Note: This page contains sample records for the topic pancreatic duct stent from Science.gov.
While these samples are representative of the content of Science.gov,
they are not comprehensive nor are they the most current set.
We encourage you to perform a real-time search of Science.gov
to obtain the most current and comprehensive results.
Last update: August 15, 2014.
1

Internal pancreatic stent causing irreversible dilatation of pancreatic duct.  

PubMed

A 28-year-old woman underwent a pylorus preserving Whipple procedure for pancreatic serous cystadenoma located on the head of the pancreas. During the operation, an internal stent (7F silastic catheter, 9 cm in length) was placed within the pancreatic duct in the area of pancreaticojejunal end-to-end Dunking type anastomosis to prevent development of fistula. The stent was positioned so that one third of its length would lie into the pancreatic duct, and it was anchored to the periductal pancreatic tissue with only one rapidly absorbable chromic suture. Leakage from the anastomosis was not observed, and she was discharged without any complaint. Early postoperative abdominal CT examination revealed that the stent was retained within the normal caliber pancreatic duct (Fig. 1a). Six months after the operation, she began to complain to epigastric pain triggered by the meals. The laboratory analysis was normal, particularly liver biochemical tests and serum amylase. The internal pancreatic stent within the dilated pancreatic duct was detected by an additional CT examination (Fig. 1b). The stent was removed endoscopically at the third attempt. The pain was resolved after its removal. Control CT examination which was taken at the 18th month after removal of the stent showed dilatation of the pancreatic duct (Fig. 2a). The patient remained free of any complaint, although regressed pancreatic duct dilatation has persisted over 4 years of follow-up (Fig. 2b). PMID:24799775

Hasbahceci, Mustafa; Erol, Cengiz

2014-02-01

2

Role of pancreatic duct stenting in the treatment of chronic pancreatitis  

Microsoft Academic Search

Background: Endoscopic retrograde cholangiopancreatography and stent placement are relatively new alternatives to surgery for the treatment of chronic pancreatitis. The objective of this study was to determine the efficacy of pancreatic duct stent placement for the treatment of chronic pancreatitis. Methods: This study included 89 patients treated with pancreatic stents between 1993 and 2002. The patients were contacted via telephone

G. C. Vitale; K. Cothron; E. A. Vitale; N. Rangnekar; C. M. Zavaleta; G. M. Larson; J. Binford; B. Hammond

2004-01-01

3

Can pancreatic duct stenting prevent post-ERCP pancreatitis in patients who undergo pancreatic duct guidewire placement for achieving selective biliary cannulation? A prospective randomized controlled trial  

Microsoft Academic Search

Background  Although pancreatic duct guidewire placement (P-GW) for achieving selective biliary cannulation is reported to be effective\\u000a in patients in whom endoscopic retrograde cholangiopancreatography (ERCP) is difficult, this technique entails a possible\\u000a increased risk of post-ERCP pancreatitis. We conducted a prospective randomized controlled trial to evaluate the prophylactic\\u000a effect of pancreatic duct stenting on the frequency of post-ERCP pancreatitis in patients

Kei Ito; Naotaka Fujita; Yutaka Noda; Go Kobayashi; Takashi Obana; Jun Horaguchi; Osamu Takasawa; Shinsuke Koshita; Yoshihide Kanno; Takahisa Ogawa

2010-01-01

4

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

5

Covered Metal Stenting for Malignant Lower Biliary Stricture with Pancreatic Duct Obstruction: Is Endoscopic Sphincterotomy Needed?  

PubMed Central

Aims. To evaluate the need for endoscopic sphincterotomy (EST) before covered self-expandable metal stent (CSEMS) deployment for malignant lower biliary stricture with pancreatic duct obstruction. Methods. This study included 79 patients who underwent CSEMS deployment for unresectable malignant lower biliary stricture with pancreatic duct obstruction. Treatment outcomes and complications were compared between 38 patients with EST before CSEMS deployment (EST group) and 41 without EST (non-EST group). Results. The technical success rates were 100% in both the EST and the non-EST group. The incidence of pancreatitis was 2.6% in the EST, and 2.4% in the non-EST group (P = 0.51). The incidences of overall complications were 18.4% and 14.6%, respectively, (P = 0.65). Within the non-EST groups, the incidence of pancreatitis was 0% in patients with fully covered stent deployment and 3.6% in those with partially covered stent deployment (P = 0.69). In the multivariate analysis, younger age (P = 0.003, OR 12) and nonpancreatic cancer (P = 0.001, OR 24) were significant risk factors for overall complications after CSEMS deployment. EST was not identified as a risk factor. Conclusions. EST did not reduce the incidence of pancreatitis after CSEMS deployment in patients of unresectable distal malignant obstruction with pancreatic duct obstruction.

Nakahara, Kazunari; Okuse, Chiaki; Suetani, Keigo; Michikawa, Yosuke; Kobayashi, Shinjiro; Otsubo, Takehito; Itoh, Fumio

2013-01-01

6

Treatment of Common Bile Duct Obstruction by Pancreatic Cancer Using Various Stents: Single-Center Experience  

SciTech Connect

Purpose: To compare the effectiveness of various means of stenting in patients with biliary obstruction caused by pancreatic cancer in a retrospective analysis. Methods: Sixty-two patients with biliary obstruction due to unresectable pancreatic cancer underwent biliary stenting. On the basis of the findings obtained by percutaneous transhepatic cholangiography(10 patients) and endoscopic retrograde cholangiography (52 patients),the site of obstruction was distal to the hilar confluence,predominantly especially in the middle to lower third of the common bile duct. Polyurethane-covered Wallstents (9 mm in diameter) we reinserted in 13 patients, while uncovered Wallstents (10 mm in diameter)were used in 10 patients and plastic stents (10 Fr and 12 Fr) were used in 39 patients. Results: Stenting was successful in 34 patients (87.2%) treated with plastic stents and in 22 patients(95.7%) treated with Wallstents. Effective biliary drainage was achieved in 32 out of 34 patients (94.1%) treated with plastic stents and in 21 out of 22 patients (95.5%) treated with Wallstents. The cumulative patency rate was significantly higher for the uncovered and covered Wallstents compared to plastic stents, but was not significantly higher for covered than for uncovered Wallstents. Stentocclusion occurred in 23 patients (70%; all by clogging) from the plastic stent group, in two patients (22%; by tumor ingrowth) from the uncovered Wallstent group, and in one patient (9%; by clogging) from the covered Wallstent group. The survival rate showed no significant difference among the three stent groups. Conclusion: The Wallstent is effective for long-term palliation in patients with obstruction caused by pancreatic cancer invading the middle to lower part of the common bile duct. The covered Wallstent can prevent tumor ingrowth, a problem with the uncovered Wallstent. However, it may be necessary to take measures to prevent the migration or clogging of covered Wallstents.

Nakamura, Toshifumi; Hirai, Ritsuko; Kitagawa, Mutsuo; Takehira, Yasunori; Yamada, Masami [Department of Gastroenterology, Hamamatsu Medical Center, 328 Tomitsuka-cho, Hamamatsu, Shizuoka (Japan); Tamakoshi, Katsutoshi; Kobayashi, Yoshimasa; Nakamura, Hirotoshi [SecondDepartment of Internal Medicine, Hamamatsu University School ofMedicine, Shizuoka (Japan); Kanamori, Masao [Department of Public Health, HamamatsuUniversity School of Medicine, Shizuoka (Japan)

2002-10-15

7

A Minimally Invasive Alternative for Managing Large Pancreatic Duct Stones Using a Modified Expandable Metal Mesh Stent  

Microsoft Academic Search

Background and Aim: Endoscopic clearance of large or impacted stones in the main pancreatic duct (MPD) remains a clinical challenge. In this study, we attempted to technically modify the metallic stent to facilitate the clearance of large pancreatic stones in 4 patients, hoping to lower the operative risks and shorten hospital stay. Patients and Methods: Four patients with chronic pancreatitis

Xiu-Jiang Yang; Yong Lin; Xin Zeng; Jian Shi; Yue-Xiang Chen; Jian-Wei Shen; Wei-Fen Xie

2009-01-01

8

Treatment of Common Bile Duct Obstruction by Pancreatic Cancer Using Various Stents: Single-Center Experience  

Microsoft Academic Search

Purpose: To compare the effectiveness of various means of stenting in patients with biliary obstruction caused by pancreatic cancer in a retrospective analysis. Methods: Sixty-two patients with biliary obstruction due to unresectable pancreatic cancer underwent biliary stenting. On the basis of the findings obtained by percutaneous transhepatic cholangiography (10 patients) and endoscopic retrograde cholangiography (52 patients), the site of obstruction

Toshifumi Nakamura; Ritsuko Hirai; Mutsuo Kitagawa; Yasunori Takehira; Masami Yamada; Katsutoshi Tamakoshi; Yoshimasa Kobayashi; Hirotoshi Nakamura; Masao Kanamori

2002-01-01

9

Treatment of Common Bile Duct Obstruction by Pancreatic Cancer Using Various Stents: Single-Center Experience  

Microsoft Academic Search

Purpose: To compare the effectiveness of various means of stenting in patients with biliary obstruction caused by pancreatic cancer in a retrospective analysis. Methods: Sixty-two patients with biliary obstruction due to unresectable pancreatic cancer underwent biliary stenting. On the basis of the findings obtained by percutaneous transhepatic cholangiography(10 patients) and endoscopic retrograde cholangiography (52 patients),the site of obstruction was distal

Toshifumi Nakamura; Ritsuko Hirai; Mutsuo Kitagawa; Yasunori Takehira; Masami Yamada; Katsutoshi Tamakoshi; Yoshimasa Kobayashi; Hirotoshi Nakamura; Masao Kanamori

2002-01-01

10

Management of common bile duct stricture caused by chronic pancreatitis with metal mesh self expandable stents  

Microsoft Academic Search

Twenty patients with chronic pancreatitis and signs of biliary obstruction were treated by endoscopic placement of self expandable metal mesh stents, and followed up prospectively. Eleven had been treated previously with plastic endoprostheses. All had persistent cholestasis, seven patients had jaundice, and three overt cholangitis. Endoscopic stent placement was successful in all cases. No early clinical complication was seen and

J Deviere; M Cremer; M Baize; J Love; B Sugai; A Vandermeeren

1994-01-01

11

Pancreatographic investigation of the pancreatic duct system  

Microsoft Academic Search

Background  Embryologically, the pancreatic duct system develops by the fusion between the dorsal and ventral pancreatic bud ducts. It\\u000a has been suggested that the proximal part of the main dorsal pancreatic duct partially regresses to form the accessory pancreatic\\u000a duct (APD). Aim of this study was to clarify the anatomy of the pancreatic duct system of the head of the pancreas

T. Kamisawa; Y. Tu; N. Egawa; K. Tsuruta; A. Okamoto

2007-01-01

12

Proximal migration of a 5 French pancreatic stent during bile stone extraction: a successful retrieval using mini-snare.  

PubMed

Pancreatic stents are used for a variety of conditions during therapeutic endoscopic retrograde cholangio pancreatography (ERCP). Pancreatic duct stenting reduces the incidence of post-ERCP pancreatitis and facilitate bilitary cannulation in difficult cases. Proximal migration of a pancreatic stent during bile duct stone extraction is an infrequent event, but its management can be technically challenging. We present a case that a double flanged pancreatic stent (5 French (Fr), 5 cm) was placed to facilitate the bilitary cannulation during the bile duct stone extraction. The pancreatic duct stent migrated into the proximal pancreas duct at the end of the bile duct stone clearance. After two unsuccessful attempts to remove the impacted stent with a balloon catheter and forceps, wire-guided endoscopic snare retrieval was conducted. Firstly, a guide wire was placed in the pancreatic duct and a soft mini-snare was passed over the guide wire. Then, the mini-snare was advanced into the proximal pancreatic duct over the guide wire and the proximally migrated stent was removed successfully with the mini-snare. Wire-guided endoscopic snare retrieval of proximally migrated pancreatic stents is safe and effective. The successful case of the retrieval with mini-snare provides another option for proximal migration retrieval of pancreatic stent retrieval. Further studies are needed to confirm its effectiveness and elucidate its associated complications. PMID:24714023

Liao, Yu-Sheng; Zhao, Qiu; Fan, Yan; Wu, Jie

2014-01-01

13

Pancreatic duct strictures  

Microsoft Academic Search

Opinion statement  \\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a The treatment of pancreatic duct strictures is based on an accurate assessment of the etiology of the disease, and then the\\u000a degree of symptomatology. Our outline for therapy is as follows:\\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a Exclude a diagnosis of malignancy by using radiologic, endoscopic, histologic, and molecular biologic modalities.\\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a Once a benign stricture has been demonstrated, we favor a

Jawad Ahmad; John Martin

2000-01-01

14

Involvement of pancreatic and bile ducts in autoimmune pancreatitis  

PubMed Central

AIM: To examine the involvement of the pancreatic and bile ducts in patients with autoimmune pancreatitis. METHODS: Clinical and cholangiopancreatographic findings of 28 patients with autoimmune pancreatitis were evaluated. For the purposes of this study, the pancreatic duct system was divided into three portions: the ventral pancreatic duct; the head portion of the dorsal pancreatic duct; and the body and tail of the dorsal pancreatic duct. RESULTS: Both the ventral and dorsal pancreatic ducts were involved in 24 patients, while in 4 patients only the dorsal pancreatic duct was involved. Marked stricture of the bile duct was detected in 20 patients and their initial symptom was obstructive jaundice. Six patients showed moderate stenosis to 30%-40% of the normal diameter, and the other two patients showed no stenosis of the bile duct. Although marked stricture of the bile duct was detected in 83% (20/24) of patients who showed narrowing of both the ventral and dorsal pancreatic ducts, it was not observed in the 4 patients who showed involvement of the dorsal pancreatic duct alone (P?=?0.0034). CONCLUSION: Both the ventral and dorsal pancreatic and bile ducts are involved in patients with autoimmune pancreatitis.

Kamisawa, Terumi; Tu, Yuyang; Egawa, Naoto; Nakajima, Hitoshi; Tsuruta, Kouji; Okamoto, Atsutake

2006-01-01

15

Unexpected anomaly of the common bile duct and pancreatic duct  

PubMed Central

Variations in the bile duct and pancreatic duct opening are related to the process of rotation and recanalization during embryologic development. Complete non-union of distal common bile duct and pancreatic duct gives rise to double papillae of Vater. The separation of the drainage of the main pancreatic duct and bile duct can be appreciated by careful assessment at the time of endoscopic retrograde cholangiopancreatograpy. The cranial orifice is a bile duct opening, whereas the caudal orifice is a pancreatic duct opening. The separate orifice finding can be confirmed by cholangiogram and pancreatogram with no communication between the two orifices. Endoscopists should be aware of this rare variant because late recognition can result in unnecessary manipulation and contrast injections of the main pancreatic duct and biliary cannulation failure.

Chavalitdhamrong, Disaya; Draganov, Peter V

2014-01-01

16

Unexpected anomaly of the common bile duct and pancreatic duct.  

PubMed

Variations in the bile duct and pancreatic duct opening are related to the process of rotation and recanalization during embryologic development. Complete non-union of distal common bile duct and pancreatic duct gives rise to double papillae of Vater. The separation of the drainage of the main pancreatic duct and bile duct can be appreciated by careful assessment at the time of endoscopic retrograde cholangiopancreatograpy. The cranial orifice is a bile duct opening, whereas the caudal orifice is a pancreatic duct opening. The separate orifice finding can be confirmed by cholangiogram and pancreatogram with no communication between the two orifices. Endoscopists should be aware of this rare variant because late recognition can result in unnecessary manipulation and contrast injections of the main pancreatic duct and biliary cannulation failure. PMID:24579069

Chavalitdhamrong, Disaya; Draganov, Peter V

2014-02-16

17

Need for pancreatic stenting after sphincterotomy in patients with difficult cannulation  

PubMed Central

AIM: To investigate the need for pancreatic stenting after endoscopic sphincterotomy (EST) in patients with difficult biliary cannulation. METHODS: Between April 2008 and August 2013, 2136 patients underwent endoscopic retrograde cholangiopancreatography (ERCP)-related procedures. Among them, 55 patients with difficult biliary cannulation who underwent EST after bile duct cannulation using the pancreatic duct guidewire placement method (P-GW) were divided into two groups: a stent group (n = 24; pancreatic stent placed) and a no-stent group (n = 31; no pancreatic stenting). We retrospectively compared the two groups to examine the need for pancreatic stenting to prevent post-ERCP pancreatitis (PEP) in patients undergoing EST after biliary cannulation by P-GW. RESULTS: No differences in patient characteristics or endoscopic procedures were observed between the two groups. The incidence of PEP was 4.2% (1/24) and 29.0% (9/31) in the Stent and no-stent groups, respectively, with the no-stent group having a significantly higher incidence (P = 0.031). The PEP severity was mild for all the patients in the stent group. In contrast, 8 had mild PEP and 1 had moderate PEP in the no-stent group. The mean serum amylase levels (means ± SD) 3 h after ERCP (183.1 ± 136.7 vs 463.6 ± 510.4 IU/L, P = 0.006) and on the day after ERCP (209.5 ± 208.7 vs 684.4 ± 759.3 IU/L, P = 0.002) were significantly higher in the no-stent group. A multivariate analysis identified the absence of pancreatic stenting (P = 0.045; odds ratio, 9.7; 95%CI: 1.1-90) as a significant risk factor for PEP. CONCLUSION: In patients with difficult cannulation in whom the bile duct is cannulated using P-GW, a pancreatic stent should be placed even if EST has been performed.

Nakahara, Kazunari; Okuse, Chiaki; Suetani, Keigo; Michikawa, Yosuke; Kobayashi, Shinjiro; Otsubo, Takehito; Itoh, Fumio

2014-01-01

18

Specific transduction and labeling of pancreatic ducts by targeted recombinant viral infusion into mouse pancreatic ducts.  

PubMed

Specific labeling of pancreatic ducts has proven to be quite difficult. Such labeling has been highly sought after because of the power it would confer to studies of pancreatic ductal carcinogenesis, as well as studies of the source of new insulin-producing ?-cells. Cre-loxp recombination could, in theory, lineage-tag pancreatic ducts, but results have been conflicting, mainly due to low labeling efficiencies. Here, we achieved a high pancreatic duct labeling efficiency using a recombinant adeno-associated virus (rAAV) with a duct-specific sox9 promoter infused into the mouse common biliary/pancreatic duct. We saw rapid, diffuse duct-specific labeling, with 50 and 89% labeling in the pancreatic tail and head region, respectively. This highly specific labeling of ducts should greatly enhance our ability to study the role of pancreatic ducts in numerous aspects of pancreatic growth, development and function. PMID:24100509

Guo, Ping; Xiao, Xiangwei; El-Gohary, Yousef; Criscimanna, Angela; Prasadan, Krishna; Rymer, Christopher; Shiota, Chiyo; Wiersch, John; Gaffar, Iliana; Esni, Farzad; Gittes, George K

2013-11-01

19

Treatment of nasolacrimal duct obstruction in adults with polyurethane stent  

Microsoft Academic Search

PURPOSE: To evaluate the efficacy of polyurethane nasolacrimal duct stents in the treatment of epiphora resulting from primary acquired nasolacrimal duct obstruction in adults.MATERIALS AND METHODS: In 25 patients (21 women and four men with mean age of 44 years, range 20 to 74 years) with nasolacrimal duct obstruction, 28 hollow polyurethane stents designed by Song and associates were placed

Bülent Yazici; Zeynep Yazici; Müfit Parlak

2001-01-01

20

Prophylactic Pancreatic Stent Placement for Endoscopic Duodenal Ampullectomy: A Single-Center Retrospective Study  

PubMed Central

Background/Aims We investigated the efficacy of prophylactic pancreatic stent placement for preventing postprocedure pancreatitis in patients undergoing endoscopic papillectomy. Methods This retrospective study included 82 consecutive patients who underwent endoscopic papillectomy for benign ampullary neoplasm at Samsung Medical Center between August 2002 and June 2011. The patients were subdivided into two groups, namely, those who received prophylactic pancreatic stent placement and those who did not. Patient demographics, baseline blood test, tumor characteristics, and endoscopic treatment data were collected. The primary endpoint was postprocedure pancreatitis. Results There was no difference in the development of postprocedure pancreatitis between the stent group and the no stent group (6/54, 10.5% and 2/28, 7.14%, respectively; p=1.00). At baseline, there were no significant differences between the two groups in terms of their risk factors for pancreatitis except pancreatic duct dye injection. The stent group was more likely to have dye injection than the nonstent group (100% vs 42.8%, p<0.001). However, in a logistic regression analysis, no significant difference was observed in the risk factors for pancreatitis including dye injection. Conclusions Our data suggest that routine prophylactic pancreatic duct stent placement in all patients undergoing endoscopic papillectomy may not be necessary and that large-scale prospective studies are required to identify the subgroup of patients who would benefit.

Chang, Woo Ik; Min, Yang Won; Yun, Hwan Sic; Lee, Jong Kyun; Lee, Kyu Taek; Rhee, Poong-Lyul

2014-01-01

21

[Metal stents in the biliopancreatic duct system--assessment of current status].  

PubMed

By the end of the eighties mesh stents were implanted in malignant stenoses of the biliary and pancreatic ducts for the first time. In the following years, self-expanding as well as balloon-expandable mesh stents were increasingly implanted in malignant stenoses by radiologists or interventional gastroenterologists, either percutaneously or endoscopically retrograde. In randomized comparative studies different teams showed relevant advantages of this new type of prosthesis in comparison to the commonly used plastic stents. Especially the significantly lower rate of late complications and longer patency rates speak in favor of the mesh stents. The higher cost of the mesh stent makes it important to carefully select patients before implantation, to let patients with potentially longer survival time profit from the advantages of the procedure. Expandable mesh stents were successfully implanted in benign stenoses of the biliopancreatic ducts as well, although the lack of randomized comparative studies makes a final assessment difficult. Concluding from already presented results, there might be a new therapeutical option for selected patients with benign stenoses of the biliopancreatic ducts. PMID:10025058

Hoepffner, N; Foerster, E C; Domschke, W

1998-12-01

22

Endoscopic clearance of the pancreatic duct in chronic pancreatitis with severe pain  

Microsoft Academic Search

In a phase I study endoscopic removal of pancreatic duct stones and protein plugs was attempted in five patients suffering from chronic pancreatitis with severe chronic pain. The pancreatic duct contents could be extracted after successful sphincterotomy in three patients. Clearance of the pancreatic duct was followed by complete or partial relief of pain. The follow-up period was 17–48 months.

Stefan Linder; Carl-Fredrik Engström; Anette Rosen; Karl-Ludvig Wiechel

1993-01-01

23

Pancreatitis from Metastatic Small Cell Lung Cancer: Successful Treatment with Endoscopic Intrapancreatic Stenting  

PubMed Central

Lung cancer metastases can occur in almost any organ. However, metastasis of small cell lung cancer to the pancreas is rare. Moreover, not all cases present with clinically diagnosed pancreatitis. We recently treated a patient with small cell lung carcinoma that invaded the pancreatic duct causing acute pancreatitis. Generally, the treatment for tumor-induced acute pancreatitis is initially supportive followed by aggressive chemotherapy or surgery. If the patient can tolerate the insertion of an endoscopic intrapancreatic stent, this is performed in addition to chemotherapy and surgery; this approach offers a safe and effective treatment modality for such patients.

Woo, Jong-Shin; Woo, Yong Sik; Jang, Jae Young; Chang, Young Woon; Lee, Joung Il; Chang, Rin

2006-01-01

24

Pancreatico-jejunostomy with a biodegradable pancreatic stent and without stitches through the pancreas.  

PubMed

Previous experimental studies have shown that multiple puncturing and stitching of the pancreas results in an increased pancreatic injury response. Furthermore, post-operative pancreatitis, which still is a largely under-diagnosed condition, appears to be an important mediator of many post-operative complications after pancreatic head resection. Stenting has been suggested to improve both short-term and long-term outcome after pancreaticojejunostomy. We have recently developed a biodegradable, radiopaque self-expanding stent, which has experimentally been shown suitable for pancreatobiliary applications. In this pilot study we tested the new technique for pancreatico-jejunostomy in 3 patients. In this novel anastomosis technique with a biodegradable stent the pancreatic stump is first sunk into the jejunum and tightened with a purse string in the bowel serosa, without any stitches through the pancreatic tissue, and the patency of the pancreatic duct is secured with a biodegradable stent against the compression of the tightened purse-string. The creation of anastomosis was possible as planned in all 3 patients. They all recovered without complications. The stent was seen in x-ray in all 3 during hospitilization, was found to have disappeared by 1 month in 2 patients, but was still in place at 3 months in 1 patient. The initial experiences described herein encourage progression to a phase I safety study, and later possibly to a phase II randomized trial to test the efficacy of the new method. PMID:18613357

Nordback, Isto; Lämsä, Teemu; Laukkarinen, Johanna; Leppiniemi, Jenni; Kellomäki, Minna; Sand, Juhani

2008-01-01

25

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

Microsoft Academic Search

The purpose of this study was to evaluate the radiographic and biological effects of different polyurethane nasolacrimal duct\\u000a 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

K. E. Wilhelm; B. Grabolle; H. Urbach; R. Tolba; H. Schild; F. Paulsen

2006-01-01

26

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

Microsoft Academic Search

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

K. E. Wilhelm; B. Grabolle; H. Urbach; R. Tolba; H. Schild; F. Paulsen

2006-01-01

27

Complete traumatic main pancreatic duct disruption treated endoscopically: a case report  

PubMed Central

Introduction Pancreatic injury is uncommon and the management remains controversial. The integrity of the main pancreatic duct is considered the most important determinant for prognosis. Case presentation A 19-year-old Greek man was referred to our tertiary referral centre due to blunt abdominal trauma and an associated grade III pancreatic injury. He was haemodynamically stable and his initial treatment was conservative. Due to deterioration in his clinical symptomatology he underwent an endoscopy 20 days postinjury, where a stent was placed in the proximal pancreatic duct remnant and a bulging fluid collection of the lesser sac was drained transgastrically. He made an uneventful recovery and remains well 7 months postinjury, but a stricture with upstream dilatation of his main pancreatic duct has developed. Conclusions The clinical status of the patient rather than the grade of pancreatic injury should be the principal determinant to guide treatment. Endoscopic stenting and drainage is an attractive minimally invasive procedure and it may obviate the need for surgery. However, further investigation is required regarding the safety and outcome.

2014-01-01

28

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

29

Polyurethane stents for lacrimal duct stenoses: 5-year results  

Microsoft Academic Search

Purpose  To present 5-year results of polyurethane stent implantation for treatment of postsaccal lacrimal duct stenoses.Methods  Ninety-two consecutive patients admitted to our hospital for stent implantation between 1997 and 2001 were retrospectively analysed. The patients who were not re-treated in our clinic were asked by questionnaire about their satisfaction and complaints.Results  In 5 patients (5.4%) the implantation was not completed, 38 patients (41.3%)

Eckart Bertelmann; Peter Rieck

2006-01-01

30

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

31

Clinical efficacy of the polyurethane stent without fluoroscopic guidance in the treatment of nasolacrimal duct obstruction  

Microsoft Academic Search

PurposeTo evaluate the clinical efficacy of the polyurethane (Song) stent in the treatment of nasolacrimal duct obstruction without fluoroscopic guidance, especially at the junction between the lacrimal sac and nasolacrimal duct or at the nasolacrimal duct.

Jong Soo Lee; Geun Jung; Boo Sup Oum; Sang Hyup Lee; Hwan Jung Roh

2000-01-01

32

The polyurethane nasolacrimal duct stent for lower tear duct obstruction: long-term success rate and complications  

Microsoft Academic Search

Background: The polyurethane nasolacrimal duct stent is used as an alternative to conventional techniques for treatment of lower tear\\u000a duct obstruction. The aim of this study was to evaluate the clinical success rate after a follow-up of 2 years. Methods: Nasolacrimal duct stent implantation was attempted in 19 patients with nasolacrimal duct obstruction proven by digital substraction\\u000a dacryocystography. The median

Ulrich Schaudig; Rainer Maas

2000-01-01

33

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

Microsoft Academic Search

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

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

2008-01-01

34

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

35

Endoscopic treatment of chronic pancreatitis  

Microsoft Academic Search

Treatment of chronic pancreatitis has been exclusively surgical for a long time. Recently, endoscopic therapy has become widely used as a primary therapeutic option. Initially performed for drainage of pancreatic cysts and pseudocysts, endoscopic treatments were adapted to biliary and pancreatic ducts stenosis. Pancreatic sphincterotomy which allows access to pancreatic ducts was firstly reported. Secondly, endoscopic methods of stenting, dilatation,

Laurent Heyries; Jose Sahel

2007-01-01

36

Placement of prophylactic pancreatic stents to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis in high-risk patients: A meta-analysis  

PubMed Central

AIM: To assess the effectiveness of pancreatic stents for preventing pancreatitis in high-risk patients after endoscopic retrograde cholangiopancreatography (ERCP). METHODS: PubMed, Embase, Science Citation Index, and Cochrane Controlled Trials Register were searched to identify relevant trials published in English. Inclusion and exclusion criteria were used to screen for suitable studies. Two reviewers independently judged the study eligibility while screening the citations. The methodological quality of the included trials was assessed using the Jadad scoring system. All results were expressed as OR and 95%CI. Data were analyzed using Stata12.0 software. RESULTS: Ten eligible randomized controlled trials were selected, including 1176 patients. A fixed-effects model in meta-analysis supported that pancreatic duct stents significantly decreased the incidence of post-ERCP pancreatitis (PEP) in high-risk patients (OR = 0.25; 95%CI: 0.17-0.38; P < 0.001). Pancreatic stents also alleviated the severity of PEP (mild pancreatitis after ERCP: OR = 0.33; 95%CI: 0.21-0.54; P < 0.001; moderate pancreatitis after ERCP: OR = 0.30; 95%CI: 0.13-0.67; P = 0.004). The result of severe pancreatitis after ERCP was handled more rigorously (OR = 0.24; 95%CI: 0.05-1.16; P = 0.077). Serum amylase levels were not different between patients with pancreatic stents and control patients (OR = 1.08; 95%CI: 0.82-1.41; P = 0.586). CONCLUSION: Placement of prophylactic pancreatic stents may lower the incidence of post-ERCP pancreatitis in high-risk patients and alleviate the severity of this condition.

Shi, Qing-Qing; Ning, Xiao-Yi; Zhan, Ling-Ling; Tang, Guo-Du; Lv, Xiao-Ping

2014-01-01

37

Pancreatic stent migration into the portal vein causing portal vein thrombosis: a rare complication of a prophylactic pancreatic stent.  

PubMed

This report describes the first case of a novel complication of prophylactic pancreatic stents used to reduce the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis, whereby the stent migrated into the portal vein resulting in portal vein thrombosis. We review the literature and discuss the potential mechanisms that caused this complication. The approach and prompt treatment that resulted in a favorable clinical outcome are described. PMID:23127537

Leung, Wesley D; Parashette, Kalyan Ray; Molleston, Jean P; Sherman, Stuart

2012-01-01

38

Ultrasound imaging of the mouse pancreatic duct using lipid microbubbles  

NASA Astrophysics Data System (ADS)

Research requiring the murine pancreatic duct to be imaged is often challenging due to the difficulty in selectively cannulating the pancreatic duct. We have successfully catheterized the pancreatic duct through the common bile duct in severe combined immune deficient (SCID) mice and imaged the pancreatic duct with gas filled lipid microbubbles that increase ultrasound imaging sensitivity due to exquisite scattering at the gas/liquid interface. A SCID mouse was euthanized by CO2, a midline abdominal incision made, the common bile duct cut at its midpoint, a 2 cm, 32 gauge tip catheter was inserted about 1 mm into the duct and tied with suture. The duodenum and pancreas were excised, removed in toto, embedded in agar and an infusion pump was used to instill normal saline or lipid-coated microbubbles (10 million / ml) into the duct. B-mode images before and after infusion of the duct with microbubbles imaged the entire pancreatic duct (~ 1 cm) with high contrast. The microbubbles were cavitated by high mechanical index (HMI) ultrasound for imaging to be repeated. Our technique of catheterization and using lipid microbubbles as a contrast agent may provide an effective, affordable technique of imaging the murine pancreatic duct; cavitation with HMI ultrasound would enable repeated imaging to be performed and clustering of targeted microbubbles to receptors on ductal cells would allow pathology to be localized accurately. This research was supported by the Experimental Mouse Shared Service of the AZ Cancer Center (Grant Number P30CA023074, NIH/NCI and the GI SPORE (NIH/NCI P50 CA95060).

Banerjee, B.; McKeown, K. R.; Skovan, B.; Ogram, E.; Ingram, P.; Ignatenko, N.; Paine-Murrieta, G.; Witte, R.; Matsunaga, T. O.

2012-02-01

39

Tight junctions in human pancreatic duct epithelial cells  

PubMed Central

Tight junctions of the pancreatic duct are essential regulators of physiologic secretion of the pancreas and disruption of the pancreatic ductal barrier is known to contribute to the pathogenesis of pancreatitis and progression of pancreatic cancer. Various inflammatory mediators and carcinogens can trigger tight junction disassembly and disruption of the pancreatic barrier, however signaling events that mediates such barrier dysfunctions remain poorly understood. This review focuses on structure and regulation of tight junctions in normal pancreatic epithelial cells and mechanisms of junctional disruption during pancreatic inflammation and cancer. We will pay special attention to a novel model of human telomerase reverse transcriptase-transfected human pancreatic ductal epithelial cells and will describe the roles of major signaling molecules such as protein kinase C and c-Jun N-terminal kinase in formation and disassembly of the pancreatic ductal barrier.

Kojima, Takashi; Yamaguchi, Hiroshi; Ito, Tatsuya; Kyuno, Daisuke; Kono, Tsuyoshi; Konno, Takumi; Sawada, Norimasa

2013-01-01

40

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

41

[Bile duct involvement in autoimmune pancreatitis: classification and treatment].  

PubMed

Autoimmune pancreatitis is a rare disease characterized by inflammation of the pancreatic parenchyma, irregular narrowing of the pancreatic duct, periductal lymphoplasmacytic infiltration and fibrosis at histological examination, the presence of autoantibodies and hypergammaglobulinemia, as well as the possible association of cholangitis and other autoimmune diseases. There is a favorable response to steroid therapy. We report the case of a patient with autoimmune pancreatitis with bile duct involvement and peripheral eosinophilia, requiring long-term immunosuppressant treatment. The diagnosis of a diffuse form of AIP was made without direct histological evidence and based on indirect imaging, clinical and laboratory findings in an autoimmune context. The histological and imaging studies of bile duct involvement and the favourable response to steroids were additional arguments. PMID:18472376

Gincoul, R; Pujol, B; Dumortier, J; Scoazec, J-Y; Hervieu, V; Crombe-Ternamian, A; Pilleul, F; Napoléon, B; Ponchon, T

2008-11-01

42

Experimental Study of Poly-l-Lactic Acid Biodegradable Stents in Normal Canine Bile Ducts  

SciTech Connect

Purpose: This study was designed to clarify the advantages of biodegradable stents in terms of mucosal reaction and biodegradation after placement. We designed a biodegradable stent and assessed stent degradation and changes in the normal bile ducts of dogs. Methods: The biodegradable stent is a balloon-expandable Z stent consisting of poly-l-lactic acid (PLLA) with a diameter of 6 mm and a length of 15 mm. We assessed four groups of three beagle dogs each at 1, 3, 6, and 9 months of follow-up. After evaluating stent migration by radiography and stent and bile duct patency by cholangiography, the dogs were sacrificed to remove the bile duct together with the stent. The bile duct lumen was examined macroscopically and histologically, and the stent degradation was examined macroscopically and by scanning electron microscopy (SEM). Results: Bile duct obstruction was absent and none of the stents migrated. Macroscopic evaluation showed moderate endothelial proliferation in the bile ducts at the implant sites at 3 and 6 months and a slight change at 9 months. Slight mononuclear cell infiltration was histologically identified at all time points and epithelial hyperplasia that was moderate at 3 months was reduced to slight at 6 and 9 months. Stent degradation was macroscopically evident in all animals at 9 months and was proven by SEM in two dogs at 6 months and in all of them at 9 months. Conclusions: Our results suggest that PLLA bioabsorbable stents seems to be useful for implantation in the biliary system with further investigation.

Yamamoto, Kiyosei, E-mail: yamakiyo@zg7.so-net.ne.jp; Yoshioka, Tetsuya; Furuichi, Kinya; Sakaguchi, Hiroshi; Anai, Hiroshi; Tanaka, Toshihiro; Morimoto, Kengo [Nara Medical University, Department of Radiology (Japan); Uchida, Hideo [Daiyukai General Hospital, Department of Radiology (Japan); Kichikawa, Kimihiko [Nara Medical University, Department of Radiology (Japan)

2011-06-15

43

Insulin, transforming growth factors, and substrates modulate growth of guinea pig pancreatic duct cells in vitro  

Microsoft Academic Search

Background & Aims: Little is known of the physiological mechanisms that control cellular renewal in the pancreatic excretory duct system. This study investigated the effects of potential regulatory substances on the growth of cultured guinea pig pancreatic duct epithelial monolayers. Methods: Pancreatic duct explants were cultured for 3 days on plastic and on permeable filters in the presence and absence

Eli Bhattacharyya; Ashish Panchal; Thomas J. Wilkins; Joséde Ondarza; Seth R. Hootman

1995-01-01

44

Molecular basis of potassium channels in pancreatic duct epithelial cells  

PubMed Central

Potassium channels regulate excitability, epithelial ion transport, proliferation, and apoptosis. In pancreatic ducts, K+ channels hyperpolarize the membrane potential and provide the driving force for anion secretion. This review focuses on the molecular candidates of functional K+ channels in pancreatic duct cells, including KCNN4 (KCa3.1), KCNMA1 (KCa1.1), KCNQ1 (Kv7.1), KCNH2 (Kv11.1), KCNH5 (Kv10.2), KCNT1 (KCa4.1), KCNT2 (KCa4.2), and KCNK5 (K2P5.1). We will give an overview of K+ channels with respect to their electrophysiological and pharmacological characteristics and regulation, which we know from other cell types, preferably in epithelia, and, where known, their identification and functions in pancreatic ducts and in adenocarcinoma cells. We conclude by pointing out some outstanding questions and future directions in pancreatic K+ channel research with respect to the physiology of secretion and pancreatic pathologies, including pancreatitis, cystic fibrosis, and cancer, in which the dysregulation or altered expression of K+ channels may be of importance.

Hayashi, Mikio; Novak, Ivana

2013-01-01

45

5-Fr vs. 3-Fr pancreatic stents for the prevention of post-ERCP pancreatitis in high-risk patients: a systematic review and network meta-analysis.  

PubMed

Background and study aims: Placement of a pancreatic stent is recommended for the prevention of pancreatitis after endoscopic retrograde cholangiopancreatitis (ERCP) among high-risk patients. However, it is not known whether there is a particular feature of the pancreatic stent that is associated with a lower incidence of post-ERCP pancreatitis (PEP). This systematic review and network meta-analysis (NMA) aimed to examine whether a particular feature of pancreatic stents is associated with lower incidence of PEP. Patients and methods: The MEDLINE, Embase, and Cochrane Library databases were searched for randomized controlled trials (RCTs) that evaluated the efficacy of pancreatic stents in the prevention of PEP from September 1993 to June 2013. Trials that reported the incidence of PEP in high-risk patients randomized to one vs. another type of pancreatic stent or vs. no stent at all were included in the analysis. Results: Among the 1377 citations identified from the database searches, 6 RCTs involving 561 patients were included. Three RCTs evaluated 5-Fr straight, flanged pancreatic stents, two RCTs evaluated 5-Fr single-pigtail, unflanged stents, and three RCTs evaluated 3-Fr single-pigtail, unflanged stents. The probability of being ranked the best was 50.3?% (SD?=?0.5, Markov chain error?=?0.003) for 5-Fr single-pigtail, unflanged pancreatic stents, 46.5?% for 5-Fr straight, flanged stents, and 3.1?% for 3-Fr single-pigtail, unflanged stents. Conclusion: The 5-Fr pancreatic stent is superior to the 3-Fr pancreatic stent for the prevention of PEP in high-risk patients. The 5-Fr single-pigtail, unflanged pancreatic stent and 5-Fr straight, flanged pancreatic stent performed similarly and both performed better than the 3-Fr pancreatic stent in preventing PEP, suggesting that stent diameter is more important for the prevention of PEP than type of stent or the presence of flanges. PMID:24830399

Afghani, Elham; Akshintala, Venkata S; Khashab, Mouen A; Law, Joanna K; Hutfless, Susan M; Kim, Katherine J; Lennon, Anne Marie; Kalloo, Anthony N; Singh, Vikesh K

2014-07-01

46

Biliary drainage of the common bile duct with an enteral metal stent  

Microsoft Academic Search

In this case report we present an elderly patient who was referred to our hospital with recurrent episodes of cholangitis that persisted after placement of five metal stents for a distal common bile duct (CBD) stenosis. All metal stents were endoscopically removed from the CBD by forceps after balloon dilatation of the papilla. A profoundly dilated CBD with sludge and

Irene M Dek; Elzen van den B. D. J; P. Fockens; E. A. J. Rauws

2009-01-01

47

Dissolution of Pancreatic Lithiasis by Direct Citrate Application into the Pancreatic Duct in Two Patients with Chronic Idiopathic Pancreatitis  

Microsoft Academic Search

Several experimental and clinical studies have shown that citrates are useful in dissolving calcifications and proteic plug in pancreatic ducts both of alcoholic etiology and in patients with chronic pancreatitis. Until now, using citrates to dissolve stones in clinical studies was performed orally with satisfactory medium-term results, including control of abdominal pain and eradication of shadows on X-rays. Laboratory studies

Alfredo Güitrón; Horacio González-Loya; Ricardo Barinagarrementería; Juan Carlos Sarol; Raúl Adalid; Jorge Rodríguez-Delgado

1997-01-01

48

A prospective randomised multicentre trial comparing 10 Fr Teflon Tannenbaum stents with 10 Fr polyethylene Cotton-Leung stents in patients with malignant common duct strictures  

PubMed Central

BACKGROUND—Stent blockage is a multifactorial process in which stent design and materials, bacteria, proteins, and bile viscosity play a role.?AIMS—To compare the patency of the 10 Fr Teflon Tannenbaum (TT) stent to that of the 10 Fr Cotton-Leung (CL) polyethylene stent with sideholes, in patients with malignant obstructive jaundice.?METHODS—Patients were recruited to this prospective multicentre randomised study if they had a newly diagnosed malignant bile duct stricture below the hilum of the liver suitable for stenting with a 10 Fr stent. Data were collected and monitored by a professional monitoring company. Primary patency was the interval between stent placement and first exchange or death without recurrent jaundice.?RESULTS—134 consecutive patients were recruited between November 1994 and June 1997; 65 were randomised to the TT stent and 69 to the CL stent. Median patency and 95% confidence intervals were 181 (59, 303) days for the TT stent and 133 (92, 174) days for the CL stent, with no significant difference between the two stents (p=0.49). Median survival and 95% confidence intervals were 115 (71, 159) days for the TT stent and 151 (112, 190) days for the CL stent, with no significant difference between the two stents (p=0.765).?CONCLUSION—Neither Teflon as a stent material nor the Tannenbaum design prolong the patency of plastic stents.???Keywords: biliary prosthesis; patency; bile duct malignancy

England, R; Martin, D; Morris, J; Sheridan, M; Frost, R; Freeman, A; Lawrie, B; Deakin, M; Fraser, I; Smith, K

2000-01-01

49

Retained common bile duct stones after endoscopic sphincterotomy: temporary and longterm treatment with biliary stenting.  

PubMed Central

Basket extraction after endoscopic sphincterotomy failed to clear the bile ducts immediately in 85 (30%) of 283 consecutive patients with common bile duct stones. Temporary biliary drainage was established by the insertion of a single 7 Fr double pigtail stent before further planned endoscopic attempts at stone removal. In 84 patients (21 male: 63 female, mean age 77 years) this measure relieved biliary obstruction, mean serum bilirubin falling from 101 to 18 umol/l by the time of the second endoscopic retrograde cholangiopancreatography. Six patients died from non-biliary causes with temporary stents in situ. Common bile duct stone extraction was achieved endoscopically in 50 of the remaining 79 patients after a mean of 4.3 months (range 1-12), 34 (68%) requiring only one further procedure. Three patients were referred for biliary surgery. Single stents were also effective for longterm biliary drainage in the remaining 26 elderly patients with unextractable stones. The main biliary complication of stenting was 13 episodes of cholangitis but all except one responded to medical treatment and early stent exchange. If common bile duct stones remain after endoscopic sphincterotomy, a single 7 Fr double pigtail stent is effective and safe for temporary biliary drainage before further endoscopic attempts at duct clearance and for longterm biliary drainage especially in the old and frail.

Maxton, D G; Tweedle, D E; Martin, D F

1995-01-01

50

Age-related changes of elements and relationships among elements in the common bile and pancreatic ducts  

Microsoft Academic Search

To elucidate compositional changes of the common bile and main pancreatic ducts with aging, the authors investigated age-related\\u000a changes of element contents in the common bile and pancreatic ducts by inductively coupled plasma-atomic emission spectrometry.\\u000a After ordinary dissection by medical students was finished, the common bile ducts and main pancreatic ducts (pancreatic ducts)\\u000a were resected and the element contents were

Yoshiyuki Tohno; Setsuko Tohno; Masa-Oki Yamada; Cho Azuma; Yumi Moriwake; Takeshi Minami; Hiroshima Maruyama; Tokuko Omura

2004-01-01

51

Endoscopic retrograde cholangiopancreatography for stone burden in the bile and pancreatic ducts.  

