JOP. Journal of the Pancreas

COMING SOON

 

 

Antioxidant Therapy for Chronic Pancreatitis: Premises and Pitfalls

Joan M Braganza

Manchester, United Kingdom

 

No abstract available

 

Serum Pancreatic Enzyme Elevations in the ICU Patient: Pancreatitis or Not?

Dang S, Mirzan SH, Pitchumoni CS

Department of Surgery, Beth Israel Medical Center. New York, NY, USA

 

ABSTRACT

Hyperamylasemia and/or hyperlipasemia can occur in any ICU patient either as a result of true acute pancreatitis or as a reflection of a non-pancreatic disease, with or without abdominal pain, associated with serum pancreatic enzyme elevations (“pseudopancreatitis”). True acute pancreatitis in the ICU setting may be critical in the presence of associated co-morbid conditions of the disease for which the patient is being managed (e.g. diabetic ketoacidosis with elevated pancreatic enzymes). In this paper, we are not mentioning patients transferred to the ICU because of detected markers of poor prognosis. It is important for the clinician to be aware of the different causes of hyperamylasemia and hyperlipasemia, especially when clinical pancreatitis is not the clear diagnosis. Our aim was to identify the possible causes of non-pancreatic as well as pancreatic hyperenzymemia in the ICU patient. We reviewed articles concerning hyperamylasemia and hyperlipasemia that can be typically found in a critically ill patient. We conducted a PubMed search using keywords: “hyperamylasemia“, “hyperlipasemia”, “critically ill patient”.

 

(Abstract available on-line: October 21^st, 2011)

 

 

Administration of Xigris is not Associated with Pancreatic Parenchymal Haemorrhage in L-Arginine-Induced Experimental Acute Pancreatitis.

Ajith K Siriwardena

Hepato-Pancreato-Biliary Surgery Unit, Manchester Royal Infirmary. Manchester, United Kingdom

 

ABSTRACT

Background Microvascular thrombosis is a critical event in severe acute pancreatitis (AP).  Xigris (human recombinant activated protein C) modulates the interplay between pro-inflammatory and pro-coagulant pathways and maintains microvascular patency.  The anticoagulant properties of xigris may however precipitate bleeding from the inflamed pancreas.  This study tests the hypothesis that Xigris can ameliorate experimental AP without causing pancreatic haemorrhage. Methods Sprague Dawley rats were allocated as follows:  Gp 1: control (n=7); Gp 2: AP (n=6); Gp 3: Administration of Xigris 500 µg/kg body weight before induction of AP (n=6) and Gp 4:  Administration of Xigris 500 µg/kg body weight 30 minutes after induction of AP (n=6).  AP was induced by intraperitoneal administration of L-arginine 300mg/100g body weight.  Animals were sacrificed at 48 hours and biochemical, haematological, and histological markers of pancreatic haemorrhage and inflammation assessed. Results Lipase in animals with AP was 10 (7-16) units/ml compared to 5.5 (3-8) units/ml in control (P = 0.03).  Lipase was also elevated in animals given Xigris. Haemoglobin levels were similar in all groups. (P=0.27, Kruskal-Wallis).  There was no histologic evidence of pancreatic haemorrhage in animals treated with Xigris.  Pre-treatment with Xigris was associated with a significant reduction in pancreatic injury. This effect was absent when Xigris was administered after induction of AP. Conclusion Xigris did not lead to pancreatic haemorrhage in experimental AP. Administration of Xigris prior to induction of AP was associated with amelioration of injury.  This effect was not seen with administration of Xigris after induction of AP.

 

(Abstract available on-line: May 7^th, 2013)

 

A Proteomic Comparison of Formalin-Fixed Paraffin-Embedded Pancreatic Tissue from Autoimmune Pancreatitis, Chronic Pancreatitis, and Pancreatic Cancer

Joao A Paulo

Harvard Medical School. USA

 

ABSTRACT

Context Formalin-fixed paraffin-embedded (FFPE) tissue is a standard method of specimen preservation for hospital pathology departments, and as such FFPE tissue banks are an untapped resource of histologically-characterized specimens for retrospective biomarker investigation for pancreatic disease. Objectives We aim to use liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) analysis to compare FFPE specimens from 3 different diseases of the exocrine pancreas. Design We investigated the proteomic profile of FFPE pancreatic tissue specimens from 9 archived specimens that were histologically classified as: autoimmune pancreatitis (n=3), chronic pancreatitis (n=3), and pancreatic cancer (n=3), using LC-MS/MS. Setting This is a proteomic analysis experiment of FFPE pancreatic tissue in an academic center. Patients. FFPE tissue specimens were provided by Dana-Farber/Harvard Cancer Center (Boston, MA). Interventions FFPE tissue specimens were collected via routine surgical resection procedures. Outcome measures. We compared proteins identified from chronic pancreatitis, autoimmune pancreatitis, and pancreatic cancer FFPE pancreatic tissue. Results We identified 386 non-redundant proteins from 9 specimens. Implementing our filtering criteria, 73, 29, and 53 proteins were identified exclusively in autoimmune pancreatitis (e.g., immunoglobulins and histocompatibility antigens), chronic pancreatitis (e.g., hornerin and several ribosomal subunits); and pancreatic cancer specimens (e.g., epiplakin, protein disulfide-isomerase, and mucin 2), respectively. Conclusions We report that differentially-expressed proteins can be identified among FFPE tissues specimens originating from individuals with different histologic diagnoses. The mass spectrometry-based methodology used herein has the potential to enhance diagnostic biomarker and therapeutic target discovery, further advancing pancreatic research.

