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Radiographics : a Review Publication of... 2021Traumatic injuries of the pancreas are uncommon and often difficult to diagnose owing to subtle imaging findings, confounding multiorgan injuries, and nonspecific...
Traumatic injuries of the pancreas are uncommon and often difficult to diagnose owing to subtle imaging findings, confounding multiorgan injuries, and nonspecific clinical signs. Nonetheless, early diagnosis and treatment are critical, as delays increase morbidity and mortality. Imaging has a vital role in diagnosis and management. A high index of suspicion, as well as knowledge of the anatomy, mechanism of injury, injury grade, and role of available imaging modalities, is required for prompt accurate diagnosis. CT is the initial imaging modality of choice, although the severity of injury can be underestimated and assessment of the pancreatic duct is limited with this modality. The time from injury to definitive diagnosis and the treatment of potential pancreatic duct injury are the primary factors that determine outcome following pancreatic trauma. Disruption of the main pancreatic duct (MPD) is associated with higher rates of complications, such as abscess, fistula, and pseudoaneurysm, and is the primary cause of pancreatic injury-related mortality. Although CT findings can suggest pancreatic duct disruption according to the depth of parenchymal injury, MR cholangiopancreatography and endoscopic retrograde cholangiopancreatography facilitate direct assessment of the MPD. Management of traumatic pancreatic injury depends on multiple factors, including mechanism of injury, injury grade, presence (or absence) of vascular injury, hemodynamic status of the patient, and associated organ damage. RSNA, 2020 See discussion on this article by Patlas.
Topics: Abdominal Injuries; Cholangiopancreatography, Endoscopic Retrograde; Diagnostic Imaging; Humans; Pancreas; Pancreatic Ducts; Wounds, Nonpenetrating
PubMed: 33245670
DOI: 10.1148/rg.2021200077 -
Revista Espanola de Enfermedades... May 2023Annular pancreas is a rare congenital anatomical abnormality of the pancreas. The diagnosis is mainly based on CT and MRI. The development of endoscopic technology...
Annular pancreas is a rare congenital anatomical abnormality of the pancreas. The diagnosis is mainly based on CT and MRI. The development of endoscopic technology provides a new basis for the diagnosis of annular pancreas. We report the images of the diagnosis and classification of annular pancreas under endoscopic ultrasonography(EUS) in our center.
Topics: Adult; Humans; Endosonography; Pancreas; Pancreatic Diseases; Endoscopy; Ultrasonography
PubMed: 36148679
DOI: 10.17235/reed.2022.9103/2022 -
Current Medical Imaging 2021Former studies showed that magnetic resonance cholangiopancreatography (MRCP) is useful in diagnosing the presence of santorinicele; however, few studies have evaluated...
BACKGROUND
Former studies showed that magnetic resonance cholangiopancreatography (MRCP) is useful in diagnosing the presence of santorinicele; however, few studies have evaluated MRCP in diagnosing wirsungocele and the association between pancreatitis and santorinicele or wirsungocele. The purpose of the study was to explore the performance of MRCP in diagnosing santorinicele and wirsungocele and investigate the potential association among pancreatitis, pancreas divisum, and santorinicele or wirsungocele.
METHODS
Sixty-five patients (mean age, 55.68 years; range, 11-82 years) with santorinicele or wirsungocele were included and sorted into two groups: the santorinicele group (n = 48) and the wirsungocele group (n = 17). All patients underwent MRCP. The images were evaluated for the appearance and size of santorinicele or wirsungocele. The diagnostic sensitivity of MRCP was assessed. Additionally, whether two groups are correlated with pancreas divisum or pancreatitis were investigated.
RESULTS
The sensitivity of MRCP in detecting santorinicele and wirsungocele showed no difference (68.8% and 76.5%, respectively). The proportion of patients who developed pancreatitis in santorinicele and wirsungocele groups were 60.4% and 11.8%, respectively (p < 0.05). Pancreas divisum accounted for 77.1% and 11.8% of the patients in the santorinicele and wirsungocele groups, respectively (p < 0.05). Patients with santorinicele and pancreas divisum tended to be older when they acquired pancreatitis.
CONCLUSION
MRCP could be an alternative imaging method to detect cystic dilation of the pancreatic duct. Pancreatitis is more common in patients with santorinicele than in those with wirsungocele. Moreover, santorinicele is more closely associated with pancreatitis than with pancreas divisum.
Topics: Cholangiopancreatography, Magnetic Resonance; Dilatation, Pathologic; Humans; Middle Aged; Pancreas; Pancreatic Ducts; Pancreatitis
PubMed: 34348627
DOI: 10.2174/1573405617666210804153921 -
Genes & Development Nov 2019A comprehensive understanding of mechanisms that underlie the development and function of human cells requires human cell models. For the pancreatic lineage, protocols... (Review)
Review
A comprehensive understanding of mechanisms that underlie the development and function of human cells requires human cell models. For the pancreatic lineage, protocols have been developed to differentiate human pluripotent stem cells (hPSCs) into pancreatic endocrine and exocrine cells through intermediates resembling in vivo development. In recent years, this differentiation system has been employed to decipher mechanisms of pancreatic development, congenital defects of the pancreas, as well as genetic forms of diabetes and exocrine diseases. In this review, we summarize recent insights gained from studies of pancreatic hPSC models. We discuss how genome-scale analyses of the differentiation system have helped elucidate roles of chromatin state, transcription factors, and noncoding RNAs in pancreatic development and how the analysis of cells with disease-relevant mutations has provided insight into the molecular underpinnings of genetically determined diseases of the pancreas.
