Pancreatic disorders & therapy最新文献

{"title":"G-Tube Guided Endoscopic Retrograde Cholangiopancreatography; A Lifesaving Procedure","authors":"Y. Al-Azzawi, Matthew Fasullo, C. Marshall, W. Wassef","doi":"10.4172/2165-7092.1000181","DOIUrl":"https://doi.org/10.4172/2165-7092.1000181","url":null,"abstract":"Introduction: Acute cholangitis is a consequence of obstruction and infection of the biliary tract. Endoscopic retrograde cholangiopancreatography (ERCP) is key in the management of choice as acute cholangitis as stone extraction and/or stent insertion establishes biliary drainage and relief of infection. Anatomical variation following Roux-en-Y gastric bypass surgery or patients with esophageal obstructions like in our case are prone to make the early intervention by ERCP a challenge . We describe a case report of septic cholangitis in a patient whom gastrostomy tube (G-tube) access allowed the performance of successful ERCP which was otherwise impossible. Case report: 75-year-old male with multiple comorbidities and esophageal cancer status post G-tube placement for malnutrition who presented with cholangitis. On admission, the patient had fever, nausea and decrease in level of activity. His initial evaluation showed that the patient had a sepsis with a fever of 99.6, leukopenia with WBC of 2.0, elevation in the liver enzymes with alkaline phosphatase of 238, alanine aminotransferase of 48, total bilirubin 1.2 and lactic acid of 3.2. His infectious workup included blood cultures that grew Enterobacter cloacae. His CT scan showed stone in the common bile duct. MRCP demonstrated a 1.3 cm obstructive distal common bile duct stone with extrahepatic and intrahepatic biliary dilatation. ERCP was unsuccessful due to a partially obstructing esophageal mass. After changing to a small pediatric endoscope, the scope was able to be passing the mass and a showed a good visualization of the ampulla but therapeutic intervention was not successful. Patient was brought back for a second attempt using his G-tube. A wire was passed under fluoroscopy adjacent to the G-tube then the G-tube was removed. Then a stent anchoring system was used with 3 anchors being placed. Subsequently, an axios stent (lumen-apposing self-expandable metallic stent) was placed under combined direct vision and fluoro. The stent was then sutured down in order to prevent migration. Following placemen of the stent balloon dilatation was performed inside the stent up to 15 mm in size. Following dilatation over a jag wire the ERCP scope was passed through the stent and used to cannulate the ampulla. A sphincterotomy was performed and the stone was removed with a balloon catheter. Following completion of the stone removal the Axios stent was then removed and a G-tube was replaced and confirmed with contrast for position. The patient tolerated the procedure without any complication, his bilirubin normalized and the patient discharged in stable condition the next day on a total course of 14 days of antibiotics. Conclusion: In cholangitis patient with limited access, G-tube sites provide a useful access value to examine the gastrointestinal track for therapeutic intervention.","PeriodicalId":89708,"journal":{"name":"Pancreatic disorders & therapy","volume":"24 1","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2017-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74109808","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":"Case Report: Furosemide-Induced Acute Pancreatitis","authors":"Rupendra Ghatak, L. Masso, Daniel Kapadia","doi":"10.4172/2165-7092.1000180","DOIUrl":"https://doi.org/10.4172/2165-7092.1000180","url":null,"abstract":"Acute pancreatitis is an inflammatory condition of the pancreas characterized clinically by epigastric abdominal pain and elevated levels of pancreatic enzymes in the blood. Gallstones and chronic alcohol abuse induce the majority (>90%) of acute pancreatitis. The true incidence is unknown since there are few population-based studies available [1]. However, when the most common causes are not identified as the source of the cause of the pancreatitis practitioners must remember to take a detailed medication history. Drug-induced pancreatitis has recently gained more attention and as a result physicians are screening for medications as a cause of acute pancreatitis more frequently. We describe a case of a patient with a significant past medical history of coronary artery disease, sleep apnea, and gastroesophageal reflux disease that developed acute pancreatitis after recently starting furosemide.","PeriodicalId":89708,"journal":{"name":"Pancreatic disorders & therapy","volume":"1 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85796304","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":"Right Hepatic Duct Drainage into Gallbladder Infundibulum: An Inevitable Bile Duct Injury during Laparoscopic