1998, the authors performed 28 primary SKPTs with portal-enteric drainage and no antilymphocyte induction. All patients received triple immunosuppression with tacrolimus, mycophenolate mofetil, and steroids. The study group had a mean age of 38 years and a mean preoperative duration of diabetes of 25 years. Four patients (14%) had prior kidney transplants. Results All patients had immediate renal allograft function. Actual patient, kidney, and pancreas graft survival rates were 86%, 82%, and 82%, respectively, after a mean follow-up of 12 months. Four patients died, three as a result of cardiac events unrelated to SKPT. Five kidney and five pancreas grafts were lost, including five deaths with function and three cases of chronic rejection. The mean length of stay and total charges for the initial hospital stay were 12.5 days and $99,517. The mean number of readmissions was 2.9, and 10 patients (36%) had no readmissions. Six patients (21%) developed acute rejection, with five (18%) receiving antilymphocyte therapy. Seven patients (25%) underwent relaparotomy, including two (7%) for intraabdominal infection. Nine patients (32%) had major infections, including three (11%) with cytomegaloviral infection. Of the 24 surviving patients, 22 (92%) are both dialysis- and insulin-free. Conclusion These preliminary results suggest that SKPT with portal-enteric drainage without antilymphocyte induction can be performed with excellent outcomes. PMID:10235529

Stratta, Robert J.; Gaber, A. Osama; Shokouh-Amiri, M. Hosein; Reddy, K. Sudhakar; Alloway, Rita R.; Egidi, M. Francesca; Grewal, Hani P.; Gaber, Lillian W.; Hathaway, Donna

1999-01-01

78

Induction therapy in pancreas transplantation.  

PubMed

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

2013-07-01

79

Foetal development of the pancreas.  

PubMed

In the present study, we aimed to gather morphometric data on the localisation and development of the pancreas during the foetal period. The study was carried out on 222 human foetuses aged 9-40 weeks of gestation with no external pathology or anomaly. The abdominal wall was dissected after general external measurements of the foetuses were carried out. Data on the localisation of the pancreas in the abdominal cavity and its localisation relative to the median plane, xiphoid process, and umbilicus were acquired and various morphometric parameters including the length of the pancreas and heights of the head and body of the pancreas were measured. It was found that, in the foetal period, the foetal pancreas was primarily accumulated on the transverse plane passing through the umbilicus, and on the other quadrants. Means and standard deviations of all morphometric parameters were calculated for each gestational week, month, and trimester. There were significant relations between the parameters and gestational age (p < 0.001). There were no differences in any of the parameters between sexes (p > 0.05). In conclusion, morphometric and location data on foetal pancreases acquired in the present study will contribute to other studies carried out in obstetrics, perinatology, forensic medicine, and foetal pathology departments, aimed at identifying anomalies, pathologies, and variations of the pancreas and treatment of such cases. PMID:21120808

Desdicioglu, K; Malas, M A; Evcil, E H

2010-11-01

80

Gemcitabine and AMG 479 in Metastatic Adenocarcinoma of the Pancreas  

ClinicalTrials.gov

Adenocarcinoma of the Pancreas; Advanced Solid Tumors; Cancer; Cancer of Pancreas; Cancer of the Pancreas; Metastases; Metastatic Cancer; Metastatic Pancreatic Cancer; Pancreas Cancer; Pancreatic Cancer; Bone Metastases; Endocrine Cancer; Oncology; Oncology Patients; Solid Tumors; Advanced Malignancy

2014-03-28

81

The Preoperative Neurological Evaluation  

PubMed Central

Neurological diseases are prevalent in the general population, and the neurohospitalist has an important role to play in the preoperative planning for patients with and at risk for developing neurological disease. The neurohospitalist can provide patients and their families as well as anesthesiologists, surgeons, hospitalists, and other providers guidance in particular to the patient’s neurological disease and those he or she is at risk for. Here we present considerations and guidance for the neurohospitalist providing preoperative consultation for the neurological patient with or at risk of disturbances of consciousness, cerebrovascular and carotid disease, epilepsy, neuromuscular disease, and Parkinson disease. PMID:24198903

Probasco, John; Sahin, Bogachan; Tran, Tung; Chung, Tae Hwan; Rosenthal, Liana Shapiro; Mari, Zoltan; Levy, Michael

2013-01-01

82

Solid pseudopapillary tumour of pancreas.  

PubMed

Solid pseudopapillary tumour of pancreas (SPT) is an extremely rare pancreatic tumour, which has a low malignant potential and occurs mainly in young women. Pathologic and imaging findings include a well defined encapsulated pancreatic mass with cystic and solid components with evidence of haemorrhage. This is a case of a 16 years old girl who presented with upper abdominal pain of long duration and epigastric mass on palpation. Computed Tomography (CT) scan demonstrated a large well defined heterogenous attenuation mass of solid enhancing and cystic non enhancing areas, arising from the head of the pancreas. Radiologically it was diagnosed as a case of pancreatic neoplasm. Fine needle aspiration cytology (FNAC) and histopathology of the biopsy material diagnosed as solid pseudopapillary tumour of pancreas. PMID:24858174

Bose, B; Majumder, S; Khan, A U

2014-04-01

83

Design of a bioartificial pancreas  

PubMed Central

Summary Islet transplantation has been shown to be a viable treatment option for patients 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 to 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 in hydrogels for graft immunoisolation holds tremendous promise for diabetic patients because it has great potential to overcome these two barriers. In this review article, we will discuss the need for bioartificial pancreas, provide a detailed description of the microencapsulation process, and review the status of the technology in clinical development. We will also critically review the various factors that need to be taken into consideration in order to achieve the ultimate goal of routine clinical application. PMID:23652283

Pareta, Rajesh A; Farney, Alan C; Opara, Emmanuel C

2013-01-01

84

Your Medicare Coverage: Pancreas Transplants (Adults)  

MedlinePLUS

... covered? Search Medicare.gov for covered items Pancreas transplants (adults) How often is it covered? If you ... Stage Renal Disease (ESRD) and need a pancreas transplant, Medicare covers the transplant if one of these ...

85

Model Predictive Control for an artical pancreas  

E-print Network

Model Predictive Control for an artical pancreas B.Sc. Thesis Matias Sørensen og Simon Kristiansen with linear Model Predictive Control, MPC, with the goal of making a controller for an articial pancreas

86

Collection protocol for human pancreas.  

PubMed

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

2012-01-01

87

Collection Protocol for Human Pancreas  

PubMed Central

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 1. 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 2. 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 3. 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 diabetes4,5. 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.

2012-01-01

88

Preoperative tumor embolization.  

PubMed

In this article, the authors review general principles and technical details of preoperative embolization of various hypervascular head, neck, and spinal tumors encountered in contemporary neuroendovascular practice. Indications, treatment goals, techniques, outcomes, and complications are discussed, and illustrative case examples are presented. PMID:24994094

Ashour, Ramsey; Aziz-Sultan, Ali

2014-07-01

89

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. PMID:21197409

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

2011-01-01

90

Solid pseudopapillary neoplasm of the pancreas in an old man: age does not matter  

PubMed Central

Solid pseudopapillary tumor (SPN) of the pancreas is a rare tumor, but has favorable prognosis. It is typically observed in young women. Only few cases have been reported in young men. We report the observation of a 73-year-old man presented with a palpable mass in the left upper abdomen. CT scan showed 10 cm mass at the tail of the pancreas. This mass had mixed cystic and solid components. The patient underwent a distal pancreatectomy and splenectomy. SPN of the pancreas was diagnosed based on histopathological features. The patient recovered uneventfully and didn't receive adjuvant therapy. A CT scan performed 16 months postoperatively showed no evidence of disease recurrence. Although SPN of the pancreas is typically observed in young women, the diagnosis should not be discounted in old male patients. Male patients and those with old age, atypical histopathology and incomplete resection may have a higher risk of recurrence and death, deserving particular attention. PMID:23308315

Bouassida, Mahdi; Mighri, Mohamed Monji; Bacha, Dhouha; Chtourou, Mohamed Fadhel; Touinsi, Hassen; Azzouz, Mohamed Msaddak; Sassi, Sadok

2012-01-01

91

Anaplastic Carcinoma of the Pancreas Mimicking Submucosal Gastric Tumor: A Case Report of a Rare Tumor  

PubMed Central

Anaplastic carcinoma of the pancreas (ACP) is a rare neoplasm of the pancreas. ACPs are aggressive neoplasms with a poorer prognosis than poorly differentiated ductal adenocarcinomas of the pancreas. The 3-year survival rate of patients with ACP is less than 3%, with a life expectancy of 10 to 20 months. We describe here a 64-year-old man with ACP mimicking a submucosal gastric tumor. The patient was found to have a giant mass mimicking a submucosal tumor. Total gastrectomy with splenectomy and partial resection of the tail of the pancreas were performed. The pathological diagnosis was ACP, with immunohistological findings showing pleomorphic-type ACP. Because the surgery was noncurative, the patient received adjuvant chemotherapy with paclitaxel but died of peritoneal dissemination and multiple liver metastases 4 months after surgery. PMID:24382965

Kobayashi, Takashi; Tanaka, Michio

2013-01-01

92

Pancreatic autoantibodies after pancreas-kidney transplantation - do they matter?  

PubMed

Type 1 diabetes recurrence has been documented in simultaneous pancreas-kidney transplants (SPKT), but this diagnosis may be underestimated. Antibody monitoring is the most simple, noninvasive, screening test for pancreas autoimmune activity. However, the impact of the positive autoimmune markers on pancreas graft function remains controversial. In our cohort of 105 SPKT, we studied the cases with positive pancreatic autoantibodies. They were immunosuppressed with antithymocyte globulin, tacrolimus, mycophenolate, and steroids. The persistence or reappearance of these autoantibodies after SPKT and factors associated with their evolution and with graft outcome were analyzed. Pancreatic autoantibodies were prospectively monitored. Serum samples were collected before transplantation and at least once per year thereafter. At the end of the follow-up (maximum 138 months), 43.8% of patients were positive (from pre-transplant or after recurrence) for at least one autoantibody - the positive group. Antiglutamic acid decarboxylase was the most prevalent (31.4%), followed by anti-insulin (8.6%) and anti-islet cell autoantibodies (3.8%). Bivariate analysis showed that the positive group had higher fasting glucose, higher glycated hemoglobin (HbA1c), lower C-peptide levels, and a higher number of HLA-matches. Analyzing the sample divided into four groups according to pre-/post-transplant autoantibodies profile, the negative/positive group tended to present the higher HbA1c values. Multivariate analysis confirmed the significant association between pancreas autoimmunity and HbA1c and C-peptide levels. Positivity for these autoantibodies pre-transplantation did not influence pancreas survival. The unfavorable glycemic profile observed in the autoantibody-positive SPKT is a matter of concern, which deserves further attention. PMID:24655222

Martins, La Salete; Henriques, Antonio C; Fonseca, Isabel M; Rodrigues, Anabela S; Oliverira, José C; Dores, Jorge M; Dias, Leonidio S; Cabrita, Antonio M; Silva, José D; Noronha, Irene L

2014-04-01

93

Secondary tumors of the pancreas: a case series.  

PubMed

Metastatic carcinoma of the pancreas from another primary site is uncommon and it accounts for 2-5% of all pancreatic cancer cases. We reported the case of one patient with pancreatic metastasis from colon carcinoma in the past and would like to add another six cases of pancreatic metastases from different types of cancer. The diagnosis of cancer metastatic to the pancreas should be suspected when patients have a history of malignancy, especially of kidney, skin, lung, colon and breast cancer. Besides imaging studies, such as computed tomography (CT) scan, bone scan and positron emission tomography (PET)/CT scan, endoscopic ultrasound (EUS)-guided biopsy has most value in ruling out second primary pancreatic cancer. The prognosis of pancreatic metastases is essentially determined by the underlying primary cancer and the potential treatment options. PMID:22493384

Pan, Beiqing; Lee, Yoomi; Rodriguez, Teresa; Lee, James; Saif, Muhammad Wasif

2012-04-01

94

Pancreas and islet cell transplantation  

PubMed Central

Currently, for the patient with type 1 diabetes, a definitive treatment without resorting to the use of exogenous insulin can be achieved only with pancreas or islet cell transplantation. These means of restoring ?-cell mass can completely maintain essentially normal long-term glucose homeostasis, although the need for powerful immunosuppressive regimens limits their application to only a subgroup of adult patients. Apart from the shortage of donors that has limited all kinds of transplantation, however, the widespread use of ?-cell replacement has been precluded until recently by the drawbacks associated with both organ and islet cell transplantation. Although the study of recurrence of diabetes has generated attention, the fundamental obstacle to pancreas and islet transplantation has been, and remains, the alloimmune response. With a better elucidation of the mechanisms of alloengraftment achieved during the last 3 years, the stage has been set for further advances. PMID:12079269

Bottino, Rita; Trucco, Massimo; Balamurugan, A. N.; Starzl, Thomas E.

2011-01-01

95

Endocrine pancreas development in zebrafish.  

PubMed

Type 1 diabetes results from the autoimmune destruction of insulin-producing pancreatic ? cells. Current efforts to cure diabetes are aimed at replenishing damaged cells by generating a new supply of ? cells in vitro. The most promising strategy for achieving this goal is to differentiate embryonic stem (ES) cells by sequentially exposing them to signaling molecules that they would normally encounter in vivo. This approach requires a thorough understanding of the temporal sequence of the signaling events underlying pancreatic ?-cell induction during embryonic development. The zebrafish system has emerged as a powerful tool in the study of pancreas development. In this review, we provide a temporal summary of pancreas development in zebrafish with a special focus on the formation of pancreatic ? cells. PMID:22030554

Tehrani, Zahra; Lin, Shuo

2011-10-15

96

Clinical significance of the preoperative plasma carcinoembryonic antigen (CEA) level in patients with carcinoma of the large bowel  

Microsoft Academic Search

Preoperative levels of perchloric acid extractable plasma CEA were measured in 911 patients with complaints of the digestive\\u000a system. A final diagnosis of benign disease was made for 579 patients; 332 patients were found to have cancer. Data for the\\u000a preoperative CEA values were examined for clinical significance as an aide to diagnosis, preoperative disease staging, and\\u000a prognosis.\\u000a \\u000a The results

Karl E. Blake; Milton H. Dalbow; Joseph P. Concannon; Sheila E. Hodgson; George J. Brodmerkel; Hassan Panahandeh; Karl Zimmerman; James J. Headings

1982-01-01

97

Pre-operative anaemia.  

PubMed

Pre-operative anaemia is a relatively common finding, affecting a third of patients undergoing elective surgery. Traditionally associated with chronic disease, management has historically focused on the use of blood transfusion as a solution for anaemia in the peri-operative period. Data from large series now suggest that anaemia is an independent risk associated with poor outcome in both cardiac and non-cardiac surgery. Furthermore, blood transfusion does not appear to ameliorate this risk, and in fact may increase the risk of postoperative complications and hospital length of stay. Consequently, there is a need to identify, diagnose and manage pre-operative anaemia to reduce surgical risk. Discoveries in the pathways of iron metabolism have found that chronic disease can cause a state of functional iron deficiency leading to anaemia. The key iron regulatory protein hepcidin, activated in response to inflammation, inhibits absorption of iron from the gastrointestinal tract and further reduces bioavailability of iron stores for red cell production. Consequently, although iron stores (predominantly ferritin) may be normal, the transport of iron either from the gastrointestinal tract or iron stores to the bone marrow is inhibited, leading to a state of 'functional' iron deficiency and subsequent anaemia. Since absorption from the gastrointestinal tract is blocked, increasing oral iron intake is ineffective, and studies are now looking at the role of intravenous iron to treat anaemia in the surgical setting. In this article, we review the incidence and impact of anaemia on the pre-operative patient. We explain how anaemia may be caused by functional iron deficiency, and how iron deficiency anaemia may be diagnosed and treated. PMID:25440391

Clevenger, B; Richards, T

2015-01-01

98

Pancreas-Preserving Approach to “Paraduodenal Pancreatitis” Treatment: Why, When, and How? Experience of Treatment of 62 Patients with Duodenal Dystrophy  

PubMed Central

Background. The term “paraduodenal pancreatitis” (PP) was proposed as a synonym for duodenal dystrophy (DD) and groove pancreatitis, but it is still unclear what organ PP originates from and how to treat it properly. Objective. To assess the results of different types of treatment for PP. Method. Prospective analysis of 62 cases of PP (2004–2013) with histopathology of 40 specimens was performed; clinical presentation was assessed and the results of treatment were recorded.??Results. Preoperative diagnosis was correct in all the cases except one (1.9%). Patients presented with abdominal pain (100%), weight loss (76%), vomiting (30%), and jaundice (18%). CT, MRI, and endoUS were the most useful diagnostic modalities. Ten patients were treated conservatively, 24 underwent pancreaticoduodenectomies (PD), pancreatico- and cystoenterostomies (8), Nakao procedures (5), duodenum-preserving pancreatic head resections (5), and 10 pancreas-preserving duodenal resections (PPDR) without mortality. Full pain control was achieved after PPRDs in 83%, after PDs in 85%, and after PPPH resections and draining procedures in 18% of cases. Diabetes mellitus developed thrice after PD. Conclusions. PD is the main surgical option for PP treatment at present; early diagnosis makes PPDR the treatment of choice for PP; efficacy of PPDR for DD treatment provides proof that so-called PP is an entity of duodenal, but not “paraduodenal,” origin. PMID:24995273

Egorov, V. I.; Vankovich, A. N.; Petrov, R. V.; Starostina, N. S.; Butkevich, A. Ts.; Sazhin, A. V.; Stepanova, E. A.

2014-01-01

99

Heterotopic pancreas in the stomach: A case report and literature review  

PubMed Central

Ectopic pancreas is defined as pancreatic tissue found outside the usual anatomic location of the pancreas. It is often an incidental finding and can be found at different sites in the gastrointestinal tract. It may become clinically evident when complicated by pathologic changes such as inflammation, bleeding, obstruction, and malignant transformation. In this report, a 40 years old woman with epigastric pain due to ectopic pancreatic tissue in the stomach is described. The difficulty of making an accurate diagnosis is highlighted. The patient has remained free of symptoms since she underwent wedge resection of the lesion three years ago. Frozen sections may help in deciding the extent of resection intraoperatively. Although ectopic pancreas is rare, it should be considered in the differential diagnosis of a submucosal gastric tumour. PMID:18023108

Christodoulidis, Grigorios; Zacharoulis, Dimitris; Barbanis, Sotiris; Katsogridakis, Emmanuel; Hatzitheofilou, Konstantine

2007-01-01

100

Gastric Adenocarcinoma: Is Computed Tomography (CT) Useful in Preoperative Staging?  

PubMed Central

Background and Purpose: Although multiple studies testing the accuracy of CT in the preoperative staging of gastric adenocarcinoma have been carried out, their results are controversial. Whilst some authors claim that CT is an accurate method for preoperatively staging gastric cancer, others have advocated the contrary. Because of this discrepancy we have retrospectively reviewed preoperative CT findings compared with histopathological results in patients with gastric adenocarcinoma. Patients and Methods: Seventy-two patients diagnosed with gastric cancer who underwent potentially curative surgery and preoperative staging CT of quality were included in the study. The size, gastric wall thickening, presence of lymphadenopathy, adjacent organ invasion and location of the gastric mass was recorded. Early tumors (T1 and T2) and more advanced tumors (T3 and T4) were grouped together. CT staging was correlated with the final histopathological stage (TNM). The global results were expressed as sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results: Seventy-two cases were included with fifty-five being male and a median age of 67 years (range 33–91). CT correctly identified the location of the tumor in 56 (53% antropyloric, 18% subcardial). Median time from CT scan to surgery was fourteen days (range 2–49). In T detection: T1/T2 and T3/T4 with sensitivity of 70% and 61%. Lymph node involvement: Sensitivity 49%. Overstaged in 47% Understaged in 75%. Specificity of 53%. Nine patients with colon-mesocolon (5 patients) and pancreas (4 patients) invasion. Sensitivity 44% and specificity 96%. Conclusion: Spiral CT is not an accurate method in predicting preoperative stages in gastric cancer. PMID:20689615

Cidón, Esther Uña; Cuenca, Isabel Jiménez

2009-01-01

101

CASE REPORT Open Access Isolated granulocytic sarcoma of the pancreas  

E-print Network

CASE REPORT Open Access Isolated granulocytic sarcoma of the pancreas: A tricky diagnostic sarcoma of the pancreas that were diagnosed on the surgical specimen. Atypical clinical and morphological and therapeutic strategies. Keywords: Granulocytic sarcoma, Chloroma, Myeloid tumor, Pancreas. Background

Boyer, Edmond

102

[Symptomatic cyst of the pancreas and asymptomatic bilateral phaeochromocytoma  

PubMed

Symptomatic cyst of the pancreas and asymptomatic bilateral phaeochromocytoma. HISTORY AND CLINICAL FINDINGS: A 39-year-old woman was admitted to our department of gastroenterology with recurrent epigastrical pain. Ten years previously the diagnosis of von Hippel-Lindau (VHL)-syndrome has been established. Two years before a germ line mutation in exon 3 of the VHL-tumour suppressor gene has been detected. The patient has a healthy son with a normal VHL-gene and four healthy siblings who had refused a genetic blood test. INVESTIGATIONS: At abdominal ultrasound at the head of the pancreas three 4 2 cm large cysts and in the region of the left adrenal gland a 2,9 2,7 cm large tumor were visible. MRI of the abdomen revealed in addition a 2,2 1,5 cm large tumour of the right adrenal gland. An asymptomatic biadrenal phaeochromocytoma was detected by elevated urine catecholamines and 123I-MIBG-scintigraphy. TREATMENT AND COURSE: The cysts of the pancreas were punctured under endosonographical control and analysis of the cyst fluid was not suspicious of a malignant cystic tumour. The patient had no further abdominal complaints. After oral treatment with the alpha-blocker phentolamine the biadrenal phaeochromocytoma was treated by retroperitoneal laparoscopic surgery in an organ-sparing fashion. Postoperatively ACTH-stimulating test revealed a normal cortisol response. CONCLUSION: Adrenocortical function can be preserved by la-paroscopic adrenal-sparing surgery in bilateral phaeochromocytoma. PMID:12751023

Karvar, S; Breidert, M; Nagel, M; Kirsch, C; Pinkert, J; Ehninger, G

2001-01-01

103

Ghrelin and the endocrine pancreas.  

PubMed

Ghrelin is a 28-amino-acid peptide predominantly produced by the stomach, while substantially lower amounts derive from other tissues including the pancreas. It is a natural ligand of the GH secretagogue (GHS) receptor (GHS-R1a) and strongly stimulates GH secretion, but acylation in serine 3 is needed for its activity. Ghrelin also possesses other endocrine and nonendocrine actions reflecting central and peripheral GHS-R distribution including the pancreas. The wide spectrum of ghrelin activities includes orexigenic effect, control of energy expenditure, and peripheral gastroenteropancreatic actions. Circulating ghrelin levels mostly reflect gastric secretion as indicated by evidence that they are reduced by 80% after gastrectomy and even after gastric by-pass surgery. Ghrelin secretion is increased in anorexia and cachexia but reduced in obesity, a notable exception being Prader-Willi syndrome. The negative association between ghrelin secretion and body weight is emphasized by evidence that weight increase and decrease reduces and augments circulating ghrelin levels in anorexia and obesity, respectively, and agrees with the clear negative association between ghrelin and insulin levels. In fact, ghrelin secretion is increased by fasting whereas it is decreased by glucose load as well as during euglycemic clamp but not after arginine or free fatty acid load in normal subjects; in physiological conditions, however, the most remarkable inhibitory input on ghrelin secretion is represented by somatostatin as well as by its natural analog cortistatin that concomitantly reduce beta-cell secretion. This evidence indicates that the endocrine pancreas plays a role in directly or indirectly modulating ghrelin secretion. PMID:14610295

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

2003-10-01

104

Chronic metabolic acidosis destroys pancreas.  

PubMed

One primary reason for the current epidemic of digestive disorders might be chronic metabolic acidosis, which is extremely common in the modern population. Chronic metabolic acidosis primarily affects two alkaline digestive glands, the liver, and the pancreas, which produce alkaline bile and pancreatic juice with a large amount of bicarbonate. Even small acidic alterations in the bile and pancreatic juice pH can lead to serious biochemical/biomechanical changes. The pancreatic digestive enzymes require an alkaline milieu for proper function, and lowering the pH disables their activity. It can be the primary cause of indigestion. Acidification of the pancreatic juice decreases its antimicrobial activity, which can lead to intestinal dysbiosis. Lowering the pH of the pancreatic juice can cause premature activation of the proteases inside the pancreas with the potential development of pancreatitis. The acidification of bile causes precipitation of the bile acids, which irritate the entire biliary system and create bile stone formation. Aggressive mixture of the acidic bile and the pancreatic juice can cause erratic contractions of the duodenum's walls and subsequent bile reflux into the stomach and the esophagus. Normal exocrine pancreatic function is the core of proper digestion. Currently, there is no effective and safe treatment for enhancing the exocrine pancreatic function. Restoring normal acid-base homeostasis can be a useful tool for pathophysiological therapeutic approaches for various gastrointestinal disorders. There is strong research and practical evidence that restoring the HCO3- capacity in the blood can improve digestion. PMID:25435570

Melamed, Peter; Melamed, Felix

2014-01-01

105

Hydatid cyst of the pancreas: Report of an undiagnosed case of pancreatic hydatid cyst and brief literature review  

PubMed Central

AIM: To overview the literature on pancreatic hydatid cyst (PHC) disease, a disease frequently misdiagnosed during preoperative radiologic investigation. METHODS: PubMed, Medline, Google Scholar, and Google databases were searched to identify articles related to PHC using the following keywords: hydatid cyst, hydatid disease, unusual location of hydatid cyst, hydatid cyst and pancreas, pancreatic hydatid cyst, and pancreatic echinococcosis. The search included letters to the editor, case reports, review articles, original articles, meeting presentations and abstracts that had been published between January 2010 and April 2014 without any restrictions on language, journal, or country. All articles identified and retrieved which contained adequate information on the study population (including patient age and sex) and disease and treatment related data (such as cyst size, cyst location, and clinical management) were included in the study; articles with insufficient demographic and clinical data were excluded. In addition, we evaluated a case of a 48-year-old female patient with PHC who was treated in our clinic. RESULTS: A total of 58 patients, including our one new case, (age range: 4 to 70 years, mean ± SD: 31.4 ± 15.9 years) were included in the analysis. Twenty-nine of the patients were female, and 29 were male. The information about cyst location was available from studies involving 54 patients and indicated the following distribution of locations: pancreatic head (n = 21), pancreatic tail (n = 18), pancreatic body and tail (n = 8), pancreatic body (n = 5), pancreatic head and body (n = 1), and pancreatic neck (n = 1). Extra-pancreatic locations of hydatid cysts were reported in the studies involving 44 of the patients. Among these, no other focus than pancreas was detected in 32 of the patients (isolated cases) while 12 of the patients had hydatid cysts in extra-pancreatic sites (liver: n = 6, liver + spleen + peritoneum: n = 2, kidney: n = 1, liver + kidney: n = 1, kidney + peritoneum: n = 1 and liver + lung: n = 1). Serological information was available in the studies involving 40 patients, and 21 of those patients were serologically positive and 15 were serologically negative; the remaining 4 patients underwent no serological testing. Information about pancreatic cyst size was available in the studies involving 42 patients; the smallest cyst diameter reported was 26 mm and the largest cyst diameter reported was 180 mm (mean ± SD: 71.3 ± 36.1 mm). Complications were available in the studies of 16 patients and showed the following distribution: cystobiliary fistula (n = 4), cysto-pancreatic fistula (n = 4), pancreatitis (n = 6), and portal hypertension (n = 2). Postoperative follow-up data were available in the studies involving 48 patients and postoperative recurrence data in the studies of 51 patients; no cases of recurrence occurred in any patient for an average follow-up duration of 22.5 ± 23.1 (range: 2-120) mo. Only two cases were reported as having died on fourth (our new case) and fifteenth days respectively. CONCLUSION: PHC is a parasitic infestation that is rare but can cause serious pancreato-biliary complications. Its preoperative diagnosis is challenging, as its radiologic findings are often mistaken for other cystic lesions of the pancreas. PMID:25346801

Akbulut, Sami; Yavuz, Ridvan; Sogutcu, Nilgun; Kaya, Bulent; Hatipoglu, Sinan; Senol, Ayhan; Demircan, Firat

2014-01-01

106

Robotic surgery of the pancreas  

PubMed Central

Pancreatic surgery is one of the most challenging and complex fields in general surgery. While minimally invasive surgery has become the standard of care for many intra-abdominal pathologies the overwhelming majority of pancreatic surgery is performed in an open fashion. This is attributed to the retroperitoneal location of the pancreas, its intimate relationship to major vasculature and the complexity of reconstruction in the case of pancreatoduodenectomy. Herein, we describe the application of robotic technology to minimally invasive pancreatic surgery. The unique capabilities of the robotic platform have made the minimally invasive approach feasible and safe with equivalent if not better outcomes (e.g., decreased length of stay, less surgical site infections) to conventional open surgery. However, it is unclear whether the robotic approach is truly superior to traditional laparoscopy; this is a key point given the substantial costs associated with procuring and maintaining robotic capabilities. PMID:25356035

Joyce, Daniel; Morris-Stiff, Gareth; Falk, Gavin A; El-Hayek, Kevin; Chalikonda, Sricharan; Walsh, R Matthew

2014-01-01

107

What You Need to Know about Cancer of the Pancreas  

MedlinePLUS

... You Need To Know About™ Cancer of the Pancreas This booklet is about cancer of the pancreas, also called pancreatic cancer. There are two main ... care. This booklet covers: The anatomy of the pancreas and basics about cancer of the pancreas Treatments ...

108

Synchronous quadruple primary tumors of thyroid, breast, pancreas, and stomach: a case report.  

PubMed

We herein present the first case to be reported of synchronous quadruple primary cancer of the thyroid, breast, pancreas and stomach in a 70-year-old female. Fluorine-18-fluorodeoxyglucose (FDG)-positron-emission tomography/computed tomography (PET/CT) revealed increased FDG activity in the thyroid, left breast, pancreatic body and antrum of the stomach. To make a definitive diagnosis of synchronous quadruple primary tumors, ultrasound-guided fine-needle aspiration (FNA) cytology and biopsy of the thyroid, breast, pancreas and stomach were performed. FNA cytology and biopsy findings showed papillary carcinoma of the thyroid, invasive ductal adenocarcinoma of the breast, adenocarcinoma of the pancreas and gastrointestinal stromal tumor. To the best of our knowledge, this combination of synchronous multiple primary tumors has not been reported. PMID:23645766

Kim, Jong-Sun; Chung, Cho-Yun; Park, Hyung-Chul; Myung, Dae-Seong; Cho, Sung-Bum; Lee, Wan-Sik; Min, Jung-Joon; Joo, Young-Eun

2013-05-01

109

Heterotopic pancreas in Meckel's diverticulum in a 7-year-old child with intussusception and recurrent gastrointestinal bleeding: case report and literature review focusing on diagnostic controversies.  

PubMed

Meckel's diverticulum, the most common congenital abnormality of the small intestine, may be associated to heterotopic pancreas, often diagnosed incidentally on histopathological examination. Intussusception affects infants between the ages of 5 and 9 months, but it may also occur in older children, teenagers and adults, and in some cases can be derived by a Meckel's diverticulum resulting in acute abdomen. We analyse the management and the recent literature on similar cases, describing diagnostic options. In May 2013, a 7-year-old girl admitted to our hospital with recurrent gastrointestinal bleeding, was discovered to have an ileoileal intussusception with a leading Meckel's diverticulum with heterotopic pancreatic tissue. This association is rare evidence in children and its proper management can be controversial, in particular from a diagnostic point of view. In such cases, preoperative radiological diagnosis can be only suspected in the presence of suggestive signs, more often depicted by ultrasound or computed tomography scan. During laparotomy an accurate exploration of all ileum is recommended, for the possibility to find others heterotopic segments. PMID:25323189

Riccardo, Guanà; Valeria, Bucci; Giulia, Carbonaro; Alessia, Cerrina; Luisa, Ferrero; Elisabetta, Teruzzi; Alessandro, Mussa; Isabella, Morra; Jürgen, Schleef

2014-01-01

110

Fully automatic computer-assisted pancreas imaging.  

PubMed

Good pancreas imaging is difficult to achieve even if a computer is applied. The special computer program proposed here was developed to optimize the results and to minimize the operator interaction with the data processing system. PMID:608469

Zurowski, S; Graban, W T; Jakubowski, W

1977-12-30

111

[Pancreas transplantation in insulin dependent diabetic patients].  

PubMed

Successful transplantation of the pancreas as a whole organ, or as isolated islet cells, is the only treatment that achieves a stable normoglycemia as a result of insulin secretion and renewal of serum glucose levels control systems. Nowadays, one year patient survival after pancreas transplantation is above 90%, while functioning grafts are observed in 84% of combined pancreas kidney and in 70% of isolated pancreas transplantations. Type I insulin dependent diabetic patients aged 45 or less with severe diabetic nephropathy, without immediate life saving cardiovascular risk, highly motivated and well informed achieve the best results. Namely, these results include euglycemia without exogenous insulin, improvement of secondary complications of diabetes, protection of the kidney graft, and longer life expectancy with better quality of life, as compared to dialyzed diabetic patients. PMID:15666711

Nakash, Richard; Ben Haim, Menachem; Katz, Paulina; Yahnin, Tatiana

2004-12-01

112

Primary lymph node gastrinoma. A diagnosis of exclusion. A case for duodenotomy in the setting of a negative imaging for primary tumor: A case report and review of the literature  

PubMed Central

INTRODUCTION Zollinger–Ellison syndrome (ZES) is caused by uninhibited secretion of gastrin from a gastrinoma. Gastrinomas most commonly arise within the wall of the duodenum followed by the pancreas. Primary lymph node gastrinomas have also been reported in the literature. This is a case of ZES where preoperative localization revealed a gastrinoma in a solitary portacaval lymph node, presumed to be a primary lymph node gastrinoma. PRESENTATION OF CASE The patient is a 57 year old female diagnosed with ZES, suspected of having a primary lymph node gastrinoma. The patient underwent an exploratory laparotomy and excision of a portacaval lymph node with a frozen section which was positive for gastrinoma. Intraoperative sonography of the pancreas, upper endoscopy with transillumination of the duodenum, and a duodenotomy with bimanual examination of the duodenal wall were also performed. The patient was found to have a 4 mm duodenal mass near the pylorus, which was excised. DISCUSSION Pathology showed that the duodenal mass was primary gastrinoma. Serum gastrin levels taken four months postoperatively were normal and the repeat octreotide scan did not show any evidence of recurrence. CONCLUSION Primary lymph node gastrinoma is a diagnosis of exclusion. The duodenum and pancreas must be fully explored to rule out a primary gastrinoma that may be occult. PMID:25462049

Teng, Annabelle; Haas, Christopher; Lee, David Y.; Wang, John; Lung, Edward; Attiyeh, Fadi

2014-01-01

113

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: tanigano@takii.kmu.ac.jp; 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)

2004-09-15

114

Tumor-to-Tumor Metastasis: Report of Two Cases of Renal Cell Carcinoma Metastasizing to Microcystic Serous Cystadenoma of the Pancreas.  

PubMed

Metastatic cancer to the pancreas accounts for less than 2% of all pancreatic malignancies. In contrast to other metastatic tumors, renal cell carcinoma (RCC) has a propensity to metastasize as a solitary pancreatic lesion. While symptomatic patients may present with obstructive jaundice, abdominal pain, or gastrointestinal bleeding, the diagnosis of metastatic pancreatic involvement is often made in asymptomatic patients, during follow-up evaluation in the aftermath of an initial diagnosis of renal cell carcinoma. Microcystic serous cystadenoma of the pancreas is an uncommon pancreatic exocrine neoplasm that morphologically resembles conventional (clear cell) RCC, in so far as both tumors are characterized by neoplastic cells with clear cytoplasm, relatively uniform nuclei and scant associated tumor stroma. Herein, we report 2 immunohistochemically confirmed cases of unsuspected metastatic RCC to the pancreas, with the metastatic tumor in each case confined to a preexisting microcystic serous cystadenoma of the pancreas. PMID:24873824

Shah, Lopa; Tiesi, Gregory; Bamboat, Zubin; McCain, Donald; Siegel, Andrew; Mannion, Ciaran

2015-02-01

115

Melatonin, endocrine pancreas and diabetes.  

PubMed

Melatonin influences insulin secretion both in vivo and in vitro. (i) The effects are MT(1)-and MT(2)-receptor-mediated. (ii) They are specific, high-affinity, pertussis-toxin-sensitive, G(i)-protein-coupled, leading to inhibition of the cAMP-pathway and decrease of insulin release. [Correction added after online publication 4 December 2007: in the preceding sentence, 'increase of insulin release' was changed to 'decrease of insulin release'.] Furthermore, melatonin inhibits the cGMP-pathway, possibly mediated by MT(2) receptors. In this way, melatonin likely inhibits insulin release. A third system, the IP(3)-pathway, is mediated by G(q)-proteins, phospholipase C and IP(3), which mobilize Ca(2+) from intracellular stores, with a resultant increase in insulin. (iii) Insulin secretion in vivo, as well as from isolated islets, exhibits a circadian rhythm. This rhythm, which is apparently generated within the islets, is influenced by melatonin, which induces a phase shift in insulin secretion. (iv) Observation of the circadian expression of clock genes in the pancreas could possibly be an indication of the generation of circadian rhythms in the pancreatic islets themselves. (v) Melatonin influences diabetes and associated metabolic disturbances. The diabetogens, alloxan and streptozotocin, lead to selective destruction of beta-cells through their accumulation in these cells, where they induce the generation of ROS. Beta-cells are very susceptible to oxidative stress because they possess only low-antioxidative capacity. Results suggest that melatonin in pharmacological doses provides protection against ROS. (vi) Finally, melatonin levels in plasma, as well as the arylalkylamine-N-acetyltransferase (AANAT) activity, are lower in diabetic than in nondiabetic rats and humans. In contrast, in the pineal gland, the AANAT mRNA is increased and the insulin receptor mRNA is decreased, which indicates a close interrelationship between insulin and melatonin. PMID:18078445

Peschke, Elmar

2008-01-01

116

The Role of Combined Assessment in Preoperative Axillary Staging  

PubMed Central

Background Axillary lymph node status is the most significant single prognostic factor in breast cancer, and preoperative axillary staging is essential in determining lymph node status. Axillary ultrasound scan (AUS) is the gold standard modality in preoperative staging. However, triple assessment—including clinical examination and radiological assessment with fine needle aspiration (FNA) with or without core biopsy—ensures high sensitivity. Methods Our study included 219 women diagnosed with invasive breast cancer between 2009 and 2010. All patients underwent a preoperative staging AUS that was graded from normal (U1) to malignant (U5). All patients with ultrasound scans graded U3 (indeterminate) and above underwent FNA that was graded from C1 (inadequate for diagnosis) to C5 (malignant). Patients diagnosed preoperatively with metastatic lymph nodes were offered axillary lymph node clearance. The rest of the patients were offered sentinel lymph node biopsy. Results The 219 women were diagnosed with 228 invasive breast cancers. The mean age was 60 years (range 29-90 years). The final histology report showed metastatic axillary lymph nodes in 49 (21.5%) cases. Of these 49 cases, 22 were diagnosed preoperatively with metastatic axillary lymph node and were elected for axillary lymph node clearance, and 27 were elected for sentinel lymph node biopsy that revealed metastatic lymph nodes. AUS showed abnormal (U3/U4/U5) axillary lymph nodes in 30 of 49 (61.2%) cancer cases with an overall accuracy of 91.6%. Conclusion Combined triple assessment increases the sensitivity, negative predictive value, and overall accuracy of preoperative staging of the axilla. PMID:24357995

Khout, Hazem; Richardson, Catherine; Toghyan, Hamid; Fasih, Tarannum

2013-01-01

117

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

2013-02-01

118

Hematologic malignancies of the pancreas.  

PubMed

Hematologic malignancies are relatively uncommon neoplasms of abdominal soft tissue. This article discusses the clinical and imaging features of pancreatic lymphoma, pancreatic extraosseous multiple myeloma, granulocytic sarcoma (chloroma), posttransplant lymphoproliferative disorder, and Castleman disease. The combination of imaging findings and the appropriate clinical presentation should allow the radiologist to raise a provisional diagnosis of hematologic malignancy. PMID:25120155

Sandrasegaran, Kumar; Tomasian, Anderanik; Elsayes, Khaled M; Nageswaran, Harris; Shaaban, Akram; Shanbhogue, Alampady; Menias, Christine O

2015-02-01

119

KP Northwest Preoperative Briefing Project  

PubMed Central

In June 2001, members of the KP Northwest Region (KPNW) Patient Safety Team attending a Human Factors training program considered the patient safety challenges faced in the operating suite and identified pre-operative briefing as a necessary component of safe practice. After receiving the Human Factors training, the KPNW Patient Safety Team obtained sponsorship for a pilot project to develop preoperative briefing as a way to transform the patient safety culture in the KP Northwest Region's operating suites and to reduce the number of errors (especially burns). The project led to the KP Sunnyside Medical Center's current policy requiring preoperative briefing before each surgical intervention so that information regarding the patient's care is verified and shared. Since initiation of the preoperative briefings—which are increasingly being conducted on a routine basis—a trend of decreasing accidental injuries has been observed in the operating suite. In addition, recent questionnaire responses show an improved team culture of safety and an improved overall work climate (including such factors as teamwork, safety, perceptions of management, and working conditions). Measures reported by surgical teams in Orange County (California) and KPNW indicate the project can be transferred successfully. Staff are also expanding the briefings project to the ambulatory setting. PMID:21660158

Wright, Maureen Ann

2005-01-01

120

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. PMID:22178591

WESTMORELAND, JOBY J.; KILIC, GAMZE; SARTAIN, CAROLINE; SIRMA, SEMA; BLAIN, JENNIFER; REHG, JEROLD; HARVEY, NATASHA; SOSA–PINEDA, BEATRIZ

2012-01-01

121

Exocrine Pancreas Involvement in Celiac disease: A Review.  

PubMed

Purpose: There are numerous studies in the literature regarding the involvement of intestinal as well as extra intestinal organs during the course of celiac disease, and there is accumulating evidence regarding the pancreatic changes caused by this pathology. Method: the literature on the relationship between celiac disease and pancreatic involvement has been extensively reviewed. Results: exocrine pancreatic involvement regards both the function and the morphology of the exocrine pancreas, and superimposed or more severe clinical changes seem to be related to the nutritional disturbances caused by celiac disease or by the disease itself. Patients with celiac disease may also develop a chronic pancreatitis more frequently than in general population both the intestinal and the extraintestinal manifestations of celiac disease. Conclusions: fecal elastase 1-determination in celiacs may be useful in detecting and curing exocrine pancreatic insufficiency especially in patients with a new diagnosis of celiac disease or in those with refractory diarrhea. Few patents on pancreatic extracts are also briefly described. PMID:25417707

Pezzilli, Raffaele

2014-11-22

122

Solid Pseudopapillary Tumor of the Pancreas  

PubMed Central

Solid pseudopapillary tumors of the pancreas, known as Frantz tumors, are rare pancreatic tumors that occur predominantly in women, with very few cases reported in men. We present the case of a 27-year-old female patient who came to the emergency room with an intense upper abdominal pain associated with nausea and vomiting and a palpable mass in the left upper quadrant. She was initially diagnosed with a post-traumatic pancreatic pseudocyst. The patient underwent distal pancreatectomy with splenic preservation; the histopathological report showed a pseudopapillary solid tumor of the pancreas without malignant cells. In this report, a case of rare solid-pseudopapillary tumor of the pancreas is described. Our objective was to report an infrequent case of pancreatic pseudopapillary tumor and to carry out a review of the literature.

Gursan, Nesrin; Yildirgan, M. Ilhan; Atamanalp, S. Selcuk; Sahin, Onder; Gursan, M. Sevki

2009-01-01

123

What Are the Risk Factors for Cancer of the Pancreas?  

MedlinePLUS

... a person’s chance of getting cancer of the pancreas. Most of these are risk factors for exocrine ... smoke that enter the blood and damage the pancreas. About 20% to 30% of exocrine pancreatic cancer ...

124

Software for in Silico Testing of an Articial Pancreas  

E-print Network

Software for in Silico Testing of an Articial Pancreas Master's Thesis By Stefan Høngaard Andersen. A fully automated closed-loop Articial Pancreas (AP) has the potential to become the new stan- dard

125

[Ultrasound changes of the pancreas in patients with mucoviscidosis].  

PubMed

Pancreas sonography was performed on 171 patients with cystic fibrosis. The pancreas was visualized in 138 patients (81%) and could not be visualized in 33. 125 patients (90%) had abnormal echogenicity of the pancreas. Cysts were found in 5 patients. Two patients showed a dilatation of the pancreatic duct. The pancreas was abnormal in 98% of all patients aged more than 6 years. PMID:2191218

Winkielman, J; Gottschalk, B

1990-03-01

126

OPTN/SRTR 2013 Annual Data Report: Pancreas.  

