review of literature on clinical pancreatology - The Pancreapedia

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drainage. It was concluded that intrahepatic fluid collection in the course <strong>of</strong> acute biliarypancreatitis is a rare occurrence. The therapeutic approach is the same as that for pancreaticand peripancreatic fluid collections. In case <strong>of</strong> infection, the patient undergoes percutaneousUS/CT guided drainage [236].Endoscopic treatmentNecrosectomy is the gold standard treatment for infected pancreatic necrosis (IPN). Apercutaneous and endoscopic approach has been accepted in selected cases. Endoscopicdrainage (ED) <strong>of</strong> IPN can be performed by using transpapillary or transmural procedures, ora combination <strong>of</strong> both with or without endoscopic ultrasound. The aim <strong>of</strong> one study was todetermine the indications, complications, success rate, and the importance <strong>of</strong> assessment <strong>of</strong>main pancreatic duct integrity by endoscopic retrograde pancreatography (ERP) in patientswith IPN. Records <strong>of</strong> all patients who underwent endoscopic necrosectomy from 2002 toDecmber 2007 were <strong>review</strong>ed. A total <strong>of</strong> 56 patients were included. ED was performed usingdaily transmural and transpapillary drainage. A diagnostic pancreatogram (ERP) to searchfor communications between the pancreatic duct and the collection were performed in allcases and in cases where communication existed. A pre-cut needle knife was used topuncture the cyst wall, aspirate the content and then enter at the cyst cavity (contrast wasinjected to ensure opacification <strong>of</strong> the cyst and subsequent drainage). Sphincterotomycatheter or balloons were used to enlarge and ensure a wide cystoenterostomy. All patientswere followed with computerized tomography scans or ultrasound to ensure clinicalresolution. Mean follow-up was 21 months.49/56 patients could be successfully treated. EDwas successful in 49 patients (87 %) and in 3 (13 %) it failed. Mean follow-up was 21months. During this period, there were 2 (11 %) pseudocyst recurrences and only 1 (5 %)recurrence <strong>of</strong> new episodes <strong>of</strong> pancreatic necrosis, and all were managed clinically and/orendoscopically. No mortality was related to the procedure [237].It was described a case <strong>of</strong> successful endoscopic management <strong>of</strong> two pancreatic abscessesin a critically ill patient. CT scan showed two large abscesses. The first was bulging to theposterior wall <strong>of</strong> the stomach and another at the tail <strong>of</strong> the pancreas. An endoscopicretrograde cholangiopancreatography was performed. The pancreatic duct communicatedwith the abscess at the tail <strong>of</strong> the pancreas. The drainage <strong>of</strong> this abscess was donetranspapillarily. Endoscopic cystogastrostomy was performed to treat the pancreatic abscessthat bulged to the posterior gastric wall. A double nasocystic tube was placed for continuouslavage <strong>of</strong> the abscess. Pseudomonas aeruginosa was cultured and antibiotics wereadministered according to sensitivity tests. The clinical status returned gradually to normal. Afollow-up CT scan 4 months later showed complete resolution <strong>of</strong> abscesses. It wasconcluded that endoscopic drainge <strong>of</strong> pancreatic abscesses may be the therapy <strong>of</strong> choice insuch patients mainly because it does not prevent the chance <strong>of</strong> subsequent surgicalintervention if needed [238].Radiologic interventionsIt has previously been reported that organ failure and mortality in necrotizing pancreatitis(NP) are not different between patients with infected and sterile necrosis. However,management <strong>of</strong> this disease has evolved to include image-guided percutaneous catheterdrainage (PCD) to improve morbidity and mortality. A total <strong>of</strong> 689 consecutive patientstreated for acute pancreatitis between 2001 and 2005, <strong>of</strong> whom 64 (9 %) had pancreaticnecrosis documented on contrast-enhanced computed tomography was studied. In the 64patients with documented necrotizing pancreatitis, overall mortality was 16 percent. Thirty-sixpatients (56 %) had organ failure according to the Atlanta classification. Compared withpatients with sterile necrosis, those with infected necrosis did not have an increasedprevalence <strong>of</strong> organ failure or increased need for intubation, pressors, or dialysis but had an
increased mortality. Mortality in patients treated conservatively was 1 <strong>of</strong> 29 (3 %); in thosewith PCD alone, 6 <strong>of</strong> 11 (55 %); in those with percutaneous catheter drainage and surgery, 2<strong>of</strong> 17 (12 %); and in those with surgery alone, 1 <strong>of</strong> 7 (14 %). All patients treated with PCDalone had organ failure, whereas 10 (59%) <strong>of</strong> those with PCD and surgery had organ failure.It was concluded that the use <strong>of</strong> percutaneous catheter drainage did not improve themortality <strong>of</strong> necrotizing pancreatitisamong patients with organ failure [239].Quality <strong>of</strong> life after acute pancreatitisTo explore the quality <strong>of</strong> life in patients treated medically during the acute phase <strong>of</strong>pancreatitis as well as at 2 and 12 months after discharge from the hospital. Forty patientswere studied. The etiology <strong>of</strong> the pancreatitis was biliary causes in 31 patients and nonbiliarycauses in 9; mild disease was present in 29 patients and severe disease in 11. Thirtypatients completed the two surveys at 2 and 12 months after hospital discharge. The SF-12and EORTC QLQ-C30 questionnaires were used for the purpose <strong>of</strong> the study. The twophysical and mental component summaries <strong>of</strong> SF-12, all the domains <strong>of</strong> EORTC QLQ-C30(except for physical functioning and cognitive functioning) and some symptom scales <strong>of</strong>EORTC QLQ-C30 (fatigue, nausea/vomiting, pain, and