Showing papers in "Pancreas in 2007"
TL;DR: Acute pancreatitis hospitalizations cost more than $2 billion annually, and certain population groups (blacks and older patients) have disproportionately high hospitalization rates, highlighting the need for prevention efforts.
Abstract: Objectives:To determine the direct medical costs of hospitalizations for acute pancreatitis in the United States and analyze the demographic characteristics of hospitalized patients.Methods:We searched the 2003 Healthcare Cost and Utilization Project-National Inpatient Sample for hospitalizations wi
258 citations
TL;DR: CEACAM1 is expressed in pancreatic adenocarcinoma, and serum levels of CEACam1 serve as a useful indicator for the presence of pancreatic cancer.
Abstract: Objectives:Serum biomarkers for early diagnosis of pancreatic adenocarcinoma are not currently available. We recently observed elevated expression of CEACAM1 in pancreatic adenocarcinomas and sought to determine whether serum CEACAM1 levels were elevated in pancreatic cancer patients.Methods:CEACAM1
162 citations
TL;DR: Confirming the diagnosis of ACC preoperatively is difficult, but this diagnosis should be kept in mind while planning surgery for ordinary pancreatic cancer, and a possibility of surgical resection should be pursued to achieve better prognosis.
Abstract: Objectives:Acinar cell carcinoma (ACC) of the pancreas is a rare tumor, and many aspects remain unclear because no large-scale clinical studies have been conducted.Methods:The present study investigated the clinical characteristics, treatment, and therapeutic outcomes of 115 patients registered in t
151 citations
TL;DR: In acute pancreatitis (AP), patients with AP present with elevated blood and urine levels of pancreatic digestive enzymes, such as amylase and lipase as mentioned in this paper, which may lead to systemic inflammator.
Abstract: :Acute pancreatitis (AP) is characterized by edema, acinar cell necrosis, hemorrhage, and severe inflammation of the pancreas. Patients with AP present with elevated blood and urine levels of pancreatic digestive enzymes, such as amylase and lipase. Severe AP may lead to systemic inflammator
151 citations
TL;DR: PCa is associated with a specific decrease of distinct serum proteins, which allows a reliable differentiation between pancreatic cancer and healthy controls.
Abstract: Objective:Early detection is the only promising approach to significantly improve the survival of patients with pancreatic cancer (PCa). Noninvasive tools for the diagnosis, prognosis, and monitoring of this disease are of urgent need. The purpose of this study was to identify and validate new bioma
146 citations
TL;DR: A subpopulation of PANC-1 cells can propagate to form spheres with properties of stem cells in this assay, and it was tentatively suggested that LY6E, TACSTD1, and CD44 proteins may act as surface markers for sorting pancreatic cancer stem cells with fluorescence-activated cell sorter/magnetic-activatedcell sorter.
Abstract: Objective:Pancreatic cancer is among the most aggressive solid malignancies It is possible that pancreatic cancer contains cancer stem cells responsible for its malignancy The purposes of this study were (1) to establish an assay in which a subset of pancreatic cancer cell line (PANC-1) cells with
127 citations
TL;DR: In patients with acute pancreatitis, extrapancreatic inflammation assessed by abdominal CT scan and quantified with the EPIC score allows accurate estimation of disease severity and mortality within 24 h of admission.
Abstract: Objective:To introduce a new scoring system based on signs of systemic inflammation on computed tomography (CT) [ExtraPancreatic Inflammation on CT (EPIC) score] and evaluate this score as an early prognostic tool.Methods:Forty patients with acute pancreatitis who received an abdominal CT within 24
110 citations
TL;DR: The sensitivity of serum IgG4 tended to be higher than that of IgG in the diagnosis of AIP and should be included in the diagnostic workup for AIP.
Abstract: Objectives:Serum immunoglobulin G (IgG) and/or IgG4 elevation is one of the notable characteristics of autoimmune chronic pancreatitis (AIP). The purpose of this study was to compare the sensitivity and specificity of IgG with those of IgG4 in the diagnosis of AIP.Methods:From December 2005 to March
109 citations
TL;DR: Investigation of surgical specimens from patients with pancreatic cancer revealed continuity between the cancer cells between the inside and the outside of the perineurium, suggesting that neural invasion might be a pathway to lymphatic involvement.
