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pancreatitis advances in management

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 on the rise world-wide. T1DM is caused by the combined effects of genetic and environmental factors that makes it difficult to predict whether or not an individual will inherit disease. Due to the level of self-care necessary in the maintenance of T1DM, 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 system such as continuous subcutaneous insulin infusion (CSII) and noninvasive glucose monitoring system such as continuous glucose monitoring (CGM) allow patients with T1DM a more normal and flexible lifestyle...
October 4, 2018: Korean Journal of Pediatrics
Saransh Jain, Soumya Jagannath Mahapatra, Swatantra Gupta, Shalimar, Pramod Kumar Garg
BACKGROUND: Organ failure determines outcome in acute pancreatitis (AP). It is controversial if infected pancreatic necrosis (IPN) is also an independent determinant of mortality. We hypothesized that the predictors of mortality in AP might have changed with advances in management and consequent decline in mortality over the past decades. Our objective was to study the predictors of mortality in patients with AP. METHODS: Consecutive patients with a first episode of AP hospitalized from January 2015 to December 2016 were included in an observational study...
October 5, 2018: Clinical and Translational Gastroenterology
Brendan M Case, Kyle K Jensen, Gene Bakis, Brintha K Enestvedt, Akram M Shaaban, Bryan R Foster
Endoscopic interventions play an important role in the modern management of pancreatic fluid collections. Successful management of pancreatitis is dependent on proper classification of the disease and its local complications. The 2012 revised Atlanta classification divides acute pancreatitis into subtypes of necrotizing pancreatitis and interstitial edematous pancreatitis (IEP) on the basis of the radiologic presence or absence of necrosis, respectively. Local complications of IEP include acute pancreatic fluid collections and pseudocysts, which contain fluid only and are differentiated by the time elapsed since the onset of symptoms...
September 28, 2018: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Bhavyaa Bahl, Rohith Vadlamudi, Parekha Yedla, Roger D Smalligan
Periampullary malignancies arise in the vicinity of the ampulla of Vater, a common passage for biliary and pancreatic secretions. Determining the anatomical origin of these tumors represents a diagnostic challenge. This is especially true for large tumors due to the transitional nature of this region, proximity to different structures, anatomical variations, and overlapping features among constituting structures. This determination has significant prognostic and therapeutic implications. Among them, primary ampullary adenocarcinoma is a rare malignancy that has the best overall prognosis with high rates of potentially curative resection and possible survival even in advanced disease...
July 23, 2018: Curēus
Min Ho Cho, Rohan Mandaliya, Jennifer Tran, Wen Lee, Mitesh Patel
Obstructive jaundice, weight loss, and anorexia often raise a concern for pancreatic malignancy. Although pancreatic adenocarcinoma is the most common form of pancreatic cancer, not all pancreatic malignancies are exocrine in origin. With advancement in endoscopic ultrasound with fine needle aspiration, it has become easier to make correct diagnosis. Plasmacytoma of pancreas is a solitary tumor of plasma cells and it can also lead to the same clinical presentations. Immunohistochemistry is required to make the diagnosis of plasmacytoma...
2018: Case Reports in Gastrointestinal Medicine
Adrianne Tsen, Mary Barbara, Laura Rosenkranz
Carbohydrate antigen 19-9 (CA 19-9) is a tumor marker which has been extensively evaluated and widely utilized primarily in diagnosing and prognosticating pancreaticobiliary malignancies. Levels may be significantly influenced and elevated in cases of benign biliary conditions however, especially in obstructive jaundice, thereby posing difficulty in distinguishing between benign and malignant cholestasis. A myriad of studies have focused on elucidating proper use and interpretation of CA 19-9 in pancreatic cancer as well as in the setting of cholestasis...
September 18, 2018: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
S Baleato-González, R García-Figueiras, A Luna, M Domínguez-Robla, J C Vilanova
In addition to the classical morphological evaluation of pancreatic disease, the constant technological advances in imaging techniques based fundamentally on computed tomography and magnetic resonance imaging have enabled the quantitative functional and molecular evaluation of this organ. In many cases, this imaging-based information results in substantial changes to patient management and can be a fundamental tool for the development of biomarkers. The aim of this article is to review the role of emerging functional and molecular techniques based on computed tomography and magnetic resonance imaging in the evaluation of pancreatic disease...
September 17, 2018: Radiología
Nahir Cortes-Santiago, Daniel H Leung, Eumenia Castro, Milton Finegold, Hao Wu, Kalyani Patel
OBJECTIVES: Systematic study of allograft liver histology in children undergoing orthotopic liver transplantation (LT) for cystic fibrosis-related liver disease (CFLD). METHODS: Retrospective clinicopathologic review of explants and allograft liver biopsies from 13 children and adolescents with CFLD. RESULTS: In this study, the median age at LT for CFLD was 15.7 years. Notably, 10 of 13 (77%) CF explants had >5% steatosis and 8 of 13 (61...
