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https://www.readbyqxmd.com/read/28220262/imaging-pancreatic-cysts-with-ct-and-mri
#1
REVIEW
R Brooke Jeffrey
CT and MRI are the imaging modalities of choice to guide the clinical management of incidentally discovered pancreatic cysts. Most of these lesions are mucinous cysts with varying degrees of malignant potential. This article reviews the CT and MRI findings that help differentiate a potentially aggressive lesion that requires EUS or surgery from a lesion of low malignant potential that is appropriate for imaging surveillance. The imaging-based societal guidelines for these cysts are reviewed.
February 20, 2017: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/28218988/toxicological-effects-during-and-following-persistent-insulin-induced-hypoglycaemia-in-healthy-euglycaemic-rats
#2
Vivi F H Jensen, Anne-Marie Mølck, Line O Berthelsen, Lene Alifrangis, Lene Andersen, Melissa Chapman, Jens Lykkesfeldt, Ingrid B Bøgh
New insulin analogues with a longer duration of action and a "peakless" pharmacokinetic profile have been developed to improve efficacy, safety and convenience for diabetic patients. During non-clinical development, according to regulatory guidelines, these analogues are tested in healthy euglycaemic rats rendering them persistently hypoglycaemic. Little is known about the effect of persistent (24 hr/day) insulin-induced hypoglycaemia (IIH) in rats, complicating interpretation of results in pre-clinical studies with new longer-acting insulin analogues...
February 20, 2017: Basic & Clinical Pharmacology & Toxicology
https://www.readbyqxmd.com/read/28210708/evaluation-of-aga-and-fukuoka-guidelines-for-eus-and-surgical-resection-of-incidental-pancreatic-cysts
#3
Alexander Lee, Vivek Kadiyala, Linda S Lee
Objectives Management of asymptomatic pancreatic cysts is challenging. Guidelines by the American Gastroenterological Association (AGA) and International Association of Pancreatology (Fukuoka) seek to identify high-risk patients. We assessed performance of these guidelines in selecting patients for endoscopic ultrasound (EUS) and/or surgery. Methods PART I - We retrospectively studied 143 asymptomatic cysts with magnetic resonance imaging (MRI) followed by EUS. Appropriate selection for EUS was defined as: malignant cytology or surgical pathology, or development of concerning features on MRI as defined by the guidelines...
February 2017: Endoscopy International Open
https://www.readbyqxmd.com/read/28205123/isolated-pancreatic-uncinate-duct-ipmn
#4
Ajay V Maker, Vijay K Maker
The ventral pancreas originally forms as an evagination of the common bile duct at 32 days gestation and its duct, the uncinate duct, eventually rotates with the ventral anlage to join the dorsal pancreas and fuse with the main pancreatic duct. Thus, though often considered a "branch" duct of the pancreas, embryologically, the uncinate duct is the "main" pancreatic duct of the ventral pancreas. This concept is not fully addressed in the current definitions of intraductal papillary mucinous neoplasms of the pancreas (IPMN) where international consensus guidelines consider the main-duct IPMN as high risk for malignancy and most small branch-duct IPMN as low risk for malignancy...
February 15, 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/28187108/complicated-case-presentation-management-of-pancreatic-neuroendocrine-tumors-in-multiple-endocrine-neoplasia-type-1
#5
Claire K Mulvey, Katherine Van Loon, Emily K Bergsland, Umesh Masharani, Eric K Nakakura
Multiple endocrine neoplasia type 1 (MEN1) is an inherited predisposition to tumors of the parathyroid glands, anterior pituitary, and pancreatic islet cells. In this review, we discuss the clinical case of a 45-year-old woman with MEN1 that was presented at the 2015 North American Neuroendocrine Tumor Society Symposium. In our review of this patient's complicated clinical course and subsequent operative management, we highlight controversies in the diagnosis and management of pancreatic neuroendocrine tumors in MEN1...
