1/16. A case of eosinophilic pleural effusion induced by pancreatothoracic fistula.A 49-year-old man was admitted for evaluation of a left pleural effusion. Thoracenthesis yielded a hemorrhagic pleural effusion with a high percentage of eosinophils (15.9%). Although there were no significant abdominal signs, serological examinations demonstrated a marked increase of pancreatic enzyme activity. Moreover, abdominal CT demonstrated cystic changes between the tail of the pancreas and the spleen. Accordingly ERP was performed under pressure, and contrast medium draining from the pancreas was observed. Pancreatic pleural effusion in this patient consisted of pancreatic juice retained in the thoracic cavity, which resulted from intrapancreatic fistulation connecting to the thoracic cavity due to a pancreatic cyst caused by chronic pancreatitis. The present report indicates that we should investigate the retention of eosinophilic pleural effusion considering not only the possibility of thoracic disease, but also the possibility of a pleural effusion derived from abdominal diseases.- - - - - - - - - - ranking = 1keywords = spleen (Clic here for more details about this article) |
2/16. Biliopancreatic fistula associated with intraductal papillary-mucinous pancreatic cancer: institutional experience and review of the literature.Intraductal papillary-mucinous tumour is clinicopathologically characterized by papillary growth and mucin production within the pancreatic duct system. The category includes a wide range of dysplasia, ranging from adenoma to carcinoma, the latter designated as intraductal papillary-mucinous cancer. In general, the tumor renders a favorable prognosis after complete resection. However, intraductal papillary-mucinous tumor with overt invasion outside the gland has been reported to have a poor prognosis, as is the case with the usual type of duct cell cancer of the pancreas. We experienced two cases of intraductal papillary-mucinous cancer with obstructive jaundice due to impaction of thick mucus protruding from the pancreas via a "spontaneous" biliopancreatic fistula. Preoperative examinations of both patients showed a large intraductal papillary-mucinous tumor in the head of the pancreas with fistula formation between the intrapancreatic portion of the common bile duct and the main pancreatic duct. Histopathological investigation of the two resected specimens suggested that the fistula may not have developed from invasion by papillary or tubular adenocarcinoma, but from compression and destruction of the intercalating tissues by abundant mucinous secretion. The first patient died of peritoneal carcinomatosis with clinicopathologic features of pseudomyxoma peritonei 6 years after surgery. The second patient is alive and has been well for 2 years postoperatively. review of the world literature showed that half of the patients with intraductal papillary-mucinous cancer plus biliopancreatic fistula had no stromal invasion around the fistula, indicating that the fistula might have been caused by mechanical pressure. However, the other half of the cases did have stromal invasion around the fistula. Two-thirds of these cases, including our own patients, had foci of mucinous carcinoma in the stroma around the fistulization, implying that mucinous lakes in the stroma may have served as part of the "waterway" from the pancreatic duct to the bile duct, assisted by increased pressure by mucus production. Since intraductal papillary-mucinous cancer with biliopancreatic fistula has a comparatively favorable prognosis, surgical resection should be considered.- - - - - - - - - - ranking = 6.0604632702326keywords = cancer (Clic here for more details about this article) |
3/16. Radical distal pancreatectomy with en bloc resection of the celiac artery, plexus, and ganglions for advanced cancer of the pancreatic body: a preliminary report on perfect pain relief.OBJECTIVE: The purpose of this study was to report the effect of radical distal pancreatectomy with en bloc resection of the celiac artery, plexus, and ganglions for locally advanced cancer of the pancreatic body on intractable abdominal and/or back pain and to explore the histopathologic mechanism of this pain. patients: Five patients with pancreatic body cancer involving the celiac and/or common hepatic artery underwent this radical surgery intended to cure the cancer. DESIGN: A retrospective analysis was performed. MAIN OUTCOME MEASURES: Surgical magnitude, postoperative pain control, postoperative outcome, and histopathologic findings were studied. RESULTS: Arterial reconstruction, gastrointestinal reconstruction, and blood transfusions were unnecessary. The organ deficit was limited to the distal pancreas, spleen and left adrenal gland. There was no postoperative mortality. postoperative complications occurred in four patients, who were successfully managed with medical treatment. This led to prolonged hospital stays. The intractable preoperative abdominal and/or back pain was completely relieved immediately after surgery in all patients. Perfect pain control has been maintained from surgery to the last follow-up. Histopathologic examination of the surgical specimens revealed cancer invasion of the celiac plexus in all patients. CONCLUSIONS: This operation offers not only disease radicality but also perfect pain relief. The survival benefit has not yet been fully defined.