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The American Surgeon Sep 2023A 27-year-old previously healthy African American female presented to the Emergency Department with an acute onset of epigastric abdominal pain and nausea. Laboratory...
A 27-year-old previously healthy African American female presented to the Emergency Department with an acute onset of epigastric abdominal pain and nausea. Laboratory studies proved unremarkable. CT scan demonstrated intrahepatic and extrahepatic biliary ductal dilation with possible stones within the common bile duct. The patient was discharged with a surgery follow-up appointment. Laparoscopic cholecystectomy with intraoperative cholangiography was performed 3 weeks later due to concern for choledocholithiasis. The intraoperative cholangiogram showed multiple abnormalities, concerning for an infectious or inflammatory process. Magnetic resonance cholangiopancreatography (MRCP) demonstrated a suspected anomalous pancreaticobiliary junction and cystic lesion near the pancreatic head. Endoscopic retrograde cholangiopancreatography (ERCP) for cholangioscopy showed normal-appearing pancreaticobiliary mucosa with 3 tributaries directly from the pancreas entering the bile duct and an ansa orientation to the pancreatic duct. Biopsies of the mucosa were benign. Annual MRCP and MRI to assess for findings concerning for neoplasm given the anomalous pancreaticobiliary junction were recommended.
Topics: Female; Humans; Adult; Pancreaticobiliary Maljunction; Cholangiopancreatography, Endoscopic Retrograde; Pancreas; Pancreatic Ducts; Bile Ducts, Extrahepatic
PubMed: 37142258
DOI: 10.1177/00031348231174017 -
Medicina (Kaunas, Lithuania) Apr 2024: The pancreas, ensconced within the abdominal cavity, requires a plethora of sophisticated imaging modalities for its comprehensive evaluation, with ultrasonography... (Review)
Review
: The pancreas, ensconced within the abdominal cavity, requires a plethora of sophisticated imaging modalities for its comprehensive evaluation, with ultrasonography serving as a primary investigative technique. A myriad of pancreatic pathologies, encompassing pancreatic neoplasia and a spectrum of inflammatory diseases, are detectable through these imaging strategies. Nevertheless, the intricate anatomical confluence and the pancreas's deep-seated topography render the visualization and accurate diagnosis of its pathologies a formidable endeavor. The objective of our paper is to review the best diagnostic imagistic tools for the pancreas. : we have gathered several articles using Prisma guidelines to determine the best imagistic methods. The imperative of pancreatic scanning transcends its diagnostic utility, proving to be a pivotal element in a multitude of clinical specialties, notably surgical oncology. Within this domain, multidetector computed tomography (MDCT) of the pancreas holds the distinction of being the paramount imaging modality, endorsed for its unrivaled capacity to delineate the staging and progression of pancreatic carcinoma. In synergy with MDCT, there has been a notable advent of avant-garde imaging techniques in recent years. These advanced methodologies, including ultrasonography, endoscopic ultrasonography, contrast-enhanced ultrasonography, and magnetic resonance imaging (MRI) conjoined with magnetic resonance cholangiopancreatography (MRCP), have broadened the horizon of tumor characterization, offering unparalleled depth and precision in oncological assessment. Other emerging diagnostic techniques, such as elastography, also hold a lot of potential and promise for the future of pancreatic imaging. Fine needle aspiration (FNA) is a quick, minimally invasive procedure to evaluate lumps using a thin needle to extract tissue for analysis. It is less invasive than surgical biopsies and usually performed as an outpatient with quick recovery. Its accuracy depends on sample quality, and the risks include minimal bleeding or discomfort. Results, guiding further treatment, are typically available within a week. Elastography is a non-invasive medical imaging technique that maps the elastic properties and stiffness of soft tissue. This method, often used in conjunction with ultrasound or MRI, helps differentiate between hard and soft areas in tissue, providing valuable diagnostic information. It is particularly useful for assessing liver fibrosis, thyroid nodules, breast lumps, and musculoskeletal conditions. The technique is painless and involves applying gentle pressure to the area being examined. The resulting images show tissue stiffness, indicating potential abnormalities. Elastography is advantageous for its ability to detect diseases in early stages and monitor treatment effectiveness. The procedure is quick, safe, and requires no special preparation, with results typically available immediately. : The assembled and gathered data shows the efficacy of various techniques in discerning the nature and extent of neoplastic lesions within the pancreas. : The most common imaging modalities currently used in diagnosing pancreatic neoplasms are multidetector computed tomography (MDCT), endoscopic ultrasound (EUS), and magnetic resonance imaging (MRI), alongside new technologies, such as elastography.