March 2017: Pancreas
https://www.readbyqxmd.com/read/28185886/macronutrient-intake-in-preschoolers-with-cystic-fibrosis-and-the-relationship-between-macronutrients-and-growth
#6
Stephanie S Filigno, Shannon M Robson, Rhonda D Szczesniak, Leigh A Chamberlin, Meredith A Baker, Stephanie M Sullivan, John Kroner, Scott W Powers
BACKGROUND: Adequate nutrition is essential for growth in children with cystic fibrosis (CF). The new CF Foundation Clinical Practice Guidelines bring attention to monitoring macronutrient intake as well as total energy. METHODS: Dietary intake of 75 preschool children with CF and pancreatic insufficiency was examined and compared to the Clinical Practice Guidelines. Regression analyses examined relationships between macronutrient intake and growth. RESULTS: Approximately 45% of children met the 110% minimum recommended dietary allowance (RDA) recommendation...
February 6, 2017: Journal of Cystic Fibrosis: Official Journal of the European Cystic Fibrosis Society
https://www.readbyqxmd.com/read/28168570/early-enteral-nutrition-in-critically-ill-patients-esicm-clinical-practice-guidelines
#7
REVIEW
Annika Reintam Blaser, Joel Starkopf, Waleed Alhazzani, Mette M Berger, Michael P Casaer, Adam M Deane, Sonja Fruhwald, Michael Hiesmayr, Carole Ichai, Stephan M Jakob, Cecilia I Loudet, Manu L N G Malbrain, Juan C Montejo González, Catherine Paugam-Burtz, Martijn Poeze, Jean-Charles Preiser, Pierre Singer, Arthur R H van Zanten, Jan De Waele, Julia Wendon, Jan Wernerman, Tony Whitehouse, Alexander Wilmer, Heleen M Oudemans-van Straaten
PURPOSE: To provide evidence-based guidelines for early enteral nutrition (EEN) during critical illness. METHODS: We aimed to compare EEN vs. early parenteral nutrition (PN) and vs. delayed EN. We defined "early" EN as EN started within 48 h independent of type or amount. We listed, a priori, conditions in which EN is often delayed, and performed systematic reviews in 24 such subtopics. If sufficient evidence was available, we performed meta-analyses; if not, we qualitatively summarized the evidence and based our recommendations on expert opinion...
February 6, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28154369/sham-feeding-with-chewing-gum-in-early-stage-of-acute-pancreatitis-a-randomized-clinical-trial
#8
Zongxing Jiang, Hongyin Liang, Zhu Huang, Jiajia Tang, Lijun Tang
BACKGROUND The correlation between sham feeding and acute pancreatitis (AP) has only been examined in limited studies. We aimed to investigate the efficacy and safety of sham feeding in the early stage of AP. MATERIAL AND METHODS A randomized controlled clinical trial was performed. Equal groups of AP patients were recruited. Patients in the sham feeding group received chewing gum 4 times a day after admission. All patients in the trial received standard treatment consistent with the guidelines for AP. The primary outcomes were mortality, length of stay (LOS), and medical expenses...
February 3, 2017: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
https://www.readbyqxmd.com/read/28152894/engaging-managing-physicians-in-clinical-staging-prior-to-the-initiation-of-cancer-treatment
#9
Carol Huibregtse, Marija Bjegovich-Weidman, James L Weese
: 143 Background: Managing physicians (medical oncologist, radiation oncologist, surgeons) have a responsibility to clinically stage patients prior to the initiation of cancer treatment. Clinical staging not only directs the treatment plan, but identifies appropriate clinical trials and estimates prognosis. We sought to determine whether engagement of managing physicians would result in increased clinical staging for various types of cancer. METHODS: Baseline data on clinical staging for breast, colorectal (colon, rectal, anal, rectosigmoid junction)*, thoracic (lung esophageal)†, genitourinary (prostate, penis, testes)‡, and pancreatic primary cancers were obtained...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28151898/how-much-does-decompressive-laparotomy-reduce-the-mortality-rate-in-primary-abdominal-compartment-syndrome-a-single-center-prospective-study-on-66-patients
#10
Mircea Muresan, Simona Muresan, Klara Brinzaniuc, Septimiu Voidazan, Daniela Sala, Ovidiu Jimborean, Al Husseim Hussam, Tivadar Bara, Gabriel Popescu, Cristian Borz, Radu Neagoe
Contribution of decompressive laparotomy within the framework of the complex therapeutic algorithm of abdominal compartment syndrome (ACS) is cited with an extremely heterogeneous percentage in terms of survival. The purpose of this study was to present new data regarding contribution of each therapeutic step toward decreasing the mortality of this syndrome.This is a longitudinal prospective study including 134 patients with risk factors for ACS. The intra-abdominal pressure was measured every hour indirectly based on transvesical approach and the appearance of organ dysfunction...