- - - - - - - - - - ranking = 6.387078462429keywords = spleen, cancer (Clic here for more details about this article) |
4/16. Placement of self-expanding metallic stents in the pancreatic duct for treatment of obstructive complications of pancreatic cancer.BACKGROUND: stents have been placed through malignant pancreatic strictures, mainly to alleviate pain of presumed obstructive origin. Self-expanding metallic stents have major advantages over plastic stents when used for treatment of malignant biliary strictures. However, there are few reports of their use in patients with malignant pancreatic duct strictures, especially those with complications related to ductal obstruction. methods: Self-expanding metallic stents were placed in the pancreatic ducts of 3 patients with obstructive complications of pancreatic cancer: smoldering pancreatitis, a disrupted pancreatic duct with pseudocyst caused by open surgical biopsy, and a disrupted pancreatic duct with fistula and resultant liver abscess. All 3 patients had metallic stents placed concomitantly in the biliary tract; one had enteral stents placed as well. Clinical and pathology records and imaging studies were reviewed retrospectively. OBSERVATIONS: In all cases, there was resolution of the specific clinical problem and reasonable survival (1.5 years in one patient). CONCLUSIONS: The use of self-expanding metallic stents for treatment of certain obstructive complications of pancreatic tumors is feasible and effective.- - - - - - - - - - ranking = 3.3669240390181keywords = cancer (Clic here for more details about this article) |
5/16. Complete transection of the body of the stomach resulting from blunt trauma.Gastric perforation due to blunt trauma is rare, especially in children. The authors present a case of complete transection of the stomach in a 10-year-old boy who was thrown across the steel back of a seat in a school bus. Associated injuries included hematoma, a torn spleen, a seromuscular tear of the duodenojejunal flexure and complete transection of the pancreas and rectus abdominis muscle. The boy's postoperative course was complicated by the development of peritonitis with abscess formation and a pancreatic fistula. To the author's knowledge this is The first case of complete transection of the stomach, due to blunt trauma reported in the English literature.- - - - - - - - - - ranking = 1keywords = spleen (Clic here for more details about this article) |
6/16. Cure of intractable pancreatic fistula by subcutaneous fistulojejunostomy.Fistulojejunostomy was performed at the subcutaneous level in two patients with intractable pancreatic fistula that occurred after surgery for cancer of the ampulla of vater and carcinoma of the lower bile duct. The treatment yielded mostly satisfactory results, though one patient incurred postoperative wound dehiscence, which was healed with conservative measures. Compared with conventional procedures, this method is technically easy to perform, as it does not involve surgical separation of the fistula up to a site deep within the abdominal cavity, rarely results in side injury, and poses few potential risks of cicatricial stenosis of the fistular lumen, because blood supply to the fistula is preserved. Subcutaneous fistulojejunostomy is considered to be recommendable for pancreatic fistulas that occur long after surgery and which are stenosed at the site of the pancreatojejunal stenosis and thus require surgical treatment.- - - - - - - - - - ranking = 0.67338480780362keywords = cancer (Clic here for more details about this article) |