PubMed

Pancreas listings and transplants decreased during the past decade, most notably pancreas after kidney transplants. Center-reported outcomes of pancreas transplant across all groups, short-term and long-term, improved during the same period. Changes to the pancreas allocation system creating an efficient, uniform national system will be implemented in late 2014. Pancreas-alone and simultaneous pancreas-kidney (SPK) candidates will form a single match-run list with priority to most SPK candidates ahead of kidney-alone candidates to decrease waiting times for SPK candidates, given their higher waitlist mortality compared with nondiabetic kidney transplant candidates. The changes are expected to eliminate local variability, providing more consistent pancreas allocation nationwide. Outcomes after pancreas transplant are challenging to interpret due to lack of a uniform definition of graft failure. Consequently, SRTR has not published data on pancreas graft failure for the past 2 years. The Organ Procurement and Transplantation Network Pancreas Transplantation Committee is working on a definition that could provide greater validity for future outcomes analyses. Challenges in pancreas transplantation include high risk of technical failures, rejection (early and late), and surgical complications. Continued outcome improvement and innovation has never been more critical, as alternatives such as islet transplant and artificial pancreas move closer to clinical application. PMID:25626343

Kandaswamy, R; Skeans, M A; Gustafson, S K; Carrico, R J; Tyler, K H; Israni, A K; Snyder, J J; Kasiske, B L

2015-01-01

127

Cell Stem Cell The Adult Mouse and Human Pancreas Contain  

E-print Network

Cell Stem Cell Article The Adult Mouse and Human Pancreas Contain Rare Multipotent Stem Cells.smukler@utoronto.ca DOI 10.1016/j.stem.2011.01.015 SUMMARY The search for putative precursor cells within the pancreas has been the focus of extensive research. Previously, we identified rare pancreas-derived mul- tipotent

128

Expression of Sox Transcription Factors in the Developing Mouse Pancreas  

E-print Network

PATTERNS Expression of Sox Transcription Factors in the Developing Mouse Pancreas Oleg Lioubinski,1 family in the mouse pancreas. We detected transcripts for Sox11, Sox4, Sox13, Sox5, Sox9, Sox8, Sox10, Sox7, Sox17, Sox18, Sox15, and Sox30 in embryonic pancreas and found Sox4, Sox9, and Sox13 in adult

Sander, Maike

129

Primary squamous cell carcinoma of the pancreas: a case report and review of the literature  

PubMed Central

Introduction Primary squamous cell carcinoma of the pancreas is a rare tumor with poor prognosis and is found in the literature only as case reports. The optimal management course remains poorly defined. We present a case of primary basaloid squamous cell carcinoma of the pancreas metastatic to the liver, which was treated with surgery and systemic chemotherapy. Our patient survived for 15?months: the longest survival reported in the literature to date. Case presentation A 70-year-old Caucasian man presented to hospital with a three-month history of weight loss, pruritus and icterus. Imaging studies confirmed the presence of an operable mass lesion in the head of the pancreas. Following a pancreaticoduodenectomy, histology results led us to make a diagnosis of squamous cell carcinoma. Postoperative restaging showed multiple metastases in the liver. He underwent palliative systemic chemotherapy with cisplatin and 5-fluorouracil achieving partial response and an excellent quality of life. He then went on to start second-line chemotherapy, but unfortunately died of sepsis soon thereafter. Conclusions This case report emphasizes that achievement of a worthwhile objective and symptomatic palliative response is possible using platinum-based chemotherapy in squamous cell carcinoma of the pancreas. PMID:22973995

2012-01-01

130

Primary angiosarcoma of the pancreas mimicking severe acute pancreatitis - Case report.  

PubMed

Primary angiosarcoma of the pancreas is an extremely rare neoplasm that often mimicks severe acute pancreatitis. A 58-year-old man was admitted with clinical and laboratory signs of severe acute pancreatitis. Contrast enhanced CT scan demonstrated haemorrhagic necrotizing inflammation of the pancreas involving the pancreatic tail, splenic hilum and small bowels with multiple peripancreatic and free abdominal fluid collection. Percutaneous drainage was performed. After 13 days, laparotomy was indicated because of persistent intra-abdominal bleeding, fever and a palpable, rapidly growing mass in the left upper quadrant of the abdomen. During the operation a necrotic, haemorrhagic mass was found in the pancreatic tail; a frozen section showed malignancy, although the tumour was unresectable. Despite all conservative and surgical therapeutic attempts, the patient died within four weeks after diagnosis. Final histology justified primary angiosarcoma of the pancreas. If a patient with signs of severe acute pancreatitis has fever without elevated PCT, the presence of a malignant tumour of the pancreas should be considered. PMID:25541144

Csiszkó, Adrienn; László, István; Palatka, Károly; Szabó, Károly Gábor; Kanyári, Zsolt; Bidiga, László; Csonka, Tamás; Damjanovich, László; Szentkereszty, Zsolt

2015-01-01

131

Acute gallbladder torsion - a continued pre-operative diagnostic dilemma  

PubMed Central

Acute gallbladder volvulus continues to remain a relatively uncommon process, manifesting itself usually during exploration for an acute surgical abdomen with a presumptive diagnosis of acute cholecystitis. The pathophysiology is that of mechanical organo-axial torsion along the gallbladder's longitudinal axis involving the cystic duct and cystic artery, and with a pre-requisite of local mesenteric redundancy. The demographic tendency is septua- and octo-genarians of the female sex, and its overall incidence is increasing, this being attributed to increasing life expectancy. We discuss two cases of elderly, fragile women presenting to the emergency department complaining of sudden onset right upper quadrant abdominal pain. Their subsequent evaluation suggested acute cholecystitis. Ultimately both were taken to the operating room where the correct diagnosis of gallbladder torsion was made. Pre-operative diagnosis continues to be a major challenge with only 4 cases reported in the literature diagnosed with pre-operative imaging; the remainder were found intra-operatively. Consequently, a delay in diagnosis can have devastating patient outcomes. Herein we propose a necessary high index of suspicion for gallbladder volvulus in the outlined patient demographic with symptoms and signs mimicking acute cholecystitis. PMID:21489292

2011-01-01

132

Nonfunctional Islet Cell Tumor of the Pancreas in a Patient with Tuberous Sclerosis: A Case Report with Literature Review  

PubMed Central

Islet cell tumors (ICTs) are rare tumors of the pancreas. Association of this type of tumor with tuberous sclerosis is extremely rare. Only 13 cases of pancreatic ICT with tuberous sclerosis have so far been documented in the literature. However, awareness of the association of tuberous sclerosis and ICT is important for early diagnosis and appropriate treatment of this condition. This article presents the case of a 63-year-old female with angiomyolipoma (AML) of the kidney and liver, calcified subependymal nodules and a large mass in the pancreas, which was proven to be an ICT on histopathological examination. PMID:24678435

Cansu, Aysegul; Ahmetoglu, Ali; Kul, Sibel; Uzman, Dilek; Ersoz, Safak

2014-01-01

133

Preoperative Optimization of Crohn Disease  

PubMed Central

Crohn disease is a chronic disease that is treated with aminosalicylates, antibiotics, and immunosuppressant agents. Most patients ultimately require surgical intervention and many will require additional surgery for recurrent disease. Consequently, surgery is generally performed only when medical management fails; however, these patients are often malnourished and immunosuppressed. Preoperative optimization is necessary to minimize morbidity, including intra-abdominal septic complications and anastomotic leaks. In this article, the authors review some considerations to improve the surgical outcome in Crohn disease. PMID:24436653

Sharma, Amit; Chinn, Bertram T.

2013-01-01

134

Ultrastructure of the Pancreas of Bradypus tridactylus  

Microsoft Academic Search

The fine structure of the pancreas of the South American three toed sloth, Bradypus trídactylus, is described. In exocrine cells two types of granules are found. The first variety of granules is circular, of about 0.9 ?m mean diameter, and probably represents zymogen granules. The second type of granule is larger (up to 1.4 ?m in diameter) and contains a

P. Abrahamsohn; D. J. Pallot; P. B. N. Pinheiro; V. B. Coutinho; R. G. Pessoa; H. B. Coutinho

1981-01-01

135

CARCINOMA OF THE EXOCRINE PANCREAS IN MEDAKA  

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...

136

Xanthogranulomatous Cholecystitis Masquerading as Gallbladder Cancer: Can It Be Diagnosed Preoperatively?  

PubMed Central

Background. Xanthogranulomatous cholecystitis (XGC) is often misdiagnosed as gallbladder cancer (GBC). We aimed to determine the preoperative characteristics that could potentially aid in an accurate diagnosis of XGC masquerading as GBC. Methods. An analysis of patients operated upon with a preoperative diagnosis of GBC between January 2008 and December 2012 was conducted to determine the clinical and radiological features which could assist in a preoperative diagnosis of XGC. Results. Out of 77 patients who underwent radical cholecystectomy, 16 were reported as XGC on final histopathology (Group A), while 60 were GBC (Group B). The incidences of abdominal pain, cholelithiasis, choledocholithiasis, and acute cholecystitis were significantly higher in Group A, while anorexia and weight loss were higher in Group B. On CT, diffuse gallbladder wall thickening, continuous mucosal line enhancement, and submucosal hypoattenuated nodules were significant findings in Group A. CT findings on retrospect revealed at least one of these findings in 68.7% of the cases. Conclusion. Differentiating XGC from GBC is difficult, and a definitive diagnosis still necessitates a histopathological examination. An accurate preoperative diagnosis requires an integrated review of clinical and characteristic radiological features, the presence of which may help avoid radical resection and avoidable morbidity in selected cases. PMID:25404941

Rammohan, Ashwin; Cherukuri, Sathya D.; Sathyanesan, Jeswanth; Palaniappan, Ravichandran; Govindan, Manoharan

2014-01-01

137

Rare Nonneoplastic Cysts of Pancreas  

PubMed Central

Pancreatic cysts represent a small proportion of pancreatic diseases, but their incidence has been recently increasing. Most pancreatic cysts are identified incidentally, causing a dilemma for both clinicians and patients. In contrast to ductal adenocarcinoma, neoplastic pancreatic cysts may be cured by resection. In general, pancreatic cysts are classified as neoplastic or non-neoplastic cysts. The predominant types of neoplastic cysts include intraductal papillary mucinous neoplasms, mucinous cystic neoplasms, serous cystic neoplasms, and solid pseudopapillary neoplasms. With the exception of serous type, neoplastic cysts, have malignant potential, and in most cases requires resection. Non-neoplastic cysts include pseudocyst, retention cyst, benign epithelial cysts, lymphoepithelial cysts, squamous lined cysts (dermoid cyst and epidermal cyst in intrapancreatic accessory spleen), mucinous nonneoplastic cysts, and lymphangiomas. The incidence of nonneoplastic, noninflammatory cysts is about 6.3% of all pancreatic cysts. Despite the use of high-resolution imaging technologies and cytologic tissue acquisition with endosonography, distinguishing nonneoplastic from neoplastic cysts remains difficult with most differentiations made postoperatively. Nonetheless, the definitive distinction between non-neoplastic and neoplastic cysts is crucial as unnecessary surgery could be avoided with proper diagnosis. Therefore, consideration of these rare disease entities should be entertained before deciding on surgery. PMID:25674524

Cho, Jae Hee

2015-01-01

138

Case report: intraductal tubulopapillary neoplasm of the pancreas with unique clear cell phenotype  

PubMed Central

Intraductal tubulopapillary neoplasms of the pancreas are very rare tumors characterized by intraductal tubulopapillary growth, ductal differentiation, scant intracellular mucin production and cellular dysplasia. Here, we report the first case of an intraductal tubulopapillary neoplasm of the pancreas with clear cell morphology. The tumor was detected during the diagnostic work-up of acute pancreatitis in a 43- year old female. Histological examination revealed a tumor with the typical architecture of an intraductal tubulopapillary neoplasm of the pancreas with tumor cells showing abundant clear cytoplasm and Di-PAS negativity. Immunohistochemistry revealed positivity for Pan-CK, CK7, CK8/18, MUC1, MUC6, carbonic anhydrase IX, CD10, EMA, ?-catenin and e-cadherin. Sanger sequencing did not detect mutations for ?-catenin, BRAF, KRAS, PIK3CA and GNAS. Altogether, histology, immunohistochemical expression profile (MUC1+, MUC6+, MUC2-, MUC5AC-, thrypsin-, chymotrypsin-, CDX2-) and sequencing results led to the diagnosis of intraductal tubulopapillary neoplasm. However, the neoplasm consisted of cells showing abundant clear cytoplasm, a morphological pattern not being described so far in the current classification of pancreatic intraductal neoplasms. Potential differential diagnosis and the molecular basis of clear cell morphology are discussed. In conclusion, we consider this tumor as intraductal tubulopapillary neoplasm of the pancreas with unique clear cell phenotype. After surgery and without adjuvant therapy, the patient’s clinical course has been uneventful for over two years now. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1051828790117127 PMID:24443801

2014-01-01

139

Pancreas transplants: Evaluation using perfusion scintigraphy  

SciTech Connect

To determine the value of scintigraphic perfusion studies in evaluating pancreas transplant patients, we reviewed 56 of these studies in 22 patients who had 27 transplants. Seventeen patients underwent two or more studies. The perfusion studies were performed with 20 mCi (740 MBq) of 99mTc-DTPA injected as a bolus followed by eight to 16 serial 2-sec images and a 500,000-count immediate static image. Images were evaluated for (1) the time and intensity of pancreatic peak radioactivity relative to the time and intensity of the iliac arterial peak; (2) relative pancreatic to iliac arterial intensity on the static image; and (3) size, homogeneity, and definition of the pancreas. Clinical diagnoses at the time of scintigraphy of normal function (n = 36), rejection (n = 13), pancreatitis (n = 6), or arterial thrombosis (n = 1) were based on insulin requirement, urine amylase, serum glucose, serum amylase, response to therapy, cultures, CT, MR, sonography, scintigraphy with 67Ga or 111In-WBCs, percutaneous drainage results, angiography, surgery, and pathologic examination of resected transplants. Three 99mTc-DTPA perfusion studies showed no pancreatic perfusion, four showed decreasing perfusion on serial studies, and five showed progressive loss of definition of the pancreas on serial studies. Of the three patients with no detectable perfusion, one had a normally functioning transplant, one had arterial thrombosis with transplant infarction, and one had severe rejection with minimal function. Decreasing perfusion was associated with rejection in three patients and pancreatitis in one. Decreasing definition was seen in four patients with rejection and one with pancreatitis. We conclude that perfusion scintigraphy is useful, primarily when performed serially, although nonspecific for evaluating pancreas transplants.

Kuni, C.C.; du Cret, R.P.; Boudreau, R.J.

1989-07-01

140

Improvement of preoperative management in patients with adrenal pheochromocytoma  

PubMed Central

Objective: To investigate methods for improving the preoperative management of patients with pheochromocytoma. Methods: We collected 155 cases diagnosed as adrenal pheochromocytoma and with hypertension. During preoperative preparation, 85 patients had antihypertensive therapy by using the selective ?1-blocker doxazosin controlled-release tablets; 70 patients was controlled by using the nonselective ?-blocker phenoxybenzamine; All 155 patients underwent qualitative diagnosis by determination of 24-hour urinary vanilmandelic acid (VMA) or [11C]meta-hydroxyephedrine (mHED) positron emission tomography computed tomography (PET-CT) and underwent computed tomography (CT) for tumor localization; Results: In doxazosin group, with the exception of two patients who had radical fluctuations in blood pressure during surgery, other patients showed a smooth blood pressure control during surgery. No hypertensive crisis and hypotensive shock appeared after surgery. In phenoxybenzamine group, ten patients had sharp fluctuations in blood pressure during surgery, and no hypertensive crisis and hypotensive shock appeared after surgery. Conclusion: Compared with phenoxybenzamine, doxazosin has minimal adverse reactions, with high security as a preoperative preparation for adrenal pheochromocytoma, and it is easy to be taken. MHED PET-CT examination has a clear diagnostic value for patients with normal 24-hour urinary VMA. PMID:25664068

Li, Jiang; Yang, Chang-Hai

2014-01-01

141

Preoperative local MRI-staging of patients with a suspected pancreatic mass.  

PubMed

The aim of this study was to define the value of MRI of the pancreas for preoperative local staging of patients with a suspected pancreatic mass. Ninety-four patients (41 women, 53 men; age range 32-87 years) with a suspected pancreatic tumor underwent preoperative staging with MRI on a 1.5-T system. The MRI protocol included breath-hold MR cholangiopancreatography in turbo spin-echo technique, biphasic contrast-enhanced 3D MR angiography, and MRI of the upper abdomen with breath-hold T2-weighted half-Fourier acquired single-shot turbo spin-echo and T1-weighted fast-low-angle-shot (pre- and postcontrast) sequences. Data were collected prospectively and analyzed by two radiologists in agreement modality. Evaluation criteria were vascular involvement, resectability, and a characterization benign vs malignant. Results were compared to histopathology in 78 patients. Sixteen patients were followed-up. In 74 of 94 patients a solid tumor or an inflammation of the pancreas ( n=62) or the papilla ( n=12) was detected. In this group, MRI had a sensitivity of 98%, a specificity of 92%, and an accuracy of 96% in the characterization of malignant tumors. Regarding only the solid tumors, the positive predictive value of MRI was 87% with respect to resectability. Other pathologic findings included adenoma or inflammation of the duodenum ( n=5), carcinoma or benign stenosis of the choledochus duct ( n=7) and carcinoma of the gall bladder ( n=2). In 6 patients MRI did not depict any pathologic findings, and follow-up confirmed this interpretation. Magnetic resonance imaging allows a local preoperative staging in patients with suspected pancreatic tumor. Limitations, however, concern to the diagnostics of peritoneal and/or liver metastases. PMID:11870425

Fischer, U; Vosshenrich, R; Horstmann, O; Becker, H; Salamat, B; Baum, F; Grabbe, E

2002-02-01

142

The effect of systemic venous drainage of the pancreas on insulin sensitivity in dogs.  

PubMed Central

To assess the metabolic consequences of the diversion of the pancreatic venous drainage to the systemic circulation, the pancreaticoduodenal and gastrosplenic veins were anastomosed to the inferior vena cava in nine normal dogs. This procedure maintained the integrity of the entire pancreas while shunting the hormonal output of the pancreas to the periphery. The metabolic effects were assessed from the sensitivity to insulin during a euglycemic hyperinsulinemic glucose clamp using an insulin infusion of 800 microU/kg per min. The studies were controlled by their duplication in seven dogs identically treated but with the pancreatic veins reanastomosed to the portal vein. No differences in systemic insulin levels or insulin sensitivity before and after surgery were seen under these circumstances. After diversion, however, basal insulin levels rose from 4.5 +/- 1.0 to 11.5 +/- 2.5 microU/ml. Basal glucose metabolic clearance rate (MCR) rose to 3.0 +/- 0.4 from 2.0 +/- 0.3 ml/kg per min. On insulin infusion, maximal stimulation of MCR within the 2-h infusion period was to 15.2 +/- 2.5 ml/kg per min preoperatively and to 7.2 +/- 0.8 ml/kg per min after diversion. Using ratios of MCR-to-insulin concentration as an index of insulin sensitivity, it was demonstrated that this index decreased by at least 50% after diversion. These data imply that portal venous drainage of the pancreas is an important factor in the determination of peripheral insulin sensitivity. PMID:8104957

Radziuk, J; Barron, P; Najm, H; Davies, J

1993-01-01

143

Preoperative risk factors for postoperative delirium  

Microsoft Academic Search

The objective of this article was to estimate the incidence of delirium in a sample of patients undergoing elective surgery and to identify the preoperative factors most closely associated with developing this complication. Consecutive patients (n=500) underwent a full preoperative medical evaluation including assessment of cognitive and functional status. Daily evaluation on postoperative days 1 through 4 included medical record

David Litaker; Joseph Locala; Kathleen Franco; David L. Bronson; Ziad Tannous

2001-01-01

144

Guideline implementation: preoperative patient skin antisepsis.  

PubMed

Performing preoperative skin antisepsis to remove soil and microorganisms at the surgical site may help prevent patients from developing a surgical site infection. The updated AORN "Guideline for preoperative skin antisepsis" addresses the topics of preoperative patient bathing and hair removal, selection and application of skin antiseptics, and safe handling, storage, and disposal of skin antiseptics. This article focuses on key points of the guideline to help perioperative personnel develop protocols for patient skin antisepsis. The key points include the need for the patient to take a preoperative bath or shower and the need for perioperative personnel to manage hair at the surgical site, select a safe and effective antiseptic for the individual patient, perform a safe preoperative surgical site prep, and appropriately store skin antiseptics. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures. PMID:25537328

Cowperthwaite, Liz; Holm, Rebecca L

2015-01-01

145

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

PubMed

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

2013-01-01

146

Post-splenectomy intrapancreatic accessory spleen mimicking endocrine tumor of the pancreas  

PubMed Central

INTRODUCTION Intrapancreatic accessory spleen is an uncommon congenital abnormality of the spleen with no indication for surgical intervention. Among the few cases reported, IPAS coexisted with a normal spleen. We here report the first case of IPAS arising a couple years after splenectomy with the appearance of an endocrine tumor of the pancreas. PRESENTATION OF CASE A 62-year-old female presented with a one-week history of left upper quadrant discomfort. She had splenectomy for the treatment of hypersplenism caused by cirrhotic portal hypertension two years before this admission. Her physical examination was unremarkable and laboratory data was within the normal range. Both the ultrasonography and magnetic resonance image revealed a small oval-shaped mass in the tail of her pancreas with the diameter 2 cm or less. A distal pancreatectomy was performed for the suspection of malignant neuroendocrine tumor of the pancreas. An intrapancreatic accessory spleen was confirmed by the pathologic examination. DISCUSSION Intrapancreatic accessory spleen is one kind of congenital ectopic spleen without indication for operative intervention. We present the case to support that intrapancreatic accessory spleen may enlarge through a compensatory mechanism, and raise the awareness of this intrapacreatic entity to avoid unnecessary surgical operation. CONCLUSION IPAS should be highly considered as a differential diagnosis while the lesion is no more than 2.5 cm in diameter and/or other accessory spleens show around the splenic hilum. PMID:25437661

Zhu, Hong-xu; Lou, Wen-hui; Kuang, Tian-tao; Wang, Dan-song

2014-01-01

147

Littoral cell angiomas of the spleen associated with solid pseudopapillary tumor of the pancreas  

PubMed Central

Littoral cell angiomas (LCA) of the spleen are vascular tumors of unknown etiology arising from the littoral cells of the splenic red pulp sinuses. Usually a benign and incidental finding, LCA have been repeatedly reported in association with a variety of visceral malignancies and hold the potential for dissemination per se. We encountered a case of a 30 year old female who was diagnosed with solid pseudopapillary tumor of the head and distal pancreas by fine needle aspiration cytology. A distal pancreatectomy with splenectomy was performed in addition to a pylorus-preserving Whipple’s procedure and cholecystectomy. Histopathological examination confirmed solid pseudopapillary tumor of the pancreas and showed multiple well-circumscribed anastomosing vascular channels in the spleen. The diagnosis of LCA of the spleen was confirmed by immunohistochemistry that revealed co-expression of endothelial cell marker, CD31 and CD34, along with histiocytic marker, CD68 by the vascular lining cells. LCA has been previously reported in association with colorectal and pancreatic adenocarcinoma, malignant lymphoma, myelodysplasia and autoimmune disorders. We report the first case of LCA associated with solid pseudopapillary tumor of the pancreas. PMID:21860837

Bhavsar, Tapan; Wang, Congli; Huang, Yajue; Karachristos, Andreas; Inniss, Susan

2011-01-01

148

Lymphoepithelial cysts and cystic lymphangiomas: Under-recognized benign cystic lesions of the pancreas  

PubMed Central

AIM: To identify their diagnostic and prognostic clinical characteristics in a large series. METHODS: Retrospective review of clinicopathologic and imaging characteristics of patients diagnosed with lymphoepithelial cysts and cystic lymphangiomas of the pancreas at Massachusetts General Hospital. RESULTS: Twelve patients were identified between 1/1/1997 and 8/1/2007. Their median age was 55.5 years (range 19-78 years), and 6 were females. The lesion was incidentally discovered in half of the patients. Contrast enhanced computed tomography demonstrated that the cysts had thin walls, without calcifications, pancreatic duct dilation or pancreatic parenchyma invasion. Endoscopic ultrasound with fine needle aspiration (EUS/FNA) confirmed the diagnosis of a lymphoepithelial cyst in 3 patients, one of whom was spared an operation and continues to do well after 6 years. Eleven patients had a resection: 3 pancreaticoduodenectomies, 7 distal pancreatectomies, and 1 enucleation. The median size of the cysts was 3 cm (range 2-20 cm). At a median follow-up of 57 mo no recurrences or other pancreas-related conditions occurred. CONCLUSION: Lymphoepithelial cysts and cystic lymphangiomas of the pancreas can be diagnosed with a combination of contrast-enhanced computed tomography scans and EUS/FNA. If the lesion is asymptomatic, an operation might be avoided. PMID:25068011

Konstantinidis, Ioannis T; Kambadakone, Avinash; Catalano, Onofrio A; Sahani, Dushyant V; Deshpande, Vikram; Forcione, David G; Wargo, Jennifer A; Fernandez-del Castillo, Carlos; Lillemoe, Keith D; Warshaw, Andrew L; Ferrone, Cristina R

2014-01-01

149

Ultrastructure of the pancreas of Bradypus tridactylus.  

PubMed

The fine structure of the pancreas of the South American three toed sloth, Bradypus tridactylus, is described. In exocrine cells two types of granules are found. The first variety of granules is circular, of about 0.9 micrometer mean diameter, and probably represents zymogen granules. The second type of granule is larger (up to 1.4 micrometer in diameter) and contains a granular electron-dense material which is separated from the limiting membrane by a wide space. Only one type of islet cell was found. It contains spherical membrane-bound granules of uniform size. PMID:7020322

Abrahamsohn, P; Pallot, D J; Pinheiro, P B; Coutinho, V B; Pessoa, R G; Coutinho, H B

1981-01-01

150

Successful removal of a huge hypervascular tentorial cavernous angioma after preoperative endovascular embolization.  

PubMed

The authors report a rare case of a huge hypervascular tentorial cavernous angioma treated with preoperative endovascular embolization, followed by successful gross-total removal. A 15-year-old girl presented with scintillation, diplopia, and papilledema. Computed tomography and MRI studies revealed a huge irregularly shaped tumor located in the right occipital and suboccipital regions. The tumor, which had both intra- and extradural components, showed marked enhancement and invasion of the overlying occipital bone. Angiography revealed marked tumor stain, with blood supply mainly from a large branch of the left posterior meningeal artery. Therefore, this lesion was diagnosed as a tentorium-based extraaxial tumor. For differential diagnosis, meningioma, hemangiopericytoma, and malignant skull tumor were considered. Tumor feeders were endovascularly embolized with particles of polyvinyl alcohol. On the following day, the tumor was safely gross totally removed with minimum blood loss. Histopathological examination confirmed the diagnosis of cavernous angioma. To date, there have been no reports of tentorium-based cavernous angiomas endovascularly embolized preoperatively. A tentorial cavernous angioma is most likely to show massive intraoperative bleeding. Therefore, preoperative embolization appears to be quite useful for safe maximum resection. Hence, the authors assert that the differential diagnosis of tentorium-based tumors should include tentorial cavernous angioma, for which preoperative endovascular embolization should be considered. PMID:24866940

Yoshimura, Junichi; Tsukamoto, Yoshihiro; Sano, Masakazu; Hasegawa, Hitoshi; Nishino, Kazuhiko; Saito, Akihiko; Fukuda, Masafumi; Okamoto, Kouichirou; Fujii, Yukihiko

2014-07-01

151

Autonomous and Continuous Adaptation of a Bihormonal Bionic Pancreas in Adults and  

E-print Network

Autonomous and Continuous Adaptation of a Bihormonal Bionic Pancreas in Adults and Adolescents pancreas algorithm, initialized with only subject weight; to adapt automatically to the different insulin

152

Favorite Demonstration: Localization and Visualization of the Pancreas  

NSDL National Science Digital Library

This demonstration describes a simple procedure that helps students to identify the entire pancreas, including its boundaries. The method exposes the head, body, and tail of the pancreas so students may learn to appreciate its structure and the way it reg

Angela R. Porta

2000-03-01

153

Formation of the digestive system in zebrafish. ii. pancreas morphogenesis  

Microsoft Academic Search

Recent studies have suggested that the zebrafish pancreas develops from a single pancreatic anlage, located on the dorsal aspect of the developing gut. However, using a transgenic zebrafish line that expresses GFP throughout the endoderm, we report that, in fact, two pancreatic anlagen join to form the pancreas. One anlage is located on the dorsal aspect of the developing gut

Holly A. Field; P. D. Si Dong; Dimitris Beis; Didier Y. R. Stainier

2003-01-01

154

Combination harvesting procedure for liver and whole pancreas  

Microsoft Academic Search

Combination harvesting procedures for the liver and whole pancreas can be carried out successfully in most instances, but this requires agreement between the liver and pancreas teams concerning the vascular supply for the grafts. If one donor team is in charge of both organs, the procedure has considerable economical advantages. Even if one organ is not suitable, partial success is

H. Bunzendahl; B. Ringe; H. J. Meyer; G. Gubernatis; R. Pichlmayr

1988-01-01

155

[Value of core needle biopsy in preoperative diagnostics of soft tissue tumors: possibilities and limitations].  

PubMed

The differential diagnosis of soft tissue swellings encompasses a variety of benign, intermediate, low-grade malignant and high-grade neoplastic lesions in addition to tumor-like reactive processes. As treatment of these heterogeneous conditions varies greatly from conservative observation and simple local excision up to extensive radical surgical resection, treatment decisions are based mainly on a precise preoperative histological diagnosis on limited biopsy material. Even for clinically unequivocal sarcomas, the importance of the preoperative histological diagnosis has been increasingly emphasized as different therapeutic regimens have been established for different sarcoma types and the indications for preoperative treatment is influenced by the tumor grade and by the entity itself. Other factors positively influencing the increasing use of core needle biopsy for preoperative tumor diagnosis in soft tissue pathology are the availability of modern high-resolution imaging modalities as well as the establishment of several new second generation immunohistochemical markers and the discovery of entity-specific translocations detected by fluorescence in situ hybridization (FISH) in several sarcoma subtypes. In this review it will be shown that a targeted approach for processing core needle biopsies oriented towards the characteristic topographical, demographic, cytomorphological and architectural features of soft tissue lesions facilitates a precise diagnosis of soft tissue neoplasms in most cases. However, profound knowledge of the different aspects of soft tissue tumor diagnostics and familiarity with the frequent as well as the less common and rare tumor entities and variants is a prerequisite for appropriate interpretation of core needle biopsy findings and for selecting a limited but well-suited marker panel. The utilization of modern immunohistochemistry and/or FISH methods is highly useful for establishing the diagnosis of rare and unusual neoplasms in core needle biopsies. PMID:25394967

Agaimy, A

2014-11-01

156

Histological comparison between preoperative and surgical specimens of non-small cell lung cancer for distinguishing between "squamous" and "non-squamous" cell carcinoma  

PubMed Central

Background Non-small cell lung cancers (NSCLCs) are frequently heterogeneous and in approximately 70% of cases, NSCLCs are diagnosed and staged by small biopsies or cytology rather than by examination of surgically resected specimens. Thus, in most patients, the diagnosis is established based on examination of preoperative specimens alone. Recently, classification of NSCLC into pathologic subtypes has been shown to be important for selecting the appropriate systemic therapy, from both the point of view of treatment efficacy and prevention of toxicity. Methods We retrospectively reviewed the data of 225 patients to compare the preoperative classification of the NSCLC subtype on biopsy specimens with the postoperative classification based on examination of the resected specimens, in order to compare the accuracy of the two for the diagnosis of various histological subtypes of NSCLC. Results In 169 of the 225 (75.1%) patients, the preoperative diagnosis was definite malignancy. Histologically, the final pathologic diagnosis made from the surgical specimens was adenocarcinoma (ADC) in 169 patients, and in 75.5% of these cases, the diagnosis was concordant with the preoperative diagnosis. Among the patients who had squamous cell carcinoma (SQC) in the preoperative specimens, the diagnosis was concordant with the preoperative diagnosis in 65.7% of cases. Misclassified preoperative biopsies included an even number of SQCs and ADCs, with all the misclassified biopsies being ADCs morphologically mimicking SQC due to solid growth. Significantly higher specificity, negative predictive value and accuracy were observed for the diagnosis of SQC. Conclusions Our study suggested that the concordance rates for diagnosis of the NSCLC subtypes, especially the "squamous" or "non-squamous" histologies, between preoperative and surgical specimens were satisfactory, as compared with previous reports. Therefore, pretreatment diagnosis of lung cancer using small samples is reasonable for selecting the optimal treatment. However, in order not to lose the opportunity for selecting an effective treatment, we should be aware that the diagnosis in preoperative small samples might be different from that based on examination of the surgical specimens. Virtual Slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2032698427120488 PMID:24885169

2014-01-01

157

Subtotal resection of the head of the pancreas combined with ductal obliteration of the distal pancreas in chronic pancreatitis.  

PubMed Central

Subtotal resection of the head of the pancreas combined with duct obliteration of the distal pancreas by prolamine was performed in 12 selected patients who had chronic alcohol-induced pancreatitis with most destruction in the proximal pancreas. The main indication for operation was intractable pain. There was no postoperative mortality but morbidity was high when no pancreaticojejunostomy was constructed. After a follow-up period of 32 months, lasting pain relief was obtained in 10 patients; pseudocyst formation occurred in three patients; calcification of the distal pancreas, absent before operation, was demonstrated in four of six patients; six of 11 nondiabetic patients became hyperglycemic either abruptly (1 patient) or progressively (5 patients); quality of life improved in most patients. This procedure preserves the stomach, duodenum, spleen, distal pancreas and common bile duct if possible. However, pancreatic ductal obliteration with prolamine does not prevent relapses of chronic pancreatitis. PMID:3827358

Kerremans, R P; Penninckx, F M; De Groote, J; Fevery, J

1987-01-01

158

Regeneration and repair of the exocrine pancreas.  

PubMed

Pancreatitis is caused by inflammatory injury to the exocrine pancreas, from which both humans and animal models appear to recover via regeneration of digestive enzyme-producing acinar cells. This regenerative process involves transient phases of inflammation, metaplasia, and redifferentiation, driven by cell-cell interactions between acinar cells, leukocytes, and resident fibroblasts. The NF?B signaling pathway is a critical determinant of pancreatic inflammation and metaplasia, whereas a number of developmental signals and transcription factors are devoted to promoting acinar redifferentiation after injury. Imbalances between these proinflammatory and prodifferentiation pathways contribute to chronic pancreatitis, characterized by persistent inflammation, fibrosis, and acinar dedifferentiation. Loss of acinar cell differentiation also drives pancreatic cancer initiation, providing a mechanistic link between pancreatitis and cancer risk. Unraveling the molecular bases of exocrine regeneration may identify new therapeutic targets for treatment and prevention of both of these deadly diseases. PMID:25386992

Murtaugh, L Charles; Keefe, Matthew D

2015-02-10

159

The monocarboxylate transporters exist in the cattle endocrine pancreas.  

PubMed

Extensive studies are published concerning the distribution of monocarboxylate transporters (MCTs) in various animal issues including ruminants; nonetheless, nothing is known about their cellular expression and localization in the ruminant pancreas. The present study was carried out to examine the expression and cellular localization of all the fourteen MCT isoforms in cattle pancreas. RT-PCR verified the existence of mRNA transcripts for eight MCT isoforms, namely, MCT1, MCT2, MCT3, MCT4, MCT5, MCT8, MCT13, and MCT14 in cattle pancreas. Western blotting analysis confirmed the protein expression of these eight MCTs in the cattle pancreatic tissue. Immunohistochemical study, within the whole pancreas, was conducted to localize the eight MCTs identified, and the results showed strong positive immunoreactive staining for MCT1, MCT2, MCT4, MCT5, MCT13, and MCT14 on nearly all the islet cells of Langerhans, while we could not detect immunopositive signals in the acinar cells with any of MCTs antibodies used. This study, for the first time, showed the cellular localization and expression of MCT1-MCT5, MCT8, MCT13, and MCT14 within the ruminant pancreas. The distribution and expression pattern of MCT1, MCT2, MCT4, and CD147 in the cattle pancreas are different from that previously published on monogastric pancreas. Our study suggested that MCT1, MCT2, MCT4, MCT5, MCT13, and MCT14 may participate in the regulation of the pancreatic endocrine secretions in ruminants. PMID:25224143

Kirat, Doaa; Kato, Seiyu

2015-02-01

160

[Treatment and diagnostic policy in gunshot wounds of the pancreas].  

PubMed

Results of treatment of 71 patients with gun-shot wounds of the pancreas were analyzed. Features and structure of gun-shot abdominal penetrating wounds with injury of the pancreas, potential of up-to-date diagnostic methods were studied. Surgical policy in combined injuries of hollow organs and pancreas was developed. Variants and sequence of surgeries were determined depending on location and types of pancreatic injuries. Proposed treatment and diagnostic policy permitted to reduce rate of purulent and septic complications by 11.1% and lethality by 5.3%. PMID:14983156

Vo?novski?, E A; Abakumov, M M; Vasil'ev, A Iu; Vo?novski?, A E

2004-01-01

161

Sensitivity of EUS and ERCP Endoscopic Procedures in the Detection of Pancreatic Cancer During Preoperative Staging Correlated with CT and CT Angiography Imaging Methods  

PubMed Central

The goal: The goal of this work was to give advantage to EUS as endoscopic method in diagnosis and following therapeutic treatment of pancreatic cancer in relation to radiological methods of CT and CTA. Material and Methods: The study included 49 patients, 20 women and 29 men hospitalized at the Clinic for gastroenterohepatology, due to suspicion on pancreatic cancer during observed 2 years period. All cancers were histologically and cytologically confirmed. The patients underwent ERCP as a mandatory part of staging and all patients underwent endoscopic ultrasound as well as CT or CT angiography. Results: Testing of differences was carried out using Fisher’s exact test in open-source software R. The following characteristics were tested: involvement of the blood vessels, lymph nodes, metastases, tumor size and duodenum infiltration. Results showed statistically significant difference at the 0.05 level for EUS, CT and CT angiography. Risk ratio showed that EUS is less effective in detecting infiltration of blood vessels within a malignant process then CTA where RR=0.52, CI 0.2–1.38, p-value=0.33. EUS and CTA are equal in the diagnosis of enlarged lymph nodes affected by malignancy where RR=1.3, CI 0.75–1.42, p-value=0.09. Comparison according to distant metastases showed that EUS is less effective compared to CT in approximately 30% of cases. In the diagnosis of duodenal infiltration EUS is in 5% of cases less accurate than the CT with the RR=0.95, CI 0.27–3.32, p-value=0.76, but the CTA method is more efficient because the comparison of EUS and CTA showed RR=12.52, CI 0.2–1.38, p-value=0.33. EUS as a diagnostic method is dominant in determining the size of malignant lesions located in the pancreas as compared to CT and CTA. Conclusion: EUS as endoscopic method compared to CT and CTA is one of the more invasive methods of examination but due to its ability to be performed immediately, to locate a changes smaller than 5 mm and the target biopsy option, to measure the change and that in many cases determine the relationship of malignant lesions with blood vessels, along with visualization of the surrounding lymph nodes and metastases in neighboring organs, we may give this method an advantage over other methods in the preoperative staging of patients with pancreatic cancer. PMID:25132706

Vukobrat-Bijedic, Zora; Husic-Selimovic, Azra; Bijedic, Nina; Gornjakovic, Srdjan; Sofic, Amela; Gogov, Bisera; Bjelogrlic, Ivana; Mehmedovic, Amila; Glavas, Sanjin

2014-01-01

162

Cardiopulmonary Exercise Capacity and Preoperative Markers of Inflammation  

PubMed Central

Explanatory mechanisms for the association between poor exercise capacity and infections following surgery are underexplored. We hypothesized that aerobic fitness—assessed by cardiopulmonary exercise testing (CPET)—would be associated with circulating inflammatory markers, as quantified by the neutrophil-lymphocyte ratio (NLR) and monocyte subsets. The association between cardiopulmonary reserve and inflammation was tested by multivariable regression analysis with covariates including anaerobic threshold (AT) and malignancy. In a first cohort of 240 colorectal patients, AT was identified as the sole factor associated with higher NLR (P = 0.03) and absolute and relative lymphopenia (P = 0.01). Preoperative leukocyte subsets and monocyte CD14+ expression (downregulated by endotoxin and indicative of chronic inflammation) were also assessed in two further cohorts of age-matched elective gastrointestinal and orthopaedic surgical patients. Monocyte CD14+ expression was lower in gastrointestinal patients (n = 43) compared to age-matched orthopaedic patients (n = 31). The circulating CD14+CD16? monocyte subset was reduced in patients with low cardiopulmonary reserve. Poor exercise capacity in patients without a diagnosis of heart failure is independently associated with markers of inflammation. These observations suggest that preoperative inflammation associated with impaired cardiorespiratory performance may contribute to the pathophysiology of postoperative outcome. PMID:25061264

Sultan, Pervez; Edwards, Mark R.; Gutierrez del Arroyo, Ana; Cain, David; Sneyd, J. Robert; Struthers, Richard; Minto, Gary; Ackland, Gareth L.

2014-01-01

163

Preoperative Serum Tumor Marker Levels in Gastric Cancer  

PubMed Central

Objective: Tumor markers have shown little benefit as a method for screening. However, they can be used clinically for the monitoring of tumor recurrence and used as prognostic factors because higher levels have been observed in advanced disease. This study aimed to investigate the relationship between the preoperative tumor marker levels and different clinical aspects of gastric cancer. Methods: One hundred and six consecutive patients with confirmed diagnosis of gastric cancer and 106 subjects (age and sex matched) with no malignancy as control group were included prospectively in this study in 3 years. The relationships between tumor markers CEA, CA 19-9 and stage of disease, tumor differentiation, presence of ringlet cell type, presence of peritoneal carcinomatozis were investigated. Results: The serum CEA and CA 125 levels were found to be significantly elevated in gastric cancer patients than in controls. The serum level of CEA had showed a significant elevation with the presence of distant metastasis. The CA 19-9 and CA 125 levels had showed significant elevations with the presence of peritoneal carcinomatozis. Conclusions: This study showed that there is a limited clinical benefit of preoperative tumor marker measurements in gastric cancer such as estimation of peritoneal dissemination. PMID:24639849

Polat, Erdal; Duman, Ugur; Duman, Mustafa; Derya Peker, Kivanc; Akyuz, Cebrail; Fatih Yasar, Necdet; Uzun, Orhan; Akbulut, Sabiye; Birol Bostanci, Erdal; Yol, Sinan

2014-01-01

164

National trends in resection of the distal pancreas  

PubMed Central

AIM: To investigate national trends in distal pancreatectomy (DP) through query of three national patient care databases. METHODS: From the Nationwide Inpatient Sample (NIS, 2003-2009), the National Surgical Quality Improvement Project (NSQIP, 2005-2010), and the Surveillance Epidemiology and End Results (SEER, 2003-2009) databases using appropriate diagnostic and procedural codes we identified all patients with a diagnosis of a benign or malignant lesion of the body and/or tail of the pancreas that had undergone a partial or distal pancreatectomy. Utilization of laparoscopy was defined in NIS by the International Classification of Diseases, Ninth Revision correspondent procedure code; and in NSQIP by the exploratory laparoscopy or unlisted procedure current procedural terminology codes. In SEER, patients were identified by the International Classification of Diseases for Oncology, Third Edition diagnosis codes and the SEER Program Code Manual, third edition procedure codes. We analyzed the databases with respect to trends of inpatient outcome metrics, oncologic outcomes, and hospital volumes in patients with lesions of the neck and body of the pancreas that underwent operative resection. RESULTS: NIS, NSQIP and SEER identified 4242, 2681 and 11??082 DP resections, respectively. Overall, laparoscopy was utilized in 15% (NIS) and 27% (NSQIP). No significant increase was seen over the course of the study. Resection was performed for malignancy in 59% (NIS) and 66% (NSQIP). Neither patient Body mass index nor comorbidities were associated with operative approach (P = 0.95 and P = 0.96, respectively). Mortality (3% vs 2%, P = 0.05) and reoperation (4% vs 4%, P = 1.0) was not different between laparoscopy and open groups. Overall complications (10% vs 15%, P < 0.001), hospital costs [44??741 dollars, interquartile range (IQR) 28 347-74 114 dollars vs 49 792 dollars, IQR 13 299-73 463, P = 0.02] and hospital length of stay (7 d, IQR 4-11 d vs 7 d, IQR 6-10, P < 0.001) were less when laparoscopy was utilized. One and two year survival after resection for malignancy were unchanged over the course of the study (ductal adenocarinoma 1-year 63.6% and 2-year 35.1%, P = 0.53; intraductal papillary mucinous neoplasm and nueroendocrine 1-year 90% and 2-year 84%, P = 0.25). The majority of resections were performed in teaching hospitals (77% NIS and 85% NSQIP), but minimally invasive surgery (MIS) was not more likely to be used in teaching hospitals (15% vs 14%, P = 0.26). Hospitals in the top decile for volume were more likely to be teaching hospitals than lower volume deciles (88% vs 43%, P < 0.001), but were no more likely to utilize MIS at resection. Complication rate in teaching and the top decile hospitals was not significantly decreased when compared to non-teaching (15% vs 14%, P = 0.72) and lower volume hospitals (14% vs 15%, P = 0.99). No difference was seen in the median number of lymph nodes and lymph node ratio in N1 disease when compared by year (P = 0.17 and P = 0.96, respectively). CONCLUSION: There appears to be an overall underutilization of laparoscopy for DP. Centralization does not appear to be occurring. Survival and lymph node harvest have not changed. PMID:22969197

Rosales-Velderrain, Armando; Bowers, Steven P; Goldberg, Ross F; Clarke, Tatyan M; Buchanan, Mauricia A; Stauffer, John A; Asbun, Horacio J

2012-01-01

165

Adenocarcinoma arising from intrahepatic heterotopic pancreas: A case report and literature review  

PubMed Central

Heterotopic pancreas is mostly found incidentally, and adenocarcinoma arising from heterotopic pancreas appears to be extremely rare. A case of a 46-year-old woman with adenocarcinoma arising from intrahepatic heterotopic pancreas is reported herein. Computed tomography demonstrated a mass located in the bile duct of the left hepatic lobe. Pathological examination revealed a moderately differentiated adenocarcinoma arising from intrahepatic heterotopic pancreas with nerve infiltration. This may be the first reported case of adenocarcinoma arising from intrahepatic heterotopic pancreas. PMID:22719201

Yan, Mao-Lin; Wang, Yao-Dong; Tian, Yi-Feng; Lin, Ying

2012-01-01

166

Genetics Home Reference: Pearson marrow-pancreas syndrome  

MedlinePLUS

Pearson marrow-pancreas syndrome Mitochondrial DNA Related Condition(s) References Quick links to this topic MedlinePlus Health information Additional NIH Resources National Institutes of Health Educational resources Information ...

