International journal of pancreatology : official journal of the International Association of Pancreatology最新文献

{"title":"Experience with duodenal necrosis. A rare complication of acute necrotizing pancreatitis.","authors":"G H Sakorafas,&nbsp;G G Tsiotos,&nbsp;M G Sarr","doi":"10.1385/IJGC:25:2:147","DOIUrl":"https://doi.org/10.1385/IJGC:25:2:147","url":null,"abstract":"<p><p>Duodenal necrosis is a rare, but very serious complication of acute necrotizing pancreatitis that most likely is the result of vascular compromise and ischemia of the peri-Vaterian aspect of the duodenal wall. In this article, we present three patients with duodenal necrosis complicating acute necrotizing pancreatitis. The diagnosis was made at the time of necrosectomy. Management options of this challenging complication of necrotizing pancreatitis are discussed.</p>","PeriodicalId":73464,"journal":{"name":"International journal of pancreatology : official journal of the International Association of Pancreatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1999-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1385/IJGC:25:2:147","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21228806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonoperative management of pancreatic pseudocysts. Problems in differential diagnosis.","authors":"U Boggi,&nbsp;G Di Candio,&nbsp;A Campatelli,&nbsp;A Pietrabissa,&nbsp;F Mosca","doi":"10.1385/ijgc:25:2:123","DOIUrl":"https://doi.org/10.1385/ijgc:25:2:123","url":null,"abstract":"<p><strong>Conclusion: </strong>The evaluation of pancreatic cystic lesions entails a misdiagnosis risk. Awareness of the problem, knowledge of the natural history of these lesions, and meticulous posttreatment follow-up can reduce the consequences of diagnostic errors. If all these precautions are adopted, pancreatic pseudocysts can be safely treated nonoperatively.</p><p><strong>Background: </strong>The accurate diagnosis of pancreatic cystic lesions remains a problem. The aim of this study was to ascertain the incidence of and the reasons the diagnostic errors occurred in a series of pseudocysts drained percutaneously and to compare these data to those reported in the literature.</p><p><strong>Methods: </strong>Data from 70 patients bearing one or more pseudocysts who underwent a percutaneous drainage were reviewed. The pretreatment workup included medical history, physical examination, ultrasound (US) and computed tomography (CT) scans, amylase assay in both the serum and the cystic fluid, culture and cytology of the cystic fluid. After removal of the drainage, the minimum follow-up period was 12 mo.</p><p><strong>Results: </strong>Four patients died, and two cancer-associated pseudocysts were identified before removal of the drainage. Sixty-four patients were followed up for a mean of 51.9 mo (range 12-154 mo). A third cancer and a mucinous cystic tumor, fully communicating with the main duct, were further detected during this period.</p>","PeriodicalId":73464,"journal":{"name":"International journal of pancreatology : official journal of the International Association of Pancreatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1999-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1385/ijgc:25:2:123","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21228849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The link between exocrine pancreatic cancer and the endocrine pancreas.","authors":"P M Pour,&nbsp;B Schmied","doi":"10.1385/IJGC:25:2:77","DOIUrl":"https://doi.org/10.1385/IJGC:25:2:77","url":null,"abstract":"<p><strong>Conclusion: </strong>Experimental and human studies during 20 years of research in our laboratories point to the importance of pancreatic islets in the development of ductal-type adenocarcinomas. We believe that pancreatic cancer that develops within ducts, but more frequently within islets, derives from pancreatic stem cells that are distributed within the ductal trees and within the islets.</p><p><strong>Background: </strong>The histogenesis of pancreatic cancer is still debatable. Ductal, ductular, and acinar cells all have been declared the tumor progenitor cells. Our long-term human and experimental studies indicate that pancreatic ductal adenocarcinomas arise within ductal cells and islets. Supporting studies are presented in this article.</p><p><strong>Methods: </strong>Several human studies and experimental studies on Syrian hamsters conducted within the last 20 years were used in this article. Hamster and human islets were established, and their growth and morphologic changes were examined electron microscopically, immunohistochemically, cytogenetically, and molecular biologically.