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1

Do Pancreatic Duct Stents Cause or Prevent Pancreatic Sepsis?  

Microsoft Academic Search

BackgroundPancreatic sepsis can occur after contrast injection into an obstructed or disrupted pancreatic duct. Whether stents cause or prevent pancreatic sepsis is unknown. Accordingly, the pancreatic duct bacteriology in patients with pancreatic duct stents was retrospectively reviewed and contrasted with biliary cultures taken from patients at the time of bile duct stent retrieval and\\/or exchange.

Richard Kozarek; Oistein Hovde; Fouad Attia; Renee France

2003-01-01

2

Does pancreatic duct stenting decrease the rate of pancreatic fistula following pancreaticoduodenectomy? Results of a prospective randomized trial  

Microsoft Academic Search

Pancreatic duct stenting remains an attractive strategy to reduce the incidence of pancreatic fistulas following pancreaticoduodenectomy\\u000a (PD) with encouraging results in both retrospective and prospective studies. We performed a prospective randomized trial to\\u000a test the hypothesis that internal pancreatic duct stenting reduces the development of pancreatic fistulas following PD. Two\\u000a hundred thirty-eight patients were randomized to either receive a pancreatic

Jordan M. Winter; John L. Cameron; Kurtis A. Campbell; David C. Chang; Taylor S. Riall; Richard D. Schulick; Michael A. Choti; JoAnn Coleman; Mary B. Hodgin; Patricia K. Sauter; Christopher J. Sonnenday; Christopher L. Wolfgang; Michael R. Marohn; Charles J. Yeo

2006-01-01

3

Clinical Study on the Prevention of Post-ERCP Pancreatitis by Pancreatic Duct Stenting  

Microsoft Academic Search

Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is one of the most common and serious complications\\u000a of ERCP, which has become a major concern for digestive endoscopists. In the present study, we examine whether pancreatic\\u000a duct stenting can reduce the incidence of PEP. Forty patients who underwent an ERCP in our hospital were selected according\\u000a to their risk factors for PEP.

Xiao-Ping PanTong; Tong Dang; Xian-Mei Meng; Kai-Cheng Xue; Zhi-Heng Chang; Ya-Ping Zhang

4

Endoscopic management of pancreatic duct injury by endoscopic stent placement: a case report and literature review  

PubMed Central

Recently, the diagnostic evaluation of pancreatic injury has improved dramatically. On the other hand, it is occasionally difficult to diagnose pancreatic injury, because there are no specific signs, symptoms, or laboratory findings. Radiological imaging also often fails to identify pancreatic injury in the acute phase. Delayed diagnosis results in significant morbidity and mortality. Most cases of pancreatic injury with suspicion or pancreatic duct disruption require surgery. Endoscopic retrograde cholangiopancreatography is one of the most accurate modalities for ductal evaluation and therapy and might enable one to avoid unnecessary surgery. We describe endoscopic management of pancreatic duct injury by endoscopic stent placement. A 45-year-old woman was admitted after a traffic accident. A computed tomography scan showed pancreatic parenchyma disruption at the pancreatic head. Endoscopic retrograde cholangiopancreatography demonstrated disruption of the pancreatic duct with extravasation into the peripancreatic fluid collection. A 5-French endoscopic nasopancreatic drainage (ENPD) tube was placed. Her symptoms dramatically improved. ENPD tube was exchanged for a 5-French 5-cm pancreatic stent. Subsequent follow-up CT revealed remarkable improvement. On the 26th day, the patient was discharged from the hospital without symptoms or complications. In this report, a pancreatic stent may lead to rapid clinical improvement and enable surgery to be avoided. On the other hand, the reported complications of long-term follow-up make the role of stenting uncertain. Thus, close attention should be paid to stenting management in the follow-up period. A pancreatic stent is useful for pancreatic ductal injury. If pancreatic ductal injury is managed appropriately, a pancreatic stent may improve the clinical condition, and also prevent unnecessary surgery.

2012-01-01

5

Endoscopic therapy for pancreatic duct leaks and disruptions.  

PubMed

Pancreatitis, whether acute or chronic, can lead to a plethora of complications, such as fluid collections, pseudocysts, fistulas, and necrosis, all of which are secondary to leakage of secretions from the pancreatic ductal system. Partial and side branch duct disruptions can be managed successfully by transpapillary pancreatic duct stent placement, whereas patients with disconnected pancreatic duct syndrome require more complex endoscopic interventions or multidisciplinary care for optimal treatment outcomes. This review discusses the current status of endoscopic management of pancreatic duct leaks and emerging concepts for the treatment of disconnected pancreatic duct syndrome. PMID:24079795

Varadarajulu, Shyam; Rana, Surinder S; Bhasin, Deepak K

2013-07-12

6

Biliary sphincterotomy is not required for bile duct stent placement.  

PubMed

BACKGROUND: The aim of the present study was to assess the success and outcome of bile duct stent placement without the use of endoscopic biliary sphincterotomy (EBS). PATIENTS AND METHODS: Over a period of 10 years and 9 months, all patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) were prospectively identified. Bile duct stent placement was routinely done without EBS unless additional therapy (stone removal, multiple stenting) was anticipated. RESULTS: Of 5020 patients who underwent ERCP, bile duct stents were placed in 1668 patients. After excluding those requiring additional endoscopic therapy, 1112 patients (89.5%) had ERCP and stent placement without a sphincterotomy and 130 patients (10.5%) had ERCP and stent placement with asphincterotomy. Deployed endoprostheses were self-expandable metallic stents in 15.7% and plastic in 77.5%. Caliber of plastic stents was 10?Fr in 78.9% and <10?Fr in 21.1%. All stents were successfully placed in these 1112 patients without the need for EBS. Comparing patients undergoing bile duct stenting with and without sphincterotomy, no difference was seen in rates of pancreatitis (1.54% vs 2.07%, P?>?0.9999). CONCLUSION: Single bile duct stents, both plastic and metal, can be deployed without EBS. PMID:23517140

Wilcox, C Mel; Kim, Hwasoon; Ramesh, Jayapal; Trevino, Jessica; Varadarajulu, Shyam

2013-03-20

7

Usefulness of pancreatic duct wire-guided endoscopic papillectomy for ampullary adenoma for preventing post-procedure pancreatitis.  

PubMed

Background and study aims: After endoscopic papillectomy, pancreatic duct stenting is important in preventing pancreatitis, but duct cannulation can be difficult following conventional snare resection. Pancreatic duct wire-guided endoscopic snaring before resection can reduce the post-procedure stenting failure rate. We evaluated the usefulness of this approach.Patients and methods: Pancreatic duct wire-guided endoscopic papillectomy was performed in 72 patients with ampullary adenoma. The snare loop was passed over a guide wire inserted into the pancreatic duct. After resection, a pancreatic stent was immediately placed along or alongside the guide wire.Results: Pancreatic duct stenting was successful in all patients after endoscopic papillectomy. Post-procedure pancreatitis occurred in 6/72 (8 %), but was mild and resolved with conservative treatment. Complete endoscopic resection of ampullary adenoma was achieved in 65/72 (90 %), with en bloc resection in 60/72 (83 %). There was no procedure-associated mortality. Follow-up (mean 23.7 months) showed recurrence in 5/65 (8 %) who had undergone complete resection. Conclusions: Pancreatic duct wire-guided endoscopic snare papillectomy for ampullary adenoma effectively facilitated pancreatic duct stenting to prevent severe post-procedure pancreatitis. PMID:23918619

Kim, Shin Hee; Moon, Jong Ho; Choi, Hyun Jong; Kim, Dong Choon; Lee, Tae Hoon; Cheon, Young Koog; Cho, Young Deok; Park, Sang-Heum; Kim, Sun-Joo

2013-08-05

8

Assessment of pancreatic duct strictures.  

PubMed

It should be fairly clear that the evaluation of pancreatic duct strictures is complex. Short of surgical resection, there is no gold standard that will provide an etiological diagnosis unless cancer is found on a biopsy specimen. To complicate matters further, much of the literature was generated in reference to differentiating between pancreatic cancer and pancreatitis. Using the same data to evaluate the patient with a pancreatic duct stricture may not be appropriate because the clinical scenario may not be comparable. Bearing these shortcomings in mind, however, a thoughtful history combined with the judicious use of abdominal imaging, ERCP, and the biopsy techniques discussed will lead to a clinical diagnosis that usually will prove to be correct in most cases. The role of tumor markers in patients with pancreatic duct strictures is still being defined. Although no tumor marker has proved especially helpful so far, the potential exists that a more useful one is just over the horizon. In situations in which the diagnosis remains uncertain, exploratory laparotomy in an appropriate surgical candidate by an experienced pancreatic surgeon will provide a definitive diagnosis in almost all cases. PMID:7728341

Jowell, P S

1995-01-01

9

Acute Suppuration of the Pancreatic Duct in a Patient with Tropical Pancreatitis  

PubMed Central

Background/Aim Pancreatic sepsis secondary to infected necrosis, pseudocyst, or pancreatic abscess is a well-known clinical entity. Acute suppuration of the pancreatic duct (ASPD) in the setting of chronic calcific pancreatitis and pancreatic ductal obstruction with septicemia is a rare complication that is seldom reported. It is our aim to report a case of ASPD with Klebsiella ornithinolytica, in the absence of pancreatic abscess or infected necrosis. Case Report A 46-year-old Asian-Indian man with chronic tropical pancreatitis who was admitted with recurrent epigastric pain that rapidly evolved into septic shock. A CT scan of abdomen revealed a dilated pancreatic duct with a large calculus. Broad-spectrum antibiotics, vasopressors and activated recombinant protein C were initiated. Emergency ERCP showed the papilla of Vater spontaneously expelling pus. Probing and stenting was instantly performed until pus drainage ceased. Repeat CT scan confirmed the absence of pancreatic necrosis or fluid collection, and decreasing ductal dilatation. Dramatic clinical improvement was observed within 36 hours after intervention. Blood cultures grew Klebsiella ornithinolytica. The patient completed his antibiotic course and was discharged. Conclusion ASPD without pancreatic abscess or infected necrosis is an exceptional clinical entity that should be included in the differential diagnosis of pancreatic sepsis. A chronically diseased pancreas and diabetes may have predisposed to the uncommon pathogen. The presence of intraductal pancreatic stones obstructing outflow played a major role in promoting bacterial growth, suppuration and septicemia. Immediate drainage of the pancreatic duct with endoscopic intervention is critical and mandatory.

Deeb, Liliane S.; Bajaj, Jasmeet; Bhargava, Sandeep; Alcid, David; Pitchumoni, C.S.

2008-01-01

10

Acute Cholecystitis Caused by Malignant Cystic Duct Obstruction: Treatment with Metallic Stent Placement  

SciTech Connect

We report the successful management of acute cholecystitis using cystic duct stent placement in 3 patients with inoperable malignant cystic duct obstruction (2 cholangiocarcinoma and 1 pancreatic carcinoma). All patients underwent stent placement in the bile duct, using an uncovered stent in 2 and a covered stent in 1, to relieve jaundice occurring 8-184 days (mean 120 days) before the development of acute cholecystitis. The occluded cystic duct was traversed by a microcatheter and a stent was implanted 4-17 days (mean 12 days) after cholecystostomy. Acute cholecystitis was improved after the procedure in all patients. Two patients died 3 and 10 months later, while 1 has survived without cholecystitis for 22 months after the procedure to date.

Miyayama, Shiro, E-mail: s-miyayama@fukui.saiseikai.or.jp; Yamashiro, Masashi; Takeda, Taro; Aburano, Hiroyuki [Fukuiken Saiseikai Hospital, Department of Diagnostic Radiology (Japan); Komatsu, Tetsuya [Fukuiken Saiseikai Hospital, Department of Radiation Oncology (Japan); Sanada, Taku; Kosaka, Shotaro; Toya, Daisyu [Fukuiken Saiseikai Hospital, Department of Internal Medicine (Japan); Matsui, Osamu [Kanazawa University Graduate School of Medical Science, Department of Radiology (Japan)

2008-07-15

11

Randomized controlled trial of pancreatic stenting to prevent pancreatitis after endoscopic retrograde cholangiopancreatography  

PubMed Central

AIM: To determine the effectiveness of pancreatic duct (PD) stent placement for the prevention of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) in high risk patients. METHODS: Authors conducted a single-blind, randomized controlled trial to evaluate the effectiveness of a pancreatic spontaneous dislodgement stent against post-ERCP pancreatitis, including rates of spontaneous dislodgement and complications. Authors defined high risk patients as having any of the following: sphincter of Oddi dysfunction, difficult cannulation, prior history of post-ERCP pancreatitis, pre-cut sphincterotomy, pancreatic ductal biopsy, pancreatic sphincterotomy, intraductal ultrasonography, or a procedure time of more than 30 min. Patients were randomized to a stent group (n = 60) or to a non-stent group (n = 60). An abdominal radiograph was obtained daily to assess spontaneous stent dislodgement. Post-ERCP pancreatitis was diagnosed according to consensus criteria. RESULTS: The mean age (± standard deviation) was 67.4 ± 13.8 years and the male: female ratio was 68:52. In the stent group, the mean age was 66 ± 13 years and the male: female ratio was 33:27, and in the non-stent group, the mean age was 68 ± 14 years and the male: female ratio was 35:25. There were no significant differences between groups with respect to age, gender, final diagnosis, or type of endoscopic intervention. The frequency of post-ERCP pancreatitis in PD stent and non-stent groups was 1.7% (1/60) and 13.3% (8/60), respectively. The severity of pancreatitis was mild in all cases. The frequency of post-ERCP pancreatitis in the stent group was significantly lower than in the non-stent group (P = 0.032, Fisher’s exact test). The rate of hyperamylasemia were 30% (18/60) and 38.3% (23 of 60) in the stent and non-stent groups, respectively (P = 0.05, ?2 test). The placement of a PD stent was successful in all 60 patients. The rate of spontaneous dislodgement by the third day was 96.7% (58/60), and the median (range) time to dislodgement was 2.1 (2-3) d. The rates of stent migration, hemorrhage, perforation, infection (cholangitis or cholecystitis) or other complicationss were 0% (0/60), 0% (0/60), 0% (0/60), 0% (0/60), 0% (0/60), respectively, in the stent group. Univariate analysis revealed no significant differences in high risk factors between the two groups. The pancreatic spontaneous dislodgement stent safely prevented post-ERCP pancreatitis in high risk patients. CONCLUSION: Pancreatic stent placement is a safe and effective technique to prevent post-ERCP pancreatitis. Therefore authors recommend pancreatic stent placement after ERCP in high risk patients.

Kawaguchi, Yoshiaki; Ogawa, Masami; Omata, Fumio; Ito, Hiroyuki; Shimosegawa, Tooru; Mine, Tetsuya

2012-01-01

12

Update on Endoscopic Management of Main Pancreatic Duct Stones in Chronic Calcific Pancreatitis  

PubMed Central

Pancreatic duct stones are a common complication during the natural course of chronic pancreatitis and often contribute to additional pain and pancreatitis. Abdominal pain, one of the major symptoms of chronic pancreatitis, is believed to be caused in part by obstruction of the pancreatic duct system (by stones or strictures) resulting in increasing intraductal pressure and parenchymal ischemia. Pancreatic stones can be managed by surgery, endoscopy, or extracorporeal shock wave lithotripsy. In this review, updated management of pancreatic duct stones is discussed.

Choi, Eun Kwang

2012-01-01

13

Spontaneous pancreatic duct-colon fistula.  

PubMed

A fistula between the pancreatic duct and the colon is quite rare and usually associated with such manifestations as bleeding and sepsis. We have seen a patient with such a fistula detected almost incidentally at ERCP. We report the course of this fistula and review the literature to suggest a place for conservative surgical management. PMID:3517133

Thomas, C T; Hinton, P J; Thomas, E

1986-02-01

14

Expandable metal stents in chronic pancreatitis  

PubMed Central

Background Biliary obstruction in chronic pancreatitis may be relieved by the insertion of a biliary endoprosthesis. Stenting is usually achieved with a plastic device, but self-expandable metal stents may also be used. Case outlines Two patients are described with severe chronic pancreatitis complicated by biliary obstruction and portal vein thrombosis, who underwent insertion of metallic biliary endoprostheses. In both patients the endoprostheses became occluded, at 12 and 7 months respectively, which necessitated open operation. Both patients experienced surgical complications and one patient died postoperatively. Discussion The use of metal endoprostheses in chronic pancreatitis may result in occlusion, necessitating open operation. Such stents should be used with caution in these patients, who are likely to be high-risk surgical candidates.

Charnley, RM

2003-01-01

15

Update on endoscopic management of main pancreatic duct stones in chronic calcific pancreatitis.  

PubMed

Pancreatic duct stones are a common complication during the natural course of chronic pancreatitis and often contribute to additional pain and pancreatitis. Abdominal pain, one of the major symptoms of chronic pancreatitis, is believed to be caused in part by obstruction of the pancreatic duct system (by stones or strictures) resulting in increasing intraductal pressure and parenchymal ischemia. Pancreatic stones can be managed by surgery, endoscopy, or extracorporeal shock wave lithotripsy. In this review, updated management of pancreatic duct stones is discussed. PMID:22403495

Choi, Eun Kwang; Lehman, Glen A

2012-02-28

16

Percutaneous Transcholecystic Placement of an ePTFE/FEP-Covered Stent in the Common Bile Duct  

SciTech Connect

We report the case of a 78-year-old male patient with obstructive jaundice due to a pancreatic head neoplasm. The patient's general condition did not permit an endoscopic approach and the presence of diffuse liver metastases prohibited hepatic puncture for percutaneous biliary drainage, therefore the transcolecystic transperitoneal approach was decided to be the safest decompression route. Through a gallbladder access, a Viabil-covered stent with a mesh extension was placed in the distal common bile duct, without complications. The patient died 8 months later without signs of stent dysfunction or necessity of reintervention. Transcholecystic transperitoneal access is a safe option when diffuse liver metastases prohibit the transhepatic approach, even in cases where placement of a covered stent is considered necessary.

Krokidis, Miltiadis E., E-mail: mkrokidis@hotmail.co [University Hospital of Heraklion, Department of Radiology (Greece); Hatzidakis, Adam A. [Medical School of Crete (Greece)

2010-06-15

17

Double Duct to Mucosa Pancreaticojejunostomy for Bifid Pancreatic Duct following Pylorus Preserving Pancreaticoduodenectomy: A Case Report  

PubMed Central

Bifid pancreatic duct represents a relatively rare anatomical variation of the pancreatic ductal system, in which the main pancreatic duct is bifurcated along its length. This paper describes the challenging surgical management of a 68-year-old male patient, with presumptive diagnosis of periampullary malignancy who underwent a successful double duct to mucosa pancreaticojejunostomy for bifid pancreatic duct. Following pylorus preserving pancreaticoduodenectomy, careful intraoperative inspection of the cut surface of the residual dorsal pancreas identified the main in addition to the secondary pancreatic duct orifice. Bifid duct anatomy was confirmed via intraoperative probing and direct visualization of the ductal orifices. A decision was made for the performance of an end-to-site double duct to mucosa pancreaticojejunostomy. Postoperative outcome was favorable without any complications. Although bifid pancreatic duct is relatively rare, pancreatic surgeons should be aware of this anatomical variation and be familiar with the surgical techniques for its successful management. Lack of knowledge and surgical expertise for dealing with this anatomical variant may lead to serious, life threatening postoperative complications following pancreatic resections.

Vasiliadis, K.; Papavasiliou, C.; Lamprou, N.; Delivorias, P.; Papaioannou, S.; Karagiannidis, A.; Makridis, C.

2012-01-01

18

Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction  

Microsoft Academic Search

Background & Aims: Patients with sphincter of Oddi dysfunction are at high risk of developing pancreatitis after endoscopic biliary sphincterotomy. Impaired pancreatic drainage caused by pancreatic sphincter hypertension is the likely explanation for this increased risk. A prospective, randomized controlled trial was conducted to determine if ductal drainage with pancreatic stenting protects against pancreatitis after biliary sphincterotomy in patients with

Paul R. Tarnasky; Yuko Y. Palesch; John T. Cunningham; Patrick D. Mauldin; Peter B. Cotton; Robert H. Hawes

1998-01-01

19

Pain in chronic pancreatitis: Managing beyond the pancreatic duct  

PubMed Central

Chronic pancreatitis (CP) continues to be a clinical challenge. Persistent or recurrent abdominal pain is the most compelling symptom that drives patients to seek medical care. Unfortunately, in spite of using several treatment approaches in the clinical setting, there is no single specific treatment modality that can be earmarked as a cure for this disease. Traditionally, ductal hypertension has been associated with causation of pain in CP; and patients are often subjected to endotherapy and surgery with a goal to decompress the pancreatic duct. Recent studies on humans (clinical and laboratory based) and experimental models have put forward several mechanisms, including neuroimmune alterations, which could be responsible for pain. This might explain the partial or no response to single modality treatment in a significant proportion of patients. The current review discusses the recent concepts of pain generation in CP and evidence based therapeutic approaches (other than ductal decompression) to handle persistent or recurrent pain. We focus primarily on parenchymal and neural components; and discuss the role of antioxidants and the existing controversies, drugs that interfere with neural transmission, pancreatic enzyme supplementation, celiac neurolysis, and pancreatic resection procedures. The review concludes with the treatment approach that we follow at our institute.

Talukdar, Rupjyoti; Reddy, D Nageshwar

2013-01-01

20

Pain in chronic pancreatitis: Managing beyond the pancreatic duct.  

PubMed

Chronic pancreatitis (CP) continues to be a clinical challenge. Persistent or recurrent abdominal pain is the most compelling symptom that drives patients to seek medical care. Unfortunately, in spite of using several treatment approaches in the clinical setting, there is no single specific treatment modality that can be earmarked as a cure for this disease. Traditionally, ductal hypertension has been associated with causation of pain in CP; and patients are often subjected to endotherapy and surgery with a goal to decompress the pancreatic duct. Recent studies on humans (clinical and laboratory based) and experimental models have put forward several mechanisms, including neuroimmune alterations, which could be responsible for pain. This might explain the partial or no response to single modality treatment in a significant proportion of patients. The current review discusses the recent concepts of pain generation in CP and evidence based therapeutic approaches (other than ductal decompression) to handle persistent or recurrent pain. We focus primarily on parenchymal and neural components; and discuss the role of antioxidants and the existing controversies, drugs that interfere with neural transmission, pancreatic enzyme supplementation, celiac neurolysis, and pancreatic resection procedures. The review concludes with the treatment approach that we follow at our institute. PMID:24151350

Talukdar, Rupjyoti; Nageshwar Reddy, D

2013-10-14

21

A Mathematical Model of the Pancreatic Duct Cell Generating High Bicarbonate Concentrations in Pancreatic Juice  

Microsoft Academic Search

Objective: To develop a simple, physiologically based mathemati- cal model of pancreatic duct cell secretion using experimentally de- rived parameters that generates pancreatic fluid bicarbonate concen- trations of >140 mM after CFTR activation. Methods: A new mathematical model was developed simulating a duct cell within a proximal pancreatic duct and included a sodium-2- bicarbonate cotransporter (NBC) and sodium-potassium pump (NaK

David C. Whitcomb; G. Bard Ermentrout

2004-01-01

22

Tumor-associated focal chronic pancreatitis from invasion of the pancreatic duct by common bile duct carcinoma: radiologic–pathologic correlation  

Microsoft Academic Search

We report a case of tumor-associated focal chronic pancreatitis of the uncinate process of the pancreas. The chronic pancreatitis\\u000a was secondary to stenosis of the main pancreatic duct from invasion by a common bile duct carcinoma. A feature distinguishing\\u000a the chronic pancreatitis from pancreatic carcinoma was the localized dilatation of pancreatic duct branches evident in the\\u000a focal lesion of the

T. Gabata; J. Sanada; S. Kobayashi; N. Terayama; M. Kadoya; O. Matsui

2003-01-01

23

Evaluation of Polyurethane Nasolacrimal Duct Stents: In Vivo Studies in New Zealand Rabbits  

SciTech Connect

The purpose of this study was to evaluate the radiographic and biological effects of different polyurethane nasolacrimal duct stents in an animal model. Fifteen polyurethane nasolacrimal duct stents (n = 5 mushroom-type stents, n = 5 newly designed S-shaped TearLeader stents without hydrophilic coating, and n = 5 S-shaped TearLeader stents with hydrophilic coating) were implanted in the nasolacrimal ducts of eight unaffected New Zealand rabbits. One nasolacrimal system served as control. Clinical and radiographic follow-up was performed at 1-, 2-, and 4-week intervals, then after a 3-month interval, after which the animals were euthanized. All stents were implanted without major periprocedural complications. The stents proved to be patent by the end of the procedure. During follow-up, all mushroom-type stents were occluded at 4 weeks. None of these stents opened to forced irrigation. Clinically, all rabbits demonstrated severe dacryocystitis. Three out of five TearLeader stents without hydrophilic coating were blocked at 4 weeks; one out of five was open to irrigation. Best results were observed in the stent group with hydrophilic coating. Follow-up dacryocystography demonstrated patent stents in nasolacrimal ducts of all animals after 4 weeks. In only one of five cases, the coated stent became partially occluded after 2 months. These animals were free of clinical symptoms. After 3 months, at least three out of five stents still opened to forced irrigation and only one stent was completely blocked. Dislocation of the stents was not observed. Refinement of the stent surface and stent design improves the results of nasolacrimal duct stenting in this animal model. Implantation of hydrophilic-coated S-shaped stents is highly superior to conventional mushroom-type stents and noncoated stent types. Hydrophilic coating seems to prevent foreign-body reactions, resulting in maximized stent patency.

Wilhelm, K.E., E-mail: wilhelm@uni-bonn.de; Grabolle, B.; Urbach, H. [University Hospital Bonn, Department of Radiology (Germany); Tolba, R. [Clinics of the University of Bonn, Haus fuer Experimentelle Therapie (Germany); Schild, H. [University Hospital Bonn, Department of Radiology (Germany); Paulsen, F. [Martin Luther University of Halle-Wittenberg, Department of Anatomy and Cell Biology (Germany)

2006-10-15

24

Reflux of duodenal contents into the pancreatic duct of dogs.  

PubMed

Previously we demonstrated that postprandial duodenal pressure transiently exceeds pancreatic duct pressure in the dog. To determine whether this presure gradient causes reflux from the duodenum into the pancreatic duct, we provided each of five dogs with a permanent pancreatodochal catheter and three indwelling duodenal cutaneous catheters. 14C-PEG was infused through the proximal duodenal catheter; intraluminal pressures were monitored through the middle catheter at the level of the pancreatic duct orifice; and 15 cm abroad, duodenal contents were recovered from the third catheter. Fifteen-minute pooled samples were collected 1 hr preprandially and 2 hr postprandially from the pancreatic duct and duodenum and were analyzed for volume, lipase activity, and marker concentration. Reflux of duodenal contents occurred only in 10.8% of fasting periods but was observed in 38% of postprandial periods (p < 0.05). The total volume of duodenal content refluxed per 15 min approximated 0.1 ml and represented between 0.5% and 1% of total pancreatic volume flow and between 0.05% and 0.07% of total duodenal volume flow. Thus we have provided evidence that small amounts of duodenal contents may reflux into the pancreatic duct of dogs in our experimental model. This finding may be relevant to the pathogenesis of pancreatitis and pancreatic cancer. PMID:7419970

Hendricks, J C; DiMagno, E P; Go, V L; Dozois, R R

1980-11-01

25

Extracorporeal Shock Wave Lithotripsy for Obstructing Pancreatic Duct Calculi  

Microsoft Academic Search

PurposeA review was done to determine the effectiveness of extracorporeal shock wave lithotripsy (ESWL††Dornier Medical Systems, Inc., Marietta, Georgia.) in the treatment of impacted pancreatic duct calculi.

Keith Matthews; Roy J. Correa; Robert P. Gibbons; Robert M. Weissman; Richard A. Kozarek

1997-01-01

26

[Bile duct dilatation associated with pancreatic heterotopia: a case report].  

PubMed

Pancreatic heterotopia or aberrant pancreas is a rare congenital anomaly, usually asymptomatic. Its diagnosis is difficult. We report an original observation in an 8-month-old infant, operated in the neonatal period for esophageal atresia type III in the context of VACTERL syndrome, cystic dilatation of the bile duct, and pancreatic heterotopia. PMID:21216134

Atarraf, K; Lachqar, M; Znati, K; Elfatemi, H; Arroud, M; Rami, M; Khattala, K; El Madi, A; Amarti, A; Hida, M; Afifi, A; Bouabdallah, Y

2011-01-07

27

Physiology and pathophysiology of bicarbonate secretion by pancreatic duct epithelium.  

PubMed

HCO3- -rich fluid in the pancreatic juice (2-3 L/day) is secreted by epithelial cells lining the pancreatic duct tree, while digestive enzymes are secreted by acinar cells with a small amount of Cl- -rich fluid. Ductal HCO3- secretion is not only regulated by gastrointestinal hormones and cholinergic nerves but is also influenced by luminal factors: intraductal pressure, Ca2+ concentration, pathological activation of protease and bile reflux. The maximum HCO3- concentration of the juice under secretin stimulation reaches 140-150 mM. Thus pancreatic duct cells secrete HCO3- against a approximately 7-fold concentration gradient. HCO3- secretion critically depends on the activity of CFTR, a cAMP-dependent anion channel localized in the apical membrane of various epithelia. In the proximal part of pancreatic ducts close to acinar cells HCO3 secretion across the apical membrane is largely mediated by SLC26A6 CI- -HCO3- exchanger. In distal ducts where the luminal HCO3- concentration is already high, most of the HCO3- secretion is mediated by HCO3- conductance of CFTR. CFTR is the causative gene for cystic fibrosis. Loss of function due to severe mutations in both alleles causes typical cystic fibrosis characterized by dehydrated, thick, and viscous luminal fluid/mucus in the respiratory and gastrointestinal tract, pancreatic duct, and vas deferens. A compound heterozygote of mutations/polymorphisms (causing a mild dysfunction of CFTR) involves a risk of developing CFTR-related diseases such as chronic pancreatitis. In cystic fibrosis and certain cases of chronic pancreatitis, the pancreatic duct epithelium secretes a small amount of fluid with neutral-acidic pH, which causes an obstruction of the duct lumen by a protein plug or viscous mucus. PMID:22515107

Ishiguro, Hiroshi; Yamamoto, Akiko; Nakakuki, Miyuki; Yi, Lanjuan; Ishiguro, Mariko; Yamaguchi, Makoto; Kondo, Shiho; Mochimaru, Yuka

2012-02-01

28

Primary Patency of Wallstents in Malignant Bile Duct Obstruction: Single vs. Two or More Noncoaxial Stents  

SciTech Connect

The purpose of this study was to determine the primary patency of two or more noncoaxial self-expanding metallic Wallstents (Boston Scientific, Natick, MA) and to compare this with the primary patency of a single stent in malignant bile duct obstruction. From August 2002 to August 2004, 127 patients had stents placed for malignant bile duct obstruction. Forty-five patients were treated with more than one noncoaxial self-expanding metallic stents and 82 patients had a single stent placed. Two patients in the multiple-stent group were lost to follow-up. The primary patency period was calculated from the date of stenting until the first poststenting intervention for stent occlusion, death, or the time of last documented follow-up. The patency of a single stent was significantly different from that of multiple stents (P = 0.0004). In the subset of patients with high bile duct obstruction, the patency of a single stent remained significantly different from that of multiple stents (P = 0.02). In the single-stent group, there was no difference in patency between patients with high vs. those with low bile duct obstruction (P = 0.43). The overall median patency for the multistent group and the single-stent group was 201 and 261 days, respectively. In conclusion, the patency of a single stent placed for malignant low or high bile duct obstruction is similar, and significantly longer than, that of multiple stents placed for malignant high bile duct obstruction. Given the median patency of 201 days, when indicated, percutaneous stenting of multiple bile ducts is an effective palliative measure for patients with malignant high bile duct obstruction.

Maybody, Majid, E-mail: maybodym@mskcc.org; Brown, Karen T.; Brody, Lynn A.; Covey, Anne M.; Sofocleous, Constantinos T.; Thornton, Raymond H.; Getrajdman, George I. [Interventional Radiology Section, Memorial Sloan-Kettering Cancer Center (United States)

2009-07-15

29

Activation of phosphatidylinositol-3 kinase regulates pancreatic duodenal homeobox-1 in duct cells during pancreatic regeneration  

PubMed Central

OBJECTIVE The purpose of our study was to determine whether the phosphatidylinositol 3-kinase (PI3K)/Akt pathway contributes to expression of pancreatic duodenal homeobox-1 (PDX-1) in duct cells and the cell differentiation during pancreatic regeneration. METHODS The role of PI3K in PDX-1 expression and duct cell differentiation with pancreatic regeneration in mice after partial pancreatectomy (Px) was examined using either wortmannin, a pharmacologic PI3K inhibitor, or siRNA directed to the p85? regulatory subunit of PI3K. Akt phosphorylation, a marker of PI3K activation, and PDX-1 expression were assessed by Western blot analysis and immunohistochemistry. RESULTS Both PDX-1 levels and Akt phosphorylation were concomitantly increased in pancreatic ducts following partial Px, and, conversely, blocked by treatment with wortmannin or p85? siRNA. Pancreatic duct cell differentiation, as assessed by appearance of insulin-positive cells 3 days after partial Px, was effectively reduced by wortmannin. CONCLUSIONS PI3K/Akt activation plays a critical role for both PDX-1 expression and pancreatic duct cell differentiation into insulin-producing cells during pancreatic regeneration.

Watanabe, Hiroaki; Saito, Hiroshi; Nishimura, Haruto; Ueda, Junji; Evers, B. Mark

2008-01-01

30

Moderate and severe postendoscopic retrograde cholangiopancreatography pancreatitis despite prophylactic pancreatic stent placement: The effect of early prophylactic pancreatic stent dislodgement  

PubMed Central

BACKGROUND: Placement of prophylactic pancreatic stents (PPS) is a method proven to reduce the rate and severity of postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in high-risk patients; however, PPS do not eliminate the risk completely. Early PPS dislodgement may occur prematurely and contribute to more frequent or severe PEP. OBJECTIVE: To determine the effect of early dislodgement of PPS in patients with moderate or severe PEP. METHOD: A total of 27,176 ERCP procedures from January 1994 to September 2007 for PPS placement in high-risk patients were analyzed. Patient and procedure data were analyzed to assess risk factors for PEP, and to evaluate the severity of pancreatitis, length of hospitalization and subsequent complications. Timing of stent dislodgment was assessed radiographically. RESULTS: PPS were placed in 7661 patients. Of these, 580 patients (7.5%) developed PEP, which was graded as mild in 460 (6.0%), moderate in 87 (1.1%) and severe in 33 (0.4%). Risk factors for developing PEP were not different in patients who developed moderate PEP compared with those with severe PEP. PPS dislodged before 72 h in seven of 59 (11.9%) patients with moderate PEP and five of 27 (18.5%) patients with severe PEP (P=0.505). The mean (± SD) length of hospitalization in patients with moderate PEP with stent dislodgement before and after 72 h were 7.43±1.46 days and 8.37±1.16 days, respectively (P=0.20). The mean length of hospitalization in patients with severe PEP whose stent dislodged before and after 72 h were 21.6±6.11 and 22.23±3.13 days, respectively (P=0.96). CONCLUSION: Early PPS dislodgement was associated with moderate and severe PEP in less than 20% of cases and was not associated with a more severe course. Factors other than ductal obstruction contribute to PEP in high-risk patients undergoing ERCP and PPS placement.

Moffatt, Dana C; Kongkam, Pradermchai; Avula, Haritha; Sherman, Stuart; Fogel, Evan L; Lehman, Glen A

2011-01-01

31

Regulation of Pancreatic Duct Cell Differentiation by Phosphatidylinositol-3 Kinase  

PubMed Central

We have previously demonstrated that the phosphatidylinositol-3 kinase (PI3K)/Akt signaling is essential for pancreatic regeneration after partial pancreatectomy in mice. In the present study, we examined a role of PI3K/Akt signaling for pancreatic duct cell differentiation into insulin-producing cells. Epithelial-like cells were isolated from mouse pancreas and confirmed to be positive for a duct cell marker cytokeratin-20 (CK-20) but negative for insulin. Incubation of these cells with epidermal growth factor, exhibited a gradual increase in Akt phosphorylation and expression of pancreatic duodenal homeobox-1 (PDX-1), a regulator of ?-cell differentiation. Three weeks later, these CK-20-positive cells were noted to express insulin as determined by immunofluorescent double-staining. Akt phosphorylation, PDX-1 expression, and insulin production were effectively reduced by blocking the PI3K/Akt pathway using siRNA to the p85? regulatory subunit of PI3K. Our results demonstrate that PI3K/Akt activation has a critical role for pancreatic duct cell differentiation into insulin-producing cells.

Watanabe, Hiroaki; Saito, Hiroshi; Ueda, Junji; Evers, B. Mark

2010-01-01

32

Hemostasis using a fully covered self-expandable metal stent for marked bleeding from the bile duct following stent removal (with videos).  

PubMed

We describe a case of life-threatening hemorrhage from the bile duct following stent removal. Eventually, hemostasis was achieved by tamponade using a fully covered self-expandable metal stent. PMID:22539088

Tonozuka, Ryosuke; Itoi, Takao; Sofuni, Atsushi; Itokawa, Fumihide; Ishii, Kentaro

2013-02-01

33

Meandering Main Pancreatic Duct as a Relevant Factor to the Onset of Idiopathic Recurrent Acute Pancreatitis  

PubMed Central

Background Meandering main pancreatic duct (MMPD), which comprises loop type and reverse-Z type main pancreatic duct (MPD), has long been discussed its relation to pancreatitis. However, no previous study has investigated its clinical significance. We aimed to determine the non-biased prevalence and the effect of MMPD on idiopathic pancreatitis using non-invasive magnetic resonance (MR) technique. Methods and Findings A cross-sectional study performed in a tertiary referral center. The study enrolled 504 subjects from the community and 30 patients with idiopathic pancreatitis (7 acute, 13 chronic, and 10 recurrent acute). All subjects underwent MR scanning and medical examination. MMPD was diagnosed when the MPD in the head of pancreas formed two or more extrema in the horizontal direction on coronal images of MR cholangiopancreatography, making a loop or a reverse-Z shaped hairpin curves and not accompanied by other pancreatic ductal anomaly. Statistical comparison was made among groups on the rate of MMPD including loop and reverse-Z subtypes, MR findings, and clinical features. The rate of MMPD was significantly higher for all idiopathic pancreatitis/idiopathic recurrent acute pancreatitis (RAP) (20%/40%; P<0.001/0.0001; odds ratio (OR), 11.1/29.0) than in the community (2.2%) but was not higher for acute/chronic pancreatitis (14%/8%; P?=?0.154/0.266). Multiple logistic regression analysis revealed MMPD to be a significant factor that induces pancreatitis/RAP (P<0.0001/0.0001; OR, 4.01/26.2). Loop/reverse-Z subtypes were found more frequently in idiopathic RAP subgroup (20%/20%; P?=?0.009/0.007; OR, 20.2/24.2) than in the community (1.2%/1.0%). The other clinical and radiographic features were shown not associated with the onset of pancreatitis. Conclusions MMPD is a common anatomical variant and might be a relevant factor to the onset of idiopathic RAP.

Gonoi, Wataru; Akai, Hiroyuki; Hagiwara, Kazuchika; Akahane, Masaaki; Hayashi, Naoto; Maeda, Eriko; Yoshikawa, Takeharu; Kiryu, Shigeru; Tada, Minoru; Uno, Kansei; Ohtsu, Hiroshi; Okura, Naoki; Koike, Kazuhiko; Ohtomo, Kuni

2012-01-01

34

Saline infusion through the pancreatic duct leads to changes in calcium homeostasis similar to those observed in acute pancreatitis.  

PubMed

This work focuses on studying the early events associated with pancreatic damage after retrograde infusion through the pancreatic duct in rats. We have analyzed changes in calcium homeostasis and secretory response in pancreatic acini from rats with taurocholate-induced acute pancreatitis. Moreover, in order to test whether pancreatic duct manipulation can trigger damage inside pancreatic acinar cells, we have studied both parameters in acini from animals infused with saline. Our study demonstrates that taurocholate causes evident damage to acinar cells, impairing both calcium homeostasis and secretory response to CCK. In saline, a significant decrease in calcium cytosolic response to CCK was observed. Calcium disturbances similar to those observed in acute pancreatitis appear before secretion blockade and inflammation processes in saline treated rats. These results could be interesting since pancreatitis is associated to clinical procedures that require duct manipulation such as endoscopic retrograde cholangiopancreatography. PMID:18600455

García, Mónica; Barbáchano, Ernesto Hernández; Lorenzo, Pilar Hernández; San Román, José Ignacio; López, María A; Coveńas, Rafael; Calvo, José Julián

2008-07-04

35

Regulation of the Na+\\/Ca2+ Exchanger in Rat Pancreatic Ducts  

Microsoft Academic Search

The Ca2+ content of pancreatic juice is closely regulated by yet unknown mechanisms. One aim of the present study was to find whether rat pancreatic ducts have a Na+\\/Ca2+ exchanger, as found in some Ca2+ transporting epithelia. Another aim was to establish whether the exchanger is regulated by hormones\\/agonists affecting pancreatic secretion. Whole pancreas, pure pancreatic acini and ducts were

I. Ankorina-Stark; J. Amstrup; I. Novak

2002-01-01

36

Safety and Efficacy of Radiofrequency Ablation in the Management of Unresectable Bile Duct and Pancreatic Cancer: A Novel Palliation Technique  

PubMed Central

Objectives. Radiofrequency ablation (RFA) has replaced photodynamic therapy for premalignant and malignant lesions of the esophagus. However, there is limited experience in the bile duct. The objective of this pilot study was to assess the safety and efficacy of RFA in malignant biliary strictures. Methods: Twenty patients with unresectable malignant biliary strictures underwent RFA with stenting between June 2010 and July 2012. Diameters of the stricture before and after RFA, immediate and 30 day complications and stent patency were recorded prospectively. Results. A total of 25 strictures were treated. Mean stricture length treated was 15.2?mm (SD = 8.7?mm, Range = 3.5–33?mm). Mean stricture diameter before RFA was 1.7?mm (SD = 0.9?mm, Range = 0.5–3.4?mm) while the mean diameter after RFA was 5.2?mm (SD = 2?mm, Range = 2.6–9?mm). There was a significant increase of 3.5?mm (t = 10.8, DF = 24, P value = <.0001) in the bile duct diameter post RFA. Five patients presented with pain after the procedure, but only one developed mild post-ERCP pancreatitis and cholecystitis. Conclusions: Radiofrequency ablation can be a safe palliation option for unresectable malignant biliary strictures. A multicenter randomized controlled trial is required to confirm the long term benefits of RFA and stenting compared to stenting alone.

Figueroa-Barojas, Paola; Bakhru, Mihir R.; Habib, Nagy A.; Ellen, Kristi; Millman, Jennifer; Jamal-Kabani, Armeen; Gaidhane, Monica; Kahaleh, Michel

2013-01-01

37

Mechanisms of cell death after pancreatic duct obstruction in the opossum and the rat  

Microsoft Academic Search

BACKGROUND & AIMS: Mechanisms of cell death in human and experimental pancreatitis remain poorly understood. The aim of this study was to determine the mechanisms of cell death, apoptosis vs. necrosis, in models of pancreatitis induced by pancreatic duct ligation in the opossum and rat. METHODS: Morphological changes were shown by light and electron microscopy, chromatin condensation and DNA breaks

AS Gukovskaya; P Perkins; V Zaninovic; D Sandoval; R Rutherford; T Fitzsimmons; SJ Pandol; S Poucell-Hatton

1996-01-01

38

Blunt pancreatic trauma with main pancreatic duct disruption managed successfully with total parenteral nutrition: report of a case.  

PubMed

Although surgery is the usual treatment of choice for pancreatic trauma with disruption of the main pancreatic duct, we report herein the case of a patient in whom blunt pancreatic trauma with disruption of the proximal main pancreatic duct was successfully managed by conservative treatment. An 18-year-old women presented with abdominal pain 22 days after being involved in a car accident in which her upper abdomen was thrust against the steering wheel. Computed tomography revealed a pancreatic pseudocyst and a prevertebral pancreatic fracture, and endoscopic retrograde pancreatography showed complete disruption of the main pancreatic duct at the neck. Considering that the patient had been clinically stable since the accident, we elected to continue with conservative management and placed her on total parenteral nutrition. Rapid recovery followed and 6 years later, the patient remains well without any exocrine or endocrine insufficiency despite atrophy of the distal pancreas. This experience indicates that selected cases of main pancreatic duct disruption following blunt trauma may be amenable to conservative management. PMID:7749295

Shirai, Y; Tsukada, K; Yamadera, Y; Ohtani, T; Muto, T; Hatakeyama, K

1995-01-01

39

Small serotonin-positive pancreatic endocrine tumors caused obstruction of the main pancreatic duct  

PubMed Central

We report 2 cases of pancreatic endocrine tumors that caused obstruction of the main pancreatic duct (MPD). A 49-year-old asymptomatic man was referred to our institution because dilation of the MPD was revealed by abdominal ultrasonography (US). No tumor was detected by endoscopic ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI). The diameter of the MPD was > 20 mm at the body, and no dilation was noted at the head. Although malignancy was not confirmed through cytology or imaging, pancreatic cancer was strongly suspected. Pancreaticoduo- denectomy was performed. Pathological and immunohistochemical examination revealed a 5 mm × 3 mm serotonin-positive endocrine tumor. Fibrosis was present around the MPD and seemed to cause stricture. A 32-year-old asymptomatic man had elevated serum amylase, and US demonstrated dilation of the MPD. No tumor was detected by CT and MRI. Pancreatic cancer was suspected due to stricture and dilation of the MPD. Pancreatectomy of middle part of pancreas was performed. Pathological and immunohistochemical examination revealed a serotonin-positive endocrine tumor sized 5 mm × 4 mm. We report 2 cases of serotonin-positive pancreatic endocrine tumors that caused stricture of the MPD in spite of the small size of the tumor.

Ogawa, Masami; Kawaguchi, Yoshiaki; Maruno, Atsuko; Ito, Hiroyuki; Nakagohri, Toshio; Hirabayashi, Kenichi; Yamamuro, Hiroshi; Yamashita, Tomohiro; Mine, Tetsuya

2012-01-01

40

Analysis of K-ras gene mutation in hyperplastic duct cells of the pancreas without pancreatic disease  

Microsoft Academic Search

BACKGROUND & AIMS: We and others have previously shown that the mutation of K-ras codon 12 was found in the majority of pancreatic adenocarcinomas. The mutation has also been identified in the pancreatic duct with mucous cell hyperplasia in association with chronic pancreatitis. Ductal hyperplasia is also frequently found in the pancreas free from pancreatic carcinoma or chronic pancreatitis. The

M Tada; M Ohashi; Y Shiratori; T Okudaira; Y Komatsu; T Kawabe; H Yoshida; R Machinami; K Kishi; M Omata

1996-01-01

41

Penetration of lanthanum through the main pancreatic duct epithelium in cats following exposure to infected human bile  

Microsoft Academic Search

The main pancreatic duct epithelium acts as a barrier to the diffusion of molecules from the duct lumen into pancreatic acinar and interstitial tissue. We studied sequential ultrastructural characteristics of the loss of epithelial barrier function in the cat using lanthanum, an electron-opaque tracer, following perfusion of the duct from the tail to the duodenum with infected human bile. Tight

Thomas Arendt

1991-01-01

42

Comparison between magnetic resonance cholangiopancreatography and ERCP for evaluation of the pancreatic duct  

Microsoft Academic Search

OBJECTIVE:To date, ERCP has been the reference technique in the diagnosis of pancreatic duct pathology. The aim of the present study was to evaluate the accuracy of magnetic resonance cholangiopancreatography (MRCP), a relatively new, noninvasive diagnostic method, in studying the pancreatic duct.METHODS:A prospective 15-month study was done of 78 patients with suspected biliopancreatic pathology and indications for ERCP. In all

Mari M Calvo; Luis Bujanda; Angel Calderón; Ińaki Heras; José L Cabriada; Antonio Bernal; Victor Orive; Elena Astigarraga

2002-01-01

43

Biliary peritonitis secondary to perforation of common bile duct: an unusual presentation of chronic calcific pancreatitis.  

PubMed Central

Common bile duct perforation causing biliary peritonitis is an unusual entity and a pancreatic calculus causing this perforation is all the more rare, and to our knowledge has not been reported previously. Such an unusual presentation of chronic calcific pancreatitis is herein reported. Images Figure 1

Kumar, A.; Kataria, R.; Chattopadhyay, T. K.; Karak, P. K.; Tandon, R. K.

1992-01-01

44

Biliary peritonitis secondary to perforation of common bile duct: an unusual presentation of chronic calcific pancreatitis.  

PubMed

Common bile duct perforation causing biliary peritonitis is an unusual entity and a pancreatic calculus causing this perforation is all the more rare, and to our knowledge has not been reported previously. Such an unusual presentation of chronic calcific pancreatitis is herein reported. PMID:1461860

Kumar, A; Kataria, R; Chattopadhyay, T K; Karak, P K; Tandon, R K

1992-10-01

45

Successful Closure and Embolization of a Fistula Between the Pancreatic Duct and a Pseudocyst Using Ethibloc  

SciTech Connect

We successfully achieved complete regression of a pancreatic pseudocyst after Ethibloc embolization of a fistula between the cyst and the pancreatic duct. Previous treatment by percutaneous drainage over 6 weeks had failed. Treatment with a somatostatin analog had not been undertaken.

Buecker, Arno; Keulers, Peter; Guenther, Rolf W. [Clinic for Diagnostic Radiology, University of Technology Aachen, Pauwelsstrasse 30, D-52074 Aachen (Germany)

1997-09-15

46

Pancreatic duct replication is increased with obesity and type 2 diabetes in humans  

Microsoft Academic Search

Aims\\/hypothesis  In a high-fat-fed rat model of type 2 diabetes we noted increased exocrine duct replication. This is a predisposing factor\\u000a for pancreatitis and pancreatic cancer, both of which are more common in type 2 diabetes. The aim of the study reported here\\u000a was to establish if obesity and\\/or type 2 diabetes are associated with increased pancreatic ductal replication in humans.

A. E. Butler; R. Galasso; A. Matveyenko; R. A. Rizza; S. Dry; P. C. Butler

2010-01-01

47

Regulation of the Na+/Ca2+ exchanger in rat pancreatic ducts.  

PubMed

The Ca2+ content of pancreatic juice is closely regulated by yet unknown mechanisms. One aim of the present study was to find whether rat pancreatic ducts have a Na+/Ca2+ exchanger, as found in some Ca2+ transporting epithelia. Another aim was to establish whether the exchanger is regulated by hormones/agonists affecting pancreatic secretion. Whole pancreas, pure pancreatic acini and ducts were obtained from rats and used for RT-PCR and Western blot analysis, immunohistochemistry and intracellular Ca2+ measurements using Fura-2. RT-PCR analysis indicated Na+/Ca2+-exchanger isoforms NCX1.3 and NCX1.7 in acini and pancreas. Western blot with NCX1 antibody identified bands of 70, 120 and 150 kDa in isolated ducts, acini and pancreas. Immunofluorescence experiments showed the Na+/Ca2+ exchanger on the basolateral membrane of acini and small intercalated/intralobular ducts, but in larger intralobular/extralobular ducts the exchanger was predominantly on the luminal membrane. Na+/Ca2+ exchange in ducts was monitored by changes in intracellular Ca2+ activity upon reversal of the Na+ gradient. Secretin (1 nM) and carbachol (1 mM) reduced Na+/Ca2+ exchange by 40% and 51%, respectively. Insulin (1 nM) increased Na+/Ca2+ exchange by 230% within 5 min. The present study shows that pancreatic ducts express the Na+/Ca2+ exchanger. Its distinct localization along the ductal tree and regulation by secretin, carbachol and insulin indicate that ducts might be involved in regulation of Ca2+ concentrations in pancreatic juice. PMID:11891588

Ankorina-Stark, I; Amstrup, J; Novak, I

2002-03-01

48

Differentiation of affinity-purified human pancreatic duct cells to beta-cells.  

PubMed

To test whether pancreatic duct cells are in vitro progenitors, they were purified from dispersed islet-depleted human pancreatic tissue using CA19-9 antibody. The purified fraction was almost entirely CK19+ with no insulin+ cells, whereas the unpurified cells (crude duct) were 56% CK19+ and 0.4% insulin+ of total cells (0.7% of CK19+ cells). These cells were expanded as monolayers, aggregated under serum-free conditions, and transplanted into normoglycemic NOD/SCID mice. In crude duct grafts, insulin+ cells increased to 6.1% of CK19+ cells. Purified duct cells had slow expansion and poor aggregation, as well as engraftment. The addition of 0.1% cultured stromal cells improved these parameters. These stromal cells contained no CK19+ cells and no insulin by either quantitative RT-PCR or immunohistochemistry; stromal cell aggregates and grafts contained no insulin+ cells. Aggregation of purified duct plus stromal preparations induced insulin+ cells (0.1% of CK19+ cells), with further increase to 1.1% in grafts. Insulin mRNA mirrored these changes. In these grafts, all insulin+ cells were in duct-like structures, while in crude duct grafts, 85% were. Some insulin+ cells coexpressed duct markers (CK19 and CA19-9) and heat shock protein (HSP)27, a marker of nonislet cells, suggesting the transition from duct. Thus, purified duct cells from adult human pancreas can differentiate to insulin-producing cells. PMID:17473224

Yatoh, Shigeru; Dodge, Rikke; Akashi, Tomoyuki; Omer, Abdulkadir; Sharma, Arun; Weir, Gordon C; Bonner-Weir, Susan

2007-05-01

49

A Novel Model of Severe Gallstone Pancreatitis: Murine Pancreatic Duct Ligation Results in Systemic Inflammation and Substantial Mortality  

PubMed Central

Background Suitable experimental models of gallstone pancreatitis with systemic inflammation and mortality are limited. We developed a novel murine model of duct-ligation-induced acute pancreatitis associated with multiorgan dysfunction and severe mortality. Methods Laparotomy was done on C57/BL6 mice followed by pancreatic duct (PD) ligation, bile duct (BD) ligation without PD ligation, or sham operation. Results Only mice with PD ligation developed acute pancreatitis and had 100% mortality. Pulmonary compliance was significantly reduced after PD ligation but not BD ligation. Bronchoalveolar lavage fluid neutrophil count and interleukin-1? concentration, and the plasma creatinine level, were significantly elevated with PD ligation but not BD ligation. Pancreatic nuclear factor ?B (p65) and activator protein 1 (c-Jun) were activated within 1 h of PD ligation. Conclusion PD-ligation-induced acute pancreatitis in mice is associated with systemic inflammation, acute lung injury, multiorgan dysfunction and death. The development of this novel model is an exciting and notable advance in the field.

