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1

Is preoperative diagnosis possible? A clinical and radiological review of lymphoepithelial cysts of the pancreas.  

PubMed

Lymphoepithelial cysts of the pancreas are rare lesions found mainly in middle-aged men. They are usually benign and have no clear natural history except one study linking their occurrence with HIV infection. Nevertheless, they often cause enormous psychological stress to patients as they tend to mimic pancreatic neoplasms which are known to carry poor prognosis. The authors have therefore assessed the published literature from PubMed in order to determine whether lymphoepithelial cysts can be diagnosed preoperatively using novel imaging techniques. Based on our findings, it is evident that three-dimensional computed tomography scans, in-phase and out-of phase magnetic resonance imaging studies, and endosonography have enabled better characterization of pancreatic lymphoepithelial cysts than a decade ago. Endoscopic ultrasound-guided fine needle aspiration has also added considerably to the promise of preoperative diagnosis. Thus, the authors can affirm that despite surgical excision of the cyst with pathological examination being the gold standard for diagnosis, it is possible that a combination of the modern imaging techniques and/or minimally-invasive approach can enable patients avoid unnecessary surgery in the future. PMID:23306330

Osiro, Stephen; Rodriguez, Jonier R; Tiwari, Kevin J; Rodriguez, Iliana I; Mathenge, Njambi; Tubbs, Robert Shane; Loukas, Marios

2013-01-01

2

Preoperative chemoradiation for marginally resectable adenocarcinoma of the pancreas.  

PubMed

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

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

2001-01-01

3

Diagnosis and Surgical Therapy of Pancreas Tumors.  

National Technical Information Service (NTIS)

The efficiency of surgery and presurgical diagnosis on several tumorous diseases of the pancreas is investigated. If there is the clinical suspicion of a pancreas carcinoma, sonography computerized tomography, and endoscopic-retrograde cholangio-pancreati...

A. Heid

1981-01-01

4

Preoperative chemoradiation for marginally resectable adenocarcinoma of the pancreas  

Microsoft Academic Search

Only 10% to 20% of patients with pancreatic cancer are considered candidates for curative resection at the time of diagnosis.\\u000a We postulated that preoperative chemoradiation therapy might promote tumor regression, eradicate nodal metastases, and allow\\u000a for definitive surgical resection in marginally resectable patients. The objective of this study was to evaluate the effect\\u000a of a preoperative chemoradiation therapy regimen on

Vivek K. Mehta; George Fisher; James A. Ford; Joseph C. Poen; Mark A. Vierra; Harry Oberhelman; John Niederbuber; Augusto Bastidas

2001-01-01

5

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

PubMed Central

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

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

2013-01-01

6

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

PubMed

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

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

2013-07-01

7

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

SciTech Connect

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

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

1984-04-01

8

Diagnosis of early pancreas graft failure via antibody-mediated rejection: single-center experience with 256 pancreas transplantations.  

PubMed

Early pancreas graft loss is usually attributed to technical failure while the possibility of antibody-mediated rejection (AMR) is generally overlooked. To investigate the role of AMR in early pancreas graft loss, we retrospectively assessed 256 patients with simultaneous pancreas-kidney transplantation (SPK) between 1985 and 2010 at our institute. We included 33 SPK patients who lost their pancreas graft <1 year after transplantation. AMR was diagnosed based on donor-specific antibodies, C4d and histology in 7 cases, 8 cases were suspicious for AMR and 18 pancreas graft losses were not due to AMR. Acute AMR occurred >1 month after transplantation in 6/7 cases, whereas all other causes typically led to loss <1 month after transplantation. Thrombotic lesions occurred equally among the 33 cases. In 12/18 concurrent kidney specimens, the diagnostic results paralleled those of the pancreas graft. All patients with acute AMR of the pancreas graft lost their renal grafts <1 year after transplantation. In the setting of a thrombotic event, histopathological analysis of early pancreas graft loss is advisable to rule out the possibility of AMR, particularly because a diagnosis of acute AMR has important consequences for renal graft outcomes. PMID:24712331

de Kort, H; Mallat, M J K; van Kooten, C; de Heer, E; Brand-Schaaf, S H; van der Wal, A M; Roufosse, C; Roelen, D L; Bruijn, J A; Claas, F H; de Fijter, J W; Bajema, I M

2014-04-01

9

Preoperative Diagnosis of Adult Intussusception Caused by Small Bowel Lipoma.  

PubMed

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

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

2009-01-01

10

Preoperative diagnosis of pelvic actinomycosis by clinical cytology  

PubMed Central

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

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

2012-01-01

11

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

Microsoft Academic Search

Objective: To evaluate the power of prenatal 2-D ultrasound examination in the 2nd trimester as a method of choice for accurate diagnosis of annular pancreas. Methods: Co-incidence of the double bubble sign (often accompanying gastroduodenal dilatation) together with a hyperechogenic band around the duodenum (corresponding with the tissue of annular pancreas) was used as a diagnostic criterion. Findings from postnatal

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

2008-01-01

12

[Intraoperative diagnosis of pheochromocytoma preoperative symptoms in a case of Recklinghausen's disease].  

PubMed

Phaechromocytoma is a rare catecholamine secreting tumor, which occasionally presents as a life threatening crisis in association with surgery and anesthesia. We report a 58-year-old women with known Recklinghausen's disease who was admitted for elective resection of a pancreas tail cystadenoma. A cystadenocarcinoma was taken into account differential diagnostically. No clinical symtoms or signs pointing to a hormone active tumor were found preoperatively. After opening of the abdomen and palpation of the tumor, a hypertensive crisis occurred accompanied by considerable tachycardia, leading to the tentative diagnosis of a phaeochromocytoma in connection to the known phacomatosis. The hypertensive crisis was treated with nitroglycerin and esmolol. The putative tumor of the pancreas represented itself as an adrenal tumor without relationship to the pancreas. Following ligature of the suprarenal vein, antihypertensive therapy could be finished. For stabilization of blood pressure a noradrenaline application was necessary in descending dosage over a period of two days. The further postoperative course was without complications. The results of the urine catecholamine measurements and histological examinations confirmed the intraoperative diagnosis. An unidentified phaeochromocytoma is a vital threat for patients during surgery and anesthesia. Phaeochromocytomas are observed in patients suffering from Recklinghausen's disease (and other phacomatoses) in an above average incidence. Therefore, such a tumor should be excluded in these patients before elective surgery even if the patient does not show symptoms (asymptomatic phaeochromocytomas occur). The determination of catecholamines in 24 hour urine collections is an easy and specific diagnostic procedure and should be used in patients suffering from phacomatoses before elective surgery. PMID:11252575

Kretzschmar, M; Ufert, S; Hohmann, U; Schramm, H; Schirrmeister, W

2001-02-01

13

[State-art: diagnosis and management in pancreas divisum].  

PubMed

Pancreas divisum (PD), the most common congenital variant of pancreatic duct anatomy, occurs when the ductal systems of the ventral and dorsal pancreatic ducts fail to fuse during the second month of gestation. With non-union of the ducts, the major portion of the pancreatic exocrine secretion enters the duodenum by way of the dorsal duct and minor papilla. It has been generally accepted that a relative obstruction to pancreatic exocrine secretory flow through the minor duct and minor papilla could result in pancreatitis in small numbers of patients with PD. The debate whether PD causes pancreatitis continues, although most authorities agree that PD is a definite cause in a subgroup of patients. Most patients with PD and well-documented acute recurrent pancreatitis have responded favorably to surgical sphincteroplasty of the minor papilla. Endoscopic retrograde cholangiopancreatography (ERCP) is the most common procedure for diagnosis PD in patients who have pancreatobiliary symptoms. MRCP is being increasingly used to establish the diagnosis and secretin stimulation can improve ductal images greatly. Endoscopic management of symptomatic patients with PD is evolving. Only a limited number of series are available, using endoscopic pancreatic stent placement, minor papilla endoscopic papillotomy, or both to decompress the dorsal duct in an effort to restore pancreatic exocrine secretory flow. Even with relatively small numbers of patients and a near absence of controlled, randomized trials, it appears that the patients most likely to benefit, as with surgery, are those with well-documented ARP rather than pain alone or chronic pancreatitis. Overall we recommend that pancreatic stenting and pancreatic sphincterotomy should be done only in large centers with experience in therapeutic ERCP. Further randomized trials would be of interest. PMID:17469416

Yimcharoen, Panot; Fogel, Evan L; McHenry, Lee; Watkins, James; Sherman, Stuart; Lehman, Glen A

2005-07-01

14

[Preoperative diagnosis for stage II endometrial carcinoma using endocervical conization].  

PubMed

It is generally difficult to identify stage II endometrial carcinoma correctly. To differentiate cervical involvement, endocervical conization was performed on 31 patients with endometrial cancer between May 1982 and September 1983. The preoperative diagnosis of stage II endometrial carcinoma was confirmed by postoperative histologic examination. In stage I patients, there was no microscopic cervical involvement after the operation. Fractional curettage and hysteroscopy are commonly used to detect stage II endometrial carcinoma. However, these examinations may overlook cervical stromal invasion. Endocervical conization is a simple procedure and highly useful to detect cervical stromal involvement. We recommend the of endocervical conization combined with hysteroscopy to diagnose stage II endometrial carcinoma. PMID:6471397

Fukuda, K; Masubuchi, S; Masubuchi, K

1984-07-01

15

Macroscopic classification and preoperative diagnosis of intrahepatic cholangiocarcinoma in Japan.  

PubMed

We reviewed the records of 64 patients with resected intrahepatic cholangiocarcinoma (ICC) according to the macroscopic classification proposed by the Liver Cancer Study Group of Japan, in which ICC is classified into three types based on the macroscopic appearance of the cut sur-face of the tumor: mass-forming, periductal-infiltrating, and intraductal growth types. There were 24 patients with the periductal-infiltrating type, 28 with the mass-forming type, and 12 with the intraductal growth type. The mass-forming type essentially showed expansive growth irrespective of hilar invasion. The periductal-infiltrating type of tumor exhibited diffuse infiltration along the portal pedicle, and preoperative planning of the resection procedure was similar to that for primary bile duct carcinoma of the hepatic confluence. Vascular resection and reconstruction was required in some patients with advanced disease. In the intraductal growth type of tumor, precise determination of tumor extent was difficult because of the ambiguity caused by abundant mucin secreted by the tumor and/or by the superficial mucosal spread of the tumor along the bile duct. Percutaneous transhepatic cholangioscopy provided the most reliable information for designing the operative procedure. The macroscopic classification is useful for preoperative diagnosis of tumor extent and for planning the surgical procedure. PMID:10398895

Sano, T; Kamiya, J; Nagino, M; Uesaka, K; Kondo, S; Kanai, M; Hayakawa, N; Nimura, Y

1999-01-01

16

Neutrophil to lymphocyte ratio for preoperative diagnosis of uterine sarcomas: A case-matched comparison  

Microsoft Academic Search

BackgroundUterine sarcomas are rare among all uterine malignancies, and frequently misdiagnosed as benign uterine diseases such as leiomyoma and adenomyosis because of lack of feasible tools for the preoperative diagnosis. Although some studies have suggested the role of serum CA-125 levels for the preoperative diagnosis, the efficacy is controversial. Since malignancy is known to be associated with systemic inflammation which

H. S. Kim; K. H. Han; H. H. Chung; J. W. Kim; N. H. Park; Y. S. Song; S. B. Kang

2010-01-01

17

Preoperative Aspiration Culture for Preoperative Diagnosis of Infection in Total Hip or Knee Arthroplasty  

PubMed Central

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

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

2013-01-01

18

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

PubMed

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

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

2013-11-01

19

Preoperative diagnosis of choledocholithiasis: the role of MRCP.  

PubMed

Biliary imaging has changed as a result of technological advances, but the timing and modality of preoperative biliary tree imaging is controversial. An ideal imaging modality would be risk free and have a high sensitivity and specificity, a role fulfilled by magnetic resonance cholangiopancreatography (MRCP). PMID:19516211

Al Samaraee, Ahmad; Khan, Usman; Almashta, Zaid; Yiannakou, Yan

2009-06-01

20

[Progress of preoperative diagnosis of pancreatic tumor--with special reference to extension of pancreatic cancer].  

PubMed

Preoperative diagnosis of the extension of pancreatic cancer is very important for determining the range of resection. We evaluated the preoperative imaging diagnosis of the tumors and compared it with the pathological diagnosis. Out of 68 pancreatic head cancers, the percentage of correct diagnosis of serosal invasion was 69.1%, that of over-estimate was 23.5% and that of under-estimate was 7.4%. In the case of retroperitoneal invasion, a correct diagnosis had been made in 79.1%, over-estimate in 4.5% and under-estimate in 16.4%. In the case of portal vein invasion, these percentages were 52.8%, 39.6% and 7.5%, respectively. In the case of lymph node involvement, these percentages were 85.3%, 2.9% and 11.8%, respectively. The percentage of preoperative over-estimate was higher for serosal invasion and that of preoperative under-estimate was higher for retroperitoneal invasion. In the case of portal vein invasion, the percentage of preoperative over-estimate was relatively high. Of the 12 patients who had paraortic lymph node metastases, 6 patients had a single metastatic node in the paraortic area. The minimum size of these nodes was 2 x 2 mm. Only 5 cases could be diagnosed preoperatively. We evaluated the usefulness of abdominal CT scan and superior mesenteric arteriography for the diagnosis of superior mesenteric arterial wall invasion. In both methods, the over-estimate rate was 0%, but the under-estimate rate was relatively high. Conclusively the preoperative diagnosis of the extension of the pancreatic cancer by conventional imaging methods has some limits. PMID:8139120

Ueno, K; Tuchihara, K; Yoshimitu, Y; Suzaki, Y; Takeda, T; Mori, K; Kobayashi, H; Kayahara, M; Ohta, T; Nagakawa, T

1994-02-01

21

Cervical ectopic thymic cyst: a rare preoperative diagnosis.  

PubMed

We present a case of a 5-year-old child with a painless swelling on the neck. Imaging revealed a multilocular cystic lesion lying in close proximity to carotid vessels. Based on imaging a possibility of ectopic thymic cyst was considered, which was confirmed on histopathology. Ectopic cervical cyst is an infrequent cause of neck cyst in a child which is rarely diagnosed preoperatively. PMID:22679153

Tandon, Anupama; Tandon, Rajesh; Chandrashekhar, M; Das, Poonam; Bansal, Bhavna; Bhatia, Nalin

2011-01-01

22

Preoperative sonographic diagnosis of sealed-off perforated gastric ulcer.  

PubMed

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

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

1998-06-01

23

Prediction of staging with preoperative parameters and frozen/section in patients with a preoperative diagnosis of grade 1 endometrioid tumor in endometrial cancer  

PubMed Central

Objective To investigate the likelihood of the detection of the necessity of staging preoperatively with the use of clinical parameters and frozen/section (FS). Material and Methods 219 patients were included who were operated on between 1996 and 2010 with a diagnosis of grade 1 endometrioid adenocarcinoma in probe curettage. Results Among the clinical characteristics, only age and body mass index (BMI) predicted staging preoperatively. The probability of staging increased as age increased and BMI decreased. The concordance between preoperative diagnosis and FS was 89.5%. The diagnosis was upgraded at postoperative evaluation for 13 patients (5.9%), and downgraded for 2 patients (0.9%) compared with FS. The wrong diagnosis regarding grade, the depth of myometrial invasion DMI, tumour type and cervical invasion in FS was clinically significant and affected the decision of staging in 10 patients. In conclusion, only 7 patients (3.2%) who acquired staging surgery were missed in FS. Conclusion It was shown that preoperative clinical parameters could not effectively predict the patients who should be staged. FS predicted the lymphatic involvement with high accuracy. The patient with a preoperative diagnosis of grade 1 endometrium cancer should be operated upon in centres where FS is utilised and oncologic staging surgery can be performed.

Karalok, Alper; Ureyen, Is?n; Reis, Y?ld?z; Oktay, Ozge; Turan, Taner; Boran, Nurettin; Bulbul, Dilek; Tulunay, Gokhan; Kose, Mehmet Faruk

2014-01-01

24

Enterocolic lymphocytic phlebitis: an oncologic surgical resection without a preoperative pathologic diagnosis.  

PubMed

A patient with complaints of an abdominal (mesenteric) mass is presented. Differential diagnosis included neoplastic processes, such as malignant lymphoma, desmoid tumour, a carcinoid or a gastro-intestinal stromal cell tumour. An oncological resection was performed. Despite the malignant appearance of the tumour no malignancy was found with histopathological examination. Vasculitic lesions were seen in venous structures, resembling veno-occlusive disease with signs of recanalization and with the presence of inflammatory cells, mainly lymphocytes. A diagnosis of enterocolic lymphocytic phlebitis was made. This benign condition can mimic malignancy, necessitating a wide excision, also because obtaining a pre-operative histopathological diagnosis is hardly possible. PMID:24876508

Huiberts, Astrid A M; Donkervoort, Sandra C; Blok, Willem L; Blaauwgeers, Hans L G

2014-01-01

25

Enterocolic lymphocytic phlebitis: an oncologic surgical resection without a preoperative pathologic diagnosis  

PubMed Central

A patient with complaints of an abdominal (mesenteric) mass is presented. Differential diagnosis included neoplastic processes, such as malignant lymphoma, desmoid tumour, a carcinoid or a gastro-intestinal stromal cell tumour. An oncological resection was performed. Despite the malignant appearance of the tumour no malignancy was found with histopathological examination. Vasculitic lesions were seen in venous structures, resembling veno-occlusive disease with signs of recanalization and with the presence of inflammatory cells, mainly lymphocytes. A diagnosis of enterocolic lymphocytic phlebitis was made. This benign condition can mimic malignancy, necessitating a wide excision, also because obtaining a pre-operative histopathological diagnosis is hardly possible.

Huiberts, Astrid A.M.; Donkervoort, Sandra C.; Blok, Willem L.; Blaauwgeers, Hans L.G.

2014-01-01

26

Jejunal duplication cyst displaying peristalsis and a five-layered appearance of the wall: a preoperative ultrasound diagnosis  

Microsoft Academic Search

A case of preoperatively diagnosed jejunal duplication cyst displaying the characteristic five-layered appearance of the gastrointestinal tract wall and peristaltic activity is reported. Both these rare features allowed a specific diagnosis of enteric duplication to be made.

V. Šimonovský

1996-01-01

27

Accuracy of Magnetic Resonance Cholangiopancreatography in the Diagnosis of Pancreas Divisum  

Microsoft Academic Search

Background  Patients with pancreas divisum may develop pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) is the gold\\u000a standard for diagnosing pancreas divisum. Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive test reported\\u000a to be highly accurate in diagnosing pancreas divisum.\\u000a \\u000a \\u000a \\u000a \\u000a Aim  To evaluate the diagnostic accuracy of MRCP in detecting pancreas divisum at our institution.\\u000a \\u000a \\u000a \\u000a Methods  We reviewed patients who underwent both ERCP and MRCP. Patients

Patrick MoslerF; F. Akisik; K. Sandrasegaran; E. Fogel; J. Watkins; W. Alazmi; S. Sherman; G. Lehman; T. Imperiale; L. McHenry

28

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

PubMed Central

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

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

2014-01-01

29

SENSITIVITY OF ENDOSCOPIC ULTRASOUND, MULTIDETECTOR COMPUTER TOMOGRAPHY AND MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY IN THE DIAGNOSIS OF PANCREAS DIVISUM: A TERTIARY CENTER EXPERIENCE  

PubMed Central

OBJECTIVES There are limited data comparing imaging modalities in the diagnosis of pancreas divisum. We aimed to: 1. Evaluate the sensitivity of endoscopic ultrasound (EUS), magnetic resonance cholangiopancreatography (MRCP) and multi-detector computed tomography (MDCT) for pancreas divisum. 2. Assess interobserver agreement (IOA) among expert radiologists for detecting pancreas divisum on MDCT and MRCP. METHODS For this retrospective cohort study, we identified 45 consecutive patients with pancreaticobiliary symptoms and pancreas divisum established by endoscopic retrograde pancreatography (ERP) who underwent EUS and cross-sectional imaging. The control group was composed of patients without pancreas divisum who underwent ERP and cross-sectional imaging. RESULTS The sensitivity of EUS for pancreas divisum was 86.7%, significantly higher than sensitivity reported in the medical records for MDCT (15.5%) or MRCP (60%) [p<0.001 for each]. On review by expert radiologists the sensitivity of MDCT increased to 83.3% in cases where the pancreatic duct was visualized, with fair IOA (?=0.34). Expert review of MRCPs did not identify any additional cases of pancreas divisum; IOA was moderate (?=0.43). CONCLUSIONS EUS is a sensitive test for diagnosing pancreas divisum and is superior to MDCT and MRCP. Review of MDCT studies by expert radiologists substantially raises its sensitivity for pancreas divisum.

Kushnir, Vladimir M.; Wani, Sachin B.; Fowler, Kathryn; Menias, Christine; Varma, Rakesh; Narra, Vamsi; Hovis, Christine; Murad, Faris; Mullady, Daniel; Jonnalagadda, Sreenivasa S.; Early, Dayna S.; Edmundowicz, Steven A.; Azar, Riad R.

2014-01-01

30

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

PubMed Central

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

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

2012-01-01

31

Preoperative Diagnosis of Tubular Adenoma of Breast - 10 years of experience  

PubMed Central

Background: Tubular adenomas are rare benign neoplasms of female breast affecting women, predominantly of child-bearing age group. Definitive diagnosis of this tumor is usually achieved after histopathological study. Clinical, radiological, and even cytological features are often insufficient for accurate diagnosis. Aim: The aim of the present study was planned to analyze clinical and radiological features of histologically confirmed cases of tubular adenoma of breast to find out a clue for accurate preoperative cytological diagnosis. Materials and Methods: In our 10-year research program, all histologically confirmed tubular adenoma cases of breast were studied. Clinico-radio-cytological features, if available, were analyzed and tabulated. Results: Thirty-three cases of tubular adenoma of breast were studied. Radiological and cytological assessments are available for 12 and 26 cases, respectively. Tubular adenoma could be diagnosed in only two cases (7.7%) by cytological assessment, but in none by radiological assessment. Conclusions: Clinico-cyto-radiological assessment could identify the benign nature of the tumors in most cases, but final confirmation was possible only after histopathological study.

Sengupta, Sanjay; Pal, Subrata; Biswas, Biplab Kr; Phukan, Jyoti Prakash; Sinha, Anuradha; Sinha, Rajani

2014-01-01

32

Contribution of Double-Labelling Scintigraphy to the Diagnosis of Pancreas Tumours.  

National Technical Information Service (NTIS)

A general discussion on the pancreas is followed by an attempt to show the progress made in pancreatic scintigraphy, with regard firstly to the improvement of equipment and secondly to the discovery of a still imperfect indicator, exp 75 Se-selenomethioni...

R. Godin

1975-01-01

33

Jejunal duplication cyst displaying peristalsis and a five-layered appearance of the wall: a preoperative ultrasound diagnosis.  

PubMed

A case of preoperatively diagnosed jejunal duplication cyst displaying the characteristic five-layered appearance of the gastrointestinal tract wall and peristaltic activity is reported. Both these rare features allowed a specific diagnosis of enteric duplication to be made. PMID:8797972

Simonovský, V

1996-01-01

34

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

PubMed Central

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

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

2013-01-01

35

Heterotopic Pancreas Leading to Ileo-Ileal Intussusception  

PubMed Central

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.

Ratan, KN; Rani, Babita; Tina

2012-01-01

36

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

SciTech Connect

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

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

1987-12-01

37

Intraductal tubulopapillary neoplasm of the pancreas on fine needle aspiration: case report with differential diagnosis.  

PubMed

Intraductal tubulopapillary neoplasm (ITPN) is a rare primary pancreatic neoplasm accounting for less than 1% of all pancreatic exocrine neoplasms and 3% of intraductal neoplasms of the pancreas. Data on this entity are still limited. Here, we report a case of ITPN with cytopathologic and histopathologic findings. A 41-year-old woman with a 2.2 cm cyst in the head of the pancreas for five years was referred to our institution. The endoscopic ultrasound-guided fine-needle aspiration produced cytospins were moderately cellular with a few fragments of markedly atypical epithelium. The neoplastic cells displayed high-grade nuclear atypia with enlarged, eccentric nuclei, anisonucleosis and prominent nucleoli, irregular nuclear membranes, high nucleus to cytoplasmic (N/C) ratios, and a moderate amount of cytoplasm with no intracytoplasmic mucin. Histologically, the lesion was found to be an ITPN with focal high-grade dysplasia. No invasive carcinoma was identified. The neoplastic cells exhibited luminal immunolabeling for MUC-1, but were negative for MUC-2, trypsin, chymotrypsin, and P53. Approximately 5% of the neoplastic cells showed Ki-67 immunoreactivity. ITPN of pancreas may be a source of markedly atypical epithelial cells in pancreatic cystic aspiration. Clinical and radiographic findings, molecular mutational analysis, in combination with cytological features are essential to differentiate it from other disease entities. PMID:22807417

Guan, Hui; Gurda, Grzegorz; Lennon, Anne Marie; Hruban, Ralph H; Erozan, Yener S

2014-02-01

38

Lymphoepithelial cysts of the pancreas: The use of endoscopic ultrasound-guided fine-needle aspiration in diagnosis  

PubMed Central

Lymphoepithelial cysts (LECs) are rare non-neoplastic lesions that can appear as a complex cyst or a mass in the pancreas. Cytology from endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) can be helpful in making a diagnosis with the aim of avoiding unnecessary surgical resection. A case involving a 51-year-old woman with lower abdominal pain who was found to have a multiloculated cystic lesion at the junction of the pancreatic body and tail is described. Cytology from EUS-FNA was consistent with a pancreatic LEC. The lesion was managed conservatively and follow-up imaging of the cyst over the following two years was unchanged. The patient remains clinically well. Cytology from EUS-FNA can help distinguish LECs from cystic neoplasms, thus preventing radical surgical resection of this benign pancreatic cyst.

Karim, Zamil; Walker, Blair; Lam, Eric C

2010-01-01

39

A radiopharmaceutical for pancreatic exocrine functional diagnosis: 62Zn-EDDA metabolism in pancreas.  

PubMed

The metabolic pathway of radioactive 62Zn-EDDA (ethylenediamine-N,N'-diacetic acid), in the exocrine pancreas was studied with respect to that of endogenous Zn. In pancreatic duct cannulated dog, the secretion of intravenously injected exogenous 62Zn into pancreatic juice increased under the stimulation of CCK-PZ (pancreatic protein secretion stimulating hormone), which closely correlated to endogenous Zn. Moreover, in pancreatic juice, 62Zn as well as endogenous Zn was selectively bound to Zn-metalloenzymes, carboxypeptidase A and B. These results demonstrated the close correlation between the endogenous and the exogenously-administered Zn (62Zn-EDDA), as well as the high availability of 62Zn-EDDA as a marker of pancreatic function for the follow up of carboxypeptidase metabolism. PMID:3086247

Fujibayashi, Y; Saji, H; Kawai, K; Unuma, Y; Miyata, S; Okuno, T; Hosotani, R; Inoue, K; Adachi, H; Horiuchi, K

1986-01-01

40

Extra-gastrointestinal stromal tumor of the pancreas: case report and review of the literature  

PubMed Central

Primary extra-gastrointestinal stromal tumor (EGISTs) arising in the pancreas is extremely rare: only 20 cases have previously been reported in the English literature from 2000 to 2013. We reported a case of EGIST of the pancreas in a 69-year-old woman who presented with abdominal pain and with a solid, heterogeneously enhancing neoplasm in the uncinate process of the pancreas, revealed preoperatively by an abdominal computed tomography scan. A diagnosis of neuroendocrine tumor was suggested. Positron emission tomography with 68Ga-DOTATOC did not show pathological accumulation of the tracer in the pancreas. The patient underwent enucleation, under ultrasonic guidance, of the pancreatic tumor that emerged to the surface of the pancreas. Histopathology and immunohistochemical examination confirmed the final diagnosis of EGIST of the pancreas (CD117+), with one mitosis per 50 high-power fields. Although rarely, GIST can involve the pancreas as a primary site, and this tumor should be considered in the differential diagnosis of pancreatic neoplasms.

2014-01-01

41

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

PubMed Central

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

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

2014-01-01

42

Preoperative Diagnosis of Lymph Node Metastasis in Biliary and Pancreatic Carcinomas: Evaluation of the Combination of Multi-detector CT and Serum CA19-9 Level  

Microsoft Academic Search

Background  It is difficult to diagnose lymph node metastasis in biliary and pancreas carcinomas before surgery.\\u000a \\u000a \\u000a \\u000a Aim  The aim of this study was to assess the utility of the combination of multi-detector computed tomographic (MDCT) findings\\u000a and serum carbohydrate antigen (CA)19-9 level in the diagnosis of lymph node metastasis in biliary and pancreas carcinomas.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  The subjects were 139 patients with biliary and

Atsushi NanashimaIchiro; Ichiro Sakamoto; Tomayoshi Hayashi; Syuuichi Tobinaga; Masato Araki; Masaki Kunizaki; Takashi Nonaka; Hiroaki Takeshita; Shigekazu Hidaka; Terumitsu Sawai; Toru Yasutake; Takeshi Nagayasu

2010-01-01

43

Pancreas Transplantation  

PubMed Central

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

Sutherland, David ER

2010-01-01

44

Isolated metastasis of uterine leiomyosarcoma to the pancreas: Report of a case and review of the literature  

PubMed Central

INTRODUCTION Metastatic tumors of the pancreas are uncommon and rarely detectable clinically. Metastases to the pancreas are rare. We present a patient with pancreatic metastases from a leiomyosarcoma of the uterus and review the literature about the clinical features of pancreatic metastasis and its surgical management. PRESENTATION OF CASE A 40-year-old woman, who underwent hysterectomy, left oophorectomy, omentectomy and lymp node dissection for leiomyosarcoma of the uterus. At the follow up, the patient complained of non-specific abdominal discomfort. Preoperative diagnosis were pancreatic pseudocyst, cystadenoma or cystadenocarcinoma. At laparotomy, a cystic mass was found in the tail of the pancreas which was invased to the transverse colon mesenterium and the spleen. Distal pancreatectomy with splenectomy and transverse colon resection was performed. Histologically, the tumor was evaluated as poorly differentiated leiomyosarcoma. DISCUSSION Metastatic lesions of the pancreas are uncommon and less than 2% of all pancreatic malignancies. However a few cases of leiomyosarcoma with metastases to the pancreas have been reported in the literature. Before deciding that the lesion in the pancreas was metastasis, primary leiomyosarcoma of the pancreas had to be ruled out. Histologically, leiomyosarcoma of the pancreas contains interlacing spindle cells with varying degrees of atypia and pleomorphism. The surgical approach to the pancreatic metastases must be aimed complete excision of the tumor with a wide negative margin of clear tissue and maximum preservation of pancreatic remnant if possible. CONCLUSION In the absence of widespread metastatic disease, aggressive surgical approach with negative margins must be aimed.

Ozturk, Safak; Unver, Mutlu; Ozturk, Burcin Kibar; Bozb?y?k, Osman; Erol, Varl?k; Kebabc?, Eyup; Olmez, Mustafa; Zalluhoglu, Nihat; Bayol, Umit

2014-01-01

45

Diagnosis of periprosthetic infection following total hip arthroplasty – evaluation of the diagnostic values of pre- and intraoperative parameters and the associated strategy to preoperatively select patients with a high probability of joint infection  

Microsoft Academic Search

BACKGROUND: The correct diagnosis of a prosthetic joint infection (PJI) is crucial for adequate surgical treatment. The detection may be a challenge since presentation and preoperative tests are not always obvious and precise. This prospective study was performed to evaluate a variety of pre- and intraoperative investigations. Furthermore a detailed evaluation of concordance of each preoperative diagnosis was performed, together

Michael Mueller; Lars Morawietz; Olaf Hasart; Patrick Strube; Carsten Perka; Stephan Tohtz

2008-01-01

46

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

PubMed

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

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

2005-01-01

47

Pre-operative diagnosis of breast cancer in screening: problems and pitfalls.  

PubMed

The widespread use of mammographic breast screening and the introduction of even more sensitive radiological techniques have placed increasing demands upon the pathologist for the accurate diagnosis and histological categorisation of screen-detected lesions. Subsequent management algorithms rely on correct pathological classification. Needle core biopsy (NCB) has become the mainstay of non-operative diagnosis in many Breast Units. However, despite good specificity and sensitivity, there remain lesions that are particularly challenging on NCB. This may be because they can mimic invasive carcinoma or because there is a risk of associated carcinoma. Particular areas of difficulty arise as a result of the focal nature of sampling inherent with biopsy specimens. Troublesome lesions include atypical epithelial proliferations, sclerosing lesions and radial scars, papillary, columnar cell and apocrine lesions and lobular in situ neoplasia. Immunohistochemistry can be helpful in clarifying the nature of some of these lesions in NCB material but subsequent management nevertheless often remains controversial. Finally, special type invasive carcinomas such as lobular and metaplastic cancers and non-primary malignancies such as lymphoma and metastasis can be misdiagnosed in the limited material of a NCB, particularly if not considered in the differential diagnosis. Good communication between clinician, radiologist and pathologist is especially important in the breast screening setting, in order to avoid misdiagnosis, ensure correct categorisation of NCB samples and to ensure optimum patient care. PMID:19089735

Provenzano, Elena; Pinder, Sarah E

2009-01-01

48

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

PubMed

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

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

2012-01-01

49

Artifical Pancreas  

NASA Astrophysics Data System (ADS)

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

Fei, Jiangfeng

2013-03-01

50

Diagnosis and preoperative imaging of multiple endocrine neoplasia type 2: current status and future directions.  

PubMed

Multiple endocrine neoplasia type 2 (MEN2) is a rare autosomal dominant syndrome caused by mutations in the RET protooncogene and is characterized by a strong penetrance of medullary thyroid carcinoma (all subtypes) and is often accompanied by pheochromocytoma (MEN2A/2B) and primary hyperparathyroidism (MEN2A). The evaluation and management of MEN2-related tumours is often different from that of sporadic counterparts. This review article provides an overview of clinical manifestations, diagnosis and surgical management of MEN2 patients. This review also presents applications of the most up-to-date imaging modalities to MEN2 patients that are tightly linked to the clinical management and aims to guide physicians towards a rationale for the use of imaging prior to prophylactic thyroidectomy, initial surgery and reoperations for persistent/recurrent disease. This review also concludes that, in the near future, it is expected that these patients will indeed benefit from newly developed positron emission tomography approaches which will target peptide receptors and protein kinases. Identification of MEN2-specific radiopharmaceuticals will also soon arise from molecular profiling studies. Furthermore, subtotal (cortical-sparing) adrenalectomy, which is a valid option in MEN2 for avoiding long-term steroid replacement, will benefit from an accurate estimation through imaging of differential adrenocortical function. PMID:24889858

Taïeb, David; Kebebew, Electron; Castinetti, Fréderic; Chen, Clara C; Henry, Jean-François; Pacak, Karel

2014-09-01

51

Management of mucinous cystic neoplasms of the pancreas  

PubMed Central

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

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

2010-01-01

52

What Is the Pancreas?  

MedlinePLUS

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

53

Organ Facts: Pancreas  

MedlinePLUS

... Lung Kidney Pancreas Kidney/Pancreas Liver Intestine Pancreas Facts The pancreas is a five to six inch ... Camps for kids Contacting my donor family Data Facts about living donation Financing a transplant Matching organs ...

54

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

PubMed Central

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

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

2011-01-01

55

Cystic lymphangioma of the pancreas  

PubMed Central

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

Sohn, Bok-Kyung; Cho, Chang-Ho

2011-01-01

56

Pancreas Transplantation  

PubMed Central

Over the last 5 years, there has been a resumed interest in treating diabetes by transplantation, particularly islet transplantation. However, despite advances being reported in Canada and the US, replication in the UK has been much more difficult. At present there is still only one treatment that can consistently reverse insulin independence in the long-term and that is whole pancreas transplantation. Long-term normoglycaemia has beneficial effects on preventing and ameliorating the secondary complications of diabetes and will be discussed.

White, SA; Manas, DW

2008-01-01

57

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

PubMed Central

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

2009-01-01

58

National Pancreas Foundation  

MedlinePLUS

... Information Animated Pancreas Patient About the Pancreas Pancreatic Cancer Chronic Pancreatitis Acute Pancreatitis Children/Pediatric Other Pancreas Ailments Patient/Family Information Clinical Trials Financial Assistance Research Research ...

59

Normal Pancreas Anatomy  

MedlinePLUS

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

60

Organ Facts: Kidney / Pancreas  

MedlinePLUS

... Kidney Pancreas Kidney/Pancreas Liver Intestine Kidney/Pancreas Facts The kidneys are a pair of reddish-brown ... Camps for kids Contacting my donor family Data Facts about living donation Financing a transplant Matching organs ...

61

Pancreas Divisum  

PubMed Central

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

DiMagno, Matthew J.; Wamsteker, Erik-Jan

2011-01-01

62

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

PubMed Central

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

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

2013-01-01

63

Squamous cell carcinoma of the pancreas.  