</p><p><strong>Results: </strong>Studies using the hamster pancreatic cancer model showed that most pancreatic adenocarcinomas develop within islets, most probably from stem cells, which are also believed to be the progenitor cells for tumors that develop within ducts. Studies in newly established human and hamster islets culture validated the immense potential of islet cells to differentiate and become malignant. The higher susceptibility of islet cells to become malignant could be related to their high drug-metabolizing enzymes and their high proliferation rate. Dietary studies indicate that the promoting effect of a high-fat diet on pancreatic carcinogenesis is unrelated to the energy intake, but rather is related to its effect on islet cell replication.</p>","PeriodicalId":73464,"journal":{"name":"International journal of pancreatology : official journal of the International Association of Pancreatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1999-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1385/IJGC:25:2:77","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21228298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality from acute pancreatitis. Late septic deaths can be avoided but some early deaths still occur.","authors":"A Lowham,&nbsp;J Lavelle,&nbsp;T Leese","doi":"10.1385/IJGC:25:2:103","DOIUrl":"https://doi.org/10.1385/IJGC:25:2:103","url":null,"abstract":"<p><strong>Conclusion: </strong>In patients with acute pancreatitis, late \"septic\" deaths resulting from infection of pancreatic tissue can be avoided, but some early deaths are unavoidable owing to serious multiorgan dysfunction often combined with age or other comorbid conditions.</p><p><strong>Methods: </strong>A retrospective review was conducted of 105 patients admitted to the Royal Lancaster Infirmary with the diagnosis of acute pancreatitis over a 2-yr period (January 1, 1996 to December 31, 1997).</p><p><strong>Results: </strong>Six patients admitted during the study period died with a mortality rate of 5.7%. All patients died within 6 d of admission and received care in the intensive care unit. All presented with serious comorbid medical problems and/or developed early multiorgan dysfunction syndrome (MODS). Ten patients underwent pancreatic necrosectomy with no mortality.</p>","PeriodicalId":73464,"journal":{"name":"International journal of pancreatology : official journal of the International Association of Pancreatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1999-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1385/IJGC:25:2:103","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21228846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proteases and protease inhibitors in taurocholate-induced acute pancreatitis in rats.","authors":"P Kruse,&nbsp;E Hage,&nbsp;A Lasson","doi":"10.1385/IJGC:25:2:113","DOIUrl":"https://doi.org/10.1385/IJGC:25:2:113","url":null,"abstract":"<p><strong>Conclusion: </strong>Taurocholate-induced acute pancreatitis (AP) in the rat mimics early necrotizing human pancreatitis. Protease activation and protease inhibitor consumption occur consistent with a two-stage development, and contact-phase activation is a possible primary event in this model.</p><p><strong>Background: </strong>Proteases and protease inhibitors have been indicated to play an important role in both human and experimental acute pancreatitis, although little is known about them in rats.</p><p><strong>Methods: </strong>Three percent sodium taurocholate was infused into the bilio-pancreatic duct to induce AP, and over 0-72 h we measured lipase, amylase, albumin, prekallikrein, factor X, alpha-1-macroglobulin, alpha-2-antiplasmin, antithrombin III, alpha-1-protease inhibitor, and C1-esterase inhibitor (all in plasma) and histologic and macroscopic findings.</p><p><strong>Results: </strong>A severe necrotizing, nonlethal, AP was induced with an early increase in plasma lipase and alpha-amylase activity levels and peritoneal exudate followed by a return to near control levels after 72 h. Histologic score and pancreatic wet weight ratio increased initially and remained high during the observation period. The protease inhibitors C1-esterase inhibitor, alpha-2-antiplasmin, and antithrombin III decreased early, within 0-6 h, whereafter levels normalized. The protease inhibitors alpha-1-macroglobulin and alpha-1-protease inhibitor later gradually decreased over the 72 h.