February 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28144084/should-every-patient-with-pancreatic-cancer-receive-perioperative-neoadjuvant-therapy
#11
REVIEW
Ulrich Nitsche, Bo Kong, Alexander Balmert, Helmut Friess, Jörg Kleeff
Pancreatic ductal adenocarcinoma is a highly aggressive disease, and medical as well as surgical therapeutic options are limited. This article reviews stage dependent treatment options, with a special focus on the current controversy of perioperative treatment regimens in initially borderline resectable or locally advanced patients. Neoadjuvant treatment can potentially increase the rate of complete tumor resection and may be more effective than adjuvant systemic therapy. Further, in the case of disease progression during or after neoadjuvant therapy, patients can be spared extensive surgery...
October 2016: Indian Journal of Medical and Paediatric Oncology
https://www.readbyqxmd.com/read/28141617/nutritional-management-of-acute-pancreatitis
#12
Kumar Krishnan
PURPOSE OF REVIEW: Acute pancreatitis is one of the most common causes for hospitalization related to a gastrointestinal disorder. It carries significant morbidity, and when severe, significant mortality. Multiple interventions have been studied to treat pancreatitis. Of all these interventions, none is more important or impactful than nutrition. RECENT FINDINGS: High-quality evidence along with society guidelines have recommended the use of enteral nutrition over parenteral nutrition in patients with pancreatitis...
March 2017: Current Opinion in Gastroenterology
https://www.readbyqxmd.com/read/28133097/-a-study-of-gemctabine-plus-nab-paclitaxel-therapy-for-advanced-local-progressive-pancreatic-cancer
#13
Yutaka Itoh, Hiroyuki Saito, Shunsuke Yamagishi, Yuki Suematsu, Miyuki Takahashi, Mao Nakayama, Michiko Fukabori, Akihiko Morita, Kazuhiko Wakabayashi
We studied the significance of gemcitabine plus nab-paclitaxel(GnP)therapy for locally progressive pancreatic cancer. We enrolled 10 patients with local progression without distant metastasis. We used GnP therapy for the ablative borderline resectable(BR)and unresectable(UR)cases based on images that followed NCCN pancreatic cancer treatment guidelines. In 1 case of resectable(R)pancreatic cancer, the tumor was located in the pancreas body but we determined that surgery was impossible because of the underlying disease detected on imaging analysis...
November 2016: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/28129813/diagnosis-of-cystic-fibrosis-in-nonscreened-populations
#14
Patrick R Sosnay, Terry B White, Philip M Farrell, Clement L Ren, Nico Derichs, Michelle S Howenstine, Jerry A Nick, Kris De Boeck
OBJECTIVE: Although the majority of cases of cystic fibrosis (CF) are now diagnosed through newborn screening, there is still a need to standardize the diagnostic criteria for those diagnosed outside of the neonatal period. This is because newborn screening started relatively recently, it is not performed everywhere, and even for individuals who were screened, there is the possibility of a false negative. To limit irreversible organ pathology, a timely diagnosis of CF and institution of CF therapies can greatly benefit these patients...
February 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/28126546/management-of-undifferentiated-solitary-mucinous-cystic-lesion-of-the-pancreas-a-clinical-dilemma
#15
Alexandra M Roch, Katherine Bigelow, Christian M Schmidt, Rosalie A Carr, Andrea L Jester, Eugene P Ceppa, Michael G House, Nicholas J Zyromski, Attila Nakeeb, C Max Schmidt
BACKGROUND: Management of solitary mucinous cystic lesions of the pancreas (MCLs) relies on correct differentiation between branch-duct intraductal papillary mucinous neoplasm(BD-IPMN) and mucinous cystic neoplasm(MCN). Current international consensus guidelines recommend resection for MCN, whereas unifocal BD-IPMN may be followed in the absence of worrisome features/high-risk stigmata. We hypothesized that preoperative differentiation of solitary MCLs is suboptimal, and that all solitary MCLs should be treated similarly...