PubMed

Squamous cell carcinoma (SCC) of the pancreas is a controversial entity of uncertain origin, as the pancreas is entirely devoid of squamous cells. Cases of pancreatic carcinomas that exhibit primary squamous morphology are rarely described in the literature. We report a case of primary SCC of the pancreas in a 66-year-old woman with complaints of epigastric pain of five months duration. Imaging studies demonstrated a solid tumor in the body of the pancreas that invaded the superior mesenteric (SMA) and celiac arteries, as well as regional lymph nodes. Cytological examination of an endosonography-guided fine needle aspiration (EUS-FNA) specimen confirmed the diagnosis of well-differentiated SCC of the pancreas. On the basis of diagnosis and examinations prior to chemotherapy, we did not detect any SCC lesions that might have metastasized to the pancreas. Primary SCC of the pancreas is a rare entity that comprises 0.05% of all exocrine pancreatic carcinomas. The clinical profile and biological behavior of pancreas SCC are similar to typical pancreatic ductal adenocarcinomas. PMID:23725072

Nikfam, Sepideh; Sotoudehmanesh, Rasoul; Pourshams, Akram; Sadeghipour, Alireza; Sotoudeh, Masoud; Mohamadnejad, Mehdi

2013-06-01

64

Inflammatory myofibroblastic tumor (IMT) of the pancreas.  

PubMed

Inflammatory myofibroblastic tumor (IMT) is an uncommon mass lesion composed of a variety of inflammatory and other mesenchymal cells. Although IMT was originally reported in the lung, it is now recognized that IMT can occur in a variety of organs. The occurrence of IMT in the pancreas, however, is rare. Here, we report a case of IMT arising from the head of the pancreas in a 55-year-old man. He underwent pancreaticoduodenectomy, with the diagnosis of carcinoma of the pancreas; the pathological diagnosis of the tumor was IMT. By referring to previously reported cases, we conclude that, in the management of IMT in the pancreas, surgical excision is the primary choice, in order to obtain a definitive diagnosis as well as to relieve symptoms, and strict follow-up after surgery is required. PMID:12021906

Yamamoto, Hiroshi; Watanabe, Kazuo; Nagata, Matsuo; Tasaki, Kentaro; Honda, Ichiro; Watanabe, Satoshi; Soda, Hiroaki; Takenouti, Toshinao

2002-01-01

65

Torsion of wandering spleen and distal pancreas  

SciTech Connect

Wandering spleen is the term applied to the condition in which a long pedicle allows the spleen to lie in an abnormal location. Torsion of a wandering spleen is an unusual cause of an acute abdomen and is rarely diagnosed preoperatively. Associated torsion of the distal pancreas is even more uncommon. The authors describe a patient with torsion of a wandering spleen and distal pancreas, who was correctly diagnosed, and define the merits of the imaging methods used. The initial examination should be /sup 99//sup m/Tc-sulfur colloid liner-spleen scanning.

Sheflin, J.R.; Lee, C.M.; Kretchmar, K.A.

1984-01-01

66

Small bowel obstruction secondary to internal hernia through a defect of the broad ligament: preoperative multi-detector CT diagnosis.  

PubMed

We report a case of small bowel obstruction secondary to internal hernia through a defect in the broad ligament diagnosed by MDCT and confirmed at surgery. The CT findings that allow the diagnosis of this very rare cause of SBO are presented here. PMID:22274751

Quiroga, Sergi; Sarrias, Manuel; Sánchez, José Luis; Rivero, Joaquín

2012-12-01

67

Assessment of Pancreas Cells.  

National Technical Information Service (NTIS)

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 ver...

C. Vanoss

1978-01-01

68

Pancreas preservation for pancreas and islet transplantation  

PubMed Central

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.

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

2010-01-01

69

Xenopus Pancreas Development  

PubMed Central

Understanding how the pancreas develops is vital to finding new treatments for a range of pancreatic diseases, including diabetes and pancreatic cancer. Xenopus is a relatively new model organism for the elucidation of pancreas development, and has already made contributions to the field. Recent studies have shown benefits of using Xenopus for understanding both early patterning and lineage specification aspects of pancreas organogenesis. This review focuses specifically on Xenopus pancreas development, and covers events from the end of gastrulation, when regional specification of the endoderm is occurring, right through metamorphosis, when the mature pancreas is fully formed. We have attempted to cover pancreas development in Xenopus comprehensively enough to assist newcomers to the field and also to enable those studying pancreas development in other model organisms to better place the results from Xenopus research into the context of the field in general and their studies specifically.

Pearl, Esther J.; Bilogan, Cassandra K.; Mukhi, Sandeep; Brown, Donald D.; Horb, Marko E.

2010-01-01

70

Detection of overexpressed COX-2 in precancerous lesions of hamster pancreas and lungs by molecular imaging: implications for early diagnosis and prevention.  

PubMed

The enzyme cyclooxygenase-2 (COX-2) is overexpressed in many cancers, cardiovascular disease, neurodegenerative disorders, and arthritis. Selective inhibitors of COX-2 have been developed as therapeutics or preventive agents for these diseases. However, recent reports have revealed a significant increase in cardiovascular mortality in long-term users of the COX-2 inhibitors Vioxx and Celebrex, emphasizing the need for noninvasive tests that allow the identification of individuals whose COX-2 levels are overexpressed prior to assignment to treatment with these drugs. In this study, we have prepared a radioiodinated analogue of the selective COX-2 inhibitor celecoxib, and verified its binding to the COX-2 enzyme in vitro. Biodistribution studies in hamsters demonstrated significantly higher levels of radiotracer in animals treated with the tobacco carcinogen NNK in lung, pancreas, and liver. Assessment of COX-2 levels by whole-body planar nuclear imaging two hours after injection of the radiotracer was suggestive of a distinct increase in COX-2 in the pancreas and liver of a hamster treated for 10 weeks with NNK, in the lungs and liver of a second animal, and in the liver only, in two additional animals from the same treatment group. Immunostains showed selective overexpression of COX-2 in pre-neoplastic lesions of the pancreas and lungs in only those animals that showed tracer accumulation in these organs and in the livers of all NNK-treated hamsters. Immunostains for COX-1 yielded detectable reactions in the intestinal epithelium but not in pancreas, lungs, or liver, supporting the specificity of the tracer for COX-2. Our data provide proof of principle for the hypothesis that molecular imaging with radiolabeled COX-2 inhibitors can be used for the noninvasive monitoring of overexpressed COX-2 levels. PMID:16892400

Schuller, Hildegard M; Kabalka, George; Smith, Gary; Mereddy, Arjun; Akula, Murthy; Cekanova, Maria

2006-06-01

71

Cystic tumors of the pancreas  

PubMed Central

Cystic tumors of the pancreas are less frequent than solid lesions and are often detected incidentally, as many of these lesions are small and asymptomatic. However, they may be associated with pancreatitis or have malignant potential. With advancements in diagnostic imaging, cystic lesions of the pancreas are being detected with increasing frequency. Many lesions can cause a pancreatic cyst, most being non-neoplastic while approximately 10% are cystic tumors, ranging from benign to highly malignant tumors. With increasing experience it is becoming clear that the prevalence of pseudocyst among cystic lesions of the pancreas is lower than usually presumed. A presumptive diagnosis of pseudocyst based on imaging appearance alone can cause a diagnostic error, and neoplastic cysts of the pancreas are particularly susceptible to this misdiagnosis, which can result in inappropriate treatment. Cystic tumors of the pancreas are formed by serous or mucinous structures showing all stages of cellular differentiation. According to the WHO classification, they can be subdivided on the basis of their histological type and biological behavior into benign tumors, borderline tumors, and malignant tumors. Cystic pancreatic tumors can be subdivided into peripheral (serous cystadenomas, mucinous cystic tumors, solid and papillary epithelial neoplasms, cystic islet cell tumors), which do not communicate with the main pancreatic duct, and ductal tumors (mucinous tumor), according to their site of origin. On the basis of imaging criteria alone, it can be very difficult to differentiate non-tumoral cystic lesions from neoplastic ones. The management of these patients is complex, and it is important to correlate imaging findings with knowledge of the patient’s symptoms and of the natural history and predictors of malignancy in pancreatic cysts.

Morana, Giovanni; Guarise, Alessandro

2006-01-01

72

A patient with cystic lymphangioma in pancreas  

PubMed Central

Cystic lymphangioma of the pancreas is extremely rare, accounting for less than 1% of pancreatic tumors. Though congenital, it can affect all age groups. Cystic lympangioma occurs more frequently in females. Patients usually present with epigastric pain and an associated palpable epigastric mass. Complete excision is curative, even though, depending on the tumor location, surgery may be simple or involve extensive pancreatic resection and anastomoses. In this case report, we discuss a 63-year old patient who presented with epigastric pain and on investigation was found to have pancreatic head cystic lymphangioma. At surgery the tumor was completely excised, with preservation of pancreatic duct. Histology and immunohistochemistry confirmed cystic lymphangioma of the pancreas. This case highlights that a diagnosis of cystic lymphangioma of the pancreas should be taken into consideration as a differential diagnosis of pancreatic cystic lesions.

Mousavi, Seyed Reza; Moradi, Afshin; Jabbehdari, Sayena; Azimi, Behzad; Lotfollahzadeh, Saran; Sadeghi, Nazli; Jafarian, Nafisseh

2013-01-01

73

Primary monophasic synovial sarcoma of the pancreas.  

PubMed

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

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

2013-04-01

74

Zebrafish pancreas development  

Microsoft Academic Search

An accurate understanding of the molecular events governing pancreas development can have an impact on clinical medicine related to diabetes, obesity and pancreatic cancer, diseases with a high impact in public health. Until 1996, the main animal models in which pancreas formation and differentiation could be studied were mouse and, for some instances related to early development, chicken and Xenopus.

Natascia Tiso; Enrico Moro; Francesco Argenton

2009-01-01

75

Preoperative intravenous feeding--a controlled trial  

Microsoft Academic Search

Seventy-four patients with a pre-operative diagnosis of stomach or oesophageal cancer were entered into a randomized, controlled clinical trial to assess the value of a short course of pre-operative intravenous nutrition. The effectiveness of this treatment was assessed by the clinical course and monitored by means of immune and biochemical profiles. Pre-operative parenteral nutrition given over a 7-10-day period resulted

R. V. Heatley; R. H. Williams; M. H. Lewis

1979-01-01

76

Minute malignant islet cell tumor of the pancreas: report of a case.  

PubMed

We present herein the case of a 73-year-old Japanese man in whom a minute malignant islet cell tumor, 7 mm in maximal diameter, was discovered. The patient was admitted to our hospital to undergo a gastrectomy for gastric cancer, at which time preoperative ultrasonography (US) revealed a minute hypoechoic mass located in the head of the pancreas. Endoscopic retrograde pancreatography, angiography, computed tomography, and magnetic resonance imaging failed to reveal the features or location of the tumor; however, these details were obtained by endoscopic and intraoperative US. Although intraoperative fine-needle aspiration cytology of the tumor enabled a diagnosis of islet cell tumor to be made, it failed to provide enough material to evaluate the grade of malignancy, which was confirmed by histologic examination of the enucleated tumor, allowing the appropriate surgical procedure to be decided. PMID:7640475

Soda, K; Yamada, S; Yamanaka, T; Kashii, A; Miyata, M

1995-01-01

77

Assessment of pancreas cells  

NASA Technical Reports Server (NTRS)

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

Vanoss, C. J.

1978-01-01

78

Deconstructing Pancreas Developmental Biology  

PubMed Central

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

Benitez, Cecil M.; Goodyer, William R.

2012-01-01

79

Pancreas.org  

NSDL National Science Digital Library

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

Whitcomb, David

80

[Pancreas. Congenital changes, acute and chronic pancreatitis].  

PubMed

The pancreas develops from ventral and dorsal buds, which undergo fusion. Failure to fuse results in pancreas divisum, which is defined by separate pancreatic ductal systems draining into the duodenum. Risk of developing pancreatitis is increased in pancreas divisum. MR cholangiopancreatography (MRCP) is the technique of choice for detecting it non-invasively. Annular pancreas is the result of incomplete rotation of the pancreatic bud around the duodenum with the persistence of parenchyma or a fibrous band encircling (stenosing) the duodenum. Acute pancreatitis is usually caused by bile duct stones or alcohol abuse. Contrast-enhanced multi-detector row CT is the method of choice to assess the extent of this disease. In acute pancreatitis, the role of MRCP is mainly limited to finding bile duct stones in patients with suspected biliary pancreatitis. Chronic pancreatitis results in relentless and irreversible loss of exocrine (and sometimes endocrine) function of the pancreas. MDCT even shows subtle calcifications. MRCP is the method of choice for non-invasive assessment of the duct. Inflammatory pseudotumor in chronic pancreatitis and groove pancreatitis are difficult to differentiate from pancreatic cancer. In these cases, multiple imaging methods such as MDCT, MRI and endosonography including biopsy may be used to make a diagnosis. PMID:17468982

Schima, W; Ba-Ssalamah, A; Plank, C; Kulinna-Cosentini, C; Püspök, A

2007-05-01

81

Imaging pancreas transplants.  

PubMed

Pancreas transplants are performed in multiple centres across the UK with good graft survival rates. This places an increasing demand on radiology services, particularly as the complication rates are not insignificant. The imaging appearances of pancreas transplants and their complications can be difficult to interpret. This review provides an illustrative journey through the anatomical appearances of a graft and the imaging appearances of complications, as a reference tool for radiologists. PMID:24026227

Yates, A; Parry, C; Stephens, M; Eynon, A

2013-10-01

82

Pancreas and kidney transplantation  

Microsoft Academic Search

Kidney transplantation is preferred over dialysis for management of end-stage renal disease complicating type 1 or type 2\\u000a diabetes, for those who are eligible. Simultaneous pancreas-kidney (SPK) or pancreas after kidney transplantation (PAK) is\\u000a an important alternative to kidney transplantation alone for type 1 diabetes patients if the patient is able to withstand\\u000a the additional risks of these procedures, because

Jennifer Larsen; Lynn Mack-Shipman

2002-01-01

83

Circumportal pancreas: a clinicoradiological and embryological review.  

PubMed

Circumportal pancreas is a congenital fusion anomaly of the pancreas where the pancreatic tissue from the uncinate process, anomalously encases the portal vein and/or the superior mesenteric vein. Depending upon the level of the pancreatic annulus the variant can be classified into three subtypes-suprasplenic, infrasplenic or mixed; and each subtype exhibits either an anteportal or retroportal main pancreatic duct. Limited literature is available on this intriguing anomaly primarily because of its relatively low prevalence in humans (published prevalence rates vary from 0.2 to 2.5 %), probable lack of awareness among medical professionals and its generally symptomless course. In an attempt to appraise the embryological basis, clinicoradiological manifestations and potential surgical implications of circumportal pancreas, literature published in English was searched using PubMed and information collated so as to provide up-to-date information on this relatively understudied entity. The anomaly by itself remains innocuous but its preoperative recognition in those undergoing pancreatic resection bears decisive influence on planning and selecting apposite surgical resection planes as inadvertent duct injury can lead to pancreatic fistula. PMID:23982900

Arora, Ankur; Velayutham, Prabhakaran; Rajesh, S; Patidar, Yashwant; Mukund, Amar; Bharathy, Kishore G S

2014-05-01

84

Localized Adenocarcinoma of the Pancreas: The Rationale for Preoperative Chemoradiation  

Microsoft Academic Search

Pancreatic adenocarcinoma is the fifth leading cause of cancer-related death in the U.S. In spite of advancements in surgical treatment, nearly 80% of patients thought to have localized pancreatic cancer die of recurrent or metastatic disease when treated with surgery alone. Therefore, efforts to alter the patterns of recurrence and improve survival for patients with pancreatic cancer cur- rently focus

JEFFREY D. WAYNE; EDDIE K. ABDALLA; ROBERT A. WOLFF; CHRISTOPHER H. CRANE; PETER W. T. P ISTERS; DOUGLAS B. EVANSa

85

The pancreatographic effect during pharmacoangiography of the pancreas.  

PubMed

Angiography of the pancreas was performed in 55 patients after the administration of different drugs stimulating the blood flow in the pancreas and the pancreatographic effect in this group was compared with that in a series of 174 celiac angiographies without drugs. With drugs the pancreatographic effect appeared more frequently (74.5 per cent) than without (18.4 per cent). The small pancreatic arteries and veins were better demonstrated with drugs. The pancreatographic effect seems to be of value for the differential diagnosis of chronic pancreatitis and carcinoma of the pancreas. PMID:1155214

Schmarsow, R; Peters, P E

1975-01-01

86

?-Methylacyl-CoA racemase (P504S) is a useful marker for the differential diagnosis of solid pseudopapillary neoplasm of the pancreas.  

PubMed

The differential diagnosis of solid pseudopapillary neoplasm (SPN) from some other nonductal pancreatic tumors may be difficult because of similarities in morphological features. Therefore, immunohistochemical staining is frequently necessary. ?-Methylacyl-CoA racemase (AMACR) is a diagnostically useful marker for prostatic cancer and papillary renal cell carcinoma. The aim of this study was to investigate AMACR as a new immunohistochemical marker to differentiate SPNs from other nonductal pancreatic tumors. We investigated immunohistochemical staining for AMACR in 26 SPNs, 21 pancreatic neuroendocrine tumors, and 7 acinar cell carcinomas. All cases of SPN showed granular cytoplasmic expression of AMACR, whereas all cases of pancreatic neuroendocrine tumors and acinar cell carcinomas were negative for this immunohistochemical marker. Hence, our findings demonstrate for the first time that AMACR is a useful immunohistochemical marker for the differential diagnosis of SPNs. PMID:24675392

Shen, Yanying; Wang, Zhaoliang; Zhu, Jianshan; Chen, Yiming; Gu, Wanqing; Liu, Qiang

2014-06-01

87

Imaging spectrum after pancreas transplantation with enteric drainage.  

PubMed

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

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

2014-01-01

88

Imaging of the pancreas: Recent advances  

PubMed Central

A wide spectrum of anomalies of pancreas and the pancreatic duct system are commonly encountered at radiological evaluation. Diagnosing pancreatic lesions generally requires a multimodality approach. This review highlights the new advances in pancreatic imaging and their applications in the diagnosis and management of pancreatic pathologies. The mainstay techniques include computed tomography (CT), magnetic resonance imaging (MRI), endoscopic ultrasound (EUS), radionuclide imaging (RNI) and optical coherence tomography (OCT).

Chaudhary, Vikas; Bano, Shahina

2011-01-01

89

Pseudocyst of Ectopic Pancreas of the Duodenal Wall Masquerading as Malignant Cystic Tumor of Pancreas  

PubMed Central

We report a patient who underwent pancreaticoduodenectomy for a cystic lesion in the region of the pancreatic head and duodenum. Preoperatively, we had suspected a malignant lesion; however, it turned out to be ectopic pancreatic tissue in the duodenal wall, with the changes of chronic pancreatitis and pseudocyst formation. With this report we seek to highlight the rarity of this particular pathologic combination and the difficulties in its correct preoperative diagnosis and management.

Sharma, Dharamanjai K.; Agarwal, Shaleen; Saran, Ravindra K.; Agarwal, Anil K.

2009-01-01

90

Fine needle aspiration cytology of neuroendocrine tumors of the pancreas. A cytologic, immunocytochemical and electron microscopic study.  

PubMed

We report the fine needle aspiration cytology findings in six cases of neuroendocrine tumor of the pancreas. Three cases were from the pancreas, two from hepatic metastases and one from a peripancreatic lymph node metastasis. The cytologic features that permitted a preoperative diagnosis of pancreatic neuroendocrine tumor were: a cellular aspirate; numerous isolated cells and irregular, loose, dyshesive cellular aggregates; minimal nuclear pleomorphism; infrequent mitoses; fine, evenly dispersed nuclear chromatin with occasional inconspicuous nucleoli; a scant-moderate amount of granular, amphophilic, well-defined cytoplasm; clustering of tumor cells around segments of capillaries; and rosette formation. The differential diagnosis includes cells derived from normal pancreatic acini, islet cell hyperplasia, acinic cell carcinoma, well-differentiated pancreatic adenocarcinoma, metastatic small cell undifferentiated carcinoma of the lung, pancreatic small cell anaplastic carcinoma and malignant lymphoma. The application of immunocytochemistry to cytologic smears can be easily and reliably performed to confirm the neuroendocrine nature of the tumor and identify the specific type of polypeptide hormone or hormones produced by these tumors. Four aspirates showed immunoreactivity for chromogranin, and one was positive for gastrin. Cells of a lipid-rich neuroendocrine tumor were negative for chromogranin; however, the tissue section contained neuron specific enolase, and neurosecretory granules were demonstrated by electron microscopy. PMID:1523921

al-Kaisi, N; Weaver, M G; Abdul-Karim, F W; Siegler, E

1992-01-01

91

Diagnosis by endoscopic ultrasound guided fine needle aspiration of tuberculous lymphadenitis involving the peripancreatic lymph nodes: A case report  

PubMed Central

Pancreatic tuberculosis is an extremely rare form of extrapulmonary disease. The diagnosis preoperatively is difficult because clinical, laboratory and radiologic findings are nonspecific. Published data indicate that these lesions mimic cystic neoplasms of the pancreas and the confirmation of clinical suspicion could only be obtained by an open surgical biopsy. Recently, fine needle aspiration cytology has been shown to be a safe, reliable and cost-effective alternative. We report a new case of a peripancreatic tuberculosis in a 52 year old woman and review the relevant literature, paying special attention to the usefulness of endoscopic ultrasound guided-fine needle aspiration in the diagnosis of abdominal tuberculosis.

Boujaoude, Joseph D; Honein, Khalil; Yaghi, Cesar; Ghora, Claude; Abadjian, Gerard; Sayegh, Raymond

2007-01-01

92

Large platelet aggregates in endoscopic ultrasound-guided fine-needle aspiration of the pancreas and peripancreatic region: a clue for the diagnosis of intrapancreatic or accessory spleen.  

PubMed

Intrapancreatic and intraabdominal accessory spleens (IPIASs) are rarely encountered in endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) biopsies. However, as incidentally discovered IPIAS can mimic a benign or malignant pancreatic neoplasm on imaging studies, a definitive diagnosis made by EUS-FNA can avert an unnecessary surgical intervention or additional radiologic follow-up. We report five cases of intrapancreatic splenules and one case of accessory spleen (AS) in which a definitive diagnosis was made on EUS-FNA. Previously recognized FNA cytomorphologic features of splenic tissue, including ASs and splenosis, are endothelial cells and polymorphous lymphocytes admixed with neutrophils, eosinophils, plasma cells, histiocytes, and lymphoglandular bodies. We describe the additional finding of abundant large platelet aggregates as another distinguishing feature of splenic tissue on FNA. In all six cases, large platelet aggregates were identified along with polymorphous lymphoid cells, lymphoglandular bodies, loose aggregates of endothelial cells and scattered or aggregated bland spindle cells. A review of 10 consecutive cases of EUS-FNA-sampled benign intraabdominal lymph nodes showed that the presence of large platelet aggregates, three-dimensional aggregates of lymphoid cells and of bland slender spindle cells and the absence of follicular germinal cell components (tingible body macrophages and lymphohistiocytic aggregates) are useful in differentiating IPIASs from reactive lymph nodes. Immunoperoxidase stains were useful to confirm a suspected IPIASs by showing CD31-positive acellular flocculent material, consistent with large platelet aggregates and a rich CD8-positive endothelial cell network between CD45-positive lymphoid cells and CD68-positive histiocytes in all six cases. PMID:22045629

Conway, Andrea B; Cook, Shelly M; Samad, Arbaz; Attam, Rajeev; Pambuccian, Stefan E

2013-08-01

93

Pancreas organ transplantation  

Microsoft Academic Search

Diabetes mellitus is a very common and dreadful disease which cannot be cured by exogenous insulin substitution. Many of the patients suffer from recurrent, and sometimes rather dangerous, hypo- or hyperglycemias and, in the long term, from the well-known secondary diabetic complications. At the moment, pancreas transplantation is the only known therapy to reliably reestablish endogenous insulin secretion responsive to

Ulrich Theodor Hopt; Oliver Drognitz

2000-01-01

94

Pancreas allograft thrombosis.  

PubMed

Thrombosis of the transplanted pancreas is a common and often catastrophic event. Predisposing factors include the hypercoagulable state of many patients with diabetic renal failure, preservation-related graft endothelial injury, and low-velocity venous flow. Clinical management includes optimization of modifiable risk factors, controlled anticoagulation, graft monitoring, and early therapeutic intervention. PMID:20616765

Muthusamy, Anand S R; Giangrande, Paul L F; Friend, Peter J

2010-10-15

95

Extramedullary Plasmacytoma of the Pancreas Diagnosed Using Endoscopic Ultrasonography-Guided Fine Needle Aspiration  

PubMed Central

Extramedullary plasmacytoma involves organs outside the bone marrow; however, involvement of the pancreas is rare. We recently experienced a case of extramedullary plasmacytoma of the pancreas that was diagnosed by endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA). EUS-FNA, which has a high diagnostic accuracy and an excellent safety profile, is the modality of choice for establishing tissue diagnosis. We report a case of extramedullary plasmacytoma of the pancreas diagnosed using EUS-FNA.

Roh, Young Hoon; Lee, Seon-Mi; Im, Jung Woo; Kim, Joon Suk; Kwon, Kyeong A; Song, Joo Yeon; Jeong, Soo Yeong

2014-01-01

96

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

PubMed Central

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

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

2012-01-01

97

Aspiration biopsy of carcinoma of the pancreas.  

PubMed Central

Peroperative pancreatic aspiration biopsies were performed on 21 patients with pancreatic lesions using a standard 20-ml disposable syringe and a 21-gauge needle. No complications were recorded which could be attributed to this procedure. A further 10 aspiration biopsies were carried out on postmortem specimens in an attempt to determine the accuracy of this method in the diagnosis of carcinoma of the pancreas. It is concluded that peroperative pancreatic needle biopsy is a safe procedure which is easily performed without special instruments. In can be of enormous value to the surgeon in planning the treatment of patients with pancreatic lesions. In cases where there is an operable mass in the pancreas it offers a simple and quick method of determining the presence of malignant cells and thus definitive surgery may be performed with confidence. For the inoperable cases it offers a method of histological confirmation of the operative findings.

Shorey, B A

1975-01-01

98

Preoperative Clinical Factors for Diagnosis of Incidental Prostate Cancer in the Era of Tissue-Ablative Surgery for Benign Prostatic Hyperplasia: A Korean Multi-Center Review  

PubMed Central

Purpose To identify potential predictive factors of incidental prostate cancer (IPca) in patients considering tissue-ablation treatment for benign prostatic hyperplasia (BPH). Materials and Methods From the 11 centers, 1,613 men who underwent transurethral resection of the prostate (TURP) or open prostatectomy were included. Before surgery, prostate biopsy was performed in all patients with prostate-specific antigen (PSA) ?4.0 ng/ml or with abnormal digital rectal examination (DRE) findings. The patients with prostate cancer preoperatively or with PSA >20 ng/ml were excluded. As predictive factors of IPca, age, body mass index, PSA, DRE, and transrectal ultrasonography (TRUS) findings, including total prostate volume (TPV), transition zone volume (TZV), and the presence of hypoechoic lesions, were reviewed. PSA density (PSAD) and PSAD in the transition zone (PSAD-TZV) were calculated. Results IPca was diagnosed in 78 patients (4.8%). DRE findings, PSA, and TZV were independent predictive factors in the multivariate analysis. In the receiver operating characteristic curve analysis of PSA, PSAD, and PSAD-TZV, the area under the curve (AUC) was the largest for PSAD-TZV (AUC, 0.685). Conclusions IPca was detected in 4.8% of the population studied. In addition to DRE findings, the combination of TZV and PSA can be useful predictive factors of IPca in patients considering tissue-ablation treatment as well as TURP.

Yoo, Changhee; Oh, Cheol Young; Kim, Se Joong; Kim, Sun Il; Kim, Young Sig; Park, Jong Yeon; Seong, Do Hwan; Song, Yun Seob; Yang, Won Jae; Chung, Hyun Chul; Cho, In Rae; Cho, Sung Yong; Cheon, Sang Hyeon; Hong, Sungjoon

2012-01-01

99

MR imaging of the pancreas.  

PubMed

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

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

2014-07-01

100

[Pancreas. Part I: congenital changes, acute and chronic pancreatitis].  

PubMed

The pancreas develops from ventral and the dorsal buds, which undergo fusion. Failure to fuse results in pancreas divisum, which is defined by separate pancreatic ductal systems draining into the duodenum. Risk of developing pancreatitis is increased in pancreas divisum because of insufficient drainage. MR cholangiopancreatography (MRCP) is the technique of choice for detecting pancreas divisum non-invasively. Annular pancreas is the result of incomplete rotation of the pancreatic bud around the duodenum with the persistence of parenchyma or a fibrous band encircling (and sometimes stenosing) the duodenum. Acute pancreatitis is usually caused by bile duct stones or alcohol abuse. The Atlanta classification differentiates between mild acute and severe acute pancreatitis associated with organ failure and/or local complications such as necrosis, abscess or pseudocyst. Contrast-enhanced multi-detector row CT is the method of choice to assess the extent of disease. Balthazar et al.'s CT severity index assesses the risk of mortality and morbidity. In acute pancreatitis, the role of MRCP is mainly limited to finding bile duct stones in patients with suspected biliary pancreatitis. Chronic pancreatitis results in relentless and irreversible loss of exocrine (and sometimes endocrine) function of the pancreas. MDCT even shows subtle calcifications. MRCP is the method of choice for non-invasive assessment of the duct. Inflammatory pseudotumor in chronic pancreatitis and groove pancreatitis are difficult to differentiate from pancreatic cancer. In these cases, multiple imaging methods such as MDCT, MRI and endosonography including biopsy may be used to make a diagnosis. PMID:16496105

Schima, W; Ba-Ssalamah, A; Plank, C; Kulinna-Cosentini, C; Püspök, A

2006-04-01

101

[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

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

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

2014-03-01

102

Automatic segmentation of abdominal vessels for improved pancreas localization  

NASA Astrophysics Data System (ADS)

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

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

2014-03-01

103

Cystic lesions of the pancreas  

PubMed Central

Summary In contrast to the relatively uniform pathology and the unyielding dismal outcome associated with infiltrating ductal adenocarcinoma of the pancreas, cystic lesions have a broad spectrum of gross and microscopic pathologies, and a range of clinical outcomes. The common cystic lesions of the pancreas are reviewed with emphasis on practical tips for distinguishing between the main entities.

Hruban, Ralph H.; Fukushima, Noriyoshi

2008-01-01

104

Transdifferentiation of pancreas to liver  

Microsoft Academic Search

Transdifferentiation is the name used to describe the direct conversion of one differentiated cell type into another. Cells which have the potential to interconvert by transdifferentiation generally arise from adjacent regions in the developing embryo. For example, the liver and pancreas arise from the same region of the endoderm. The transdifferentiation of pancreas to liver (and vice versa) has been

Chia-Ning Shen; Marko E. Horb; Jonathan M. W. Slack; David Tosh

2003-01-01

105

Staging cancer of the pancreas  

PubMed Central

Abstract Pancreatic carcinoma is the fourth cause of death from cancer in the United States, with a survival rate at 5 years of less than 5%. About 60% of tumors originate at the head of the pancreas, 15% in the body, 5% in the tail; 20% are diffuse within the pancreas. This article discusses the imaging and staging of pancreatic cancer.

Cancian, L.; Pozzi Mucelli, R.; Cugini, C.

2010-01-01

106

Preoperative Fasting in Children  

Microsoft Academic Search

hildren undergo a preoperative fast in an at- tempt to minimize the fluid and solid food com- ponent of gastric contents. The importance of a preoperative fast was acknowledged early in the evo- lution of anesthesia as a discipline of medicine. In response to concerns about the aspiration of gastric contents, a prolonged fast presumably came into vogue. With this

William M. Splinter; Mark S. Schreiner

1999-01-01

107

Colonic duplication in an adult mimicking a tumor of pancreas  

PubMed Central

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

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

2008-01-01

108

[The valve of selective retrograde cholangiography in the radiological diagnosis of diseases of the biliary passages(author's transl)].  

PubMed

The value of selective endoscopic retrograde cholangiography in the radiological diagnosis of diseases of the biliary passages and neighbouring organs is discussed on the basis of 400 retrograde pancreatocholangiograms. The results of this endoscopic examination were compared with the findings of all the other preoperative examinations carried out. The diagnostic usefulness and limitations of various methods are discussed in relation to stenosis of the papilla, pancreatitis, carcinoma of the pancreas, tumours of the extrahepatic bile ducts and postoperative bile duct abnormalities. The diagnostic accuracy of 97% emphasises the value of co-operation between radiologists and endoscopists. PMID:125682

Sobbe, A; Miegerer, S E; Löffler, A; Stadelmann, O

1975-05-01

109

Mortality assessment for pancreas transplants.  

PubMed

We determined and compared the mortality of pancreas transplant recipients and of patients on the pancreas waiting lists by using United Network for Organ Sharing (UNOS) and International Pancreas Transplant Registry (IPTR) data. From January 1, 1995, through May 31, 2003, a total of 12,478 patients were listed for a simultaneous pancreas-kidney (SPK) transplant; 2942 for a pancreas after (previous) kidney transplant (PAK); and 1207 for a pancreas transplant alone (PTA). In this retrospective observational cohort study, patients with multiple listings at different transplant centers and patients who changed transplant centers were counted only once. The Social Security Death Master File (SSDMF) and the UNOS kidney transplant database were used to update mortality information. By univariate analyses, 4-year patient survival rates on the waiting lists (vs. post-transplant), in the SPK category, were 58.7% (vs. 90.3%); in the PAK category, 81.7% (vs. 88.3%); and in the PTA category, 87.3% (vs. 90.5%). Up to one-third of recipient deaths after post-transplant day 90 were not related to the transplant procedure itself. Multivariate analyses showed that the overall mortality in all three categories was not increased after transplantation (for SPK recipients only, it was significantly decreased). In summary, the mortality for solitary pancreas transplant recipients is not higher than for wait-listed patients. PMID:15575904

Gruessner, Rainer W G; Sutherland, David E R; Gruessner, Angelika C

2004-12-01

110

Molecular Pathways Controlling Pancreas induction  

PubMed Central

Recent advances in generating pancreatic cell types from human pluripotent stem cells has depended on our knowledge of the developmental processes that regulate pancreas development in vivo. The developmental events between gastrulation and formation of the embryonic pancreatic primordia are both rapid and dynamic and studies in frog, fish, chick, and mouse have identified the molecular basis of how the pancreas develops from multipotent endoderm progenitors. Here, we review the current status of our understanding of molecular mechanisms that control endoderm formation, endoderm patterning, and pancreas specification and highlight how these discoveries have allowed for the development of robust methods to generate pancreatic cells from human pluripotent stem cells.

McCracken, Kyle W.; Wells, James M.

2012-01-01

111

Clinical implications of fatty pancreas: Correlations between fatty pancreas and metabolic syndrome  

Microsoft Academic Search

AIM: To investigate the clinical implications of lipid deposition in the pancreas (fatty pancreas). METHODS: The subjects of this study were 293 patients who had undergone abdominal computed tomography (CT) and sonography. Fatty pancreas was diagnosed by sonographic findings and subdivided into mild, moderate, and severe fatty pancreas groups comparing to the retroperitoneal fat echogenicity. RESULTS: Fatty pancreas was associated

Jun Seok Lee; Sang Heum Kim; Dae Won Jun; Jee Hye Han; Eun Chul Jang; Ji Young Park; Byung Kwan; Seong Hwan Kim; Yoon Ju Jo; Yong Soo Kim

2009-01-01

112

Emerging therapies in pancreas cancer.  

PubMed

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

Kotowski, Adam; Ma, Wen W

2011-06-01

113

Emerging therapies in pancreas cancer  

PubMed Central

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

Kotowski, Adam

2011-01-01

114

Who needs an artificial pancreas? (?).  

PubMed

The development of a closed-loop "artificial pancreas" would be a welcome advance for both endocrinologists and diabetic patients struggling to attain near normal glycemic control. While great strides in automatically controlling blood sugar in the fasting, sedentary state have been made through complex mathematical modeling, management of blood sugar excursions due to food and exercise have been more problematic. An artificial pancreas is not feasible at this time because of limitations inherent in the currently available technology. PMID:23601378

Winikoff, Janet; Drexler, Andrew

2013-09-01

115

Lymphoepithelial cyst of the pancreas.  

PubMed Central

A rare case of lymphoepithelial cyst of the pancreas is reported. Microscopically the cyst content consisted of keratinous material and the walls were lined by mature squamous epithelium surrounded by dense lymphoid tissue. Immunohistochemistry showed diffuse reactivity for CD20 and CD3 in the lymphoid tissue and uniform positivity for cytokeratins in the squamous epithelium. Although the histogenesis of lymphoepithelial cysts of the pancreas is not understood, awareness of this lesion is helpful in differentiating it from other pancreatic cystic lesions. Images

Gafa, R; Grandi, E; Cavazzini, L

1997-01-01

116

Single Dose of Alemtuzumab Induction With Steroid-Free Maintenance Immunosuppression in Pancreas Transplantation  

PubMed Central

Background The use of alemtuzumab (humanized anti-CD52 monoclonal antibody) has been primarily studied in renal transplantation, and the experience of alemtuzumab induction in pancreas transplantation is still limited. The objective of this study is to analyze the outcome of pancreas transplantation by using a single dose of 30 mg alemtuzumab induction with steroid-free maintenance immunosuppression. Methods We performed a total 28 pancreas transplants (17 simultaneous kidney-pancreas transplantation [SPK], 5 pancreas after kidney transplantation [PAK], and 6 pancreas transplant alone [PTA]) between November 2006 and April 2010. Median follow-up was 25 months (range, 8–49 months). Maintenance immunosuppression consists of tacrolimus and mycophenolate. We analyzed patient/graft survival, graft function, and complications. Results One-year actuarial patient/graft survival was 100%/100% in SPK, PAK, and PTA. Three-year actuarial patient/pancreas graft survival rates for SPK, PAK, and PTA were 100%/100%, 100%/100%, and 100%/83%, respectively. Excellent pancreas and kidney graft functions were observed. Acute cellular rejection occurred in 42% of patients. Most of the rejection episode occurred approximately 1 or 6 months after transplant. Absolute lymphocyte count remained below preoperative level for 1 year posttransplant and WBC counts were significantly lower for 3 years after transplant compared with pretransplant level. Cytomegalovirus infection and bacterial infection occurred in 28% and 36% of patients, respectively. Eleven percent of patients developed donor-specific antibodies and 7% of patients experienced antibody-mediated rejection. Conclusion A single dose of 30 mg alemtuzumab induction with steroid-free maintenance immunosuppression achieved excellent mid-term patient and graft survival for pancreas transplantation with acceptable complication rate.

