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pancreatitis advances in management

Vasilios Karavasilis, Epaminontas Samantas, Georgia-Angeliki Koliou, Anna Kalogera-Fountzila, George Pentheroudakis, Ioannis Varthalitis, Helena Linardou, Grigorios Rallis, Maria Skondra, Georgios Papadopoulos, George Papatsibas, Joseph Sgouros, Athina Goudopoulou, Konstantine T Kalogeras, Christos Dervenis, Dimitrios Pectasides, George Fountzilas
BACKGROUND: The prognosis of patients with advanced pancreatic cancer is dismal, and there is a need for novel and effective treatments. OBJECTIVES: Tο determine the maximum tolerated dose (MTD) and dose-limiting toxicities (DLTs) of a novel gemcitabine (G) and temsirolimus (T) combination (phase I) and estimate the 6-month progression-free survival (PFS) in patients treated with the T + G combination (phase II). PATIENTS AND METHODS: Eligible patients with histologically confirmed inoperable or metastatic pancreatic carcinoma (MPC) were entered into the trial...
November 28, 2018: Targeted Oncology
Andrew McGuigan, Paul Kelly, Richard C Turkington, Claire Jones, Helen G Coleman, R Stephen McCain
This review aims to outline the most up-to-date knowledge of pancreatic adenocarcinoma risk, diagnostics, treatment and outcomes, while identifying gaps that aim to stimulate further research in this understudied malignancy. Pancreatic adenocarcinoma is a lethal condition with a rising incidence, predicted to become the second leading cause of cancer death in some regions. It often presents at an advanced stage, which contributes to poor five-year survival rates of 2%-9%, ranking firmly last amongst all cancer sites in terms of prognostic outcomes for patients...
November 21, 2018: World Journal of Gastroenterology: WJG
Olatunji B Alese, Renjian Jiang, Walid Shaib, Christina Wu, Mehmet Akce, Madhusmita Behera, Bassel F El-Rayes
BACKGROUND: High-grade neuroendocrine carcinomas are rare in the gastrointestinal tract. However, treatment patterns and outcomes have not been well described. SUBJECTS, MATERIALS, AND METHODS: The National Cancer Database was analyzed. The primary objective was to describe the clinical outcomes and identify prognostic factors. Univariate and multivariate analyses were done to identify factors associated with patient outcome. RESULTS: A total of 1,861 patients were identified between 2004 and 2013...
November 27, 2018: Oncologist
Timothy R Koch, Timothy R Shope, Michael Camilleri
The worldwide rise in the prevalence of obesity supports the need for an increased interaction between ongoing clinical research in the allied fields of gastrointestinal medicine/surgery and diabetes mellitus. There have been a number of clinically-relevant advances in diabetes, obesity, and metabolic syndrome emanating from gastroenterological research. Gastric emptying is a significant factor in the development of upper gastrointestinal symptoms. However, it is not the only mechanism whereby such symptoms occur in patients with diabetes...
November 15, 2018: World Journal of Diabetes
Zhenjun Zhang, Wenjie Qin, Yuling Sun
BACKGROUND: Pancreatic cancer (PaC) is one of the deadliest types of tumor, and it is regarded as a fatal disease, with a 5-year survival rate less than 10%. Most clinical diagnoses for PaC are made at an advanced stage because of the insidious onset of the disease, which leads to an extremely poor prognosis. RECENT FINDINGS: The relationship between diabetes mellitus (DM) and PaC has been established by several decades of research, and the prevalence of DM in patients with PaC has been reported to be 40%, with half of the patients having developed new-onset DM within 2 years or less...
December 2018: Pathology, Research and Practice
Akira Nakamura, Masahiro Hiraoka, Satoshi Itasaka, Mitsuhiro Nakamura, Mami Akimoto, Yoshitomo Ishihara, Nobutaka Mukumoto, Yoko Goto, Takahiro Kishi, Michio Yoshimura, Yukinori Matsuo, Shinsuke Yano, Takashi Mizowaki
Intensity-modulated radiotherapy (IMRT) is now regarded as an important treatment option for patients with locally advanced pancreatic cancer (LAPC). To reduce the underlying tumor motions and dosimetric errors during IMRT as well as the burden of respiratory management for patients, we started to apply a new treatment platform of the dynamic tumor dynamic tumor-tracking intensity-modulated radiotherapy (DTT-IMRT) using the gimbaled linac, which can swing IMRT toward the real-time tumor position under patients' voluntary breathing...
November 20, 2018: Scientific Reports
Bharat Rao, Aslam Syed, Shailendra Singh, Abhishek Gulati, Ghita Moussiade, Mrinal Garg, Manav Sharma, Suzanne Morrissey, Harry Williams, Donald Atkinson, Suzanne Schiffman, Dulabh Monga, Anthony Lupetin, Alexander Kirichenko, Marcia Mitre, Amy Tang, Manish Dhawan, Abhijit Kulkarni, Shyam Thakkar
OBJECTIVES: Surgery is the curative treatment for pancreatic ductal adenocarcinoma (PDA). Guidelines recommend utilizing a multidisciplinary pancreatic cancer conference (MDPC) in treatment; however, data are limited. The objective of this study was to assess the accuracy of an MDPC. METHODS: Patients with PDA presented at an MDPC were prospectively collected from April 2013 to August 2016. Patients were included if the MDPC predicted them to have resectable PDA and underwent upfront surgery...
