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2.
JAMA ; 322(24): 2422-2434, 2019 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-31860051

RESUMO

Importance: Chronic pancreatitis (CP) is a chronic inflammatory and fibrotic disease of the pancreas with a prevalence of 42 to 73 per 100 000 adults in the United States. Observations: Both genetic and environmental factors are thought to contribute to the pathogenesis of CP. Environmental factors associated with CP include alcohol abuse (odds ratio [OR], 3.1; 95% CI, 1.87-5.14) for 5 or more drinks per day vs abstainers and light drinkers as well as smoking (OR, 4.59; 95% CI, 2.91-7.25) for more than 35 pack-years in a case-control study involving 971 participants. Between 28% to 80% of patients are classified as having "idiopathic CP." Up to 50% of these individuals have mutations of the trypsin inhibitor gene (SPINK1) or the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Approximately 1% of people diagnosed with CP may have hereditary pancreatitis, associated with cationic trypsinogen (PRSS1) gene mutations. Approximately 80% of people with CP present with recurrent or chronic upper abdominal pain. Long-term sequelae include diabetes in 38% to 40% and exocrine insufficiency in 30% to 48%. The diagnosis is based on pancreatic calcifications, ductal dilatation, and atrophy visualized by imaging with computed tomography, magnetic resonance imaging, or both. Endoscopic ultrasound can assist in making the diagnosis in patients with a high index of suspicion such as recurrent episodes of acute pancreatitis when imaging is normal or equivocal. The first line of therapy consists of advice to discontinue use of alcohol and smoking and taking analgesic agents (nonsteroidal anti-inflammatory drugs and weak opioids such as tramadol). A trial of pancreatic enzymes and antioxidants (a combination of multivitamins, selenium, and methionine) can control symptoms in up to 50% of patients. Patients with pancreatic ductal obstruction due to stones, stricture, or both may benefit from ductal drainage via endoscopic retrograde cholangiopancreatography (ERCP) or surgical drainage procedures, such as pancreaticojejunostomy with or without pancreatic head resection, which may provide better pain relief among people who do not respond to endoscopic therapy. Conclusions and Relevance: Chronic pancreatitis often results in chronic abdominal pain and is most commonly caused by excessive alcohol use, smoking, or genetic mutations. Treatment consists primarily of alcohol and smoking cessation, pain control, replacement of pancreatic insufficiency, or mechanical drainage of obstructed pancreatic ducts for some patients.


Assuntos
Pâncreas/cirurgia , Pancreatite Crônica , Dor Abdominal/terapia , Alcoolismo/complicações , Diagnóstico por Imagem , Predisposição Genética para Doença , Humanos , Manejo da Dor , Pancreatite Crônica/diagnóstico , Pancreatite Crônica/etiologia , Pancreatite Crônica/fisiopatologia , Pancreatite Crônica/terapia , Prognóstico , Fatores de Risco , Fumar/efeitos adversos
4.
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
5.
Tohoku J Exp Med ; 248(4): 225-238, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31378749

RESUMO

Chronic pancreatitis (CP) is a pancreatic disease with poor prognosis characterized clinically by abdominal pain, morphologically by pancreatic stones/calcification, duct dilatation and atrophy, and functionally by pancreatic exocrine and endocrine insufficiency. CP is also known as a risk factor for the development of pancreatic cancer. CP has long been understood based on a fixed disease concept deduced from the clinical and morphological features of the end-stage disease. However, identification of causal genes for hereditary pancreatitis and success in the isolation and culture of pancreatic stellate cells have advanced the understanding of the underlying pathological mechanisms, the early-stage pathophysiology, and the mechanisms behind pancreatic fibrosis. These advances have led to moves aimed at improving patient prognosis through prevention of disease progression by early diagnosis and early therapeutic intervention. The strategy for preventing disease progression has included a proposal for diagnostic criteria for early CP and introduction of a new definition of CP in consideration of the pathological mechanisms. Our group has been committed deeply to these studies and has provided a large amount of information to the world.