Cholecystectomy","authors":"Ting-Lung Lin, Kung-Chuan Cheng, Yu-Hung Lin, Wei-Feng Li, C. Yong, Tsan‐Shiun Lin, L. Tsang, Y. Chiu, Chi-Chih Wang, Chao-Long Chen","doi":"10.4172/2165-7092.1000179","DOIUrl":"https://doi.org/10.4172/2165-7092.1000179","url":null,"abstract":"Laparoscopic cholecystectomy is gold standard for symptomatic gallstone and is world widely used for decades. With this minimally invasive approach, patients recovered from operation quicker than traditional open method. But biliary complication during this operation was not rare and had been reported. Literatures had suggested many preoperative image studies and intraoperative methods to avoid biliary complications. However, patients with biliary tree variation may have higher risk of bile duct injury during operation. Here, we present the patient with extremely rare biliary variation who encountered bile duct injury during laparoscopic cholecystectomy. The preoperative images, intraoperative findings, managements for complications, outcome and short review of the literature were recorded.","PeriodicalId":89708,"journal":{"name":"Pancreatic disorders & therapy","volume":"43 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80045900","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":"Secondary Common Bile Duct Stones in Congenital Right Side Diaphragmatic Hernia: A Case Report","authors":"Kai-huan Yu, Yong Song, Pengchai Ma, Jia Yu, Ai-min Zhang, Jun Ren, Chen Chen","doi":"10.4172/2165-7092.1000178","DOIUrl":"https://doi.org/10.4172/2165-7092.1000178","url":null,"abstract":"Congenital diaphragmatic hernia (CDH), which usually induces pulmonary symptoms, is more diagnosed in infant than in adult. Right-side hernia is rarer because the right pleuroperitoneal canal closes earlier and the liver buttresses the right diaphragm. We report an unusual case of a right-sided congenital diaphragmatic hernia complicating with secondary common bile duct stones in a 43-year-old man.","PeriodicalId":89708,"journal":{"name":"Pancreatic disorders & therapy","volume":"3 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2016-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75485025","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":"Update on Acute Pancreatitis","authors":"N. Gunasingam, A. Stoita","doi":"10.4172/2165-7092.1000177","DOIUrl":"https://doi.org/10.4172/2165-7092.1000177","url":null,"abstract":"Acute pancreatitis (AP) is an inflammatory disorder of the pancreas. Majority of cases will recover without complications, but the remainder will have severe disease. It is the most common gastrointestinal disorder that requires hospitalisation. Gallstones and alcohol are the leading culprits. Stratifying severity using the revised Atlanta Classification is of paramount importance. Important aspects of management include fluid resuscitation in the first 24 hours and adequate opiate analgesia. Endoscopic retrograde cholangio pancreatography (ERCP) should be performed within 24 hours in patients with biliary pancreatitis and concurrent cholangitis. Cholecystectomy should be performed in the index admission in cases of mild biliary pancreatitis. Complications of severe pancreatitis should be managed in a multidisciplinary centre with expertise in management of the more complex aspects of the condition including pseudocysts and walled off pancreatic necrosis. This article will explore the aetiology, diagnosis and current advances in the treatment of acute pancreatitis.","PeriodicalId":89708,"journal":{"name":"Pancreatic disorders & therapy","volume":"19 1","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2016-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83300499","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":"Inflammatory Response to Exercise in a Pancreatic-cancer Patient: a Case Report","authors":"A. Pedrinolla, L. Ardigò, G. Salvagno, G. Volti, E. Caveggion, A. Mambrini, P. Mazzi, P. Cormie, Gian Cesare Guid, F. Schena","doi":"10.4172/2165-7092.1000176","DOIUrl":"https://doi.org/10.4172/2165-7092.1000176","url":null,"abstract":"Background: Pancreatic-adenocarcinoma is relatively uncommon, but has been proven to be an unyielding adversity. Although it is known the importance of exercise in improving quality of life in cancer patients, currently there are no available data identifying the inflammatory-response during exercise in pancreatic-cancer patients undergoing chemotherapy. Methods: A control-supported case study was performed on a 67 yr old man diagnosed with stage IV pancreaticcancer. Two 24-hour non-stop ultra-endurance walking races (24 hr Walk) completed by the patient prior to cancerdiagnosis (No Chemo, 6 months prior to the diagnosis) and after cancer-diagnosis during chemotherapy (Chemo) were compared. Comparison to control-participants without cancer (n=2, Ctrl 1 and Ctrl 2) was also conducted. Throughout 24 hr Walk blood-samples