September 18, 2018: Journal of Pediatric Gastroenterology and Nutrition
Cindy Neuzillet, Sébastien Gaujoux, Nicolas Williet, Jean-Baptiste Bachet, Lucile Bauguion, Laurianne Colson Durand, Thierry Conroy, Laetitia Dahan, Marine Gilabert, Florence Huguet, Lysiane Marthey, Julie Meilleroux, Louis de Mestier, Bertrand Napoléon, Fabienne Portales, Antonio Sa Cunha, Lilian Schwarz, Julien Taieb, Benoist Chibaudel, Olivier Bouché, Pascal Hammel
BACKGROUND: This document is a summary of the French intergroup guidelines regarding the management of pancreatic adenocarcinoma (PA), updated in July 2018. DESIGN: This collaborative work was produced under the auspices of all French medical and surgical societies involved in the management of PA. It is based on the previous guidelines, recent literature review and expert opinions. Recommendations were graded in three categories, according to the level of evidence...
August 18, 2018: Digestive and Liver Disease
Mohamad Fawzi Mahomoodally, Arzu Atalay, Marie Carene Nancy Picot, Onur Bender, Evrim Celebi, Adriano Mollica, Gokhan Zengin
Antidesma madagascariense Lam. (AM), an indigenous medicinal plant to the Mascarene Islands, is used for the treatment of several diseases. We endeavoured to validate its use via evaluating the kinetics of inhibition of crude aqueous extract (CAE) and crude methanol extract (CME) of AM against key metabolic enzymes (pancreatic lipase, cholesterol esterase [CEase], acetylcholinesterase [AChE], and urease). In vitro antiglycation, antioxidant, cytotoxicity using iCELLigence real time cell analysis system and WST-1 methods, were used...
November 30, 2018: Journal of Pharmaceutical and Biomedical Analysis
Ajay Bhandarwar, Eham Arora, Raj Gajbhiye, Saurabh Gandhi, Chintan Patel, Amol Wagh, Priyank Kothari, Shekhar Jadhav
BACKGROUND: Chronic pancreatitis (CP) is a debilitating condition resulting in severe pain with progressive deterioration of pancreatic function. "Tropical" pancreatitis represents a variant of the disease with widely dilated ducts, numerous calculi, and few strictures. Traditionally, modified Puestow's procedure has been the treatment of choice for a dilated pancreatic ductal system. However, it has only recently been adapted to laparoscopic approach which is a technically demanding procedure primarily due to need for extensive intra-corporeal suturing...
September 7, 2018: Surgical Endoscopy
Robert A Moran, B Joseph Elmunzer
PURPOSE OF REVIEW: Pain is the most common symptom of chronic pancreatitis, having a profound effect on patients and a broad socioeconomic impact. Endoscopy is guideline recommended as first-line management for chronic pancreatitis pain in certain clinical scenarios. Herein, we provide an evidence-based review of the endoscopic treatment of pain due to chronic pancreatitis while highlighting some important confounders in the measurement of this outcome in clinical practice and research...
November 2018: Current Opinion in Gastroenterology
Emerson Y Chen, Gina M Vaccaro
Small bowel adenocarcinoma is a clinically and anatomically distinct gastrointestinal cancer that lacks prospective data to support its optimal management. Patients with inflammatory bowel disease and inherited conditions that cause gastrointestinal polyps are at especially high risk. Due to a lack of effective surveillance programs resulting in missed or delayed diagnoses only when symptoms develop, this disease is generally discovered at an advanced stage. Surgical resection is the only treatment modality with a chance of cure...
September 2018: Clinics in Colon and Rectal Surgery
Ramesh Kumar
The prevalence of diabetes mellitus in cirrhotic patients is much higher than that in the general population. Two types of diabetes are usually seen in patients with cirrhosis: type 2 diabetes mellitus and hepatogenous diabetes (HD). The HD is an acquired condition which is believed to be caused by impaired insulin clearance and pancreatic β-cell dysfunction in cirrhotic patients. Increased levels of advanced glycation end products and hypoxia-inducible factors have been implicated in the pathogenesis of HD...
July 2018: Indian Journal of Endocrinology and Metabolism
Amanda Almeida de Oliveira, R Clinton Webb, Kenia Pedrosa Nunes
Diabetes is one of the most concerning diseases in modern times. Despite considerable advances in therapeutic management, the prevalence of diabetes and its contribution to death and disability continue to be a major health problem. Diabetic vasculopathies are the leading cause of mortality and morbidity in diabetic patients. Its pathophysiology includes oxidative stress, advanced glycation end products, and a low-grade inflammatory state. Lately, actions of the innate immune system via Toll-like receptors (TLRs) have been suggested as a new insight in this field...
August 20, 2018: Current Drug Targets
Michel Kahaleh
Acute pancreatitis is a constant management challenge, especially with peripancreatic collection that are one of the most common complications; after the first surgical attempts that had high mortality, there had to be a new approach based in decades of acquired knowledge in physiopathology added to the development of endoscopic intervention techniques and the evolution of endoscopic devices help to establish less invasive and conservative management. This review allows us to know the last advances in the management of acute pancreatitis, pancreatic pseudocyst and walled off necrosis, determined the right time for the management to become more invasive, even considering surgery at a final stage...
April 2018: Revista de Gastroenterología del Perú: órgano Oficial de la Sociedad de Gastroenterología del Perú
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