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Pancreatic malignancy
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Giovanni Morana, Alex Faccinetto, Michele Fusaro
Neoplastic lesions of the pancreas represent a heterogeneous group of entities that can be discovered incidentally at imaging or during examinations tailored towards suspected pancreatic disease. Accurate imaging is essential in the differential diagnosis, since prognosis, management, and therapies vary. Imaging of pancreatic neoplasms may help in detection, characterization, and staging. Suitable imaging modalities include ultrasonography (US) and US-related techniques, multislice computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine. A multimodality approach is mandatory and has a synergistic effect in improving diagnostic accuracy.
System Imaging in Unexplained Fever
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
In the evaluation of retroperitoneal and psoas abscesses, neither ultrasound nor nuclear medicine is as efficient as computed tomography.17 CT imaging of the pancreas remains invaluable both in the diagnosis and treatment of pancreatic disease.18 It is apparent that CT can aid in the diagnosis and treatment of retro- and intraperitoneal inflammatory fluid collections, but percutaneous needle aspiration of the fluid is necessary to separate infected from noninfected collections.
Biochemical and Pharmacological Rationales in Radiotracer Design
Published in Lelio G. Colombetti, Principles of Radiopharmacology, 2019
Raymond E. Counsell, Nancy Korn
Recognition of this fact led to the synthesis of 75Se-L-selenomethionine (SeM), which possessed properties similar to methionine with respect to uptake in the pancreas.21,157 Both carcinoma and pancreatitis are characterized by a diminished or absence of visualization, and it is generally agreed that this represents a reliable indication of pancreatic disease. A number of clinical disadvantages are associated with this agent and include high concentrations of radioactivity in the liver and long biological and physical half-lives.158
A chronicle of the pancreatoduodenectomy technique development – from the surgeon’s hand to the robotic arm
Published in Acta Chirurgica Belgica, 2023
Marek Olakowski, Beata Jabłońska, Sławomir Mrowiec
In the second half of the nineteenth century, with the advent of ether anesthesia and Lister’s introduction of carbolic acid as an antiseptic, a new era in abdominal surgery began [1]. Pancreatic surgery during this period did not exist because three factors inhibited its development: the first- anatomical location of the pancreas which made it inaccessible for examination, the second- lack of diagnosis- diagnosis of pancreatic disease was usually made by pathologists after the death of the patient and the third- physiological pitfalls associated with endo- and exocrine function of the organ. Therefore, excerpts from opinions written by two leading surgeons of that era on pancreas surgery, presented below, are not surprising [2]:Jan Mikulicz Radecki (1850–1905) in Annals of Surgery: ‘As late as 1891 and 1892 the anatomists von Gerlach (1820–1896) and Joessel (1838–1892) dismissed in a few words the subject of the topographical anatomy of the pancreas, stating that this organ is of no clinical importance, since it is almost impossible for the surgeon to reach it’ (1903),Sir Moynihan (1865–1936) in his book of abdominal surgery: 'The treatment of malignant pancreatic disease by a surgeon cannot be said to exist… the mechanical difficulties of the operation are almost insurmountable, and if courage and luck are the gifts of the operator, the result to the patient scarcely justifies the means’ (1906).
Impact of genetic testing and smoking on the distribution of risk factors in patients with recurrent acute and chronic pancreatitis
Published in Scandinavian Journal of Gastroenterology, 2022
Merve Gurakar, Niloofar Y. Jalaly, Mahya Faghih, Tina Boortalary, Javad R. Azadi, Mouen A. Khashab, Christopher Fan, Anthony N. Kalloo, Atif Zaheer, Vikesh K. Singh, Elham Afghani
Our study had several limitations. The inclusion of patients from a subspecialty clinic at a tertiary referral center is a limitation. However, patients with idiopathic pancreatitis are mostly evaluated in specialty clinics focused on pancreatic disease as they are typically referred for evaluation. Another limitation of our study is that patients considered to have ‘single-risk factor’ etiologies, including biliary stones/sludge or heavy alcohol use did not undergo genetic testing. This is because of the high cost of genetic testing and the high likelihood of insurance denial in these situations. Our study also predates more recent commercially available genetic testing panels which have the capacity to detect additional pathogenic and ‘small effect’ genetic variants. These panels are likely to continue expanding as additional variants continue to be identified such as pancreatic lipase and TRPV6 which were initially reported in 2019 and 2020, respectively [53,54]. Other limitations include the fact that we were unable to test 42.9% of patients with idiopathic pancreatitis due to loss to follow-up and insurance denial. This may overestimate the prevalence of idiopathic pancreatitis in our cohort.
Can circulating tumor and exosomal nucleic acids act as biomarkers for pancreatic ductal adenocarcinoma?
Published in Expert Review of Molecular Diagnostics, 2019
Daniel S.K. Liu, Mireia Mato Prado, Elisa Giovannetti, Long R. Jiao, Jonathan Krell, Adam E. Frampton
In this study, Bernard et al. [1] collected plasma samples from 194 PDAC patients (April 2015 – October 2017). There were two cohorts consisting of 71 patients with localized disease and 123 with metastatic disease (confirmed either at the surgery or through a radiological investigation). A further 37 patients were included as controls; 25 diagnosed with pancreatic cysts and 12 with non-neoplastic pancreatic disease. All samples underwent isolation of cell-free circulating tumor DNA (ctDNA) and exosomal DNA (exoDNA) to assess the KRAS oncogene mutant allelic fraction (MAF) in both. Whole-blood samples were centrifuged at 2,500 g for 10 min for plasma and an ultracentrifugation protocol was used to isolate exosomes. Both ctDNA and exoDNA were extracted using QIAamp Circulating Nucleic Acid mini kit, and digital droplet PCR was used with a multiplex KRAS (codon 12 and 13) mutation assay. Baseline KRAS MAF was calculated and 34 patients from each cohort were available for longitudinal follow up whilst undergoing treatment (either surgery, chemotherapy consisting of gemcitabine and nab-paclitaxel (Abraxane) or FOLFIRINOX (folinic acid, 5-fluorouracil, irinotecan, and oxaliplatin) or neoadjuvant chemoradiotherapy, using radiosensitizing gemcitabine/capecitabine and 30 or 50.4 Grays).