were collected every 6 hours and analyzed for intereukin-1β (IL-1β), interleukin-1ra (IL-1ra), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α), monochemoattractant protein-1 (MCP-1), C-reactive protein (CRP), alanine aminotransferase (ALT), pancreatic amylase (AmylP), and albumin. All training performed since the cancer-diagnosis was monitored. Results: No adverse events occurred neither during 24 hr walks nor during the training. The number of walk per week, distance, and speed diminished following the diagnosis of pancreatic-cancer. Changes in IL-1β, IL-6, IL-8, IL-10, TNF-α, MCP-1, ALT, AmylP, and albumin did not differ between No Chemo and Chemo. IL-1ra decreased in No Chemo, but increased in Chemo. CRP increased in both No Chemo and Chemo, and in the controls as well. Changes in ALT and AmylP in Ctrl 1 and Ctrl 2 differed to both No Chemo and Chemo. Conclusions: Understanding the inflammatory-response to exercise in cancer-patients may be useful to design and delivery adapted exercise-programs in this growing population. The inflammatory-response, hepatic, and pancreatic functionality during prolonged-exercise were not exacerbated by concurrent chemotherapy in a pancreatic-cancer patient.","PeriodicalId":89708,"journal":{"name":"Pancreatic disorders & therapy","volume":"20 1","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2016-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89496890","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":"Are Quality Indicators associated with Postoperative Outcomes after Resection for Pancreatic Adenocarcinoma","authors":"S. Hurton, R. Urquhart, C. Kendall, A. Levy, M. Molinari","doi":"10.4172/2165-7092.1000175","DOIUrl":"https://doi.org/10.4172/2165-7092.1000175","url":null,"abstract":"Introduction: Although quality of care has become a central aspect of modern medicine, a definite relationship between quality indicators (QIs) and outcomes has not been fully established in patients with pancreatic cancer (PC). The primary aim of this study was to examine the possible association of established process-based QIs with short and long term outcomes in patients undergoing PC resection. Methods: All adult patients undergoing resection for PC in Nova Scotia between 2001 and 2011 were included in a retrospective cohort study. Logistic and Cox model regression analyses were used to test the hypothesis that meeting selected QIs was associated with improved perioperative morbidity, mortality and overall survival. Results: Pancreaticoduoedenectomy was performed in 82 (87%) patients and distal pancreatectomy in 12 patients (13%). Multivariable analysis adjusting for patient and tumour characteristics showed that only preoperative radiological staging obtained within 8 weeks from the date of surgery was associated with better survival (HR for death=0.34, 95% CI=0.14-0.84). Other QIs failed to show any association with perioperative morbidity and mortality and overall survival. Conclusions: With the exception of preoperative staging within the recommended time interval, meeting QIs was not associated with improved short and long term outcome in resected PC patients.","PeriodicalId":89708,"journal":{"name":"Pancreatic disorders & therapy","volume":"12 1","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2016-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78509553","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":"Efficacy of Modified Technique in Pancreatojejunostomy to Prevent Postoperative Pancreatic Fistula after Pancreatoduodenectomy","authors":"N. Chiba, M. Shimazu, Masaaki Okihara, T. Sano, K. Tomita, K. Takano, S. Kawachi","doi":"10.4172/2165-7092.1000174","DOIUrl":"https://doi.org/10.4172/2165-7092.1000174","url":null,"abstract":"Introduction: In pancreatoduodenectomy (PD), postoperative pancreatic fistula (POPF) remains the single most important cause of morbidity. We present a modification for duct to mucosa pancreaticojejunostomy. Materials and Methods: Total 134 patients, who had undergone PD or pylorus preserving PD (PPPD) between November 2007 and October 2013 at our institution, were analyzed. From April 2012 to December 2014, 53 consecutive patients underwent PD or PPPD by the new modified technique and 81 patients by the former technique before March 2012. The preoperative demographics and clinical information were retrospectively obtained from both groups and were analyzed along with risk factors of POPF. Moreover, risk factors for POPF grade B/C were analysed by univariate and multivariate analysis. Results: Operation procedures were pylorus preserving PD in 119 and PD in 15. Incidence of POPF grade B/C was 11% in the new method, which was significantly lower than in the former method (38%) (p=0.0135). Moreover, risk factors for POPF grade B/C in univariate analysis were texture of pancreas (p=0.0004), dilatation of pancreatic duct (p=0.0100), and anastomosis method (p=0.0135). In multivariate analysis, risk factors were texture of pancreas (p=0.0010) and anastomosis method (p=0.053). Conclusions: The new technique in pancreticojejunostomy was safe and reliable with low POPF grade B/C rate.","PeriodicalId":89708,"journal":{"name":"Pancreatic disorders & therapy","volume":"23 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2016-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81894520","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":"Strategy to Treat Pancreatic Fistula Using Comprehensive Endoscopic Procedures Together with Percutaneous Methods","authors":"M. Kikuyama, M. Kawaguchi, Tatsuki Ueda, Yuji Ota","doi":"10.4172/2165-7092.1000173","DOIUrl":"https://doi.org/10.4172/2165-7092.1000173","url":null,"abstract":"Objective: Pancreatic fistula (PF) is an early complication after pancreatoduodenectomy. PF occurs because \u0000of disruption to the pancreatodigestive tract anastomosis with stricture or occlusion. A strategy to treat PF using interventional methods is proposed. \u0000Methods: We treated a total of 6 patients with PF by endoscopic ultrasound (EUS)-guided or percutaneous \u0000pancreatic duct drainage. In this paper, these patients are reviewed based on the applied treatment for PF. \u0000Results: At the time of introduction to our department, all the patients, except for one, had a percutaneous drainage tube implanted prior to surgery. In 2 patients undergoing pancreatojejunostomy within 3 months of the previous surgery, percutaneous introduction of a guidewire into the anastomosed jejunum, via the disrupted anastomosis, through the percutaneous fistula and the implantation of a percutaneous jejunal tube for 6 weeks was an effective PF treatment. There were 4 patients (3 pancreatojejunostomy, 1 pancreatogastrostomy) with more than 3 months of PF, with an occluded anastomosis and the pancreatic juice flow had to be rerouted by making another pancreatodigestive tract anastomosis using percutaneous or EUS-guided puncture of the pancreatic duct. \u0000Conclusions: The optimal treatment for PF is considered to be the recanalization of the stricture or occluded anastomosis, or rerouting of the pancreatic juice flow by making another anastomosis. Considering our experiences in the treatment of PF, EUS-guided puncture of the pancreatic duct near the occluded anastomosis using a convex-type EUS endoscopy is the most preferable method to treat PF. In patients for whom it is difficult to introduce the endoscope into the afferent loop in the pancreatojejunostomy, various methods, including percutaneous approaches, are feasible to treat PF.","PeriodicalId":89708,"journal":{"name":"Pancreatic disorders & therapy","volume":"79 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2016-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82003658","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":"Vitamin D Deficiency in Patients with Pancreatitis: Is Vitamin D Replacement Required?","authors":"Zhiyong Han, S. Margulies, Divya Kurian, M. Elliott","doi":"10.4172/2165-7092.1000172","DOIUrl":"https://doi.org/10.4172/2165-7092.1000172","url":null,"abstract":"Clinical findings have shown that approximately 40% of patients with pancreatitis, acute or chronic, have severe vitamin D deficiency; this can reach up to 60% of patients with chronic pancreatitis. These findings raise an important question: Is vitamin D deficiency a cause or a result of pancreatitis? The answer(s) to this question is clinically important given that high oral doses of vitamin D supplementation are widely prescribed for individuals with vitamin D deficiency. Considering that there is active conversion of 25(OH)D3 to 1,25(OH)2D3 by activated macrophages in tissues undergoing inflammation, that elevation of the blood levels of 1,25(OH)2D3 levels can cause hypercalcemia, that hypercalcemia can precipitate pancreatitis, that excessive use of vitamin D supplementation can cause acute pancreatitis and that sarcoidosis causes elevated blood levels of 1,25(OH)2D3, hypercalcemia and acute pancreatitis, it is reasonable to consider both 25(OH)D3 and 1,25(OH)2D3 as negative acute-phase reactants, specifically in the context of the pathogenesis of pancreatitis. Thus, down-regulation of blood levels of 25(OH)D3 and 1,25(OH)2D3 in patients with pancreatitis appears to be a protective mechanism to prevent the development hypercalcemia, which would exacerbate the pancreatitis. Therefore, it is reasonable to consider that vitamin D replacement treatment may produce more harm than benefit for patients with pancreatitis.","PeriodicalId":89708,"journal":{"name":"Pancreatic disorders & therapy","volume":"141 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2016-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74791558","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}