1/151. learning from case reports: diagnostic issues in an epidemiologic study of pancreatic cancer.epidemiologic studies on exocrine pancreatic cancer show a large heterogeneity in diagnostic criteria applied to define "caseness." Reanalyses conducted after review of diagnostic information have yielded substantially different results than those based on more crude classifications of disease. During a multicenter prospective study on mutations in the K-ras gene in pancreatic and biliary diseases, hospital diagnoses from 602 patients were reviewed by a panel of experts. There were two main motivations to do so: a generic interest for the quality of the diagnostic data, and the anticipation that a firm diagnosis could be needed to assess whether patients whose tumors did not harbor the mutation were true negatives or false negatives. In addition, the review of diagnoses was helpful to minimize tissue misclassification, and it had a high educational value for clinicians and epidemiologists. This article illustrates why and how this was so through a brief presentation of the 10 most significant cases. With respect to selection and classification of subjects, the main issues that studies on pancreatic cancer need to address are the differential diagnosis of exocrine pancreatic cancer and pancreatitis, the differential diagnosis of exocrine pancreatic cancer and other abdominal tumors, and the use of survival as a hallmark of pancreatic cancer. In epidemiologic studies of pancreatic cancer, it is warranted that a panel of experts centrally reviews all the existing diagnostic evidence (cytohistological and other) of all patients, regardless of whether they have cytohistological confirmation and of their hospital discharge diagnosis.- - - - - - - - - - ranking = 1keywords = pancreatitis (Clic here for more details about this article) |
2/151. Postoperative acute pulmonary thromboembolism in patients with acute necrotizing pancreatitis with special reference to apheresis therapy.Eight patients with pancreatic abscesses secondary to acute necrotizing pancreatitis underwent drainage of their abscesses under laparotomy. Two of them died of acute pulmonary thromboembolism (PTE) within 1 week. autopsy revealed a large thrombus at the main trunk of the pulmonary artery and in the left common iliac vein. Femoral catheter insertion/indwelling, immobilization, surgery, increased trypsin/kinin/kallikrein, increased endotoxin, and decreased antithrombin-III (AT-III) were present following drainage of the pancreatic abscesses. With respect to the bedside diagnosis of acute PTE, alveolar-arterial oxygen gradients obtained by blood gas analysis and mean pulmonary artery pressure estimated by pulsed Doppler echocardiography are very useful. In terms of the treatment, attention should be paid to the following to prevent deep venous thrombosis: prophylactic administration of low molecular weight heparin and administration of AT-III (AT-III > or = 80%), use of the subclavian vein whenever possible as blood access for apheresis therapy, as short a compression time as possible after removing the blood access catheter (< or =6 h), and application of intermittent pneumatic compression devices or elastic compression stockings on the lower extremities.- - - - - - - - - - ranking = 5keywords = pancreatitis (Clic here for more details about this article) |
3/151. Annular pancreas associated with pancreatolithiasis: a case report.We present a case of annular pancreas associated with pancreatolithiasis. A 41 year-old Japanese man with epigastric pain was admitted to the surgical service at Miyazaki Medical College Hospital. Contrast duodenography revealed severe stenosis of the descending duodenum. cholangiography showed a stenotic segment of the intrapancreatic common bile duct surrounded by calcifications. Computed tomography of the abdomen revealed calcifications in the posterior region of the pancreatic head. Percutaneous cannulation of the pancreatic ductal system, using ultrasonic guidance, demonstrated a slightly dilated pancreatic duct in the body, stenosis of the duct of Wirsung in the pancreatic head, a normal duct of Santorini, and calcifications in the duct of an annular pancreas which communicated with the duct of Wirsung. At surgery, the second portion of the duodenum was completely encircled by the annular pancreas, and a Whipple procedure was performed. Including this patient, 170 adult cases of annular pancreas have been reported in japan since 1922. Surgery was performed on 122 patients; 106 of these procedures were well documented. A Whipple procedure was performed on 16 patients, including the present case. Nine of these 16 patients had associated malignant disease, while the others had benign pancreatic disease. This is the fifth reported case of pancreatolithiasis associated with an annular pancreas in japan. This case emphasizes that an annular pancreas may predispose to localized chronic pancreatitis and pancreatolithiasis.- - - - - - - - - - ranking = 1keywords = pancreatitis (Clic here for more details about this article) |
