Showing papers in "Pancreas in 2006"
TL;DR: The incidence of acute pancreatitis seems to be increasing, and the case fatality rate has decreased over time, but the overall population mortality rate per 100,000 has remained unchanged.
Abstract: Objective:To systematically review trends in the epidemiology of the first attack of acute pancreatitis (AP) based on reported population-based studies.Methods:From Medline, we retrieved 18 full-length English language peer-reviewed original articles published from 1966 to June 2005 with population-
620 citations
TL;DR: The incidence rate of acute pancreatitis rose for the period between 1994 and 2001, however, there was no reduction in the 14- or 91-day case-fatality rate; and in a risk-adjusted model, patients with alcoholic pancreatitis had the highest risk of dying.
Abstract: Objective To better define the epidemiology of acute pancreatitis in a racially diverse population. Methods Analysis of all patients hospitalized in California with first-time acute pancreatitis for the period between January 1994 and September 2001. Subtypes were classified based on the presence or absence of predisposing conditions. Results There were 70,231 patients hospitalized for first-time acute pancreatitis; 32.6% had biliary tract disease alone, 20.3% had alcohol abuse alone, and 36.6% were idiopathic. The age-standardized incidence increased by 32% from 33.2 to 43.8 cases per 100,000 adults for the period between 1994 and 2001, with the largest increase in the biliary group (52%). The standardized incidence rate of alcoholic and idiopathic pancreatitis was highest in African Americans, whereas biliary pancreatitis was highest in Hispanics. There was no change over time in the percentage of patients dying in the first 14 or 91 days; and in a risk-adjusted model, patients with alcoholic pancreatitis had the highest risk of dying. Conclusions The incidence rate of acute pancreatitis rose for the period between 1994 and 2001. However, there was no reduction in the 14- or 91-day case-fatality rate. Further research is needed to explain both the rise in the incidence rate of pancreatitis and the absence of any improvement in the early case-fatality rate.
291 citations
TL;DR: The survival of patients with pancreatic cancer depends mainly on tumor stage, but it is also affected by the number of circulating lymphocytes, suggesting that the immune system plays an important role in pancreatic adenocarcinoma immunosurveillance and immunoediting.
Abstract: Objectives:An impaired host immunity might concur in determining the dismal prognosis of patients with pancreatic cancer (PC). Our aim was to ascertain whether the immunophenotype pattern of blood lymphocytes in PC correlates with tumor stage, grade, or survival.Methods:We studied 115 patients with
238 citations
TL;DR: Malignant SPTs are low-grade tumors with good prognosis, but especially, SPTs over 5 cm in diameter need to be treated carefully because of the chance of malignant pathology.
Abstract: Objectives:It has been suggested that the histopathologic features associated with malignant potential in solid pseudopapillary tumors (SPTs) of the pancreas include cellular polymorphism, mitotic activity, peripancreatic tissue invasion, neural invasion, lymphovascular invasion, and lymph node meta
166 citations
TL;DR: Active surgical resection should be attempted even in patients with poor prognostic factors, as typical ductal adenocarcinoma of the pancreas might have a poorer survival rate.
Abstract: Objectives:The purpose of this study was to determine the outcome of surgical resection for pancreatic cancer and to characterize the clinicopathologic features of actual long-term survivorsMethods:Of the 789 pancreatic cancer patients, we retrospectively analyzed 242 patients who underwent an oper
165 citations
TL;DR: To the Editor: autoimmune pancreatitis is a recently recognized disorder and a new clinical entity associated with the irregular narrowing of the pancreatic duct and the enlargement of the entire pancreas.
Abstract: To the Editor:Autoimmune pancreatitis (AIP) is a recently recognized disorder and a new clinical entity associated with the irregular narrowing of the pancreatic duct and the enlargement of the entire pancreas.1 AIP is often associated with sclerosing cholangitis (SC). SC with AIP and primary sclero
161 citations
TL;DR: Findings suggest that PSTI may be related to the pathogenesis of AIP, and autoantibodies against PSTI can be a useful diagnostic marker for the disease.
