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Pancreas anatomy

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https://www.readbyqxmd.com/read/28733926/perioperative-management-of-endocrine-insufficiency-after-total-pancreatectomy-for-neoplasia
#1
REVIEW
Ajay V Maker, Raashid Sheikh, Vinita Bhagia
PURPOSE: Indications for total pancreatectomy (TP) have increased, including for diffuse main duct intrapapillary mucinous neoplasms of the pancreas and malignancy; therefore, the need persists for surgeons to develop appropriate endocrine post-operative management strategies. The brittle diabetes after TP differs from type 1/2 diabetes in that patients have absolute deficiency of insulin and functional glucagon. This makes glucose management challenging, complicates recovery, and predisposes to hospital readmissions...
July 21, 2017: Langenbeck's Archives of Surgery
https://www.readbyqxmd.com/read/28726321/the-prevalence-of-transpancreatic-common-hepatic-artery-and-coexisting-variant-anatomy
#2
Kousei Ishigami, Akihiro Nishie, Yoshiki Asayama, Yasuhiro Ushijima, Yukihisa Takayama, Daisuke Okamoto, Nobuhiro Fujita, Tomoharu Yoshizumi, Norifumi Harimoto, Takao Ohtsuka, Kohei Nakata, Hiroshi Honda
PURPOSE: We studied the prevalence of the transpancreatic common hepatic artery (tp-CHA) and coexisting variant anatomy. MATERIALS AND METHODS: The study group comprised 788 consecutive liver transplant donor candidates who had undergone thin-section multidetector-row computed tomography (MDCT) studies to investigate vascular anatomy. Multiplanar reformatted (MPR) images obtained from the arterial phase were retrospectively reviewed to assess the presence/absence of the tp-CHA...
July 20, 2017: Clinical Anatomy
https://www.readbyqxmd.com/read/28634319/common-hepatic-artery-quadrifurcation-associated-with-right-hepatic-artery-from-superior-mesenteric-artery-during-laparoscopic-total-splenopancreasectomy
#3
Francesco Caruso, Giorgio Alessandri, Francesca Ciccarese, Giovanni Cesana, Matteo Uccelli, Giorgio Castello, Roberta Villa, Stefano Olmi
Hepatobiliopancreatic surgery is challenging becouse of the complexity of resections and reconstructions and variability of vascular anatomy. The arterial vascularization of the liver is susteined by the common hepatic artery (CHA) that originates from the celiac trunk (CT). The CHA bifurcates into the gastroduodenal artery (GDA) and proper hepatic artery (PHA) 0.5-1 cm medial to the common bile duct (CBD), and the PHA bifurcates into a right and a left branch at hepatic hilum. The most frequent variants are the right hepatic artery (RHA) from the superior mesenteric artery (SMA), the left hepatic artery (LHA) from the left gastric artery (LGA) or a combination of these two variants...
June 12, 2017: Annali Italiani di Chirurgia
https://www.readbyqxmd.com/read/28597678/a-giant-hiatal-hernia-and-intrathoracic-pancreas
#4
Ismael Mora-Guzmán, Juan Antonio Del Pozo Jiménez, Elena Martín-Pérez
Transhiatal herniation of the pancreas is an extremely rare condition, with only a few more than ten cases reported. Most patients are symptomatic at initial presentation and multi-detector computed tomography allows a detailed visualization of the anatomy and size of the diaphragmatic defect. Surgical repair is recommended for symptomatic cases.
June 2017: Revista Española de Enfermedades Digestivas
https://www.readbyqxmd.com/read/28523348/closed-loop-of-main-duct-of-pancreas-a-rare-variant-configuration
#5
Harsimran Jit Singh, Anjali Aggarwal, Rakesh K Kochhar, T D Yadav, Tulika Gupta, Daisy Sahni
During routine dissection, duplication of main pancreatic duct extending from body to head region of pancreas was observed in a 78-year-old formalin fixed male cadaver. Main pancreatic duct gave a prominent branch which joined back the parent duct in head resulting in the formation of a closed loop. This gave the appearance of focal duplication in the form of a closed loop, an unusual variant. This was an incidental finding. Such cases usually remain asymptomatic; however, if undetected may be the cause of postoperative pancreatic fistula following pancreaticobiliary surgery...
