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Sample records for pancreas preoperative diagnosis

  1. Endoscopic ultrasound in the diagnosis and management of carcinoma pancreas

    PubMed Central

    Puri, Rajesh; Manrai, Manish; Thandassery, Ragesh Babu; Alfadda, Abdulrahman A

    2016-01-01

    Endoscopic ultrasound (EUS) has become an important component in the diagnosis and treatment of carcinoma pancreas. With the advent of advanced imaging techniques and tissue acquisition methods the role of EUS is becoming increasingly important. Small pancreatic tumors can be reliably diagnosed with EUS. EUS guided fine needle aspiration establishes diagnosis in some cases. EUS plays an important role in staging of carcinoma pancreas and in some important therapeutic methods that include celiac plexus neurolysis, EUS guided biliary drainage and drug delivery. In this review we attempt to review the role of EUS in diagnosis and management of carcinoma pancreas. PMID:26839647

  2. Pancreas.

    PubMed

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

    2016-01-01

    Even though pancreas transplant numbers have steadily declined over the past decade, new listings increased in 2014 compared with the previous year, notably for pancreas transplant alone (PTA) and simultaneous pancreas-kidney transplant. The number of new PTAs also increased over the past two years. Whether this is a sustainable trend remains to be seen. Significant events in 2014 included implementation of a new pancreas allocation system and development of a proposed uniform definition of pancreas graft failure. Meanwhile, overall pancreas transplant rates and outcomes continued to improve. Substantial decline in pancreas after kidney transplants remains a serious concern. SRTR has not published pancreas graft failure data in the program-specific reports for the past two years. While this will not change in the near future, the acceptance of a uniform definition of graft failure is a crucial first step toward resuming graft failure reporting. Continued improvements and innovation, both surgical and immunological, will be critical to keep pancreas transplant as a viable option for treatment of insulin-dependent diabetes. As alternative therapies for diabetes such as islet transplant and artificial pancreas are evolving, improved outcomes with minimizations of complications are more important than ever. PMID:26755263

  3. Solid pseudopapillary tumor of the pancreas: emphasis on differential diagnosis from aggressive tumors of the pancreas.

    PubMed

    Aydiner, Fatma; Erinanç, Hilal; Savaş, Berna; Erden, Esra; Karayalçin, Kaan

    2006-09-01

    Solid pseudopapillary tumor is an unusual primary tumor of the pancreas with a low potential for malignancy and unknown cell origin, seen mostly in young women. Although it is discussed among pancreatic epithelial tumors, many cases do not express cytokeratin but show neuroendocrine differentiation. Three cases (2 female, 1 male, aged 24, 45 and 50 years, respectively) of solid pseudopapillary tumor localized in the pancreas are presented. All cases displayed a well-circumscribed tumor, with an average diameter of 6 cm and a red-brown colored, hemorrhagic, cystic cut surface. Microscopically they were encapsulated with large areas composed of thin papillary formations and solid areas focally. Tumor cells were dyscohesive with small, round- to-oval, central nuclei, and vacuolated, clear or eosinophilic cytoplasm without mitotic activity. NSE, vimentin, synaptophysin, ER, PR, Ki-67, S-100, Pan CK, a1-antitrypsin, a2-antichymotrypsin, and antibodies were used in the immunohistochemical study. Vimentin, synaptophysin, NSE, PR, and a1-antitrypsin showed expression in all cases, while Pan-CK was expressed in two cases. Ki-67 expression was below 1% in all cases. Morphologic features of solid pseudopapillary tumor may be confused with pancreatic endocrine neoplasm and ductal adenocarcinoma. All cases showed features of histiocytic and neuroendocrine differentiation. Epithelial differentiation was identified in two cases. We conclude that immunohistochemistry is incapable of giving additional information for the diagnosis of solid pseudopapillary tumor due to different lines of differentiation of tumor cells. We believe that macroscopic and microscopic features (using hematoxylin and eosin stain) are more important for the diagnosis and differential diagnosis of this tumor. PMID:16941259

  4. Preoperative chemoradiation and IOERT for unresectable or borderline resectable pancreas cancer

    PubMed Central

    Moss, Adyr A.; Rule, William G.; Callister, Matthew G.; Reddy, K. Sudhakar; Mulligan, David C.; Collins, Joseph M.; De Petris, Giovanni; Gunderson, Leonard L.; Borad, Mitesh

    2013-01-01

    Background and objectives Pre-operative chemoradiation (preop CRT) plus intraoperative electron irradiation (IOERT) has been used in the multidisciplinary treatment for patients with locally advanced unresectable or borderline resectable pancreas cancer. This review was performed to evaluate survival, relapse patterns and prognostic factors in patients treated with curative intent. Methods Between January 2002 and December 2010, 48 patients with locally advanced pancreatic ductal adenocarcinoma received preop CRT prior to an attempt at resection and IOERT. 31/48 (65%) patients proceeded to curative-intent surgical resection. Resection status prior to preop CRT was locally unresectable (20 patients) and borderline resectable (11 patients). Preop CRT (45-50.4 Gy/25-28 Fx in 27/31) was delivered with concurrent 5FU or gemcitabine-based regimens. Subsequent gross total resection was achieved in 16 patients (R0, 11; R1, 5). IOERT was delivered in 28 patients (dose, 10-20 Gy). 16 patients also received adjuvant post-operative systemic chemotherapy. Outcomes evaluated include survival, local failure in the EBRT field (LF), central failure in the IOERT field (CF), and distant metastases. Results Resection status was predictive for survival and for patterns of relapse. For patients with at least a gross total resection after preop CRT (R0/R1; n=16) vs. no resection (n=15), both median and overall survival were improved (median 23 vs. 10 months; 2-year, 40% vs. 17%; 3-year, 40% vs. 0%; P=0.002). Liver or peritoneal relapse was documented in 22/31 patients (71%); LF/CF in 5/26 (16%). Conclusions Long term survival and disease control are achievable in select patients with borderline resectable or locally unresectable pancreas cancer when gross total surgical resection is achieved after preop CRT. Continued evaluation of curative-intent combined modality therapy is warranted in this high risk population, but additional strategies are needed to improve resectability and disease control. PMID:24294506

  5. Preoperative diagnosis of pelvic actinomycosis by clinical cytology

    PubMed Central

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

    2012-01-01

    Background The purpose of this work was to investigate whether clinical cytology could be useful in the preoperative diagnosis of pelvic actinomycosis. Methods This study involved the prospective collection of samples derived from the endometrium and the uterine cervix, and retrospective data analysis. Nine patients with clinically diagnosed pelvic actinomycosis were enrolled. The clinical and hematological characteristics of patients were recorded, and detection of actinomyces was performed by cytology, pathology, and bacteriological culture of samples and by imprint intrauterine contraceptive device (IUD) cytology. Results The detection rate of actinomyces was 77.7% by combined cervical and endometrial cytology, 50.0% by pathology, and 11.1% by bacterial culture. Conclusion The higher detection rate of actinomyces by cytology than by pathology or bacteriology suggests that careful cytological examination may be clinically useful in the preoperative diagnosis of pelvic actinomycosis. PMID:23071423

  6. Role of Special Coagulation Studies for Preoperative Screening of Thrombotic Complications in Simultaneous Pancreas-Kidney Transplantation

    PubMed Central

    Moiz, Abdul; Javed, Tariq; Bohorquez, Humberto; Bruce, David S.; Carmody, Ian C.; Cohen, Ari J.; Staffeld-Coit, Catherine; Luo, Qingyang; Loss, George E.; Garces, Jorge

    2015-01-01

    Background Vascular thrombosis is a well-known complication after simultaneous pancreas-kidney (SPK) transplantation procedures. The role of preoperative special coagulation studies to screen patients at high risk for vascular thrombosis is unclear and not well studied. Methods This study reports a retrospective medical record review of 83 SPK procedures performed between April 2007 and June 2013 in a single institution. All SPK transplantation recipients underwent preoperative screening for hypercoagulable state. Results Eighteen of 83 patients (21.69%) were diagnosed with vascular thrombosis of the pancreas. Of the 23 patients with at least 1 positive screening test, only 4 had a thrombotic event (17.39%). On the other hand, 14 of 60 patients with negative screening tests developed vascular thrombosis (23.33%). The hypercoagulable screening workup had a positive predictive value of 17.39% and a negative predictive value of 76.67%. The workup also demonstrated low sensitivity (22.22%) and specificity (70.77%). Conclusion No differences were seen in patient or graft survival between groups at 12 months. This retrospective study did not show any benefit of using special coagulation studies to rule out patients at risk for vascular thrombosis after SPK transplantation. PMID:26413003

  7. Non-functional neuroendocrine tumors of the pancreas: Advances in diagnosis and management

    PubMed Central

    Cloyd, Jordan M; Poultsides, George A

    2015-01-01

    Nonfunctional neuroendocrine tumors of the pancreas (NF-PNETs) are a heterogeneous group of neoplasms. Although rare, the incidence of NF-PNETs is increasing significantly. The classification of PNETs has evolved over the past decades and is now based on a proliferation grading system. While most NF-PNETs are slow growing, tumors with more aggressive biology may become incurable once they progress to unresectable metastatic disease. Tumors of higher grade can be suspected preoperatively based on the presence of calcifications, hypoenhancement on arterial phase computed tomography, positron emission technology avidity and lack of octreotide scan uptake. Surgery is the only curative treatment and is recommended for most patients for whom complete resection is possible. Liver-directed therapies (thermal ablation, transarterial embolization) can be useful in controlling unresectable hepatic metastatic disease. In the presence of unresectable progressive disease, somatostatin analogues, everolimus and sunitinib can prolong progression-free survival. This article provides a comprehensive review of NF-PNETs with special emphasis on recent advances in diagnosis and management. PMID:26327759

  8. Optimising preoperative diagnosis in phyllodes tumour of the breast

    PubMed Central

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

    2006-01-01

    The role of the pathologist in the preoperative diagnosis of phyllodes tumours of the breast is critical to appropriate surgical planning. However, reliable differentiation of phyllodes tumour from cellular fibroadenoma remains difficult. Preoperative diagnostic accuracy allows correct surgical treatment, avoiding the pitfalls of reoperation because of inadequate excision, or surgical overtreatment. Specific clinical indices may arouse diagnostic suspicion but are unreliable for confirmation, as with current imaging modes. Fine needle aspiration cytology has a high false negative rate. Few studies have evaluated the role of core needle biopsy, but it may prove a useful adjunct. Both diagnostic and prognostic information may in future be gained from application of immunohistochemical and other techniques assessing the expression of proliferative markers including p53, Ki‐67, and others. PMID:16461806

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

    SciTech Connect

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

    1981-08-01

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

  10. Diagnosis and management of cystic lesions of the pancreas

    PubMed Central

    2015-01-01

    Pancreatic cystic lesions (PCLs) are being increasingly identified in recent years. They show a wide spectrum of imaging and clinical features. The diagnosis and discrimination of these lesions are very important because of the risk for concurrent or later development of malignancy. PCLs are usually first diagnosed and characterized by conventional imaging modalities such as trans-abdominal ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI). However, their ability to differentiate the benign and malignant lesions remains limited. Endoscopic US may be more helpful for the diagnosis and differentiation of PCLs because of its high resolution and better imaging characteristics than cross-sectional imaging modalities. It also allows for fine-needle aspiration (FNA) of cystic lesions for biochemical, cytological and DNA analysis that might be further helpful for diagnosis and differentiation. The management options of PCLs are to observe, endoscopic treatment or surgical resection. However, the decision for management is sometimes hampered by limitations in current diagnostic and tissue sampling techniques. As further diagnostic and non-invasive management options become available, clinical decision-making will become much easier for these lesions. PMID:26261724

  11. Clear cell neuroendocrine tumor of pancreas: Endoscopic Ultrasound-guided fine needle aspiration diagnosis of an uncommon variant

    PubMed Central

    Kaur, Gagandeep; Bakshi, Pooja; Singla, Vikas; Verma, Kusum

    2016-01-01

    The cytomorphologic features of clear cell neuroendocrine tumor of pancreas have been rarely reported in cytology literature. The cytomorphology of this rare variant mimics many primary and metastatic clear cell tumors of the pancreas. However, a precise cytological diagnosis can be rendered by awareness of this entity and judicious use of immunohistochemistry. We report one such case in a young woman diagnosed on endoscopic ultrasound fine needle aspiration. The tumor cells showed positive staining with synaptophysin, chromogranin, and also with inhibin.

  12. [Usefulness of imaging examinations in preoperative diagnosis of acute appendicitis].

    PubMed

    Nitoń, Tomasz; Górecka-Nitoń, Aleksandra

    2014-01-01

    Acute appendicitis (AA) is the cause one of most operations perform in department of general surgery on emergency ward. Frequency of acute appendicitis range from 6-8% of population. Clinical presentation is frequently unspecified and despite common occurence leads to many difficulties in diagnosis. Diagnosis of acute appendicitis includes clinical examination, laboratory tests, diagnostic scoring systems, computer programs as physisian aids and imaging examinations. About 30-45% patients suspected of acute appendicitis have untypical clinical presentation and here use of US or CT is very helpful. Longstanding use of US resulted in high AA evaluation accuracy with high sensitivity (75-90%) and specificity (84-100%). CT demonstrates above 95% ratio of correct diagnoses, reduces negative appendectomy rates and perforation rates as well as unnecessary observations. CT sensitivity and specificity CT is estimated between 83-100% among different authors. Expedited AA diagnosis, surgery and reduced hospitalization time are possible advantages of imaging tests. Additionally these tests can detect alternative deseases imitating acute appnedicitis. Use of imaging tests especially CT is beneficial in fertile women because of frequent genito-urinary disorders leading to the most diagnostic errors. However thera are contraindications in use of CT, for example it can not be performed in early pregnancy etc... PMID:26030962

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

    PubMed

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

    2015-02-01

    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. PMID:24554389

  14. Difficult preoperative diagnosis of a patient with sclerosing splenic hemangioma

    SciTech Connect

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

    1989-07-01

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

  15. Preoperative endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors, including magnifying endoscopy

    PubMed Central

    Tsuji, Shigetsugu; Doyama, Hisashi; Tsuji, Kunihiro; Tsuyama, Sho; Tominaga, Kei; Yoshida, Naohiro; Takemura, Kenichi; Yamada, Shinya; Niwa, Hideki; Katayanagi, Kazuyoshi; Kurumaya, Hiroshi; Okada, Toshihide

    2015-01-01

    Superficial non-ampullary duodenal epithelial tumor (SNADET) is defined as a sporadic tumor that is confined to the mucosa or submucosa that does not arise from Vater’s papilla, and it includes adenoma and adenocarcinoma. Recent developments in endoscopic technology, such as high-resolution endoscopy and image-enhanced endoscopy, may increase the chances of detecting SNADET lesions. However, because SNADET is rare, little is known about its preoperative endoscopic diagnosis. The use of endoscopic resection for SNADET, which has no risk of metastasis, is increasing, but the incidence of complications, such as perforation, is significantly higher than in any other part of the digestive tract. A preoperative diagnosis is required to distinguish between lesions that should be followed up and those that require treatment. Retrospective studies have revealed certain endoscopic findings that suggest malignancy. In recent years, several new imaging modalities have been developed and explored for real-time diagnosis of these lesion types. Establishing an endoscopic diagnostic tool to differentiate between adenoma and adenocarcinoma in SNADET lesions is required to select the most appropriate treatment. This review describes the current state of knowledge about preoperative endoscopic diagnosis of SNADETs, such as duodenal adenoma and duodenal adenocarcinoma. Newer endoscopic techniques, including magnifying endoscopy, may help to guide these diagnostics, but their additional advantages remain unclear, and further studies are required to clarify these issues. PMID:26557007

  16. Preoperative diagnosis of cavernous hemangioma presenting with melena using wireless capsule endoscopy of the small intestine

    PubMed Central

    Akazawa, Yu; Hiramatsu, Katsushi; Nosaka, Takuto; Saito, Yasushi; Ozaki, Yoshihiko; Takahashi, Kazuto; Naito, Tatsushi; Ofuji, Kazuya; Matsuda, Hidetaka; Ohtani, Masahiro; Nemoto, Tomoyuki; Suto, Hiroyuki; Yamaguchi, Akio; Imamura, Yoshiaki; Nakamoto, Yasunari

    2016-01-01

    Background and study aims: Primary neoplasms of the small intestine are relatively rare in all age groups, accounting for about 5 % of all gastrointestinal tumors 1. Cavernous hemangiomas of the small intestine are also rare, can cause gastrointestinal bleeding, and are extremely difficult to diagnose preoperatively 2. We present a patient who presented with melena and iron deficiency anemia, for whom wireless capsule endoscopy and single-balloon enteroscopy facilitated the diagnosis of cavernous hemangioma. PMID:27004239

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

    PubMed Central

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

    2014-01-01

    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

  18. Mammary analogue secretory carcinoma of parotid: Is preoperative cytological diagnosis possible?

    PubMed

    Oza, Nikita; Sanghvi, Kintan; Shet, Tanuja; Patil, Asawari; Menon, Santosh; Ramadwar, Mukta; Kane, Shubhada

    2016-06-01

    Mammary analogue secretory carcinoma is a recently recognized tumor of salivary gland with characteristic t(12;15)(q13;q25) that results in ETV6-NTRK3 fusion product. Distinguishing mammary analogue secretory carcinoma from other salivary gland tumors is important. Present study highlights cytologic findings in three cases of mammary analogue secretory carcinoma of parotid which facilitate preoperative diagnosis with the aid of ancillary diagnostic techniques. Fine needle aspiration cytology of parotid was performed on three cases after clinical examination. Immunocytochemistry for mammoglobin and S100 were performed. Parotidectomy was done in all cases. The corresponding hematoxylin and eosin stained slides and blocks of all cases were studied. Molecular analysis was done in one of the cases. Cases 1 and 3 revealed uniform atypical epithelial cells arranged in branching papillary pattern with few cells in microcystic pattern. Case 2 showed atypical cells arranged mainly in loose clusters and few singly dissociated. Individual cells revealed round nuclei, vesicular chromatin, prominent nucleoli and abundant finely vacuolated cytoplasm with metachromasia prominent in May-Grunwald-Giemsa smear (case 3). Characteristic hob-nail cells covering papillae were observed in cases 1 and 3. Immunocytochemistry showed strong positivity for mammoglobin and S100 thereby confirming the diagnosis of mammary analogue secretory carcinoma preoperatively. The diagnosis was in concordance with surgical specimen. Also, characteristic ETV6-NTRK3 translocation was confirmed in case 1. Increased awareness and high index of suspicion is necessary for the upfront diagnosis, more so for the papillary variant of mammary analogue secretory carcinoma. Immunocytochemistry aids in confirming this preoperative diagnosis, based on which treatment can be planned. Diagn. Cytopathol. 2016;44:519-525. © 2016 Wiley Periodicals, Inc. PMID:26945684

  19. Challenge in preoperative diagnosis of retroperitoneal mucinous cyst in a pediatric patient

    PubMed Central

    Zhang, Deying; Zhang, Yan; Liu, Xing; Zhu, Jin; Feng, Chuan; Yang, Chunjiang; Wu, Shengde; Liu, Junhong; Hua, Yi; Liu, Feng; Zhang, Nan; Zhang, Yuanyuan; He, Dawei; Lin, Tao; Wei, Guanghui

    2015-01-01

    Mucinous cystic lesions of the retroperitoneum can be either neoplastic or non-neoplastic. It is very important to make a correct diagnosis, or at least, an accurate classification, to proceed with an optimal treatment strategy. In spite of advantage of ultrasound and X-ray image examinations, it is still a challenge to make differential diagnosis of retroperitoneal mucinous cyst from gangliocytoma because both tumors have similar density under the image assessment. In this article, we reported an asymptomatic 8-year-old boy with multiple bronchogenic cysts in both lung and adrenal area on the left side, the latter was considered to be a gangliocytoma preoperatively by ultrasound and computed tomography, but confirmed as bronchogenic cyst by histopathology post laparoscopic resection. The differential diagnosis, imaging features and treatment of bronchogenic cyst are discussed and the relative literatures are reviewed. PMID:26770607

  20. Diagnosis of ectopic pancreas by endoscopic ultrasound with fine-needle aspiration

    PubMed Central

    Attwell, Augustin; Sams, Sharon; Fukami, Norio

    2015-01-01

    AIM: To study the clinical, endoscopic, sonographic, and cytologic features of ectopic pancreas (EP). METHODS: This was a retrospective study performed at an academic referral center including two hospitals. Institutional review board approval was obtained. Patients referred to the University Hospital or Denver Health Medical Center Gastrointestinal Endoscopy Lab for gastroduodenal subepithelial lesions (SEL) with a final diagnosis of EP between January 2009 and December 2013 were identified. Patients in this group were selected for the study if they underwent endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) or deep biopsy. A review of the medical record was performed specifically to review the following information: presenting symptoms, endoscopic and EUS findings, computed tomography or magnetic resonance imaging findings, pathology results, procedure-related adverse events, and subsequent treatments after EUS-FNA. EUS with FNA or deep submucosal biopsy was performed in all patients on an outpatient basais by one of two physicians (Attwell A, Fukami N). Review of all subsequent clinic notes and operative reports was performed in order to determine follow-up and final diagnoses. RESULTS: Between July 2009 and December 2013, 10 patients [3 males, 7 females, median age 52 (26-64) years] underwent EUS for a gastroduodenal SEL and were diagnosed with EP. One patient was symptomatic. Six (60%) lesions were in the antrum, 3 (30%) in the body, and 1 (10%) in the duodenum. A mucosal dimple was noted in 6 (60%). Mean lesion size was 17 (8-25) mm. Gastrointestinal wall involvement: muscularis mucosae, 10%; submucosa, 70%; muscularis propria, 60%; and serosa, 10%. Nine (90%) lesions were hypoechoic and 5 (50%) were homogenous. A duct was seen in 5 (50%). FNA was attempted in 9 (90%) and successful in 8 (80%) patients after 4 (2-6) passes. Cytology showed acini or ducts in 7 of 8 (88%). Superficial biopsies in 7 patients (70%) showed normal gastric mucosa. Deep endoscopic biopsies were taken in 2 patients and diagnostic in one. One patient (10%) developed pancreatitis after EUS-FNA. Two patients (20%) underwent surgery to relieve symptoms or confirm the diagnosis. The main limitation of the study was the fact that it was retrospective and performed at a single medical center. CONCLUSION: EUS features of EP include antral location, mucosal dimple, location in layers 3-4, and lesional duct, and FNA or biopsy is accurate and effective. PMID:25741143

  1. Recent development of optical coherence tomography for preoperative diagnosis of esophageal malignancies

    PubMed Central

    Uno, Kaname; Koike, Tomoyuki; Shimosegawa, Tooru

    2015-01-01

    Endoscopic diagnosis with histological evidence is necessary to decide the best strategy for treating esophageal squamous cell carcinoma and Barrett’s-associated neoplasia, and the recent development of endoscopic technologies have made possible real-time information of malignant hallmarks. We focused on the development of optical coherence tomography (OCT), the only technology that can depict real-time cross-sectional images with high resolution. With the improvements in image resolution, acquisition rate and demonstrable area of three-dimensional devices with Doppler capability, OCT imaging was shown to enable visualization of structural/functional alterations in the mucosal/submucosal tissue of the esophagus, resulting in more accurate preoperative diagnosis of such malignancies. Moreover, it approved to be useful for targeting malignant areas for biopsy and treatment as well as for predicting the treatment effects. Therefore, further development of this technology is expected to overcome the current clinical issues in management strategies of esophageal malignancies. PMID:26240688

  2. Three cases of struma ovarii underwent laparoscopic surgery with definite preoperative diagnosis.

    PubMed

    Nurliza Binti Md Nor; Kusumoto, Tomoyuki; Inoue, Seiji; Nakamura, Keiichiro; Seki, Noriko; Hongo, Atsushi; Kodama, Junichi; Hiramatsu, Yuji

    2013-01-01

    Struma ovarii is a rare neoplasm that accounts for approximately 0.3% of ovarian tumors. Due to its ultrasound morphology, which is quite similar to that of malignant ovarian carcinoma, most struma ovarii cases are open operated with laparotomy rather than laparoscopy. We present 3 cases of struma ovarii, which were diagnosed preoperatively by imaging studies and removed by laparoscopic surgery. All patients were premenopausal women between ages 31‒50. The magnetic resonance imaging (MRI) findings were complex masses composed of multiple cysts and solid components with T2-hypointense regions as well as multiple T1-hyperintense cystic areas, findings that are typical for struma ovarii. A combination of plain computed tomography (CT), positron emission tomography (PET)-CT, and scintigraphy was useful for diagnosis. Laboratory examination revealed elevated serum thyroglobulin, which led to the diagnosis of struma ovarii. Laparoscopic surgeries were performed without rupturing the tumors. Although it has been difficult to differentiate between struma ovarii and malignant tumors by conventional methods, recently MRI techniques appear make it possible to diagnose struma ovarii preoperatively from the abovementioned imaging characteristic, together with laboratory data. As for treatment, we think laparoscopy could be successful for struma ovarii, but the surgeon must be careful not to rupture the tumor intra-abdominally in order to prevent dissemination, which could lead to malignancy. PMID:23804143

  3. Endoscopic ultrasound-guided fine-needle aspiration diagnosis of secondary tumors involving the pancreas: An institution's experience

    PubMed Central

    Alomari, Almed K.; Ustun, Berrin; Aslanian, Harry R.; Ge, Xinquan; Chhieng, David; Cai, Guoping

    2016-01-01

    Background: Pancreatic masses may seldom represent a metastasis or secondary involvement by lymphoproliferative disorders. Recognition of this uncommon occurrence may help render an accurate diagnosis and avoid diagnostic pitfalls during endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). In this study, we review our experience in diagnosing secondary tumors involving the pancreas. Materials and Methods: The electronic database of cytopathology archives was searched for cases of secondary tumors involving the pancreas at our institution and a total of 31 cases were identified. The corresponding clinical presentations, imaging study findings, cytological diagnoses, the results of ancillary studies, and surgical follow-up, if available, were reviewed. Results: Nineteen of the patients were male and 12 female, with a mean age of 66 years. Twenty-three patients (74%) had a prior history of malignancy, with the latency ranging from 6 months to 19 years. The secondary tumors involving the pancreas included metastatic carcinoma (24 cases), metastatic sarcoma (3 cases), diffuse large B-cell lymphoma (2 cases), and plasma cell neoplasm (2 cases). The most common metastatic tumors were renal cell carcinoma (8 cases) and lung carcinoma (7 cases). Correct diagnoses were rendered in 29 cases (94%). The remaining two cases were misclassified as primary pancreatic carcinoma. In both cases, the patients had no known history of malignancy, and no ancillary studies were performed. Conclusions: Secondary tumors involving the pancreas can be accurately diagnosed by EUS-FNA. Recognizing uncommon cytomorphologic features, knowing prior history of malignancy, and performing ancillary studies are the keys to improve diagnostic performance and avoid diagnostic pitfalls. PMID:26955395

  4. Heterotopic Pancreas Leading to Ileo-Ileal Intussusception

    PubMed Central

    Ratan, KN; Rani, Babita; Tina

    2012-01-01

    A heterotopic pancreas as the lead point of ileo-ileal intussusception is extremely rare. A 12-year-old previously healthy boy, presented to the emergency room with the complaint of severe abdominal pain for the last 6-8 hours. A preoperative diagnosis of ileo-ileal intussusception was made on ultrasound and an emergency exploratory laparotomy was done. At laparotomy an ileo-ileal intussusception was found and a polyp noted as a lead point. On histopathology this polyp was found to be heterotopic pancreas. PMID:22953306

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

    SciTech Connect

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

    1987-12-01

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

  6. 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 ...

  7. Incarcerated femoral hernia containing the right uterine tube. A pre-operative diagnosis is possible.

    PubMed

    Engin, Omer; Cicek, Ebru; Oner, Soner Recai; Yildirim, Mehmet

    2011-01-01

    The incarcerated femoral hernia containing the right uterine tube is very rare to see. The case report is important to accumulate knowledge of very rare cases. The diagnosis of the case was established pre-operatively with abdominal computerized tomography (CT) On CT examination, the mass in the hernia sac was not connected with the intestines and a tubal structure on the right side of the uterus was shown to extend out of the abdomen. In the operation, the right uterine tube(RUT) was reduced into the abdomen after its blood supply was shown to be normal. A hernia repair was performed. Sometimes in obese patients, incarcerated femoral or inguinal hernias may not been noted. Ultrasonography, CT and magnetic resonance imaging (MRI) is used frequently to diagnose abdominal wall hernias. The organs in the incarcerated sac must be examined carefully and the viability must be checked. The surgeon must decide whether or not to resect the organs. In our case, strangulation was not found and polypropylene mesh was not used for hernia repair due to a fear of infection of the prosthesis. Incarceration of the uterine tube in the sac is traumatic and this condition may lead to infection. Such conditions may lead to ectopic pregnancy. The patient must be informed about ectopic pregnancy due to a previous incarceration of the tube because ectopic pregnancy may be fatal. PMID:21988051

  8. Polycystic Pancreas

    PubMed Central

    Amarapurkar, Deepak N.; Amarapurkar, Anjali D.

    2016-01-01

    Polycystic disease of the pancreas is a very rare entity with very few cases reported in the literature. We report a symptomatic case of polycystic pancreas associated with pheochromocytoma that was treated surgically. PMID:27144204

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

    PubMed Central

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

    2014-01-01

    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% (κ value=0.61; P<0.05); T2 stage accuracy, 86.7% with a specificity of 87.5% and sensitivity of 83.3% (κ value=0.71; P<0.05); T3 stage accuracy, 90% with a specificity and sensitivity of 90% (κ value=0.78; P<0.05); and T4 stage accuracy, 96.7% with a specificity of 100% and sensitivity of 87.5% (κ 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

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

    PubMed

    Huo, Xianying; Yuan, Kuangsheng; Shen, Yuexia; Li, Min; Wang, Qi; Xing, Lingxiao; Shi, Gaofeng

    2014-07-01

    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% (κ value=0.61; P<0.05); T2 stage accuracy, 86.7% with a specificity of 87.5% and sensitivity of 83.3% (κ value=0.71; P<0.05); T3 stage accuracy, 90% with a specificity and sensitivity of 90% (κ value=0.78; P<0.05); and T4 stage accuracy, 96.7% with a specificity of 100% and sensitivity of 87.5% (κ 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

  11. The Role of Fine Needle Aspiration in the Diagnosis of Parotid Gland Tumors: Correlation With Preoperative Computerized Tomography Tumor Size.

    PubMed

    Ghantous, Yasmine; Naddaf, Raja; Barak, Michal; Abd-Elraziq, Murad; Abu Eln-Naaj, Imad

    2016-03-01

    The role of fine needle aspiration cytology (FNAC) in the diagnosis of parotid gland masses is still controversial, regarding its sensitivity and specificity that vary between 41% and 100% and between 86% and 100% respectively.The aim of this study was to identify the specificity and sensitivity of FNAC of parotid gland tumors in relation to the tumor size as characterized preoperatively by computer tomography. The medical files of 79 patients whom were referred to the MaxilloFacila Surgery Department, Rambam medical center, over a 10.5-year period (2000-2010) were analyzed retrospectively.The extensity of the operation was determined by the location of the tumor as presented in computed tomography (CT) radiography, and preoperative FNAC examination.The majority of the masses were located in the superficial lobe (88.52%), and only 11.48% of the patients were located in the deep lobe (8:1 ratio). FNAC results were nondiagnostic in 7 patients (8.86%), 62 patients were diagnosed as inflammatory and benign lesion in (78.48%), malignant tumors were diagnosed in 10 patients (12.65%).The sensitivity in our study was 90%, the specificity was 98%, positive predictive value was 90%, negative predictive value was 98%, and diagnostic accuracy was 88%. The positive predictive value was 90%, the negative predictive value was 98%.Analyzing the effect of the preoperative CT size upon the accuracy of the FNAC diagnosis, we found that lesion with preoperative CT size greater than 24 mm has a more accurate FNAC result (P = 0.034). PMID:26872280

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

    PubMed Central

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

    2012-01-01

    Pancreatic dermoid cysts represent a rare entity with 35 cases described in the world literature, including the present one. Pre-operative diagnosis is difficult, with definitive diagnosis usually taking place intra-operatively. We report the case of a 63 year old male with a symptomatic, 6 cm cystic mass in the body of the pancreas. The pre-operative evaluation suggested a cystic neoplasm, but was indeterminate as to whether the lesion was benign or malignant. The diagnosis of dermoid cyst was made intra-operatively with frozen section. Although the diagnosis could not be made pre-operatively this retrospective report highlights the difficulty in evaluating cystic pancreatic lesions by imaging and summarizes the current body of knowledge on this rare entity. PMID:23365699

  13. Cystic Lymphangioma of Pancreas.

    PubMed

    Bihari, Chhagan; Rastogi, Archana; Rajesh, S; Arora, Ankur; Arora, Asit; Kumar, Nikhil

    2016-03-01

    Lymphangiomas are benign hamartomatous malformations which can arise either from congenitally sequestered lymphatic channels or due to acquired obstruction caused by fibrosis of lymph channels. They are common in the pediatric age group in the soft tissue of neck and the axilla. Abdominal lymphangiomas are rare; even rarer is the primary involvement of pancreas. It occurs more frequently in females and is often located in the distal pancreas. The authors report the case of cystic lymphangioma of pancreas in a 26-year old female presenting with recurrent episodes of upper abdominal pain that was treated with laparoscopic cyst excision. Although exceptionally rare, lymphangioma of the pancreas should be considered in the differential diagnosis of pancreatic cystic lesions, especially in young women. PMID:27065694

  14. [Pheochromocytoma: role of preoperative diagnosis in the assessment of malignancy risk and in the choice of surgical approach].

    PubMed

    Lombardi, C P; Raffaelli, M; De Crea, C; Traini, E; D'Amore, A M; Bellantone, R

    2005-01-01

    Pheochromocytomas are malignant in 5-26% of the cases. Differential diagnosis with benign lesions can be difficult even on a pathological basis. Local invasion and distant metastasis are the only well established indicators of malignancy. It has been reported that the risk of malignancy increases with the lesion size. Despite safe laparoscopic adrenalectomy (LA) has been reported for lesions up to 10 cm, it is considered hazardous for pheochromocytoma larger than 6 cm, because of the risk of malignancy and iatrogenic pheochromocytomatosis. We evaluated the possibility to pre-operatively recognize pheochromocytomas at risk of being malignant that should not be selected for LA. The medical records of all the patients who underwent adrenalectomy for pheochromocytoma were reviewed. All the preoperatively available data (demographic, clinical, biochemical and radiological) were recorded as well as final pathological diagnosis. Comparative analysis of patients with benign and malignant pheochromocytomas was performed. Sixty-three adrenalectomies for pheochromocytoma were performed in 60 patients. Fifty-seven benign and 6 malignant pheochromocytomas were identified. No significant difference was found between patients with malignant and benign lesions concerning age, gender, family history, symptoms, laboratory and radiological findings. In particular, no significant difference was found for lesion size between the benign (63.3 +/- 30.6 mm, range, 20-150) and the malignant group (48.6 +/- 16.5 mm; range, 30-70). The largest diameter recorded for a malignant lesion was 70 mm. No preoperatively available data can reliably differentiate between benign and malignant pheochromocytomas. All malignant lesions in this series were smaller than 7 cm. Thus, pheochromocytoma size does not seem a reliable predictor of malignancy. In absence of the evidence of gross local invasion or metastatic disease, LA can be safely proposed also for large lesions. Conversion is mandatory in presence of local invasion or difficult dissection that could involve inadequate resection. PMID:16437995

  15. Prevalence of Co-existing Endometrial Carcinoma in Patients with Preoperative Diagnosis of Endometrial Hyperplasia

    PubMed Central

    Kadirogullari, Pinar; Atalay, Cemal Resat; Sari, Mustafa Erkan

    2015-01-01

    Introduction Endometrial hyperplasia has been associated with the presence of concomitant endometrial carcinoma. In this study, patients who were diagnosed with endometrial hyperplasia and had hysterectomy, determination of the incidence of endometrial cancer accompanying postoperatively and clinical parameters associated with cancer are aimed. Materials and Methods Endometrial biopsies were taken from patients for various reasons and among them 158 patients diagnosed with endometrial hyperplasia from pathologic examination results were retrospectively evaluated. All of the patient’s age, parity, weight, transvaginal ultrasound measured by endometrial thickness, concomitant systemic disease (diabetes, hypertension, hypothyroidism), tamoxifen use, hormone use and whether in reproductive age or menopause were all questioned. Patients who applied with endometrial cancer, their cervical stromal involvement, lymph node involvement, cytology positivity and omental metastases were examined. Patients were classified according to their stage and grade. Patients who had intraoperative frozen were re-evaluated. Results Fifteen cases with preoperative endometrial hyperplasia diagnosed with endometrial cancer postoperatively, 2 cases had complex hyperplasia without atypia and 13 cases had complex atypical hyperplasia. The rate of preoperative hyperplasia with postoperative endometrial cancer was found to be 10.8% where by 15 cases of patients diagnosed with endometrial cancer postoperatively 11 cases were in postmenopausal period. In patients diagnosed with endometrial cancer according to their histologic types 14 cases had endometrioid adenocarcinoma while one patient with preoperative complex hyperplasia without atypia was diagnosed with serous papillary carcinoma postoperatively. Evaluation of stages in patients diagnosed with cancer, 7 cases of patients had stage IA, 7 cases of patients had stage IB, and 7 cases cases of patients with serous papillary carcinoma were evaluated as stage 3C. Conclusion The risk of endometrial cancer in patients diagnosed with endometrial hyperplasia especially endometrial hyperplasia ranges between 15% to 45% and among them 7.9%–51% are found to have myometrial inversion. Therefore, preoperative ultrasound and magnetic resonance imaging should be perfomed in patients diagnosed with complex atypical hyperplasia. Even intraoperative frozen section examination can provide useful information in selected cases. PMID:26557570

  16. Evaluation of surgical outcome, complications, and mortality in dogs undergoing preoperative computed tomography angiography for diagnosis of an extrahepatic portosystemic shunt: 124 cases (2005-2014).

    PubMed

    Brunson, Benjamin W; Case, J Brad; Ellison, Gary W; Fox-Alvarez, W Alexander; Kim, Stanley E; Winter, Matthew; Garcia-Pereira, Fernando L; Farina, Lisa L

    2016-01-01

    This study evaluated the safety of preoperative computed tomography angiography (CTA) and its effect on surgical time and clinical outcomes in dogs that underwent surgical correction of a single congenital extrahepatic portosystemic shunt (CEPSS). Patient data were retrospectively collected from medical records and owner communications for 124 dogs with single CEPSS, undergoing preoperative CTA (n = 43) or not (n = 81) which were surgically treated from 2005 to 2014. The frequency of major postoperative complications was 4.7% and 9.9% for the CTA and no CTA groups, respectively (P = 0.49). Mean standard deviation (SD) surgical time for the preoperative CTA group was 84 40 min and 81 31 min for the no CTA group (P = 0.28). We conclude that anesthetized preoperative CTA appears to be a safe method for diagnosis and surgical planning in dogs with single CEPSS, and does not appear to affect surgical procedure time, complication rate, or clinical outcome. PMID:26740699

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

    PubMed Central

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

    2013-01-01

    Hydatid cyst of the breast is endemic in some areas like sheep-raising countries. The location of the disease is mostly in the liver and lungs. We presents a case of 66-year-old female with hydatid cyst of the breast diagnosed pre-operatively by core needle biopsy. Complete radiology workup are also provided which includes mammography, ultrasound, and computed tomography images. Hydatid cyst of the breast is extremely rare even in endemic areas, its only accounts for 0.27% of all cases. Only few reports are published in the literatures about breast hydatid cyst and majority of cases have been diagnosed post-operatively with no complete radiology workup. PMID:23717714

  18. Pancreas transplant

    MedlinePlus

    ... liver cells, where it can be used as fuel. In people with type 1 diabetes , the pancreas ... controlled angina , or severe coronary artery disease ) Smoking, alcohol or drug abuse, or other lifestyle habits that ...

  19. Artifical Pancreas

    NASA Astrophysics Data System (ADS)

    Fei, Jiangfeng

    2013-03-01

    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.

  20. Preoperative diagnosis of a ruptured intracranial dermoid cyst by computerized tomography. Case report.

    PubMed

    Amendola, M A; Garfinkle, W B; Ostrum, B J; Katz, M R; Katz, R I

    1978-06-01

    A case of ruptured intracranaial dermoid cyst in the right middle fossa is reported. A definitive diagnosis of the lesion and the fact that it had ruptured was made possible by specific computerized tomographic findings. The findings were confirmed at surgery. PMID:660237

  1. [Difficulty in Preoperative Diagnosis of Residual Gastric Cancer after Distal Gastrectomy for Duodenal Ulcer].

    PubMed

    Yamada, Masanori; Nakai, Koji; Inoue, Kentaro; Hijikawa, Takeshi; Kitade, Hiroaki; Yoshioka, Kazuhiko; Kon, Masanori

    2015-10-01

    A 67-year-old man underwent distal gastrectomy via the Billroth Ⅱ method (B-Ⅱ) for a duodenal ulcer. He presented with appetite loss and nausea in May 2014. Gastrointestinal endoscopy revealed wall thickness around gastrojejunostomy and the gastric mucosal fold. Biopsy and re-biopsy revealed a group 2 tumor. Laparotomy for diagnosis was performed because of stenosis and tumor progression. Intraoperative frozen section examination revealed adenocarcinoma in the lymph nodes of the jejunum. Residual gastrectomy with reconstruction using the Roux-en-Y method was performed for residual gastric cancer. Histopathological findings revealed pT4a, pN0, pM1 for the tumor in the lymph nodes of the jejunum, pStage Ⅳ. A distorted gastrojejunostomy site and the presence of anastomotic strictures are important for the rapid diagnosis of residual gastric cancer. PMID:26489571

  2. [Pelvic actinomycosis: the value of preoperative diagnosis. Apropos of a case].

    PubMed

    Garbin, O; Hummel, M; Camus, E; Dellenbach, P

    1994-01-01

    Pelvic actinomycosis is a chronic suppurative granulomatous disease caused by an anaerobic Gram positive germ, Actinomyces. This rare disease can be severe and life-threatening. A intra pelvic bridge becomes chronic and produces a pseudo-tumoural syndrome of the pelvis with retroperitoneal infiltration or extension to neighbouring organs. Initially, neoplasia is usually diagnosed, leading to mutilating surgical exeresis before the pathology results reveal the presence of pelvic actinomycosis. The most difficult task is to entertain the diagnosis in a patient with an intrauterine device and poor general health, signs of infection and a pelvic syndrome. We observed such a case where the diagnosis was suspected before surgery. Adapted first intention antibiotic therapy led to spectacular recovery and allowed limited surgery without unnecessary ablation of neighbouring organs. PMID:8051367

  3. A molecular computational model improves the preoperative diagnosis of thyroid nodules

    PubMed Central

    2012-01-01

    Background Thyroid nodules with indeterminate cytological features on fine needle aspiration (FNA) cytology have a 20% risk of thyroid cancer. The aim of the current study was to determine the diagnostic utility of an 8-gene assay to distinguish benign from malignant thyroid neoplasm. Methods The mRNA expression level of 9 genes (KIT, SYNGR2, C21orf4, Hs.296031, DDI2, CDH1, LSM7, TC1, NATH) was analysed by quantitative PCR (q-PCR) in 93 FNA cytological samples. To evaluate the diagnostic utility of all the genes analysed, we assessed the area under the curve (AUC) for each gene individually and in combination. BRAF exon 15 status was determined by pyrosequencing. An 8-gene computational model (Neural Network Bayesian Classifier) was built and a multiple-variable analysis was then performed to assess the correlation between the markers. Results The AUC for each significant marker ranged between 0.625 and 0.900, thus all the significant markers, alone and in combination, can be used to distinguish between malignant and benign FNA samples. The classifier made up of KIT, CDH1, LSM7, C21orf4, DDI2, TC1, Hs.296031 and BRAF had a predictive power of 88.8%. It proved to be useful for risk stratification of the most critical cytological group of the indeterminate lesions for which there is the greatest need of accurate diagnostic markers. Conclusion The genetic classification obtained with this model is highly accurate at differentiating malignant from benign thyroid lesions and might be a useful adjunct in the preoperative management of patients with thyroid nodules. PMID:22958914

  4. Preoperative Assessment of TERT Promoter Mutation on Thyroid Core Needle Biopsies Supports Diagnosis of Malignancy and Addresses Surgical Strategy.

    PubMed

    Crescenzi, A; Trimboli, P; Modica, D C; Taffon, C; Guidobaldi, L; Taccogna, S; Rainer, A; Trombetta, M; Papini, E; Zelano, G

    2016-03-01

    In the last decade, several molecular markers have been proposed to improve the diagnosis of thyroid nodules. Among these, mutations in the telomerase reverse transcriptase (TERT) promoter have been correlated to malignant tumors, characterized by highest recurrence and decreased patients' survival. This suggests an important role of TERT mutational analysis in the clinical diagnosis and management of thyroid cancer patients. The aim of the study was to demonstrate the adequacy of core needle biopsy (CNB) for the preoperative assessment of TERT mutational status, to reach a more accurate definition of malignancy and a more appropriate surgical planning. Indeed, CNB is gaining momentum for improving diagnosis of thyroid nodules deemed inconclusive by fine needle aspirate (FNA). The study included 50 patients submitted to CNB due to inconclusive FNA report. TERT mutational status was correlated with BRAF mutation, definitive histology, and post-operative TNM staging of the neoplasia. C228T mutation of the TERT promoter was reported in 10% of the papillary carcinomas (PTC) series. When compared with final histology, all cases harboring TERT mutation resulted as locally invasive PTCs. The prevalence of TERT mutated cases was 17.6% among locally advanced PTCs. TERT analysis on CNB allows the assessment of the pathological population on paraffin sections before DNA isolation, minimizing the risk of false negatives due to poor sampling that affects FNA, and gathering aggregate information about morphology and TERT mutational status. Data indicating a worse outcome of the tumor might be used to individualize treatment decision, surgical option, and follow-up design. PMID:25951319

  5. Management of mucinous cystic neoplasms of the pancreas

    PubMed Central

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

    2010-01-01

    The purpose of this study was to investigate the actual management of mucinous cystic neoplasm (MCN) of the pancreas. A systematic review was performed in December 2009 by consulting PubMed MEDLINE for publications and matching the key words “pancreatic mucinous cystic neoplasm”, “pancreatic mucinous cystic tumour”, “pancreatic mucinous cystic mass”, “pancreatic cyst”, and “pancreatic cystic neoplasm” to identify English language articles describing the diagnosis and treatment of the mucinous cystic neoplasm of the pancreas. In total, 16 322 references ranging from January 1969 to December 2009 were analysed and 77 articles were identified. No articles published before 1996 were selected because MCNs were not previously considered to be a completely autonomous disease. Definition, epidemiology, anatomopathological findings, clinical presentation, preoperative evaluation, treatment and prognosis were reviewed. MCNs are pancreatic mucin-producing cysts with a distinctive ovarian-type stroma localized in the body-tail of the gland and occurring in middle-aged females. The majority of MCNs are slow growing and asymptomatic. The prevalence of invasive carcinoma varies between 6% and 55%. Preoperative diagnosis depends on a combination of clinical features, tumor markers, computed tomography (CT), magnetic resonance imaging, endoscopic ultrasound with cyst fluid analysis, and positron emission tomography-CT. Surgery is indicated for all MCNs. PMID:21128317

  6. Multicentric solid pseudopapillary neoplasms of the pancreas diagnosed by endoscopic ultrasound-guided fine needle aspiration: a case report.

    PubMed

    Yamaguchi, Megumi; Fukuda, Toshikatsu; Nakahara, Masahiro; Amano, Mio; Takei, Daisuke; Kawashima, Masumi; Sumi, Yusuke; Amano, Hironobu; Yonehara, Shuji; Hanada, Keiji; Noriyuki, Toshio

    2015-12-01

    Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare tumor. This neoplasm usually arises as a single mass; multicentricity is exceptionally rare. We report the preoperative diagnosis of multicentric SPNs by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). A 32-year-old woman presented to the hospital with a pancreatic tumor that was detected on abdominal echography. Contrast-enhanced computed tomography (CT) scans revealed a 5-mm low-density mass in the body of the pancreas and a 10-mm mass in the tail of the pancreas. Magnetic resonance imaging (MRI) also revealed two tumors in the body and tail of the pancreas. On endoscopic ultrasonography (EUS), two indistinct and heterogeneous echogenic masses were found, and EUS-FNA was performed for each of these tumors. Cytological analysis revealed that the two masses were highly cellular with papillary groups of small, uniform, oval cells surrounding a fibrovascular core. Immunohistochemistry was positive for α-1 antitrypsin, vimentin, neuron-specific enolase (NSE), CD10, and progesterone receptor. These features confirmed the preoperative diagnosis of multicentric SPNs. The patient underwent laparoscopic distal pancreatectomy with splenectomy. The final pathologic diagnosis was multicentric SPNs. During 2 years of follow-up, she has not developed any recurrence. PMID:26943434

  7. Difficult preoperative diagnosis in a case of rapidly progressive carcinomatous pericarditis.

    PubMed

    Wada, Tomoyuki; Anai, Hirofumi; Shuto, Takashi; Okamoto, Keitaro; Kawano, Madoka; Kozaki, Satoshi; Hirota, Jun; Miyamoto, Shinji

    2016-04-01

    A 54-year-old woman initially diagnosed with stage IIIb squamous cell carcinoma of the uterine cervix was treated with chemotherapy and radiation therapy. After 8 months, she developed dyspnea, leg edema, pleural effusion, pericardial effusion, and liver congestion. Her cardiac ejection fraction was normal and cardiomegaly was not evident. Metastatic carcinomatous pericarditis or pleurisy was suspected, but laboratory findings, including tumor markers, were normal. She was transferred to our hospital for the repair a cardiac injury caused by a pericardial drainage procedure. Emergency surgery was performed for the misplaced drainage catheter in the right atrium and for an abnormal mass in her right and left atria. The clinical diagnosis of carcinomatous pericarditis was made; however, her condition rapidly deteriorated, and she died 6 days postoperatively. At autopsy, metastasis was identified in a large area of the pericardium and myocardium. PMID:24980145

  8. Cystadenomas and Cystadenocarcinomas of the Pancreas

    PubMed Central

    Le Borgne, Joël; de Calan, Loïc; Partensky, Christian

    1999-01-01

    Objective To review the features of patients with benign and malignant cystadenomas of the pancreas, focusing on preoperative diagnostic accuracy and long-term outcome, especially for nonoperated serous cystadenomas and resected cystadenocarcinomas. Summary Background Data Serous cystadenomas (SCAs) are benign tumors. Mucinous cystic neoplasms should be resected because of the risk of malignant progression. A correct preoperative diagnosis of tumor type is based on morphologic criteria. Despite the high quality of recent imaging procedures, the diagnosis frequently remains uncertain. Invasive investigations such as endosonography and diagnostic aspiration of cystic fluid may be helpful, but their assessment is limited to small series. The management of typical SCA may require resection or observation. Survival after pancreatic resection seems better for cystadenocarcinomas (MCACs) than for ductal adenocarcinomas of the pancreas. Methods Three hundred ninety-eight cases of cystadenomas of the pancreas were collected between 1984 and 1996 in 73 institutions of the French Surgical Association. Clinical presentation, radiologic evaluation, and surgical procedures were analyzed for 144 operated SCAs, 150 mucinous cystadenomas (MCAs), and 78 MCACs. The outcome of 372 operated patients and 26 nonoperated patients with SCA was analyzed. Results Cystadenomas represented 76% of all primary pancreatic cystic tumors (398/522). An asymptomatic tumor was discovered in 32% of patients with SCA, 26% of those with MCA, and 13% of those with MCAC. The tumor was located in the head or uncinate process of the pancreas in 38% of those with SCA, 27% of those with MCA, and 49% of those with MCAC. A communication between the cyst and pancreatic duct was discovered in 0.6% of those with SCA, 6% of those with MCA, and 10% of those with MCAC. The main investigations were ultrasonography and computed tomography (94% for SCA, MCA, and MCAC), endosonography (34%, 28%, and 22% for SCA, MCA, and MCAC respectively), endoscopic retrograde cholangiopancreatography (16%, 14%, 22%), and cyst fluid analysis (22%, 31%, 35%). An accurate preoperative diagnosis of tumor type was proposed for 20% of those with SCA (144 cases), 30% of those with MCA, and 29% of those with MCAC. An atypical unilocular macrocyst was observed in 10% of SCA cases. The most common misdiagnosis for mucinous cystic tumors was pseudocyst (9% of MCAs, 15% of MCACs). Intraoperative frozen sections (126 cases) allowed a diagnosis according to definitive histologic examination in 50% of those with SCA and MCA and 62% of those with MCAC. For management, 93% of patients underwent surgery. Nonoperated patients (7%) had exclusively typical SCA. A complete cyst excision was performed in 94% of benign cystadenomas, with an operative mortality rate of 2% for SCA and 1.4% for MCA. Resection was possible in 74% of cases of MCAC. Mean follow-up of 26 patients with nonresected SCAs was 38 months, and no patients required surgery. For resected MCACs, the actuarial 5-year survival rate was 63%. Conclusions Spiral computed tomography is the examination of choice for a correct prediction of tumor type. Endosonography may be useful to detect the morphologic criteria of small tumors. Diagnostic aspiration of the cyst allows differentiation of the macrocystic form of SCA (10% of cases) and the unilocular type of mucinous cystic neoplasm from a pseudocyst. Surgical resection should be performed for symptomatic SCAs, all mucinous cystic neoplasms, and cystic tumors that are not clearly defined. Conservative management is wholly justified for a well-documented SCA with no symptoms. An extensive resection is warranted for MCAC because the 5-year survival rate may exceed 60%. PMID:10450728

  9. Massive Neurilemoma of the Hard Plate in Which Preoperative Diagnosis Was Difficult

    PubMed Central

    Kudoh, Masanori; Harada, Hiroyuki; Matsumoto, Koshi; Sato, Yuriko; Omura, Ken; Ishii, Yoshimasa

    2015-01-01

    The patient was an 84-year-old man who was referred to our hospital in mid-December 2012 for a close examination of a mass arising from the left side of the hard palate that was found by a local dentist. The initial examination revealed the presence of a 3.0-cm elastic soft, dome-shaped mass in the left hard palate. CE-CT showed a lesion of size 1.8 × 1.4 cm in the right hard palate, which extended upward and invaded the nasal cavity. The mass was a solid tumor associated with resorption of surrounding bone and expansion of the greater palatine canal. CE-MRI indicated that the mass extended upward and invaded the nasal cavity, and the mass showed hypointensity on T1-weighted images, hyperintensity on T2-weighted images, and an irregular margin with internal enhancement. Abnormal uptake of FDG on PET-CT (SUVmax = 5.2) was observed in the left hard palate. The biopsy site lesion rapidly increased in size and biopsy was performed again in January 2013 due to suspicion of a malignant tumor. The histopathological diagnosis was a suspected malignant neurogenic tumor. Therefore, the patient underwent partial maxillectomy and a split-thickness skin graft in late February 2013. No recurrence was noted 29 months after the operation. PMID:26301112

  10. Accuracy of diagnosis of solid pseudopapillary tumor of the pancreas on fine needle aspiration: A multi-institution experience of ten cases

    PubMed Central

    Jahangir, Sidra; Loya, Asif; Siddiqui, Momin T.; Akhter, Noreen; Yusuf, Muhammed Aasim

    2015-01-01

    Introduction: Solid pseudopapillary tumor of the pancreas (SPTP) is a neoplasm of uncertain origin and indolent biologic behavior with distinctive morphological features occurring predominantly in young women. This tumor has an excellent prognosis compared to neuroendocrine and acinar cell carcinoma, which are close differential diagnoses based on morphology, hence making it crucial to diagnose SPTP correctly. Objectives: To discuss the cytomorphological features of 10 cases of SPTP reported in two institutions and to evaluate the diagnostic accuracy of endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) cytology in establishing the diagnosis of SPTP. Methods: Ten diagnosed cases of SPTP were retrieved from the computerized endoscopy and pathology databases of our two tertiary care institutions. Nine patients had subsequent histological follow-up available. Eight patients underwent EUS-FNA while one patient each had ultrasound and computed tomography-guided FNA. The rapid on-site evaluation was carried out in all 10 cases, and additional material was retained for cell block preparation. Immunohistochemical (IHC) stains ranging from synaptophysin, progesterone receptor, chromogranin, β-catenin, CD10, and NSE were applied on cell blocks. Histological sections of all resected specimens were reviewed, and findings were correlated with those obtained by FNA. Results: Adequate material was obtained in all ten cases. IHC stains helped to confirm the cytological impression of SPTP. Histological examination of resection specimens, available in 9/10 cases, confirmed the cytological diagnosis. Conclusions: FNA particularly that obtained with EUS guidance is an effective tool in the accurate diagnosis of SPTP. PMID:26884802

  11. Molecular Analyses of Aspirated Cystic Fluid for the Differential Diagnosis of Cystic Lesions of the Pancreas: A Systematic Review and Meta-Analysis

    PubMed Central

    Guo, Xiaorong; Zhan, Xianbao; Li, Zhaoshen

    2016-01-01

    Background. Researchers have evaluated various molecular tests for improving the differential diagnosis of cystic lesions of the pancreas. Methods. Six electronic databases were searched for articles on molecular tests for the diagnosis of pancreatic cysts. Measures of accuracy were extracted from selected articles and pooled by the random-effects model. Summary receiver operating characteristic curves were used to analyze the overall accuracy of the molecular tests. Pooled sensitivity and specificity values [95% confidence intervals] are reported. Results. The systematic review included eight studies of 428 patients in total. We determined the sensitivities and specificities of tests for KRAS mutations (0.47 [0.39–0.54], 0.98 [0.93–0.99]) and loss of heterozygosity (0.63 [0.54–0.71], 0.76 [0.63–0.87]) for distinguishing mucinous from nonmucinous cysts, as well as the sensitivities and specificities of tests for KRAS mutations (0.59 [0.46–0.71], 0.78 [0.71–0.85]) and loss of heterozygosity (0.89 [0.78–0.96], 0.69 [0.60–0.76]) for differentiating malignant from benign cysts. Conclusion. Tests of KRAS mutations could confirm but not exclude a diagnosis of a mucinous or malignant pancreatic cyst. PMID:26819604

  12. The "Endothelialized Muscularis Mucosae": A Case Report Describing a Large Cavernous Hemangioma at the Terminal Ileum and a New Histologic Clue for Preoperative Diagnosis from Endoscopic Biopsy.

    PubMed

    Purdy-Payne, Erin K; Miner, Jean F; Foles, Brandon; Tran, Tien-Anh N

    2015-01-01

    Cavernous hemangiomas of the gastrointestinal tract are quite rare and, until now, have been difficult to diagnose preoperatively due their nonspecific presentations and imaging features, as well as a lack of histologic description pertaining to small superficial biopsies such as those obtained endoscopically. We report a unique case of a 4 cm transmural cavernous hemangioma in the terminal ileum with literature review and describe a new histologic finding-the "endothelialized muscularis mucosae," which was discovered upon review of the endoscopic biopsy and could potentially facilitate preoperative diagnosis of these lesions from endoscopic biopsies in the future. These lesions have classically required surgical resection in order to make a definitive diagnosis and rule out malignancy, with which they share many historical and radiographic features. Due to their potential to cause bowel obstruction, intussusception, perforation, and hemorrhage, these lesions may ultimately require surgical resection to relieve symptoms or prevent or treat complications-however, surgical planning and patient counseling could be greatly improved by a preoperative diagnosis. Therefore, gastroenterologists, pathologists, and surgeons should be aware of the "endothelialized muscularis mucosae" which can be very helpful in diagnosing GI cavernous hemangiomas from endoscopic biopsies. PMID:26442160

  13. Arteriovenous malformation of the pancreas: a case report.

    PubMed

    Abe, Tsuyoshi; Suzuki, Nobuyasu; Haga, Junichirou; Azami, Ayaka; Todate, Yukitoshi; Waragai, Mitsuru; Sato, Atai; Takano, Yoshinao; Kawakura, Kenji; Imai, Shigeki; Sakuma, Hideo; Teranishi, Yasushi

    2016-12-01

    Arteriovenous malformation (AVM) of the pancreas is uncommon in the gastrointestinal tract. We present a case of AVM of the pancreatic head in a 59-year-old male. He was admitted to a hospital with hematemesis and tarry stool and referred to our hospital in March 2014 on the diagnosis of pancreatic artery pseudoaneurysm. A computed tomography scan showed the presence of irregular dilated and/or stenotic vessels with meandering in the pancreatic head. Magnetic resonance imaging showed strong enhancement of the conglomeration in the pancreatic head. Selective angiography showed the proliferation of a vascular network in the pancreatic head and an early visualization of the portal vein at the arterial phase. The patient qualified for surgery with a preoperative diagnosis of AVM of the pancreatic head. We performed pylorus-preserving pancreaticoduodenectomy. The histological results confirmed the presence of irregular dilated tortuous arteries and veins in the pancreatic head. Surgical treatment may represent definitive management of symptomatic AVM. PMID:26943682

  14. Premalignant and malignant lesions of the heterotopic pancreas in the esophagus: a case report and review of the literature.

    PubMed

    Ulrych, Jan; Fryba, Vladimir; Skalova, Helena; Krska, Zdenek; Krechler, Tomas; Zogala, David

    2015-06-01

    Heterotopic pancreas is a congenital pathology of the gastrointestinal tract, particularly rare in the esophagus. Both symptomatology and findings during preoperative examinations are non-specific and therefore do not often lead to an accurate diagnosis, which is usually revealed only by histopathological assessment of a resected specimen. We report an unusual case of a patient suffering from severe dysphagia caused by heterotopic pancreas in the distal esophagus with chronic inflammation and foci of premalignant changes. This article also reviews 14 adult cases of heterotopic pancreas in the esophagus previously reported in the literature, with the aim of determining the clinical features of this disease and possible complications including rare premalignant lesions and malignant transformation. Especially with regard to those complications, we suggest that both symptomatic and incidentally found asymptomatic lesions should be resected. PMID:26114184

  15. Normal Pancreas Anatomy

    MedlinePlus

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

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

    PubMed Central

    2009-01-01

    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

  17. Pancreas Transplantation

    MedlinePlus

    ... En Español Type 1 Type 2 About Us Online Community Meal Planning Sign In Search: Search More Sites ... Twitter Pinterest Youtube Instagram Diabetes Stops Here Blog Online Community Site Menu Are You at Risk? Diagnosis Lower ...

  18. Preoperative chemoradiation in resectable pancreatic cancer.

    PubMed

    Chandler, Nicole M; Canete, Jonathan J; Stuart, Keith E; Callery, Mark P

    2003-01-01

    Despite advancements in the field of surgical oncology, the diagnosis of pancreatic cancer still carries a grave and dismal prognosis. Surgery alone for adenocarcinoma of the pancreatic head or uncinate process has a median survival time of 12 months. These grim statistics have led many to study the effects of combined multimodality therapy in the fight against pancreatic cancer. The long recovery time associated with pancreaticoduodenectomy has resulted in as many as 25% of patients unable to proceed with planned adjuvant therapy. For these reasons preoperative or neoadjuvantc hemoradiation therapy (CRT) has been evaluated. Pre-operative CRT ensures that all eligible patients receive the benefits of multimodality therapy, and patients who manifest metastatic disease on restaging evaluations are spared the morbidity of an unnecessary laparotomy. Multimodality therapy appears to lengthen the survival duration in patients with pancreatic cancer. It also affords a selection advantage, in that patients with aggressive disease biology with advanced metastatic disease following CRT are spared the morbidity of surgery. Conversely, a limited subset of patients may even be downstaged, allowing for a potentially curative resection. In this article we review the current status of neoadjuvant chemoradiation in adenocarcinoma of the pancreas. We discuss its rationale in light of the reported strengths and weaknesses of postoperative adjuvant CRT. PMID:12918459

  19. Preoperative Clinics.

    PubMed

    Edwards, Angela F; Slawski, Barbara

    2016-03-01

    Preoperative evaluation clinics have been shown to enhance operating room efficiency, decrease day-of-surgery cancellations, reduce hospital costs, and improve the quality of patient care. Although programs differ in staffing, structure, financial support, and daily operations, they share the common goal of preoperative risk reduction in order for patients to proceed safely through the perioperative period. Effective preoperative evaluation occurs if processes are standardized to ensure clinical, regulatory, and accreditation guidelines are met while keeping medical optimization and patient satisfaction at the forefront. Although no universally accepted standard model exists, there are key components to a successful preoperative process. PMID:26927735

  20. Preoperative Consultations.

    PubMed

    Thilen, Stephan R; Wijeysundera, Duminda N; Treggiari, Miriam M

    2016-03-01

    Preoperative consultation is an important intervention that likely has most benefits for intermediate-risk to high-risk patients undergoing major surgery. Consultation rates are likely increasing and there is significant practice variation in the use of consultation. Consultations should be available within a well-organized and coordinated process of preoperative assessment. Preoperative consults should be accessible to anesthesia and surgical teams involved in the procedure and to the providers involved in postoperative care. The role of preoperative consultation should evolve as a rational approach and emerge as a value-based service. New payment methodologies are likely to facilitate appropriate use of this important resource. PMID:26927736

  1. Preoperative Prediction of Ki-67 Labeling Index By Three-dimensional CT Image Parameters for Differential Diagnosis Of Ground-Glass Opacity (GGO)

    PubMed Central

    Peng, Mingzheng; Peng, Fei; Zhang, Chengzhong; Wang, Qingguo; Li, Zhao; Hu, Haiyang; Liu, Sida; Xu, Binbin; Zhu, Wenzhuo; Han, Yudong; Lin, Qiang

    2015-01-01

    The aim of this study was to predict Ki-67 labeling index (LI) preoperatively by three-dimensional (3D) CT image parameters for pathologic assessment of GGO nodules. Diameter, total volume (TV), the maximum CT number (MAX), average CT number (AVG) and standard deviation of CT number within the whole GGO nodule (STD) were measured by 3D CT workstation. By detection of immunohistochemistry and Image Software Pro Plus 6.0, different Ki-67 LI were measured and statistically analyzed among preinvasive adenocarcinoma (PIA), minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC). Receiver operating characteristic (ROC) curve, Spearman correlation analysis and multiple linear regression analysis with cross-validation were performed to further research a quantitative correlation between Ki-67 labeling index and radiological parameters. Diameter, TV, MAX, AVG and STD increased along with PIA, MIA and IAC significantly and consecutively. In the multiple linear regression model by a stepwise way, we obtained an equation: prediction of Ki-67 LI=0.022*STD+0.001* TV+2.137 (R=0.595, R’s square=0.354, p<0.001), which can predict Ki-67 LI as a proliferative marker preoperatively. Diameter, TV, MAX, AVG and STD could discriminate pathologic categories of GGO nodules significantly. Ki-67 LI of early lung adenocarcinoma presenting GGO can be predicted by radiologic parameters based on 3D CT for differential diagnosis. PMID:26061252

  2. 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 ...