Abstract: Objectives: Although autoimmune pancreatitis (AIP) has been recently recognized as a new disease entity of chronic pancreatitis, the clinical diagnosis of the disease remains disputed. Autoantibodies against carbonic anhydrase II and lactoferrin are detected in most patients with AIP, but not in about 10%. We undertook this study to determine whether additional autoantibodies are present in the serum level of AIP patients. Methods: We recruited 26 patients with AIP for the study. For comparison, we also recruited 53 patients with various pancreatic diseases and 12 healthy subjects. We immunoscreened human pancreatic cDNA library using patients' sera. Positive clones were analyzed by DNA sequencing and were constructed into a pGEX-4T-1 expression vector. The recombinant proteins were used as antigens in enzyme-linked immunosorbent assay to screen the subjects' sera for autoantibodies. Results: We cloned a cDNA encoding the pancreatic secretory trypsin inhibitor (PSTI). Among 26 patients with AIP, autoantibodies against PSTI were significantly positive in 11 (42.3%) by western blotting and in 8 (30.8%) by enzyme-linked immunosorbent assay, respectively. However, none of control subjects was positive for anti-PSTI antibodies. Conclusions: These findings suggest that PSTI may be related to the pathogenesis of AIP, and autoantibodies against PSTI can be a useful diagnostic marker for the disease.
150 citations
TL;DR: Serum HMGB1 levels were significantly increased in patients with SAP and were correlated with disease severity, suggesting thatHMGB1 may act as a key mediator for inflammation and organ failure in SAP.
Abstract: Objective:Multiple organ failure because of systemic inflammatory response in the early phase and sepsis in the late phase is the main contributor to high mortality in severe acute pancreatitis (SAP). High-mobility group box chromosomal protein 1 (HMGB1) was recently identified as a potent proinflam
147 citations
TL;DR: Autoimmune pancreatitis exhibits a high serum circulating immune complex values in its active state, which links to a complement activation system with a classic pathway rather than the mannose-binding lectin pathway or alternative pathways.
Abstract: Objectives Autoimmune pancreatitis is characterized by increased serum level of IgG4, but its pathogenesis has not been fully elucidated. Because this disease is occasionally associated with decreased levels of complements, we sought to clarify which complement activation system was operating in its active state. Methods We measured serum levels of complements, mannose-binding lectin, and circulating immune complex in patients with autoimmune pancreatitis, patients with chronic pancreatitis, and healthy controls. Results We found high serum circulating immune complex values, which decreased significantly after corticosteroid therapy. In patients with autoimmune pancreatitis, elevated levels of circulating immune complex, as determined by C1q assay, were significantly associated with increased serum levels of IgG1 and decreased levels of C4, as well as with a tendency toward decreased levels of C3. There were no significant differences in the serum levels of mannose-binding lectin or in the frequency of a mutant allele of mannose-binding lectin between patients with autoimmune pancreatitis and those with chronic calcifying pancreatitis. Furthermore, corticosteroid therapy had no effect on the level of mannose-binding lectin. Conclusions Autoimmune pancreatitis exhibits a high serum circulating immune complex values in its active state, which links to a complement activation system with a classic pathway rather than the mannose-binding lectin pathway or alternative pathways.
146 citations
TL;DR: Translational research combined with clinical trials will hopefully lead to improved survival and better quality of life for pancreatic cancer patients in the future.
Abstract: :Pancreatic ductal adenocarcinoma is one of the most aggressive human malignancies, with an overall 5-year survival rate of less than 4%. On the molecular level, an increasing number of genetic and epigenetic alterations have been discovered, with a particular focus on growth factors and rel
129 citations
TL;DR: Findings indicated that steroid therapy has a beneficial effect on the clinical courses of DM in approximately half of AIP patients, however, it also has negative effect on glucose tolerance in some patients, particularly older patients, and thus, careful observation for involvement of DM should be required in A IP patients treated with steroids.
Abstract: Objective:The aim of this study was to estimate the number of autoimmune pancreatitis (AIP) patients in Japan and evaluate the influence of steroid therapy on the course of diabetes mellitus (DM) in AIP.Methods:A total of 2972 departments were randomly selected with hospital stratification throughou
TL;DR: In this paper, the authors performed histopathologic and immunohistochemical analyses of gastric transcription factor SOX2 and gastric mucin MUC5AC to better understand the stepwise progression of pancreatic carcinoma.