Abstract: Objectives:Neural invasion is one of the most important modes of tumor extension in pancreatobiliary tract cancer. However, the precise pattern of neural invasion and the relationship between neural invasion and nodal involvement are unknown.Methods:Using 8 surgical specimens from patients with panc
106 citations
TL;DR: Statins seem to be protective against the development of pancreatic cancer, and the magnitude of the effect correlates with the duration of statin use, which is seen across different age and racial groups.
Abstract: OBJECTIVE Statins are commonly used cholesterol-lowering agents that are noted to suppress tumor cell growth in several in vitro and animal models. METHODS We studied the association between pancreatic cancer and statins in veterans. A retrospective, nested case-control study was conducted using prospectively collected data from the Veterans Integrated Service Networks 16 Veteran Affairs database from 1998 to 2004. We analyzed data on 483,733 patients from 8 states located in south central United States. The primary variables of interest were pancreatic cancer and the use of statins before the diagnosis of pancreatic cancer. Multiple logistic regression analysis was done to adjust for covariates including age, sex, body mass index, smoking, diabetes, and race. The SAS software was used for statistical computing. RESULTS Of the 483,733 patients in the study, 163,467 (33.79%) were on statins, and 475 (0.098%) patients had a primary diagnosis of pancreatic cancer. Statin use of more than 6 months was associated with a risk reduction of pancreatic cancer of 67% (adjusted odds ratio, 0.33; 95% confidence interval, 0.26-0.41; P < 0.01).A dose-response relationship was noted between statin use and pancreatic cancer with an 80% risk reduction (adjusted odds ratio, 0.2; 95% confidence interval, 0.13-0.29; P < 0.01) with use of statin for more than 4 years. Furthermore, the protective effect of statin was seen across different age and racial groups, and was irrespective of the presence of diabetes, smoking, or alcohol use. CONCLUSIONS Statins seem to be protective against the development of pancreatic cancer, and the magnitude of the effect correlates with the duration of statin use.
105 citations
TL;DR: This review will discuss the current understanding of the role of the ECM in directing pancreatic cancer growth, progression, and metastasis, and future directions for the study of the integrin-ECM axis and its role in Pancreatic cancer progression, including potential therapeutic strategies.
Abstract: Pancreatic cancer is the fifth leading cause of adult cancer death in the United States, with 5-year survival rates of only 1% to 4%. Current therapeutic strategies generally result in only a few months of extended life. Recent evidence from several independent laboratories in vitro and in vivo indicate that integrin-mediated cell attachment to the extracellular matrix (ECM), components of which are highly up-regulated in pancreatic cancer, evokes phenotypes and signaling pathways that regulate tumor cell growth and migration. In this review, we will discuss our current understanding of the role of the ECM in directing pancreatic cancer growth, progression, and metastasis. Topics covered include a survey of the existing literature regarding the in vivo and in vitro expression of the ECM and its cell surface receptors, the integrins, in pancreatic cancer; mechanisms involved in the integrin-ECM-mediated malignant phenotype; and future directions for the study of the integrin-ECM axis and its role in pancreatic cancer progression, including potential therapeutic strategies.
TL;DR: Prolonged lactation and increased parity are associated with a reduced risk for pancreatic cancer, and no association was found between family history, allergy, or obesity and pancreaticcancer in Egypt.
Abstract: Objectives:This study examined the epidemiology of pancreatic cancer in Egypt.Methods:We obtained detailed information on smoking, occupational, medical, and reproductive histories from 194 pancreatic cancer cases and 194 controls.Results:Compared with not smoking, smoking cigarettes alone or in con
TL;DR: In this high-risk population of heavy drinkers, the prevalence of pancreatitis is at least 3%, and preliminary data regarding potential cofactors for pancreatitis in heavy drinkers is provided.
Abstract: Objectives:To determine the prevalence of pancreatitis and associated risk factors among heavy-drinking veterans.Methods:At a large Veterans Administration Outpatient Detoxification Program (ODP) that systematically collects risk information, 1409 black and white male veterans with International Cla
TL;DR: Identification of differentially expressed proteins from pancreatitis juice provides useful information for future study of specific pancreatitis-associated proteins and to eliminate potential false-positive biomarkers for pancreatic cancer.