</p>","PeriodicalId":73464,"journal":{"name":"International journal of pancreatology : official journal of the International Association of Pancreatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1999-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1385/IJGC:25:2:113","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21228847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic unilateral lymphoedema caused by a pancreatic pseudocyst.","authors":"C D Sutton,&nbsp;S A White,&nbsp;G S Robertson,&nbsp;A R Dennison","doi":"10.1385/IJGC:25:2:143","DOIUrl":"https://doi.org/10.1385/IJGC:25:2:143","url":null,"abstract":"","PeriodicalId":73464,"journal":{"name":"International journal of pancreatology : official journal of the International Association of Pancreatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1999-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1385/IJGC:25:2:143","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21228850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neopterin serum levels in pancreatic adenocarcinoma.","authors":"G Manes,&nbsp;O A Spada,&nbsp;P G Rabitti,&nbsp;B Feola,&nbsp;S Misso,&nbsp;A Minerva,&nbsp;G Uomo","doi":"10.1385/IJGC:25:1:31","DOIUrl":"https://doi.org/10.1385/IJGC:25:1:31","url":null,"abstract":"<p><strong>Conclusions: </strong>Activation of the immune system in pancreatic cancer is demonstrated by increased serum levels of neopterin, soluble Interleukin 2 receptor (sIL-2R), and Interleukin 6 (IL-6). Determination of these parameters does not provide benefit in the diagnosis of pancreatic cancer.</p><p><strong>Background: </strong>The aim of the study was to define the diagnostic value of serum neopterin, an in vivo marker of macrophage activity, in pancreatic cancer.</p><p><strong>Methods: </strong>Thirty-four patients with pancreatic cancer were studied. According to the UICC TNM classification 6 were in stage I, 9 in stage II, 6 in stage III, and 13 in stage IV. Twenty-four patients with chronic pancreatitis, 72 healthy blood donors, and 20 patients with jaundice resulting from gallstones were used as control groups. Neopterin, tumor necrosis factor (TNF), sIL-2R, and IL-6 were measured in serum in the different groups; Ca 19-9 was also measured in cancer and pancreatitis.</p><p><strong>Results: </strong>Serum levels of neopterin, sIL-2R, and IL-6 were higher in cancer than in pancreatitis and healthy donors, and in pancreatitis higher than in donors. Serum TNF was similar in the three groups. Serum levels of neopterin, TNF, sIL-2R, and IL-6 were not related to the tumor stage or to Ca 19-9 levels. A positive correlation was found between sIL-2R and neopterin levels. Neopterin levels in obstructive jaundice were similar to those of pancreatitis. Ca 19-9 at the recommended cutoff of 37 U/mL showed the best sensitivity and specificity (88.2 and 87.5%, respectively). At the selected cutoff neopterin, TNF, sIL-2R, and IL-6 showed low sensitivity and specificity in differentiating cancer from pancreatitis.</p>","PeriodicalId":73464,"journal":{"name":"International journal of pancreatology : official journal of the International Association of Pancreatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1999-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1385/IJGC:25:1:31","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21082073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Molecular forms of serum pancreatic stone protein in acute pancreatitis.","authors":"Y Nakae,&nbsp;S Naruse,&nbsp;M Kitagawa,&nbsp;H Ishiguro,&nbsp;M Kato,&nbsp;S Hayakawa,&nbsp;T Kondo,&nbsp;T Hayakawa","doi":"10.1385/IJGC:25:1:17","DOIUrl":"https://doi.org/10.1385/IJGC:25:1:17","url":null,"abstract":"<p><strong>Conclusion: </strong>Elevation of serum pancreatic stone protein-(PSP) S1 suggests activation of trypsinogen in the pancreas. This information would prompt the start of intensive treatment and may improve prognosis of acute pancreatitis (AP).</p><p><strong>Background: </strong>PSP exists in two molecular forms, PSP-S2-5 and PSP-S1. PSP-S1 is produced by enzyme cleavage of PSP-S2-5 by trypsin. Total serum PSP rose in AP, but little is known about its molecular forms. In this study, we characterized the molecular forms of serum PSP in AP.</p><p><strong>Methods: </strong>Sera were taken from 8 patients with severe acute pancreatitis (sAP) and from 11 patients with mild acute pancreatitis (mAP). Serum PSP was characterized by high-performance liquid chromatography (HPLC) followed by the specific enzyme immunoassay (EIA).</p><p><strong>Results: </strong>The total serum PSP in sAP was higher than in mAP, but the difference was not significant. The PSP-S1 was detected in serum in all (7/7) patients in sAP and in 72% (8/11) of patients in mAP. Serum level of PSP-S1 was significantly higher in sAP than that in mAP (p < 0.05), and the cutoff value to distinguish the two groups was 30 ng/mL. Serum PSP-S1 did not show significant correlation with total PSP, immunoreactive trypsin, or C-reactive protein.