November 17, 2018: Pancreas
Marine Gilabert, Olivier Turrini, Jacques Ewald, Laurence Moureau-Zabotto, Flora Poizat, Jean-Luc Raoul, Jean-Robert Delpero
BACKGROUND: To describe, in patients with resectable pancreatic ductal adenocarcinoma (PDAC), the laparotomy findings, treatments and outcomes before (period 1) and after 2010 (period 2). METHODS: From 2000 to 2015, patients newly diagnosed with resectable PDAC at Paoli-Calmettes Institute, France, were evaluated. Survival was examined using the Kaplan-Meier method, and statistical comparisons were conducted using log rank tests. RESULTS: Among 1175 patients diagnosed with pancreatic mass, 164 underwent laparotomy with an intention of pancreatic resection...
December 2018: Surgical Oncology
Sally A El-Zahaby, Yosra S R Elnaggar, Ossama Y Abdallah
Pancreatic cancer is nowadays the most life-threatening cancer type worldwide. The problem of poor diagnosis, anti-neoplastics resistance and biopharmaceutical drawbacks of effective anti-cancer drugs lead to worsen disease state. Nanotechnology-based carrier systems used in both imaging and treatment procedures had solved many of these problems. It is critical to develop advanced detection method to save patients from being too late diagnosed. Targeting the pancreatic cancer cells as well helped in decreasing the side effects associated with normal cells destruction...
November 14, 2018: Journal of Controlled Release: Official Journal of the Controlled Release Society
Benjamin Myles Shandro, Rani Nagarajah, Andrew Poullis
Pancreatic exocrine insufficiency (PEI) occurs when the insufficient secretion or function of pancreatic enzymes leads to maldigestion, most commonly as a result of chronic pancreatitis and pancreatic cancer. The condition is associated with significant morbidity and reductions in quality of life, even in milder forms. The challenges in approaching this condition include the non-specific presentation of mild to moderate PEI, and the lack of a convenient, accurate diagnostic test in this cohort. Classical symptoms appear late in the disease, and the diagnosis should be considered before steatorrhoea develops...
October 25, 2018: World Journal of Gastrointestinal Pharmacology and Therapeutics
Chelsey C Ciambella, Rachel E Beard, Thomas J Miner
Pancreatic adenocarcinoma is the third leading cause of cancer death in the United States. Unfortunately, at diagnosis, most patients are not candidates for curative resection. Surgical palliation, a procedure performed with the intention of relieving symptoms or improving quality of life, comes to the forefront of management. This article reviews the palliative management of unresectable pancreatic cancer, including obstructive jaundice, duodenal obstruction and pain control with celiac plexus block. Although surgical bypasses for both biliary and duodenal obstructions usually achieve good technical success, they result in considerable perioperative morbidity and mortality, even when performed laparoscopically...
October 27, 2018: World Journal of Gastrointestinal Surgery
Jasmine F Plows, Joanna L Stanley, Philip N Baker, Clare M Reynolds, Mark H Vickers
Gestational diabetes mellitus (GDM) is a serious pregnancy complication, in which women without previously diagnosed diabetes develop chronic hyperglycemia during gestation. In most cases, this hyperglycemia is the result of impaired glucose tolerance due to pancreatic β-cell dysfunction on a background of chronic insulin resistance. Risk factors for GDM include overweight and obesity, advanced maternal age, and a family history or any form of diabetes. Consequences of GDM include increased risk of maternal cardiovascular disease and type 2 diabetes and macrosomia and birth complications in the infant...
October 26, 2018: International Journal of Molecular Sciences
Naveen Patel, Dhananjai Rai, Soni Shivam, Shraddha Shahane, Umesh Mishra
Background and sources: Lipase enzyme is a naturally occurring enzyme found in the stomach and pancreatic juice. They function is to digests fats and lipids, helping to maintain correct gallbladder function. Lipase is the one such widely used and versatile enzyme. These enzymes are obtained from animals, plants and as well as from several microorganisms and are sufficiently stable. These are considered as nature's catalyst but commercially only microbial lipases are being used significantly. Applications: They found enormous application in the industries of fat and oil processing, oleochemical industry, food industry, detergents, pulp and paper industry, detergents, environment management, tea processing, biosensors and cosmetics and perfumery...