May 18, 2017: Surgical and Radiologic Anatomy: SRA
https://www.readbyqxmd.com/read/28516004/endoscopic-ultrasound-reaching-where-others-can-t
#6
Fady G Haddad, Magda Daoud, Ying Liu, Sherif Andrawes
Endoscopic ultrasound (EUS) has been increasingly used for the diagnosis and staging of pancreatic cancer. It has recently become the modality of choice in assessing pancreatic lesions overcoming other traditional modalities. Typically lesions located at the tail of the pancreas are best accessed through the stomach. We present a patient with pancreatic tail mass occurring in the setting of a large hiatal hernia, intrathoracic stomach, and severe lumbar levoscoliosis. Due to altered anatomy and extensive vascular connections of the mass, any surgical or radiological intervention was considered high risk for the patient...
April 15, 2017: Curēus
https://www.readbyqxmd.com/read/28469915/theoretical-investigation-of-transgastric-and-intraductal-approaches-for-ultrasound-based-thermal-therapy-of-the-pancreas
#7
Serena J Scott, Matthew S Adams, Vasant Salgaonkar, F Graham Sommer, Chris J Diederich
BACKGROUND: The goal of this study was to theoretically investigate the feasibility of intraductal and transgastric approaches to ultrasound-based thermal therapy of pancreatic tumors, and to evaluate possible treatment strategies. METHODS: This study considered ultrasound applicators with 1.2 mm outer diameter tubular transducers, which are inserted into the tissue to be treated by an endoscopic approach, either via insertion through the gastric wall (transgastric) or within the pancreatic duct lumen (intraductal)...
2017: Journal of Therapeutic Ultrasound
https://www.readbyqxmd.com/read/28447199/a-novel-reconstruction-technique-during-pancreaticoduodenectomy-after-roux-en-y-gastric-bypass-how-i-do-it
#8
George Younan, Susan Tsai, Douglas B Evans, Kathleen K Christians
The altered anatomy in patients after bariatric surgery who have undergone a Roux-en-Y gastric bypass may pose a technical challenge for surgical removal of the pancreatic head. We treat patients with pancreas cancer with multimodality therapy in a neoadjuvant fashion followed by pancreaticoduodenectomy (PD). In patients with Roux-en-Y gastric bypass anatomy, the gastric remnant is preserved and used for pancreaticogastrostomy reconstruction and subsequently drained by the same jejunal limb used for the hepaticojejunostomy...
July 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/28331142/usefulness-of-color-coding-resected-samples-from-a-pancreaticoduodenectomy-with-tissue-marking-dyes-for-a-detailed-examination-of-surgical-margin-surrounding-the-uncinate-process-of-the-pancreas
#9
Satoshi Mizutani, Hideyuki Suzuki, Takayuki Aimoto, Seiji Yamagishi, Keisuke Mishima, Masanori Watanabe, Yasuhiko Kitayama, Norio Motoda, Saiko Isshiki, Eiji Uchida
BACKGROUND: Characteristics of a cancer-positive margin around a resected uncinate process of the pancreas (MUP) due to a pancreticoduodenectomy are difficult to understand by standardized evaluation because of its complex anatomy. The purposes of this study were to subclassify the MUP with tissue marking dyes of different colors and to identify the characteristics of sites that showed positivity for cancer cells in patients with pancreatic head carcinoma who underwent circumferential superior mesenteric arterial nerve plexus-preserving pancreaticoduodenectomy...
2017: Journal of Nippon Medical School, Nippon Ika Daigaku Zasshi
https://www.readbyqxmd.com/read/28281726/anastomotic-loop-between-common-hepatic-artery-and-gastroduodenal-artery-in-coexistence-with-an-aberrant-right-hepatic-artery
#10
Konstantinos Natsis, Maria Piagkou, Theodosis Stamatopoulos, Ioannis Spyridakis, Stylianos Apostolidis
Anatomical variations of the hepatic arteries are not uncommon. The anomalous hepatic arterial supply is of paramount importance in hepatobiliary, pancreatic or liver transplantation and in laparoscopic surgery. We describe an unusual case of a 66-year-old Greek male cadaver, where a rare anastomosis (in the form of an enlarged arterial loop, 4.84 mm in diameter) between the common hepatic artery (6.42 mm) and the gastroduodenal artery (GDA) (4.82 mm) coexisted with an aberrant right hepatic artery (ARHA) (6...
