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Progress in Retinal and Eye Research Sep 2023Primary acquired nasolacrimal duct obstruction, or PANDO, is a common adult lacrimal drainage disorder. The current treatment modality of dacryocystorhinostomy to bypass... (Review)
Review
Primary acquired nasolacrimal duct obstruction, or PANDO, is a common adult lacrimal drainage disorder. The current treatment modality of dacryocystorhinostomy to bypass the obstructed nasolacrimal duct has excellent outcomes. However, the understanding of the disease etiopathogenesis needs to be revisited. There are not many studies that specifically assessed any hypothesis or ones that convincingly put forth the presumed or confirmed interpretations regarding the PANDO pathogenesis or the mechanisms or pathways involved therein. Histopathological evidence points to recurrent inflammation of the nasolacrimal duct, subsequent fibrosis, and the resultant obstruction. The disease etiopathogenesis is considered multifactorial. Several implicated suspects include anatomical narrowing of the bony nasolacrimal duct, vascular factors, local hormonal imbalance, microbial influence, nasal abnormalities, autonomic dysregulation, surfactants, lysosomal dysfunction, gastroesophageal reflux, tear proteins, and deranged local host defenses. The present work reviewed the literature on the etiopathogenesis of primary acquired nasolacrimal duct obstruction (PANDO) to gain insights into the present state of the understanding and the high-value translational implications of precisely decoding the disease etiology.
Topics: Adult; Humans; Nasolacrimal Duct; Lacrimal Duct Obstruction; Dacryocystorhinostomy; Risk Factors; Inflammation
PubMed: 37394093
DOI: 10.1016/j.preteyeres.2023.101193 -
The Korean Journal of Gastroenterology... Oct 2023The ampulla of Vater is a small projection formed by the confluence of the main pancreatic duct and common bile duct in the second part of the duodenum. Primary... (Review)
Review
The ampulla of Vater is a small projection formed by the confluence of the main pancreatic duct and common bile duct in the second part of the duodenum. Primary ampullary adenocarcinoma is a rare malignancy, accounting for only 0.2% of gastrointestinal cancers and approximately 7% of all periampullary cancers. Jaundice from a biliary obstruction is the most common symptom of ampullary adenocarcinoma. In the early stages, radical pancreatoduodenectomy is the standard surgical approach. On the other hand, no randomized controlled trial has provided evidence to guide physicians on the choice of adjuvant/palliative chemotherapy because of the rarity of the disease and the paucity of related research. This paper reports the biology, histology, current therapeutic strategies, and potential future therapies of ampullary adenocarcinoma.
Topics: Humans; Ampulla of Vater; Adenocarcinoma; Pancreatic Neoplasms; Common Bile Duct Neoplasms; Duodenal Neoplasms
PubMed: 37876255
DOI: 10.4166/kjg.2023.110 -
Gastrointestinal Endoscopy Clinics of... Oct 2023Disconnected pancreatic duct (DPD) is common after acute necrotizing pancreatitis (ANP). Its clinical implications vary according to the course of disease. In the early... (Review)
Review
Disconnected pancreatic duct (DPD) is common after acute necrotizing pancreatitis (ANP). Its clinical implications vary according to the course of disease. In the early phase of ANP, parenchymal necrosis along with disruption of pancreatic duct cause acute necrotic collection that evolves into walled-off necrosis (WON). In the later phase, DPD becomes evident as confirmed by magnetic resonance cholangiopancreatography. Clinical manifestations of DPD can vary from being asymptomatic, recurrent pain, recurrent pancreatic fluid collection (PFC), obstructive pancreatitis, or external pancreatic fistula (EPF). Few patients develop new-onset diabetes. Long-term indwelling plastic stents have been proposed to prevent the recurrent PFC.