Abstract: Objectives:The purpose of this study was to perform histopathologic and immunohistochemical analyses of gastric transcription factor SOX2 and gastric mucin MUC5AC to better understand the stepwise progression of pancreatic carcinoma.Methods:Twenty-eight representative sections from 14 surgically res
TL;DR: Lymph node ratio seems to be a new promising prognostic factor in patients with respectable node-positive pancreatic head cancer, and significantly correlated with a poorer survival.
Abstract: OBJECTIVES The aim of this study was to evaluate the prognostic value of nodal involvement in resected adenocarcinoma of the pancreatic head. METHODS For the period between 1980 and 2002, 96 patients underwent pancreaticoduodenectomy for pancreatic cancer. Lymph nodes were numbered and classified into groups according to the Japan Pancreatic Society rules. Metastatic lymph nodes were identified based on hematoxylin and eosin staining. RESULTS Sixty-four (66.7%) patients had positive lymph nodes. The median number of metastatic nodes was 2 (95% confidence interval [CI], 1.0-3.0) and the median ratio of metastatic/resected nodes was 9.7% (95% CI, 7.1%-14.4%). The median survival was 14.2 months (95% CI, 10.7-17.7) and was significantly higher for node-negative than node-positive patients (27.9; 95% CI, 20.9-34.9 vs. 10.6; 95% CI, 8.7-12.5; P < 0.001). The Cox proportional hazards model, including all patients, demonstrated that nodal involvement (hazard ratio [HR], 1.461; 95% CI, 1.177-12.024), moderate or poor tumor differentiation (HR, 2.330; 95% CI, 1.181-6.949), and positive resection margins (HR, 3.838; 95% CI, 1.390-10.597) were independent negative prognostic factors. If the analysis was limited to node-positive patients, lymph node ratio of more than 20% (HR, 1.364; 95% CI, 1.116-2.599), moderate or poor tumor differentiation (HR, 3.393; 95% CI, 1.041-11.061), and positive resection margins (HR, 9.400; 95% CI, 2.235-39.536) significantly correlated with a poorer survival. CONCLUSIONS Lymph node ratio seems to be a new promising prognostic factor in patients with respectable node-positive pancreatic head cancer.
TL;DR: For the long-term survival of patients with pancreatic ductal adenocarcinoma, complete excision is the most important therapeutic option, and adjuvant therapy is a significant contributing factor.
Abstract: OBJECTIVES We reviewed the pancreatectomies that were done for pancreatic ductal adenocarcinoma to evaluate patient survival and prognostic predictors. METHODS A review was performed on 94 patients who underwent surgical resection for pancreatic ductal adenocarcinomas from 1995 to 2002. The perioperative factors were compared between the proximal and distal lesions by the chi2 test and t test. Possible predictors for survival were examined for by univariate and multivariate analysis. RESULTS The 5-year survival was 16%. The proximal lesions had a smaller tumor size (3.0 +/- 0.11 vs. 3.9 +/- 0.33 cm, respectively; P = 0.03), a higher incidence of nodal involvement (60.6% vs. 34.8%, respectively; P = 0.031), and poorer histologic differentiation (25.4% vs. 13.0%, respectively; P = 0.01) compared with the distal lesions, and both types of lesions had similar rates of intraoperative transfusion, complete resection, and survival. The factors shown to have favorable independent prognostic significance were negative resection margins (hazard ratio [HR] = 0.23; 95% confidence interval [CI] = 0.12-0.42; P < 0.001), a tumor diameter less than 3 cm (HR = 0.46; 95% CI = 0.27-0.78; P = 0.004), well/moderate tumor differentiation (HR = 0.37; 95% CI = 0.19-0.72; P = 0.004), and adjuvant therapy (HR = 0.61; 95% CI = 0.37-0.99; P = 0.49). CONCLUSIONS For the long-term survival of patients with pancreatic ductal adenocarcinoma, complete excision is the most important therapeutic option, and adjuvant therapy is a significant contributing factor.
