Computed tomography (CT) and magnetic resonance imaging (MRI) are excellent modalities which have the ability to detect,depict and stage the nerve invasion associated with pancreatic carcinoma.The aim of this article ...Computed tomography (CT) and magnetic resonance imaging (MRI) are excellent modalities which have the ability to detect,depict and stage the nerve invasion associated with pancreatic carcinoma.The aim of this article is to review the CT and MR patterns of pancreatic carcinoma invading the extrapancreatic neural plexus and thus provide useful information which could help the choice of treatment methods.Pancreatic carcinoma is a common malignant neoplasm with a high mortality rate.There are many factors influencing the prognosis and treatment options for those patients suffering from pancreatic carcinoma,such as lymphatic metastasis,adjacent organs or tissue invasion,etc.Among these factors,extrapancreatic neural plexus invasion is recognized as an important factor when considering the management of the patients.展开更多
Pancreatic carcinoma is an extremely high-grade malignant tumor with fast development and high mortality. The incidence of pancreatic carcinoma continues to increase. Peripancreatic invasion and metastasis are the mai...Pancreatic carcinoma is an extremely high-grade malignant tumor with fast development and high mortality. The incidence of pancreatic carcinoma continues to increase. Peripancreatic invasion and metastasis are the main characteristics and important prognostic factors in pancreatic carcinoma, especially invasion into the nervous system; pancreatic nerve innervation includes the intrapancreatic and extrapancreatic nerves. A strong grasp of pancreatic nerve innervation may contribute to our understanding of pancreatic pain modalities and the metastatic routes for pancreatic carcinomas. Computed tomography (CT) and magnetic resonance imaging (MRI) are helpful techniques for depicting the anatomy of extrapancreatic nerve innervation. The purpose of the present work is to show and describe the anatomy of the extrapancreatic neural plexus and to elucidate its characteristics using CT and MRI, drawing on our own previous work and the research findings of others.展开更多
BACKGROUND Acute pancreatitis(AP)is a pancreatic inflammatory disorder that is commonly complicated by extrapancreatic organ dysfunction.Dachengqi decoction(DCQD)has a potential role in protecting the extrapancreatic ...BACKGROUND Acute pancreatitis(AP)is a pancreatic inflammatory disorder that is commonly complicated by extrapancreatic organ dysfunction.Dachengqi decoction(DCQD)has a potential role in protecting the extrapancreatic organs,but the optimal oral administration time remains unclear.AIM To screen the appropriate oral administration time of DCQD for the protection of extrapancreatic organs based on the pharmacokinetics and pharmacodynamics of AP rats.METHODS This study consisted of two parts.In the first part,24 rats were divided into a sham-operated group and three model groups.The four groups were intragastrically administered with DCQD(10 g/kg)at 4 h,4 h,12 h,and 24 h postoperatively,respectively.Tail vein blood was taken at nine time points after administration,and then the rats were euthanized and the extrapancreatic organ tissues were immediately collected.Finally,the concentrations of the major DCQD components in all samples were detected.In the second part,84 rats were divided into a sham-operated group,as well as 4 h,12 h,and 24 h treatment groups and corresponding control groups(4 h,12 h,and 24 h control groups).Rats in the treatment groups were intragastrically administered with DCQD(10 g/kg)at 4 h,12 h,and 24 h postoperatively,respectively,and rats in the control groups were administered with normal saline at the same time points.Then,six rats from each group were euthanized at 4 h and 24 h after administration.Serum amylase and inflammatory mediators,and pathological scores of extrapancreatic organ tissues were evaluated.RESULTS For part one,the pharmacokinetic parameters(C max,T max,T 1/2,and AUC 0→t)of the major DCQD components and the tissue distribution of most DCQD components were better when administering DCQD at the later(12 h and 24 h)time points.For part two,delayed administration of DCQD resulted in lower IL-6 and amylase levels and relatively higher IL-10 levels,and pathological injury of extrapancreatic organ tissues was slightly less at 4 h after administration,while the results were similar between the treatment and corresponding control groups at 24 h after administration.CONCLUSION Delayed administration of DCQD might reduce pancreatic exocrine secretions and ameliorate pathological injury in the extrapancreatic organs of AP rats,demonstrating that the late time is the optimal dosing time.展开更多