167

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: cwikiel@umich.edu

2007-04-15

168

Simultaneous pancreas and kidney transplantation: current trends and future directions  

PubMed Central

Purpose of review Important trends are being observed in pancreas transplantation in the USA. We will describe recent trends in simultaneous pancreas kidney (SPK) transplantation related to immunosuppression, treatment of rejection, and transplantation for patients of advanced age and C-peptide positive diabetes. Recent findings Rates of pancreas transplantation have declined, despite improved pancreatic graft outcomes. Regarding immunosuppression, trends in SPK transplantation include T-cell depletion induction therapy, waning mammalian target of rapamycin inhibitor use and steroid use in greater than 50% of pancreas transplant recipients with few patients undergoing late steroid weaning. Rejection of the pancreas may be discordant with the kidney after SPK and there is a greater appreciation of antibody-mediated rejection of the pancreas allograft. De-novo donor-specific antibody without graft dysfunction remains an active area of study, and the treatment for this condition is unclear. SPKs are being performed with greater frequency in type 2 diabetes mellitus patients and in patients of advanced age, with exemplary results. Summary The current state of the art in SPK transplantation is yielding superb and improving results. PMID:25565444

Redfield, Robert R.; Scalea, Joseph R.; Odorico, Jon S.

2015-01-01

169

Pseudomyxoma peritonei as an intractable disease and its preoperative assessment to help improve prognosis after surgery: A review of the literature  

PubMed Central

Summary Pseudomyxoma peritonei (PMP) is a rare and intractable disease with an estimated incidence of one per million population per year. Many aspects of PMP need to be fully and precisely understood; these include its preoperative assessment, i.e. diagnosis, early diagnosis, pathologic classification, and staging according to the peritoneal cancer index, and its surgical treatment. This review focuses on elements of preoperative assessment and surgery using the Sugarbaker procedure to help improve the prognosis for patients with PMP. Accurate data on the incidence of PMP must be based on large populations rather than estimates, and much work needs to be done especially in China. Special attention should be paid to its preoperative assessment. Also proposed here are steps to manage PMP with an emphasis on preoperative assessment. PMID:25343082

Zhong, Yuesi; Deng, Meihai; Xu, Ruiyun; Kokudo, Norihiro; Tang, Wei

2012-01-01

170

High precision innovative micropump for artificial pancreas  

NASA Astrophysics Data System (ADS)

The concept of artificial pancreas, which comprises an insulin pump, a continuous glucose meter and a control algorithm, is a major step forward in managing patient with type 1 diabetes mellitus. The stability of the control algorithm is based on short-term precision micropump to deliver rapid-acting insulin and to specific integrated sensors able to monitor any failure leading to a loss of accuracy. Debiotech's MEMS micropump, based on the membrane pump principle, is made of a stack of 3 silicon wafers. The pumping chamber comprises a pillar check-valve at the inlet, a pumping membrane which is actuated against stop limiters by a piezo cantilever, an anti-free-flow outlet valve and a pressure sensor. The micropump inlet is tightly connected to the insulin reservoir while the outlet is in direct communication with the patient skin via a cannula. To meet the requirement of a pump dedicated to closed-loop application for diabetes care, in addition to the well-controlled displacement of the pumping membrane, the high precision of the micropump is based on specific actuation profiles that balance effect of pump elasticity in low-consumption push-pull mode.

Chappel, E.; Mefti, S.; Lettieri, G.-L.; Proennecke, S.; Conan, C.

2014-03-01

171

Pharmacogenetics in neuroendocrine tumors of the pancreas.  

PubMed

Neuroendocrine tumors (NETs) arise from cells distributed throughout the endocrine system. Although, NETs are heterogeneous in their behavior, they tend to be more aggressive when arising in the pancreas. Pancreatic NET (panNET) represents three percent of all primary pancreatic neoplasms. Symptomatic and progressive panNETs are generally treated with cytotoxic chemotherapy, whereas molecular targeted therapy is used for nonfunctional tumors without aggressive features. Pharmacogenetics has increasingly been used recently to better identify potential targets for therapy and help select patient-specific therapy. In this review, we discuss two abstracts (Abstracts #4113 and #e15169) presented at the ASCO Annual Meeting in Chicago this year, outlining the potential role of tumor gene and gene product profiling in disease management. We describe what is known about the pathogenesis of these tumors, role of decreased gene product expression (MGMT, RRM1, MET) and its application in cytotoxic therapy selection, as well as genetic mutations that can be used for molecular targeted therapy. With an overall shift towards personalized medicine, it has become ever more important to identify the molecular signature of a tumor as it appears to dictate the clinical behavior and response to therapy. PMID:25076325

Rizvi, Syed Mujtaba; Wong, Joyce; Saif, Muhammad Wasif; Jia, Yuxia

2014-07-01

172

Transplantation of irradiated heterotopic segmental human pancreas.  

PubMed

The results of three irradiated segmental pancreatic autotransplantations in patients with cancer of the pancreatic head are presented. The grafts with ligated ducts were irradiated with 5000 or 2000 rad. Following irradiation, the pancreatic tails that were tumor-free at the section line were autotransplanted by anastomosing the splenic vessels to the common femoral vessels. The first graft (5000 rad) that was necrotic, was removed on the 15th postoperative day and the patient was placed on insulin therapy. The second and third patient (2000 rad) are both alive with functioning grafts without exocrine secretion and with normal carbohydrate metabolism, 7 months and 1 month after transplantation, respectively. Technically, irradiated pancreas transplantation is a feasible procedure, which could be applicable to patients with cancer of the pancreatic head to avoid secondary complications of diabetes after total pancreatectomy, and to patients with juvenile or chronic pancreatitis. It is possible that high-dose irradiation can completely destroy eventual multicenter tumor foci in the pancreatic tail. PMID:6312859

Tersigni, R; Toledo-Pereyra, L H; Fallucca, F; Cavallini, M; Capece, G; Giagrande, L; Capua, G; Stipa, S

1983-09-01

173

Microendoscopes for imaging of the pancreas  

NASA Astrophysics Data System (ADS)

Patients diagnosed with pancreatic cancer have a 5-year survival rate of only 3%. Endoscopic imaging of the pancreas is limited by the small size of the pancreatic duct, which has an average size of 3 mm. To improve imaging capabilities for the pancreatic duct, two small catheter-based imaging systems have been developed that will fit through the therapeutic channel of a clinical endoscope and into the pancreatic duct. One is a miniature endoscope designed to provide macro-imaging of tissue with both white light reflectance and fluorescence imaging modes. The 1.75 mm diameter catheter consists of separate illumination and imaging channels. At a nominal focal distance of 10 mm, the field of view of the system is ~ 10 mm, and the corresponding in-plane resolution is 60 microns. To complement the broadfield view of the tissue, a confocal microendoscope with 2 micron lateral resolution over a field of view of 450 microns and 25 micron axial resolution has been developed. With an outer diameter of 3 mm, the catheter in this system will also fit through the therapeutic channel and into the pancreatic duct. Images of tissue with both the miniature endoscope and confocal microendoscope are presented.

Kano, Angelique L.; Rouse, Andrew R.; Kroto, Shona M.; Gmitro, Arthur F.

2004-07-01

174

Radiologic and intraoperative detection of need for mesenteric vein resection in patients with adenocarcinoma of the head of the pancreas  

PubMed Central

Objective The need for mesenteric venous resection (MVR) is determined by a combination of preoperative radiologic and intraoperative surgical assessments. A single-centre review was performed to determine how efficient these processes are in evaluating the need for MVR. Methods A retrospective study was performed of 343 patients who received resection for adenocarcinoma of the head of the pancreas, 100 of whom underwent MVR. Three radiologic signs (abutment, fat plane obliteration, focal narrowing) were evaluated for their ability to predict the need for MVR. Pathologic assessment was performed to determine if MVR had been necessary to achieve negative-margin (R0) resection. Microscopic tumour in the vein wall, or within 1 mm of the vein wall, was considered to indicate that MVR had been necessary to achieve an R0 resection. Results Radiologic evaluation (showing any of the three signs) had sensitivity of only 60%. Overall, 40% of the patients who required MVR showed none of the signs. Specificity was 77%. A total of 80% of patients who underwent MVR had either microscopic invasion or abutment. R0 resection at the vein margin was achieved in 98% of patients in both the MVR and non-MVR groups. Conclusions Preoperative radiologic evaluation is not highly reliable in predicting the need for MVR. Therefore, surgical teams performing resections of cancers of the head of the pancreas must be skilled in MVR as the need for this procedure may arise unexpectedly. Surgical assessment of the need for MVR has an accuracy of about 80% and is nearly 100% accurate in determining when MVR is not required. PMID:21843264

Porembka, Matthew R; Hawkins, William G; Linehan, David C; Gao, Feng; Ma, Changqing; Brunt, Elizabeth M; Strasberg, Steven M

2011-01-01

175

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)

2009-03-15

176

Potential usefulness of mucin immunohistochemical staining of preoperative pancreatic biopsy or juice cytology specimens in the determination of treatment strategies for intraductal papillary mucinous neoplasm  

PubMed Central

We classified resected intraductal papillary mucinous neoplasms (IPMNs) into four subtypes (gastric, intestinal, pancreatobiliary and oncocytic) according to their morphological features and mucin expression, determined their clinicopathological characteristics and investigated the possibility of preoperatively diagnosing these subtypes. Sixty resected tumors, 4 preoperative tumor biopsies and 10 preoperative pancreatic juice cytology specimens were analyzed. The gastric and intestinal types accounted for the majority of IPMNs. Non-gastric type IPMNs were of high-grade malignancy. Many of the pancreatobiliary-type IPMNs were in an advanced stage and were associated with a poor prognosis. The results of mucin immunohistochemical staining of preoperative biopsy and surgically resected specimens were in agreement with each other, and in close agreement with those for pancreatic juice cytology specimens obtained from 10 patients during endoscopic retrograde cholangiopancreatography (ERCP). The immunostaining of preoperative biopsy specimens and ERCP-obtained pancreatic juice cytology specimens may be useful in the differential diagnosis of gastric and intestinal types of IPMN. If such techniques enable the preoperative diagnosis of IPMN subtypes, their use in combination with conventional preoperative imaging modalities may lead to surgical treatment best suited for the biological characteristics of the four subtypes. PMID:24008495

HISAKA, TORU; HORIUCHI, HIROYUKI; UCHIDA, SHINJI; ISHIKAWA, HIROTO; KAWAHARA, RYUICHI; KAWASHIMA, YUSUKE; AKASHI, MASANORI; MIKAGI, KAZUHIRO; ISHIDA, YUSUKE; OKABE, YOSHINOBU; NAKAYAMA, MASAMICHI; NAITO, YOSHIKI; YANO, HIROHISA; TAIRA, TOMOKI; KAWAHARA, AKIHIKO; KAGE, MASAYOSHI; KINOSHITA, HISAFUMI; SHIROZU, KAZUO

2013-01-01

177

Preoperative liver donor evaluation: Imaging and pitfalls  

Microsoft Academic Search

This article discusses the rationale behind living (related) donor liver transplantation, the role of imaging in the preoperative evaluation of the potential donor, and the currently available imaging modalities for fulfilling this task. Furthermore, the normal hepatic vascular and biliary anatomy, as seen on imaging, is reviewed and the most common anomalies are highlighted. Finally, critical concepts in the diagnostic

Koenraad J. Mortelé; Vito Cantisani; Roberto Troisi; Bernard de Hemptinne; Stuart G. Silverman

2003-01-01

178

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

1996-08-20

179

Preoperational test report, vent building ventilation system  

SciTech Connect

This represents a preoperational test report for Vent Building Ventilation Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides Heating, Ventilation, and Air Conditioning (HVAC) for the W-030 Ventilation Building. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

Clifton, F.T.

1997-11-04

180

Preoperational test report, primary ventilation system  

SciTech Connect

This represents a preoperational test report for Primary Ventilation Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides vapor space filtered venting of tanks AY101, AY102, AZ101, AZ102. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

Clifton, F.T.

1997-11-04

181

Temperature profiles of different cooling methods in porcine pancreas procurement.  

PubMed

Porcine islet xenotransplantation is a promising alternative to human islet allotransplantation. Porcine pancreas cooling needs to be optimized to reduce the warm ischemia time (WIT) following donation after cardiac death, which is associated with poorer islet isolation outcomes. This study examines the effect of four different cooling Methods on core porcine pancreas temperature (n = 24) and histopathology (n = 16). All Methods involved surface cooling with crushed ice and chilled irrigation. Method A, which is the standard for porcine pancreas procurement, used only surface cooling. Method B involved an intravascular flush with cold solution through the pancreas arterial system. Method C involved an intraductal infusion with cold solution through the major pancreatic duct, and Method D combined all three cooling Methods. Surface cooling alone (Method A) gradually decreased core pancreas temperature to <10 °C after 30 min. Using an intravascular flush (Method B) improved cooling during the entire duration of procurement, but incorporating an intraductal infusion (Method C) rapidly reduced core temperature 15-20 °C within the first 2 min of cooling. Combining all methods (Method D) was the most effective at rapidly reducing temperature and providing sustained cooling throughout the duration of procurement, although the recorded WIT was not different between Methods (P = 0.36). Histological scores were different between the cooling Methods (P = 0.02) and the worst with Method A. There were differences in histological scores between Methods A and C (P = 0.02) and Methods A and D (P = 0.02), but not between Methods C and D (P = 0.95), which may highlight the importance of early cooling using an intraductal infusion. In conclusion, surface cooling alone cannot rapidly cool large (porcine or human) pancreata. Additional cooling with an intravascular flush and intraductal infusion results in improved core porcine pancreas temperature profiles during procurement and histopathology scores. These data may also have implications on human pancreas procurement as use of an intraductal infusion is not common practice. PMID:25040217

Weegman, Bradley P; Suszynski, Thomas M; Scott, William E; Ferrer Fábrega, Joana; Avgoustiniatos, Efstathios S; Anazawa, Takayuki; O'Brien, Timothy D; Rizzari, Michael D; Karatzas, Theodore; Jie, Tun; Sutherland, David E R; Hering, Bernhard J; Papas, Klearchos K

2014-01-01

182

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. PMID:22042785

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

2011-01-01

183

Solid pseudopapillary neoplasms ofthe pancreas: clinicopathologic features and surgical treatment of 19 cases  

PubMed Central

Solid pseudopapillary neoplasms (SPNs) of the pancreas are very rare neoplasms. The present study is to summarize our experience of the diagnosis, surgical treatment and prognosis of SPNs. The clinical data of 19 cases that underwent surgery for pathologically confirmed SPNs, admitted in our hospital from Mar. 2007 to Mar. 2013, were analyzed retrospectively. The clinicopathologic feature, surgical treatment and prognosis were described in detail. The 19 patients were 17 females and 2 males, with a median age of 29 years. All patients had curative resections, including eight distal pancreatectomies with splenectomy, four spleen-preserving distal pancreatectomies, two pancreaticoduodenectomies, two pylorus-preserving pancreaticoduodenectomies, two duodenum-preserving pancreatic head resections and one central pancreatectomy. The tumors were 6.3 cm in diameter on average, and were mostly located in the body or tail of the pancreas (63.2%). Pathologically, the tumors contained a mixture of solid, cystic, and pseudopapillary patterns in various proportions. None of the patients had lymph nodes metastases and local invasion. All patients were alive and disease-free at a median follow-up of 38.4 months. SPNs are rare neoplasms, typically affecting young women without notable symptoms, with a low malignant potential but excellent prognosis. Radical surgical resection with clear margins is the treatment of choice. PMID:25400772

Ren, Zeqiang; Zhang, Pengbo; Zhang, Xiuzhong; Liu, Bin

2014-01-01

184

Preoperative glucose abnormalities in patients with pancreatic tumours  

PubMed Central

Introduction Pancreatic cancer is a neoplasm characterised by poor prognosis. The only effective, possible treatment is radical surgery, but most patients do not qualify for surgery because of delayed diagnosis. Aim To determine if assessment of endocrine pancreatic function could serve as a means of screening for pancreatic cancer. Material and methods This prospective study was conducted on a group of 50 patients diagnosed with pancreatic tumour, who were qualified for surgery. Results From 1.07.2010 to 4.07.2011 a further 50 patients were added to the study group. They had been admitted to the hospital with pancreatic tumours. During the preoperative period, nine of these people had been treated for diabetes, 14 were newly diagnosed with diabetes and 15 had been diagnosed with impaired glucose tolerance, but only 12 had a normal glucose profile. Afterwards, patients underwent the surgical treatment. Histopathological examination revealed that out of the 50 operated patients, 36 suffered from malignant disease, and of these only four had no impaired glucose tolerance before treatment. Conclusions In most cases, patients with pancreatic tumours have impaired glucose tolerance. Screening patients over 50 years of age could speed up diagnosis and surgical treatment. PMID:25061491

Durlik, Marek; Ka?u?a, Bernadetta; Milczarczyk, Alicja; Franek, Edward

2014-01-01

185

Equivalent success of simultaneous pancreas kidney and solitary pancreas transplantation. A prospective trial of tacrolimus immunosuppression with percutaneous biopsy.  

PubMed Central

OBJECTIVE: This study was designed to evaluate the results of solitary pancreas transplantation in a protocol that uses the new immunosuppressant tacrolimus (FK) and liberally applies ultrasound-guided percutaneous pancreas biopsy to diagnose rejection. SUMMARY BACKGROUND DATA: Pancreas graft survival in patients who simultaneously receive a kidney transplant (SPK) historically has been 75% to 90% at 1 year, approaching that of cadaveric kidney transplantations. In sharp contrast, graft survival rates in patients who receive a pancreas atone (PA) have remained static over the past decade, with approximately 50% functional at 1 year. It was hypothesized that the results of PA transplantations would improve with newer maintenance immunosuppressants and biopsy techniques. METHODS: Twenty-seven PA recipients prospectively were treated with FK-based immunosuppression (PA-FK). Percutaneous biopsy was performed for hyperamylasemia, hyperlipasemia, hypoamylasuria, or unexplained fever. One year pancreas graft survival in these patients was compared to 15 cyclosporine treated PA cases (PA-CsA) and 113 SPK recipients. RESULTS: The 1-year pancreas graft survival rate of 90.1% in technically successful PA-FK patients was significantly better than the 53.4% rate in PA-CsA recipients (p = 0.002) and no different than the 87.4% rate in SPK recipients. The only graft lost to acute rejection in the PA-FK group was because of acknowledged patient noncompliance. Percutaneous biopsy substantially improved the diagnostic certainty in cases of suspected rejection and was associated with a low complication rate (3/178 = 1.5%). CONCLUSIONS: Modern immunosuppression and biopsy techniques have improved the success of solitary pancreas transplantations to the point where outcome is now equivalent to that of SPKs. PMID:8857849

Bartlett, S T; Schweitzer, E J; Johnson, L B; Kuo, P C; Papadimitriou, J C; Drachenberg, C B; Klassen, D K; Hoehn-Saric, E W; Weir, M R; Imbembo, A L

1996-01-01

186

In vitro pancreas organogenesis from dispersed mouse embryonic progenitors.  

PubMed

The pancreas is an essential organ that regulates glucose homeostasis and secretes digestive enzymes. Research on pancreas embryogenesis has led to the development of protocols to produce pancreatic cells from stem cells (1). The whole embryonic organ can be cultured at multiple stages of development (2-4). These culture methods have been useful to test drugs and to image developmental processes. However the expansion of the organ is very limited and morphogenesis is not faithfully recapitulated since the organ flattens. We propose three-dimensional (3D) culture conditions that enable the efficient expansion of dissociated mouse embryonic pancreatic progenitors. By manipulating the composition of the culture medium it is possible to generate either hollow spheres, mainly composed of pancreatic progenitors expanding in their initial state, or, complex organoids which progress to more mature expanding progenitors and differentiate into endocrine, acinar and ductal cells and which spontaneously self-organize to resemble the embryonic pancreas. We show here that the in vitro process recapitulates many aspects of natural pancreas development. This culture system is suitable to investigate how cells cooperate to form an organ by reducing its initial complexity to few progenitors. It is a model that reproduces the 3D architecture of the pancreas and that is therefore useful to study morphogenesis, including polarization of epithelial structures and branching. It is also appropriate to assess the response to mechanical cues of the niche such as stiffness and the effects on cell´s tensegrity. PMID:25079453

Greggio, Chiara; De Franceschi, Filippo; Figueiredo-Larsen, Manuel; Grapin-Botton, Anne

2014-01-01

187

Tissue-specific deletion of c-Jun in the pancreas has limited effects on pancreas formation  

SciTech Connect

It is well known that activating protein-1 (AP-1) is involved in a variety of cellular functions such as proliferation, differentiation, apoptosis, and oncogenesis. AP-1 is a dimer complex consisting of different subunits, and c-Jun is known to be one of its major components. In addition, it has been shown that mice lacking c-Jun are embryonic lethal and that c-Jun is essential for liver and heart development. However, the role of c-Jun in the pancreas is not well known. The aim of this study was to examine the possible role of c-Jun in the pancreas. First, c-Jun was strongly expressed in pancreatic duct-like structures at an embryonic stage, while a lower level of expression was observed in some part of the adult pancreas, implying that c-Jun might play a role during pancreas development. Second, to address this point, we generated pancreas-specific c-Jun knock-out mice (Ptf1a-Cre; c-Jun{sup flox/flox} mice) by crossing Ptf1a-Cre knock-in mice with c-Jun floxed mice. Ptf1a is a pancreatic transcription factor and its expression is confined to pancreatic stem/progenitor cells, which give rise to all three types of pancreatic tissue: endocrine, exocrine, and duct. Contrary to our expectation, however, there was no morphological difference in the pancreas between Ptf1a-Cre; c-Jun{sup flox/flox} and control mice. In addition, there was no difference in body weight, pancreas weight, and the expression of various pancreas-related factors (insulin, glucagon, cytokeratin, and amylase) between the two groups. Furthermore, there was no difference in glucose tolerance between Ptf1a-Cre; c-Jun{sup flox/flox} and control mice. Taken together, although we cannot exclude the possibility that c-Jun ablation is compensated by some unknown factors, c-Jun appears to be dispensable for pancreas development at least after ptf1a gene promoter is activated.

Yamamoto, Kaoru; Miyatsuka, Takeshi; Tanaka, Ayako; Toyoda, Shuichi; Kato, Ken; Shiraiwa, Toshihiko; Fujitani, Yoshio; Yamasaki, Yoshimitsu; Hori, Masatsugu; Matsuhisa, Munehide; Matsuoka, Taka-aki [Department of Internal Medicine and Therapeutics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871 (Japan); Kaneto, Hideaki [Department of Internal Medicine and Therapeutics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871 (Japan)], E-mail: kaneto@medone.med.osaka-u.ac.jp

2007-11-30

188

En-bloc liver-pancreas transplant in Iran.  

PubMed

Liver transplant can be challenging in cirrhotic patients with diabetes mellitus. In chronic liver disease, the glucose metabolism is altered; uncontrolled diabetes negatively influences the outcome of liver transplantation and poses difficulty in the management of immediate post transplantation period. Simultaneous liver-pancreas transplantation is an option to prevent early complications due to diabetes and also to improve the quality of life after transplantation in patients with Insulin-Dependent Diabetes Mellitus (IDDM) and chronic liver disease. We report the first en-bloc liver-pancreas transplant done in the transplant history of Iran. We describe the technical details of the procedure as well as the short term outcome after transplantation. In this case report, we also discuss in some details, the surgical, medical and immunological advantages of combined liver-pancreas transplantation as opposed to separate implantation of both organs. PMID:25204483

Nikeghbalian, Saman; Mehdi, Seyed Haider; Aliakbarian, Mohsen; Kazemi, Kourosh; Shamsaeefar, Alireza; Bahreini, Amin; Gholami, Siavash; Malekhosseini, Seyed Ali

2014-09-01

189

Cellular Plasticity within the Pancreas— Lessons Learned from Development  

PubMed Central

The pancreas has been the subject of intense research due to the debilitating diseases that result from its dysfunction. In this review, we summarize current understanding of the critical tissue interactions and intracellular regulatory events that take place during formation of the pancreas from a small cluster of cells in the foregut domain of the mouse embryo. Importantly, an understanding of principles that govern the development of this organ has equipped us with the means to manipulate both embryonic and differentiated adult cells in the context of regenerative medicine. The emerging area of lineage modulation within the adult pancreas is of particular interest, and this review summarizes recent findings that exemplify how lessons learned from development are being applied to reveal the potential of fully differentiated cells to change fate. PMID:20230744

Puri, Sapna; Hebrok, Matthias

2014-01-01

190

Heterotopic pancreas in excluded stomach diagnosed after gastric bypass surgery  

PubMed Central

Background Heterotopic pancreas is defined as finding of pancreatic tissue without anatomic and vascular continuity with the normal pancreas. Heterotopic pancreas is a rare condition difficult to diagnose and with controversial clinical management. Case presentation We describe a 43 year old female patient previously submitted to laparoscopic gastric bypass for primary treatment of morbid obesity; 5 years later, the patient was discovered to have a mass in the antrum of the excluded stomach that was found to be heterotopic pancreatic tissue. Before gastric bypass surgery, the presence of the pancreatic mass in the gastric wall was unnoticed in the imagiologic records. Conclusion This is the first reported case of pancreatic heterotopy diagnosed in the excluded stomach after gastric bypass. A putative role of incretin hormones in mediating pancreatic cell hyperplasia of heterotopic pancreatic remnants should be considered an additional hypothesis that requires further research. PMID:24267291

2013-01-01

191

Imaging heterogeneity in the mitochondrial redox state of premalignant pancreas in the pancreas-specific PTEN-null transgenic mouse model  

PubMed Central

Background Metabolic alteration is one of the hallmarks of carcinogenesis. We aimed to identify certain metabolic biomarkers for the early detection of pancreatic cancer (PC) using the transgenic PTEN-null mouse model. Pancreas-specific deletion of PTEN in mouse caused progressive premalignant lesions such as highly proliferative ductal metaplasia. We imaged the mitochondrial redox state of the pancreases of the transgenic mice approximately eight months old using the redox scanner, i.e., the nicotinamide adenine dinucleotide/oxidized flavoproteins (NADH/Fp) fluorescence imager at low temperature. Two different approaches, the global averaging of the redox indices without considering tissue heterogeneity along tissue depth and the univariate analysis of multi-section data using tissue depth as a covariate were adopted for the statistical analysis of the multi-section imaging data. The standard deviations of the redox indices and the histogram analysis with Gaussian fit were used to determine the tissue heterogeneity. Results All methods show consistently that the PTEN deficient pancreases (Pdx1-Cre;PTENlox/lox) were significantly more heterogeneous in their mitochondrial redox state compared to the controls (PTENlox/lox). Statistical analysis taking into account the variations of the redox state with tissue depth further shows that PTEN deletion significantly shifted the pancreatic tissue to an overall more oxidized state. Oxidization of the PTEN-null group was not seen when the imaging data were analyzed by global averaging without considering the variation of the redox indices along tissue depth, indicating the importance of taking tissue heterogeneity into account for the statistical analysis of the multi-section imaging data. Conclusions This study reveals a possible link between the mitochondrial redox state alteration of the pancreas and its malignant transformation and may be further developed for establishing potential metabolic biomarkers for the early diagnosis of pancreatic cancer. PMID:24252270

2013-01-01

192

Experience with 500 simultaneous pancreas-kidney transplants.  

PubMed Central

METHODS: From December 1985 to October 1997, 500 simultaneous pancreas-kidney transplants (SPKs) were performed at the University of Wisconsin. Bladder drainage (BD) was used in 388 and enteric drainage (ED) in 112. All pancreas transplants were preserved in UW solution. RESULTS: Patient survival at 1, 5, and 10 years was 96.4%, 88.6%, and 76.3%; kidney function, 88.6%, 80.3%, and 66.6%; and pancreas function, 87.5%, 78.1%, and 67.2%. Thrombosis of the pancreas occurred in three to four (0.6% to 0.8%) and primary nonfunction in one (0.2%). There was a 4.2% acute tubular necrosis rate for the kidney. Conversion from BD to ED was required in 24% of cases. Primary indications for enteric conversion (EC) were leak (14%), urethritis and extravasation (7%), and chronic hematuria (3%). No graft was lost as a result of EC. There was no difference in 1-year graft survival between ED and BD. Leading causes of pancreas loss were rejection in 45 patients and death with a functioning graft in 27 patients. Since June 1995, mycophenolate mofetil was used for immunosuppression (n = 109). One-year survival rates with mycophenolate mofetil are patient, 98.1 %; kidney, 94.2%; and pancreas, 93.1%. Steroid-resistant rejections decreased from 48% to 15%. CONCLUSIONS: This series represents the world's largest experience with SPK, including the longest follow-up for BD pancreatic transplants. Ten-year graft survival rates exceed those of all other transplants, with the exception of HLA-identical living-related grafts. This series confirms that SPK is a highly successful procedure for selected diabetic patients with renal failure. PMID:9742912

Sollinger, H W; Odorico, J S; Knechtle, S J; D'Alessandro, A M; Kalayoglu, M; Pirsch, J D

1998-01-01

193

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)

1997-09-15

194

ULTRASTRUCTURE OF NORMAL AND NEOPLASTIC EXOCRINE PANCREAS IN THE MUMMICHOG, FUNDULUS HETEROLCLITUS  

EPA Science Inventory

The ultrastructure of normal exocrine pancreas and exocrine pancreatic neoplasms in Fundulus heteroclitus from a creosote-contaminated environment in the Elizabeth River, Virginia, is described. he normal exocrine pancreas in this species was an anastomosing tubular rather than a...

195

showed that the calf's pancreas during the trough of the PPS cycle did not secrete the  

E-print Network

showed that the calf's pancreas during the trough of the PPS cycle did not secrete the same pattern). These results demonstrated that the diet containing soybean meal modified the exocrine function of the pancreas

Paris-Sud XI, Université de

196

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

2010-01-01

197

Preoperative planning in revision hip surgery  

Microsoft Academic Search

The usefulness of preoperative planning has been described by various studies. In revision hip surgery this method helps\\u000a to analyze biomechanical changes due to bony defects and suggests a surgical tactic for restoration of hip function. When\\u000a using this method the surgeon gains information of biomechanical changes which have to be addressed in order to achieve good\\u000a postoperative results. Data

Wolfgang Klauser; Cornel van Gorp; Philip Lubinus

2001-01-01

198

Pancreas tumor model in rabbit imaged by perfusion CT scans  

NASA Astrophysics Data System (ADS)

The goal of this work was to develop and validate a pancreas tumor animal model to investigate the relationship between photodynamic therapy (PDT) effectiveness and photosensitizer drug delivery. More specifically, this work lays the foundation for investigating the utility of dynamic contrast enhanced blood perfusion imaging to be used to inform subsequent PDT. A VX2 carcinoma rabbit cell line was grown in the tail of the pancreas of three New Zealand White rabbits and approximately 3-4 weeks after implantation the rabbits were imaged on a CT scanner using a contrast enhanced perfusion protocol, providing parametric maps of blood flow, blood volume, mean transit time, and vascular permeability surface area product.

Gunn, Jason; Tichauer, Kenneth; Moodie, Karen; Kane, Susan; Hoopes, Jack; Stewart, Errol E.; Hadway, Jennifer; Lee, Ting-Yim; Pereira, Stephen P.; Pogue, Brian W.

2013-03-01

199

[Analyzing and tracking preoperative and intraoperative astigmatism].  

PubMed

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

2012-03-01

200

Glucagonoma and its angiographic diagnosis  

SciTech Connect

Four patients with metastatic glucagonoma are described. Angiography demonstrated a small avascular primary tumor of the tail of the pancreas in one patient and large hypervascular tumors of the pancreatic head in the other three. Liver metastases were hypervascular in all four. 21 cases from the literature, including our 4 of glucagonomas show a 92% incidence of increased tumor vascularity - thus increasing the likelihood of successful angiographic diagnosis. The awareness of clinically subtle or atypical glucagonomas and use of plasma glucagon determination are important factors leading to early diagnosis of these neoplasms. Since angiography can localize the tumor, assess its extent, and detect hepatic metastases, it is essential to the detailed evaluation of glucagonomas.

Wawrukiewicz, A.S.; Roesch, J.; Keller, F.S.; Lieberman, D.A.

1982-01-01

201

Role of preoperative tracheobronchoscopy in newborns with esophageal atresia: A review  

PubMed Central

Preoperative tracheobronchoscopy (TBS) in the diagnostic assessment of newborns affected by esophageal atresia (EA) was described in 1981. Nevertheless, the value of the procedure is actually much debated; only a few studies have clearly explored the advantages of TBS and this procedure is not yet routinely included in the diagnostic and therapeutic assessment in many international pediatric surgery settings. Routine preoperative TBS is a safe procedure that enables the accurate examination of the tracheobronchial tree, the visualization of tracheoesophageal fistula and the diagnosis of tracheomalacia or associated respiratory anomalies. When a distal fistula is found, its occlusion with a Fogarty balloon catheter improves mechanical ventilation and facilitates surgical repair. This review provides a detailed overview on the use of TBS in newborns with EA, focusing on technical aspects, anesthesiological management, indications and limits. The benefits and risks of the procedure are also compared with alternative diagnostic tools, such as an esophageal contrast study, computed tomography scan and ultrasound. PMID:25324919

Parolini, Filippo; Boroni, Giovanni; Stefini, Stefania; Agapiti, Cristina; Bazzana, Tullia; Alberti, Daniele

2014-01-01

202

Vet Path0134:138-145 (1997) Canine Neuroendocrine Tumors of the Pancreas: A Study Using  

E-print Network

Vet Path0134:138-145 (1997) Canine Neuroendocrine Tumors of the Pancreas: A Study Using Image tumor; morphometry; neuroendocrinetumorof the pancreas;nuclearimagehistometry; prognosis of the pancreas(NETPs) on the basis of a common phenotype characterized by ex- pression of neuroendocrine marker

Rodenacker, Karsten

203

Enzyme potentialities of the abomasum and pancreas of the calf. II. —  

E-print Network

Enzyme potentialities of the abomasum and pancreas of the calf. II. — Effects of weaning weight in the three groups was similar. At slaughter, the abomasum and pancreas of each animal were to ruminant calves had a depressive effect on the activities of the enzymes (except chymosin), in the pancreas

Paris-Sud XI, Université de

204

Building an artificial pancreas U, Mayo Clinic working to develop a revolutionary treatment  

E-print Network

Fall 2012 Building an artificial pancreas U, Mayo Clinic working to develop a revolutionary are working together to build an artificial pancreas that would eliminate this burden. As part of this work continuous glucose sensor that would make the artificial pancreas a better treatment option. Tackling

Minnesota, University of

205

Nutritional and circadian variations in lipase activity and colipase saturation in rat pancreas  

E-print Network

Nutritional and circadian variations in lipase activity and colipase saturation in rat pancreas was to determine if lipase follows the same pattern as the other hydrolases in the pancreas, and whether variations-hour period. The pancreas was excised and quick-frozen. Lipase content was determined on 10 p. 100

Paris-Sud XI, Université de

206

The Journal of Immunology B7x in the Periphery Abrogates Pancreas-Specific Damage  

E-print Network

The Journal of Immunology B7x in the Periphery Abrogates Pancreas-Specific Damage Mediated by Self effector CD8 T cells were capable of migrating to the pancreas but failed to robustly destroy tissue when-producing b cells of the pancreas, resulting in a breakdown of glucose homeostasis. Genetic mapping and gene

Zang, Xingxing

207

FINAL Draft Feb 23 Predicting pancreas cell fate decisions and reprogramming with a  

E-print Network

FINAL Draft Feb 23 Predicting pancreas cell fate decisions and reprogramming with a hierarchical-producing cells from other pancreas cells can be achieved by external modulation of key transcription factors as regenerative medicine, such as insulin-secreting pancreas cells and cardiac muscle cells. However, the current

Ahlers, Guenter

208

Pancreas ? cell regeneration and type 1 diabetes (Review)  

PubMed Central

Diabetes mellitus, which may cause hyperglycemia and a number of complications, mostly results from a deficiency of ? cell mass (type 1 diabetes) or a limitation of ? cell function (type 2 diabetes). Currently, enhancing ? cell regeneration and increasing cell proliferation have not only been described in experimental diabetes models, but have also been proven to improve outcomes for patients with diabetes. Therefore, understanding the mechanisms controlling the development and regeneration of ? cells in the human pancreas may be helpful for the treatment of ? cell-deficient disease. In this review, we first introduce the various cell types in the adult pancreas and thereby clarify their functions and origins. Then, the known mechanisms of ? cell development and expansion in the normal human pancreas are described. The potential mechanisms of ? cell regeneration, including ? cell self-replication, neogenesis from non-? cell precursors and transdifferentiation from ? cells, are discussed in the next part. Finally, the ability of the pancreas to regenerate mature ? cells is explored in pathological conditions, including type 1 diabetes, chronic pancreatitis and persistent hyperinsulinemic hypoglycemia of infancy.

WU, JINXIAO; YANG, XIYAN; CHEN, BIN; XU, XIUPING

2015-01-01

209

Stimulus-secretion coupling in the developing exocrine pancreas  

SciTech Connect

Acinar cells of the embryonic pancreas are filled with zymogen granules containing, among others, the secretory protein, cholecystokinin (CCK) ..cap alpha..-amylase, the rate of amylase secretion from pancreatic lobules incubated in vitro was not increased in response to CCK. In contrast, the rate of CCK-stimulated amylase discharge from the neonatal pancreas was increased 4- to 8-fold above that seen in the embryonic gland. The postnatal amplification of secretory responsiveness was not associated with an increase in the level of /sup 125/I-CCK octapeptide specifically bound/cell equivalent or a change in the affinity of binding. Light microscopic autoradiography revealed a similar /sup 125/I-CCK-33 labeling pattern in pancreatic lobules from both ages with autoradiographic grains specifically localized at the periphery of acinar cells. In order to determine whether CCK binding is coupled to a rise in the cytosolic Ca/sup + +/concentration, (Ca/sup + +/)c, in the embryonic pancreas, /sup 45/Ca/sup + +/ efflux from tracer-loaded lobules was measured. Efflux of /sup 45/Ca/sup + +/ from both embryonic and neonatal pancreas was comparably increased in the presence of CCK.

Chang, A.Y.S.

1986-01-01

210

The Role of Tobacco-Derived Carcinogens in Pancreas Cancer  

PubMed Central

The extremely poor outcome from pancreas cancer is well known. However, its aetiology less well appreciated, and the molecular mechanisms underlying this are poorly understood. Tobacco usage is one of the strongest risk factors for this disease, and this is a completely avoidable hazard. In addition, there are well described hereditary diseases which predispose, and familial pancreas cancer. We have sought here to summarise the role of tobacco-derived carcinogens and the mode of their tumorigenic action on the pancreas. There is compelling evidence from animal and human studies (laboratory including cell line studies and epidemiologic) that tobacco derived carcinogens cause pancreas cancer. However, the manner in which they do so is not entirely apparent. There is also compelling evidence that synergism with genetic and other life-style factors—like diet obesity—results in a multifactorial causation of the disease. Ascertaining the role of tobacco carcinogens in the development of this cancer and their interaction with other risk factors will enable novel therapeutic and preventative strategies to improve outcome from this appalling malignancy. PMID:22084727

Lochan, Rajiv; Reeves, Helen L.; Daly, Anne K.; Charnley, Richard M.

2011-01-01

211

Islet cell responses to glucose in human transplanted pancreas.  

PubMed

Postsurgery, pancreas transplantation results in alterations of carbohydrate metabolism. Additionally, immunosuppressive therapy impacts on glucose regulation. We evaluated the hormonal and metabolic responses of pancreas allografts, utilizing the hyperglycemic clamp technique coupled with the tritiated glucose methodology, in 11 volunteers who had received simultaneous pancreas-kidney transplantation (P-K) with systemic drainage. Their responses were compared with seven volunteers who had received only a kidney (K) graft and with seven normal control (C) volunteers. Although basal glucose and hepatic glucose output were similar in all three groups, basal insulin, C-peptide, glucagon, and pancreatic polypeptide were highest in the P-K group and lowest in normal subjects. During hyperglycemia, all groups showed a similar characteristic, initial complete suppression of hepatic glucose production, with recovery followed by a later suppression. Peripheral glucose uptake was similar in P-K and C subjects but decreased in K patients. Systemic insulin levels were fourfold higher in the pancreas transplant patients than in healthy subjects. Thus, under basal and hyperglycemic stimulation, 1) hepatic glucose homeostasis is regulated normally, even with pancreatic drainage into the systemic circulation; 2) overall glucose disposal is normal in P-K patients because of marked hyperinsulinemia; and 3) there is loss of tonic inhibition of endocrine pancreatic function secondary to pancreatic denervation. PMID:1767840

Elahi, D; Clark, B A; McAloon-Dyke, M; Wong, G; Brown, R; Shapiro, M; Minaker, K L; Flanagan, T L; Pruett, T; Gingerich, R

1991-12-01

212

Solid pseudopapillary tumor: a rare neoplasm of the pancreas.  

PubMed

Solid pseudopapillary tumor is a rare primary neoplasm of the pancreas that typically affects young women. It is a relatively a benign tumor, with a favorable prognosis. We here report a 27-year-old woman with solid pseudopapillary neoplasm, who presented with mild jaundice, mildly elevated liver function tests and right upper quadrant pain. Ultrasound was suggestive of hemorrhagic hepatic adenoma; however, on magnetic resonance imaging, a heterogenous mass was found in the head of pancreas. Endoscopic ultrasound-guided fine needle aspiration (FNA) revealed tumor cells with papillary architecture and immunohistochemical analysis showing cells positive for markers including beta-catenin, vimentin, alpha 1 antitrypsin etc. These findings were consistent with solid pseudopapillary neoplasm. The patient underwent pancreaticoduodenectomy. Post-surgical biopsy confirmed the FNA findings with tumor localized to the pancreas. The patient was not given any adjuvant therapy. She remained asymptomatic and showed no signs of disease after four months follow-up. It is important to differentiate this tumor from other pancreatic neoplasms, because this type is amenable to cure after complete surgical resection, even in cases with capsular invasion, unlike malignant tumors of the pancreas. PMID:24759340

Shuja, Asim; Alkimawi, Khalid A

2014-05-01

213

Somatostatin: Abundance of Immunoreactive Hormone in Rat Stomach and Pancreas  

Microsoft Academic Search

Growth hormone release inhibiting hormone (somatostain), a hypothalamic peptide that inhibits the release of growth hormone and also the secretion of insulin, glucagon, and gastrin, was found in the rat stomach and pancreas in a concentration similar to that in the hypothalamus, as measured by radioimmunoassay. Somatostatin was also found in the duodenum and jejunum, but in a smaller concentration.

Akira Arimura; Haruko Sato; Andre Dupont; Nozomu Nishi; Andrew V. Schally

1975-01-01

214

[Intraductal papillary mucinous neoplasm of the pancreas].  

PubMed

The diagnosis of cystic pancreatic lesions is raised more often within the last years. This is due to the fact that diagnostic opportunities and modalities such as endosonography (EUS), magnetic resonance imaging (MRI), magnetic resonance cholangio-pancreatography (MRCP), and computertomography (CT) have both improved and are more widely used. As such new recommendations were needed, since the knowledge on cystic pancreatic lesions has increased after the last consensus statement published in 2006. ?In this review the main aspects of the recent consensus statements for diagnosis and therapy or in some cases the surveillance strategy of intraductal papillary mucinous neoplasm will be summarized. Main duct IPMN will in most cases in surgically "fit" patients be resected, since the risk of malignancy is high in this entity. In patients with branch duct IPMN a careful "watch and wait" strategy can be applied if no "worrisome features" or "high-risk stigmata" can be detected. MRI is the imaging modality of choice, while EUS should be applied in centers with expertise. PMID:24760694

Rosendahl, J; Mössner, J

2014-05-01

215

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. PMID:10450725

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

1999-01-01

216

Intraduct papillary mucinous neoplasm of the pancreas: a tumour linked with IgG4-related disease?  

PubMed Central

Objectives Intraduct papillary mucinous neoplasm (IPMN) is a pancreatic tumour that is often associated with chronic pancreatitis (CP) in the surrounding pancreas. Type 1 autoimmune pancreatitis (AIP) is a fibro-inflammatory condition with characteristic histological features and prominent IgG4+ plasma cells and is part of the spectrum of IgG4-related disease (IgG4-RD). The aim of this study was to determine whether CP associated with pancreatic IPMN commonly represents AIP. Methods We identified two consecutive ‘index’ cases of pancreatic IPMN during routine reporting in which the adjacent pancreas showed morphological features suggestive of AIP. These cases were investigated using the Boston criteria for the histopathological diagnosis of IgG4-RD and the HISORt criteria for the clinical and histopathological diagnosis of AIP. Using the same criteria, we proceeded to a clinical review of 12 extra cases of IPMN in which the tumour or the surrounding pancreas showed significant lymphoplasmacytic inflammation and/or fibrosis. Results Both of the ‘index’ cases fulfilled the HISORt criteria for AIP and both had morphological features characteristic of IgG4-RD using the Boston criteria, although only one possessed features ‘highly suggestive of IgG4-RD’ after immunohistochemistry. Additionally, both ‘index’ cases had radiological features that could represent extrapancreatic manifestations. Review of the 12 additional cases of IPMN revealed no further examples showing co-existent AIP. Conclusion While pancreatic IPMN and AIP may co-exist, most CP associated with IPMN does not represent AIP. PMID:23596150

Bateman, Adrian C; Culver, Emma L; Sommerlad, Matthew; Chetty, Runjan

2013-01-01

217

Secondary tumors of the pancreas diagnosed by endoscopic ultrasound-guided fine-needle aspiration: a 10-year experience.  

PubMed

Determining whether a pancreatic mass is a primary or secondary neoplasm is necessary for appropriate treatment. We reviewed our experience using endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for diagnosis of pancreatic tumors to identify clinical and cytopathologic characteristics of metastatic disease. We reviewed all cases of tumors metastatic to the pancreas evaluated at The University of Texas MD Anderson Cancer Center and The Methodist Hospital in Houston, Texas during the period from 2002 to 2012. The review included cytologic specimens, clinical history, radiologic findings, primary tumor type, and clinical follow-up. We identified 66 patients with disease metastatic to the pancreas for which cytologic material was available: 38 (58%) men and 28 (42%) women, with an average age of 63 years (range, 40-89 years). Most metastases (98%) were single lesions, and nearly half were located in the head of the pancreas (30/66). The most common site of origin for these metastases was kidney (27 [41%] cases). Follow-up information was available for 65 (98%) patients, and duration of follow-up ranged from <1 to 10 years (mean, 2.3 years). Thirty-three patients (50%) were alive at the time of the most recent follow-up contact. Of the 25 patients with metastatic renal cell carcinoma, clear cell type, 19 (76%) were alive at the time of the most recent follow-up. It was concluded that metastases may mimic primary pancreatic carcinomas both clinically and cytologically. Ancillary studies in conjunction with clinical history are necessary for the accurate diagnosis of FNAs of secondary pancreatic tumors. PMID:24554612

Waters, Lindsay; Si, Quisheng; Caraway, Nancy; Mody, Dina; Staerkel, Gregg; Sneige, Nour

2014-09-01

218

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. 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.