Topics: Humans; Pancreas; Cholangiopancreatography, Magnetic Resonance; Bile Duct Diseases; Necrosis; Pancreatic Diseases; Pancreatic Ducts
PubMed: 37709409
DOI: 10.1016/j.giec.2023.04.004 -
Interventional Cardiology Clinics Jul 2024Lymphatic disorders in congenital heart disease can be broadly classified into chest compartment, abdominal compartment, or multicompartment disorders. Heavily... (Review)
Review
Lymphatic disorders in congenital heart disease can be broadly classified into chest compartment, abdominal compartment, or multicompartment disorders. Heavily T2-weighted noninvasive lymphatic imaging (for anatomy) and invasive dynamic contrast magnetic resonance lymphangiography (for flow) have become the main diagnostic modalities of choice to identify the cause of lymphatic disorders. Selective lymphatic duct embolization (SLDE) has largely replaced total thoracic duct embolization as the main lymphatic therapeutic procedure. Recurrence of symptoms needing repeat interventions is more common in patients who underwent SLDE. Novel surgical and transcatheter thoracic duct decompression strategies are promising, but long-term follow-up is critical and eagerly awaited.
Topics: Humans; Heart Defects, Congenital; Embolization, Therapeutic; Lymphatic Diseases; Lymphography; Magnetic Resonance Imaging; Thoracic Duct
PubMed: 38839168
DOI: 10.1016/j.iccl.2024.03.002 -
Ophthalmic Plastic and Reconstructive...The term dacryoliths refers to the concretions found within the lacrimal system. When the term dacryoliths is unspecified, it usually refers to the noninfectious... (Review)
Review
The term dacryoliths refers to the concretions found within the lacrimal system. When the term dacryoliths is unspecified, it usually refers to the noninfectious dacryoliths commonly isolated from the lacrimal sac and the nasolacrimal duct. More often, they are diagnosed incidentally during a dacryocystorhinostomy, and the reported incidence among all dacryocystorhinostomy surgeries is 5.7% to as high as 18%. Dacryolithiasis is a complex process occurring within the lacrimal system, and current evidence suggests a multifactorial etiology. The sequence of events can be summarized broadly into 4 stages: stage of susceptibility, stage of initiation/trigger, stage of development, and stage of maintenance. The triggering event is the breach of the lacrimal sac or nasolacrimal duct epithelium, resulting in microtrauma with blood leakage. The blood clots act as a nidus for subsequent sequential laying of mucopeptides, cellular debris present locally, debris washed from the ocular surface, and extraneous agents in tears. This process is aided by altered rheology and composition of the tear film. After the formation of dacryoliths, extracellular neutrophil traps usually form on the surface, which help to maintain the dacryoliths (which do not dissolve). This review highlights and discusses the possible sequence of events during dacryolithiasis.
Topics: Humans; Lacrimal Duct Obstruction; Dacryocystorhinostomy; Calculi; Nasolacrimal Duct; Lacrimal Apparatus
PubMed: 37988056
DOI: 10.1097/IOP.0000000000002557 -
Gastrointestinal Endoscopy Clinics of... Jul 2024Per-oral pancreatoscopy (POP) is a pancreas-preserving modality that allows for targeted pancreatic duct interventions, particularly in cases where standard techniques... (Review)
Review
Per-oral pancreatoscopy (POP) is a pancreas-preserving modality that allows for targeted pancreatic duct interventions, particularly in cases where standard techniques fail. POP specifically has an emerging role in the diagnosis, risk stratification, and disease extent determination of main duct intraductal papillary mucinous neoplasms (IPMNs). It has also been successfully used for laser ablation of IPMNs in poor surgical candidates, lithotripsy for complex stone disease, and laser stricturoplasty. As experience with POP increases beyond select referral center practices, further studies validating POP efficacy with long-term follow-up will help clarify when POP-guided intervention is most beneficial in relation to surgical intervention.
Topics: Humans; Pancreatic Diseases; Endoscopy, Digestive System; Pancreatic Ducts; Pancreatic Neoplasms; Pancreatic Intraductal Neoplasms
PubMed: 38796290
DOI: 10.1016/j.giec.2024.02.007 -
Ophthalmic Genetics Aug 2023We describe the ocular findings in two infants who were found to have unusual internal eyelid folds during routine probing for nasolacrimal duct (NLD) obstruction.
BACKGROUND
We describe the ocular findings in two infants who were found to have unusual internal eyelid folds during routine probing for nasolacrimal duct (NLD) obstruction.
MATERIALS AND METHODS
Medical records review of two patients with similar eyelid folds.
RESULTS
Both children had unusual eyelid folds that began on the inner eyelid adjacent to the lacrimal canaliculi and extended to a position near the caruncle. Both children had resolution of NLDO following routine surgery, suggesting that the eyelid anomalies were an incidental finding at the time of NLDO surgery.