 

(Abstract available on-line: April 11^th, 2013)

 

Effect of the Time of Day and Queue Position in the Endoscopic Schedule on the Performance Characteristics of EUS-FNA for Diagnosing Pancreatic Malignancies

Ali Ahmed Siddiqui

Division of Gastroenterology, Thomas Jefferson University Hospital. Philadelphia, PA, USA

 

ABSTRACT

Aim The aim of this study was to determine if procedure time or queue position affected performance characteristics of EUS-FNA for diagnosing solid pancreatic malignancies. Patients and Methods We conducted a retrospective study evaluating patients with solid pancreatic lesions in whom EUS-FNA was performed. Three timing variables were evaluated as surrogate markers for endoscopist fatigue: procedure start times, morning vs. afternoon procedures and endoscopy queue position. Statistical analyses were performed to determine whether timing variables predicted performance characteristics of EUS-FNA. Results We identified 609 patients (mean age 65.8 years, 52.1% male) with solid pancreatic lesions who underwent EUS-FNA. The sensitivity of EUS-FNA was 100% for procedures that started at 0700 hours while cases that started at 1600 hours had a sensitivity of 81%. Using start time on a continuous scale, each elapsed hour was associated with a 1.9% decrease in EUS-FNA sensitivity (p=0.003). Similarly, a 10% reduction in EUS-FNA sensitivity was detected between morning and afternoon procedures (92% versus 82% respectively, P<0.01). A linear regression comparing procedure start time and diagnostic accuracy revealed a decreased of approximately 1.7% in procedure accuracy for every hour later a procedure was started. A 16% reduction in EUS-FNA accuracy was detected between morning and afternoon procedures (100% versus 84% respectively, P < 0.01). When queue position was assessed, a 2.4% reduction in accuracy was noted for each increase in the queue position (p=0.01). Conclusions Sensitivity and diagnostic accuracy of EUS-FNA for solid pancreatic lesions declines with progressively later EUS starting times and increasing numbers of procedures before a given EUS, potentially from endoscopist and cytotechnologist fatigue.

 

(Abstract available on-line: March 23^rd, 2013)

 

The Effect of Oral Pancreatic Enzyme Supplementation on the Course and Outcome of Acute Pancreatitis. A Randomized, Double-Blind Parallel-Group Study

Kahl S, Schütte K, Glasbrenner B, Mayerle J, Simon P, Henniges F, Sander-Struckmeier S, Lerch MM, Malfertheiner P

Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Magdeburg Magdeburg, Germany

 

ABSTRACT

Objective To evaluate whether oral pancreatic enzyme supplementation (Creon^® 25,000 Minimicrospheres) improves the recovery of pancreatic exocrine function and to explore the efficacy, safety and tolerability of pancreatic enzyme supplementation in patients during the refeeding period after acute pancreatitis. Methods Prospective double-blind, placebo controlled, randomized study, including 56 patients with pancreatitis. Primary efficacy variable was recovery from pancreatic exocrine insufficiency. Secondary objectives were body weight, glucose metabolism, abdominal pain, course of APACHE II-score, patient’s symptoms and quality of life. Results 20 of 56 patients showed low fecal elastase values indicating pancreatic exocrine insufficiency after acute pancreatitis. Median time to recovery from exocrine pancreatic insufficiency was 14 days in the enzyme supplementation group and 23 days in the placebo group but overall differences for primary and all but one secondary endpoint did not reach statistical significance. However, a positive tendency in favour of enzyme supplementation was found for quality of life parameters (FACT-Pa) in all subscores. There were no relevant differences between placebo and Creon^® detected with respect to safety and tolerability. Creon^® can be considered to be safely administered. Conclusion Enzyme supplementation positively effects the course of acute pancreatitis if administered during the early refeeding phase after acute pancreatitis. There is indication that Creon^® has a positive impact on the course of the disease and the global health status (less weight loss, less flatulence, improved quality of life). Creon^® was safely administered and can be added to the treatment regime of patients in a refeeding status after severe acute pancreatitis.