  3. 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 ...

  4. National Pancreas Foundation

    MedlinePlus

    ... NPF Shop at our eStore The National Pancreas Foundation 3 Bethesda Metro Center Suite 700 Bethesda, MD ... Social Networking Button – Medium © 2014 The National Pancreas Foundation | Health Disclaimer | Financial Disclosure & Privacy Policy Google Analytics

  5. What Is the Pancreas?

    MedlinePlus

    ... Trials Database Supporting Research Raising Awareness Our Blog Patient Education Pancreas News Basics of Pancreatic Cancer FAQs The ... Detection- Goggins Lab Sol Goldman Center Discussion Board Patient Education / Basics of Pancreatic Cancer The Pancreas Parts of ...

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

    PubMed Central

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

    2010-01-01

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

  7. The avian pancreas in health and disease.

    PubMed

    Pilny, Anthony A

    2008-01-01

    The avian endocrine pancreas shares some similarities with mammals but also some clinically relevant differences in anatomy and physiology. Diabetes mellitus, an uncommon disease of pet birds, is a challenging condition because of lack of knowledge of the exact pathophysiology and responses to insulin therapy. This article reviews the anatomy and physiology of the avian pancreas and describes the etiology, diagnosis, and treatment of diabetes mellitus in pet birds. PMID:18165136

  8. Pancreas preservation for pancreas and islet transplantation

    PubMed Central

    Iwanaga, Yasuhiro; Sutherland, David E.R.; Harmon, James V.; Papas, Klearchos K.

    2010-01-01

    Purpose of review To summarize advances and limitations in pancreas procurement and preservation for pancreas and islet transplantation, and review advances in islet protection and preservation. Recent findings Pancreases procured after cardiac death, with in-situ regional organ cooling, have been successfully used for islet transplantation. Colloid-free Celsior and histidine-tryptophan-ketoglutarate preservation solutions are comparable to University of Wisconsin solution when used for cold storage before pancreas transplantation. Colloid-free preservation solutions are inferior to University of Wisconsin solution for pancreas preservation prior to islet isolation and transplantation. Clinical reports on pancreas and islet transplants suggest that the two-layer method may not offer significant benefits over cold storage with the University of Wisconsin solution: improved oxygenation may depend on the graft size; benefits in experimental models may not translate to human organs. Improvements in islet yield and quality occurred from pancreases treated with inhibitors of stress-induced apoptosis during procurement, storage, isolation or culture. Pancreas perfusion may be desirable before islet isolation and transplantation and may improve islet yields and quality. Methods for real-time, noninvasive assessment of pancreas quality during preservation have been implemented and objective islet potency assays have been developed and validated. These innovations should contribute to objective evaluation and establishment of improved pancreas preservation and islet isolation strategies. Summary Cold storage may be adequate for preservation before pancreas transplants, but insufficient when pancreases are processed for islets or when expanded donors are used. Supplementation of cold storage solutions with cytoprotective agents and perfusion may improve pancreas and islet transplant outcomes. PMID:18685343

  9. Preoperative diagnosis and staging of rectal cancer using diffusion-weighted and water imaging combined with dynamic contrast-enhanced scanning

    PubMed Central

    ZHAO, QILI; LIU, LIJIAN; WANG, QIUYAN; LIANG, ZEXIA; SHI, GAOFENG

    2014-01-01

    The aim of the present study was to evaluate the value of diffusion-weighted imaging (DWI) and water imaging combined with dynamic contrast-enhanced scanning for the preoperative diagnosis and staging of rectal cancer. In total, 72 patients with pathologically confirmed rectal cancer were selected for examination using magnetic resonance imaging (MRI) with phased-array coils, DWI, water imaging and dynamic contrast-enhanced scanning. The patients were divided into two groups, experimental (simple enhanced scanning plus diffusion combined with water imaging) and control (simple enhanced scanning), for the pathological observations. The sensitivity, specificity and accuracy for the T staging of the carcinomas using scan enhancement with DWI and the evaluation of cancer using water imaging were 98.5% (65/66), 66.7% (4/6) and 95.8% (69/72), respectively, and the accuracy for N staging was 89%. Whereas, the sensitivity, specificity and accuracy for the T staging of the carcinomas using simple scan enhancement were 85.7% (42/49), 78.3% (18/23) and 83.3% (60/72), respectively, and the accuracy for N staging was 61%. Therefore, the combination of multiple MRI techniques may be of high value for the early diagnosis and exact staging of rectal cancer. PMID:25360178

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

    SciTech Connect

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

    1983-05-01

    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.

  11. Lymphoepithelial cyst of the pancreas.

    PubMed

    Domen, Hiromitsu; Ohara, Masanori; Kimura, Noriko; Takahashi, Mizuna; Yamabuki, Takumi; Komuro, Kazuteru; Iwashiro, Nozomu; Ishizaka, Masanori

    2012-09-01

    Cystic lesions of the pancreas can be divided into true cysts, pseudocysts, and cystic neoplasms. Lymphoepithelial cysts (LECs) are a type of true cyst that can mimic pseudocysts and cystic neoplasms. LECs are rare lesions; fewer than 90 cases have been reported in the English language literature. The case of a 60-year-old man with an LEC of the pancreas is reported. He was admitted with upper abdominal discomfort. Computed tomography showed a 64 × 39 mm cystic mass in the retroperitoneum behind the duodenum and inferior caval vein. Magnetic resonance imaging revealed a right-sided mass on T1-weighted imaging, with a clear boundary between the mass and its surroundings, except for the pancreas. The mass had an inhomogeneous intensity on T2-weighted imaging. Within the mass, small floating nodules with low intensity were seen. Endoscopic ultrasound showed many high-echoic nodules and smaller grains scattered everywhere in the mass. Fine needle aspiration and cytologic examination were performed. Characteristic chylaceous fluid was obtained in which anucleate squamous cells were found. There were also a few atypical large cells with irregularly shaped marked nucleoli and degenerative cytoplasm. Cytologic diagnosis was suspicious for malignancy. The lesion was diagnosed as a retroperitoneal cyst, probably of pancreatic origin. Since a neoplastic lesion could not be ruled out, surgery was performed. The lesion was palpable on the dorsal side of the second portion of the duodenum. The mass was completely resected. Macroscopically, the lesion was a multilocular cyst with a thin septal wall. The cyst was filled with cottage cheese-like substance. Microscopically, the cyst wall was composed of stratified squamous epithelium and dense subepithelial lymphatic tissue with developed lymph follicles. The epithelial cells had no atypia. The histopathologic diagnosis was LEC of the pancreas. The patient's postoperative course was good. PMID:23139650

  12. Metastatic Renal Cell Carcinoma to the Pancreas: A Review.

    PubMed

    Cheng, Shaun Kian Hong; Chuah, Khoon Leong

    2016-06-01

    The pancreas is an unusual site for tumor metastasis, accounting for only 2% to 5% of all malignancies affecting the pancreas. The more common metastases affecting the pancreas include renal cell carcinomas, melanomas, colorectal carcinomas, breast carcinomas, and sarcomas. Although pancreatic involvement by nonrenal malignancies indicates widespread systemic disease, metastatic renal cell carcinoma to the pancreas often represents an isolated event and is thus amenable to surgical resection, which is associated with long-term survival. As such, it is important to accurately diagnose pancreatic involvement by metastatic renal cell carcinoma on histology, especially given that renal cell carcinoma metastasis may manifest more than a decade after its initial presentation and diagnosis. In this review, we discuss the clinicopathologic findings of isolated renal cell carcinoma metastases of the pancreas, with special emphasis on separating metastatic renal cell carcinoma and its various differential diagnoses in the pancreas. PMID:27232353

  13. The “Endothelialized Muscularis Mucosae”: A Case Report Describing a Large Cavernous Hemangioma at the Terminal Ileum and a New Histologic Clue for Preoperative Diagnosis from Endoscopic Biopsy

    PubMed Central

    Purdy-Payne, Erin K.; Miner, Jean F.; Foles, Brandon; Tran, Tien-Anh N.

    2015-01-01

    Cavernous hemangiomas of the gastrointestinal tract are quite rare and, until now, have been difficult to diagnose preoperatively due their nonspecific presentations and imaging features, as well as a lack of histologic description pertaining to small superficial biopsies such as those obtained endoscopically. We report a unique case of a 4 cm transmural cavernous hemangioma in the terminal ileum with literature review and describe a new histologic finding—the “endothelialized muscularis mucosae,” which was discovered upon review of the endoscopic biopsy and could potentially facilitate preoperative diagnosis of these lesions from endoscopic biopsies in the future. These lesions have classically required surgical resection in order to make a definitive diagnosis and rule out malignancy, with which they share many historical and radiographic features. Due to their potential to cause bowel obstruction, intussusception, perforation, and hemorrhage, these lesions may ultimately require surgical resection to relieve symptoms or prevent or treat complications—however, surgical planning and patient counseling could be greatly improved by a preoperative diagnosis. Therefore, gastroenterologists, pathologists, and surgeons should be aware of the “endothelialized muscularis mucosae” which can be very helpful in diagnosing GI cavernous hemangiomas from endoscopic biopsies. PMID:26442160

  14. Mucinous cystadenocarcinoma of the pancreas with anaplastic carcinoma: A case report and review of the literature

    PubMed Central

    MUNEKAGE, MASAYA; KOHSAKI, TAKUHIRO; UEMURA, SUNAO; KITAGAWA, HIROYUKI; NAMIKAWA, TSUTOMU; HANAZAKI, KAZUHIRO

    2016-01-01

    Few reports of mucinous cystic neoplasm (MCN) in association with anaplastic carcinoma exist. The present study reported an unusual case of a 25-year-old female exhibiting large pancreatic MCN with anaplastic carcinoma. Notably, the patient was a Jehovah's Witness and therefore refused any blood transfusions. Preoperative diagnosis was invasive pancreatic MCN measuring 12.5 cm with ascites. Distal pancreatectomy was performed in combination with splenectomy and partial resection of the transverse colon. Intraoperative estimated blood loss was 400 ml, therefore a blood transfusion was not required. The patient had an uneventful postoperative course. The pathological diagnosis was mucinous cystadenocarcinoma of the pancreas with anaplastic carcinoma. Although the patient underwent postoperative adjuvant chemotherapy with gemcitabine and oral fluoropyrimidine (S-1), recurrence with peritoneal dissemination was detected 20 months following surgery and the patient succumbed to the recurrence 32 months following surgery. To the best of our knowledge, this is the first case report of MCN with anaplastic carcinoma of the pancreas in a Jehovah's Witness patient undergoing pancreatic surgery. PMID:27073646

  15. Assessment of pancreas cells

    NASA Technical Reports Server (NTRS)

    Vanoss, C. J.

    1978-01-01

    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.

  16. Synchronous neuroendocrine tumors in both the pancreas and ileum: A case report

    PubMed Central

    Tsunenari, Takazumi; Aosasa, Suefumi; Ogata, Sho; Hoshikawa, Mayumi; Nishikawa, Makoto; Noro, Takuji; Shinto, Eiji; Tsujimoto, Hironori; Ueno, Hideki; Hamabe, Fumiko; Shinmoto, Hiroshi; Hase, Kazuo; Yamamoto, Junji

    2016-01-01

    Introduction Although it is well-known that in multiple endocrine neoplasia type 1 (MEN 1) disease, multiple endocrine lesions frequently occur, synchronous or metachronous neuroendocrine tumors (NETs) in non-MEN 1 patients are extremely rare. Presentation of case An asymptomatic 72-year-old woman with an ileal NET was referred to our hospital. Abdominal computed tomography revealed another circular tumor within the pancreatic head. She was classified as a non-MEN 1 patient. An operative procedure was performed with a preoperative diagnosis of synchronous NET, which was confirmed by pathological examination. Discussion Both morphologic and immunophenotypic findings were different between in the ileum and pancreas. Therefore, it was reasonable to consider that both tumors were primary tumors. The synchronous occurrence of these tumors is unusual, and it may be considered as a chance occurrence. Conclusion We here report the first case of synchronous pancreatic NET and ileal NET in a non-MEN 1 patient. PMID:27046104

  17. [The endocrine pancreas].

    PubMed

    Corteso, L; Saraiva, A M; Guerreiro, L

    1995-06-01

    The islets of Langerhans provide energy storage and disposal, and protection from plasma glucose excursions, especially hypoglycemia. Insulin-dependent diabetes mellitus (IDDM) results from autoimmune beta-cell damage. Prevention of IDDM has already been achieved in animal investigation and some centers are now screening and treating individuals at high risk for developing IDDM. Immunosuppressive drugs can induce transient remission of recent-onset IDDM. Intensive insulin treatment of IDDM delays the onset and slows the progression of long-term complications. Non-insulin dependent diabetes mellitus (NIDDM) is the result of beta-cell malfunction and is strongly associated with X syndrome. Diet and exercise are of undoubted importance in NIDDM prevention and treatment. Functional endocrine tumors of the pancreas (FET) are rare hormone and peptide-secreting neoplasms. These peptides may or may not occur naturally in the islets. FETs often occur with multiple endocrine neoplasia 1 (MEN 1) so that MEN-1 screening should always be performed, and extended to family members whenever diagnosed. Drugs--alcohol, insulin and sulfonilureas--are the main cause of hypoglycemia. Insulinoma is the main cause of post-absorptive organic hypoglycemia. Non islet-cell tumors seldom cause hypoglycemia. Insulinoma often is a solitary tumor, but it may be multicentric and may coexist with cell hyperplasia and nesidioblastosis. Symptoms of neuroglycopenia may be mistaken for neuropsychiatric disease. The diagnosis is based on confirmation of post absorptive hypoglycemia and hyperinsulinism. Gastrinoma causes Zollinger-Ellison syndrome (ZES) which is characterized by fulminating peptic ulcer disease. The tumor is often malignant, and it may be multicentric and may occur with cell hyperplasia and nesidioblastosis.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7653306

  18. [Tertiary syphilis of the pancreas and liver in 82-year-old patient: case study].

    PubMed

    Denisova, T L; Tiul'tiaeva, L A; Lipatova, T E; Bakulev, A L; Alipova, L N; Apanasevich, A V; Bezrodnaia, L A; Borisova, E A

    2013-01-01

    It has been described a clinical case of late diagnosis of syphilis of the pancreas and liver of elderly patients. Two years before that it was wrongly diagnosed with cancer of the pancreas with liver metastases, and the patient was operated on with the imposition of cholecystostomy. It was conducted appropriate therapy and reconstructive surgery after verification of the diagnosis of syphilis of the pancreas and liver. PMID:24772875

  19. [Diabetes and pancreas transplantation].

    PubMed

    Esmatjes Mompó, E; Ricart Brulles, M J

    2008-05-01

    Kidney disease is a severe and frequent complication in diabetes. In the terminal phase, treatment requires dialysis and, if possible, kidney transplantation. Provided that there are no contraindications, simultaneous kidney/pancreas transplantation is currently considered the treatment of choice in patients with type 1 diabetes mellitus and terminal kidney disease. Pancreas transplantation is a complex process initially associated with a greater morbidity than kidney transplant alone. At present, however, patient and graft survival is good thereby leading to total normalization of metabolic control and allowing the patient to carry out a normal life without the need to administer insulin and with the consequent benefits in quality of life and the evolution of the complications of the disease. The results of pancreas transplant alone are somewhat worse than those with combined kidney/pancreas transplantation. They are, however, sufficiently satisfactory to be considered a good therapeutic option in patients who have previously received a kidney. Nonetheless, the transplantation of the pancreas alone in diabetic patients without renal insufficiency or previous kidney transplant is another question. Although this type of transplantation would be ideal, it currently remains restricted to patients with a labile diabetes who require repeated hospital admission due to metabolic decompensation and/or severe hypoglycemic episodes accompanied by loss of consciousness. PMID:18714413

  20. Therapeutic Approach to Cystic Neoplasms of the Pancreas.

    PubMed

    Al Efishat, Mohammad; Allen, Peter J

    2016-04-01

    Management of cystic neoplasms of the pancreas is challenging as it relies on radiologic and cyst fluid markers to discriminate between benign and pre-cancerous lesions, however their ability to predict malignancy is limited. While asymptomatic serous cystadenomas can be managed conservatively, mucinous cystic neoplasms and intraductal papillary mucinous neoplasms are more difficult to manage. A selective approach, based on the preoperative likelihood of high-grade dysplasia or invasive disease, is the standard of care. Research is focusing on the development of pre-operative markers for identifying high risk lesions, which will spare patients with low-risk or benign lesions the risks of pancreatectomy. PMID:27013369

  1. Enucleation of an Insulinoma of the Pancreas Using Reduced Port Surgery: Report of a Case.

    PubMed

    Shibao, Kazunori; Higure, Aiichiro; Yamaguchi, Koji; Minagawa, Noritaka

    2011-12-01

    Reduced port surgery (RPS) is a new surgical modality producing increased cosmetic benefits over conventional endoscopic surgery. We herein report the first case of insulinoma of the pancreas treated by RPS. RPS enucleation was performed for a 23-year-old Japanese female who was admitted to our hospital with repeated episodes of hypoglycemia attributable to an insulinoma. The preoperative examinations confirmed the diagnosis of a solitary insulinoma of the pancreatic tail. Enucleation of the insulinoma using RPS was performed. A 2.5-cm umbilical incision was made, and three laparoscopic trocars were individually inserted into the abdominal cavity via this incision. Another 3-mm trocar was inserted from the left subcostal region. All procedures that were usually performed in conventional laparoscopic surgery were also performed by RPS: intraoperative ultrasonography, mobilization of the tail of the pancreas, enucleation of the tumor, and suturing of the stump. A mechanical manipulator, the Radius Surgical System (Radius), was used for suturing and ligation. The Radius was sufficient to overcome in-line viewing and hand/instrument collisions, and enabled us to perform precise suturing and ligation. Serial blood sugar, C-peptide immunoreactivity (CPR), and immunoreactive insulin (IRI) measurements revealed that all values were normal after resection. The patient had an uneventful postoperative course. RPS was successfully applied for enucleation of a solitary mass in the tail of the pancreas, and represents an alternative to conventional laparoscopic surgery. This method is technically feasible and results in superior cosmesis. The Radius facilitated advanced laparoscopic surgery and may also have advantages in RPS. PMID:22504977

  2. 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

    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

    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

  3. Retinoids in the pancreas

    PubMed Central

    Brun, Pierre-Jacques; Wongsiriroj, Nuttaporn

    2016-01-01

    Retinoids (vitamin A and its natural and synthetic analogs) are required by most tissues for maintaining the normal health of the tissue. This is certainly true for the pancreas. The recent literature is convincing that retinoids are needed by the adult to assure normal pancreatic endocrine functions, especially those of the α- and β-cells. It is also well established that retinoids are required to insure normal pancreas development in utero, including the development of the endocrine pancreas. The actions of retinoids for maintaining normal pancreatic islet functions has drawn considerable research interest from investigators interested in understanding and treating metabolic disease. Pancreatic retinoids are also of interest to investigators studying the origins of pancreatic disease, including the development of pancreatic fibrosis and its sequelae. This research interest is focused on pancreatic stellate cells (PSCs) which store retinoids and possess the metabolic machinery needed to metabolize retinoids. The literature on pancreatic disease and retinoids suggests that there is an association between impairments in pancreatic retinoid storage and metabolism and the development of pancreatic disease. These topics will be considered in this review. PMID:26904552

  4. [The pancreas and alcohol].

    PubMed

    Singer, M V

    1985-07-20

    The action of acute and chronic administration of ethanol on pancreatic exocrine secretion in humans and several animal species is reviewed. If the data concerning the secretory action of ethanol on the pancreas are to the property assessed, several experimental variables have to be considered. Acute intravenous administration of ethanol inhibits basal and hormonally stimulated pancreatic secretion of bicarbonate and protein in nonalcoholic humans and most species of animals tested. Oral or intraduodenal ethanol causes moderate stimulation of pancreatic bicarbonate and enzyme secretion. Since anticholinergic agents and truncal vagotomy diminish the ethanol-induced inhibition of pancreatic secretion in the intact animal, it is possible that the action of ethanol on the pancreas is at least partly mediated by inhibitory cholinergic mechanisms. The action of ethanol on the pancreas may also be mediated by release of gastrointestinal hormones. Intravenous and oral administration of ethanol releases gastrin in dogs but not in humans. Pancreatic polypeptide is unlikely to be the hormonal mediator of the ethanol-induced inhibition of exocrine pancreatic secretion in humans and dogs, since ethanol does not release pancreatic polypeptide. The main secretory changes induced by chronic alcoholism in humans and dogs are increased basal secretion of pancreatic enzymes and decreased basal bicarbonate output, and these secretory changes may favour the occurrence of protein precipitates which are believed to be the first lesion of chronic pancreatitis in man. A decrease in the concentration of "pancreatic stone protein" in pancreatic juice may favour the development of protein precipitates in chronic alcoholic patients. PMID:3901251

  5. Cytology Specimen Management, Triage and Standardized Reporting of Fine Needle Aspiration Biopsies of the Pancreas

    PubMed Central

    Yoon, Won Jae; Bishop Pitman, Martha

    2015-01-01

    The recent advances in pancreas cytology specimen sampling methods have enabled a specific cytologic diagnosis in most cases. Proper triage and processing of the cytologic specimen is pivotal in making a diagnosis due to the need for ancillary testing in addition to cytological evaluation, which is especially true in the diagnosis of pancreatic cysts. Newly proposed terminology for pancreaticobiliary cytology offers a standardized language for reporting that aims to improve communication among patient caregivers and provide for increased flexibility in patient management. This review focuses on these updates in pancreas cytology for the optimal evaluation of solid and cystic lesions of the pancreas. PMID:26265683

  6. Human pancreas development.

    PubMed

    Jennings, Rachel E; Berry, Andrew A; Strutt, James P; Gerrard, David T; Hanley, Neil A

    2015-09-15

    A wealth of data and comprehensive reviews exist on pancreas development in mammals, primarily mice, and other vertebrates. By contrast, human pancreatic development has been less comprehensively reviewed. Here, we draw together those studies conducted directly in human embryonic and fetal tissue to provide an overview of what is known about human pancreatic development. We discuss the relevance of this work to manufacturing insulin-secreting β-cells from pluripotent stem cells and to different aspects of diabetes, especially permanent neonatal diabetes, and its underlying causes. PMID:26395141

  7. Choledochocele: A Case Report and Discussion of Diagnosis Criteria.

    PubMed

    Zhu, Linlin; Lv, Zhibao; Liu, Jiangbin; Xu, Weijue

    2015-12-01

    A 6-year-old girl presented with intermittent abdominal pain, without jaundice and a palpable mass in the epigastrium. Preoperative imaging and upper endoscopy suggested duodenal duplication. During surgery, the patient was diagnosed with a rare type of choledochal cyst-choledochocele (type 3b). The authors emphasize that, in children, choledochocele should be included in the differential diagnosis of cystic lesions located in the duodenal area and the head of the pancreas area, regardless of jaundice or abnormal liver function. Since mucosal histology showing duodenal mucosa did not match the final diagnosis, we suggest that three criteria should be met for the diagnosis of a choledochocele to be diagnosed: (1) a cyst protruding into the duodenal lumen; (2) filling with contrast during cholangiography and (3) a filling defect on X-ray barium meal. PMID:26788455

  8. Choledochocele: A Case Report and Discussion of Diagnosis Criteria

    PubMed Central

    Zhu, Linlin; Lv, Zhibao; Liu, Jiangbin; Xu, Weijue

    2015-01-01

    A 6-year-old girl presented with intermittent abdominal pain, without jaundice and a palpable mass in the epigastrium. Preoperative imaging and upper endoscopy suggested duodenal duplication. During surgery, the patient was diagnosed with a rare type of choledochal cyst—choledochocele (type 3b). The authors emphasize that, in children, choledochocele should be included in the differential diagnosis of cystic lesions located in the duodenal area and the head of the pancreas area, regardless of jaundice or abnormal liver function. Since mucosal histology showing duodenal mucosa did not match the final diagnosis, we suggest that three criteria should be met for the diagnosis of a choledochocele to be diagnosed: (1) a cyst protruding into the duodenal lumen; (2) filling with contrast during cholangiography and (3) a filling defect on X-ray barium meal. PMID:26788455

  9. The lipids of mammalian pancreas

    PubMed Central

    Prottey, C.; Hawthorne, J. N.

    1966-01-01

    1. The total lipids of ox and guinea-pig pancreas were fractionated on silicic acid columns. 2. The high lipid content of both tissues was due to triglyceride. The major fatty acids of this triglyceride were stearic acid, palmitic acid and oleic acid. 3. The pattern of individual phospholipids resembled that of liver, though pancreas contained more plasmalogen. PMID:5971782

  10. Cystic Neoplasms of the Pancreas

    PubMed Central

    Tran Cao, Hop S.; Kellogg, Benjamin; Lowy, Andrew M.; Bouvet, Michael

    2015-01-01

    Whereas pancreatic duct adenocarcinoma (PDA) is a well-studied (but still poorly understood) disease with a dismal prognosis, cystic neoplasms of the pancreas form a more recently recognized group of pancreatic tumors. They are diverse and variable in their pathologic characteristics, clinical course, and outcomes,13 although all portend a better overall prognosis than PDA. In recent years, with the improved sensitivity and increasing use of cross-sectional imaging in clinical practice, these lesions are more commonly identified,4 with many being discovered incidentally. Indeed, large radiological series using computed tomography (CT) or magnetic resonance imaging (MRI) have reported detection rates of pancreatic cystic lesions between 1.2% and almost 20%,5,6 approaching the 24.3% prevalence rate in an autopsy series by Kimura and colleagues.7 Although most of these lesions are pseudocysts, a significant portion consist of cystic neoplasms, which are estimated to represent 10% to 15% of all primary pancreatic cystic lesions.8 Given the growing clinical relevance of these tumors, a keen understanding of their natural history and pathophysiology is needed. This article reviews pancreatic cystic neoplasms, with a focus on the challenges encountered in their diagnosis and treatment. PMID:20159515

  11. Automatic segmentation of abdominal vessels for improved pancreas localization

    NASA Astrophysics Data System (ADS)

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

    2014-03-01

    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.

  12. [Solid and papillary epithelial neoplasm of the pancreas--a rare malignant tumor of pancreas].

    PubMed

    Solecki, Rafał; Kedra, Bogdan; Czupryna, Antoni; Nowak, Krystyna

    2005-01-01

    The paper presents two cases of solid and papillary epithelial neoplasm of the pancreas (SPENP)--a rare pancreatic neoplasm in a 45-year-old woman admitted to the hospital with the diagnosis of pancreatic tail tumor and 22-year-old woman with the diagnosis of pancreatic head tumor. First patient was subjected to peripheral pancreatic resection; the second patient was subjected to Whipple pancreatoduodenectomy. Histopathological examination confirmed SPENP. The authors present cases and review of the literature on SPENP. PMID:16786800

  13. Pancreas transplantation in type II diabetes mellitus

    PubMed Central

    Weems, Phillip; Cooper, Matthew

    2014-01-01

    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. PMID:25540731

  14. Tumours of the pancreas.

    PubMed

    Kircher, C H; Nielsen, S W

    1976-01-01

    Tumours of the pancreas occur most commonly in dogs and cats and only rarely in other domestic species. The incidence of neoplasms, both exocrine and endocrine, increases with age. Exocrine adenocarcinomas are the most common malignant tumours and have three fairly distinct morphological patterns: small tubular, large tubular, and acinar cell (rare). They readily metastasize, usually before clinical signs are apparent. A "starry sky" pattern with clear histiocytes scattered among tumour cells is a regular feature of poorly differentiated areas of small tubular adenocarcinomas and undifferentiated carcinomas. Islet cell tumours occur in a significant number only in dogs. Metastases are found in about half of the tumours, but malignancy cannot always be predicted by the morphological appearance. Slightly more than half of the islet cell tumours reported in the dog have been associated with clinical signs of hypoglycaemia. Nodular hyperplasia and exocrine adenomas are sometimes difficult to differentiate. Adenomas are considered rare while nodular hyperplasia is common in old animals. PMID:1086150

  15. [A case of gastrointestinal stromal tumor of the jejunum successfully treated by preoperative induction chemotherapy with imatinib mesylate administered through jejunostomy and subsequent surgical resection].

    PubMed

    Kimura, Hideyo; Ohtsuka, Takao; Toma, Hiroki; Ueda, Junji; Mizuuchi, Yusuke; Yamamoto, Hidetaka; Takahata, Shunichi; Oda, Yoshinao; Ueki, Takashi; Tanaka, Masao

    2014-03-01

    A 70 -year-old female patient with a palpable mass in the left upper abdomen suffered from abdominal pain and fever. Abdominal computed tomography showed a jejunal tumor 11 cm in diameter with ascites, suggesting rupture of the tumor. Histological diagnosis via endoscopic ultrasound-guided fine needle aspiration indicated c-kit-positive gastrointestinal stromal tumor. Diagnostic laparoscopy demonstrated a large jejunal tumor possibly invading the stomach and pancreas. The patient then underwent tube jejunostomy. Thereafter, preoperative induction chemotherapy with imatinib mesylate(400mg/ body/day)via jejunostomy was administered for 6 months, resulting in 20%reduction of the tumor diameter and disappearance of any indication of stomach and pancreas invasion. The patient then underwent radical partial resection of the jejunum without combined resection of either the stomach or pancreas. Postoperative adjuvant chemotherapy with imatinib mesylate (400mg/body/day)was also indicated. No sign of recurrence has been detected to date after 1 year of follow-up. PMID:24743291

  16. Common Disorders of the Pancreas

    MedlinePlus

    ... the disease becomes more chronic, patients can develop malnutrition and weight loss. If the pancreas becomes destroyed ... with these disorders may have chronic pain, diarrhea, malnutrition, or diabetes. Treatment focuses on pain control and ...

  17. Current status of pancreas transplantation.

    PubMed Central

    Cook, D W; Sasaki, T

    1989-01-01

    Pancreas transplantation for the treatment of diabetes mellitus is being done with increasing frequency. Refined operative techniques, an improved immunosuppression regimen, and an earlier recognition of rejection have led to dramatic increases in both graft and patient survival rates. Preliminary data suggest that a functioning pancreatic allograft may arrest or reverse most of the complications of diabetes, although the effects on retinopathy remain controversial. Patients also acquire a strong sense of well-being after successful pancreas transplantation. PMID:2660412

  18. Pancreas Acinar Cell Differentiation

    PubMed Central

    Mizoguchi, Masako; Parsa, Ismail; Marsh, Walton H.; Fitzgerald, Patrick J.

    1972-01-01

    After rat pancreas anlagen were grown in an organ culture medium for 9 days and further incubated for 15, 30 or 60 minutes in media to which C3H3-Sadenosyl-L-methionine (C3H3-SAM) was added, autoradiography demonstrated radioactivity in the nucleolus, nucleus and cytoplasm of the acinar cell. Under similar circumstances, except that the anlagen were grown in a methionine-deficient (CD-MD) medium prior to incubation with C3H3-SAM, much greater concentrations of radioactivity were present in the nucleolus, nucleus and cytoplasm of the acinar cell than in the respective compartments of anlagen grown in control medium. The nucleolus showed the highest concentration of radioactivity in anlagen grown in either control or methionine-deficient medium. The nucleolus of the acinar cell of anlagen grown in CD-MD medium appeared to be the most undermethylated cellular compartment and was larger than the nucleolus of the acinar cell grown in the control CD medium, so it is possible that a deficient methylation of ribosomal RNA precursors led to a piling up of RNA in the nucleolus and a decrease in the flow of ribosomal precursors to the cytoplasm. Other substance might have been undermethylated and thereby have inhibited differentiation. ImagesFig 2Fig 3Fig 4Fig 1 PMID:4634737

  19. Fetal MRI in the pre-operative diagnosis and assessment of secondary abdominal pregnancy: a rare sequela of a previous caesarean section.

    PubMed

    Mittal, Shireesh Kumar; Singh, Neetu; Verma, Ashok Kumar; Agarwal, Himanshu; Kulkarni, Chaitanya D; Kanaujia, Reeta

    2012-01-01

    Secondary abdominal pregnancy is a rare type of ectopic pregnancy. Following fertilization, the blastocyst escapes from the uterine cavity and implants in the peritoneal cavity. The early antenatal diagnosis and identification of the site and extent of placental implantation in an abdominal pregnancy are important to prepare for the eventual surgery. We present the case of a 24-year-old patient presenting with loss of fetal movement at 26 weeks of gestation for whom an abdominal pregnancy was suspected on ultrasonography and later confirmed on magnetic resonance imaging (MRI). She had one caesarean section in the past. The MRI findings suggested a scar dehiscence. She was eventually managed surgically, and the unviable fetus was removed. Abdominal pregnancies must be treated as emergencies. They usually present with complications such as fetal death and intra-abdominal hemorrhaging and can be easily missed on routine antenatal ultrasonography. The exact anatomical relationships of the fetus, the placenta, and vital maternal intra-abdominal structures can be accurately delineated with MRI, which greatly aids the management of patients with abdominal pregnancy. A proposed imaging protocol and technical suggestions for improving the diagnostic capability of ultrasonography and MRI in abdominal pregnancies have been provided to aid in the appropriate evaluation of suspect cases. PMID:22274996

  20. Preoperative Nutrition and Prehabilitation.

    PubMed

    Gupta, Ruchir; Gan, Tong J

    2016-03-01

    Enhanced recovery after surgery is the natural evolution of what were previously referred to as fast track programs and seeks to implement a series of interventions to improve and enhance recovery after major surgical procedures. Two important preoperative aspects are nutrition and prehabilitation. Identifying nutritionally deficient patients allows preoperative intervention to optimize their nutritional status. The contribution of cardiopulmonary exercise testing to the evaluation of perioperative risk, subsequent development of a training program, and the use of indices to risk stratify and measure improvement after a training program allow a personalized preoperative program to be developed for each patient. PMID:26927744

  1. [Pancreas transplantation: who and when?].

    PubMed

    Saudek, F; Boucek, P; Adamec, M

    2001-04-12

    Hyperglycemia is an important factor in the development and progression of the complications of diabetes. Pancreas transplantation is currently the only method able to achieve sustained normoglycemia in type I diabetes. By now, this procedure has become an accepted treatment option combined with kidney transplantation for selected patients with end-stage diabetic nephropathy. The definite benefits of pancreas transplantation comprise relieve from insulin administration, superb glycemic control, improved quality of life and long-term survival of patient with severe autonomic neuropathy. Presumed benefits represent stabilization or slowing of progression of microvascular complications. Definite disadvantages are the risk of the surgical procedure, graft rejection and the necessity of permanent immunosuppression. Isolated pancreas transplantation in nonuremic type-1 diabetic patients is still controversial. Diabetic complications of the potential recipient have to be potentially correctable by the transplantation and their significance must exceed all risks of the operation and life-long immunosuppression. Currently, approx. 25 combined transplants are performed per year in IKEM with the results comparable to those reported by the International Pancreas Transplant Registry. Seven nonuremic type-1 diabetic recipients of 8 operated in IKEM by June 2000 have been insulin-independent for 1-33 months. The main indication for isolated pancreas transplantation is brittle diabetes with hypoglycemia unawareness syndrome and labile diabetes with severe autonomic neuropathy and rapid progression of microangiopathy despite appropriate intensified insulin therapy. PMID:11374222

  2. Design of a bioartificial pancreas

    PubMed Central

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

    2013-01-01

    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

  3. Clinical imaging of the pancreas

    SciTech Connect

    May, G.; Gardiner, R.

    1987-01-01

    Featuring more than 300 high-quality radiographs and scan images, clinical imaging of the pancreas systematically reviews all appropriate imaging modalities for diagnosing and evaluating a variety of commonly encountered pancreatic disorders. After presenting a succinct overview of pancreatic embryology, anatomy, and physiology, the authors establish the clinical indications-including postoperative patient evaluation-for radiologic examination of the pancreas. The diagnostic capabilities and limitations of currently available imaging techniques for the pancreas are thoroughly assessed, with carefully selected illustrations depicting the types of images and data obtained using these different techniques. The review of acute and chronic pancreatitis considers the clinical features and possible complications of their variant forms and offers guidance in selecting appropriate imaging studies.

  4. Gemcitabine and AMG 479 in Metastatic Adenocarcinoma of the Pancreas

    ClinicalTrials.gov

    2014-03-28

    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

  5. Lymphoepithelial cyst of the pancreas mimicking malignant cystic tumor: report of a case.

    PubMed

    Ryu, Dong Hee; Sung, Ro Hyun; Kang, Min Ho; Choi, Jae Woon

    2015-08-01

    Lymphoepithelial cysts of the pancreas are a type of true cyst that can mimic pseudocysts and cystic neoplasms. They are very rare, non-malignant lesions that are unilocular or multilocular cystic lesions lined predominantly by mature squamous epithelium and surrounded by non-neoplastic lymphoid elements. We, herein, present a patient with a cystic pancreas tumor mimicking a malignant cystic neoplasm. The patient was admitted with upper abdominal discomfort. Computed tomography showed a 6439 mm cystic mass in the pancreas tail. She underwent distal pancreatectomy and splenectomy. In the fluid analysis of the pancreas cystic mass, the CEA and CA19-9 were 618 ng/ml and 3.9 U/ml, respectively. The resected pancreas specimen showed a 6.5 cm-sized cyst the pancreas tail. The cyst was well circumscribed and multilocular. The final pathology report of the resected pancreas specimen noted that the cyst was multilocular, and the cyst lining was showing stratified squamous epithelium covering the lymphoid tissue (containing lymphoid follicles), which was consistent with a lymphoepithelial cyst. The patient recovered uneventfully from surgery and has been doing well for the past 3 months. A differential diagnosis of cystic pancreatic lesions is important. We suggest that lymphoepithelial cysts, although very rare, may be included in the differential diagnosis of cystic pancreatic tumors. PMID:26379736

  6. Primitive Neuroectodermal Tumor of the Pancreas: A Case Report and Review of the Literature

    PubMed Central

    Teixeira, Uirá; Goldoni, Marcos; Unterleider, Michelle; Diedrich, João; Balbinot, Diogo; Rodrigues, Pablo; Monteiro, Rodolfo; Gomes, Daniel; Sampaio, José; Fontes, Paulo; Waechter, Fábio

    2015-01-01

    Primitive neuroectodermal tumors (PNETs) are presented as rare malignant neoplasms. In unusual cases, those neoplasms may arise in solid organs containing neuroendocrine cells, such as the pancreas. Herein the case of a 28-year-old patient that underwent gastroduodenopancreatectomy after the diagnosis of a huge mass (PNET) located in both head and body of the pancreas is reported. This is the 19th case of pancreatic PNET reported in literature. PMID:26101685

  7. [Preoperative structured patient education].

    PubMed

    Lamarche, D

    1993-04-01

    This article describes the factors that motivated the nursing staff of the cardiac surgery unit at the Royal Victoria Hospital in Montreal, to revise their preoperative teaching program. The motivating factors described are the length of the preoperative waiting period; the level of preoperative anxiety; the decreased length of hospital stay; the dissatisfaction of the nursing staff with current patient teaching practices; and the lack of available resources. The reorganization of the teaching program was based upon the previously described factors combined with a review of the literature that demonstrated the impact of preoperative anxiety, emotional support and psycho-educational interventions upon the client's recovery. The goals of the new teaching program are to provide the client and the family with cognitive and sensory information about the client's impending hospitalization, chronic illness and necessary lifestyle modifications. The program consists of a system of telephone calls during the preoperative waiting period; a videotape viewing; a tour of the cardiac surgery unit; informal discussion groups; and the availability of nursing consultation to decrease preoperative anxiety. The end result of these interventions is more time for client support and integration of necessary information by the client and family. This kind of program has the potential to provide satisfaction at many levels by identifying client's at risk; increasing client knowledge; increasing support; decreasing anxiety during the preoperative waiting period; and decreasing the length of hospital stay. The nursing staff gained a heightened sense of accomplishment because the program was developed according to the nursing department's philosophy, which includes primary nursing.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8472243

  8. Lesions of the avian pancreas.

    PubMed

    Schmidt, Robert E; Reavill, Drury R

    2014-01-01

    Although not well described, occasional reports of avian exocrine and endocrine pancreatic disease are available. This article describes the lesions associated with common diseases of the avian pancreas reported in the literature and/or seen by the authors. PMID:24274918

  9. [Preoperative hand disinfection].

    PubMed

    Kristiansen, B E; Johnsen, R L

    1994-11-30

    At Telemark Central Hospital we decided to change the procedure for preoperative disinfection of the hands in order to improve antimicrobial efficacy and to minimize skin problems for the personnel. Previously, preoperative disinfection of hands was performed by scrubbing the hand with a detergent containing chlorohexidine (Hibiscrub) which often caused dryness, fissures and dermatitis. In the recent years it has been amply shown that alcoholic solutions have a very good and immediate antibacterial effect on the skin flora, while chlorohexidine has a prolonged effect. In this paper we describe our new procedures for preoperative disinfection of hands and the necessary planning and preparation we undertook to obtain acceptance for these procedures among the personnel. PMID:7998055

  10. The Preoperative Neurological Evaluation

    PubMed Central

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

    2013-01-01

    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

  11. [Preoperative analysis in rhinoplasty].

    PubMed

    Nguyen, P S; Bardot, J; Duron, J B; Levet, Y; Aiach, G

    2014-12-01

    Preoperative analysis in rhinoplasty consists in analyzing individual anatomical and functional characteristics without losing sight of the initial requirements of the patient to which priority should be given. The examination is primarily clinical but it also uses preoperative photographs taken at specific accurate angles. Detecting functional disorders or associated general pathologies, which will reduce the risk of complications. All of these factors taken into account, the surgeon can work out a rhinoplasty plan which he or she will subsequently explain to the patient and obtain his or her approbation. PMID:25154314

  12. Preoperative tumor embolization.

    PubMed

    Ashour, Ramsey; Aziz-Sultan, Ali

    2014-07-01

    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

  13. Cavernous hemangioma of adult pancreas: A case report and literature review

    PubMed Central

    Mondal, Utpal; Henkes, Nichole; Henkes, David; Rosenkranz, Laura

    2015-01-01

    Pancreatic hemangioma is a rare type of benign vascular tumor. Low clinical suspicion and inability of current cross sectional imaging techniques to differentiate it from other pancreatic lesions, contribute to the difficulty in making the correct diagnosis. Without a definitive diagnosis, and due to concern for malignancy, in many instances, surgery is performed. We report a case of pancreas cavernous hemangioma in an 18-year-old female. The patient presented with three-month history of epigastric pain. Physical examination and routine blood tests were normal. Abdominal Computed Tomography scan revealed a 5 cm × 6 cm complex non-enhancing cystic mass in the head of pancreas. Magnetic resonance imaging, endoscopic ultrasonography (EUS) and EUS guided fine needle aspiration cytology were non-diagnostic. Because of uncontrolled symptoms, the patient underwent surgical resection. Histopathology and Immunohistochemical staining confirmed the diagnosis of cavernous hemangioma of pancreas. PMID:26361427

  14. Deep convolutional networks for pancreas segmentation in CT imaging

    NASA Astrophysics Data System (ADS)

    Roth, Holger R.; Farag, Amal; Lu, Le; Turkbey, Evrim B.; Summers, Ronald M.

    2015-03-01

    Automatic organ segmentation is an important prerequisite for many computer-aided diagnosis systems. The high anatomical variability of organs in the abdomen, such as the pancreas, prevents many segmentation methods from achieving high accuracies when compared to state-of-the-art segmentation of organs like the liver, heart or kidneys. Recently, the availability of large annotated training sets and the accessibility of affordable parallel computing resources via GPUs have made it feasible for "deep learning" methods such as convolutional networks (ConvNets) to succeed in image classification tasks. These methods have the advantage that used classification features are trained directly from the imaging data. We present a fully-automated bottom-up method for pancreas segmentation in computed tomography (CT) images of the abdomen. The method is based on hierarchical coarse-to-fine classification of local image regions (superpixels). Superpixels are extracted from the abdominal region using Simple Linear Iterative Clustering (SLIC). An initial probability response map is generated, using patch-level confidences and a two-level cascade of random forest classifiers, from which superpixel regions with probabilities larger 0.5 are retained. These retained superpixels serve as a highly sensitive initial input of the pancreas and its surroundings to a ConvNet that samples a bounding box around each superpixel at different scales (and random non-rigid deformations at training time) in order to assign a more distinct probability of each superpixel region being pancreas or not. We evaluate our method on CT images of 82 patients (60 for training, 2 for validation, and 20 for testing). Using ConvNets we achieve maximum Dice scores of an average 68% +/- 10% (range, 43-80%) in testing. This shows promise for accurate pancreas segmentation, using a deep learning approach and compares favorably to state-of-the-art methods.

  15. Composite pheochromocytoma masquerading as solid-pseudopapillary neoplasm of pancreas.

    PubMed

    Gupta, Geetanjali; Saran, Ravindra Kumar; Godhi, Satyajit; Srivastava, Siddharth; Saluja, Sundeep Singh; Mishra, Pramod Kumar

    2015-05-16

    Pheochromocytoma and ganglioneuroma form rare composite tumours of the adrenal medulla comprising less than 3% of all sympathoadrenal tumours. We present a case of intraoperatively detected adrenal medullary tumour of composite pheochromocytoma and ganglioneuroma diagnosed on histopathology, in a normotensive patient. A 50-year-old male with a past history of chronic obstructive pulmonary disease presented with abdominal pain and significant weight loss since one month. Ultrasound and contrast-enhanced computed tomography abdomen revealed a large lobulated lesion in the distal body and tail of pancreas suggestive of solid and papillary neoplasm of body and tail of pancreas. Intra-operatively, a 15 cm × 10 cm solid lesion with cystic areas was seen arising from the left lower pole of the adrenal gland pushing the pancreas which appeared unremarkable. In our case, exploratory laparotomy with tumour excision was done. Extensive sectioning and microscopic examination of this adrenal tumour confirmed a diagnosis of composite Pheochromocytoma with Ganglioneuroma on histopathology. Immunophenotyping with S-100 further supported the diagnosis. The goal of this report is to increase the awareness of this rare disease and to further identify its variable presentation. PMID:25984524

  16. Composite pheochromocytoma masquerading as solid-pseudopapillary neoplasm of pancreas

    PubMed Central

    Gupta, Geetanjali; Saran, Ravindra Kumar; Godhi, Satyajit; Srivastava, Siddharth; Saluja, Sundeep Singh; Mishra, Pramod Kumar

    2015-01-01

    Pheochromocytoma and ganglioneuroma form rare composite tumours of the adrenal medulla comprising less than 3% of all sympathoadrenal tumours. We present a case of intraoperatively detected adrenal medullary tumour of composite pheochromocytoma and ganglioneuroma diagnosed on histopathology, in a normotensive patient. A 50-year-old male with a past history of chronic obstructive pulmonary disease presented with abdominal pain and significant weight loss since one month. Ultrasound and contrast-enhanced computed tomography abdomen revealed a large lobulated lesion in the distal body and tail of pancreas suggestive of solid and papillary neoplasm of body and tail of pancreas. Intra-operatively, a 15 cm × 10 cm solid lesion with cystic areas was seen arising from the left lower pole of the adrenal gland pushing the pancreas which appeared unremarkable. In our case, exploratory laparotomy with tumour excision was done. Extensive sectioning and microscopic examination of this adrenal tumour confirmed a diagnosis of composite Pheochromocytoma with Ganglioneuroma on histopathology. Immunophenotyping with S-100 further supported the diagnosis. The goal of this report is to increase the awareness of this rare disease and to further identify its variable presentation. PMID:25984524

  17. Wearable and implantable pancreas substitutes.

    PubMed

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

    2013-03-01

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

  18. Breast cancer characteristics-comparison of preoperative and postoperative values.

    PubMed

    Kolarik, Dusan; Pecha, Vaclav; Skovajsova, Miroslava; Zahumensky, Jozef; Trnkova, Marketa; Petruzelka, Lubos; Halaska, Michael; Sottner, Oldrich; Otcenasek, Michal; Kolarova, Hana

    2013-07-01

    Breast cancer characteristics obtained at the time of diagnosis are important for setting the basic strategy of the treatment. Reliability of preoperative investigation differs for various features of the disease. The aim of this study was to ascertain the agreements and differences between preoperative and postoperative values. This retrospective study analyzed the results of 617 women with primary surgery of the breast and axilla. Cohen's kappa coefficient has been employed to measure the degree of agreement between preoperative and postoperative values. Substantial or "almost perfect" agreement has been documented for the histological type of the tumors, their histopathological grade, proliferation index Ki67, as well as for estrogen, progesterone, and HER-2/neu receptors. Substantial differences exist between preoperative and postoperative diagnoses of invasiveness of the tumor, determination of the size of the tumors, and the number of tumor foci. Preoperative imaging and clinical examination of lymph nodes exhibited unacceptably high false negative rates. Heterogeneity of breast cancer cell population, methodology of histology examinations, and insufficient imaging of lymph nodes are the major limitations precluding satisfactory accuracy of preoperative diagnosis. Preoperatively diagnosed in situ carcinomas, as well as multifocal lesions, were the most often sources of diagnostic failures. PMID:23726929

  19. Metastases to the Pancreas Encountered on Endoscopic Ultrasound-Guided, Fine-Needle Aspiration.

    PubMed

    Pang, Judy C; Roh, Michael H

    2015-10-01

    Metastatic lesions in the pancreas are very uncommon and may be difficult to differentiate from the more commonly encountered primary neoplasms derived from the exocrine and endocrine pancreas because of the significant overlap in clinical presentation, imaging, and cytologic features. Metastasis to the pancreas may occur years after treatment of the primary neoplasm and is often not considered on initial evaluation because of the rarity of such events. The possibility of a metastasis to the pancreas should be entertained in patients with any prior history of malignancy because a proper diagnosis is essential in identifying surgical candidates, or avoiding potentially unnecessary surgery and facilitating triage to more appropriate nonoperative therapy. Herein, we describe intrapancreatic metastases secondary to renal cell carcinoma, melanoma, and lung carcinoma, as documented by cytologic examination of endoscopic ultrasound-guided fine-needle aspiration of the pancreatic masses. PMID:26414469

  20. Elevated Erythropoietin and Multicystic Neoplasm of the Pancreas

    PubMed Central

    Nai, Qiang; Regeti, Kalyani; Arshed, Sabrina; Hossain, Mohammed Amzad; Zhang, Ping; Luo, Hongxiu; Singh, Shilpi; Mathew, Teena; Islam, Mohammed; Sen, Shuvendu; Yousif, Abdalla M.; Duhl, Jozsef

    2015-01-01

    Cystic lesions of the pancreas are more frequently recognized due to the widespread use of improved imaging techniques. There are a variety of pancreatic cystic lesions with different clinical presentations and malignant potentials, and their management depends on the type of the cysts. Although the early recognition of a cystic neoplasm with malignant potential provides an opportunity of early surgical treatment, the precise diagnosis of the cystic neoplasm can be a challenge, largely due to the lack of reliable biomarkers of malignant transformation. We report a case of a large, multicystic neoplasm within the body and tail of the pancreas complicated by elevated erythropoietin, which is likely related to the malignant transformation of the pancreatic neoplasm. PMID:25873882

  1. A case of epidermoid cyst in an intrapancreatic accessory spleen mimicking pancreas neoplasms: MRI with DWI.

    PubMed

    Kwak, Min Kyu; Lee, Nam Kyung; Kim, Suk; Han, Ga Jin; Seo, Hyung Il; Park, Do Youn; Lee, So Jeong; Kim, Tae Un

    2016-01-01

    We report on a rare case of an epidermoid cyst in an intrapancreatic accessory spleen (ECIAS) that presented as a cystic lesion in the tail of the pancreas, in a 21-year-old woman. ECIAS is very rare; thus, accurate diagnosis before surgery is difficult. When a wall within the lesion presents with similar imaging features to accessory splenic tissues on magnetic resonance imaging with diffusion-weighted imaging, ECIAS should be considered in the differential diagnosis of cystic lesions in the tail of the pancreas. PMID:26422768

  2. Pancreas Transplantation in the Modern Era.

    PubMed

    Redfield, Robert R; Rickels, Michael R; Naji, Ali; Odorico, Jon S

    2016-03-01

    The field of pancreas transplantation has evolved from an experimental procedure in the 1980s to become a routine transplant in the modern era. With short- and long-term outcomes continuing to improve and the significant mortality, quality-of-life, and end-organ disease benefits, pancreas transplantation should be offered to more patients. In this article, we review current indications, patient selection, surgical considerations, complications, and outcomes in the modern era of pancreas transplantation. PMID:26895686

  3. The Role of CA19-9 in Predicting Tumour Resectability in Carcinoma Head of Pancreas

    PubMed Central

    Viswanathan, Subramanian; Antomy, Thomas Babu; Thirumuruganand, Sathyamoorthy; Kumaresan, Dhandapani Subramanian

    2016-01-01

    Introduction Carbohydrate antigen 19-9 (CA 19-9) is a tumour associated antigen. Blood levels may be elevated in benign as well as malignant conditions. Its sensitivity (70-90%) and specificity (68-91%) are inadequate for accurate diagnosis. It can be used to predict the extent of disease and outcome after resection. Aim The aim of the present study was to assess the role of CA 19-9 in predicting the resectability of the tumour in the head of pancreas. Materials and Methods This was a prospective study which included 30 patients and study period was from May 2012 to October 2014. Data collected from all patients with carcinoma of the head of pancreas on the basis of contrast enhanced computed tomography/Magnetic resonance cholangiopancreaticography. CA 19-9 levels were measured and recorded. Patients who were medically unfit for surgery or those who didn’t warrant palliative surgery were excluded from the study. During surgery the operative findings on operability were documented and tabulated against corresponding CA 19-9 levels. Results Of the 30 patients who were operated, 13(43.3%) patients had operable tumours and underwent Whipple’s procedure and 17(56.7%) underwent palliative bypass procedure. Of the 30, CA 19-9 levels were elevated in 9(30.0%) and were normal in 21(70.0%). Among 13(43.3%) who had operable tumours, CA 19-9 was elevated in 4(13.3) and was normal in 9(30.0%). Of the 17(56.7%) who had inoperable tumours CA 19-9 was elevated in 5(16.7%) and was normal in 12(40.0%). Among the 17 who had inoperable tumours, 8(47.1%) were diagnosed preoperatively and of them CA 19-9 levels were raised in 2(11.8%) and normal in 6(35.3%). In the group of 9(52.9%) who had inoperable tumours diagnosed intraoperatively, CA 19-9 was raised in 3(17.6%) of them and was normal in the remaining 6(35.3%) of them. Conclusion Based on the study findings, it can be stated that there is no significant correlation with resectability of pancreatic adenocarcinoma and CA 19-9 and it doesn’t predict vascular involvement and liver metastasis. PMID:27134925

  4. Ghrelin and the endocrine pancreas.

    PubMed

    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

    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

  5. Cybersecurity in Artificial Pancreas Experiments.

    PubMed

    O'Keeffe, Derek T; Maraka, Spyridoula; Basu, Ananda; Keith-Hynes, Patrick; Kudva, Yogish C

    2015-09-01

    Medical devices have transformed modern health care, and ongoing experimental medical technology trials (such as the artificial pancreas) have the potential to significantly improve the treatment of several chronic conditions, including diabetes mellitus. However, we suggest that, to date, the essential concept of cybersecurity has not been adequately addressed in this field. This article discusses several key issues of cybersecurity in medical devices and proposes some solutions. In addition, it outlines the current requirements and efforts of regulatory agencies to increase awareness of this topic and to improve cybersecurity. PMID:25923544

  6. Design of a bioartificial pancreas+

    PubMed Central

    Opara, Emmanuel C.; Mirmalek-Sani, Sayed-Hadi; Khanna, Omaditya; Moya, Monica L; Brey, Eric M.

    2010-01-01

    Introduction In Type 1 diabetes, the β-cells that secrete insulin have been destroyed such that daily exogenous insulin administration is required for the control of blood sugar in individuals afflicted with the disease. Following the development of reliable techniques for the isolation of islets from the human pancreas, islet transplantation has emerged as a therapeutic option, albeit, for only a few selected patients largely because there are not enough islets for the millions of patients requiring the treatment, and there is also the need to use immunosuppressive drugs to prevent transplant rejection. In 1980, the concept of islet immunoisolation by microencapsulation was introduced as a technique to overcome these two major barriers to islet transplantation. Microencapsulation of islets and transplantation in the peritoneal cavity was then described as a bioartificial pancreas. However, it is difficult to retrieve encapsulated islets transplanted in the peritoneal cavity, thus making it difficult to meet all the criteria for a bioartificial pancreas. A new design of a bioartificial pancreas comprising islets co-encapsulated with angiogenic protein in perm-selective multilayer alginate-poly-L-ornithine-alginate (APA) microcapsules and transplanted in an omentum pouch is described in this paper. Materials & Methods The multilayer APA microcapsules are made with ultrapure alginate using poly-L-ornithine as a semi-permeable membrane separating the two alginate layers. The inner alginate layer is used to encapsulate the islets and the outer layer is used to encapsulate angiogenic protein, which would induce neovascularization around the graft within the omentum pouch. Results In in vitro studies, we found that both the wild-type and the heparin binding-growth associated molecule (HBGAM)-FGF-1 chimera can be encapsulated and released in a controlled and sustained manner from the outer alginate layer with a mean diameter in the range of 113–164 microns when 1.25% high guluronic acid alginate is used to formulate this outer layer. Discussion We are currently performing in vivo experiments to determine the ability of angiogenic proteins released from this outer layer to induce neovascularization around the grafts in the omentum pouch. We will subsequently examine the effect of co-encapsulation of islets with angiogenic protein on blood sugar control in diabetic animals. It is hoped that addition of tissue engineering to encapsulated islet transplantation will result in long-term survival of the islets and their ability to control blood sugar in Type 1 diabetes without the necessity to use risky immunosuppressive drugs to prevent transplant rejection. PMID:20683347

  7. Imaging preoperatively for pancreatic adenocarcinoma

    PubMed Central

    Pietryga, Jason Alan

    2015-01-01

    Pancreatic cancer is a highly lethal malignancy which is increasing in incidence and mortality. The fourth leading cause of cancer death in the U.S., pancreatic cancer is projected to become the second leading cause of cancer death by 2020. Patients with pancreatic cancer have an abysmal 5-year survival of 6%, and 90% of these patients eventually die from the disease. This is in large part due to the commonly advanced stage of disease at the time of diagnosis. Currently, the only potentially curative therapy for pancreatic carcinoma is complete surgical resection. Patients who undergo incomplete resection with residual disease have similar survival rates to those patients with metastatic disease and should be spared this relatively morbid surgery. Thus, the key to impacting prognosis is the detection of smaller and earlier stage lesions, and the key to optimal management is accurately determining which patients have potentially resectable surgery and which patients would not benefit from surgery. Cross-sectional imaging plays an essential role in both the diagnosis and appropriate staging of pancreatic carcinoma. The diagnosis and staging of pancreatic adenocarcinoma is performed with cross-sectional imaging. Multi-detector computed tomography (MDCT) is the most commonly used, best-validated imaging modality for the diagnosis and staging of pancreatic cancer. Modern contrast-enhanced magnetic resonance imaging (MRI) has been demonstrated to be equivalent to MDCT in detection and staging of pancreatic cancer. Endoscopic ultrasound (EUS) is very sensitive for detecting pancreatic masses; however, due to limitations in adequate overall abdominal staging, it is generally used in addition to or after MDCT. Transabdominal ultrasound and positron emission tomography/computed tomography (PET/CT) have limited roles in the diagnosis and staging of pancreatic cancer. Preoperative imaging is used to characterize patients as having resectable disease, borderline resectable disease, locally advanced disease (unresectable) and metastatic disease (unresectable). As the definitions of borderline resectable and unresectable may vary from institution to institution and within institutions, it is essential to accurately assess and describe the factors relevant to staging including: local extent of tumor, vascular involvement, lymph node involvement and distant metastatic disease. To facilitate this, standardized reporting templates for pancreatic ductal adenocarcinoma have been created and published. Structured reporting for pancreatic cancer has been reported to provide superior evaluation of pancreatic cancer, facilitate surgical planning, and increase surgeons confidence about tumor resectability. PMID:26261722

  8. Molecular therapeutics in pancreas cancer.

    PubMed

    Narayanan, Vignesh; Weekes, Colin D

    2016-04-15

    The emergence of the "precision-medicine" paradigm in oncology has ushered in tremendous improvements in patient outcomes in a wide variety of malignancies. However, pancreas ductal adenocarcinoma (PDAC) has remained an obstinate challenge to the oncology community and continues to be associated with a dismal prognosis with 5-year survival rates consistently less than 5%. Cytotoxic chemotherapy with gemcitabine-based regimens has been the cornerstone of treatment in PDAC especially because most patients present with inoperable disease. But in recent years remarkable basic science research has improved our understanding of the molecular and genetic basis of PDAC. Whole genomic analysis has exemplified the genetic heterogeneity of pancreas cancer and has led to ingenious efforts to target oncogenes and their downstream signaling cascades. Novel stromal depletion strategies have been devised based on our enhanced recognition of the complex architecture of the tumor stroma and the various mechanisms in the tumor microenvironment that sustain tumorigenesis. Immunotherapy using vaccines and immune checkpoint inhibitors has also risen to the forefront of therapeutic strategies against PDAC. Furthermore, adoptive T cell transfer and strategies to target epigenetic regulators are being explored with enthusiasm. This review will focus on the recent advances in molecularly targeted therapies in PDAC and offer future perspectives to tackle this lethal disease. PMID:27096032

  9. Molecular therapeutics in pancreas cancer

    PubMed Central

    Narayanan, Vignesh; Weekes, Colin D

    2016-01-01

    The emergence of the “precision-medicine” paradigm in oncology has ushered in tremendous improvements in patient outcomes in a wide variety of malignancies. However, pancreas ductal adenocarcinoma (PDAC) has remained an obstinate challenge to the oncology community and continues to be associated with a dismal prognosis with 5-year survival rates consistently less than 5%. Cytotoxic chemotherapy with gemcitabine-based regimens has been the cornerstone of treatment in PDAC especially because most patients present with inoperable disease. But in recent years remarkable basic science research has improved our understanding of the molecular and genetic basis of PDAC. Whole genomic analysis has exemplified the genetic heterogeneity of pancreas cancer and has led to ingenious efforts to target oncogenes and their downstream signaling cascades. Novel stromal depletion strategies have been devised based on our enhanced recognition of the complex architecture of the tumor stroma and the various mechanisms in the tumor microenvironment that sustain tumorigenesis. Immunotherapy using vaccines and immune checkpoint inhibitors has also risen to the forefront of therapeutic strategies against PDAC. Furthermore, adoptive T cell transfer and strategies to target epigenetic regulators are being explored with enthusiasm. This review will focus on the recent advances in molecularly targeted therapies in PDAC and offer future perspectives to tackle this lethal disease. PMID:27096032

  10. Pre-operative anaemia.

    PubMed

    Clevenger, B; Richards, T

    2015-01-01

    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

  11. Possible link between ectopic pancreas and holoprosencephaly

    PubMed Central

    Kin, Tatsuya; Korbutt, Gregory S.; Shapiro, A.M. James

    2012-01-01

    We report on the incidental observation of ectopic pancreas in a donor for islet cell transplantation. The donor’s clinical and imaging presentation was definitive for holoprosencephaly. This case report discusses a possible link between ectopic pancreas and holoprosencephaly. PMID:22688061

  12. Solitary fibrous tumor of the pancreas.

    PubMed

    Baxter, Andrew R; Newman, Elliot; Hajdu, Cristina H

    2015-01-01

    Solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms of fibroblastic origin. Most commonly they affect the pleura but they been described in other viscera. SFT of the pancreas is extremely rare, and only eight cases have been reported to date. We perform a literature review and report a ninth case. The patient is a 54-year-old African-American female who presented with several months of abdominal pain. Abdominal radiography demonstrated a lesion in the head of the pancreas, and she underwent a Whipple operation. Pathology demonstrated SFT of the pancreas. She is alive and well 1 year post-operatively. SFT of the pancreas predominately affects middle-aged women. These tumors are difficult to distinguish radiologically from neuroendocrine tumors. While SFT of the pancreas tend to have an indolent course, there is the potential for malignancy. We recommend complete surgical excision. PMID:26628714

  13. Solitary fibrous tumor of the pancreas

    PubMed Central

    Baxter, Andrew R.; Newman, Elliot; Hajdu, Cristina H.

    2015-01-01

    Solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms of fibroblastic origin. Most commonly they affect the pleura but they been described in other viscera. SFT of the pancreas is extremely rare, and only eight cases have been reported to date. We perform a literature review and report a ninth case. The patient is a 54-year-old African-American female who presented with several months of abdominal pain. Abdominal radiography demonstrated a lesion in the head of the pancreas, and she underwent a Whipple operation. Pathology demonstrated SFT of the pancreas. She is alive and well 1 year post-operatively. SFT of the pancreas predominately affects middle-aged women. These tumors are difficult to distinguish radiologically from neuroendocrine tumors. While SFT of the pancreas tend to have an indolent course, there is the potential for malignancy. We recommend complete surgical excision. PMID:26628714

  14. Spectrum and Classification of Cystic Neoplasms of the Pancreas.

    PubMed

    Greer, Jonathan B; Ferrone, Cristina R

    2016-04-01

    As patients are living longer and axial imaging is more widespread, increasing numbers of cystic neoplasms of the pancreas are found. Intraductal papillary mucinous neoplasms and mucinous cystic neoplasms are the most common. The revised Sendai guidelines provide a safe algorithm for expectant management of certain cystic neoplasms; however, studies are ongoing to identify further subgroups that can be treated nonoperatively. For those patients with high-risk clinical features or symptoms, surgical resection can be performed safely at high-volume pancreatic centers. Accurate diagnosis is critical for accurate decision making. PMID:27013368

  15. [Case of giant cell anaplastic ductal carcinoma of the pancreas].

