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1.
Zhonghua Wai Ke Za Zhi ; 57(12): 912-916, 2019 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-31826595

RESUMO

Objective: To evaluate the role of multidisciplinary team (MDT) clinic in the diagnosis of pancreatic diseases and patient compliance with MDT advice in the current medical system. Methods: The study included 512 patients that had visited the pancreas-oriented MDT clinic of Zhongshan Hospital between May 2015 and May 2019.The clinical and pathological data were collected and analyzed retrospectively. Diseases were classified in accordance with 2010 WHO classification of tumors of the digestive system and usual clinical practices. Compliance was determined according to whether a patient received corresponding therapies or undergoing further checks or follow-ups. Results: Among the 512 patients that had visited the MDT clinic, 121 patients were referred due to undetermined diagnosis. Classified according to the final diagnosis, the rate of undetermined diagnosis in different disease categories from high to low in order was inflammatory diseases of the pancreas (75.0%, 24/32), other lesions of the pancreas (56.1%,23/41), pancreatic cystic lesions (19.1%,17/89), pancreatic carcinomas (18.3%,48/262) and pancreatic neuroendocrine neoplasms (pNEN)(10.2%,9/88). The MDT clinic made diagnosis to 68 patients directly with an accuracy of 89.7%. The rate of compliance in the entire cohort was 63.4%. The rate of compliance of patients from June 2017 to May 2019 (68.4%) was higher than that of patients from May 2015 to May 2017(59.6%). The compliance rate of patients in different disease categories from high to low in order was inflammatory diseases of the pancreas(84.4%, 27/32), pancreatic carcinomas (67.9%, 178/262), pNEN(60.2%,53/88), other lesions of the pancreas (56.1%,23/41), and pancreatic cystic lesions(49.4%, 44/89). The compliance rate of patients with different MDT advice from high to low in order was best supportive care(78.6%,22/28), antitumor approaches beyond surgery(71.6%,159/222), further tests(62.6%, 77/123), surgery(53.7%, 65/121) and follow-up(49.2%, 31/63). In patients suggested for surgery, the compliance rate of patients with carcinomas(67.4%, 33/49) was higher than patients with other kinds of neoplasms. Conclusions: MDT clinic could facilitate the diagnosis of pancreatic diseases conveniently and inexpensively. The overall compliance rate of MDT clinic patients is rather low, and patients with carcinomas have a relative high rate of compliance with the suggestion of surgery.


Assuntos
Ambulatório Hospitalar , Pancreatopatias/diagnóstico , Pancreatopatias/terapia , Cooperação do Paciente , China , Estudos de Coortes , Humanos , Neoplasias Pancreáticas/diagnóstico , Equipe de Assistência ao Paciente , Estudos Retrospectivos
2.
Cells ; 8(8)2019 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-31426422

RESUMO

During foetal life, the liver plays the important roles of connection and transient hematopoietic function. Foetal liver cells develop in an environment called a hematopoietic stem cell niche composed of several cell types, where stem cells can proliferate and give rise to mature blood cells. Embryologically, at about the third week of gestation, the liver appears, and it grows rapidly from the fifth to 10th week under WNT/ß-Catenin signaling pathway stimulation, which induces hepatic progenitor cells proliferation and differentiation into hepatocytes. Development of new strategies and identification of new cell sources should represent the main aim in liver regenerative medicine and cell therapy. Cells isolated from organs with endodermal origin, like the liver, bile ducts, and pancreas, could be preferable cell sources. Furthermore, stem cells isolated from these organs could be more susceptible to differentiate into mature liver cells after transplantation with respect to stem cells isolated from organs or tissues with a different embryological origin. The foetal liver possesses unique features given the co-existence of cells having endodermal and mesenchymal origin, and it could be highly available source candidate for regenerative medicine in both the liver and pancreas. Taking into account these advantages, the foetal liver can be the highest potential and available cell source for cell therapy regarding liver diseases and diabetes.