PubMed

Stones in biliary and pancreatic ducts are entities that plague hundreds of thousands of patients worldwide every year. Symptoms can be mild (pain) to life threatening (cholangitis, severe acute pancreatitis). In the last few decades, management of these stones has transitioned from exclusively surgical to now predominantly endoscopic techniques. This article reviews the evolution of endoscopic techniques used in the management of stones in the common bile duct and pancreatic duct. PMID:22748241

Rosenkranz, Laura; Patel, Sandeep N

2012-07-01

52

Functional Pancreatic Acinar Cell Carcinoma Extending into the Main Pancreatic Duct and Splenic Vein  

Microsoft Academic Search

Introduction  Pancreatic acinar cell carcinoma (ACC) has several unique characteristics, such as its progression pattern, spreading into\\u000a the pancreatic duct and large blood vessels, and its secretion of pancreatic exocrine enzymes, which induces a paraneoplastic\\u000a syndrome.\\u000a \\u000a \\u000a \\u000a \\u000a Case Report  A 79-year-old Japanese man, with medical history of chronic renal failure, was referred to our institution for the examination\\u000a of his abdominal pain and

Mineo Iwatate; Hiroyuki Matsubayashi; Keiko Sasaki; Naoki Kishida; Shusuke Yoshikawa; Hiroyuki Ono; Anirban Maitra

53

Segmental occlusion of the pancreatic duct with prolamine to prevent fistula formation after distal pancreatectomy.  

PubMed Central

OBJECTIVE: The authors used prolamine (Ethibloc, Ethicon GmBH, Norderstedt, Germany) for segmental obstruction of the pancreatic duct to prevent pancreatic fistula development after distal pancreatectomy combined with total gastrectomy for gastric malignancies. SUMMARY BACKGROUND DATA: Although the initial clinical application of prolamine was pancreatic duct obstruction for patients with pancreatitis and undergoing pancreatic transplantation and pancreaticoduodenectomy for pancreatic cancer, there are no reports on prevention of pancreatic fistula formation after distal pancreatectomy. METHODS: Prolamine (0.2 mL) was injected into the distal segment of the main duct in the remaining pancreata of 51 patients. Small pancreatic ducts on the cut surface, from which prolamine extravasates, were closed by ligation, the main duct was ligated doubly, and the transected pancreatic margin was closed 15 minutes after phenylpropanolamine hydrochloride injection. RESULTS: No patient developed a pancreatic fistula or the complication of arterial bleeding due to prolonged infection. CONCLUSION: Segmental obstruction of the pancreatic duct with prolamine is useful for preventing pancreatic fistula development after distal pancreatectomy. Images Figure 2. Figure 3. Figure 4.

Konishi, T; Hiraishi, M; Kubota, K; Bandai, Y; Makuuchi, M; Idezuki, Y

1995-01-01

54

Biliary drainage of the common bile duct with an enteral metal stent.  

PubMed

In this case report we present an elderly patient who was referred to our hospital with recurrent episodes of cholangitis that persisted after placement of five metal stents for a distal common bile duct (CBD) stenosis. All metal stents were endoscopically removed from the CBD by forceps after balloon dilatation of the papilla. A profoundly dilated CBD with sludge and concrements was seen. To ensure adequate bile drainage an enteral metal stent was inserted in the CBD. This case shows that proximally migrated uncovered metal stents in the CBD can be safely removed endoscopically under certain circumstances. We suggest that in the case of a CBD drainage problem due to an extremely dilated CBD, placement of an enteral metal stent in the CBD could be considered, especially in patients who are unfit for surgery. PMID:19452591

Dek, Irene M; van den Elzen, Bram D J; Fockens, Paul; Rauws, Erik A J

2009-05-21

55

Zebrafish sox9b is crucial for hepatopancreatic duct development and pancreatic endocrine cell regeneration.  

PubMed

Recent zebrafish studies have shown that the late appearing pancreatic endocrine cells are derived from pancreatic ducts but the regulatory factors involved are still largely unknown. Here, we show that the zebrafish sox9b gene is expressed in pancreatic ducts where it labels the pancreatic Notch-responsive cells previously shown to be progenitors. Inactivation of sox9b disturbs duct formation and impairs regeneration of beta cells from these ducts in larvae. sox9b expression in the midtrunk endoderm appears at the junction of the hepatic and ventral pancreatic buds and, by the end of embryogenesis, labels the hepatopancreatic ductal system as well as the intrapancreatic and intrahepatic ducts. Ductal morphogenesis and differentiation are specifically disrupted in sox9b mutants, with the dysmorphic hepatopancreatic ducts containing misdifferentiated hepatocyte-like and pancreatic-like cells. We also show that maintenance of sox9b expression in the extrapancreatic and intrapancreatic ducts requires FGF and Notch activity, respectively, both pathways known to prevent excessive endocrine differentiation in these ducts. Furthermore, beta cell recovery after specific ablation is severely compromised in sox9b mutant larvae. Our data position sox9b as a key player in the generation of secondary endocrine cells deriving from pancreatic ducts in zebrafish. PMID:22537488

Manfroid, Isabelle; Ghaye, Aurélie; Naye, François; Detry, Nathalie; Palm, Sarah; Pan, Luyuan; Ma, Taylur P; Huang, Wei; Rovira, Meritxell; Martial, Joseph A; Parsons, Michael J; Moens, Cecilia B; Voz, Marianne L; Peers, Bernard

2012-06-15

56

Morphological and Functional Evaluation of the Pancreatic Duct with Secretin-Stimulated Magnetic Resonance Cholangiopancreatography in Alcoholic Pancreatitis Patients  

Microsoft Academic Search

Objectives The aim of this investigation was to evaluate the pancreatographic findings and dynamics of pancreatic duct diameter, as\\u000a determined by secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP), in patients with acute alcoholic pancreatitis\\u000a or chronic alcoholic pancreatitis and in a control group. Methods S-MRCP was performed in patients with acute alcoholic pancreatitis who did not manifest the functional and radiological (ultrasonography

Isabel Pascual; José Soler; Andrés Peña; Ramón Añón; Pedro Almela; Vicente Sánchiz; Miguel Mínguez; Francisco Mora; Adolfo Benages

2008-01-01

57

The role of endoscopic retrograde pancreatography in the treatment of traumatic pancreatic duct injury  

Microsoft Academic Search

Background: The status of the main pancreatic duct (MPD) is the most important determinant of the morbidity and mortality associated with pancreatic trauma. Early diagnosis and optimal treatment are critical, especially when there is MPD injury. Methods: Twenty-three patients with pancreatic trauma were studied prospectively with respect to clinical and laboratory findings, CT, and endoscopic retrograde pancreatography (ERP). Treatment modalities

Hyun Soo Kim; Dong Ki Lee; Il Whoi Kim; Soon Koo Baik; Sang Ok Kwon; Joong Wha Park; Nam Cheon Cho; Byung Seon Rhoe

2001-01-01

58

Medical devices; gastroenterology-urology devices; classification of pancreatic drainage stent and delivery system. Final order.  

PubMed

The Food and Drug Administration (FDA) is classifying the pancreatic drainage stent and delivery system into class II (special controls). The special controls that will apply to the device are identified in this order, and will be part of the codified language for the pancreatic drainage stent and delivery system classification. The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device. PMID:24873019

2014-05-29

59

Resection of hepatic duct bifurcation and transhepatic stenting for sclerosing cholangitis.  

PubMed Central

Thirty-one patients with sclerosing cholangitis underwent reconstruction of their hepatic duct bifurcation and long-term stenting between 1980 and 1987. Indications for surgery were persistent jaundice in 29 and recurrent cholangitis in two. The mean serum bilirubin level before surgery was 10.4 mg/dl. Liver biopsy revealed that 26 patients had varying degrees of hepatic fibrosis, and five patients had progressed to secondary biliary cirrhosis. In 29 patients the major obstructive duct disease was at or near the hepatic duct bifurcation, and in two patients it was in the distal common duct. The operative procedure consisted of: (1) excision of the hepatic duct bifurcation and extrahepatic biliary tree, (2) dilatation of the intrahepatic ducts, (3) insertion of Silastic transhepatic biliary stents, and (4) bilateral hepaticojejunostomies. Two of the five patients (40%) with cirrhosis died after surgery. In contrast, only one of 26 patients (3.9%) with hepatic fibrosis died after operation. The 1-, 3-, and 5-year actuarial survival rates for patients with cirrhosis were 20%, 20%, and 20%, respectively. The only long-term survivor underwent a liver transplant. The 1-, 3-, and 5-year actuarial survival rates for patients with hepatic fibrosis were 92%, 87%, and 71%, respectively. In addition, the mean serum bilirubin levels of patients with hepatic fibrosis at 1, 2, 3, 4, and 5 years were 3.4 mg/dl, 2.9 mg/dl, 4.0 mg/dl, 5.4 mg/dl, and 4.3 mg/dl, respectively. Two of the long-term survivors subsequently underwent a liver transplant. Patients with sclerosing cholangitis, persistent jaundice, and biliary cirrhosis should be referred for consideration of liver transplantation. However, in the absence of biliary cirrhosis, if the major obstructive disease is at the hepatic duct bifurcation, primary biliary reconstruction and long-term stenting should be considered. Images Fig. 1. Fig. 2. Fig. 3. Fig. 6.

Cameron, J L; Pitt, H A; Zinner, M J; Herlong, H F; Kaufman, S L; Boitnott, J K; Coleman, J

1988-01-01

60

Endoscopic stent therapy in patients with chronic pancreatitis: A 5-year follow-up study  

PubMed Central

AIM: This study analyzed clinical long-term outcomes after endoscopic therapy, including the incidence and treatment of relapse. METHODS: This study included 19 consecutive patients (12 male, 7 female, median age 54 years) with obstructive chronic pancreatitis who were admitted to the 2nd Medical Department of the Technical University of Munich. All patients presented severe chronic pancreatitis (stage III°) according to the Cambridge classification. The majority of the patients suffered intermittent pain attacks. 6 of 19 patients had strictures of the pancreatic duct; 13 of 19 patients had strictures and stones. The first endoscopic retrograde pancreatography (ERP) included an endoscopic sphincterotomy, dilatation of the pancreatic duct, and stent placement. The first control ERP was performed 4 wk after the initial intervention, and the subsequent control ERP was performed after 3 mo to re-evaluate the clinical and morphological conditions. Clinical follow-up was performed annually to document the course of pain and the management of relapse. The course of pain was assessed by a pain scale from 0 to 10. The date and choice of the therapeutic procedure were documented in case of relapse. RESULTS: Initial endoscopic intervention was successfully completed in 17 of 19 patients. All 17 patients reported partial or complete pain relief after endoscopic intervention. Endoscopic therapy failed in 2 patients. Both patients were excluded from further analysis. One failed patient underwent surgery, and the other patient was treated conservatively with pain medication. Seventeen of 19 patients were followed after the successful completion of endoscopic stent therapy. Three of 17 patients were lost to follow-up. One patient was not available for interviews after the 1st year of follow-up. Two patients died during the 3rd year of follow-up. In both patients chronic pancreatitis was excluded as the cause of death. One patient died of myocardial infarction, and one patient succumbed to pneumonia. All three patients were excluded from follow-up analysis. Follow-up was successfully completed in 14 of 17 patients. 4 patients at time point 3, 2 patients at time point 4, 3 patients at time point 5 and 2 patients at time point 6 and time point 7 used continuous pain medication after endoscopic therapy. No relapse occurred in 57% (8/14) of patients. All 8 patients exhibited significantly reduced or no pain complaints during the 5-year follow-up. Seven of 8 patients were completely pain free 5 years after endoscopic therapy. Only 1 patient reported continuous moderate pain. In contrast, 7 relapses occurred in 6 of the 14 patients. Two relapses were observed during the 1st year, 2 relapses occurred during the 2nd year, one relapse was observed during the 3rd year, one relapse occurred during the 4th year, and one relapse occurred during the 5th follow-up year. Four of these six patients received conservative treatment with endoscopic therapy or analgesics. Relapse was conservatively treated using repeated stent therapy in 2 patients. Analgesic treatment was successful in the other 2 patients. CONCLUSION: 57% of patients exhibited long-term benefits after endoscopic therapy. Therefore, endoscopic therapy should be the treatment of choice in patients being inoperable or refusing surgical treatment.

Weber, Andreas; Schneider, Jochen; Neu, Bruno; Meining, Alexander; Born, Peter; von Delius, Stefan; Bajbouj, Monther; Schmid, Roland M; Algul, Hana; Prinz, Christian

2013-01-01

61

[Hepatic artery pseudoaneurysm after endoscopic biliary stenting for pancreatic cancer].  

PubMed

A man in his sixties presented to our hospital with obstructive jaundice and was diagnosed with inoperable pancreatic cancer. Chemoradiotherapy was initiated, and an expandable metallic stent was inserted endoscopically to drain the biliary system. Six months later, he was referred to our hospital with 1-week history of epigastric pain and obstructive jaundice. On admission for further evaluation, he experienced hematemesis and went into severe shock. Upper gastrointestinal endoscopy and endoscopic retrograde cholangiopancreatography showed active bleeding from the duodenal papilla. Therefore, we performed endoscopic nasobiliary drainage (ENBD). On day 4, blood was detected in the ENBD tube, and the patient again experienced hematemesis. Emergent enhanced computed tomography revealed a right hepatic arterial aneurysm that had likely ruptured and caused the hemobilia. The aneurysm was successfully embolized, and the patient was discharged on hospital day 21. PMID:24806237

Asayama, Naoki; Sasaki, Tamito; Serikawa, Masahiro; Minami, Tomoyuki; Okazaki, Akihito; Ishigaki, Takashi; Ishii, Yasutaka; Mouri, Teruo; Yoshimi, Satoshi; Tsuboi, Tomonori; Fujino, Hatsue; Chayama, Kazuaki

2014-05-01

62

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

63

Subcellular Fractionation Enhances Proteome Coverage of Pancreatic Duct Cells  

PubMed Central

Objectives Subcellular fractionation of whole cell lysates offers a means of simplifying protein mixtures, potentially permitting greater depth of proteomic analysis. Here we compare proteins identified from pancreatic duct cells (PaDC) following organelle enrichment to those identified from PaDC whole cell lysates to determine if the additional procedures of subcellular fractionation increases proteome coverage. Methods We used differential centrifugation to enrich for nuclear, mitochondrial, membrane, and cytosolic proteins. We then compared - via mass spectrometry-based analysis - the number of proteins identified from these four fractions with four biological replicates of PaDC whole cell lysates. Results We identified similar numbers of proteins among all samples investigated. In total, 1658 non-redundant proteins were identified in the replicate samples, while 2196 were identified in the subcellular fractionation samples, corresponding to a 30% increase. Additionally, we noted that each organelle fraction was in fact enriched with proteins specific to the targeted organelle. Conclusions Subcellular fractionation of PaDC resulted in greater proteome coverage compared to PaDC whole cell lysate analysis. Although more labor intensive and time consuming, subcellular fractionation provides greater proteome coverage, and enriches for compartmentalized sub-populations of proteins. Application of this subcellular fractionation strategy allows for a greater depth of proteomic analysis and thus a better understanding of the cellular mechanisms of pancreatic disease.

Paulo, Joao A.; Gaun, Aleksandr; Kadiyala, Vivek; Ghoulidi, Ali; Banks, Peter A.; Conwell, Darwin L.; Steen, Hanno

2013-01-01

64

The effect of biliary stenting on difficult common bile duct stones  

PubMed Central

Introduction If common bile duct (CBD) stones (choledocholithiasis) are left untreated, they may cause increases in morbidity and mortality due to several conditions. Aim In this study, using transient biliary stenting following the failure of an initial endoscopic retrograde cholangiopancreatography (ERCP) session, we aimed to show the effects of making the CBD stones smaller and easier to remove in the following session. Material and methods In 156 of 1300 (12%) patients with CBD stones, who underwent balloon screening and/or basket lithotripsy following ERCP and CBD cannulation, it was not possible to remove the stones in the first session. Of these 156 patients, 64 (4.9%) were further followed and tested following transient biliary stenting. Results In the last ERCP following biliary stenting, the maximum stone sizes and stone indices were decreased in 54 (83%) patients and stone fragmentation was observed in 46 (72%) patients. Complete and incomplete removal was obtained in 40 (62.5%) and 24 (37.5%) patients, respectively. Conclusions Biliary stenting, fragmentation and the reduction in the size of difficult common bile duct stones caused by the first session of ERCP may increase the chance of success in the next session of ERCP.

Arabul, Mahmut; Celik, Mustafa; Alper, Emrah; Unsal, Belk?s

2014-01-01

65

Repair of bile duct defect with degradable stent and autologous tissue in a porcine model  

PubMed Central

AIM: To introduce and evaluate a new method to repair bile duct defect with a degradable stent and autologous tissues. METHODS: Eight Ba-Ma mini-pigs were used in this study. Experimental models with common bile duct (CBD) defect (0.5-1.0 cm segment of CBD resected) were established and then CBD was reconstructed by duct to duct anastomosis with a novel degradable stent made of poly [sebacic acid-co-(1,3-propanediol)-co-(1,2-propanediol)]. In addition, a vascularized greater omentum was placed around the stent and both ends of CBD. Cholangiography via gall bladder was performed for each pig at postoperative months 1 and 3 to rule out stent translocation and bile duct stricture. Complete blood count was examined pre- and post-operatively to estimate the inflammatory reaction. Liver enzymes and serum bilirubin were examined pre- and post-operatively to evaluate the liver function. Five pigs were sacrificed at month 3 to evaluate the healing of anastomosis. The other three pigs were raised for one year for long-term observation. RESULTS: All the animals underwent surgery successfully. There was no intraoperative mortality and no bile leakage during the observation period. The white blood cell counts were only slightly increased on day 14 and month 3 postoperatively compared with that before operation, the difference was not statistically significant (P = 0.652). The plasma level of alanine aminotransferase on day 14 and month 3 postoperatively was also not significantly elevated compared with that before operation (P = 0.810). Nevertheless, the plasma level of ?-glutamyl transferase was increased after operation in both groups (P = 0.004), especially 2 wk after operation. The level of serum total bilirubin after operation was not significantly elevated compared with that before operation (P = 0.227), so did the serum direct bilirubin (P = 0.759). By cholangiography via gall bladder, we found that the stent maintained its integrity of shape and was still in situ at month 1, and it disappeared completely at month 3. No severe CBD dilation and stricture were observed at both months 1 and 3. No pig died during the 3-mo postoperative observation period. No sign of necrosis, bile duct stricture, bile leakage or abdominal abscess was found at reoperation at month 3 postoperatively. Pigs had neither fragments of stent nor stones formed in the CBD. Collagen deposit was observed in the anastomosis by hematoxylin and eosin (HE) and Masson’s trichrome stains. No severe cholestasis was observed in liver parenchyma by HE staining. Intestinal obstruction was found in a pig 4 mo after operation, and no bile leakage, bile duct stricture or biliary obstruction were observed in laparotomy. No sign of bile duct stricture or bile leakage was observed in the other two pigs. CONCLUSION: The novel method for repairing bile duct defect yielded a good short-term effect without postoperative bile duct stricture. However, the long-term effect should be further studied.

Liang, Yue-Long; Yu, Yi-Chen; Liu, Kun; Wang, Wei-Jia; Ying, Jiang-Bo; Wang, Yi-Fan; Cai, Xiu-Jun

2012-01-01

66

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; Iñaki Heras; José L Cabriada; Antonio Bernal; Victor Orive; Elena Astigarraga

2002-01-01

67

Quantification of pancreatic exocrine function with secretin-enhanced magnetic resonance cholangiopancreatography: normal values and short-term effects of pancreatic duct drainage procedures in chronic pancreatitis. Initial results  

Microsoft Academic Search

The aim of this study was to quantify pancreatic exocrine function in normal subjects and in patients with chronic pancreatitis (CP) before and after pancreatic duct drainage procedures (PDDP) with dynamic secretin-enhanced magnetic resonance (MR) cholangiopancreatography (S-MRCP). Pancreatic exocrine secretions [quantified by pancreatic flow output (PFO) and total excreted volume (TEV)] were quantified twice in ten healthy volunteers and before

M. A. Bali; A. Sztantics; T. Metens; M. Arvanitakis; M. Delhaye; J. Devière; C. Matos

2005-01-01

68

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

Microsoft Academic Search

The purpose of this study was to compare the clinical effectiveness of expanded polytetrafluoroethylene\\/fluorinated-ethylene-propylene\\u000a (ePTFE\\/FEP)–covered stents with that of uncovered nitinol stents for the palliation of malignant jaundice caused by inoperable\\u000a pancreatic head cancer. Eighty patients were enrolled in a prospective randomized study. Bare nitinol stents were used in\\u000a half of the patients, and ePTFE\\/FEP–covered stents were used in the

Miltiadis Krokidis; Fabrizio Fanelli; Gianluigi Orgera; Dimitrios Tsetis; Ioannis Mouzas; Mario Bezzi; Elias Kouroumalis; Roberto Pasariello; Adam Hatzidakis

2011-01-01

69

Diagnosis of pancreatic duct-portal vein fistula; a case report and review of the literature  

PubMed Central

Pseudocysts containing activated enzymes are a common complication of pancreatitis. Pseudocysts can rupture into adjacent structures including the peritoneal cavity, adjacent organs, and rarely vascular structures. While arterial pseudoaneurysms and venous thrombosis or occlusion are well known complications of acute and chronic pancreatitis, only 17 cases of pancreas-portal venous fistula have been encountered in review of the literature. A patient with chronic pancreatitis presented with a history of weight loss, fatigue and was found to have a pancreatic duct-portal vein fistula. The patient was treated surgically with good outcome.

Brown, Anthony; Malden, Eric; Kugelmas, Marcelo; Kortz, Eric

2014-01-01

70

Concomitant pancreatic adenocarcinoma in a patient with branch-duct intraductal papillary mucinous neoplasm  

PubMed Central

Branch duct intraductal papillary mucinous neoplasms (BD-IPMN) are pre-malignant pancreatic cystic lesions which carry a small risk of malignant transformation within the cyst. Guidelines exist with respect to surveillance of the cysts using computed tomography, magnetic resonance imaging, and/or endoscopic ultrasound (EUS). There are reports that patients with IPMNs are at increased risk of developing pancreatic adenocarcinoma, which arises in an area separate to the IPMNs. We present two cases of pancreatic adenocarcinoma arising within the parenchyma, distinct from the IPMN-associated cyst, identified with EUS. This case report highlights that patients with BD-IPMN are at increased risk for pancreatic adenocarcinoma separate from the cyst and also the importance for endosonographers to carefully survey the rest of the pancreatic parenchyma separate from the cyst in order to identify small pancreatic adenocarcinomas.

Law, Joanna K; Wolfgang, Christopher L; Weiss, Matthew J; Lennon, Anne Marie

2014-01-01

71

Involution of the pancreas after ligation of the pancreatic ducts. I: a histological study.  

PubMed Central

A detailed histological study of pancreatic involution after ligation of the pancreatic duct is reported. Cytological evidence acinar cell damage is evident from the beginning and loss of zymogen granules occurs early. The acini diminish in size rapidly from the 36th hour to the 3rd day. The cell deletion appears to occur in 2 phases with apparently different characteristics. The first phase appears to be related to the initial cell damage. The letter phase is more general but of uncertain nature. Considerable proliferation of cells occurs in the ducts resulting, with the few remaining acinar cells, in duct-like structures which themselves undergo involution. The duct changes therefore are not passive but involve continued cell proliferation and cell death over a long period. Images Fig. 1 Fig. 2 Fig. 3 Figs. 5 and 6 Figs. 7 and 8 Figs. 9-10

Pound, A. W.; Walker, N. I.

1981-01-01

72

[Heterotopic pancreatic tissue in the bifurcation of the bile duct : Rare diagnosis mimicking a Klatskin tumour].  

PubMed

Heterotopic tissue of the pancreas can be found in 1-2% of autopsies. The main locations are stomach, duodenum, jejunum, Meckel's diverticulum, and ileum. Less frequently it is observed in the liver, gallbladder, common bile duct, and papilla of Vateri. We report the first case of heterotopic pancreatic tissue in the bifurcation of the bile duct mimicking a Klatskin's tumour. The case is discussed based on the current literature. PMID:19234682

Heer, C; Pförtner, M; Hamberger, U; Raute-Kreinsen, U; Hanraths, M; Bartsch, D K

2010-02-01

73

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

74

[A case of intraductal mucinous neoplasms with the whole main pancreatic duct dilation treated via segment pancreatectomy].  

PubMed

The patient was a 77-year-old woman. She was diagnosed as intraducal papillary mucinous neoplasms (IPMN). She refused an operation for 3 years. After all, a nodule in the main pancreatic duct was pointed out, she agreed and was referred to us. Her past history showed pacemaker implantation for third-degree atrioventricular block, and no impaired glucose tolerance. Abdominal CT showed a dilated whole pancreatic duct and a multilocular cystic tumor. Endoscopic retrograde pancreatography showed a marked dilation of the main pancreatic duct. We diagnosed as main duct IPMN. Intraoperative US showed no nodule in pancreatic duct, and there was no suspicious lesion of invasive cancer. We performed segmental pancreatectomy between the left side of common bile duct and the pancreas tail. The tumor was resected with clear margins. Both cut-ends of the main pancreatic duct were anastomosed to a jejunal loop. The postoperative course was excellent. She was discharged on day 16. The glycemic control was good, she needed no treatment for diabetes. Total pancreatectomy has many problems such as insulin and pancreatic polypeptide deficiency, hypoglycemia, malabsorption, diarrhea and liver dysfunction. We avoided total pancreatectomy so that her quality of life was maintained. Still a careful follow -up is required. PMID:22202412

Yamaura, Tadayoshi; Sakamoto, Hirohiko; Amikura, Katsumi; Tanaka, Yoichi; Oba, Hanako; Kurosumi, Masafumi

2011-11-01

75

Pancreatic pseudocystwith stent placement in the background of narcotic use: a case report  

PubMed Central

A 49 year old gentleman presents with recurrent abdominal pain. The patient has a known history of chronic pancreatitis, alcoholism and narcotic addiction. Work-up, including computed tomography (CT) of the abdomen, demonstrated a 5.6 × 5.8 cm fluid collection contiguous with the pancreas. This was not seen on CT 18 months earlier. The patient's pain did not improve with bowel rest and pain control. He was transferred to another institution for endoscopic placement of a transgastric pancreatic stent. The procedure decreased the size the cyst and the patient's pain became more manageable.

Offord, Stephen; Gumustop, Bora; Shepard, Arthur

2008-01-01

76

Effective Endovascular Stenting of Malignant Portal Vein Obstruction in Pancreatic Cancer  

PubMed Central

We report herein the case of a patient successfully treated by transhepatic portal venous stent placement for malignant portal vein obstruction with associated gastric and small bowel varices and repeated gastrointestinal bleeding. CT angiography and portography showed severe portal vein obstruction from recurrent pancreatic cancer 15 months following pancreaticoduodenectomy with tumor encasement and dilated collateral veins throughout the gastric and proximal small bowel wall as the suspected cause of the GI bleeding. Successful transhepatic endovascular stent placement of the splenic vein at the portal vein confluence followed by balloon dilation was performed with immediate decompression of the gastric and small bowel varices and relief of GI hemorrhage in this patient until his death four months later. The treatment for patients with this dilemma can prove to be difficult, but as we have shown endovascular stenting of the portal system is an effective treatment option.

Ellis, Christian M.; Shenoy, Sadashiv; Litwin, Alan; Soehnlein, Stephanie; Gibbs, John F.

2009-01-01

77

Internal compared with external drainage of pancreatic duct during pancreaticoduodenectomy: a retrospective study  

PubMed Central

Objective To compare internal with external drainage of the pancreatic duct during pancreaticoduodenectomy with regard to the incidence of postoperative pancreatic fistula (POPF) and other complications. Methods We retrospectively analyzed 316 patients who underwent pancreaticoduodenectomy with a placed drainage tube (external, n=128; internal, n=188) in the pancreatic duct from 1 January 1999 to 31 December 2011 in Tianjin Third Central Hospital of China. The incidence of POPF and some other complications were compared. Results There was no difference in the incidence rates of POPF between those given an internal or external drainage tube (P=0.788), but POPF was more severe in the former (P=0.014). Intraperitoneal bleeding rate was also higher in the patients with internal drainage (P=0.040), but operative time and postoperative hospitalization were longer in those with external drainage (P=0.002 and P=0.007, respectively). There was no difference between the groups with regard to the incidence rates of gastrointestinal bleeding, delayed gastric emptying, pulmonary infection, or incision infection and in-hospital mortality. Conclusions External drainage of the pancreatic duct during pancreaticoduodenectomy can decrease the severity of POPF, but operative time and postoperative hospitalization will be extended.

Meng, Guangxing; Xing, Qianzhe; Yuan, Qiang; Du, Zhi

2014-01-01

78

Response of small intestinal flora to elemental diet and pancreatic duct ligation in vervet monkey.  

PubMed

The small intestinal flora of vervet monkeys (cercopithecus aethiops) was examined before and after feeding elemental diet and after ligation of the pancreatic duct. Elemental diet did not produce significant changes of the intestinal microbial flora. However, an increase of the microbial count consisting mainly of Enterobacteriaceae, molds and yeasts was observed in the duct-ligated animals, significantly more pronounced than in the sham-operated controls. The data confirm previous studies demonstrating the possible role of the exocrine pancreas in the maintenance of a normal intestinal flora. PMID:7277464

Gyr, K; Abee, C; Felsenfeld, O

1981-01-01

79

Stent grafting of acute hepatic artery bleeding following pancreatic head resection.  

PubMed

The purpose of this study was to report the potential of hepatic artery stent grafting in cases of acute hemorrhage of the gastroduodenal artery stump following pancreatic head resection. Five consecutive male patients were treated because of acute, life-threatening massive bleeding. Instead of re-operation, emergency angiography, with the potential of endovascular treatment, was performed. Because of bleeding from the hepatic artery, a stent graft (with the over-the-wire or monorail technique) was implanted to control the hemorrhage by preserving patency of the artery. The outcome was evaluated. In all cases, the hepatic artery stent grafting was successfully performed, and the bleeding was immediately stopped. Clinically, immediately after the procedure, there was an obvious improvement in the general patient condition. There were no immediate procedure-related complications. Completion angiography (n=5) demonstrated control of the hemorrhage and patency of the hepatic artery and the stent graft. Although all patients recovered hemodynamically, three individuals died 2 to 10 days after the procedure. The remaining two patients survived, without the need for re-operation. Transluminal stent graft placement in the hepatic artery is a safe and technically feasible solution to control life-threatening bleeding of the gastroduodenal artery stump. PMID:16932877

Stoupis, Christoforos; Ludwig, Karin; Inderbitzin, Daniel; Do, Dai-Do; Triller, Juergen

2007-02-01

80

[Cyst of the duodenum with termination of the bile and pancreatic ducts (author's transl)].  

PubMed

The radiological findings in a 27-year old female Turkish patient with a cyst in the wall of the duodenum are described. It caused a sharply demarkated, smooth thumb-print in the duodenum shown by barium meal. An intravenous and intra-operative cholangiogram caused filling of the cyst with contrast through the bile duct. The bile and pancreatic ducts terminated on the medial side of the cyst through the papilla of Vater. The size of the cyst varied, depending on its degree of filling with bile and pancreatic juice. Its position and morphology has been confirmed at operation. Histology showed an external cover of small bowel mucosa and an inner lining of small bowel mucosa interspersed with islands of gastric mucosa. The development of this cyst is explained as a developmental anomaly during recalisation of the embryonic duodenum. PMID:133940

Bargon, V G

1976-07-01

81

Extracorporeal shock wave lithotripsy for pancreatic and large common bile duct stones  

PubMed Central

Extraction of large pancreatic and common bile duct (CBD) calculi has always challenged the therapeutic endoscopist. Extracorporeal shockwave lithotripsy (ESWL) is an excellent tool for patients with large pancreatic and CBD calculi that are not amenable to routine endotherapy. Pancreatic calculi in the head and body are targeted by ESWL, with an aim to fragment them to < 3 mm diameter so that they can be extracted by subsequent endoscopic retrograde cholangiopancreatography (ERCP). In our experience, complete clearance of the pancreatic duct was achieved in 76% and partial clearance in 17% of 1006 patients. Short-term pain relief with reduction in the number of analgesics ingested was seen in 84% of these patients. For large CBD calculi, a nasobiliary tube is placed to help target the calculi, as well as bathe the calculi in saline - a simple maneuver which helps to facilitate fragmentation. The aim is to fragment calculi to < 5 mm size and clear the same during ERCP. Complete clearance of the CBD was achieved in 84.4% of and partial clearance in 12.3% of 283 patients. More than 90% of the patients with pancreatic and biliary calculi needed three or fewer sessions of ESWL with 5000 shocks being delivered at each session. The use of epidural anesthesia helped in reducing patient movement. This, together with the better focus achieved with newer third-generation lithotripters, prevents collateral tissue damage and minimizes the complications. Complications in our experience with nearly 1300 patients were minimal, and no extension of hospital stay was required. Similar rates of clearance of pancreatic and biliary calculi with minimal adverse effects have been reported from the centers where ESWL is performed regularly. In view of its high efficiency, non-invasive nature and low complication rates, ESWL can be offered as the first-line therapy for selected patients with large pancreatic and CBD calculi.

Tandan, Manu; Reddy, D Nageshwar

2011-01-01

82

Gallstone Pancreatitis: A Prospective Study on the Incidence of Cholangitis and Clinical Predictors of Retained Common Bile Duct Stones  

Microsoft Academic Search

Objective: The aim of this study was to define the incidence of cholangitis in gallstone pancreatitis, in the absence of cholangitis, to identify the clinical predictors of persistent common bile duct (CBD) stones at endoscopic retrograde cholangiography (ERCP) or at intraoperative cholangiography (IOC). Methods: A total of 122 consecutive patients with acute gallstone pancreatitis were prospectively evaluated for the presence

Lin Chang; Simon K Lo; Bruce E Stabile; Roger J Lewis; Christian de Virgilio

1998-01-01

83

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

84

Effects of Clostridium perfringens enterotoxin via claudin-4 on normal human pancreatic duct epithelial cells and cancer cells  

Microsoft Academic Search

The tight junction protein claudin-4 is frequently overexpressed in pancreatic cancer, and is also a receptor for Clostridium perfringens enterotoxin (CPE). The cytotoxic effects of CPE are thought to be useful as a novel therapeutic tool for pancreatic cancer.\\u000a However, the responses to CPE via claudin-4 remain unknown in normal human pancreatic duct epithelial (HPDE) cells. We introduced\\u000a the human

Hiroshi Yamaguchi; Takashi Kojima; Tatsuya Ito; Daisuke Kyuno; Yasutoshi Kimura; Masafumi Imamura; Koichi Hirata; Norimasa Sawada

85

Genes and Proteins Differentially Expressed during In Vitro Malignant Transformation of Bovine Pancreatic Duct Cells1  

PubMed Central

Abstract Pancreatic carcinoma has an extremely bad prognosis due to lack of early diagnostic markers and lack of effective therapeutic strategies. Recently, we have established an in vitro model recapitulating the first steps in the carcinogenesis of the pancreas. SV40 large T antigen-immortalized bovine pancreatic duct cells formed intrapancreatic adenocarcinoma tumors on k-rasmut transfection after orthotopic injection in the nude mouse pancreas. Here we identified genes and proteins differentially expressed in the course of malignant transformation using reciprocal suppression subtractive hybridization and 2D gel electrophoresis and mass spectrometry, respectively. We identified 34 differentially expressed genes, expressed sequence tags, and 15 unique proteins. Differential expression was verified for some of the genes or proteins in samples from pancreatic carcinoma. Among these genes and proteins, the majority had already been described either to be influenced by a mutated ras or to be differentially expressed in pancreatic adenocarcinoma, thus proving the feasibility of our model. Other genes and proteins (e.g., BBC1, GLTSCR2, and rhoGDI?), up to now, have not been implicated in pancreatic tumor development. Thus, we were able to establish an in vitro model of pancreatic carcinogenesis, which enabled us to identify genes and proteins differentially expressed during the early steps of malignant transformation.

Jesnowski, R; Zubakov, Dmitri; Faissner, Ralf; Ringel, Jorg; Hoheisel, Jorg D; Losel, Ralf; Schnolzer, Martina; Lohr, Matthias

2007-01-01

86

Regulation of tight junctions in human normal pancreatic duct epithelial cells and cancer cells.  

PubMed

To investigate the regulation of tight junction molecules in normal human pancreatic duct epithelial (HPDE) cells and pancreatic cancer cells, we introduced the human telomerase reverse transcriptase (hTERT) gene into HPDE cells in primary culture and compared them to pancreatic cancer cell lines. The hTERT-transfected HPDE cells were positive for PDE markers and expressed claudin-1, claudin-4, claudin-7, and claudin-18, occludin, tricellulin, marvelD3, JAM-A, zonula occludens (ZO)-1, and ZO-2. The tight junction molecules, including claudin-4 and claudin-18 of normal HPDE cells, were in part regulated via a protein kinase C signal pathway by transcriptional control. In addition, claudin-18 in normal HPDE cells and pancreatic cancer cells was markedly induced by a PKC activator, and claudin-18 in pancreatic cancer cells was also modified by DNA methylation. In the marvel family of normal HPDE cells and pancreatic cancer cells, tricellulin was upregulated via a c-Jun N-terminal kinase pathway, and marvelD3 was downregulated during Snail-induced epithelial-mesenchymal transition. PMID:22671593

Kojima, Takashi; Sawada, Norimasa

2012-06-01

87

A novel gene delivery method transduces porcine pancreatic duct epithelial cells.  

PubMed

Gene therapy offers the possibility to treat pancreatic disease in cystic fibrosis (CF), caused by mutations in the CF transmembrane conductance regulator (CFTR) gene; however, gene transfer to the pancreas is untested in humans. The pancreatic disease phenotype is very similar between humans and pigs with CF; thus, CF pigs create an excellent opportunity to study gene transfer to the pancreas. There are no studies showing efficient transduction of pig pancreas with gene-transfer vectors. Our objective is to develop a safe and efficient method to transduce wild-type (WT) porcine pancreatic ducts that express CFTR. We catheterized the umbilical artery of WT newborn pigs and delivered an adeno-associated virus serotype 9 vector expressing green-fluorescent protein (AAV9CMV.sceGFP) or vehicle to the celiac artery, the vessel that supplies major branches to the pancreas. This technique resulted in stable and dose-dependent transduction of pancreatic duct epithelial cells that expressed CFTR. Intravenous (IV) injection of AAV9CMV.sceGFP did not transduce the pancreas. Our technique offers an opportunity to deliver the CFTR gene to the pancreas of CF pigs. The celiac artery can be accessed via the umbilical artery in newborns and via the femoral artery at older ages--delivery approaches that can be translated to humans. PMID:24257348

Griffin, M A; Restrepo, M S; Abu-El-Haija, M; Wallen, T; Buchanan, E; Rokhlina, T; Chen, Y H; McCray, P B; Davidson, B L; Divekar, A; Uc, A

2014-02-01

88

Establishment of three-dimensional cultures of human pancreatic duct epithelial cells  

SciTech Connect

Three-dimensional (3D) cultures of epithelial cells offer singular advantages for studies of morphogenesis or the role of cancer genes in oncogenesis. In this study, as part of establishing a 3D culture system of pancreatic duct epithelial cells, we compared human pancreatic duct epithelial cells (HPDE-E6E7) with pancreatic cancer cell lines. Our results show, that in contrast to cancer cells, HPDE-E6E7 organized into spheroids with what appeared to be apical and basal membranes and a luminal space. Immunostaining experiments indicated that protein kinase Akt was phosphorylated (Ser473) and CTMP, a negative Akt regulator, was expressed in both HPDE-E6E7 and cancer cells. However, a nuclear pool of CTMP was detectable in HPDE-E6E7 cells that showed a dynamic concentrated expression pattern, a feature that further distinguished HPDE-E637 cells from cancer cells. Collectively, these data suggest that 3D cultures of HPDE-E6E7 cells are useful for investigating signaling and morphological abnormalities in pancreatic cancer cells.

Gutierrez-Barrera, Angelica M. [Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Unit 426, 1515 Holcombe Boulevard, Houston, TX 77030 (United States); Menter, David G. [Department of Thoracic Head and Neck Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Abbruzzese, James L. [Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Unit 426, 1515 Holcombe Boulevard, Houston, TX 77030 (United States); Reddy, Shrikanth A.G. [Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Unit 426, 1515 Holcombe Boulevard, Houston, TX 77030 (United States)]. E-mail: sa08366@wotan.mdacc.tmc.edu

2007-07-06

89

Can pancreatic duct-derived progenitors be a source of islet regeneration?  

SciTech Connect

The regenerative process of the pancreas is of interest because the main pathogenesis of diabetes mellitus is an inadequate number of insulin-producing {beta}-cells. The functional mass of {beta}-cells is decreased in type 1 diabetes, so replacing missing {beta}-cells or triggering their regeneration may allow for improved type 1 diabetes treatment. Therefore, expansion of the {beta}-cell mass from endogenous sources, either in vivo or in vitro, represents an area of increasing interest. The mechanism of islet regeneration remains poorly understood, but the identification of islet progenitor sources is critical for understanding {beta}-cell regeneration. One potential source is the islet proper, via the dedifferentiation, proliferation, and redifferentiation of facultative progenitors residing within the islet. Neogenesis, or that the new pancreatic islets can derive from progenitor cells present within the ducts has been reported, but the existence and identity of the progenitor cells have been debated. In this review, we focus on pancreatic ductal cells, which are islet progenitors capable of differentiating into islet {beta}-cells. Islet neogenesis, seen as budding of hormone-positive cells from the ductal epithelium, is considered to be one mechanism for normal islet growth after birth and in regeneration, and has suggested the presence of pancreatic stem cells. Numerous results support the neogenesis hypothesis, the evidence for the hypothesis in the adult comes primarily from morphological studies that have in common the production of damage to all or part of the pancreas, with consequent inflammation and repair. Although numerous studies support a ductal origin for new islets after birth, lineage-tracing experiments are considered the 'gold standard' of proof. Lineage-tracing experiments show that pancreatic duct cells act as progenitors, giving rise to new islets after birth and after injury. The identification of differentiated pancreatic ductal cells as an in vivo progenitor for pancreatic {beta}-cells has implications for a potentially important, expandable source of new islets for diabetic replenishment therapy.

Xia, Bing [Department of Endocrinology, First Hospital of Harbin Medical University, Harbin, Hei Long Jiang Province 150001 (China)] [Department of Endocrinology, First Hospital of Harbin Medical University, Harbin, Hei Long Jiang Province 150001 (China); Zhan, Xiao-Rong, E-mail: xiaorongzhan@sina.com [Department of Endocrinology, First Hospital of Harbin Medical University, Harbin, Hei Long Jiang Province 150001 (China)] [Department of Endocrinology, First Hospital of Harbin Medical University, Harbin, Hei Long Jiang Province 150001 (China); Yi, Ran [Department of Endocrinology, First Hospital of Harbin Medical University, Harbin, Hei Long Jiang Province 150001 (China)] [Department of Endocrinology, First Hospital of Harbin Medical University, Harbin, Hei Long Jiang Province 150001 (China); Yang, Baofeng [Department of Pharmacology, State Key Laboratory of Biomedicine and Pharmacology, Harbin Medical University, Harbin, Hei Long Jiang Province 150001 (China)] [Department of Pharmacology, State Key Laboratory of Biomedicine and Pharmacology, Harbin Medical University, Harbin, Hei Long Jiang Province 150001 (China)

2009-06-12

90

Pancreatico-pericardial fistula as a complication of chronic pancreatitis  

PubMed Central

Pancreatico-pericardial fistula is an extremely rare complication of chronic pancreatitis. We present a case of a 58-year-old man who presented with syncope. Transthoracic echocardiogram revealed a pericardial effusion with tamponade physiology. Pericardiocentesis and pericardial fluid analysis demonstrated a lipase level of 2321 U/L. Subsequently, an endoscopic retrograde cholangiopancreatography (ERCP) was performed, confirming the presence of a pancreatico-pericardial fistula (PPF) from the distal body of the pancreas. A pancreatic duct stent was placed across the duct disruption on two separate occasions; however, despite stent placement, the patient continued to re-accumulate pericardial fluid and deteriorated. While rare, PPFs may complicate chronic pancreatitis, may not respond to pancreatic duct stenting and may portend a poor prognosis.

Wilcox, C. Mel

2014-01-01

91

[A case of intraductal papillary mucinous neoplasm of the pancreas arising from pancreas divisum without ventral pancreatic duct of Wirsung].  

PubMed

Most reported cases of intraductal papillary mucinous neoplasms (IPMNs) originate from Wirsung's duct or their branches. IPMNs arising from Santorini's duct and its branches have rarely been reported. Eight cases of IPMN arising from Santorini's duct have been published worldwide. However, these cases are associated with incomplete type of pancreas divisum. Recently, one report of IPMN with complete absence of Wirsung's duct has been reported. This patient was a 57-year-old woman who was admitted to the hospital due to progressive jaundice. On endoscopic retrograde cholangiopancreatography, there was a severely bulging ampulla of Vater and patulous minor papilla draining mucinous material and a cystic lesion communicating with the dilated Santorini's duct without any communication with Wirsung's duct. A pancreaticoduodenectomy was performed and the pathologic examination of resected specimen showed no evidence of Wirsung's duct, but an IPMN arising from Santorini's duct with peripancreatic lymph node metastasis. Herein, we report a case of invasive IPMN arising from pancreatic head without ventral pancreatic duct with a review of the relevant literatures. PMID:16554676

Kim, Sung Cheol; Kim, Seong Hwan; Myung, Suk Jin; Choi, Jin Woo; Song, Moon Hee; Jo, Yoon Ju; Park, Young Sook; Joo, Jong Eun; Park, Sung Won

2006-03-01

92

Endosonography-guided cholangiopancreatography as a salvage drainage procedure for obstructed biliary and pancreatic ducts  

PubMed Central

Endoscopic ultrasound allows transmural access to the bile or pancreatic ducts and subsequent contrast injection to provide ductal drainage under fluoroscopy using endoscopic retrograde cholangiopancreatography (ERCP)-based techniques. Differing patient specifics and operator techniques result in six possible variant approaches to this procedure, known as endosonography-guided cholangiopancreatography (ESCP). ESCP has been in clinical use for a decade now, with over 300 cases reported. It has become established as a salvage procedure after failed ERCP in the palliation of malignant biliary obstruction. Its role in the management of clinically severe chronic/relapsing pancreatitis remains under scrutiny. This review aims to clarify the concepts underlying the use of ESCP and to provide technical tips and a detailed step-by-step procedural description.

