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 for the management of acute pancreatitis: characteristics, basic findings and effects

The most important factor in improving the survival rates of the patients with breast cancer is early detection. A high cure rate can be expected if the condition is discovered in early stage. There were 195 patients with primary breast cancer in our hospital from August 1978 to November 1986. Among 280 patients with breast cancer who received radical operations from July 1970 to November 1986, there were 50 patients (18%) with recurrence. Mammography and echography were effective for the diagnosis of infiltrating cancer smaller than 10mm in diameter as well as those between 11 and 20mm in diameter. None of the patients with non-infiltrating or infiltrating carcinomas smaller than 15 mm or smaller than 20 mm in diameter with negative nodes had recurrence. Consequently, at present we define early breast cancer as the lesions of pathologically noninfiltrating or infiltrating smaller than 15 mm in diameter, or infiltrating smaller than 20 mm in diameter with negative nodes.

A study on the definition of early breast cancer

Primaly mucosal carcinoma of the duodenal bulb. Report of a case.

Use of ultrasonography in the evaluation of acute appendicitis

目的:乳 頭機 能 は正常 と考 え られ なが ら胆管 拡張 を み る症例 を経験 す る事 があ り,い か な る因子が 関与 す るのか興 味 ある ところであ る.し か し,実 験的 に慢 性 の拡 張 胆 管 作製 は困 難 と され,下 部 胆 管 の 不 完 全 狭 窄1)や乳頭不 全2)に よる方法 が とられ て きた.わ れ われ は 胃癌根 治手術 時 に胆管 周 囲を剥 離す る と拡張 が起 こ る ことに注 目し,肝 外胆 管 を周 囲組織 よ り遊離 し乳頭 を温 存 した拡張 胆管 を 作製 した. 材 料 お よび方 法:15~20kgの 雑種 成 犬15頭 を 全 身 麻酔 下 にて開 腹,胆 嚢 管を結 紮 し胆道 内圧 測定,胆 道 造影 を行 った後,肝 外 胆管 を肝 門部 よ り十 二指 腸上 縁 まで周 囲組織 か ら完 全 に遊離 させ た.4週 後 に同一 条 件下 で再 開腹 し,胆 道 内圧 測定,胆 道造影 を行 い剖検 した.胆 道 内圧測 定 は0.2,0.4,0.6,0.8,1.6ml/min の5段 階 の定 流灌 流法 に て行 った. 成 績:胆 管 造影 に よ る内 径の 変化 は初 回手術 時 に上 部1.50±0.68mm,中 部2.07±0.94mm,下 部2.40± 1.17mm,最 大径部2.73±1.00mmで あ った の に対 し,

Tadahiro Takada

Papers

Jpn guidelines for the management of acute pancreatitis: characteristics, basic findings and effects

A study on the definition of early breast cancer

Primaly mucosal carcinoma of the duodenal bulb. Report of a case.

Use of ultrasonography in the evaluation of acute appendicitis

Experimental canine bile duct stripping as a model of biliary dilatation with preservation of papillary function