2012-01-01

219

JOP. J. Pancreas (Online) 2001; 2(4 Suppl):229-236. JOP. Journal of the Pancreas http://www.joplink.net Vol.2, No.4 Suppl. July 2001 229  

E-print Network

JOP. J. Pancreas (Online) 2001; 2(4 Suppl):229-236. JOP. Journal of the Pancreas ­ http) and glycolipids (asialo-GM1, proposed to be an important bacterial binding site on the #12;JOP. J. Pancreas (Online) 2001; 2(4 Suppl):229-236. JOP. Journal of the Pancreas ­ http://www.joplink.net ­ Vol.2, No.4

Machen, Terry E.

220

Preoperational test report, primary ventilation condensate system  

SciTech Connect

Preoperational test report for Primary Ventilation Condensate System, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides a collection point for condensate generated by the W-030 primary vent offgas cooling system serving tanks AYIOI, AY102, AZIOI, AZI02. The system is located inside a shielded ventilation equipment cell and consists of a condensate seal pot, sampling features, a drain line to existing Catch Tank 241-AZ-151, and a cell sump jet pump. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

Clifton, F.T.

1997-01-29

221

Preoperational test report, recirculation ventilation systems  

SciTech Connect

This represents a preoperational test report for Recirculation Ventilation Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides vapor space cooling of tanks AY1O1, AY102, AZ1O1, AZ102 and supports the ability to exhaust air from each tank. Each system consists of a valved piping loop, a fan, condenser, and moisture separator; equipment is located inside each respective tank farm in its own hardened building. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

Clifton, F.T.

1997-11-11

222

Pancreatic head resectable adenocarcinoma: preoperative chemoradiation improves local control but does not affect survival  

PubMed Central

Background This study assesses the impact of preoperative chemoradiation on recurrence, surgical morbidity, histopathological data and survival in resectable adenocarcinoma of the pancreatic head. Methods We carried out a retrospective study with an intention-to-treat analysis. From 1997 to 2006, 173 patients with resectable pancreas head carcinoma were treated in two reference centres in France using different treatment strategies. Results Sixty-seven of 85 (79%) patients in the surgery-first (SF) group and 38 of 88 (43%) patients in the chemoradiation (CR) group underwent surgical resection (P < 0.001). Overall morbidity was 40% (15/38) in the CR group and 43% (29/67) in the SF group (P = 0.837). In the CR group, median tumour size was smaller (1.5 cm vs. 3.0 cm; P < 0.001) and fewer patients were node-positive (29% vs. 64%; P = 0.001) than in the SF group. There was less perineural (43% vs. 93%; P < 0.001), lymphatic and vascular (21% vs. 92%; P < 0.001) invasion in the CR group than in the SF group. In both groups, 89% of patients had recurrence (31/35 in the CR group and 57/64 in the SF group; P = 1.000), predominantly involving metastasis and carcinomatosis in the CR group (30/31 vs. 35/57; P < 0.001) and locoregional recurrence in the SF group (24/57 vs. 3/31; P = 0.002). Median survival for all patients and for resected patients in the CR and SF groups was, respectively, 15 months vs. 17 months, and 21 months vs. 18 months (P = non-significant). Conclusions Preoperative chemoradiation allows for good local control of the disease but does not increase survival, mainly for reasons of metastatic spread. Other options should be developed to improve both local and distant control of the disease. PMID:21159106

Barbier, Louise; Turrini, Olivier; Grégoire, Emilie; Viret, Frédéric; Le Treut, Yves-Patrice; Delpero, Jean-Robert

2011-01-01

223

Indications requiring preoperative magnetic resonance imaging before knee arthroscopy  

PubMed Central

Introduction Knee arthroscopy knee is gold standard in diagnosis and simultaneous treatment of knee disorders. But most patients undergo magnetic resonance imaging (MRI) before arthroscopy, although MRI results are not always consistent with arthroscopic findings. This raises the question in which suspected diagnoses MRI really has influence on diagnosis and consecutive surgical therapy. Material and methods Preoperative MRI of 330 patients with knee disorders were compared with arthroscopic findings. The MRI were performed by 23 radiologists without specialization in musculoskeletal diagnostics. Specificity, sensitivity, negative/positive predictive value and accuracy of MRI were calculated in comparison to arthroscopic findings. Results We found sensitivity/specificity of 58%/93% for anterior horn, 94%/46% for posterior horn of medial meniscus and 71%/81% for anterior and 62%/82% for posterior horn of lateral meniscus. Related to anterior cruciate ligament injuries we showed sensitivity/specificity of 82%/91% for grade 0 + I and 72%/96% for grade II + III. For Cartilage damage sensitivity/specificity of 98%/7% for grade I-, 89%/29% for grade II-, 96%/38% for grade III- and 96%/69% for grade IV-lesions were revealed. Conclusions The MRI should not be used as routine diagnostic tool for knee pain. No relevant information for meniscal lesions and anterior cruciate ligament ruptures has been gained with MRI from non-specialized outside imaging centres. The MRI should not be used as routine diagnostic tool for knee pain. No relevant information for meniscal lesions and anterior cruciate ligament ruptures has been gained with MRI from non-specialized outside imaging centres.

Roßbach, Björn Peter; Pietschmann, Matthias Frank; Gülecyüz, Mehmet Fatih; Niethammer, Thomas Richard; Ficklscherer, Andreas; Wild, Stefan; Jansson, Volkmar

2014-01-01

224

Pancreas transplantation: The Wake Forest experience in the new millennium  

PubMed Central

AIM: To investigate the Wake Forest experience with pancreas transplantation in the new millennium with attention to surgical techniques and immunosuppression. METHODS: A monocentric, retrospective review of outcomes in simultaneous kidney-pancreas transplant (SKPT) and solitary pancreas transplant (SPT) recipients was performed. All patients underwent pancreas transplantation as intent-to-treat with portal venous and enteric exocrine drainage and received depleting antibody induction; maintenance therapy included tapered steroids or early steroid elimination with mycophenolate and tacrolimus. Recipient selection was based on clinical judgment whether or not the patient exhibited measureable levels of C-peptide. RESULTS: Over an 11.25 year period, 202 pancreas transplants were performed in 192 patients including 162 SKPTs and 40 SPTs. A total of 186 (92%) were primary and 16 (8%) pancreas retransplants; portal-enteric drainage was performed in 179 cases. A total of 39 pancreas transplants were performed in African American (AA) patients; of the 162 SKPTs, 30 were performed in patients with pretransplant C-peptide levels > 2.0 ng/mL. In addition, from 2005-2008, 46 SKPT patients were enrolled in a prospective study of single dose alemtuzumab vs 3-5 doses of rabbit anti-thymocyte globulin induction therapy. With a mean follow-up of 5.7 in SKPT vs 7.7 years in SPT recipients, overall patient (86% SKPT vs 87% SPT) and kidney (74% SKPT vs 80% SPT) graft survival rates as well as insulin-free rates (both 65%) were similar (P = NS). Although mortality rates were nearly identical in SKPT compared to SPT recipients, patterns and timing of death were different as no early mortality occurred in SPT recipients whereas the rates of mortality following SKPT were 4%, 9% and 12%, at 1-, 3- and 5-years follow-up, respectively (P < 0.05). The primary cause of graft loss in SKPT recipients was death with a functioning graft whereas the major cause of graft loss following SPT was acute and chronic rejection. The overall incidence of acute rejection was 29% in SKPT and 27.5% in SPT recipients (P = NS). Lower rates of acute rejection and major infection were evidenced in SKPT patients receiving alemtuzumab induction therapy. Comparable kidney and pancreas graft survival rates were observed in AA and non-AA recipients despite a higher prevalence of a “type 2 diabetes” phenotype in AA. Results comparable to those achieved in insulinopenic diabetics were found in the transplantation of type 2 diabetics with detectable C-peptide levels. CONCLUSION: In the new millennium, acceptable medium-term outcomes can be achieved in SKPT and SPTs as nearly 2/3rds of patients are insulin independent following pancreas transplantation. PMID:25512802

Rogers, Jeffrey; Farney, Alan C; Orlando, Giuseppe; Iskandar, Samy S; Doares, William; Gautreaux, Michael D; Kaczmorski, Scott; Reeves-Daniel, Amber; Palanisamy, Amudha; Stratta, Robert J

2014-01-01

225

Preoperative evaluation for lung cancer resection  

PubMed Central

During the last decades lung cancer is the leading cause of death worldwide for both sexes. Even though cigarette smoking has been proved to be the main causative factor, many other agents (e.g., occupational exposure to asbestos or heavy metals, indoor exposure to radon gas radiation, particulate air pollution) have been associated with its development. Recently screening programs proved to reduce mortality among heavy-smokers although establishment of such strategies in everyday clinical practice is much more difficult and unknown if it is cost effective compared to other neoplasms (e.g., breast or prostate cancer). Adding severe comorbidities (coronary heart disease, COPD) to the above reasons as cigarette smoking is a common causative factor, we could explain the low surgical resection rates (approximately 20-30%) for lung cancer patients. Three clinical guidelines reports of different associations have been published (American College of Chest Physisians, British Thoracic Society and European Respiratory Society/European Society of Thoracic Surgery) providing detailed algorithms for preoperative assessment. In the current mini review, we will comment on the preoperative evaluation of lung cancer patients. PMID:24672690

Spyratos, Dionysios; Porpodis, Konstantinos; Angelis, Nikolaos; Papaiwannou, Antonios; Kioumis, Ioannis; Pitsiou, Georgia; Pataka, Athanasia; Tsakiridis, Kosmas; Mpakas, Andreas; Arikas, Stamatis; Katsikogiannis, Nikolaos; Kougioumtzi, Ioanna; Tsiouda, Theodora; Machairiotis, Nikolaos; Siminelakis, Stavros; Argyriou, Michael; Kotsakou, Maria; Kessis, George; Kolettas, Alexander; Beleveslis, Thomas; Zarogoulidis, Konstantinos

2014-01-01

226

Simultaneous pancreas-kidney transplantation from live donors.  

PubMed Central

OBJECTIVE: In this first report of a clinical series of simultaneous pancreas-kidney transplants (SPKs) from live donors, the authors assess donor and recipient outcome as well as the spectrum of surgical and metabolic complications. SUMMARY BACKGROUND DATA: The rationale for live (vs. cadaveric) donation includes an immunologic advantage (better matching, decreased drugs, and fewer rejection episodes) and elimination of waiting time. Only sequential kidney and pancreas or pancreas transplants alone from live donors had been done until the authors' current series. METHODS: Between March 15, 1994, and March 15, 1997, the authors performed 20 SPKs from live donors (6 human leukocyte antigen-identical siblings, 14 mismatched relatives [5 parents, 7 siblings, 1 daughter, 1 aunt]). Of the 20 donors, 13 were women, and 7 were men; median age was 43 years (range, 30-58 years). All donors underwent standardized metabolic workup, including oral glucose tolerance tests, determination of hemoglobin A1 c levels, and tests to study insulin secretion and functional insulin secretory reserve. Of the 20 recipients, 12 were women, and 8 were men; median age was 34 years (range, 14-50 years). Management of exocrine pancreatic secretions was with bladder drainage in 17 and duct injection in 3 recipients. Median follow-up was 9 months (range, 1-36 months). RESULTS: Currently, all 20 kidney grafts are functioning. Of the 20 pancreas grafts, 15 are functioning, 3 thrombosed, but 2 of those patients underwent immediate retransplantation from a cadaveric donor, and their grafts currently are functioning. Recipient complications included three anastomotic leaks and three intra-abdominal abscesses. Donor complications included four splenectomies, two peripancreatic fluid collections, one pseudocyst, and one intra-abdominal abscess; two donors underwent reoperation. Three donors had impaired glucose metabolism postdonation. Using tacrolimus and mycophenolate mofetil for mainstay immunosuppression, only 8 of 20 recipients experienced > or =1 rejection episode; only 1 pancreas graft was lost to rejection. Donor and recipient mortality was 0%. CONCLUSION: Simultaneous pancreas-kidney transplants from live donors can be done with no mortality and good graft outcome. With stringent donor criteria, this approach could become another surgical alternative for endocrine replacement therapy in selected patients with uremic type I diabetes. Images Figure 1. Figure 2. PMID:9351715

Gruessner, R W; Kendall, D M; Drangstveit, M B; Gruessner, A C; Sutherland, D E

1997-01-01

227

Does varicocele correction lead to normalization of preoperatively elevated mean platelet volume levels?  

PubMed Central

Introduction: There are several studies on the relationship between increased mean platelet volume (MPV) and varicocele. We investigated the relationship between preoperative and 6-month postoperative MPV values in patients whose varicocele was corrected with surgery. Methods: A total of 282 patients underwent surgery at our urology clinic between December 2011 and December 2013 for primary varicocele. We retrospectively examined the records of 61 patients who came to the 6-month postoperative follow-up. The preoperative varicocele diagnosis was made with physical examination findings and supported with colour Doppler ultrasonography. Results: The varicocele was grade I in 12 patients, grade II in 34 patients and grade III in 11 patients. When the preoperative and 6-month postoperative haemoglobin (Hb), MPV, mean corpuscular volume, platelet, and platelet distribution width (PDW) values were compared, there was a significant decrease in MPV (p = 0.019), and a significant increase in Hb (p < 0.001). A noticeable increase was also present in PDW, but it was not statistically significant (p = 0.058). Conclusion: We found that MPV increased in patients with varicocele and tended to decrease again after the varicocele was surgically corrected. However, we feel larger prospective series are needed. PMID:25624970

Coban, Soner; Keles, Ibrahim; Biyik, ?smail; Guzelsoy, Muhammet; Turkoglu, Ali R?za; Ocak, Nihal

2015-01-01

228

Preoperative anemia increases postoperative morbidity in elective cranial neurosurgery  

PubMed Central

Background: Preoperative anemia may affect postoperative mortality and morbidity following elective cranial operations. Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was used to identify elective cranial neurosurgical cases (2006-2012). Morbidity was defined as wound infection, systemic infection, cardiac, respiratory, renal, neurologic, and thromboembolic events, and unplanned returns to the operating room. For 30-day postoperative mortality and morbidity, adjusted odds ratios (ORs) were estimated with multivariable logistic regression. Results: Of 8015 patients who underwent elective cranial neurosurgery, 1710 patients (21.4%) were anemic. Anemic patients had an increased 30-day mortality of 4.1% versus 1.3% in non-anemic patients (P < 0.001) and an increased 30-day morbidity rate of 25.9% versus 14.14% in non-anemic patients (P < 0.001). The 30-day morbidity rates for all patients undergoing cranial procedures were stratified by diagnosis: 26.5% aneurysm, 24.7% sellar tumor, 19.7% extra-axial tumor, 14.8% intra-axial tumor, 14.4% arteriovenous malformation, and 5.6% pain. Following multivariable regression, the 30-day mortality in anemic patients was threefold higher than in non-anemic patients (4.1% vs 1.3%; OR = 2.77; 95% CI: 1.65-4.66). The odds of postoperative morbidity in anemic patients were significantly higher than in non-anemic patients (OR = 1.29; 95% CI: 1.03-1.61). There was a significant difference in postoperative morbidity event odds with a hematocrit level above (OR = 1.07; 95% CI: 0.78-1.48) and below (OR = 2.30; 95% CI: 1.55-3.42) 33% [hemoglobin (Hgb) 11 g/dl]. Conclusions: Preoperative anemia in elective cranial neurosurgery was independently associated with an increased risk of 30-day postoperative mortality and morbidity when compared to non-anemic patients. A hematocrit level below 33% (Hgb 11 g/dl) was associated with a significant increase in postoperative morbidity. PMID:25422784

Bydon, Mohamad; Abt, Nicholas B.; Macki, Mohamed; Brem, Henry; Huang, Judy; Bydon, Ali; Tamargo, Rafael J.

2014-01-01

229

An immunohistochemical study of the endocrine pancreas in raptors.  

PubMed

The cytoarchitecture of the endocrine pancreas of 10 raptors (golden eagles, peregrine falcons, Saker falcon, turkey vultures, red-tailed hawk and unspecified falcon) was examined by immunohistochemistry. Three islet types were identified: type A mixed islets composed mainly by glucagon (A)-secreting cells, type B mixed islets with predominantly insulin (B)-secreting cell component and type M mixed islets (type M) consisting of variable number of glucagon-, insulin- and somatostatin (D)-secreting cells. The latter were further characterized into Type I, II or III according to the cell distribution of the three cell types. A and D cells were also randomly scattered within the exocrine pancreas. The results of this study suggest that the classical concept in birds of a segregation of A and B cells in well-defined and distinct islets is not applicable in raptors, reflecting an evolutionary adaptation to different dietary habits and variation in developmental mechanisms. PMID:25468799

Palmieri, C; Shivaprasad, H L

2014-11-01

230

Trichomegaly of Eyelashes after Treatment with Erlotinib in Carcinoma Pancreas  

PubMed Central

Epidermal growth factor receptor (EGFR) inhibitors have been widely used for the treatment of epithelial malignancies. A wide spectrum of skin toxicities have been described in patients receiving EGFR inhibitors. Trichomegaly, especially of the eyelashes is a rare side effect of this therapy. We report a case of trichomegaly of eyelashes in a 39-year-old male, a case of carcinoma pancreas. This side-effect of these medications gives prospects as a therapy to stimulate the growth of hair. PMID:25114450

Goel, Varun; Raina, Shubhra; Chandragouda, D; Singh, Sajjan; Talwar, Vineet; Patnaik, Nivedita

2014-01-01

231

Annular Pancreas in Children: A Decade of Experience  

PubMed Central

Objective: Annular pancreas is an uncommon cause of duodenal obstruction in children. In this study, the clinical, radiological, and prognostic findings related to this disorder over a 12-year review period were analyzed. Materials and Methods: A retrospective review of 22 patients with annular pancreas who were treated with surgical repair between April 1998 and February 2010 was performed at two different pediatric surgical units. Presenting symptoms, associated anomalies, radiological findings, the type of surgery performed, postoperative outcomes, and complications were analyzed. Results: Twenty-two patients were identified. Thirteen of the 22 patients (59.1%) were born prematurely, 11 patients (50%) had low birth weight, 2 patients (9.1%) had very low birth weight and 1 patient (4.5%) had extremely low birth weight. The mean birth weight was 2285.23±675.12 g. (970-3300). All patients presented with vomiting, which was bilious in nine (40.9%). Nine patients (40.9%) had chromosomal anomalies. Corrective surgery consisted of duodenoduodenostomy in 9 patients (40.9 %), duodenojejunostomy in 9 patients (40.9%), and gastrojejunostomy in 4 patients (18.1%). Fourteen of the 22 patients have survived (63.6%). The causes of death were combinations of sepsis, pneumonia, brain hemorrhage, and cardiac anomaly. Conclusion: Infants with annular pancreas associated with duodenal obstruction were often born prematurely and/or had low birth weights; many had cardiovascular anomalies. Annular pancreas associated with duodenal obstruction correlated strongly with the trisomy 21 karyotype among the chromosomal anomalies, as did duodenal atresia. The oral feeding tolerance time was nearly the same for all patients regardless of the surgical procedure used.

Yigiter, Murat; Yildiz, Abdullah; Firinci, Binali; Yalcin, Onur; Oral, Akgun; Salman, Ahmet Bedii

2010-01-01

232

Development of the Human Pancreas From Foregut to Endocrine Commitment  

PubMed Central

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.

2013-01-01

233

Designing an artificial pancreas architecture: the AP@home experience.  

PubMed

The latest achievements in sensor technologies for blood glucose level monitoring, pump miniaturization for insulin delivery, and the availability of portable computing devices are paving the way toward the artificial pancreas as a treatment for diabetes patients. This device encompasses a controller unit that oversees the administration of insulin micro-boluses and continuously drives the pump based on blood glucose readings acquired in real time. In order to foster the research on the artificial pancreas and prepare for its adoption as a therapy, the European Union in 2010 funded the AP@home project, following a series of efforts already ongoing in the USA. This paper, authored by members of the AP@home consortium, reports on the technical issues concerning the design and implementation of an architecture supporting the exploitation of an artificial pancreas platform. First a PC-based platform was developed by the authors to prove the effectiveness and reliability of the algorithms responsible for insulin administration. A mobile-based one was then adopted to improve the comfort for the patients. Both platforms were tested on real patients, and a description of the goals, the achievements, and the major shortcomings that emerged during those trials is also reported in the paper. PMID:25430423

Lanzola, Giordano; Toffanin, Chiara; Di Palma, Federico; Del Favero, Simone; Magni, Lalo; Bellazzi, Riccardo

2014-11-28

234

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. PMID:20499918

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

2010-01-01

235

Gata6 is an important regulator of mouse pancreas development  

PubMed Central

Gata4, Gata5, and Gata6 represent a subfamily of zinc-finger transcriptional regulators that are important in the development and differentiation of numerous tissues, including many endodermally-derived organs. We demonstrate that Gata4 and Gata6 have overlapping expression patterns in the early pancreatic epithelium. Later, Gata4 becomes restricted to exocrine tissue and Gata6 becomes restricted to a subset of endocrine cells. In addition, we show Gata6, but not Gata4, physically interacts with Nkx2.2, an essential islet transcription factor. To begin determining the roles that Gata4 and Gata6 play during pancreatic development, we expressed Gata4-Engrailed and Gata6-Engrailed dominant repressor fusion proteins in the pancreatic epithelium and in the islet. At e17.5, transgenic Gata6-Engrailed embryos exhibit two distinct phenotypes: a complete absence of pancreas or a reduction in pancreatic tissue. In the embryos that do form pancreas, there is a significant reduction of all pancreatic cell types, with the few differentiated endocrine cells clustered within, or in close proximity to, enlarged ductal structures. Conversely, the majority of transgenic Gata4-Engrailed embryos do not have a pancreatic phenotype. This study suggests that Gata6 is an important regulator of pancreas specification. PMID:16887115

Decker, Kimberly; Goldman, Devorah C.; Grasch, Catherine L.; Sussel, Lori

2009-01-01

236

Preoperative total parenteral nutrition for bowel resection in Crohn's disease  

Microsoft Academic Search

To examine the effect of preoperative total parenteral nutrition (TPN) on patients with Crohn's disease undergoing bowel resection, an historical cohort was assembled of 103 patients resected between 1982 and 1984 by a single surgical team. Preoperative, perioperative, and postoperative variables were compared between patients receiving TPN and patients not receiving TPN. Analysis was stratified for three surgical procedures: segmental

Bret A. Lashner; Alison A. Evans; Stephen B. Hanauer

1989-01-01

237

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.

2007-01-01

238

Surgical site infection, preoperative body washing and hair removal.  

PubMed

Estimates suggest one in 20 patients develop an infection following surgery, costing the NHS around pounds 1bn each year (SSHAIP 2004). This article discusses surgical site infections and the commonest bacteria which cause them. It then explores two practices, preoperative body washing and preoperative hairremoval, and their effect on bacterial reduction and surgical site infection. PMID:18616201

Tanner, Judith; Khan, Debra

2008-06-01

239

Predictors of preoperative anxiety in children.  

PubMed

This study aimed to identify factors contributing to anxiety at induction of anaesthesia in children. One hundred and twenty children aged five to twelve years and scheduled for surgery requiring general anaesthesia were included. Children were interviewed and assessed prior to surgery. Parents completed anxiety measures prior to surgery and were interviewed after the induction of anaesthesia. The level of children's anxiety was determined at the time of induction of anaesthesia by the modified Yale Preoperative Anxiety Scale. Factors associated with increased levels of anxiety in the children included increased number of people in the room at induction of anaesthesia; longer waiting time between admission at the hospital and induction of anaesthesia; negative memories of previous hospital experiences; and having a mother who does not practise a religion. Suggestions for implementation of the findings and for future research are provided. PMID:12635399

Wollin, S R; Plummer, J L; Owen, H; Hawkins, R M F; Materazzo, F

2003-02-01

240

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.

1997-11-04

241

Pancoast tumors: characteristics and preoperative assessment.  

PubMed

Superior sulcus tumors (SSTs), or as otherwise known Pancoast tumors, make up a clinically unique and challenging subset of non-small cell carcinoma of the lung (NSCLC). Although the outcome of patients with this disease has traditionally been poor, recent developments have contributed to a significant improvement in prognosis of SST patients. The combination of severe and unrelenting shoulder and arm pain along the distribution of the eighth cervical and first and second thoracic nerve trunks, Horner's syndrome (ptosis, miosis, and anhidrosis) and atrophy of the intrinsic hand muscles comprises a clinical entity named as "Pancoast-Tobias syndrome". Apart NSCLC, other lesions may, although less frequently, result in Pancoast syndrome. In the current review we will present the main characteristics of the disease and focus on the preoperative assessment. PMID:24672686

Panagopoulos, Nikolaos; Leivaditis, Vasilios; Koletsis, Efstratios; Prokakis, Christos; Alexopoulos, Panagiotis; Baltayiannis, Nikolaos; Hatzimichalis, Antonios; Tsakiridis, Kosmas; Zarogoulidis, Paul; Zarogoulidis, Konstantinos; Katsikogiannis, Nikolaos; Kougioumtzi, Ioanna; Machairiotis, Nikolaos; Tsiouda, Theodora; Kesisis, Georgios; Siminelakis, Stavros; Madesis, Athanasios; Dougenis, Dimitrios

2014-03-01

242

Pancoast tumors: characteristics and preoperative assessment  

PubMed Central

Superior sulcus tumors (SSTs), or as otherwise known Pancoast tumors, make up a clinically unique and challenging subset of non-small cell carcinoma of the lung (NSCLC). Although the outcome of patients with this disease has traditionally been poor, recent developments have contributed to a significant improvement in prognosis of SST patients. The combination of severe and unrelenting shoulder and arm pain along the distribution of the eighth cervical and first and second thoracic nerve trunks, Horner’s syndrome (ptosis, miosis, and anhidrosis) and atrophy of the intrinsic hand muscles comprises a clinical entity named as “Pancoast-Tobias syndrome”. Apart NSCLC, other lesions may, although less frequently, result in Pancoast syndrome. In the current review we will present the main characteristics of the disease and focus on the preoperative assessment. PMID:24672686

Panagopoulos, Nikolaos; Leivaditis, Vasilios; Koletsis, Efstratios; Prokakis, Christos; Alexopoulos, Panagiotis; Baltayiannis, Nikolaos; Hatzimichalis, Antonios; Tsakiridis, Kosmas; Zarogoulidis, Konstantinos; Katsikogiannis, Nikolaos; Kougioumtzi, Ioanna; Machairiotis, Nikolaos; Tsiouda, Theodora; Kesisis, Georgios; Siminelakis, Stavros; Madesis, Athanasios; Dougenis, Dimitrios

2014-01-01

243

Preoperative visceral angiography alters intraoperative strategy during the Whipple procedure.  

PubMed

To determine the importance of preoperative visceral angiography prior to pancreaticoduodenectomy, all Whipple procedures performed between 1985 and 1991 at the Virginia Mason Medical Center were retrospectively reviewed. During this period, 77 pancreaticoduodenectomies were performed for both neoplastic disease (n = 54, 70%) and chronic pancreatitis (n = 23, 30%). Sixty-four preoperative angiograms were obtained, of which 39 (61%) were abnormal findings. Thirty percent (19 of 64) of the angiograms revealed a significant vascular abnormality that required specific preoperative or intraoperative measures that might not have been performed without knowledge of these findings. Examples include celiac axis revascularization for celiac occlusion, hepatic artery preservation for replaced vessels, preoperative embolization for pseudoaneurysm or arteriovenous fistula, and splenectomy for splenic vein thrombosis. Because of the high percentage of significant findings requiring an intraoperative or preoperative technical change, we recommend the use of angiography in order to diminish morbidity in all patients preparing to undergo pancreaticoduodenectomy. PMID:8098185

Biehl, T R; Traverso, L W; Hauptmann, E; Ryan, J A

1993-05-01

244

Impact of high preoperative steroid doses on postoperative complications among patients on prolonged preoperative steroid therapy.  

PubMed

Corticosteroids are essential to maintain the organic homeostasis. Steroid, glucocorticoid or its synthetic analog is widely used for inflammatory and autoimmune diseases. Prolonged steroid therapy is reported to cause the susceptibility to infection, impaired wound healing and psychoneurosis, however whether the quantity of taking the preoperative steroid is associated the postoperative complication is still unknown. The aim of this study was to elucidate whether the steroid dose in patients on prolonged preoperative steroid therapy is associated postoperative morbidity and mortality. Twenty-five patients taking steroid for various illnesses and underwent the surgery under general anesthesia were selected in this study. The mean +/- standard deviation and the median of the steroid dose converted into hydrocortisone (mg/day) were 39.2 +/- 31.0 and 20, respectively. Of 25 cases, postoperative complications were seen in 10 cases. The postoperative complication was severe based on the grade of Clavien and Dindo by ANOVA as the doses of taking steroid increased (p = 0.0171). The grave postoperative complication classified as Clavien and Dindo grade III occurred with 100% sensitivity and 87% specificity for the steroid dose converted into hydrocortisone > 80 mg/day. Preoperative taking the large amount of steroid (> 80 mg/day) could cause a grave complication. More careful selection of the operative procedure might improve the mobidity rate. PMID:24693677

Iguchi, Tomohiro; Shirabe, Ken; Inoue, Kentaro; Ito, Shuhei; Ohga, Takefumi; Nozoe, Tadahiro; Ezaki, Takahiro; Yoshizumi, Tomoharu; Uchiyama, Hideaki; Soejima, Yuji; Ikegami, Toru; Yamashita, Yo-Ichi; Kawanaka, Hirofumi; Ikeda, Tetsuo; Saeki, Hiroshi; Morita, Masaru; Maehara, Yoshihiko

2013-12-01

245

Videolaryngostroboscopy versus microlaryngoscopy for the diagnosis of benign vocal cord lesions: a prospective clinical study.  

PubMed

The aim of this study is to prospectively compare rigid videolaryngostroboscopy with microlaryngoscopy for the diagnosis of benign vocal cord lesions. Eighty-five adult patients with benign vocal cord lesions were evaluated with videolaryngostroboscopy and later underwent microlaryngoscopy. During microlaryngoscopy, systematic examination of the glottis was conducted, including careful inspection and meticulous palpation of the vocal cords from anterior commissure to arytenoids. Preoperative and intraoperative diagnoses were analyzed. One hundred and forty-one lesions were diagnosed preoperatively with rigid videolaryngostroboscopy in 85 patients. Microlaryngoscopy revealed a total of 199 lesions in these patients, demonstrating a 41.1 % higher diagnostic yield. Forty-five (77.6 %) of the 58 additional lesions involved structural abnormalities, including sulcus vocalis, microwebs, vascular ectasia, mucosal bridges, and anterior web. The preoperative diagnosis was consistent with the postoperative diagnosis in only 29 patients (34.2 %). For the rest of the patients (n = 56, 65.8 %), the preoperative diagnosis was either changed, or new lesions were identified during microlaryngoscopy. Intraoperative diagnosis of benign vocal cord lesions differs significantly from preoperative diagnosis, regarding both the type and number of lesions present. A large proportion of patients diagnosed with videolaryngostroboscopy have additional lesions, particularly structural abnormalities. Precise inspection and palpation of vocal cords are thus essential during microlaryngoscopy. PMID:25033931

Akbulut, Sevtap; Altintas, Hande; Oguz, Haldun

2015-01-01

246

Three-dimensional reconstruction of the pancreas and its surrounding structures  

Microsoft Academic Search

In order to establish a visible three-dimensional model of the pancreas and its surrounding structures, successive cross-sectional images were retrieved from the first data set of a visible Chinese woman, and a visible model of the pancreas and its surrounding structures was established. Finally three-dimensional reconstruction of the pancreas and its surrounding structures was carried out. The reconstructed, three-dimensional model

Yun Jin; Gang Chen; Shao-Xiang Zhang; Li-Wen Tang; Guang-jiu Liu; Kai Li; Jia-hong Dong

2008-01-01

247

Tight junctional permeability of the resting and carbachol stimulated exocrine rabbit pancreas  

Microsoft Academic Search

Summary  The permeability of the pancreatic epithelium to horseradish peroxidase is investigated in the resting and carbachol stimulated\\u000a rabbit pancreas. Horse radish peroxidase administered to the bathing medium of the isolated rabbit pancreas appears in the\\u000a secreted fluid of the pancreas in a relatively low concentration. Carbachol stimulates both protein secretion and the passage\\u000a of horse radish peroxidase into the secretory

G. A. J. Kuijpers; I. G. P. Van Nooy; M. E. M. Vossen; A. M. Stadhouders; A. Van Uyen; J. J. H. H. M. De Pont; S. L. Bonting

1985-01-01

248

Comparison of Endoscopic Retrograde and Magnetic Resonance Cholangiopancreatography in the Surgical Diagnosis of Pancreatic Diseases  

Microsoft Academic Search

Background: Magnetic resonance cholangiopancreatography (MRCP) is a newly developing noninvasive examination of the biliopancreatic trees. Roles of MRCP in the diagnosis of pancreatic diseases have not been scrutinized.Methods: Endoscopic retrograde cholangiopancreatography (ERCP) and MRCP were reviewed in 52 Japanese patients with various pancreatic diseases and 6 patients with normal pancreas to compare their diagnostic usefulness and limitation.Results: In those with

Koji Yamaguchi; Kazuo Chijiiwa; Shuji Shimizu; Kazunori Yokohata; Takashi Morisaki; Masao Tanaka

1998-01-01

249

Identification of transcripts with enriched expression in the developing and adult pancreas  

PubMed Central

Background Despite recent advances, the transcriptional hierarchy driving pancreas organogenesis remains largely unknown, in part due to the paucity of comprehensive analyses. To address this deficit we generated ten SAGE libraries from the developing murine pancreas spanning Theiler stages 17-26, making use of available Pdx1 enhanced green fluorescent protein (EGFP) and Neurog3 EGFP reporter strains, as well as tissue from adult islets and ducts. Results We used a specificity metric to identify 2,536 tags with pancreas-enriched expression compared to 195 other mouse SAGE libraries. We subsequently grouped co-expressed transcripts with differential expression during pancreas development using K-means clustering. We validated the clusters first using quantitative real time PCR and then by analyzing the Theiler stage 22 pancreas in situ hybridization staining patterns of over 600 of the identified genes using the GenePaint database. These were then categorized into one of the five expression domains within the developing pancreas. Based on these results we identified a cascade of transcriptional regulators expressed in the endocrine pancreas lineage and, from this, we developed a predictive regulatory network describing beta-cell development. Conclusion Taken together, this work provides evidence that the SAGE libraries generated here are a valuable resource for continuing to elucidate the molecular mechanisms regulating pancreas development. Furthermore, our studies provide a comprehensive analysis of pancreas development, and insights into the regulatory networks driving this process are revealed. PMID:18554416

Hoffman, Brad G; Zavaglia, Bogard; Witzsche, Joy; Ruiz de Algara, Teresa; Beach, Mike; Hoodless, Pamela A; Jones, Steven JM; Marra, Marco A; Helgason, Cheryl D

2008-01-01

250

Test performance characteristics of quantitative nucleic acid testing for polyomaviruses in kidney and kidney-pancreas transplant recipients.  

PubMed

Screening for polyoma BK virus (BK) using nucleic testing (NAT) is recommended for kidney and kidney-pancreas transplant recipients, but the performance characteristics of quantitative BK NAT at different thresholds of plasma BK viral loads are unclear. We aim to evaluate the diagnostic accuracy of quantitative BK NAT as an add-on test to qualitative polyoma NAT for the diagnosis of BK virus-associated nephropathy (BKVAN) in kidney and kidney transplant recipients. We calculated the test sensitivity, specificity, and predictive values at the different thresholds of plasma BK viral load for BKVAN. At the recommended threshold of >1 × 10(3) serum BK copies/mL serum for test positivity, the sensitivity for BKVAN was 92.9% (95% confidence intervals [CI]: 66.1-99.8) and specificity 79.1% (95%: CI 67.4-88.1), with corresponding positive and negative predictive values of 42.0% (95% CI: 24.8-57.7%) and 98.6% (95% CI: 98.3-99.9%), respectively. The overall area under curve for the quantitative BK NAT was 0.92 (95% CI: 0.85-0.97). Quantitative BK NAT displays properties of high sensitivity and specificity that are fit for purpose as an add-on test to qualitative polyomavirus NAT for kidney and kidney-pancreas transplant recipients at risk of BKVAN. PMID:23952788

Myint, T M M; Turner, R M; Craig, J C; Cross, N B; Kable, K; Nankivell, B J; Chapman, J R; Webster, A C; O'Connell, P; Dwyer, D E; Jeoffreys, N; Roger, S D; Wong, G

2013-01-01

251

Effects of a medical expert system on differential diagnosis of renal masses: A prospective study  

Microsoft Academic Search

A medical expert system, RMDS, was used to prospectively evaluate patients undergoing nephrectomy for suspected renal masses. The effects of a medical expert system on differential diagnosis of renal masses were investigated. After RMDS consultation, three chief residents and one junior attending physician changed their preoperative diagnosis and significantly increased their diagnostic accuracy. The results indicate that the medical expert

Phei Lang Chang; Yu-chuan Li; Shih Tsong Huang; Ta Min Wang; Ming Li Hsien

1996-01-01

252

Adoption of Preoperative Radiation Therapy for Rectal Cancer From 2000 to 2006: A Surveillance, Epidemiology, and End Results Patterns-of-Care Study  

SciTech Connect

Purpose: The German rectal study determined that preoperative radiation therapy (RT) as a component of combined-modality therapy decreased local tumor recurrence, increased sphincter preservation, and decreased treatment toxicity compared with postoperative RT for rectal cancer. We evaluated the use of preoperative RT after the presentation of the landmark German rectal study results and examined the impact of tumor and sociodemographic factors on receiving preoperative RT. Methods and Materials: In total, 20,982 patients who underwent surgical resection for T3-T4 and/or node-positive rectal adenocarcinoma diagnosed from 2000 through 2006 were identified from the Surveillance, Epidemiology, and End Results tumor registries. We analyzed trends in preoperative RT use before and after publication of the findings from the German rectal study. We also performed multivariate logistic regression to identify factors associated with receiving preoperative RT. Results: Among those treated with RT, the proportion of patients treated with preoperative RT increased from 33.3% in 2000 to 63.8% in 2006. After adjustment for age; gender; race/ethnicity; marital status; Surveillance, Epidemiology, and End Results registry; county-level education; T stage; N stage; tumor size; and tumor grade, there was a significant association between later year of diagnosis and an increase in preoperative RT use (adjusted odds ratio, 1.26/y increase; 95% confidence interval, 1.23-1.29). When we compared the years before and after publication of the German rectal study (2000-2003 vs. 2004-2006), patients were more likely to receive preoperative RT than postoperative RT in 2004-2006 (adjusted odds ratio, 2.35; 95% confidence interval, 2.13-2.59). On multivariate analysis, patients who were older, who were female, and who resided in counties with lower educational levels had significantly decreased odds of receiving preoperative RT. Conclusions: After the publication of the landmark German rectal study, there was widespread, rapid adoption of preoperative RT for locally advanced rectal cancer. However, preoperative RT may be underused in certain sociodemographic groups.

Mak, Raymond H. [Harvard Radiation Oncology Program, Boston, MA (United States); McCarthy, Ellen P. [Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (Israel); Das, Prajnan [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Hong, Theodore S. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Mamon, Harvey J. [Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA (United States); Hoffman, Karen E., E-mail: khoffman1@mdanderson.org [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)

2011-07-15

253

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. PMID:23484581

Gheza, Federico; Raimondi, Paolo; D'Ugo, Stefano; Calatayud, David; Giulianotti, Pier C.

2012-01-01

254

The Human Pancreas Proteome Defined by Transcriptomics and Antibody-Based Profiling  

PubMed Central

The pancreas is composed of both exocrine glands and intermingled endocrine cells to execute its diverse functions, including enzyme production for digestion of nutrients and hormone secretion for regulation of blood glucose levels. To define the molecular constituents with elevated expression in the human pancreas, we employed a genome-wide RNA sequencing analysis of the human transcriptome to identify genes with elevated expression in the human pancreas. This quantitative transcriptomics data was combined with immunohistochemistry-based protein profiling to allow mapping of the corresponding proteins to different compartments and specific cell types within the pancreas down to the single cell level. Analysis of whole pancreas identified 146 genes with elevated expression levels, of which 47 revealed a particular higher expression as compared to the other analyzed tissue types, thus termed pancreas enriched. Extended analysis of in vitro isolated endocrine islets identified an additional set of 42 genes with elevated expression in these specialized cells. Although only 0.7% of all genes showed an elevated expression level in the pancreas, this fraction of transcripts, in most cases encoding secreted proteins, constituted 68% of the total mRNA in pancreas. This demonstrates the extreme specialization of the pancreas for production of secreted proteins. Among the elevated expression profiles, several previously not described proteins were identified, both in endocrine cells (CFC1, FAM159B, RBPJL and RGS9) and exocrine glandular cells (AQP12A, DPEP1, GATM and ERP27). In summary, we provide a global analysis of the pancreas transcriptome and proteome with a comprehensive list of genes and proteins with elevated expression in pancreas. This list represents an important starting point for further studies of the molecular repertoire of pancreatic cells and their relation to disease states or treatment effects. PMID:25546435

Fagerberg, Linn; Hallström, Björn M.; Schwenk, Jochen M.; Uhlén, Mathias; Korsgren, Olle; Lindskog, Cecilia

2014-01-01

255

Reducing preoperative fasting time: A trend based on evidence.  

PubMed

Preoperative fasting is mandatory before anesthesia to reduce the risk of aspiration. However, the prescribed 6-8 h of fasting is usually prolonged to 12-16 h for various reasons. Prolonged fasting triggers a metabolic response that precipitates gluconeogenesis and increases the organic response to trauma. Various randomized trials and meta-analyses have consistently shown that is safe to reduce the preoperative fasting time with a carbohydrate-rich drink up to 2 h before surgery. Benefits related to this shorter preoperative fasting include the reduction of postoperative gastrointestinal discomfort and insulin resistance. New formulas containing amino acids such as glutamine and other peptides are being studied and are promising candidates to be used to reduce preoperative fasting time. PMID:21160851

de Aguilar-Nascimento, José Eduardo; Dock-Nascimento, Diana Borges

2010-03-27

256

Reducing preoperative fasting time: A trend based on evidence  

PubMed Central

Preoperative fasting is mandatory before anesthesia to reduce the risk of aspiration. However, the prescribed 6-8 h of fasting is usually prolonged to 12-16 h for various reasons. Prolonged fasting triggers a metabolic response that precipitates gluconeogenesis and increases the organic response to trauma. Various randomized trials and meta-analyses have consistently shown that is safe to reduce the preoperative fasting time with a carbohydrate-rich drink up to 2 h before surgery. Benefits related to this shorter preoperative fasting include the reduction of postoperative gastrointestinal discomfort and insulin resistance. New formulas containing amino acids such as glutamine and other peptides are being studied and are promising candidates to be used to reduce preoperative fasting time. PMID:21160851

de Aguilar-Nascimento, José Eduardo; Dock-Nascimento, Diana Borges

2010-01-01

257

Appraisal of guidelines for pre-operative body wash.  

PubMed

The pre-operative body wash is a strategy for reducing post-operative infection. However, there is a lack of knowledge about its importance. The purpose of the present study was to evaluate the quality of guidelines for the pre-operative body wash using the AGREE instrument--35 guidelines containing instructions for the pre-operative body wash or preparation were included. The AGREE instrument was employed to establish a quality assessment framework that facilitated a comparison of the guidelines. The results were based on the six domains of the AGREE instrument, all of which were found to have low adherence. Descriptive statistics were used to present the assessment score. The AGREE instrument is useful for evaluating the quality of clinical guidelines. The development of evidence-based guidelines must include clinical activities. Further research is required to clarify the pre-operative body wash process and how it should be performed to reduce post-operative infection. PMID:25426523

Edström, Elisabet; Westerberg, Lisa; Henricson, Maria

258

Cystic Lymphangioma of the Pancreas with Spontaneous Rupture: Report of a Case  

PubMed Central

Lymphangioma is a benign and congenital malformation of the lymphatic system. Most lymphangiomas are preferentially located in the head and neck region. The abdominal organs are uncommon sites of origin. Several cases of lymphangioma in abdominal organs were reported, however, the pancreas is one of the rarest origins. Generally, intra-abdominal lymphangioma is asymptomatic and found incidentally, but in some cases, the patient complains of abdominal distension or a palpable mass. We describe the case of a 38-year-old male who presented with sudden-onset upper abdominal pain. Rupture of a cystic tumor of the pancreatic head was suspected, based on the findings of computed tomography, magnetic resonance imaging and endoscopic ultrasonography. Subtotal stomach-preserving pancreaticoduodenectomy was undertaken. The tumor, which was 4 × 4.5 × 8 cm in size, was pathologically diagnosed as a cystic lymphangioma. In conclusion, pancreatic lymphangioma is mostly asymptomatic, a ruptured case causing ‘acute abdomen’ has never been reported. Since lymphangioma is benign, it could be observed with accurate diagnosis. The surgical indication would be limited to cases of symptomatic lymphangiomas. PMID:21712979

Kawaguchi, Kei; Motoi, Fuyuhiko; Ohtsuka, Hideo; Fukuyama, Shoji; Rikiyama, Toshiki; Katayose, Yu; Egawa, Shinichi; Satoh, Masahiro; Asakura, Toru; Shimosegawa, Toru; Unno, Michiaki

2011-01-01

259

Successful removal of intrathyroidal parathyroid adenoma diagnosed and accurately located preoperatively by parathyroid scintigraphy (SPECT-CT)  

PubMed Central

We describe the case of a large intrathyroidal parathyroid adenoma in a 46-year-old woman who had a history of recently diagnosed hypercalcaemia and a 2-year history of an asymptomatic enlargement of the right lobe of the thyroid. This rare case highlights the potential difficulties that can arise in the evaluation of hyperparathyroidism, especially in cases of multinodular goiter. In some cases, including this one, even a thorough preoperative evaluation that includes radiological studies (ultrasonography and computed tomography [CT]) may not allow for a definitive preoperative diagnosis due to limited sensitivity, especially in multinodular goiter. The overlapping histological features between thyroid and parathyroid lesions can also be problematic at the time of the intraoperative frozen-section evaluation. We present a case in which, with parathyroid scintigraphy and combination of structural and functional imaging (SPECT-CT), we could accurately locate the intrathyroidal parathyroid adenoma in a patient with multinodular goiter. PMID:21188066

Kaushal, Dinesh Kumar; Mishra, Atul; Mittal, Naveen; Bordoloi, Jayanta K

2010-01-01

260

Preoperative infusional chemoradiation therapy for Stage T3 rectal cancer  

Microsoft Academic Search

To evaluate preoperative infusional chemoradiation for patients with operable rectal cancer. Preoperative chemoradiation therapy using infusional 5-fluorouracil (5-FU), (300 mg\\/m²\\/day) together with daily irradiation (45 Gy\\/25 fractions\\/5 weeks) was administered to 77 patients with clinically Stage T3 rectal cancer. Endoscopic ultrasound confirmed the digital rectal exam in 63 patients. Surgery was performed approximately 6 weeks after the completion of chemoradiation

Tyvin A. Rich; John M. Skibber; Jaffer A. Ajani; Daniel J. Buchholz; Karen R. Cleary; Ronelle A. Dubrow; Bernard Levin; Patrick M. Lynch; Sarkis H. Meterissian; Leor D. Roubein; David M. Ota

1995-01-01

261

Structured preoperative patient education for patient-controlled analgesia  

Microsoft Academic Search

Study Objective: To investigate the effectiveness of a structured preoperative education program in patients receiving patient-controlled analgesia (PCA).Design: Randomized controlled trial.Setting: University-affiliated hospital.Patients: 60 ASA physical status I and II women undergoing major gynecologic surgery.Interventions: Patients were randomly allocated to receive either standard information given during routine preanesthetic assessment (n = 30) or additional structured preoperative education on the use

Kwok Key Lam; Matthew T. V Chan; Phoon Ping Chen; Warwick D. Ngan Kee

2001-01-01

262

Pancreas Transplantation: Lessons Learned From a Decade of Experience at Wake Forest Baptist Medical Center  

PubMed Central

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.