Assuntos
Pancreatite Crônica/patologia , Interação Gene-Ambiente , Predisposição Genética para Doença , Humanos , Modelos Biológicos , Neoplasias Pancreáticas/patologia , Células Estreladas do Pâncreas/metabolismo , Células Estreladas do Pâncreas/patologia , Pancreatite Crônica/diagnóstico , Pancreatite Crônica/genética
6.
Trials ; 20(1): 501, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412955

RESUMO

BACKGROUND: Chronic pancreatitis (CP) is a progressive, fibro-inflammatory disease characterized by enzymatic autoactivation and subsequent fibrotic replacement of acinar cells. A significant proportion of patients develop pain, which may be due to many causes, including perineural inflammation, altered central processing of pain signals, parenchymal structural changes, and ductal obstruction. Currently there are no approved medical treatment options for CP-associated pain. NI-03 (camostat mesilate) is an orally administered serine protease inhibitor that reduces pancreatic enzyme activity and has been widely used for the treatment of CP-associated pain in Japan. The current study will assess the safety and efficacy of NI-03 for reduction of CP-associated pain in the USA. METHODS: The current study consists of two phases. First, a phase I study will be performed to establish the pharmacokinetics and safety profile over a 1-week period following a single dose (100, 200, or 300 mg). Subsequently, a phase II study will be performed consisting of a double-blind, randomized, controlled trial (RCT). This RCT will evaluate the efficacy of each of the three doses of NI-03 given three times daily compared to placebo over 28 days. A 7-day, single-blind, run-in period will precede the double-blind phase to assess baseline pain characteristics. The primary efficacy outcome is the average of worst daily pain scores (numeric rating scale of 0-10) over the terminal 7 days of the study period compared to baseline. Secondary efficacy outcomes include change in opioid dose and quality of life measures, and time to first rescue intravenous analgesic. Adverse events will be recorded. DISCUSSION: NI-03 has been used successfully and safely in Japan to treat CP-associated pain. The aim of the current study is to assess the safety and efficacy of NI-03 using a rigorous RCT in a population in the USA. This study may fill an important clinical gap to provide an effective medical treatment option for CP-associated pain. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02693093 . Registered through the National Institutes of Health on 26 February 2016.


Assuntos
Gabexato/análogos & derivados , Pancreatite Crônica/tratamento farmacológico , Inibidores de Proteases/farmacocinética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/administração & dosagem , Ensaios Clínicos Fase I como Assunto , Ensaios Clínicos Fase II como Assunto , Método Duplo-Cego , Feminino , Gabexato/administração & dosagem , Gabexato/efeitos adversos , Gabexato/farmacocinética , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Pancreatite Crônica/diagnóstico , Inibidores de Proteases/administração & dosagem , Inibidores de Proteases/efeitos adversos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Estados Unidos , Adulto Jovem
7.
Am J Case Rep ; 20: 896-901, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31231118

RESUMO

BACKGROUND The effective and safe treatment of chronic frequently relapsing pancreatitis is challenging. CASE REPORT We present the case of a 63-year-old male patient with severe complications of this variant of the disease: parapancreatitis with the formation of an inflammatory mass, fermentative ascites-peritonitis, 2-sided pleural effusions, sepsis, and cachexia. Conservative treatment was ineffective, and emergency surgery was chosen. A novel surgical procedure - open internal stenting of the main pancreatic duct via pancreatowirsungotomy and duodenotomy - was used successfully in this difficult case. The elimination of pancreatic ductal hypertension and maintenance of maximum physiological pancreatic juice outflow, achieved via surgery, led to rapid improvement in the patient's condition. He was discharged on the 26th day after surgery. The clinical outcome was good at the 2-year follow-up. CONCLUSIONS Open stenting of the main pancreatic duct can be recommended for treating patients similar to the patient described in this paper - having severe complications of CP against the background of a relapse, exhaustion, and being in a severely or critically ill general condition. This surgical procedure is especially important when minimally invasive methods of eliminating pancreatic hypertension are technically unsuccessful or impossible due to the lack of necessary equipment and staff.