Assuntos
Feto/metabolismo , Hepatócitos/transplante , Hepatopatias/terapia , Fígado , Medicina Regenerativa , Transplante de Células-Tronco , Animais , Diabetes Mellitus/terapia , Hepatócitos/citologia , Humanos , Fígado/citologia , Fígado/metabolismo , Regeneração Hepática , Camundongos , Pancreatopatias/terapia , Células-Tronco/citologia
3.
BMJ Case Rep ; 12(5)2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-31068351

RESUMO

Haemosuccus pancreaticus (HP) is an uncommon cause of upper gastrointestinal (GI) bleeding, most often intermittent, making it difficult to diagnose, becoming fatal. It usually occurs in patients with chronic pancreatitis and is caused by the rupture of a visceral aneurysm within the main pancreatic duct. The association between pseudoaneurysm formation and pancreatitis is well established. Pseudoaneurysm occurs in 3.5%-10% of pancreatitis cases and its rupture is a rare but life-threatening complication of chronic pancreatitis occurring in 6%-8% of patients with pseudocysts and corresponds to less than 1% of cases of GI bleeding.Its diagnosis is challenging, given the intermittent nature of bleeding. Angiographic therapy is considered the first-choice treatment, especially in patients who are stable haemodynamically. We present a case of embolisation of inferior pancreaticoduodenal branches with polyvinyl alcohol microparticles in the treatment of HP.


Assuntos
Falso Aneurisma/diagnóstico por imagem , Embolização Terapêutica , Hemorragia Gastrointestinal/diagnóstico por imagem , Artéria Mesentérica Superior/diagnóstico por imagem , Pâncreas/irrigação sanguínea , Pancreatopatias/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Dor Abdominal/diagnóstico por imagem , Adulto , Falso Aneurisma/fisiopatologia , Falso Aneurisma/terapia , Angiografia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Masculino , Melena , Artéria Mesentérica Superior/fisiopatologia , Pâncreas/diagnóstico por imagem , Pancreatopatias/fisiopatologia , Pancreatopatias/terapia , Álcool de Polivinil/administração & dosagem , Resultado do Tratamento
4.
Pancreas ; 48(5): 690-697, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31091217

RESUMO

OBJECTIVES: Pancreatic duct stones contribute to pain in patients with chronic pancreatitis, and per-oral pancreatoscopy (POP) allows visualization, fragmentation, and removal of these stones. This study compared the safety and efficacy of endoscopic retrograde pancreatography (ERP) with and without POP. METHODS: This single-center retrospective review compared ERP with and without POP for treatment of main-duct pancreatic duct stones. The primary outcome was technical success, defined as partial or complete stone removal, which was compared between the 2 groups. RESULTS: In all, 223 patients underwent 549 ERPs with a technical success rate of 92.4% and complete stone clearance rate of 74.9%. Patients undergoing ERP with POP (n = 94) had higher technical success than patients undergoing ERP without POP (n = 129, 98.9% vs 87.6%, P < 0.001), but required more ERPs (3.1 vs 1.9, P = 0.02). Endoscopic retrograde pancreatography with POP was associated with larger stone size (8.9 vs 6.1 mm, P = 0.001), more stones per case (5+ stones: 33.8% vs 21.1%, P = 0.002), and more impacted stones (48.8% vs 10.3%, P < 0.001). CONCLUSIONS: Per-oral pancreatoscopy-guided lithotripsy permits effective stone removal in cases not amenable to standard ERP techniques, including those with larger or more numerous stones.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Endoscopia Gastrointestinal/métodos , Litotripsia/métodos , Pancreatopatias/terapia , Ductos Pancreáticos/patologia , Cálculos Urinários/terapia , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adulto , Idoso , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Endoscopia Gastrointestinal/efeitos adversos , Feminino , Humanos , Litotripsia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Dor/complicações , Dor/prevenção & controle , Pancreatite Crônica/complicações , Pancreatite Crônica/terapia , Estudos Retrospectivos , Resultado do Tratamento , Cálculos Urinários/complicações
5.
Dtsch Med Wochenschr ; 144(9): 630-632, 2019 05.
Artigo em Alemão | MEDLINE | ID: mdl-31026872

RESUMO

Prof. Dr. med. Joachim Mössner has always been committed to an honest, evidence-based medicine that focuses on the patient. To him, research has always been an important basis of good medicine: His research focuses on the physiological and pathophysiological processes of pancreatic diseases. He was successful in characterizing signaling pathways at the cellular level. Based on his findings, genetic association studies were conducted. He thus contributed to a better understanding of the development of acute and chronic pancreatitis.


