Sample records for pancreas preoperative diagnosis

  1. Preoperative cyst fluid analysis is useful for the differential diagnosis of cystic lesions of the pancreas

    Microsoft Academic Search

    Pascal Hammel; Philippe Levy; Hélène Voitot; Michaël Levy; Valérie Vilgrain; Marc Zins; Jean-François Flejou; Georges Molas; Philippe Ruszniewski; Pierre Bernades

    1995-01-01

    Background\\/Aims: It has been suggested that activity of pancreatic enzymes and concentrations of tumoral markers in cyst fluid may help to distinguish pseudocyst, serous, and mucinous cystadenomas. The aim of this study was to prospectively assess the reliability of preoperative biochemical and tumor marker analysis in cyst fluids obtained by fine-needle aspiration for pathological diagnosis. Methods: Cyst fluid was obtained

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

    PubMed Central

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

    2013-01-01

    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. PMID:23463761

  3. Intraductal Papillary Mucinous Neoplasms of the Pancreas: Performance of Pancreatic Fluid Analysis for Positive Diagnosis and the Prediction of Malignancy

    Microsoft Academic Search

    Frédérique Maire; Hélène Voitot; Alain Aubert; Laurent Palazzo; Dermot O'Toole; Anne Couvelard; Philippe Levy; Michel Vidaud; Alain Sauvanet; Philippe Ruszniewski; Pascal Hammel

    2008-01-01

    INTRODUCTION:The preoperative diagnosis of intraductal papillary mucinous neoplasms (IPMN) of the pancreas must be as reliable as possible because large or even total pancreatectomy may be necessary. Early diagnosis of malignant forms is important to improve prognosis. The diagnostic accuracy of fluid analysis using endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has been confirmed in cystic lesions of the pancreas. It is

  4. Giant serous microcystic adenoma of the pancreas safely resected after preoperative arterial embolization.

    PubMed

    Tajima, Hidehiro; Ohta, Tetsuo; Kitagawa, Hirohisa; Shinbashi, Hiroyuki; Hirose, Atsushi; Sakai, Seisho; Makino, Isamu; Hayashi, Hironori; Nakagawara, Hisatoshi; Onishi, Ichiro; Takamura, Hiroyuki; Ninomiya, Itasu; Fushida, Sachio; Tani, Takashi; Fujimura, Takashi; Kayahara, Masato; Koda, Wataru; Matsui, Osamu

    2010-09-01

    Serous microcystic adenomas are rare and account for 1-2% of all exocrine pancreatic tumors and 25% of all pancreatic cystic neoplasms. Recently, with advances in imaging techniques, these adenomas have been identified at an increasing frequency. A 63-year-old woman visited her doctor in 1999 due to a gastric deformity detected by upper gastrointestinal endoscopy. An abdominal computed tomography scan revealed a cystic lesion measuring 6.0 cm in diameter, resulting in a diagnosis of serous microcystic adenoma of the pancreatic head. During follow-up, the tumor increased steadily in size, measuring 6.0 cm in diameter in 1999 and 13.0 cm in 2008, while remaining asymptomatic throughout this period of time. The risk of malignant transformation appears to be low even over the long-term. However, some cases of malignant transformation to serous cystadenocarcinoma have recently been reported. In this case, assessment of the relationship between the tumor and adjacent vascular structures, such as massive drainage vein development on the surface or tumor flow into the portal and superior mesenteric veins and the celiac and superior mesenteric arteries, was critical for determining tumor resectability. The risk of massive intra-operative hemorrhage was felt to be considerable, given the extent of the veins on the surface of the tumor, as well as the size and location of the primary pancreatic mass. Therefore, preoperative embolization of the tumor-feeding arteries arising from the celiac axis (gastroduodenal, splenic and dorsal pancreatic arteries) was performed. Tumor resection with pancreaticoduodenectomy was performed without a blood transfusion, with an estimated blood loss of 570 ml. The final pathology confirmed the diagnosis of serous microcystic adenoma. The patient is currently alive and disease-free. Preoperative partial embolization of the tumor feeding arteries and intra-operative resection of the right gastric and inferior pancreatoduodenal arteries, allowed the tumor blood supply to be arrested without preoperative tumor necrosis. Subsequently, intraoperative blood loss was reduced. Preoperative partial embolization of the feeding arteries is useful for the resection of hypervascular large tumors of the pancreas. PMID:22966391

  5. Giant serous microcystic adenoma of the pancreas safely resected after preoperative arterial embolization

    PubMed Central

    TAJIMA, HIDEHIRO; OHTA, TETSUO; KITAGAWA, HIROHISA; SHINBASHI, HIROYUKI; HIROSE, ATSUSHI; SAKAI, SEISHO; MAKINO, ISAMU; HAYASHI, HIRONORI; NAKAGAWARA, HISATOSHI; ONISHI, ICHIRO; TAKAMURA, HIROYUKI; NINOMIYA, ITASU; FUSHIDA, SACHIO; TANI, TAKASHI; FUJIMURA, TAKASHI; KAYAHARA, MASATO; KODA, WATARU; MATSUI, OSAMU

    2010-01-01

    Serous microcystic adenomas are rare and account for 1–2% of all exocrine pancreatic tumors and 25% of all pancreatic cystic neoplasms. Recently, with advances in imaging techniques, these adenomas have been identified at an increasing frequency. A 63-year-old woman visited her doctor in 1999 due to a gastric deformity detected by upper gastrointestinal endoscopy. An abdominal computed tomography scan revealed a cystic lesion measuring 6.0 cm in diameter, resulting in a diagnosis of serous microcystic adenoma of the pancreatic head. During follow-up, the tumor increased steadily in size, measuring 6.0 cm in diameter in 1999 and 13.0 cm in 2008, while remaining asymptomatic throughout this period of time. The risk of malignant transformation appears to be low even over the long-term. However, some cases of malignant transformation to serous cystadenocarcinoma have recently been reported. In this case, assessment of the relationship between the tumor and adjacent vascular structures, such as massive drainage vein development on the surface or tumor flow into the portal and superior mesenteric veins and the celiac and superior mesenteric arteries, was critical for determining tumor resectability. The risk of massive intra-operative hemorrhage was felt to be considerable, given the extent of the veins on the surface of the tumor, as well as the size and location of the primary pancreatic mass. Therefore, preoperative embolization of the tumor-feeding arteries arising from the celiac axis (gastroduodenal, splenic and dorsal pancreatic arteries) was performed. Tumor resection with pancreaticoduodenectomy was performed without a blood transfusion, with an estimated blood loss of 570 ml. The final pathology confirmed the diagnosis of serous microcystic adenoma. The patient is currently alive and disease-free. Preoperative partial embolization of the tumor feeding arteries and intra-operative resection of the right gastric and inferior pancreatoduodenal arteries, allowed the tumor blood supply to be arrested without preoperative tumor necrosis. Subsequently, intraoperative blood loss was reduced. Preoperative partial embolization of the feeding arteries is useful for the resection of hypervascular large tumors of the pancreas. PMID:22966391

  6. Role of Endoscopic Ultrasound in the Diagnosis of Pancreas Divisum

    PubMed Central

    Rana, Surinder Singh; Bhasin, Deepak Kumar; Sharma, Vishal; Rao, Chalapathi; Singh, Kartar

    2013-01-01

    Objective: The published data on the accuracy of the detection of pancreas divisum by endoscopic ultrasound (EUS) is limited. In this study, we evaluate the accuracy of detection of pancreas divisum by radial EUS in patients with chronic pancreatitis. Methods: We retrospectively evaluated patients with chronic pancreatitis who underwent EUS followed by endoscopic retrograde cholangiopancreatography (ERCP) in the last four years to identify patients with complete pancreas divisum. Results: One hundred and forty six patients with chronic pancreatitis underwent EUS examination and 20 patients (13.6%) had pancreas divisum. The overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy of absence of stack sign on EUS for the diagnosis of pancreas divisum were 50%, 97%, 73%, 93% and 91%, respectively and for the inability to trace pancreatic duct from the head to the body were 100%, 96%, 80%, 100% and 96%, respectively. Conclusion: EUS can diagnose pancreas divisum in a majority of patients. Pancreas divisum can be reliably excluded if pancreatic duct could be tracked backwards from the head to the body around the genu. PMID:24949360

  7. [Diagnosis of neuroendocrine neoplasms of the pancreas].

    PubMed

    Kochatkov, A V; Kubyshkin, V A; Kriger, A G; Karmazanovski?, G G; Zamolodchikov, R D; Makeeva-Malinovskaia, N Iu; Tsygankov, V N

    2014-01-01

    The rare clinical case of multiple primary gastrointestinal stromal tumors (GIST) in one patient is presented in the article. The analysis of the available material confirmed that there is the problem of early detection of this type of tumors and their differential diagnosis. The minutes of outpatient radiological methods of research should include methods of identifying GIST in various locations. Early diagnosis of the disease allows you to make a radical mini-invasive intervention in the endoscopic or robotic-assisted version. This tactic is characterized by high efficiency in combination with the chemotherapeutic treatment. PMID:24736533

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

    PubMed Central

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

    2013-01-01

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

  9. Preoperative Diagnosis of Usual Leiomyoma, Atypical Leiomyoma, and Leiomyosarcoma

    PubMed Central

    Matsuda, M.; Ichimura, T.; Kasai, M.; Murakami, M.; Kawamura, N.; Hayashi, T.; Sumi, T.

    2014-01-01

    Uterine smooth muscle tumors (SMTs) are common pelvic tumors in women, and most of them are diagnosed as usual leiomyoma (UL). Exclusion of malignant disease is important in the management of SMTs. However, differentiation of SMTs remains difficult. In this study, we aimed to improve the preoperative diagnosis of SMTs. We examined 21 ULs, 7 atypical leiomyomas (ALs), and 6 leiomyosarcomas (LMSs), all of which were diagnosed by uterine tumor biopsy. Immunohistochemical findings (low-molecular-mass polypeptide 2 (LMP2) and Ki-67) and clinical features (serum lactate dehydrogenase level and menopause) were evaluated. Statistically significant differences in the expression of LMP2 and Ki-67 were observed between UL and AL and between UL and LMS. The combined LMP2 and Ki-67 score was significantly different between UL and AL, between UL and LMS, and between AL and LMS. The combined immunohistochemistry and clinical findings score (total score) was also significantly different between pathological types. The findings of this study suggest that the accuracy of the preoperative diagnosis of SMTs may be improved by using a combination of immunohistochemical and clinical findings. PMID:25400500

  10. Solid variant of serous cystadenoma of the pancreas

    PubMed Central

    Yasuda, Akira; Sawai, Hirozumi; Ochi, Nobuo; Matsuo, Yoichi; Okada, Yuji; Takeyama, Hiromitsu

    2011-01-01

    We describe a case of a solid variant of serous cystadenoma of the pancreas. The preoperative examination results led to a diagnosis of a nonfunctional pancreatic islet cell tumour, and the patient underwent a pylorus-preserving pancreaticoduodenectomy. The tumour was diagnosed as a solid variant of serous cystadenoma by histopathological examination. Solid variant of serous cystadenoma of the pancreas is difficult to diagnose preoperatively. More cases must be accumulated and investigated to obtain clues for accurate diagnosis. PMID:22291781

  11. The role of volume perfusion CT in the diagnosis of pathologies of the pancreas.

    PubMed

    Grözinger, G; Grözinger, A; Horger, M

    2014-12-01

    The review discusses the potential role of volume perfusion CT (VPCT) in the diagnosis and follow-up of different pathologies of the pancreas. VPCT enables a differentiation of different pancreatic tumors like adenocarcinoma or neuroendocrine tumors based on functional parameters like blood flow, blood volume and permeability. Furthermore, the article discusses the potential indications for VPCT imaging of inflammatory diseases of the pancreas such as acute or chronic pancreatitis and autoimmune pancreatitis. PMID:25122172

  12. Epidemiology, Diagnosis, and Management of Cystic Lesions of the Pancreas

    PubMed Central

    de Jong, Koen; Bruno, Marco J.; Fockens, Paul

    2012-01-01

    Although little is known on the true prevalence of pancreatic cysts, physicians are currently more frequently confronted with pancreatic cysts because of the increasing use of sophisticated cross-sectional abdominal imaging. Cystic lesions of the pancreas comprise of a heterogeneous group of diagnostic entities, some of which are benign such as inflammatory pseudocysts or serous cystadenomas and do not require resection when asymptomatic. Others like mucinous cysts or intraductal papillary mucinous neoplasms (IPMN) have a malignant potential and in these cases surgical resection is often indicated. For this reason an adequate distinction between the various cysts is crucial to optimize management strategy. Different diagnostic methods that could be of value in the differentiation include radiologic imaging techniques such as CT, MR, and endosonography. In addition, fluid aspiration for cytopathology, tumormarkers or molecular analysis is widely used. Different guidelines are available but so far no optimal diagnostic algorithm exists. We summarize the epidemiology, classification, clinical presentation, diagnostics, management, and future perspectives. PMID:22007199

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

    PubMed Central

    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

    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

  14. Intraductal papillary mucinous neoplasms of the pancreas: diagnosis and management.

    PubMed

    Dongbin, Liu; Fei, Li; Werner Josefin, Björk; Roland, Andersson

    2010-09-01

    Intraductal papillary mucinous neoplasms (IPMNs), characterized by intraductal papillary growth and thick mucin secretion, have increasingly been recognized. Despite modern preoperative evaluation, major difficulties still remain in distinguishing malignant invasive types from benign IPMNs. Following a PubMed database search, all relevant abstracts and articles on IPMN published in English and Chinese were reviewed. Main-duct and the mixed type IPMNs carry a higher risk of malignancy as compared with branch-duct type IPMNs. Treatment of branch-duct type IPMNs remains controversial. Once operation is indicated, intraoperative frozen section of margins plays an important role in the decision concerning the extent and type of surgery. Pancreatectomy, partly preserving both endocrine and exocrine pancreatic function, is advocated for most patients with IPMN, though total pancreatectomy may be necessary in some. Both for patients subjected to surgery and those only observed, IPMN patients need regular close follow-up to identify recurrence or progressive disease. PMID:20520560

  15. Intraductal papillary and mucinous tumors of the pancreas: accuracy of preoperative computed tomography, endoscopic retrograde pancreatography and endoscopic ultrasonography, and long-term outcome in a large surgical series

    Microsoft Academic Search

    Christophe Cellier; Emmanuel Cuillerier; Laurent Palazzo; Fabienne Rickaert; Jean-Francois Flejou; Bertrand Napoleon; Daniel Van Gansbeke; Natacha Bely; Philippe Ponsot; Christian Partensky; Paul-Henri Cugnenc; Jean-Philippe Barbier; Jacques Devière; Michel Cremer

    1998-01-01

    Background: Few data are available on the accuracy of preoperative imaging or on long-term outcome after surgery for intraductal papillary and mucinous tumors of the pancreas. The aims of this study were to assess the following: (1) the accuracy of preoperative computed tomography, endoscopic retrograde pancreatography, and endoscopic ultrasonography for determination of tumor invasion and pancreatic extension as compared with

  16. Patchy distribution of pathologic abnormalities in autoimmune pancreatitis: implications for preoperative diagnosis.

    PubMed

    Chandan, Vishal S; Iacobuzio-Donahue, Christine; Abraham, Susan C

    2008-12-01

    Autoimmune pancreatitis (AIP) is a distinctive form of chronic pancreatitis that can mimic pancreatic carcinoma. In the past, AIP accounted for up to 27% of Whipple resections performed for suspected adenocarcinoma. More recently, with increased awareness of AIP and reports of its steroid responsiveness, tru-cut needle biopsies are increasingly used as an aid in preoperative diagnosis. We noticed a distinctive patchy distribution to the pathologic abnormalities in many cases of resected AIP that could potentially interfere with preoperative diagnosis by needle biopsy. We studied 39 pancreatic resections with AIP, defined by the following triad of features: (1) lymphoplasmacytic infiltrates around ducts, (2) acinar lymphoplasmacytic inflammation with atrophy and fibrosis, and (3) obliterative phlebitis. Criteria for inclusion in the study included either submission of the entire resection specimen (n=21) or extensive histologic sampling (n=18) defined as submission of > or =10 sections. We reviewed all hematoxylin and eosin-stained sections and (1) mapped areas of sparing and involvement by AIP, (2) classified the AIP as lobulocentric, ductocentric, or mixed, and (3) tabulated numbers of immunoglobulin (Ig) G4+ plasma cells in areas of involvement and sparing. To be included as an area of sparing, both duct and acinar parenchyma had to be free of lymphoplasmacytic inflammation, and the focus had to be at least 0.5 cm in diameter. Our results demonstrate a high prevalence of patchiness in AIP. Thirty-two (82%) specimens had areas of sparing (mean of 22% of each specimen spared, range 0.8% to 80%). The largest focus of uninvolved pancreas varied from 0.5 to 8.8 cm(2) (mean: 1.8 cm(2)). In the remaining 7 (18%) cases, the changes of AIP were diffuse, with involvement of the entire submitted specimen. Number of IgG4+ plasma cells correlated highly with areas of involvement versus sparing by AIP; there were > or =5 IgG4+ plasma cells/20x field in 34 of 35 (97%) involved foci, but in only 1 of 26 (4%) histologically uninvolved foci (P<0.001). Classification as lobulocentric AIP (n=11), ductocentric AIP (n=15), and mixed AIP (n=12) did not correlate with extent of patchiness (P=0.92) or with the volume of spared parenchyma (P=1.0). These results demonstrate patchy involvement by AIP in a majority of resected pancreata. In specimens containing large areas of uninvolved parenchyma, this raises the potential for underdiagnosis by tru-cut biopsy. In patients with radiologic and serologic features (eg, elevated serum IgG4 level) suspicious for AIP, this potential pitfall in pathologic diagnosis should be considered before proceeding to surgery. IgG4 immunostaining of apparently negative biopsies may be helpful, but only in a small minority of cases. PMID:18779731

  17. Preoperative diagnosis of bicipitoradial bursitis: a case report

    PubMed Central

    Aldhilan, Asim

    2014-01-01

    Inflammation of the bicipitoradial bursa is a rare condition and only few reports can be found in literature. Several causes for a cubital bursitis have been suggested in the past. The need to include a malignant lesion in the differential diagnosis has only been mentioned in one of these reports. May main objective in reporting this case is to make this pathological entity better known. PMID:25018791

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

    PubMed Central

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

    2014-01-01

    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

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

    PubMed Central

    Brugge, William R

    2008-01-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  2. Macrocystic serous cystadenoma of the pancreas: CT and endosonographic features.

    PubMed

    Gouhiri, M; Soyer, P; Barbagelatta, M; Rymer, R

    1999-01-01

    Recently, the term "serous cystadenoma" has been adopted in the pathological community to qualify the so-called microcystic adenoma of the pancreas. This change in terminology was based on the emergence of a new type of serous cystadenoma of the pancreas, i.e., the macrocystic variant. We report one case of pathologically proven macrocystic serous cystadenoma of the pancreas for which the diagnosis of mucinous cystadenoma was suggested preoperatively. This rare but benign macrocystic variant exhibits radiological features similar to those of mucinous cystadenoma. In addition, inflammatory changes and foci of hemorrhage within the tumor may simulate mucinous cystadenocarcinoma. PMID:9933678

  3. Preoperative diagnosis of the Mirizzi syndrome: limitations of sonography and computed tomography

    SciTech Connect

    Becker, C.D.; Hassler, H.; Terrier, F.

    1984-09-01

    Preoperative recognition of the Mirizzi syndrome permits avoidance of several serious pitfalls at surgery. The typical diagnostic signs of the Mirizzi syndrome are 1) dilatation of the common hepatic duct above the level of 2) a gallstone impacted in the cystic duct, with 3) normal duct width below the stone. Since jaundice is the leading clinical symptom, sonography and computed tomography (CT) are now the primary radiologic tests. The syndrome does not regularly have typical features, however, and therefore cannot be detected routinely on sonography or CT. Direct cholangiography is often necessary. On the other hand, direct cholangiography should follow either sonography or CT because these imagining methods are superior for demonstrating extraluminal signs of malignancy, which is the most important differential diagnosis. The findings at preoperative examinations in seven patients with surgically confirmed Mirizzi syndrome are analyzed retrospectively.

  4. Utility of cell block in the cytological preoperative diagnosis of keratocystic odontogenic tumor.

    PubMed

    Rivero, Elena Riet Correa; Grando, Liliane Janete; de Oliveira Ramos, Grasieli; da Silva Belatto, Maria Fernanda; Daniel, Filipe Ivan

    2014-04-01

    In most cases involving jaw lesions, a biopsy and a histopathological analysis are necessary to establish the final diagnosis. However, biopsy may be a complex procedure at some maxillomandibular sites, and some systemic conditions could contraindicate the procedure. Thus, a search for new, less invasive techniques, which could eventually replace biopsy and simplify the diagnostic process, would benefit both professionals and patients. The aim of this study was to evaluate the cell block technique, prepared from the aspiration of luminal contents, in the preoperative diagnosis of keratocystic odontogenic tumors (KCOT). From 135 cases of lesions aspirated and processed by the cell block technique, we selected those containing keratin. In all cases selected, histological diagnosis was based on surgical biopsy. From 20 cases containing keratin in the cytological analyses, 19 were KCOTs and one was an orthokeratinized odontogenic cyst (OOC). In all KCOT cases, we observed the presence of parakeratin, even in those with intense inflammation. In the cytological analysis of the OOC, parakeratin was not observed. In conclusion, there is strong evidence that KCOT can be confidently diagnosed preoperatively by cytological analyses of lesions punctured and processed by the cell block technique. PMID:24433974

  5. Effect of Gender and Preoperative Diagnosis on Results of Revision Total Knee Arthroplasty

    PubMed Central

    Pun, Stephanie Y.

    2008-01-01

    Recent studies question an effect of gender on outcome of primary TKA. We questioned whether the results of revision TKA were affected by gender. We separated 67 revision TKAs by gender and preoperative diagnosis into four groups (arthrofibrosis, infection, instability, and wear and loosening). Each revision TKA was individually matched by age and gender to two primary TKAs. Postoperative Knee Society pain and function scores after revision TKA were lower than for primary TKA for both females and males. However, postoperative Knee Society pain and function scores were similar in males and females. Postoperative pain and function scores were lower for all revision groups compared with primary TKA, except for pain and function scores after revision for instability. Postoperative pain and function scores were higher for instability and wear or loosening than for arthrofibrosis. Our data suggest the results of revision TKA are affected by preoperative diagnosis but not gender. Level of Evidence: Level III, retrospective matched cohort study. See Guidelines for Authors for a complete description of levels of evidence. PMID:18726656

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

    PubMed Central

    Attwell, Augustin; Sams, Sharon; Fukami, Norio

    2015-01-01

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

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

    SciTech Connect

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

    1987-12-01

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

  8. Diagnosis and laparoscopic treatment of ileoileal intussusception secondary to heterotopic pancreas in an infant: case report and review of the literature.

    PubMed

    Seifarth, Federico G; Ryan, Marc L; Triana, Jason; Knight, Colin G

    2011-02-01

    Small bowel intussusception in infancy owing to a pathologic lead point is a rare event requiring immediate surgical attention. We report a case of a 7-month-old patient presenting with ileoileal intussusception with isolated heterotopic pancreas as the lead point. We review the literature of small bowel intussusception focusing on diagnosis and treatment. In contrast to comparable previous reports of infants with heterotopic pancreas and intussusception, the diagnosis was based solely on ultrasound findings followed by operative management using a laparoscopically assisted surgical approach. PMID:21292068

  9. Primary Hyperparathyroidism: Role of the Preoperative Oral Calcium Loading Test in the Differential Diagnosis Between Adenoma and Hyperplasia

    Microsoft Academic Search

    P. Hagag; E. Kummer; M. Weiss

    2008-01-01

    Whereas the sensitivity of the membrane calcium receptors is decreased in parathyroid adenoma, extracellular calcium may reduce\\u000a parathyroid hormone (PTH) secretion through the protein kinase C pathway in parathyroid hyperplasia. The aim of this study\\u000a was to determine the role of a preoperative oral calcium loading test in the differential diagnosis between adenoma and hyperplasia.\\u000a Twenty-two subjects with adenoma (group

  10. Serous cystic neoplasms of the whole pancreas in a patient with von Hippel-Lindau disease.

    PubMed

    Kanno, Atsushi; Satoh, Kennichi; Hamada, Shin; Hirota, Morihisa; Masamune, Atsushi; Motoi, Fuyuhiko; Egawa, Shinichi; Unno, Michiaki; Ishida, Kazuyuki; Kimura, Kenji; Shuin, Taro; Shimosegawa, Tooru

    2011-01-01

    We describe here a case of von Hippel-Lindau (VHL) disease with a serous cystic neoplasm of the whole pancreas. The patient was a 35-year-old woman suffering from a palpable abdominal tumor. She had a history of hemangioblastomas of the cerebellum. CT revealed large solid tumors in the pancreatic head and body, and multiple cystic lesions in the whole pancreas as well as a right renal tumor. When endoscopic retrograde cholangiopancreatography (ERCP) was performed, bleeding from the duodenal papilla was detected. Since she had some distinguishing clinical features, the diagnosis of VHL disease was made. The preoperative diagnosis of the pancreatic lesion was serous cystic neoplasms with hemosuccus pancreaticus and total pancreatectomy was performed. Histological examination of the specimen revealed serous cystic neoplasms which occupied the entire pancreas. VHL cases operated on for serous cystic neoplasms of the entire pancreas are very rare. PMID:21673464

  11. Pancreas Transplantation

    MedlinePLUS

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

  12. Importance of accurate preoperative diagnosis in the management of aggressive angiomyxoma: report of three cases and review of the literature

    Microsoft Academic Search

    A. Wiser; J. Korach; W. H. Gotlieb; E. Fridman; S. Apter; G. Ben-Baruch

    2006-01-01

    Background:  Aggressive angiomyxoma is a benign but locally aggressive tumor that occurs mostly in young women. Because excision is often\\u000a incomplete, the risk of local recurrence is high. This report describes differences in presentation and the importance of\\u000a accurate preoperative diagnosis of this rare neoplasm.\\u000a \\u000a \\u000a \\u000a Methods and results:  We describe three cases with different presentations. Two were initially misdiagnosed, and local recurrence

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

    PubMed Central

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

    2012-01-01

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

  14. Preoperative Diagnosis of Lymph Node Metastases of Colorectal Cancer by FDG-PET\\/CT

    Microsoft Academic Search

    Yoshiyuki Tsunoda; Masaaki Ito; Hirofumi Fujii; Hiroyuki Kuwano; Norio Saito

    Purpose: The purpose of this study was to assess the diagnostic value of 18F-fluorodeoxy- glucose positron emission tomography\\/computed tomography (FDG-PET\\/CT) for lymph node (LN) metastasis of colorectal cancer. Methods: FDG-PET\\/CT was used to preoperatively evaluate 88 patients with colorectal cancer. In this study, LN sites were divided into proximal and distant according to their dis- tance from the primary tumor.

  15. Lipomatous Pseudohypertrophy of the Pancreas

    PubMed Central

    Altinel, Deniz; Basturk, Olca; Sarmiento, Juan M.; Martin, Diego; Jacobs, Michael J.; Kooby, David A.; Adsay, N. Volkan

    2011-01-01

    Objectives Owing to the challenges in obtaining pancreatic biopsies, pancreatic resection for presumed malignancy is often performed without histological confirmation. As a result, benign lesions are sometimes surgically removed. One such condition, which is poorly defined in the literature, is referred to as lipomatous pseudohypertrophy (LPH) of the pancreas. Methods Five cases of LPH were analyzed. Results Four patients underwent surgical resection, 3 of which were diagnosed preoperatively by radiology as having ductal adenocarcinoma. The fourth case was correctly interpreted by magnetic resonance imaging as LPH, but the patient underwent resection because of the intractable pain due to pancreatitis. The fifth patient has been placed on watchful waiting. Two tumors were in the pancreatic head, one in the tail, one in the uncinate process, and one demonstrated diffuse involvement. Microscopically, they were characterized as having normal lipocytes without lipoblasts or inflammation. Within the adipose tissue, scattered microscopic foci of pancreatic parenchyma could be seen. Conclusion Lipomatous pseudohypertrophy of the pancreas is a distinct entity characterized by localized/diffuse replacement of pancreatic parenchyma with mature adipose tissue. It forms a pseudotumor that may be difficult to distinguish clinically from pancreatic adenocarcinoma. This entity should be considered when evaluating patients with a new diagnosis of a hypodense pancreatic neoplasm on imaging. PMID:19904221

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

    PubMed

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

    2012-06-01

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

  17. Preoperative diagnosis of obscure gastrointestinal bleeding due to a GIST of the jejunum: a case report

    PubMed Central

    Kotoulas, Dimitrios; Aloizos, Stavros; Kolovou, Aikaterini; Salemis, Nikolaos S; Kantounakis, Ioannis

    2009-01-01

    Gastrointestinal stromal tumours are rare mesenchymal neoplasms affecting the digestive tract or nearby structures within the abdomen. We present a case of a 66-year-old female patient who presented with obscure anemia due to gastrointestinal bleeding and underwent exploratory laparotomy during which a large gastrointestinal stromal tumour of the small intestine was discovered. Examining the preoperative results of video capsule endoscopy, computed tomography, and angiography and comparing them with the operative findings we discuss which of these investigations plays the most important role in the detection and localization of gastrointestinal stromal tumours. A sort review of the literature is also conducted on these rare mesenchymal tumours. PMID:19918463

  18. Preoperative diagnosis of obscure gastrointestinal bleeding due to a GIST of the jejunum: a case report

    PubMed Central

    2009-01-01

    Gastrointestinal stromal tumours (GISTs) are rare mesenchymal neoplasms affecting the digestive tract or nearby structures within the abdomen. We present a case of a 66-year-old female patient who presented with obscure anemia due to gastrointestinal bleeding and underwent exploratory laparotomy during which a large GIST of the small intestine was discovered. Examining the preoperative results of video capsule endoscopy, computed tomography, and angiography and comparing them with the operative findings we discuss which of these investigations plays the most important role in the detection and localization of GIST. A sort review of the literature is also conducted on these rare mesenchymal tumours. PMID:20062725

  19. [Preoperative diagnosis of lymph node metastases and sentinel node navigation surgery in patients with upper gastrointestinal cancer].

    PubMed

    Takeuchi, Hiroya; Kitagawa, Yuko

    2008-03-01

    In spite of recent advances in diagnostic tools such as computed tomography, endoscopic ultrasonography, and positron-emission tomography, preoperative diagnosis of lymph node metastases in patients with upper gastrointestinal (GI) cancer has been problematic because of the low sensitivity and accuracy in the detection of micrometastases. To overcome this issue, the sentinel node (SN) concept has attracted attention in recent years and is anticipated to become a novel diagnostic tool for the identification of clinically undetectable lymph node metastases in patients with early upper GI cancer. For early-stage gastric cancer, in which a better prognosis can generally be achieved using conventional surgical approaches, individualized, minimally invasive gastrectomy based on a combination of laparoscpic surgery with SN navigation surgery should be established as the next surgical milestone. Several issues remain to be resolved in laparoscopic gastrectomy with three-dimensional computed tomography navigation. PMID:18409586

  20. Annular pancreas

    MedlinePLUS

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

  1. Pancreas transplant

    MedlinePLUS

    ... damage Nerve damage Stroke A pancreas transplant can cure diabetes and eliminate the need for insulin shots. Because of the risks involved with surgery, most persons with type 1 diabetes do not have a pancreas transplant just ...

  2. Preoperative diagnosis by three-dimensional angiography of a leiomyosarcoma arising from the left ovarian vein

    PubMed Central

    Saigusa, Susumu; Ohi, Masaki; Inoue, Yasuhiro; Kusunoki, Masato

    2013-01-01

    Leiomyosarcoma arising from the ovarian vein is extremely rare; we present a case with this unusual finding. A 78-year-old woman, diagnosed 2?years prior with a left retroperitoneal mass located in the lower part of the left kidney, was admitted to our hospital with a decrease in oral intake and a palpable, hard, abdominal mass. Contrast-enhanced CT showed a solid mass in the left lower abdominal cavity. On three-dimensional (3D) angiography the mass appeared to originate from the left ovarian vein. A simple total excision, including the involved vein, was performed and the tumour was found to be leiomyosarcoma. The patient's postoperative course was uneventful. There was no evidence of recurrence 5?months after surgery. In this patient, the previous information about the location of the retroperitoneal mass as well as the 3D angiography results were helpful in giving preoperative evidence of leiomyosarcoma originating from the left ovarian vein. PMID:23595179

  3. Papillary Thyroid Cancer: Dual-Energy Spectral CT Quantitative Parameters for Preoperative Diagnosis of Metastasis to the Cervical Lymph Nodes.

    PubMed

    Liu, Xuewen; Ouyang, Dian; Li, Hui; Zhang, Rong; Lv, Yanchun; Yang, Ankui; Xie, Chuanmiao

    2015-04-01

    Purpose To evaluate the use of dual-energy spectral computed tomographic (CT) quantitative parameters compared with the use of conventional CT imaging features for preoperative diagnosis of metastasis to the cervical lymph nodes in patients with papillary thyroid cancer. Materials and Methods This study was approved by the ethics committee and all patients provided written informed consent. Analyses of quantitative gemstone spectral imaging data and qualitative conventional CT imaging features were independently performed by different groups of radiologists. Excised lymph nodes were located and labeled during surgery according to location on preoperative CT images and were evaluated histopathologically. Single and combined parameters were fitted to simple and multiple logistic regression models, respectively, by means of the generalized estimating equations method. Sensitivity and specificity analyses were performed by using receiver operating characteristic curves and were compared with data from the qualitative analysis. Results The slope of the spectral Hounsfield unit curve ( ?HU slope of the spectral Hounsfield unit curve ), normalized iodine concentration, and normalized effective atomic number measured during both arterial and venous phases were significantly higher in metastatic than in benign lymph nodes. The best single parameter for detection of metastatic lymph nodes was venous phase ?HU, with sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 62.0%, 91.1%, 80.6%, 79.7%, and 81.0%, respectively. The best combination of parameters was venous phase ?HU slope of the spectral Hounsfield unit curve and arterial phase normalized iodine concentration, with values of 73.0%, 88.4%, 82.9%, 78.0%, and 85.3%, respectively. Compared with qualitative analysis, the venous phase ?HU slope of the spectral Hounsfield unit curve showed higher specificity (91.1% vs 83.0%, P < .001) and similar sensitivity (62.0% vs 61.9%, P > .99), and the combined venous phase ?HU slope of the spectral Hounsfield unit curve and arterial phase normalized iodine concentration showed higher sensitivity (73.0% vs 61.9%, P < .001) and specificity (88.4% vs 83.0%, P < .001). Conclusion Quantitative assessment with gemstone spectral imaging quantitative parameters showed higher accuracy than qualitative assessment of conventional CT imaging features for preoperative diagnosis of metastatic cervical lymph nodes in patients with papillary thyroid cancer. (©) RSNA, 2014 Online supplemental material is available for this article. PMID:25521777

  4. Macrocystic serous cystadenoma of the pancreas.

    PubMed

    Fujiwara, H; Ajiki, T; Fukuoka, K; Mitsutsuji, M; Yamamoto, M; Kuroda, Y

    2000-01-01

    We report a 47-year-old woman with macrocystic serous cystadenoma of the pancreas. She had no past history of abdominal surgery, instrumentation, or trauma. Ultrasonography and computed tomography revealed a unilocular cyst in the body of the pancreas. On magnetic resonance imaging, the cyst showed heterogeneous signal intensity on T1-weighted images, and was homogeneously hyperintense and oligolocular is on T2-weighted images. A preoperative diagnosis of mucinous cystic neoplasm of the pancreas was made, and distal pancreatectomy was performed. The resected oligolocular cyst was 5.0 x 4.5 x 3.0 cm and was lined with a single layer of cuboidal epithelium similar to that seen in microcystic serous cystadenomas. Abundant glycogen was demonstrated within the epithelial cells, as assessed by periodic acid-Schiff (PAS) staining with and without diastase digestion. The cyst exhibited a gross appearance distinct from that of typical microcystic adenomas, resulting in diagnostic difficulties for the radiologists and surgeon involved in the patient's care. PMID:10982598

  5. Solid serous adenoma of the pancreas: an uncommon but important entity.

    PubMed

    Machado, M C; Machado, M A

    2008-07-01

    Serous cystic neoplasms of the pancreas have currently five recognized subtypes: serous microcystic adenoma, serous oligocystic ill-demarcated adenoma, solid serous adenoma, von Hippel-Lindau-associated cystic neoplasm, and serous cystadenocarcinoma. Although these neoplasms are histologically similar they may differ in location, gross appearance and biology. Solid serous adenoma of the pancreas is by far the rarest subtype with only nine cases published thus far. In this review, we will discuss clinical features, imaging characteristics and histopathological findings, considering in particular (1) difficulties in preoperative diagnosis; and (2) relevant immunohistochemical analysis. After analyzing the literature, including one case from our Department, we can conclude that there is enough evidence to support that solid serous adenomas of the pancreas is a solid variant of serous cystadenomas. To date no malignant transformation is reported so far and therefore, to our knowledge, all patients are alive and without recurrence. Incidence is generally around seventh decade of life with no gender preference. Preoperative diagnosis is difficult to establish but magnetic resonance cholangiopancreatography may be useful. Given benign nature of this solid variant conservative surgery is recommended. It is definitively a rare entity but oncologic surgeons should be aware of this neoplasm in order to make a correct preoperative diagnosis that will ultimately result in more conservative surgeries. PMID:18440191

  6. What Is the Pancreas?

    MedlinePLUS

    ... Pancreas Function of the Pancreas What is the pancreas? The pancreas is a long flattened gland located ... controller of blood sugar levels. Where is the pancreas? The pancreas is located deep in the abdomen. ...

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

    PubMed Central

    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

    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. PMID:24858977

  8. Pancreatic pseudotumors: non-neoplastic solid lesions of the pancreas that clinically mimic pancreas cancer.

    PubMed

    Adsay, N Volkan; Basturk, Olca; Klimstra, David S; Klöppel, Günter

    2004-11-01

    In the pancreas, a variety of non-neoplastic conditions may form solid masses that may mimic cancer. Up to 5% of pancreatectomies performed with the preoperative clinical diagnosis of carcinoma will prove to be non-neoplastic by pathologic examination, although this figure is decreasing with improved diagnostic modalities. Chronic inflammatory lesions are the leading cause of this phenomenon ("pseudotumoral pancreatitis"), and among these, autoimmune and paraduodenal pancreatitides (discussed separately in this issue) are most important. In this article, we will focus on the noninflammatory lesions that may form tumor-like lesions of the pancreas. Adenomyomatous hyperplasia of ampulla of Vater is a subtle lesion that is difficult to define; larger examples (>5 mm) have been found to be the cause of obstructive jaundice. Accessory (heterotopic) spleen may form a well-defined nodule within the tail of the pancreas and is typically mistaken for endocrine neoplasm. Lipomatous hypertrophy is the replacement of pancreatic tissue with mature adipose tissue that occasionally leads to moderate to marked enlargement of the pancreas. Hamartomas are very rare if the entity is defined strictly. They are characterized by irregularly arranged mature pancreatic elements admixed with stromal tissue. A cellular, spindle-cell variant with c-kit (CD117) expression is recognized. Pseudolymphoma forms well-defined nodules composed of hyperplastic lymphoid tissue. Rarely, foreign-body deposits, granulomatous inflammations (such as sarcoidosis or tuberculosis), and congenital lesions may form tumoral lesions. In conclusion, it is important to recognize the types of conditions that form pseudotumors in the pancreas so that they can be distinguished from ductal adenocarcinomas, especially clinically, but also pathologically. Nonspecific terms such as "inflammatory pseudotumor" ought to be avoided, and every attempt should be made to classify a "pseudotumor" into a more specific diagnostic category discussed above. PMID:16273945

  9. Organ Facts: Pancreas

    MedlinePLUS

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

  10. Management of mucinous cystic neoplasms of the pancreas

    PubMed Central

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

    2010-01-01

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

  11. Solid Serous Cystadenoma of the Pancreas: A Case Report of 2 Patients Revealing Vimentin, ?-Catenin, ?-1 Antitrypsin, and ?-1 Antichymotrypsin as New Immunohistochemistry Staining Markers.