Uemura, Tadahiro; Ramprasad, Varun; Matsushima, Kazuhide; Shike, Hiroko; Valania, Tracy; Kwon, Osun; Ghahramani, Nasrollah; Shah, Riaz; Farooq, Umar; Khan, Akhtar; Kadry, Zakiyah

2012-01-01

117

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

PubMed Central

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

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

1999-01-01

118

Classification, morphology and molecular pathology of premalignant lesions of the pancreas.  

PubMed

Over the past few years there have been substantial advances in our knowledge of premalignant lesions of the pancreas. Given the dismal prognosis of untreated pancreatic cancer, and the small proportion of patients who are operative candidates, an understanding of these premalignant lesions is essential for the development of strategies for early diagnosis and prevention. The 2010 WHO classification has added new entities, including intraductal tubular papillary neoplasms (ITPNs), and clarified the nomenclature and grading of previously recognised precursor lesions of pancreatic adenocarcinoma, such as intraductal papillary mucinous neoplasms (IPMNs), mucinous cystic neoplasms (MCNs) and pancreatic intraepithelial neoplasia (PanIN). In particular, there has been an upsurge of interest in the natural history of IPMN, driven partly by improvements in imaging modalities and the consequent apparent increase in their incidence, and partly by recognition that subtypes based on location or histological appearance define groups with significantly different behaviours. In mid 2012 revised international guidelines for the classification and management of IPMNs and MCNs were published, although in several respects these guidelines represent a consensus view rather than being evidence-based. In recent years major advances in molecular technologies, including whole-exome sequencing, have significantly enhanced our knowledge of pancreatic premalignancy and have identified potentially highly specific diagnostic biomarkers such as mutations in GNAS and RNF43 that could be used to pre-operatively assess pancreatic cysts. PMID:23442735

Cooper, Caroline L; O'Toole, Sandra A; Kench, James G

2013-04-01

119

Pancreas Cell Fate  

PubMed Central

Diabetes is characterized by decreased function of insulin-producing insulin ? cells and insufficient insulin output resulting from an absolute (Type 1) or relative (Type 2) inadequate functional ? cell mass. Both forms of the disease would greatly benefit from treatment strategies that could enhance ? cell regeneration and/or function. Successful and reliable methods of generating? cells or whole islets from progenitor cells in vivo or in vitro could lead to restoration of ? cell mass in individuals with Type 1 diabetes and enhanced ? cell compensation in Type 2 patients. A thorough understanding of the normal developmental processes that occur during pancreatic organogenesis, e.g., transcription factors, cell signaling molecules, and cell-cell interactions that regulate endocrine differentiation from the embryonic pancreatic epithelium, is required in order to successfully reach these goals. This review summarizes our current understanding of pancreas development, with particular emphasis on factors intrinsic or extrinsic to the pancreatic epithelium that are involved in regulating the development and differentiation of the various pancreatic cell types. We also discuss the recent progress in generating insulin-producing cells from progenitor sources.

Guney, Michelle A.; Gannon, Maureen

2009-01-01

120

Pancreas Acinar Cell Differentiation  

PubMed Central

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

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

1972-01-01

121

[Preoperative imaging in chronic otitis surgery].  

PubMed

High resolution computed tomography (CT) is presently the most accurate technique to study the temporal bone. Nevertheless, there is no general agreement about its usefulness in pre-operative evaluation of chronic otitis media. Indeed, if we rule out some exceptions, CT is not fundamental for diagnosis which can often be obtained through an accurate otomicroscopy. The Otology Group in Piacenza applies the following absolute indications for pre-operative CT in chronic otitis media: 1) difficult otomicroscopy evaluation; 2) suspected petrous bone cholesteatoma; 3) dubious diagnosis; 4) suspect of malformations; 5) review of cases that had previously undergone mastoidectomy; 6) suspected intracranial complications and/or meningoencephalic herniation (in this case also a magnetic resonance imaging must be performed). With the exception of these specific conditions, pre-operative CT is useless in cases of simple chronic otitis. However, when a cholesteatoma is suspected, CT can provide the surgeon, particularly when inexperienced, useful, but not indispensable, informations. Pre-operative knowledge of these informations can allow a more accurate evaluation of the case, with a better planning of the surgical procedure, in order to ensure a more specific informed consent. Finally, the Authors point out the fact that surgeon must be able to interpret by his own the CT data to have a real advantage by this examination. PMID:12236008

Falcioni, M; Taibah, A; De Donato, G; Piccirillo, E; Caruso, A; Russo, A; Sanna, M

2002-02-01

122

Pancreas Acinar Cell Regeneration  

PubMed Central

Protein metabolism was studied in the regenerating rat pancreas acinar cell by 3H-leucine autoradiography. Rats were placed for 10 days on a protein-free ethionine (PFE) regimen which caused necrosis of most of the acinar cells. Withdrawing the PFE regimen and instituting a stock diet (SD) on day 11 was followed by good restitution of acinar cell morphology. DNA synthesis peaked at day 15. Intraperitoneal injection of 3H-leucine and sacrifice at 5, 10 and 30 minutes and at 1, 4 and 24 hours after injection at PFE-SD days 10, 12, 15 and 29 and at the same time periods in control SD animals provided tissue for autoradiography. At PFE-SD days 10, 12 and 15, there were great increases in the concentration of autoradiographic grains over the nucleolus, nucleus and cytoplasm of acinar cells as compared to similar compartments in SD animals. There also were more total grains per nucleus and nucleolus in the PFE-SD animals at these days. The grains per unit area of nucleus and cytoplasm of PFE-SD acinar cells at days 10, 12 and 15 increased to about the same degree, but the increase in concentration of grains per unit area of nucleolus was much higher than in the two other compartments. The increase in total number of grains in the nucleolus was much higher than that per nucleus in PFE-SD animals on days 12 and 15. Some of the disproportionately high concentration and amount of newly synthesized labeled protein in the nucleolus at PFE-SD days 12 and 15 may have been involved in genomic activity, giving rise to the peak of DNA synthesis at day 15. ImagesFig 8Fig 1Fig 9Fig 2Fig 3Fig 4Fig 5Fig 6Fig 7

Vinijchaikul, Kamolwat; Fitzgerald, Patrick J.

1972-01-01

123

[Total pancreas sampling and transplantation].  

PubMed

Pancreas removal and transplantation consists in three main steps: sampling, preparation of the transplant with reconstruction of vessels and finally transplantation. Sampling requires good anatomical knowledge and perfect synchronization between hepatic surgeons so as to ensure adequate dissection of liver and pancreas vessels: portal vein, splenic, upper mesenteric and hepatic arteries. Washing and conservation of organs require the use of University of Wisconsin solution. The preparation of the pancreatic graft consists in reconstructing the unique arterial axis using an iliac arterial fork sutured with upper mesenteric and splenic arteries. The portal vein is lengthened step by step, avoiding venous patch source of thrombosis. The transplantation is realized in the right flank, on the aorta and the vena cava near the iliac crossroads. The digestive anastomosis is performed between duodenum of the transplant and first bowel hail of the recipient. It must be done carefully to avoid any risk of pancreas fistula. PMID:16552905

Gaudez, F; Meria, P; Desgrandchamps, F; Roussin, F; Roussin, O; Teillac, P

2006-02-01

124

Design of a bioartificial pancreas  

PubMed Central

Summary Islet transplantation has been shown to be a viable treatment option for patients afflicted with Type 1 diabetes. However, the severe shortage of human pancreas and the need to use risky immunosuppressive drugs to prevent transplant rejection remain two major obstacles to routine use of islet transplantation in diabetic patients. Successful development of a bioartificial pancreas using the approach of microencapsulation with perm-selective coating of islets in hydrogels for graft immunoisolation holds tremendous promise for diabetic patients because it has great potential to overcome these two barriers. In this review article, we will discuss the need for bioartificial pancreas, provide a detailed description of the microencapsulation process, and review the status of the technology in clinical development. We will also critically review the various factors that need to be taken into consideration in order to achieve the ultimate goal of routine clinical application.

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

2013-01-01

125

Solid pseudopapillary tumour of pancreas.  

PubMed

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

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

2014-04-01

126

Serous cystadenocarcinoma of the pancreas.  

PubMed

A case of serous cystadenocarcinoma of the pancreas in an 85-year-old woman is reported. The tumor extensively involved the body and tail of the pancreas and contiguously invaded the spleen. The histopathology of the tumor was similar to that of serous cystadenoma, but mild nuclear hyperchromatism and atypism were noted, and the neoplastic invasion of nerve fibers in the stroma was observed. In the spleen neoplastic cells forming microcysts were diffusely insinuated in the red pulp without the fibrous stroma. The patient is in good health without recurrence and metastasis after the operation. The present case is the second example of this kind of neoplasm that showed direct splenic invasion. Because serous cystadenocarcinoma of the pancreas exhibits bland cytological features, diligent search for the invasion of the surrounding tissue or peripheral nerves is needed for the differentiation from its benign counterpart. PMID:15982220

Shintaku, Masayuki; Arimoto, Akira; Sakita, Nobuko

2005-07-01

127

[Appendicular mucocele. A report of a case diagnosed preoperatively].  

PubMed

Mucocele of the appendix is an unusual clinical entity. Despite a recognized constellation of findings, the diagnosis is not usually made prior to surgical exploration. A 35 year old man is reported in whom clinical evaluation, including US and CT scans, resulted in the correct preoperative diagnosis confirmed at surgery and leading to appropriate operative decisions. PMID:7746457

Zago, A; Ferrara, R; Fasoli, G; Gandolfi, P; Caudana, R; di Benedetto, P; Rosa, G

1994-12-01

128

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

PubMed

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

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

2011-01-01

129

Hydatid cyst of the pancreas mimicking neoplasm.  

PubMed

Hydatid disease is a cyclozoonotic infection caused by the cestode genus Echinococcus. It occurs throughout the world and is especially common in sheep- and cattle-raising regions of Africa, Australia, New Zealand, India, the Middle East, South America, and the Mediterranean. The incidence of humans infected with hydatid disease is approximately 1-2:1000. It is higher in rural areas. Infection occurs via ingestion of infected meat. Hydatidosis is caused by sheep and cattle ingesting tapeworm eggs in dog feces. These eggs hatch in the duodenum and invade the liver, lungs, or bones of sheep and cattle. Humans are infected by ingesting the infected meat from these animals. In the organs, the embryo transforms into a cyst, which develops the germinal epithelium that produces capsules, larval forms, and eventually the infectious scolices. Although hydatid cyst of the pancreas is rare, it must be considered in the differential diagnosis of pancreatic lesions. We present a rare case. PMID:24906281

Khoshmohabat, Hady; Moqadam, Javad Akhavan; Sohrabi, Saeedeh Zienab; Kalantar Motamedi, Mohammad Hosein; Azizi, Taghi

2014-05-01

130

Heterotopic Pancreas as a Leading Point for Small-Bowel Intussusception in a Pregnant Woman  

Microsoft Academic Search

Context Adult intussusception occurs infrequently and differs from childhood intussusception in its presentation, etiology and treatment. Diagnosis can be delayed because of its longstanding, intermittent, and non-specific symptoms, and most cases are diagnosed at emergency laparotomy. Case report We present the diagnosis and management of our patient, a pregnant woman, who had adult intussusception due to a heterotopic pancreas .

Bunyamin Gurbulak; Esin Kabul; Cem Dural; Gamze Citlak; Hakan Yanar; Mine Gulluoglu; Korhan Taviloglu

131

Heterotopic pancreas presenting as ileoileal intussusception  

PubMed Central

Heterotopic, aberrant or ectopic pancreas is defined as the presence of pancreatic tissue in topographic anomaly, with no anatomical, neural or vascular connection to the normal pancreas. It is a rare condition found mainly in stomach, duodenum and jejunum. Ileal heterotopic pancreas is an uncommon condition and has been rarely reported in children so far. Hereby we report a case of heterotopic pancreas presenting as ileal poyp leading to ileoileal intussusception in a 12 year child.

Singh, S; Batra, A; Sangwaiya, AK; Marwah, N; Rattan, KN; Sen, R

2012-01-01

132

Intraductal papillary mucinous tumor of the native pancreas in a pancreas-kidney transplant recipient.  

PubMed

Recent data from the International Pancreas Transplant Registry confirm the benefits of pancreas transplantation, even in high-risk diabetic patients previously considered unqualified for such procedures. With patient survival currently extending into decades, de novo malignancies are now more frequently diagnosed in pancreas recipients. This is the first reported case of an intraductal papillary mucinous tumor of the native pancreas in a high-risk pancreas after kidney recipient. The patient underwent a partial pancreaticoduodenectomy and has remained tumor-free for 9 months. This case report demonstrates that (1) pancreas transplantation can be successfully done in patients with significant cardiocerebrovascular disease, (2) de novo pancreas malignancies can occur within the first year after pancreas transplantation, and (3) tumors of the native pancreas warrant the same surgical treatment in pancreas recipients as in the general population, despite the need for posttransplant immunosuppression and the increased operative risk. PMID:15097864

Jie, Tun; Harmon, James V; Gulbahce, H Evin; Gruessner, Rainer

2004-05-01

133

[Intraabdominal mass with difficult diagnosis: Solitary fibrous tumor].  

PubMed

Solitary fibrous tumor (SFT) is a rare neoplasm of mesenchymal origin. The most commonly reported locations are the pleura and meninges. Less frequently, SFT manifests as an asymptomatic mass in the pancreas, liver, peritoneum or kidney. Clinical and radiological findings have failed to provide any specific diagnostic pattern but allow malignant development to be suspected due to infiltration or metastasis. In addition, preoperative cytology often yields inconclusive or misleading results. Therefore the definitive diagnosis is achieved after both surgical resection and immunohistochemical analysis, with markers such as CD34, vimentin and desmin. We present a case of SFT, which was difficult to diagnose, even after an extensive battery of tests based on imaging techniques. PMID:20206414

Alonso, Inmaculada; Hernández-Guerra, Manuel; González, Yanira; Gimeno-García, Antonio; Méndez, Rafael; Malagón, Antonio; Quintero Carrión, Enrique

2010-04-01

134

Thorascopic resection of esophageal heterotopic pancreas.  

PubMed

Heterotopic pancreas is normal pancreatic tissue that lacks anatomic and vascular continuity with the main body of the pancreas. Heterotopic pancreatic tissue is a rare congenital anomaly found usually in the stomach, duodenum, or jejunum and is rarely seen in the esophagus. This is a case of heterotopic pancreas found in the esophagus that was removed thorascopically. PMID:24182471

Lowry, Debra M; Mack, Takman E; Partridge, Brett J; Barbick, Brian C; Marks, Robert M; Kindelan, Joshua T

2013-11-01

135

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

PubMed Central

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

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

2011-01-01

136

Cystic lesions of the pancreas  

Microsoft Academic Search

Although cystic tumors of the pancreas are relatively rare, they constitute an increasingly important category. Advances in imaging and interventional techniques and the sharp drop in the mortality rate of pancreatic surgery have rendered pancreatic biopsies and resections commonplace specimens. Consequently, in the past two decades, the nature of many cystic tumors in this organ has been better characterized. The

N Volkan Adsay

2007-01-01

137

Uncommon form of pancreas divisum  

Microsoft Academic Search

Summary  A rare form of pancreas divisum is presented, in which the two ducts communicate despite their separate development. In such\\u000a cases cannulation of the papilla of Vater is sufficient for visualization of both the ventral and dorsal pancreatic ducts.\\u000a The two ducts are probably linked by secondary branches.

Z. Tulassay; J. Papp

1983-01-01

138

Long-term results after pancreas transplantation.  

PubMed

With the advances in technique and immunosupression, not only the short- but the long-term outcomes of pancreas transplantation have improved significantly. This retrospective study describes the long-term outcomes of simultaneous pancreas and kidney (SPK) transplants, pancreas after kidney (PAK), and pancreas transplants alone (PTA). An overall analysis was performed for all deceased donor (DD) primary pancreas transplants performed in the United States between 1988 and 1999. In addition, the long-term outcome for pancreas transplants performed at the University of Minnesota (UM) was analyzed. For SPK transplants performed in the United States between 1998 and 1999, the half-life of the pancreas was almost 12 years, and was 12.5 years for kidneys. For SPK cases where the pancreas was functioning at 1 year, the half-lives of both the pancreas and the kidney grafts extended more than 14 years. The half-lives of solitary pancreas transplants were between 7 years for PAK and 9 years for PTA cases. For US solitary transplants with at least 1 year of graft function, the half-lives extended to almost 9 years. Pancreas transplants performed at the UM showed the same significant improvements over time. Of special interest is the excellent long-term graft function of pancreas transplants from a living donor, which in the early years clearly surpassed that of solitary DD pancreas transplants. A multivariate analysis showed that the factor with the highest impact on long-term graft function in all three transplant categories was the use of a young donor. In SPK cases, the most frequent reason for late graft loss was death with a functioning graft. In solitary pancreas transplants, most late graft losses were still due to immunological reasons. PMID:17889177

Sutherland, D E R; Gruessner, A C

2007-09-01

139

The cytological diagnosis of paediatric renal tumours  

Microsoft Academic Search

Fine needle aspiration cytology (FNAC) is used for preoperative diagnosis of paediatric renal tumours, especially in centres where preoperative chemotherapy is advocated in Wilms’ tumour. This review focuses on salient cytological features in specific paediatric renal tumours, the approach to resolving a differential diagnosis and the role of ancillary methods in diagnosis of paediatric renal tumours. Crucial differential diagnoses include

T Shet; S Viswanathan

2009-01-01

140

Cystic dystrophy of the gastric and duodenal wall developing in heterotopic pancreas: an unrecognised entity.  

PubMed Central

Ten patients in whom cystic dystrophy developed in a heterotopic pancreas of the duodenal (nine patients) or gastric (one patient) wall are reported. All were young or middle aged white men, only two of whom were alcoholic. The symptoms were caused by intestinal or biliary stenosis, or both, secondary to the inflammation and fibrosis. Only endosonography provided strong evidence for the diagnosis in three patients. All patients underwent surgery: a pancreaticoduodenectomy was performed in eight patients. The surgical specimen showed cystic lesions of the gut wall, occurring in inflammatory and fibrous heterotopic pancreatic tissue. The pancreas proper was normal in all patients. It is suggested that cystic dystrophy is an uncommon and serious complication of heterotopic pancreas. Similar cases associated with chronic pancreatitis of the pancreas have been observed and it is suggested that this process could be responsible for some of the chronic pancreatitis encountered in young, non-alcoholic patients. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5

Flejou, J F; Potet, F; Molas, G; Bernades, P; Amouyal, P; Fekete, F

1993-01-01

141

Cystic dystrophy of the gastric and duodenal wall developing in heterotopic pancreas: an unrecognised entity.  

PubMed

Ten patients in whom cystic dystrophy developed in a heterotopic pancreas of the duodenal (nine patients) or gastric (one patient) wall are reported. All were young or middle aged white men, only two of whom were alcoholic. The symptoms were caused by intestinal or biliary stenosis, or both, secondary to the inflammation and fibrosis. Only endosonography provided strong evidence for the diagnosis in three patients. All patients underwent surgery: a pancreaticoduodenectomy was performed in eight patients. The surgical specimen showed cystic lesions of the gut wall, occurring in inflammatory and fibrous heterotopic pancreatic tissue. The pancreas proper was normal in all patients. It is suggested that cystic dystrophy is an uncommon and serious complication of heterotopic pancreas. Similar cases associated with chronic pancreatitis of the pancreas have been observed and it is suggested that this process could be responsible for some of the chronic pancreatitis encountered in young, non-alcoholic patients. PMID:8097180

Fléjou, J F; Potet, F; Molas, G; Bernades, P; Amouyal, P; Fékété, F

1993-03-01

142

Pancreas and islet cell transplantation  

PubMed Central

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

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

2011-01-01

143

Vascular instruction of pancreas development.  

PubMed

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

Cleaver, Ondine; Dor, Yuval

2012-08-01

144

Cystic tumours of the pancreas  

PubMed Central

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

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

2007-01-01

145

Laparoscopic donor distal pancreatectomy for living donor pancreas and pancreas-kidney transplantation.  

PubMed

With the proliferation and expanding applications of laparoscopic techniques, we determined the applicability of the laparoscopic approach to living pancreas donation. We performed the first laparoscopic donor distal pancreatectomy in 1999. We herein present our initial experience with five hand-assisted laparoscopic donor pancreatectomies. Three donors underwent distal pancreatectomy alone; two underwent a simultaneous left nephrectomy. The mean donor age was 48.4+/-8.7 years with a body mass index of 23.7 kg/m2. The donor and recipient survival rate was 100% at up to 3 years of follow-up. There were no episodes of pancreatitis, leaks, or pseudocysts. All donors returned to their preoperative state of health and to work. None of the donors have required oral anti-diabetic medications or insulin. We conclude that laparoscopic donor distal pancreatectomy is a safe and efficient procedure; hand-assisted laparoscopic distal pancreatectomy appears to be preferable, because of the added margin of safety from increased tactile feedback and ease of pancreatic dissection. The procedure can be accomplished with a single 6-cm periumbilical incision and only two 12-mm ports, resulting in excellent cosmesis and high donor satisfaction. PMID:15996246

Tan, Miguel; Kandaswamy, Raja; Sutherland, David E R; Gruessner, Rainer W G

2005-08-01

146

The Italsat preoperational programme  

NASA Astrophysics Data System (ADS)

The Italsat preoperational satellite system configuration is described. The purpose of the system is to implement a large capacity commutated network, capable of providing both telephony and new services with a very large flexibility, typically unknown in terrestrial networks. A very strict integration with the Italian terrestrial network is foreseen. The system will use all levels of capacity reassignment, i.e., traffic rearrangement, dynamic management and commutation, and is compatible with future addition of T-stages onboard. The main system features are use of 20/30 GHz bands, multibeam coverage, SS-TDMA, onboard regeneration and modular frame structure.

Tirro, S.

147

SPONTANEOUS ARTERIOENTERIC FISTULA AFTER PANCREAS TRANSPLANTATION  

PubMed Central

Chronic pancreas transplant rejection with enteric exocrine drainage can lead to significant long-term complications. We report a case of a 47-year-old male insulin-dependent diabetic who survived the complications of peripancreatic abscess, enterocutaneous fistula, and arterioenteric fistula related to pancreas transplantation. To avoid these long-term complications, we now recommend elective removal of nonfunctioning, enterically drained pancreas allografts.

Gritsch, H. Albin; Shapiro, Ron; Egidi, Francesca; Randhawa, Parmjeet S.; Starzl, Thomas E.; Corry, Robert J.

2010-01-01

148

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

Microsoft Academic Search

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

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

1982-01-01

149

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

PubMed Central

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

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

2014-01-01

150

Design of a bioartificial pancreas+  

PubMed Central

Introduction In Type 1 diabetes, the ?-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.

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

2010-01-01

151

Mucinous cystic neoplasm of the pancreas in a male patient  

PubMed Central

Mucinous cystic neoplasms (MCNs) make up a morphologic family of similar appearing tumors arising in the ovary and various extraovarian organs such as pancreas, hepatobiliary tract and mesentery. MCNs of the pancreas occur almost exclusively in women. Here, we report a rare case of MCN in a male patient. A 39-year-old man was admitted to our hospital with the chief complaint of back pain. Abdominal computed tomography revealed a multilocular cyctic mass 6.3 cm in diameter in the pancreatic tail. In addition, the outer wall and septae with calcification were demonstrated in the cystic lesion. On magnetic resonance imaging , the cystic fluid had low intensity on T1-weighted imaging and high intensity on T2-weighted imaging. Endoscopic retrograde cholangio-pancreatography (ERCP) showed neither communication between the cystic lesion and the main pancreatic duct nor encasement of the main pancreatic duct. Endoscopic ultrasonography revealed neither solid component nor thickness of the septae in the cystic lesion. Consequently, we performed distal pancreatectomy with splenectomy under the diagnosis of cystic neoplasia of the pancreas. Histopathologically, the cystic lesion showed two distinct component: an inner epithelial layer and an outer densely cellular ovarian-type stromal layer. Based on these findings, the cystic lesion was diagnosed as MCN.

Tokuyama, Yasuharu; Osada, Shinji; Sanada, Yuichi; Takahashi, Takao; Yamaguchi, Kazuya; Yoshida, Kazuhiro

2011-01-01

152

Multimodality Imaging Evaluation of an Uncommon Entity: Esophageal Heterotopic Pancreas  

PubMed Central

A 25-year-old male was referred to the Radiology Department with new onset of right upper quadrant and epigastric abdominal pain. He had no past medical or surgical history. Physical exam was unremarkable. The patient underwent computed tomography (CT), fluoroscopic upper gastrointestinal (GI) evaluation, endoscopic ultrasound (EUS), and positron emission tomography (PET) evaluation, revealing the presence of a heterogeneous esophageal mass. In light of imaging findings and clinical workup, the patient was ultimately referred for thorascopic surgery. Surgical findings and histology confirmed the diagnosis of esophageal heterotopic pancreas.

Mack, Takman; Lowry, Debra; Carbone, Peter; Barbick, Brian; Kindelan, Joshua; Marks, Robert

2014-01-01

153

Multimodality imaging evaluation of an uncommon entity: esophageal heterotopic pancreas.  

PubMed

A 25-year-old male was referred to the Radiology Department with new onset of right upper quadrant and epigastric abdominal pain. He had no past medical or surgical history. Physical exam was unremarkable. The patient underwent computed tomography (CT), fluoroscopic upper gastrointestinal (GI) evaluation, endoscopic ultrasound (EUS), and positron emission tomography (PET) evaluation, revealing the presence of a heterogeneous esophageal mass. In light of imaging findings and clinical workup, the patient was ultimately referred for thorascopic surgery. Surgical findings and histology confirmed the diagnosis of esophageal heterotopic pancreas. PMID:24744946

Mack, Takman; Lowry, Debra; Carbone, Peter; Barbick, Brian; Kindelan, Joshua; Marks, Robert

2014-01-01

154

Development and Regeneration in the Endocrine Pancreas  

PubMed Central

The pancreas is composed of two compartments that deliver digestive enzymes and endocrine hormones to control the blood sugar level. The endocrine pancreas consists of functional units organized into cell clusters called islets of Langerhans where insulin-producing cells are found in the core and surrounded by glucagon-, somatostatin-, pancreatic polypeptide-, and ghrelin-producing cells. Diabetes is a devastating disease provoked by the depletion or malfunction of insulin-producing beta-cells in the endocrine pancreas. The side effects of diabetes are multiple, including cardiovascular, neuropathological, and kidney diseases. The analyses of transgenic and knockout mice gave major insights into the molecular mechanisms controlling endocrine pancreas genesis. Moreover, the study of animal models of pancreas injury revealed that the pancreas has the propensity to undergo regeneration and opened new avenues to develop novel therapeutic approaches for the treatment of diabetes. Thus, beside self-replication of preexisting insulin-producing cells, several potential cell sources in the adult pancreas were suggested to contribute to beta-cell regeneration, including acinar, intraislet, and duct epithelia. However, regeneration in the adult endocrine pancreas is still under controversial debate.

Mansouri, Ahmed

2012-01-01

155

Environmental Factors and Diseases of Pancreas.  

National Technical Information Service (NTIS)

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

D. S. Longnecker

1976-01-01

156

Pathology of Kidney and Pancreas Transplants  

Microsoft Academic Search

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

Lillian Gaber; Byron P. Croker

157

Heterotopic mucinous cystadenoma of the pancreas  

Microsoft Academic Search

Summary A 46-year-old female who had been experiencing severe diarrhea and marked weight loss underwent exploratory laparotomy because of a mass near the tail of the pancreas noted on CT scan. Pathologic examination revealed a mucinous cystadenoma of the pancreas occurring in heterotopic pancreatic tissue. This is the second reported case of mucinous cystadenoma occurring in heterotopic pancreatic tissue.

Ned Z. Carp; Anthony R. Paul; Michael J. Kowalyshyn; Robert O. Petersen; John P. Hoffman

1992-01-01

158

[Responsibility of the anaesthesiologist in the preoperative risk evaluation].  

PubMed

Correct indications are essential to perform surgical procedures. However, appropriate timing to achieve minimal rates of complications even in high-risk patients or major surgery is at the top of the priority list. Perioperative responsibility is divided between anaesthesiologists and surgeons. While the surgeon is accountable for the surgical procedure, the anaesthesiologist is responsible for preoperative risk evaluation, perioperative management, and maintenance of vital organ functions. Both of these medical specialities must weigh the urgency of the procedure against patient-associated risk factors. Goals are optimal patient safety, efficient preoperative evaluation and subsequent optimisation to reduce the burden for the health care systems. For most patients without underlying diseases, a thorough history and physical examination is sufficient. In teaching hospitals, some laboratory results for screening of organ function are advisable. Patients can be stratified on clinical grounds into low-, medium-, and high-risk categories. Use of these categories, along with consideration of the type and urgency of surgery, allows for a reasonable approach to preoperative testing. Testing directed towards assessment of organ system functional reserve and identification of organs at risk rather than the diagnosis of a specific disease, is the primary goal of preoperative evaluation prior to surgery. These results are essential to prepare an effective anaesthetic plan. Along with increased patient comfort, the number of preoperative hospital days can be reduced by outpatient preoperative evaluation clinics. PMID:12232641

Lingnau, W; Strohmenger, H U

2002-09-01

159

Gastrointestinal stromal tumor of the pancreas: A case report and review of the literature  

PubMed Central

Context: Primary stromal tumors of the pancreas are extremely rare. Only four cases have been reported in the literature. We describe a new case and analyze, through a review of the literature, the clinical and pathological data, and the outcome of the previously reported cases. Case report: We report the case of a 52-year-old-woman who presented with epigastric pain. Preoperatively, abdominal pelvic computed tomography revealed a pancreatic head mass. The surgery confirmed the presence of a large tumor of the pancreatic head. Pathologic results revealed a malignant gastrointestinal stromal tumor of the pancreatic head, completely removed. There is no recurrence or metastases 10 months after surgery. Conclusion: The current case consolidates the possibility that this rare tumor can involve the pancreas as a primary site and that GIST of primary pancreatic localization are usually of high risk of malignancy.

Trabelsi, Amel; Yacoub-Abid, Lilia Ben; Mtimet, Abdallah; Abdelkrim, Soumaya Ben; Hammedi, Faten; Ali, Ali Ben; Mokni, Moncef

2009-01-01

160

Primary mediastinal hemangiopericytoma treated with preoperative embolization and surgery.  

PubMed

Hemangiopericytomas are rare tumors originating from vascular pericytes. The mediastinum is an extremely uncommon site with only a few cases reported. Diagnosis is based on histopathology and immunohistochemistry, which differentiates them from synovial sarcoma and solitary fibrous histiocytoma. They have a variable malignant potential. Treatment is mainly surgical extirpation as the role of adjuvant therapy is controversial. Preoperative embolization has been sparingly used. We report a case of primary mediastinal hemangiopericytoma in a 47-year-old man treated successfully with preoperative embolization and surgery. PMID:24384191

Kulshreshtha, Pranjal; Kannan, Narayanan; Bhardwaj, Reena; Batra, Swati; Gupta, Srishti

2014-01-01

161

Transcriptional control of mammalian pancreas organogenesis.  

PubMed

The field of pancreas development has markedly expanded over the last decade, significantly advancing our understanding of the molecular mechanisms that control pancreas organogenesis. This growth has been fueled, in part, by the need to generate new therapeutic approaches for the treatment of diabetes. The creation of sophisticated genetic tools in mice has been instrumental in this progress. Genetic manipulation involving activation or inactivation of genes within specific cell types has allowed the identification of many transcription factors (TFs) that play critical roles in the organogenesis of the pancreas. Interestingly, many of these TFs act at multiple stages of pancreatic development, and adult organ function or repair. Interaction with other TFs, extrinsic signals, and epigenetic regulation are among the mechanisms by which TFs may play context-dependent roles during pancreas organogenesis. Many of the pancreatic TFs directly regulate each other and their own expression. These combinatorial interactions generate very specific gene regulatory networks that can define the different cell lineages and types in the developing pancreas. Here, we review recent progress made in understanding the role of pancreatic TFs in mouse pancreas formation. We also summarize our current knowledge of human pancreas development and discuss developmental pancreatic TFs that have been associated with human pancreatic diseases. PMID:24221136

Cano, David A; Soria, Bernat; Martín, Francisco; Rojas, Anabel

2014-07-01

162

In vivo endomicroscopy of donor duodenum improves early detection of pancreas rejection in a recipient of simultaneous duodenum-drained pancreas-kidney transplantation: a case report  

PubMed Central

Confocal laser endomicroscopy (CLE) is a new technique, which allows subsurface histological diagnosis at a cellular and subcellular level in vivo and could provide histological diagnosis during endoscopic examination. Up to now histological examination of the tissue sample is the only definitive way of diagnosis and monitoring organ rejection after transplantation. In case of pancreas transplantation percutaneous pancreas biopsy under imaging control is still the method of choice for obtaining tissue samples. However in 73–89% of biopsy attempts, it was shown that the duodenal histology predicts the initial diagnosis of rejection of the pancreas, usefulness of transplanted duodenum biopsies for graft rejection monitoring was also described. The histology technique is time consuming, and the therapeutic decision could not be made quickly, in spite of clinical necessity. In this paper we described feasibility of visualization and biopsy of donor duodenum and detection of microscopic changes in 2 cases of transplanted duodenum, expressed as destruction of the villi and dispersed goblet cells in comparison to a microscopic view of their own healthy duodenum No or only small, endoscopically non-significant macroscopic changes in transplanted duodenum in those patients were observed. In both cases, the histological examination confirmed acute organ rejection. We demonstrated for the first time that CLE is promising and effective method to detect acute phase of organ rejection and also for follow up in those patients.

Zuk, Krystian; Durlik, Marek; Rydzewski, Andrzej

2013-01-01

163

In vivo endomicroscopy of donor duodenum improves early detection of pancreas rejection in a recipient of simultaneous duodenum-drained pancreas-kidney transplantation: a case report.  

PubMed

Confocal laser endomicroscopy (CLE) is a new technique, which allows subsurface histological diagnosis at a cellular and subcellular level in vivo and could provide histological diagnosis during endoscopic examination. Up to now histological examination of the tissue sample is the only definitive way of diagnosis and monitoring organ rejection after transplantation. In case of pancreas transplantation percutaneous pancreas biopsy under imaging control is still the method of choice for obtaining tissue samples. However in 73-89% of biopsy attempts, it was shown that the duodenal histology predicts the initial diagnosis of rejection of the pancreas, usefulness of transplanted duodenum biopsies for graft rejection monitoring was also described. The histology technique is time consuming, and the therapeutic decision could not be made quickly, in spite of clinical necessity. In this paper we described feasibility of visualization and biopsy of donor duodenum and detection of microscopic changes in 2 cases of transplanted duodenum, expressed as destruction of the villi and dispersed goblet cells in comparison to a microscopic view of their own healthy duodenum No or only small, endoscopically non-significant macroscopic changes in transplanted duodenum in those patients were observed. In both cases, the histological examination confirmed acute organ rejection. We demonstrated for the first time that CLE is promising and effective method to detect acute phase of organ rejection and also for follow up in those patients. PMID:24501611

Zuk, Krystian; Durlik, Marek; Rydzewski, Andrzej; Rydzewska, Gra?yna

2013-12-01

164

Therapeutic Laparoscopy of the Pancreas  

PubMed Central

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

Park, Adrian E.; Heniford, B. Todd

2002-01-01

165

Solid Pseudopapillary Neoplasm of the Pancreas: A Case Report with Review of the Diagnostic Dilemmas and Tumor Behavior  

PubMed Central

Solid pseudopapillary neoplasm of the pancreas is a rare tumor of the pancreas often detected initially on imaging. Of uncertain histogenesis, it has a low-grade malignant potential with excellent post-surgical curative rates and rare metastasis. Despite advances in imaging, pseudocysts and other cystic neoplasms feature in the differential diagnosis. Pathological and/or cytological evaluation remains the gold standard in reaching a definitive diagnosis. On morphology alone, other primary pancreatic tumors and metastatic tumors pose a diagnostic challenge. Recent advances in immunohistochemical characterization have made the histopathologic diagnosis more specific and, in turn, shed light on the likely histogenesis of this rare tumor. We report a case of solid pseudopapillary neoplasm of the pancreas that was suspected on radiology and diagnosed intraoperatively on imprint cytology guiding definitive surgery. The diagnostic dilemmas are reviewed.

Lakhtakia, Ritu; Al-Wahaibi, Khalifa; Zahid, Khawaja F.; Malik, Kamran A.; Burney, Ikram A.