4/151. Surgical approaches for pancreatic ascites: report of three cases.Pancreatic ascites can occur in association with the rupture of a pseudocyst or the disruption of a pancreatic duct during the natural course of chronic pancreatitis. We report herein the successful treatment of three patients with pancreatic ascites by performing a surgical procedure after 4-6 weeks of total parenteral nutrition (TPN) proved ineffective. The principles of our surgical procedure for pancreatic ascites are as follows: (1) minimum pancreatic tissue is resected; (2) surgical intervention to repair leaking sites is not necessary; (3) pancreatic duct drainage is facilitated by an intestinal Roux-en-Y loop; (4) An external drainage tube is inserted through the Roux-en-Y loop into the main pancreatic duct. All three patients who underwent our surgical procedure had a good outcome. Although the mean follow-up time is still only 18.3 months, their condition has improved, with no evidence of recurrent ascites. Thus, our surgical procedure should be considered as an appropriate treatment for pancreatic ascites because it can be applied for all types of leakage, including leakage from the posterior wall of pancreas; it preserves pancreatic function, especially endocrine function; and it enables preservation of the spleen.- - - - - - - - - - ranking = 1keywords = pancreatitis (Clic here for more details about this article) |
5/151. Pancreatic arteriovenous malformation observed to bleed from the bile duct and a duodenal ulcer: report of a case.A 48-year-old man with recurrent episodes of biliary colic and subsequent pancreatitis was admitted to undergo a cholecystectomy. A gastroduodenal fiberscopic examination was performed because of massive melena on the seventh day after admission. It revealed a shallow ulcer on the posterior wall of a duodenal bulbus with rubor and an exposed vessel, which was clipped endoscopically to stop the bleeding. Further observations showed the papilla of Vater to be bleeding from the papilla. A contrast-enhanced abdominal computed tomography scan demonstrated a dilatation of the common bile duct and several dilated vasculatures around the portal vein, some of which drained into the portal vein. Based on the angiography findings, a diagnosis of arteriovenous malformation in the pancreas head was obtained and an embolization of the gastroduodenal artery was performed. Although the melena subsided, he underwent a pylorus-preserving pancreatoduodenectomy to prevent the recurrence of hemorrhaging. The histopathological findings of the bile duct revealed inflammatory cell infiltration and a detachment of the epithelium, except in a small part of the bile duct. A rupture of a damaged vessel inside the bile duct was observed, which was thought to be the cause of hemobilia. Sections of the pancreatic head demonstrated an inflammatory lesion with fibrosis and saponification as well as a large degree of arteriovenous anastomosis. The patient was discharged on the 35th day after the operation following an uneventful postoperative course.- - - - - - - - - - ranking = 1keywords = pancreatitis (Clic here for more details about this article) |
6/151. nesidioblastosis in an adult man--case report.We report a case of nesidioblastosis in a 66-year-old man with chronic alcohol-induced pancreatitis manifested by attacks of hypoglycemia for several years. The state of the patient improved after subtotal pancreatectomy.- - - - - - - - - - ranking = 1keywords = pancreatitis (Clic here for more details about this article) |
