EASL-EORTC clinical practice guidelines : management of hepatocellular carcinoma

Background and objective The Atlanta classification of acute pancreatitis enabled standardised reporting of research and aided communication between clinicians. Deficiencies identified and improved understanding of the disease make a revision necessary. Methods A web-based consultation was undertaken in 2007 to ensure wide participation of pancreatologists. After an initial meeting, the Working Group sent a draft document to 11 national and international pancreatic associations. This working draft was forwarded to all members. Revisions were made in response to comments, and the web-based consultation was repeated three times. The final consensus was reviewed, and only statements based on published evidence were retained. Results The revised classification of acute pancreatitis identified two phases of the disease: early and late. Severity is classified as mild, moderate or severe. Mild acute pancreatitis, the most common form, has no organ failure, local or systemic complications and usually resolves in the first week. Moderately severe acute pancreatitis is defined by the presence of transient organ failure, local complications or exacerbation of co-morbid disease. Severe acute pancreatitis is defined by persistent organ failure, that is, organ failure >48 h. Local complications are peripancreatic fluid collections, pancreatic and peripancreatic necrosis (sterile or infected), pseudocyst and walled-off necrosis (sterile or infected). We present a standardised template for reporting CT images. Conclusions This international, web-based consensus provides clear definitions to classify acute pancreatitis using easily identified clinical and radiologic criteria. The wide consultation among pancreatologists to reach this consensus should encourage widespread adoption.

/pdf/classification-of-acute-pancreatitis-2012-revision-of-the-608d2rjeud.pdf

Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus

background The effect of adjuvant treatment on survival in pancreatic cancer is unclear. We report the final results of the European Study Group for Pancreatic Cancer 1 Trial and update the interim results. methods In a multicenter trial using a two-by-two factorial design, we randomly assigned 73 patients with resected pancreatic ductal adenocarcinoma to treatment with chemoradiotherapy alone (20 Gy over a two-week period plus fluorouracil), 75 patients to chemotherapy alone (fluorouracil), 72 patients to both chemoradiotherapy and chemotherapy, and 69 patients to observation. results The analysis was based on 237 deaths among the 289 patients (82 percent) and a median follow-up of 47 months (interquartile range, 33 to 62). The estimated five-year survival rate was 10 percent among patients assigned to receive chemoradiotherapy and 20 percent among patients who did not receive chemoradiotherapy (P=0.05). The five-year survival rate was 21 percent among patients who received chemotherapy and 8 percent among patients who did not receive chemotherapy (P=0.009). The benefit of chemotherapy persisted after adjustment for major prognostic factors. conclusions Adjuvant chemotherapy has a significant survival benefit in patients with resected pancreatic cancer, whereas adjuvant chemoradiotherapy has a deleterious effect on survival.

https://pancreaticcanceraction.org/wp-content/uploads/2010/09/ESPAC1.pdf

A Randomized Trial of Chemoradiotherapy and Chemotherapy after Resection of Pancreatic Cancer

https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.1002/hep.29913

Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases

/pdf/nccn-clinical-practice-guidelines-in-oncology-hepatobiliary-1kpacqqvi8.pdf

NCCN clinical practice guidelines in oncology: hepatobiliary cancers.

JPN guidelines 2010. Foreword

Purpose: This study was designed to clarify the change of the cytokine levels in acute pancreatitis (AP), and investigate the concern over the cytokine storm in AP with its course of inflammatory attack, as well as the effect of continuous arterial infusion therapy (CAI). Subjects and methods: Twenty-seven patients with AP were subjected during latest 3 years. The serum cytokines were determined before and after the treatment. Results: (1) In all subjects, high levels pro-inflammatory cytokines (IL-6, IL-8) were observed at the day of admission. However, after receiving the intensive treatments, IL-6, IL-8 levels tended to decline. (2) According to the severity of AP, the levels of IL-6 and IL-8 in severe cases were significantly higher than those in moderate and mild cases. (3) In five severe cases with infections, renewed rising of serum IL-6 was observed. (4) Abnormally heightened IL-10 (anti-inflammatory cytokine) was observed in complicated cases with infections. (5) The serum IL-6 was decreased immediately in severe cases after CAI, more rapidly than those without CAI. Conclusions: High levels of cytokines resumed in most cases of AP; when inflammation occurred, cytokine storm was suddenly observed. These molecules appear to be valuable markers of severity and effects of CAI.

Cytokine storm in acute pancreatitis: influence of inflammatory attack and arterial infusion therapy

Incomplete torsion of the gallbladder due to wandering gallbladder (Gross A) was diagnosed preoperatively in a 32-year-old male patient by means of ultrasonography and ERCP. Deviation of the gallbladder and an improvement in symptoms obtained by repositioning were achieved. This case is thought to be the first report of incomplete torsion of the gallbladder diagnosed preoperatively in Japan.

https://www.jstage.jst.go.jp/article/ringe1963/47/5/47_5_680/_pdf

Incomplete torsion of the gallbladder -report of a case diagnosed prior to operation-

エビデンスに基づいた急性膵炎の診療ガイドライン(案)の紹介

We, the editors of surgery journals, believe that conducting sex-inclusive biomedical and clinical research is imperative to improving health outcomes of men and women. Note that the word “sex” is being used rather than “gender.” Sex is the genotype by which one is born and gender is the phenotype. It is the chromosomal sex of the human, animal, tissue, or cell to which we are referring. Recent studies have shown that the majority of biomedical research in the field of surgery and related topics is conducted on male animals and male cells, even when studying diseases prevalent in women [1]. Human clinical research suffers from a lack of sex-based reporting and sex-based analysis of the results [2, 3]. Given these findings, the National Institutes of Health has now asked that sex be considered as a biologic variable in all National Institutes of Health-funded research [4]. As such, we support uniform, defined reporting of the sex used for human, animal, tissue, and cell research in ALL manuscripts published in our journals. If only one sex is studied, authors must include a justification statement as to why a single-sex study was conducted. We also will require sex-based reporting and analysis of data for all human, animal, tissue, and cell research. As a group, we will require this among all our collective surgery journals.

Tadahiro Takada

Papers

JPN guidelines 2010. Foreword

Cytokine storm in acute pancreatitis: influence of inflammatory attack and arterial infusion therapy

Incomplete torsion of the gallbladder -report of a case diagnosed prior to operation-

エビデンスに基づいた急性膵炎の診療ガイドライン(案)の紹介

Joint statement by the Surgery Journal Editors Group