2013-01-01

166

The Artificial Pancreas: How Sweet Engineering Will Solve Bitter Problems  

Microsoft Academic Search

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

David C. Klonoff

2007-01-01

167

Cystadenoma and Cystadenocarcinoma of the Pancreas  

PubMed Central

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

Muzac, Eddy S.

1979-01-01

168

Preoperative radiochemotherapy in rectal cancer  

Microsoft Academic Search

Purpose: To assess toxicity and long-term results of preoperative chemoradiotherapy in rectal cancer.Methods and Materials: Between 1989 and 1997, as a phase II study, 66 patients with T3 M0 rectal cancer received preoperatively a 45 Gy dose pelvic radiotherapy (XRT) combined with two 5-day chemotherapy courses (CT) of 5-Fluorouracil (5-FU) and Leucovorin (LV) delivered the first and fifth week of

Jean-François Bosset; Valérie Magnin; Philippe Maingon; Georges Mantion; Edouard P Pelissier; Mariette Mercier; Gaelle Chaillard; Jean-Claude Horiot

2000-01-01

169

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

PubMed

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

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

170

Choledochocele with pancreas divisum: A rare co-occurrence diagnosed on magnetic resonance cholangiopancreatography  

PubMed Central

We report a case of a 42-year-old male with symptomatic choledochocele and incidental pancreas divisum diagnosed with magnetic resonance cholangiopan- creatography (MRCP). Small choledochocele is rare congenital malformation associated with non-specific symptoms and a delay in diagnosis. The coexistence of choledochocele and pancreas divisum is extremely rare with only two case reports published in literature. In both cases MRCP failed to diagnose any biliary or pancreatic abnormality. This case suggests that the patients with recurrent abdominal pain and pancreas divisum should not be presumed to be suffering from pancreatitis. Careful evaluated for additional anomalies in the biliary tree should be sought for refractory symptoms. MRCP is a useful one-stop-shop for diagnosing pancreatic and biliary ductal anomalies.

Patidar, Yashwant; Agarwal, Nitesh; Gupta, Shailesh; Arora, Ankur; Mukund, Amar; Rajesh, S

2013-01-01

171

Detection of circulating pancreas epithelial cells in patients with pancreatic cystic lesions.  

PubMed

Hematogenous dissemination is thought to be a late event in cancer progression. We recently showed in a genetic model of pancreatic ductal adenocarcinoma that pancreas cells can be detected in the bloodstream before tumor formation. To confirm these findings in humans, we used microfluidic geometrically enhanced differential immunocapture to detect circulating pancreas epithelial cells in patient blood samples. We captured more than 3 circulating pancreas epithelial cells/mL in 7 of 21 (33%) patients with cystic lesions and no clinical diagnosis of cancer (Sendai criteria negative), 8 of 11 (73%) with pancreatic ductal adenocarcinoma, and in 0 of 19 patients without cysts or cancer (controls). These findings indicate that cancer cells are present in the circulation of patients before tumors are detected, which might be used in risk assessment. PMID:24333829

Rhim, Andrew D; Thege, Fredrik I; Santana, Steven M; Lannin, Timothy B; Saha, Trisha N; Tsai, Shannon; Maggs, Lara R; Kochman, Michael L; Ginsberg, Gregory G; Lieb, John G; Chandrasekhara, Vinay; Drebin, Jeffrey A; Ahmad, Nuzhat; Yang, Yu-Xiao; Kirby, Brian J; Stanger, Ben Z

2014-03-01

172

Acute non-traumatic pancreatitis in a patient with pancreas divisum: a case report  

PubMed Central

Pancreas divisum is a frequent congenital anatomical anomaly characterized by the failure of fusion of the ducts of Santorini and Wirsung during fetal development. Although the condition usually remains asymptomatic, it has been reported to be a predisposing factor of chronic and recurrent idiopathic pancreatitis. We report a case of acute non-traumatic pancreatitis in a 54-year-old Caucasian male with pancreas divisum. Diagnosis was established based on the findings from magnetic resonance imaging and magnetic resonance cholangiopancreatography. The patient was managed conservatively and was discharged home having an uneventful clinical course after five days of hospitalization. Although the role of the pancreas in the induction of acute pancreatitis is still a matter of debate, physicians have to be aware about this prevalent pancreatic anatomic abnormality. Timely detection may help in the prevention of potential recurrent pancreatic reaction.

Anyfantakis, D; Partalis, N; Polimili, G; Kastanakis, S

2013-01-01

173

Hyperinsulinaemic hypoglycaemia: genetic mechanisms, diagnosis and management.  

PubMed

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

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

2012-07-01

174

Fully automatic computer-assisted pancreas imaging.  

PubMed

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

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

1977-12-30

175

Recurrence of Autoimmunity Following Pancreas Transplantation  

PubMed Central

Pancreas transplantation is a therapeutic option for patients with type 1 diabetes. Advances in immunosuppression have reduced immunological failures, and these are usually categorized as chronic rejection. Yet studies in our cohort of pancreas transplant recipients identified several patients in whom chronic islet autoimmunity led to recurrent diabetes, despite immunosuppression that prevented rejection. Recurrent diabetes in our cohort is as frequent as chronic rejection, and thus is a significant cause of immunological graft failure. Our studies demonstrated islet autoimmunity by the presence of autoantibodies and autoreactive T-cells, which mediated ?-cell destruction in a transplantation model. Biopsy of the transplanted pancreas revealed variable degrees of ?-cell loss, with or without insulitis, in the absence of pancreas and kidney transplant rejection. Additional research is needed to better understand recurrent disease and to identify new treatment regimens that can suppress autoimmunity, as in our experience this is not effectively inhibited by conventional immunosuppression.

Burke, George W.; Vendrame, Francesco; Pileggi, Antonello; Ciancio, Gaetano; Reijonen, Helena

2014-01-01

176

Successful treatment of liver metastasis from solid pseudopapillary tumor of the pancreas: a case report.  

PubMed

Solid pseudopapillary tumor of the pancreas is a rare pancreatic neoplasm that typically occurs in young females. As a low-grade malignancy, the tumor seldom recurs and metastasizes. Management of liver metastasis from such a tumor remains unclear. We present a case of a young girl with liver metastasis due to solid pseudopapillary tumor of the pancreas. She was admitted with chief complaints of epigastric mass on palpation for 16 months and upper abdominal pain for 2 months. An abdominal CT scan detected a mass in the pancreas and multiple nodules in the liver. Then, percutaneous CT-guided tru-cut biopsy was performed and pathological diagnosis of the biopsy material revealed solid pseudopapillary tumor of the pancreas. At 3 months after surgical resection of the pancreatic and liver tumors, CT scan found nodules in her liver. The patient received treatment with transcatheter arterial chemoembolization. She remained well during the 3 years of follow-up with no evidence of recurrence. Therefore, it is suggested that although solid pseudopapillary tumor of the pancreas may be associated with malignant potentiality, a favorable prognosis can also be obtained via rigorous treatment. PMID:24592130

Liu, Taiguo; He, Jianping; Cao, Dan; Huang, Ying

2013-01-01

177

The current state of pancreas transplantation.  

PubMed

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

Gruessner, Rainer W G; Gruessner, Angelika C

2013-09-01

178

Endoscopic submucosal dissection of gastric ectopic pancreas  

PubMed Central

Patients with gastric tumors usually present with symptoms of discomfort or pain in the epigastrium, regurgitations, nausea, vomiting or melena. Treatment options include open and laparoscopic total or partial gastrectomy and recently endoscopic mucosal resection. A case of successful endoscopic submucosal dissection is described with the unusual pathological finding of heterotopic pancreatic tissue forming a gastric tumor. The 67-year-old male patient was operated on due to the initial diagnosis of gastro-intestinal stromal tumor of the gastric trunk. Two intra-operative biopsies were negative for cancer cells. Submucosal endoscopic dissection was performed with IT and Hook knives (Olympus). A literature review was performed. The operative time was 180 min with hospital stay of 6 days. During the injection of the carmine dye and the air insufflation pneumoperitoneum occurred and remained clinically silent during the observation period. The pathology result showed a heterotopic pancreatic tissue type 2 according to Heinrich's classification with microfoci of intestinal metaplasia. Preoperative diagnostics of gastric masses might be misleading and such tumors not necessarily should be excised. There are several surgical options with endoscopic submucosal dissection being probably the safest one and a non-disabling approach. Patients tolerate that kind of surgery well with good postoperative functional outcomes.

Makarewicz, Wojciech; Dubowik, Michal; Kosinski, Adam; Jastrzebski, Tomasz; Jaskiewicz, Janusz

2013-01-01

179

Endoscopic submucosal dissection of gastric ectopic pancreas.  

PubMed

Patients with gastric tumors usually present with symptoms of discomfort or pain in the epigastrium, regurgitations, nausea, vomiting or melena. Treatment options include open and laparoscopic total or partial gastrectomy and recently endoscopic mucosal resection. A case of successful endoscopic submucosal dissection is described with the unusual pathological finding of heterotopic pancreatic tissue forming a gastric tumor. The 67-year-old male patient was operated on due to the initial diagnosis of gastro-intestinal stromal tumor of the gastric trunk. Two intra-operative biopsies were negative for cancer cells. Submucosal endoscopic dissection was performed with IT and Hook knives (Olympus). A literature review was performed. The operative time was 180 min with hospital stay of 6 days. During the injection of the carmine dye and the air insufflation pneumoperitoneum occurred and remained clinically silent during the observation period. The pathology result showed a heterotopic pancreatic tissue type 2 according to Heinrich's classification with microfoci of intestinal metaplasia. Preoperative diagnostics of gastric masses might be misleading and such tumors not necessarily should be excised. There are several surgical options with endoscopic submucosal dissection being probably the safest one and a non-disabling approach. Patients tolerate that kind of surgery well with good postoperative functional outcomes. PMID:24130642

Makarewicz, Wojciech; Bobowicz, Maciej; Dubowik, Michal; Kosinski, Adam; Jastrzebski, Tomasz; Jaskiewicz, Janusz

2013-09-01

180

Pancreas transplantation. An initial experience with systemic and portal drainage of pancreatic allografts.  

PubMed Central

Pancreas transplantation has evolved dramatically since its introduction in 1966. As new centers for transplantation have developed, the evaluation of complications associated with pancreas transplantation has led to advances in surgical technique. Furthermore, surgical alterations of the pancreas resulting from transplantation (systemic release of insulin and denervation) are of unproven consequence on glucose metabolism. Since 1988, the authors have performed 21 transplants (16 combined pancreas/kidney, 3 pancreas alone, which includes 1 retransplantation, 1 pancreas after previous kidney transplant, and 1 "cluster") in 20 patients aged 18 to 49 years; mean, 35 +/- 1 years. Overall patient survival is 95%. Three pancreatic grafts failed within the first year because of technical failure; one additional pancreas was lost to an immunologic event on postoperative day 449, for an overall pancreatic graft survival of 81%. No renal grafts were lost. To evaluate causes of graft failure, demographic data were compared, which included age and sex of the donor and the recipient, operative time, intraoperative blood transfusion, and ischemic time of the graft. No statistically significant differences were found between groups except for ischemic time (11.7 +/- 6.4 hours for the technical success group versus 19.8 +/- 3.7 hours for the technical failure group; p less than 0.05 by unpaired Student's t test). Quadruple immunosuppression was used, which included prednisone, cyclosporine, azathioprine, and antilymphoblast globulin. A mean of 1.2 (range, 0 to 3) rejection episodes per patient occurred. Mean hospital stay was 24 +/- 11 days. Surgical and infectious complications were evaluated by comparing the technical success (TS) group (n = 17) with the technical failure (TF) group. Surgical complications in the TS group revealed a mean of 1.3 episodes per patient, whereas the TF group had 3.7 episodes per patient. The TS also had a reduced incidence of infectious complications compared with the TF (1.7 versus 4.3 episodes per patient). Cytomegalovirus was common in both groups, accounting for 11 infectious episodes, and occurred on a mean postoperative day of 38. Mean postoperative HbA1C levels dropped to 5 +/- 1% from 11 +/- 3%. The authors developed a new technique that incorporates portal drainage of the pancreatic venous effluent in three recipients. Preoperative metabolic studies disclosed a mean fasting glucose of 211 +/- 27 mg/dL and a mean stimulated glucose value of 434 +/- 41 mg/dL for all patients; the mean fasting insulin was 23 +/- 4 microU/mL.(ABSTRACT TRUNCATED AT 400 WORDS) Images FIG. 5.

Rosenlof, L K; Earnhardt, R C; Pruett, T L; Stevenson, W C; Douglas, M T; Cornett, G C; Hanks, J B

1992-01-01

181

Simultaneous Pancreas-Kidney and Sequential Pancreas-After-Kidney Transplantation. Health Technology Assessment Number 4.  

National Technical Information Service (NTIS)

Simultaneous pancreas-kidney (SPK) or pancreas-after-kidney (PAK) transplantation has been advocated as an alternative to kidney transplant alone (KTA) for type 1 diabetics with end-stage renal disease. Advocates of combined transplant assert that the pro...

T. V. Holohan

1995-01-01

182

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

PubMed

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

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

2013-06-27

183

Preoperatively diagnosed mucocele of the appendix.  

PubMed

Mucocele of the appendix is an infrequent entity, characterizedby distension of the lumen due to accumulation of mucoidsubstance and is rarely diagnosed preoperatively. If untreated, mucocele may rupture producing a potentially fatal entityknown as pseudomyxoma peritonei. The type of surgicaltreatment is related to the dimensions and the histology of themucocele. Appendectomy is used for simple mucocele or forcystadenoma. Right hemi-colectomy is recommended forcystadenocarcinoma. In this paper, we report a case of anasymptomatic 37-year-old woman in whom mucocele wasfound on a routine ultrasound examination and preoperativecomputed tomography scan. Surgery revealed a big appendixmeasuring 84 mm in length and 40 mm in diameter. The finalpathologic diagnosis was simple mucocele. PMID:24956351

Rojnoveanu, Gh; Ghidirim, Gh; Mishin, I; Vozian, M; Mishina, A

2014-01-01

184

[Patient Blood Management - The preoperative patient].  

PubMed

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

Müller, Markus M; Fischer, Dania; Stock, Ulrich; Geisen, Christof; Steffen, Björn; Nussbaumer, Judith; Meybohm, Patrick

2014-04-01

185

Preoperative Autologous Blood Donation (PABD).  

National Technical Information Service (NTIS)

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

2000-01-01

186

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

NASA Astrophysics Data System (ADS)

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

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

2013-02-01

187

Cystic neoplasms and true cysts of the pancreas.  

PubMed

As the spectrum of pancreatic cysts evolves, sped by the increasing utilization of CT scanning, it becomes apparent that the surgeon must gain information preoperatively about the family history, as well as the personal history of the patient. The presence of cysts in the liver or kidney should be sought. The relation of the lesion to the duodenum and biliary tract needs to be defined. The possibility that the "cyst" represents necrosis of a primary adenocarcinoma of the pancreatic duct should be considered prior to laparotomy. At the time of operation, biopsy of the cyst wall and frozen-section study are fundamental to a decision whether resection or drainage is the treatment of choice. Resection is generally the treatment of the cystic neoplasms, drainage the treatment of pseudocysts. The failure of the surgeon to distinguish between the two groups may be catastrophic. The true cysts and cystic neoplasms of the pancreas are rare lesions. The clinical and radiologic characteristics, the pathologic features, and the natural history of these lesions are not fully documented. Therefore, when they are encountered, the clinician who will carefully document their characteristics can make a contribution to our knowledge. PMID:2658166

Howard, J M

1989-06-01

188

Preoperative needle biopsy and immunohistochemical analysis for gastrointestinal stromal tumor of the rectum mimicking vaginal leiomyoma.  

PubMed

Accurate preoperative diagnosis for gastrointestinal stromal tumor (GIST) was obtained using the endoscopic approach in about 50% of the cases. Preoperative assessment is quite important in reproductive women for the treatment of pelvic tumor. We report the first case of GIST of the rectum that was accurately diagnosed with preoperative needle biopsy from the vaginal wall. The case was a 38-year-old woman who presented with a history of genital bleeding. Internal examination revealed a round and elastic mass (7 x 7 cm) in the left pelvic cavity. The biopsy specimen from the left sidewall of the vagina using a manually manipulated biopsy needle showed strong reaction for CD34 and CD117 (c-KIT). The patient underwent low anterior resection of the rectum, tumor resection, and partial resection of the posterior vagina. Preoperative biopsy with vaginal approach might be helpful to make a diagnosis for pelvic tumor of unknown origin and unknown malignant potential. PMID:16681789

Takano, M; Saito, K; Kita, T; Furuya, K; Aida, S; Kikuchi, Y

2006-01-01

189

Complete rupture of the pancreas after a kick into the abdomen during a football match.  

PubMed

Pancreatic injury is uncommon, accounting for less than 7% of penetrating and 5% of blunt abdominal trauma. Blunt isolated pancreatic trauma in football has been rarely described in the literature and its diagnosis, detection and treatment still remains a challenge. We report a case of a young adult with an isolated complete rupture of the pancreatic body due to a blunt abdominal trauma during a football game. In order to preserve the pancreas and therefore retain function, we performed a terminolateral pancreaticojejunostomy. The postoperative course of the patient was uneventful. The diagnosis of isolated injuries of the pancreas in blunt abdominal trauma can be difficult and challenging and due to the nature of the game physicians should be highly alerted when dealing with football players sustaining abdominal trauma. PMID:24891482

Papalampros, Alexandros; Fard-Aghaie, Mohammad; Maghsoudi, Tina; Oldhafer, Karl

2014-01-01

190

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

PubMed Central

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

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

2012-01-01

191

Bringing the Artificial Pancreas Home: Telemedicine Aspects  

PubMed Central

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

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

2011-01-01

192

Health Technology Review No. 11, August 1995. Isolated Pancreas Transplantation.  

National Technical Information Service (NTIS)

Pancreas transplants have been successfully performed and have effectively freed some diabetics from dependence on insulin injections. Most of the transplants have been done as simultaneous pancreas-kidney transplants, with only a small fraction having be...

S. S. Hotta

1995-01-01

193

Primary Yolk Sac Tumor Arising in the Pancreas with Hepatic Metastasis: a Case Report  

PubMed Central

Extragonadal yolk sac tumor (YST) is a relatively rare entity. We describe here the case of an extragonadal YST that occurred in the pancreas with hepatic metastasis in an adult woman. The contrast enhanced CT images of the abdomen revealed a heterogeneous, solitary mass occupying the pancreatic neck and body with slightly inhomogeneous contrast enhancement. Two low-density lesions in the liver were also displayed on the CT images. The patient underwent surgery and the diagnosis of YST was pathologically verified.

Zhang, Bo; Gao, Shunliang; Chen, Ying

2010-01-01

194

Successful Treatment of Mediastinal Unicentric Castleman's Disease Using Video-Assisted Thoracoscopic Surgery with Preoperative Embolization.  

PubMed

Unicentric Castleman's disease is a rare, benign lymphoproliferative disorder that is curable with surgical resection. However, significant bleeding often occurs during surgery because of tumor hypervascularity. We herein present a case of hyaline-vascular-type mediastinal unicentric Castleman's disease, successfully resected using video-assisted thoracoscopic surgery with preoperative embolization. In the present case, tumor hypervascularity and feeding vessels were revealed by computed tomography (CT), which led us to perform preoperative angiography and embolization to the tumor feeding arteries to reduce intraoperative bleeding. Castleman's disease should be considered in the differential diagnosis of hypervascular mediastinal tumors. Tumor vascularity should be assessed prior to surgery, and preoperative embolization should be considered. PMID:24198836

Amano, Yosuke; Takai, Daiya; Ohishi, Nobuya; Shinozaki-Ushiku, Aya; Fukayama, Masashi; Akahane, Masaaki; Nakajima, Jun; Nagase, Takahide

2013-01-01

195

[Gastrointestinal hemorrhage secondary to heterotopic jejunal pancreas].  

PubMed

A case of heterotopic pancreas located in the small intestine is herewith presented. The 19-years male patient had been admitted three times since 1991 for an anemic syndrome secondary to melena. The origin of the hemorrhage was not determined with the studies performed (intestinal transit, opaque enema, esophagogastroscopy, colonoscopy and gammagraphy with technetium 99). On the last admission a vascular lesion low flow was observed on arteriography of the upper mesenteric artery on the mesenteric edge of the proximal jejunum. Following laparotomy a small tumor was found in the jejunum and 5 cm of the intestine including the tumor was resected. The anatomic pathologic results demonstrated a heterotopic pancreas. PMID:7621279

Montalvo, I I; Yuste, R; Castiella, A; Arriola, A; Alzate, L F; Saralegui, Y; Elorza, J L; Irazusta, M; Toledano, M; Madina, I

1995-02-01

196

Gene regulatory networks governing pancreas development  

PubMed Central

Summary Elucidation of cellular and gene regulatory networks (GRNs) governing organ development will accelerate progress toward tissue replacement. Here, we have compiled reference GRNs underlying pancreas development from data mining that integrates multiple approaches including mutant analysis, lineage tracing, cell purification, gene expression and enhancer analysis, and biochemical studies of gene regulation. Using established computational tools, we integrated and represented these networks into frameworks that should enhance understanding of the surging output of genomic-scale genetic and epigenetic studies of pancreas development and diseases like diabetes and pancreatic cancer. We envision similar approaches would be useful for understanding development of other organs.

Arda, H. Efsun; Benitez, Cecil; Kim, Seung K.

2013-01-01

197

Refractory hematuria in an oliguric patient after pancreas transplantation with exocrine pancreas bladder drainage.  

PubMed

A 52-yr-old man presented with hematuria and clot retention. He had undergone simultaneous pancreas-kidney transplantation with exocrine pancreas bladder drainage 16 yr ago. The patient suffered from progressive transplant kidney failure with gradually decreasing urine output and needed hemodialysis every other day. Gross hematuria persisted after removal of all blood clots. Cystoscopy showed multiple small, flat ulcers of the bladder mucosa. Some bled discretely and were coagulated cautiously. However, hematuria was refractory to multiple urological interventions, which eventually necessitated an enteric diversion of the exocrine pancreas. Hematuria ceased following an uneventful postoperative course. PMID:19560858

Kiss, Bernhard; Birkhäuser, Frédéric D; Fleischmann, Achim; Candinas, Daniel; Studer, Urs E; Kessler, Thomas M

2011-03-01

198

[Intraductal papillary mucinous pancreas tumor].  

PubMed

Data of the literature on the epidemiology, patogenesis, diagnosis, peculiarities of the symptoms and the treatment of the intraduct papillar pancreatic tumor, are analyzed in this review. These tumors are rare, there are up to 1% of the exocrine pancreatic tumors. Intraduct proliferation of the mucin producing cells, that are disposed as papillars is typical of these tumors. There are the symptoms of the acute or chronic pancreatitis, sometimes the diagnosis of this tumor is accidental. The main diagnostic methods are ultrasound (US) and computed tomography (CT). Endoluminal ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP) are the main methods to reveal the intraduct growth. The surgical treatment is necessary for these patients. PMID:19334451

Maev, I V; Kaziulin, A N; Kucheriavy?, Iu A

2008-01-01

199

Proceedings of the 48th annual pancreas club meeting.  

PubMed

The 48th annual Pancreas Club meeting was held on May 2 and 3, 2014, at the Westin Lombard in Lombard, IL. Two hundred sixty attendees included pancreatologists from 17 countries. Two hundred eleven abstracts were submitted; from these, a record number (64) oral presentations and 136 posters were selected. Table 1 documents oral abstract titles with institutional affiliation. Full abstracts for all oral presentations and posters are available at the Pancreas Club website, http://pancreasclub.com . Representative abstracts from each of the eight sessions are summarized below. Table 1 Oral papers presented at the 48th Annual Pancreas Club meeting Number Title Institution Scientific session 1 ?Topic: Borderline resectable pancreatic cancer ??1 Diagnostic laparoscopy to detect occult metastatic disease prior to neoadjuvant chemoradiation in borderline resectable pancreatic ductal adenocarcinoma Cleveland Clinic Foundation ??2 Risk of venous thromboembolism during neoadjuvant therapy for resectable and borderline resectable (BLR) pancreatic adenocarcinoma (PC) Medical College of Wisconsin ??3 Impact of surgical resection after chemoradiotherapy for locally advanced unresectable pancreatic ductal adenocarcinoma Mie University (Japan) ?Topic: Neoadjuvant chemotherapy/radiation therapy ??4 A comprehensive assessment of neoadjuvant therapy for pancreatic adenocarcinoma: results from the National Cancer Database (NCDB) University of Pennsylvania ??5 does the use of neoadjuvant therapy for pancreatic adenocarcinoma increase postoperative morbidity and mortality rates? MD Anderson Cancer Center ??6 Neoadjuvant chemoradiation versus neoadjuvant chemotherapy prior to pancreaticoduodenectomy for pancreatic cancer Roswell Park Cancer Institute ??7 Changes in body composition during preoperative therapy for resectable pancreatic cancer: do they matter? MD Anderson Cancer Center ??8 Prospective randomized controlled study comparing outcome between standard resection and an extended resection that included dissection of the nerve plexus and various lymph nodes in patients with pancreatic head cancer Seoul National University ??9 Microscopic residual tumor after pancreaticoduodenectomy for cancer. Preliminary results of a multicentric university of Rome prospective randomized trial University of Rome Scientific session II ?Topic: Minimally invasive techniques/screening for cancer ??10 Minimally invasive pancreatoduodenectomy: is the learning curve surmountable? Indiana University ??11 Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Mayo Clinic ??12 Preliminary results of a swedish, mr based, screening program for individuals at risk for pancreas cancer Karolinska Institute (Sweden) ??13 Early detection of pancreatic intraepithelial neoplasia using non-invasive imaging to localize and grade protease activity University of California San Francisco Scientific session III: translational studies ??14 Role of CYB5A in pancreatic cancer: correlation with clinical outcome and functional characterization in the modulation of autophagy and oncogenic phenotypes University of Pisa (Italy) ??15 CA 19-9 response to neoadjuvant therapy predicts outcome in pancreatic adenocarcinoma University of Pittsburgh ??16 Detection of clinically relevant genetic alterations in fine needle aspirates of pancreatic cancer is possible using next-generation sequencing Johns Hopkins University ??17 New platforms for PDAC preclinical studies: 3D tissue-engineered models based on primary cancer cells and synthetic scaffolds University of Pisa (Italy) ??18 Bioluminescent orthotopic pancreatic-ductal-adenocarcinoma (PDAC) mouse models derived from primary PDAC cells as a platform for therapeutic discovery University of Pisa (Italy) ??19 Counteracting cancer cell survival strategy: sensitization of pancreatic cancer cells to trail induced cell death by jak2/stat3 pathway inhibition by preventing death receptor down regula

Baker, Marshall S; Zyromski, Nicholas J

2014-08-01

200

Adult intussusceptions: preoperative predictive factors for malignant lead point  

PubMed Central

Purpose Adult intussusception is uncommon, but an organic lesion is found to be the lead point in 75% to 90% of the cases. This study was designed to review our experience with adult intussusception and to determine if there are any preoperative predictive factors for a malignant lead point. Methods Thirty-three patients over 15 years of age were diagnosed with intussusceptions through operative finding over a period of 20 years. We reviewed the medical records of these patients retrospectively, and preoperative predictive factors of malignant lead points were analyzed. Results The preoperative diagnosis of intussusception had been made correctly in 86% of the cases, and computed tomography could find a lead point in 79%. A causative organic lesion was found in 29 patients (88%) pathologically; 16 cases (48%) were due to benign tumors, and 13 (39%) were due to malignant tumors. A malignant lead point was present in four of 21 enteric (20%) versus nine of 13 colonic intussusceptions (75%). The period from symptom appearance to hospital visit showed a more chronic nature in malignant neoplasm than in benign neoplasm (P = 0.006), and the location of causative organic lesion showed significant difference between benign and malignant groups (P = 0.003). Conclusion Adult intussusceptions are commonly secondary to a pathologic lead point, and a computed tomography is an effective diagnostic tool for finding a lead point preoperatively. The chronic nature of the disease presentation and colonic location of the lead point may suggest a malignant neoplasm.

Kim, Kil Hwan; Park, Dong Guk

2014-01-01

201

Minimally invasive parathyroidectomy: how effective is preoperative sestamibi scanning?  

PubMed

Minimally invasive parathyroidectomy (MIP) guided by preoperative sestamibi scanning has been shown to reduce operative time, hospital stay, and cost in treating primary hyperparathyroidism. However, controversy exists over routine preoperative sestamibi scanning. The purpose of this study was to determine the utility of sestamibi scanning at our institution as part of the MIP protocol and to analyze calcium and parathyroid hormone levels as possible predictors of successful sestamibi scanning. Charts of 37 consecutive patients undergoing MIP at our institution were reviewed, and age, sex, preoperative calcium, and parathyroid (PTH) levels, invasiveness of procedure, and pathologic diagnosis were recorded. Sestamibi scans were reviewed and scored by 4 nuclear medicine faculty based on the level of suspicion for parathyroid adenoma. Neither calcium nor PTH correlated significantly with sestamibi scan score (Spearman coefficient, r = 0.075, P = 0.67 and r = 0.277, P = 0.10, respectively). Receiver-operating-characteristic (ROC) analysis showed sestamibi scanning to have sensitivity and specificity in predicting MIP completion (87% and 68%). Logistic regression showed only sestamibi scan (P = 0.038), not calcium or PTH (P = 0.977 and P = 0.767) to be predictive of MIP completion. In conclusion, sestamibi scanning effectively predicted the ability to perform MIP. However, preoperative calcium and PTH predicted neither sestamibi scan results nor completion of MIP. PMID:14700297

Vassy, W Matthew; Nelson, Henry S; Mancini, Matthew L; Timaran, Carlos H; Hall, Nathan C; Smith, Gary T

2003-12-01

202

Preoperative oral rehydration therapy with 2.5 % carbohydrate beverage alleviates insulin action in volunteers.  

PubMed

Preoperative carbohydrate loading enhances insulin action by approximately 50 %. In some Japanese hospitals, preoperative oral rehydration therapy is performed for preventing dehydration during surgery. We hypothesized that preoperative oral rehydration therapy with a 2.5 % carbohydrate beverage that is widely used in Japan can enhance insulin action. Therefore, we investigated the effect of this 2.5 % carbohydrate beverage on insulin action in volunteers. Six healthy volunteers participated in this crossover randomized study. The participants were segregated into 2 groups: an oral rehydration therapy with 2.5 % carbohydrate beverage group (group A) and a control group (group B). Subjects in group B were allowed to drink only water from 9 pm the day before the test; conversely, group A fasted from 9 pm onward and drank 500 ml of the beverage containing 2.5 % carbohydrate (OS-1; Otsuka Pharmaceutical Factory, Tokushima, Japan) between 9 and 12 pm and again at 6.30 am. At 8.30 am, a hyperinsulinemic normoglycemic clamp was initiated using an artificial pancreas STG-22 (Nikkiso, Tokyo, Japan). Insulin action was evaluated in both groups using the glucose infusion rate. Blood glucose levels at the initiation of the clamp procedure were similar. However, the glucose infusion rate for group A was significantly higher than that of group B (8.6 ± 1.5 vs. 6.8 ± 2.0 mg/kg/min, p = 0.009). In conclusion, the hyperinsulinemic normoglycemic clamp using an artificial pancreas showed that the administration of a 2.5 % carbohydrate oral rehydration solution for preoperative oral rehydration therapy improves insulin action in volunteers. PMID:23917335

Yatabe, Tomoaki; Tamura, Takahiko; Kitagawa, Hiroyuki; Namikawa, Tsutomu; Yamashita, Koichi; Hanazaki, Kazuhiro; Yokoyama, Masataka

2013-12-01

203

Preoperative Chemo and Endocrine Therapy  

Microsoft Academic Search

Primary systemic therapy (PST) or preoperative therapy has been part of the multidisciplinary approach to locally advanced\\u000a and inflammatory breast cancer since the early 1970s. The administration of chemotherapy allowed surgical resection of inoperable\\u000a tumours and improved clinical outcome [1]. The chance of downsizing the tumour extended its use to operable large breast tumour\\u000a candidates for mastectomy in order to

Rosalba Torrisi

204

Peptidergic (VIP) nerves in the pancreas  

Microsoft Academic Search

Vasoactive intestinal peptide (VIP) was found to occur in nerves in the pancreas of all species examined, as demonstrated by immunohistochemistry. Immunoreactive nerve terminals were seen to run in the stroma, around acini, and in the wall of blood vessels. Clusters of immunoreactive nerve cell bodies were encountered in the parenchyma; in addition other ganglia were densely innervated by VIP

F. Sundler; J. Alumets; R. Håkanson; J. Fahrenkrug; O. Schaffalitzky de Muckadell

1978-01-01

205

Carcinoma of the Exocrine Pancreas in Medaka.  

National Technical Information Service (NTIS)

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. Three cases occurred in specimens from control g...

J. W. Fournie W. E. Hawkins M. S. J. Battalora W. W. Walker

1991-01-01

206

Imaging of whole-organ pancreas transplants.  

PubMed

Whole pancreas transplantation is an established treatment for selected patients with diabetic nephropathy or poorly controlled diabetes. Surgical techniques vary and have evolved over the past 4 decades. Imaging evaluation of the whole-pancreas transplant should begin with an understanding of the most commonly used surgical techniques and the spectrum of postoperative complications. Ultrasonography (US) should be the first-line modality in evaluating the pancreas allograft and vasculature. Computed tomography (CT) is useful in the assessment of extra-allograft processes, particularly in ruling out abscess formation or evaluating suspected bowel complications. Magnetic resonance (MR) imaging is reserved for cases in which complete evaluation with US or CT is not possible. MR angiography can help provide an accurate assessment of vascular abnormalities. The radiologist must be familiar with the spectrum of surgical techniques and the normal postoperative imaging appearances of the whole-pancreas transplant so as to be able to recognize abnormal postoperative findings. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.322115144/-/DC1. PMID:22411940

Vandermeer, Fauzia Q; Manning, Maria A; Frazier, Aletta A; Wong-You-Cheong, Jade J

2012-01-01

207

Ductal Adenocarcinoma Arising in Duodenopyloric Heterotopic Pancreas  

Microsoft Academic Search

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

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

1994-01-01

208

Malignant Fibrous Histiocytoma of The Pancreas  

PubMed Central

A case of fibrous histiocytoma of low grade malignancy arising from the uncinate lobe of the pancreas is reported. This is an unusual site for these extremely rare tumours. Survival up to 4 years has been achieved in our patient following surgical resection.

Garvey, J. F. W.; Ng, A.; England, J. F.

1989-01-01

209

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

PubMed Central

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

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

2014-01-01

210

The history of pancreas transplantation: past, present and future.  

PubMed

The first attempt to cure type 1 diabetes by pancreas transplantation was done at the University of Minnesota, in Minneapolis, on December 17, 1966, followed by a series of whole pancreas transplantation. Due to the lack of potent immunosuppressive drugs, rejections and infections, it was concluded that pancreas was less antigenic than the kidney which was less antigenic than the duodenum. It opened the door to a period, between the mid 70's to mid 80's where only segmental pancreatic grafts were used in the recipient. Numerous techniques for diverting or dealing with the pancreas juice secretion were described, none of them being satisfactory. In the late 70's - early 80's, three major events happened and boosted the development of pancreas transplantation: firstly the introduction of Cyclosporine A in the clinical field, secondly the organization on March 1980, of the first international meeting on Pancreas Transplantation with the first report of the International Pancreas Transplantation Registry (IPTR) and finally in 1982, the organization of the first informal so-called Spitzingsee meetings where pancreas transplantation successes but mainly failures were discussed which precluded the onset of IPITA (International Pancreas and Islet Transplantation Association), EuroSPK (European Study Group for simultaneous Pancreas and Kidney Transplantation) and EPITA (European Pancreas and Islet Transplantation Association). During one of the Spitzingsee meetings, participants had the idea to renew the urinary drainage technique of the exocrine secretion of the pancreatic graft with segmental graft and eventually with whole pancreaticoduodenal transplant. That was clinically achieved during the mid 80's and remained the mainstay technique during the next decade. In parallel, the Swedish group developed the whole pancreas transplantation technique with enteric diversion. It was the onset of the whole pancreas reign. The enthusiasm for the technique was rather moderated in its early phase due to the rapid development of liver transplantation and the need for sharing vascular structures between both organs, liver and pancreas. During the modern era of immunosuppression, the whole pancreas transplantation technique with enteric diversion became the gold standard for simultaneous pancreas and kidney transplantation (SPK), with portal drainage of the venous effluent of the pancreas, even for pancreas after kidney (PAK) or pancreas transplantation alone (PTA). Today, there remains room for improvement: safety of using the duodeno-duodenal anastomosis technique must be confirmed by prospective analysis while preventing ischemic reperfusion injuries, using specific drugs; that must be assessed in new trials. PMID:18710120

Squifflet, J-P; Gruessner, R W G; Sutherland, D E R

2008-01-01

211

Variability of preoperative breast MRI utilization among older women with newly diagnosed early-stage breast cancer.  

PubMed

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

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

2013-01-01

212

One hundred eleven simultaneous pancreas-kidney transplantations: 10-year experience from a single center in Portugal.  