Perez-Miranda, Manuel; de la Serna, Carlos; Diez-Redondo, Pilar; Vila, Juan J

2010-01-01

93

Mutagenicity of carcinogenic nitrosamines when activated by hamster and human pancreatic duct epithelial cells  

Microsoft Academic Search

We have measured the ability of pancreatic duct epithelial cells (DEC) from Syrian hamsters and humans and CK cells, immortalized hamster DEC, to metabolize chemical carcinogens to species that were mutagenic in S. typhimurium TA98 and in V79 cells. The chemicals were N-nitrosobis(2-oxopropyl)amine (BOP), 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) and 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP). The ability of ethanol (EtOH) to modify the metabolizing efficiency was

Carol Kolar; Terence Lawson

1997-01-01

94

Differentiating Branch Duct and Mixed IPMN in Endoscopically Collected Pancreatic Cyst Fluid via Cytokine Analysis  

PubMed Central

Background. Differentiating branch duct from mixed intraductal papillary mucinous neoplasm (BD-IPMN) is problematic, but clinically important as mixed IPMNs are managed surgically, while some BD-IPMN may be followed. Inflammatory mediator proteins (IMPs) have been implicated in acute and chronic inflammatory and malignant pancreatic diseases. Aim. To compare IMP profile of pancreatic cyst fluid collected endoscopically from BD-IPMN and mixed IPMN. Methods. Pancreatic cyst fluid from ten patients (5 BD-IPMN and 5 mixed IPMN) was collected by endoscopic ultrasound-guided fine needle aspiration or endoscopic retrograde cholangiopancreatography. Concentrations of 89 IMPs in these samples were determined using a multiplexed bead-based microarray protein assay and compared between BD-IPMN and mixed IPMN. Results. Eighty-six of 89 IMPs were detected in at least one of the 10 samples. Fourteen IMPs were detected only in mixed IPMN, while none were only in BD-IPMN. Of these, TGF-?1 was most prevalent, present in 3 of 5 mixed IPMNs. Seventy-two IMPs were detected in both BD-IPMN and mixed IPMNs. Of these, only G-CSF (P < 0.05) was present in higher concentrations in mixed IPMNs. Conclusion. TGF-?1 and G-CSF detected in endoscopically collected pancreatic cyst fluid are potential diagnostic biomarkers capable of distinguishing mixed IPMN from BD-IPMN.

Lee, Linda S.; Bellizzi, Andrew M.; Banks, Peter A.; Sainani, Nisha I.; Kadiyala, Vivek; Suleiman, Shadeah; Conwell, Darwin L.; Paulo, Joao A.

2012-01-01

95

Differentiating Branch Duct and Mixed IPMN in Endoscopically Collected Pancreatic Cyst Fluid via Cytokine Analysis.  

PubMed

Background. Differentiating branch duct from mixed intraductal papillary mucinous neoplasm (BD-IPMN) is problematic, but clinically important as mixed IPMNs are managed surgically, while some BD-IPMN may be followed. Inflammatory mediator proteins (IMPs) have been implicated in acute and chronic inflammatory and malignant pancreatic diseases. Aim. To compare IMP profile of pancreatic cyst fluid collected endoscopically from BD-IPMN and mixed IPMN. Methods. Pancreatic cyst fluid from ten patients (5 BD-IPMN and 5 mixed IPMN) was collected by endoscopic ultrasound-guided fine needle aspiration or endoscopic retrograde cholangiopancreatography. Concentrations of 89 IMPs in these samples were determined using a multiplexed bead-based microarray protein assay and compared between BD-IPMN and mixed IPMN. Results. Eighty-six of 89 IMPs were detected in at least one of the 10 samples. Fourteen IMPs were detected only in mixed IPMN, while none were only in BD-IPMN. Of these, TGF-?1 was most prevalent, present in 3 of 5 mixed IPMNs. Seventy-two IMPs were detected in both BD-IPMN and mixed IPMNs. Of these, only G-CSF (P < 0.05) was present in higher concentrations in mixed IPMNs. Conclusion. TGF-?1 and G-CSF detected in endoscopically collected pancreatic cyst fluid are potential diagnostic biomarkers capable of distinguishing mixed IPMN from BD-IPMN. PMID:23326260

Lee, Linda S; Bellizzi, Andrew M; Banks, Peter A; Sainani, Nisha I; Kadiyala, Vivek; Suleiman, Shadeah; Conwell, Darwin L; Paulo, Joao A

2012-01-01

96

New developments in diagnosis and non-surgical treatment of chronic pancreatitis.  

PubMed

Chronic pancreatitis is progressive and irreversible, leading to digestive and absorptive disorders by destruction of the exocrine pancreas and to diabetes mellitus by destruction of the endocrine pancreas. When complications such as pancreatolithiasis and pseudocyst occur, elevated pancreatic ductal pressure exacerbates pain and induces other complications, worsening the patient's general condition. Combined treatment with extracorporeal shock-wave lithotripsy and endoscopic lithotripsy is a useful, minimally invasive, first-line treatment approach that can preserve pancreatic exocrine function. Pancreatic duct stenosis elevates intraductal pressure and favor both pancreatolithiasis and pseudocyst formation, making effective treatment vitally important. Endoscopic treatment of benign pancreatic duct stenosis stenting frequently decreases pain in chronic pancreatitis. Importantly, stenosis of the main pancreatic duct increases risk of stone recurrence after treatment of pancreatolithiasis. Recently, good results were reported in treating pancreatic duct stricture with a fully covered self-expandable metallic stent, which shows promise for preventing stone recurrence after lithotripsy in patients with pancreatic stricture. Chronic pancreatitis has many complications including pancreatic carcinoma, pancreatic atrophy, and loss of exocrine and endocrine function, as well as frequent recurrence of stones after treatment of pancreatolithiasis. As early treatment of chronic pancreatitis is essential, the new concept of early chronic pancreatitis, including characteristics findings in endoscopic ultrasonograms, is presented. PMID:24251715

Inui, Kazuo; Yoshino, Junji; Miyoshi, Hironao; Yamamoto, Satoshi; Kobayashi, Takashi

2013-12-01

97

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

98

Gallstone Pancreatitis: A Prospective Study on the Incidence of Cholangitis and Clinical Predictors of Retained Common Bile Duct Stones  

Microsoft Academic Search

Objective:The aim of this study was to define the incidence of cholangitis in gallstone pancreatitis, in the absence of cholangitis, to identify the clinical predictors of persistent common bile duct (CBD) stones at endoscopic retrograde cholangiography (ERCP) or at intraoperative cholangiography (IOC).Methods:A total of 122 consecutive patients with acute gallstone pancreatitis were prospectively evaluated for the presence of CBD stones

Lin Chang; Simon K. Lo; Bruce E. Stabile; Roger J. Lewis; Christian de Virgilio

1998-01-01

99

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

Microsoft Academic Search

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.

Philip M. Thompson; Christopher M. B. Hare; William R. Lees

2004-01-01

100

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

101

Permanent stenting in “unextractable” common bile duct stones in high risk patients. A prospective randomized study comparing two different stents  

Microsoft Academic Search

Background  Endoscopic sphincterotomy (ES) and stone extraction is the treatment of choice for bile duct stones. Therefore, if ES and\\u000a conventional stone extraction fail, further treatment is mandatory. Insertion of a biliary endoprosthesis is an effective\\u000a option.\\u000a \\u000a \\u000a \\u000a Materials and methods  We treated 30 high-risk patients (17 women and 13 men, mean age 82 years) affected by difficult common bile duct stones. The\\u000a patients

Franco Pisello; Girolamo Geraci; Francesco Li Volsi; Giuseppe Modica; Carmelo Sciumè

2008-01-01

102

Hollow-spheres: a new model for analyses of differentiation of pancreatic duct epithelial cells.  

PubMed

We discovered a unique feature of a subclone of the pancreatic carcinoma cell line A818. A818-1-derived hollow-spheres developed under three-dimensional growth conditions. Hollow-spheres consist of a single layer of 50-200 epithelial cells surrounding an inner lumen. In contrast to A818-1, the subclone A818-4 and all other pancreatic tumor cell lines tested (n = 5), formed spheroids as the only three-dimensional phenotype. A dramatically reduced proliferation rate compared to the corresponding monolayer was observed in hollow-spheres when bromodeoxyuridine (BrdU) incorporation was measured. This finding was confirmed by immunostaining using the MIB-1 antibody. Mechanically disrupted hollow-spheres not only attached but also grew as monolayer with the same doubling time as the founder cells. Hollow-spheres developed in fetal calf serum (FCS) containing RPMI 1640 medium without additionally added cytokines. A818-1 hollow-sphere formation and integrity was influenced by interferon-gamma. Tumor necrosis factor-alpha (TNF-alpha) led to cell death. Exogenously added hepatocyte growth factor (HGF) showed no effect neither on hollow-sphere formation nor on the integrity of completely developed hollow-spheres. Moreover, no changes were observed when cells were treated with a neutralizing antibody for HGF. Interestingly, hollow-spheres showed intensive immunoreactivity for the HGF-receptor (c-met) and its ligand (HGF). Immunostaining for the biliary glycoprotein (BGP), the non-specific cross-reacting antigen 95 (NCA95) and beta-catenin revealed a polar organization of hollow-spheres. Immunhistochemically, hollow-spheres were negative for the carcinoembryonic antigen (CEA). When hollow-spheres were embedded into matrigel, duct-like tubes grew out. Taken together, A818-1 hollow-spheres resemble normally differentiated duct-like structures and will serve as an excellent model to study differentiation of human pancreatic epithelial cells. PMID:10415853

Lehnert, L; Trost, H; Schmiegel, W; Röder, C; Kalthoff, H

1999-06-30

103

Prospective, randomized, single-center trial comparing 3 different 10F plastic stents in malignant mid and distal bile duct strictures  

Microsoft Academic Search

Background: The aim of this study was to determine whether patency rates differ with respect to the material, design, and surface texture of 3 different plastic stents. Methods: A total of 120 patients (median age 70.5 years; interquartile range 62-78 years) with malignant mid or distal bile duct strictures, seen between March 1996 and May 1999, were prospectively randomized to

Dieter Schilling; Günter Rink; Joachim C. Arnold; Claus Benz; Henning E. Adamek; Ralf Jakobs; Jürgen F. Riemann

2003-01-01

104

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

PubMed Central

Background Keratinocyte 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 diabetic rat. Methodology and Results In vitro and in vivo duct cell proliferation was measured by BrdU incorporation assay. The implication of MAPK-ERK1/2 in the mediation of KGF-induced cell proliferation was determined by inactivation of this pathway, using the pharmacological inhibitor or antisense morpholino-oligonucleotides against MEK1. In vivo KGF-induced duct cell differentiation was assessed by the immunolocalization of PDX1 and Glut2 in ductal cells and the implication of PI3K/AKT in this process was investigated. We showed that KGF exerted a potent mitogenic effect on ductal cells. Both in vitro and in vivo, its effect on cell proliferation was mediated through the activation of ERK1/2 as evidenced by the abolition of duct cell proliferation in the context of MEK/ERK inactivation. In vivo, KGF treatment triggered ductal cell differentiation as revealed by the expression of PDX1 and Glut2 in a subpopulation of ductal cells via a PI3K-dependent mechanism. Conclusion Here we show that KGF promotes beta-cell regeneration by stimulating duct cell proliferation in vivo. Moreover, we demonstrated for the first time that KGF directly induces the expression of PDX1 in some ductal cells thus inducing beta-cell neogenesis. We further explored the molecular mechanisms involved in these processes and showed that the effects of KGF on duct cell proliferation are mediated by the MEK-ERK1/2 pathway, while the KGF-induced cell differentiation is mediated by the PI3K/AKT pathway. These findings might have important implications for the in vivo induction of duct-to-beta cell neogenesis in patients with beta-cell deficiency.

Uzan, Benjamin; Figeac, Florence; Portha, Bernard; Movassat, Jamileh

2009-01-01

105

Pancreatic Duct Glands are Distinct Ductal Compartments that React to Chronic Injury and Mediate Shh-induced Metaplasia  

PubMed Central

Background & Aims Pancreatic intraepithelial neoplasia (PanIN) are pancreatic cancer precursor lesions of unclear origin and significance. PanIN aberrantly express sonic hedgehog (Shh), an initiator of pancreatic cancer, and gastrointestinal mucins. The majority of PanIN are thought to arise from ducts. We identified a novel ductal compartment that is gathered in gland-like outpouches (pancreatic duct glands, PDG) of major ducts and characterized its role in injury and metaplasia. Methods The ductal system was analyzed in normal pancreata and chronic pancreatitis in humans and mice. Anatomy was assessed by serial H&E sections and scanning electron microscopy of corrosion casts. Expression of mucins and developmental genes and proliferation were assessed by immunohistochemistry or RT-qPCR. Effects of Shh on ductal cells were investigated by exposure to Shh in vitro and transgenic misexpression in vivo. Results Three-dimensional analysis revealed blind-ending outpouches of ducts in murine and human pancreata. These PDG are morphologically and molecularly distinct from normal ducts; even in normal pancreata they display PanIN and metaplastic features such as expression of Shh and gastric mucins. They express other developmental genes, such as Pdx-1 and Hes-1. In injury, Shh is upregulated along with gastric mucins. Expansion of the PDG compartment results in a mucinous metaplasia. Shh promotes this transformation in vitro and in vivo. Conclusions PDG are a distinct gland-like mucinous compartment with a distinct molecular signature. In response to injury PDG undergo a Shh-mediated mucinous gastrointestinal metaplasia with PanIN-like features. PDG may provide a link between Shh, mucinous metaplasia and neoplasia.

STROBEL, OLIVER; ROSOW, DAVID E.; RAKHLIN, ELENA Y.; LAUWERS, GREGORY Y.; TRAINOR, AMANDA G.; ALSINA, JANIVETTE; CASTILLO, CARLOS FERNANDEZ-DEL; WARSHAW, ANDREW L.; THAYER, SARAH P.

2013-01-01

106

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

107

Differential Diagnosis of Focal Non-Cystic Pancreatic Lesions With and Without Proximal Dilation of Pancreatic Duct Noted on CT Scan  

PubMed Central

OBJECTIVES: Pancreatic duct (PD) dilation proximal to a solid focal pancreatic lesion on computed tomography (CT) scan is considered highly suggestive of pancreatic adenocarcinoma. There is, however, no published data on the differential diagnosis of focal non-cystic pancreatic lesions with and without PD dilation. We assessed the diagnostic utility of this radiologic finding. METHODS: This is a retrospective analysis of a prospectively maintained database of university-based clinical practice. A total of 445 non-jaundiced patients who underwent endoscopic ultrasound (EUS) (2002–2010) for evaluation of solid pancreatic lesions noted on CT scan were included. Final diagnosis was based on surgical pathology or definitive cytology with supporting clinical follow-up of ?12 months. Main outcome measurements included (1) differential diagnoses and (2) performance characteristics of EUS-fine needle aspiration (FNA) for diagnosing neoplasm in patients with non-cystic pancreatic lesions with and without PD dilation. RESULTS: A neoplasm was finally diagnosed in 152 of 187 patients with and 87 of 258 patients without PD dilation on CT scan. Chronic pancreatitis (diffuse and focal) was the predominant non-malignant diagnosis in patients with PD dilation. In patients without PD dilation, malignant lesions included neuroendocrine tumor, adenocarcinoma, metastasis, PEComa (perivascular epitheloid cell tumor), and lymphoma; and the non-neoplastic diagnosis included chronic pancreatitis, intrapancreatic lymph nodes, and infected pancreatic fluid collection. EUS-FNA had 97.6% accuracy for diagnosing a neoplasm in these patients. CONCLUSIONS: Dilation PD proximal to a focal solid pancreatic lesion increases the likelihood of malignancy but the performance characteristics of this radiologic finding are probably inadequate to guide clinical management. Neoplasms without dilated PD often require immunostaining for a definitive diagnosis.

Tummala, MD, Pavan; Rao, MD, Savitha; Agarwal, MD, Banke

2013-01-01

108

Pancreatic duct ligation after almost complete ?-cell loss: exocrine regeneration but no evidence of ?-cell regeneration.  

PubMed

There has been great interest in the extent of ?-cell regeneration after pancreatic duct ligation (PDL) and whether ?- to ?-cell conversion might account for ?-cell regeneration after near-complete ?-cell loss. To assess these questions, we established a PDL-model in adult male rats after almost complete beta-cell depletion achieved by giving a single high dose of streptozocin (STZ) in the fasted state. Because of the resultant severe diabetes, rats were given islet cell transplants to allow long-term follow-up. Although animals were followed up to 10 months, there was no meaningful ?-cell regeneration, be it through replication, neogenesis, or ?- to ?-cell conversion. In contrast, the acinar cell compartment underwent massive changes with first severe acinar degeneration upon PDL injury followed by the appearance of pancreatic adipocytes, and finally near-complete reappearance of acini. We conclude that ?-cells and acinar cells, although originating from the same precursors during development, have very distinct regenerative potentials in our PDL model in adult rats. PMID:24029238

Cavelti-Weder, Claudia; Shtessel, Maria; Reuss, Joshua E; Jermendy, Agnes; Yamada, Takatsugu; Caballero, Francisco; Bonner-Weir, Susan; Weir, Gordon C

2013-12-01

109

Progressive genomic alterations in intraductal papillary mucinous tumours of the pancreas and morphologically similar lesions of the pancreatic ducts.  

PubMed

Intraductal papillary mucinous tumours (IPMTs) of the pancreas are rare neoplasms characterized by a prominent intraductal component, and by malignant potential. Little data exists concerning numerical chromosome aberrations in IPMTs. The biological significance of mucinous epithelial changes (mucinous hyperplasia) in small branching ducts adjacent to IPMTs also remains unclear. From a series of 12 IPMTs, we investigated by interphase cytogenetics 22 foci with mucinous hyperplasia, 27 foci with borderline lesions, and 11 samples with either intraductal (CIS) or invasive carcinoma. Chromosome 6 loss was detected in areas with mucinous hyperplasia (36.3%), borderline lesions (96.3%), and CIS/invasive carcinoma (100%). Similar losses, indicating clonal progression, were found for chromosome 17 (18.2%, 81.5%, and 100%), and for chromosome 18 (0%, 18.5%, and 100%). Quantitative analysis showed a significant intraductal expansion of cell clones harbouring these numerical aberrations within the spectrum of IPMTs. Mucinous epithelial changes in 11 resection samples with chronic pancreatitis showed monosomy 6 (36%) and monosomy 17 (27%). Conversely, areas with low-grade pancreatic intraepithelial neoplasia (PanIN-1), obtained from eight surgical specimens with ductal adenocarcinoma, showed monosomies for chromosome 6, 17, and 18 (100%, 87%, and 50%, respectively). We conclude that monosomies, as defined by FISH analysis, are frequent in both IPMTs and mucinous hyperplasia of pancreatic ducts adjacent to IPMTs. Monosomy 6 may represent an early event in the stepwise accumulation of genomic mutations necessary for the neoplastic transformation of pancreatic duct epithelia, whereas loss of chromosome 18 may be implicated in the progression of borderline to malignant IPMT. The detection of complex chromosomal aberrations in mucinous epithelial changes, and the quantitative expansion of monosomic cell clones in pancreatic ducts, provide evidence for a continuum between hyperplastic and dysplastic epithelial changes. PMID:12635136

Soldini, Davide; Gugger, Matthias; Burckhardt, Elisabeth; Kappeler, Andreas; Laissue, Jean A; Mazzucchelli, Luca

2003-04-01

110

Biliary stenting: indications, choice of stents and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline.  

PubMed

This article is part of a combined publication that expresses the current view of the European Society of Gastrointestinal Endoscopy about endoscopic biliary stenting. The present Clinical Guideline describes short-term and long-term results of biliary stenting depending on indications and stent models; it makes recommendations on when, how, and with which stent to perform biliary drainage in most common clinical settings, including in patients with a potentially resectable malignant biliary obstruction and in those who require palliative drainage of common bile duct or hilar strictures. Treatment of benign conditions (strictures related to chronic pancreatitis, liver transplantation, or cholecystectomy, and leaks and failed biliary stone extraction) and management of complications (including stent revision) are also discussed. A two-page executive summary of evidence statements and recommendations is provided. A separate Technology Review describes the models of biliary stents available and the stenting techniques, including advanced techniques such as insertion of multiple plastic stents, drainage of hilar strictures, retrieval of migrated stents and combined stenting in malignant biliary and duodenal obstructions.The target readership for the Clinical Guideline mostly includes digestive endoscopists, gastroenterologists, oncologists, radiologists, internists, and surgeons while the Technology Review should be most useful to endoscopists who perform biliary drainage. PMID:22297801

Dumonceau, J-M; Tringali, A; Blero, D; Devière, J; Laugiers, R; Heresbach, D; Costamagna, G

2012-03-01

111

Up-regulation of L1CAM in pancreatic duct cells is transforming growth factor beta1- and slug-dependent: role in malignant transformation of pancreatic cancer.  

PubMed

Pancreatic ductal adenocarcinoma (PDAC) is thought to originate from ductal structures, exhibiting strong desmoplastic reaction with stromal pancreatic myofibroblasts (PMF), which are supposed to drive PDAC tumorigenesis. Previously, we observed high expression of the adhesion molecule L1CAM (CD171) in PDAC cells accounting for chemoresistance. Thus, this study aimed to investigate whether PMFs are involved in the induction of tumoral L1CAM and whether this contributes to malignant transformation of pancreatic ductal cells and PDAC tumorigenesis. Immunohistochemistry of tissues from chronic pancreatitis specimens revealed considerable L1CAM expression in ductal structures surrounded by dense fibrotic tissue, whereas no L1CAM staining was seen in normal pancreatic tissues. Using the human pancreatic duct cell line H6c7, we show that coculture with PMFs led to a transforming growth factor-beta1 (TGF-beta1)-dependent up-regulation of L1CAM expression. Similarly, L1CAM expression increased in monocultured H6c7 cells after administration of exogenous TGF-beta1. Both TGF-beta1- and PMF-induced L1CAM expression were independent of Smad proteins but required c-Jun NH(2)-terminal kinase activation leading to the induction of the transcription factor Slug. Moreover, Slug interacted with the L1CAM promoter, and its knockdown abrogated the TGF-beta1- and PMF-induced L1CAM expression. As a result of L1CAM expression, H6c7 cells acquired a chemoresistant and migratory phenotype. This mechanism of TGF-beta1-induced L1CAM expression and the resulting phenotype could be verified in the TGF-beta1-responsive PDAC cell lines Colo357 and Panc1. Our data provide new insights into the mechanisms of tumoral L1CAM induction and how PMFs contribute to malignant transformation of pancreatic duct cells early in PDAC tumorigenesis. PMID:19435915

Geismann, Claudia; Morscheck, Mascha; Koch, Dorothee; Bergmann, Frank; Ungefroren, Hendrik; Arlt, Alexander; Tsao, Ming-Sound; Bachem, Max G; Altevogt, Peter; Sipos, Bence; Fölsch, Ulrich R; Schäfer, Heiner; Müerköster, Susanne Sebens

2009-05-15

112

Pancreatic cancer cells and normal pancreatic duct epithelial cells express an autocrine catecholamine loop that is activated by nicotinic acetylcholine receptors ?3, ?5 and ?7  

PubMed Central

Pancreatic cancer is the fourth leading cause of cancer deaths in developed countries. Smoking is an established risk factor for this malignancy but the underlying mechanisms are poorly understood. Previous reports have provided evidence that nicotinic acetylcholine receptors (nAChRs) and beta-adrenergic receptors (?-ARs) stimulate the growth and migration of pancreatic cancer cells. But a potential cooperation of these two receptor families in the regulation of pancreatic cancer has not been studied to date. Using two pancreatic cancer cell lines and immortalized pancreatic duct epithelia in vitro, our current data show, that all three cell lines synthesized and released the catecholamine neurotransmitters noradrenaline and adrenaline upon exposure to nicotine and that this activity was regulated by ?3, ?5, and ?7-nAChRs. In accord with the established function of these catecholamines as ?-AR agonists, nicotine-induced cell proliferation was blocked by the ?-AR antagonist propranolol. Nicotine-induced proliferation was also abolished by the ?7-nAChR antagonist ?-bungarotoxin while catecholamine production in response to nicotine was blocked by gene knockdown of the ?3, ?5, and ?7-nAChRs. The nicotinic agonists acetylcholine, nicotine, and its nitrosated carcinogenic derivative NNK induced the phosphorylation of CREB, ERK, Src and AKT and these responses were inhibited by propranolol. Our findings identify this hitherto unknown autocrine catecholamine loop as an important regulatory cascade in pancreatic cancer that may prove a promising new target for cancer intervention.

Al-Wadei, Mohammed H; Al-Wadei, Hussein AN; Schuller, Hildegard M

2012-01-01

113

A meta-analysis for the effect of prophylactic GTN on the incidence of post-ERCP pancreatitis and on the successful rate of cannulation of bile ducts  

Microsoft Academic Search

BACKGROUND: Glyceryl trinitrate (GTN) has been shown to be able to relax the sphincter of Oddi (SO) both in animals and humans. Theoretically, the use of these compounds during and after endoscopic retrograde cholangiopancreatgraphy (ERCP) could relax the biliary and pancreatic sphincters, facilitating cannulation of common bile duct (CBD) during the procedure, or minimizing potential pancreatic outflow obstruction after the

Bin Chen; Tao Fan; Chun-hui Wang

2010-01-01

114

Age-Related Change of the Secretory Flow of Pancreatic Juice in the Main Pancreatic Duct: Evaluation With Cine-Dynamic MRCP Using Spatially Selective Inversion Recovery Pulse.  

PubMed

OBJECTIVE. The purpose of this study is to evaluate age-related changes in the secretory flow of pancreatic juice in the main pancreatic duct noninvasively by means of nonpharmacologic cine-dynamic MRCP using spatially selective inversion recovery (IR) pulse. MATERIALS AND METHODS. Fifty-three subjects without a history of pancreatic disease were included. Four-second breath-hold MRCP using spatially selective IR pulse was performed every 15 seconds during 5 minutes (acquiring a total of 20 images) in cine-dynamic fashion. The secretion grade was classified into five grades by the distance of pancreatic juice inflow within the tagged area. The mean secretion grade and the frequency of secretion in cine-dynamic MRCP were compared among three age-range groups (group 1, < 40 years; group 2, 40-70 years; and group 3, > 70 years). Statistical analysis was performed using Spearman rank correlation coefficient and Kruskal-Wallis and Mann-Whitney U tests. RESULTS. The secretion grade and the frequency of secretion were significantly reduced with aging (r = -0.77, p < 0.001; and r = -0.74, p < 0.001, respectively). The mean secretion grade and the frequency of secretion were significantly lower in group 3 than in group 2 (mean grade, 0.36 vs 1.48, p = 0.001; and 4.8 vs 11.9 times, p = 0.001) and were lower in group 2 than in group 1 (mean grade, 1.48 vs 2.48, p < 0.001; and 11.9 vs 16.2 times, p = 0.011). CONCLUSION. Cine-dynamic MRCP using spatially selective IR pulse was able to show the age-related decrease of the secretory flow of pancreatic juice in the main pancreatic duct visually and noninvasively. PMID:24758654

Torigoe, Teruyuki; Ito, Katsuyoshi; Yamamoto, Akira; Kanki, Akihiko; Yasokawa, Kazuya; Tamada, Tsutomu; Yoshida, Koji

2014-05-01

115

The nerves of the accessory pancreatic ducts of the common starling (Sturnus vulgaris): an ultrastructural and light microscopic study.  

PubMed

An ultrastructural and light microscopic study was undertaken to examine the nerves of the accessory pancreatic ducts of the starling (Sturnus vulgaris), previously noted (Vinnicombe, 1982) to have a particularly dense innervation. Large numbers of nerves were found in the ducts, predominantly in the lamina propria, and all contained exclusively unmyelinated axons. Probable neuron cell bodies were observed in the smooth muscle layer, but not in the lamina propria. Schwann cells invested all the axons, and these displayed terminal swellings in a 'synapse en passage' arrangement. The nerves of the lamina propria were most numerous in the region immediately beneath the epithelium and were present in the epithelial folds. One axon was observed to have penetrated the epithelial basal lamina and to lie between two epithelial cells. Examination of the terminal profiles and their contained synaptic vesicles showed the innervation to have probable pain afferent, cholinergic, adrenergic and perhaps peptidergic components. The results of this study were compared with reports on pancreatic duct innervation in other species, mostly as parts of wider studies on pancreatic innervation. PMID:6490527

McAllister, R M; Kendall, M D

1984-10-01

116

The nerves of the accessory pancreatic ducts of the common starling (Sturnus vulgaris): an ultrastructural and light microscopic study.  

PubMed Central

An ultrastructural and light microscopic study was undertaken to examine the nerves of the accessory pancreatic ducts of the starling (Sturnus vulgaris), previously noted (Vinnicombe, 1982) to have a particularly dense innervation. Large numbers of nerves were found in the ducts, predominantly in the lamina propria, and all contained exclusively unmyelinated axons. Probable neuron cell bodies were observed in the smooth muscle layer, but not in the lamina propria. Schwann cells invested all the axons, and these displayed terminal swellings in a 'synapse en passage' arrangement. The nerves of the lamina propria were most numerous in the region immediately beneath the epithelium and were present in the epithelial folds. One axon was observed to have penetrated the epithelial basal lamina and to lie between two epithelial cells. Examination of the terminal profiles and their contained synaptic vesicles showed the innervation to have probable pain afferent, cholinergic, adrenergic and perhaps peptidergic components. The results of this study were compared with reports on pancreatic duct innervation in other species, mostly as parts of wider studies on pancreatic innervation. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4

McAllister, R M; Kendall, M D

1984-01-01

117

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

118

Stenting of the arterial duct combined with banding of the pulmonary arteries and atrial septectomy or septostomy: a new approach to palliation for the hypoplastic left heart syndrome  

Microsoft Academic Search

OBJECTIVE--To assess the feasibility of pulmonary artery banding, atrial septectomy or septostomy, and percutaneous stenting of the arterial duct in babies with the hypoplastic left heart syndrome. PATIENTS--Four infants with hypoplastic left heart syndrome. SETTING--Two supraregional paediatric cardiac centres. METHODS--Ductal patency was maintained initially with prostaglandin E. Banding of the proximal branch pulmonary arteries was performed through a median sternotomy

J L Gibbs; C Wren; K G Watterson; S Hunter; J R Hamilton

1993-01-01

119

Randomized trial of stent placed above and across the sphincter of Oddi in malignant bile duct obstruction  

Microsoft Academic Search

Background: Placement of stents above an intact sphincter of Oddi might prevent migration of bacteria and deposition of organic material into the stent. In patients with malignant obstructive jaundice prolongation of function time of the stent would be expected if it is placed above the sphincter of Oddi. Methods: Thirty-four patients were randomized to stent placement either above (n =

Finn Møller Pedersen; Annmarie Touborg Lassen; Ove B. Schaffalitzky de Muckadell

1998-01-01

120

Congenital Variants and Anomalies of the Pancreas and Pancreatic Duct: Imaging by Magnetic Resonance Cholangiopancreaticography and Multidetector Computed Tomography  

PubMed Central

Though congenital anomalies of the pancreas and pancreatic duct are relatively uncommon and they are often discovered as an incidental finding in asymptomatic patients, some of these anomalies may lead to various clinical symptoms such as recurrent abdominal pain, nausea and vomiting. Recognition of these anomalies is important because these anomalies may be a surgically correctable cause of recurrent pancreatitis or the cause of gastric outlet obstruction. An awareness of these anomalies may help in surgical planning and prevent inadvertent ductal injury. The purpose of this article is to review normal pancreatic embryology, the appearance of ductal anatomic variants and developmental anomalies of the pancreas, with emphasis on magnetic resonance cholangiopancreaticography and multidetector computed tomography.

Erden, Ayse; Turkoglu, Mehmet Akif; Yener, Ozlem

2013-01-01

121

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

Microsoft Academic Search

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

Miltiadis E. Krokidis; Adam A. Hatzidakis

2010-01-01

122

Actin cytoskeleton controls movement of intracellular organelles in pancreatic duct epithelial cells.  

PubMed

In most eukaryotic cells, microtubules and filamentous actin (F-actin) provide tracks on which intracellular organelles move using molecular motors. Here we report that cytoplasmic movement of both mitochondria and lysosomes is slowed by F-actin meshwork formation in pancreatic duct epithelial cells (PDEC). Mitochondria and lysosomes were labeled with fluorescent Mitotracker Red CMXRos and Lysotracker Red DND-99, respectively, and their movements were monitored using epi-fluorescence and confocal microscopy. Mitochondria and lysosomes moving actively at rest stopped rapidly within several seconds after an intracellular Ca(2+) rise induced by activation of P2Y(2) purinergic receptors. The 'freezing' of the organelles was inhibited by blocking the Ca(2+) rise or by pretreatment with latrunculin B, an inhibitor of F-actin formation. Indeed, this freezing effect on the organelles was accompanied by the formation of F-actin in the whole cytoplasm as stained with Alexa 488-phalloidin in fixed PDEC. For real-time monitoring of F-actin formation in live cells, we expressed sGFP-fimbrin actin binding domain2 (fABD2) in PDEC. Rapid recruitment of the fluorescent probe near the nucleus and lysosomes suggested dense F-actin formation around intracellular structures. The development of F-actin paralleled that of organelle freezing. We conclude that rapid Ca(2+)-dependent F-actin formation physically restrains intracellular organelles and reduces their mobility non-selectively in PDEC. PMID:22579052

Jung, Seung-Ryoung; Seo, Jong Bae; Shim, Donghwan; Hille, Bertil; Koh, Duk-Su

2012-06-01

123

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

124

Proximal bile duct tumors: surgical management with silastic transhepatic biliary stents.  

PubMed Central

Over a nine-year period, 27 patients with proximal biliary tumors were operated upon. In ten of the 27 patients (37%) tumor resection including the hepatic bifurcation was possible, and bilateral hepaticojejunostomies were performed using silastic transhepatic biliary stents. In the remaining 17 patients the tumor was partially resected, dilated, or bypassed, and reconstruction to a Roux-en-Y-jejunal loop was carried out using silastic transhepatic biliary stents. Hospital mortality for those patients undergoing resection was zero, and for the entire group 4% (1/27). The mean bilirubin on admission was 13.2 mg/dl and after discharge fell to a mean of 1.5 mg/dl. Mean survival for the entire group is 18 months with 11 patients still alive. Mean survival for the first nine patients undergoing resection is 21 months with seven patients still alive (one for over 5 years). The 15 patients dying following discharge survived for a mean of 14 months. Images Fig. 1. Fig. 2. Fig. 3.

Cameron, J L; Broe, P; Zuidema, G D

1982-01-01

125

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

Microsoft Academic Search

We report the case of a 78-year-old male patient with obstructive jaundice due to a pancreatic head neoplasm. The patient’s\\u000a general condition did not permit an endoscopic approach and the presence of diffuse liver metastases prohibited hepatic puncture\\u000a for percutaneous biliary drainage, therefore the transcolecystic transperitoneal approach was decided to be the safest decompression\\u000a route. Through a gallbladder access, a

Miltiadis E. Krokidis; Adam A. Hatzidakis

2010-01-01

126

Loss of Canonical Smad4 Signaling Promotes KRAS Driven Malignant Transformation of Human Pancreatic Duct Epithelial Cells and Metastasis  

PubMed Central

Pancreatic ductal adenocarcinoma (PDAC) is the fourth most common cause of cancer death in North America. Activating KRAS mutations and Smad4 loss occur in approximately 90% and 55% of PDAC, respectively. While their roles in the early stages of PDAC development have been confirmed in genetically modified mouse models, their roles in the multistep malignant transformation of human pancreatic duct cells have not been directly demonstrated. Here, we report that Smad4 represents a barrier in KRAS-mediated malignant transformation of the near normal immortalized human pancreatic duct epithelial (HPDE) cell line model. Marked Smad4 downregulation by shRNA in KRASG12V expressing HPDE cells failed to cause tumorigenic transformation. However, KRAS-mediated malignant transformation occurred in a new HPDE-TGF-? resistant (T?R) cell line that completely lacks Smad4 protein expression and is resistant to the mito-inhibitory activity of TGF-?. This transformation resulted in tumor formation and development of metastatic phenotype when the cells were implanted orthotopically into the mouse pancreas. Smad4 restoration re-established TGF-? sensitivity, markedly increased tumor latency by promoting apoptosis, and decreased metastatic potential. These results directly establish the critical combination of the KRAS oncogene and complete Smad4 inactivation in the multi-stage malignant transformation and metastatic progression of normal human HPDE cells.

Leung, Lisa; Radulovich, Nikolina; Zhu, Chang-Qi; Wang, Dennis; To, Christine; Ibrahimov, Emin; Tsao, Ming-Sound

2013-01-01

127

Risk factors for postoperative pancreatic fistula after pancreaticoduodenectomy: the significance of the ratio of the main pancreatic duct to the pancreas body as a predictor of leakage  

Microsoft Academic Search

Objective  Postoperative pancreatic fistula (POPF) is a severe and frequent complication after pancreaticoduodenectomy (PD). The aim\\u000a of this study was to identify an independent predictor of POPF and to assess the efficacy of preoperative multidetector row\\u000a computed tomography (MDCT) images as an indicator for POPF.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A total of 122 patients who underwent PD with an end-to-side, duct-to-mucosa pancreaticojejunostomy between January 2005

Nobuhisa Akamatsu; Yasuhiko Sugawara; Masahiko Komagome; Nobuhiro Shin; Narihiro Cho; Takashi Ishida; Fumiaki Ozawa; Daijo Hashimoto

2010-01-01

128

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

129

GLI1 is regulated through Smoothened-independent mechanisms in neoplastic pancreatic ducts and mediates PDAC cell survival and transformation  

PubMed Central

Pancreatic ductal adenocarcinoma (PDAC) is characterized by the deregulation of the hedgehog signaling pathway. The Sonic Hedgehog ligand (Shh), absent in the normal pancreas, is highly expressed in pancreatic tumors and is sufficient to induce neoplastic precursor lesions in mouse models. We investigated the mechanism of Shh signaling in PDAC carcinogenesis by genetically ablating the canonical bottleneck of hedgehog signaling, the transmembrane protein Smoothened (Smo), in the pancreatic epithelium of PDAC-susceptible mice. We report that multistage development of PDAC tumors is not affected by the deletion of Smo in the pancreas, demonstrating that autocrine Shh–Ptch–Smo signaling is not required in pancreatic ductal cells for PDAC progression. However, the expression of Gli target genes is maintained in Smo-negative ducts, implicating alternative means of regulating Gli transcription in the neoplastic ductal epithelium. In PDAC tumor cells, we find that Gli transcription is decoupled from upstream Shh–Ptch–Smo signaling and is regulated by TGF-? and KRAS, and we show that Gli1 is required both for survival and for the KRAS-mediated transformed phenotype of cultured PDAC cancer cells.

Nolan-Stevaux, Olivier; Lau, Janet; Truitt, Morgan L.; Chu, Gerald C.; Hebrok, Matthias; Fernandez-Zapico, Martin E.; Hanahan, Douglas

2009-01-01

130

Insulinoma-associated antigen-1 zinc-finger transcription factor promotes pancreatic duct cell trans-differentiation.  

PubMed

Insulinoma-associated antigen-1 (INSM1/IA-1) is a unique zinc-finger transcription factor restrictedly expressed in pancreatic beta-cells during early pancreas development. INSM1 is transiently activated by the islet-specific endocrine factor neurogenin 3, and it subsequently regulates downstream target genes NeuroD1 and insulin during beta-cell maturation. Here, we examined how the INSM1 transcription factor contributes to endocrine cell differentiation using a defined serum-free medium-primed pancreatic duct cell model. We showed that ectopic expression of INSM1 can promote Panc-1 cell trans-differentiation. INSM1 up-regulates two islet transcription factors (ITFs), paired box 6 and homeodomain transcription factor 6.1, whereas other ITFs, including pancreatic duodenal homeobox-1 (Pdx-1), homeodomain transcription factor 2.2, NeuroD1, paired box 4, and neurogenin 3, were either down-regulated or absent. The result suggests that INSM1 is capable of regulating multiple ITFs and the insulin gene either directly or indirectly. When we overexpressed three ITFs, INSM1/Pdx-1/NeuroD1, in the Panc-1 differentiation model, higher insulin expression was observed in parallel with the activation of an additional ITF, neurogenin 3, signifying endocrine cell activation. Insulin expression from the three ITFs stimulation was readily detected by immunostaining and increased 40% as compared with the insulin-transferrin-selenium-LacZ control. Furthermore, we examined the differential chromatin acetylation patterns within the insulin promoter region using the chromatin immunoprecipitation assay. INSM1 alone can selectively enhance acetylation of histone H4, whereas NeuroD1 and Pdx-1 favor the acetylation of histone H3. Both H3 and H4 histone acetylations facilitate insulin gene expression. The consistent functional effect of INSM1, either with or without other ITFs, promotes pancreatic duct cell differentiation as well as induces Panc-1 cell cycle arrest. PMID:20215568

Zhang, Tao; Wang, Hongwei; Saunee, Nicolle A; Breslin, Mary B; Lan, Michael S

2010-05-01

131

Ductal adenocarcinoma of the pancreatic head: A focus on current diagnostic and surgical concepts  

PubMed Central

Complete surgical resection still remains the only possibility of curing pancreatic cancer, however, only 10% of patients undergo curative surgery. Pancreatic resection currently remains the only method of curing patients, and has a 5-year overall survival rate between 7%-34% compared to a median survival of 3-11 mo for unresected cancer. Pancreatic surgery is a technically demanding procedure requiring highly standardized surgical techniques. Nevertheless, even in experienced hands, perioperative morbidity rates (delayed gastric emptying, pancreatic fistula etc.) are as high as 50%. Different strategies to reduce postoperative morbidity, such as different techniques of gastroenteric reconstruction (pancreatico-jejunostomy vs pancreatico-gastrostomy), intraoperative placement of a pancreatic main duct stent or temporary sealing of the main pancreatic duct with fibrin glue have not led to a significant improvement in clinical outcome. The perioperative application of somatostatin or its analogues may decrease the incidence of pancreatic fistulas in cases with soft pancreatic tissue and a small main pancreatic duct (< 3 mm). The positive effects of external pancreatic main duct drainage and antecolic gastrointestinal reconstruction have been observed to decrease the rate of pancreatic fistulas and delayed gastric emptying, respectively. Currently, the concept of extended radical lymphadenectomy has been found to be associated with higher perioperative morbidity, but without any positive impact on overall survival. However, there is growing evidence that portal vein resections can be performed with acceptable low perioperative morbidity and mortality but does not achieve a cure.

Ouaissi, Mehdi; Giger, Urs; Louis, Guillaume; Sielezneff, Igor; Farges, Olivier; Sastre, Bernard

2012-01-01

132

Ductal adenocarcinoma of the pancreatic head: a focus on current diagnostic and surgical concepts.  

PubMed

Complete surgical resection still remains the only possibility of curing pancreatic cancer, however, only 10% of patients undergo curative surgery. Pancreatic resection currently remains the only method of curing patients, and has a 5-year overall survival rate between 7%-34% compared to a median survival of 3-11 mo for unresected cancer. Pancreatic surgery is a technically demanding procedure requiring highly standardized surgical techniques. Nevertheless, even in experienced hands, perioperative morbidity rates (delayed gastric emptying, pancreatic fistula etc.) are as high as 50%. Different strategies to reduce postoperative morbidity, such as different techniques of gastroenteric reconstruction (pancreatico-jejunostomy vs pancreatico-gastrostomy), intraoperative placement of a pancreatic main duct stent or temporary sealing of the main pancreatic duct with fibrin glue have not led to a significant improvement in clinical outcome. The perioperative application of somatostatin or its analogues may decrease the incidence of pancreatic fistulas in cases with soft pancreatic tissue and a small main pancreatic duct (< 3 mm). The positive effects of external pancreatic main duct drainage and antecolic gastrointestinal reconstruction have been observed to decrease the rate of pancreatic fistulas and delayed gastric emptying, respectively. Currently, the concept of extended radical lymphadenectomy has been found to be associated with higher perioperative morbidity, but without any positive impact on overall survival. However, there is growing evidence that portal vein resections can be performed with acceptable low perioperative morbidity and mortality but does not achieve a cure. PMID:22791941

Ouaïssi, Mehdi; Giger, Urs; Louis, Guillaume; Sielezneff, Igor; Farges, Olivier; Sastre, Bernard

2012-06-28

133

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

134

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

135

Mutagenicity of carcinogenic nitrosamines when activated by hamster and human pancreatic duct epithelial cells.  