    PubMed

    Yamabe, Satoshi; Yuruki, Hideto; Matsuno, Kenshi; Urata, Masayuki; Ikeshima, Satoshi; Yoshimatsu, Shinichi; Shimada, Shinya; Sasaki, Yutaka

    2014-02-01

    A 56-year-old woman was admitted to our hospital with fever and systemic malaise. Abdominal computed tomography revealed an enhanced tumor of the pancreatic head, measuring 9cm in maximal diameter and containing a low-density area. Subtotal stomach-preserving pancreatoduodenectomy was performed. Hemorrhage and necrosis were evident within the tumor, and osteoclastic polynuclear giant cells were also identified. A diagnosis of giant cell anaplastic ductal carcinoma of the pancreas was made. The patient has been free from recurrence for 6 months since surgery. PMID:24500324

  16. Duodenal leaks after pancreas transplantation with enteric drainage - characteristics and risk factors.

    PubMed

    Spetzler, Vinzent N; Goldaracena, Nicolas; Marquez, Max A; Singh, Sunita K; Norgate, Andrea; McGilvray, Ian D; Schiff, Jeffrey; Greig, Paul D; Cattral, Mark S; Selzner, Markus

    2015-06-01

    Pancreas-kidney transplantation with enteric drainage has become a standard treatment in diabetic patients with renal failure. Leaks of the graft duodenum (DL) remain a significant complication after transplantation. We studied incidence and predisposing factors of DLs in both simultaneous pancreas-kidney (SPK) and pancreas after kidney (PAK) transplantation. Between January 2002 and April 2013, 284 pancreas transplantations were performed including 191 SPK (67.3%) and 93 PAK (32.7%). Patient data were analyzed for occurrence of DLs, risk factors, leak etiology, and graft survival. Of 18 DLs (incidence 6.3%), 12 (67%) occurred within the first 100 days after transplantation. Six grafts (33%) were rescued by duodenal segment resection. Risk factors for a DL were PAK transplantation sequence (odds ratio 3.526, P = 0.008) and preoperative immunosuppression (odds ratio 3.328, P = 0.012). In the SPK subgroup, postoperative peak amylase as marker of preservation/reperfusion injury and recipient pretransplantation cardiovascular interventions as marker of atherosclerosis severity were associated with an increased incidence of DLs. CMV-mismatch constellations showed an increased incidence in the SPK subgroup, however without significance probability. Long-term immunosuppression in PAK transplantation is a major risk factor for DLs. Early surgical revision offers the chance of graft rescue. PMID:25647150

  17. Glucagon in the Artificial Pancreas

    PubMed Central

    2014-01-01

    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

  18. Robotic surgery of the pancreas

    PubMed Central

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

    2014-01-01

    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

  19. Pylorus preserving pancreatoduodenectomy versus Whipple procedure for adenocarcinoma of the head of the pancreas.

    PubMed

    Belli, L; Riolo, F; Romani, F; Baticci, F; Rossetti, O; Puttini, M

    1989-10-01

    Thirty eight patients underwent pancreatoduodenectomy for histologically confirmed adenocarcinoma of the head of the pancreas. Twenty one underwent a pylorus preserving pancreatoduodenectomy and seventeen the classical Whipple procedure. We undertook this retrospective analysis to compare longterm survival following the two different surgical procedures. Patients in the two groups were comparable for preoperative laboratory data, age and pathological staging. Minor and major morbidity was not different between the two group (33.3% and 35.2% respectively). In the pylorus preservation group a delayed resumption of full oral diet and a consequent prolonged hospital stay has been noted (21.3 days vs 15.4 days, p less than 0.05). Mean survival was 21 months in the pylorus preservation group and 17 in the Whipple group. No statistical difference was observed between the two survival curves. According to these data the pylorus preserving pancreatoduodenectomy represents a reasonable option for adenocarcinoma of the head of the pancreas. PMID:2487385

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

    PubMed

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

    2004-04-01

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

  1. Preoperative Safety Briefing Project

    PubMed Central

    DeFontes, James; Surbida, Stephanie

    2004-01-01

    Context: Increased media attention on surgical procedures that were performed on the wrong anatomic site or wrong patient has prompted the health care industry to identify and address human factors that lead to medical errors. Objective: To increase patient safety in the perioperative setting, our objective was to create a climate of improved communication, collaboration, team-work, and situational awareness while the surgical team reviewed pertinent information about the patient and the pending procedure. Methods: A team of doctors, nurses, and technicians used human factors principles to develop the Preoperative Safety Briefing for use by surgical teams, a briefing similar to the preflight checklist used by the airline industry. A six-month pilot of the briefing began in the Kaiser Permanente (KP) Anaheim Medical Center in February 2002. Four indicators of safety culture were used to measure success of the pilot: occurrence of wrong-site/wrong procedures, attitudinal survey data, near-miss reports, and nursing personnel turnover data. Results: Wrong-site surgeries decreased from 3 to 0 (300%) per year; employee satisfaction increased 19%; nursing personnel turnover decreased 16%; and perception of the safety climate in the operating room improved from “good” to “outstanding.” Operating suite personnel perception of teamwork quality improved substantially. Operating suite personnel perception of patient safety as a priority, of personnel communication, of their taking responsibility for patient safety, of nurse input being well received, of overall morale, and of medical errors being handled appropriately also improved substantially. Conclusions: Team members who work together and communicate well can quickly detect and more easily avoid errors. The Preoperative Safety Briefing is now standard in many operating suites in the KP Orange County Service Area. The concepts and design of this project are transferable, and similar projects are underway in the Departments of Radiology and of Labor and Delivery at KP Anaheim Medical Center. PMID:26704913

  2. Cystadenoma and Cystadenocarcinoma of the Pancreas

    PubMed Central

    Muzac, Eddy S.

    1979-01-01

    Cystadenomas and cystadenocarcinomas of the pancreas are rare, with few cases encountered by any one surgeon or institution. Cystadenomas account for less than ten percent of all cystic lesions of the pancreas with less than 300 examples reported in the literature. Cystadenocarcinomas represent one percent of all pancreatic cancers with very few cases reported. This report is a presentation of a 48-year-old black female who was treated at Meharry Medical College for cystadenocarcinoma of the pancreas, and is followed by a review of the world literature. ImagesFigure 1Figure 2 PMID:448761

  3. Primary Small Cell Carcinoma of the Pancreas Presenting With Likely Paraneoplastic Features

    PubMed Central

    Jordan, Mark; Kumar, Prashant; Gray, Christopher

    2016-01-01

    Primary small cell carcinoma of the pancreas (SCCP) is a rare malignancy, and has been associated with paraneoplastic features in only 2 reported cases. We report a rare and fatal case of SCCP with likely paraneoplastic features in a previously well 67-year-old woman presenting with abdominal pain. She was found to have abnormal biochemical markers (hyperkalaemia and hyponatraemia) with a normal abdominal CT. Emergency laparotomy identified a mass at the head of the pancreas and liver metastases, she died soon after, and diagnosis was confirmed post-mortem. PMID:27144201

  4. [Pancreas transplantation: status of the problem in experimental and clinical medicine].

    PubMed

    Florack, G

    1985-10-01

    Transplantations of pancreas grafts are performed in patients with juvenile onset of diabetes to halt the progression of secondary microangiopathic organ lesions. The treatment of the exocrine secretion of pancreas grafts remains problematic. Duct occlusion seems to be the safest approach but results in fibrosis of the gland. Therefore more recently drainage is directed to a hollow organ, generally performed as pancreaticojejunostomy. New immunosuppressive therapies improved the transplant results. The diagnosis of occurring rejection is difficult since monitoring of plasma glucoses is not very sensitive. Cold storage of grafts in SGF-solution is a reliable preservation procedure. Islet cell transplantation might be a promising alternative technique in the future. PMID:3936292

  5. A compound heterozygous mutation of ABCC8 gene causing a diazoxide-unresponsive congenital hyperinsulinism with an atypical form: Not a focal lesion in the pancreas reported by ¹⁸F-DOPA-PET/CT scan.

    PubMed

    Zhang, Wen; Liu, Li; Wen, Zhe; Cheng, Jing; Li, Cuiling; Li, Xiuzhen; Niu, Huilin; Wang, Fenghua; Sheng, Huiying; Liu, Hongsheng

    2015-11-10

    Congenital hyperinsulinism (CHI) is a severe heterogeneous disorder due to dysregulation of insulin secretion from the pancreatic β-cells leading to severe hypoglycemia in infancy. 18-fluoro-l-3,4-dihydroxyphenylalanine positron emission tomography ((18)F‑DOPA‑PET)/CT is a useful tool in distinguishing between focal and diffuse disease preoperatively. But recent studies have suggested that the scanning may not be accurate as initially estimated. In this study we characterize a case of CHI with a compound heterozygous mutation of ABCC8 gene. The results of clinical investigation, gene mutation analysis, (18)F‑DOPA‑PET/CT scan, and pathological examination showed some new characteristics that have never been reported. The patient was unresponsive to medical therapy with diazoxide and received pancreatectomy twice. Genetic analysis identified a compound heterozygous mutation in ABCC8 genes. Imaging with (18)F‑DOPA‑PET/CT indicated a focal lesion in the head of the pancreas. The pathological diagnosis was an atypical form of CHI. The patient presented with a phenotype of atypical CHI unresponsive to diazoxide. It is considered that a relationship existed between the compound heterozygous mutation and the atypical form. (18)F‑DOPA‑PET/CT is a useful tool in distinguishing between focal and diffuse forms preoperatively but the accuracy is not 100%. The scan result is best combined with genetic analysis and intra-operative biopsy to confirm the histological subtypes. The combination will provide the optimal strategy for the surgical treatment of patients with CHI. PMID:26162674

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

    PubMed Central

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

    2014-01-01

    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

  7. [Synchronous malignant intraductal papillary mucinous neoplasms of the bile duct and pancreas requiring left hepatectomy and total pancreatectomy].

    PubMed

    Moon, Deok-Bog; Lee, Sung-Gyu; Jung, Dong-Hwan; Park, Gil-Chun; Park, Yo-Han; Park, Hyung-Woo; Kim, Myung-Hwan; Lee, Sung-Koo; Yu, Eun-Sil; Kim, Ji-Hoon

    2014-02-01

    Intraductal papillary mucinous neoplasm of the bile duct (IPMN-B) and intraductal papillary mucinous neoplasm of the pancreas (IPMN-P) have striking similarities and are recognized as counterparts. However, simultaneous occurrence of IPMN-B and IPMN-P is extremely rare. A 66 year-old female presented with recurrent epigastric pain and fever. During the past 9 years, she had three clinical episodes related to intrahepatic duct stones and IPMN-P in the pancreas head and was managed by medical treatment. Laboratory test results at admission revealed leukocytosis (12,600/mm(3)) and elevated CA 19-9 level (1,200 U/mL). Imaging study demonstrated liver abscess in the Couinaud's segment 4, IPMN-B in the left lobe, and IPMN-P in the whole pancreas with suspicious malignant change. Liver abscess was drained preoperatively, followed by left lobectomy with bile duct resection and total pancreatectomy with splenectomy. On histologic examination, non-invasive intraductal papillary mucinous carcinoma arising from various degree of dysplastic mucosa of the liver and pancreas could be observed. However, there was no continuity between the hepatic and pancreatic lesions. This finding in our case supports the theory that double primary lesions are more likely explained by a diffuse IPMN leading to synchronous tumors arising from both biliary and pancreatic ducts rather than by a metastatic process. Herein we present a case of simultaneous IPMN of the bile duct and pancreas which was successfully treated by surgical management. PMID:24561701

  8. Solid Pseudo-Papillary Tumor of the Pancreas in a 10 Year Old Girl.

    PubMed

    Goudarzipour, K; Jenabzadeh, A; Mirzaei Ilali, H; Behnam, B; Tavassol, H

    2015-01-01

    Background Solid pseudo-papillary tumor of the pancreas (SPTP) is a rare disease with a low malignant potential. Though it shows low malignant potential 10% to 15% of the cases show aggressive behavior with metastatic involvement of the liver. The symptoms include abdominal discomfort and abdominal pain. It is very rare in early years of age. This is the case of a 10 year old girl with abdominal pain and her evaluation revealed solid pseudo papillary tumor of pancreas. In family history, her grandmother died because of pancreas cancer. The mass was excised and in her 6-month follow up she didn't have any problems. This case is presented to point out physicians that more attention to pseudo- papillary tumor can bring us significant improvement in the diagnosis of this pathology, though pseudo- papillary tumor is a rare pathologic condition in children. PMID:26705457

  9. Solid Pseudo-Papillary Tumor of the Pancreas in a 10 Year Old Girl

    PubMed Central

    Goudarzipour, K; Jenabzadeh, A; Mirzaei Ilali, H; Behnam, B; Tavassol, H

    2015-01-01

    Background Solid pseudo-papillary tumor of the pancreas (SPTP) is a rare disease with a low malignant potential. Though it shows low malignant potential 10% to 15% of the cases show aggressive behavior with metastatic involvement of the liver. The symptoms include abdominal discomfort and abdominal pain. It is very rare in early years of age. This is the case of a 10 year old girl with abdominal pain and her evaluation revealed solid pseudo papillary tumor of pancreas. In family history, her grandmother died because of pancreas cancer. The mass was excised and in her 6-month follow up she didn’t have any problems. This case is presented to point out physicians that more attention to pseudo- papillary tumor can bring us significant improvement in the diagnosis of this pathology, though pseudo- papillary tumor is a rare pathologic condition in children. PMID:26705457

  10. The current state of pancreas transplantation.

    PubMed

    Gruessner, Rainer W G; Gruessner, Angelika C

    2013-09-01

    For many patients with type 1 diabetes mellitus and selected patients with type 2 diabetes mellitus, a successful pancreas transplant is the only definitive long-term treatment that both restores euglycaemia without the risk of severe hypoglycaemia and prevents, halts or reverses secondary complications. These benefits come at the cost of major surgery and lifelong immunosuppression. Nevertheless, pancreas transplants are safe and effective, with patient survival rates currently >95% at 1 year and >88% at 5 years; graft survival rates are almost 85% at 1 year and >60% at 5 years. The estimated half-life of a pancreas graft is now 7-14 years. The improvements in graft survival are attributable to considerable reductions in technical failures and in immunologic graft losses. Pancreas recipients have reduced mortality compared with waiting candidates or patients with diabetes mellitus who undergo a kidney transplant alone. Pancreas transplants should be more frequently offered to nonuraemic patients with brittle diabetes mellitus to prevent the development of secondary diabetic complications and to avoid the need for a kidney transplant. Although the results of islet transplantation have also improved, islet recipients rarely maintain long-term insulin independence despite the use of multiple organ donor pancreases. Pancreas transplants and islet transplants should be considered complementary, not mutually exclusive, procedures that are chosen on the basis of the individual patient's surgical risk. PMID:23897173

  11. Cystic lesions of the pancreas.

    PubMed

    Karoumpalis, Ioannis; Christodoulou, Dimitrios K

    2016-01-01

    Different types of benign or malignant cystic lesions can be observed in the pancreas. Pancreatic cystic lesions are classified under pathology terms into simple retention cysts, pseudocysts and cystic neoplasms. Mucinous cystic neoplasm is a frequent type of cystic neoplasm and has a malignant potential. Serous cystadenoma follows in frequency and is usually benign. Intraductal papillary mucinous neoplasms are the most commonly resected cystic pancreatic neoplasms characterized by dilated segments of the main pancreatic duct and/or side branches, the wall of which is covered by mucus secreting cells. These neoplasms can occupy the pancreatic head or any part of the organ. Solid pseudopapillary tumor is rare, has a low tendency for malignancy, and is usually located in the pancreatic body or tail. Endoscopic ultrasound with the use of fine-needle aspiration and cytology permits discrimination of those lesions. In this review, the main characteristics of those lesions are presented, as well as recommendations regarding their follow up and management according to recent guidelines. PMID:27065727

  12. The Pancreas: Causes for Malabsorption

    PubMed Central

    Hackert, Thilo; Schtte, Kerstin; Malfertheiner, Peter

    2014-01-01

    Summary Background The pancreas has a central function in digestion and glucose homeostasis. With regard to the exocrine function, which is responsible for the digestion and absorption of nutrients and vitamins, the most important disturbances of these physiological processes are based on deficiencies in enzyme production and secretion, either due to impaired excretion caused by obstruction of the pancreatic duct or due to loss of pancreatic tissue. Both conditions result in maldigestion, malabsorption, and malnutrition. Methods Systematic literature review. Results Symptoms associated with pancreatic exocrine failure are gastrointestinal discomfort, steatorrhea, and weight loss. Pancreatic exocrine insufficiency caused by ductal obstruction occurs in chronic pancreatitis or with neoplasia of the pancreatic head. Loss of functional parenchyma can be caused either by chronic pancreatitis resulting in fibrotic replacement of the destroyed parenchyma or by a postoperative state of pancreatic resection. Conclusion In patients with chronic pancreatitis, a stage-adapted and timely therapy including conservative as well as surgical measures is essential to prevent functional deterioration and to preserve residual function. In the case of pancreatic resection for chronic pancreatitis, this can be achieved with modern organ-sparing surgery such as the duodenum-preserving pancreatic head resection. In patients requiring more extended pancreatic resections and even total duodenopancreatectomy, regardless of the underlying indication, adequate enzyme replacement and monitoring of the nutritional status is critical to prevent impairment of quality of life as well as detrimental malnutrition in the long term. PMID:26288593

  13. Cystic Neoplasm of the Pancreas.

    PubMed

    Pulvirenti, Alessandra; Marchegiani, Giovanni; Malleo, Giuseppe; Borin, Alex; Allegrini, Valentina; Bassi, Claudio; Salvia, Roberto

    2015-10-01

    Cystic neoplasms of the pancreas (CNPs) are not considered as rare entities any more. Imaging-based population studies attested an overall prevalence of 2 %, but that becomes five times higher on individuals of more than 70 year old. This family of neoplasms includes a wide spectrum of benign, borderline, and malignant lesions whose actual biological behavior has not been completely clarified yet. Moreover, the management of CNPs still represents a challenge for gastrointestinal (GI) specialists. While many CNPs have an indolent behavior that justifies surveillance, others should be resected because of the risk of progression to invasive cancer. Due to the high morbidity related to pancreatic resections, the surgeon should balance very carefully the advantages of a radical resection with the risks of an unrequested dangerous procedure. We reviewed the current issues regarding CNPs, with a particular focus on the clinical and radiological features that are integrated in the current guidelines and that drive the management of these patients. PMID:26722201

  14. Cystic lesions of the pancreas

    PubMed Central

    Karoumpalis, Ioannis; Christodoulou, Dimitrios K.

    2016-01-01

    Different types of benign or malignant cystic lesions can be observed in the pancreas. Pancreatic cystic lesions are classified under pathology terms into simple retention cysts, pseudocysts and cystic neoplasms. Mucinous cystic neoplasm is a frequent type of cystic neoplasm and has a malignant potential. Serous cystadenoma follows in frequency and is usually benign. Intraductal papillary mucinous neoplasms are the most commonly resected cystic pancreatic neoplasms characterized by dilated segments of the main pancreatic duct and/or side branches, the wall of which is covered by mucus secreting cells. These neoplasms can occupy the pancreatic head or any part of the organ. Solid pseudopapillary tumor is rare, has a low tendency for malignancy, and is usually located in the pancreatic body or tail. Endoscopic ultrasound with the use of fine-needle aspiration and cytology permits discrimination of those lesions. In this review, the main characteristics of those lesions are presented, as well as recommendations regarding their follow up and management according to recent guidelines. PMID:27065727

  15. Solid cystic pseudopapillary tumor of pancreas with splenic metastasis: Case report and review of literature

    PubMed Central

    Yagmur, Yusuf; Yigit, Ebral; Gumus, Serdar; Babur, Mehmet; Can, Mehmet Ali

    2015-01-01

    Introduction Solid-cystic pseudopapillary tumor of the pancreas is rare and most commonly seen in young women. We present a young women with solid-cystic pseudopapillary tumor of the pancreas and discuss the literature. Presentation of case Thirty nine years old female patient with a mass about 12 cm in the pancreas with splenic invasion seen in our clinic. After having CT and PET-CT view, patient underwent surgery. Distal pancreatectomy with mass excision and splenectomy was performed. Microscopic examination result was solid cystic pseudopapillary tumor with spleen invasion. Discussion Solid-cystic pseudopapillary tumor of the pancreas has cystic solid pseudopapillary structures. Prognosis of tumor is better than other pancreatic tumor. Complete resection of tumor with splenic inclusion is surgical treatment. Conclusion In case of large slow growing pancreatic tumor with splenic metastasis, solid-cystic pseudopapillary tumor of the pancreas should be considered in the diagnosis. Complete surgical resection is associated with long-term survival even in the presence of metastatic disease. Close follow-up is necessary after surgery. PMID:26225837

  16. Is there a case for selective, rather than routine, preoperative laryngoscopy in thyroid surgery?

    PubMed Central

    González-Sánchez, Carmen; Aguilera-Molina, Yari Yuritzi; Rozo-Coronel, Orlando; Estévez-Alonso, José Santiago; Muñoz-Herrera, Ángel

    2015-01-01

    Background According to some authors, routine preoperative laryngoscopy should be the standard of care in all patients undergoing thyroid surgery. The rationale for this approach is (I) the risk that a patient has a preoperative vocal cord palsy (VCP) without symptoms; (II) the presence of VCP preoperatively is suggestive of invasive malignancy; (III) it is relevant for the use of intraoperative nerve monitoring; and (IV) surgical strategy may be better defined if a paralysed vocal cord is detected preoperatively. Methods This is a review of studies of patients who underwent routine preoperative laryngoscopy to anticipate preoperative VCP and that evaluated related risk factors, including previous surgery, voice function complaints, and a diagnosis of malignancy. The estimated risk of sustaining preoperative VCF in the absence of these factors was determined. The relevant current guidelines from different professional bodies are also addressed. Results The level of evidence that supports routine preoperative laryngoscopy is weak. The risk of harboring preoperative VCP in the absence of previous neck or other risk-related surgery, advanced malignancy or voice symptoms is very low (0.5% of cases). Conclusions Selective rather than routine use of preoperative laryngoscopy may be acceptable provided that the risk of undetected paralysis is as low as can be reasonably ascertained from the available literature. PMID:25713775

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

    PubMed

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

    2012-01-01

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

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed

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

    2013-07-01

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

  20. Multipotent pancreas progenitors: Inconclusive but pivotal topic

    PubMed Central

    Jiang, Fang-Xu; Morahan, Grant

    2015-01-01

    The establishment of multipotent pancreas progenitors (MPP) should have a significant impact not only on the ontology of the pancreas, but also for the translational research of glucose-responding endocrine β-cells. Deficiency of the latter may lead to the pandemic type 1 or type 2 diabetes mellitus, a metabolic disorder. An ideal treatment of which would potentially be the replacement of destroyed or failed β-cells, by restoring function of endogenous pancreatic endocrine cells or by transplantation of donor islets or in vitro generated insulin-secreting cells. Thus, considerable research efforts have been devoted to identify MPP candidates in the pre- and post-natal pancreas for the endogenous neogenesis or regeneration of endocrine insulin-secreting cells. In order to advance this inconclusive but critical field, we here review the emerging concepts, recent literature and newest developments of potential MPP and propose measures that would assist its forward progression. PMID:26730269

  1. Multipotent pancreas progenitors: Inconclusive but pivotal topic.

    PubMed

    Jiang, Fang-Xu; Morahan, Grant

    2015-12-26

    The establishment of multipotent pancreas progenitors (MPP) should have a significant impact not only on the ontology of the pancreas, but also for the translational research of glucose-responding endocrine ?-cells. Deficiency of the latter may lead to the pandemic type 1 or type 2 diabetes mellitus, a metabolic disorder. An ideal treatment of which would potentially be the replacement of destroyed or failed ?-cells, by restoring function of endogenous pancreatic endocrine cells or by transplantation of donor islets or in vitro generated insulin-secreting cells. Thus, considerable research efforts have been devoted to identify MPP candidates in the pre- and post-natal pancreas for the endogenous neogenesis or regeneration of endocrine insulin-secreting cells. In order to advance this inconclusive but critical field, we here review the emerging concepts, recent literature and newest developments of potential MPP and propose measures that would assist its forward progression. PMID:26730269

  2. [Ectopic pancreas imitating gastric neoplasm -- a case report].

    PubMed

    Buczek, Tomasz; Puzdrowski, Witold; Lenekowski, Radosław; Kruszewski, Wiesław Janusz

    2013-01-01

    Ectopic pancreas is a rare developmental disorder. Usually is asymptomatic. Most frequently is diagnosed in its gastric location accidentally during endoscopy. A patient with ectopic pancreas was described manifesting as a gastric tumor arousing oncological concern. PMID:24455840

  3. Intraductal Papillary Mucinous Neoplasm of Pancreas

    PubMed Central

    Machado, Norman Oneil; al Qadhi, Hani; al Wahibi, Khalifa

    2015-01-01

    Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are neoplasms that are characterized by ductal dilation, intraductal papillary growth, and thick mucus secretion. This relatively recently defined pathology is evolving in terms of its etiopathogenesis, clinical features, diagnosis, management, and treatment guidelines. A PubMed database search was performed. All the relevant abstracts in English language were reviewed and the articles in which cases of IPMN could be identified were further scrutinized. Information of IPMN was derived, and duplication of information in several articles and those with areas of persisting uncertainties were excluded. The recent consensus guidelines were examined. The reported incidence of malignancy varies from 57% to 92% in the main duct-IPMN (MD-IPMN) and from 6% to 46% in the branch duct-IPMN (BD-IPMN). The features of high-risk malignant lesions that raise concern include obstructive jaundice in a patient with a cystic lesion in the pancreatic head, the findings on radiological imaging of a mass lesion of >30 mm, enhanced solid component, and the main pancreatic duct (MPD) of size ≥10 mm; while duct size 5-9 mm and cyst size <3 mm are considered as “worrisome features.” Magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS) are primary investigations in diagnosing and following up on these patients. The role of pancreatoscopy and the analysis of aspirated cystic fluid for cytology and DNA analysis is still to be established. In general, resection is recommended for most MD-IPMN, mixed variant, and symptomatic BD-IPMN. The 5-year survival of patients after surgical resection for noninvasive IPMN is reported to be at 77-100%, while for those with invasive carcinoma, it is significantly lower at 27-60%. The follow-up of these patients could vary from 6 months to 1 year and would depend on the risk stratification for invasive malignancy and the pathology of the resected specimen. The understanding of IPMN has evolved over the years. The recent guidelines have played a role in this regard. PMID:26110127

  4. [Persistent neonatal hypoglycemia in nesidioblastosis of the pancreas].

    PubMed

    Reiterer, F; Gamillscheg, A; Ritschl, E; Müller, W D; Schwingshandl, J; Borkenstein, M; Klos, J; Ratschek, M; Fellbaum, C

    1990-01-01

    A now 10 month old female infant suffered from persistent non ketotic neonatal hypoglycemia despite continuous intravenous application of glucose (greater than 10 mg/kg/min). There was only a transient response of blood glucose after intravenous administration of glucagon and prednisolon. Biochemical findings indicated hyperinsulinismus (insulin level of 26 mE/ml during hypoglycemia). Oral diazoxid treatment in high doses (22 mg/kg) stopped hypoglycemia episodes for several days but the newborn remained glucose infusion depended. Finally the treatment had to be interrupted because of vomiting. At the age of 4 1/2 weeks a subtotal pancreatectomy was performed. The histological examination of the pancreas confirmed the clinically suspected diagnosis of nesidioblastosis. After pancreatectomy the infant required insulin therapy. Since six months the girl is without insulin in a good condition. Despite periods of arrested head growth before pancreatectomy the psychomotoric development is normal. PMID:2326089

  5. [Patient blood management--The preoperative patient].

    PubMed

    Mller, Markus M; Fischer, Dania; Stock, Ulrich; Geisen, Christof; Steffen, Bjrn; Nussbaumer, Judith; Meybohm, Patrick

    2014-04-01

    Preoperative anaemia is an independent risk factor for an increase in perioperative morbidity and mortality. Patient Blood Management (PBM) aims for an early detection of anaemia in elective surgery patients. Reasons for anaemia should be detected and causally treated if possible. A multidisciplinary team of specialists aims for diagnosis and causative treatment of easily treatable and frequent causes of anaemia like iron deficiency, bleeding or (autoimmune) haemolysis using patients' specific history, examination, laboratory and technical methods. Such an outpatient PBM programme is only feasible, if anaesthesiologists, surgeons, haematologists, gastroenterologists, gynecologists, laboratory and transfusion medicine specialists work together in a PBM team using a common PBM plan. Communication within this team as well as with the patients' physicians in their private offices is key for a long lasting success of such a PBM programme. PMID:24792598

  6. Preoperative staging of rectal cancer.

    PubMed

    Smith, Neil; Brown, Gina

    2008-01-01

    Detailed preoperative staging using high resolution magnetic resonance imaging (MRI) enables the selection of patients that require preoperative therapy for tumour regression. This information can be used to instigate neoadjuvant therapy in those patients with poor prognostic features prior to disturbing the tumour bed and potentially disseminating disease. The design of trials incorporating MR assessment of prognostic factors prior to therapy has been found to be of value in assessing treatment modalities and outcomes that are targeted to these preoperative prognostic subgroups and in providing a quantifiable assessment of the efficacy of particular chemoradiation treatment protocols by comparing pre-treatment MR staging with post therapy histology assessment. At present, we are focused on achieving clear surgical margins of excision (CRM) to avoid local recurrence. We recommend that all patients with rectal cancer should undergo pre-operative MRI staging. Of these, about half will have good prognosis features (T1-T3b, N0, EMVI negative, CRM clear) and may safely undergo primary total mesorectal excision. Of the remainder, those with threatened or involved margins will certainly benefit from pre-operative chemoradiotherapy with the aim of downstaging to permit safe surgical excision. In the future, our ability to recognise features predicting distant failure, such as extramural vascular invasion (EMVI) may be used to stratify patients for neo-adjuvant systemic chemotherapy in an effort to prevent distant relapse. The optimal pre-operative treatment regimes for these patients (radiotherapy alone, systemic chemotherapy alone or combination chemo-radiotherapy) is the subject of current and future trials. PMID:17957502

  7. Preoperative Anemia: Evaluation and Treatment.

    PubMed

    Kansagra, Ankit J; Stefan, Mihaela S

    2016-03-01

    Previously undiagnosed anemia is often identified during routine assessment of surgical patients. Although studies suggest that perioperative anemia is associated with worse outcomes and a strong predictor for postoperative red cell transfusions, anemia is frequently ignored. Preoperative optimization of patients undergoing elective surgical procedures associated with significant blood loss, along with strategies to minimize intraoperative blood loss, shows promise for reducing postoperative transfusions and improving outcomes. In most situations, anemia can be corrected prior to elective surgeries and interventions. Future research should assess the timing and methods of optimization of preoperative anemia in surgery and which patients are best candidates for therapy. PMID:26927743

  8. [Preoperative fasting guidelines: an update].

    PubMed

    López Muñoz, A C; Busto Aguirreurreta, N; Tomás Braulio, J

    2015-03-01

    Anesthesiology societies have issued various guidelines on preoperative fasting since 1990, not only to decrease the incidence of lung aspiration and anesthetic morbidity, but also to increase patient comfort prior to anesthesia. Some of these societies have been updating their guidelines, as such that, since 2010, we now have 2 evidence-based preoperative fasting guidelines available. In this article, an attempt is made to review these updated guidelines, as well as the current instructions for more controversial patients such as infants, the obese, and a particular type of ophthalmic surgery. PMID:25443866

  9. OPTN/SRTR 2013 Annual Data Report: pancreas.

    PubMed

    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

    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

  10. Perioperative Computed Tomography Assessments of the Pancreas Predict Nonalcoholic Fatty Liver Disease After Pancreaticoduodenectomy

    PubMed Central

    Ohgi, Katsuhisa; Okamura, Yukiyasu; Yamamoto, Yusuke; Ashida, Ryo; Ito, Takaaki; Sugiura, Teiichi; Aramaki, Takeshi; Uesaka, Katsuhiko

    2016-01-01

    Abstract Nonalcoholic fatty liver disease (NAFLD) after pancreaticoduodenectomy (PD) has become a clinically important issue. Although pancreatic exocrine insufficiency has been reported to be a main cause of NAFLD after PD, a clinically practical examination to assess the pancreatic exocrine function has not been established. The aim of this study was to evaluate risk factors for NAFLD after PD with a focus on perioperative computed tomography (CT) assessments of the pancreas. A retrospective review of 245 patients followed for more than 6 months after PD was conducted. We evaluated several pancreatic CT parameters, including the pancreatic parenchymal thickness, pancreatic duct-to-parenchymal ratio, pancreatic attenuation, and remnant pancreatic volume (RPV) on pre- and/or postoperative CT around 6 months after surgery. The variables, including the pancreatic CT parameters, were compared between the groups with and without NAFLD after PD. The incidence of NAFLD after PD was 19.2%. A multivariate analysis identified 5 independent risk factors for NAFLD after PD: a female gender (odds ratio [OR] 5.66, P < 0.001), RPV < 12 mL (OR 4.73, P = 0.001), preoperative pancreatic attenuation of <30 Hounsfield units (OR 4.50, P = 0.002), dissection of the right-sided nerve plexus around the superior mesenteric artery (OR 3.02, P = 0.017) and a preoperative serum carbohydrate antigen 19–9 level of ≥70 U/mL (OR 2.58, P = 0.029). Our results showed that 2 pancreatic CT parameters, the degree of preoperative pancreatic attenuation and RPV, significantly influence the development of NAFLD after PD. Perioperative CT assessments of the pancreas may be helpful for predicting NAFLD after PD. PMID:26871772

  11. Current practices of donor pancreas allocation in the UK: future implications for pancreas and islet transplantation.

    PubMed

    Ridgway, Dan M; White, Steven A; Kimber, Rachel M; Nicholson, Michael L

    2005-07-01

    Recent refinements in technique mean islet cell transplantation offers the chance of a cure to an increasing patient cohort with diabetes. Such developments put pressure upon the scarce resource of donor organs, with potential competition between the modalities of cellular and solid organ transplantation. This questionnaire based study examines current patterns of donor pancreas procurement and use. Reasons for non procurement are studied together with the attitudes of transplant professionals to pancreas allocation. The minority of potentially useful pancreata are currently made available to either whole pancreas or islet transplant programs. Whilst professionals appreciate the role of each modality, there is a need to define criteria for pancreas allocation to avoid under use of donor organs. PMID:15948863

  12. 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...

  13. Pathophysiology of Hyperinsulinemia Following Pancreas Transplantation

    PubMed Central

    Earnhardt, Richard C.; Veldhuis, Johannes D.; Cornett, Greg; Hanks, John B.

    2002-01-01

    Objective To evaluate the effect of the anatomical alterations of the pancreas required for transplantation on pulsatile insulin secretion. Summary Background Data Pancreas transplantation involves anatomical changes that have unknown consequences on glucose homeostasis. Pancreas transplant patients are free of exogenous insulin requirements, yet appear to have endogenous hyperinsulinemia. The effect of surgical alterations on posttransplant insulin release is not completely known, specifically with regards to possible alterations in patterns of pulsatile release. Methods Pulsatile and invariant basal insulin secretion was studied in normal dogs (n = 4) and three canine models of the anatomical alterations of pancreas transplantation: 70% partial pancreatectomy (PPX, n = 4), partial pancreatectomy with splenocaval venous diversion (SC, n = 4), and partial pancreatectomy with remnant autotransplantation (PAT, n = 4). Plasma insulin kinetics were determined for each dog, and then blood sampled at 1-minute intervals in a fasted and IV glucose-stimulated state twice to delineate the time structure of insulin secretion by multiple parameter deconvolution analysis utilizing dog-specific insulin half-lives. Results Fasting plasma glucose concentrations in each group were similar, but all surgical groups were hyperglycemic with IV glucose challenge. Secretory pulse amplitude was decreased with decreased ? cell mass (PPX), partially normalized with systemic insulin release (SC), and further normalized with denervation (PAT). Interpulse interval and pulse duration were increased in all surgical groups when stimulated. Denervation of PAT resulted in a threefold increase in fasting basal invariant insulin secretion. Stimulated basal insulin secretion is inconsequential. Conclusions Hyperinsulinemia and apparent insulin insensitivity after pancreas transplantation may be due to increased less potent basal secretion in the fasting state and less frequent, less discrete pulsatile insulin secretion in the simulated state. PMID:12368677

  14. 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)

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

    2013-02-01

    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.

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

    PubMed

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

    2015-01-01

    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

  16. National trends in resection of cystic lesions of the pancreas

    PubMed Central

    Reames, Bradley N.; Scally, Christopher P.; Frankel, Timothy L.; Dimick, Justin B.; Nathan, Hari

    2016-01-01

    Background Management of cystic lesions of the pancreas (CLP) is controversial. In this study, we sought to evaluate national changes in the resection of CLP over time, to better understand the impact of evolving guidelines on CLP management. Methods We used Medicare data to examine CLP resection among patients undergoing pancreatic resection between 2001 and 2012. Patients with a diagnosis of CLP were identified and compared to patients with non-CLP indications. We then examined changes over time in patient and hospital characteristics and outcomes among patients with a CLP diagnosis. Results We identified 56,419 Medicare patients undergoing pancreatic resection, of which 2129 had a CLP diagnosis. The annual number of CLP resections, and proportion of all resections performed for CLP increased significantly during the period, from 2.1% (65/3072) resections in 2001, to 4.5% (286/6348) in 2012 (p < 0.001). The proportion of CLP resections with a malignant diagnosis did not change (15.5% in 2001–2003 vs. 13.1% in 2010–2012, p = 0.4). Overall rates of 30-day mortality decreased significantly during the period (9.6% in 2001–2003 vs. 5.5% in 2010–2012, p < 0.001). Discussion CLP resections were performed with increasing frequency in Medicare patients between 2001 and 2012, but this did not correspond to increased diagnosis of malignancy. Additional research is needed to understand the influence of recent guidelines on management of CLP. PMID:27037208

  17. Sub-branch and mixed-type intraductal papillary mucinous neoplasms of the pancreas: 2 case reports

    PubMed Central

    Ozmen, Zafer; Aktas, Fatma; Okan, İsmail; Özsoy, Zeki; Arıcı, Akgül

    2016-01-01

    Intraductal papillary mucinous neoplasia (IPMN) is one of the cystic neoplasias of the pancreas. The imaging findings provide that these tumors are differentiated from the other cystic lesions of the pancreas, especially from the chronic pancreatitis, where the treatment protocol is completely different. Therefore, the correct diagnosis and classification of the IPMN ensures that the patient receives the correct approach and the appropriate surgery, if necessary. The purpose of this study is to emphasize the imaging findings of the different types of the IPMN and the changes in the management protocol of the patients according to these radiological findings. PMID:26973726

  18. Rare Nonneoplastic Cysts of Pancreas

    PubMed Central

    Cho, Jae Hee

    2015-01-01

    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

  19. FFTF preoperational survey. Program report

    SciTech Connect

    Twitty, B.L.; Bicehouse, H.J.

    1980-12-01

    The FFTF will become operational with criticality early in 1980. This facility is composed of the test reactor, fuel examination cells, expended fuel storage systems and fuel handling systems. The reactor and storage systems are sodium-cooled with the heat load dumped to the ambient air through heat exchangers. In order to assure that the operation of the FFTF has minimal impact on the environment, a monitoring program has been established. Prior to operation of a new facility, a preoperational environmental survey is required. It is the purpose of this report to briefly describe the environmental survey program and to provide the background data obtained during the preoperational phase of the survey program. Nine stations in the program of particular importance to FFTF are discussed in detail with results of monitoring given. No unexplained trends were noted.

  20. The value of preoperative planning.

    PubMed

    Graves, Matt L

    2013-10-01

    "Better to throw your disasters into the waste paper basket than to consign your patients to the scrap heap" has been a proverb of Jeff Mast, one of the greatest fracture and deformity surgeons in the history of our specialty. Stated slightly more scientifically, one of the major values of simulation is that it allows one to make mistakes in a consequence-free environment. Preoperative planning is the focus of this article. The primary goal is not to provide you with a recipe of how to steps. Rather, the primary goal of this article is to explain why preoperative planning should be standard, to clarify what should be included, and to provide examples of what can happen when planning is ignored. At the end of this, we should all feel the need to approach fracture care more intellectually with forethought, both in our own practices and in our educational system. PMID:23880563

  1. Laparoscopic pylorus preserving pancreaticoduodenectomy in paediatric age for solid pseudopapillary neoplasm of head of the pancreas - case report.

    PubMed

    Senthilnathan, P; Patel, Nikunj; Nalankilli, V P; Palanivelu, C; Parthasarthi, R; Praveenraj, P

    2014-01-01

    Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare tumour commonly seen in young women without significant clinical features. SPN is usually a lowgrade malignant neoplasm which warrants resection. Recurrence and metastasis is seen rarely after complete resection. Pancreaticoduodenectomy is indicated for SPN situated in head of the pancreas which is generally performed by open approach. Laparoscopic pancreaticoduodenectomy (LPD) is difficult to perform for this condition because of smaller size of pancreatic and hepatic ducts more so in paediatric population. We report a case of 12 years old girl having SPN arising from head of the pancreas. She underwent laparoscopic pylorus preserving pancreaticoduodenectomy. Post-operative period was uneventful. Histological examination of resected specimen confirmed diagnosis of SPN. At 6 months follow up, she was doing well without any recurrence. To best of our knowledge, no case of LPD in paediatric patients is reported in literature available to us. PMID:25459567

  2. Pancreas segmentation from 3D abdominal CT images using patient-specific weighted subspatial probabilistic atlases

    NASA Astrophysics Data System (ADS)

    Karasawa, Kenichi; Oda, Masahiro; Hayashi, Yuichiro; Nimura, Yukitaka; Kitasaka, Takayuki; Misawa, Kazunari; Fujiwara, Michitaka; Rueckert, Daniel; Mori, Kensaku

    2015-03-01

    Abdominal organ segmentations from CT volumes are now widely used in the computer-aided diagnosis and surgery assistance systems. Among abdominal organs, the pancreas is especially difficult to segment because of its large individual differences of the shape and position. In this paper, we propose a new pancreas segmentation method from 3D abdominal CT volumes using patient-specific weighted-subspatial probabilistic atlases. First of all, we perform normalization of organ shapes in training volumes and an input volume. We extract the Volume Of Interest (VOI) of the pancreas from the training volumes and an input volume. We divide each training VOI and input VOI into some cubic regions. We use a nonrigid registration method to register these cubic regions of the training VOI to corresponding regions of the input VOI. Based on the registration results, we calculate similarities between each cubic region of the training VOI and corresponding region of the input VOI. We select cubic regions of training volumes having the top N similarities in each cubic region. We subspatially construct probabilistic atlases weighted by the similarities in each cubic region. After integrating these probabilistic atlases in cubic regions into one, we perform a rough-to-precise segmentation of the pancreas using the atlas. The results of the experiments showed that utilization of the training volumes having the top N similarities in each cubic region led good results of the pancreas segmentation. The Jaccard Index and the average surface distance of the result were 58.9% and 2.04mm on average, respectively.

  3. Preoperative depression symptom severity and its impact on adherence to preoperative beta-blocker therapy

    PubMed Central

    Schonberger, Robert B.; Feinleib, Jessica; Holt, Natalie; Dai, Feng; Brandt, Cynthia; Burg, Matthew M.

    2014-01-01

    Objective 1) To test the association among depression symptoms, distressed personality-type, and preoperative beta-blocker non-adherence. 2) To estimate the prevalence of untreated major depression in this population. Design Prospective Observational Study Setting A Veterans hospital Patients 120 subjects on outpatient beta-blocker therapy presenting for surgery. Interventions The Patient Health Questionnaire (PHQ)-9, the D-Scale-14 (DS14), and Modified Morisky Scale (MMS) questionnaires. Measurements and Main Results Of 99 participants who presented for surgery, the incidence of preoperative non-adherence was 14.1% (95% CI 7–21%), consistent with prior research. Non-adherence was 9.5% among those with no depression, 27.8% among those with mild depression, and 28.6% among those with moderate to severe depression (Cochrane-Armitage test for trend p=0.03). Distressed personality-type was found in 35% of the cohort (95% CI 26–45%) and was not associated with beta-blocker non-adherence (Fisher’s exact p=0.24). Among participants with symptoms of Major Depressive Disorder (N=25, 25.3%), over half (N=14, 56%) had no indication of depression listed at their most recent primary care visit. Conclusions Patients with symptoms of depression on chronic beta-blocker therapy are prone to medication non-adherence on the day of surgery. The majority of surgical patients with symptoms of major depression lack a diagnosis of depression. Preoperative depression screening may thus 1) identify a population at increased risk of beta-blocker withdrawal and 2) identify patients who may benefit from anesthesiologist-initiated referral for this treatable condition. PMID:25263776

  4. Pancreas Transplantation: Solid Organ and Islet

    PubMed Central

    Mittal, Shruti; Johnson, Paul; Friend, Peter

    2014-01-01

    Transplantation of the pancreas, either as a solid organ or as isolated islets of Langerhans, is indicated in a small proportion of patients with insulin-dependent diabetes in whom severe complications develop, particularly severe glycemic instability and progressive secondary complications (usually renal failure). The potential to reverse diabetes has to be balanced against the morbidity of long-term immunosuppression. For a patient with renal failure, the treatment of choice is often a simultaneous transplant of the pancreas and kidney (SPK), whereas for a patient with glycemic instability, specifically hypoglycemic unawareness, the choice between a solid organ and an islet transplant has to be individual to the patient. Results of SPK transplantation are comparable to other solid-organ transplants (kidney, liver, heart) and there is evidence of improved quality of life and life expectancy, but the results of solitary pancreas transplantation and islets are inferior with respect to graft survival. There is some evidence of benefit with respect to the progression of secondary diabetic complications in patients with functioning transplants for several years. PMID:24616200

  5. Imaging of pancreas divisum by linear-array endoscopic ultrasonography.

    PubMed

    Sharma, Malay; Pathak, Amit; Rameshbabu, Chittapuram Srinivasan; Rai, Praveer; Kirnake, Vijendra; Shoukat, Abid

    2016-01-01

    Pancreas divisum (PD) is the most common developmental anatomic variant of pancreatic duct. Endoscopic ultrasound (EUS) is often performed to evaluate idiopathic pancreatitis and has been shown to have high accuracy in diagnosis of PD. The different techniques to identify PD by linear EUS have been described differently by different authors. If EUS is done with a proper technique it can be a valuable tool in the diagnosis of PD. The anatomical and technical background of different signs has not been described so far. This article summarizes the different techniques of imaging of pancreatic duct in a suspected case of PD and gives a technical explanation of various signs. The common signs seen during evaluation of pancreatic duct in PD are stack sign of linear EUS, crossed duct sign on linear EUS, the dominant duct and ventral dorsal duct (VD) transition. Few other signs are described which include duct above duct, short ventral duct /absent ventral duct, separate opening of ducts with no communication, separate opening of ducts with filamentous communication, stacking of duct of Santorini and indirect signs like santorinecele. The principles of the sign have been explained on an anatomical basis and the techniques and the principles described in the review will be helpful in technical evaluation of PD during EUS. PMID:26879163

  6. Imaging of pancreas divisum by linear-array endoscopic ultrasonography

    PubMed Central

    Sharma, Malay; Pathak, Amit; Rameshbabu, Chittapuram Srinivasan; Rai, Praveer; Kirnake, Vijendra; Shoukat, Abid

    2016-01-01

    Pancreas divisum (PD) is the most common developmental anatomic variant of pancreatic duct. Endoscopic ultrasound (EUS) is often performed to evaluate idiopathic pancreatitis and has been shown to have high accuracy in diagnosis of PD. The different techniques to identify PD by linear EUS have been described differently by different authors. If EUS is done with a proper technique it can be a valuable tool in the diagnosis of PD. The anatomical and technical background of different signs has not been described so far. This article summarizes the different techniques of imaging of pancreatic duct in a suspected case of PD and gives a technical explanation of various signs. The common signs seen during evaluation of pancreatic duct in PD are stack sign of linear EUS, crossed duct sign on linear EUS, the dominant duct and ventral dorsal duct (VD) transition. Few other signs are described which include duct above duct, short ventral duct /absent ventral duct, separate opening of ducts with no communication, separate opening of ducts with filamentous communication, stacking of duct of Santorini and indirect signs like santorinecele. The principles of the sign have been explained on an anatomical basis and the techniques and the principles described in the review will be helpful in technical evaluation of PD during EUS. PMID:26879163

  7. Intraductal Papillary Mucinous Neoplasm of the Pancreas: An Update

    PubMed Central

    Xiao, Shu-Yuan

    2012-01-01

    Intraductal papillary mucinous neoplasm (IPMN) is a cystic tumor of the pancreas. The etiology is unknown, but increasing evidence suggests the involvement of several tumorigenesis pathways, including an association with hereditary syndromes. IPMN occurs more commonly in men, with the mean age at diagnosis between 64 and 67 years old. At the time of diagnosis, it may be benign, with or without dysplasia, or frankly malignant with an invasive carcinoma. Tumors arising from the main pancreatic duct are termed main-duct IPMNs, those involving the branch ducts, branch-duct IPMNs. In general, small branch-duct IPMNs are benign, particularly in asymptomatic patients, and can be safely followed. In contrast, main-duct tumors should be surgically resected and examined carefully for an invasive component. In the absence of invasion, patient's survival is excellent, from 94 to 100%. For patients with an IPMN-associated invasive carcinoma, the prognosis overall is better than those with a de novo pancreatic ductal adenocarcinoma, with a 5-year survival of 40% to 60% in some series. However, no survival advantage can be demonstrated if the invasive component in an IPMN patient is that of the conventional tubular type (versus mucinous carcinoma). Several histomorphologic variants are recognized, although the clinical significance of this “subtyping” is not well defined. PMID:24278753

  8. Preoperative cardiovascular investigations in liver transplant candidate: An update

    PubMed Central

    Sehgal, Lalit; Srivastava, Piyush; Pandey, Chandra Kant; Jha, Amit

    2016-01-01

    Cardiovascular complications are a major cause of morbidity and mortality in patients with end-stage liver disease (ESLD) undergoing liver transplantation. Identifying candidates at the highest risk of postoperative cardiovascular complications is the cornerstone for optimizing the outcome. Ischaemic heart disease contributes to major portion of cardiovascular complications and therefore warrants evaluation in the preoperative period. Patients of ESLD usually demonstrate increased cardiac output, compromised ventricular response to stress, low systemic vascular resistance and occasionally bradycardia. Despite various recommendations for preoperative evaluation of cardiovascular disease in liver transplant candidates, a considerable controversy on screening methodology persists. This review critically focuses on the rapidly expanding body of evidence for diagnosis and risk stratification of cardiovascular disorder in liver transplant candidates. PMID:26962249

  9. Preoperative Computed Tomography to Predict and Stratify the Risk of Severe Pancreatic Fistula After Pancreatoduodenectomy

    PubMed Central

    Sandini, Marta; Bernasconi, Davide Paolo; Ippolito, Davide; Nespoli, Luca; Baini, Melissa; Barbaro, Salvatore; Fior, Davide; Gianotti, Luca

    2015-01-01

    Abstract The aim of this article is to assess whether measures of abdominal fat distribution, visceral density, and antropometric parameters obtained from computed tomography (CT) may predict postoperative pancreatic fistula (POPF) occurrence. We analyzed 117 patients who underwent pancreatoduodenectomy (PD) and had a preoperative CT scan as staging in our center. CT images were processed to obtain measures of total fat volume (TFV), visceral fat volume (VFV), density of spleen, and pancreas, and diameter of pancreatic duct. The predictive ability of each parameter was investigated by receiver-operating characteristic (ROC) curves methodology and assessing optimal cutoff thresholds. A stepwise selection method was used to determine the best predictive model. Clinically relevant (grades B and C) POPF occurred in 24 patients (20.5%). Areas under ROC-curves showed that none of the parameters was per se significantly predictive. The multivariate analysis revealed that a VFV >2334 cm3, TFV >4408 cm3, pancreas/spleen density ratio <0.707, and pancreatic duct diameter <5 mm were predictive of POPF. The risk of POPF progressively increased with the number of factors involved and age. It is possible to deduce objective information on the risk of POPF from a simple and routine preoperative radiologic workup. PMID:26252274

  10. Assessment of Islet Function Following Islet and Pancreas Transplantation

    PubMed Central

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

    2014-01-01

    Pancreas and islet transplant recipients are monitored using various metabolic and imaging methods. The inaccessibility of the transplanted whole pancreas and of the isolated islets poses specific problems (eg, all assessment techniques are indirect). Although successful pancreas transplantation typically restores normal glucose homeostasis, islet transplantation into the liver does not completely normalize islet hormone secretion and glucose metabolism. Development of better testing strategies, such as direct islet imaging, will significantly advance the field. PMID:16879785

  11. The molecular mechanisms, diagnosis and management of congenital hyperinsulinism

    PubMed Central

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

    2013-01-01

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

  12. Portal annular pancreas: the pancreatic duct ring sign on MRCP

    PubMed Central

    Lath, Chinar O.; Agrawal, Dilpesh S.; Timins, Michael E.; Wein, Melissa M.

    2015-01-01

    Portal annular pancreas is a rare pancreatic variant in which the uncinate process of the pancreas extends and fuses to the dorsal surface of the body of the pancreas by surrounding the portal vein. It is asymptomatic, but it can be mistaken for a pancreatic head mass on imaging and could also have serious consequences during pancreatic surgery, if unrecognized. We report this case of a 53-year-old female patient who was diagnosed to have portal annular pancreas on the basis of an unusual course (ring appearance) of the main pancreatic duct on magnetic resonance cholangiopancreatography, not described earlier in the radiology literature. PMID:26649117

  13. Preoperative Assessment of Geriatric Patients.

    PubMed

    Knittel, Justin G; Wildes, Troy S

    2016-03-01

    Geriatric patients are over-represented in hospitalizations, surgeries, and perioperative complications. Special consideration is required for this patient group in the perioperative period because of the prevalence of comorbid diseases, functional impairments, and other deficits. A comprehensive preoperative evaluation strategy is recommended to identify and address these issues. Systematic, multidomain assessments should be performed and paired with risk reduction efforts. A shared understanding of patient function and long-term health goals is also important for providing patient-centered care of the geriatric surgical patient. PMID:26927746

  14. Islet Cell Tumors of the Pancreas.

    PubMed

    Amin, Sunil; Kim, Michelle Kang

    2016-03-01

    Islet cell tumors of the pancreas, also known as pancreatic neuroendocrine tumors, constitute less than 5% of pancreatic tumors, and 7% of all neuroendocrine tumors. Most are non-functional, and patients often present with metastatic disease. Functional tumors present with distinct clinical syndromes. Accurate staging is critical as surgery is both the cornerstone of treatment, and the only hope for cure. Medical management involves treating the manifestations of hormonal excess, and using somatastatin analogues when appropriate. Systemic chemotherapy, targeted molecular therapy, and peptide receptor radiotherapy may be used for refractory disease in lieu of or as an adjunct to surgery. PMID:26895682

  15. The Cystic Fibrosis of Exocrine Pancreas

    PubMed Central

    Wilschanski, Michael

    2013-01-01

    The cystic fibrosis transmembrane conductance regulator (CFTR) protein is highly expressed in the pancreatic duct epithelia, and permits anions and water to enter the ductal lumen. This results in an increased volume of alkaline fluid allowing the highly concentrated proteins secreted by the acinar cells to remain in a soluble state. This work will expound on the pathophysiology and pathology caused by the malfunctioning CFTR protein with special reference to ion transport and acid-base abnormalities both in humans and animal models. We will also discuss the relationship between cystic fibrosis (CF) and pancreatitis, and outline present and potential therapeutic approaches in CF treatment relevant to the pancreas. PMID:23637307

  16. Banff schema for grading pancreas allograft rejection: working proposal by a multi-disciplinary international consensus panel.

    PubMed

    Drachenberg, C B; Odorico, J; Demetris, A J; Arend, L; Bajema, I M; Bruijn, J A; Cantarovich, D; Cathro, H P; Chapman, J; Dimosthenous, K; Fyfe-Kirschner, B; Gaber, L; Gaber, O; Goldberg, J; Honsová, E; Iskandar, S S; Klassen, D K; Nankivell, B; Papadimitriou, J C; Racusen, L C; Randhawa, P; Reinholt, F P; Renaudin, K; Revelo, P P; Ruiz, P; Torrealba, J R; Vazquez-Martul, E; Voska, L; Stratta, R; Bartlett, S T; Sutherland, D E R

    2008-06-01

    Accurate diagnosis and grading of rejection and other pathological processes are of paramount importance to guide therapeutic interventions in patients with pancreas allograft dysfunction. A multi-disciplinary panel of pathologists, surgeons and nephrologists was convened for the purpose of developing a consensus document delineating the histopathological features for diagnosis and grading of rejection in pancreas transplant biopsies. Based on the available published data and the collective experience, criteria for the diagnosis of acute cell-mediated allograft rejection (ACMR) were established. Three severity grades (I/mild, II/moderate and III/severe) were defined based on lesions known to be more or less responsive to treatment and associated with better- or worse-graft outcomes, respectively. The features of chronic rejection/graft sclerosis were reassessed, and three histological stages were established. Tentative criteria for the diagnosis of antibody-mediated rejection were also characterized, in anticipation of future studies that ought to provide more information on this process. Criteria for needle core biopsy adequacy and guidelines for pathology reporting were also defined. The availability of a simple, reproducible, clinically relevant and internationally accepted schema for grading rejection should improve the level of diagnostic accuracy and facilitate communication between all parties involved in the care of pancreas transplant recipients. PMID:18444939

  17. A large mural nodule in branch duct intraductal papillary mucinous adenoma of the pancreas: a case report.

    PubMed

    Haruki, Koichiro; Wakiyama, Shigeki; Futagawa, Yasuro; Shiba, Hiroaki; Misawa, Takeyuki; Yanaga, Katsuhiko

    2015-12-01

    Indications for resection of branch duct intraductal papillary mucinous neoplasms (IPMNs) remain controversial because of their low tendency to be malignant. Surgical resection should be recommended if any factors indicating malignancy are present. However, preoperative differentiation between benign and malignant tumors is very difficult, especially in cases of branch duct IPMNs. We herein report a case of branch duct intraductal papillary mucinous adenoma (IPMA) of the pancreas with a large mural nodule of 25 mm. A 74-year-old woman was admitted for examination and treatment for a cystic tumor in the head of the pancreas. Magnetic resonance cholangiopancreatography and computed tomography showed a cystic lesion, 50 mm in diameter, with an irregular mural nodule in the pancreatic head. Endoscopic ultrasonography demonstrated a multicystic tumor connected with the main pancreatic duct (MPD). The mural nodule had a diameter of 18 mm, and the MPD had a slight dilation of 6 mm. These findings suggested a high potential for malignancy. The patient underwent pancreaticoduodenectomy with lymph node dissection. The excised pancreas showed multiple cysts located in the branch pancreatic duct with a maximum diameter of 75 mm. The mural nodule had a maximum diameter of 25 mm. The tumor was diagnosed as an IPMA by pathological examination. After operation, the patient was discharged without any complications. Two years after resection, the patient remains in remission with no evidence of tumor recurrence. PMID:26943388

  18. Preoperative anemia and postoperative outcomes after hepatectomy

    PubMed Central

    Tohme, Samer; Varley, Patrick R.; Landsittel, Douglas P.; Chidi, Alexis P.; Tsung, Allan

    2015-01-01

    Background Preoperative anaemia is associated with adverse outcomes after surgery but outcomes after liver surgery specifically are not well established. We aimed to analyze the incidence of and effects of preoperative anemia on morbidity and mortality in patients undergoing liver resection. Methods All elective hepatectomies performed for the period 2005–2012 recorded in the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database were evaluated. We obtained anonymized data for 30-day mortality and major morbidity (one or more major complication), demographics, and preoperative and perioperative risk factors. We used multivariable logistic regression models to assess the adjusted effect of anemia, which was defined as (hematocrit <39% in men, <36% in women), on postoperative outcomes. Results We obtained data for 12,987 patients, of whom 4260 (32.8%) had preoperative anemia. Patients with preoperative anemia experienced higher postoperative major morbidity and mortality rates compared to those without anemia. After adjustment for predefined variables, preoperative anemia was an independent risk factor for postoperative major morbidity (adjusted OR 1.21, 1.09–1.33). After adjustment, there was no significant difference in postoperative mortality for patients with or without preoperative anemia (adjusted OR 0.88, 0.66–1.16). Conclusion Preoperative anemia is independently associated with an increased risk of major morbidity in patients undergoing hepatectomy. Therefore, it is crucial to readdress preoperative blood management in anemic patients prior to hepatectomy. PMID:27017165

  19. MicroRNAs in pancreas development.

    PubMed

    Dumortier, O; Van Obberghen, E

    2012-10-01

    The development of the pancreas is a tightly regulated process involving extensive morphogenesis, proliferation and differentiation of the epithelium. The finely orchestrated control of gene expression plays a key role in this equilibrium by coordinating the expression of selected gene products at specific moments and in precise locations. MicroRNAs (miRNAs) are small non-coding RNAs that function in general as negative regulators of gene transcripts by interacting with the three prime untranslated regions (3'UTR) of target mRNAs. MiRNAs modulate the expression of numerous target genes that are involved in a variety of cellular systems. Hence the homeostatic control of miRNA biosynthesis and activity is important for the fine-tuning of many physiological processes such as cell differentiation, cell proliferation and organ development. In the present review, we will focus on the implication of these miRNAs on the development of the pancreas and more specifically on β-cells. PMID:22928561

  20. Malignant Solitary Fibrous Tumor of the Pancreas.

    PubMed

    Estrella, Jeannelyn S; Wang, Huamin; Bhosale, Priya R; Evans, Harry L; Abraham, Susan C

    2015-08-01

    Solitary fibrous tumor (SFT) arising in the pancreas is exceedingly rare, with only 11 cases reported in the English literature. All cases described thus far have exhibited benign histology. We report the first case of malignant SFT of the pancreas. The patient was a 52-year-old woman who presented with obstructive jaundice and a 15-cm pancreatic head mass. The mass showed areas with typical histologic features for SFT including small fibroblastlike cells arranged in the well-characterized "patternless pattern" of architecture, hemangiopericytomalike vessels, areas with dense collagen and infrequent mitoses (0-2 per 10 high-power fields [HPFs]). In addition, multiple areas with an overtly sarcomatous morphology were present, containing large spindle and epithelioid cells with nuclear pleomorphism, marked cellularity, up to17 mitoses per 10 HPFs, and necrosis. Immunohistochemical stains were positive for CD34 and B-cell CLL/lymphoma 2 (Bcl-2) in both benign and malignant components and showed strong, diffuse p53 and p16 staining in the malignant component. At last follow-up (40 months), the patient was alive and well without evidence of disease. However, given that the presence of a malignant component in extrapancreatic SFT has been associated with recurrence/metastasis and death, complete surgical resection and close long-term follow-up is required. PMID:26166470

  1. Artificial Pancreas Project at Cambridge 2013.

    PubMed

    Hovorka, R

    2015-08-01

    The development and clinical testing of closed-loop systems (the artificial pancreas) is underpinned by advances in continuous glucose monitoring and benefits from concerted academic and industry collaborative efforts. This review describes the progress of the Artificial Pancreas Project at the University of Cambridge from 2006 to 2014. Initial studies under controlled laboratory conditions, designed to collect representative safety and performance data, were followed by short to medium free-living unsupervised outpatient studies demonstrating the safety and efficacy of closed-loop insulin delivery using a model predictive control algorithm. Accompanying investigations included assessment of the psychosocial impact and key factors affecting glucose control such as insulin kinetics and glucose absorption. Translation to other disease conditions such as critical illness and Type 2 diabetes took place. It is concluded that innovation of iteratively enhanced closed-loop systems will provide tangible means to improve outcomes and quality of life in people with Type 1 diabetes and their families in the next decade. PMID:25819473

  2. Synaptophysin immunoreactivity in the mammalian endocrine pancreas.

    PubMed

    Redecker, P; Jörns, A; Jahn, R; Grube, D

    1991-06-01

    Synaptophysin, a major membrane glycoprotein of small presynaptic vesicles in neurons, has also been found in microvesicles of endocrine cells, e.g., of the endocrine pancreas. In the present study, the endocrine pancreas in 9 mammalian species (man, dog, mink, bovine, rabbit, guinea pig, rat, mouse, gerbil) has been investigated immunohistochemically for synaptophysin immunoreactivity. Synaptophysin-positive cells have been identified and localized on semithin plastic sections. Our study demonstrates that, in all species examined, all pancreatic endocrine cell types are consistently synaptophysin-positive independent of their location within the tissue, or the conditions of tissue processing. In addition, a few cells that cannot be hormonally identified show synaptophysin immunoreactivity. Hence, synaptophysin appears to be a regular constituent of all pancreatic endocrine cells in mammals. In several species, a subpopulation of endocrine cells, consisting of glucagon-containing and/or pancreatic-polypeptide-containing cells, exhibits a significantly higher degree of synaptophysin immunoreactivity. In the gerbil, this heterogeneity can readily be detected from the day of birth onwards. Our findings indicate that closely related endocrine cell types may differ with respect to the content of synaptophysin. PMID:1907886

  3. Jejunal small ectopic pancreas developing into jejunojejunal intussusception: A rare cause of ileus

    PubMed Central

    Hirasaki, Shoji; Kubo, Motoharu; Inoue, Atsushi; Miyake, Yasuyuki; Oshiro, Hisako

    2009-01-01

    Intussusception is rare in adults. We describe a 62-year-old man with jejunal ectopic pancreas that led to jejunojejunal intussusception and ileus. The patient was admitted to our hospital because of intermittent abdominal pain. Plain abdominal radiography showed some intestinal gas and fluid levels. Abdominal CT scan demonstrated a target sign suggesting bowel intussusception. Jejunography using a naso-jejunal tube showed an oval-shaped mass about 15 mm in diameter with a smooth surface in the jejunum, which suggested a submucosal tumor (SMT), and edematous mucosa around the mass. Partial jejunal resection was carried out and the resected oval-shaped tumor, 14 mm × 11 mm in size, was found to be covered with normal jejunal mucosa. The tumor was histologically diagnosed as type III ectopic pancreas according to the classification proposed by Heinrich. Abdominal pain resolved postoperatively. This case reminds us that jejunal ectopic pancreas should be included in the differential diagnosis of intussusception caused by an SMT in the intestine. PMID:19701981

  4. [A solid variant of a serous cystadenocarcinoma of the pancreas].