    PubMed

    Wu, Wenming; Hong, Xiafei; Li, Ji; Dai, Menghua; Wang, Wenze; Tong, Anli; Zhu, Zhaohui; Dai, Hongmei; Zhao, Yupei

    2015-03-01

    Solid serous cystadenoma (SCA) of the pancreas is a rare type of pancreatic solid tumors. Postoperative pathological evaluation is of particular importance for distinguishing solid SCA of the pancreas from other pancreatic solid tumors.Here we present 2 cases of solid SCA of the pancreas, both preoperatively diagnosed with pancreatic neuroendocrine tumors. One case had positive OctreoScan test.Surgical resections were done for both cases. Postoperative immunohistochemistry assays were conducted with marker panels for SCA and 2 types of pancreatic solid tumors, which were neuroendocrine tumor (pNET) and solid pseudopapillary tumor (SPT).Two cases showed typical staining patterns for SCA markers. Notably, both cases showed positivity for 4 SPT markers (vimentin, ?-catenin, ?-1 antitrypsin, and ?-1 antichymotrypsin).Emphasis should be paid to those 4 new markers for future pathological diagnosis of solid SCA of the pancreas. PMID:25816032

  12. Cystadenomas and Cystadenocarcinomas of the Pancreas

    PubMed Central

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

    1999-01-01

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

  13. Artifical Pancreas

    NASA Astrophysics Data System (ADS)

    Fei, Jiangfeng

    2013-03-01

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

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

    PubMed Central

    Alahmadi, Raha; Almuhammadi, Saud

    2014-01-01

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

  15. Adenocarcinoma arising in gastric heterotopic pancreas. Case report and review of the literature.

    PubMed

    Lemaire, J; Delaunoit, T; Molle, G

    2014-01-01

    A sixty years-old patient was admitted with a gastric tumor corresponding to an adenocarcinoma developed in ectopic pancreatic tissue. Hundred cases of gastric heterotopic pancreas are shown in literature. This entity may remain asymptomatic. Symptoms such abdominal pain are described as the result of tumour growth. Carcinogenesis of ectopic pancreas (EPa) is however rare. Diagnosis is rarely pre-operative because modern imaging depicts a gastric tumour with no more information. The only treatment is surgery, with a best interest in frozen sections to direct the procedure, in this case a total gastrectomy with D2 lymphadenectomy. Based on this case report, an analysis of the literature focusing on diagnosis and treatment is presented. PMID:24720145

  16. Left-sided portal hypertension caused by serous cystadenoma of the pancreas: report of a case.

    PubMed

    Ito, Koji; Kudo, Atsushi; Nakamura, Noriaki; Tanaka, Shinji; Teramoto, Kenichi; Arii, Shigeki

    2008-01-01

    We report a case of serous cystadenoma of pancreas causing left-sided portal hypertension and gastric varices. A 68-year-old man was admitted for treatment of a pancreatic body tumor. Contrast-enhanced computed tomography (CT) showed a honeycombed cystic mass. A celiac angiogram showed a hypervascular tumor supplied mainly by a dilated splenic artery and dorsal pancreatic artery. In the venous phase, the patent splenic vein had a large hepatopetal collateral vein via the coronary gastric vein. Upper gastrointestinal endoscopy showed isolated varices of the gastric fundus. We made a preoperative diagnosis of a serous cystic tumor of the pancreas with left-sided portal hypertension and performed distal pancreatectomy with splenectomy. The resected tumor was 8 cm in diameter and had a typical honeycombed microcystic pattern with central stellate scarring. The spleen was not enlarged. Histopathological examination confirmed a diagnosis of serous cystadenoma without any sign of malignancy. Postoperative endoscopy showed disappearance of the gastric varices. PMID:18239883

  17. Dermoid Cyst of the Pancreas: A Report of an Unusual Case and a Review of the Literature

    PubMed Central

    Albayrak, Aynur; Yildirim, Umran; Aydin, Metin

    2013-01-01

    Pancreatic dermoid cysts are a rare entity. Preoperative diagnosis is difficult. The diagnosis is generally taking intraoperative. A 20-year-old female presented with epigastric pain without nausea, vomiting, diarrhea, fever, jaundice, and weight loss of one-month duration. Ultrasonography and computed tomography showed a smooth borders, solid, hyperechoic tumor within midline abdomen, without any connection to the stomach or spleen. At surgery, the entire mass was excised off of the head and inferior part of pancreas. Histopathologic evaluation revealed the rare diagnosis of a dermoid cyst. The diagnosis is difficult preoperatively in evaluating cystic pancreatic lesions by imaging. Therefore, we want to summarize the literature on this rare entity knowledge. PMID:24349815

  18. Organ Facts: Kidney / Pancreas

    MedlinePLUS

    ... Lung Kidney Pancreas Kidney/Pancreas Liver Intestine Kidney/Pancreas Facts The kidneys are a pair of reddish- ... the chemical (electrolyte) composition of the blood. The pancreas is a five to six inch gland located ...

  19. 75Se-selenomethionine scanning in the diagnosis of tumours of the pancreas and adjacent viscera: The use of the test and its impact on survival

    PubMed Central

    McCarthy, Denis M.; Brown, Pamela; Melmed, R. N.; Agnew, J. E.; Bouchier, I. A. D.

    1972-01-01

    The results of pancreatic scanning with 75Se-selenomethionine in 393 carefully documented patients over a two-year period are presented. On follow up 50 patients had operatively proven malignant tumours in the gland and a further 22 had similar tumours in adjacent organs, clinically mimicking carcinoma of the pancreas and in many cases causing scan abnormalities. Five patients had pancreatic adenomata. Remote tumours rarely affected the scan. Examination of the role of scanning in patients with neoplastic disease revealed that the test was effective in screening and in detection; false negative diagnoses were rare. By contrast, survival following diagnosis was extremely poor with only 8% of pancreatic tumours resectable and 50% metastasized at the time of surgery. Causes of pancreatic dysfunction, other than pancreatitis or carcinoma, which were associated with abnormalities on the scan are described and general aspects of reporting on the scan are discussed. The patterns seen in abnormal scans, while non-specific with regard to aetiology, were anatomically meaningful and useful adjuncts to the diagnosis of pancreatic disease. A normal scan excluded pancreatic cancer with a probability greater than 95%. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5Fig. 6Fig. 7Fig. 8Fig. 9Fig. 10 PMID:5045709

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

    PubMed Central

    2010-01-01

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

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

    PubMed Central

    2009-01-01

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

  2. [Solid-pseudopapillary tumor of the pancreas. Presentation of 3 clinical cases].

    PubMed

    Venturelli, Francisco M; Carrasco, Cristian L; Del Pozo, Maeva L; Cárcamo, Carlos I; Felmer, Orlando E; Ibaceta, Marcela Cárcamo; Leonelli, Aliro Venturelli

    2011-01-01

    The solid-pseudopapillary tumors of the pancreas (TSPP) are a uncommon neoplasm (1- 2% of exocrine tumors). Are more frequent in young women and presents a low malignant potential (15% develop metastases). Its preoperative diagnosis is very difficult, because these tumors haven`t radiological features that makes distinguish from the other pancreatic cysts tumors. Usually are a histopathological finding. Surgical therapy provides good survival, even in the presence of metastases. We present 3 cases with clinical, imaging, treatment and histopathology to provide more information about this rare disease. PMID:21544159

  3. Adenocarcinoma of the pancreas

    PubMed Central

    Hruban, Ralph H.; Klimstra, David S.

    2015-01-01

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

  4. Endoscopic ultrasonography-guided trucut biopsy for the preoperative diagnosis of peripancreatic Castleman's disease: a case report.

    PubMed

    Rhee, Kyoung-Hoon; Lee, Sang-Soo; Huh, Joo-Ryung

    2008-04-01

    Castleman's disease (CD) of the pancreas/peripancreas is extremely rare. The recently introduced, endoscopic ultrasonography (EUS)-guided trucut biopsy (TCB) is a useful diagnostic modality for obtaining tissue samples from peripancreatic lesions. However, its role in diagnosing CD remains unknown. We report a case of localized, peripancreatic, hyaline-vascular CD biopsied using EUS. The pathology results were initially interpreted as an extranodal, marginal-zone B-cell lymphoma. However, polymerase chain reaction (PCR) study for the IgH gene rearrangement revealed a polyclonal pattern. We also reviewed the relevant literature. To our knowledge, this is the first illustrated report on EUS-TCB findings of CD with its pathology results of EUS-TCB mimicked a B-cell lymphoma. PMID:18395917

  5. Castleman's disease in the head of the pancreas: report of a rare clinical entity and current perspective on diagnosis, treatment, and outcome

    Microsoft Academic Search

    Hongbei Wang; Rosemary L Wieczorek; Michael E Zenilman; Fidelina Desoto-Lapaix; Bimal C Ghosh; Wilbur B Bowne

    2007-01-01

    BACKGROUND: Castleman's disease of the pancreas is a very rare condition that may resemble more common disease entities as well as pancreatic cancer. CASE PRESENTATION: Here we report the case of a 58-year-old African American male with an incidentally discovered lesion in the head of the pancreas. The specimen from his pancreaticoduodectomy contained a protuberant, encapsulated mass, exhibiting microscopic features

  6. Enlarged pancreas: not always a cancer.

    PubMed

    Calculli, Lucia; Festi, Davide; Pezzilli, Raffaele

    2015-02-01

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

  7. Normal Pancreas Anatomy

    MedlinePLUS

    ... Pictures 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 ...

  8. Preoperative Assessment

    Microsoft Academic Search

    Ruth Spencer; Andrew K McIndoe

    2003-01-01

    The preoperative evaluation of patients is an essential component of their subsequent successful management. Its importance is often underestimated and it can be time consuming. In addition to assessing the patient's physical health, the preoperative visit is the first contact between patient and anaesthetist so it is important for establishing the patient's confidence.The aims of assessment are summarized in Figure

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

    PubMed Central

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

    2013-01-01

    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. PMID:23696922

  10. Preoperative Evaluation

    Microsoft Academic Search

    Marcy Neuburg

    \\u000a Any comprehensive text of complications in cutaneous surgery should begin with a review of the preoperative evaluation. Complications\\u000a in surgery are generally defined as unanticipated morbid events or occurrences leading to suboptimal outcomes. Consequently,\\u000a if physicians could accurately anticipate such untoward events, they might be effectively minimized or even prevented. A comprehensive\\u000a preoperative evaluation will often allow the surgeon to

  11. Pancreas Divisum

    PubMed Central

    DiMagno, Matthew J.; Wamsteker, Erik-Jan

    2011-01-01

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

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

    Microsoft Academic Search

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

    1983-01-01

    A 24-year-old man with persistent low back pain and right sciatica, was found to have an osteoid osteoma of the right pedicle of the second lumbar vertebra. \\/sup 99m\\/Tc-MDP bone scan and CAT scan produced an early diagnosis of the lesion. Intraoperative \\/sup 99m\\/Tc-MDP in vitro combined with imaging and quantitative activity measurements were useful for accurate localization and complete

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

    SciTech Connect

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

    1983-05-01

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

  14. [Ganglioneuroblastoma of the head of the pancreas. Report of a case in a 2-year-old boy].

    PubMed

    Galifer, R B; Margueritte, G; Balmes, M; Barneon, G; Rieu, D

    1983-01-01

    This is a case report of a two years old young boy whose abdominal tumor was discovered by a routine examination. The mass was a huge, solid and painless one, located anteriorly in the right upper quadrant of the abdomen. Abdominal X-ray, IVP and ultrasonography showed a calcified mass with a normal right kidney. Urinary catecholamine excretion was significantly increased and the diagnosis of extrasurrenal prerenal sympathoblastoma was preoperatively suspected. Transverse laparotomy founded an encapsulated solid tumor, widening the duodenal loop and developing in the head of the pancreas. A cephalic duodenopancreatectomy was performed with an un eventful post-operative course. Histopathological examination confirmed it was a ganglioneuroblastoma of the head of the pancreas with lymphatic metastasis and local invasion of the neighbouring pancreas with immature tissues. The child was then treated with radiotherapy (35 Grays) and chemotherapy (Oncovin-Endoxan alternated with Oncovin-Adriamycine). The boy is now in good health with a two years follow up. Malignant pancreatic tumors are exceedingly rare in the pediatric age group (about 40 cases in the literature). Most of them are carcinoma and sympathoblastoma is quite exceptional (Research has yielded only one case : Bienaymé, 1976). The presence of a nervous tumor in such an unusual position explains the lack of precision in the preoperative location and brings up the difficult question of prognosis. It leads to pathogenic hypothesis. PMID:6671264

  15. Getting a New Pancreas: Facts about Pancreas Transplants

    MedlinePLUS

    ... December 2006 Revised March 2012 Getting A New Pancreas Facts About Pancreas Transplants American Society of Transplantation 1120 Route 73, ... represent the views of the Society. _________________________________ Facts About Pancreas Transplants When you get a pancreas transplant, there ...

  16. [Cystic tumors of the pancreas].

    PubMed

    Hurtado Andrade, H; Cortés Espinosa, T

    1997-01-01

    Cystic tumors of the pancreas are rare, accounting for only 10 to 15% of cystic lesions of the pancreas and 1% of malignant neoplasms. They can be benign or malignant and well circumscribed and localized. Their identification, the differential diagnosis and treatment are difficult and one example is that up to a third of them may be confused with pseudocysts. The most important are serous microcystic cystadenomas, mucinous cystadenomas, mucinous cystadenocarcinomas, mucin-producing adenocarcinomas and adenocarcinomas associated to pseudocyst or to simple cyst. The most useful studies for diagnosis are ultrasound, computed axial tomography, endoscopic retrograde cholangiopancreatography, guided punction of the cyst with study of the fluid, and biopsy. The choice of the type of treatment depends on the variety of the tumor. The localization and extension, the surgical risk, the experience of the surgeon and the institutional resources. The prognosis of these tumors is better than that of ductal adenocarcinoma, even if they are malignant. PMID:9480530

  17. Mucinous cystic neoplasm of the pancreas presenting with hemosuccus pancreaticus: report of a case.

    PubMed

    Shinzeki, Makoto; Hori, Yuichi; Fujino, Yasuhiro; Matsumoto, Ippei; Toyama, Hirochika; Tsujimura, Toshiaki; Sakai, Tetsuya; Ajiki, Tetsuo; Kuroda, Yoshikazu; Ku, Yonson

    2010-05-01

    Hemosuccus pancreaticus (HP) is mostly induced by a ruptured pseudoaneurysm or hemorrhage from a pseudocyst in chronic pancreatitis. We herein report a rare case with HP induced by tumor hemorrhage. The present patient is a 71-year-old woman referred to us with a diagnosis of severe progressive anemia. Endoscopy revealed hemorrhage from the papilla of Vater. Computed tomography showed a multilocular cystic tumor in the tail of the pancreas. The patient underwent a distal pancreatectomy. The histopathological diagnosis was carcinoma in mucinous cystadenoma. No cancer infiltration into the pancreatic duct was detected. Pancreatography of the resected specimen demonstrated an overt communication between the main pancreatic duct and the cystic cavity of the tumor, which was not demonstrated preoperatively by endoscopic retrograde pancreatography. Although the cause of HP is mainly acute or chronic pancreatitis, we should bear in mind that a pancreatic tumor may be a possible cause of HP and that, as such, prompt and proper treatment is mandatory. PMID:20425553

  18. Annular pancreas (image)

    MedlinePLUS

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

  19. Pancreas transplant - series (image)

    MedlinePLUS

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

  20. Pancreas divisum

    Microsoft Academic Search

    Subodh Varshney; Colin D. Johnson

    1999-01-01

    Summary  Endoscopicretrograde cholangiopancreatography (ERCP) is diagnostic. Similarly, secretin stimulated ultrasonography may positively\\u000a predict the outcome of minor papilla therapy. Computed tomography is only helpful for the detection of complications. Magnetic\\u000a resonance cholangiopancreatography (MRCP) is a new noninvasive diagnostic tool in development. It is accurate and might replace\\u000a ERCP for diagnosis.\\u000a \\u000a Clinically, symptomatic patients with PD may be divided into five groups:

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

    PubMed Central

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

    2014-01-01

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

  2. 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

    PubMed Central

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

    2008-01-01

    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 with a final diagnosis to assess the accuracy of the pre-operative assumption of PJI. Methods Between 01/2005 and 02/2007, a prospective analysis was performed in 50 patients, who had a two stage revision because of assumed PJI. Based on clinical presentation, radiography, haematological screening, or early failure, infection was assumed and a joint aspiration was performed. Depending upon these findings, a two stage revision was performed, with intra-operative samples for culture and histological evaluation obtained. Final diagnosis of infection was based upon the interpretation of the clinical presentation and the pre- and intraoperative findings. Results In 37 patients a positive diagnosis of PJI could be made definitely. The histopathology yielded the highest accuracy (0.94) in identification of PJI and identified 35 of 37 infections (sensitivity 0.94, specificity 0.94, positive-/negative predictive value 0.97/0.86). Intra-operative cultures revealed sensitivities, specificities, positive-/negative predictive values and accuracy of 0.78, 0.92, 0.96, 0.63 and 0.82. These values for blood screening tests were 0.95, 0.62, 0.88, 0.80, and 0.86 respectively for the level of C-reactive protein, and 0.14, 0.92, 0.83, 0.29 and, 0.34 respectively for the white blood-cell count. The results of aspiration were 0.57, 0.5, 0.78, 0.29, and 0.54. Conclusion The detection of PJI is still a challenge in clinical practice. The histopathological evaluation emerges as a highly practical diagnostic tool in detection of PJI. Furthermore, we found a discrepancy between the pre-operative suspicion of PJI and the final post-operative diagnosis, resulting in a slight uncertainty in whether loosening is due to bacterial infection or not. The variation in accuracy of the single tests may influence the detection of PJI. Level of Evidence: Diagnostic Level I. PMID:18644107

  3. The Endocrine Pancreas

    Microsoft Academic Search

    Stefano La Rosa; Daniela Furlan; Fausto Sessa; Carlo Capella

    \\u000a Although the endocrine component of the pancreas represents about less than 10% of the volume of the gland, it plays a crucial\\u000a role in regulating the metabolic functions, mainly the glucose metabolism. The diseases affecting the endocrine pancreas lead\\u000a to clinical pictures due to the increase or decrease of glucose blood levels. Pathology of the endocrine pancreas includes\\u000a non-neoplastic and

  4. Mucin secreting cystic lesions of the pancreas: treatment by enucleation.

    PubMed

    Madura, James A; Yum, Moo-Nahm; Lehman, Glen A; Sherman, Stuart; Schmidt, C Max

    2004-02-01

    Ninety per cent of pancreatic cysts are inflammatory pseudocysts. The other 10 per cent are congenital or neoplastic and include congenital true cysts, retention cysts, lymphoepithelial cysts, the mucinous cystadenoma, mucinous cystadenocarcinoma, and serous microcystic cystadenomas and the more recently described intraductal papillary mucin-secreting neoplasms. The advent of computerized tomographic scanning, endoscopic retrograde cholangiopancreatography (ERCP), and endoscopic ultrasonography (EUS) has brought many of these lesions to light when they are minimally symptomatic or are incidentally found while investigating unrelated problems. If there is any suspicion of actual or potentially malignant disease, then total excision of the lesion with part of or the entire pancreas is indicated to achieve a likely cure, as survival is better than for the more common ductal adenocarcinomas. There are few reliable preoperative studies to distinguish accurately the etiology and prognosis of this spectrum of cystic lesions, and usually the actual diagnosis is made only at the time of operation or histopathologic examination after the cystic lesion has been biopsied or excised. If a cyst is confirmed to be totally benign, as in the congenital true cyst, lymphoepithelial cyst, or a benign mucinous cyst, they may lend themselves to nonoperative observation or excision without sacrifice of pancreatic parenchyma. However, many mucin-producing cystic lesions may evolve into a dysplastic or invasive malignant lesion requiring more aggressive resective treatment, and it is important not to miss that diagnosis early when cure is still possible. This report presents four benign mucin-secreting cysts treated by local excision. All four were in the head of the pancreas and communicated with the main pancreatic duct and lacked ovarian-type stroma, thus categorizing them as side-branch intraductal papillary mucinous neoplasms. These lesions were able to be easily dissected out of the pancreas with only one patient developing a transient pancreatic fistula. Intraoperative and final histopathology confirmed the benign status, and these patients have remained disease free 3 to 5 years postoperatively. A review of benign tumors reported to have been treated by cyst enucleation in the literature confirms the rationale of this approach in highly selected lesions. PMID:15011911

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

    PubMed Central

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

    2014-01-01

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

  6. An annular pancreas associated with carcinoma of the papilla of Vater: report of a case.

    PubMed

    Yazawa, Naoki; Imaizumi, Toshihide; Furukawa, Daisuke; Matsuyama, Masahiro; Gunji, Hisashi; Kato, Kenichiro; Tobita, Kosuke; Nakagohri, Toshio; Makuuchi, Hiroyasu; Hirabayashi, Kenichi; Ogoshi, Kyoji

    2012-05-01

    An annular pancreas is an uncommon congenital anomaly that usually presents early in childhood. Malignancy in the setting of an annular pancreas is unusual. We herein report a case of annular pancreas with carcinoma of the papilla of Vater. A 59-year-old man presented with epigastric discomfort and was referred to us after gastroduodenal endoscopy showed a tumor of the papilla of Vater. Preoperative imaging showed the pancreatic parenchyma encircling the descending duodenum and a tumor at the papilla of Vater. A pancreaticoduodenectomy was performed for the annular pancreas and the ampullary tumor. Histological examination confirmed a complete annular pancreas and carcinoma in situ of the papilla of Vater. We also provide a review of the reported cases of an annular pancreas with periampullary neoplasms and discuss the clinical characteristics of this anomaly. PMID:22116396

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

    PubMed Central

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

    2014-01-01

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

  8. Diagnosis and management of insulinoma.

    PubMed

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

    2013-02-14

    Insulinomas, the most common cause of hypoglycemia related to endogenous hyperinsulinism, occur in 1-4 people per million of the general population. Common autonomic symptoms of insulinoma include diaphroresis, tremor, and palpitations, whereas neuroglycopenenic symptoms include confusion, behavioural changes, personality changes, visual disturbances, seizure, and coma. Diagnosis of suspected cases is based on standard endocrine tests, especially the prolonged fasting test. Non-invasive imaging procedures, such as computed tomography and magnetic resonance imaging, are used when a diagnosis of insulinoma has been made to localize the source of pathological insulin secretion. Invasive modalities, such as endoscopic ultrasonography and arterial stimulation venous sampling, are highly accurate in the preoperative localization of insulinomas and have frequently been shown to be superior to non-invasive localization techniques. The range of techniques available for the localization of insulinomas means that blind resection can be avoided. Intraoperative manual palpation of the pancreas by an experienced surgeon and intraoperative ultrasonography are both sensitive methods with which to finalize the location of insulinomas. A high proportion of patients with insulinomas can be cured with surgery. In patients with malignant insulinomas, an aggressive medical approach, including extended pancreatic resection, liver resection, liver transplantation, chemoembolization, or radiofrequency ablation, is recommended to improve both survival and quality of life. In patients with unresectable or uncontrollable insulinomas, such as malignant insulinoma of the pancreas, several techniques should be considered, including administration of ocreotide and/or continuous glucose monitoring, to prevent hypoglycemic episodes and to improve quality of life. PMID:23430217

  9. Assessment of pancreas cells

    NASA Technical Reports Server (NTRS)

    Vanoss, C. J.

    1978-01-01

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

  10. Intraductal neoplasms of the pancreas.

    PubMed

    Klöppel, Günter; Basturk, Olca; Schlitter, Anna Melissa; Konukiewitz, Björn; Esposito, Irene

    2014-11-01

    There are three types of pancreatic neoplasms that predominantly have an intraductal growth pattern: the common, usually cystic, intraductal papillary mucinous neoplasms (IPMNs); the rare, usually solid intraductal tubulopapillary neoplasms (ITPNs); and the rare intraductal tubular pyloric gland-type adenoma. In addition to these three tumor types, pancreatic neoplasms with a usually solid growth pattern such as acinar cell carcinomas, neuroendocrine tumors, and undifferentiated carcinomas may present, though very rarely, as predominantly intraductally growing neoplasms. IPMNs can be subclassified into main duct and branch duct tumors; into low- and high-grade dysplasia groups; and into tumors with intestinal, pancreatobiliary, oncocytic, or gastric cellular differentiation. The intestinal-, pancreatobiliary-, and oncocytic-type IPMNs occur predominantly in the main duct of the head of the pancreas and more commonly progress to invasive adenocarcinomas. The gastric-type IPMNs are frequently multifocal, occur predominantly in the branch ducts of the uncinate process, and have a low risk of progressing to invasive carcinoma. The prognosis for patients with an IPMN depends largely on the subtype and the presence and the stage of an invasive carcinoma. ITPNs are nodular tumors, often in the pancreatic head, and composed of densely packed tubular glands. Molecular genetics reveal KRAS, GNAS, and RNF43 as the most frequently mutated genes in IPMNs, while ITPNs show wild-type KRAS. Recent progress in genetic sequencing of pancreatic neoplasms and the identification of specific genetic mutations also holds promise for the future development of novel gene-based diagnostic tests in intraductal neoplasms of the pancreas that might even be used in preoperative conditions. PMID:25282472

  11. National Pancreas Foundation

    MedlinePLUS

    ... Read More... View Calendar News Easy-to-undestand animations, expert explinations & patient interviews on pancreatic disease. Continue ... Featured Programs Animated Pancreas Patient Easy-to-understand animations, expert explanations & patient interviews on pancreatic disease. Research ...

  12. Pancreas.org

    NSDL National Science Digital Library

    Whitcomb, David

    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.

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

    PubMed

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

    2007-01-21

    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. PMID:17230623

  14. Imaging Spectrum after Pancreas Transplantation with Enteric Drainage

    PubMed Central

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

    2014-01-01

    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

  15. Imaging spectrum after pancreas transplantation with enteric drainage.

    PubMed

    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

    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

  16. Giant serous microcystic pancreas adenoma.

    PubMed

    Dikmen, Kursat; Bostanci, Hasan; Yildirim, Ali Cihat; Sakrak, Omer; Kerem, Mustafa

    2012-10-10

    Serous cystadenomas are rare tumors comprising 1-2% of exocrine pancreas tumors. They are mostly known as benign conditions but malign transformation as serous cystadenocarcinoma is also reported. It is usually seen in females. Non-specific symptoms, such as abdominal pain or symptoms due to mass affect, are usually seen. A 64-year old female patient was investigated for abdominal pain. Physical and laboratory findings were normal. Abdomen ultrasonography confirmed an 11×9.5 cm solid cystic lesion and abdomen computed tomography scan confirmed a 12×11 cm lobulated cystic solid lesion which had central cystic necrotic areas extending from liver hilus inferiorly. Fine needle biopsy confirmed benign cytology and trucut biopsy of the pancreatic mass reported chronic inflamation. Nevertheless, this mass could have malignant contents and transformation potential. A laparatomy was decided due to patient's symptoms and mass effect. Due to vascular invasion of the tumor, Whipple procedure was performed. The pathology report confirmed serous microcystic adenoma. These rare tumors are usually benign but pre-operative malignity criterias are not identified. There are few differential diagnostic tools for excluding malignity. We suggest surgical resection as best treatment approach for selected cases. PMID:23372920

  17. Giant serous microcystic pancreas adenoma

    PubMed Central

    Dikmen, Kursat; Bostanci, Hasan; Yildirim, Ali Cihat; Sakrak, Omer; Kerem, Mustafa

    2012-01-01

    Serous cystadenomas are rare tumors comprising 1–2% of exocrine pancreas tumors. They are mostly known as benign conditions but malign transformation as serous cystadenocarcinoma is also reported. It is usually seen in females. Non-specific symptoms, such as abdominal pain or symptoms due to mass affect, are usually seen. A 64-year old female patient was investigated for abdominal pain. Physical and laboratory findings were normal. Abdomen ultrasonography confirmed an 11×9.5 cm solid cystic lesion and abdomen computed tomography scan confirmed a 12×11 cm lobulated cystic solid lesion which had central cystic necrotic areas extending from liver hilus inferiorly. Fine needle biopsy confirmed benign cytology and trucut biopsy of the pancreatic mass reported chronic inflamation. Nevertheless, this mass could have malignant contents and transformation potential. A laparatomy was decided due to patient's symptoms and mass effect. Due to vascular invasion of the tumor, Whipple procedure was performed. The pathology report confirmed serous microcystic adenoma. These rare tumors are usually benign but pre-operative malignity criterias are not identified. There are few differential diagnostic tools for excluding malignity. We suggest surgical resection as best treatment approach for selected cases. PMID:23372920

  18. Predictive Factors of Malignant or Invasive Intraductal Papillary-Mucinous Neoplasms of the Pancreas

    Microsoft Academic Search

    Yoshiaki Murakami; Kenichiro Uemura; Yasuo Hayashidani; Takeshi Sudo; Taijiro Sueda

    2007-01-01

    The aim of this study was to identify useful preoperative diagnostic findings indicative of malignant or invasive intraductal\\u000a papillary-mucinous neoplasms (IPMN) of the pancreas to determine an optimal operative procedure for IPMN. Sixty-two IPMNs,\\u000a which consisted of 29 adenomas, 10 borderline tumors, 11 adenocarcinomas in situ, and invasive adenocarcinomas were reviewed\\u000a from 1990 to 2003. Preoperative predictive factors of malignant

  19. 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

    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

    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. PMID:22741046

  20. Pancreas organ transplantation

    Microsoft Academic Search

    Ulrich Theodor Hopt; Oliver Drognitz

    2000-01-01

    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

  1. Mucinous cystic neoplasms of the pancreas: are we overestimating malignant potential?

    PubMed

    Nguyen, David; Dawson, David W; Hines, O Joe; Reber, Howard A; Donahue, Timothy R

    2014-10-01

    Surgical resection is recommended for all mucinous cystic neoplasms (MCNs) of the pancreas as a result of: 1) lack of an accurate tumor marker for invasive cancer; 2) young age at diagnosis; and 3) historical studies revealing 36 per cent incidence of malignancy in resected lesions. This study compares the clinicopathologic and prognostic features of our series of resected MCNs to recent studies using the current International Association of Pancreatology (IAP) system. Thirty-eight resected MCNs were identified. Almost all patients were female (97.4%); median age at diagnosis was 53.5 years (interquartile range [IQR], 41.3 to 61.0). The majority occurred in the body/tail of the pancreas (86.8%); median size on computed tomography/magnetic resonance imaging was 5.0 cm (IQR, 3 to 8.8). Comparison of the five high-grade (HG, 13.2%) and 33 low-grade (86.8%) MCNs revealed that 1) patients were similar in age (55.0 vs 52.0 years, respectively) and 2) HG lesions were significantly larger on preoperative imaging (9.9 vs 3.5 cm) and final pathology (10.9 vs 3.5 cm). These data, taken together with five recent studies that adhere to the 2012 IAP criteria (385 total MCNs), reveal that a cutoff of less than 3 cm without mural nodules would have only missed one (0.26%) HG lesion. Surveillance of these lesions may be appropriate for some patients. PMID:25264629

  2. Heterotopic Pancreas: A Rare Cause of Ileo-Ileal Intussusception

    PubMed Central

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

    2014-01-01

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

  3. Macrocystic serous cystadenocarcinoma of the pancreas: the first report of a new pattern of pancreatic carcinoma.

    PubMed

    Gupta, R; Dinda, A K; Singh, M K; Misra, M C

    2008-03-01

    Cystic pancreatic neoplasms are rare and include mucinous and microcystic cystadenoma (carcinomas) and the recently described macrocystic adenoma. Their accurate diagnosis is difficult by radiology, and histopathology remains the modality of choice. The case of a 42-year-old woman presenting with a gradually enlarging abdominal mass is reported. Imaging studies revealed a large unilocular cystic lesion in the pancreas. An exploratory laparotomy was done with excision of the cyst along with pancreas. Numerous microscopic sections revealed a serous neoplasm with atypical nuclear features and focal invasion of the cyst wall. A final pathological diagnosis of macrocystic serous cystadenocarcinoma of the pancreas was made. The patient has been doing well two years after surgery. This is the first case of a macrocystic serous cystadenocarcinoma of the pancreas, highlighting the need for extensive sampling of all cystic lesions of the pancreas in order to reach a correct diagnosis. PMID:18305183

  4. Mucinous Cystic Neoplasms of the Pancreas: Imaging Features and Diagnostic Difficulties

    Microsoft Academic Search

    J. SCOTT; I. MARTIN; D. REDHEAD; P. HAMMOND; O. J. GARDEN

    2000-01-01

    AIMS: To review the imaging features of mucinous cystic neoplasms (MCNs) of the pancreas and to highlight difficulties in differentiating these lesions from pancreatic pseudocysts.MATERIALS AND METHODS: The imaging investigations, case notes and histopathology of 13 patients who underwent surgery for an MCN of the pancreas, were reviewed.RESULTS: An erroneous diagnosis of a pancreatic pseudocyst had been made in five

  5. Preoperative Evaluations in Revision Total Knee Arthroplasty

    Microsoft Academic Search

    Steven J. MacDonald; Robert B. Bourne

    2006-01-01

    There are many causes of total knee arthroplasty failure, and an accurate preoperative diagnosis is essential to optimize the results of revision surgery. We discuss our standard pre- operative evaluation routine and we retrospectively reviewed the last 295 patients who underwent revision total knee ar- throplasty to establish the clinical value of the most com- monly performed investigations used to

  6. Microvasculature of the pancreas

    Microsoft Academic Search

    Dale E. Bockman

    1992-01-01

    Summary  Local or generalized alteration of microcirculation may be expected in diseases of the pancreas. Changes may range from increased\\u000a permeability of capillaries to hemorrhage. Tissue necrosis may result from prolonged ischemia owing to intravascular coagulation\\u000a and severely impaired blood flow. It is possible to observe early microvascular changes by intravital microscopy. Klar and\\u000a coworkers have demonstrated by this method that

  7. A Case of Pancreatic Intraepithelial Neoplasia That Was Difficult to Diagnose Preoperatively

    PubMed Central

    Ito, Hiroyuki; Kawaguchi, Yoshiaki; Kawashima, Yohei; Maruno, Atsuko; Ogawa, Masami; Hirabayashi, Kenichi; Mine, Tetsuya

    2015-01-01

    A 63-year-old female patient presented to a local physician with pain in her back and epigastric region. An abdominal computed tomography (CT) scan revealed a pancreatic tumor, and the patient was referred to our hospital. Multiple imaging studies that included ultrasonography (US), CT, MRI, and endoscopic US revealed a cystic lesion 3–4 cm in size with node-like projections in the body of the pancreas. The distal main pancreatic duct was also found to be dilated. Endoscopic retrograde pancreatography revealed an irregular stenosis of the main pancreatic duct proximal to the cystic lesion, and malignancy was suspected. The patient was preoperatively diagnosed with pancreatic ductal carcinoma concomitant with intraductal papillary mucinous carcinoma, and a distal pancreatectomy was performed. Rapid pathological diagnosis during surgery revealed positive surgical margins for pancreatic intraepithelial neoplasia (PanIN). Further resection was performed twice, her surgical margin was positive and total pancreatectomy was ultimately conducted. Histopathological findings revealed diffuse microinvasive cancerous lesions corresponding to PanIN-2 (moderate dysplasia) to PanIN-3 (carcinoma in situ) throughout the pancreas. PanIN involves microlesions of the ductal epithelium that may precede pancreatic cancer. Ascertaining changes in PanIN using images provided by diagnostic modalities such as CT and US is challenging. Ductal stenosis and distal cystic lesions resulting from atrophy and fibrosis of pancreatic tissue were noted around PanIN. Considering the possibility of PanIN, a precancerous lesion during differential diagnosis will help to improve early detection and prognosis for patients with pancreatic cancer.

  8. Endosonographic Features of Histologically Proven Gastric Ectopic Pancreas

    PubMed Central

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

    2014-01-01

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

  9. Serous microcystic adenoma of the pancreas: case report and review of the literature.

    PubMed

    Köksal, Aydin Seref; Asil, Mehmet; Turhan, Nesrin; Yolcu, Omer Faruk; Küçükay, Fahrettin; Ako?lu, Musa; Sahin, Burhan

    2004-09-01

    Cystic tumors of the pancreas are rare neoplasms. They are more frequently identified given the improvements in imaging techniques. Serous cystadenomas are the most common among cystic neoplasms of the pancreas. In this case report we present a patient who was incidentally found to have a cystic mass in the pancreas during an abdominal imaging done for unrelated reasons and was diagnosed as serous cystadenoma of the pancreas. She was asymptomatic on admission and was operated six years later because of the progressive growth of the tumor during that period. Distal pancreatectomy was performed. Histopathologic examination of the surgery specimen confirmed the diagnosis of serous microcystic adenoma. Despite their rarity, serous cystadenomas should be kept in mind in the differential diagnosis of the cystic lesions of the pancreas. Furthermore, the differentiation of serous cystadenoma from other cystic tumors as well as from non-neoplastic cysts is very important because of the great difference in their management. PMID:15492919

  10. Automatic segmentation of abdominal vessels for improved pancreas localization

    NASA Astrophysics Data System (ADS)

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

    2014-03-01

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

  11. [Unilocular macrocystic serous cystadenoma of the pancreas: a morphologic variant to be considered].

    PubMed

    Ayadi-Kaddour, A; Goutallier-Ben Fadhel, C; Rezgui, L; Lahmar-Boufaroua, A; Khalfallah, M T; Mzabi-Regaya, S

    2003-04-01

    Serous cystadenoma of the pancreas is a benign cystic tumor, which radiological diagnosis is easy in its typical microcystic variant. The macrocystic variant is uncommon and raises diagnostic problems with other macrocystic lesions of the pancreas such as pseudocysts and mucinous cystadenomas. We report the case of a young woman with a unilocular macrocystic serous cystadenoma of the pancreas which was identified on pathologic examination of the surgical specimen, after unconclusive abdominal ultrasound and CT-scan. This case describes an unusual clinical presentation of this cystic tumor and emphasizes that the diagnosis of such an entity is still based on pathological examination after cyst removal. PMID:12821086

  12. Cystic Neoplasms of the Pancreas

    PubMed Central

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

    2015-01-01

    Whereas pancreatic duct adenocarcinoma (PDA) is a well-studied (but still poorly understood) disease with a dismal prognosis, cystic neoplasms of the pancreas form a more recently recognized group of pancreatic tumors. They are diverse and variable in their pathologic characteristics, clinical course, and outcomes,1–3 although all portend a better overall prognosis than PDA. In recent years, with the improved sensitivity and increasing use of cross-sectional imaging in clinical practice, these lesions are more commonly identified,4 with many being discovered incidentally. Indeed, large radiological series using computed tomography (CT) or magnetic resonance imaging (MRI) have reported detection rates of pancreatic cystic lesions between 1.2% and almost 20%,5,6 approaching the 24.3% prevalence rate in an autopsy series by Kimura and colleagues.7 Although most of these lesions are pseudocysts, a significant portion consist of cystic neoplasms, which are estimated to represent 10% to 15% of all primary pancreatic cystic lesions.8 Given the growing clinical relevance of these tumors, a keen understanding of their natural history and pathophysiology is needed. This article reviews pancreatic cystic neoplasms, with a focus on the challenges encountered in their diagnosis and treatment. PMID:20159515

  13. Cystic lesions of the pancreas

    PubMed Central

    Hruban, Ralph H.; Fukushima, Noriyoshi

    2008-01-01

    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. PMID:20953247

  14. Circus tomography of the pancreas

    Microsoft Academic Search

    Kazue Kimura; Yozo Ogiwara

    1968-01-01

    The following results were obtained after analysation into the questionnaires on the frequency and the actual condition of the alcohol-induced pancreatitis, after investigation into the pancreatic dysfunction by the intake of the excess volume of alcohol, and finally examination of the effect of the diet on the pancreas both clinically and experimentally. 1) The diseases of the pancreas which were

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

    PubMed Central

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

    2013-01-01

    Purpose The purpose of the study was to determine the sensitivity of the 18fluoro-dihydroxyphenylalanine positron emission tomography/computed tomography scan (18 F-PET/CT) in the diagnosis of focal congenital hyperinsulinism (HI). Methods A retrospective review of children with HI who underwent a preoperative 18 F-PET/CT scan was performed. Results Between 1/2008 and 2/2012 we performed 105 consecutive 18 F-PET/CT scans on infants with HI. Fifty-three patients had focal HI. Of those fifty-three patients, eight had a preoperative 18 F-PET/CT scan read as “diffuse disease”. The sensitivity of the study in the diagnosis of focal HI was 85%. The location of the eight missed focal lesions was: head (3), body (2), and tail (3). The 18 F-PET/ CT of the missed head lesions showed homogeneous tracer uptake (n =2) or heterogeneous uptake throughout the pancreas (n=1). The 18 F-PET/CT of the 2 missed body lesions and 1 missed tail lesion showed heterogeneous uptake throughout the pancreas. The 18 F-PET/CT of the other 2 missed tail lesions showed lesions adjacent to and obscured by the signal of the upper renal pole, identified retrospectively by closer observation. Fifty-two of the 105 patients had diffuse HI. Two of them had 18 F-PET/CT studies read as “focal disease”. Therefore, the specificity of the study was 96%. Of the forty-seven 18 F-PET/CT studies read as “focal disease”, forty-five had true focal HI. Therefore, the positive predictive value of the study in the diagnosis of focal HI was 96%. Conclusion The sensitivity and specificity of 18 F-PET/CT can be affected by certain anatomic features of the pancreas, by the location of the lesion, and by the reader’s experience. PMID:23414871

  16. Preoperative Check List

    Microsoft Academic Search

    Rami R. Zanoun; Giselle G. Hamad

    The primary objectives of bariatric surgery are to improve obesity-related comorbidities and quality of life. The success\\u000a of the bariatric surgical procedure relies not only on the technical expertise of the surgeon, but also on the proper preoperative\\u000a evaluation and management of the patient’s comorbid conditions.\\u000a \\u000a In the preoperative setting, the bariatric surgeon should utilize a multidisciplinary approach for assessment

  17. Strategies to improve preoperative care

    Microsoft Academic Search

    L. C. Lemmens

    2009-01-01

    The contents and organization of the preoperative care have gained increasing attention over the past decade. Several strategies have emerged to evaluate and optimize patients before surgery, aiming to minimize the risk of complications. In this thesis two different strategies for preoperative evaluation and optimization were studied: outpatient preoperative evaluation clinics (OPE clinics) and preoperative interventions embedded in clinical pathways

  18. The Preoperative Neurological Evaluation

    PubMed Central

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

    2013-01-01

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

  19. Major duodenal injuries in children: diagnosis, operative management, and outcome.

    PubMed

    Pokorny, W J; Brandt, M L; Harberg, F J

    1986-07-01

    The diagnosis, treatment, and outcome of ten children less than 13 years old operated on for major duodenal injuries is reviewed. Three had gun shot wounds with perforation and seven had blunt trauma resulting in duodenal disruption. Of those with blunt trauma, three had massive injuries requiring immediate operation, and four had what appeared to be lesser injuries. The symptoms of those children with lesser injuries were initially vague and delayed in onset, resulting in a delay of 24 hours to 7 days from time of injury to admission. At the time of admission, all four had tenderness localized to the right lower quadrant and an unclear preoperative diagnosis. Eight had associated injuries, most commonly to the pancreas. The single death occurred within 48 hours of injury and was the result of an associated head injury. The surviving nine patients left the hospital between the 11th and 22nd postoperative day doing well. One patient with a transected pancreas and extensive duodenal injury underwent a pancreaticoduodenectomy with a Whipple type reconstruction. Two patients with an extensive blowout injury to the duodenum and one with a crush injury to the pancreas underwent a pyloric exclusion and gastrojejunostomy. These patients did well with no fistula formation. The remaining seven children underwent debridement and primary closure of the duodenal injury. Four developed fistulae; however, two were pancreatic, one was jejunal, and only one was duodenal. All drained less than 250 mL per 24 hours and all except the jejunal fistula were closed by the 17th postoperative day. All were supported nutritionally either intravenously or more recently with a jejunal catheter placed at operation.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3525803

  20. Development and Congenital Anomalies of the Pancreas

    PubMed Central

    Tadokoro, Hiroyuki; Takase, Masaru; Nobukawa, Bunsei

    2011-01-01

    Understanding how the pancreas develops is essential to understand the pathogenesis of congenital pancreatic anomalies. Recent studies have shown the advantages of investigating the development of frogs, mice, and chickens for understanding early embryonic development of the pancreas and congenital anomalies, such as choledochal cysts, anomalous pancreaticobiliary junction, annular pancreas, and pancreas divisum. These anomalies arise from failure of complete rotation and fusion during embryogenesis. There are many theories in the etiology of congenital anomalies of the pancreas. We review pancreas development in humans and other vertebrates. In addition, we attempt to clarify how developmental failure is related to congenital pancreatic anomalies. PMID:22567291