PubMed

We have measured the ability of pancreatic duct epithelial cells (DEC) from Syrian hamsters and humans and CK cells, immortalized hamster DEC, to metabolize chemical carcinogens to species that were mutagenic in S. typhimurium TA98 and in V79 cells. The chemicals were N-nitrosobis(2-oxopropyl)amine (BOP), 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) and 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP). The ability of ethanol (EtOH) to modify the metabolizing efficiency was also measured. When an S9 preparation from EtOH-treated CK cells was used to metabolize NNK the number of revertants was 271 +/- 73 compared with 17 +/- 2 when the S9 from control CK cells was used. When hamster DEC were used there was no increase in the mutation frequency for BOP in V79 cells (64 +/- 20 mutants/10(6) survivors per mumol) when EtOH-DEC were used. However, the mutation frequencies of NNK and PhIP rose when the EtOH-treated DEC were used from 62 +/- 31 to 198 +/- 28 mutants/10(6) survivors per mumol for NNK and from 94 +/- 25 to 166 +/- 25 mutants/10(6) survivors per mumol for PhIP. A similar result was obtained when human DEC were used, i.e. no change in BOP mutagenicity and a slight increase in PhIP mutagenicity, from 34 +/- 14 to 65 +/- 12 mutants/10(6) survivors per mumol. There were large increases in the mutagenicity of NNK with each of the three samples of human DEC that were used, from 75 +/- 0 to 213 +/- 38, 75 +/- 13 to 175 +/- 25 and 38 +/- 13 to 285 +/- 25 mutants/10(6) survivors per mumol. The EtOH treatment regimen that was used more closely mimicked chronic exposure at low concentrations in vivo. These data show that hamster DEC are capable of metabolizing NNK, which is carcinogenic in these cells in vivo. Furthermore, human DEC metabolized NNK as efficiently as hamster DEC. PMID:9377542

Kolar, C; Lawson, T

1997-08-19

136

Characterization of H+ and HCO3- transporters in CFPAC-1 human pancreatic duct cells  

PubMed Central

AIM: To characterize H+ and HCO3- transporters in polarized CFPAC-1 human pancreatic duct cells, which were derived from a cystic fibrosis patient with the ?F508 CFTR mutation. METHODS: CFPAC-1 cells were seeded at high density onto permeable supports and grown to confluence. The cells were loaded with the pH-sensitive fluorescent dye BCECF, and mounted into a perfusion chamber, which allowed the simultaneous perfusion of the basolateral and apical membranes. Transmembrane base flux was calculated from the changes in intracellular pH and the buffering capacity of the cells. RESULTS: Our results showed differential permeability to HCO3-/CO2 at the apical and basolateral membranes of CFPAC-1 cells. Na+/HCO3- co-transporters (NBCs) and Cl-/HCO3- exchangers (AEs) were present on the basolateral membrane, and Na+/H+ exchangers (NHEs) on both the apical and basolateral membranes of the cells. Basolateral HCO3- uptake was sensitive to variations of extracellular K+ concentration, the membrane permeable carbonic anhydrase (CA) inhibitors acetazolamide (100 µmol/L) and ethoxyzolamide (100 µmol/L), and was partially inhibited by H2-DIDS (600 µmol/L). The membrane-impermeable CA inhibitor 1-N-(4-sulfamoylphenylethyl)-2,4,6-trimethylpyridine perchlorate did not have any effect on HCO3- uptake. The basolateral AE had a much higher activity than that in the apical membrane, whereas there was no such difference with the NHE under resting conditions. Also, 10 µmol/L forskolin did not significantly influence Cl-/HCO3- exchange on the apical and basolateral membranes. The administration of 250 µmol/L H2-DIDS significantly inhibited the basolateral AE. Amiloride (300 µmol/L) completely inhibited NHEs on both membranes of the cells. RT-PCR revealed the expression of pNBC1, AE2, and NHE1 mRNA. CONCLUSION: These data suggest that apart from the lack of CFTR and apical Cl-/HCO3- exchanger activity, CFPAC-1 cells express similar H+ and HCO3- transporters to those observed in native animal tissue.

Jr, Zoltan Rakonczay; Fearn, Amy; Hegyi, Peter; Boros, Imre; Gray, Michael A; Argent, Barry E

2006-01-01

137

Incidence of Pancreatic Fistula after Distal Pancreatectomy and Efficacy of Endoscopic Therapy for Its Management: Results from a Tertiary Care Center  

PubMed Central

Pancreatic fistula is a known complication of distal pancreatectomy. Endotherapy with pancreatic duct stent placement and pancreatic sphincterotomy has been shown to be effective in its management; however, experience of endotherapy in the management of this complication has not been extensively reported from the United States. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) with pancreatic stent placement has also been proposed to prevent this complication after distal pancreatectomy. In our cohort of 59 patients who underwent distal pancreatectomy, 13 (22%) developed a pancreatic fistula in the immediate postoperative period, of whom 8 (14%) patients (5 female, mean age 52 years) were referred for an ERCP because of ongoing symptoms related to the pancreatic fistula. The pancreatic fistula resolved in all patients after a median duration of 62 days from the index ERCP. The median number of ERCPs required to document resolution of the pancreatic fistula was 2. Although a sizeable percentage of patients develop a pancreatic fistula after distal pancreatectomy, only a small percentage of patients require ERCP for management of this complication. Given the high success rate of endotherapy in resolving pancreatic fistula and the fact that the majority of patients who undergo distal pancreatectomy never require an ERCP, performing ERCP for prophylactic pancreatic duct stent prior to distal pancreatectomy might not be necessary.

Reddymasu, Savio C.; Pakseresht, Kavous; Moloney, Brian; Alsop, Benjamin; Oropezia-Vail, Melissa; Olyaee, Mojtaba

2013-01-01

138

Transformation of hamster pancreatic duct cells by 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), in vitro.  

PubMed

The tobacco specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) is a potent carcinogen in laboratory animals. In the present study, in vitro transformation of spontaneously immortal hamster pancreatic duct cells following exposure to 20 mM NNK for 1,3,5 and 7 days is described. NNK imparted a dose-dependent and time-dependent toxicity to pancreatic duct cells in vitro. After NNK treatment, duct cells were grown either in complete duct medium (CDM) or in the absence of bovine pituitary extract, epidermal growth factor and Nu-serum (incomplete duct medium, IDM). Addition of NNK to the culture for 1 and 3 days did not affect the growth of the cells, whereas exposure of the cells for 5 and 7 days was inhibitory. One and 3 day NNK-treated cells were able to grow in the absence of growth factors and serum immediately after the treatment without any inhibition of growth. Untreated cells grew as a monolayer consisting of tightly packed polygonal cells with single nuclei. NNK treated cells also grew as a monolayer with numerous mitotic figures and multi-nucleated large cells. The doubling time between the untreated (16 h) and NNK-treated cells (14 h) was not significantly different prior to injection into the nude mice. NNK treated cells grown in IDM displayed anchorage independency in soft-agar. The tumorigenicity of the untreated and NNK treated cells (5 x 10(6)) was determined in nude mice. One and 3 day NNK-treated cells grown in CDM produced well-differentiated, mucinous tumors with a lower frequency (2/4 sites) and longer duration, but produced tumors at a higher frequency (4/4 sites) and shorter duration when grown in IDM. Five and 7 day NNK-treated cells grown in CDM did not produce any tumors; however, they produced tumors when grown in CDM followed by IDM (5/8 and 6/8 sites) with a shorter duration in nude mice. Analysis of DNA for k-ras mutation at codons 12, 13 and 61 showed G-A transition at codon 12 of the k-ras oncogene in tumor cells of 1 and 3 day NNK treatment. No mutation was detected in tumor cells from 5 and 7 day treatment. PMID:7955092

Baskaran, K; Laconi, S; Reddy, M K

1994-11-01

139

Extraperitoneal Fluid Collection due to Chronic Pancreatitis  

PubMed Central

A 39-year-old man was referred to our hospital for the investigation of abdominal fluid collection. He was pointed out to have alcoholic chronic pancreatitis. Laboratory data showed inflammation and slightly elevated serum direct bilirubin and amylase. An abdominal computed tomography demonstrated huge fluid collection, multiple pancreatic pseudocysts and pancreatic calcification. The fluid showed a high level of amylase at 4,490 IU/l. Under the diagnosis of pancreatic ascites, endoscopic pancreatic stent insertion was attempted but was unsuccessful, so surgical treatment (Frey procedure and cystojejunostomy) was performed. During the operation, a huge amount of fluid containing bile acid (amylase at 1,474 IU/l and bilirubin at 13.5 mg/dl) was found to exist in the extraperitoneal space (over the peritoneum), but no ascites was found. His postoperative course was uneventful and he shows no recurrence of the fluid. Pancreatic ascites is thought to result from the disruption of the main pancreatic duct, the rupture of a pancreatic pseudocyst, or possibly leakage from an unknown site. In our extremely rare case, the pancreatic pseudocyst penetrated into the hepatoduodenal ligament with communication to the common bile duct, and the fluid flowed into the round ligament of the liver and next into the extraperitoneal space.

Yasuda, Takeo; Kamei, Keiko; Araki, Mariko; Nakata, Yasuyuki; Ishikawa, Hajime; Yamazaki, Mitsuo; Sakamoto, Hiroki; Kitano, Masayuki; Nakai, Takuya; Takeyama, Yoshifumi

2013-01-01

140

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

141

Pancreatic Fibrosis Correlates with Exocrine Pancreatic Insufficiency after Pancreatoduodenectomy  

Microsoft Academic Search

Background: Obstruction of the pancreatic duct can lead to pancreatic fibrosis. We investigated the correlation between the extent of pancreatic fibrosis and the postoperative exocrine and endocrine pancreatic function. Methods: Fifty-five patients who were treated for pancreatic and periampullary carcinoma and 19 patients with chronic pancreatitis were evaluated. Exocrine pancreatic function was evaluated by fecal elastase-1 test, while endocrine pancreatic

T. C. K. Tran; G. van ‘t Hof; G. Kazemier; W. C. J. Hop; C. J. Pek; A. W. van Toorenenbergen; H. van Dekken; C. H. J. van Eijck

2008-01-01

142

[Pancreatic tumors].  

PubMed

The management of pancreatic cancer is complex and prognosis is poor. The etiopathogenesis of pancreatic cancer has been related to several factors, such as diabetes mellitus, smoking and alcohol use, the presence of pancreatic cystic lesions and distinct genetic syndromes. Among the diagnostic options, endoscopic ultrasound (EUS) continues to be developed, with the use of elastography, contrast agents and EUS-guided aspiration and the application of technical improvements that increase diagnostic efficacy (such as the use of specific stains, new aspiration needles, etc.). New biomarkers are also being sought that would help in differential diagnosis, such as M2PK, adiponectin, and Reg4. Among prognostic factors, the importance of nodal involvement and study of surgical resection margins has been confirmed. The role of individual predisposition in determining response to specific treatments continues to be investigated. Research also continues into the development of EUS-guided injection of therapeutic substances and the role of oncological treatment, with new data on the utility of gemcitabine and of statins as mediators of angiogenic suppression or of high-dose vitamin C with cytotoxic effects. Notable in the field of palliative treatment is the development of new biliary stents that aim to reduce obstruction rates. The development of EUS and EUS-guided fine-needle aspiration has been crucial in cystic pancreatic tumors, especially in distinguishing benign from malignant lesions or those with potential for malignant transformation (presence of mural modules, dilatation of the main pancreatic duct, the presence of masses, CEA levels, etc.). The characteristics of these tumors must be determined to evaluate whether surgery or conservative management is the best therapeutic option. PMID:19434873

Iglesias-García, Julio

2008-10-01

143

The stoichiometry of the electrogenic sodium bicarbonate cotransporter pNBC1 in mouse pancreatic duct cells is 2 HCO3?:1 Na+  

PubMed Central

The electrogenic sodium bicarbonate cotransporter pNBC1 is believed to play a major role in the secretion of bicarbonate by pancreatic duct cells, by transporting bicarbonate into the cell across the basolateral membrane. Thermodynamics predict that this function can be achieved only if the reversal potential of the cotransporter is negative to the cell’s membrane potential, or equivalently that the HCO3?:Na+ stoichiometry is not larger then 2:1. However, there are no data available on either the reversal potential or the HCO3?:Na+ stoichiometry of pNBC1 in pancreatic cells. We studied pNBC1 function in mouse pancreatic duct cells. RT-PCR analysis of total RNA revealed that these cells contain the message for pNBC1, but not for kNBC1, NBC2 or NBC3. To measure cotransporter activity, mouse pancreatic duct cells were grown to confluence on a porous substrate, mounted in an Ussing chamber, and the apical plasma membrane permeabilized with amphotericin B. Ion flux through pNBC1 was achieved by applying Na+ concentration gradients across the basolateral plasma membrane. The current through the cotransporter was isolated as the difference current due to the reversible inhibitor dinitrostilbene disulfonate (DNDS). Current-voltage relationships for the cotransporter, measured at three different Na+ concentration gradients, were linear over a range of about 100 mV. The reversal potential data, obtained from these current-voltage relationships, all corresponded to a 2 HCO3?:1 Na+ stoichiometry. The data indicate that pNBC1 is functionally expressed in mouse pancreatic duct cells. The cotransporter operates with a 2 HCO3?:1 Na+ stoichiometry in these cells, and mediates the transport of bicarbonate into the cell across the basolateral membrane.

Gross, E; Abuladze, N; Pushkin, A; Kurtz, I; Cotton, C U

2001-01-01

144

The Role of Nonsteroidal Anti-inflammatory Drugs in the Prevention of Post Endoscopic Retrograde Cholangiopancreatography Pancreatitis.  

PubMed

Post-ERCP pancreatitis (PEP) is the most common major complication associated with ERCP. Beginning with an overview of the risk factors for the development of PEP, this review introduces the mechanism of injury in PEP and the role of pharmacological prevention. NSAIDs are increasingly found to offer prevention against the development of PEP, and their mechanism and supportive data are summarized, especially in relationship to the practice of prophylactic pancreatic duct stenting. PMID:24865531

Sheikh, Imran; Fontenot, Eric; Waghray, Nisheet; Ismail, Mohammad K; Tombazzi, Claudio; Smith, J Lacey

2014-01-01

145

Are liver function tests, pancreatitis and cholecystitis predictors of common bile duct stones? Results of a prospective, population-based, cohort study of 1171 patients undergoing cholecystectomy  

PubMed Central

Objective: The purpose of this study was to explore the accuracy of elevated liver function values, age, gender, pancreatitis and cholecystitis as predictors of common bile duct stones (CBDS). Methods: All patients operated on for gallstone disease over a period of 3 years in a Swedish county of 302 564 citizens were registered prospectively. Intraoperative cholangiography (IOC) was used to detect CBDS. Results: A total of 1171 patients were registered; 95% of these patients underwent IOC. Common bile duct stones were found in 42% of patients with elevated liver function values, 20% of patients with a history of pancreatitis and 9% of patients with cholecystitis. The presence of CBDS was significantly predicted by elevated liver function values, but not by age, gender, history of acute pancreatitis or cholecystitis. A total of 93% of patients with normal liver function tests had a normal IOC. The best agreement between elevated liver function values and CBDS was seen in patients undergoing elective surgery without a history of acute pancreatitis or cholecystitis. Conclusions: Although alkaline phosphatase (ALP) and bilirubin levels represented the most reliable predictors of CBDS, false positive and false negative values were common, especially in patients with a history of cholecystitis or pancreatitis, which indicates that other mechanisms were responsible for elevated liver function values in these patients.

Videhult, Per; Sandblom, Gabriel; Rudberg, Claes; Rasmussen, Ib Christian

2011-01-01

146

Deep Sequencing of Cancer-Related Genes Revealed GNAS Mutations to Be Associated with Intraductal Papillary Mucinous Neoplasms and Its Main Pancreatic Duct Dilation  

PubMed Central

Background To clarify the genetic mutations associated with intraductal papillary mucinous neoplasms (IPMN) and IPMN-related pancreatic tumours, we conducted cancer-related gene profiling analyses using pure pancreatic juice and resected pancreatic tissues. Methods Pure pancreatic juice was collected from 152 patients [nine with a normal pancreas, 22 with chronic pancreatitis (CP), 39 with pancreatic ductal adenocarcinoma (PDAC), and 82 with IPMN], and resected tissues from the pancreas were collected from 48 patients (six IPMNs and 42 PDACs). The extracted DNA was amplified by multiplexed polymerase chain reaction (PCR) targeting 46 cancer-related genes containing 739 mutational hotspots. The mutations were analysed using a semiconductor-based DNA sequencer. Results Among the 46 cancer-related genes, KRAS and GNAS mutations were most frequently detected in both PDAC and IPMN cases. In pure pancreatic juice, GNAS mutations were detected in 7.7% of PDAC cases and 41.5% of IPMN cases (p<0.001 vs. others). All PDAC cases with GNAS mutations (n?=?3) were accompanied by IPMN. Multivariate analysis revealed that GNAS mutations in IPMN cases were associated with dilated main pancreatic ducts (MPD, p?=?0.016), while no statistically independent associations with clinical variables were observed for KRAS mutations. In the resected pancreatic tissues, GNAS mutations were detected in 50% of PDAC cases concomitant with IPMN, 33.3% of PDAC cases derived from IPMN, and 66.7% of IPMN cases, while no GNAS mutations were detected in cases of PDAC without IPMN. Conclusions The GNAS mutation was specifically found in the cases with IPMN and it was speculated that some PDACs might be influenced by the concomitant but separately-located IPMN in their pathogenic mechanism. Furthermore, the GNAS mutation was significantly associated with MPD dilatation in IPMN cases, suggesting its role in mucus hypersecretion.

Takano, Shinichi; Fukasawa, Mitsuharu; Maekawa, Shinya; Kadokura, Makoto; Miura, Mika; Shindo, Hiroko; Takahashi, Ei; Sato, Tadashi; Enomoto, Nobuyuki

2014-01-01

147

ERCP for biliary strictures associated with chronic pancreatitis.  

PubMed

Chronic pancreatitis (CP)-related common bile duct (CBD) strictures are more difficult to treat endoscopically compared with benign biliary strictures because of their nature, particularly in patients with calcific CP. Before any attempt at treatment, malignancy must be excluded. Single plastic stents can be used for immediate symptom relief and as "bridge to surgery and/or bridge to decision," but are not suitable for definitive treatment of CP-related CBD strictures because of long-term poor results. Temporary simultaneous placement of multiple plastic stents has a high technical success rate and provides good long-term results. PMID:24079793

Familiari, Pietro; Boškoski, Ivo; Bove, Vincenzo; Costamagna, Guido

2013-10-01

148

Pancreatic duct disruption and duodenal hematoma associated with endoscopic retrograde cholangiopancreatography.  

PubMed

We have reported a case of intraduodenal duct disruption and duodenal hematoma associated with ERCP. The location of the extravasated contrast material created a confusing picture, which preoperatively was thought to be a pseudocyst, but was found at operation to be a duodenal hematoma. In retrospect, the upper gastrointestinal series done immediately after ERCP was very helpful. We believe that an upper GI series done immediately after ERCP will help determine the location of unusual collections of contrast material seen at ERCP. PMID:3686150

Sisley, J F; Bowden, T A; Mansberger, A R

1987-11-01

149

Localized gene expression following administration of adeno-associated viral vectors via pancreatic ducts.  

PubMed

Gene transfer into pancreatic cells in vivo could be of immense therapeutic benefit in cases of type 1 diabetes (T1D) through the production of molecules capable of interrupting the progression of autoimmunity or promoting regeneration of insulin-secreting beta cells. We adapted a clinically relevant surgical technique (endoscopic retrograde cholangiopancreatography) to deliver rAAV encoding human alpha1-antitrypsin (approved gene symbol SERPINA1) to the pancreas of 3-week-old Fisher 344 rats and C57BL/6 mice. We compared natural as well as bioengineered serotypes of rAAV (rAAV1, rAAV2/Apo, rAAV8) as well as different promoters (chicken beta-actin, human insulin) for their expression in vivo. Rats injected with rAAV1 showed the highest hAAT expression (week 2, rAAV1/CB-AT, 579 +/- 457 ng/ml). In mice, rAAV8 vector delivered the highest serum concentration of hAAT (week 2, rAAV8/CB-AT, 19 +/- 6 microg/ml). The chicken beta-actin promoter provided the highest expression in both rodent experiments. Immunohistochemical staining indicated transduction primarily of pancreatic acinar cells with either the rAAV1/CB-AT vector in the rat or the rAAV8/CB-AT vector in the mouse. This study demonstrates that rAAV vectors can be designed to deliver therapeutic genes efficiently to the pancreas and achieve high levels of gene expression and may be useful in treating pancreatic disorders, including T1D. PMID:15979413

Loiler, Scott A; Tang, Qiushi; Clarke, Tracy; Campbell-Thompson, Martha L; Chiodo, Vince; Hauswirth, William; Cruz, Pedro; Perret-Gentil, Marcel; Atkinson, Mark A; Ramiya, Vijayakumar K; Flotte, Terence R

2005-09-01

150

Reversal of diabetes in rats using GLP-1-expressing adult pancreatic duct-like precursor cells transformed from acinar to ductal cells.  

PubMed

Pancreatic injury induces replacement of exocrine acinar cells with ductal cells. These ductal cells have the potential to regenerate the pancreas, but their origin still remains unknown. It has been reported that adult pancreatic acinar cells have the potential to transdifferentiate to ductal progenitor cells. In this regards, we established novel adult pancreatic duct-like progenitor cell lines YGIC4 and YGIC5 and assessed the usefulness of these ductal progenitors in the cell therapy of diabetic rats. Acinar cells were cultured from pancreata of male Sprague Dawley rats and gradually attained ductal cell characteristics, such as expression of CK19 and CFTR with a concomitant down-regulation of amylase expression over time, suggesting transdifferentiation from acinar to ductal cells. During cell culture, the expression of Pdx-1, c-Kit, and vimentin peaked and then decreased, suggesting that transdifferentiation recapitulated embryogenesis. Overexpression of pancreas development regulatory genes and CK19, as well as the ability to differentiate into insulin-producing cells, suggests that the YGIC5 cells had characteristics of pancreatic progenitor cells. Finally, YGIC5 cells coexpressing Green fluorescent protein (GFP) and glucagon-like peptide (GLP)-1 under the activation of a zinc-inducible metallothionein promoter were intravenously infused to STZ-induced diabetic rats. Hyperglycemia was ameliorated with elevation of plasma insulin, and GFP-positive donor cells were colocalized in the acinar and islet areas of recipient pancreata following zinc treatment. In conclusion, after establishing pancreatic progenitor cell lines YGIC4 and YGIC5 under the concept of acinar to ductal transdifferentiation in vitro, we demonstrate how these adult pancreatic stem/progenitor cells can be used to regulate adult pancreatic differentiation toward developing therapy for pancreatic disease such as diabetes mellitus. PMID:19125629

Lee, Jieun; Wen, Jing; Park, Jeong Youp; Kim, Sun-A; Lee, Eun Jig; Song, Si Young

2009-09-01

151

Obstructive jaundice due to von Hippel-Lindau disease-associated pancreatic lesions: A case report  

PubMed Central

von Hippel-Lindau (VHL) disease is an autosomal dominantly inherited neoplastic syndrome that may lead to pancreatic masses and obstructive jaundice. The present study describes the case of a 20-year-old male who suffered from obstructive jaundice due to VHL disease-associated pancreatic lesions whose primary symptom was dizziness, followed by the appearance of jaundice. Since the excision of the renal cell carcinomas was not possible, the patient also refused surgery to resect the pancreatic head mass. A metallic stent was placed at the stenosis site of the common bile duct. Percutaneous transhepatic cholangiography (PTCD) surgery was later performed following complete blockage of the stent, however, to date, the patient continues to rely on PTCD. VHL disease-associated pancreatic lesions are rarely the direct cause of mortality, however, obstructive jaundice due to these lesions may be lethal. Therefore, the treatment of patients with incurable renal or central nervous system tumors and obstructive jaundice presents a problem.

LIANG, XIAOYU; HU, FANGUO; MA, ZHICHENG; LI, NAN; CHEN, YAN; ZHANG, JIE

2014-01-01

152

The role of biliary drainage in patients with pancreatic adenocarcinoma.  

PubMed

Pancreatic cancer is one of the leading causes of cancer deaths worldwide and constitutes a major public health problem. One of the most common symptoms associated with pancreatic adenocarcinoma is jaundice, caused by the obstruction of common bile duct. Endobiliary stenting is used to relief these patients either preoperatively or merely for palliation and plastic or metal stents are usually endoscopically or percutaneously placed. Two interesting studies were presented at the 2014 ASCO Gastrointestinal Cancers Symposium. Strom et al. sought to investigate the effect of preoperative biliary drainage on recurrence and survival and they concluded that percutaneous biliary decompression was an independent predictor of worse overall survival and was associated with non-significant increase in hepatic recurrence (Abstract #314). Montero et al. presented the results of their study regarding the cost-effectiveness of metal stents in patients with inoperable pancreatic cancer and they concluded that placement of metal biliary stents is cost saving, improves overall survival and quality-adjusted survival compared with plastic stents (Abstract #260). Both studies concluded to useful results that along with the existing literature and formulated guidelines may help the provision of more effective, higher quality management of these patients. PMID:24618435

Toki, Maria I; Syrigos, Konstantinos N; Saif, Muhammad Wasif

2014-03-01

153

[Nutrition, probiotics, antibiotics, antioxidative therapy, endoscopy in chronic pancreatitis].  

PubMed

Treatment of chronic pancreatitis is dependent on the stage of the disease and consists of several arms: treatment of pain when ever possible according to its pathogenesis; treatment of complications primarily by interventional endoscopy, in cases of failure by surgery; therapy of exocrine insufficiency with porcine pancreatic extracts; treatment of endocrine insufficiency with insulin. Pseudocysts can be drained according to their location by either the transgastric, transduodenal, transpapillary or transcutaneous route. Distal prepapillary stenoses of the main pancreatic duct can be handled by placement of a plastic stent; similarily to treatment of biliary strictures. Stones leading to obstruction of the main pancreatic duct can be disintegrated by extracorporeal shock wave lithotripsy (ESWL) and the fragments removed by endoscopy after papillotomy. Transgastral endoscopic drainage of retroperitoneal necroses is still experimental. Prospective randomized multicenter trials comparing surgery with interventional endoscopy are still lacking. Failure of endoscopic therapy or suspicion of tumor is clearly an indication for surgery. There is no need for a specific diet in patients with chronic pancreatitis without having diabetes. In severe attacks, clinically similar to acute pancreatitis, enteral nutrition via a jejunal tube is replacing parenteral nutrition. However, prospective comparative trials are still mandatory. Prophylactic application of antibiotics in patients with pancreatic necrosis is again under debate. Whether probiotics are capable to decrease the risk of secondary pancreatic infection of necrosis has not been thoroughly studied. The hypothesis that capture of oxygen free radicals by drugs such as selenium may prevent frequency and severity of acute relapses has also not been proven. PMID:17111847

Mössner, J

2006-10-18

154

Pancreatitis  

MedlinePLUS

... the hormones insulin and glucagon into the bloodstream. Pancreatitis is inflammation of the pancreas. It happens when digestive enzymes start digesting the pancreas itself. Pancreatitis can be acute or chronic. Either form is ...

155

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

156

The Detection of Bile Duct Stones in Suspected Biliary Pancreatitis: Comparison of MRCP, ERCP, and Intraductal US  

Microsoft Academic Search

OBJECTIVES:Early ERCP and endoscopic sphincterotomy for stone extraction can benefit the prognosis in patients with severe biliary pancreatitis, but are associated with complications. The ability to identify choledocholithiasis by noninvasive means in biliary pancreatitis is limited. The aim of this study was evaluation of the ability of MRCP to detect choledocholithiasis in patients with acute biliary pancreatitis. In addition, we

Jong Ho Moon; Young Deok Cho; Sang Woo Cha; Young Koog Cheon; Hyun Cheol Ahn; Young Seok Kim; Yun Soo Kim; Joon Seong Lee; Moon Sung Lee; Hae Kyung Lee; Chan Sup Shim; Boo Sung Kim

2005-01-01

157

Stent Selection for Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections: A Multicenter Study in China  

PubMed Central

Aims. We attempted to establish some guidelines for the selection of transmural stents during endoscopic drainage of PFCs by retrospective review of the clinical data obtained from three tertiary hospitals. Patients and Methods. Clinical data of 93 patients with attempted endoscopic drainage of symptomatic PFCs were obtained through chart review and prospective follow-up. Results. Treatment success for acute pseudocyst (n = 67), chronic pseudocyst (n = 9), and WOPN (n = 17) was 95.3%, 100%, and 88.2%, respectively (P = 0.309). Clinical success for single-stent drainage was 93.9% (46/49) versus 97.4% (37/38) for multiple-stent drainage (P = 0.799). Secondary infection for single-stent drainage was 18.4% (9/49) versus 5.3% (2/38) for multiple-stent drainage (P = 0.134). Secondary infection for stent diameter less than or equal to 8.5?F was 3.4% (1/29) versus 17.2% (10/58) for stent diameter larger than or equal to 10?F (P = 0.138). Conclusion. EUS-guided transmural drainage is an effective therapy for PFCs. Single-stent transmural drainage of PFCs is enough and does not seem to influence clinical success. The number or diameter of stents does not seem to be associated with secondary infection.

Lin, Hui; Zhan, Xian-Bao; Sun, Si-Yu; Yang, Xiu-Jiang; Jin, Zhen-Dong; Zou, Duo-Wu; Li, Zhao-Shen

2014-01-01

158

Gamma-amino butyric acid (GABA) prevents the induction of nicotinic receptor-regulated signaling by chronic ethanol in pancreatic cancer cells and normal duct epithelia  

PubMed Central

Pancreatic cancer has a high mortality rate and alcoholism is a risk factor independent of smoking. We have shown that nicotinic acetylcholine receptors (nAChRs) regulate pancreatic ductal epithelia and pancreatic ductal adenocarcinoma (PDAC) cells in an autocrine fashion by stimulating their production of the stress neurotransmitters noradrenaline and adrenaline that signal through beta-adrenergic receptors (?-ARs). Our current study has investigated the modulation of this autocrine regulatory loop by chronic ethanol and explored the potential prevention of these effects by ?-amino butyric acid (GABA). Using MTT assays, cell migration assays, western blotting, immunoassays, and gene knockdown of individual nAChRs in two PDAC cell lines and in immortalized human pancreatic duct epithelial cells, our data show that treatment for seven days with ethanol induced the protein expression and sensitivity of nAChRs ?3, ?5 and ?7 resulting in increased production of noradrenaline and adrenaline which drive proliferation and migration via cAMP-dependent signaling downstream of ?-ARs. Treatment with GABA prevented all of these responses to chronic ethanol, reducing cell proliferation and migration below base levels in untreated cells. Our findings suggest that alcoholism induces multiple cAMP-dependent PDAC stimulating signaling pathways by up-regulating the protein expression and sensitivity of nAChRs that regulate stress neurotransmitter production. Moreover, our data identify GABA as a promising agent for the prevention of PDAC in individuals at risk due to chronic alcohol consumption.

Al-Wadei, Mohammed H.; Al-Wadei, Hussein A.N.; Schuller, Hildegard M.

2012-01-01

159

Medium-term results of experimental stent implantation into the ductus arteriosus  

Microsoft Academic Search

Baloon dilation is disappointing in maintaining patency of the arterial duct. In neonatal lambs, stent implantation in the arterial duct results in significantly larger ducts with greater pulmonary blood flow than balloon dilation. Little is known, however, about the duration of duct patency after stent implantation. The outcome of slent implantation into the arterial duct in 12 lambs was observed

Eric Rosenthal; Shakeel A. Qureshi; A. Hussein Tabatabaie; Deo Persaud; Ashok P. Kakadekar; Edwrd J. Baker; Michael Tynan

1996-01-01

160

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

161

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

PubMed

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. PMID:19033647

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

2009-01-01

162

Role of endoscopic ultrasound and endoscopic retrograde cholangiopancreatography in isolated pancreatic metastasis from lung cancer.  

PubMed

A case is reported of a 50-year-old woman with a history of small-cell lung cancer admitted with pancreatic head lesions, discovered during investigation for obstructive jaundice. Endoscopic ultrasound assisted fine needle aspiration of the pancreatic mass was consistent with small cell carcinoma, presenting as an isolated metastasis from the previously diagnosed lung cancer. Endoscopic retrograde cholangiopancreatography (ERCP) showed extrinsic compression and a bile duct stricture, requiring sphincterotomy and stent insertion. This case highlights that acute pancreatitis and biliary obstruction can occur as a manifestation of small cell lung cancer metastasizing to the pancreas. EUS is a safe, low risk and rapid diagnostic tool in such cases, and ERCP with stenting offers a safe and effective treatment option. PMID:22816014

Singh, Dushyant; Vaidya, Omkar U; Sadeddin, Esmat; Yousef, Osama

2012-07-16

163

Endoscopic Ultrasound-guided Bilio-pancreatic Drainage  

PubMed Central

The echoendoscopic biliary drainage is an option to treat obstructive jaundices when endoscopic retrograde cholangiopancreatography (ERCP) drainage fails. These procedures compose alternative methods to the side of surgery and percutaneous transhepatic biliary drainage, and it was only possible by the continuous development and improvement of echoendoscopes and accessories. The development of linear sectorial array echoendoscopes in early 1990 brought a new approach to diagnostic and therapeutic dimension on echoendoscopy capabilities, opening the possibility to perform punction over direct ultrasonografic view. Despite of the high success rate and low morbidity of biliary drainage obtained by ERCP, difficulty could be found at the presence of stent tumor ingrown, tumor gut compression, periampullary diverticula and anatomic variation. The echoendoscopic technique starts performing punction and contrast of the left biliary tree. When performed from gastric wall, the access is made through hepatic segment III. From duodenum, direct common bile duct punction. Diathermic dilatation of the puncturing tract is required using a 6-Fr cystostome and a plastic or metal stent is introducted. The techincal success of hepaticogastrostomy is near 98%, and complications are present in 20%: pneumoperitoneum, choleperitoneum, infection and stent disfunction. To prevent bile leakage, we have used the 2-stent techniques. The first stent introduced was a long uncovered metal stent (8 or 10 cm) and inside this first stent a second fully covered stent of 6 cm was delivered to bridge the bile duct and the stomach. Choledochoduodenostomy overall success rate is 92%, and described complications include, in frequency order, pneumoperitoneum and focal bile peritonitis, present in 14%. By the last 10 years, the technique was especially performed in reference centers, by ERCP experienced groups, and this seems to be a general guideline to safer procedure execution. The ideal approach for pancreatic pseudocyst (PPC) puncture combines endos-copy with real time endosonography using an interventional echoendoscope. Several authors have described the use of endoscopic ultrasound (EUS) longitudinal scanners for guidance of transmural puncture and drainage procedures. The same technique could be used to access a dilated pancreatic duct in cases in which the duct cannot be drained by conventional ERCP because of complete obstruction.

Giovannini, Marc; Bories, Erwan; Tellez-Avila, Felix I.

2012-01-01

164

Intraductal papillary mucinous neoplasm of the bile duct with gastric and duodenal fistulas  

PubMed Central

Intraductal papillary mucinous neoplasm (IPMN) of the bile duct is still rare and not yet understood despite of its increased incidence and similar clinicopathologic characteristics compared with IPMN of the pancreas. The fistula formation into other organs can occur in IPMN, especially the pancreatic type. To our knowledge, only two cases of IPMN of the bile duct with a choledochoduodenal fistula were reported and we have recently experienced a case of IPMN of the bile duct penetrating into two neighboring organs of the stomach and duodenum presenting with abdominal pain and jaundice. Endoscopy showed thick mucin extruding from two openings of the fistulas. Endoscopic suction of thick mucin using direct peroral cholangioscopy with ultra-slim endoscope through choledochoduodenal fistula was very difficult and ineffective because of very thick mucin and next endoscopic suction through the stent after prior insertion of biliary metal stent into choledochogastric fistula also failed. Pathologic specimen obtained from the proximal portion of the choledochogastric fistula near left intrahepatic bile duct through the metal stent showed a low grade adenoma. The patient declined the surgical treatment due to her old age and her abdominal pain with jaundice was improved after percutaneous transhepatic biliary drainage with the irrigation of N-acetylcysteine three times daily for 10 d.

Hong, Man Yong; Yu, Dong Wook; Hong, Seung Goun

2014-01-01

165

Intraductal papillary mucinous neoplasm of the bile duct with gastric and duodenal fistulas.  

PubMed

Intraductal papillary mucinous neoplasm (IPMN) of the bile duct is still rare and not yet understood despite of its increased incidence and similar clinicopathologic characteristics compared with IPMN of the pancreas. The fistula formation into other organs can occur in IPMN, especially the pancreatic type. To our knowledge, only two cases of IPMN of the bile duct with a choledochoduodenal fistula were reported and we have recently experienced a case of IPMN of the bile duct penetrating into two neighboring organs of the stomach and duodenum presenting with abdominal pain and jaundice. Endoscopy showed thick mucin extruding from two openings of the fistulas. Endoscopic suction of thick mucin using direct peroral cholangioscopy with ultra-slim endoscope through choledochoduodenal fistula was very difficult and ineffective because of very thick mucin and next endoscopic suction through the stent after prior insertion of biliary metal stent into choledochogastric fistula also failed. Pathologic specimen obtained from the proximal portion of the choledochogastric fistula near left intrahepatic bile duct through the metal stent showed a low grade adenoma. The patient declined the surgical treatment due to her old age and her abdominal pain with jaundice was improved after percutaneous transhepatic biliary drainage with the irrigation of N-acetylcysteine three times daily for 10 d. PMID:25031793

Hong, Man Yong; Yu, Dong Wook; Hong, Seung Goun

2014-07-16

166

Palliative portal vein stent placement in malignant and symptomatic extrinsic portal vein stenosis or occlusion.  

PubMed

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. PMID:18956224

Novellas, Sébastien; Denys, Alban; Bize, Pierre; Brunner, Philippe; Motamedi, Jean Paul; Gugenheim, Jean; Caroli, François-Xavier; Chevallier, Patrick

2009-05-01

167

Dasatinib and Gemcitabine Hydrochloride or Gemcitabine Hydrochloride Alone in Treating Patients With Pancreatic Cancer Previously Treated With Surgery  

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; Stage III Pancreatic Cancer

2013-11-06

168

Endoscopic Stenting for Malignant Biliary Obstruction  

Microsoft Academic Search

.   Use of endoscopic stents to manage patients with malignant obstructive jaundice is a well accepted measure. Interpretation\\u000a of the results of endoscopic stenting must be made with reference to the level of the bile duct obstruction. Results were\\u000a generally unsatisfactory for hilar lesions, especially when the intrahepatic ducts were segregated into multiple isolated\\u000a systems. After deployment, stent dysfunction due

Edward C. S. Lai; Chung-Mau Lo; Chee-Leung Liu

2001-01-01

169

CT of the pancreas: comparison of image quality and pancreatic duct depiction among model-based iterative, adaptive statistical iterative, and filtered back projection reconstruction techniques.  

PubMed

The purpose of this study is to compare CT images of the pancreas reconstructed with model-based iterative reconstruction (MBIR), adaptive statistical iterative reconstruction (ASiR), and filtered back projection (FBP) techniques for image quality and pancreatic duct (PD) depiction. Data from 40 patients with contrast-enhanced abdominal CT [CTDIvol: 10.3 ± 3.0 (mGy)] during the late arterial phase were reconstructed with FBP, 40% ASiR-FBP blending, and MBIR. Two radiologists assessed the depiction of the main PD, image noise, and overall image quality using 5-point scale independently. Objective CT value and noise were measured in the pancreatic parenchyma, and the contrast-to-noise ratio (CNR) of the PD was calculated. The Friedman test and post-hoc multiple comparisons with Bonferroni test following one-way ANOVA were used for qualitative and quantitative assessment, respectively. For the subjective assessment, scores for MBIR were significantly higher than those for FBP and 40% ASiR (all P < 0.001). No significant differences in CT values of the pancreatic parenchyma were noted among FBP, 40% ASiR, and MBIR images (P > 0.05). Objective image noise was significantly lower and CNR of the PD was higher with MBIR than with FBP and 40% ASiR (all P < 0.05). Our results suggest that pancreatic CT images reconstructed with MBIR have lower image noise, better image quality, and higher conspicuity and CNR of the PD compared with FBP and ASiR. PMID:24496703

Lin, Xiao-Zhu; Machida, Haruhiko; Rt, Isao Tanaka; Rt, Rika Fukui; Ueno, Eiko; Chen, Ke-Min; Yan, Fu-Hua

2014-06-01

170

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

171

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

172

Evaluation of fully covered self-expanding metal stents in benign biliary strictures and bile leaks  

PubMed Central

AIM: To investigate the use of fully covered metal stents in benign biliary strictures (BBS) and bile leaks. METHODS: We studied 17 patients, at Harbor-UCLA Medical center (Los Angeles), with BBS (n = 12) and bile leaks (n = 5) from July 2007 to February 2012 that had received placement of fully covered self-expanding metal stents (FCSEMs). Fourteen patients had endoscopic placement of VIABIL® (Conmed, Utica, New York, United States) stents and three had Wallflex® (Boston Scientific, Mass) stents. FCSEMS were 8 mm or 10 mm in diameter and 4 cm to 10 cm in length. Patients were followed at regular intervals to evaluate for symptoms and liver function tests. FCSEMS were removed after 4 or more weeks. Resolution of BBS and leak was documented cholangiographically following stent removal. Stent patency can be defined as adequate bile and contrast flow from the stent and into the ampulla during endoscopic retrograde cholangiopancreatography (ERCP) without clinical signs and/or symptoms of biliary obstruction. Criterion for bile leak resolution at ERCP is defined as absence of contrast extravasation from the common bile duct, cystic duct remanent, or gall bladder fossa. Rate of complications such as migration, and in-stent occlusion were recorded. Failure of endoscopic therapy was defined as persistent biliary stenosis or continuous biliary leakage after 12 mo of stent placement. RESULTS: All 17 patients underwent successful FCSEMS placement and removal. Etiologies of BBS included: cholecystectomies (n = 8), cholelithiasis (n = 2), hepatic artery compression (n = 1), pancreatitis (n = 2), and Whipple procedure (n = 1). All bile leaks occurred following cholecystectomy. The anatomic location of BBS varied: distal common bile duct (n = 7), common hepatic duct (n = 1), hepaticojejunal anastomosis (n = 2), right intrahepatic duct (n = 1), and choledochoduodenal anastomatic junction (n = 1). All bile leaks were found to be at the cystic duct. Twelve of 17 patients had failed prior stent placement or exchange. Resolution of the biliary strictures and bile leaks was achieved in 16 of 17 patients (94%). The overall median stent time was 63 d (range 27-251 d). The median stent time for the BBS group and bile leak group was 62 ± 58 d (range 27-199 d) and 92 ± 81 d (range 48-251 d), respectively. All 17 patients underwent successful FCSEMS removal. Long term follow-up was obtained for a median of 575 d (range 28-1435 d). Complications occurred in 5 of 17 patients (29%) and included: migration (n = 2), stent clogging (n = 1), cholangitis (n = 1), and sepsis with hepatic abscess (n = 1). CONCLUSION: Placement of fully covered self-expanding metal stents may be used in the management of benign biliary strictures and bile leaks with a low rate of complications.

Lalezari, David; Singh, Inder; Reicher, Sofiya; Eysselein, Viktor Ernst

2013-01-01

173

UK wide survey on the prevention of post-ERCP pancreatitis  

PubMed Central

Objective In 2010, the European Society of Gastrointestinal Endoscopy delivered guidelines on the prophylaxis of postendoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis (PEP). These included Grade A recommendations advising the use of prophylactic pancreatic stent (PPS) and non-steroidal anti-inflammatory drugs (NSAIDs) in high-risk cases. Our study aim was to capture the current practice of UK biliary endoscopists in the prevention of PEP. Design In summer 2012, an anonymous online 15-item survey was emailed to 373 UK consultant gastroenterologists, gastrointestinal surgeons and radiologists identified to perform ERCP. Results The response rate was 59.5% (222/373). Of the respondents, 52.5% considered ever using PPS for the prevention of PEP. PPS users always attempted insertion for the following procedural risk factors: pancreatic sphincterotomy (48.9%), suspected sphincter of Oddi dysfunction (46.5%), pancreatic duct instrumentation (35.9%), previous PEP (25.2%), precut sphincterotomy (8.5%) and pancreatic duct injection (7.8%). Prophylactic NSAID use was significantly associated with attempts at PPS placement (p<0.001). 64.1% of non-PPS users cited a lack of conviction in their benefit as the main reason for their decision. Self-reported pharmacological use rates for PEP prevention were: NSAIDs (34.6%), antibiotics (20.6%), rapid intravenous fluids (13.2%) and octreotide (1.6%). 6% routinely measured amylase post-ERCP. Conclusions Despite strong evidence-based guidelines for prevention of PEP, less than 53% of ERCP practitioners use pancreatic stenting or NSAIDs. This suggests a need for the development of British Society of Gastroenterology guidelines to increase awareness in the UK. Even among stent users, PPS are being underused for most high-risk cases. Prophylactic pharmacological measures were rarely used as was routine post-ERCP serum amylase measurement.

Hanna, Mina S; Portal, Andrew J; Dhanda, Ashwin D; Przemioslo, Robert

2014-01-01

174

Bilateral kidney preservation by volumetric-modulated arc therapy (RapidArc) compared to conventional radiation therapy (3D-CRT) in pancreatic and bile duct malignancies  

PubMed Central

Background To compare volumetric-modulated arc therapy plans with conventional radiation therapy (3D-CRT) plans in pancreatic and bile duct cancers, especially for bilateral kidney preservation. Methods A dosimetric analysis was performed in 21 patients who had undergone radiotherapy for pancreatic or bile duct carcinoma at our institution. We compared 4-field 3D-CRT and 2 arcs RapidArc (RA) plans. The treatment plan was designed to deliver a dose of 50.4 Gy to the planning target volume (PTV) based on the gross disease in a 1.8 Gy daily fraction, 5 days a week. Planning objectives were 95% of the PTV receiving 95% of the prescribed dose and no more than 2% of the PTV receiving more than 107%. Dose-volume histograms (DVH) for the target volume and the organs at risk (right and left kidneys, bowel tract, liver and healthy tissue) were compared. Monitor units and delivery treatment time were also reported. Results All plans achieved objectives, with 95% of the PTV receiving ? 95% of the dose (D95% for 3D-CRT = 48.9 Gy and for RA = 48.6 Gy). RapidArc was shown to be superior to 3D-CRT in terms of organ at risk sparing except for contralateral kidney: for bowel tract, the mean dose was reduced by RA compared to 3D-CRT (16.7 vs 20.8 Gy, p = 0.0001). Similar result was observed for homolateral kidney (mean dose of 4.7 Gy for RA vs 12.6 Gy for 3D-CRT, p < 0.0001), but 3D-CRT significantly reduced controlateral kidney dose with a mean dose of 1.8 Gy vs 3.9 Gy, p < 0.0007. Compared to 3D-CRT, mean MUs for each fraction was significantly increased with RapidArc: 207 vs 589, (p < 0.0001) but the treatment time was not significantly different (2 and 2.66 minutes, p = ns). Conclusion RapidArc allows significant dose reduction, in particular for homolateral kidney and bowel, while maintaining target coverage. This would have a promising impact on reducing toxicities.

2011-01-01

175

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

176

Belgian consensus on chronic pancreatitis in adults and children: statements on diagnosis and nutritional, medical, and surgical treatment.  