CONCLUSION
The etiology of these unusual inner eyelid folds is not certain but may represent schisis or incomplete separation of the inner eyelid margin.
Topics: Child; Infant; Humans; Nasolacrimal Duct; Lacrimal Duct Obstruction; Eyelids; Lacrimal Apparatus; Eyelid Diseases; Treatment Outcome; Retrospective Studies
PubMed: 36636984
DOI: 10.1080/13816810.2022.2127151 -
VideoGIE : An Official Video Journal of... Nov 2023Percutaneous gallbladder drainage has traditionally been the reference standard treatment for cholecystitis in patients deemed unfit for surgery. Endoscopic... (Review)
Review
BACKGROUND AND AIMS
Percutaneous gallbladder drainage has traditionally been the reference standard treatment for cholecystitis in patients deemed unfit for surgery. Endoscopic transpapillary gallbladder drainage has emerged as a reliable alternative that offers an internal, incisionless option in nonsurgical patients. The aim of this study was to describe techniques for successful selective cystic duct cannulation and gallbladder drainage during ERCP.
METHODS
A series of endoscopic transpapillary gallbladder procedures is shown, including endoscopic and fluoroscopic video and images. Each case highlights best practices, devices, and techniques to aid with successful completion of challenging cases.
RESULTS
Standard cystic duct cannulation and gallbladder access is described using a standard catheter and a 0.035-inch angled guidewire. Challenges to selective cystic duct cannulation are overcome using various approaches, including using a rotatable catheter system, downsizing to a smaller guidewire, occluding the proximal common hepatic duct with an occlusion balloon, and directly intubating the cystic duct using peroral cholangioscopy. Dilation of the cystic duct is performed using standard devices designed for biliary intervention, but smaller, percutaneous angioplasty balloons are used for small ducts and severe strictures. After dilation, a plastic, double-pigtail stent is deployed across the papilla, and access is reobtained in a similar fashion to place a second, parallel stent. To eliminate the need to re-access the gallbladder after initial stent deployment, a cytology brush catheter is repurposed to obtain dual-wire access within the gallbladder before initial stent deployment.
CONCLUSIONS
When the fundamentals of ERCP and the techniques described here are used, endoscopic transpapillary gallbladder drainage can be performed safely and effectively to treat cholecystitis in patients who are not surgical candidates.
PubMed: 38026704
DOI: 10.1016/j.vgie.2023.07.007 -
Journal of Medical Ultrasonics (2001) Jul 2023Conventional ultrasonography (US) for biliary tract disease shows high time and spatial resolution. In addition, it is simple and minimally invasive, and is selected as... (Review)
Review
Conventional ultrasonography (US) for biliary tract disease shows high time and spatial resolution. In addition, it is simple and minimally invasive, and is selected as a first-choice examination procedure for biliary tract disease. Currently, contrast-enhanced US (CEUS), which facilitates the more accurate assessment of lesion blood flow in comparison with color and power Doppler US, is performed using a second-generation ultrasonic contrast agent. Such agents are stable and provide a timeline for CEUS diagnosis. Gallbladder lesions are classified into three types: gallbladder biliary lesion (GBL), gallbladder polypoid lesion (GPL), and gallbladder wall thickening (GWT). Bile duct lesions can also be classified into three types: bile duct biliary lesion (BBL), bile duct polypoid lesion (BDPL), and bile duct wall thickening (BDWT). CEUS facilitates the differentiation of GBL/BBL from tumorous lesions based on the presence or absence of blood vessels. In the case of GPL, it is important to identify a vascular stalk attached to the lesion. In the case of GWT, the presence or absence of a non-contrast-enhanced area, the Rokitansky-Aschoff sinus, and continuity of a contrast-enhanced gallbladder wall layer are important for differentiation from gallbladder cancer. In the case of BDWT, it is useful to evaluate the contour of the contrast-enhanced medial layer of the bile duct wall for differentiating IgG4-related sclerosing cholangitis from primary sclerosing cholangitis. CEUS for ampullary carcinoma accurately reflects histopathological findings of the lesion. Evaluating blood flow in the lesion, continuity of the gallbladder wall, and contour of the bile duct wall via CEUS provides useful information for the diagnosis of biliary tract disease.
PubMed: 37523000
DOI: 10.1007/s10396-023-01338-3