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

    ClinicalTrials.gov

    2014-03-28

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

  2. Preoperative diagnosis of obturator hernia by computed tomography in six patients 1 1 Selected Topics: Emergency Radiology is coordinated by Jack Keene, MD, of Emergency Treatment Associates, Rhinebeck, New York

    Microsoft Academic Search

    Masayoshi Nishina; Chiiho Fujii; Ryukoh Ogino; Ryozoh Kobayashi; Akitsugu Kohama

    2001-01-01

    Obturator hernia is a rare condition, and the prognosis of patients with this condition is poor. A retrospective study was performed on six patients with obturator hernia between 1993 and 1998. They had been diagnosed preoperatively by computed tomography (CT). The initial CT scan of the abdomen, including the pelvic area, revealed an incarcerated bowel in the obturator foramen of

  3. Design of a bioartificial pancreas

    PubMed Central

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

    2013-01-01

    Summary Islet transplantation has been shown to be a viable treatment option for patients afflicted with Type 1 diabetes. However, the severe shortage of human pancreas and the need to use risky immunosuppressive drugs to prevent transplant rejection remain two major obstacles to routine use of islet transplantation in diabetic patients. Successful development of a bioartificial pancreas using the approach of microencapsulation with perm-selective coating of islets in hydrogels for graft immunoisolation holds tremendous promise for diabetic patients because it has great potential to overcome these two barriers. In this review article, we will discuss the need for bioartificial pancreas, provide a detailed description of the microencapsulation process, and review the status of the technology in clinical development. We will also critically review the various factors that need to be taken into consideration in order to achieve the ultimate goal of routine clinical application. PMID:23652283

  4. Model Predictive Control for an artical pancreas

    E-print Network

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

  5. 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

    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

    To establish diagnostic criteria for ductal adenocarcinomas of the pancreas (PCs), bacterial artificial chromosome (BAC) array-based methylated CpG island amplification was performed using 139 tissue samples. Twelve BAC clones, for which DNA methylation status was able to discriminate cancerous tissue (T) from noncancerous pancreatic tissue in the learning cohort with a specificity of 100%, were identified. Using criteria that combined the 12 BAC clones, T-samples were diagnosed as cancers with 100% sensitivity and specificity in both the learning and validation cohorts. DNA methylation status on 11 of the BAC clones, which was able to discriminate patients showing early relapse from those with no relapse in the learning cohort with 100% specificity, was correlated with the recurrence-free and overall survival rates in the validation cohort and was an independent prognostic factor by multivariate analysis. Genome-wide DNA methylation profiling may provide optimal diagnostic markers and prognostic indicators for patients with PCs. PMID:21197409

  6. Preoperatively diagnosed mucocele of the appendix.

    PubMed

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

    2014-01-01

    Mucocele of the appendix is an infrequent entity, characterized by distension of the lumen due to accumulation of mucoid substance and is rarely diagnosed preoperatively. If untreated, mucocele may rupture producing a potentially fatal entity known as pseudomyxoma peritonei. The type of surgical treatment is related to the dimensions and the histology of the mucocele. Appendectomy is used for simple mucocele or for cystadenoma. Right hemi-colectomy is recommended for cystadeno carcinoma. In this paper, we report a case of an asymptomatic 37-year-old woman in whom mucocele was found on a routine ultrasound examination and preoperative computed tomography scan. Surgery revealed a big appendix measuring 84 mm in length and 40 mm in diameter. The final pathologic diagnosis was simple mucocele. PMID:24956351

  7. Pre-operative anaemia.

    PubMed

    Clevenger, B; Richards, T

    2015-01-01

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

  8. Preoperative Assessment of Risk

    Microsoft Academic Search

    Joan Weinryb

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

  9. Angioarchitecture of the atrophic pancreas.

    PubMed

    Weaver, C

    The pancreas has a complex vasculature which comprises both exocrine and endocrine structures. Copper deficiency induces highly selective acinar cell degeneration and progressive noninflammatory lipomatosis in pancreas while Langerhans islets, ducts, and nerves remain unaffected. Pancreatic vasculature was examined in rats that had dietary copper deficiency to characterize changes in the angioarchitecture of the gland. This model was used to assess the degree to which the vasculature of non-acinar components of the gland are potentially altered under conditions of exocrine atrophy. Ultrastructure of pancreas was examined by histology, enzyme histochemistry and immunohistochemistry, corrosion casting and scanning electron microscopy, in situ vascular staining, microsphere injection, biochemical analysis, and morphometry in copper-deficient rats. Results show that no acute angiopathic changes indicative of vascular disorganization accompany atrophy. Only a reduction in the complexity of the capillary beds, which normally vascularize the dense acinar parenchyma, was found. Microsphere quantitation also showed that blood flow to the lipomatous gland remains intact. Furthermore, analysis of the angioarchitecture of the atrophied pancreas supports a largely autonomous blood supply to islets and ducts. These observations support the hypothesis that while the vasculature of the atrophied gland is modified in vascular regions severely targeted by acinar necrosis, the overall structural features of the angioarchitecture are preserved. The atrophied gland thus provides an experimental model to study the vascular routes supplying islet and ductal blood flow within the complex pancreatic circulation. PMID:9220429

  10. Evolving surgical strategies for pancreas transplantation.

    PubMed

    Leeser, David B; Bartlett, Stephen T

    2004-08-01

    Pancreas transplant has become a reliably predictable treatment and cure for patients with type 1 diabetes mellitus and hypoglycemic unawareness or renal failure. During the past 2 years, the use of enteric drainage has been shown to decrease morbidity over traditional bladder drainage, and the use of the portal system for venous drainage continues to be explored. Technically, the use of circular staplers, over a hand-sown anastomosis for duodenal drainage, has gained popularity, and alternative arterial reconstruction methods have been developed. Living donor pancreas and kidney transplants are also becoming more common throughout the world. In the area of immunosuppression, steroid-free protocols, now commonplace in kidney transplants, are being applied successfully to pancreas transplantation. Finally, the benefit of solitary pancreas and pancreas after kidney transplantation has been questioned, and a more complete analysis of pancreas alone and pancreas after kidney transplants is anticipated in the near future. PMID:15265475

  11. Autoimmune diabetes recurrence should be routinely monitored after pancreas transplantation

    PubMed Central

    Martins, La Salete

    2014-01-01

    Autoimmune type 1 diabetes recurrence in pancreas grafts was first described 30 years ago, but it is not yet completely understood. In fact, the number of transplants affected and possibly lost due to this disease may be falsely low. There may be insufficient awareness to this entity by clinicians, leading to underdiagnosis. Some authors estimate that half of the immunological losses in pancreas transplantation are due to autoimmunity. Pancreas biopsy is the gold standard for the definitive diagnosis. However, as an invasive procedure, it is not the ideal approach to screen the disease. Pancreatic autoantibodies which may be detected early before graft dysfunction, when searched for, are probably the best initial tool to establish the diagnosis. The purpose of this review is to revisit the autoimmune aspects of type 1 diabetes and to analyse data about the identified autoantibodies, as serological markers of the disease. Therapeutic strategies used to control the disease, though with unsatisfactory results, are also addressed. In addition, the author’s own experience with the prospective monitoring of pancreatic autoantibodies after transplantation and its correlation with graft outcome will be discussed. PMID:25346891

  12. Elevated Erythropoietin and Multicystic Neoplasm of the Pancreas

    PubMed Central

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

    2015-01-01

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

  13. Solid pseudopapillary tumour (Frantz's tumour) of the pancreas in childhood.

    PubMed

    Escobar, Mauricio Antonio; Bond, Blake J; Schopp, James

    2014-01-01

    An 11-year-old girl presented with acute pancreatitis and mass in the head of the pancreas. MRI revealed a heterogeneous right-upper quadrant retroperitoneal mass measuring 6.8×6.1×5.5 cm arising from the pancreatic head. Endoscopic ultrasound with fine-needle aspirate revealed a solid pseudopapillary tumour (SPT) of the pancreas. The patient underwent a pylorus-preserving Whipple procedure. Pathology confirmed SPT. First described by Frantz, SPT represents less than 3% of all exocrine tumours. It is especially rare in children and shows different clinical features compared with adults. In our patient, tumour cells were arranged at the periphery of fibrovascular cores, but they did not show definite gland formation, keratinisation or cytoplasmic pigment accumulation. A periodic acid-Schiff stain without diastase did not show appreciable glycogen within the tumour cells, classic for Frantz's tumour. The literature, diagnosis, management and pathogenesis on this rare entity in children are reviewed and discussed. PMID:24488660

  14. Primitive Neuroectodermal Tumour of Pancreas; Second Case from Asia

    PubMed Central

    CHANGAL, Khalid Hamid; MIR, Mohmad Hussain; AZAZ, Sheikh Aejaz; QADRI, Sumyra Khurshid; LONE, Abdul Rashid

    2014-01-01

    Primitive neuroectodermal tumours (PNETs) are malignant tumours composed of small round cells of neuroectodermal origin that affect soft tissue and bone. PNETs originating in the pancreas are extremely rare; previous to this report, only 14 cases were reported worldwide, making this case the fifteenth in the world and the second in Asia. We present the case of a painful pancreatic lump diagnosed as PNET of the pancreas after a thorough workup. The diagnosis of PNET is made according to the overall clinical picture, imaging, histopathology, cytogenetics, and immunohistochemistry, as in the case we present. It is essential to differentiate primary pancreatic PNET from a secondary involvement. A review of all of the cases diagnosed worldwide thus far is also provided.

  15. Vascular instruction of pancreas development

    PubMed Central

    Cleaver, Ondine; Dor, Yuval

    2012-01-01

    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

  16. Ischemia and reperfusion in pancreas.

    PubMed

    Hoffmann, T F; Leiderer, R; Harris, A G; Messmer, K

    Ischemic diseases of heart and brain are the primary causes of mortality in industrialized nations. The ischemic injury with the consecutive reperfusion is responsible for the disturbance of microcirculation with ensuing tissue damage and organ dysfunction. Recent evidence suggests that oxygen-derived free radicals and activated polymorphonuclear leukocytes produced in ischemic tissue are instrumental in the development of ischemic cell injury. In pancreas, ischemia/ reperfusion is proposed as a potentially damaging factor accounting in part for the pathogenesis of acute pancreatitis. Apart from ischemia/reperfusion injury, the kallikrein-kinin system mediates acute inflammation associated with enhanced capillary permeability and accumulation of polymorphonuclear leukocytes, cardinal features of ischemia/reperfusion injury also in acute pancreatitis. Therefore, it seems reasonable to use bradykinin-antagonists to influence postischemic reperfusion injury of the pancreas. In the following, we describe the pathophysiology of ischemia/reperfusion injury with special reference to the pancreatic microcirculation and morphological changes as observed in a model of complete and reversible ischemia. Furthermore, we will discuss the effects of two bradykinin-antagonists (HOE 140 and CP-0597) on functional integrity of the pancreas after ischemia/ reperfusion. PMID:9220431

  17. Real-time tissue elastography in the diagnosis of autoimmune pancreatitis.

    PubMed

    Dietrich, C F; Hirche, T O; Ott, M; Ignee, A

    2009-08-01

    Endoscopic ultrasound (EUS) elastography distinguishes tissues on the basis of their specific consistency. The preoperative diagnosis of autoimmune pancreatitis (AIP) is of the utmost importance in order to avoid surgery. The aim of this prospective evaluation of five patients was to investigate the role of this new technique in the characterization of mass lesions caused by AIP, with histology as the gold standard. All five patients with AIP presented with a characteristic stiff elastographic pattern not only of the mass lesion but also of the surrounding pancreatic parenchyma, which was not found in 17 patients with ductal adenocarcinoma and 10 healthy subjects. EUS elastography of the pancreas shows a typical and unique finding with homogenous stiffness of the whole organ, and this distinguishes AIP from the circumscribed mass lesion in ductal adenocarcinoma. PMID:19618344

  18. Serous cystadenoma of the pancreas presenting as a third primary neoplasm.

    PubMed

    Köksal, Aydin Seref; Ulker, Aysel; Asil, Mehmet; Tunç, Bilge; Arda, Kemal; Savkilio?lu, Metin; Ozo?ul, Yusuf; Turhan, Nesrin

    2003-09-01

    Serous cystadenomas are the most common cystic neoplasms of the pancreas. They may occur solely or coexist with other neoplasms. A 10 cm mass involving the body of the pancreas was observed in the computed tomography of a 61-year-old man with a previous history of bladder and prostate carcinoma. Ultrasonography and computed tomography of the mass demonstrated multiple small cysts associated with a central calcified scar. A distal pancreatectomy was performed. Pathological examination confirmed the diagnosis of serous microcystic adenoma. This is the first report of a serous cystadenoma of the pancreas with two metachronous neoplasms. This feature should be kept in mind during the diagnosis and evaluation of patients with serous cystadenoma. PMID:14532929

  19. [Serous oligocystic adenoma of the pancreas].

    PubMed

    Alcalá-Galiano, A; Borruel Nacenta, S; Jiménez-Arranz, S; Martín-Medina, P

    2007-01-01

    Serous oligocystic or macrocystic adenoma of the pancreas is a very uncommon morphological variant of what was classically termed microcystic adenoma of the pancreas. This is a benign neoplasm; however, its radiological appearance mimicks that of potentially malignant mucinous neoplasms of the pancreas. Therefore, radiologists need to be familiar with this entity to ensure the most appropriate therapeutic management and help to avoid unnecessary surgery. PMID:18021674

  20. Spontaneous arterioenteric fistula after pancreas transplantation.

    PubMed

    Gritsch, H A; Shapiro, R; Egidi, F; Randhawa, P S; Starzl, T E; Corry, R J

    1997-03-27

    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. PMID:9089233

  1. Primary mediastinal hemangiopericytoma treated with preoperative embolization and surgery.

    PubMed

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

    2014-01-01

    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

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

    PubMed Central

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

    2015-01-01

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

  3. Clinical factors predictive of malignant and premalignant cystic neoplasms of the pancreas: a single institution experience

    PubMed Central

    Jones, Natalie B; Hatzaras, Ioannis; George, Nathaniel; Muscarella, Peter; Ellison, E Christopher; Melvin, W Scott; Bloomston, Mark

    2009-01-01

    Background: As cystic neoplasms of the pancreas are discovered with advanced imaging techniques, pancreatic surgeons often struggle with identifying who is at risk of having or developing pancreatic cancer. We sought to review our experience with the surgical management of cystic neoplasms of the pancreas to determine pre-operative clinical indicators of malignancy or premalignant (i.e. mucinous) lesions. Methods: Between 1996 and 2007, 114 consecutive patients with cystic neoplasms of the pancreas underwent a pancreatectomy. Invasive adenocarcinoma was identified in 35 whereas 79 had benign lesions. Mucinous lesions were considered premalignant and consisted of 29 intraductal papillary mucinous neoplasms (IPMN) and 17 mucinous cystic neoplasms (MCN). The remaining 33 benign lesions were serous microcystic adenomas. Descriptive statistics were calculated and multivariate logistic regression was performed. Receiver-operating characteristic (ROC) curves were constructed for continuous variables and the area under the curves compared. Likelihood ratios were calculated from the combinations of predictors. Results: Patients with pancreatic cancer arising from a cystic neoplasm were older than those with benign cysts. Mucinous lesions with or without associated cancer were more likely to be symptomatic and present with elevated serum carbohydrate antigen (CA)19-9 levels. Cancers more commonly presented in the head of the pancreas and were associated with longer hospitalizations after resection. Using multivariate logistic regression, size and elevated CA19-9 were predictors of malignancy whereas male gender and size were predictors of mucinous lesions with or without malignancy. Size, however, was not an accurate test to determine premalignant or malignant lesions using area under the ROC curve analysis whereas CA19-9 performed the best regardless of gender or lesion location. Conclusions: Based upon our single institution experience with resection of cystic neoplasms of the pancreas, we advocate an aggressive surgical approach to any patient with a cystic neoplasm of the pancreas and associated elevated CA19-9. PMID:20495634

  4. Sclerosing mesenteritis involving the pancreas: a mimicker of pancreatic cancer.

    PubMed

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

    2010-04-01

    Sclerosing mesenteritis (SM), also known as mesenteric lipodystrophy, rarely involves the parenchyma of the pancreas. When SM does involve the pancreas, it can mimic pancreatic carcinoma both clinically and radiographically with pain, obstructive jaundice, a mass lesion, and even the appearance of vascular invasion. We report 6 patients with SM involving the pancreas (mean age 43.2 y, 5 female), and review their clinical presentation, radiographic findings, pathology, and outcome. Five of these 6 patients were originally thought to have a primary pancreatic neoplasm. Initial presenting clinical information was available for each patient: all 6 reported abdominal or epigastric pain, 3 reported weight loss, and 2 reported one or more of the following: back pain, fever, abdominal bloating/distention, nausea with/without vomiting, and anorexia. The lesions formed masses with an infiltrative pattern and all had 3 key histologic features: fibrosis, chronic inflammation, and fat necrosis-without a known etiology. The inflammatory infiltrate was composed of a mixture of lymphocytes, plasma cells, and scattered eosinophils. Of the 5 patients with post-treatment clinical information available, 4 had at least a partial response to treatment with steroids, tamoxifen, azathioprine, resection, or a combination of these, and 1 did not respond. A dramatic response to immunosuppressive therapy is illustrated by the case of a 46-year-old woman who presented with the presumptive diagnosis of an unresectable pancreatic cancer. Distinguishing SM from pancreatic carcinoma is crucial to appropriate management, as patients with SM may benefit from immunosuppressive therapy. PMID:20351487

  5. Design of a bioartificial pancreas+

    PubMed Central

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

    2010-01-01

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

  6. Preoperative evaluation : risk management and implementation aspects

    Microsoft Academic Search

    W. A. van Klei

    2002-01-01

    In preoperative risk management the anesthesiologist uses diagnostic information to estimate the probability of outcomes and to decide on the anesthetic strategy in a particular patient. The aim of this thesis was explore to what extent simple patient characteristics, particularly obtained from preoperative patient history and physical examination, could contribute to preoperative risk management. Furthermore, the implementation of outpatient preoperative

  7. Sonographic features of agenesis of dorsal pancreas

    PubMed Central

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

    2013-01-01

    Agenesis of dorsal pancreas is an extremely rare congenital anomaly that occurs due to failure of the dorsal pancreatic bud to form the body and tail of the pancreas. We report the sonographic appearance of this condition in six cases. PMID:24082486

  8. Huge lipomatous pseudohypertrophy of the pancreas.

    PubMed

    Nakamura, M; Katada, N; Sakakibara, A; Okumura, N; Kato, E; Takeichi, M; Kondo, T; Mano, H

    1979-08-01

    A rare case of lipomatous pseudohypertrophy of the pancreas associated with multiple cysts in an adult is presented. Endoscopic retrograde pancreatography showed a long, willow-like main pancreatic duct. Resected body and tail of the pancreas weighed 1,200 gm. PMID:474558

  9. Effect of alcohol on the pancreas

    Microsoft Academic Search

    Masayuki Oda; Yozo Ogiwara

    1968-01-01

    The following results were obtained after analysation into the questionnaires on the frequency and the actual condition of the alcohol-induced pancreatitis, after investigation into the pancreatic dysfunction by the intake of the excess volume of alcohol, and finally examination of the effect of the diet on the pancreas both clinically and experimentally. 1) The diseases of the pancreas which were

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

    PubMed Central

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

    2014-01-01

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

  11. Primary squamous cell carcinoma of pancreas diagnosed by EUS-FNA: A case report

    PubMed Central

    Lai, Larry Hin; Romagnuolo, Joseph; Adams, David; Yang, Jack

    2009-01-01

    Squamous cell carcinoma of the pancreas has been sparsely described since the 1940s, and generally has a poor prognosis. Herein, we present a case of primary squamous cell carcinoma of the pancreas with liver metastasis, both confirmed by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). To the best of our knowledge, this is the first case report in literature utilizing EUS-FNA for a cell-type specific diagnosis of primary pancreatic squamous cell carcinoma with a liver metastasis. PMID:19750582

  12. Primary fallopian tube carcinoma diagnosed preoperatively by cervical smear.

    PubMed

    Ural, Ulku Mete; Balik, Gulsah; Tekin, Yesim Bayoglu; Sehitoglu, Ibrahim; Bedir, Recep; Sahin, Figen Kir

    2014-01-01

    Primary fallopian tube carcinoma is a rare clinical entity that constitutes a diagnostic challenge in gynecological practice. Patients generally suffer from the three symptoms: vaginal bleeding, pelvic pain, and vaginal discharge; however, this is usually not sufficient for confirming the diagnosis preoperatively in most circumstances. In this case report, we present a 49-year-old woman whose cervical smear raised a suspicion for fallopian tube carcinoma. All preoperative examination measures such as ultrasonography, hysteroscopy, and endometrial aspiration were normal. Repeated cervical smears were consistent with adenocarcinoma presumably ensourcing from the fallopian tube. The patient underwent laparatomy,total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic para-aortic lymph node dissection. The primary serous papillary adenocarcinoma of the right fallopian tube was detected at the histopathological analysis, and the patient was referred for adjuvant chemotherapy. Cervical smear findings can be the only clue for the diagnosis of fallopian tube carcinoma. PMID:25827704

  13. Cystic neoplasms of the pancreas: A diagnostic challenge

    PubMed Central

    Hutchins, Grant F; Draganov, Peter V

    2009-01-01

    Cystic neoplasms of the pancreas are increasingly recognized due to the expanding use and improved sensitivity of cross-sectional abdominal imaging. Major advances in the last decade have led to an improved understanding of the various types of cystic lesions and their biologic behavior. Despite significant improvements in imaging technology and the advent of endoscopic-ultrasound (EUS)-guided fine-needle aspiration, the diagnosis and management of pancreatic cystic lesions remains a significant clinical challenge. The first diagnostic step is to differentiate between pancreatic pseudocyst and cystic neoplasm. If a pseudocyst has been effectively excluded, the cornerstone issue is then to determine the malignant potential of the pancreatic cystic neoplasm. In the majority of cases, the correct diagnosis and successful management is based not on a single test but on incorporating data from various sources including patient history, radiologic studies, endoscopic evaluation, and cyst fluid analysis. This review will focus on describing the various types of cystic neoplasms of the pancreas, their malignant potential, and will provide the clinician with a comprehensive diagnostic approach. PMID:19115467

  14. Pancreas transplant imaging: how I do it.

    PubMed

    Tolat, Parag P; Foley, W Dennis; Johnson, Christopher; Hohenwalter, Mark D; Quiroz, Francisco A

    2015-04-01

    Pancreas transplantation aims to restore physiologic normoglycemia in diabetic patients with glomerulopathy and avoid or delay the onset of diabetic retinopathy and arteriopathy. Simultaneous pancreas-kidney transplant is the most common approach, using a cadaveric pancreas donation in conjunction with either cadaveric or live donor renal transplant. Alternative techniques include pancreas after kidney transplant, in which the pancreas transplant is performed some years after renal transplant. Pancreas transplant alone is utilized rarely in diabetic patients with compensated renal function. Pancreas grafts have vascular and enteric connections that vary in their anatomic approach, and understanding of this is critical for imaging with ultrasonography, computed tomography, or magnetic resonance imaging. Imaging techniques are directed to display the pancreatic transplant arterial and venous vasculature, parenchyma, and intestinal drainage pathway. Critical vascular information includes venous thrombosis (partial or complete), arterial occlusion, or aneurysm. Parenchymal abnormalities are nonspecific and occur in pancreatitis, graft rejection, and subsequent graft ischemia. Peripancreatic fluid collections include hematoma/seroma, pseudocyst, and abscess. The latter two are related to pancreatitis, duct disruption, or leak from the duodenojejunostomy. An understanding of transplant anatomy and complications will lead to appropriate use of imaging techniques to diagnose or exclude important complications. Online supplemental material is available for this article. (©) RSNA, 2015. PMID:25799333

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

    PubMed Central

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

    2013-01-01

    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. PMID:23908697

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

    PubMed

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

    2013-09-15

    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. PMID:24146696

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

    PubMed Central

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

    2013-01-01

    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. PMID:24146696

  18. Pregnancy after combined pancreas-kidney transplantation.

    PubMed

    Tydén, G; Brattström, C; Björkman, U; Landgraf, R; Baltzer, J; Hillebrand, G; Land, W; Calne, R; Brons, I G; Squifflet, J P

    1989-01-01

    Four successful cases of pregnancy after combined pancreas-kidney transplantation at four different centers are summarized. The techniques used for the pancreas transplantations were duct obstruction in one patient and enteric exocrine diversion in two patients; in all three patients the insulin delivery was to the systemic circulation. In one patient exocrine diversion was to the stomach and the vascular anastomosis to the splenic vessels, thus accomplishing portal insulin delivery. Immunosuppression consisted of cyclosporin and prednisolone in two patients; cyclosporin alone in one patient; and cyclosporin, azathioprine, and prednisolone in one patient. In all a cesarean section was performed, due to deteriorating renal function in two patients, a fall in fetal growth in one patient, and fear of inducing pancreas-graft pancreatitis during normal delivery in one patient. In all four women, perfect metabolic control was retained throughout the pregnancy, and despite the proximity of the pancreas graft to the growing uterus in three of the women, the pancreas grafts did not suffer any damage during the pregnancy. However, in one patient the pancreas graft was lost in acute rejection after delivery. This pancreas had functioned normally for 3 yr before this occasion. Of the offspring, one was completely normal, one had a bilateral cataract, and two were small for date. The latter two subsequently showed normal growth development. At follow-up at 3, 5, 7, and 28 mo, all kidney grafts and three of the pancreas grafts remained functional. We conclude that after combined pancreas-kidney transplantation, successful conception and pregnancy can be obtained. Despite reduced islet mass (segmental grafts), normal metabolic control can be retained throughout the pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2642857

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

    MedlinePLUS

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

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

    PubMed

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

    2014-01-01

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

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

    SciTech Connect

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

    2004-09-15

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

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

    NASA Astrophysics Data System (ADS)

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

    2013-02-01

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

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

    PubMed Central

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

    2014-01-01

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

  4. Preoperative evaluation of pancreaticobiliary tumor using MR multi-imaging techniques

    Microsoft Academic Search

    Liang Zhong; Lei Li; Qiu-Ying Yao

    Abstract Abstract Abstract Abstract AIM: To evaluate the clinical value of MR multi-imaging techniques in diagnosing and preoperative assessment of pancreaticobiliary tumor. METHODS: MR multi-imaging techniques, including MR cross-sectional imaging, MR cholangiopancreatography (MRCP) and 3D dynamic contrast-enhanced MR angiography (3D DCE MRA), were performed to make prospective diagnosis and preoperative evaluation in 28 patients with suspected pancreaticobiliary tumors. There were

  5. Essential role of clusterin in pancreas regeneration.

    PubMed

    Lee, Song; Hong, Seok-Woo; Min, Bon-Hong; Shim, Young-Jun; Lee, Ki-Up; Lee, In-Kyu; Bendayan, M; Aronow, Bruce J; Park, In-Sun

    2011-03-01

    Based on our previous observations that clusterin induction accompanies pancreas regeneration in the rat, we sought to determine if regeneration might be impaired in mice that lacked clusterin. We studied the impact of absent clusterin on morphogenic and functional features of regenerating pancreas. Clusterin induction was accompanied in the regenerating pancreas by a robust development of new lobules with ductules, acini, and endocrine islets in wild type after partial pancreatectomy. In clusterin knock-out mice, however, pancreatectomy resulted in a poor formation of regenerating lobule. In particular, regeneration of beta-cells was also significantly reduced and was associated with persistent hyperglycemia. Duct cells obtained from pancreatectomized clusterin knock-out mice exhibited impaired beta-cell formation in vitro; this was restored by administration of exogenous clusterin. We suggest that clusterin plays a critical role to promote both exocrine and endocrine regeneration following pancreas injury, as well as for in vitro beta-cell regeneration. PMID:21290478

  6. [Pancreas transplantation in insulin dependent diabetic patients].

    PubMed

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

    2004-12-01

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

  7. Preoperative assessment for pulmonary resection

    Microsoft Academic Search

    George G. Hallward; Brian Keogh

    2008-01-01

    Adequate preoperative assessment is important to stratify and therefore minimize the risk associated with pulmonary resection. It is a multidisciplinary process but should focus on selecting those with surgically resectable disease who will tolerate surgery with an acceptable risk. Anaesthetic assessment focuses on cardiovascular fitness and lung function, in particular evaluating the effects of resection on postoperative lung function. Predicted

  8. Sclerosing mesenteritis involving the pancreas: A mimicker of pancreatic cancer

    PubMed Central

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

    2010-01-01

    Sclerosing mesenteritis (SM), also known as mesenteric lipodystrophy, rarely involves the parenchyma of the pancreas. When sclerosing mesenteritis does involve the pancreas, it can mimic pancreatic carcinoma both clinically and radiographically with pain, obstructive jaundice, a mass lesion and even the appearance of vascular invasion. We report 6 patients with sclerosing mesenteritis involving the pancreas (mean age 43.2 years, 5 female), and review their clinical presentation, radiographic findings, pathology, and outcome. Five of these 6 patients were originally thought to have a primary pancreatic neoplasm. Initial presenting clinical information was available for each patient: all 6 reported abdominal or epigastric pain, 3 reported weight loss, and 2 reported one or more of the following: back pain, fever, abdominal bloating/distention, nausea with/without vomiting, and anorexia. The lesions formed masses with an infiltrative pattern, and all had three key histologic features: fibrosis, chronic inflammation, and fat necrosis—without a known etiology. The inflammatory infiltrate was composed of a mixture of lymphocytes, plasma cells, and scattered eosinophils. Of the five patients with post-treatment clinical information available, four had at least a partial response to treatment with steroids, tamoxifen, azathioprine, resection, or a combination of these, and 1 did not respond. A dramatic response to immunosuppressive therapy is illustrated by the case of a 46-year-old woman who presented with the presumptive diagnosis of an unresectable pancreatic cancer. Distinguishing sclerosing mesenteritis from pancreatic carcinoma is crucial to appropriate management, as patients with sclerosing mesenteritis may benefit from immunosuppressive therapy. PMID:20351487

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

    PubMed Central

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

    2013-01-01

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

  10. Mixed serous cystadenoma with mucinous cystadenoma of the pancreas.

    PubMed

    Abe, Hideki; Kimura, Wataru; Mori, Masaya; Makuuchi, Masatoshi; Yanagisawam, Akio

    2005-07-01

    We report a case of serous cystadenoma of the pancreas mixed with mucinous cystadenoma. A 65-year-old woman was admitted to our hospital for evaluation of a palpable, elastic, hard mass measuring 6 cm in diameter in the right upper quadrant of the abdomen. A diagnosis of mucinous cystadenocarcinoma of the pancreas was made, and pancreatoduodenectomy was performed. The tumor was composed of a dominant compartment of macroscopic cyst, and its thick wall was filled with numerous microscopic cysts. The light microscopy findings with hematoxylin and eosin staining, and by the periodic acid-Schiff reaction, were almost perfectly consistent with the characteristics of microcystic or glycogen-rich cystadenoma, but the apical portion of the cytoplasm of the neoplastic cells was stained with Alcian blue at pH 2.4 and by the mucicarmine method. Neoplastic cells containing epithelial acidic mucin are usually found in mucinous cystadenomas. No K-ras point mutations were detected at the sites where neoplastic cells were present, whether or not they contained epithelial acidic mucin. Pancreatic serous cystadenomas that include a mucinous-cystadenoma component are extremely rare, and the difference between serous and mucinous cystadenomas is not always distinct. PMID:15968256

  11. Early postoperative continuous glucose monitoring in pancreas transplant recipients.

    PubMed

    Mittal, Shruti; Franklin, Rachel H; Policola, Caterina; Sharples, Edward; Friend, Peter J; Gough, Stephen C L

    2015-05-01

    Continuous glucose monitoring (CGM) is used in people with type 1 diabetes to help with insulin treatment regimens. Its value in whole-organ pancreas transplantation (PT) is largely unknown. This study aimed to use CGM to assess the metabolic profile of pancreas transplant recipients in the early post-transplant period. We studied CGM data in 30 PT recipients and related findings to an early oral glucose tolerance test (OGTT). Complete data were available for 26 recipients. Seven days after a PT, normoglycaemia was present 77.9% of the time. Hypoglycaemic events (glucose <3.9 mmol/l) occurred in 10 of 26 (38.5%) of the cohort, but were infrequent (present 1.4% of the time). Hyperglycaemia (glucose >7.8 mmol/l) was present for 20.7% of the study period and correlated with a diagnosis of abnormal glucose tolerance. Whilst normoglycaemia is successfully achieved for the majority of the time after PT, hypoglycaemia can occur. Hyperglycaemia is more common and correlates well with the early postoperative OGTT, which is associated with graft failure. CGM is easier to perform and provides 24-h data that could inform clinical decision-making in patients in the postoperative period. PMID:25689138

  12. FFTF preoperational survey. Program report

    SciTech Connect

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

    1980-12-01

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

  13. Nonalcoholic fatty pancreas disease1

    PubMed Central

    Mathur, Abhishek; Marine, Megan; Lu, Debao; Swartz-Basile, Deborah A.; Saxena, Romil; Zyromski, Nicholas J.

    2007-01-01

    Background. Obesity leads to fat infiltration of multiple organs including the heart, kidneys, and liver. Under conditions of oxidative stress, fat-derived cytokines are released locally and result in an inflammatory process and organ dysfunction. In the liver, fat infiltration has been termed nonalcoholic fatty liver disease, which may lead to nonalcoholic steatohepatitis. No data are available, however, on the influence of obesity on pancreatic fat and cytokines, and nonalcoholic fatty pancreas disease (NAFPD) has not been described. Therefore, we designed a study to determine whether obesity is associated with increased pancreatic fat and cytokines. Materials and methods. Thirty C57BL/6J lean control and 30 leptin-deficient obese female mice were fed a 15% fat diet for 4 weeks. At 12 weeks of age all animals underwent total pancreatectomy. Pancreata from each strain were pooled for measurement of a) wet and dry weight, b) histologic presence of fat, c) triglycerides, free fatty acids (FFAs), cholesterol, phospholipids, and total fat, and d) interleukin (IL)-1? and tumor necrosis factor-alpha (TNF-?). Data were analyzed by Student's t test and Fisher's exact test. Results. Pancreata from obese mice were heavier (p<0.05) and had more fat histologically (p<0.05). Pancreata from obese mice had more triglycerides, FFAs, cholesterol, and total fat (p<0.05). Triglycerides represented 11% of pancreatic fat in lean mice compared with 67% of pancreatic fat in obese mice (p<0.01). Cytokines IL-1? and TNF-? also were elevated in the pancreata of obese mice (p<0.05). Conclusions. These data suggest that obese mice have 1) heavier pancreata, 2) more pancreatic fat, especially triglycerides and FFAs, and 3) increased cytokines. We conclude that obesity leads to nonalcoholic fatty pancreatic disease. PMID:18345311

  14. Blood flow in the atrophied pancreas.

    PubMed

    Weaver, F C

    1990-01-01

    Pancreatic and islet blood flow was measured by quantitative determination of microspheres within atrophied pancreases of rats rendered dietarily copper-deficient. The deficient state effects selective acinar necrosis and its replacement with non-inflammatory lipomatosis. While blood flow to lipomatous glands remained intact, it was significantly less (0.41 +/- 0.02 ml/min X g pancreas) compared to normal control glands (0.50 +/- 0.01 ml/min X g pancreas). Blood flow to islets, which remain unaffected by selective acinar atrophy of the copper-deficient state, was not significantly altered (50.8 +/- 2.13 microliters/min X g pancreas) compared to controls (55.7 +/- 2.66 microliters/min X g pancreas). The percent of islet blood flow (IBF) within atrophied glands (12.2 +/- 0.31) was found to be significantly greater than control glands (10.7 +/- 0.21). It is suggested that the maintenance of IBF and IBF percentage in the atrophic pancreas may reflect the parallel arrangement of islet angioarchitecture which based on morphological data is not appreciably altered with attenuation of acinar plexuses. Microspheres, although not quantitated, were also found distributed within the adventitia of ducts as well as in vessels supplying intrapancreatic nerves and ganglia which remain intact in copper deficiency-induced acinar atrophy. PMID:2188848

  15. Cystic neoplasms of the pancreas.

    PubMed

    Goldsmith, Jeffrey D

    2003-06-01

    Although a minority of pancreatic cystic tumors are neoplastic, proper diagnosis of these neoplasms is important owing to their varied clinical course and behavior. The clinicopathologic features of pancreatic cystic neoplasms, including mucinous cystic neoplasms, intraductal papillary mucinous neoplasms, solid pseudopapillary tumors, and serous microcystic adenomas, are discussed in this review. PMID:12951841

  16. Periampullary carcinoma in a patient with agenesis of dorsal pancreas

    PubMed Central

    Kapoor, A; Singh, RK

    2011-01-01

    Agenesis of dorsal pancreas is a rare developmental anomaly. We here report a case of agenesis of dorsal pancreas in a patient of periampullary carcinoma and highlight its implications on the management. PMID:24950505

  17. Neuroendocrine tumors of the pancreas

    Microsoft Academic Search

    Karen Davies; Kevin C. Conlon

    2009-01-01

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

  18. Glucose Sensing Issues for the Artificial Pancreas

    PubMed Central

    DeVries, J. Hans

    2008-01-01

    The first retrospective continuous glucose monitor entered the market in 1999. Now that this tool gives online data, the question arises whether it is ready to be incorporated into a closed-loop system. The author discusses the following questions: (1) Is the accuracy of current continuous glucose monitoring (CGM) systems good enough for use in a prototype artificial pancreas system?; (2) How do we assess CGM accuracy?; (3) What is the minimal distance between a continuous glucose monitor and an insulin delivery site in which a CGM can function accurately?; and (4) Does any physiological and instrumental delay associated with continuous glucose monitoring hamper the development of an artificial pancreas? PMID:19885253

  19. Serous microcystic adenoma of the pancreas.

    PubMed

    Malur, Prakash R; Suranagi, Vijayalaxmi V; Bannur, Hema B; Kulgod, Shashikant

    2009-01-01

    Serous microcystic adenoma (SMA) is a rare benign neoplasm. It accounts for 1-2% of all exocrine pancreatic tumors. It is thought to arise from the ductal epithelial cells. It is usually located in the body and the tail of the pancreas. It is important to identify SMAs and distinguish them from mucinous cystic neoplasm, which can be premalignant or malignant, and pseudocyst, which is a non neoplastic condition. We present one such rare case of SMA occurring in the head of the pancreas, an infrequent location requiring a Whippel's resection. PMID:19679977

  20. Enormous serous microcystic adenoma of the pancreas.

    PubMed

    Vernadakis, Spiridon; Kaiser, Gernot M; Christodoulou, Evangelos; Mathe, Zoltan; Troullinakis, Michail; Bankfalvi, Agnes; Paul, Andreas

    2009-01-01

    Serous microcystic adenomas or serous cystadenomas are rare and account for 1-2% of the exocrine neoplasms of the pancreas. Recently, due to the improvements in imaging techniques, they have been identified more frequently. We present the case of a patient in whom a serous microcystic adenoma, 26 cm in diameter, was found incidentally in the pancreas, the largest reported in the literature thus far. Pylorus-preserving pancreaticoduodenectomy was performed, combined with a right hemicolectomy because of the tumor localization. Despite their size, the resection of serous microcystic adenomas, even of that magnitude, is operatively efficient and should always be taken into consideration when examining therapeutic options. PMID:19454830

  1. Biochemical and ultrasonic abnormalities of the pancreas in anorexia nervosa

    Microsoft Academic Search

    Kenneth L. Cox; Robert A. Cannon; Marvin E. Ament; Harry E. Phillips; Charles B. Schaffer

    1983-01-01

    Seven of 10 patients with anorexia nervosa had ultrasonic and\\/or biochemical abnormalities of the pancreas. Seven patients had elevated amylase creatinine clearance ratios (>4%), three patients had elevated serum amylase values (>90 units\\/liter), and three patients had reduced echogenicity of the pancreas. There was no consistent association between presenting abdominal symptoms and abnormal ultrasonic and biochemical studies of the pancreas.

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

    PubMed

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

    2015-01-01

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

  3. Cell Stem Cell The Adult Mouse and Human Pancreas Contain

    E-print Network

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

  4. Expression of Sox Transcription Factors in the Developing Mouse Pancreas

    E-print Network

    Sander, Maike

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

  5. Giant retroperitoneal ancient schwannoma: Is preoperative biopsy always mandatory?

    PubMed Central

    Al Skaini, Mohammad Saad; Haroon, Hesham; Sardar, Ali; Bazeed, Mohammad; Al Zain, Abbas; Al Shahrani, Mushabab; El Hakeem, Howaida; Al Shraim, Mubarak; Al Amri, Abdul Rahman M.; Ezzedien Rabie, M.

    2014-01-01

    INTRODUCTION Schwannoma is the term given to tumours arising from Schwann cells of any nerve sheath. It may arise in the retroperitoneum, where it can attain enormous sizes and cause considerable diagnostic and therapeutic difficulties. A variety of incapacitating symptoms may arise, depending on its size alone and the related contagious organs. PRESENTATION OF CASE A 71-year-old female, who was incapacitated by a giant abdominal mass, associated with weight loss, immobility, general weakness and constipation. Radiologically, the presence of a huge pelviabdominal tumour was confirmed. A preoperative tissue diagnosis was entertained but omitted, and we resorted to direct surgical excision instead. During surgery, significant bleeding from the surrounding lumbar vessels was encountered, but it was controlled and the tumour was excised intact. Histopathologically, it showed the histologic features of ancient schwannoma. DISCUSSION In the patient presented here, who was rendered immobile by the tumour, total excision or at least debulking seemed appropriate, regardless of any biopsy result. CONCLUSION The diagnosis of retroperitoneal schwannoma and its variant “ancient schwannoma” should be considered when a huge pelviabdominal tumour is encountered. Although CT guided biopsy may be helpful in reaching a preoperative diagnosis, this might not change the decision for the need of total tumour excision or at least debulking, in the presence of incapacitating symptoms. With large tumours, the possibility of perioperative exanginating haemorrhage should be remembered and the necessary precautions activated. PMID:25553529

  6. Ultrastructure of the Pancreas of Bradypus tridactylus

    Microsoft Academic Search

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

    1981-01-01

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

  7. [Cystic lesions of the pancreas].