PubMed

Chronic pancreatitis (CP) is an inflammatory disorder characterized by inflammation and fibrosis, resulting in a progressive and irreversible destruction of exocrine and endocrine pancreatic tissue. Clinicians should attempt to classify patients into one of the six etiologic groups according to the TIGARO classification system. MRI/MRCP, if possible with secretin enhancement, is considered the imaging modality of choice for the diagnosis of early-stage disease.In CP, pain is the most disabling symptom, with a significant impact on quality of life. Pain should be assessed using the Izbicki score and preferably treated using the "pain ladder" approach. In painful CP, endoscopic therapy (ET) can be considered as early as possible. This procedure can be combined with extracorporeal shock-wave lithotripsy (ESWL) in the presence of large (> 4 mm), obstructive stone(s) in the pancreatic head, and with ductal stenting in the presence of a single main pancreatic duct (MPD) stricture in the pancreatic head with a markedly dilated MPD. Pancreatic stenting should be pursued for at least 12 months in patients with persistent pain relief. On-demand stent exchange should be the preferred strategy. The simultaneous placement of multiple, side-by-side, pancreatic stents can be recommended in patients with MPD strictures persisting after 12 months of single plastic stenting. We recommend surgery in the following cases: a) technical failure of ET ; b) early (6 to 8 weeks) clinical failure ; c) definitive biliary drainage at a later time point; d) pancreatic ductal drainage when repetitive ET is considered unsuitable for young patients; e) resection of an inflammatory pancreatic head when pancreatic cancer cannot be ruled out; f) duodenal obstruction. Duodenopancreatectomy or oncological distal pancreatectomy should be considered for patients with suspected malignancy. Pediatricians should be aware of and systematically search for CP in the differential diagnosis of chronic abdominal pain. As malnutrition is highly prevalent in CP patients, patients at nutritional risk should be identified in order to allow for dietary counseling and nutritional intervention using oral supplements. Patients should follow a healthy balanced diet taken in small meals and snacks, with normal fat content. Enzyme replacement therapy is beneficial to symptomatic patients, but also in cases of subclinical insufficiency. Regular follow-up should be considered in CP patients, primarily to detect subclinical maldigestion and the development of pancreatogenic diabetes. Screening for pancreatic cancer is not recommended in CP patients, except in those with the hereditary form. PMID:24761691

Delhaye, Myriam; Van Steenbergen, Werner; Cesmeli, Ercan; Pelckmans, Paul; Putzeys, Virginie; Roeyen, Geert; Berrevoet, Frederik; Scheers, Isabelle; Ausloos, Floriane; Gast, Pierrette; Ysebaert, Dirk; Plat, Laurence; van der Wijst, Edwin; Hans, Guy; Arvanitakis, Marianna; Deprez, Pierre H

2014-03-01

177

Cecum perforation due to biliary stent migration.  

PubMed

The endoscopic placement of biliary stents for benign and malignant biliary disease has been performed for over a decade. Several complications of stent placement have been described such as pancreatitis, hemorrhage, cholangitis, and perforation. Migration of biliary stents is a rare event, which can cause severe complications such as gastrointestinal tract perforation. We report the case of a 26-year-old woman with a cecum perforation due to biliary stent migration. We present the second case of cecal perforation related to the migration of a biliary stent. PMID:25028235

Barut, Ibrahim; Tarhan, Omer R

2014-07-01

178

Combined use of videoendoscopy and X-ray imaging for improved monitoring of stenting application  

NASA Astrophysics Data System (ADS)

The subject of this paper concerns advanced techniques of procedures and imaging used in minimally invasive surgery and in non-operable cases of the alimentary tract tumor therapy. Examples of videoendoscopy and X-ray imaging used for the application of stents (prostheses) and catheters allowing for the performance of diagnostic and endo-therapeutic procedures are described. The possibility was indicated to elaborate a new method of proceeding in tumor therapy in the patients for whom the methods used so far were ineffective. In the paper examples of combined imaging the application of metallic stents and plastic catheters allowing for the performance of diagnostic and therapeutic procedures are presented. The cases shown refer to tumor located in the esophagus and in the bile and pancreatic ducts.

Cysewska-Sobusiak, A. R.; Sowier, A.; Skrzywanek, P.

2005-09-01

179

Trimming of a Migrated Biliary Nitinol Stent Using Argon Plasma  

Microsoft Academic Search

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

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

2009-01-01

180

Autoimmune pancreatitis can develop into chronic pancreatitis.  

PubMed

Autoimmune pancreatitis (AIP) has been recognized as a distinct type of pancreatitis that is possibly caused by autoimmune mechanisms. AIP is characterized by high serum IgG4 and IgG4-positive plasma cell infiltration in affected pancreatic tissue. Acute phase AIP responds favorably to corticosteroid therapy and results in the amelioration of clinical findings. However, the long-term prognosis and outcome of AIP remain unclear. We have proposed a working hypothesis that AIP can develop into ordinary chronic pancreatitis resembling alcoholic pancreatitis over a long-term course based on several clinical findings, most notably frequent pancreatic stone formation. In this review article, we describe a series of study results to confirm our hypothesis and clarify that: 1) pancreatic calcification in AIP is closely associated with disease recurrence; 2) advanced stage AIP might have earlier been included in ordinary chronic pancreatitis; 3) approximately 40% of AIP patients experience pancreatic stone formation over a long-term course, for which a primary risk factor is narrowing of both Wirsung's and Santorini's ducts; and 4) nearly 20% of AIP patients progress to confirmed chronic pancreatitis according to the revised Japanese Clinical Diagnostic Criteria, with independent risk factors being pancreatic head swelling and non-narrowing of the pancreatic body duct. PMID:24884922

Maruyama, Masahiro; Watanabe, Takayuki; Kanai, Keita; Oguchi, Takaya; Asano, Jumpei; Ito, Tetsuya; Ozaki, Yayoi; Muraki, Takashi; Hamano, Hideaki; Arakura, Norikazu; Kawa, Shigeyuki

2014-01-01

181

Autoimmune pancreatitis can develop into chronic pancreatitis  

PubMed Central

Autoimmune pancreatitis (AIP) has been recognized as a distinct type of pancreatitis that is possibly caused by autoimmune mechanisms. AIP is characterized by high serum IgG4 and IgG4-positive plasma cell infiltration in affected pancreatic tissue. Acute phase AIP responds favorably to corticosteroid therapy and results in the amelioration of clinical findings. However, the long-term prognosis and outcome of AIP remain unclear. We have proposed a working hypothesis that AIP can develop into ordinary chronic pancreatitis resembling alcoholic pancreatitis over a long-term course based on several clinical findings, most notably frequent pancreatic stone formation. In this review article, we describe a series of study results to confirm our hypothesis and clarify that: 1) pancreatic calcification in AIP is closely associated with disease recurrence; 2) advanced stage AIP might have earlier been included in ordinary chronic pancreatitis; 3) approximately 40% of AIP patients experience pancreatic stone formation over a long-term course, for which a primary risk factor is narrowing of both Wirsung’s and Santorini’s ducts; and 4) nearly 20% of AIP patients progress to confirmed chronic pancreatitis according to the revised Japanese Clinical Diagnostic Criteria, with independent risk factors being pancreatic head swelling and non-narrowing of the pancreatic body duct.

2014-01-01

182

[A case of intraductal papillary mucinous neoplasm with internal pancreatic fistula causing left ureteral obstruction].  

PubMed

A 75-year-old man had been admitted to another hospital because of left abdominal pain, and was given a diagnosis of left hydronephrosis and acute pancreatitis. After a JJ stent insertion and medication, he was transferred to our hospital for further examinations. US and EUS revealed a chronic pancreatitis-like pattern and multicystic lesion in the pancreas head and body. At that time enhanced CT findings showed an extrapancreatic low density area to be inflammatory change, extending from the pancreas body to the left crus of the diaphragm and posteriorly the spreading from the left crus of the diaphragm via the left urinary duct into the left iliopsoas muscle, in which MRI revealed partial high intensity. ERCP and MRCP showed focal irregular narrowing of the pancreatic duct of unknown cause, and we decided that an internal pancreatic fistula due to pancreatitis had induced left ureteral obstruction, caused by a protein plug or alcohol. Follow-up 6 months later showed that extrapancreatic spreading of the low density area had markedly regressed without any change in the ureteral obstruction. PMID:17675827

Takahashi, Sho; Homma, Hisato; Akiyama, Takehide; Mesawa, Shinichi; Hirata, Kenichiro; Kogawa, Katsuhisa; Takanashi, Kunihiro; Ishiwatari, Hirotoshi; Kawano, Yutaka; Hayashi, Tsuyoshi; Takada, Kohichi; Miyanishi, Koji; Kato, Junji; Niitsu, Yoshiro

2007-08-01

183

Simultaneous stenting of tightly stenosed patent ductus arteriosus and pulmonary artery bifurcation using two stents (Y stenting): An innovative technique.  

PubMed

Stenting of patent ductus arteriosus (PDA) is a palliative technique that is evolving as an alternative to shunt surgery. Patients with duct-dependant pulmonary circulation and branch pulmonary artery stenosis are often palliated by shunt surgery with repair of branch pulmonary arteries under cardiopulmonary bypass. We present here an 8-month-old male child with duct-dependant pulmonary circulation with bifurcation stenosis who was palliated successfully by transcatheter means. He had stenosed PDA with tight pulmonary artery bifurcation stenosis and underwent successful "Y" stenting of PDA with simultaneous deployment of two stents. He successfully underwent bidirectional Glenn surgery 8 months after the procedure. Simultaneous stenting of bifurcation stenosis of branch pulmonary arteries with two stents has not been described in the literature. © 2014 Wiley Periodicals, Inc. PMID:24478204

Garg, Gaurav; Srivastava, Anurakti; Radha, Anil Sivadasan

2014-06-01

184

Hydrophilic hydromer-coated polyurethane stents versus uncoated stents in malignant biliary obstruction: a randomized trial  

Microsoft Academic Search

Background: Hydromer-coated polyurethane stents (HCPS) have a low coefficient of friction that may reduce sludge formation and potentially increase stent longevity. Methods: Eighty-three patients (39 men, mean age 69.3 years) with malignant mid or distal bile duct strictures were prospectively randomized to receive either 10F HCPS (n = 40) or standard polyethylene stents (n = 43). Results: Fifteen patients (18.1%)

Guido Costamagna; Massimiliano Mutignani; Gianluca Rotondano; Livio Cipolletta; Luigi Ghezzo; Alberto Foco; Alessandro Zambelli

2000-01-01

185

Unilateral multiple metallic stent-in-stent for a case of hilar biliary cancer: An alternative stenting strategy.  

PubMed

The stenting strategy has been discussed in cases with unresectable hilar bile duct cancer (HBDC). We describe here a case of HBDC, 4 cm in size, invading the right portal vein and hepatic artery, which was only treated with repeated metallic stent placement, and the patient survived for a long period (51 months). Against Bismuth type-IV hilar biliary stricture, our strategy was to maintain the drainage of the largest, viable hepatic area (>50% of total liver) by unilateral multiple stent-in-stent. PMID:24976285

Matsubayashi, Hiroyuki; Kishida, Yoshihiro; Imai, Kenichiro; Hotta, Kinichi; Kakushima, Naomi; Tanaka, Masaki; Takizawa, Kohei; Ono, Hiroyuki

2014-01-01

186

Unilateral Multiple Metallic Stent-in-stent for a Case of Hilar Biliary Cancer: An Alternative Stenting Strategy  

PubMed Central

The stenting strategy has been discussed in cases with unresectable hilar bile duct cancer (HBDC). We describe here a case of HBDC, 4 cm in size, invading the right portal vein and hepatic artery, which was only treated with repeated metallic stent placement, and the patient survived for a long period (51 months). Against Bismuth type-IV hilar biliary stricture, our strategy was to maintain the drainage of the largest, viable hepatic area (>50% of total liver) by unilateral multiple stent-in-stent.

Matsubayashi, Hiroyuki; Kishida, Yoshihiro; Imai, Kenichiro; Hotta, Kinichi; Kakushima, Naomi; Tanaka, Masaki; Takizawa, Kohei; Ono, Hiroyuki

2014-01-01

187

Self-Expandable Metal Stents and Trans-stent Light Delivery: Are Metal Stents and Photodynamic Therapy Compatible?  

PubMed Central

Background and Objectives: Obstructive non-small cell lung cancer and obstructive esophageal cancer are US FDA approved indications of photodynamic therapy (PDT). The usefulness of PDT for the treatment of cholangiocarcinoma is currently under clinical investigation. Endoscopic stenting for lumen restoration is a common palliative intervention for those indications. It is important to assess whether self-expandable metal stents are compatible with trans-stent PDT light delivery. Study Design/Materials and Methods: Direct effects of various components of metal biliary (n = 2), esophageal (n = 2), and bronchial (n = 1) stents on PDT light transmittance and distribution were examined using a point or linear light source (630 or 652 nm diode laser). Resected pig biliary duct and esophageal wall tissues were used to examine the feasibility of PDT light delivery through the fully expanded metal stents. Results: While using a point light source, the metal components (thread and joint) of the stent could cause a significant shadow effect. The liner material (polytetrafluoroethylene or polyurethane) could cause various degrees of light absorption. When the stent was covered with a thin layer of biliary duct and esophageal tissues containing all wall layers, the shadow effect could be mitigated due to tissue scattering. Conclusions: This study clearly demonstrates that it is feasible to combine stenting and PDT for the treatment of luminal lesions. PDT light dose should be adjusted to counteract the reduction of light transmittance caused by the metal and liner materials of stent.

Wang, Luo-Wei; Li, Li-Bo; Li, Zhao-Shen; Chen, Yang K; Hetzel, Fred W.; Huang, Zheng

2008-01-01

188

Pancreatitis after sphincter of Oddi manometry  

Microsoft Academic Search

The nature, frequency, severity, and possible causes of complications after 207 sphincter of Oddi manometry measurements were studied in 146 patients. Acute pancreatitis was diagnosed in 6% (12 of 207) of the investigations and in 8% (12 of 146) of the patients examined. The pancreatitis was mild in all patients. After cannulation of the pancreatic duct, acute pancreatitis occurred in

P Rolny; B Anderberg; I Ihse; E Lindström; G Olaison; A Arvill

1990-01-01

189

[Autoimmune pancreatitis].  

PubMed

Autoimmune pancreatitis is a relatively rare form of chronic pancreatitis which is characterized by a lymphoplasmatic infiltrate with a storiform fibrosis and often goes along with painless jaundice and discrete discomfort of the upper abdomen. Clinically we distinguish between two subtypes, which differ in terms of their histology, clinical picture and prognosis. Type 1 autoimmune pancreatitis is the pancreatic manifestation of the IgG4-associated syndrome which also involves other organs. About one third of the patients can only be diagnosed after either histological prove or a successful steroid trail. Type 2 is IgG4-negative with the histological picture of an idiopathic duct centric pancreatitis and is to higher degree associated with inflammatory bowel disease. A definitive diagnosis can only be made using biopsy. Usually both forms show response to steroid treatment, but in type 1 up to 50?% of the patients might develop a relapse. The biggest challenge and most important differential diagnosis remains the discrimination of AIP from pancreatic cancer, because also AIP can cause mass of the pancreatic head, lymphadenopathy and ductal obstruction. This article summarizes recent advances on epidemiology, clinical presentation, diagnostic strategy, therapy and differential diagnosis in this relatively unknown disease. PMID:24193862

Beyer, G; Menzel, J; Krüger, P-C; Ribback, S; Lerch, M M; Mayerle, J

2013-11-01

190

Chronic Pancreatitis  

PubMed Central

Purpose of review We review important new clinical observations in chronic pancreatitis (CP) reported in 2011. Recent findings Smoking increases the risk of non-gallstone acute pancreatitis (AP) and the progression of AP to CP. Binge drinking during Oktoberfest did not associate with increased hospital admissions for AP. The unfolded protein response is an adaptive mechanism to maintain pancreatic health in response to noxious stimuli such as alcohol. Onset of diabetes mellitus in CP is likely due to progressive disease rather than individual variables. Insufficient pancreatic enzyme dosing is common for treatment of pancreatic steatorrhea; 90,000 USP U of lipase should be given with meals. Surgical drainage provides sustained, superior pain relief compared to endoscopic treatment in patients advanced CP with a dilated main duct +/? pancreatic stones. The central acting gabapentoid pregabalin affords a modest 12% pain reduction in patients with CP but ~30% of patients have significant side effects. Summary Patients with non-gallstone related AP or CP of any etiology should cease smoking. Results of this year’s investigations further elucidated the pancreatic pathobiology due to alcohol, onset of diabetes mellitus in CP, and the mechanisms and treatment of neuropathic pain in CP.

DiMagno, Matthew J.; DiMagno, Eugene P.

2012-01-01

191

Role of stents and laser therapy in biliary strictures  

NASA Astrophysics Data System (ADS)

The most frequent primary cancers causing malignant obstructive jaundice were pancreatic cancer (57%), hilar biliary cancer (19% including metastatic disease), nonhilar biliary cancer (14%) and papillary cancer (10%). Endoscopic stenting has widely replaced palliative surgery for malignant biliary obstruction because of its lower risk and cost. Self-expandable metal stents are the preferred mode of palliation for hilar malignancies. Plastic stents have a major role in benign biliary strictures. Major complications and disadvantages associated with metallic stents include high cost, cholangitis. malposition, migration, unextractability, and breakage of the stents, pancreatitis and stent dysfunction. Dysfunction due to tumor ingrowth can be relieved by thermal methods (argon plasma coagulator therapy). We present a concise review of the efficacy of metallic stents for palliation of malignant strictures.

Chennupati, Raja S.; Trowers, Eugene A.

2001-05-01

192

Risk factors for post-ERCP pancreatitis: a systematic review of clinical trials with a large sample size in the past 10 years  

PubMed Central

Background Post- endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is the most common and most severe complication associated with diagnostic and therapeutic ERCP. A multivariate analysis of risk factors for PEP is essential for identifying patients at high risk and subsequently choosing other suitable diagnoses. Methods Pertinent publications were identified through systematic searches of MEDLINE, Elsevier, and Springer; we performed a systematic review of 12 clinical studies published in the past ten years, selected out of 451 reviewed articles, in which risk factors for pancreatitis were identified. Seven probable risk factors were evaluated, and outcomes expressed in the case of dichotomous variables, as an odds ratio (OR) (with a 95% confidence interval, 95% CI). Results When the risk factors were analyzed, the OR for female gender was 1.40 (95% CI 1.24 to 1.58); the OR for previous PEP was 3.23 (95% CI 2.48 to 4.22); the OR for previous pancreatitis was 2.00 (95% CI 1.72 to 2.33); the OR for endoscopic sphincterotomy was 1.42 (95% CI 1.14 to 1.78); the OR for precut sphincterotomy was 2.11 (95% CI 1.72 to 2.59); the OR for Sphincter of Oddi dysfunction was 4.37 (95% CI 3.75 to 5.09); and the OR for non-prophylactic pancreatic duct stent was 2.10 (95% CI 1.63 to 2.69). Conclusions It appears that female gender, previous PEP, previous pancreatitis, endoscopic sphincterotomy, precut sphincterotomy, Sphincter of Oddi dysfunction, and non-prophylactic pancreatic duct stent are the risk factors for post-ERCP pancreatitis.

2014-01-01

193

Sphincter of oddi (pancreatic) hypertension and recurrent pancreatitis  

Microsoft Academic Search

Major papilla pancreatic sphincter dysfunction, a variant of sphincter of Oddi dysfunction, causes pancreatitis and pancreatic-type\\u000a pain. The gold standard for diagnosis is sphincter of Oddi manometry, most commonly performed at endoscopic retrograde cholangiopancreatography\\u000a (ERCP). Noninvasive testing, such as secretin-stimulated transabdominal or endoscopic ultrasound assessment of pancreatic\\u000a duct diameter, is less reliable and has relatively low sensitivity. Two thirds of

Benedict M. Devereaux; Stuart Sherman; Glen A. Lehman

2002-01-01

194

The effect of indwelling endoprosthesis on stone size or fragmentation after long-term treatment with biliary stenting for large stones  

Microsoft Academic Search

Background: Endoscopic biliary stenting is often used for large or difficult common bile duct (CBD) stones, but the effect of indwelling endoprosthesis on size or fragmentation of stones after long-term treatment with biliary stenting has not been formally established. We compared the stone size or fragmentation of common bile duct stones after a long period of biliary stenting. Methods: Endoscopic

P. Katsinelos; I. Galanis; I. Pilpilidis; G. Paroutoglou; P. Tsolkas; B. Papaziogas; S. Dimiropoulos; E. Kamperis; D. Katsiba; M. Kalomenopoulou; A. Papagiannis

2003-01-01

195

Hepato-biliary-enteric stent drainage as palliative treatment for proximal malignant obstructive jaundice.  

PubMed

The proximal malignant obstructive jaundice remains one of the most challenging problems for hepato-biliary surgeons. Particularly when the findings preclude surgical resection at exploration, the next decision seems hard to make. A novel palliative treatment called "hepato-biliary-enteric stent drainage" was designed for these proximal malignant obstructive jaundice patients. Hepato-biliary-enteric stent drainage was performed with silicone tube whose diameter was determined according to the degree of dilated biliary ducts, and the proximal end of the tube was placed to intrahepatic ducts as far as possible, the distal end was placed across the duodenal papilla. Between February 2011 and August 2012, 23 patients with the proximal malignant obstructive jaundice of unresectable tumors at exploration received hepato-biliary-enteric stent drainage. Patient's liver function results, symptoms, complications, and survival time were documented. The bilirubin levels of all 23 patients had a considerable and persistent decrease after operation and remained low or normal before death except for four cases of recurrent jaundice (two resulted from migration of tube and other two resulted from hepatocellular carcinoma extensively involving liver parenchyma). After effective drainage, clinical symptoms of cholangitis such as fever or pain were markedly relieved. No procedure-related bleeding, bile leakage, pancreatitis were observed. The median survival time was 212 days, half-year and 1-year survival rate were 56.5 and 21.7%, respectively. Hepato-biliary-enteric stent drainage with less expense, less complications, and easy operation may be an ideal option for patients with unresectable malignancy in the hilar region at exploration. PMID:24464214

Pan, Hao; Liang, Zhang; Yin, Tian-sheng; Xie, Yan; Li, De-wei

2014-03-01

196

Polymeric photosensitizer-embedded self-expanding metal stent for repeatable endoscopic photodynamic therapy of cholangiocarcinoma.  

PubMed

Photodynamic therapy (PDT) is a new therapeutic approach for the palliative treatment of malignant bile duct obstruction. In this study, we designed photosensitizer-embedded self-expanding nonvascular metal stent (PDT-stent) which allows repeatable photodynamic treatment of cholangiocarcinoma without systemic injection of photosensitizer. Polymeric photosensitizer (pullulan acetate-conjugated pheophorbide A; PPA) was incorporated in self-expanding nonvascular metal stent. Residence of PPA in the stent was estimated in buffer solution and subcutaneous implantation on mouse. Photodynamic activity of PDT-stent was evaluated through laserexposure on stent-layered tumor cell lines, HCT-116 tumor-xenograft mouse models and endoscopic intervention of PDT-stent on bile duct of mini pigs. Photo-fluorescence imaging of the PDT-stent demonstrated homogeneous embedding of polymeric Pheo-A (PPA) on stent membrane. PDT-stent sustained its photodynamic activities at least for 2 month. And which implies repeatable endoscopic PDT is possible after stent emplacement. The PDT-stent after light exposure successfully generated cytotoxic singlet oxygen in the surrounding tissues, inducing apoptotic degradation of tumor cells and regression of xenograft tumors on mouse models. Endoscopic biliary in-stent photodynamic treatments on minipigs also suggested the potential efficacy of PDT-stent on cholangiocarcinoma. In vivo and in vitro studies revealed our PDT-stent, allows repeatable endoscopic biliary PDT, has the potential for the combination therapy (stent plus PDT) of cholangiocarcinoma. PMID:25043500

Bae, Byoung-Chan; Yang, Su-Geun; Jeong, Seok; Lee, Don Haeng; Na, Kun; Kim, Joon Mee; Costamagna, Guido; Kozarek, Richard A; Isayama, Hiroyuki; Deviere, Jacques; Seo, Dong Wan; Nageshwar Reddy, D

2014-10-01

197

Laparoscopic surgery of the bile ducts.  

PubMed

Laparoscopic surgery of the bile ducts is evolving rapidly. Laparoscopic bile duct exploration is reaching wide application and is competitive with postoperative ERCP for treatment of choledocholithiasis. Staging laparoscopy is an important laparoscopic advance that is increasing resectability rates for pancreatic and hepatic tumors through laparoscopic detection of unresectable tumors. Bile duct injury is an important problem in laparoscopic cholecystectomy. Classification, avoidance, and management are discussed. PMID:8903564

Strasberg, S M; Callery, M P; Soper, N J

1996-01-01

198

Fully Covered Self-Expandable Metal Stents for Treatment of Both Benign and Malignant Biliary Disorders  

PubMed Central

Transpapillary stents are increasingly being used for biliary strictures, whether benign or malignant. However, there are different stent types and available data is controversial. Recently, completely covered self-expandable metal stents (CSEMSs) have been proposed as an alternative therapeutic option in different biliary indications, including strictures of the distal bile duct, anastomotic stenosis after orthotopic liver transplantation, bile duct leaks, periampullary perforation following endoscopic sphincterotomy (ES), and postsphincterotomy bleeding. Despite the higher costs of these devices, fully covered self-expanding metal stents seem to be a suitable therapeutic option to relief biliary obstruction due to bile duct stenosis, regardless of the underlying cause.

Abdel Samie, Ahmed; Theilmann, Lorenz

2012-01-01

199

Pathological significance of santorini’s duct of the pancreas  

Microsoft Academic Search

Summary  The pathological significance of the duct of Santorini has been studied on the basis of ERCP studies. Decompression function\\u000a of the duct could be established by radiomorphological analysis and by changes in blood enzyme levels that followed endoscopic\\u000a pancreatography. While diffuse fibrosis of the pancreatic parenchyma in chronic pancreatitis may interfere with this role\\u000a of the duct of Santorini, increased

Z. Tulassay; J. Papp; E. Kollin; O. Koller

1980-01-01

200

Indications for Endoscopic or Surgical Treatment of Chronic Pancreatitis  

Microsoft Academic Search

In patients suffering from chronic pancreatitis, pain as the predominant symptom remains a therapeutic challenge which often cannot be tackled conservatively. Since pancreatic duct obstruction – frequently within the pancreatic head – is an important etiological factor, treatment in these cases aims at decompressing the duct either endoscopically or surgically. Endoscopic drainage includes sphincterotomy, dilation of strictures, removal of stones,

Simon Rieder; Christoph W. Michalski; Helmut Friess

2010-01-01

201

Role of antimicrobial-impregnated polymer and teflon in the prevention of biliary stent blockage  

Microsoft Academic Search

Biliary stent blockage and microbial colonization is a common complication associated with polyurethane stents used for the relief of bile-duct obstruction caused by benign or malignant disease. In an attempt to overcome this problem the application of a ‘Teflon” (polytetrafluoroethylene) stent and an antimicrobial benzalkonium chloride (BZC) impregnated polymer were investigated. The effects of these materials on microbial colonization were

E. N. Rees; S. E. Tebbs; T. S. J. Elliott

1998-01-01

202

Wirsung and Santorini: the men behind the ducts.  

PubMed

During the 16th and 17th centuries, several important discoveries were accomplished by anatomists whose contribution has enlightened the most important anatomic structures of the pancreas. Following the earliest discoveries, researchers of several medical specialities further investigated the ductal pancreatic system. The accessory pancreatic duct with its minor papilla, the main pancreatic duct and the papilla major along with the confluence of the main pancreatic duct with the bile duct and pancreas divisum, have been the objects of interest of several personalities of the medical history. Eponyms in pancreatic anatomy were given to remember some of them, although anatomical misattributions are frequent and controversial. The aim of the authors was to dedicate a small tribute to the researchers who have written, during the last 500 years, important chapters of the medical history and who dedicated their lives to study the pancreatic ducts and their duodenal endings. Furthermore, a brief outlook was dedicated to the impact of anatomic variations and of embryologic anomalies of the pancreatic ducts in our clinical practice and in our actual understanding of duct-related diseases. The authors are confident that the genial curiosity of few extraordinary personalities of the past and the opportunities provided by modern technology continue to play a major role that may finally add wisdom to decision-making in dealing with duct-related biliopancreatic diseases and safety to diagnostic and therapeutic procedures employed. PMID:12120005

Flati, Giancarlo; Andrén-Sandberg, Ake

2002-01-01

203

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

204

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

2014-03-03

205

Percutaneous Endoscopic Retrieval and Replacement of a Knitted (Ultraflex) Biliary Stent  

SciTech Connect

A knitted (Ultraflex) biliary stent became obstructed after 5 months causing recurrent jaundice in a 92-year-old man with pancreatic cancer. The obstructed stent was successfully removed percutaneously by retrieval forceps under guidance by an 8.4 Fr fiberoptic biliary endoscope. A new stent was placed. No complications were encountered.

Sawada, Satoshi [Department of Radiology, University Hospital of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-01 (Japan); Kobayashi, Masami [Department of Radiology, Tottori University Hospital, 36-1 Nishimachi, Yonago 683 (Japan); Tanigawa, Noboru; Okuda, Yoshikazu; Mishima, Kazuya; Ohmura, Naoto; Kobayashi, Midori [Department of Radiology, University Hospital of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-01 (Japan)

1997-09-15

206

100 consecutive common duct explorations without mortality.  

PubMed

It has been suggested that the incidence of morbidity and mortality after common duct exploration no longer justifies its use in patients with a gallbladder in situ. Therefore endoscopic sphincterotomy has been advocated for removal of common duct stones before cholecystectomy in selected patients. The purpose of this study was to determine our current rate of retained common duct stones and the morbidity and mortality rates associated with common duct exploration. Charts of 100 consecutive patients who underwent cholecystectomy and common duct exploration from January 1982 through December 1986 were reviewed. Indications for duct exploration included jaundice, dilated common bile duct, gallstone pancreatitis, multiple small stones, and abnormal intraoperative cholangiogram. Common duct exploration was done by manual technique or choledochoscopy, as determined by the surgeon's preference. Only two patients required duodenotomy for extraction of difficult stones. There were no deaths in this series of consecutive common duct exploration. The total morbidity rate was 15.7%, which included a 5.3% incidence of retained common duct stones. There was a 7.4% major complication rate, including deep vein thrombosis, bleeding gastric ulcer, and pneumonia. The remaining complications were minor and did not prolong hospitalization. There was one wound infection and no postoperative pancreatitis. None of the complications were directly attributable to choledochotomy or duct exploration. All retained common duct stones were removed by endoscopic retrograde cholangiopancreatography or by angiographic basket and did not require reoperation. It is concluded that operative common duct exploration not requiring duodenotomy is safe and does not appreciably increase the incidence of complications after cholecystectomy. Endoscopic sphincterotomy continues to be the preferable alternative to operative common duct exploration for patients with retained common duct stones. PMID:2310236

Pappas, T N; Slimane, T B; Brooks, D C

1990-03-01

207

Lensing duct  

DOEpatents

A lensing duct to condense (intensify) light using a combination of front surface lensing and reflective waveguiding is described. 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. 3 figures.

Beach, R.J.; Benett, W.J.

1994-04-26

208

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

209

Trimming of a Broken Migrated Biliary Metal Stent with the Nd:YAG Laser  

PubMed Central

Biliary metal stents are a permanent solution for bile duct stenosis. Complications can arise when the stent migrates, breaks or is overgrown by tumour. The following case demonstrates how a Nd:YAG laser can be used to solve these problems. A 93-year-old man presented with jaundice and fever. Two years earlier a 6-cm metal stent had been implanted into a postinflammatory stenosis of the common bile duct after recurrent cholangitis and repetitive plastic stenting. Duodenoscopy showed that the stent was broken. It had migrated about 3 cm into the duodenum, leading to kinking of the stent and breaking of the wires. The stent was also occluded. It was necessary to purge the common bile duct and to introduce a second stent. However, the only way to reach the papilla was through the broken wires. Placing a second stent this way was impossible. Thus we trimmed the stent with a Nd:YAG laser. The piece that had migrated into the duodenum was retrieved. Now the papilla could be reached. The rest of the metal stent was purged with NaCl 0.9%. A second metal stent was placed. Since an Nd:YAG laser is part of the equipment of most endoscopy units, it can be used to trim a broken or migrated biliary metal stent.

Zuber-Jerger, I.; Kullmann, F.

2009-01-01

210

A patient with pancreas divisum, recurrent acute pancreatitis, and homozygosity for the cystic fibrosis transmembrane regulator-associated protein 5T allele.  

PubMed

Mutations in the gene encoding the cystic fibrosis transmembrane regulator (CFTR) have been reported to increase the risk of recurrent acute pancreatitis in patients with pancreas divisum. We assessed the CFTR gene in a young male patient with pancreas divisum and recurrent acute pancreatitis. Magnetic resonance cholangiopancreatography and computed tomography revealed that the patient had pancreas divisum, with an enlarged and tortuous pancreatic duct; he also had positive results from the cystic fibrosis sweat test. Genetic analysis did not identify any common CFTR mutations, but did show that he was homozygous for the 5T allele in intron 8 IVS8 5T-12TG (which affects splicing at intron 8). Endoscopic sphincterotomy and stenting of papilla minor was performed. The IVS8 5T-12TG variant has been associated with abnormal organ development, therefore it is possible that CFTR has an important role in the development of the pancreatic duct. We propose this patient has recurrent acute pancreatitis resulting from a developmental defect associated with a suboptimal CFTR function. PMID:23416327

Montagnani, Marco; Cazzato, Salvatore; Mutignani, Massimiliano; Cevenini, Monica; Guidetti, Elena; Zvi, Ido Ben; Aldini, Rita; Saraceni, Giacomo; Cavoli, Carlotta; Garagnani, Paolo; Ferrari, Simona; Mantovani, Vilma

2013-05-01

211

Acute idiopathic pancreatitis: clinical and diagnostic contribution.  

PubMed

Acute idiopathic pancreatitis is a term used when no underlying cause can be identified on routine investigations. However more specialized investigations, such as endoscopic, endoscopic retrocolangio pancreopathy (CPRE), may detect aetiological factors, particularly biliary sludge and pancreatic duct abnormalities. The authors, reviewing the current literature, report their caseload of idiopathic pancreatitis. They conclude that CPRE is indicated if ultrasonography shows a calibre of the common duct at the superior limits of normal values and in each idiopathic recurrent AP. PMID:9444796

Forte, A; Montesano, G; Gallinaro, L; Bertagni, A; Turano, R; Hueck, S; Illuminati, G

1997-01-01

212

Intestinal morphology and cytokinetics in pancreatic insufficiency  

Microsoft Academic Search

Intraluminal pancreatic enzymes influence intestinal function, adaptation, and susceptibility to injury. These effects may be mediated partly through changes in the rate of epithelial cell turnover. We assessed intestinal morphology and cytokinetics in a rat model of exocrine pancreatic insufficiency that does not alter anatomic relationships or animal growth. Pancreatic duct occlusion was performed by applying metal clips on both

Martin Hauer-Jensen; Gudbrand Skjonsberg; Eva Moen; Ole Petter Fraas Clausen

1995-01-01

213

Gemcitabine Hydrochloride With or Without Erlotinib Hydrochloride Followed By the Same Chemotherapy Regimen With or Without Radiation Therapy and Capecitabine or Fluorouracil in Treating Patients With Pancreatic Cancer That Has Been Removed By Surgery  

ClinicalTrials.gov

Acinar Cell Adenocarcinoma of the Pancreas; Duct Cell Adenocarcinoma of the Pancreas; Intraductal Papillary Mucinous Neoplasm of the Pancreas; Stage IA Pancreatic Cancer; Stage IB Pancreatic Cancer; Stage IIA Pancreatic Cancer; Stage IIB Pancreatic Cancer

2014-05-19

214

Preventing Post-ERCP Pancreatitis: Where Are We?  

Microsoft Academic Search

Summary Acute pancreatitis still represents the most common complication after procedures involving Vater's papilla; the reported incidence of this complication varies from less than 1% up to 40%. Attempts at preventing post-ERCP pancreatitis have been carried out using technical measures, pharmacological prophylaxis, or patient selection. Balloon sphincter of Oddi dilatation, difficult papillary cannulation, pancreatic sphincterotomy and multiple pancreatic duct injections

Pier Alberto Testoni; Gastrointestinal Endoscopy

215

Endoscopic Placement of Metal Stents in Treating Patients With Cancer- Related Duodenal Obstruction  

ClinicalTrials.gov

Colorectal Cancer; Constipation, Impaction, and Bowel Obstruction; Extrahepatic Bile Duct Cancer; Gastric Cancer; Gastrointestinal Carcinoid Tumor; Gastrointestinal Stromal Tumor; Pancreatic Cancer; Quality of Life; Small Intestine Cancer

2012-05-31

216

Pancreatic trauma: a concise review.  

PubMed

Traumatic injury to the pancreas is rare and difficult to diagnose. In contrast, traumatic injuries to the liver, spleen and kidney are common and are usually identified with ease by imaging modalities. Pancreatic injuries are usually subtle to identify by different diagnostic imaging modalities, and these injuries are often overlooked in cases with extensive multiorgan trauma. The most evident findings of pancreatic injury are post-traumatic pancreatitis with blood, edema, and soft tissue infiltration of the anterior pararenal space. The alterations of post-traumatic pancreatitis may not be visualized within several hours following trauma as they are time dependent. Delayed diagnoses of traumatic pancreatic injuries are associated with high morbidity and mortality. Imaging plays an important role in diagnosis of pancreatic injuries because early recognition of the disruption of the main pancreatic duct is important. We reviewed our experience with the use of various imaging modalities for diagnosis of blunt pancreatic trauma. PMID:24379625

Debi, Uma; Kaur, Ravinder; Prasad, Kaushal Kishor; Sinha, Saroj Kant; Sinha, Anindita; Singh, Kartar

2013-12-21

217

Pancreatic trauma: A concise review  

PubMed Central

Traumatic injury to the pancreas is rare and difficult to diagnose. In contrast, traumatic injuries to the liver, spleen and kidney are common and are usually identified with ease by imaging modalities. Pancreatic injuries are usually subtle to identify by different diagnostic imaging modalities, and these injuries are often overlooked in cases with extensive multiorgan trauma. The most evident findings of pancreatic injury are post-traumatic pancreatitis with blood, edema, and soft tissue infiltration of the anterior pararenal space. The alterations of post-traumatic pancreatitis may not be visualized within several hours following trauma as they are time dependent. Delayed diagnoses of traumatic pancreatic injuries are associated with high morbidity and mortality. Imaging plays an important role in diagnosis of pancreatic injuries because early recognition of the disruption of the main pancreatic duct is important. We reviewed our experience with the use of various imaging modalities for diagnosis of blunt pancreatic trauma.

Debi, Uma; Kaur, Ravinder; Prasad, Kaushal Kishor; Sinha, Saroj Kant; Sinha, Anindita; Singh, Kartar

2013-01-01

218

[Successful endoscopic removal of pancreatic catheter after Whipple resection being effective for improving repeated pancreatitis-a case report].  

PubMed

A 54-year-old man had repeated pancreatitis since three years after pylorus-preserving pancreatoduodenectomy (PpPD) and reconstruction by the modified Child method. Since abdominal pain appeared after meals, a pancreatic duct tube was removed endoscopically, which resulted in an improvement. It has been postulated that a pancreatic duct tube, used at the anastomosis between the pancreas and gastrointestinal tract, is spontaneously dislodged or creates a spatial gap with the wall of the main pancreatic duct enough to let the pancreatic juice outflow. However, endoscopic removal of the tube remained in place was significantly effective. We here discussed this case with reference of previous published reports. PMID:19194097

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

2009-02-01

219

[Nasolacrimal stent implantation: report of a case].  

PubMed

Epiphora (watering eye) is generally caused by insufficient drainage of tears. The most common cause of epiphora in adults is idiopathic inflammatory obstruction of the nasolacrimal duct. The traditional surgical treatment of nasolacrimal duct obstruction is an external dacryocystorhinostomy, which has an 85% to 95% success rate. To eliminate cutaneus wounds and scarring some techniques were introduced, for example the endonasal laser dacryocystorhinostomy and the nasolacrimal stent. The aim of this report was to evaluate the first case of nasolacrimal stent implantation in Brazil. The procedure was performed in the "Hospital das Clínicas" of the University of São Paulo - USP. A female patient with tearing of the right eye and secretion was submitted to a nasolacrimal stent implantation, with fluoroscopic guidance. The stent used in this procedure was the polyurethane Tearleader stent set. (Dr. Wilhelm type-PBN MEDICALS - Denmark). After 3 months, the patient started complaining of tearing, so the stent was removed and the patient was submitted to an external dacryocystorhinostomy. At present the patient does not have any symptoms or complaints. This procedure is less invasive and simple, causes no facial scars and avoids surgical trauma, but the long term success rates achieved using polyurethane nasolacrimal stents are low as compared with the external dacryocystorhinostomy. In addition, the patients usually complaint of tearing even having patent lacrimal system. In summary, long-term studies are needed to resolve some complications. Maybe a new stent design and new methods of unblocking the stent in situ would improve in the near future the levels of patency that currently are modest. PMID:18408851

Lunardelli, Patrícia; Aoki, Lísia; Jervásio, Ana Carolina; Zagui, Roberta Melissa Benetti; Matayoshi, Suzana

2008-01-01

220

The tobacco-specific carcinogen, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone stimulates proliferation of immortalized human pancreatic duct epithelia through ?-adrenergic transactivation of EGF receptors  

Microsoft Academic Search

Purpose: Pancreatic ductal adenocarcinoma is an aggressive smoking-associated human cancer in both men and women. The nicotine-derived\\u000a 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) is thought to contribute to the development of these neoplasms in smokers\\u000a through genotoxic effects. However, NNK has been recently identified as an agonist for both ?1- and ?2-adrenergic receptors. Binding of NNK to these receptors stimulates proliferation of pulmonary and

Minoo D. F. Askari; Ming-Sound Tsao; Hildegard M. Schuller

2005-01-01

221

Editorial: Pancreas Divisum Does Not Cause Pancreatitis, But Associates With CFTR Mutations  

Microsoft Academic Search

Abstract: Bertin et al. partially dispel arguments that pancreas divisum (PD) causes pancreatitis, but fascinatingly indicate that PD associates with CFTR gene mutations predisposing to pancreatitis. This association, however, does not definitely confer a pathophysiological role for PD in pancreatitis but may denote that PD co-mingles with CFTR mutations without influencing pancreatitis or CFTR mutations influence pancreatic duct embryogenesis. We

Matthew J DiMagno; Eugene P DiMagno

2012-01-01

222

Ileal exposure to pig pancreatic juice and bile inhibit exocrine pancreatic secretion in pigs  

Microsoft Academic Search

The mechanisms involved in the down regulation of the exocrine pancreas are still not fully elucidated. The purpose of the present study was to examine the effect of duodenal and ileal exposure to pancreatic enzymes and bile on pancreatic secretion. Experiments were performed with pigs fitted with pancreatic duct, ileal and jugular vein catheters, and duodenal T-shaped cannula. A negative

S. G. Pierzynowski; V. Sileikiene; J. L. Valverde Piedra; S. Szymanczyk; P. C. Gregory; D. Kruszewska; R. Mosenthin; A. Rzasa; S. Kowalik; R. Zabielski; B. Weström

2007-01-01

223

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

224

Airway stenting in Japan.  

PubMed

Various types of outstanding airway stents have been made commercially available. In Japan, a total of 1004 airway stents (Dumon stents (Novatech, Aubagne, France), Gianturco Z stents (Cook Ins, Bloomington, USA), Ultraflex stents (Boston Scientific Corp, Natick, MA, USA), and Dynamic Y stents (Ruesch AG, Kernen, Germany)) were implanted from July 1991 until February 1998. Of all the various stents, the Dumon stent has become the standard worldwide. Also, the Dumon stent has been replacing the Gianturco Z stent as the preferred stent throughout Japan. The Dumon stent was the first stent covered by Japanese National Health Insurance. Therefore, we present our 5-year experience with the Dumon stent at our institution. In our experience, stenting is effective for the immediate and lasting relief of symptoms in patients with severe malignant obstruction of major airways. PMID:10201048

Miyazawa, T; Arita, K

1998-12-01

225

Management of bile duct leaks.  

PubMed

The cause of bile duct leaks can be either iatrogenic or more rarely, traumatic. The most common cause is related to laparoscopic cholecystectomy. While surgical repair has been the standard for many years, management in these often morbid and complex situations must currently be multidisciplinary incorporating the talents of interventional radiologists and endoscopists. Based on the literature and in particular the recent recommendations of the European Society of Gastrointestinal Endoscopy (ESGE), this review aims to update the management strategy. The incidence of these complications decreases with surgeon experience attesting to the value of training to prevent these injuries. Bile duct injuries must be categorized and their mapping detailed by magnetic resonance cholangiography MRCP or endoscopic cholangiography (ERCP) when endoscopic therapy is considered. Endoscopic management should be preferred in the absence of complete circumferential interruption of the common bile duct. The ESGE recommends insertion of a plastic stent for 4 to 8 weeks without routine sphincterotomy. For complete circumferential injuries, hepaticojejunostomy is usually necessary. In conclusion, adequate training of surgeons is essential for prevention since the incidence of bile duct injury decreases with experience. Faced with a bile duct injury, a multidisciplinary team approach, involving radiologists, endoscopists and surgeons improves patient outcome. PMID:23791984

Pioche, M; Ponchon, T

2013-06-01

226

Duct closure  

DOEpatents

A closure for an inclined duct having an open upper end and defining downwardly extending passageway. The closure includes a cap for sealing engagement with the open upper end of the duct. Associated with the cap are an array of vertically aligned plug members, each of which has a cross-sectional area substantially conforming to the cross-sectional area of the passageway at least adjacent the upper end of the passageway. The plug members are interconnected in a manner to provide for free movement only in the plane in which the duct is inclined. The uppermost plug member is attached to the cap means and the cap means is in turn connected to a hoist means which is located directly over the open end of the duct.