Samuel, Isaac; Yuan, Zuobiao; Meyerholz, David K.; Twait, Erik; Williard, Deborah E.; Kempuraj, Duraisamy

2010-01-01

50

Temporary Fibrin Glue Occlusion of the Main Pancreatic Duct in the Prevention of Intra-Abdominal Complications After Pancreatic Resection  

PubMed Central

Objective To determine whether temporary occlusion of the main pancreatic duct with human fibrin glue decreases the incidence of intra-abdominal complications after pancreatoduodenectomy (PD) or distal pancreatectomy (DP). Summary Background Data To the authors’ knowledge, there are no randomized studies comparing outcomes after pancreatic resection with or without main pancreatic duct occlusion by injection of fibrin glue. Of three nonrandomized studies, two reported no fistulas after intracanal injection and ductal occlusion with fibrin glue after PD with immediate pancreatodigestive anastomosis, while another study reported no protective effect of glue injection. Methods This prospective, randomized, single-blinded, multicenter study, conducted between January 1995 and January 1999, included 182 consecutive patients undergoing PD followed by immediate pancreatic anastomosis or DP, whether for benign or malignant tumor or for chronic pancreatitis. One hundred two underwent pancreatic resection followed by ductal occlusion with fibrin glue (made slowly resorbable by the addition of aprotinin); 80 underwent resection without ductal occlusion. The main end point was the number of patients with one or more of the following intra-abdominal complications: pancreatic or other digestive tract fistula, intra-abdominal collections (infected or not), acute pancreatitis, or intra-abdominal or digestive tract hemorrhage. Severity factors included postoperative mortality, repeat operations, and length of hospital stay. Results The two groups were similar in pre- and intraoperative characteristics except that there were significantly more patients in the ductal occlusion group who were receiving octreotide, who had reinforcement of their anastomosis by fibrin glue, and who had fibrotic pancreatic stumps. However, the rate of patients with one or more intra-abdominal complications, and notably with pancreatic fistula, did not differ significantly between the two groups. There was still no significant difference found after statistical adjustment for these patient characteristic discrepancies, confirming the inefficacy of fibrin glue. The rate of intra-abdominal complications was significantly higher in the presence of a normal, nonfibrotic pancreatic stump and main pancreatic duct diameter less than 3 mm, whereas reinforcement of the anastomosis with fibrin glue or use of octreotide did not influence outcome. In multivariate analysis, however, normal pancreatic parenchyma was the only independent risk factor for intra-abdominal complications. No significant differences were found in the severity of complications between the two groups. Conclusions Ductal occlusion by intracanal injection of fibrin glue decreases neither the rate nor the severity of intra-abdominal complications after pancreatic resection.

Suc, Bertrand; Msika, Simon; Fingerhut, Abe; Fourtanier, Gilles; Hay, Jean-Marie; Holmieres, Franck; Sastre, Bernard; Fagniez, Pierre-Louis

2003-01-01

51

The spectrum and natural history of common bile duct stenosis in chronic alcohol-induced pancreatitis.  

PubMed Central

Sixty patients with chronic alcohol-induced pancreatitis with endoscopic retrograde cholangiopancreatography evidence of common bile duct stenosis were studied to determine the clinical spectrum and natural history of this complication, as well as the indications for biliary bypass. In 17% of patients, common bile duct stenosis (CBDS) was an incidental finding at ERCP, while in the remaining cases pain and jaundice were the predominant symptoms in 35% and 48%, respectively. Biliary drainage was performed in 38% of patients for persistent or recurrent jaundice, cholangitis, and while undergoing pancreatic duct or cyst drainage procedures for pain. The benign nature of CBDS in chronic alcohol-induced pancreatitis (CAIP) in patients without persistent jaundice is emphasized. In particular, no histologically proved cases of secondary biliary cirrhosis were noted. The majority of patients with CBDS due to CAIP may be safely managed without biliary bypass but require close follow-up. Images Fig. 1. Fig. 2. Fig. 3.

Kalvaria, I; Bornman, P C; Marks, I N; Girdwood, A H; Bank, L; Kottler, R E

1989-01-01

52

Pancreatitis-Induced Extrahepatic Portal Vein Stenosis Treated by Percutaneous Transhepatic Stent Placement: a Case Report  

SciTech Connect

One month after onset of an acute biliary pancreatitis, a 75-year-old man developed refractory ascites. Duplex ultrasound and CT scan revealed a focal stenosis of the extrahepatic portal vein as confirmed by transhepatic direct portography. In the same session, this stenosis, responsible for symptomatic prehepaticportal hypertension, was successfully dilated and stented and afterwards a residual pressure gradient of 1 mmHg over the stented segment was measured. One week after the stenting procedure the patient was free of ascites and control physical and biochemical examination one year later is completely normal.

Maleux, G., E-mail: geert.maleux@uz.kuleuven.ac.be; Vaninbroukx, J. [University Hospitals, Leuven, Department of Radiology (Belgium); Verslype, C. [University Hospitals, Leuven, Department of Hepatology (Belgium); Vanbeckevoort, D. [University Hospitals, Leuven, Department of Radiology (Belgium); Hootegem, P. van [AZ Sint-Lucas, Assebroek-Brugge, Department of Gastroenterology (Belgium); Nevens, F. [University Hospitals, Leuven, Department of Hepatology (Belgium)

2003-08-15

53

Plasticity of Adult Human Pancreatic Duct Cells by Neurogenin3-Mediated Reprogramming  

PubMed Central

Aims/Hypothesis Duct cells isolated from adult human pancreas can be reprogrammed to express islet beta cell genes by adenoviral transduction of the developmental transcription factor neurogenin3 (Ngn3). In this study we aimed to fully characterize the extent of this reprogramming and intended to improve it. Methods The extent of the Ngn3-mediated duct-to-endocrine cell reprogramming was measured employing genome wide mRNA profiling. By modulation of the Delta-Notch signaling or addition of pancreatic endocrine transcription factors Myt1, MafA and Pdx1 we intended to improve the reprogramming. Results Ngn3 stimulates duct cells to express a focused set of genes that are characteristic for islet endocrine cells and/or neural tissues. This neuro-endocrine shift however, is incomplete with less than 10% of full duct-to-endocrine reprogramming achieved. Transduction of exogenous Ngn3 activates endogenous Ngn3 suggesting auto-activation of this gene. Furthermore, pancreatic endocrine reprogramming of human duct cells can be moderately enhanced by inhibition of Delta-Notch signaling as well as by co-expressing the transcription factor Myt1, but not MafA and Pdx1. Conclusions/Interpretation The results provide further insight into the plasticity of adult human duct cells and suggest measurable routes to enhance Ngn3-mediated in vitro reprogramming protocols for regenerative beta cell therapy in diabetes.

Bonne, Stefan; Heremans, Yves; Borup, Rehannah; Van de Casteele, Mark; Ling, Zhidong; Pipeleers, Daniel; Ravassard, Philippe; Nielsen, Finn; Ferrer, Jorge; Heimberg, Harry

2012-01-01

54

Facts and fallacies of common bile duct obstruction by pancreatic pseudocysts.  

PubMed Central

Although it is commonly accepted that pancreatic pseudocysts can cause obstruction of the common bile duct, few documented examples of this phenomenon exist. Most cases of obstructive jaundice associated with pseudocysts appear to be due to fibrotic stricture of the intrapancreatic portion of the common bile duct, rather than to pressure on the duct by the pseudocyst. We report three additional cases, in two of which fibrosis and not the pseudocyst caused the biliary obstruction. This experience illustrates the imperative to perform intraoperative cholangiography after drainage of the pseudocyst and the necessity of a biliary-enteric bypass if bile duct obstruction has not been relieved by simple decompression of the pseudocyst. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4. Fig. 5. Fig. 6. Fig. 7.

Warshaw, A L; Rattner, D W

1980-01-01

55

Superior Mesenteric Artery Stent-graft Placement in a Patient with Pseudoaneurysm Developing from a Pancreatic Pseudocyst  

SciTech Connect

Pseudoaneurysm is a relatively rare but serious complication of pancreatitis which is often fatal. We report successful stent-graft placement in the superior mesenteric artery in a 45-year-old man with a pancreatic pseudocyst that grew during therapy for chronic pancreatitis and developed into a pseudoaneurysm. After a stent graft was inserted in the superior mesenteric artery, the pseudoaneurysm disappeared and no further complications developed. Stent-graft placement was considered to be a useful therapy for pseudoaneurysms in the superior mesenteric arterial region.

Ogino, H.; Banno, T.; Sato, Y.; Hara, M.; Shibamoto, Y. [Nagoya City University School of Medicine 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Department of Radiology (Japan)

2004-01-15

56

Long-term follow-up of endoscopic stenting in patients with chronic pancreatitis secondary to pancreas divisum  

Microsoft Academic Search

Background  Pancreas divisum is the most common anatomic variant of pancreatic development and may lead to pancreatitis. This study evaluated\\u000a the efficacy of endoscopic stenting in patients with chronic pancreatitis due to pancreas divisum.\\u000a \\u000a \\u000a \\u000a Methods  Between 1993 and 2005, 32 patients with chronic pancreatitis due to pancreas divisum were treated with endoscopic stenting.\\u000a Each patient underwent an endoscopic retrograde cholangiopancreatography to confirm

Gary C. Vitale; Michael Vitale; David S. Vitale; John C. Binford; Ben Hill

2007-01-01

57

Membrane localization of H+ and HCO3- transporters in the rat pancreatic duct.  

PubMed

The pancreatic duct secretes alkaline fluid that is rich in HCO3- and poor in Cl-. The molecular mechanisms that mediate ductal secretion and are responsible for the axial gradients of Cl- and HCO3- along the ductal tree are not well understood because H+ and HCO3- transport by duct cells have not been characterized or localized. To address these questions, we microdissected the intralobular, main, and common segments of the rat pancreatic duct. H+ and HCO3- transporters were characterized and localized by following intracellular pH while perfusing the bath and the lumen of the ducts. In intralobular ducts, Na(+)-dependent and amiloride-sensitive recovery from acid load in the absence of HCO3- was used to localize a Na+/H+ exchanger to the basolateral membrane (BLM). Modification of Cl- gradients across the luminal (LM) and BLM in the presence of HCO3- showed the presence of Cl-/HCO3- exchangers on both membranes of intralobular duct cells. Measurement of the effect of Cl- on one side of the membrane on the rate and extent of pHi changes caused by removal and addition of Cl- to the opposite side suggested that both exchangers are present in the same cell. In the presence of HCO3-, intralobular duct cells used three separate mechanisms to extrude H+: (a) BLM-located Na+/H+ exchange, (b) Na(+)-independent vacuolar-type H+ pump, and (c) BLM-located, Na(+)-dependent, amiloride-insensitive, and 4',4'-diisothiocyanatostilbene-2,2'-disulfonic acid sensitive mechanism, possibly a Na(+)-dependent HCO3- transporter. The main and common segments of the duct displayed similar mechanisms and localization of H+ and HCO3- transporters to the extent studied in the present work. In addition to the transporters found in intralobular ducts, the main and common ducts showed Na+/H+ exchange activity in the LM. Three tests were used to exclude a significant luminal to basolateral Na+ leak as the cause for an apparent luminal Na+/H+ exchange in an HCO3- secreting cells: (a) addition of amiloride and removal of Na+ from the LM had a profound effect on Na+/H+ exchange activity on the BLM and vice versa; (b) inhibition of all transporters in the BLM by bathing the duct in the inert hydrocarbon Fluorinert FC-75 did not prevent cytosolic acidification caused by removal of luminal Na+; and (c) luminal Na+ did not activate the basolateral Na(+)-dependent HCO3- transporter. An Na(+)-independent, bafilomycin-sensitive H+ pumping activity was marginal in the absence of HCO3-.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:7964596

Zhao, H; Star, R A; Muallem, S

1994-07-01

58

Biliary Obstruction Due to Isolated Pancreatic Tuberculosis  

Microsoft Academic Search

A 38 -year-old male from Iraq without any history of previous infections presented at our institute with recently developed jaundice caused by a pancreatic head mass. A CT scan of the abdomen showed the mass in the pancreatic head without lymph node involvement or infiltration of the vascular structures (Image 1). ERCP revealed a double duct sign. Endoscopic stent placement

Sietze A Koopal; Robby E Kibbelaar; Jan A Zijlstra

59

Multifocal pancreatic intraepithelial neoplasia (PanIN) lesions of the branch ducts associated with lobular parenchymal atrophy in a Japanese patient diagnosed to have familial pancreatic cancer  

Microsoft Academic Search

This report presents a case of Japanese familial pancreatic cancer (FPC) with multifocal pancreatic intraepithelial neoplasia\\u000a (PanIN) lesions of the branch ducts probably associated with lobular parenchymal atrophy. The risk of pancreatic cancer is\\u000a significantly increased in those associated with FPC, and this risk increases with increasing numbers of affected first-degree\\u000a relatives, but there have been four Japanese cases reported.

Mitsuhiro Inagaki; Junichi Goto; Yoshihiko Tokusashi; Naoyuki Miyokawa; Kazunori Yokoyama; Sunao Ikeue; Shinichi Kasai

2009-01-01

60

Percutaneous Palliation of Pancreatic Head Cancer: Randomized Comparison of ePTFE/FEP-Covered Versus Uncovered Nitinol Biliary Stents  

SciTech Connect

The purpose of this study was to compare the clinical effectiveness of expanded polytetrafluoroethylene/fluorinated-ethylene-propylene (ePTFE/FEP)-covered stents with that of uncovered nitinol stents for the palliation of malignant jaundice caused by inoperable pancreatic head cancer. Eighty patients were enrolled in a prospective randomized study. Bare nitinol stents were used in half of the patients, and ePTFE/FEP-covered stents were used in the remaining patients. Patency, survival, complications, and mean cost were calculated in both groups. Mean patency was 166.0 {+-} 13.11 days for the bare-stent group and 234.0 {+-} 20.87 days for the covered-stent group (p = 0.007). Primary patency rates at 3, 6, and 12 months were 77.5, 69.8, and 69.8% for the bare-stent group and 97.5, 92.2, and 87.6% for the covered-stent group, respectively. Mean secondary patency was 123.7 {+-} 22.5 days for the bare-stent group and 130.3 {+-} 21.4 days for the covered-stent group. Tumour ingrowth occurred exclusively in the bare-stent group in 27.5% of cases (p = 0.002). Median survival was 203.2 {+-} 11.8 days for the bare-stent group and 247.0 {+-} 20 days for the covered-stent group (p = 0.06). Complications and mean cost were similar in both groups. Regarding primary patency and ingrowth rate, ePTFE/FEP-covered stents have shown to be significantly superior to bare nitinol stents for the palliation of malignant jaundice caused by inoperable pancreatic head cancer and pose comparable cost and complications. Use of a covered stent does not significantly influence overall survival rate; nevertheless, the covered endoprosthesis seems to offer result in fewer reinterventions and better quality of patient life.

Krokidis, Miltiadis, E-mail: mkrokidis@hotmail.com [Guy's and St. Thomas' Hospitals, Department of Radiology (United Kingdom); Fanelli, Fabrizio ['La Sapienza' University of Rome, Department of Radiological Sciences (Italy); Orgera, Gianluigi [European Institute of Oncology, Unit of Interventional Radiology (Italy); Tsetis, Dimitrios [University Hospital of Heraklion, Medical School of Crete, Department of Radiology (Greece); Mouzas, Ioannis [University Hospital of Heraklion, Medical School of Crete, Department of Gastroenterology (Greece); Bezzi, Mario ['La Sapienza' University of Rome, Department of Radiological Sciences (Italy); Kouroumalis, Elias [University Hospital of Heraklion, Medical School of Crete, Department of Gastroenterology (Greece); Pasariello, Roberto ['La Sapienza' University of Rome, Department of Radiological Sciences (Italy); Hatzidakis, Adam [Medical School of Crete (Greece)

2011-04-15

61

Different purinergic receptors lead to intracellular calcium increases in pancreatic ducts  

Microsoft Academic Search

Extracellular adenosine 5’-triphosphate (ATP) has been described to act as a regulator in many cells and tissues, including\\u000a epithelia, and in the gastrointestinal tract ATP is one of the substances involved in non-cholinergic non-adrenergic control.\\u000a However, very little is known about the effect of ATP on pancreatic ducts, which normally secrete bicarbonate-rich fluid in\\u000a response to secretin. Hence, the aim

B. C. Christoffersen; M. J. Hug; I. Novak

1998-01-01

62

Characterization of pancreatic stem cells derived from adult human pancreas ducts by fl uorescence activated cell sorting  

Microsoft Academic Search

AIM: To isolate putative pancreatic stem cells (PSCs) from human adult tissues of pancreas duct using serum- free, conditioned medium. The characterization of surface phenotype of these PSCs was analyzed by fl ow cytometry. The potential for pancreatic lineage and the capability of ?-cell differentiation in these PSCs were evaluated as well. METHODS: By using serum-free medium supplemented with essential

Han-Tso Lin; Shih-Hwa Chiou; Chung-Lan Kao; Yi-Ming Shyr; Chien-Jen Hsu; Yih-Wen Tarng; Larry L-T Ho; Ching-Fai Kwok; Hung-Hai Ku

63

Long-term Follow-up in Small Duct Chronic Pancreatitis  

PubMed Central

Background: A pancreatic duct diameter (PDD) ranging from 4 to 5 mm is regarded as “normal.” The “large duct” form of chronic pancreatitis (CP) with a PDD >7 mm is considered a classic indication for drainage procedures. In contrast, in patients with so-called “small duct chronic pancreatitis” (SDP) with a PDD <3 mm extended resectional procedures and even, in terms of an “ultima ratio,” total pancreatectomy are suggested. Methods: Between 1992 and 2004, a total of 644 patients were operated on for CP. Forty-one prospectively evaluated patients with SDP underwent a new surgical technique aiming at drainage of the entire major PD (longitudinal “V-shaped excision” of the anterior aspect of the pancreas). Preoperative workup for imaging ductal anatomy included ERCP/MRCP, visualizing the PD throughout the entire gland. The interval between symptoms and therapeutic intervention varied from 12 to 120 months. Median follow-up was 83 months (range, 39–117 months). A pain score as well as a multidimensional psychometric quality-of-life questionnaire was used. Results: Hospital mortality was 0%. The perioperative (30 days) morbidity was 19.6%. Postoperative, radiologic imaging showed an excellent drainage of the entire gland and the PD in all but 1 patient. Global quality-of-life index increased in median by 54% (range, 37.5%–80%). Median pain score decreased by 95%. Twenty-seven patients (73%) had complete pain relief. Sixteen patients (43%) developed diabetes, while the exocrine pancreatic function was well preserved in 29 patients (78%). Conclusion: “V-shaped excision” of the anterior aspect of the pancreas is a secure and effective approach for SDP, achieving significant improvement in quality of life and pain relief, hereby sparing patients from unnecessary, extended resectional procedures. The deterioration of exocrine and endocrine pancreatic functions is comparable with that observed during the natural course of the disease.

Yekebas, Emre F.; Bogoevski, Dean; Honarpisheh, Human; Cataldegirmen, Guellue; Habermann, Christian R.; Seewald, Stefan; Link, Bjoern C.; Kaifi, Jussuf T.; Wolfram, Lars; Mann, Oliver; Bubenheim, Michael; Izbicki, Jakob R.

2006-01-01

64

Stent-guided sphincterotomy.  

PubMed

Performing sphincterotomy when either Billroth II gastrectomy or complicated periampullary diverticula are present may increase the risk of complications. In addition a sphincterotomy on the main pancreatic sphincter or the papilla of Santorini presents complicated problems. Stent-guided sphincterotomy has been utilized in 229 patients presenting to our institution from 1983 through 1992. They were performed in 67 patients who had undergone Billroth II gastrectomy, 23 with periampullary diverticula, 57 with pancreas divisum, and 82 with a history of recurrent pancreatitis. To prevent ductal injury or perforation, a stent is first inserted into the biliary or pancreatic duct to guide the sphincterotomy incision. The sphincterotomy is performed using electrocautery current delivered through a "needle knife" sphincterotome. Pancreatitis occurred in 19 patients (8.3%). It was mild in 17 and moderate in two patients. One patient experienced severe hemorrhage requiring surgery. No mortality or perforations occurred. The stent-guided needle knife sphincterotomy approach is an effective technique. It has a low complication rate even in these difficult anatomic conditions. It assures that the incision precisely follows the duct when performing pancreatic sphincterotomy. PMID:7988820

Siegel, J H; Cohen, S A; Kasmin, F E; Veerappan, A

65

Pancreatic duct guidewire placement for biliary cannulation in a single-session therapeutic ERCP  

PubMed Central

AIM: To investigate the technical success and clinical complication rate of a cannulated pancreatic duct with guidewire for biliary access. METHODS: During a five-year study period, a total of 2843 patients were included in this retrospective analysis. Initial biliary cannulation method consisted of single-guidewire technique (SGT) for up to 5 attempts, followed by double-guidewire technique (DGT) when repeated unintentional pancreatic duct cannulation had taken place. Pre-cut papillotomy technique was reserved for when DGT had failed or no pancreatic duct cannulation had been previously achieved. Main outcome measurements were defined as biliary cannulation success and post-endoscopic retrograde cholangiopancreatography (ERCP) complication rate. RESULTS: SGT (92.3% success rate) was characterized by statistically significant enhanced patient outcome compared to either the DGT (43.8%, P < 0.001), pre-cut failed DGT (73%, P < 0.001) or pre-cut as first step method (80.6%, P = 0.002). Pre-cut as first step method offered a statistically significantly more favorable outcome compared to the DGT (P < 0.001). The incidence of post-ERCP pancreatitis did not differ in a statistically significant manner between either method (SGT: 5.3%, DGT: 6.1%, Pre-cut failed DGT: 7.9%, Pre-cut as first step: 7.5%) or with patients’ gender. CONCLUSION: Although DGT success rate proved not to be superior to SGT or pre-cut papillotomy, it is considered highly satisfactory in terms of safety in order to avoid the risk of a pre-cut when biliary therapy is necessary in difficult-to-cannulate cases.

Xinopoulos, Dimitrios; Bassioukas, Stefanos P; Kypreos, Dimitrios; Korkolis, Dimitrios; Scorilas, Andreas; Mavridis, Konstantinos; Dimitroulopoulos, Dimitrios; Paraskevas, Emmanouil

2011-01-01

66

Adult pancreatic acinar cells give rise to ducts but not endocrine cells in response to growth factor signaling  

PubMed Central

Studies in both humans and rodents have found that insulin+ cells appear within or near ducts of the adult pancreas, particularly following damage or disease, suggesting that these insulin+ cells arise de novo from ductal epithelium. We have found that insulin+ cells are continuous with duct cells in the epithelium that makes up the hyperplastic ducts of both chronic pancreatitis and pancreatic cancer in humans. Therefore, we tested the hypothesis that both hyperplastic ductal cells and their associated insulin+ cells arise from the same cell of origin. Using a mouse model that develops insulin+ cell-containing hyperplastic ducts in response to the growth factor TGF?, we performed genetic lineage tracing experiments to determine which cells gave rise to both hyperplastic ductal cells and duct-associated insulin+ cells. We found that hyperplastic ductal cells arose largely from acinar cells that changed their cell fate, or transdifferentiated, into ductal cells. However, insulin+ cells adjacent to acinar-derived ductal cells arose from pre-existing insulin+ cells, suggesting that islet endocrine cells can intercalate into hyperplastic ducts as they develop. We conclude that apparent pancreatic plasticity can result both from the ability of acinar cells to change fate and of endocrine cells to reorganize in association with duct structures.

Blaine, Stacy A.; Ray, Kevin C.; Anunobi, Reginald; Gannon, Maureen A.; Washington, Mary K.; Means, Anna L.

2010-01-01

67

Bestrophin expression and function in the human pancreatic duct cell line, CFPAC-1.  

PubMed

Pancreatic duct epithelial cells (PDECs) have been shown to express calcium activated chloride channels (CaCCs) and there is evidence for their involvement in fluid secretion from these cells. The molecular identity of the CaCC in PDECs remains unknown. Recently, the bestrophin family of proteins have been proposed as a potential molecular candidate for CaCCs. Expression of bestrophins is strongly correlated with the function of CaCCs in a variety of tissues. In the present study, the expression of bestrophins has been investigated in the cystic fibrosis pancreatic duct cell line, CFPAC-1. Iodide efflux analysis was used to characterise native CaCCs in CFPAC-1 cell monolayers. Efflux was induced with the addition of UTP (100 microM, 10.2 +/- 1.5 nmol min(-1)), which was blocked by the chloride channel blockers niflumic acid (81%) and DIDS (90%). The UTP-stimulated iodide efflux was shown to be Ca(2+) dependent and cAMP independent. RT-PCR analysis of RNA isolated from CFPAC-1 cells demonstrated positive identification of all four human bestrophin mRNAs. Western blot of CFPAC-1 cell protein isolates with antibodies specific to human bestrophin 1 (hBest1) showed that hBest1 protein was expressed in this cell line. HBest1 was present on the cell surface, demonstrated using biotinylation and confocal imaging, as well as in the cytoplasm. SiRNA-mediated silencing of hBest1 in CFPAC-1 cells reduced the UTP-stimulated iodide efflux by around 40%. This study provides evidence that the bestrophins are expressed in pancreatic duct cells and, more specifically, that hBest1 plays a role in the CaCCs found in these cells. PMID:19237432

Marsey, Laura L; Winpenny, John P

2009-02-23

68

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

PubMed

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

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

1998-01-01

69

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

PubMed Central

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

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

1998-01-01

70

Pancreatic Expression of Keratinocyte Growth Factor Leads to Differentiation of Islet Hepatocytes and Proliferation of Duct Cells  

PubMed Central

Keratinocyte growth factor, (KGF), a member of the fibroblast growth factor (FGF) family, is involved in wound healing. It also promotes the differentiation of many epithelial tissues and proliferation of epithelial cells as well as pancreatic duct cells. Additionally, many members of the highly homologous FGF family (including KGF), influence both growth and cellular morphology in the developing embryo. We have previously observed elevated levels of KGF in our interferon-? transgenic mouse model of pancreatic regeneration. To understand the role of KGF in pancreatic differentiation, we generated insulin promoter-regulated KGF transgenic mice. Remarkably, we have found that ectopic KGF expression resulted in the emergence of hepatocytes within the islets of Langerhans in the pancreas. Additionally, significant intra-islet duct cell proliferation in the pancreata of transgenic KGF mice was observed. The unexpected appearance of hepatocytes and proliferation of intra-islet duct cells in the pancreata of these mice evidently stemmed directly from local exposure to KGF.

Krakowski, Michelle L.; Kritzik, Marcie R.; Jones, Ellene M.; Krahl, Troy; Lee, Jae; Arnush, Marc; Gu, Danling; Sarvetnick, Nora

1999-01-01

71

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

Microsoft Academic Search

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

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

2002-01-01

72

Spatial arrangement of the pancreatic ducts in the head of the pancreas with special reference to the branches of the uncinate process  

Microsoft Academic Search

Background: It remains very difficult to clarify the spatial arrangement of the branches of the pancreatic ducts in the head of the pancreas despite recent progress in diagnostic imaging techniques. Methods: We minutely dissected the head region from 15 cadavers after injection of silicone rubber into the ducts through the papilla of Vater to investigate the distribution of these ducts.

Sadao Takahashi; Keiichi Akita; Narihide Goseki; Tatsuo Sato

1999-01-01

73

Characterization of store-operated Ca2+ channels in pancreatic duct epithelia.  

PubMed

Store-operated Ca2+ channels (SOCs) are activated by depletion of intracellular Ca2+ stores following agonist-mediated Ca2+ release. Previously we demonstrated that Ca2+ influx through SOCs elicits exocytosis efficiently in pancreatic duct epithelial cells (PDEC). Here we describe the biophysical, pharmacological, and molecular properties of the duct epithelial SOCs using Ca2+ imaging, whole-cell patch-clamp, and molecular biology. In PDEC, agonists of purinergic, muscarinic, and adrenergic receptors coupled to phospholipase C activated SOC-mediated Ca2+ influx as Ca2+ was released from intracellular stores. Direct measurement of [Ca2+] in the ER showed that SOCs greatly slowed depletion of the ER. Using IP3 or thapsigargin in the patch pipette elicited inwardly rectifying SOC currents. The currents increased ?8-fold after removal of extracellular divalent cations, suggesting competitive permeation between mono- and divalent cations. The current was completely blocked by high doses of La3+ and 2-aminoethoxydiphenyl borate (2-APB) but only partially depressed by SKF-96365. In polarized PDEC, SOCs were localized specifically to the basolateral membrane. RT-PCR screening revealed the expression of both STIM and Orai proteins for the formation of SOCs in PDEC. By expression of fluorescent STIM1 and Orai1 proteins in PDEC, we confirmed that colocalization of the two proteins increases after store depletion. In conclusion, basolateral Ca2+ entry through SOCs fills internal Ca2+ stores depleted by external stimuli and will facilitate cellular processes dependent on cytoplasmic Ca2+ such as salt and mucin secretion from the exocrine pancreatic ducts. PMID:23968882

Kim, Mean-Hwan; Seo, Jong Bae; Burnett, Lindsey A; Hille, Bertil; Koh, Duk-Su

2013-08-20

74

Serotonin Expression in Pancreatic Neuroendocrine Tumors Correlates with a Trabecular Histologic Pattern and Large Duct Involvement  

PubMed Central

Pancreatic neuroendocrine tumors (PanNETs) with prominent stromal fibrosis are often clinically, radiographically, and grossly indistinguishable from ductal adenocarcinoma. We recently described a small series of fibrotic PanNETs that express serotonin. In order to understand better the relationship between histopathological patterns and serotonin expression, we reviewed 361 PanNETs to identify those with prominent stromal fibrosis exceeding 50% of total tumor area. We identified 52 cases, and immunolabeled these neoplasms with antibodies to serotonin and Ki-67. Two predominant histologic subtypes were identified: 14 of 52 (26.9%) had a trabecular or trabecular-glandular cellular pattern with interspersed fibrosis, while 38 of 52 (73.1%) had solid architecture. Fourteen of the 52 (26.9%) PanNETs showed at least focal serotonin immunoreactivity. Tumors with predominantly trabecular architecture were significantly more likely to express serotonin than those with solid architecture (P < 0.01). Only 2 of 34 PanNETs with fibrosis less than 30% of total tumor area expressed serotonin. The 14 serotonin-expressing tumors were less likely to have lymph node metastases (P = 0.016) and more likely to involve large pancreatic ducts (P < 0.01) than were the 38 serotonin-negative tumors. The serotonin-expressing tumors were also found in a younger patient population (P < 0.01). There was no significant association of serotonin immunoreactivity with Ki-67 proliferation index, tumor size, or distant metastases. Our data demonstrate a strong correlation between trabecular architecture and serotonin immunoreactivity in PanNETs with stromal fibrosis. Serotonin-expressing tumors are also less likely to have lymph node metastases and more likely to involve large pancreatic ducts.

McCall, Chad M.; Shi, Chanjuan; Klein, Alison P.; Konukiewitz, Bjorn; Edil, Barish H.; Ellison, Trevor A.; Wolfgang, Christopher L.; Schulick, Richard D.; Kloppel, Gunter; Hruban, Ralph H.

2011-01-01

75

Protein kinase C mediates the inhibitory effect of substance P on HCO3- secretion from guinea pig pancreatic ducts.  

PubMed

The inhibitory control of pancreatic ductal HCO(3)(-) secretion may be physiologically important in terms of limiting the hydrostatic pressure developed within the ducts and in terms of switching off pancreatic secretion after a meal. Substance P (SP) inhibits secretin-stimulated HCO(3)(-) secretion by modulating a Cl(-)-dependent HCO(3)(-) efflux step at the apical membrane of the duct cell (Hegyi P, Gray MA, and Argent BE. Am J Physiol Cell Physiol 285: C268-C276, 2003). In the present study, we have shown that SP is present in periductal nerves within the guinea pig pancreas, that PKC mediates the effect of SP, and that SP inhibits an anion exchanger on the luminal membrane of the duct cell. Secretin (10 nM) stimulated HCO(3)(-) secretion by sealed, nonperfused, ducts about threefold, and this effect was totally inhibited by SP (20 nM). Phorbol 12,13-dibutyrate (PDBu; 100 nM), an activator of PKC, reduced basal HCO(3)(-) secretion by approximately 40% and totally blocked secretin-stimulated secretion. In addition, bisindolylmaleimide I (1 nM to 1 microM), an inhibitor of PKC, relieved the inhibitory effect of SP on secretin-stimulated HCO(3)(-) secretion and also reversed the inhibitory effect of PDBu. Western blot analysis revealed that guinea pig pancreatic ducts express the alpha-, beta(I)-, delta-, epsilon-, eta-, theta-, zeta-, and mu-isoforms of PKC. In microperfused ducts, luminal H(2)DIDS (0.5 mM) caused intracellular pH to alkalinize and, like SP, inhibited basal and secretin-stimulated HCO(3)(-) secretion. SP did not inhibit secretion further when H(2)DIDS was present in the lumen, suggesting that SP and H(2)DIDS both inhibit the activity of an anion exchanger on the luminal membrane of the duct cell. PMID:15625303

Hegyi, Péter; Rakonczay, Zoltán; Tiszlavicz, László; Varró, András; Tóth, András; Rácz, Gábor; Varga, Gábor; Gray, Michael A; Argent, Barry E

2004-12-29

76

Bile duct stents: Is there an increased rate of complications in patients receiving chemotherapy?  

Microsoft Academic Search

The aim of this study was to determine whether palliative chemotherapy accelerates the rate of biliary stent occlusion, in patients with a malignant biliary obstruction. Such treatment can induce neutropenia and increase the risk of bacterial sepsis. Overgrowth of bacteria within the bile of patients receiving chemotherapy could accelerate the rate of stent occlusion. Retrospective analysis of treatment records for

F. J. Lofts; T. R. J. Evans; J. L. Mansi; J. P. Glees; M. J. Knight

1997-01-01

77

Bile Duct Disruption Following Radiofrequency Ablation: Successful Repair Using a Covered Stent  

SciTech Connect

Persistent biliary leaks, whether iatrogenic or secondary to malignancy, often present a difficult management problem. Recent reports have suggested a role for covered metallic stents in this context. We describe the successful use of a covered stent to seal a persistent biliary leak following radiofrequency ablation of colorectal liver metastases.

Thompson, Philip M.; Hare, Christopher M.B., E-mail: christopher.hare@uclh.org; Lees, William R. [Middlesex Hospital, Department of Radiology (United Kingdom)

2004-08-15

78

Purinergic regulation of CFTR and Ca(2+)-activated Cl(-) channels and K(+) channels in human pancreatic duct epithelium.  

PubMed

Purinergic agonists have been considered for the treatment of respiratory epithelia in cystic fibrosis (CF) patients. The pancreas, one of the most seriously affected organs in CF, expresses various purinergic receptors. Studies on the rodent pancreas show that purinergic signaling regulates pancreatic secretion. In the present study we aim to identify Cl(-) and K(+) channels in human pancreatic ducts and their regulation by purinergic receptors. Human pancreatic duct epithelia formed by Capan-1 or CFPAC-1 cells were studied in open-circuit Ussing chambers. In Capan-1 cells, ATP/UTP effects were dependent on intracellular Ca(2+). Apically applied ATP/UTP stimulated CF transmembrane conductance regulator (CFTR) and Ca(2+)-activated Cl(-) (CaCC) channels, which were inhibited by CFTRinh-172 and niflumic acid, respectively. The basolaterally applied ATP stimulated CFTR. In CFPAC-1 cells, which have mutated CFTR, basolateral ATP and UTP had negligible effects. In addition to Cl(-) transport in Capan-1 cells, the effects of 5,6-dichloro-1-ethyl-1,3-dihydro-2H-benzimidazol-2-one (DC-EBIO) and clotrimazole indicated functional expression of the intermediate conductance K(+) channels (IK, KCa3.1). The apical effects of ATP/UTP were greatly potentiated by the IK channel opener DC-EBIO. Determination of RNA and protein levels revealed that Capan-1 cells have high expression of TMEM16A (ANO1), a likely CaCC candidate. We conclude that in human pancreatic duct cells ATP/UTP regulates via purinergic receptors both Cl(-) channels (TMEM16A/ANO1 and CFTR) and K(+) channels (IK). The K(+) channels provide the driving force for Cl(-)-channel-dependent secretion, and luminal ATP provided locally or secreted from acini may potentiate secretory processes. Future strategies in augmenting pancreatic duct function should consider sidedness of purinergic signaling and the essential role of K(+) channels. PMID:23364268

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

2013-01-30

79

Endoscopic Retrograde Cholangiopancreatography Double Duct Sign without Visible Tumor on Cross-Sectional Imaging – Old but Still Good to Diagnose Pancreatic Cancer?  

Microsoft Academic Search

SummaryCase Report: A 64-year-old man with cystic liver and kidney disease and renal insufficiency on hemodialysis presented with abdominal pain and jaundice. Neither ultrasound nor CT nor MRI nor endoscopic ultrasound revealed any evidence of a tumor mass in the pancreatic head. However, a high-grade and long stricture of both the distal common bile duct as well as pancreatic duct

Stefan Groth; Asad Kutup; Jan-Hendrik Buhk; Andreas Marx; Gerhard Adam; Jakob R. Izbicki; Guido Sauter; Thomas Rösch

2009-01-01

80

Endotherapy in chronic pancreatitis  

PubMed Central

Chronic pancreatitis (CP) is a progressive disease with irreversible changes in the pancreas. Patients commonly present with pain and with exocrine or endocrine insufficiency. All therapeutic efforts in CP are directed towards relief of pain as well as the management of associated complications. Endoscopic therapy offers many advantages in patients with CP who present with ductal calculi, strictures, ductal leaks, pseudocyst or associated biliary strictures. Endotherapy offers a high rate of success with low morbidity in properly selected patients. The procedure can be repeated and failed endotherapy is not a hindrance to subsequent surgery. Endoscopic pancreatic sphincterotomy is helpful in patients with CP with minimal ductal changes while minor papilla sphincterotomy provides relief in patients with pancreas divisum and chronic pancreatitis. Extracorporeal shock wave lithotripsy is the standard of care in patients with large pancreatic ductal calculi. Long term follow up has shown pain relief in over 60% of patients. A transpapillary stent placed across the disruption provides relief in over 90% of patients with ductal leaks. Pancreatic ductal strictures are managed by single large bore stents. Multiple stents are placed for refractory strictures. CP associated benign biliary strictures (BBS) are best treated with multiple plastic stents, as the response to a single plastic stent is poor. Covered self expanding metal stents are increasingly being used in the management of BBS though further long term studies are needed. Pseudocysts are best drained endoscopically with a success rate of 80%-95% at most centers. Endosonography (EUS) has added to the therapeutic armamentarium in the management of patients with CP. Drainage of pseudcysts, cannulation of inaccessible pancreatic ducts and celiac ganglion block in patients with intractable pain are all performed using EUS. Endotherapy should be offered as the first line of therapy in properly selected patients with CP who have failed to respond to medical therapy and require intervention.

Tandan, Manu; Reddy, D Nageshwar

2013-01-01

81

Metal versus Plastic Stent for Transmural Drainage of Pancreatic Fluid Collections  

PubMed Central

The conventional management of pancreatic fluid collections (PFCs) involves surgery or percutaneous drainage. While surgery is associated with significant complications and mortality, percutaneous drainage is associated with prolonged hospitalization and oftentimes the need for other adjunctive treatment measures. Therefore, the use of endoscopy to drain PFCs is becoming increasingly popular. Randomized trials have demonstrated that endoscopic ultrasound-guided drainage is superior to conventional endoscopy in terms of technical success and potentially decreases the rates of procedural complications. While transmural drainage is usually undertaken by deployment of plastic endoprosthesis, of late, fully covered self-expandable metal stents are being placed with increasing frequency. However, the benefits of this approach are unclear and require further validation in prospective trials.

Bang, Ji Young

2013-01-01

82

Combined pancreatic resection and pancreatic duct-navigation surgery for multiple lesions of the pancreas: intraductal papillary mucinous neoplasm of the pancreas concomitant with ductal carcinoma of the pancreas.  

PubMed

When a branch-type IPMN of the uncinate process is concomitant with ductal carcinoma of the body of the pancreas, total pancreatectomy may be recommended. However, a decrease in quality of life becomes a serious problem after total pancreatectomy because of the abolition of endocrine and exocrine pancreatic function. We proposed the combined resection, which consists of resection of the uncinate process of the pancreas with distal pancreatectomy. This surgical procedure of combined resection is most suitable for preservation of the pancreatic functions. In addition, we recommend the pancreatic duct-navigation surgery to enable us to prevent injury to the main pancreatic duct, and to dissect at the optimal cutting point of the pancreatic branch duct. PMID:19102402

Kuroki, Tamotsu; Tajima, Yoshitsugu; Tsuneoka, Noritsugu; Adachi, Tomohiko; Kanematsu, Takashi

83

An intermediate-conductance Ca2+-activated K+ channel is important for secretion in pancreatic duct cells.  

PubMed

Potassium channels play a vital role in maintaining the membrane potential and the driving force for anion secretion in epithelia. In pancreatic ducts, which secrete bicarbonate-rich fluid, the identity of K(+) channels has not been extensively investigated. In this study, we investigated the molecular basis of functional K(+) channels in rodent and human pancreatic ducts (Capan-1, PANC-1, and CFPAC-1) using molecular and electrophysiological techniques. RT-PCR analysis revealed mRNAs for KCNQ1, KCNH2, KCNH5, KCNT1, and KCNT2, as well as KCNN4 coding for the following channels: KVLQT1; HERG; EAG2; Slack; Slick; and an intermediate-conductance Ca(2+)-activated K(+) (IK) channel (K(Ca)3.1). The following functional studies were focused on the IK channel. 5,6-Dichloro-1-ethyl-1,3-dihydro-2H-benzimidazole-2-one (DC-EBIO), an activator of IK channel, increased equivalent short-circuit current (I(sc)) in Capan-1 monolayer, consistent with a secretory response. Clotrimazole, a blocker of IK channel, inhibited I(sc). IK channel blockers depolarized the membrane potential of cells in microperfused ducts dissected from rodent pancreas. Cell-attached patch-clamp single-channel recordings revealed IK channels with an average conductance of 80 pS in freshly isolated rodent duct cells. These results indicated that the IK channels may, at least in part, be involved in setting the resting membrane potential. Furthermore, the IK channels are involved in anion and potassium transport in stimulated pancreatic ducts. PMID:22555847

Hayashi, Mikio; Wang, Jing; Hede, Susanne E; Novak, Ivana

2012-05-02

84

Apical Cl-/HCO3- exchanger stoichiometry in the modeling of HCO3- transport by pancreatic duct epithelium.  

PubMed

Pancreatic duct cells secrete a HCO(3)(-)-rich (approximately 140 mM) fluid. Using a computer model of the pancreatic duct, Sohma, et al. have demonstrated that the activity of a Cl(-)/HCO(3)(-) exchanger with a 1: 1 stoichiometry at the apical membrane would have to be suppressed in order to achieve such a HCO(3)(-)-rich secretion. Recently the apical exchanger in pancreatic ducts has been identified as SLC26A6 and this probably mediates most of Cl(-)-dependent HCO(3)(-) secretion across the apical membrane. SLC26A6 is reported to mediate electrogenic Cl(-)/2HCO(3)(-) exchange when expressed in Xenopus oocytes. To assess the implications of this 1: 2 stoichiometry for HCO(3)(-) secretion, we have reconstructed the Sohma model using MATLAB/Simulink. To do this we have formulated an expression for the turnover rate of Cl(-)/2HCO(3)(-) exchange using network thermodynamics and we have estimated the constants from published experimental data. Preliminary data suggest that the 1: 2 stoichiometry of SLC26A6 would favor HCO(3)(-) secretion at higher concentrations. PMID:20224216

Yamaguchi, Makoto; Ishiguro, Hiroshi; Steward, Martin; Sohma, Yoshiro; Yamamoto, Akiko; Shimouchi, Akito; Kondo, Takaharu

2009-01-01

85

A comparative study of the retention or removal of jejunal mucosa during pancreatic duct to jejunal anastomosis.  

PubMed

Aim: The aim of this study was to compare the two anastomosis methods, that is, the retention or the removal of the jejunal mucosa during pancreatic duct to jejunal anastomosis after pancreaticoduodenectomy (PD). Methods: For this purpose, 46 PD patients were randomly and equally divided into groups A and B. In group A, the remnant pancreas was inserted 3 cm into the jejunum and the connecting part was sutured. In group B, the jejunal mucous membrane was cauterized 3 cm at the end, the remnant pancreas was sutured with the jejunal muscle layer, and the jejunum and pancreas were sutured together. Results: We found that in group A, the reoperation rate due to delayed bleeding was 13% (3/23) and the ulcer bleeding around anastomosis was 4.3% (1/23). In group B, the reoperation rate due to bleeding was 4.3% (1/23) and the incidence of postoperative pancreatic fistula was 17.4% (4/23). The duration of pancreaticojejunostomy operation in group A (46 ± 0.34 min) was shorter than in group B (P<0.001). Conclusion: We, therefore, concluded that the pancreatic duct to jejunal anastomosis with retained jejunal mucosa was a simple and easy to perform method while it also excluded the risk of postoperative pancreatic fistula formation. PMID:24019048

Qin, Q; Li, H; Wang, L B; Li, A H; Ouyang, J; Xie, S Q; Liang, Z H

2013-08-01

86

New fully-covered self-expandable metal stent for endoscopic ultrasonography-guided intervention in infectious walled-off pancreatic necrosis (with video).  

PubMed

Endoscopic ultrasonography (EUS)-guided pancreatic pseudocyst drainage using a self-expandable metal stent (SEMS) has been reported for satisfactory drainage and endoscopic necrosectomy. Here, we described an interesting case in which successful endoscopic therapy was performed using a new SEMS in infectious walled-off pancreatic necrosis. PMID:22926337

Itoi, Takao; Nageshwar Reddy, D; Yasuda, Ichiro

2013-03-01

87

Effects of chronic nicotine on the autocrine regulation of pancreatic cancer cells and pancreatic duct epithelial cells by stimulatory and inhibitory neurotransmitters  

PubMed Central

Pancreatic ductal adenocarcinoma (PDAC) has a mortality rate near 100%. Smoking is a documented risk factor. However, the mechanisms of smoking-associated pancreatic carcinogenesis are poorly understood. We have shown that binding of nicotine to nicotinic acetylcholine receptors (nAChRs) expressing subunits ?7, ?3 and ?5 in PDAC and pancreatic duct epithelial cells in vitro triggered the production of the neurotransmitters noradrenaline and adrenaline by these cells. In turn, this autocrine catecholamine loop significantly stimulated cell proliferation via cyclic adenosine 3?,5?-monophosphate-dependent signaling downstream of beta-adrenergic receptors. However, the observed responses only represent acute cellular reactions to single doses of nicotine whereas nicotine exposure in smokers is chronic. Using the PDAC cell lines BxPC-3 and Panc-1 and immortalized pancreatic duct epithelial cell line HPDE6-C7, our current experiments reveal a significant sensitization of the nAChR-driven autocrine catecholamine regulatory loop in cells pre-exposed to nicotine for 7 days. The resulting increase in catecholamine production was associated with significant inductions in the phosphorylation of signaling proteins ERK, CREB, Src and AKT, upregulated protein expression of nAChR subunits ?3, ?4, ?5 and ?7 and increased responsiveness to nicotine in 3-(4,5-dimethylthiazole-2-yl)-2,5-diphenyl tetrazolium bromide and cell migration assays. All three cell lines produced the inhibitory neurotransmitter ?-aminobutyric acid, an activity inhibited by gene knockdown of the ?4?2nAChR and suppressed by chronic nicotine via receptor desensitization. All of the observed adverse effects of chronic nicotine were reversed by treatment of the cells with ?-aminobutyric acid, suggesting the potential usefulness of this agent for the improvement of PDAC intervention strategies in smokers.

Schuller, Hildegard M.

2012-01-01

88

Resting energy expenditure in patients undergoing pylorus preserving pancreatoduodenectomies for bile duct cancer or pancreatic tumors  

PubMed Central

We measured the energy expenditure weekly in patients undergoing a pylorus preserving pancreatoduodenectomy for bile duct cancer or pancreatic tumors. Twelve patients (5 women and 7 men; mean age 70.1 years) were enrolled in this study, and their resting energy expenditure levels were determined by indirect calorimetry. In these patients, a significant correlation was observed between the measured resting energy expenditures and the predicted resting energy expenditures calculated by the Harris-Benedict equation. The resting energy expenditures measured before surgery were almost the same as the predicted resting energy expenditures (measured resting energy expenditure: 22.4 ± 3.9 kcal/kg/day vs predicted resting energy expenditure: 21.7 ± 2.0 kcal/kg/day). The measured resting energy expenditure/predicted resting energy expenditure ratio, which reflects the stress factor, was 1.02 ± 0.10. After the pylorus preserving pancreatoduodenectomy, a significant increase in energy expenditure was observed, and the measured resting energy expenditure was 25.7 ± 3.5 kcal/kg/day on postoperative day 7 and 25.4 ± 4.9 kcal/kg/day on postoperative day 14. The measured resting energy expenditure/predicted resting energy expenditure ratio was 1.16 ± 0.14 on postoperative day 7, and 1.16 ± 0.18 on postoperative day 14 respectively. In conclusion, patients undergoing a pylorus preserving pancreatoduodenectomy showed a hyper-metabolic status as evaluated by their measured resting energy expenditure/predicted resting energy expenditure ratio. From our observations, we recommend that nutritional management based on 30 kcal/body weight/day (calculated by the measured resting energy expenditure×activity factor 1.2–1.3) may be optimal for patients undergoing a pylorus preserving pancreatoduodenectomy.

Sasaki, Masaya; Okamoto, Haruka; Johtatsu, Tomoko; Kurihara, Mika; Iwakawa, Hiromi; Tanaka, Toshihiro; Shiomi, Hisanori; Naka, Shigeyuki; Kurumi, Yoshimasa; Tani, Tohru

2011-01-01

89

Effect of Medical or Surgical Admission on Outcome of Patients with Gallstone Pancreatitis and Common Bile Duct Stones  

Microsoft Academic Search

Introduction  Management of uncomplicated common bile duct stone (CBDS) and gallstone pancreatitis (GP) presumably varies based on whether\\u000a a patient is admitted to medicine or surgery. This study evaluates the impact of admitting team on outcome and cost.\\u000a \\u000a \\u000a \\u000a Methods  Three hundred seventy patients admitted to the Massachusetts General Hospital for CBDS or GP were retrospectively analyzed\\u000a for demographics, insurance status, procedures, complications,

Jennifer LaFemina; Suzanne M. Sokal; Yuchiao Chang; Deborah McGrath; David L. Berger

2008-01-01

90

Fracture of Self-Expandable Metal Stent during Endoscopic Removal in Benign Biliary Stricture  

PubMed Central

The endoscopic insertion of the self-expandable metal stent (SEMS) in benign biliary stricture has become an alternative to surgery. Fracture or migration of SEMS can occur rarely as complications. We report a case of fracture of SEMS during endoscopic retrieval in patients with chronic pancreatitis. In this case, broken stent was successfully removed with endoscopic ballooning of bile duct and with a snare device.

Joo, Kyu Re; Chung, Woo Chul; Lee, Kang-Moon; Yang, Jin Mo

2013-01-01

91

Neogenesis and proliferation of {beta}-cells induced by human betacellulin gene transduction via retrograde pancreatic duct injection of an adenovirus vector  

SciTech Connect

Betacellulin (BTC) has been shown to have a role in the differentiation and proliferation of {beta}-cells both in vitro and in vivo. We administered a human betacellulin (hBTC) adenovirus vector to male ICR mice via retrograde pancreatic duct injection. As a control, we administered a {beta}-galactosidase adenovirus vector. In the mice, hBTC protein was mainly overexpressed by pancreatic duct cells. On immunohistochemical analysis, we observed features of {beta}-cell neogenesis as newly formed insulin-positive cells in the duct cell lining or islet-like cell clusters (ICCs) closely associated with the ducts. The BrdU labeling index of {beta}-cells was also increased by the betacellulin vector compared with that of control mice. These results indicate that hBTC gene transduction into adult pancreatic duct cells promoted {beta}-cell differentiation (mainly from duct cells) and proliferation of pre-existing {beta}-cells, resulting in an increase of the {beta}-cell mass that improved glucose tolerance in diabetic mice.

Tokui, Yae [Department of Internal Medicine and Molecular Science, Graduate School of Medicine, Osaka University, 2-2-B5, Yamadaoka, Suita-city, Osaka 565-0871 (Japan)]. E-mail: ytokui@imed2.med.osaka-u.ac.jp; Kozawa, Junji [Department of Internal Medicine and Molecular Science, Graduate School of Medicine, Osaka University, 2-2-B5, Yamadaoka, Suita-city, Osaka 565-0871 (Japan); Yamagata, Kazuya [Department of Internal Medicine and Molecular Science, Graduate School of Medicine, Osaka University, 2-2-B5, Yamadaoka, Suita-city, Osaka 565-0871 (Japan); Zhang, Jun [Department of Internal Medicine and Molecular Science, Graduate School of Medicine, Osaka University, 2-2-B5, Yamadaoka, Suita-city, Osaka 565-0871 (Japan); Ohmoto, Hiroshi [Carna Biosciences, Inc., 5-5-2 KIBC511, Minatojima-cho, Chuo-ku, Kobe 650-0047 (Japan); Tochino, Yoshihiro [Department of Internal Medicine and Molecular Science, Graduate School of Medicine, Osaka University, 2-2-B5, Yamadaoka, Suita-city, Osaka 565-0871 (Japan); Okita, Kohei; Iwahashi, Hiromi [Department of Internal Medicine and Molecular Science, Graduate School of Medicine, Osaka University, 2-2-B5, Yamadaoka, Suita-city, Osaka 565-0871 (Japan); Namba, Mitsuyoshi [Division of Diabetes and Metabolism, Internal Medicine Department, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya 663-8501 (Japan); Shimomura, Iichiro [Department of Internal Medicine and Molecular Science, Graduate School of Medicine, Osaka University, 2-2-B5, Yamadaoka, Suita-city, Osaka 565-0871 (Japan); Miyagawa, Jun-ichiro [Department of Internal Medicine and Molecular Science, Graduate School of Medicine, Osaka University, 2-2-B5, Yamadaoka, Suita-city, Osaka 565-0871 (Japan)]|[Division of Diabetes and Metabolism, Internal Medicine Department, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya 663-8501 (Japan)

2006-12-01

92

Pancreatitis-Associated Splenic Artery Pseudoaneurysm: Endovascular Treatment with Self-Expandable Stent-Grafts  

SciTech Connect

We present a patient with a splenic arterypseudoaneurysm (SAPA) treated with placement of self-expandable stent-grafts. The procedure was complicated by stent-graft migration,but successful management resulted in lasting exclusion of the SAPA,while the patency of the splenic artery was preserved. This is the first report of self-expandable stent-graft treatment of SAPA.