TL;DR: Emerging evidence of the ability to reestablish endogenous insulin production in the pancreas even after the diabetic damage occurs envisions the exogenous supplementation of islets to patients also as a temporary therapeutic aid, useful to buy time toward a possible self-healing process of the pancreatic islets.
Abstract: Pancreatic islet cell transplantation is an attractive treatment of type 1 diabetes (T1D). The success enhanced by the Edmonton protocol has fostered phenomenal progress in the field of clinical islet transplantation in the past 5 years, with 1-year rates of insulin independence after transplantation near 80%. Long-term function of the transplanted islets, however, even under the Edmonton protocol, seems difficult to accomplish, with only 10% of patients maintaining insulin independence 5 years after transplantation. These results differ from the higher metabolic performance achieved by whole pancreas allotransplantation, and autologous islet cell transplantation, and form the basis for a limited applicability of islet allografts to selected adult patients. Candidate problems in islet allotransplantation deal with alloimmunity, autoimmunity, and the need for larger islet cell masses. Employment of animal islets and stem cells, as alternative sources of insulin production, will be considered to face the problem of human tissue shortage. Emerging evidence of the ability to reestablish endogenous insulin production in the pancreas even after the diabetic damage occurs envisions the exogenous supplementation of islets to patients also as a temporary therapeutic aid, useful to buy time toward a possible self-healing process of the pancreatic islets. All together, islet cell transplantation is moving forward.
TL;DR: This randomized, placebo-controlled trial found that Creon 10 treatment controlled steatorrhea, as reflected in reduced fat excretion, decreased stool frequency and improved stool consistency.
Abstract: Objectives:Creon 10 Minimicrospheres is an enteric-coated, delayed-release pancrelipase preparation designed to deliver active pancreatic enzymes to the small intestine. The primary objective of this study was to compare the effect of Creon 10 with placebo in the control of steatorrhea in chronic pa
TL;DR: Comprehensive testing of the CFTR, PRSS1, and SPINK1 genes identified genetic variants in nearly half of all subjects considered by their physicians as candidates for genetic testing.
Abstract: Objectives Chronic pancreatitis is a progressive inflammatory disorder leading to irreversible exocrine and/or endocrine impairment. It is well documented that mutations in the cationic trypsinogen (PRSS1) gene can cause hereditary pancreatitis. Mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) and the serine protease inhibitor Kazal type 1 (SPINK1) genes are also associated with pancreatitis. Methods We analyzed 381 patients with a primary diagnosis of chronic or recurrent pancreatitis using the Ambry Test: Pancreatitis to obtain comprehensive genetic information for the CFTR, SPINK1, and PRSS1 genes. Results The results identified 32% (122/381) of patients with 166 mutant CFTR alleles, including 12 novel CFTR variants: 4375-20 A>G, F575Y, K598E, L1260P, G194R, F834L, S573C, 2789 + 17 C>T, 621+83 A>G, T164S, 621+25 A>G, and 3500-19 G>A. Of 122 patients with CFTR mutations, 5.5% (21/381) also carried a SPINK1 mutation, and 1.8% (7/381) carried a PRSS1 mutation. In addition, 8.9% (34/381) of all patients had 1 of 11 different SPINK1 mutations. Another 6.3% (24/381) of the patients had 1 of 8 different PRSS1 mutations. Moreover, 1.3% of the patients (5/381) had 1 PRSS1 and 1 SPINK1 mutation. A total 49% (185/381) of the patients carried one or more mutations. Conclusions Comprehensive testing of the CFTR, PRSS1, and SPINK1 genes identified genetic variants in nearly half of all subjects considered by their physicians as candidates for genetic testing. Comprehensive test identified numerous novel variants that would not be identified by standard clinical screening panels.
TL;DR: The aggravated coagulation parameters predict a fatal outcome in patients with acute pancreatitis, and an AT-III value of 69% at admission was the best cut-off value to predict fatal outcome.
Abstract: Objectives:To evaluate the clinical applicability of the determination of disseminated intravascular coagulation (DIC) parameters in acute pancreatitis.Methods:The subjects for this study were 139 consecutive patients with acute pancreatitis. DIC parameters were assessed at the initial observation o
TL;DR: Foxp3+CD4+ T cells are good markers for metastasis detection in PC patients and more accurate than other conventional tumor markers, especially at advanced stages of the disease.
