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1.
Medicine (Baltimore) ; 99(17): e19783, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332621

RESUMO

INTRODUCTION: Solitary fibrous tumor (SFT) is an uncommon mesenchymal tumor that is most common in the pleura. However, according to previous studies, the SFT of the pancreas is extremely rare; only 20 cases have been reported so far. Here, we conduct a literature review and report the first case of atypical/malignant SFT of the pancreas with spleen vein invasion. PATIENT CONCERNS: The patient is a 61-year-old Chinese male who presented with 1 week of upper abdominal pain. Abdominal magnetic resonance imaging showed a huge mass (>10 cm) at the distal end of the pancreas, and the mass obstructing the splenic vein. DIAGNOSIS: Atypical/malignant SFT of the pancreas with splenic vein tumor thrombus. INTERVENTIONS: The patient underwent laparoscopic distal pancreatectomy with splenectomy procedure to achieve a radical resection, and did not undergo chemotherapy or radiotherapy. OUTCOMES: Abdominal computed tomography scans were performed at 1 and 4 months after resection, and no signs of recurrence or metastasis were found (. B).(Figure is included in full-text article.) CONCLUSION:: The clinical symptoms of atypical/malignant SFT of the pancreas with spleen vein invasion are not atypical, and imaging feature is lack of specificity. Preoperative diagnosis is difficult, and there is a potential for malignancy. However, due to the paucity of randomized control trials, there is no established, globally accepted treatment strategy, radiation therapy and chemotherapy regimens have not demonstrated global effectiveness, and no standardized treatments have been identified. Therefore, we recommend complete surgical resection and close clinical follow-up.


Assuntos
Pâncreas/anormalidades , Tumores Fibrosos Solitários/diagnóstico , Veia Esplênica/anormalidades , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Pâncreas/fisiopatologia , Pâncreas/cirurgia , Tumores Fibrosos Solitários/diagnóstico por imagem , Tumores Fibrosos Solitários/cirurgia , Veia Esplênica/fisiopatologia , Veia Esplênica/cirurgia , Tomografia Computadorizada por Raios X/métodos
2.
Rev Med Suisse ; 16(681): 331-333, 2020 Feb 12.
Artigo em Francês | MEDLINE | ID: mdl-32049457

RESUMO

Pancreatic arteriovenous malformations are rare conditions, mostly asymptomatic and increasingly diagnosed incidentally. Once symptomatic, patients can present with non specific abdominal pain, potentially life-threatening gastrointestinal bleeding, acute pancreatitis or portal hypertension. The aim of this article is to present the pathophysiology underlying this type of vascular malformation, to discuss its diagnostic modalities and the therapeutic options described to date in the literature.


Assuntos
Malformações Arteriovenosas/diagnóstico , Malformações Arteriovenosas/terapia , Pâncreas/patologia , Pâncreas/fisiopatologia , Doença Aguda , Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/patologia , Hemorragia Gastrointestinal/complicações , Humanos , Hipertensão Portal/complicações , Pancreatite/complicações
3.
Georgian Med News ; (295): 51-56, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31804199

RESUMO

The transabdominal elastography method requires estimation of liver and pancreatic structure in terms of its stiffness. Whether the results in children may be affected by anthropometric data is still the question. Objective. To evaluate the influence of obesity on liver and pancreatic stiffness parameters in children according to shear wave elastography data and to determine the major factors affecting the liver and pancreatic elasticity. This case-control study included 101 patients aged 6 to 17 years with an average age of patients (11,60±2,30) years. Determination of liver (LS) and pancreatic stiffness (PS) were carried out by shear wave elastography with SONEUS P7 system (Ultrasign, Ukraine- Switherland). Steatometry with the determination of the average ultrasound attenuation coefficient (aUAC) was performed with SONEUS P7 (Ultrasign, Ukraine-Switherland). According to the presence of obesity patients were divided into 2 groups: 1 group - 59 obese children, 2 group - 42 patients without obesity. Baseline descriptive variables included age, gender, body mass index, waist circumference (WC), laboratory data (general blood count and liver/pancreas function test, high density lipoproteins level). Insulin level was assessed by ELISA with calculation of HOMA1-IR. The average values of LS in obese and nonobese children were (4,98±0,83) kPa and (4,83±1,04) kPa, respectively, (p>0,05). Pancreatic stiffness also didn't differ between groups - (3,55±0,81) kPa and (3,60±0,448) kPa in 1st and 2d groups, respectively (p>0,05). LS positively correlated with body weight, WC, HOMA1-IR, aUAC (p<0,05). Also, we determined that liver aUAC had influence on liver stiffness (r=0,25, p<0,05) as well as pancreatic aUAC had influence on pancreatic stiffness (r=0,25, p<0,05). Obesity by itself did not affect the stiffness of the liver and pancreas according to the data of shear wave elastography. Pancreatic and liver stiffness showed association with metabolic changes. Steatometry can be useful tool for differentiation of fibrosis/inflammation and steatosis and so can improve specifity of elastography.