BACKGROUND Many scores have been suggested to assess the severity of acute pancreatitis upon onset.The extrapancreatic necrosis volume is a novel,promising score that appears to be superior to other scores investigate...BACKGROUND Many scores have been suggested to assess the severity of acute pancreatitis upon onset.The extrapancreatic necrosis volume is a novel,promising score that appears to be superior to other scores investigated so far.AIM To evaluate the discriminatory power of extrapancreatic necrosis volume to identify severe cases of acute pancreatitis.METHODS A total of 123 patients diagnosed with acute pancreatitis at Institute of Gastroenterology and Hepatology,St Spiridon Hospital between January 1,2017 and December 31,2019 were analyzed retrospectively.Pancreatitis was classified according to the revised Atlanta classification(rAC)as mild,moderate,or severe.Severity was also evaluated by computed tomography and classified according to the computed tomography severity index(CTSI)and the modified CTSI(mCTSI).The results were compared with the extrapancreatic volume necrosis to establish the sensitivity and specificity of each method.RESULTS The CTSI and mCTSI imaging scores and the extrapancreatic necrosis volume were highly correlated with the severity of pancreatitis estimated by the rAC(r=0.926,P<0.001 and r=0.950,P<0.001;r=0.784,P<0.001,respectively).The correlation of C-reactive protein with severity was positive but not as strong,and was not significant(r=0.133,P=0.154).The best predictor for the assessment of severe pancreatitis was the extrapancreatic necrosis volume[area under the curve(AUC)=0.993;95%confidence interval(CI):0.981-1.005],with a 99.5%sensitivity and 99.0%specificity at a cutoff value of 167 mL,followed by the mCTSI 2007 score(AUC=0.972;95%CI:0.946-0.999),with a 98.0%sensitivity and 96.5%specificity,and the CTSI 1990 score(AUC=0.969;95%CI:0.941-0.998),with a 97.0%sensitivity and 95.0%specificity.CONCLUSION Radiological severity scores correlate strongly and positively with disease activity.Extrapancreatic necrosis volume shows the best diagnostic accuracy for severe cases.展开更多
Diabetes has been one of the major concerns in recent years,due to the increasing rate of morbidity and mortality worldwide.The available treatment strategies for uncontrolled diabetes mellitus(DM)are pancreas or isle...Diabetes has been one of the major concerns in recent years,due to the increasing rate of morbidity and mortality worldwide.The available treatment strategies for uncontrolled diabetes mellitus(DM)are pancreas or islet transplantation.However,these strategies are limited due to unavailability of quality pancreas/islet donors,life-long need of immunosuppression,and associated complications.Cell therapy has emerged as a promising alternative options to achieve the clinical benefits in the management of uncontrolled DM.Since the last few years,various sources of cells have been used to convert into insulin-producingβ-like cells.These extrapancreatic sources of cells may play a significant role inβ-cell turnover and insulin secretion in response to environmental stimuli.Stem/progenitor cells from liver have been proposed as an alternative choice that respond well to glucose stimuli under strong transcriptional control.The liver is one of the largest organs in the human body and has a common endodermal origin with pancreatic lineages.Hence,liver has been proposed as a source of a large number of insulinproducing cells.The merging of nanotechnology and 3D tissue bioengineering has opened a new direction for producing islet-like cells suitable for in vivo transplantation in a cordial microenvironment.This review summarizes extrapancreatic sources for insulin-secreting cells with reference to emerging technologies to fulfill the future clinical need.展开更多
High rates of extrapancreatic malignancies,in particular colorectal cancer(CRC),have been detected in patients with intraductal papillary mucinous neoplasm(IPMN).So far,there is no distinct explanation in the literatu...High rates of extrapancreatic malignancies,in particular colorectal cancer(CRC),have been detected in patients with intraductal papillary mucinous neoplasm(IPMN).So far,there is no distinct explanation in the literature for the development of secondary or synchronous malignancies in patients with IPMN.In the past few years,some data related to common genetic alterations in IPMN and other affiliated cancers have been published.This review elucidated the association between IPMN and CRC,shedding light on the most relevant genetic alterations that may explain the possible relationship between these entities.In keeping with our findings,we suggested that once the diagnosis of IPMN is made,special consideration of CRC should be undertaken.Presently,there are no specific guidelines regarding colorectal screening programs for patients with IPMN.We recommend that patients with IPMNs are at high-risk for CRC,and a more rigorous colorectal surveillance program should be implemented.展开更多
BACKGROUND Acute pancreatitis(AP)is a common acute abdominal disease worldwide,and its incidence rate has increased annually.Approximately 20%of AP patients develop into necrotizing pancreatitis(NP),and 40%to 70%of NP...BACKGROUND Acute pancreatitis(AP)is a common acute abdominal disease worldwide,and its incidence rate has increased annually.Approximately 20%of AP patients develop into necrotizing pancreatitis(NP),and 40%to 70%of NP patients have infectious complications,which usually indicate a worse prognosis.Infection is an important sign of complications in NP patients.AIM To investigate the difference in infection time,infection site,and infectious strain in NP patients with infectious complications.METHODS The clinical data of AP patients visiting the Department of General Surgery of Xuanwu Hospital of Capital Medical University from January 1,2014 to December 31,2018 were collected retrospectively.Enhanced