Brountzos, Elias N. [Second Department of Radiology, Medical School, Athens University, Eugenidion Hospital, 20Papadiamantopoulou Street, Athens 11528 (Greece); Vagenas, Kostantinos [Department of Surgery, Medical School, Patras University, Patras University Hospital, Rion, Patras (Greece); Apostolopoulou, Sotiria C.; Panagiotou, Irene [Second Department of Radiology, Medical School, Athens University, Eugenidion Hospital, 20 Papadiamantopoulou Street, Athens 11528 (Greece); Lymberopoulou, Dimitra [Department of Surgery, Medical School, Patras University, Patras University Hospital, Rion, Patras (Greece); Kelekis, Dimitrios A. [Second Department of Radiology, Medical School, Athens University, Eugenidion Hospital, 20 Papadiamantopoulou Street, Athens 11528 (Greece)

2003-02-15

93

Treatment of pancreatic duct disruption in children by an endoscopically placed stent  

Microsoft Academic Search

Background: Injuries to the pancreas from blunt abdominal trauma in children are rare. Most are minor and are best treated conservatively. The mainstay for treatment of major ductal injuries has been prompt surgical resection. Diagnostic imaging modalities are the key to the accurate classification of these injuries and planning appropriate treatment. Computed tomography (CT) scan has been the major imaging

Timothy G. Canty; David Weinman

2001-01-01

94

Survivin Is Required for Beta-Cell Mass Expansion in the Pancreatic Duct-Ligated Mouse Model  

PubMed Central

Aims/Hypothesis Pancreatic beta-cell mass expands through adulthood under certain conditions. The related molecular mechanisms are elusive. This study was designed to determine whether surviving (also known as Birc5), which is transiently expressed perinatally in islets, was required for beta-cell mass expansion in the pancreatic duct-ligated mouse model. Methods Mice with beta cell–specific deletion of survivin (RIPCre+survivinfl/fl) and their control littermates (RIPCre+survivin+/+) were examined to determine the essential role of survivin in partial pancreatic duct ligation (PDL)-induced beta-cell proliferation, function and survival. Results Resurgence of survivin expression occurred as early as day 3 post-PDL. By day 7 post-PDL, control mice showed significant expansion of beta-cell mass and increase in beta-cell proliferation and islet number in the ligated tail of the pancreas. However, mice deficient in beta-cell survivin showed a defect in beta-cell mass expansion and proliferation with a marked attenuation in the increase of total islet number, largely due to an impairment in the increase in number of larger islets while sparing the increase in number of small islets in the ligated tail of pancreas, resulting in insufficient insulin secretion and glucose intolerance. Importantly however, beta cell neogenesis and apoptosis were not affected by the absence of survivin in beta cells after PDL. Conclusions/Interpretation Our results indicate that survivin is essential for beta-cell mass expansion after PDL. Survivin appears to exhibit a preferential requirement for proliferation of preexisting beta cells.

Wu, Xiaohong; Zhang, Qinfeng; Wang, Xiaojing; Zhu, Jiayu; Xu, Kuangfeng; Okada, Hitoshi; Wang, Rennian; Woo, Minna

2012-01-01

95

Predictive Factors of Pancreatic Cancer in Patients with Chronic Pancreatitis and K-ras Gene Mutation Detected in Pancreatic Duct Brushings  

Microsoft Academic Search

Background: Chronic pancreatitis (CP) has been shown to be a predisposing factor of pancreatic cancer (PC). The purpose of this study was to examine the prognostic sig- nificance of various factors characterizing CP and the presence of K-ras gene mutation in regard to PC development. Methods: 146 patients with CP were studied. Etiology was alcoholic CP in 109 patients (74.4%),

M. Arvanitakis; J.-L. van Laethem; J. Parma; M. Delhaye

96

Fully covered self-expanding metal stents placed temporarily in the bile duct: safety profile and histologic classification in a porcine model  

Microsoft Academic Search

Background  Fully covered Self-Expanding metal stents (FCSEMS) have been shown efficacious in palliating malignant biliary obstructions.\\u000a There is little data analyzing mucosal response to their temporary placement in the bile duct.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Ten mini pigs underwent endoscopic placement of a FCSEMS (Wallflex, Boston Scientific). FCSEMS were kept in place for three\\u000a months. At the end of the 3 months, FCSEMS were removed

Mihir R Bakhru; Patricia L Foley; Jeremy Gatesman; Timothy Schmitt; Christopher A Moskaluk; Michel Kahaleh

2011-01-01

97

Calcium-activated chloride conductance in a pancreatic adenocarcinoma cell line of ductal origin (HPAF) and in freshly isolated human pancreatic duct cells.  

PubMed

Using the whole-cell patch-clamp technique, a calcium-activated chloride conductance (CACC) could be elicited in HPAF cells by addition of 1 microM ionomycin to the bath solution (66 +/- 22 pA/pF;Vm + 60 mV) or by addition of 1 microM calcium to the pipette solution (136 +/- 17 pA/pF; Vm + 60 mV). Both conductances had similar biophysical characteristics, including time-dependent inactivation at hyperpolarising potentials and a linear/slightly outwardly rectifying current/voltage (I/V) curve with a reversal potential (Erev) close to the calculated chloride equilibrium potential. The anion permeability sequence obtained from shifts in Erev was I > Br >/= Cl. 4,4'-Diisothiocyanatostilbene disulphonic acid (DIDS, 500 microM) caused a 13% inhibition of the current (Vm + 60 mV) while 100 microM glibenclamide, 30 nM TS-TM-calix[4]arene and 10 microM tamoxifen, all chloride channel blockers, had no marked effects (8%, -6% and -2% inhibition respectively). Niflumic acid (100 microM) caused a voltage-dependent inhibition of the current of 48% and 17% (Vm +/- 60 mV, respectively). In freshly isolated human pancreatic duct cells (PDCs) a CACC was elicited with 1 microM calcium in the pipette solution (260 +/- 62 pA/pF; Vm + 60 mV). The presence of this CACC in human PDCs could provide a possible therapeutic pathway for treatment of pancreatic insufficiency of the human pancreas in cystic fibrosis. PMID:9518508

Winpenny, J P; Harris, A; Hollingsworth, M A; Argent, B E; Gray, M A

1998-05-01

98

Mechanisms of KGF Mediated Signaling in Pancreatic Duct Cell Proliferation and Differentiation  

Microsoft Academic Search

BackgroundKeratinocyte growth factor (KGF; palifermin) is a growth factor with a high degree of specificity for epithelial cells. KGF is an important effector of epithelial growth and tissue homeostasis in various organs including the pancreas.Here we investigated the intracellular signaling pathways involved in the mediation of pancreatic ductal cell proliferation and differentiation induced by exogenous KGF during beta-cell regeneration in

Benjamin Uzan; Florence Figeac; Bernard Portha; Jamileh Movassat; Kathrin Maedler

2009-01-01

99

Chronic GLP-1 Receptor Activation by Exendin-4 Induces Expansion of Pancreatic Duct Glands in Rats and Accelerates Formation of Dysplastic Lesions and Chronic Pancreatitis in the KrasG12D Mouse Model  

PubMed Central

Pancreatic duct glands (PDGs) have been hypothesized to give rise to pancreatic intraepithelial neoplasia (PanIN). Treatment with the glucagon-like peptide (GLP)-1 analog, exendin-4, for 12 weeks induced the expansion of PDGs with mucinous metaplasia and columnar cell atypia resembling low-grade PanIN in rats. In the pancreata of Pdx1-Cre; LSL-KrasG12D mice, exendin-4 led to acceleration of the disruption of exocrine architecture and chronic pancreatitis with mucinous metaplasia and increased formation of murine PanIN lesions. PDGs and PanIN lesions in rodent and human pancreata express the GLP-1 receptor. Exendin-4 induced proproliferative signaling pathways in human pancreatic duct cells, cAMP–protein kinase A and mitogen-activated protein kinase phosphorylation of cAMP-responsive element-binding protein, and increased cyclin D1 expression. These GLP-1 effects were more pronounced in the presence of an activating mutation of Kras and were inhibited by metformin. These data reveal that GLP-1 mimetic therapy may induce focal proliferation in the exocrine pancreas and, in the context of exocrine dysplasia, may accelerate formation of neoplastic PanIN lesions and exacerbate chronic pancreatitis.

Gier, Belinda; Matveyenko, Aleksey V.; Kirakossian, David; Dawson, David; Dry, Sarah M.; Butler, Peter C.

2012-01-01

100

Purinergic Receptors Stimulate Na+\\/Ca2+ Exchange in Pancreatic Duct Cells: Possible Role of Proteins Handling and Transporting Ca2&plus  

Microsoft Academic Search

Most purinergic receptors activate intracellular Ca2+ signalling, and in epithelia they stimulate transport of major ions. Aim of the present study on pancreatic ducts was to find whether P2 receptors also regulate cellular Ca2+ transport, such as that via the Na+\\/Ca2+ exchanger (NCX). Since NCX can also be connected with epithelial Ca2+ transport, we also investigated expression of some Ca2+-handling\\/transporting

Mette R. Hansen; Simon Krabbe; Ieva Ankorina-Stark; Ivana Novak

2009-01-01

101

Enhanced expression of insulin receptor substrate–2 and activation of protein kinase B\\/Akt in regenerating pancreatic duct epithelium of 60 %-partial pancreatectomy rats  

Microsoft Academic Search

.\\u000a Aims\\/hypothesis:   Early compensatory mechanisms of regeneration following partial pancreatectomy involve ductal proliferation and, subsequently,\\u000a differentiation into acinar and endocrine cell types, although it is not clear how these processes are regulated. We investigated\\u000a the expression and roles of insulin receptor substrate-2 (IRS-2) and protein kinase B\\/Akt (Akt) in pancreatic regeneration\\u000a that starts with the common duct epithelium using a

T. L. Jetton; Y. Q. Liu; W. E. Trotman; P. W. Nevin; X. J. Sun; J. L. Leahy

2001-01-01

102

Pancreatic ascites in childhood.  

PubMed

A case is reported of pancreatic ascites in a 14-year-old girl who had acute and chronic pancreatitis associated with pancreatic duct stones and a ruptured pancreatic duct. Abdominal erythema ab igne was considered to be an important physical sign of genuine severe abdominal pain. PMID:2144996

Mucklow, E S; Freeman, N V

1990-06-01

103

Protease-activated Receptor-2 Increases Exocytosis via Multiple Signal Transduction Pathways in Pancreatic Duct Epithelial Cells*  

PubMed Central

Protease-activated receptor-2 (PAR-2) is activated when trypsin cleaves its NH2 terminus to expose a tethered ligand. We previously demonstrated that PAR-2 activates ion channels in pancreatic duct epithelial cells (PDEC). Using real-time optical fluorescent probes, cyan fluorescence protein-Epac1-yellow fluorescence protein for cAMP, PHPLC-?1-enhanced green fluorescent protein for phosphatidylinositol 4,5-bisphosphate, and protein kinase C? (PKC?)-C1-yellow fluorescence protein for diacylglycerol, we now define the signaling pathways mediating PAR-2 effect in dog PDEC. Although PAR-2 activation does not stimulate a cAMP increase, it induces phospholipase C to hydrolyze phosphatidylinositol 4,5-bisphosphate into inositol 1,4,5-trisphosphate and diacylglycerol. Intracellular Ca2+ mobilization from inositol 1,4,5-trisphosphate-sensitive Ca2+ stores and a subsequent Ca2+ influx through store-operated Ca2+ channels cause a biphasic increase in intracellular Ca2+ concentration ([Ca2+]i), measured with Indo-1 dye. Single-cell amperometry demonstrated that this increase in [Ca2+]i in turn causes a biphasic increase in exocytosis. A protein kinase assay revealed that trypsin also activates PKC isozymes to stimulate additional exocytosis. Paralleling the increased exocytosis, mucin secretion from PDEC was also induced by trypsin or the PAR-2 activating peptide. Consistent with the serosal localization of PAR-2, 1 ?m luminal trypsin did not induce exocytosis in polarized PDEC monolayers; on the other hand, 10 ?m trypsin at 37 °C damaged the epithelial barrier sufficiently so that it could reach and activate the serosal PAR-2 to stimulate exocytosis. Thus, in PDEC, PAR-2 activation increases [Ca2+]i and activates PKC to stimulate exocytosis and mucin secretion. These functions may mediate the reported protective role of PAR-2 in different models of pancreatitis.

Kim, Mean-Hwan; Choi, Bo-Hwa; Jung, Seung-Ryoung; Sernka, Thomas J.; Kim, Seunghwan; Kim, Kyong-Tai; Hille, Bertil; Nguyen, Toan D.; Koh, Duk-Su

2008-01-01

104

Pneumoperitoneum Caused by Transhepatic Air Leak After Metallic Biliary Stent Placement  

SciTech Connect

A self-expanding metallic biliary stent was placed for palliation of a common bile duct obstruction in a 68-year-old male with unresectable pancreatic head cancer 3 days after initial percutaneous right transhepatic catheter decompression. The stent crossed the ampulla of Vater. Three days later, the stent was balloon-dilated and the percutaneous access was removed. At removal, a small contrast leak from the transhepatic tract was seen. Three days later, pneumoperitoneum was found with symptoms of peritoneal irritation and fever. A widely open sphincter of Oddi caused by the metallic stent, accompanied by delayed sealing of the transhepatic tract, may have caused the air and bile leakage into the peritoneal space. This case shows that pneumoperitoneum may occur without ductal tear or bowel injury, with a biliary stent crossing the ampulla of Vater.

Lee, Jei Hee; Lee, Deok Hee; Yu, Jeong-Sik [Department of Diagnostic Radiology, Yonsei University College of Medicine, YongDong Severance Hospital, 146-92 Dokok-Dong, Kangnam-Ku, Seoul 135-270 (Korea, Republic of); Lee, Se Joon [Department of Internal Medicine, Yonsei University College of Medicine, YongDong Severance Hospital, 146-92 Dokok-Dong, Kangnam-Ku, Seoul 135-270 (Korea, Republic of); Kwon, Woo-Cheol; Kim, Ki Whang [Department of Diagnostic Radiology, Yonsei University College of Medicine, YongDong Severance Hospital, 146-92 Dokok-Dong, Kangnam-Ku, Seoul 135-270 (Korea, Republic of)

2000-11-15

105

Successful management of hepatic artery pseudoaneurysm complicating chronic pancreatitis by stenting  

Microsoft Academic Search

A 41-year old alchoholic male with a history of chronic pancreatitis was admitted for nausea, vomiting and weight loss. Angiogram was performed and demonstrated an aneurysmal sac with a narrow neck originating from the inferior aspect of the distal portion of the proper hepatic artery. The origin of the pseudoaneurysm was covered with a 5 mm × 2.5 cm Viabahn

Cynthia Sudar Singh; Kamini Giri; Renuka Gupta; Mohammed Aladdin; Harinder Sawhney

2006-01-01

106

Human pancreatic duct cells can produce tumour necrosis factor-? that damages neighbouring beta cells and activates dendritic cells  

Microsoft Academic Search

Aims\\/hypothesis  In the human pancreas, a close topographic relationship exists between duct cells and beta cells. This explains the high proportion of duct cells in isolated human islet preparations. We investigated whether human duct cells are a source of TNF-mediated interactions with beta cells and immune cells. This cytokine has been implicated in the development of autoimmune diabetes in mice.Methods  Human duct

B. Movahedi; M. Van de Casteele; N. Caluwé; G. Stangé; K. Breckpot; K. Thielemans; G. Vreugdenhil; C. Mathieu; D. Pipeleers

2004-01-01

107

Defective regulation of gap junctional coupling in cystic fibrosis pancreatic duct cells  

PubMed Central

The cystic fibrosis (CF) gene encodes a cAMP-gated Cl– channel (cystic fibrosis transmembrane conductance regulator [CFTR]) that mediates fluid transport across the luminal surfaces of a variety of epithelial cells. We have previously shown that gap junctional communication and Cl– secretion were concurrently regulated by cAMP in cells expressing CFTR. To determine whether intercellular communication and CFTR-dependent secretion are related, we have compared gap junctional coupling in a human pancreatic cell line harboring the ?F508 mutation in CFTR and in the same cell line in which the defect was corrected by transfection with wild-type CFTR. Both cell lines expressed connexin45 (Cx45), as evidenced by RT-PCR, immunocytochemistry, and dual patch-clamp recording. Exposure to agents that elevate intracellular cAMP or specifically activate protein kinase A evoked Cl– currents and markedly increased junctional conductance of CFTR-expressing pairs, but not in the parental cells. The latter effect, which was caused by an increase in single-channel activity but not in unitary conductance of Cx45 channels, was not prevented by exposing CFTR-expressing cells to a Cl– channel blocker. We conclude that expression of functional CFTR restored the cAMP-dependent regulation of junctional conductance in CF cells. Direct intercellular communication coordinates multicellular activity in tissues that are major targets of CF manifestations. Consequently, defective regulation of gap junction channels may contribute to the altered functions of tissues affected in CF. J. Clin. Invest. 103:1677–1684 (1999).

Chanson, Marc; Scerri, Isabelle; Suter, Susanne

1999-01-01

108

Pancreatitis  

MedlinePLUS

... as an ERCP (endoscopic retrograde cholangiopancreatography) or MRCP (magnetic resonance cholangiopancreatography) may be required. An ERCP consists ... How is pancreatitis diagnosed? How is pancreatitis treated? NORTH AMERICAN SOCIETY FOR PEDIATRIC GASTROENTEROLOGY, HEPATOLOGY AND NUTRITION ...

109

Efficacy and safety of capecitabine in combination with docetaxel and mitomycin C in patients with pre-treated pancreatic, gallbladder, and bile duct carcinoma  

Microsoft Academic Search

Purpose  Preclinical data indicate the improvement of the antitumor activity of capecitabine by mitomycin C and docetaxel through upregulation\\u000a of thymidine phosphorylase activity. Therefore, we have established a combination regimen of these drugs (DocMitoCape), which\\u000a demonstrated preliminary activity especially in bile duct and pancreatic carcinoma.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Here we report the safety and efficacy of the DocMitoCape regimen in pre-treated patients with gallbladder,

Jens KruthJohanna; Johanna Nissen; Thomas Ernst; Melanie Kripp; Nadine Lukan; Kirsten Merx; Wolf-Karsten Hofmann; Andreas Hochhaus; Ralf-Dieter Hofheinz

2010-01-01

110

Transcriptional Control of Tight Junction Proteins via a Protein Kinase C Signal Pathway in Human Telomerase Reverse Transcriptase-Transfected Human Pancreatic Duct Epithelial Cells  

PubMed Central

In human pancreatic cancer, integral membrane proteins of tight junction claudins are abnormally regulated, making these proteins promising molecular diagnostic and therapeutic targets. However, the regulation of claudin-based tight junctions remains unknown not only in the pancreatic cancer cells but also in normal human pancreatic duct epithelial (HPDE) cells. To investigate the regulation of tight junction molecules including claudins in normal HPDE cells, we introduced the human telomerase reverse transcriptase (hTERT) gene into HPDE cells in primary culture. The hTERT-transfected HPDE (hTERT-HPDE) cells were positive for the pancreatic duct epithelial markers such as CK7, CK19, and carbonic anhydrase isozyme 2 and expressed epithelial tight junction molecules claudin-1, -4, -7 and, -18, occludin, JAM-A, ZO-1, ZO-2, and tricellulin. By treatment with fetal bovine serum or 12-O-tetradecanoylphorbol 13-acetate (TPA), the tight junction molecules were up-regulated at the transcriptional level via a protein kinase C (PKC) signal pathway. A PKC-? inhibitor, Gö6976, prevented up-regulation of claudin-4 by TPA. Furthermore, a PKC-? inhibitor, rottlerin, prevented up-regulation of claudin-7, occludin, ZO-1, and ZO-2 by TPA. By GeneChip analysis, up-regulation of the transcription factor ELF3 was observed in both fetal bovine serum- and TPA-treated cells. Treatment with small interfering RNAs of ELF3 prevented up-regulation of claudin-7 by TPA. These data suggest that tight junctions of normal HPDE cells were at least in part regulated via a PKC signal pathway by transcriptional control.

Yamaguchi, Hiroshi; Kojima, Takashi; Ito, Tatsuya; Kimura, Yasutoshi; Imamura, Masafumi; Son, Seiichi; Koizumi, Jun-ichi; Murata, Masaki; Nagayama, Minoru; Nobuoka, Takayuki; Tanaka, Satoshi; Hirata, Koichi; Sawada, Norimasa

2010-01-01

111

Difficult bile duct stones.  

PubMed

Bile duct stones are routinely removed at time of endoscopic retrograde cholangiopancreatography (ERCP) after biliary sphincterotomy with standard balloon or basket extraction techniques. However, in approximately 10% to 15% of patients, bile duct stones may be difficult to remove due to challenging access to the bile duct (periampullary diverticulum, Billroth II anatomy, Roux-en-Y gastrojejunostomy), large (> 15 mm in diameter) bile duct stones, intrahepatic stones, or impacted stones in the bile duct or cystic duct. The initial approach to the removal of the difficult bile duct stone is to ensure adequate biliary sphincter orifice diameter with extension of biliary sphincterotomy or balloon dilation of the orifice. Mechanical lithotripsy is a readily available adjunct to standard stone extraction techniques and should be available in all ERCP units. If stone extraction fails with these maneuvers, two or more bile duct stents should be inserted, and ursodiol added to aid in duct decompression, stone fragmentation, and stone dissolution. Follow-up ERCP attempts to remove the difficult bile duct stones may be performed locally if expertise is available or alternatively referred to a tertiary center for advanced extracorporeal or intracorporeal fragmentation (mother-baby laser or electrohydraulic lithotripsy) techniques. Nearly all patients with bile duct stones can be treated endoscopically if advanced techniques are utilized. For the rare patient who fails despite these efforts, surgical bile duct exploration, percutaneous approach to the bile duct, or long-term bile duct stenting should be discussed with the patient and family to identify the most appropriate therapeutic option. A thoughtful approach to each patient with difficult bile duct stones and a healthy awareness of the operator/endoscopy unit limitations is necessary to ensure the best patient outcomes. Consultation with a dedicated tertiary ERCP specialty center may be necessary. PMID:16539873

McHenry, Lee; Lehman, Glen

2006-04-01

112

IRBIT coordinates epithelial fluid and HCO3– secretion by stimulating the transporters pNBC1 and CFTR in the murine pancreatic duct  

PubMed Central

Fluid and HCO3– secretion are vital functions of secretory epithelia. In most epithelia, this entails HCO3– entry at the basolateral membrane, mediated by the Na+-HCO3– cotransporter, pNBC1, and exit at the luminal membrane, mediated by a CFTR-SLC26 transporters complex. Here we report that the protein IRBIT (inositol-1,4,5-trisphosphate [IP3] receptors binding protein released with IP3), a previously identified activator of pNBC1, activates both the basolateral pNBC1 and the luminal CFTR to coordinate fluid and HCO3– secretion by the pancreatic duct. We used video microscopy and ion selective microelectrodes to measure fluid secretion and Cl– and HCO3– concentrations in cultured murine sealed intralobular pancreatic ducts. Short interference RNA–mediated knockdown of IRBIT markedly inhibited ductal pNBC1 and CFTR activities, luminal Cl– absorption and HCO3– secretion, and the associated fluid secretion. Single-channel measurements suggested that IRBIT regulated CFTR by reducing channel mean close time. Furthermore, expression of IRBIT constructs in HEK cells revealed that activation of pNBC1 required only the IRBIT PEST domain, while activation of CFTR required multiple IRBIT domains, suggesting that IRBIT activates these transporters by different mechanisms. These findings define IRBIT as a key coordinator of epithelial fluid and HCO3– secretion and may have implications to all CFTR-expressing epithelia and to cystic fibrosis.

Yang, Dongki; Shcheynikov, Nikolay; Zeng, Weizhong; Ohana, Ehud; So, Insuk; Ando, Hideaki; Mizutani, Akihiro; Mikoshiba, Katsuhiko; Muallem, Shmuel

2008-01-01

113

Does internal stenting of the pancreaticojejunostomy improve outcomes after pancreatoduodenectomy? A prospective study  

Microsoft Academic Search

Aim  This study’s aim is to evaluate the effectiveness of using an internal stent when fashioning a duct-to-mucosa pancreatojejunostomy\\u000a on preventing pancreatic fistula formation, as well as on the overall outcome for patients undergoing pancreaticoduodenectomy.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods  Between January 2000 and December 2008, 82 consecutive patients underwent pancreaticoduodenectomy and duct-to-mucosa pancreaticojejunostomy\\u000a in an isolated jejunal loop, either with or without the

Vassilios Smyrniotis; Nikolaos Arkadopoulos; Maria A. Kyriazi; Michael Derpapas; Theodosios Theodosopoulos; Constantinos Gennatas; Agathi Kondi-Paphiti; Ioannis Vassiliou

2010-01-01

114

Pathophysiological relevance of apical large-conductance Ca2+-activated potassium channels in pancreatic duct epithelial cells  

Microsoft Academic Search

BackgroundAcute pancreatitis is among the few inflammatory diseases for which no specific pharmacological treatment is available. It has previously been shown that bile acids alter pancreatic ductal secretion and these effects are probably involved in the pathogenesis of bile-induced pancreatitis.ObjectiveTo understand the mechanism responsible for bile-induced hypersecretion and, in particular, to identify the molecular target for bile acids in native

Viktória Venglovecz; Péter Hegyi; Zoltán Rakonczay; László Tiszlavicz; Antonio Nardi; Morten Grunnet; Michael A Gray

2010-01-01

115

NSAIDs for prevention of pancreatitis after endoscopic retrograde cholangiopancreatography: Ready for prime time?  

PubMed Central

Acute pancreatitis is the most common and the most fearful complication of endoscopic retrograde cholangiopancreatography (ERCP). Prevention of post-ERCP pancreatitis has therefore been of great interest to endoscopists performing ERCP procedures. So far, only pancreatic duct stenting during ERCP and rectal administration of a non-steroidal anti-inflammatory drug (NSAID) prior to or immediately after ERCP have been consistently shown to be effective for prevention of post-ERCP pancreatitis. This commentary focuses on a short discussion about the rates, mechanisms, and risk factors for post-ERCP pancreatitis, and effective means for its prevention with emphasis on the use of NSAIDs including a recent clinical trial published in The New England Journal of Medicine by Elmunzer et al[11].

Parsi, Mansour A

2012-01-01

116

Pancreatic carcinoma: Palliative surgical and endoscopic treatment1  

PubMed Central

The majority of patients with pancreatic carcinoma (hepaticojejunostomy) unfortunately will have palliative treatment and palliation of symptoms is important to improve Quality of Life. The most common symptoms that require palliation are jaundice, gastric outlet obstruction and pain. Obstructive jaundice should be trated with a biliary bypass, the optimal palliation in relatively fit patients and endoscopic stenting is preferred in patients with short survival (3–6 months). To prevent gastric outlet obstruction a prophylactic gastroenterostomy should be performed routinely during bypass surgery. Symptomatic patients after earlier stenting of the bile duct can be treated nowadays by doudenal stenting. Pain management is according to the progressive analgesic ladder but a (percutaneous) neurolytic celiac plexus block may be indicated. Currently a R1 (palliative) resection is acceptable in high volume centres but so far there is a very limited role for planned R2 palliative resections.

Busch, O.R.C.; Van Gulik, T.M.

2006-01-01

117

Pancreatic uncinate carcinoma: sonographic findings  

Microsoft Academic Search

Background: Pancreatic carcinoma arising from the uncinate process (pancreatic uncinate carcinoma) is relatively rare. We wished to define its clinical manifestations and sonographic findings. Methods: Clinical and sonographic data of eight cases were reviewed. Results: The common bile duct and the pancreatic duct were not dilated until a very late stage. The lesion mimicked a mesenteric tumor in two cases.

M. Sato; H. Ishida; K. Konno; Y. Hamashima; H. Naganuma; T. Komatsuda; M. Funaoka; J. Ishida; S. Watanabe

2001-01-01

118

A Multicenter, Prospective Study of a New Fully Covered Expandable Metal Biliary Stent for the Palliative Treatment of Malignant Bile Duct Obstruction  

PubMed Central

Background and Study Aims. Endoscopic placement of self-expanding metal stents (SEMSs) is indicated for palliation of inoperable malignant biliary obstruction. A fully covered biliary SEMS (WallFlex Biliary RX Boston Scientific, Natick, USA) was assessed for palliation of extrahepatic malignant biliary obstruction. Patients and Methods. 58 patients were included in this prospective, multicenter series conducted under an FDA-approved IDE. Main outcome measurements included (1) absence of stent occlusion within six months or until death, whichever occurred first and (2) technical success, need for reintervention, bilirubin levels, stent patency, time to stent occlusion, and adverse events. Results. Technical success was achieved in 98% (57/58), with demonstrated acute removability in two patients. Adequate clinical palliation until completion of followup was achievedin 98% (54/55) of evaluable patients, with 1 reintervention due to stent obstruction after 142 days. Mean total bilirubin decreased from 8.9?mg/dL to 1.2?mg/dL at 1 month. Device-related adverse events were limited and included 2 cases of cholecystitis. One stent migrated following radiation therapy. Conclusions. The WallFlex Biliary fully covered stent yielded technically successful placement with uncomplicated acute removal where required, appropriate reduction in bilirubin levels, and low rates of stent migration and occlusion. This SEMS allows successful palliation of malignant extrahepatic biliary obstruction.

Petersen, Bret T.; Kahaleh, Michel; Kozarek, Richard A.; Loren, David; Gupta, Kapil; Kowalski, Thomas; Freeman, Martin; Chen, Yang K.; Branch, Malcolm S.; Edmundowicz, Steven; Gluck, Michael; Binmoeller, Kenneth; Baron, Todd H.; Shah, Raj J.; Kinney, Timothy; Ross, William; Jowell, Paul; Carr-Locke, David

2013-01-01

119

Palliative Portal Vein Stent Placement in Malignant and Symptomatic Extrinsic Portal Vein Stenosis or Occlusion  

SciTech Connect

This article evaluates the results of portal vein (PV) stent placement in patients with malignant extrinsic lesions stenosing or obstructing the PV and causing symptomatic PV hypertension (PVHT). Fourteen patients with bile duct cancer (n = 7), pancreatic adenocarcinoma (n = 4), or another cancer (n = 3) underwent percutaneous transhepatic portal venous stent placement because of gastroesophageal or jejunal varices (n = 9), ascites (n = 7), and/or thrombocytopenia (n = 2). Concurrent tumoral obstruction of the main bile duct was treated via the transhepatic route in the same session in four patients. Changes in portal venous pressure, complications, stent patency, and survival were evaluated. Mean {+-} standard deviation (SD) gradient of portal venous pressure decreased significantly immediately after stent placement from 11.2 mmHg {+-} 4.6 to 1.1 mmHg {+-} 1.0 (P < 0.00001). Three patients had minor complications, and one developed a liver abscess. During a mean {+-} SD follow-up of 134.4 {+-} 123.3 days, portal stents remained patent in 11 patients (78.6%); stent occlusion occurred in 3 patients, 2 of whom had undergone previous major hepatectomy. After stent placement, PVHT symptoms were relieved in four (57.1%) of seven patients who died (mean survival, 97 {+-} 71.2 days), and relieved in six (85.7%) of seven patients still alive at the end of follow-up (mean follow-up, 171.7 {+-} 153.5 days). Stent placement in the PV is feasible and relatively safe. It helped to relieve PVHT symptoms in a single session.

Novellas, Sebastien [Hopital Archet, Department of Radiology and Interventional Radiology (France); Denys, Alban, E-mail: Alban.Denys@chuv.ch; Bize, Pierre, E-mail: pierrebize@bluewin.c [Centre Hospitalier Universitaire Vaudois, Department of Radiology and Interventional Radiology (Switzerland); Brunner, Philippe; Motamedi, Jean Paul [Hopital Archet, Department of Radiology and Interventional Radiology (France); Gugenheim, Jean [Hopital Archet, Department of Surgery (France); Caroli, Francois-Xavier [Hopital Archet, Department of Medical Oncology (France); Chevallier, Patrick [Hopital Archet, Department of Radiology and Interventional Radiology (France)

2009-05-15

120

Biliary tract obstruction in chronic pancreatitis  

PubMed Central

Bile duct strictures are a common complication in patients with advanced chronic pancreatitis and have a variable clinical presentation ranging from an incidental finding to overt jaundice and cholangitis. The diagnosis is mostly made during investigations for abdominal pain but jaundice may be the initial clinical presentation. The jaundice is typically transient but may be recurrent with a small risk of secondary biliary cirrhosis in longstanding cases. The management of a bile duct stricture is conservative in patients in whom it is an incidental finding as the risk of secondary biliary cirrhosis is negligible. Initial conservative treatment is advised in patients who present with jaundice as most will resolve once the acute on chronic attack has subsided. A surgical biliary drainage is indicated when there is persistent jaundice for more than one month or if complicated by secondary gallstones or cholangitis. The biliary drainage procedure of choice is a choledocho-jejunostomy which may be combined with a pancreaticojejunostomy in patients who have associated pain. Since many patients with chronic pancreatitis have an inflammatory mass in the head of the pancreas, a Frey procedure is indicated but a resection should be performed when there is concern about a malignancy. Temporary endoscopic stenting is reserved for cholangitis while an expandable metal stent may be indicated in patients with severe co-morbid disease.

Abdallah, Abdul A.; Krige, Jake E. J.

2007-01-01

121

Endoscopic approach through the minor papilla for the management of pancreatic diseases  

PubMed Central

AIM: To clarify the efficacy and safety of an endoscopic approach through the minor papilla for the management of pancreatic diseases. METHODS: This study included 44 endoscopic retrograde cholangiopancreatography (ERCP) procedures performed in 34 patients using a minor papilla approach between April 2007 and March 2012. We retrospectively evaluated the clinical profiles of the patients, the endoscopic interventions, short-term outcomes, and complications. RESULTS: Of 44 ERCPs, 26 were diagnostic ERCP, and 18 were therapeutic ERCP. The most common cause of difficult access to the main pancreatic duct through the major papilla was pancreas divisum followed by distortion of Wirsung’s duct. The overall success rate of minor papilla cannulation was 80% (35/44), which was significantly improved by wire-guided cannulation (P = 0.04). Endoscopic minor papillotomy (EMP) was performed in 17 of 34 patients (50%) using a needle-knife (13/17) or a pull-type papillotome (4/17). EMP with pancreatic stent placement, which was the main therapeutic option for patients with chronic pancreatitis, recurrent acute pancreatitis, and pancreatic pseudocyst, resulted in short-term clinical improvement in 83% of patients. Mild post-ERCP pancreatitis occurred as an early complication in 2 cases (4.5%). CONCLUSION: The endoscopic minor papilla approach is technically feasible, safe, and effective when the procedure is performed in a high-volume referral center by experienced endoscopists.

Fujimori, Nao; Igarashi, Hisato; Asou, Akira; Kawabe, Ken; Lee, Lingaku; Oono, Takamasa; Nakamura, Taichi; Niina, Yusuke; Hijioka, Masayuki; Uchida, Masahiko; Kotoh, Kazuhiro; Nakamura, Kazuhiko; Ito, Tetsuhide; Takayanagi, Ryoichi

2013-01-01

122

Stent Scraping for Histology: An Alternative Method for Obtaining Tissue to Rule out Neoplasia  

PubMed Central

Despite improvement in diagnostic modalities, confirmation of a histologic diagnosis of cancer of the biliary tree and pancreas remains elusive. Attempts to collect positive cytology specimens from vigorous brushings or washings obtained at endoscopy or percutaneously are often unsuccessful. In our unit, we have increased the yield by obtaining tissue scraped from prostheses that have been previously placed in either the bile duct or the pancreatic duct. The stents are first flushed with saline to collect cytology specimens, after which, they are bisected and scraped, and these contents are prepared in a manner similar to that used to prepare biopsy samples. Twelve of 16 scraped samples, 9 bile duct and 3 pancreas, were positive for adenocarcinoma. The cytology specimens were positive in only 4 of the 12. We recommend this method of sampling from material contained within prostheses as an adjunct when previous brushings, washings, or biopsies are negative.

Veerappan, Annamali; Prudente, Romulo; Kasmin, Franklin E.; Cohen, Seth A.

1994-01-01

123

Stent Scraping for Histology: An Alternative Method for Obtaining Tissue to Rule out Neoplasia.  

PubMed

Despite improvement in diagnostic modalities, confirmation of a histologic diagnosis of cancer of the biliary tree and pancreas remains elusive. Attempts to collect positive cytology specimens from vigorous brushings or washings obtained at endoscopy or percutaneously are often unsuccessful. In our unit, we have increased the yield by obtaining tissue scraped from prostheses that have been previously placed in either the bile duct or the pancreatic duct. The stents are first flushed with saline to collect cytology specimens, after which, they are bisected and scraped, and these contents are prepared in a manner similar to that used to prepare biopsy samples. Twelve of 16 scraped samples, 9 bile duct and 3 pancreas, were positive for adenocarcinoma. The cytology specimens were positive in only 4 of the 12. We recommend this method of sampling from material contained within prostheses as an adjunct when previous brushings, washings, or biopsies are negative. PMID:18493350

Siegel, J H; Veerappan, A; Prudente, R; Kasmin, F E; Cohen, S A

1994-01-01

124

Gastrointestinal Stent Update  

PubMed Central

The use of self-expanding metallic stents in the upper gastrointestinal tract, placed under radiologic imaging or endoscopic guidance, is the current treatment of choice for the palliation of malignant gastrointestinal outlet obstructions. Advances in metallic stent design and delivery systems have progressed to the stage where this treatment is now considered a minimally invasive therapy. Metallic stent placement will broaden further into the field of nonsurgical therapy for the gastrointestinal tract. To date, metallic stents placed in the esophagus, gastric outlet, colorectum, and bile ducts are not intended to be curative, but rather to provide a palliative treatment for obstructions. The evolution of metallic stent technology will render such procedures not only palliative but also therapeutic, by enabling local drug delivery, and the use of biodegradable materials will reduce procedure-related complications.

2010-01-01

125

Infected Walled-Off Pancreatic Necrosis following EUS-Guided Drainage Successfully Treated Using Multiple Stents in Different Sites Technique  

PubMed Central

Walled-off pancreatic necrosis (WOPN) is one of the most life-threatening complications of acute severe pancreatitis. Regarding its high mortality and morbidity without appropriate treatment, the drainage procedure is still the mainstay of the treatment for this condition. There are multiple drainage options for this event. To date, endoscopic drainage alone has not been adequate for this condition, while surgical drainage has been reported to have a high morbidity. Endoscopic drainage with pancreatic necrosectomy is the most effective and safe method, while endoscopic drainage with aggressive lavage is another acceptable treatment option. The procedural details have been described elsewhere in many studies. In this report, we describe an alternative technique of drainage by endoscopy alone, without aggressive lavage procedure, that yielded an acceptable outcome with an easier procedure.

Prachayakul, Varayu; Phisalprapa, Pojamana; Aswakul, Pitulak

2013-01-01

126

Bicarbonate and fluid secretion evoked by cholecystokinin, bombesin and acetylcholine in isolated guinea-pig pancreatic ducts.  

PubMed

1. HCO3- secretion was investigated in interlobular duct segments isolated from guinea-pig pancreas using a semi-quantitative fluorometric method. Secretagogue-induced decreases in intracellular pH, following blockade of basolateral HCO3- uptake with a combination of amiloride and DIDS, were measured using the pH-sensitive fluoroprobe BCECF. Apparent secretory HCO3- fluxes were calculated from the initial rate of intracellular acidification. 2. In the presence of HCO3-, stimulation with secretin (10 nM) or forskolin (5 microM) more than doubled the rate of intracellular acidification. This effect was abolished in the absence of HCO3-. It was also abolished in the presence of HCO3- when DIDS and NPPB were applied to the luminal membrane by microperfusion. We therefore conclude that the increase in acidification rate is a useful index of secretagogue-induced HCO3- secretion across the luminal membrane. 3. Secretin, cholecystokinin (CCK) and bombesin each stimulated HCO3- secretion in a dose-dependent fashion. They evoked comparable maximal responses at about 10 nM and the EC50 values were 0.5 nM for secretin, 0.2 nM for CCK and 30 pM for bombesin. Acetylcholine (ACh) was also effective, with a maximum effect at 10 microM. 4. The stimulatory effect of CCK was blocked completely by the CCK1 receptor antagonist devazepide but not by the CCK2 receptor antagonist L365,260. The CCK analogue JMV-180 (Boc-Tyr(SO3H)-Nle-Gly-Trp-Nle-Asp-phenylethyl ester), which is an agonist of the high-affinity CCK1 receptor but an antagonist of the low-affinity receptor, also stimulated HCO3- secretion but with a smaller maximal effect than CCK. JMV-180 partially inhibited the response to a high concentration of CCK but not to a lower concentration, suggesting that both high- and low-affinity states of the CCK1 receptor evoke HCO3- secretion. 5. The stimulatory effect of bombesin was blocked completely by the gastrin-releasing peptide (GRP) receptor antagonist D-Phe6-bombesin(6-13)-methyl ester (BME) but not by the neuromedin B (NMB) receptor antagonist D-Nal-cyclo[Cys-Tyr-D-Trp-Orn-Val-Cys]-Nal-NH2 (BIM-23127). 6. Secretagogue-evoked fluid secretion was also examined using video microscopy to measure the rate of swelling of ducts whose ends had sealed during overnight culture. Secretin, CCK, bombesin and ACh all evoked fluid secretion with maximal rates of approximately 0.6 nl x min(-1) x mm(-2), and with concentration dependences similar to those obtained for HCO3- secretion. 7. We conclude that CCK, bombesin and ACh stimulate the secretion of a HCO3--rich fluid by direct actions on the interlobular ducts of the guinea-pig pancreas and that these responses are mediated by CCK1 receptors, GRP receptors and muscarinic cholinoceptors, respectively. PMID:11559776

Szalmay, G; Varga, G; Kajiyama, F; Yang, X S; Lang, T F; Case, R M; Steward, M C

2001-09-15

127

Transcatheter Closure of a Chronic Iatrogenic Arteriovenous Fistula Between the Carotid Artery and the Brachiocephalic Vein with an Amplatzer Duct Occluder in Combination with a Carotid Stent  

SciTech Connect

We report an original method of transcatheter closure of an arteriovenous fistula using the combination of an Amplatzer PDA occluder and a carotid stent. The fistula was between the left carotid artery and the brachiocephalic vein. The patient had significant left-to-right shunt and was highly symptomatic. Due to the large orifice and pseudoaneurysmatic enlargement of the fistula, we had to use a large Amplatzer PDA occluder and the protruding part of the PDA device disk had to be covered with a carotid stent. The fistula was completely closed. The patient stopped having symptoms and, 2 years after the procedure, the effect persists.

Stasek, Josef, E-mail: stasek@fnhk.c [Charles University Prague, Cardiocenter of University Hospital Hradec Kralove, 1st Department of Medicine, Faculty of Medicine Hradec Kralove (Czech Republic); Lojik, Miroslav [Charles University Prague, Cardiocenter of University Hospital Hradec Kralove, Department of Radiology, Faculty of Medicine Hradec Kralove (Czech Republic); Bis, Josef [Charles University Prague, Cardiocenter of University Hospital Hradec Kralove, 1st Department of Medicine, Faculty of Medicine Hradec Kralove (Czech Republic); Horak, David [Regional Hospital Liberec, Department of Cardiology (Czech Republic); Dusek, Jaroslav [Charles University Prague, Cardiocenter of University Hospital Hradec Kralove, 1st Department of Medicine, Faculty of Medicine Hradec Kralove (Czech Republic); Brtko, Miroslav; Polansky, Pavel [Charles University Prague, Cardiocenter of University Hospital Hradec Kralove, Department of Cardiovascular Surgery, Faculty of Medicine Hradec Kralove (Czech Republic); Babu, Anush; Vojacek, Jan [Charles University Prague, Cardiocenter of University Hospital Hradec Kralove, 1st Department of Medicine, Faculty of Medicine Hradec Kralove (Czech Republic)

2009-05-15

128

[Combined management of pancreatic injury after airgunshot--case report].  

PubMed

Pancreatic trauma is a big diagnostic and therapeutic challenge for physicians. Because of retroperitoneal localization pancreas is protected from damages. Isolated pancreatic injury is rare. Usually it is connected with a multiple trauma. Damages of the other organs mask the symptoms of pancreas disorders and delay the diagnosis. On the other hand the prognosis is strictly connected with the state of the other organs. Early diagnosis and precise evaluation of the trauma extensiveness determines the appropriate method of the treatment. Surgery is a main therapy but the combined method of management is often necessary, including endoscopy. Computed tomography (CT) is the first diagnostic method showing the pancreatic parenchymas damage and its complications. Endoscopic Retrograde Cholangiopancreatography (ERCP) is the best tool to show the major ductal injury. The status of the major pancreas duct determines surgery management. Often the placement of stents is required. This therapy can save the patient from pancreatectomy. In this article was depicted a case of 19th patient with pancreatic injury who sustained airgun shot. Despite laparotomy and surgery external drainage the pancreatocutaneous fistula appeared. It was successfully treated by endoscopic placement of stent during ERCP. PMID:19606704

Babski, Pawe?; Dziekiewicz, Miros?aw; Gil, Jerzy; Wojtu?, Stanis?aw; Maruszy?ski, Marek

2009-05-01

129

Transcatheter Closure of a Chronic Iatrogenic Arteriovenous Fistula Between the Carotid Artery and the Brachiocephalic Vein with an Amplatzer Duct Occluder in Combination with a Carotid Stent  

Microsoft Academic Search

We report an original method of transcatheter closure of an arteriovenous fistula using the combination of an Amplatzer PDA occluder and a carotid stent. The fistula was between the left carotid artery and the brachiocephalic vein. The patient had significant left-to-right shunt and was highly symptomatic. Due to the large orifice and pseudoaneurysmatic enlargement of the fistula, we had to

Josef Stasek; Miroslav Lojik; Josef Bis; David Horak; Jaroslav Dusek; Miroslav Brtko; Pavel Polansky; Anush Babu; Jan Vojacek

2009-01-01

130

Combination Chemotherapy With or Without Oregovomab and Stereotactic Radiotherapy Together With Nelfinavir Mesylate in Treating Patients With Localized or Locally Advanced Pancreatic Cancer  

ClinicalTrials.gov

Acinar Cell Adenocarcinoma of the Pancreas; Duct Cell Adenocarcinoma of the Pancreas; Recurrent Pancreatic Cancer; Stage IA Pancreatic Cancer; Stage IB Pancreatic Cancer; Stage IIA Pancreatic Cancer; Stage IIB Pancreatic Cancer

2013-10-08

131

Transcatheter Closure of a Chronic Iatrogenic Arteriovenous Fistula Between the Carotid Artery and the Brachiocephalic Vein with an Amplatzer Duct Occluder in Combination with a Carotid Stent  

Microsoft Academic Search

We report an original method of transcatheter closure of an arteriovenous fistula using the combination of an Amplatzer PDA\\u000a occluder and a carotid stent. The fistula was between the left carotid artery and the brachiocephalic vein. The patient had\\u000a significant left-to-right shunt and was highly symptomatic. Due to the large orifice and pseudoaneurysmatic enlargement of\\u000a the fistula, we had to

Josef Stasek; Miroslav Lojik; Josef Bis; David Horak; Jaroslav Dusek; Miroslav Brtko; Pavel Polansky; Anush Babu; Jan Vojacek

2009-01-01

132

Histopathologically proven autoimmune pancreatitis mimicking neuroendocrine tumor or pancreatic cancer.  

PubMed

Autoimmune pancreatitis (AIP) can be difficult to distinguish from pancreatic cancer. We report a case of histopathologically proven AIP mimicking neuroendocrine tumor (NET) or pancreatic cancer in a 53-year-old man. He was referred to our hospital for further evaluation of a pancreatic mass detected on ultrasonography at a medical check-up. Abdominal ultrasonography showed a 15-mm hypoechoic mass located in the pancreatic body. Computed tomography revealed a tumor without any contrast enhancement, and magnetic resonance imaging demonstrated the mass to be hyperintense on diffusion-weighted image. Endoscopic retrograde cholangiopancreatography revealed slight dilatation of a branch of the pancreatic duct without stricture of the main pancreatic duct. The common bile duct seemed intact. Under suspicion of a non-functioning NET or malignant neoplasm, laparotomy was performed. At laparotomy, an elastic firm and well-circumscribed mass was found suggestive of a non-functioning NET, thus enucleation was performed. Histopathologically, the lesion corresponded to AIP. PMID:22423237

Onda, Shinji; Okamoto, Tomoyoshi; Kanehira, Masaru; Fujioka, Shuichi; Harada, Tohru; Hano, Hiroshi; Fukunaga, Masaharu; Yanaga, Katsuhiko

2012-01-20

133

Recurrent Attacks of Autoimmune Pancreatitis Result in Pancreatic Stone Formation  

Microsoft Academic Search

OBJECTIVES:Autoimmune pancreatitis has been characterized by irregular narrowing of the main pancreatic duct and sonolucent swelling of the parenchyma, both of which are due to lymphoplasmacytic inflammation at the active stage of the disease, and by the absence of pancreatic stone formation. The aim of the present study was to confirm or deny whether or not this disease is progressive

Mari Takayama; Hideaki Hamano; Yasuhide Ochi; Hisanobu Saegusa; Kenichi Komatsu; Takashi Muraki; Norikazu Arakura; Yasuharu Imai; Osamu Hasebe; Shigeyuki Kawa

2004-01-01

134

Autoimmune Pancreatitis – Recent Advances  

Microsoft Academic Search

Autoimmune pancreatitis (AIP) is recognized as a distinct clinical entity, identified as a chronic inflammatory process of the pancreas in which the autoimmune mechanism is involved. Clinically and histologically, AIP has two subsets: type 1 – lymphoplasmatic sclerosing pancreatitis with abundant infiltration of the pancreas and other affected organs with immunoglobulin G4-positive plasma cells, and type 2 – duct centric

I. Novotný; J. Lata; H. Nechutová

2010-01-01

135

Pancreatic cancer  

PubMed Central

Introduction Pancreatic cancer is the fourth most common cause of cancer death in higher-income countries, with 5-year survival only 10% even in people presenting with early-stage cancer. Risk factors include smoking, high alcohol intake, and dietary factors, while diabetes mellitus and previous pancreatitis may also increase the risk. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of surgical treatments in people with pancreatic cancer considered suitable for complete tumour resection? What are the effects of interventions to prevent pancreatic leak after pancreaticoduodenectomy in people with pancreatic cancer considered suitable for complete tumour resection? What are the effects of adjuvant treatments in people with completely resected pancreatic cancer? What are the effects of interventions in people with non-resectable (locally advanced or advanced) pancreatic cancer? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2009 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 46 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: chemoradiotherapy; chemoradiotherapy for non-resectable pancreatic cancer; chemoradiotherapy for resected pancreatic cancer; fibrin glue; fluorouracil-based chemotherapy (adjuvant) for resected pancreatic cancer (with or without surgery); fluorouracil-based chemotherapy for non-resectable pancreatic cancer; fluorouracil-based chemotherapy (systemic); fluorouracil-based combination chemotherapy; fluorouracil-based monotherapy for non-resectable pancreatic cancer; gemcitabine-based chemotherapy (adjuvant) for resected pancreatic cancer; gemcitabine-based chemotherapy (systemic); gemcitabine-based combination chemotherapy; gemcitabine-based monotherapy for non-resectable pancreatic cancer; lymphadenectomy (extended [radical], or standard) in people having pancreaticoduodenectomy; pancreatic duct occlusion; pancreaticoduodenectomy (pylorus-preserving); pancreaticoduodenectomy (Whipple's procedure); pancreaticogastrostomy reconstruction; pancreaticojejunostomy; and somatostatin and somatostatin analogues.

2010-01-01

136

Therapeutic pancreatic endoscopy.  

PubMed

The role of endoscopic retrograde cholangiopancreatography (ERCP) in the management of pancreatic diseases is continuing to evolve. This article reviews recent publications spanning a wide range of topics related to therapeutic pancreatic endoscopy: Over the last 12 months, several case series have added to the literature on the short-term and long-term effectiveness of endoscopic therapy of pseudocysts, pancreatic abscesses and fistulas. Identification of a communication between pancreatic duct and a pseudocyst has been suggested to predict response to percutaneous drainage. The importance of identifying pancreatic leaks in patients with severe pancreatitis has been stressed. In addition, endotherapy has been reported to be effective in patients with idiopathic chronic pancreatitis. Endoscopic removal of pancreatic stones after extracorporeal lithotripsy has been shown to result in long-term improvement in clinical outcomes in patients with chronic calcific pancreatitis. Other interesting publications addressed new techniques and tricks to achieve access to the difficult pancreatic duct. Finally, no review of pancreatic endotherapy would be complete without a reminder--as recently stated by a National Institutes of Health consensus panel--that there is considerable need for higher-quality and controlled trials in this and other areas of interventional endoscopy. PMID:12510226

Mergener, K; Kozarek, R A

2003-01-01

137

A Case of Successful Placement of a Fully Covered Metallic Stent for Hemobilia Secondary to Hepatocellular Carcinoma with Bile Duct Invasion  

PubMed Central

Hemobilia represents gastrointestinal bleeding that develops as a result of communication between blood vessels and the biliary tract, which causes the blood to reach the duodenal papilla. It is characterized by biliary colic as the initial symptom, and the complications of cholangitis, obstructive jaundice and/or anemia. In general, definitive diagnosis is made by esophagogastroduodenoscopy which confirms bleeding from the duodenal papilla. Abdominal US and abdominal enhanced CT are performed to identify the source of the bleeding, as well as ERCP for biliary drainage to control the comorbid cholangitis. If active hemorrhage accompanied by worsening of the anemia is suspected, abdominal angiography is performed to selectively image the hepatic artery. Then, embolization of the culprit vessel is recommended. In our patients with difficult hemostasis, because of the direct compression hemostasis to the tumor site achieved with the fully covered metallic stent and secondary compression hemostasis due to blood clots, the bleeding could be controlled.

Kawaguchi, Yoshiaki; Ogawa, Masami; Maruno, Atsuko; Ito, Hiroyuki; Mine, Tetsuya

2012-01-01

138

Proteomic analysis of pancreatic juice for the identification of biomarkers of pancreatic cancer  

Microsoft Academic Search

Introduction  Protein profiles of endoscopically collected pancreatic juice from normal, chronic pancreatitis patients and pancreatic cancer\\u000a patients were compared to identify diagnostic biomarkers of pancreatic cancer.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Secretin was injected intravenously and pancreatic juice was collected via selective cannulation of the pancreatic duct during\\u000a endoscopic retrograde cholangiopancreatography. Pancreatic juices consisting of three pooled samples for normal control, chronic\\u000a pancreatitis, and pancreatic cancer

Jeong Youp Park; Sun-A Kim; Joo Won Chung; Seungmin Bang; Seung Woo Park; Young-Ki Paik; Si Young Song

2011-01-01

139

A new pancreaticojejunostomy technique: A battle against postoperative pancreatic fistula  

PubMed Central

AIM: To present a new technique of end-to-side, duct-to-mucosa pancreaticojejunostomy with seromuscular jejunal flap formation, and insertion of a silicone stent. METHODS: We present an end-to-side, duct-to-mucosa pancreaticojejunostomy with seromuscular jejunal flap formation, and the insertion of a silicone stent. This technique was performed in thirty-two consecutive patients who underwent a pancreaticoduodenectomy procedure by the same surgical team, from January 2005 to March 2011. The surgical procedure performed in all cases was classic pancreaticoduodenectomy, without preservation of the pylorus. The diagnosis of pancreatic leakage was defined as a drain output of any measurable volume of fluid on or after postoperative day 3 with an amylase concentration greater than three times the serum amylase activity. RESULTS: There were 32 patients who underwent end-to-side, duct-to-mucosa pancreaticojejunostomy with seromuscular jejunal flap formation. Thirteen of them were women and 19 were men. These data correspond to 40.6% and 59.4%, respectively. The mean age was 64.2 years, ranging from 55 to 82 years. The mean operative time was 310.2 ± 40.0 min, and was defined as the time period from the intubation up to the extubation of the patient. Also, the mean time needed to perform the pancreaticojejunostomy was 22.7 min, ranging from 18 to 25 min. Postoperatively, one patient developed a low output pancreatic fistula, three patients developed surgical site infection, and one patient developed pneumonia. The rate of overall morbidity was 15.6%. There was no 30-d postoperative mortality. CONCLUSION: This modification appears to be a significantly safe approach to the pancreaticojejunostomy without adversely affecting operative time.