Assuntos
Técnicas de Imagem por Elasticidade , Fígado , Obesidade , Pâncreas , Adolescente , Estudos de Casos e Controles , Criança , Humanos , Fígado/fisiopatologia , Cirrose Hepática , Obesidade/complicações , Pâncreas/fisiopatologia , Reprodutibilidade dos Testes , Ucrânia
5.
Georgian Med News ; (292-293): 39-44, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31560660

RESUMO

Chronic pancreatitis is one of the leading gastroenterologic disorders which is characterised by polymorphism of clinical manifestations, polyetiologic course and, usually, polymorbidity. The presence of such a combination of signs makes both diagnosis and treatment more difficult. This is why nowadays it is necessary to use a range of clinical, laboratory and instrumental methods of a diagnostic endeavour in order to make a diagnosis and determine the state of the pancreas. The aim of this study - to investigate and analyse structural changes in the pancreas in chronic pancreatitis in the anamnestic and clinical dimensions. In the present study, in order to achieve our aim 102 patients with chronic pancreatitis underwent general physical and laboratory examination. All the patients experienced hypertension II as a comorbid condition. In the formed group, female patients prevailed (55,9%) with the average age being 51,0±10,0 years. The duration of chronic pancreatitis was within a range of 7,0±3,0 years, whereas the hypertension duration range was 5,0±2,0 years. The following instrumental examination procedures were performed: sonographic examination of the abdominal cavity, esophagogastroduodenoscopy, duodenal drainage and endoscopic retrograde cholangiopancreatography (ERCP). Apart from hypertension, the patients with chronic pancreatitis belonging to the treatment group were diagnosed with other morphological and functional disorders related to the endocrine system, the digestive system and cardiovascular system which were revealed with the use of additional laboratory and instrumental methods. When the clinical picture was assessed on admission to hospital, all the patients presented with pain dyspeptic syndrome and exocrine pancreatic insufficiency in different proportions. 12 patients with chronic pancreatitis, whose clinical picture showed a marked pain abdominal syndrome, the intensity of which did not subside during 3 weeks of background therapy, and the absence of dynamic changes according to the ultrasound examination of the pancreas, underwent the additional diagnostic procedure ERCP to identify structural changes of the pancreatic ducts and parenchymatous parameters of the pancreas. The findings were as follows: the signs of the dilation of the major pancreatic duct were identified in all examined patients (100%), which did not coincide with the data provided by the ultrasound examination; the dilation of the small pancreatic ducts was found in 2 (16,7%) patients, lithiasis of Wirsung's duct in 3 (25,0%) patients; the combination of cystic transformation and calcinosis of the major pancreatic duct in 1 patient (8,4%); and cystic transformation in combination with the dilation of the duct of Wirsung in 2 (16,7%) patients. The imaging of structural changes in the pancreas requires the combination of instrumental and diagnostic methods, in particular EGD and ultrasound examination, as well as ERCP in order to make accurate assessment of the pancreatic ducts and parenchymatous parameters of the pancreas in case of a relapsing course of disease. The analysis of the identified disorders of the pancreatic ducts and parenchyma makes it possible to adjust treatment protocols to provide proper clinical care to patients with chronic pancreatitis.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Endoscopia do Sistema Digestório , Pâncreas/diagnóstico por imagem , Ductos Pancreáticos/diagnóstico por imagem , Pancreatite Crônica/diagnóstico por imagem , Adulto , Doença Crônica , Comorbidade , Drenagem , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Pâncreas/fisiopatologia , Pancreatite Crônica/diagnóstico , Pancreatite Crônica/epidemiologia
6.
J Diabetes Res ; 2019: 9536032, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31179344

RESUMO

Thyrotropin (TSH) is a modulator of glucose metabolism by binding to its receptor on pancreatic cells. We used thyrotropin receptor (TSHR) knockout mice (Tshr -/-) as a model of TSH deletion to study its function in pancreatic ß cells. Tshr -/- mice had a similar body weight at birth compared with Tshr +/+ mice, but grew at a significantly slower rate until adulthood with adequate thyroxine supplementation. TSH deletion led to lower fasting and postprandial blood glucose, insulin secretion impairment, and atrophy of islets in adult mice. Transcription factors and markers of pancreatic ß cell maturation, Pdx1, Nkx6.1, Glut2, and insulin, together with cell proliferation marker Ki67 showed no differences at the mRNA level between the two groups. However, the Bax/Bcl-2 ratio was remarkably elevated in Tshr -/- mice at both mRNA and protein levels. We hypothesized that pancreatic cell apoptosis, rather than abnormal cell proliferation and maturation, is associated with pancreatic dysfunction and glucose intolerance in the absence of TSH modulation.