computerized tomography or magnetic resonance imaging findings in patients with NP were included in the study.Statistical analysis of infectious bacteria,infection site,and infection time in NP patients with infectious complications was performed,because knowledge about pathogens and their antibiotic susceptibility patterns is essential for selecting an appropriate antibiotic.In addition,the factors that might influence the prognosis of patients were analyzed.RESULTS In this study,539 strains of pathogenic bacteria were isolated from 162 patients with NP infection,including 212 strains from pancreatic infections and 327 strains from extrapancreatic infections.Gram-negative bacteria were the main infectious species,the most common of which were Escherichia coli and Pseudomonas aeruginosa.The extrapancreatic infection time(9.1±8.8 d)was earlier than the pancreatic infection time(13.9±12.3 d).Among NP patients with early extrapancreatic infection(<14 d),bacteremia(25.12%)and respiratory tract infection(21.26%)were predominant.Among NP patients with late extrapancreatic infection(>14 d),bacteremia(15.94%),respiratory tract infection(7.74%),and urinary tract infection(7.71%)were predominant.Drug sensitivity analysis showed that P.aeruginosa was sensitive to enzymatic penicillins,thirdand fourth-generation cephalosporins,and carbapenems.Acinetobacter baumannii and Klebsiella pneumoniae were sensitive only to tigecycline;Staphylococcus epidermidis and Enterococcus faecium were highly sensitive to linezolid,tigecycline,and vancomycin.CONCLUSION In this study,we identified the timing,the common species,and site of infection in patients with NP.展开更多
Retroperitoneal fibrosis is a rare disease characterized by the development of inflammation and fibrosis in the soft tissues of the retroperitoneum and other abdominal organs.Retroperitoneal fibrosis can be of 2 types...Retroperitoneal fibrosis is a rare disease characterized by the development of inflammation and fibrosis in the soft tissues of the retroperitoneum and other abdominal organs.Retroperitoneal fibrosis can be of 2 types:idiopathic and secondary.The recently advocated concept and diagnostic criteria of immunoglobulin G4(IgG4)-related disease,derived from research on autoimmune pancreatitis(AIP),has led to widespread recognition of retroperitoneal fibrosis as a condition caused by IgG4-related disease.We now know that previously diagnosed idiopathic retroperitoneal fibrosis includes IgG4-related disease;however,the actual prevalence is unclear.Conversely,some reports on AIP suggest that retroperitoneal fibrosis is concurrently found in about 10% of IgG4-related disease.Because retroperitoneal fibrosis has no specific symptoms,diagnosis is primarily based on diagnostic imaging(computed tomography and magnetic resonance imaging),which is also useful in evaluating the effect of therapy.Idiopathic retroperitoneal fibrosis can occur at different times with other lesions of IgG4-related disease including AIP.Thus,the IgG4 assay is recommended to diagnose idiopathic retroperitoneal fibrosis.High serum IgG4 levels should be treated and monitored as a symptom of IgG4-related disease.The first line of treatment for retroperitoneal fibrosis is steroid therapy regardless of its cause.For patients with concurrent AIP,i.e.,IgG4-related retroperitoneal fibrosis,the starting dose of steroid is usually 30-40 mg/d.The response to steroid therapy is generally favorable.In most cases,the pancreatic lesion and retroperitoneal fibrosis improve after the initial treatment.However,the epidemiology,treatment for recurring retroperitoneal fibrosis,and long-term prognosis are still largely unknown.Further analysis of such cases and research are necessary.展开更多
BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB) is pathologically similar to intraductal papillary mucinous neoplasm(IPMN). However, there are several significant differences between them. The rate of...BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB) is pathologically similar to intraductal papillary mucinous neoplasm(IPMN). However, there are several significant differences between them. The rate of IPMN associated with extrapancreatic malignancies has been reported to range from 10%-40%, and it may occasionally be complicated with the presence of fistulas. IPMN associated with malignant IPNB is extremely rare and only nine cases have been reported in the literature.CASE SUMMARY We report a 52-year-old man who presented with recurrent cholangitis for nine months. Computed tomography and magnetic resonance cholangiopancreatography showed the common bile duct stricture with dilated pancreatobiliary duct without other abnormal findings. The underlying pathogenesis could not be identified based on the radiologic images. Endoscopic retrograde cholangiopancreatography revealed a pancreatobiliary fistula with dilated main pancreatic duct, biliary stricture with dilated biliary tree, and mucus discharge from the enlarged orifice of the major papilla. The patient underwent SpyGlass cholangiopancreatoscopy due to a suspected mucin-producing biliary neoplasm and indeterminate main pancreatic duct dilatation. Multiple papillary growing neoplasms with vascular images, with the extent of lesions spreading in the biliopancreatic ductal lumens, were identified by SpyGlass. In addition, the presence of a pancreatobiliary fistula was also identified. The patient was diagnosed as having benign IPMN and malignant IPNB with focal invasion by postoperative pathology. Furthermore, varying histological subtypes were present in both IPMN and IPNB. Pylorus-preserving pancreaticoduodenectomy was performed on the patient with excellent results during the 52 month followup period.CONCLUSION We deemed that pancreatography and SpyGlass allowed for an efficient diagnosis of IPMN with pancreatobiliary fistula, whereas the etiology could not be identified by radiologic imaging.展开更多