PubMed

From May 2000 to May 2010, we performed 111 simultaneous pancreas-kidney transplants (SPKT) from cadaveric donors, by using enteric drainage and systemic vascular anastomosis. In 26 cases they showed 6 HLA mismatches. Immunosuppression included antithymocyte globulin, tacrolimus, mycophenolate mofetil, and steroids. The patients' mean age was 34 ± 6 years, and mean time from diabetes diagnosis was 23 ± 6 years; 107 patients had been on dialysis for 32 ± 24 months, and 4 had a preemptive status. Acute rejection episodes were detected in 20 patients (18%): in 3 cases they affected both organs, in 9 only the kidney, and in 8 only the pancreas. The incidence of complications needing reoperation was 28.8%. They were mostly pancreas graft-related, including bleeding, thrombosis, and infection. In more recent years, after a slight modification of surgical technique, we noted a decreased rate of complications. Six patients died from: 2 from cardiovascular or cerebrovascular disease, 3 from infection, and 1 from an unknown cause. Pancreas graft loss occurred in 26 and kidney graft loss in 12 patients. Four patients underwent a second pancreas and 5 a second kidney graft. Patients with surviving grafts showed good function: serum creatinine, 1.09 ± 0.23 mg/dL; fasting blood glucose, 79.7 ± 9.8 mg/dL; and HbA(1c), 4.88 ± 0.47%. Patient, kidney, and pancreas survival results were 96%, 96%, and 83% at 1; 94%, 91%, and 75% at 5; and 94%, 62%, and 69% at 10 years, respectively. These good results, compared with larger series and to recent pancreas transplant registry reports, are a strong motivation for the further development of this unique program in Portugal. PMID:21335189

Martins, L; Henriques, A C; Dias, L; Pedroso, S; Almeida, M; Santos, J; Dores, J; Almeida, R; Cabrita, A; Teixeira, M

2011-01-01

213

Resectable carcinoma developing in the remnant pancreas 7 years and 10 months after distal pancreatectomy for invasive ductal carcinoma of the pancreas: report of a case  

PubMed Central

Background Pancreatic ductal adenocarcinoma, which represents 90% of pancreatic cancers, is one of the most lethal and aggressive malignancies. Operative resection remains the only treatment providing prolonged survival, however, recurrence of pancreatic ductal adenocarcinoma occurs in up to 80% of patients with pancreatic cancer within 2 years of a potential curative resection. There are few reports of pancreatic carcinoma recurrence (primary second cancer) in the remnant pancreas after pancreatectomy. Case presentation A 52-year-old woman underwent a distal pancreatectomy for pancreatic cancer in September 2004. Adjuvant chemotherapy was started after surgery and continued for 4 years. In March 2012, marked elevation of DUPAN-II was observed, followed by an irregular stenotic finding in the main duct. We performed an en bloc resection of the remnant pancreas in July 2012. Histologically, the tumor contained a second primary pancreatic carcinoma with lymph node metastasis. At follow-up 20 months after the second operation, the patient was alive without recurrence. Fourteen cases of resectable cancer developing in the remnant pancreas after a pancreatectomy for cancer have been reported; a minority of these was identified as second primary tumors. Therefore, our patient’s primary second cancer is a rare event. Conclusion The patient is considered to have shown a rare, unique pancreatic cancer recurrence. Persistent elevation of a tumor marker and extensive imaging led to proper diagnosis and treatment.

2014-01-01

214

The molecular mechanisms, diagnosis and management of congenital hyperinsulinism  

PubMed Central

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

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

2013-01-01

215

The molecular mechanisms, diagnosis and management of congenital hyperinsulinism.  

PubMed

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

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

2013-01-01

216

Cystic neoplasia of the pancreas: pathology and biology.  

PubMed

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

Adsay, N Volkan

2008-03-01

217

Preoperative optimization and risk assessment.  

PubMed

Because most older adults with hip fractures require urgent surgical intervention, the preoperative medical evaluation focuses on the exclusion of the small number of contraindications to surgery, and rapid optimization of patients for operative repair. Although many geriatric fracture patients have significant chronic medical comorbidities, most patients can be safely stabilized for surgery with medical and orthopedic comanagement by anticipating a small number of common physiologic responses and perioperative complications. In addition to estimating perioperative risk, the team should focus on intravascular volume restoration, pain control, and avoidance of perioperative hypotension. PMID:24721361

Nicholas, Joseph A

2014-05-01

218

Preoperative assessment: an anesthesiologist's perspective.  

PubMed

Advances in anesthesia and surgery have made it so that almost any patient with a resectable lung malignancy is now an operative candidate given a full understanding of the risks and after appropriate investigation. This situation necessitates a change in the paradigm that anesthesiologists use for preoperative assessment. Understanding and stratifying the perioperative risks allows the anesthesiologist to develop a systematic focused approach to these patients at the time of the initial contact and immediately before induction, which can be used to guide anesthetic management. PMID:15707343

Slinger, Peter D; Johnston, Michael R

2005-02-01

219

Preoperative assessment for pulmonary resection.  

PubMed

Because of recent advances in anesthesia and surgery, almost any patient with a resectable lung malignancy is now an operative candidate, given a full understanding of the risks and provided he or she is investigated appropriately. This progress necessitates a change in the paradigm that one uses for preoperative assessment. Understanding and stratifying the perioperative risks allows the anesthesiologist to develop a systematic focused approach to these patients at the time of the initial contact and immediately before induction, which then can be used to guide anesthetic management (Fig. 7). PMID:11571900

Slinger, P D; Johnston, M R

2001-09-01

220

Squamous cell carcinoma of the pancreas  

PubMed Central

Pancreatic malignancies can be subdivided into endocrine and non-endocrine processes. Of the non-endocrine tumours, ductal carcinoma is the most common, and the ductal carcinomas can be further subdivided into adenocarcinomas and squamous cell carcinomas. The adenocarcinomas constitute most of the non-endocrine pancreatic malignancies, and the treatment options for these, although limited in efficacy, are relatively well established. The squamous cell carcinoma pathology is a rare entity, and few reports of it are found in the literature. As a result, treatment options for squamous cell carcinoma of the pancreas are poorly understood. Here, we report the presentation of a 48-year-old woman with metastatic squamous cell carcinoma of the pancreas. The subsequent investigations, treatment, and outcome are described.

Al-Shehri, A.; Silverman, S.; King, K.M.

2008-01-01

221

Ultrasonography of the pancreas. 2. Harmonic imaging.  

PubMed

Tissue harmonic imaging (THI) is a relatively new ultrasonographic imaging modality which has been implemented in many modern scanners. As several previous studies have pointed out, THI can help to overcome some shortcomings of conventional B-mode ultrasonography (US). The aim of this article is to give a compact summary of the potentials of THI, focused on pancreatic imaging. Beginning with a recapitulation of the technical background of THI, the particularities and suitable applications of THI in US of the pancreas are discussed. Examination protocols and typical indications are presented together with example images. Finally, new trends and developments in B-mode sonography of the pancreas such as panorama US, compound imaging, and photopic US are mentioned. PMID:16850350

Hohl, C; Schmidt, T; Honnef, D; Günther, R W; Haage, P

2007-01-01

222

Porcelain gallbladder complicated with pancreas divisum.  

PubMed

We report a rare case of porcelain gallbladder associated with pancreas divisum (PD). A 60-year-old woman suffered from discomfort in the back of the right side. An abdominal radiograph revealed a calcified spherical mass in the right upper quadrant. Ultrasonography revealed a scattered echo with a posterior acoustic shadow in the gallbladder wall. A plain computed tomography (CT) scan showed flecks of intramural calcification in the wall of the gallbladder. Endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP) showed separate openings for the Santorini and Wirsung ducts. The patient underwent cholecystectomy after porcelain gallbladder and pancreas divisum had been diagnosed. The porcelain gallbladder resulted from a stone impacted in the neck of the gallbladder. Patients with PD should be followed carefully, because gallstones often accompany PD, and porcelain gallbladder may result, as in this patient. PMID:17139436

Takeda, Kazuhisa; Sekido, Hitoshi; Sugita, Mitsutaka; Tanaka, Kuniya; Endo, Itaru; Togo, Shinji; Shimada, Hiroshi

2006-01-01

223

Epigenetic regulation of pancreas development and function  

PubMed Central

Multiple signaling systems and transcription factor cascades control pancreas development and endocrine cell fate determination. Epigenetic processes contribute to the control of this transcriptional hierarchy, involving both histone modifications and DNA methylation. Here, we summarize recent advances in the field that demonstrate the importance of epigenetic regulation in pancreas development, ?-cell proliferation, and cell fate choice. These breakthroughs were made using the phenotypic analysis of mice with mutations in genes that encode histone modifying enzymes and related proteins; by application of activators or inhibitors of the enzymes that acetylate or methylate histones to fetal pancreatic explants in culture; and by genomic approaches that determined the patterns of histone modifications and chromatin state genome-wide.

Avrahami, Dana; Kaestner, Klaus H.

2012-01-01

224

Lymphoepithelial cyst of the pancreas in a 65-year-old man.  

PubMed

A case of an extremely rare cystic lesion of the pancreas is presented. The multilocular cyst was found adjacent to the upper border of the pancreatic body, and the cyst contained bean curd lees-like substances. Histologically, the cyst wall consisted of mature keratinizing squamous epithelium and surrounding lymphoid tissue stroma, and the cyst was filled with keratinized materials. A histopathologic diagnosis of typical lymphoepithelial cyst of the pancreas, proposed by Truong et al (Am J Surg Pathol 11:899-903, 1987), was made. Its histogenesis is still unknown; however, we hypothesize that it might arise from a benign epithelial inclusion of a peripancreatic lymph node, followed by squamous metaplasia of the epithelial inclusion. We recently found a retropyloric lymph node with a squamous epithelial inclusion, which might support this hypothesis regarding the histogenesis of the cyst. PMID:1717361

Hisaoka, M; Haratake, J; Horie, A; Yasunami, Y; Kimura, T

1991-09-01

225

Incremental Value of the Pancreas Allograft to the Survival of Simultaneous Pancreas-Kidney Transplant Recipients  

PubMed Central

OBJECTIVE To quantify the incremental survival benefit of the pancreas allograft in simultaneous pancreas-kidney (SPK) transplant recipients. RESEARCH DESIGN AND METHODS Data from the national transplant database from 2000 to 2007 were analyzed. SPK recipients who had functioning allografts to 1-year post transplant (n = 3,304) were compared with those who had failure of the renal (n = 233) or pancreatic (n = 112) graft. The main outcome was a projection of 10 life-years of patient survival beyond the first transplant anniversary. RESULTS Recipients with function of both organs accrued 9.4 life-years following transplantation. Projected survival in patients with kidney failure was reduced to 2.5 life-years. Pancreas failure reduced predicted survival to 8 life-years. Renal allograft failure impacts life expectancy significantly (adjusted hazard ratio [aHR] 12.13). However, pancreas allograft failure was also associated with reduced survival (aHR 2.62). CONCLUSIONS Although the majority of the survival benefit of SPK transplant is due to the renal transplant, pancreas allograft function does contribute to patient survival.

Salvalaggio, Paolo R.; Dzebisashvili, Nino; Pinsky, Brett; Schnitzler, Mark A.; Burroughs, Thomas E.; Graff, Ralph; Axelrod, David A.; Brennan, Daniel C.; Lentine, Krista L.

2009-01-01

226

Solid-cystic tumour of the pancreas  

Microsoft Academic Search

Summary Immunohistochemical studies and DNA flow-cytometric investigations were performed in a case of solid-cystic tumour of the pancreas in a 35-year-old woman. All tumour cells were immunoreactive for the neuroendocrine cell markers chromogranin A and neuron-specific?-enolase. Moreover, about 10% of tumour cells were immunoreactive for insulin, while hypoglycaemia was absent. Few tumour cells (less than 1%) were immunoreactive for somatostatin,

A. von Herbay; B. Sieg; H. F. Otto

1990-01-01

227

Annular pancreas associated with diffuse chronic pancreatitis.  

PubMed

A patient with longstanding diabetes and renal failure presented with painless vomiting due to duodenal obstruction was found to have an annular pancreas. Initial operative evaluation, later pathologically confirmed, demonstrated involvement of not only the annulus, but also the entire gland by diffuse atrophic chronic pancreatitis. We speculate on the possible influence of the underlying diabetes and renal disease on the pathogenesis of the unusual generalized chronic inflammatory changes and the precipitation of duodenal obstruction in this patient. PMID:3605030

Gilinsky, N H; Lewis, J W; Flueck, J A; Fried, A M

1987-07-01

228

Pancreas transplantation: solid organ and islet.  

PubMed

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

Mittal, Shruti; Johnson, Paul; Friend, Peter

2014-04-01

229

Pancreas transplantation: a treatment option for people with diabetes.  

PubMed

Since the first pancreas transplants in the early 1960s, whole-organ pancreas transplantation, either alone or combined with kidney transplantation, has become commonplace in many countries around the world. Whole-organ pancreas transplantation is available in the UK, with ~200 transplants currently carried out per year. Patient survival and pancreas graft outcome rates are now similar to other solid organ transplant programmes, with high rates of long-term insulin independence. In the present review, we will discuss whole-pancreas transplantation as a treatment for diabetes, focusing on indications for transplantation, the nature of the procedure performed, graft survival rates and the consequences of pancreas transplantation on metabolic variables and the progression of diabetes-related complications. PMID:24313883

Mittal, S; Gough, S C L

2014-05-01

230

Metastatic disease to the pancreas documented by endoscopic ultrasound guided fine-needle aspiration: a seven-year experience.  

PubMed

The study was performed to determine the frequency and origin for metastatic disease to the pancreas as found in an endoscopic ultrasound directed fine-needle aspiration series. The records of the Departments of Pathology at the University of Utah School of Medicine and the David Geffen School of Medicine were electronically searched for all fine-needle aspirates obtained from pancreatic masses between January 1, 2002 and March 31, 2010. All cases with a diagnosis of metastatic disease were reviewed and whenever possible correlated with subsequent resection specimens. A total of 17 metastatic malignancies to the pancreas were detected in pancreatic FNAs representing 0.73% of all cases. Primaries included eight renal cell carcinomas, one medullary carcinoma of the thyroid, four lymphomas, one alveolar rhabdomyosarcoma, one squamous cell carcinoma derived from the esophagus, and a second squamous cell carcinoma originating from a lung primary and a small cell carcinoma of the lung. Metastatic renal cell carcinoma was the most frequent metastasis to the pancreas representing 47% of metastatic lesions detected by FNA. The metastatic deposits could be detected in the pancreas as many as 10 years following the original diagnosis and resection of the renal cell carcinoma. PMID:22334524

Layfield, Lester J; Hirschowitz, Sharon L; Adler, Douglas G

2012-03-01

231

Acute perforative appendicitis during preoperative chemotherapy for Wilms tumor.  

PubMed

Infectious complications are not uncommon in children undergoing treatment for cancer. Abdominal pain, especially right lower quadrant pain secondary to appendiceal and cecal inflammation, is a major concern in immunocompromised hosts and a potential source of sepsis. The authors report the case of a child who developed acute perforative appendicitis requiring appendectomy while on preoperative chemotherapy for Wilms tumor, stage IV, favorable histology. Problems related to diagnosis and management of acute abdominal pain and infection in an immunocompromised child with an abdominal mass are discussed along with a review of the literature. PMID:12554525

Velez, Maria C; Athale, Uma H; Loe, William; Warrier, R P

2003-03-01

232

Laparoscopic Diagnosis and Treatment in Gynecologic Emergencies  

PubMed Central

Objective: To present an analysis of our experience with 22 consecutive cases of acute abdominal gynecologic emergencies managed with a laparoscopic approach. Methods: From March 1997 to October 1998, 22 patients with a diagnosis of acute abdominal gynecologic emergencies underwent laparoscopic intervention. A transvaginal ultrasound was performed on all patients preoperatively to supplement the diagnostic workup. Surgical time, complications, and length of hospital stay were evaluated, and the laparoscopic diagnosis was compared with the preoperative diagnosis. Results: The laparoscopic diagnosis was different from the preoperative diagnosis in 31.8% of patients. Of the 22 patients, laparoscopic therapeutic procedures were performed in 18 (81.8%), all satisfactorily, and with no need for conversion to open surgery. No morbidity or mortality occurred. Conclusion: Laparoscopy is a safe and effective method for diagnosing and treating gynecologic emergencies.

Cantele, Hector; Leyba, Jose Luis; Navarrete, Manuel; Llopla, Salvador Navarrete

2003-01-01

233

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

PubMed Central

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

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

1993-01-01

234

Laryngeal cancer: diagnosis and preoperative work-up.  

PubMed

Laryngeal carcinoma is the eleventh-most common form of cancer among men worldwide and is the second-most common malignancy of the head and neck. The primary functions of the larynx involve phonation, respiration, and deglutition but it also contributes to taste and smell by allowing the movement of air over the special sense organs. Thus, loss of laryngeal function affects speech and swallowing and some of the senses that allow us to enjoy the world. Moreover, total laryngectomy bypasses the critical humidification function of the upper aerodigestive tract that renders pulmonary toiletry problematic for these patients. With relatively little change in mortality since the 1970s, recent research has focused not only on improving survival but on laryngeal preservation modalities. PMID:18570953

Chu, Eugene A; Kim, Young J

2008-08-01

235

Preoperative localization procedures for initial surgery in primary hyperparathyroidism.  

PubMed

The experience of the surgeon and precise localization of abnormal parathyroid glands determine the success of surgery for primary hyperparathyroidism (HPT). In HPT patients undergoing repeat surgery, the use of localization studies improved the ability to identify the remaining abnormal parathyroid tissue. This study investigated the roles of preoperative localization techniques for initial surgery for primary HPT. From 1985 through 1997, two noninvasive localization procedures, ultrasonography (US) and 201thallium chloride-99mtechnetium pertechnetate subtraction scanning (Tl-Tc), were used prior to initial exploration for primary HPT in 76 patients. Their accuracy was determined on the basis of surgical and pathologic results. The surgical success rate was 96% (73/76). The sensitivities of US and Tl-Tc were 71% and 49%, respectively. The sensitivity of Tl-Tc was higher for the lower parathyroid glands. In 21 of 26 patients who underwent fine-needle aspiration (FNA) of the suspected enlarged parathyroid gland, the diagnosis of parathyroid adenoma was confirmed preoperatively. We conclude that the concomitant use of US and FNA is a safe and convenient method for preoperative localization of the parathyroid glands prior to initial surgical exploration in patients with primary HPT. Bilateral neck exploration by an experienced surgeon should be the routine procedure. US and Tl-Tc alone offer limited localization information, and unilateral exploration should be reserved for selected cases in which the results of these two imaging studies are consistent with one another. PMID:9830277

Huang, S H; Lai, I R; Liaw, K Y; Cheng, Y C; Hsiao, Y L; Chang, T C

1998-10-01

236

Seven-Year Experience of Noninvasive Preoperative Diagnostics in Children with Congenital Heart Defects: Comprehensive Analysis of 2,788 Consecutive Patients  

Microsoft Academic Search

The spectrum of patients operated on without preoperative catheterization and angiography, the accuracy of echocardiographic diagnosis and its impact on the results of surgical treatment were prospectively assessed in 2,788 children consecutively operated for congenital heart defects (CHD) between 1986 and 1992. The overall percentage of surgery based solely on noninvasive preoperative examination increased from 63% in 1986 to 81%

Jan Marek; Jan Škovránek; Václav Chaloupecký; Petr Tax; Oleg Reich; Milan Šamánek

1995-01-01

237

Development of diabetes mellitus in living pancreas donors and recipients.  

PubMed

Previously, recurrence of insulin-dependent diabetes mellitus after pancreas transplants was only sporadically reported. Newer data, however, indicate recurrence rates as high as 5%. After identical-twin pancreas transplants, diabetes recurs in the absence of immunosuppressive therapy - strong evidence that it is an autoimmune disease. After deceased donor pancreas transplants, immunologic markers (autoantibodies, autoreactive T cells) herald recurrence. Selective destruction of ? cells, still relatively uncommon, is not restricted to MHC compatibility. The development of diabetes in living pancreas donors is rare; it can be largely avoided by meticulous metabolic evaluation before donation and prevention of obesity after donation. PMID:21790295

Gruessner, Rainer W G; Pugliese, Alberto; Reijonen, Helena K; Gruessner, Stephan; Jie, Tun; Desai, Chirag; Sutherland, David E R; Burke, George W

2011-07-01

238

A noninvasive mucinous cystic neoplasm with intermediate-grade dysplasia of the pancreas and extensive squamous metaplasia: a case report with clinicopathological correlation  

PubMed Central

Abstract Squamous metaplasia presenting in noninvasive mucinous cystic neoplasm (MCN) of the pancreas is extremely rare. We described a case of 39-year-old Chinese female with a 5-year history of a slow growing mass in the left upper abdomen and an 18-month history of surgical incision exudation. The patient underwent cystojejunostomy, laparotomy and distal pancreatectomy consecutively because of the initial diagnosis of “pancreatic cyst”. The histological section showed columnar mucin-producing epithelium formed small papillary projections and extensively visible squamous metaplasia. Therefore the diagnosis of “noninvasive MCN with intermediate-grade dysplasia of the pancreas and extensive squamous metaplasia” was made finally. The squamous component of the pancreas may be derived from pluripotent stem cells, and may be in association with cystojejunostomy. Virtual slides The virtual slide(s) for this article can be found here http://www.diagnosticpathology.diagnomx.eu/vs/1322364365718540

2012-01-01

239

Preoperative Imaging Staging of Rectal Cancer  

Microsoft Academic Search

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

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

2007-01-01

240

Preoperative easily misdiagnosed telangiectatic osteosarcoma: clinical-radiologic-pathologic correlations.  

PubMed

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

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

2013-01-01

241

One Institution's Experience With Pancreas Transplantation  

PubMed Central

The University of Minnesota has the largest experience with pancreas transplantation of any institution, with 130 cases since 1966, including 116 in 98 patients between July 1978 and June 1985. Currently, 30 patients are insulin-independent, 19 for greater than one year, the longest for seven years. One-year patient and graft survival rates overall are 87% and 30%, respectively. Of 98 recipients, 49 had had previous kidney transplants, while 49 had not, and currently most of the pancreas recipients do not have uremia and have not had a kidney transplant but have early complications of diabetes. A total of 44 of the grafts were procured from related and 72 from cadaver donors. Although 32 of the 116 grafts (28%) failed for technical reasons, the most common cause of graft failure has been rejection. Various immunosuppressive regimens have been used in attempts to reduce the rejection rate, and one combination, low-dose cyclosporine-azathioprine-prednisone (triple therapy), has been particularly effective, with a one-year functional survival rate of 73% in recipients of technically successful grafts from human leukocyte antigen-mismatched cadaver or related donors (N = 20). The pancreas graft survival rates have improved gradually (43% for 1984 to 1985, N = 30; versus 27% for 1978 to 1983, N = 86) for transplants from both related and cadaver donors. Metabolic studies from most recipients with functioning grafts (insulin-independent) show normal or nearly normal results. Preliminary observations on secondary complications suggest a more favorable course in recipients whose grafts have functioned long term than in those whose grafts failed early.

Sutherland, David E. R.; Kendall, David M.; Najarian, John S.; Goetz, Frederick C.

1985-01-01

242

The cystic fibrosis of exocrine pancreas.  

PubMed

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

Wilschanski, Michael; Novak, Ivana

2013-05-01

243

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

PubMed

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 x 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

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

2009-08-21

244

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

PubMed Central

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

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

2014-01-01

245

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

PubMed Central

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

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

2011-01-01

246

851 resected cystic tumors of the pancreas: A 33-year experience at the Massachusetts General Hospital  

PubMed Central

Background The objective of this study was to identify trends in the diagnosis and treatment of cystic neoplasms of the pancreas using a retrospective review of patients from a surgical database at an academic referral center during a 33-year period. Methods Patient characteristics, including demographics, pathology, and survival, were analyzed over 5 time periods between 1978 and 2011. Results A total of 851 consecutive patients underwent resection for a cystic neoplasm of the pancreas during a 33-year period. Sixty-five percent of patients were female, and mean age was 60 years. The most common pathologic diagnoses were intraductal papillary mucinous neoplasm (38%), mucinous cystic neoplasm (23%), serous cystadenoma (16%), and cystic neuroendocrine neoplasm (7%). There was a stepwise increase in the number of resections across time periods (67 between 1978 and 1989; 376 between 2005 and 2011), with a parallel increase in the proportion of incidentally discovered lesions (22% to 50%). Diagnosis of intraductal papillary mucinous neoplasm was very uncommon in the first 2 time periods (before the first recognition of intraductal papillary mucinous neoplasm as a distinct entity) but predominated in the last 2 (41% and 49%), and cystic neuroendocrine neoplasms, which constituted 3% of the cystic neoplasms in the first time-period, now comprise more than 8% of pancreatic cystic neoplasms. The proportion of malignant neoplasms decreased over time (41% between 1978 and 1989; 12% between 2005 and 2011), reflecting probably the earlier diagnosis and treatment of premalignant neoplasms. Although operative mortality was minimal (4/849, 0.5%), the postoperative complication rate was 38%. Overall 5-year survival for all mucinous lesions was 87%. Conclusion Cystic neoplasms of the pancreas are being diagnosed and treated with increasing frequency. At present, most are incidentally discovered intraductal papillary mucinous neoplasms. (Surgery 2012;152:S4–12.)

Valsangkar, Nakul P.; Morales-Oyarvide, Vicente; Thayer, Sarah P.; Ferrone, Cristina R.; Wargo, Jennifer A.; Warshaw, Andrew L.; Castillo, Carlos Fernandez-del

2013-01-01

247

Pseudoaneurysm after combined kidney/pancreas transplantation presenting with sentinel bleeding: A case report and review.  

PubMed

Background Vascular complications, most commonly arterial or venous thrombosis, are one of the most common causes of early graft loss after pancreas transplantation. However, only a few cases of pseudoaneurysm formation have been reported. Case Report This case report is unique for the presentation of pancreatic graft pseudoaneurysm with a sentinel retroperitoneal bleed as well as the failure to achieve diagnosis by ultrasound or standard cut CT scanning. The case emphasizes the importance of clinical suspicion and the need for dedicated fine-cut CT angiography or standard percutaneous angiography for diagnosis. The site of the anastomosis precluded minimally invasive treatment options and open repair with graft salvage was accomplished with minimal morbidity. Conclusions Although pseudoaneurysm after pancreas transplantation is uncommon, unexplained post-operative bleeding, even in the stable patient, should raise the suspicion of a sentinel bleeding event necessitating urgent angiography. Rapid diagnosis and treatment can prevent potential life- and graft-threatening rebleeding. The choice between minimally invasive and open surgical repair should be individualized depending on the site of the lesion. PMID:24995594

Montenovo, Martin; Vaidya, Sandeep; Bakthavatsalam, Ramasamy; Halldorson, Jeffrey

2014-01-01

248

A case report of a patient with advanced acinar cell carcinoma of the pancreas: long-term survival with regional, systemic and targeted therapy.  

PubMed

Acinar cell carcinoma of the pancreas is an uncommon malignancy for which there are no prospective, randomized data to guide therapy. We describe the clinical course and management of a patient with advanced pancreatic acinar cell carcinoma who is alive seven years after diagnosis using systemic and regional chemotherapies as well as molecularly targeted agents. PMID:23748831

Ang, Celina; Herran, Luis A; Lagunes, Diane Reidy; Klimstra, David S; Kemeny, Nancy E

2013-01-01

249

Cystic fibrosis presenting as recurrent pancreatitis in a young child with a normal sweat test and pancreas divisum: a case report  

Microsoft Academic Search

INTRODUCTION: Pancreatitis is a rare manifestation of cystic fibrosis (CF) and may rarely be the presenting symptom in adolescent or adult patients with CF. We report a case of a 4 year-old female who initially presented with recurrent pancreatitis, a normal sweat test, and a diagnosis of pancreas divisum. She was subsequently diagnosed with cystic fibrosis at the age of

Laurie Conklin; Pamela L Zeitlin; Carmen Cuffari

2008-01-01

250

Primary yolk sac tumor arising in the pancreas with hepatic metastasis: a case report.  

PubMed

Extragonadal yolk sac tumor (YST) is a relatively rare entity. We describe here the case of an extragonadal YST that occurred in the pancreas with hepatic metastasis in an adult woman. The contrast enhanced CT images of the abdomen revealed a heterogeneous, solitary mass occupying the pancreatic neck and body with slightly inhomogeneous contrast enhancement. Two low-density lesions in the liver were also displayed on the CT images. The patient underwent surgery and the diagnosis of YST was pathologically verified. PMID:20592932

Zhang, Bo; Gao, Shunliang; Chen, Ying; Wu, Yulian

2010-01-01

251

A systematic study of the vascularisation of the pancreas  

Microsoft Academic Search

Summary The anatomy of the vessels of the pancreas is well known. However, some refinement is necessary in response to new requirements. In this study 40 specimens of pancreas plus duodenum were dissected after injecting the vessels with latex. Arteries and veins were measured and drawn. The origin and course of the vessels and their anastomoses were studied. If the

B Donatini

1990-01-01

252

Update Lecture: Benign Diseases of the Exocrine Pancreas  

Microsoft Academic Search

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

Joachim Mössner

2011-01-01

253

Favorite Demonstration: Localization and Visualization of the Pancreas  

NSDL National Science Digital Library

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

Porta, Angela R.

2000-03-01

254

Comparison of Celsior and UW Solution in Experimental Pancreas Preservation  

Microsoft Academic Search

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

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

2002-01-01

255

What is artificial endocrine pancreas? Mechanism and history  

Microsoft Academic Search

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

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

2009-01-01

256

Two synchronous solid and cystic tumors of the pancreas.  

PubMed

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

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

1998-06-01

257

A novel proteinase from human pancreas.  

PubMed Central

A cholesterol-binding protein was previously isolated from human pancreas [Sziegoleit (1982) Biochem. J. 207, 573-582] and shown to consist of a single polypeptide chain with an apparent Mr of 28 000 and an isoelectric point of pH 4.9. In further investigations, a proteolytic activity was observed to be present in preparations of this protein. The enzyme activity was not dissociable from the cholesterol-binding protein. It decreased in the presence of sodium dodecyl sulphate or urea parallel to degradation of the protein, indicating autodegradation in the presence of these denaturants. Glucagon digestion studies indicated the carbonyl bond of alanine to be a favoured site of the enzymic cleavage. The proteinase was inactive against chromogenic substrates relatively specific for elastase, trypsin and chymotrypsin, but was found to cleave benzyloxycarbonylalanine p-nitrophenyl ester efficiently. The enzyme was inactivated by phenylmethanesulphonyl fluoride and was thus classified as a serine proteinase. Autoradiographic studies demonstrated binding to serum alpha 1-antitrypsin and alpha 2-macroglobulin in a similar manner to that observed with other pancreatic endo-proteinases. The collective results indicate that the isolated protein, provisionally named 'cholesterol-binding pancreatic proteinase', is a novel proteinase of the human pancreas. Quantitative measurements indicate that it comprises 4-6% of total protein in pancreatic secretions. Images Fig. 1. Fig. 4. Fig. 5. Fig. 6.

Sziegoleit, A

1984-01-01

258

Gastric cancer: the role of diffusion weighted imaging in the preoperative staging.  

PubMed

Purpose: Evaluate the role of diffusion-weighted-imaging (DWI) in the diagnosis and staging of gastric carcinoma. Materials and methods: A total of 31 patients with gastric adenocarcinoma, which underwent preoperative staging with 3Tesla Magnetic Resonance Imaging (MRI), were enrolled. Two radiologists evaluated the tumor staging in DWI. Results were compared to postsurgical pathologic findings. Results: The T factor accuracy of conventional MRI and DWI was 73% and 80% respectively; while the N staging accuracy of conventional MRI and DWI was 80% and 93%, respectively. Conclusion: DWI and apparent diffusion coefficient (ADC) values showed to be useful in preoperative staging of gastric cancer. PMID:24654696

Caivano, R; Rabasco, P; Lotumolo, A; D' Antuono, F; Zandolino, A; Villonio, A; Macarini, L; Guglielmi, G; Salvatore, M; Cammarota, A

2014-06-01

259

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

PubMed

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

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

2014-07-01

260

Technical failure of the pancreas after SPK transplant: are these patients good candidates for later pancreas retransplant?  

PubMed

Technical failure of the pancreas graft after a simultaneous pancreas-kidney (SPK) transplant is not uncommon, affecting roughly 10% of SPK recipients. These patients often recover with good kidney function, but have persistent issues related to their diabetes. The aim of this study was to determine if these patients were good candidates for a later pancreas retransplant. Outcomes were compared between 21 PASPK (pancreas after SPK) recipients and 361 recipients of a primary pancreas after kidney (PAK) transplant. Except for kidney graft source, there was no significant difference in the demographic characteristics between these two groups. In general, early surgical complications were more common in PASPK than PAK recipients (47.6% vs. 35.5%, p = 0.15), although the difference was not statistically significant. The incidence of acute rejection was no different between these two groups (28% vs. 33%, p = NS). At three yr post-transplant, patient and pancreas graft survival rates were also no different between the two groups (p = NS). The most common cause for graft loss in both groups was acute or chronic rejection. In conclusion, pancreas retransplant is a viable option for SPK recipients experiencing early technical failure of the pancreas graft. These recipients are not at higher immunologic risk vs. primary PAK recipients. PMID:18217905

Wang, Shen-Nien; Sturdevant, Mark; Kandaswamy, Raja; Gruessner, Rainer G W; Sutherland, David E R; Humar, Abhinav

2008-01-01

261

A fresh look at preoperative body washing.  

PubMed

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

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

2012-01-01

262

A fresh look at preoperative body washing  

PubMed Central

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

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

2012-01-01

263

Preoperative chemoradiotherapy versus preoperative radiotherapy in rectal cancer patients: assessment of acute toxicity and treatment compliance  

Microsoft Academic Search

The European Organisation for Research and Treatment of Cancer (EORTC) 22921 four-arm randomised trial questioned the value of preoperative chemoradiation (XRT-CT) versus preoperative radiation (XRT) and the value of additional postoperative chemotherapy (CT) versus none in T3-T4 M0 resectable rectal cancer patients. We report on the preoperative toxicity, treatment compliance and early deaths (all deaths up to 30 days after

J. F. Bosset; G. Calais; A. Daban; C. Berger; L. Radosevic-Jelic; P. Maingon; E. Bardet; M. Pierart; A. Briffaux

2004-01-01

264

Identification of early complications following pancreas and renal transplantation using contrast enhanced ultrasound (CEUS) - first results.  

PubMed

AIM: Identification of acute and subacute complications following pancreas and renal transplantation using contrast enhanced ultrasound (CEUS) in comparison with Magnetic Resonance Tomography (MRI), Computed Tomography (CT), Digital Subtraction Angiography (DSA) or Ultrasound (US). The study evaluated whether CEUS could confirm the preliminary diagnosis or even provide additional information, relevant for the therapeutic strategy. MATERIAL AND METHODS: Retrospective evaluation of 19 patients (13 male, 6 female, age 26-77 years, mean 53.2 years) following renal transplantation and 10 patients (4 male, 6 female, age 35-56 years, mean 45.7 years) following combined pancreas and renal transplantation. CEUS was used as an additional diagnostic method when obscure diagnostic findings occurred in US, CT, MRI or DSA. Fundamental B-scan, Color Coded Doppler Sonography (CCDS) and CEUS were performed in all patients by an experienced examiner using a multifrequency convex transducer (1-5 MHz). After a bolus injection of up to 2.4 ml SonoVue® [BRACCO, Italy] digital raw data was stored as cine-loops up to 5 minutes in length. RESULTS: In all patients, the pathological features and suspected diagnostic findings identified in the other imaging modalities could be confirmed using CEUS (100%). In 25 out of 29 patients (86.2%), new clinically relevant findings were detected. In 27 patients, the diagnosis of CEUS was confirmed during surgery (7), DSA (5), follow-up CEUS (13), CT (1) and MRI (1). In 4 patients renal AV-fistulas were found following biopsy, 3 patients showed post-operative allograft arterial stenosis or dissection, 1 patient demonstrated a stenosis of the common iliac artery and 2 patients were diagnosed with post-operative allograft venous thrombosis or stenosis. In 2 patients, a definite diagnosis of a benign lesion following renal transplantation was possible. In 1 patient a malignant lesion was suspected and confirmed following surgery. In 6 patients, normal perfusion of the pancreas and renal parenchyma and the corresponding vessels was diagnosed, in 5 patients the parenchymal perfusion was diminished and 1 patient suffered from pancreatitis. CONCLUSION: These first results show that CEUS can provide additional, clinically relevant informations in patients with acute and subacute complications following pancreas and renal transplantation. Thus, an early application within the diagnostic course seems favorable. PMID:23380964

Rennert, Janine; Farkas, Stefan; Georgieva, Martina; Loss, Martin; Dornia, Christian; Jung, Wolfgang; Stroszczynski, Christian; Jung, Ernst-Michael

2013-02-01

265

Pancreas Transplantation: Does Age Increase Morbidity?  

PubMed Central

Introduction. Pancreas transplantation (PTx) is the only definitive intervention for type 1 diabetes. Medical advancements in diabetes care have led to an aging PTx candidate pool. We report our experience with patients ?50 years of age undergoing PTx. Methods. We reviewed 136 consecutive PTx patients at our institution from 1996–2010; 17 were ?50 years of age. We evaluated demographics, surgical complications, acute rejection (AR) rates, nonsurgical infections, and survival outcomes. Results. Demographic data was similar (P > .05) between groups, excluding age. The two groups had comparable major and minor surgical complication rates (P = .10 and P = .25, resp.). The older group had a lower 1-year and overall AR rate (P = .04 and P = .03, resp.). The incidence of non-surgical infections and overall patient and graft survival was similar between groups (P > .05). Conclusion. Older patients with type 1 diabetes are feasible candidates for PTx, as surgical morbidity, incidence of infections, and AR rates are low.