Assuntos
Hipertensão/cirurgia , Ductos Pancreáticos/cirurgia , Pancreatite Crônica/cirurgia , Stents , Estado Terminal , Duodeno/cirurgia , Humanos , Hipertensão/diagnóstico , Hipertensão/etiologia , Masculino , Pessoa de Meia-Idade , Pancreatite Crônica/diagnóstico , Pancreatite Crônica/etiologia , Recidiva
8.
Optom Vis Sci ; 96(6): 453-458, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31107845

RESUMO

SIGNIFICANCE: Vitamin A deficiency is a known concern in developing countries, but it is often overlooked in developed regions. A history of conditions causing alimentary malabsorption should be considered when patients present with complaints of nyctalopia. PURPOSE: A case of vitamin A deficiency with nyctalopia in a patient with chronic pancreatitis including pertinent diagnostic testing, treatment, and management is presented. The intent is to draw attention to the condition as a differential diagnosis for nyctalopia due to increased prevalence of conditions causing malabsorption. CASE REPORT: A patient with a history of chronic pancreatitis and pancreatic tumor presented with symptoms of nyctalopia and xerophthalmia. Given his systemic history, testing was ordered to determine serum vitamin A levels and retinal function. After results had confirmed depleted vitamin A levels and diminished retinal function, treatment with both oral and intramuscular vitamin A supplementation was initiated to normalize vitamin A levels and improve retinal photoreceptor function. Subjective improvement in symptoms was reported shortly after beginning supplementation, and ultimately, vitamin A levels and retinal function showed improvement after intramuscular treatment. CONCLUSIONS: Detailed case history and a careful review of systems along with serum vitamin A testing and, if available, electroretinography to assess retinal function can help to make a definitive diagnosis. With appropriate comanagement with the patient's primary care physician, it is possible for those with nyctalopia to begin vitamin A supplementation and regain retinal function.


Assuntos
Cegueira Noturna/diagnóstico , Pancreatite Crônica/diagnóstico , Deficiência de Vitamina A/diagnóstico , Vitamina A/administração & dosagem , Administração Oral , Diagnóstico Diferencial , Suplementos Nutricionais , Eletrorretinografia , Humanos , Masculino , Pessoa de Meia-Idade , Cegueira Noturna/tratamento farmacológico , Cegueira Noturna/fisiopatologia , Pancreatite Crônica/fisiopatologia , Células Fotorreceptoras de Vertebrados , Retina/fisiopatologia , Vitamina A/sangue , Deficiência de Vitamina A/tratamento farmacológico , Deficiência de Vitamina A/fisiopatologia , Xeroftalmia/diagnóstico
10.
Dig Dis ; 37(5): 416-421, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31079114

RESUMO

BACKGROUND: Diagnosis of pancreatic cancer (PC) in early stages is still challenging for gastroenterologists. The early detection of cancer is one of the utmost importance for the successful therapy of this malignancy. An accurate differential diagnosis of focal pancreatic lesions plays also an important role, whether it is differential diagnosis of chronic pancreatitis from PC or autoimmune pancreatitis (AIP) from PC. Raised serum immunoglobulin G4 (IgG4) levels to twice the normal value are considered one of significant diagnostic features of type 1 AIP. However, IgG4 can be increased also in patients with PC, but levels usually do not exceed twice the normal value. METHODS: In years 2012-2017, IgG4 serum levels were examined in 115 patients with histologically confirmed PC. Patients with PC and elevated IgG4 level (above 135 mg/dL) had tested their histological resection specimens or bioptic specimens from pancreatic lesion, with targeted detection of the presence of IgG4 and plasmocytes in the pancreatic tissue and changes characteristic for type 1 AIP. RESULTS: A plasmatic IgG4 level in 115 patients with diagnosed PC was higher than 135 mg/dL in 14 patients (12.2%). Out of them, 2 patients (1.7%) revealed a serum IgG4 level higher than double the normal value, that is, higher than 270.0 mg/dL (suggestive of AIP). One patient met histological criteria for diagnosis of AIP in the simultaneous presence of PC. CONCLUSION: Diagnosis of early cancer stages, particularly differentiating AIP from PC can be sometimes problematic. IgG4 levels can be slightly elevated also in case of PC. A targeted biopsy of the pancreas is the method of choice in cases suspected from a focal form of AIP and we recommend to prefer it over other modalities, such as, for example, response to steroid therapy.