Katsaragakis, Stylianos; Larentzakis, Andreas; Panousopoulos, Sotirios-Georgios; Toutouzas, Konstantinos G; Theodorou, Dimitrios; Stergiopoulos, Spyridon; Androulakis, Georgios

2013-01-01

140

The "flying" bile duct: avulsion of the common bile duct in a plane crash survivor.  

PubMed

Blunt trauma is an unusual cause of extrahepatic bile duct injury. This is a case of a 51-year-old gentleman who sustained a significant seatbelt injury in a plane crash. Laparotomy, performed due to persistent abdominal pain, revealed that the common bile duct (CBD) was completely avulsed from the duodenum. Following insertion of drains and transfer to a hepatobiliary centre, the devascularised CBD was excised and replaced with a roux-en-y hepaticojejunostomy. Necrotic tissue was debrided from the pancreatic head. A persistent bile leak developed from the sub-hepatic drain. Repeat laparotomy revealed a bile leak from small ducts on the liver surface. Ligation of the ducts and bioglue sealing of the area were successfully performed. Subsequent to this a pancreatic fistula developed from the main pancreatic duct, which has since resolved. This unusual case illustrates the need for prompt recognition and early repair to optimise outcomes in traumatic CBD injury. PMID:18839268

Mohan, H; Beddy, D; Latif, A; Bangash, T; Quill, D; Traynor, O

2009-12-01

141

Lensing duct  

DOEpatents

A lensing duct to condense (intensify) light using a combination of front surface lensing and reflective waveguiding. The duct tapers down from a wide input side to a narrow output side, with the input side being lens-shaped and coated with an antireflective coating for more efficient transmission into the duct. The four side surfaces are uncoated, preventing light from escaping by total internal reflection as it travels along the duct (reflective waveguiding). The duct has various applications for intensifying light, such as in the coupling of diode array pump light to solid state lasing materials, and can be fabricated from inexpensive glass and plastic.

Beach, Raymond J. (Livermore, CA), Benett

1994-01-01

142

Dissolution of pancreatic stones.  

PubMed

Chronic calcific pancreatitis (CCP) is the most clear-cut form of chronic pancreatitis. Till date, the common treatment of CCP has been directed toward discontinuation of alcohol consumption if the disease is associated closely with alcohol abuse, relief of pain, enzyme replacement, and the management of some complications like diabetes mellitus, cyst or abscess of the pancreas, malnutrition etc. In 1979, the research group for chronic pancreatitis in Japan proposed the therapeutic policy for this disease as illustrated in Fig. 1. A plausible new treatment is the dissolution of protein precipitates or calcified stones in pancreatic ducts by oral or intravenous administration of drugs. PMID:2219444

Noda, A

143

Alisertib and Gemcitabine Hydrochloride in Treating Patients With Solid Tumors or Pancreatic Cancer  

ClinicalTrials.gov

Acinar Cell Adenocarcinoma of the Pancreas; Duct Cell Adenocarcinoma of the Pancreas; Recurrent Pancreatic Cancer; Stage III Pancreatic Cancer; Stage IV Pancreatic Cancer; Unspecified Adult Solid Tumor, Protocol Specific

2013-08-14

144

A randomized trial of endoscopic drainage methods for inoperable malignant strictures of the common bile duct  

Microsoft Academic Search

Background: Although metallic stents remain patent longer than plastic stents, the optimal palliation of inoperable malignant biliary strictures remains controversial because of the high cost of metallic stents and short patient survival. Methods: A total of 101 patients (mean age 72.5 ± 12.9 years) with malignant strictures of the common bile duct were included in this study, after three exclusions for

Frederic Prat; Olivier Chapat; Beatrice Ducot; Thierry Ponchon; Gilles Pelletier; Jacques Fritsch; Andre Daniel Choury; Catherine Buffet

1998-01-01

145

Removal of an embedded "covered" biliary stent by the "stent-in-stent" technique  

PubMed Central

A 46-year-old man was admitted with obstructive jaundice and cross-sectional imaging with computed tomography suggested distal biliary obstruction. A distal common bile duct stricture was found at endoscopic retrograde cholangiopancreatography (ERCP) and cytology was benign. A 6 cm fully covered self-expanding metal stent (SEMS) was inserted across the stricture to optimize biliary drainage. However, the SEMS could not be removed at repeat ERCP a few months later. A further fully covered SEMS was inserted within the existing stent to enable extraction and both stents were retrieved successfully a few weeks later. Fully covered biliary (SEMS) are used to treat benign biliary strictures. This is the first reported case of inability to remove a fully-covered biliary SEMS. Possible reasons for this include tissue hyperplasia and consequent overgrowth into the stent proximally, or chemical or mechanical damage to the polymer covering of the stent. Application of the stent-in-stent technique allowed successful retrieval of the initial stent.

Menon, Shyam

2013-01-01

146

Transpapillary iridium-192 wire in the treatment of malignant bile duct obstruction.  

PubMed Central

Twenty four patients with malignant bile duct obstruction were treated with intraluminal radiotherapy using iridium-192 wire inserted through an endoscopically placed nasobiliary catheter. Biliary drainage after treatment was maintained by an endoprosthesis. The median dose of intraluminal radiotherapy was 6000 cGy; two patients with cholangiocarcinoma were given a second course because of disease extension; four patients with pancreatic carcinoma received additional external irradiation (3000 cGy). There was one early death from a cerebrovascular accident (30 day mortality, 4.2%). Cholangitis (30%) was the major early complication and stent blockage (40%) the major late complication; there were no complications directly attributable to radiotherapy. The median survival for patients with pancreatic carcinoma was 250 days and for cholangiocarcinoma, 300 days. This method is technically feasible and may prove safer than the transhepatic technique. The ability of intraluminal irradiation to improve palliation or lengthen survival in patients with malignant bile duct obstruction remains uncertain. Assessment by a prospective, controlled trial is essential.

Levitt, M D; Laurence, B H; Cameron, F; Klemp, P F

1988-01-01

147

Anatomy-Specific Pancreatic Stump Management to Reduce the Risk of Pancreatic Fistula After Pancreatic Head Resection  

Microsoft Academic Search

Background  The anatomical status of the pancreatic remnant after a pancreatic head resection varies greatly among patients. The aim of\\u000a the present study was to improve management of the pancreatic remnant for reducing pancreatic fistula after pancreatic head\\u000a resection.\\u000a \\u000a \\u000a \\u000a Methods  Ninety-five consecutive patients who underwent an end-to-side, duct-to-mucosa pancreaticojejunostomy after pancreatic head\\u000a resection were included in the study. To approximate the pancreatic

Yoshitsugu Tajima; Tamotsu Kuroki; Noritsugu Tsuneoka; Tomohiko Adachi; Taiichiro Kosaka; Tatsuya Okamoto; Mitsuhisa Takatsuki; Susumu Eguchi; Takashi Kanematsu

2009-01-01

148

AAST grade III pancreatic injury following blunt abdominal trauma.  

PubMed

Isolated pancreatic trauma with major pancreatic duct disruption is a rare finding; it can present with equivocal clinical signs. Serum amylase levels and diagnostic contrast-enhanced computed tomography can facilitate the diagnostic process. PMID:22856446

Laing, G L; Jeetoo, S D; Oosthuizen, G; Clarke, D

2012-07-11

149

Receptor strategies in pancreatitis.  

PubMed Central

A variety of receptors on pancreatic acinar and duct cells regulate both pancreatic exocrine secretion and intracellular processes. These receptors are potential sites of action for therapeutic agents in the treatment of pancreatitis. Cholecystokinin (CCK) receptor antagonists, which may reduce the level of metabolic "stress" on acinar cells, have been shown to mitigate the severity of acute pancreatitis in a number of models. Not all studies have shown a benefit, however, and differences may exist between different structural classes of antagonists. Because increased pancreatic stimulation due to loss of feedback inhibition of CCK has been proposed to contribute to the pain of some patients with chronic pancreatitis, CCK receptor antagonists could also be of benefit in this setting. Somatostatin and its analogs diminish pancreatic secretion of water and electrolytes and have been effective in treating pancreatic fistulas and pseudocysts. These agents are also being evaluated for their ability to reduce pain in chronic pancreatitis (perhaps by reducing ductal pressure by diminishing secretory volume) and mitigating the severity of acute pancreatitis (possibly by reducing the metabolic load on acinar cells). Recently described secretin receptor antagonists may also have therapeutic value as a means of selectively inhibiting pancreatic secretion of water and electrolytes.

Grendell, J. H.

1992-01-01

150

Covered metallic stent for ischemic hilar biliary stricture.  

PubMed

Compared with surgery, endoscopic treatment is safe and highly effective for a postoperative hilar benign bile duct stricture (BDS). However, the long-term outcome of conventional placement of a single biliary stent for hilar benign BDS is generally poor. Although the placement of multiple biliary stents is preferred, multiple stenting in a BDS is difficult. Alternatively, single or multiple stent placement above the papilla ('inside stent') or fully-covered self-expandable metallic stents (SEMS) are feasible approaches for benign BDS. Nevertheless, controversy remains regarding whether and how to perform endoscopic biliary drainage for a hilar benign BDS. In patients with hilar benign BDS, endoscopic biliary drainage can be performed by placing conventional plastic stents across the papilla, plastic stents above the papilla or fully-covered SEMS. Individualized treatment should be considered. We report the placement of a fully-covered SEMS for a hilar benign biliary stricture after extended left hepatectomy. PMID:22533752

Kawakami, Hiroshi; Kuwatani, Masaki; Eto, Kazunori; Kudo, Taiki; Asaka, Masahiro

2012-05-01

151

Intrahepatic Plastic Stent Entrapment Due to Guide Wire Stripping  

Microsoft Academic Search

During endoscopic retrograde cholangiopancreatography (ERCP) of a 56-year-old female patient on the periodic stent exchange program due to benign biliary stricture treatment, it was realized that the guide wire could not be pulled out after insertion of a 7-F biliary stent in the right intrahepatic duct. There was a thickening and deformity at the distal tip of the guide wire

Selcuk Disibeyaz; Sedef Kuran; Bahattin Cicek; Erkan Parlak; Burhan Sahin

2007-01-01

152

Pancreatitis - discharge  

MedlinePLUS

Chronic pancreatitis - discharge; Pancreatitis - chronic - discharge; Pancreatic insufficiency - discharge ... You were in the hospital because you have pancreatitis, or swelling of the pancreas You may have ...

153

Detection of point mutation in K-ras oncogene at codon 12 in pancreatic diseases  

Microsoft Academic Search

AIM: To investigate frequency and clinical significance of K- ras mutations in pancreatic diseases and to identify its diagnostic values in pancreatic carcinoma. METHODS: 117 ductal lesions were identified in the available sections from pancreatic resection specimens of pancreatic ductal adenocarcinoma, comprising 24 pancreatic ductal adenocarcinoma, 19 peritumoral ductal atypical hyperplasia, 58 peritumoral ductal hyperplasia and 19 normal duct at

Yue-Xin Ren; Guo-Ming Xu; Zhao-Shen Li; Yu-Gang Song

2004-01-01

154

Plastic or metal stents for benign extrahepatic biliary strictures: a systematic review  

Microsoft Academic Search

BACKGROUND: Benign biliary strictures may be a consequence of surgical procedures, chronic pancreatitis or iatrogenic injuries to the ampulla. Stents are increasingly being used for this indication, however it is not completely clear which stent type should be preferred. METHODS: A systematic review on stent placement for benign extrahepatic biliary strictures was performed after searching PubMed and EMBASE databases. Data

Petra GA van Boeckel; Frank P Vleggaar; Peter D Siersema

2009-01-01

155

A pancreatic ductal leak should be sought to direct treatment in patients with acute pancreatitis  

Microsoft Academic Search

Background: The end result of leakage of pancreatic juice into the peripancreatic space can be sterile necrosis, infected necrosis, or rupture into an adjacent hollow viscus or blood vessel (eg, colon, small bowel, or pseudoaneurysm). If a pancreatic duct (PD) leak is present, should treatment be aimed at minimizing the sequela of the leakage of pancreatic juice and not just

Stanley T Lau; Erik J Simchuk; Richard A Kozarek; L. William Traverso

2001-01-01

156

Bile and pancreatic juice exclusion activates acinar stress kinases and exacerbates gallstone pancreatitis  

PubMed Central

Hypothesis: Bile and pancreatic juice exclusion from gut activates acinar stress kinases and exacerbates gallstone pancreatitis as evidenced by ameliorating effects of replacement therapy in an experimental model of duct ligation-induced acute pancreatitis. In early stages of gallstone pancreatitis, bile-pancreatic juice cannot enter the gut. Enteral exclusion worsens pancreatitis by causing feedback hyperstimulation of the exocrine pancreas that activates acinar cell stress kinases. Investigations using a unique surgical model, the Donor Rat Model, showed that duodenal replacement of bile-pancreatic juice in rats with duct ligation attenuates pancreatic stress kinase activation, reduces pancreatic cytokine production, and ameliorates pancreatic morphologic changes. These findings suggest that exclusion-induced acinar hyperstimulation, in the presence of duct obstruction, exacerbates acute pancreatitis via stress kinase activation. Although acinar hyperstimulation has often been implicated in acute pancreatitis pathogenesis, the lack of supporting evidence remains a conspicuous lacuna. The proposed hypothesis draws on fresh evidence to present a new paradigm that re-examines the role of exocrine pancreatic hyperstimulation in gallstone pancreatitis pathogenesis.

Samuel, Isaac

2008-01-01

157

Acute pancreatitis complicating Crohn's disease: mere coincidence or causality?  

PubMed Central

An example of acute pancreatitis developing five weeks after initial treatment with 5-aminosalicylic acid (5-ASA) and methylprednisolone for severe Crohn's disease is reported in a 37 year old female patient. She had undergone cholecystectomy for gall stones some years earlier. There was no evidence of acute or chronic pancreatitis. No morphological changes of the upper gastrointestinal tract were found except for some irregularity of the main pancreatic duct and the secondary ducts on endoscopic retrograde pancreatography. Rechallenge with 5-ASA did not induce recurrent pancreatitis or changes in pancreatic enzymes. This case report supports the concept of an association between acute pancreatitis and Crohn's disease. Images Figure 3

Tromm, A; Huppe, D; Micklefield, G H; Schwegler, U; May, B

1992-01-01

158

Stenting of a gastroduodenal artery aneurysm: report of a case.  

PubMed

We present a case of gastroduodenal artery stenting in a patient with recurrent episodes of pancreatitis due to gastroduodenal artery aneurysm. Stenting was performed under local anesthesia using a 6 × 38-mm primary covered Advanta V12 vascular stent graft. The procedure was successful and the patient is asymptomatic 21 months later. Endovascular treatment of gastroduodenal artery aneurysm should be considered a promising alternative to open surgery, due to lower mortality and morbidity. PMID:22075656

Lykoudis, Panagis M; Stafyla, Vaia K; Koutoulidis, Vassilis; Xatziioannou, Achileas; Arkadopoulos, Nikolaos; Mourikis, Ioannis; Smyrniotis, Vasilios

2011-11-12

159

Operable malignant jaundice: To stent or not to stent before the operation?  

PubMed Central

Traditionally, pre-operative biliary drainage (PBD) was believed to improve multi-organ dysfunction, and for this reason, was practiced worldwide. Over the last decade, this concept was challenged by many reports, including meta-analyses that showed no difference in morbidity and mortality between surgery with, and surgery without PBD, in operable malignant jaundice. The main disadvantages of PBD are seen to be the additional cost of the procedure itself, and the need for longer hospitalization. In addition, many studies showed the significance of specific complications resulting from PBD, such as recurrent jaundice, cholangitis, pancreatitis, cutaneous fistula, and bleeding. However, the results of these studies remain inconclusive as to date there has been no perfect study that equally randomized comparable patients according to the level of obstruction and technique used for PBD. Generally, endoscopic stent insertion (ES) is preferred for common duct obstruction, whereas endoscopic nasobiliary drainage and percutaneous biliary drainage is reserved for hilar obstruction, since ES in hilar block confers a high rate of cholangitis. Although, there is no guideline which either supports or refutes this approach, certain subgroups of patients, including those with symptomatic jaundice, cholangitis, impending renal failure, hilar block requiring preoperative portal vein embolization, and those who need pre-operative neoadjuvant therapy, are suitable candidates for PBD.

Rerknimitr, Rungsun; Kullavanijaya, Pinit

2010-01-01

160

Chronic pancreatitis: diagnosis and treatment.  

PubMed Central

Three-dimensional magnetic resonance cholangiopancreatography is currently the most exciting new imaging technique for chronic pancreatitis. Endoscopy-assisted duodenal intubation during the secretin-cholecystokinin test reduces intubation time in difficult cases. The NBT-para-amino benzoic acid test has been refined to enhance its discriminant power. The cholesteryl-[C13]octanoate breath test and the faecal elastase test are newer highly sensitive and specific tubeless tests. Pain in chronic pancreatitis continues to be a vexing therapeutic issue. Enzyme treatment continues despite criticism. Neurotensin is the new suspected mediator of the feedback mechanism, which is downregulated by enzyme therapy. Steroid ganglion block is an exciting therapeutic tool for pain relief. Endoscopic pancreatic sphincterotomy, Dormia basketing and pancreatic stenting in conjunction with extracorporeal shock wave lithotripsy should be performed early in chronic pancreatitis to prevent parenchymal atrophy with ensuing exocrine and endocrine pancreatic dysfunction. The modified Puestow's procedure preserves endocrine and exocrine pancreatic functions besides relieving pain. Closed loop insulin infusion allows superior management of pancreatic diabetes following near total pancreatectomy. The standardised incidence rate of pancreatic cancer is 16.5 in patients with alcoholic chronic pancreatitis and 100 for tropical chronic pancreatitis. Aggressive treatment protocols combining neo-adjuvant chemoradiation and intra-operative radiation with surgery are being used to improve the prognosis in this dismal complication of chronic pancreatitis.

Sidhu, S.; Tandon, R. K.

1996-01-01

161

Management of fibrosing pancreatitis in children presenting with obstructive jaundice  

Microsoft Academic Search

Background—Children with fibrosing pancreatitis are conventionally treated surgically to relieve common bile duct (CBD) obstruction caused by pancreatic compression. Residual pancreatic function has not been formally tested in these patients.Aims—To evaluate the usefulness of non-surgical temporary drainage in children with fibrosing pancreatitis and to assess pancreatic function after resolution of their CBD obstruction.Patients—Four children (1.5–13 years; three girls).Methods and results—Abdominal

F A Sylvester; B Shuckett; E Cutz; P R Durie; M A Marcon

1998-01-01

162

Type 1 autoimmune pancreatitis  

PubMed Central

Before the concept of autoimmune pancreatitis (AIP) was established, this form of pancreatitis had been recognized as lymphoplasmacytic sclerosing pancreatitis or non-alcoholic duct destructive chronic pancreatitis based on unique histological features. With the discovery in 2001 that serum IgG4 concentrations are specifically elevated in AIP patients, this emerging entity has been more widely accepted. Classical cases of AIP are now called type 1 as another distinct subtype (type 2 AIP) has been identified. Type 1 AIP, which accounts for 2% of chronic pancreatitis cases, predominantly affects adult males. Patients usually present with obstructive jaundice due to enlargement of the pancreatic head or thickening of the lower bile duct wall. Pancreatic cancer is the leading differential diagnosis for which serological, imaging, and histological examinations need to be considered. Serologically, an elevated level of IgG4 is the most sensitive and specific finding. Imaging features include irregular narrowing of the pancreatic duct, diffuse or focal enlargement of the pancreas, a peri-pancreatic capsule-like rim, and enhancement at the late phase of contrast-enhanced images. Biopsy or surgical specimens show diffuse lymphoplasmacytic infiltration containing many IgG4+ plasma cells, storiform fibrosis, and obliterative phlebitis. A dramatic response to steroid therapy is another characteristic, and serological or radiological effects are normally identified within the first 2 or 3 weeks. Type 1 AIP is estimated as a pancreatic manifestation of systemic IgG4-related disease based on the fact that synchronous or metachronous lesions can develop in multiple organs (e.g. bile duct, salivary/lacrimal glands, retroperitoneum, artery, lung, and kidney) and those lesions are histologically identical irrespective of the organ of origin. Several potential autoantigens have been identified so far. A Th2-dominant immune reaction and the activation of regulatory T-cells are assumed to be involved in the underlying immune reaction. IgG4 antibodies have two unique biological functions, Fab-arm exchange and a rheumatoid factor-like activity, both of which may play immune-defensive roles. However, the exact role of IgG4 in this disease still remains to be clarified. It seems important to recognize this unique entity given that the disease is treatable with steroids.

2011-01-01

163

[Early diagnosis and staging of pancreatic cancer].  

PubMed

Case of pancreatic cancer have increased in number, and the number of deaths from that disease has reached 20,000 in recent years in Japan. Only a few patients with pancreatic cancer can be cured. However, the prognosis in small pancreatic cancer such as TS1 less than 2 cm is relatively good if radical surgical resection is performed. Therefore early diagnosis of pancreatic cancer is important to improve the dismal prognosis. Although clinical symptoms are not reliable for the diagnosis of pancreatic cancer, 30% of TS1 patients have abdominal or back pain. Recent epidemiologic studies have shown that familial history of pancreatic cancer, chronic pancreatitis, diabetes, obesity, and smoking are possible high-risk factors for pancreatic cancer. Serum pancreatic enzyme and tumor markers in terms of CA19-9 and CEA are measured first. Ultrasonography (US) should be performed as soon as possible. Not only tumors but also slightly dilated main pancreatic ducts and/or small simple cysts that may represent indirect changes due to pancreatic cancer can be detected with US. Enhanced computed tomography, magnetic resonance cholangiopancreatography and endoscopic US are also useful. Endoscopic retrograde cholangiopancreatography yields more detailed images of branch ducts, and the cytology of pancreatic juice can be determined following examination. Unfortunately, position-emission tomography is not a reliable method for the diagnosis of small tumors in the pancreas. Finally, TNM staging of pancreatic cancer is performed based on the results of these imaging examinations. PMID:16878407

Shiratori, Keiko

2006-07-01

164

Endoscopic ultrasound-guided choledochoduodenostomies with fully covered self-expandable metallic stents  

PubMed Central

AIM: To investigate the long-term outcomes of endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) with a fully covered self-expandable metallic stent (FCSEMS). METHODS: From April 2009 to August 2010, 15 patients with distal malignant biliary obstructions who were candidates for alternative techniques for biliary decompression due to a failed endoscopic retrograde cholangiopancreatography (ERCP) were included. These 15 patients consisted of 8 men and 7 women and had a median age of 61 years (range: 30-91 years). The underlying causes of the distal malignant biliary obstruction were pancreatic cancer (n = 9), ampulla of Vater cancer (n = 2), renal cell carcinoma (n = 1), advanced gastric cancer (n = 1), lymphoma (n = 1), and duodenal cancer (n = 1). RESULTS: The technical success rate of EUS-CDS with an FCSEMS was 86.7% (13/15), and functional success was achieved in 100% (13/13) of those cases. In two patients, the EUS-CDS failed because an FCSEMS with a delivery device could not be passed into the common bile duct. The mean duration of stent patency was 264 d. Early adverse events developed in three patients (3/13, 23.1%), including self-limited pneumoperitoneum in two patients and cholangitis requiring stent reposition in one patient. During the follow-up period (median: 186 d, range: 52-388 d), distal stent migration occurred in four patients (4/13, 30.8%). In 3 patients, the FCSEMS could be reinserted through the existing choledochoduodenal fistula tract. CONCLUSION: EUS-CDS with an FCSEMS is technically feasible and can lead to effective palliation of distal malignant biliary obstructions after failed ERCP.

Song, Tae Jun; Hyun, Yil Sik; Lee, Sang Soo; Park, Do Hyun; Seo, Dong Wan; Lee, Sung Koo; Kim, Myung-Hwan

2012-01-01

165

CT pancreatogram in carcinoma of the pancreas and chronic pancreatitis  

SciTech Connect

CT has made it possible to determine the contour of the pancreatic duct, to measure its caliber, and to detect dilatation of the duct. CT scans of 75 patients with pancreatic carcinoma and of 45 patients with chronic pancreatitis were obtained. Dilatation of the pancreatic duct was seen in 56% of patients with carcinoma, and in 70% of those with tumors confined to the pancreatic head and body. Smooth dilatation (43%) or beaded dilatation (40%) were most commonly associated with carcinoma. Ductal dilatation was present in 58% of the patients with chronic pancreatitis, and irregular dilatation was seen in 73% of the patients in this group. About half of the patients who had irregular dilatation had calculi within the ducts. Eight cases of dilatation of the duct with no detectible pancreatic mass were seen in a subgroup of 13 patients who had small carcinomas of the pancreas (tumor size of 3 cm or less). Our findings indicate that a dilated pancreatic duct with a smooth contour and a ratio of duct to total gland width of 0.50 or greater suggests carcinoma as the underlying pathology.

Karasawa, E.; Goldberg, H.I.; Moss, A.A.; Federle, M.P.; London, S.S.

1983-08-01

166

Management of Biliary and Duodenal Complications of Chronic Pancreatitis  

Microsoft Academic Search

Biliary stricture and duodenal obstruction have been increasingly recognized as complications of chronic pancreatitis. The anatomical relationship of the distal common bile duct and the duodenum with the head of the pancreas is the main factor for their involvement in chronic pancreatitis. In hospitalized patients with pancreatitis, the incidence of biliary stricture and duodenal obstruction is reported to be about

Joseph D. Vijungco; Richard A. Prinz

2003-01-01

167

Endoscopic Palliation for Pancreatic Cancer  

PubMed Central

Pancreatic cancer is devastating due to its poor prognosis. Patients require a multidisciplinary approach to guide available options, mostly palliative because of advanced disease at presentation. Palliation including relief of biliary obstruction, gastric outlet obstruction, and cancer-related pain has become the focus in patients whose cancer is determined to be unresectable. Endoscopic stenting for biliary obstruction is an option for drainage to avoid the complications including jaundice, pruritus, infection, liver dysfunction and eventually failure. Enteral stents can relieve gastric obstruction and allow patients to resume oral intake. Pain is difficult to treat in cancer patients and endoscopic procedures such as pancreatic stenting and celiac plexus neurolysis can provide relief. The objective of endoscopic palliation is to primarily address symptoms as well improve quality of life.

Bakhru, Mihir; Tekola, Bezawit; Kahaleh, Michel

2011-01-01

168

Long-term outcomes of autoimmune pancreatitis: a multicentre, international analysis.  

PubMed

OBJECTIVE: Autoimmune pancreatitis (AIP) is a treatable form of chronic pancreatitis that has been increasingly recognised over the last decade. We set out to better understand the current burden of AIP at several academic institutions diagnosed using the International Consensus Diagnostic Criteria, and to describe long-term outcomes, including organs involved, treatments, relapse frequency and long-term sequelae. DESIGN: 23 institutions from 10 different countries participated in this multinational analysis. A total of 1064 patients meeting the International Consensus Diagnostic Criteria for type 1 (n=978) or type 2 (n=86) AIP were included. Data regarding treatments, relapses and sequelae were obtained. RESULTS: The majority of patients with type 1 (99%) and type 2 (92%) AIP who were treated with steroids went into clinical remission. Most patients with jaundice required biliary stent placement (71% of type 1 and 77% of type 2 AIP). Relapses were more common in patients with type 1 (31%) versus type 2 AIP (9%, p<0.001), especially those with IgG4-related sclerosing cholangitis (56% vs 26%, p<0.001). Relapses typically occurred in the pancreas or biliary tree. Retreatment with steroids remained effective at inducing remission with or without alternative treatment, such as azathioprine. Pancreatic duct stones and cancer were uncommon sequelae in type 1 AIP and did not occur in type 2 AIP during the study period. CONCLUSIONS: AIP is a global disease which uniformly displays a high response to steroid treatment and tendency to relapse in the pancreas and biliary tree. Potential long-term sequelae include pancreatic duct stones and malignancy, however they were uncommon during the study period and require additional follow-up. Additional studies investigating prevention and treatment of disease relapses are needed. PMID:23232048

Hart, Phil A; Kamisawa, Terumi; Brugge, William R; Chung, Jae Bock; Culver, Emma L; Czakó, László; Frulloni, Luca; Go, Vay Liang W; Gress, Thomas M; Kim, Myung-Hwan; Kawa, Shigeyuki; Lee, Kyu Taek; Lerch, Markus M; Liao, Wei-Chih; Löhr, Matthias; Okazaki, Kazuichi; Ryu, Ji Kon; Schleinitz, Nicolas; Shimizu, Kyoko; Shimosegawa, Tooru; Soetikno, Roy; Webster, George; Yadav, Dhiraj; Zen, Yoh; Chari, Suresh T

2012-12-11

169

Elective operations in chronic alcohol induced pancreatitis.  

PubMed

The role of surgical treatment in the management of chronic pancreatitis has increased, mainly because of improved diagnostic methods. In the present study, 83 consecutive patients who were operated upon for chronic alcohol induced pancreatitis between 1970 and 1980 are reviewed. The results indicate that the best results with regard to pain relief were achieved with lateral drainage operation in patients with dilated pancreatic ducts. A sufficient pancreatic resection gives satisfactory results in patients with nondilated ducts. Patients with severe pancreatic changes and a long history of alcoholism are best treated by extended pancreatic resections with regard to pain relief; however, most of the patients are still unable to work after the operation. A constant follow-up and active surgical attitude at the early stage of the disease before the circulus vitiosus of pain, drugs, inability to work and disturbances in social life are of paramount importance. PMID:6204392

Kiviluoto, T; Schröder, T; Lempinen, M

1984-07-01

170

Clinical outcomes in patients who undergo extracorporeal shock wave lithotripsy for chronic calcific pancreatitis  

Microsoft Academic Search

Background: There is controversy as to whether extracorporeal shock wave lithotripsy fragmentation and ERCP retrieval of pancreatic stones are associated with relief of chronic pain or relapsing attacks of pancreatitis. Our most recent experience with this technology is reviewed. Methods: Forty patients with chronic calcific pancreatitis who required extracorporeal shock wave lithotripsy between 1995 and 2000 to facilitate pancreatic duct

Richard A. Kozarek; John J. Brandabur; Terrence J. Ball; Michael Gluck; David J. Patterson; Fouad Attia; Renee France; L. William Traverso; Paul Koslowski; Robert P. Gibbons

2002-01-01

171

Cystic pancreatic lymphangioma  

PubMed Central

Lymphangioma of the pancreas is a rare benign tumor of lymphatic origin. Retroperitoneal lymphangiomas account for 1% of all lymphangiomas. Herein, we report a case of cystic pancreatic lymphangioma diagnosed in 34 year-old female patient who was hospitalized for a slight pain in the epigastrium and vomiting. Radiological imaging revealed a large multiloculated cystic abdominal mass with enhancing septations involving the upper retroperitoneum. During the laparoscopic surgery, a well circumscribed polycystic tumor was completely excised preserving the pancreatic duct. The patient made a complete recovery and is disease-free 12 months postoperatively.

Gures, Nazim; Gurluler, Ercument; Alim, Altan; Berber, Ibrahim; Gurkan, Alihan

2012-01-01

172

Severe Acute Pancreatitis with Complicating Colonic Fistula Successfully Closed Using the Over-the-Scope Clip System  

PubMed Central

A 44-year-old man presenting to our hospital emergency room with abdominal pain was hospitalized for hyperlipidemic acute pancreatitis. A pig-tail catheter was placed percutaneously to drain an abscess on day 22. Although the abscess improved gradually and good clinical progress was seen, pancreatic duct disruption was strongly suspected and endoscopic retrograde cholangiopancreatography was performed on day 90. An endoscopic nasopancreatic drainage tube was placed, but even with concurrent use of a somatostatin analogue, treatment was ineffective. Surgical treatment was elected, but was subsequently postponed as the abscess culture was positive for extended-spectrum ?-lactamase-producing Escherichia coli and methicillin-resistant Staphylococcus aureus. Drainage tubography showed a small fistula of the colon at the splenic flexure on day 140. Colonoscopy was performed on day 148. After indigo carmine had been injected, a fistula into the splenic flexure of the colon showed blue staining. The over-the-scope clip (OTSC) system was used to seal the fistula and complete closure was shown. A liquid diet was started on day 159 and was smoothly upgraded to a full diet. Following removal of the pancreatic stent on day 180, drainage volume immediately decreased and the percutaneous drain was removed. On day 189, computed tomography showed no exacerbation of the abscess and the patient was discharged on day 194. This case of colonic fistula caused by severe acute pancreatitis was successfully treated using the OTSC system, avoiding the need for an open procedure.

Ito, Ken; Igarashi, Yoshinori; Mimura, Takahiko; Kishimoto, Yui; Kamata, Itaru; Kobayashi, Shunsuke; Yoshimoto, Kensuke; Okano, Naoki

2013-01-01

173

Pancreatic trauma: Diagnostic and therapeutic strategies  

Microsoft Academic Search

Opinion statement  The management of pancreatic trauma provides trauma surgeons with diagnostic and therapeutic challenges. The two most important\\u000a facts that must be established are the location of the injury in relation to the superior mesenteric artery and vein and the\\u000a status of the main pancreatic duct. If a pancreatic injury is discovered at the time of exploration and no main

Herb A. Phelan; Joseph P. Minei

2005-01-01

174

Spinal cord stimulation for chronic visceral pain secondary to chronic non-alcoholic pancreatitis.  

PubMed

Spinal cord stimulation (SCS) suppresses visceral response to colon distension in an animal model. In humans, it may be an effective therapy for chronic pain of pelvic origin, irritable bowel syndrome, and persistent unspecified abdominal pain. Described here is the case of SCS for 38-year-old woman with visceral pain secondary to chronic pancreatitis. Previous therapies included numerous endoscopic retrograde cholangiopancreatographies, multiple pancreatic duct stenting, chemical and surgical sympathectomies with short-lasting pain relief. After the initial evaluation, the patient underwent retrograde epidural differential block to determine possible source of pain. Delay in pain recurrence after block suggested that the origin of her pain was visceral. After the psychologic evaluation, the patient underwent SCS trial over 14 days. She had 2 trial leads placed epidurally via T9-T10 paramedian entry with the tips of both leads positioned at T6 vertebral body. During the trial, visual analog scale pain score decreased from 8 to 1 cm, Pain Disability Index from 62 to 14, and opioid use from 150 to 0 mg of morphine sulfate equivalent a day. After the completion of successful SCS trial, she was implanted with dual octrode leads and rechargeable pulse generator. Median pain scores decreased from 8 to 1 at 3 months after the implant. Pain Disability Index changed from 62 to 15. Opiate use decreased to none. It seems that SCS may have a significant therapeutic potential for the treatment of visceral pain secondary to chronic pancreatitis. PMID:18496389

Kapural, Leonardo; Rakic, Mladen

2008-07-01

175

Autoimmune pancreatitis: current concepts.  

PubMed

Autoimmune pancreatitis (AIP) is a distinct type of chronic pancreatitis with unique clinical, pathological, serological, and imaging features. AIP usually presents with obstructive jaundice. Imaging studies often reveal enlargement of the pancreas with a pancreatic mass and strictures of the main pancreatic duct. Two subtypes of AIP have recently been identified. Type I AIP is more prevalent in elderly Asian males and is characterized by lymphoplasmacytic sclerosing pancreatitis, obliterative phlebitis, and infiltration of large numbers of IgG4-positive plasma cells. Type II AIP is more prevalent in Caucasians and is characterized by granulocyte epithelial lesions. Most patients with type I AIP have a significantly elevated serum IgG4 concentration, which is an important feature for diagnosis and for differentiating between AIP and other conditions such as pancreatic cancer. Extrapancreatic complications are common, such as sclerosing cholangitis, sclerosing sialadenitis, retroperitoneal fibrosis in type I AIP, and ulcerative colitis in type II AIP. A rapid response to glucocorticoids treatment is suggestive of AIP, but the relapse rate is high, warranting the use of immunosuppressant treatment. B-cell depletion with rituximab may be a promising therapy. The prognosis of AIP is generally benign if treated promptly, and spontaneous remission occurs in a proportion of patients. PMID:23526391

Wang, Qian; Zhang, Xuan; Zhang, Fengchun

2013-03-23

176

Multicenter Randomized Trial of 10-French versus 11.5-French Plastic Stents for Malignant Biliary Obstruction  

PubMed Central

Background. There is little prospective data on whether bigger plastic stents are better for patients with malignant biliary obstruction with jaundice. Goals. Multicenter prospective study to compare technical success, clinical response, stent occlusion, and patient survival in patients with malignant biliary obstruction randomized to 10-French or 11.5-French plastic stent. Study. Patients with malignant biliary obstruction were randomized to 10-French or 11.5-French biliary stents. Patients were prospectively assessed for stent occlusion, stent-related interventions, hospital stay, and change in bilirubin. Main outcome measurements included technical success, clinical response, rates of stent occlusion, and survival. Results. 234 patients (47 hilar and 187 common bile duct strictures) were randomized. Outcomes were similar for the 10-French and 11.5-French groups (technical success 99.1% versus 97.4%, P = 0.37). Overall, median stent survival was 213 days, but there was no statistically significant difference in stent survival between 10-French and 11.5-French stents (149 versus 258 days, P = 0.16). Stent survival was significantly longer when placed for common bile duct versus hilar strictures (231 versus 115 days, P = 0.049). Conclusions. The theoretical advantage of improved bile flow for the 11.5-French stent does not translate into more prolonged patency, better clinical response, and longer patient survival than the 10-French stent.

Wagh, Mihir S.; de Bellis, Mario; Fogel, Evan L.; Frakes, James T.; Johanson, John F.; Qaseem, Tahir; Howell, Douglas A.; Lehman, Glen A.; Sherman, Stuart

2013-01-01

177

CORNICE DUCT SYSTEM  

Microsoft Academic Search

SYNERGETICS, INC., is in the process of designing, developing, and testing an air handling duct system that integrates the air duct with the cornice trim of interior spaces. The device has the advantage that the normal thermal losses from ducts into unconditioned attics and crawl spaces can be totally eliminated by bringing the ducts internal to the conditioned space. The

Chuck Ladd; TC Howard

2002-01-01

178

Computed tomographic appearance of resectable pancreatic carcinoma  

SciTech Connect

Thirteen patients with resectable pancreatic carcinoma were examined by computed tomography (CT). Nine had a mass, 2 had dilatation of the main pancreatic duct, 1 appeared to have ductal dilatation, and 1 had no sign of abnormality. Resectable carcinoma was diagnosed retrospectively in 8 cases, based on the following criteria: a mass with a distinct contour, frequently containing a tiny or irregular low-density area and accompanied by dilatation of the caudal portion of the main pancreatic duct without involvement of the large vessels, liver, or lymph nodes. Including unresectable cancer, chronic pancreatitis, and obstructive jaundice from causes other than cancer, the false-positive rate was less than 6%. However, a small cancer without change in pancreatic contour is difficult to detect with CT.

Itai, Y. (Univ. of Tokyo, Japan); Araki, T.; Tasaka, A.; Maruyama, M.

1982-06-01

179

Stent fractures after superficial femoral artery stenting  

PubMed Central

Stent fracture is one of the major factors compromising implanted stent patency due to its consequences including in-stent restenosis, thrombosis, perforation, and migration. Stent fracture can occur from stress (extrinsic or intrinsic) and biomechanical forces at different implantation sites. We report on 2 cases of stent fractures and pertinent literature. One patient, a 75-year-old male, presented with recurrence of claudication 14 months after superficial femoral artery stenting; a femoral artery occlusion with stent fracture was found, and he underwent femoropopliteal bypass. The other patient, a 72-year-old male presented with recurrence of claudication; a stent fracture was found without femoral artery occlusion, and he was treated with additional femoral artery stenting to secure the fracture site.

Park, Jae Young; Jeon, Yong Sun; Cho, Soon Gu; Jin, Chan Ik; Kim, Kyung Rae; Shin, Woo Young; Hong, Kee Chun

2012-01-01

180

Circumferential Stent Fracture  

PubMed Central

Circumferential stent fracture is extremely uncommon, and in rare cases, it can cause stent thrombosis. Recognizing stent fracture can be difficult on conventional fluoroscopy because of poor stent radiopacity. We found that StentBoost image acquisition yields improved visibility of stent struts, enabling the identification of stent fracture and the precise positioning of new stents over previously stented segments. We report the case of a 50-year-old man who presented with acute myocardial infarction and subacute stent thrombosis a week after percutaneous transluminal coronary angioplasty and placement of a bare-metal stent. The new lesion was crossed with a guidewire, but multiple attempts to advance a balloon catheter were unsuccessful. Live StentBoost image acquisition revealed circumferential stent fracture into 2 separate sections, with abnormal angulation between the proximal and distal portions of the stent. With StentBoost guidance, the wire and balloon catheter were both easily manipulated to cross the lesion, and angioplasty and restenting were completed with good results. StentBoost can be a useful adjunctive tool for the cardiac interventionist during complex percutaneous transluminal coronary angioplasty, and it was invaluable in this challenging situation. We discuss stent fracture and the benefits of using StentBoost in such situations.

Ramegowda, Raghu T.; Chikkaswamy, Srinivas B.; Bharatha, Ashalatha; Radhakrishna, Jayashree; Krishnanaik, Geetha B.; Nanjappa, Manjunath C.; Panneerselvam, Arunkumar

2012-01-01

181

Leitbakteria of microbial biofilm communities causing occlusion of biliary stents.  

PubMed

Biliary stents inserted to relieve obstructive jaundice caused by biliary or pancreatic malignancies inevitably become occluded by microbial growth in the form of diverse microbial community biofilms. The scarce information available on these communities is based on cultivation methods, but such methods usually provide distorted overviews of community composition, so commonalities and differences in biliary stent communities are uncertain. We extracted DNA and RNA from the microbial communities of 11 biliary stents explanted from nine patients in hospitals from two different countries, amplified 16S rRNA and rDNA sequences, analysed the amplicons by the single-strand conformation polymorphism (SSCP) method, and sequenced and deduced phylogenetic assignments of the major amplicons representing the major biofilm community members. We used a Modified Robbins Device (MRD) to study de novo development of a stent biofilm from a patient stent microbial community. Single-strand conformation polymorphism fingerprinting revealed the same six abundant bacterial species, here designated Leitbakteria, namely Klebsiella pneumoniae, Enterococcus faecalis, Pseudomonas aeruginosa, Enterobacter aerogenes, and two unculturable bacteria distantly related to E. coli and Shigella sonnei, in all of the stent biofilm communities. In the experimental biliary stent system, a sequential colonization of the stent surface was observed, with P. aeruginosa being the pioneer colonizer, followed by K. pneumoniae and one of the unculturable Leitbakteria, followed by the remainder of the community. The overview of microbial biofilm communities of biliary stents gained by the use of culture-independent methods revealed new unculturable bacteria as major members of biliary stent biofilms, and the diversity of the abundant members of the stent biofilms is considerably lower than suggested from earlier studies based on cultivation methods, and that communities from different stents from different patients in different countries are remarkably similar and have similar major members, the stent Leitbakteria. PMID:14510839

Wenderoth, Dirk F; Ferslev, Björn; Macarri, Giampiero; Molinari, Gabriella; Lünsdorf, Heinrich; Timmis, Kenneth N

2003-10-01

182

A Minimally Invasive Approach for Postoperative Pancreatic Fistula  

SciTech Connect

Pancreas fistula is a well-known and severe complication of pancreaticoduodenectomy. It is difficult to control with conservative therapy, inducing further complications and severe morbidity. Until now, re-operation has been the only way to resolve pancreatic fistula causing complete dehiscence of the pancreatic-enteric anastomosis (complete pancreatic fistula). Percutaneous transgastric fistula drainage is one of the treatments for pancreatic fistula. This procedure allows both pancreas juice drainage and anastomosis re-construction at the same time. This is effective and minimally invasive but difficult to adapt to a long or complicated fistula. In particular, dilatation of the main pancreatic duct is indispensable. This paper reports the successful resolution of a postoperative pancreatic fistula by a two-way-approach percutaneous transgastric fistula drainage procedure. Using a snare catheter from the fistula and a flexible guidewire from the transgastric puncture needle, it can be performed either with or without main pancreatic duct dilatation.

Yamazaki, Shintaro [Nihon University School of Medicine, 30-1 Ohyaguchi kamimachi, Itabashi-ku, Tokyo 173-8610, Third Department of Surgery (Japan)], E-mail: yamazaki-nmed@umin.ac.jp; Kuramoto, Kenmei [National Hospital Tokyo, Disaster Medical Center, Tokyo, Department of Radiology (Japan); Itoh, Yutaka [National Hospital Tokyo, Disaster Medical Center, Tokyo, Department of Surgery (Japan); Watanabe, Yoshika [Nihon University School of Medicine, 30-1 Ohyaguchi kamimachi, Itabashi-ku, Tokyo 173-8610, Third Department of Surgery (Japan); Ueda, Toshisada [National Hospital Tokyo, Disaster Medical Center, Tokyo, Department of Surgery (Japan)

2003-11-15

183

A pancreatography study of chronic calcific pancreatitis of the tropics.  

PubMed

Chronic Calcific Pancreatitis of Tropics is a disease of unknown aetiology and is characterised by chronic pancreatitis with calcification in young persons who present with pain, diabetes, and/or steatorrhoea. ERCP performed on 42 patients with this condition revealed changes compatible with chronic pancreatitis. These changes were however, more marked and somewhat different from those seen in the alcoholic chronic pancreatitis. Cystic dilatation, tortuosity, and obstruction of the main pancreatic duct were similar to that in alcoholic pancreatitis. The features of CCPT that were different from those of latter, were large pancreatic calculi, absence of strictures/stenosis and absence of irregularity of the ductal wall. The calculi were predominantly in the head region of the pancreas causing maximal dilatation of the main pancreatic duct in the head of pancreas. The secondary branches were stunted, short and scanty but revealed a lower grade of changes, than the changes documented in the main pancreatic duct. The pancreatic ductal changes in CCPT seems to be different from that seen in chronic alcoholic pancreatitis and may be due to the difference in the pathophysiology of the underlying disease. PMID:12833701

Saraya, A; Acharya, S K; Vashist, S; Tandon, R K

184

Duct Joining System  

DOEpatents

A duct joining system for providing an air-tight seal and mechanical connection for ducts and fittings is disclosed. The duct joining system includes a flexible gasket affixed to a male end of a duct or fitting. The flexible gasket is affixed at an angle relative to normal of the male end of the duct. The female end of the other duct includes a raised bead in which the flexible gasket is seated when the ducts are properly joined. The angled flexible gasket seated in the raised bead forms an air-tight seal as well as fastens or locks the male end to the female end. Alternatively, when a flexible duct is used, a band clamp with a raised bead is clamped over the female end of the flexible duct and over the male end of a fitting to provide an air tight seal and fastened connection.

Proctor, John P. (Fairfax, CA)

2001-02-27

185

Endoscopic stenting of gastric staple line leak following sleeve gastrectomy.  

PubMed

Laparoscopic sleeve gastrectomy is known to be associated with a risk of gastric staple line leak. We report on our experience with endoscopic stenting of the anomalous leaking tract. Three cases of post sleeve gastric leak confirmed by computed tomography scan were treated by endoscopic stenting of their leak with a plastic endoprosthesis under fluoroscopic and endoscopic guidance. Endoscopic stenting by means of biliary or pancreatic endoprosthesis was successful in the three patients. The median number of endoscopy procedures per patient was 1.3. Stents were extracted 6 to 10 weeks after their placement. Neither morbidity nor recurrence was noticed on follow-up. Endoscopic stenting of gastric staple line leak following sleeve gastrectomy proved to be an efficacious technique for leak healing. PMID:23990479

Slim, Rita; Smayra, Tarek; Chakhtoura, Ghassan; Noun, Roger

2013-11-01

186

In Vivo Study of Polyurethane-Coated Gianturco-Rosch Biliary Z-Stents  

SciTech Connect

Purpose: Prototypes of Gianturco-Rosch Z-stents coated with polycarbonate urethane (PCU) were placed in the biliary tree of pigs, in order to test their biomechanical behavior, stability, and biocompatibility. Methods: The stents were surgically implanted in the common bile duct of three pairs of pigs, which were killed after 1, 3, and 6 months respectively. Explanted livers from pigs of the same race, age, and size were used to provide comparative data. The bile ducts were radiologically and histopathologically examined; the stents were processed and examined by scanning electron microscopy. Results: No complications occurred and the animals showed a normal weight gain. The main bile duct appeared radiologically and macroscopically dilated, but the stents proved to be in place. Histologically, the bile duct epithelium was destroyed, but neither hyperplastic nor inflammatory fibrotic reactions of the wall were evident. Both the metallic structure and the polymeric coating of the stents were intact. A layer of organic material with a maximum thickness of approximately 3 {mu}m was evident on the inner surface of the stents. Conclusion: The present in vivo study demonstrates the biocompatibility, efficacy, and stability of PCU-coated Gianturco-Rosch stents in the biliary environment.

Severini, Aldo [Divisione di Radiologia Gastroenterologica, Istituto Nazionale Tumori, Via Venezian 1, I-20133 Milan (Italy); Mantero, Sara [Dipartimento di Bioingegneria, Politecnico di Milano, Piazza Leonardo da Vinci 32, I-20133 Milan (Italy); Tanzi, Maria Cristina; Cigada, Alberto [Dipartimento di Fisica Chimica Applicata, Politecnico di Milano, Piazza Leonardo da Vinci 32, I-20133 Milan (Italy); Addis, Flaminio [Clinica Chirurgica Veterinaria, Universita di Milano, Via Ponzio 7, I-20133 Milan (Italy); Cozzi, Guido; Salvetti, Monica [Divisione di Radiologia Gastroenterologica, Istituto Nazionale Tumori, Via Venezian 1, I-20133 Milan (Italy); Andreola, Salvatore [Divisione di Anatomia Patologica, Istituto Nazionale Tumori, Via Venezian 1, I-20133 Milan (Italy); Motta, Antonella [Stazione Sperimentale per la Seta, Via G. Colombo 81, I-20133 Milan (Italy); Regalia, Enrico; Pulvirenti, Andrea [Divisione di Chirurgia dell'Apparato Digerente, Istituto Nazionale Tumori, Via Venezian 1, I-20133 Milan (Italy); De Pedri, Enrico [Divisione di Radiologia Gastroenterologica, Istituto Nazionale Tumori, Via Venezian 1, I-20133 Milan (Italy); Doci, Roberto [Divisione di Chirurgia dell'Apparato Digerente, Istituto Nazionale Tumori, Via Venezian 1, I-20133 Milan (Italy)

1999-11-15

187

Development of the islets, exocrine pancreas, and related ducts in the Nile tilapia, Oreochromis niloticus (Pisces: Cichlidae).  

PubMed

Pancreatic development and the relationship of the islets with the pancreatic, hepatic, and bile ducts were studied in the Nile tilapia, Oreochromis niloticus, from hatching to the onset of maturity at 7 months. The number of islets formed during development was counted, using either serial sections or dithizone staining of isolated islets. There was a general increase in islet number with both age and size. Tilapia housed in individual tanks grew more quickly and had more islets than siblings of the same age left in crowded conditions. The pancreas is a compact organ in early development, and at 1 day posthatch (dph) a single principal islet, positive for all hormones tested (insulin, SST-14, SST-28, glucagon, and PYY), is partially surrounded by exocrine pancreas. However, the exocrine pancreas becomes more disseminated in older fish, following blood vessels along the mesenteries and entering the liver to form a hepatopancreas. The epithelium of the pancreatic duct system from the intercalated ducts to the main duct entering the duodenum was positive for glucagon and SST-14 in 8 and 16 dph tilapia. Individual insulin-immunopositive cells were found in one specimen. At this early stage in development, therefore, the pancreatic duct epithelial cells appear to be pluripotent and may give rise to the small islets found near the pancreatic ducts in 16-37 dph tilapia. Glucagon, SST-14, and some PPY-positive enteroendocrine cells were present in the intestine of the 8 dph larva and in the first part of the intestine of the 16 dph juvenile. Glucagon and SST-14-positive inclusions were found in the apical cytoplasm of the mid-gut epithelium of the 16 dph tilapia. These hormones may have been absorbed from the gut lumen, since they are produced in both the pancreatic ducts and the enteroendocrine cells. At least three hepatic ducts join the cystic duct to form the bile duct, which runs alongside the pancreatic duct to the duodenum. PMID:15281064

Morrison, Carol M; Pohajdak, Bill; Tam, Janet; Wright, James R

2004-09-01

188

New bifurcation stenting technique: shunt stenting.  

PubMed

The optimal treatment of bifurcation lesions remains controversial. We describe a new technique we term shunt stenting. This technique incorporates both the new technology of drug-eluting stents and a novel procedure for optimizing the ostial side branch stent positioning. To date, early angiographic and clinical follow-up have been encouraging. PMID:15558760

Prasan, Ananth M; Pitney, Mark R; Ramsay, David; Jepson, Nigel S; Friedman, Daniel; Taylor, David; Giles, Robert W

2004-12-01

189

Enteral Exclusion Increases Map Kinase Activation and Cytokine Production in a Model of Gallstone Pancreatitis  

Microsoft Academic Search

Background: We have previously demonstrated that enteral exclusion augments pancreatic p38 mitogen-activated protein (MAP) kinase activation and tumor necrosis factor-? (TNF-?) production after bile-pancreatic duct ligation in rats. Methods: In the present study, we evaluated c-Jun NH2-terminal kinase (JNK) and extracellular signal-regulated kinase (ERK) activation, and cytokine production, in pancreata of duct-ligated rats with and without duodenal bile-pancreatic juice replacement

Isaac Samuel; Linda Tephly; Deborah E. Williard; A. Brent Carter

2008-01-01

190

Treating bilio-duodenal obstruction: Combining new endoscopic technique with 6 Fr stent introducer  

PubMed Central

Periampullary cancer may cause not only biliary but also duodenal obstructions. In patients with concomitant duodenal obstructions, endoscopic biliary stenting remains technically difficult and may often require percutaneous transhepatic biliary drainage. We describe a method of metal stent placement via a thin forward-viewing endoscope in patients with simultaneous biliary and duodenal obstruction. In two consecutive patients with biliary and duodenal obstruction due to pancreatic cancer, a new biliary metal stent mounted in a slim delivery catheter was placed via a thin forward viewing endoscope after passage across the duodenal stenosis without balloon dilation. In both patients, with our new placement technique, metallic stents were successfully placed in a short time without adverse events. After biliary stenting, one patient received curative resection and the other received duodenal stenting for palliation. Metallic stent placement with a forward-viewing thin endoscope is a beneficial technique, which can avoid percutaneous drainage in patients with bilio-duodenal obstructions due to periampullary cancer.