Assuntos
Medicina Baseada em Evidências , Gastroenterologia , Pancreatopatias/terapia , Assistência Centrada no Paciente , Pesquisa Biomédica , Humanos
6.
J Laparoendosc Adv Surg Tech A ; 29(6): 839-844, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30985231

RESUMO

Purpose: There is a lack of experience with stenting for benign pancreaticobiliary disorders in children. Materials and Methods: Fifteen children (9 male and 6 female) with a median age of 7.1 years (range 0.7-14.2 years) who underwent treatment with a plastic stent for a benign disorder of the pancreaticobiliary system between May 2003 and September 2017 were recruited to this retrospective study. Results: Biliary and/or pancreatic plastic stents were inserted into 5 patients with congenital, 4 with post-traumatic, and 6 with idiopathic pathologies. Median duration of individual stent placement was 111 days (range 14-1569 days). Eleven children (73%) were treated with one stent only. In 4 cases, up to 22 stents were successively placed over time. There were no complications during stent insertion or stent removal. Seven patients (47%) experienced adverse effects during stenting, including choledocholithiasis, pancreaticolithiasis, cholangitis, acute pancreatitis, stent obstruction, and stent fracture. At follow-up, in 11 cases (73%), the underlying condition was resolved. In 4 children, all of whom suffered from congenital pancreaticobiliary disorders, stent therapy was considered as a temporary treatment before definite surgery. Conclusions: Patients with congenital anomalies of the pancreaticobiliary tree often require surgery for definitive management. However, temporary stent placement can be accomplished safely and successfully and this serves as a bridge to temporize their obstructive process while awaiting surgical intervention. Children with post-traumatic or idiopathic disorders can frequently be managed definitively by stenting alone and many of these require only one single stent insertion.


Assuntos
Doenças Biliares/terapia , Colangiopancreatografia Retrógrada Endoscópica , Pancreatopatias/terapia , Stents , Adolescente , Doenças Biliares/diagnóstico por imagem , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Pancreatopatias/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento
7.
Rom J Intern Med ; 57(3): 209-219, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30901317

RESUMO

Obesity is a growing health burden worldwide, increasing the risk for several diseases featuring the metabolic syndrome - type 2 diabetes mellitus, dyslipidemia, non-alcoholic fatty liver disease and cardiovascular diseases. With the increasing epidemic of obesity, a new pathologic condition has emerged as a component of the metabolic syndrome - that of non-alcoholic fatty pancreas disease (NAFPD). Similar to non-alcoholic fatty liver disease (NAFLD), NAFPD comprises a wide spectrum of disease - from deposition of fat in the pancreas - fatty pancreas, to pancreatic inflammation and possibly pancreatic fibrosis. In contrast with NAFLD, diagnostic evaluation of NAFPD is less standardized, consisting mostly in imaging methods. Also the natural evolution of NAFPD and its association with pancreatic cancer is much less studied. Not least, the clinical consequences of NAFPD remain largely presumptions and knowledge about its metabolic impact is limited. This review will cover epidemiology, pathogenesis, diagnostic evaluation tools and treatment options for NAFPD, with focus on practices for clinicians.


Assuntos
Tecido Adiposo/patologia , Pancreatopatias/diagnóstico , Pancreatopatias/patologia , Endossonografia , Humanos , Síndrome Metabólica/complicações , Obesidade/complicações , Pancreatopatias/epidemiologia , Pancreatopatias/terapia , Tomografia Computadorizada por Raios X
8.
S D Med ; 72(2): 54-57, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30855730

RESUMO

Annular pancreas is an uncommon congenital cause of gastric outlet obstruction. The incidence is usually referenced at between five and 15 per 100,000 based on autopsy series. When present, this rare condition surfaces with symptoms in the pediatric population during the first few months of life. An adult presenting with symptoms of gastric outlet obstruction due to annular pancreas is an unusual incident. This case describes gastric outlet obstruction due to a partial annular pancreatic band in an otherwise healthy 32-year-old male. Given the scarcity of this pathological process in adults; no specific guidelines exist about the management of this condition. Continued reporting of this pathology is essential for development of such guidelines. Literature review, embryology and treatment options will be discussed.


