Pub Date : 2021-01-01DOI: 10.36648/1590-8577.21.S4.001
M. Riyaz
{"title":"Surgical Management of Intraductal Papillary Neoplasm(IPNB) of the Bile Duct","authors":"M. Riyaz","doi":"10.36648/1590-8577.21.S4.001","DOIUrl":"https://doi.org/10.36648/1590-8577.21.S4.001","url":null,"abstract":"","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69688977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.36648/1590-8577.22.1.31-35
Murat zdede, H. Oral
Context Vildagliptin is an oral anti-diabetic agent of the dipeptidyl-peptidase 4 inhibitor (DPP-4i) class of drugs. Together with glucagon-like peptide analogs (GLP1a), DPP-4i drugs are being known as incretin-based therapies (IBT). Results of clinical trials are conflicted about a potential association between IBT and acute pancreatitis. Case Reports We present the history, clinical progress, and diagnostic findings of two cases of acute pancreatitis occurred in a patient treated with vildagliptin. In both cases, other known causes of acute pancreatitis were ruled out. The first case was a woman who had a history of biliary pancreatitis, and the second case was a social drinker. Vildagliptin was suspected to be associated with acute pancreatitis since other identifiable causes were absent. Conclusions The combination of two pathophysiologically distinct processes can still associate and synergize in each individual.
{"title":"Two Sporadic Cases of Acute Pancreatitis Associated with Vildagliptin","authors":"Murat zdede, H. Oral","doi":"10.36648/1590-8577.22.1.31-35","DOIUrl":"https://doi.org/10.36648/1590-8577.22.1.31-35","url":null,"abstract":"Context Vildagliptin is an oral anti-diabetic agent of the dipeptidyl-peptidase 4 inhibitor (DPP-4i) class of drugs. Together with glucagon-like peptide analogs (GLP1a), DPP-4i drugs are being known as incretin-based therapies (IBT). Results of clinical trials are conflicted about a potential association between IBT and acute pancreatitis. Case Reports We present the history, clinical progress, and diagnostic findings of two cases of acute pancreatitis occurred in a patient treated with vildagliptin. In both cases, other known causes of acute pancreatitis were ruled out. The first case was a woman who had a history of biliary pancreatitis, and the second case was a social drinker. Vildagliptin was suspected to be associated with acute pancreatitis since other identifiable causes were absent. Conclusions The combination of two pathophysiologically distinct processes can still associate and synergize in each individual.","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"22 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69689782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.36648/1590-8577.21.22.114-118
K. Vutipongsatorn, N. Zafar, Z. Hamady, J. Al-Musawi
Context Acute pancreatitis (AP) is a common emergency condition. Despite a complication rate of up to 20%, current management only includes supportive treatment and surgery in specific circumstances. Non-steroidal anti-inflammatory drugs (NSAIDs) are shown to reduce post-endoscopic retrograde cholangiopancreatography pancreatitis. Objective To assess the effect of NSAIDs on disease progress and patient outcomes in acute pancreatitis in a large district general hospital. Methods A retrospective analysis was performed on 361 consecutive, adult patients with AP from April 2018 to September 2020. Demographic data, biochemical information, pancreatitis severity scores and clinical outcomes were recorded. Patients were divided into two groups based on NSAID usage prior to hospital admission. Results Patients on NSAIDs prior to admission were older (69.4 vs 54.4, p-value<0.0001) and less likely to have ASA grade I (16.1% vs 34.6%, p-value=0.0446). They had a significantly lower Day 5 C-reactive protein (CRP) (89.0 mg/L vs 155.4 mg/L, p-value=0.0226). No patient using NSAIDs prior to admission developed pancreatic necrosis, however, this was not statistically significant (0.0% vs 6.4%, p-value=0.1478). There were no statistically significant differences in other clinical and biochemical outcomes. Discussions Routine NSAIDs use appears to reduce CRP level five days after admission and may protect from pancreatic necrosis after AP. Despite being older and in a poorer fitness level, patients on NSAIDs had similar outcomes to those without NSAIDs, suggesting potential benefits on AP. Conclusion NSAIDs may have some therapeutic value in AP. More studies are recommended to evaluate this further.