Background: The occurrence of infectious complications characterizes the more severe forms of acute pancreatitis(AP) and is associated with high mortality. We investigated the effects of infection at different sites i...Background: The occurrence of infectious complications characterizes the more severe forms of acute pancreatitis(AP) and is associated with high mortality. We investigated the effects of infection at different sites in patients with AP, including those with necrotizing pancreatitis(NP).Methods: We conducted a retrospective analysis of 285 patients who met the inclusion criteria for AP and were admitted to Tianjin Nankai Hospital between January 2016 and September 2019. According to the source of the culture positivity during hospitalization, patients were divided into four groups: sterile group(n=148), pancreatic infection group(n=65), extrapancreatic infection group(n=22) and combined infection group(n=50). The source of infection, microbiology, biochemical parameters and prognostic indicators were analyzed.Results: In terms of baseline characteristics, the four groups were similar in age, sex, aetiology, previous pancreatitis and diabetes. Compared with the severity of the disease in the other groups, the APACHE II scores(9.91±4.65, 9.46±5.05, respectively) and organ failure rate(40.9% and 50%, respectively)were higher in the extrapancreatic infection group and the combined infection group(P<0.05). The frequency of surgical intervention and hospitalization time in patients with NP complicated with extrapancreatic infection was greatly increased(P<0.05). Regarding the primary outcome, patients in the combined infection group had longer hospital stays(68.28±51.80 vs. 55.58±36.24, P<0.05) and higher mortality(24.0% vs. 9.2%, P<0.05) than patients in the pancreatic infection group. In addition, patients in the extrapancreatic infection group also showed high intensive care utilization(59.1%) and mortality rates(18.2%). Among the 137 AP patients with infection complications, 89 patients exhibited multidrug-resistant(MDR) microorganisms, and the mortality rate of patients with MDR bacterial infection was higher than that of patients with non-MDR bacterial infection(24.7% vs. 3.6%, P=0.001).Conclusions: Clinicians should be aware that extrapancreatic infection(EPI) significantly aggravates the main outcome in pancreatic infection patients. Infection with MDR bacteria is also associated with AP mortality.展开更多
The hypoglycaemia paraneoplastic is uncommon in diabetic patients. Our aim was to report a case of paraneoplastic hypoglycaemia discovered after the diagnosis of gastric adenocarcinoma in a diabetic patient. A 65 year...The hypoglycaemia paraneoplastic is uncommon in diabetic patients. Our aim was to report a case of paraneoplastic hypoglycaemia discovered after the diagnosis of gastric adenocarcinoma in a diabetic patient. A 65 years old man, was hospitalized for the management of acute digestive haemorrhage. In his medical history, he had diabetes since 20 years. He was alcoholic weaned for 3 years and had an unexplored repetitive epigastralgia. During his hospitalization, the exploration of acute digestive haemorrhage found a gastric adenocarcinoma with hepatic metastasis. At the 4th day of his hospitalization, he presented a hypoglycaemic coma with capillary blood glucose at 0.36 g/L. The patient was conscious after the infusion of Hypertonic Glucose Solution (HGS) 10%. After 3 days, the recurrent hypoglycaemia occurred and we intermittently treated by infusion of glucose solution 10%. The measurements of insulin level and C-peptide weren’t performed because they didn’t exist in the city. So, the notion of cancer and the recurrent hypoglycaemia even if we stopped the oral antidiabetic therapy make us think of a paraneoplastic syndrome. The chemotherapy associated with corticosteroid therapy is the standard treatment of the hypoglycaemia paraneoplastic but the patient refused the chemotherapy and we couldn’t use the corticosteroid therapy because of digestive haemorrhage. At the end of his hospitalization, he still had hypoglycaemia treated by infusion of glucose solution 10%. In the absence of means of diagnosis, we should think of paraneoplastic syndrome in front of recurrent hypoglycaemia and cancer in the diabetic patient.展开更多