    PubMed

    Buerke, B; Schülke, C

    2015-02-01

    Due to the widespread use of computed tomography (CT) and magnetic resonance imaging (MRI) of the abdomen, the incidence of cystic pancreatic lesions as an incidental finding in asymptomatic patients is increasing; however, most of these lesions are less than 2 cm in size at the time of diagnosis making a correct classification difficult. A more differentiated understanding of the pathophysiology of these lesions has been developed during recent years. Technical improvements in imaging techniques have resulted in an increase in image resolution and has enabled radiologists to differentiate between intraductal papillary mucinous neoplasms (IPMN), serous cystic neoplasms (SCN) and mucinous cystic neoplasms (MCN). A correct classification, including the differentiation from malignant pancreatic tumors, can only be achieved by combining the knowledge of lesion pathophysiology and basic epidemiological data, such as age and sex distribution with modern imaging techniques. In conjunction with the correct diagnosis, the radiologist has to decide on the further management of the newly found lesion. This differs greatly depending on the biological behavior, especially the potential for malignant transformation, e.g. in main duct IPMN. This review gives an overview of the different cystic pancreatic lesions, their underlying pathophysiology and imaging characteristics along with recommendations for the further clinical management. PMID:25646005

  8. Improvement of preoperative management in patients with adrenal pheochromocytoma

    PubMed Central

    Li, Jiang; Yang, Chang-Hai

    2014-01-01

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

  9. Primary hepatic gastrinoma causing zollinger-ellison syndrome: a rare and challenging diagnosis.

    PubMed

    Harvey, Adrian; Pasieka, Janice L; Al-Bisher, Hassan; Dixon, Elijah

    2012-01-01

    The majority of gastrinomas causing Zollinger-Ellison syndrome (ZES) are located in the duodenum or the pancreas. Primary hepatic gastrinomas (PHG) are extremely rare and difficult to diagnose because the liver is the commonest site of metastatic disease and gastrinomas can be very small. Furthermore, gastrinomas are typically slow-growing thus a missed, occult primary tumour may not become evident for many years. The diagnosis of PHG is therefore dependent on a careful search for a primary and long-term biochemical follow-up following curative hepatic resection. We report a case of a 7 cm PHG in a 48 year old man with ZES. Preoperatively, both a basal and stimulated gastrin levels were elevated. Surgical exploration including intraoperative ultrasound and duodenotomy, failed to reveal a primary. Patient underwent a right hepatectomy. Yearly, gastrin and secretin stimulation tests remain normal 6 years following surgery. He remains symptom free off all medication. An additional 26 cases of PHG were found. Including this case, 21 had at least 1 year follow-up, however only eight had greater than 5 years (median 24 months). Post-op gastrin levels were reported in 25, however provocative testing was done in only 10. Persistence and recurrence occurred in one and four, respectively. PHG causing ZES is extremely rare. Although the current literature claims to include 26 additional cases of PHG, without a thorough search for the primary and long-term follow-up data including provocative testing, this diagnosis remains a challenge. PMID:24213231

  10. Predictive Value of Sonographic Features in Preoperative Evaluation of Malignant Thyroid Nodules in a Multinodular Goiter

    Microsoft Academic Search

    Artür Salmasl?o?lu; Ye?im Erbil; Cem Dural; Halim ??sever; Yersu Kapran; Selçuk Özarma?an; Serdar Tezelman

    2008-01-01

    Background  The primary goal of ultrasonography (US) in the evaluation of a thyroid nodule is to determine its malignancy, although the\\u000a diagnosis of a malignant nodule on the basis of US alone is nearly impossible. The aim of this prospective study was to evaluate\\u000a the predictive value of sonographic features in the preoperative diagnosis of malignant thyroid nodules, and to determine

  11. Preoperative diagnosis of obturator hernia by computed tomography

    Microsoft Academic Search

    Masayoshi Nishina; Chiiho Fujii; Ryukoh Ogino; Ryozoh Kobayashi; Keisuke Kumada; Kunikazu Yamane; Akitsugu Kohama

    2002-01-01

    A retrospective study of 6 patients with obturator hernia diagnosed before surgery by X-ray and computed tomography (CT) was conducted between 1993 and 2000. The initial CT of the abdomen including the pelvic area revealed incarcerated bowel in the obturator foramen of all 6 patients. All patients underwent laparotomy as soon as possible after CT scans were obtained. Resection of

  12. 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

    2014-01-01

    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. PMID:25034035

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

    PubMed

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

    2008-01-01

    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

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

    PubMed

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

    1998-01-01

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

  15. Guideline implementation: preoperative patient skin antisepsis.

    PubMed

    Cowperthwaite, Liz; Holm, Rebecca L

    2015-01-01

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

  16. [Acute diarrhea after kidney or kidney-pancreas transplantation].

    PubMed

    Carena, Alberto A; Boughen, Santiago; Gagliardi, María Inés; Galante, Mariana

    2015-01-01

    Diarrhea is a frequent and potentially severe complication of kidney transplantation. We describe here, in a cross-sectional study, the epidemiological and microbiological characteristics of acute and persistent diarrhea in 52 inpatients with kidney and kidney-pancreas transplant in a hospital in Buenos Aires, 42 (80.8%) of whom had received a kidney and 10 (19.2%) a kidney-pancreas transplant. Diarrhea was the reason of admission of 34 cases (65.4%). The etiology could be studied in 50 patients: 25 (50%) had no etiological diagnosis of diarrhea and 18 (36%) had a specific infectious etiology: 3 (6%) cytomegalovirus disease, 6 (12%) diarrhea attributed to cytomegalovirus, 5 (10%) to rotavirus and 4 (8%) to Clostridium difficile. In 7 (14%) diarrhea was attributed to drugs (mycophenolate mofetil and sirolimus). Patients with infectious diarrhea had recently received high doses of immunosuppressive therapy more frequently than the rest (p = 0.048). Those with diarrhea attributed to drugs were more frequently on mycophenolate mofetil than the rest (p = 0.039). Empirical modification of the immunosuppressive treatment was done in 16 (30.8%) and empirical antibiotic therapy was given to 47 patients (90.4%). Median length of hospital stay was 6 days. Seven patients (14.6%) persisted with diarrhea at the fifth day of admission. At hospital discharge all cases had complete resolution of symptoms and one third persisted with kidney failure. Information provided in this study can be useful as a starting point for improving preventive, diagnostic and therapeutic measures in these patients. PMID:25637897

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

    PubMed Central

    Xiao, Shu-Yuan

    2012-01-01

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

  18. Intraductal papillary mucinous neoplasm of the pancreas: an update.

    PubMed

    Xiao, Shu-Yuan

    2012-01-01

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

  19. [Pancreaticoduodenectomy for cancer of the head of the pancreas].

    PubMed

    Huguier, M; Barrier, A; Gouillat, C; Suc, B; Jaeck, D; Launois, B

    2008-01-01

    Many modifications of the original technique have been proposed to try to improve the results of the pancreaticoduodenectomy described by Whipple. To evaluate these modifications, we have reviewed randomized controlled trials, meta-analyses, and well-conducted retrospective series. Neither total pancreatectomy nor extended lymph node dissections have shown an improve of survival in retrospective studies. Preoperative evidence of mesenteric or portal vein involvement does not contraindicate pancreatic resection and survival rates are similar to those of patients with no venous involvement. Prospective trials and one meta-analysis have shown neither advantage nor disadvantage of pylorus-preserving pancreaticoduodenectomy or of pancreatico-gastric anastomosis. Three trials and one meta-analysis of pancreatico-gastric anastomosis have failed to demonstrate a decrease in the risk of pancreatic fistula. Two trials suggest that the risk of fistula formation is decreased by implantation of the pancreatic remnant into the jejunum or by trans-jejunal stenting of the pancreatico-jejunal anastomosis with external drainage; but these findings are not supported by a third trial. The results of the antisecretory use of somatostatin are contradictory. Leak and fistula formation were decreased when the criteria for leakage was based on laboratory findings; but in 4 out of 5 trials, somatostatin did not decrease the incidence of clinical fistula. The use of fibrin glue to occlude the pancreatic duct or seal the cut surface of the pancreas did not decrease the rate of intra-abdominal complications. In conclusion, the pancreaticoduodenal resection described by Whipple may still be considered the gold standard for resection of pancreatic cancer. The technical experience of surgeons and their institutional support staff resulted in lower perioperative morbidity and mortality and in higher survival rates. PMID:18438276

  20. Rare Nonneoplastic Cysts of Pancreas

    PubMed Central

    Cho, Jae Hee

    2015-01-01

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

  1. Renal Angiomyolipoma: Preoperative Identification of Atypical Fat-Poor AML.

    PubMed

    Farrell, Crystal; Noyes, Sabrina L; Tourojman, Mouafak; Lane, Brian R

    2015-03-01

    The preoperative distinction between benign and malignant renal masses is a well-known radiographic diagnostic challenge. With angiomyolipoma (AML) and renal cell carcinoma (RCC) representing the most common benign and malignant renal parenchymal lesions, respectively, differentiating these two entities is especially important due to their vastly different treatments and prognoses. Renal AML is typically composed of smooth muscle cells, dysmorphic blood vessels, and varying amounts of adipose tissue. In most cases, "typical" AML can be diagnosed by identifying macroscopic fat with ultrasound, computed tomography, or magnetic resonance imaging. However, approximately 4-5 % of AML tumors have fat that is grossly undetectable by conventional techniques, precluding a straightforward diagnosis. The overlapping radiographic features between "atypical" or "fat-poor" AML and RCC, especially in smaller (<3-4 cm) lesions, lead many patients with benign AML to undergo unnecessary surgery for suspected RCC when the diagnosis is not established beforehand. This review presents the most recent studies and developments in preoperative evaluation of fat-poor AML. PMID:25677233

  2. Porcelain gallbladder complicated with pancreas divisum.

    PubMed

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

    2006-01-01

    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

  3. Squamous cell carcinoma of the pancreas

    PubMed Central

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

    2008-01-01

    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. PMID:19079631

  4. Endoscopic ultrasound-guided fine-needle aspiration of metastases to the pancreas: A study of 25 cases

    PubMed Central

    Gilbert, Christopher M.; Monaco, Sara E.; Cooper, Scott T.; Khalbuss, Walid E.

    2011-01-01

    Background: Metastases to the pancreas are an uncommon cause of pancreatic masses seen on endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA). The purpose of this study is to retrospectively review the cytomorphology, clinical findings, and results of ancillary studies in a large series of these unusual cases. Materials and Methods: We searched our institution's pathology database for EUS-guided FNAs of the pancreas that were diagnostic of metastatic tumor over a 5-year period. The final cytologic diagnosis, results of ancillary studies, corresponding histological material, and clinical follow-up data were reviewed in these cases. Results: A total of 1172 pancreatic EUS-guided FNAs were identified, of which 25 cases (2.1%) had a confirmed diagnosis of a pancreatic metastasis. This included 12 (48%) cases of renal cell carcinoma, 3 (12%) melanomas, 3 (12%) small cell carcinomas, and 7 (28%) other malignancies. In these metastatic tumors involving the pancreas, 20 (80%) of the lesions were solitary. Four (16%) cases had no prior history of malignancy. The average time to diagnosis of pancreatic metastasis was 5.3 years. Immunohistochemistry and special stains were performed in 22 (88%) and 9 (36%) cases, respectively. Conclusions: Our data shows that although metastases to the pancreas are rare, they can present as a solitary mass many years after the primary malignancy is diagnosed and can even be the first manifestation of an extrapancreatic primary in a small number of cases. It is important to consider the possibility of a metastatic lesion in the pancreas because this may require a different management than a primary pancreatic tumor. PMID:21713016

  5. Pancreatic polypeptide cell hyperplasia of the pancreas.

    PubMed

    Albazaz, R; Da Costa, P E; Verbeke, C S

    2006-10-01

    A case of pancreatic polypeptide cell hyperplasia in a 76-year-old man who presented with subacute bowel pseudo-obstruction is reported. A computed tomography scan incidentally showed a pancreatic head lesion that was resected by pancreaticoduodenectomy. Histological examination showed expansion of the endocrine pancreas with increased numbers of pancreatic polypeptide cells in irregularly enlarged islets, ragged endocrine cell clusters, ductulo-insular complexes and microadenomas. The clinicopathological features of this rare and poorly understood condition are discussed. PMID:17021132

  6. Evolving surgical strategies for pancreas transplantation

    Microsoft Academic Search

    David B. Leeser; Stephen T. Bartlett

    2004-01-01

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

  7. Contrast-enhanced ultrasound of the pancreas

    PubMed Central

    D’Onofrio, Mirko; Gallotti, Anna; Principe, Francesco; Mucelli, Roberto Pozzi

    2010-01-01

    The introduction of contrast-enhanced ultrasonography (CEUS) has led to major improvements in the diagnostic capabilities of ultrasound (US). The innovative use of CEUS for study of the pancreas has created the need for a definition of the most frequent dynamic features of solid and cystic masses. CEUS is less expensive compared to computed tomography and magnetic resonance imaging and is able to significantly improve the accuracy of US, allowing better characterization and staging of pancreatic pathologies. PMID:21160942

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

    PubMed

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

    2014-07-01

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

  9. A case report of anaplastic carcinoma of the pancreas with remarkable intraductal tumor growth into the main pancreatic duct

    PubMed Central

    Okazaki, Mitsuyoshi; Makino, Isamu; Kitagawa, Hirohisa; Nakanuma, Shinichi; Hayashi, Hironori; Nakagawara, Hisatoshi; Miyashita, Tomoharu; Tajima, Hidehiro; Takamura, Hiroyuki; Ohta, Tetsuo

    2014-01-01

    We herein report a case of anaplastic carcinoma of the pancreas with remarkable intraductal tumor growth into the main pancreatic duct. A 76-year-old male was referred to our hospital for treatment of a pancreatic tumor. Preoperative examinations revealed a poorly defined tumor in the main pancreatic duct in the body of the pancreas, accompanied with severe dilatation of the main pancreatic duct, which was diagnosed as an intraductal papillary-mucinous neoplasm. We performed distal pancreatectomy and splenectomy. The pathological examination revealed that the tumor consisted of a mixture of anaplastic carcinoma (giant cell type) and adenocarcinoma in the pancreas. There was a papillary projecting tumor composed of anaplastic carcinoma in the dilated main pancreatic duct. The patient is now receiving chemotherapy because liver metastasis was detected 12 mo after surgery. In this case, we could observe a remarkable intraductal tumor growth into the main pancreatic duct. We also discuss the pathogenesis and characteristics of this rare tumor with specific tumor growth. PMID:24574758

  10. A case of successfully treated giardiasis in pancreas.

    PubMed

    Miyahara, T; Kubokawa, M; Koyanagi, S; Migita, Y; Oogoshi, K; Sakai, H; Ito, T; Nakano, I; Nawata, H

    1997-09-01

    We report a case of giardiasis in the pancreas in a patient with diabetes mellitus. The patient is interesting in the following: 1) Giardia lamblia was found only in the pancreas and not in the gall bladder by cytology on endoscopic retrograde cholangiopancreaticography (ERCP) and by cerulein-secretin test (CST). 2) ERCP revealed multiple small cysts scattered throughout the pancreas. 3) Decreased pancreatic exocrine function was recovered by treatment with metronidazole. PMID:9364099

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

    PubMed

    Agaimy, A

    2014-11-01

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

  12. Amyand's Hernia: A Serendipitous Diagnosis

    PubMed Central

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

    2013-01-01

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

  13. 851 resected cystic tumors of the pancreas: A 33-year experience at the Massachusetts General Hospital

    PubMed Central

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

    2013-01-01

    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.) PMID:22770958

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2011-06-15

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

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

    PubMed Central

    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

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

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

    PubMed Central

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

    2011-01-01

    Pancreas transplant recipients continue to suffer high surgical morbidity. Current robotic technology provides a unique opportunity to test whether laparoscopy can improve the post-operative course of pancreas transplantation (PT). Current knowledge on robotic pancreas and renal transplantation was reviewed to determine feasibility and safety of robotic PT. Information available from literature was included in this review, together with personal experience including three PT, and two renal allotransplants. As of April 2011, the relevant literature provides two case reports on robotic renal transplantation. The author’s experience consists of one further renal allotransplantation, two solitary PT, and one simultaneous pancreas-kidney transplantation. Information obtained at international conferences include several other renal allotransplants, but no additional PT. Preliminary data show that PT is feasible laparoscopically under robotic assistance, but raises concerns regarding the effects of increased warm ischemia time on graft viability. Indeed, during construction of vascular anastomoses, graft temperature progressively increases, since maintenance of a stable graft temperature is difficult to achieve laparoscopically. There is no proof that progressive graft warming produces actual damage to transplanted organs, unless exceedingly long. However, this important question is likely to elicit a vibrant discussion in the transplant community. PMID:21720670

  18. [A case of invasive micropapillary carcinoma of the pancreas concomitant with intraductal papillary mucinous neoplasm].

    PubMed

    Tanaka, Hiroki; Baba, Youichirou; Matsusaki, Shimpei; Isono, Yoshiaki; Sase, Tomohiro; Okano, Hiroshi; Saito, Tomonori; Mukai, Katsumi; Kaneko, Hiroshi; Watanabe, Gen

    2014-11-01

    Invasive micropapillary carcinoma (IMPC), a rare subtype of adenocarcinoma, has a high incidence of lymph node metastasis and is associated with a poor prognosis. A 77-year-old woman was admitted to our hospital for the assessment of intraductal papillary mucinous neoplasm (IPMN). We diagnosed her with pancreatic cancer concomitant with IPMN and performed pancreaticoduodenectomy. The lesion was predominantly composed of ductal adenocarcinoma with a micropapillary component. On immunohistochemical analysis, a characteristic " inside-out pattern" was observed in the micropapillary component. This confirmed the diagnosis of pancreatic cancer with a micropapillary component. In the present report, we describe a very rare case of IMPC of the pancreas. PMID:25373376

  19. CT virtual pancreatoscopy: a new method for diagnosing intraductal papillary mucinous neoplasm (IPMN) of the pancreas

    Microsoft Academic Search

    N. Sata; K. Kurihara; M. Koizumi; M. Tsukahara; K. Yoshizawa; H. Nagai

    2006-01-01

    Background  We sought to validate computed tomographic virtual pancreatoscopy (CT-VP) created by multidetector row CT (MD-CT) in the clinical\\u000a diagnosis of intraductal papillary mucinous neoplasm (IPMN) of the pancreas.\\u000a \\u000a \\u000a \\u000a Methods  Five cases of pancreatic IPMNs were included in this study. A nasopancreatic drainage tube was inserted and the pancreatic\\u000a duct was filled with contrast medium, after which an upper abdominal scan was

  20. Ultrastructure of the pancreas of Bradypus tridactylus.

    PubMed

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

    1981-01-01

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

  1. The effect of automated alerts on preoperative anemia management.

    PubMed

    Dilla, Andrew; Wisniewski, Mary Kay; Waters, Jonathan H; Triulzi, Darrell J; Yazer, Mark H

    2015-04-01

    Objectives This study evaluated the role of an automated anemia notification system that alerted providers about anemic pre-operative patients. Methods After scheduling surgery, the alert program continuously searched the patient's laboratory data for hemoglobin value(s) in the medical record. When an anemic patient according to the World Health Oganization's criteria was identified, an email was sent to the patient's surgeon, and/or assistant, and/or patient's primary care physician suggesting that the anemia be managed before surgery. Results Thirteen surgeons participated in this pilot study. In 11 months, there were 70 pre-surgery anemia alerts generated on 69 patients. The surgeries were 60 orthopedic, 7 thoracic, 2 general surgery, and 1 urological. The alerts were sent 15±10 days before surgery. No pre-operative anemia treatment could be found in 37 of 69 (54%) patients. Some form of anemia management was found in 32 of 69 (46%) patients. Of the 23 patients who received iron, only 3 of 23 (13%) of these patients started iron shortly after the alert was generated. The alert likely resulted in the postponement of one surgery for anemia correction. Discussion Although anemia diagnosis and management can be complex, it was hoped that receipt of the alert would lead to the management of all anemic patients. Alerts are only effective if they are received and read by a healthcare provider empowered to treat the patient or to make an appropriate referral. Conclusions Automated preoperative alerts alone are not likely to alter surgeons' anemia management practices. These alerts need to be part of a comprehensive anemia management strategy. PMID:25148476

  2. [Serous microcystic adenoma of the pancreas: cytologic and histologic features].

    PubMed

    Tomsová, M; Pohn?talová, D

    2003-10-01

    Cytologic and histologic features in a case of serous microcystic adenoma of the pancreas in a 61-year-old female are presented. In fine-needle aspiration materials, epithelial cells arranged singly, in small clusters and in monolayer sheets were found. The neoplastic cells had round to oval nuclei with finely distributed chromatin and inconspicuous nucleoli. Nuclear atypia and mitoses were not seen. The cytoplasm was moderately abundant and finely granular. Histologically, the encapsulated tumor was composed of multiple small cysts lined by a single layer of flat to cuboidal cells. The tumor cells contained clear cytoplasm with glycogen and centrally located round to oval nuclei with inconspicuous nucleoli without any atypia. Mitoses were absent. The intervening stromal septa were hypocellular. Immunohistochemically, the tumor cells revealed diffuse positivity of cytokeratins and epithelial membrane antigen. Proliferative antigen Ki-67 was positive only in sporadic cells. No immunoreactivity for vimentin, carcinoembryonal antigen and S-100 protein was found. Chromogranin A and synaptophysin were expressed only in Langerhans' islets in the tumor capsula. In differential diagnosis, it is important to distinguish serous microcystic adenoma mainly from lymphangioma, cavernous hemangioma, serous cystadenocarcinoma, mucinous cystadenoma or cystadenocarcinoma, solid and pseudopapillary epithelial tumour, acinar cell cystadenocarcinoma, renal cell carcinoma and mesothelioma. PMID:14663926

  3. Favorite Demonstration: Localization and Visualization of the Pancreas

    NSDL National Science Digital Library

    Angela R. Porta

    2000-03-01

    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

  4. Out of the F-box: reawakening the pancreas.

    PubMed

    Seifert, Bryce A; Xiong, Yue

    2014-08-01

    The adult pancreas lacks stem cells, and consequently, differentiation of pancreatic endocrine cells has been restricted to embryonic development or experimental manipulation. In this issue of Cell Stem Cell, Sancho et al. (2014) show that pancreas-specific loss of the ubiquitin ligase Fbxw7 stabilizes an endocrine-specific transcription factor, Ngn3, thus inducing in vivo ? cell neogenesis. PMID:25105572

  5. Evaluation of steady state free precession imaging of the pancreas

    Microsoft Academic Search

    Christoph U. Herborn; Florian M. Vogt; Thomas C. Lauenstein; Mathias Goyen; Jörg F. Debatin; Stefan G. Ruehm

    2005-01-01

    The aim of this work was to assess the diagnostic value of fast steady state free precession (SSFP) for the detection, characterization, and delineation of pancreatic lesions. Forty-eight patients referred for magnetic resonance (MR) imaging of the pancreas were included in the study. In addition to the standard protocol, axial pre-contrast SSFP slices of the pancreas were acquired. The standard

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

    Microsoft Academic Search

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

    2003-01-01

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

  7. Cardiopulmonary Exercise Capacity and Preoperative Markers of Inflammation

    PubMed Central

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

    2014-01-01

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

  8. Preoperative Serum Tumor Marker Levels in Gastric Cancer

    PubMed Central

    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

    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

  9. Lipomatosis of the pancreas. A morphometrical investigation.

    PubMed

    Schmitz-Moormann, P; Pittner, P M; Heinze, W

    1981-12-01

    The study was performed in 50 human autoptic pancreata. After postmortem ductography and formalin fixation the organs were cut in slices of 8 mm thickness. After paraffinembedding histological sections were made from these slices. In photographical magnification (20 X) of these sections the amount of adipose tissue and pancreatic parenchyma were measured by morphometric means. The length of the pancreatic duct was determined in the radiographs. The data were evaluated by statistical methods. The share of the adipose tissue and the total weight of the pancreata are positively correlated depending on age and body weight. In contrast the weight of the pancreatic parenchyma shows no correlation to age, body length and weight. The amount of lipomatosis is the same in the various parts of the dorsal pancreatic anlage. On the other hand, the amount is clearly diminished in the ventral anlage. In the lipomatous pancreata the main duct is longer than in the normal. The lipomatosis of the pancreas is not correlated with a loss of parenchyma, which means, that there is not a true lipomatous atrophy. Even if the parenchyma in the lipomatous pancreata is replaced by fat tissue, which includes the undestroyed pancreatic islets, the parenchymal weight of the pancreas remains unchanged. This and the lengthening of the pancreatic duct in lipomatous organs allow the conclusion that the loss of parenchyma may be compensated by new parenchymal growth. PMID:7335549

  10. Serous microcystic adenoma (glycogen-rich cystadenoma) of the pancreas: study of 11 cases showing clinicopathological and immunohistochemical correlations.

    PubMed

    Yasuhara, Yumiko; Sakaida, Noriko; Uemura, Yoshiko; Senzaki, Hideto; Shikata, Nobuaki; Tsubura, Airo

    2002-04-01

    Serous microcystic adenoma of the pancreas, also known as microcystic adenoma, glycogen-rich cystadenoma or serous cystadenoma, is an uncommon benign tumor. We have studied 11 cases involving eight women and three men. The average age at diagnosis was 61.7 years. Four tumors were discovered incidentally. Tumors varied from 1.2 to 20 cm in maximum diameter and all were multicystic. Within the pancreas, three were located in the pancreas head, one involved the head and body, one was located in the body, five were in the tail, and one occupied the whole pancreas. Central stellate scar was seen in five (45%) cases. Histologically, all tumors were composed of microglandular cysts lined by clear epithelial cells rich in glycogen, which were separated by fibrocollagenous stroma. The expression of keratin in clear epithelial cells resembled that in ductal and/or centroacinar cells, but not acinar cells. alpha-Smooth muscle actin (SMA)-positive myoepithelial cells and stromal amyloid deposits were not detected. Ultrastructurally, fibrocollagenous stroma was composed of alpha-SMA-positive myofibroblasts and endothelial cells embedded in thick collagen bundles. Regardless of female propensity, estrogen and progesterone receptors were not detected. Therefore, female predominance in this tumor remains to be elucidated. PMID:12031087

  11. Routine preoperative medical testing for cataract surgery

    PubMed Central

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

    2012-01-01

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

  12. Routine preoperative medical testing for cataract surgery

    PubMed Central

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

    2014-01-01

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

  13. Preoperative patient education in thoracic surgery.

    PubMed

    Whyte, Richard I; Grant, Patricia D

    2005-05-01

    Preoperative patient teaching may take many forms and is offered to patients across many venues and formats. The goal of patient teaching is to improve patients' understanding of their disease process and the operation that they are about to experience with the goal of enlisting their active participation in the healing process. The additional goal of obtaining informed consent is not only codified in law, but also has become an ingrained component to the current physician-patient relationship. The preoperative teaching process is best approached as a team effort, and multiple modalities often must be used so that the patient becomes a knowledgeable and willing member of the team. PMID:15999517

  14. The monocarboxylate transporters exist in the cattle endocrine pancreas.

    PubMed

    Kirat, Doaa; Kato, Seiyu

    2015-02-01

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

  15. Hippo Signaling Regulates Pancreas Development through Inactivation of Yap

    PubMed Central

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

    2012-01-01

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

  16. Regeneration and repair of the exocrine pancreas.

    PubMed

    Murtaugh, L Charles; Keefe, Matthew D

    2015-02-10

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

  17. Serous cystadenocarcinoma of the pancreas with liver metastases.

    PubMed

    Eriguchi, N; Aoyagi, S; Nakayama, T; Hara, M; Miyazaki, T; Kutami, R; Jimi, A

    1998-01-01

    Serous cystadenocarcinoma of the pancreas is a rare entity. We report a primary tumor of the pancreas in a 56-year-old woman that was histologically indistinguishable from microcystic adenoma, but which behaved in a malignant fashion. Metastatic lesions were found in the liver at the time of the initial operation. Nine years after the initial operation, new metastatic liver nodules were found, and the histologic characteristics of these lesions were quite similar to those of the pancreatic neoplasm. This is a very rare case which may support the existence of the entity, serous cystadenocarcinoma of the pancreas. PMID:9931400

  18. Control of Cell Identity in Pancreas Development and Regeneration

    PubMed Central

    Stanger, Ben Z.; Hebrok, Matthias

    2013-01-01

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

  19. Metabolic signatures of malignant and non-malignant mass-forming lesions in the periampulla and pancreas in FDG PET/CT scan: an atlas with pathologic correlation.

    PubMed

    Santhosh, Sampath; Mittal, Bhagwant Rai; Rana, Surinder Singh; Srinivasan, Radhika; Bhattacharya, Anish; Das, Ashim; Bhasin, Deepak

    2014-10-01

    Positron emission tomography (PET) has been used for the characterization of pancreatic and periampullary lesions. Pancreatitis-associated inflammation affecting only a portion of the pancreas gives the appearance of a mass lesion on imaging. Consequently, the differential diagnosis between cancer and pancreatitis becomes a commonly encountered problem. Traditionally, PET was interpreted as positive (to denote malignancy) if fluorodeoxyglucose (FDG) activity in the pancreas exceeded background activity and as negative (to denote benign) if activity was less than or equal to background activity. However, the specificity was limited with this method of interpretation. A relatively wide overlap has been reported between semiquantitative uptake values obtained in cancers and those in inflammatory lesions. Also, the qualitative (metabolic patterns) and quantitative variables (standardized uptake values) have been complementary and at sometimes controversial to each other in various clinical situations. There is paucity of data in the literature highlighting the role of FDG PET/CT in characterization of such mass lesions. The primary aim of this pictorial review is to list the various pathologic processes of pancreas and periampulla that could be studied with FDG PET/CT and recognize the different FDG uptake patterns and apply this information to characterize the different lesions affecting the pancreas and periampulla. We have also discussed the limitations of conventional imaging and advantages of FDG PET/CT for the evaluation mass-forming lesions of the pancreas and periampulla. PMID:25296997

  20. Preoperative Evaluation of Complex Laparoscopic Patients

    Microsoft Academic Search

    Dmitry Oleynikov; Karen D. Horvath IV

    Complex laparoscopic patients require careful preoperative planning for optimal outcome. These patients present unique problems that necessitate special consideration and a surgeon experienced in basic laparoscopic cases. This chapter discusses a number of such patient groups, including patients with previous abdominal surgery, significant cardiopulmonary comorbidity, obesity, and pregnancy. When evaluating any of these patients, six questions should be asked: 1.

  1. Preoperational test report, primary ventilation system

    SciTech Connect

    Clifton, F.T.

    1997-11-04

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

  2. PREDICTIVE SURGICAL SIMULATION FOR PREOPERATIVE PLANNING OF

    E-print Network

    Leow, Wee Kheng

    PREDICTIVE SURGICAL SIMULATION FOR PREOPERATIVE PLANNING OF COMPLEX CARDIOVASCULAR SURGERIES LI PLANNING OF COMPLEX CARDIOVASCULAR SURGERIES LI, HAO (HT050623N) (B.Sc., Fudan University, China, 2005. Leow involved me in the project of cardiovascular surgery simulation in the first place. He taught me

  3. Preoperative Surgical Planning Using Virtual Laparoscopic Camera

    E-print Network

    Zhukov, Leonid

    Preoperative Surgical Planning Using Virtual Laparoscopic Camera Dmitry Oleynikov, M.D Leonid require the surgeon to operate based on a 2-dimensional (2D) image visible through the laparoscopic camera. The objective of this study is to generate a 3D laparoscopic simulation of peri- toneal surface anatomy based

  4. Preoperative considerations and creation of normal ostomies.

    PubMed

    Brand, Marc I; Dujovny, Nadav

    2008-02-01

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

  5. National trends in resection of the distal pancreas

    PubMed Central

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

    2012-01-01

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

  6. Computed tomographic diagnosis of obturator foramen hernia

    Microsoft Academic Search

    Moulay A. Meziane; Elliot K. Fishman; Stanley S. Siegelman

    1983-01-01

    Computed tomography was performed on a patient presenting with cryptic small bowel obstruction. A correct preoperative diagnosis of obturator foramen hernia was arrived at based on the recognition of a loop of ileum protruding between the pectineus and external obturator muscles.

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

    PubMed

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

    2008-02-01

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

  8. Testosterone biotransformation by the isolated perfused canine pancreas

    SciTech Connect

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

    1991-01-01

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

  9. [Cholestatic jaundice complicating lipomatous pseudo-hypertrophy of the pancreas].

    PubMed

    Henkinbrant, A; Khalek, W; Farchakh, E; Henry, M

    1990-01-01

    The authors describe a major pancreatic lipomatous infiltration, causing a "pseudo-hypertrophy" of the pancreas, in a 70-year-old man. This lesion was responsible of a hyperechogenic area at ultrasonography and of an empty pancreatic bed ("vanishing pancreas") at computed tomography, suggesting lipomatosis. This entity is a special modality of senescence of pancreatic tissue whose origin remains obscure. The progressive atrophy of the acinar lobules and the islets of Langerhans was finally responsible of a mild degree of malabsorption and of diabetes type II. The compression of the main bile duct by the enlarged lipomatous pancreas, demonstrated by percutaneous cholangiography, caused a cholestatic jaundice with abdominal pain, which was treated by a surgical derivation (hepatico-duodenostomy). This is the first description of a lipomatous pseudohypertrophy of the pancreas causing an obstruction of the common bile duct. PMID:2077797

  10. En bloc simultaneous pancreas and kidney allotransplantation in the pig.

    PubMed

    Gruessner, R W; Tzardis, P J; Schechner, R; Heil, J; Matas, A J; Najarian, J S; Sutherland, D E

    1990-10-01

    The pig is a large animal suitable for experimental pancreas transplantation due to its anatomy and transplant immunology, both of which are similar to humans. We established a model of en bloc simultaneous pancreas and kidney transplantation that decreases preservation time, operation time, and clamp time. The donor aorta--with celiac axis, superior mesenteric artery, and left renal artery--is anastomosed en bloc to the recipient's aorta in a side-to-oblique fashion. The portal vein is anastomosed end-to-side to the distal vena cava, and the left renal vein end-to-side to the left common iliac vein. The donor duodenum is anastomosed to the bladder to allow monitoring of the urinary amylase for rejection. En bloc transplantation is preferable for separating pancreas and kidney anastomoses in pigs. This technique could be used in humans, especially in adult uremic diabetic patients who receive a combined pancreas/kidney transplant from a pediatric cadaver donor. PMID:2214748

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

    SciTech Connect

    Weller, R.E.

    1994-03-01

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

  12. Endovascular Management of Acute Enteric Bleeding from Pancreas Transplant

    SciTech Connect

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

    2007-04-15

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

  13. Preoperative glucose abnormalities in patients with pancreatic tumours

    PubMed Central

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

    2014-01-01

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

  14. Interpretation of Preoperative CardioRespiratory Function Tests

    Microsoft Academic Search

    Andrew Cohen; Alain Vuylsteke

    2003-01-01

    Preoperative cardio-respiratory tests aim to identify patients with increased perioperative risk, enabling clinicians to assign optimal preoperative treatment, anaesthetic management and intraoperative monitoring techniques, and assess the need for postoperative ‘high dependency’ or intensive care. Such evaluation is based on a history and examination supplemented by appropriate clinical tests. One must distinguish patients who require little or no preoperative testing

  15. Preoperative cognitive impairment and psychological distress in hospitalized elderly hip fracture patients.

    PubMed

    Daniels, Alan H; Daiello, Lori A; Lareau, Craig R; Robidoux, Kathryn A; Luo, Wylie; Ott, Brian; Hayda, Roman A; Born, Christopher T

    2014-07-01

    We conducted a prospective study to evaluate the prevalence of cognitive impairment (CI) in elderly inpatients awaiting surgery for hip fracture, and to compare CI and normal cognition (NC) patients with respect to preoperative pain, fear, and anxiety. The study included patients who were older than 65 years when admitted to a hospital after acute hip fracture. Preoperative assessment involved use of Confusion Assessment Method-Short Form, Montreal Cognitive Assessment (MoCA), visual analog scales for anxiety and fear, and Wong-Baker Faces Pain Scale. Patients with delirium were excluded from the study. Patients with CI and NC, as determined by MoCA score, were compared for each assessment. Of the 65 hip fracture patients enrolled, 62 had evaluable cognitive data. Of these 62 patients, 23 (37.1%) had NC (MoCA score, ? 23) and 39 (62.9%) had CI (MoCA score, < 23). Only 5 (7.7%) of the 65 patients had a documented diagnosis of CI or dementia at time of hospitalization. Mean preoperative pain scores were significantly (P < .001) higher for CI patients (5.3) than for NC patients (2.8). Our study results showed that many elderly hip fracture patients had unrecognized CI before surgery, and CI patients had significantly more pain than NC patients did. Appropriate identification of preoperative CI and treatment of pain are crucial in optimizing patient outcomes. PMID:25046191

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

    PubMed Central

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

    2015-01-01

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

  17. Diagnosis of pancreatitis in dogs and cats.

    PubMed

    Xenoulis, P G

    2015-01-01

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

  18. Pancreas-preserving biliary amputation with pancreatic diversion: a new surgical technique for complete resection of the intrapancreatic biliary system.

    PubMed

    Kondo, Satoshi; Hirano, Satoshi; Ambo, Yoshiyasu; Tanaka, Eiichi; Morikawa, Toshiaki; Okushiba, Shunichi; Katoh, Hiroyuki

    2004-01-01

    Pancreatoduodenectomy is not optimal for organ preservation in patients with mucosal carcinoma of the choledochus. When the lesion spreads near the papilla of Vater, pancreas-preserving biliary amputation may be indicated to achieve complete resection of the biliary system. The first successful case is reported here with technical considerations. First, the pancreatic neck was divided and a tube was inserted into the main pancreatic duct beyond the papilla. The choledochus was dissected downward with division of the posterior pancreatoduodenal vessels. The main pancreatic duct was isolated with the aid of palpation of the tube, and was then ligated and divided. Subsequent dissection was performed to the level of the duodenal mucosa, which was incised circularly. The duodenal defect was then closed. The elevated jejunum was interposed between the pancreatic stumps and bilateral pancreaticojejunostomies were created. The procedure was successfully performed in a patient with superficially spreading cholangiocarcinoma. Postoperative bile leak and pancreatic fistula were controlled with medical management. The patient is currently well without tumor recurrence 19 months after surgery. Her glucose tolerance, which was moderately impaired preoperatively, has been maintained. Pancreas-preserving biliary amputation has been developed as an organ-preserving procedure alternative to pancreatoduodenectomy. Indications, methods of pancreatic reconstruction, and long-term results require further study. PMID:15362726

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

    SciTech Connect

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

    2009-03-15

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

  20. Perineovulvovaginal preoperative preparation in minor gynecological surgery.

    PubMed

    Adeleye, J A

    1976-09-01

    Fifty consecutive patients underwent minor elective gynecologic surgery. Most of them were from the low socioeconomic class. Twenty-five patients had their pubic, vulval and perineal hair shaved as part of the preoperative preparation. All patients underwent the same routine perineal, vulval and vaginal swabbing in the operating room. All patients were then examined for postoperative complications. Only two women (who were shaved) complained of mild lower abdominal pain 48 hours after operation, but neither had any clinical evidence of genital or urinary infection. Their symptoms disappeared with the use of analgesics. Even in developing countries where patients with poor personal hygiene are common, preoperative vulval, pubic and perineal hair shaving prior to minor gynecologic surgery is unnecessary. We suggest that this procedure should be discontinued. PMID:965183

  1. High precision innovative micropump for artificial pancreas

    NASA Astrophysics Data System (ADS)

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

    2014-03-01

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

  2. Epidemiology of pancreas cancer in Los Angeles

    SciTech Connect

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

    1981-03-15

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

  3. [Pancreas and biliary tract: recent developments].

    PubMed

    de-Madaria, Enrique

    2014-09-01

    Acute pancreatitis (AP) is a common disease that is associated with significant morbidity and considerable mortality. In this article, developments relating to this disease that were presented in DDW 2014 are reviewed. Pancreatic steatosis could be a cause of recurrent AP. Patients with DM have an increased incidence of AP and pancreatic cancer. The use of anti-TNF drugs in inflammatory bowel disease may protect against the occurrence of AP. The presence of pancreas divisum protects against acute biliary pancreatitis. The PANCODE system for describing local complications of AP has good interobserver agreement, when the new definitions of the revised Atlanta classification are applied. The use of prophylactic antibiotics in early-stage AP predisposes the development of intra-abdominal fungal infections. Fluid sequestration in AP is linked with young age, alcoholism and indicators of systemic inflammatory response syndrome. The most common cause of mortality in AP is early onset of multiple organ failure, not pancreatic necrosis infection. Patients with AP and vitamin D deficiency could benefit from taking vitamin D supplements. Moderate fluid administration in emergencies (500-1000 mL) could be associated with better AP development. PMID:25294273

  4. Approach to cystic lesions of the pancreas.

    PubMed

    Schmid, Roland M; Siveke, Jens T

    2014-02-01

    Cystic lesions of the pancreas are detected more frequently due to the improvement of imaging technologies. Their prevalence increases with age. In 95?% of cases, the spectrum of cystic neoplasia includes intraductal papillary mucinous neoplasia (IPMN), mucinous cystic neoplasia (MCN), serous cystic neoplasia, and solid pseudopapillary neoplasia (SPN). Diagnostic procedures aim to distinguish between neoplastic cystic and non-neoplastic cystic lesions as well as serous and mucinous lesions because of their different malignant potential. In most cases,cystic lesions are detected incidentally by computed tomography and magnetic resonance imaging (MRI) performed for other reasons. In our opinion, MRI/magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS) are complementary diagnostic procedures. In doubtful cases, cyst fluid analysis might be performed. The most frequent lesions are IPMNs. MRI/MRCP allows the detection of the number of cystic lesions, the relation to the main pancreatic duct, and the size of the lesion. EUS is superior to evaluate mural nodules. The relation to the main pancreatic duct can more easily appreciated with secretin MRI, MCN, SPN as well as main-duct type IPMN and BD-IPMN with "high-risk stigmata" for malignancy should be resected. Asymptomatic BD-IPMN without mural nodules, no main duct involvement, and a size less than 30 mm can be followed with a watchful waiting strategy. PMID:24254128

  5. Optimizing preoperative imaging in primary hyperparathyroidism

    Microsoft Academic Search

    Lutz S. Freudenberg; Andrea Frilling; Sien-Yi Sheu; Rainer Görges

    2006-01-01

    Background  Scintigraphy of the hyperfunctioning parathyroid glands using technetium 99m (99mTc)-methoxyisobutylisonitrile (99mTc-MIBI) is an established and highly sensitive preoperative localization tool whose importance has been further increased by advances in minimally invasive surgery .The goal of the present prospective study was to determine the benefit of optimized imaging in a consistent patient population.Methods  Eighty-four patients with first presentations of primary hyperparathyroidism were

  6. [Analyzing and tracking preoperative and intraoperative astigmatism].