急性胰腺炎(AP)是一种常见的急症。尽管并发症发生率高达20%，但目前的治疗方法仅包括在特定情况下的支持性治疗和手术。非甾体抗炎药(NSAIDs)显示减少内镜后逆行胰胆管造影术胰腺炎。目的评价非甾体抗炎药对某大型区级综合医院急性胰腺炎患者病情进展及预后的影响。方法对2018年4月至2020年9月连续361例成年AP患者进行回顾性分析。记录人口统计学数据、生化信息、胰腺炎严重程度评分和临床结果。根据入院前非甾体抗炎药的使用情况将患者分为两组。结果入院前服用非甾体抗炎药的患者年龄较大(69.4 vs 54.4, p值<0.0001)，ASA I级的可能性较小(16.1% vs 34.6%， p值=0.0446)。他们的第5天c反应蛋白(CRP)显著降低(89.0 mg/L vs 155.4 mg/L, p值=0.0226)。入院前使用非甾体抗炎药的患者没有发生胰腺坏死，但这没有统计学意义(0.0% vs 6.4%， p值=0.1478)。其他临床及生化指标差异无统计学意义。常规使用非甾体抗炎药可降低入院后5天的CRP水平，并可防止AP后的胰腺坏死。尽管年龄较大，健康水平较差，但服用非甾体抗炎药的患者与未服用非甾体抗炎药的患者结果相似，这表明非甾体抗炎药对AP有潜在的益处。结论非甾体抗炎药可能对AP有一定的治疗价值，建议进一步研究对此进行评估。
{"title":"The Effect of Non-Steroidal Anti-Inflammatory Drugs on Acute Pancreatitis: A Retrospective Study at a London District General Hospital","authors":"K. Vutipongsatorn, N. Zafar, Z. Hamady, J. Al-Musawi","doi":"10.36648/1590-8577.21.22.114-118","DOIUrl":"https://doi.org/10.36648/1590-8577.21.22.114-118","url":null,"abstract":"Context Acute pancreatitis (AP) is a common emergency condition. Despite a complication rate of up to 20%, current management only includes supportive treatment and surgery in specific circumstances. Non-steroidal anti-inflammatory drugs (NSAIDs) are shown to reduce post-endoscopic retrograde cholangiopancreatography pancreatitis. Objective To assess the effect of NSAIDs on disease progress and patient outcomes in acute pancreatitis in a large district general hospital. Methods A retrospective analysis was performed on 361 consecutive, adult patients with AP from April 2018 to September 2020. Demographic data, biochemical information, pancreatitis severity scores and clinical outcomes were recorded. Patients were divided into two groups based on NSAID usage prior to hospital admission. Results Patients on NSAIDs prior to admission were older (69.4 vs 54.4, p-value<0.0001) and less likely to have ASA grade I (16.1% vs 34.6%, p-value=0.0446). They had a significantly lower Day 5 C-reactive protein (CRP) (89.0 mg/L vs 155.4 mg/L, p-value=0.0226). No patient using NSAIDs prior to admission developed pancreatic necrosis, however, this was not statistically significant (0.0% vs 6.4%, p-value=0.1478). There were no statistically significant differences in other clinical and biochemical outcomes. Discussions Routine NSAIDs use appears to reduce CRP level five days after admission and may protect from pancreatic necrosis after AP. Despite being older and in a poorer fitness level, patients on NSAIDs had similar outcomes to those without NSAIDs, suggesting potential benefits on AP. Conclusion NSAIDs may have some therapeutic value in AP. More studies are recommended to evaluate this further.","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"22 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69688783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.36648/1590-8577.21.22.108-110
M. K. Albuni, Ruba Zuhri Yafi, B. Sabbagh, M. Moubarak, Lina Khouri
Background Pancreatic tuberculosis is very rare, mostly due to the antibacterial effects of the pancreatic enzymes. The association of thrombosis and Tb has been reported but that of inferior vena cava thrombosis and pancreatic Tb is extremely rare and has only been reported once. Case presentation a case of pancreatic Tuberculosis and IVC thrombosis presented with constitutional symptoms. Ultrasonography and computerized tomography showed a lesion in the head of the pancreas and large lymph mass. Magnetic resonance imaging (MRI) of inferior vena cava (IVC) showed thrombosis in the IVC. Histological examination revealed necrotizing granulomas after a laparotomy. The patient received antituberculosis chemotherapy and low molecular weight heparin. Conclusion Tuberculosis could never stop from amazing us and we should always put it in the deferential.