Severe acute pancreatitis is commonly associated with pancreatic and extrapancreatic necrosis(EPN).Progressive EPN leading to necrotizing fasciitis of the retroperitoneum and abdominal wall has been reported.However,e...Severe acute pancreatitis is commonly associated with pancreatic and extrapancreatic necrosis(EPN).Progressive EPN leading to necrotizing fasciitis of the retroperitoneum and abdominal wall has been reported.However,extension of retroperitoneal necrosis to the scrotum causing Fournier’s gangrene is uncommon.We present a case of 39-year-old male admitted with severe acute pancreatitis requiring prolonged mechanical ventilation.He was managed with percutaneous drainage and culture specific antibiotics during the 1st month of hospital stay.During the 3rd month of hospital stay,the patient started developing pain and ulceration over the scrotum.He was diagnosed with Fournier’s gangrene based on clinical examination and was planned for debridement.During surgery,the track extending up to the deep inguinal ring was widened and drain was placed into the right lateral pelvic wall through the deep ring via a separate stab incision to reduce further scrotal wound contamination.The case highlights a rare but potentially fatal complication of Fournier’s gangrene following severe acute necrotizing pancreatitis and the importance of measures to prevent further contamination of scrotum after surgical debridement.Concomitant management of two potentially fatal conditions poses numerous challenges.展开更多
基金Supported by National Nature Science Foundation of China,No. 30370436
文摘Computed tomography (CT) and magnetic resonance imaging (MRI) are excellent modalities which have the ability to detect,depict and stage the nerve invasion associated with pancreatic carcinoma.The aim of this article is to review the CT and MR patterns of pancreatic carcinoma invading the extrapancreatic neural plexus and thus provide useful information which could help the choice of treatment methods.Pancreatic carcinoma is a common malignant neoplasm with a high mortality rate.There are many factors influencing the prognosis and treatment options for those patients suffering from pancreatic carcinoma,such as lymphatic metastasis,adjacent organs or tissue invasion,etc.Among these factors,extrapancreatic neural plexus invasion is recognized as an important factor when considering the management of the patients.
基金Supported by National Nature Science Foundation of China, No. 30370436
文摘Pancreatic carcinoma is an extremely high-grade malignant tumor with fast development and high mortality. The incidence of pancreatic carcinoma continues to increase. Peripancreatic invasion and metastasis are the main characteristics and important prognostic factors in pancreatic carcinoma, especially invasion into the nervous system; pancreatic nerve innervation includes the intrapancreatic and extrapancreatic nerves. A strong grasp of pancreatic nerve innervation may contribute to our understanding of pancreatic pain modalities and the metastatic routes for pancreatic carcinomas. Computed tomography (CT) and magnetic resonance imaging (MRI) are helpful techniques for depicting the anatomy of extrapancreatic nerve innervation. The purpose of the present work is to show and describe the anatomy of the extrapancreatic neural plexus and to elucidate its characteristics using CT and MRI, drawing on our own previous work and the research findings of others.
基金Supported by the National Natural Science Foundation of China,No.81603480 and No.81573857.
文摘BACKGROUND Acute pancreatitis(AP)is a pancreatic inflammatory disorder that is commonly complicated by extrapancreatic organ dysfunction.Dachengqi decoction(DCQD)has a potential role in protecting the extrapancreatic organs,but the optimal oral administration time remains unclear.AIM To screen the appropriate oral administration time of DCQD for the protection of extrapancreatic organs based on the pharmacokinetics and pharmacodynamics of AP rats.METHODS This study consisted of two parts.In the first part,24 rats were divided into a sham-operated group and three model groups.The four groups were intragastrically administered with DCQD(10 g/kg)at 4 h,4 h,12 h,and 24 h postoperatively,respectively.Tail vein blood was taken at nine time points after administration,and then the rats were euthanized and the extrapancreatic organ tissues were immediately collected.Finally,the concentrations of the major DCQD components in all samples were detected.In the second part,84 rats were divided into a sham-operated group,as well as 4 h,12 h,and 24 h treatment groups and corresponding control groups(4 h,12 h,and 24 h control groups).Rats in the treatment groups were intragastrically administered with DCQD(10 g/kg)at 4 h,12 h,and 24 h postoperatively,respectively,and rats in the control groups were administered with normal saline at the same time points.Then,six rats from each group were euthanized at 4 h and 24 h after administration.Serum amylase and inflammatory mediators,and pathological scores of extrapancreatic organ tissues were evaluated.RESULTS For part one,the pharmacokinetic parameters(C max,T max,T 1/2,and AUC 0→t)of the major DCQD components and the tissue distribution of most DCQD components were better when administering DCQD at the later(12 h and 24 h)time points.For part two,delayed administration of DCQD resulted in lower IL-6 and amylase levels and relatively higher IL-10 levels,and pathological injury of extrapancreatic organ tissues was slightly less at 4 h after administration,while the results were similar between the treatment and corresponding control groups at 24 h after administration.CONCLUSION Delayed administration of DCQD might reduce pancreatic exocrine secretions and ameliorate pathological injury in the extrapancreatic organs of AP rats,demonstrating that the late time is the optimal dosing time.