Assuntos
Células Secretoras de Insulina/patologia , Tireotropina/fisiologia , Animais , Apoptose , Peso Corporal , Proliferação de Células , Feminino , Deleção de Genes , Perfilação da Expressão Gênica , Glucose/metabolismo , Teste de Tolerância a Glucose , Transportador de Glucose Tipo 2/metabolismo , Heterozigoto , Proteínas de Homeodomínio/metabolismo , Homeostase , Insulina/metabolismo , Masculino , Camundongos , Camundongos Knockout , Tamanho do Órgão , Pâncreas/fisiopatologia , Receptores da Tireotropina/genética , Tiroxina/uso terapêutico , Transativadores/metabolismo
7.
Pancreas ; 48(5): 726-733, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31091222

RESUMO

OBJECTIVES: The pancreatic burnout hypothesis postulated an increasing absence of pain with simultaneous functional insufficiency in advanced stages of chronic pancreatitis (CP). However, the underlying data remain scarce and contradictory. We aimed to analyze, first, the frequency of a pancreatic burnout in CP, and, second, its association with etiological risk factors. METHODS: We performed a multicenter, retrospective, cross-sectional study with 741 patients with CP categorized according to the M-ANNHEIM classification. Pancreatic burnout was defined by different combinations of exocrine or endocrine insufficiency with partial or complete absence of abdominal pain. RESULTS: The frequency of a pancreatic burnout increased with prolonged disease duration and was observed in a maximum of 38% of patients after 20 years. Development of a pancreatic burnout was significantly associated with alcohol consumption (P < 0.05, Mann-Whitney U test), but not with other etiological risk factors. After a disease duration of more than 10 years, the likelihood of a burnout was 8 times higher in alcoholic CP than in nonalcoholic CP (95% confidence interval, 1.5-42.0; P = 0.015, logistic regression analysis). CONCLUSIONS: A pancreatic burnout does not regularly occur in CP. Increased burnout rates are only observed in patients with alcoholic CP.


Assuntos
Insuficiência Pancreática Exócrina/fisiopatologia , Pâncreas/fisiopatologia , Pancreatite Alcoólica/fisiopatologia , Pancreatite Crônica/fisiopatologia , Dor Abdominal/etiologia , Dor Abdominal/fisiopatologia , Adulto , Estudos Transversais , Insuficiência Pancreática Exócrina/etiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pancreatite Alcoólica/complicações , Pancreatite Crônica/complicações , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
8.
J Med Ultrason (2001) ; 46(4): 425-433, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30993580

RESUMO

PURPOSE: To assess the feasibility and the clinical usefulness of a newly developed endoscopic ultrasonography (EUS) shear-wave elastography technique (EUS shear-wave measurement: EUS-SWM) in the diagnosis and treatment of autoimmune pancreatitis (AIP). METHODS: Tissue elasticity was measured in the pancreas in 160 patients. The success rate of EUS-SWMs, the velocity of the shear wave (Vs, m/s), and the reliability index of the Vs measurement (VsN) were evaluated, and the elasticity (median Vs) was compared between AIP patients (n = 14) and normal controls. RESULTS: A total of 3837 EUS-SWMs were performed without adverse events. Overall, 97.6% (3743/3837) were successful. The median VsN was 74%. The median Vs values of the pancreas were as follows: 2.22 m/s in the pancreatic head (push position), 2.36 m/s in the head (pull position), 1.99 m/s in the body, and 2.25 m/s in the tail. The median Vs of the AIP group (2.57 m/s) was significantly higher than that of the normal controls (1.89 m/s) (P = 0.0185). The mean Vs significantly decreased from 3.32 m/s to 2.46 m/s after steroid therapy (n = 6) (P = 0.0234). CONCLUSION: EUS-SWM is feasible and generates credible results. EUS-SWM was a useful method for assessment of the effect of steroid therapy in AIP patients.