Assuntos
Doenças Autoimunes/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Pancreatite Crônica/diagnóstico , Idoso , Doenças Autoimunes/sangue , Doenças Autoimunes/diagnóstico por imagem , Doenças Autoimunes/patologia , Doença Crônica , Diagnóstico Diferencial , Endossonografia , Feminino , Humanos , Imunoglobulina G/sangue , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/sangue , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/patologia , Pancreatite Crônica/sangue , Pancreatite Crônica/diagnóstico por imagem , Pancreatite Crônica/patologia
11.
Orv Hetil ; 160(22): 873-879, 2019 Jun.
Artigo em Húngaro | MEDLINE | ID: mdl-31131607

RESUMO

The paraduodenal, or groove pancreatitis is a lesser-known type of chronic pancreatitis, often mimicking malignancy, hence resulting in serious differential diagnostic challenges. Herein we report two cases of this entity. Both required analysis of the surgical specimen in order to ensure the diagnosis due to inadequate preoperative histological sampling and a vague clinical presentation. In the first case, strong suspicion of malignancy following imaging, while in the second, severe gastric outlet stenosis indicated the resection. In our report, we give a clinicopathological summary from the literature of this entity, including its epidemiology, clinical presentation and applicable diagnostic methods as well as macroscopic and microscopic pathomorphology. The pathogenesis of this disease is complex. Beside the role of alcohol, anatomic variations of the pancreatic ductal system, pancreatic islets in duodenal wall resulting from incomplete involution of dorsal pancreas, or Brunner gland hyperplasia (often observed as part of the lesion) can all play a role in the disturbance of pancreatic fluid discharge in the minor papilla area, eventually leading to this specific localised inflammation. In addition, recent investigations revealed a susceptible role of genetic polymorphism in the persistent inflammatory disorders of the pancreas. Besides summarizing the differential diagnostic aspects, we also discuss therapeutic possibilities, underlining the conservative methods, which can be used with good efficacy after a successful identification of this entity. Orv Hetil. 2019; 160(22): 873-879.


Assuntos
Pâncreas/patologia , Pancreatite Crônica/diagnóstico , Alcoolismo/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite Crônica/patologia , Pancreatite Crônica/terapia
12.
Pancreatology ; 19(4): 569-577, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31031206

RESUMO

BACKGROUND: Fucosylated haptoglobin detected by Pholiota squarrosa lectin (PhoSL) that had specificity for fucose α1-6 was reported as an effective biomarker for several gastrointestinal diseases. The aim of this study was to verify Fucosylated haptoglobin detected by Pholiota squarrosa lectin (PhoSL-HP) as a pancreatic cancer (PC) marker using a new method of PhoSL-ELISA. METHODS: PhoSL-HP in sera from 98 PC patients and 158 non-PC samples including 32 intraductal papillary mucinous neoplasm (IPMN) patients, 21 chronic pancreatitis (CP) patients and 105 non-pancreatic disease controls (NPDC) were measured. We compared sensitivities, specificities and areas under the curves (AUC) of PhoSL-HP, CA19-9 and CEA as single markers. We also evaluated PhoSL-HP as combination marker by comparing AUC of CA19-9 combined with PhoSL-HP or CEA. RESULTS: The sensitivities of PhoSL-HP, CA19-9 and CEA for PC were 58%, 76% and 42%, respectively. Although the specificity of PhoSL-HP for NPDC was inferior to both of CA19-9 and CEA, that for pancreatic diseases was higher than both of CA19-9 and CEA. Combined CA19-9 with PhoSL-HP, the AUC was significantly higher at 0.880 than single use of CA19-9 at 0.825 in case of distinguishing PC from other pancreatic diseases. In contrast, the AUC of CA19-9 was not elevated significantly when combined with CEA. CONCLUSION: PhoSL-HP would be a useful marker for PC and have sufficient complementarity for CA19-9.