    PubMed

    Brandone, Nicolas; Poizat, Flora; Thomassin-Piana, Jeanne; Turrini, Olivier; Popovici, Cornel; Terris, Benoît

    2016-04-01

    Cystic pancreatic neoplasms concern 1 to 2 % of the pancreatic tumours. The serous ones are considered benign tumours but since 1989, several pancreatic serous cystadenocarcinomas (SCAC) cases have been reported. We report the case of a SCAC with a particular pattern. An 80-year-old female patient presented a 4-cm tumour in the neck of the pancreas associated with liver lesions evoking, on imagery exams, focal nodular hyperplasia nests. A cephalic duodenopancreatectomy and a resection of the liver lesions were carried out. The gross exam showed a tumour with a pattern mostly solid and an area made of cysts. The microscopic exam displayed two patterns: the solid one, predominant, made of mild atypical clear cells, and the cystic one. The liver lesions revealed solid pattern similar to the pancreatic tumour one. The tumoral cells were cytokeratin 7, AE1/AE3 and inhibin positives. The Periodic-acid Schiff showed cytoplasmic granulations, which were digested after diasatasis. Only the presence of metastases allows distinguishing a pancreatic serous cystadenoma from a SCAC. To date, thirty cases of pancreatic SCAC have been reported. Immunohistochemistry cannot confirm the malignancy nature of the lesion but it needs to be done in order to cross out the differential diagnosis, that is pancreatic metastatic clear cell renal carcinoma. Nevertheless, it remains a pathology with good prognosis. Only two cases have been reported but ours case a predominant solid pattern. PMID:26995101

  5. Two synchronous solid and cystic tumors of the pancreas.

    PubMed

    Kobayashi, T; Kimura, T; Takabayashi, N; Sugimura, H

    1998-06-01

    We report a 17-year-old woman who had two synchronous solid and cystic tumors of the pancreas (SCTP) detected by abdominal echography and computed tomography. There was a 6 x 5 cm mass in the pancreatic body and a 3 x 3 cm mass in the tail, with the two lesions being separate. No distal metastases were detected. The resected tumors consisted of solid and cystic components and both were well demarcated with fibrous capsules. The larger tumor was predominantly solid and the smaller one was mostly hemorrhagic. On microscopy, the tumor cells were small, eosinophilic, and arranged, in part, like pseudorosettes. The tumor cells were immunohistochemically positive for alpha-1 antitrypsin, neuron-specific enolase, and synaptophysin. The final diagnosis was SCTP arising synchronously and independently at two sites. As far as we know, only one case of multicentric SCTP has been reported previously. Local recurrence of SCTP suggests the possibility of multicentric occurrence, and we believe that reports of such cases may increase in the future with advances in echography and computed tomography. PMID:9658328

  6. The biosynthesis of phosphatidic acid and phosphatidylinositol in mammalian pancreas

    PubMed Central

    Prottey, C.; Hawthorne, J. N.

    1967-01-01

    1. The labelling of guinea-pig pancreas phospholipids in vivo after intraperitoneal injection of [32P]orthophosphate is described. 2. Acyl-CoA synthetase activity in pancreas homogenates has been studied. There is no absolute requirement for added fatty acids, indicating an adequate supply of endogenous fatty acids in these preparations. 3. Phosphatidic acid is formed in guinea-pig pancreas preparations by two distinct routes, namely the acylation of l-3-glycerophosphate and the phosphorylation of 1,2-diglyceride. Phosphatidic acid formed by either mechanism is converted into phosphatidylinositol by guinea-pig pancreas in vitro. 4. The enzymes of pancreas that convert phosphatidic acid into phosphatidylinositol via CDP-diglyceride have been characterized. 5. Addition of bovine serum albumin is necessary in assaying certain of these enzymes. PMID:4293959

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

    SciTech Connect

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

    1985-02-01

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

  8. Biliary cirrhosis secondary to obstruction of the common bile duct by ectopic pancreas in a cow.

    PubMed

    Shimada, A; Iwata, K; Morita, T; Umemura, T; Yamaga, Y; Kagota, K

    1998-01-01

    A 10-year-old Japanese Black cow showed icterus with gradual emaciation for a period of 3 months. Ultrasonography demonstrated increased "echogenicity" of the entire liver, with marked dilatation of the gall-bladder. At necropsy, the common bile duct was found to be obstructed by focally thickened fibrous tissue adjacent to a flesh-like mass (9 x 4 x 4 mm) attached to the wall of the duct. The mass consisted of normal pancreatic tissue. The liver showed moderate fibrosis, with nodular regeneration of the hepatic tissue and bile duct hyperplasia. A diagnosis of biliary cirrhosis secondary to ectopic pancreas in the common bile duct was made. PMID:9500240

  9. Preoperative embolization of primary bone tumors: A case control study

    PubMed Central

    Jha, Roushan; Sharma, Raju; Rastogi, Shishir; Khan, Shah Alam; Jayaswal, Arvind; Gamanagatti, Shivanand

    2016-01-01

    AIM: To study the safety and effectiveness of preoperative embolization of primary bone tumors in relation to intraoperative blood loss, intraoperative blood transfusion volume and surgical time. METHODS: Thirty-three patients underwent preoperative embolization of primary tumors of extremities, hip or vertebrae before resection and stabilization. The primary osseous tumors included giant cell tumors, aneurysmal bone cyst, osteoblastoma, chondroblastoma and chondrosarcoma. Twenty-six patients were included for the statistical analysis (embolization group) as they were operated within 0-48 h within preoperative embolization. A control group (non-embolization group, n = 28) with bone tumor having similar histological diagnosis and operated without embolization was retrieved from hospital record for statistical comparison. RESULTS: The mean intraoperative blood loss was 1300 mL (250-2900 mL), the mean intraoperative blood transfusion was 700 mL (0-1400 mL) and the mean surgical time was 221 ± 76.7 min for embolization group (group I, n = 26). Non-embolization group (group II, n = 28), the mean intraoperative blood loss was 1800 mL (800-6000 mL), the mean intraoperative blood transfusion was 1400 mL (700-8400 mL) and the mean surgical time was 250 ± 69.7 min. On comparison, statistically significant (P < 0.001) difference was found between embolisation group and non-embolisation group for the amount of blood loss and requirement of blood transfusion. There was no statistical difference between the two groups for the surgical time. No patients developed any angiography or embolization related complications. CONCLUSION: Preoperative embolization of bone tumors is a safe and effective adjunct to the surgical management of primary bone tumors that leads to reduction in intraoperative blood loss and blood transfusion volume. PMID:27158424

  10. Preoperative easily misdiagnosed telangiectatic osteosarcoma: clinical–radiologic–pathologic correlations

    PubMed Central

    Gao, Zhen-Hua; Yin, Jun-Qiang; Liu, Da-Wei; Meng, Quan-Fei

    2013-01-01

    Abstract Purpose: To describe the clinical, imaging, and pathologic characteristics and diagnostic methods of telangiectatic osteosarcoma (TOS) for improving the diagnostic level. Materials and methods: The authors retrospectively reviewed patient demographics, serum alkaline phosphatase (AKP) levels, preoperative biopsy pathologic reports, pathologic materials, imaging findings, and treatment outcomes from 26 patients with TOS. Patient images from radiography (26 cases) and magnetic resonance (MR) imaging (22 cases) were evaluated by 3 authors in consensus for intrinsic characteristics. There were 15 male and 11 female patients in the study, with an age of 9–32 years (mean age 15.9 years). Results: Eighteen of 26 patients died of lung metastases within 5 years of follow-up. The distal femur was affected more commonly (14 cases, 53.8%). Regarding serum AKP, normal (8 cases) or mildly elevated (18 cases) levels were found before preoperative chemotherapy. Radiographs showed geographic bone lysis without sclerotic margin (26 cases), cortical destruction (26 cases), periosteal new bone formation (24 cases), soft-tissue mass (23 cases), and matrix mineralization (4 cases). The aggressive radiographic features of TOS simulated the appearance of conventional high-grade intramedullary osteosarcoma, though different from aneurysmal bone cyst. MR images demonstrated multiple big (16 cases) or small (6 cases) cystic spaces, fluid-fluid levels (14 cases), soft-tissue mass (22 cases), and thick peripheral and septal enhancement (22 cases). Nine of 26 cases were misdiagnosed as aneurysmal bone cysts by preoperative core-needle biopsy, owing to the absence of viable high-grade sarcomatous cells in the small tissue samples. Conclusion: The aggressive growth pattern with occasional matrix mineralization, and multiple big or small fluid-filled cavities with thick peripheral, septal, and nodular tissue surrounding the fluid-filled cavities are characteristic imaging features of TOS, and these features are helpful in making the correct preoperative diagnosis of TOS. PMID:24334494

  11. Regeneration and Repair of the Exocrine Pancreas

    PubMed Central

    Murtaugh, L. Charles; Keefe, Matthew

    2015-01-01

    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 pro-inflammatory and pro-differentiation 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

  12. Exocrine Pancreas in Cats With Diabetes Mellitus.

    PubMed

    Zini, E; Ferro, S; Lunardi, F; Zanetti, R; Heller, R S; Coppola, L M; Guscetti, F; Osto, M; Lutz, T A; Cavicchioli, L; Reusch, C E

    2016-01-01

    Pancreatitis has been described in cats with diabetes mellitus, although the number of studies currently available is very limited. In addition, ketoacidosis has been hypothesized to be associated with pancreatitis in diabetic cats. The aims of the present study were to investigate whether diabetic cats have pancreatitis and to determine if pancreatitis is more frequent with ketoacidosis. Samples of pancreas were collected postmortem from 37 diabetic cats, including 15 with ketoacidosis, and 20 control cats matched for age, sex, breed, and body weight. Sections were stained with hematoxylin and eosin, double-labeled for insulin/CD3, insulin/CD20, insulin/myeloperoxidase, insulin/PCNA, and glucagon/Ki67, and single-labeled for Iba1. A previously proposed semiquantitative score was used to characterize pancreatitis, along with counts of inflammatory cells. Scores of pancreatitis and the number of neutrophils, macrophages, and lymphocytes in the exocrine pancreas did not differ between diabetic and control cats or between diabetic cats with and without ketoacidosis. Of note, PCNA-positive acinar cells were increased (P = .002) in diabetic cats, particularly near islets (P < .001). Ki67-positive acinar cells were increased only near islets (P = .038). Ketoacidosis was not linked to proliferation. The results suggest that histopathologic evidence of pancreatitis may not be more frequent in diabetic cats and that ketoacidosis may not be associated with it at the time of death. Augmented PCNA-positive acinar cells might indicate increased proliferation due to chronic pancreatitis. The reason behind the prevalent proliferation of acinar cells surrounding pancreatic islets deserves further investigation. PMID:26319779

  13. Hippo Signaling Regulates Pancreas Development through Inactivation of Yap

    PubMed Central

    Day, Caroline E.; Boerner, Brian P.; Johnson, Randy L.; Sarvetnick, Nora E.

    2012-01-01

    The mammalian pancreas is required for normal metabolism, with defects in this vital organ commonly observed in cancer and diabetes. Development must therefore be tightly controlled in order to produce a pancreas of correct size, cell type composition, and physiologic function. Through negative regulation of Yap-dependent proliferation, the Hippo kinase cascade is a critical regulator of organ growth. To investigate the role of Hippo signaling in pancreas biology, we deleted Hippo pathway components in the developing mouse pancreas. Unexpectedly, the pancreas from Hippo-deficient offspring was reduced in size, with defects evident throughout the organ. Increases in the dephosphorylated nuclear form of Yap are apparent throughout the exocrine compartment and correlate with increases in levels of cell proliferation. However, the mutant exocrine tissue displays extensive disorganization leading to pancreatitis-like autodigestion. Interestingly, our results suggest that Hippo signaling does not directly regulate the pancreas endocrine compartment as Yap expression is lost following endocrine specification through a Hippo-independent mechanism. Altogether, our results demonstrate that Hippo signaling plays a crucial role in pancreas development and provide novel routes to a better understanding of pathological conditions that affect this organ. PMID:23071096

  14. Cyst Features and Risk of Malignancy in Intraductal Papillary Mucinous Neoplasms of the Pancreas: Imaging and Pathology

    PubMed Central

    Grenacher, Lars; Strauß, Albert; Bergmann, Frank; Birdsey, Matthew; Mayerle, Julia

    2015-01-01

    Summary Background Intraductal papillary mucinous neoplasms (IPMNs) display diverse macroscopic, histological, and immunohistochemical characteristics with typical morphological appearance in magnetic resonance imaging. Depending on those, IPMNs may show progression into invasive carcinomas with variable frequency. Overall, IPMN-associated invasive carcinomas are found in about 30% of all IPMNs, revealing phenotpyes comparable with conventional ductal adenocarcinomas or mucinous (colloid) carcinomas of the pancreas. In Sendai-negative side-branch IPMNs, however, the annual risk of the development of invasive cancer is 2%; thus, risk stratification with regard to imaging and preoperative biomarkers and cytology is mandatory. Methods and Results The present study addresses the radiological and interventional preoperative measures including histological features to determine the risk of malignancy and the prognosis of IPMNs. Conclusion While preoperative imaging largely relies on the detection of macroscopic features of IPMNs, which are associated with a divergent risk of malignant behavior, in resected specimens the determination of the grade of dysplasia and the detection of an invasive component are the most important features to estimate the prognosis of IPMNs. PMID:26288613

  15. Control of Cell Identity in Pancreas Development and Regeneration

    PubMed Central

    Stanger, Ben Z.; Hebrok, Matthias

    2013-01-01

    The endocrine and exocrine cells in the adult pancreas are not static, but can change differentiation state in response to injury or stress. This concept of cells in flux means that there may be ways to generate certain types of cells (such as insulin-producing ?-cells) and prevent formation of others (such as transformed, neoplastic cells). We review different aspects of cell identity in the pancreas, discussing how cells achieve their identity during embryonic development and maturation, and how this identity remains plastic, even in the adult pancreas. PMID:23622126

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

    PubMed

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

    2014-07-01

    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

  17. Proteomic analysis of pancreas derived from adult cloned pig

    SciTech Connect

    Chae, Jung-Il; Cho, Young Keun; Cho, Seong-Keun; Kim, Jin-Hoi; Han, Yong-Mahn; Koo, Deog-Bon Lee, Kyung-Kwang

    2008-02-08

    The potential medical applications of animal cloning include xenotransplantation, but the complex molecular cascades that control porcine organ development are not fully understood. Still, it has become apparent that organs derived from cloned pigs may be suitable for transplantation into humans. In this study, we examined the pancreas of an adult cloned pig developed through somatic cell nuclear transfer (SCNT) using two-dimensional electrophoresis (2-DE) and Western blotting. Proteomic analysis revealed 69 differentially regulated proteins, including such apoptosis-related species as annexins, lamins, and heat shock proteins, which were unanimously upregulated in the SCNT sample. Among the downregulated proteins in SCNT pancreas were peroxiredoxins and catalase. Western blot results indicate that several antioxidant enzymes and the anti-apoptotic protein were downregulated in SCNT pancreas, whereas several caspases were upregulated. Together, these data suggest that the accumulation of reactive oxygen species (ROS) in the pancreas of an adult cloned pig leads to apoptosis.

  18. Occupational exposure and cancer of the pancreas: a review.

    PubMed Central

    Pietri, F; Clavel, F

    1991-01-01

    Many hypotheses have been proposed about the aetiology of cancer of the pancreas, especially concerning the effects of tobacco, coffee, alcohol, diet, and pancreatic pathology. Results of numerous epidemiological studies are, however, inconsistent. Chemical carcinogens have been implicated as possible risk factors. Animal studies have been carried out to determine the role of these chemical factors but, except for nitrosamines and their derivatives (components of tobacco), chemicals have not been proved carcinogenic for the pancreas. Many studies have also been conducted among occupational groups. Several of them showed an excess risk of cancer of the pancreas, especially in the chemical and petroleum industries. The lack of accuracy about the nature of products used, however, does not permit a definitive conclusion as to their carcinogenic role. This paper is a review of publications about occupational exposures and cancer of the pancreas. PMID:1911399

  19. Testosterone biotransformation by the isolated perfused canine pancreas

    SciTech Connect

    Fernandez-del Castillo, C.; Diaz-Sanchez, V.; Varela-Fascinetto, G.; Altamirano, A.; Odor-Morales, A.; Lopez-Medrano, R.M.; Robles-Diaz, G. )

    1991-01-01

    There is strong evidence indicating that the pancreas is under the influence of sex steroid hormones, and that it may even participate in their biosynthesis and metabolism. In the present study, (3H)testosterone was perfused into the isolated canine pancreas, and measured in the effluent with several of its metabolites (5 alpha-dihydrotestosterone, androstenedione, and estradiol). Results show that testosterone is readily transformed by the canine pancreas. The main product found in the effluent is androstenedione. The testis and spleen were also perfused with (3H)testosterone and used as controls. In both cases, this hormone appeared mostly unchanged in the effluent as compared to the pancreatic perfusion (p less than 0.0001). From our data, we conclude that the canine pancreas has the capacity to transform sex steroid hormones, and could be considered an extragonadal site of sex steroid biosynthesis.

  20. Rat pancreas uptake of [11C]dihydrotetrabenazine stereoisomers.

    PubMed

    Kilbourn, Michael R

    2010-11-01

    (+)-α-[(11)C]Dihydrotetrabenazine ((+)-[(11)C]DTBZ), a radioligand for the vesicular monoamine transporter type 2 (VMAT2), has been previously proposed as an in vivo marker of beta-cell degeneration in the pancreas. The stereospecificity of uptake of [(11)C]DTBZ into rat pancreas was examined here using radiolabeled forms of the (+)- and (-)-isomers. Pancreas localization of (+)-[(11)C]DTBZ could be partially blocked by prior administration of unlabeled (+)-DTBZ. Pancreatic uptake of the (-)-isomer was unexpectedly high and could not be blocked by pretreatment with (+)-DTBZ, but could be significantly reduced by treatment with racemic tetrabenazine, an in vivo source of (-)-DTBZ. These studies indicate that the inactive isomer of DTBZ does not provide a mechanism for defining the nonspecific binding of (+)-DTBZ in rat pancreas. PMID:21055616

  1. Proteomic analysis of pancreas derived from adult cloned pig.

    PubMed

    Chae, Jung-Il; Cho, Young Keun; Cho, Seong-Keun; Kim, Jin-Hoi; Han, Yong-Mahn; Koo, Deog-Bon; Lee, Kyung-Kwang

    2008-02-01

    The potential medical applications of animal cloning include xenotransplantation, but the complex molecular cascades that control porcine organ development are not fully understood. Still, it has become apparent that organs derived from cloned pigs may be suitable for transplantation into humans. In this study, we examined the pancreas of an adult cloned pig developed through somatic cell nuclear transfer (SCNT) using two-dimensional electrophoresis (2-DE) and Western blotting. Proteomic analysis revealed 69 differentially regulated proteins, including such apoptosis-related species as annexins, lamins, and heat shock proteins, which were unanimously upregulated in the SCNT sample. Among the downregulated proteins in SCNT pancreas were peroxiredoxins and catalase. Western blot results indicate that several antioxidant enzymes and the anti-apoptotic protein were downregulated in SCNT pancreas, whereas several caspases were upregulated. Together, these data suggest that the accumulation of reactive oxygen species (ROS) in the pancreas of an adult cloned pig leads to apoptosis. PMID:18060867

  2. Recognizing the distinct cytomorphologic features of solid pseudopapillary neoplasm of the pancreas

    PubMed Central

    Dietz, Robin; Perez, Mia C. N.

    2016-01-01

    Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare low-grade malignant tumor with an indolent clinical course and a favorable prognosis that is most commonly seen in young women of reproductive age. We present a case of SPN in a middle-aged man, diagnosed on a limited cytology specimen. Interestingly, this tumor has unique cytomorphologic findings in fine needle aspiration cytology smears, which help distinguish it from other pancreatic lesions. The presence of fibrovascular cores lined by loosely cohesive monomorphic neoplastic cells is a reliable cytomorphologic feature on aspiration cytology. Recognition of this characteristic finding is crucial for the diagnosis of this entity, especially when it presents in unexpected patient populations or when faced with scant cytology specimens. This report focuses on the distinguishing characteristics of SPN and how they compare and contrast with other pancreatic lesions that are in the differential diagnosis of SPN. PMID:27034801

  3. Recognizing the distinct cytomorphologic features of solid pseudopapillary neoplasm of the pancreas.

    PubMed

    Haque, Saadiya; Dietz, Robin; Perez, Mia C N

    2016-04-01

    Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare low-grade malignant tumor with an indolent clinical course and a favorable prognosis that is most commonly seen in young women of reproductive age. We present a case of SPN in a middle-aged man, diagnosed on a limited cytology specimen. Interestingly, this tumor has unique cytomorphologic findings in fine needle aspiration cytology smears, which help distinguish it from other pancreatic lesions. The presence of fibrovascular cores lined by loosely cohesive monomorphic neoplastic cells is a reliable cytomorphologic feature on aspiration cytology. Recognition of this characteristic finding is crucial for the diagnosis of this entity, especially when it presents in unexpected patient populations or when faced with scant cytology specimens. This report focuses on the distinguishing characteristics of SPN and how they compare and contrast with other pancreatic lesions that are in the differential diagnosis of SPN. PMID:27034801

  4. Stem cells versus plasticity in liver and pancreas regeneration.

    PubMed

    Kopp, Janel L; Grompe, Markus; Sander, Maike

    2016-02-25

    Cell replacement in adult organs can be achieved through stem cell differentiation or the replication or transdifferentiation of existing cells. In the adult liver and pancreas, stem cells have been proposed to replace tissue cells, particularly following injury. Here we review how specialized cell types are produced in the adult liver and pancreas. Based on current evidence, we propose that the plasticity of differentiated cells, rather than stem cells, accounts for tissue repair in both organs. PMID:26911907

  5. Endovascular Management of Acute Enteric Bleeding from Pancreas Transplant

    SciTech Connect

    Semiz-Oysu, Aslihan; Cwikiel, Wojciech

    2007-04-15

    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.

  6. [Current status and future prospect of pancreas and islet transplantation].

    PubMed

    Nakagawa, Y; Teraoka, S; Babazono, T; Tomonaga, O; Iwamoto, Y

    1999-03-01

    As of November 1997, 9,891 pancreas transplantation were reported to the International Pancreas Transplant Registry. In the United States, for all 1994-97, SPK, PAK, and PTA transplants, one-year graft survival rates were 82%, 71%, and 62%, respectively. The 1994-97 pancreas survival rates in all categories were higher than in previous eras. The improvement in graft survival rates has been associated with the introduction of FK506 and MMF, but excellent results are seen with cyclosporine, so the improvement may in part be due to the increasing experience that centers now have with pancreas transplantation. Although the standard surgical procedure remains pancreas-exocrine bladder drainage, the number of enteric drainage cases is increasing. It has been reported that the portal venous and enteric drainages are safe, with outcomes similar to those of standard technique. It appears that these will become the standard methods in the near future. Although 15 pancreas transplantations have been carried out in Japan, they ceased after 1994. Currently, social debate to determine the rules governing such procedures is ongoing. As of December 1995, 306 adult islet allotransplantation were reported to the Islet Transplant Registry. One-year islet survival rates were 27% in cases for 1990-94. Islet transplantation has the potential to be the most physiological advantage for the treatment of diabetes mellitus. However, the endocrine function provided by these transplants has been far from optimal. PMID:10199160

  7. Simultaneous pancreas and kidney transplantation: current trends and future directions

    PubMed Central

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

    2015-01-01

    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

  8. [Pancreas transplantation: State of the art and future prospects].

    PubMed

    Saudek, František; Girman, Peter; Lipár, Květoslav; Bouček, Petr; Kožnarová, Radka; Kočík, Matěj

    2015-01-01

    During the past 30 years pancreas transplantation evolved into a routine procedure especially suitable for type 1 diabetic recipients undergoing simultaneously kidney transplantation significantly improving quality of life and life expectancy as compared with kidney only recipients. It provides insulin independence with near-normal glucose control without special dietary restriction, freedom from hypoglycemia and chance for halting or regression of microangiopathic diabetes complications. As a separate procedure, pancreas transplantation is carried out mainly in selected subjects suffering from severe hypoglycemic episodes and impaired hypoglycemia awareness or as a subsequent procedure in type 1 diabetic kidney recipients from both cadaveric or living donors. Five-year insulin independence rate following combined pancreas and kidney, pancreas only and pancreas after kidney procedures currently exceed 75, 50 and 62 %, respectively. Though the outcomes still continue to improve, the rate of pancreas transplants has reached a plateau in several European countries or even declines in the United States. Main reasons for that include fewer referrals from diabetes specialist, decreased donor quality, introduction of islet transplantation as a less invasive procedure but probably most of all probably insufficient information on the latest progress and trends achieved in this area. In the area of transplant therapy of diabetes Czech Republic traditionally ranks to the most active countries providing different transplant options according to individual clinical needs including islet transplantation. PMID:26375705

  9. [Prospects for standardization of surgical procedures for carcinoma of the pancreas].

    PubMed

    Wataru, Kimura

    2003-05-01

    Since physicians need to guarantee the efficacy of medical therapy for patients, therapies for patients with cancer should be standardized to some extent. Carcinoma of the pancreas has the highest death rate of all cancers, with a resection rate as low as about 25% to 30% and a 5-year survival rate of around 9%. It is very difficult in such a situation to standardize the surgical strategy for carcinoma of the pancreas. Because pancreatic cancer is a general disease, the treatment strategy should include not only complete surgical resection but also local control methods with intraoperative radiation, prevention of liver metastasis, development of effective anti-cancer drugs, etc. Major progress in therapy for pancreatic carcinoma may be expected in the near future by with the cumulative use of effective therapies. Standard resection and extended resection: For carcinoma of the head of the pancreas, pancreaticoduodenectomy with regional lymph node dissection is performed in Japan, as is extended resection with thorough lymph node dissection of the retroperitoneal and paraaortic region. However, so far the prognosis of patients who undergo extended resection is not better than those who undergo standard resection. A randomized controlled trial of the two types of resection is now being conducted and its results are awaited. For carcinoma of the body and tail of the pancreas, distal pancreatectomy and splenectomy with lymph node dissection is performed if hematogenous or massive lymph node metastasis or direct invasion of the large vessels has not occurred. The Appleby procedure is performed in some cases. Reconstruction and complications of surgical procedures of carcinoma of the pancreas: It appears that a decrease in complications and a lower death rate have been achieved due to pancreaticoduodenectomy rather than due to the extent of lymph node dissection. In particular, progress in anastomosis techniques of the pancreas and intestine and in perioperative control has been marked. For prevention of complications, it is important that absorbable synthetic sutures be used in the pancreaticojejunal anastomosis, that the cut end of the pancreas be sutured and covered by the jejunum without dead space, and that the stent tube be inserted into the main pancreatic duct. The pancreaticojejunal anastomosis should be bordered by the greater omentum. This technique will prevent both the spread of the pancreatic juice into the intraabdominal cavity and rupture of the blood vessels, which can cause fatal postoperative bleeding. Sufficient intraabdominal drains should be in place, especially around the pancreaticojejunal anastomosis. Radiochemotherapy: There are no effective anticancer drugs for the treatment of carcinoma of the pancreas. It was reported that low-dose 5-fluorouracil and cisplatin (5-FU and CDDP) and gemcitabine plus either 5-FU, epirubicin, or CDDP has some effect. The efficacy of intraoperative radiotherapy has not been confirmed. It is not apparent whether radiochemotherapy is superior to surgery. Curable pancreatic carcinoma: Intraductal papillary-mucinous tumors of the pancreas (IPMT) take their name from the histological feature of mucin production and correspond to so-called mucin-producing tumors of the pancreas. This tumor is classified into two types, the main pancreatic duct type and the branch type. About 90% of the main pancreatic duct type and 20% of the branch type are malignant. The branch type of IPMT resembles a bunch of grasps in imaging procedures. Approximately 60% of cases with the branch type of IPMT can be followed up without surgery. Since the prognosis of IPMT is fairly good and the 5-year survival after surgery is about 70% to 80%, limited resection of the pancreas with organ preservation is under investigation. Mucinous cystic tumors of the pancreasin are characterized by development in the body and tail of the pancreas in middle-aged women, with histological ovarian-type stroma in the wall of the tumor, and round cystic lesions with a fibrous capsule containing multiple cystic components of various sizes, which resembles a Chinese citron upon imaging procedures. Surgery should be performed if such a diagnosis is made. PMID:12774526

  10. Formation and regeneration of the endocrine pancreas

    PubMed Central

    Dhawan, Sangeeta; Georgia, Senta; Bhushan, Anil

    2009-01-01

    The elaboration of the pancreas from epithelial buds to the intricate organ requires complex patterning information that controls fundamental cellular processes such as differentiation and proliferation of pancreatic progenitor cells. During pancreatic organogenesis, endocrine cells are generated from a population of pancreatic progenitor cells. The progenitor cells during the early development simultaneously receive multiple signals, some mitogenic and some inducing differentiation. These extrinsic signals are interpreted through an intrinsic mechanism that either commits the progenitor cell to the mitotic cell cycle or lead to exit from the cell cycle in order to differentiate. The endocrine cells that differentiate from progenitor cells are postmitotic, and direct lineage tracing analyses indicate that a population of progenitor cells persists throughout embryogenesis to allow the differentiation of new endocrine cells. At the end of embryogenesis and early postnatal period is characterized by high rates of beta cell proliferation leading to massive increases in beta cell mass. The beta cell mass expansion considerably slows down in adult animals, though variations in insulin demand due to physiological and pathological states such as pregnancy and obesity can lead to adaptive changes in the beta cells that include hyperplasia, hypertrophy, and increased insulin synthesis and secretion. Deciphering the mechanisms that regulate the plasticity of beta cell mass can be important steps in developing effective strategies to treat diabetes PMID:18061427

  11. Epidemiology of pancreas cancer in Los Angeles

    SciTech Connect

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

    1981-03-15

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

  12. Microendoscopes for imaging of the pancreas

    NASA Astrophysics Data System (ADS)

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

    2004-07-01

    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.

  13. Radionuclide surveillance of the allografted pancreas

    SciTech Connect

    George, E.A.; Salimi, Z.; Carney, K.; Castaneda, M.; Garvin, P.J.

    1988-04-01

    To determine the value of scintigraphy to detect posttransplantation complications of the allografted pancreas, we retrospectively reviewed 209 scintigrams obtained with /sup 99m/Tc-sulfur colloid (/sup 99m/Tc-SC) and /sup 99m/Tc-glucoheptonate (/sup 99m/Tc-GH). The scintigraphic studies were performed in 37 recipients of simultaneous renal and pancreatic allografts harvested from the same donor. /sup 99m/Tc-SC was used as an indicator of thrombotic vasculitis; pancreatic perfusion and blood-pool parameters were monitored with /sup 99m/Tc-GH. In 11 of the 37 recipients, scintigraphic abnormalities suggested posttransplantation infarction. Recurrent episodes of acute rejection of the pancreatic allograft, which always coincided with acute rejection of the renal allograft, were monitored in 24 recipients. Rejection-induced ischemic pancreatitis was suggested in 12 of the 24 recipients and persisted in 10 recipients for several weeks after improvement of renal allograft rejection. Pancreatic atrophy was suggested scintigraphically in 16 of the 24 recipients with recurrent episodes of rejection. Spontaneous pancreatic-duct obstruction and obstructive pancreatitis were associated with a scintigraphic pattern similar to that of rejection-induced ischemic pancreatitis. We concluded that the specific radionuclides used in this series are useful for the surveillance and assessment of posttransplantation pancreatic infarction, acute rejection, pancreatitis, and atrophy

  14. Stromal reengineering to treat pancreas cancer.

    PubMed

    Stromnes, Ingunn M; DelGiorno, Kathleen E; Greenberg, Philip D; Hingorani, Sunil R

    2014-07-01

    Pancreatic ductal adenocarcinoma co-opts multiple cellular and extracellular mechanisms to create a complex cancer organ with an unusual proclivity for metastasis and resistance to therapy. Cell-autonomous events are essential for the initiation and maintenance of pancreatic ductal adenocarcinoma, but recent studies have implicated critical non-cell autonomous processes within the robust desmoplastic stroma that promote disease pathogenesis and resistance. Thus, non-malignant cells and associated factors are culprits in tumor growth, immunosuppression and invasion. However, even this increasing awareness of non-cell autonomous contributions to disease progression is tempered by the conflicting roles stromal elements can play. A greater understanding of stromal complexity and complicity has been aided in part by studies in highly faithful genetically engineered mouse models of pancreatic ductal adenocarcinoma. Insights gleaned from such studies are spurring the development of therapies designed to reengineer the pancreas cancer stroma and render it permissive to agents targeting cell-autonomous events or to reinstate immunosurveillance. Integrating conventional and immunological treatments in the context of stromal targeting may provide the key to a durable clinical impact on this formidable disease. PMID:24908682

  15. Stromal reengineering to treat pancreas cancer

    PubMed Central

    Stromnes, Ingunn M.; DelGiorno, Kathleen E.; Greenberg, Philip D.; Hingorani, Sunil R.

    2014-01-01

    Pancreatic ductal adenocarcinoma co-opts multiple cellular and extracellular mechanisms to create a complex cancer organ with an unusual proclivity for metastasis and resistance to therapy. Cell-autonomous events are essential for the initiation and maintenance of pancreatic ductal adenocarcinoma, but recent studies have implicated critical non-cell autonomous processes within the robust desmoplastic stroma that promote disease pathogenesis and resistance. Thus, non-malignant cells and associated factors are culprits in tumor growth, immunosuppression and invasion. However, even this increasing awareness of non-cell autonomous contributions to disease progression is tempered by the conflicting roles stromal elements can play. A greater understanding of stromal complexity and complicity has been aided in part by studies in highly faithful genetically engineered mouse models of pancreatic ductal adenocarcinoma. Insights gleaned from such studies are spurring the development of therapies designed to reengineer the pancreas cancer stroma and render it permissive to agents targeting cell-autonomous events or to reinstate immunosurveillance. Integrating conventional and immunological treatments in the context of stromal targeting may provide the key to a durable clinical impact on this formidable disease. PMID:24908682

  16. High precision innovative micropump for artificial pancreas

    NASA Astrophysics Data System (ADS)

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

    2014-03-01

    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.

  17. A historical perspective on the discovery of the accessory duct of the pancreas, the ampulla 'of Vater' and pancreas divisum.

    PubMed Central

    Stern, C D

    1986-01-01

    The discovery of the accessory duct of the pancreas is usually ascribed to Giovanni Domenico Santorini (1681-1737), after whom this structure is named. The papilla duodeni (ampulla 'of Vater', or papilla 'of Santorini') is named after Abraham Vater (1684-1751) or after GD Santorini. Pancreas divisum, a persistence through non-fusion of the embryonic dorsal and ventral pancreas is a relatively common clinical condition, the discovery of which is usually ascribed to Joseph Hyrtl (1810-1894). In this review I report that pancreas divisum, the accessory duct and the papilla duodeni (ampulla 'of Vater') had all been observed and the observations published during the 17th century by at least seven anatomists before Santorini, Vater, and Hyrtl. I further suggest, in the light of frequent anatomical misattributions in common usage, that anatomical structures be referred to only by their proper anatomical names. Images Fig. 1 PMID:3512385

  18. Lymphoepithelial cysts of the pancreas: a report of 12 cases and a review of the literature.

    PubMed

    Adsay, N Volkan; Hasteh, Farnaz; Cheng, Jeanette D; Bejarano, Pablo A; Lauwers, Gregory Y; Batts, Kenneth P; Klppel, Gnter; Klimstra, David S

    2002-05-01

    Lymphoepithelial cyst (LEC) of the pancreas is a rare lesion of undetermined pathogenesis that had been documented almost exclusively in males. The literature on this entity is limited to reports of single or small numbers of cases. Here is presented a clinicopathologic analysis of 12 patients with LEC, 4 of whom were female. The mean age of the patients was 56 years. Four patients presented with abdominal pain and nausea, but in two patients, the cysts were detected incidentally. Only one patient had a history of chronic pancreatitis, and another had a family member with pancreatic cancer. In one patient, a clinical diagnosis of pseudocyst was rendered, and the remaining patients were clinically thought to have cystic neoplasms. None of the patients had any identifiable immunosuppression, HIV positivity, autoimmune disorder (such as Sjogren syndrome) or lymphoma. Seven cysts were located in the head of the pancreas, and 5 were in the tail. The mean size was 4.8 cm (range, 1.2-17 cm). Five LECs were multilocular, three were unilocular; in others, the number of loculi was not recorded. All were "macrocystic" lesions. Two patients had two separate lesions, both in the tail of the pancreas. Histologically, all cases were characterized by cysts, some containing keratin, and lined by mature stratified squamous epithelium surrounded by dense lymphoid tissue, often with prominent follicles. In some areas, the lining epithelium had more cuboidal, flattened, or transitional appearance. Mucinous goblet-like cells were seen in one case. Acute inflammation was not seen. Four cases contained solid lymphoepithelial islands, a feature not previously described in LECs. No squamous metaplasia was identified in the uninvolved pancreatic tissue and no epithelial elements were identified in peripancreatic lymph nodes. In summary, LEC of the pancreas is a rare but distinctive lesion that may be seen in the tail of the organ where most cystic pancreatic neoplasms are encountered. In contrast to the impression from the literature, LECs may also develop in females and, therefore, should be considered in the clinical differential diagnosis of mucinous cystic neoplasms that affect a similar age group. LECs are not associated with the clinical syndromes that are seen with their analogues in the salivary glands. PMID:12011254

  19. Gallbladder tuberculosis: False-positive PET diagnosis of gallbladder cancer

    PubMed Central

    Ramia, JM; Muffak, K; Fernández, A; Villar, J; Garrote, D; Ferron, JA

    2006-01-01

    Gallbladder tuberculosis (GT) is an extremely rare disease, and very few cases have been reported in the literature. The first case of GT was described in 1870 by Gaucher. A correct preoperative diagnosis of GT is unusual, and it is frequently confused with various gallbladder diseases. We present a new case of a patient who underwent surgery with the preoperative diagnosis of gallbladder cancer after a false positive positron emission tomography scan in the diagnostic work-up. PMID:17072992

  20. [Contribution of ultrasonography for the preoperative assessment of gastric contents].

    PubMed

    Bouvet, L; Chassard, D

    2014-04-01

    The assessment of the risk of pulmonary aspiration of gastric contents may be difficult in the preoperative period, apart from typical circumstances. The development of ultrasonography in anesthesia and critical care has led to consider ultrasonic imaging of gastric contents for preoperative risk assessment of "full" stomach in clinical practice. Ultrasonography of the body of the stomach allows direct visualization of the gastric contents. However, the stomach is often difficult to identify, particularly when it is empty. Moreover, quantitative assessment of gastric volume is delicate, and no standardized method of ultrasonography of the body of the stomach for preoperative assessment of gastric contents was described. On the contrary, ultrasonography of the antral cross-sectional area, which was initially described for the assessment of gastric emptying as an alternative method to repeated measurements of the variations of antropyloric volume after ingestion of a test meal, is easy to perform and is highly reproducible through using the aorta and the left lobe of the liver as internal landmarks. Qualitative assessment of the gastric antrum allows easily diagnosis of a "full" stomach. The measurement of antral area may allow a more accurate estimate of the presence or absence of gastric contents at risk of lung injury in the event of regurgitation and aspiration (gastric volume >0.8 ml/kg and/or with solid particles), defining the "risk" stomach. The use of antral ultrasonography may help the anesthesiologist to assess the risk of pulmonary aspiration according to clinical history of the patient, in order to choose an appropriate strategy minimizing the occurrence of this complication. PMID:24631006

  1. Repurposed biological scaffolds: kidney to pancreas.

    PubMed

    Willenberg, Bradley J; Oca-Cossio, Jose; Cai, Yunqing; Brown, Alicia R; Clapp, William L; Abrahamson, Dale R; Terada, Naohiro; Ellison, Gary W; Mathews, Clayton E; Batich, Christopher D; Ross, Edward A

    2015-01-01

    Advances in organ regeneration have been facilitated by gentle decellularization protocols that maintain distinct tissue compartments, and thereby allow seeding of blood vessels with endothelial lineages separate from populations of the parenchyma with tissue-specific cells. We hypothesized that a reconstituted vasculature could serve as a novel platform for perfusing cells derived from a different organ: thus discordance of origin between the vascular and functional cells, leading to a hybrid repurposed organ. The need for a highly vascular bed is highlighted by tissue engineering approaches that involve transplantation of just cells, as attempted for insulin production to treat human diabetes. Those pancreatic islet cells present unique challenges since large numbers are needed to allow the cell-to-cell signaling required for viability and proper function; however, increasing their number is limited by inadequate perfusion and hypoxia. As proof of principle of the repurposed organ methodology we harnessed the vasculature of a kidney scaffold while seeding the collecting system with insulin-producing cells. Pig kidneys were decellularized by sequential detergent, enzymatic and rinsing steps. Maintenance of distinct vascular and collecting system compartments was demonstrated by both fluorescent 10 micron polystyrene microspheres and cell distributions in tissue sections. Sterilized acellular scaffolds underwent seeding separately via the artery (fibroblasts or endothelioma cells) and retrograde (murine βTC-tet cells) up the ureter. After three-day bioreactor incubation, histology confirmed separation of cells in the vasculature from those in the collecting system. βTC-tet clusters survived in tubules, glomerular Bowman's space, demonstrated insulin immunolabeling, and thereby supported the feasibility of kidney-to-pancreas repurposing. PMID:26252820

  2. Repurposed biological scaffolds: kidney to pancreas

    PubMed Central

    Willenberg, Bradley J; Oca-Cossio, Jose; Cai, Yunqing; Brown, Alicia R; Clapp, William L; Abrahamson, Dale R; Terada, Naohiro; Ellison, Gary W; Mathews, Clayton E; Batich, Christopher D; Ross, Edward A

    2015-01-01

    ABSTRACT. Advances in organ regeneration have been facilitated by gentle decellularization protocols that maintain distinct tissue compartments, and thereby allow seeding of blood vessels with endothelial lineages separate from populations of the parenchyma with tissue-specific cells. We hypothesized that a reconstituted vasculature could serve as a novel platform for perfusing cells derived from a different organ: thus discordance of origin between the vascular and functional cells, leading to a hybrid repurposed organ. The need for a highly vascular bed is highlighted by tissue engineering approaches that involve transplantation of just cells, as attempted for insulin production to treat human diabetes. Those pancreatic islet cells present unique challenges since large numbers are needed to allow the cell-to-cell signaling required for viability and proper function; however, increasing their number is limited by inadequate perfusion and hypoxia. As proof of principle of the repurposed organ methodology we harnessed the vasculature of a kidney scaffold while seeding the collecting system with insulin-producing cells. Pig kidneys were decellularized by sequential detergent, enzymatic and rinsing steps. Maintenance of distinct vascular and collecting system compartments was demonstrated by both fluorescent 10 micron polystyrene microspheres and cell distributions in tissue sections. Sterilized acellular scaffolds underwent seeding separately via the artery (fibroblasts or endothelioma cells) and retrograde (murine βTC-tet cells) up the ureter. After three-day bioreactor incubation, histology confirmed separation of cells in the vasculature from those in the collecting system. βTC-tet clusters survived in tubules, glomerular Bowman's space, demonstrated insulin immunolabeling, and thereby supported the feasibility of kidney-to-pancreas repurposing. PMID:26252820

  3. Endocrine Pancreas in Cats With Diabetes Mellitus.

    PubMed

    Zini, E; Lunardi, F; Zanetti, R; Heller, R S; Coppola, L M; Ferro, S; Guscetti, F; Osto, M; Lutz, T A; Reusch, C E; Cavicchioli, L

    2016-01-01

    Pancreatic amyloidosis and loss of α and β cells have been shown to occur in cats with diabetes mellitus, although the number of studies currently available is very limited. Furthermore, it is not known whether pancreatic islet inflammation is a common feature. The aims of the present study were to characterize islet lesions and to investigate whether diabetic cats have inflammation of the pancreatic islets. Samples of pancreas were collected postmortem from 37 diabetic and 20 control cats matched for age, sex, breed, and body weight. Histologic sections were stained with hematoxylin and eosin and Congo red; double labeled for insulin/CD3, insulin/CD20, insulin/myeloperoxidase, insulin/proliferating cell nuclear antigen, and glucagon/Ki67; and single labeled for amylin and Iba1. Mean insulin-positive cross-sectional area was approximately 65% lower in diabetic than control cats (P = .009), while that of amylin and glucagon was similar. Surprisingly, amyloid deposition was similar between groups (P = .408). Proliferation of insulin- and glucagon-positive cells and the number of neutrophils, macrophages, and T (CD3) and B (CD20) lymphocytes in the islets did not differ. The presence of T and B lymphocytes combined tended to be more frequent in diabetic cats (n = 8 of 37; 21.6%) than control cats (n = 1 of 20; 5.0%). The results confirm previous observations that loss of β cells but not α cells occurs in diabetic cats. Islet amyloidosis was present in diabetic cats but was not greater than in controls. A subset of diabetic cats had lymphocytic infiltration of the islets, which might be associated with β-cell loss. PMID:26113611

  4. Transepithelial Bicarbonate Secretion: Lessons from the Pancreas

    PubMed Central

    Park, Hyun Woo; Lee, Min Goo

    2012-01-01

    Many cystic fibrosis transmembrane conductance regulator (CFTR)-expressing epithelia secrete bicarbonate (HCO3−)-containing fluids. Recent evidence suggests that defects in epithelial bicarbonate secretion are directly involved in the pathogenesis of cystic fibrosis, in particular by building up hyperviscous mucus in the ductal structures of the lung and pancreas. Pancreatic juice is one of the representative fluids that contain a very high concentration of bicarbonate among bodily fluids that are secreted from CFTR-expressing epithelia. We introduce up-to-date knowledge on the basic principles of transepithelial bicarbonate transport by showing the mechanisms involved in pancreatic bicarbonate secretion. The model of pancreatic bicarbonate secretion described herein may also apply to other exocrine epithelia. As a central regulator of bicarbonate transport at the apical membrane, CFTR plays an essential role in both direct and indirect bicarbonate secretion. The major role of CFTR in bicarbonate secretion would be variable depending on the tissue and cell type. For example, in epithelial cells that produce a low concentration of bicarbonate-containing fluid (up to 80 mm), either CFTR-dependent Cl−/HCO3− exchange or CFTR anion channel with low bicarbonate permeability would be sufficient to generate such fluid. However, in cells that secrete high-bicarbonate-containing fluids, a highly selective CFTR bicarbonate channel activity is required. Therefore, understanding the molecular mechanism of transepithelial bicarbonate transport and the role of CFTR in each specific epithelium will provide therapeutic strategies to recover from epithelial defects induced by hyposecretion of bicarbonate in cystic fibrosis. PMID:23028131

  5. Synchronous or metachronous double cancers of the pancreas and other organs: report on 12 cases.

    PubMed

    Eriguchi, N; Aoyagi, S; Hara, M; Okuda, K; Tamae, T; Fukuda, S; Hashino, K; Sato, S; Fujiki, K; Furukawa, S; Jimi, A

    2000-01-01

    Pancreatic carcinoma carries a poor prognosis, especially invasive ductal carcinoma of the pancreas. This retrospective study describes the results of the treatment and prognosis for double cancers in which cancer of the pancreas was associated with malignancies in other organs in 12 patients who were diagnosed and treated at Kurume University Hospital. The patients included 4 women and 8 men, with an average age of 67 years. Of the 12 tumors, 7 were metachronous pancreatic cancers which occurred after resections of other organ malignancies. Five patients had synchronous double cancers, one of whom was diagnosed to have gastric cancer on admission. Two other patients of this group were diagnosed to have lung cancer, while the remaining 2 patients suffered from colon cancer. By the time pancreatic cancer was diagnosed, gastrectomies had been performed in 7 patients for either gastric cancer or ulcers. In addition, one patient underwent a hysterectomy for uterine carcinoma and another received a low anterior resection for rectal carcinoma. Four of 5 patients in the synchronous group had nonresectable tumors and a palliative bypass operation was performed in 2 of these patients. Six patients who had metachronous double cancers died because of pancreatic cancer recurrence or metastases. We conclude that the prognosis of double cancers, where cancer of the pancreas is associated with other organ malignancies, primarily depends on the prognosis of the pancreatic carcinoma, and the present study suggests the necessity of long-term follow-up examinations for gastrectomy patients in order to make an early diagnosis of pancreatic cancer. PMID:10955735

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

    SciTech Connect

    Stockland, Andrew H.; Willingham, Darrin L.; Paz-Fumagalli, Ricardo; Grewal, Hani P.; McKinney, J. Mark; Hughes, Christopher B.; Walser, Eric M.

    2009-03-15

    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.

  7. Preoperative Biliary Drainage in Cases of Borderline Resectable Pancreatic Cancer Treated with Neoadjuvant Chemotherapy and Surgery

    PubMed Central

    Tsuboi, Tomofumi; Sasaki, Tamito; Serikawa, Masahiro; Ishii, Yasutaka; Mouri, Teruo; Shimizu, Akinori; Kurihara, Keisuke; Tatsukawa, Yumiko; Miyaki, Eisuke; Kawamura, Ryota; Tsushima, Ken; Murakami, Yoshiaki; Uemura, Kenichiro; Chayama, Kazuaki

    2016-01-01

    Objective. To elucidate the optimum preoperative biliary drainage method for patients with pancreatic cancer treated with neoadjuvant chemotherapy (NAC). Material and Methods. From January 2010 through December 2014, 20 patients with borderline resectable pancreatic cancer underwent preoperative biliary drainage and NAC with a plastic or metallic stent and received NAC at Hiroshima University Hospital. We retrospectively analyzed delayed NAC and complication rates due to biliary drainage, effect of stent type on perioperative factors, and hospitalization costs from diagnosis to surgery. Results. There were 11 cases of preoperative biliary drainage with plastic stents and nine metallic stents. The median age was 64.5 years; delayed NAC occurred in 9 cases with plastic stent and 1 case with metallic stent (p = 0.01). The complication rates due to biliary drainage were 0% (0/9) with metallic stents and 72.7% (8/11) with plastic stents (p = 0.01). Cumulative rates of complications determined with the Kaplan-Meier method on day 90 were 60% with plastic stents and 0% with metallic stents (log-rank test, p = 0.012). There were no significant differences between group in perioperative factors or hospitalization costs from diagnosis to surgery. Conclusions. Metallic stent implantation may be effective for preoperative biliary drainage for pancreatic cancer treated with NAC. PMID:26880897

  8. Long term studies of pancreas transplantation in experimental diabetes mellitus.

    PubMed Central

    Orloff, M J; Lee, S; Charters, A C; Grambort, D E; Storck, L G; Knox, D

    1975-01-01

    Alloxan diabetes was induced in inbred rats that then were divided into four groups consisting of unoperated diabetic controls, sham-operated diabetic controls, rats given pancreaticoduodenal isografts, and rats given duct-ligated pancreas isografts. The animals were studied for from 18 months (controls) to two years (transplants) and the following important results were obtained: 1) In striking contrast to the diabetic controls, pancreas transplants of both types produced immediate and permanent relief of hyperglycemia, immediate and lasting elevation of serum insulin levels, a normal weight and growth curve, and good health for two years. Removal of the graft was followed by recurrence of severe diabetes. 2) Pancreas transplants of both types prevented the widespread and severe renal, ophthalmic and neural lesions of diabetes that were found in the diabetic controls. 3) The duct-ligated pancreas graft and pancreaticoduodenal transplant were equally effective in controlling diabetes. Ligation of the pancreatic duct was not followed by significant morphologic or clinical evidence of pancreatitis or by loss of endocrine function. 4) Portal venous drainage of the pancreas transplant was unnecessary for good endocrine function. PMID:1099993

  9. Elastography for the pancreas: Current status and future perspective.

    PubMed

    Kawada, Natsuko; Tanaka, Sachiko

    2016-04-14

    Elastography for the pancreas can be performed by either ultrasound or endoscopic ultrasound (EUS). There are two types of pancreatic elastographies based on different principles, which are strain elastography and shear wave elastography. The stiffness of tissue is estimated by measuring the grade of strain generated by external pressure in the former, whereas it is estimated by measuring propagation speed of shear wave, the transverse wave, generated by acoustic radiation impulse (ARFI) in the latter. Strain elastography is difficult to perform when the probe, the pancreas and the aorta are not located in line. Accordingly, a fine elastogram can be easily obtained in the pancreatic body but not in the pancreatic head and tail. In contrast, shear wave elastography can be easily performed in the entire pancreas because ARFI can be emitted to wherever desired. However, shear wave elastography cannot be performed by EUS to date. Recently, clinical guidelines for elastography specialized in the pancreas were published from Japanese Society of Medical Ultrasonics. The guidelines show us technical knacks of performing elastography for the pancreas. PMID:27076756

  10. GATA4 and GATA6 control mouse pancreas organogenesis

    PubMed Central

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

    2012-01-01

    Recently, heterozygous mutations in GATA6 have been found in neonatal diabetic patients with failed pancreatic organogenesis. To investigate the roles of GATA4 and GATA6 in mouse pancreas organogenesis, we conditionally inactivated these genes within the pancreas. Single inactivation of either gene did not have a major impact on pancreas formation, indicating functional redundancy. However, double Gata4/Gata6 mutant mice failed to develop pancreata, died shortly after birth, and displayed hyperglycemia. Morphological defects in Gata4/Gata6 mutant pancreata were apparent during embryonic development, and the epithelium failed to expand as a result of defects in cell proliferation and differentiation. The number of multipotent pancreatic progenitors, including PDX1+ cells, was reduced in the Gata4/Gata6 mutant pancreatic epithelium. Remarkably, deletion of only 1 Gata6 allele on a Gata4 conditional knockout background severely reduced pancreatic mass. In contrast, a single WT allele of Gata4 in Gata6 conditional knockout mice was sufficient for normal pancreatic development, indicating differential contributions of GATA factors to pancreas formation. Our results place GATA factors at the top of the transcriptional network hierarchy controlling pancreas organogenesis. PMID:23006330

  11. [Pancreas and islet transplantation in patients with diabetes mellitus].

    PubMed

    Sá, João Roberto de; Gonzalez, Adriano Miziara; Melaragno, Cláudio Santiago; Saitovich, David; Franco, Denise Reis; Rangel, Erika Bevilaqua; Noronha, Irene Lourdes; Pestana, José Osmar Medina; Bertoluci, Marcelo Casaccia; Linhares, Marcelo; Miranda, Marcelo Perosa de; Monteagudo, Patricia; Genzini, Tércio; Eliaschewitz, Freddy Goldberg

    2008-03-01

    Pancreas and kidney transplants have specific indications, benefits and risks. The procedure has become more common and more often as long-term success has improved and risks have decreased. Compared with a patient being on dialysis, simultaneous pancreas-kidney transplant offers a distinct advantage when it comes to mortality, quality of life and diabetic complications. Since there can be a living-donor kidney transplant,, a possibly similar patient and graft survival by 10 years follow-up, this procedure should be considered. Pancreas after kidney transplants, when successful, can improve microvascular complications compared with kidney transplant alone, but immediate mortality may be higher. Solitary pancreas transplantation can improve the quality of life in selected patients, but it may also increase the immediate risk of mortality due to the complexity of the surgery and the risks of immunosupression. The results of Islet transplantation differ from the higher metabolic performance achieved by whole pancreas allotransplantation and its applicability is limited to selected adult diabetic patients. PMID:18438547

  12. Stereotactic Body Radiotherapy (SBRT) Reirradiation for Recurrent Pancreas Cancer

    PubMed Central

    Dagoglu, Nergiz; Callery, Mark; Moser, James; Tseng, Jennifer; Kent, Tara; Bullock, Andrea; Miksad, Rebecca; Mancias, Joseph D.; Mahadevan, Anand

    2016-01-01

    Objectives: After adjuvant or definitive radiation for pancreas cancer, there are limited conventional treatment options for recurrent pancreas cancer. We explored the role of (Stereotactic Body Radiotherapy) SBRT for reirradiation of recurrent pancreas Cancer. Methods: This is a retrospective study of patients reirradiated with SBRT for recurrent pancreas cancer. All patients were deemed unresectable and treated with systemic therapy. Fiducial gold markers were used. CT simulation was performed with oral and IV contrast and patients were treated with respiratory motion tracking in the CyberknifeTM system. Results: 30 patients (17 men and 13 women) with a median age of 67 years were included in the study. The median target volume was 41.29cc. The median prescription dose was 25Gy (24-36Gy) in a median of 5 fractions prescribed to a mean 78% isodose line. The median overall survival was 14 months. The 1 and 2 year local control was 78%. The worst toxicity included 3/30(10%) Grade III acute toxicity for pain, bleeding and vomiting. There was 2/30 (7%) Grade III long-term bowel obstructions. Conclusions: SBRT can be a useful and tolerable option for patients with recurrent pancreas cancer after prior radiation. PMID:26918041

  13. Elastography for the pancreas: Current status and future perspective

    PubMed Central

    Kawada, Natsuko; Tanaka, Sachiko

    2016-01-01

    Elastography for the pancreas can be performed by either ultrasound or endoscopic ultrasound (EUS). There are two types of pancreatic elastographies based on different principles, which are strain elastography and shear wave elastography. The stiffness of tissue is estimated by measuring the grade of strain generated by external pressure in the former, whereas it is estimated by measuring propagation speed of shear wave, the transverse wave, generated by acoustic radiation impulse (ARFI) in the latter. Strain elastography is difficult to perform when the probe, the pancreas and the aorta are not located in line. Accordingly, a fine elastogram can be easily obtained in the pancreatic body but not in the pancreatic head and tail. In contrast, shear wave elastography can be easily performed in the entire pancreas because ARFI can be emitted to wherever desired. However, shear wave elastography cannot be performed by EUS to date. Recently, clinical guidelines for elastography specialized in the pancreas were published from Japanese Society of Medical Ultrasonics. The guidelines show us technical knacks of performing elastography for the pancreas. PMID:27076756

  14. Rare pancreas tumor mimicking adenocarcinoma: Extramedullary plasmacytoma

    PubMed Central

    Akyuz, Filiz; Şahin, Davut; Akyuz, Umit; Vatansever, Sezai

    2014-01-01

    Neoplastic proliferation of plasma cells is called plasma cell dyscrasias, and these neoplasms can present as a solitary neoplasm or multiple myeloma. Extramedullary plasmacytoma, in particular pancreatic plasmacytoma, is a rare manifestation of multiple myeloma. Although computerized tomography is useful for the diagnosis of extramedullary plasmacytoma, there are no specific radiologic markers that distinguish it from adenocarcinoma. Histological confirmation by biopsy is necessary for accurate diagnosis and management of the tumor. Endosonography is the most sensitive method for the diagnosis of pancreatic tumors, and the use of fine needle aspiration by endosonography is associated with a lower risk for malignant seeding and complications. Here, we report a case of pancreatic plasmacytoma in newly identified multiple myeloma as diagnosed by endosonography. Endosonography is a reliable and rapid method for the diagnosis of extramedullary plasmacytoma. Therefore, endosonographic fine needle aspiration should be the first choice for histological evaluation when pancreatic plasmacytoma is suspected. Ideally, the pathology would be performed at the same site as endosonographic biopsy. PMID:24634714

  15. Knowledge retention from preoperative patient information.

    PubMed

    Stern, Cindy; Lockwood, Craig

    2005-04-01

    Background  Preoperative education is a common feature of the preoperative preparation for many surgical procedures. It is anticipated that this education will result in beneficial outcomes for the patient. Many studies have evaluated the effectiveness of different formats used to deliver the information, and the effect of this information on a variety of outcomes. While there has been substantial research and several meta-analyses undertaken on different aspects of preoperative education, there has been no previous attempt to summarise this body of research to evaluate its impact on knowledge and understanding of patients. Objective  The objective of this review was to present the best available evidence related to knowledge retention and/or correct performance of postoperative activities after preoperative patient education. Review method  This review considered all studies that included adults in a hospital setting, either as inpatients or same day surgical patients, and who received some form of information and/or instruction before an operative procedure. Interventions were the methods of preoperative patient education, instruction or teaching, and included evaluations of the effectiveness of different presentations such as: •  written information; •  audio-visual aids; •  computer-assisted instruction; •  learning packages in either group or individual formats, at either pre-admission or post-admission. The primary outcomes were those associated with the understanding of the information related to the operative or postoperative period that were provided in the intervention and included: 1 increased knowledge; 2 ability to perform postoperative activities; 3 time to teach skills. This review considered randomised controlled trials that evaluated forms of preoperative patient education and their effect on patient understanding, knowledge and ability to perform postoperative activities. Results  The findings of this review support the use of pamphlets to inform patients and to improve their skills. The role of videos as a preoperative instruction tool has not been rigorously evaluated. However, existing studies support the use of preoperative videos to improve patient knowledge and skill. The data suggest that the instructional method, the act of educating a patient by delivering directions for actions or behaviour is useful for improving patients' knowledge of their treatment and their ability to perform and comply with required exercises. However, instruction is likely to be more effective if provided before admission. If teaching is to be done after admission, using a group format has been shown to be equally as effective as individual instruction. Conclusions  Although numerous studies have been performed on many aspects of preoperative education, little high-quality research has assessed the effectiveness of this information on patient knowledge and ability to perform specific skills such as exercises. Further research is required to examine: (i) the effectiveness of pamphlets and other written material for people with English as a second language or limited literary skills; (ii) the accuracy of information provided in preoperative pamphlets; (iii) the effectiveness of pamphlets on general populations; (iv) the role of videos and learning packages; (v) the effectiveness of preoperative instruction; and (vi) the changes in patient misconceptions with the provision of preoperative information. PMID:21631744

  16. Routine preoperative medical testing for cataract surgery

    PubMed Central

    Keay, Lisa; Lindsley, Kristina; Tielsch, James; Katz, Joanne; Schein, Oliver

    2012-01-01

    Background Cataract surgery is practiced widely and substantial resources are committed to an increasing cataract surgical rate in developing countries. With the current volume of cataract surgery and the increases in the future, it is critical to optimize the safety and cost-effectiveness of this procedure. Most cataracts are performed on older individuals with correspondingly high systemic and ocular comorbidities. It is likely that routine preoperative medical testing will detect medical conditions, but it is questionable whether these conditions should preclude individuals from cataract surgery or change their perioperative management. Objectives (1) To investigate the evidence for reductions in adverse events through preoperative medical testing, and (2) to estimate the average cost of performing routine medical testing. Search strategy We searched CENTRAL, MEDLINE, EMBASE and LILACS using no date or language restrictions. We used reference lists and the Science Citation Index to search for additional studies. Selection criteria We included randomized clinical trials in which routine preoperative medical testing was compared to no preoperative or selective preoperative testing prior to age-related cataract surgery. Data collection and analysis Two review authors independently assessed abstracts to identify possible trials for inclusion. For each included study, two review authors independently documented study characteristics, extracted data, and assessed methodological quality. Main results The three randomized clinical trials included in this review reported results for 21,531 total cataract surgeries with 707 total surgery-associated medical adverse events, including 61 hospitalizations and three deaths. Of the 707 medical adverse events reported, 353 occurred in the pretesting group and 354 occurred in the no testing group. Most events were cardiovascular and occurred during the intraoperative period. Routine preoperative medical testing did not reduce the risk of intraoperative (OR 1.02, 95% CI 0.85 to 1.22) or postoperative medical adverse events (OR 0.96, 95% CI 0.74 to 1.24) when compared to selective or no testing. Cost savings were evaluated in one study which estimated the costs to be 2.55 times higher in those with preoperative medical testing compared to those without preoperative medical testing. There was no difference in cancellation of surgery between those with preoperative medical testing and those with no or limited preoperative testing, reported by two studies. Authors’ conclusions This review has shown that routine pre-operative testing does not increase the safety of cataract surgery. Alternatives to routine preoperative medical testing have been proposed, including self-administered health questionnaires, which could substitute for health provider histories and physical examinations. Such avenues may lead to cost-effective means of identifying those at increased risk of medical adverse events due to cataract surgery. However, despite the rare occurrence, adverse medical events precipitated by cataract surgery remain a concern because of the large number of elderly patients with multiple medical comorbidities who have cataract surgery in various settings. The studies summarized in this review should assist recommendations for the standard of care of cataract surgery, at least in developed settings. Unfortunately, in developing country settings, medical history questionnaires would be useless to screen for risk since few people have ever been to a physician, let alone been diagnosed with any chronic disease. PMID:19370681

  17. Routine preoperative medical testing for cataract surgery

    PubMed Central

    Keay, Lisa; Lindsley, Kristina; Tielsch, James; Katz, Joanne; Schein, Oliver

    2014-01-01

    Background Cataract surgery is practiced widely and substantial resources are committed to an increasing cataract surgical rate in developing countries. With the current volume of cataract surgery and the increases in the future, it is critical to optimize the safety and cost-effectiveness of this procedure. Most cataracts are performed on older individuals with correspondingly high systemic and ocular comorbidities. It is likely that routine preoperative medical testing will detect medical conditions, but it is questionable whether these conditions should preclude individuals from cataract surgery or change their perioperative management. Objectives (1) To investigate the evidence for reductions in adverse events through preoperative medical testing, and (2) to estimate the average cost of performing routine medical testing. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 12), MEDLINE (January 1950 to December 2011), EMBASE (January 1980 to December 2011), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to December 2011), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 9 December 2011. We used reference lists and the Science Citation Index to search for additional studies. Selection criteria We included randomized clinical trials in which routine preoperative medical testing was compared to no preoperative or selective preoperative testing prior to age-related cataract surgery. Data collection and analysis Two review authors independently assessed abstracts to identify possible trials for inclusion. For each included study, two review authors independently documented study characteristics, extracted data, and assessed methodological quality. Main results The three randomized clinical trials included in this review reported results for 21,531 total cataract surgeries with 707 total surgery-associated medical adverse events, including 61 hospitalizations and three deaths. Of the 707 medical adverse events reported, 353 occurred in the pretesting group and 354 occurred in the no testing group. Most events were cardiovascular and occurred during the intraoperative period. Routine preoperative medical testing did not reduce the risk of intraoperative (OR 1.02, 95% CI 0.85 to 1.22) or postoperative medical adverse events (OR 0.96, 95% CI 0.74 to 1.24) when compared to selective or no testing. Cost savings were evaluated in one study which estimated the costs to be 2.55 times higher in those with preoperative medical testing compared to those without preoperative medical testing. There was no difference in cancellation of surgery between those with preoperative medical testing and those with no or limited preoperative testing, reported by two studies. Authors' conclusions This review has shown that routine pre-operative testing does not increase the safety of cataract surgery. Alternatives to routine preoperative medical testing have been proposed, including self-administered health questionnaires, which could substitute for health provider histories and physical examinations. Such avenues may lead to cost-effective means of identifying those at increased risk of medical adverse events due to cataract surgery. However, despite the rare occurrence, adverse medical events precipitated by cataract surgery remain a concern because of the large number of elderly patients with multiple medical comorbidities who have cataract surgery in various settings. The studies summarized in this review should assist recommendations for the standard of care of cataract surgery, at least in developed settings. Unfortunately, in developing country settings, medical history questionnaires would be useless to screen for risk since few people have ever been to a physician, let alone been diagnosed with any chronic disease. PMID:22419323

  18. Minimizing the Risk of Preoperative Brain Injury in Neonates with Aortic Arch Obstruction

    PubMed Central

    Algra, Selma O.; Haas, Felix; Poskitt, Kenneth J.; Groenendaal, Floris; Schouten, Antonius N. J.; Jansen, Nicolaas J. G.; Azakie, Anthony; Gandhi, Sanjiv; Campbell, Andrew; Miller, Steven P.; McQuillen, Patrick S.; de Vries, Linda S.