Assuntos
Obstrução da Saída Gástrica/etiologia , Pâncreas/anormalidades , Pancreatopatias/complicações , Adulto , Humanos , Masculino , Pâncreas/embriologia , Pancreatopatias/embriologia , Pancreatopatias/terapia
9.
Pancreas ; 48(3): 343-349, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30789387

RESUMO

OBJECTIVES: This study aimed to compare the efficacy of percutaneous drainage (PCD) versus peritoneal lavage (PL) for the treatment for severe acute pancreatitis patients with pancreatic ascites (PAs). METHODS: Severe acute pancreatitis patients with PAs were randomly assigned within 3 days of onset of symptoms to receive either PL or PCD. The primary end point was a composite of mortality or major complications during hospitalization and within 1 month of discharge. Per-protocol analyses were performed. RESULTS: Between September 2011 and June 2014, 86 patients were randomly assigned to intervention with PL or PCD. Ultimately, 41 patients in the PCD group and 39 patients in the PL group completed the study. The primary end point occurred in 15 (36.6%) of 41 patients in the PCD group and in 17 (43.6%) of 39 patients in the PL group (risk ratio, 0.84; 95% confidence interval, 0.49-1.44; P = 0.27). Mortality or major complications did not differ between the groups. Percutaneous drainage reduced intra-abdominal hypertension; however, PL reduced the incidence of deep venous thrombosis and pancreatic encephalopathy and was associated with a reduced need for intervention. CONCLUSIONS: In our study, the PCD was not superior to the PL in reducing mortality or major complications in severe acute pancreatitis patients with PAs.


Assuntos
Ascite/terapia , Drenagem/métodos , Pancreatopatias/terapia , Pancreatite/terapia , Lavagem Peritoneal/métodos , Doença Aguda , Adulto , Ascite/complicações , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatopatias/complicações , Pancreatite/complicações , Pancreatite/patologia , Estudos Prospectivos , Índice de Gravidade de Doença , Análise de Sobrevida
10.
BMC Gastroenterol ; 19(1): 35, 2019 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-30808288

RESUMO

BACKGROUND: Single-operator, per-oral cholangiopancreatoscopy (SOPCP) enables direct biliopancreatic ductal visualization, targeted tissue sampling, and therapeutic intervention. At Karolinska University Hospital, SOPCP was introduced early and has since been extensively utilized according to a standardized protocol. We analysed the clinical value of SOPCP in the diagnosis and treatment of biliopancreatic diseases in a single high volume center. METHODS: All SOPCP procedures performed between March 2007 and December 2014 were retrospectively reviewed. Each procedure's diagnostic yield and therapeutic value was evaluated using a predefined 4 grade scale; 1 - no diagnostic or therapeutic value, 2 - information gained did not impact clinical decision-making and in case of a therapeutic intervention, did not alter the clinical course of the patient, 3 - information gained had an impact on clinical decision-making and in the case of a therapeutic intervention, assisted subsequent disease management, and finally, 4 - information gained was essential and critical for clinical decision-making and in case of a therapeutic intervention, solved the clinical problem requiring no further therapeutic actions. Descriptive statistics were used to analyse results, with uni- and multivariate analyses completed to assess risk of adverse events. RESULTS: During the study period, 365 SOPCP procedures were performed. We found SOPCP of pivotal importance (grade 4) in 19% of cases, and of great clinical significance (grade 3) in 44% of cases. SOPCP did not affect clinical decision-making or alter clinical course (grade 1 and 2) in 37% of cases. CONCLUSION: SOPCP offers direct access to the biliopancreatic ducts for both diagnostic and therapeutic purposes, adding significant clinical value in 64% of cases. TRIAL REGISTRATION: As this is a purely observational and retrospectively registered study in which the assignment of the medical intervention was not at the discretion of the investigator, it has not been registered in a registry.