Abstract: Objectives:Further metastasis should be avoided in pancreatic cancer (PC) patients for effective surgical treatment. Regulatory T cells (Foxp3+CD4+ T cells including CD4+CD25+ T cells and CD4+CD25− T cells) play important roles in tumor immunity. This study aimed to investigate whether regulatory T
TL;DR: Several abandoned terms are frequently used, and new terms have emerged that describe manifestations in acute pancreatitis that were not specifically addressed during the Atlanta symposium, demonstrating that the Atlanta classification is still not universally accepted.
Abstract: Objectives:The 1992 Atlanta classification is a clinically based classification system that defines the severity and complications of acute pancreatitis. The purpose of this review was to assess whether the terms abandoned by the Atlanta classification are really discarded in the literature. The sec
TL;DR: In this article, the authors describe the clinical characteristics, indications, technical procedures, and outcome of a consecutive series of laparoscopic distal pancreatic resections performed by the same surgical team.
Abstract: Objective:To describe the clinical characteristics, indications, technical procedures, and outcome of a consecutive series of laparoscopic distal pancreatic resections performed by the same surgical team.Summary Background Data:Laparoscopic distal pancreatic resection has increasingly been described
TL;DR: Pancreaticoduodenectomy may have a therapeutic role in association with chemotherapy when compared with current chemotherapy, radiotherapy, or combined methods.
Abstract: Objectives:Non-Hodgkin lymphoma predominantly involving the pancreas is a rare tumor and accounts for less than 0.7% of all pancreatic malignancies and 1% of extranodal lymphomas. Diagnosis of primary pancreatic lymphoma can be difficult because it may mimic carcinoma. The principal aims of this rev
TL;DR: In nonalcoholic ICP, smoking is associated with disease progression as measured by the appearance of pancreatic calcification and, to a lower extent, of diabetes.
Abstract: Objectives:Chronic pancreatitis is usually caused by heavy alcohol intake and, in many studies, also smoking. Because heavy drinkers usually smoke, making it difficult to separate the effects of these 2 factors, we thought to study the impact of smoking on the progression of nonalcoholic idiopathic
TL;DR: The role of hedgehog signaling during pancreatic development, its role in the pathogenesis of both chronic pancreatitis and pancreatic cancer, and the implications of this newly available information with regards to treatment of pancreaticcancer are discussed.
Abstract: The hedgehog (Hh) family of genes, sonic hedgehog (Shh), Indian hedgehog (Ihh), and desert hedgehog (Dhh) encode signaling molecules that regulate multiple functions during organ development and in adult tissues. Altered hedgehog signaling has been implicated in disturbed organ development as well as in different degenerative and neoplastic human diseases. Hedgehog signaling plays an important role in determination the fate of the mesoderm of the gut tube, as well as in early pancreatic development, and islet cell function. Recently, it has been shown that deregulation of hedgehog signaling molecules contributes to the pathogenesis and progression of pancreatic cancer and of chronic pancreatitis. Inhibition of hedgehog signaling using hedgehog antagonists reduces pancreatic cancer cell growth in vitro and in vivo, thus holding promise of novel agents in the treatment of this devastating disease. In this review, we discuss the role of hedgehog signaling during pancreatic development, its role in the pathogenesis of both chronic pancreatitis and pancreatic cancer, and lastly, the implications of this newly available information with regards to treatment of pancreatic cancer.
TL;DR: In acute biliary pancreatitis, body overweight and obesity represent a risk of more "severe" disease and the number and type of complications increase in categories of increasing BMI.