    2015-01-01

    Objective To determine whether prenatal diagnosis lowers the risk of preoperative brain injury by assessing differences in the incidence of preoperative brain injury across centers. Study design From 2 prospective cohorts of newborns with complex congenital heart disease studied by preoperative cerebral magnetic resonance imaging, one cohort from the University Medical Center Utrecht (UMCU) and a combined cohort from the University of California San Francisco (UCSF) and University of British Columbia (UBC), patients with aortic arch obstruction were selected and their imaging and clinical course reviewed. Results Birth characteristics were comparable between UMCU (n = 33) and UCSF/UBC (n = 54). Patients had a hypoplastic aortic arch with either coarctation/interruption or hypoplastic left heart syndrome. In subjects with prenatal diagnosis, there was a significant difference in the prevalence of white matter injury (WMI) between centers (11 of 22 [50%] at UMCU vs 4 of 30 [13%] at UCSF/UBC; P < .01). Prenatal diagnosis was protective for WMI at UCSF/UBC (13% prenatal diagnoses vs 50% postnatal diagnoses; P < .01), but not at UMCU (50% vs 46%, respectively; P > .99). Differences in clinical practice between prenatally diagnosed subjects at UMCU vs UCSF/UBC included older age at surgery, less time spent in the intensive care unit, greater use of diuretics, less use of total parenteral nutrition (P < .01), and a greater incidence of infections (P = .01). In patients diagnosed postnatally, the prevalence of WMI was similar in the 2 centers (46%at UMCU vs 50% at UCSF/UBC; P > .99). Stroke prevalence was similar in the 2 centers regardless of prenatal diagnosis (prenatal diagnosis: 4.5% at Utrecht vs 6.7% at UCSF/UBC, P = .75; postnatal diagnosis: 9.1% vs 13%, respectively, P > .99). Conclusion Prenatal diagnosis can be protective for WMI, but this protection may be dependent on specific clinical management practices that differ across centers. PMID:25306190

  19. Obstructive jaundice in a metastatic tumor of the pancreas from breast cancer: a case report.

    PubMed

    Kitamura, Naomi; Murata, Satoshi; Abe, Hajime; Hanasawa, Kazuyoshi; Tsukashita, Shizuki; Tani, Tohru

    2003-02-01

    Metastatic pancreas tumors from breast cancer are comparatively uncommon and patients with this tumor usually remain asymptomatic during their life. A 55-year-old woman presented with obstructive jaundice following mastectomy for invasive ductal carcinoma. We diagnosed obstructive jaundice due to a pancreatic tumor demonstrated on computed tomography and performed percutaneous transhepatic cholangio-drainage. Although the patient recovered from the jaundice, she had exacerbation of pneumonia from which she died. At autopsy, invasive ductal carcinoma was found in the pancreas tumor. Immunohistochemical staining was performed to confirm whether the pancreatic tumor was primary or secondary. Human milk fat globules 1 and 2 and gross cystic disease fluid protein-15, which characteristically exist in normal breast tissue or breast carcinoma, were expressed both in the primary breast tumor and the pancreatic tumor. In contrast, both the anti-estrogen receptor and anti-progesterone receptor antibodies stained positively in the primary breast cancer; however, neither of them was positive in the metastatic pancreatic tumor. We report a rare case of a patient who presented with obstructive jaundice from a pancreatic tumor metastasizing from breast cancer and in whom immunohistochemical staining using the antibodies unique to the mammary gland was effective for the diagnosis of this secondary tumor. PMID:12629061

  20. A case study of a collision tumor composed of cancers of the bile duct and pancreas.

    PubMed

    Izumi, Hideki; Furukawa, Daisuke; Yazawa, Naoki; Masuoka, Yoshihito; Yamada, Misuzu; Tobita, Kosuke; Kawashima, Yohei; Ogawa, Masami; Kawaguchi, Yoshiaki; Hirabayashi, Kenichi; Nakagohri, Toshio

    2015-12-01

    In this case report, we describe the extremely rare case of a collision tumor comprising cancers of the bile duct and the pancreas. A 70-year-old man was referred to our hospital with a diagnosis of obstructive jaundice. He was diagnosed with pancreatic head cancer, and we performed a pancreaticoduodenectomy with lymph node dissection. At laparotomy, there were two palpable masses in the vicinity of the confluence of the cystic duct and the head of the pancreas. The resected specimen demonstrated tumors at the confluence of the cystic duct and in the pancreatic head. Histopathological examination demonstrated a moderately differentiated tubular adenocarcinoma in the pancreatic head and a well-differentiated tubular adenocarcinoma at the confluence of the cystic duct. Immunostaining was negative for p53 and MUC6 in the pancreatic head tumor; however, immunostaining was positive for both in the tumor located at the confluence of the cystic duct. The two tumors were histologically different and were diagnosed as collision cancer caused by the collision of the bile duct and pancreatic cancers. PMID:26943405

  1. INTESTINAL ATRESIA OR STENOSIS IN THE NEWBORN—Associated with Fibrocystic Disease of the Pancreas

    PubMed Central

    Donnell, George N.; Cleland, Robert S.

    1961-01-01

    In a review of cases of intestinal atresia or stenosis in the newborn at Children's Hospital of Los Angeles it was noted that in approximately 10 per cent there was clinical or anatomic evidence of fibrocystic disease of the pancreas. Histologic sections of the bowel in all these cases showed the alterations of the mucosa commonly found in fibrocystic disease. Extensive ulceration, foreign body reaction and calcium deposition in the bowel wall were observed in five cases. Sections through the site of obstruction in one patient showed narrowing of the diameter of the bowel with preservation of muscular layers, but replacement of the central portion by a vascular, fibrous diaphragm in which giant cells, hemosiderin and calcium were prominent. This suggested that in certain instances obstruction of the intestine may be caused by fibrosis secondary to injury of the mucosa by abnormal meconium. Awareness of the common association of intestinal obstruction and fibrocystic disease of the pancreas and recognition of the histologic change in the bowel in fibrocystic disease may lead to early diagnosis of this disorder in some infants with intestinal obstruction. ImagesFigure 1.Figure 2.Figure 3.Figure 4.Figure 5. PMID:13723755

  2. [Serous cystadenoma of the pancreas showing enlargement on images: a case report].

    PubMed

    Nakamoto, Mitsuhiro; Minagawa, Noritaka; Yamaguchi, Koji

    2012-06-01

    Serious Cystadenoma (SCA) of the Pancreas is seldom malignant and is usually monitored over time. Here we report a case of SCA an enlarged cyst that had to be excised because it was difficult to diagnose by intraductal papillary-mucinous neoplasm (IPMN). The patient was a 58-year-old woman with thecoma of the right ovary accompanied by Meigs syndrome, who had undergone abdominal total hysterectomy and bilateral oophorectomy. Abdominal computed tomography scan (CT) showed a multilocular cyst 2.4 cm in diameter in the head of the pancreas. Fourteen months later, a periodic CT showed that the multilocular cyst had enlarged from 2.4 to 3.5 cm in diameter. Branch duct intraductal papillary-mucinous neoplasm (IPMN) with a tendency to enlargement and with mural nodule was suspected. Pylorus-preserving pancreatoduodenectomy (PPPD) was performed, and pathological findings revealed that the cyst was lined with a single layer of simple cuboidal epithelium. Periodic acid-Shiff staining, with and without diastase digestion, showed abundant glycogen within epithelial cells, yielding a definitive diagnosis of SCA. The ascites were probably due to the Meigs syndrome pressing the cyst, and the size of the cyst appeared smaller than the real size. PMID:22768427

  3. Preoperative simulation of outcomes using adaptive optics.

    PubMed

    Bille, J F

    2000-01-01

    Measurements of the wavefront of light reflected from the retina of the human eye can be used to determine optical aberrations of the human eye for large pupils. An instrument based on the Hartmann-Shack principle was developed. The wavefront is refracted by a microlens array and detected by a CCD camera. In first clinical studies human volunteer eyes and preoperative and postoperative refractive surgical patient eyes have been examined. An adaptive optical closed loop system has been devised for preoperative simulation of refractive outcomes of aberration free refractive surgical procedures. PMID:11019883

  4. Correlating Preoperative Imaging with Histologic Subtypes of Renal Cell Carcinoma and Common Mimickers.

    PubMed

    Gordetsky, Jennifer; Zarzour, Jessica

    2016-07-01

    Renal cell carcinoma (RCC) consists of distinct subtypes that have unique pathologic and imaging features as well as specific cytogenetic and molecular characteristics. As the prognosis and therapeutic strategies may differ for each subtype, correlation of the preoperative imaging with the pathologic findings is of great clinical relevance. In addition, differentiation of RCC from benign entities is ideal in order to prevent overtreatment. However, a noninvasive diagnosis with imaging alone is not always straightforward due to the overlapping appearance of RCC with benign lesions such as fat-poor angiomyolipoma and oncocytoma. With new imaging modalities, there have been significant improvements in correlating preoperative imaging with pathologic characteristics. These new discoveries are able to aid in a more specific, noninvasive, diagnosis that in turn helps direct patient management. PMID:27154238

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

    SciTech Connect

    Yamamoto, Kaoru; Miyatsuka, Takeshi; Tanaka, Ayako; Toyoda, Shuichi; Kato, Ken; Shiraiwa, Toshihiko; Fujitani, Yoshio; Yamasaki, Yoshimitsu; Hori, Masatsugu; Matsuhisa, Munehide; Matsuoka, Taka-aki; Kaneto, Hideaki

    2007-11-30

    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.

  6. [Present status of preoperative staging and contemplation on preoperative precision staging for gastric cancer].

    PubMed

    Zhu, Zhenggang

    2016-02-25

    The aim of the preoperative staging of gastric cancer was to evaluate the depth of tumor infiltration (T-stage), the extent or number of metastasized lymph nodes (N-stage), and distant metastasis (M-stage) before surgery, to develop an optimal therapeutic scheme for the patients with gastric cancer. Traditional methods of preoperative staging for gastric cancer are usually imaging diagnostic techniques, such as endoscopic ultrasonography (EUS), CT scan, magnetic resonance imaging (MRI) and laparoscopic exploration. At present, the accuracy of preoperative TNM staging of gastric cancer can generally reach 70% to 85% with significant clinical benefit. The accurate preoperative staging for cancer patients can have a major role in determining the final clinical outcome and in predicting the prognosis. According to the concept of "precision medicine", to achieve "preoperative precision staging of gastric cancer", the application of imaging diagnostic techniques must be combined with the analysis of individual genetic information or tumor molecular pathological classification, which should be based on research of the disease genomics, proteomics and metabolomics. In this article, we provide a review of results on preoperative staging of gastric cancer in recent years, and we also discuss how to think about the "preoperative precision staging of gastric cancer", with special emphasis on the potential of molecular imaging techniques, circulating tumor cells (CTCs) or circulating tumor DNA (ctDNA), molecular targets for tumor targeting therapy and molecular pathological classification, etc. in judging bio-molecular behavior of gastric cancer before surgery. PMID:26831874

  7. [Interrelation of the endocrine and exocrine portions of the pancreas].

    PubMed

    Rasulev, N I; Gokhberg, S L

    1982-01-01

    Ultrastructural organization of cells and functional activity of the rat pancreas was studied under peroral administration of 80% glucose solution (4 times, 20 ml every 15 min) and a single subcutaneous administration of insulin (5 units). When glucose was administered, both the exocrine and endocrine parts of the pancreas responded with an increased insulin production, revealed by means of the immunoreactive method, with an intensified synthesis of the digestive enzymes (amilase, protease). Ultrastructural organization of beta-cells demonstrated their sharp functional strain resulting in exhaustion, and in the acinar cells--in an increased secret formation. On the contrary, insulin administration resulted in a sharp decrease of the functional activity in the exocrine part of the pancreas, that was reflected correspondingly in the ultrastructural organization of the acinar cells, while the structure of beta-cells demonstrated a delayed excretion of insulin-containing granules from their cytoplasm. PMID:7039558

  8. A new indication for pancreas transplantation: high grade pancreatic dysplasia.

    PubMed

    Charpentier, Kevin P; Brentnall, Teresa A; Bronner, Mary P; Byrd, David; Marsh, Christopher

    2004-02-01

    A 42-yr-old male presented with a family history of pancreatic carcinoma inherited an autosomal dominant pattern. The development of endocrine and exocrine pancreatic insufficiency served as early markers for neoplastic transformation. Screening endoscopic ultrasound and ERCP showed abnormalities suggestive of pancreatic dysplasia. Total pancreatectomy was performed and pathology confirmed carcinoma in situ, also known as high-grade pancreatic ductal dysplasia or Pan IN-3. The patient's post-operative course was complicated by life threatening, brittle diabetes. Pancreas transplantation was successfully performed. One year following transplantation, the patient has excellent pancreas graft function. He remains insulin free and has no signs of malignancy. Total pancreatectomy followed by pancreas transplantation is a viable therapeutic option for patients in the dysplastic but still pre-malignant phase of familial pancreatic adenocarcinoma who develop hypoglycemic unawareness following total pancreatectomy. PMID:15108779

  9. The evolution of diabetic chronic complications after pancreas transplantation.

    PubMed

    de Sá, João R; Monteagudo, Patricia T; Rangel, Erika B; Melaragno, Cláudio S; Gonzalez, Adriano M; Linhares, Marcelo M; Salzedas, Alcides; Neves, Maria-Deolinda F; Stela, Camila; Medina-Pestana, José O

    2009-01-01

    Pancreas transplantation is an invasive procedure that can restore and maintain normoglycemic level very successfully and for a prolonged period in DM1 patients. The procedure elevates the morbimortality rates in the first few months following the surgery if compared to kidney transplants with living donors, but it offers a better quality of life to patients.Although controversial, several studies have shown the stabilization or the improvement of some of the chronic complications related to diabetes, as well as the extra number of years of life that patients submitted to a double pancreas-kidney transplantation may gain.Recent studies have demonstrated clashing outcomes regarding isolated pancreas transplantations, a fact which reinforces the need for a more discerning selection of patients for this procedure. PMID:19825148

  10. The evolution of diabetic chronic complications after pancreas transplantation

    PubMed Central

    de Sá, João R; Monteagudo, Patricia T; Rangel, Érika B; Melaragno, Cláudio S; Gonzalez, Adriano M; Linhares, Marcelo M; Salzedas, Alcides; Neves, Maria-Deolinda F; Stela, Camila; Medina-Pestana, José O

    2009-01-01

    Pancreas transplantation is an invasive procedure that can restore and maintain normoglycemic level very successfully and for a prolonged period in DM1 patients. The procedure elevates the morbimortality rates in the first few months following the surgery if compared to kidney transplants with living donors, but it offers a better quality of life to patients. Although controversial, several studies have shown the stabilization or the improvement of some of the chronic complications related to diabetes, as well as the extra number of years of life that patients submitted to a double pancreas-kidney transplantation may gain. Recent studies have demonstrated clashing outcomes regarding isolated pancreas transplantations, a fact which reinforces the need for a more discerning selection of patients for this procedure. PMID:19825148

  11. Cystadenomas of the pancreas: is enucleation an adequate operation?

    PubMed Central

    Talamini, M A; Moesinger, R; Yeo, C J; Poulose, B; Hruban, R H; Cameron, J L; Pitt, H A

    1998-01-01

    OBJECTIVE: The objective was to determine whether surgical enucleation of mucinous cystadenoma of the pancreas is a safe and adequate operation. SUMMARY BACKGROUND DATA: Mucinous cystadenomas of the pancreas are premalignant cystic lesions. Resection is the preferred treatment but often requires a pancreatoduodenectomy or a distal pancreatectomy with or without a splenectomy. Although these procedures can now be performed with a low mortality rate, substantial morbidity still occurs, especially in patients who have an otherwise normal pancreas. METHODS: Between January 1990 and June 1997, 36 mucinous cystadenomas of the pancreas were resected at The Johns Hopkins Hospital. Most of these patients underwent pancreatoduodenectomy or distal pancreatectomy. However, 10 patients (28%) underwent enucleation of their cystic tumor. These 10 patients had a mean age of 63 years, and 6 were men. The cystic lesion was demonstrated by computed tomography in all patients. Enucleation of the cyst was performed in each patient, and four underwent another concomitant abdominal procedure. These 10 patients were followed with periodic computed tomographic scans and clinical examinations. RESULTS: Enucleation took less time and was associated with less blood loss than resection. Pancreatic fistulas occurred more frequently after enucleation, but the incidence of major complications was similar between the two groups. Follow-up after enucleation averaged 43 months, and none of the patients developed late sequelae or recurrence. CONCLUSIONS: This experience suggests that enucleation of mucinous cystadenomas of the pancreas can be performed safely and that the recurrence rate is low after this procedure. The authors conclude that enucleation is an adequate procedure for benign cystic neoplasms of the pancreas. Images Figure 2. Figure 4. PMID:9637553

  12. The Artificial Pancreas: How Sweet Engineering Will Solve Bitter Problems

    PubMed Central

    Klonoff, David C.

    2007-01-01

    An artificial pancreas is a closed-loop system containing only synthetic materials which substitutes for an endocrine pancreas. No artificial pancreas system is currently approved; however, devices that could become components of such a system are now becoming commercially available. An artificial pancreas will consist of functionally integrated components that will continuously sense glucose levels, determine appropriate insulin dosages, and deliver the insulin. Any proposed closed loop system will be closely scrutinized for its safety, efficacy, and economic impact. Closed loop control utilizes models of glucose homeostasis which account for the influences of feeding, stress, insulin, exercise, and other factors on blood glucose levels. Models are necessary for understanding the relationship between blood glucose levels and insulin dosing; developing algorithms to control insulin dosing; and customizing each user's system based on individual responses to factors that influence glycemia. Components of an artificial pancreas are now being developed, including continuous glucose sensors; insulin pumps for parenteral delivery; and control software, all linked through wireless communication systems. Although a closed-loop system providing glucagon has not been reported in 40 years, the use of glucagon to prevent hypoglycemia is physiologically attractive and future devices might utilize this hormone. No demonstration of long-term closed loop control of glucose in a free-living human with diabetes has been reported to date, but many centers around the world are working on closed loop control systems. It is expected that many types of artificial pancreas systems will eventually be available, and they will greatly benefit patients with diabetes. PMID:19888383

  13. Microencapsulation of Pancreatic Islets for Use in a Bioartificial Pancreas

    PubMed Central

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

    2013-01-01

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

  14. Pancreas tumor model in rabbit imaged by perfusion CT scans

    NASA Astrophysics Data System (ADS)

    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

    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.

  15. Ectopic Pancreas Presenting as a Solid Mediastinal Mass.

    PubMed

    Koh, Hyun Min; Chang, Jee Won; Jeong, Sun Young; Hyun, Chang Lim; Kim, Young Sill; Jang, Bo Geun; Maeng, Young Hee

    2015-10-01

    Ectopic pancreas is a well-known developmental anomaly found in approximately 2% of all autopsies, frequently in the gastrointestinal tract. Mediastinal pancreatic ectopia is very rare; only a few cases have been described in the English-language literature. According to previous reports, the pancreatic tissue is detected in the cyst wall or appears as small solid components of cystic masses within the anterior mediastinum. In this report, we present a case of ectopic pancreas appearing as a large solid mass in the anterior mediastinum of a 17-year-old male patient. PMID:26215218

  16. Multidisciplinary approach to tumors of the pancreas and biliary tree.

    PubMed

    Brown, Kimberly M

    2009-02-01

    Tumors of the pancreas and biliary tree remain formidable challenges to patients and clinicians. These tumors elude early detection, rapidly spread locally and systemically, and frequently recur despite apparently complete resection. Cystic tumors of the pancreas, however, may represent a subset of patients who do not uniformly require aggressive resection, and a thoughtful, evidence-based approach to work-up allows for the rational application of surgical therapy. Increasing evidence supports treating patients who have pancreaticobiliary disease in a multidisciplinary setting. PMID:19186234

  17. Intrathoracic major duodenal papilla with transhiatal herniation of the pancreas and duodenum: A case report and review of the literature

    PubMed Central

    Jäger, Tarkan; Neureiter, Daniel; Nawara, Clemens; Dinnewitzer, Adam; Öfner, Dietmar; Lamadé, Wolfram

    2013-01-01

    Transhiatal herniation of the pancreas is an extremely rare condition. In the published literature we found only eleven cases reported in the period of 1958 to 2011. A coincidental hiatal herniation of the duodenum is described in two cases only. To our knowledge, we report the first case with a hiatal herniation of the complete duodenum and proximal pancreas presenting an intrathoracic major duodenal papilla with consecutive intrahepatic and extrahepatic cholestasis. A 72-year-old Caucasian woman was admitted to our department with a hiatal hernia grade IV for further evaluation. According to our recommendation of surgical hernia repair soon after the diagnosis of a transhiatal herniation of the proximal pancreas and entire duodenum, we had to respect the declared intention of the patient for a conservative procedure. So we were forced to wait for surgical repair within an emergency situation complicated by a myocardial infarction and reduced general condition. We discuss the therapeutic decision making process and a complete literature review of this rare entity. PMID:23805366

  18. 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...

  19. Artificial Pancreas to Get Long-Term 'Real-Life' Trial

    MedlinePlus

    ... nlm.nih.gov/medlineplus/news/fullstory_156528.html Artificial Pancreas to Get Long-Term 'Real-Life' Trial ... News) -- A long-term clinical trial of an artificial pancreas designed to control blood sugar levels in ...

  20. Preoperational test report, primary ventilation system

    SciTech Connect

    Clifton, F.T.

    1997-11-04

    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.

  1. Preoperational test report, vent building ventilation system

    SciTech Connect

    Clifton, F.T.

    1997-11-04

    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.

  2. Under Utilization of Pancreas Transplants in Cystic Fibrosis Recipients in the United Network Organ Sharing (UNOS) Data 1987-2014.

    PubMed

    Usatin, D J; Perito, E R; Posselt, A M; Rosenthal, P

    2016-05-01

    Despite a high prevalence of pancreatic endocrine and exocrine insufficiency in cystic fibrosis (CF), pancreas transplantation is rarely reported. United Network for Organ Sharing (UNOS) data were used to examine utilization of pancreas transplant and posttransplant outcomes in CF patients. Between 1987-2014, CF patients (N = 4600) underwent 17 liver-pancreas, three lung-pancreas, one liver-lung pancreas, four kidney-pancreas, and three pancreas-only transplants. Of the 303 CF patients who received liver transplantation, 20% had CF-related diabetes (CFRD) before transplantation, and nine of those received a liver-pancreas transplant. Of 4241 CF patients who underwent lung transplantation, 33% had CFRD before transplantation, and three of those received a pancreas transplant. Of 49 CF patients who received a liver-lung transplant, 57% had CFRD before transplantation and one received a pancreas transplant. Posttransplantation diabetes developed in 7% of CF pancreas transplant recipients versus 24% of CF liver and 29% of CF lung recipients. UNOS has no data on pancreas exocrine insufficiency. Two-year posttransplantation survival was 88% after liver-pancreas transplant, 33% after lung-pancreas transplant, and 100% after pancreas-kidney and pancreas-only transplants. Diabetes is common pretransplantation and posttransplantation in CF solid organ transplant recipients, but pancreas transplantation remains rare. Further consideration of pancreas transplant in CF patients undergoing other solid organ transplant may be warranted. PMID:26603034

  3. Can mood disorder in women with breast cancer be identified preoperatively?

    PubMed Central

    Ramirez, A. J.; Richards, M. A.; Jarrett, S. R.; Fentiman, I. S.

    1995-01-01

    The Hospital Anxiety and Depression (HAD) scale, a self-report questionnaire, was tested as a method of identifying mood disorder among patients with operable breast cancer during the year after diagnosis. In a cohort of 91 patients anxiety and depression were assessed preoperatively, and at 3 and 12 months post-operatively, using a standardised psychiatric interview and diagnostic rating criteria. The patients also completed the HAD scale at each assessment. Fifty out of 91 (55%) patients were full or borderline cases of depression and/or anxiety at one or more assessment points. Using a receiver operator characteristic curve analysis, the optimum threshold for the preoperative HAD scale total score to identify psychiatric disorder either preoperatively or at 3 and 12 months post-operatively was 11. With this threshold 70% of both full and borderline cases occurring at any of the assessment points were correctly identified. The false-positive rate was 12%. This approach was particularly sensitive to full cases, correctly identifying 90% of them. The potential for the preoperative HAD scale total score to identify mood disorder in the year after diagnosis was influenced by age. Among women aged less than 50 years, a preoperative HAD scale total score > or = 11 provided a highly sensitive indicator of mood disorder (full and borderline cases) at any time in the year after diagnosis (sensitivity = 90%). The false-positive rate was 40%. Among women older than 50 who experienced a mood disorder, only 57% were correctly identified by a HAD scale total score of > or = 11 (sensitivity = 57%). However, the false-positive rate among older women was low (3%). This simple preoperative screening approach can be used to identify patients who have or are at high risk of developing severe mood disorder in the year after diagnosis. The HAD scale is also sensitive to the detection of borderline mood disorder in patients under the age of 50. It is a specific screening tool among patients over 50, but is not sensitive to the detection of borderline mood disorder in this age group. PMID:8519668

  4. Pearson marrow pancreas syndrome in patients suspected to have Diamond-Blackfan anemia.

    PubMed

    Gagne, Katelyn E; Ghazvinian, Roxanne; Yuan, Daniel; Zon, Rebecca L; Storm, Kelsie; Mazur-Popinska, Magdalena; Andolina, Laura; Bubala, Halina; Golebiowska, Sydonia; Higman, Meghan A; Kalwak, Krzysztof; Kurre, Peter; Matysiak, Michal; Niewiadomska, Edyta; Pels, Salley; Petruzzi, Mary Jane; Pobudejska-Pieniazek, Aneta; Szczepanski, Tomasz; Fleming, Mark D; Gazda, Hanna T; Agarwal, Suneet

    2014-07-17

    Pearson marrow pancreas syndrome (PS) is a multisystem disorder caused by mitochondrial DNA (mtDNA) deletions. Diamond-Blackfan anemia (DBA) is a congenital hypoproliferative anemia in which mutations in ribosomal protein genes and GATA1 have been implicated. Both syndromes share several features including early onset of severe anemia, variable nonhematologic manifestations, sporadic genetic occurrence, and occasional spontaneous hematologic improvement. Because of the overlapping features and relative rarity of PS, we hypothesized that some patients in whom the leading clinical diagnosis is DBA actually have PS. Here, we evaluated patient DNA samples submitted for DBA genetic studies and found that 8 (4.6%) of 173 genetically uncharacterized patients contained large mtDNA deletions. Only 2 (25%) of the patients had been diagnosed with PS on clinical grounds subsequent to sample submission. We conclude that PS can be overlooked, and that mtDNA deletion testing should be performed in the diagnostic evaluation of patients with congenital anemia. PMID:24735966

  5. A rare cause of susceptibility to neutropenic sepsis in a patient with metastatic pancreas cancer

    PubMed Central

    Suarez Martinez-Falero, Beatriz; Gillmore, Roopinder

    2014-01-01

    A 71-year-old patient receiving combination chemotherapy (irinotecan, oxaliplatin and 5-fluorouracil (5-FU)) for metastatic pancreas cancer was admitted after her first cycle of chemotherapy with a severe and unexpectedly prolonged episode of neutropenic sepsis associated with pancytopenia and marked mucositis. Owing to the unusual picture, the patient was tested for mutations in the gene encoding the enzyme dihydropyrimidine dehydrogenase (DPD)—an enzyme involved in the metabolism of the chemotherapy drug 5-FU. The patient was found to be heterozygous for a mutation, DPD IVS14+1G>A, leading to the severe toxicity exhibited following this regimen caused by delayed metabolism of 5-FU. She was treated aggressively with supportive care and recovered from this episode. Importantly she was subsequently switched to an alternative chemotherapy regimen to treat her disease. She continues to maintain an excellent quality of life some 9 months after her initial diagnosis on third-line chemotherapy. PMID:24700034

  6. [Heterotopic pancreas as a cause of intussusception: first case reported in Peru].

    PubMed

    Bazn Zender, Carlos; Reyes Coloma, Luis; Len Cueto, Jos Luis; Revoredo Palacios, Giancarlo; Arias Stella Castillo, Javier; Pezo, Alonso

    2015-01-01

    The heterotopic pancreas (HP) is a rare condition in the pediatric population. HP cases involving an ileal intussusception are rare in children and very rarely reported, usually presenting with symptoms of intestinal obstruction. We report the case of a one year old male patient with a chronic history of anorexia, irritability, abdominal pain, accompanied by intermittent episodes of "currant jelly" stools that evolved to rectal bleeding. The patient presented a concomitant diagnosis of allergic colitis, which prolonged the effective surgical treatment at an external health center. In the abdominal CT scan, the classic "target" sign was found. In the exploratory laparotomy an ileoileal intussusception was confirmed, a mass was found that the histopathology laboratory confirmed as HP. To our knowledge, it is the first case of pediatric intussusception by HP reported in Peru. PMID:26580946

  7. Intraductal Papillary Mucinous Neoplasm of the Pancreas: Current State of the Art and Ongoing Controversies.

    PubMed

    Fong, Zhi Ven; Ferrone, Cristina R; Lillemoe, Keith D; Fernández-Del Castillo, Carlos

    2016-05-01

    With the widespread use and advances in radiographic imaging, Intraductal Papillary Mucinous Neoplasms (IPMNs) of the pancreas are identified with increasing frequency. Although many studies have addressed its biology and treatment, true understanding of its natural history continues to elude us. Its malignant potential places careproviders in a clinical dilemma of balancing the morbidity of pancreatectomy against the risk of malignant transformation while under continuous surveillance. Recently, there have been conflicting data published in the literature, generating more uncertainty in the field. In this article, we critically analyze the contrasting consensus guidelines from the International Association of Pancreatology and the American Gastroenterology Association, and address lingering questions and controversies. We also synthesize newly published data in the context of current standard of care, and provide a comprehensive review and recommendations for the clinical diagnosis, treatment, and follow-up strategy in the management of patients with Intraductal Papillary Mucinous Neoplasms. PMID:26727096

  8. Merkel cell carcinoma of unknown primary with lymph node and mesenteric metastasis involving the pancreas and duodenum

    PubMed Central

    Lim, Brian S.; Flannery, Christopher M.; Koh, Stephen S.; Yaghsezian, Harout

    2016-01-01

    Merkel cell carcinoma (MCC) of skin is a rare, aggressive cutaneous malignancy of neuroendocrine origin. MCC predominantly affects elderly Caucasians and has high predilection for sun exposed areas. Histologic exam and immunohistochemical profile is required to establish the diagnosis. It has high propensity for local recurrence and metastasis, and carries poor prognosis. However, metastasis to mesentery involving the duodenum is very uncommon and rarely reported in literature. We hereby describe a patient with lymph node and mesenteric metastasis invading duodenum and pancreas with unknown primary origin of MCC. PMID:27034815

  9. Merkel cell carcinoma of unknown primary with lymph node and mesenteric metastasis involving the pancreas and duodenum.

    PubMed

    Yaramada, Priyanka; Lim, Brian S; Flannery, Christopher M; Koh, Stephen S; Yaghsezian, Harout

    2016-04-01

    Merkel cell carcinoma (MCC) of skin is a rare, aggressive cutaneous malignancy of neuroendocrine origin. MCC predominantly affects elderly Caucasians and has high predilection for sun exposed areas. Histologic exam and immunohistochemical profile is required to establish the diagnosis. It has high propensity for local recurrence and metastasis, and carries poor prognosis. However, metastasis to mesentery involving the duodenum is very uncommon and rarely reported in literature. We hereby describe a patient with lymph node and mesenteric metastasis invading duodenum and pancreas with unknown primary origin of MCC. PMID:27034815

  10. Juxtaglomerular cell tumor that was preoperatively diagnosed using selective renal venous sampling.

    PubMed

    Osawa, Saeko; Hosokawa, Yoshiya; Soda, Tetsuji; Yasuda, Tetsuyuki; Kaneto, Hideaki; Kitamura, Tetsuhiro; Kozawa, Junji; Otsuki, Michio; Imagawa, Akihisa; Okumi, Masayoshi; Miyagawa, Yasushi; Nonomura, Norio; Shimomura, Iichiro

    2013-01-01

    We herein report the case of a patient with a juxtaglomerular cell tumor (JCT). Dynamic enhanced computed tomography revealed a small nodule on the surface of the lower pole of the right kidney. Selective renal venous sampling showed an elevated level of plasma renin activity (PRA) in the right lower pole renal vein only. We performed right partial nephrectomy and diagnosed the patient with JCT. Making a diagnosis of JCT is often difficult due to the small size of the tumor and the lack of lateralization of the PRA on renal venous sampling. This case highlights the importance of performing selective renal venous sampling for the preoperative diagnosis of JCT. PMID:23994987

  11. Preoperative Chemotherapy Versus Preoperative Chemoradiotherapy for Stage III (N2) Non-Small-Cell Lung Cancer

    SciTech Connect

    Higgins, Kristin; Chino, Junzo P.; Marks, Lawrence B.; Ready, Neal; D'Amico, Thomas A.; Clough, Robert W.; Kelsey, Chris R.

    2009-12-01

    Purpose: To compare preoperative chemotherapy (ChT) and preoperative chemoradiotherapy (ChT-RT) in operable Stage III non-small-cell lung cancer. Methods and Materials: This retrospective study analyzed all patients with pathologically confirmed Stage III (N2) non-small-cell lung cancer who initiated preoperative ChT or ChT-RT at Duke University between 1995 and 2006. Mediastinal pathologic complete response (pCR) rates were compared using a chi-square test. The actuarial overall survival, disease-free survival, and local control were estimated using the Kaplan-Meier method and compared using the log-rank test. Multivariate Cox regression analysis was also performed. Results: A total of 101 patients who initiated preoperative therapy with planned resection were identified. The median follow-up was 20 months for all patients and 38 months for survivors. The mediastinal lymph nodes were reassessed after preoperative therapy in 88 patients (87%). Within this group, a mediastinal pCR was achieved in 35% after preoperative ChT vs. 65% after preoperative ChT-RT (p = 0.01). Resection was performed in 69% after ChT and 84% after ChT-RT (p = 0.1). For all patients, the overall survival, disease-free survival, and local control rate at 3 years was 40%, 27%, and 66%, respectively. No statistically significant differences were found in the clinical endpoints between the ChT and ChT-RT subgroups. On multivariate analysis, a mediastinal pCR was associated with improved disease-free survival (p = 0.03) and local control (p = 0.03), but not overall survival (p = 0.86). Conclusion: Preoperative ChT-RT was associated with higher mediastinal pCR rates but not improved survival.

  12. Diagnosis and management of endocrine gland neoplasmas. Revision 1

    SciTech Connect

    Weller, R.E.

    1994-03-01

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

  13. Stimulus-secretion coupling in the developing exocrine pancreas

    SciTech Connect

    Chang, A.Y.S.

    1986-01-01

    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.

  14. Peripheral primitive neuroectodermal tumors arising in the pancreas: the first case report in Asia and a review of the 14 total reported cases in the world

    PubMed Central

    Sang, Xinting; Liang, Naixin; Yang, Huayu; Lu, Xin; Yang, Zhiying; Du, Shunda; Xu, Yiyao; Zhao, Haitao; Zhong, Shouxian; Huang, Jiefu; Millis, J. Michael

    2013-01-01

    Objective To discuss the diagnosis and treatment of peripheral primitive neuroectodermal tumors of the pancreas based on our case and all the cases in the world. Methods The first case of peripheral primitive neuroectodermal tumors of the pancreas in Asia was preliminarily reported by our group in 2006. The patient underwent three operations for the primary tumor and recurrences over 41 months prior to the patient’s death in November 2007. All 14 reported cases of pancreatic PNETs in the world were analyzed. The corresponding literatures on its diagnosis and treatment of were reviewed. Results A 13 year-old female patient was diagnosed with pancreatic PNETs by the clinical, microscopic, immunohistochemical features, and cytogenetic analysis after the resection of the tumor located in the uncinate process of the pancreas at PUMC Hospital. During the follow-up course, radiotherapy and chemotherapy were given after the first operation. Two additional operations were performed 10 months and 25 months after the first one, respectively, because of tumor recurrence. The patient died 41 months after the initial diagnosis with the recurrence and metastasis that were not suitable for a further surgery. Primitive neuroectodermal tumors of the pancreas are extremely rare. A review of the world’s literature on this tumor identified fourteen cases with a mean survival time of 12 months (ranging from 6 to 50 months). These patients often have no specific clinical symptoms, but most do present with abdominal pain and/or jaundice. The diagnosis is established by small round tumor cells seen on light microscopy, immunohistochemical features of positive P30/32MIC2 with at least two positive neuronal markers., and cytogenetic analysis showing characteristic translocation of t[11;22][q24;q12]. Since pancreatic PNETs are highly aggressive, early diagnosis, immediate surgical resection and re-resection if possible, early radiotherapy and chemotherapy and close follow-up are required. Conclusions Peripheral primitive neuroectodermal tumors can arise in pancreas. The diagnosis and treatment should be made as early as possible, aggressive surgeries for the primary and recurrences may help to improve the prognosis. PMID:24570916

  15. Feasibility of automated pancreas segmentation based on dynamic MRI

    PubMed Central

    Gou, S; Wu, J; Liu, F; Lee, P; Rapacchi, S; Hu, P

    2014-01-01

    Objective: MRI-guided radiotherapy is particularly attractive for abdominal targets with low CT contrast. To fully utilize this modality for pancreas tracking, automated segmentation tools are needed. A hybrid gradient, region growth and shape constraint (hGReS) method to segment two-dimensional (2D) upper abdominal dynamic MRI (dMRI) is developed for this purpose. Methods: 2D coronal dynamic MR images of two healthy volunteers were acquired with a frame rate of 5 frames per second. The regions of interest (ROIs) included the liver, pancreas and stomach. The first frame was used as the source where the centres of the ROIs were manually annotated. These centre locations were propagated to the next dMRI frame. Four-neighborhood region transfer growth was performed from these initial seeds before refinement using shape constraints. Results from hGReS and two other automated segmentation methods using integrated edge detection and region growth (IER) and level set, respectively, were compared with manual contours using Dice's index (DI). Results: For the first patient, the hGReS resulted in the organ segmentation accuracy as a measure by the DI (0.77) for the pancreas, superior to the level set method (0.72) and IER (0.71). The hGReS was shown to be reproducible on the second subject, achieving a DI of 0.82, 0.92 and 0.93 for the pancreas, stomach and liver, respectively. Motion trajectories derived from the hGReS were highly correlated to respiratory motion. Conclusion: We have shown the feasibility of automated segmentation of the pancreas anatomy on dMRI. Advances in knowledge: Using the hybrid method improves segmentation robustness of low-contrast images. PMID:25270713

  16. Primary pancreatic hydatid cyst: an unexpected differential diagnosis.

    PubMed

    Hiremath, Bharati; Subramaniam, Narayana; Boggavarapu, Manobhiram

    2015-01-01

    Hydatid disease, caused by the cystic stage of Echinococcus granulosus, most commonly involves the liver (59-75%) and lung (27%), and rarely involves the kidney (3%), bone (1-4%) and brain (1-2%). Even rarer sites include the heart and spleen, and skeletal muscle, with virtually no site being immune. The pancreas is an exceedingly rare site for primary disease (without concomitant involvement of the liver or peritoneum), with less than 20 reported cases in the literature. This case report describes a 48-year-old woman presenting with a solitary cystic lesion arising from the neck of the pancreas, which was ultimately determined to be a hydatid cyst on histopathological examination. It also discusses the difficulties in preoperative and postoperative management and includes a review of the literature. PMID:26336187

  17. Inverted Meckel's diverticulum preoperatively diagnosed using double-balloon enteroscopy.

    PubMed

    Takagaki, Kosuke; Osawa, Satoshi; Ito, Tatsuhiro; Iwaizumi, Moriya; Hamaya, Yasushi; Tsukui, Hiroe; Furuta, Takahisa; Wada, Hidetoshi; Baba, Satoshi; Sugimoto, Ken

    2016-05-01

    An inverted Meckel's diverticulum is a rare gastrointestinal congenital anomaly that is difficult to diagnose prior to surgery and presents with anemia, abdominal pain, or intussusception. Here, we report the case of 57-year-old men with an inverted Meckel's diverticulum, who was preoperatively diagnosed using double-balloon enteroscopy. He had repeatedly experienced epigastric pain for 2 mo. Ultrasonography and computed tomography showed intestinal wall thickening in the pelvis. Double-balloon enteroscopy via the anal route was performed for further examination, which demonstrated an approximately 8-cm, sausage-shaped, submucosal tumor located approximately 80 cm proximal to the ileocecal valve. A small depressed erosion was observed at the tip of this lesion. Forceps biopsy revealed heterotopic gastric mucosa. Thus, the patient was diagnosed with an inverted Meckel's diverticulum, and single-incision laparoscopic surgery was performed. This case suggests that an inverted Meckel's diverticulum should be considered as a differential diagnosis for a submucosal tumor in the ileum. Balloon-assisted enteroscopy with forceps biopsy facilitate a precise diagnosis of this condition. PMID:27158212

  18. Preoperative localization of hyperfunctioning parathyroid glands with 4D-CT.

    PubMed

    Lundstroem, Anke Katrin; Trolle, Waldemar; Soerensen, Christian Hjort; Myschetzky, Peter Sand

    2016-05-01

    Primary hyperparathyroidism (pHPT) is almost exclusively the result of a solitary parathyroid adenoma. In most cases, the affected gland can be surgically removed, but precise preoperative imaging is essential for adenoma localization prior to surgical intervention. In this study, we evaluated the diagnostic value of four-dimensional computed tomography (4D-CT) as a preoperative imaging tool in relation to the localization of pathologic parathyroid glands in patients with pHPT and negative sestamibi scans. This study included 43 consecutive patients with pHPT referred for parathyroidectomy at the Department of Head and Neck Surgery of Copenhagen University Hospital Rigshospitalet in 2011 and 2012. All patients had a 4D-CT performed prior to parathyroidectomy. CT localization of the suspected adenoma was correlated to the actual surgical findings and subsequent histological diagnosis was also available as references for the accuracy of this imaging tool. Hyperfunctioning parathyroid glands were found in 40 patients. 4D-CT identified 32 solitary hyperfunctioning parathyroid glands located on the correct side of the neck (PPV 76 %) and 21 located within the correct quadrant (PPV 49 %). Unilateral resection was performed in 72 % of patients due to the localization findings of preoperative imaging. 4D-CT can, therefore, be considered an effective method for the preoperative localization of parathyroid adenomas and is an important tool in surgical intervention for patients referred to parathyroidectomy. PMID:25773486

  19. [Preoperative pulmonary function analysis and cardiorespiratory risk assessment: the current standard].

    PubMed

    Egenlauf, B; Herth, F J F; Kappes, J

    2014-09-01

    The aim of preoperative lung function analysis and diagnostic cardiology is to identify patients with an increased risk of complications and to best inform the patients about treatment options and risks so that an informed treatment decision can be made. The identification of patients at increased peri-interventional risk by preoperative physiological diagnostics also forms the basis for further developments and improvements of interventions and intervention techniques in order to reduce the risk of complications. The acquisition of a detailed medical history, a thorough physical examination, and the diagnosis using ECG and spirometry may provide the first evidence for the presence of relevant comorbidities. In elective surgery a detailed preoperative evaluation of comorbidities must be done. The association of age and operative mortality is not only due to age alone, but also involves the spectrum of comorbidities. The algorithms for Germany are based on the "S3 Guidelines of the German Society of Pneumology of 2010". Both German and international guidelines recommend the discussion of each case before lung resections in an interdisciplinary case discussion with thoracic surgeons, oncologists, radio-oncologists and pulmonologists. Patients of advanced age should always be subjected to an extended preoperative cardiopulmonary investigation. PMID:25264727

  20. Relationship of preoperative neutrophil lymphocyte ratio with prognosis in gastrointestinal stromal tumors

    PubMed Central

    Kargın, Süleyman; Çakır, Murat; Gündeş, Ebubekir; Yavuz, Yusuf; Esen, Hacı Hasan; Sinan İyisoy, M.; Kökbudak, Naile; Küçükkartallar, Tevfik

    2015-01-01

    Objective: Gastrointestinal stromal tumors are believed to play a role in immunosuppression with their local effect. In some cancers with associated inflammation, an increased pretreatment neutrophil lymphocyte ratio is considered as an indicator of poor prognosis. The aim of our study was to assess the relationship of increased blood neutrophil lymphocyte ratio with disease prognosis in patients with gastrointestinal stromal tumors. Material and Methods: The data of 78 patients who underwent surgery with the diagnosis of primary gastrointestinal stromal tumor in our clinic were evaluated retrospectively. The preoperative neutrophil lymphocyte ratio in the peripheral blood was determined. The neutrophil lymphocyte ratio and its relationship with tumor risk and prognosis were compared. The data were evaluated by Pearson’s correlation analysis and the Welch ANOVA test. Results: The preoperative neutrophil lymphocyte ratio was significantly increased in the high-risk groups (p<0.05). An increased preoperative neutrophil lymphocyte ratio was associated with shorter survival (r=−0.32, p=0.009). In addition, an increase in the neutrophil lymphocyte ratio was associated with an increase in the mitotic activity of the tumor (r=−0.364, p=0.025). Conclusion: The preoperative neutrophil lymphocyte ratio in gastrointestinal stromal tumors can be used as an indicator of high-risk tumors and poor prognosis. PMID:26170750

  1. Diagnosis of pancreatitis in dogs and cats.

    PubMed

    Xenoulis, P G

    2015-01-01

    Pancreatitis is the most common disorder of the exocrine pancreas in both dogs and cats. Ante-mortem diagnosis of canine and feline pancreatitis can be challenging. The clinical picture of dogs and cats with pancreatitis varies greatly (from very mild to severe or even fatal) and is characterised by non-specific findings. Complete blood count, serum biochemistry profile and urinalysis should always be performed in dogs and cats suspected of having pancreatitis, although findings are not-specific for pancreatitis. Serum amylase and lipase activities and trypsin-like immunoreactivity (TLI) concentrations have no or only limited clinical value for the diagnosis of pancreatitis in either dogs or cats. Conversely, serum pancreatic lipase immunoreactivity (PLI) concentration is currently considered to be the clinicopathological test of choice for the diagnosis of canine and feline pancreatitis. Abdominal radiography is a useful diagnostic tool for the exclusion of other diseases that may cause similar clinical signs to those of pancreatitis. Abdominal ultrasonography can be very useful for the diagnosis of pancreatitis, but this depends largely on the clinician's experience. Histopathological examination of the pancreas is considered the gold standard for the diagnosis and classification of pancreatitis, but it is not without limitations. In clinical practice, a combination of careful evaluation of the animal's history, serum PLI concentration and abdominal ultrasonography, together with pancreatic cytology or histopathology when indicated or possible, is considered to be the most practical and reliable means for an accurate diagnosis or exclusion of pancreatitis compared with other diagnostic modalities. PMID:25586803

  2. An analysis of the lack of donor pancreas utilization from younger adult organ donors.

    PubMed

    Wiseman, Alexander C; Wainright, Jennifer L; Sleeman, Elizabeth; McBride, Maureen A; Baker, Tim; Samana, Ciara; Stock, Peter

    2010-09-15

    Donor pancreas utilization rates for whole organ transplant have remained low and have decreased over time. To identify the reasons for nonuse of pancreas from donors who meet common baseline acceptance criteria, we examined Organ Procurement and Transplantation Network data from 2005 to 2007 and identified a subgroup of 1763 "potential pancreas donors" defined by age (19-40 years), body mass index (<30 kg/m), successful liver donation, and negative viral serology testing, which were not used. We characterize this cohort of potential donors including reasons for refusal, factors that may contribute to pancreas acceptance and function, and potential explanations for the lack of growth in pancreas organ utilization. PMID:20595930

  3. Preoperative Embolization of Cervical Spine Tumors

    SciTech Connect

    Vetter, Sylvia C.; Strecker, Ernst-Peter; Ackermann, Ludwig W.; Harms, Juergen

    1997-09-15

    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.

  4. Preoperative Evaluation: Estimation of Pulmonary Risk.

    PubMed

    Lakshminarasimhachar, Anand; Smetana, Gerald W

    2016-03-01

    Postoperative pulmonary complications (PPCs) are common after major non-thoracic surgery and associated with significant morbidity and high cost of care. A number of risk factors are strong predictors of PPCs. The overall goal of the preoperative pulmonary evaluation is to identify these potential, patient and procedure-related risks and optimize the health of the patients before surgery. A thorough clinical examination supported by appropriate laboratory tests will help guide the clinician to provide optimal perioperative care. PMID:26927740

  5. Implications of preoperative hypoalbuminemia in colorectal surgery.

    PubMed

    Truong, Adam; Hanna, Mark H; Moghadamyeghaneh, Zhobin; Stamos, Michael J

    2016-05-27

    Serum albumin has traditionally been used as a quantitative measure of a patient's nutritional status because of its availability and low cost. While malnutrition has a clear definition within both the American and European Societies for Parenteral and Enteral Nutrition clinical guidelines, individual surgeons often determine nutritional status anecdotally. Preoperative albumin level has been shown to be the best predictor of mortality after colorectal cancer surgery. Specifically in colorectal surgical patients, hypoalbuminemia significantly increases the length of hospital stay, rates of surgical site infections, enterocutaneous fistula risk, and deep vein thrombosis formation. The delay of surgical procedures to allow for preoperative correction of albumin levels in hypoalbuminemic patients has been shown to improve the morbidity and mortality in patients with severe nutritional risk. The importance of preoperative albumin levels and the patient's chronic inflammatory state on the postoperative morbidity and mortality has led to the development of a variety of surgical scoring systems to predict outcomes efficiently. This review attempts to provide a systematic overview of albumin and its role and implications in colorectal surgery. PMID:27231513

  6. Preoperative Planning in Primary Total Knee Arthroplasty.

    PubMed

    Tanzer, Michael; Makhdom, Asim M

    2016-04-01

    Preoperative planning is of paramount importance in primary total knee arthroplasty. A thorough preoperative analysis helps the surgeon envision the operation, anticipate any potential issues, and minimize the risk of premature implant failure. Obtaining a thorough history is critical for appropriate patient selection. The physical examination should evaluate the integrity of the soft tissues, the neurovascular status, range of motion, limb deformity, and the status of the collateral ligaments to help determine the soft-tissue balancing and constraint strategy required. Standard radiographs, with a known magnification, should be obtained for preoperative total knee arthroplasty templating. Routine standing AP, lateral, and skyline radiographs of the knee can help the surgeon plan the bone cuts and tibial slope as well as the implant size and position at the time of surgery. In certain circumstances, such as severe coronal deformities, bone deficiencies, and/or extra-articular deformities, additional measures are frequently necessary to successfully reconstruct the knee. Constrained implants, metal augments, and bone graft must be part of the surgeon's armamentarium. PMID:26990712

  7. Implications of preoperative hypoalbuminemia in colorectal surgery

    PubMed Central

    Truong, Adam; Hanna, Mark H; Moghadamyeghaneh, Zhobin; Stamos, Michael J

    2016-01-01

    Serum albumin has traditionally been used as a quantitative measure of a patient’s nutritional status because of its availability and low cost. While malnutrition has a clear definition within both the American and European Societies for Parenteral and Enteral Nutrition clinical guidelines, individual surgeons often determine nutritional status anecdotally. Preoperative albumin level has been shown to be the best predictor of mortality after colorectal cancer surgery. Specifically in colorectal surgical patients, hypoalbuminemia significantly increases the length of hospital stay, rates of surgical site infections, enterocutaneous fistula risk, and deep vein thrombosis formation. The delay of surgical procedures to allow for preoperative correction of albumin levels in hypoalbuminemic patients has been shown to improve the morbidity and mortality in patients with severe nutritional risk. The importance of preoperative albumin levels and the patient’s chronic inflammatory state on the postoperative morbidity and mortality has led to the development of a variety of surgical scoring systems to predict outcomes efficiently. This review attempts to provide a systematic overview of albumin and its role and implications in colorectal surgery. PMID:27231513

  8. Preoperative measurement of ACL insertion sites.

    PubMed

    Schwartzberg, Randy; Snyder, Kevin; Reuss, Bryan

    2015-02-01

    This study was designed to evaluate preoperative predictions of the femoral and tibial ACL insertion lengths. Intraoperative measurements were made of the femoral and tibial ACL insertion lengths with an arthroscopic ruler. A musculoskeletal radiologist and a sports medicine orthopedic surgeon measured the ACL insertions from preoperative magnetic resonance imagings (MRIs) in a blinded fashion. Correlations between height, weight, body mass index, and gender with intraoperative ACL insertion length measures were also evaluated. Patient height and male gender demonstrated strong correlations with intraoperative ACL insertion measures. A moderate correlation was seen between patient weight and intraoperative ACL insertion measures. When evaluating the frequency with which the raters' respective MRI measures were exactly the same as the intraoperative measures, moderate correlations were seen. The radiologist and orthopedic surgeons' MRI measures were within 3 mm of the intraoperative measures 98 and 75% of the time, respectively, for the femur and 92 and 83% of the time, respectively, for the tibia. This study concludes that preoperative MRI measures of ACL insertion lengths can be used to predict intraoperative ACL insertion lengths. Also, it is expected that taller patients and male patients should have greater ACL insertion lengths seen arthroscopically. PMID:24622911

  9. Preoperative Ambulatory Inspiratory Muscle Training in Patients Undergoing Esophagectomy. A Pilot Study

    PubMed Central

    Agrelli, Taciana Freitas; de Carvalho Ramos, Marisa; Guglielminetti, Rachel; Silva, Alex Augusto; Crema, Eduardo

    2012-01-01

    A major decline in pulmonary function is observed on the first day after upper abdominal surgery. This decline can reduce vital and inspiratory capacity and can culminate in restrictive lung diseases that cause atelectasis, reduced diaphragm movement, and respiratory insufficiency. The objective of this study was to evaluate the efficacy of preoperative ambulatory respiratory muscle training in patients undergoing esophagectomy. The sample consisted of 20 adult patients (14 men [70%] and 6 women [30%]) with a diagnosis of advanced chagasic megaesophagus. A significant increase in maximum inspiratory pressure was observed after inspiratory muscle training when compared with baseline values (from −55.059 ± 18.359 to −76.286 ± 16.786). Preoperative ambulatory inspiratory muscle training was effective in increasing respiratory muscle strength in patients undergoing esophagectomy and contributed to the prevention of postoperative complications. PMID:23113846

  10. Preoperative ambulatory inspiratory muscle training in patients undergoing esophagectomy. A pilot study.

    PubMed

    Agrelli, Taciana Freitas; de Carvalho Ramos, Marisa; Guglielminetti, Rachel; Silva, Alex Augusto; Crema, Eduardo

    2012-01-01

    A major decline in pulmonary function is observed on the first day after upper abdominal surgery. This decline can reduce vital and inspiratory capacity and can culminate in restrictive lung diseases that cause atelectasis, reduced diaphragm movement, and respiratory insufficiency. The objective of this study was to evaluate the efficacy of preoperative ambulatory respiratory muscle training in patients undergoing esophagectomy. The sample consisted of 20 adult patients (14 men [70%] and 6 women [30%]) with a diagnosis of advanced chagasic megaesophagus. A significant increase in maximum inspiratory pressure was observed after inspiratory muscle training when compared with baseline values (from -55.059 18.359 to -76.286 16.786). Preoperative ambulatory inspiratory muscle training was effective in increasing respiratory muscle strength in patients undergoing esophagectomy and contributed to the prevention of postoperative complications. PMID:23113846

  11. A novel strategy for long-term implantable artificial pancreas.

    PubMed

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

    2011-01-01

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

  12. Implication of epigenetics in pancreas development and disease.

    PubMed

    Quilichini, Evans; Haumaitre, Cécile

    2015-12-01

    Pancreas development is controlled by a complex interaction of signaling pathways and transcription factor networks that determine pancreatic specification and differentiation of exocrine and endocrine cells. Epigenetics adds a new layer of gene regulation. DNA methylation, histone modifications and non-coding RNAs recently appeared as important epigenetic factors regulating pancreas development. In this review, we report recent findings obtained by analyses in model organisms as well as genome-wide approaches that demonstrate the role of these epigenetic regulators in the control of exocrine and endocrine cell differentiation, identity, function, proliferation and regeneration. We also highlight how altered epigenetic processes contribute to pancreatic disorders: diabetes and pancreatic cancer. Uncovering these epigenetic events can help to better understand these diseases, provide novel therapeutical targets for their treatment, and improve cell-based therapies for diabetes. PMID:26696517

  13. Immunosuppression in pancreas transplantation: the Euro SPK trials and beyond.

    PubMed

    Malaise, J; De Roover, A; Squifflet, J P; Land, W; Neuhaus, P; Pratschke, J; Kahl, A; Pascher, A; Boas-Knoop, S; Arbogast, H; Hoffmann, J; Illner, W D; Seissler; Schlamp; Viebahn; Wunsch; Hajt; Klar, E; Scharek, W; Hopt; Pisarski, P; Drognitz, O; Thurow, C; Dette, K; Bechstein, W O; Woeste, G; Klempnauer, J; Becker, T; Lück; Neipp; Königsrainer, A; Steurer, W; Margreiter, R; Mark; Bonatti; Saudek, F; Boucek, P; Adamec, M; Havrdova, T; Koznarova, R; Vanrenterghem, Y; Pirenne, J; Maes, B; Kuypers, D; Coosemans, W; Evenepoel, P; van Ophem, D; Marcelis, V; van Vlem; Peeters; de Hemptinne; de Roose; Fernandez-Cruz, L; Ricart, M J; Nakache, R; Morel, P; Berney, T; Demuylder, S

    2008-01-01

    The Immunosuppression in Pancreas Transplantation was historically based on the fact that the pancreas is an extremely immunogenic organ. Quadruple drug therapy with polyclonal or monoclonal antibodies induction was the mainstay therapy since the introduction of Cyclosporine A. In the modern era of Immunosuppression, Mycophenolate Mofetil replaced Azathioprine while Tacrolimus-another potent calcineurin inhibitor-had-and still has-a difficult challenge to replaced Cyclosporine A, due to its potential diabetogenic effect. Thanks to the first two EuroSPK studies which prospectively tried to answer several questions in that field. But, the future challenge will be in understanding the impact of innate immunity and ischemic reperfusion injuries on the long-term graft function. Hopefully, new drugs will be available and tested to block unspecific deleterious reactions to attenuate the proinflammatory response. It will be the aim of the third Euro SPK Study. PMID:19241916

  14. An immunohistochemical study of the endocrine pancreas in raptors.

    PubMed

    Palmieri, C; Shivaprasad, H L

    2014-12-01

    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

  15. [Dysphagia. Diagnosis, differential diagnosis].

    PubMed

    Collo, D

    1976-11-11

    The wide scope of differential diagnosis in dysphagia makes interdisplinary team-work essential. The aim of this review therefore is to show the various specialties of medicine dealing with dysphagia and to point out possible causes and therapeutic measures. PMID:992550

  16. Laparoscopic Surgery for Solid Pseudopapillary Tumor of the Pancreas

    PubMed Central

    Afridi, Shabbir A.; Kazaryan, Airazat M.; Marangos, Irina Pavlik; Rsok, Brd I.; Fretland, smund A.; Yaqub, Sheraz

    2014-01-01

    Background and Objectives: Solid pseudopapillary tumors of the pancreas are rare and occur most frequently in young women. They have an uncertain pathogenesis and unclear clinical behavior. Our aim was to evaluate the clinical presentation of solid pseudopapillary tumors and assess the efficacy of treatment with minimally invasive surgery. Methods: From March 1997 to February 2011, 13 of 273 patients who underwent laparoscopic procedures on the pancreas were found to have solid pseudopapillary tumors. There were 12 female patients and 1 male patient. The median age was 21 years (range, 1577 years). Abdominal pain was the most common presenting symptom (n = 9). Tumors were incidentally found in 3 patients on computed tomography scans obtained for other reasons. Results: Enucleation of the tumor was performed in 4 patients, including 3 in whom the tumor was located in the head of the pancreas. Eight patients underwent distal pancreatectomy with splenectomy, whereas spleen-preserving distal pancreatectomy was performed in one case. The median tumor size was 6 cm (range, 1.511 cm), the median operative time was 197 minutes (range, 68320 minutes), and the median blood loss was 50 mL (range, <50750 mL). Distal resections were performed with a linear stapler. Four patients had postoperative complications. The median length of hospital stay was 5 days (range, 212 days). During a median follow-up period of 11 months (range, 3121 months), no local recurrences or distant metastases were found. Conclusion: Laparoscopic resections and enucleations of solid pseudopapillary tumors of the pancreas can be performed safely and with adequate resection margins even if the tumors are located in the head of the organ. PMID:24960486

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

    SciTech Connect

    Mahadevan, Anand; Miksad, Rebecca; Goldstein, Michael; Sullivan, Ryan; Bullock, Andrea; Buchbinder, Elizabeth; Pleskow, Douglas; Sawhney, Mandeep; Kent, Tara; Vollmer, Charles; Callery, Mark

    2011-11-15

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

  18. Association of Preoperative Biliary Drainage With Postoperative Outcome Following Pancreaticoduodenectomy

    PubMed Central

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

    1999-01-01

    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

  19. What You Need to Know about Cancer of the Pancreas

    MedlinePlus

    ... Research Diagnosis and Staging Symptoms Diagnosis Staging Prognosis Questions to Ask about Your Diagnosis Research Cancer Treatment Types of Treatment Side Effects Clinical Trials Information for Patients and Caregivers A ...