Assuntos
/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Corticosteroides/uso terapêutico , Idoso , /fisiopatologia , Endossonografia/métodos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/diagnóstico por imagem , Pâncreas/fisiopatologia , Estudos Prospectivos , Reprodutibilidade dos Testes
9.
Pancreatology ; 19(4): 595-601, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31005377

RESUMO

BACKGROUND: Pancreatico-enteric anastomosis after pancreaticoduodenectomy can be performed using either a pancreaticojejunostomy (PJ) or pancreaticogastrostomy (PG). Differences in surgical outcomes are still a matter of debate, and less is known about long-term functional outcomes. METHODS: Twelve years after the conclusion of a comparative study evaluating the surgical outcomes of PJ and PG (Bassi et al., Ann Surg 2005), available patients underwent morphological and functional pancreatic assessment: pancreatic volume and duct diameter measured by MRI, impaired secretion after secretin, fecal fat, fecal elastase-1 (FE-1), serum vitamin D and endocrine function. Quality of life and symptom scores were evaluated with the EORTC QLQ-C30 questionnaire. RESULTS: Only 34 patients were available for assessment. No differences were found in terms of BMI variation, endocrine function, quality of life or symptoms. Exocrine function was more severely impaired after PG than after PJ (fecal fats 26.6 ±â€¯4.1 vs 18.2 ±â€¯3.6 g/day; FE-1 121.4 ±â€¯6.7 vs 170.2 ±â€¯25.5 µg/g, vitamin D 18.1 ±â€¯1.8 vs. 23.2 ±â€¯3.1 ng/mL). MRI assessment identified a lower pancreatic volume (26 ±â€¯3.1 vs. 36 ±â€¯4.1 cm3) and a more dilated pancreatic duct (4.6 ±â€¯0.92 vs. 2.4 ±â€¯0.18 mm) in patients with PG compared to those with PJ. CONCLUSION: Compared to PJ, PG is associated with a more severely impaired exocrine function long-term, but they result similar endocrine function and quality of life. In patients with a long life expectancy, this should be taken into account.


Assuntos
Gastrostomia , Pâncreas/fisiopatologia , Pâncreas/cirurgia , Pancreaticoduodenectomia , Pancreaticojejunostomia , Adulto , Idoso , Anastomose Cirúrgica , Fezes/química , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pâncreas/diagnóstico por imagem , Testes de Função Pancreática , Neoplasias Pancreáticas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia , Qualidade de Vida , Resultado do Tratamento
10.
Invest Radiol ; 54(7): 403-408, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30817380

RESUMO

OBJECTIVES: The aim of this study was to investigate if pancreatic steatosis measured by proton density fat fraction (PDFF) is associated with exocrine pancreatic function defined by fecal elastase concentrations. MATERIALS AND METHODS: A total of 1458 volunteers (777 women; age range, 21-88 years) underwent magnetic resonance imaging of the pancreas, and organ fat content was quantified by using confounder corrected PDFF. Exocrine pancreatic function was categorized by fecal elastase levels using defined cutoffs: greater than 200 µg/g normal function (n = 1319) and 200 µg/g or less impaired function (n = 139). Statistical analysis to correlate pancreatic fat content with fecal elastase included linear regression, and analyses were adjusted for known confounders for pancreatic steatosis, such as age, sex, and body mass index. RESULTS: Overall mean (±standard deviation) of pancreatic fat content was 7.50% ± 3.78%. Pancreatic fat content was significantly higher in subjects with impaired pancreatic exocrine function (9.36% ± 4.95%) compared with subjects with normal function (7.30% ± 3.59%; P < 0.01). Linear regression analyses showed an inverse correlation between pancreatic fat and fecal elastase levels over the whole study population (beta, -7.19 [standard error, 1.39]; P < 0.01) as well as in the subgroup of subjects with normal function (-4.26 [1.32]; P < 0.01). Among subjects with impaired pancreatic exocrine function, a trend toward an inverse relation was detected (-1.28 [0.84]; P < 0.13). CONCLUSIONS: An inverse correlation between PDFF of the pancreas and fecal elastase suggests an association between pancreatic steatosis and impaired pancreatic exocrine function.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Insuficiência Pancreática Exócrina/diagnóstico , Imagem por Ressonância Magnética/métodos , Pancreatopatias/diagnóstico por imagem , Pancreatopatias/patologia , Tecido Adiposo/patologia , Tecido Adiposo/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Insuficiência Pancreática Exócrina/enzimologia , Insuficiência Pancreática Exócrina/fisiopatologia , Fezes/enzimologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/diagnóstico por imagem , Pâncreas/patologia , Pâncreas/fisiopatologia , Pancreatopatias/fisiopatologia , Elastase Pancreática/análise , Adulto Jovem
11.
Virulence ; 10(1): 207-221, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-30829107