Abstract: Objectives Body overweight and obesity have been associated with an increased morbidity in acute pancreatitis, but conflicting results were reported in the literature with regard to the type and frequency of complications. We investigated the occurrence of complications in different classes of overweight in a homogeneous group of patients with gallstone pancreatitis. Methods Data were collected prospectively from 250 patients with biliary pancreatitis to allow calculation of the Blamey (Glasgow) and Acute Physiology and Chronic Health Evaluation (APACHE II) scores. According to their body mass index (BMI), the patients were allocated to different categories of body overweight. The outcome for each category was measured by the components of the Atlanta criteria. Secondary end points of the study were the length of hospital stay, the length of stay at the intensive care unit, and the number of abdominal operations. Results When compared with normal-weight patients (BMI 18.5-24.9), all categories with BMI > or =25 had an increased risk of developing the "severe" form of acute pancreatitis [odds ratio (OR): 3.55, 95% confidence interval (CI): 1.50-8.40]. Patients with class I obesity (BMI 30-34.9) developed significantly more organ failure and local complications (OR: 3.469, 95% CI: 1.15-10.43). Patients with class II and III obesity (BMI 35-49.9) had, in addition to more organ failure and local complications, also more metabolic complications (OR: 7.33, 95% CI: 1.62-33.24) than did their normal-weight counterparts. They needed also more frequently intensive care and had a longer total hospital stay. Conclusion In acute biliary pancreatitis, body overweight and obesity represent a risk of more "severe" disease and the number and type of complications increase in categories of increasing BMI.
TL;DR: The less frequent detection of pathological factors concerned with tumor invasiveness in patients with invasive IPMN suggested the lower aggressive behavior of this tumor.
Abstract: Objectives:Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is an indolent neoplasm by nature; however, it sometimes acquires invasive potential and has been classified as invasive IPMN. The aim of the present study was to investigate the clinicopathologic difference between invasive I
TL;DR: It is demonstrated that antisense HIF-1&agr; inhibits expressions of survivin and &bgr;1 integrin, enhancing apoptosis in human pancreatic cancer cells and restraining the progression and metastasis of pancreaticcancer.
Abstract: OBJECTIVES The aim of the study was to observe the effect of antisense hypoxia-inducible factor 1alpha (HIF-1alpha) on progression, metastasis, and chemosensitivity of pancreatic cancer METHODS BxPc-3 cells transfected with antisense HIF-1alpha plasmid were exposed to 05% O2 for 4 hours Expressions of HIF-1alpha, survivin, and beta1 integrin were detected by reverse transcriptase -polymerase chain reaction and Western blotting Growth inhibition rates and apoptosis rates of BxPc-3 cells under different dosages of chemotherapy agents (5-fluorouracil, doxorubicin, and gemcitabine) were measured by MTT colorimetric assay and flow cytometry The migration of BxPc-3 cells was assayed using transwell cell culture chambers Subcutaneous transplantation of BxPc-3 cells in nude mice for 8 weeks was to assess progression and metastasis of pancreatic cancer RESULTS Expression of HIF-1alpha was obviously down-regulated, and at the same time, survivin and beta1-integrin expressions were markedly down-regulated in the experimental group (P < 005) Higher dosages (100, 200, and 400 mg/L of 5-fluorouracil; 005, 0075, and 01 mg/L of doxorubicin; and 10(-9), 10(-8), and 10(-7) mol/L of gemcitabine) caused a greater increase of inhibition in the experimental group than in control (P < 005) The number of migrated BxPc-3 cells in the experimental group was far less than in control (P < 005) In vivo, the tumor size and weight in the experimental group were significantly lower than those in control (P < 005) CONCLUSION Our data demonstrate that antisense HIF-1alpha inhibits expressions of survivin and beta1 integrin, enhancing apoptosis in human pancreatic cancer cells and restraining the progression and metastasis of pancreatic cancer Therefore, HIF-1alpha may play a very important role in progression, metastasis, and chemosensitivity of human pancreatic cancer Blocking HIF-1alpha in pancreatic cancer cells may offer an avenue for gene therapy
TL;DR: This review discusses the current imaging modalities for the diagnosis and staging of solid and cystic pancreatic lesions and for the assessment of acute and chronic pancreatitis, and the future role of emerging technologies in the management of pancreatic diseases.
Abstract: :This review discusses the current imaging modalities for the diagnosis and staging of solid and cystic pancreatic lesions and for the assessment of acute and chronic pancreatitis, and the future role of emerging technologies in the management of pancreatic diseases. Multidetector row spiral