7/16. Biliopancreatic fistula caused by an intraductal papillary-mucinous tumor of the pancreas confirmed by biochemical analysis of mucin.Intraductal papillary-mucinous tumor of the pancreas is occasionally accompanied by biliopancreatic fistula. However, it is difficult to show the inflow of mucin produced by the tumor into the common bile duct. To confirm the biliopancreatic fistula, the mucin-rich fraction was purified from the bile and stained with antimucin antibodies. Western blot analysis showed characteristic smear staining patterns for mucin molecules with three types of antimucin antibodies. Immunohistochemical analysis with the antibody showed significant signals of the cancer cells and the luminal content of the dilated pancreatic duct. These results showed that the bile contained an abundance of mucin, which was produced by the primary pancreatic tumor. In cases with intraductal papillary-mucinous tumor of the pancreas, biochemical analysis of mucin molecules in the bile can be of clinical use in consideration of pathological process of tumor progression.- - - - - - - - - - ranking = 0.67338480780362keywords = cancer (Clic here for more details about this article) |
8/16. Laparoscopic spleen-preserving pancreatic tail resection for an intrapancreatic accessory spleen mimicking a nonfunctioning endocrine tumor: report of a case.Laparoscopic surgery is now performed for several pancreatic disorders, such as benign tumors of the pancreatic body or tail, which are a good indication for laparoscopic resection. However, the risk of pancreatic fistula after distal pancreatectomy, performed laparoscopically or by open surgery, is a topic of debate. We report the case of a 61-year-old man in whom a routine follow-up computed tomography (CT) scan showed a solid, well-defined mass, 1.5 cm in diameter, in the pancreatic tail. The mass was homogeneously enhanced from the early phase to the super-delayed phase on enhanced CT. We suspected a nonfunctioning endocrine tumor of the pancreas, and surgery was performed laparoscopically. After dissecting the pancreatic tail away from the splenic hilum and the splenic vessels, it was resected using only a linear stapler. The histological diagnosis was an intrapancreatic accessory spleen. The patient was discharged on postoperative day 14, but was readmitted 6 days later because of a pancreatic fistula, which was treated by CT-guided percutaneous drainage.- - - - - - - - - - ranking = 9keywords = spleen (Clic here for more details about this article) |
9/16. Two-staged hepato-pancreatoduodenectomy and interventional pancreaticojejunostomy.Two-staged pancreatoduodenectomy, including exteriorization of the pancreatic juice and second-look pancreaticojejunostomy, has been recommended for high-risk patients to avoid pancreatic leakage, which often causes intra-abdominal hemorrhage. We present a new technique of interventional pancreaticojejunostomy under both fluoroscopy and endoscopy without second-look laparotomy. A 77-year-old woman with local recurrence and liver metastasis from colon cancer underwent hepato-pancreatoduodenectomy with the external drainage of pancreatic juice via the pancreatic duct tube without pancreaticojejunostomy. Two months later, the jejunum was punctured with the insertion of a 5-F needle-knife into the pancreatic fistula during endoscopic observation of jejunal lumen, followed by the insertion of two 0.35-inch guidewires into the jejunum and the pancreatic fistula. Finally, a 10-Fr stenting tube was placed between the jejunum and the pancreatic fistula. No complications developed.- - - - - - - - - - ranking = 0.67338480780362keywords = cancer (Clic here for more details about this article) |
10/16. Radiofrequency ablation of unresectable pancreatic carcinoma: feasibility, efficacy and safety.CONTEXT: Unresectable pancreatic cancer has a dismal prognosis. Palliative surgery and chemo-radiotherapy have not produced significant improvement in survival. We evaluated the safety and the efficacy of radiofrequency ablation for cytoreduction of unresectable tumors of the pancreas. CASE REPORT: Radiofrequency ablation was performed in three patients with histologically proven unresectable cancer of the pancreas: two females and one male; 48, 60, and 66 years of age (mean 58 years). The sizes of the pancreatic tumors were 5.0, 6.5, and 8.0 cm (mean 6.5 cm), respectively. Two patients underwent radiofrequency ablation during an open operation while one patient had percutaneous CT guided radiofrequency ablation. All had endobiliary stenting for obstructive jaundice. Partial necrosis (up to 3 cm) of the tumor was achieved in all cases. There was no major morbidity or mortality. Self-limiting minor complications occurred in two patients. CONCLUSION: Radiofrequency ablation is a local ablative method used with increasing frequency and may be used safely for cytoreduction in locally advanced inoperable pancreatic malignancies. Further studies are required to ascertain whether this can improve survival/quality of life alone or in combination with other therapies.- - - - - - - - - - ranking = 1.3467696156072keywords = cancer (Clic here for more details about this article) |
| | Next -> |