 

(Abstract available on-line: May 10^th, 2012)

 

 

Hepatoid Variant of Pancreatic Cancer: Insights from a Case and Literature Review

Shounak Majumder, Constantin A Dasanu

University of Connecticut Health Center. USA

 

ABSTRACT

‘Hepatoid’ cancer refers to an extrahepatic neoplasm with hepatocellular differentiation. The stomach is the most common site and pancreatic origin is distinctly uncommon. We describe a patient with hepatoid pancreatic tumor who presented with inoperable metastatic disease. Serum levels or tissue staining with alfa-fetoprotein (AFP) may not be a reliable tumor marker in these cases and an experienced pathologist and appropriate immunohistochemical staining are essential for early diagnosis. This report incorporates a comprehensive literature review outlining the clinical presentation, diagnostic difficulties, management and outcomes associated with this rare pathological entity.

 

(Abstract available on-line: April 27^th, 2013)

 

Locally Advanced Pseudopapillary Neoplasm of Pancreas in Male Patient

Mirhalik Javadov, Wafi Attaallah, Fatma Gulcicek Ayranci, Deniz Filinte, Ender Dulundu, Cumhur Yegen

Department of General Surgery, Marmara University School of Medicine. Istanbul, Turkey

 

ABSTRACT

Context Solid pseudopapillary tumor of the pancreas is a rare neoplasm, predominantly observed in young women and with greatest incidence in the second and third decade. Although large at the time of diagnosis, it has clinically good behavior. The occurrence of infiltrating varieties of solid pseudopapillary tumors (SPT) is very rare. Case report We report the case of a forty-eight-year-old man with a giant mass in the pancreas, incidentally discovered during an abdominal ultrasonography. The mass was later investigated using multidetector computed tomography and magnetic resonance imaging. The lobulated lesion had cystic-necrotic appearances which lead the radiologists to suggest the possibility of either a gastrointestinal stromal tumor or a pancreas cancer. Patient was operated. Operative signs showed that the tumor invaded the splenic hillus and mesentery of transvers colon. En-block resection of pancreas, spleen and transvers colon was performed as the mass was thought to be a locally advanced pancreas tumor. Pathological diagnosis reported a solid pseudopapillary tumor. Conclusion As a conclusion, although SPT is considered a rare tumor, with a very rare rate of locally infiltrating variety, and rarely presents in males, it must be kept in mind while making the differential diagnosis of cystic pancreatic lesions to begin appropriate clinical management.

 

(Abstract available on-line: April 27^th, 2013)

 

Alternative Arterial Reconstruction After Extended Pancreatectomy. Case Report and Some Considerations of Locally Advanced Pancreatic Cancer

Benedetto Ielpo

Sanchinarro Hospital. Spain

 

ABSTRACT

Context The clinical benefits of distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic body cancer remains controversial, therefore declared unresectable in most cases. Appleby first described extended distal pancreatectomy with celiac axis resection for locally advanced gastric cancer. Case report We report a case of a 65-year-old female who presented a locally advanced pancreatic carcinoma with infiltration of celiac axis. After radio-chemo neoadjuvant treatment, the patient underwent exploratory laparoscopy and subsequent distal pancreatectomy with en bloc resection of celiac axis. Arterial reconstruction was necessary as hepatic flow was not adequate, determined by intraoperative Doppler ultrasonography. It consists of end to end anastomosis with prosthetic graft between hepatic artery directly to the aorta, as an atheromatous plaque was at the origin of the celiac axis. The postoperative course was uneventful with a perfect relief of pain. She presents a long term survival of 36 months, very exceptional for this type of disease. Conclusion The particularity of this case is not only the surgical treatment, rarely offered to these patients, but also and especially the subsequent vascular reconstruction. To our knowledge, this is the first report of this type of arterial reconstruction. Besides, we briefly discuss the recent advances in results of extended distal pancreatectomy with arterial resection for locally advanced pancreatic carcinoma.

 

(Abstract available on-line: April 11^th, 2013)

 

Successful Treatment of Brittle Diabetes Following Total Pancreatectomy by Islet Allo-Tansplantation: A Case Report

Angela Koh, Sharleen Imes, James Shapiro, Peter Senior

University of Alberta. Canada

 

ABSTRACT

Context Allo-transplantation of islets can successfully treat subjects with type 1 diabetes complicated by severe hypoglycemia and erratic glycemic control. Insulin independence is often lost over time due to several factors, including recurrent autoimmunity. Brittle diabetes (frequent hypoglycemia and labile glycemic control) is common after pancreatectomy. This is ameliorated by auto-islet transplantation in pancreatectomized patients who have better glycemic control, even without insulin independence. Case report We herein report a case where islet allo-transplantation was carried out in a patient who had undergone total pancreatectomy. Following two islet infusions, he became insulin independent with excellent glycemic control and remains so currently, more than four years after his second islet infusion. Side effects from immunosuppressive therapy were minimal. Discussion Islet allo-transplantation can be considered in selected individuals post-pancreatectomy. The absence of autoimmunity may be advantageous for long term graft function relative to islet allo-transplantation in type 1 diabetic recipients.

 

(Abstract available on-line: April 11^th, 2013)

(Last Update: May 10th, 2013)