Vowell, Kennison L. (Canoga Park, CA)

1987-01-01

227

Extracorporeal Shock Wave Lithotripsy in the Management of Chronic Calcific Pancreatitis: A Meta-Analysis  

Microsoft Academic Search

Context Main pancreatic duct stones may contribute to pain in chronic pancreatitis. Extracorporeal shock wave lithotripsy (ESWL) has been used alone or in combination with endoscopic therapy for fragmentation of stones. Published studies have shown mixed efficacy due to small sample size. Objective Systematic analysis of all published data evaluating ESWL with or without endoscopic therapy in pancreatic duct clearance

Nalini M Guda; Susan Partington; Martin L Freeman

2005-01-01

228

Pancreaticodigestive anastomosis and the postoperative management strategies to prevent postoperative pancreatic fistula formation after pancreaticoduodenectomy.  

PubMed

Over the past 100 years, advances in surgical techniques and perioperative management have reduced the morbidity and mortality after pancreaticoduodenectomy (PD). Many techniques have been proposed for the reconstruction of the pancreaticodigestive anastomosis to prevent the development of a postoperative pancreatic fistula (POPF), but which is the best approach is still highly debated. We carried out a systematic review to determine and compare the effectiveness of various methods of anastomosis after PD. A meta-analysis and most randomized controlled trials (RCTs) showed that the mortality, POPF rate and incidence of other postoperative complications were not statistically different between the pancreaticogastrostomy and pancreaticojejunostomy (PJ) groups. One RCT showed that a binding PJ significantly decreased the risk of POPF and other postoperative complications compared with conventional PJ. External duct stenting reduced the risk of clinically relevant POPF in a meta-analysis and RCTs. The prophylactic use of octreotide after PD does not result in a reduced incidence of POPF. In conclusion, our findings suggest that the successful management of pancreatic anastomoses may depend more on the meticulous surgical technique, surgical volume, and other management parameters than on the type of technique used. However, some new approaches, such as binding PJ, and the use of external stents should be considered in further RCTs. PMID:23842691

Hashimoto, Daisuke; Chikamoto, Akira; Ohmuraya, Masaki; Hirota, Masahiko; Baba, Hideo

2014-07-01

229

One-channel double stent implantation for hilar biliary obstructions  

PubMed Central

The aim of this study was to evaluate the effect of percutaneous one-channel double stent implantation on hilar biliary obstruction involving both hepatic ducts and its clinical value. A total of 8 patients with hilar biliary obstruction involving the left and right hepatic ducts were enrolled. A percutaneous unilateral approach was adopted. Two stents were implanted, one between the left and right hepatic ducts and the other between the hepatic ducts and the common bile duct for biliary drainage. Interventional therapies such as arterial chemoembolization were performed for antitumor treatment. All surgical procedures were successfully accomplished. At 2 weeks after stenting, total bilirubin decreased to 61.2±13.4 ?mol/l (the preoperative value was 267.1±154.7 ?mol/l). No severe complications or mortalities occurred. Single-channel double stent implantation should be the preferred method of treatment for patients with hilar biliary obstruction involving both hepatic ducts. Drainage and antitumor treatment should also be used when necessary.

CAO, GUANGSHAO; CAO, HUICUN; LIU, JIAN; WANG, YUDAN; WANG, ZHENYU

2013-01-01

230

Laparoscopic transcystic duct balloon dilatation of the sphincter of Oddi  

Microsoft Academic Search

Balloon dilatation of the sphincter of Oddi has been performed via a laparoscopic transcystic duct technique. Small common duct stones and stone debris have been successfully lavaged into the duodenum in 17 of 20 cases (85%) by this method. Postoperative hyperamylasemia was noted in four patients. Mild clinical pancreatitis was observed in three patients (15%). Further evaluation of this technique

B. J. Carroll; E. H. Phillips; M. Chandra; M. Fallas

1993-01-01

231

Endoscopic ultrasonography in the management of pancreatic cancer  

NASA Astrophysics Data System (ADS)

Pancreatic cancer diagnosis and management has been enhanced with the application of endoscopic ultrasound. The close proximity of the pancreas to the stomach and duodenum permits detailed imaging with intraluminal ultrasonography and staging of pancreatic tumors. EUS directed fine needle aspiration and injection may be successfully employed with patients with pancreatic cancer. Expandable metal stents can palliate patients with obstruction of the pancreaticobiliary tract as well as the gastroduodenum. The efficacy of EUS in the management of pancreatic cancer is critically reviewed.

Trowers, Eugene A.

2001-05-01

232

Endoscopic therapy for chronic pancreatitis: An evidence-based review  

Microsoft Academic Search

In the setting of chronic pancreatitis, pancreatic ductal obstruction, and ductal leak, pseudocyst formation and biliary obstruction\\u000a present many challenges for endoscopists. Although chronic pancreatitis has a variety of clinical manifestations, most commonly\\u000a patients present with intermittent or chronic abdominal pain. Recent studies suggest stenting of pancreatic ductal strictures\\u000a has a significant impact on reducing chronic pain. The removal of

C. Mel Wilcox; Shyam Varadarajulu

2006-01-01

233

[Atypical biliary stenting in patient with obstructive biliary jaundice].  

PubMed

Obstructive biliary jaundice is a common complication in patients with malignancies which infiltrate biliary ducts. If untreated efficiently the jaundice is fatal a short period of time. We present a case of 60-year-old male patient who had undergone Whipple procedure in the past and presented with local recurrence treated successfully by percutaneous stenting of obstructed biliary duct. When passing through the obstruction we observed a contrast-bile leakage at the level of occluded segment and instability of implanted stent which was a complication that extorted atypical approach. We applied a covered stent in association with oversized nitinol stent which allowed to form a funnel-like construction efficiently decompressing biliary tree. Thanks to this management we also avoided further complications. PMID:23276050

Garcarek, Jerzy; Kurcz, Jacek; Guzi?ski, Maciej; Janczak, Dariusz

2012-01-01

234

Bile Duct Cancer  

MedlinePLUS

... Net Guide Bile Duct Cancer Overview Statistics Medical Illustrations Risk Factors Symptoms and Signs Diagnosis Stages Treatment ... down the bile duct from the liver. See illustrations of the bile duct . Types of bile duct ...

235

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

PubMed Central

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.

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

2013-01-01

236

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

237

Duct Fires  

Microsoft Academic Search

This report analyzes fuel rich fires spreading within ventilated fuel-lined ducts. The conditions for the occurrence of these intense high hazard fires are discussed.Overall energy balance arguments can be used to predict the fire spread velocity provided one knows: (1) the energy Hvap required to vaporize unit mass of fuel at ambient temperatures and (2) the net heat loss rate

JOHN DE RIS

1970-01-01

238

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

Microsoft Academic Search

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

Aldo Severini; Sara Mantero; Maria Cristina Tanzi; Alberto Cigada; Flaminio Addis; Guido Cozzi; Monica Salvetti; Salvatore Andreola; Antonella Motta; Enrico Regalia; Andrea Pulvirenti; Enrico De Pedri; Roberto Doci

1999-01-01

239

Nitinol Stents for Palliative Treatment of Malignant Obstructive Jaundice: Should We Stent the Sphincter of Oddi in Every Case?  

Microsoft Academic Search

Purpose: To evaluate the necessity of metallic stenting of the sphincter of Oddi in malignant obstructive jaundice when the tumor is more than 2 cm from the papilla of Vater.Methods: Sixty-seven self-expandable biliary stents were used in 60 patients with extrahepatic lesions of the common hepatic or common bile duct and with the distal margin of the tumor located more

Adam A. Hatzidakis; Dimitris Tsetis; Evangelia Chrysou; Elias Sanidas; John Petrakis; Nicholas C. Gourtsoyiannis

2001-01-01

240

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

PubMed

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

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

2007-05-01

241

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

242

Sow milk feeding vs. pancreatic exocrine secretion in pigs  

Microsoft Academic Search

Though milk promotes gastrointestinal tract growth during ontogenic development of mammals, our studies have shown that feeding milk does not stimulate exocrine pancreas secretion in pigs before weaning. To study the mechanisms behind these findings pancreatic secretion was studied in pigs surgically fitted with a pancreatic duct catheter and a duodenal re-entrant cannula. Pancreatic secretion was measured at 1h intervals

S. G. Pierzynowski; B. R. Weström; B. W. Karlsson

1997-01-01

243

Effect of IL4 on altered expression of complement activation regulators in rat pancreatic cells during severe acute pancreatitis  

Microsoft Academic Search

AIM: To investigate the effect of IL-4 on the altered ex- pression of complement activation regulators in pancreas and pancreatic necrosis during experimental severe acute pancreatitis (SAP). METHODS: SAP model of rats was established by ret- rograde injection of 5% sodium taurocholate (1 mL\\/kg) into the pancreatic duct. We immunohistochemically assayed the expression of three complement activation regulators: decay accelerating

Cheng Zhang; Chun-Lin Ge; Ren-Xuan Guo; San-Guang He

244

Polyurethane-Covered Nitinol Strecker Stents as Primary Palliative Treatment of Malignant Biliary Obstruction  

Microsoft Academic Search

Purpose: To evaluate the clinical efficacy of the polyurethane-covered Nitinol Strecker stent in the treatment of patients with malignant biliary obstruction.Methods: Twenty-three covered stents produced by us were placed in 18 patients with malignant biliary obstruction. Jaundice was caused by cholangiocarcinoma (n = 5), pancreatic cancer (n = 6), gallbladder cancer (n = 4), metastatic lymph nodes (n = 2),

Shuzo Kanasaki; Akira Furukawa; Teruyuki Kane; Kiyoshi Murata

2000-01-01

245

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

246

Pain Management in chronic pancreatitis  

Microsoft Academic Search

Opinion statement  Painful chronic pancreatitis is difficult to manage. We believe a multidisciplinary approach is the best means of evaluating\\u000a this complex syndrome. In our opinion, the initial evaluation should aim at firmly establishing the diagnosis of chronic pan-creatitis:\\u000a calcifications on imaging; duct morphologic changes on pancreatography; parenchymal changes on ultrasound; or evidence of\\u000a pancreatic dysfunction on secre-tin\\/ cholecystokinin stimulation tests.

Darwin L. Conwell; Gregory Zuccaro

1999-01-01

247

Simultaneous non-traumatic perforation of the right hepatic duct and gallbladder: an atypical occurrence.  

PubMed

Simultaneous non-traumatic perforation of the extrahepatic bile duct and the gallbladder is an uncommon occurrence that has been infrequently reported. We describe a patient with a spontaneous perforation of both the extrahepatic bile duct and the gallbladder. A contrast-enhanced computed tomography (CECT) scan of the abdomen and endoscopic retrograde cholangiopancreatography (ERCP) demonstrated a perforation of the gallbladder and a free leak from the right hepatic duct, respectively. Endoscopic biliary drainage following a sphincterotomy and biliary stent placement led to a dramatic improvement in the patient's general condition. He was subsequently scheduled to undergo an elective cholecystectomy. Repeat ERCP performed at 4 weeks after the initial stenting showed a normal cholangiogram and a distally migrated stent, which was there after removed. However, early stent removal led to re-perforation of hepatic duct and gallbladder. A repeat endoscopic biliary drainage did not help, and the patient developed biliary peritonitis. Surgical exploration revealed a perforation at the fundus of the gallbladder, 400 ml of biliopurulent collection and a frozen Calot's triangle. A subtotal cholecystectomy, gall stone removal, and a thorough peritoneal lavage were undertaken. The patient improved postoperatively. The second biliary stent was removed after 4 months. This case report highlights the role of endoscopic biliary drainage in the management of an extrahepatic bile duct perforation and warns against the early removal of a biliary stent. PMID:23610553

Garg, Pankaj Kumar; Jain, Bhupendra Kumar; Pandey, Satya Deo; Rathi, Vinita; Puri, Amarendra Singh

2012-07-01

248

Simultaneous Non-Traumatic Perforation of the Right Hepatic Duct and Gallbladder: An Atypical Occurrence  

PubMed Central

Simultaneous non-traumatic perforation of the extrahepatic bile duct and the gallbladder is an uncommon occurrence that has been infrequently reported. We describe a patient with a spontaneous perforation of both the extrahepatic bile duct and the gallbladder. A contrast-enhanced computed tomography (CECT) scan of the abdomen and endoscopic retrograde cholangiopancreatography (ERCP) demonstrated a perforation of the gallbladder and a free leak from the right hepatic duct, respectively. Endoscopic biliary drainage following a sphincterotomy and biliary stent placement led to a dramatic improvement in the patient’s general condition. He was subsequently scheduled to undergo an elective cholecystectomy. Repeat ERCP performed at 4 weeks after the initial stenting showed a normal cholangiogram and a distally migrated stent, which was there after removed. However, early stent removal led to re-perforation of hepatic duct and gallbladder. A repeat endoscopic biliary drainage did not help, and the patient developed biliary peritonitis. Surgical exploration revealed a perforation at the fundus of the gallbladder, 400 ml of biliopurulent collection and a frozen Calot’s triangle. A subtotal cholecystectomy, gall stone removal, and a thorough peritoneal lavage were undertaken. The patient improved postoperatively. The second biliary stent was removed after 4 months. This case report highlights the role of endoscopic biliary drainage in the management of an extrahepatic bile duct perforation and warns against the early removal of a biliary stent.

Garg, Pankaj Kumar; Jain, Bhupendra Kumar; Pandey, Satya Deo; Rathi, Vinita; Puri, Amarendra Singh

2012-01-01

249

Treatment of nasolacrimal duct obstruction in children with trisomy 21  

Microsoft Academic Search

Background: Nasolacrimal duct (NLD) obstruction and tear film abnormalities occur frequently in children with trisomy 21. This study describes the outcomes of treatment for NLD obstruction in this population. Methods: The records of 15 children with trisomy 21 treated for NLD obstruction were reviewed. Eight patients were initially treated with NLD probing with or without placement of nonfixated lacrimal stents.

Gregg T. Lueder

2000-01-01

250

Upper Gastrointestinal Stent  

PubMed Central

Gastrointestinal (GI) stent has been developed for palliation of obstructive symptoms in various diseases causing obstruction of GI tract. Self-expanding metal stent (SEMS) has replaced old type of plastic stent, and endoscopic insertion of stent has replaced fluoroscopy-guided insertion. Nowadays, newly-designed SEMSs have been developed for prevention of complications such as stent migration and re-obstruction, and indications of stent recently have been widened into benign conditions as well as malignant obstruction. In this review, the types, method of insertion, indications and clinical outcomes of stent in the upper GI tract would be discussed.

Kim, Sang Gyun

2012-01-01

251

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

252

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

PubMed

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. PMID:20533606

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

2010-06-14

253

Morphohistological Features of Pancreatic Stump Are the Main Determinant of Pancreatic Fistula after Pancreatoduodenectomy  

PubMed Central

Introduction. Pancreatic surgery is challenging and associated with high morbidity, mainly represented by postoperative pancreatic fistula (POPF) and its further consequences. Identification of risk factors for POPF is essential for proper postoperative management. Aim of the Study. Evaluation of the role of morphological and histological features of pancreatic stump, other than main pancreatic duct diameter and glandular texture, in POPF occurrence after pancreaticoduodenectomy. Patients and Methods. Between March 2011 and April 2013, we performed 145 consecutive pancreaticoduodenectomies. We intraoperatively recorded morphological features of pancreatic stump and collected data about postoperative morbidity. Our dedicated pathologist designed a score to quantify fibrosis and inflammation of pancreatic tissue. Results. Overall morbidity was 59,3%. Mortality was 4,1%. POPF rate was 28,3%, while clinically significant POPF were 15,8%. Male sex (P = 0.009), BMI ? 25 (P = 0.002), prolonged surgery (P = 0.001), soft pancreatic texture (P < 0.001), small pancreatic duct (P < 0.001), pancreatic duct decentralization on stump anteroposterior axis, especially if close to the posterior margin (P = 0.031), large stump area (P = 0.001), and extended stump mobilization (P = 0.001) were related to higher POPF rate. Our fibrosis-and-inflammation score is strongly associated with POPF (P = 0.001). Discussion and Conclusions. Pancreatic stump features evaluation, including histology, can help the surgeon in fitting postoperative management to patient individual risk after pancreaticoduodenectomy.

Ridolfi, Cristina; Angiolini, Maria Rachele; Gavazzi, Francesca; Spaggiari, Paola; Tinti, Maria Carla; Uccelli, Fara; Madonini, Marco; Montorsi, Marco; Zerbi, Alessandro

2014-01-01

254

Fibrin Glue Sandwich Prevents Pancreatic Fistula following Distal Pancreatectomy  

Microsoft Academic Search

. Pancreatic fistula is a major form of morbidity following pancreatic resection. We conducted a nonrandomized clinical\\u000a trial comparing the sealing and sandwich techniques of spraying fibrin glue to prevent pancreatic fistula following distal\\u000a pancreatectomy. The pancreas was transected with a scalpel to identify and suture the main pancreatic duct and its small branches.\\u000a In the sealing group, fibrin glue

Susumu Ohwada; Tetsushi Ogawa; Yoshifumi Tanahashi; Seiji Nakamura; Izumi Takeyoshi; Toshihiro Ohya; Toshiroh Ikeya; Kenji Kawashima; Yoshiyuki Kawashima; Yasuo Morishita

1998-01-01

255

Enteric duplication cyst of the pancreas associated with chronic pancreatitis and pancreatic cancer.  

PubMed

Pancreas-associated enteric duplication cysts are rare developmental anomalies that communicate with the main pancreatic duct and may be associated with recurrent acute and chronic abdominal pain in children. In adults, these lesions may masquerade as pancreatic pseudocysts or pancreatic cystic neoplasms. An adult patient with a pancreas-associated enteric duplication is described which represents the first reported instance of association with both chronic calcific pancreatitis and pancreatic cancer. The clinical spectrum of pancreas-associated enteric duplication cyst, including diagnostic and therapeutic options, is reviewed. PMID:24366368

Chiu, Alexander S; Bluhm, David; Xiao, Shu-Yan; Waxman, Irving; Matthews, Jeffrey B

2014-05-01

256

Endoscopic ultrasound-guided double stenting for biliary and duodenal obstruction  

PubMed Central

Endoscopic biliary stenting for malignant biliary obstruction is currently the gold standard for biliary drainage. Biliary cancer treatment is crucial. Cases of gastric outlet obstruction that includes the duodenum because of cancer invasion and biliary obstruction are seldom observed. The required treatment for such cases is simple biliary stenting and a different treatment for duodenal obstruction. Hence, double stenting for bile duct and duodenal obstruction has drawn attention. In the present review, we state different treatment strategies for malignant duodenal obstruction and then describe double stenting in biliary obstruction that also includes non-biliary cancer malignant lesions and duodenal obstruction.

Itoi, Takao; Itokawa, Fumihide; Sofuni, Atsushi; Kurihara, Toshio; Ishii, Kentaro; Tsuji, Shujiro; Ikeuchi, Nobuhito; Umeda, Junko; Tanaka, Rena; Tonozuka, Ryosuke; Moriyasu, Fuminori

2012-01-01

257

Autoantibodies in Autoimmune Pancreatitis  

PubMed Central

Autoimmune pancreatitis (AIP) was first used to describe cases of pancreatitis with narrowing of the pancreatic duct, enlargement of the pancreas, hyper-?-globulinaemia, and antinuclear antibody (ANA) positivity serologically. The main differential diagnosis, is pancreatic cancer, which can be ruled out through radiological, serological, and histological investigations. The targets of ANA in patients with autoimmune pancreatitis do not appear to be similar to those found in other rheumatological diseases, as dsDNA, SS-A, and SS-B are not frequently recognized by AIP-related ANA. Other disease-specific autoantibodies, such as, antimitochondrial, antineutrophil cytoplasmic antibodies or diabetes-specific autoantibodies are virtually absent. Further studies have focused on the identification of pancreas-specific autoantigens and reported significant reactivity to lactoferrin, carbonic anhydrase, pancreas secretory trypsin inhibitor, amylase-alpha, heat-shock protein, and plasminogen-binding protein. This paper discusses the findings of these investigations and their relevance to the diagnosis, management, and pathogenesis of autoimmune pancreatitis.

Smyk, Daniel S.; Rigopoulou, Eirini I.; Koutsoumpas, Andreas L.; Kriese, Stephen; Burroughs, Andrew K.; Bogdanos, Dimitrios P.

2012-01-01

258

Hepatobiliary and pancreatic ascariasis.  

PubMed

Ascariasis is a helminthic infection of global distribution with more than 1.4 billion persons infected throughout the world. The majority of infections occur in the developing countries of Asia and Latin America. Of 4 million people infected in the United States, a large percentage are immigrants from developing countries. Ascaris-related clinical disease is restricted to subjects with heavy worm load, and an estimated 1.2 to 2 million such cases, with 20,000 deaths, occur in endemic areas per year. More often, recurring moderate infections cause stunting of linear growth, cause reduced cognitive function, and contribute to existing malnutrition in children in endemic areas. HPA is a frequent cause of biliary and pancreatic disease in endemic areas. It occurs in adult women and can cause biliary colic, acute cholecystitis, acute cholangitis, acute pancreatitis, and hepatic abscess. RPC causing hepatic duct calculi is possibly an aftermath of recurrent biliary invasion in such areas. Ultrasonography can detect worms in the biliary tract and pancreas and is a useful noninvasive technique for diagnosis and follow-up of such patients. ERCP can help diagnose biliary and pancreatic ascariasis, including ascaris in the duodenum. Also, ERCP can be used to extract worms from the biliary and pancreatic ducts when indicated. Pyrantel pamoate, mebendazole, albendazole and levamisole are effective drugs and can be used for mass therapy to control ascariasis in endemic areas. PMID:11293175

Khuroo, M S

2001-03-01

259

Prevention of Postendoscopic Retrograde Cholangiopancreatography Pancreatitis: The Endoscopic Technique  

PubMed Central

Pancreatitis is the most frequent and distressing complication of endoscopic retrograde cholangiopancreatography (ERCP). Many recent studies have reported the use of pharmacological agents to reduce post-ERCP pancreatitis (PEP); however, the most effective agents have not been established. Reduction in the incidence of PEP in high-risk patients has been reported through specific cannulation techniques such as guide wire-assisted cannulation and the use of pancreatic stents. The present review focuses on ERCP techniques for the prevention of PEP.

Song, Byeong Jun

2014-01-01

260

Metallic stents in malignant biliary obstruction  

SciTech Connect

Purpose. Retrospective analysis of our results with metallic stent placement for malignant biliary strictures. We sought to determine parameters that influence stent patency. Methods. A total of 95 Wallstents were implanted in 65 patients (38 men, 27 women; mean age, 65.1 years) with malignant biliary obstruction. Serum bilirubin levels were assessed in 48 patients; the mean value prior to intervention was 15.0 mg/dl. Results. In 12 patients (21%) complications occurred as a result of percutaneous transhepatic drainage. Stent implantation was complicated in 13 patients, but was possible in all patients. A significant decrease in bilirubin level was seen in 83.3% of patients following stent implantation. Approximately 30% of patients developed recurrent jaundice after a mean 97.1 days. In 9 patients (15%) the recurrent jaundice was caused by stent occlusion due to tumor growth. The mean follow-up was 141.8 days, the mean survival 118.7 days. Patients with cholangiocarcinomas and gallbladder carcinomas had the best results. Worse results were seen in patients with pancreatic tumors and with lymph node metastases of colon and gastric cancers. Conclusions. The main predictive factors for occlusion rate and survival are the type of primary tumor, tumor stage, the decrease in bilirubin level, and the general condition of the patient.

Rieber, Andrea; Brambs, Hans-Juergen [University of Ulm, Department of Diagnostic Radiology (Germany)

1997-01-15

261

Treatment of Complete Obstruction of the Nasolacrimal System by Temporary Placement of Nasolacrimal Polyurethane Stents: Preliminary Results  

Microsoft Academic Search

AIM: To assess the efficacy of the temporary placement of polyurethane nasolacrimal stents as a treatment for complete post-saccal obstruction of the lacrimal apparatus.MATERIALS AND METHODS: Polyurethane nasolacrimal stents were inserted under radiological guidance in nine patients with grade IV epiphora due to complete obstruction of the lacrimal system, at the junction of the lacrimal sac and duct (eight patients)

L Paúl; I Pinto; J. M Vicente

2003-01-01

262

New stents for SFA.  

PubMed

Endovascular stent implantation was introduced to femoropopliteal procedures almost two decades ago. Initial results with balloon-expandable stainless steel stents and self expanding Elgiloy stents, however, were disappointing. In particular, recurrence rates after long-segment femoropopliteal stenting were rather high, in the range of 60% to 80% at 1 year. After years of stagnation, recent developments in femoropopliteal stent technology have been promising. Self-expanding nitinol stents have been evaluated in several prospective studies. Initial problems with stent fractures seem to be resolved using second-generation devices. The second generation of Nitinol stents have an enhanced flexibility particularly also in axial direction due to a reduction of cell interconnections and a more spiral orientation of the interconnections. However, until now there is no proof of any impact of the stent design on restenosis rate. Otherwise, stenting has been shown to be beneficial compared to balloon angioplasty especially in longer femoropopliteal lesions. The superior fracture resistance of the latest stent generation in combination with the production of long nitinol stents of up to 20 cm in length allow that more difficult and complex lesions can be treated endovascularly. The main unresolved problem with femoropopliteal stenting is the treatment of instent restenosis. Future concepts to further improve long-term patency after femoropopliteal stenting are therefore under investigation, including drug-eluting stents (DES), biodegradable stents, and coated stent-grafts. Stent grafts appear to be a viable option for the treatment of complex superficial femoral artery lesions, with comparable outcomes to prosthetic above-knee femoropopliteal bypass surgery. Concerning DES, we have to wait for the results of the ongoing studies. PMID:19741579

MINAR, E; SCHILLINGER, M

2009-10-01

263

Exocrine Pancreatic Secretions in Growing Pigs Fed Diets Containing Fish Oil, Rapeseed Oil or Coconut Oil1'2  

Microsoft Academic Search

Two experiments were performed to study the effect of feeding diets containing oils with different fatty acid composition on exocrine pancreatic secretions in growing pigs using two different methods to collect pancreatic juice. In the first experiment, three barrows (initial weight 37 kg) were fitted with a pancreatic pouch re-entrant cannula. An isolated pouch was prepared where the pancreatic duct

VINCE M. GABERT; METTE S. JENSEN; RICARDA M. ENGBERG; Ano S; REN K. JENSEN

264

Autoimmune Pancreatitis: A Case Report  

PubMed Central

Autoimmune pancreatitis is a fibro-inflammatory form of chronic pancreatitis. It is diagnosed by the combination of imaging studies such as a CT scan and pancreatography, laboratory analyses that include IgG4 and/or autoantibodies, histopathological evaluations and positive response to corticosteroid therapy. We report the case of a 41-year-old female with a history of jaundice and increasing abdominal pain for two weeks prior to her clinic visit. Laboratory results were significant for an increase in alkaline phosphatase (ALP) and erythrocyte sedimentation rate (ESR). Magnetic resonance cholangiopancreatography (MRCP) confirmed areas of stenosis and dilatation in the pancreatic duct and in the intra- and extra-hepatic bile ducts similar to primary sclerosantcholangitis. Laboratory analyses showed increased levels of IgG4 with thepresence of antinuclear antibodies.

Salari, Masoumeh; Hosseini, Mousareza; Nekooei, Sirous; Ataei Azimi, Sajad; Farzanehfar, Mohammad Reza

2014-01-01

265

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

266

[Stenting central airways with tracheobronchial stents].  

PubMed

Tracheobronchial stenting is indicated in the palliative care of cancer patients with central airways obstruction due to primary chest and neck tumors, metastatic and congenital lesions of these organs. Stents, tubular prostheses, solid or wired, removable or not, of different shape, size, material, are used to treat airway obstructions due to endobronchial overgrowing, infiltration, compression, or relaxation of the airway walls. Silicone stents are well tolerated and removable. Their limitations are: the mucociliary clearance impairment, thick walls, displacement possibility. Rigid bronchoscopy is required for insertion of the prosthesis. Metal stents allow mucociliary transport, exactly match the trachea or bronchus dimension and are insertable with the bronchofiberscope. Attempts of self-absorbed stents application in the course of tracheobronchomalacia and post surgical bronchial wall collapse are being made. The choice of the type of the stent used is made on the basis of personnel experience, type and localisation of the obstruction, clinical status and accompanying diseases. PMID:16813273

Mróz, Robert M; Chyczewska, Elzbieta

2006-01-01

267

Fluid collections developing after pancreatic transplantation: radiologic evaluation and intervention.  

PubMed

The usefulness of real-time sonography, duplex sonography, computed tomography (CT), cystography, diagnostic aspiration, and percutaneous drainage in the diagnosis and treatment of peri-pancreatic-transplant fluid collections was retrospectively assessed in 46 recipients of extraperitoneal pancreatic transplants. Forty-four abnormalities were identified in the extraperitoneal space at sonography, including four pancreatic pseudocysts associated with malfunction of the pancreatic duct, seven abscesses, six hematomas, nine urinomas, six early postoperative fluid collections that spontaneously resolved, six cases of pancreatitis, and six cases of vascular occlusion. Sonography (including pulsed Doppler sonography) was the procedure of choice in detecting fluid collections and diagnosing pancreatitis, rejection, vascular thrombosis, and pancreatic duct malfunction. CT was diagnostic in four of six hematomas; cystography was diagnostic in seven of nine urinomas. Sonographically guided percutaneous intervention enabled three patients to avoid surgery and allowed optimal surgical planning for six patients. PMID:1887034

Patel, B K; Garvin, P J; Aridge, D L; Chenoweth, J L; Markivee, C R

1991-10-01

268

Influence of feeding regimen and postnatal developmental stages on antibacterial activity of pancreatic juice  

Microsoft Academic Search

Summary  Antibacterial activity of pancreatic juice in the pig (n = 8) was investigated during early postnatal development and in cattle (n = 6) receiving a different feeding regimen. For pancreatic juice collection, a catheter was surgically implanted in the pancreatic\\u000a duct. Reintroduction of pancreatic juice was achieved through a T-shaped cannula in the duodenum. Pancreatic juice was collected\\u000a for 30

Stefan Pierzynowski; Peeyush Sharma; Jerzy Sobczyk; Stanislaw Garwacki; Wieslaw Baref

1992-01-01

269

Hereditary Pancreatitis  

MedlinePLUS

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

270

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

PubMed

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

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

2006-04-01

271

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

272

Trimming of a Migrated Biliary Nitinol Stent Using Argon Plasma.  

PubMed

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. PMID:21103276

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

2009-01-01

273

BPC 157 therapy to detriment sphincters failure-esophagitis-pancreatitis in rat and acute pancreatitis patients low sphincters pressure.  

PubMed

Possibly, acute esophagitis and pancreatitis cause each other, and we focused on sphincteric failure as the common causative key able to induce either esophagitis and acute pancreatitis or both of them, and thereby investigate the presence of a common therapy nominator. This may be an anti-ulcer pentadecapeptide BPC 157 (tested for inflammatory bowel disease, wound treatment) affecting esophagitis, lower esophageal and pyloric sphincters failure and acute pancreatitis (10 ?g/kg, 10 ng/kg intraperitoneally or in drinking water). The esophagitis-sphincter failure procedure (i.e., insertion of the tubes into the sphincters, lower esophageal and pyloric) and acute pancreatitis procedure (i.e., bile duct ligation) were combined in rats. Esophageal manometry was done in acute pancreatitis patients. In rats acute pancreatitis procedure produced also esophagitis and both sphincter failure, decreased pressure 24 h post-surgery. Furthermore, bile duct ligation alone immediately declines the pressure in both sphincters. Vice versa, the esophagitis-sphincter failure procedure alone produced acute pancreatitis. What's more, these lesions (esophagitis, sphincter failure, acute pancreatitis when combined) aggravate each other (tubes into sphincters and ligated bile duct). Counteraction occurred by BPC 157 therapies. In acute pancreatitis patients lower pressure at rest was in both esophageal sphincters in acute pancreatitis patients. We conclude that BPC 157 could cure esophagitis/sphincter/acute pancreatitis healing failure. PMID:22204800

Petrovic, I; Dobric, I; Drmic, D; Sever, M; Klicek, R; Radic, B; Brcic, L; Kolenc, D; Zlatar, M; Kunjko, K; Jurcic, D; Martinac, M; Rasic, Z; Boban Blagaic, A; Romic, Z; Seiwerth, S; Sikiric, P

2011-10-01

274

Early ductal lesions of pancreatic carcinogenesis in animals and humans  

Microsoft Academic Search

Summary  Two cases of human early pancreatic duct adenocarcinoma were presented, and ductal lesions observed histologically were compared\\u000a to those induced in hamsters using a rapid-production model of pancreatic carcinoma. In human cases, direct histologic evidence\\u000a was obtained to suggest that cancerous changes arose from duct epithelial cell hyperplasia, because lesions of hyperplasia\\u000a and carcinoma coexisted in continuity. In hamster serialkilling

Yoichi Konishi; Kazuhiro Mizumoto; Shunji Kitazawa; Toshifumi Tsujiuchi; Masahiro Tsutsumi; Toshiki Kamano

1990-01-01

275

Pancreatic tuberculosis-abdominal tuberculosis presenting as pancreatic abscesses and colonic perforation  

PubMed Central

Isolated pancreatic tuberculosis is an extremely rare condition, more so in an immunocompetent individual. Its presentation as pancreatic abscesses with colonic perforation has not been reported so far. This condition poses difficulties in clinical diagnoses. Herein we report a case who was operated in another hospital for pancreatic abscesses, and referred to our institution later when he developed fecal peritonitis due to colonic perforation. Re-laparotomy, resection and exteriorisation of the colon were done. Acid fast bacilli was seen in the histopathological examination of the resected colon. The patient responded remarkably to anti-tuberculous therapy and two sittings of debridement. Post procedure the patient developed pancreatic fistula, which was managed successfully with stenting. Pancreatic tuberculosis should be considered as a differential diagnosis when pancreatitis is atypical.

Veerabadran, Premanayagam; Sasnur, Prasad; Subramanian, Sankar; Marappagounder, Subramanian

2007-01-01

276

Pathophysiology of autoimmune pancreatitis.  

PubMed

Autoimmune pancreatitis (AIP) is a recently discovered form of pancreatitis and represents one of the diseases of the pancreas which can be cured and healed medically. International consensus diagnostic criteria have been developed, and the clinical phenotypes associated with the histopathologic patterns of lymphoplasmacytic sclerosing pancreatitis and idiopathic duct-centric pancreatitis should be referred to as type 1 and type 2 AIP, respectively. Most importantly, in type 1 AIP, the pancreatic manifestations are associated with other extrapancreatic disorders, resembling an immunoglobulin G4 (IgG4)-related disease. In addition, the pancreas of a patient with AIP is often infiltrated by various types of immune cells; the cluster of differentiation (CD) 4 or CD8 T lymphocytes and IgG4-bearing plasma cells have been found in the pancreatic parenchyma and other involved organs in AIP and factors regulating T-cell function may influence the development of AIP. From a genetic point of view, it has also been reported that DRB1*0405 and DQB1*0401 mutations are significantly more frequent in patients with AIP when compared to those with chronic calcifying pancreatitis, and that only DQB1*0302 had a significant association with the relapse of AIP. Finally, it has been found that the polymorphic genes encoding cytotoxic T lymphocyte-associated antigen 4, a key negative regulator of the T-cell immune response, are associated with AIP in a Chinese population. Even if these data are not concordant, it is possible that physiological IgG4 responses are induced by prolonged antigen exposure and controlled by type 2 helper T cells. We reviewed the current concepts regarding the pathophysiology of this intriguing disease, focusing on the importance of the humoral and cellular immune responses. PMID:24891971

Pezzilli, Raffaele; Pagano, Nico

2014-02-15

277

Pathophysiology of autoimmune pancreatitis  

PubMed Central

Autoimmune pancreatitis (AIP) is a recently discovered form of pancreatitis and represents one of the diseases of the pancreas which can be cured and healed medically. International consensus diagnostic criteria have been developed, and the clinical phenotypes associated with the histopathologic patterns of lymphoplasmacytic sclerosing pancreatitis and idiopathic duct-centric pancreatitis should be referred to as type 1 and type 2 AIP, respectively. Most importantly, in type 1 AIP, the pancreatic manifestations are associated with other extrapancreatic disorders, resembling an immunoglobulin G4 (IgG4)-related disease. In addition, the pancreas of a patient with AIP is often infiltrated by various types of immune cells; the cluster of differentiation (CD) 4 or CD8 T lymphocytes and IgG4-bearing plasma cells have been found in the pancreatic parenchyma and other involved organs in AIP and factors regulating T-cell function may influence the development of AIP. From a genetic point of view, it has also been reported that DRB1*0405 and DQB1*0401 mutations are significantly more frequent in patients with AIP when compared to those with chronic calcifying pancreatitis, and that only DQB1*0302 had a significant association with the relapse of AIP. Finally, it has been found that the polymorphic genes encoding cytotoxic T lymphocyte-associated antigen 4, a key negative regulator of the T-cell immune response, are associated with AIP in a Chinese population. Even if these data are not concordant, it is possible that physiological IgG4 responses are induced by prolonged antigen exposure and controlled by type 2 helper T cells. We reviewed the current concepts regarding the pathophysiology of this intriguing disease, focusing on the importance of the humoral and cellular immune responses.

Pezzilli, Raffaele; Pagano, Nico

2014-01-01

278

Pathophysiology of chronic pancreatitis  

PubMed Central

Chronic pancreatitis (CP) is an inflammatory disease of the pancreas characterized by progressive fibrotic destruction of the pancreatic secretory parenchyma. Despite the heterogeneity in pathogenesis and involved risk factors, processes such as necrosis/apoptosis, inflammation or duct obstruction are involved. This fibrosing process ultimately leads to progressive loss of the lobular morphology and structure of the pancreas, deformation of the large ducts and severe changes in the arrangement and composition of the islets. These conditions lead to irreversible morphological and structural changes resulting in impairment of both exocrine and endocrine functions. The prevalence of the disease is largely dependent on culture and geography. The etiological risk-factors associated with CP are multiple and involve both genetic and environmental factors. Throughout this review the M-ANNHEIM classification system will be used, comprising a detailed description of risk factors such as: alcohol-consumption, nicotine-consumption, nutritional factors, hereditary factors, efferent duct factors, immunological factors and miscellaneous and rare metabolic factors. Increased knowledge of the different etiological factors may encourage the use of further advanced diagnostic tools, which potentially will help clinicians to diagnose CP at an earlier stage. However, in view of the multi factorial disease and the complex clinical picture, it is not surprising that treatment of patients with CP is challenging and often unsuccessful.

Brock, Christina; Nielsen, Lecia M?ller; Lelic, Dina; Drewes, Asbj?rn Mohr

2013-01-01

279

Endoscopic Therapy in Chronic Pancreatitis  

PubMed Central

Chronic pancreatitis (CP) is a debilitating disease that can result in chronic abdominal pain, malnutrition, and other related complications. The main aims of treatment are to control symptoms, prevent disease progression, and correct any complications. A multidisciplinary approach involving medical, endoscopic, and surgical therapy is important. Endoscopic therapy plays a specific role in carefully selected patients as primary interventional therapy when medical measures fail or in patients who are not suitable for surgery. Endoscopic therapy is also used as a bridge to surgery or as a means to assess the potential response to pancreatic surgery. This review addresses the role of endoscopic therapy in relief of obstruction of the pancreatic duct (PD) and bile du ct, closure of PD leaks, and drainage of pseudocysts in CP. The role of endoscopic ultrasound-guided celiac plexus block for pain in chronic pancreatitis is also discussed.

Tan, Damien Meng Yew

2011-01-01

280

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. (44 Glen Dr., Fairfax, CA 94930); deKieffer, Robert C. (Boulder, CO)

2001-01-01

281

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

282

What predicts gastroenterologists' and surgeons' diagnosis and management of common bile duct stones?  

Microsoft Academic Search

Background: Because the literature suggests numerous indicators of common bile duct stones, we undertook a systematic assessment of physicians' judgments of the clinical utility of eight indicators: patient age, history of jaundice, history of pancreatitis, levels of serum alanine aminotransferase, alkaline phosphatase, amylase, and total bilirubin, and common bile duct diameter on ultrasonography. Methods: Random samples of 1500 gastroenterologists and

Judy A. Shea; David A. Asch; Romaine F. Johnson; Rudolf N. Staroscik; Peter F. Malet; Bonnie J. Pollack; John R. Clarke; Paul E. Green; J. Stanford Schwartz; Sankey V. Williams

1997-01-01

283

[Clinical efficacy of MRCP for diagnosis of patients with pancreatic neoplasm].  

PubMed

We examined the usefulness of MRCP in pancreatic cancer compared with ERCP. Moreover, it examined in the same way in focal pancreatitis, too. We compare three findings of 1) main pancreatic duct, 2) branches of the stricture part, 3) side of tail main pancreatic duct about ERCP and MRCP. As for the branches of the stricture part, MRCP was poor compared with ERCP but as for the property of the side of the tail main pancreatic duct, MRCP excelled. The study of mass forming chronic pancreatitis was a similar result and was not the one, which excels ERCP in case of qualitative diagnosis. However, we thought that it was not invasively, suitable behind the digestive operation and digestive passage fault, in case of elapse observation and moreover that MRCP is suitable for pick up the pancreatic cancer in our clinic. PMID:9847620

Yamamoto, H; Watahiki, H; Suzuki, M; Iwai, T; Momo, S; Takeuchi, T; Higuchi, T; Egawa, Y; Kondo, M; Nagata, H; Hagino, K; Ichijo, K; Takehara, Y

1998-11-01

284

Hollow lensing duct  

DOEpatents

A hollow lensing duct to condense (intensify) light using a combination of focusing using a spherical or cylindrical lens followed by reflective waveguiding. The hollow duct tapers down from a wide input side to a narrow output side, with the input side consisting of a lens that may be coated with an antireflective coating for more efficient transmission into the duct. The inside surfaces of the hollow lens duct are appropriately coated to be reflective, preventing light from escaping by reflection as it travels along the duct (reflective waveguiding). The hollow duct has various applications for intensifying light, such as in the coupling of diode array pump light to solid state lasing materials.

Beach, Raymond J. (Livermore, CA) [Livermore, CA; Honea, Eric C. (Sunol, CA) [Sunol, CA; Bibeau, Camille (Dublin, CA) [Dublin, CA; Mitchell, Scott (Tracy, CA) [Tracy, CA; Lang, John (Pleasanton, CA) [Pleasanton, CA; Maderas, Dennis (Pleasanton, CA) [Pleasanton, CA; Speth, Joel (San Ramon, CA) [San Ramon, CA; Payne, Stephen A. (Castro Valley, CA) [Castro Valley, CA

2000-01-01

285

Minute pancreatic carcinoma with initial symptom of acute pancreatitis.  

PubMed

We experienced a case of minute pancreatic carcinoma in a 59-year-old man who complained of upper abdominal pain after drinking alcohol. Abdominal ultrasonography (US) revealed dilatation of the main pancreatic duct (MPD). Abdominal computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) showed slight dilatation of the MPD and its obstruction near the portal vein. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated occlusion of the MPD, and cytology of aspirated pancreatic juice was negative for malignancy. With the diagnosis of benign localized obstruction of the MPD, the patient underwent surgery. There was a clear demarcation of hardness and color of the pancreas on the left margin of the superior mesenteric vein, and the caudal pancreas was hard and fibrotic. Intraoperative US revealed slight dilatation of the MPD, and the aspiration cytology result was class IV. First, segmental resection of the pancreas was performed, but pathological examination of frozen section showed neither malignancy nor stenotic lesion. An additional small portion of the proximal pancreas was resected. The specimen included a ductal carcinoma, 5 mm in diameter. Accordingly, a pylorus-preserving pancreatoduodenectomy was performed. Microscopically, the minute carcinoma had already penetrated the duct wall and infiltrated lymph vessels and veins. The patient has been under close observation at our outpatient clinic, and so far there have been no signs of recurrence. To improve the poor prognosis of pancreatic cancer, we should be alert to the occurrence of acute pancreatitis as an initial symptom. PMID:12541052

Imamura, Mikio; Asahi, Shuji; Yamauchi, Hidemi; Tadokoro, Keiichi; Suzuki, Hiroyoshi

2002-01-01

286

Closure of the distal pancreatic stump with a seromuscular flap.  

PubMed

We describe herein our new method for transecting the pancreas and closing its stump in distal pancreatectomy, devised to decrease the risk of pancreatic fistula formation. With this technique, the pancreas is transected in such a way that a convex stump is left, whereby the pancreatic secretions from the parenchyma near the pancreatic stump are fully drained into the main pancreatic duct. A pedicled seromuscular flap of the stomach or jejunum is then used to cover the cut surface of the pancreas. This new technique provides tight closure of the pancreatic stump after distal pancreatectomy. PMID:8640031

Moriura, S; Kimura, A; Ikeda, S; Iwatsuka, Y; Ikezawa, T; Naiki, K

1995-01-01

287

MRI with spin labeling for diagnosis of early chronic pancreatitis.  

PubMed

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

Takahashi, Naoki; Chari, Suresh T

2014-05-01

288

Differential Oxidative Injury in Extrapancreatic Tissues During Experimental Pancreatitis  

Microsoft Academic Search

Oxidative stress is considered to be a pathogenic factor for multisystem organ failure during acute pancreatitis. Infusion of 3% and 5% sodium taurocholate into the pancreatic duct of rats resulted in a 24-hr lethality of 8% and 82%, respectively. Kidney tissue showed a long-lasting significant elevation of malondialdehyde (lipid peroxidation). Only small amounts of this aldehyde were formed in the

Olaf Gilgenast; Barbara Brandt-Nedelev; Ingrid Wiswedel; Hans Lippert; Walter Halangk; Thomas Reinheckel

2001-01-01

289

[Endoscopic management of the complications of pancreatitis].  