Afaneh, Cheguevara; Rich, Barrie S.; Aull, Meredith J.; Hartono, Choli; Leeser, David B.; Kapur, Sandip

2011-01-01

266

Short- and long-term outcome for living pancreas donors.  

PubMed

The advantages of living donor pancreas transplants for the recipient include good HLA matching, lower immunologic risk, less immunosuppression, lower risk of infection and of posttransplant malignancies, and shorter pancreas graft preservation time. In 2008, a total of 155 segmental pancreas transplants using living donors were reported to the International Pancreas Transplant Registry from six countries. Pancreas living donors need to undergo a thorough pretransplant endocrinologic workup in order to minimize the risk of metabolic complications. The pretransplant workup has evolved over time, after initial reports showed that up to 25% of living donors had elevated hemoglobin A(1c) levels after donation. Avoiding obesity after donation diminishes the risk of long-term metabolic complications. The risk of surgical complications for the donor (such as pancreatitis, pancreatic leak or fistula, pancreatic abscess, and pancreatic pseudocyst) is less than 5%. If both the donor and recipient operations are technically successful, the long-term graft survival rate is significantly higher for living (versus deceased) donor pancreas transplant recipients. Future long-term studies of metabolic function in living donors are warranted to determine whether living donor pancreas transplants can safely be applied more widely and whether living donors can be used for islet transplants. PMID:19652901

Reynoso, Jason F; Gruessner, Christine E; Sutherland, David E R; Gruessner, Rainer W G

2010-03-01

267

One hundred pancreas transplants performed in a Brazilian institution.  

PubMed

After decades of controversy surrounding the therapeutic validity of pancreas transplantation, the procedure has become accepted as the preferred treatment for selected patients with type 1 diabetes mellitus. Between January 2001 and January 2008, 100 patients underwent pancreatic transplantation at our center: 88 simultaneous pancreas-kidney transplantation and 12 pancreas transplantations alone. Pancreas graft management of the exocrine drainage technique involved enteric drainage in 8 (all simultaneous pancreas-kidney) and the bladder in 92 cases. The recipient systemic venous system was used for the pancreas graft venous effluent in all cases. Our overall results have shown that the number of functioning pancreatic grafts was 64 of 100. Graft losses were: rejection (n = 8), venous thrombosis (n = 9), arterial thrombosis (n = 1), or surgical complications such as anastomotic leak (n = 3), perigraft infection (n = 10), pancreatitis of the graft (n = 5). Most cases of pancreatitis (80%) had preservation times exceeding 18 hours. Despite surgical and immunosuppressive complications, our impression was that pancreas transplantation was a highly effective therapy for diabetes mellitus. After 7 years of the program and 100 transplantations, we believe that there is a major role for transplantation in diabetes management. PMID:20005382

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

2009-12-01

268

OPTN/SRTR 2011 Annual Data Report: pancreas.  

PubMed

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

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

2013-01-01

269

Zebrafish mnx genes in endocrine and exocrine pancreas formation.  

PubMed

The pancreas consists of two components, which exert distinct homeostatic function, an endocrine part that secretes hormones including insulin and an exocrine part that produces digestive enzymes. In mouse, one of the factors essential for development of the pancreas is the Mnx-class homeobox transcription factor Hb9. Genetic studies showed that Hb9 is required for both initial morphogenesis of the pancreas as well as subsequent differentiation of insulin-producing beta-cells [Nat. Genet. 23 (1999) 71; Nat. Genet. 23 (1999) 67]. To get a better understanding of what role mnx genes play in pancreas development, we isolated and characterized mnx genes in the model organism zebrafish. We found one gene with homology to hb9 orthologs and two that display homology to the related chicken mnr2. Embryonic expression of the zebrafish mnx genes is very dynamic and is detected in derivatives of all three germ layers. Endodermal expression of hb9 takes place in the early gut endoderm and, later, in the endocrine pancreas and the swim bladder. In addition, one of the mnr2 genes, mnr2a, shows expression in an endodermal cell population that is initially intermingled with insulin-positive cells and that later becomes restricted to the exocrine pancreas. In knockdown studies using antisense morpholinos, we show that hb9 is essential for differentiation of the insulin-producing beta-cells but unlike mouse Hb9 is not needed for early morphogenesis of the pancreas. In contrast, mnr2a is required during late morphogenesis of the exocrine pancreas. In summary, our data suggest a tissue-specific mnx-expression code in the zebrafish pancreas and they reveal a novel role of an mnr2-related gene. PMID:15063174

Wendik, Björn; Maier, Esther; Meyer, Dirk

2004-04-15

270

Control of Cell Identity in Pancreas Development and Regeneration  

PubMed Central

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.

Stanger, Ben Z.; Hebrok, Matthias

2013-01-01

271

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

PubMed Central

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

2014-01-01

272

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

PubMed

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

Bouvet, L; Chassard, D

2014-04-01

273

[Results of preoperative preparation with mannitol in colorectal surgery. January-December 1995].  

PubMed

A study on the results obtained in 20 patients selected by the simple randomized method, who were preoperatively prepared for colorectal surgery with the oral administration of manitol and complementary antimicrobial therapeutics at the ASaturnino Lora@ Provincial Teaching Hospital, in Santiago de Cuba, from January to December, 1995, was conducted aimed at evaluating the results attained with the use of manitol in the preoperative preparation for colorectal surgery, determining its complications, analyzing its advantages, and assessing the patient, nurse and surgeon's opinion about the new procedure. The following variables were taken into account: age, preoperative diagnosis and previous operations. The percentage statistical method was used. Most of the patients were elderly, who were able to undergo surgery. There were no complications in connection with the preoperative preparation, which has the following advantages: it is simpler and more efficient that the traditional use of enemas, it is easy to apply, it saves time and resources on reducing the preoperative stay, it is considered as more comfortable for patients and nurses, and it is much more economic and effective, which was proved by surgeons during the operation. PMID:9934233

Torres Panuncia, B; Rodríguez Fernández, Z; Piña Prieto, L R

1998-01-01

274

The role of preoperative colonoscopy in colorectal cancer.  

PubMed

Routine preoperative colonoscopy has been recommended for those patients with the diagnosis of colorectal cancer to identify synchronous polyps and/or cancers which might otherwise be undetected on barium enema or at the time of operation. It has been suggested that this approach may alter surgical therapy or follow-up. The charts of 98 patients who underwent preoperative colonoscopy solely for the purpose of detecting additional polyps or cancers prior to open surgical resection for colorectal cancer were retrospectively reviewed. All patients had biopsy or barium-enema evidence of colorectal cancer. Patients with familial polyposis or chronic ulcerative colitis were excluded. Synchronous cancers were detected in 7.1 percent of patients, and synchronous neoplastic polyps in 29 percent. Forty-three percent of synchronous cancers and 73 percent of synchronous neoplastic polyps would not have been included in the standard surgical resection for the index cancer if the additional information provided by colonoscopy had not been available. Surgical treatment and/or follow-up were altered in 33 percent of patients as a consequence of the colonoscopic evaluation. Colonoscopy prior to surgery for colorectal carcinoma is highly desirable and may potentially improve long-term survival. PMID:3595362

Isler, J T; Brown, P C; Lewis, F G; Billingham, R P

1987-06-01

275

Preoperative serum tumor marker levels in gastric cancer.  

PubMed

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

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

2014-01-01

276

Cardiopulmonary Exercise Capacity and Preoperative Markers of Inflammation  

PubMed Central

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

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

2014-01-01

277

Preoperative Serum Tumor Marker Levels in Gastric Cancer  

PubMed Central

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

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

2014-01-01

278

Preoperative evaluation and oncologic principles of colon cancer surgery.  

PubMed

Colorectal cancer is the third most common malignancy in men and women and accounts for 10% of all cancer deaths. The primary risk factor for colorectal cancer is advancing age, but other factors also play a role in its development, including genetic predisposition, smoking, alcohol consumption, obesity, and high-fat, low-fiber diet. Colon cancer survival is primarily related to the stage of disease at diagnosis. The main screening tests for colon cancer are fecal occult blood testing, flexible sigmoidoscopy, double-contrast barium enema, and colonoscopy. The pre-operative evaluation should include a complete blood count, carcinoembryonic antigen (CEA), colonoscopy, and chest radiograph. Other preoperative evaluations are patient specific or of unproven benefit. The operative procedure should include a bowel preparation, parenteral antibiotics, and deep venous thrombosis prophylaxis. The procedure performed must be tailored to the location of the colon cancer but should include complete, en bloc resection of the cancer and its lymphatic drainage, including locally invaded structures. The bowel margins of resection should be at least 5 cm from the tumor to minimize anastomotic recurrences. Laparoscopic colectomy has been shown to be as safe and effective as open colectomy for the treatment of colon cancer. The use of sentinel lymph node biopsy is feasible but has not yet been proved clinically useful. Surveillance after surgery for colon cancer is necessary to monitor for metastatic disease or local recurrence. Several groups have made surveillance recommendations including office visits, colonoscopy, and CEA monitoring. PMID:20011299

Lynch, Matthew L; Brand, Marc I

2005-08-01

279

Bionic Pancreas Outperforms Insulin Pump in Adults, Youth  

MedlinePLUS

... 2014, 9 p.m. EDT Bionic pancreas outperforms insulin pump in adults, youth NIH grantees test device ... type 1 diabetes to replace fingerstick tests, manual insulin injections People with type 1 diabetes who used ...

280

Proteomic analysis of pancreas derived from adult cloned pig  

SciTech Connect

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.

Chae, Jung-Il; Cho, Young Keun [Centre for Regenerative Medicine, Korea Research Institute of Bioscience and Biotechnology (KRIBB), 111 Gwahangno, Yuseong-gu, Daejeon 305-806 (Korea, Republic of); Cho, Seong-Keun [Division of Applied Life Science, College of Agriculture and Life Science, Gyeongsang National University, Jinju, GyeongNam (Korea, Republic of); Kim, Jin-Hoi [Department of Animal Biotechnology, College of Animal Bioscience and Technology, KonKuk University, Seoul (Korea, Republic of); Han, Yong-Mahn [Department of Biological Sciences, Korea Advanced Institute of Science and Technology, Daejeon 305-701 (Korea, Republic of); Koo, Deog-Bon [Centre for Regenerative Medicine, Korea Research Institute of Bioscience and Biotechnology (KRIBB), 111 Gwahangno, Yuseong-gu, Daejeon 305-806 (Korea, Republic of)], E-mail: dbkoo@kribb.re.kr; Lee, Kyung-Kwang [Centre for Regenerative Medicine, Korea Research Institute of Bioscience and Biotechnology (KRIBB), 111 Gwahangno, Yuseong-gu, Daejeon 305-806 (Korea, Republic of)], E-mail: leekk@kribb.re.kr

2008-02-08

281

What You Need to Know about Cancer of the Pancreas  

MedlinePLUS

... in the pancreas . This disease is also called pancreatic cancer. In 2013, more than 45,000 Americans will ... years old. There are two main types of pancreatic cancer. Most often, pancreatic cancer starts in the ducts ...

282

Recurrence of autoimmunity in pancreas transplant patients: research update  

PubMed Central

SUMMARY Type 1 diabetes is an autoimmune disorder leading to loss of pancreatic ?-cells and insulin secretion, followed by insulin dependence. Islet and whole pancreas transplantation restore insulin secretion. Pancreas transplantation is often performed together with a kidney transplant in patients with end-stage renal disease. With improved immunosuppression, immunological failures of whole pancreas grafts have become less frequent and are usually categorized as chronic rejection. However, growing evidence indicates that chronic islet autoimmunity may eventually lead to recurrent diabetes, despite immunosuppression to prevent rejection. Thus, islet autoimmunity should be included in the diagnostic work-up of graft failure and ideally should be routinely assessed pretransplant and on follow-up in Type 1 diabetes recipients of pancreas and islet cell transplants. There is a need to develop new treatment regimens that can control autoimmunity, as this may not be effectively suppressed by conventional immunosuppression.

Pugliese, Alberto; Reijonen, Helena K; Nepom, Jerry; Burke, George W

2011-01-01

283

Double-Nuclide Subtraction Scintiscanning of the Pancreas.  

National Technical Information Service (NTIS)

The paper intends to find out if there is a correlation between clinical pancreas diagnoses and diagnoses by subtraction scintiscanning; furthermore, the findings of scintiscanning are compared with those of radiological and sonographic methods. In order ...

E. C. Streithoff

1978-01-01

284

Pre-Surgical Radiologic Diagnostics of Pancreas Diseases.  

National Technical Information Service (NTIS)

At the example of a comparative study with 112 patients it should be demonstrated that the different radiologic techniques are complementary in pancreas diagnostics with respect to their indication and proposition. The study yields the following procedure...

C. Seifried

1979-01-01

285

Genetics Home Reference: Pearson marrow-pancreas syndrome  

MedlinePLUS

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

286

Testosterone biotransformation by the isolated perfused canine pancreas  

SciTech Connect

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.

Fernandez-del Castillo, C.; Diaz-Sanchez, V.; Varela-Fascinetto, G.; Altamirano, A.; Odor-Morales, A.; Lopez-Medrano, R.M.; Robles-Diaz, G. (Instituto Nacional de la Nutricion Salvador Zubiran, Mexico City (Mexico))

1991-01-01

287

[Technique of vascular reconstructive bench surgery in pancreas transplantation].  

PubMed

Vascular reconstructive bench surgery has become a basic step in pancreas transplantation, in order to prevent vascular thrombosis. The Authors describe their experience, also reporting literature results. PMID:8679427

Arcuri, V; Tommasi, G V; Fontana, I; Manolitsi, O; Vassallo, S; Casolino, V; Paraluppi, G L; Valente, U

1996-03-01

288

Atypical presentations of screen-detected DCIS Implications for pre-operative assessment and surgical intervention.  

PubMed

Few series are published on DCIS that forms parenchymal lesions on screening mammograms. The implications of these unusual presentations for pre-operative assessment and surgical intervention are of interest. In the setting of a large, population-based breast cancer screening program, the diagnostic and management implications of DCIS presenting as parenchymal lesions on screening mammograms are investigated. A total of 125 lesions (20.1% of all DCIS) presented as a mass (n=99) or microcalcifications with an associated parenchymal lesion (n=26). Cytology was positive in 47.1% of cases. Core biopsy diagnosed DCIS in 68.4% of cases. Breast surgery after a definite preoperative diagnosis achieved negative initial margins in 69.4% case, versus 54.7% without a pre-operative malignant diagnosis. The mastectomy rate was 26.4%. Axillary surgery was carried out in 32.8% cases, including axillary clearance in 26.4% of cases. One in five cases of DCIS detected during mammographic screening has features other than pure microcalcifications. This has implications for pre-operative assessment and surgical management. PMID:17097878

Farshid, Gelareh; Downey, Peter; Gill, P Grantley

2007-04-01

289

[Cystic dystrophy of the duodenal wall in aberrant pancreas].  

PubMed

Cystic dystrophy of the duodenal wall developing in heterotopic pancreas is rare. Pancreaticoduodenectomy is usually advocated in cases of symptomatic cystic dystrophy without chronic pancreatitis but little is known about long-term results. We report a case of cystic dystrophy of the duodenum wall developing in heterotopic pancreas responsible for abdominal pain and duodenal obstruction associated with chronic pancreatitis. Pancreaticoduodenectomy allowed complete relief of symptoms. Chronic pancreatitis associated with cystic dystrophy may complicate the choice of appropriate therapy. PMID:10089671

Wind, P; Pardies, P; Roullet, M H; Rouzier, R; Zinzindohoué, F; Cugnenc, P H

1999-01-01

290

Gene Expression Based Categorization of Pancreas Transplant Biopsies  

PubMed Central

Gene expression profiling has emerged as a powerful strategy to define transcriptional mechanism activated in diseased human organs. We performed a feasibility study of mRNA based pancreas transplant biopsy stratification. The mRNAs expression of 32 genes observed in renal transplant dysfunction and ten pancreas specific genes were evaluated in 26 pancreas transplant biopsy specimens by qRT-PCR using TaqMan Low Density Array (TLDA) technology. Unsupervised 2D hierarchical clustering segregated the biopsies in two main cluster branches, A and B. Six out of seven patients (85.7%) in cluster A and 6 out of 19 (31.6%) in cluster B retained functioning pancreas allograft. CD20/MS4A1 mRNA and protein were detected in 4 biopsy specimens in cluster B. Three of the four CD20 positive pancreas transplant were subsequently lost despite anti-rejection treatment. This feasibility study demonstrates the association of pancreas gene expression with clinical outcome of the transplant and justifies the evaluation in further studies.

Luan, Fu F.; Trillsch, Fabian; Henger, Anna; Eichinger, Felix; Norman, Silas; Appelman, Henry; Kretzler, Matthias

2013-01-01

291

Diffuse Peritonitis due to Perforated Gastric Ectopic Pancreas  

PubMed Central

Ectopic pancreas is frequently found in the gastrointestinal tract. Lesions comprise well-developed and normally organized pancreatic tissue outside the pancreas, without anatomic or vascular connections with the true pancreas. Most patients with ectopic pancreas are asymptomatic or exhibit nonspecific symptoms. A 68-year-old Japanese woman had been experiencing intermittent pain in the right upper abdomen. Suddenly, the abdominal pain changed to intense pain in the right flank of the abdomen 2 days later. On initial medical examination, the abdomen exhibited rebound tenderness and distension. The results of laboratory tests revealed increased inflammatory reaction. Abdominal computed tomography showed free air and ascites on the surface of the liver and elevated levels of adipose tissue around the antrum and pylorus of the stomach. Perforation of the upper gastrointestinal tract was diagnosed and we performed urgent surgery. The site of perforation, whose size was 25 mm, was the lesser curvature of the antrum of the stomach. Since it was not possible to perform omentopexy, we performed extensive gastric resection. The reconstruction was a Billroth II operation. Microscopic analysis revealed pancreatic tissue within the ulceration, showing islets of Langerhans, acini, and ducts; the lesion was diagnosed as type I using Heinrich's criteria. The postoperative course was uneventful. The patient was discharged on day 13 and remains clinically healthy. Gastric perforation due to ectopic pancreas has been reported in 2 cases, including our patient, and is extremely rare. Once gastric perforation has been diagnosed, the presence of ectopic pancreas might be considered.

Fukino, Nobutada; Oida, Takatsugu; Mimatsu, Kenji; Kida, Kazutoshi; Kawasaki, Atsushi; Kuboi, Youichi; Kano, Hisao

2012-01-01

292

Control of blood glucose in diabetics using an artificial pancreas.  

PubMed

Studies have been performed using an on-line computer system programmed for blood gucose control of insulin and dextrose infusion (artificial pancreas). The aim of these studies was to test performance of the artificial pancreas and to suggest directions for future optimisation. Blood glucose stabilisation studies of diabetic volunteers were extended throughout the day and included three main meals and light exercise periods. Monitoring of blood glucose profiles of the same diabetics after depot insulin were performed on a separate occasion for comparison. The presence of insulin antibodies did not impair operation of the artificial pancreas. Most of the insulin infused by the artificial pancreas was to initially correct hyperglycaemia with relatively little required to subsequently maintian euglycaemia. The afternoon intra-meal average infusion rate was 0-9 U/hr. It is suggested that correction of fasting hyperglycaemia and maintenance of euglycaemia in diabetics be treated as separate control problems for the artificial pancreas. The overall ability of the artificial pancreas to control blood glucose to a degree not attainable by conventional insulin therapy is confirmed, in this case under conditions which include patient activity. PMID:334138

Kraegen, E W; Campbell, L V; Chia, Y O; Meler, H; Lazarus, L

1977-06-01

293

A Case of Jejunal Adenocarcinoma Diagnosed by Preoperative Double Balloon Enteroscopy  

PubMed Central

Despite a thorough history, physical examination, and complete diagnostic workup, the correct diagnosis of small-intestinal malignancy is established preoperatively in only 50% of cases; an exploratory laparotomy is often required. However, recent advances in endoscopic technologies, such as double-balloon enteroscopy (DBE), have been shown to facilitate the preoperative diagnosis of these tumors. Confirmation of malignancy using DBE in equivocal cases may greatly increase both patients' acceptance of surgery and the confidence of the physician planning a surgical resection. We describe herein the case of a 53-year-old woman with a stage I jejunal adenocarcinoma that was diagnosed by DBE and treated by laparoscopic jejunectomy. Histopathological examination revealed a stage I jejunal adenocarcinoma (T2N0M0) without muscularis propria invasion, lymphovascular invasion, or lymph-node metastasis.

Lee, Hong Joo; Lee, Joung Il; Joo, Kwang Ro; Jung, Sung Won; Shin, Hyun Phil

2009-01-01

294

Epidemiology of pancreas cancer in Los Angeles  

SciTech Connect

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

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

1981-03-15

295

Pharmacogenetics in neuroendocrine tumors of the pancreas.  

PubMed

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

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

2014-01-01

296

Microendoscopes for imaging of the pancreas  

NASA Astrophysics Data System (ADS)

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

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

2004-07-01

297

High precision innovative micropump for artificial pancreas  

NASA Astrophysics Data System (ADS)

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

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

2014-03-01

298

Formation and regeneration of the endocrine pancreas  

PubMed Central

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

Dhawan, Sangeeta; Georgia, Senta; Bhushan, Anil

2009-01-01

299

Solitary hepatic granuloma preoperatively diagnosed as intrahepatic cholangiocellular carcinoma: report of a case.  

PubMed

We herein report the case of a 67-year-old female with a solitary hepatic granuloma preoperatively diagnosed as a mass-forming type of intrahepatic cholangiocellular carcinoma. Magnetic resonance imaging using gadolinium-ethoxybenzyl-diethylenetriaminepentaacetic acid as a contrast medium is expected to be useful for making a differential diagnosis between hepatic granuloma and other hypovascular liver tumors, such as the mass-forming type of intrahepatic cholangiocellular carcinoma and metastatic liver tumors. PMID:22678661

Fukushima, Daizo; Iwane, Takeru; Sato, Kazushige; Kawagishi, Naoki; Sekiguchi, Satoshi; Ishida, Kazuyuki; Satomi, Susumu

2012-12-01

300

Neuroendocrine Tumors of the Gastro-Entero-Pancreatic System: The Role of Early Diagnosis, Genetic Testing and Preventive Surgery  

Microsoft Academic Search

Surgery is the only curative approach in neuroendocrine gastro-entero-pancreatic (GEP) tumors. As cure is highly dependent of tumor size, early diagnosis is a prerequisite for surgical success. Diagnosis of nonfunctioning tumors of the pancreas or midgut origin is due to symptoms related to the tumor burden, thus early diagnosis is mostly incidental. Functioning pancreatic tumors should be operated early in

U. Plöckinger; B. Wiedenmann

2002-01-01

301

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

PubMed Central

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

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

2011-01-01

302

Isoform-specific upregulation of palladin in human and murine pancreas tumors.  

PubMed

Pancreatic ductal adenocarcinoma (PDA) is a lethal disease with a characteristic pattern of early metastasis, which is driving a search for biomarkers that can be used to detect the cancer at an early stage. Recently, the actin-associated protein palladin was identified as a candidate biomarker when it was shown that palladin is mutated in a rare inherited form of PDA, and overexpressed in many sporadic pancreas tumors and premalignant precursors. In this study, we analyzed the expression of palladin isoforms in murine and human PDA and explored palladin's potential use in diagnosing PDA. We performed immunohistochemistry and immunoblot analyses on patient samples and tumor-derived cells using an isoform-selective monoclonal antibody and a pan-palladin polyclonal antibody. Immunoblot and real-time quantitative reverse transcription-PCR were used to quantify palladin mRNA levels in human samples. We show that there are two major palladin isoforms expressed in pancreas: 65 and 85-90 kDa. The 65 kDa isoform is expressed in both normal and neoplastic ductal epithelial cells. The 85-90 kDa palladin isoform is highly overexpressed in tumor-associated fibroblasts (TAFs) in both primary and metastatic tumors compared to normal pancreas, in samples obtained from either human patients or genetically engineered mice. In tumor-derived cultured cells, expression of palladin isoforms follows cell-type specific patterns, with the 85-90 kDa isoform in TAFs, and the 65 kDa isoform predominating in normal and neoplastic epithelial cells. These results suggest that upregulation of 85-90 kDa palladin isoform may play a role in the establishment of the TAF phenotype, and thus in the formation of a desmoplastic tumor microenvironment. Thus, palladin may have a potential use in the early diagnosis of PDA and may have much broader significance in understanding metastatic behavior. PMID:20436683

Goicoechea, Silvia M; Bednarski, Brian; Stack, Christianna; Cowan, David W; Volmar, Keith; Thorne, Leigh; Cukierman, Edna; Rustgi, Anil K; Brentnall, Teresa; Hwang, Rosa F; McCulloch, Christopher A G; Yeh, Jen Jen; Bentrem, David J; Hochwald, Steven N; Hingorani, Sunil R; Kim, Hong Jin; Otey, Carol A

2010-01-01

303

Role of preoperative breast MRI in ductal carcinoma in situ for prediction of the presence and assessment of the extent of occult invasive component.  

PubMed

Ductal carcinoma in situ (DCIS) is a common neoplasm that may be associated with focal invasive breast cancer lesions. The aim of our study was to evaluate the role of preoperative magnetic resonance imaging (MRI) in determining occult invasive presence and disease extent in patients with preoperative diagnosis of pure DCIS. We analyzed 125 patients with postoperative pure DCIS (n = 91) and DCIS plus invasive component (n = 34). Diagnostic mammography (MRX) showed a size underestimation rate of 30.4% while MRI showed an overestimation rate of 28.6%. Comparing the mean absolute error between preoperative MRI and MRX evaluations and final disease extent, MRI showed an improved accuracy of 51.2%. In our analysis preoperative breast MRI showed a better accuracy in predicting postoperative pathologic extent of disease, adding strength to the growing evidences that preoperative MRI can lead to a more appropriate management of DCIS patients. PMID:24750509

Nori, Jacopo; Meattini, Icro; Giannotti, Elisabetta; Abdulcadir, Dalmar; Mariscotti, Giovanna; Calabrese, Massimo; Angelino, Francesca; Chiesa, Fabio; Saieva, Calogero; Vanzi, Ermanno; Boeri, Cecilia; Bianchi, Simonetta; Sanchez, Luis; Orzalesi, Lorenzo; Casella, Donato; Susini, Tommaso; Livi, Lorenzo

2014-05-01

304

An Ultrasensitive New DNA Microarray Chip Provides Gene Expression Profiles for Preoperative Esophageal Cancer Biopsies without RNA Amplification  

Microsoft Academic Search

Objectives: Gene expression profiling using pretreatment biopsies has been limited due to their small sample sizes. This study evaluated the usefulness of an ultrasensitive new DNA microarray chip, which has a unique array structure, for the clinical diagnosis of esophageal cancer using preoperative biopsies. Methods: Paired cancer and normal esophageal epithelial tissues from 56 patients who underwent esophagectomy and from

Tetsuo Ito; Eiji Tanaka; Tadashi Kadowaki; Takatsugu Kan; Motoshige Higashiyama; Satoshi Shiojima; Shiori Tomoda; Akira Myoumoto; Hideo Akiyama; Hitoshi Nobumasa; Shigemi Matsumoto; Shinichi Miyamoto; Michihide Mitsumori; Fumiaki Sato; Go Watanabe; Atsushi Itami; Stephen J. Meltzer; Gozoh Tsujimoto; Yutaka Shimada

2007-01-01

305

Preoperative skin preparation: a historical perspective.  

PubMed

The incidence of health-care-associated infections has reduced since skin antisepsis was introduced in the 19th century. Despite this, health-care-associated infections, including post-surgical sepsis, continue to cause significant morbidity and mortality. This article reviews the evidence for the use of preoperative skin preparations. PMID:19966703

Crosby, C T; Tsj, Elliott; Lambert, P A; Adams, D

2009-10-01

306

[How to deal with preoperative hypertension].  

PubMed

Although there only limited supportive evidence it is suggested that in the setting of elective surgery whenever possible one should aim for a normal preoperative blood pressure in hypertensive patients. If preoperative pressure is >180 mmHg (adequate and correct blood pressure measurement technique, whenever needed 24 h-ABPM) an elective surgical intervention should be postponed and blood pressure control should be optimized. Blood pressure of <180 mmHg is regarded as no contraindication for an elective surgical intervention. The perioperative risk in suboptimally treated hypertensive patients is not elevated as long as perioperative anesthesia handling is optimal and in the absence of relevant comorbidities. In summary present evidence suggests that the pre- and perioperative hypertension is a controllable risk factor of minor relevance. However this does not mean that one should ignore elevated preoperative blood pressure values. More than ten years ago an editorialist brought it to the point by saying: "Preoperative hypertension: remain wary? Yes - cancel surgery? No". PMID:24129297

Muggli, Franco; Suter, Paolo M

2013-10-16

307

Preoperational test report, primary ventilation system  

SciTech Connect

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

Clifton, F.T.

1997-11-04

308

Preoperative Cardiac Evaluation for Elective Noncardiac Surgery  

Microsoft Academic Search

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

Darryl Potyk; Peter Raudaskoski

1998-01-01

309

Beneficial effects of ischemic preconditioning on pancreas cold preservation.  

PubMed

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

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

2012-01-01

310

Preoperative risk factors for postoperative delirium.  

PubMed

The objective of this article was to estimate the incidence of delirium in a sample of patients undergoing elective surgery and to identify the preoperative factors most closely associated with developing this complication. Consecutive patients (n=500) underwent a full preoperative medical evaluation including assessment of cognitive and functional status. Daily evaluation on postoperative days 1 through 4 included medical record review and direct standardized patient interviews. Logistic regression was used to explore the associations between preoperative factors and postoperative delirium. Delirium was detected in 57 (11.4%) patients. Univariate factors associated with delirium included age> or =70 years (RR=3.1 [1.75,5.55]), preexisting cognitive impairment (RR=3.1 [1.73, 5.43]), greater preoperative functional limitations (RR=1.57 [1.27, 1.94]), and a history of prior delirium (RR 4.1 [1.98 to 8.27]. Adjusting for other factors, previous delirium (OR=4.08 [1.85, 9.0]), age> or =70 years (OR=3.2 [1.6, 6.0], and preexisting cognitive impairment (OR=2.16 [1.15, 4.0] remained predictive of delirium. Patients' perceptions that alcohol had affected their health (OR=6.53 [1.58 to 28.1]) and use of narcotic analgesics just prior to admission (OR=2.7 [1.37 to 5.3]) were also significantly associated with delirium postoperatively. Several easily obtained preoperative clinical factors can be used to identify patients at risk for postoperative delirium. This approach, when combined with specialized delirium teams using established guidelines, may be more effective in targeting patients at risk, thus reducing the number of episodes and days of delirium. PMID:11313076

Litaker, D; Locala, J; Franco, K; Bronson, D L; Tannous, Z

2001-01-01

311

Preoperative Anxiety in Candidates for Heart Surgery  

PubMed Central

Objective: The goal of this study was to evaluate preoperative anxiety and its predisposing factors in a group of adult patients who were candidate for any kind of heart surgery. Methods: We evaluated preoperative anxiety in 300 patients undergoing heart surgery whose ages ranged between 18-65 years. Relationship of probable demographic factors like gender, educational level, marital status, number of children, family support, opium addiction, occupational status, and left ventricular ejection fraction (LVEF) with anxiety level of the patients were evaluated. To determine anxiety, the State-Trait Anxiety Inventory (STAI) was completed by the subjects. Results: Descriptive anxiety levels showed that mean of state and trait anxiety of our studied patients were in moderate scaling. Correlation between state and trait anxiety was more prominent in females (r = 0.80) than in males (r = 0.70) (p < 0.001). Distribution of males and females was significantly different (p = 0.048). All the patients had significantly different underlying diseases (p = 0.018), opioid addiction (yes/no) was significantly different in all of the patients (p < 0.001), while family support (yes/no) was not significantly different in all of the patients (p = 0.453). There were significant differences between mean of preoperative anxiety at different LVEF values of any EF level (p < 0.001, F = 6.47); those who had LVEF of more than 50% had significantly lower mean anxiety scores. Conclusion: Preoperative psychiatric consultation should be focused more on women and patients with higher EF. Moreover, physical activity strength may be effective on reducing preoperative anxiety.

Fathi, Mehdi; Alavi, Seyed Mostafa; Joudi, Marjan; Joudi, Mitra; Mahdikhani, Helia; Ferasatkish, Rasool; Bakhshandeh, Houman; Jabbari Nooghabi, Mehdi

2014-01-01

312

Clinical Evaluation of a Personalized Artificial Pancreas  

PubMed Central

OBJECTIVE An artificial pancreas (AP) that automatically regulates blood glucose would greatly improve the lives of individuals with diabetes. Such a device would prevent hypo- and hyperglycemia along with associated long- and short-term complications as well as ease some of the day-to-day burden of frequent blood glucose measurements and insulin administration. RESEARCH DESIGN AND METHODS We conducted a pilot clinical trial evaluating an individualized, fully automated AP using commercial devices. Two trials (n = 22, nsubjects = 17) were conducted using a multiparametric formulation of model predictive control and an insulin-on-board algorithm such that the control algorithm, or “brain,” can be embedded on a chip as part of a future mobile device. The protocol evaluated the control algorithm for three main challenges: 1) normalizing glycemia from various initial glucose levels, 2) maintaining euglycemia, and 3) overcoming an unannounced meal of 30 ± 5 g carbohydrates. RESULTS Initial glucose values ranged from 84–251 mg/dL. Blood glucose was kept in the near-normal range (80–180 mg/dL) for an average of 70% of the trial time. The low and high blood glucose indices were 0.34 and 5.1, respectively. CONCLUSIONS These encouraging short-term results reveal the ability of a control algorithm tailored to an individual’s glucose characteristics to successfully regulate glycemia, even when faced with unannounced meals or initial hyperglycemia. To our knowledge, this represents the first truly fully automated multiparametric model predictive control algorithm with insulin-on-board that does not rely on user intervention to regulate blood glucose in individuals with type 1 diabetes.

Dassau, Eyal; Zisser, Howard; Harvey, Rebecca A.; Percival, Matthew W.; Grosman, Benyamin; Bevier, Wendy; Atlas, Eran; Miller, Shahar; Nimri, Revital; Jovanovic, Lois; Doyle, Francis J.

2013-01-01

313

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

SciTech Connect

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.

Higgins, Kristin, E-mail: kristin.higgins@duke.ed [Department of Radiation Oncology, Duke University of Medical Center, Durham, NC (United States); Chino, Junzo P. [Department of Radiation Oncology, Duke University of Medical Center, Durham, NC (United States); Marks, Lawrence B. [Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC (United States); Ready, Neal [Department of Medicine, Division of Medical Oncology, Duke University of Medical Center, Durham, NC (United States); D'Amico, Thomas A. [Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University of Medical Center, Durham, NC (United States); Clough, Robert W.; Kelsey, Chris R. [Department of Radiation Oncology, Duke University of Medical Center, Durham, NC (United States)

2009-12-01

314

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

PubMed Central

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

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

1996-01-01

315

Functioning pancreas graft with thromboses of splenic and superior mesenteric arteries after simultaneous pancreas-kidney transplantation: a case report.  

PubMed

Graft thrombosis is the most common cause of early graft loss after pancreas transplantation. The grafted pancreas is difficult to salvage after complete thrombosis, especially arterial thrombosis, and graft pancreatectomy is required. We describe a patient presenting with a functioning pancreas graft with thromboses of the splenic artery (SA) and superior mesenteric artery (SMA) after simultaneous pancreas-kidney transplantation (SPK). A 37-year-old woman with a 20-year history of type 1 diabetes mellitus underwent SPK. The pancreaticoduodenal graft was implanted in the right iliac fossa with enteric drainage. A Carrel patch was anastomosed to the recipient's right common iliac artery, and the graft gastroduodenal artery was anastomosed to the common hepatic artery using an arterial I-graft. The donor portal vein was anastomosed to the recipient's inferior vena cava. Four days after surgery, graft thromboses were detected by Doppler ultrasound without increases in the serum amylase and blood glucose levels. Contrast enhanced computed tomography revealed thromboses in the SA, splenic vein and SMA. Selective angiography showed that blood flow was interrupted in the SA and SMA. However, pancreatic graft perfusion was maintained by the I-graft in the head of the pancreas and the transverse pancreatic artery in the body and tail of the pancreas. We performed percutaneous direct thrombolysis and adjuvant thrombolytic therapy. However, we had to stop the thrombolytic therapy because of gastrointestinal hemorrhage. Thereafter, the postoperative course was uneventful and the pancreas graft was functioning with a fasting blood glucose level of 75 mg/dL, HbA1c of 5.1%, and serum C-peptide level of 1.9 ng/mL at 30 months post-transplantation. PMID:24767399

Matsumoto, I; Shinzeki, M; Asari, S; Goto, T; Shirakawa, S; Ajiki, T; Fukumoto, T; Ku, Y

2014-04-01

316

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

PubMed Central

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

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

2013-01-01

317

A conserved role for retinoid signaling in vertebrate pancreas development.  