Assuntos
Ductos Biliares/diagnóstico por imagem , Doenças Biliares/diagnóstico por imagem , Colangiopancreatografia Retrógrada Endoscópica/métodos , Pancreatopatias/diagnóstico por imagem , Ductos Pancreáticos/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Biliares/terapia , Criança , Pré-Escolar , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Tomada de Decisão Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatopatias/terapia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
11.
Clin Radiol ; 74(5): 408.e1-408.e7, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30808501

RESUMO

AIM: To find potential predictors at unenhanced computed tomography (CT) to evaluate the stone clearance rate (SCR) of pancreatic duct stones (PDS) by extracorporeal shock wave lithotripsy (ESWL). MATERIALS AND METHODS: A total of 106 consecutive patients with multiple stones of maximal transverse length (MTL) 0.3-3.6 cm in pancreatic head region were enrolled. Unenhanced CT was performed both before and after ESWL therapy. All patients underwent ESWL therapy using an electromagnetic lithotripter, and were divided into three groups with threshold values of >90%, 50-90% and <50% of SCR. Factors including sex, age, MTL, mean stone density (MSD), standard deviation of stone density (SDSD), variation coefficient of stone density (VCSD), attenuation density (AD), pancreatic duct diameter (PDD), skin-to-stone distance (SSD), and number of ESWL sessions were analysed, and their impact on SCR was evaluated by univariate and multivariate analyses. The diagnostic threshold of the independent predicting index was further calculated, and its relationship with SCR and ESWL was analysed by drawing a trend line. RESULTS: The only significant predictor of SCR by ESWL was MSD (p<0.05). More courses of ESWL therapy are required in PDS patients with an MSD higher than the cut-off value of 375.4 HU (mean, 2.6 versus 1.8), but with a relatively lower SCR (mean, 43.96 versus 88.68%) . CONCLUSION: MSD on pre-treatment unenhanced CT is an independent predictor for SCR of PDS patients treated with ESWL. Using a cut-off value of 375.4 HU, patients with low MSD are good candidates for ESWL therapy.


Assuntos
Cálculos/terapia , Litotripsia/métodos , Pancreatopatias/terapia , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ductos Pancreáticos , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
13.
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
14.
Gastrointest Endosc ; 89(2): 384-389, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30176224

RESUMO

BACKGROUND AND AIMS: Per-oral pancreatoscopy (POP) permits direct evaluation of the pancreatic duct for the visualization and sampling of neoplastic lesions and treatment of pancreatic duct stones by using intraductal lithotripsy techniques. Pancreatic laser endotherapy of mucosa has been described in animal models for tumor ablation, but human experience is lacking. We describe 3 unique and challenging clinical situations that benefited from pancreatic laser dissection and ablation. CASE DESCRIPTION: Case 1 was a 75-year-old woman with presumed divisum-associated chronic pancreatitis who had recurrent acute pancreatitis despite minor papilla sphincterotomy and therapeutic stent placement. POP showed a side-branch intraductal papillary mucinous neoplasm within the neck of the pancreas. POP-guided holmium laser ablation of neoplastic tissue was performed, followed by pancreatic stent placement every 6 months, with no further hospitalizations at 20 months of follow-up. Case 2 was a 69-year-old woman with divisum-associated chronic calcific pancreatitis and recalcitrant mid-body stenosis. Previous attempts at balloon dilation and stent placement failed to resolve the stenosis. POP-guided holmium laser dissection of the stenosis was pursued, with immediate radiographic resolution. Case 3 was a 65-year-old woman with chronic calcific pancreatitis and a large stone burden who underwent POP-guided electrohydraulic lithotripsy and partial stone extraction followed by stent placement. Unfortunately, the stent fractured during the subsequent removal attempt because the fragment was impacted in the pancreatic body. POP-guided laser dissection and lithotripsy were used to debulk dense fibrous tissue and stones surrounding the stent fragment, respectively, followed by removal. CONCLUSIONS: Pancreatoscopy-guided laser endotherapy is a novel and potentially useful technique to manage difficult benign and neoplastic pancreatic disorders.


Assuntos
Cálculos/terapia , Endoscopia do Sistema Digestório/métodos , Corpos Estranhos/cirurgia , Terapia a Laser/métodos , Litotripsia/métodos , Pancreatopatias/terapia , Ductos Pancreáticos/cirurgia , Neoplasias Intraductais Pancreáticas/cirurgia , Idoso , Calcinose/complicações , Cálculos/etiologia , Constrição Patológica/cirurgia , Dissecação/métodos , Feminino , Humanos , Lasers de Estado Sólido , Pancreatopatias/etiologia , Pancreatite Crônica/complicações , Stents
15.
Horm Res Paediatr ; 91(1): 56-61, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30114684