Topics: Cell Differentiation; Genome-Wide Association Study; Humans; Models, Biological; Pancreas; Pancreatic Diseases; Pluripotent Stem Cells
PubMed: 31676735
DOI: 10.1101/gad.331397.119 -
BMJ Case Reports Apr 2022A middle-aged man had an incidental finding of 10.1 cm lipomatous mass arising from pancreatic body/neck detected on CT scan. He was asymptomatic. He underwent...
A middle-aged man had an incidental finding of 10.1 cm lipomatous mass arising from pancreatic body/neck detected on CT scan. He was asymptomatic. He underwent surgical resection of the mass due to concern for malignancy. His postoperative course was complicated by a high-volume pancreatic leak of approximately 900 mL/day. He underwent endoscopic retrograde cholangiopancreatography and insertion of a pancreatic stent, with some improvement in the pancreatic leak. His leak eventually settled after 3 months. The final histopathology showed lobules of mature adipocytes with small islands of disorganised benign pancreatic ducts and acini interspersed within them, suggestive of pancreatic hamartoma of lipomatous variant. Pancreatic lipomatous hamartomas are rare and are often diagnosed on final histopathology when the initial resection was performed due to diagnostic uncertainty or concern for malignancy. It is a benign lesion with an indolent course and must be discriminated from other lipomatous lesions of the pancreas. An awareness of the condition is important to help guide management.
Topics: Cholangiopancreatography, Endoscopic Retrograde; Hamartoma; Humans; Lipoma; Male; Middle Aged; Pancreas; Pancreatic Ducts; Tomography, X-Ray Computed
PubMed: 35393275
DOI: 10.1136/bcr-2021-248132 -
ANZ Journal of Surgery Jan 2021Pancreatic trauma is rare and complex. Non-operative management of pancreatic injuries is often appropriate, and when surgical intervention is required there may be a...
BACKGROUND
Pancreatic trauma is rare and complex. Non-operative management of pancreatic injuries is often appropriate, and when surgical intervention is required there may be a choice between resectional or more conservative approaches. This is especially true for distal injuries. Operative management of proximal pancreatic injuries is extremely challenging and has less room for conservatism. We sought to characterize the surgical treatment of pancreatic injuries, comparing outcomes for those undergoing formal resection (FR) versus those undergoing more conservative surgical treatment. Our hypothesis was that 'biting the bullet' and resecting is not associated with worse outcomes than less invasive approaches.
METHODS
All patients undergoing surgery for pancreatic injuries between June 2001 and June 2019 at the Alfred Hospital in Melbourne were included. Outcome measures including length of stay, return to theatre, total parenteral nutrition use, pancreatic fistula, intra-abdominal infection and mortality were compared between patients undergoing FR and those undergoing non-resectional procedures.
RESULTS
Of nearly 60 000 trauma presentations, 194 patients sustained pancreatic injury and 51 underwent surgical intervention. Over 70% were secondary to blunt trauma. There were 27 FR and 22 non-resectional procedures. No major outcome differences were detected. FR was not associated with worse outcomes.
CONCLUSION
In distal injuries, where there is doubt regarding parenchymal viability or ductal integrity, FR can safely be performed with non-inferior outcomes to more conservative surgery. Patients with high-grade proximal injuries will usually have multiple other injuries and require resuscitation, temporization and staged reconstruction.
Topics: Abdominal Injuries; Australia; Humans; Pancreas; Pancreatectomy; Pancreatic Fistula; Retrospective Studies; Wounds, Nonpenetrating
PubMed: 33369826
DOI: 10.1111/ans.16498 -
Diabetes Sep 2020The human brain has inherent methodology to efficiently interpret complex environmental stimuli into understanding. This visual perception is governed by the law of...
The human brain has inherent methodology to efficiently interpret complex environmental stimuli into understanding. This visual perception is governed by the law of simplicity, which is fundamental to Gestalt theory. First introduced in a seminal article by Wertheimer in 1923, the theory explains how the mind groups similar images and fills in gaps in order to perceive an amenable version of reality. The world we see consists of complex visual scenes, but rarely is the entire picture visible to us. Since it is inefficient for all visual data to be analyzed at once, certain patterns are given higher importance and made to stand out from the rest of the field in our brain. Here we propose that Gestalt theory may explain why rodent islet architecture has historically been seen as having a core-mantle arrangement. By filling in apparent gaps in the non-β-cell lining, the mind interprets it as a "whole" mantle, which may have further led to widely accepted notions regarding islet microcirculation, intra-islet signaling, and islet development. They are largely based on the prevailing stereotypic islet architecture in which an enclosed structure is presumed. Three-dimensional analysis provides more integrated views of islet and pancreatic microcirculation.