文摘BACKGROUND Many scores have been suggested to assess the severity of acute pancreatitis upon onset.The extrapancreatic necrosis volume is a novel,promising score that appears to be superior to other scores investigated so far.AIM To evaluate the discriminatory power of extrapancreatic necrosis volume to identify severe cases of acute pancreatitis.METHODS A total of 123 patients diagnosed with acute pancreatitis at Institute of Gastroenterology and Hepatology,St Spiridon Hospital between January 1,2017 and December 31,2019 were analyzed retrospectively.Pancreatitis was classified according to the revised Atlanta classification(rAC)as mild,moderate,or severe.Severity was also evaluated by computed tomography and classified according to the computed tomography severity index(CTSI)and the modified CTSI(mCTSI).The results were compared with the extrapancreatic volume necrosis to establish the sensitivity and specificity of each method.RESULTS The CTSI and mCTSI imaging scores and the extrapancreatic necrosis volume were highly correlated with the severity of pancreatitis estimated by the rAC(r=0.926,P<0.001 and r=0.950,P<0.001;r=0.784,P<0.001,respectively).The correlation of C-reactive protein with severity was positive but not as strong,and was not significant(r=0.133,P=0.154).The best predictor for the assessment of severe pancreatitis was the extrapancreatic necrosis volume[area under the curve(AUC)=0.993;95%confidence interval(CI):0.981-1.005],with a 99.5%sensitivity and 99.0%specificity at a cutoff value of 167 mL,followed by the mCTSI 2007 score(AUC=0.972;95%CI:0.946-0.999),with a 98.0%sensitivity and 96.5%specificity,and the CTSI 1990 score(AUC=0.969;95%CI:0.941-0.998),with a 97.0%sensitivity and 95.0%specificity.CONCLUSION Radiological severity scores correlate strongly and positively with disease activity.Extrapancreatic necrosis volume shows the best diagnostic accuracy for severe cases.
文摘Diabetes has been one of the major concerns in recent years,due to the increasing rate of morbidity and mortality worldwide.The available treatment strategies for uncontrolled diabetes mellitus(DM)are pancreas or islet transplantation.However,these strategies are limited due to unavailability of quality pancreas/islet donors,life-long need of immunosuppression,and associated complications.Cell therapy has emerged as a promising alternative options to achieve the clinical benefits in the management of uncontrolled DM.Since the last few years,various sources of cells have been used to convert into insulin-producingβ-like cells.These extrapancreatic sources of cells may play a significant role inβ-cell turnover and insulin secretion in response to environmental stimuli.Stem/progenitor cells from liver have been proposed as an alternative choice that respond well to glucose stimuli under strong transcriptional control.The liver is one of the largest organs in the human body and has a common endodermal origin with pancreatic lineages.Hence,liver has been proposed as a source of a large number of insulinproducing cells.The merging of nanotechnology and 3D tissue bioengineering has opened a new direction for producing islet-like cells suitable for in vivo transplantation in a cordial microenvironment.This review summarizes extrapancreatic sources for insulin-secreting cells with reference to emerging technologies to fulfill the future clinical need.
文摘High rates of extrapancreatic malignancies,in particular colorectal cancer(CRC),have been detected in patients with intraductal papillary mucinous neoplasm(IPMN).So far,there is no distinct explanation in the literature for the development of secondary or synchronous malignancies in patients with IPMN.In the past few years,some data related to common genetic alterations in IPMN and other affiliated cancers have been published.This review elucidated the association between IPMN and CRC,shedding light on the most relevant genetic alterations that may explain the possible relationship between these entities.In keeping with our findings,we suggested that once the diagnosis of IPMN is made,special consideration of CRC should be undertaken.Presently,there are no specific guidelines regarding colorectal screening programs for patients with IPMN.We recommend that patients with IPMNs are at high-risk for CRC,and a more rigorous colorectal surveillance program should be implemented.