PubMed

Acute and chronic pancreatitis may lead to complications that prior the recent advancement of therapeutic endoscopy had to be treated with conventional surgery. The current techniques in interventional endoscopy allow us to access the pancreas and treat some of the complications in a minimally invasive way leading to less morbidity in our patients. Approximately 90% of acute pancreatitis episodes are edematous with early resolution of clinical symptoms and rarely leading to major complications. Patients with necrotizing pancreatitis are susceptible to local and systemic complications particularly in the setting of organ failure. On the other hand chronic pancreatitis is as a chronic inflammatory process that leads to fibrosis of the gland and in occasions to exocrine and/or endocrine insufficiency. The main objective of therapeutic endoscopy in chronic pancreatitis is to relief the obstruction and decreases the pressure in the pancreatic duct with the intention to alleviate abdominal pain. In this review we will address the indications and endoscopic techniques to treat the different complications of pancreatitis such as pseudo cyst drainage, walled off necrosis debridement, disconnected duct syndrome and different options for endoscopic therapy in chronic pancreatitis. PMID:24108377

Coronel, Emmanuel; Czul, Frank; Gelrud, Andres

2013-01-01

290

Ducts isolated from the pancreas of CFTR-null mice secrete fluid  

Microsoft Academic Search

The pancreatic pathology in cystic fibrosis (CF) is normally attributed to the failure of ductal fluid secretion resulting\\u000a from the lack of functional CF transmembrane conductance regulator (CFTR). However, murine models of CF show little or no\\u000a pancreatic pathology. To resolve this dichotomy we analysed the transport mechanisms involved in fluid and electrolyte secretion\\u000a by pancreatic ducts isolated from CFTR-null

Patricia Pascua; Mónica García; M. Paz Fernández-Salazar; M. Pilar Hernández-Lorenzo; José J. Calvo; William H. Colledge; R. Maynard Case; Martin C. Steward; José I. San Román

2009-01-01

291

Autoimmune pancreatitis complicated by an infected pseudocyst  

Microsoft Academic Search

A 53-year-old man was admitted due to upper abdominal pain. He had been diagnosed with autoimmune pancreatitis (AIP) 4 years\\u000a previously and had been taking steroids for maintenance therapy since that time. Abdominal computed tomography revealed multiple\\u000a pseudocysts in the head of the pancreas and a dilated pancreatic duct with mottled calcifications around the pseudocyst. Despite\\u000a the continuation of steroid therapy

Kyung Ae Chang; Tae Nyeun Kim; Si Hyung Lee

2010-01-01

292

In vivo study of polyurethane-coated gianturco-rosch biliary Z-stents  

Microsoft Academic Search

Purpose: Prototypes of Gianturco-Rosch Z-stents coated with polycarbonate urethane (PCU) were placed in the biliary tree of pigs,\\u000a in order to test their biomechanical behavior, stability, and biocompatibility.\\u000a \\u000a \\u000a Methods: The stents were surgically implanted in the common bile duct of three pairs of pigs, which were killed after 1, 3, and 6\\u000a months respectively. Explanted livers from pigs of the

Aldo Severini; Sara Mantero; Maria Cristina Tanzi; Alberto Cigada; Flaminio Addis; Guido Cozzi; Monica Salvetti; Salvatore Andreola; Antonella Motta; Enrico Regalia; Andrea Pulvirenti; Enrico De Pedri; Roberto Doci

1999-01-01

293

Polyurethane-covered metal stent for management of distal malignant biliary obstruction  

Microsoft Academic Search

Background: The efficacy of polyurethane-covered metal expandable stents for treatment of neoplastic distal biliary obstruction was analyzed. Methods: Twenty-one patients with unresectable malignant tumors involving the mid to distal bile duct who were seen with obstructive jaundice were consecutively enrolled. Eighteen patients underwent endoscopic implantation of a polyurethane-covered metal stent and 3 patients underwent transhepatic insertion because of duodenal obstruction.

Hiroyuki Isayama; Yutaka Komatsu; Takeshi Tsujino; Haruhiko Yoshida; Minoru Tada; Yasushi Shiratori; Takao Kawabe; Masao Omata

2002-01-01

294

Protective effect of the combined treatment of pancreatic and neutrophil elastase inhibitors on acute pancreatitis elicited by lipopolysaccharide in rats given intraductal injection of taurocholate plus trypsin  

Microsoft Academic Search

A severe acute pancreatitis was produced by intraperitoneal injection of lipopolysaccharide (LPS) in rats with preexisting\\u000a hemorrhagic and necrotizing pancreatitis induced by retrograde injection of a 5% taurocholate plus 1% trypsin solution into\\u000a the pancreatic duct. Mortality and time-course changes in pancreatic, hepatic, renal and pulmonary functions, and organ myeloperoxidase\\u000a (MPO) levels were examined in this model. LPS at an

Mayumi Yamano; Masako Umeda; Keiji Miyata; Toshimitsu Yamada

1998-01-01

295

Nitinol Stents for Palliative Treatment of Malignant Obstructive Jaundice: Should We Stent the Sphincter of Oddi in Every Case?  

Microsoft Academic Search

Purpose: To evaluate the necessity of metallic stenting of the sphincter of Oddi in malignant obstructive jaundice when the tumor\\u000a is more than 2 cm from the papilla of Vater.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: Sixty-seven self-expandable biliary stents were used in 60 patients with extrahepatic lesions of the common hepatic or common\\u000a bile duct and with the distal margin of the tumor located

Adam A. Hatzidakis; Dimitris Tsetis; Evangelia Chrysou; Elias Sanidas; John Petrakis; Nicholas C. Gourtsoyiannis

2001-01-01

296

Gallbladder Stent Placement for Prevention of Cholecystitis in Patients Receiving Covered Metal Stent for Malignant Obstructive Jaundice: A Feasibility Study  

Microsoft Academic Search

Purpose  Covered self-expanding metal stents (CSEMS) have been used for palliation of malignant distal biliary strictures. Occlusion\\u000a of the cystic duct by CSEMS may be complicated by cholecystitis. This potentially could be prevented by placement of a transpapillary\\u000a gallbladder stent (GBS).\\u000a \\u000a \\u000a \\u000a \\u000a Patients and Methods  Between 11\\/2006 and 10\\/2007, a total of 73 patients (50 male) aged 65 ± 14 years underwent CSEMS placement for palliation

Sonia Gosain; Hugo Bonatti; LaVone Smith; Michele E. Rehan; Andrew Brock; Anshu Mahajan; Melissa Phillips; Henry C. Ho; Kristi Ellen; Vanessa M. Shami; Michel Kahaleh

2010-01-01

297

Salivary duct stones  

MedlinePLUS

... of minerals in the ducts that drain the salivary glands. Salivary duct stones are a type of salivary gland disorder. ... Saliva (spit) is produced by the salivary glands in the mouth. The ... that can block the salivary ducts. When saliva cannot exit ...

298

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

299

Treatment of Malignant Biliary Obstruction with a PTFE-Covered Self-Expandable Nitinol Stent  

PubMed Central

Objective We wanted to determine the technical and clinical efficacy of using a PTFE-covered self-expandable nitinol stent for the palliative treatment of malignant biliary obstruction. Materials and Methods Thirty-seven patients with common bile duct strictures caused by malignant disease were treated by placing a total of 37 nitinol PTFE stents. These stents were covered with PTFE with the exception of the last 5 mm at each end; the stent had an unconstrained diameter of 10 mm and a total length of 50-80 mm. The patient survival rate and stent patency rate were calculated by performing Kaplan-Meier survival analysis. The bilirubin, serum amylase and lipase levels before and after stent placement were measured and then compared using a Wilcoxon signed-rank test. The average follow-up duration was 27.9 weeks (range: 2-81 weeks). Results Placement was successful in all cases. Seventy-six percent of the patients (28/37) experienced adequate palliative drainage for the remainder of their lives. There were no immediate complications. Three patients demonstrated stent sludge occlusion that required PTBD (percutaneous transhepatic biliary drainage) irrigation. Two patients experienced delayed stent migration with stone formation at 7 and 27 weeks of follow-up, respectively. Stent insertion resulted in acute elevations of the amylase and lipase levels one day after stent insertion in 11 patients in spite of performing endoscopic sphincterotomy (4/6). The bilirubin levels were significantly reduced one week after stent insertion (p < 0.01). The 30-day mortality rate was 8% (3/37), and the survival rates were 49% and 27% at 20 and 50 weeks, respectively. The primary stent patency rates were 85%, and 78% at 20 and 50 weeks, respectively. Conclusion The PTFE-covered self-expandable nitinol stent is safe to use with acceptable complication rates. This study is similar to the previous studies with regard to comparing the patency rates and survival rates.

Kwak, Hyo-Sung; Jin, Gong-Yong; Lee, Seung-Ok; Chung, Gyung-Ho

2007-01-01

300

Pancreatic tuberculosis or autoimmune pancreatitis.  

PubMed

Introduction. Isolated pancreatic and peripancreatic tuberculosis is a challenging diagnosis due to its rarity and variable presentation. Pancreatic tuberculosis can mimic pancreatic carcinoma. Similarly, autoimmune pancreatitis can appear as a focal lesion resembling pancreatic malignancy. Endoscopic ultrasound-guided fine needle aspiration provides an effective tool for differentiating between benign and malignant pancreatic lesions. The immune processes involved in immunoglobulin G4 related systemic diseases and tuberculosis appear to have some similarities. Case Report. We report a case of a 59-year-old Southeast Asian male who presented with fever, weight loss, and obstructive jaundice. CT scan revealed pancreatic mass and enlarged peripancreatic lymph nodes. Endoscopic ultrasound-guided fine needle aspiration confirmed the presence of mycobacterium tuberculosis. Patient also had high immunoglobulin G4 levels suggestive of autoimmune pancreatitis. He was started on antituberculosis medications and steroids. Clinically, he responded to treatment. Follow-up imaging showed findings suggestive of chronic pancreatitis. Discussion. Pancreatic tuberculosis and autoimmune pancreatitis can mimic pancreatic malignancy. Accurate diagnosis is imperative as unnecessary surgical intervention can be avoided. Endoscopic ultrasound-guided fine needle aspiration seems to be the diagnostic test of choice for pancreatic masses. Long-term follow-up is warranted in cases of chronic pancreatitis. PMID:24839445

Salahuddin, Ayesha; Saif, Muhammad Wasif

2014-01-01

301

Pancreatic Tuberculosis or Autoimmune Pancreatitis  

PubMed Central

Introduction. Isolated pancreatic and peripancreatic tuberculosis is a challenging diagnosis due to its rarity and variable presentation. Pancreatic tuberculosis can mimic pancreatic carcinoma. Similarly, autoimmune pancreatitis can appear as a focal lesion resembling pancreatic malignancy. Endoscopic ultrasound-guided fine needle aspiration provides an effective tool for differentiating between benign and malignant pancreatic lesions. The immune processes involved in immunoglobulin G4 related systemic diseases and tuberculosis appear to have some similarities. Case Report. We report a case of a 59-year-old Southeast Asian male who presented with fever, weight loss, and obstructive jaundice. CT scan revealed pancreatic mass and enlarged peripancreatic lymph nodes. Endoscopic ultrasound-guided fine needle aspiration confirmed the presence of mycobacterium tuberculosis. Patient also had high immunoglobulin G4 levels suggestive of autoimmune pancreatitis. He was started on antituberculosis medications and steroids. Clinically, he responded to treatment. Follow-up imaging showed findings suggestive of chronic pancreatitis. Discussion. Pancreatic tuberculosis and autoimmune pancreatitis can mimic pancreatic malignancy. Accurate diagnosis is imperative as unnecessary surgical intervention can be avoided. Endoscopic ultrasound-guided fine needle aspiration seems to be the diagnostic test of choice for pancreatic masses. Long-term follow-up is warranted in cases of chronic pancreatitis.

Saif, Muhammad Wasif

2014-01-01

302

Biodegradable Ureteral Stents  

NASA Astrophysics Data System (ADS)

Ureteral stents have been associated with painful symptoms and require a secondary procedure for removal if the suture tether is removed. Biodegradable stents have been attempted in the past, but are no longer used since they resulted in histological inflammation or unpredictable variability in degradation time. This article reviews past degradable materials used in both the prostatic urethra and ureter as well as identifies a new degradable ureteral stent that lasts between 2 to 4 weeks in a porcine model.

Chew, Ben H.; Hadaschik, Boris A.; Paterson, Ryan F.; Lange, Dirk

2008-09-01

303

Postburn pancreatitis.  

PubMed Central

OBJECTIVE: The authors examined the prevalence and complications of pancreatitis in severely burned patients. Factors predictive for the development of pancreatitis after burns are considered. SUMMARY BACKGROUND DATA: Pancreatitis has been documented at necropsy after burns; however, it is not clinically recognized as a common complication of burn injury. Recent improvements in survival rates could yield previously unrecognized complications, such as pancreatitis, particularly in those patients who previously would have not survived. The hypothesis is that pancreatitis is a frequent complication after major burn injury and causes significant morbidity for patients with large burns. METHODS: This retrospective review of adult patients with large burns examines postburn pancreatitis using stepwise logistic regression analysis. RESULTS: Forty-nine of 121 (40%) patients developed hyperamylasemia or hyperlipasemia well after the admission period (23 +/- 3 days), and all enzyme abnormalities were temporally associated with emerging infections. Most of these patients (40/49, 82%) had symptoms of pancreatitis. Three patients (6%) had pancreatic pseudocysts or abscesses. Inhalation injury (p = 0.0001), associated trauma (p = 0.0311), and escharotomy (p = 0.0415) were risk factors for pancreatitis. Using Fischer's exact test, patients with pancreatitis had increased mortality and length of stay. Patients with high enzyme elevations and > or = 50% body surface area burned were at severe risk of pancreatic pseudocyst or abscess development (43%; 90% confidence interval of 23-77%). CONCLUSIONS: Pancreatitis is a frequent complication after large burn injuries. Patients at high risk for pancreatitis complications should receive surveillance examinations during their acute hospitalization.

Ryan, C M; Sheridan, R L; Schoenfeld, D A; Warshaw, A L; Tompkins, R G

1995-01-01

304

Pancreatic Anastomosis Disruption Seven Years Postpancreaticoduodenectomy  

PubMed Central

We are reporting a case of a 22 year-old female patient, who underwent a pancreaticoduodenectomy previously for a solid-pseudopapillary neoplasm of the pancreas and was re-admitted seven years later with a pancreatic leak following disruption of the pancreatico-jejunal anastomosis. Exploratory laparotomy revealed a large collection at the level of the pancreatic anastomosis with major disruption of the pancreatico-jejunal anastomosis. The pancreatic stump was refreshed as well as the jejunal site and a duct to mucosa anastomosis was performed. She remains well with a follow up of 18 months.

Faraj, Walid; Abou Zahr, Zaki; Mukherji, Deborah; Zaghal, Ahmad; Khalife, Mohamed

2010-01-01

305

Pancreatic anastomosis disruption seven years postpancreaticoduodenectomy.  

PubMed

We are reporting a case of a 22 year-old female patient, who underwent a pancreaticoduodenectomy previously for a solid-pseudopapillary neoplasm of the pancreas and was re-admitted seven years later with a pancreatic leak following disruption of the pancreatico-jejunal anastomosis. Exploratory laparotomy revealed a large collection at the level of the pancreatic anastomosis with major disruption of the pancreatico-jejunal anastomosis. The pancreatic stump was refreshed as well as the jejunal site and a duct to mucosa anastomosis was performed. She remains well with a follow up of 18 months. PMID:20814558

Faraj, Walid; Abou Zahr, Zaki; Mukherji, Deborah; Zaghal, Ahmad; Khalife, Mohamed

2010-01-01

306

Postoperative pancreatitis as a complication of biliary surgery.  

PubMed

Forty patients who underwent biliary surgery were investigated for postoperative pancreatic disturbance as measured by the amylase creatinine clearance ration (ACCR). Its relevance to preoperative pancreatitis, exploration of the common bile duct, and operative cholangiography were examined. The results suggested that a recent clinically proven episode of pancreatitis did not predispose to a postoperative recurrence following biliary surgery. Similarly, cholecystectomy alone did not produce a postoperative pancreatic disturbance. However, exploration of the common bile duct did frequently cause a postoperative elevated ACCR, and hence we recommend that duct exploration should be performed as carefully and as atraumatically as possible. The small number of patients who did not have operative cholangiograms prevented statistical evaluation of the effect of this procedure on the pancreas. However, information from elsewhere suggests that the plasma amylase level is not likely to be raised by cholangiography. PMID:291412

Ingram, D M; House, A K; Garcia-Webb, P

1979-08-01

307

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

308

Effects of intraduodenal administration of tarazepide on pancreatic secretion and duodenal EMG in neonatal calves  

Microsoft Academic Search

The influence of CCK-A receptor antagonism on pancreatic exocrine secretion and duodenal EMG, and the mechanism(s) involved in CCK-induced pancreatic secretion were studied in conscious calves. Seven 1-week-old calves were fitted with a pancreatic duct catheter, duodenal cannula and duodenal electrodes. Pancreatic exocrine secretion and duodenal EMG were studied following intraduodenal CCK-A receptor antagonist (Tarazepide), intravenous atropine, and intravenous or

Romuald Zabielski; Violetta Le?niewska; Jürgen Borlak; Peter C Gregory; Pawe? Kiela; Stefan G Pierzynowski; Wies?aw Barej

1998-01-01

309

Polyurethane-Covered Nitinol Strecker Stents as Primary Palliative Treatment of Malignant Biliary Obstruction  

SciTech Connect

Purpose: To evaluate the clinical efficacy of the polyurethane-covered Nitinol Strecker stent in the treatment of patients with malignant biliary obstruction.Methods: Twenty-three covered stents produced by us were placed in 18 patients with malignant biliary obstruction. Jaundice was caused by cholangiocarcinoma (n = 5), pancreatic cancer (n = 6), gallbladder cancer (n = 4), metastatic lymph nodes (n = 2), and tumor of the papilla (n 1).Results: The mean patency period of the stents was 37.5 weeks (5-106 weeks). Recurrent obstructive jaundice occurred in two patients (11%). Adequate biliary drainage over 50 weeks or until death was achieved in 17 of 18 patients (94.4%). Late cholangitis was observed in two patients whose stents bridged the ampulla of Vater. Other late severe complications were not encountered.Conclusion: Although more study is necessary, our results suggest the clinical efficacy of our covered Nitinol Strecker stent in the management of obstructive jaundice caused by malignant diseases.

Kanasaki, Shuzo; Furukawa, Akira [Department of Radiology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu Shiga, 520-2192 (Japan); Kane, Teruyuki [Department of Internal Medicine, Yujinkai Yamazaki Hospital, Takegahana-cho 80, Hikone Shiga (Japan); Murata, Kiyoshi [Department of Radiology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu Shiga, 520-2192 (Japan)

2000-03-15

310

[Percutaneous treatment of benign biliary stenosis: bilioplasty and stenting].  

PubMed

We reviewed our personal experience in 46 patients with biliary strictures, who underwent percutaneous balloon dilatation between 1983 and 1988. The strictures were iatrogenic in 24% of the cases, anastomotic in 52%, inflammatory in 17%, and associated with sclerosing cholangitis in 7%. The treatment consisted in dilating the bile ducts with balloon catheters of different kinds and sizes ("bilioplasty") and placing an internal drainage catheter for a varying period of time ("stenting"). In 22 patients the catheter was removed after an average time of 7.7 months. The rate of stricture recurrence was 13.5% (average follow-up: 20 months). In the remaining 24 patients the stents are still in situ, waiting for removing. Major complication rate was 6.4% (2 pleural effusions and 1 hepatic artery bleeding). We also report our initial experience with metallic self-expanding stents which appear as a promising tool in the management of recurring strictures. PMID:2608938

Rossi, P; Salvatori, F M; Maccioni, F; Santoro, P; Gandini, R; Maradei, A; Martinucci, A

1989-11-01

311

Endosonography-guided drainage of malignant fluid collections using lumen-apposing, fully covered self-expanding metal stents.  

PubMed

Endosonography (EUS)-guided drainage of paragastric fluid collections using fully covered self-expanding metal stents (FCSEMS) is now a well-established procedure. Recently, new and specially designed lumen-apposing, fully-covered metal cystgastrostomy stents have been employed for this indication. In this case series, the use of these new stents for the drainage of malignant fluid collections in three symptomatic patients is described. Cases included a large pancreatic pseudocyst, secondary to underlying acute lymphoblastic leukemia, and two large collections of loculated ascites due to metastatic ovarian and cervical cancer, respectively. Technical success in inserting the new stents was achieved in all three patients, and resulted in symptomatic relief. There were no clinically significant complications directly attributed to the stents. These new lumen-apposing cystgastrostomy stents may provide a viable, minimally invasive, and effective alternative for drainage of malignant fluid collections, either for definitive treatment or for palliation of symptoms. PMID:24932652

Musumba, Crispin; Tutticci, Nicholas; Nanda, Kavinderjit; Kwan, Vu

2014-08-01

312

Prevention of post-ERCP pancreatitis.  

PubMed

Post-procedure pancreatitis is the most common complication of endoscopic retrograde cholangio pancreatography (ERCP) and carries a high morbidity and mortality occurring in at least 3%-5% of all procedures. We reviewed the available literature searching for "ERCP" and "pancreatitis" and "post-ERCP pancreatitis". in PubMed and Medline. This review looks at the diagnosis, risk factors, causes and methods of preventing post-procedure pancreatitis. These include the evidence for patient selection, endoscopic techniques and pharmacological prophylaxis of ERCP induced pancreatitis. Selecting the right patient for the procedure by a risk benefits assessment is the best way of avoiding unnecessary ERCPs. Risk is particularly high in young women with sphincter of Oddi dysfunction (SOD). Many of the trials reviewed have rather few numbers of subjects and hence difficult to appraise. Meta-analyses have helped screen for promising modalities of prophylaxis. At present, evidence is emerging that pancreatic stenting of patients with SOD and rectally administered nonsteroidal anti-inflammatory drugs in a large unselected trial reduce the risk of post-procedure pancreatitis. A recent meta-analysis have demonstrated that rectally administered indomethecin, just before or after ERCP is associated with significantly lower rate of pancreatitis compared with placebo [OR = 0.49 (0.34-0.71); P = 0.0002]. Number needed to treat was 20. It is likely that one of these prophylactic measures will begin to be increasingly practised in high risk groups. PMID:24891970

Wong, Lin-Lee; Tsai, Her-Hsin

2014-02-15

313

Prevention of post-ERCP pancreatitis  

PubMed Central

Post-procedure pancreatitis is the most common complication of endoscopic retrograde cholangio pancreatography (ERCP) and carries a high morbidity and mortality occurring in at least 3%-5% of all procedures. We reviewed the available literature searching for “ERCP” and “pancreatitis” and “post-ERCP pancreatitis”. in PubMed and Medline. This review looks at the diagnosis, risk factors, causes and methods of preventing post-procedure pancreatitis. These include the evidence for patient selection, endoscopic techniques and pharmacological prophylaxis of ERCP induced pancreatitis. Selecting the right patient for the procedure by a risk benefits assessment is the best way of avoiding unnecessary ERCPs. Risk is particularly high in young women with sphincter of Oddi dysfunction (SOD). Many of the trials reviewed have rather few numbers of subjects and hence difficult to appraise. Meta-analyses have helped screen for promising modalities of prophylaxis. At present, evidence is emerging that pancreatic stenting of patients with SOD and rectally administered nonsteroidal anti-inflammatory drugs in a large unselected trial reduce the risk of post-procedure pancreatitis. A recent meta-analysis have demonstrated that rectally administered indomethecin, just before or after ERCP is associated with significantly lower rate of pancreatitis compared with placebo [OR = 0.49 (0.34-0.71); P = 0.0002]. Number needed to treat was 20. It is likely that one of these prophylactic measures will begin to be increasingly practised in high risk groups.

Wong, Lin-Lee; Tsai, Her-Hsin

2014-01-01

314

Endoscopic management of bile duct stones: residual bile duct stones after surgery, cholangitis, and "difficult stones".  

PubMed

Endoscopic treatment has become, according to the latest recommendations, the standard treatment for common bile duct stones (CBDS), although in certain situations, surgical clearance of the common duct at the time of laparoscopic cholecystectomy is still considered a possible alternative. The purpose of this article is not to compare endoscopic with surgical treatment of CBDS, but to describe the various techniques of endoscopic treatment, detailing their preferential indications and the various treatment options that must sometimes be considered when faced with "difficult calculi" of the CBD. The different techniques of lithotripsy and the role of biliary drainage with plastic or metallic stents will be detailed as well as papillary balloon dilatation and particularly the technique of sphincterotomy with macrodilatation of the sphincter of Oddi (SMSO), a recently described approach that has changed the strategy for endoscopic management of CBDS. Finally, the overall strategy for endoscopic management of CBDS, with description of different techniques, will be exposed. PMID:23817008

Karsenti, D

2013-06-01

315

Intra-pancreatic splenic artery pseudoaneurysmA rare complication of chronic calcific pancreatitis  

Microsoft Academic Search

The authors present the case of a 12-year-old boy with a history of chronic upper abdominal pain. Based on ultrasonography,\\u000a endoscopic retrograde cholangiopancreatography, and computerized tomography, a diagnosis of chronic calcific pancreatitis\\u000a with dilation of the main pancreatic duct and a pseudocyst of the proximal pancreas was made. At surgery, in addition to confirmation\\u000a of the above findings, a pseudoaneurysm

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

1998-01-01

316

Endovascular management of vascular complications in pancreatic transplants.  

PubMed

Vascular complications after pancreatic transplantation carry a high rate of graft loss. Endovascular management of these complications is confined to stent placement for iliac artery inflow disease and embolization for arteriovenous fistulae (AVFs), pseudoaneurysms, or active bleeding. The current study describes the endovascular management of pancreatic transplant venous thrombosis (N = 1), arterial stenosis (N = 5), thrombosis (N = 3), pseudoaneurysms (N = 1), and AVF (N = 2). In addition, embolization of nonfunctioning grafts is described as an endovascular alternative to pancreatectomy. PMID:22492112

Saad, Wael E A; Darwish, Wael E; Turba, Ulku C; Angle, John F; Wagner, Cynthia E; Matsumoto, Alan H; Brayman, Kenneth; Hagspiel, Klaus D

2012-04-01

317

Coronary artery stent (image)  

MedlinePLUS

... with a balloon catheter and expands when the balloon is inflated. The stent is then left there to help keep the artery open. ... with a balloon catheter and expands when the balloon is inflated. The stent is then left there to help keep the artery open.

318

Endomicroscopy in bile duct: Inflammation interferes with pCLE applied in the bile duct: A prospective study of 54 patients  

PubMed Central

Background The preoperative diagnosis of biliary stenosis is associated with low accuracy. As a consequence, probe-based confocal laser endomicroscopy (pCLE), an in-vivo histological imaging technique, was applied in the bile duct. The aim of this study was to establish whether previous inflammation of the bile duct affects confocal interpretation. The findings from pCLE were compared in two groups of patients: those in whom there had been no cholangitis nor stenting and those in whom stents had been used and subsequently retrieved or who had suffered cholangitis. Patients and methods pCLE was performed on 54 patients (mean age 66 years; 31 men, 23 women) from September 2008 to July 2011. Patients were divided in two groups: group 1: 39 patients who had not undergone a biliary procedure in the month preceding the pCLE procedure; and group 2: 15 patients who had undergone stent placement or presented with cholangitis in the month preceding the pCLE procedure. Endoscopic and pCLE data were collected prospectively. pCLE results were compared to benchmark histology (surgery, endoultrasonography, percutaneous biopsy). Patients with a benign stricture who did not undergo operation were followed for 1 year. pCLE images of the bile duct were obtained during endoscopic retrograde cholangiopancreatography procedures. pCLE images were interpreted prospectively using the Miami classification in vivo and in real time. Results In group 1, sensitivity, specificity, and accuracy were 88, 83, and 87%, respectively. In group 2, sensitivity, specificity, and accuracy were 75, 71, and 73%, respectively. Diagnostic accuracy of pCLE was lower when applied to group 2 (p?ducts affected by inflammation from cholangitis or previous stenting. Conclusions Inflammatory lesions of the bile duct interfere with interpretation of pCLE. A refined pCLE description of inflammatory lesions should improve accuracy of pCLE in bile duct stenosis.

Bories, Erwan; Poizat, Flora; Pesenti, Christian; Esterni, Benjamin; Monges, Genevieve; Giovannini, Marc

2013-01-01

319

Pancreatic body adenocarcinoma with neuroendocrine tumor characteristics: A case report  

PubMed Central

A 61-year-old female with pancreatic body cancer underwent a distal pancreatectomy. The tumor was a moderately- to poorly-differentiated adenocarcinoma. Tumor growth filled the dilated main pancreatic duct (MPD) and infiltrated the surrounding area. Six months later, metastases to the left diaphragm and MPD of the remnant pancreatic head were detected. Chemoradiotherapy was administered, but the patient succumbed 22 months after surgery. An autopsy demonstrated that a moderately- to poorly-differentiated adenocarcinoma had arisen from the pancreatic head and infiltrated the duodenum and bile duct. Huge liver metastases and multiple peritoneal disseminations were also present. Microscopically, a portion of the tumor had a pseudo-rosette appearance in the adenocarcinoma component, while another section showed characteristics of a neuroendocrine tumor (NET) immunohistochemically. The original surgically-resected tumor also showed NET characteristics immunohistochemically. It is therefore necessary to search for NET components in pancreatic cancer with atypical growth and metastases, even when adenocarcinoma has been diagnosed histologically.

TAJIMA, HIDEHIRO; KITAGAWA, HIROHISA; SHOJI, MASATOSHI; WATANABE, TOSHIFUMI; NAKANUMA, SHINICHI; OKAMOTO, KOICHI; SAKAI, SEISHO; KINOSHITA, JUN; MAKINO, ISAMU; FURUKAWA, HIROYUKI; NAKAMURA, KEISHI; HAYASHI, HIRONORI; OYAMA, KATSUNOBU; INOKUCHI, MASAFUMI; NAKAGAWARA, HISATOSHI; MIYASHITA, TOMOHARU; ITOH, HIROSHI; TAKAMURA, HIROYUKI; NINOMIYA, ITASU; FUSHIDA, SACHIO; FUJIMURA, TAKASHI; OHTA, TETSUO; SATOH, HIROHIDE; IKEDA, HIROKO; HARADA, KENICHI; NAKANUMA, YASUNI

2014-01-01

320

Close relationship between autoimmune pancreatitis and multifocal fibrosclerosis  

PubMed Central

Background: Autoimmune pancreatitis is a unique clinical entity proposed recently, and is sometimes associated with inflammation of other organs. Aims: To examine the pathophysiology of the pancreas and other organs in patients with autoimmune pancreatitis. Patients and methods: We evaluated clinicopathological findings in six resected and one autopsied patient with autoimmune pancreatitis. The pancreas, peripancreatic tissue, bile duct, and gall bladder were examined histologically and immunohistochemically. Biopsied salivary gland and cervical lymph node of one patient were also examined. We also performed similar immunohistochemical examinations in pancreatectomy specimens from 10 patients with alcoholic chronic pancreatitis and biopsied salivary glands from five patients with Sjögren’s syndrome. Results: Stenosis of the extrahepatic bile duct was detected in all patients. Histological findings were characterised by diffuse lymphoplasmacytic infiltration with marked interstitial fibrosis and acinar atrophy, obliterated phlebitis of the pancreatic veins, and involvement of the portal vein. Immunohistochemically, diffusely infiltrating cells consisted predominantly of CD4 or CD8 positive T lymphocytes and IgG4 positive plasma cells. Similar inflammatory processes also involved the peripancreatic tissue, extrahepatic bile duct, gall bladder, and salivary gland. Lymph nodes were swollen with infiltration of IgG4 positive plasma cells. None of these findings was seen in alcoholic chronic pancreatitis or Sjögren’s syndrome. Conclusions: The development of the specific inflammations in extensive organs as well as the pancreas in patients with autoimmune pancreatitis strongly suggests a close relationship between autoimmune pancreatitis and multifocal fibrosclerosis.

Kamisawa, T; Funata, N; Hayashi, Y; Tsuruta, K; Okamoto, A; Amemiya, K; Egawa, N; Nakajima, H

2003-01-01

321

Pancreatic Cancer  

PubMed Central

The past two decades have witnessed an explosion in our understanding of pancreatic cancer, and it is now clear that pancreatic cancer is a disease of inherited (germ-line) and somatic gene mutations. The genes mutated in pancreatic cancer include KRAS2, p16/CDKN2A, TP53, and SMAD4/DPC4, and these are accompanied by a substantial compendium of genomic and transcriptomic alterations that facilitate cell cycle deregulation, cell survival, invasion, and metastases. Pancreatic cancers do not arise de novo, and three distinct precursor lesions have been identified. Experimental models of pancreatic cancer have been developed in genetically engineered mice, which recapitulate the multistep progression of the cognate human disease. Although the putative cell of origin for pancreatic cancer remains elusive, minor populations of cells with stem-like properties have been identified that appear responsible for tumor initiation, metastases, and resistance of pancreatic cancer to conventional therapies.

Maitra, Anirban; Hruban, Ralph H.

2009-01-01

322

Difficult bile duct stones  

Microsoft Academic Search

Opinion statement  Bile duct stones are routinely removed at time of endoscopic retrograde cholangiopancreatography (ERCP) after biliary sphincterotomy\\u000a with standard balloon or basket extraction techniques. However, in approximately 10% to 15% of patients, bile duct stones\\u000a may be difficult to remove due to challenging access to the bile duct (periampullary diverticulum, Billroth II anatomy, Roux-en-Y\\u000a gastrojejunostomy), large (> 15 mm in

Lee McHenry; Glen Lehman

2006-01-01

323

Groove Pancreatitis: Spectrum of Imaging Findings and Radiology-Pathology Correlation  

PubMed Central

OBJECTIVE Groove pancreatitis is a rare form of chronic pancreatitis affecting the “groove” between the pancreatic head, duodenum, and common bile duct. The exact cause is unknown, although there are strong associations with long-term alcohol abuse, functional obstruction of the duct of Santorini, and Brunner gland hyperplasia. CONCLUSION Unfortunately, differentiating groove pancreatitis from malignancy on the basis of imaging features, clinical presentation, or laboratory markers can be extraordinarily difficult, and the vast majority of these patients ultimately undergo a pancreaticoduodenectomy (Whipple procedure) because of an inability to completely exclude malignancy. In certain cases, however, the imaging features on CT and MRI can allow the radiologist to prospectively suggest the correct diagnosis.

Raman, Siva P.; Salaria, Safia N.; Hruban, Ralph H.; Fishman, Elliot K.

2014-01-01

324

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

PubMed

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

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

1992-01-01

325

Lightweight Valve Closes Duct Quickly  

NASA Technical Reports Server (NTRS)

Expanding balloon serves as lightweight emergency valve to close wide duct. Uninflated balloon stored in housing of duct. Pad resting on burst diaphragm protects balloon from hot gases in duct. Once control system triggers valve, balloon inflates rapidly to block duct. Weighs much less than does conventional butterfly, hot-gas, or poppet valve capable of closing duct of equal diameter.

Fournier, Walter L.; Burgy, N. Frank

1991-01-01

326

Endoscopic management of difficult common bile duct stones.  

PubMed

Endoscopy is widely accepted as the first treatment option in the management of bile duct stones. In this review we focus on the alternative endoscopic modalities for the management of difficult common bile duct stones. Most biliary stones can be removed with an extraction balloon, extraction basket or mechanical lithotripsy after endoscopic sphincterotomy. Endoscopic papillary balloon dilation with or without endoscopic sphincterotomy or mechanical lithotripsy has been shown to be effective for management of difficult to remove bile duct stones in selected patients. Ductal clearance can be safely achieved with peroral cholangioscopy guided laser or electrohydraulic lithotripsy in most cases where other endoscopic treatment modalities have failed. Biliary stenting may be an alternative treatment option for frail and elderly patients or those with serious co morbidities. PMID:23345939

Trikudanathan, Guru; Navaneethan, Udayakumar; Parsi, Mansour A

2013-01-14

327

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

328

Endoscopic management of difficult common bile duct stones  

PubMed Central

Endoscopy is widely accepted as the first treatment option in the management of bile duct stones. In this review we focus on the alternative endoscopic modalities for the management of difficult common bile duct stones. Most biliary stones can be removed with an extraction balloon, extraction basket or mechanical lithotripsy after endoscopic sphincterotomy. Endoscopic papillary balloon dilation with or without endoscopic sphincterotomy or mechanical lithotripsy has been shown to be effective for management of difficult to remove bile duct stones in selected patients. Ductal clearance can be safely achieved with peroral cholangioscopy guided laser or electrohydraulic lithotripsy in most cases where other endoscopic treatment modalities have failed. Biliary stenting may be an alternative treatment option for frail and elderly patients or those with serious co morbidities.

Trikudanathan, Guru; Navaneethan, Udayakumar; Parsi, Mansour A

2013-01-01

329

Bile duct obstruction  

MedlinePLUS

... cholangiopancreatography) Percutaneous transhepatic cholangiogram (PTCA) Magnetic resonance cholangiopancreatography (MRCP) A blocked bile duct may also alter the results of the following tests: Amylase blood test Gallbladder ...

330

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

Microsoft Academic Search

Four patients with malignant obstruction of the common bile duct had been treated with uncovered Wallstents and suffered from\\u000a a reobstruction after 2–13 months (mean 5.3 months). Repeat cholangiography revealed severe stenosis of the stent lumen caused\\u000a by tumor ingrowth through the mesh. A Wallstent with a self-made polyurethane-cover was inserted through the uncovered stent\\u000a in these patients. The four

Toshifumi Nakamura; Mutsuo Kitagawa; Yasunori Takehira; Masami Yamada; Tsunehisa Kawasaki; Hirotoshi Nakamura

2000-01-01

331

Acute Pancreatitis and Pregnancy  

MedlinePLUS

Acute Pancreatitis and Pregnancy Timothy Gardner, MD Acute pancreatitis is defined as the sudden inflammation of the pancreas manifested ... of acute pancreatitis in pregnancy. Reasons for Acute Pancreatitis and Pregnancy While acute pancreatitis is responsible for ...

332

Does aging influence pancreatic response in the ultrasound secretin test by impairing hydrokinetic exocrine function or sphincter of Oddi motor function?  

Microsoft Academic Search

Background. Secretin administration induces a brief distinct dilatation of the main pancreatic duct in healthy persons, visible at ultrasonography. Several investigations have indicated that sonographic duct measurements before and after secretin injections are a useful tool in the diagnostic screening for pancreatic disease.Aims. Aim of this study was to evaluate the influence of aging on the test results.Methods. We examined

J. Glaser; K. Stienecker

2000-01-01

333

Pancreatitis of the Gastroduodenal Groove: A Case Report  

PubMed Central

Groove pancreatitis, a form of chronic pancreatitis affecting the head of the pancreas, is localized within the groove between the pancreas head, duodenum, and common bile duct. We report a case of a male patient with groove pancreatitis who initially underwent a duodenal preserving gastrenteranastomosis. Unfortunately, the patient's symptoms were only partially controlled, necessitating a pancreaticoduodenectomy in due course as the definite surgical restoration procedure. The surgical approach selected proved inadequate since the patient's symptoms did not resolve over time. This reflects that by-pass operations like these are not indicated for the management of patients with groove pancreatitis.

German, Vasileios; Ekmektzoglou, Konstantinos A.; Kyriakos, Nicolaos; Patouras, Paraskevas; Kikilas, Athanasios

2010-01-01

334

Relief of metastatic biliary obstruction by stent placement: is it worthwhile?  

PubMed

Twenty-one patients undergoing stent placement for extra-hepatic biliary obstruction by metastatic disease were reviewed. Primary tumours (colorectal 8, stomach 4, breast 2, ovary 2, others 5) had been diagnosed 13 months (median) before presentation with bile duct obstruction, which was at the porta hepatis or common hepatic duct in 14 patients and in the common bile duct in seven. Endoscopic stent placement was achieved in 14 out of 20 patients in whom it was attempted. A percutaneous trans-hepatic procedure was necessary in five patients. Two patients could not be stented. Median survival was 5 months (range 1 month to 6 years) in patients stented successfully but only 1 month (2 weeks to 3 months) in unsuccessful cases (P < 0.01). Nine patients survived more than 4 months. Patients with proximal obstruction fared less well than those with distal obstruction; they required more procedures and survived for shorter periods (median 1 month versus 5 months, P < 0.05). Worthwhile palliation is afforded to almost half these patients by endoscopic stent placement and individual patients may achieve prolonged, symptom-free survival. PMID:7504561

Anderson, I D; Manson, J M; Martin, D F; Tweedle, D E

1993-01-01

335

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

2013-01-01

336

Advanced Duct Sealing Testing  

SciTech Connect

Duct leakage has been identified as a major source of energy loss in residential buildings. Most duct leakage occurs at the connections to registers, plenums or branches in the duct system. At each of these connections a method of sealing the duct system is required. Typical sealing methods include tapes or mastics applied around the joints in the system. Field examinations of duct systems have typically shown that these seals tend to fail over extended periods of time. The Lawrence Berkeley National Laboratory has been testing sealant durability for several years. Typical duct tape (i.e. fabric backed tapes with natural rubber adhesives) was found to fail more rapidly than all other duct sealants. This report summarizes the results of duct sealant durability testing of five UL 181B-FX listed duct tapes (three cloth tapes, a foil tape and an Oriented Polypropylene (OPP) tape). One of the cloth tapes was specifically developed in collaboration with a tape manufacturer to perform better in our durability testing. The first test involved the aging of common ''core-to-collar joints'' of flexible duct to sheet metal collars, and sheet metal ''collar-to-plenum joints'' pressurized with 200 F (93 C) air. The second test consisted of baking duct tape specimens in a constant 212 F (100 C) oven following the UL 181B-FX ''Temperature Test'' requirements. Additional tests were also performed on only two tapes using sheet metal collar-to-plenum joints. Since an unsealed flexible duct joint can have a variable leakage depending on the positioning of the flexible duct core, the durability of the flexible duct joints could not be based on the 10% of unsealed leakage criteria. Nevertheless, the leakage of the sealed specimens prior to testing could be considered as a basis for a failure criteria. Visual inspection was also documented throughout the tests. The flexible duct core-to-collar joints were inspected monthly, while the sheet metal collar-to-plenum joints were inspected weekly. The baking test specimens were visually inspected weekly, and the durability was judged by the observed deterioration in terms of brittleness, cracking, flaking and blistering (the terminology used in the UL 181B-FX test procedure).

Sherman, Max H.; Walker, Iain S.

2003-08-01

337

Duct Tape Durability Testing  

SciTech Connect

Duct leakage is a major source of energy loss in residential buildings. Most duct leakage occurs at the connections to registers, plenums, or branches in the duct system. At each of these connections, a method of sealing the duct system is required. Typical sealing methods include tapes or mastics applied around the joints in the system. Field examinations of duct systems have shown that taped seals tend to fail over extended periods of time. The Lawrence Berkeley National Laboratory (LBNL) has been testing sealant durability for several years using accelerated test methods and found that typical duct tape (i.e., cloth-backed tapes with natural rubber adhesives) fails more rapidly than other duct sealants. This report summarizes the results of duct sealant durability testing over two years for four UL 181B-FX listed duct tapes (two cloth tapes, a foil tape and an Oriented Polypropylene (OPP) tape). One of the cloth tapes was specifically developed in collaboration with a tape manufacturer to perform better in our durability testing. The tests involved the aging of common ''core-to-collar joints'' of flexible duct to sheet metal collars. Periodic air leakage tests and visual inspection were used to document changes in sealant performance. After two years of testing, the flex-to-collar connections showed little change in air leakage, but substantial visual degradation from some products. A surprising experimental result was failure of most of the clamps used to mechanically fasten the connections. This indicates that the durability of clamps also need to be addressed ensure longevity of the duct connection. An accelerated test method developed during this study has been used as the basis for an ASTM standard (E2342-03).

Sherman, Max H.; Walker, Iain S.

2004-04-01

338

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

339

Duct-Flow Analysis  

NASA Technical Reports Server (NTRS)

Quasi-two-dimensional velocity distribution through annular duct calculated. Computer program ANDUCT developed for calculating velocity distribution along arbitrary line between inner and outer walls of annular duct with axisymmetric swirling flow. Velocity gradient equation used with assumed variation of meridional streamline curvature. ANDUCT written in FORTRAN IV for use on IBM 370/3033 computer.

Katsanis, T.

1985-01-01

340

Duct Pressure Actuated Nozzle.  

National Technical Information Service (NTIS)

The patent application relates to a variable area nozzle which uses high pressure duct nozzle air directly to actuate a variable area nozzle and thereby control the nozzle throat area. A servo controlled air valve directs the duct air pressure into a pres...

J. H. Maurer

1976-01-01

341

Loft duct project report  

SciTech Connect

On October 16, 1992, during a routine examination of the loft of Building 332, the Building Coordinator observed cracks in the welds of the duct work that services the fume hoods for Rooms 1313, 1321, and 1329. Further examination revealed cracks in the weld of the duct work that services the gloveboxes in Rooms 1321 and 1329. Upon discovery of the cracked welds, facility management immediately took the following two actions: Because one crack in the fume hood exhaust extended 70% around the duct circumference, a 1-ton chain fall was used to secure the duct to the roof support structure to prevent the duct from falling if the duct completely fractured. The Facility Manager suspended plutonium handling operations in the gloveboxes and work in the fume hoods in the affected rooms until the situation could be thoroughly investigated. Building 332 is ventilated by drawing conditioned air from the building hallways into the laboratories, hoods, and gloveboxes. This air is filtered through two sets of high-efficiency particulate air (HEPA) filters before being exhausted from the facility. Figure 1 is a schematic of the typical air flow pattern for the facility. All affected duct work is located in the loft of the facility or pressure zone 4. This ducting is fabricated from 12-, 14- and 16-gauge, 304 stainless-steel sheet stock and joined by the Gas Tungsten Arc Welding (GTAW) process.

Reed, J.R.

1993-06-01

342

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

343

Biliary stents: models and methods for endoscopic stenting.  

PubMed

Biliary stenting is widely used to palliate malignant obstruction or to treat benign biliary diseases. Recently, the most important changes have related to self-expandable metal stents (SEMSs), which are now available in a wide variety of designs, and to treatment techniques. This article is part of a combined publication that expresses the current view of the European Society of Gastrointestinal Endoscopy (ESGE) about endoscopic biliary stenting: a technology review describes the stent models and stenting techniques, and a separate clinical guideline states the evidence and recommendations regarding stenting. PMID:21614754

Dumonceau, J-M; Heresbach, D; Devière, J; Costamagna, G; Beilenhoff, U; Riphaus, A

2011-07-01

344

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

345

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

346

Prevention of postendoscopic retrograde cholangiopancreatography pancreatitis: the endoscopic technique.  