Maetani, Iruru; Nambu, Tomoko; Omuta, Shigefumi; Ukita, Takeo; Shigoka, Hiroaki

2010-01-01

191

Stenting for in-stent restenosis.  

PubMed

Intravascular ultrasound studies have shown that additional stent implantation is the only percutaneous technique that allows for recovery of all the lumen area of the original implantation procedure. Despite this theoretical advantage, information on systematic additional stent implantation is still forthcoming, especially concerning the impact of new stent designs. This prospective study evaluated the efficacy of routine additional stent implantation for treatment of in-stent restenosis in 68 consecutive patients. Repeat stenting was successful in all cases, and second-generation tubular stents were used in 84% of patients. The mean additional stent length was 19.2 +/- 9.4 mm, and 15% of patients had multiple stent implantation. The postprocedure minimum lumen diameter was 3.11 +/- 0.41 mm, and the percentage residual stenosis was 2% +/- 7%. At a mean clinical follow-up of 10 +/- 8 months (follow-up rate 100%), the incidence of major adverse events was 21% (1 death, 13 target vessel revascularizations). Overall, angiographic restenosis rate was 32% (angiographic follow-up rate 79%). By multivariate analysis, the only predictors of recurrence after additional stenting were unstable angina at the second procedure (OR 8.70, 95% CI 1.50-50.33, P = 0.019), and early clinical recurrence after the first stent procedure (OR 4.83, 95% CI 1.13-20.71, P = 0.038). Additional stenting is a safe and effective treatment modality for the majority of patients with in-stent restenosis. Alternative treatments should be considered only for patients with in-stent restenosis presenting as unstable angina or early recurrence after a first stent procedure. PMID:10751759

Antoniucci, D; Valenti, R; Moschi, G; Trapani, M; Santoro, G M; Bolognese, L; Taddeucci, E; Dovellini, E

2000-04-01

192

Pancreatic Transection from Blunt Abdominal Trauma: Early versus Delayed Diagnosis and Surgical Management  

Microsoft Academic Search

Background and Aims: Pancreatic trauma is relatively uncommon, but carries high morbidity and mortality rates, especially when diagnosis is delayed or inappropriate surgery is attempted. Patient Material: The clinical course and surgical management of 14 patients with distal pancreatic transection or severe laceration with or without main pancreatic duct (MPD) injury caused by blunt abdominal trauma were analyzed in a

Attila Oláh; Ákos Issekutz; László Haulik; Roland Makay

2003-01-01

193

Alteration of membrane fusion as a cause of acute pancreatitis in the rat  

Microsoft Academic Search

Infusion of supramaximal doses of cerulein induces acute edematous pancreatitis in the rat. Cannulation of the main pancreatic duct does not prevent the formation of the edema but reveals an almost complete reduction of pancreatic flow. Using freeze-fracture techniques and thin-section electron microscopy, earliest structural alterations were observed at membranes of zymogen granules and the plasma membrane. Fusion of zymogen

Guido Adler; Gerhard Rohr; Horst F. Kern

1982-01-01

194

Repair of a Post-Hepatectomy Posterior Sectoral Duct Injury Secondary to Anomalous Bile Duct Anatomy Using a Novel Combined Surgical-Interventional Radiologic Approach  

PubMed Central

A 64-year-old woman with a completely transected posterior sectoral duct following extended hepatectomy underwent a combined operative procedure with interventional radiology and surgery to restore biliary-enteric drainage. The anterior and posterior sectoral ducts were identified, and catheters were inserted into both systems. The posterior sectoral catheter was placed intraoperatively through a preoperatively placed sheath, and a new tunnel was created through the regenerated liver surface. Biliary-enteric anastomoses were created over the stents.

Shanker, Beth-Ann; Eng, Oliver S.; Gendel, Vyacheslav; Nosher, John; Carpizo, Darren R.

2013-01-01

195

Autoimmune pancreatitis.  

PubMed

Autoimmune pancreatitis is becoming a more widely recognized form of pancreatitis that can mimic pancreatic or biliary malignancy. The combination of serological, histological and radiographic findings makes it unique among pancreatic diseases. The presence of autoantibodies, IgG4 and a lymphoplasmacytic infiltrate reflect its autoimmune etiology. The dramatic response to steroids is also a distinguishing feature and differentiates it from other pancreatic diseases. PMID:20477698

Barth, Erin; Savides, Thomas J

2009-11-01

196

[Prognostic factors in the treatment of the bile duct injuries and strictures].  

PubMed

To describe the prognostic factors after surgical reconstruction data. were collected prospectively on 60 patients treated at the Scientific Center of Surgery named after M.Topchubashov and N5 City Hospital with major bile duct injuries and postoperative bile duct strictures between 2000 and 2009. Of the 60 patients 21 had bile duct injuries, other 39 had postoperative strictures. In 15 of 53 patients with iatrogenic injury of bile ducts trauma was recognized and repaired intraoperatively. In 22 patients was early, in 16 patients delayed recognition of bile duct injury. Most of patients had undergone a choledocho (8) or hepaticojejunostomy (33) by Roux. External drainage of bile ducts was performed in 24 patients. Of the 60 patients undergoing surgical reconstruction, 47 hud completed treatment. Of patients who had completed treatment, 82,9% were considered to have a successful outcome (24 patients excellent, 15 patients - good results) without the need for follow-up invasive, diagnostic, or therapeutic interventional procedures. Patients with reconstruction after injury or stricture-without external drainage had a better overall outcome (92,9% successful outcome) than patients with drainage of bile ducts (68,4% successful outcome). Number of stents and length of postoperative stenting also were significant predictors of outcome. Type of operation (laparoscopic or open cholecystectomy) had nd significant influence on outcome. At the same time a successful outcome, without the need for biliary stents, was obtained in 87,5% of patients after laparoscopic cholecystectomy versus 71,8% after open cholecystectomy. PMID:21311472

Agaev, B A; Muslimov, G F; Alieva, G R; Ibragimov, T R

2010-01-01

197

Duct to islet-cell differentiation and islet growth in the pancreas of duct-ligated adult rats  

Microsoft Academic Search

Summary  We investigated the growth of islet beta and alpha cells in adult rats which had undergone partial pancreatic duct ligation. Whereas the non-ligated head portion of the pancreas remained unaffected in terms of histology and cell population dynamics, the ligated tail part of the pancreas showed pronounced changes in histology and cell growth. These changes included replacement of exocrine acini

R. N. Wang; G. Klöppel; L. Bouwens

1995-01-01

198

Pseudocyst of the head of the pancreas: relationship to the duct of Santorini.  

PubMed Central

A series of 14 patients with chronic alcoholic pancreatitis is presented which illustrates that cysts originating in the superior segment of the head of the pancreas communicate with the duct of Santorini which normally drains this area of the gland. Cysts in this location do not communicate with the major pancreatic duct (Wirsung) in most instances, and therefore may be overlooked in the standard retrograde drainage procedures employed to relieve pancreatic exocrine obstruction. Images Fig. 2. Fig. 3. Fig. 4. Fig. 5. Fig. 6. Fig. 7. Fig. 8. Fig. 9. Fig. 10. Fig. 11. Fig. 12.

Anderson, M C

1979-01-01

199

Biomedical engineering in design and application of nitinol stents with shape memory effect  

NASA Astrophysics Data System (ADS)

Our studies in the field of endosurgery in collaboration with the physicians of the National Research Center of Surgery of the Academy of Medical Sciences are carried out beginning in 1983. These studies laid the foundation for the new direction of X-ray surgery--X-ray Nitinol stenting of vessels and tubular structures. X-ray nitinol stents are unique self-fixing shells based on the shape memory effect and superelasticity of nickel-titanium alloys self- reconstructed under human body temperature. Applied for stenting of arteries in cases of stenosis etc., bile ducts in cases of benign and malignant stenoses, digestive tract in cases of oesophageal cancer and cervical canal uterus in cases of postsurgical atresiss and strictures of uterine. The purpose of stenting is restoration of the shape of artery or tubular structure by a cylinder frame formation. The especially elaborated original method of stenting allows to avoid the traditional surgical operation, i.e. the stenting is performed without blood, narcosis and surgical knife. The stent to be implanted is transported into the affected zone through the puncture under the X-ray control. Clinical applications of X-ray endovascular stenting has been started in March 1984. During this period nearly 400 operations on stenting have been performed on femoral, iliac, brachio-cephalic, subclavian arteries, bile ducts, tracheas, digestive tract and cervical canal uterus.

Ryklina, E. P.; Khmelevskaya, I. Y.; Morozova, Tamara V.; Prokoshkin, S. D.

1996-04-01

200

Use of diffusion-weighted MRI to differentiate chronic pancreatitis from pancreatic cancer.  

PubMed

OBJECTIVE. The purpose of this study was to compare diffusion-weighted MRI (DWI) and conventional (non-DWI) MRI sequences in differentiating mass-forming chronic pancreatitis from pancreatic cancer. MATERIALS AND METHODS. A retrospective cohort study included 36 patients who underwent pancreatic resection for pancreatic cancer (n = 13) and chronic pancreatitis (n = 23) after preoperative MRI with DWI. Two independent reviewers assessed the DW images for signal intensity and apparent diffusion coefficient (ADC) values. Four weeks later, they reviewed the other MR images for size of mass, double-duct sign, pancreatic duct cutoff, and perivascular soft-tissue cuffing. A score for conventional MRI was given with 1 meaning definitely benign and 5 meaning definitely malignant. Univariate and multivariate analyses and receiver operating characteristic (ROC) curve analysis were performed with surgical pathologic examination as the reference standard. RESULTS. The only finding that differentiated the two groups was the presence of a well-defined mass, favoring the diagnosis of cancer (p = 0.02, p < 0.01). There was no significant difference between the two groups in signal intensity on DW images (p = 0.82, p = 0.85) or ADC (p = 0.51, p = 0.76). Double-duct sign, pancreatic duct cutoff, and perivascular soft-tissue cuffing were not useful in differentiating the two groups. The areas under the ROC curve were 0.873 and 0.878 for the conventional MRI scores, compared with 0.602 and 0.552 for ADC measurements (p = 0.02, p = 0.008). CONCLUSION. The addition of DWI to conventional MRI does not facilitate differentiation of pancreatic cancer from chronic pancreatitis. PMID:24147470

Sandrasegaran, Kumaresan; Nutakki, Kavitha; Tahir, Bilal; Dhanabal, Aginiprakash; Tann, Mark; Cote, Gregory A

2013-11-01

201

Unilateral versus bilateral endoscopic biliary stenting for malignant hilar biliary strictures.  

PubMed

The present review compared unilateral versus bilateral stenting in order to determine the optimal stenting strategy for malignant hilar biliary strictures based on the previous literature. The role of preoperative biliary drainage prior to liver resection for hilar cholangiocarcinoma remains under discussion. However, in Japan, endoscopic placement of single nasobiliary drainage in the future remnant hepatic lobe is currently considered the most suitable method. In most unresectable cases, unilateral stenting appears to be adequate for ameliorating jaundice. It is technically easier and less expensive than bilateral stenting, with reintervention for stent dysfunction also being considerably easier. However, contrast medium injection into undrained bile ducts is associated with uncontrolled cholangitis and poor prognosis. To prevent this complication, bilateral stenting may be preferred to unilateral stenting. Additionally, previous studies have demonstrated bilateral stenting to be associated with longer stent patency as compared to unilateral stenting. We consider that further large-scale studies are required to clarify whether unilateral or bilateral stenting is a better therapeutic technique for malignant hilar biliary stricture. PMID:23617655

Yasuda, Ichiro; Mukai, Tsuyoshi; Moriwaki, Hisataka

2013-05-01

202

Trimming of a Migrated Biliary Nitinol Stent Using Argon Plasma  

PubMed Central

Metallic stent migration is a well-known complication which cannot always be managed by removal or repositioning, especially in case of uncovered stent. We report a patient who developed obstructive jaundice due to migration of an expandable metallic stent (EMS) inserted in the lower bile duct. Trimming of the EMS using argon plasma was performed, with the power setting of 60 W and 2.0 l/min of argon flow. The distal part of the EMS was removed and mechanical cleaning using balloon catheter was performed for remnant EMS. Without additional stent insertion, jaundice was relieved in a few days. No complication was recognized during the procedure and no recurrence of jaundice in the rest of his life.

Matsubayashi, Hiroyuki; Hasuike, Noriaki; Tanaka, Masaki; Takizawa, Kohei; Yamaguchi, Yuichiro; Ono, Hiroyuki

2009-01-01

203

Renal-hepatic-pancreatic dysplasia: an autosomal recessive malformation.  

PubMed Central

We report two brothers with a cystic malformation of the kidneys, liver, and pancreas. In both cases the malformation was fatal and the children died shortly after birth. The pathological findings, consisting of multicystic dysplastic kidneys, dilated and dysgenetic bile ducts, dilated pancreatic ducts, and polysplenia, correspond to those reported by Ivemark as renal-hepatic-pancreatic dysplasia. Many polymalformation syndromes include cystic affectation of these three organs, so this syndrome could be an isolated entity or a final common pathway of response of these organs to a variety of developmental disturbances, which could also include splenic abnormalities. We propose an autosomal recessive pattern of inheritance for renal-hepatic-pancreatic dysplasia. Images

Torra, R; Alos, L; Ramos, J; Estivill, X

1996-01-01

204

IgG4-positive plasma cell infiltration in the diagnosis of autoimmune pancreatitis  

Microsoft Academic Search

Autoimmune pancreatitis typically produces an enlarged pancreas with narrowing of the pancreatic duct, and can mimic carcinoma. Autoimmune pancreatitis usually responds to corticosteroid treatment, making it important to differentiate from pancreatic ductal adenocarcinoma. Affected patients often have an elevated serum IgG4. It has been proposed that increased numbers of IgG4-positive plasma cells in tissue might be a marker for the

Lizhi Zhang; Kenji Notohara; Michael J Levy; Suresh T Chari; Thomas C Smyrk

2007-01-01

205

Pancreatic carcinoma in fibrocalcific pancreatic diabetes: An eastern India perspective  

PubMed Central

Fibrocalcific pancreatic diabetes (FCPD) is a rare cause of diabetes (<1%) of uncertain etiology associated with >100-fold increased risk of pancreatic cancer. We present 3 patients of FCPD with pancreatic cancer who had long duration of diabetes (19 years, 25 years, and 28 years, respectively), all of whom presented with anorexia, weight loss, and worsened glycemic control. Patient-1 in addition presented with deep venous thrombosis. All the 3 patients had evidence of metastasis at the time of diagnosis. Computerized tomography (CT) abdomen revealed atrophic pancreas, dilated pancreatic ducts, and multiple calculi in the head, body, and tail of pancreas in all of them. Patient-1 had 38 mm × 38 mm × 32 mm mass in the tail of pancreas with multiple target lesions were seen in the right lobe of liver. Patient-2 had a mass in the tail of pancreas (46 × 34 × 31 mm) encasing the celiac plexus and superior mesenteric artery infiltrating the splenic hilum and splenic flexure of colon. Patient-3 also had a mass in the tail of pancreas (33 × 31 × 22 mm), with multiple target lesions in the liver, suggestive of metastasis. All patients had elevated serum CA19-9 (828.8, 179.65, and 232 U/L, respectively; normal <40 U/L). Patients of FCPD with anorexia, weight loss, worsening of glycemic control should be evaluated to rule out pancreatic cancer. Studies are warranted to evaluate CA19-9 as a screening tool for diagnosing pancreatic cancer at an earlier stage in FCPD.

Chakraborty, Partha Pratim; Dutta, Deep; Biswas, Kaushik; Sanyal, Triranjan; Ghosh, Sujoy; Mukhopadhyay, Satinath; Chowdhury, Subhankar

2012-01-01

206

Autoimmune pancreatitis: a guide for the histopathologist.  

PubMed

Autoimmune pancreatitis (AIP) is a distinct form of pancreatitis with a characteristic histological appearance. Clinically and radiologically, many of these patients show enlargement of pancreas and pancreatic duct/bile duct strictures, thus mimicking pancreatic carcinoma. There are 2 forms of the disease: (1) type 1 AIP characterized by storiform type fibrosis, obliterative phlebitis, and elevated numbers of immunoglobulin G4 (IgG4) positive plasma cells, typically >50 per high-power field, and, (2) type 2 AIP characterized by granulocytic epithelial lesions and only occasional IgG4-bearing plasma cells, typically <10 per high-power field. The type 1 variant of AIP is the pancreatic manifestation of IgG4-related disease, thus both pancreatic and extrapancreatic recurrences are common. The type 2 variant is unrelated to IgG4-related disease, and disease recurrence is uncommon. Both forms of the disease show a swift response to immunosuppressive therapy. This review highlights the clinical and pathological differences between the 2 forms of AIP. We also review guidelines that assist in distinguishing AIP from its closest mimic, pancreatic adenocarcinoma. PMID:23068298

Shinagare, Shweta; Shinagare, Atul B; Deshpande, Vikram

2012-11-01

207

Pancreatic Carcinogenesis  

Microsoft Academic Search

Pancreatic cancer is an almost universally lethal disease. Research over the last two decades has shown that pancreatic cancer is fundamentally a genetic disease, caused by inherited germline and acquired somatic mutations in cancer-associated genes. Multiple alterations in genes that are important in pancreatic cancer progression have been identified, including tumor suppressor genes, oncogenes, and genome maintenance genes. Furthermore, the

Jan-Bart M. Koorstra; Steven R. Hustinx; G. Johan A. Offerhaus; Anirban Maitra

2008-01-01

208

Pancreatic complications following orthotopic liver transplantation  

PubMed Central

During fiscal year 1986, 40 out of 196 patients (21%) developed hyperamylasemia following orthotopic liver transplantation. The placement of a retropancreatic aortohepatic arterial interposition graft was associated with hyperamylasemia (p < 0.025). Eight patients (20%) developed clinically significant acute pancreatitis and its sequelae; abscesses and pseudocysts each in 2. Pancreatitis was attributable to the retropancreatic arterial graft in 4, viral infection in 2 and obstruction of the pancreatic duct in 1 patient. All 4 patients with arterial graft-related pancreatitis exhibited poor graft function immediately postoperatively, of whom 2 required retransplantation – both of which failed to function. Five patients died (63%); 2 from primary graft non-function, 2 due to sepsis and 1 from systemic cytomegalovirus infection. We conclude that acute pancreatitis after liver transplantation is a life-threatening complication which is often associated with graft non-function.

Yanaga, Katsuhiko; Shimada, Mitsuo; Gordon, Robert D.; Tzakis, Andreas G.; Makowka, Leonard; Marsh, J. Wallis; Stieber, Andrei C.; Todo, Satoru; Iwatsuki, Shunzaburo; Starzl, Thomas E.

2010-01-01

209

Safety and Efficacy of Argon Plasma Coagulation Trimming of Malpositioned and Migrated Biliary Metal Stents: A Controlled Study in the Porcine Model  

Microsoft Academic Search

BACKGROUND:Argon plasma coagulation (APC) has been used to trim uncovered Elgiloy® stents, but the extent of thermal damage and bile duct injury is not known. The goal of this study was to evaluate the safety and efficacy of APC for this application.METHODS:Eight Elgiloy® (covered and uncovered) and four nitinol stents were deployed in the bile duct at ERCP in 12

Yang K. Chen; Vaman Jakribettuu; Erik W. Springer; Raj J. Shah; Jeanine Penberthy; S. Russell Nash

2006-01-01

210

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

PubMed

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

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

211

Low loss duct burner  

Microsoft Academic Search

A jet propulsion engine with a fan bypass duct includes a duct burner with a plurality of flame stabilizers therein each mounted to inner case and outer case members through spherical bearings. Each of the stabilizers consists of two blade members having integral arms thereon actuated by fore and aft motion of an external actuating ring to assume an expanded

H. M. Mar; S. B. Reider

1985-01-01

212

Low loss duct burner  

SciTech Connect

A jet propulsion engine with a fan bypass duct includes a duct burner with a plurality of flame stabilizers therein each mounted to inner case and outer case members through spherical bearings. Each of the stabilizers consists of two blade members having integral arms thereon actuated by fore and aft motion of an external actuating ring to assume an expanded position to increase duct turbulence for mixing air flow therethrough with a fuel supply and into a retracted position against each other to reduce pressure drop under nonafterburning operation. Each of the flame stabilizer blades has a platform that controls communication between a hot air source and a duct for improving fuel vaporization during afterburner operation thereby to increase afterburning limits; the platforms close communication between the hot air source and the duct during nonafterburning operation when flame stabilization is not required.

Mar, H. M.; Reider, S. B.

1985-07-09

213

Current Status of Photodynamic Therapy for Bile Duct Cancer  

PubMed Central

The most common form in bile duct cancers is a highly desmoplastic cancer with a growth pattern characterized by periductal extension and infiltration. The prognosis of bile duct cancers, especially hilar cholangiocarcinoma, is limited by tumor spread along the biliary tree leading to refractory obstructive cholestasis, cholangitis, and liver failure. Although biliary endoprosthesis improves occlusion rates and reduces the number of therapeutic interventions, median survival time is not ameliorated. Photodynamic therapy (PDT) is a local photochemical tumor treatment that consists of a photosensitizing agent in combination with laser irradiation of a distinct wavelength. Tumor ablation with PDT combined with biliary stenting reduces cholestasis and significantly improves median survival time in selected patients with bile duct cancers.

Lee, Tae Yoon; Shim, Chan Sup

2013-01-01

214

Endoscopic ultrasonography for evaluating patients with recurrent pancreatitis.  

PubMed

Acute recurrent pancreatitis (ARP) is still a complex diagnostic and therapeutic challenge in clinical practice. In up to 30% of cases of ARP, it is not possible to establish the etiology of the disease. In the other 70%, many factors play an etiological role in ARP: microlithiasis, sphincter of Oddi dysfunction (SOD), pancreas divisum, hereditary pancreatitis, cystic fibrosis, a choledochocele, annular pancreas, an anomalous pancreatobiliary junction, pancreatic tumors or chronic pancreatitis are diagnosed. EUS should be useful in ARP as it is sensitive for diagnosing bile duct stones, gallbladder sludge, pancreatic lesions, ductal abnormalities and chronic pancreatitis. Endoscopic ultrasound (EUS) appears to be diagnostic in the majority of patients with previously unexplained pancreatitis, and offers an alternative to endoscopic retrograde cholangiopancreatography (ERCP) as the initial diagnostic test in patients with ARP. PMID:18286681

Petrone, Maria Chiara; Arcidiacono, Paolo G; Testoni, Pier Alberto

2008-02-21

215

A minimally invasive approach to bile duct injury after blunt liver trauma in pediatric patients  

Microsoft Academic Search

A 12-year-old boy presented with a large liver laceration after blunt abdominal trauma. He was treated nonoperatively and subsequently had bile peritonitis from a bile leak. Endoscopic retrograde cholangiopancreatography (ERCP) visualized the bile duct injury and allowed decompression of the biliary tree with an endoscopically placed biliary stent. A drain also was placed over the laceration through a small subcostal

Neal G. Church; Gary May; David L. Sigalet

2002-01-01

216

Endoscopic ultrasound for the diagnosis of chronic pancreatitis  

PubMed Central

Endoscopic ultrasound (EUS) has become a well accepted test for the diagnosis of chronic pancreatitis. Advantages include its ability to detect subtle and severe changes of the pancreatic duct and parenchyma, and its relative safety compared with endoscopic retrograde cholangiopancreatography. Limitations include inter- and intra-observer variability, operator dependence, and an incomplete understanding of its true accuracy. The Rosemont classification has recently been proposed as a weighted, standardized method that may improve EUS chronic pancreatitis scoring. This paper reviews the published evidence regarding the accuracy of EUS in chronic pancreatitis diagnosis, and enumerates the emerging technologies that have been recently studied which may ultimately improve endosonographic imaging of the pancreas.

Stevens, Tyler; Parsi, Mansour A

2010-01-01

217

Lanreotide autogel-induced acute pancreatitis in a patient with acromegaly.  

PubMed

Somatostatin and somatostatin analogues are considered very useful for the treatment of hormone producing tumors and acute variceal bleeding. They have also been proposed for the treatment of acute pancreatitis and for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis although clinical trials have failed to show any efficacy. The authors report the case of a 45-year-old man, recently diagnosed of acromegaly, which developed an acute pancreatitis shortly after his first injection of lanreotide autogel. The patient developed a severe dilatation of his hypocontractile gallbladder with distension of the intra and extrahepatic biliary ducts, the choledochus and the main pancreatic duct, without lithiasis or other abnormalities at the papilla, which resolved spontaneously in a month. We consider that lanreotide most likely induced a functional spasm of the Sphincter of Oddi, with impairment of the biliary-pancreatic outflow, leading to an acute pancreatitis, and review the literature concerning this drug related pancreatitis. PMID:22749514

Sequeira Lopes da Silva, José Tiago; González Casas, Olga; Bejarano Moguel, Verónica; Lobo Pascua, Maria; López-Santamaría Redondo, Antonio; Cordero Torres, Remigio

2012-06-29

218

Prospective randomized trial comparing Tannenbaum Teflon and standard polyethylene stents in distal malignant biliary stenosis  

Microsoft Academic Search

Background:  Our aim was to compare the clinical efficacy of the Tannenbaum (TB) biliary prostheses, a recently designed Teflon stent without side holes, with the Cotton-Huibregtse (CH) polyethylene stent. Methods:  Fifty-seven patients (26 men, mean age 75.5 years) with unresectable malignant tumors and distal biliary stenosis were included (38 pancreatic head cancer, 17 cholangiocarcinoma, 2 ampullary cancer). Patients were prospectively

Vittorio Terruzzi; Umberto Comin; Federico De Grazia; Gian Luigi Toti; Alessandro Zambelli; Sandro Beretta; Giorgio Minoli

2000-01-01

219

Persistent mullerian duct syndrome  

PubMed Central

Persistent Mullerian duct syndrome (PMDS) is a rare form of internal male pseudohermaphroditism in which Mullerian duct derivatives are seen in a male patient. This syndrome is characterized by the persistence of Mullerian duct derivatives (i.e. uterus, cervix, fallopian tubes and upper two thirds of vagina) in a phenotypically and karyotypically male patient. In this article we present the USG and MRI features of a case of PMDS with bilateral cryptorchidism and left sided inguinal hernia, containing the uterus and fallopian tubes.

Renu, Divya; Rao, B Ganesh; Ranganath, K; Namitha

2010-01-01

220

Utility of Stent-Grafts in Treatment of Porto-Biliary Fistula  

SciTech Connect

A porto-biliary fistula causing hemobilia is a known complication of percutaneous transhepatic biliary drainage (PTBD). We present two patients with hemobilia secondary to porto-biliary fistula, treated successfully by percutaneous placement of stent-grafts. In one case, the stent-graft was placed in the bile duct, and in the other case, it was placed in the intrahepatic portal vein branch. Hemobilia stopped and there were no complications except a small area of hepatic infarction, distal to the stent-graft in the portal vein.

Peynircioglu, Bora; Cwikiel, Wojciech [University of Michigan Hospital, Department of Radiology (United States)], E-mail: cwikiel@med.umich.edu

2006-12-15

221

Pancreatic and biliary secretion are both altered in cystic fibrosis pigs.  

PubMed

The pancreas, liver, and gallbladder are commonly involved in cystic fibrosis (CF), and acidic, dehydrated, and protein-rich secretions are characteristic findings. Pancreatic function studies in humans have been done by sampling the jejunal fluid. However, it has been difficult to separately study the function of pancreatic and biliary systems in humans with CF, because jejunal fluid contains a mixture of bile and pancreatic fluids. In contrast, pancreatic and biliary ducts open separately into the porcine intestine; therefore, biliary and pancreatic fluid can be individually analyzed in CF pigs. We studied newborn wild-type (WT) and CF pigs and found that CFTR was localized to the pancreatic ducts. We collected bile and pancreatic fluid and analyzed pancreatic enzymes with activity assays and immunoblot. Pancreatic enzyme expression was significantly decreased in CF compared with WT pigs. The volume and pH of pancreatic fluid were significantly lower and protein concentration was >5-fold higher in CF pigs. Secretin stimulation increased pancreatic fluid volume and pH in WT, but not CF, pigs. Baseline bile volume did not differ between WT and CF pigs, but volume did not increase in response to secretin in CF pigs. Bile pH was lower and protein concentration was twofold higher in CF pigs. These results indicate that pancreatic and biliary secretions are altered in CF pigs. Abnormal pancreatic and biliary secretion in CF may have important implications in disease pathogenesis. PMID:22936270

Uc, Aliye; Giriyappa, Radhamma; Meyerholz, David K; Griffin, Michelle; Ostedgaard, Lynda S; Tang, Xiao Xiao; Abu-El-Haija, Marwa; Stoltz, David A; Ludwig, Paula; Pezzulo, Alejandro; Abu-El-Haija, Maisam; Taft, Peter; Welsh, Michael J

2012-08-30

222

Pancreatic and biliary secretion are both altered in cystic fibrosis pigs  

PubMed Central

The pancreas, liver, and gallbladder are commonly involved in cystic fibrosis (CF), and acidic, dehydrated, and protein-rich secretions are characteristic findings. Pancreatic function studies in humans have been done by sampling the jejunal fluid. However, it has been difficult to separately study the function of pancreatic and biliary systems in humans with CF, because jejunal fluid contains a mixture of bile and pancreatic fluids. In contrast, pancreatic and biliary ducts open separately into the porcine intestine; therefore, biliary and pancreatic fluid can be individually analyzed in CF pigs. We studied newborn wild-type (WT) and CF pigs and found that CFTR was localized to the pancreatic ducts. We collected bile and pancreatic fluid and analyzed pancreatic enzymes with activity assays and immunoblot. Pancreatic enzyme expression was significantly decreased in CF compared with WT pigs. The volume and pH of pancreatic fluid were significantly lower and protein concentration was >5-fold higher in CF pigs. Secretin stimulation increased pancreatic fluid volume and pH in WT, but not CF, pigs. Baseline bile volume did not differ between WT and CF pigs, but volume did not increase in response to secretin in CF pigs. Bile pH was lower and protein concentration was twofold higher in CF pigs. These results indicate that pancreatic and biliary secretions are altered in CF pigs. Abnormal pancreatic and biliary secretion in CF may have important implications in disease pathogenesis.

Giriyappa, Radhamma; Meyerholz, David K.; Griffin, Michelle; Ostedgaard, Lynda S.; Tang, Xiao Xiao; Abu-El-Haija, Marwa; Stoltz, David A.; Ludwig, Paula; Pezzulo, Alejandro; Abu-El-Haija, Maisam; Taft, Peter; Welsh, Michael J.

2012-01-01

223

Pancreatic panniculitis.  

PubMed

Pancreatic panniculitis (PP) is a rare variant of panniculitis characterized by subcutaneous fat necrosis, that affects 0.3-3% of patients across a range of different pancreatic disorders. It presents with painful, tender, erythematous to violaceous nodules that may undergo spontaneous ulceration and discharge of an oily brown, viscous material, resulting from liquefactive necrosis of adipocytes. These lesions usually involve the lower extremities, although may also spread over the buttocks, trunk, arms and scalp. In addition to the skin, fat necrosis may involve periarticular, abdominal and intramedullary adipose tissue. In 40% of cases, skin manifestations can precede by 1 to 7 months the abdominal symptoms of pancreatic disease, which include mostly acute and chronic pancreatitis, pancreatic carcinoma, more frequently of acinar cell type, and pancreatic abnormalities. Histopathologically, PP shows characteristic features of mostly lobular panniculitis with marked necrosis of adipocytes. The necrotic adipocytes with finely granular and basophilic material in the cytoplasm due to calcium deposits are known as "ghost adipocytes". The treatment of pancreatic panniculitis is directed to the underlying pancreatic disease. The prognosis is poor in cases associated with pancreatic carcinoma. When there is widespread and persistent disease, frequent relapses, or ulceration, the possibility of an occult carcinoma of the pancreas should be always considered. While describing three patients seen at the Dermatology Section of the University of Genova from 1990 to 2012, we highlight that, in addition to the rarity of the disease, the precise diagnosis requires adequate samples consisting in large-scalpel incisional biopsies of fully developed lesions. PMID:23900163

Rongioletti, F; Caputo, V

2013-08-01

224

Total invasion of the pancreatic gland by a rare aggressive IPMN: Report of a case?  

PubMed Central

INTRODUCTION The intraductal papillary mucinous neoplasms (IPMNs) are increasingly diagnosed entities with high potential of malignancy and significant recurrence rates. PRESENTATION OF CASE In this case report a rare mixed IPMN with full invasion of the pancreatic ducts was identified. DISCUSSION Difficulties in determining the grade of pancreatic duct involvement make the surgical management tough. CONCLUSION In multifocal IPMNs the management of the patients is even more challenging. In this case the patient was treated successfully with total pancreatectomy.

Makris, Marinos C.; Koumarelas, Konstantinos C.; Mitrousias, Apostolos S.; Karamveri, Christina N.; Yettimis, Evripidis P.; Zevlas, Adreas N.

2013-01-01

225

Update on ureteral stent technology  

PubMed Central

Ureteral stents are commonly used in urology but are frequently associated with patient discomfort, stent encrustation and stent-related infection. New biomaterials, coatings and designs have been designed to attempt to reduce these problems. This article reviews coatings to reduce bacterial adhesion and encrustation. In addition, metal ureteral stents, the triclosan and ketorolac drug eluting ureteral stents, and biodegradable ureteral stents are discussed. In summary there is no perfect ureteral stent that avoids all morbidity but there have been significant advances in the last few years in stent technology.

Lange, Dirk; Chew, Ben H.

2009-01-01

226

Emodin promoted pancreatic claudin-5 and occludin expression in experimental acute pancreatitis rats  

PubMed Central

AIM: To investigate the effect of emodin on pancreatic claudin-5 and occludin expression, and pancreatic paracellular permeability in acute pancreatitis (AP). METHODS: Experimental pancreatitis was induced by retrograde injection of 5% sodium taurocholate into the biliopancreatic duct. Emodin was injected via the external jugular vein 0 or 6 h after induction of AP. Rats from sham operation and AP groups were injected with normal saline at the same time. Samples of pancreas were obtained 6 or 12 h after drug administration. Pancreatic morphology was examined with hematoxylin and eosin staining. Pancreatic edema was estimated by measuring tissue water content. Tumor necrosis factor (TNF)-? and interleukin (IL)-6 level were measured by enzyme-linked immunosorbent assay. Pancreatic paracellular permeability was assessed by tissue dye extravasation. Expression of pancreatic claudin-5 and occludin was examined by immunohistology, quantitative real-time reverse transcriptase polymerase chain reaction and western blotting. RESULTS: Pancreatic TNF-? and IL-6 levels, wet/dry ratio, dye extravasation, and histological score were significantly elevated at 3, 6 and 12 h following sodium taurocholate infusion; treatment with emodin prevented these changes at all time points. Immunostaining of claudin-5 and occludin was detected in rat pancreas, which was distributed in pancreatic acinar cells, ductal cells and vascular endothelial cells, respectively. Sodium taurocholate infusion significantly decreased pancreatic claudin-5 and occludin mRNA and protein levels at 3, 6 and 12 h, and that could be promoted by intravenous administration of emodin at all time points. CONCLUSION: These results demonstrate that emodin could promote pancreatic claudin-5 and occludin expression, and reduce pancreatic paracellular permeability.

Xia, Xian-Ming; Li, Bang-Ku; Xing, Shi-Mei; Ruan, Hai-Ling

2012-01-01

227

Expandable Metal Stents for the Palliation of Malignant Gastroduodenal Obstruction  

SciTech Connect

Purpose: Gastric outlet obstruction is a debilitating complication of upper gastrointestinal malignancy. We present our experience with insertion of self-expanding metal stents (SEMS).Methods: Twenty-eight patients were referred, stenting being attempted in 23. Two patients had esophageal Wallstents inserted through a gastrostomy; 21 had an endoscopic approach with enteral Wallstents.Results: One stent insertion failed, ten patients (45%) returned to a normal diet, ten patients (45%) managed semi-solid food and two patients (9%) had no significant improvement. No immediate complications were seen. One patient subsequently developed pancreatitis. Reintervention (4 stents, 1 jejunostomy, 1 gastro jejunostomy) was required in six of 22 patients (27%) for inadequate stent expansion (1), second stricture (2), stent migration (1), and tumor ingrowth (2). The mean survival was 95.4 days (SD 78.8 days, range 3-230 days). The mean follow-up time was 98.9 days (SD 86.7 days, range 3-309 days).Conclusions: SEMS are effective in palliating malignant gastric outlet obstruction. A combined endoscopic/fluoroscopic approach allows the most complete assessment of the stricture and removes the need for gastrostomy insertion. Careful assessment of the gastrointestinal tract distal to the lesion is important.

Razzaq, Rubeena; Laasch, Hans-Ulrich; England, Ruth; Marriott, Angie; Martin, Derrick [Department of Radiology, South Manchester University Hospital NHS Trust, Nell Lane, Withington, Manchester M20 2LR (United Kingdom)

2001-09-15

228

Estrogen-Eluting Stents  

Microsoft Academic Search

Coronary stenting is routinely utilized to treat symptomatic obstructive coronary artery disease. However, the efficacy of\\u000a bare metal coronary stents has been historically limited by restenosis, which is primarily due to excessive neointima formation.\\u000a Drug-eluting stents (DES) are composed of a stainless steel backbone encompassed by a polymer in which a variety of drugs\\u000a that inhibit smooth muscle cell proliferation

Sung Kee Ryu; Ehtisham Mahmud; Sotirios Tsimikas

2009-01-01

229

Experience with common bile duct exploration at Lumbini Medical College.  

PubMed

Common bile duct stones represent a significant danger to patients, because they can lead to biliary colic, obstructive jaundice, cholangitis, or pancreatitis. Common bile duct stones either migrate from the gallbladder or form primarily within the bile ducts themselves. Primary stones are more common in South Asia and are usually sequelae of biliary infection and stasis. In the United States and other Western countries, common bile duct stones are predominantly secondary stones, having formed in the gallbladder. In patients who have gallstones, and in whom a cholecystectomy is considered, common bile duct stones can be found preoperatively, intraoperatively, or postoperatively. Ten percent to 15% of patients undergoing a cholecystectomy will be found to have choledocholithiasis at some point during their treatment. We present our case of 16 patients of common bile duct stones with or without cholelithiasis from April 2011 to March 2012. To review the treatment and outcome of patients with common bile duct (CBD) stones who underwent cholecystecomy with open common bile exploration (CBDE). We analysed the fact that cholecystectomy with commonbile duct exploration still holds as a good modality of treatment where ERCP (Endoscopic Retrograde cholangio pancreaticogram) is not available. All 16 persons in age group of 20-65 years, all females with body weight in the range of 45-60 kgs undergoing inpatient common bile duct exploration during April 2011- March 2012 were included. Common bile duct exploration was successful in all patients. Mean operating time was 120 +/- 40 minutes and length of hospital stay was 13 +/- 3days. 3 complications (18.75%) were recorded, 2 cases of retained stone (12.5%) who underwent choledochoduodenostomy. In 16 patients undergoing common bile duct exploration, CBD stones were discovered with flexible choledochoscope and intraoperative cholangiography. None of the Gallbladder specimen revealed any feature of malignancy in final histopatholgical report. All patients are doing fine till date. Open common bile duct exploration can still be a gold standard technique in set up where ERCP is not available. The results of common bile duct exploration are good with less complications in experienced hands. PMID:23671956

Pokharel, N; Sapkota, P; Kc, B; Rimal, S

2012-06-01

230

Symptomatic Wingspan stent stenosis and occlusion: stent-in-stent rescue  

Microsoft Academic Search

The use of the Wingspan stent in severe intracranial stenosis is associated with a relatively high in-stent re-stenosis rate. Reported management strategies for re-stenosis have included angioplasty alone or angioplasty with placement of a second Wingspan stent. A case is presented in which thrombosis within a Wingspan stent was treated with a balloon expandable cobalt-chromium stent within the Wingspan stent.

Tri M Le; John R Gaughen; Mary E Jensen; Avery J Evans

2010-01-01

231

Successful Treatment with a Covered Stent and 6-Year Follow-Up of Biliary Complication After Liver Transplantation  

SciTech Connect

The role of covered stent in the management of biliary complications is not yet defined in liver transplant recipients. This Case Report presents a patient with anastomotic stricture and leakage with biloma treated with a covered stent 32 months following liver transplantation. Signs of in-stent restenosis developed 52 months following covered stent placement, which was resolved by balloon dilation. There were no complications during the interventions. The latest follow-up, at 69 months following primary and 19 months following secondary percutaneous intervention, shows a patent covered stent without any clinical or morphological sign of further restenosis. The clinical success with long-term follow-up data suggests that covered stent implantation can be a rational, minimally invasive option for simultaneous treatment of bile duct stenosis and bile leak following liver transplantation in selected cases.

Doros, Attila, E-mail: dorattila@yahoo.com; Nemeth, Andrea; Deak, Akos Pal; Hartmann, Erika; Gerlei, Zsuzsa; Fazakas, Janos; Kobori, Laszlo [Semmelweis University, Department of Transplantation and Surgery (Hungary)

2010-04-15

232

Obesity, Pancreatitis, and Pancreatic Cancer  

Microsoft Academic Search

The only universally accepted risk factors for the development of pancreatic cancer are a positive family history or a history\\u000a of smoking. Although the contribution of pancreatitis to pancreatic carcinogenesis has been debated for decades in the epidemiology\\u000a literature, the actual mechanism is still unclear. With the rising epidemic of obesity, scientists have begun to focus on\\u000a the contribution of

Andrew A. Gumbs

2008-01-01

233

Materials for metallic stents.  

PubMed

Stents are expandable tubes of metallic mesh that were developed to address the negative sequelae of balloon angioplasty and are currently used in cardiovascular medicine. In this review, the use of particular metals to make stents is discussed from the viewpoint of materials engineering. The properties and characteristics of metals used for stents, such as stainless steels, nickel-titanium alloys, tantalum, cobalt-chromium alloys, and magnesium alloys, are explained. In addition, problems and disadvantages related to metallic stents and their possible solutions are given. PMID:19536623

Hanawa, Takao

2009-06-18

234

Implantation of migrated biliary stents in the digestive tract  

PubMed Central

Background Biliary stents constitute an alternative for the palliative treatment of benign or malignant biliary obstruction, biliary strictures, choledocholithiasis, biliary fistulas from lateral lesions of the biliary duct or cystic duct leaks due to slippage of clip closure. Obstruction resulting in cholangitis is common. Proximal migration to the biliary duct or distal migration to the duodenum with subsequent passage per rectum are relatively frequent, but impaction and perforation of the bowel are rare. Case outlines Two cases are reported. In one patient a migrated stent impacted in the caecal wall, and in the other the impaction produced a perforation of an adherent small bowel loop. Both patients were treated surgically and made an uneventful recovery. Discussion Biliary stents migrate in 8–10% of patients and are generally eliminated by natural means. Occasionally they impact and perforate the digestive tract, usually in the duodenum or other fixed areas or in bowel affected by adhesions due to a previous operation. Although endoscopy is the treatment of choice to retrieve them, operation should be performed whenever there is suspicion of perforation of the intestinal wall.

Cerisoli, C; Gimenez, M; Oria, M; Pardo, R; Pujato, M

2003-01-01

235

Mild acute pancreatitis with vildagliptin use.  

PubMed

Vildagliptin has not been associated with the development of acute pancreatitis in postmarketing reports except one case report from Sydney, Australia. We present the case report of 42 year old male, diabetic, with no historyof alcohol use, on vildagliptin 50 mg and metformin 500 mg daily since 6 months, who presented with severe abdominal pain radiating to back, nausea and fever. On evaluation, serum pancreatic enzymes were elevated, triglycerides were not raised and ultrasound showed swollen and echogenic pancreas, loss of peripancreatic fat plane and pancreatic duct was not dilated. Vildagliptin was stopped and the pancreatits resolved. On Follow up, no secondary cause was not identified. This appears to be the first reported case of acute pancreatitis from India probably attributable to use of vildagliptin, thus raising the possibility that this rare reaction may be a class effect of the DPP-4 inhibitors. PMID:23565473

Saraogi, Ravikant; Mallik, Ritwika; Ghosh, Sujoy

2012-12-01

236

Mild acute pancreatitis with vildagliptin use  

PubMed Central

Vildagliptin has not been associated with the development of acute pancreatitis in postmarketing reports except one case report from Sydney, Australia. We present the case report of 42 year old male, diabetic, with no historyof alcohol use, on vildagliptin 50 mg and metformin 500 mg daily since 6 months, who presented with severe abdominal pain radiating to back, nausea and fever. On evaluation, serum pancreatic enzymes were elevated, triglycerides were not raised and ultrasound showed swollen and echogenic pancreas, loss of peripancreatic fat plane and pancreatic duct was not dilated. Vildagliptin was stopped and the pancreatits resolved. On Follow up, no secondary cause was not identified. This appears to be the first reported case of acute pancreatitis from India probably attributable to use of vildagliptin, thus raising the possibility that this rare reaction may be a class effect of the DPP-4 inhibitors.

Saraogi, Ravikant; Mallik, Ritwika; Ghosh, Sujoy

2012-01-01

237

Acute Pancreatitis  

PubMed Central

For many decades two types of acute pancreatitis have been recognized: the edematous or interstitial and the hemorrhagic or necrotic. In most cases acute pancreatitis is associated with alcoholism or biliary tract disease. Elevated serum or urinary ?-amylase is the most important finding in diagnosis. The presence of methemalbumin in serum and in peritoneal or pleural fluid supports the diagnosis of the hemorrhagic form of the disease in patients with a history and enzyme studies suggestive of pancreatitis. There is no characteristic clinical picture in acute pancreatitis, and its complications are legion. Pancreatic pseudocyst is probably the most common and pancreatic abscess is the most serious complication. The pathogenetic principle is autodigestion, but the precise sequence of biochemical events is unclear, especially the mode of trypsinogen activation and the role of lysosomal hydrolases. A host of metabolic derangements have been identified in acute pancreatitis, involving lipid, glucose, calcium and magnesium metabolism and changes of the blood clotting mechanism, to name but a few. Medical treatment includes intestinal decompression, analgesics, correction of hypovolemia and other supportive and protective measures. Surgical exploration is advisable in selected cases, when the diagnosis is in doubt, and is considered imperative in the presence of certain complications, especially pancreatic abscess.

Geokas, Michael C.

1972-01-01

238

[Pancreatic ascites].  

PubMed

Two cases of pancreatic ascites have been presented. 1. A 29 year old man, heavy alcoholic, with fast growing ascites presented since long biochemic features of pancreatitis. The diagnosis of the pancreatic origin of ascites was made on the ground of the high level of amylase in the ascitic fluid. Conservative treatment was effectless. The patients refused surgical therapy. Then he died in septic shock. Autopsy confirmed the pancreatic origin of ascites. 2. A 43 year old man heavy alcoholic as well admitted because of fast growing ascites. As in the first case examination of the fluid confirmed the diagnosis of pancreatic origin of ascites. Again a high level of amylase and protein was found. After clinical treatment and parenteral nutrition the condition of the patient improved and he was dismissed 4 weeks later. PMID:7479248

Jasi?ski, A; Suchanek, W; Mitlener, S; Kryszewski, A

1995-03-01

239

Endovascular Exclusion of Visceral Artery Aneurysms with Stent-Grafts: Technique and Long-Term Follow-up  

SciTech Connect

This paper describes four cases of visceral artery aneurysms (VAAs) successfully treated with endovascular stent-grafts and discusses the endovascular approach to VAAs and the long-term results. Four balloon expandable stent-grafts were used to treat three splenic artery aneurysms and one bleeding common hepatic artery pseudoaneurysm. The percutaneous access site and the materials were chosen on the basis of CT angiography findings. In all cases the aneurysms were successfully excluded. In one case a splenic infarction occurred, with nonrelevant clinical findings. At 16- to 24-month follow-up three patients had patent stents and complete exclusion and shrinkage of the aneurysms. One patient died due to pancreatitis and sepsis, 16 days after successful stenting and exclusion of a bleeding pseudoaneurysm. We conclude that endovascular treatment using covered stent-grafts is a valid therapeutic option for VAAs. Multislice CT preoperative study helps in planning stent-graft positioning.

Rossi, Michele; Rebonato, Alberto, E-mail: albertorebonato@libero.it; Greco, Laura; Citone, Michele; David, Vincenzo [S. Andrea, University Hospital 'La Sapienza', Interventional Radiology Unit, Radiology Department (Italy)

2008-01-15

240

Zinc and Copper Concentrations in Serum, Blood and Liver in Moderate Experimental Pancreatic Insufficiency  

Microsoft Academic Search

Serum and liver concentrations of zinc and copper were studied in the rat after ligation of the pancreatic duct. Ligation of the bile duct was done close to the duodenum and high up in the hilum of the liver. The bile flow was by-passed into the intestine via a plastic catheter. The surgical method used was found suitable for a

M. Abdulla; B. Andersson; A. Evander; P. Lilja; I. Lundquist; S. Svensson; I. Ihse

1978-01-01

241

Bilio-pancreatic anomalies obscured with MRCP.  

PubMed

In this article the authors discuss whether or not diagnostic potential of MR cholangiopancreatography is strong enough to replace direct cholangiography in all cases. The pre-surgery analysis of a variety of pancreato-biliary disorders diagnosed using MRCP images is presented with the emphasising the importance of source images. Six cases of pancreato-biliary disorders are presented in which MRCP indicated the place of ductal stenosis as well as the morphologic variants or ductal uninspected shape which is critical for surgery or planned drainage. Coronal and axial MRCP source and MIP images were obtained with 0.5 T Gyroscan NT. Anomalies of the biliary or pancreatic ducts included two cases of choledochal cystic dilatation; two cases of aberrant biliary ducts, one case of gallbladder duct variant and a case of an additional pancreatic duct. In 3 out of 6 cases, the MRCP source images produced using the complementary method supplied more complete information concerning ductal junctions than the MIP images. Whereas in 3 out of 6 cases, both kinds of images were equally reliable. In 4 out of 6 cases, endoscopy was performed, and in 2 cases ERCP images were not diagnostic for ductal anatomy. However, full delineation of biliary and pancreatic ducts was complete in all MRCP images. MRCP within source images and maximum intensity projections show particular promise for the assessment of pancreato-biliary anomalies in order to reduce the number of higher-risk endoscopic interventions. The technique should be the method of choice in cases of suspected pancreato-biliary anomaly resulting from any imaging modality and is helpful for planning the optimal drainage method. In the long run this practice would reduce the number of ducts damaged during surgery. PMID:11905251

Bobek-Billewicz, Barbara; Gorycki, Tomasz; Studniarek, Micha?; Szurowska, Edyta

2002-01-01

242

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

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

EV Loftus; BA Olivares-Pakzad; KP Batts; MC Adkins; DH Stephens; MG Sarr; EP DiMagno

1996-01-01

243

Palliative Percutaneous Jejunal Stent for Patients with Short Bowel Syndrome  

PubMed Central

Gastrointestinal obstruction is a common preterminal event in patients with gastric and pancreatic cancer who often undergo palliative bypass surgery. Although endoscopic palliation with self-expandable metallic stents has emerged as a safe and effective alternative to surgery, experience with this technique remains limited. In particular, a proximal jejunal obstruction requires more technical expertise than a duodenal obstruction. Palliative treatment modalities include both surgical and nonsurgical approaches. In this report, we describe the successful placement of self-expandable metallic stents at the proximal jejunum using a combination of percutaneous endoscopic, intraoperative, and transstomal stenting. Usually endoscopy is not indicated in cases of proximal jejunal obstruction, but some cases may require palliative endoscopy instead of bypass operation.

Takayama, Satoru; Ochi, Yasuo; Yasuda, Akira; Sakamoto, Masaki; Takahashi, Hideki; Akamo, Yoshimi; Takeyama, Hiromitsu

2009-01-01

244

What is the role of endotherapy in chronic pancreatitis?  

PubMed Central

Chronic pancreatitis (CP) can have debilitating clinical course due to chronic abdominal pain, malnutrition and related complications. Medical, endoscopic and surgical treatment of CP should aim at control of symptoms, prevention of progression of the disease and correction of complications. Endoscopic management plays a specific role in carefully selected patients as primary interventional therapy when medical measures fail or in high-risk surgical candidates. Endotherapy for CP is utilized also as a bridge to surgery or to assess potential response to pancreatic surgery. In this review we address the role of endotherapy for the relief of obstruction of the pancreatic duct (PD) and bile duct, closure of PD leaks and drainage of pseudocysts in the setting of CP. In addition, endotherapy for relief of pancreatic pain by endoscopic ultrasound-guided celiac plexus block for CP is discussed.

Avula, Haritha; Sherman, Stuart

2010-01-01

245

CORNICE DUCT SYSTEM  

SciTech Connect

SYNERGETICS, INC., is in the process of designing, developing, and testing an air handling duct system that integrates the air duct with the cornice trim of interior spaces. The device has the advantage that the normal thermal losses from ducts into unconditioned attics and crawl spaces can be totally eliminated by bringing the ducts internal to the conditioned space. The following report details work conducted in the second budget period to develop the Cornice Duct System into a viable product for use in a variety of residential or small commercial building settings. A full-scale prototype has been fabricated and tested in a laboratory test building. Based on the results of that testing, the prototype design as been refined, fabricated, installed, and extensively tested in a residential laboratory house. The testing indicates that the device gives substantially superior performance to a standard air distribution system in terms of energy performance and thermal comfort. A patent has been submitted, refined based on feedback from the patent office, and resubmitted. Additional refinements to the design will lead to additional claims being added to the patent in the near future. Designs are being finalized for a refined version that will be fabricated and tested in the same residential laboratory house. Work is expected to be complete on this project in April of 2003.

Wayne Place; Chuck Ladd; TC Howard

2002-12-01

246

Pancreatic Mass Lesions Associated with Raised Concentration of IgG4  

Microsoft Academic Search

Autoimmune pancreatitis (AIP) is a recognized benign disease characterized by irregular narrowing of the pancreatic duct, swelling of parenchyma, lymphoplasmacytic infiltration and fibrosis, and a favorable response to corticosteroid treatment. In this condition, the whole pancreas is diffusely affected. Recently, however, a few cases with locally affected lesions were reported, with some of them showing features similar to cancer. We

Kenji Hirano; Yutaka Komatsu; Natsuyo Yamamoto; Yousuke Nakai; Naoki Sasahira; Nobuo Toda; Hiroyuki Isayama; Minoru Tada; Takao Kawabe; Masao Omata

2004-01-01

247

Role of differential neuroaxial blockade in the evaluation and management of pain in chronic pancreatitis  

Microsoft Academic Search

OBJECTIVES:Chronic pancreatic pain is difficult to treat. Surgical and medical therapies directed at reducing pain have met with little long-term success. In addition, there are no reliable predictors of response including pancreatic duct diameter. A differential neuroaxial blockade allows characterization of chronic abdominal pain into visceral and nonvisceral pain origins and may be useful as a guide to the treatment.