Assuntos
Biomarcadores Tumorais/análise , Haptoglobinas/análise , Neoplasias Pancreáticas/sangue , Neoplasias Pancreáticas/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Antígeno CA-19-9/sangue , Antígeno Carcinoembrionário/sangue , Reações Falso-Positivas , Feminino , Fucose , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatopatias/sangue , Pancreatopatias/diagnóstico , Pancreatite Crônica/sangue , Pancreatite Crônica/diagnóstico , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
13.
Pancreas ; 48(4): 574-578, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30946237

RESUMO

OBJECTIVES: We compared outcomes of acute alcoholic pancreatitis (AAP), acute biliary pancreatitis (ABP), and post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). METHODS: This was a retrospective cohort study conducted at a tertiary care center between June 2007 and June 2012. RESULTS: A total of 300 (68%) patients were diagnosed with AAP, 88 (20%) with ABP, and 55 (12%) with PEP. Longer length of hospital stay (LOHS) was more common in ABP (23%) as compared with AAP (10%) and PEP (7%, P = 0.025). Pseudocyst (P = 0.048), organ failure (OF) (P = 0.01), need for interventions (P ≤ 0.001), and mortality (P = 0.002) occurred more in ABP as compared with other groups. Systemic inflammatory response syndrome was associated with LOHS of more than 10 days (P = 0.01) and multi-OF (P = 0.05). Chronic pancreatitis was associated more with pseudocyst (P < 0.001) and mortality (P = 0.03). Serum urea nitrogen of greater than 25 g/dL predicted LOHS of more than 10 days (P = 0.02), OF (P < 0.001), multi-OF (P < 0.001), and persistent OF (P < 0.001). CONCLUSIONS: Acute biliary pancreatitis is a more severe disease compared with PEP and AAP. Chronic pancreatitis, systemic inflammatory response syndrome, and high serum urea nitrogen are important predictors of morbidity.


Assuntos
Doenças Biliares/complicações , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Tempo de Internação/estatística & dados numéricos , Pancreatite Alcoólica/diagnóstico , Pancreatite/diagnóstico , Doença Aguda , Adolescente , Adulto , Nitrogênio da Ureia Sanguínea , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos , /estatística & dados numéricos , Pancreatite/etiologia , Pancreatite/terapia , Pancreatite Crônica/diagnóstico , Pancreatite Crônica/etiologia , Pancreatite Crônica/terapia , Estudos Retrospectivos , Adulto Jovem
14.
Am J Case Rep ; 20: 567-574, 2019 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-31006768

RESUMO

BACKGROUND Aneurysm of the inferior pancreaticoduodenal artery (IPDA) is rare among visceral artery aneurysms. Aneurysm and/or pancreatitis may have a causal relation with hemosuccus pancreaticus (HP). HP causes an obscure bleeding in the digestive tract, and this rare disease may lead to life-threatening condition. Although interventional radiology is generally employed as the initial treatment for visceral aneurysms, aneurysmic recanalization is a critical problem. CASE REPORT A 58-year-old male was incidentally diagnosed as groove pancreatitis, and his pancreatitis was successfully treated by conservative management. One year later, an IPDA aneurysm was detected in image studies. Gastrointestinal bleeding was objectively observed, and a diagnosis of asymptomatic HP was made. Arterio-pancreatic duct fistula was suspected, but was not identified. Coil embolization was successfully completed. Six months later, he suffered a relapse of HP, and visited our emergency unit. Pseudocystic lesion around metallic coils were confirmed. Subtotal stomach-preserving pancreaticoduodenectomy without any extended resections was performed. Intentional dissections of nerve plexuses and lymph nodes were all waived. Even a pancreatography of the resected specimen did not clarify his arterio-pancreatic duct fistula. He was discharged at postoperative day 10, and smoothly returned to his work. CONCLUSIONS Pancreatic juice-related complications after advanced pancreaticoduodenectomy for malignancies are often intractable. However, simple pancreaticoduodenectomy which omits extended resections and intentional dissections is safe and feasible for benign diseases. After the initial interventional radiology for pancreatic aneurysms, an elective pancreatic surgery should be considered to avoid unwanted recanalization and refractory HP.