2011-01-01

263

Tuberculosis of pancreas and peripancreatic lymph nodes in immunocompetent patients: experience from China  

Microsoft Academic Search

AIM: To determine the clinical, radiographic and laboratory characteristics, diagnostic methods, and therapeutic variables in immunocompetent patients with tuberculosis (TB) of the pancreas and peripancreatic lymph nodes. METHODS: The records of 16 patients (6 male, 10 female; mean age 37 years, range 18-56years) with tuberculosis of the pancreas and peripancreatic lymph nodes from 1983 to 2001 in the Southwest Hospital

Feng Xia; Ronnie Tung-Ping Poon; Shu-Guang Wang; Ping Bie; Xue-Quan Huang; Jia-Hong Dong; Xia F; Poon RTP; Wang SG

264

Enzyme potentialities of the abomasum and pancreas of the calf. I. —  

E-print Network

Enzyme potentialities of the abomasum and pancreas of the calf. I. — Effect of age. The effect of age on the enzyme potentialities of abomasum (chymosin and pepsin) and pancreas (chymotrypsin. The abomasal and pancreatic glands of the foetus contained large amounts of enzymes, except pepsin and amylase

Boyer, Edmond

265

Distribution, ontogeny and ultrastructure of somatostatin immunoreactive cells in the pancreas and gut  

Microsoft Academic Search

Somatostatin cells are numerous in the pancreas and digestive tract of mammals as well as birds. In the pancreas of chicken, cat and dog they occur in both the exocrine parenchyma and in the islets. In the rat and rabbit, somatostatin cells have a peripheral location in the islets, whereas in the cat, dog and man the cells are usually

J. Alumets; F. Sundler; R. Hgtkanson

1977-01-01

266

Phase II trial of gemcitabine (2,2?-difiuorodeoxycytidine) in patients with adenocarcinoma of the pancreas  

Microsoft Academic Search

Gemcitabine is a novel nucleoside analog which demonstrated a broad spectrum of preclinical acitivity in solid tumor models, and responses in patients with pancreas cancer during phase I evaluation. Patients with measurable adenocarcinoma of the pancreas who had received no previous chemotherapy were eligible for this multicenter phase II clinical trial. Gemcitabine 800 mg\\/m2 was administered intravenously weekly for 3

Ephraim S. Casper; Mark R. Green; David P. Kelsen; Robert T. Heelan; Thomas D. Brown; Carlos D. Flombaum; Bonnie Trochanowski; Peter G. Tarassoff

1994-01-01

267

Using pancreas tissue slices for in situ studies of islet of Langerhans and acinar cell biology.  

PubMed

Studies on the cellular function of the pancreas are typically performed in vitro on its isolated functional units, the endocrine islets of Langerhans and the exocrine acini. However, these approaches are hampered by preparation-induced changes of cell physiology and the lack of an intact surrounding. We present here a detailed protocol for the preparation of pancreas tissue slices. This procedure is less damaging to the tissue and faster than alternative approaches, and it enables the in situ study of pancreatic endocrine and exocrine cell physiology in a conserved environment. Pancreas tissue slices facilitate the investigation of cellular mechanisms underlying the function, pathology and interaction of the endocrine and exocrine components of the pancreas. We provide examples for several experimental applications of pancreas tissue slices to study various aspects of pancreas cell biology. Furthermore, we describe the preparation of human and porcine pancreas tissue slices for the validation and translation of research findings obtained in the mouse model. Preparation of pancreas tissue slices according to the protocol described here takes less than 45 min from tissue preparation to receipt of the first slices. PMID:25393778

Marciniak, Anja; Cohrs, Christian M; Tsata, Vasiliki; Chouinard, Julie A; Selck, Claudia; Stertmann, Julia; Reichelt, Saskia; Rose, Tobias; Ehehalt, Florian; Weitz, Jürgen; Solimena, Michele; Slak Rupnik, Marjan; Speier, Stephan

2014-12-01

268

Preoperative, intraoperative, and postoperative measures to further reduce spinal infections  

PubMed Central

Background: The rate of postoperative spinal infections varies from 0.4% to 3.5%. Although the introduction of additional preoperative, intraoperative, and postoperative methods of prophylaxis should further reduce spinal infection rates, these measures will not succeed unless surgeons are well informed of their availability, utility, and efficacy. This study provides a review of several preoperative, intraoperative, and postoperative methods of prophylaxis that could minimize the risk of postoperative spinal infections. Various preoperative, intraoperative, and postoperative measures could further reduce the risk of spinal infections. Preoperative prophylaxis against methicillin-resistant Staphylococcus aureus could utilize (1) nasal cultures and Bactroban ointment (mupirocin), and (2) multiple prophylactic preoperative applications of chlorhexidine gluconate (CHG) 4% to the skin. Intraoperative prophylactic measures should not only include the routine use of an antibiotic administered within 60 min of the incision, but should also include copious intraoperative irrigation [normal saline (NS) and/or NS with an antibiotic]. Intraoperatively, instrumentation coated with antibiotics, and/or the topical application of antibiotics may further reduce the infection risk. Whether postoperative infections are reduced with the continued use of antibiotic prophylaxis remains controversial. Other postoperative measures may include utilization of a silver (AgNO3)-impregnated dressing (Silverlon dressing) and the continued use of bed baths with CHG 4%. The introduction of multiple preoperative, intraoperative, and postoperative modalities in addition to standardized prophylaxis may further contribute to reducing postoperative spinal infections. PMID:21427784

Epstein, Nancy E.

2011-01-01

269

given and not given preoperative total parenteral nutrition  

E-print Network

Objective. The effect of preoperative total parenteral nutrition (TPN) on the rate of early (within 30 days) postoperative complications in patients with moderate to severe Crohn’s disease (CD) was examined. Material and methods. Aseries of 15 consecutive patients with CD (mean CD activity index score, 270) given preoperative TPN for 18–90 days (mean, 46 days) and undergoing bowel resection and primary anastomosis was compared with matching controls (105 patients) consecutively selected from all CD patients operated in Stockholm County during a preceding 20-year period without preoperative TPN. Results. DuringthepreoperativeTPN,allthepatientsstudied displayed clinical remission of CD as reflected in improvement in their general well-being, relief of abdominal pain, and abatement of fever and diarrhea. There was no significant early postoperative complication in the TPN-treated group, whereas there were 29 patients with early postoperative complications in the control group, which means a significantly higher rate of postoperative complications when preoperative TPN was not provided. During the preoperative TPN, some crucial variables increased such as the body weight, the serum concentrations of albumin and triiodothyronine reflecting improved nutritional state, whereas the serum concentration of haptoglobin and the white cell count decreased reflecting decreased inflammatory activity. Conclusions. This study shows that preoperative TPN for at least 18 days may be recommended to be given to patients with moderate to severe CD until clinical remission is achieved in order to minimize the risk of early postoperative complications. Key Words: Crohn’s disease, parenteral nutrition, postoperative complications

Stefan Jacobson

270

Preoperative and intraoperative localisation of gastrointestinal bleeding of obscure origin.  

PubMed Central

In the past six years, 37 patients with gastrointestinal bleeding of obscure origin had their bleeding sites localised preoperatively or intraoperatively. Preoperative investigations followed a regime consisting of endoscopy, barium meal and follow through, small bowel enema, 99mTc pertechnetate scan, 99mTc-labelled red blood cell scan and selective coeliac and mesenteric angiography. Bleeding lesions were localised preoperatively in 36 patients. In one patient, diagnostic laparotomy had to be carried out immediately before any investigation because the bleeding was severe. At operation, angiosarcoma of ileum was found. Unless preoperative investigations showed the lesions to be in anatomically fixed organs like the duodenum or colon, the lesions had still to be found at operation. Palpation and transillumination detected the lesion intraoperatively in 21 patients while only some lesions were found in three patients with multiple lesions. Sigmoidoscopy through enterotomies was required in one patient. Intraoperative enteroscopy was done for small lesions not found grossly at operation in nine patients, to detect additional lesions in three patients or to rule out suspicious lesion shown on preoperative tests in one patient. In another patient with diffuse lymphoma of small bowel with bleeding from only a small segment of jejunum, injection of methylene blue intraoperatively through a previously placed angiographic catheter stained the bleeding segment of jejunum blue. This segment was identified easily and resected. These preoperative and intraoperative localisation procedures were simple and effective and we recommend them to be used more freely. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 PMID:3498667

Lau, W Y; Fan, S T; Wong, S H; Wong, K P; Poon, G P; Chu, K W; Yip, W C; Wong, K K

1987-01-01

271

Preoperative factors influencing success in pterygium surgery  

PubMed Central

Background To identify preoperative, perioperative and postoperative risk factors that influence the success of pterygium surgery. Methods This is a prospective study of thirty-six patients with primary or recurrent pterygia. A detailed anamnesis and an ophthalmological examination were performed looking for the following factors: age, race, latitude and altitude of the main place of residence, hours of exposure to the sun, use of protective measures against UV-radiation, classification of pterygium, width of the pterygium at limbus, surgical technique (conjunctival autograft plus suturing versus tissue glue), graft alterations (misapposition, granuloma, haemorrhage, oedema, retraction or necrosis), and postoperative symptoms (foreign-body sensation, pain). The examinations were performed 2 and 7 days and 2, 6 and 12 months after surgery. In addition, recurrence was defined as any growth of conjunctiva into the cornea. Results A logistic regression and a survival analysis have been used to perform data analysis. A total number of 36 patients completed a one year follow-up. A total of 13 patients were born and lived in Spain, and 26 came from other countries, mostly Latin America. A total number of 8 males (no women) presented a recurrence, mainly between 2 and 6 months. The hours of sun exposure through their life was independently related to surgical success. Pterygia of less than 5 mm of base width showed a weak positive correlation with recurrence. None of the other factors considered were significantly related to recurrence. Conclusions Male gender and high sun exposure are strongly and independently related to surgical success after the removal of pterygia. PMID:22873737

2012-01-01

272

Metabolic regulation of cellular plasticity in the pancreas  

PubMed Central

SUMMARY Obese individuals exhibit an increase in pancreatic ?-cell mass; conversely, scarce nutrition during pregnancy has been linked to ?-cell insufficiency in the offspring (reviewed in [1, 2]). These phenomena are thought to be mediated mainly through effects on ?-cell proliferation, since a nutrient sensitive ?-cell progenitor population in the pancreas has not been identified. Here, we employed the FUCCI (Fluorescent Ubiquitination-based Cell Cycle Indicator) system to investigate ?-cell replication in real-time, and found that high nutrient concentrations induce rapid ?-cell proliferation. Importantly, we found that high nutrient concentrations also stimulate ?-cell differentiation from progenitors in the intrapancreatic duct (IPD). Using a new zebrafish line where ?-cells are constitutively ablated, we further show that ?-cell loss and high nutrient intake synergistically activate these progenitors. At the cellular level, this activation process causes ductal cell reorganization as it stimulates their proliferation and differentiation. Notably, we link the nutrient-dependent activation of these progenitors to a down-regulation of Notch signaling specifically within the IPD. Furthermore, we show that the nutrient sensor mechanistic Target Of Rapamycin (mTOR) is required for endocrine differentiation from the IPD under physiological conditions as well as in the diabetic state. This study thus reveals critical insights into how cells modulate their plasticity in response to metabolic cues and identifies nutrient sensitive progenitors in the mature pancreas. PMID:23791726

Ninov, Nikolay; Hesselson, Daniel; Gut, Philipp; Zhou, Amy; Fidelin, Kevin; Stainier, Didier Y.R.

2013-01-01

273

Isolation of genes involved in pancreas regeneration by subtractive hybridization.  

PubMed

The deterioration of ? cells in the pancreas is a crucial factor in the progression of diabetes mellitus; therefore, the recovery of ? cells is of vital importance for effective diabetic therapeutic strategies. Partially pancreatectomized rats have been used for the investigation of pancreatic regeneration. Because it was determined that tissue extract from the partially-dissected pancreas induces pancreatic differentiation in embryonic stem cells, paracrine factors were thought to be involved in the regeneration. In this study, we screened for genes that had higher mRNA levels 2 days after 60%-pancreatectomy. The genes were isolated using subtractive hybridization and DNA sequencing. Twelve genes (adipsin, Aplp2, Clu, Col1a2, Glul, Krt8, Lgmn, LOC299907, LOC502894, Pla2g1b, Reg3? and Xbp1) were identified, and RT-PCR and real-time PCR analyses were performed to validate their expression levels. Among the genes identified, three genes (Glul, Lgmn and Reg3a) were selected for further analyses. Assays revealed that Glul and Reg3? enhance cell growth. Glul, Lgmn and Reg3? change the expression level of islet marker genes, where NEUROD, NKX2.2, PAX4 and PAX6 are up-regulated and somatostatin is down-regulated. Thus, we believe that Glul, Lgmn and Reg3a can serve as novel targets in diabetes mellitus genetic therapy. PMID:20536387

Choi, Jong-Ho; Lee, Min-Young; Kim, Yoolee; Shim, Jeong-Yun; Han, Sang-Moon; Lee, Kyung-Ah; Choi, Young-Kil; Jeon, Hae-Myung; Baek, Kwang-Hyun

2010-09-01

274

Laparoscopic distal pancreatectomy for adenocarcinoma of the pancreas  

PubMed Central

Since the first report on laparoscopic distal pancreatectomy (LDP) appeared in the 1990s, the procedure has been performed increasingly frequently to treat both benign and malignant lesions of the pancreas. Many earlier publications have shown LDP to be a good alternative to open distal pancreatectomy for benign lesions, although this has never been studied in a prospective, randomized manner. The evidence for the use of LDP to treat adenocarcinoma of the pancreas is not as well established. The purpose of this review is to evaluate the current evidence for LDP in cases of pancreatic adenocarcinoma. We conducted a review of English language publications reporting LDP results between 1990 and 2013. All studies reporting results in patients with histologically proven pancreatic adenocarcinoma were included. Thirty-nine publications were found and included in the results for a total of 309 cases of pancreatic adenocarcinoma (potential double publications were not eliminated). Most LDP procedures are performed in selected cases and generally involve smaller tumors than open distal pancreatectomy (ODP) procedures. Some of the papers report unselected cases and include procedures on larger tumors. The number of lymph nodes harvested using LDP is comparable to the number obtained with ODP, as is the frequency of R0 resections. Current data suggest that similar short term oncological results can be obtained using LDP as those obtained using ODP. PMID:25309072

Björnsson, Bergthor; Sandström, Per

2014-01-01

275

Metastatic tumors to the pancreas: The role of surgery  

PubMed Central

Pancreatic metastases from other primary malignancies are a rare entity. By far, the most common primary cancer site resulting in an isolated pancreatic metastasis is the kidney, followed by colorectal cancer, melanoma, breast cancer, lung carcinoma and sarcoma. Only few data on the surgical outcome of pancreatic resections performed for metastases from other primary tumor have been published, and there are no guidelines to address the surgical treatment for these patients. In this study, we performed a review of the published literature, focusing on the early and long-term results of surgery for the most frequent primary tumors metastasizing to the pancreas. Results for the Literature’s analysis show that in last years an increasing number of surgical resections have been performed in selected patients with limited pancreatic disease. Pancreatic resection for metastatic disease can be performed with acceptable mortality and morbidity rates. The usefulness of pancreatic resection is mainly linked to the biology of the primary tumor metastasizing to the pancreas. The benefit of metastasectomy in terms of patient survival has been observed for metastases from renal cell cancer, while for other primary tumors, such as lung and breast cancers, the role of surgery is mainly palliative. PMID:25320654

Sperti, Cosimo; Moletta, Lucia; Patanè, Giuseppe

2014-01-01

276

Primers on molecular pathways: bicarbonate transport by the pancreas.  

PubMed

The pancreas has both endocrine and exocrine functions. As an endocrine organ, stimulation of the pancreatic ?-cells results in insulin secretion to control systemic glucose levels. The exocrine function of the pancreas and the need for alkaline pancreatic secretion (pH 8.0-8.5) have been appreciated for more than 40 years. Yet, our knowledge of the cellular mechanisms (signaling, transporters and channels) which accomplish these critical functions has evolved greatly. In the mid-1990s, basolateral Na-bicarbonate (HCO(3)(-)) uptake by NBCe1 (Slc4a4) was shown to be critical for the generation of approximately 75% of stimulated HCO(3)(-) secretion. In the last 10 years, several new HCO(3)(-) transporters in the Slc26 family and their interaction with the cystic fibrosis transmembrane conductance regulator-chloride channel have elucidated the HCO(3)(-) exit step at the ductal lumen. Most recently, both IRBIT (inositol 1,4,5-trisphosphate receptor-binding protein) and WNK [with no lysine (K)] kinase have been implicated as additional HCO(3)(-) secretory controllers. and IAP. PMID:21242704

Sin?i?, Aleksandra; Sussman, Caroline R; Romero, Michael F

2010-01-01

277

Acid-base transport in pancreas—new challenges  

PubMed Central

Along the gastrointestinal tract a number of epithelia contribute with acid or basic secretions in order to aid digestive processes. The stomach and pancreas are the most extreme examples of acid (H+) and base (HCO?3) transporters, respectively. Nevertheless, they share the same challenges of transporting acid and bases across epithelia and effectively regulating their intracellular pH. In this review, we will make use of comparative physiology to enlighten the cellular mechanisms of pancreatic HCO?3 and fluid secretion, which is still challenging physiologists. Some of the novel transporters to consider in pancreas are the proton pumps (H+-K+-ATPases), as well as the calcium-activated K+ and Cl? channels, such as KCa3.1 and TMEM16A/ANO1. Local regulators, such as purinergic signaling, fine-tune, and coordinate pancreatic secretion. Lastly, we speculate whether dys-regulation of acid-base transport contributes to pancreatic diseases including cystic fibrosis, pancreatitis, and cancer. PMID:24391597

Novak, Ivana; Haanes, Kristian A.; Wang, Jing

2013-01-01

278

Magnetic resonance image-guided photodynamic therapy of xenograft pancreas tumors with verteporfin  

NASA Astrophysics Data System (ADS)

Pancreatic cancer generally has very poor prognosis, with less than 4% survival at 5 years after diagnosis. This dismal survival rate is in part due to the aggressive nature of the adenocarcinoma, leading to a late-stage at diagnosis and exhibits resistance to most therapies. Photodynamic therapy (PDT) is a model cellular and vascular therapy agent, which uses light activation of the delivered drug to photosensitize the local cellular millieu. We suggest that interstitial verteporfin (benzoporphyrin derivative monoacid ring A) PDT has the potential to be an adjuvant therapy to the commonly used Gemcitabine chemotherapy. In the current study, an orthotopic pancreatic cancer model (Panc-1) has undergone interstitial verteporfin PDT (40 J/cm with verteporfin and 40 J/cm without verteporfin). Prior to PDT, magnetic resonance (MR) imaging was used to determine the location and size of the tumor within the pancreas, allowing accurate placement of the diffusing fiber. The success of therapy was monitored in vivo by assessing the total tumor and vascular perfusion volumes 24 hours pre- and 48 hours post-PDT. Total tumor and vascular perfusion volumes were determined using T2 weighted (T2W) and Gd-DTPA difference T1 weighted (T1W) turbo spin echo (TSE) MR imaging sequences, respectively. The validity of the in vivo imaging for therapeutic response was confirmed by ex vivo fluorescence and histological staining of frozen tissue sections. The ex vivo DiOC7(3) fluorescence analysis correlates well with the information provided from the MR images, indicating that MR imaging will be a successful surrogate marker for interstitial PDT.

Samkoe, Kimberley S.; Chen, Alina; Rizvi, Imran; O'Hara, Julia A.; Hoopes, P. Jack; Hasan, Tayyaba; Pogue, Brian W.

2009-02-01

279

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: dbsgzy@nus.edu.sg

2006-05-15

280

Nasolabial cysts: clinical features, diagnosis, and treatment.  

PubMed

The aim of this study was to review our experience, examine the clinical and pathological features of nasolabial cysts, and to provide a basis for the diagnosis and treatment in an Asian population. We made a retrospective review of patients with nasolabial cysts who were treated at the Department of Otolaryngology, Tan Tock Seng Hospital between January 1999 and December 2004. Clinical data, presenting symptoms, clinical features, pathological findings, preoperative investigations, treatment, and outcome were analysed for each case. We found 17 patients with nasolabial cysts. The findings of adult onset, higher incidence among women and preponderance on the left side confirmed current opinion. The clinical diagnosis of nasolabial cyst was accurate in all cases. Preoperative computed tomograms (CTs) done for one patient did not alter the management. All patients had the cysts excised completely through a sublabial incision. Breaches of the nasal vestibular mucosa healed spontaneously without repair. Histopathological examination showed that cysts were lined with pseudostratified columnar (n=9), stratified squamous (n=4), mixed respiratory and squamous epithelium (n=3), and simple cuboidal epithelium (n=1). No patient developed complications or recurrences. Nasolabial cysts are relatively common in Singapore, and the diagnosis must be kept in mind if they are to be treated early. Diagnosis is based on clinical features and the treatment of choice is complete excision. PMID:17030357

Yuen, Heng-Wai; Julian, Cheow-Yew Lee; Samuel, Chow-Lin Yeak

2007-06-01

281

CONFIDENTIAL Thank you for your interest in the Pancreas Transplant Program at Massachusetts General Hospital. Below is a list  

E-print Network

CONFIDENTIAL Thank you for your interest in the Pancreas Transplant Program at Massachusetts/pancreas or pancreas after kidney transplant list, but only the tests indicated with an * are required to initiate business days by a transplant nurse coordinator and a transplant nephrologist to determine if the patient

Mootha, Vamsi K.

282

Inactivation of TIF1c Cooperates with KrasG12D Cystic Tumors of the Pancreas  

E-print Network

Inactivation of TIF1c Cooperates with KrasG12D to Induce Cystic Tumors of the Pancreas David F/lox ), we selectively abrogated Tif1c expression in the pancreas of Pdx1-Cre;Tif1clox/lox mice. We also suppression in the pancreas, brings new insight into the genetics of pancreatic cancer, and constitutes

Paris-Sud XI, Université de

283

La "conversione" delle cellule della cute che producono insulina: nuova arma contro diabete e tumore del pancreas  

E-print Network

tumore del pancreas Uno studio dell'Università degli Studi di Milano su PNAS scopre un metodo, sicuro alterarne il DNA. Straordinarie le potenzialità nella terapia del diabete e del tumore al pancreas. La i vari tipi di diabete e per il tumore del pancreas. La ricerca, finanziata da AIRC, MIUR e Regione

De Cindio, Fiorella

284

Surgical sentinel lymph node biopsy in early breast cancer. Could it be avoided by performing a preoperative staging procedure? A pilot study  

PubMed Central

Summary Background The aim of this pilot trial was to study the feasibility of sentinel node percutaneous preoperative gamma probe-guided biopsy as a valid preoperative method of assessment of nodal status compared to surgical sentinel lymph node biopsy. Material/Methods This prospective study enrolled 10 consecutive patients without evidence of axillary lymph node metastases at preoperative imaging. All patients underwent sentinel node occult lesion localization (SNOLL) using radiotracer intradermic injection that detected a “hot spot” corresponding to the sentinel node in all cases. Gamma probe over the skin detection with subsequent ultrasonographically guided needle biopsy of the sentinel node were performed. The percutaneous needle core histopathological diagnosis was compared to the results of the surgical biopsy. Results Preoperative sentinel node identification was successful in all patients. Conclusions The combination of preoperative gamma probe sentinel node detection and ultrasound-guided biopsy could represent a valid alternative to intraoperative sentinel node biopsy in clinically and ultrasonographically negative axillary nodes, resulting in shorter duration of surgery and lower intraoperative risks. PMID:22936189

Testori, Alberto; Meroni, Stefano; Moscovici, Oana Codrina; Magnoni, Paola; Malerba, Paolo; Chiti, Arturo; Rahal, Daoud; Travaglini, Roberto; Cariboni, Umberto; Alloisio, Marco; Orefice, Sergio

2012-01-01

285

The preoperative evaluation prevent the postoperative complications of thyroidectomy  

PubMed Central

Objective Thyroid surgery is generally a safe surgery but its complications are still common. We wish to identify preoperative factors that predict postoperative complications. Methods A nationwide survey was conducted by senior surgeons from 16 medical centers and 5 regional hospitals in Taiwan to thyroid operations performed over 3 years. 3846 cases were retrospectively examined to identify factors influencing complications: indication for surgery, preoperative evaluation, such as ultrasonography, chest X-ray, computed tomography and magnetic resonance imaging, isotope scanning, fine-needle aspiration cytology (FNAC) and thyroid function test, and patient characteristics. Results Eighty-four percent of patients were female. Seven percent of the patients had immediate postoperative hypocalcemia (mild and severe) and 2.3%, hoarseness (recurrent laryngeal nerve (RLN) injury, temporary/permanent). Logistic regression analysis identified an association between hypocalcemia and RLN injury with age, hospital category, surgical procedure types (total thyroidectomy, unilateral, bilateral subtotal or total resection). A lower incidence of hypocalcemia was related to preoperative neck ultrasound and FNAC analysis (the odds ratio (OR) = 0.5 and 0.65, [95% confidence interval (CI) 0.331–0.768 and 0.459–0.911], P = 0.0014 and 0.0127, respectively), while RLN injury was not associated with any preoperative evaluation. The ORs of hypocalcemia and RLN injury for patients older than 50 years were 0.55 and 2.15, [0.393–0.763 and 1.356–3.4], P < 0.001 and 0.0012, respectively. Conclusions The success of thyroid surgery depends on careful preoperative planning, including a preoperative neck ultrasound to determine the proximity of the nodule to the recurrent laryngeal nerve course, and the consideration of the type of anesthesia, adjuvant devices for intra-op monitoring of the RLN, and surgical modalities. Our results suggest that preoperative evaluation implementations are positively associated with strategy of surgery and postoperative hypocalcemia prevention.

Huang, Chien-Feng; Jeng, Yachung; Chen, Kuo-Dong; Yu, Ji-Kuen; Shih, Chao-Ming; Huang, Shih-Ming; Lee, Chen-Hsen; Chou, Fong-Fu; Shih, Ming-Lang; Jeng, Kee-Ching; Chang, Tzu-Ming

2014-01-01

286

[Problems in diagnosis and therapy of renal adenomas (author's transl)].  

PubMed

Diagnostic and surgical problems of renal adenoma are discussed on the basis of seven own cases and the literature. The surgical procedure should be based on exact histomorphological classification of the tumors, which can be classified as: "Benign adenoma", "adenoma with questionable malignancy", and "Malignant degenerated adenoma". The often recommended radical surgery in all cases of renal adenomas should not be necessary. Histological diagnosis is most accurate with serial sections of embedded tumor material. False positive results from intraoperative histomorphologic diagnosis of frozen sections are not here. The difficult preoperative diagnosis of renal adenomas could be improved by computed tomography and ultrasonography. PMID:452185

Leistenschneider, W; Nagel, R; Pfannkuch, F

1979-05-01

287

Targeted agents in treatment of neuroendocrine tumors of pancreas.  

PubMed

Neuroendocrine tumors (NET) of the pancreas are uncommon neoplasms that arise from the pancreatic islet cells. Surgical resections are being tested, as well as multiple chemotherapy agents. Current treatment options for nonresectable disease include somatostatin analogs and chemotherapy. New therapies focus on specific molecular targets such as sunitinib, angiogenesis inhibitor, that target vascular endothelial growth factor receptor (VEGFR) and other growth factor receptors and everolimus, an inhibitor of the mammalian target of rapamycin. Functionally based medical therapies for NET include somatostatin analogs to control symptoms. The 2014 annual meeting of American Society of Clinical Oncology (ASCO) brought us new insights into the management of pancreatic neuroendocrine tumors. The focus of this review will serve to highlight specific Abstracts (#e15160 and #e15161), that shed light on new therapeutic options that help target the unique pathways of this malignancies. PMID:25076341

Karampelas, Ilias N; Syrigos, Kostas N; Saif, Muhammad Wasif

2014-07-01

288

Glucagon in the artificial pancreas: supply and marketing challenges.  

PubMed

The use of glucagon, in conjunction with insulin, in a dual chamber pump (artificial pancreas, AP) is a working goal for multiple companies and researchers. However, capital investment to create, operate, and maintain facilities with sufficient scale to produce enough glucagon to treat millions of patients, at a level of profit that makes it feasible, will be substantial. It can be assumed that the marketplace will expect the daily cost of glucagon (to the consumer) to be similar to the daily cost of insulin. After one subtracts wholesaler and pharmacy markup, there may be very few dollars remaining for the drug company to cover profit, capital expenditures, marketing, burden, and other costs. Without the potential for adequate margins, manufacturers may not be willing to take the risk. Assuming that the projections discussed in this article are in the right ballpark, advance planning for the supply for glucagon needs to start today and not wait for the AP to come to market. PMID:25139825

Rylander, Dick

2015-01-01

289

Clinical problems in radiotherapy of carcinoma of the pancreas  

SciTech Connect

Since 1975, 94 patients with localized unresectable carcinoma of the pancreas have been irradiated using helium and heavier particles at the University of California Lawrence Berkeley Laboratory. Despite surgical exploration and an extensive diagnostic workup including radiological, nuclear medicine, and computer-assisted tomographic studies, many patients proved to have occult liver metastases manifested within 9 months post treatment. In addition, local and regional control of the primary neoplasm (approx.20%) has been difficult to obtain even with doses of 6000 equivalent rad in 7 1/2 weeks. Gastric and biliary obstruction have required surgical bypass procedures since irradiation has not been successful in relieving obstructive symptoms. Evidence of gastrointestinal injury has been present in postradiation therapy in approximately 10% of patients, a figure which might be higher if more patients had a longer survival (average 10 months). Some patients require pancreatic enzyme supplementation because of pancreatic deficiency either secondary to tumor or treatment.

Castro, J.R.; Saunders, W.M.; Quivey, J.M.; Chen, G.T.; Collier, J.M.; Woodruff, K.H.; Lyman, J.T.; Twomey, P.; Frey, C.; Phillips, T.L.

1982-01-01

290

A Hybrid Method for Pancreas Extraction from CT Image Based on Level Set Methods  

PubMed Central

This paper proposes a novel semiautomatic method to extract the pancreas from abdominal CT images. Traditional level set and region growing methods that request locating initial contour near the final boundary of object have problem of leakage to nearby tissues of pancreas region. The proposed method consists of a customized fast-marching level set method which generates an optimal initial pancreas region to solve the problem that the level set method is sensitive to the initial contour location and a modified distance regularized level set method which extracts accurate pancreas. The novelty in our method is the proper selection and combination of level set methods, furthermore an energy-decrement algorithm and an energy-tune algorithm are proposed to reduce the negative impact of bonding force caused by connected tissue whose intensity is similar with pancreas. As a result, our method overcomes the shortages of oversegmentation at weak boundary and can accurately extract pancreas from CT images. The proposed method is compared to other five state-of-the-art medical image segmentation methods based on a CT image dataset which contains abdominal images from 10 patients. The evaluated results demonstrate that our method outperforms other methods by achieving higher accuracy and making less false segmentation in pancreas extraction. PMID:24066016

Tan, Hanqing; Fujita, Hiroshi

2013-01-01

291

Role of preoperative CT colonography in patients with colorectal cancer.  

PubMed

In patients with colorectal cancer (CRC), accurate preoperative evaluation is essential for a correct therapeutic plan. Colonoscopy and intravenous contrast-enhanced computed tomography (CT) are currently recommended in the preoperative work-up for CRC. Preoperative colonoscopy has some limitations such as misdiagnosis of synchronous cancers in cases of incomplete exploration of the colon and inaccurate tumor localization. Intravenous contrast-enhanced CT successfully documents distant metastases although it sometimes enables unsatisfactory locoregional staging. Computed tomography colonography (CTC) is obtained after gas insufflation of the colon and offers a comprehensive preoperative evaluation in patients with CRC, including a definition of the segmental location of the tumor, presence of synchronous lesions or lack thereof, and fairly accurate locoregional staging. CTC has some limitations, including a lack of biopsy capability, suboptimal sensitivity for synchronous small polyps, and unsatisfactory nodal staging. Bearing in mind these limitations, CTC could be employed as a "one-stop-shop" examination for preoperative assessment in patients with CRC. PMID:24744573

Sali, Lapo; Falchini, Massimo; Taddei, Antonio; Mascalchi, Mario

2014-04-14

292

Validation of a virtual preoperative evaluation clinic: a pilot study.  

PubMed

Patients scheduled for surgery at the Omaha VA Medical Center were evaluated preoperatively via telemedicine. Following the examination, patients filled out a 15 item, 5 point Likert scale questionnaire regarding their opinion of preoperative evaluation in a VTC format. Evaluations were performed under the direction of nationally recognized guidelines and recommendations of experts in the field of perioperative medicine and were overseen by a staff anesthesiologist from the Omaha VA Medical Center. No significant difficulties were encountered by the patient or the evaluator regarding the quality of the audio/visual capabilities of the VTC link and its ability to facilitate preoperative evaluation. 87.5% of patients felt that virtual evaluation would save them travel time; 87.5% felt virtual evaluation could save them money; 7.3% felt uncomfortable using the VTC link; 12.2% felt the virtual evaluation took longer than expected; 70.7% preferred to be evaluated via VTC link; 21.9% were undecided; 9.7% felt they would rather be evaluated face-to-face with 26.8% undecided; 85.0% felt that teleconsultation was as good as being seen at the Omaha surgical evaluation unit; 7.5% were undecided. Our study has shown that effective preoperative evaluation can be performed using a virtual preoperative evaluation clinic; patients are receptive to the VTC format and, in the majority of cases, prefer it to face-to-face evaluation. PMID:21335890

Zetterman, Corey V; Sweitzer, Bobbie J; Webb, Brad; Barak-Bernhagen, Mary A; Boedeker, Ben H

2011-01-01

293

Artificial Pancreas: Model Predictive Control Design from Clinical Experience  

PubMed Central

Background The objective of this research is to develop a new artificial pancreas that takes into account the experience accumulated during more than 5000 h of closed-loop control in several clinical research centers. The main objective is to reduce the mean glucose value without exacerbating hypo phenomena. Controller design and in silico testing were performed on a new virtual population of the University of Virginia/Padova simulator. Methods A new sensor model was developed based on the Comparison of Two Artificial Pancreas Systems for Closed-Loop Blood Glucose Control versus Open-Loop Control in Patients with Type 1 Diabetes trial AP@home data. The Kalman filter incorporated in the controller has been tuned using plasma and pump insulin as well as plasma and continuous glucose monitoring measures collected in clinical research centers. New constraints describing clinical knowledge not incorporated in the simulator but very critical in real patients (e.g., pump shutoff) have been introduced. The proposed model predictive control (MPC) is characterized by a low computational burden and memory requirements, and it is ready for an embedded implementation. Results The new MPC was tested with an intensive simulation study on the University of Virginia/Padova simulator equipped with a new virtual population. It was also used in some preliminary outpatient pilot trials. The obtained results are very promising in terms of mean glucose and number of patients in the critical zone of the control variability grid analysis. Conclusions The proposed MPC improves on the performance of a previous controller already tested in several experiments in the AP@home and JDRF projects. This algorithm complemented with a safety supervision module is a significant step toward deploying artificial pancreases into outpatient environments for extended periods of time. J Diabetes Sci Technol 2013;7(6):1470-1483 PMID:24351173

Toffanin, Chiara; Messori, Mirko; Palma, Federico Di; Nicolao, Giuseppe De; Cobelli, Claudio; Magni, Lalo

2013-01-01

294

Characteristics and Outcomes of Adenosquamous Carcinoma of the Pancreas  

PubMed Central

ABSTRACT BACKGROUND: Adenosquamous carcinoma of the pancreas (ASCAP) is a rare histologic type of pancreatic carcinoma that constitutes 1% to 4% of all pancreatic exocrine malignancies. It has a clinical presentation similar to that of adenocarcinoma of the pancreas (ACP), but may have a worse overall prognosis, with most patients surviving for less than 2 years. METHODS: This was an institutional, retrospective, cohort analysis of 237 patients who underwent resection of pancreatic cancer with curative intent. RESULTS: Of the 237 cases examined, we identified 7 (2.9%) with histologically confirmed ASCAP. Demographics, comorbidities, risk factors, presenting symptoms, survival data, tumor characteristics, and types of treatment for each patient were included in the analysis. Risk factors for development of ASCAP were not conclusive. Although human papilloma virus (HPV) has been implicated in other squamous cell cancers, in our cohort, its involvement in ASCAP was 0%. Presurgical fine-needle aspiration failed to identify the invasive squamous cell component in all cases. In this cohort analysis, overall survival ranged from 3 to 25 months, with 2 patients surviving more than 20 months after surgical resection. With a median follow-up of 2.9 years, our data demonstrate a trend to worse median overall survival for ASCAP than for ACP (8.2 vs. 20.4 months; P = .23), with a limited number of long-term survivors. CONCLUSIONS: Although recommended, adjuvant treatment was inconsistently provided for patients in this ASCAP cohort. Published data show variability in overall survival, but our findings support that surgical resection is one of the few options for control of this rare, poorly understood pancreatic malignancy. Further research is necessary to define risk factors and adjuvant and neoadjuvant treatments, to help improve patient outcomes. PMID:23936547

Simone, Christine G.; Zuluaga Toro, Tania; Chan, Ellie; Feely, Michael M.; Trevino, Jose G.

2013-01-01

295

CLINICAL PROGRAMS OF STEM CELL THERAPIES FOR LIVER AND PANCREAS  

PubMed Central

Regenerative medicine is transitioning into clinical programs utilizing stem/progenitor cell therapies for repair of damaged organs. We summarize those for liver and pancreas, organs that share endodermal stem cell populations, biliary tree stem cells (hBTSCs), located in peribiliary glands: they are precursors to hepatic stem/progenitors in canals of Hering and to committed progenitors in pancreatic duct glands. They give rise to maturational lineages along a radial axis within bile duct walls and a proximal-to-distal axis starting at the duodenum and ending with mature cells in the liver or pancreas. Clinical trials have been ongoing for years assessing effects of fetal-liver-derived hepatic stem/progenitors transplanted into the hepatic artery of patients with various liver diseases. Immunosuppression was not required. Control subjects, those given standard of care for a given condition, all died within a year or deteriorated in their liver functions. Subjects transplanted with 100–150 million hepatic stem/progenitor cells had improved liver functions and survival extending for several years. Full evaluations of safety and efficacy of transplants are still in progress. Determined stem cell therapies for diabetes utilizing hBTSCs remain to be explored but are likely to occur following ongoing preclinical studies. In addition, mesenchymal stem cells (MSCs) and hematopoietic stem cells (HSCs) are being used for patients with chronic liver conditions or with diabetes. MSCs have demonstrated significant effects through paracrine signaling of trophic and immune-modulatory factors, and there is limited evidence for inefficient lineage restriction into mature parenchymal or islet cells. HSCs’ effects are primarily via modulation of immune mechanisms. PMID:23873634

Lanzoni, Giacomo; Oikawa, Tsunekazu; Wang, Yunfang; Cui, Cai-Bin; Carpino, Guido; Cardinale, Vincenzo; Gerber, David; Gabriel, Mara; Dominguez-Bendala, Juan; Furth, Mark E.; Gaudio, Eugenio; Alvaro, Domenico; Inverardi, Luca; Reid, Lola M.

2013-01-01

296

Fault diagnosis  

NASA Technical Reports Server (NTRS)

The objective of the research in this area of fault management is to develop and implement a decision aiding concept for diagnosing faults, especially faults which are difficult for pilots to identify, and to develop methods for presenting the diagnosis information to the flight crew in a timely and comprehensible manner. The requirements for the diagnosis concept were identified by interviewing pilots, analyzing actual incident and accident cases, and examining psychology literature on how humans perform diagnosis. The diagnosis decision aiding concept developed based on those requirements takes abnormal sensor readings as input, as identified by a fault monitor. Based on these abnormal sensor readings, the diagnosis concept identifies the cause or source of the fault and all components affected by the fault. This concept was implemented for diagnosis of aircraft propulsion and hydraulic subsystems in a computer program called Draphys (Diagnostic Reasoning About Physical Systems). Draphys is unique in two important ways. First, it uses models of both functional and physical relationships in the subsystems. Using both models enables the diagnostic reasoning to identify the fault propagation as the faulted system continues to operate, and to diagnose physical damage. Draphys also reasons about behavior of the faulted system over time, to eliminate possibilities as more information becomes available, and to update the system status as more components are affected by the fault. The crew interface research is examining display issues associated with presenting diagnosis information to the flight crew. One study examined issues for presenting system status information. One lesson learned from that study was that pilots found fault situations to be more complex if they involved multiple subsystems. Another was pilots could identify the faulted systems more quickly if the system status was presented in pictorial or text format. Another study is currently under way to examine pilot mental models of the aircraft subsystems and their use in diagnosis tasks. Future research plans include piloted simulation evaluation of the diagnosis decision aiding concepts and crew interface issues. Information is given in viewgraph form.

Abbott, Kathy

1990-01-01

297

Development of a tele-anesthesia preoperative clinic to support distant military treatment facilities for the European regional medical command.  

PubMed

Landstuhl Regional Medical Center (LRMC) provides primary care services for more than 65,000 beneficiaries and specialty care and hospitalization for 245,000 U.S. Service Members and their Families serving in Europe. These personnel are located in Germany, Italy and Belgium (See Fig 1). Anesthesia preoperative diagnosis/work was done by telemedicine at the distant, end user site, and significant cost savings and enhanced patient service was accomplished. A novel use of existing technologies was implemented to enhance provider and patient satisfaction and create a sustainable, user friendly system. PMID:24732550

Turabi, Ali; Nessen, Shawn C; Boedeker, David; Boedeker, Ben

2014-01-01

298

Clinical skills: an evidence-based approach to preoperative fasting.  

PubMed

The procedure of fasting from midnight until induction of anaesthesia arose from concern that patients could regurgitate during induction of general anaesthesia when the pharyngeal and laryngeal refluxes are depressed. In this situation, the contents of the stomach do not come out of the patient's mouth, but go up into the oesophagus and trachea and are drawn back down into the lungs. This can damage the lungs, causing chemical inflammation, a condition referred to as aspiration pneumonitis or Mendelson's syndrome, a serious although rare complication of general anaesthesia. For many years, preoperative fasting has been a traditional practice for reducing this risk, but patients are being fasted for considerably longer than the evidence indicates is necessary. This article considers the current evidence for preoperative fasting times and examines why patients are still being subjected to prolonged preoperative fasting. Based on the evidence presented, recommendations are made regarding this aspect of care. PMID:15389137

Oshodi, Titilayo O

299

Preoperative embolization of carotid chemodectoma: a technical challenge that can be customized according to angioarchitecture. Illustrative cases.  

PubMed

Preoperative embolization of carotid paraganglioma is increasingly used to reduce the risk of surgical bleeding obtaining a more precise and extensive tumor resection. Currently the technique can be customized in consideration of the different tumor angioarchitecture, thanks to embolic materials with different vascular penetration: solid particles of polyvinyl-alcohol (PVA), histoacryl glue, and liquid polymer (Onyx(®)). Two cases of swelling dissection with volume progression over time came to our observation. Both patients (45 and 70-year-old women) were studied with neck ultrasound imaging and computed tomography (CT) and/or magnetic resonance (MR). In both cases the radiological investigations confirmed the clinical suspicion of carotid paraganglioma. Both patients were sent for angiography control and preoperative devascularization of the lesion. The treatment was performed under general anesthesia using, depending on the type of tumor vasculature, in case 1 solid particles of PVA and histoacryl glue, and in case 2 Onyx(®) (Covidien, Irvine). The patients successfully underwent excision of the lesion via cervicotomy within a week from the embolization procedure, without any complications. The histological findings confirmed the diagnosis of chemodectoma, and macrophage infiltrates were seen in the regions previously embolized. At one-year follow-up, there was no evidence of recurrent disease. The preoperative embolization of vascular lesions of the neck represents a safe technique that yields the best results when customized over the type of vascularization of the lesion, enabling the use of the most appropriate materials, depending on the case to be treated. PMID:24355187

Faragò, Giuseppe; Castellani, Carlotta; Ponzi, Silvano; Jankovic, Claudio; Saginario, Vittorio; Berardi, Carlo; Pollo, Bianca; Ciceri, Elisa F

2013-12-01

300

[Endoscopic-histopathological correlation in gastric lymphoma diagnosis: the experience of an oncologic institute].  