{"title":"Pediatric Pancreatic Lymphadenitis Tuberculosis Causing IVC Thrombosis in Syria: A Case Report","authors":"M. K. Albuni, Ruba Zuhri Yafi, B. Sabbagh, M. Moubarak, Lina Khouri","doi":"10.36648/1590-8577.21.22.108-110","DOIUrl":"https://doi.org/10.36648/1590-8577.21.22.108-110","url":null,"abstract":"Background Pancreatic tuberculosis is very rare, mostly due to the antibacterial effects of the pancreatic enzymes. The association of thrombosis and Tb has been reported but that of inferior vena cava thrombosis and pancreatic Tb is extremely rare and has only been reported once. Case presentation a case of pancreatic Tuberculosis and IVC thrombosis presented with constitutional symptoms. Ultrasonography and computerized tomography showed a lesion in the head of the pancreas and large lymph mass. Magnetic resonance imaging (MRI) of inferior vena cava (IVC) showed thrombosis in the IVC. Histological examination revealed necrotizing granulomas after a laparotomy. The patient received antituberculosis chemotherapy and low molecular weight heparin. Conclusion Tuberculosis could never stop from amazing us and we should always put it in the deferential.","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"28 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69688509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.36648/1590-8577.21.22.83-86
Ebral Yiğit
Aim In the treatment of acute biliary pancreatitis (ABP), a cholecystectomy is used to prevent acute pancreatitis recurrences. In this study, we aimed to compare the results of early and late-stage LC in patients hospitalized in our clinic with an ABP diagnosis. Material and Methods The patient group was comprised of 35 females (77.8%) and 10 males (22.2%). The 22 patients who underwent LC after ABP treatment were in Group 1, while the patients who were given a two-month interval after the ABP treatment and then underwent LC were in Group 2. Results The average age of the patients was 56 (range: 26–93) years. The average hospital stay was 13.18 days in Group 1 and 8.3 days in Group 2. The mean duration of LC was 57.8 minutes in Group 1 and 45.7 minutes in Group 2 (p < 0.01). The conversion to a conventional cholecystectomy was performed in three (13.6%) patients in Group 1 and two (8.7%) in Group 2. Postoperative complications were seen in four (18.1%) patients in Group 1 and four (17.4%) patients in Group 2. Acute pancreatitis was seen again in one (4.5%) patient in Group 1 and two (8.7%) patients in Group 2. Conclusion In this study, we showed that cholecystectomy surgery can be performed safely after the ABP picture regresses.