PubMed

Retinoic acid (RA) signaling plays critical roles in the regionalization of the central nervous system and mesoderm of all vertebrates that have been examined. However, to date, a role for RA in pancreas and liver development has only been demonstrated for the teleost zebrafish. Here, we demonstrate that RA signaling is required for development of the pancreas but not the liver in the amphibian Xenopus laevis and the avian quail. We disrupted RA signaling in Xenopus tadpoles, using both a pharmacological and a dominant-negative strategy. RA-deficient quail embryos were obtained from hens with a dietary deficiency in vitamin A. In both species we found that pancreas development was dependent on RA signaling. Furthermore, treatment of Xenopus tadpoles with exogenous RA led to an expansion of the pancreatic field. By contrast, liver development was not perturbed by manipulation of RA signaling. Taken together with our previous finding that RA signaling is necessary and sufficient for zebrafish pancreas development, these data support the hypothesis that a critical role for RA signaling in pancreas development is a conserved feature of the vertebrates. PMID:15322880

Stafford, D; Hornbruch, A; Mueller, P R; Prince, V E

2004-09-01

318

Surgical outcome of adenosquamous carcinoma of the pancreas.  

PubMed

Adenosquamous carcinoma is rare, accounting for 3%-4% of all pancreatic carcinoma cases. These tumors are characterized by the presence of variable proportions of mucin-producing glandular elements and squamous components, the latter of which should account for at least 30% of the tumor tissue. Recently, several reports have described cases of adenosquamous carcinoma of the pancreas. However, as the number of patients who undergo resection at a single institute is limited, large studies describing the clinicopathological features, therapeutic management, and surgical outcome for adenosquamous carcinoma of the pancreas are lacking. We performed a literature review of English articles retrieved from Medline using the keywords 'pancreas' and 'adenosquamous carcinoma'. Additional articles were obtained from references within the papers identified by the Medline search. Our subsequent review of the literature revealed that optimal adjuvant chemotherapy and/or radiotherapy regimens for adenosquamous carcinoma of the pancreas have not been established, and that curative surgical resection offers the only chance for long-term survival. Unfortunately, the prognosis of the 39 patients who underwent pancreatic resection for adenosquamous carcinoma was very poor, with a 3-year overall survival rate of 14.0% and a median survival time of 6.8 mo. Since the postoperative prognosis of adenosquamous carcinoma of the pancreas is currently worse than that of pancreatic adenocarcinoma, new adjuvant chemotherapies and/or radiation techniques should be investigated as they may prove indispensible to the improvement of surgical outcomes. PMID:19058301

Okabayashi, Takehiro; Hanazaki, Kazuhiro

2008-11-28

319

MRI with spin labeling for diagnosis of early chronic pancreatitis.  

PubMed

OBJECTIVE. The purpose of this article is to discuss MRI with spin labeling for diagnosis of chronic pancreatitis. CONCLUSION. Because of the unique functional information it can provide, MRI with spin labeling appears to be a useful adjunctive technique that can be added to routine anatomic imaging of the pancreas and pancreatic duct. PMID:24758656

Takahashi, Naoki; Chari, Suresh T

2014-05-01

320

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

PubMed Central

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

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

2012-01-01

321

62Zn-EDDA: a radiopharmaceutical for pancreatic functional diagnosis.  

PubMed

As Zn is closely associated with the exocrine and endocrine functions of the pancreas, exploitation of Zn metabolism for anatomical and functional diagnosis was conceived, namely with the recent availability of positron emitting 62Zn (t1/2 = 9 h). In the present paper, response changes in Zn biodistribution (mice) and Zn excretion through the pancreatic duct (rats) due to the stimulation of gastro-intestinal hormones like secretin, CCK-PZ (exocrine stimulation) and glucose (endocrine stimulation) were studied. Under these stimuli, the pancreatic secretion of radioactive Zn through cannulated pancreatic duct showed increased Zn secretion only under the CCK-PZ effect, 3 h post 65Zn (t1/2 = 270 d) injection. Tissue biodistribution in mice pre-injected with 65Zn showed pancreas specific decrease of radioactive Zn whenever a gastro-intestinal hormone was post-administered, whereas the glucose effect was negligible. Thus, the effective mobilization of the injected radioactive Zn, upon exocrine stimulation, represented by CCK-PZ, favored the exploration of a functional study of the pancreas with the positron computed tomograph (PCT) using short lived nuclide labeled 62Zn-EDDA in dog. Evidence of the applicability of this system in regional function studies of the pancreas was obtained. Demonstration of Zn participation in the exocrine function of the pancreas in-vivo holds considerable promise for diagnosis of pancreatic diseases. PMID:3086246

Fujibayashi, Y; Saji, H; Yomoda, I; Kawai, K; Horiuchi, K; Adachi, H; Torizuka, K; Yokoyama, A

1986-01-01

322

Managing complexity in pre-operative information management systems  

Microsoft Academic Search

Preoperative assessment is composed of a set of clinical investigations that precede anaesthesia and surgery. Due to the vast scope of pre-operative assessment, the clinical domain knowledge potentially relevant for assessment is virtually limitless. For this reason, a generic preoperative assessment has traditionally focused on identifying common allergies, cardiovascular and respiratory risks and pre-empting potential airway complications, such as difficult

Matt-Mouley Bouamrane; Frances Mair; Cui Tao

2011-01-01

323

Preoperative glucose abnormalities in patients with pancreatic tumours  

PubMed Central

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

Durlik, Marek; Kaluza, Bernadetta; Milczarczyk, Alicja; Franek, Edward

2014-01-01

324

Synchronous primary epithelial tumors of the pancreas  

PubMed Central

INTRODUCTION Pancreatic incidentalomas are diagnosed at increased rates due to advanced pancreatic imaging. Coexistence of such lesions with another pancreatic pathology, however, is uncommon and their management might be perplexed by the anatomical location and the histological features of the lesion. PRESENTATION OF CASE A patient with obstructive jaundice was diagnosed with adenocarcinoma of the pancreatic head and underwent routine pancreatic imaging (CT) which revealed the coexistence of a small cystic lesion at the pancreatic body. Further investigation with MRCP and ERCP was unable to confirm a benign lesion and total pancreatoduodenectomy was performed. Histological examination showed a rare type of mixed serous–mucinous cystadenoma of borderline malignancy at the pancreatic body coexistent with an adenocarcinoma of the pancreatic head. DISCUSSION Coexistence of a peripheral pancreatic cystic tumor with a ductal adenocarcinoma of the pancreatic head is a very rare incidence in medical literature. The management of the peripheral lesion is not straightforward and there can be uncertainty as to the extent of the pancreatic resection that may be required. CONCLUSION Appropriate preoperative imaging has a significant impact on the definitive management of synchronous pancreatic tumors. Implications of a common pathogenetic pathway are also raised for this rare occurrence of two primary epithelial pancreatic tumors.

Karidis, Nikolaos P.; Paraskeva, Panoraia; Mantas, Dimitrios

2012-01-01

325

Role of angiography in the diagnosis of pancreatic neoplasms.  

PubMed

The vascular architecture of the pancreas has been described, but few reports indicate preoperative accuracy. During the last 3 years, selective superior mesenteric and celiac angiography was performed in 471 patients. In 35 of these patients, additional selective angiography of the superior pancreaticoduodenal and inferior pancreaticoduodenal arteries was performed to reveal the detailed vascular pattern of the pancreas and its surrounding structures. Exploratory surgery was performed in all patients except the four control subjects. The angiographic findings reflected a poorly vascularized infiltrating lesion with invasion of the blood vessels and serpiginous encasements. Peripancreatic extension of the tumor indicated nonresectability. In early pancreatitis, the pancreas showed increased vascularity and occasional stretched vessels. In more advanced pancreatitis, the arteries were prominent and irregular with increased parenchymal accumulation of contrast medium in the capillary phase. In pseudocysts of the pancreas, the only finding was stretching of the vessels around the lesion. A well circumscribed lesion with increased contrast medium in the capillary and venous phases diagnostic of pancreatic adenoma. Pancreatic angiography is an important diagnostic tool in evaluating and staging pancreatic neoplasms. PMID:495855

Ghosh, B C; Mojab, K; Esfahani, F; Moss, G S; Das Gupta, T K

1979-11-01

326

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

PubMed Central

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.

Jager, Tarkan; Neureiter, Daniel; Nawara, Clemens; Dinnewitzer, Adam; Ofner, Dietmar; Lamade, Wolfram

2013-01-01

327

Incidence and prediction of invasive disease and nodal metastasis in preoperatively diagnosed ductal carcinoma in situ.  

PubMed

For breast cancer patients with a preoperative diagnosis of ductal carcinoma in situ (DCIS), sentinel lymph node (SN) biopsy has been proposed as an axillary staging procedure in selected patients with a higher likelihood of having occult invasive lesions. With detailed histological examination of primary tumors and molecular whole-node analysis of SNs, we aimed to validate whether this selective application accurately identifies patients with SN metastasis. The subjects were 336 patients with a preoperative needle-biopsy diagnosis of DCIS who underwent SN biopsy using the one-step nucleic acid amplification assay in the period 2009-2011. The incidence and preoperative predictors of upstaging to invasive disease on final pathology and SN metastasis, and their correlation, were investigated. Of the 336 patients, 113 (33.6%) had invasive disease, and 6 (1.8%) and 17 (5.0%) had macro- and micrometastasis in axillary nodes respectively. Of the 113 patients with invasive disease, 4 (3.5%) and 9 (8.0%) had macro- and micrometastasis. Predictors of invasive disease included palpability, mammographic mass, and calcifications (spread >20 mm), and intraductal solid structure, but no predictor was found for SN metastasis. Therefore, even though occult invasive disease was found at final pathology, most of the patients had no metastasis or only micrometastasis in axillary nodes. Predictors of invasive disease and SN metastasis were not completely consistent, so the selective SN biopsy for patients with a higher risk of invasive disease may not accurately identify those with SN metastasis. More accurate application of SN biopsy is required for patients with a preoperative diagnosis of DCIS. PMID:24533797

Osako, Tomo; Iwase, Takuji; Ushijima, Masaru; Horii, Rie; Fukami, Yasuyoshi; Kimura, Kiyomi; Matsuura, Masaaki; Akiyama, Futoshi

2014-05-01

328

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

SciTech Connect

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

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

2007-11-30

329

[Pancreas divisum, chronic pancreatitis and diabetes mellitus. Improvement by pancreaticojejunostomy].  

PubMed

The relationship between pancreas divisum and chronic pancreatitis is controversial. We report the cases of two patients aged 40 and 53 years suffering from recurrent pancreatitis and known to have histologically proven idiopathic chronic pancreatitis. One patient had insulin dependent diabetes. Pancreatography demonstrated in these two cases a pancreas divisum with a dilated dorsal pancreatic duct. A pancreatico-jejunostomy was performed, associated in one case with splenopancreatectomy for pseudo-cyst. With a follow-up of 32 and 78 months, both patients were free of symptoms and the diabetic patient had normal blood glucose levels with diet alone. The clinical history of the patients suggests a relationship between pancreas divisum and chronic pancreatitis and that pancreatico-jejunostomy may improve pancreatic pain and pancreatic function. PMID:1456695

Wind, P; Berger, A; Chevallier, J M; Frileux, P; Cugnenc, P H

1992-01-01

330

The evolution of diabetic chronic complications after pancreas transplantation  

PubMed Central

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.

de Sa, Joao R; Monteagudo, Patricia T; Rangel, Erika B; Melaragno, Claudio S; Gonzalez, Adriano M; Linhares, Marcelo M; Salzedas, Alcides; Neves, Maria-Deolinda F; Stela, Camila; Medina-Pestana, Jose O

2009-01-01

331

Cellular Plasticity within the Pancreas-- Lessons Learned from Development  

PubMed Central

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

Puri, Sapna; Hebrok, Matthias

2014-01-01

332

Different ghrelin localisation in adult human and rat endocrine pancreas.  

PubMed

Ghrelin is an endocrine peptide that has been identified in gastric oxyntic glands and that induces growth hormone secretion in the pituitary gland. This growth hormone secretagogue is expressed in many tissues such as stomach, pituitary gland, thyroid, testis, placenta and pancreas. Initial studies of ghrelin focused on its role as a circulating orexigenic signal. However, ghrelin has also been found to be involved in the modulation of glucose homeostasis. Although a number of studies have reported ghrelin expression in developing pancreas, the location of ghrelin-immunoreactive cells in adult pancreas (epsilon cells) remains controversial. In this study, we have analysed the distribution of pancreatic epsilon cells in adult human and rat islets by immunohistochemistry and in situ hybridisation. In humans, our immunohistochemical analysis has shown that ghrelin is expressed in glucagon-secreting cells, whereas in rats, it is present in insulin-secreting cells. Similar observations have been revealed by in situ hybridisation. PMID:23584608

Raghay, Kawtar; Gallego, Rosalia; Scoazec, Jean-Yves; Garcia-Caballero, Tomas; Morel, Gérard

2013-06-01

333

Experience with 53 portal-duodenal drained solitary pancreas transplants.  

PubMed

Systemic-enteric drainage is currently the most common technique for pancreas transplantation (PT). A novel alternative technique, portal-duodenal drainage (PDD), has potential physiological benefits and provides improved monitoring of the pancreatic graft. The current study describes 53 solitary PT procedures (43 pancreas after kidney and 10 pancreas transplant alone) using the PDD technique over the last three yr. This method resulted in one-yr patient survival at 96% and 83% graft survival. There were five cases (9.4%) of thrombosis, in which transplantectomy and two-layer closure of the native duodenum were performed. No fistulas were observed. Here, we demonstrate that the PDD technique in PT was as safe and effective as current techniques in clinical use. PMID:24382212

Perosa, Marcelo; Noujaim, Huda; Ianhez, Luiz E; Oliveira, Rodrigo A; Mota, Leonardo T; Branez, Juan R; Paredes, Marcio M; Giacaglia, Luciano; Genzini, Tercio

2014-02-01

334

Histone changes during degeneration and regeneration of the pancreas  

PubMed Central

1. Changes in the microstructure of histones from the pancreas were followed in rats given ethionine while on a protein-free diet. The lysine-rich histone F1 and the other histones extracted subsequently with 250mm-hydrochloric acid were isolated. When the ethionine-treated rats returned to the stock diet, regeneration of the pancreas was accompanied by an immediate increase in phosphate content of the total histone extract from which histone F1 had been removed. After 3–4 days there was a further increase in the phosphate content of this extract, and also in that of histone F1. 2. Similar changes in the phosphate and thiol+disulphide content of pancreas histones other than F1 were produced by starvation and re-feeding.

Fitzgerald, P. J.; Marsh, W. H.; Ord, Margery G.; Stocken, L. A.

1970-01-01

335

Endosonographic Preoperative Evaluation for Tumors of the Ampulla of Vater Using Endoscopic Ultrasonography and Intraductal Ultrasonography  

PubMed Central

Background/Aims In recent years, endoscopic snare papillectomy has been performed to treat tumors of the ampulla of Vater. This procedure requires accurate preoperative evaluation. In this study, we diagnosed the focal extension of such tumors by using endoscopic ultrasonography (EUS) and intraductal ultrasonography (IDUS), and examined the indications for endoscopic snare papillectomy. Methods The subjects were 48 patients with a papillary tumor (13 patients, surgical resection; 35 patients, endoscopic snare papillectomy) who were evaluated preoperatively with EUS and IDUS. The tumor-node-metastasis classification was used for the endosonographic evaluation and pathological diagnosis of these tumors. Results The diagnostic accuracy of EUS was 97% for diagnosing adenomas and pTis tumors, 73% for pT1 tumors, 50% for pT2 tumors, and 50% for pT3-4 tumors, for an overall accuracy of 85% for T-staging. The diagnostic accuracy of IDUS was 94% for adenomas and pTis tumors, 73% for pT1 tumors, 50% for pT2 tumors, and 100% for pT3-4 tumors, for an overall accuracy of 80% for T-staging. Conclusions EUS and IDUS are highly capable of evaluating tumors of the ampulla of Vater preoperatively. However, these techniques are not sufficient for evaluating the focal extension of carcinomas preoperatively. Currently, endoscopic snare papillectomy is adequate for treating adenomas and pTis tumors.

Igarashi, Yoshinori; Hara, Seiichi; Takuma, Kensuke; Kamata, Itaru; Kishimoto, Yui; Mimura, Takahiko; Ito, Ken; Sumino, Yasukiyo

2014-01-01

336

Experience with 500 simultaneous pancreas-kidney transplants.  

PubMed Central

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

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

1998-01-01

337

Angiomyolipoma of the kidney: a clinical enigma in diagnosis and management.  

PubMed Central

Renal angiomyolipomas are uncommon benign tumours which clinically mimic renal cell carcinoma. They have characteristic features on ultrasound and CT scanning which may enable their diagnosis preoperatively. We review our experience of six cases of renal angiomyolipoma. These cases highlight the difficulties in making a preoperative diagnosis despite the use of modern scanning. We advocate conservative resection when the diagnosis is made preoperatively and when technically possible, but radical nephrectomy should be performed if there is a possibility of a carcinoma. Images Figure 1 Figure 2 Figure 3

Wong, K.; Waters, C. M.; Hershman, M. J.; Kaisary, A. V.; Horner, J.

1992-01-01

338

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

PubMed Central

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

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

2012-01-01

339

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

PubMed

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

Suarez Martinez-Falero, Beatriz; Gillmore, Roopinder

2014-01-01

340

Assistive Communication Robot for Preoperative Health Care  

Microsoft Academic Search

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

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

2010-01-01

341

Preoperative cardiac testing before major vascular surgery  

Microsoft Academic Search

Conclusions  Preoperative risk assessment with a noninvasive stress test (MPS or DSE) is necessary only in high-risk patients without unnecessary\\u000a delay for vascular surgery. High-risk patients can easily be selected through the risk score index. Prophylactic revascularization\\u000a should only be performed in those with unstable coronary artery disease. The optimal perioperative medical treatment, especially\\u000a tight heart-rate control, is essential for decreasing

Sanne E. Hoeks; Olaf Schouten; Maureen J. van der Vlugt; Don Poldermans

2007-01-01

342

Pancreas tumor model in rabbit imaged by perfusion CT scans  

NASA Astrophysics Data System (ADS)

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

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

2013-03-01

343

Reducing anxiety in preoperative patients: a systematic review.  

PubMed

There are still uncertainties regarding the appropriateness and effectiveness of various modes of delivering preoperative education. Hence, this systematic review was conducted to investigate the effectiveness of various preoperative educational interventions in reducing preoperative anxiety. Fourteen interventional trials (12 randomised controlled trials and two pre/post test trials) involving a total of 1752 participants were included in the review. Four studies used audiovisual; two trials used visual; two trials used multimedia-supported education; one trial used a website; two trials involved verbal education delivered by a psychologist or a nurse facilitator coupled with leaflets; and one trial involved informational leaflets only. Eight of the 14 trials demonstrated that preoperative education intervention reduced preoperative anxiety significantly (P<0.05). It can be concluded that preoperative education interventions are promising in reducing preoperative anxiety in patients scheduled for surgical procedures. PMID:24732993

Ayyadhah Alanazi, Alaa

2014-04-10

344

Comparison of pre-operative bilirubin level in simple appendicitis and perforated appendicitis  

PubMed Central

Background Delay in diagnosis and treatment of perforated appendicitis may cause life-threatening complications.The aim of this study was to determine and compare pre-operative total and direct bilirubin levels incases of simple and perforated acute appendicitis in order to improve the clinical decision making. Methods This prospective observational study included eighty patients who underwent open appendectomy,during a one-year period from March 2010 to March 2011 in the surgical department of Hazrat-e-Rasool AkramHospital, an academic teaching hospital in Tehran- Iran. Pre-operative total and direct levels of bilirubin werecompared in two groups of histologically proved appendicitis (simple and perforated), each including 40 patients. Results Eighty patients who underwent open appendectomy including 70% men and 30% women with a meanage of 34±11 years in Group I (perforated appendicitis) and 47.5% women and 52.5% men with a mean age of33±14 in Group II (simple appendicitis) were included in this study. The mean bilirubin levels were higher forpatients with perforated acute appendicitis compared to those with a non-perforated simple appendicitis(1.04±05 mg/dl vs 0.7±0.1 mg/dl) and this difference is highly significant (p<0.01). Conclusion Assessment of preoperative total bilirubin is useful for the differential diagnosis of perforatedversus acute simple appendicitis and total bilirubin should be used as an independent parameter in the early diagnosisof appendix perforation

Vaziri, Mohammad; Pazouki, Abdolreza; Maghsoudloo, Farshid; Pishgahroudsari, Mohadeseh; Chaichian, Shahla

2013-01-01

345

The location of VIP in the pancreas of man and rat  

Microsoft Academic Search

Summary  VIP has powerful stimulatory effects on both endocrine and exocrine pancreas but its localisation within the gland has not been established. In this study, human pancreas was obtained fresh at surgery (eleven) or within four hours of death (seven). The pancreas was also removed from rats (twenty-two). Immunocytochemical staining showed VIP to be present in fine nerve fibres in all

A. E. Bishop; J. M. Polak; I. C. Green; M. G. Bryant; S. R. Bloom

1980-01-01

346

Trefoil Factors Are Expressed in Human and Rat Endocrine Pancreas: Differential Regulation by Growth Hormone  

Microsoft Academic Search

Trefoil factors (TFFs) 1, 2, and 3 are expressed in mucosal epithelia. TFFs are particular abundant in the intestine in which they play a crucial role in maintenance and restitution of the epithelium. Because pancreas developmentally arises from the primitive foregut, we explored the expression of TFFs in the pancreas in man and rat. Immunocytochemical staining of adult human pancreas

Malene Jackerott; Ying C. Lee; K. Mollgard; Hans Kofod; Janne Jensen; Sonja Rohleder; Nicole Neubauer; Louise W. Gaarn; Jeanette Lykke; Rikke Dodge; Louise T. Dalgaard; B. Sostrup; Dennis B. Jensen; Lars Thim; E. Nexo; Peter Thams; H. C. Bisgaard; Jens H. Nielsen

2006-01-01

347

Dorsal pancreas agenesis in retinoic acid-deficient Raldh2 mutant mice  

Microsoft Academic Search

During embryogenesis, the pancreas arises from dorsal and ventral pancreatic protrusions from the primitive gut endoderm upon induction by different stimuli from neighboring mesodermal tissues. Recent studies have shown that Retinoic Acid (RA) signaling is essential for the development of the pancreas in non-mammalian vertebrates. To investigate whether RA regulates mouse pancreas development, we have studied the phenotype of mice

Mercè Martín; Jabier Gallego-Llamas; Vanessa Ribes; Michèle Kedinger; Karen Niederreither; Pierre Chambon; Pascal Dollé; Gérard Gradwohl

2005-01-01

348

Cochlin-tomoprotein (CTP) detection test identified perilymph leakage preoperatively in revision stapes surgery.  

PubMed

Perilymphatic fistula (PLF) is defined as an abnormal leakage between perilymph from the labyrinth to the middle ear. Symptoms include hearing loss, tinnitus, and vertigo. The standard mode of PLF detection is intraoperative visualization of perilymph leakage and fistula, which ostensibly confirms the existence of PLF. Other possible methods of diagnosis include confirmation of pneumolabyrinth via diagnostic imaging. Recently, a cochlin-tomoprotein (CTP) detection test has been developed that allows definitive diagnosis of PLF-related hearing loss. We report the case of a 45-year-old man who presented with right-sided tinnitus, hearing loss, and dizziness 30 years after stapes surgery. Middle ear lavage was performed after myringotomy. A preoperative diagnosis of PLF was reached using the CTP detection test. Intraoperative observations included a necrotic long process of the incus, displaced wire piston, and fibrous tissue in the oval window. Perilymph leakage was not evident. The oval window was closed with fascia, and vertigo disappeared within 2 weeks postoperatively. When PLF is suspected after stapes surgery, the CTP detection test can be a useful, highly sensitive, and less invasive method for preoperative diagnosis. PMID:23084787

Kataoka, Yuko; Ikezono, Tetsuo; Fukushima, Kunihiro; Yuen, Koji; Maeda, Yukihide; Sugaya, Akiko; Nishizaki, Kazunori

2013-08-01

349

[Intraoperative localization of recurrent pancreatic insulinoma-a resected case of the metastatic lesions in the residual pancreas and the lymph node].  

PubMed

We describe herein a 39-year-old woman with tumor recurrence in the residual pancreas and metastasis to the lymph node about 5 years after an eneclation for insulinoma in the body of the pancreas. A certain day in the morning in June 2002, she was immediately admitted to our hospital due to impairment of consciousness based hypoglycemia. On diagnostic imaging including an arterial stimulation venous sampling, localization of the recurrent lesions was not identified. In October 2002, we underwent laparotomy for the purpose of localization of the recurrent lesions and treatment. During the operation, peripheral blood glucose level, portal blood glucose level and portal insulin level were measured periodically. The mobilization started from the tail of the pancreas. Blood glucose levels were gradually elevated during the mobilization. The pancreas was mobilized to the right edge of the portal vein and was resected. Histopathological diagnosis was recurrent insulinoma in a peripancreatic lymph node and intra-pancreatic subcapsular tumor embolization. Postoperative course was uneventful. More than 8 years after surgery, she is doing well without signs of recurrence. PMID:22202272

Fujisaki, Shigeru; Tomita, Ryouichi; Park, Eichi; Hirano, Tomohiro; Sakurai, Kenichi; Takayama, Tadatoshi; Nemoto, Norimichi

2011-11-01

350

Abnormal endocrine pancreas function at birth in cystic fibrosis ferrets.  

PubMed

Diabetes is a common comorbidity in cystic fibrosis (CF) that worsens prognosis. The lack of an animal model for CF-related diabetes (CFRD) has made it difficult to dissect how the onset of pancreatic pathology influences the emergence of CFRD. We evaluated the structure and function of the neonatal CF endocrine pancreas using a new CFTR-knockout ferret model. Although CF kits are born with only mild exocrine pancreas disease, progressive exocrine and endocrine pancreatic loss during the first months of life was associated with pancreatic inflammation, spontaneous hyperglycemia, and glucose intolerance. Interestingly, prior to major exocrine pancreas disease, CF kits demonstrated significant abnormalities in blood glucose and insulin regulation, including diminished first-phase and accentuated peak insulin secretion in response to glucose, elevated peak glucose levels following glucose challenge, and variably elevated insulin and C-peptide levels in the nonfasted state. Although there was no difference in lobular insulin and glucagon expression between genotypes at birth, significant alterations in the frequencies of small and large islets were observed. Newborn cultured CF islets demonstrated dysregulated glucose-dependent insulin secretion in comparison to controls, suggesting intrinsic abnormalities in CF islets. These findings demonstrate that early abnormalities exist in the regulation of insulin secretion by the CF endocrine pancreas. PMID:22996690

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

2012-10-01

351

The endocrine cells of the pancreas and related tumours  

Microsoft Academic Search

Up to seven endocrine cell types have been identified ultrastructurally in the pancreas, including glucagon A cells, insulin B cells, somatostatin D cells, pancreatic peptide F cells and 5-hydroxytryptamine EC cells. In addition, D1 cells, which have been proposed as the cell type producing VIP and possible P cells of unknown function are seen. Various patterns of endocrine cell differentiation

C. Capella; E. Solcia; B. Frigerio; R. Buffa; L. Usellini; P. Fontana

1977-01-01

352

Quality of Life After Simultaneous Pancreas–Kidney Transplantation  

Microsoft Academic Search

Even recipients with satisfactory function of transplanted pancreas and kidney may show physical and\\/or social disability due to diabetic complications. Our aims were to evaluate diabetic complications influencing recipient quality of life and to assess patients’ psychosociological status. Nineteen patients with functioning grafts who consented to take part in the study, underwent clinical evaluation and answered questions regarding their quality

A. Kwiatkowski; G. Michalak; J. Czerwinski; M. Wszola; R. Nosek; K. Ostrowski; A. Chmura; R. Danielewicz; W. Lisik; L. Adadynski; P. Malkowski; S. Fesolowicz; M. Bieniasz; T. Kasprzyk; M. Bernas; K. Szczeklik-Kumala; A. Glowania; M. Durlik; J. Walaszewski; J. Tato?; W. Rowinski

2005-01-01

353

Solid pseudopapillary tumor: a rare neoplasm of the pancreas  

PubMed Central

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

Shuja, Asim; Alkimawi, Khalid A.

2014-01-01

354

The Role of Tobacco-Derived Carcinogens in Pancreas Cancer  

PubMed Central

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

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

2011-01-01

355

Visualization of Mouse Pancreas Architecture Using MR Microscopy  

PubMed Central

Pancreatic diseases, which include diabetes, pancreatitis, and pancreatic cancer, are often difficult to detect and/or stage, contributing to a reduced quality of life and lifespan for patients. Thus, there is need for a technology that can visualize tissue changes in the pancreas, improve understanding of disease progression, and facilitate earlier detection in the human population. Because of low spatial resolution, current clinical magnetic resonance imaging (MRI) at low field strength has yet to fully visualize the exocrine, endocrine, vascular, and stromal components of the pancreas. We used high field strength magnetic resonance microscopy (?MRI) to image mouse pancreas ex vivo without contrast agents at high spatial resolution. We analyzed the resulting high-resolution images using volume rendering to resolve components in the pancreas, including acini, islets, blood vessels, and extracellular matrix. Locations and dimensions of pancreatic components as seen in three-dimensional ?MRI were compared with histological images, and good correspondence was found. Future longitudinal studies could expand on the use of in vivo ?MRI in mouse models of pancreatic diseases. Capturing three-dimensional structural changes through ?MRI could help to identify early cellular and tissue changes associated with pancreatic disease, serving as a mode of improved detection in the clinic for endocrine and exocrine pathologies.

Grippo, Paul J.; Venkatasubramanian, Palamadai N.; Knop, Richard H.; Heiferman, Daniel M.; Iordanescu, Gheorghe; Melstrom, Laleh G.; Adrian, Kevin; Barron, Morgan R.; Bentrem, David J.; Wyrwicz, Alice M.

2011-01-01

356

Human Islet Autotransplantation to Prevent Diabetes after Pancreas Resection  

Microsoft Academic Search

In severe cases of chronic pancreatitis pain relief can often only be achieved by pancreas resection, however this may render the patient diabetic. In an effort to prevent diabetes some patients may be suitable for a simultaneous islet autotransplant. The last report from the International Islet Transplant Registry has reported 222 cases. This review discusses the current progress in human

Steven A. White; Gavin S. M. Robertson; Nick J. M. London; Ashley R. Dennison

2000-01-01

357

Chemoradiotherapy in the Management of Localized Tumors of the Pancreas  

Microsoft Academic Search

In western countries, carcinoma of the pancreas remains the most lethal of the common malignancies. Even the favorable “organ-confined” tumors present a considerable challenge. The lack of anatomic barriers to local infiltration and the biological propensity for early lymphatic, perineural, and vascular invasion are nearly insurmountable obstacles to complete surgical eradication of this malignancy. Various combinations of chemotherapy and radiotherapy

Joseph C. Poen; James M. Ford; John E. Niederhuber

1999-01-01

358

Acinar cell carcinoma with fatty change arising from the pancreas  

PubMed Central

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

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

2011-01-01

359

Purification of classical pancreatic lipase from dog pancreas  

Microsoft Academic Search

The purification of canine classical pancreatic lipase from canine pancreatic juice, but not from pancreatic tissue, has been reported previously. Given the logistic difficulties associated with collection of pancreatic juice in dogs and efforts to minimize experiments in live animals the objective of this project was to purify canine classical pancreatic lipase from dog pancreas. Dog pancreata were collected from

Jörg M Steiner; David A Williams

2002-01-01

360

Sonographic changes of the pancreas in chronic renal failure  

Microsoft Academic Search

Several abnormalities regarding pancreatic morphology and function have been reported in patients with chronic renal failure (CRF) with an incidence as high as 72%. In a prospective study we investigated 96 outpatients from our chronic ambulatory hemodialysis program by abdominal ultrasound. Of the patients with CRF, 20.6% were found to have morphologic alterations of the pancreas compared to 4.7% of

Markus M. Lerch; Jochen Riehl; Helmut Mann; Irmgard Nolte; Heinz-Giinter Sieberth; Siegfried Matern

1989-01-01

361

Neonatal pancreas transplantation and liver enzyme activities in diabetic mice.  

PubMed

The aim of this study was to estimate the influence of transplantation of neonatal pancreas from singenic donors on glucose production and utilisation in alloxan diabetic mice. The alloxan diabetic mice, 20 days after alloxan, received neonatal pancreas from singenic donors under the kidney capsule. Enzymes involved in glycolytic, gluconeogenic, lipogenic and pentose phosphate pathway were examined in liver of experimental mice. The fructose-1, 6-diphosphatase (FDPase) activity in the liver of diabetics increased for about 60%, while the pyruvate inase (PK) and ATP-citrate lyase (CEE) activity decreased for about 40% of the values in the healthy mice. The values of glucose-6-phosphate dehydrogenase (G6P-DH) and 6-phosphogluconate dehydrogenase (6-PGDH) were not statistically different in diabetic liver compared with the liver off healthy animals. After pancreas transplantation some of diabetic animals become normoglycaemic, while the others remained hyperglycaemic. The FDPase activity in hyperglycaemic diabetic recipients was similar to those in diabetic mice that did not received transplant, while in normoglycaemic recipients the FDPase activity returned to the normal values. However, the activities of PK and CCE in hyperglycaemic recipients were similar to those in healthy animals, while in normogglycaemic recipients the enzyme activities were much higher. Results obtained showed that glycolytic, gluconeogenic and lipogenic enzyme activities in the liver of normoglycaemic mice that received pancreas transplant reached approximate the physiological values within 30 days after transplantation. PMID:10664326

Novak Mirceti?, R; Slijepcevi?, M; Cetkovi?-Cvrlje, M; Svetina, A

1999-12-01

362

[Papillary-cystic tumor of the pancreas in young women].  

PubMed

A case of papillary-cystic (solid cystic) tumor of the pancreas in a 15-year-old woman is presented. This type of tumor is of low grade malignancy and is without endocrinological activity. It is usually found in young women. The treatment is surgical resection. PMID:3212427

Schroeder, R; Chessex, D; Genton, C Y; Queloz, J

1988-12-24

363

Effects of soybean flour on the pancreas of rats.  

PubMed Central

We have reviewed the growth-promoting and carcinogenic effects of feeding raw soya flour to rats. If the raw soya flour-containing diets are fed for more than a year, about 10% of the animals develop pancreatic cancer. In addition, feeding raw soya flour markedly potentiates the action of even subthreshold amounts of pancreatic carcinogens. The raw soya flour therefore acts as a potent promoter, as well as a weak carcinogen. In view of this promotion, the rat fed raw soya flour is a sensitive model for screening pancreatic carcinogens. It is not known whether the human pancreas responds to dietary trypsin inhibitors in a manner similar to the rat. However, in view of the use of soya-based products in human nutrition--especially in infant foods--we urge that the effect of all soya-based products intended for human use be tested on the rat pancreas in long-term feeding studies, combined with subthreshold doses of azaserine to highlight any promoting activity of the product. It seems probable that if a product exerts no effect on the rat pancreas, the human pancreas will also be spared from noxious effects.

McGuinness, E E; Morgan, R G; Wormsley, K G

1984-01-01

364

Stimulus-secretion coupling in the developing exocrine pancreas  

SciTech Connect

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

Chang, A.Y.S.

1986-01-01

365

Neuroendocrine neoplasms of the gut and pancreas: new insights  

Microsoft Academic Search

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

Bertram Wiedenmann; Guido Rindi

2011-01-01

366

Visualization of mouse pancreas architecture using MR microscopy.  

PubMed

Pancreatic diseases, which include diabetes, pancreatitis, and pancreatic cancer, are often difficult to detect and/or stage, contributing to a reduced quality of life and lifespan for patients. Thus, there is need for a technology that can visualize tissue changes in the pancreas, improve understanding of disease progression, and facilitate earlier detection in the human population. Because of low spatial resolution, current clinical magnetic resonance imaging (MRI) at low field strength has yet to fully visualize the exocrine, endocrine, vascular, and stromal components of the pancreas. We used high field strength magnetic resonance microscopy (?MRI) to image mouse pancreas ex vivo without contrast agents at high spatial resolution. We analyzed the resulting high-resolution images using volume rendering to resolve components in the pancreas, including acini, islets, blood vessels, and extracellular matrix. Locations and dimensions of pancreatic components as seen in three-dimensional ?MRI were compared with histological images, and good correspondence was found. Future longitudinal studies could expand on the use of in vivo ?MRI in mouse models of pancreatic diseases. Capturing three-dimensional structural changes through ?MRI could help to identify early cellular and tissue changes associated with pancreatic disease, serving as a mode of improved detection in the clinic for endocrine and exocrine pathologies. PMID:21683673

Grippo, Paul J; Venkatasubramanian, Palamadai N; Knop, Richard H; Heiferman, Daniel M; Iordanescu, Gheorghe; Melstrom, Laleh G; Adrian, Kevin; Barron, Morgan R; Bentrem, David J; Wyrwicz, Alice M

2011-08-01

367

The Next Generation of Artificial Pancreas Control Algorithms  

Microsoft Academic Search

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

Rodrigo E. Teixeira; Stephen Malin

2008-01-01

368

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

PubMed

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

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

2012-01-01

369

[Relation of pre-operative ecography to laparoscopic cholecystectomy difficulty at the Central Military Hospital].  