  20. The Endocrine Pancreas: insights into development, differentiation and diabetes

    PubMed Central

    2012-01-01

    In the developing embryo, appropriate patterning of the endoderm fated to become pancreas requires the spatial and temporal coordination of soluble factors secreted by the surrounding tissues. Once pancreatic progenitor cells are specified in the developing gut tube epithelium, epithelial-mesenchymal interactions, as well as a cascade of transcription factors, subsequently delineate three distinct lineages, including endocrine, exocrine and ductal cells. Simultaneous morphological changes, including branching, vascularization, and proximal organ development, also influence the process of specification and differentiation. Decades of research using mouse genetics have uncovered many of the key factors involved in pancreatic cell fate decisions. When pancreas development or islet cell functions go awry, due to mutation in genes important for proper organogenesis and development, the result can lead to a common pancreatic affliction, diabetes mellitus. Current treatments for diabetes are adequate but not curative. Therefore researchers are utilizing the current understanding of normal embryonic pancreas development in vivo, to direct embryonic stem cells toward a pancreatic fate with the goal of transplanting these in vitro generated “islets” into patients. Mimicking development in vitro has proven difficult; however, significant progress has been made and the current differentiation protocols are becoming more efficient. The continued partnership between developmental biologists and stem cell researchers will guarantee that the in vitro generation of insulin-producing beta cells is a possible therapeutic option for the treatment of diabetes. PMID:22905335

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

    PubMed

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

    2015-12-01

    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

  2. Primary cilia regulate Gli/Hedgehog activation in pancreas

    PubMed Central

    Cervantes, Sara; Lau, Janet; Cano, David A.; Borromeo-Austin, Cecilia; Hebrok, Matthias

    2010-01-01

    Previous studies have suggested that defects in pancreatic epithelium caused by activation of the Hedgehog (Hh) signaling pathway are secondary to changes in the differentiation state of the surrounding mesenchyme. However, recent results describe a role of the pathway in pancreatic epithelium, both during development and in adult tissue during neoplastic transformation. To determine the consequences of epithelial Hh activation during pancreas development, we employed a transgenic mouse model in which an activated version of GLI2, a transcriptional mediator of the pathway, is overexpressed specifically in the pancreatic epithelium. Surprisingly, efficient Hh activation was not observed in these transgenic mice, indicating the presence of physiological mechanisms within pancreas epithelium that prevent full Hh activation. Additional studies revealed that primary cilia regulate the level of Hh activation, and that ablation of these cellular organelles is sufficient to cause significant up-regulation of the Hh pathway in pancreata of mice overexpressing GLI2. As a consequence of overt Hh activation, we observe profound morphological changes in both the exocrine and endocrine pancreas. Increased Hh activity also induced the expansion of an undifferentiated cell population expressing progenitor markers. Thus, our findings suggest that Hh signaling plays a critical role in regulating pancreatic epithelial plasticity. PMID:20479231

  3. What is artificial endocrine pancreas? Mechanism and history

    PubMed Central

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

    2009-01-01

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

  4. Monitoring Artificial Pancreas Trials Through Agent-based Technologies

    PubMed Central

    Scarpellini, Stefania; Di Palma, Federico; Toffanin, Chiara; Del Favero, Simone; Magni, Lalo; Bellazzi, Riccardo

    2014-01-01

    The increase in the availability and reliability of network connections lets envision systems supporting a continuous remote monitoring of clinical parameters useful either for overseeing chronic diseases or for following clinical trials involving outpatients. We report here the results achieved by a telemedicine infrastructure that has been linked to an artificial pancreas platform and used during a trial of the AP@home project, funded by the European Union. The telemedicine infrastructure is based on a multiagent paradigm and is able to deliver to the clinic any information concerning the patient status and the operation of the artificial pancreas. A web application has also been developed, so that the clinic staff and the researchers involved in the design of the blood glucose control algorithms are able to follow the ongoing experiments. Albeit the duration of the experiments in the trial discussed in the article was limited to only 2 days, the system proved to be successful for monitoring patients, in particular overnight when the patients are sleeping. Based on that outcome we can conclude that the infrastructure is suitable for the purpose of accomplishing an intelligent monitoring of an artificial pancreas either during longer trials or whenever that system will be used as a routine treatment. PMID:24876570

  5. Mallotus roxburghianus modulates antioxidant responses in pancreas of diabetic rats.

    PubMed

    Roy, V K; Chenkual, L; Gurusubramanian, G

    2016-03-01

    Mallotus roxburghianus has long been used by Mizo tribal people for the treatment of diabetes. Scientific validation at known doses may provide information about its safety and efficacy. Methanolic leaf extract of M. roxburghianus (MRME 100 and 400mg/kg) was tested in comparison with normal and alloxan diabetic rats for 28 days p.o. in terms of body and pancreatic weight, blood glucose level, antioxidant enzymes, expression of visfatin and PCNA, histopathology and histomorphometric measurements of pancreas. The results were evaluated statistically using ANOVA, correlation and regression and Principal component analysis (PCO). MRME (100 and 400mg/kg) treatment significantly (p<0.0001) decreased the body weight, blood glucose level, improved the mass and size of pancreas, elevated the levels of antioxidant enzymes and up regulate the expression of visfatin and PCNA. PCO analysis was good to fitness and prediction distinguishes the therapeutic effects of M. roxburghianus from the alloxan induced diabetic rats. MRME has significant role in protecting animals from alloxan-induced diabetic oxidative stress in pancreas and exhibited promising antihyperglycaemic and antioxidant activities along with significant reversal of disturbed antioxidant status and lipid peroxidative damage. Pancreatic architecture and physiology under diabetic oxidative stress have been significantly modulated by MRME and validated as a drug candidate for antidiabetic treatment. M. roxburghianus treatment restores the antioxidant enzyme system and rejuvenates the islets mass in alloxanized rat by accelerating visfatin and PCNA expression in pancreatic tissue. PMID:26764087

  6. Primary cilia regulate Gli/Hedgehog activation in pancreas.

    PubMed

    Cervantes, Sara; Lau, Janet; Cano, David A; Borromeo-Austin, Cecilia; Hebrok, Matthias

    2010-06-01

    Previous studies have suggested that defects in pancreatic epithelium caused by activation of the Hedgehog (Hh) signaling pathway are secondary to changes in the differentiation state of the surrounding mesenchyme. However, recent results describe a role of the pathway in pancreatic epithelium, both during development and in adult tissue during neoplastic transformation. To determine the consequences of epithelial Hh activation during pancreas development, we employed a transgenic mouse model in which an activated version of GLI2, a transcriptional mediator of the pathway, is overexpressed specifically in the pancreatic epithelium. Surprisingly, efficient Hh activation was not observed in these transgenic mice, indicating the presence of physiological mechanisms within pancreas epithelium that prevent full Hh activation. Additional studies revealed that primary cilia regulate the level of Hh activation, and that ablation of these cellular organelles is sufficient to cause significant up-regulation of the Hh pathway in pancreata of mice overexpressing GLI2. As a consequence of overt Hh activation, we observe profound morphological changes in both the exocrine and endocrine pancreas. Increased Hh activity also induced the expansion of an undifferentiated cell population expressing progenitor markers. Thus, our findings suggest that Hh signaling plays a critical role in regulating pancreatic epithelial plasticity. PMID:20479231

  7. Clinical impact of preoperative endoscopic ultrasound-guided fine-needle aspiration for pancreatic ductal adenocarcinoma

    PubMed Central

    Tsutsumi, Hideharu; Hara, Kazuo; Mizuno, Nobumasa; Hijioka, Susumu; Imaoka, Hiroshi; Tajika, Masahiro; Tanaka, Tsutomu; Ishihara, Makoto; Yoshimura, Kenichi; Shimizu, Yasuhiro; Niwa, Yasumasa; Sasaki, Yutaka; Yamao, Kenji

    2016-01-01

    Aim: To reveal the impact of preoperative endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of pancreatic ductal adenocarcinoma (PDAC). Materials and Methods: We retrospectively reviewed 242 patients who underwent surgery for PDAC at our institution between January 1996 and July 2012. Among them, there were three patients with R2 resection and 30 patients with a follow-up period of less than 1 year, who were excluded because they did not meet the conditions for evaluating recurrence. Consequently, 209 patients were enrolled in the present study. The patients were divided into two groups: 126 patients who underwent preoperative EUS-FNA (FNA group) and 83 patients who did not (non-FNA group) undergo preoperative EUS-FNA. Results: There were no significant differences in baseline characteristics between FNA and non-FNA groups except mean age (66.6 ± 8.9 years vs. 63.5 ± 8.9 years, respectively, P = 0.02) and the administration rate of gemcitabine as adjuvant chemotherapy (42.9% vs. 18.1%, P < 0.01). Sampling adequacy of preoperative EUS-FNA was 99.2% (125/126) and sensitivity for diagnosis was 92.9% (117/126). The rate of complications related to EUS-FNA was 1.6% (2/126); two patients experienced reduction in hemoglobin (≥2.0 g/dL). These two patients did not have any apparent bleeding and could be managed conservatively. No severe complications were seen. We evaluated long-term outcomes of preoperative EUS-FNA, especially disease-free survival, needle-track seeding and recurrence. Kaplan-Meier analysis indicated no significant difference in disease-free survival between the two groups (P = 0.12). The site of recurrence was not significantly different between groups. Needle-track seeding was not observed in this study. Multivariate analysis of recurrence factors showed that preoperative EUS-FNA did not affect postoperative recurrence. Conclusion: Preoperative EUS-FNA for PDAC was shown to be a safe procedure with high diagnostic ability, and not a risk factor for postoperative recurrence. PMID:27080607

  8. Diagnosis of pelvic actinomycosis by fine needle aspiration. A case report.

    PubMed

    Lininger, J R; Frable, W J

    1984-01-01

    A case of pelvic abscess caused by Actinomyces in a patient wearing an intrauterine contraceptive device is presented. The diagnosis was established preoperatively by transvaginal fine needle aspiration. The cytologic, surgical and histologic findings are discussed. PMID:6207695

  9. Cochlear implantation: preoperative counselling and postoperative problems.

    PubMed

    Ito, J

    1994-01-01

    Some patients cannot understand the reasons for a cochlear implant, nor the implications of such a device, and thus a clear explanation is required during patient counselling. Approximately one tenth of the patients with hearing loss examined in our hospital have received cochlear implants. Adequate preoperative examinations can make the surgery less difficult. Following cochlear implantation, speech comprehension of the patients with prelingual hearing loss is poor, and even patients with good speech comprehension have complaints about the clarity of the voice by the cochlear implant. PMID:7993233

  10. Preoperational test report, raw water system

    SciTech Connect

    Clifton, F.T.

    1997-10-29

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

  11. Preoperational test report, recirculation ventilation systems

    SciTech Connect

    Clifton, F.T.

    1997-11-11

    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.

  12. Preoperative risk reduction: strategies to optimize outcomes.

    PubMed

    Martindale, Robert G; Deveney, Clifford W

    2013-10-01

    The success of hernia repair is measured by absence of recurrence, appearance of the surgical scar, and perioperative morbidity. Perioperative surgical site occurrence (SSO), defined as infection, seroma, wound ischemia, and dehiscence, increases the risk of recurrent hernia by at least 3-fold. The surgeon should optimize all measures that promote healing, reduce infection, and enhance early postoperative recovery. In the population with ventral hernia, the most common complication in the immediate perioperative period is surgical site infection. This article reviews several preoperative measures that have been reported to decrease SSOs and shorten length of hospital stay. PMID:24035075

  13. Predicting Meningioma Consistency on Preoperative Neuroimaging Studies.

    PubMed

    Shiroishi, Mark S; Cen, Steven Y; Tamrazi, Benita; D'Amore, Francesco; Lerner, Alexander; King, Kevin S; Kim, Paul E; Law, Meng; Hwang, Darryl H; Boyko, Orest B; Liu, Chia-Shang J

    2016-04-01

    This article provides an overview of the neuroimaging literature focused on preoperative prediction of meningioma consistency. A validated, noninvasive neuroimaging method to predict tumor consistency can provide valuable information regarding neurosurgical planning and patient counseling. Most of the neuroimaging literature indicates conventional MRI using T2-weighted imaging may be helpful to predict meningioma consistency; however, further rigorous validation is necessary. Much less is known about advanced MRI techniques, such as diffusion MRI, MR elastography (MRE), and MR spectroscopy. Of these methods, MRE and diffusion tensor imaging appear particularly promising. PMID:27012379

  14. [A case of chronic pancreatitis occurring in gastric aberrant pancreas poorly distinguishable from gastric aberrant pancreas ductal carcinoma].

    PubMed

    Ogawa, Sayaka; Miyaoka, Youichi; Fujiwara, Aya; Tsukano, Kousuke; Kotani, Satoshi; Yamanouchi, Satoshi; Kusunoki, Ryusaku; Ito, Satoko; Fujishiro, Hirofumi; Kohge, Nariaki; Onuma, Hideyuki

    2015-11-01

    A man in his 40s was referred to our hospital with abdominal pain. A gastric submucosal tumor (SMT) was diagnosed nine years previously, but the patient was lost to follow-up. Upon our evaluation, the SMT had enlarged, as demonstrated by esophagogastroduodenoscopy and abdominal computed tomography. Endoscopic ultrasonography revealed a hypoechoic and isoechoic mosaic mass, which primarily occupied the third and fourth layers of the gastric wall. Aspiration cytodiagnosis was performed, the results of which led to a suspicion of adenocarcinoma arising from gastric ectopic pancreas. Next, we conducted segmental gastrectomy. Pathological examination showed adiponecrosis, a pancreatic stone, chronic inflammatory cell infiltration, and fibrosis. Thus, the patient was diagnosed with chronic pancreatitis occurring in a gastric aberrant pancreas. PMID:26537325

  15. Simultaneous pancreas-kidney (SPK) and pancreas living-donor kidney (SPLK) transplantation at the University of Maryland.

    PubMed

    Philosophe, B; Farney, A C; Schweitzer, E J; Colonna, J O; Jarrell, B E; Foster, C E; Wiland, A M; Bartlett, S T

    2000-01-01

    The evolution of enteric and portal venous drainage, better immunosuppression, and better patient care has elevated pancreas transplantation with dramatically improved results. At our center, long-term graft survival and rejection has significantly improved with portal venous drainage, which has become our gold standard. This improvement is exemplified by the excellent one-year patient and graft survival rates for SPLK transplants. SPLK has proven to be an ideal approach in uremic Type 1 diabetic patients with living donors and should become the procedure of choice for that population. Moreover, the improved monitoring of rejection has allowed a similar success of pancreas transplantation alone in non-uremic patients with brittle diabetes. The treatment of diabetes mellitus has room for great improvement, however, and there is no question that islet transplantation, xenotransplantation, and the pursuit of immunologic tolerance will play an extremely important role in that endeavor. PMID:11512315

  16. The effect of preoperative smoking cessation or preoperative pulmonary rehabilitation on outcomes after lung cancer surgery: a systematic review.

    PubMed

    Schmidt-Hansen, Mia; Page, Richard; Hasler, Elise

    2013-03-01

    The preferred treatment for lung cancer is surgery if the disease is considered resectable and the patient is considered surgically fit. Preoperative smoking cessation and/or preoperative pulmonary rehabilitation might improve postoperative outcomes after lung cancer surgery. The objectives of this systematic review were to determine the effectiveness of (1) preoperative smoking cessation and (2) preoperative pulmonary rehabilitation on peri- and postoperative outcomes in patients who undergo resection for lung cancer. We searched MEDLINE, PreMedline, Embase, Cochrane Library, Cinahl, BNI, Psychinfo, Amed, Web of Science (SCI and SSCI), and Biomed Central. Original studies published in English investigating the effect of preoperative smoking cessation or preoperative pulmonary rehabilitation on operative and longer-term outcomes in ≥ 50 patients who received surgery with curative intent for lung cancer were included. Of the 7 included studies that examined the effect of preoperative smoking cessation (n = 6) and preoperative pulmonary rehabilitation (n = 1) on outcomes after lung cancer surgery, none were randomized controlled trials and only 1 was prospective. The studies used different smoking classifications, the baseline characteristics differed between the study groups in some of the studies, and most had small sample sizes. No formal data synthesis was therefore possible. The included studies were marked by methodological limitations. On the basis of the reported bodies of evidence, it is not possible to make any firm conclusions about the effect of preoperative smoking cessation or of preoperative pulmonary rehabilitation on operative outcomes in patients undergoing surgery for lung cancer. PMID:23017983

  17. Preoperative carbohydrate nutrition reduces postoperative nausea and vomiting compared to preoperative fasting

    PubMed Central

    Yilmaz, Neslihan; Çekmen, Nedim; Bilgin, Ferruh; Erten, Ela; Özhan, Mehmet Özhan; Coşar, Ahmet

    2013-01-01

    Background: The aim of this prospective, randomized, single-blinded study was to compare the effects of a carbohydrate drink 400 mL given 2 h before the surgery with preoperative overnight fasting on the gastric pH and residual volume, postoperative nausea and vomiting (PONV) and antiemetic consumption in patients undergoing laparoscopic cholecystectomy. Materials And Methods: Forty American Society of Anesthesiologists physical status I-II patients who underwent elective laparoscopic cholecystectomy. Randomized, prospective, controlled study, Gulhane Medical Faculty and Guven Hospital Department of Anesthesiology and Reanimation. Patients were randomly assigned into two groups: Pre-operative carbohydrate drink group (group C, n = 20) and preoperative fasting group (group F, n = 20). Group C was given a 400 mL carbohydrate drink 2 h before to the surgery. The patients of group F were fasted 8 h before the surgery. Both groups were operated under general anesthesia with volatile anesthetics. Results: Hemodynamic parameters, demographic data, gastric acidity and residual volumes were similar for both groups. No complications were observed. PONV and antiemetic consumption was lower in group C compared to group F (P = 0.001). Patient's satisfaction was higher in group C (P < 0.001). Conclusion: This study showed that pre-operative carbohydrate drink may be used safely and also improves patient's satisfaction and comfort in patients undergoing laparoscopic cholecystectomy. PMID:24497851

  18. Evaluation of a Preoperative Clinic for Women With Gynecologic Cancer.

    PubMed

    Huang, Fang; Chia, Yen Y; Eng, Chui L; Lim, Yong K; Yam, Kwai L; Tan, Soh C; Hockenberry, Marilyn

    2015-12-01

    Although many patients with gynecologic cancer undergo surgery, time constraints during the preoperative consultation may affect the accuracy of the information exchange, as well as compromise the quality of the patient assessment and care plan. Both put patients at a higher risk for complications during surgery and the postoperative period. This article describes an advanced practice RN-led preoperative assessment and education clinic designed to improve the quality of preoperative preparation and postoperative outcomes of patients with gynecologic cancer. PMID:26583642

  19. Preoperative Preparation and Anesthesia for Trabeculectomy

    PubMed Central

    2016-01-01

    ABSTRACT Preoperative preparation should improve the likelihood of successful trabeculectomy surgery. The team can reconsider the appropriateness of the proposed surgery, and steps can be taken to maximize the chance of a good outcome. For example, adjustments to anti-hypertensive or anti-coagulant medications may be made, and topical ocular medications adjusted. Choice of anesthesia technique is of particular relevance to the trabeculectomy patient. Some anesthesia techniques are more likely to have serious complications, and glaucoma patients may be at higher risk of some sight-threatening complications, because the optic nerve is already damaged and vulnerable. Posterior placement of local anesthesia (retrobulbar, peribulbar, posterior sub-Tenon’s techniques) could potentially damage the optic nerve, and thereby cause “wipe-out” of vision. Anesthesia technique may influence the likelihood of vitreous bulge and surgical difficulty. Regarding long-term control of intraocular pressure, there is no good evidence to indicate that any particular anesthesia technique is better than another. There is little high-quality evidence on this topic. The author’s preferred technique for trabeculectomy is subconjunctival-intracameral anesthesia without sedation. How to cite this article: Eke T. Preoperative Preparation and Anesthesia for Trabeculectomy. J Curr Glaucoma Pract 2016; 10(1):21-35. PMID:27231416

  20. [Preoperative oral hydration for pregnant women].

    PubMed

    Okutomi, Toshiyuki; Kato, Rie

    2011-07-01

    Preoperative oral hydration is an important component of "enhanced recovery after surgery" strategies. This was originally developed for patients undergoing colon surgery. The Obstetric Anesthesia Practice Guideline issued by American Society of Anesthesiologists states that intake of minimum amount of clear fluid 2 hours prior to surgery may be safe. However, anesthesiologists have to consider physiological changes that parturients undergo during pregnancy, such as increased risk of aspiration and impaired glucose tolerance. We also have to consider the potential effect of glucose loading on neonates. Mothers are more likely to develop ketosis by glucose loading. It also stimulates insulin release in the fetus, which can result in neonatal hypoglycemia. In addition, sodium overloading may deteriorate intra-vascular dehydration and cause lung edema to mothers. On the other hand, oral hydration can alleviate a sense of thirst and increase maternal satisfaction. Our data showed that maternal urinal ketone body at delivery tended to decrease with oral hydration during labor. Moreover, some articles suggest that oral hydration may improve utero-placental perfusion. Therefore, we have to balance risks and benefits of oral hydration in parturients. Further investigations are needed among this specific subgroup of patients in order to establish the safe application of preoperative oral hydration. PMID:21800658

  1. Preoperative chemoradiotherapy for locally advanced gastric cancer

    PubMed Central

    2013-01-01

    Background To examine toxicity and outcomes for patients treated with preoperative chemoradiotherapy (CRT) for gastric cancer. Methods Patients with gastroesophageal (GE) junction (Siewert type II and III) or gastric adenocarcinoma who underwent neoadjuvant CRT followed by planned surgical resection at Duke University between 1987 and 2009 were reviewed. Overall survival (OS), local control (LC) and disease-free survival (DFS) were estimated using the Kaplan-Meier method. Toxicity was graded according to the Common Toxicity Criteria for Adverse Events version 4.0. Results Forty-eight patients were included. Most (73%) had proximal (GE junction, cardia and fundus) tumors. Median radiation therapy dose was 45 Gy. All patients received concurrent chemotherapy. Thirty-six patients (75%) underwent surgery. Pathologic complete response and R0 resection rates were 19% and 86%, respectively. Thirty-day surgical mortality was 6%. At 42 months median follow-up, 3-year actuarial OS was 40%. For patients undergoing surgery, 3-year OS, LC and DFS were 50%, 73% and 41%, respectively. Conclusions Preoperative CRT for gastric cancer is well tolerated with acceptable rates of perioperative morbidity and mortality. In this patient cohort with primarily advanced disease, OS, LC and DFS rates in resected patients are comparable to similarly staged, adjuvantly treated patients in randomized trials. Further study comparing neoadjuvant CRT to standard treatment approaches for gastric cancer is indicated. PMID:23286735

  2. Preoperative transarterial Embolisation in bone tumors

    PubMed Central

    Gupta, Pankaj; Gamanagatti, Shivanand

    2012-01-01

    Bone tumors include a variety of lesions, both primary and metastatic. The treatment modalities for bone tumors vary with the individual lesion, but in general surgical excision is the treatment of choice with other adjunctive therapies. However, surgery for many bone tumors is complex due to several factors including tumor bulk, vascularity, vicinity to vital structures and potentially inaccessible location of the lesion. Transarterial Embolisation (TAE) is one of the important adjuvant treatment modalities and in some cases it may be the primary and curative treatment. Preoperative TAE has proved to be effective in both primary and metastatic bone tumors. It reduces tumor vascularity and intraoperative blood loss, the need for blood transfusion and associated complications, allows better definition of tissue planes at surgery affording more complete excision, and hence reduced recurrence. Preoperative chemoEmbolisation has also been shown to increase the sensitivity of some tumors to subsequent chemotherapy and radiotherapy. There are several techniques and embolic agents available for this purpose, but the ultimate aim is to achieve tumor devascularization. In this review, we discuss the techniques including the choice of embolic agent, application to individual lesions and potential complications. PMID:22761978

  3. A critical inventory of preoperative skull replicas

    PubMed Central

    Beinemann, J; Schaller, K; Gailloud, P

    2013-01-01

    Introduction Physical replicas of organs are used increasingly for preoperative planning. The quality of these models is generally accepted by surgeons. In view of the strong trend towards minimally invasive and personalised surgery, however, the aim of this investigation was to assess qualitatively the accuracy of such replicas, using skull models as an example. Methods Skull imaging was acquired for three cadavers by computed tomography using clinical routine parameters. After digital three-dimensional (3D) reconstruction, physical replicas were produced by 3D printing. The facsimilia were analysed systematically and compared with the best gold standard possible: the macerated skull itself. Results The skull models were far from anatomically accurate. Non-conforming rendering was observed in particular for foramina, sutures, notches, fissures, grooves, channels, tuberosities, thin-walled structures, sharp peaks and crests, and teeth. Conclusions Surgeons should be aware that preoperative models may not yet render the exact anatomy of the patient under consideration and are advised to continue relying, in specific conditions, on their own analysis of the native computed tomography or magnetic resonance imaging. PMID:24025287

  4. Brotizolam as a pre-operative hypnotic

    PubMed Central

    Ahmad, F.; Rittmeyer, P.; Goetzke, Edda; Köster, J.

    1983-01-01

    1 Efficacy of and tolerance to brotizolam when used as a preoperative hypnotic were studied in two double-blind, randomised parallel group studies. 2 Brotizolam (0.25 and 0.50 mg) was superior to placebo. Efficacy was assessed as good-to-satisfactory in 73.0% of patients with 0.25 mg and in 88.0% with 0.5 mg. A similar assessment was reached in 40.0% of patients with placebo. Brotizolam 0.5 mg was superior to 0.25 mg, and with the higher dose subjective assessments of anxiety were reduced. 3 Efficacy of tolerance to 0.5 mg brotizolam and 2.0 mg flunitrazepam were compared, and both drugs were found to be effective and well tolerated. Brotizolam maintained sleep throughout the night more effectively than flunitrazepam. 4 A dose range of 0.25-0.5 mg brotizolam is recommended as a pre-operative hypnotic. PMID:6362702

  5. Jejunioleal Bypass Procedures in Morbid Obesity: Preoperative Psychological Findings

    ERIC Educational Resources Information Center

    Webb, Warren W.; And Others

    1976-01-01

    Seventy patients who averaged 155 percent overweight and requested jejunioleal bypass surgery as a treatment intervention for morbid obesity were studied preoperatively for prominent psychological characteristics. (Author)

  6. Arterio-enteric fistula in failed enteric-drained pancreas transplants: an impending danger.

    PubMed

    Villa, Manuel; Siskind, Eric; Jaimes, Natalia; Eckstein, Donna; Bhaskaran, Madhu; Sachdeva, Mala; Jhaveri, Kenar; Calderon, Kellie; Greben, Craig; Sharan, Lauren; Coppa, Gene; Krishnasastry, Kambhampaty; Molmenti, Ernesto; Nicastro, Jeffrey

    2014-03-01

    Enteric drainage is the preferred method of exocrine diversion in simultaneous kidney-pancreas transplantation. Because of improvements in immunosuppression, enteric drainage has become the preferred method of pancreas transplantation in general. Although associated with less potential complications than bladder-drained pancreas, potentially lethal arterio-enteric fistulas in the setting of nonfunctioning allografts represent a constant threat. We herein present a case report, a review of the literature, and a call for caution. PMID:24627620

  7. Arterio-Enteric Fistula in Failed Enteric-Drained Pancreas Transplants: An Impending Danger

    PubMed Central

    Villa, Manuel; Siskind, Eric; Jaimes, Natalia; Eckstein, Donna; Bhaskaran, Madhu; Sachdeva, Mala; Jhaveri, Kenar; Calderon, Kellie; Greben, Craig; Sharan, Lauren; Coppa, Gene; Krishnasastry, Kambhampaty; Molmenti, Ernesto; Nicastro, Jeffrey

    2013-01-01

    Enteric drainage is the preferred method of exocrine diversion in simultaneous kidney–pancreas transplantation. Because of improvements in immunosuppression, enteric drainage has become the preferred method of pancreas transplantation in general. Although associated with less potential complications than bladder-drained pancreas, potentially lethal arterio-enteric fistulas in the setting of nonfunctioning allografts represent a constant threat. We herein present a case report, a review of the literature, and a call for caution. PMID:24627620

  8. The Preoperative Evaluation of Infective Endocarditis via 3-Dimensional Transesophageal Echocardiography

    PubMed Central

    Yong, Matthew S.; Killu, Ammar M.; Coffey, Sean; Burkhart, Harold M.; Wan, Siu-Hin; Malouf, Joseph F.

    2015-01-01

    Transesophageal echocardiography continues to have a central role in the diagnosis of infective endocarditis and its sequelae. Recent technological advances offer the option of 3-dimensional imaging in the evaluation of patients with infective endocarditis. We present an illustrative case and review the literature regarding the potential advantages and limitations of 3-dimensional transesophageal echocardiography in the diagnosis of complicated infective endocarditis. A 51-year-old man, an intravenous drug user who had undergone bioprosthetic aortic valve replacement 5 months earlier, presented with prosthetic valve endocarditis. Preoperative transesophageal echocardiography with 3D rendition revealed a large abscess involving the mitral aortic intervalvular fibrosa, together with a mycotic aneurysm that had ruptured into the left atrium, resulting in a left ventricle-to-left atrium fistula. Three-dimensional transesophageal echocardiography enabled superior preoperative anatomic delineation and surgical planning. We conclude that 3-dimensional transesophageal echocardiography can be a useful adjunct to traditional 2-dimensional transesophageal echocardiography as a tool in the diagnosis of infective endocarditis. PMID:26413022

  9. Xantogranulomatous pyelonephritis: The missed diagnosis

    PubMed Central

    EL Abiad, Yassine; Dehayni, Youness; Qarro, Abdelmounaim; Balla, Bouzid; Ammani, Abdelghani; Alami, Mohammed

    2015-01-01

    Introduction Xantogranulomatous pyelonephritis (XGPN) is a rare chronic inflammatory disease of the kidney that can be focal or diffuse with the focal form imitating greatly renal cell carcinoma (RCC). Presentation of case We report a challenging clinical case of a 38-year old male with right flank pain persisting for 3-months, imaging showed an 8 cm heterogenous mass of the upper pole of the right kidney and invading the liver. A right radical nephrectomy including the adrenal in the resection was performed under the tentative diagnosis of renal cell carcinoma (RCC) whereas histology revealed focal XGPN. Discussion Preoperative diagnosis of focal XGPN was difficult because of radiological similarities to RCC and lack of history of stone disease or urinary tract infection. Conclusion This case highlights the need to include XGPN in the differential diagnosis of RCC even in the era of modern imaging. PMID:26684864

  10. Signs and symptoms of pediatric brain tumors and diagnostic value of preoperative EEG.

    PubMed

    Preuß, Matthias; Preiss, Sophia; Syrbe, Steffen; Nestler, Ulf; Fischer, Lars; Merkenschlager, Andreas; Bertsche, Astrid; Christiansen, Holger; Bernhard, Matthias K

    2015-11-01

    In pediatric patients, brain tumors have been estimated to be the cause for seizures in only 0.2-0.3% of cases, whereas seizures occurred in about 13% of pediatric brain tumor patients at presentation. This survey was conducted to analyze EEG findings in pediatric tumor patients over the past 14 years to evaluate the diagnostic value of preoperative EEG for diagnosis of brain tumors. Surface EEG was obtained in awake patients using the international 10- to 20-electrode placement in all pediatric patients with intracranial neoplasms between 2000 and 2013 at the University Hospital of Leipzig except for those who needed emergency operative treatment. One hundred forty-two pediatric patients with 80 infratentorial and 62 supratentorial tumors (WHO grades I-II: 91 patients; WHO grades III-IV: 46 patients). Symptomatic hydrocephalus was found in 37. Sensitivity and specificity of ophthalmologic examination for predicting hydrocephalus was 0.39 and 0.72. Preoperative EEG has been conducted in 116 patients, showing normal activity in 54 patients (47%). Out of 62 pathologic EEGs, 40 indicated correctly to the site of the lesion, 15 were pathologic despite of infratentorial location of the tumor. Nineteen patients had a history of seizures of which six had normal EEGs. Sensitivity for and specificity of EEG examination for symptomatic epilepsy was 0.68 and 0.7. Conclusion Preoperative routine EEG provides no additional value in the diagnostic algorithm of pediatric train tumors. The low specificity and sensitivity of EEG (even in patients with clinical seizures as primary symptom of a brain tumor) underline that EEG does not contribute to diagnosis and a normal EEG might even delay correct diagnosis. PMID:26248670

  11. [Infectious endocarditis complicated with preoperative infectious intracranial aneurysm;report of a case].

    PubMed

    Ezure, Masahiko; Kaneko, Tatsuo; Hasegawa, Yutaka; Kimura, Chieri; Okada, Shuichi; Okonogi, Shuichi; Takihara, Hitomi; Naito, Noritsugu

    2015-02-01

    A 44-year-old man was admitted with the diagnosis of active infective endocarditis( IE) due to Streptococcus mitis, complicated with infectious intracranial aneurysm. Preoperative echocardiography showed mobile vegetation on the mitral leaflet, size of which was 20 mm. The magnetic resonance imaging( MRI) demonstrated that the size of aneurysm was increasing, and infectious intracranial aneurysm was treated surgically. Twenty one days after the operation, the mitral valve plasty was performed. He was discharged on foot without any neurological findings. The duration between the brain surgery and the cardiac surgery was thought to be important to prevent the new neurological complication. PMID:25743362

  12. Automatic Data Processing to Achieve a Safe Telemedical Artificial Pancreas

    PubMed Central

    Hernando, M. Elena; García-Sáez, Gema; Martínez-Sarriegui, Iñaki; Rodríguez-Herrero, Agustín; Pérez-Gandía, Carmen; Rigla, Mercedes; de Leiva, Alberto; Capel, Ismael; Pons, Belén; Gómez, Enrique J.

    2009-01-01

    Background The use of telemedicine for diabetes care has evolved over time, proving that it contributes to patient self-monitoring, improves glycemic control, and provides analysis tools for decision support. The timely development of a safe and robust ambulatory artificial pancreas should rely on a telemedicine architecture complemented with automatic data analysis tools able to manage all the possible high-risk situations and to guarantee the patient's safety. Methods The Intelligent Control Assistant system (INCA) telemedical artificial pancreas architecture is based on a mobile personal assistant integrated into a telemedicine system. The INCA supports four control strategies and implements an automatic data processing system for risk management (ADP-RM) providing short-term and medium-term risk analyses. The system validation comprises data from 10 type 1 pump-treated diabetic patients who participated in two randomized crossover studies, and it also includes in silico simulation and retrospective data analysis. Results The ADP-RM short-term risk analysis prevents hypoglycemic events by interrupting insulin infusion. The pump interruption has been implemented in silico and tested for a closed-loop simulation over 30 hours. For medium-term risk management, analysis of capillary blood glucose notified the physician with a total of 62 alarms during a clinical experiment (56% for hyperglycemic events). The ADP-RM system is able to filter anomalous continuous glucose records and to detect abnormal administration of insulin doses with the pump. Conclusions Automatic data analysis procedures have been tested as an essential tool to achieve a safe ambulatory telemedical artificial pancreas, showing their ability to manage short-term and medium-term risk situations. PMID:20144417

  13. Pre-operatively misdiagnosed undifferentiated embryonal sarcoma of the liver: analysis of 16 cases

    PubMed Central

    Li, Yanzhuo; Cai, Quanyu; Jia, Ningyang; Chen, Dong; Lu, Lun

    2015-01-01

    Background To investigate the clinical features of undifferentiated embryonal sarcoma of the liver (UESL) to improve its preoperative diagnostic accuracy. Methods The clinical, imaging, and histopathologic findings of 16 UESL patients whose disease was pathologically confirmed but preoperatively misdiagnosed were retrospectively analyzed. Results Among these 16 patients, 9 were clinically misdiagnosed as primary liver cancer, 3 as hepatoblastoma, and 4 as malignant hepatic mass. In 12 patients who were presented due to abdominal discomfort, ultrasound showed that predominantly solid lesions, whereas computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated predominantly cystic masses within irregular soft tissue. Contrast-enhanced imaging showed enhancement intralesional foci, multiple internal septations, and edges. The postoperative pathology showed the cutting surface of tumors was variegated, with solid and cystic gelatinous areas, hemorrhage, and necrosis. Intracytoplasmic hyaline globules were commonly present among cancer cells. Conclusions UESL is a rare clinical condition without specific clinical manifestations. The inconsistencies between ultrasound and CT/MRI findings may be helpful to improve the preoperative diagnosis accuracy. PMID:26807408

  14. Glomus Tumors: A Review of Preoperative Magnetic Resonance Imaging to Detect Satellite Lesions.

    PubMed

    Giugale, Juan M; Fowler, John R

    2015-10-01

    Glomus tumors are malformations of the neuromyoarterial system that commonly develop in the digits and cause exquisite tenderness, especially with cold temperatures. Treatment typically involves surgical excision, although there is a tendency to avoid aggressive resections, which may lead to aesthetically displeasing nail plate deformities. In a minority of patients, symptoms may persist and the tumor may recur. The etiology of the persistent of symptoms is debatable. One theory for the persistence of symptoms is an incomplete initial excision of the glomus tumor. Another theory suggests that clinically unapparent satellite lesions exist at the time of diagnosis that are not excised, and they later mature into symptomatic recurrent tumors. Although not clinically visible, if present, these satellite lesions should be seen on preoperative magnetic resonance imaging. The authors reviewed all cases of pathology-confirmed glomus tumors in the past 7 years at a single institution in which preoperative magnetic resonance imaging using a high-powered 3.0 Tesla (General Electric, Buckinghamshire, United Kingdom) magnet was performed. Six cases met inclusion criteria and only 1 case developed a recurrent glomus tumor. None of the cases were found to have satellite lesions associated with the primary glomus tumor on magnetic resonance imaging. Preventing recurrence seems to be dependent on the completeness of the initial excision. Preoperative magnetic resonance imaging is a valuable tool used to delineate the extent of the tumor for surgical planning. PMID:26488783

  15. Comparison of Preoperative Temporal Bone CT with Intraoperative Findings in Patients with Cholesteatoma

    PubMed Central

    Rogha, Mehrdad; Hashemi, Sayyed Mostafa; Mokhtarinejad, Farhad; Eshaghian, Afrooz; Dadgostar, Alireza

    2014-01-01

    Introduction: Cholesteatoma is traditionally diagnosed by otoscopic examination and treated by surgery. The necessity for imaging in an uncomplicated case is controversial. This study was planned to investigate the usefulness of a preoperative high-resolution computed tomography (HRCT) scan in depicting the status of middle ear structures in the presence of cholesteatoma and also to compare the correspondence between pre- and intraoperative CT findings in patients with cholesteatoma. Materials and Methods: This prospective descriptive study was performed from January 2009 to May 2011 in 36 patients with cholesteatoma who were referred to the Kashani and Al-Zahra Clinics of Otolaryngology. Preoperative high-resolution temporal bone CT scans (axial and coronal views) were carried out and compared with intraoperative findings. Results: Evaluation of 36 patients and their CT scans revealed excellent correlation for sigmoid plate erosion, widening of aditus, and erosion of scutum; good correlation for erosion of malleus and tegmen; moderate correlation for lateral canal fistula (LCF) and erosion of mastoid air cells; and poor correlation for facial nerve dehiscence (FND), incus, and stapes erosion. Conclusion: A preoperative CT scan may be helpful in relation to diagnosis and decision making for surgery in cases of cholesteatoma and ossicular erosion. The CT scan can accurately predict the extent of disease and is helpful for detection of lateral canal fistula, erosions of dural plate, and ossicular erosions. However it is not able to distinguish between cholesteatoma and mucosal disease, facial nerve dehiscency, incus, and stapes erosion. PMID:24505568

  16. Plasticity and Dedifferentiation within the Pancreas: Development, Homeostasis, and Disease

    PubMed Central

    Puri, Sapna; Folias, Alexandra E.; Hebrok, Matthias

    2014-01-01

    Cellular identity is established by genetic, epigenetic, and environmental factors that regulate organogenesis and tissue homeostasis. Although some flexibility in fate potential is beneficial to overall organ health, dramatic changes in cellular identity can have disastrous consequences. Emerging data within the field of pancreas biology are revising current beliefs about how cellular identity is shaped by developmental and environmental cues under homeostasis and stress conditions. Here, we discuss the changes occurring in cellular states upon fate modulation and address how our understanding of the nature of this fluidity is shaping therapeutic approaches to pancreatic disorders such as diabetes and cancer. PMID:25465113

  17. Solid and papillary epithelial neoplasm of the pancreas

    SciTech Connect

    Friedman, A.C.; Lichtenstein, J.E.; Fishman, E.K.; Oertel, J.E.; Dachman, A.H.; Siegelman, S.S.

    1985-02-01

    Solid and papillary epithelial neoplasm of the pancreas is an uncommon low grade malignant tumor histologically distinct from the usual ductal adenocarcinoma and amenable to cure by surgical excision. It tends to occur in black women in their second or third decade of life and has often been misclassified as nonfunctional islet cell tumor or as cystadenoma or cystadenocarcinoma. Twelve cases were reviewed. Sonography and CT of solid and pipillary epithelial neoplasms depict a well-demarcated mass that can be solid, mixed cystic and solid, or largely cystic. The radiologic appearance is dependent on the maintenance of the integrity of the neoplasm versus the extent of retrogressive changes that have occurred.

  18. Agent-based model of macrophage action on endocrine pancreas.

    PubMed

    Martínez, Ignacio V; Gómez, Enrique J; Hernando, M Elena; Villares, Ricardo; Mellado, Mario

    2012-01-01

    This paper proposes an agent-based model of the action of macrophages on the beta cells of the endocrine pancreas. The aim of this model is to simulate the processes of beta cell proliferation and apoptosis and also the process of phagocytosis of cell debris by macrophages, all of which are related to the onset of the autoimmune response in type 1 diabetes. We have used data from the scientific literature to design the model. The results show that the model obtains good approximations to real processes and could be used to shed light on some open questions concerning such processes. PMID:23155767

  19. Preoperational test report, recirculation condenser cooling systems

    SciTech Connect

    Clifton, F.T.

    1997-11-04

    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.

  20. Pre-operative optimisation of lung function

    PubMed Central

    Azhar, Naheed

    2015-01-01

    The anaesthetic management of patients with pre-existing pulmonary disease is a challenging task. It is associated with increased morbidity in the form of post-operative pulmonary complications. Pre-operative optimisation of lung function helps in reducing these complications. Patients are advised to stop smoking for a period of 4–6 weeks. This reduces airway reactivity, improves mucociliary function and decreases carboxy-haemoglobin. The widely used incentive spirometry may be useful only when combined with other respiratory muscle exercises. Volume-based inspiratory devices have the best results. Pharmacotherapy of asthma and chronic obstructive pulmonary disease must be optimised before considering the patient for elective surgery. Beta 2 agonists, inhaled corticosteroids and systemic corticosteroids, are the main drugs used for this and several drugs play an adjunctive role in medical therapy. A graded approach has been suggested to manage these patients for elective surgery with an aim to achieve optimal pulmonary function. PMID:26556913

  1. Pancoast tumors: characteristics and preoperative assessment

    PubMed Central

    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

    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

  2. The Preoperative Assessment of Multiple Valve Disease

    PubMed Central

    Kavanagh-Gray, D.; Gerein, A.

    1964-01-01

    Representative case histories are used to discuss the difficulties in preoperative assessment of patients with multiple valve disease and the dangers of correcting one lesion when two or more valves are seriously damaged. Errors fall into three broad categories: existing second valve disease (1) may not be suspected, (2) may be considered insignificant or (3) may be considered a consequence of the first. Recommendations are offered to minimize these errors. The four valves should be studied physiologically, no matter how normal the other three may appear to be clinically, whenever open-heart surgery is contemplated. In bivalvular disease angiographic methods are preferable to pressure studies, for data so obtained are not dependent on cardiac output. Mitral and tricuspid regurgitation can never be attributed with certainty to a more distal lesion but require direct examination at time of operation for assessment. PMID:14199819

  3. Preoperative pulmonary assessment of the older adult.

    PubMed

    Smetana, Gerald W

    2003-02-01

    Postoperative pulmonary complications in the elderly are common and are a significant source of morbidity, mortality, and prolonged length of stay. Risk factors differ from the well-known risk factors for cardiac complications and can be divided into patient- and procedure-related factors. Patient-related factors include COPD, recent cigarette use, poor general health status as defined by Goldman or ASA class, dependent functional status, and laboratory parameters including abnormal chest radiograph, renal insufficiency, and low serum albumin. Age is a minor risk factor when adjusted for comorbidities and confers approximately a two-fold increase in risk. Elderly patients who are otherwise acceptable surgical candidates should not be denied surgery based solely on age and concern for postoperative pulmonary complications. The surgical site is the single most important predictor of pulmonary complications. High-risk surgeries include thoracic, upper abdominal, aortic, neurosurgery, and peripheral vascular. Other procedure-related risk factors include surgery lasting longer than 3 hours, the use of general anesthesia, pancuronium use, and emergency surgery. Clinicians should not recommend routine preoperative spirometry before high-risk surgery because it is no more accurate in predicting risk than clinical evaluation. Patients who might benefit from preoperative spirometry include those who have unexplained dyspnea or exercise intolerance and those who have COPD or asthma in whom uncertainty exists as to the status of airflow obstruction when compared with baseline. After identifying patients at risk for postoperative pulmonary complications, clinicians can recommend strategies to reduce risk throughout the operative period. In addition to minimizing or avoiding the above risk factors, optimization of COPD or asthma, deep breathing exercises, incentive spirometry, and epidural local anesthetics reduce the risk of postoperative pulmonary complications in elderly surgical patients. PMID:12735114

  4. Background parenchymal enhancement in preoperative breast MRI

    PubMed Central

    Kohara, Satoko; Ishigaki, Satoko; Satake, Hiroko; Kawamura, Akiko; Kawai, Hisashi; Kikumori, Toyone; Naganawa, Shinji

    2015-01-01

    ABSTRACT We aimed to assess the influence of background parenchymal enhancement (BPE) on surgical planning performed using preoperative MRI for breast cancer evaluation. Between January 2009 and December 2010, 91 newly diagnosed breast cancer patients (mean age, 55.5 years; range, 30−88 years) who underwent preoperative bilateral breast MRI followed by planned breast conservation therapy were retrospectively enrolled. MRI was performed to assess the tumor extent in addition to mammography and breast ultrasonography. BPE in the contralateral normal breast MRI at the early dynamic phase was visually classified as follows: minimal (n=49), mild (n=27), moderate (n=7), and marked (n=8). The correlations between the BPE grade and age, menopausal status, index tumor size, changes in surgical management based on MRI results, positive predictive value (PPV) of MRI, and surgical margins were assessed. Patients in the strong BPE groups were significantly younger (p=0.002) and generally premenopausal (p<0.001). Surgical treatment was not changed in 67 cases (73.6%), while extended excision and mastectomy were performed in 12 cases (13.2%), each based on additional lesions on MRI. Six of 79 (7.6%) patients who underwent breast conservation therapy had tumor-positive resection margins. In cases where surgical management was changed, the PPV for MRI-detected foci was high in the minimal (91.7%) and mild groups (66.7%), and 0% in the moderate and marked groups (p=0.002). Strong BPE causes false-positive MRI findings and may lead to overly extensive surgery, whereas MRI may be beneficial in select patients with weak BPE. PMID:26412883

  5. Neoadjuvant chemotherapy and radical radiotherapy associated with cetuximab for laryngeal cancer in a pancreas and renal recipient.

    PubMed

    Bonetta, Alberto; Bandera, Laura; Roviello, Giandomenico; Cafaro, Ines; Bottini, Alberto; Generali, Daniele

    2016-06-01

    The oncological treatment for advanced stage head and neck cancer is based on a combination of cisplatin and cetuximab, and radiotherapy. However, very few data are available on this multimodal approach for this type of cancer in pancreas and renal recipients. We report the case of a pancreas and renal recipient being treated with combined chemoradiotherapy for a locally advanced squamous cancer of the larynx. The patient was under treatment with ciclosporin-based immunosuppressive therapy at the time of cancer diagnosis, which was then replaced by everolimus. After 4 years of follow-up, the patients is still free from disease, with a local complete response, only mild residual dysphonia, and with edema of the chin. Cetuximab plus radiation could be an adequate option for cancer treatment in solid organ transplant recipients affected by locally advanced head and neck cancer; the concomitant use of mammalian target of rapamycin pathway inhibitors may have a synergistic effect in enhancing tumor control in these patients; however, further dedicated studies are warranted. PMID:26908347

  6. Prevention and Intervention Strategies to Alleviate Preoperative Anxiety in Children

    ERIC Educational Resources Information Center

    Wright, Kristi D.; Stewart, Sherry H.; Finley, G. Allen; Buffett-Jerrott, Susan E.

    2007-01-01

    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…

  7. Preoperative angiography and intraoperative transit time flow measurement to detect coronary graft patency in reoperations: an integrated approach--a case report.

    PubMed

    D'Ancona, G; Karamanoukian, H; Ricci, M; Bergsland, J; Salerno, T A

    2000-09-01

    Coronary angiography is the gold standard for preoperative diagnosis of coronary artery disease. In reoperative coronary artery surgery the physiologic significance of suspect lesions by angiography can be confirmed by direct intraoperative measurement of blood flow in the old grafts; such interpretation can prevent unnecessary graft revisions. PMID:10999619

  8. Roles of Commensal Microbiota in Pancreas Homeostasis and Pancreatic Pathologies

    PubMed Central

    Leal-Lopes, Camila; Velloso, Fernando J.; Campopiano, Julia C.; Sogayar, Mari C.; Correa, Ricardo G.

    2015-01-01

    The pancreas plays a central role in metabolism, allowing ingested food to be converted and used as fuel by the cells throughout the body. On the other hand, the pancreas may be affected by devastating diseases, such as pancreatitis, pancreatic adenocarcinoma (PAC), and diabetes mellitus (DM), which generally results in a wide metabolic imbalance. The causes for the development and progression of these diseases are still controversial; therefore it is essential to better understand the underlying mechanisms which compromise the pancreatic homeostasis. The interest in the study of the commensal microbiome increased extensively in recent years, when many discoveries have illustrated its central role in both human physiology and maintenance of homeostasis. Further understanding of the involvement of the microbiome during the development of pathological conditions is critical for the improvement of new diagnostic and therapeutic approaches. In the present review, we discuss recent findings on the behavior and functions played by the microbiota in major pancreatic diseases and provide further insights into its potential roles in the maintenance of pancreatic steady-state activities. PMID:26347203

  9. Metastatic tumors to the pancreas: The role of surgery

    PubMed Central

    Sperti, Cosimo; Moletta, Lucia; Patanè, Giuseppe

    2014-01-01

    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

  10. Pdx1 regulates pancreas tubulogenesis and E-cadherin expression.

    PubMed

    Marty-Santos, Leilani; Cleaver, Ondine

    2016-01-01

    Current efforts in developing treatments for diabetes focus on in vitro generation of functional ?-cells for cell replacement therapies; however, these attempts have only been partly successful because factors involved in islet formation remain incompletely understood. The embryonic pancreas, which gives rise to ?-cells, undergoes early epithelial rearrangements, including transient stratification of an initially monolayered epithelium, followed by microlumen formation and later resolution into branches. Within the epithelium, a multipotent progenitor cell (MPC) population is specified, giving rise to three important lineages: acinar, ductal and endocrine. Pdx1 is a transcription factor required for pancreas development and lineage specification; however, few Pdx1 targets that regulate pancreatogenesis have been identified. We find that pancreatic defects in Pdx1(-/-) embryos initiate at the time when the progenitor pool is specified and the epithelium should resolve into branches. Pdx1(-/-) microlumen diameters expand aberrantly, resulting in failure of epithelial tubulogenesis and ductal plexus formation. Pdx1(-/-) epithelial cell proliferation is decreased and the MPC pool is rapidly lost. We identify two conserved Pdx1 binding sites in the epithelial cadherin (E-cad, Cdh1) promoter, and show that Pdx1 directly binds and activates E-cad transcription. In addition, Pdx1 is required in vivo for maintenance of E-cad expression, actomyosin complex activity and cell shape. These findings demonstrate a novel link between regulators of epithelial architecture, specification of pancreatic cell fate and organogenesis. PMID:26657766

  11. Pancreatic pseudocyst or a cystic tumor of the pancreas?

    PubMed Central

    Rabie, Mohammad Ezzedien; El Hakeem, Ismail; Al Skaini, Mohammad Saad; El Hadad, Ahmad; Jamil, Salim; Tahir Shah, Mian; Obaid, Mahmoud

    2014-01-01

    Pancreatic pseudocysts are the most common cystic lesions of the pancreas and may complicate acute pancreatitis, chronic pancreatitis, or pancreatic trauma. While the majority of acute pseudocysts resolve spontaneously, few may require drainage. On the other hand, pancreatic cystic tumors, which usually require extirpation, may disguise as pseudocysts. Hence, the distinction between the two entities is crucial for a successful outcome. We conducted this study to highlight the fundamental differences between pancreatic pseudocysts and cystic tumors so that relevant management plans can be devised. We reviewed the data of patients with pancreatic cystic lesions that underwent intervention between June 2007 and December 2010 in our hospital. We identified 9 patients (5 males and 4 females) with a median age of 40 years (range, 30–70 years). Five patients had pseudocysts, 2 had cystic tumors, and 2 had diseases of undetermined pathology. Pancreatic pseudocysts were treated by pseudocystogastrostomy in 2 cases and percutaneous drainage in 3 cases. One case recurred after percutaneous drainage and required pseudocystogastrostomy. The true pancreatic cysts were serous cystadenoma, which was treated by distal pancreatectomy, and mucinous cystadenocarcinoma, which was initially treated by drainage, like a pseudocyst, and then by distal pancreatectomy when its true nature was revealed. We conclude that every effort should be exerted to distinguish between pancreatic pseudocysts and cystic tumors of the pancreas to avoid the serious misjudgement of draining rather than extirpating a pancreatic cystic tumor. Additionally, percutaneous drainage of a pancreatic pseudocyst is a useful adjunct that may substitute for surgical drainage. PMID:23958054

  12. Exocytosis of insulin: in vivo maturation of mouse endocrine pancreas.

    PubMed

    Rozzo, Aldo; Meneghel-Rozzo, Tiziana; Delakorda, Sasa Lipovsek; Yang, Shi-Bing; Rupnik, Marjan

    2009-01-01

    The aim of this study was to define when an insulin-positive cell becomes functional in vivo and starts to exocytose insulin in a regulated nutrient-dependent manner. Insulin-positive cells appear in embryonic life (midgestation) and complete their maturation, presumably around birth. In order to work with embryonic and newborn endocrine pancreas, we used organotypic slices. The mouse embryonic pancreas slices show high basal insulin release that is not further elevated by high glucose levels. Despite the presence of functional voltage-activated ion channels, the cells are not electrically active in the presence of secretagogues. At birth, the high basal insulin release drops and, after postnatal day 2, the insulin-positive cells show both adult-like bursting electrical activity and hormone release induced by high glucose levels. These properties allowed us to define them as beta cells. Despite the apparent stability of the transcription factor profile reported in insulin-positive cells during late-embryonic life, functional beta cells appear only 2 days after birth. PMID:19161376

  13. Endothelium-derived essential signals involved in pancreas organogenesis.

    PubMed

    Talavera-Adame, Dodanim; Dafoe, Donald C

    2015-05-20

    Endothelial cells (ECs) are essential for pancreas differentiation, endocrine specification, and endocrine function. They are also involved in the physiopathology of type 1 and type 2 diabetes. During embryogenesis, aortic ECs provide specific factors that maintain the expression of key genes for pancreas development such as pancreatic and duodenal homeobox-1. Other unknown factors are also important for pancreatic endocrine specification and formation of insulin-producing beta cells. Endocrine precursors proliferate interspersed with ductal cells and exocrine precursors and, at some point of development, these endocrine precursors migrate to pancreatic mesenchyme and start forming the islets of Langerhans. By the end of the gestation and close to birth, these islets contain immature beta cells with the capacity to express vascular endothelial growth factor and therefore to recruit ECs from the surrounding microenvironment. ECs in turn produce factors that are essential to maintain insulin secretion in pancreatic beta cells. Once assembled, a cross talk between endocrine cells and ECs maintain the integrity of islets toward an adequate function during the whole life of the adult individual. This review will focus in the EC role in the differentiation and maturation of pancreatic beta cells during embryogenesis as well as the current knowledge about the involvement of endothelium to derive pancreatic beta cells in vitro from mouse or human pluripotent stem cells. PMID:25992319

  14. Endothelium-derived essential signals involved in pancreas organogenesis

    PubMed Central

    Talavera-Adame, Dodanim; Dafoe, Donald C

    2015-01-01

    Endothelial cells (ECs) are essential for pancreas differentiation, endocrine specification, and endocrine function. They are also involved in the physiopathology of type 1 and type 2 diabetes. During embryogenesis, aortic ECs provide specific factors that maintain the expression of key genes for pancreas development such as pancreatic and duodenal homeobox-1. Other unknown factors are also important for pancreatic endocrine specification and formation of insulin-producing beta cells. Endocrine precursors proliferate interspersed with ductal cells and exocrine precursors and, at some point of development, these endocrine precursors migrate to pancreatic mesenchyme and start forming the islets of Langerhans. By the end of the gestation and close to birth, these islets contain immature beta cells with the capacity to express vascular endothelial growth factor and therefore to recruit ECs from the surrounding microenvironment. ECs in turn produce factors that are essential to maintain insulin secretion in pancreatic beta cells. Once assembled, a cross talk between endocrine cells and ECs maintain the integrity of islets toward an adequate function during the whole life of the adult individual. This review will focus in the EC role in the differentiation and maturation of pancreatic beta cells during embryogenesis as well as the current knowledge about the involvement of endothelium to derive pancreatic beta cells in vitro from mouse or human pluripotent stem cells. PMID:25992319

  15. 77 FR 69863 - Antiseptic Patient Preoperative Skin Preparation Products; Public Hearing; Request for Comments

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-21

    ... HUMAN SERVICES Food and Drug Administration Antiseptic Patient Preoperative Skin Preparation Products... skin preparation drug products. Currently, patient preoperative skin preparations are not required to.... Contaminated patient preoperative skin preparations have been associated with clinical infections and...

  16. Simultaneous pancreas-kidney transplantation with duodeno-duodenal anastomosis.

    PubMed

    Khubutia, M; Pinchuk, A; Dmitriev, I; Storozhev, R

    2014-01-01

    Simultaneous pancreas-kidney transplantation (SPKT) is now accepted as the method of choice for patients with insulin-dependent diabetes mellitus (type I) who have end-stage renal disease (ESRD). We believe that retroperitoneal positioning of the donor pancreas with the formation of duodeno-duodenal anastomosis is the most physiologically relevant. Starting in January 2008, the SPKT was chosen as the treatment method of 32 patients with diabetes mellitus. In 15 cases comprising group I (46.9%), the pancreas was placed intra-abdominally (including the formation of the duodeno-jejunal anastomosis). In the remaining 17 patients (53.1%) comprising group II, the pancreas was positioned retroperitoneally (including the formation of the duodeno-duodenal anastomosis). We compared the main parameters of the early postoperative period in these groups. There were no substantial differences between the groups in the prevalence of immunological (13.3% and 11.8%, P = .9), surgical (20% and 23.5%, P = .81), and infectious complications (20% and 5.9%, P = .23). On discharge there were no significant differences in the values of the following between the two groups, respectively: serum creatinine values, 112.7 ± 31.2 and 104.8 ± 54.6 μmol/L, P = .17; glomerular filtration rate, 73.5 ± 28.6 and 78.7 ± 24.9 mL/min, P = .55; α-amylase, 121.9 ± 63.6 and 150.1 ± 72.1 U/L, P = .27; pancreatic amylase, 102 ± 51.5 and 122.5 ± 75.4 U/L, P = .6; lipase, 115.4 ± 67.3 and 96 ± 65.7 U/L, P = .5; С-peptide, 4.44 ± 1.9 and 4.02 ± 2.4 ng/mL, P = .47; HbA1c, 5.45 ± 0.8% and 5.56 ± 1.12%, P = .9; and intact insulin, 12.2 ± 5.4 and 12.9 ± 8.8 mcIU/mL, P = .95). SPKT remains the best method of medical and social rehabilitation for patients who have diabetes mellitus (type-I) with ESRD. Compared to the classic method, we have seen no significant deviations in either of the following: the qualitative features marking the restoration of function of the two transplanted organs and/or the quality of compensation of carbohydrate metabolism, incidence of rejection, and graft loss. At the same time, retroperitoneal positioning of the pancreas exhibited lower repeat surgery rates. PMID:25131067

  17. Simultaneous pancreas-kidney transplantation: which organ should be transplanted first?

    PubMed

    Salzedas-Netto, A; Linhares, M; Lopes-Filho, G; Melaragno, C; de Sa, J; Rangel, E B; Rangel, E; Goncalves, M; Pestana, J; Gonzalez, A

    2010-09-01

    Simultaneous pancreas-kidney transplantation (SPKT) has been accepted as treatment for type I diabetic patients with end-stage renal disease. Its success depends largely on the surgical technique. This study sought to compare groups of SPKT with initial pancreas implantation versus initial kidney implantation. From December 2000 to September 2006, 151 SPKT were performed by a single center. In 85 cases, the pancreas was implanted first (group 1), and in 66 cases the order was inverted (group 2). Variables were implantation sequence, pancreas and kidney ischemia time, donor age, venous drainage, previous donor peritoneal dialysis, and recipient age and gender. Outcome variables included pancreas vascular thrombosis, 3-month graft survival, 3-month patient survival, pancreas rejection episodes, intra-abdominal infection, diabetes control and reoperations. We observed a 10.6% incidence of vascular thrombosis in group 1 but none in group 2 (P = .005). In groups 1 and 2, the 3-month pancreas survivals were 74.1% and 89.4% (P = .022), and the mean hospital stays were 24.3 and 15.8 days, respectively (P = .002). Our results suggested that, when 2 different teams are involved in SPKT, with >1 exposure and the need for retractor replacement, the kidney should be transplanted first, because the pancreas may be damaged during the surgical procedure. PMID:20832561

  18. Acute graft-versus-host disease following simultaneous pancreas-kidney transplantation: report of a case.

    PubMed

    Asari, Sadaki; Matsumoto, Ippei; Toyama, Hirochika; Shinzeki, Makoto; Goto, Tadahiro; Tanaka, Masaki; Shirakawa, Sachiyo; Yamashita, Hironori; Ajiki, Tetsuo; Fukumoto, Takumi; Ku, Yonson

    2015-12-01

    Acute graft-versus-host-disease (aGVHD) is a rare complication in the setting of pancreas-kidney transplantation (PKT). We herein describe the case of a 37-year-old male with severe type 1 diabetes with chronic renal failure who received simultaneous PKT from a female donor. Diarrhea developed on postoperative day (POD) 10. Subsequently, fever and liver dysfunction occurred on POD 32. Skin rashes appeared with pain and itching on his trunk and extremities on POD 40. As pancytopenia occurred on POD 63, bone marrow biopsies demonstrated profound hypoplastic marrow. On POD 69, we eventually made a definitive diagnosis of aGVHD because skin biopsies revealed the XX chromosome signal in a fluorescence in situ hybridization analysis. Thereafter, 100 mg of prednisolone was administered for 5 days. Although every symptom was temporarily improved, on POD 156, the patient expired from the septic pneumonia without any effects of antibiotics. Clinician should be aware that PKT has the potential to induce aGVHD. PMID:25373363

  19. Calculating life years from transplant (LYFT): methods for kidney and kidney-pancreas candidates.

    PubMed

    Wolfe, R A; McCullough, K P; Schaubel, D E; Kalbfleisch, J D; Murray, S; Stegall, M D; Leichtman, A B

    2008-04-01

    The Organ Procurement and Transplantation Network (OPTN) Kidney Committee is considering a proposal for a new deceased donor kidney allocation system. Among the components under consideration is a strategy to rank candidates in part by the estimated incremental years of life that are expected to be achieved with a transplant from a specific available deceased donor, computed as the difference in expected median lifespan with that transplant compared with remaining on dialysis. This concept has been termed life years from transplant or LYFT. Median lifespans could be calculated, based on objective medical criteria, for each candidate when a deceased donor kidney becomes available, based on Cox regression models using current candidate and donor medical information. The distribution of the calculated LYFT scores for an average nonexpanded criteria donor kidney is similar across candidate sex, race/ethnicity, insurance status and, with the exception of diabetes, diagnosis. LYFT scores tend to be higher for younger candidates and lower for diabetics receiving a kidney-alone rather than a simultaneous kidney-pancreas transplant. Prioritizing candidates with higher LYFT scores for each available kidney could substantially increase total years of life among both transplant candidates and recipients. LYFT is also a powerful metric for assessing trends in allocation outcomes and for comparing alternative allocation systems. PMID:18336702

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

    SciTech Connect

    Wan Haiyan; Korzh, Svitlana; Li Zhen; Mudumana, Sudha Puttur; Korzh, Vladimir; Jiang Yunjin; Lin Shuo; Gong Zhiyuan . E-mail: dbsgzy@nus.edu.sg

    2006-05-15

    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.

  1. ECM Signaling Regulates Collective Cellular Dynamics to Control Pancreas Branching Morphogenesis.

    PubMed

    Shih, Hung Ping; Panlasigui, Devin; Cirulli, Vincenzo; Sander, Maike

    2016-01-12

    During pancreas development, epithelial buds undergo branching morphogenesis to form an exocrine and endocrine gland. Proper morphogenesis is necessary for correct lineage allocation of pancreatic progenitors; however, the cellular events underlying pancreas morphogenesis are unknown. Here, we employed time-lapse microscopy and fluorescent labeling of cells to analyze cell behaviors associated with pancreas morphogenesis. We observed that outer bud cells adjacent to the basement membrane are pleomorphic and rearrange frequently; additionally, they largely remain in the outer cell compartment even after mitosis. These cell behaviors and pancreas branching depend on cell contacts with the basement membrane, which induce actomyosin cytoskeleton remodeling via integrin-mediated activation of FAK/Src signaling. We show that integrin signaling reduces E-cadherin-mediated cell-cell adhesion in outer cells and provide genetic evidence that this regulation is necessary for initiation of branching. Our study suggests that regulation of cell motility and adhesion bylocal niche cues initiates pancreas branching morphogenesis. PMID:26748698

  2. Preoperative Sleep Disruption and Postoperative Delirium

    PubMed Central

    Leung, Jacqueline M.; Sands, Laura P.; Newman, Stacey; Meckler, Gabriela; Xie, Yimeng; Gay, Caryl; Lee, Kathryn

    2015-01-01

    Study Objectives: To describe preoperative and postoperative sleep disruption and its relationship to postoperative delirium. Design: Prospective cohort study with 6 time points (3 nights pre-hospitalization and 3 nights post-surgery). Setting: University medical center. Patients: The sample consisted of 50 English-speaking patients ≥ 40 years of age scheduled for major non-cardiac surgery, with an anticipated hospital stay ≥ 3 days. Interventions: None. Measurements and results: Sleep was measured before and after surgery for a total of 6 days using a wrist actigraph to quantify movement in a continuous fashion. Postoperative delirium was measured by a structured interview using the Confusion Assessment Method. Sleep variables for patients with (n = 7) and without (n = 43) postoperative delirium were compared using the unpaired Student t-tests or χ2 tests. Repeated measures analysis of variance for the 6 days was used to examine within-subject changes over time and between group differences. The mean age of the patients was 66 ± 11 years (range 43–91 years), and it was not associated with sleep variables or postoperative delirium. The incidence of postoperative delirium observed during any of the 3 postoperative days was 14%. For the 7 patients who subsequently developed postoperative delirium, wake after sleep onset (WASO) as a percentage of total sleep time was significantly higher (44% ± 22%) during the night before surgery compared to the patients who did not subsequently developed delirium (21% ± 20%, p = 0.012). This sleep disruption continued postoperatively, and to a greater extent, for the first 2 nights after surgery. Patients with WASO < 10% did not experience postoperative delirium. Self-reported sleep disturbance did not differ between patients with vs. without postoperative delirium. Conclusions: In this pilot study of adults over 40 years of age, sleep disruption was more severe before surgery in the patients who experienced postoperative delirium. A future larger study is necessary to confirm our results and determine if poor sleep is associated with delirium in larger samples and what specific sleep problems best predict postoperative delirium in older surgical patients. Citation: Leung JM, Sands LP, Newman S, Meckler G, Xie Y, Gay G, Lee K. Preoperative sleep disruption and postoperative delirium. J Clin Sleep Med 2015;11(8):907–913. PMID:25979094

  3. [Incretin-based antidiabetic treatment and diseases of the pancreas (pancreatitis, pancreas carcinoma)].

    PubMed

    Jermendy, György

    2016-04-01

    In the last couple of years incretin-based antidiabetic drugs became increasingly popular and widely used for treating patients with type 2 diabetes. Immediately after launching, case reports and small case series were published on the potential side effects of the new drugs, with special attention to pancreatic disorders such as acute pancreatitis or pancreatic cancer. As clinical observations accumulated, these side-effects were noted with nearly all drugs of this class. Although these side-effects proved to be rare, an intensive debate evolved in the literature. Opinion of diabetes specialists and representatives of pharmaceutical industry as well as position statements of different international scientific boards and health authorities were published. In addition, results of randomized clinical trials with incretin-based therapy and meta-analyses became available. Importantly, in everyday clinical practice, the label of the given drug should be followed. With regards to incretins, physicians should be cautious if pancreatitis in the patients' past medical history is documented. Early differential diagnosis of any abdominal pain during treatment of incretin-based therapy should be made and the drug should be discontinued if pancreatitis is verified. Continuous post-marketing surveillance and side-effect analysis are still justified with incretin-based antidiabetic treatment in patients with type 2 diabetes. Orv. Hetil., 2016, 157(14), 523-528. PMID:27017851

  4. [Pancreas transplantation: a survey on indications, surgical techniques, immunosuppression, complications and outcome].