March 10, 2017: Folia Morphologica (Warsz)
https://www.readbyqxmd.com/read/28241234/laparoscopic-total-pancreatectomy-with-islet-autotransplantation-and-intraoperative-islet-separation-as-a-treatment-for-patients-with-chronic-pancreatitis
#11
Caleb J Fan, Kenzo Hirose, Christi M Walsh, Michael Quartuccio, Niraj M Desai, Vikesh K Singh, Rita R Kalyani, Daniel S Warren, Zhaoli Sun, Marie N Hanna, Martin A Makary
Importance: Pain management of patients with chronic pancreatitis (CP) can be challenging. Laparoscopy has been associated with markedly reduced postoperative pain but has not been widely applied to total pancreatectomy with islet autotransplantation (TPIAT). Objective: To examine the feasibility of using laparoscopic TPIAT (L-TPIAT) in the treatment of CP. Design, Setting, and Participants: Thirty-two patients with CP presented for TPIAT at a tertiary hospital from January 1, 2013, through December 31, 2015...
June 1, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28230608/specialized-imaging-and-procedures-in-pediatric-pancreatology-a-north-american-society-for-pediatric-gastroenterology-hepatology-and-nutrition-clinical-report
#12
Tom K Lin, David M Troendle, Daniel B Wallihan, Bradley Barth, Victor L Fox, Douglas S Fishman, Veronique D Morinville
OBJECTIVES: An increasing number of children are being diagnosed with pancreatitis and other pancreatic abnormalities. Dissemination of the information regarding existing imaging techniques and endoscopic modalities to diagnose and manage pancreatic disorders in children is sorely needed. METHODS: We conducted a review of the medical literature on the use of the following imaging and procedural modalities in pediatric pancreatology: transabdominal ultrasonography (TUS), computed tomography (CT), magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasonography (EUS), and endoscopic retrograde cholangiopancreatography (ERCP)...
March 2017: Journal of Pediatric Gastroenterology and Nutrition
https://www.readbyqxmd.com/read/28203311/portal-annular-pancreas-a-rare-and-overlooked-anomaly
#13
Puneet Mittal, Ranjana Gupta, Amit Mittal, Arshad Ahmed
BACKGROUND: Portal annular pancreas is a rare pancreatic developmental anomaly which is often overlooked at imaging, and often diagnosed retrospectively when it is detected incidentally at the time of surgery. Although the anomaly itself is asymptomatic, it becomes important in cases where pancreatic resection/anastomosis is planned, because of varying ductal anatomy, risk of ductal injury and increased risk of postoperative pancreatic fistula formation. CASE REPORT: We present imaging findings in a case of portal annular pancreas in a 45-year-old male patient...
2017: Polish Journal of Radiology
https://www.readbyqxmd.com/read/28149833/assessment-of-the-link-between-in-utero-exposure-to-2-aminoanthracene-2aa-and-type-1-diabetes-t1d
#14
Christopher A Mays, Daniel A Hunter, Wilson Yau, Worlanyo E Gato
BACKGROUND: A recent diabetes report revealed an increased incidence in diabetes including type 1-diabetes (T1D). The increase in the numbers of T1D incidences are thought to be related to environmental reasons such as the exposure to environmental chemicals including arylamine 2-aminoanthracene (2AA). T1D is an autoimmune disease of the pancreatic islet in which insulin-producing beta cells are destroyed by auto-reactive T-cells and monocytic cells. METHODS: The purpose of this study is to examine the extent to which 2AA exposure contributes to T1D...
2017: Journal of Diabetes and Metabolic Disorders
https://www.readbyqxmd.com/read/28089481/recommendations-for-mri-based-contouring-of-gross-tumor-volume-and-organs-at-risk-for-radiation-therapy-of-pancreatic-cancer
#15
H D Heerkens, W A Hall, X A Li, P Knechtges, E Dalah, E S Paulson, C A T van den Berg, G J Meijer, E J Koay, C H Crane, K Aitken, M van Vulpen, B A Erickson
PURPOSE: Local recurrence is a common and morbid event in patients with unresectable pancreatic adenocarcinoma. A more conformal and targeted radiation dose to the macroscopic tumor in nonmetastatic pancreatic cancer is likely to reduce acute toxicity and improve local control. Optimal soft tissue contrast is required to facilitate delineation of a target and creation of a planning target volume with margin reduction and motion management. Magnetic resonance imaging (MRI) offers considerable advantages in optimizing soft tissue delineation and is an ideal modality for imaging and delineating a gross tumor volume (GTV) within the pancreas, particularly as it relates to conformal radiation planning...