RESUMO

Enteroviral infections are frequent, often asymptomatic in humans and during gravidity. The present study is an extension of our previous investigations where we had shown pancreatitis in challenged pups of CVB4-E2-infected dams. Present investigation describes the effect of gestational infection with this virus on the pancreas of both dams and their challenged pups. Gravid CD1 outbred mice were orally infected with CVB4-E2 virus at different gestation times. Pups were challenged orally with the same virus after 25 days of birth. Organs were collected at selected intervals postinfection (p.i.), and replicating virus and viral-RNA copies were analyzed. Additional readouts included histopathology and immunohistochemical (IHC) analysis for localization and identification of Ly6G+ cells (neutrophils), CD11b+ cells (macrophages), and viral protein in pancreatic tissue sections of the infected dams and their challenged pups. Our results show the presence of replicating virus in the pancreas of infected dams and their challenged pups, with inflammation leading to chronic necrotizing pancreatitis and atrophy of pancreatic acini of the dams and their offspring. IHC analysis of the infiltrating cells showed pronounced Ly6G+ neutrophils in dams only, whereas CD11b+ macrophages were present in tissues of both, the pups and the dams. Time of infection during gravidity as well as the p.i. intervals when mice were sacrificed influenced the pancreatic pathophysiology in both groups. We conclude that coxsackievirus infection during pregnancy is a risk factor for chronic affliction of the exocrine tissue and could affect endocrine pancreas in the mother and child.


Assuntos
Infecções por Coxsackievirus/transmissão , Pâncreas/fisiopatologia , Pâncreas/virologia , RNA Viral/análise , Animais , Modelos Animais de Doenças , Feminino , Transmissão Vertical de Doença Infecciosa , Camundongos , Pancreatite/patologia , Pancreatite/virologia , Gravidez , Replicação Viral
12.
Diabetologia ; 62(5): 744-753, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30675626

RESUMO

In type 1 diabetes, pancreatic beta cells are destroyed by chronic autoimmune responses. The disease develops in genetically susceptible individuals, but a role for environmental factors has been postulated. Viral infections have long been considered as candidates for environmental triggers but, given the lack of evidence for an acute, widespread, cytopathic effect in the pancreas in type 1 diabetes or for a closely related temporal association of diabetes onset with such infections, a role for viruses in type 1 diabetes remains unproven. Moreover, viruses have rarely been isolated from the pancreas of individuals with type 1 diabetes, mainly (but not solely) due to the inaccessibility of the organ. Here, we review past and recent literature to evaluate the proposals that chronic, recurrent and, possibly, persistent enteroviral infections occur in pancreatic beta cells in type 1 diabetes. We also explore whether these infections may be sustained by different virus strains over time and whether multiple viral hits can occur during the natural history of type 1 diabetes. We emphasise that only a minority of beta cells appear to be infected at any given time and that enteroviruses may become replication defective, which could explain why they have been isolated from the pancreas only rarely. We argue that enteroviral infection of beta cells largely depends on the host innate and adaptive immune responses, including innate responses mounted by beta cells. Thus, we propose that viruses could play a role in type 1 diabetes on multiple levels, including in the triggering and chronic stimulation of autoimmunity and in the generation of inflammation and the promotion of beta cell dysfunction and stress, each of which might then contribute to autoimmunity, as part of a vicious circle. We conclude that studies into the effects of vaccinations and/or antiviral drugs (some of which are currently on-going) is the only means by which the role of viruses in type 1 diabetes can be finally proven or disproven.


Assuntos
Antivirais/uso terapêutico , Diabetes Mellitus Tipo 1/virologia , Infecções por Enterovirus/prevenção & controle , Pâncreas/fisiopatologia , Vacinas Virais/uso terapêutico , Imunidade Adaptativa , Autoimunidade , Bancos de Espécimes Biológicos , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/epidemiologia , Infecções por Enterovirus/complicações , Infecções por Enterovirus/tratamento farmacológico , Humanos , Imunidade Inata , Células Secretoras de Insulina/metabolismo , Pâncreas/virologia , Vacinas Virais/economia
13.
Gastroenterology ; 156(7): 1951-1968.e1, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30660731

RESUMO

Since the discovery of the first trypsinogen mutation in families with hereditary pancreatitis, pancreatic genetics has made rapid progress. The identification of mutations in genes involved in the digestive protease-antiprotease pathway has lent additional support to the notion that pancreatitis is a disease of autodigestion. Clinical and experimental observations have provided compelling evidence that premature intrapancreatic activation of digestive proteases is critical in pancreatitis onset. However, disease course and severity are mostly governed by inflammatory cells that drive local and systemic immune responses. In this article, we review the genetics, cell biology, and immunology of pancreatitis with a focus on protease activation pathways and other early events.