基金Supported by the Beijing Municipal Science &Technology Commission,No.Z171100001017077the Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support,No.XMLX201404
文摘BACKGROUND Acute pancreatitis(AP)is a common acute abdominal disease worldwide,and its incidence rate has increased annually.Approximately 20%of AP patients develop into necrotizing pancreatitis(NP),and 40%to 70%of NP patients have infectious complications,which usually indicate a worse prognosis.Infection is an important sign of complications in NP patients.AIM To investigate the difference in infection time,infection site,and infectious strain in NP patients with infectious complications.METHODS The clinical data of AP patients visiting the Department of General Surgery of Xuanwu Hospital of Capital Medical University from January 1,2014 to December 31,2018 were collected retrospectively.Enhanced computerized tomography or magnetic resonance imaging findings in patients with NP were included in the study.Statistical analysis of infectious bacteria,infection site,and infection time in NP patients with infectious complications was performed,because knowledge about pathogens and their antibiotic susceptibility patterns is essential for selecting an appropriate antibiotic.In addition,the factors that might influence the prognosis of patients were analyzed.RESULTS In this study,539 strains of pathogenic bacteria were isolated from 162 patients with NP infection,including 212 strains from pancreatic infections and 327 strains from extrapancreatic infections.Gram-negative bacteria were the main infectious species,the most common of which were Escherichia coli and Pseudomonas aeruginosa.The extrapancreatic infection time(9.1±8.8 d)was earlier than the pancreatic infection time(13.9±12.3 d).Among NP patients with early extrapancreatic infection(<14 d),bacteremia(25.12%)and respiratory tract infection(21.26%)were predominant.Among NP patients with late extrapancreatic infection(>14 d),bacteremia(15.94%),respiratory tract infection(7.74%),and urinary tract infection(7.71%)were predominant.Drug sensitivity analysis showed that P.aeruginosa was sensitive to enzymatic penicillins,thirdand fourth-generation cephalosporins,and carbapenems.Acinetobacter baumannii and Klebsiella pneumoniae were sensitive only to tigecycline;Staphylococcus epidermidis and Enterococcus faecium were highly sensitive to linezolid,tigecycline,and vancomycin.CONCLUSION In this study,we identified the timing,the common species,and site of infection in patients with NP.
基金Supported by The Research Program of Intractable Disease and the Research Committee of Intractable Pancreatic Diseases of the Ministry of Health,Labor and Welfare of Japan
文摘Retroperitoneal fibrosis is a rare disease characterized by the development of inflammation and fibrosis in the soft tissues of the retroperitoneum and other abdominal organs.Retroperitoneal fibrosis can be of 2 types:idiopathic and secondary.The recently advocated concept and diagnostic criteria of immunoglobulin G4(IgG4)-related disease,derived from research on autoimmune pancreatitis(AIP),has led to widespread recognition of retroperitoneal fibrosis as a condition caused by IgG4-related disease.We now know that previously diagnosed idiopathic retroperitoneal fibrosis includes IgG4-related disease;however,the actual prevalence is unclear.Conversely,some reports on AIP suggest that retroperitoneal fibrosis is concurrently found in about 10% of IgG4-related disease.Because retroperitoneal fibrosis has no specific symptoms,diagnosis is primarily based on diagnostic imaging(computed tomography and magnetic resonance imaging),which is also useful in evaluating the effect of therapy.Idiopathic retroperitoneal fibrosis can occur at different times with other lesions of IgG4-related disease including AIP.Thus,the IgG4 assay is recommended to diagnose idiopathic retroperitoneal fibrosis.High serum IgG4 levels should be treated and monitored as a symptom of IgG4-related disease.The first line of treatment for retroperitoneal fibrosis is steroid therapy regardless of its cause.For patients with concurrent AIP,i.e.,IgG4-related retroperitoneal fibrosis,the starting dose of steroid is usually 30-40 mg/d.The response to steroid therapy is generally favorable.In most cases,the pancreatic lesion and retroperitoneal fibrosis improve after the initial treatment.However,the epidemiology,treatment for recurring retroperitoneal fibrosis,and long-term prognosis are still largely unknown.Further analysis of such cases and research are necessary.
文摘BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB) is pathologically similar to intraductal papillary mucinous neoplasm(IPMN). However, there are several significant differences between them. The rate of IPMN associated with extrapancreatic malignancies has been reported to range from 10%-40%, and it may occasionally be complicated with the presence of fistulas. IPMN associated with malignant IPNB is extremely rare and only nine cases have been reported in the literature.CASE SUMMARY We report a 52-year-old man who presented with recurrent cholangitis for nine months. Computed tomography and magnetic resonance cholangiopancreatography showed the common bile duct stricture with dilated pancreatobiliary duct without other abnormal findings. The underlying pathogenesis could not be identified based on the radiologic images. Endoscopic retrograde cholangiopancreatography revealed a pancreatobiliary fistula with dilated main pancreatic duct, biliary stricture with dilated biliary tree, and mucus discharge from the enlarged orifice of the major papilla. The patient underwent SpyGlass cholangiopancreatoscopy due to a suspected mucin-producing biliary neoplasm and indeterminate main pancreatic duct dilatation. Multiple papillary growing neoplasms with vascular images, with the extent of lesions spreading in the biliopancreatic ductal lumens, were identified by SpyGlass. In addition, the presence of a pancreatobiliary fistula was also identified. The patient was diagnosed as having benign IPMN and malignant IPNB with focal invasion by postoperative pathology. Furthermore, varying histological subtypes were present in both IPMN and IPNB. Pylorus-preserving pancreaticoduodenectomy was performed on the patient with excellent results during the 52 month followup period.CONCLUSION We deemed that pancreatography and SpyGlass allowed for an efficient diagnosis of IPMN with pancreatobiliary fistula, whereas the etiology could not be identified by radiologic imaging.