March 2017: Practical Radiation Oncology
https://www.readbyqxmd.com/read/28048258/su-f-r-47-quantitative-shape-relationship-analysis-of-ptv-modification-for-critical-anatomy-sparing-and-its-impact-on-pathologic-response-for-neoadjuvant-stereotactic-radiotherapy-for-pancreatic-cancer
#16
Z Cheng, L Rosati, L Chen, S Robertson, J Moore, L Peng, O Mian, A Narang, A Hacker-Prietz, J Herman, T McNutt
PURPOSE: Stereotactic body radiation therapy (SBRT) may be used to increase surgery candidacy in borderline resectable (BRPC) and locally advanced (LAPC) pancreatic cancer. However, the planning target volume (PTV) may need to be limited to avoid toxicity when the gross tumor volume (GTV) is anatomically involved with surrounding critical structures. Our study aims to characterize the coverage of GTV and investigate the association between modified PTV and pathologic (pCR) or near pathologic (npCR) complete response rates determined from the surgical specimen...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/27913913/improved-image-quality-in-abdominal-ct-in-patients-who-underwent-treatment-for-hepatocellular-carcinoma-with-small-metal-implants-using-a-raw-data-based-metal-artifact-reduction-algorithm
#17
Keitaro Sofue, Takeshi Yoshikawa, Yoshiharu Ohno, Noriyuki Negi, Hiroyasu Inokawa, Naoki Sugihara, Kazuro Sugimura
OBJECTIVES: To determine the value of a raw data-based metal artifact reduction (SEMAR) algorithm for image quality improvement in abdominal CT for patients with small metal implants. METHODS: Fifty-eight patients with small metal implants (3-15 mm in size) who underwent treatment for hepatocellular carcinoma were imaged with CT. CT data were reconstructed by filtered back projection with and without SEMAR algorithm in axial and coronal planes. To evaluate metal artefact reduction, mean CT number (HU and SD) and artefact index (AI) values within the liver were calculated...
December 2, 2016: European Radiology
https://www.readbyqxmd.com/read/27813710/usefulness-of-three-dimensional-modeling-in-surgical-planning-resident-training-and-patient-education
#18
Ciro Andolfi, Alejandro Plana, Patrick Kania, P Pat Banerjee, Stephen Small
BACKGROUND: Imaging has a critical impact on surgical decision making and three-dimensional (3D) digital models of patient pathology can now be made commercially. We developed a 3D digital model of a cancer of the head of the pancreas by integrating actual CT data with 3D modeling process. After this process, the virtual pancreatic model was also produced using a high-quality 3D printer. PATIENTS AND METHODS: A 56-year-old female with pancreatic head adenocarcinoma presented with biliary obstruction and jaundice...
May 2017: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
https://www.readbyqxmd.com/read/27797245/pancreaticobiliary-ductal-anatomy-in-the-normal-population
#19
Jakrapan Jirasiritham, Chumpon Wilasrusmee, Napaphat Poprom, Noppadol Larbcharoensub
BACKGROUND: The complex anatomy of the pancreaticobiliary duct was crucial in management of pancreatic and biliary tract disease. MATERIALS AND METHODS: Fresh specimens of pancreas, common bile duct (CBD), and duodenum were obtained en bloc from autopsies of 160 patients. RESULTS: Ninety-three male and 67 female patients were included. The length of the pancreas ranged from 9.8-20 cm (mean, 16.20 +/- 1.70 cm). The intrapancreatic portion of the CBD showed patterns of three types: most common (85...
2016: Asian Pacific Journal of Cancer Prevention: APJCP
https://www.readbyqxmd.com/read/27789228/vascular-development-in-the-vertebrate-pancreas
#20
D Berfin Azizoglu, Diana C Chong, Alethia Villasenor, Judith Magenheim, David M Barry, Simon Lee, Leilani Marty-Santos, Stephen Fu, Yuval Dor, Ondine Cleaver
The vertebrate pancreas is comprised of a highly branched tubular epithelium, which is intimately associated with an extensive and specialized vasculature. While we know a great deal about basic vascular anatomy of the adult pancreas, as well as islet capillaries, surprisingly little is known about the ontogeny of its blood vessels. Here, we analyze development of the pancreatic vasculature in the mouse embryo. We show that pancreatic epithelial branches intercalate with the fine capillary plexus of the surrounding pancreatic mesenchyme...
December 1, 2016: Developmental Biology
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