Assuntos
Pâncreas , Pancreatite , Animais , Apoptose , Ativação Enzimática , Predisposição Genética para Doença , Humanos , Mediadores da Inflamação/metabolismo , Mutação , Necrose , Pâncreas/enzimologia , Pâncreas/imunologia , Pâncreas/patologia , Pâncreas/fisiopatologia , Pancreatite/enzimologia , Pancreatite/genética , Pancreatite/patologia , Pancreatite/fisiopatologia , Peptídeo Hidrolases/genética , Peptídeo Hidrolases/metabolismo , Fenótipo , Prognóstico , Dobramento de Proteína , Fatores de Risco , Transdução de Sinais
14.
Curr Diabetes Rev ; 15(5): 382-394, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30648511

RESUMO

BACKGROUND: The incidence of diabetes is increasing steeply; the number of diabetics has doubled over the past three decades. Surprisingly, the knowledge of type 3c diabetes mellitus (T3cDM) is still unclear to the researchers, scientist and medical practitioners, leading towards erroneous diagnosis, which is sometimes misdiagnosed as type 1 diabetes mellitus (T1DM), or more frequently type 2 diabetes mellitus (T2DM). This review is aimed to outline recent information on the etiology, pathophysiology, diagnostic procedures, and therapeutic management of T3cDM patients. METHODS: The literature related to T3cDM was thoroughly searched from the public domains and reviewed extensively to construct this article. Further, existing literature related to the other forms of diabetes is reviewed for projecting the differences among the different forms of diabetes. Detailed and updated information related to epidemiological evidence, risk factors, symptoms, diagnosis, pathogenesis and management is structured in this review. RESULTS: T3cDM is often misdiagnosed as T2DM due to the insufficient knowledge differentiating between T2DM and T3cDM. The pathogenesis of T3cDM is explained which is often linked to the history of chronic pancreatitis, pancreatic cancer. Inflammation, and fibrosis in pancreatic tissue lead to damage both endocrine and exocrine functions, thus leading to insulin/glucagon insufficiency and pancreatic enzyme deficiency. CONCLUSION: Future advancements should be accompanied by the establishment of a quick diagnostic tool through the understanding of potential biomarkers of the disease and newer treatments for better control of the diseased condition.


Assuntos
Diabetes Mellitus Tipo 2 , Diabetes Mellitus , Pâncreas Exócrino , Pancreatopatias , Pancreatite Crônica , Diabetes Mellitus/diagnóstico , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/terapia , Humanos , Insulina , Pâncreas/fisiopatologia , Pâncreas Exócrino/fisiopatologia , Pancreatopatias/diagnóstico , Pancreatopatias/terapia , Pancreatite Crônica/fisiopatologia
15.
J Clin Endocrinol Metab ; 104(4): 1201-1210, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30407535

RESUMO

CONTEXT: Intrapancreatic lipid (IPL) has been linked to ß-cell dysfunction. Black populations disproportionately develop type 2 diabetes (T2D) and show distinctions in ß-cell function compared with white populations. OBJECTIVE: We quantified IPL in white European (WE) and black West African (BWA) men with early T2D and investigated the relationships between IPL and ß-cell insulin secretory function (ISF). DESIGN, SETTING, AND PARTICIPANTS: We performed a cross-sectional assessment of 18 WE and 19 BWA middle-age men with early T2D as part of the South London Diabetes and Ethnicity Phenotyping study. MAIN OUTCOME MEASURES: The participants underwent Dixon MRI to determine IPL in the pancreatic head, body, and tail and subcutaneous and visceral adipose tissue volumes. Modeled first- and second-phase ISFs were comprehensively determined using C-peptide measurements during a 3-hour meal tolerance test and a 2-hour hyperglycemic clamp test. RESULTS: The WE men had greater mean IPL levels compared with BWA men (P = 0.029), mainly owing to greater IPL levels in the pancreatic head (P = 0.009). The mean IPL level was inversely associated with orally stimulated first-phase ISF in WE but not BWA men (WE, r = -0.554, P = 0.026; BWA, r = -0.183, P = 0.468). No association was found with orally stimulated second-phase ISF in either WE or BWA men. No associations were found between the mean IPL level and intravenously stimulated ISF. CONCLUSIONS: The IPL levels were lower in BWA than WE men with early T2D, and the lack of inverse association with first-phase ISF in BWA men indicates that IPL might be a less important determinant of the development of T2D in BWA than in WE men.


