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Survival Analysis
Published in Trevor F. Cox, Medical Statistics for Cancer Studies, 2022
This was the fourth trial in a series of five trials to date, for pancreatic cancer by the European study Group for Pancreatic Cancer (ESPAC), although Trial number 2 never came to fruition. Figure 3.22 shows a diagram of the pancreas. The pancreas has two functions, (i) to produce enzymes and secrete them into the small intestine for breaking down food and (ii) to produce insulin which regulates glucose in the body. The most common type of pancreatic cancer is “ductal” where the tumour develops around the pancreatic duct. Ampullary cancers occur in the “Ampulla of Vater” where the pancreatic and bile ducts meet the small intestine. Peri-ampullary cancers occur around the area. Pancreatic cancer has a notoriously poor survival rate with only of patients surviving more than 5 years, but longer for those diagnosed at an early stage. Patients with peri-ampullary cancers can fare better.
Cystic Fibrosis and Pancreatic Disease
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Elissa M. Downs, Jillian K. Mai, Sarah Jane Schwarzenberg
Clinical signs and symptoms result from effects of pancreatic duct obstruction or direct pancreatic acinar cell injury that lead to premature activation of the pancreatic digestive enzymes in the pancreas itself rather than in the intestines. The resulting inflammation leads to symptoms of epigastric pain which may radiate to the back, as well as nausea and vomiting. If due to biliary disease such as gallstones, children may have associated jaundice and scleral icterus. However, in younger children, symptoms can be non-specific and may include non-focal pain or irritability. Thus the diagnosis is made clinically with a combination of two out of three of the following: suggestive abdominal pain or symptoms, levels of serum amylase and/or lipase that are greater than three times the upper limit of normal, and imaging findings such as a diffusely enlarged pancreas and surrounding fluid (Table 19.4).
Abdominal Injuries
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
Pancreatic injuries are among the most challenging and complicated to deal with. However, there are some practical issues in the context of forward surgery. First, the diagnosis of the pancreatic injury is very difficult, especially with no CT scanner. It should be suspected when peri-pancreatic haematoma is seen and confirmed after opening of the lesser sac. If the patient is operated a few hours after the injury, the signs of steatonecrosis (white patches) might appear around the pancreas, on omentum, or on the root of mesentery – indicative of pancreatic injury. Most injuries to the pancreas with no main pancreatic duct involvement may be successfully treated by adequate drainage alone and supportive therapy, including somatostatin and total parenteral nutrition. Only when the Virsung duct is transected are more complex and sophisticated surgical intervention is required – but this does not require definitive primary surgery! The best solution to define the extent of the pancreatic injury is not to perform aggressive pancreatic exploration. Minor damage may be easily converted to the big problem! Simply looking at the pancreatic surface and minimal haematoma evacuation may provide the necessary information about the next steps (Figure 10.17). If the pancreatic head is destroyed, drain it! If there is complete transection of the neck of pancreas is diagnosed, close both pancreatic sides using a stapling device, or multiple U-stitches. Neither Whipple’s procedure nor distal pancreatectomy is recommended!
Quality of life after total pancreatectomy with islet autotransplantation for chronic pancreatitis in Japan
Published in Islets, 2023
Tadashi Takaki, Daisuke Chujo, Toshiaki Kurokawa, Akitsu Kawabe, Nobuyuki Takahashi, Kyoji Ito, Koji Maruyama, Fuyuki Inagaki, Koya Shinohara, Kumiko Ajima, Yzumi Yamashita, Hiroshi Kajio, Mikio Yanase, Chihaya Hinohara, Makoto Tokuhara, Yukari Uemura, Yoshihiro Edamoto, Nobuyuki Takemura, Norihiro Kokudo, Shinichi Matsumoto, Masayuki Shimoda
Chronic pancreatitis (CP) is an inflammatory disease of the pancreas that eventually culminates in irreversible fibrosis and loss of function.1 Patients with CP often have severe and intractable abdominal pain that leads to decreased quality of life (QOL), inability to work or attend school, and increased health care costs due to repeated emergency room visits and hospitalizations.2,3 The first-line treatment for CP includes a low-fat diet, pancreatic enzyme therapy to reduce pancreatic irritation, comprehensive pain management, and endoscopic sphincterotomy and stenting by endoscopic retrograde cholangiopancreatography (ERCP).4,5 If medical or ERCP therapy is unsuccessful, surgical treatment, such as pancreatic duct drainage or parenchymal resection, may be considered, depending on the morphology of the pancreatic duct and tissue. Total pancreatectomy (TP) with islet autotransplantation (TPIAT) may also be considered in some patients, particularly those with diffuse small pancreatic duct disease, hereditary pancreatitis, or a history of failed surgery.6–8 The aims of TP are to relieve pain and restore QOL, while islet autotransplantation (IAT) is intended to reduce the burden of postoperative diabetes.9
Heating of metallic biliary stents during magnetic hyperthermia of patients with pancreatic ductal adenocarcinoma: an in silico study
Published in International Journal of Hyperthermia, 2022
Oriano Bottauscio, Irene Rubia-Rodríguez, Alessandro Arduino, Luca Zilberti, Mario Chiampi, Daniel Ortega
The bile duct is a tube that connects the gallbladder and the duodenum in the small intestine to transport there the bile, where it performs essential tasks for food digestion [11]. This tube is part of the biliary tree, which starts in the liver. The part of this tree that comes out from the gallbladder is called cystic duct which is joined along with the common hepatic duct into the common bile duct. This goes through the pancreas and joins with the pancreatic duct, ending up in the ampulla of Vater in the duodenum. It is very common to see that the tumor blocks this path in pancreatic ductal adenocarcinoma (PDAC) patients, avoiding the bile to reach the small intestine [12]. This is clinically shown as jaundice (yellow colored skin) due to the accumulation of bilirubin in the blood, which is a component of the bile.
In reply: ‘multiple etiologies explain the association between sarcoidosis and diabetes mellitus’
Published in Expert Review of Respiratory Medicine, 2022
Amr Ehab El-Qushayri, Sherief Ghozy, Sheikh Mohammed Shariful Islam
The lungs and the lymph nodes are the most common site of sarcoidosis involvement, with a prevalence of 90% and 75% of all sarcoidosis cases [5]. Pancreatic sarcoidosis affects about 1–3% of sarcoidosis patients and mainly remain asymptomatic [9]. Symptomatic presentation of pancreatic involvement mostly mimics tumor-like manifestations such as weight loss, obstructive jaundice, and abdominal pain resulting from the compression on the pancreatic duct and the surrounding organs [9–11]. To a lesser extent, pancreatitis presentation may occur [12]. In addition, hyperglycemia was reported in a previously diabetic patients with pancreatic sarcoid involvement after a 7-day course of prednisone treatment. This suggests that diabetes affection is more linked to the treatment itself than the autoimmune pancreatitis cascade [9]. Moreover, sarcoidosis patients that received glucocorticoid treatment had more risk for developing DM (HR = 2.85 (95%CI: 0.76–10.75)) when compared to patients who did not receive glucocorticoid treatment [13].