Abstract: Pancreatic cancer is a highly lethal disease.1,2 The death rate nearly matches the incidence because the diagnosis usually occurs late, after metastases have occurred, and the only chance for a cure (ie, surgical excision) has been eliminated. The problem of early diagnosis is complicated by the obscure location of the pancreas, the absence of reliable symptoms, and the insensitivity and expense of current tests. Better methods of detecting early stages of cancer or precancerous lesions are needed.
In the efforts to develop biomarkers for the early detection of pancreatic cancer, one of the problems is the false-positive involvement of pancreatitis patients. Pancreatitis is an inflammatory condition of the pancreas that shares many molecular features with pancreatic cancer. Thus, biomarkers present in the setting of pancreatic cancer frequently occur in pancreatitis, providing an unacceptably low level of specificity for screening. It is therefore important to understand the proteins that underlie pancreatitis, as they could be a source of false-positive biomarkers for pancreatic cancer. Moreover, chronic pancreatitis is risk factor for eventual neoplastic progression; thus, understanding the proteins involved in both diseases may yield some insights into the mechanisms that link these events.
Recently, there has been substantial interest in applying proteomic methods for the discovery of new targets for therapeutics and new biomarkers for diagnosis and early detection.3 In particular, quantitative proteomics has enabled researchers to use a combination of biochemistry, biology, and bioinformatics to detect proteins that are differentially expressed in cancer. In pancreatic cancer, recent studies using proteomics approach have focused on pancreatic cancer tissues.4–6 However, from a biomarker’s standpoint, pancreatic juice is an excellent starting specimen for the identification of protein biomarkers. Pancreatic juice is a rich source for cancer-specific proteins because the highly proliferative cancer cells are shed into the juice, as they undergo cellular turnover and degradation.7
Pancreatic juice was extensively studied in late 1970s and 1980s, primarily by early 2-dimensional electrophoresis analyses, which led to the discovery and description of several pancreatic enzymes.8–12 Recently, Gronborg and colleagues13 used a mass spectrometry-based proteomic approach for the analysis of pancreatic juice which used 1-dimensional electrophoresis and liquid chromatography (LC) tandem mass spectrometry (MS/MS). We previously used an isotope-coded affinity tag (ICAT)–based quantitative proteomic approach to identify and characterize potential biomarkers from pancreatic cancer juice.14 A total of 30 proteins were identified that exhibited greater than 2-fold abundance change in pancreatic cancer juice compared with normal pancreatic juice. Given the false-positive role of pancreatitis in pancreatic cancer, it is important to discover possible pancreatitis specific proteins that can be used to differentiate pancreatic cancer and pancreatitis. In addition, discovery of the proteins in pancreatitis could help identify proteins that might contribute to false-positive findings of pancreatic cancer.
Isotope-coded affinity tag (ICAT) technology provides a comprehensive approach for quantitative proteomic analysis.15,16 This methodology demonstrates a significant improvement over gel-based methods in identifying low-abundant proteins, and it minimizes problems associated with solubility and extremes of pH.17 In this study, we used ICAT technology to perform comprehensive quantitative protein profiling of the pancreatitis juice. We performed the analyses by comparing pooled normal pancreatic juice with pancreatic juice from a chronic pancreatitis patient. Identification and quantification of the proteins from pancreatic juice were accomplished by differentially labeling the target proteins (pancreatitis) with heavy ICAT reagents and the normal comparator proteins with light ICAT reagents. The isotopically labeled proteins were then combined, purified, and followed by LC MS/MS analysis. Protein identification and quantification were then accomplished by using a suite of bioinformatics software. The proteomic analysis of pancreatitis juice was then compared with the analysis of pancreatic cancer juice.
TL;DR: In this paper, the profiles of K-ras mutations and p16 and preproenkephalin (ppENK) promoter hypermethylation and their associations with cigarette smoking in pancreatic cancer patients were examined.