Topics: Humans; Pancreatic Neoplasms; Ultrasonography; Magnetic Resonance Imaging; Multidetector Computed Tomography; Pancreas
PubMed: 38792878
DOI: 10.3390/medicina60050695 -
Cell Metabolism Nov 2021Finding endogenous, renewable sources for insulin-producing beta cells in the adult pancreas is one of the holy grails of stem cell research and regenerative medicine....
Finding endogenous, renewable sources for insulin-producing beta cells in the adult pancreas is one of the holy grails of stem cell research and regenerative medicine. Through lineage tracing and scRNA-seq approaches, Gribben et al. (2021) have recently reported that Ngn3-expressing ductal cells could serve as progenitors for new beta cells in the adult pancreas.
Topics: Insulin-Secreting Cells; Pancreas
PubMed: 34731654
DOI: 10.1016/j.cmet.2021.10.007 -
Frontiers in Endocrinology 2022Although type 1 diabetes (T1D) is primarily a disease of the pancreatic beta-cells, understanding of the disease-associated alterations in the whole pancreas could be...
Although type 1 diabetes (T1D) is primarily a disease of the pancreatic beta-cells, understanding of the disease-associated alterations in the whole pancreas could be important for the improved treatment or the prevention of the disease. We have characterized the whole-pancreas gene expression of patients with recently diagnosed T1D from the Diabetes Virus Detection (DiViD) study and non-diabetic controls. Furthermore, another parallel dataset of the whole pancreas and an additional dataset from the laser-captured pancreatic islets of the DiViD patients and non-diabetic organ donors were analyzed together with the original dataset to confirm the results and to get further insights into the potential disease-associated differences between the exocrine and the endocrine pancreas. First, higher expression of the core acinar cell genes, encoding for digestive enzymes, was detected in the whole pancreas of the DiViD patients when compared to non-diabetic controls. Second, In the pancreatic islets, upregulation of immune and inflammation related genes was observed in the DiViD patients when compared to non-diabetic controls, in line with earlier publications, while an opposite trend was observed for several immune and inflammation related genes at the whole pancreas tissue level. Third, strong downregulation of the regenerating gene family () genes, linked to pancreatic islet growth and regeneration, was observed in the exocrine acinar cell dominated whole-pancreas data of the DiViD patients when compared with the non-diabetic controls. Fourth, analysis of unique features in the transcriptomes of each DiViD patient compared with the other DiViD patients, revealed elevated expression of central antiviral immune response genes in the whole-pancreas samples, but not in the pancreatic islets, of one DiViD patient. This difference in the extent of antiviral gene expression suggests different statuses of infection in the pancreas at the time of sampling between the DiViD patients, who were all enterovirus + in the islets by immunohistochemistry based on earlier studies. The observed features, indicating differences in the function, status and interplay between the exocrine and the endocrine pancreas of recent onset T1D patients, highlight the importance of studying both compartments for better understanding of the molecular mechanisms of T1D.