    PubMed

    Perez, M

    2012-03-01

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

  7. Preoperative hyperthermochemoradiotherapy for patients with rectal cancer.

    PubMed

    Mori, M; Sugimachi, K; Matsuda, H; Ohno, S; Inoue, T; Nagamatsu, M; Kuwano, H

    1989-04-01

    Preoperative hyperthermochemoradiotherapy (HCR therapy), consists of a combination of hyperthermia at 42 to 45 degrees C for 40 minutes (2 times per week for two weeks), 5-fluorouracil (5-FU) intravenously (total, 1000 to 1750 mg), and a total of 30 Gy irradiation. The therapy was prescribed preoperatively most recently for 11 patients with rectal cancer. The authors used a radiofrequency system involving an endotract electrode with thermosensors for the hyperthermia. The effectiveness of preoperative HCR therapy was evaluated by irrigography, fiberscopy, and histopathologic findings in the resected specimens. Reduction in tumor size and amount was evident in all patients, with all modes of assessment. Histologically, no or only a few viable cancer cells were seen in the resected specimens in six patients, a small number of viable cancer cells in three, and a fair number of viable cancer cells in two patients; there were no complications. This method of treatment is expected to play an important role in the interdisciplinary treatment for rectal cancer. PMID:2924671

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

    PubMed Central

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

    2011-01-01

    Background. Acinar cell carcinoma (ACC) of the pancreas is a rare neoplasm, accounting for 1% of all pancreatic neoplasms. There remains a lack of data regarding the use of systemic therapy in this disease. We present a series of 40 consecutive cases of ACC of the pancreas treated at Memorial Sloan-Kettering Cancer Center, with an emphasis on evaluation of activity of new therapeutic agents. Methods. Patients reviewed at our institution from January 2000 through January 2011 were identified from an institutional database with prior institutional review board approval. Pathology was confirmed in all cases as ACC or a closely related entity. Results. Forty patients were identified; 29 were male (73%). The median age at diagnosis was 65 years (range, 16–87 years). The median overall survival (OS) time for patients with localized, resectable disease was 56.9 months and the OS time for patients with metastatic ACC (n = 18) was 19.6 months. Six patients with metastatic or recurrent ACC had a partial response to chemotherapy and five patients had stable disease for ?6 months on systemic chemotherapy. Clinical observation was made of a patient with ACC and hereditary nonpolyposis colorectal cancer and a patient with ACC and a BRCA1 germline mutation. Conclusions. ACC is moderately chemoresponsive to agents that have activity in pancreatic adenocarcinoma and colorectal carcinoma. A potential association between germline mutations in DNA mismatch repair genes and ACC warrants further evaluation. PMID:22042785

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

    PubMed Central

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

    2014-01-01

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

  10. Frey operation for chronic pancreatitis associated with pancreas divisum: case report and review of the literature

    PubMed Central

    Skórzewska, Magdalena; Romanowicz, Tomasz; Mielko, Jerzy; Kurylcio, Andrzej; Pertkiewicz, Jan; Zymon, Robert

    2014-01-01

    Pancreas divisum (PD) is the most common congenital anomaly of the pancreas, which increases susceptibility to recurrent pancreatitis. Usually, after failure of initial endoscopic therapies, surgical treatment combining pancreatic resection or drainage is used. The Frey procedure is used for chronic pancreatitis, but it has not been reported to be applied in an adult patient with PD-associated pancreatitis. The purpose of the paper was to describe effective treatment of this rare condition by the Frey procedure after failure of interventional endoscopic treatment. A 39-year-old female patient was initially treated for recurrent acute pancreatitis. After endoscopic diagnosis of PD, the minor duodenal papilla was incised and a plastic stent was inserted into the dorsal pancreatic duct. During the following 36 months, the patient was hospitalised several times because of recurrent episodes of pancreatitis. Thereafter, local resection of the pancreatic head combined with lateral pancreaticojejunostomy was performed with no complications. After 54 months of follow-up, the patient demonstrates abnormal glucose metabolism, with a need for enzyme supplementation, and she is free of pain. Local resection of the pancreatic head combined with lateral pancreaticojejunostomy (Frey procedure) offers a favourable outcome after failure of endoscopic papillotomy and duct stenting for pancreatitis associated with PD. PMID:25097717

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

    PubMed

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

    2014-10-16

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed

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

    2013-06-27

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

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

    PubMed

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

    2014-04-01

    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

  16. Rare pancreas tumor mimicking adenocarcinoma: Extramedullary plasmacytoma.

    PubMed

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

    2014-03-16

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

  17. Rare pancreas tumor mimicking adenocarcinoma: Extramedullary plasmacytoma

    PubMed Central

    Akyuz, Filiz; ?ahin, Davut; Akyuz, Umit; Vatansever, Sezai

    2014-01-01

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

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

    PubMed Central

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

    1999-01-01

    Objective To determine whether preoperative biliary instrumentation and preoperative biliary drainage are associated with increased morbidity and mortality rates after pancreaticoduodenectomy. Summary Background Data Pancreaticoduodenectomy is accompanied by a considerable rate of postoperative complications and potential death. Controversy exists regarding the impact of preoperative biliary instrumentation and preoperative biliary drainage on morbidity and mortality rates after pancreaticoduodenectomy. Methods Two hundred forty consecutive cases of pancreaticoduodenectomy performed between January 1994 and January 1997 were analyzed. Multiple preoperative, intraoperative, and postoperative variables were examined. Pearson chi square analysis or Fisher’s exact test, when appropriate, was used for univariate comparison of all variables. Logistic regression was used for multivariate analysis. Results One hundred seventy-five patients (73%) underwent preoperative biliary instrumentation (endoscopic, percutaneous, or surgical instrumentation). One hundred twenty-six patients (53%) underwent preoperative biliary drainage (endoscopic stents, percutaneous drains/stents, or surgical drainage). The overall postoperative morbidity rate after pancreaticoduodenectomy was 48% (114/240). Infectious complications occurred in 34% (81/240) of patients. Intraabdominal abscess occurred in 14% (33/240) of patients. The postoperative mortality rate was 5% (12/240). Preoperative biliary drainage was determined to be the only statistically significant variable associated with complications (p = 0.025), infectious complications (p = 0.014), intraabdominal abscess (p = 0.022), and postoperative death (p = 0.037). Preoperative biliary instrumentation alone was not associated with complications, infectious complications, intraabdominal abscess, or postoperative death. Conclusions Preoperative biliary drainage, but not preoperative biliary instrumentation alone, is associated with increased morbidity and mortality rates in patients undergoing pancreaticoduodenectomy. This suggests that preoperative biliary drainage should be avoided whenever possible in patients with potentially resectable pancreatic and peripancreatic lesions. Such a change in current preoperative management may improve patient outcome after pancreaticoduodenectomy. PMID:10450725

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

    PubMed Central

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

    2012-01-01

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

  20. Synchronous primary epithelial tumors of the pancreas

    PubMed Central

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

    2012-01-01

    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. PMID:22705936

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

    PubMed

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

    2014-07-17

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

  2. Ectopic Pancreas in the Stomach Successfully Resected by Endoscopic Submucosal Dissection

    PubMed Central

    Tsuzuki, Takao; Ohya, Shogen; Okada, Hiroyuki; Tanaka, Takehiro; Hori, Keisuke; Kita, Masahide; Kawano, Seiji; Kawahara, Yoshiro; Yamamoto, Kazuhide

    2015-01-01

    A 32-year-old Japanese man presented with a gastric submucosal tumor. Esophagogastroduodenoscopy showed a sessile submucosal tumor measuring approximately 10?mm in diameter on the greater curvature of the gastric antrum. Endoscopic ultrasonography examination revealed a solid tumor with a diameter of 11.8?mm, which was located in the deep mucosal and submucosal layers. The internal echogenicity was homogenous and hypoechoic. Biopsy examinations were performed twice but were not diagnostic since only the intact mucosal layer was obtained. The patient was subsequently diagnosed with ectopic pancreas in the stomach by endoscopic submucosal dissection (ESD). This case underscores the usefulness of the ESD technique for the pathological diagnosis of gastric submucosal tumors.

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

    SciTech Connect

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

    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.

  4. [Preoperative and postoperative management of adrenal masses].

    PubMed

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

    2010-01-01

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

  5. Experience with 53 portal-duodenal drained solitary pancreas transplants.

    PubMed

    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

    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

  6. Type 2 diabetes: is pancreas transplantation an option?

    PubMed

    Ciancio, Gaetano; Burke, George W

    2014-11-01

    Transplantation of the whole vascularized pancreas can provide insulin secretion in patients with insulin-dependent, type 1 diabetes mellitus (T1D). It restores euglycemia in most patients, with the potential to impact the chronic diabetic complications and quality of life. Pancreas transplantation (PT) is presently controversial for type 2 diabetes mellitus (T2D). For those patients with severe glycemic dysregulation, T2D can be associated with the same life-threatening sequelae as T1D such as severe hypoglycemia and kidney failure that could be corrected by pancreas (and kidney) transplantation. Thus, clinical indications and patient selection criteria are very important. This chapter will review the current status of PT for T2D and discuss the options and evolution of transplant perspectives. PMID:25189435

  7. Pleiotropic Roles of PDX-1 in the Pancreas

    PubMed Central

    Kaneto, Hideaki; Miyatsuka, Takeshi; Kawamori, Dan; Matsuoka, Taka-aki

    2007-01-01

    It is well known that pancreatic and duodenal homeobox factor-1 (PDX-1) plays a pleiotropic role in the pancreas. In the developing pancreas, PDX-1 is involved in both pancreas formation and ?-cell differentiation. In mature ?-cells, PDX-1 transactivates insulin and other ?-cell-related genes such as GLUT2 and glucokinase. Furthermore, PDX-1 plays an important role in the induction of insulin-producing cells in various non-?-cells and is thereby a possible therapeutic target for diabetes. On the other hand, under diabetic conditions, expression and/or activity of PDX-1 in ?-cells is reduced, which leads to suppression of insulin biosynthesis and secretion. It is likely that PDX-1 inactivation explains, at least in part, the molecular mechanism for ?-cell glucose toxicity found in diabetes. PMID:18338074

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

    EPA Science Inventory

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

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

    E-print Network

    Paris-Sud XI, Université de

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

  10. Preoperative imaging for staging bladder cancer.

    PubMed

    McKibben, Maxim J; Woods, Michael E

    2015-04-01

    Accurate preoperative staging of bladder cancer is essential in determining the extent of disease and optimal treatment. The current gold standard of transurethral resection of bladder tumor (TURBT) followed by computed tomography (CT) imaging provides excellent staging specificity, but often understages the disease, leading to pathologic upstaging and adverse outcomes in patients undergoing radical cystectomy. Newer imaging modalities, such as multiparametric magnetic resonance (MR) imaging and positron emission tomography (PET) combined with CT or MR provides promising imaging alternatives which may improve accuracy of staging both local and distant disease. PMID:25724433

  11. Organophosphate increases the sensitivity of human exocrine pancreas to acetylcholine.

    PubMed

    Kandalaft, K; Liu, S; Manivel, C; Borner, J W; Dressel, T D; Sutherland, D E; Goodale, R L

    1991-07-01

    Human pancreas contains two cholinesterase isoenzymes: acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE). In the present study, binding potency of two organophosphates for human cholinesterases were compared by the Ellman method. Echothiophate was found to have much greater potency than iso-OMPA for both cholinesterases. Using Karnovsky histochemical stains on human pancreatic tissue, the same results were confirmed. Dose-response studies with acetylcholine were done on viable pancreas fragments from nine human donors, without pancreatic disease (group I). Cold-preservation time was less than 30 h. Pancreas was minced into fragments, after the technique of Scheele and Palade, placed in Eagle's medium, and gassed with O2. Amylase release was measured by the Phadebas Method and corrected for basal release. There was a dose-dependent response to acetylcholine at 1 and 2 h, with a shift in peak amylase release to the left, when fragments were preincubated in 10(-4) M echothiophate. This indicated a 100-fold increase in sensitivity to acetylcholine. In three patients with chronic pancreatitis (Group II), there were variable patterns of response of amylase release to acetylcholine, and higher basal outputs. In Group III, prolonged storage conditions of over 40 h were tested for 4 pancreas donor tissues. There was no response to acetylcholine. These studies show that for up to 30 h cold storage, fragments of pancreas from human organ donors respond to acetylcholine in dose-dependent manner. An organophosphate, echothiophate (10(-4) M) which inhibits both cholinesterases, increases pancreatic sensitivity to acetylcholine, and these results are similar to findings from canine pancreas fragments, which also showed increased sensitivity. PMID:1715083

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

    NASA Astrophysics Data System (ADS)

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

    2013-03-01

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

  13. Multivariable adaptive identification and control for artificial pancreas systems.

    PubMed

    Turksoy, Kamuran; Quinn, Laurie; Littlejohn, Elizabeth; Cinar, Ali

    2014-03-01

    A constrained weighted recursive least squares method is proposed to provide recursive models with guaranteed stability and better performance than models based on regular identification methods in predicting the variations of blood glucose concentration in patients with Type 1 Diabetes. Use of physiological information from a sports armband improves glucose concentration prediction and enables earlier recognition of the effects of physical activity on glucose concentration. Generalized predictive controllers (GPC) based on these recursive models are developed. The performance of GPC for artificial pancreas systems is illustrated by simulations with UVa-Padova simulator and clinical studies. The controllers developed are good candidates for artificial pancreas systems with no announcements from patients. PMID:24557689

  14. [Four years of simultaneous pancreas-kidney transplantations in Finland].

    PubMed

    Lempinen, Marko; Nordin, Arno; Ortiz, Fernanda; Koskinen, Petri; Ekstrand, Agneta

    2014-01-01

    The first simultaneous pancreas-kidney transplantation in Finland was performed in 2010. On a global scale, already more than 45,000 pancreatic transplantations have been performed. Pancreatic transplantation restores the blood glucose level to normal, but only at the cost of possible adverse effects due to surgery and anti-rejection drugs. Based on our experience with 24 patients, this operation has met the expectations and shown that simultaneous pancreas-kidney transplantation is a good alternative for selected type 1 diabetics instead of mere kidney transplantation. In the future we aim to conduct approximately 15 combined transplantations per year. PMID:25558605

  15. Preoperative recombinant human erythropoietin in anemic surgical patients

    Microsoft Academic Search

    Terri G Monk

    2004-01-01

    Preoperative anemia in a surgical patient predisposes to poor outcomes and allogeneic blood transfusions. As an alternative to transfusions, pharmacologic management of preoperative anemia with recombinant human erythropoietin (rHuEPO) has been well studied in many different types of surgery. rHuEPO, when used alone or in combination with preoperative autologous blood donation before elective surgery, stimulates erythropoiesis and helps to avoid

  16. Simulation for Preoperative Planning and Intraoperative Application of Titanium Implants

    Microsoft Academic Search

    Oliver Schorr; Jörg Raczkowsky; Heinz Wörn

    2003-01-01

    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

  17. Preoperative and intraoperative localisation of gastrointestinal bleeding of obscure origin

    Microsoft Academic Search

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

    1987-01-01

    In the past six years, 37 patients with gastrointestinal bleeding of obscure origin had their bleeding sites localised preoperatively or intraoperatively. Preoperative investigations followed a regime consisting of endoscopy, barium meal and follow through, small bowel enema, 99mTc pertechnetate scan, 99mTc-labelled red blood cell scan and selective coeliac and mesenteric angiography. Bleeding lesions were localised preoperatively in 36 patients. In

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

    PubMed

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

    2011-11-01

    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

  19. Solid pseudopapillary tumor of the pancreas in a patient with cervical cancer: relation of E-cadherin/?-catenin adhesion complex in their carcinogenesis.

    PubMed

    Vijay, Adarsh; Ram, Lakshmi; Mathew, Renol Koshy; Chawdhery, Muhammad Zafar

    2015-01-01

    Solid pseudopapillary tumor (SPT) of the pancreas is one of the most uncommon histotypes of all exocrine pancreatic neoplasms. Disorganization of E-cadherin and ?-catenin mutations, two key components of the Wnt signal transduction pathway, has been implicated in the development of SPT, but not other pancreatic tumors. Loss of E-cadherin/?-catenin proteins and tyrosine phosphorylation of E-cadherin/?-catenin have been postulated in cervical carcinogenesis and cancer invasion. A 38-year-old married woman, who had undergone brachytherapy, radiotherapy and chemotherapy for cervical cancer in Philippines in 2011, was admitted to our hospital after follow-up CT scan of abdomen in 2012 revealed a lesion in the tail of pancreas. The patient underwent distal pancreatectomy and splenectomy. The pathological diagnosis was SPT of pancreas. We suspect that the concurrent SPT pancreas and cervical cancer in this woman were triggered by a primary insult, a process in which E-cadherin/?-catenin/Wnt-signaling pathway played important roles. PMID:25848087

  20. Solid pseudopapillary tumor of the pancreas in a patient with cervical cancer: relation of E-cadherin/?-catenin adhesion complex in their carcinogenesis

    PubMed Central

    Vijay, Adarsh; Ram, Lakshmi; Mathew, Renol Koshy; Chawdhery, Muhammad Zafar

    2015-01-01

    Solid pseudopapillary tumor (SPT) of the pancreas is one of the most uncommon histotypes of all exocrine pancreatic neoplasms. Disorganization of E-cadherin and ?-catenin mutations, two key components of the Wnt signal transduction pathway, has been implicated in the development of SPT, but not other pancreatic tumors. Loss of E-cadherin/?-catenin proteins and tyrosine phosphorylation of E-cadherin/?-catenin have been postulated in cervical carcinogenesis and cancer invasion. A 38-year-old married woman, who had undergone brachytherapy, radiotherapy and chemotherapy for cervical cancer in Philippines in 2011, was admitted to our hospital after follow-up CT scan of abdomen in 2012 revealed a lesion in the tail of pancreas. The patient underwent distal pancreatectomy and splenectomy. The pathological diagnosis was SPT of pancreas. We suspect that the concurrent SPT pancreas and cervical cancer in this woman were triggered by a primary insult, a process in which E-cadherin/?-catenin/Wnt-signaling pathway played important roles. PMID:25848087

  1. Preoperative evaluation for lung cancer resection

    PubMed Central

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

    2014-01-01

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

  2. Preoperative transarterial Embolisation in bone tumors.

    PubMed

    Gupta, Pankaj; Gamanagatti, Shivanand

    2012-05-28

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

  3. Inflammatory breast cancer: novel preoperative therapies.

    PubMed

    Overmoyer, Beth A

    2010-02-01

    The treatment of inflammatory breast cancer (IBC) has been hampered by the diagnostic rarity of the disease and its consequent inclusion in clinical trials of preoperative treatment for the more indolent locally advanced breast cancer (LABC). Patients with IBC have a 2-fold greater probability of dying of their disease compared with patients diagnosed with LABC. The aggressive clinical portrait of IBC supports the recent investigative focus on determining molecular changes specific to IBC and developing novel systemic therapies that will favorably affect its poor disease prognosis. A significant amount of laboratory research has been involved in defining a specific "inflammatory signature" for IBC, denoting molecular changes consistently found in IBC. This work has involved human IBC tissue and cell lines and has demonstrated overexpression of several molecules governing metastatic dissemination, such as overexpression of E-cadherin concurrent with a dysfunctional mucin 1. An increased prevalence of mutant TP53, overexpression of RhoC, and vascular endothelial growth factor-A has been found to contribute to the dominant influence of angiogenesis in this disease. A greater understanding of the molecular mechanisms governing the pathophysiology of IBC has led to the development and clinical application of novel targeting agents for preoperative therapy. This study reviews the advances in molecular understanding of IBC and focuses on the efficacy of therapies that target the epidermal growth factor pathway and angiogenesis as well as early investigational therapies involving RhoC and TP53. PMID:20133255

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

    Microsoft Academic Search

    P B Cotton

    1980-01-01

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

  5. Structure of Pancreas in Zebra Finch (Poephila bichenovi) and Pigeon (Streptopelia decaocto laughing nove)

    Microsoft Academic Search

    Zohreh Saadatfar; Maryam Asadian; Elias Alishahi

    2010-01-01

    Saadatfar, Z., Asadian, M. and Alishahi, E. 2010. Structure of pancreas in zebra finch (Poephila bichenovi) and pigeon (Streptopelia decaocto laughing nove). J. Appl. Anim. Res., 37: 157–160.To compare pancreas of finch and pigeon 5 samples from each were examined. In finch's pancreas the number of islets in dorsal lobe was less than in ventral lobe. A islets were smaller

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

    E-print Network

    Boyer, Edmond

    RESEARCH ARTICLE Open Access Is there adaptation of the exocrine pancreas in wild animal? The case: Physiology of the exocrine pancreas has been well studied in domestic and in laboratory animals as well death, the pancreas was removed for tissue sample collection and then analyzed. When expressed

  7. Insulin-promoter-factor 1 is required for pancreas development in mice

    Microsoft Academic Search

    Jörgen Jonsson; Lena Carlsson; Thomas Edlund; Helena Edlund

    1994-01-01

    THE mammalian pancreas is a mixed exocrine and endocrine gland that, in most species, arises from ventral and dorsal buds which subsequently merge to form the pancreas. In both mouse and rat the first histological sign of morphogenesis of the dorsal pancreas is a dorsal evagination of the duodenum at the level of the liver at around the 22-25-somite stage,

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

    E-print Network

    Zang, Xingxing

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

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

    E-print Network

    Paris-Sud XI, Université de

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

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

    E-print Network

    Ahlers, Guenter

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

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

    E-print Network

    Rodenacker, Karsten

    1997-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2014-09-01

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

  14. Preoperative anemia increases postoperative morbidity in elective cranial neurosurgery

    PubMed Central

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

    2014-01-01

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

  15. Smith-Lemli-Opitz Syndrome: A Case with Annular Pancreas

    PubMed Central

    Demirdöven, Mehmet; Yazgan, Hamza; Korkmaz, Mevlit; Gebe?çe, Arzu; Tonbul, Alparslan

    2014-01-01

    Smith-Lemli-Opitz syndrome is an autosomal recessive disease of cholesterol metabolism. It is a multiple malformation syndrome with typical dysmorphic features such as bitemporal narrowing, ptosis, epicanthus, microcephaly, micrognathia, and cardiovascular, skeletal, urogenital, and gastrointestinal anomalies. This report presents a typical case of Smith-Lemli-Opitz syndrome with annular pancreas which is an unreported gastrointestinal abnormality. PMID:25165593

  16. Somatostatin: Abundance of Immunoreactive Hormone in Rat Stomach and Pancreas

    Microsoft Academic Search

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

    1975-01-01

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

  17. Pancreatic Juice Cytology in IPMN of the Pancreas

    Microsoft Academic Search

    Koji Yamaguchi; Masafumi Nakamura; Kengo Shirahane; Masahiko Kawamoto; Hiroyuki Konomi; Masayukii Ohta; Masao Tanaka

    2005-01-01

    Background: Intraductal papillary-mucinous neoplasm (IPMN) of the pancreas is a disease ranging from adenoma to borderline (with moderate dysplasia) and further to carcinoma (noninvasive and invasive) and surgical strategy is different by the grades of dysplasia. Methods: Preoperativepancreatic juice cytology in IPMN was reviewed in 71 patients with IPMN who underwent surgical resection. Results: The IPMN was adenoma in 48

  18. Human Islet Autotransplantation to Prevent Diabetes after Pancreas Resection

    Microsoft Academic Search

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

    2000-01-01

    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

  19. Single-Cell Transcript Analysis of Pancreas Development

    Microsoft Academic Search

    Ming-Ko Chiang; Douglas A Melton

    2003-01-01

    DNA microarray analysis was combined with a modified single-cell PCR procedure to study gene expression profiles of single cells at different stages of pancreatic development. This method identifies distinct cell types at embryonic day 10.5, a stage when the pancreatic epithelium is morphologically uniform. Some cells express unexpected combinations of genes, and these expression patterns provide new insights into pancreas

  20. The surgical anatomy of the lymphatic system of the pancreas.

    PubMed

    Cesmebasi, Alper; Malefant, Jason; Patel, Swetal D; Plessis, Maira Du; Renna, Sarah; Tubbs, R Shane; Loukas, Marios

    2015-05-01

    The lymphatic system of the pancreas is a complex, intricate network of lymphatic vessels and nodes responsible for the drainage of the head, neck, body, and tail of the pancreas. Its anatomical divisions and embryological development have been well described in the literature with emphasis on its clinical relevance in regards to pancreatic pathologies. A thorough knowledge and understanding of the lymphatic system surrounding the pancreas is critical for physicians in providing diagnostic and treatment strategies for patients with pancreatic cancer and pancreatitis. Pancreatic cancer has an extremely poor prognosis and is a notable cause of morbidity and mortality worldwide. Although a surgeon may try to predict the routes for metastasis for pancreatic cancer, the complexity of this system presents difficulty due to variable drainage patterns. Pancreatitis also presents as another severe disease which has been shown to have an association with the lymphatics. The aim of this article is to review the literature on the lymphatics of the pancreas, pancreatic pathologies, and the available imaging methodologies used to study the pancreatic lymphatics. Clin. Anat. 28:527-537, 2015. © 2014 Wiley Periodicals, Inc. PMID:25220721

  1. Effect of Glucagon and Insulin on the Isolated Exocrine Pancreas

    Microsoft Academic Search

    V. Wizemann; P. Weppler; R. Mahrt

    1974-01-01

    The effect of insulin and glucagon on exocrine pancreatic secretion (volume and amylase output) was tested in an isolated cat pancreas preparation. Glucagon reversibly inhibited volume and amylase secretion, whereas insulin did not show an influence on fluid and enzyme output.Copyright © 1974 S. Karger AG, Basel

  2. Proinsulinemia in simultaneous pancreas and kidney transplant recipients.

    PubMed

    Bak, M I; Grochowiecki, T; Ga?azka, Z; Nazarewski, S; Jakimowicz, T; Pietrasik, K; Wojtaszek, M; Durlik, M; Karnafel, W; Szmidt, J

    2006-01-01

    It has been shown that lipid profiles do not differ between pancreas recipients with systemic and portal venous anastomosis. However, it is unclear whether venous drainage from the transplanted pancreas has an impact on recipient atherogenesis and if other factors should be considered. Increased concentration of proinsulin correlates with tachycardia and other risk factors for ischemic heart disease. The aim of this study was to compare proinsulin levels in different types of pancreatic graft venous drainage. Twenty-four simultaneous pancreas and kidney transplantation (SPK) recipients with systemic venous drainage (group S, n = 12) and portal venous drainage (group P, n = 12) under identical immunosuppressive treatment were prospectively observed during 24 months. Following transplantation, only recipients with normoglycemia, normal HbA1c, and normal serum creatine were evaluated. Proinsulin was assessed in fasting state; after glucagon stimulation (Delta-proinsulin), and during oral 75-g glucose tolerance test twice: between 3 and 6 months and 12 to 24 months posttransplantation. All SPK patients had higher proinsulin concentration in fasting state compared with age-matched healthy controls. After stimulation, proinsulin level did not significantly differ between groups; the type of the pancreas venous anastomosis did not change the release of proinsulin and should not have impact on cardiovascular risk factors. PMID:16504725

  3. Oestrogen receptor proteins in malignant and fetal pancreas

    Microsoft Academic Search

    B Greenway; M J Iqbal; P J Johnson; R Williams

    1981-01-01

    High levels of high-affinity oestrogen binding were detected in cytosolic and nuclear fractions of tumour tissue from six patients with pancreatic carcinoma. Similar binding was found in fetal but not in normal adult pancreas, making depression of fetal genes a possibility. Specific androgen binding was not detectable. These findings suggest that anti-oestrogen treatment may offer a new approach to the

  4. Pancreas ? cell regeneration and type 1 diabetes (Review)

    PubMed Central

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

    2015-01-01

    Diabetes mellitus, which may cause hyperglycemia and a number of complications, mostly results from a deficiency of ? cell mass (type 1 diabetes) or a limitation of ? cell function (type 2 diabetes). Currently, enhancing ? cell regeneration and increasing cell proliferation have not only been described in experimental diabetes models, but have also been proven to improve outcomes for patients with diabetes. Therefore, understanding the mechanisms controlling the development and regeneration of ? cells in the human pancreas may be helpful for the treatment of ? cell-deficient disease. In this review, we first introduce the various cell types in the adult pancreas and thereby clarify their functions and origins. Then, the known mechanisms of ? cell development and expansion in the normal human pancreas are described. The potential mechanisms of ? cell regeneration, including ? cell self-replication, neogenesis from non-? cell precursors and transdifferentiation from ? cells, are discussed in the next part. Finally, the ability of the pancreas to regenerate mature ? cells is explored in pathological conditions, including type 1 diabetes, chronic pancreatitis and persistent hyperinsulinemic hypoglycemia of infancy. PMID:25667609

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

    E-print Network

    Machen, Terry E.

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

  6. A case of undifferentiated carcinoma of the pancreas mimicking main-duct intraductal papillary mucinous neoplasm (IPMN).

    PubMed

    Kawai, Yuichi; Nakamichi, Rei; Kamata, Noriko; Miyake, Hideo; Fujino, Masahiko; Itoh, Shigeki

    2015-03-01

    We report here a rare case of undifferentiated carcinoma of the pancreas mimicking main-duct intraductal papillary mucinous neoplasm. In an 80-year-old woman, an approximately 8-mm papillary mass was incidentally detected at the downstream edge of a dilatated main pancreatic duct lumen on CT and MRI. Main pancreatic duct dilatation in the pancreatic body and tail and parenchymal atrophy were observed in the upstream of the mass. Histopathologically, the tumor protruded into the downstream edge of the dilatated main pancreatic duct lumen in the pancreatic body. The tumor cells had highly atypical nuclei and abundant polymorphic structures, and showed positive staining for granulocyte colony-stimulating factor, which led to the diagnosis of undifferentiated carcinoma. A total of 13 cases of undifferentiated carcinoma with intraductal tumor growth have been reported to date. The case report by Bergmann et al. has been the smallest in histopathological specimen, and the present case is the smallest in size detected by radiological images. Since early undifferentiated carcinoma of the pancreas can resemble those of main-duct intraductal papillary mucinous neoplasm in cross-sectional images, we have to consider undifferentiated carcinoma in the differential diagnosis of the solitary and papillary mass with low contrast enhancement in early phase in the main pancreatic duct. PMID:25526684

  7. Pancoast tumors: characteristics and preoperative assessment

    PubMed Central

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

    2014-01-01

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

  8. Preoperational test report, recirculation condenser cooling systems

    SciTech Connect

    Clifton, F.T.

    1997-11-04

    This represents a preoperational test report for Recirculation Condenser Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The four system provide condenser cooling water for vapor space cooling of tanks AY1O1, AY102, AZ1O1, AZ102. Each system consists of a valved piping loop, a pair of redundant recirculation pumps, a closed-loop evaporative cooling tower, and supporting instrumentation; equipment is located outside the farm on concrete slabs. Piping is routed to the each ventilation condenser inside the farm via below-grade concrete trenches. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  9. Preoperative evaluation and preparation of patients for orthopedic surgery.

    PubMed

    Abel, Richard B; Rosenblatt, Meg A

    2014-12-01

    Orthopedic patients frequently have multiple comorbidities when they present for surgery. This article discusses risk stratification of this population and the preoperative work-up for patients with specific underlying conditions who often require orthopedic procedures. Preoperative strategies to decrease exposure to allogeneic blood and advantages of the Perioperative Surgical Home model in this unique population are discussed. PMID:25453668

  10. Scabies Diagnosis

    MedlinePLUS

    ... message, please visit this page: About CDC.gov . Parasites - Scabies Parasites Home Share Compartir Diagnosis Diagnosis of a scabies ... Cases Publications Information For: Institutions Travelers Related Links Parasites A-Z Index Parasites Glossary Neglected Tropical Diseases ...

  11. Preoperative Informed Consent: Is It Truly Informed?

    PubMed Central

    Jawaid, M; Farhan, M; Masood, Z; Husnain, SMN

    2012-01-01

    Background: Pre-operative informed consent is an important aspect of surgery, yet there has been no formal training regarding it in Pakistan. This study was done to assess the preoperative informed consent practice. Methods: After taking informed permission, a questionnaire was filled in during an interview with 350 patients, who have undergone elective surgical procedures under routine practice conditions from July to October 2010. All the patients were asked a set of standard questions which related to the information they were provided before the operation as a part of standard informed consent practice. Results: Most i.e. 307 (87.7%) patients were informed about their condition but very few 12 (3.4%) were briefed regarding complications. Only 17 (4.9%) patients said they knew about the risks and complications of proposed anesthesia. One hundred thirty-eight (39.4%) patients said that they were allowed to ask questions while giving consent. Most of the time 196 (56%) consent was taken one day before surgery but in few 2 (0.6%) instances it was taken on the morning of surgery and on operation table in some cases 3 (0.9%) as reported by patients. The consent form was signed by the patients themselves in only 204 (58.3%) cases and by their relatives in the rest. About half the number of patients 171 (48.9%) interviewed were satisfied from the information they received as informed consent process. Conclusion: This study highlights the poor quality of patient knowledge about surgical procedures and the inadequate information provided. PMID:23193502

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

    E-print Network

    Mootha, Vamsi K.

    General Hospital. Below is a list of all of the medical records required for listing on the kidney/pancreas or pancreas after kidney transplant list, but only the tests indicated with an * are required to initiate meets criteria to be scheduled for a multidisciplinary kidney/pancreas or pancreas after kidney

  13. Multiple hepatocellular adenomas presenting in a male 8 years post-pancreaticoduodenectomy for islet cell tumor of the pancreas

    PubMed Central

    Gallagher, Tom Kevin; Venkatesh, Udupa K.; Maguire, Donal M.

    2015-01-01

    We report the case of a 29-year-old male who presented with vague right upper quadrant pain, 8 years following a pancreaticoduodenectomy for a symptomatic pancreatic islet cell tumor. Subsequent imaging revealed multiple lesions in the right lobe of the liver. A diagnosis of metastatic disease could not be out ruled and hence a formal resection was performed. A formal retrospective review of case notes, preoperative imaging, operative notes, subsequent histology as well as a review of the current literature using the Medline, CINAHL, and EMBASE databases was performed. Histologic analysis showed these lesions to be hepatocellular adenomas. We highlight in this case the importance of preoperative imaging and workup, discuss hepatocellular adenomas in males and hypothesize as to the underlying pathophysiology in this particular case based on the available evidence. PMID:25810673

  14. 77 FR 69863 - Antiseptic Patient Preoperative Skin Preparation Products; Public Hearing; Request for Comments

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-21

    ...No. FDA-2012-N-1040] Antiseptic Patient Preoperative Skin Preparation Products...to address microbial contamination of patient preoperative skin preparation drug products. Currently, patient preoperative skin preparations are...

  15. Pancreas transplantation: The Wake Forest experience in the new millennium

    PubMed Central

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

    2014-01-01

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

  16. Diagnostic accuracy of preoperative tests for lymph node status in endometrial cancer: a systematic review

    PubMed Central

    Trum, J.W.; Bakers, F.C.H.; Beets-Tan, R.G.H.; Smits, L.J.M.; Kruitwagen, R.F.P.M.

    2013-01-01

    Abstract Background: Approximately 72% of endometrial cancers are FIGO stage I at diagnosis and about 10% have lymph node metastases. An ideal diagnostic test for nodal disease would be able to prevent both overtreatment (i.e. unnecessary lymphadenectomy) and undertreatment (i.e. withholding lymphadenectomy or adjuvant postoperative treatment to patients with lymph node metastases). Objectives: In this review we compare the accuracy of preoperative tests (computed tomography, magnetic resonance imaging, positron emission tomography-computed tomography, CA-125 serum levels, and ultrasonography) for the detection of lymph node metastases in endometrial cancers with the final histopathologic diagnosis after complete pelvic and para-aortic lymphadenectomy as the gold standard. Method: A systematic search in MEDLINE (using PubMed), Embase and The Cochrane Library was performed up to 23 July 2012. Results: We found one article that met our inclusion criteria for computed tomography, none for magnetic resonance imaging, 2 for positron emission tomography/computed tomography), 2 for CA-125 and none for ultrasonography. Conclusions: Due to the lack of high-quality articles on a preoperative test for lymph node status in endometrial cancer, no proper comparison between these modalities can be made. PMID:23876490

  17. Preoperative parameters to predict incidental (T1a and T1b) prostate cancer

    PubMed Central

    Sakamoto, Hirofumi; Matsumoto, Kazuhiro; Hayakawa, Nozomi; Maeda, Takahiro; Sato, Atsuko; Ninomiya, Akiharu; Mukai, Kiyoshi; Nakamura, So

    2014-01-01

    Introducton: Prostate cancer has been found incidentally in transurethral resection of the prostate (TURP) specimens without prior diagnosis in 5% to 13% of the patients. We evaluated whether incidental prostate cancer (stages T1a and T1b) could be predicted preoperatively. Methods: TURP was performed in 307 patients between 2006 and 2011. Patient age, prostate-specific antigen (PSA) level, total prostate volume, transitional zone volume, PSA density, history of needle biopsy, and pathological diagnosis on TURP specimen were assessed. We analyzed the association between these parameters and prostate cancer detection. Results: Incidental prostate cancer was found in 31 patients (10.1%), and 13 cases (4.2%) had cancer with T1b and/or Gleason ?7. Multivariate analysis demonstrated that age ?75 years (odds ratio [OR] 2.58, p = 0.022), prostate volume ?50 cc (OR 4.11, p < 0.001), and the absence of preoperative needle biopsy despite PSA ?4 ng/mL (OR 2.65, p = 0.046) were independent risk factors. In patients who had 2 or 3 of these risk factors, incidental prostate cancer and cancer with T1b and/or Gleason ?7 were observed in 25% to 50% and 16% to 25% cases, respectively. Conclusions: Older patient age, small prostate volume, and the absence of previous needle biopsy (despite a high PSA level) might be independent risk factors for detecting incidental prostate cancer, although external validation is warranted to confirm our results. PMID:25485009

  18. Diagnostic value of preoperative serum carcinoembryonic antigen and carbohydrate antigen 19-9 in colorectal cancer

    PubMed Central

    Polat, E.; Duman, U.; Duman, M.; Atici, A.E.; Reyhan, E.; Dalgic, T.; Bostanci, E.B.; Yol, S.

    2014-01-01

    Background Since the first introduction of tumour markers, their usefulness for diagnosis has been a challenging question. The aim of the present prospective study was to investigate, in colorectal cancer patients, the relationship between preoperative tumour marker concentrations and various clinical variables. Methods The study prospectively enrolled 131 consecutive patients with a confirmed diagnosis of colorectal carcinoma and 131 age- and sex-matched control subjects with no malignancy. The relationships of the tumour markers carcinoembryonic antigen (cea) and carbohydrate antigen (ca) 19-9 with disease stage, tumour differentiation (grade), mucus production, liver function tests, T stage, N stage, M stage were investigated. Results Serum concentrations of cea were significantly higher in the patient group than in the control group (p = 0.001); they were also significantly higher in stage iii (p = 0.018) and iv disease (p = 0.001) than in stage i. Serum concentrations of cea were significantly elevated in the presence of spread to lymph nodes (p = 0.005) in the patient group. Levels of both tumour markers were significantly elevated in the presence of distant metastasis in the patient group (p = 0.005 for cea; p = 0.004 for ca 19-9). Conclusions Preoperative levels of cea and ca 19-9 might provide an estimate of lymph node invasion and distant metastasis in colorectal cancer patients. PMID:24523606

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

    SciTech Connect

    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

    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.

  20. [Popliteal artery aneurysma as an important differential diagnosis].

    PubMed

    Gombert, A; Jalaie, H; Jacobs, M J; Grommes, J

    2015-03-01

    A common reason for painful lesions of the popliteal fossa are baker's cysts. An important differential diagnosis is the popliteal artery aneurysm, which is rare, but is associated with severe complications. The preferred method of diagnosis is the colour-coded duplex ultrasound. By showing the case of a 58-year-old man, who experienced life-threatening complications caused by an insufficient diagnosis before the operation of a Baker's cyst, we want to underline the importance of preoperative duplex ultrasound diagnosis in this context. PMID:25798725

  1. [Possibilities of laparoscopic ultrasound diagnosis].

    PubMed

    Sohn, C; Wallwiener, D

    1996-01-01

    Both pre-operative transvaginal sonography and laparoscopical diagnosis leave gaps in the diagnosis of adnexal tumors. The combination of both methods seems to fill these gaps. For diagnosis with Laparoscopical Sonography a special scan head is needed: After removing the optical components there was a little linear-array installed into the original gastroscope with a diameter of only 9 mm which enables maximum flexibility during examinations. The linear-array consists of 128 crystals with a frequency of 7.5 MHz (penetration depth: 6 cm), enabling B-Image Sonography, Pulsed and Color Doppler as well as Angio-Color-Technique. Laparoscopical Sonography in addition to transvaginal and transabdominal sonography leads to progress in diagnosis and therapy. As the scan head can be placed directly in front of the area which is normally hardly detectable diagnosis is possible and plannings for the further operations as well as color-doppler controls during operations can be improved. In several cases this method allowed detection of metastases of the liver which were not visible by transabdominal ultrasound. PMID:8851098

  2. Whole-organ pancreas transplantation at Baylor Regional Transplant Institute: a chance to cure diabetes.

    PubMed

    Sanchez, Edmund Q; Melton, Larry B; Chinnakotla, Srinath; Levy, Marlon F; Fischbach, Bernard V; Goldstein, Robert; Klintmalm, Göran B

    2010-01-01

    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. PMID:20157494

  3. Arthrosonography in the Diagnosis of Pigmented Villonodular Synovitis

    Microsoft Academic Search

    R. A. Kaufman; R. B. Towbin; D. S. Babcock; A. H. Crawford

    Sonography has been used in the evaluation of lesions of the extremities including: popliteal cyst, popliteal aneurysm, rheumatoid arthritis of the knee, and abscess, hematoma, lymphocoele, and solid tumors elsewhere in the appendic- ulan skeleton (1 , 2). We report a patient in whom sonognaphy helped to establish a preoperative diagnosis of pigmented villonodulan synovitis of the knee. Case Report

  4. [Amylin under examination. Fibrillogenic polypeptide hormone of the pancreas].