Abstract: Objectives—To examine the profiles of K-ras mutations and p16 and preproenkephalin (ppENK) promoter hypermethylation and their associations with cigarette smoking in pancreatic cancer patients. Methods—In plasma DNA of 83 patients with untreated primary pancreatic ductal adenocarcinoma, DNA hypermethylation was determined by methylation-specific polymerase chain reaction and Kras codon 12 mutations by enriched-nested polymerase chain reaction followed by direct sequencing. Information on smoking exposure was collected by in-person interview. Pearson χ 2 test and Fisher exact test were used in statistical analysis. Results—K-ras mutations, ppENK, and p16 promoter hypermethylation were detected in 32.5%, 29.3%, and 24.6% of the patients, respectively. Sixty-three percent (52/83) of patients exhibited at least one of the alterations. Smoking was associated with the presence of K-ras mutations (P = 0.003). A codon 12 G-to-A mutation was predominantly observed in regular smokers and in heavy smokers (pack-year of smoking ≥36). Smoking was not associated with p16 or ppENK hypermethylation. Conclusions—These preliminary observations suggest that plasma DNA might be a useful surrogate in detecting genetic and epigenetic alterations of pancreatic cancer. The findings on the association between K-ras mutation and smoking were in consistency with previous studies. Further studies on environmental modulators of epigenetic changes in pancreatic cancer are warranted.
TL;DR: This review discusses and compares the 4 current diagnostic criteria for autoimmune chronic pancreatitis, focusing on their own strength and weakness with the aim of providing a framework for the development of unified criteria that represent an international consensus.
Abstract: Autoimmune chronic pancreatitis (AIP) is increasingly being recognized as a worldwide entity. In 2002, the Japan Pancreas Society published diagnostic criteria for AIP. Since then, increased attention toward this relatively new disease entity has enabled more cases of AIP to be correctly diagnosed, allowing for proper management and avoidance of surgery. Retrospective inclusion of previously unrecognized or misdiagnosed cases of AIP has revealed an increasing number of cases that are not in full accordance with the Japanese diagnostic criteria. As a result, some groups have developed and cited their own criteria in the reporting of AIP, and the Japan Pancreas Society criteria have also undergone revision recently. The absence of consistent and uniform criteria has made the comparison of different cases diagnosed under various guidelines difficult. In this review, we discuss and compare the 4 current diagnostic criteria, focusing on their own strength and weakness with the aim of providing a framework for the development of unified criteria that represent an international consensus.
TL;DR: In this retrospective study, biliary tract disease was the main etiologic factor of severe acute pancreatitis in China and the highest mortality occurred in severe idiopathic pancreatitis, and there was no clear relationship between mortality and age.
Abstract: Objectives:Many epidemiological studies have recently been published on acute pancreatitis; however, there is no known published report on pancreatitis in China. The present study aims to assess the etiology and mortality of severe acute pancreatitis in China.Methods:Fifteen medical centers located
TL;DR: Quercetin, apigenin, and luteolin inhibited cytotoxicity in RIN cells and attenuated the decrease of glucose-stimulated insulin secretion in islets by IL-1β and IFN-γ.
Abstract: Objectives:In the past few decades, the use of natural compounds, such as flavonoids, as anti-inflammatory agents has gained much attention. Our current study focuses on the preventive effects of quercetin, apigenin, and luteolin on cytokine-induced β-cell damage.Methods:Pancreatic β-cells or islets
TL;DR: Evaluation of the histological types of IPMN may help to predict the clinical course of patients with IPMN and to design improved clinical management for these patients.