Assuntos
Aneurisma Roto/terapia , Aneurisma da Aorta Abdominal/terapia , Pancreatite Crônica/complicações , Radiologia Intervencionista/métodos , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Tratamento Conservador , Duodeno/irrigação sanguínea , Embolização Terapêutica/métodos , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/irrigação sanguínea , Pancreatite Crônica/diagnóstico , Pancreatite Crônica/terapia , Medição de Risco , Resultado do Tratamento
17.
Ann Surg Oncol ; 26(7): 2104-2111, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30820789

RESUMO

BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is a lethal neoplasm because of difficulties in early detection. Several studies have recently suggested that exosomes may have potential as novel biomarkers. This study aimed to isolate exosomes from pancreatic juice and to investigate whether exosomal microRNAs (ex-miRs) could be used as biomarkers for PDAC. METHODS: Pancreatic juice was collected from patients with PDAC and chronic pancreatitis (CP) by endoscopic retrograde pancreatography. Exosomes were extracted by ultracentrifugation. The presence of exosomes was confirmed by electron microscopy and Western blotting using anti-CD63, -CD81, and -TSG101 antibodies. Relative levels of ex-miR-21 and ex-miR-155 were quantified and compared between PDAC and CP patients. RESULTS: A total of 35 pancreatic juice samples (27 PDAC and 8 CP) were collected. Relative levels of both ex-miR-21 and ex-miR-155 were significantly higher in PDAC patients compared with CP patients (p < 0.001 and p = 0.008, respectively). By contrast, no significant difference was apparent in relative levels of miR-21 and miR-155 in whole pancreatic juice from PDAC patients compared with CP patients (p = 0.08 and p = 0.61, respectively). Ex-miR-21 and ex-miR-155 levels discriminated PDAC patients from CP patients with area under the curve values of 0.90 and 0.89, respectively. The accuracies of ex-miR-21 levels, ex-miR-155 levels, and pancreatic juice cytology were 83%, 89%, and 74%, respectively. When combining the results of ex-miR profiling with pancreatic juice cytology, the accuracy was improved to 91%. CONCLUSIONS: We successfully extracted exosomes from pancreatic juice. Ex-miRs, including ex-miR-21 and ex-miR-155, in pancreatic juice may be developed as biomarkers for PDAC.


Assuntos
Biomarcadores Tumorais/genética , Carcinoma Ductal Pancreático/diagnóstico , Exossomos/genética , MicroRNAs/genética , Suco Pancreático/metabolismo , Neoplasias Pancreáticas/diagnóstico , Pancreatite Crônica/diagnóstico , Adulto , Idoso , Carcinoma Ductal Pancreático/genética , Diagnóstico Diferencial , Feminino , Seguimentos , Regulação Neoplásica da Expressão Gênica , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/genética , Pancreatite Crônica/genética , Prognóstico , Taxa de Sobrevida
18.
World J Surg ; 43(6): 1604-1611, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30815742

RESUMO

BACKGROUND: Autoimmune pancreatitis (AIP) is an uncommon form of chronic pancreatitis. Whilst being corticosteroid responsive, AIP often masquerades radiologically as pancreatic neoplasia. Our aim is to appraise demographic, radiological and histological features in our cohort in order to differentiate AIP from pancreatic malignancy. METHODS: Clinical, biochemical, histological and radiological details of all AIP patients 1997-2016 were analysed. The initial imaging was re-reviewed according to international guidelines by three blinded independent radiologists to evaluate features associated with autoimmune pancreatitis and pancreatic cancer. RESULTS: There were a total of 45 patients: 25 in type 1 (55.5%), 14 type 2 (31.1%) and 6 AIP otherwise not specified (13.3%). The median (IQR) age was 57 (51-70) years. Thirty patients (66.6%) were male. Twenty-six patients (57.8%) had resection for suspected malignancy and one for symptomatic chronic pancreatitis. Three had histologically proven malignancy with concurrent AIP. Two patients died from recurrent pancreatic cancer following resection. Multidisciplinary team review based on radiology and clinical history dictated management. Resected patients (vs. non-resected group) were older (64 vs. 53, p = 0.003) and more frequently had co-existing autoimmune pathologies (22.2 vs. 55.6%, p = 0.022). Resected patients also presented with less classical radiological features of AIP, which are halo sign (0/25 vs. 3/17, p = 0.029) and loss of pancreatic clefts (18/25 vs. 17/17, p = 0.017). There were no differences in demographic features other than age. CONCLUSION: Despite international guidelines for diagnosing AIP, differentiation from pancreatic cancer remains challenging. Resection remains an important treatment option in suspected cancer or where conservative treatment fails.


