The presence of pancreatic cancer during childhood is extremely rare,and physicians may be tempted to overlook this diagnosis based on age criteria.However,there are primary malignant pancreatic tumors encountered in ...The presence of pancreatic cancer during childhood is extremely rare,and physicians may be tempted to overlook this diagnosis based on age criteria.However,there are primary malignant pancreatic tumors encountered in pediatric patients,such as pancreatoblastoma,and tumors considered benign in general but may present a malignant potential,such as the solid pseudo-papillary tumor,insulinoma,gastrinoma,and vasoactive intestinal peptide secreting tumor.Their early diagnosis and management are of paramount importance since the survival rates tend to differ for various types of these conditions.Many pediatric cancers may present pancreatic metastases,such as renal cell carcinoma,which may evolve with pancreatic metastatic disease even after two or more decades.Several childhood diseases may create a predisposition for the development of pancreatic cancer during adulthood;hence,there is a need for extensive screening strategies and complex programs to facilitate the transition from pediatric to adult healthcare.Nevertheless,genetic studies highlight the fact the specific gene mutations and family aggregations may be correlated with a special predisposition towards pancreatic cancer.This review aims to report the main pancreatic cancers diagnosed during childhood,the most important childhood diseases predisposing to the development of pancreatic malignancies,and the gene mutations associates with pancreatic malignant tumors.展开更多
BACKGROUND Despite significant technical and training improvements, the incidence of postendoscopic retrograde cholangiopancreatography(ERCP) pancreatitis(PEP) has not significantly dropped. Although many studies have...BACKGROUND Despite significant technical and training improvements, the incidence of postendoscopic retrograde cholangiopancreatography(ERCP) pancreatitis(PEP) has not significantly dropped. Although many studies have evaluated the efficacy of various agents, e.g. nonsteroidal anti-inflammatory drugs, octreotide,antioxidants, administered via various dosages, routes(oral, intrarectal or parenteral), and schedules(before or after the procedure), the results have been conflicting.AIM To evaluate efficacy of three pharmacologic prophylactic methods for prevention of PEP.METHODS In this prospective, single-center randomized trial, patients who underwent firsttime ERCP for choledocholithiasis were randomly assigned to three groups. The first group received 600 mg N-acetylcysteine 15 min prior to ERCP, and perrectum administration of 50 mg indomethacin both prior to and after completion of the ERCP. The second group was administered only the 50 mg indomethacin per-rectum both prior to and after the ERCP. The third group was administeredper-rectum 100 mg indomethacin only after the ERCP, representing the control group given the guideline-recommended regimen. The primary end-point was PEP prevention.RESULTS Among the total 211 patients evaluated during the study, 186 fulfilled the inclusion criteria and completed the protocol. The percentages of patients who developed PEP in each of the three groups were not significantly different(χ2 =2.793, P = 0.247). Among the acute PEP cases, for all groups, 14 patients developed mild pancreatitis(77.77%) and 4 moderate. No severe cases of PEP occurred, and in all PEP cases the resolution was favorable. No adverse events related to the medications(digestive hemorrhage, rectal irritation, or allergies)occurred.CONCLUSION The efficacies of split-dose indomethacin and combined administration(Nacetylcysteine with indomethacin) for preventing PEP were similar to that of the standard regimen.展开更多
文摘The presence of pancreatic cancer during childhood is extremely rare,and physicians may be tempted to overlook this diagnosis based on age criteria.However,there are primary malignant pancreatic tumors encountered in pediatric patients,such as pancreatoblastoma,and tumors considered benign in general but may present a malignant potential,such as the solid pseudo-papillary tumor,insulinoma,gastrinoma,and vasoactive intestinal peptide secreting tumor.Their early diagnosis and management are of paramount importance since the survival rates tend to differ for various types of these conditions.Many pediatric cancers may present pancreatic metastases,such as renal cell carcinoma,which may evolve with pancreatic metastatic disease even after two or more decades.Several childhood diseases may create a predisposition for the development of pancreatic cancer during adulthood;hence,there is a need for extensive screening strategies and complex programs to facilitate the transition from pediatric to adult healthcare.Nevertheless,genetic studies highlight the fact the specific gene mutations and family aggregations may be correlated with a special predisposition towards pancreatic cancer.This review aims to report the main pancreatic cancers diagnosed during childhood,the most important childhood diseases predisposing to the development of pancreatic malignancies,and the gene mutations associates with pancreatic malignant tumors.
文摘BACKGROUND Despite significant technical and training improvements, the incidence of postendoscopic retrograde cholangiopancreatography(ERCP) pancreatitis(PEP) has not significantly dropped. Although many studies have evaluated the efficacy of various agents, e.g. nonsteroidal anti-inflammatory drugs, octreotide,antioxidants, administered via various dosages, routes(oral, intrarectal or parenteral), and schedules(before or after the procedure), the results have been conflicting.AIM To evaluate efficacy of three pharmacologic prophylactic methods for prevention of PEP.METHODS In this prospective, single-center randomized trial, patients who underwent firsttime ERCP for choledocholithiasis were randomly assigned to three groups. The first group received 600 mg N-acetylcysteine 15 min prior to ERCP, and perrectum administration of 50 mg indomethacin both prior to and after completion of the ERCP. The second group was administered only the 50 mg indomethacin per-rectum both prior to and after the ERCP. The third group was administeredper-rectum 100 mg indomethacin only after the ERCP, representing the control group given the guideline-recommended regimen. The primary end-point was PEP prevention.RESULTS Among the total 211 patients evaluated during the study, 186 fulfilled the inclusion criteria and completed the protocol. The percentages of patients who developed PEP in each of the three groups were not significantly different(χ2 =2.793, P = 0.247). Among the acute PEP cases, for all groups, 14 patients developed mild pancreatitis(77.77%) and 4 moderate. No severe cases of PEP occurred, and in all PEP cases the resolution was favorable. No adverse events related to the medications(digestive hemorrhage, rectal irritation, or allergies)occurred.CONCLUSION The efficacies of split-dose indomethacin and combined administration(Nacetylcysteine with indomethacin) for preventing PEP were similar to that of the standard regimen.