Abstract: OBJECTIVES Intraductal papillary-mucinous neoplasm (IPMN) of the pancreas encompasses a spectrum of neoplasms with both morphological and immunohistochemical variations of mucin glycoproteins Recently, a consensus nomenclature and criteria were histologically defined for classifying these variants of IPMNs into gastric, intestinal, pancreatobiliary, and oncocytic types The purpose of this study was to determine associations between the histological types and clinicopathological features in patients with IPMN METHODS Sixty-one patients with IPMN operated upon at Tohoku University Hospital between 1988 and 2006 were retrospectively analyzed RESULTS Our series included 27 gastric-, 29 intestinal-, 4 pancreatobiliary-, and 1 oncocytic-type IPMNs Statistically, the types of IPMN were significantly associated with the histological diagnoses, macroscopic types, and survival of the patients Characteristically, the gastric-type IPMNs were likely to be diagnosed as benign, to be confined to branch ducts, and to have fair prognoses On the other hand, the intestinal-type IPMNs were likely to be diagnosed as malignant, occupy the main duct, and have poor prognoses Because of the small number of pancreatobiliary-type IPMNs and only 1 case of oncocytic-type IPMN, we were unable to determine any of their clinicopathological characteristics in our series CONCLUSIONS Evaluation of the histological types of IPMN may help to predict the clinical course of patients with IPMN and to design improved clinical management for these patients
TL;DR: This topic was debated at the November 2003 Annual Meeting of the American Pancreatic Association and Drs Eugene DiMagno of the Mayo Clinic and Glen Lehman of Indiana University debated this topic and their arguments have submitted their arguments in writing.
Abstract: Dr William M. Steinberg Endoscopic therapy for pancreas divisum (PD) in patients presenting with idiopathic pancreatitis (IP) is widely practiced among clinicians who perform endoscopic retrograde cholangiopancreatography (ERCP). But what is the evidence that the benefits of endoscopic therapy outweigh the risks? At the November 2003 Annual Meeting of the American Pancreatic Association held in Chicago, Ill, Drs Eugene DiMagno of the Mayo Clinic and Glen Lehman of Indiana University debated this topic. They and their colleagues have submitted their arguments in writing. I hope you will find that this is an important contribution to the world’s literature on this subject.
TL;DR: Intensive nonsurgical treatment is very effective and safe and should be considered as an initial treatment modality for patients with infected pancreatic necrosis.
Abstract: Objectives:We conducted this study to evaluate the efficacy of nonsurgical treatment for patients with infected pancreatic necrosis (IPN).Methods:Among 224 patients with acute pancreatitis from 2000 to 2004, there were 31 patients diagnosed as having IPN complication. The diagnostic criteria for IPN
TL;DR: The association between autoimmune pancreatitis (AIP) and pancreatic cancer (PaC) remains unknown, but it is possible that AIP may also predispose to PaC.
Abstract: To the Editor: The association between autoimmune pancreatitis (AIP) and pancreatic cancer (PaC) remains unknown. Usual chronic pancreatitis is known to increase the risk of developing PaC. This complication usually occurs decades after onset of disease. Increased cell turnover in chronic inflammation and fibrosis is believed to induce mutations that can increase the risk of cancer in these patients. It is, therefore, possible that AIP may also predispose to PaC.
TL;DR: Endoscopic stent therapy is a safe, minimally invasive, and effective procedure in patients experiencing pain attacks during chronic pancreatitis associated with dilated pancreatic duct and a relapse rate of approximately 30% can be expected within 2 years after stent extraction.
Abstract: OBJECTIVES: Obstruction of the pancreatic duct is a common feature of chronic pancreatitis and often requires interventional therapy. The current prospective study investigated clinical success in 19 patients after initial endoscopic retrograde pancreaticography and relapse rates during a 2-year follow-up period. METHODS: Seventeen of 19 patients with chronic pancreatitis (stage III according to the Cambridge classification) were treated by sphincterotomy and stent insertion. Endoscopic retrograde pancreaticography failed in 2 patients. RESULTS: Strictures were cannulated, dilated, and stones were removed with a dormia basket in 13 of 17 patients. Extracorporeal shock wave lithotripsy was necessary in 5 patients. Polyethylene stents (7F-11.5F) were placed into the dilated pancreatic duct. Mean duration of internal pancreatic stenting was 5.6 months. Three of 17 patients had recurrence of pain during the first follow-up year after stent extraction; in the second follow-up year, another 2 patients had a relapse. Overall, patients' assessment of the stent therapy revealed complete satisfaction in 17 of 19 patients. CONCLUSIONS: Endoscopic stent therapy is a safe, minimally invasive, and effective procedure in patients experiencing pain attacks during chronic pancreatitis associated with dilated pancreatic duct. According to our results, a relapse rate of approximately 30% can be expected within 2 years after stent extraction. These patients may be treated by repeated stent therapy.