Topics: Antiviral Agents; Diabetes Mellitus, Type 1; Humans; Inflammation; Pancreas; Pancreas, Exocrine; Transcriptome
PubMed: 35498413
DOI: 10.3389/fendo.2022.861985 -
Gastrointestinal Endoscopy Clinics of... Jul 2023The detection of incidental pancreatic cystic lesions has increased over time. It is crucial to separate benign from potentially malignant or malignant lesions to guide... (Review)
Review
The detection of incidental pancreatic cystic lesions has increased over time. It is crucial to separate benign from potentially malignant or malignant lesions to guide management and reduce morbidity and mortality. The key imaging features used to fully characterize cystic lesions are optimally assessed by contrast-enhanced magnetic resonance imaging/magnetic resonance cholangiopancreatography, with pancreas protocol computed tomography offering a complementary role. While some imaging features have high specificity for a particular diagnosis, overlapping imaging features between diagnoses may require further investigation with follow-up diagnostic imaging or tissue sampling.
Topics: Humans; Magnetic Resonance Imaging; Pancreatic Neoplasms; Pancreas; Cholangiopancreatography, Magnetic Resonance; Pancreatic Cyst
PubMed: 37245932
DOI: 10.1016/j.giec.2023.03.007 -
Gastroenterologia Y Hepatologia 2022
Topics: Cholangiopancreatography, Endoscopic Retrograde; Drainage; Endosonography; Humans; Pancreas; Pancreatic Ducts
PubMed: 35074450
DOI: 10.1016/j.gastrohep.2022.01.005 -
BMJ Case Reports Oct 2023Pancreatic panniculitis is a rare cutaneous manifestation of pancreatic disease with only scant case reports available to guide management. In this report, a woman in...
Pancreatic panniculitis is a rare cutaneous manifestation of pancreatic disease with only scant case reports available to guide management. In this report, a woman in her 60s developed a painful, erythematous and indurated, nodular rash after an episode of acute pancreatitis postendoscopic retrograde cholangiopancreatography (ERCP). While clinically and radiologically the pancreatitis improved with standard conservative management, the panniculitis remained severely debilitating. Repeat testing of serum pancreatic enzymes revealed persistent and marked elevation. Octreotide was started to inhibit pancreatic enzyme release, and the lesions improved, with resolution of the panniculitis correlating with falling serum pancreatic enzyme levels. Hence, serial pancreatic enzyme testing may have utility in monitoring and management of pancreatic panniculitis.
Topics: Female; Humans; Acute Disease; Lipase; Pancreas; Pancreatitis; Panniculitis; Aged
PubMed: 37899080
DOI: 10.1136/bcr-2022-254370 -
The Journal of Maternal-fetal &... Jul 2020To determine whether fetal pancreatic echogenicity assessment is associated with gestational diabetes mellitus (GDM). A prospective cross-sectional study was conducted...
To determine whether fetal pancreatic echogenicity assessment is associated with gestational diabetes mellitus (GDM). A prospective cross-sectional study was conducted in a cohort of 160 pregnant women with uncomplicated singleton pregnancies. Fetal ultrasonography was performed between 24 and 28 weeks of gestation for conventional fetal biometry. Based on their pancreatic sonogram results, subjects were divided into two groups, that is, hyperechogenic pancreas group and iso-moderate echogenic pancreas group. Birth characteristics (mode of delivery) and fetal outcomes (gestational age at birth, fetal gender, birth length and weight, Apgar for 1. Versus 5. Minutes) were recorded and the relationship between pancreatic hyperechogenicity and the presence of GDM was assessed. Sixty-six cases with hyperechogenic pancreas (group 1) and 70 cases with iso-moderate echogenic pancreas (group 2) were included to the study. There were no significant differences in maternal demographic and obstetric features between the groups. Fetal birth weight and length were significantly higher in the hyperechogenic pancreas group ( < .0001, = .013; respectively). Hyperechogenic pancreas was significantly and positively associated with GDM risk. Hyperechogenic pancreas was significantly and positively associated with an increased GDM risk by 29.8 times compared to grade 1 isoechogenic group ( < .0001). An accurate prediction model for GDM among pregnant women hyperechogenic pancreas may be created. Fetal hyperechogenic pancreas may be used as a complementary biomarker for the detection of pregnant women suspected of GDM.