PubMed

Among the Gastric Lymphoma' chief features are the varied endoscopic appearances and the difficulty for its conventional bioptic diagnosis. In order to focusing on this problem we analyzed 15 years of experience on this matter at the "Luis Razetti" Oncological Institute. 10 cases were morphologicaly classified as follow: a) Exophytic type 5/50%. The most difficult morphology for its endoscopic diagnosis was the infiltrative type, in its large gastric folds category 2/20%, yielding a 33% of bening diagnosis. Histopathologicaly a 66% of bening diagnosis was obtained and a 33% of uncertain diagnosis. The exophytic type in its erosive protruding mass category was the second most difficult morphology fot both endoscopic and histopathologic diagnosis. When the last two categories were associated with ulceration, the malignant diagnosis increased. 40 of the cases were operated on without preoperative histological diagnosis. All the cases were operated on without preoperative histological diagnosis. All the cases corresponded with Large cells diffuse type of Non Hodgkin's Lymphoma, a diagnosis reached in only one opportunity by endoscopic biopsy. No correlation between tumoral morphology and intraparietal growth was found. 3 patients survived for more than 1 years. It can be concluded that video endoscopic methods could help to improve the endoscopic knowledge in gastric lymphoma diagnosis, while polipectomy snare biopsy, dye methods like Indigo Carmin and special techniques like mucosectomy could help to improve the histologic diagnosis, because conventional biopsy provides small and superficial samples. PMID:8598256

Bracho Mosquera, V E; Mendez, A; Paredes, R; Garrido, I; Montes, A; de Carvajal, A D; Oliver, G

1995-01-01

301

The Diagnosis of Periprosthetic Infection  

PubMed Central

Periprosthetic infection (PJI) is the most serious joint replacement complication, occurring in 0.8-1.9% of knee arthroplasties and 0.3-1.7% of hip arthroplasties. A definition of PJI was proposed in the November 2011 issue of the journal Clinical Orthopedics and Related Research. The presence of a fistula or of local inflammatory signs is indicative of PJI, but in many cases local pain is the only symptom. In the absence of underlying inflammatory conditions, C-reactive protein measurement is the most useful preoperative blood test for detecting infection associated with a prosthetic joint. The most useful preoperative diagnostic test is the aspiration of synovial joint fluid to obtain a total and differential cell count and culture. Intraoperative frozen sections of periprosthetic tissues produce excellent accuracy in predicting a diagnosis of PJI but only moderate accuracy in ruling out the diagnosis. In this process, obtaining a quality sample is the first step, and determines the quality of microbiological results. Specimens for culture should be obtained prior to the initiation of antibiotic treatment. Sonication of a removed implant may increase the culture yield. Plain radiography has low sensitivity and low specificity for detecting infection associated with a prosthetic joint. Computed tomography and magnetic resonance imaging may be useful in the evaluation of complex cases, but metal inserts interfere with these tests, and abnormalities may be non-specific. Labelled-leucocyte imaging (e.g., leucocytes labelled with indium-111) combined with bone marrow imaging with the use of technetium-99m–labelled sulphur colloid is considered the imaging test of choice when imaging is necessary. PMID:23898349

del Arco, Alfonso; Bertrand, María Luisa

2013-01-01

302

Preoperative brain shift: study of three surgical cases  

NASA Astrophysics Data System (ADS)

In successful brain tumor surgery, the neurosurgeon's objectives are threefold: (1) reach the target, (2) remove it and (3) preserve eloquent tissue surrounding it. Surgical Planning (SP) consists in identifying optimal access route(s) to the target based on anatomical references and constrained by functional areas. Preoperative images are essential input in Multi-modal Image Guided NeuroSurgery systems (MIGNS) and update of these images, with precision and accuracy, is crucial to approach the anatomical reality in the Operating Room (OR). Intraoperative brain deformation has been previously identified by many research groups and related update of preoperative images has also been studied. We present a study of three surgical cases with tumors accompanied with edema and where corticosteroids were administered and monitored during a preoperative stage [t 0, t I = t 0 + 10 days]. In each case we observed a significant change in the Region Of Interest (ROI) and in anatomical references around it. This preoperative brain shift could induce error for localization during intervention (time t S) if the SP is based on the t 0 preoperative images. We computed volume variation, distance maps based on closest point (CP) for different components of the ROI, and displacement of center of mass (CM) of the ROI. The matching between sets of homologous landmarks from t 0 to t I was performed by an expert. The estimation of the landmarks displacement showed significant deformations around the ROI (landmarks shifted with mean of 3.90 +/- 0.92 mm and maximum of 5.45 mm for one case resection). The CM of the ROI moved about 6.92 mm for one biopsy. Accordingly, there was a sizable difference between SP based at t 0 vs SP based at t I, up to 7.95 mm for localization of reference access in one resection case. When compared to the typical MIGNS system accuracy (2 mm), it is recommended that preoperative images be updated within the interval time [t I,t S] in order to minimize the error correspondence between the anatomical reality and the preoperative data. This should help maximize the accuracy of registration between the preoperative images and the patient in the OR.

El Ganaoui, O.; Morandi, X.; Duchesne, S.; Jannin, P.

2008-03-01

303

RESEARCH ARTICLE Open Access Is there adaptation of the exocrine pancreas in  

E-print Network

Background Physiology of the exocrine pancreas has been well stud- ied in domestic (dog, pig, sheep, cattle and in their * Correspondence: Paul.Guilloteau@rennes.inra.fr 1 INRA, U1341, Nutrition et Adaptations Digestives, Nerveuses et

Boyer, Edmond

304

Reporter islets in the eye reveal the plasticity of the endocrine pancreas  

PubMed Central

The islets of Langerhans constitute the endocrine part of the pancreas and are responsible for maintenance of blood glucose homeostasis. They are deeply embedded in the exocrine pancreas, limiting their accessibility for functional studies. Understanding regulation of function and survival and assessing the clinical outcomes of individual treatment strategies for diabetes requires a monitoring system that continuously reports on the endocrine pancreas. We describe the application of a natural body window that successfully reports on the properties of in situ pancreatic islets. As proof of principle, we transplanted “reporter islets” into the anterior chamber of the eye of leptin-deficient mice. These islets displayed obesity-induced growth and vascularization patterns that were reversed by leptin treatment. Hence, reporter islets serve as optically accessible indicators of islet function in the pancreas, and also reflect the efficacy of specific treatment regimens aimed at regulating islet plasticity in vivo. PMID:24248353

Ilegems, Erwin; Dicker, Andrea; Speier, Stephan; Sharma, Aarti; Bahow, Alan; Edlund, Patrick Karlsson; Leibiger, Ingo B.; Berggren, Per-Olof

2013-01-01

305

On the diabetic menu: Zebrafish as a model for pancreas development and function  

PubMed Central

Summary Development of the vertebrate pancreas is a complex stepwise process comprising regionalization, cell differentiation, and morphogenesis. Studies in zebrafish are contributing to an emerging picture of pancreas development in which extrinsic signaling molecules influence intrinsic transcriptional programs to allow ultimate differentiation of specific pancreatic cell types. Zebrafish experiments have revealed roles for several signaling molecules in aspects of this process; for example our own work has shown that Retinoic Acid signals specify the pre-pancreatic endoderm. Time-lapse imaging of live zebrafish embryos has started to provide detailed information about early pancreas morphogenesis. In addition to modeling embryonic development, the zebrafish has recently begun to be used as a model for pancreas regeneration studies. Here we review the significant progress in these areas and consider the future potential of zebrafish as a diabetes research model. PMID:19204986

Kinkel, Mary D.; Prince, Victoria E.

2009-01-01

306

Hepatobiliary/Pancreas Pathology: SY11-2 RECENT PROGRESS IN BILIARY TRACT PATHOLOGY AND CHOLANGIOCARCINOMA.  

PubMed

The biliary tract and pancreas develop from the foregut at almost same time, and the morphology of the biliary tract and pancreatic ducts share several features. In addition, there are peribiliary glands around the biliary tract, which occasionally contain pancreatic acini and enzymes. Some pancreatic and biliary tract diseases share similar pathological features. For example, IgG4-related disease affects the pancreas (autoimmune pancreatitis) and the biliary tract (IgG4-related sclerosing cholangitis), and peribiliary cysts and pancreatic damages in chronic alcoholics show similar histologies. Interestingly, perihilar cholangiocarcinoma and pancreatic duct adenocarcinoma, and their precursor lesions such as biliary intraepithelial neoplasm (BilIN) and pancreatic intraepithelial neoplasm (PanIN), show similar histologies and phenotypes, suggesting that these carcinoma and precursor lesions share similar developmental processes. Based on the similarities between the pancreas and biliary tract, we would like to propose that several biliary diseases have their counterparts in the pancreas (pancreatic diseases with pancreatic counterparts). PMID:25188108

Nakanuma, Yasuni

2014-10-01

307

Intraoperative imaging of pancreas transplant allografts using indocyanine green with laser fluorescence.  

PubMed

Vascular thrombosis is a cause of allograft loss after pancreas transplantation. We present the use of intraoperative fluorescence imaging with the SPY imaging device (Novadaq Technologies Inc, Toronto, Canada) in two pancreas transplants as a means to assess potency of the vascular anastomoses. Intravenous indocyanine green 2.5 mg/mL was fluoresced with the device to create the intraoperative video sequences, which were recorded. After 60-day follow-up, real-time SPY imaging on these two pancreas transplants did not demonstrate adverse effects on patients or the transplanted allografts. This method of vascular imaging could prove useful in improving short-term graft survival and possibly lowering the thrombosis rates seen with pancreas transplantation. Long-term correlation studies between intraoperative findings and graft survival must be performed to confirm the utility of this imaging method. PMID:18628923

Sanchez, Edmund Q; Chinnakotla, Srinath; Khan, Tariq; Nikitin, Dmitriy; Vasani, Sugam; Randall, Henry B; McKenna, Greg J; Ruiz, Richard; Onaca, Nicholas; Levy, Marlon F; Goldstein, Robert M; Docherty, John C; Hurd, David K; Klintmalm, Göran B

2008-07-01

308

Distinct function of the head region of human pancreas in the pathogenesis of diabetes.  

PubMed

The large size of the human pancreas challenges unbiased quantitative analyses that require a practical stereological approach. While many histological studies of the pancreas in the past lacked regional information, we have shown marked heterogeneity within an individual, where islet distribution/density is relatively low in the head and gradually increases through the body toward the tail region by>2-fold. Studies focusing on the tail region may be prone to overestimation of ?-cell/islet mass when normalizing measured values per person by using pancreas weight or volume. In this article, beyond technical issues, we discuss the pathophysiological importance of studying the head region of the human pancreas regarding its unique characteristics in early development, and the anatomical disposition that may lead to a preferential loss of ?-cells in patients with type 2 diabetes and the development of pancreatic cancer. PMID:24045229

Savari, Omid; Zielinski, Mark C; Wang, Xiaojun; Misawa, Ryosuke; Millis, J Michael; Witkowski, Piotr; Hara, Manami

2013-01-01

309

Fibrosis of the pancreas: the initial tissue damage and the resulting pattern.  

PubMed

Fibrosis in the pancreas is caused by such processes as necrosis/apoptosis, inflammation or duct obstruction. The initial event that induces fibrogenesis in the pancreas is an injury that may involve the interstitial mesenchymal cells, the duct cells and/or the acinar cells. Damage to any one of these tissue compartments of the pancreas is associated with cytokine-triggered transformation of resident fibroblasts/pancreatic stellate cells into myofibroblasts and the subsequent production and deposition of extracellular matrix. Depending on the site of injury in the pancreas and the involved tissue compartment, predominantly inter(peri)lobular fibrosis (as in alcoholic chronic pancreatitis), periductal fibrosis (as in hereditary pancreatitis), periductal and interlobular fibrosis (as in autoimmune pancreatitis) or diffuse inter- and intralobular fibrosis (as in obstructive chronic pancreatitis) develops. PMID:15138818

Klöppel, Günter; Detlefsen, Sönke; Feyerabend, Bernd

2004-07-01

310

Acute biliary pancreatitis: diagnosis and treatment.  

PubMed

Gallstones are the commonest cause of acute pancreatitis (AP), a potentially life-threatening condition, worldwide. The pathogenesis of acute pancreatitis has not been fully understood. Laboratory and radiological investigations are critical for diagnosis as well prognosis prediction. Scoring systems based on radiological findings and serologic inflammatory markers have been proposed as better predictors of disease severity. Early endoscopic retrograde cholangiopancreatography (ERCP) is beneficial in a group of patients with gallstone pancreatitis. Laparoscopic cholecystectomy with preoperative endoscopic common bile duct clearance is recommended as a treatment of choice for acute biliary pancreatitis. The timing of cholecystectomy, following ERCP, for biliary pancreatitis can vary markedly depending on the severity of pancreatitis. PMID:19636174

Hazem, Zakaria M

2009-01-01

311

Pre-existing histological type and developmental mechanism of mucinous noncystic carcinoma of pancreas  

Microsoft Academic Search

Eleven cases with mucinous noncystic carcinoma (MC) of the pancreas were studied by histology and mucin immunohistochemistry,\\u000a to elucidate the mechanism, or route of development, and pre-existing histological type of MC of the pancreas. These MCs were\\u000a observed in close approximation to, or surrounding, intraductal papillary-mucinous carcinomas (IPMCs), and were centrally\\u000a situated among ductal adenocarcinomas (DAs). Hence, the 11 cases

Koichi Suda; Bunsei Nobukawa; Shigetaka Yamasaki; Fujihiko Suzuki; Hideo Shimizu; Masaru Takase

2000-01-01

312

Pax6 is required for differentiation of glucagon-producing alpha-cells in mouse pancreas  

Microsoft Academic Search

The functional unit of the endocrine pancreas is the islet of Langerhans. Islets are nested within the exocrine tissue of the pancreas and are composed of alpha-, beta-, delta- and gamma-cells1. beta-Cells produce insulin and form the core of the islet, whereas alpha-, delta- and gamma-cells are arranged at the periphery of the islet and secrete glucagon, somatostatin and a

Luc St-Onge; Beatriz Sosa-Pineda; Kamal Chowdhury; Ahmed Mansouri; Peter Gruss

1997-01-01

313

EUS-guided radiofrequency ablation in the pancreas: results in a porcine model  

Microsoft Academic Search

Background:  Our aim in this study was to investigate the feasibility and safety of performing radiofrequency (RF) ablation in the pancreas with endoscopic ultrasound (EUS). Methods:  RF was applied to normal pancreatic tissue in 13 anesthetized Yorkshire pigs with specially modified 19-gauge needle electrodes (1.0 to 1.5 cm tip). The pancreas was localized with EUS and punctured through a transgastric

S. Nahum Goldberg; Shawn Mallery; G. Scott Gazelle; William R. Brugge

1999-01-01

314

Extramedullary Myeloid Tumor Involving the Pancreas: A Case Report and Review of the Literature  

PubMed Central

Extramedullary myeloid tumors (EMMTs) are the tumors of myeloid cells. These tumors may occur in all of the organs of the body, but some localizations are rare. Pancreatic involvement of EMMTs is a rare entity. Here we report a case of EMMT of the pancreas 4 years after allogeneic stem cell transplantation and we review the existing data about EMMTs involving the pancreas. PMID:25330524

Payda?, Semra; Özdo?u, Hakan; Günald?, Meral; Haksöyler, Veysel; Aç?kal?n, Arbil; Ergin, Melek

2014-01-01

315

Diffusion Tensor Magnetic Resonance Imaging of the Pancreas  

PubMed Central

Purpose To develop a diffusion-tensor-imaging (DTI) protocol that is sensitive to the complex diffusion and perfusion properties of the healthy and malignant pancreas tissues. Materials and Methods Twenty-eight healthy volunteers and nine patients with pancreatic-ductal-adenocacinoma (PDAC), were scanned at 3T with T2-weighted and DTI sequences. Healthy volunteers were also scanned with multi-b diffusion-weighted-imaging (DWI), whereas a standard clinical protocol complemented the PDAC patients’ scans. Image processing at pixel resolution yielded parametric maps of three directional diffusion coefficients ?1, ?2, ?3, apparent diffusion coefficient (ADC), and fractional anisotropy (FA), as well as a ?1-vector map, and a main diffusion-direction map. Results DTI measurements of healthy pancreatic tissue at b-values 0,500 s/mm2yielded: ?1?=?(2.65±0.35)×10?3, ?2?=?(1.87±0.22)×10?3, ?3?=?(1.20±0.18)×10?3, ADC?=?(1.91±0.22)×10?3 (all in mm2/s units) and FA?=?0.38±0.06. Using b-values of 100,500 s/mm2 led to a significant reduction in ?1, ?2, ?3 and ADC (p<.0001) and a significant increase (p<0.0001) in FA. The reduction in the diffusion coefficients suggested a contribution of a fast intra-voxel-incoherent-motion (IVIM) component at b?100 s/mm2, which was confirmed by the multi-b DWI results. In PDACs, ?1, ?2, ?3 and ADC in both 0,500 s/mm2 and 100,500 s/mm2 b-values sets, as well as the reduction in these diffusion coefficients between the two sets, were significantly lower in comparison to the distal normal pancreatic tissue, suggesting higher cellularity and diminution of the fast-IVIM component in the cancer tissue. Conclusion DTI using two reference b-values 0 and 100 s/mm2 enabled characterization of the water diffusion and anisotropy of the healthy pancreas, taking into account a contribution of IVIM. The reduction in the diffusion coefficients of PDAC, as compared to normal pancreatic tissue, and the smaller change in these coefficients in PDAC when the reference b-value was modified from 0 to 100 s/mm2, helped identifying the presence of malignancy. PMID:25549366

Nissan, Noam; Golan, Talia; Furman-Haran, Edna; Apter, Sara; Inbar, Yael; Ariche, Arie; Bar-Zakay, Barak; Goldes, Yuri; Schvimer, Michael; Grobgeld, Dov; Degani, Hadassa

2014-01-01

316

Dynamic expression and localization of c-MET isoforms in the developing rat pancreas  

PubMed Central

Pancreata from Sprague Dawley rats of different developmental stages were studied to determine the expression and cellular localization of different c-MET isoforms in the developing rat pancreas. Pancreatic mRNA and protein expression levels of c-MET at different developmental stages from embryo to adult were detected by reverse transcription-polymerase chain reaction and by western blotting. To identify the cellular localization of c-MET protein in the developing rat pancreas, double immunofluorescent staining was performed using antibodies for cell type-specific markers and for c-MET. The expression of two isoforms of c-MET (190 kDa and 170 kDa) coincided with the development of the pancreas. The 190 kDa isoform of c-MET is expressed during embryonic stages, and its expression is replaced by the expression of the 170 kDa isoform as the pancreas develops. Only the 170 kDa isoform is expressed in the adult rat pancreas. Throughout all stages of pancreatic development, c-MET is expressed by vimentin-positive cells. In contrast, c-MET staining was stronger in rat pancreata from newborn to adult stages and overlapped with insulin-positive beta-cells. The dynamic expression and localization of different c-MET isoforms in the rat pancreas during different developmental stages indicates that distinct c-MET isoform might be involved in different aspects of pancreatic development.

Wu, Yulong; Cheng, Mei; Shi, Zhen; Feng, Zhenqing; Guan, Xiaohong

2014-01-01

317

Model-based pancreas segmentation in portal venous phase contrast-enhanced CT images.  

PubMed

This study aims to automatically detect and segment the pancreas in portal venous phase contrast-enhanced computed tomography (CT) images. The institutional review board of the University of Erlangen-Nuremberg approved this study and waived the need for informed consent. Discriminative learning is used to build a pancreas tissue classifier incorporating spatial relationships between the pancreas and surrounding organs and vessels. Furthermore, discrete cosine and wavelet transforms are used to build texture features to describe local tissue appearance. Classification is used to guide a constrained statistical shape model to fit the data. The algorithm to detect and segment the pancreas was evaluated on 40 consecutive CT data that were acquired in the portal venous contrast agent phase. Manual segmentation of the pancreas was carried out by experienced radiologists and served as reference standard. Threefold cross validation was performed. The algorithm-based detection and segmentation yielded an average surface distance of 1.7 mm and an average overlap of 61.2 % compared with the reference standard. The overall runtime of the system was 20.4 min. The presented novel approach enables automatic pancreas segmentation in portal venous phase contrast-enhanced CT images which are included in almost every clinical routine abdominal CT examination. Reliable pancreatic segmentation is crucial for computer-aided detection systems and an organ-specific decision support. PMID:23471751

Hammon, Matthias; Cavallaro, Alexander; Erdt, Marius; Dankerl, Peter; Kirschner, Matthias; Drechsler, Klaus; Wesarg, Stefan; Uder, Michael; Janka, Rolf

2013-12-01

318

Sequential evaluation of islet cell responses to glucose in the transplanted pancreas in humans.  

PubMed

We evaluated the hormonal and metabolic responses of denervated pancreas allografts in nine volunteers 3 to 12 months after the transplant (initial) and again 1 year later (follow-up). Eight of the patients received simultaneous pancreas-kidney transplants. The glucose clamp technique was used to create a square wave of hyperglycemia 5.5 mmol/L above the basal glucose level for 2 hours. A biphasic insulin response was evident in each subject, both initially and at follow-up. The initial plasma insulin response was fourfold higher in patients with pancreas-kidney transplants than in normal volunteers. However, the plasma insulin response of the patients with pancreas-kidney transplants at the follow-up study was more similar to that of the normal controls. The plasma glucagon levels were elevated in follow-up clamp studies. Hepatic glucose production and glucose disposal were similar in both studies. At the follow-up examination only, GLUT4, the major insulin-sensitive glucose transporter, was measured in muscle homogenates by immunoblotting. GLUT4 levels in the patients with pancreas-kidney transplants were only 55% as abundant as in normal volunteers. This may be due, in part, to immunosuppressive therapy or to persistent, albeit reduced, levels of hyperinsulinemia even 2 years after transplantation. We concluded that, despite systemic drainage of the pancreas and immunosuppressive therapy, pancreatic insulin secretion, peripheral insulin levels, and muscle insulin responsiveness are restored toward normal levels approximately 2 years after the transplant. PMID:8418690

Elahi, D; McAloon-Dyke, M; Clark, B A; Kahn, B B; Weinreb, J E; Minaker, K L; Wong, G A; Morse, L A; Brown, R S; Shapiro, M E

1993-01-01

319

Determination of Acquisition Frequency for Intrafractional Motion of Pancreas in CyberKnife Radiotherapy  

PubMed Central

Purpose. To report the characteristics of pancreas motion as tracked using implanted fiducials during radiotherapy treatments with CyberKnife. Methods and Materials. Twenty-nine patients with pancreas cancer treated using CyberKnife system were retrospectively selected for this study. During the treatment, the deviation is examined every 3-4 nodes (~45?s interval) and compensated by the robot. The pancreas displacement calculated from X-ray images acquired within the time interval between two consecutive couch motions constitute a data set. Results. A total of 498 data sets and 4302 time stamps of X-ray images were analyzed in this study. The average duration for each data set is 634?s. The location of the pancreas becomes more dispersed as the time elapses. The acquisition frequency depends on the prespecified movement distance threshold of pancreas. If the threshold between two consecutive images is 1?mm, the acquisition frequency should be less than 30?s, while if the threshold is 2?mm, the acquisition frequency can be around 1?min. Conclusions. The pancreas target moves significantly and unpredictably during treatment. Effective means of compensating the intrafractional movement is critical to ensure adequate dose coverage of the tumor target. PMID:24959616

Zhang, Huailing; Zhao, Guoru; Xie, Yaoqin

2014-01-01

320

Quality Management in Middle Ear Surgery: Controversies Regarding Preoperative Imaging  

Microsoft Academic Search

Today a large variety of different imaging techniques are available for middle ear investigation. However, imaging is not suitable to give essential information in every case on the surgical strategy to be chosen. This article discusses the most frequent indications for preoperative imaging and the relevant techniques. CT scanning, MRI and rotational tomography are taken into consideration as well as

T. Zahnert; C. Offergeld

2010-01-01

321

Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors.  

PubMed

Based on previous studies, we hypothesized that the clinical phenomena of preoperative anxiety, emergence delirium, and postoperative maladaptive behavioral changes were closely related. We examined this issue using data obtained by our laboratory over the past 6 years. Only children who underwent surgery and general anesthesia using sevoflurane/O(2)/N(2)O and who did not receive midazolam were recruited. Children's anxiety was assessed preoperatively with the modified Yale Preoperative Anxiety Scale (mYPAS), emergence delirium was assessed in the postanesthesia care unit, and behavioral changes were assessed with the Post Hospital Behavior Questionnaire (PHBQ) on postoperative days 1, 2, 3, 7, and 14. Regression analysis showed that the odds of having marked symptoms of emergence delirium increased by 10% for each increment of 10 points in the child's state anxiety score (mYPAS). The odds ratio of having new-onset postoperative maladaptive behavior changes was 1.43 for children with marked emergence status as compared with children with no symptoms of emergence delirium. A 10-point increase in state anxiety scores led to a 12.5% increase in the odds that the child would have a new-onset maladaptive behavioral change after the surgery. This finding is highly significant to practicing clinicians, who can now predict the development of adverse postoperative phenomena, such as emergence delirium and postoperative behavioral changes, based on levels of preoperative anxiety. PMID:15562048

Kain, Zeev N; Caldwell-Andrews, Alison A; Maranets, Inna; McClain, Brenda; Gaal, Dorothy; Mayes, Linda C; Feng, Rui; Zhang, Heping

2004-12-01

322

Prospective preoperative determination of mucinous pancreatic cystic neoplasms  

Microsoft Academic Search

Background. Optimal management of pancreatic cystic neoplasms includes identification and resection of mucinous neoplasms. This study was performed to assess the accuracy of preoperative variables in determining a mucinous lesion. Methods. Patients referred for a cystic neoplasm were prospectively assessed by presenting symptoms, blinded radiologic review, and endoscopic ultrasound-guided cyst aspirate analysis. Patients who were symptomatic, or had aspirate findings

R. Matthew Walsh; J. Michael Henderson; David P Vogt; Mark E Baker; Charles M O'Malley; Brian Herts; Gregory Zuccaro; John J Vargo; John A Dumot; Darwin L Conwell; Charles V Biscotti; Nancy Brown

2002-01-01

323

Preoperative iodine staining may complicate the demarcation of esophageal carcinoma.  

PubMed

A 53-year-old man was suspected of having an esophageal neoplasm. An endoscopic examination including Lugol chromoendoscopy suggested an esophageal squamous cell neoplasm limited to the lamina propria. A targeted biopsy showed atypical squamous cells, and an endoscopic submucosal dissection was performed 22 days after the previous endoscopy. Although a single 40 mm unstained area was observed by preoperative Lugol chromoendoscopy, intraoperative endoscopy revealed a 25 mm iodine-unstained area, with small unstained areas scattered on the oral side. We included the small unstained areas in the extent of the resection through assessment by preoperative endoscopy. Histopathologically, the tumor extent appeared to coincide with the preoperative assessment. Tumor cells were found in the basal-parabasal layers of the mucosa, in which small unstained areas were scattered, although the superficial layers exhibited well-differentiated cells containing glycogen in the cytoplasm. Although Lugol chromoendoscopy, which can induce chemical esophagitis, is widely used, re-epithelialization after mucosal damage by preoperative iodine staining may complicate the intraoperative demarcation of tumors. PMID:23898393

Asada-Hirayama, Itsuko; Ono, Satoshi; Kodashima, Shinya; Niimi, Keiko; Mochizuki, Satoshi; Yamamichi, Nobutake; Fujishiro, Mitsuhiro; Matsusaka, Keisuke; Fukayama, Masashi; Koike, Kazuhiko

2013-07-01

324

Preoperative planning and training simulation for risk reducing surgery  

E-print Network

1 Preoperative planning and training simulation for risk reducing surgery Dipl.-Inform. Tobias Salb need for simulation can be determined for surgery in complex regions of the human body during surgery which can be achieved by the use of an appropriate simulation system. The main focus

Weyrich, Tim

325

Pancoast tumors: improved survival with preoperative and postoperative radiotherapy  

Microsoft Academic Search

Long-term survival after treatment of Pancoast tumors has been limited in most series to those patients without positive lymph nodes or residual tumor. In our series of 18 consecutive patients treated with preoperative irradiation and resection, 14 underwent supplemental postoperative radiotherapy because of positive lymph nodes, tumor at the resection margin, or both. No hospital deaths occurred. Eight patients subsequently

David M. Shahian; Wilford B. Neptune; F. Henry Ellis Jr.

1987-01-01

326

Cancer diagnosis.  

PubMed

Essential facts Around 300,000 people were diagnosed with cancer in England and Wales in 2011, and more than one in three people in the UK will develop cancer in some form during their lifetime. An early diagnosis is the best way to tackle the disease and improve survival rates. However, not enough is being done to identify cancer and treat it an early stage, says the National Institute for Health and Care Excellence (NICE). PMID:25605088

2015-01-21

327

Paraganglioma of the pancreas: a potentially functional and malignant tumor  

PubMed Central

Paragangliomas are neoplasms that arise from extra-adrenal chromaffin cells. Pancreatic paragangliomas are rare, and few are malignant. To the best of our knowledge, no cases of functional pancreatic paragangliomas have been reported in the literature to date. We present two cases of pancreatic paragangliomas with pathological confirmation. In the case 1, clinical testing and pathological analysis revealed functional and malignant characteristics of the tumor, which carried a poor prognosis. In case 2, functional paraganglioma was suspected. The clinical presentations and outcomes of these two patients are summarized, and the relevant literature is reviewed. Because of the small number of cases reported previously, few characteristics of these tumors are known. The best methods of predicting the malignant and functional potential of these tumors remain unknown. We propose careful preoperative treatment and close postoperative follow-up of paraganglioma patients because of the functional and malignant potential of these tumors. PMID:25030833

2014-01-01

328

Melanoma Diagnosis  

NASA Astrophysics Data System (ADS)

The chapter deals with the diagnosis of the malignant melanoma of the skin. This aggressive type of cancer with steadily growing incidence in white populations can hundred percent be cured if it is detected in an early stage. Imaging techniques, in particular dermoscopy, have contributed significantly to improvement of diagnostic accuracy in clinical settings, achieving sensitivities for melanoma experts of beyond 95% at specificities of 90% and more. Automatic computer analysis of dermoscopy images has, in preliminary studies, achieved classification rates comparable to those of experts. However, the diagnosis of melanoma requires a lot of training and experience, and at the time being, average numbers of lesions excised per histology-proven melanoma are around 30, a number which clearly is too high. Further improvements in computer dermoscopy systems and their competent use in clinical settings certainly have the potential to support efforts of improving this situation. In the chapter, medical basics, current state of melanoma diagnosis, image analysis methods, commercial dermoscopy systems, evaluation of systems, and methods and future directions are presented.

Horsch, Alexander

329

Colorectal Stenting: An Effective Therapy for Preoperative and Palliative Treatment  

SciTech Connect

Purpose. To demonstrate the effectiveness of preoperative and palliative colorectal stent placement in acute colonic obstruction. Methods. Sixty-seven consecutive patients (mean age 67.3 years, range 25-93 years) with clinical and radiological signs of colonic obstruction were treated: 45 (67%) preoperatively and 22 (33%) with a palliative intent. In 59 patients (88%) the obstruction was malignant, while in 8 (12%) it was benign. A total of 73 enteric Wallstents were implanted under combined fluoroscopic/endoscopic guidance. Results. Forty-five patients were treated preoperatively with a technical success rate of 84%, a clinical success rate of 83%, and a complication rate of 16%. Of the 38 patients who were successfully stented preoperatively, 36 (95%) underwent surgery 2-22 days (mean 7.2 days) after stent insertion. The improved general condition and adequate bowel cleansing allowed single-stage tumor resection and primary end-to-end anastomosis without complications in 31 cases (86% of all operations), while only 5 patients had colostomies. Stent placement was used as the final palliative treatment in 22 patients. The technical success rate was 95%, the clinical success rate 72%, and the complication rate relatively high at 67%, caused by reocclusion in most cases. After noninvasive secondary interventions (e.g., tube placement, second stenting, balloon dilatation) the secondary patency of stents was 71% and mean reported survival time after stent insertion was 92 days (range 10-285 days). Conclusion. Preoperative stent placement in acute colonic obstruction is minimally invasive and allows an elective one-stage surgery in most cases. Stent placement also proved a valuable alternative to avoid colostomy in palliation.

Jost, Rahel S. [Kantonsspital Winterthur, Department of Surgery (Switzerland)], E-mail: raheljost@dplanet.ch; Jost, Res [Kantonsspital Winterthur, Department of Internal Medicine, Section of Gastroenterology (Switzerland); Schoch, Erich [Kantonsspital Winterthur, Department of Radiology (Switzerland); Brunner, Brigit [Kantonsspital Winterthur, Department of Internal Medicine, Section of Gastroenterology (Switzerland); Decurtins, Marco [Kantonsspital Winterthur, Department of Surgery (Switzerland); Zollikofer, Christoph L. [Kantonsspital Winterthur, Department of Radiology (Switzerland)

2007-06-15

330

The Use of Preoperative Epoetin-? in Revision Hip Arthroplasty  

PubMed Central

Purpose: To evaluate the efficacy of preoperative epoetin-? on the revision hip arthroplasty patient. We hypothesized that epoetin-? will reduce blood transfusion. A pertinent review of the literature is provided. Methods: Forty-six patients were retrospectively reviewed. Sixteen patients received epoetin-?. Patients were case matched by age, preoperative hemoglobin, surgery, gender, and BMI. The clinical triggers for blood transfusion during or after the procedure were determined based on peri- and postoperative hemoglobin levels, ASA score, and/or clinical symptoms consistent with anemia. Blood salvage was not used. Results: Blood transfusion and length of stay were decreased in the epoetin-? group. Hemoglobin in the intervention group increased from 12.0 to 14.5, preoperatively. Patients who received epoetin-? were 0.78 (RR=0.225) times as likely to receive a transfusion. Number Needed to Treat (NNT) to avoid one allogeneic transfusion was 1.84. Age, Gender, BMI, ASA, total and hidden blood loss, preoperative Iron supplements, preop Hct, preop PLT, PT, PTT, and INR were similar. One (6.0%) patient developed an uncomplicated deep venous thrombosis in the intervention group. Conclusions: The mildly anemic revision hip arthroplasty patient is at increased risk for transfusion. Epoetin-? increased preoperative hemoglobin counts and reduced transfusions in this study; it also decreased patient length of hospital stay likely allowing for an earlier readiness to resume normal activities and/or meet short-term milestones. A randomized study to evaluate the direct and indirect costs of such a treatment methodology in the mildly anemic revision patient may be warranted. PMID:22629289

Delasotta, Lawrence A; Rangavajjula, Ashwin; Frank, Michael L; Blair, Jamie; Orozco, Fabio; Ong, Alvin

2012-01-01

331

Neuroimaging diagnosis for cerebral infarction  

PubMed Central

Objective: To identify global research trends in neuroimaging diagnosis for cerebral infarction using a bibliometric analysis of the Web of Science. Data Retrieval: We performed a bibliometric analysis of data retrieval for neuroimaging diagnosis for cerebral infarction containing the key words “CT, magnetic resonance imaging, MRI, transcranial Doppler, transvaginal color Doppler, digital subtraction angiography, and cerebral infarction” using the Web of Science. Selection Criteria: Inclusion criteria were: (a) peer-reviewed articles on neuroimaging diagnosis for cerebral infarction which were published and indexed in the Web of Science; (b) original research articles and reviews; and (c) publication between 2004–2011. Exclusion criteria were: (a) articles that required manual searching or telephone access; and (b) corrected papers or book chapters. Main Outcome Measures: (1) Annual publication output; (2) distribution according to country; (3) distribution according to institution; (4) top cited publications; (5) distribution according to journals; and (6) comparison of study results on neuroimaging diagnosis for cerebral infarction. Results: Imaging has become the predominant method used in diagnosing cerebral infarction. The most frequently used clinical imaging methods were digital subtraction angiography, CT, MRI, and transcranial color Doppler examination. Digital subtraction angiography is used as the gold standard. However, it is a costly and time-consuming invasive diagnosis that requires some radiation exposure, and is poorly accepted by patients. As such, it is mostly adopted in interventional therapy in the clinic. CT is now accepted as a rapid, simple, and reliable non-invasive method for use in diagnosis of cerebrovascular disease and preoperative appraisal. Ultrasonic Doppler can be used to reflect the hardness of the vascular wall and the nature of the plaque more clearly than CT and MRI. Conclusion: At present, there is no unified standard of classification of cerebral infarction imaging. Detection of clinical super-acute cerebral infarction remains controversial due to its changes on imaging, lack of specificity, and its similarity to a space-occupying lesion. Neuroimaging diagnosis for cerebral infarction remains a highly active area of research and development.

Du, Yan; Yang, Xiaoxia; Song, Hong; Chen, Bo; Li, Lin; Pan, Yue; Wu, Qiong; Li, Jia

2012-01-01

332

Electrolytic ablation of the rat pancreas: a feasibility trial  

PubMed Central

Background Pancreatic cancer is a biologically aggressive disease with less than 20% of patients suitable for a "curative" surgical resection. This, combined with the poor 5-year survival indicates that effective palliative methods for symptom relief are required. Currently there are no ablative techniques to treat pancreatic cancer in clinical use. Tissue electrolysis is the delivery of a direct current between an anode and cathode to induce localised necrosis. Electrolysis has been shown to be safe and reliable in producing hepatic tissue and tumour ablation in animal models and in a limited number of patients. This study investigates the feasibility of using electrolysis to produce localised pancreatic necrosis in a healthy rat model. Method Ten rats were studied in total. Eight rats were treated with variable "doses" of coulombs, and the systemic and local effects were assessed; 2 rats were used as controls. Results Seven rats tolerated the procedure well without morbidity or mortality, and one died immediately post procedure. One control rat died on induction of anaesthesia. Serum amylase and glucose were not significantly affected. Conclusion Electrolysis in the rat pancreas produced localised necrosis and appears both safe, and reproducible. This novel technique could offer significant advantages for patients with unresectable pancreatic tumours. The next stage of the study is to assess pancreatic electrolysis in a pig model, prior to human pilot studies. PMID:11570977

Fosh, Beverley G; Finch, Jonathon Guy; Anthony, Adrian A; Texler, Michael; Maddern, Guy J

2001-01-01

333

Molecular pathology of intraductal papillary mucinous neoplasms of the pancreas  

PubMed Central

Since the first description of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas in the eighties, their identification has dramatically increased in the last decades, hand to hand with the improvements in diagnostic imaging and sampling techniques for the study of pancreatic diseases. However, the heterogeneity of IPMNs and their malignant potential make difficult the management of these lesions. The objective of this review is to identify the molecular characteristics of IPMNs in order to recognize potential markers for the discrimination of more aggressive IPMNs requiring surgical resection from benign IPMNs that could be observed. We briefly summarize recent research findings on the genetics and epigenetics of intraductal papillary mucinous neoplasms, identifying some genes, molecular mechanisms and cellular signaling pathways correlated to the pathogenesis of IPMNs and their progression to malignancy. The knowledge of molecular biology of IPMNs has impressively developed over the last few years. A great amount of genes functioning as oncogenes or tumor suppressor genes have been identified, in pancreatic juice or in blood or in the samples from the pancreatic resections, but further researches are required to use these informations for clinical intent, in order to better define the natural history of these diseases and to improve their management. PMID:25110429

Paini, Marina; Crippa, Stefano; Partelli, Stefano; Scopelliti, Filippo; Tamburrino, Domenico; Baldoni, Andrea; Falconi, Massimo

2014-01-01

334

Impact of simultaneous pancreas-kidney transplantation: patients’ perspectives  

PubMed Central

Background: Few qualitative studies of simultaneous pancreas-kidney transplantation (SPK Tx) have been published. The aims of this study were to explore from the perspective of patients, the experience of living with diabetes mellitus type 1 (T1DM), suffering from complications, and undergoing SPK Tx with good outcome; and to determine the impact of SPK Tx on patients and their social and cultural environment. Methods: We performed a focused ethnographic study. Twenty patients were interviewed. Data were analyzed using content analysis and constant comparison following the method proposed by Miles and Huberman. Results: A functioning SPK Tx allowed renal replacement therapy and insulin to be discontinued. To describe their new situation, patients used words and phrases such as “miracle”, “being reborn” or “coming back to life”. Although the complications of T1DM, its surgery and treatment, and associated psychological problems did not disappear after SPK Tx, these were minimized when compared with the pretransplantation situation. Conclusion: For patients, SPK Tx represents a recovery of their health and autonomy despite remaining problems associated with the complications of T1DM and SPK Tx. The understanding of patients’ existential framework and their experience of disease are key factors for planning new intervention and improvement strategies. PMID:22936846

Isla Pera, P; Moncho Vasallo, J; Guasch Andreu, O; Ricart Brulles, MJ; Torras Rabasa, A

2012-01-01

335

[Surgical therapy of intraductal papillary mucinous neoplasms of the pancreas].  

PubMed

Intraductal papillary mucinous neoplasms (IPMN) of the pancreas constitute an increasingly recognized entity of cystic pancreatic tumors which are characterized by mucin production and epithelial growth within the pancreatic ducts and show a wide spectrum of morphologic variants. They may arise in the main pancreatic duct, its major side branches or in both (mixed type). Furthermore, IPMNs are considered as precursor lesions to pancreatic adenocarcinoma. However, it is not clear what the time course of such potential neoplastic transformation might be and whether all lesions progress to malignant tumors. As currently no diagnostic test can reliably differentiate between benign and malignant tumors the majority of newly diagnosed IPMNs should be surgically resected. According to current treatment guidelines (Sendai criteria), only asymptomatic side branch IPMNs of less than 3 cm in diameter without suspicious radiologic features, such as nodules, thickness of the cystic wall or size progression, should be treated conservatively without the need for surgical resection. Recently, this approach has become controversial due to a relevant number of reported Sendai negative IPMNs which revealed malignant transformation on final histological examination. The focus of this review is on the surgical treatment of IPMNs with regard to the current state of knowledge. PMID:22271055

Fritz, S; Büchler, M W; Werner, J

2012-02-01

336

Molecular pathology of intraductal papillary mucinous neoplasms of the pancreas.  

PubMed

Since the first description of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas in the eighties, their identification has dramatically increased in the last decades, hand to hand with the improvements in diagnostic imaging and sampling techniques for the study of pancreatic diseases. However, the heterogeneity of IPMNs and their malignant potential make difficult the management of these lesions. The objective of this review is to identify the molecular characteristics of IPMNs in order to recognize potential markers for the discrimination of more aggressive IPMNs requiring surgical resection from benign IPMNs that could be observed. We briefly summarize recent research findings on the genetics and epigenetics of intraductal papillary mucinous neoplasms, identifying some genes, molecular mechanisms and cellular signaling pathways correlated to the pathogenesis of IPMNs and their progression to malignancy. The knowledge of molecular biology of IPMNs has impressively developed over the last few years. A great amount of genes functioning as oncogenes or tumor suppressor genes have been identified, in pancreatic juice or in blood or in the samples from the pancreatic resections, but further researches are required to use these informations for clinical intent, in order to better define the natural history of these diseases and to improve their management. PMID:25110429

Paini, Marina; Crippa, Stefano; Partelli, Stefano; Scopelliti, Filippo; Tamburrino, Domenico; Baldoni, Andrea; Falconi, Massimo

2014-08-01

337

A generic telemedicine infrastructure for monitoring an artificial pancreas trial.  

PubMed

Telemedicine systems are seen as a possible solution for the remote monitoring of physiological parameters and can be particularly useful for chronic patients treated at home. Implementing those systems however has always required spending a great effort on the underlying infrastructure instead of focusing on the application cores as perceived by their users. This paper proposes an abstract unifying infrastructure for telemedicine services which is loosely based on the multi-agent paradigm. It provides the capability of transferring to the clinic any remotely acquired information, and possibly sending back updates to the patient. The infrastructure is a layered one, with the bottom layer acting at the data level and implemented in terms of a software library targeting a wide set of hardware devices. On top of this infrastructure several services can be written shaping the functionality of the telemedicine application while at the highest level, adhering to a simple agent model, it is possible to reuse those functional components porting the application to different platforms. The infrastructure has been successfully used for implementing a telemonitoring service for a randomized controlled study aimed at testing the effectiveness of the artificial pancreas as a treatment within the AP@home project funded by the European Union. PMID:23415079

Capozzi, Davide; Lanzola, Giordano

2013-06-01

338

Adaptive control of artificial pancreas systems - a review.  

PubMed

Artificial pancreas (AP) systems offer an important improvement in regulating blood glucose concentration for patients with type 1 diabetes, compared to current approaches. AP consists of sensors, control algorithms and an insulin pump. Different AP control algorithms such as proportional-integral-derivative, model-predictive control, adaptive control, and fuzzy logic control have been investigated in simulation and clinical studies in the past three decades. The variability over time and complexity of the dynamics of blood glucose concentration, unsteady disturbances such as meals, time-varying delays on measurements and insulin infusion, and noisy data from sensors create a challenging system to AP. Adaptive control is a powerful control technique that can deal with such challenges. In this paper, a review of adaptive control techniques for blood glucose regulation with an AP system is presented. The investigations and advances in technology produced impressive results, but there is still a need for a reliable AP system that is both commercially viable and appealing to patients with type 1 diabetes. PMID:24691384

Turksoy, Kamuran; Cinar, Ali

2014-01-01

339

Clinical implications of pre-operative rapid BRAF analysis for papillary thyroid cancer.  