PubMed

Pancreatitis is the most frequent and distressing complication of endoscopic retrograde cholangiopancreatography (ERCP). Many recent studies have reported the use of pharmacological agents to reduce post-ERCP pancreatitis (PEP); however, the most effective agents have not been established. Reduction in the incidence of PEP in high-risk patients has been reported through specific cannulation techniques such as guide wire-assisted cannulation and the use of pancreatic stents. The present review focuses on ERCP techniques for the prevention of PEP. PMID:24944984

Song, Byeong Jun; Kang, Dae Hwan

2014-05-01

347

Pancreatic fistula  

Microsoft Academic Search

Opinion statement  External and internal pancreatic fistulas have a different etiology and natural history. Approximately 50% of internal and\\u000a 70% to 90% of external pancreatic fistulas can be expected to heal with nonoperative management. Nonclosure is predicted by\\u000a anatomic factors, which may be defined at endoscopic retrograde cholangiopancreatography or by CT if disconnected pancreatic\\u000a segments are seen. Enteral nutrition beyond the

Miranda Voss; Theodore Pappas

2002-01-01

348

[Pancreatic trauma: a case report].  

PubMed

Pancreatic trauma is a rare event, accounting for approximately 3% of all blunt abdominal traumas. The related mortality is quite high, around 5-30%, mostly due to the associated haemorrhagic lesions and to the delay in establishing the diagnosis, while pancreatic damage is directly responsible for death in only 5-10% of cases. We report here on a case of severe pancreatic trauma, underestimated initially and treated surgically at a later stage. The literature shows that the main difficulty in cases of pancreatic trauma is still related to failure recognizing the injury or to the frequent delay in diagnosing the condition, above all in haemodynamically unstable patients. In these cases, as in the one treated in this report, the clinical evidence and the priority accorded to the treatment of the shock are factors that tend to limit thorough examination. In haemodynamically stable patients, on the other hand, the multislice CT-scan and MR pancreatography-wirsungography are useful for the diagnosis. The treatment can be either conservative or surgical, depending on the extent of the damage, especially to the Wirsung duct. Surgical treatment with preservation of the entire pancreatic parenchyma, as performed in our case, even if technically demanding, makes it possible to maintain the function of the pancreas, thus reducing the risk of metabolic complications. PMID:16729615

La Greca, Gaetano; Castello, Giorgio; Barbagallo, Francesco; Conti, Pietro; Latteri, Saverio; Randazzo, Valentina; Gresta, Sebastiano; Bonaccorso, Rosario; Russello, Domenico

2006-01-01

349

Diagnosing pancreatic cancer using methylation specific PCR analysis of pancreatic juice.  

PubMed

The aim of this study was to determine the utility of detecting methylated ppENK and pi6 in pancreatic juice by methylation specific PCR as a marker of pancreatic adeno-carcinoma. Pancreatic juice samples were collected either intraoperatively, from 92 patients undergoing pancreaticoduodenectomy for benign (n=20) and malignant periampullary disease (n = 72) or endoscopically (by duodenal aspiration after secretin infusion), from 13 patients undergoing investigation for pancreatic disease. Methylated ppENK was detected in the pancreatic juice of 30 (66.7%) of 45 patients with pancreatic ductal adenocarcinoma, in 4 (44.4%) of 9 patients with intraductal papillary-mucinous adenocarcinoma, and in 7 (41.2%) of 17 patients with other periampullary carcinomas, using methylation specific PCR. Methylated pi6 was detected in a lower percentage of these patients (11.1%, 11.1% and 23.5%, respectively). In contrast, methylated ppENK and pi6 were not detected in 20 patients with non-malignant periampullary disease including 12 patients with chronic pancreatitis. Methylated ppENK was detected in 30 of 33 (90.9%) primary pancreatic adenocarcinoma and methylated pi6 was in 6/33 (1 8.2%). Despite the absence of ppENKand pi6 methylation in normal pancreas, methylated ppENK and pi6 was present in the duodenum of 90.5% and 28.6%, respectively of patients without cancer. Further, methylated ppENK and pi6 was seen in 88.9% and 11.1%, respectively of pancreatic juice samples obtained by duodenal aspiration from patients without cancer. We conclude that since ppENK and pi6 are not normally methylated in pancreatic secretions, detection of methylated ppENK and pi6 in pure pancreatic juice obtained by direct cannulation of the pancreatic duct to avoid duodenal secretions may suggest the presence of pancreatic adenocarcinoma PMID:12673124

Fukushima, Noriyoshi; Walter, Kimberly M; Uek, Takashi; Sato, Norihiro; Matsubayashi, Hiroyuki; Cameron, John L; Hruban, Ralph H; Canto, Marcia; Yeo, Charles J; Goggins, Michael

2003-01-01

350

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

351

Intraoperative pancreatoscopy: a valuable tool for pancreatic surgeons?  

PubMed

Effective treatment of pancreatic pathology relies on both preoperative and intraoperative decision making. Traditionally, the use of preoperative imaging and endoscopic modalities, in combination with intraoperative findings and pathologic evaluation, has guided the surgeons to perform the correct operative procedure. We hypothesize that the intraoperative use of pancreatoscopy (fiberoptic endoscopy of the pancreatic duct) is a valuable adjunct in selected cases to facilitate the performance of the appropriate definitive surgical treatment. We queried our IRB-approved, prospectively maintained the pancreatic surgery database identifying the uses of intraoperative pancreatoscopy in all pancreatic resections at our institution from 2005-2012. Operative notes, pathology reports, and perioperative outcomes were evaluated. During the study period, 1,016 pancreatic resections were performed at our institution. Twenty-three cases during this period included the use of intraoperative pancreatoscopy. Eighteen (78 %) of these operations were performed for presumed main duct intraductal papillary mucinous neoplasm. In five cases (22 %), the surgical resection was extended secondary to the intraoperative pancreatoscopy findings. Appropriate surgical treatment of the pancreatic lesions can be challenging in the face of preoperative imaging limitations. The selective use of intraoperative fiberoptic endoscopy to evaluate the pancreatic duct appears to help to enable the surgeon to better perform the appropriate resection and optimal treatment. PMID:24664423

Pucci, Michael J; Johnson, Caitlyn M; Punja, Viren P; Siddiqui, Ali A; Lopez, Kelly; Winter, Jordan M; Lavu, Harish; Yeo, Charles J

2014-06-01

352

A New Stent Graft  

PubMed Central

Summary The use of stents improves the result after balloon coronary angioplasty. Restenosis due to neointimal hyperplasia and proliferation of smooth muscle cells are, however; a concern. In the present report, we studied the prevention of restenosis to allow endothelial cell migration and growth to proceed through micropores using our developed stent graft with micropored segmented polyurethane (SPU) thin film in a normal beagle model. Our developed stent graft was made from Palmaz stent and micropored SPU thin film. The SPU film was arranged into four different micropore densities around the circumference: no micropores, arrangement 4; micropores of 30µm in diameter with an orderly distance of 250µm; (arrangement 1), 500µm; (arrangement 2) and 125µm (arrangement 3) between the neighboring two pores. Micropores were made using the Excimer laser ablation technique. The Palmaz stent was wrapped with micropored film, sutured, and glued with DMF (dimethyl formamide) under aid of a microscope. These stents were placed in the common carotid arteries of beagles (n = 5). They were sacrificed at 1 month, and a histological study and scanning electron microscopy study were performed for evaluation of endoluminal endothelialization. In 10 arteries applied with stent grafts, there was no severe stenosis although it did occur to some extent. All stented arteries were patent. Endothelial cell migration and growth through micropores were observed histologically on micropored SPU thin film in this model, which did not affect the intraluminal diameter. In most non-porous regions, significant thrombi were found between the SPU film and the neointimal layer. On the other hand, in the porous region, little thrombosis was observed except in the lowest density region. In 125µm of distance between two neighboring pores, the neointimal layer was the thinnest, which was suitable for wide intraluminal space after placement of a stent graft. Endothelial cell migration and growth through micropores were confirmed in the animal model using our developed micropored stent graft. The proceeding of their migration was controlled by micropore density under a constant micropore diameter. The stent graft with micropored SPU thin film is promising for the prevention of restenosis due to neointimal hyperplasia.

Nishi, S.; Nakayama, Y.; Ueda, H.; Ishikawa, M.; Matsuda, T.

2000-01-01

353

Larynx: implants and stents.  

PubMed

In the human larynx, implants a primarily used for the correction of glottis insufficiency. In a broader sense laryngeal stents may be considered as implants as well. Laryngeal implants can be differentiated into injectable and solid. The most important representatives of both groups are discussed in detail along with the respective technique of application. Laryngeal stents are primarily used perioperatively. Different types and their use are presented. PMID:22073097

Sittel, Christian

2009-01-01

354

Larynx: implants and stents  

PubMed Central

In the human larynx, implants a primarily used for the correction of glottis insufficiency. In a broader sense laryngeal stents may be considered as implants as well. Laryngeal implants can be differentiated into injectable and solid. The most important representatives of both groups are discussed in detail along with the respective technique of application. Laryngeal stents are primarily used perioperatively. Different types and their use are presented.

Sittel, Christian

2011-01-01

355

Stopping duct quacks: Longevity of residential duct sealants  

Microsoft Academic Search

Duct leakage has been identified as a major source of energy loss in residential buildings. Most duct leakage occurs at the connections to registers, plenums or branches in the duct system. At each of these connections a method of sealing the duct system is required. Typical sealing methods include tapes or mastics applied around the joints in the system. Field

Max H. Sherman; Iain S. Walker; Darryl J. Dickerhoff

2000-01-01

356

Phosphorylcholine-coated stents.  

PubMed

Stainless steel stents have been developed to perform their primary purpose of providing sufficient physical support to an artery following percutaneous transluminal coronary angioplasty (PTCA) in order to prevent vessel recoil. Early clinical problems, largely caused by subacute thrombosis (SAT), have been significantly reduced with a new generation of antiplatelet agents. Despite improved pharmacological control of SAT in many patients, the potential for stent occlusion remains a life-threatening problem for those with more complex lesions. One strategy for dealing with this is to improve the hemocompatibility of the stent surface with coatings. A phosphorylcholine (PC)-based stent coating has been designed for this purpose; we describe in detail the evaluation of the device, in vitro, through preclinical and early clinical data. We discuss studies that demonstrate that the PC-coated stent may offer some clinical advantage over uncoated counterparts. The extensive experience with this PC-coated device supports its nonthrombogenic nature, excellent acceptance by arterial tissue, and long-term stability in vivo. These characteristics, together with its ability to load and release a variety of therapeutic agents, also make the device a natural choice of platform for future stent-mediated drug delivery for treating restenosis. PMID:12627785

Lewis, Andrew L; Stratford, Peter W

2002-01-01

357

A prospective randomised study of "covered" versus "uncovered" diamond stents for the management of distal malignant biliary obstruction  

PubMed Central

Background and aim: Covered self-expandable metal stents (EMS) were recently developed to overcome tumour ingrowth in conventional EMS. However, supporting evidence for the efficacy of covered EMS is lacking. Patients and methods: We enrolled 112 patients with unresectable distal biliary malignancies. They were randomly assigned to polyurethane covered (n?=?57) or original diamond stent (n?=?55). Results: Stent occlusion occurred in eight patients (14%) after a mean of 304 days in the covered group, and in 21 patients (38%) after a mean of 166 days in the uncovered group. The incidence of covered EMS occlusion was significantly lower than that of uncovered EMS (p?=?0.0032). The cumulative stent patency of covered stents was significantly higher than that of uncovered stents (p?=?0.0066). No tumour ingrowth occurred in the covered group while it was observed in 15 patients in the uncovered group. In subgroup analysis, the cumulative patency of the covered EMS was significantly higher in pancreatic cancer (p?=?0.0363) and metastatic lymph nodes (p?=?0.0354). There was no significant difference in survival between the two groups. Acute cholecystitis was observed in two of the covered group and in none of the uncovered group. Mild pancreatitis occurred in five of the covered group and in one of the uncovered group. Conclusions: Covered diamond stents successfully prevented tumour ingrowth and were significantly superior to uncovered stents for the treatment of patients with distal malignant biliary obstruction. However, careful attention must be paid to complications specific to covered self-expandable metal stents, such as acute cholecystitis and pancreatitis.

Isayama, H; Komatsu, Y; Tsujino, T; Sasahira, N; Hirano, K; Toda, N; Nakai, Y; Yamamoto, N; Tada, M; Yoshida, H; Shiratori, Y; Kawabe, T; Omata, M

2004-01-01

358

Stent fracture and restenosis after zotarolimus-eluting stent implantation.  

PubMed

Stent fracture (SF) has been found in peripheral and coronary vasculatures, and in the latter mostly after implantation of sirolimus- or paclitaxel-eluting stents. We report a patient with a fractured stent associated with restenosis after zotarolimus-eluting stent (ZES) implantation which was confirmed by fluoroscopy, intravascular ultrasound and computerized tomography. To our knowledge, this is the first published report of SF after ZES implantation. PMID:19203806

Park, Jong-Seon; Cho, Ihn-Ho; Kim, Young-Jo

2011-03-01

359

Pancreatic enzyme therapy for pancreatic exocrine insufficiency  

Microsoft Academic Search

Pancreatic exocrine insufficiency with steatorrhea is a major consequence of pancreatic diseases (eg, chronic pancreatitis,\\u000a cystic fibrosis, severe acute necrotizing pancreatitis, pancreatic cancer), extrapancreatic diseases such as celiac disease\\u000a and Crohn’s disease, and gastrointestinal and pancreatic surgical resection. Recognition of this entity is highly relevant\\u000a to avoid malnutrition-related morbidity and mortality. Therapy for pancreatic exocrine insufficiency is based on the

J. Enrique Domínguez-Muñoz

2007-01-01

360

Pancreatic pseudocyst  

Microsoft Academic Search

Pancreatic pseudocysts are complications of acute or chronic pancreatitis. Initial diagnosis is accomplished most often by cross-sectional imaging. Endoscopic ultrasound with fine needle aspiration has become the preferred test to help distinguish pseudocyst from other cystic lesions of the pancreas. Most pseudocysts resolve spontaneously with supportive care. The size of the pseudocyst and the length of time the cyst has

Samir Habashi; Peter V Draganov

2009-01-01

361

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

362

The stent decade: 1987 to 1997. Stanford Stent Summit faculty.  

PubMed

In January 1997, experts from the United States, Europe, and Japan gathered at Stanford University to review their collective experience with intracoronary and noncoronary stenting and to identify and prioritize issues requiring further clinical investigation. This report summarizes the discussions that took place during this stent summit. Knowledge of stent-tissue interaction from animal and human pathologic specimens was reviewed in the context of evolving stent designs. The relative merits of coil and slotted tubular stent designs were discussed. Stent deployment routines, including self-expansion, balloon expansion, and high-pressure delivery were debated. The potential for covered stents and coated stents was explored. Problems surrounding the routine deployment of stents were identified: small vessel disease, long lesions, bifurcation stenoses, vein graft disease, ostial disease, left main stenoses, and intrastent restenosis. The value of intravascular ultrasound, as an adjunct to stenting, was explored and debated. An algorithm for "provisional stenting" based on ultrasound criteria was developed. Noncoronary stenting of the aorta, iliacs, and carotids were discussed. Clinical applications that may lead to randomized clinical trials were identified. PMID:9778060

Oesterle, S N; Whitbourn, R; Fitzgerald, P J; Yeung, A C; Stertzer, S H; Dake, M D; Yock, P G; Virmani, R

1998-10-01

363

Case Review of Impacted Bile Duct Stone at Duodenal Papilla: Detection and Endoscopic Treatment  

PubMed Central

Purpose A bile duct stone impacted at the duodenal papilla is an urgent condition that can rapidly lead to either suppurative cholangitis or acute pancreatitis due to almost complete obstruction of the bilio-pancreatic outflow. This study evaluated the clinical characteristics and results of endoscopic treatment for a bile duct stone impacted at the duodenal papilla. Materials and Methods Forty-six patients who had been diagnosed with an impacted papillary stone were retrospectively reviewed. Results The typical features of acute cholangitis (Charcot's triad) and pancreatitis were only observed only in 10 patients (21.7%) and 17 patients (37.0%), respectively. After the endoscopic retrograde cholangiopancreatography, 30 patients (65.2%) were found to have a solitary stone impacting the duodenal papilla and 16 patients had one or more stones in the bile duct. On the radiological studies, the former patients were associated more commonly with no visible stone or no bile duct dilatation (p < 0.05). All impacted papillary stones were successfully removed by endoscopic sphincterotomy: 23 by a needle knife and 23 by a pull type papillotome. The procedure-related complications (n = 7, 4 bleeding, 3 pancreatitis) were not serious and did not differ, based on endoscopic findings and the procedure used. Conclusion A bile duct stone impacted at the duodenal papilla requires both clinical and radiographic evidence to support the diagnosis. Endoscopic sphincterotomy, either with a needle knife or a pull type papillotome, was safe and effective for removing the impacted papillary stone.

Cha, Jae Myung; Jung, Sung Won; Shin, Hyun Phil; Lee, Joung Il; Suh, Yu Jin; Joo, Sunhyung; Bang, Sung-Jo

2010-01-01

364

The influence of potato fibre on exocrine pancreatic secretions and on plasma levels of insulin, secretin and cholecystokinin in growing pigs  

Microsoft Academic Search

The effect of a potato fibre preparation on exocrine pancreatic secretions and on gastrointestinal hormone levels in plasma was studied in three 8 weeks old piglets that were surgically fitted with a jugular vein catheter for blood sampling, a pancreatic duct catheter and a T?shaped duodenal cannula for collection of pancreatic juice. The animals were fed for 2 weeks a

S. Jakob; R. Mosenthin; B. R. Weström; J. F. Rehfeld; O. Olsen; S. Karlsson; B. Ahrén; A. Ohlsson; B. W. Karlsson; S. G. Pierzynowski

2000-01-01

365

A Case of Obstructive Jaundice Caused by Impaction of a Pancreatic Stone in the Papilla for Which a Needle Knife Precut Papillotomy Was Effective  

Microsoft Academic Search

Context Obstructive jaundice in chronic pancreatitis is generally caused by stenosis of the bile duct in the pancreas. Obstructive jaundice caused by the impaction of a pancreatic stone in the papilla is markedly rare, with only seven cases reported to date. Case report We report a case of obstructive jaundice caused by the impaction of a pancreatic stone in the

Itaru Naitoh; Takahiro Nakazawa; Hirotaka Ohara; Tomoaki Ando; Kazuki Hayashi; Fumihiro Okumura; Shozo Togawa; Yasuhiro Kitajima; Tessin Ban; Katsuyuki Miyabe; Koichiro Ueno; Hiroaki Yamashita; Takashi Joh; Hitoshi Sano

366

Sound propagation in curved ducts  

NASA Technical Reports Server (NTRS)

An analysis of the sound field in a circularly curved duct of rectangular cross-section is carried out for both rigid and locally-reacting absorbing walls. The field is excited by a piston source at one end of the duct section, and comparisons of the acoustic field and the net power flow along the duct axis are made with corresponding results for a straight duct section for various frequencies. It is found that in general the curved duct yields a significant increase in sound attenuation along the duct axis as compared to the straight duct.

Myers, M. K.; Mungur, P.

1975-01-01

367

An unusual case of autoimmune pancreatitis presenting as pancreatic mass and obstructive jaundice: a case report and review of the literature  

PubMed Central

Background Autoimmune pancreatitis is a rare chronic inflammatory pancreatic disease that is increasingly being diagnosed worldwide. As a result of overlap in clinical and radiological features, it is often misdiagnosed as pancreatic cancer. We report the case of a patient with autoimmune pancreatitis that was initially misdiagnosed as pancreatic cancer. Case presentation A 31-year-old Caucasian man presented to our hospital with epigastric pain, jaundice and weight loss. His CA 19-9 level was elevated, and computed tomography and endoscopic ultrasound revealed a pancreatic head mass abutting the portal vein. Endoscopic retrograde cholangiopancreaticography showed narrowing of the biliary duct and poor visualization of the pancreatic duct. Fine-needle aspiration biopsy revealed atypical ductal epithelial cells, which raised clinical suspicion of adenocarcinoma. Because of the patient's unusual age for the onset of pancreatic cancer and the acuity of his symptoms, he was referred to a tertiary care center for further evaluation. His immunoglobulin G4 antibody level was 365 mg/dL, and repeat computed tomography showed features typical of autoimmune pancreatitis. The patient's symptoms resolved with corticosteroid therapy. Conclusion Autoimmune pancreatitis is a rare disease with an excellent response to corticosteroid therapy. Its unique histological appearance and response to corticosteroid therapy can reduce unnecessary surgical procedures. A thorough evaluation by a multidisciplinary team is important in rendering the diagnosis of autoimmune pancreatitis.

2011-01-01

368

Turbofan Duct Propagation Model.  

National Technical Information Service (NTIS)

The CDUCT code utilizes a parabolic approximation to the convected Helmholtz equation in order to efficiently model acoustic propagation in acoustically treated, complex shaped ducts. The parabolic approximation solves one-way wave propagation with a marc...

J. H. Lan

2001-01-01

369

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

370

Recurrent Acute Pancreatitis and Cholangitis in a Patient with Autosomal Dominant Polycystic Kidney Disease  

PubMed Central

Autosomal dominant polycystic kidney disease (ADPKD) is an inherited disorder associated with multiple cyst formation in the different organs. Development of pancreatic cyst in ADPKD is often asymptomatic and is associated with no complication. A 38-year-old man with ADPKD was presented with six episodes of acute pancreatitis and two episodes of cholangitis in a period of 12 months. Various imaging studies revealed multiple renal, hepatic and pancreatic cysts, mild ectasia of pancreatic duct, dilation of biliary system and absence of biliary stone. He was managed with conservative treatment for each attack. ADPKD should be considered as a potential risk factor for recurrent acute and/or chronic pancreatitis and cholangitis.

Yazdanpanah, Kambiz; Manouchehri, Navid; Hosseinzadeh, Elinaz; Emami, Mohammad Hassan; Karami, Mehdi; Sarrami, Amir Hossein

2013-01-01

371

Mayo Clinic researchers decode origin of inflammation-driven pancreatic cancer  

Cancer.gov

Researchers at Mayo Clinic in Florida have revealed the process by which chronic inflammation of the pancreas, pancreatitis, morphs into pancreatic cancer. They say their findings point to ways to identify pancreatitis patients at risk of pancreatic cancer and to potential drug therapies that might reverse the process. The study, published online in The Journal of Cell Biology, maps how inflammation pushes acinar cells in the pancreas — those that produce digestive enzymes — to transform into duct-like cells. As these cells change, they can acquire mutations that can result in further progression to pancreatic cancer.

372

Pancreatitis Associated with Pancreatic Carcinoma  

Microsoft Academic Search

The combined occurrence of pancreatic carcinoma with acute or chronic pancreatitis is seldom seen in medical practice, but when present it is a challenging dilemma, plagued by confusing overlapping clinical findings and pitfalls in diagnostic imaging tests. This article reviews the presumptive pathophysiological aspects of this relationship, the perplexing clinical presentations and the advantages and limitations of the noninvasive imaging

E. J. Balthazar

2005-01-01

373

Impaired pancreatic ductal bicarbonate secretion in cystic fibrosis.  

PubMed

Patients with cystic fibrosis demonstrate a defect in HCO(3)(-) secretion by their pancreatic duct cells. However, attempts toward understanding or correcting this defect have been hampered by a lack of knowledge regarding the cellular and molecular mechanisms mediating HCO(3)(-) transport in these cells. Recent functional and molecular studies indicate a major role for a basolateral electrogenically-driven Na(+):HCO(3)(-) cotransporter (NBC1) in mediating the transport of HCO(3)(-) into the duct cells. The HCO(3)(-) exits at the lumen predominantly via two recently discovered apical HCO(3)(-) transporters. cAMP, which mediates the stimulatory effect of secretin on pancreatic ductal HCO(3)(-) secretion, potentiates the basolateral Na(+):HCO(3)(-) cotransporter due to generation of a favorable electrogenic gradient as a result of membrane depolarization by Cl(-)-secreting cystic fibrosis transmembrane conductance regulator (CFTR). Two apical HCO(3)(-) transporters drive the secretion of bicarbonate into the pancreatic duct lumen. Molecular and functional studies indicate that CFTR upregulates the expression of these two apical HCO(3)(-) transporters. In addition, CFTR may also upregulate the expression of certain water channels and facilitate the secretion of fluid into the duct lumen. In brief, current research suggests that the defect in pancreatic HCO(3)(-) secretion in patients with cystic fibrosis is multifactorial and involves the alteration in the function/expression of transporters at the basolateral and luminal membrane domains of the duct cells. PMID:11875265

Soleimani, M

2001-07-01

374

Pancreatic Exocrine Secretion During the First Days After Weaning in Pigs1  

Microsoft Academic Search

Feed replacement at weaning plays an important role in the induction of pancreatic maturation. To understand the changes in the exo- crine pancreas at weaning and the relation to postweaning problems, we studied the function of the exocrine pancreas and changes of intestinal hemolytic Escherichia coli in four pigs. The pigs were chronically fitted with pancreatic duct catheters and T-shaped

D. Rantzer; P. Kiela; J. Svendsen; B. Ahren; S. Karlsson; S. G. Pierzynowski

2010-01-01

375

New Frontiers in the Pharmacological Prevention of Post-ERCP Pancreatitis: The Cytokines  

Microsoft Academic Search

Summary Acute pancreatitis is a major complication of endoscopic retrograde cholangiopancreato- graphy (ERCP), its incidence varying with the indications for the procedure (<5% for the management of common bile duct stones and up to 20% in the case of sphincter of Oddi dysfunction) and also with events occurring during the ERCP such as acinarization and pancreatic sphincterotomy. If the triggering

Anne Demols; Jacques Deviere

376

Follicular pancreatitis, report of a case clinically mimicking pancreatic cancer and literature review.  

PubMed

We herein present a 71-year-old man who underwent pancreatoduodenectomy with the diagnosis of follicular pancreatitis. We could not completely deny malignancy by a preoperative imaging study. Endoscopic ultrasonography-guided fine needle aspiration biopsy demonstrated clusters of benign acinar cells and no proliferation of atypical lymphoid cells or rich plasma cells. Histologically, the prominent lymphoid follicle formation was seen in an ill-defined mass, 15 mm in size, in the pancreatic parenchyma. Duct-centered fibrotic rims were seen in the pancreatic ducts accompanied by mild fibrotic change between the follicles and obliterative phlebitis. No neoplastic epithelial cells were observed in the resected specimen, and infiltrating lymphocytes did not show any morphological atypia and monoclonal proliferation by immunohistochemical staining with B and T cell markers. In addition, we could exclude IgG4-related disease, because plasmacytic cells were rarely positive for IgG4. Although follicular pancreatitis is rare, this mass-forming inflammatory disease (pancreatitis) should be included in the preoperative differential diagnosis of pancreatic cancer. PMID:24476826

Mizuuchi, Yusuke; Aishima, Shinichi; Hattori, Masami; Ushijima, Yasuhiro; Aso, Akira; Takahata, Shunichi; Ohtsuka, Takao; Ueda, Junji; Tanaka, Masao; Oda, Yoshinao

2014-02-01

377

A case of obstructive jaundice due to autoimmune pancreatitis and a review of the literature.  

PubMed

A 33-year-old man presented with jaundice, mild pancreatitis, and some weight loss. Laboratory tests showed cholestatic icterus. Imaging revealed distal bile duct obstruction and a mass in the head of the pancreas suspicious for cancer. Besides the enlargement of the head, the whole pancreatic parenchyma was altered. Therefore, autoimmune pancreatitis was considered. Endoscopic ultrasound biopsy found pancreatic tissue with lymphoplasmacytic inflammation and fibrosis. IgG4 serum concentration was within normal range. Due to the benign histology, a therapeutic attempt with prednisolone was initiated. The radiologic changes improved within 2 weeks, which supported the diagnosis of autoimmune pancreatitis. Bile duct obstruction and radiologic abnormalities of the pancreas completely resolved after a 4-month course of steroid treatment. Within 10 months, no relapse occurred. In context with this case, the recent literature was reviewed and the international consensus diagnostic criteria for autoimmune pancreatitis are summarized. PMID:24482076

Wewalka, Friedrich; Ziachehabi, Alexander

2014-02-01

378

[Autoimmune pancreatitis mimicking pancreatic tumor].  

PubMed

Autoimmune pancreatitis (AIP) is a rare disease of unknown pathomechanism. AIP belongs to the IgG4-related disease family and responds well to steroids, although the relapse rate can reach up to 20-30%. Differentiation of AIP from the more common pancreatic cancer can be very challenging. About 20% of autoimmune pancreatitis is diagnosed postoperatively during final histological examination. While each of diagnostic investigations provide some additional information towards definitive diagnosis, the question still remains whether it is possible to prevent unnecessary pancreatic resection. We demonstrate the differential diagnostic opportunities when we present our case as well as discuss the literature data of this condition. In conclusion, we think that in case of a focal pancreatic lesion AIP should always be considered. PMID:24566656

Dede, Kristóf; Salamon, Ferenc; Taller, András; Bursics, Attila

2014-02-01

379

Intrapancreatic course of the splenic artery with combined pancreatic anomalies.  

PubMed

In a 47-year-old male cadaver the splenic artery traveled partially through the substance of the pancreas. Additionally, the pancreas was apparently large and had an unusual shape; the neck of the organ could not be differentiated; the uncinate processus was absent; two pancreatic ducts were present. The probable reason for this combined anomaly was abnormal fusion of the ventral and dorsal pancreatic buds due to different levels of origin. PMID:9479717

Ozan, H; Onderoglu, S

1997-01-01

380

Chronic pancreatitis  

PubMed Central

Introduction Chronic pancreatitis affects 3–9 people in 100,000; 70% of cases are alcohol-induced. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of lifestyle interventions in people with chronic pancreatitis? What are the effects of dietary supplements in people with chronic pancreatitis? What are the effects of drug interventions in people with chronic pancreatitis? What are the effects of nerve blocks for pain relief in people with chronic pancreatitis? What are the effects of different invasive treatments for specific complications of chronic pancreatitis? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2011 (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 27 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: avoiding alcohol consumption, biliary decompression, calcium supplements, ductal decompression (endoscopic or surgical), low-fat diet, nerve blocks, opioid analgesics, pancreatic enzyme supplements, pseudocyst decompression (endoscopic or surgical), resection using distal pancreatectomy, resection using pancreaticoduodenectomy (Kausch–Whipple or pylorus-preserving), and vitamin/antioxidant supplements.

2011-01-01

381

Chronic pancreatitis  

PubMed Central

Introduction Chronic pancreatitis affects 3–9 people in 100,000; 70% of cases are alcohol-induced. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of lifestyle interventions in people with chronic pancreatitis? What are the effects of dietary supplements in people with chronic pancreatitis? What are the effects of drug interventions in people with chronic pancreatitis? What are the effects of nerve blocks for pain relief in people with chronic pancreatitis? What are the effects of different invasive treatments for specific complications of chronic pancreatitis? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2008 (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 23 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: avoiding alcohol consumption, biliary decompression, calcium supplements, ductal decompression (endoscopic or surgical), low-fat diet, nerve blocks, opioid analgesics, pancreatic enzyme supplements, pseudocyst decompression (endoscopic or surgical), resection using distal pancreatectomy, resection using pancreaticoduodenectomy (Kausch–Whipple or pylorus-preserving), and vitamin/antioxidant supplements.

2008-01-01

382

Pancreatic sarcoidosis.  

PubMed

Sarcoidosis affects every organ in the body; the most frequently involved structures are the lung, lymph nodes, liver, spleen, eyes, joints and heart. Gastrointestinal system affliction is uncommon. The pancreas is rarely affected by sarcoidosis. A review of the literature revealed only 13 patients with biopsy proven granulomas in pancreas or peripancreatic nodes. In a review of all autopsies performed between 1950 and 1993 at Los Angeles County + University of Southern California School of Medicine, Los Angeles, USA, the authors found one patient with pancreatic and 5 with peripancreatic lymph node granuloma. The authors also describe three previously unreported cases of pancreatic sarcoidosis. From the discussion, a clinically useful and pragmatic profile of pancreatic sarcoidosis emerges. Two thirds of the patients with pancreatic sarcoidosis have abdominal pain, and three quarters of them have bilateral hilar adenopathy. The occurrence of abdominal pain in a woman with bilateral hilar adenopathy with or without pulmonary infiltration should lead one to think of pancreatic sarcoidosis. The diagnosis should be established by a tissue biopsy because the laboratory and radiographic techniques do not differentiate pancreatic sarcoidosis from other inflammatory and malignant disorders of the pancreas. The prognosis of pancreatic sarcoidosis is good. PMID:8865406

Garcia, C; Kumar, V; Sharma, O P

1996-03-01

383

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

384

The Management of Acute and Chronic Pancreatitis  

PubMed Central

Pancreatitis, which is most generally described as any inflammation of the pancreas, is a serious condition that manifests in either acute or chronic forms. Chronic pancreatitis results from irreversible scarring of the pancreas, resulting from prolonged inflammation. Six major etiologies for chronic pancreatitis have been identified: toxic/ metabolic, idiopathic, genetic, autoimmune, recurrent and severe acute pancreatitis, and obstruction. The most common symptom associated with chronic pancreatitis is pain localized to the upper-to-middle abdomen, along with food malabsorption, and eventual development of diabetes. Treatment strategies for acute pancreatitis include fasting and short-term intravenous feeding, fluid therapy, and pain management with narcotics for severe pain or nonsteroidal anti-inflammatories for milder cases. Patients with chronic disease and symptoms require further care to address digestive issues and the possible development of diabetes. Dietary restrictions are recommended, along with enzyme replacement and vitamin supplementation. More definitive outcomes may be achieved with surgical or endoscopic methods, depending on the role of the pancreatic ducts in the manifestation of disease.

Banks, Peter A.; Conwell, Darwin L.; Toskes, Phillip P.

2010-01-01

385

Clear cell carcinoid tumor of the distal common bile duct  

PubMed Central

Background Carcinoid tumors rarely arise in the extrahepatic bile duct and can be difficult to distinguish from carcinoma. There are no reports of clear cell carcinoid (CCC) tumors in the distal bile duct (DBD) to the best of our knowledge. Herein, we report a CCC tumor in the DBD and review the literature concerning extrahepatic bile duct carcinoid tumors. Case presentation A 73-old man presented with fever and occult obstructive jaundice. Ultrasonography, computed tomography (CT) and magnetic resonance cholangiopancreaticography (MRCP) demonstrated a nodular tumor projection in the DBD without regional lymph node swelling. Under suspicion of carcinoma, we resected the head of the pancreas along with 2nd portion duodenectomy and a lymph node dissection. The surgical specimen showed a golden yellow polypoid tumor in the DBD (0.8 × 0.6 × 0.5 cm in size). The lesion was composed of clear polygonal cells arranged in nests and a trabecular pattern. The tumor invaded through the wall into the fibromuscular layer. Immunohistochemical stains showed that neoplastic cells were positive for neuron-specific enolase (NSE), chromogranin A, synaptophysin, and pancreatic polypeptide and negative for inhibin, keratin, CD56, serotonin, gastrin and somatostatin. The postoperative course was uneventful and he is living well without relapse 12 months after surgery. Conclusion Given the preoperative difficulty in differentiating carcinoid from carcinoma, the pancreaticoduodenectomy is an appropriate treatment choice for carcinoid tumors located within the intra-pancreatic bile duct.

Todoroki, Takeshi; Sano, Takaaki; Yamada, Shuji; Hirahara, Nobutsune; Toda, Naotaka; Tsukada, Katsuhiko; Motojima, Ryuji; Motojima, Teiji

2007-01-01

386

[Drug-eluting coronary stents].  

PubMed

The first method of percutaneously treating a diseased vessel was developed by Dotter and Judkins in 1964. Andreas Grüntzig performed the first coronary angioplasty in 1977. In 1985 Palmaz et al. implanted the first balloon-mounted stent in a peripheral artery. Puel and Sigwart implanted the first human coronary stent in March 1986; it was a self-expanding mesh-like device. Schatz et al. applied some small modifications to the original Palmaz stent, which resulted in the first coronary stent available on the market, called Palmaz-Schatz stent. In 1987 Sigwart was the first to suggest the use of coronary stents in acute vessel occlusions during unsuccessful PTCA. Using the device it became possible to cover the intimal flap and to prevent elastic recoil. Because of the high incidence of subacute stent thromboses and the bleeding complications (aggressive anticoagulation regimens) these times the coronary stents were implanted only in order to avoid emergency CABG surgery. In 1993 BENESTENT and STRESS trials have proved that elective stent implantation can significantly reduce the incidence of restenosis. The dual antiplatelet therapy and the high pressure stent implantation technique dramatically reduced the incidence of subacute stent thrombosis. The treatment of coronary artery disease has undergone revolutionary changes in the past decade but remained the leading cause of mortality in the developed world. The most important limitation of PCI has been in-stent restenosis, which occurs in 20-40% of stent implantations. Clinically it results in recurrent ischemic episodes most often requiring repeat revascularisation (rePCI or CABG). With the use of drug-eluting stents the incidence of in-stent restenosis can be reduced dramatically, based on the currently available clinical trials it remains below 10%. PMID:17297752

Fontos, Géza

2006-10-29

387

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

388

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

389

Endoscopic management of bile duct stones.  

PubMed

The surgical risk of common duct exploration for the treatment of biliary calculi is considerably higher than that of cholecystectomy. Therefore, introduction of endoscopic sphincterotomy in 1974 was a major advance. It has become the therapy of choice in cholecystectomized patients or in those with an increased operative risk. Endoscopic sphincterotomy has a mortality rate of around 1% and a morbidity rate of 7%. These figures compare favourably with open surgery, especially in old patients. The procedure fails in about 10% of all patients referred for endoscopic removal of their calculi. However, several techniques have been described or are currently under evaluation to overcome these failures: intracorporeal or extracorporeal lithotripsy, long-term stenting of the bile duct, or direct application of solvents. Long-term follow-up studies show that between 2% and 20% of successfully managed patients may develop recurrent stones, mainly caused by bile stasis and infection. Patients with a functioning gall-bladder and no concomitant gall-bladder stones probably do not require cholecystectomy after successful endoscopic treatment of their choledochal stones. While endoscopic stone removal has replaced surgery in the elderly frail patients it has no major advantages in the young and fit patients, especially when the gall-bladder is still in situ. PMID:1611022

Sauerbruch, T

1992-01-01

390

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

391

The role of oxygen free radicals in experimental acute pancreatitis in the rat  

Microsoft Academic Search

Summary  In order to elucidate the role of oxygen-derived free radicals in acute pancreatitis, scavengers and an inhibitor of production\\u000a of these free radicals were administered to rats with experimentally-induced acute pancreatitis. Acute reflux pancreatitis\\u000a was produced by the occlusion of the common bile duct (OCD). Catalase and superoxide dismutase (SOD) were used as scavengers,\\u000a and allopurinol was used as an

Toshihiko Koiwai; Hisao Oguchi; Shigeyuki Kawa; Yasutoshi Yanagisawa; Takeshi Kobayashi; Tatsuji Homma

1989-01-01

392

[Criteria of diagnostics of pancreatitis at children's age according to ultrasound research].  

PubMed

In the article new criteria of diagnostics of chronic and reactive pancreatitis due to sonography data are described. Among symptoms of reactive pancreatitis are as follows: presence of pancreatic edema, appearance of hyper echogenic lineal admixtures (visualization of connective tissues jumpers). Among criteria of reactive pancreatitis due to ultrasonography belong all as follows: local (59.7%) or diffuse hyper echogenic (18.8%) parenchyma comparatively to parenchyma of parotic gland, as well as small dots or triangle-like formations - marker of fibrosis. At the same time among signs of long-lasting pancreatitis these symptoms are also characteristic areas of hypoechogenic parenchyma which mimic areas of hyperechogenic structure of pancreas (44.0% of incidences). Widening of pancreatic duct like prominent symptom of chronic pancreatitis they noticed in 1/3 cases of reactive pancreatitis together with local edema of pancreas. PMID:24772868

Lembrik, I S

2013-01-01

393

Comparison of scanning electron microscopy findings regarding biofilm colonization with microbiological results in nasolacrimal stents for external, endoscopic and transcanalicular dacryocystorhinostomy  

PubMed Central

AIM To compare bacterial biofilm colonization in lacrimal stents following external dacryocystorhinostomy (EX-DCR), endoscopic dacryocystorhinostomy (EN-DCR), and transcanalicular dacryocystorhinostomy (TC-DCR) with multidiode laser. METHODS This prospective study included 30 consecutive patients with nasolacrimal duct obstruction who underwent EXT-, EN-, or TC-DCR. Thirty removed lacrimal stent fragments and conjunctival samples were cultured. The lacrimal stent biofilms were examined by scanning electron microscopy (SEM). RESULTS Eleven (36.7%) of the 30 lacrimal stent cultures were positive for aerobic bacteria (most commonly Staphylococcus epidermidis and Pseudomonas aeruginosa). However anaerobic bacteria and fungi were not identified in the lacrimal stent cultures. Twenty-seven (90%) patients had biofilm-positive lacrimal stents. The conjunctival culture positivity after the DCR, biofilm positivity on stents, the grade of biofilm colonization, and the presence of mucus and coccoid and rod-shaped organisms did not significantly differ between any of the groups (P>0.05). However, a significant difference was found when the SEM results were compared to the results of the lacrimal stent and conjunctival cultures (P<0.001). CONCLUSION Type of dacryocystorhinostomy (DCR) surgery did not affect the biofilm colonization of the lacrimal stents. SEM also appears to be more precise than microbiological culture for evaluating the presence of biofilms on lacrimal stents.

Balikoglu-Yilmaz, Melike; Yilmaz, Tolga; Cetinel, Sule; Taskin, Umit; Banu Esen, Ayse; Taskapili, Muhittin; Kose, Timur

2014-01-01

394

Molecular mechanisms of pancreatic injury  

PubMed Central

Purpose of review The pathogenesis of acute pancreatitis (AP) is still not well understood. This articles reviews recent advances in our understanding of AP with emphasis on literature published during the last year. Recent Findings Zymogen activation was shown to be sufficient to induce AP. Another key early event, NFkB activation has previously been shown to induce AP. The relationship between these two key early steps is beginning to be clarified. The mechanisms responsible for zymogen activation- pathologic calcium signaling, pH changes, colocalization and autophagy; mechanisms of NFkB activation and potential therapeutic targets both upstream and downstream of these key events have been explored. Additional key findings have been elucidation of the dual role of oxidative stress in AP and role of bioenergetics in determining mode of cell death, recognition of endoplasmic reticulum stress as an early step and duct cells as important players in pancreatic injury. Summary Current findings have provided further insight into the roles and mechanisms of zymogen activation and inflammatory pathways in pancreatic injury. Future studies are being undertaken to establish the relative contributions of these pathways during acute pancreatitis which will be critical to identifying successful therapeutic targets.

Sah, Raghuwansh P; Saluja, Ashok

2013-01-01

395

Endoscopic treatment of pancreatic calculi.  

PubMed

Chronic pancreatitis is a progressive inflammatory disease that destroys pancreatic parenchyma and alters ductal stricture, leading to ductal destruction and abdominal pain. Pancreatic duct stones (PDSs) are a common complication of chronic pancreatitis that requires treatment to relieve abdominal pain and improve pancreas function. Endoscopic therapy, extracorporeal shock wave lithotripsy (ESWL), and surgery are treatment modalities of PDSs, although lingering controversies have hindered a consensus recommendation. Many comparative studies have reported that surgery is the superior treatment because of reduced duration and frequency of hospitalization, cost, pain relief, and reintervention, while endoscopic therapy is effective and less invasive but cannot be used in all patients. Surgery is the treatment of choice when endoscopic therapy has failed, malignancy is suspected, or duodenal stricture is present. However, in patients with the appropriate indications or at high-risk for surgery, endoscopic therapy in combination with ESWL can be considered a first-line treatment. We expect that the development of advanced endoscopic techniques and equipment will expand the role of endoscopic treatment in PDS removal. PMID:24944986

Kim, Yong Hoon; Jang, Sung Ill; Rhee, Kwangwon; Lee, Dong Ki

2014-05-01

396

Endoscopic Treatment of Pancreatic Calculi  

PubMed Central

Chronic pancreatitis is a progressive inflammatory disease that destroys pancreatic parenchyma and alters ductal stricture, leading to ductal destruction and abdominal pain. Pancreatic duct stones (PDSs) are a common complication of chronic pancreatitis that requires treatment to relieve abdominal pain and improve pancreas function. Endoscopic therapy, extracorporeal shock wave lithotripsy (ESWL), and surgery are treatment modalities of PDSs, although lingering controversies have hindered a consensus recommendation. Many comparative studies have reported that surgery is the superior treatment because of reduced duration and frequency of hospitalization, cost, pain relief, and reintervention, while endoscopic therapy is effective and less invasive but cannot be used in all patients. Surgery is the treatment of choice when endoscopic therapy has failed, malignancy is suspected, or duodenal stricture is present. However, in patients with the appropriate indications or at high-risk for surgery, endoscopic therapy in combination with ESWL can be considered a first-line treatment. We expect that the development of advanced endoscopic techniques and equipment will expand the role of endoscopic treatment in PDS removal.

Kim, Yong Hoon; Jang, Sung Ill; Rhee, Kwangwon

2014-01-01

397

CT appearance of implanted esophageal stents.  

PubMed

Three different types of esophageal stents, the Z-stent, Ultraflex, and Wall-stent, exhibit different shapes on CT, which may suggest a difference in the radial forces applied by each of the stents. CT is useful for displaying the relationship between an esophageal stent and adjacent structures and complications. PMID:10667652

Iwasaki, Y; Nakajima, Y; Ishikawa, T; Wakabayashi, M; Ashida, H

2000-01-01

398

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

399

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

PubMed

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. PMID:10795847

Nakamura, T; Kitagawa, M; Takehira, Y; Yamada, M; Kawasaki, T; Nakamura, H

2000-01-01