    PubMed

    Drognitz, O; Hopt, U T

    2003-10-01

    Since its introduction in 1966, pancreas transplantation has undergone considerable progress. Refinements in surgical technique, better organ preservation solutions, and more potent immunosuppressive therapies have improved patient and graft-survival rates dramatically. Survival rates for patient and pancreas at 1 year approach 95 and 83 %, resp., for simultaneous pancreas and kidney transplantation, and 97 and 78 %, resp., for pancreas alone. US pancreas graft and patient survival rates do not significantly differ from the results of the European centers. However, there is still a hesitant acceptance of combined pancreas-kidney transplantation in Germany. Combined pancreas-kidney transplantation is nowadays the treatment of choice in carefully selected patients with type 1 insulin-dependent diabetes mellitus and end-stage renal failure. Many US centers even advocate combined transplantation in diabetic patients at a pre-uremic stage. Pancreas transplantation significantly improves quality of life and provides excellent long-term glycemic control which halts or even ameliorates secondary diabetic complications such as microangiopathy and neuropathy. In addition, there is increasing evidence that successful pancreas transplantation significantly prolongs patient survival mainly by a reduction of cardiovascular-related mortality. Current 10-year patient survival rate after SPK exceeds 70 %. For diabetics with end-stage renal disease there is no alternative treatment available with comparable live expectancy. However, morbidity and mortality after SPK is still higher than for kidney transplantation alone in the first year. Outcome of isolated pancreas transplantation is also improving but this technique is still restricted to non-uremic patients with severe diabetic complications or with brittle diabetes and severe impairment of quality of life. PMID:14628231

  5. [Preoperative radiation therapy for rectal cancer. personal experience

    PubMed

    Mayer, A; Patyánik, M; Kegye, A; Mészáros, E

    2001-01-01

    PURPOSE: Comparison of the effectiveness of preoperative and "sandwich" (preoperative and postoperative) radiation therapy in the treatment of midrectum and lower rectum carcinoma, based on a prospective clinical trial. MATERIAL AND METHOD: Over the period between 1990 and 1997, we treated 115 patients suffering from mid-rectum and lower rectum carcinoma at the Budapest Oncoradiological Centre, using sandwich therapy (22.5 Gy preoperative-27.5 Gy postoperative) in the case of 36 patients and 36 Gy preoperative radiation therapy in the case of 79 patients with external-beam megavoltage therapy with mostly telecobalt radiation and to a smaller number of cases 6 MV energy. The external-beam radiation therapy was nearly always applied with a 4-field box technique, and radical surgery was performed within 10 days following the preoperative radiation treatment. Effectiveness was evaluated in terms of a Log-Rank and Peto-Wilcoxon tests and the Kaplan-Meier survival curve. RESULTS: The effectiveness of the different therapies was compared in terms of the percentage of local failure and the rate of disease-free survival. The results show that when using the "sandwich" radiation therapy local failure is expected to occur in 13.8% of all cases, compared with 17.7%, when only preoperative radiation therapy is used. In terms of five-year disease-free survival, the sandwich therapy seems to be better, but for a higher number of years, namely 7.5, the preoperative radiation therapy yielded better results. CONCLUSION: In terms of local failure, the effectiveness of the preoperative and the "sandwich" radiation therapies for the treatment of mid-rectum and lower rectum carcinoma was nearly identical, while preoperative radiation therapy provided longer disease-free survival. Further trials using multivariation analysis need to be performed to evaluate the two types of radiation treatments, taking into account other parameters, such as grading, age and lymphatic spread. PMID:12050699

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

    NASA Astrophysics Data System (ADS)

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

    2009-02-01

    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.

  7. Magnetic resonance imaging of the pancreas in streptozotocin-induced diabetic rats: Gadofluorine P and Gd-DOTA

    PubMed Central

    Cho, Hye Rim; Lee, Youkyung; Doble, Philip; Bishop, David; Hare, Dominic; Kim, Young-Jae; Kim, Kwang Gi; Jung, Hye Seung; Park, Kyong Soo; Choi, Seung Hong; Moon, Woo Kyung

    2015-01-01

    AIM: To investigate the performance of Gadofluorine P-enhanced magnetic resonance imaging (MRI) on the diagnosis of diabetes in a streptozotocin (STZ) -induced diabetic rat model. METHODS: Fischer 344 rats were treated with STZ. Rats not treated with STZ served as controls. T1-weighted MRI was performed using a 3T scanner before and after the injection of Gd-DOTA or Gadofluorine P (6 diabetic rats, 5 controls). The normalized signal intensity (SI) and the enhancement ratio (ER) of the pancreas were measured at each time point, and the values were compared between the normal and diabetic rats using the Mann-Whitney test. In addition, the values were correlated with the mean islet number. Optimal cut-off values were calculated using a positive test based on receiver operating characteristics. Intrapancreatic Gd concentration after the injection of each contrast media was measured using laser ablation-inductively coupled plasma-mass spectrometry in a separate set of rats (4 diabetic rats, 4 controls for Gadofluorine P; 2, 2 for Gd-DOTA). RESULTS: The normalized SI and ER of the pancreas using Gd-DOTA were not significantly different between diabetic rats and controls. With Gadofluorine P, the values were significantly higher in the diabetic rats than in the control rats 30 min after injection (P < 0.05). The area under the receiver operating characteristic curve that differentiated diabetic rats from the control group was greater for Gadofluorine P than for Gd-DOTA (0.967 vs 0.667, P = 0.085). An increase in normalized SI 30 min after Gadofluorine P was correlated with a decrease in the mean number of islets (r2 = 0.510, P = 0.014). Intra-pancreatic Gd was higher in rats with Gadofluorine P injection than Gd-DOTA injection (Gadofluorine P vs Gd-DOTA, 7.37 vs 0.00, P < 0.01). A significant difference in the concentration of intrapancreatic Gd was observed between the control and diabetic animals that were sacrificed 30 min after Gadofluorine P injection (control vs diabetic, 3.25 ng/g vs 10.55 ng/g, P < 0.05) CONCLUSION: In this STZ-induced diabetes rat model, Gadofluorine P-enhanced MRI of the pancreas showed high accuracy in the diagnosis of diabetes. PMID:26019447

  8. Preoperative cutaneous lymphoscintigraphy in malignant melanoma

    SciTech Connect

    Lock-Andersen, J.; Rossing, N.; Drzewiecki, K.T.

    1989-01-01

    To identify the regional lymph node basins cutaneous lymphoscintigraphy with technetium 99m rhenium sulfide colloid (/sup 99m/Tc-ReS) was performed in 45 patients and with technetium 99m antimony sulfide colloid (/sup 99m/Tc-Sb2S3) in seven patients after excisional biopsy of the primary tumor. All patients had skin tumors located in the face or neck or on the trunk with 47 cases of cutaneous malignant melanoma and 5 cases of benign or premalignant lesions. In 48 patients the scintiscans 1 hour after perilesional injection of the tracer colloid clearly showed the lymphatic drainage patterns from the tumor sites, of them 25 patients demonstrated unidirectional drainage, whereas the remaining 23 patients had multidirectional drainage to two or three lymph node groups. There were technical difficulties in performing the examinations in four patients. The authors recommend cutaneous lymphoscintigraphy as a safe, simple and reliable technique for mapping the lymphatic drainage preoperatively in patients with Stage I cutaneous malignant melanoma of axial localization.

  9. Preoperative arterial embolization of large liver hemangiomas

    PubMed Central

    Topaloğlu, Serdar; Oğuz, Şükrü; Kalaycı, Orhan; Öztürk, M. Halil; Çalık, Adnan; Dinç, Hasan; Çobanoğlu, Ümit

    2015-01-01

    PURPOSE We aimed to investigate the efficacy and safety of preoperative selective intra-arterial embolization (PSIAE) in the surgical treatment of large liver hemangiomas. METHODS Data of 22 patients who underwent resection of large liver hemangiomas were retrospectively analyzed. PSIAE was performed in cases having a high risk of severe blood loss during surgery (n=11), while it was not applied in cases with a low risk of blood loss (n=11). RESULTS A total of 19 enucleations and six anatomic resections were performed. Operative time, intraoperative bleeding amount, Pringle period, and blood transfusion were comparable between the two groups (P > 0.05, for all). The perioperative serum aspartate transaminase level was not different between groups (P = 1.000). Perioperative total bilirubin levels were significantly increased in the PSIAE group (P = 0.041). Postoperative hospital stay was longer in the PSIAE group. Surgical complications were comparable between groups (P = 0.476). CONCLUSION Patients who underwent PSIAE due to a high risk of severe blood loss during resection of large liver hemangiomas had comparable operative success as patients with a low risk of blood loss who were operated without PSIAE. Hence, PSIAE can be used for the control of intraoperative blood loss, especially in surgically difficult cases. PMID:25858526

  10. The Preoperative Patient With a Systolic Murmur

    PubMed Central

    Cowie, Brian

    2015-01-01

    Context: Patients with undifferentiated systolic murmurs present commonly during the perioperative period. Traditional bedside assessment and auscultation has not changed significantly in almost 200 years and relies on interpreting indirect acoustic events as a means of evaluating underlying cardiac pathology. This is notoriously inaccurate, even in expert cardiology hands, since many different valvular and cardiac diseases present with a similar auditory signal. Evidence Acquisition: The data on systolic murmurs, physical examination, perioperative valvular disease in the setting of non-cardiac surgery is reviewed. Results: Significant valvular heart disease increases perioperative risk in major non-cardiac surgery and increases long term patient morbidity and mortality. We propose a more modern approach to physical examination that incorporates the use of focused echocardiography to allow direct visualization of cardiac structure and function. This improves the diagnostic accuracy of clinical assessment, allows rational planning of surgery and anaesthesia technique, risk stratification, postoperative monitoring and appropriate referral to physicians and cardiologists. Conclusions: With a thorough preoperative assessment incorporating focused echocardiography, anaesthetists are in the unique position to enhance their role as perioperative physicians and influence short and long term outcomes of their patients. PMID:26705529

  11. Computed Tomography Angiography for Preoperative Thoracoabdominal Flap Planning.

    PubMed

    O'Malley, Ryan B; Robinson, Tracy J; Kozlow, Jeffrey H; Liu, Peter S

    2016-01-01

    Mastectomy rates have increased, coinciding with more advanced reconstruction options. Deep inferior epigastric perforator (DIEP) flaps decrease abdominal donor site morbidity, but require considerable technical expertise. Preoperative computed tomography angiography (CTA) can accurately demonstrate DIEA anatomy and perforator courses, facilitating preoperative planning and flap design, allowing for more targeted intraoperative microdissection. Patients who undergo CTA before DIEP flap have better clinical outcomes with shorter operative times and hospital length of stay, which can decrease overall associated health care costs. Future directions include selected imaging of the thoracic anatomy and recipient vasculature, allowing for additional preoperative planning and customization. PMID:26654396

  12. Preoperative considerations for patients with chronic obstructive pulmonary disease.

    PubMed

    Mandra, Ana; Simić, Dusica; Stevanović, Vesna; Ugrinović, Djordje; Skodrić, Vesna; Kalezić, Nevena

    2011-01-01

    Chronic obstructive pulmonary disease is a risk factor for development of intraoperative and postoperative pulmonary complications. Regarding the type and the extent of surgical procedure, patients with COPD are at risk of aggravation of pulmonary function which leads to complicated perioperative course. In order to reduce perioperative complications, preoperative evaluation and preoperative patient preparation are of great importance. Goals of preoperative preparation and anesthesia in patients with COPD are maintaining ventilation-perfusion ratio, preventing development of hipoxemia, intraoperative brochospasm, pneumothorax and disturbances of cardivascular system. PMID:21879653

  13. Pancreatic Steatosis and Fibrosis: Quantitative Assessment with Preoperative Multiparametric MR Imaging.

    PubMed

    Yoon, Jeong Hee; Lee, Jeong Min; Lee, Kyung Bun; Kim, Sun-Whe; Kang, Mee Joo; Jang, Jin-Young; Kannengiesser, Stephan; Han, Joon Koo; Choi, Byung Ihn

    2016-04-01

    Purpose To evaluate the diagnostic performance of multiparametric pancreatic magnetic resonance (MR) imaging, including the T2*-corrected Dixon technique and intravoxel incoherent motion (IVIM) diffusion-weighted (DW) imaging, in the quantification of pancreatic steatosis and fibrosis, with histologic analysis as the reference standard, and to determine the relationship between MR parameters and postoperative pancreatic fistula. Materials and Methods This retrospective study was approved by the institutional review board, and the informed consent requirement was waived. A total of 165 patients (93 men, 72 women; mean age, 62 years) underwent preoperative 3-T MR imaging and subsequent pancreatectomy (interval, 0-77 days). Fat fractions, IVIM DW imaging parameters (true diffusion coefficient [D], pseudodiffusion coefficient [D*], and perfusion fraction [f]), pancreas-to-muscle signal intensity ratios on unenhanced T1-weighted images, and pancreatic duct sizes were compared with the fat fractions and fibrosis degrees (F0-F3) of specimens. In 95 patients who underwent pancreatoenteric anastomosis, MR parameters were compared between groups with clinically relevant postoperative pancreatic fistula and those without. The relationship between postoperative pancreatic fistula and MR parameters was evaluated by using logistic regression analysis. Results Fat fractions at MR imaging showed a moderate relationship with histologic findings (r = 0.71; 95% confidence interval: 0.63, 0.78). Patients with advanced fibrosis (F2-F3) had lower D*([39.72 ± 13.64] ×10(-3)mm(2)/sec vs [32.50 ± 13.09] ×10(-3)mm(2)/sec [mean ± standard deviation], P = .004), f (29.77% ± 8.51 vs 20.82% ± 8.66, P < .001), and unenhanced T1-weighted signal intensity ratio (1.43 ± 0.26 vs 1.21 ± 0.30, P < .001) than did patients with F0-F1 disease. Clinically relevant fistula developed in 14 (15%) of 95 patients, and f was significantly associated with postoperative pancreatic fistula (odds ratio, 1.17; 95% confidence interval: 1.05, 1.30). Conclusion Multiparametric MR imaging of the pancreas, including imaging with the T2*-corrected Dixon technique and IVIM DW imaging, may yield quantitative information regarding pancreatic steatosis and fibrosis, and f was shown to be significantly associated with postoperative pancreatic fistulas. (©) RSNA, 2015 Online supplemental material is available for this article. PMID:26566228

  14. Preoperative Education and Decreasing Preoperative Anxiety Among Children Aged 8 - 10 Years Old and Their Mothers

    PubMed Central

    Sadegh Tabrizi, Jafar; Seyedhejazi, Mahin; Fakhari, Ali; Ghadimi, Farzaneh; Hamidi, Masood; Taghizadieh, Nasrin

    2015-01-01

    Background: Preoperative anxiety is associated with adverse clinical, behavioral, and psychological outcomes. Various effective interventions targeting preoperative anxiety in children exist. Objectives: The aim of this study was to evaluate the educational intervention by residents on children and maternal anxiety and their satisfaction from anxiety management. Patients and Methods: After obtaining the institutional ethics committee approval and written informed parental consent, 36 ASA-I, II children (age range, 8 - 10 years) underwent small operations were included in this prospective randomized study. The participants were allocated into the intervention (n =18) and control (n =18) groups. Children in the first group were prepared routinely. In the second group children and their mothers received data about anesthesia and operation by the booklet. Children-maternal anxiety was assessed using the anxiety level form, at the night and in the morning before surgery. Few days after surgery mothers, residents, and children experiences and satisfaction from anxiety management were assessed in the focus group discussion. Results: Mean scores and standard deviations of state anxiety in the intervention group before and after training were 33.1 ± 5.5 and 30.8 ± 6, respectively (P = 0.06). In the control group it was 32 ± 6.5 on the night and 34.1 ± 6.7 in the morning before surgery (P = 0.00). Comparison between groups was not significant (P = 0.6) and (P = 0.1). The mean levels of anxiety in the control group mothers on the night before and in the morning of surgery were 39.2 ± 13.1 and 42.8 ± 14 (P = 0.00), respectively. In the intervention group, mothers’ anxiety before education was 41 ± 12.7 and after education it was 35.6 ± 9.5 (P = 0.04). Comparison between groups was not significant (P = 0.7) and (P = 0.1). According to the focus group discussions, booklet study, provided education, sympathy of medical team, spiritual issues and beliefs reduced anxiety and fear of surgery. Anesthesia and lack of knowledge of what will happen, crying and restlessness of children increased preoperative anxiety. Conclusions: In this study, the preoperative anxiety was reduced by explaining anesthesia and surgery to the mothers and children (in mothers it was significant P < 0.05). Since there is a direct relation between mothers’ and their children’s anxiety, using an effective method to reduce anxiety in children and their mothers together at the same time would be very useful for children and their mothers. PMID:26473103

  15. 17 beta-hydroxysteroid dehydrogenase activity in canine pancreas

    SciTech Connect

    Mendoza-Hernandez, G.; Lopez-Solache, I.; Rendon, J.L.; Diaz-Sanchez, V.; Diaz-Zagoya, J.C.

    1988-04-15

    The mitochondrial fraction of the dog pancreas showed NAD(H)-dependent enzyme activity of 17 beta-hydroxysteroid dehydrogenase. The enzyme catalyzes oxidoreduction between androstenedione and testosterone. The apparent Km value of the enzyme for androstenedione was 9.5 +/- 0.9 microM, the apparent Vmax was determined as 0.4 nmol mg-1 min-1, and the optimal pH was 6.5. In phosphate buffer, pH 7.0, maximal rate of androstenedione reduction was observed at 37 degrees C. The oxidation of testosterone by the enzyme proceeded at the same rate as the reduction of the androstenedione at a pH of 6.8-7.0. The apparent Km value and the optimal pH of the enzyme for testosterone were 3.5 +/- 0.5 microM and 7.5, respectively.

  16. Closed-Loop Artificial Pancreas Systems: Engineering the Algorithms

    PubMed Central

    Huyett, Lauren M.; Lee, Joon Bok; Zisser, Howard C.; Dassau, Eyal

    2014-01-01

    In this two-part Bench to Clinic narrative, recent advances in both the preclinical and clinical aspects of artificial pancreas (AP) development are described. In the preceding Bench narrative, Kudva and colleagues provide an in-depth understanding of the modified glucoregulatory physiology of type 1 diabetes that will help refine future AP algorithms. In the Clinic narrative presented here, we compare and evaluate AP technology to gain further momentum toward outpatient trials and eventual approval for widespread use. We enumerate the design objectives, variables, and challenges involved in AP development, concluding with a discussion of recent clinical advancements. Thanks to the effective integration of engineering and medicine, the dream of automated glucose regulation is nearing reality. Consistent and methodical presentation of results will accelerate this success, allowing head-to-head comparisons that will facilitate adoption of the AP as a standard therapy for type 1 diabetes. PMID:24757226

  17. Glucagon in the artificial pancreas: supply and marketing challenges.

    PubMed

    Rylander, Dick

    2015-01-01

    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

  18. Targeted agents in treatment of neuroendocrine tumors of pancreas.

    PubMed

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

    2014-07-01

    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

  19. The Human Endocrine Pancreas: New Insights on Replacement and Regeneration.

    PubMed

    Domínguez-Bendala, Juan; Lanzoni, Giacomo; Klein, Dagmar; Álvarez-Cubela, Silvia; Pastori, Ricardo L

    2016-03-01

    Islet transplantation is an effective cell therapy for type 1 diabetes (T1D) but its clinical application is limited due to shortage of donors. After a decade-long period of exploration of potential alternative cell sources, the field has only recently zeroed in on two of them as the most likely to replace islets. These are pluripotent stem cells (PSCs) (through directed differentiation) and pancreatic non-endocrine cells (through directed differentiation or reprogramming). Here we review progress in both areas, including the initiation of Phase I/II clinical trials using human embryonic stem cell (hESc)-derived progenitors, advances in hESc differentiation in vitro, novel insights on the developmental plasticity of the pancreas, and groundbreaking new approaches to induce β cell conversion from the non-endocrine compartment without genetic manipulation. PMID:26774512

  20. Leptin Controls Parasympathetic Wiring of the Pancreas during Embryonic Life.

    PubMed

    Croizier, Sophie; Prevot, Vincent; Bouret, Sebastien G

    2016-04-01

    The autonomic nervous system plays a critical role in glucose metabolism through both its sympathetic and parasympathetic branches, but the mechanisms that underlie the development of the autonomic innervation of the pancreas remain poorly understood. Here, we report that cholinergic innervation of pancreatic islets develops during mid-gestation under the influence of leptin. Leptin-deficient mice display a greater cholinergic innervation of pancreatic islets beginning in embryonic life, and this increase persists into adulthood. Remarkably, a single intracerebroventricular injection of leptin in embryos caused a permanent reduction in parasympathetic innervation of pancreatic β cells and long-term impairments in glucose homeostasis. These developmental effects of leptin involve a direct inhibitory effect on the outgrowth of preganglionic axons from the hindbrain. These studies reveal an unanticipated regulatory role of leptin on the parasympathetic nervous system during embryonic development and may have important implications for our understanding of the early mechanisms that contribute to diabetes. PMID:27052164

  1. Laparoscopic pancreas-preserving total duodenectomy for familial adenomatous polyposis.

    PubMed

    Benetatos, Nikolaos; Ammori, Mohannad B; Ammori, Basil J

    2011-12-01

    Patients with duodenal polyps associated with familial adenomatous polyposis (FAP) have a considerable risk of developing duodenal carcinoma. Prophylactic resection of the duodenum for Spigelman stage III disease is the treatment of choice to prevent progression to cancer. Pancreaticoduodenectomy and pancreas-preserving total duodenectomy (PPTD) are the techniques that have been described for the surgical treatment of duodenal polyposis. We report the first case of laparoscopic PPTD in a patient with previous total colectomy for FAP and Spigelman stage III duodenal polyposis. A laparoscopic total dissection of the duodenum was carried out and the restoration was achieved performing pancreatico-biliary-jejunostomy and gastrojejunostomy. The postoperative period was uneventful. Laparoscopic PPTD can be performed safely in selected cases for the management of FAP. PMID:22146186

  2. Large mucinous cystic neoplasm of the pancreas associated with pregnancy

    PubMed Central

    Ikuta, Shin-ichi; Aihara, Tsukasa; Yasui, Chiaki; Iida, Hiroya; Yanagi, Hidenori; Mitsunobu, Masao; Kakuno, Ayako; Yamanaka, Naoki

    2008-01-01

    Mucinous cystic neoplasms (MCNs) of the pancreas occur mostly in females and are potentially sex hormone-sensitive. However, a MCN occurring during pregnancy is quite rare. A 30-year-old woman in the tenth week of pregnancy was referred to us because of a rapid increase in left hypochondrial distending pain. On ultrasound, the patient had a large intra-abdominal cystic lesion. She was thereafter diagnosed with missed abortion and a computed tomography scan showed that the lesion was a cystic tumor 18 cm in diameter originating from the pancreatic tail. The patient subsequently underwent tumor resection with distal pancreatectomy, sparing the spleen. Histopathological analysis of the specimen revealed a pancreatic MCN with moderate dysplasia. Immunohistochemically, the tumor was positive for both estrogen and progesterone receptors. To our knowledge, this is the first reported case of pancreatic MCN with moderate dysplasia in association with pregnancy. Our case strongly indicates that pancreatic MCN is female-hormone dependent. PMID:19084943

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

    SciTech Connect

    Mak, Raymond H.; McCarthy, Ellen P.; Das, Prajnan; Hong, Theodore S.; Mamon, Harvey J.

    2011-07-15

    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.

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

    PubMed

    Akbulut, Sevtap; Altintas, Hande; Oguz, Haldun

    2015-01-01

    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

  5. Maternal obesity alters endoplasmic reticulum homeostasis in offspring pancreas.

    PubMed

    Soeda, Jumpei; Mouralidarane, Angelina; Cordero, Paul; Li, Jiawei; Nguyen, Vi; Carter, Rebeca; Kapur, Sabrina R; Pombo, Joaquim; Poston, Lucilla; Taylor, Paul D; Vinciguerra, Manlio; Oben, Jude A

    2016-06-01

    The prevalence of non-alcoholic fatty pancreas disease (NAFPD) is increasing in parallel with obesity rates. Stress-related alterations in endoplasmic reticulum (ER), such as the unfolded protein response (UPR), are associated with obesity. The aim of this study was to investigate ER imbalance in the pancreas of a mice model of adult and perinatal diet-induced obesity. Twenty female C57BL/6J mice were assigned to control (Con) or obesogenic (Ob) diets prior to and during pregnancy and lactation. Their offspring were weaned onto Con or Ob diets up to 6 months post-partum. Then, after sacrifice, plasma biochemical analyses, gene expression, and protein concentrations were measured in pancreata. Offspring of Ob-fed mice had significantly increased body weight (p < 0.001) and plasma leptin (p < 0.001) and decreased insulin (p < 0.01) levels. Maternal obesogenic diet decreased the total and phosphorylated Eif2α and increased spliced X-box binding protein 1 (XBP1). Pancreatic gene expression of downstream regulators of UPR (EDEM, homocysteine-responsive endoplasmic reticulum-resident (HERP), activating transcription factor 4 (ATF4), and C/EBP homologous protein (CHOP)) and autophagy-related proteins (LC3BI/LC3BII) were differently disrupted by obesogenic feeding in both mothers and offspring (from p < 0.1 to p < 0.001). Maternal obesity and Ob feeding in their offspring alter UPR in NAFPD, with involvement of proapoptotic and autophagy-related markers. Upstream and downstream regulators of PERK, IRE1α, and ATF6 pathways were affected differently following the obesogenic insults. PMID:26979740

  6. CLINICAL PROGRAMS OF STEM CELL THERAPIES FOR LIVER AND PANCREAS

    PubMed Central

    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

    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

  7. Secretin-enhanced MR Imaging of the Pancreas.

    PubMed

    Manfredi, Riccardo; Pozzi Mucelli, Roberto

    2016-04-01

    Secretin is a hormone that stimulates the exocrine pancreatic secretion of bicarbonate-rich fluid from the acinar cells of the pancreas that accumulates within the pancreatic ductal lumen. The exogenous administration of secretin improves the visualization of pancreatic ducts at magnetic resonance (MR) cholangiopancreatography (MRCP), because of an enlargement of the pancreatic duct system and an increase of the fluid content within the lumen of the pancreatic ducts, responsible of an increase of MR signal. In this review, the technique of secretin-enhanced MRCP, which has the aim to depict the whole pancreatic duct system, the biliary tree, the major and minor papillae, and the duodenum, will be described. Because of the anatomic contiguity between the pancreas and the gastrointestinal tract, the presence of fluid within the stomach may overlap with the pancreatic duct system and therefore the pancreatic duct may be difficult to visualize, representing a potential source of diagnostic pitfalls. The technique to reduce the signal intensity of the static fluid present within the stomach and in the duodenal lumen is also described. The technique of secretin administration will be illustrated, with emphasis on the synchronization of secretin administration and MR image acquisition. Furthermore, the frequency and number of MRCP images necessary to achieve a temporal resolution adequate to visualize the physiologic changes in the pancreatic gland, induced by the administration of secretin, is described. The assessment of pancreatic, morphologic, and functional response to the administration of secretin, as depicted on MRCP images, will be illustrated. Finally, the indications for secretin-enhanced MRCP will be discussed to define which patients will benefit from secretin-enhanced MR imaging for their treatment planning. (©) RSNA, 2016. PMID:26989929

  8. Artificial Pancreas: Model Predictive Control Design from Clinical Experience

    PubMed Central

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

    2013-01-01

    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

  9. Characterization of integrin chains in normal and neoplastic human pancreas.

    PubMed

    Hall, P A; Coates, P; Lemoine, N R; Horton, M A

    1991-09-01

    Integrins are a complex family of non-covalently linked heterodimeric glycoproteins which function as cell adhesion molecules, interacting with extracellular matrix molecules such as laminin, fibronectin, vitronectin, and collagen, and also having a role in intercellular adhesion. Each integrin subfamily is characterized by a common beta chain associated with variable alpha chains. We have examined, using immunohistological methods, the expression of the VLA (very late activation) family comprising beta 1 in association with alpha 1-6, and also alpha 6 in association with beta 4, the LFA beta chain beta 2, and the vitronectin receptor, in association with beta 1 or beta 5 and as the complex alpha v beta 3. Cryostat sections of normal pancreas, pancreatic adenocarcinomas, and ampullary tumours were studied together with six pancreatic carcinoma cell lines. Normal pancreas showed expression of beta 1 in all parenchyma. alpha 2 and alpha 6 had a similar distribution whereas alpha 3 expression was confined to ducts, including the very smallest radicles. Staining along the basement membranes of ducts was seen with beta 4 and the anti-vitronectin alpha v chain receptor antibody 13C2. Islet cells failed to stain with any antibody. No staining of epithelial components was seen with antibodies to alpha 1, alpha 4, alpha 5, or to the alpha v beta 3 form of the vitronectin receptor (beta 3 and alpha v beta 3 using the antibody 23C6). Pancreatic adenocarcinomas and ampullary tumours showed expression of alpha 2, alpha 3, alpha 6, beta 1, beta 4, and the vitronectin receptor (alpha v associated with beta 1 or beta 5).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1720170

  10. ANF and exocrine pancreas: ultrastructural autoradiographic localization in acinar cells

    SciTech Connect

    Chabot, J.G.; Morel, G.; Belles-Isles, M.; Jeandel, L.; Heisler, S.

    1988-03-01

    Atrial natriuretic factor (ANF) binding sites have been recently demonstrated to be present in exocrine pancreas by an in vitro autoradiographic approach. An autoradiographic study was carried out to identify the exocrine cells containing ANF binding sites and to monitor the fate of /sup 125/I-labeled ANF in acinar cells after removal of pancreas at specific time intervals (1-30 min) after intravenous administration. At the light microscopic level, silver grains were found over acinar and centroacinar cells. Concomitant injection of an excess of unlabeled ANF inhibited the binding of labeled peptide by approximately 60%. At the electron microscopic level, the time-course study in acinar cells has revealed that of the cell compartments examined, plasma membrane, Golgi apparatus, mitochondria, and zymogen granules, the nucleus had distinct labeling patterns. Plasma membrane was maximally labeled 1 and 2 min after injection with /sup 125/I-ANF. Golgi apparatus was significantly labeled from 2 to 30 min after injection, mitochondria from 1 to 30 min after injection, zymogen granules at 1 and 15 min, and the nucleus only at 30 min. The lysosomal compartment was not labeled during the 30-min observation period. These results suggest that after binding to the plasma membrane, ANF is rapidly internalized and distributed to the intracellular organelles as a function of time. Labeling of the zymogen granules suggests that they may bind ANF and that the atrial peptide may be secreted by acinar cells. The significance of association of radioactivity with mitochondria and nuclei remains to be elucidated but may represent intracellular sites of action of ANF complementary to those on plasma membranes.

  11. Pancreas transplant alone: a procedure coming of age.

    PubMed

    Gruessner, Rainer W G; Gruessner, Angelika C

    2013-08-01

    The goal of this review is to highlight the significant improvements, over the past four decades, in outcomes after a pancreas transplant alone (PTA) in patients with brittle diabetes and recurrent episodes of hypoglycemia and/or hypoglycemic unawareness. A successful PTA-in contrast to intensive insulin regimens and insulin pumps-restores normoglycemia without the risk of hypoglycemia and prevents, halts, or reverses the development or progression of secondary diabetes complications. In this International Pancreas Transplant Registry (IPTR) analysis, we reviewed the records of 1,929 PTA recipients from December 1966 to December 2011. We computed graft survival rates according to the Kaplan-Meier method and used uni- and multivariate analyses. In the most recent era (January 2007-December 2011), patient survival rates were >95% at 1 year posttransplant and >90% at 5 years. Graft survival rates with tacrolimus-based maintenance therapy were 86% at 1 year and 69% at 3 years and with sirolimus, 94 and 84%. Graft survival rates have significantly improved owing to marked decreases in technical and immunologic graft failure rates (P < 0.05). As a result, the need for a subsequent kidney transplant has significantly decreased, over time, to only 6% at 5 years. With patient survival rates of almost 100% and graft survival rates of up to 94% at 1 year, a PTA is now a highly successful long-term option. It should be considered in nonuremic patients with brittle diabetes in order to achieve normoglycemia, to avoid hypoglycemia, and to prevent the development or progression of secondary diabetes complications. PMID:23881967

  12. Scintigraphic and sonographic diagnosis of neonatal mesoblastic nephroma: case report

    SciTech Connect

    Sacks, G.; Mitchell, M.; Fleischer, A.C.; Sandler, M.

    1983-06-01

    The morphologic characteristics of mesoblastic nephroma result in a scintigraphic appearance which distinguishes this benign neonatal tumor from Wilms' tumor. This case report describes a patient in whom the use of scintigraphy and real-time sonography permitted preoperative diagnosis of mesoblastic nephroma.

  13. Preoperative assessment and optimization in periampullary and pancreatic cancer.

    PubMed

    Myatra, S; Divatia, J V; Jibhkate, B; Barreto, G S; Shrikhande, S V

    2011-01-01

    Perioperative management of pancreatic and periampullary cancer poses a considerable challenge to the pancreatic surgeon, anesthesiologist, and the intensive care team. The preoperative surgical evaluation of a pancreatic lesion aims to define the nature of the lesion (malignant or benign), stage the tumor, and to determine resectability or other non-surgical treatment options. Patients are often elderly and may have significant comorbidities and malnutrition. Obstructive jaundice may lead to coagulopathy, infection, renal dysfunction, and adverse outcomes. Routine preoperative biliary drainage can result in higher complication rates, and metal stents may be preferred over plastic stents in selected patients with resectable disease. Judicious use of antibiotics and maintaining fluid volume preoperatively can reduce the incidence of infection and renal dysfunction, respectively. Perioperative fluid therapy with hemodynamic optimization using minimally invasive monitoring may help improve outcomes. Careful patient selection, appropriate preoperative evaluation and optimization can greatly contribute to a favorable outcome after major pancreatic resections. PMID:21248439

  14. What Is the Best Preoperative Imaging for Endometrial Cancer?

    PubMed

    Haldorsen, Ingfrid S; Salvesen, Helga B

    2016-04-01

    Although endometrial cancer is surgicopathologically staged, preoperative imaging is recommended for diagnostic work-up to tailor surgery and adjuvant treatment. For preoperative staging, imaging by transvaginal ultrasound (TVU) and/or magnetic resonance imaging (MRI) is valuable to assess local tumor extent, and positron emission tomography-CT (PET-CT) and/or computed tomography (CT) to assess lymph node metastases and distant spread. Preoperative imaging may identify deep myometrial invasion, cervical stromal involvement, pelvic and/or paraaortic lymph node metastases, and distant spread, however, with reported limitations in accuracies and reproducibility. Novel structural and functional imaging techniques offer visualization of microstructural and functional tumor characteristics, reportedly linked to clinical phenotype, thus with a potential for improving risk stratification. In this review, we summarize the reported staging performances of conventional and novel preoperative imaging methods and provide an overview of promising novel imaging methods relevant for endometrial cancer care. PMID:26922331

  15. Phenotypic characterization of GPR120-expressing cells in the interstitial tissue of pancreas.

    PubMed

    Zhao, Yufeng; Zha, Dingjun; Wang, Li; Qiao, Li; Lu, Lianjun; Mei, Lin; Chen, Chen; Qiu, Jianhua

    2013-12-01

    GPR120 functions as a plasma membrane receptor for unsaturated long-chain free fatty acids and involves in GLP-1 secretion, adipogenesis and the control of energy balance. Pancreas is the key organ in fuel and energy metabolism. Here GPR120 expression in human and rat pancreas was observed by RT-PCR, and the distribution and phenotypes of GPR120-positive cells in human and rat pancreas were shown by immunohistochemical staining. GPR120 mRNA expression was found in human and rat pancreas. GPR120-positive cells were scattered mainly in the interstitial tissues of human and rat pancreas, and they were not co-localized with nestin, vimentin, alpha-SMA and glucagon, respectively. However, GPR120 was distributed on the cells positively stained by CD68, the specific marker of macrophages, and on the cells positive stained by CD34 and CD117, the markers of interstitial cells. In conclusion, this study demonstrates the expression of GPR120 in pancreas and shows the distribution of GPR120 in human and rat pancreas. PMID:23993698

  16. A novel nonneuronal catecholaminergic system: exocrine pancreas synthesizes and releases dopamine.

    PubMed Central

    Mezey, E; Eisenhofer, G; Harta, G; Hansson, S; Gould, L; Hunyady, B; Hoffman, B J

    1996-01-01

    Cells of the exocrine pancreas produce digestive enzymes potentially harmful to the intestinal mucosa. Dopamine has been reported to protect against mucosal injury. In looking for the source of dopamine in the small intestine, we found that the duodenal juice contains high levels of dopamine and that the pancreas itself has a high dopamine [and dihydroxyphenylalanine (dopa)] content that does not change significantly after chemical sympathectomy. Furthermore, we were able to demonstrate tyrosine hydroxylase (TH) activity in control pancreas as well as in pancreas from rats after chemical sympathectomy. Immunostaining and in situ hybridization histochemistry confirmed both the presence of TH, dopamine, and the dopamine transporter, and the mRNAs encoding TH and dopamine transporter, and the presence of both types of vesicular monoamine transporters in the exocrine cells of the pancreas. Since there are no catecholaminergic enteric ganglia in the pancreas, the above results indicate that pancreatic cells have all the characteristics of dopamine-producing cells. We suggest that the pancreas is an important source of nonneuronal dopamine in the body, and that this dopamine has a role in protecting the intestinal mucosa and suggests that dopamine D1b receptor agonists might be used to help mucosal healing in the gastrointestinal tract. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 PMID:8816808

  17. Scabies Diagnosis

    MedlinePlus

    ... Monday-Friday Closed Holidays Contact CDC-INFO Scabies General Information Scabies FAQs Workplace FAQs Epidemiology & Risk Factors Biology Disease Diagnosis Treatment Prevention & Control Resources for Health ...

  18. The role of preoperative prophylactic antibiotics in hypospadias repair

    PubMed Central

    Baillargeon, Emilie; Duan, Kai; Brzezinski, Alex; Jednak, Roman; El-Sherbiny, Mohamed

    2014-01-01

    Introduction: We sought to determine whether the use of preoperative antibiotics is effective in reducing postoperative wound infections and urinary tract infections (UTI) in hypospadias repair. Methods: We retrospectively reviewed all hypospadias repairs performed at the Montreal Children’s Hospital between March 2009 and September 2012. All types of primary hypospadias repairs and redo cases were included. Patients with no adequate follow-up or with missing records of antibiotics were excluded. Preoperative antibiotics were given in the form of cefazolin (50 mg/kg intravenously) when appropriate. Postoperative oral antibiotics were administered as decided by the pediatric urologist. Primary outcomes included postoperative wound infection and UTI. Secondary outcomes included the need for reoperation of hypospadias due to urethrocutaneous fistula, meatal stenosis, urethral stricture and wound dehiscence. Results: In total, 157 cases of hypospadias repair were reviewed; of these 7 were excluded due to lack of follow-up. Of the remaining 150 patients, 62 received preoperative antibiotics and 88 did not. The groups were well-matched for age, hypospadias characteristics, type of repair and repair of curvature. The group that received preoperative antibiotics had a significantly higher number of stented cases (82% vs. 52% of the non-preoperative antibiotic group). Two cases of wound infection were reported (1 in the pre-operative antibiotic group and 1 in the non-preoperative antibiotic group). There was no symptomatic UTI or culture-demonstrated UTI in either group. Moreover, there was no statistically significant difference between the 2 groups in terms of primary outcomes. The complication rate was 11% (17/150 repairs) and all patients needed reoperation. This study’s important limitations include the rarity of studied end points combined with the small sample and the retrospective nature of our study. Conclusion: Our findings do not support the routine use of preoperative antibiotics in hypospadias repair. PMID:25210545

  19. Preoperative Assessment of Adult Patients for Intracranial Surgery

    PubMed Central

    Sivanaser, Vanitha; Manninen, Pirjo

    2010-01-01

    The preoperative assessment of the patient for neurosurgical and endovascular procedures involves the understanding of the neurological disease and its systemic presentation, and the requirements of the procedure. There is a wide spectrum of different neurosurgical disorders and procedures. This article provides an overview of the preoperative evaluation of these patients with respect to general principles of neuroanesthesia, and considerations for specific intracranial and vascular neurosurgical and interventional neuroradiological procedures. PMID:20700431

  20. Preoperative transcutaneous electrical nerve stimulation for localizing superficial nerve paths.

    PubMed

    Natori, Yuhei; Yoshizawa, Hidekazu; Mizuno, Hiroshi; Hayashi, Ayato

    2015-12-01

    During surgery, peripheral nerves are often seen to follow unpredictable paths because of previous surgeries and/or compression caused by a tumor. Iatrogenic nerve injury is a serious complication that must be avoided, and preoperative evaluation of nerve paths is important for preventing it. In this study, transcutaneous electrical nerve stimulation (TENS) was used for an in-depth analysis of peripheral nerve paths. This study included 27 patients who underwent the TENS procedure to evaluate the peripheral nerve path (17 males and 10 females; mean age: 59.9 years, range: 18-83 years) of each patient preoperatively. An electrode pen coupled to an electrical nerve stimulator was used for superficial nerve mapping. The TENS procedure was performed on patients' major peripheral nerves that passed close to the surgical field of tumor resection or trauma surgery, and intraoperative damage to those nerves was apprehensive. The paths of the target nerve were detected in most patients preoperatively. The nerve paths of 26 patients were precisely under the markings drawn preoperatively. The nerve path of one patient substantially differed from the preoperative markings with numbness at the surgical region. During surgery, the nerve paths could be accurately mapped preoperatively using the TENS procedure as confirmed by direct visualization of the nerve. This stimulation device is easy to use and offers highly accurate mapping of nerves for surgical planning without major complications. The authors conclude that TENS is a useful tool for noninvasive nerve localization and makes tumor resection a safe and smooth procedure. PMID:26420473

  1. Preoperative and intraoperative localisation of gastrointestinal bleeding of obscure origin.

    PubMed Central

    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

    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

  2. Cytological and molecular diagnosis of solid variant of papillary thyroid carcinoma: A case report

    PubMed Central

    Troncone, Giancarlo; Russo, Maria; Malapelle, Umberto; Accardo, Marina; Ferraro, Angelo; Cozzolino, Immacolata; Palombini, Lucio

    2008-01-01

    Papillary thyroid carcinoma (PTC) composed by predominant solid areas is diagnosed as a distinct variant on histological samples. Here we present a case of PTC recognized preoperatively by fine needle cytology as a solid variant. This diagnosis was made by combining cytology with the detection of the BRAFVK600-1E mutation, the molecular hallmark of the solid variant of PTC. Histological and molecular evaluation of the surgical specimen confirmed this pre-operative diagnosis. Thus combining cytology to BRAF molecular analysis is useful to refine the cytological diagnosis of this variant also on FNC specimens. PMID:18353179

  3. Facial Nerve Schwannoma of Parotid Gland: Difficulties in Diagnosis and Management.

    PubMed

    Damar, Murat; Dinç, Aykut Erdem; Şevik Eliçora, Sultan; Bişkin, Sultan; Erten, Gül; Biz, Serdar

    2016-01-01

    Facial nerve schwannomas (FNS) are encapsulated benign tumors arising from Schwann cells of seventh cranial nerve. Most of the facial nerve schwannomas are localized in intratemporal region; only 9% of cases involve a portion of the extratemporal segment. Preoperative diagnosis is often unclear; diagnosis is often made intraoperatively. Management of intraparotid FNS is troublesome because of the facial nerve paralysis. In this report we presented a case of intraparotid schwannoma in a 55-year-old male patient complaining of a painless mass without peripheral facial nerve palsy in left parotid gland. Clinical features, preoperative and intraoperative diagnosis, and difficulties during management are discussed with the review of the literature. PMID:26904338

  4. Facial Nerve Schwannoma of Parotid Gland: Difficulties in Diagnosis and Management

    PubMed Central

    Damar, Murat; Dinç, Aykut Erdem; Şevik Eliçora, Sultan; Bişkin, Sultan; Erten, Gül; Biz, Serdar

    2016-01-01

    Facial nerve schwannomas (FNS) are encapsulated benign tumors arising from Schwann cells of seventh cranial nerve. Most of the facial nerve schwannomas are localized in intratemporal region; only 9% of cases involve a portion of the extratemporal segment. Preoperative diagnosis is often unclear; diagnosis is often made intraoperatively. Management of intraparotid FNS is troublesome because of the facial nerve paralysis. In this report we presented a case of intraparotid schwannoma in a 55-year-old male patient complaining of a painless mass without peripheral facial nerve palsy in left parotid gland. Clinical features, preoperative and intraoperative diagnosis, and difficulties during management are discussed with the review of the literature. PMID:26904338

  5. Serous Microcystic Adenocarcinoma of Pancreas Infiltrating Into Spleen: A Case Report

    PubMed Central

    Ramu, Sathyalakshmi; Mishra, Nidhi; Adaikalam, Mary Lilly Susai; Venkatesan, Ramya

    2015-01-01

    Cystic tumours of pancreas account for 5-10% of all pancreatic neoplasms and serous tumours represent 1% among those tumours. Most of the serous tumours are benign and very rarely they infiltrate adjacent organs like liver and spleen. Herewith we present a rare case report of serous cystadenocarcinoma of pancreas in a 65-year-old woman. The tumour involved the body and tail of pancreas and contiguously invaded the spleen. The histopathology of tumour was similar to serous cystadenoma with mild nuclear hyperchromasia and atypia. The spleen showed tumour infiltration as microcysts diffusely infitrating the red pulp. PMID:26500911

  6. [Three cases of resected pulmonary metastasis from colorectal cancer after preoperative chemotherapy].

    PubMed

    Imaizumi, Ken; Koshiishi, Haruya; Nakata, Takuya; Matsuyama, Takatoshi; Hirano, Takayuki; Okuno, Keisuke; Yoshimura, Tetsuki; Ebana, Hiroki; Ikeda, Norihiko

    2014-11-01

    We describe three cases of resected pulmonary metastasis from postoperative colorectal cancer after preoperative 5-fluorouracil, Leucovorin, oxaliplatin (FOLFOX) chemotherapy. The first case is a 38-year-old man who underwent low anterior resection for rectal cancer in 2003. Subsequently, left lung metastasis occurred in February 2009. FOLFOX chemotherapy was administered, resulting in a partial response (PR) of tumor size. Post-chemotherapy, segmental resection of he S1+2 segments of the left lung was performed in May 2009. A pathological diagnosis of Grade 1b was made. The patient remained recurrence-free 5 years post-surgery. The second case is a 68-year-old man who underwent left half colon resection for descending colon cancer with left lung metastasis in March 2006. FOLFOX chemotherapy was administered, with a PR of lung metastasis size. Post-chemotherapy, a segmental resection of the S4 segment of the left lung was performed in September 2006. A pathological diagnosis of Grade 1b was made. The patient was alive 8 years post-surgery. The third case is a 64-year-old man who underwent low anterior resection for rectal cancer in November 2007. A year later, bilateral lung metastases were detected. FOLFOX+bevacizumab was administered, with a stable disease effect on tumor size. Post-chemotherapy, partial resection of both lungs was performed in March and April 2010. A pathological diagnosis of Grade 1a was made. The patient was recurrence-free at the 4-year follow up. We believe that preoperative FOLFOX chemotherapy may be effective in treating lung metastasis from colon cancer. PMID:25731421

  7. Undifferentiated carcinoma of the head of pancreas with osteoclast-like giant cells presenting as a symptomatic cystic mass, following acute pancreatitis: Case report and review of the literature

    PubMed Central

    Georgiou, Georgios Κ.; Balasi, Ephimia; Siozopoulou, Vasiliki; Tsili, Athina; Fatouros, Michalis; Glantzounis, Georgios

    2015-01-01

    Introduction Undifferentiated head of pancreas carcinoma with osteoclast-like giant cells (UC-OGC) is a rare neoplasm, with less than a hundred cases reported. We present such a case, in which the UC-OGC presented atypically as a cystic lesion following acute pancreatitis and led to late diagnosis. Presentation of case A 75-year-old female patient, who had suffered acute pancreatitis three years ago, was referred with a diagnosis of osteoclast-like giant cell (OGC) tumor of the head of pancreas. She had suffered acute pancreatitis three years ago. Two years ago she developed abdominal pain, steatorrhea and weight loss. Abdominal computed tomography imaging showed a cystic mass in the head of the pancreas (maximum diameter 4 cm). The initial diagnosis was pancreatic pseudocyst; however as the mass gradually increased in size and the patient continued to be symptomatic, a CT-guided biopsy was performed. Histological examination revealed an OGC pancreatic tumor. In laparotomy a large (9 cm) encapsulated heterogeneous mass was found with partial involvement of the common hepatic artery. Pancreaticoduodenectomy was performed and the involved part of the common hepatic artery was replaced with a homologous graft from the major saphenous vein. Post-operative course was uneventful. Histology revealed an undifferentiated pancreatic adenocarcinoma with OGCs. She survived 10 months after the operation. Discussion Pancreatic undifferentiated carcinomas with OGCs are very rare neoplasms and can present with an atypical clinical picture. Conclusions A symptomatic cystic lesion of the pancreas, which is growing in size, should be investigated promptly in order to exclude the presence of malignancy. PMID:26745313

  8. Ultrasound Imaging of the Hepatobiliary System and Pancreas.

    PubMed

    Larson, Martha Moon

    2016-05-01

    Ultrasound is an extremely valuable diagnostic modality for the diagnosis of hepatobiliary and pancreatic disease. Normal appearance and normal variations are important to understand to avoid misinterpretation. Although ultrasound can identify a lesion, cytology and histopathology are usually needed for a final diagnosis. PMID:26851975

  9. Simultaneous Extensive Intraductal Papillary Neoplasm of the Bile Duct and Pancreas: A Very Rare Entity

    PubMed Central

    Luvira, Vor; Pugkhem, Ake; Tipwaratorn, Theerawee; Chamgramol, Yaovalux; Pairojkul, Chawalit; Bhudhisawasdi, Vajarabhongsa

    2016-01-01

    Intraductal papillary neoplasm of the bile duct (IPNB) is a specific type of bile duct tumor. It has been proposed that it could be the biliary counterpart of the intraductal papillary neoplasm of the pancreas (IPMN-P). This hypothesis is supported by the presence of simultaneous intraductal tumors of both the bile duct and pancreas. There have been five reports of patients with simultaneous IPNB and IPMN-P. In all of these cases, biliary involvement was limited to the intrahepatic and perihilar bile duct, which had characteristics similar to IPMN-P and usually had slow progression in nature. Herein, we present the first case of extensive intraductal neoplasm involving the extrahepatic bile duct, intrahepatic bile duct, and entire length of the pancreas with a poor outcome, even after being treated aggressively with radical surgery and adjuvant chemotherapy. Additionally, we summarize previous case reports of simultaneous intraductal lesions of the bile duct and pancreas. PMID:26925284

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

    PubMed Central

    Kinkel, Mary D.; Prince, Victoria E.

    2009-01-01

    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

  11. Adenocarcinoma arising from heterotopic pancreas at the third portion of the duodenum

    PubMed Central

    Fukino, Nobutada; Oida, Takatsugu; Mimatsu, Kenji; Kuboi, Youichi; Kida, Kazutoshi

    2015-01-01

    A 62-year-old Japanese man presented to our hospital with a history of weight loss of 6 kg in 4 mo. Imaging examinations revealed a tumor located on the third portion of the duodenum with stenosis. We suspected duodenal carcinoma and performed pancreas-preserving segmental duodenectomy. Adenocarcinoma arising from a heterotopic pancreas at the third portion of the duodenum was finally diagnosed by immunohistochemical staining. Malignant transformation in the duodenum arising from a heterotopic pancreas is extremely rare; to our knowledge, only 13 cases have been reported worldwide, including the present case. The most common location of malignancy is the proximal duodenum at the first and descending portion. Herein, we describe the first case of adenocarcinoma arising from a heterotopic pancreas, which was located in the third portion of the duodenum, with a review of the literature. PMID:25852297

  12. A 3D map of the islet routes throughout the healthy human pancreas

    PubMed Central

    Ionescu-Tirgoviste, Constantin; Gagniuc, Paul A.; Gubceac, Elvira; Mardare, Liliana; Popescu, Irinel; Dima, Simona; Militaru, Manuella

    2015-01-01

    Islets of Langerhans are fundamental in understanding diabetes. A healthy human pancreas from a donor has been used to asses various islet parameters and their three-dimensional distribution. Here we show that islets are spread gradually from the head up to the tail section of the pancreas in the form of contracted or dilated islet routes. We also report a particular anatomical structure, namely the cluster of islets. Our observations revealed a total of 11 islet clusters which comprise of small islets that surround large blood vessels. Additional observations in the peripancreatic adipose tissue have shown lymphoid-like nodes and blood vessels captured in a local inflammatory process. Our observations are based on regional slice maps of the pancreas, comprising of 5,423 islets. We also devised an index of sphericity which briefly indicates various islet shapes that are dominant throughout the pancreas. PMID:26417671

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

    PubMed Central

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

    2013-01-01

    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

  14. Does preoperative transarterial embolization decrease blood loss during spine tumor surgery?

    PubMed Central

    Qiao, Zhihong; He, Qian

    2015-01-01

    This paper aimed to evaluate the effect of preoperative transarterial embolization (TAE) on estimated blood loss (EBL) during surgical excision of the vertebral tumors. Three hundred and forty-eight patients with spinal tumors were retrospectively analyzed. The preoperative TAE group consisted of 190 patients and the control group consisted of 158 patients. Gelatin sponge particles mixed withy contrast agent were used in the TAE group to embolize the tumor-feeding artery. The factors evaluated included: the time interval between embolism and surgery; the number of vertebrae involved by the tumor; pathological type of tumor; surgical approach; extent of excision and instrumental fixation. The time interval (P = 0.4669)between embolism and surgery had no significant correlation with EBL during surgery. The pathological diagnosis of vertebral tumor such as plasma cell myeloma, giant cell tumor, chondrosarcoma, hemangioma and metastasis had no significant correlation with EBL between the TAE group and control group during surgery, while the EBL of chordoma in the TAE group was significantly higher than that in the control group (p = 0.0254). The number of vertebrae involved (p = 0.4669, 0.6804, 0.6677), posterior approach (p = 0.3015), anterior approach (p = 0.2446), partial excision (p = 0.1911) and instrumental fixation (p = 0.1789) had no significant correlation with EBL during surgery between the TAE group and the control group. This study showed that preoperative TAE of the spinal tumor had no significant effect on intra-operative blood loss during surgical excision of the spinal tumor. In view of the risk of embolism, this method should be carefully considered. PMID:25934787

  15. Infectious complications following 72 consecutive enteric-drained pancreas transplants.

    PubMed

    Berger, N; Wirmsberger, R; Kafka, R; Margreiter, C; Ebenbichler, C; Stelzmueller, I; Margreiter, R; Steurer, W; Mark, W; Bonatti, H

    2006-07-01

    New immunosuppressive protocols and advanced surgical technique resulted in an improved outcome of pancreatic transplantation (PTx) with infection remaining the most common complication. Seventy-two enteric-drained whole PTxs performed at the Innsbruck University Hospital between September 2002 and October 2004 were retrospectively analyzed. Prophylactic immunosuppression consisted of either the standard protocol consisting of single bolus antithymocyteglobulin (ATG) (Thymoglobulin, Sangstat or ATG Fresenius) induction (9 mg/kg), tacrolimus (TAC), mycophenylate mofetil (MMF) and steroids (38 patients) or a 4-day course of ATG (4 mg/kg) tacrolimus and steroids with MMF (n = 19), or Sirolimus (n = 15). Perioperative antimicrobial prophylaxis consisted of Piperacillin/Tazobactam (4.5 g q 8 h) in combination with ciprofloxacin (200 mg q 12 h) and fluconazole (400 mg daily). Ganciclovir was used for cytomegalovirus (CMV) prophylaxis if donor was positive and recipient-negative. Patient, pancreas, and kidney graft survival at 1 year were 97.2%, 88.8%, and 93%, respectively, with no difference between the groups. All retransplants (n = 8) and single transplants (n = 8) as well as all type II diabetics and nine of 11 patients older 55 years received standard immunosuppression (IS). The rejection rate was 14% and infection rate 46% with no difference in terms of incidence or type according to the three groups. Severe infectious complications included intra-abdominal infection (n = 12), wound infection (n = 7), sepsis (n = 13), respiratory tract infection (n = 4), urinary tract infection (n = 12), herpes simplex/human herpes virus 6 infection (n = 5), CMV infection/disease (n = 7), post-transplant lymphoproliferative disorder (PTLD, n = 3), invasive filamentous fungal infection (n = 4), Clostridial/Rotavirus colitis (n = 1), and endocarditis (n = 1). All four patients in this series died of infectious complications (invasive aspergillosis n = 2) (one with Candida glabrata superinfection), invasive zygomycosis (n = 1), PTLD (n = 1). Five grafts were lost (vascular thrombosis n = 3, pancreatitis n = 1, noncompliance n = 1). Infection represented the most frequent complication in this series and all four deaths were of infectious origin. Better prophylaxis and management of infections now should be the primary target to be addressed in the field of pancreas transplantation. PMID:16764633

  16. Degradation of zinc metallothionein after intravenous zinc administration in chicken liver and pancreas

    SciTech Connect

    Chang, C.H.; McCormick, C.C. )

    1991-03-15

    Previous results from the authors' laboratory have indicated that metallothionein (MT) mRNA levels following oral or parenteral zinc do not correspond to the accumulation of protein in liver and pancreas. Since the degradation of MT may influence the ultimate accumulation of MT in various tissues, the present study was conducted to investigate the rate of zinc MT degradation in liver and pancreas. Four-week-old male chicks were given intravenous zinc injections as zinc acetate. At various times, liver and pancreas were excised and homogenized. The cytosolic zinc MT was determined by gel filtration chromatography. To confirm relative tissue differences in the concentration of MT, G-75 fractions containing zinc MT from liver and pancreas cytosol were concentrated by ultrafiltration. Equal amounts of concentrate were subjected to PAGE and silver stain enhancement analysis. The results of PAGE verified that indeed the pancreas possesses over 2x higher MT than liver. Zinc MT degradation analysis was conducted beginning 24 hours following zinc administration. Since MT mRNA levels were minimal in both tissues after this time, changes in the concentration of MT were considered to reflect primarily degradation. The half-life of zinc MT for pancreas and liver was calculated to be 3.2 days and 2.0 days, respectively. Degradation rates of zinc MT in liver and pancreas were 0.0149 {plus minus} .005 h{sup {minus}1} and 0.0085 {plus minus} .004 h{sup {minus}1}, respectively. These data suggest that the rate of degradation of zinc MT in liver and pancreas accounts, in part, for the observed differences in MT concentration.

  17. Lessons From Pancreas Transplantation in Type 1 Diabetes: Recurrence of Islet Autoimmunity.

    PubMed

    Burke, George W; Vendrame, Francesco; Virdi, Sahil K; Ciancio, G; Chen, Linda; Ruiz, Phillip; Messinger, Shari; Reijonen, Helena K; Pugliese, Alberto

    2015-12-01

    Type 1 diabetes recurrence (T1DR) affecting pancreas transplants was first reported in recipients of living-related pancreas grafts from twins or HLA identical siblings; given HLA identity, recipients received no or minimal immunosuppression. This observation provided critical evidence that type 1 diabetes (T1D) is an autoimmune disease. However, T1DR is traditionally considered very rare in immunosuppressed recipients of pancreas grafts from organ donors, representing the majority of recipients, and immunological graft failures are ascribed to chronic rejection. We have been performing simultaneous pancreas-kidney (SPK) transplants for over 25 years and find that 6-8 % of our recipients develop T1DR, with symptoms usually becoming manifest on extended follow-up. T1DR is typically characterized by (1) variable degree of insulitis and loss of insulin staining, on pancreas transplant biopsy (with most often absent), minimal to moderate and rarely severe pancreas, and/or kidney transplant rejection; (2) the conversion of T1D-associated autoantibodies (to the autoantigens GAD65, IA-2, and ZnT8), preceding hyperglycemia by a variable length of time; and (3) the presence of autoreactive T cells in the peripheral blood, pancreas transplant, and/or peripancreatic transplant lymph nodes. There is no therapeutic regimen that so far has controlled the progression of islet autoimmunity, even when additional immunosuppression was added to the ongoing chronic regimens; we hope that further studies and, in particular, in-depth analysis of pancreas transplant biopsies with recurrent diabetes will help identify more effective therapeutic approaches. PMID:26547222

  18. Dietary habits and past medical history as related to fatal pancreas cancer risk among Adventists.

    PubMed

    Mills, P K; Beeson, W L; Abbey, D E; Fraser, G E; Phillips, R L

    1988-06-15

    Epidemiologic studies of diet and pancreas cancer are few, and include ecologic comparisons and a limited number of prospective and case-control studies. Foods and/or nutrients that have been suggested to be associated with increased risk of this cancer include total fat intake, eggs, animal protein, sugar, meat, coffee and butter. Consumption of raw fruits and vegetables has been consistently associated with decreased risk. Dietary habits and medical history variables were evaluated in a prospective study of fatal pancreas cancer among 34,000 California Seventh-day Adventists between 1976 and 1983. Forty deaths from pancreas cancer occurred during the follow-up period. Compared to all US whites, Adventists experienced decreased risk from pancreas cancer death (standardized mortality ratio [SMR] = 72 for men; 90 for women), which was not statistically significant. Although there was a suggestive relationship between increasing meat, egg, and coffee consumption and increased pancreatic cancer risk, these variables were not significantly related to risk after controlling for cigarette smoking. However, increasing consumption of vegetarian protein products, beans, lentils, and peas as well as dried fruit was associated with highly significant protective relationships to pancreas cancer risk. A prior history of diabetes was associated with increased risk of subsequent fatal pancreas cancer, as was a history of surgery for peptic or duodenal ulcer. A history of tonsillectomy was associated with a slight, nonsignificant protective relationship as was history of various allergic reactions. These findings suggest that the protective relationships associated with frequent consumption of vegetables and fruits high in protease-inhibitor content are more important than any increase in pancreas cancer risk attendant on frequent consumption of meat or other animal products. Furthermore, the previously reported positive associations between diabetes and abdominal surgery and pancreas cancer risk are supported in these data. PMID:3365678

  19. Preoperative Ultrasound Guided Fine Needle Aspiration Cytology of Ovarian Lesions- Is It a Rapid and Effective Diagnostic Modality?

    PubMed Central

    Datta, Saikat; Chaudhuri, Snehamay; Paul, Prabir Chandra; Khandakar, Binny; Mandal, Sonali

    2016-01-01

    Introduction The deep seated ovarian lesions unapproachable by unguided aspiration cytology were easily done under ultrasound guidance. It gave a before hand cytological diagnosis of the lesion to the surgeon determining the modality of treatment for the patient. Aim To find the diagnostic accuracy of the method of ultrasound guided cytological assessment of ovarian lesion. Materials and Methods The study was conducted as a prospective observational study over a period of one year, in hospital setting, where ultrasound guided fine needle aspiration had been used to aspirate ovarian lesions, giving a rapid cytological diagnosis. In 43 sample cases, aspiration of fluid done from ovarian lesions were followed by cyto-centrifugation and staining by May-Grunwald-Giemsa (MGG) and Papanicolaou (Pap) stain providing a cytological opinion regarding benign/malignant nature of the lesion and further categorization. Later the cytological diagnosis was compared with final histopathological diagnosis, taking it as a gold standard. Results The overall sensitivity, specificity, and diagnostic accuracy of ultrasound guided aspiration and cytological analysis were high, 96%, 76.92% and 89.47% respectively as calculated by comparing the cytological diagnosis with histological diagnosis, taking it as gold standard. Conclusion This method has evolved as a highly sensitive, rapid, simple and effective modality for screening and as well as accurate preoperative diagnosis of ovarian lesions. PMID:27134878

  20. The artificial endocrine pancreas in clinical practice and research. The present position and future perspectives.

    PubMed

    Marena, S; Imperiale, G; Pagano, G

    1993-06-01

    The artificial endocrine pancreas (AEP) is a controlled glucose and/or insulin infusion system in which continuously monitored blood sugar values are fed to a computerised analyser that uses predetermined algorithms to establish the doses to be administered. Since its first appearance in clinical practice and diabetological research during the Sixties, the AEP has been modified in various ways to overcome technical problems associated with the gluco-sensor and algorithms so as to make better use of the glucose-insulin feedback mechanism, and hence obtain a closer correspondence to physiological islet cell activity. As a result of these changes, the AEP can be employed in accordance with the physiopathological principles of insulin secretion in a variety of clinical conditions to secure the short-term control of metabolic alterations in the diabetic. Surgery is one field in which the AEP is used to great advantage, since this and its accompanying anaesthetics are the source of stress, which in turn may result in a rapid and sometimes serious postoperative metabolic derangement, including an increased secretion of anti-insulin hormones. The AEP has also been proposed for diabetic pregnancy and for the treatment of subjects in diabetic coma. It has proved useful in the diagnosis and management of hypoglycaemia due to organic hyperinsulinism, in diabetics with renal failure, in the honeymoon period, and in cases of unstable diabetes. The versatility of its application and its underlying physiopathological principles have enabled the AEP to be predominantly employed in research.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8414626

  1. Activation of pancreatic-duct-derived progenitor cells during pancreas regeneration in adult rats

    PubMed Central

    Li, Wan-Chun; Rukstalis, J. Michael; Nishimura, Wataru; Tchipashvili, Vaja; Habener, Joel F.; Sharma, Arun; Bonner-Weir, Susan

    2010-01-01

    The adult pancreas has considerable capacity to regenerate in response to injury. We hypothesized that after partial pancreatectomy (Px) in adult rats, pancreatic-duct cells serve as a source of regeneration by undergoing a reproducible dedifferentiation and redifferentiation. We support this hypothesis by the detection of an early loss of the ductal differentiation marker Hnf6 in the mature ducts, followed by the transient appearance of areas composed of proliferating ductules, called foci of regeneration, which subsequently form new pancreatic lobes. In young foci, ductules express markers of the embryonic pancreatic epithelium – Pdx1, Tcf2 and Sox9 – suggesting that these cells act as progenitors of the regenerating pancreas. The endocrine-lineage-specific transcription factor Neurogenin3, which is found in the developing embryonic pancreas, was transiently detected in the foci. Islets in foci initially resemble embryonic islets in their lack of MafA expression and lower percentage of β-cells, but with increasing maturation have increasing numbers of MafA+ insulin+ cells. Taken together, we provide a mechanism by which adult pancreatic duct cells recapitulate aspects of embryonic pancreas differentiation in response to injury, and contribute to regeneration of the pancreas. This mechanism of regeneration relies mainly on the plasticity of the differentiated cells within the pancreas. PMID:20663919

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

    PubMed

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

    2014-01-01

    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. PMID:25674220

  3. Synthesis of guanidinoacetate and creatine from amino acids by rat pancreas.

    PubMed

    da Silva, Robin P; Clow, Kathy; Brosnan, John T; Brosnan, Margaret E

    2014-02-01

    Creatine is an important molecule involved in cellular energy metabolism. Creatine is spontaneously converted to creatinine at a rate of 1·7% per d; creatinine is lost in the urine. Creatine can be obtained from the diet or synthesised from endogenous amino acids via the enzymes arginine:glycine amidinotransferase (AGAT) and guanidinoacetate N-methyltransferase (GAMT). The liver has high GAMT activity and the kidney has high AGAT activity. Although the pancreas has both AGAT and GAMT activities, its possible role in creatine synthesis has not been characterised. In the present study, we examined the enzymes involved in creatine synthesis in the pancreas as well as the synthesis of guanidinoacetate (GAA) and creatine by isolated pancreatic acini. We found significant AGAT activity and somewhat lower GAMT activity in the pancreas and that pancreatic acini had measurable activities of both AGAT and GAMT and the capacity to synthesise GAA and creatine from amino acids. Creatine supplementation led to a decrease in AGAT activity in the pancreas, though it did not affect its mRNA or protein abundance. This was in contrast with the reduction of AGAT activity and mRNA and protein abundance in the kidney, suggesting that the regulatory mechanisms that control the expression of this enzyme in the pancreas are different from those in the kidney. Dietary creatine increased the concentrations of GAA, creatine and phosphocreatine in the pancreas. Unexpectedly, creatine supplementation decreased the concentrations of S-adenosylmethionine, while those of S-adenosylhomocysteine were not altered significantly. PMID:24103317

  4. Oxidative stress associated with pathological changes in the pancreas of cattle naturally infected by Eurytrema coelomaticum.