RESUMO

BACKGROUND: A long-acting somatostatin analogue (lanreotide) is used in the management of a diazoxide-unresponsive diffuse form of congenital hyperinsulinism (CHI). However, no reports of its use in patients with the focal form of CHI exist. Case 1: A 1-month-old boy diagnosed with diazoxide-unresponsive CHI due to a paternal heterozygous ABCC8 gene mutation showed partial response to octreotide. 18F-DOPA-PET/CT scan revealed a focal lesion in the pancreatic head. Surgical removal of the lesion was unsuccessful. He was switched to monthly lanreotide treatment at the age of 11 months, which stabilised his blood glucose over a 12-month period. Case 2: A 1-month-old boy with diazoxide-unresponsive CHI due to a paternal heterozygous KCNJ11 gene mutation was partially responsive to octreotide. 18F-DOPA-PET/CT scan confirmed a focal pancreatic head lesion. Over 6 months, he underwent 3 lesionectomies and afterwards responded to octreotide. At the age of 9 months, treatment was switched to monthly lanreotide. Currently, he is aged 3, with stable glycaemia, and improved fasting tolerance. Case 3: A 3-week-old girl with a paternal heterozygous ABCC8 gene mutation was unresponsive to diazoxide. 18F-DOPA-PET/CT scan confirmed a focal pancreatic head lesion. She responded to octreotide, and her parents preferred to avoid pancreatic surgery. At the age of 20 months, treatment was switched to monthly lanreotide, resulting in euglycaemia over the last 7 months. CONCLUSION: CHI patients with focal pancreatic head lesions are challenging, especially if not surgically amenable. Conservative treatment is preferable, and lanreotide might be an option. The therapeutic impact of lanreotide treatment in patients with the focal forms of CHI should be confirmed in prospective studies with close monitoring of the side effects.


Assuntos
Hiperinsulinismo Congênito/diagnóstico por imagem , Hiperinsulinismo Congênito/tratamento farmacológico , Peptídeos Cíclicos/administração & dosagem , Tomografia por Emissão de Pósitrons , Somatostatina/análogos & derivados , Tomografia Computadorizada por Raios X , Hiperinsulinismo Congênito/genética , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pancreatopatias/induzido quimicamente , Pancreatopatias/diagnóstico por imagem , Pancreatopatias/terapia , Peptídeos Cíclicos/efeitos adversos , Canais de Potássio Corretores do Fluxo de Internalização/genética , Somatostatina/administração & dosagem , Somatostatina/efeitos adversos , Receptores Sulfonilureia/genética
16.
Clin J Gastroenterol ; 12(1): 88-91, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30155834

RESUMO

Bleeding from the pancreatic duct is a rare source of gastrointestinal hemorrhage and is referred to as hemosuccus pancreaticus. Often a result of pseudoaneurysm formation from chronic pancreatitis, hemosuccus pancreaticus is a difficult diagnosis due to its peculiar clinical presentation. This is a case of a 51-year-old male with a history of chronic pancreatitis, who initially presented with a pancreatic mass found on CT scan. The mass was found to be inconclusive for malignancy on endoscopic ultrasound-guided fine needle aspiration. The patient subsequently was lost to follow-up and returned with melena and evidence of a superior mesenteric pseudoaneurysm in the previous mass on CT angiography. The pseudoaneurysm was successfully treated with endovascular embolization. Diagnosis of hemosuccus pancreaticus can be challenging due to the intermittent nature of hemorrhage and the variable clinical presentation-which initially appeared as a pancreatic neoplasm in our patient. Repeat imaging and angiography are invaluable for both the diagnosis and treatment of gastrointestinal bleeding from an unknown source in the setting of chronic pancreatitis.


Assuntos
Falso Aneurisma/complicações , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Artéria Mesentérica Superior , Pancreatopatias/diagnóstico por imagem , Pancreatopatias/etiologia , Ductos Pancreáticos/diagnóstico por imagem , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/terapia , Diagnóstico Diferencial , Embolização Terapêutica , Hemorragia Gastrointestinal/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatopatias/terapia , Neoplasias Pancreáticas/diagnóstico , Pancreatite Crônica/complicações
17.
Dig Dis Sci ; 64(1): 249-261, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30259278