7/151. Complete recovery after spontaneous drainage of pancreatic abscess into the stomach.Pancreatic abscess is a dreaded complication of acute pancreatitis, with a high death rate even with aggressive surgical treatment. We report two cases in which recovery followed spontaneous drainage into the stomach. A 75-year-old woman with biliary pancreatitis and a 63-year-old man with ethanol-induced pancreatitis both developed pancreatic abscess, diagnosed by computed tomography scans and ultrasound. The spontaneous gastric fistula was heralded by a large emesis of purulent and necrotic material in one case and copious nasogastric tube secretions of a similar material in the other. Defervescence was immediate, and both patients went on to complete recovery without any further interventions. Contrast studies showed the fistulae. It is concluded that in the event that a pancreatic pseudocyst spontaneously drains into the stomach a 'wait and see' policy should be adopted, and a favorable outcome can be expected.- - - - - - - - - - ranking = 3keywords = pancreatitis (Clic here for more details about this article) |
8/151. Endoscopic pancreatic sphincter balloon dilation for effective retrieval of pancreatic duct stone.To facilitate pancreatic stone retrieval, four patients with chronic pancreatitis and pancreatic stones underwent endoscopic pancreatic sphincter balloon dilation (EPSBD) rather than pancreatic sphincterotomy. Extracorporeal shock wave lithotripsy combined with endoscopic removal was carried out in three patients. Stone removal following EPSBD was completely successful in all four patients. patients showed no severe complications during the dilation procedure. In one patient, to prevent pancreatitis, an endoscopic nasopancreatic drain was placed for 1 week after EPSBD. Compared with pancreatic sphincterotomy, EPSBD can be performed safely in patients with chronic pancreatitis to assist in the extraction of pancreatic duct stones. Use of the EPSBD procedure in cases of chronic pancreatitis provides a useful approach to improve endoscopic clearance of pancreatic duct stones.- - - - - - - - - - ranking = 4keywords = pancreatitis (Clic here for more details about this article) |
9/151. A case of hemorrhagic cyst of the pancreas resembling the cystic endometriosis.A 47-year-old Japanese woman with a history of epigastric pain and a recent episode of acute pancreatitis (back pain, nausea, and vomiting) and anemia was found to have a pancreatic cyst of the tail on CT-scan and ultrasonography. Especially, ultrasonography revealed the papillary solid lesion in the cyst. With the tentative diagnosis of a cystic neoplasm, distal pancreatectomy was performed. Histological examination of sections showed massive hemorrhage, surrounded fibrous connective tissue, and numerous macrophages with hemosiderin deposits; these histological findings resembled cystic endometriosis. The clinicopathological features and pathogenesis of the pancreatic endometrial cyst are discussed.- - - - - - - - - - ranking = 1keywords = pancreatitis (Clic here for more details about this article) |
10/151. Maternally inherited diabetes and deafness (MIDD): unusual occult exocrine pancreatic manifestation in an affected German family.The mitochondrial (mt) 3243 dna mutation is an underlying cause of maternally inherited diabetes and deafness (MIDD) syndrome and the syndrome of mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS). We report an affected German MIDD pedigree with maternal lineage over three generations. The index patient, her mother, her maternal aunt and her maternal grandmother all suffered from diabetes and premature hearing loss and were positive on testing for the mt 3243 dna mutation. The 27-year-old index patient had a history of grand mal seizures. As sequela of abdominal ultrasound and confirmed by magnetic resonance cholangio-pancreaticography, she was diagnosed with chronic pancreatitis with pancreatic calcifications and pancreatic duct dilation, although she was completely asymptomatic and with no signs of steatorrhoea. She did not have gallstones and the common bile duct was normal. A possible etiopathogenic pathway for pancreatitis could be a suppressive effect of the mt 3243 mutation on the oxidative phosphorylation in affected mitochondria. Although pancreatitis and pancreatic dysfunction in association with the mt 3243 mutation, especially in patients with comorbidity of MELAS and diabetes, has previously been described as a rare manifestation, this case is specific because of the discrepancy of advanced morphological pancreatic alterations and complete lack of pancreatogenic symptoms.- - - - - - - - - - ranking = 3keywords = pancreatitis (Clic here for more details about this article) |
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