Topics: Animals; Humans; Islets of Langerhans; Pancreas
PubMed: 32669392
DOI: 10.2337/db20-0304 -
Annual International Conference of the... Nov 2021Pancreatic cancer poses a great threat to our health with an overall five-year survival rate of 8%. Automatic and accurate segmentation of pancreas plays an important...
Pancreatic cancer poses a great threat to our health with an overall five-year survival rate of 8%. Automatic and accurate segmentation of pancreas plays an important and prerequisite role in computer-assisted diagnosis and treatment. Due to the ambiguous pancreas borders and intertwined surrounding tissues, it is a challenging task. In this paper, we propose a novel 3D Dense Volumetric Network (3DVNet) to improve the segmentation accuracy of pancreas organ. Firstly, 3D fully convolutional architecture is applied to effectively incorporate the 3D pancreas and geometric cues for volume-to-volume segmentation. Then, dense connectivity is introduced to preserve the maximum information flow between layers and reduce the overfitting on limited training data. In addition, a auxiliary side path is constructed to help the gradient propagation to stabilize the training process. Adequate experiments are conducted on a challenging pancreas dataset in Medical Segmentation Decathlon challenge. The results demonstrate our method can outperform other comparison methods on the task of automated pancreas segmentation using limited data.Clinical relevance-This paper proposes an accurate automated pancreas segmentation method, which can provide assistance to clinicians in the diagnosis and treatment of pancreatic cancer.
Topics: Abdomen; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Pancreas; Tomography, X-Ray Computed
PubMed: 34892006
DOI: 10.1109/EMBC46164.2021.9630789 -
International Journal of Molecular... Oct 2019Adenosine regulates exocrine and endocrine secretions in the pancreas. Adenosine is considered to play a role in acini-to-duct signaling in the exocrine pancreas. To...
Adenosine regulates exocrine and endocrine secretions in the pancreas. Adenosine is considered to play a role in acini-to-duct signaling in the exocrine pancreas. To identify the molecular basis of functional adenosine receptors in the exocrine pancreas, immunohistochemical analysis was performed in the rat, mouse, and guinea pig pancreas, and the secretory rate and concentration of HCO in pancreatic juice from the rat pancreas were measured. The A adenosine receptor colocalized with ezrin, an A-kinase anchoring protein, in the luminal membrane of duct cells in the mouse and guinea pig pancreas. However, a strong signal ascribed to A adenosine receptors was detected in insulin-positive β cells in islets of Langerhans. The A adenosine receptor agonist 4-[2-[[6-Amino-9-(-ethyl-β-D-ribofuranuronamidosyl)-9-purin-2-yl]amino]ethyl]benzenepropanoic acid (CGS 21680) stimulated HCO-rich fluid secretion from the rat pancreas. These results indicate that A adenosine receptors may be, at least in part, involved in the exocrine secretion of pancreatic duct cells via acini-to-duct signaling. The adenosine receptors may be a potential therapeutic target for cancer as well as exocrine dysfunctions of the pancreas.
Topics: Animals; Bicarbonates; Cytoskeletal Proteins; Female; Guinea Pigs; Islets of Langerhans; Male; Mice; Pancreas; Pancreatic Ducts; Rats; Receptors, Purinergic P1; Rodentia
PubMed: 31717704
DOI: 10.3390/ijms20215329 -
Developmental Cell Jun 2022Diabetic patients show elevated plasma IL18 concentrations. IL18 has two receptors: the IL18 receptor (IL18r) and the Na-Cl co-transporter (NCC). Here, we report that...
Diabetic patients show elevated plasma IL18 concentrations. IL18 has two receptors: the IL18 receptor (IL18r) and the Na-Cl co-transporter (NCC). Here, we report that IL18 is expressed on islet α cells, NCC on β cells, and IL18r on acinar cells in human and mouse pancreases. The deficiency of these receptors reduces islet size, β cell proliferation, and insulin secretion but increases β cell apoptosis and exocrine macrophage accumulation after diet-induced glucose intolerance or streptozotocin-induced hyperglycemia. Together with the glucagon-like peptide-1 (GLP1), IL18 uses the NCC and GLP1 receptors on β cells to trigger β cell development and insulin secretion. IL18 also uses the IL18r on acinar cells to block hyperglycemic pancreas macrophage expansion. The β cell-selective depletion of the NCC or acinar-cell-selective IL18r depletion reduces glucose tolerance and insulin sensitivity with impaired β cell proliferation, enhanced β cell apoptosis and macrophage expansion, and inflammation in mouse hyperglycemic pancreas. IL18 uses NCC, GLP1r, and IL18r to maintain islet β cell function and homeostasis.
Topics: Animals; Glucagon-Like Peptide 1; Humans; Insulin; Insulin Secretion; Insulin-Secreting Cells; Interleukin-18; Mice; Pancreas
PubMed: 35675813
DOI: 10.1016/j.devcel.2022.05.013