constipation) were significantlyimpaired during the acute phase <strong>of</strong> pancreatitis. There was a significant improvement in theSF-12 physical component summary, and global health, role functioning, social functioning,nausea/vomiting, pain, dyspnea, and financial difficulties (EORTC QLQ-C30) at 2 monthsafter discharge as compared to the basal evaluation. Similar results were found after 12months except for the mental component score at 12-month evaluation, which wassignificantly impaired in acute pancreatitis patients in comparison to the norms. The physicalfunctioning <strong>of</strong> the EORTC QLQ-C30 at basal evaluation was significantly impaired in patientswith severe pancreatitis in comparison to patients with mild pancreatitis. It was concludedthat two different patterns can be recognized in the quality <strong>of</strong> life <strong>of</strong> patients with acutepancreatitis: physical impairment is immediately present followed by mental impairmentwhich appears progressively in the follow-up period [240].ExperimentalThe aim <strong>of</strong> one study was to study the effects <strong>of</strong> resveratrol on severe acute pancreatitis(SAP)-induced brain injury. Ninety-six male Sprague-Dawley rats were randomly divided into4 equal groups: sham operation, SAP, resveratrol-treated, and dexamethasone-treated.Each group was evaluated at 3, 6, and 12 hours. Myelin basic protein and zonula occludens1 levels <strong>of</strong> the resveratrol group were lower than the SAP group at all time points. Thetreated group had significantly improved pathologic brain, increase in Bcl-2 expression, anddecrease in Bax and caspases-3 expressions compared with the SAP group. The authorsconcluded that degradation <strong>of</strong> zonula occludens 1 is involved in the pathophysiology <strong>of</strong> braininjury in SAP; myelin basic protein can be used as a marker <strong>of</strong> brain injury in SAP. Theprotective effect <strong>of</strong> resveratrol might be associated with the up-regulation <strong>of</strong> Bcl-2 and downregulation<strong>of</strong> Bax and caspase-3 [241].It was previously observed decreased histopathological severity <strong>of</strong> acute necrotizingpancreatitis by parenteral nutrition with n-3 fatty acids. Thus, it was now sequentiallyanalyzed the impact <strong>of</strong> n-3 fatty acids on prostaglandin and leukotriene synthesis innecrotizing pancreatitis in 198 Sprague-Dawley rats (11 groups, n=18) who underwentintraductal glycodesoxycholat instillation and 6-hour cerulein infusion. Afterward, saline wasinfused in groups 2, 4, 6, 8, and 10, whereas groups 3, 5, 7, 9, and 11 received infusion richin n-3 fatty acids. Animals were killed after 6 (group 1), 10 (groups 2 and 3), 14 (groups 4and 5), 18 (groups 6 and 7), 22 (groups 8 and 9), and 26 hours (groups 10 and 11). The
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REVIEW OF LITERATURE ONCLINICAL PAN
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ABBREVIATIONAAPacute alcoholicABPac
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FMF AIPfocal mass-forming autoimmun
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ODPopen distal pancreatectomyOForga
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USUTDTVESDVTEZESWHOXIAPUnited State
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Ectopic pancreasCircumportal annula
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SymptomsEndocopic ultrasography (EU
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HSP27HuRIGF-1 receptorIntegrinesInt
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HemodialysisSerous cystadenomasSero
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CRPC-reactive proteinCRTchemoradiot
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ITNPintrathecal narcotics pumpJCGAI
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QSRquantitative systematic
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PANCREATIC HISTORYEarly conceptsPan
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derived from broadly Harveian anato
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acute appendicitis, intestinal obst
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dogma and its implied presence <str
Page 33 and 34: In the late 19th century, explorato
Page 35 and 36: performed. In 1880, Carl Thiersch <
Page 37 and 38: cancer was reported by Nestor Dimit
Page 39 and 40: Modern pancreatic historyHoward Reb
Page 41 and 42: PANCREATIC DEVELOPMENT, EMBRYOLOGY
Page 43 and 44: preparations. They were also employ
Page 45 and 46: pancreas can be diagnosed without t
Page 47 and 48: PANCREATIC PHYSIOLOGYSphincter <str
Page 49 and 50: acid profile and d
Page 51 and 52: hormones. The roles of</str
Page 53 and 54: ACUTE PANCREATITISAcute pancreatiti
Page 55 and 56: necrosis or a severe course, and lo
Page 57 and 58: of 245 cases <stro
Page 59 and 60: plasty of the mino
Page 61 and 62: no significant difference. The stro
Page 63 and 64: Urinary trypsinogen-2There is not a
Page 65 and 66: groups. None of th
Page 67 and 68: evaluated the presence or absence <
Page 69 and 70: adical, etc, further studies are st
Page 71 and 72: Precut at sphincterotomyPrecut is p
Page 73 and 74: indications [204].Hypercalcemia-ind
Page 75 and 76: endoscopic retrograde cholangiopanc
Page 77 and 78: (before ERCP), serum TAP was detect
Page 79 and 80: concentration and clinical symptoms
Page 81 and 82: However, the recipients of<
Page 83: less safe for predominantly cephali
Page 87 and 88: Epidemiology and demographyChinaCHR
Page 89 and 90: for the first time the significance
Page 91 and 92: endoscopic ultrasound accurately de
Page 93 and 94: possible to at least reduce relapse
Page 95 and 96: etiologies have been proposed and a
Page 97 and 98: patients, can be performed with mod
Page 99 and 100: negative binomial model. One hundre
Page 101 and 102: Halofuginone did n
Page 103 and 104: years, the risk of
Page 105 and 106: patients with a proven exocrine pan
Page 107 and 108: high-risk patients [296].Cystic fib
Page 109 and 110: TNF-alpha promoter were performed.