目的在急性胆源性胰腺炎(ABP)的治疗中，采用胆囊切除术预防急性胰腺炎复发。在这项研究中，我们的目的是比较在我们诊所就诊的ABP诊断患者的早期和晚期LC的结果。材料与方法患者组女性35例(77.8%)，男性10例(22.2%)。22例ABP治疗后行LC的患者为1组，ABP治疗后间隔2个月再行LC的患者为2组。结果患者平均年龄56岁(26 ~ 93岁)。组1平均住院时间13.18天，组2平均住院时间8.3天。LC的平均持续时间1组为57.8 min, 2组为45.7 min (p < 0.01)。1组3例(13.6%)患者转行常规胆囊切除术，2组2例(8.7%)患者转行常规胆囊切除术。术后并发症1组4例(18.1%)，2组4例(17.4%)。1组1例(4.5%)，2组2例(8.7%)再次出现急性胰腺炎。结论在本研究中，我们发现在ABP图像恢复后，可以安全地进行胆囊切除术。
{"title":"A Comparison of Results from Early and Late Laparoscopic Cholestectomies in Acute Biliary Pancreatitis Treatment","authors":"Ebral Yiğit","doi":"10.36648/1590-8577.21.22.83-86","DOIUrl":"https://doi.org/10.36648/1590-8577.21.22.83-86","url":null,"abstract":"Aim In the treatment of acute biliary pancreatitis (ABP), a cholecystectomy is used to prevent acute pancreatitis recurrences. In this study, we aimed to compare the results of early and late-stage LC in patients hospitalized in our clinic with an ABP diagnosis. Material and Methods The patient group was comprised of 35 females (77.8%) and 10 males (22.2%). The 22 patients who underwent LC after ABP treatment were in Group 1, while the patients who were given a two-month interval after the ABP treatment and then underwent LC were in Group 2. Results The average age of the patients was 56 (range: 26–93) years. The average hospital stay was 13.18 days in Group 1 and 8.3 days in Group 2. The mean duration of LC was 57.8 minutes in Group 1 and 45.7 minutes in Group 2 (p < 0.01). The conversion to a conventional cholecystectomy was performed in three (13.6%) patients in Group 1 and two (8.7%) in Group 2. Postoperative complications were seen in four (18.1%) patients in Group 1 and four (17.4%) patients in Group 2. Acute pancreatitis was seen again in one (4.5%) patient in Group 1 and two (8.7%) patients in Group 2. Conclusion In this study, we showed that cholecystectomy surgery can be performed safely after the ABP picture regresses.","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"22 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69688895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.36648/1590-8577.22.1.11-20
J. Khan, Suryati Mokhtar, K. Raman, Harjit Singh, Leow Voon Meng, M. Subramaniam
Objective To identify trends in management and analyse outcomes of patients undergoing interventions for infected pancreatic necrosis with specific reference to factors predictive of mortality. Method A cross sectional study of patients undergoing intervention for IPN between 2009-2018 were performed at two of the largest hepatopancreatobiliary centres in Malaysia. Final outcome measure of complete resolution was compared against mortality (D). Head to head comparison of percutaneous catheter drainage alone versus Videoscopic Assisted Retroperitoneal Debridement was performed based on final predictive factor on mortality. Results A total number of 65 patients with IPN were identified. Data from 59/65 patients were analysed for final outcome of death (D) versus complete resolution. 6 patients were omitted due to incomplete data precluding proper analysis. Overall mortality rate was 25% (15/59 patients). 8 patients had no interventions performed but were included in the analysis. Percutaneous catheter drainage alone and Videoscopic Assisted Retroperitoneal Debridement were the 2 commonest interventions performed (34/55). Multivariable analysis predictive of mortality included persistent organ failure requiring intensive care unit (ICU) admission (OR= 336.425, CI 95% =3.722-999.999 p value= 0.0113) and when PCD alone was employed compared to VARD (OR = 48.923, CI 95% = 1.888-999.999, p-value = 0.019). Conclusion Our present study shows that both persistent organ failure requiring ICU admission and Percutaneous Catheter Drainage alone when compared to a minimally invasive step up approach (in the form of Video assisted Retroperitoneal Debridement) are predictive factors of mortality in patients undergoing intervention for IPN. A step up approach is necessary to prevent mortality in patients with infected pancreatic necrosis requiring intervention while PCD without debridement results in significant mortality.