    PubMed

    Marsza?ek, Ma?gorzata

    2014-01-01

    In patients or animals affected by type 2 diabetes mellitus (DM2, non-insulin dependent diabetes mellitus [NIDDM]) some pathological deposits, called amyloid, are observed among cells of islets of Langerhans. Among other constituents, deposits consist of an insoluble, fibrillar form of peptide neurohormone called amylin, produced by pancreatic beta cells. It is thought that formation of fibrillar deposits of misfolded and aggregated peptide is highly toxic to beta cells and leads to cell dysfunction, cell loss, pancreas destruction and progress of the disease. This relatively small 37-amino acid peptide constitutes a serious scientific, research and to some extent a medical problem. This article presents amylin as a hormone, neurohormone and as a fibrillating molecule which participates in amyloid deposit formation in human and animal pancreas. The role of some amino acids important for fibril formation has been highlighted. PMID:24491893

  5. [Amylin under examination. Fibrillogenic polypeptide hormone of the pancreas].

    PubMed

    Marsza?ek, Ma?gorzata

    2014-01-01

    In patients or animals affected by type 2 diabetes mellitus (DM2, non-insulin dependent diabetes mellitus [NIDDM]) some pathological deposits, called amyloid, are observed among cells of islets of Langerhans. Among other constituents, deposits consist of an insoluble, fibrillar form of peptide neurohormone called amylin, produced by pancreatic beta cells. It is thought that formation of fibrillar deposits of misfolded and aggregated peptide is highly toxic to beta cells and leads to cell dysfunction, cell loss, pancreas destruction and progress of the disease. This relatively small 37-amino acid peptide constitutes a serious scientific, research and to some extent a medical problem. This article presents amylin as a hormone, neurohormone and as a fibrillating molecule which participates in amyloid deposit formation in human and animal pancreas. The role of some amino acids important for fibril formation has been highlighted. PMID:24988648

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

    PubMed

    Palmieri, C; Shivaprasad, H L

    2014-12-01

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

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

    PubMed

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

    2011-01-01

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

  8. Squamous cell carcinoma and lipomatous pseudohypertrophy of the pancreas.

    PubMed

    Bralet, M P; Terris, B; Brégeaud, L; Ruszniewski, P; Bernades, P; Belghiti, J; Fléjou, J F

    1999-06-01

    A 68-year-old woman who had been treated for non-insulin-dependent diabetes mellitus for the past 20 years was admitted to hospital because of abdominal pain and weight loss. Radiological investigation revealed a tumour in the body of the pancreas and numerous intraductal calcifications in both the tail and the head of the pancreas. Left-sided pancreatectomy was performed to remove the tumour. The resection specimen showed fatty enlargement of the parenchyma and numerous intraductal calcifications in the tissue adjacent to the tumour, which was 7 cm in diameter and was found to be a primary squamous cell carcinoma with a spindle cell component. There was also lipomatous pseudohypertrophy. PMID:10394894

  9. Beta-Cell Function of the Pancreas after Necrotizing Pancreatitis

    Microsoft Academic Search

    H. C. J. L. Buscher; M. L. Jacobs; G. L. Ong; H. van Goor; R. F. A. Weber; H. A. Bruining

    1999-01-01

    Aim: To investigate the late sequellae of necrotizing pancreatitis on the endocrine function of the pancreas. Patients and Methods: Twenty patients, 15 men (mean ± SEM age 52.2 ± 2.6 years and BMI 26.8 ± 0.8 kg\\/m2) and 5 women (age 51.0 ± 7.6 years and BMI 26.7 ± 0.8 kg\\/m2) were submitted to a glucagon stimulation test 63 (range

  10. State of the Art in Radiation Therapy for Pancreas Cancer

    Microsoft Academic Search

    Aaron C. Spalding; Edgar Ben-Josef

    \\u000a Despite an extraordinary tendency for metastatic spread, radiotherapy may have an important role in the management of locally\\u000a advanced unresectable cancer of the pancreas. Local control remains a significant clinical problem. In patients with unresectable\\u000a disease, failure to control local disease is virtually uniform, and in patients undergoing curative resection, the rate of\\u000a local relapse is 50–85% (1). Failure to

  11. Laparoscopic Surgery for Solid Pseudopapillary Tumor of the Pancreas

    PubMed Central

    Afridi, Shabbir A.; Kazaryan, Airazat M.; Marangos, Irina Pavlik; Røsok, Bård I.; Fretland, Åsmund A.; Yaqub, Sheraz

    2014-01-01

    Background and Objectives: Solid pseudopapillary tumors of the pancreas are rare and occur most frequently in young women. They have an uncertain pathogenesis and unclear clinical behavior. Our aim was to evaluate the clinical presentation of solid pseudopapillary tumors and assess the efficacy of treatment with minimally invasive surgery. Methods: From March 1997 to February 2011, 13 of 273 patients who underwent laparoscopic procedures on the pancreas were found to have solid pseudopapillary tumors. There were 12 female patients and 1 male patient. The median age was 21 years (range, 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. PMID:24960486

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

    SciTech Connect

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

    2011-07-15

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

  13. Preoperative cutaneous lymphoscintigraphy in malignant melanoma

    SciTech Connect

    Lock-Andersen, J.; Rossing, N.; Drzewiecki, K.T.

    1989-01-01

    To identify the regional lymph node basins cutaneous lymphoscintigraphy with technetium 99m rhenium sulfide colloid (/sup 99m/Tc-ReS) was performed in 45 patients and with technetium 99m antimony sulfide colloid (/sup 99m/Tc-Sb2S3) in seven patients after excisional biopsy of the primary tumor. All patients had skin tumors located in the face or neck or on the trunk with 47 cases of cutaneous malignant melanoma and 5 cases of benign or premalignant lesions. In 48 patients the scintiscans 1 hour after perilesional injection of the tracer colloid clearly showed the lymphatic drainage patterns from the tumor sites, of them 25 patients demonstrated unidirectional drainage, whereas the remaining 23 patients had multidirectional drainage to two or three lymph node groups. There were technical difficulties in performing the examinations in four patients. The authors recommend cutaneous lymphoscintigraphy as a safe, simple and reliable technique for mapping the lymphatic drainage preoperatively in patients with Stage I cutaneous malignant melanoma of axial localization.

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

    PubMed

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

    2014-11-28

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

  15. Development of the Human Pancreas From Foregut to Endocrine Commitment

    PubMed Central

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

    2013-01-01

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

  16. Adenoma of the minor papilla associated with pancreas divisum.

    PubMed

    Nakamura, Yoshiharu; Tajiri, Takashi; Uchida, Eiji; Aimoto, Takayuki; Taniai, Nobuhiko; Katsuno, Akira; Cho, Kazumitsu; Yoshida, Hiroshi

    2007-09-01

    Tumors of the minor papilla of the duodenum are quite rare. We report the first documented case of an adenoma of the minor papilla complicating pancreas divisum. A 52-year-old woman was admitted to our hospital for treatment of an asymptomatic duodenal tumor detected by computed tomography scan. Endoscopy showed an 18-mm, whitish-colored, sessile mass located in the descending duodenum proximal to a normal appearing major papilla. Endoscopic retrograde pancreatography revealed divisum of the pancreas with dilatation of pancreatic duct ranged in the dorsal pancreas. Transduodenal minor papillectomy was performed because there is malignant potential of the tumor and the possibility of acute pancreatitis. The Santorini orifice was then re-approximated to the duodenal wall for protection against acute pancreatitis caused by scarring and stenosis of the duct orifice as a possible late complication. The patient's postoperative course was uneventful and she has been asymptomatic without evidence of tumor recurrence or stenosis of the Santorini orifice on endoscopic examination for the last 4 years. PMID:18019730

  17. Quercetin Aglycone Is Bioavailable in Murine Pancreas and Pancreatic Xenografts

    PubMed Central

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

    2010-01-01

    Quercetin is a potential chemopreventive and chemotherapeutic agent for pancreatic and other cancers. This study was to examine the distribution of quercetin in plasma, lung, liver, pancreas and pancreatic cancer xenografts in a murine in vivo model and the uptake of quercetin in pancreatic cancer MiaPaCa-2 cells in cellular in vitro model. Mice were randomly allocated to control diet, 0.2 and 1% quercetin diet groups utilizing the AIN93G-based diet (n=12 per group) for 6 weeks. In addition, 6 mice from each group were injected weekly with chemotherapeutic drug gemcitabine (120 mg/kg mouse, i.p.). MiaPaCa cells were collected from culture medium after cells were exposed to 30 µM of quercetin for 0.5, 1, 2, 4, 8, and 24 hrs. Levels of quercetin and 3-O’-methyl-quercetin in mice tissues and MiaPaCa-2 cells were measured by high-pressure liquid chromatography following enzymatic hydrolysis and then extraction. Our study showed that quercetin is accumulated in pancreatic cancer cells, and is absorbed in the circulating system, tumors and tissues of pancreas, liver and lung in vivo. A higher proportion of total quercetin found in tumors and pancreas are aglycones. Gemcitabine co-treatment with quercetin reduced absorption of quercetin in mice circulatory system and liver. Results from the study provide important information on the interpretation of chemo-therapeutic efficacy of quercetin. PMID:20499918

  18. Appraisal of guidelines for pre-operative body wash.

    PubMed

    Edström, Elisabet; Westerberg, Lisa; Henricson, Maria

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

  19. Preoperative lower limb venography in patients undergoing total hip arthroplasty.

    PubMed

    Chumas, P; O'Doherty, D P; Pearse, M; Magnussen, P; Crozier, A; Gregg, P J

    1988-01-01

    Using bilateral ascending venography, the authors examined 93 consecutive patients undergoing total hip arthroplasty for the presence of asymptomatic preoperative leg vein thrombosis. Radiologic abnormalities were seen in only four patients, and this was not statistically significant (P greater than .1). There were no complications from the procedure. It is suggested that routine preoperative screening for deep vein thrombosis prior to hip arthroplasty is unnecessary but may be appropriate in patients at particularly high risk for thromboembolic complications. PMID:3183676

  20. Preoperative Evaluation and Preparation in the Elderly Thoracic Surgery Patient

    Microsoft Academic Search

    Ticiana Leal; Noelle K. LoConte; Anai Kothari; Tracey L. Weigel

    \\u000a The United States population is aging and median life expectancy is increasing as well. Older age is one of the strongest\\u000a predictors for heart disease and cancer that require cardiothoracic surgery. The traditional preoperative evaluation has been\\u000a unsuccessful in risk stratifying the older patient fit for elective surgery. This chapter is innovative, focusing on the preoperative\\u000a assessment of the geriatric

  1. An ICU Preanesthesia Evaluation Form Reduces Missing Preoperative Key Information

    PubMed Central

    Chuy, Katherine; Yan, Zhe; Fleisher, Lee; Liu, Renyu

    2013-01-01

    Background A comprehensive preoperative evaluation is critical for providing anesthetic care for patients from the intensive care unit (ICU). There has been no preoperative evaluation form specific for ICU patients that allows for a rapid and focused evaluation by anesthesia providers, including junior residents. In this study, a specific preoperative form was designed for ICU patients and evaluated to allow residents to perform the most relevant and important preoperative evaluations efficiently. Methods The following steps were utilized for developing the preoperative evaluation form: 1) designed a new preoperative form specific for ICU patients; 2) had the form reviewed by attending physicians and residents, followed by multiple revisions; 3) conducted test releases and revisions; 4) released the final version and conducted a survey; 5) compared data collection from new ICU form with that from a previously used generic form. Each piece of information on the forms was assigned a score, and the score for the total missing information was determined. The score for each form was presented as mean ± standard deviation (SD), and compared by unpaired t test. A P value < 0.05 was considered statistically significant. Results Of 52 anesthesiologists (19 attending physicians, 33 residents) responding to the survey, 90% preferred the final new form; and 56% thought the new form would reduce perioperative risk for ICU patients. Forty percent were unsure whether the form would reduce perioperative risk. Over a three month period, we randomly collected 32 generic forms and 25 new forms. The average score for missing data was 23 ± 10 for the generic form and 8 ± 4 for the new form (P = 2.58E-11). Conclusions A preoperative evaluation form designed specifically for ICU patients is well accepted by anesthesia providers and helped to reduce missing key preoperative information. Such an approach is important for perioperative patient safety. PMID:23853741

  2. Unicentric Castleman’s disease of the pancreas with massive central calcification

    PubMed Central

    Goetze, Oliver; Banasch, Matthias; Junker, Klaus; Schmidt, Wolfgang E.; Szymanski, Christian

    2005-01-01

    Unicentric Castleman’s disease of the pancreas is extremely rare, with only six cases described in the worldwide literature. An asymptomatic case of unicentric, hyaline, vascular-type Castleman’s disease (UCD) localized to the tail of the pancreas with central calcification imitating a primary neoplasm of the pancreas is presented. This is the first description of endosonographic and endoscopic retrograde pancreatographic findings of pancreatic UCD. Additionally, computed tomography, histological and serologic findings are reported. PMID:16425374

  3. Lipoma of the pancreas, a case report and a review of the literature

    PubMed Central

    Lee, Ser Yee; Thng, Choon Hua; Chow, Pierce KH

    2011-01-01

    Lipomas of the pancreas are very rare. There are fewer than 25 reported cases of lipoma originating from the pancreas. We present a case of pancreatic lipoma in a 61-year-old woman with magnetic resonance imaging findings and confirmatory histological findings. We discuss and highlight the radiological features distinguishing a pancreatic lipoma from other fatty lesions of the pancreas and pancreatic liposarcoma and provide a brief review of the literature. PMID:22229078

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

    PubMed Central

    Epstein, Nancy E.

    2011-01-01

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

  5. [Annular pancreas with high confluence of pancreaticobiliary ducts in an adult].

    PubMed

    Kodama, Ryo; Watanabe, Takayuki; Maruyama, Masahiro; Ito, Tetsuya; Yoneda, Suguru; Maruyama, Masafumi; Muraki, Takashi; Hamano, Hideaki; Arakura, Norikazu; Tanaka, Eiji

    2011-09-01

    A man in his 80's was admitted complaining of epigastralgia, and acute pancreatitis was diagnosed. Abdominal CT and MRI showed enlargement of the pancreatic head encircling the descending part of the duodenum and a duodenal diverticulum. Endoscopic retrograde cholangio-pancreatography (ERCP) revealed annular pancreas and high confluence of pancreaticobiliary ducts. Annular pancreas had been reported to have associated with a broad spectrum of pancreatic anomalies, few cases of annular pancreas coexisting with high confluence of pancreaticobiliary ducts, or pancreaticobiliary maljunction have been reported. Combination of both anomalies was interesting from the view point of embryology. We report a rare case of annular pancreas with high confluence of pancreaticobiliary ducts. PMID:21892000

  6. Fenestral otosclerosis: significance of preoperative CT evaluation

    SciTech Connect

    Swartz, J.D.; Faerber, E.N.; Wolfson, R.J.; Marlowe, F.I.

    1984-06-01

    Thirty-five consecutive patients with the clinical diagnosis of fenestral otosclerosis were evaluated with high-resolution computed tomography (CT). Twenty-six were diagnosed as having this disorder by CT evidence of abnormal bony excrescences at or adjacent to the oval window. Sections were also evaluated for evidence of plaque formation elsewhere in the lateral wall of the labyrinth and for surgical obstacles such as an abnormally wide cochlear aqueduct, a high jugular vein, and a dehiscent facial nerve. It is concluded that fenestral otosclerosis may be accurately diagnosed with proper CT techniques.

  7. PFA-100 closure times in preoperative screening in 500 pediatric patients.

    PubMed

    Roschitz, Birgit; Thaller, Sigrid; Koestenberger, Martin; Wirnsberger, Andrea; Leschnik, Bettina; Fritsch, Peter; Muntean, Wolfgang

    2007-07-01

    Three to five percent of patients undergoing surgery have either an acquired or congenital platelet defect or von Willebrand disease (vWD). The predictive value of preoperative coagulation screening is questionable. PFA-100 is now routinely used in preoperative screening in our pediatric outpatient service. We wanted to assess whether the PFA-100 would help to identify patients with primary haemostatic defects or if the additional use of PFA-100 would add to the problem of unnecessary pathologic preoperative laboratory values resulting in delay of surgical procedure. We investigated 500 children consecutively seen in our outpatient service before surgery. Blood cell count, aPTT, PFA-100 closure times (CT) were done in all patients. If abnormalities were found, the patient was presented to a haemostatic expert. vWF:AG, R:Cof and factor VIII were analysed in all patients with prolonged closure times and APTT values. One hundred twenty-six patients (25.2%) showed abnormalities in APTT and/or PFA-100. Further investigations in 89 of these 126 patients did not yield a specific diagnosis; neither diagnostic criteria for impaired haemostasis were found by questionnaire. None of these 89 patients had a bleeding complication during surgery. Forty-eight patients showed prolonged CTs. Twelve patients with low vWF:AG were detected, 10 of these patients were found by PFA-100. Four of these patients did present with normal APTT values. Our study shows that similar to the APTT the PFA-100 is probably only a good screening method when a haemostatic defect in a patient is clinically likely, especially to screen forVWD, and the test should not be used in general unselective screening. PMID:17598019

  8. The Use of Protein-Based Biomarkers for the Diagnosis of Cystic Tumors of the Pancreas

    PubMed Central

    Kwon, Richard S.; Simeone, Diane M.

    2011-01-01

    Proteomics is a powerful method used to identify, characterize, and quantify proteins within biologic samples. Pancreatic cystic neoplasms are a common clinical entity and represent a diagnostic and management challenge due to difficulties in accurately diagnosing cystic lesions with malignant potential and assessing the risk of malignant degeneration. Currently, cytology and other biomarkers in cyst fluid have had limited success in accurately distinguishing both the type of cystic neoplasm and the presence of malignancy. Emerging data suggests that the use of protein-based biomarkers may have greater utility in helping clinicians correctly diagnose the type of cyst and to identify which cystic neoplasms are malignant. Several candidate proteins have been identified within pancreatic cystic neoplasms as potential biomarkers. Future studies will be needed to validate these findings and move these biomarkers into the clinical setting. PMID:22110950

  9. The human pancreas proteome defined by transcriptomics and antibody-based profiling.

    PubMed

    Danielsson, Angelika; Pontén, Fredrik; Fagerberg, Linn; Hallström, Björn M; Schwenk, Jochen M; Uhlén, Mathias; Korsgren, Olle; Lindskog, Cecilia

    2014-01-01

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

  10. Robot-Assisted Subtotal Pancreas-Preserving Duodenectomy

    PubMed Central

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

    2012-01-01

    Background: Angiodysplasia of the duodenum is a rare disorder, often requiring surgical resection. Technical difficulties have made the use of the minimally invasive approach uncommon. Herein, we present a subtotal pancreas-preserving duodenectomy using robotic assistance. Methods: The patient is a 60-y-old female with a long medical history including chronic gastrointestinal bleeding due to angiodysplasia with intermittent melena, and requiring multiples blood transfusions. A capsule endoscopy and double-balloon upper endoscopy showed angiectasis, which appeared to be limited to the third and fourth portion of the duodenum and the proximal loops of the jejunum. Despite multiple endoscopic cauterizations, the patient continued to require blood transfusion for several years. The patient underwent a robot-assisted subtotal pancreas-preserving duodenectomy. Results: The operation lasted 420 min with minimal blood loss. The postoperative course was uneventful. The pathology report showed multiple small bowel mucosal and submucosal distorted and dilated vasculature, consistent with angiodysplasia. At 2-mo follow-up, the patient was totally asymptomatic. A barium swallow study showed contrast passed antegrade through the duodenojejunostomy with no evidence of obstruction, stricture, or leakage. Conclusion: The use of robotic assistance to perform a subtotal pancreas-preserving duodenectomy for the treatment of benign duodenal disease, such as angiodysplasia, is feasible and safe. The technical advantages include a high degree of freedom offered by the robotic instruments, as well as enhanced visualization, which allows for precise microdissection and microsuture, thereby preserving the benefits of minimally invasive surgery. The use of robotic technology allows for a wider range of indications for minimally invasive surgery. PMID:23484581

  11. Carcinoma ex microcystic adenoma of the pancreas: a report of a novel form of malignancy in serous neoplasms.

    PubMed

    Zhu, Hongfa; Qin, Lihui; Zhong, Minghao; Gordon, Ronald; Raoufi, Mohammad; Hechtman, Jaclyn F; Schwartz, Myron; Roayaie, Sasan; Klimstra, David S

    2012-02-01

    Serous cystic neoplasms of the pancreas are generally considered benign lesions. Malignant counterparts have been occasionally described, and the diagnosis of malignancy is based solely on the presence of synchronous or metachronous metastases to the lymph nodes or liver, direct tumor invasion into adjacent organs, or vascular invasion. However, these malignant serous cystic tumors are lined by benign-appearing glycogen-rich cuboidal cells, which have been morphologically indistinguishable from benign microcystic serous cystadenoma in all the cases reported so far. We report a unique case of microcystic serous cystadenoma giving rise to carcinoma with distinctive histologic features including signet ring-like cells and solid nests. We believe that this case represents the first case of a cytologically malignant neoplasm arising from a benign serous cystadenoma (carcinoma ex microcystic serous cystadenoma). PMID:22189969

  12. Treatment of cancer of the pancreas by precision high dose (PHD) external photon beam and intraoperative electron beam therapy (IOEBT)

    SciTech Connect

    Dobelbower, R.R. Jr.; Howard, J.M.; Bagne, F.R.; Eltaki, A.; Merrick, H.W. III

    1989-01-01

    Twenty-five patients with a diagnosis of unresectable adenocarcinoma of the pancreas were explored in the Clement O. Miniger (COMROC) IOEBT operating amphitheater at the Medical College of Ohio. Seventeen were treated with IOEBT (20-30 Gy, 15 or 18 meV electrons) PHD external beam radiation therapy (40-60 Gy, 1.8 Gy per fraction) plus appropriate operative biliary and gastrointestinal bypass procedures. No intraoperative complications were observed. Two patients died of causes that may have been treatment-related. Two patients developed abdominocutaneous fistulae. Pain was ameliorated in eleven of twelve patients. Jaundice was relieved in all patients. Four of ten patients with weight loss showed a reversal of that trend. Patient survival was not significantly different from that of patients treated with high-dose precision therapy alone.

  13. Intestinal adenocarcinoma with pancreas and lymph node metastases in a captive cotton-top tamarin (Saguinus oedipus).

    PubMed

    Liu, Chen-Hsuan; Chen, Yu-Ting; Wang, Pao-Jung; Chin, Shih-Chien

    2004-10-01

    A case of intestinal adenocarcinoma with metastases to the pancreas and regional lymph node was found in a 9-year-old, captive female cotton-top tamarin (Saguinus oedipus) with intermittent diarrhea. At necropsy, the tumor mass was located in the ileo-cecal junction causing circumferential thickening and annular stenosis. Microscopically, the lesions at primary and metastatic sites showed typical features of mucinous adenocarcinoma as seen in humans, including intracellular and extracellular mucin production and characteristic appearance of a signet ring of the tumor cells. The diagnosis was confirmed by histological evaluation, positive cytokeratin immunostain, and mucin production demonstrated by PAS and Alcian blue stain. It is speculated that the development of intestinal carcinoma was partly attributable to the excessive absorption of a diet of refined food, unbalanced nutrition, and the nature of these animals to develop stress easily. PMID:15528865

  14. AANA Journal course: Update for nurse anesthetists--Part 4--preoperative cardiac evaluation.

    PubMed

    Halliburton, Bob; Bell, Donald; Preston, John

    2004-10-01

    This AANA Journal course discusses the American College of Cardiology (ACC) and American Heart Association (AHA) guideline on perioperative cardiovascular evaluation for noncardiac surgery. The intent of the ACC/AHA guideline is to assist clinicians in clinical decision making by describing a range of generally acceptable approaches for the diagnosis, management, and prevention of cardiac diseases. Optimizing the anesthetic management of the cardiac patient undergoing noncardiac surgery is becoming increasingly important: as the percentage of Americans older than 65 years continues to grow, so does the prevalence of cardiac disease in this population. Simply accepting a preoperative cardiology clearance for the cardiac patient undergoing noncardiac surgery provides little information that can be used for risk assessment and management of anesthesia. While national practice patterns vary significantly, there is an important need to standardize cost-effective preoperative cardiac evaluation. By using evidence-based studies, the ACC/AHA guideline delineates methods to objectively categorize cardiovascular risk and use data from the cardiology consultation to refine anesthetic management. Use of the guideline can lead to more efficient evaluation of the noncardiac patient with cardiac disease, which can decrease morbidity, mortality, and cost. PMID:15529733

  15. Laparoscopic pancreas-preserving subtotal duodenectomy for gastrointestinal stromal tumor.

    PubMed

    Corcione, Francesco; Pirozzi, Felice; Sciuto, Antonio; Galante, Francesco; Bracale, Umberto; Andreoli, Federica

    2013-06-01

    Gastrointestinal stromal tumors (GISTs) of the duodenum are rare neoplasms. The optimal surgical procedure is debated and several options ranging from limited resections to pancreaticoduodenectomy have been reported. The laparoscopic approach has been validated for gastric GISTs, but it does not yet represent a standard technique for tumors of the duodenum. We report the case of a localized duodenal GIST that was successfully treated by totally laparoscopic pancreas-preserving subtotal duodenectomy. This procedure may represent a feasible and effective treatment option for localized GISTs of the duodenum. Large series with long-term follow-up are needed. PMID:22732015

  16. Cystic tumors of the pancreas: imaging and management.

    PubMed

    Dewhurst, Catherine E; Mortele, Koenraad J

    2012-05-01

    Cystic tumors of the pancreas are a subset of rare pancreatic tumors that vary from benign to malignant. Many have specific imaging findings that allow them to be differentiated from each other. This article (1) reviews the imaging features of the common cystic pancreatic lesions, including serous microcystic adenoma, mucinous cystic tumor, intraductal papillary mucinous tumor, and solid pseudopapillary tumor, and including the less common lesions such as cystic endocrine tumors, cystic metastases, cystic teratomas, and lymphangiomas; and (2) provides comprehensive algorithms on how to manage the individual lesions, with recommendations on when to reimage patients. PMID:22560692

  17. Pancreatic stellate cells—role in pancreas cancer

    Microsoft Academic Search

    Max G. Bachem; Shaoxia Zhou; Karin Buck; Wilhelm Schneiderhan; Marco Siech

    2008-01-01

    Background  Adenocarcinomas of the pancreas are characterized by a rapid progression, an early metastasis, a limited response to chemo-\\u000a and radiotherapy, and an intense fibrotic reaction known as tumor desmoplasia. Carcinoma cells are surrounded by a dense stroma\\u000a consisting of myofibroblast-like cells, collagens, and fibronectin.\\u000a \\u000a \\u000a \\u000a Materials and methods  This review describes the interaction of activated pancreatic stellate cells (myofibroblast-like cells) with tumor

  18. Role of preoperative CT colonography in patients with colorectal cancer

    PubMed Central

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

    2014-01-01

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

  19. Role of preoperative CT colonography in patients with colorectal cancer.

    PubMed

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

    2014-04-14

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

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

    E-print Network

    Boyer, Edmond

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

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

    Microsoft Academic Search

    J. Alumets; F. Sundler; R. Hgtkanson

    1977-01-01

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

  2. Primary hepatocellular carcinoma (“hepatoid” carcinoma) of the pancreas: a case report and review of the literature

    PubMed Central

    Steen, Shawn; Wolin, Edward; Geller, Stephen A; Colquhoun, Steven

    2013-01-01

    Key Clinical Message We present a case of hepatocellular carcinoma located within the pancreas. These tumors occur in the body and tail of the pancreas, with a male predominance, and at a younger age. Tumors with pure hepatocellular histopathology have better survival and recurrence rates and should be offered surgical therapy if possible. PMID:25356215

  3. Occult adenocarcinoma of the pancreas in a patient with Lindau's disease

    Microsoft Academic Search

    T. Tomita; E. Vachal; S. Rengachary; I. Watanabe

    1978-01-01

    Summary An occult adenocarcinoma of the pancreas found at autopsy is reported in a 27-year-old white male with Lindau's disease. The present case, with hemangioblastomas of the cerebellum and brain stem, is associated with adenocarcinoma of the pancreas, pancreatic cysts, multiple renal cysts, multiple renal cell carcinomas, and cystadenomas of epididymes. The fact that the occurrence of occult adenocarcinoma is

  4. [Hypoechogenic aspects of the ventral embryonic cephalic pancreas: a large prospective clinical study].

    PubMed

    Coulier, B

    1996-06-01

    Global echogenicity of the normal pancreas increases essentially with lipomatous involution which is common with aging. However, the two embryologic different parts of the cephalic pancreas may present a different echogenicity: the "embryologic ventral" pancreas-posterior cephalic pancreas + uncinate process-is then hypoechoic because of less fatty involution. It is important to distinguish such normal variant from a pathological process. The clinical prevalence and morphologic characteristics of this normal variant have been prospectively studied in a large series of 446 patients including 275 females and 171 males. The study confirms the proportional increase of pancreatic echogenicity with age. The variant has a sharp female predominance: 27.5% of males vs 43.3% females, corresponding to a sex ratio of 1:1.52. Hypoechoic ventral embryologic cephalic pancreas is never encountered before the age of 25 and is most frequent in middle aged females with moderately echoic pancreas. There is not any difference in global cephalic pancreatic thickness between our positive group and a negative group of reference of 66 patients. These observations rather plead a genetic uneven fatty involution in positive cases instead of ventral pancreas atrophy in negative cases. The morphological and biometric characteristics of the hypoechoic embryologic ventral pancreas are rather stable. These are relatively independent from age, sex, and global pancreatic echogenicity. PMID:8765075

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

    Microsoft Academic Search

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

    1994-01-01

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

  6. [A safely resected case of hypervascular pancreatic giant tumor after preoperative arterial embolization].

    PubMed

    Hirose, Atsushi; Tajima, Hidehiro; Okamoto, Koichi; Makino, Isamu; Kinoshita, Jun; Hayashi, Hironori; Nakamura, Keishi; Oyama, Katsunobu; Nakagawara, Hisatoshi; Inokuchi, Masafumi; Fujita, Hideto; Takamura, Hiroyuki; Ninomiya, Itasu; Kitagawa, Hirohisa; Fushida, Sachio; Tani, Takashi; Fujimura, Takashi; Ohta, Tetsuo; Koda, Wataru; Matsui, Osamu

    2011-11-01

    A 73-year-old woman visited our hospital for a treatment of pancreatic tumor that increased steadily in size of 6 cm in diameter in 1999 to 13 cm in 2008, while remaining in asymptomatic condition throughout this follow-up time. The tumor was big and flowed from many vessels such as portal and superior mesenteric veins and the celiac and superior mesenteric arteries. These were critical for determining tumor respectability and the risk of massive intra-operative hemorrhage was felt to be considerable. Therefore, preoperative embolization of the tumor-feeding arteries arising from the celiac axis (gastroduodenal, splenic and dorsal pancreatic arteries) was performed on the previous day of operation. Tumor resection with pancreaticoduodenectomy and partial resection of portal vein and reconstruction were performed. We got to SMA with the use of "paraduodenal mesenteric approach", we called, and we finished the operation without a blood transfusion. The final pathology confirmed the diagnosis of serous microcystic adenoma. PMID:22202410

  7. Bilateral vocal cord injury following anterior cervical discectomy: could a better preoperative exam have prevented it?

    PubMed Central

    Hachwa, Bachar; Halim-Armanios, Mona

    2006-01-01

    We present a rare case of bilateral vocal cord injury (BVCI) following anterior cervical discectomy with fusion (ACD/F) in a 47 year old man. The patient experienced post-extubation stridor and whispering voice in the recovery room. Clinical assessment led to the diagnosis of BVCI. The patient was treated by tracheostomy and made a full recovery. What is unique about this case is that the patient had no reason for a preexisting unilateral vocal cord injury (UVCI) prior to this surgery. There have been only two similar cases in the English literature in which the patients had a preexisting unilateral vocal cord paralysis (UVCI). We recommend a more detailed preoperative airway exam to include a voice exam with specific voice fatigue questioning on all patients coming for ACD/F. Such detailed assessment may uncover hidden UVCI and allow a safer perioperative period. PMID:21526013

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

    NASA Astrophysics Data System (ADS)

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

    2009-02-01

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

  9. Microcytic adenoma coexistent with low-grade malignant islet cell tumor of the pancreas.

    PubMed

    Jung, H K; Son, H Y; Lee, H C; Yi, S Y

    2001-01-01

    We report a case of microcystic (glycogen-rich) adenoma of the whole pancreas with coexistent pancreatic low-grade malignant islet cell tumor in a 29-year-old woman. She complained of nausea, vomiting, and growing abdominal mass. Abdominal computed tomography showed multiple cysts in the whole pancreas and a calcified solid mass in the pancreatic head. A Whipple's operation and total pancreatectomy with splenectomy was performed to treat pancreatic cystic neoplasm. The pancreas was entirely replaced by variable-sized, multilocular cysts, which were lined by a flattened-to-cuboidal glycogen-rich epithelium. Furthermore, in the head of the pancreas, a focal yellowish solid mass showed a positive reaction for chromogranin A and neuron-specific enolase. Careful examination of the pancreas is warranted in cases of microcystic adenoma to rule out a possible coexistent pancreatic malignancy. PMID:11319320

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

    PubMed

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

    2014-01-01

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

  11. Metabolic regulation of cellular plasticity in the pancreas

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

    Sperti, Cosimo; Moletta, Lucia; Patanè, Giuseppe

    2014-01-01

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

  13. Acid-base transport in pancreas—new challenges

    PubMed Central

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

    2013-01-01

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

  14. Pancreas transplantation. An immunohistologic and histopathologic examination of 100 grafts.

    PubMed Central

    Sibley, R. K.; Sutherland, D. E.

    1987-01-01

    The authors examined tissues obtained by biopsy, pancreatectomy, and autopsy from 100 pancreas grafts to determine the cause of dysfunction or failure of the graft. Immunohistologic examination of 42 tissues to determine the mononuclear cell phenotypes and Class I and II antigen expression was performed as well. Technical factors--infections, thrombosis, obstruction--accounted for a large number of graft losses, but immunologic-mediated mechanisms resulted in graft dysfunction and failure as well. Pleomorphic inflammatory infiltrates were present in grafts with acute rejection, as well as Silastic and Prolamine duct-obstructed grafts. Criteria useful in the identification of acute rejection from pancreatitis included a more intense, predominantly mononuclear cell infiltration of transformed lymphocytes in the exocrine pancreas and evidence of vascular rejection--endovasculitis or fibrinoid necrosis. Increased expression and/or induction of Class I and II antigens on pancreatic constituents occurred in grafts with evidence of acute rejection, but also with Silastic and prolamine duct-obstructed pancreatitis. An isletitis occurred in 25% of the grafts. Nine of the 25 grafts (36%) with isletitis also had selective loss of beta cells from the islets. Recurrent diabetes mellitus appeared to have developed in these cases, which accounted for loss of graft function. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 Figure 14 PMID:3037911

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

    SciTech Connect

    Wan Haiyan [Department of Biological Sciences, National University of Singapore (Singapore); Korzh, Svitlana [Department of Biological Sciences, National University of Singapore (Singapore); Li Zhen [Department of Biological Sciences, National University of Singapore (Singapore); Mudumana, Sudha Puttur [Department of Biological Sciences, National University of Singapore (Singapore); Korzh, Vladimir [Department of Biological Sciences, National University of Singapore (Singapore); Laboratory of Fish Developmental Biology, Institute of Molecular and Cell Biology (Singapore); Jiang Yunjin [Laboratory of Developmental Signaling and Patterning, Institute of Molecular and Cell Biology (Singapore); Lin Shuo [Department of Molecular, Cell and Developmental Biology, University of California at Los Angeles, CA 90024 (United States); Gong Zhiyuan [Department of Biological Sciences, National University of Singapore (Singapore) and Department of Molecular, Cell and Developmental Biology, University of California at Los Angeles, CA 90024 (United States)]. E-mail: dbsgzy@nus.edu.sg

    2006-05-15

    In contrast to what we know on development of endocrine pancreas, the formation of exocrine pancreas remains poorly understood. To create an animal model that allows observation of exocrine cell differentiation, proliferation, and morphogenesis in living animals, we used the zebrafish elastaseA (elaA) regulatory sequence to develop transgenic zebrafish that display highly specific exocrine pancreas expression of GFP in both larvae and adult. By following GFP expression, we found that the pancreas in early development was a relatively compact organ and later extended posterior along the intestine. By transferring the elaA:gfp transgene into slow muscle omitted mutant that is deficient in receiving Hedgehog signals, we further showed that Hedgehog signaling is required for exocrine morphogenesis but not for cell differentiation. We also applied the morpholino knockdown and toxin-mediated cell ablation approaches to this transgenic line. We showed that the development of exocrine pancreas is Islet-1 dependent. Injection of the diphtheria toxin A (DTA) construct under the elastaseA promoter resulted in selective ablation of exocrine cells while the endocrine cells and other endodermal derivatives (liver and intestine) were not affected. Thus, our works demonstrated the new transgenic line provided a useful experimental tool in analyzing exocrine pancreas development.

  16. Intestinal strictures complicating preoperative radiation therapy followed by radical cystectomy

    SciTech Connect

    Hillyard, R.W. Jr.; el-Mahdi, A.M.; Schellhammer, P.F.

    1986-07-01

    Between January 1975 and January 1981, 100 patients with invasive bladder cancer were evaluated for therapy. Of these patients 51 were selected for treatment with preoperative radiation therapy followed by radical cystectomy. Of 36 patients who actually completed the integrated therapy 4 (11 per cent) had clinical intestinal strictures. Three strictures occurred more than 24 months and 1 less than 6 months postoperatively. Strictures involved the colon in 3 cases and the ileum in 1. An operation was required in 2 cases. We present these 4 cases, and discuss the pathophysiology and treatment of the radiation-injured intestine. Our experience suggests that preoperative radiation therapy in conjunction with radical cystectomy may be associated with the development of clinically significant bowel injury. This factor should be considered in the decision to combine preoperative radiation therapy with radical cystectomy in the treatment of bladder cancer.