Page 111 and 112: were validated in another series <s
Page 113 and 114: vascular invasion (14/15). Abnormal
Page 115 and 116: and other lymph nodes, salivary gla
Page 117 and 118: HEREDITARY PANCREATITISPatients wit
Page 119 and 120: Classification of
Page 121 and 122: historically, but recent life-style
Page 123 and 124: carcinogen exposure with cancer ris
Page 125 and 126: the risk of pancre
Page 127 and 128: conducted a cohort analysis <strong
Page 129 and 130: emain to be solved in screening for
Page 131 and 132: considered for women with Lynch syn
Page 133 and 134: Annexin A5Protein misfolding is a c
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CTNNB1To use fluorescence in situ h
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expression was not associated with
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(ECM) are not fully understood. In
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lines. However, the role of
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andomized to high-dose vitamin A, t
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Synuclein-gammaPerineural invasion
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interventions. Cancer nests were ma
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the optimal combination of<
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which is essential in tumor and nod
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provide conclusive evidence for the
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MD-CT is suitable for evaluating tu
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approved study and imaged during sh
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Quantum dotsIt was reported the suc
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clearly have a very high incidence
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patients for operation and when cou
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demonstrated using the confocal mic
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cancer [468].To evaluate pancreatic
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pancreaticoduodenectomy (PD). The s
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safe option as an interposition gra
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a curative surgery, while double-by
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%), pseudocyst (3 %), and trauma (3
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procedure is failing to progress la
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Glucos metabolism after pancreatect
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Quality of lifeOne
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was observed in the NACRT group. Th
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interval 0.80 to 0.96]. On subgroup
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ate in patients with pancreatic can
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median survival time was 7 versus 7
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and the endoscopic ultrasound-guide
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local recurrence of1.5 cm (odds ratio 2.4), and
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adenocarcinoma must be addressed at
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Molecular biologyCD44v6The purpose
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IPMN were studied. Two-dimensional
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the NT-IPMN-Br group. Eleven patien
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metastatic neoplasms showing cystic
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Solid pseudopapillary neoplasms <st
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The tumor cells were negative for p
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Duodenal tumorsColorectal polyposis
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Colorectal carcinomaPancreatic meta
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It was described a case of<
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evaluation. The purpose of<
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perforation of a p
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the 28 had pancreatic duct injury <
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ENDOCRINE PANCREATIC TUMORSHistoryA
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25-111 pg/mL). Mean Hemoglobin A1C
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clinical features, misdiagnosis occ
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achieved in selected cases by tissu
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Overall survivalPancreatic neuroend
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REFERENCES001. Metter CC. History <
Page 237 and 238:
044. Fitz RH. The symptomatology an
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089. McClusky DA, Skandalakis LJ, C
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126. Toouli J. Sphincter of
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162. Deshpande AV, Thomas G, Shun A
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196. Park JH, Lee TH, Cheon SL, Sun
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226. Botoi G, Andercou A. Early and
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260. Nakamura H, Morifuji M, Muraka
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292. Borak GD, Romagnuolo J, Alsola
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324. Oh HC, Kim MH, Choi KS, Moon S
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358. Koornstra JJ, Mourits MJ, Sijm
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391. Chen JY, Amos CI, Merriman KW,
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421. Horwhat JD, Gerke H, Acosta RD
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451. Zamboni G, Capelli P, Scarpa A
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483. Rosa F, Pacelli F, Papa V, Tor
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517. Isayama H, Nakai Y, Togawa O,
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545. Pino MS, Milella M, Gelibter A
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576. Tanno S, Sasajima J, Koizumi K
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605. Ayadi L, Ellouze S, Khabir A,
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637. Nagar AM, Raut AA, Morani AC,
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670. Lejonklou M, Edfeldt K, Johans
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