    PubMed

    Schwertz, Claiton I; Gabriel, Mateus E; Henker, Luan C; Bottari, Nathieli B; Carmo, Guilherme do; Guarda, Naiara Dos S; Moresco, Rafael N; Machado, Gustavo; Morsch, Vera M; Schetinger, Maria Rosa C; Stedille, Fernanda A; Baska, Piotr; Mattei, Vanessa; da Silva, Aleksandro S; Mendes, Ricardo E

    2016-06-15

    Although Eurytrema coelomaticum is considered a parasite with low pathogenicity, it may be associated with mortality and loss of productive performance in animals due to chronic pancreatitis. The aim of this study was to evaluate the occurrence of oxidative stress caused by E. coelomaticum in naturally infected cattle, correlating the biochemical findings with the parasite load and histopathological changes. For this study, blood and pancreas samples from 51 cattle were collected, and levels of the thiobarbituric acid reactive substances (TBARS), advanced oxidation protein products (AOPP) and ferric reducing ability of plasma (FRAP) were measured in the serum and pancreas, and superoxide dismutase (SOD) activity was measured in total blood. Parasite burden was determined opening the pancreatic ducts, and then fragments of pancreas were collected and fixed in 10% buffered formalin and routinely processed for histopathology. From the 51 collected pancreas, 33 (63.5%) were parasitized. The average parasite burden per pancreas was 532 (12-2,578). TBARS and FRAP showed higher levels in serum and pancreas of infected animals (p<0.05), with a positive correlation between the histopathological changes and the number of parasites. SOD level in blood was 42% higher in parasitized group compared with control group (p<0.05), as well as AOPP in serum. Based on these results, we concluded that in natural infection by E. coelomaticum in cattle, oxidative stress occurs, characterized by the occurrence of protein oxidation, lipid peroxidation and activation of antioxidant system. PMID:27198785

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

    PubMed Central

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

    2014-01-01

    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. PMID:25674220

  6. [Asthma diagnosis].

    PubMed

    Ortega Martell, José Antonio; Fernández Vega, Margarita

    2009-01-01

    The diagnosis of asthma is based primarily on patient history, conducting the interrogation to the search for risk factors for developing it and the triggers of their symptoms. This chapter will detail some laboratory tests and cabinet that can support this clinical diagnosis. Respiratory function tests help to show the degree of airway obstruction and its reversibility with treatment. Allergy tests help prove the existence of cells sensitized to a specific allergen and once identified, implement environmental control measures or if necessary to control this immunomodulation exaggerated immune response. The exhaled nitric oxide test has been most useful in assessing the course of asthma during treatment, rather than for diagnosis. Sometimes the confirmatory diagnosis of asthma is achieved after excluding other diseases that may present a similar clinical picture, and especially after knowing the response to standard treatment with bronchodilators and anti-inflammatory drugs. PMID:20873051

  7. Effect of Preoperative Pain on Inferior Alveolar Nerve Block.

    PubMed

    Aggarwal, Vivek; Singla, Mamta; Subbiya, Arunajatesan; Vivekanandhan, Paramasivam; Sharma, Vikram; Sharma, Ritu; Prakash, Venkatachalam; Geethapriya, Nagarajan

    2015-01-01

    The present study tested the hypothesis that the amount and severity of preoperative pain will affect the anesthetic efficacy of inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. One-hundred seventy-seven adult volunteer subjects, actively experiencing pain in a mandibular molar, participated in this prospective double-blind study carried out at 2 different centers. The patients were classified into 3 groups on the basis of severity of preoperative pain: mild, 1-54 mm on the Heft-Parker visual analog scale (HP VAS); moderate, 55-114 mm; and severe, greater than 114 mm. After IANB with 1.8 mL of 2% lidocaine, endodontic access preparation was initiated. Pain during treatment was recorded using the HP VAS. The primary outcome measure was the ability to undertake pulp access and canal instrumentation with no or mild pain. The success rates were statistically analyzed by multiple logistic regression test. There was a significant difference between the mild and severe preoperative pain group (P = .03). There was a positive correlation between the values of preoperative and intraoperative pain (r = .2 and .4 at 2 centers). The amount of preoperative pain can affect the anesthetic success rates of IANB in patients with symptomatic irreversible pulpitis. PMID:26650491

  8. Endorectal ultrasound for control of preoperative radiotherapy of rectal cancer.

    PubMed Central

    Glaser, F; Kuntz, C; Schlag, P; Herfarth, C

    1993-01-01

    Endorectal ultrasound (EUS) is known to be a reliable method for preoperative staging of rectal tumors. In this study, EUS was used to select patients with rectal cancer suitable for preoperative radiation therapy. By performing EUS before and after radiation, the aim of the study was to evaluate the role of EUS in monitoring the effects of preoperative radiation therapy. In 17 patients with large T3 or T4 rectal tumors, a complete staging by EUS was done before and after radiation therapy. Beside a shrinkage of the tumor, there was a change of echopattern to more hyperechoic gray levels to be observed in the irradiated tumor. The rectal wall lost its normal architecture, and lymph nodes disappeared or changed their echopattern from echopoor to echorich. There was no down-staging of a tumor seen by EUS. Complete preoperative staging was correct in 13 of 17 patients because of endosonographic examination before and after preoperative radiation therapy. New interpretation criteria are given for evaluation of patients with rectal cancer treated by radiation therapy. Images Figure 1. Figure 2. Figure 3. Figure 4. Figure 5. Figure 6. Figure 7. PMID:8424703

  9. Preoperative Evaluation with fMRI of Patients with Intracranial Gliomas

    PubMed Central

    Kapsalakis, Ioannis Z.; Kapsalaki, Eftychia Z.; Gotsis, Efstathios D.; Verganelakis, Dimitrios; Toulas, Panagiotis; Hadjigeorgiou, Georgios; Chung, Indug; Fezoulidis, Ioannis; Papadimitriou, Alexandros; Robinson, Joe Sam; Lee, Gregory P.; Fountas, Kostas N.

    2012-01-01

    Introduction. Aggressive surgical resection constitutes the optimal treatment for intracranial gliomas. However, the proximity of a tumor to eloquent areas requires exact knowledge of its anatomic relationships to functional cortex. The purpose of our study was to evaluate fMRI's accuracy by comparing it to intraoperative cortical stimulation (DCS) mapping. Material and Methods. Eighty-seven patients, with presumed glioma diagnosis, underwent preoperative fMRI and intraoperative DCS for cortical mapping during tumor resection. Findings of fMRI and DCS were considered concordant if the identified cortical centers were less than 5 mm apart. Pre and postoperative Karnofsky Performance Scale and Spitzer scores were recorded. A postoperative MRI was obtained for assessing the extent of resection. Results. The areas of interest were identified by fMRI and DCS in all participants. The concordance between fMRI and DCS was 91.9% regarding sensory-motor cortex, 100% for visual cortex, and 85.4% for language. Data analysis showed that patients with better functional condition demonstrated higher concordance rates, while there also was a weak association between tumor grade and concordance rate. The mean extent of tumor resection was 96.7%. Conclusions. Functional MRI is a highly accurate preoperative methodology for sensory-motor mapping. However, in language mapping, DCS remains necessary for accurate localization. PMID:22848821

  10. COMPARATIVE ANALYSIS OF PREOPERATIVE ULTRASONOGRAPHY REPORTS WITH INTRAOPERATIVE SURGICAL FINDINGS IN CHOLELITHIASIS

    PubMed Central

    KREIMER, Flávio; CUNHA, Daniel José Dias; FERREIRA, Carolina Cavalcanti Gonçalves; RODRIGUES, Thais Menezes; FULCO, Lucas Gomes de Morais; GODOY, Eduardo Sávio Nascimento

    2016-01-01

    Background: Laparoscopic cholecystectomy is widely used for cholelithiasis. Abdominal ultrasonography often precedes this operation and can prove diagnosis, as well as helps in showing possible complications during the perioperative period. Aim: Evaluate the description of variables of gallbladder and bile ducts present in reports of preoperative abdominal ultrasonography in cholelithiasis comparing with surgical findings. Methods: Were studied 91 patients who underwent elective laparoscopic cholecystectomy with previous abdominal ultrasonography. Variables such as identification and amount of gallstones involved were evaluated, both in preoperative ultrasonography and during surgery to evaluate sensitivity, specificity, concordance and positive and negative predictive values. Results: The reports did not mention diameter of vesicular light (98.9%), organ distension (62.6%), gallstone sizes (58.2%), wall thickness (41.8%) and evaluation of the common bile duct (39.6%). Ultrasound had high values for sensitivity, consistency and positive predictive value for identifying the presence/absence of gallstones: 98.8%, 96.7% and 97.8% respectively. As for the amount of stones, ultrasonography showed agreement in 82.7%, negative predictive value in 89.1% and specificity in 87.7%, with lower values for sensitivity (68.2%) and positive predictive value (65.2%). Conclusions: The ultrasound reports were flawed in standardization. Significant percentage of them did not have variables that could predict perioperative complications and surgical conversion. PMID:27120735

  11. [Predisposition to latex allergy undetected on preoperative evaluation: a case report].

    PubMed

    Kimura, Yuriko; Okamura, Makoto; Harioka, Tokuya; Hara, Tadashi; Kamiya, Kiyoshi; Matsukawa, Takashi

    2013-12-01

    A 70-year-old man was scheduled to undergo laparoscopic total gastrectomy for stomach cancer. He had no history of atopy, fruit allergies, or frequent exposure to natural rubber. Preoperative latex-specific IgE antibodies were negative. Anesthesia was induced, and the surgery was started uneventfully. Soon after the surgeon had begun to manipulate the intestine, the blood pressure suddenly dropped to 27/21 mmHg. Facial flushing was also observed. Anaphylactic shock caused by latex was strongly suspected, and surgery was immediately halted. The surgical gloves were changed to latex-free ones, and adrenaline was administered. The blood pressure was gradually normalized within 30 min, and the facial flushing mostly disappeared. Postoperative laboratory examination revealed that serum tryptase had increased to 34.4 microg l-1, 40 minutes after the onset of anaphylaxis, and decreased to 19.4 microg l-1, 24 hours than later. Latex-specific IgE antibodies and a prick test with latex were both positive. Consequently, the diagnosis of latex-induced anaphylactic reaction was confirmed. Because even detailed questioning and examination does not always identify such a predisposition, avoiding contactwith latex products is more rational exhaustively checking every preoperative patient for latex allergy PMID:24498786

  12. Preoperative localization of parathyroid lesion: diagnostic usefulness of color doppler ultrasonography

    PubMed Central

    mohammadi, Afshin; Moloudi, Farzad; Ghasemi-rad, Mohammad

    2012-01-01

    Introduction Recently, minimally invasive parathyroidectomy (MIP) has been developed and is gaining popularity among surgeons. For this reason, preoperative localization is playing an important role to detect the precise location of the affected gland and to increase the success rate. Material and methods From June 2007 to June 2011, 56 consecutive patients (11 men and 45 women) with primary or secondary hyperparathyroidism in our center underwent Gray scale, color Doppler and 99m-Tc MIBI scan prior to operative management of parathyroid lesions. Results The sensitivity, specificity and accuracy of US and MIBI scan for pHPT was 88%, 94%, 91% and 70%, 100% and 85% respectively. In patients with sHPT, the sensitivity, specificity and accuracy of US and MIBI scan was 54%, 93%, 76% and 25%, 100% and 72.9% respectively. The overall sensitivity of combined US and MIBI scan in pHPT and sHPT was 97% and 45% respectively. The overall sensitivity, specificity and accuracy of CDUS in diagnosis of parathyroid lesions in pHPT and sHPT is 97%, 100%, 98.6% and 62%, 100% and 83% respectively. Conclusion The overall sensitivity and specificity of US and MIBI in preoperative localization of parathyroid adenoma in sHPT is lower than pHPT and performing CDUS can increases the overall sensitivity and specificity of imaging methods in accurate localization of parathyroid lesion. PMID:22328952

  13. Is Preoperative Biochemical Testing for Pheochromocytoma Necessary for All Adrenal Incidentalomas?

    PubMed

    Jun, Joo Hyun; Ahn, Hyun Joo; Lee, Sangmin M; Kim, Jie Ae; Park, Byung Kwan; Kim, Jee Soo; Kim, Jung Han

    2015-11-01

    This study examined whether imaging phenotypes obtained from computed tomography (CT) can replace biochemical tests to exclude pheochromocytoma among adrenal incidentalomas (AIs) in the preoperative setting.We retrospectively reviewed the medical records of all patients (n = 251) who were admitted for operations and underwent adrenal-protocol CT for an incidentally discovered adrenal mass from January 2011 to December 2012. Various imaging phenotypes were assessed for their screening power for pheochromocytoma. Final diagnosis was confirmed by biopsy, biochemical tests, and follow-up CT.Pheochromocytomas showed similar imaging phenotypes as malignancies, but were significantly different from adenomas. Unenhanced attenuation values ≤10 Hounsfield units (HU) showed the highest specificity (97%) for excluding pheochromocytoma as a single phenotype. A combination of size ≤3 cm, unenhanced attenuation values ≤ 10 HU, and absence of suspicious morphology showed 100% specificity for excluding pheochromocytoma.Routine noncontrast CT can be used as a screening tool for pheochromocytoma by combining 3 imaging phenotypes: size ≤3 cm, unenhanced attenuation values ≤10 HU, and absence of suspicious morphology, and may substitute for biochemical testing in the preoperative setting. PMID:26559265

  14. In Vivo Reflectance Confocal Microscopy of Basal Cell Carcinoma: Feasibility of Preoperative Mapping of Cancer Margins

    PubMed Central

    Pan, Zhan-Yan; Lin, Jing-Ran; Cheng, Ting-Ting; Wu, Jia-Qiang; Wu, Wen-Yu

    2012-01-01

    Reflectance confocal microscopy (RCM) images skin at cellular resolution and has shown utility for the diagnosis of nonmelanoma skin cancer in vivo. It has the potential to define lesion margins before surgical therapy. Objectives To investigate the feasibility of RCM in defining the margins of basal cell carcinoma before surgery. Methods The margins of 10 lesions were evaluated using RCM. Biopsies of the margins were used to confirm the results. A protocol was constructed to define margins. RCM was used to delineate preoperative surgical margins in 13 patients. Intraoperative frozen biopsy was used to confirm the margins. Results In seven of 10 (70.0%) cases, the margins of the cancer were identified suing RCM. The tumor island was the critical feature in identifying the margins. In 12 of 13 (92.3%) cases, frozen biopsy corroborated that the surgical margins delineated by RCM were clear. Conclusion RCM imaging of the margins is feasible and demonstrates the possibility of preoperative mapping of cancer margins. PMID:23039159

  15. Preimplantation diagnosis.

    PubMed Central

    Goldberg, J D; Martin, M C; Lebo, R V; Pedersen, R A

    1993-01-01

    Preimplantation embryonic biopsy and analysis offer couples at increased risk of having offspring affected with a genetic disorder the possibility of an early prenatal diagnosis. For many couples, this approach would avoid the issue of the selective termination of affected fetuses. Substantial advances have been made in the area of preimplantation diagnosis, but the possible difficulties with this approach cannot be ignored. Images PMID:8236971

  16. Centroacinar Cells Are Progenitors That Contribute to Endocrine Pancreas Regeneration.

    PubMed

    Delaspre, Fabien; Beer, Rebecca L; Rovira, Meritxell; Huang, Wei; Wang, Guangliang; Gee, Stephen; Vitery, Maria del Carmen; Wheelan, Sarah J; Parsons, Michael J

    2015-10-01

    Diabetes is associated with a paucity of insulin-producing β-cells. With the goal of finding therapeutic routes to treat diabetes, we aim to find molecular and cellular mechanisms involved in β-cell neogenesis and regeneration. To facilitate discovery of such mechanisms, we use a vertebrate organism where pancreatic cells readily regenerate. The larval zebrafish pancreas contains Notch-responsive progenitors that during development give rise to adult ductal, endocrine, and centroacinar cells (CACs). Adult CACs are also Notch responsive and are morphologically similar to their larval predecessors. To test our hypothesis that adult CACs are also progenitors, we took two complementary approaches: 1) We established the transcriptome for adult CACs. Using gene ontology, transgenic lines, and in situ hybridization, we found that the CAC transcriptome is enriched for progenitor markers. 2) Using lineage tracing, we demonstrated that CACs do form new endocrine cells after β-cell ablation or partial pancreatectomy. We concluded that CACs and their larval predecessors are the same cell type and represent an opportune model to study both β-cell neogenesis and β-cell regeneration. Furthermore, we show that in cftr loss-of-function mutants, there is a deficiency of larval CACs, providing a possible explanation for pancreatic complications associated with cystic fibrosis. PMID:26153247

  17. Diet and other risk factors for cancer of the pancreas.

    PubMed

    Gold, E B; Gordis, L; Diener, M D; Seltser, R; Boitnott, J K; Bynum, T E; Hutcheon, D F

    1985-01-15

    The findings of a case - control study of cancer of the pancreas, which was conducted in the Baltimore metropolitan area, are reported. Two hundred one patients with pancreatic cancer were matched on age (+/- 5 years), race, and sex to hospital and non-hospital controls, the latter selected by random-digit-dialing (RDD). All subjects were interviewed regarding diet, beverage consumption, occupational and environmental exposures, and medical and surgical history. Significantly decreased risks were associated with consumption of raw fruits and vegetables and diet soda, and significantly increased risks were associated with consumption of white bread when cases were compared with hospital and RDD controls. A significantly reduced risk was associated with consumption of wine when cases were compared to RDD controls. Risk ratios for consumption of coffee were not significantly different from one, although there appeared to be a dose - response relationship in women. A moderate but statistically nonsignificant increase in relative odds was found for cigarette smoking, and cessation of smoking was associated with a marked reduction in risk. No significant associations were found with particular occupational exposures. Tonsillectomy was associated with a significantly reduced risk, a finding that has been observed for other cancers as well. The current evidence indicates that pancreatic cancer is likely to result from a complex interaction of factors and suggests that the study of its etiology requires a multidisciplinary approach involving both laboratory and epidemiologic components. PMID:3965101

  18. Fully Integrated Artificial Pancreas in Type 1 Diabetes

    PubMed Central

    Breton, Marc; Farret, Anne; Bruttomesso, Daniela; Anderson, Stacey; Magni, Lalo; Patek, Stephen; Dalla Man, Chiara; Place, Jerome; Demartini, Susan; Del Favero, Simone; Toffanin, Chiara; Hughes-Karvetski, Colleen; Dassau, Eyal; Zisser, Howard; Doyle, Francis J.; De Nicolao, Giuseppe; Avogaro, Angelo; Cobelli, Claudio; Renard, Eric; Kovatchev, Boris

    2012-01-01

    Integrated closed-loop control (CLC), combining continuous glucose monitoring (CGM) with insulin pump (continuous subcutaneous insulin infusion [CSII]), known as artificial pancreas, can help optimize glycemic control in diabetes. We present a fundamental modular concept for CLC design, illustrated by clinical studies involving 11 adolescents and 27 adults at the Universities of Virginia, Padova, and Montpellier. We tested two modular CLC constructs: standard control to range (sCTR), designed to augment pump plus CGM by preventing extreme glucose excursions; and enhanced control to range (eCTR), designed to truly optimize control within near normoglycemia of 3.9–10 mmol/L. The CLC system was fully integrated using automated data transfer CGM→algorithm→CSII. All studies used randomized crossover design comparing CSII versus CLC during identical 22-h hospitalizations including meals, overnight rest, and 30-min exercise. sCTR increased significantly the time in near normoglycemia from 61 to 74%, simultaneously reducing hypoglycemia 2.7-fold. eCTR improved mean blood glucose from 7.73 to 6.68 mmol/L without increasing hypoglycemia, achieved 97% in near normoglycemia and 77% in tight glycemic control, and reduced variability overnight. In conclusion, sCTR and eCTR represent sequential steps toward automated CLC, preventing extremes (sCTR) and further optimizing control (eCTR). This approach inspires compelling new concepts: modular assembly, sequential deployment, testing, and clinical acceptance of custom-built CLC systems tailored to individual patient needs. PMID:22688340

  19. Thrombotic microangiopathy after simultaneous pancreas-kidney transplantation.

    PubMed

    Rangel, Erika B; Gonzalez, Adriano M; Linhares, Marcelo M; Araújo, Sérgio R R; Franco, Marcello F; de Sá, João R; Pestana, José O M; Melaragno, Cláudio S

    2007-01-01

    Thrombotic microangiopathy (TMA) is rare after transplantation and is associated with a high incidence of kidney graft dysfunction. Between December 2000 and March 2006, 136 simultaneous pancreas-kidney transplantations were performed with an incidence of TMA of 5.1% (71.4% localized to kidney allograft). All cases were diagnosed during the first three months and were attributed to tacrolimus; 74% were women. Systemic TMA presented higher values of lactate dehydrogenase (2658 +/- 659 U/L vs. 1331 +/- 473 U/L, p = 0.04) and a greater decrease in hematocrit (45.8 +/- 17.7% vs. 19.2 +/- 6%, p = 0.02) than in localized TMA. Acute kidney rejection complicated almost 90% of the cases with 43% of kidney graft lost. Tacrolimus was switched to sirolimus and fresh-frozen plasma was administered. Creatinine clearance after a mean follow-up of two yr was 100.7 mL/min/1.73 m(2) and 57.9 mL/min/1.73 m(2) in patients with systemic and localized TMA, respectively. In conclusion, sirolimus is an alternative to TMA associated with tacrolimus. PMID:17425752

  20. Impact of simultaneous pancreas-kidney transplantation: patients’ perspectives

    PubMed Central

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

    2012-01-01

    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

  1. Molecular pathology of intraductal papillary mucinous neoplasms of the pancreas

    PubMed Central

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

    2014-01-01

    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

  2. Patients' Perception and Future Acceptance of an Artificial Pancreas

    PubMed Central

    van Bon, Arianne C.; Kohinor, Miriam J. E.; Hoekstra, Joost B. L.; von Basum, Golo; DeVries, J. Hans

    2010-01-01

    Background Little is known of patient acceptance of an artificial pancreas (AP). The purpose of this study was to investigate future acceptance of an AP and its determinants. Methods Patients with type 1 diabetes treated with insulin pump therapy were interviewed using questions based on the technology acceptance model and completed the diabetes treatment and satisfaction questionnaire (DTSQ). Results Twenty-two adults with type 1 diabetes participated. Half of the patients were followed in a university hospital, and the others were under treatment in an affiliated teaching hospital. Half of the patients were male. The mean DTSQ score was 29 (range 23–33). The AP was perceived as likely to be useful. Perceived advantages were a stable glucose regulation, less need for self-monitoring of blood glucose, relief of daily concerns, and time saving. Participants were confident in their capability to use the system. Although many participants (58%) had been reluctant to start continuous subcutaneous insulin infusion, the majority (79%) felt they would have no barriers to start using the AP. Trust in the AP was related to the quality of glucose control it would provide. Almost everyone expressed the intention to use the new system when available, even if it would initially not cover 24/24 hours. Conclusion The overall attitude on the AP was positive. Intention to use was dependent on trust in the AP, which was related to the quality of glucose control provided by the AP. PMID:20513325

  3. The biosynthesis of glucagon in perfused rat pancreas

    PubMed Central

    O'Connor, Kevin J.; Gay, Adrian; Lazarus, Norman R.

    1973-01-01

    The biosynthesis of glucagon was studied by using the recirculated, isolated perfused rat pancreas. [3H]Tryptophan was initially incorporated into acid–ethanol-extractable protein, which on gel filtration was eluted with a molecular weight of about 9000 and contained a small amount of glucagon immunoreactivity. With longer incubation [3H]tryptophan incorporation into a second peak was obtained in an identical position with that of the majority of rat glucagon immunoreactivity. This peak of labelled protein exhibited migration characteristics on polyacrylamide-gel electrophoresis identical with those of rat glucagon and was identified as newly synthesized glucagon by demonstration of specific binding and dissociation behaviour with glucagon antibodies. The incorporation of [3H]tryptophan into acid–ethanol-extractable protein was inhibited by cycloheximide. High concentrations of glucose increased [3H]tryptophan incorporation into high-molecular-weight protein but decreased incorporation into proteins smaller than cytochrome c. The pattern of [3H]leucine incorporation into protein was similar to that of [3H]tryptophan. PMID:16742807

  4. Simultaneous resection of pancreas and liver metastases from different metachronous primary cancers.

    PubMed

    Harada, M; Fukuta, Y; Horiuchi, M; Ikawa, K; Matsumura, T; Terashima, Y; Hino, A; Uehara, H; Maeda, T; Tashiro, S

    2001-01-01

    Resection of a pancreatic head tumor and partial resection of the liver for metastatic lesions were carried out simultaneously in a 72-year-old woman. The patient had a history of two previous operations, right nephrectomy for renal cell carcinoma (clear cell type), done 14 years previously, and an Autincloss procedure for cancer of the left breast (solid tubular carcinoma); (T1N0M0; stage I) done 7 years previously. At the current presentation, preoperative radiographic examination showed a hypervascular tumor in each of the pancreatic and hepatic lesions, but with different patterns. On the basis of histological findings in the two resected specimens, it was difficult to establish whether the hepatic tumor originated from the renal cell carcinoma or the breast cancer, but postoperative immunohistochemical studies for carcinoembryonic antigen (CEA), estrogen receptors, and gross cystic disease fluid protein (GCDFP)-15 showed that the pancreatic tumor had metastasized from the renal cell carcinoma, and the liver tumor from the breast cancer. The immunohistochemical investigation of different markers thus proved to be useful in making the final diagnosis of metastatic lesions from different and metachronous cancers. PMID:11702260

  5. Preoperative surgical marking: a case of seeing double.

    PubMed

    Rughani, Milap; Kokkinakis, Michail; Davison, Marc

    2010-01-01

    Preoperative marking is an integral part of the care of patients undergoing surgical procedures. It occurs on a daily basis in hospitals and involves all members of the healthcare staff and the patient. Incorrect marking or errors can lead to devastating consequences for the patient and staff involved. We present an unusual case of seeing double arrows on a patient undergoing emergency orthopaedic surgery, despite standard preoperative marking procedures. This was recognised in the anaesthetic room and the correct site was confirmed. We aim to highlight this specific problem and remind all involved in preoperative marking of the dangers of a mirror imprint, thereby avoiding seeing double in the anaesthetic or operating room. PMID:22315636

  6. Effect of preoperative biliary drainage on outcome of classical pancreaticoduodenectomy

    PubMed Central

    Bhati, Chandra Shekhar; Kubal, Chandrashekhar; Sihag, Pankaj Kumar; Gupta, Ankur Atal; Jenav, Raj Kamal; Inston, Nicholas G; Mehta, Jagdish M

    2007-01-01

    AIM: To investigate the role of preoperative biliary drainage (PBD) in the outcome of classical pancreaticoduodenectomy. METHODS: A 10-year retrospective data analysis was performed on patients (n = 48) undergoing pancreaticoduodenectomy from March 1994 to March 2004 in department of surgery at SMS medical college, Jaipur, India. Demographic variables, details of preoperative stenting, operative procedure and post operative complications were noted. RESULTS: Preoperative biliary drainage was performed in 21 patients (43.5%). The incidence of septic complications was significantly higher in patients with biliary stent placement (P < 0.05, 0 vs 4). This group of patients also had a significantly higher minor biliary leak rate. Mortality and hospital stay in each group was comparable. CONCLUSION: Within this study population the use of PBD by endoscopic stenting was associated with a high incidence of infective complications. These findings do not support the routine use of biliary stenting in patients prior to pancreatico-duodenectomy. PMID:17451206

  7. TSH-secreting pituitary adenoma: benefits of pre-operative octreotide

    PubMed Central

    Healy, E; Cooke, R S; Ellis, P K; Harper, R; Hunter, S J

    2015-01-01

    Summary TSH-secreting pituitary adenomas are rare and the optimal investigation and management is uncertain. We describe a case of a 43 year-old woman with a TSH-secreting pituitary adenoma, highlighting diagnostic testing and our use, pre-operatively of somatostatin analogue therapy, which induced biochemical euthyroidism and a reduction in tumour size. Learning points The differential diagnosis of the syndrome of inappropriate TSH secretion is non-thyroidal illness, medications, assay interference due to heterophilic antibodies, thyroid hormone resistance and TSH-secreting pituitary adenoma.TRH stimulation test and triiodothyronine suppression test assist in differentiating thyroid hormone resistance and TSH-secreting pituitary adenoma.Somatostatin analogue therapy can induce biochemical euthyroidism and reduce tumour size. PMID:26113979

  8. A case of primary jejunal cancer diagnosed by preoperative small intestinal endoscopy.

    PubMed

    Nabeshima, Kazuhito; Machimura, Takao; Wasada, Mitsuru; Takayasu, Hiroyuki; Ogoshi, Kyoji; Makuuchi, Hiroyasu

    2008-04-01

    The patient was a 37-year-old female. She was brought to our hospital by ambulance with nausea and vomiting. Abdominal ultra sound and abdominal enhanced CT scan showed a tumor in left side of the abdominal aorta 6 cm in size, and it showed an expanded stomach and duodenum. Upper gastrointestinal series revealed an apple core sign in upper jejunum near the Treitz' ligament. Small intestinal endoscopy (XSIF-240 endoscope, Olympus Inc.) revealed stenosis related to an epithelially protruding lesion with an irregular surface in the jejunum on the anal side of the horizontal duodenal peduncle. Biopsy suggested a well-differentiated adenocarcinoma. Scintigraphy showed hot spot in left middle abdomen. Under a diagnosis of primary jejunum cancer, Partial resection of the jejunum and partial resection of the transverse colon was performed. Histopathologically, the tumor was well differentiated adenocarcinoma exposed serosal surface. Postoperatively, the stage was evaluated as III (T3, N1, M0). Preoperative diagnosis to use small intestinal endoscopy was effectiveness. We report a patient with primary jejunum cancer in whom a definitive diagnosis was made before surgery. PMID:21318964

  9. Perception Is Reality: quality metrics in pancreas surgery – a Central Pancreas Consortium (CPC) analysis of 1399 patients

    PubMed Central

    Abbott, Daniel E.; Martin, Grace; Kooby, David A.; Merchant, Nipun B.; Squires, Malcolm H.; Maithel, Shishir K.; Weber, Sharon M.; Winslow, Emily R.; Cho, Clifford S.; Bentrem, David J.; Kim, Hong Jin; Scoggins, Charles R.; Martin, Robert C.; Parikh, Alexander A.; Hawkins, William G.; Ahmad, Syed A.

    2016-01-01

    Introduction Several groups have defined pancreatic surgery quality metrics that identify centers delivering quality care. Although these metrics are perceived to be associated with good outcomes, their relationship with actual outcomes has not been established. Methods A national cadre of pancreatic surgeons was surveyed regarding perceived quality metrics, which were evaluated against the Central Pancreas Consortium (CPC) database to determine actual performance and relationships with long-term outcomes. Results The most important metrics were perceived to be participation in clinical trials, appropriate clinical staging, perioperative mortality, and documentation of receipt of adjuvant therapy. Subsequent analysis of 1399 patients in the CPC dataset demonstrated that a R0 retroperitoneal and neck margin was obtained in 79% (n = 1109) and 91.4% (n = 1278) of cases, respectively. 74% of patients (n = 1041) had >10 lymph nodes harvested, and LN positivity was 65% (n = 903). 76% (n = 960) of eligible patients (surgery first approach) received adjuvant therapy within 60 days of surgery. Multivariate analysis demonstrated margin status, identification of >10 lymph nodes, nodal status, tumor grade and delivery of adjuvant therapy within 60 days to be associated with improved overall survival. Conclusions These analyses demonstrate that systematic monitoring of surgeons' perceived quality metrics provides critical prognostic information, which is associated with patient survival. PMID:27154811

  10. Preoperative testing before low-risk surgical procedures

    PubMed Central

    Kirkham, Kyle R.; Wijeysundera, Duminda N.; Pendrith, Ciara; Ng, Ryan; Tu, Jack V.; Laupacis, Andreas; Schull, Michael J.; Levinson, Wendy; Bhatia, R. Sacha

    2015-01-01

    Background: There is concern about increasing utilization of low-value health care services, including preoperative testing for low-risk surgical procedures. We investigated temporal trends, explanatory factors, and institutional and regional variation in the utilization of testing before low-risk procedures. Methods: For this retrospective cohort study, we accessed linked population-based administrative databases from Ontario, Canada. A cohort of 1 546 223 patients 18 years or older underwent a total of 2 224 070 low-risk procedures, including endoscopy and ophthalmologic surgery, from Apr. 1, 2008, to Mar. 31, 2013, at 137 institutions in 14 health regions. We used hierarchical logistic regression models to assess patient- and institution-level factors associated with electrocardiography (ECG), transthoracic echocardiography, cardiac stress test or chest radiography within 60 days before the procedure. Results: Endoscopy, ophthalmologic surgery and other low-risk procedures accounted for 40.1%, 34.2% and 25.7% of procedures, respectively. ECG and chest radiography were conducted before 31.0% (95% confidence interval [CI] 30.9%–31.1%) and 10.8% (95% CI 10.8%–10.8%) of procedures, respectively, whereas the rates of preoperative echocardiography and stress testing were 2.9% (95% CI 2.9%–2.9%) and 2.1% (95% CI 2.1%–2.1%), respectively. Significant variation was present across institutions, with the frequency of preoperative ECG ranging from 3.4% to 88.8%. Receipt of preoperative ECG and radiography were associated with older age (among patients 66–75 years of age, for ECG, adjusted odds ratio [OR] 18.3, 95% CI 17.6–19.0; for radiography, adjusted OR 2.9, 95% CI 2.8–3.0), preoperative anesthesia consultation (for ECG, adjusted OR 8.7, 95% CI 8.5–8.8; for radiography, adjusted OR 2.2, 95% CI 2.1–2.2) and preoperative medical consultation (for ECG, adjusted OR 6.8, 95% CI 6.7–6.9; for radiography, adjusted OR 3.6, 95% CI 3.5–3.6). The median ORs for receipt of preoperative ECG and radiography were 2.3 and 1.6, respectively. Interpretation: Despite guideline recommendations to limit testing before low-risk surgical procedures, preoperative ECG and chest radiography were performed frequently. Significant variation across institutions remained after adjustment for patient- and institution-level factors. PMID:26032314

  11. Effect of preoperative irradiation on healing of low colorectal anastomoses

    SciTech Connect

    Morgenstern, L.; Sanders, G.; Wahlstrom, E.; Yadegar, J.; Amodeo, P.

    1984-02-01

    The effect of preoperative irradiation on the healing of low colorectal anastomoses was studied experimentally. In 12 dogs in whom preoperative irradiation of 4,000 rads was given before low colorectal stapled anastomosis was performed, anastomotic leakage occurred in 66 percent. More than half of the anastomotic leaks were associated with either severe sepsis or death. In a matched group of control animals that underwent stapled anastomoses without irradiation, no anastomotic complications occurred. The clinical implications of this study are that stapled anastomoses in irradiated colon are at serious risk of anastomotic dehiscence and, therefore, should be protected with a proximal colostomy.

  12. [Importance of preoperative and intraoperative imaging for operative strategies].

    PubMed

    Nitschke, P; Bork, U; Plodeck, V; Podlesek, D; Sobottka, S B; Schackert, G; Weitz, J; Kirsch, M

    2016-03-01

    Recent advances in preoperative and postoperative imaging have an increasing influence on surgical decision-making and make more complex surgical interventions possible. This improves the possibilities for frequently occurring challenges and promoting improved functional and oncological outcome. This manuscript reviews the role of preoperative and intraoperative imaging in surgery. Various techniques are explained based on examples from hepatobiliary surgery and neurosurgery, in particular real-time procedures, such as the online use of augmented reality and in vivo fluorescence, as well as new and promising optical techniques including imaging of intrinsic signals and vibrational spectroscopy. PMID:26939896

  13. Preoperative brain shift: study of three surgical cases

    NASA Astrophysics Data System (ADS)

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

    2008-03-01

    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.

  14. Extracorporeal machine perfusion of the pancreas: technical aspects and its clinical implications - a systematic review of experimental models.

    PubMed

    Kuan, Kean Guan; Wee, Mau Nam; Chung, Wen Yuan; Kumar, Rohan; Mees, Soeren Torge; Dennison, Ashley; Maddern, Guy; Trochsler, Markus

    2016-01-01

    Pancreas or pancreatic islet transplantation is an important treatment option for insulin-dependent diabetes and its complications. However, as the pancreas is particularly susceptible to ischaemic-reperfusion injury, the criteria for pancreas and islet donation are especially strict. With a chronic shortage of donors, one critical challenge is to maximise organ availability and expand the donor pool. To achieve that, continuous improvement in organ preservation is required, with the aims of reducing ischaemia-reperfusion injury, prolong preservation time and improve graft function. Static cold storage, the only method used in clinical pancreas and islet cell transplant currently, has likely reached its plateau. Machine perfusion, hypothermic or normothermic, could hold the key to improving donor pancreas quality as well as quantity available for transplant. This article reviews the literature on experimental models of pancreas machine perfusion, examines the benefits of machine perfusion, the technical aspects and their clinical implications. PMID:26253243

  15. A new computational model for human thyroid cancer enhances the preoperative diagnostic efficacy

    PubMed Central

    Li, Tuo; Sheng, Jianguo; Li, Weiqin; Zhang, Xin; Yu, Hongyu; Chen, Xueyun; Zhang, Jianquan; Cai, Quancai; Shi, Yongquan; Liu, Zhimin

    2015-01-01

    Considering the high rate of missed diagnosis and delayed treatments for thyroid cancer, an effective systematic model for the differential diagnosis is highly needed. Thus we analyzed the data on the clinicopathological characteristics, routine laboratory tests and imaging examinations in a cohort of 13,980 patients with thyroid cancer to establish a new diagnostic model for differentiating thyroid cancer in clinical practice. Here, we randomly selected two-thirds of the population to develop the thyroid malignancy risk scoring system (TMRS) for preoperative differentiation between thyroid cancer and benignant thyroid diseases, and then validated its differential diagnostic power in the rest one-third population. The 18 predictors finally enrolled in the TMRS included male gender, clinical manifestations (fever, neck sore, neck lump, palpitations or sweating), laboratory findings (TSH>1.56mIU/L, FT3>5.85pmol/L, TPOAb>14.97IU/ml, TgAb>48.00IU/ml, Tg>34.59μg/L, Ct>64.00ng/L, and CEA>0.41μg/L), and ultrasound features (tumor number≤ 23mm, site, size, echo texture, margins, and shape of neck lymphnodes). The TMRS is validated to be well-calibrated (P = 0.437) and excellently discriminated (AUC = 0.93, 95% CI [0.92, 0.94]), with an accuracy of 83.2%, a sensitivity of 89.3%, a specificity of 81.5%, positive and negative predictive values of 56.8% and 96.6%, positive and negative likelihood ratios of 4.83 and 0.13 in the development cohort, respectively. The TMRS highlights that this differential diagnostic system could help provide accurate preoperative risk stratification for thyroid cancer, and avoid unnecessary over- and under-treatment for such patients. PMID:26325368

  16. Fault diagnosis

    NASA Technical Reports Server (NTRS)

    Abbott, Kathy

    1990-01-01

    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.

  17. Neuroendocrine tumors of the pancreas: current concepts and controversies.

    PubMed

    Reid, Michelle D; Balci, Serdar; Saka, Burcu; Adsay, N Volkan

    2014-03-01

    In the past decade, the clinico-pathologic characteristics of neuroendocrine tumors (NETs) in the pancreas have been further elucidated. Previously termed "islet cell tumors/carcinomas" or "endocrine neoplasms", they are now called pancreatic NETs (PanNETs). They occur in relatively younger patients and may arise anywhere in the pancreas. Some are associated with von Hippel-Lindau, MEN1, and other syndromes. It is now widely recognized that, with the exception of tumorlets (minute incipient neoplasms) that occur in some syndromes like MEN1, all PanNETs are malignant, albeit low-grade, and although they have a protracted clinical course and overall 10-year survival of 60-70 %, even low-stage and low-grade examples may recur and/or metastasize on long-term follow-up. Per recent consensus guidelines adopted by both European and North American NET Societies (ENETS and NANETs) and WHO-2010, PanNETs are now graded and staged separately, unlike previous classification schemes that used a combination of grade, stage, and adjunct prognosticators in an attempt to define "benign behavior" or "malignant" categories. For staging, the ENETs proposal may be more applicable than CAP/AJCC, which is based on the staging of exocrine tumors. Current grading of PanNETs is based on mitotic activity and ki-67 index. Other promising prognosticators such as necrosis, CK19, c-kit, and others are still under investigation. It has also been recognized that PanNETs have a rather wide morphologic repertoire including oncocytic, pleomorphic, ductulo-insular, sclerosing, and lipid-rich variants. Most PanNETs are diagnosed by fine needle aspiration biopsy, in which single, monotonous plasmacytoid cells with fair amounts of cytoplasm and distinctive neuroendocrine chromatin are diagnostic. Molecular alterations of PanNETs are also very different than that of ductal or acinar tumors. Loss of expression of DAXX and ATRX proteins has been recently identified in 45 %. Along with these improvements, several controversies remain, including grading, value of current cutoff ranges, and the best methods for counting ki-67 index (manual count by computer-captured image may be the most practical for the time being). More important is the controversial use of the term "carcinoma", which was previously employed in WHO-2004 only for invasive and metastatic cases but has now been made synonymous with grade 3 group of tumors. It is becoming clear that grade 3 group comprises two distinct categories: (1) differentiated but proliferatively more active tumors which typically have ki-67 indices in the 20-50 % range and (2) true poorly differentiated NE carcinomas as defined in the lung, with ki-67 typically >50 %. Further studies are needed to address these controversial aspects of PanNETs. PMID:24430597

  18. Concise Review: Pancreas Regeneration: Recent Advances and Perspectives

    PubMed Central

    Lysy, Philippe A.; Bonner-Weir, Susan

    2012-01-01

    The replacement of functional pancreatic β-cells is seen as an attractive potential therapy for diabetes, because diabetes results from an inadequate β-cell mass. Inducing replication of the remaining β-cells and new islet formation from progenitors within the pancreas (neogenesis) are the most direct ways to increase the β-cell mass. Stimulation of both replication and neogenesis have been reported in rodents, but their clinical significance must still be shown. Because human islet transplantation is limited by the scarcity of donors and graft failure within a few years, efforts have recently concentrated on the use of stem cells to replace the deficient β-cells. Currently, embryonic stem cells and induced pluripotent stem cells achieve high levels of β-cell differentiation, but their clinical use is still hampered by ethical issues and/or the risk of developing tumors after transplantation. Pancreatic epithelial cells (duct, acinar, or α-cells) represent an appealing alternative to stem cells because they demonstrate β-cell differentiation capacities. Yet translation of such capacity to human cells after significant in vitro expansion has yet to be achieved. Besides providing new β-cells, cell therapy also has to address the question on how to protect the transplanted cells from destruction by the immune system via either allo- or autoimmunity. Encouraging developments have been made in encapsulation and immunomodulation techniques, but many challenges still remain. Herein, we discuss recent advances in the search for β-cell replacement therapies, current strategies for circumventing the immune system, and mandatory steps for new techniques to be translated from bench to clinics. PMID:23197762

  19. Human ductal adenocarcinomas of the pancreas express extracellular matrix proteins.

    PubMed Central

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

    1994-01-01

    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

  20. Minimization and withdrawal of steroids in pancreas and islet transplantation.

    PubMed

    Mineo, Davide; Sageshima, Junichiro; Burke, George W; Ricordi, Camillo

    2009-01-01

    For reducing the corticosteroid (CS)-related side-effects, especially cardiovascular events, CS-sparing protocols have become increasingly common in pancreas transplantation (PT). Lympho-depleting induction antibodies, such as rabbit anti-thymocyte globulin (rATG) or alemtuzumab, have been widely used in successful trials. The results of various CS-sparing protocols combining calcineurin inhibitors (CNI) and mycophenolate or sirolimus, have been mixed for rejection and survival rates. Most of the studies were uncontrolled trials of low-risk patients, therefore the grade of evidence is limited. Large-scale prospective studies with long-term follow up are necessary to assess risks and benefits of CS-sparing regimens in PT before recommending such strategies as standard practice. Islet allo-transplantation for patients with brittle type 1 diabetes mellitus, less invasive and safer procedure than PT, has been attempted since late 1980s, but diabetogenic immunosuppressants at maintenance, mainly CS and high-dose CNI, prevented satisfactory results (10% insulin-independence at 1-year post-transplant). Since 2000, CS-free and CNI-reducing protocols, including more potent induction [daclizumab, OKT3gamma1(ala-ala) anti-CD3 antibody, rATG] and maintenance (sirolimus, mycophenolate) agents, have significantly improved short-term outcomes whereas long-term are still inadequate (from 80% to 20% insulin-independence from 1- to 5-year post-transplant). Main limitations are allo- and autoimmunity, immunosuppression-related islet and systemic toxicity and transplant site unsuitability, which tolerogenic protocols and biotechnological solutions may solve. PMID:18855850

  1. Mechanisms of Action of GLP-1 in the Pancreas

    PubMed Central

    Doyle, Máire E.; Egan, Josephine M.

    2007-01-01

    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

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

    PubMed

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

    2013-12-01

    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

  3. Diagnostic accuracy of pre-operative imaging findings in presumed clinical T1a renal cell carcinomas

    PubMed Central

    NAKASHIMA, KAZUFUMI; KITAGAWA, YASUHIDE; IZUMI, KOUJI; MIZOKAMI, ATSUSHI; GABATA, TOSHIFUMI; NAMIKI, MIKIO

    2016-01-01

    Despite the development of recent imaging modalities, certain pathological misdiagnoses remain for surgical specimens of presumed small renal cell carcinomas (RCCs). In the present study, a retrospective analysis of benign pathological lesions diagnosed as small RCC prior to surgery was performed. In total, the cases of 196 sporadic renal tumors that was surgically treated as clinical T1a RCCs were reviewed, and the accuracy of the pathological diagnoses was calculated. The pre-operative findings for benign pathological lesions was investigated, and the lesions were observed in 13 (6.63%) of the 196 tumors. Pre-operative computed tomography images were obtained in all cases, and magnetic resonance images were available in 10 cases. The diagnostic accuracy of imaging modalities was significantly lower in the tumors with a diameter of ≤20 mm. In all cases, the possible pathological diagnosis of RCC could not be excluded even by retrospective imaging analysis. Several benign pathological lesions were found in small renal masses presumed to be clinical T1a RCC. In conclusion, there may be limitations to the pre-operative imaging for certain types of small renal mass.

  4. Perfusion-decellularized pancreas as a natural 3D scaffold for pancreatic tissue and whole organ engineering

    PubMed Central

    Goh, Saik-Kia; Bertera, Suzanne; Olsen, Phillip; Candiello, Joe; Halfter, Willi; Uechi, Guy; Balasubramani, Manimalha; Johnson, Scott; Sicari, Brian; Kollar, Elizabeth; Badylak, Stephen F.; Banerjee, Ipsita

    2013-01-01

    Approximately 285 million people worldwide suffer from diabetes, with insulin supplementation as the most common treatment measure. Regenerative medicine approaches such as a bioengineered pancreas has been proposed as potential therapeutic alternatives. A bioengineered pancreas will benefit from the development of a bioscaffold that supports and enhances cellular function and tissue development. Perfusion-decellularized organs are a likely candidate for use in such scaffolds since they mimic compositional, architectural and biomechanical nature of a native organ. In this study, we investigate perfusion-decellularization of whole pancreas and the feasibility to recellularize the whole pancreas scaffold with pancreatic cell types. Our result demonstrates that perfusion-decellularization of whole pancreas effectively removes cellular and nuclear material while retaining intricate three-dimensional microarchitecture with perfusable vasculature and ductal network and crucial extracellular matrix (ECM) components. To mimic pancreatic cell composition, we recellularized the whole pancreas scaffold with acinar and beta cell lines and cultured up to 5 days. Our result shows successful cellular engraftment within the decellularized pancreas, and the resulting graft gave rise to strong up-regulation of insulin gene expression. These findings support biological utility of whole pancreas ECM as a biomaterials scaffold for supporting and enhancing pancreatic cell functionality and represent a step toward bioengineered pancreas using regenerative medicine approaches. PMID:23787110

  5. Perfusion-decellularized pancreas as a natural 3D scaffold for pancreatic tissue and whole organ engineering.

    PubMed

    Goh, Saik-Kia; Bertera, Suzanne; Olsen, Phillip; Candiello, Joseph E; Halfter, Willi; Uechi, Guy; Balasubramani, Manimalha; Johnson, Scott A; Sicari, Brian M; Kollar, Elizabeth; Badylak, Stephen F; Banerjee, Ipsita

    2013-09-01

    Approximately 285 million people worldwide suffer from diabetes, with insulin supplementation as the most common treatment measure. Regenerative medicine approaches such as a bioengineered pancreas has been proposed as potential therapeutic alternatives. A bioengineered pancreas will benefit from the development of a bioscaffold that supports and enhances cellular function and tissue development. Perfusion-decellularized organs are a likely candidate for use in such scaffolds since they mimic compositional, architectural and biomechanical nature of a native organ. In this study, we investigate perfusion-decellularization of whole pancreas and the feasibility to recellularize the whole pancreas scaffold with pancreatic cell types. Our result demonstrates that perfusion-decellularization of whole pancreas effectively removes cellular and nuclear material while retaining intricate three-dimensional microarchitecture with perfusable vasculature and ductal network and crucial extracellular matrix (ECM) components. To mimic pancreatic cell composition, we recellularized the whole pancreas scaffold with acinar and beta cell lines and cultured up to 5 days. Our result shows successful cellular engraftment within the decellularized pancreas, and the resulting graft gave rise to strong up-regulation of insulin gene expression. These findings support biological utility of whole pancreas ECM as a biomaterials scaffold for supporting and enhancing pancreatic cell functionality and represent a step toward bioengineered pancreas using regenerative medicine approaches. PMID:23787110

  6. Glycerol interference in serum lipase assay falsely indicates pancreas injury.

    PubMed

    Bilodeau, L; Grotte, D A; Preese, L M; Apple, F S

    1992-09-01

    The measurement of serum lipase activity has been shown to be a very sensitive and specific marker for the diagnosis of pancreatic injury. Two case reports are presented showing that glycerol ingested coincidentally in the formulation of several medications taken therapeutically and given in the emergency room causes a falsely elevated serum lipase activity when measured on the Kodak Ektachem 700 clinical analyzer (Eastman Kodak Co., Rochester, NY). The transient but falsely elevated serum lipase activity could potentially affect the differential diagnosis of patients by the admitting physician. PMID:1499907

  7. Computed Tomography and MRI of the Hepatobiliary System and Pancreas.

    PubMed

    Marolf, Angela J

    2016-05-01

    MRI and computed tomographic (CT) imaging are becoming more common in the diagnosis of hepatobiliary and pancreatic disorders in small animals. With the advent of multislice CT scanners, sedated examinations in veterinary patients are feasible increasing the use of this imaging modality. CT and MRI provide additional information for dogs and cats with hepatobiliary and pancreatic diseases because of lack of superimposition of structures, operator dependence, and through intravenous contrast administration. This added value provides more information for diagnosis, prognosis, and surgical planning. PMID:26838961

  8. Predicting Risk of Death in General Surgery Patients on the Basis of Preoperative Variables Using American College of Surgeons National Surgical Quality Improvement Program Data

    PubMed Central

    Vaid, Sachin; Bell, Ted; Grim, Rod; Ahuja, Vanita

    2012-01-01

    Objectives: To use the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database to develop an accurate and clinically meaningful preoperative mortality predictor (PMP) for general surgery on the basis of objective information easily obtainable at the patients bedside and to compare it with the preexisting NSQIP mortality predictor (NMP). Methods: Data were obtained from the ACS NSQIP Participant Use Data File (2005 to 2008) for current procedural terminology codes that included open pancreas surgery and open/laparoscopic colorectal, hernia (ventral, umbilical, or inguinal), and gallbladder surgery. Chi-square analysis was conducted to determine which preoperative variables were significantly associated with death. Logistic regression followed by frequency analysis was conducted to assign weight to these variables. PMP score was calculated by adding the scores for contributing variables and was applied to 2009 data for validation. The accuracy of PMP score was tested with correlation, logistic regression, and receiver operating characteristic analysis. Results: PMP score was based on 16 variables that were statistically reliable in distinguishing between surviving and dead patients (p < 0.05). Statistically significant variables predicting death were inpatient status, sepsis, poor functional status, do-not-resuscitate directive, disseminated cancer, age, comorbidities (cardiac, renal, pulmonary, liver, and coagulopathy), steroid use, and weight loss. The model correctly classified 98.6% of patients as surviving or dead (p < 0.05). Spearman correlation of the NMP and PMP was 86.9%. Conclusion: PMP score is an accurate and simple tool for predicting operative survival or death using only preoperative variables that are readily available at the bedside. This can serve as a performance assessment tool between hospitals and individual surgeons. PMID:23251111

  9. The Diagnosis of Periprosthetic Infection

    PubMed Central

    del Arco, Alfonso; Bertrand, Mara Luisa

    2013-01-01

    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-99mlabelled sulphur colloid is considered the imaging test of choice when imaging is necessary. PMID:23898349

  10. The Concept of Death in Preoperational Retarded Children.

    ERIC Educational Resources Information Center

    Sternlicht, Manny

    1980-01-01

    Fourteen preoperational retarded boys and girls were interviewed for their concepts of death. Subjects did not have realistic concepts of when they would die, or of the permanence of death, but did have knowledge of how things die. Types of replies subjects made were significantly related to subjects' cognitive level. (Author/RH)

  11. Preoperative digital mammography imaging in conservative mastectomy and immediate reconstruction

    PubMed Central

    Angrigiani, Claudio; Hammond, Dennis; Nava, Maurizio; Gonzalez, Eduardo; Rostagno, Roman; Gercovich, Gustavo

    2016-01-01

    Background Digital mammography clearly distinguishes gland tissue density from the overlying non-glandular breast tissue coverage, which corresponds to the existing tissue between the skin and the Cooper’s ligaments surrounding the gland (i.e., dermis and subcutaneous fat). Preoperative digital imaging can determine the thickness of this breast tissue coverage, thus facilitating planning of the most adequate surgical techniques and reconstructive procedures for each case. Methods This study aimed to describe the results of a retrospective study of 352 digital mammograms in 176 patients with different breast volumes who underwent preoperative conservative mastectomies. The breast tissue coverage thickness and its relationship with the breast volume were evaluated. Results The breast tissue coverage thickness ranged from 0.233 to 4.423 cm, with a mean value of 1.952 cm. A comparison of tissue coverage and breast volume revealed a non-direct relationship between these factors. Conclusions Preoperative planning should not depend only on breast volume. Flap evaluations based on preoperative imaging measurements might be helpful when planning a conservative mastectomy. Accordingly, we propose a breast tissue coverage classification (BTCC). PMID:26855903

  12. The Role of Preoperative TIPSS to Facilitate Curative Gastric Surgery

    SciTech Connect

    Norton, S.A.; Vickers, J.; Callaway, M.P. Alderson, D.

    2003-08-15

    The use of TIPSS to facilitate radical curative upper gastrointestinal surgery has not been reported. We describe a case in which curative gastric resection was performed for carcinoma of the stomach after a preoperative TIPSS and embolization of a large gastric varix in a patient with portal hypertension.

  13. Patterns of Response After Preoperative Treatment in Gastric Cancer

    SciTech Connect

    Diaz-Gonzalez, Juan A.; Rodriguez, Javier; Hernandez-Lizoain, Jose L.; Ciervide, Raquel; Gaztanaga, Miren; San Miguel, Inigo; Arbea, Leire; Aristu, J. Javier; Chopitea, Ana; Martinez-Regueira, Fernando; Valenti, Victor; Garcia-Foncillas, Jesus; Martinez-Monge, Rafael; Sola, Jesus J.

    2011-07-01

    Purpose: To analyze the rate of pathologic response in patients with locally advanced gastric cancer treated with preoperative chemotherapy with and without chemoradiation at our institution. Methods and Materials: From 2000 to 2007 patients were retrospectively identified who received preoperative treatment for gastric cancer (cT3-4/ N+) with induction chemotherapy (Ch) or with Ch followed by concurrent chemoradiotherapy (45 Gy in 5 weeks) (ChRT). Surgery was planned 4-6 weeks after the completion of neoadjuvant treatment. Pathologic assessment was used to investigate the patterns of pathologic response after neoadjuvant treatment. Results: Sixty-one patients were analyzed. Of 61 patients, 58 (95%) underwent surgery. The R0 resection rate was 87%. Pathologic complete response was achieved in 12% of the patients. A major pathologic response (<10% of residual tumor) was observed in 53% of patients, and T downstaging was observed in 75%. Median follow-up was 38.7 months. Median disease-free survival (DFS) was 36.5 months. The only patient-, tumor-, and treatment-related factor associated with pathologic response was the use of preoperative ChRT. Patients achieving major pathologic response had a 3-year actuarial DFS rate of 63%. Conclusions: The patterns of pathologic response after preoperative ChRT suggest encouraging intervals of DFS. Such a strategy may be of interest to be explored in gastric cancer.

  14. Influence of preoperative nutritional state on inflammatory response after surgery.

    PubMed

    Nakamura, K; Moriyama, Y; Kariyazono, H; Hamada, N; Toyohira, H; Taira, A; Yamada, K

    1999-01-01

    To investigate whether the preoperative nutritional state influences the postoperative inflammatory reaction and immunity, we grouped patients whose postoperative nutritional support was performed by total parenteral nutrition into the good nutritional state group (group I) and the latent protein-calorie malnutrition suggested group (group II) based on the preoperative rapid turnover protein (RTP). Nutritional markers markedly decreased after surgery and recovered almost to preoperative levels on postoperative day (POD-) 7 in groups I and II. Nutritional markers on POD-7 in group II were significantly lower than those in group I (RTP, P < 0.001; albumin, P < 0.05). After surgery, levels of interleukin-6 (IL-6), C-reactive protein (CRP), and polymorphonuclear (PMN-) elastase were higher in group II than in group I (P < 0.01). In groups I and II, IL-6 and interleukin-8 (IL-8) rose before the remarkable elevation of CRP and PMN-elastase. In group I, all the nutritional markers showed a negative correlation with CRP and PMN-elastase. Further, a positive correlation was observed between IL-6 and CRP and between IL-8 and PMN-elastase. In conclusion, evaluation of the preoperative nutritional state appears to be very important for the prediction of postoperative complication. PMID:10575657

  15. Value of quantitative nucleolar features in the preoperative cytological diagnosis of follicular neoplasias of the thyroid.

    PubMed Central

    Montironi, R; Braccischi, A; Scarpelli, M; Matera, G; Alberti, R

    1991-01-01

    Nucleolar prevalence, size, and outline were investigated on cytological material from cold thyroid nodules obtained by fine needle aspiration. The percentage of nucleolated nuclei in follicular adenoma (32 cases) was less than in follicular carcinoma (26 cases). In adenoma most nuclei contained one nucleolus, and nuclei with two or more nucleoli were less common than in carcinoma where most cases showed the highest nucleolar diameter values. There was some overlap between adenomas and carcinomas, however, when the mean of the 10 largest values of the major nucleolar diameter was considered. In follicular carcinoma the percentage of marginated nucleoli--that is, those touching the nuclear membrane--was, in general, greater than 20%; in adenoma the values were equal to or lower than 16%. The overlap index showed that the percentages of marginated nucleoli and nucleolated nuclei are the two best discriminatory features between adenoma and carcinoma. PMID:2066431

  16. Dual Diagnosis

    MedlinePlus

    ... that make them feel better temporarily. Sometimes the substance abuse occurs first. Over time, that can lead to emotional and mental problems. Someone with a dual diagnosis must treat both conditions. For the treatment to be effective, the person needs to stop ...

  17. An Activated Immune and Inflammatory Response Targets the Pancreas of Newborn Pigs with Cystic Fibrosis

    PubMed Central

    Abu-El-Haija, Maisam; Sinkora, Marek; Meyerholz, David K.; Welsh, Michael J.; McCray, Jr., Paul B.; Butler, John; Uc, Aliye

    2011-01-01

    Background/Aims: In cystic fibrosis (CF), pancreatic disease begins in utero and progresses over time to complete destruction of the organ. Although inflammatory cells have been detected in the pancreas of humans and pigs with CF, their subtypes have not been characterized. Methods: Using four-color flow cytometry, we analyzed the surface antigens of leukocytes in pancreas, blood, and mesenteric lymph nodes (MLN) of newborn pigs with CF (CFTR/ and CFTR?F508/?F508) and in those without CF (CFTR+/, CFTR+/?F508, CFTR+/+). Pancreatic histopathology was examined with HE stain. Results: CF pig pancreas had patchy distribution of inflammatory cells with neutrophils/macrophages in dilated acini, and lymphocytes in the interstitium compared to non-CF. B cells, effector (MHC-II+) and cytotoxic (CD2+CD8+) ?? T cells, activated (MHC-II+ and/or CD25+) and effector (CD4+CD8+) ?? T helper cells, effector natural killer cells (MHC-II+CD3?CD8+), and monocytes/macrophages and neutrophils were increased in the CF pig pancreas compared to pigs without CF. Blood and MLN leukocyte populations were not different between CF and non-CF pigs. Conclusions: We discovered an activated immune response that was specific to the pancreas of newborn CF pigs; inflammation was not systemic. The presence of both innate and adaptive immune cells suggests that the disease process is complex and extensive. PMID:22057257

  18. Mucus retention in heterotopic pancreas of the gastric antrum. A lesion mimicking mucinous carcinoma.

    PubMed

    Nopajaroonsri, C

    1994-09-01

    This report describes mucus retention developing in heterotopic pancreas of the gastric antrum. This unusual complication of heterotopic pancreas was seen in a 54-year-old black man who presented with postprandial nausea, vomiting, and weight loss. Gastroscopy revealed a 2-cm pyloric polyp, which was seen to intermittently obstruct the pylorus. Exploratory laparotomy confirmed an intramural mass in the antrum with serosal thickening and nodules. Frozen-section examination of the serosal nodule revealed a pool of mucus containing epithelial clusters and chronic inflammatory cells with no verifiable pancreatic tissue. These findings suggested the possibility of a mucinous carcinoma involving the serosa. Following gastrectomy, however, heterotopic pancreatic tissue was identified in the outer muscular propria extending to the mucosa of the antrum with no evidence of carcinoma. This heterotopic pancreatic tissue showed ductal obstruction and mucus retention. As a result, some ducts were ruptured and transformed into small nodules of mucus lakes with clusters of residual ductal epithelium. We therefore concluded that the mucous extravasation nodules on the antral serosa represented a benign lesion resulting from mucus retention in the heterotopic pancreas. In contrast to mucinous carcinoma, these benign mucous extravasation nodules were closely associated with the heterotopic pancreas, and showed significant inflammation and fibrosis but no overt epithelial anaplasia. The significance of the mucous extravasation nodule in the heterotopic pancreas is its potential confusion with mucinous carcinoma. PMID:8067516

  19. ECM signaling regulates collective cellular dynamics to control pancreas branching morphogenesis

    PubMed Central

    Shih, Hung Ping; Panlasigui, Devin; Cirulli, Vincenzo; Sander, Maike

    2015-01-01

    Summary During pancreas development, epithelial buds undergo branching morphogenesis to form an exocrine and endocrine gland. Proper morphogenesis is necessary for correct lineage allocation of pancreatic progenitors; however, the cellular events underlying pancreas morphogenesis are unknown. Here, we employed time-lapse microscopy and fluorescent labeling of cells to analyze cell behaviors associated with pancreas morphogenesis. We observed that outer bud cells adjacent to the basement membrane are pleomorphic and rearrange frequently; as well, they largely remain in the outer cell compartment even after mitosis. These cell behaviors and pancreas branching depend on cell contacts with the basement membrane, which induce actomyosin cytoskeleton remodeling via integrin-mediated activation of FAK/Src signaling. We show that integrin signaling reduces E-cadherin-mediated cell-cell adhesion in outer cells, and provide genetic evidence that this regulation is necessary for initiation of branching. Our study suggests that regulation of cell motility and adhesion by local niche cues initiates pancreas branching morphogenesis. PMID:26748698

  20. Estrogen Receptor α Regulates β-Cell Formation During Pancreas Development and Following Injury.

    PubMed

    Yuchi, Yixing; Cai, Ying; Legein, Bart; De Groef, Sofie; Leuckx, Gunter; Coppens, Violette; Van Overmeire, Eva; Staels, Willem; De Leu, Nico; Martens, Geert; Van Ginderachter, Jo A; Heimberg, Harry; Van de Casteele, Mark

    2015-09-01

    Identifying pathways for β-cell generation is essential for cell therapy in diabetes. We investigated the potential of 17β-estradiol (E2) and estrogen receptor (ER) signaling for stimulating β-cell generation during embryonic development and in the severely injured adult pancreas. E2 concentration, ER activity, and number of ERα transcripts were enhanced in the pancreas injured by partial duct ligation (PDL) along with nuclear localization of ERα in β-cells. PDL-induced proliferation of β-cells depended on aromatase activity. The activation of Neurogenin3 (Ngn3) gene expression and β-cell growth in PDL pancreas were impaired when ERα was turned off chemically or genetically (ERα(-/-)), whereas in situ delivery of E2 promoted β-cell formation. In the embryonic pancreas, β-cell replication, number of Ngn3(+) progenitor cells, and expression of key transcription factors of the endocrine lineage were decreased by ERα inactivation. The current study reveals that E2 and ERα signaling can drive β-cell replication and formation in mouse pancreas. PMID:26015547