目的探讨感染性胰腺坏死患者的治疗趋势，并分析其预后，具体参考预测死亡率的因素。方法在马来西亚两家最大的肝胆管中心对2009-2018年期间接受IPN干预的患者进行横断面研究。最终结局指标完全消退与死亡率进行比较(D)。根据死亡率的最终预测因素，对单独经皮导管引流与腹腔镜辅助腹膜后清创进行头对头比较。结果共确诊IPN患者65例。对59/65例患者的最终死亡结局(D)和完全缓解的数据进行分析。6例患者因资料不完整，无法进行适当的分析而被忽略。总死亡率为25%(15/59)。8例患者未进行干预，但被纳入分析。单独经皮导管引流和腹腔镜辅助腹膜后清创是两种最常见的干预措施(34/55)。多变量分析预测死亡率包括需要入住重症监护病房(ICU)的持续性器官衰竭(OR= 336.425, CI 95% =3.722-999.999 p值= 0.0113)和单独使用PCD与VARD比较(OR= 48.923, CI 95% = 1.888-999.999, p值= 0.019)。结论:我们目前的研究表明，与微创强化方法(以视频辅助腹膜后清创的形式)相比，需要ICU住院的持续性器官衰竭和单独经皮导管引流都是接受IPN干预患者死亡率的预测因素。对于需要干预的感染性胰腺坏死患者，有必要采取进一步的措施来预防死亡，而不进行清创的PCD会导致显著的死亡率。
{"title":"A Ten Year Cross Sectional Multicentre Study of Infected Pancreatic Necrosis, Trends in Management and an Analysis of Factors Predicting Mortality for Interventions in Infected Pancreatic Necrosis","authors":"J. Khan, Suryati Mokhtar, K. Raman, Harjit Singh, Leow Voon Meng, M. Subramaniam","doi":"10.36648/1590-8577.22.1.11-20","DOIUrl":"https://doi.org/10.36648/1590-8577.22.1.11-20","url":null,"abstract":"Objective To identify trends in management and analyse outcomes of patients undergoing interventions for infected pancreatic necrosis with specific reference to factors predictive of mortality. Method A cross sectional study of patients undergoing intervention for IPN between 2009-2018 were performed at two of the largest hepatopancreatobiliary centres in Malaysia. Final outcome measure of complete resolution was compared against mortality (D). Head to head comparison of percutaneous catheter drainage alone versus Videoscopic Assisted Retroperitoneal Debridement was performed based on final predictive factor on mortality. Results A total number of 65 patients with IPN were identified. Data from 59/65 patients were analysed for final outcome of death (D) versus complete resolution. 6 patients were omitted due to incomplete data precluding proper analysis. Overall mortality rate was 25% (15/59 patients). 8 patients had no interventions performed but were included in the analysis. Percutaneous catheter drainage alone and Videoscopic Assisted Retroperitoneal Debridement were the 2 commonest interventions performed (34/55). Multivariable analysis predictive of mortality included persistent organ failure requiring intensive care unit (ICU) admission (OR= 336.425, CI 95% =3.722-999.999 p value= 0.0113) and when PCD alone was employed compared to VARD (OR = 48.923, CI 95% = 1.888-999.999, p-value = 0.019). Conclusion Our present study shows that both persistent organ failure requiring ICU admission and Percutaneous Catheter Drainage alone when compared to a minimally invasive step up approach (in the form of Video assisted Retroperitoneal Debridement) are predictive factors of mortality in patients undergoing intervention for IPN. A step up approach is necessary to prevent mortality in patients with infected pancreatic necrosis requiring intervention while PCD without debridement results in significant mortality.","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"11 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69689411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.36648/1590-8577.21.S5.17-18
Jianjun Han
{"title":"Early Detection of Pancreatic Cancer in Patient","authors":"Jianjun Han","doi":"10.36648/1590-8577.21.S5.17-18","DOIUrl":"https://doi.org/10.36648/1590-8577.21.S5.17-18","url":null,"abstract":"","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69689746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.36648/1590-8577.22.3.63-69
Venu Bhargava, Pawan Kumar, T. Yadav, S. Sinha, Kochhar, Vikas Gupta
Introduction Postoperative pancreatic fistula is a dreaded complication following pancreatic head resections. There are many variables which predict occurrence of pancreatic fistula we analysed the anatomical factors at the pancreatic transection to predict occurrence of pancreatic fistula. Materials and Methods It is a prospective observational study done from 2014 July to 2015 December. Eighty patients were included, intraoperatively we measured the anteroposterior thickness, cranio caudal thickness and thickness anterior, posterior, cranial and caudal to duct. We correlated these anatomical factors with postoperative complications. Results POPF was seen in 19 patients (23.75%) of which clinically significant fistula was seen in 5 patients (6.25%) and biochemical fistula is seen in 14 patients (17.5%). As the parenchymal thickness cranial to duct increased the chance of POPF increased (mean ± SD-15.26 ± 3.03 mm, p=0.014). As the thickness anterior to duct increases (7.18 ± 1.50 mm, p=0.023) and mean thickness posterior to duct decreases (5.34 ± 3.32 mm, p=0.036) chance of POPF increased. Clinically relevant fistula was significantly seen to be related with thickness anterior to duct, at a thickness >6.5 mm sensitivity of occurrence of fistula 68.4% and specificity was 74%. Conclusions At the transaction point when the thickness anterior to duct increases chances of clinically relevant fistula increases. As the thickness anterior to duct increases duct would be positioned more posteriorly creating difficulty while placing sutures.