Darwin L. Conwell; John J. Vargo; Gregory Zuccaro; Teresa E. Dews; Nagy Mekhail; Judith Scheman; R. Matthew Walsh; Sharon F. Grundfest-Broniatowski; John A. Dumot; Steven S. Shay

2001-01-01

248

Collapse pressures of biodegradable stents  

Microsoft Academic Search

Biodegradable stent prototypes were produced from poly l-lactic acid polymers with different molecular weights. The effects of molecular weight, drug incorporation and stent design on the collapse pressure of the stents were evaluated. While molecular weights did not show a significant effect on the collapse pressure of the stents, drug incorporation at high percentage decreased the collapse pressure of the

Subbu Venkatraman; Tan Lay Poh; Tjong Vinalia; Koon Hou Mak; Freddy Boey

2003-01-01

249

Pancreatic pseudocyst causing extrahepatic biliary obstruction in a dog.  

PubMed

A 3-year-old Rhodesian Ridgeback was examined because of recurrent pancreatitis of 2 months duration. The dog had signs of abdominal pain and jaundice. Blood biochemical findings were consistent with extrahepatic bile duct obstruction, but on abdominal ultrasonography no cause of obstruction was identified. At surgery a pancreatic pseudocyst was found in the body of the pancreas. Cystoduodenostomy, cystic omentalization and biliary diversion resulted in excellent long-term recovery. PMID:10736669

Marchevsky, A M; Yovich, J C; Wyatt, K M

2000-02-01

250

Classification and management of bile duct injuries  

PubMed Central

To review the classification and general guidelines for treatment of bile duct injury patients and their long term results. In a 20-year period, 510 complex circumferential injuries have been referred to our team for repair at the Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán” hospital in Mexico City and 198 elsewhere (private practice). The records at the third level Academic University Hospital were analyzed and divided into three periods of time: GI-1990-99 (33 cases), GII- 2000-2004 (139 cases) and GIII- 2004-2008 (140 cases). All patients were treated with a Roux en Y hepatojejunostomy. A decrease in using transanastomotic stents was observed (78% vs 2%, P = 0.0001). Partial segment IV and V resection was more frequently carried out (45% vs 75%, P = 0.2) (to obtain a high bilioenteric anastomosis). Operative mortality (3% vs 0.7%, P = 0.09), postoperative cholangitis (54% vs 13%, P = 0.0001), anastomosis strictures (30% vs 5%, P = 0.0001), short and long term complications and need for reoperation (surgical or radiological) (45% vs 11%, P = 0.0001) were significantly less in the last period. The authors concluded that transition to a high volume center has improved long term results for bile duct injury repair. Even interested and tertiary care centers have a learning curve.

Mercado, Miguel Angel; Dominguez, Ismael

2011-01-01

251

Pancreatic carcinoma in fibrocalcific pancreatic diabetes: An eastern India perspective.  

PubMed

Fibrocalcific pancreatic diabetes (FCPD) is a rare cause of diabetes (<1%) of uncertain etiology associated with >100-fold increased risk of pancreatic cancer. We present 3 patients of FCPD with pancreatic cancer who had long duration of diabetes (19 years, 25 years, and 28 years, respectively), all of whom presented with anorexia, weight loss, and worsened glycemic control. Patient-1 in addition presented with deep venous thrombosis. All the 3 patients had evidence of metastasis at the time of diagnosis. Computerized tomography (CT) abdomen revealed atrophic pancreas, dilated pancreatic ducts, and multiple calculi in the head, body, and tail of pancreas in all of them. Patient-1 had 38 mm × 38 mm × 32 mm mass in the tail of pancreas with multiple target lesions were seen in the right lobe of liver. Patient-2 had a mass in the tail of pancreas (46 × 34 × 31 mm) encasing the celiac plexus and superior mesenteric artery infiltrating the splenic hilum and splenic flexure of colon. Patient-3 also had a mass in the tail of pancreas (33 × 31 × 22 mm), with multiple target lesions in the liver, suggestive of metastasis. All patients had elevated serum CA19-9 (828.8, 179.65, and 232 U/L, respectively; normal <40 U/L). Patients of FCPD with anorexia, weight loss, worsening of glycemic control should be evaluated to rule out pancreatic cancer. Studies are warranted to evaluate CA19-9 as a screening tool for diagnosing pancreatic cancer at an earlier stage in FCPD. PMID:23565475

Chakraborty, Partha Pratim; Dutta, Deep; Biswas, Kaushik; Sanyal, Triranjan; Ghosh, Sujoy; Mukhopadhyay, Satinath; Chowdhury, Subhankar

2012-12-01

252

[Stent for neurovascular diseases].  

PubMed

A stent is a medical device that can provide scaffolding to vessels and organ walls to keep the arteries open. Different types of stents have been used in the filed of neurovascular diseases, such as atherosclerosis and aneurysms. Carotid artery stenting (CAS) was approved in 2007 in Japan, and it has been widely used as an alternative to carotid endarterectomy (CEA) for treating severe carotid artery stenosis. According to current approval, the indications of carotid artery stenting are observed in high-surgical-risk patients, patients with more than 50% symptomatic stenosis, and those with more than 80% asymptomatic stenosis. The use of nickel-titanium (nitinol) crush-resistant self-expanding stents (Precise) and emblic-protection devices (Angioguard XP) has been approved. Intracranial atherosclerotic disease have frequently posed a risk for recurrent stroke despite the intensive medical treatment. The design of the Wingspan stent system is different from that of balloon-expandable stents. Target lesions are predilated with an undersized angioplasty balloon, followed by stent deployment. Another important indication is for intracranial aneurysms. Since the discovery Guglielmi dechatable coils (GDC) in the early 1990s, endovascular treatment has been drastically improved all over the world. However, a high recurrence rate is observed when large and wide-necked aneurysms are treated with detachble coils. The application of self-expanding stents such as Neuroform, Enterprize, or LEO, is effective for packing coils into the aneurysm, and flow modification effect can be achieved for the curative reconstruction of the parent arteries. Further reserch will confirm the application of stents for the treatment of cerebrovascular disease. PMID:19803401

Sakai, Nobuyuki; Sakai, Chiaki

2009-09-01

253

Oblique Bile Duct Predisposes to the Recurrence of Bile Duct Stones  

PubMed Central

Background and Study Aims Bile stones represent a highly prevalent condition and abnormalities of the biliary tree predispose to stone recurrence due to development of biliary stasis. In our study, we assessed the importance of an altered bile duct course for stone formation. Patients and Methods 1,307 patients with choledocholithiasis in the absence of any associated hepatobiliary disease who underwent endoscopic retrograde cholangiopancreatography (ERCP) between 2002 and 2009 were analysed. The angle enclosed between the horizontal portion of the common bile duct (CBD) and the horizontal plane was measured (angle ?). Oblique common bile duct (OCBD) was defined as a CBD with angle ?<45°. Results 103 patients (7.9%) were found to harbour OCBD and these were compared to 104 randomly selected control subjects. Compared to controls, OCBD patients were (i) significantly older (72±13 vs. 67±13, p<0.00001); (ii) more frequently underwent a cholecystectomy (p?=?0.02) and biliary surgery (p?=?0.003) prior to the diagnosis and (iii) more often developed chronic pancreatitis (p?=?0.04) as well as biliary fistulae (p?=?0.03). Prior to and after ERCP, OCBD subjects displayed significantly elevated cholestatic parameters and angle ? negatively correlated with common bile duct diameter (r?=?-0.29, p?=?0.003). OCBD subjects more often required multiple back-to-back ERCP sessions to remove bile stones (p?=?0.005) as well as more ERCPs later on due to recurrent stone formation (p<0.05). Conclusion OCBD defines a novel variant of the biliary tree, which is associated with chronic cholestasis, hampers an efficient stone removal and predisposes to recurrence of bile duct stones.

Strnad, Pavel; von Figura, Guido; Gruss, Regina; Jareis, Katja-Marlen; Stiehl, Adolf; Kulaksiz, Hasan

2013-01-01

254

Particle deposition in ventilation ducts  

SciTech Connect

Exposure to airborne particles is detrimental to human health and indoor exposures dominate total exposures for most people. The accidental or intentional release of aerosolized chemical and biological agents within or near a building can lead to exposures of building occupants to hazardous agents and costly building remediation. Particle deposition in heating, ventilation and air-conditioning (HVAC) systems may significantly influence exposures to particles indoors, diminish HVAC performance and lead to secondary pollutant release within buildings. This dissertation advances the understanding of particle behavior in HVAC systems and the fates of indoor particles by means of experiments and modeling. Laboratory experiments were conducted to quantify particle deposition rates in horizontal ventilation ducts using real HVAC materials. Particle deposition experiments were conducted in steel and internally insulated ducts at air speeds typically found in ventilation ducts, 2-9 m/s. Behaviors of monodisperse particles with diameters in the size range 1-16 {micro}m were investigated. Deposition rates were measured in straight ducts with a fully developed turbulent flow profile, straight ducts with a developing turbulent flow profile, in duct bends and at S-connector pieces located at duct junctions. In straight ducts with fully developed turbulence, experiments showed deposition rates to be highest at duct floors, intermediate at duct walls, and lowest at duct ceilings. Deposition rates to a given surface increased with an increase in particle size or air speed. Deposition was much higher in internally insulated ducts than in uninsulated steel ducts. In most cases, deposition in straight ducts with developing turbulence, in duct bends and at S-connectors at duct junctions was higher than in straight ducts with fully developed turbulence. Measured deposition rates were generally higher than predicted by published models. A model incorporating empirical equations based on the experimental measurements was applied to evaluate particle losses in supply and return duct runs. Model results suggest that duct losses are negligible for particle sizes less than 1 {micro}m and complete for particle sizes greater than 50 {micro}m. Deposition to insulated ducts, horizontal duct floors and bends are predicted to control losses in duct systems. When combined with models for HVAC filtration and deposition to indoor surfaces to predict the ultimate fates of particles within buildings, these results suggest that ventilation ducts play only a small role in determining indoor particle concentrations, especially when HVAC filtration is present. However, the measured and modeled particle deposition rates are expected to be important for ventilation system contamination.

Sippola, Mark R.

2002-09-01

255

Expression of ErbB receptors during pancreatic islet development and regrowth  

Microsoft Academic Search

We have characterized expression of the ErbB receptor family and one of its ligands, heregulin, in an effort to identify molecules associated with pancreatic development and regeneration. In addition to studying expression during fetal pancreatic development, we have also studied expression during pancreatic regeneration in the interferon-gamma (IFN)-transgenic mouse, which exhibits significant duct cell proliferation and new islet formation. These

M R Kritzik; T Krahl; A Good; C Lai; H Fox; N Sarvetnick

2000-01-01

256

Gene Expression Profiling of Microdissected Pancreatic Ductal Carcinomas Using High-Density DNA Microarrays  

Microsoft Academic Search

Pancreatic ductal adenocarcinoma (PDAC) remains an important cause of malignancy-related death and is the eighth most common cancer with the lowest overall 5-year relative survival rate. To identify new molecular markers and candidates for new therapeutic regimens, we investigated the gene expression profile of microdissected cells from 11 normal pancreatic ducts, 14 samples of PDAC, and 4 well-characterized pancreatic cancer

Robert Grützmann; Christian Pilarsky; Ole Ammerpohl; Jutta Lüttges; Armin Böhme; Bence Sipos; Melanie Foerder; Ingo Alldinger; Beatrix Jahnke; Hans Konrad Schackert; Holger Kalthoff; Bernd Kremer; Günter Klöppel; Hans Detlev Saeger

2004-01-01

257

Anomalous pancreaticobiliary union and chronic pancreatitis: rare presentation with biliary peritonitis.  

PubMed

Anomalous pancreaticobiliary union (APBU) has varied presentations. We report the case of a 12-year-old female who presented with biliary peritonitis due to a perforation of the common bile duct due to impaction of a pancreatic calculus at the duodenal papilla. She had a long common-biliary channel and pancreas divisum with chronic calcific pancreatitis involving the pancreatic head and neck. To our knowledge, this is the first such reported case in the literature. PMID:11666058

Shenoy, V G; Jawale, S A; Oak, S N; Kulkarni, B K

2001-09-01

258

Review of experimental animal models of acute pancreatitis  

PubMed Central

The underlying mechanisms involved in the pathogenesis of acute pancreatitis are ill understood. The mortality rate of this disease has not significantly improved over the past few decades. Current treatment options are limited, and predominantly aimed at supportive therapy. A key feature of severe acute pancreatitis is the presence of extensive tissue necrosis with both local and systemic manifestations of inflammatory response syndromes. A better understanding of the underlying pathophysiology of severe acute pancreatitis may lead to more targeted therapeutic options, potentially leading to improved survival. Animal models of acute pancreatitis are therefore an essential investigative tool for these aims to be achieved. This review discusses the suitability of recent non-invasive models of acute pancreatitis such as hormone-induced, alcohol-induced, immune-mediated, diet-induced, gene knockout and L-arginine; and invasive models including closed duodenal loop, antegrade pancreatic duct perfusion, biliopancreatic duct injection, combination of secretory hyperstimulation with minimal intraductal bile acid exposure, vascular-induced, ischaemia/reperfusion and duct ligation.

Hue Su, Kim; Cuthbertson, Christine

2006-01-01

259

Symptomatic Wingspan stent stenosis and occlusion: stent-in-stent rescue.  

PubMed

The use of the Wingspan stent in severe intracranial stenosis is associated with a relatively high in-stent re-stenosis rate. Reported management strategies for re-stenosis have included angioplasty alone or angioplasty with placement of a second Wingspan stent. A case is presented in which thrombosis within a Wingspan stent was treated with a balloon expandable cobalt-chromium stent within the Wingspan stent. Subsequent follow-up imaging has shown persistent patency of the treated vessel, with no subsequent in-stent stenosis. PMID:21990644

Le, Tri M; Gaughen, John R; Jensen, Mary E; Evans, Avery J

2010-06-04

260

Acute Pancreatitis after Percutaneous Mechanical Thrombectomy: Case Report and Review of the Literature  

SciTech Connect

Purpose: We describe a case of severe acute pancreatitis after percutaneous mechanical thrombectomy (PMT) and review the literature for the occurrence of this complication. Materials and Methods: A 53-year-old man with a history of bilateral external iliac artery stent placement sought care for acute onset of lifestyle-limiting left claudication. Angiography confirmed left external iliac stent occlusion, and PMT with the AngioJet Xpeedior catheter (Possis Medical, Minneapolis MN) was performed. Results: After PMT of the occluded external iliac artery, a residual in-stent stenosis required the placement of a second iliac stent. The procedure was complicated by severe acute pancreatitis. Other causes of pancreatitis were eliminated during the patient's hospital stay. A literature review revealed nine cases of acute pancreatitis after PMT. Conclusion: Although rare, pancreatitis can be a devastating complication of PMT. The development of pancreatitis seems to be related to the products of extensive hemolysis triggering an inflammatory process. To prevent this complication, we recommend that close attention be paid to the duration and extent of PMT, thereby avoiding extensive hemolysis and subsequent complications.

Hershberger, Richard C., E-mail: rihershberger@lumc.edu; Bornak, Arash; Aulivola, Bernadette; Mannava, Krishna [Loyola University Chicago Medical Center, Division of Vascular Surgery and Endovascular Therapy (United States)

2011-02-15

261

Common and unusual CT and MRI manifestations of pancreatic adenocarcinoma: a pictorial review  

PubMed Central

Pancreatic adenocarcinoma is the most common malignancy of the pancreas with high death rate. Preoperative imaging is crucial for the assessment of the disease and the planning of treatment. In this review, we discussed the common and unusual findings of pancreatic carcinoma. The common CT and MR findings include hypovascular mass, dilataion of upstream biliary and pancreatic ducts, invasion to adjacent structures and metastasis. The uncommon CT and MR findings include: a cystic mass, a mass without dilataion of upstream ducts, multiple masses or a lesion diffusively infiltrating most parts of the pancreas without distorting its configuration.

Yang, Min-Jie; Li, Su; Liu, Yong-Guang; Jiao, Na

2013-01-01

262

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

PubMed

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

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

2012-07-01

263

Drug-eluting stents.  

PubMed

Drug-eluting stents represent the third revolution in the field of Interventional Cardiology following balloon angioplasty (PTCA) and the implantation of metal stents. The main limitation of percutaneous coronary intervention (PCI) is restenosis. The introduction of drug eluting stents able to release antiproliferative compounds led to the evaluation of several antiproliferative drugs in order to reduce restenosis. Rapamycin (Sirolimus) has been demonstrated to inhibit smooth muscle cell (SMC) proliferation and migration in vitro and to reduce in vivo neointima formation with blockage of the cell cycle progression at the G1-S transition. In a pilot study, recently confirmed by a randomized trial, rapamycin drug-eluting stents have been reported to eliminate restenosis after stent implantation. Promising data also come from the use of paclitaxel drug-eluting stents. Paclitaxel (Taxol) is a microtubule-stabilizing agent with potent antiproliferative activity. Even if drug-eluting stents represent one of the most promising fields in Interventional Cardiology today before being sure of their real potential it is necessary to wait for results from several ongoing clinical studies, their usage in real-world lesions and extended follow-up to 5 years. PMID:12384624

Chieffo, A; Colombo, A

2002-10-01

264

Pancreatic Carcinogenesis  

PubMed Central

Pancreatic cancer is an almost universally lethal disease. Research over the last two decades has shown that pancreatic cancer is fundamentally a genetic disease, caused by inherited germline and acquired somatic mutations in cancer-associated genes. Multiple alterations in genes that are important in pancreatic cancer progression have been identified, including tumor suppressor genes, oncogenes, and genome maintenance genes. Furthermore, the identification of noninvasive precursor lesions of pancreatic adenocarcinoma has led to the formulation of a multi-step progression model of pancreatic cancer and the subsequent identification of early and late genetic alterations culminating in invasive cancer. In addition, an increased understanding of the molecular basis of the disease has facilitated the identification of new drug targets enabling rational drug design. The elucidation of genetic alterations in combination with the development of high-throughput sensitive techniques should lead to the discovery of effective biomarkers for early detection of this malignancy. This review focuses mainly on the current knowledge about the molecular insights of the pathogenesis of pancreatic ductal adenocarcinoma.

Koorstra, Jan-Bart M.; Hustinx, Steven R.; Offerhaus, G. Johan A.; Maitra, Anirban

2008-01-01

265

Liver Repopulation and Correction of Metabolic Liver Disease by Transplanted Adult Mouse Pancreatic Cells  

PubMed Central

The emergence of cells with hepatocellular properties in the adult pancreas has been described in several experimental models. To determine whether adult pancreas contains cells that can give rise to therapeutically useful and biochemically normal hepatocytes, we transplanted suspensions of wild-type mouse pancreatic cells into syngeneic recipients deficient in fumarylacetoacetate hydrolase and manifesting tyrosinemia. Four of 34 (12%) mutant mice analyzed were fully rescued by donor-derived cells and had normal liver function. Ten additional mice (29%) showed histological evidence of donor-derived hepatocytes in the liver. Previous work has suggested that pancreatic liver precursors reside within or close to pancreatic ducts. We therefore performed additional transplantations using either primary cell suspensions enriched for ducts or cultured ducts. Forty-four mutant mice were transplanted with cells enriched for pancreatic duct cells, but only three of the 34 (9%) recipients analyzed displayed donor-derived hepatocytes. In addition, 28 of the fumarylacetoacetate hydrolase-deficient mice were transplanted with cultured pancreatic duct cells, but no donor-derived hepatocytes were observed. Our results demonstrate for the first time that adult mouse pancreas contains hepatocyte progenitor cells capable of significant therapeutic liver reconstitution. However, contrary to previous reports, we were unable to detect these cells within the duct compartment.

Wang, Xin; Al-Dhalimy, Muhsen; Lagasse, Eric; Finegold, Milton; Grompe, Markus

2001-01-01

266

Blocked Tear Duct  

MedlinePLUS

... cancer treatment. If you've had radiation or chemotherapy to treat cancer, particularly if the radiation was focused on your face or head, you're at higher risk of developing a blocked tear duct. Complications Because your tears aren't draining the way ...

267

Drug-eluting stents  

PubMed Central

Coronary artery disease (CAD) is currently a leading cause of death worldwide. Drug-eluting stents (DESs) have been dominant for the treatment of CAD in the interventional cardiology world owing to their efficacy in significantly reducing restenosis. However, late stage stent thrombosis has become a major concern. Stent platform, drug delivery vehicle and type of drug are three parts of DES and each part affects the performance of the DES. Aiming to provide a clue for the design of future DES, this review focuses on the development of the three major components of DES and their roles in restenosis and thrombosis

Ma, Xiaodong; Wu, Tim; Robich, Michael P; Wang, Xingwei; Wu, Hao; Buchholz, Bryan; McCarthy, Stephen

2010-01-01

268

Coincidental Occurrence of Acute In-stent Thrombosis and Iatrogenic Vessel Perforation During a Wingspan Stent Placement: Management with a Stent In-stent Technique  

PubMed Central

We presented a case that an acute in-stent thrombosis after the deployment of a Wingspan stent was successfully managed with a stent in-stent technique. Because vessel perforation and subarachnoid hemorrhage were iatrogenically developed during the procedure, we were unable to use the thrombolytic agents to correct the in-stent thrombosis. When a thrombotic complication following an intracranial stent placement occurs with a coincidentally hemorrhagic complication, the stent in-stent technique should be considered as a treatment option.

Lee, Sun Joo; Shin, Hee Sup; Lee, Seung Hwan

2012-01-01

269

Cornice Duct System  

SciTech Connect

SYNERGETICS, INC., has designed, developed, and tested an air handling duct system that integrates the air duct with the cornice trim of interior spaces. The device has the advantage that the normal thermal losses from ducts into unconditioned attics and crawl spaces can be totally eliminated by bringing the ducts internal to the conditioned space. The following report details work conducted in the second budget period to develop the Cornice Duct System into a viable product for use in a variety of residential or small commercial building settings. A full-scale prototype has been fabricated and tested in a laboratory test building at the Daylighting Facility at North Carolina State University., Based on the results of that testing, the prototype design as been refined, fabricated, installed, and extensively tested in a residential laboratory house. The testing indicates that the device gives substantially superior performance to a standard air distribution system in terms of energy performance and thermal comfort. Patent Number US 6,511,373 B2 has been granted on the version of the device installed and tested in the laboratory house. (A copy of that patent is attached.) Refinements to the device have been carried through two additional design iterations, with a particular focus on reducing installation time and cost and refining the air control system. These new designs have been fabricated and tested and show substantial promise. Based on these design and testing iterations, a final design is proposed as part of this document. That final design is the basis for a continuation in part currently being filed with the U.5, Patent office.

Wayne Place; Chuck Ladd

2004-10-29

270

Short-term result of ductus arteriosus stent implantation compared with surgically created shunts.  

PubMed

This report aims to compare the researchers' early experience with the safety, efficacy, short-term outcomes, and complications of patent ductus arteriosus (PDA) stents in neonates having duct-dependent pulmonary circulation with those of surgically created shunts. Between April 2009 and April 2011, 18 infants with duct-dependent pulmonary circulation underwent cardiac catheterization for PDA stenting as the first palliative procedure in a referral center. For comparison, 20 infants who underwent surgical aortopulmonary shunt placement in another center were used. Follow-up assessment included clinical examination, echocardiography, oxygen saturation, and cardiac catheterization studies. Access and stenting for the PDA were successful in 15 patients (83.3 %). The mean procedure time was 58.43 ± 41.25 min, and the mean fluoroscopy time was 18.81 ± 5.64 min. Three patients (20 %) in the stented group and 6 patients (30 %) in the surgical group died (P = 0.09). After a 6-month follow-up period, none of the patients had significant stent stenosis requiring reintervention. The oxygen saturation increase did not differ significantly between the two groups either immediately after the procedure or 6 months later (P > 0.5). The left pulmonary artery diameter, McGoon ratio, and Nakata index did not differ significantly between the two groups (P > 0.05), but the right pulmonary diameter was larger in the stented group (5.01 ± 0.45 vs 4.1 ± 0.49 mm; P = 0.0001). Stenting for the PDA is an appropriate alternative to surgical shunt creation in many patients with duct-dependent circulation. In our sample, the two groups did not differ significantly in terms of outcome or mortality. PMID:22447384

Amoozgar, Hamid; Cheriki, Sirous; Borzoee, Mohammad; Ajami, Gholamhossein; Soltani, Manouchehr; Ahmadipour, Maryam; Peiravian, Farah; Amirghofran, Amirali

2012-03-25

271

Transpapillary iridium-192 wire in the treatment of malignant bile duct obstruction  

Microsoft Academic Search

Twenty four patients with malignant bile duct obstruction were treated with intraluminal radiotherapy using iridium-192 wire inserted through an endoscopically placed nasobiliary catheter. Biliary drainage after treatment was maintained by an endoprosthesis. The median dose of intraluminal radiotherapy was 6000 cGy; two patients with cholangiocarcinoma were given a second course because of disease extension; four patients with pancreatic carcinoma received

M D Levitt; B H Laurence; F Cameron; P F Klemp

1988-01-01

272

Everolimus-eluting coronary stents  

PubMed Central

Bare metal stents enabled a reduction in the risk of early procedural complications and restenosis in comparison with balloon angioplasty alone, but introduced a new and device-specific iatrogenic condition, ie, in-stent restenosis due to increased neointimal hyperplasia. Sirolimus- and paclitaxel-eluting stents reduce restenosis and the need for new revascularizations in comparison with bare metal stents, although at the cost of a slight increase in the risk of late stent thrombosis and a need for prolonged dual antiplatelet therapy. Everolimus is an analog of sirolimus with an increased solubility. In this review, the currently available evidence for everolimus-eluting stents is revised, including randomized trials against bare metal stents, and head-to-head trials comparing this stent with other drug-eluting stents.

Saez, Alejandro; Moreno, Raul

2010-01-01

273

Traumatic pancreatic fistula with sinistral portal hypertension: Surgical management.  

PubMed

Combined ductal and vascular injuries are awesome complications of pancreatic injury. We report on a 29-year-old male unrestrained driver who sustained a blunt abdominal injury from the steering wheel in a high velocity head-on car collision. He developed a pancreatic fistula, portosplenic venous thrombosis and sinistral portal hypertension as a result of complete duct disruption at the pancreatic neck. We describe a safe surgical strategy of spleen-preserving distal pancreatectomy after failed medical and endoscopic management. PMID:21160883

Bojal, Shoukat Ahmad; Leung, Kam Fung; Meshikhes, Abdul-Wahed Nasir

2010-07-27

274

Pancreas divisum. A cause of chronic relapsing pancreatitis.  

PubMed

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

Marshall, J B; Eckhauser, M L

1985-06-01

275

ePTFE\\/FEP-Covered Metallic Stents for Palliation of MalignantBiliary Disease: Can Tumor Ingrowth Be Prevented?  

Microsoft Academic Search

Purpose  To determine the\\u000a application and clinical effectiveness of ePTFE\\/FEP-covered metallic stents for\\u000a palliation of malignant biliary disease, and to evaluate the efficiency of\\u000a stent coverage in preventing tumor ingrowth.\\u000a \\u000a \\u000a \\u000a Methods  During a 3-year\\u000a period, 36 patients with malignant obstructive jaundice were treated with\\u000a ePTFE\\/FEP-covered stents, with or without proximal side holes. The stricture\\u000a was located in the lower common bile duct

Adam Hatzidakis; Miltiadis Krokidis; Kostantinos Kalbakis; Jiannis Romanos; Ioannis Petrakis; Nicholas Gourtsoyiannis

2007-01-01

276

[Computed tomography of pancreatic tumors].  

PubMed

Computed tomography (CT) and in particular multi-detector row computed tomography (MDCT), also known as multislice CT (MSCT), is ideally suited for detecting pancreatic tumors because of the high spatial resolution.The method of choice is hydro-CT which involves distension of the stomach and duodenum by administration of 1-1.5 l water as a negative contrast medium under medically induced hypotension by administration of buscopan. The patient is laid on the right side at an angle of 30-45 degrees in order to obtain an artefact-free image of the close anatomical relationship around the pancreas head. In addition, curved MPRs or in rare cases 3D reconstructions could be very helpful in identifying the critical anatomic tumor site in the neighbourhood of the visceral vessel system. After the correct diagnosis of an adenocarcinoma has been made only 20% of all patients are shown to have a surgically resectable disease, but the overall survival rate is significantly higher after resection in combination with a multimodal tumor therapy strategy. The reason is that the correct diagnosis of the resectability of the tumor is one of the main criteria for overall survival of these patients. Currently practically all pancreatic tumors can be detected using MDCT and the detection rate varies between 70% and 100% (most recent literature references give a sensitivity of 89% and specificity up to 99%). In some rare cases the differentiation between focal necrotizing pancreatitis and pancreatic carcinoma can be difficult even with sophisticated protocols. Resectability can be correctly diagnosed with MDCT with a sensitivity of 94% and a specificity of 89%. MDCT is an ideal tool for the detection of neuroendocrine tumors, metastases and for the differentiation of cystic pancreatic lesions such as pseudocysts, microcystic adenomas or intraductal papillary mucinous neoplasms (IPMN). Particularly, the differentiation of the latter into benign, borderline or malignant transformation is not always possible, but indirect signs, such as small nodules adjacent to the ductal wall, the diameter of the pancreatic duct, or a direct communication between cystic lesions and duct can be detected because of the high spatial resolution and is comparable to the findings in MRI. Moreover MD-CT is an ideal procedure for the differentiation of local tumor stages in patients under neoadjuvant or adjuvant chemotherapy. PMID:19137277

Grenacher, L; Klauss, M

2009-02-01

277

Polyurethane-covered wallstents to recanalize wallstents obstructed by tumor ingrowth from malignant common bile duct obstruction  

SciTech Connect

Four patients with malignant obstruction of the common bile duct had been treated with uncovered Wallstents and suffered from a reobstruction after 2-13 months (mean 5.3 months). Repeat cholangiography revealed severe stenosis of the stent lumen caused by tumor ingrowth through the mesh. A Wallstent with a self-made polyurethane-cover was inserted through the uncovered stent in these patients. The four patients were followed for 3-13 months (mean 6.3 months) until death. There was good drainage with no evidence of recurrent obstruction in all patients. We conclude that a covered Wallstent may extend patency of stented bile ducts, preventing tumor ingrowth in patients with neoplastic obstruction. Further observations are needed.

Nakamura, Toshifumi; Kitagawa, Mutsuo; Takehira, Yasunori; Yamada, Masami [Hamamatsu Medical Center, Department of Gastroenterology (Japan); Kawasaki, Tsunehisa; Nakamura, Hirotoshi [Hamamatsu University School of Medicine, Second Department of Internal Medicine (Japan)

2000-03-15

278

Process for making electroformed stents  

DOEpatents

This invention is directed to an expandable stent useful for implantation into an artery or the like. The stents are made using electroforming techniques in which an electrically-conductive mandrel is coated with a suitable resist material, after which the resist is exposed to an appropriate light pattern and frequency so as to form a stent pattern in the resist. The mandrel is then electroplated with a suitable stent material. The mandrel is etched away once a sufficient layer of stent material is deposited, leaving a completed stent.

Hines, Richard A. (Stilwell, KS)

2000-02-01

279

A Newly Designed Y-shaped Covered Stent in the Palliative Treatment of Hepatic Hilar Malignant Obstruction: Case Report  

PubMed Central

We report a case in an inoperable patient with the hilar malignant biliary obstruction treated palliatively by the use of a newly designed Y-shaped covered stent without interfering contra-lateral bile duct. We percutaneously inserted a newly designed Y-shaped covered stent into a biliary tree in an inoperable patient with Bismuth Type II cholangiocarcinoma. We checked tubograms, enhanced CT studies, and blood bilirubin levels before, one week after, and at every three month after the stenting, by observing closely the signs of clinical infection as well. The follow-up period was about 12 months. The placement of the Y-shaped covered stent was successful and resulted in adequate biliary drainage in the immediate post-procedural tubogram and in the follow-up abdominal CT. The serum bilirubin levels did not show elevation after the insertion of the Y-shaped covered stent.

Lee, So Yon; Chung, Hwan Hoon

2013-01-01

280

[Surgical correction of complicated forms of chronic pancreatitis].  

PubMed

In the clinic in 2009 - 2011 yrs 43 patients were operated for complicated forms of chronic pancreatitis (CHP). Basing on the CT and endoscopic retrograde pancreatocholangiography data, the pancreatic pathology variants, significant for the operative method choice, were delineated. The intraoperative biopsy material estimation have shown, that the main sign of CHP in all the cases was prominent pancreatic fibrosis, and in the degree III fibrose the fibrous tissue have constituted 68.2-76.4% of pancreatic tissue, exocrine--16.2-24.8%, in the degree IV fibrose--79.5-95.5 and 2.3-10.8% accordingly. The indications for organ preserving resectional, resection-draining interventions and isolated, draining pancreatic duct system operations, were formulated. The rate of combined resection-draining interventions with duodenal preserving have constituted 30.2%. Total postoperative stationary mortality was 2.3%. The stationary postoperative patients stay was (9.1 +/- 0.8) days. PMID:23718027

Ratchik, V M; Ga?dar, Iu A

2013-03-01

281

Erythema ab igne in chronic pancreatic pain: a diagnostic sign.  

PubMed Central

Two patients with severe chronic pain of pancreatic origin are described. In both there was severe back pain and an area of erythema ab igne lay directly over the portion of the pancreas giving rise to the pain. In both patients therapy directed at these areas of diseased pancreas resulted in relief of symptoms. The presence of erythema ab igne on a patient's back at the level of T12-L2 should arouse suspicion of underlying pancreatic pathology, and this may be valuable in a disease with remarkably little to find on clinical examination. In one patient early obstruction of the pancreatic duct by pancreatic carcinoma caused distal chronic pancreatitis and back pain many months before the onset of obstructive jaundice. Images Figure 1. A Figure 1. B Figure 2. A Figure 2. B

Mok, D W; Blumgart, L H

1984-01-01

282

[Pancreatic anastomosis -- a video comparison of different techniques].  

PubMed

Introduction: The pancreatic anastomosis seems to be the most difficult and dangerous anastomosis in general surgery, especially in a soft pancreas. Many techniques have been described. The techniques most often used are: anastomosis of the pancreas to the jejunum as a pancreatico-jejunostomy (duct-to-mucosa anastomosis) or as a pancreato-jejunostomy (invaginating anastomosis). Another widely used anastomosis for reconstruction after pancreatic head resection is from the stomach to the pancreas, i.e., pancreato-gastrostomy. In literature the data concerning postoperative complications (pancreatic fistula, postoperative bleeding and others) are not consistent. Indications: Reconstruction after pancreatic head resection. Procedure: Anastomosis between small intestine or stomach and the pancreas. Conclusion: There is no gold standard for pancreatic anastomosis. Thus, of the different commonly used techniques, in our opinion, the best technique for each surgeon seems to be the one that he/she is most familiar with. PMID:23450394

Grützmann, R; Distler, M; Keck, T; Niedergethmann, M

2013-02-28

283

Synchronous pancreatic solid pseudopapillary neoplasm and intraductal papillary mucinous neoplasm  

PubMed Central

Solid pseudopapillary neoplasm (SPN) is a rare and low-grade malignant pancreatic neoplasm composed of poorly cohesive monomorphic neoplastic cells forming solid and pseudopapillary structures with frequent hemorrhagic-cystic degeneration. Intraductal papillary mucinous neoplasm (IPMN) is a pancreatic exocrine tumor composed of intraductal papillary growth of mucin containing neoplastic cells in the main pancreatic duct or its major branches. In the case presented here, a 53-year-old, Japanese man was found to have multiple cystic lesions and dilatation of the main pancreatic duct in the neck of the pancreas. Histological examination revealed a main-duct and branch-duct type IPMN, of the gastric-type, involving the neck of the pancreas, associated with a 0.5 cm SPN in the caudal side of the IPMN. We diagnosed this case as synchronous SPN and IPMN. As far as we know, only one other case of synchronous SPN and IPMN has been reported. Both the present case and the previously reported case showed abnormal nuclear expression of ?-catenin in SPN, whereas IPMN showed no abnormal nuclear expression. These results suggest that ?-catenin abnormality is not a common pathogenetic factor of synchronous SPN and IPMN.

Hirabayashi, Kenichi; Zamboni, Giuseppe; Ito, Hiroyuki; Ogawa, Masami; Kawaguchi, Yoshiaki; Yamashita, Tomohiro; Nakagohri, Toshio; Nakamura, Naoya

2013-01-01

284

Intra-pancreatic splenic artery pseudoaneurysm. A rare complication of chronic calcific pancreatitis.  

PubMed

The authors present the case of a 12-year-old boy with a history of chronic upper abdominal pain. Based on ultrasonography, endoscopic retrograde cholangio-pancreatography, and computerized tomography, a diagnosis of chronic calcific pancreatitis with dilation of the main pancreatic duct and a pseudocyst of the proximal pancreas was made. At surgery, in addition to confirmation of the above findings, a pseudoaneurysm arising from the splenic artery was found in the head and body of the pancreas. Pancreaticoduodenal resection including the pseudoaneurysm was performed. Postoperatively the child developed diabetes, which is easily managed with small doses of insulin. PMID:9563038

Srinivas, M; Kataria, R; Bhatnagar, V; Tandon, N; Iyer, K V; Gupta, A K; Mitra, D K

1998-03-01

285

Complicated bile duct stones.  

PubMed

Common bile duct stones (CBDSs) are solid deposits that can either form within the gallbladder or migrate to the common bile duct (CBD), or form de novo in the biliary tree. In the USA around 15% of the population have gallstones and of these, 3% present with symptoms annually. Because of this, there have been major advancements in the management of gallstones and related conditions. Management is based on the patient's risk profile; young and healthy patients are likely to be recommended for surgery and elderly patients with comorbidities are usually recommended for endoscopic procedures. Imaging of gallstones has advanced in the last 30 years with endoscopic retrograde cholangiopancreatography evolving from a diagnostic to a therapeutic procedure in removing CBDSs. We present a complicated case of a patient with a CBDS and periampullary diverticulum and discuss the techniques used to diagnose and remove the stone from the biliary system. PMID:23946532

Roy, Ashwin; Martin, Derrick

2013-08-14

286

Hereditary Pancreatitis and Familial Pancreatic Cancer  

Microsoft Academic Search

Important advances in the understanding of pancreatic diseases have taken place through the application of molecular methods in the study of the inherited form of pancreatitis and pancreas cancer. Mutations of the cationic trypsinogen gene have been found to be causative for hereditary pancreatitis with important implications for the molecular pathogenesis of acute and chronic pancreatitis. A variety of cancer

Margaret D. Finch; Nathan Howes; Ian Ellis; Roger Mountford; Robert Sutton; Michael Raraty; John P. Neoptolemos

1997-01-01

287

Autoimmune Pancreatitis  

PubMed Central

Autoimmune pancreatitis (AIP) is a rare, heterogeneous, fibroinflammatory disorder of the pancreas. It has gained increasing recognition due to a presentation that can mimic difficult to treat disorders such as pancreatic cancer, cholangiocarcinoma and primary sclerosing cholangitis. In contrast, autoimmune pancreatitis is a benign disease that is very responsive to therapy with corticosteroids. There are two types of AIP. Type 1 disease is the most common worldwide and is associated with extrapancreatic manifestations and elevated levels of IgG4-positive cells. Type 2 AIP is characterized by a paucity of IgG4-positive cells, and is more difficult to diagnose. This review provides an update on the diagnosis, pathophysiology and treatment of AIP, with special emphasis on the two subtypes.

Ketwaroo, Gyanprakash A; Sheth, Sunil

2013-01-01

288

Endoscopic retrograde cholangiopancreatography with rendezvous cannulation reduces pancreatic injury  

PubMed Central

AIM: To examine whether rendezvous endoscopic retrograde cholangiopancreatography (ERCP) is associated with less pancreatic damage, measured as leakage of proenzymes, than conventional ERCP. METHODS: Patients (n = 122) with symptomatic gallstone disease, intact papilla and no ongoing inflammation, were prospectively enrolled in this case-control designed study. Eighty-one patients were subjected to laparoscopic cholecystectomy and if intraoperative cholangiography suggested common bile duct stones (CBDS), rendezvous ERCP was performed intraoperatively (n = 40). Patients with a negative cholangiogram constituted the control group (n = 41). Another 41 patients with CBDS, not subjected to surgery, underwent conventional ERCP. Pancreatic proenzymes, procarboxypeptidase B and trypsinogen-2 levels in plasma, were analysed at 0, 4, 8 and 24 h. The proenzymes were determined in-house with a double-antibody enzyme linked immunosorbent assay. Pancreatic amylase was measured by an enzymatic colourimetric modular analyser with the manufacturer’s reagents. All samples were blinded at analysis. RESULTS: Post ERCP pancreatitis (PEP) occurred in 3/41 (7%) of the patients cannulated with conventional ERCP and none in the rendezvous group. Increased serum levels indicating pancreatic leakage were significantly higher in the conventional ERCP group compared with the rendezvous ERCP group regarding pancreatic amylase levels in the 4- and 8-h samples (P = 0.0015; P = 0.03), procarboxypeptidase B in the 4- and 8-h samples (P < 0.0001; P < 0.0001) and trypsinogen-2 in the 24-hour samples (P = 0.03). No differences in these markers were observed in patients treated with rendezvous cannulation technique compared with patients that underwent cholecystectomy alone (control group). Post procedural concentrations of pancreatic amylase and procarboxypeptidase B were significantly correlated with pancreatic duct cannulation and opacification. CONCLUSION: Rendezvous ERCP reduces pancreatic enzyme leakage compared with conventional ERCP cannulation technique. Thus, laparo-endoscopic technique can be recommended with the ambition to minimise the risk for post ERCP pancreatitis.

Swahn, Fredrik; Regner, Sara; Enochsson, Lars; Lundell, Lars; Permert, Johan; Nilsson, Magnus; Thorlacius, Henrik; Arnelo, Urban

2013-01-01

289

[Endoscopic stent or surgical bypass? A review and evidence-based comparison of palliative procedures in inoperable pancreas tumours].  

PubMed

This review summarises the data of current meta-analyses on the outcome of endoscopic and surgical biliary bypass procedures applied for inoperable pancreatic tumours. The authors suggest that plastic biliary stents should be used in cases only with short survival (less than six months). In patients with a prognosis of longer than six month, self-expandable metal stents are more cost-effective. This latter technique is as efficient as the traditional surgical bypass procedures. However, surgical bypass is preferable in cases if tumour resection is questionable after staging or in patients with gastric emptying problems.Furthermore, application of duodenal stents is suggested in selected cases only due to relatively frequent late complications (stent migration, perforation, obstruction). Duodenal stents can be used in patients with advanced stage disease or very high operative risk. PMID:17984013

Olgyai, Gábor; Oláh, Attila

2007-10-01

290

DRUG DISTRIBUTION AND STENT RETENTION OF DRUG ELUTING STENTS  

Microsoft Academic Search

In this paper the examinations of drug eluting coronary stents are shown, such as the morphology of the coatings before expansion, drug distribution, the methodology and the value of stent retention. Surface qualities of drug coatings were examined with stereo- microscope, metallographic microscope and scanning electron microscope. Examinations with confocal microscope show drug distribution in the coatings. Stent retention is

E. Bognár; T. Balázs

291

Small Arteriovenous Malformation of the Common Bile Duct Causing Hemobilia in a Patient with Hereditary Hemorrhagic Telangiectasia  

SciTech Connect

We report a 54-year-old male patient with arteriovenous malformation located at the common bile duct and hereditary hemorrhagic telangiectasia. The patient was treated as gallstone pancreatitis at first. Three days after endoscopic nasobiliary drainage (ENBD) for biliary drainage to subside gallstone pancreatitis, hemobilia was drained from the ENBD tube and the serum hemoglobin level gradually decreased. Cholangioscopy and angiography revealed that hemobilia was due to a small arteriovenous malformation located at the common bile duct. Subsequently, the patient was successfully treated by endovascular intervention.

Hayashi, Sadao, E-mail: hayashi@m.kufm.kagoshima-u.ac.jp; Baba, Yasutaka; Ueno, Kazuto; Nakajo, Masayuki [Kagoshima University Graduate School of Medical and Dental Sciences, Department of Radiology (Japan)

2008-07-15

292

Is endoscopic therapy the treatment of choice in all patients with chronic pancreatitis?  

PubMed Central

Chronic pancreatitis (CP) is a progressive inflammatory disease of the pancreas characterized by destruction of the pancreatic parenchyma with subsequent fibrosis that leads to pancreatic exocrine and endocrine insufficiency. Abdominal pain and local complications (bile duct or duodenal stenosis and pancreatic tumor) secondary to CP are indications for therapy. At the beginning, medical therapy is used. More invasive treatment is recommended for patients with pancreatic duct stones (PDS) and pancreatic obstruction in whom standard medical therapy is not sufficient. Recently, Clarke et al assessed the long-term effectiveness of endoscopic therapy (ET) in CP patients. The authors compared ET with medical treatment. They reported that ET was clinically successful in 50% of patients with symptomatic CP. In this commentary, current CP treatment, including indications for ET and surgery in CP patients, is discussed. Recommendations for endoscopic treatment of CP according to the European Society of Gastrointestinal Endoscopy Clinical Guidelines are reviewed. Different surgical methods used in the treatment of CP patients are also discussed. ET is the most useful in patients with large PDS, pancreatic duct obstruction and dilation. It should be the first-line option because it is less invasive than surgery. Surgery should be the first-line option in patients in whom ET has failed or in those with a pancreatic mass with suspicion of malignancy. ET is a very effective and less invasive procedure, but it cannot be recommended as the treatment of choice in all CP patients.

Jablonska, Beata

2013-01-01

293

Importance of hospital volume in the overall management of pancreatic cancer.  

PubMed Central

OBJECTIVE: To determine whether hospital volume is associated with clinical and economic outcomes for patients with pancreatic cancer who underwent pancreatic resection, palliative bypass, or endoscopic or percutaneous stent procedures in Maryland between 1990 and 1995. SUMMARY BACKGROUND DATA: Previous studies have demonstrated that outcomes for patients undergoing a Whipple procedure improve with higher surgical volume, but only 20% to 35% of patients with pancreatic cancer qualify for curative resection. Most patients undergo palliative procedures instead with a surgical bypass or biliary stent. METHODS: Analysis of hospital discharge data from all nonfederal acute care hospitals in Maryland identified all patients with pancreatic cancer who underwent a pancreatic resection, palliative bypass, or stent procedure between 1990 and 1995. Hospitals (n = 48) were categorized as high-, medium-, and low-volume providers according to their average annual volume of these procedures. Multivariate regression was used to examine the association between hospital volume and in-hospital mortality rate, length of stay, and hospital charges, after adjusting for differences in case mix and surgeon volume. RESULTS: Increased hospital volume is associated with markedly decreased in-hospital mortality rates and a decreased or similar length of stay for all three types of procedures and with decreased or similar hospital charges for resections and stents. After adjustment for case mix differences, the relative risk (RR) of in-hospital death after pancreatic resection was 19.3 and 8 at the low- and medium-volume hospitals, respectively, versus the high-volume hospital; after bypasses, the RR of death was 2.7 and 1.9, respectively; and after stents, the RR was 4.3 and 4.8, respectively. CONCLUSIONS: Patients with pancreatic cancer who are to be treated with curative or palliative procedures appear to benefit from referral to a high-volume provider. Images Figure 1. Figure 2. Figure 3. Figure 4.

Sosa, J A; Bowman, H M; Gordon, T A; Bass, E B; Yeo, C J; Lillemoe, K D; Pitt, H A; Tielsch, J M; Cameron, J L

1998-01-01

294

Magnetic resonance (MR) imaging and MR cholangiopancreatography findings in cats with cholangitis and pancreatitis.  

PubMed

Cholangiohepatitis/cholangitis is second only to hepatic lipidosis as the most common liver disease in cats and is often associated with concurrent pancreatitis. Magnetic resonance imaging (MRI) and MR cholangiopancreatography (MRCP) have developed into an accurate, highly sensitive and specific imaging tool for the diagnosis of biliary and pancreatic duct disorders in humans. In this prospective case series, 10 cats with suspected cholangitis and/or pancreatitis were enrolled based on clinical history, physical examination and appropriate diagnostic test results. MRI and MRCP sequences with secretin stimulation of the cranial abdomen were performed, and sonography and laparoscopic biopsies for histologic diagnosis were obtained for comparison. MRI detected pancreatic abnormalities in cats suspected of pancreatitis, including T1 pre-contrast hypointense and T2 hyperintense pancreatic parenchyma and a dilated pancreatic duct. The MRI findings of the liver were non-specific. Nine of 10 cats had biliary abnormalities, including gall bladder wall thickening, gall bladder wall moderate contrast enhancement and/or gall bladder debris. Eight of 10 cats had histologic evidence of pancreatitis, as well as hepatitis or cholangitis, with one cat diagnosed with hepatic lymphoma. The advantages of MRI/MRCP over sonography of these cats included the striking pancreatic signal changes associated with pancreatitis and the ability to comprehensibly assess and measure the pancreas and hepatobiliary structures without operator dependence or interference from bowel gas. MRI/MRCP imaging of the feline abdomen may be beneficial in cases with equivocal ultrasound imaging findings. PMID:23143839

Marolf, Angela J; Kraft, Susan L; Dunphy, Thomas R; Twedt, David C

2012-11-09

295

Miniprobe EUS in management of pancreatic pseudocyst  

PubMed Central

Pancreatic pseudocysts (PP) arise from trauma and pancreatitis; endoscopic gastro-cyst drainage (EGCD) under endoscopic ultrasonography (EUS) in symptomatic PP is the treatment of choice. Miniprobe EUS (MEUS) allows EGCD in children. We report our experience on MEUS-EGCD in PP, reviewing 13 patients (12 children; male:female = 9:3; mean age: 10 years, 4 mo; one 27 years, malnourished male Belardinelli-syndrome; PP: 10 post-pancreatitis, 3 post-traumatic). All patients underwent ultrasonography, computed tomography and magnetic resonance imaging. Conservative treatment was the first option. MEUS EGCD was indicated for retrogastric cysts larger than 5 cm, diameter increase, symptoms or infection. EGCD (stent and/or nasogastrocystic tube) was performed after MEUS (20-MHz-miniprobe) identification of place for diathermy puncture and wire insertion. In 8 cases (61.5%), there was PP disappearance; one, surgical duodenotomy and marsupialization of retro-duodenal PP. In 4 cases (31%), there was successful MEUS-EGCD; stent removal after 3 mo. No complications and no PP relapse in 4 years of mean follow-up. MEUS EGCD represents an option for PP, allowing a safe and effective procedure.

De Angelis, Paola; Romeo, Erminia; Rea, Francesca; Torroni, Filippo; Caldaro, Tamara; Federici di Abriola, Giovanni; Foschia, Francesca; Caloisi, Claudia; Lucidi, Vincenzina; Dall'Oglio, Luigi

2013-01-01

296

Laparoscopic management of bile duct and bowel injury during laparoscopic cholecystectomy  

Microsoft Academic Search

Accidentai injuries to the bile duct and bowel are significant risks of laparoscopic surgery and sometimes require conversion\\u000a to open surgery. Although some of the injuries related to laparoscopic cholecystectomy can be managed by endoscopic techniques,\\u000a laparoscopic surgery is not yet sufficiently perfected. We investigated the efficacy of laparoscopic management combined with\\u000a endoscopic tube or stent insertion in cases of

A.-Hon Kwon; Hiroyuki Inui; Yasuo Kamiyama

2001-01-01

297

Whistler leakage from narrow ducts  

NASA Astrophysics Data System (ADS)

Low altitude satellite observations of a variation in the upper cut-off-frequency of whistlers with latitude (at constant altitude) can be convincingly explained in terms of different whistler frequencies leaving a duct at different altitudes. This selective leakage is explained by a downcoming wave escaping from a duct at an altitude where its wavelength becomes approximately equal to the duct width. This altitude is shown to decrease with increasing wave frequency. Leakage according to this mechanism is shown to result in a minimum duct width at a given altitude for ducted guidance of VLF waves. It is found to be consistent with the distribution of duct widths inferred from whistler observations made aboard the low altitude satellite ISIS 1.

Strangeways, H. J.

1986-05-01

298

The role of the FOLFIRINOX regimen for advanced pancreatic cancer.  

PubMed

In 2010, the FOLFIRINOX regimen (bolus and infusional 5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) emerged as a new option in patients with metastatic pancreatic cancer and a good performance status. However, at that time, some doubts were raised regarding safety issues. Similarly, no data on FOLFIRINOX were published in patients with unresectable/locally advanced or borderline resectable pancreatic cancer. This article presents the available experience with FOLFIRINOX outside clinical trials in metastatic and locally advanced pancreatic cancer patients. The safety of the regimen in patients with biliary stents and in previously treated patients is also described. FOLFIRINOX usage in clinical practice, including modification of the regimen (omission of bolus 5-fluorouracil; FOLFOXIRI regimen), is also presented. These data suggest that a phase III randomized study is warranted to further explore the role of FOLFIRINOX in locally advanced pancreatic cancer. PMID:23341367

Conroy, Thierry; Gavoille, Céline; Samalin, Emmanuelle; Ychou, Marc; Ducreux, Michel

2013-04-01

299

Isolated Right Segmental Hepatic Duct Injury Following Laparoscopic Cholecystectomy  

SciTech Connect

Purpose. Laparoscopic cholecystectomy (LC) is the treatment of choice for gallstones. There is an increased incidence of bile duct injuries in LC compared with the open technique. Isolated right segmental hepatic duct injury (IRSHDI) represents a challenge not only for management but also for diagnosis. We present our experience in the management of IRSHDI, with long-term follow-up after treatment by a multidisciplinary approach. Methods. Twelve consecutive patients (9 women, mean age 48 years) were identified as having IRSHDI. Patients' demographics, clinical presentation, management and outcome were collected for analysis. The mean follow-up was 44 months (range 2-90 months). Results. Three patients had the LC immediately converted to open surgery without repair of the biliary injury before referral. Treatments before referral included endoscopic retrograde cholangiopancreatography (ERCP), percutaneous drainage and surgery, isolated or in combination. The median interval from LC to referral was 32 days. Eleven patients presented with biliary leak and biloma, one with obstruction of an isolated right hepatic segment. Post-referral management of the biliary lesion used a combination of ERCP stenting, percutaneous drainage and stent placement and surgery. In 6 of 12 patients ERCP was the first procedure, and in only one case was IRSHDI identified. In 6 patients, percutaneous transhepatic cholangiography (PTC) was performed first and an isolated right hepatic segment was demonstrated in all. The final treatment modality was endoscopic management and/or percutaneous drainage and stenting in 6 patients, and surgery in 6. The mean follow-up was 44 months. No mortality or significant morbidity was observed. Conclusion. Successful management of IRSHDI after LC requires adequate identification of the lesion, and multidisciplinary treatment is necessary. Half of the patients can be treated successfully by nonsurgical procedures.