Assuntos
Diabetes Mellitus Tipo 2/etnologia , Disparidades nos Níveis de Saúde , Células Secretoras de Insulina/metabolismo , Lipídeos/análise , Pâncreas/química , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Idoso , Estudos Transversais , Diabetes Mellitus Tipo 2/diagnóstico por imagem , Diabetes Mellitus Tipo 2/fisiopatologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Humanos , Insulina/metabolismo , Gordura Intra-Abdominal/diagnóstico por imagem , Londres , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pâncreas/diagnóstico por imagem , Pâncreas/fisiopatologia
16.
J Pediatr Endocrinol Metab ; 32(1): 19-26, 2019 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-30530906

RESUMO

Background Ectopic visceral fat is a major risk factor for obesity complications including insulin resistance and metabolic syndrome. Ultrasonography is a simple bedside screening tool used for the assessment of ectopic visceral fat including fatty pancreas. This study investigates the association between insulin resistance, metabolic syndrome and fatty pancreas detected by ultrasound in children with obesity. Methods This case-control study included 50 prepubertal obese (body mass index [BMI] ≥95th age- and sex-specific percentiles) and 30 lean children (BMI 5th-85th age- and sex-specific percentiles) as the control group. Clinical and laboratory parameters of metabolic syndrome including anthropometric indices of central obesity, blood pressure, fasting glucose and lipid profile were measured. Homeostasis model assessment-insulin resistance (HOMA-IR) was used to assess insulin resistance. Ultrasonographic assessment for pancreatic fat was done for all children. Results Fifty-eight percent of obese children had fatty pancreas. Obese children with fatty pancreas had a higher rate of metabolic syndrome (p=0.013) and insulin resistance than those with non-fatty pancreas (p=0.012). Regression analysis revealed that fatty pancreas is an independent predictor of metabolic syndrome and insulin resistance. Fatty pancreas increases the risk for metabolic syndrome (odds ratio [OR] 11.40; 95% confidence interval [CI]: 2.69-48.22) and insulin resistance (OR 7.85; 95% CI: 2.20-28.05) in children with obesity. Conclusions Obese children have higher pancreatic fat accumulation than lean children. Obese children with fatty pancreas are more susceptible to insulin resistance and metabolic syndrome.


Assuntos
Resistência à Insulina , Gordura Intra-Abdominal/fisiopatologia , Síndrome Metabólica/etiologia , Obesidade/complicações , Pâncreas/fisiopatologia , Biomarcadores/análise , Índice de Massa Corporal , Estudos de Casos e Controles , Criança , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Síndrome Metabólica/metabolismo , Síndrome Metabólica/patologia , Prognóstico , Fatores de Risco
17.
Gastroenterology ; 156(4): 1010-1015, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30391469

RESUMO

BACKGROUND & AIMS: Changes in intestinal microbiome composition are associated with inflammatory, metabolic, and malignant disorders. We studied how exocrine pancreatic function affects intestinal microbiota. METHODS: We performed 16S ribosomal RNA gene sequencing analysis of stool samples from 1795 volunteers from the population-based Study of Health in Pomerania who had no history of pancreatic disease. We also measured fecal pancreatic elastase by enzyme-linked immunosorbent assay and performed quantitative imaging of secretin-stimulated pancreatic fluid secretion. Associations of exocrine pancreatic function with microbial diversity or individual genera were calculated by permutational analysis of variance or linear regression, respectively. RESULTS: Differences in pancreatic elastase levels associated with significantly (P < .0001) greater changes in microbiota diversity than with participant age, body mass index, sex, smoking, alcohol consumption, or dietary factors. Significant changes in the abundance of 30 taxa, such as an increase in Prevotella (q < .0001) and a decrease of Bacteroides (q < .0001), indicated a shift from a type-1 to a type-2 enterotype. Changes in pancreatic fluid secretion alone were also associated with changes in microbial diversity (P = .0002), although to a lesser degree. CONCLUSIONS: In an analysis of fecal samples from 1795 volunteers, pancreatic acinar cell, rather than duct cell, function is presently the single most significant host factor to be associated with changes in intestinal microbiota composition.