胰瘘是胰头切除术后最可怕的并发症。预测胰瘘发生的变量很多，我们分析了胰腺横断处的解剖学因素来预测胰瘘的发生。材料与方法前瞻性观察研究于2014年7月至2015年12月完成。纳入80例患者，术中我们测量了前后壁厚度、颅尾厚度以及前、后、颅和尾侧导管厚度。我们将这些解剖学因素与术后并发症联系起来。结果19例(23.75%)患者出现POPF, 5例(6.25%)患者出现有临床意义的瘘管，14例(17.5%)患者出现生化性瘘管。随着脑实质厚度的增加，脑导管发生POPF的几率增加(平均±SD-15.26±3.03 mm, p=0.014)。随着导管前壁厚度的增加(7.18±1.50 mm, p=0.023)和导管后壁平均厚度的减少(5.34±3.32 mm, p=0.036)，发生POPF的机会增加。临床相关性瘘与导管前壁厚度显著相关，厚度为>6.5 mm时，瘘发生的敏感性为68.4%，特异性为74%。结论在导管前壁厚度增加的交易点，临床相关瘘的发生几率增加。随着导管前部厚度的增加，导管的位置会更靠后，这给缝合带来了困难。
{"title":"Anatomy at Pancreatic Transection Point in Predicts Occurrence of Postoperative Pancreatic Fistula","authors":"Venu Bhargava, Pawan Kumar, T. Yadav, S. Sinha, Kochhar, Vikas Gupta","doi":"10.36648/1590-8577.22.3.63-69","DOIUrl":"https://doi.org/10.36648/1590-8577.22.3.63-69","url":null,"abstract":"Introduction Postoperative pancreatic fistula is a dreaded complication following pancreatic head resections. There are many variables which predict occurrence of pancreatic fistula we analysed the anatomical factors at the pancreatic transection to predict occurrence of pancreatic fistula. Materials and Methods It is a prospective observational study done from 2014 July to 2015 December. Eighty patients were included, intraoperatively we measured the anteroposterior thickness, cranio caudal thickness and thickness anterior, posterior, cranial and caudal to duct. We correlated these anatomical factors with postoperative complications. Results POPF was seen in 19 patients (23.75%) of which clinically significant fistula was seen in 5 patients (6.25%) and biochemical fistula is seen in 14 patients (17.5%). As the parenchymal thickness cranial to duct increased the chance of POPF increased (mean ± SD-15.26 ± 3.03 mm, p=0.014). As the thickness anterior to duct increases (7.18 ± 1.50 mm, p=0.023) and mean thickness posterior to duct decreases (5.34 ± 3.32 mm, p=0.036) chance of POPF increased. Clinically relevant fistula was significantly seen to be related with thickness anterior to duct, at a thickness >6.5 mm sensitivity of occurrence of fistula 68.4% and specificity was 74%. Conclusions At the transaction point when the thickness anterior to duct increases chances of clinically relevant fistula increases. As the thickness anterior to duct increases duct would be positioned more posteriorly creating difficulty while placing sutures.","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"22 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69690247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.36648/1590-8577.22.1.1-10
Manami Ikemune, K. Uchida, M. Yanagawa, S. Tsukuda, T. Tomiyama, Toshihiro Tanaka, Y. Ando, T. Ikeura, Takashi Yamaguchi, T. Fukui, A. Nishio, K. Okazaki