Perini, Rafael F. [Medical University of South Carolina, Division of Gastroenterology (United States); Uflacker, Renan [University of South Carolina, Division of Interventional Radiology (United States)], E-mail: uflacker@musc.edu; Cunningham, John T. [Medical University of South Carolina, Division of Gastroenterology (United States); Selby, J. Bayne [University of South Carolina, Division of Interventional Radiology (United States); Adams, David [University of South Carolina, Division of GI Surgery (United States)

2005-04-15

300

A stent is not just a stent: stent construction and design do matter in its clinical performance  

Microsoft Academic Search

The undisputed superiority of stents over conventional balloon angioplasty has resulted in a plethora of stents in clinical use. Recent data, however, have indicated not all stent models are the same. Nuances in stent design and construction have impacted significantly on the immediate and long-term clinical outcome. Among the stainless steel stents, those with multicellular or tubular designs have proven

K W Lau; A Johan; U Sigwart; J S Hung

2004-01-01

301

The surgical spectrum of hereditary pancreatitis in adults.  

PubMed Central

The role of operative intervention for hereditary pancreatitis, a rare form of chronic parenchymal destruction, is unclear. To determine whether surgical therapy is safe and provides prolonged symptomatic relief, the authors reviewed the management of 22 adults (11 men, 11 women) with hereditary pancreatitis treated surgically between 1950 and 1989. Hereditary pancreatitis was defined as a family history of two or more relatives with pancreatitis and clinical, biochemical, or radiologic evidence of pancreatitis. The mean ages at onset of symptoms and at operation were 15 years (range, 3 to 52 years) and 31 years (range, 18 to 54 years), respectively. Pain was the primary indication for operation in all patients. Additional symptoms included nausea, vomiting (73%), weight loss (55%), and diarrhea (41%). Ductal dilatation was present in 68%, pancreatic parenchymal calcifications in 73%, pseudocysts in 36%, and splenic vein thrombosis in 18%. Primary operations included ductal drainage in 10 patients, pancreatic resection alone in three, resection with drainage in three, cholecystectomy plus sphincteroplasty in two, cholecystectomy with or without common bile duct exploration in two, pancreatic abscess drainage in one, and pseudocyst drainage in one. There were no perioperative deaths, and the morbidity rate was 14% (intra-abdominal abscess, wound infection, and urinary tract infection). Symptoms recurred in nine patients. Severity prompted reoperation in five. Secondary operations included pancreatic resection in three, pseudocyst excision in one, and pancreaticolithotomy in one. Follow-up to date is complete and extends for a median of 85 months. Eighteen patients (82%) are clinically improved or asymptomatic. Symptoms have persisted in four patients, and two patients have died of pancreatic carcinoma. Two patients died of unrelated causes. Surgical therapy for patients with hereditary pancreatitis selected on the basis of the traditional indications for surgical treatment of chronic pancreatitis is safe and efficacious.

Miller, A R; Nagorney, D M; Sarr, M G

1992-01-01

302

Bicarbonate secretion in interlobular ducts from guinea-pig pancreas.  

PubMed

1. The transport of HCO3- across the luminal membrane of pancreatic duct cells was studied by monitoring the luminal pH of isolated guinea-pig interlobular ducts after microinjection of an extracellular fluoroprobe, the dextran conjugate of 2'7'-bis(2-carboxyethyl)-5(6)-carboxyfluorescein (BCECF-dextran). Luminal Cl- concentration was also measured by microfluorometry following microinjection of the dextran conjugates of 6-methoxy-N-(4-aminoalkyl)quinolinium bromide (ABQ-dextran) and Cl-NERF (Cl-NERF-dextran). 2. When HCO3-/CO2 was admitted to the bath, a transient acidification of the duct lumen was observed, followed by a marked alkalinization. The latter was abolished when the luminal Cl- concentration was reduced to 25-35 mM by replacement with glucuronate and may, therefore, be attributed to Cl(-)-HCO3- exchange at the luminal membrane. 3. Secretin, forskolin and acetylcholine stimulated HCO3- secretion into the lumen even when the luminal Cl- concentration was reduced to approximately 7 mM. Furthermore, agonist-evoked HCO3- secretion was not inhibited by luminal glibenclamide, dihydro-4,4'-diisothiocyanostilbene-2,2'-disulphonic acid (H2DIDS) or 5-nitro-2-(3-phenylpropylamino)-benzoic acid (NPPB). These observations are not easily reconciled with HCO3- transport across the luminal membrane being mediated by Cl(-)-HCO3- exchange in parallel with a Cl- conductance. 4. Agonist-stimulated HCO3- secretion was blocked by omitting Na+ from the bath but not by addition of N-methyl-N-isobutylamiloride (MIA) or bafilomycin A1. This supports our previous conclusion that HCO3- entry into duct cells from the extracellular fluid requires Na+ but is not dependent on Na(+)-H+ exchange or vacuolar-type H(+)-ATPase activity. 5. The three actions of secretin on guinea-pig pancreatic duct cells described in this and the accompanying paper - stimulation of a relatively Cl(-)-insensitive luminal HCO3- efflux pathway, stimulation of basolateral Na(+)-HCO3- cotransport, and lack of effect on intracellular pH- require the current model of pancreatic HCO3- secretion to be modified. PMID:8866361

Ishiguro, H; Steward, M C; Wilson, R W; Case, R M

1996-08-15

303

Bicarbonate secretion in interlobular ducts from guinea-pig pancreas.  

PubMed Central

1. The transport of HCO3- across the luminal membrane of pancreatic duct cells was studied by monitoring the luminal pH of isolated guinea-pig interlobular ducts after microinjection of an extracellular fluoroprobe, the dextran conjugate of 2'7'-bis(2-carboxyethyl)-5(6)-carboxyfluorescein (BCECF-dextran). Luminal Cl- concentration was also measured by microfluorometry following microinjection of the dextran conjugates of 6-methoxy-N-(4-aminoalkyl)quinolinium bromide (ABQ-dextran) and Cl-NERF (Cl-NERF-dextran). 2. When HCO3-/CO2 was admitted to the bath, a transient acidification of the duct lumen was observed, followed by a marked alkalinization. The latter was abolished when the luminal Cl- concentration was reduced to 25-35 mM by replacement with glucuronate and may, therefore, be attributed to Cl(-)-HCO3- exchange at the luminal membrane. 3. Secretin, forskolin and acetylcholine stimulated HCO3- secretion into the lumen even when the luminal Cl- concentration was reduced to approximately 7 mM. Furthermore, agonist-evoked HCO3- secretion was not inhibited by luminal glibenclamide, dihydro-4,4'-diisothiocyanostilbene-2,2'-disulphonic acid (H2DIDS) or 5-nitro-2-(3-phenylpropylamino)-benzoic acid (NPPB). These observations are not easily reconciled with HCO3- transport across the luminal membrane being mediated by Cl(-)-HCO3- exchange in parallel with a Cl- conductance. 4. Agonist-stimulated HCO3- secretion was blocked by omitting Na+ from the bath but not by addition of N-methyl-N-isobutylamiloride (MIA) or bafilomycin A1. This supports our previous conclusion that HCO3- entry into duct cells from the extracellular fluid requires Na+ but is not dependent on Na(+)-H+ exchange or vacuolar-type H(+)-ATPase activity. 5. The three actions of secretin on guinea-pig pancreatic duct cells described in this and the accompanying paper - stimulation of a relatively Cl(-)-insensitive luminal HCO3- efflux pathway, stimulation of basolateral Na(+)-HCO3- cotransport, and lack of effect on intracellular pH- require the current model of pancreatic HCO3- secretion to be modified.

Ishiguro, H; Steward, M C; Wilson, R W; Case, R M

1996-01-01

304

Fine structure of the organic matrix of human pancreatic stones.  

PubMed

Pancreatic stones that were removed from the pancreatic ducts of patients with chronic calcifying pancreatitis were decalcified so the organic matrix could be studied by scanning and transmission electron microscopy. The observations made by scanning electron microscopy were compared with those made on undecalcified stones, and the findings were correlated with light microscopic observations. After the calcium carbonate was removed, the stones consisted of multiple partitions arranged like a sponge. They were embedded in a gel-like matrix. The organic partitions frequently were composed of dense surface layers and sparse central reticular accumulations, which had surrounded and bound calcium carbonate crystals. The organic matrix was heterogeneous in texture. Some areas had dense, regular, proteinaceous fibrous material. Deposits resembling fibrin were observed. Altered cellular constituents appeared to make up minor portions of the matrix. Calcium carbonate, which was precipitated in vitro in pancreatic juice, resembled the morphology of pancreatic stones more than that of pure calcium carbonate crystals. These results are consistent with the coformation of pancreatic stones from constituents in the pancreatic juice [including pancreatic stone protein (PSP), glycosaminoglycans, and occasional cells] and precipitated calcium carbonate. PMID:3575306

Bockman, D E; Kennedy, R H; Multigner, L; DeCaro, A; Sarles, H

1986-01-01

305

Parotid sialolithiasis in Stensens duct  

Microsoft Academic Search

Salivary duct lithiasis is a condition characterized by the obstruction of a salivary gland or its excretory duct due to the for- mation of calcareous concretions or sialoliths resulting in salivary ectasia and even provoking the subsequent dilation of the salivary gland. Sialolithiasis accounts for 30% of salivary diseases and most commonly involves the submaxillary gland (83 to 94%) and

Daniel Torres Lagares; Sebastián Barranco Piedra; María Ángeles; Serrera Figallo; Pilar Hita Iglesias

306

Mining machine duct work arrangement  

SciTech Connect

A mining machine is disclosed which has a vehicle body with a first end thereof having a boom pivoted for up and down rotational movement about an axis extending transversely of the vehicle. A cutter head is carried by the boom and a conveyor is mounted on the vehicular body to carry away material cut by the cutter head. A dust collection system is mounted on the boom and vehicle body to convey dust away from the cutting head area. The dust control system has duct work associated therewith which includes a generally rectangularly intake duct section associated with the boom and a generally rectangularly fixed duct section mounted on the vehicle. A transition section connects the intake and the fixed duct sections. The transition section consists of a two piece arrangement wherein each piece is hinged to the intake duct section and is capable of slidingly engaging the fixed duct section at the end thereof adjacent the boom to sealing couple the intake duct section to the fixed duct section as the boom swings upwardly and downwardly.

Melhuish, J.J.

1985-12-10

307

Regulation of Wolffian Duct Development  

Microsoft Academic Search

Wolffian ducts (WDs) are the embryonic structures that form the male internal genitalia. These ducts develop in both the male and female embryo. However, in the female they subsequently regress, whereas in the male they are stabilised by testosterone. The WDs then develop into separate but contiguous organs, the epididymis, vas deferens and seminal vesicles. Recently, considerable progress has been

Sabine E. Hannema; Ieuan A. Hughes

2007-01-01

308

Intrahepatic transposition of bile ducts.  

PubMed

Objective. To describe the intrahepatic bile duct transposition (anatomical variation occurring in intrahepatic ducts) and to determine the frequency of this variation. Material and Methods. The researches were performed randomly on 100 livers of adults, both sexes. Main research methods were anatomical macrodissection. As a criterion for determination of variations in some parts of bile tree, we used the classification of Segmentatio hepatis according to Couinaud (1957) according to Terminologia Anatomica, Thieme Stuugart: Federative Committee on Anatomical Terminology, 1988. Results. Intrahepatic transposition of bile ducts was found in two cases (2%), out of total examined cases (100): right-left transposition (right segmental bile duct, originating from the segment VIII, joins the left liver duct-ductus hepaticus sinister) and left-right intrahepatic transposition (left segmental bile duct originating from the segment IV ends in right liver duct-ductus hepaticus dexter). Conclusion. Safety and success in liver transplantation to great extent depends on knowledge of anatomy and some common embryological anomalies in bile tree. Variations in bile tree were found in 24-43% of cases, out of which 1-22% are the variations of intrahepatic bile ducts. Therefore, good knowledge on ductal anatomy enables good planning, safe performance of therapeutic and operative procedures, and decreases the risk of intraoperative and postoperative complications. PMID:22550601

Deli?, Jasmin; Savkovi?, Admedina; Isakovi?, Eldar; Markovi?, Sergije; Bajtarevic, Alma; Denjali?, Amir

2012-04-03

309

Effectiveness and safety of endoscopic treatment of benign biliary strictures using a new fully covered self expandable metal stent.  

PubMed

Background. In patients with benign biliary strictures, the use of fully covered self-expandable metal stents (SEMS) has been proposed as an alternative to plastic stenting, but high quality prospective data are sparse. This study was performed to evaluate the long-term effectiveness and safety of a new fully covered SEMS for benign biliary strictures. Methods. All consecutive patients with benign biliary strictures were treated with placement of a fully covered SEMS (WallFlex) for 6 months. Short- and long-term stricture resolution, adverse events, and ease of stent removal were recorded. Results. 23 patients were enrolled. Stricture etiology was chronic pancreatitis (14), postorthotopic liver transplant (4), idiopathic (4), and biliary stones (1). All ERCPs were technically successful. All stents were successfully removed. Short-term stricture resolution was seen in 22/23 (96%) patients. Long-term success was 15/18 (83.3%). All 3 failures were patients with biliary strictures in the setting of chronic calcific pancreatitis. Conclusions. The use of the new SEMS for the treatment of benign biliary strictures led to short-term stricture resolution in the vast majority of patients. Over a long-term followup the success rate appears favorable compared to historical results achieved with multiple plastic stenting, particularly in patients with chronic pancreatitis. The study was registered with ClinicalTrials.gov (NCT01238900). PMID:23956613

Wagh, Mihir S; Chavalitdhamrong, Disaya; Moezardalan, Koorosh; Chauhan, Shailendra S; Gupte, Anand R; Nosler, Michael J; Forsmark, Chris E; Draganov, Peter V

2013-05-11

310

Effectiveness and Safety of Endoscopic Treatment of Benign Biliary Strictures Using a New Fully Covered Self Expandable Metal Stent  

PubMed Central

Background. In patients with benign biliary strictures, the use of fully covered self-expandable metal stents (SEMS) has been proposed as an alternative to plastic stenting, but high quality prospective data are sparse. This study was performed to evaluate the long-term effectiveness and safety of a new fully covered SEMS for benign biliary strictures. Methods. All consecutive patients with benign biliary strictures were treated with placement of a fully covered SEMS (WallFlex) for 6 months. Short- and long-term stricture resolution, adverse events, and ease of stent removal were recorded. Results. 23 patients were enrolled. Stricture etiology was chronic pancreatitis (14), postorthotopic liver transplant (4), idiopathic (4), and biliary stones (1). All ERCPs were technically successful. All stents were successfully removed. Short-term stricture resolution was seen in 22/23 (96%) patients. Long-term success was 15/18 (83.3%). All 3 failures were patients with biliary strictures in the setting of chronic calcific pancreatitis. Conclusions. The use of the new SEMS for the treatment of benign biliary strictures led to short-term stricture resolution in the vast majority of patients. Over a long-term followup the success rate appears favorable compared to historical results achieved with multiple plastic stenting, particularly in patients with chronic pancreatitis. The study was registered with ClinicalTrials.gov (NCT01238900).

Wagh, Mihir S.; Chavalitdhamrong, Disaya; Moezardalan, Koorosh; Chauhan, Shailendra S.; Gupte, Anand R.; Nosler, Michael J.; Forsmark, Chris E.; Draganov, Peter V.

2013-01-01

311

[Pancreatic cancer].  

PubMed

About 7200 new cases of pancreatic adenocarcinomas are diagnosed each year in France. At the time of diagnosis, an efficient carcinologic surgery will not be possible for nearly 80% of patients, in relation to loco-regional extension or metastatic dissemination. After surgical resection, the median survival of resected patients ranges from 12 to 20 months, with a high rate of relapses. Currently, the use of radiotherapy for patients with pancreatic cancer is controversial. In adjuvant setting, the standard treatment is six months of chemotherapy with FUFOL or gemcitabine. Chemoradiation (CRT) may improve the survival of patients with incompletely resected tumors (R1). This must be validated in a prospective trial. Neoadjuvant CRT is a promising treatment but always under evaluation. For the treatment of patients with locally advanced tumors, there is not a standart treatment. A strategy of initial chemotherapy followed by CRT for non progressive patients is under evaluation. Whereas in the first trials of CRT large fields were used, the current trend is to reduce the treated volumes to improve tolerance. The delineation of target volumes has been improved by the use of simulation CT. The aims of this work are to precise the radio-anatomical particularities, the pattern of spread of pancreatic cancer and the principles of 3D conformal radiotherapy illustrated with a clinical case. PMID:21129675

Huguet, F; Orthuon, A; Touboul, E; Marseguerra, R; Mornex, F

2010-11-01

312

Stent-Graft Treatment for Bleeding Superior Mesenteric Artery Pseudoaneurysm After Pancreaticoduodenectomy  

SciTech Connect

We report two cases of intraperitoneal bleeding from superior mesenteric artery (SMA) pseudoaneurysm after pancreaticoduodenectomy for pancreatic head carcinoma. In both cases, a stent-graft was deployed on the main SMA to exclude pseudoaneurysm and to preserve blood flow to the bowel. Bleeding stopped after the procedure. One patient was able to be discharged but died from carcinoma recurrence 4 months later. The other patient died of sepsis and stent-graft infection 5 months later. These patients remained free of intraperitoneal rebleeding during the follow-up period.

Suzuki, Kojiro, E-mail: kojiro@med.nagoya-u.ac.jp; Mori, Yoshine; Komada, Tomohiro; Matsushima, Masaya; Ota, Toyohiro; Naganawa, Shinji [Nagoya University Graduate School of Medicine, Department of Radiology (Japan)

2009-07-15

313

Stenoses of the salivary ducts-sialendoscopy based diagnosis and treatment.  

PubMed

Our aim was to analyse the nature of a sialendoscopy-based classification and present its use in the treatment of stenoses of Wharton's and Stensen's ducts. The classification of stenoses of Wharton's duct has not been published before. We did 133 sialendoscopies in 114 patients who presented with possible obstruction of the ducts to the tertiary centre for ENT at the University Department in Pozna?. Twenty-seven patients had their parotid ducts treated, and 24 their submandibular ducts. Suspicion of stenotic changes of the ductal system was suggested during ultrasound examination. They were examined with semirigid endoscopes that enabled direct visualisation of the stenotic areas. A total of 69 stenoses were diagnosed in 51 patients. Stenoses were divided into three groups according to their site. Patients with stenosis of the salivary ducts were treated by dilatation of the stenotic area, intraductal steroid injections, and insertion of a stent for 14-21 days. Forty of the 51 reported considerable improvement, and 7 partial improvement. Four patients had no improvement. Sialendoscopy is a safe way to treat obstruction of the salivary glands. Short and medium term follow up show that it is extremely successful. PMID:22938753

Kope?, Tomasz; Szyfter, Witold; Wierzbicka, Ma?gorzata; Nealis, Justin

2012-08-29

314

[Endoscopic therapy in advanced pancreatic cancer. Minimally invasive surgery].  

PubMed

We report a 70 years old male with an advanced pancreatic carcinoma who was admitted to the hospital due to vomiting, progressive jaundice and severe itching. An upper gastrointestinal endoscopy showed an extrinsic duodenal compression and the abdominal ultrasound, a dilated biliary tract. During an endoscopic retrograde pancreatography a papilotomy was performed and a 7 F biliary stent was installed. Also, an endoscopic percutaneous gastrostomy was done, installing a jejunostomy. These procedures allowed a better quality of life in this patient. PMID:9334486

Rodríguez, J

1996-12-01

315

The impact of duct-to-duct interaction on the hex duct dilation  

SciTech Connect

Dilation of the hex duct is an important factor in the operational lifetime of fuel subassemblies in liquid metal fast reactors. It is caused primarily by the irradiation-enhanced creep and void swelling of the hex duct material. Excessive dilation may jeopardize subassembly removal from the core or cause a subassembly storage problem where the grid size of the storage basket is limited. Dilation of the hex duct in Experimental Breeder Reactor II (EBR-II) limits useful lifetime because of these storage basket limitations. It is, therefore, important to understand the hex duct dilation behavior to guide the design and in-core management of fuel subassemblies in a way that excessive duct deformation can be avoided. To investigate the dilation phenomena, finite-element models of the hex duct have been developed. The inelastic analyses were performed using the structural analysis code, ANSYS. Both Type 316 and D9 austenitic stainless steel ducts are considered. The calculated dilations are in good agreement with profilometry measurements made after irradiation. The analysis indicates that subassembly interaction is an important parameter in addition to neutron fluence and temperature in determining hex duct dilation. 5 refs.

Lee, M.J.; Chang, L.K.; Lahm, C.E.; Porter, D.L.

1992-01-01

316

The impact of duct-to-duct interaction on the hex duct dilation  

SciTech Connect

Dilation of the hex duct is an important factor in the operational lifetime of fuel subassemblies in liquid metal fast reactors. It is caused primarily by the irradiation-enhanced creep and void swelling of the hex duct material. Excessive dilation may jeopardize subassembly removal from the core or cause a subassembly storage problem where the grid size of the storage basket is limited. Dilation of the hex duct in Experimental Breeder Reactor II (EBR-II) limits useful lifetime because of these storage basket limitations. It is, therefore, important to understand the hex duct dilation behavior to guide the design and in-core management of fuel subassemblies in a way that excessive duct deformation can be avoided. To investigate the dilation phenomena, finite-element models of the hex duct have been developed. The inelastic analyses were performed using the structural analysis code, ANSYS. Both Type 316 and D9 austenitic stainless steel ducts are considered. The calculated dilations are in good agreement with profilometry measurements made after irradiation. The analysis indicates that subassembly interaction is an important parameter in addition to neutron fluence and temperature in determining hex duct dilation. 5 refs.

Lee, M.J.; Chang, L.K.; Lahm, C.E.; Porter, D.L.

1992-07-01

317

21 CFR 876.4620 - Ureteral stent.  

Code of Federal Regulations, 2010 CFR

...2010-04-01 2010-04-01 false Ureteral stent. 876.4620 Section 876.4620 Food and... Surgical Devices § 876.4620 Ureteral stent. (a) Identification. A ureteral stent is a tube-like implanted device...

2010-04-01

318

21 CFR 876.4620 - Ureteral stent.  

Code of Federal Regulations, 2010 CFR

...2009-04-01 2009-04-01 false Ureteral stent. 876.4620 Section 876.4620 Food and... Surgical Devices § 876.4620 Ureteral stent. (a) Identification. A ureteral stent is a tube-like implanted device...

2009-04-01

319

Partial avulsion of common bile duct and duodenal perforation in a blunt abdominal trauma.  

PubMed

Complete or partial avulsion of common bile duct is a very rare injury following blunt abdominal trauma in children. A 7-year old boy presented to ER following blunt abdominal trauma by a moving motorcycle. X ray abdomen revealed free air under diaphragm and CT scan showed pancreatic contusion injury. At operation anterior wall of common bile duct (CBD) along with a 2mm rim of duodenal tissue on either side of anterior wall of CBD were found avulsed from the duodenum. The avulsed portion of CBD and duodenum were reanastomosed and a tube cholecystostomy performed. The patient had an uneventful recovery. PMID:22953262

Mirza, Bilal; Ijaz, Lubna; Iqbal, Shahid; Sheikh, Afzal

2010-12-01

320

Hepatic S4a + S5 and bile duct resection for gallbladder carcinoma.  

PubMed

In the surgical treatment of gallbladder cancer, segment 4a + 5 hepatic resection and bile duct resection is usually recommended for T2 and/or T3 gallbladder cancer involving hepatic parenchyma without hepatic biliary confluence. This procedure does not affect liver function excessively, provided there is correct identification of hepatic S4a and S5, the most important aspect of this procedure. In this paper, the technique of hepatic S4a + 5 and bile duct resection is described in detail. This surgical procedure could be a useful option for the surgical treatment of the hepatobiliary pancreatic malignancies. Surgeons should therefore master the surgical techniques for this procedure. PMID:22374509

Miyazaki, Masaru; Shimizu, Hiroaki; Ohtsuka, Masayuki; Yoshidome, Hiroyuki; Kato, Atsushi; Yoshitomi, Hideyuki; Furukawa, Katsunori; Kimura, Fumio

2012-05-01

321

[Advances in the diagnosis and therapy of chronic pancreatitis].  

PubMed

Chronic pancreatitis is a permanent diagnostic and therapeutic problem. There is no method diagnosing early stages of the disease. Contemporary diagnosis is based on morphological methods. The gold standard is ERCP, but similar results are provided also by non-invasive NMR cholangiopancreatography. Ultrasound examination provides reliable information on the presence of cystoids and major solid formations. Spiral CT is the method which by visualizing the pancreatic duct and structural changes is indispensible. Functional tests are in the diagnostic algorithm only marginal. Treatment of the disease involves dietetic provisions, prohibition of alcohol, supplementation with pancreatic enzymes and administration of analgetics. If this treatment fails, endoscopic or surgical solutions are indicated. Chronic pancreatitis is associated with the risk of development of carcinoma of the pancreas and this is another reason why it calls for permanent and systematic dispensarization. PMID:16737119

Dít?, P

2002-09-01

322

Mechanical Characteristics of Composite Knitted Stents  

SciTech Connect

We used metal wires and fibers to fabricate a composite knitted stent and then compare the mechanical characteristics of this stent with those of a pure metallic stent of the same construction in order to develop a stent that offers a comparable degree of expandability as metallic stents but can be used for highly curved lesions that cannot be treated using metallic stents. We fabricated two types of composite knitted stent (N-Z stents), using nitinol wire with a diameter of 0.12 mm and polypara-phenylene-benzobisoxazole (PBO) multifilament fiber (Zyron AS; Toyobo, Osaka, Japan). Stents were knitted into a cylindrical shape using the same textile pattern as a Strecker stent. Two loop lengths (L) of nitinol wire were used in the N-Z stents: L = 1.84 mm (N-Z stent L = 1.84) and L = 2.08 mm (N-Z stent L = 2.08). For the sake of comparison, we fabricated a metallic stent of nitinol using the same textile pattern (N-N stent L = 1.92). We applied a radial compression force diametrically to each stent and applied a bending force diametrically at the free end of a stent with one end fixed in order to evaluate the relationship between stent elasticity and load values. In addition, we macroscopically evaluated the generation of kinks when the stent was bent 180{sup o}. The radial compressive force when the stent diameter was reduced by 53% was 6.44 N in the case of N-Z stent L = 1.84, 6.14 N in the case of N-Z stent L = 2.08, and 4.96 N in the case of N-N stent L = 1.92 mm. The composite stent had a radial compressive force higher than that of a metallic stent. The restoring force to longitudinal direction at a 90{sup o} bending angle was 0.005 N for N-Z stent L = 1.84, 0.003 N for N-Z stent L = 2.08, and 0.034 N for N-N stent L = 1.92. The restoring force of the composite stent was significantly lower. Finally, the composite stent generated no definitive kinks at a bending angle of 180{sup o}, regardless of loop length. However, the N-N stent clearly produced kinks, causing blockage of the inner cavity. In conclusion, the use of a metal and fiber composite in the construction of a knitted stent ensures an expansion performance comparable to that of metallic stents, while providing better kink resistance.

Tokuda, Takanori, E-mail: tkdtknr@gmail.com; Shomura, Yuzo; Tanigawa, Noboru; Kariya, Shuji [Kansai Medical University Hirakata Hospital, Department of Radiology (Japan); Komemushi, Atsushi [Kansai Medical University Takii Hospital, Department of Radiology (Japan); Kojima, Hiroyuki; Sawada, Satoshi [Kansai Medical University Hirakata Hospital, Department of Radiology (Japan)

2009-09-15

323

Management of malignant biliary obstruction: Technical and clinical results using an expanded polytetrafluoroethylene fluorinated ethylene propylene (ePTFE\\/FEP)-covered metallic stent after 6-year experience  

Microsoft Academic Search

To evaluate the efficacy and safety of an expanded polytetrafluoroethylene-fluorinated ethylene-propylene (ePTFE\\/FEP)-covered\\u000a metallic stent in the management of malignant biliary obstruction. Eighty consecutive patients with malignant common bile\\u000a duct strictures were treated by placement of 83 covered metallic stents. The stent-graft consists of an inner ePTFE\\/FEP lining\\u000a and an outer supporting structure of nitinol wire. Clinical evaluation, assessment of serum

Fabrizio Fanelli; Gianluigi Orgera; Mario Bezzi; Plinio Rossi; Massimiliano Allegritti; Roberto Passariello

2008-01-01

324

Necessity of a repeat cholangiogram during biliary stent removal after postcholecystectomy bile leak  

PubMed Central

PURPOSE: To assess the need for repeat endoscopic retrograde cholangiography (ERC) in patients undergoing biliary stent removal after management of postcholecystectomy bile leak. METHODS: A retrospective analysis of the Clinical Outcomes Research Initiative endoscopy database at PennState Milton S Hershey Medical Center (Hershey, Pennsylvania, USA) identified all patients referred for ERC with an indication of postcholecystectomy bile leak from January 2001 to June 2010. Baseline demographics, location of bile leak, size of biliary stent placed, duration of stenting, bile leak persistence, and the presence of stone, sludge or strictures on repeat ERC were analyzed. RESULTS: A total of 81 patients underwent ERC for management of bile leaks after cholecystectomy. One patient was excluded due to a complete transection of the common bile duct necessitating immediate surgical intervention. Fourteen (17.5%) patients underwent open cholecystectomy, 46 (57.5%) underwent laparoscopic procedures and 10 (12.5%) procedures were converted from a laparoscopic to an open approach intraoperatively. Of the 80 patients, 47 (58.7 %) had a cystic duct leak, 11 (13.7 %) had a right hepatic duct leak, 11 (13.7%) had a common bile duct leak, five (6.2%) had a gallbladder fossa leak, four (5%) had a common hepatic duct leak and the remaining two (2.5%) had a left hepatic duct leak. All 80 patients underwent biliary stenting as part of management for their bile leak. Fifty-seven of the 80 patients (71.2%) had a 10 Fr stent placed, with the remainder undergoing placement of a 7 Fr stent. Seventy-five (93.7%) patients underwent biliary sphincterotomy during the initial ERC. Sixty-nine patients underwent repeat ERC after a mean duration of 8.2 weeks (range 0.4 to 18.5 weeks). Eleven patients had no reviewable records regarding a repeat procedure performed for stent removal. Three patients required an early repeat ERC due to suspicion of cholangitis and, hence, were excluded from the final analysis. Of the 66 patients included in the final analysis, 61 (92.4%) had resolution of their bile leak on repeat ERC. All patients had resolution of their bile leak by the third ERC. Fifteen patients (22.7%) had an abnormality on repeat cholangiography (persistent leak in four, stones in three, sludge in seven, and a combination of leak and stone in one) that required further endoscopic intervention including balloon sweep or additional stenting. CONCLUSION: Although the majority of postcholecystectomy bile leaks resolve after biliary stent placement, a sizeable percentage (22.7%) of patients had abnormalities on subsequent cholangiograms that required further intervention. These findings suggest the need for a repeat ERC at the time of biliary stent removal in the management of postcholecystectomy bile leaks.

Jain, Vishal; Yeasted, Nathan; Pooran, Nakechand

2012-01-01

325

Treatment of Alcoholic Pancreatitis  

Microsoft Academic Search

Chronic pancreatitis is characterized by progressive and irreversible loss of pancreatic exocrine and endocrine function. The majority of cases in the Western world are related to alcohol consumption. Treatment of alcoholic chronic pancreatitis has been difficult, since the mechanisms of disease progression and the causes of pain are poorly understood. The conservative management of chronic pancreatitis focuses on (a) avoidance

Roland H. Pfützer; Alexander Schneider

2005-01-01

326

Coincidental Occurrence of Acute In-stent Thrombosis and Iatrogenic Vessel Perforation During a Wingspan Stent Placement: Management with a Stent In-stent Technique.  

PubMed

We presented a case that an acute in-stent thrombosis after the deployment of a Wingspan stent was successfully managed with a stent in-stent technique. Because vessel perforation and subarachnoid hemorrhage were iatrogenically developed during the procedure, we were unable to use the thrombolytic agents to correct the in-stent thrombosis. When a thrombotic complication following an intracranial stent placement occurs with a coincidentally hemorrhagic complication, the stent in-stent technique should be considered as a treatment option. PMID:22454784

Lee, Sun Joo; Shin, Hee Sup; Lee, Seung Hwan; Koh, Jun Seok

2012-02-29

327

Pancreatic choledochal fistula complicating acute pancreatitis  

PubMed Central

Summary Background: Biliary tract involvement in acute necrotizing pancreatitis is rare. Case Report: We report a case of a 53-year-old man who had a pancreatic choledochal fistula complicating acute necrotizing pancreatitis. The fistula was suspected at computed tomography and confirmed at surgery. The patient underwent necrosectomy, cholecystectomy and proximal biliary diversion. He is well at 1-year follow-up. Conclusions: Simultaneous presence of air in the biliary tree and pancreatic collection is highly suggestive of a pancreaticobiliary fistula. Pancreatic necrosectomy and proximal biliary diversion resulted in closure of the fistula.

Brar, Rahat; Singh, Iqbal; Brar, Preetinder; Prasad, Abhishek; Doley, Rudra Prasad; Wig, Jai Dev

2012-01-01

328

Dopamine in models of alcoholic acute pancreatitis.  

PubMed Central

Acute oedematous pancreatitis and acute haemorrhagic pancreatitis were studied using the low pressure duct perfusion models of alcoholic pancreatitis in cats. After creating either form over 24 hours, each pancreas was histologically graded and assigned an inflammatory score (0-16; absent-severe). Urinary trypsinogen activation peptide concentrations were also used as a measure of severity. Using the model of acute haemorrhagic pancreatitis, it was previously shown that low dose dopamine (5 micrograms/kg.m) reduced the inflammatory score at 24 hours and that this effect was mediated by a reduction in pancreatic microvascular permeability acting via dopaminergic and beta adrenergic receptors. Further studies were conducted and are reported here. In experiment 1 different doses of dopamine in established alcoholic acute haemorrhagic pancreatitis were studied. In group 1 control cats (no dopamine), the inflammatory score was 10.5 (interquartile range (IQR)4). In groups 2, 3, and 4, haemorrhagic pancreatitis was induced. Twelve hours later dopamine was infused for six hours, in the doses of 2 micrograms/kg.min, 5 micrograms/kg.min, and 50 micrograms/kg.min respectively. The inflammatory score in group 2 was 7 (IQR 0.5, p < 0.05 v group 1), in group 3 it was 7 (IQR 2, p < 0.05 v group 1), and in group 4 it was 7 (IQR 4, p < 0.05 v group 1). This was matched by significantly lower levels of urinary tripsinogen activation peptide at 24 hours. In experiment 2 (group 5) we tried to reduce microvascular permeability further by combining dopamine with antihistamines, but there was no improvement in the inflammatory score. As oedematous pancreatitis is the commoner and milder form of acute pancreatitis in clinical practice, in experiment 3 we looked at the effect of dopamine in this model. In group 6 control cats (no treatment), the inflammatory score was 7 (IQR 3, p < 0.05 v group 1). In group 7 cats given dopamine (5 micrograms/kg.min for six hours) from 12 hours after the onset of actue oedematous pancreatitis, the inflammatory score was reduced to 4(IQR 2, p < 0.05 v group 6). This was matched by a significant reduction in the 24 hour urinary tripsin activation peptide concentration.

Karanjia, N D; Widdison, A L; Lutrin, F J; Reber, H A

1994-01-01

329

Basic tips for duct design  

SciTech Connect

During the last few years, ASHRAE Journal and other trade publications have presented lucid descriptions of the basic physics of airflow in ductwork, pressure drop and methods of sizing and optimization (Brooks 1995, Tsal et al. 1988a, Williams 1995). What is missing is a practical means for numerically modeling HVAC duct systems. This article is centered on the performance, economics and modeling of duct systems. Specific subjects examined include duct shape, fitting performance, leakage and appropriate oversizing. Computer modeling is discussed to provide a better grasp as to how it can be used as a practical design tool.

Evans, R.A. [Evans Associates, Richland, WA (United States); Tsal, R.J. [Netsal and Associates, Fountain Valley, CA (United States)

1996-07-01

330

Endoscopic management of chronic pancreatitis.  

PubMed

Chronic pancreatitis (CP) is a common gastrointestinal illness, which affects the quality of life with substantial morbidity and mortality. The management includes medical, endoscopic and surgical approaches with the need for interaction between various specialties, calling for a concerted multidisciplinary approach. However, at the time of this publication, guidelines to establish care of these patients are lacking. This review provides the reader with a comprehensive overview of the studies summarizing the various treatment options available, including medical, surgical and endoscopic options. In addition, technological advances such as endoscopic retrograde cholangiopancreatogrophy, endoscopic shock wave lithotripsy and endoscopic ultrasound can now be offered with reasonable success for pancreatic decompression, stricture dilatation with stent placement, stone fragmentation, pseudocyst drainage, and other endoscopic interventions such as celiac plexus block for pain relief. We emphasize the endoscopic options in this review, and attempt to extract the most up to date information from the current literature. The treatment of CP and its complications are discussed extensively. Complications such as biliary strictures. pancreatic pseudocysts, and chronic pain are common issues that arise as long-term complications of CP. These often require endoscopic or surgical management and possibly a combination of approaches, however choosing amongst the various therapeutic and palliative modalities while weighing the risks and benefits, makes the management of CP challenging. Treatment goals should be not just to control symptoms but also to prevent disease progression. Our aim in this paper is to advocate and emphasize an evidence based approach for the management of CP and associated long term complications. PMID:23330050

Oza, Veeral M; Kahaleh, Michel

2013-01-16

331

Treatment of malignant gastric outlet obstruction with endoscopically placed self-expandable metal stents  

PubMed Central

Malignant gastroduodenal obstruction can occur in up to 20% of patients with primary pancreatic, gastric or duodenal carcinomas. Presenting symptoms include nausea, vomiting, abdominal distention, pain and decreased oral intake which can lead to dehydration, malnutrition, and poor quality of life. Endoscopic stent placement has become the primary therapeutic modality because it is safe, minimally invasive, and a cost-effective option for palliation. Stents can be successfully deployed in the majority of patients. Stent placement appears to lead to a shorter time to symptomatic improvement, shorter time to resumption of an oral diet, and shorter hospital stays as compared with surgical options. Recurrence of the obstructive symptoms resulting from stent occlusion, due to tumor ingrowth or overgrowth, can be successfully treated with repeat endoscopic stent placement in the majority of the cases. Both endoscopic stenting and surgical bypass are considered palliative treatments and, to date, no improvement in survival with either modality has been demonstrated. A tailored therapeutic approach, taking into consideration patient preferences and involving a multidisciplinary team including the therapeutic endoscopist, surgeon, medical oncologist, radiation therapist, and interventional radiologist, should be considered in all cases.

Gaidos, Jill KJ; Draganov, Peter V

2009-01-01

332

Invasive carcinoma derived from branch duct-type IPMN may be a more aggressive neoplasm than that derived from main duct-type IPMN  

PubMed Central

The present study aimed to evaluate the long-term follow-up results of patients with intraductal papillary mucinous neoplasm (IPMN) and to estimate the degree of IPMN malignancy based on pathological and molecular features of resected specimens. The detection rate of IPMN has increased over the last decade; however, the management of this neoplasm remains controversial. This is particularly so for branch duct-type IPMN, which carries a high potential for malignancy and risk of recurrence. We retrospectively reviewed a single institution’s prospective pancreatic resection database to identify IPMN patients who underwent pancreatectomy with curative intent. The clinicopathological variables of 100 patients resected for IPMN were analyzed with a detailed review of histopathological results (borderline lesions, non-invasive carcinoma and invasive carcinoma) to determine the grade of IPMN malignancy based on transforming growth factor (TGF)-?/SMAD4 signaling. The incidence of malignant change was significantly higher in patients with main duct-type IPMN (69.7%) compared with branch duct-type IPMN cases (17.9%). However, patients with an invasive carcinoma had a significantly worse outcome if it was derived from branch duct-type IPMN compared with those derived from main duct-type IPMN, and TGF-? mRNA expression was significantly increased in the former patient group. Immunohistochemistry also showed higher numbers of SMAD4-positive cells in patients with carcinoma derived from branch duct-type IPMN. Our results demonstrated that invasive carcinoma derived from branch duct-type IPMN is more aggressive than that derived from main duct-type IPMN, once invasive morphological change takes place. Determining TGF-? and/or SMAD4 status at initial diagnosis may be useful for stratifying IPMN patients into treatment regimens.

OKABAYASHI, TAKEHIRO; SHIMA, YASUO; KOSAKI, TAKUHIRO; SUMIYOSHI, TATSUAKI; KOZUKI, AKIHITO; IIYAMA, TASTUO; TAKEZAKI, YUKA; KOBAYASHI, MICHIYA; NISHIMORI, ISAO; OGAWA, YASUHIRO; HANAZAKI, KAZUHIRO

2013-01-01

333

Newly developed autoimmune cholangitis without relapse of autoimmune pancreatitis after discontinuing prednisolone  

PubMed Central

A 57-year-old man presented with a 2-wk history of painless jaundice and weight loss. He had a large ill-defined enhancing mass-like lesion in the uncinate process of the pancreas with stricture of the distal common bile duct. Aspiration cytology of the pancreatic mass demonstrated inflammatory cells without evidence of malignancy. Total serum immunoglobulin G level was slightly elevated, but IgG4 level was normal. After the 2-wk 40 mg prednisolone trial, the patient’s symptoms and bilirubin level improved significantly. A follow-up computed tomography (CT) scan showed a dramatic resolution of the pancreatic lesion. A low dose steroid was continued. After six months he self-discontinued prednisolone for 3 wk, and was presented with jaundice again. A CT scan showed newly developed intrahepatic biliary dilatation and marked concentric wall thickening of the common hepatic duct and the proximal common bile duct without pancreatic aggravation. The patient’s IgG4 level was elevated to 2.51 g/L. Prednisolone was started again, after which his serum bilirubin level became normal and the thickening of the bile duct was resolved. This case suggests that autoimmune pancreatitis can progress to other organs that are not involved at the initial diagnosis, even with sustained pancreatic remission.

Kim, Ji Hun; Chang, Jae Hyuck; Nam, Sung Min; Lee, Mi Jeong; Maeng, Il Ho; Park, Jin Young; Im, Yun Sun; Kim, Tae Ho; Kim, Chang Whan; Han, Sok Won

2012-01-01

334

Newly developed autoimmune cholangitis without relapse of autoimmune pancreatitis after discontinuing prednisolone.  

PubMed

A 57-year-old man presented with a 2-wk history of painless jaundice and weight loss. He had a large ill-defined enhancing mass-like lesion in the uncinate process of the pancreas with stricture of the distal common bile duct. Aspiration cytology of the pancreatic mass demonstrated inflammatory cells without evidence of malignancy. Total serum immunoglobulin G level was slightly elevated, but IgG4 level was normal. After the 2-wk 40 mg prednisolone trial, the patient's symptoms and bilirubin level improved significantly. A follow-up computed tomography (CT) scan showed a dramatic resolution of the pancreatic lesion. A low dose steroid was continued. After six months he self-discontinued prednisolone for 3 wk, and was presented with jaundice again. A CT scan showed newly developed intrahepatic biliary dilatation and marked concentric wall thickening of the common hepatic duct and the proximal common bile duct without pancreatic aggravation. The patient's IgG4 level was elevated to 2.51 g/L. Prednisolone was started again, after which his serum bilirubin level became normal and the thickening of the bile duct was resolved. This case suggests that autoimmune pancreatitis can progress to other organs that are not involved at the initial diagnosis, even with sustained pancreatic remission. PMID:23139619

Kim, Ji Hun; Chang, Jae Hyuck; Nam, Sung Min; Lee, Mi Jeong; Maeng, Il Ho; Park, Jin Young; Im, Yun Sun; Kim, Tae Ho; Kim, Chang Whan; Han, Sok Won

2012-11-01

335

Association of oesophageal atresia and cholecystohepatic duct.  

PubMed

A rare hepatobiliary malformation in which the common hepatic duct drains directly into the gallbladder or the cystic duct (cholecystohepatic duct) is described in two children born with oesophageal atresia. Attention is drawn to the rarity of this combination. A brief review of the literature of cholecystohepatic and accessory hepatic ducts is also presented. PMID:9914348

Redkar, R G; Davenport, M; Myers, N; Howard, E R

1999-01-01

336

Longitudinal pancreaticojejunostomy in chronic relapsing pancreatitis with onset in childhood.  

PubMed Central

Despite the rarity of chronic relapsing pancreatitis in children, in the last 15 years at Vanderbilt University Medical Center and its Children's Hospital we have used longitudinal pancreaticojejunostomy in treatment of eight patients whose symptoms began in childhood. Duration of symptoms ranged from 2 to 36 years. Seven of the eight patients had hereditary pancreatitis. Recurrent epigastric pain was characteristic and serum amylase was elevated in all patients on admission or shortly thereafter. Demonstration of an obstructed dilated pancreatic duct in all and stones in seven of eight patients by operative pancreatography in three early patients and by endoscopic retrograde cholangiopancreatography (ERCP) in five others established the therapeutic problem and facilitated treatment by removal of stones and longitudinal pancreaticojejunostomy. Results were uniformly excellent, both in the early postoperative period and in long-range follow-ups. Early diagnosis and early surgical drainage of the obstructed pancreatic duct by longitudinal pancreaticojejunostomy are desirable objectives in chronic relapsing pancreatitis with onset in childhood. Images Fig. 6. Fig. 7. Fig. 8.

Scott, H W; Neblett, W W; O'Neill, J A; Sawyers, J L; Avant, G S; Starnes, V A

1984-01-01

337

Pancreatic Amylase, Plasma Glucose, and Insulin Responses to Propionate or Monensin in Sheep1  

Microsoft Academic Search

Yearling wethers fitted with reentrant bile-pancreatic duct cannulae were in a two-part study of effects of duodenal propionate infusions or increased ruminaI propionate caused by dietary monensin on pancreatic a-amylase secretion and glucose and insulin in blood plasma. Continuous duodenal infusion of propi- onate increased concentrations of glucose and insulin in blood plasma of wethers fed alfalfa. Results supported a

D. D. Johnson; G. E. Mitchell; R. E. Tucker; R. B. Muntifering

1986-01-01

338

Endoscopic retrograde pancreatography criteria to diagnose autoimmune pancreatitis: an international multicentre study  

Microsoft Academic Search

BackgroundCharacteristic pancreatic duct changes on endoscopic retrograde pancreatography (ERP) have been described in autoimmune pancreatitis (AIP). The performance characteristics of ERP to diagnose AIP were determined.MethodsThe study was done in two phases. In phase I, 21 physicians from four centres in Asia, Europe and the USA, unaware of the clinical data or diagnoses, reviewed 40 preselected ERPs of patients with

Aravind Sugumar; Michael J Levy; Terumi Kamisawa; George J M Webster; Myung-Hwan Kim; Felicity Enders; Zahir Amin; Todd H Baron; Mike H Chapman; Nicholas I Church; Jonathan E Clain; Naoto Egawa; Gavin J Johnson; Kazuichi Okazaki; Randall K Pearson; Stephen P Pereira; Bret T Petersen; Samantha Read; Raghuwansh P Sah; Neomal S Sandanayake; Naoki Takahashi; Mark D Topazian; Kazushige Uchida; Santhi Swaroop Vege; Suresh T Chari

2010-01-01

339

Notch2-positive progenitors with the intrinsic ability to give rise to pancreatic ductal cells  

Microsoft Academic Search

Pancreatic adenocarcinomas display foci of duct-like structures that are positive for markers of pancreatic ductal cells. The development of these tumors is promoted by conditions leading to acinar-to-ductal metaplasia, a process by which acinar cells are replaced by ductal cells. Acinar-to-ductal metaplasia has recently been shown to proceed through intermediary cells expressing Nestin. To create an in vitro system to

Kwang M Lee; Hiroaki Yasuda; Michael A Hollingsworth; Michel M Ouellette

2005-01-01

340

Stent evolution for peripheral arterial disease.  

PubMed

Endovascular treatment and stent implantation for peripheral arterial disease have been proposed for over 20 years. However, the first experiments with stainless stents were relatively disappointing. The first improvement consisted in the introduction of nitinol self-expanding stents. This technology allowed an initial improvement of clinical performances, but the first generation of nitinol stents demonstrated a relatively high rate of fractures. Better knowledge of arterial biomechanics and advances in technology allowed to propose a second generation of nitinol stents with improved flexibility, which decreased the rates of fracture. In-stent restenosis related to neointimal hyperplasia has also led to the development of new concepts to improve patency rates after stenting: drug-eluting stents (coated-stents), biodegradable stents, and covered stents. These technologies will help to treat more complex lesions in the future, but we are still waiting for results of ongoing studies. PMID:22433736

Lejay, A; Thaveau, F; Girsowicz, E; Georg, Y; Heim, F; Durand, B; Chakfé, N

2012-02-01

341

What Is Bile Duct Cancer?  

MedlinePLUS

... tiny tubes (ductules) where bile collects from the liver cells. The ductules come together to form small ducts , ... be confused with cancers that start in the liver cells, which are called hepatocellular carcinomas , and are often ...

342

Endoscopic guided single self-linking silicone stent in pediatric external dacryocystorhinostomy.  

PubMed

Abstract Aims: To study the efficacy of a new technique of single self-linking silicone stent exclusively in pediatric external dacryocystorhinostomy (DCR) and to report the new use and advantages of endoscopic guidance for the same. Material and methods: Prospective interventional case series, including 11 eyes of ten patients with nasolacrimal duct obstruction. Data collected included demographic data, clinical presentation, laterality, status of lids and puncta, syringing findings, probing interpretations, types and duration of intubation. Consecutive pediatric patients with post-saccal obstruction who underwent an external dacryocystorhinostomy were included. Exclusion criteria included patients who had undergone a DCR in the past by any route via external, endonasal or transcanalicular. Primary outcome measures were stent retention and ease of stent removal. Secondary outcome measures were anatomic patency of the passage and resolution of symptoms. Results: There were three male and seven female patients. Mean age was 9.4 years (range 6-15). A total of 11 procedures were carried out. Following placement of self-linked stents, the removal was done at a mean duration of 13.2 weeks (range:12-16 weeks). None of the patients had a stent prolapse during this period. All stents were removed in the outpatient without the use of general anesthesia with minimal endoscopic guidance. A minimum follow-up of three months following removal was considered for final analysis. Follow-up ranged from three months to six months after tube removal. The anatomical and functional success rate was 91%. There was one anatomical failure three months following tube removal and the remaining patients were free of symptoms at the last follow-up. Conclusions: Self-linking stents are a useful modality in pediatric patients not only to prevent stent prolapse but also to allow easy removal with minimum discomfort. Endoscopic guidance is a useful addition to this technique. PMID:23418934

Ali, Mohammad Javed; Gupta, Himika; Naik, Milind N; Honavar, Santosh G

2013-02-19

343

Nasal packing and stenting  

PubMed Central

Nasal packs are indispensable in ENT practice. This study reviews current indications, effectiveness and risks of nasal packs and stents. In endoscopic surgery, nasal packs should always have smooth surfaces to minimize mucosal damage, improve wound healing and increase patient comfort. Functional endoscopic endonasal sinus surgery allows the use of modern nasal packs, since pressure is no longer required. So called hemostatic/resorbable materials are a first step in this direction. However, they may lead to adhesions and foreign body reactions in mucosal membranes. Simple occlusion is an effective method for creating a moist milieu for improved wound healing and avoiding dryness. Stenting of the frontal sinus is recommended if surgery fails to produce a wide, physiologically shaped drainage path that is sufficiently covered by intact tissue.

Weber, Rainer K.

2011-01-01

344

Cytoplasmic expression of LGR5 in pancreatic adenocarcinoma.  

PubMed

Background: CD133 has been identified as a cancer stem cell marker for pancreatic ductal adenocarcinoma. Although leucine-rich-repeat-containing G-protein-coupled receptor 5 (LGR5), a marker of intestinal stem cells, has been shown to be on a higher level of the stem cell hierarchy than CD133, the expression and function of LGR5 in pancreatic cancer tissue remains unclear. This study investigated tissue expression of LGR5 and CD133 in resected pancreatic cancer tissue. Methods: LGR5 and CD133 expression was immunohistochemically examined in 9 patients with pancreatic ductal adenocarcinoma who underwent resection. Results: LGR5 was expressed in the cytoplasm of pancreatic cancer cells in 4 of 9 cases. CD133 was not detected in cancerous tissue. In non-neoplastic tissue, LGR5 was expressed in the basolateral membrane of a subset of endocrine cells. Conversely, CD133 was expressed in the apical membrane of small duct cells. Co-localization of LGR5 and CD133 was not found in either neoplastic or non-neoplastic tissue. LGR5 expression in pancreatic cancer cells showed no statistically significant correlation with survival after surgery. Conclusion: We have demonstrated that LGR5 is expressed in the cytoplasm of pancreatic adenocarcinoma cells, and the basolateral membrane of a subset of endocrine cells of the human pancreas. Further investigation is required to clarify any prognostic significance of LGR5 expression. PMID:24133453

Mizuno, Nobumasa; Yatabe, Yasushi; Hara, Kazuo; Hijioka, Susumu; Imaoka, Hiroshi; Shimizu, Yasuhiro; Ko, Shigeru B H; Yamao, Kenji

2013-09-26

345

Clinical Study on Acute Pancreatitis in Pregnancy in 26 Cases  

PubMed Central

Aim. This paper investigated the pathogenesis and treatment strategies of acute pancreatitis (AP) in pregnancy. Methods. We analyzed retrospectively the characteristics, auxiliary diagnosis, treatment strategies, and clinical outcomes of 26 cases of patients with AP in pregnancy. Results. All patients were cured finally. (1) Nine cases of 22 mild acute pancreatitis (MAP) patients selected automatic termination of pregnancy because of the unsatisfied therapeutic efficacy or those patients' requirements. (2) Four cases of all patients were complicated with severe acute pancreatitis (SAP); 2 cases underwent uterine incision delivery while one of them also received cholecystectomy, debridement and drainage of pancreatic necrosis, and percutaneous jejunostomy. One case had a fetal death when complicated with SAP; she had to receive extraction of bile duct stones and drainage of abdominal cavity after induced abortion. The other one case with hyperlipidemic pancreatitis was given induced abortion and hemofiltration. Conclusions. The first choice of MAP in pregnancy is the conventional therapy. Apart from the conventional therapy, we need to terminate pregnancy as early as possible for patients with SAP. Removing biliary calculi and drainage is supposed to be considered for acute biliary pancreatitis. Lowering blood lipids treatment should be applied to hyperlipidemic pancreatitis or given to hemofiltration when necessary.