RESUMO

Ethnic health disparity is a well-acknowledged issue in many disease settings, but not diseases of the exocrine pancreas. A systematic review and meta-analysis was conducted to explore the race- and ethnicity-specific burden of diseases of the exocrine pancreas. Studies that compared health-related endpoints between two or more ethnicities were eligible for inclusion. Proportion meta-analyses were conducted to compare burden between groups. A total of 42 studies (24 on pancreatic cancer, 17 on pancreatitis, and one on pancreatic cyst) were included in the systematic review, of which 19 studies were suitable for meta-analyses. The incidence of pancreatic cancer was 1.4-fold higher among African-Americans, while the incidence of acute pancreatitis was 4.8-fold higher among an indigenous population (New Zealand Maori) compared with Caucasians. The prevalence of post-pancreatitis diabetes mellitus was up to 3.0-fold higher among certain ethnicities, including Asians, Pacific Islanders, and indigenous populations compared with Caucasians. The burden of diseases of the exocrine pancreas differs between ethnicities, with African-Americans and certain indigenous populations being at the greatest risk of developing these diseases. Development of race- and ethnicity-specific screening as well as protocols for lifestyle modifications may need to be considered with a view to reducing the disparities in burden of diseases of the exocrine pancreas.


Assuntos
Afro-Americanos , Disparidades nos Níveis de Saúde , Saúde das Minorias/etnologia , Pâncreas Exócrino , Pancreatopatias/etnologia , Grupos Populacionais , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/etnologia , Humanos , Incidência , Estilo de Vida/etnologia , Pâncreas Exócrino/patologia , Cisto Pancreático/diagnóstico , Cisto Pancreático/etnologia , Pancreatopatias/diagnóstico , Pancreatopatias/mortalidade , Pancreatopatias/terapia , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/etnologia , Pancreatite/diagnóstico , Pancreatite/etnologia , Fatores de Risco
18.
Gastroenterology ; 156(1): 254-272.e11, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30315778

RESUMO

BACKGROUND & AIMS: Estimates of disease burden can inform national health priorities for research, clinical care, and policy. We aimed to estimate health care use and spending among gastrointestinal (GI) (including luminal, liver, and pancreatic) diseases in the United States. METHODS: We estimated health care use and spending based on the most currently available administrative claims from commercial and Medicare Supplemental plans, data from the GI Quality Improvement Consortium Registry, and national databases. RESULTS: In 2015, annual health care expenditures for gastrointestinal diseases totaled $135.9 billion. Hepatitis ($23.3 billion), esophageal disorders ($18.1 billion), biliary tract disease ($10.3 billion), abdominal pain ($10.2 billion), and inflammatory bowel disease ($7.2 billion) were the most expensive. Yearly, there were more than 54.4 million ambulatory visits with a primary diagnosis for a GI disease, 3.0 million hospital admissions, and 540,500 all-cause 30-day readmissions. There were 266,600 new cases of GI cancers diagnosed and 144,300 cancer deaths. Each year, there were 97,700 deaths from non-malignant GI diseases. An estimated 11.0 million colonoscopies, 6.1 million upper endoscopies, 313,000 flexible sigmoidoscopies, 178,400 upper endoscopic ultrasound examinations, and 169,500 endoscopic retrograde cholangiopancreatography procedures were performed annually. Among average-risk persons aged 50-75 years who underwent colonoscopy, 34.6% had 1 or more adenomatous polyps, 4.7% had 1 or more advanced adenomatous polyps, and 5.7% had 1 or more serrated polyps removed. CONCLUSIONS: GI diseases contribute substantially to health care use in the United States. Total expenditures for GI diseases are $135.9 billion annually-greater than for other common diseases. Expenditures are likely to continue increasing.


Assuntos
Gastroenteropatias/economia , Gastroenteropatias/terapia , Custos de Cuidados de Saúde/tendências , Gastos em Saúde/tendências , Hepatopatias/economia , Hepatopatias/terapia , Pancreatopatias/economia , Pancreatopatias/terapia , Adolescente , Adulto , Idoso , Efeitos Psicossociais da Doença , Feminino , Gastroenteropatias/diagnóstico , Gastroenteropatias/etnologia , Necessidades e Demandas de Serviços de Saúde/economia , Humanos , Incidência , Hepatopatias/diagnóstico , Hepatopatias/etnologia , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde/economia , Pancreatopatias/diagnóstico , Pancreatopatias/etnologia , Prevalência , Fatores Socioeconômicos , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto Jovem
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