Topics: Adult; Biomarkers; Cross-Sectional Studies; Diabetes, Gestational; Female; Humans; Infant, Newborn; Pancreas; Pregnancy; Prospective Studies; ROC Curve; Ultrasonography, Prenatal
PubMed: 30458660
DOI: 10.1080/14767058.2018.1551351 -
Diabetes & Metabolic Syndrome Nov 2023The global burden of cardiovascular diseases continues to rise, and it is increasingly acknowledged that guidelines based on traditional risk factors fail to identify a...
BACKGROUND
The global burden of cardiovascular diseases continues to rise, and it is increasingly acknowledged that guidelines based on traditional risk factors fail to identify a substantial fraction of people who develop cardiovascular diseases. Fat in the pancreas could be one of the unappreciated risk factors. This study aimed to investigate the associations of dyslipidemia states with fat in the pancreas.
METHODS
All participants underwent magnetic resonance imaging on the same 3.0 T scanner for quantification of fat in the pancreas, analyzed as both binary (i.e., fatty change of the pancreas) and continuous (i.e., intra-pancreatic fat deposition) variables. Statistical analyses were adjusted for body mass index, glycated hemoglobin, fasting insulin, ethnicity, age, and sex.
RESULTS
There were 346 participants studied. On most adjusted analyses, high-density lipoprotein cholesterol dyslipidemia was significantly associated with both fatty change of the pancreas (p = 0.010) and intra-pancreatic fat deposition (p = 0.008). Neither low-density lipoprotein cholesterol dyslipidemia nor triglyceride dyslipidemia were significantly associated with fatty change of the pancreas and intra-pancreatic fat deposition. The absence of any dyslipidemia was inversely associated with both fatty change of the pancreas (p = 0.016) and intra-pancreatic fat deposition (p < 0.001).
CONCLUSIONS
Dyslipidemias are uncoupled when it comes to the relationship with fat in the pancreas, with only high-density lipoprotein cholesterol dyslipidemia having a consistent and strong link with it. The residual cardiovascular diseases risk may be attributed to fatty change of the pancreas.
Topics: Humans; Cardiovascular Diseases; Pancreas; Risk Factors; Cholesterol, HDL; Dyslipidemias
PubMed: 37862954
DOI: 10.1016/j.dsx.2023.102881 -
The Journal of International Medical... Dec 2019Because of the complicated blood supply and vascular structure of the pancreas, blood vessel reconstruction and reshaping are generally required during pancreas...
OBJECTIVE
Because of the complicated blood supply and vascular structure of the pancreas, blood vessel reconstruction and reshaping are generally required during pancreas transplantation. We modified the vascular preparation procedure for the donor pancreas (i.e., no vascular reconstruction was performed) based on experiences in our department and in other domestic and international transplantation centers.
METHODS
Twelve donor pancreas preparations without vascular reconstruction were performed. The patch (Carrel patch), celiac trunk, and superior mesenteric artery were preserved as arterial inflow channels for the donor pancreas. The common hepatic artery and the gastroduodenal artery were transected at a site 0.5 cm away from the bifurcation. The bifurcated portion was preserved for the donor liver. The stumps of the gastroduodenal artery and common hepatic artery were then ligated. The portal vein was transected in the middle of the hepatoduodenal ligament during separation of the liver and pancreas. The partial portal vein preserved with the pancreas was used as the outflow channel of the donor pancreas.
RESULTS
The transplanted pancreas functioned well in the recipients, and no vascular complications were reported.
CONCLUSION
The overall efficacy of pancreas transplantation without vascular reconstruction has been improved.
Topics: Adult; Female; Humans; Kidney Function Tests; Kidney Transplantation; Male; Middle Aged; Pancreas; Pancreas Transplantation; Tissue Donors; Treatment Outcome
PubMed: 31500486
DOI: 10.1177/0300060519870894