</p>","PeriodicalId":73464,"journal":{"name":"International journal of pancreatology : official journal of the International Association of Pancreatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1999-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1385/IJGC:25:1:17","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21082107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intrapancreatic accessory spleen. A rare cause of a pancreatic mass.","authors":"J M Läuffer,&nbsp;H U Baer,&nbsp;C A Maurer,&nbsp;M Wagner,&nbsp;A Zimmermann,&nbsp;M W Büchler","doi":"10.1385/IJGC:25:1:65","DOIUrl":"https://doi.org/10.1385/IJGC:25:1:65","url":null,"abstract":"<p><strong>Conclusion: </strong>The clinical significance of intrapancreatic accessory spleens resides in the mimicry of pancreatic cancer. Radionuclide tests (Octreotide scan and Tc99m sulfur colloid scan) should be undertaken to distinguish these lesions from neuroendocrine tumors, hypervascular metastases and pancreatic carcinoma. If the tests are equivocal, diagnostic laparotomy or laparoscopy is recommended.</p><p><strong>Background: </strong>Despite its relatively common occurrence, intrapancreatic ectopic splenic tissue is rarely detected owing to its asymptomatic nature.</p><p><strong>Methods: </strong>We report a case of a clinically asymptomatic patient in which abdominal computed tomography (CT) scans revealed a mass of 1.5 cm in diameter in the distal pancreas. The tumor markers CA 19-9 and carcinoembryonic antigen (CEA) were slightly elevated, and pancreatic neoplasm was suspected.</p><p><strong>Results: </strong>Left pancreatic resection and splenectomy were performed. The removed specimen disclosed the presence of an accessory spleen within the pancreatic tail.</p>","PeriodicalId":73464,"journal":{"name":"International journal of pancreatology : official journal of the International Association of Pancreatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1999-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1385/IJGC:25:1:65","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21082077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative hepatic functional risk assessed with technetium-99m diethylenetriamine pentaacetic acid-galactosyl human serum albumin liver scintigraphy in patients undergoing pancreaticoduodenectomy complicated by obstructive jaundice.","authors":"H Nakano,&nbsp;K Kumada,&nbsp;Y Takekuma,&nbsp;S Hasebe,&nbsp;Y Yoshizawa,&nbsp;M Yamaguchi,&nbsp;D Jaeck","doi":"10.1385/IJGC:25:1:3","DOIUrl":"https://doi.org/10.1385/IJGC:25:1:3","url":null,"abstract":"<p><strong>Conclusion: </strong>Liver scintigraphy with technetium-99m diethylenetriamine pentaacetic acid-galactosyl human serum albumin (Tc-GSA) can be used to predict outcome of biliary drainage and hepatic function after pancreaticoduodenectomy in patients with pancreatic, biliary, and ampullary carcinomas complicated by obstructive jaundice.</p><p><strong>Background: </strong>Preoperative obstructive jaundice has been reported as a crucial risk factor for serious postoperative complications in patients undergoing pancreaticoduodenectomy. The aim of the present study was to investigate whether Tc-GSA liver scintigraphy can assess hepatic functional risk in patients with pancreatic, biliary, and ampullary carcinomas complicated by obstructive jaundice.</p><p><strong>Methods: </strong>Liver scintigraphy was performed before biliary drainage in 18 patients with obstructive jaundice. The maximum removal rate of Tc-GSA (GSA-Rmax; standard normal value > or = 0.60) was calculated. These patients underwent pancreaticoduodenectomy with wide lymphadenectomy. The efficacy of preoperative biliary drainage was assessed with the decrease in serum bilirubin concentration in the first week after biliary drainage. Postoperative liver function was assessed with the increase in serum bilirubin concentration, which was the difference between the immediate preoperative and maximal postoperative bilirubin concentrations.</p><p><strong>Results: </strong>Serum bilirubin decreased more in the first week after biliary drainage in patients with GSA-Rmax > or = 0.60 (7.64 +/- 1.09 mg/Dl/wk) than in patients with GSA-Rmax < 0.60 (3.56 +/- 1.25 mg/DL/wk, p = 0.042). Postoperative bilirubin increased less in patients with GSA-Rmax > or = 0.60 (0.81 +/- 0.30 mg/dL) than in patients with GSA-Rmax < 0.60 (4.00 +/- 0.69 mg/DL, p = 0.0012). Multivariate analysis showed that GSA-Rmax significantly predicted the postoperative bilirubin increase (p = 0.020).</p>","PeriodicalId":73464,"journal":{"name":"International journal of pancreatology : official journal of the International Association of Pancreatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1999-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1385/IJGC:25:1:3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21082105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}