文摘Background: The occurrence of infectious complications characterizes the more severe forms of acute pancreatitis(AP) and is associated with high mortality. We investigated the effects of infection at different sites in patients with AP, including those with necrotizing pancreatitis(NP).Methods: We conducted a retrospective analysis of 285 patients who met the inclusion criteria for AP and were admitted to Tianjin Nankai Hospital between January 2016 and September 2019. According to the source of the culture positivity during hospitalization, patients were divided into four groups: sterile group(n=148), pancreatic infection group(n=65), extrapancreatic infection group(n=22) and combined infection group(n=50). The source of infection, microbiology, biochemical parameters and prognostic indicators were analyzed.Results: In terms of baseline characteristics, the four groups were similar in age, sex, aetiology, previous pancreatitis and diabetes. Compared with the severity of the disease in the other groups, the APACHE II scores(9.91±4.65, 9.46±5.05, respectively) and organ failure rate(40.9% and 50%, respectively)were higher in the extrapancreatic infection group and the combined infection group(P<0.05). The frequency of surgical intervention and hospitalization time in patients with NP complicated with extrapancreatic infection was greatly increased(P<0.05). Regarding the primary outcome, patients in the combined infection group had longer hospital stays(68.28±51.80 vs. 55.58±36.24, P<0.05) and higher mortality(24.0% vs. 9.2%, P<0.05) than patients in the pancreatic infection group. In addition, patients in the extrapancreatic infection group also showed high intensive care utilization(59.1%) and mortality rates(18.2%). Among the 137 AP patients with infection complications, 89 patients exhibited multidrug-resistant(MDR) microorganisms, and the mortality rate of patients with MDR bacterial infection was higher than that of patients with non-MDR bacterial infection(24.7% vs. 3.6%, P=0.001).Conclusions: Clinicians should be aware that extrapancreatic infection(EPI) significantly aggravates the main outcome in pancreatic infection patients. Infection with MDR bacteria is also associated with AP mortality.
文摘The hypoglycaemia paraneoplastic is uncommon in diabetic patients. Our aim was to report a case of paraneoplastic hypoglycaemia discovered after the diagnosis of gastric adenocarcinoma in a diabetic patient. A 65 years old man, was hospitalized for the management of acute digestive haemorrhage. In his medical history, he had diabetes since 20 years. He was alcoholic weaned for 3 years and had an unexplored repetitive epigastralgia. During his hospitalization, the exploration of acute digestive haemorrhage found a gastric adenocarcinoma with hepatic metastasis. At the 4th day of his hospitalization, he presented a hypoglycaemic coma with capillary blood glucose at 0.36 g/L. The patient was conscious after the infusion of Hypertonic Glucose Solution (HGS) 10%. After 3 days, the recurrent hypoglycaemia occurred and we intermittently treated by infusion of glucose solution 10%. The measurements of insulin level and C-peptide weren’t performed because they didn’t exist in the city. So, the notion of cancer and the recurrent hypoglycaemia even if we stopped the oral antidiabetic therapy make us think of a paraneoplastic syndrome. The chemotherapy associated with corticosteroid therapy is the standard treatment of the hypoglycaemia paraneoplastic but the patient refused the chemotherapy and we couldn’t use the corticosteroid therapy because of digestive haemorrhage. At the end of his hospitalization, he still had hypoglycaemia treated by infusion of glucose solution 10%. In the absence of means of diagnosis, we should think of paraneoplastic syndrome in front of recurrent hypoglycaemia and cancer in the diabetic patient.
文摘Severe acute pancreatitis is commonly associated with pancreatic and extrapancreatic necrosis(EPN).Progressive EPN leading to necrotizing fasciitis of the retroperitoneum and abdominal wall has been reported.However,extension of retroperitoneal necrosis to the scrotum causing Fournier’s gangrene is uncommon.We present a case of 39-year-old male admitted with severe acute pancreatitis requiring prolonged mechanical ventilation.He was managed with percutaneous drainage and culture specific antibiotics during the 1st month of hospital stay.During the 3rd month of hospital stay,the patient started developing pain and ulceration over the scrotum.He was diagnosed with Fournier’s gangrene based on clinical examination and was planned for debridement.During surgery,the track extending up to the deep inguinal ring was widened and drain was placed into the right lateral pelvic wall through the deep ring via a separate stab incision to reduce further scrotal wound contamination.The case highlights a rare but potentially fatal complication of Fournier’s gangrene following severe acute necrotizing pancreatitis and the importance of measures to prevent further contamination of scrotum after surgical debridement.Concomitant management of two potentially fatal conditions poses numerous challenges.