PubMed

This study included 62 patients diagnosed with known vesicular disease, who underwent laparoscopic cholecystectomy between August 1999 and March 2000, at the Central Military Hospital. Those patients showing alterations in the hepatic function tests and dilatation of the biliary tract in the pre-operative echography were excluded from the study. The patients selected were subjected to evaluation of the echographic parameters one day before the surgery in order to determine the vesicular volume and ejection fraction. The maximum ejection fraction was calculated as the difference between the fasting gastric volume and the residual volume, in the fasting volume percentage. We evaluated the above-mentioned operative parameters one day following the laparoscopic cholecystectomy, using a visual analog scale (VAS) for evaluation of the surgical difficulty and bleeding during surgery. The surgery duration was measured in minutes. Subsequently, the pre-operative echographic parameters, excluding the ballstone parameter in the main biliary tract, were related to the surgery parameters, obtaining the following results: -The pre-operative echographic parameters, thickness of the vesicular wall and vesicular ejection fraction, are the best indicators of surgical difficulty in laparoscopic cholecystectomy. -The pre-operative echographic parameter, vesicular ejection fraction <50% and vesicular wall thickness = 3 mm are indicators of larger bleeding during laparoscopic cholecystectomy. -The pre-operative echographic parameter, vesicular ejection fraction in gallbladder indicates prolongation of surgery duration in laparoscopic cholecystectomy. -Finally, our study supports the use of echography as a useful diagnosis mean in patients undergoing laparoscopic cholecystectomy, and which can predict, through some of its echographic parameters, cases with technical difficulty, bleeding during surgery and prolongation of surgery time in laparoscopic cholecystectomy. PMID:12098742

Pinto Paz, Mirian Elizabeth

2002-01-01

370

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

PubMed

Determining whether a pancreatic mass is a primary or secondary neoplasm is necessary for appropriate treatment. We reviewed our experience using endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for diagnosis of pancreatic tumors to identify clinical and cytopathologic characteristics of metastatic disease. We reviewed all cases of tumors metastatic to the pancreas evaluated at The University of Texas MD Anderson Cancer Center and The Methodist Hospital in Houston, Texas during the period from 2002 to 2012. The review included cytologic specimens, clinical history, radiologic findings, primary tumor type, and clinical follow-up. We identified 66 patients with disease metastatic to the pancreas for which cytologic material was available: 38 (58%) men and 28 (42%) women, with an average age of 63 years (range, 40-89 years). Most metastases (98%) were single lesions, and nearly half were located in the head of the pancreas (30/66). The most common site of origin for these metastases was kidney (27 [41%] cases). Follow-up information was available for 65 (98%) patients, and duration of follow-up ranged from <1 to 10 years (mean, 2.3 years). Thirty-three patients (50%) were alive at the time of the most recent follow-up contact. Of the 25 patients with metastatic renal cell carcinoma, clear cell type, 19 (76%) were alive at the time of the most recent follow-up. It was concluded that metastases may mimic primary pancreatic carcinomas both clinically and cytologically. Ancillary studies in conjunction with clinical history are necessary for the accurate diagnosis of FNAs of secondary pancreatic tumors. Diagn. Cytopathol. 2014;42:738-743. © 2014 Wiley Periodicals, Inc. PMID:24554612

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

2014-09-01

371

Accuracy of preoperative vulva biopsy and the outcome of surgery in vulvar intraepithelial neoplasia 2 and 3.  

PubMed

To assess the accuracy of preoperative vulva biopsy and the outcome of surgery in vulvar intraepithelial neoplasia (VIN) 2 and 3. In this study 186 consecutive patients with VIN 2 and 3, who were treated with local wide excision or skinning vulvectomy at the Department of Obstetrics and Gynecology, Medical University of Vienna, between 1996 and 2008, were enrolled. Accuracy of preoperative vulva biopsy was assessed by evaluating the rates of correct diagnosis, underdiagnosis, and occult cancer. Histologic findings of preoperative vulva biopsy and surgery were compared. To assess risk factors for incomplete resection, univariate and multivariate analyses were performed, by using the presence of multifocal VIN, histologic grade, patients' age, surgeons' expertise, and lesion diameter as independent variables. VIN 2 and 3 were correctly diagnosed by preoperative vulva biopsy in 55.8% (29/52) and 88.1% (118/134) patients, respectively. Underdiagnosis occurred in 44.2% (23/52) and 11.9% (16/134) of preoperative vulva biopsies with an occult cancer rate of 3.8% (2/52) and 11.9% (16/134) for VIN 2 and 3, respectively. Complete resection was achieved in 43.0% (80/186) of patients. Presence of multifocal VIN was the only factor that was associated with incomplete resection in our study population in univariate and multivariate analyses (P=0.001, P=0.001). Mean patients' age at the time of diagnosis was 51.1 (SD: 15.7) years, multifocal lesions were present in 36.0% (67/186), and the median lesion diameter was 15.0 mm (interquartile range: 10.0-30.0). A significant number of VIN 2 and 3 were underdiagnosed by preoperative vulva biopsy. The rate of incomplete resection after surgery is notable. PMID:19851204

Polterauer, Stephan; Catharina Dressler, Anne; Grimm, Christoph; Seebacher, Veronika; Tempfer, Clemens; Reinthaller, Alexander; Hefler, Lukas

2009-11-01

372

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

PubMed

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

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

2013-01-01

373

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

PubMed Central

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

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

2012-01-01

374

Preoperative risk reduction: strategies to optimize outcomes.  

PubMed

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

Martindale, Robert G; Deveney, Clifford W

2013-10-01

375

Hypertension. Preoperative assessment and perioperative management.  

PubMed Central

Hypertension is a frequently encountered abnormality in patients being prepared for surgical procedures. This condition complicates anesthetic and postoperative management, but careful monitoring and treatment allow hypertensive patients to tolerate surgery safely. Particular attention should be directed toward continuing antihypertensive medicine until the time of the surgical procedure or initiating treatment before it, monitoring the blood pressure frequently after the operation, and controlling postoperative hypertension with one of many parenteral agents available. The possibility of the presence of secondary hypertension and cardiovascular complications of hypertension should be considered during the preoperative assessment.

Laslett, L

1995-01-01

376

Anesthesiologic preoperative evaluation of drug addicted patient.  

PubMed

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

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

2005-06-01

377

A preoperative stress inquiry and a vulnerable US military population.  

PubMed

The preoperative setting is fraught with many stressors, often increasing in magnitude as patients progress through the perioperative environment. Individuals exposed to traumatic or threatening environments, such as US military personnel involved in combat operations, may be at increased risk of developing altered mental and physical health conditions. Collectively, this may result in a hyperarousal state significantly amplifying psychological symptoms and magnifying physiological alterations. The purposes of this article are to (1) describe stress-related concepts and preoperative stress, (2) discuss potential risk factors for preoperative stress in the adult surgical population, (3) present various psychological and physiological measures of preoperative stress, (4) explore preoperative stress interventions, and (5) discuss potential implications for future preoperative stress research in high-stressed populations. PMID:23522266

Bopp, Eric J; Spence, Dennis L; Burkard, Joseph F

2013-04-01

378

Measurement tool for preoperative anxiety in young children: The yale preoperative anxiety scale  

Microsoft Academic Search

To develop a preoperative anxiety scale (YPAS) for children undergoing surgery, 21 specific behaviors indicating anxiety were defined within five domains (activity, emotional expressivity, state of arousal, vocalization, and use of adults). A reliability Kappa analysis revealed that inter-observer agreement ranged from .66 to .94, while intra-observer Kappa ranged from .66 to .91. Validity analysis between a Visual Analog Scale

Zeev N. Kain; Linda C. Mayes; Domenic V. Cicchetti; Lisa A. Caramico; Martha Spieker; Margaret M. Nygren; Stephen Rimar

1995-01-01

379

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

PubMed Central

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.

Yilmaz, Neslihan; Cekmen, Nedim; Bilgin, Ferruh; Erten, Ela; Ozhan, Mehmet Ozhan; Cosar, Ahmet

2013-01-01

380

Simulation for Preoperative Planning and Intraoperative Application of Titanium Implants  

Microsoft Academic Search

Towards semi-automated transfer of preoperatively planned bone repositionings in the operation theatre, this paper presents\\u000a a solution by performing preoperative bending of common titanium plate implants. The approach is based on our simulation system\\u000a KasOp which defines preoperatively bone cut trajectories and bone repositionings. According to physiological matters the segments\\u000a are repositioned and the computer models of the implants are

Oliver Schorr; Jörg Raczkowsky; Heinz Wörn

2003-01-01

381

Preoperative transarterial Embolisation in bone tumors  

PubMed Central

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.

Gupta, Pankaj; Gamanagatti, Shivanand

2012-01-01

382

One hundred pancreas transplants at a single institution.  

PubMed Central

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

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

1984-01-01

383

Simultaneous pancreas-kidney transplantation from live donors.  

PubMed Central

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

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

1997-01-01

384

Nephroureterectomy for Transitional Cell Carcinoma - The Value of Pre-Operative Histology  

PubMed Central

INTRODUCTION Nephroureterectomy with excision of a cuff of bladder remains the standard for managing upper tract transitional cell carcinoma (TCC). Increasing use of diagnostic upper tract endoscopy has underlined the importance of obtaining a pre-operative histological diagnosis in order to avoid under-treating high-grade or multifocal disease and over-treating low-grade disease, which could, in selected cases, be managed conservatively. We review nephroureterectomy at our institution over a 10-year period with particular reference to a pre-operative histological diagnosis. PATIENTS AND METHODS Nephroureterectomy was performed in 113 patients from February 1994 to February 2004. Of these cases, 58 were for upper tract TCC and 50 of these 58 had intravenous urography (IVU): 9 had only IVU, 28 had an additional CT scan, 5 had an additional ultrasonography and 8 had additional CT + ultrasonography for pre-operative work-up. Thirty-four of the 58 cases had retrograde pyelography. Nineteen (32.7%) of the 58 cases had a pre-operative ureteroscopy (URS) and biopsy; 14 of these had rigid URS for tumours in the lower (11) and middle (3) thirds of the ureter and 5 had flexible URS for pelvicalyceal tumours by an experienced endourologist. Thirty-one (53%) of the 58 tumours were within the pelvicalyceal system and 27 within the ureter (upper, 5; middle, 3; lower, 19). Forty-eight patients underwent a total nephroureterectomy: 40 had a two incision approach and 8 had an endoscopic resection of the lower ureter. Five of the 58 cases had a sub-total nephroureterectomy and 5 a laparoscopic nephroureterectomy with open excision of lower ureter. RESULTS Nineteen (32.7%) of the 58 patients had a pre-operative histological diagnosis – 17 G2pTa, 1 G1pTa, and 1 G2pT1. Fourteen (74%) biopsies matched the final postoperative histology, but 1 was down-staged, 3 up-staged and 1 up-graded compared to the original histology. Five (12.8%) of 39 patients without pre-operative histology had no TCC in the final surgical specimen: 4 (10.25%) had benign pathology such as capillary haemangioma, urothelial cysts and reactive urothelial changes while one had renal cell carcinoma (RCC). CONCLUSIONS This study underlines the importance of obtaining a pre-operative histological diagnosis in cases with presumed upper tract TCC. Failure to do so can result in unnecessary ablative surgery for benign disease. Such an approach can also help identify multifocality and grade of disease so that treatment of upper tract TCC can be tailored more appropriately with ablative surgery for high-grade or multifocal disease and conservative (endoscopic) therapy for low-grade disease in selected cases. Patients with suspected TCC of the upper tract should be managed at centres where facilities for the comprehensive evaluation of such tumours exist.

Chitale, Sudhanshu; Mbakada, Rashidi; Irving, Stuart; Burgess, Neil

2008-01-01

385

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

SciTech Connect

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

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

2011-11-15

386

Fine-needle aspiration of squamous-lined cysts of the pancreas.  

PubMed

Squamous-lined cysts (SLC) in the pancreas are rare and include lymphoepithelial cysts (LEC), dermoid cysts (DC), and epidermoid cysts in heterotopic spleen (EC). Previously only rare case reports and small case series have been published describing the FNA findings in these entities. The departmental archives were searched for surgically excised SLC from the pancreas. Twenty-five specimens were identified: 20 LEC, four EC, and one DC. Eight corresponding FNA specimens taken prior to resection were identified and available for review: seven LEC and one EC. A junior and senior pathologist reviewed the cases individually and then together for consensus. On morphological review, all lesions contained single nucleated and anucleated mature squamous cells, macrophages, and varying amounts of lymphocytes. Benign squamous fragments were found in half of all specimens. Amorphous debris was found in all cases. Keratin was found in all but two cases and its appearance varied among cases. Half of all cases contained cholesterol crystals. No nuclear atypia or necrosis was noted. Inspissated mucin, a potentially misleading finding, was seen in three cases. The most important goal in evaluating pancreatic cystic lesions is to exclude a mucin-producing neoplasm. If features of a SLC are present, the differential diagnosis should include LEC, DC, and EC. Only 38% (3/8) cases had the most specific features of an SLC present (squamous fragments, cholesterol crystals, keratin, and squamous cells), which suggests that most cases will not be specifically identified on FNA even by experienced cytopathologists. Diagn. Cytopathol. 2014;42:592-599. © 2013 Wiley Periodicals, Inc. PMID:24376211

VandenBussche, Christopher J; Maleki, Zahra

2014-07-01

387

Preoperative detection of sentinel lymph nodes in endometrial cancer using SPECT/CT.  

PubMed

We report the use of SPECT/CT in sentinel lymph node biopsy in endometrial cancer. The patient was a 54-year-old woman with the diagnosis of endometrial adnenocarcinoma, grade 2. Preoperative MRI and transvaginal ultrasound scans revealed tumor infiltrating more than 50% of the myometrium. The patient was qualified for total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic/paraaortic lymphadenectomy. Before the surgery, 2 cervical injections of the (99m)Tc-labeled nanocolloid (0.5 mCi) were administered and the SPECT/CT was performed using a standard dual-head gamma camera and a 6-slice spiral CT component. PMID:23797222

Sawicki, Sambor; Kobierski, Juliusz; Lass, Piotr; Cytawa, Wojciech; Wydra, Dariusz

2013-09-01

388

[Morphology of the endocrine portion of the reptile pancreas].  

PubMed

The endocrinous part of the pancreatic gland of reptiles Lacerta agilis, Agama sanguinolenta, Varanus griseus, Testudo horsfieldi and Clemmus Caspica is formed by A-, B- and D-cells. The main form of its structural organization is pancreatic islands. In adition to them, remnants of the "external epithelium" are found in Varanus griseus and A-cells disposed outside of the pancreatic islands in Testudo horsfieldi and Clemmys caspica. As compared with amphibia, reptiles have a better developed counterinsular component (A-cells) of the endocrinous part of the pancreas. The acino-island cells of "A" and "D" types are also found in the pancreas of reptiles, "A"-type cells being predominant among them. PMID:799926

Iaglov, V V

1976-01-01

389

Isolation and characterization of somatostatin from pigeon pancreas.  

PubMed Central

Most of the somatostatin-like activity from pigeon pancreas was found to correspond to small species with an apparent molecular weight of 1500--2500. This species was isolated under conditions minimizing intermolecular interactions and protease activities. The isolated product was characterized by two somatostatin radioimmunoassays, a bioassay, endgroup determination, and amino acid analysis. The structure of the isolated compound was determined to be H-Ala-Gly-cyclo-(Cys-Lys-Asn-Phe-Phe-Trp-Lys-Thr-Phe-Thr-Ser-Cys)-OH. Additionally, small amounts of des-Ala1-somatostatin, a possible degradation product of pancreatic somatostatin, and a large somatostatin-like species with an apparent molecular weight of 11,000--12,500 were detected. It is concluded that the main somatostatin-like polypeptide isolated from pigeon pancreas is identical to the mammalian hypothalamic tetradecapeptide somatostatin.

Spiess, J; Rivier, J E; Rodkey, J A; Bennett, C D; Vale, W

1979-01-01

390

Generation and Regeneration of Cells of the Liver and Pancreas  

PubMed Central

Liver and pancreas progenitors develop from endoderm cells in the embryonic foregut. Shortly after their specification, liver and pancreas progenitors rapidly acquire markedly different cellular functions and regenerative capacities. These changes are elicited by inductive signals and genetic regulatory factors that are highly conserved in vertebrate evolution. Interest in the development and regeneration of the organs has been fueled by the intense need for hepatocytes and pancreatic ?-cells in the therapeutic treatment of liver failure and type I diabetes. Studies in diverse model organisms have revealed evolutionarily conserved inductive signals and transcription factor networks that elicit the differentiation of liver and pancreatic cells, and provide guidance for how to promote hepatocyte and ?-cell differentiation from diverse stem and progenitor cell types.

Grompe, Markus

2009-01-01

391

Acid-base transport in pancreas--new challenges  

PubMed Central

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

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

2013-01-01

392

Whole-organ pancreas transplantation at Baylor Regional Transplant Institute: a chance to cure diabetes  

PubMed Central

The success of pancreas transplantation has improved over the past several decades with advancements in surgical technique, immunosuppressive medicines, and immunologic testing. We retrospectively reviewed our experience with pancreas transplantation from 1995 to 2008. At the Baylor Regional Transplant Program, 151 pancreas transplants were performed in 147 patients: 135 were simultaneous pancreas-kidney transplants, 10 were pancreas transplants after kidney transplants, and 6 were pancreas transplants alone. Follow-up information was available for 138 patients. The 1-year acute cellular rejection rate was 31.6%; the 30-day surgical reexploration rate was 10%; and the technical failure rate was 5.3%. Five-year pancreas graft survival rates were 67% for simultaneous pancreas and kidney transplants and 50% for pancreas transplants after kidney transplants. These outcomes exceed expected results as calculated by the Scientific Registry of Transplant Recipients. In addition, the median time to transplant was 3.8 months, compared with a US median of 14.1 months. Pancreas transplantation is currently the closest thing to a cure for diabetes and should be given as an option for diabetic patients with or without end-stage renal disease.

Melton, Larry B.; Chinnakotla, Srinath; Levy, Marlon F.; Fischbach, Bernard V.; Goldstein, Robert; Klintmalm, Goran B.

2010-01-01

393

Biocompatible polymer alloy membrane for implantable artificial pancreas  

Microsoft Academic Search

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

Tomoaki Uchiyama; Junji Watanabe; Kazuhiko Ishihara

2002-01-01

394

Collagenase activity of an enzyme preparation from pig pancreas  

Microsoft Academic Search

Diced pig pancreas (i kg) was extracted three times with acetone at volume ratios of 1:3, 1:2, and 1:2, and then with six volumes of 0.i M acetate buffer pH 4.7; the resulting suspension was filtered. The filtrate was used for extraction of enzyme with elastase activity, and the cake remaining on the filter was collected and used for extraction

A. D. Neklyudov; M. I. Baburina; E. Yu. Kulikova; L. K. Bartkova; T. I. Kozlovskaya

1991-01-01

395

Palmitate induced lipoapoptosis of exocrine pancreas AR42J cells  

Microsoft Academic Search

Chronic surplus of dietary consumption, typical to obesity, results in overflow of fat to non-adipose tissues. Intracellular\\u000a accumulation of fat in non-adipose tissues is associated with cellular dysfunction and cell death and ultimately contributes\\u000a to the pathogenesis of chronic diseases. The influence of fat overflow on the exocrine pancreas is not known. The purpose\\u000a of this research was to study

Z. Landau; E. Forti; M. Alcaly; R. Z. Birk

2006-01-01

396

Laparoscopic Surgery for Solid Pseudopapillary Tumor of the Pancreas  

PubMed Central

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, 15–77 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, 1.5–11 cm), the median operative time was 197 minutes (range, 68–320 minutes), and the median blood loss was 50 mL (range, <50–750 mL). Distal resections were performed with a linear stapler. Four patients had postoperative complications. The median length of hospital stay was 5 days (range, 2–12 days). During a median follow-up period of 11 months (range, 3–121 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.

Afridi, Shabbir A.; Kazaryan, Airazat M.; Marangos, Irina Pavlik; R?sok, Bard I.; Fretland, Asmund A.; Yaqub, Sheraz

2014-01-01

397

Histopathological study of intraductal papillary mucinous tumor of the pancreas  

Microsoft Academic Search

Aim. In this study, we investigated the tissue expression of Survivin, p53, and Bcl-2 in intraductal papillary-mucinous tumor\\u000a (IPMT) of the pancreas to identify their roles in tumorigenesis of IPMT, and examined their correlations with tumor cell apoptosis\\u000a and proliferation in IPMT. The diagnostic values of the expression of Survivin, p53, and Bcl-2 and the apoptotic index (AI)\\u000a and Ki-67

Ma Jinfeng; Wataru Kimura; Fumiaki Sakurai; Toshiyuki Moriya; Akiko Takeshita; Ichiro Hirai

2002-01-01

398

Rat pancreas secretes particulate ecto-nucleotidase CD39  

PubMed Central

In exocrine pancreas, acini release ATP and the excurrent ducts express several types of purinergic P2 receptors. Thereby, ATP, or its hydrolytic products, might play a role as a paracrine regulator between acini and ducts. The aim of the present study was to elucidate whether this acinar-ductal signalling is regulated by nucleotidase(s), and to characterize and localize one of the nucleotidases within the rat pancreas. Using RT-PCR and Western blotting we show that pancreas expresses the full length ecto-nucleoside triphosphate diphosphohydrolase, CD39. Immunofluorescence shows CD39 localization on basolateral membranes of acini and intracellularly. In small intercalated/ interlobular ducts, CD39 immunofluorescence was localized on the luminal membranes, while in larger ducts it was localized on the basolateral membranes. Upon stimulation with cholecystokinin-octapeptide-8 (CCK-8), acinar CD39 relocalizes in clusters towards the lumen and is secreted. As a result, pancreatic juice collected from intact pancreas stimulated with CCK-8 contained nucleotidase activity, including that of CD39, and no detectable amounts of ATP. Anti-CD39 antibodies detected the full length (78 kDa) CD39 in pancreatic juice. This CD39 was confined only to the particulate and not to the soluble fraction of CCK-8-stimulated secretion. No CD39 activity was detected in secretion stimulated by secretin. The role of secreted particulate, possibly microsomal, CD39 would be to regulate intraluminal ATP concentrations within the ductal tree. In conclusion, we show a novel inducible release of full length particulate CD39, and propose its role in the physiological context of pancreatic secretion.

S?rensen, Christiane E; Amstrup, Jan; Rasmussen, Hans N; Ankorina-Stark, Ieva; Novak, Ivana

2003-01-01

399

Nuclear magnetic resonance of the liver, spleen, and pancreas  

Microsoft Academic Search

This review includes the initial experience with NMR imaging of the liver, spleen, and pancreas at the University of California,\\u000a San Francisco, using a prototype 0.35 Tesla system. This experience shows great promise for detection of hepatic metastases\\u000a using T1-weighted pulse sequences. T2-weighted pulse sequences appear sensitive for detecting cavernous hemangioma of the liver and may allow tissue specific discrimination

David D. Stark; Albert A. Moss; Henry I. Goldberg

1986-01-01

400

Clinical outcome of pancreas transplantation from marginal donors in Japan.  

PubMed

In Japan, absolute shortage of donors still continues even after the law allowing organ transplantation from deceased donors came into force in 1997. With the passage of the waiting period after registration for pancreas transplantation (PTx), both deaths and serious cases of diabetic complications necessitating withdrawal of the registration have undoubtedly increased. Therefore, so-called "marginal donor" (MD) has been considered as a potential solution for shortage of donors in Japan. The aim of the present study is to evaluate feasibility of MD in terms of post-PTx outcomes using data from Japan Organ Transplantation Network. A total of 148 PTx were performed from deceased donors in Japan from 2000 to 2012. MD was defined as follows: (1) >45 years old; (2) hemodynamically unstable at harvest using a high-dose dopamine or more than 2 vasopressors; or (3) non-heart-beating status. Postoperative outcomes after PTx were compared between the MD group and the non-MD group. Among the 148 PTx donors, 108 donors (73.0%) satisfied the criteria of MD. Early graft loss of pancreas graft during 3 months post-transplant was observed in 15 patients (10.1%), and the marginality (MD vs non-MD) was not significantly correlated with the early loss of pancreas graft. The overall patient survival of the MD group (1, 3, 5 years: 94.7%, 94.7%, 94.7%) was not significantly different from that of the non-MD group (1, 3, 5 years: 95.0%, 95.0%, 95.0%). Pancreas graft survival in the MD group (1, 3, 5 years: 80.9%, 73.2%, 66.0%) seemed to be slightly lower than that in the non-MD group (1, 3, 5 years: 92.5%, 85.2%, 77.4%), but no statistically significant differences were found between the 2 groups. These results suggest the feasibility of the use of MD for PTx. PMID:24767389

Tomimaru, Y; Ito, T; Kawamoto, K; Hama, N; Wada, H; Kobayashi, S; Eguchi, H; Tanemura, M; Mori, M; Doki, Y; Nagano, H

2014-04-01

401

A new approach toward a pancreas-seeking zinc radiopharmaceutical. II. 62Zn-EDDA (ethylenediamine-N,N'-diacetic acid) for pancreas PCT imaging.  

PubMed

The functionality of various zinc complexes of amino acid derivatives as a zinc radiopharmaceutical for pancreas PCT imaging was tested using 65Zn, which has a long half-life, and 62Zn, which has a short half-life. Because of the favorable results obtained in previous in vitro pancreas section studies, the ability of those Zn complexes to retain their integrity in the presence of blood serum or in living organisms was screened using Sephadex column chromatography and mice biodistribution studies. A relationship between the structure and stability of Zn complexes played a determining role on the in vivo availability of Zn for the pancreas or liver. Among the Zn complexes tested, the tetra-coordinated structure of the Zn-EDDA complex at an equimolar ratio showed proper accumulation in the pancreas, inducing an appropriate pancreas PCT image in the dog with the positron emitter 62Zn-EDDA administered at 1 mg Zn/kg body weight. PMID:3089790

Fujibayashi, Y; Saji, H; Yomoda, I; Suzuki, K H; Torizuka, K; Yokoyama, A

1986-01-01

402

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

PubMed Central

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.

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

2014-01-01

403

Preoperative imatinib facilitates complete resection of locally advanced primary GIST by a less invasive procedure.  

PubMed

Complete resection is the most effective therapy for gastrointestinal stromal tumors (GISTs). Complete resection of locally advanced primary GIST by less invasive procedure is usually difficult at initial diagnosis. Imatinib has been successful in treating locally advanced and metastatic GIST and this report shares the experiences in preoperative use of imatinib for patients with locally advanced primary GISTs. The procedure of treatment and completeness of resection were retrospectively accessed for locally advanced primary GIST. Disease-free survival (DFS) and overall survival (OS) after resection were analyzed. Thirteen patients were treated with imatinib preoperatively. All patients received surgical resection after a median imatinib treatment of 7 months when most tumors shrunk. All patients achieved R0 resection without tumor rupture. Two patients received an en-bloc multivisceral resection for the invasion of surrounding organs and 3 patients underwent Mile's operation for a low rectal tumor. Eleven patients were disease-free. Median DFS or OS had not been reached, while 1- and 3-year DFS were estimated to be 92.3 and 76.9 %, respectively. 1- and 3-year OS were both estimated to be 100 %. Preoperative use of imatinib is useful in locally advanced primary GIST by downsizing the tumor in most patients and facilitating complete resection through less invasive procedures without tumor rupture. PMID:25056206

Yang, Weili; Yu, Jiren; Gao, Yuan; Shen, Qianyun; Zhang, Qing; Liu, Xiaosun; Zhao, Zhicheng; Shi, Xiaoxiao; Zhu, Kankai; Ma, Yingchun

2014-09-01

404

Characterization of preneoplastic and neoplastic lesions in the rat pancreas.  

PubMed Central

Nodules of acinar cells with increased proliferative potential develop in the pancreas of carcinogen-treated rats and in untreated aged rats. Large nodules are classed as adenomas. Phenotypic and genotypic characteristics of nodule cells were compared with normal pancreas and transplantable acinar cell carcinomas by several methods. Nuclei of acinar cells from normal pancreas, adenomas, and three carcinomas in situ had normal diploid DNA content as determined by flow cytometry. One of two primary carcinomas had a hypodiploid DNA content. Two of three transplantable carcinomas were aneuploid with a DNA content in the tetraploid range. Explants from nodules and adenomas failed to grow in soft agar, whereas several carcinomas were positive in this assay. A primary carcinoma was serially transplanted, but transplantation of nodules or adenomas failed. Transfection of DNA from carcinomas in situ yielded a higher frequency of NIH 3T3 transformants than DNA from adenomas. DNAs from the transformants did not contain ras sequences. These studies indicate that cells from nodules and adenomas have low growth potential and lack critical phenotypic and genotypic characteristics of transformed malignant cells that were present in some primary and transplanted carcinomas. Images Figure 2

Longnecker, D. S.; Pettengill, O. S.; Davis, B. H.; Schaeffer, B. K.; Zurlo, J.; Hong, H. L.; Kuhlmann, E. T.

1991-01-01

405

Promoting ectopic pancreatic fates: pancreas development and future diabetes therapies.  

PubMed

Diabetes is a disease that could be treated more effectively with a better understanding of pancreas development. This review examines the role of master regulator genes driving crucial steps in pancreas development, from foregut specification to differentiation of the five endocrine cell types. The roles of Pdx1, Ptf1a, and Ngn3 are particularly examined as they are both necessary and sufficient for promoting pancreatic cell fates (Pdx1, Ptf1a) and endocrine cell development (Ngn3). The roles of Arx and Pax4 are studied as they compose part of the regulatory mechanism balancing development of different types of endocrine cells within the iselts and promote the development of alpha/PP and beta/delta cell progenitors, respectively. The roles of the aforementioned genes, and the consequences of misexpression of them for functionality of the pancreas, are examined through recent studies in model organisms, particularly Xenopus and zebrafish. Recent developments in cell replacement therapy research are also covered, concentrating on stem cell research (coaxing both adult and embryonic stem cells toward a beta cell fate) and transdifferentiation (generating beta cells from other differentiated cell types). PMID:18783407

Pearl, E J; Horb, M E

2008-10-01

406

The Endocrine Pancreas: insights into development, differentiation and diabetes  

PubMed Central

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.

2012-01-01

407

No evidence for ? cell neogenesis in murine adult pancreas.  

PubMed

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

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

2013-05-01

408

Dynamics of embryonic pancreas development using real-time imaging  

PubMed Central

Current knowledge about developmental processes in complex organisms has relied almost exclusively on analyses of fixed specimens. However, organ growth is highly dynamic, and visualization of such dynamic processes, e.g. real-time tracking of cell movement and tissue morphogenesis, is becoming increasingly important. Here, we use live imaging to investigate expansion of the embryonic pancreatic epithelium in mouse. Using time-lapse imaging of tissue explants in culture, fluorescently labeled pancreatic epithelium was found to undergo significant expansion accompanied by branching. Quantification of the real-time imaging data revealed lateral branching as the predominant mode of morphogenesis during epithelial expansion. Live imaging also allowed documentation of dynamic ß-cell formation and migration. During in vitro growth, appearance of newly formed ß-cells was visualized using pancreatic explants from MIP-GFP transgenic animals. Migration and clustering of ß-cells were recorded for the first time using live imaging. Total ß-cell mass and concordant aggregation increased during the time of imaging, demonstrating that cells were clustering to form “pre-islets”. Finally, inhibition of Hedgehog signaling in explant cultures led to a dramatic increase in total ß-cell mass, demonstrating application of the system in investigating roles of critical embryonic signaling pathways in pancreas development including ß-cell expansion. Thus, pancreas growth in vitro can be documented by live imaging, allowing visualization of the developing pancreas in real-time.

Puri, Sapna; Hebrok, Matthias

2007-01-01

409

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

PubMed Central

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

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

2013-01-01

410

Preoperational test report, recirculation condenser cooling systems  

SciTech Connect

This represents a preoperational test report for Recirculation Condenser Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The four system provide condenser cooling water for vapor space cooling of tanks AY1O1, AY102, AZ1O1, AZ102. Each system consists of a valved piping loop, a pair of redundant recirculation pumps, a closed-loop evaporative cooling tower, and supporting instrumentation; equipment is located outside the farm on concrete slabs. Piping is routed to the each ventilation condenser inside the farm via below-grade concrete trenches. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

Clifton, F.T.

1997-11-04

411

[Preoperative embolization for meningiomas using PVA particles].  

PubMed

Preoperative embolization for highly vascularized and large meningiomas is an indispensable technique for facilitating their surgical removal by decreasing blood loss during the operation. This is a report of 4 large and highly vascularized meningiomas in the skull base, on which embolization of feeders was performed preoperatively by PVA (Polyvinyl alcohol foam) particles (150-250 micron produced by INGENOR CO, Paris) and small strips of gelfoam (0.5 x 0.5 x 3-5mm). Under EEG monitoring, Isosorbide dinitrate was used for prevention and relief of vascular spasm. Lidocaine injection tests (Xylocaine 2%: 50mg mixed in equal volumes with Iopamiron 300) were performed for checking before embolization. In the intracranial portion, standard taper steerable guide wire was changed to seeker flexible soft-tip guide wire. In two cases, the meningioma was located in the medial part of the sphenoidal ridge. In the other two cases, one meningioma was in the lateral part of the sphenoidal ridge and the other was in the olfactory groove. In all 4 cases, we successfully performed embolization without complication. In one case, we had to perform embolization twice, because of revascularization detected by angiography 3 weeks after the first embolization. In this latter case, we had performed central embolization only, by using PVA particles, having left feeder without occlusion (peripheral embolization) using gelfoam. The result suggested that it was also necessary to perform peripheral embolization especially if the tumor is fed by large tortuous and irregular abnormal vessels. Peripheral embolization may prevent PVA particles from washing out and causing progressive thrombosis by PVA particles.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1570057

Kurata, A; Saegusa, H; Ohmomo, T; Takano, M; Yamazaki, Y; Tokiwa, K; Irikura, K; Miyasaka, Y; Yada, K; Kan, S

1992-04-01

412

Preoperative localization and radioguided parathyroid surgery.  

PubMed

Clinical or subclinical hyperparathyroidism is one of the most common endocrine disorders. Excessive secretion of parathyroid hormone is most frequently caused by an adenoma of >or=1 parathyroid gland. Unsuccessful surgery with persistent hyperparathyroidism, due to inadequate preoperative or intraoperative localization, may be observed in about 10% of patients. The conventional surgical approach is bilateral neck exploration, whereas minimally invasive parathyroidectomy (MIP) has been made possible by the introduction of (99m)Tc-sestamibi scintigraphy for preoperative localization of parathyroid adenomas. In MIP, the incision is small, dissection is minimal, postoperative pain is less, and hospital stay is shorter. Localization imaging techniques include ultrasonography, CT, MRI, and scintigraphy. Parathyroid scintigraphy with (99m)Tc-sestamibi is based on longer retention of the tracer in parathyroid than in thyroid tissue. Because of the frequent association of parathyroid adenomas with nodular goiter, the optimal imaging combination is (99m)Tc-sestamibi scintigraphy and ultrasonography. Different protocols are used for (99m)Tc-sestamibi parathyroid scintigraphy, depending on the institutional logistics and experience (classical dual-phase scintigraphy, various subtraction techniques in combination with radioiodine or (99m)Tc-pertechnetate). MIP is greatly aided by intraoperative guidance with a gamma-probe, based on in vivo radioactivity counting after injection of (99m)Tc-sestamibi. Different protocols used for gamma-probe-guided MIP are based on different timing and doses of tracer injected. Gamma-probe-guided MIP is a very attractive surgical approach to treat patients with primary hyperparathyroidism due to a solitary parathyroid adenoma. The procedure is technically easy, safe, with a low morbidity rate, and has better cosmetic results and lower overall cost than conventional bilateral neck exploration. Specific guidelines should be followed when selecting patients for gamma-probe-guided MIP. PMID:12960191

Mariani, Giuliano; Gulec, Seza A; Rubello, Domenico; Boni, Giuseppe; Puccini, Marco; Pelizzo, Maria Rosa; Manca, Gianpiero; Casara, Dario; Sotti, Guido; Erba, Paola; Volterrani, Duccio; Giuliano, Armando E

2003-09-01

413

Accuracy of clinical diagnosis in patients undergoing knee arthroscopy.  

PubMed

A retrospective analysis of patients who underwent knee arthroscopy was undertaken to determine the accuracy of clinical diagnosis when compared with arthroscopic findings, and to see whether any specific pathologies were difficult to diagnose. The preoperative diagnosis was compared with the operative findings and the accuracy, sensitivity and specificity of the clinical diagnosis calculated. Six hundred ninety-eight patients were included. The overall accuracy, sensitivity and specificity of clinical diagnosis was 99%, 70% and 99%, respectively. Ninety percent of patients underwent a beneficial procedure, while 10% had a normal knee diagnosed at operation. Medial meniscal tear was the hardest pathology to diagnose with accuracy, sensitivity and specificity rates of 82%, 92% and 79%, respectively. Clinical examination remains an accurate method of assessing whether patients would benefit from an arthroscopy, although the correct diagnosis may not be determined preoperatively, particularly if pain was located in the medial tibio-femoral joint. PMID:19337731

Nickinson, Richard; Darrah, Clare; Donell, Simon

2010-02-01

414

Piaget's Preoperational Stage of Development and Applications for Special Preschoolers.  

ERIC Educational Resources Information Center

Many preschool children with developmental delays in cognition and language are in the preoperational stage as defined by Jean Piaget's theory of cognitive development. The preoperational stage is divided into the preconceptual and the intuitive phases. During the preconceptual phase, the preschooler is unable to form true concepts and often…

Lowenthal, Barbara

415

Data collection variation in preoperative assessment: a literature review  

Microsoft Academic Search

This study is a systematic literature review to identify data collected in the preoperative assessment. The PubMed and CINAHL databases were searched for articles published from 1997 to 2007. From the included articles, data items that were described as part of the preoperative assessment were extracted. Identified data items were categorized into 13 categories originating from SNOMED CT. Forty-one relevant

L. Ahmadian; R. Cornet; Klei van W. A; Keizer de N. F

2011-01-01

416

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

Microsoft Academic Search

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

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

2002-01-01