October 28, 2018: Recent Patents on Biotechnology
Kazuyuki Matsumoto, Hironari Kato, Shigeru Horiguchi, Koichiro Tsutsumi, Yosuke Saragai, Saimon Takada, Sho Mizukawa, Shinichiro Muro, Daisuke Uchida, Takeshi Tomoda, Hiroyuki Okada
BACKGROUND: Advanced pancreatic cancer is accompanied not only by bile duct obstruction, but also occasionally by duodenal obstruction. With new advances in chemotherapy and improvement in the management of stent dysfunction, the life expectancy of patients with pancreatic cancer has increased. This study aimed to evaluate the efficacy and safety of chemotherapy for advanced pancreatic cancer, as well as to analyze the prognostic factors, following endoscopic double stenting. METHODS: This retrospective study was conducted from January 1, 2007 to October 31, 2015 at an academic center...
October 26, 2018: BMC Gastroenterology
Oliver Strobel, John Neoptolemos, Dirk Jäger, Markus W Büchler
Pancreatic cancer is likely to become the second most frequent cause of cancer-associated mortality within the next decade. Surgical resection with adjuvant systemic chemotherapy currently provides the only chance of long-term survival. However, only 10-20% of patients with pancreatic cancer are diagnosed with localized, surgically resectable disease. The majority of patients present with metastatic disease and are not candidates for surgery, while surgery remains underused even in those with resectable disease owing to historical concerns regarding safety and efficacy...
October 19, 2018: Nature Reviews. Clinical Oncology
Tateaki Naito, Shuichi Mitsunaga, Satoru Miura, Noriatsu Tatematsu, Toshimi Inano, Takako Mouri, Tetsuya Tsuji, Takashi Higashiguchi, Akio Inui, Taro Okayama, Teiko Yamaguchi, Ayumu Morikawa, Naoharu Mori, Toshiaki Takahashi, Florian Strasser, Katsuhiro Omae, Keita Mori, Koichi Takayama
BACKGROUND: Combinations of exercise and nutritional interventions might improve the functional prognosis for cachectic cancer patients. However, high attrition and poor compliance with interventions limit their efficacy. We aimed to test the feasibility of the early induction of new multimodal interventions specific for elderly patients with advanced cancer Nutrition and Exercise Treatment for Advanced Cancer (NEXTAC) programme. METHODS: This was a multicentre prospective single-arm study...
October 18, 2018: Journal of Cachexia, Sarcopenia and Muscle
S Narayanasamy, S Krishna, A K Prasad Shanbhogue, T A Flood, N Sadoughi, P Sathiadoss, N Schieda
This article presents an updated review of cystic renal mass imaging. Most cystic renal masses encountered incidentally are benign and can be diagnosed confidently on imaging and require no follow-up. Hyperattenuating masses discovered at unenhanced or single-phase enhanced computed tomography (CT) measuring between 20-70 HU are indeterminate and can be further investigated first by using ultrasound and, then with multi-phase CT or magnetic resonance imaging (MRI); as the majority represent haemorrhagic/proteinaceous cysts (HPCs)...
October 9, 2018: Clinical Radiology
Qinghai Chen, Peng Jin, Xiaoyan Ji, Haiwei Du, Junhua Lu
Selective bile duct cannulation is the prerequisite for all endoscopic biliary therapeutic interventions, but this cannot always be achieved easily. Despite advances and new developments in endoscopic accessories, selective biliary access fails in 5%-15% of cases, even in expert high volume centers. Various techniques - such as double-guidewire induced cannulation, pre-cut papillotomy or transpancreatic sphincterotomy with or without placement of a pancreatic stent - have been used to improve cannulation success rates...
October 9, 2018: Clinics and Research in Hepatology and Gastroenterology
Bhaskar Venkata Kameswara Subrahmanya Lakkakula, Batoul Farran, Saikrishna Lakkakula, Sujatha Peela, Nagendra Sastry Yarla, Pallaval Veera Bramhachari, Mohammad Amjad Kamal, Madhu Sudhana Saddala, Ganji Purnachandra Nagaraju
Pancreatic cancer (PC) is an aggressive carcinoma and the fourth cause of cancer deaths in Western countries. Although surgery is the most effective therapeutic option for PC, the management of unresectable, locally advanced disease is highly challenging. Our improved understanding of pancreatic tumor biology and associated pathways has led to the development of various treatment modalities that can control the metastatic spread of PC. This review intends to present trials of small molecule tyrosine kinase inhibitors (TKIs) in PC management and the troubles encountered due to inevitable acquired resistance to TKIs...
October 9, 2018: Seminars in Cancer Biology
Chong Kun Cheon
The incidence of type 1 diabetes mellitus (T1DM) in children and adolescents is increasing worldwide. Combined effects of genetic and environmental factors cause T1DM, which make it difficult to predict whether an individual will inherit the disease. Due to the level of self-care necessary in T1DM maintenance, it is crucial for pediatric settings to support achieving optimal glucose control, especially when adolescents are beginning to take more responsibility for their own health. Innovative insulin delivery systems, such as continuous subcutaneous insulin infusion (CSII), and noninvasive glucose monitoring systems, such as continuous glucose monitoring (CGM), allow patients with T1DM to achieve a normal and flexible lifestyle...
October 2018: Korean Journal of Pediatrics
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