Qihui, Cheng; Xiping, Zhang; Xianfeng, Ding

2012-01-01

346

Cytoplasmic expression of LGR5 in pancreatic adenocarcinoma  

PubMed Central

Background: CD133 has been identified as a cancer stem cell marker for pancreatic ductal adenocarcinoma. Although leucine-rich-repeat-containing G-protein-coupled receptor 5 (LGR5), a marker of intestinal stem cells, has been shown to be on a higher level of the stem cell hierarchy than CD133, the expression and function of LGR5 in pancreatic cancer tissue remains unclear. This study investigated tissue expression of LGR5 and CD133 in resected pancreatic cancer tissue. Methods: LGR5 and CD133 expression was immunohistochemically examined in 9 patients with pancreatic ductal adenocarcinoma who underwent resection. Results: LGR5 was expressed in the cytoplasm of pancreatic cancer cells in 4 of 9 cases. CD133 was not detected in cancerous tissue. In non-neoplastic tissue, LGR5 was expressed in the basolateral membrane of a subset of endocrine cells. Conversely, CD133 was expressed in the apical membrane of small duct cells. Co-localization of LGR5 and CD133 was not found in either neoplastic or non-neoplastic tissue. LGR5 expression in pancreatic cancer cells showed no statistically significant correlation with survival after surgery. Conclusion: We have demonstrated that LGR5 is expressed in the cytoplasm of pancreatic adenocarcinoma cells, and the basolateral membrane of a subset of endocrine cells of the human pancreas. Further investigation is required to clarify any prognostic significance of LGR5 expression.

Mizuno, Nobumasa; Yatabe, Yasushi; Hara, Kazuo; Hijioka, Susumu; Imaoka, Hiroshi; Shimizu, Yasuhiro; Ko, Shigeru B. H.; Yamao, Kenji

2013-01-01

347

Two New Duct Leakage Tests  

SciTech Connect

Two variations on the tests for duct leakage currently embodied in ASHRAE Standard 152P (Method of Test for Determining the Design and Seasonal Efficiencies of Residential Thermal Distribution Systems) are presented. Procedures are derived for calculating supply and return duct leakage to/from outside using these new variations. Results of these tests are compared with the original ones in Standard 152P on the basis of data collected in three New York State homes.

Andrews, J.W.

1998-12-01

348

TWO NEW DUCT LEAKAGE TESTS  

SciTech Connect

Two variations on the tests for duct leakage currently embodied in ASHRAE Standard 152P (Method of Test for Determining the Design and Seasonal Efficiencies of Residential Thermal Distribution Systems) are presented. Procedures are derived for calculating supply and return duct leakage to/from outside using these new variations. Results of these tests are compared with the original ones in Standard 152P on the basis of data collected in three New York State homes.

ANDREWS,J.W.

1998-12-01

349

Flow duct for nuclear reactors  

DOEpatents

Improved liquid sodium flow ducts for nuclear reactors are described wherein the improvement comprises varying the wall thickness of each of the walls of a polygonal tubular duct structure so that each of the walls is of reduced cross-section along the longitudinal center line and of a greater cross-section along wall junctions with the other walls to form the polygonal tubular configuration.

Straalsund, Jerry L. (Richland, WA)

1978-01-01

350

Controversies around carotid stenting.  

PubMed

In the last 10 years, CAS became an important alternative to surgery. However, many of the trials regarding stroke prevention had controversial requirements regarding the endovascular approach, leading to questionable conclusions. This review critically addresses results from previous randomized studies on efficacy and safety of the first established therapy for carotid artery stenosis, carotid endarterectomy (CEA) compared to the challenger, carotid artery stenting (CAS), as a newer and less invasive endovascular technique. PMID:21618849

Grunwald, I Q; Kühn, A L

351

Behavioral changes in response to feeding pancreatic-like enzymes to exocrine pancreatic insufficiency pigs.  

PubMed

Behavioral changes during pancreatic enzyme therapy have never been studied. The present study investigated behavioral changes in exocrine pancreatic insufficiency (EPI) pigs when their feed was supplemented with pancreatic-like enzymes of microbial origin. A crossover design study was used to test the effect of enzyme supplementation in 2 × 4 EPI pigs that underwent pancreatic duct ligation (PDL). After 40 d of adaptation, the study commenced, comprising 2 control and 2 enzyme feeding periods of 10 d each in sequence. On days 7 and 10 of each experimental period, behavior was monitored for 24 h and feed consumption and BW were recorded. Behavioral observations focused on the pigs' activity-- lying down or passive, or sitting, or standing or active--and were expressed as percentage activity for 24 h. During the adaptation period, BW gain was completely inhibited after PDL whereas for the entire study period, the body weight increased from 10.5 ± 1.1 to 14.0 ± 1.4 kg (P < 0.01). Exocrine pancreatic insufficiency pigs were more active when fed the enzymes (21 vs. 18% per 24 h; P < 0.01). Microbial enzyme supplementation not only improved the growth of the EPI pigs but it also increased their activity. This behavior change contradicts the generally accepted norm that satiety evokes by digestion and subsequent nutrients absorption reduces human or animal motility. PMID:23365403

Pierzynowski, S; Swieboda, P; Filip, R; Szwiec, K; Valverde Piedra, J L; Gruijc, D; Prykhodko, O; Fedkiv, O; Kruszewska, D; Botermans, J; Svendsen, J; Skibo, G; Kovalenko, T; Osadchenko, I; Goncharova, K; Ushakova, G; Weström, B

2012-12-01

352

Natural course of acute pancreatitis  

Microsoft Academic Search

Acute pancreatitis comprises, in terms of clinical, pathologic, biochemical, and bacteriologic data, four entities. Interstitial\\u000a edematous pancreatitis and necrotizing pancreatitis are the most frequent clinical manifestations; pancreatic pseudocyst and\\u000a pancreatic abscess are late complications after necrotizing pancreatitis, developing after 3 to 5 weeks. Determinants of the\\u000a natural course of acute pancreatitis are pancreatic parenchymal necrosis, extrapancreatic retroperitoneal fatty tissue necrosis,

H. G. Beger; B. Rau; J. Mayer; U. Pralle

1997-01-01

353

Expandable metal biliary stenting in patients with recurrent premature polyethylene stent occlusion  

Microsoft Academic Search

OBJECTIVES:Expandable metal stents are currently used to treat biliary tract obstruction. Few data exist on the role of metal stents in patients with recurrent premature plastic biliary stent occlusion. We report our preliminary results using an expandable metal biliary stent with enhanced stent flexibility in this group of patients. Our aim was to assess the efficacy of the Diamond biliary

Krishna Menon; Joseph Romagnuolo; Alan N. Barkun

2001-01-01

354

[Chronic tropical pancreatitis: a case report].  

PubMed

The purpose of this report is to describe a case of tropical calcific pancreatitis (TCP). This disease is specific to tropical regions and constitutes the main cause of chronic pancreatitis in children worldwide. It can also be observed in young adults (2nd and 3rd decade). Shortage of dietary lipids during childhood has been implicated in the development of TCP and mutation of the SPINK1 gene has been cited as a predisposing genetic factor. The underlying pathophysiology of TCP is the same as chronic calcific pancreatitis (CCP) due to alcohol abuse. The main features are a sex ratio of 1, absence of alcohol consumption, occurrence of childhood diabetes in one third of cases, low incidence of acidoketosis, and presence of macro-calcifications especially in ducts. In 10% of cases TCP is complicated by pancreatic carcinoma occurring at an early age, located mainly in the body and tail of the pancreas, and having a less favorable prognosis than primary cancer. Treatment of patients with TCP is the same as for patients with CCP due to alcohol abuse. Prevention depends on improvement of nutritional status of the population. PMID:12910661

Coton, T; Carre, D; Guisset, M; Touze, J-E; Delpy, R; Barea, D

2003-01-01

355

Role of Kasai procedure in surgery of hilar bile duct strictures  

PubMed Central

AIM: To assess the application of the Kasai procedure in the surgical management of hilar bile duct strictures. METHODS: Ten consecutive patients between 2005 and 2011 with hilar bile duct strictures who underwent the Kasai procedure were retrospectively analyzed. Kasai portoenterostomy with the placement of biliary stents was performed in all patients. Clinical characteristics, postoperative complications, and long-term outcomes were analyzed. All patients were followed up for 2-60 mo postoperatively. RESULTS: Patients were classified according to the Bismuth classification of biliary strictures. There were two Bismuth III and eight Bismuth IV lesions. Six lesions were benign and four were malignant. Of the benign lesions, three were due to post-cholecystectomy injury, one to trauma, one to inflammation, and one to inflammatory pseudotumor. Of the malignant lesions, four were due to hilar cholangiocarcinoma. All patients underwent Kasai portoenterostomy with the placement of biliary stents. There were no perioperative deaths. One patient experienced anastomotic leak and was managed conservatively. No other complications occurred perioperatively. During the follow-up period, all patients reported a good quality of life. CONCLUSION: The Kasai procedure combined with biliary stents may be appropriate for patients with hilar biliary stricture that cannot be managed by standard surgical methods.

Gao, Jin-Bo; Bai, Li-Shan; Hu, Zhi-Jian; Wu, Jun-Wei; Chai, Xin-Qun

2011-01-01

356

Advances in Ureteral Stent Design  

Microsoft Academic Search

Ureteral stents are commonly used in urolithiasis patients for relief of obstruction or in association with stone treatments such as ureteroscopy and extracorporeal shock wave lithotripsy. There are currently many different bulk materials and coatings available for the manufacture of ureteral stents, however the ideal material has yet to be discovered. All potential biomaterials must undergo rigorous physical and biocompatibility

Darren T. Beiko; Bodo E. Knudsen; John D. Denstedt

2003-01-01

357

Improved stents for pediatric applications  

Microsoft Academic Search

Balloon expandable intravascular stents have become an integral therapeutic option offered to children and adults with congenital heart disease over the past decade. Initially, the stainless steel Palmaz stent was developed for the treatment of adult peripheral vascular disease but was quickly integrated into the interventional pediatric cardiologist's armamentarium to treat vascular obstructions resistant to conventional balloon angioplasty. Unfortunately, the

John P Cheatham

2001-01-01

358

PATIENT INFORMATION BOOKLET Wingspan™ Stent ...  

Center for Biologics Evaluation and Research (CBER)

Text Version... check to see how the Stent is working for you. ... The majority of people return to work within a few ... card will explain that you have a Stent in your brain. ... More results from www.fda.gov/downloads/advisorycommittees/committeesmeetingmaterials

359

Fatigue and durability of Nitinol stents  

Microsoft Academic Search

Nitinol self-expanding stents are effective in treating peripheral artery disease, including the superficial femoral, carotid, and renal arteries. However, fracture occurrences of up to 50% have been reported in some stents after one year. These stent fractures are likely due to in vivo cyclic displacements. As such, the cyclic fatigue and durability properties of Nitinol-based endovascular stents are discussed in

A. R. Pelton; V. Schroeder; M. R. Mitchell; Xiao-Yan Gong; M. Barney; S. W. Robertson

2008-01-01

360

Treatment of pancreatic cutaneous fistulas with a somatostatin analog.  

PubMed

Five pancreatic cutaneous fistulas were treated by subcutaneous administration of a long-acting synthetic analog of somatostatin, SMS 201-995. Patients included four men and one woman who ranged in age from 52 to 77 years. The fistulas developed after drainage of a pancreatic abscess, biopsy of a pancreatic mass, splenectomies for idiopathic thrombocytopenic purpura and Felty's syndrome, and operative trauma, respectively. Fistula output consisted of 1,000 ml/day of amylase- and lipase-rich fluid in the patient with a pancreatic biopsy. The other four patients had low-output fistulas (100 to 250 ml/day) that had been draining for 1 to 12 months. Direct communication with the pancreatic duct was demonstrated by endoscopic retrograde cholangiopancreatography, sinography, or both in four of the five patients. Fistula output decreased from 340 +/- 376 ml/day to 63 +/- 36 ml/day on the first day of therapy with two daily doses of 0.05 mg SMS 201-995 (p less than 0.03) and to 13 +/- 19 ml/day on the seventh day of therapy (p less than 0.03). Two patients had prompt closure of their fistulas and one closed in 3 months. One patient with chronic pancreatitis and a duct stricture and one patient with recurring infection did not achieve permanent fistula closure with SMS 201-995. Because of its safety, ease of administration, and efficacy in decreasing fistula output, we believe somatostatin analog therapy is beneficial in hastening closure of pancreatic fistulas. PMID:2893556

Prinz, R A; Pickleman, J; Hoffman, J P

1988-01-01

361

Role of platelet-activating factor in pancreatitis-associated acute lung injury in the rat.  

PubMed Central

Acute necrotizing pancreatitis induced by infusion of bile salt into the pancreatic duct in rats is consistently associated with acute lung injury similar to the adult respiratory distress syndrome. The role of platelet-activating factor (PAF) in this pancreatitis-associated remote organ failure (lung injury) was investigated. Pulmonary tissue levels of PAF were increased gradually and reached a level of 1345 +/- 455 pg/g (6 times the control level) at 12 hours after induction of pancreatitis, whereas pancreatic PAF levels were undetectable and blood PAF remained unchanged. This local pulmonary PAF accumulation occurred at approximately the same time as the progression of lung injury. Pulmonary responses detected (i.e., eicosanoid production, leukocytic infiltration, Evan's blue extravasation, beta-glucuronidase release) were attenuated to varying degrees by treatment of rats in which pancreatitis was initiated with the PAF receptor antagonists (WEB2170 and BN52021). Rat lung lavages were examined after a 12-hour course of pancreatitis and no changes in PAF concentration, surfactant content, and phospholipase A2 (PLA2) activity were noted. Intravenous administration of PLA2 promoted pulmonary PAF production in experimental rats with pancreatitis but not in normal rats. This observation indicates that PLA2, which was determined to be elevated in plasma during pancreatitis, may be responsible for the accumulation of PAF in the lung. In conclusion, pancreatitis-associated lung injury appears to result from an endogenous inflammatory response in which PAF may play an important role. Images Figure 1

Zhou, W.; McCollum, M. O.; Levine, B. A.; Olson, M. S.

1992-01-01

362

Hemodynamically Driven Stent Strut Design  

PubMed Central

Stents are deployed to physically reopen stenotic regions of arteries and to restore blood flow. However, inflammation and localized stent thrombosis remain a risk for all current commercial stent designs. Computational fluid dynamics results predict that nonstreamlined stent struts deployed at the arterial surface in contact with flowing blood, regardless of the strut height, promote the creation of proximal and distal flow conditions that are characterized by flow recirculation, low flow (shear) rates, and prolonged particle residence time. Furthermore, low shear rates yield an environment less conducive for endothelialization, while local flow recirculation zones can serve as micro-reaction chambers where procoagulant and pro-inflammatory elements from the blood and vessel wall accumulate. By merging aerodynamic theory with local hemodynamic conditions we propose a streamlined stent strut design that promotes the development of a local flow field free of recirculation zones, which is predicted to inhibit thrombosis and is more conducive for endothelialization.

Jimenez, Juan M.; Davies, Peter F.

2010-01-01

363

Management of an occluded biliary metallic stent  

PubMed Central

In patients with a malignant biliary obstruction who require biliary drainage, a self-expandable metallic stent (SEMS) provides longer patency duration than a plastic stent (PS). Nevertheless, a stent occlusion by tumor ingrowth, tumor overgrowth and biliary sludge may develop. There are several methods to manage occluded SEMS. Endoscopic management is the preferred treatment, whereas percutaneous intervention is an alternative approach. Endoscopic treatment involves mechanical cleaning with a balloon and a second stent insertion as stent-in-stent with either PS or SEMS. Technical feasibility, patient survival and cost-effectiveness are important factors that determine the method of re-drainage and stent selection.

Ridtitid, Wiriyaporn; Rerknimitr, Rungsun

2012-01-01

364

Pancreatic-pleural fistula in chronic pancreatitis.  

PubMed

Pancreatic-pleural fistula is a rare condition and few data related to its diagnosis and treatment are available. A fistulous connection linking the pancreas with the pleura via the diaphragm or mediastinum through the retroperitoneal area is formed. We report on a case with pancreatic-pleural fistula at its early stages in an alcoholic male patient aged 45 years with known chronic pancreatitis. The operation by Roux-en-Y jejuno-pseudocystostomy was followed by chest tube drainage. PMID:22560825

Elkaoui, Hakim; Atoini, Fouad; Bouchentouf, Sidi Mohamed; El Omari, Fatima; Mahi, Mohamed; Ait Ali, Abdelmounaim; Bounaim, Ahmed; Sair, Khalid; Zentar, Aziz

2012-04-04

365

Main Bile Duct Stricture Occurring After Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma  

SciTech Connect

The purpose of this study was to evaluate the clinical course of main bile duct stricture at the hepatic hilum after transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). Among 446 consecutive patients with HCC treated by TACE, main bile duct stricture developed in 18 (4.0%). All imaging and laboratory data, treatment course, and outcomes were retrospectively analyzed. All patients had 1 to 2 tumors measuring 10 to 100 mm in diameter (mean {+-} SD 24.5 {+-} 5.4 mm) near the hepatic hilum fed by the caudate arterial branch (A1) and/or medial segmental artery (A4) of the liver. During the TACE procedure that caused bile duct injury, A1 was embolized in 8, A4 was embolized in 5, and both were embolized in 5 patients. Nine patients (50.0%) had a history of TACE in either A1 or A4. Iodized oil accumulation in the bile duct wall was seen in all patients on computed tomography obtained 1 week later. Bile duct dilatation caused by main bile duct stricture developed in both lobes (n = 9), in the right lobe (n = 3), in the left lobe (n = 4), in segment (S) 2 (n = 1), and in S3 (n = 1). Serum levels of alkaline phosphatase and {gamma}-glutamyltranspeptidase increased in 13 patients. Biloma requiring drainage developed in 2 patients; jaundice developed in 4 patients; and metallic stents were placed in 3 patients. Complications after additional TACE sessions, including biloma (n = 3) and/or jaundice (n = 5), occurred in 7 patients and were treated by additional intervention, including metallic stent placement in 2 patients. After initial TACE of A1 and/or A4, 8 patients (44.4%), including 5 with uncontrollable jaundice or cholangitis, died at 37.9 {+-} 34.9 months after TACE, and 10 (55.6%) have survived for 38.4 {+-} 37.9 months. Selective TACE of A1 and/or A4 carries a risk of main bile duct stricture at the hepatic hilum. Biloma and jaundice are serious complications associated with bile duct strictures.

Miyayama, Shiro, E-mail: s-miyayama@fukui.saiseikai.or.jp; Yamashiro, Masashi; Okuda, Miho; Yoshie, Yuichi; Nakashima, Yoshiko; Ikeno, Hiroshi; Orito, Nobuaki [Fukuiken Saiseikai Hospital, Department of Diagnostic Radiology (Japan); Notsumata, Kazuo; Watanabe, Hiroyuki; Toya, Daisyu; Tanaka, Nobuyoshi [Fukuiken Saiseikai Hospital, Department of Internal Medicine (Japan); Matsui, Osamu [Kanazawa University Graduate School of Medical Science, Department of Radiology (Japan)

2010-12-15

366

Effects of experimental acute pancreatitis in dogs on metabolism of lung surfactant phosphatidylcholine.  

PubMed

Acute haemorrhagic pancreatitis was produced in the dogs by transduodenal injection of autologous bile into the main pancreatic duct. There was no significant change in the activity of three regulatory enzymes of phosphatidylcholine biosynthesis (glycerophosphate acyltransferase, cytidyltransferase and cholinephosphotransferase) in lung; however, there was a 42% decrease in the amount of dipalmitoyl phosphatidylcholine (surfactant) in lung lavage due to acute pancreatitis. The decrease in lavage phospholipid content was associated with 5-fold increase in phospholipase A2 activity of lung lavage, and massive accumulation of osmiophilic spheroid structures in the alveolar space. PMID:3036136

Das, S K; Scott, M T; McCuiston, S

1987-05-29

367

Pancreatic Neoplasms in Carnivorae.  

National Technical Information Service (NTIS)

In 18 cases of pancreatic neoplasms isolated in over 5,000 dissected dog and cat corpses, it was observed that the malignant pancreatic neoplasm, regardless of its histologic structure, had vast lymphogenic and hematogenic metastases. Histologically, the ...

S. M. Morozova I. V. Skorodumova

1975-01-01

368

Effect of stent on radiation dosimetry in an in-stent restenosis model  

Microsoft Academic Search

Purpose: Intravascular brachytherapy is the leading modality being evaluated for treatment of in-stent restenosis. Stent struts may have an effect on the dose distributions of various radiation sources. We evaluated dosimetry in a stented coronary artery model using a variety of beta and gamma sources and stent materials.Methods: We determined the dose distributions with and without stent in the in-stent

Pei Fan; Sou-Tung Chiu-Tsao; Neil Suresh Patel; Allen Shih; Kumar Ravi; Warren Sherman; Hung-Sheng Tsao; Julianna Pisch; Louis B. Harrison

2001-01-01

369

Problems of pancreatitis  

Microsoft Academic Search

Pancreatitis is not one disease but several and perhaps many. Diagnosis is imperfect in all forms and the usual lack of histologic\\u000a material has hampered attempts to understand the pathogenesis and possible interrelationships of the different forms of pancreatic\\u000a inflammation. Acute pancreatitis does not as a rule evolve into chronic pancreatitis, even after multiple recurrences. Recurrent\\u000a acute attacks can be

Andrew L. Warshaw

1986-01-01

370

Vertebral body stenting  

Microsoft Academic Search

Zusammenfassung  \\u000a Ziel der Studie war es, eine Methode zur minimal-invasiven Reposition und Aufrichtung frakturierter Wirbelkrper zu entwickeln.\\u000a \\u000a \\u000a \\u000a \\u000a Methoden. 7 humane Lendenwirbelkrper wurden unter axialer Last bis zur Frakturgrenze belastet und die Kompressionscharakteristik erfasst.\\u000a Anschlieend erfolgte Bildwandler-gesteuert die transpedikulre Einfhrung zweier mit Stents armierter Ballonkatheter, welche\\u000a unter BV-Kontrolle bis zum Erreichen der ursprnglichen Wirbelkrperform mit Kontrastmittel dilatiert wurden. Danach erfolgte\\u000a die

S. Fürderer; M. Anders; B. Schwindling; M. Salick; C. Düber; K. Wenda; R. Urban; M. Glück; P. Eysel

2002-01-01

371

[Stenting in acute stroke].  

PubMed

Hemodynamic impairment caused by pseudo-occlusion or occlusion of the internal carotid artery (ICA) is a rare etiology of stroke. Acute revascularization of the vessel can restore the flow to the brain. This retrospective study shows that ICA stenting with proximal and distal protection devices in patients with acute stroke and pseudo-occlusion or occlusion of the ICA is technically feasible and can prevent further hemodynamic strokes. In contrast, selected patients have a high risk of reperfusion syndrome with intracranial hemorrhage and peri-interventional monitoring of blood pressure in an ICU is recommended. PMID:15827708

du Mesnil de Rochemont, R; Sitzer, M; Zanella, F E; Berkefeld, J

2005-05-01

372

Notch-mediated patterning and cell fate allocation of pancreatic progenitor cells  

PubMed Central

Early pancreatic morphogenesis is characterized by the transformation of an uncommitted pool of pancreatic progenitor cells into a branched pancreatic epithelium that consists of ‘tip’ and ‘trunk’ domains. These domains have distinct molecular signatures and differentiate into distinct pancreatic cell lineages. Cells at the branched tips of the epithelium develop into acinar cells, whereas cells in the trunk subcompartment differentiate into endocrine and duct cells. Recent genetic analyses have highlighted the role of key transcriptional regulators in the specification of these subcompartments. Here, we analyzed in mice the role of Notch signaling in the patterning of multipotent pancreatic progenitor cells through mosaic overexpression of a Notch signaling antagonist, dominant-negative mastermind-like 1, resulting in a mixture of wild-type and Notch-suppressed pancreatic progenitor cells. We find that attenuation of Notch signaling has pronounced patterning effects on multipotent pancreatic progenitor cells prior to terminal differentiation. Relative to the wild-type cells, the Notch-suppressed cells lose trunk marker genes and gain expression of tip marker genes. The Notch-suppressed cells subsequently differentiate into acinar cells, whereas duct and endocrine populations are formed predominantly from the wild-type cells. Mechanistically, these observations could be explained by a requirement of Notch for the expression of the trunk determination gene Nkx6.1. This was supported by the finding of direct binding of RBP-j? to the Nkx6.1 proximal promoter.

Afelik, Solomon; Qu, Xiaoling; Hasrouni, Edy; Bukys, Michael A.; Deering, Tye; Nieuwoudt, Stephan; Rogers, William; MacDonald, Raymond J.; Jensen, Jan

2012-01-01

373

Primary duct closure versus T-tube drainage following exploration of the common bile duct.  

PubMed

T-tube drainage of the common bile duct (CBD) following duct exploration has become standard surgical practice. This randomized prospective study has compared primary closure versus T-tube drainage of the CBD following exploration for calculous disease. Thirty-seven patients underwent primary closure and 26 underwent closure over T-tube. Both groups were comparable in terms of age, indications for surgery, associated illnesses, pre-operative bilirubin, amylase and white cell count. Forty-three per cent of operations were performed by a consultant in the primary closure group and 65% in the T-tube group. There was no significant difference in the duration of operation, incidence of wound infection, surgical or other complications following operation between the two groups. However, the postoperative stay was significantly prolonged in the T-tube group, to a median of 11 days, compared to 8 days in the primary closure group (P = 0.0001). This prolongation in stay was unrelated to whether admission was as an emergency or elective. T-tube drainage of the bile continued for a median of 7 days postoperative, whereas the bile drained via a wound drain in only 13 (35%) of the primary closure group, for a median of 5 days in these 13 patients. Long-term follow up was achieved in 48 patients, by a questionnaire sent at a median of 2.8 years following operation. Abdominal pains following recovery from the operation were experienced by 18% of the primary closure group and 20% of the T-tube group. No patient developed jaundice or pancreatitis, nor needed further biliary surgery following operation.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7980254

Williams, J A; Treacy, P J; Sidey, P; Worthley, C S; Townsend, N C; Russell, E A

1994-12-01

374

An isolated nasolacrimal duct osteoma.  

PubMed

Osteomas of the nose and paranasal sinus are common benign tumors that can extend to surrounding structures and result in orbital or intracranial involvement. Presenting symptoms include facial pain, headache, cerebral symptoms, ocular symptoms, and so on, depending on the location and size of the tumor. They commonly occur within the frontal, ethmoid, maxillary, and sphenoid sinuses; however, there are rare cases of reported osteomas in the nasal cavity, turbinate, or orbit. Our case report describes a patient with nasolacrimal duct osteoma who presented with ipsilateral ocular pain, epiphora, and medial canthal swelling. We performed intranasal dacryocystorhinostomy using a nasal endoscope and removed the lacrimal duct osteoma. This report describes symptoms and management of an isolated nasolacrimal duct stone with a review of the literature. PMID:23851853

Kim, Joo Yeon; Kwon, Jae Hwan

2013-07-01

375

Pancreatic cancer in chronic pancreatitis; aetiology, incidence, and early detection.  

PubMed

Acute pancreatitis, chronic pancreatitis and pancreatic cancer are responsible for most of the burden of exocrine pancreatic disease. Glandular damage from recurrent bouts of acute pancreatitis can lead to irreversible changes characteristic of chronic pancreatitis. In recent decades accumulating evidence has defined longstanding pre-existing chronic pancreatitis as a strong risk factor for pancreatic cancer. The lag period between diagnosis of chronic pancreatitis and pancreatic cancer is usually one or two decades: pancreatitis appearing a year or two before the diagnosis of pancreatic cancer is often the result of tumour-related ductal obstruction. The risk of developing pancreatic cancer appears to be highest in rare types of pancreatitis with an early onset, such as hereditary pancreatitis and tropical pancreatitis. Even though there is a strong link between chronic pancreatitis and pancreatic cancer, over a 20 year period only around five percent of patients with chronic pancreatitis will develop pancreatic cancer. Until the development of more sophisticated screening procedures, screening is not recommended for patients with chronic pancreatitis. PMID:20510834

Raimondi, Sara; Lowenfels, Albert B; Morselli-Labate, Antonio M; Maisonneuve, Patrick; Pezzilli, Raffaele

2010-06-01

376

Acute pancreatitis in pregnancy  

Microsoft Academic Search

OBJECTIVE: Our purpose was to determine the cause and describe the natural history of acute pancreatitis complicating pregnancy and its effect on maternal and perinatal outcomes.STUDY DESIGN: Over the last decade we admitted 43 pregnant women with acute pancreatitis to our hospital. We reviewed presentation, diagnosis, management, and maternal and perinatal outcomes.RESULTS: The incidence of acute pancreatitis was one in

Kirk D. Ramin; Susan M. Ramin; Sherrie D. Richey; F. Gary Cunningham

1995-01-01

377

Classification of pancreatitis  

Microsoft Academic Search

An international group of doctors interested in pancreatic disease met in Cambridge in March 1983, under the auspices of the Pancreatic Society of Great Britain and Ireland, to discuss the classification of pancreatitis in the light of developments that have taken place in the 20 years since the crucial conference in Marseille.

M Sarner; P B Cotton

1984-01-01

378

Colonic stents in colorectal obstruction.  

PubMed

Obstruction is the presenting symptom of colorectal cancer in up to 40 per cent of patients. Benign strictures and other neoplasms including lymphoma and gynecologic tumors occur as well. Emergent operative therapy is often suboptimal and associated with significant morbidity and mortality. Our objective was to review our experience with stent placement for colonic obstruction. Seven patients underwent stent placement for a total of eight procedures. There were three patients with unresectable colorectal cancer, two patients with metastatic gynecologic cancer, one patient with rectal lymphoma, and one patient with metastatic cancer of unknown primary. All colonic stents were Wallstents placed by the same endoscopist under fluoroscopic and endoscopic guidance. Stents were successfully placed in all patients without complication. One patient underwent placement of two stents in succession for a long stenosis. Six of seven patients (86%) had resolution of the obstruction and return of bowel function. Five of seven were tolerating a diet within 24 hours. One patient's mental status did not allow for oral intake. Four patients were discharged within 48 hours. Two patients died within the same hospitalization as a result of metastatic disease. One patient was found to have multilevel disease requiring stoma placement. There was no morbidity or mortality associated with stent placement, and 86 per cent of patients had palliation of the obstruction. We conclude that colonic stent placement is a safe and effective therapy for colorectal obstruction at this institution. PMID:9764708

Arnell, T; Stamos, M J; Takahashi, P; Ojha, S; Sze, G; Eysselein, V

1998-10-01

379

Late bare metal stent thrombosis.  

PubMed

Late stent thrombosis is very rare in bare metal stents. We report on a 72-year-old male patient who developed late thrombosis of a bare metal stent implanted in the left main coronary artery (LMCA). The patient presented with cardiogenic shock 350 days after the first stent implantation. Coronary angiography showed total occlusion of the stent. Following the first balloon predilatation of the lesion, a flow in the LMCA was observed, but there was no flow in the left anterior descending (LAD) artery. Then, a bare metal stent was implanted into the LAD. Although the flow was maintained and all inotropic support continued, hypotension persisted. Angiography of the right coronary artery demonstrated 90% stenosis at the same location which had been observed as a noncritical lesion during the first percutaneous coronary intervention. As the patient was in shock, the right coronary artery was also stented and TIMI 3 flow was obtained. However, the patient developed cardiac arrest and died despite repeated efforts of cardiopulmonary resuscitation. It was learned that the patient had undergone an urological operation for bladder stone nine days before, for which both aspirin and clopidogrel were discontinued six days before the operation. Only aspirin was reinitiated three days after the procedure. He then presented to our hospital with cardiogenic shock on his first day after discharge. PMID:21200123

Oduncu, Vecih; Erkol, Ayhan; Tanbo?a, Ibrahim Halil; K?rma, Cevat

2010-09-01

380

Metachronous pancreatic head ductal carcinoma three years after resection of gallbladder cancer  

PubMed Central

We report a rare case of female patient with metachronous gallbladder cancer and pancreatic head ductal carcinoma. At the age of 53 years, the patient underwent a cholecystectomy and resection of the liver bed for gallbladder cancer. The post-operation diagnosis was a well-differentiated adenocarcinoma with serosa involvement(T3N0M0, stage IIA). Three years later, an irregular and enhanced 2.4 cm mass in the pancreatic head with obviously pancreatic duct dilated was found by abdominal imaging. We considered it as pancreatic head cancer and performed pancreaticoduodenectomy. The histological diagnosis was a pancreatic ductal carcinoma (T2N0M0, stage I). No recurrence was found after thirty-three months follow up.

Chen, Dingwei; Yan, Jiafei; Mou, Yiping

2013-01-01

381

Pathogenesis of Chronic Pancreatitis: An Evidence-Based Review of Past Theories and Recent Developments  

Microsoft Academic Search

In the past several decades, four prominent theories of chronic pancreatitis pathogenesis have emerged: the toxic-metabolic theory, the oxidative stress hypothesis, the stone and duct obstruction theory, and the necrosis-fibrosis hypothesis. Although these traditional theories are formulated based on compelling scientific observations, substantial contradictory data also exist for each. Furthermore, the basic premises of some of these theories are directly

Tyler Stevens; Darwin L. Conwell; Gregory Zuccaro

2004-01-01

382

Pancreatic Stem/Progenitor Cells for the Treatment of Diabetes  

PubMed Central

Patients with type 1 diabetes, and most patients with type 2 diabetes, have associated hyperglycemia due to the absence or reduction of insulin production by pancreatic ?-cells. Surgical resection of the pancreas may also cause insulin-dependent diabetes depending on the size of the remaining pancreas. Insulin therapy has greatly improved the quality of life of diabetic patients, but this method is inaccurate and requires lifelong treatment that only mitigates the symptoms. The successes achieved over the last few decades by the transplantation of whole pancreas and isolated islets suggest that diabetes can be cured by the replenishment of deficient ?-cells. These observations are proof-of-principle and have intensified interest in treating diabetes by cell transplantation, and by the use of stem cells. Pancreatic stem/progenitor cells could be one of the sources for the treatment of diabetes. Islet neogenesis, the budding of new islets from pancreatic stem/progenitor cells located in or near pancreatic ducts, has long been assumed to be an active process in the postnatal pancreas. Several in vitro studies have shown that insulin-producing cells can be generated from adult pancreatic ductal tissues. Acinar cells may also be a potential source for differentiation into insulin-producing cells. This review describes recent progress on pancreatic stem/progenitor cell research for the treatment of diabetes.

Noguchi, Hirofumi

2010-01-01

383

Autoimmune pancreatitis characterized by predominant CD8+ T lymphocyte infiltration  

PubMed Central

Autoimmune pancreatitis (AIP) is a rare form of pancreatitis characterized by prominent lymphocyte infiltration and pancreatic fibrosis resulting in organ dysfunction. The pathogenesis and pathology of AIP remain unknown. A 64-year-old Chinese man presented with symptoms and signs of bile duct obstruction diffuse enlargement of the head of pancreas, elevated IgG levels, and negative autoimmune antibody responses. A pylorus-preserving pancreatoduodenectomy was performed and a pancreatic tumor was suspected. However, periductal lymphoplasmacytic infiltration and fibrosis were found in the head of pancreas and nearby organs instead of tumor cells. Four months after surgery, the patient was readmitted because of reoccurrence of severe jaundice and sustained abdominal distension. Prednisone 30 mg/d was administered orally as an AIP was suspected. One and a half months later, the symptoms of the patient disappeared, and globulin, aminotransferase and bilirubin levels decreased significantly. Over a 9-mo follow-up period, the dose of prednisone was gradually decreased to 10 mg/d and the patient remained in good condition. We further demonstrated dominant CD3+/CD8+ populations, CD20+ cells and a few CD4+ cells in the pancreatic parenchyma, duodenum and gallbladder wall by immunohistochemical assay. This AIP case presented with significant CD8+ T lymphocyte infiltration in the pancreas and extra-pancreatic lesions, indicating that this cell population may be more important in mediating AIP pathogenesis than previously known and that AIP might be a poorly defined autoimmune disease with heterogeneous pathogenesis.

Li, She-Yu; Huang, Xiang-Yang; Chen, Yong-Tao; Liu, Yi; Zhao, Sha

2011-01-01

384

Bile Duct (Cholangiocarcinoma) Cancer: Radiation Therapy  

MedlinePLUS

... cancer Next Topic Chemotherapy for bile duct cancer Radiation therapy for bile duct cancer Radiation therapy is ... are different kinds of radiation therapy. External beam radiation therapy (EBRT) This type of radiation therapy uses ...

385

Tests of Modified Radiosonde Hygristor Duct.  

National Technical Information Service (NTIS)

To evaluate a modified configuration of the National Weather Service's radiosonde humidity duct, wind tunnel and flight tests were made by the Sea-Air Interaction Laboratory. These tests show that the new duct virtually eliminates the solar heating proble...

W. W. Shinners G. E. Putland P. B. Conners

1971-01-01

386

Duct Remediation Program: Remediation operations and implementation.  

National Technical Information Service (NTIS)

Plutonium holdup material has accumulated in the process ventilation duct systems at Rocky Flats. Non-Destructive Assay (NDA) measurements identified ducts containing this material. The Defense Nuclear Facility Safety Board and the Department of Energy es...

T. Beckman M. M. Davis T. M. Karas

1992-01-01

387

The quandary of preresection biliary drainage for pancreatic cancer.  

PubMed

Surgery in patients with obstructive jaundice caused by a tumor in the pancreatic head area is associated with a higher risk of postoperative complications. Preoperative biliary drainage was introduced in an attempt to improve the general condition and reduce morbidity and mortality. Extensive experimental studies have been performed to analyze the beneficial effect of biliary drainage and showed improvement in liver function, nutritional status, and cell-mediated immune function as well as reduction in mortality. However, despite the results seen in the experimental studies, clinical studies reported both beneficial and adverse effects, and most studies advised against routinely performing preoperative biliary drainage. To add clarity to the ongoing controversy, a recent randomized controlled trial was performed and reported more overall complications in patients with jaundice who underwent preoperative biliary drainage followed by surgery compared to those who underwent surgery alone. Many of these complications were stent related. Like most clinical studies, a plastic stent was used to initiate biliary drainage. Patients with jaundice because of a tumor in the pancreatic head area without locoregional irresectability or metastases should be candidates for early surgery. Preoperative biliary drainage should not be performed routinely. However, some selected patients might benefit from preoperative biliary drainage, in cases of severe jaundice, neoadjuvant therapy, or postponed surgery due to logistics. In these cases, the use of metal biliary stents is indicated. PMID:23187841

Tol, Johanna A M G; Busch, Olivier R C; van der Gaag, Niels A; van Gulik, Thomas M; Gouma, Dirk J

388

Nodal and lefty signaling regulates the growth of pancreatic cells.  

PubMed

Nodal and its antagonist, Lefty, are important mediators specifying the laterality of the organs during embryogenesis. Nodal signals through activin receptors in the presence of its co-receptor, Cripto. In the present study, we investigated the possible roles of Nodal and Lefty signaling during islet development and regeneration. We found that both Nodal and Lefty are expressed in the pancreas during embryogenesis and islet regeneration. In vitro studies demonstrated that Nodal inhibits, whereas Lefty enhances, the proliferation of a pancreatic cell line. In addition, we showed that Lefty-1 activates MAPK and Akt phosphorylation in these cells. In vivo blockade of endogenous Lefty using neutralizing Lefty-1 monoclonal antibody results in a significantly decreased proliferation of duct epithelial cells during islet regeneration. This is the first study to decipher the expression and function of Nodal and Lefty in pancreatic growth. Importantly, our results highlight a novel function of Nodal-Lefty signaling in the regulation of expansion of pancreatic cells. PMID:18393305

Zhang, You-Qing; Sterling, Lori; Stotland, Aleksandr; Hua, Hong; Kritzik, Marcie; Sarvetnick, Nora

2008-05-01

389

Prospective risk of pancreatic cancer in familial pancreatic cancer kindreds  

Microsoft Academic Search

Individuals with a family history of pancreatic cancer have an in- creased risk of developing pancreatic cancer. Quantification of this risk provides a rational basis for cancer risk counseling and for screening for early pancreatic cancer. In a prospective registry-based study, we esti- mated the risk of pancreatic cancer in individuals with a family history of pancreatic cancer. Standardized incidence

Alison P. Klein; Kieran A. Brune; Gloria M. Petersen; Michael Goggins; Anne C. Tersmette; G. J. A. Offerhaus; C. Griffin; J. L. Cameron; C. H. J. Yeo; S. Kern; R. H. Hruban

2004-01-01

390

Multifocal lesions with pancreatic atrophy in IgG4-related autoimmune pancreatitis: report of a case.  

PubMed

We herein report a case of IgG4-related autoimmune pancreatitis (AIP). A 72-year-old male with jaundice visited our hospital complaining of epigastralgia. A blood chemistry analysis revealed elevated serum levels of total bilirubin and DUPAN-II. Computed tomography (CT) revealed irregularly shaped pancreatic masses with a stricture of the main pancreatic duct (MPD) in the head and tail that were interposed by marked atrophy with MPD dilation in the body. F-18 fluorodeoxyglucose (FDG)-positron emission tomography/CT revealed abnormally intense FDG uptake only at the masses. During surgery, another small tumor was also found in the atrophied body; therefore, a total pancreatectomy was performed under the diagnosis of multiple pancreatic cancers. The histological analysis revealed fibrosis with dense and diffuse infiltrations of lymphocytes and IgG4-positive plasma cells. The pancreatic parenchyma of the body was firmly replaced by fibrosis. AIP can lead to the formation of multiple pancreatic lesions, and thus the correct diagnosis is occasionally difficult to establish in atypical cases. PMID:23549930

Kimura, Akifumi; Yamamoto, Junji; Hatsuse, Kazuo; Aosasa, Suefumi; Nishiyama, Kiyoshi; Maejima, Tadashi; Ogata, Sho; Shimazaki, Hideyuki; Kawaguchi, Atsushi; Hase, Kazuo

2013-04-01

391

Endoscopic versus Surgical Drainage of the Pancreatic Duct in Chronic Pancreatitis  

Microsoft Academic Search

From the Departments of Gastroenter- ology and Hepatology (D.L.C., E.A.J.R., K.H., M.J.B.), Surgery (D.J.G., M.A.B., O.R.B.), Radiology (Y.N., J.S., J.S.L.), and Clinical Epidemiology, Biostatistics, and Bioinformatics (M.G.W.D.), Academic Med- ical Center, Amsterdam. Address reprint requests to Dr. Cahen at the Department of Gastroenterology and Hepatology, Aca- demic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands, or

Djuna L. Cahen; Dirk J. Gouma; Yung Nio; Erik A. J. Rauws; Marja A. Boermeester; Olivier R. Busch; Jaap Stoker; Johan S. Laméris; Marcel G. W. Dijkgraaf; Kees Huibregtse; Marco J. Bruno

2007-01-01

392

Endovascular Stents and Stent-Grafts: Is Heparin Coating Desirable?  

SciTech Connect

Heparins are glycosaminoglycans that, in addition to their anticoagulant activity, have interactions with growth factors and other glycoproteins. These interactions may stimulate neointimal hyperplasia when heparin is delivered locally on stents and stent-grafts. Modifying the structure of heparin to retain anticoagulant activity while minimizing these stimulatory effects on the vascular endothelium is desirable and may be achieved by understanding the relationships between the structure and function of the various parts of the heparin molecule.

Nelson, Stephen R. [Department of Renal Medicine, St. George's Hospital, Blackshaw Road, London SW17 0QT (United Kingdom); Souza, Nandita M. de; Allison, David J. [Department of Imaging, Imperial College School of Medicine, Hammersmith Hospital Campus, Du Cane Road, London W12 0HS (United Kingdom)

2000-07-15

393

Performance Study of a Ducted Fan System  

Microsoft Academic Search

An experimental investigation was completed in the NASA Ames 7- by 10-Foot Wind Tunnel with the objective of determining the performance characteristics of a ducted fan. The model was an annular duct with a 38-in diameter, 10-in chord, and a 5-bladed fixed-pitch fan. Model variations included duct angle of attack, exit vane flap length, flap deflection angle, and duct chord

Anita I. Abrego; Robert W. Bulaga; Chief Engineer

394

Mathematical modeling for the design of porous coronary stents: nano- and microporous stents v. macroporous stents  

NASA Astrophysics Data System (ADS)

Drug delivery polymers play a role in late in-stent thrombosis of first generation drug-eluting coronary stents (DES) via an inflammatory reaction, which contributes to delayed endothelialization seen in patients with late stent thrombosis. Subsequent generation DES have non-polymer based DES whose surface pores serves as a drug reservoir. While drug elution for pores in the nanometer range have been shown to be comparable to polymer-based DES in terms of luminal renarrowing (i.e restenosis), how different pore sizes effect drug elution has not been fully characterized. We hypothesized that drug elution can be characterized with a mathematical model that takes into account the pore size of the stents and molecular characteristics of the eluted drug. Structural data from porous, non-polymer based stents were examined with pore radius ranging from the nanoporous to macroporous range (5 nm to > 10 mm). All stents eluted tacrolimus, sirolimus or paclitaxel. A mathematical model based on Stefan-Maxwell equations describing the mass transport of molecules through a porous media was constructed. A dimensionless number was derived characterizing molecular flux of the drugs through a porous membrane. It was observed that there was exponential rise in molecular flux of the eluted drug with pore sizes greater than 5 micrometers. The molecular characteristics of the eluted drug did not affect the molecular flux. In conclusions, stents in the nano- and microporous range will have similar drug elution profiles while macroporous stents will vary greatly. Careful attention to pore size may significantly enhance the design and efficacy of porous polymer free stents.

Habib, Anwer K.; Finn, Aloke V.

2010-03-01

395

The pathogenesis of chronic pancreatitis.  

PubMed Central

To date, there is no consensus on the evolution of chronic pancreatitis. Comfort's initial proposal of acute pancreatitis progressing to chronic pancreatitis was discarded by protagonists of the 'separate' theory. Sarles thus stresses the de novo evolution of chronic pancreatitis-acinar protein hypersecretion associated with an imbalance of pancreatic stone promoting and inhibiting factors. However, the 'necrosis-fibrosis sequence' hypothesis of Kloppel and Mallet resurrects the probability of acute pancreatitis leading to chronic pancreatitis. Dimagno offers a unifying concept that the degree of acinar injury determines the natural history of pancreatitis. Uninhibited release of toxic free radicals could be a common end point for various aetiologies resulting in acute or chronic pancreatitis. The pathogenesis of chronic calcifying pancreatitis of the tropics is possibly no different from alcoholic chronic pancreatitis. Neurocrine and paracrine mechanisms have been offered to explain pain out of proportion to radiological and histological pancreatic abnormalities in minimal change chronic pancreatitis.

Sidhu, S. S.; Tandon, R. K.

1995-01-01

396

Inherited pancreatic cancer syndromes.  

PubMed

Pancreatic cancer remains one of the most challenging of all cancers. Genetic risk factors are believed to play a major role, but other than genes coding for blood group, genetic risks for sporadic cases remain elusive. However, several germline mutations have been identified that lead to hereditary pancreatic cancer, familial pancreatic cancer, and increased risk for pancreatic cancer as part of a familial cancer syndrome. The most important genes with variants increasing risk for pancreatic cancer include BRCA1, BRCA2, PALB2, ATM, CDKN2A, APC, MLH1, MSH2, MSH6, PMS2, PRSS1, and STK11. Recognition of members of high-risk families is important for understanding pancreatic cancer biology, for recommending risk reduction strategies and, in some cases, initiating cancer surveillance programs. Because the best methods for surveillance have not been established, the recommendation to refer at-risk patients to centers with ongoing research programs in pancreatic cancer surveillance is supported. PMID:23187834

Solomon, Sheila; Das, Siddhartha; Brand, Randall; Whitcomb, David C

397

Double-duct liquid metal magnetohydrodynamic engine  

Microsoft Academic Search

An internal combustion, liquid metal (LM) magnetohydrodynamic (MHD) engine and an alternating current (AC) magnetohydrodynamic generator, are used in combination to provide useful AC electric energy output. The engine design has four pistons and a double duct configuration, with each duct containing sodium potassium liquid metal confined between free pistons located at either end of the duct. The liquid metal

Haaland; Carsten M

1997-01-01

398

Rena Ventilationskanaler (Particle Deposition in Supply Ducts).  

National Technical Information Service (NTIS)

HVAC duct systems have been reported as a source of indoor air pollutants. The project consisted of two main parts. A theoretical study of the mechanism of particle deposition in a duct system and field measurements of supply air ducts in five HVAC system...

J. I. Fransson S. H. Ruud L. Rosell

1995-01-01

399

Fluidic-Driven Ducted Heat Ejector  

Microsoft Academic Search

Unsteady, small-scale fluid mechanics and heat transport processes within a high-aspect ratio ducted heat ejector are investigated experimentally. The ducted heat ejector exploits the flow that is induced within the channel by the motion of a vibrating reed to cool the inner surfaces of the duct walls and thereby transport heat across its boundaries to cool electronic hardware by direct

D. Gerty

2005-01-01

400

Genome-wide profiling of methylated promoters in pancreatic adenocarcinoma  

PubMed Central

Many genes undergo aberrant methylation in human cancers, and microarray platforms enable more comprehensive profiling of aberrant DNA methylation patterns. Results 1,010 of 87,922 probes on the 88 K promoter array (606 genes) had a higher signal (log2 > 2) in the pancreatic cancer line, Panc-1 compared to the non-neoplastic pancreatic duct line, HPDE. Using this cut-off, bisulfite sequencing and/or MSP confirmed differential methylation of all 27 genes (66 probes) predicted to be methylated by the MCA array. More than half of the genes aberrantly hypermethylated in Panc-1 were not expressed in the pancreatic duct (HPDE) by expression array analysis. Using the 244 K CpG island array, 1,968 CpG islands were differentially methylated in MiaPaca2 compared to normal pancreas. The MCA method was more likely to identify hypermethylation within CpG islands than a cocktail of methylation sensitive restriction enzymes. DNA methylation profiles using 10 ng of DNA were highly correlated with those obtained using 5 µg of DNA (R2 = 0.98). Analysis of 57 pancreatic cancers and 34 normal pancreata using MSP identified MDFI, hsa-miR-9-1, ZNF415, CNTNAP2 and ELOVL4 as methylated in 96%, 89%, 86%, 82% and 68% of the cancers vs. 9%, 15%, 6%, 3% and 9% of normal pancreata, respectively. Methods We used methylated CpG island amplification (MCA) and Agilent promoter and CpG island microarrays to identify differential DNA methylation patterns in pancreatic cancer vs. normal pancreas. We examined MCA array reproducibility, compared it to methylation profiles obtained using a cocktail of methylation-sensitive restriction enzymes and examined gene expression of methylated genes. Conclusion Promoter and CpG island array analysis finds aberrant methylation of hundreds of promoters and CpG islands in pancreatic cancer cells.

Omura, Noriyuki; Li, Chung-Pin; Li, Ang; Hong, Seung-Mo; Walter, Kimberly; Jimeno, Antonio; Hidalgo, Manuel; Goggins, Michael

2009-01-01

401

Duct injection technology prototype development  

SciTech Connect

This report describes a test program conducted to determine the corrosion rate of materials in the dry scrubber or duct injection systems. Four materials were evaluated: 1010 carbon steel, Corten, 317SS and Hastelloy C-276. The results show that acidic conditions result in higher corrosion rates than alkaline conditions for all the materials. The carbon steel, Corten and stainless steel show moderate to heavy pitting attack in the acidic environment. For the alkaline conditions, the corrosion rates of carbon steel and Corten were higher than the stainless steel or Hastelloy C-276. Also, the corrosion rate of abraded specimens were four time those of unabraded specimens in the flue gas. It is probable that areas of wall-wetting and plugging in the duct injection process will exhibit high rates of corrosion for the carbon steel, Corten, and stainless steel materials. General corrosion and pitting corrosion will predominate. Additionally, abraded duct areas will corrode at a significantly higher rate than unabraded duct materials. 6 refs., 11 figs., 7 tabs.

Harper, S.L. (Babcock and Wilcox Co., Alliance, OH (United States). Research and Development Div.)

1991-08-01

402

AFT FAN DUCT ACOUSTIC RADIATION  

Microsoft Academic Search

A finite element code has been developed for the prediction of the radiated acoustic field from the aft fan duct of a turbofan engine. The acoustic field is modelled based on the assumption that the steady flow in and around the nacelle is irrotational as is the acoustic perturbation. The geometry of the nacelle is axisymmetric and the acoustic source

W. Eversman; D. Okunbor

1998-01-01

403

Ducted Propeller Design and Analysis.  

National Technical Information Service (NTIS)

The theory and implementation of the design of a ducted propeller blade are presented and discussed. Straightener (anti-torque) vane design is also discussed. Comparisons are made to an existing propeller design and the results and performance of two exam...

R. J. Weir

1987-01-01

404

Ducted propeller design and analysis  

Microsoft Academic Search

The theory and implementation of the design of a ducted propeller blade are presented and discussed. Straightener (anti-torque) vane design is also discussed. Comparisons are made to an existing propeller design and the results and performance of two example propeller blades are given. The inflow velocity at the propeller plane is given special attention and two dimensionless parameters independent of

1987-01-01

405

[Percutaneous diagnosis and therapy of the bile ducts and gallbladder. Feasibility and status].  

PubMed

Percutaneous transhepatic access to the bile duct has opened up new possibilities not only for diagnosis by means of cholangiography and cholangioscopy with endoscopically guided biopsy by small-bore equipment, but also for the treatment of benign and malignant obstructive jaundice. In malignant disease recanalization of the obstruction is possible by means of laser, intracavitary irritation, internal bile drainage in Klatskin tumors, large-diameter endoprostheses (e.g., a Y-shaped prosthesis) or metal stents. In benign disease, balloon dilatation of inflammatory stenoses, stone extractions from the bile duct or gallbladder by means of Dormia baskets, ultrasound or piezoelectric shockwave-contact lithotripsy and chemical litholysis are possible. Very often percutaneous access is a real alternative to surgical intervention. PMID:2041867

Hauenstein, K H; Wimmer, B; Salm, R; Farthmann, E H

1991-03-01

406

Effect of modern analgesic drugs (tramadol, pentazocine, and buprenorphine) on the bile duct sphincter in man.  

PubMed Central

Modern narcotic analgesic drugs, such as tramadol, pentazocine, and buprenorphine share similarities of molecular structure with morphine which is widely believed to cause spasm of the bile duct sphincter and so impede bile flow. This study assessed the effects of intravenously administered analgesics on bile duct sphincter motor activity measured by ERCP manometry. Ten minutes after pentazocine injection the duration of contractions and baseline pressure of the bile duct sphincter rose from 6.2 +/- 0.2 to 8.2 +/- 0.27 s and from 5.1 +/- 0.6 to 8.8 +/- 0.4 mmHg respectively. Tramadol, buprenorphine and saline showed no such effect. These data indicated that the effects of such drugs on bile duct sphincter function can be safely assessed by ERCP manometry and that pentazocine adversely affects the bile duct sphincter, whilst tramadol and buprenorphine do not. We consider therefore that pentazocine is not the premedication of first choice for endoscopic procedures involving the sphincter of Oddi and should also be avoided in patients with pancreatic and biliary disorders.

Staritz, M; Poralla, T; Manns, M; Meyer Zum Buschenfelde, K H

1986-01-01

407