  17. Colony-forming cells in the adult mouse pancreas are expandable in Matrigel and form endocrine/acinar

    E-print Network

    Sander, Maike

    Colony-forming cells in the adult mouse pancreas are expandable in Matrigel and form endocrine isolated from dissociated adult (2­4 mo old) murine pancreas. We find that a methylcellulose microfluidic expression analysis of single cells and colonies, should also advance study of pancreas

  18. Inactivation of TIF1c Cooperates with KrasG12D Cystic Tumors of the Pancreas

    E-print Network

    Paris-Sud XI, Université de

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

  19. Fault diagnosis

    NASA Technical Reports Server (NTRS)

    Abbott, Kathy

    1990-01-01

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

  20. Preoperative brain shift: study of three surgical cases

    NASA Astrophysics Data System (ADS)

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

    2008-03-01

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

  1. The Diagnosis of Periprosthetic Infection

    PubMed Central

    del Arco, Alfonso; Bertrand, María Luisa

    2013-01-01

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

  2. Dual Diagnosis

    Microsoft Academic Search

    Mark S. Gold

    2005-01-01

    It is estimated that 10 million persons in me United States have at least one mental disorder and at least one substance-related disorder in any given year. Dual disorders are common in psychiatry, but misdiagnosis may be even more common. Drug and alcohol testing should be expanded from routine use in the Olympics and intercollegiate athletics to psychiatric diagnosis of

  3. Carcinomas of the ventral and dorsal pancreas exhibit different patterns of lymphatic spread.

    PubMed

    Kitagawa, Hirohisa; Ohta, Tetsuo; Makino, Isamu; Tani, Takashi; Tajima, Hidehiro; Nakagawara, Hisatoshi; Ohnishi, Ichiro; Takamura, Hiroyuki; Kayahara, Masato; Watanabe, Hiroyuki; Gabata, Toshifumi; Matsui, Osamu; Zen, Yoh

    2008-01-01

    In patients with carcinoma of the head of the pancreas with positive lymph nodes, the extent of an adequate lymph node dissection beyond peripancreatic area has remained controversial. Based on the two anlagens, the ventral or dorsal pancreas, we assessed the lymphatic spread pattern in 58 primary adenocarcinoma of head of the pancreas. Detection of lymph node metastasis was based on microscopic detection of carcinoma in consecutive serial sections of resected specimens including lymph nodes. When the tumor was confined to the ventral pancreas domain (n=20), the lymph node metastases were limited to areas along the superior mesenteric artery (SMA) besides peripancreatic lymph nodes. When the tumor was in the dorsal pancreas domain (n=6), the lymph node metastases were limited to areas along the common hepatic artery (CHA) and the hepatoduodenal ligament besides peripancreatic lymph nodes. When the tumor was extended into both domains (n=32), the lymph node metastases were distributed widely in areas along the SMA, CHA and the hepatoduodenal ligament besides peripancreatic lymph nodes. Based on these findings, the lymphatic spread of carcinomas of the head of the pancreas can be divided into two patterns by tumor location based on the two anlagens of the pancreas. PMID:17981748

  4. Pancreas-specific deletion of mouse Gata4 and Gata6 causes pancreatic agenesis

    PubMed Central

    Xuan, Shouhong; Borok, Matthew J.; Decker, Kimberly J.; Battle, Michele A.; Duncan, Stephen A.; Hale, Michael A.; Macdonald, Raymond J.; Sussel, Lori

    2012-01-01

    Pancreatic agenesis is a human disorder caused by defects in pancreas development. To date, only a few genes have been linked to pancreatic agenesis in humans, with mutations in pancreatic and duodenal homeobox 1 (PDX1) and pancreas-specific transcription factor 1a (PTF1A) reported in only 5 families with described cases. Recently, mutations in GATA6 have been identified in a large percentage of human cases, and a GATA4 mutant allele has been implicated in a single case. In the mouse, Gata4 and Gata6 are expressed in several endoderm-derived tissues, including the pancreas. To analyze the functions of GATA4 and/or GATA6 during mouse pancreatic development, we generated pancreas-specific deletions of Gata4 and Gata6. Surprisingly, loss of either Gata4 or Gata6 in the pancreas resulted in only mild pancreatic defects, which resolved postnatally. However, simultaneous deletion of both Gata4 and Gata6 in the pancreas caused severe pancreatic agenesis due to disruption of pancreatic progenitor cell proliferation, defects in branching morphogenesis, and a subsequent failure to induce the differentiation of progenitor cells expressing carboxypeptidase A1 (CPA1) and neurogenin 3 (NEUROG3). These studies address the conserved and nonconserved mechanisms underlying GATA4 and GATA6 function during pancreas development and provide a new mouse model to characterize the underlying developmental defects associated with pancreatic agenesis. PMID:23006325

  5. A novel nonneuronal catecholaminergic system: exocrine pancreas synthesizes and releases dopamine.

    PubMed Central

    Mezey, E; Eisenhofer, G; Harta, G; Hansson, S; Gould, L; Hunyady, B; Hoffman, B J

    1996-01-01

    Cells of the exocrine pancreas produce digestive enzymes potentially harmful to the intestinal mucosa. Dopamine has been reported to protect against mucosal injury. In looking for the source of dopamine in the small intestine, we found that the duodenal juice contains high levels of dopamine and that the pancreas itself has a high dopamine [and dihydroxyphenylalanine (dopa)] content that does not change significantly after chemical sympathectomy. Furthermore, we were able to demonstrate tyrosine hydroxylase (TH) activity in control pancreas as well as in pancreas from rats after chemical sympathectomy. Immunostaining and in situ hybridization histochemistry confirmed both the presence of TH, dopamine, and the dopamine transporter, and the mRNAs encoding TH and dopamine transporter, and the presence of both types of vesicular monoamine transporters in the exocrine cells of the pancreas. Since there are no catecholaminergic enteric ganglia in the pancreas, the above results indicate that pancreatic cells have all the characteristics of dopamine-producing cells. We suggest that the pancreas is an important source of nonneuronal dopamine in the body, and that this dopamine has a role in protecting the intestinal mucosa and suggests that dopamine D1b receptor agonists might be used to help mucosal healing in the gastrointestinal tract. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 PMID:8816808

  6. Preoperative and preooperative issuesin the orthopaedic surgical patient

    Microsoft Academic Search

    Fred H. Rubin

    2002-01-01

    Elderly patients account for most cases of hip fracture, total hip replacement, and total knee replacement surgery. Although surgery in the elderly is associated with greater risk than in younger patients, this risk is due primarily to comorbidities and not to the normal aging process. Careful preoperative evaluation is required and should focus on optimizing the status of patients' chronic

  7. Preoperative evaluation of ovarian tumors in the premenopause by transvaginosonography

    Microsoft Academic Search

    Rüdiger G. W. Osmers; Margot Osmers; Bernd von Maydell; Burkhard Wagner; Walther Kuhn

    1996-01-01

    OBJECTIVE: The aim of the study was to establish reproducible sonomorphologic criteria by use of transvaginosonography in the preoperative evaluation of ovarian tumors in the premenopause. STUDY DESIGN: In a prospective study from 1987 to 1993 we investigated 1072 ovarian tumors. All tumors ?3 cm were included in the study. To avoid unnecessary operations, all tumors we rescanned after 6

  8. Preoperative portal vein embolization for extension of hepatectomy indications

    Microsoft Academic Search

    T de Baere; A Roche; D Elias; P Lasser; C Lagrange; V Bousson

    1996-01-01

    To render hepatectomy feasible in patients with an initially deficient volume of the future remnant liver (FRL), we redistributed portal blood flow rich in hepatotrophic substances toward the FRL. Redistribution was achieved with preoperative portal vein embolization (POPE) feeding the future resected liver. POPE was performed in 31 patients, under fluoroscopic guidance, via a percutaneous access. POPE was well tolerated

  9. Patterns of Response After Preoperative Treatment in Gastric Cancer

    SciTech Connect

    Diaz-Gonzalez, Juan A., E-mail: jadiaz@unav.es [Division of Radiation Oncology, Clinica Universidad de Navarra, Pamplona (Spain); Rodriguez, Javier [Division of Medical Oncology, Department of Oncology, Clinica Universidad de Navarra, Pamplona (Spain); Hernandez-Lizoain, Jose L. [Department of Surgery, Clinica Universidad de Navarra, Pamplona (Spain); Ciervide, Raquel; Gaztanaga, Miren; San Miguel, Inigo; Arbea, Leire; Aristu, J. Javier [Division of Radiation Oncology, Clinica Universidad de Navarra, Pamplona (Spain); Chopitea, Ana [Division of Medical Oncology, Department of Oncology, Clinica Universidad de Navarra, Pamplona (Spain); Martinez-Regueira, Fernando; Valenti, Victor [Department of Surgery, Clinica Universidad de Navarra, Pamplona (Spain); Garcia-Foncillas, Jesus [Division of Medical Oncology, Department of Oncology, Clinica Universidad de Navarra, Pamplona (Spain); Martinez-Monge, Rafael [Division of Radiation Oncology, Clinica Universidad de Navarra, Pamplona (Spain); Sola, Jesus J. [Department of Pathology, Clinica Universidad de Navarra, Pamplona (Spain)

    2011-07-01

    Purpose: To analyze the rate of pathologic response in patients with locally advanced gastric cancer treated with preoperative chemotherapy with and without chemoradiation at our institution. Methods and Materials: From 2000 to 2007 patients were retrospectively identified who received preoperative treatment for gastric cancer (cT3-4/ N+) with induction chemotherapy (Ch) or with Ch followed by concurrent chemoradiotherapy (45 Gy in 5 weeks) (ChRT). Surgery was planned 4-6 weeks after the completion of neoadjuvant treatment. Pathologic assessment was used to investigate the patterns of pathologic response after neoadjuvant treatment. Results: Sixty-one patients were analyzed. Of 61 patients, 58 (95%) underwent surgery. The R0 resection rate was 87%. Pathologic complete response was achieved in 12% of the patients. A major pathologic response (<10% of residual tumor) was observed in 53% of patients, and T downstaging was observed in 75%. Median follow-up was 38.7 months. Median disease-free survival (DFS) was 36.5 months. The only patient-, tumor-, and treatment-related factor associated with pathologic response was the use of preoperative ChRT. Patients achieving major pathologic response had a 3-year actuarial DFS rate of 63%. Conclusions: The patterns of pathologic response after preoperative ChRT suggest encouraging intervals of DFS. Such a strategy may be of interest to be explored in gastric cancer.

  10. The Role of Preoperative TIPSS to Facilitate Curative Gastric Surgery

    SciTech Connect

    Norton, S.A.; Vickers, J. [Bristol Royal Infirmary, Bristol BS2 8HW, University Department of Surgery (United Kingdom); Callaway, M.P. [Bristol Royal Infirmary, Bristol BS2 8HW, Department of ClinicalRadiology (United Kingdom)], E-mail: Mark.Callaway@ubht.swest.nhs.uk; Alderson, D. [Bristol Royal Infirmary, Bristol BS2 8HW, University Department of Surgery (United Kingdom)

    2003-08-15

    The use of TIPSS to facilitate radical curative upper gastrointestinal surgery has not been reported. We describe a case in which curative gastric resection was performed for carcinoma of the stomach after a preoperative TIPSS and embolization of a large gastric varix in a patient with portal hypertension.

  11. Preoperative physical assessment of thyroid glands in previously irradiated patients

    Microsoft Academic Search

    Stephen F. Sener; Edward F. Scanlon; Rafael M. Garces; Janardan D. Khandekar; E. Dennis Murphy

    1979-01-01

    The Evanston Hospital maintains an Irradiated Thyroid Evaluation Clinic that has evaluated 695 patients since 1975. One hundred fourteen patients were retrospectively analyzed, and an attempt was made to correlate the preoperative physical examination with the pathologic specimen after thyroidectomy. There was no statistically significant difference between the incidence of carcinoma in glands containing a single nodule (23 per cent)

  12. Preoperative Sizing of Meniscal Allografts in Meniscus Transplantation

    Microsoft Academic Search

    Benjamin Shaffer; Stuart Kennedy; John Klimkiewicz; Lawrence Yao

    2000-01-01

    The purpose of this study was to determine the accuracy of radiographic and magnetic resonance imaging techniques in preoperative sizing for allograft meniscus transplantation. Twelve cadaveric knee specimens underwent sequential radiographs, magnetic resonance imaging scans, and arthrotomy. Meniscus dimensions were measured in multiple planes for the purpose of determining accuracy of imaging studies in comparison with actual meniscus dimensions. Overall,

  13. Prospective preoperative determination of mucinous pancreatic cystic neoplasms

    Microsoft Academic Search

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

    2002-01-01

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

  14. Preoperative planning and training simulation for risk reducing surgery

    E-print Network

    Weyrich, Tim

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

  15. Pancoast tumors: improved survival with preoperative and postoperative radiotherapy

    Microsoft Academic Search

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

    1987-01-01

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

  16. Predicting Risk of Death in General Surgery Patients on the Basis of Preoperative Variables Using American College of Surgeons National Surgical Quality Improvement Program Data

    PubMed Central

    Vaid, Sachin; Bell, Ted; Grim, Rod; Ahuja, Vanita

    2012-01-01

    Objectives: To use the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database to develop an accurate and clinically meaningful preoperative mortality predictor (PMP) for general surgery on the basis of objective information easily obtainable at the patient’s bedside and to compare it with the preexisting NSQIP mortality predictor (NMP). Methods: Data were obtained from the ACS NSQIP Participant Use Data File (2005 to 2008) for current procedural terminology codes that included open pancreas surgery and open/laparoscopic colorectal, hernia (ventral, umbilical, or inguinal), and gallbladder surgery. Chi-square analysis was conducted to determine which preoperative variables were significantly associated with death. Logistic regression followed by frequency analysis was conducted to assign weight to these variables. PMP score was calculated by adding the scores for contributing variables and was applied to 2009 data for validation. The accuracy of PMP score was tested with correlation, logistic regression, and receiver operating characteristic analysis. Results: PMP score was based on 16 variables that were statistically reliable in distinguishing between surviving and dead patients (p < 0.05). Statistically significant variables predicting death were inpatient status, sepsis, poor functional status, do-not-resuscitate directive, disseminated cancer, age, comorbidities (cardiac, renal, pulmonary, liver, and coagulopathy), steroid use, and weight loss. The model correctly classified 98.6% of patients as surviving or dead (p < 0.05). Spearman correlation of the NMP and PMP was 86.9%. Conclusion: PMP score is an accurate and simple tool for predicting operative survival or death using only preoperative variables that are readily available at the bedside. This can serve as a performance assessment tool between hospitals and individual surgeons. PMID:23251111

  17. Experience with the technique of pancreas-sparing distal duodenectomy.

    PubMed

    Sali, Priyanka A; Shah, Rajiv; Jagannath, Palepu

    2014-01-01

    Pancreas-sparing distal duodenectomy (PSDD) is a novel surgical technique for tumors of distal duodenum below the ampulla to achieve oncologically free margins and avoid multiple anastomoses. We report PSDD performed in five cases, three duodenal adenocarcinoma, and two neuroendocrine tumors (NETs). Three patients had adenocarcinoma of D3 and D4 with free ampulla. PSDD was performed with total excision of regional nodes. In the two patients with NETs, one had a mass lesion close to the pancreatic head. The mass was excised followed by PSDD. There were four small primary NETs in the duodenum, and the mass was metastatic lymph node. The second patient had primary duodenal NET with liver metastases. After transarterial chemoembolization, PSDD with liver metastatectomy was performed. Specimens in all five cases showed clear margins. The patients had a smooth recovery and were well at a median follow up of 10 months. PMID:24243079

  18. Making ? cells from Adult Cells within the Pancreas

    PubMed Central

    Lysy, Philippe A.; Weir, Gordon C.; Bonner-Weir, Susan

    2013-01-01

    Cell therapy is currently considered as a potential therapeutic alternative to traditional treatments of diabetes. Islet and whole pancreas transplantations provided the proof- of-concept of glucose homeostasis restoration after replenishment of the deficiency of ? cells responsible for the disease. Current limitations of these procedures have led to the search for strategies targeting replication of pre-existing ? cells or transdifferentiation of progenitors and adult cells. These investigations revealed an unexpected plasticity towards ? cells of adult cells residing in pancreatic epithelium (e.g. acinar, duct and ? cells). Here we discuss recent developments in ?-cell replication and ?-cell transdifferentiation of adult epithelial pancreatic cells, with an emphasis on techniques with a potential for clinical translation. PMID:23925431

  19. Binding characteristics of the muscarinic receptor subtype in rabbit pancreas

    SciTech Connect

    van Zwam, A.J.; Willems, P.H.; Rodrigues de Miranda, J.F.; de Pont, J.J.; van Ginneken, C.A. (Catholic Univ. of Nijmegen (Netherlands))

    1990-01-01

    The muscarinic receptor in the rabbit pancreas was characterized with the use of the labeled ligand ({sup 3}H)-(-)-quinuclidinyl-benzylate (({sup 3}H)-(-)-QNB). Specific binding of ({sup 3}H)-(-)-QNB to pancreatic acini was found to be reversible and of high affinity, with an equilibrium dissociation constant (KD) of 68 pmol/l and a receptor density (RT) of 170 fmol/mg protein. Agonist binding behaviour was investigated by displacement of ({sup 3}H)-(-)-QNB binding by eight agonists like arecoline, arecadine-propargylester (APE) and carbachol, yielding only low affinity binding sites. The inhibition of ({sup 3}H)-(-)-QNB binding by the selective antagonists pirenzepine, hexahydrosiladifenidol (HHSiD) and (11-(2-(diethyl-amino)-methyl-1-piperidinyl)acetyl)-5,11-dihydro-6H-pyr ido (2,3-b) (1,4) benzodiazepin-6-one (AF-DX 116) confirmed the M3 nature of the rabbit pancreatic receptor.

  20. Novel directions in neoadjuvant therapy for pancreas adenocarcinoma.

    PubMed

    Yang, Andrew; O'Reilly, Eileen M

    2015-05-01

    Surgical resection of pancreatic carcinoma has long represented the only viable option for a potential cure of pancreas cancer. The use of adjuvant chemotherapy post-resection has been established in treating micro metastases and prolonging disease-free survival. However, studies of neoadjuvant therapy have not come to any definitive conclusion regarding the overall efficacy of such treatment, despite the theoretical benefits. In this review, we examine the historical precedent as well as the current state of affairs regarding neoadjuvant therapy in resectable and borderline resectable pancreatic adenocarcinoma. In addition, we review the definitions for resectable and borderline resectable disease and highlight key areas of clinical investigation in the field and summarize the major ongoing neoadjuvant studies focused on resectable pancreatic adenocarcinoma. PMID:25686370

  1. Endoscopic papillectomy of minor papillar adenoma associated with pancreas divisum.

    PubMed

    Kanamori, Akira; Kumada, Takashi; Kiriyama, Seiki; Sone, Yasuhiro; Tanikawa, Makoto; Hisanaga, Yasuhiro; Toyoda, Hidenori; Kawashima, Hiroki; Itoh, Akihiro; Hirooka, Yoshiki; Goto, Hidemi

    2009-03-01

    Tumors of the minor papilla of the duodenum are quite rare. We successfully and safely treated an 18-mm adenoma of the minor papilla associated with pancreas divisum using endoscopic papillectomy. A 64-year-old man was admitted to our hospital for treatment of an asymptomatic mass in the minor papilla detected by upper gastrointestinal endoscopy. Endscopic analysis showed an 18-mm, whitish, sessile mass, located in the duodenum proximal to a normal-appearing major papilla. Endoscopic retrograde pancreatography did not reveal the pancreatic duct. Magnetic resonance cholangiopancreatography showed a lack of the ventral pancreatic duct. We suspected this case was associated with pancreatic divisum; therefore, we performed endoscopic papillectomy of the minor papilla tumor. Subsequently, endoscopic pancreatic stent placement in the minor papilla was done to prevent drainage disturbance. The patient has been asymptomatic without recurrence of tumor or stenosis of the Santorini orifice upon endoscopic examination for the past 2 years. PMID:19266610

  2. Artificial three-dimensional niches deconstruct pancreas development in vitro

    PubMed Central

    Greggio, Chiara; De Franceschi, Filippo; Figueiredo-Larsen, Manuel; Gobaa, Samy; Ranga, Adrian; Semb, Henrik; Lutolf, Matthias; Grapin-Botton, Anne

    2013-01-01

    In the context of a cellular therapy for diabetes, methods for pancreatic progenitor expansion and subsequent differentiation into insulin-producing beta cells would be extremely valuable. Here we establish three-dimensional culture conditions in Matrigel that enable the efficient expansion of dissociated mouse embryonic pancreatic progenitors. By manipulating the medium composition we generate either hollow spheres, which are mainly composed of pancreatic progenitors, or complex organoids that spontaneously undergo pancreatic morphogenesis and differentiation. The in vitro maintenance and expansion of pancreatic progenitors require active Notch and FGF signaling, thus recapitulating in vivo niche signaling interactions. Our experiments reveal new aspects of pancreas development, such as a community effect by which small groups of cells better maintain progenitor properties and expand more efficiently than isolated cells, as well as the requirement for three-dimensionality. Finally, growth conditions in chemically defined biomaterials pave the way for testing the biophysical and biochemical properties of the niche that sustains pancreatic progenitors. PMID:24130330

  3. 17 beta-hydroxysteroid dehydrogenase activity in canine pancreas

    SciTech Connect

    Mendoza-Hernandez, G.; Lopez-Solache, I.; Rendon, J.L.; Diaz-Sanchez, V.; Diaz-Zagoya, J.C.

    1988-04-15

    The mitochondrial fraction of the dog pancreas showed NAD(H)-dependent enzyme activity of 17 beta-hydroxysteroid dehydrogenase. The enzyme catalyzes oxidoreduction between androstenedione and testosterone. The apparent Km value of the enzyme for androstenedione was 9.5 +/- 0.9 microM, the apparent Vmax was determined as 0.4 nmol mg-1 min-1, and the optimal pH was 6.5. In phosphate buffer, pH 7.0, maximal rate of androstenedione reduction was observed at 37 degrees C. The oxidation of testosterone by the enzyme proceeded at the same rate as the reduction of the androstenedione at a pH of 6.8-7.0. The apparent Km value and the optimal pH of the enzyme for testosterone were 3.5 +/- 0.5 microM and 7.5, respectively.

  4. Quantitative immunocytochemical analysis of the endocrine pancreas of the Nile crocodile.

    PubMed

    Rhoten, W B

    1987-02-01

    Four major pancreatic hormones were immunolocalized at the light and electron microscopic levels in the pancreas of the Nile crocodile, Crocodilus niloticus. Immunogold was used for electron microscopy, and peroxidase-antiperoxidase was used for light microscopy. Somatostatin-positive D-cells and pancreatic polypeptide-containing F-cells accounted for about 60% of the immunoreactive cells in the ventral pancreas. Glucagon-positive A-cells were the least frequent cell type in the ventral pancreas, about 15%, but were the predominant cell type, about 40%, in the pancreas that was dorsal in character. An expanded population of D-cells (relative to mammals and other higher vertebrates) in association with two very different numbers of A-cells can be expected to have important consequences for the homotropic control of secretory activity of the endocrine pancreas as well as for the function of the acinar pancreas. F-cells were absent from the dorsal part of the pancreas, whereas insulin-containing B-cells were slightly more abundant in this portion of the pancreas. The regional character of the endocrine pancreas was related to the complex looping of the proximal small intestine. Without immunolabeling, only B-granules were morphognomonic in electron micrographs. The insulin-reactive B-granules were the smallest (370 nm) of the secretory granules and were followed in size by somatostatin-positive D-granules (380 nm). The pancreatic polypeptide-containing secretory granules were the largest (580 nm). Glucagon-reactive A-granules (430 nm) sometimes exhibited a protuberance or extension of secretory granule matrix and limiting membrane. Such a morphological feature has previously been associated with secretion of glucagon and the initiation of insulin secretion. Taken together these studies indicate that protuberances have a significant, but as yet undefined, role in pancreatic endocrine cells. PMID:3554958

  5. CLINICAL PROGRAMS OF STEM CELL THERAPIES FOR LIVER AND PANCREAS

    PubMed Central

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

    2013-01-01

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

  6. Pancreas transplant alone: a procedure coming of age.

    PubMed

    Gruessner, Rainer W G; Gruessner, Angelika C

    2013-08-01

    The goal of this review is to highlight the significant improvements, over the past four decades, in outcomes after a pancreas transplant alone (PTA) in patients with brittle diabetes and recurrent episodes of hypoglycemia and/or hypoglycemic unawareness. A successful PTA-in contrast to intensive insulin regimens and insulin pumps-restores normoglycemia without the risk of hypoglycemia and prevents, halts, or reverses the development or progression of secondary diabetes complications. In this International Pancreas Transplant Registry (IPTR) analysis, we reviewed the records of 1,929 PTA recipients from December 1966 to December 2011. We computed graft survival rates according to the Kaplan-Meier method and used uni- and multivariate analyses. In the most recent era (January 2007-December 2011), patient survival rates were >95% at 1 year posttransplant and >90% at 5 years. Graft survival rates with tacrolimus-based maintenance therapy were 86% at 1 year and 69% at 3 years and with sirolimus, 94 and 84%. Graft survival rates have significantly improved owing to marked decreases in technical and immunologic graft failure rates (P < 0.05). As a result, the need for a subsequent kidney transplant has significantly decreased, over time, to only 6% at 5 years. With patient survival rates of almost 100% and graft survival rates of up to 94% at 1 year, a PTA is now a highly successful long-term option. It should be considered in nonuremic patients with brittle diabetes in order to achieve normoglycemia, to avoid hypoglycemia, and to prevent the development or progression of secondary diabetes complications. PMID:23881967

  7. Artificial Pancreas: Model Predictive Control Design from Clinical Experience

    PubMed Central

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

    2013-01-01

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

  8. Impact of New Guidelines on Physicians’ Ordering of Preoperative Tests

    PubMed Central

    Mancuso, Carol A

    1999-01-01

    OBJECTIVE To compare the number of preoperative tests ordered for elective ambulatory surgery patients during the 2 years before and the 2 years after the establishment of new hospital testing guidelines. MEASUREMENTS The patterns of preoperative testing by surgeons and a medical consultant during the 2 years before and the 2 years after the establishment of new guidelines at one orthopedic hospital were reviewed. All tests ordered preoperatively were determined by review of medical records. Preoperative medical histories, physical examinations, and comorbidities were obtained according to a protocol by the medical consultant (author). Perioperative complications were determined by review of intraoperative and postoperative events, which also were recorded according to a protocol. MAIN RESULTS A total of 640 patients were enrolled, 361 before and 279 after the new guidelines. The mean number of tests decreased from 8.0 before to 5.6 after the new guidelines (p = .0001) and the percentage decrease for individual tests varied from 23% to 44%. Except for patients with more comorbidity and patients receiving general anesthesia, there were decreases across all patient groups. In multivariate analyses only time of surgery (before or after new guidelines), age, and type of surgery remained statistically significant (p = .0001 for all comparisons). Despite decreases in surgeons’ ordering of tests, the medical consultant did not order more tests after the new guidelines (p = .60) The majority of patients had no untoward events intraoperatively and postoperatively throughout the study period, with only 6% overall requiring admission to the hospital after surgery, mainly for reasons not related to abnormal tests. Savings from charges totaled $34,000 for the patients in the study. CONCLUSIONS Although there was variable compliance among physicians, new hospital guidelines were effective in reducing preoperative testing and did not result in increases in untoward perioperative events or in test ordering by the medical consultant. PMID:10203622

  9. Improving Surgical Outcomes in Pancreatic Surgery With Preoperative Nutrition

    PubMed Central

    Ward-Boahen, Dwanna; Wallace-Kazer, Meredith

    2014-01-01

    The purposes of this study were (1) to describe the relationship between preoperative physical status and postoperative outcomes in patients undergoing Whipple resection, and (2) to determine if the use of specialized immunonutrition with IMPACT Advanced Recovery supplementation improved postoperative outcomes (pancreatic leak rate, length of stay, and postoperative complications) in patients undergoing Whipple resection. The trial was a case-controlled prospective pilot study that took place in an outpatient gastrointestinal surgical oncology office in an urban community hospital in the northeast United States. The study population consisted of nine patients undergoing Whipple surgery. Patients were given IMPACT Advanced Recovery supplementation 4 days prior to Whipple surgery. Prospective data were collected on all patients and then compared to national averages in terms of outcomes. Study approval was obtained from the Fairfield University Institutional Review Board (IRB), though IRB approval was not required by the study facility due to the fact that this was a pilot study. Consent was also not required for retrospective chart review. Patients with lower scores according to the American Society of Anesthesiologists Physical Status Classification System have a shorter operating time in the setting of preoperative nutrition. Patients in this study who received preoperative nutrition with IMPACT Advanced Recovery supplementation had outcomes comparable to the national average. This pilot study suggests that there is a need for a multi-institutional randomized study powered to further evaluate the effectiveness of preoperative nutrition in pancreatic surgery. The literature supports the fact that preoperative nutritional supplementation should be offered to patients undergoing Whipple surgery. Optimization of nutritional status can translate to decreased length of stay and cost savings. PMID:25032044

  10. Colorectal Stenting: An Effective Therapy for Preoperative and Palliative Treatment

    SciTech Connect

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

    2007-06-15

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

  11. 77 FR 71804 - Antiseptic Patient Preoperative Skin Preparation Products; Public Hearing; Request for Comments...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-04

    ...No. FDA-2012-N-1040] Antiseptic Patient Preoperative Skin Preparation Products; Public Hearing; Request for Comments...a public hearing entitled ``Antiseptic Patient Preoperative Skin Preparation Products.'' The document was published with...

  12. Risk of Other Cancers in Individuals with a Family History of Pancreas Cancer

    Microsoft Academic Search

    Michele L. Cote; Maryjean Schenk; Ann G. Schwartz; Fawn D. Vigneau; Margaret Kinnard; Joel K. Greenson; Jon P. Fryzek; Gui Shuang Ying; David H. Garabrant

    2007-01-01

    Background  Inherited predisposition to pancreas cancer accounts for approximately 10% of cases. Familial aggregation may be influenced\\u000a by shared environmental factors and shared genes. We evaluate whether a family history of pancreas cancer is a risk factor\\u000a for ten specified cancers in first-degree relatives: bladder, breast, colon, head and neck, lung, lymphoma, melanoma, ovary,\\u000a pancreas, and prostate.\\u000a \\u000a \\u000a \\u000a Methods  Risk factor data and

  13. Unique Presentation of Giant Metastatic Microcystic Serous Adenocarcinoma of the Pancreas

    PubMed Central

    Kalal, Chetan Ramesh; Bihari, Chhagan; Sahney, Amrish; Kumar, KN Chandan; Rastogi, Archana

    2014-01-01

    Tumors of the pancreas that contain substantial cystic components include mainly mucinous cystic neoplasm, intraductal papillary mucinous neoplasm, solid pseudopapillary tumor, and cystadenomas (which encompass microcystic, macrocystic/oligocystic, and rare solid serous adenomas). Microcystic adenoma of the pancreas is a tumor that is benign in nature. Malignant transformation in the tumor with metastases is rare and only about 26 cases have been reported so far. Here we present a giant microcystic adenoma of the pancreas, possibly the largest ever malignant type in this group ever reported in the literature with extensive metastases to the liver and causing extensive compression and encasement on surrounding structures. PMID:24782930

  14. Unique presentation of giant metastatic microcystic serous adenocarcinoma of the pancreas.

    PubMed

    Philips, Cyriac Abby; Kalal, Chetan Ramesh; Bihari, Chhagan; Sahney, Amrish; Kumar, Kn Chandan; Rastogi, Archana

    2014-01-01

    Tumors of the pancreas that contain substantial cystic components include mainly mucinous cystic neoplasm, intraductal papillary mucinous neoplasm, solid pseudopapillary tumor, and cystadenomas (which encompass microcystic, macrocystic/oligocystic, and rare solid serous adenomas). Microcystic adenoma of the pancreas is a tumor that is benign in nature. Malignant transformation in the tumor with metastases is rare and only about 26 cases have been reported so far. Here we present a giant microcystic adenoma of the pancreas, possibly the largest ever malignant type in this group ever reported in the literature with extensive metastases to the liver and causing extensive compression and encasement on surrounding structures. PMID:24782930

  15. Solid pseudo papillary tumor of pancreas: Presenting as acute abdomen in a female child

    PubMed Central

    Pattanshetti, Vishwanath M.; Vinchurkar, Kumar; Pattanshetti, Sheetal V.

    2014-01-01

    Solid pseudo papillary tumor (SPT) or Frantz's tumor is a slow-growing low-grade malignant tumor, commonly seen in young patients with a female predominance, which is commonly located in the body and tail of the pancreas. We report a case of SPT arising from the body of the pancreas in a 12-year-old girl who presented with acute abdomen and was treated successfully by local excision of the tumor with preservation of head of pancreas and spleen. PMID:25197185

  16. Lipomatous pseudohypertrophy of the pancreas: further evidence of advanced hepatic lesion as the pathogenesis.

    PubMed

    Kuroda, Naoto; Okada, Mitsuo; Toi, Makoto; Hiroi, Makoto; Enzan, Hideaki

    2003-02-01

    An 80-year-old Japanese man with liver cirrhosis was suspected of having lipomatous pseudohypertrophy of the pancreas on the basis of results of ultrasonography and a computed tomography scan. He eventually died of hepatic failure. He had no obesity, diabetes mellitus or pancreatic symptoms during his entire clinical course. Autopsy results confirmed lipomatous pseudohypertrophy of the pancreas, cholecystolithiasis, and postnecrotic liver cirrhosis associated with submassive hepatic necrosis was suspected. Although the pathogenesis of lipomatous pseudohypertrophy of the pancreas is not clear, the findings in the present case provide further evidence to support the hypothesis that advanced hepatic lesions cause this lesion. PMID:12588437

  17. Pediatric en bloc dual kidney-pancreas transplantation into an adult recipient: a simplified technique. Benefits of the en bloc kidney-pancreas transplantation technique in pediatric donors.

    PubMed

    Buggenhout, Alexis; Hoang, Anh Dung; Hut, Florence; Lekeufack, Jean B; Bali, Maria-Antoniela; De Pauw, Luc

    2004-04-01

    The lower age limit for pancreas donors is not well defined. Fear of inadequate islet beta-cell mass and of technical complications has hampered the use of pediatric donors. A surgical technique of 'en bloc' kidney-pancreas is described. Both kidneys and pancreas were removed en bloc from a 13-kg, 31-month-old child. During bench preparation, one anastomosis was performed between the portal vein and the inferior vena cava. The proximal end of the aorta was closed. The bloc was transplanted into a 36-year-old type I diabetic patient intraperitoneally in the right iliac fossa. The kidneys functioned immediately. Pancreatic graft function resumed after POD 15 but insulin therapy was maintained until POD 112. Currently, the patient retains excellent kidney and pancreas graft functions. Very young donors can be accepted as pancreas donors for adult recipients, although slow recovery of pancreatic function can be expected. Use of the en bloc technique is well suited for very small children, as it prevents potential vascular complications. PMID:15023161

  18. Melanoma Diagnosis

    NASA Astrophysics Data System (ADS)

    Horsch, Alexander

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

  19. Signet Ring Cell Carcinoma of the Extrahepatic Bile Duct Diagnosed by Preoperative Biopsy: A Case Report

    PubMed Central

    Kita, Emiri; Tsujimoto, Akiko; Nakamura, Kazuyoshi; Sudo, Kentaro; Hara, Taro; Kainuma, Osamu; Yamamoto, Hiroshi; Itami, Makiko; Yamaguchi, y

    2014-01-01

    A 73-year-old woman was admitted because of obstructive jaundice. Computed tomography revealed a stricture in the lower bile duct with enhanced bile duct wall. Endoscopic retrograde cholangiopancreatography (ERCP) revealed a tapering stenosis at the lower bile duct. Transpapillary histological biopsy using biopsy forceps through ERCP was performed; the diagnosis of signet ring cell carcinoma (SRCC) of the bile duct was established. Regional lymph node enlargement and distant metastases were not detected on diagnostic imaging. Pancreaticoduodenectomy with pylorus preservation was performed. Histological examination of the resected specimen confirmed SRCC of the extrahepatic bile duct coexisting with adenocarcinoma (ADC) of the extrahepatic bile duct with negative resection margins. However, tumor cells directly invaded the pancreatic parenchyma and the muscle layer of the duodenum, prompting us to administer adjuvant chemotherapy to the patient, with no sign of tumor recurrence at 1-year follow-up. Almost all tumors originating from the extrahepatic bile duct are ADC and other histological variants are rare. Of these, SRCC is extremely rare and only four cases have been reported. Furthermore, to the best of our knowledge, this is the first case report regarding the preoperative diagnosis of SRCC of the bile duct. Current reports indicate that younger age and Asian ethnicity are the clinical features of SRCC of the extrahepatic bile duct. Immunohistochemical staining of CK7, CK20 and MUC2 may be useful for predicting prognosis. Chemotherapy has not resulted in increased survival rates and only surgical resection currently serves as a curative treatment. PMID:25520605

  20. The effect of national guidelines on the implementation of outpatient preoperative evaluation clinics in Dutch hospitals

    Microsoft Academic Search

    L. C. Lemmens; Klei van W. A; N. S. Klazinga; C. L. G. Rutten; Linge van R. H; K. G. M. Moons; H. E. M. Kerkkamp

    2006-01-01

    Background and objectives: Preoperative evaluation performed by anaesthesiologists primarily aims to estimate the risk of perioperative complications and to create opportunities to optimize the patients' condition before surgery. In this study an inventory was made of the current practice of preoperative evaluation in Dutch hospitals. It was estimated how many hospitals had implemented an outpatient preoperative evaluation clinic in 2004.

  1. Dipyridamole-thallium scanning in patients undergoing vascular surgery. Optimizing preoperative evaluation of cardiac risk

    Microsoft Academic Search

    K. A. Eagle; D. E. Singer; D. C. Brewster; R. C. Darling; A. G. Mulley; C. A. Boucher

    1987-01-01

    Dipyridamole-thallium imaging has been suggested as a method of preoperatively assessing cardiac risk in patients undergoing major surgery. To define more clearly its proper role in preoperative assessment, we prospectively evaluated 111 patients undergoing vascular surgery. In the first set of 61 patients, our data confirmed the value of preoperative dipyridamole-thallium scanning in identifying the patients who suffered postoperative ischemic

  2. Keratoconus: diagnosis and treatment.

    PubMed

    Nordan, L T

    1997-01-01

    At a minimum, the refractive surgeon should use the patient's history, refraction, keratometry, and slit-lamp examination to determine the status of a patient's cornea. A diagnosis of keratoconus easily can explain a patient's symptoms or greatly alter a plan of action for refractive surgery. If the surgeon finds automated topography useful as a screening device for keratoconus, for patient education, and for the documentation of corneal status, it also should be included in the patient's examination. Indeed, most cases of keratoconus will be demonstrated by automated topography. However, the surgeon must resist the notion that automated topography replaces manual keratometry. The two modalities should be additive to provide increased information about the patient's cornea and should not be considered in competition with each other, as implied by some. The most important information obtained from automated topography is the determination of the optical quality of the cornea. This information greatly affects the choice of refractive surgery and explains postoperative problems. Far too much attention has been paid to the exact dioptric power at different corneal sites indicated by automated topography. Indeed, current automated topography techniques can only estimate the dioptric values of an aspherical cornea several millimeters from the center of the cornea. Refraction is the most accurate means for determining the refractive status of the eye. Refractive surgery is designed to correct a refractive error; it is not a topographical map. Those topography units that afford the observer the most accurate information about corneal irregular astigmatism will become very valuable. Because irregular astigmatism is linked directly to keratoconus, the more sensitive an automated topography system is in detecting irregular astigmatism, the better will it detect the subtle levels of keratoconus. Above all, the astute corneal diagnostician must learn to appreciate irregular astigmatism and should train extensively with a manual keratometer to detect subtle yet very meaningful levels of preoperative keratoconus and irregular astigmatism following refractive surgery. PMID:9101345

  3. Small bowel obstruction due to phytobezoar: CT diagnosis.

    PubMed

    Ko, S; Lee, T; Ng, S

    1997-01-01

    We report two cases of small bowel obstruction (SBO) due to phytobezoar impaction. In both cases, computed tomography (CT) demonstrated a well-defined, ovoid intraluminal mass with mottled gas pattern within the dilated small bowel at the site of obstruction and an abruptly collapsed lumen beyond the lesion. Recognition of these CT findings allows specific preoperative diagnosis of SBO owing to this uncommon lesion. PMID:9233879

  4. Preoperative radiotherapy prolongs survival in operable esophageal carcinoma: A randomized, multicenter study of pre-operative radiotherapy and chemotherapy. The second scandinavian trial in esophageal cancer

    Microsoft Academic Search

    Knut Nygaard; Steinar Hagen; Hanne Sand Hansen; Reidulv Hatlevoll; Ragnar Hultborn; Anders Jakobsen; Matti Miintyla; Hans Modig; Eva Munck-Wikland; Bengt Rosengren; Johan Tausjø; Kjell Elgen

    1992-01-01

    In a prospective multicenter study, 186 patients with squamous cell esophageal carcinoma, who after evaluation were considered suitable for surgery, were randomized to 4 treatment groups: Group 1, surgery alone; Group 2, pre-operative chemotherapy (cisplatin and bleomycin) and surgery; Group 3, pre-operative irradiation (35 Gy) and surgery; Group 4, pre-operative chemotherapy, radiotherapy, and surgery. Three-year survival was significantly higher in

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

    PubMed Central

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

    2013-01-01

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

  6. Shear mechanical properties of the porcine pancreas: experiment and analytical modelling.

    PubMed

    Nicolle, S; Noguer, L; Palierne, J-F

    2013-10-01

    We provide the first account of the shear mechanical properties of porcine pancreas using a rheometer both in linear oscillatory tests and in constant strain-rate tests reaching the non-linear sub-failure regime. Our results show that pancreas has a low and weakly frequency-dependent dynamic modulus and experiences a noticeable strain-hardening beyond 20% strain. In both linear and non-linear regime, the viscoelastic behaviour of porcine pancreas follows a four-parameter bi-power model that has been validated on kidney, liver and spleen. Among the four solid organs of the abdomen, pancreas proves to be the most compliant and the most viscous one. PMID:23820244

  7. Total dorsal pancreatectomy for intraductal papillary mucinous neoplasm in a patient with pancreas divisum.

    PubMed

    Talbot, M L; Foulis, A K; Imrie, C W

    2005-01-01

    We report a case of intraductal papillary mucinous neoplasm confined to the dorsal (Santorini) pancreatic duct. A 51-year-old woman presented with a cystic lesion in the head of her pancreas and pancreas divisum. A biopsy taken during cyst-enteric drainage revealed dysplastic epithelium so the patient was scheduled for resection. At operation, excision of the entire dorsal pancreas was performed with preservation of the unaffected ventral pancreas and the spleen and its vessels. Over 6 years later she remains well with stable weight and a good quality of life. This case illustrates the benefits of anatomical preservation in pancreatic resection, and was performed some years prior to the only other reported similar case. PMID:15855827

  8. Inferior head resection of the pancreas for noninvasive intraductal papillary mucinous adenocarcinoma.

    PubMed

    Nakagohri, Toshio; Kinoshita, Taira; Konishi, Masaru; Inoue, Kazuto; Takahashi, Shinichiro

    2004-01-01

    We report inferior head resection of the pancreas for noninvasive intraductal papillary mucinous cancer. A 77-year-old man was admitted to our hospital complaining of epigastric pain. Contrast-enhanced computed tomographic scan and magnetic resonance imaging showed a multilocular cystic tumor 3.5 cm in diameter in the head of the pancreas. We performed inferior head resection of the pancreas with partial resection of the duct of Santorini. The duodenum, the common bile duct, and most of the duct of Santorini were preserved. He is presently alive and well without any evidence of recurrent disease 49 months after the operation. Partial pancreatic resection has the advantage of preserving pancreatic parenchyma. Inferior head resection of the pancreas would play an important role in surgical management of low-grade malignant neoplasm. PMID:15011879

  9. Adenocarcinoma arising from heterotopic pancreas at the third portion of the duodenum

    PubMed Central

    Fukino, Nobutada; Oida, Takatsugu; Mimatsu, Kenji; Kuboi, Youichi; Kida, Kazutoshi

    2015-01-01

    A 62-year-old Japanese man presented to our hospital with a history of weight loss of 6 kg in 4 mo. Imaging examinations revealed a tumor located on the third portion of the duodenum with stenosis. We suspected duodenal carcinoma and performed pancreas-preserving segmental duodenectomy. Adenocarcinoma arising from a heterotopic pancreas at the third portion of the duodenum was finally diagnosed by immunohistochemical staining. Malignant transformation in the duodenum arising from a heterotopic pancreas is extremely rare; to our knowledge, only 13 cases have been reported worldwide, including the present case. The most common location of malignancy is the proximal duodenum at the first and descending portion. Herein, we describe the first case of adenocarcinoma arising from a heterotopic pancreas, which was located in the third portion of the duodenum, with a review of the literature. PMID:25852297

  10. Revised classification of neuroendocrine tumours of the lung, pancreas and gut

    Microsoft Academic Search

    C. Capella; P. U. Heitz; H. Höfler; E. Solcia; G. Klöppel

    1995-01-01

    In this article new classifications of the neuroendocrine tumours of the lung, pancreas and gut are proposed. These classifications use a common frame work and attempt to consider the morphological, functional as well as biological features of the tumours.