January 23, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28122906/updated-guideline-on-the-management-of-common-bile-duct-stones-cbds
#16
Earl Williams, Ian Beckingham, Ghassan El Sayed, Kurinchi Gurusamy, Richard Sturgess, George Webster, Tudor Young
Common bile duct stones (CBDS) are estimated to be present in 10-20% of individuals with symptomatic gallstones. They can result in a number of health problems, including pain, jaundice, infection and acute pancreatitis. A variety of imaging modalities can be employed to identify the condition, while management of confirmed cases of CBDS may involve endoscopic retrograde cholangiopancreatography, surgery and radiological methods of stone extraction. Clinicians are therefore confronted with a number of potentially valid options to diagnose and treat individuals with suspected CBDS...
January 25, 2017: Gut
https://www.readbyqxmd.com/read/28122068/factors-associated-with-invasive-intraductal-papillary-mucinous-carcinoma-of-the-pancreas
#17
Seiko Hirono, Manabu Kawai, Ken-Ichi Okada, Motoki Miyazawa, Atsushi Shimizu, Yuji Kitahata, Masaki Ueno, Akio Yanagisawa, Hiroki Yamaue
Importance: Invasive intraductal papillary mucinous carcinoma has aggressive malignant behavior, including lymph node metastasis. It is important to identify factors associated with invasive intraductal papillary mucinous carcinoma to determine operative procedures, but they remain unclear. Objective: To identify the specific factors associated with invasive intraductal papillary mucinous neoplasms for branch duct, main duct, and mixed type carcinomas. Design, Setting, and Participants: Retrospective cohort study of 286 consecutive patients who underwent surgical resection for intraductal papillary mucinous neoplasm from July 1999 to December 2015 at a tertiary institute...
January 25, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28116593/fukuoka-and-aga-criteria-have-superior-diagnostic-accuracy-for-advanced-cystic-neoplasms-than-sendai-criteria
#18
Michael Sighinolfi, Susan Y Quan, Yvonne Lee, Alvaro Ibaseta, Kimberly Pham, Monica M Dua, George A Poultsides, Brendan C Visser, Jeffery A Norton, Walter G Park
BACKGROUND: The aim of this study was to compare the American Gastroenterological Association guidelines (AGA criteria), the 2012 (Fukuoka criteria), and 2006 (Sendai criteria) International Consensus Guidelines for the diagnosis of advanced pancreatic cystic neoplasms. METHODS: All patients who underwent surgical resection of a pancreatic cyst from August 2007 through January 2016 were retrospectively analyzed at a single tertiary academic center. Relevant clinical and imaging variables along with pathology results were collected to determine appropriate classification for each guideline...
January 23, 2017: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/28112959/intraductal-papillary-mucinous-neoplasms-and-mucinous-cystadenomas-current-status-and-recommendations
#19
Maria Moris, Michael B Wallace
The real prevalence of pancreatic cystic lesions remains unknown. The malignant potential of some of these lesions remains a cause for significant concern. Thus, it is mandatory to develop a strategy to clearly discriminate those cysts with a potential for malignant transformation from those that do not carry any significant risk. Intraductal papillary mucinous neoplasms and mucinous cystadenomas are mucinous cystic neoplasms with a known malignant potential that have gained greater recognition in recent years...
January 23, 2017: Revista Española de Enfermedades Digestivas
https://www.readbyqxmd.com/read/28099382/failure-of-nonoperative-management-of-pediatric-blunt-liver-and-spleen-injuries-a-prospective-atomac-study
#20
Maria E Linnaus, Crystal S Langlais, Nilda M Garcia, Adam C Alder, James W Eubanks, R Todd Maxson, Robert W Letton, Todd A Ponsky, Shawn D St Peter, Charles Leys, Amina Bhatia, Daniel J Ostlie, David W Tuggle, Karla A Lawson, Alexander R Raines, David M Notrica
BACKGROUND: Nonoperative management (NOM) is standard of care for most pediatric blunt liver and spleen injuries (BLSI); only 5% of patients fail NOM in retrospective reports. No prospective studies examine failure of NOM of BLSI in children. The aim of this study was to determine the frequency and clinical characteristics of failure of NOM in pediatric BLSI patients. METHODS: A prospective observational study was conducted on patients ≤18 years presenting to any of ten level 1 pediatric trauma centers April 2013 and January 2016 with BLSI on computed tomography...
January 17, 2017: Journal of Trauma and Acute Care Surgery
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