Introduction Type 1 autoimmune pancreatitis is a chronic fibro-inflammatory disorder. We previously reported the involvement of M2 macrophages and basophils in autoimmune pancreatitis. It is reported that Group 2 innate lymphoid cells (ILC2s) and basophils play an important role in asthma. Thus, this study investigated the roles of innate lymphoid cells in autoimmune pancreatitis. Subjects and methods We recruited 28 patients with autoimmune pancreatitis (25 men and 3 women; mean age, 68.4 years) who were not receiving steroid therapy, 10 patients with chronic pancreatitis (CP; 2 women and 3 men with idiopathic CP and 5 men with alcoholic CP; mean age, 65.9 years), and 30 healthy controls (HCs; 5 women and 25 men; mean age, 66.9 years). Peripheral ILCs were analyzed using flow cytometry. We also analyzed two types of ILC2s (lineage− CD127+ CD161+ c-Kit+/− CRTH2+ and lineage− CD25+ IL-33R+ cells). Results The proportions of ILC2s and ILC3s were significantly higher in the autoimmune pancreatitis (0.140% ± 0.083% and 0.055% ± 0.043%, respectively) and CP groups (0.119% ± 0.055% and 0.051% ± 0.040%, respectively) than in the HC group (0.054% ± 0.039% and 0.018% ± 0.017%, respectively). The proportion of ILC1s did not differ among three groups. There was no significant correlation between the counts of the two ILC2 types. Conclusion Elevated ILC2 and ILC3 counts may be involved in the development of chronic pancreatic inflammation.
{"title":"Possible Involvement of Innate Lymphoid Cells in the Development of Chronic Inflammatory Pancreatic Diseases","authors":"Manami Ikemune, K. Uchida, M. Yanagawa, S. Tsukuda, T. Tomiyama, Toshihiro Tanaka, Y. Ando, T. Ikeura, Takashi Yamaguchi, T. Fukui, A. Nishio, K. Okazaki","doi":"10.36648/1590-8577.22.1.1-10","DOIUrl":"https://doi.org/10.36648/1590-8577.22.1.1-10","url":null,"abstract":"Introduction Type 1 autoimmune pancreatitis is a chronic fibro-inflammatory disorder. We previously reported the involvement of M2 macrophages and basophils in autoimmune pancreatitis. It is reported that Group 2 innate lymphoid cells (ILC2s) and basophils play an important role in asthma. Thus, this study investigated the roles of innate lymphoid cells in autoimmune pancreatitis. Subjects and methods We recruited 28 patients with autoimmune pancreatitis (25 men and 3 women; mean age, 68.4 years) who were not receiving steroid therapy, 10 patients with chronic pancreatitis (CP; 2 women and 3 men with idiopathic CP and 5 men with alcoholic CP; mean age, 65.9 years), and 30 healthy controls (HCs; 5 women and 25 men; mean age, 66.9 years). Peripheral ILCs were analyzed using flow cytometry. We also analyzed two types of ILC2s (lineage− CD127+ CD161+ c-Kit+/− CRTH2+ and lineage− CD25+ IL-33R+ cells). Results The proportions of ILC2s and ILC3s were significantly higher in the autoimmune pancreatitis (0.140% ± 0.083% and 0.055% ± 0.043%, respectively) and CP groups (0.119% ± 0.055% and 0.051% ± 0.040%, respectively) than in the HC group (0.054% ± 0.039% and 0.018% ± 0.017%, respectively). The proportion of ILC1s did not differ among three groups. There was no significant correlation between the counts of the two ILC2 types. Conclusion Elevated ILC2 and ILC3 counts may be involved in the development of chronic pancreatic inflammation.","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"17 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69689759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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