  11. Pancreatitis in patients with pancreas divisum: Imaging features at MRI and MRCP

    PubMed Central

    Wang, Deng-Bin; Yu, Jinxing; Fulcher, Ann S; Turner, Mary A

    2013-01-01

    AIM: To determine the magnetic resonance cholangiopancreatography (MRCP) and magnetic resonance imaging (MRI) features of pancreatitis with pancreas divisum (PD) and the differences vs pancreatitis without divisum. METHODS: Institutional review board approval was obtained and the informed consent requirement was waived for this HIPAA-compliant study. During one year period, 1439 consecutive patients underwent successful MRCP without injection of secretin and abdominal MRI studies for a variety of clinical indications using a 1.5 T magnetic resonance scanner. Two experienced radiologists retrospectively reviewed all the studies in consensus. Disputes were resolved via consultation with a third experienced radiologist. The assessment included presence and the imaging findings of PD, pancreatitis, and distribution of abnormalities. The pancreatitis with divisum constituted the study group while the pancreatitis without divisum served as the control group. MRCP and MRI findings were correlated with final diagnosis. Fisher exact tests and Pearson × 2 tests were performed. RESULTS: Pancreatitis was demonstrated at MRCP and MRI in 173 cases (38 cases with and 135 cases without divisum) among the 1439 consecutive cases. The recurrent acute pancreatitis accounted for 55.26% (21 of 38) in pancreatitis patients associated with PD, which was higher than 6.67% (9 of 135) in the control group, whereas the chronic pancreatitis was a dominant type in the control group (85.19%, 115 of 135) when compared to the study group (42.11%, 16 of 38) (?2 = 40.494, P < 0.0001). In cases of pancreatitis with PD, the dorsal pancreatitis accounted for a much higher percentage than that in pancreatitis without PD (17 of 38, 44.74% vs 30 of 135, 22.22%) (?2 = 7.257, P < 0.05). CONCLUSION: MRCP and MRI can depict the features of pancreatitis associated with divisum. Recurrent acute pancreatitis and isolated dorsal involvement are more common in patients with divisum. PMID:23946595

  12. A generic support vector machine model for preoperative glioma survival associations.

    PubMed

    Emblem, Kyrre E; Pinho, Marco C; Zöllner, Frank G; Due-Tonnessen, Paulina; Hald, John K; Schad, Lothar R; Meling, Torstein R; Rapalino, Otto; Bjornerud, Atle

    2015-04-01

    Purpose To develop a generic support vector machine (SVM) model by using magnetic resonance (MR) imaging-based blood volume distribution data for preoperative glioma survival associations and to prospectively evaluate the diagnostic effectiveness of this model in autonomous patient data. Materials and Methods Institutional and regional medical ethics committees approved the study, and all patients signed a consent form. Two hundred thirty-five preoperative adult patients from two institutions with a subsequent histologically confirmed diagnosis of glioma after surgery were included retrospectively. An SVM learning technique was applied to MR imaging-based whole-tumor relative cerebral blood volume (rCBV) histograms. SVM models with the highest diagnostic accuracy for 6-month and 1-, 2-, and 3-year survival associations were trained on 101 patients from the first institution. With Cox survival analysis, the diagnostic effectiveness of the SVM models was tested on independent data from 134 patients at the second institution. Results were adjusted for known survival predictors, including patient age, tumor size, neurologic status, and postsurgery treatment, and were compared with survival associations from an expert reader. Results Compared with total qualitative assessment by an expert reader, the whole-tumor rCBV-based SVM model was the strongest parameter associated with 6-month and 1-, 2-, and 3-year survival in the independent patient data (area under the receiver operating characteristic curve, 0.794-0.851; hazard ratio, 5.4-21.2). Discussion Machine learning by means of SVM in combination with whole-tumor rCBV histogram analysis can be used to identify early patient survival in aggressive gliomas. The SVM model returned higher diagnostic accuracy values than an expert reader, and the model appears to be insensitive to patient, observer, and institutional variations. PMID:25486589

  13. Feasibility study of the treatment of primary unresectable carcinoma of the pancreas with 103PD brachytherapy

    Microsoft Academic Search

    Adam Raben; Borys Mychalczak; Murray F. Brennan; Bruce Minsky; Lowell Anderson; Ephraim S. Casper; Louis B. Harrison

    1996-01-01

    Purpose: The purpose of this study was to assess the feasibility of 103Pd bracytherapy in the management of primary unresectable carcinoma of the pancreas.Methods and Materials: Between August 1988 and January 1992, 11 patients with biopsy-proven primary unresectable adenocarcinoma of the pancreas were treated with 103Pd brachytherapy during laparotomy. The median age was 66 (range 57–70). The most common presenting

  14. Evaluation of artificial pancreas technology for continuous blood glucose monitoring in dogs

    Microsoft Academic Search

    Akihiro MoriPeter; Peter Lee; Takeshi Yokoyama; Hitomi Oda; Kaori Saeki; Yohei Miki; Satoshi Nozawa; Daigo Azakami; Yutaka Momota; Yuki Makino; Takako Matsubara; Motohisa Osaka; Katsumi Ishioka; Toshiro Arai; Toshinori Sako

    2011-01-01

    Artificial pancreas technology, involving “closed-loop” controls with real-time blood glucose monitoring, has been increasing\\u000a in reliability as its potential for clinical use and application grows. One such device, based on this technology, is the\\u000a STG-22 (Nikkiso Co., Ltd., Tokyo, Japan) artificial pancreas apparatus. In order to assess the reliability and accuracy of\\u000a the device for measuring blood glucose, it is

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

    PubMed Central

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

    2014-01-01

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

  16. Heterotopic pancreas of the gallbladder associated with segmental adenomyomatosis of the gallbladder.

    PubMed

    Lee, Seok Won; Yun, Sung Pil; Seo, Hyung-Il

    2013-05-01

    Heterotopic pancreas in the gallbladder is extremely rare and usually incidentally discovered at the pathologic examination followed by cholecystectomy for symptomatic gallbladder disease. Up to the presents, only about 30 cases have been reported. We report the case of a 36-year-old female who presented with symptoms of cholecystitis. The histological analysis followed by cholecystectomy revealed heterotopic pancreas of the cystic duct. PMID:23646318

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

    Microsoft Academic Search

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

    2008-01-01

    Background  Despite recent advances, the transcriptional hierarchy driving pancreas organogenesis remains largely unknown, in part due\\u000a to the paucity of comprehensive analyses. To address this deficit we generated ten SAGE libraries from the developing murine\\u000a pancreas spanning Theiler stages 17-26, making use of available Pdx1 enhanced green fluorescent protein (EGFP) and Neurog3 EGFP reporter strains, as well as tissue from adult

  18. Laparoscopically Implanted Gastric Pacemaker after Kidney-Pancreas Transplantation: Treatment of Morbid Obesity and Diabetic Gastroparesis

    Microsoft Academic Search

    Hugo Bonatti; Gerald Brandacher; Elisabeth Hoeller; Ingrid Stelzmueller; Walter Mark; Raimund Margreiter; Helmut Weiss

    2007-01-01

    Combined kidney-pancreas transplantation is the treatment of choice for end-stage diabetic nephropathy. Weight gain post-transplant\\u000a increases the risk for post-transplant complications and death due to cardiovascular events. Gastric pacemakers have been\\u000a used for therapy of diabetic gastropathy and for the treatment of moderate morbid obesity. We report a patient who experienced\\u000a significant weight gain following successful kidney-pancreas transplantation and was

  19. Resected adenocarcinoma of the pancreas— 616 patients: Results, outcomes, and prognostic indicators

    Microsoft Academic Search

    Taylor A. Sohn; Charles J. Yeo; Jokn L. Cameron; Leonidas Koniaris; Sunjay Kaushal; Ross A. Abrams; Patricia IC Sauter; JoAnn Coleman; Ralph H. Hruban; Keith D. Lillemoe

    2000-01-01

    This large-volume, single-institution review examines factors influencing long-term survival after resection in patients with\\u000a adenocarcinoma of the head, neck, uncinate process, body, or tail of the pancreas. Between January 1984 and July 1999 inclusive,\\u000a 616 patients with adenocarcinoma of the pancreas underwent surgical resection. A retrospective analysis of a prospectively\\u000a collected database was performed. Both univariate and multivariate models were

  20. Rehabilitation and quality of life in diabetic patients after successful pancreas-kidney transplantation

    Microsoft Academic Search

    Ø. H. Bentdal; P. Fauchald; I. B. Brekke; H. Holdaas; A. Hartmann

    1991-01-01

    Summary  Twenty-seven Type I diabetic patients in end-stage renal failure were followed after combined pancreas-kidney transplantation. All patients received duct-occluded segmental pancreas grafts. Clinical progression of extrarenal diabetic complications was studied in 11 patients with long-term functioning pancreatic and renal transplants (Group 1), and in 16 patients who had lost pancreatic graft function, but retained renal graft function (Group 2). Pretransplant,

  1. Delayed Production of IL18 in Lungs and Pancreas of Rats with Acute Pancreatitis

    Microsoft Academic Search

    Catherine M. Pastor; Denis R. Morel; Alain Vonlaufen; Eduardo Schiffer; Pierre Lescuyer; Jean-Louis Frossard

    2010-01-01

    Background\\/Aims: During acute pancreatitis, tumor necrosis factor (TNF)-?, interleukin (IL)-1 and IL-6 play a pivotal role in promoting injury in the pancreas and remote organs. IL- 18 is a more recently discovered proinflammatory cytokine whose expression is also increased in serum. However, the profile of IL-18 expression in the pancreas and lung is unknown, and the aim of our study

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

    Microsoft Academic Search

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

    1997-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  4. [Evaluation of preoperative effect for rectal cancer by transrectal ultrasonography].

    PubMed

    Taniyama, S

    1991-02-01

    The ultrasonographic examination was applied for the purpose of volume estimation of rectal cancer. We have performed 15 cases of echographic volume estimation compared with that of resected specimen (control group) and mean volume estimation error rate was 14.6% between two methods. And we also performed 17 preoperative irradiation cases of rectal cancer. Each tumor volume of pre- and post-irradiation was estimated echogenically and was compared with that of resected specimen. In the case when irradiation effect was remarkable, estimated volume by ultrasonography was much smaller in post-irradiation compared with that of pre-irradiation. Same tendency was also recognized in the study of resected specimen. Histopathological irradiation effect was also highly recognized in the case when echographic diminished rate was prominent. This method will useful for the judgement of preoperative irradiation effect in rectal cancer. PMID:2038288

  5. Review of preoperative transarterial chemoembolization for resectable hepatocellular carcinoma

    PubMed Central

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

    2015-01-01

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

  6. Diagnosis and management of endocrine gland neoplasms

    SciTech Connect

    Weller, R.E.

    1989-05-01

    Functional and nonfunctional neoplasms of the endocrine glands constitute some of the more challenging diagnostic and therapeutic problems in veterinary cancer medicine. The clinical signs are usually the result of an overproduction of hormones that are normally biosynthesized by the neoplastic endocrine gland (orthoendocrine syndromes), as opposed to those that are the result of hormones that are not normally biosynthesized and secreted by those cells that have undergone neoplastic transformation (paraendocrine syndromes, also known as endocrine paraneoplastic syndromes or ectopic hormone syndromes). The biological effects produced by a neoplasm may be out of proportion to the actual size of the tumor. This report focuses on the clinical signs and syndromes associated with neoplasms of the thyroid, adrenal glands and pancreas. Discussion will focus on the mechanisms producing the clinical signs, diagnosis, staging, therapy and prognosis. 2 tabs.

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

    PubMed Central

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

    2014-01-01

    Pancreata from Sprague Dawley rats of different developmental stages were studied to determine the expression and cellular localization of different c-MET isoforms in the developing rat pancreas. Pancreatic mRNA and protein expression levels of c-MET at different developmental stages from embryo to adult were detected by reverse transcription-polymerase chain reaction and by western blotting. To identify the cellular localization of c-MET protein in the developing rat pancreas, double immunofluorescent staining was performed using antibodies for cell type-specific markers and for c-MET. The expression of two isoforms of c-MET (190 kDa and 170 kDa) coincided with the development of the pancreas. The 190 kDa isoform of c-MET is expressed during embryonic stages, and its expression is replaced by the expression of the 170 kDa isoform as the pancreas develops. Only the 170 kDa isoform is expressed in the adult rat pancreas. Throughout all stages of pancreatic development, c-MET is expressed by vimentin-positive cells. In contrast, c-MET staining was stronger in rat pancreata from newborn to adult stages and overlapped with insulin-positive beta-cells. The dynamic expression and localization of different c-MET isoforms in the rat pancreas during different developmental stages indicates that distinct c-MET isoform might be involved in different aspects of pancreatic development. PMID:25674220

  8. Synthesis of guanidinoacetate and creatine from amino acids by rat pancreas.

    PubMed

    da Silva, Robin P; Clow, Kathy; Brosnan, John T; Brosnan, Margaret E

    2014-02-01

    Creatine is an important molecule involved in cellular energy metabolism. Creatine is spontaneously converted to creatinine at a rate of 1·7% per d; creatinine is lost in the urine. Creatine can be obtained from the diet or synthesised from endogenous amino acids via the enzymes arginine:glycine amidinotransferase (AGAT) and guanidinoacetate N-methyltransferase (GAMT). The liver has high GAMT activity and the kidney has high AGAT activity. Although the pancreas has both AGAT and GAMT activities, its possible role in creatine synthesis has not been characterised. In the present study, we examined the enzymes involved in creatine synthesis in the pancreas as well as the synthesis of guanidinoacetate (GAA) and creatine by isolated pancreatic acini. We found significant AGAT activity and somewhat lower GAMT activity in the pancreas and that pancreatic acini had measurable activities of both AGAT and GAMT and the capacity to synthesise GAA and creatine from amino acids. Creatine supplementation led to a decrease in AGAT activity in the pancreas, though it did not affect its mRNA or protein abundance. This was in contrast with the reduction of AGAT activity and mRNA and protein abundance in the kidney, suggesting that the regulatory mechanisms that control the expression of this enzyme in the pancreas are different from those in the kidney. Dietary creatine increased the concentrations of GAA, creatine and phosphocreatine in the pancreas. Unexpectedly, creatine supplementation decreased the concentrations of S-adenosylmethionine, while those of S-adenosylhomocysteine were not altered significantly. PMID:24103317

  9. Routine preoperative laboratory analyses are unnecessary before elective laparoscopic cholecystectomy

    Microsoft Academic Search

    T. N. Robinson; W. L. Biffl; E. E. Moore; J. K. Heimbach; C. M. Calkins; J. Burch

    2003-01-01

      Background: We formulated a clinical pathway (CP) for elective laparoscopic cholecystectomy (LC), which included the following\\u000a preoperative evaluation: history and physical (H&P), right upper quadrant ultrasound (US), and liver function tests (LFTs).\\u000a We hypothesized that routine LFTs did not alter management beyond that dictated by H&P and US, and could be excluded from\\u000a the CP. Methods: The study involved 387

  10. Optimized preoperative planning of calcaneal fractures using spiral computed tomography

    Microsoft Academic Search

    M. Freund; M. Thomsen; B. Hohendorf; W. Zenker; M. Heller

    1999-01-01

    .   The aim of this study was the evaluation of spiral-CT examinations in preoperative planning of calcaneal fractures supported\\u000a by 3D reconstructions after electronic disarticulation. We examined 45 patients with 47 calcaneal fractures with diagnostic\\u000a spiral-CT examinations in a prospective study. In addition to the conventional axial slices and sagittal reconstructions,\\u000a 3D reconstructions prior to and after electronic disarticulation were

  11. Arterial embolization to preoperatively manage pulmonary disease associated with inflammation

    Microsoft Academic Search

    Tohru Sakuragi; Yukinori Sakao; Masafumi Natsuaki; Tsuyoshi Itoh

    2002-01-01

    Preoperative arterial embolization is used in pulmonary disease to reduce intraoperative blood loss resulting from exposure\\u000a of extensive adherent pleura due to repeated inflammation. Between January 1996 and February 2001, 5 patients underwent surgery\\u000a with this procedure. Underlying diseases were 3 cases of aspergilloma and 1 each of chronic expanding hematoma and lung cancer.\\u000a All embolization was permanent, involving coil

  12. Preoperative oximetry and capnometry: potential respiratory screening tools

    Microsoft Academic Search

    Frank E. Block; Kris Minic Reynolds; Terhi Kajaste; Kermatollah Nourijelyani

    1996-01-01

    The growing number of patients admitted for outpatient surgery or for same-day admission makes it difficult to obtain thorough\\u000a pulmonary evaluation. We wanted to evaluate the applicability of pre-operative pulse oximetry and capnography as possible\\u000a pulmonary screening tools. In this preliminary study, 200 unselected, unmedicated adult patients who were being admitted for\\u000a surgery were connected to a dual parameter patient

  13. Preoperative brain shift: study of three surgical cases

    Microsoft Academic Search

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

    2008-01-01

    In successful brain tumor surgery, the neurosurgeon's objectives are threefold: (1) reach the target, (2) remove it and (3) preserve eloquent tissue surrounding it. Surgical Planning (SP) consists in identifying optimal access route(s) to the target based on anatomical references and constrained by functional areas. Preoperative images are essential input in Multi-modal Image Guided NeuroSurgery systems (MIGNS) and update of

  14. Comparison of oral lavage methods for preoperative colonic cleansing

    Microsoft Academic Search

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

    1986-01-01

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

  15. Preoperative fasting: current practice and areas for improvement.

    PubMed

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

    2014-03-01

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

  16. Preoperative staging of rectal cancer by intrarectal ultrasound

    Microsoft Academic Search

    U. Hildebrandt; G. Feifel

    1985-01-01

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

  17. Diabetic neuropathy after pancreas transplantation: determinants of recovery.

    PubMed

    Allen, R D; Al-Harbi, I S; Morris, J G; Clouston, P D; O'Connell, P J; Chapman, J R; Nankivell, B J

    1997-03-27

    Although simultaneous pancreas and kidney transplantation (SPK) achieves normoglycemia and correction of uremia in type I diabetic patients with renal failure, little data are available on long-term outcome and clinical determinants of recovery of peripheral neuropathy. In this prospective study, 219 electrophysiological studies using a standardized protocol were performed before and up to 8 years after SPK in 44 patients. Nine control diabetic recipients with functioning kidney but nonfunctioning pancreas transplants were studied on 35 occasions. Patients were 38.5+/-7.9 years old (mean+/-SD) with pretransplant diabetes present for 25.2+/-7.6 years. Significant polyneuropathy (total nerve conduction scores [NCS] <-1.0) was present in 89% before transplantation, which correlated with body weight (r=0.628, P<0.001). Two distinct patterns of neurological recovery were observed after SPK. Conduction velocity (CV) improved in a biphasic pattern, with a rapid initial recovery followed by subsequent stabilization. In contrast, the recovery of nerve amplitude was monophasic, and continued to improve for up to 8 years. Initial improvement in NCS was primarily due to an increase in CV (P=0.002 vs. baseline), and was best in shorter and younger patients. Recovery of total NCS at 6 months after SPK, assessed by multivariate analysis, was least in obese recipients and when performed in patients who had started dialysis before SPK, and was associated with lower transplant kidney isotopic glomerular filtration rate and HLA mismatch (P<0.05 to 0.001). Subsequent improvement was associated with less severe initial neuropathy, smaller body weight, and longer duration of diabetes (P<0.01 to 0.001). Fasting hyperinsulinemia was associated with impairment of initial recovery and subsequent NCS after SPK, but was worse in the control group. Recovery of nerve action potential amplitudes was predicted by better initial amplitudes and HLA mismatch, lower body weight, and the use of nifedipine (P<0.05 to 0.001). Nifedipine was used for hypertension in 33% of SPK and was associated with better CV and amplitudes, particularly in the upper limbs, where there was less neuropathy. The use of angiotensin-converting enzyme inhibitors also appeared beneficial, but this was confined to the lower limbs. SPK resulted in a gradual, sustained, and late improvement in nerve action potential amplitudes, consistent with axonal regeneration and partial reversal of diabetic neuropathy. These data suggest that early transplantation of uremic diabetic patients before onset of severe neuropathy, minimizing obesity and optimizing renal transplant function, maximizes neurological recovery after SPK. Furthermore, the preliminary data support randomized clinical trials for evaluation of nifedipine and angiotensin-converting enzyme inhibitors in diabetic neuropathy. PMID:9089222

  18. Utility of Preoperative Anesthesia Clinic Videoendoscopy for Airway Management Planning

    PubMed Central

    Kallio, Peter J; Cox, Ana E; Pagel, Paul S

    2014-01-01

    Introduction: The authors performed videolaryngoscopy during the preoperative anesthesia clinic evaluation of a patient with chronic dyspnea, stridor, and a previous hemilaryngectomy scheduled to undergo a series of orthopedic surgery procedures for an infected knee arthroplasty. The findings proved crucial for determining airway management. Case Presentation: A 68-year-old man presented to the preoperative anesthesia clinic for work-up before anticipated removal of infected total knee arthroplasty hardware, placement of antibiotic spacers, incision and drainage procedures, and revision arthroplasty. The patient had previously undergone a hemilaryngectomy and tracheostomy (now closed) for squamous cell carcinoma of the right true vocal cord. The patient described chronic dyspnea with minimal exertion. Inspiratory and expiratory wheezes and intermittent inspiratory stridor were present. A transnasal videolaryngoscopy examination was performed using topical anesthesia and demonstrated significant supraglottic scarring, a narrowed glottis, and subglottic stenosis. A computed tomography study confirmed the presence of tracheomalacia with subglottic stenosis. A permanent tracheostomy was performed to establish a definitive airway before the knee arthroplasty was removed. Conclusions: The case illustrates that transnasal videolaryngoscopy conducted in the preoperative anesthesia clinic is capable of providing key information to guide airway management in patients with significant upper airway pathology. PMID:25337475

  19. The usefulness of preoperative biopsy in unilateral nasal masses.

    PubMed

    Segal, Nili; Gluck, Ofer; Bavnik, Yosef; Plakht, Ygal; Yakirevitch, Arkadi

    2014-03-01

    Unilateral nasal masses are considered suspicious for proliferative diseases. Several tools are routinely used to investigate unilateral lesions such as imaging and nasal biopsy. This study investigated the usefulness of nasal biopsy in predicting the actual nature of unilateral lesions. Preoperative nasal biopsy pathological results were compared with the final pathology obtained during an operation. Forty-six patients with unilateral nasal masses were included in the study group. In 40 patients the final pathology was similar to the preoperative nasal biopsy. In three patients the biopsy specimen was a benign polyp and the final pathology was of an inverted papilloma in two patients and hemangiopericytoma in one patient. In two patients the biopsy specimen was suspicious for an inverted papilloma and the final pathology was a benign polyp. In one patient the biopsy specimen was chordoma and the final pathology was osteosarcoma. The total agreement was 86.9%. The kappa value was 81.2%. Preoperative nasal biopsy is important and useful in evaluating unilateral nasal masses. PMID:24684868

  20. Oral Rehydration Therapy for Preoperative Fluid and Electrolyte Management

    PubMed Central

    Taniguchi, Hideki; Sasaki, Toshio; Fujita, Hisae

    2011-01-01

    Aim: Preoperative fluid and electrolyte management is usually performed by intravenous therapy. We investigated the safety and effectiveness of oral rehydration therapy (ORT) for preoperative fluid and electrolyte management of surgical patients. Methods: The study consisted of two studies, designed as a prospective observational study. In a pilot study, 20 surgical patients consumed 1000 mL of an oral rehydration solution (ORS) until 2 h before induction of general anesthesia. Parameters such as serum electrolyte concentrations, fractional excretion of sodium (FENa) as an index of renal blood flow, volume of esophageal-pharyngeal fluid and gastric fluid (EPGF), and patient satisfaction with ORT were assessed. In a follow-up study to assess the safety of ORT, 1078 surgical patients, who consumed ORS until 2 h before induction of general anesthesia, were assessed. Results: In the pilot study, water, electrolytes, and carbohydrate were effectively and safely supplied by ORT. The FENa value was increased at 2 h following ORT. The volume of EPGF collected following the induction of anesthesia was 5.3±5.6 mL. In the follow-up study, a small amount of vomiting occurred in one patient, and no aspiration occurred in the patients. Conclusion: These results suggest that ORT is a safe and effective therapy for the preoperative fluid and electrolyte management of selected surgical patients. PMID:21897763

  1. Patient perceptions of the importance of maintaining preoperative NPO status.

    PubMed

    Kramer, F M

    2000-08-01

    Although traditional "NPO (nothing by mouth) after midnight" policies are being liberalized, noncompliance with NPO status remains a threat to patient safety and may result in delays of elective surgical procedures, decrease the efficiency of the ambulatory surgery setting, and waste healthcare dollars. The purpose of the present study was to examine how comprehensive NPO instructions affected group differences in knowledge and perceptions of importance of maintaining preoperative NPO status. In this posttest-only study, 122 ambulatory surgery patients were randomly assigned to the experimental group (n = 66), who received comprehensive NPO instructions, or the control group (n = 56), who received the usual NPO instructions. Outcome measures were taken on the day of surgery via a questionnaire developed by the investigator. Outcome differences were examined, and group means were compared using analyses of variance and covariance. Although findings revealed comparable compliance rates between the groups and no significant differences when knowledge about NPO status was compared, a significant difference was found when perception of importance of maintaining NPO status was compared. Findings from the study suggest that providing patients with the rationale for adhering to preoperative NPO orders can significantly increase the patient's perception of the importance of maintaining preoperative NPO status. PMID:11125604

  2. Serum titanium level for diagnosis of a failed, metal-backed patellar component

    Microsoft Academic Search

    Seth S. Leopold; Richard A. Berger; Leslie Patterson; Anastasia K. Skipor; Robert M. Urban; Joshua J. Jacobs

    2000-01-01

    A case is presented in which an elevated serum titanium level was used to make the diagnosis of a failed metal-backed patellar component. The preoperative serum titanium level was 536.8 ppb, which was 98 times higher than the patient's previous level (taken 1 year earlier, when he was asymptomatic) and 2 orders of magnitude higher than the expected level with

  3. Effect of Prenatal Diagnosis on Outcomes in D-Transposition of the Great Arteries

    Microsoft Academic Search

    Jodi M. Bartlett; David Wypij; David C. Bellinger; Leonard A. Rappaport; Linda J. Heffner; Richard A. Jonas; Jane W. Newburger

    2010-01-01

    Background. By decreasing preoperative morbidity, prenatal diagnosis could improve neurode- velopmental outcomes in infants with critical congenital heart disease. We explored the impact of prenatal diag- nosis on perinatal and perioperative variables and on outcomes at 1 year of age. Methods. We analyzed a database of children en- rolled in prospective studies on surgical support tech- niques from 1988 to

  4. Outcomes of nonresected main-duct intraductal papillary mucinous neoplasms of the pancreas

    PubMed Central

    Daudé, Mathieu; Muscari, Fabrice; Buscail, Camille; Carrère, Nicolas; Otal, Philippe; Selves, Janick; Buscail, Louis; Bournet, Barbara

    2015-01-01

    AIM: To compare characteristics and outcomes of resected and nonresected main-duct and mixed intraductal papillary mucinous neoplasms of the pancreas (IPMN). METHODS: Over a 14-year period, 50 patients who did not undergo surgery for resectable main-duct or mixed IPMN, for reasons of precluding comorbidities, age and/or refusal, were compared with 74 patients who underwent resection to assess differences in rates of survival, recurrence/occurrence of malignancy, and prognostic factors. All study participants had dilatation of the main pancreatic duct by ? 5 mm, with or without dilatation of the branch ducts. Some of the nonsurgical patients showed evidence of mucus upon perendoscopic retrograde cholangiopancreatography or endoscopic ultrasound and/or after fine needle aspiration. For the surgical patients, pathologic analysis of resected specimens confirmed a diagnosis of IPMN with involvement of the main pancreatic duct or of both branch ducts as well as the main pancreatic duct. Clinical and biologic follow-ups were conducted for all patients at least annually, through hospitalization or consultation every six months during the first year of follow-up, together with abdominal imaging analysis (magnetic resonance cholangiopancreatography or computed tomography) and, if necessary, endoscopic ultrasound with or without fine needle aspiration. RESULTS: The overall five-year survival rate of patients who underwent resection was significantly greater than that for the nonsurgical patients (74% vs 58%; P = 0.019). The parameters of age (< 70 years) and absence of a nodule were associated with better survival (P < 0.05); however, the parameters of main pancreatic duct diameter > 10 mm, branch duct diameter > 30 mm, or presence of extra pancreatic cancers did not significantly influence the prognosis. In the nonsurgical patients, pancreatic malignancy occurred in 36% of cases within a mean time of 33 mo (median: 29 mo; range: 8-141 mo). Comparison of the nonsurgical patients who experienced disease progression with those who did not progress showed no significant differences in age, sex, symptoms, subtype of IPMN, or follow-up period; only the size of the main pancreatic duct was significantly different between these two sub-groups, with the nonsurgical patients who experienced progression showing a greater diameter at the time of diagnosis (> 10 mm). CONCLUSION: Patients unfit for surgery have a 36% greater risk of developing pancreatic malignancy of the main-duct or mixed IPMN within a median of 2.5 years.

  5. Paraganglioma of the pancreas: a potentially functional and malignant tumor

    PubMed Central

    2014-01-01

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

  6. Fully Integrated Artificial Pancreas in Type 1 Diabetes

    PubMed Central

    Breton, Marc; Farret, Anne; Bruttomesso, Daniela; Anderson, Stacey; Magni, Lalo; Patek, Stephen; Dalla Man, Chiara; Place, Jerome; Demartini, Susan; Del Favero, Simone; Toffanin, Chiara; Hughes-Karvetski, Colleen; Dassau, Eyal; Zisser, Howard; Doyle, Francis J.; De Nicolao, Giuseppe; Avogaro, Angelo; Cobelli, Claudio; Renard, Eric; Kovatchev, Boris

    2012-01-01

    Integrated closed-loop control (CLC), combining continuous glucose monitoring (CGM) with insulin pump (continuous subcutaneous insulin infusion [CSII]), known as artificial pancreas, can help optimize glycemic control in diabetes. We present a fundamental modular concept for CLC design, illustrated by clinical studies involving 11 adolescents and 27 adults at the Universities of Virginia, Padova, and Montpellier. We tested two modular CLC constructs: standard control to range (sCTR), designed to augment pump plus CGM by preventing extreme glucose excursions; and enhanced control to range (eCTR), designed to truly optimize control within near normoglycemia of 3.9–10 mmol/L. The CLC system was fully integrated using automated data transfer CGM?algorithm?CSII. All studies used randomized crossover design comparing CSII versus CLC during identical 22-h hospitalizations including meals, overnight rest, and 30-min exercise. sCTR increased significantly the time in near normoglycemia from 61 to 74%, simultaneously reducing hypoglycemia 2.7-fold. eCTR improved mean blood glucose from 7.73 to 6.68 mmol/L without increasing hypoglycemia, achieved 97% in near normoglycemia and 77% in tight glycemic control, and reduced variability overnight. In conclusion, sCTR and eCTR represent sequential steps toward automated CLC, preventing extremes (sCTR) and further optimizing control (eCTR). This approach inspires compelling new concepts: modular assembly, sequential deployment, testing, and clinical acceptance of custom-built CLC systems tailored to individual patient needs. PMID:22688340

  7. Associated factors for a hyperechogenic pancreas on endoscopic ultrasound

    PubMed Central

    Choi, Cheol Woong; Kim, Gwang Ha; Kang, Dae Hwan; Kim, Hyung Wook; Kim, Dong Uk; Heo, Jeong; Song, Geun Am; Park, Do Youn; Kim, Suk

    2010-01-01

    AIM: To identify the associated risk factors for hyperechogenic pancreas (HP) which may be observed on endoscopic ultrasound (EUS) and to assess the relationship between HP and obesity. METHODS: From January 2007 to December 2007, we prospectively enrolled 524 consecutive adults who were scheduled to undergo EUS. Patients with a history of pancreatic disease or with hepatobiliary or advanced gastrointestinal cancer were excluded. Finally, 284 patients were included in the analyses. We further analyzed the risk of HP according to the categories of visceral adipose tissue (VAT) and subcutaneous adipose tissue in 132 patients who underwent abdominal computed tomography scans. RESULTS: On univariate analysis, age older than 60 years, obesity (body mass index > 25 kg/m2), fatty liver, diabetes mellitus, hypertension and hypercholesterolemia were identified as risk factors associated with HP (P < 0.05). On multivariate analysis, fatty liver [P = 0.008, odds ratio (OR) = 2.219], male gender (P = 0.013, OR = 2.636), age older than 60 years (P = 0.001, OR = 2.874) and hypertension (P = 0.044, OR = 2.037) were significantly associated with HP. In the subgroup analysis, VAT was a statistically significant risk factor for HP (P = 0.010, OR = 5.665, lowest quartile vs highest quartile). CONCLUSION: HP observed on EUS was associated with fatty liver, male gender, age older than 60 years, hypertension and VAT. PMID:20818817

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

    PubMed

    Fritz, S; Büchler, M W; Werner, J

    2012-02-01

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

  9. Impact of simultaneous pancreas-kidney transplantation: patients’ perspectives

    PubMed Central

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

    2012-01-01

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

  10. Molecular pathology of intraductal papillary mucinous neoplasms of the pancreas

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  12. [Presence of microcysts within a cystic tumor of the pancreas does not rule out malignancy: report of two cases].

    PubMed

    Denis, Bernard; Claudel, Laurent; Marcellin, Luc; Haller-Wittersheim, Annick; Bottlaender, Jacques

    2003-06-01

    Presence of microcysts within a cystic tumor of the pancreas is usually considered as specific of serous cystadenoma and leads to conservative management and surveillance of asymptomatic patients. We report two cases of malignant cystic tumors of the pancreas with a microcystic component detected by endosonography. We conclude that presence of microcysts detected by endosonography in cystic tumors of the pancreas does not rule out malignancy. PMID:12910232

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

    ERIC Educational Resources Information Center

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

    2014-01-01

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

  14. KRAS oncogene mutations suggest a common histogenetic origin for pleomorphic giant cell tumor of the pancreas, osteoclastoma of the pancreas, and pancreatic duct adenocarcinoma

    Microsoft Academic Search

    Christopher D Gocke; David J Dabbs; Floyd A Benko; Jan F Silverman

    1997-01-01

    Giant cell neoplasms of the pancreas are rare tumors of uncertain histogenesis. Mutation of the KRAS oncogene is common in typical pancreatic duct adenocarcinoma. We have analyzed DNA from five pancreatic tumors with giant cells for mutations in the KRAS oncogene and found alterations of the second position of codon 12 in each case (four G > A transitions and

  15. Intraductal papillary-mucinous tumors of the pancreas: Clinicopathologic features, outcome, and nomenclature. Members of the Pancreas Clinic, and Pancreatic Surgeons of Mayo Clinic

    Microsoft Academic Search

    EV Loftus; BA Olivares-Pakzad; KP Batts; MC Adkins; DH Stephens; MG Sarr; EP DiMagno

    1996-01-01

    BACKGROUND & AIMS: Intraductal papillary-mucinous tumor (IPMT) of the pancreatic ducts is increasingly recognized. This study investigated if clinical, imaging, or, histological features predicated outcome, formulated a treatment algorithm, and clarified relationships among IPMT, mucinous cystic neoplasms of the pancreas (MCN), and chronic pancreatitis. METHODS: The medical records, radiographs, and pathological specimens of 15 patients with IPMT (dilated main pancreatic

  16. Risk of other cancers in individuals with a family history of pancreas cancer

    PubMed Central

    Schenk, Maryjean; Schwartz, Ann G.; Vigneau, Fawn D.; Kinnard, Margaret; Greenson, Joel K.; Fryzek, Jon P.; Ying, Gui Shuang; Garabrant, David H.

    2009-01-01

    Background Inherited predisposition to pancreas cancer accounts for approximately 10% of cases. Familial aggregation may be influenced by shared environmental factors and shared genes. We evaluate whether a family history of pancreas cancer is a risk factor for ten specified cancers in first-degree relatives: bladder, breast, colon, head & neck, lung, lymphoma, melanoma, ovary, pancreas and prostate. Methods Risk factor data and cancer family history were obtained for 1816 first-degree relatives of pancreas cancer case probands (n=247) and 3157 first-degree relatives of control probands (n=420). Unconditional logistic regression models using generalized estimating equations were used to estimate odds ratios (ORs) and 95% confidence intervals of having a first-degree relative a specified cancer. Results A family history of pancreas cancer was associated with a doubled risk of lymphoma (OR = 2.83, 95% CI = 1.02–7.86) and ovarian cancer (OR = 2.25, 95% CI = 0.77–6.60) among relatives after adjustment. Relatives with a family history of early-onset pancreas cancer in a proband had a 7-fold increased risk of lymphoma (OR = 7.31, 95% CI = 1.45 – 36.7). Relatives who ever smoked and had a family history of pancreas cancer had a 5-fold increased risk of ovarian cancer (OR = 4.89, 95% CI = 1.16–20.6). Conclusion Family history assessment of cancer risk should include all cancers. Assessment of other known and suspected risk factors in relatives will improve risk evaluation. As screening and surveillance methods are developed, identifying those at highest risk is crucial for a successful screening program. PMID:19089664

  17. Tracer diffusion has exaggerated CNS maps of direct preganglionic innervation of pancreas.

    PubMed

    Fox, E A; Powley, T L

    1986-01-01

    Small injections of True Blue (TB) into 4 different segments of the pancreas of the rat resulted in characteristic and different numbers and distributions of labeled cells within the dorsal motor nucleus of the vagus (DMN). Composites of these patterns of labeled cells in the DMN closely matched the distributions previously reported for more extensive injections of retrograde tracers into the pancreas. However, the application of a diffusion barrier (formed with a plastic wound spray) on the outer surface of the stomach and intestines adjacent to the pancreas segment which contained the TB injection depot prevented virtually all of the labeling of DMN cells. Similarly, applying a diffusion barrier directly to the injected pancreas segment itself prevented all or most (mean greater than 99%) of the DMN labeling. In contrast to this effect on DMN label, the barrier reduced more modestly the labeling of celiac ganglion somata after pancreas injections. Several additional control experiments also suggest that the absence of DMN label after the barrier application resulted from interference with tracer diffusion from the injected organ and not from neurotoxic effects. These include the following demonstrations in the presence of the barrier: (1) observation of unimpaired vagally stimulated insulin secretion, (2) uncompromised cell labeling of DMN from other organs treated with TB plus the barrier, and (3) normal hematoxylin and eosin stained pancreas tissue which had received TB injections and barrier application. It was concluded that both the number of parasympathetic preganglionic neurons that project monosynaptically to the pancreas and their distribution in the medulla may have been very significantly overestimated in previous tracer studies. PMID:3512681

  18. Perfusion-decellularized pancreas as a natural 3D scaffold for pancreatic tissue and whole organ engineering

    PubMed Central

    Goh, Saik-Kia; Bertera, Suzanne; Olsen, Phillip; Candiello, Joe; Halfter, Willi; Uechi, Guy; Balasubramani, Manimalha; Johnson, Scott; Sicari, Brian; Kollar, Elizabeth; Badylak, Stephen F.; Banerjee, Ipsita

    2013-01-01

    Approximately 285 million people worldwide suffer from diabetes, with insulin supplementation as the most common treatment measure. Regenerative medicine approaches such as a bioengineered pancreas has been proposed as potential therapeutic alternatives. A bioengineered pancreas will benefit from the development of a bioscaffold that supports and enhances cellular function and tissue development. Perfusion-decellularized organs are a likely candidate for use in such scaffolds since they mimic compositional, architectural and biomechanical nature of a native organ. In this study, we investigate perfusion-decellularization of whole pancreas and the feasibility to recellularize the whole pancreas scaffold with pancreatic cell types. Our result demonstrates that perfusion-decellularization of whole pancreas effectively removes cellular and nuclear material while retaining intricate three-dimensional microarchitecture with perfusable vasculature and ductal network and crucial extracellular matrix (ECM) components. To mimic pancreatic cell composition, we recellularized the whole pancreas scaffold with acinar and beta cell lines and cultured up to 5 days. Our result shows successful cellular engraftment within the decellularized pancreas, and the resulting graft gave rise to strong up-regulation of insulin gene expression. These findings support biological utility of whole pancreas ECM as a biomaterials scaffold for supporting and enhancing pancreatic cell functionality and represent a step toward bioengineered pancreas using regenerative medicine approaches. PMID:23787110

  19. Resection of the second portion of the duodenum sacrificing the minor papilla but preserving the pancreas for a recurrent duodenal adenocarcinoma: report of a case.

    PubMed

    Yamashita, S; Sakamoto, Y; Kaneko, J; Tamura, S; Aoki, T; Sugawara, Y; Hasegawa, K; Kokudo, N

    2012-02-01

    Duodenal adenocarcinoma is a relatively rare malignancy and pancreaticoduodenectomy would be a standard procedure to achieve curative resection. We report a case of resection of the 2nd portion of the duodenum with nodal dissection preserving the pancreas. The patient was a 75-year-old man with right-sided paresis suffering from early cancer in the 2nd portion of the duodenum. Despite 3 times of endoscopic mucosal resections, mucosal local recurrence was found. The depth of the tumour involvement continued to be limited within the mucosal layer. We performed segmental duodenal resection with nodal dissection sacrificing the minor papilla, while preserving the pancreas and the major papilla. The pathological diagnosis was primary intramucosal adenocarcinoma; the surgical margin was negative for cancer and there was no nodal metastasis. This procedure can be an alternative to pancreaticoduodenectomy in patients with earlystage adenocarcinoma in the 2nd portion of the duodenum when the major papilla can be spared, especially in high-risk patients. PMID:22426103

  20. Autoantibodies against the exocrine pancreas in autoimmune pancreatitis: gene and protein expression profiling and immunoassays identify pancreatic enzymes as a major target of the inflammatory process

    PubMed Central

    Löhr, J.-Matthias; Faissner, Ralf; Koczan, Dirk; Bewerunge, Peter; Bassi, Claudio; Brors, Benedikt; Eils, Roland; Frulloni, Luca; Funk, Anette; Halangk, Walter; Jesenofsky, Ralf; Kaderali, Lars; Kleeff, Jörg; Krüger, Burkhard; Lerch, Markus M.; Lösel, Ralf; Magnani, Mauro; Neumaier, Michael; Nittka, Stephanie; Sahin-Tóth, Miklós; Sänger, Julian; Serafini, Sonja; Schnölzer, Martina; Thierse, Hermann-Josef; Wandschneider, Silke; Zamboni, Giuseppe; Klöppel, Günter

    2011-01-01

    Objectives Autoimmune pancreatitis (AIP) is thought to be an immune-mediated inflammatory process, directed against the epithelial components of the pancreas. Methods In order to explore key targets of the inflammatory process we analysed the expression of proteins at the RNA and protein level using genomics and proteomics, immunohistochemistry, Western blot and immunoassay. An animal model of AIP with LP-BM5 murine leukemia virus infected mice was studied in parallel. RNA microarrays of pancreatic tissue from 12 patients with AIP were compared to those of 8 patients with non-AIP chronic pancreatitis (CP). Results Expression profiling revealed 272 upregulated genes, including those encoding for immunoglobulins, chemokines and their receptors, and 86 downregulated genes, including those for pancreatic proteases such as three trypsinogen isoforms. Protein profiling showed that the expression of trypsinogens and other pancreatic enzymes was greatly reduced. Immunohistochemistry demonstrated a near-loss of trypsin positive acinar cells, which was also confirmed by Western blotting. The serum of AIP patients contained high titres of autoantibodies against the trypsinogens PRSS1, and PRSS2 but not against PRSS3. In addition, there were autoantibodies against the trypsin inhibitor PSTI (the product of the SPINK1 gene). In the pancreas of AIP animals we found similar protein patterns and a reduction in trypsinogen. Conclusion These data indicate that the immune-mediated process characterizing AIP involves pancreatic acinar cells and their secretory enzymes such as trypsin isoforms. Demonstration of trypsinogen autoantibodies may be helpful for the diagnosis of AIP. PMID:20407433