TL;DR: The regulatory mechanisms of PP-mediated hepatic IR expression and combined IR and GLUT2 endocytosis after insulin binding are defective in chronic pancreatitis and contribute to the apancreatic diabetes, which characterizes this disease.
Abstract: Objectives:Exocrine and endocrine abnormalities in chronic pancreatitis contribute to the morbidity and mortality risks of the disease. Complications of exocrine insufficiency include malabsorption, vitamin deficiency syndromes, and weight loss. Oral enzyme replacement therapy is usually effective i
TL;DR: Findings indicate that exocrine dysfunction with AIP is different from CP because AIP induces stenosis of the pancreatic ducts, but ductal cells that possess the function of bicarbonate secretion are intact, and that endocrine dysfunctionWith AIP was secondary pancreatic diabetes.
Abstract: Objectives:Up to now, the characteristics of pancreatic endocrine and exocrine functions in autoimmune pancreatitis (AIP) are still unclear. The aim of this study is to evaluate pancreatic functions in AIP compared with those of chronic pancreatitis (CP).Methods:Twelve patients with AIP and 25 patie
TL;DR: Adiponectin might be useful in the differential diagnosis of PC and CP with elevated CA-19-9, giving rise to the possibility that ADP has a potential role in differentiating CP and PC.
Abstract: Objectives:Serum adiponectin (ADP) levels are reported inversely related to the risk in breast, endometrial cancer, and gastric cancer. Serum ADP as a potential marker compared with CA-19-9 in pancreatic carcinoma (PC) and chronic pancreatitis (CP) was studied. Adiponectin and CA-19-9 levels were ex
TL;DR: The results of the present study show that the coexistence of 2 different putative PDAC precursor lesions might not be a contradiction, and a progression model that originates in the centroacinar-acinar compartment and ends with the development of PanIN lesions is suggested.
Abstract: Objectives Based mainly on animal models, 2 lesions have been suggested as possible precursors of pancreatic ductal adenocarcinoma (PDAC): pancreatic intraepithelial neoplasia (PanIN) and tubular complexes (TCs). The aim of the study was to find support for either of the 2 models through the analysis of a large panel of human pancreatic tissues. Methods Ninety-two PDAC, 45 chronic pancreatitis, and 27 serous cystadenoma cases were investigated using conventional morphology and immunohistochemistry. Results Most of the cases (78% of PDAC, 93% of chronic pancreatitis, and 67% of serous cystadenoma) exhibited putative precursor lesions, predominantly TC and low-grade PanIN lesions, often present in the same tissue area. High-grade lesions were exclusively observed in PDAC specimens. In 50% to 70% of the cases with TC and associated PanIN, a transitional zone of acinar-ductular transformation with mucinous differentiation of the ductular epithelium was identified. Expression of acinar and centroacinar markers was detected in TC, in the ductular structures of the transitional zones, as well as within the epithelium of mature PanINs. Conclusions The results of the present study show that the coexistence of 2 different putative PDAC precursor lesions might not be a contradiction. A progression model that originates in the centroacinar-acinar compartment and ends with the development of PanIN lesions is suggested.
TL;DR: Histological subclassification of intraductal papillary mucinous neoplasms (IPMNs) is important because the malignant potential of each subtype is different and subtyping of IPMNs is useful for preoperative evaluation in addition to cytomorphological grading.
Abstract: Objectives:Histological subclassification of intraductal papillary mucinous neoplasms (IPMNs) is important because the malignant potential of each subtype is different. We investigated whether pancreatic juice cytology can be used to define the subtypes of IPMNs preoperatively.Methods:The cytologica
TL;DR: Smoking cessation in the first years from the clinical onset of CP reduces the risk of developing pancreatic calcifications, and alcohol cessation seems to have no influence.
Abstract: Objective:Cigarette smoking is associated with a higher risk of developing chronic pancreatitis (CP) and increases the likelihood of developing pancreatic calcifications. The aim of this study was to know whether smoking cessation modifies the course of the disease.Methods:Patients with CP who had b