Assuntos
Doenças Autoimunes/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Pancreatite Crônica/diagnóstico , Adulto , Idoso , Antígenos Glicosídicos Associados a Tumores/sangue , Doenças Autoimunes/terapia , Biomarcadores/sangue , Estudos de Coortes , Diagnóstico Diferencial , Feminino , Glucocorticoides/uso terapêutico , Humanos , Imunoglobulina G/sangue , Masculino , Pessoa de Meia-Idade , Pâncreas/diagnóstico por imagem , Neoplasias Pancreáticas/terapia , Pancreatite Crônica/terapia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
19.
Khirurgiia (Mosk) ; (2): 96-100, 2019.
Artigo em Russo | MEDLINE | ID: mdl-30855598

RESUMO

It is presented surgical treatment of the patient with pancreatic intraductal papillary mucinous tumor who was under observation with diagnosis of chronic pancreatitis for a long time. Recurrent tumor with possible malignant transformation to carcinoma was suspected in 5 years after pancreaticoduodenectomy. It was supposed to perform pancreatic stump extirpation. Redo surgery did not reveal any tumor. The cause of recurrent pain was pancreatic duct obliteration at the level of anastomosis.


Assuntos
Carcinoma Ductal Pancreático/diagnóstico , Erros de Diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Dor Abdominal/etiologia , Adenocarcinoma Mucinoso/diagnóstico , Carcinoma Papilar/diagnóstico , Humanos , Ductos Pancreáticos/patologia , Pancreaticoduodenectomia , Pancreatite Crônica/diagnóstico , Reoperação
20.
Environ Health Prev Med ; 24(1): 10, 2019 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-30732577

RESUMO

BACKGROUND: Although fat accumulation in human organs is associated with a variety of diseases, there is little evidence about the effect of a fatty pancreas on the development of subclinical chronic pancreatitis over the clinical course. METHODS: We conducted a prospective cohort study from 2008 to 2014 of patients who underwent a medical checkup consultation for fat accumulated in the pancreas. Patients included in the analysis were divided into a non-fatty pancreas group (n = 9710) and fatty pancreas group (n = 223). The primary end point was the odds ratio (OR) for chronic pancreatitis associated with fatty pancreas, which was diagnosed using ultrasonography. We used a multiple logistic regression model to estimate the OR and the corresponding 95% confidence interval (CI). RESULTS: Ninety-two people were diagnosed with chronic pancreatitis, including both presumptive and definitive diagnoses. Twelve people were diagnosed with chronic pancreatitis by ultrasonography among the 223 patients with fatty pancreas, and 80 patients among 9710 were diagnosed with non-fatty pancreas. The crude OR was 6.85 (95% CI 3.68, 12.75), and the multiple adjusted OR was 3.96 (95% CI 2.04, 7.66). CONCLUSIONS: Fat accumulation in the pancreas could be a risk factor for developing subclinical chronic pancreatitis.


Assuntos
Tecido Adiposo/patologia , Pancreatite Crônica/epidemiologia , Pancreatite Crônica/etiologia , Tecido Adiposo/diagnóstico por imagem , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Feminino , Humanos , Japão/epidemiologia , Estilo de Vida , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pâncreas/diagnóstico por imagem , Pâncreas/patologia , Pancreatite Crônica/diagnóstico , Exame Físico , Estudos Prospectivos , Fatores de Risco , Fumar/epidemiologia
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