PubMed

The activating point mutation of the BRAF gene, BRAF(T1799A), is the most common and specific genetic alteration in adult papillary thyroid carcinoma (PTC) and a possible marker of malignant potential of PTC. We have applied the PCR-RFLP method using fine-needle aspiration biopsy samples not only to our clinical practice but also to the international medical assistance effort around the Semipalatinsk Nuclear Testing Site in Kazakhstan. Seventy-seven cases (100 nodules) from Japan and 131 cases (137 nodules) from Kazakhstan were examined. There were 14 Japanese and 76 Kazakhstani cases of cytological malignant tumors from the examined samples. We detected 12 (85.7% of PTC) and 19 (25% of PTC) cases with BRAF(T1799A) among the Japanese and Kazakhstani cases, respectively. Of these cases, we found mutations in one cytologically "suspicious" case and even in two pathologically "benign" cases (after surgery in Kazakhstan). All of the BRAF mutation-positive cases, including those three, were confirmed as PTC by careful pathological examination, including immunohistochemical analysis. In summary, our PCR-RFLP method for BRAF(T1799A) detection using FNAB samples is useful not only for preoperative diagnosis of PTC but also as a complementary diagnostic tool for accurate pathological diagnosis, even after surgery. PMID:17429154

Kumagai, Atsushi; Namba, Hiroyuki; Akanov, Zhanay; Saenko, Vladimir A; Meirmanov, Serik; Ohtsuru, Akira; Yano, Hiroshi; Maeda, Shigeto; Anami, Masanobu; Hayashi, Tomayoshi; Ito, Masahiro; Sagandikova, Sagadat; Eleubaeva, Zhanar; Mussinov, Daniyal; Espenbetova, Maira; Yamashita, Shunichi

2007-06-01

340

Effect of preoperative sonographic mapping on vascular access outcomes in hemodialysis patients  

Microsoft Academic Search

Effect of preoperative sonographic mapping on vascular access outcomes in hemodialysis patients.BackgroundCurrent DOQI guidelines encourage placing arteriovenous (AV) fistulas in more hemodialysis patients. However, many new fistulas fail to mature sufficiently to be useable for hemodialysis. Preoperative vascular mapping to identify suitable vessels may improve vascular access outcomes. The present study prospectively evaluated the effect of routine preoperative vascular mapping

Michael Allon; Mark E. Lockhart; Regina Z. Lilly; Michael H. Gallichio; Carlton J. Young; Jill Barker; Mark H. Deierhoi; Michelle L. Robbin

2001-01-01

341

Enigmatic Ectopic Fat: Prevalence of Nonalcoholic Fatty Pancreas Disease and Its Associated Factors in a Chinese Population  

PubMed Central

Background Fatty infiltration of the pancreas is an enigmatic manifestation of ectopic fat deposition in obesity. Studies have shown that pancreatic lipid accumulation interferes with insulin secretion in humans. However, the prevalence of fatty pancreas and its associated factors in the general population remain unclear. The aim of this study was to investigate the prevalence of fatty pancreas and its association with diabetes, nonalcoholic fatty liver disease (NAFLD), and cardiometabolic risk factors in a Chinese population. Methods and Results This was a cross?sectional study. A total of 8097 subjects with or without fatty pancreas (n=1297 and 6800, respectively) were recruited. Each subject was assessed by using abdominal sonography to diagnose NAFLD and fatty pancreas. Clinical and metabolic parameters were compared between groups, and their associations with fatty pancreas were examined. The prevalence of fatty pancreas was 16%. The fatty pancreas group had a significantly greater proportion of subjects with diabetes (12.6% versus 5.2%) and NAFLD (67.2% versus 35.1%) than did the non–fatty pancreas group (P<0.001). In the logistic regression analysis, age (P<0.001), general or central obesity (P<0.001), diabetes (P<0.001), and NAFLD (P<0.001) were independently associated with fatty pancreas after adjustment for sex, lipid profile, alanine transaminase/aspartate transaminase ratio, hypertension, smoking, alcohol drinking, and exercise. Conclusions The prevalence of fatty pancreas is high in the general population. Both diabetes and NAFLD are important associated factors of fatty pancreas, independent of age, sex, adiposity, and other cardiometabolic risk factors. PMID:24572250

Wang, Chih?Yuan; Ou, Horng?Yih; Chen, Ming?Fong; Chang, Tien?Chun; Chang, Chih?Jen

2014-01-01

342

Diagnosis of a sigmoid volvulus in pregnancy: ultrasonography and magnetic resonance imaging findings  

PubMed Central

Sigmoid volvulus complicating pregnancy is a rare, non-obstetric cause of abdominal pain that requires prompt surgical intervention (decompression) to avoid intestinal ischemia and perforation. We report the case of a 31-week pregnant woman with abdominal pain and subsequent development of constipation. Preoperative diagnosis was achieved using magnetic resonance imaging and ultrasonography: the large bowel distension and a typical whirl sign - near a sigmoid colon transition point - suggested the diagnosis of sigmoid volvulus. The decision to refer the patient for emergency laparotomy was adopted without any ionizing radiation exposure, and the pre-operative diagnosis was confirmed after surgery. Imaging features of sigmoid volvulus and differential diagnosis from other non-obstetric abdominal emergencies in pregnancy are discussed in our report, with special emphasis on the diagnostic capabilities of ultrasonography and magnetic resonance imaging. PMID:24967020

Palmucci, Stefano; Lanza, Maria Letizia; Gulino, Fabrizio; Scilletta, Beniamino; Ettorre, Giovanni Carlo

2014-01-01

343

[Autoimmune pancreatitis is a differential diagnosis to pancreatic cancer.  

PubMed

Autoimmune pancreatitis is a rare benign inflammatory disease, treated with steroids. It consists of two clinical and histological distinct types, type 1 and type 2. Type 1 is part of an IgG4-related multiorgan disease, while type 2 is pancreas-specific. We here present a case of each type illustrating the difficult diagnostic process and how it can be misinterpreted as pancreatic carcinoma or cholangiocarcinoma. Though autoimmune pancreatitis is rare it should be considered as a differential diagnosis to pancreatic cancer. PMID:25354007

Rode, Anne A; Bremholm, Lasse

2014-10-27

344

The role of N-cadherin and S1P/S1P1 in pancreas development.  

E-print Network

??Organogenesis of epithelial organs requires interaction between epithelial and mesenchymal tissues. During pancreas development, mesenchyme-derived structures induce specification, growth and differentiation of pancreatic epithelial cells.… (more)

Johansson, Jenny

2010-01-01

345

The use of pre-operative computed tomography in the assessment of the acute abdomen  

PubMed Central

INTRODUCTION While there are a lot of data on the accuracy of computed tomography (CT) in diagnosing specific causes of an acute abdomen, there is very little information on the accuracy of CT in the acute general surgical admissions workload. We look at the diagnostic accuracy of CT in patients presenting with an acute abdomen who ultimately required a laparotomy. METHODS Patients who underwent an emergency laparotomy between 2008 and 2010 at Eastbourne District General Hospital with pre-operative CT on the same admission were included in the study. The CT report was compared with the laparotomy and histology findings and, where a discrepancy existed, the original imaging was reviewed by a senior consultant blinded to the original report and laparotomy findings. RESULTS A total of 196 emergency laparotomies were performed over the 2–year period, with 112 patients undergoing pre-operative CT. Fifteen patients were excluded from the study due to missing notes. In the remaining 97 patients, 80 CT reports correlated with the final operative diagnosis, giving a diagnostic accuracy of 82%. Of these, the on-call registrar was the initial reporter in 37 scans, with a diagnostic accuracy of 78%. On review of the CT by a second consultant, this increased to 90 correlations, yielding an accuracy of 93%. Delay between CT and the operation did not significantly alter diagnostic accuracy, nor was there any statistically significant reduction in accuracy in reports issued by on-call registrars. CONCLUSIONS On first reporting, CT misses 18% of diagnoses that ultimately require operative intervention. Reducing the threshold for obtaining a second consultant radiologist review significantly improves the diagnostic accuracy to 93%. PMID:22391377

Weir-McCall, J; Shaw, A; Arya, A; Knight, A; Howlett, DC

2012-01-01

346

Secretion of electrolytes by the pancreas of the anaestetized rat.  

PubMed Central

1. HCO-3, Na+ and K+ concentrations were measured in bile-free pancreatic juice collected from fasted and fed anaesthetized rats. 2. Resting flow rates averaged 0.62 mul. g-1 .min-1 (fasted) and 2.8 mul. g-1. min-1 (fed) and the mean HCO-3 concentrations, respectively, were 25.8 and 33.3 mM. 3. In fasted rats, instillation of HCl into the duodenum caused flow rate to increase threefold and HCO-3 concentrations to double (66 mM). Intravenous infusion of pure natural (GIH) secretin caused a fivefold increase in flow rate; HCO-3 concentrations, again, doubled (67.5 mM). Infusion of synthetic secretin produced effects essentially the same as those produced by GIH secretin. 4. Infusion of Boots secretin caused a thirteenfold increase in flow rate (8.32 mul.g-1. min-1) but HCO-3 concentrations rose only slightly (43.3 mM). However, following cessation of infusion, when flow rate approximated the maximum obtained with pure secretin, the HCO-3 concentration was much higher (57.2 mM at 3.19 uml.g-1.min-1). In fed animals the responses were similar but maximum flow rates were greater (12 mul. g-1. min-1). 5. Infusion of caerulein produced a secretory rate slightly less than with Boots secretin (5.06 mul. g-1.min-1) and HCO-3 concentrations were plasmalike (30.2 mM); infusion of the synthetic octapeptide of cholecystokinin (OP-CCK) gave similar flow rates and HCO-3 concentrations. 6. Infusion of a mixture of caerulein and GIH secretin mimicked closely the effect of Boots secretin. At maximum flow rates (7.6 mul. g-1. min-1) the HCO-3 concentration was 43.7 mM and at lower flow rates (3.90 mul.g-1. min-1) it rose to 54.2mM. 7. It is concluded that the response of the rat pancreas to secretin is qualitatively similar to that of all other vertebrates so far studied, but, relative to other animals, the response is sluggish. In contrast, the rat pancreas responds well to cholecystokinin (CCK) stimulation, yielding a juice with plasma-like HCO-3 concentration. Boots secretin, which is heavily contaminated with CCK, causes a mixed response resembling that of CCK at high secretory rates and that of pure secretin at lower rates. 8. An unexplained feature of rat pancreatic juice was that K+ concentrations, although plasma-like in unstimulated samples, rose to about 8mM when flow rate increases as a result of secretin, but not CCK, stimulation. In all other animals so far studied, the K+ concentration has been found to be independent of flow rate. PMID:1206529

Sewell, W A; Young, J A

1975-01-01

347

Human ductal adenocarcinomas of the pancreas express extracellular matrix proteins.  

PubMed Central

Pancreatic ductal adenocarcinomas are characterised by a dense connective tissue reaction. To test the hypothesis that stroma components are synthesised and produced by the tumour cells themselves, eight cell lines as well as six xenografted tumours from human ductal adenocarcinomas of the pancreas were examined for the expression of extracellular matrix proteins (ECM), using cDNA probes and antibodies to collagen types I, III and IV, vitronectin, fibronectin, undulin and laminin. All tumour cell lines (CAPAN-1, CAPAN-2, AsPC-1, BxPC-3, PANC-1, PaCa-2, PaCa-3, PaCa-44) and xenografted human pancreatic tumours expressed at least one of the examined ECM at the RNA (collagen type IV > laminin = fibronectin = vitronectin > collagen type III > undulin > collagen type I) or protein level (collagen type IV = collagen type III > vitronectin > laminin > collagen type I = fibronectin > undulin). In nude mouse tumours expression of laminin and collagen I was most pronounced in well-differentiated carcinomas. In a few tumours, collagen type III, vitronectin and undulin were expressed on the luminal side of the neoplastic glands, suggesting loss of normal polar differentiation. Incubation with fetal calf serum modulated ECM RNA levels to a varying extent in all but one cell line (AsPC-1). The results suggest that human pancreatic ductal adenocarcinomas cells are capable of synthesising and producing extracellular matrix proteins in vitro and in vivo, but that the extent and pattern of ECM expression differs between the various tumours and conditions tested. Images Figure 1 Figure 2 Figure 3 Figure 4 PMID:8286197

Löhr, M.; Trautmann, B.; Göttler, M.; Peters, S.; Zauner, I.; Maillet, B.; Klöppel, G.

1994-01-01

348

Mechanisms of Action of GLP-1 in the Pancreas  

PubMed Central

Glucagon-like peptide-1 is a hormone that is encoded in the proglucagon gene. It is mainly produced in enteroendocrine L cells of the gut and is secreted into the blood stream when food containing fat, protein hydrolysate and/or glucose enters the duodenum. Its particular effects on insulin and glucagon secretion have generated a flurry of research activity over the past twenty years culminating in a naturally occurring GLP-1 receptor agonist, exendin-4, now being used to treat type 2 diabetes. GLP-1 engages a specific G-protein coupled receptor that is present in tissues other than the pancreas (brain, kidney, lung, heart, major blood vessels). The most widely studied cell activated by GLP-1 is the insulin-secreting beta cell where its defining action is augmentation of glucose-induced insulin secretion. Upon GLP-1 receptor activation, adenylyl cyclase is activated and cAMP generated, leading, in turn, to cAMP-dependent activation of second messenger pathways, such as the PKA and Epac pathways. As well as short-term effects of enhancing glucose-induced insulin secretion, continuous GLP-1 receptor activation also increases insulin synthesis, and beta cell proliferation and neogenesis. Although these latter effects cannot be currently monitored in humans, there are substantial improvements in glucose tolerance and increases in both first phase and plateau phase insulin secretory responses in type 2 diabetic patients treated with exendin-4. This review we will focus on the effects resulting from GLP-1 receptor activation in islets of Langerhans PMID:17306374

Doyle, Máire E.; Egan, Josephine M.

2007-01-01

349

Preoperative evaluation of cystic teratoma: what does color Doppler add?  

PubMed

The aim of this prospective study lasting 4 years was to develop a scoring system using clinical parameters, sonographic findings, and transvaginal color and pulsed Doppler impedance values for the preoperative recognition of cystic teratoma. A total of 887 benign and malignant adnexal masses, among which 102 were histologically proved to be cystic teratomas, were evaluated. Using morphological criteria, cystic teratoma was successfully predicted in 95 patients. The sensitivity and specificity of a morphological scoring system were 93.1% and 99.4%, respectively, while positive and negative predictive values were 95.0% and 99.1%. A scoring system using both morphology and vascular assessment demonstrated higher sensitivity and specificity (99.02%, 99.75%). The application of a scoring system combining morphology and vascularity improves the accuracy of diagnosing cystic teratoma and of separating this entity preoperatively from other benign and malignant ovarian conditions. PMID:9142626

Kurjak, A; Kupesic, S; Babic, M M; Goldenberg, M; Illijas, M; Kosuta, D

1997-01-01

350

Review of preoperative transarterial chemoembolization for resectable hepatocellular carcinoma  

PubMed Central

Hepatocellular carcinoma (HCC) is one of the few cancers whose incidence has been continually increasing over recent years. Resection of HCC offers the only hope for cure. However, recurrences are common in patients who have undergone resection. In our opinion, the effectiveness with which transarterial chemoembolization (TACE) as a neoadjuvant therapy for resectable HCC prevents recurrence and prolongs survival has not been conclusively demonstrated. All published meta-analyses have consistently failed to demonstrate that preoperative TACE improves the prognosis of resectable HCC. We believe that these published articles have several limitations and have our own views about the results of meta-analyses. It is very important that the scientific community shed more light on the pathogenesis of HCC and relate this to choice of therapy. This review mainly concerns our understanding of preoperative TACE for resectable HCC and briefly addresses desirable directions for future studies. PMID:25624995

Gao, Zhi-Hui; Bai, Dou-Sheng; Jiang, Guo-Qing; Jin, Sheng-Jie

2015-01-01

351

Clinical evaluation of preoperative liver scintigraphy in gastric carcinoma patients.  

PubMed

The surgical and liver scintigraphic findings were compared for evaluation of preoperative diagnostic value in 150 cases of gastric carcinoma with extension to the muscularis and serosa. There was correlation in 90 per cent of the cases, with a false negative rate of 16 per cent, and a false positive rate of 6.6 per cent. Liver metastases were detected in 89 per cent, when the liver was palpable, compared to 75 per cent in those with nonpalpable livers. Four of the 150 cases had small scintigraphically undetectable metastatic foci. Although search for liver metastases at laparotomy may be inconclusive in confirming the presence of metastases, our scintigraphic detection rate correlated closely with the surgical findings. Preoperative liver scintigraphy is therefore considered to be of great diagnostic value. PMID:4432953

Watanabe, K; Kawahira, K; Matsuura, K

1974-08-01

352

[Preoperative esophagogastroduodenoscopy before elective surgical therapy of symptomatic cholelithiasis].  

PubMed

We evaluated the data of 1143 patients who underwent preoperative gastroscopy or upper gastrointestinal series before elective surgical treatment of cholelithiasis between January 1, 1981 and December 31, 1990. On these 824 women and 319 men we performed 1064 (93.1%) gastroscopies and only 78 (6.8%) upper gastrointestinal series. The incidence of pathological findings was 30.2% (345 patients), with 68.3% findings of inflammatory nature. In 28 patients (2.5%) cholecystectomy or bile duct exploration was combined with an additional gastrointestinal surgical procedure. In 227 cases (19.8%) biliary surgery was followed by pharmacological treatment of the gastrointestinal disease. Because of the high incidence of simultaneous disease of the upper gastrointestinum we believe that routine preoperative gastroscopy is indicated before elective surgical treatment of cholelithiasis. PMID:1479867

Schwenk, W; Böhm, B; Badke, A; Zarras, K; Stock, W

1992-11-01

353

Lessons Learned From More Than 1,000 Pancreas Transplants at a Single Institution  

PubMed Central

Objective To determine outcome in diabetic pancreas transplant recipients according to risk factors and the surgical techniques and immunosuppressive protocols that evolved during a 33-year period at a single institution. Summary Background Data Insulin-dependent diabetes mellitus is associated with a high incidence of management problems and secondary complications. Clinical pancreas transplantation began at the University of Minnesota in 1966, initially with a high failure rate, but outcome improved in parallel with other organ transplants. The authors retrospectively analyzed the factors associated with the increased success rate of pancreas transplants. Methods From December 16, 1966, to March 31, 2000, the authors performed 1,194 pancreas transplants (111 from living donors; 191 retransplants): 498 simultaneous pancreas–kidney (SPK) and 1 simultaneous pancreas–liver transplant; 404 pancreas after kidney (PAK) transplants; and 291 pancreas transplants alone (PTA). The analyses were divided into five eras: era 0, 1966 to 1973 (n = 14), historical; era 1, 1978 to 1986 (n = 148), transition to cyclosporine for immunosuppression, multiple duct management techniques, and only solitary (PAK and PTA) transplants; era 2, 1986 to 1994 (n = 461), all categories (SPK, PAK, and PTA), predominately bladder drainage for graft duct management, and primarily triple therapy (cyclosporine, azathioprine, and prednisone) for maintenance immunosuppression; era 3, 1994 to 1998 (n = 286), tacrolimus and mycophenolate mofetil used; and era 4, 1998 to 2000 (n = 275), use of daclizumab for induction immunosuppression, primarily enteric drainage for SPK transplants, pretransplant immunosuppression in candidates awaiting PTA. Results Patient and primary cadaver pancreas graft functional (insulin-independence) survival rates at 1 year by category and era were as follows: SPK, era 2 (n = 214) versus eras 3 and 4 combined (n = 212), 85% and 64% versus 92% and 79%, respectively; PAK, era 1 (n = 36) versus 2 (n = 61) versus 3 (n = 84) versus 4 (n = 92), 86% and 17%, 98% and 59%, 98% and 76%, and 98% and 81%, respectively; in PTA, era 1 (n = 36) versus 2 (n = 72) versus 3 (n = 30) versus 4 (n = 40), 77% and 31%, 99% and 50%, 90% and 67%, and 100% and 88%, respectively. In eras 3 and 4 combined for primary cadaver SPK transplants, pancreas graft survival rates were significantly higher with bladder drainage (n = 136) than enteric drainage (n = 70), 82% versus 74% at 1 year (P = .03). Increasing recipient age had an adverse effect on outcome only in SPK recipients. Vascular disease was common (in eras 3 and 4, 27% of SPK recipients had a pretransplant myocardial infarction and 40% had a coronary artery bypass); those with no vascular disease had significantly higher patient and graft survival rates in the SPK and PAK categories. Living donor segmental pancreas transplants were associated with higher technically successful graft survival rates in each era, predominately solitary (PAK and PTA) in eras 1 and 2 and SPK in eras 3 and 4. Diabetic secondary complications were ameliorated in some recipients, and quality of life studies showed significant gains after the transplant in all recipient categories. Conclusions Patient and graft survival rates have significantly improved over time as surgical techniques and immunosuppressive protocols have evolved. Eventually, islet transplants will replace pancreas transplants for suitable candidates, but currently pancreas transplants can be applied and should be an option at all stages of diabetes. Early transplants are preferable for labile diabetes, but even patients with advanced complications can benefit. PMID:11303130

Sutherland, David E. R.; Gruessner, Rainer W. G.; Dunn, David L.; Matas, Arthur J.; Humar, Abhinav; Kandaswamy, Raja; Mauer, S. Michael; Kennedy, William R.; Goetz, Frederick C.; Robertson, R. Paul; Gruessner, Angelika C.; Najarian, John S.

2001-01-01

354

Missed curable carcinoma of the pancreas presenting as chronic pancreatitis.  

PubMed Central

We present a case of pancreatic malignancy which presented as chronic pancreatitis. The diagnostic difficulties are discussed. We recommend that when there is any doubt about a diagnosis of chronic pancreatitis with a pancreatic mass, then early resection is appropriate. Images Figure 1 Figure 2 Figure 3 Figure 4 PMID:9373601

Wharton, S. M.; Rahman, Z.; Johnson, C. D.

1997-01-01

355

Preoperative pulmonary assessment for patients with hip fracture  

Microsoft Academic Search

Hip fracture is a common injury among the elderly. Although patients who receive hip fracture surgery carry the best functional\\u000a recovery compared to other treatment modalities, the presence of postoperative pulmonary complications, such as atelectasis,\\u000a pneumonia, and pulmonary thromboembolism, may contribute to increased length of hospital stay, perioperative morbidity, and\\u000a mortality. This review aims to provide evidence-based recommendations for preoperative

I.-L. Lo; C.-W. Siu; H.-F. Tse; T.-W. Lau; F. Leung; M. Wong

2010-01-01

356

Comparison of oral lavage methods for preoperative colonic cleansing  

Microsoft Academic Search

Polyethylene glycol electrolyte lavage solution was compared with a 10 percent mannitol solution for preoperative colonic\\u000a cleansing. Eighty patients were prepared randomly with one of these solutions on the afternoon prior to surgery. Colonic cleansing\\u000a was better with polyethylene glycol electrolyte lavage (90 percent optimal cleansingvs. 75 percent). Analysis of hematologic, biochemical, and weight changes before and after the bowel

David E. Beck; Victor W. Fazio; David G. Jagelman

1986-01-01

357

Preoperative portal vein embolization using an amplatzer vascular plug  

Microsoft Academic Search

The purpose was to evaluate the safety and efficacy of preoperative portal vein embolization (PVE) using an Amplatzer vascular\\u000a plug (AVP). Forty-one patients who underwent PVE using gelatin sponge particles and the AVP were enrolled. The right portal\\u000a branches were embolized using gelatin sponges (1–8 mm3) through a 5-F catheter, and the AVP was deployed at the first- or second-order right

Hyunkyung Yoo; Gi-Young Ko; Dong Il Gwon; Jin-Hyoung Kim; Hyun-Ki Yoon; Kyu-Bo Sung; Namguk Kim; Jeongjin Lee

2009-01-01

358

Preoperative chemotherapy for lung cancer does not increase surgical morbidity  

Microsoft Academic Search

Background. Preoperative chemotherapy (C+S) for non–small cell lung cancer (NSCLC) has increased in an attempt to improve survival. Patients receiving C+S potentially may have an increase in postoperative morbidity and mortality compared with surgery alone (S). We reviewed our experience with C+S and S in a tertiary referral center.Methods. Three hundred eighty consecutive patients underwent lobectomy or greater resection for

Michael P Siegenthaler; Katherine M Pisters; Kelly W Merriman; Jack A Roth; Stephen G Swisher; Garrett L Walsh; Ara A Vaporciyan; W. Roy Smythe; Joe B Putnam

2001-01-01

359

Prognostic value of preoperative serum tumor markers in gastric cancer  

PubMed Central

AIM: To evaluate the prognostic value of preoperative carcinoembryonic antigen (CEA), carbohydrate antigen (CA)19-9, and CA50 in patients undergoing D2 resection. METHODS: We evaluated 363 patients with gastric cancer who underwent gastrectomy at our hospital from January 2006 to December 2009. Blood samples were obtained from each patient within 1 wk before surgery. The cut-off values for serum CEA, CA19-9, and CA50 were 5 ng/mL, 37 U/mL, and 20 U/mL, respectively. The correlation between preoperative tumor marker levels and prognosis was studied by means of univariate and multivariate analyses. RESULTS: The preoperative serum positive rates of CEA, CA19-9 and CA50 were 24.0%, 18.9% and 24.5%, respectively. The positivity rate of serum CEA was significantly correlated with age (P < 0.001), sex (P = 0.022), tumor size (P = 0.007) and depth of invasion (P = 0.018); CA19-9 with tumor size (P = 0.042) and lymph node metastasis (P < 0.001); and CA50 only with lymph node metastasis (P = 0.001). In multivariate analysis, tumor size, T category, N category, vascular or neural invasion, and adjuvant chemotherapy were independent prognostic factors for overall survival. CA19-9 had an independent prognostic significance in patients without adjuvant chemotherapy (P = 0.027). CONCLUSION: Preoperative serum CEA, CA19-9 and CA50 are prognostic in patients with gastric cancer. Only CA19-9 is an independent prognostic factor after surgery without adjuvant chemotherapy. PMID:24829865

Huang, Ze-Bo; Zhou, Xin; Xu, Jun; Du, Yi-Ping; Zhu, Wei; Wang, Jian; Shu, Yong-Qian; Liu, Ping

2014-01-01

360

Preoperative fasting: current practice and areas for improvement.  

PubMed

Preoperative fasting aims to increase patient safety by reducing the risk of adverse events during general anaesthesia. However, prolonged fasting may be associated with dehydration, hypoglycaemia and electrolyte imbalance as well as patient discomfort. We aimed to examine compliance with the current best practice guidelines in a large surgical unit and to identify areas for improvement. Adult patients undergoing elective and emergency general, orthopaedic, gynaecology and vascular surgery procedures in the Royal Infirmary of Edinburgh were surveyed over a 3-month period commencing November 2011. A standardised questionnaire was used to collect information on the duration of preoperative fasting and the advice administered by medical and nursing staff. 292 patients were included. Median fast from solids was 13.5 h for elective patients (IQR 11.5-16) and 17.38 h for emergency patients (IQR 13.68-28.5 h). Similarly, the median fast from fluids was 9.36 h for elective patients (IQR 5.38-12.75 h) and 12.97 h for emergency patients (IQR 8.5-16.22 h). The instructions that elective patients received contributed to prolonged fasting times. The median fast for elective patients fully compliant with fasting advice would be 10 h for solids (IQR 8.75-12 h) and 6.25 h (IQR 3.83-9.25 h) for clear fluids. Elective patients fasted for longer than recommended confirming that clinical practice is slow to change. The use of universal fasting instructions and patient choice are factors that unnecessarily prolong preoperative fasting, which however appears to be multifactorial. Service improvement by abbreviation of the observed fasting periods will rely on targeted staff education and effective clinical communication by provision of written information for both elective and emergency surgical patients. The routine use of preoperative nutritional supplements may need to be re-examined when further evidence is available. PMID:24346767

Falconer, R; Skouras, C; Carter, T; Greenway, L; Paisley, A M

2014-03-01

361

Preoperative staging of rectal cancer by intrarectal ultrasound  

Microsoft Academic Search

Digital examination and computed tomography are the current modalities employed to assess the depth of invasion of rectal\\u000a cancer. Each technique has limitations in that high rectal tumors cannot be examined digitally and CT is unable to detect\\u000a small tumors. However, preoperative diagnostic capability can be improved with the use of intrarectal ultrasound. We have\\u000a examined 25 patients with rectal

U. Hildebrandt; G. Feifel

1985-01-01

362

Preoperative Anxiety and Emergence Delirium and Postoperative Maladaptive Behaviors  

Microsoft Academic Search

Based on previous studies, we hypothesized that the clinicalphenomenaofpreoperativeanxiety,emergence delirium, and postoperative maladaptive behavioral changes were closely related. We examined this issue using data obtained by our laboratory over the past 6 years. Only children who underwent surgery and gen- eral anesthesia using sevoflurane\\/O2\\/N2O and who did not receive midazolam were recruited. Children's anxiety was assessed preoperatively with the modified

Zeev N. Kain; Alison A. Caldwell-Andrews; Inna Maranets; Brenda McClain; Dorothy Gaal; Linda C. Mayes; Rui Feng; Heping Zhang

2004-01-01

363

Necrotizing pancreatitis: diagnosis, imaging, and intervention.  

PubMed

Acute necrotizing pancreatitis is a severe form of acute pancreatitis characterized by necrosis in and around the pancreas and is associated with high rates of morbidity and mortality. Although acute interstitial edematous pancreatitis is diagnosed primarily on the basis of signs, symptoms, and laboratory test findings, the diagnosis and severity assessment of acute necrotizing pancreatitis are based in large part on imaging findings. On the basis of the revised Atlanta classification system of 2012, necrotizing pancreatitis is subdivided anatomically into parenchymal, peripancreatic, and combined subtypes, and temporally into clinical early (within 1 week of onset) and late (>1 week after onset) phases. Associated collections are categorized as "acute necrotic" or "walled off" and can be sterile or infected. Imaging, primarily computed tomography and magnetic resonance imaging, plays an essential role in the diagnosis of necrotizing pancreatitis and the identification of complications, including infection, bowel and biliary obstruction, hemorrhage, pseudoaneurysm formation, and venous thrombosis. Imaging is also used to help triage patients and guide both temporizing and definitive management. A "step-up" method for the management of necrotizing pancreatitis that makes use of imaging-guided percutaneous catheter drainage of fluid collections prior to endoscopic or surgical necrosectomy has been shown to improve clinical outcomes. The authors present an algorithmic approach to the care of patients with necrotizing pancreatitis and review the use of imaging and interventional techniques in the diagnosis and management of this pathologic condition. PMID:25208277

Shyu, Jeffrey Y; Sainani, Nisha I; Sahni, V Anik; Chick, Jeffrey F; Chauhan, Nikunj R; Conwell, Darwin L; Clancy, Thomas E; Banks, Peter A; Silverman, Stuart G

2014-01-01

364

Establishment of a prolonged pancreas preservation model for islet isolation research in mice.  

PubMed

Establishing a prolonged pancreas preservation model in a small animal is important for islet isolation research. Use of a rat pancreas model has been reported, but no published reports have used a mouse pancreas for prolonged cold preservation prior to islet isolation. For the model, a mouse is preferred over a rat because of its small size, well-known immune characterization, and variety of gene-modulated models. In the present study, we established a prolonged pancreas preservation model in a mouse for islet isolation research. The collagenase solution was injected successfully after 24 and 48 h cold preservations in University of Wisconsin solution, and islets could be isolated from both groups of preserved pancreata. The islet yields from the control, 24 h preserved, and 48 h preserved pancreata were 183.9 ± 13.9, 128.5 ± 15.5, and 24.6 ± 12.9 per pancreas, respectively. The propidium iodide-positive area assay was significantly increased in both preserved groups, and insulin secretion levels in response to 20.0 mM glucose and stimulation indices were significantly decreased in the 48 h preserved group. Inflammation-related genes mRNA levels were significantly upregulated in the 24 h preserved group, as previously shown in the human model. Thus, this model might be useful for prehuman islet isolation screening research, reserving research using human pancreata for the most promising approaches. PMID:22045261

Itoh, Takeshi; Sugimoto, Koji; Shimoda, Masayuki; Chujo, Daisuke; Takita, Morihito; Iwahashi, Shuichi; Kanak, Mazhar; Yoshiko, Tamura; Naziruddin, Bashoo; Levy, Marlon F; Matsumoto, Shinichi

2011-01-01

365

GPRC6A mediates responses to osteocalcin in ?-cells in vitro and pancreas in vivo.  

PubMed

A bone-pancreas endocrine loop has been identified recently that involves insulin secreted from ?-cells in the pancreas stimulating insulin receptors in osteoblasts, leading to osteoblastic differentiation and increased secretion of osteocalcin (Ocn), a bone-derived hormone that regulates insulin secretion in ?-cells. The identity of the Ocn-sensing receptor in ?-cells is a missing component of this endocrine loop. The abnormalities in glucose homeostasis in Gprc6a null mice suggests that this pertussis toxin-sensitive G protein-coupled receptor is a candidate for mediating the effects of Ocn on insulin secretion in the pancreas. In support of this possibility, we found that transfection of non-Gprc6a-expressing HEK-293 cells with a full-length Gprc6a cDNA imparted a dose-dependent response to Ocn (5 to 60 ng/mL), as measured by PKD1 and ERK phosphorylation. In addition, Gprc6a is highly expressed in mouse pancreatic tissue and in the mouse TC-6 pancreatic ?-cell line. Ocn also stimulated ERK activity in TC-6 pancreatic ?-cells. Finally, intraperitoneal injection of Ocn stimulated ERK activity in the pancreas and increased serum insulin levels in wild-type mice, but these responses were markedly attenuated in Gprc6a(-/-) mice. These findings suggest that GPRC6A is a candidate for mediating the response to Ocn in the bone-pancreas endocrine loop regulating insulin signaling. PMID:21425331

Pi, Min; Wu, Yunpeng; Quarles, L Darryl

2011-07-01

366

The artificial pancreas: current status and future prospects in the management of diabetes.  

PubMed

Recent advances in insulins, insulin pumps, continuous glucose-monitoring systems, and control algorithms have resulted in an acceleration of progress in the development of artificial pancreas devices. This review discusses progress in the development of external systems that are based on subcutaneous drug delivery and subcutaneous continuous glucose monitoring. There are two major system-level approaches to achieving closed-loop control of blood glucose in diabetic individuals. The unihormonal approach uses insulin to reduce blood glucose and relies on complex safety mitigation algorithms to reduce the risk of hypoglycemia. The bihormonal approach uses both insulin to lower blood glucose and glucagon to raise blood glucose, and also relies on complex algorithms to provide for safety of the user. There are several major strategies for the design of control algorithms and supervision control for application to the artificial pancreas: proportional-integral-derivative, model predictive control, fuzzy logic, and safety supervision designs. Advances in artificial pancreas research in the first decade of this century were based on the ongoing computer revolution and miniaturization of electronic technology. The advent of modern smartphones has created the ability to utilize smartphone technology as the engineering centerpiece of an artificial pancreas. With these advances, an artificial or bionic pancreas is within reach. PMID:24725149

Peyser, Thomas; Dassau, Eyal; Breton, Marc; Skyler, Jay S

2014-04-01

367

Psychologists in preoperative programmes for children undergoing surgery.  

PubMed

This study aimed to verify whether psychologists and game activities could reduce preoperative anxiety and promote compliance in paediatric patients. More specifically, we sought to evaluate whether it would be better to propose contextualized games or just distracting activities. A total of 104 children undergoing surgery were assigned to the following 4 conditions of treatment: (1) contextual games and psychological accompaniment, (2) only contextual games, (3) distracting activities, and (4) only psychological accompaniment. Observed children's anxiety was assessed using modified Yale Preoperative Anxiety Scale and compliant behaviours with modified form of Induction Compliance Checklist. Children in the first condition (complete intervention - contextual games and psychological accompaniment) were less anxious and more cooperative in the preoperative period and during the induction of anaesthesia than in the other three conditions. In particular, contextual activities (second condition) were found to be more efficient than psychological accompaniment (fourth condition), whereas the worst condition was proposing only distracting activities (third condition). In order to help young hospitalized patients in paediatric surgery structures, it is necessary to propose games that can prepare them for what will happen as well as the support of a psychologist. PMID:25469004

Cuzzocrea, Francesca; Costa, Sebastiano; Gugliandolo, Maria Cristina; Larcan, Rosalba

2014-12-01

368

Preoperative staging of rectal cancer: the MERCURY research project.  

PubMed

The development of a surgical technique that removes the tumour and all local draining nodes in an intact package, namely total mesorectal excision (TME) surgery, has provided the impetus for a more selective approach to the administration of preoperative therapy. One of the most important factors that governs the success of TME surgery is the relationship of tumour to the circumferential resection margin (CRM). Tumour involves the CRM in up to 20% of patients undergoing TME surgery, and results in both poor survival and local recurrence. It is therefore clear that the importance of the decision regarding the use of pre-operative therapy lies with the relationship of the tumour to the mesorectal fascia. In addition, a high-spatial-resolution MRI technique will identify tumours exhibiting other poor prognostic features, namely, extramural spread >5 mm, extramural venous invasion by tumour, nodal involvement, and peritoneal infiltration. The potential benefits of a selective approach using MRI-based selection criteria are evident. That is, over 50% of patients can be treated successfully with primary surgery alone without significant risk of local recurrence or systemic failure. Of the remainder, potentially dramatic improvements may be achieved through the use of intensive and targeted preoperative therapy aimed not only at reducing the size of the primary tumour and rendering potentially irresectable tumour resectable with tumour-free circumferential margins, but also at enabling patients at high risk of systemic failure to benefit from intensive combined modality therapy aimed at eliminating micrometastatic disease. PMID:15865021

Brown, G; Daniels, I R

2005-01-01

369

Preoperative biliary drainage in hilar cholangiocarcinoma: When and how?  

PubMed Central

Hilar cholangiocarcinoma is a tumor of the extrahepatic bile duct involving the left main hepatic duct, the right main hepatic duct, or their confluence. Biliary drainage in hilar cholangiocarcinoma is sometimes clinically challenging because of complexities associated with the level of biliary obstruction. This may result in some adverse events, especially acute cholangitis. Hence the decision on the indication and methods of biliary drainage in patients with hilar cholangiocarcinoma should be carefully evaluated. This review focuses on the optimal method and duration of preoperative biliary drainage (PBD) in resectable hilar cholangiocarcinoma. Under certain special indications such as right lobectomy for Bismuth type IIIA or IV hilar cholangiocarcinoma, or preoperative portal vein embolization with chemoradiation therapy, PBD should be strongly recommended. Generally, selective biliary drainage is enough before surgery, however, in the cases of development of cholangitis after unilateral drainage or slow resolving hyperbilirubinemia, total biliary drainage may be considered. Although the optimal preoperative bilirubin level is still a matter of debate, the shortest possible duration of PBD is recommended. Endoscopic nasobiliary drainage seems to be the most appropriate method of PBD in terms of minimizing the risks of tract seeding and inflammatory reactions. PMID:24634710

Paik, Woo Hyun; Loganathan, Nerenthran; Hwang, Jin-Hyeok

2014-01-01

370

Pitfalls in the surgical management of undifferentiated sarcoma of the liver and benefits of preoperative chemotherapy.  

PubMed

Aim?Undifferentiated sarcoma of the liver (USL) is the third commonest malignant liver tumor in children. The aim of our study is to evaluate the outcome of this rare entity according to the quality of the surgical resection and the compliance to the European pediatric soft tissue sarcoma group guidelines. Patients and Methods?We conducted a monocentric review of patients referred to our department with a definitive pathologic diagnosis of USL between 1997 and 2013. We looked at the diagnosis and management pitfalls, surgical technique, and outcomes. Results are expressed as median (range). Results?There were 13 patients (M/F?=?7:6?=?1.1). Age at presentation was 8 years (range, 11 months-16 years). Of the 13 patients, 10 patients (69%) presented with abdominal pain, 5 (38%) with tumoral bleeding, and 2 (15%) with peritoneal rupture. All lesions were unique, nonmetastatic, and heterogeneous with cystic components measuring 14 (6-19) cm. Six (46%) patients had an upfront surgery: five because of wrong clinical diagnosis (three query mesenchymal hamartoma, one spontaneous peritoneal bleeding, and one cystic lymphangioma), and one because of rapid enlargement of the mass. Seven (54%) patients (including one with tumoral bleeding) received neoadjuvant chemotherapy, and had their tumor diameter decreasing by 40% (range, 0-60%). Final surgery consisted of seven right hepatectomies; one right extended hepatectomy; three mesohepatectomies; two left hepatectomies. There were three incomplete resection in the upfront surgery group versus none in the neoadjuvant chemotherapy group. The degree of tumor necrosis after chemotherapy ranged from 95 to 100%. Surgical complications included the following: liver transplantation (LT) following a Budd-Chiari syndrome after a mesohepatectomy, one biliary ducts injury treated by Roux-en-Y loop. All patients received the postoperative chemotherapy according to the European protocol. One of seven patients (14%) with neoadjuvant chemotherapy underwent radiotherapy for rupture at diagnosis versus three of six patients (50%) with upfront surgery: one for rupture at diagnosis and two for rupture during upfront surgery. One patient (17%) with upfront surgery had local recurrence at 2 years after initial surgery, and is in second complete remission 1?year after a redo surgery. All patients are alive at a median 34 months (range, 5-134) follow-up. Conclusion?USL presents with painful mixed cystic and solid liver mass. If misdiagnosed and mistreated (enucleation or unroofing), the usual good outcome of this malignancy could be impaired. Preoperative chemotherapy is recommended. PMID:25259441

Merli, Laura; Mussini, Charlotte; Gabor, Flaviu; Branchereau, Sophie; Martelli, Hélène; Pariente, Danièle; Guérin, Florent

2015-02-01

371

Identification of human glandular kallikrein in the beta cell of the pancreas.  

PubMed

To determine the cellular localization of glandular kallikrein in the human pancreas, immunohistochemical studies were performed with a monospecific antibody against the antigenically identical urinary kallikrein (urokallikrein). The localization of glandular pancreatic kallikrein to the beta cells of the islets was the same as that of insulin in normal human pancreas and in two islet-cell tumors. When beta cells were lacking in islet-cell tumors or in the pancreas of a patient with juvenile-onset diabetes, kallikrein antigen was not detectable. Anti-urokallikrein absorbed with purified urinary or pancreatic kallikrein no longer identified a pancreatic antigen, whereas absorption with insulin had no effect. The beta-cell localization of human pancreatic kallikrein, an endopeptidase that, in concert with carboxypeptidase B, converts bovine proinsulin to a polypeptide with the electrophoretic mobility of insulin, suggests that pancreatic kallikrein may be involved in the physiologic activation of proinsulin. PMID:220534

ole-MoiYoi, O K; Pinkus, G S; Spragg, J; Austen, K F

1979-06-01

372

A Case of Spontaneous Ruptured Solid Pseudopapillary Tumor of Pancreas Resected by Laparoscopic Surgery  

PubMed Central

Solid pseudopapillary tumor (SPT) is an uncommon neoplasm of the pancreas. A rare case of spontaneous rupture of SPT is reported. A 13-year-old female felt acute abdominal pain without blunt abdominal trauma. Enhanced computed tomography (CT) revealed a tumor in the pancreas tail with fluid collection around it. The tumor was diagnosed as SPT with hemoperitoneum associated with spontaneous rupture. The bleeding was stopped conservatively and she was referred for surgery at three months after the rupture. At that time, CT revealed a tumor 4?cm in diameter, which protruded from pancreas tail without distant metastases. Since peritoneal dissemination was not seen on intraoperative exploration, laparoscopic enucleation was performed. Pathologically, the tumor was diagnosed as SPT with rupture of the capsule of tumor, and complete resection was confirmed. The patient has been followed up for two years, and she is alive without recurrence. PMID:23737801

Nagano, Hiroto; Kawachi, Yasuyuki; Maruyama, Hiroshi

2013-01-01

373

[Factors causing damage and destruction of beta-cells of the islets of Langerhans in the pancreas].  

PubMed

Insulin secretion in patients with manifested diabetes mellitus tends to disappear months to decades after the diagnosis, which is a clear sign of a gradual loss of pancreatic islet beta-cells. In our sample of 30 type 2 diabetic patients, whose disease manifested between 30 and 45 years of age, about a half have retained or even increased insulin secretion 30 years later, while the other half exhibit a much diminished or lost insulin secretion. Factors that can damage or destroy beta-cells can be divided into the following groups: Metabolic factors: hyperglycemia and glucotoxicity, lipotoxicity, hypoxia, reactive oxygen species; Pharmacological factors: antimicrobial medication pentamidine, SSRI antidepressants; Factors related to impaired insulin secretion: MODY type diabetes; Environmental toxic factors: rat poison Vacor, streptozotocin, polychlorinated and polybrominated hydrocarbons; Disorders of the exocrine pancreas: tumor infiltration, fibrous infiltration, chronic pancreatitis, cystic fibrosis; Infections, inflammation, autoimmunity, viral factors: Coxsackie viruses, H1N1 influenza, enteroviruses. We are currently working on finding other factors leading to beta-cell damage, studying their effect on apoptosis and necrosis and looking for possible protective factors to prevent this damage. We our increasing knowledge about the mechanisms of beta-cell damage and destruction we come ever closer to suggest measures for their prevention. In this review we offer a brief and simplified summary of some of the findings related to this area.Key words: pancreatic islet beta-cells of Langerhans - factors damaging or destroying beta-cells - insulin secretion. PMID:25294754

And?l, Michal; N?mcová, Vlasta; Pavlíková, Nela; Urbanová, Jana; Cecháková, Marie; Havlová, Andrea; Straková, Radka; Ve?e?ová, Livia; Mandys, Václav; Ková?, Jan; Heneberg, Petr; Trnka, Jan; Polák, Jan

2014-09-01

374

Providing Preoperative Information for Children Undergoing Surgery: A Randomized Study Testing Different Types of Educational Material to Reduce Children's Preoperative Worries  

ERIC Educational Resources Information Center

This study developed three types of educational preoperative materials and examined their efficacy in preparing children for surgery by analysing children's preoperative worries and parental anxiety. The sample was recruited from three hospitals in Lisbon and consisted of 125 children, aged 8-12 years, scheduled to undergo outpatient surgery.…

Fernandes, S. C.; Arriaga, P.; Esteves, F.

2014-01-01

375

Study of surgical anatomy for duodenum-preserving resection of the head of the pancreas.  