Assuntos
Bactérias/isolamento & purificação , Insuficiência Pancreática Exócrina/fisiopatologia , Fezes/enzimologia , Microbioma Gastrointestinal , Pâncreas/fisiopatologia , Elastase Pancreática/metabolismo , Células Acinares/fisiologia , Bacteroides/isolamento & purificação , Biodiversidade , Interações entre Hospedeiro e Microrganismos , Humanos , Pâncreas/citologia , Testes de Função Pancreática , Prevotella/isolamento & purificação , RNA Ribossômico 16S/análise
18.
Anticancer Res ; 39(1): 499-504, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30591501

RESUMO

BACKGROUND/AIM: The Fistula Risk Score (FRS), as other risk scores, is a validated model predicting the development of a clinically relevant post-operative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD). We evaluated risk factors related with CR-POPF and correlated four predictive scores with the likelihood of developing CR-POPF in our cohort. PATIENTS AND METHODS: The records of 107 patients who underwent PD from 2007 to 2015 were obtained from a prospectively maintained database and reviewed. CR-POPFs were categorized by the International Study Group of Pancreatic Fistula (ISGPF) standards. Firstly, a univariate and multivariate analysis of risk factors related to CR-PPOPF was performed, and then the data were correlated with FRS, Wellner's, Robert's and Yamamoto's scores. RESULTS: In total, 30 patients developed a CR-POPF. On multivariate analysis, abdominal thickness (OR=1.02, p=0.010), Wirsung's duct diameter (OR=0.57, p=0.029), pancreatic consistency (OR=3.18, p=0.011) and histological diagnosis of the lesion (OR=1.65, p=0.012) represented independent predictive factors of CR-POPF. FRS (R2=0.596, p=0.001), Wellner's score (R2=0.285, p=0.005) and Roberts' score (R2=0.385, p=0.002) correlated with the likelihood of developing CR-POPF. CONCLUSION: Abdominal thickness, Wirsung's duct diameter, pancreatic consistency and histological diagnosis were independent predictive factors of CR-POPF. Predictive scores reflected the likelihood of CR-POPF, FRS being the score with the highest predictive value.


Assuntos
Pâncreas/cirurgia , Fístula Pancreática/fisiopatologia , Pancreaticoduodenectomia/efeitos adversos , Complicações Pós-Operatórias/fisiopatologia , Adulto , Idoso , Anastomose Cirúrgica/efeitos adversos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pâncreas/fisiopatologia , Ductos Pancreáticos/fisiopatologia , Ductos Pancreáticos/cirurgia , Fístula Pancreática/epidemiologia , Fístula Pancreática/cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
20.
Med Ultrason ; 20(4): 427-435, 2018 Dec 08.
Artigo em Inglês | MEDLINE | ID: mdl-30534648

RESUMO

AIMS: Endosonography (EUS) is one of the main diagnostic tools for the differential diagnosis of pancreatic masses. The aim of our study was to describe the value of this technique in the work-up of solid pancreatic lesions, considering the influence of the morphological evidence of pancreatic inflammation in the diagnostic process. MATERIAL AND METHODS: Retrospective analysis of prospectively collected data in our tertiary University center. From March 2007 to October 2015, 218 patients underwent EUS for a suspected solid pancreatic neoplasm (based on previous cross-sectional imaging results, idiopatic acute pancreatitis, weight loss, pancreatic hyperenzymemia, painless jaundice or elevated Ca 19-9 values). RESULTS: Malignant lesions were diagnosed in 98 (45%) patients. Sensitivity of EUS for malignancy was 91% and specificity 89.2%. Signs of pancreatic inflammation in the surrounding pancreatic parenchyma around the focal lesion were present in 97 patients (44.4%)(more often in men, smokers and drinkers, and the most common etiology was focal chronic pancreatitis) and in these patients the sensitivity and sensibility dropped to 44% and 87.1%, respectively. In patients without signs of pancreatic inflammation, the pancreatic focal lesions were adenocarcinoma, neuroendocrine tumor, ventral/dorsal split, non-pancreatic pathology, pancreatic lipomatosis and autoimmune pancreatitis. CONCLUSION: Pancreatic inflammation (either focal or involving the whole gland) lowers the diagnostic sensibility of EUS in the work- up of pancreatic masses suspected for cancer, requiring further invasive diagnostic methods. Focal autoimmune pancreatitis and paraduodenal pancreatitis are still confused with pancreatic cancer, even in the absence of pancreatic inflammation.


Assuntos
Endossonografia/métodos , Inflamação/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Inflamação/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pâncreas/diagnóstico por imagem , Pâncreas/fisiopatologia , Neoplasias Pancreáticas/fisiopatologia , Estudos Prospectivos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
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