PubMed Central

OBJECTIVE: The authors precisely examined the topography of the duodenum, pancreas, bile duct, and supplying vessels from the perspective of performing duodenum-preserving resection of the pancreatic head. SUMMARY BACKGROUND DATA: Little has been reported regarding the detailed surgical anatomy that is crucial in this procedure. METHODS: The authors precisely examined the local anatomy of the pancreas head and duodenum, using materials from 40 autopsy cases. RESULTS: Arcade formation between the anterior superior pancreaticoduodenal (ASPD) artery and the anterior inferior pancreaticoduodenal (AIPD) artery was found in all of the cases. After departing from the gastroduodenal artery, the ASPD ran toward a point 1.5 cm below the papilla of Vater, then turned to the posterior aspect of the pancreas to joint the AIPD. In 88% of the cases, an arcade was found between the posterior superior pancreaticoduodenal (PSPD) artery and the posterior inferior pancreaticoduodenal (PIPD) artery. The ASPD, AIPD, PSPD, PIPD, or their branches to the duodenum, the bile duct, and the papilla of Vater were not completely buried in the pancreatic parenchyma in any of these cases. Generally, it was easy to dissect the pancreas from the duodenum because of the loose connection. Near the accessory papilla, however, dissection of the vessels was difficult, and the pancreatic parenchyma sometimes was found in the wall of the duodenum. Dissection of the pancreas from the common bile duct and identification of the main pancreatic duct at the junction with the terminal portion of the bile duct were straightforward in all cases. CONCLUSIONS: It may be possible to remove the head of the pancreas while preserving of the vascular arcades and their branches to the duodenum, the bile duct, and the papilla of Vater. Images Figure 1. Figure 2. Figure 5. PMID:7726671

Kimura, W; Nagai, H

1995-01-01

376

Protective effect of inducible nitric oxide synthase inhibitor on pancreas transplantation in rats  

PubMed Central

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, aminoguanidine was added to intravascular infusion as the onset of reperfusion at the dose of 60 mg/kg, 80 mg/kg, 100 mg/kg body weight, respectively. Serum nitric oxide (NO) level, blood sugar and amylase activity were detected. Nitric oxide synthase (NOS) test kit was used to detect the pancreas cNOS and inducible NOS (iNOS) activity. Pancreas sections stained with HE and immunohistochemistry were evaluated under a light microscope. RESULTS: As compared with the transplant control group, the serum NO level and amylase activity decreased obviously and the evidence for pancreas injury was much less in the AG group. The AG (80 mg/kg body weight) group showed the most significant difference in NO and amylase (NO: 66.0 ± 16.6 vs 192.3 ± 60.0, P < 0.01 and amylase: 1426 ± 177 vs 4477 ± 630, P < 0.01).The expression and activity of tissue iNOS, and blood sugar in the AG (80 mg/kg body weight) group were much lower than those in the transplant control group (iNOS: 2.01 ± 0.23 vs 26.59 ± 5.78, P < 0.01 and blood sugar: 14.2 ± 0.9 vs 16.8 ± 1.1, P < 0.01). CONCLUSION: Selective iNOS inhibitor, aminoguanidine as a free radical, has a protective effect on pancreas transplantation in rats by inhibiting NO and reducing its toxicity. PMID:18023101

Li, Bai-Feng; Liu, Yong-Feng; Cheng, Ying; Zhang, Ke-Zhong; Li, Tie-Min; Zhao, Ning

2007-01-01

377

Pancreas-Targeted NIR Fluorophores for Dual-Channel Image-Guided Abdominal Surgery  

PubMed Central

Objective: Pancreas-related complications are some of the most serious ones in abdominal surgery. The goal of this study was to develop and validate novel near-infrared (NIR) fluorophores that would enable real-time pancreas imaging to avoid the intraoperative pancreatic injury. Design: After initial screening of a large NIR fluorophore library, the performance of 3 selected pancreas-targeted 700 nm NIR fluorophores, T700-H, T700-F, and MB, were quantified in mice, rats, and pigs. Dose ranging using 25 and 100 nmol, and 2.5 µmol of T700-F, and its imaging kinetics over a 4 h period were tested in each species. Three different 800 nm NIR fluorophores were employed for dual-channel FLARE™ imaging in pigs: 2 ?mol of ZW800-1 for vessels and kidney, 1 ?mol of ZW800-3C for lymph nodes, and 2 ?mol of ESNF31 for adrenal glands. Results: T700-F demonstrated the highest signal to background ratio (SBR), with peak SBR at 4 h postinjection in mice. In pigs, T700-F produced an SBR ? 2 against muscle, spleen, and lymph nodes for up to 8 h after a single intravenous injection. The combination of T700-F with each 800 nm NIR fluorophore provided simultaneous dual-channel intraoperative imaging of pancreas with surrounding organs in real time. Conclusion: Pancreas-targeted NIR fluorophores combined with the FLARE dual-channel imaging system enable the real-time intraoperative pancreas imaging which helps surgeons perform safer and more curative abdominal surgeries. PMID:25553094

Wada, Hideyuki; Hyun, Hoon; Vargas, Christina; Gravier, Julien; Park, GwangLi; Gioux, Sylvain; Frangioni, John V.; Henary, Maged; Choi, Hak Soo

2015-01-01

378

Gemcitabine-Based Combination Chemotherapy Followed by Radiation With Capecitabine as Adjuvant Therapy for Resected Pancreas Cancer  

Microsoft Academic Search

Purpose: To report outcomes for patients with resected pancreas cancer treated with an adjuvant regimen consisting of gemcitabine-based combination chemotherapy followed by capecitabine and radiation. Patients and Methods: We performed a retrospective review of a series of patients treated at a single institution with a common postoperative adjuvant program. Between January 2002 and August 2006, 43 resected pancreas cancer patients

Sameer Desai; Edgar Ben-Josef; Kent A. Griffith; Diane Simeone; Joel K. Greenson; Isaac R. Francis; Janet Hampton; Lisa Colletti; Alfred E. Chang; Theodore S. Lawrence; Mark M. Zalupski

2009-01-01

379

Regulation of the Initiation of Pancreatic Digestive Enzyme Protein Synthesis by Cholecystokinin in Rat Pancreas In Vivo  

Microsoft Academic Search

Background & Aims: Cholecystokinin (CCK) is known to stimulate the synthesis of digestive enzymes in the pancreas at the translational level. We investigated in vivo the biochemical regulation of initiation factors important for the stimulation of translation of digestive enzyme protein in rat pancreas by CCK. Methods: Intraperitoneal injection of CCK or intragastric administration of a trypsin inhibitor to elicit

2000-01-01

380

Behaviour of digestive enzymes in the pancreatic juice and pancreas of rats fed on a low-protein diet  

E-print Network

Behaviour of digestive enzymes in the pancreatic juice and pancreas of rats fed on a low (23.5 p. 100 mixed protein) on the activity of some pancreatic digestive enzymes and the amount also augmented. 3) The low-protein diet produced an overall decrease in enzyme activity in the pancreas

Boyer, Edmond

381

Effect of double-balloon enteroscopy on pancreas: An experimental porcine model  

PubMed Central

AIM: To evaluate the effect of double-balloon enteroscopy (DBE) on pancreas histology and levels of pancreatic enzymes. METHODS: Conventional upper gastrointestinal endoscopy was performed on five control pigs. Oral DBE was performed with an EN-450T5 enteroscope on 20 pigs. Two experimental groups (10 pigs each) were defined according to DBE duration: 90 min for Group 1 and 140 min for Group 2. During oral insertion, the balloons were not inflated in the descending part of the duodenum to avoid the minor duodenal papilla. Serum amylase, lipase and C-reactive protein (CRP) levels were monitored before the procedure and repeated every 30 min until the exploration was finished, as well as 24 h and 7 d after. After the procedure and for a total of 7 d, the pigs were observed twice a day for signs of decreased activity, irritability, vomiting or anorexia. Gross and microscopic examination of the pancreas was performed on day 7. RESULTS: All animals tolerated DBE without clinical manifestations of acute pancreatitis. Experimental groups had higher levels of enzymes than the control group at 24 h. Throughout the exploration, the amylase levels increased significantly above the baseline 24 h after DBE, although the increase was not statistically significant and did not reach 20% of the baseline. An increase in lipase and CRP was observed at 24 h after the procedure, although by day 7, all enzymatic levels had returned to baseline. No differences between Groups 1 and 2 were found for any enzyme and sampling site during and after the procedure. Similarly, no correlation between insertion depth and enzyme levels was observed. Direct in situ and post-removal inspection of the pancreas did not show any evidence of fluid collection, abscesses or hemorrhage. Histological examination of the pancreas from Groups 1 and 2 revealed the existence of focal areas (0.14-0.26 mm2) of ischemic necrosis in 47.4% of the animals. In the pigs with damaged pancreas, the left lobe (tail) was always affected. However, this only happened in 83.3% of the samples from the right lobe (head) and in 33.3% of the samples from the body of the pancreas. Significant differences were found between the left lobe (tail) and the body for the percentage of affected pancreas. Both the size of the lesions and the percentage of affected pancreas were higher in the left pancreatic lobe (tail). The presence of the lesions was not related to the exploration length. CONCLUSION: The increase in pancreatic enzymes after DBE could be related to focal points of pancreatic ischemic necrosis due to mechanical stress. PMID:23066311

Latorre, Rafael; Soria, Federico; López-Albors, Octavio; Sarriá, Ricardo; Sánchez-Margallo, Francisco; Esteban, Pilar; Carballo, Fernando; Pérez-Cuadrado, Enrique

2012-01-01

382

A huge adenosquamous carcinoma of the pancreas with sarcomatoid change: An unusual case report  

PubMed Central

Adenosquamous carcinoma rarely occurs in the pancreas, and is characterized by the presence of cellular components from both duct adenocarcinoma and squamous carcinoma. Here, we describe a rare case of pancreatic adenosquamous carcinoma with sarcomatous change. Immunohistochemistry showed that the sarcomatous lesion lost the epithelial marker and aberrantly expressed of acquired mesenchymal markers, which indicated that this special histological phenotype may be attributed to epithelial-mesenchymal transition. This case also indicated that a routine radical surgery without aggressive treatment strategies was still appropriate for adenosquamous carcinoma of the pancreas with sarcomatoid change. PMID:25473201

Lu, Bao-Chun; Wang, Chen; Yu, Jian-Hua; Shen, Zhi-Hong; Yang, Jian-Hui

2014-01-01

383

Gravity in mammalian organ development: differentiation of cultured lung and pancreas rudiments during spaceflight  

NASA Technical Reports Server (NTRS)

Organ culture of embryonic mouse lung and pancreas rudiments has been used to investigate development and differentiation, and to assess the effects of microgravity on culture differentiation, during orbital spaceflight of the shuttle Endeavour (mission STS-54). Lung rudiments continue to grow and branch during spaceflight, an initial result that should allow future detailed study of lung morphogenesis in microgravity. Cultured embryonic pancreas undergoes characteristic exocrine acinar tissue and endocrine islet tissue differentiation during spaceflight, and in ground controls. The rudiments developing in the microgravity environment of spaceflight appear to grow larger than their ground counterparts, and they may have differentiated more rapidly than controls, as judged by exocrine zymogen granule presence.

Spooner, B. S.; Hardman, P.; Paulsen, A.

1994-01-01

384

[Neuroendocrine complexes in the pancreas of nutria (Myocastor coypus) (an immunohistochemical study)].  

PubMed

With the application of a double immunohistochemical labeling method, several types of neuroendocrine interactions were demonstrated in the pancreas of nutria. Two types of neuroinsular complexes were detected that have the organization typical to the mammals. It was found to be typical of nutria that several pancreatic islets were integrated with nerve cells and nerve fibers. The complexes detected that reflect the interactions between nervous elements and single endocrine cells or their small groups, are species-specific. The data obtained demonstrate the diversity of neuroendocrine interactions in the pancreas and possible influence of the nervous system on B-cell differentiation. PMID:19860332

Krivova, Iu S; Barabanov, V M; savel'eva, E S; Savel'ev, S V

2009-01-01

385

P2-Receptor-mediated inhibition of noradrenaline release in the rat pancreas  

Microsoft Academic Search

The aim of the study was to find out whether, and if so through which receptors, nucleotides modulate the release of noradrenaline\\u000a in the rat pancreas. Segments of the pancreas were preincubated with [3H]-noradrenaline, superfused with medium containing desipramine (1?M) and yohimbine (1?M), and stimulated electrically, in\\u000a most experiments by 60 pulses\\/1Hz.\\u000a \\u000a The adenosine A1-receptor agonist N6-cyclopentyl-adenosine (CPA; EC50 32nM),

Helga Koch; Ivar von Kügelgen; Klaus Starke

1998-01-01

386

Effectiveness of endoscopic clipping and computed tomography gastroscopy for the preoperative localization of gastric cancer  

PubMed Central

Purpose Before laparoscopic gastrectomy for gastric cancer can be planned, it is very important to know the precise location of the tumor. The aim of this study was to evaluate 3 methods of predicting the exact location of the tumor: preoperative gastrofibroscopy (GFS), preoperative computed tomography gastroscopy (CT), and intraoperative gastroscopy-guided laparoscopy (Lap). Methods In this study, 15 patients were prospectively identified, and endoscopic clips were preoperatively placed on the proximal 1 cm of the tumor, at the angle on the greater curvature and opposite the angle on the greater curvature. The distances between the pylorus and the proximal tumor clip (PT), the angle clip (PA), the greater curvature clip (PG), and the gastroesophageal junction were measured by preoperative GFS, preoperative CT, intraoperative Lap, and visual inspection (Vis). Results PT, PA, and PG values measured by preoperative GFS differed significantly from the Vis values (P < 0.01). However, preoperative CT measurements of PT, PA, and PG did not differ from the Vis values (P = 0.78, P = 0.48, and P = 0.53, respectively). Intraoperative Lap and Vis PT values differed by only 1.1 cm on an average (P = 0.10), but PA and PG values varied by 1.9 and 3.4 cm, respectively (P = 0.01 for both). Conclusion Endoscopic clipping combined with preoperative CT gastroscopy is more useful than preoperative GFS for preoperatively predicting the location of early gastric cancers and will be helpful for planning laparoscopic gastrectomy. PMID:23396626

Jeong, Sang-Ho; Bae, Kyungsoo; Ha, Chang-Youn; Lee, Ok-Jae; Jung, Woon-Tae; Choi, Sang-Kyung; Hong, Soon-Chan; Jung, Eun-Jung; Ju, Young-Tae; Jeong, Chi-Young; Ha, Woo-Song

2013-01-01

387

Pre-operative plasma club (clara) cell secretory protein levels are associated with primary graft dysfunction after lung transplantation  

PubMed Central

Inherent recipient factors, including pre-transplant diagnosis, obesity, and elevated pulmonary pressures are established PGD risks. We evaluated the relationship between pre-operative lung injury biomarkers and PGD to gain further mechanistic insight in recipients. We performed a prospective cohort study of recipients in the lung transplant outcomes group enrolled between 2002 and 2010. Our primary outcome was grade 3 PGD on day 2 or 3. We measured pre-operative plasma levels of 5 biomarkers (CC-16, sRAGE, ICAM-1, IL-8, and Protein C) that were previously associated with PGD when measured at the post-operative timepoint. We used multivariable logistic regression to adjust for potential confounders. Of 714 subjects, 130 (18%) developed PGD. Median CC-16 levels were elevated in subjects with PGD (10.1 vs. 6.0, p<0.001). CC-16 was associated with PGD in non-IPF subjects (OR for highest quartile of CC-16: 2.87, 95% CI: 1.37, 6.00, p=0.005) but not in subjects with IPF (OR 1.38, 95% CI: 0.43, 4.45, p=0.59). After adjustment, pre-operative CC-16 levels remained associated with PGD (OR: 3.03, 95% CI: 1.26, 7.30, p=0.013) in non-IPF subjects. Our study suggests the importance of pre-existing airway epithelial injury in PGD. Markers of airway epithelial injury may be helpful in pre-transplant risk stratification in specific recipients. PMID:24400993

Shah, Rupal J.; Wickersham, Nancy; Lederer, David J.; Palmer, Scott M.; Cantu, Edward; Diamond, Joshua M.; Kawut, Steven M.; Lama, Vibha N.; Bhorade, Sangeeta; Crespo, Maria; Demissie, Ejigayehu; Sonett, Joshua; Wille, Keith; Orens, Jonathan; Weinacker, Ann; Shah, Pali; Arcasoy, Selim; Wilkes, David S.; Christie, Jason D.; Ware, Lorraine B.

2013-01-01

388

[Results of studies of carbohydrate metabolism and ultrasonography of the pancreas in man after continuous anti-orthostatic hypokinesia].  

PubMed

Data on the hypokinesia-induced transformation of the glycemic profile and ultrasonic changes in the pancreas structure are presented. The AOH study gave further evidence of transforming glycemic curves. Moreover, increased sizes of tail and head of the pancreas and a decrease in its echogeneity were observed in all test-subjects. Structural changes in the pancreas were confirmed by biochemical investigations which revealed increased levels of blood enzymes and activation of insulin secretion. Increases in the liver size, thickness of the wall of the stomach, diameter of the splenic vein were indicative of progressing venous plethora in the portal vein system. It was shown that venous plethora are the main cause for changes in the upper GI, and in the pancreas state in particular, which can be qualified as dysfunctional. These structural changes in the pancreas could suppress its functional activity manifested by increases in blood enzymes and hormones and transformation of the glycemic profile during the glucose load. PMID:10530381

Afonin, B V; Nichiporuk, I A; Nesterov, M A; Pechenkina, R A; Goncharova, N P; Belousova, I V

1999-01-01

389

A Preoperative Decolonization Protocol for Staphylococcus aureus Prevents Orthopaedic Infections  

PubMed Central

Staphylococcus aureus (S. aureus) is an independent risk factor for orthopaedic surgical site infection (SSI). To determine whether a preoperative decolonization protocol reduces S. aureus SSIs, we conducted a prospective observational study of patients undergoing elective total joint arthroplasty (TJA) at our institution, with two control groups. The concurrent control group comprised patients of surgeons who did not participate in the intervention study. The preintervention control group comprised patients of participating surgeons who had undergone elective TJA during the year before the study. Patients in the intervention group were screened preoperatively for S. aureus by nasal swab cultures. S. aureus carriers were decolonized with mupirocin ointment to the nares twice daily and chlorhexidine bath once daily for 5 days before surgery. All 164 of 636 participants (26%) who tested positive completed the decolonization protocol without adverse events and had no postoperative S. aureus SSIs at 1-year followup. In contrast, 1330 concurrent control patients had 12 S. aureus infections. If these infections had occurred in the 26% of patients expected to be nasal carriers of S. aureus at a given time, the infection rate would have been 3.5% (12 of 345) in the control group. In addition, the overall infection rate of the participating surgeons, including nonstaphylococcal infections, decreased from 2.6% during the preintervention period to 1.5% during the intervention period, translating to an adjusted economic gain of $231,741 for the hospital. The data suggest a preoperative decolonization protocol reduces S. aureus SSIs in patients undergoing TJA. Level of Evidence: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18404296

Cannella, Barbara; Crossett, Lawrence S.; Yates, A. J.; McGough, Richard

2008-01-01

390

Preoperative starvation and pulmonary aspiration. New perspectives and guidelines.  

PubMed

The fear of aspiration of gastric contents and its life-threatening consequences in patients(aspiration pneumonitis and respiratory failure), has caused many medical practitioners, particularly anaesthetists, to rigidly follow conservative (i.e. prolonged) preoperative fasting standards. This is the nil per os (NPO) order for clear fluids/liquids and solids overnight or six to eight hours preceding the induction of anaesthesia. This practice neither takes into account the differences in the rate of gastric emptying for solid food (which may exceed six hours) and clear liquids (which is one to two hours), nor the differences in scheduled times of surgery. Long-term prospective studies and retrospective reviews have shown that the incidence of significant clinical aspiration is low: 1.4-6.0 per 100,00 anaesthetics for elective general surgery. Risk factors for pulmonary aspiration include: a high American Society of Anaesthesiologists (ASA) physical status score; emergency surgery; difficult airway management; increased gastric volume and acidity; increased intra-abdominal pressure; gastro-oesophageal reflux; oesophageal disease; head injury with impaired consciousness and extremes of age. Experimental studies and reviews have consistently shown the safety of clear liquid ingestion up to two hours before induction of anaesthesia in healthy patients without risk factors, and the fact that a longer fluid fast does not necessarily offer any added protection against pulmonary aspiration. The conservative pre-operative fasting standard causes discomfort and in some cases, suffering of patients and is therefore unnecessary for patients without risk factor(s). Anecdotal reports at the University Hospital of the West Indies (UHWI) have shown that application of the liberalized guidelines for preoperative fasting and fluid intake has not resulted in increased pulmonary aspiration, morbidity or mortality. Instead it has resulted in decreased irritability, anxiety, thirst and hunger in the peri-operative period. Patients, especially children are more comfortable and the perioperative period is better tolerated. It is therefore time that all medical personnel adopt the liberalized guidelines. PMID:12632641

Scarlett, M; Crawford-Sykes, A; Nelson, M

2002-12-01

391

Ultrasound in differential diagnosis of periapical radiolucencies: A radiohistopathological study  

PubMed Central

Objectives: To evaluate the efficacy of ultrasound in differential diagnosis of periapical radiolucencies. Materials and Methods: Ten patients aged between 19 years and 40 years with periapical lesions associated with anterior maxillary or mandibular teeth were selected and consented for the study. Pre-operative periapical radiographs were obtained. Measurements and provisional diagnoses of the apical areas were made by two specialist observers on two separate occasions. Preoperative ultrasound examinations with Doppler flowmetry were then performed and the images assessed by two specialist observers for the size, contents, vascular supply and a provisional diagnosis made as to whether the lesion was a cyst or granuloma. Endodontic surgery was performed including curettage of the apical tissues to enable histopathological investigation, which provided the gold standard diagnosis. All measurements and findings were compared and statistically analyzed. Results: Total 10 lesions were identified in 10 patients. On periapical radiographs, lesions were readily identified but observers were unable to differentiate granuloma from cyst using either modality. Where sufficient buccal cortical bone had been resorbed, ultrasound imaging was simple but underestimated the size of the lesions compared with periapical radiographs. In all cases, the ultrasound diagnosis agreed with the histopathological gold standard. Conclusion: Ultrasonography (USG) can provide accurate information about the nature of intraosseous lesions of the jaws before any surgical procedure. It is proposed that USG with Doppler flowmetry can provide an additional diagnostic tool without invasive surgery, where treatment option is nonsurgical. PMID:25657525

Khambete, Neha; Kumar, Rahul

2015-01-01

392

Preoperative and postoperative care in cosmetic laser resurfacing  

NASA Astrophysics Data System (ADS)

Advances in laser technology have allowed the application of lasers to cosmetic facial skin resurfacing. While this application has been extremely advantageous to patients, the development of pre- and postoperative therapeutic regimens was necessary to mitigate potential complications associated with laser resurfacing. Potential complications of laser resurfacing include prolonged postoperative erythema, hyperpigmentation, hypopigmentation, herpetic, bacterial or candidal infection, and other concerns including scarring and abnormal wound healing. In this report we review the state of the art of preoperative and postoperative care for cosmetic laser resurfacing.

Ross, Adam T.; Becker, Daniel G.

2001-05-01

393

Delirium following vascular surgery: increased incidence with preoperative ?-blocker administration  

Microsoft Academic Search

Purpose  To determine if there is an association between perioperative administration of beta-blockers and postoperative delirium in\\u000a patients undergoing vascular surgery.\\u000a \\u000a \\u000a \\u000a Methods  After Institutional Review Board approval, data were retrospectively collected on patients who underwent vascular surgery\\u000a in an academic hospital during the period January 2006 to January 2007. Patients with preoperative altered level of consciousness,\\u000a carotid endarterectomy, or discharge within 24 h

Rita Katznelson; George Djaiani; Nicholas Mitsakakis; Thomas F. Lindsay; Gordon Tait; Zeev Friedman; Marcin Wasowicz; W. Scott Beattie

2009-01-01

394

The preoperative skin shave in neurosurgery: is it justified?  

PubMed

Shaving the scalp prior to surgery is a very common practice. Out of 105 cases operated upon without skin shave at the Royal London Hospital, only one became infected (0.95%). A search into the history of aseptic surgery shows that there are no scientific grounds for the practice of shaving. An examination of contemporary practices worldwide shows that there is a greater realization that preoperative skin shaving does not confer any benefit against postoperative wound infection and that, paradoxically, it may lead to higher rates of wound infection due to the epidermal injury that it inflicts. PMID:11013665

Siddique, M S; Matai, V; Sutcliffe, J C

1998-04-01

395

[Preoperative tests recommendations in adult patients for ambulatory surgery].  

PubMed

Anesthetic assessment traditionally included a series of laboratory tests intended to detect undiagnosed diseases, and to ensure that the patient undergoes surgery following safety criteria. These tests, without a specific clinical indication, are expensive, of questionable diagnostic value and often useless. In the context of outpatient surgery, recent evidence suggests that patients of any age without significant comorbidity, ASA physical status gradei and grade ii, do not need additional preoperative tests routinely. The aim of the present recommendations is to determine the general indications in which these tests should be performed in ASA gradei and grade ii patients undergoing ambulatory surgery. PMID:25146773

Zaballos, M; López-Álvarez, S; Argente, P; López, A

2015-01-01

396

Intraoperative laparoscopic sonography for improved preoperative sonographic pathologic characterization of adnexal masses.  

PubMed

This study compares the diagnostic accuracy of laparoscopic sonography and transvaginal sonography in the evaluation of adnexal masses. Fifty-eight women underwent transvaginal sonography, which showed 69 adnexal masses, and laparoscopic ultrasonography, which showed 68 adnexal lesions. Conventional gray-scale ultrasonography (using transvaginal sonography and laparoscopic ultrasonography) was performed with morphologic characterization of internal architecture, followed by color Doppler imaging with spectral Doppler analysis where possible. A specific diagnosis was obtained with transvaginal sonography and laparoscopic ultrasonography based on a combination of imaging features. The specific diagnosis obtained with each imaging modality was compared with the final histologic diagnosis as the gold standard in 57 patients with 68 adnexal masses who underwent cystectomy or oophorectomy. The ability of laparoscopic sonography to detect the contralateral ovary and any residual ovarian tissue in the presence of a mass was also compared with transvaginal sonography. The accuracy of laparoscopic ultrasonography in the characterization of adnexal masses was 83.8% and that of transvaginal sonography was 73.5% (P < 0.05). Laparoscopic sonography showed greater morphologic detail than that obtained with transvaginal sonography, allowed more precise and specific characterization of adnexal masses, and detected additional adnexal lesions not evident on preoperative transvaginal sonography. Laparoscopic ultrasonography showed the contralateral ovary in 86.2% of patients, compared with 81.0% using transvaginal sonography (P = 0.51). In addition, laparoscopic ultrasonography was able to demonstrate the presence of residual ovarian tissue in the side affected pathologically in 76.5% of patients compared with 59.4% using transvaginal sonography (P < 0.005). Laparoscopic sonography allows more precise morphologic characterization of internal architecture and histologic diagnosis of adnexal lesions, but it is as yet unable to increase the diagnostic accuracy of borderline or malignant lesions, possibly due to the small sample size. Laparoscopic sonography is superior to transvaginal sonography in the evaluation of residual ovarian tissue in the side affected pathologically, which may help in surgical planning between cystectomy and oophorectomy, and also in the identification of the contralateral ovary, which may potentially increase the detection of bilateral pathologic conditions. PMID:9440109

Yang, W T; Yuen, P M; Ho, S S; Leung, T N; Metreweli, C

1998-01-01

397

Near-complete pathological response with preoperative chemotherapy in a patient with metaplastic breast carcinoma.  

PubMed

Metaplastic breast carcinoma (MBC) is a rare form of breast cancer comprising less than 1% of all invasive breast carcinomas. There are no clinical studies available for the management of this rare disease and MBC is associated with a poor prognosis. We present a case of a 50-year-old female patient with MBC who showed a favorable response with preoperative chemotherapy. The patient presented with a palpable left breast mass, and diagnostic breast imaging showed a 4.4 cm mass in the left breast, which was biopsied. Pathological review led to a diagnosis of MBC. Staging workup for distant metastasis was negative. She received four cycles of dose-dense AC (doxorubicin and cyclophosphamide), followed by 10 weekly doses of carboplatin (area under the curve=2) and paclitaxel (80 mg/m). The patient underwent partial mastectomy and sentinel lymph node sampling, and pathological review indicated a near-complete pathological response, with few scattered malignant cells at the tumor bed. A current review of the literature on MBC is summarized in this report. PMID:23719538

Amini, Arya; Kakkis, Jane; Reitherman, Richard; Ibarra, Julio; Sanati, Homayoon

2013-08-01

398

Preoperative and intraoperative infection workup in apparently aseptic revision shoulder arthroplasty.  

PubMed

The possibility of infection should be considered in every revision shoulder arthroplasty even in the absence of clinical symptoms and signs of infection because indolent infection is prevalent. Detection of infection in apparently aseptic failed arthroplasties poses a diagnostic challenge as the conventional principles and criteria used for hip and knee arthroplasty are not generally applicable. Propionibacterium acnes and Staphylococcus epidermidis are among the infectious organisms most commonly identified in such situations. Serum inflammatory markers are essential but are often unreliable as they have poor sensitivity in the shoulder. Preoperative shoulder joint aspiration culture is an important step but is subject to high false-negative rates. Lower cutoff values of synovial fluid analysis are used for detection of periprosthetic infection than for native joint infection as demonstrated in the knee literature. Intraoperatively, frozen section should be considered when a diagnosis of infection has not been established even in the presence of clinical suspicion. Gram stain is currently not recommended because of its low sensitivity and negative predictive value. Intraoperative culture is critical and should be performed whenever there is clinical suspicion of infection. Unexpected positive intraoperative cultures are not uncommon, and 6% to 25% of them appear to represent true infection as demonstrated with positive follow-up cultures or subsequent development of infection. In revision shoulder arthroplasty, determining the presence of infection can be difficult. A standardized approach is needed to determine the best course of treatment in this particular clinical setting. PMID:25487903

Updegrove, Gary F; Armstrong, April D; Kim, H Mike

2014-12-01

399

Identification and preoperative optimization of risk factors to prevent periprosthetic joint infection  

PubMed Central

Despite significant improvements over the past several decades in diagnosis, treatment and prevention of periprosthetic joint infection (PJI), it still remains a major challenge following total joint arthroplasty. Given the devastating nature and accelerated incidence of PJI, prevention is the most important strategy to deal with this challenging problem and should start from identifying risk factors. Understanding and well-organized optimization of these risk factors in individuals before elective arthroplasty are essential to the ultimate success in reducing the incidence of PJI. Even though some risk factors such as demographic characteristics are seldom changeable, they allow more accurate expectation regarding individual risks of PJI and thus, make proper counseling for shared preoperative decision-making possible. Others that increase the risk of PJI, but are potentially modifiable should be optimized prior to elective arthroplasty. Although remarkable advances have been achieved in past decades, many questions regarding standardized practice to prevent this catastrophic complication remain unanswered. The current study provide a comprehensive knowledge regarding risk factors based on general principles to control surgical site infection by the review of current literature and also share own practice at our institution to provide practical and better understandings. PMID:25035840

Baek, Seung-Hoon

2014-01-01

400

Preoperative evaluation of colorectal cancer using CT colonography, MRI, and PET/CT.  

PubMed

Imaging studies are a major component in the evaluation of patients for the screening, staging and surveillance of colorectal cancer. This review presents commonly encountered findings in the diagnosis and staging of patients with colorectal cancer using computed tomography (CT) colonography, magnetic resonance imaging (MRI), and positron emission tomography (PET)/CT colonography. CT colonography provides important information for the preoperative assessment of T staging. Wall deformities are associated with muscular or subserosal invasion. Lymph node metastases from colorectal cancer often present with calcifications. CT is superior to detect calcified metastases. Three-dimensional CT to image the vascular anatomy facilitates laparoscopic surgery. T staging of rectal cancer by MRI is an established modality because MRI can diagnose rectal wall laminar structure. N staging in patients with colorectal cancer is still challenging using any imaging modality. MRI is more accurate than CT for the evaluation of liver metastases. PET/CT colonography is valuable in the evaluation of extra-colonic and hepatic disease. PET/CT colonography is useful for obstructing colorectal cancers that cannot be traversed colonoscopically. PET/CT colonography is able to localize synchronous colon cancers proximal to the obstruction precisely. However, there is no definite evidence to support the routine clinical use of PET/CT colonography. PMID:25493009

Kijima, Shigeyoshi; Sasaki, Takahiro; Nagata, Koichi; Utano, Kenichi; Lefor, Alan T; Sugimoto, Hideharu

2014-12-01

401

The role of routine magnetic resonance imaging in the preoperative evaluation of adolescent idiopathic scoliosis  

PubMed Central

The routine use of magnetic resonance imaging (MRI) in adolescent idiopathic scoliosis remains controversial, and current indications for MRI in idiopathic scoliosis vary from study to study. The purpose of this study was to demonstrate the prevalence of neural axis malformations and the clinical relevance of routine MRI studies in the evaluation of patients with adolescent idiopathic scoliosis undergoing surgical intervention without any neurological findings. A total of 249 patients with a diagnosis of idiopathic scoliosis were treated surgically between the years 2002 and 2007. A routine whole spine MRI analysis was performed in all patients. On the preoperative clinical examination, all patients were neurologically intact. There were 20 (8%) patients (3 males and 17 females) who had neural axis abnormalities on MRI. Three of those 20 patients needed additional neurosurgical procedures before corrective surgery; the remaining underwent corrective spinal surgery without any neurosurgical operations. Magnetic resonance imaging may be beneficial for patients with presumed idiopathic scoliosis even in the absence of neurological findings and it is ideally performed from the level of the brainstem to the sacrum. PMID:19506867

Karadereler, Selhan; Ornek, Ibrahim; Enercan, Meric; Ganiyusufoglu, Kursat; Hamzaoglu, Azmi

2009-01-01

402

Histopathological effects of intraoperative radiotherapy on pancreas and adjacent tissues: a postmortem analysis  

Microsoft Academic Search

Intraoperative radiotherapy (IORT) has been utilized in the treatment of resectable and unresectable pancreatic carcinoma at the National Cancer Institute. Detailed autopsy analyses of the radiation effects on the pancreas and adjacent tissues were performed on 13 patients dying at various times following therapy. IORT can induce a progressive retroperitoneal fibrosis and fibrosis of the porta hepatis in patients with

Harald J. Hoekstra; Carlos Restrepo; Timothy J. Kinsella; William F. Sindelar

1988-01-01

403

Kinetics of Insulin Release from the Perfused Rat Pancreas Caused by Glucose, Glucosamine, and Galactose  

Microsoft Academic Search

Under appropriate conditions, not only glucose but also glucosamine and galactose can serve as potent stimulants for insulin release from the isolated, perfused rat pancreas. Since galactose and, probably, glucosamine are not metabolized in the islets, and since these three compounds have in all likelihood common sites of action, it is postulated that a glucoreceptor of broad specificity is involved

Rudiger Landgraf; Janina Kotler-Brajtburg; Franz M. Matschinsky

1971-01-01

404

Medial pancreatectomy: A multi-institutional retrospective study of 53 patients by the French Pancreas Club  

Microsoft Academic Search

Background. The results of medial pancreatectomy have been previously reported anecdotally. The purpose of the study was to provide short- and long-term results of MP in a large multicenter collective series. Methods. From 1990 to 1998, 53 patients (mean age ± SD = 49 ± 15 years) underwent medial pancreatectomy for primary cystic neoplasms of pancreas (n = 19), endocrine

Alain Sauvanet; Christian Partensky; Bernard Sastre; Jean-François Gigot; Pierre-Louis Fagniez; Jean-Jacques Tuech; Bertrand Millat; Stéphane Berdah; Bertrand Dousset; Daniel Jaeck; Yves-Patrice Le Treut; Christian Letoublon

2002-01-01

405

Embolization of an Insulinoma of the Pancreas with Trisacryl Gelatin Microspheres as Definitive Treatment  

SciTech Connect

Insulinomas are rare, mostly benign neuroendocrine tumors, originating in 99% of cases from the pancreas, that synthesize and secrete insulin, causing symptomatic hypoglycemia. Today the treatment of choice is surgical removal. We present the case of an 84-year-old woman with a symptomatic insulinoma who refused surgery and was treated with arterial embolization using trisacryl gelatin microspheres as definitive treatment.

Rott, Gernot, E-mail: gernot.rott@t-online.de; Biggemann, Martin; Pfohl, Martin [Bethesda-Krankenhaus Duisburg, Medizinische Klinik (Germany)

2008-05-15

406

Effects of diazinon at different doses on rat liver and pancreas tissues  

Microsoft Academic Search

Diazinon is one of the most widely used organophosphates in agriculture. Toxic effects of diazinon are due to the inhibition of acetylcholinesterase, an enzyme needed for proper nervous system function. This study was designed to investigate the effects of diazinon at different doses on pancreas and liver tissues and in which dose level diazinon shows its effects. Sixty male Wistar

Alpaslan Gokcimen; Kanat Gulle; Hilmi Demirin; Dilek Bayram; Ahmet Kocak; Irfan Altuntas

2007-01-01

407

Carcinoembryonic antigen assay in cancer of the colon and pancreas and other digestive tract disorders  

Microsoft Academic Search

In a study of 279 persons, carcinoembryonic antigen (CEA) was detected in the sera of 32 of 35 patients with carcinoma of the colon, 13 of 13 patients with carcinoma of the pancreas, and 6 of 14 patients with other gastrointestinal cancers, confirming previous work which associated circulating CEA with GI tract malignancies. Six of 8 patients with bronchogenic carcinomas

T. L. Moore; H. Z. Kupchik; N. Marcon; N. Zamcheck

1971-01-01

408

An experimental means of transmitting pancreas disease in Atlantic salmon Salmo salar L. fry in freshwater.  

PubMed

A challenge model for pancreas disease in Atlantic salmon, Salmo salar L. fry, was developed comparing two salmonid alphavirus (SAV) subtypes: SAV1 and SAV5. Viral doses of 3 × 10(5) TCID50  mL(-1) for SAV1 and 3 × 10(4) for SAV5 were tested in triplicate tanks, each containing 450 salmon fry. Cumulative mortalities of 1.2% were recorded. Titres of virus recovered from the mortalities ranged from 10(2) to 10(7) TCID50  mL(-1) . Fry were sampled at 3, 5 and 7.5 weeks post-challenge. Sampling after 3 weeks revealed a high prevalence of infection in the absence of clinical signs, and infectious virus was recovered from 80% and 43% of sampled fry infected with SAV1 and SAV5, respectively. After 5 weeks pancreas, heart and red skeletal muscle lesions were generally observed, whilst degeneration in white skeletal muscle was observed only in fish infected with SAV1. In situ hybridisation confirmed the presence of viral genome in infected pancreas, heart and muscle. After 7.5 weeks, infectious virus (both isolates) was recovered from 13.3% of the fish sampled, with a viral titre of 10(2) TCID50  mL(-1) . Clearly, salmon fry are susceptible to SAV infection and pancreas disease. PMID:25297529

Cano, I; Joiner, C; Bayley, A; Rimmer, G; Bateman, K; Feist, S W; Stone, D; Paley, R

2015-03-01

409

Age-dependent accumulation of recombinant cells in the mouse pancreas revealed by in situ  

E-print Network

, inherited mutations in BRCA1 (8), BRCA2 (10), and FANCC (11) increase the risk of pancreatic cancer in the pancreas. With a 5-year survival rate of 5%, pancreatic cancer remains one of the deadliest cancers in the United States (17, 18). One important risk factor for pancreatic cancer is aging (19).

Engelward, Bevin

410

Cholecystokinin A and B receptors are differentially expressed in normal pancreas and pancreatic adenocarcinoma.  

PubMed Central

Cholecystokinin (CCK) plays an important role in pancreatic carcinogenesis. While human CCK-A and -B receptors have been fully characterized, their relative roles in human pancreatic adenocarcinoma remain unclear. Thus, expression of CCK-A and -B receptors in normal human pancreas, pancreatic adenocarcinomas, and other human extrapancreatic tissues and malignancies was examined, using reverse transcription followed by the polymerase chain reaction (RT-PCR). mRNA isolated from 15 normal pancreas specimens, 22 pancreatic adenocarcinomas, and 58 extrapancreatic tissues and tumors was subjected to RT-PCR using primers specific for human CCK-A and -B receptors. Expression of CCK-B receptors was detected in all tissues arising from pancreas and in most extrapancreatic tissues and tumors. In contrast, CCK-A receptors exhibited a more selective pattern of expression in gall bladder, intestine, brain, ovary, spleen, and thymus. Of significance, CCK-A receptors were expressed selectively in all pancreatic adenocarcinomas, but not in any normal pancreas specimens. In situ hybridization, using receptor-specific riboprobes, localized CCK-A receptor expression to ductal cells, the presumed origin of most human pancreatic adenocarcinomas. Southern blot analysis revealed no evidence of CCK-A receptor gene amplification or rearrangement in pancreatic adenocarcinomas. Because of its selective expression, the CCK-A receptor may serve as selective biomarker for pancreatic adenocarcinoma. PMID:9239407

Weinberg, D S; Ruggeri, B; Barber, M T; Biswas, S; Miknyocki, S; Waldman, S A

1997-01-01

411

Some Histological and Histochemical Studies of the Pancreas of the Brasilian Sloth, Bradypus tridactylus  

Microsoft Academic Search

The histological and histochemical study of the pancreas of the three-toed sloth, Bradypus tridactylus, demonstrated that with the methods employed the pancreatic islets are apparently formed by A cells exclusively. Two different types of argyrophilic cells were noticed in the exocrine secretory units when Grimelius’ method was used. The methods for the demonstration of D cells showed negative results. Aldehyde

P. B. N. Pinheiro; H. B. Coutinho; F. J. C. Aguiar; R. G. Pessoa; P. A. Abrahamsohn; D. J. Pallot; V. B. Coutinho

1981-01-01

412

Effect of maternal undernutrition on human foetal pancreas morphology in second trimester of pregnancy  

PubMed Central

Background & objectives: Maternal undernutrition and hyperglycaemia during pregnancy, as well as foetal undernutrition affecting the development of foetal endocrine pancreas structure and function, especially that of ?-cells is well known. This study was undertaken to look into the changes in pancreatic islets morphology of aborted normal human foetuses (16-20 wk old) of undernourished and adequately nourished mothers. Methods: Foetuses were collected over a 24 month period from medically terminated pregnancies of six undernourished mothers (BMI <18.5 kg/m2) and eight adequately nourished mothers (BMI >18.5 kg/m2). The sections were stained with haematoxylin & eosin as well as Masson trichrome for morphometric estimates such as islet count, area, volume, etc. and immunohistochemistry analysis of ?-cells for insulin presence was done. Results: Significant correlations between maternal and foetal parameters were seen. However, there were no statistically significant differences in the number, size or density and beta cell counts of the pancreas among foetal pancreas of mothers with BMI <18.5 and >18.5 kg/m2. Interpretation & conclusions: Our findings indicate that nutritional status of the mother may not have profound influence on the morphology of beta cells of foetal pancreas in second trimester of pregnancy. Further studies need to be done to confirm these findings. PMID:23563373

Kumar, P. Uday; Ramalaxmi, B.A.; Venkiah, K.; Sesikeran, B.

2013-01-01

413

Isolated granulocytic sarcoma of the pancreas: A tricky diagnostic for primary pancreatic extramedullary acute myeloid leukemia  

PubMed Central

We report two clinical cases of primary granulocytic sarcoma of the pancreas that were diagnosed on the surgical specimen. Atypical clinical and morphological presentations may have lead to pretherapeutic biopsies of the pancreatic mass in order to indicate primary chemotherapy. Literature review of this rare clinical presentation may help physicians to anticipate diagnostic and therapeutic strategies. PMID:22248364

2012-01-01

414

Protective effect of testosterone on early apoptotic damage induced by streptozotocin in rat pancreas  

Microsoft Academic Search

Beta-cell apoptosis is responsible for the development of insulin-dependent diabetes mellitus in the streptozotocin (STZ) rat model. It has been demonstrated that steroid hormones possess antioxidant and protective antiapoptotic effects in many tissues. The aim of the present study was to investigate the early apoptotic damage induced by STZ in rat pancreas, and the effect of testosterone in preventing apoptosis

S Morimoto; C A Mendoza-Rodríguez; M Hiriart; M E Larrieta; P Vital; Facultad de Química

2005-01-01

415

Solid–pseudopapillary neoplasms of the pancreas in men and women: do they differ?  

Microsoft Academic Search

Solid–pseudopapillary neoplasms (SPNs) of the pancreas are uncommon and occur preferentially in young women. The question whether the features of SPNs occurring in men differ from those in women has not yet been studied. For a better understanding of the clinicopathological features of SPNs of both sexes, we studied a series of 14 tumors surgically resected at a Japanese hospital

Yu Takahashi; Nobuyoshi Hiraoka; Kaoru Onozato; Tatsuhiro Shibata; Tomoo Kosuge; Yuji Nimura; Yae Kanai; Setsuo Hirohashi

2006-01-01

416

Intraductal papillary tumors and mucinous cystic tumors of the pancreas: Clinicopathologic study of 38 cases  

Microsoft Academic Search

Clinicopathological features of 28 patients with intraductal papillary tumor (IDPT) and 10 patients with mucinous cystic tumor (MCT) of the pancreas were studied. Both IDPT and MCT showed papillary projections of the epithelium with abundant mucus secretion in the ectatic ducts or cystic spaces. The patients with IDPT comprised 19 men and 9 women with a mean age of 64.9

Noriyoshi Fukushima; Kiyoshi Mukai; Yae Kanai; Takahiro Hasebe; Kazuaki Shimada; Hideo Ozaki; Taira Kinoshita; Tomoo Kosuge

1997-01-01

417

Intraoperative glycemic control procedures and the use of an artificial pancreas  

Microsoft Academic Search

Strict intraoperative glycemic control can significantly decrease the incidence of postoperative infection; however, anesthesiologists must carefully control blood glucose levels as well as properly manage the respiratory and cardiovascular systems. However, standard blood glucose measurement systems and insulin dosing algorithms, which are necessary for achieving strict glycemic control, have not yet been developed. An artificial pancreas (STG-22TM; Nikkiso Co., Tokyo,

Koichi Yamashita; Tomoaki Yatabe

2009-01-01

418

BASIC--LIVER, PANCREAS, AND BILIARY Development of Nonalcoholic Steatohepatitis in Insulin-Resistant  

E-print Network

BASIC--LIVER, PANCREAS, AND BILIARY TRACT Development of Nonalcoholic Steatohepatitis in Insulin-Resistant Liver-Specific S503A Carcinoembryonic Antigen-Related Cell Adhesion Molecule 1 Mutant Mice SANG JUN LEE Affairs Medical Center, San Francisco, California See editorial on page 1860. Background & Aims: Liver

Brand, Paul H.