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Gut and Liver Jul 2017The incidence of acute pancreatitis in children has increased over the last few decades. The development of pancreatic fluid collection is not uncommon after severe... (Review)
Review
The incidence of acute pancreatitis in children has increased over the last few decades. The development of pancreatic fluid collection is not uncommon after severe acute pancreatitis, although its natural course in children and adolescents is poorly understood. Asymptomatic fluid collections can be safely observed without any intervention. However, the presence of clinically significant symptoms warrants the drainage of these fluid collections. Endoscopic management of pancreatic fluid collection is safe and effective in adults. The use of endoscopic ultrasound (EUS)-guided procedure has improved the efficacy and safety of drainage of pancreatic fluid collections, which have not been well studied in pediatric populations, barring a scant volume of small case series. Excellent results of EUS-guided drainage in adult patients also need to be verified in children and adolescents. Endoprostheses used to drain pancreatic fluid collections include plastic and metal stents. Metal stents have wider lumens and become clogged less often than plastic stents. Fully covered metal stents specifically designed for pancreatic fluid collection are available, and initial studies have shown encouraging results in adult patients. The future of endoscopic management of pancreatic fluid collection in children appears promising. Prospective studies with larger sample sizes are required to establish their definitive role in the pediatric age group.
Topics: Adolescent; Adult; Child; Drainage; Endoscopy, Digestive System; Exudates and Transudates; Female; Humans; Male; Pancreatic Diseases; Pancreatic Juice; Pancreatitis; Stents; Treatment Outcome
PubMed: 28514841
DOI: 10.5009/gnl16137 -
Einstein (Sao Paulo, Brazil) 2017An asymptomatic 79-year-old woman, with incidental finding on abdominal ultrasound of a solid nodule in the tail of the pancreas. Magnetic resonance imaging showed a...
An asymptomatic 79-year-old woman, with incidental finding on abdominal ultrasound of a solid nodule in the tail of the pancreas. Magnetic resonance imaging showed a 12mm solid tumor. The suggested diagnosis was pancreatic neuroendocrine tumor. The pathological examination showed an intrapancreatic splenic tissue. This is a rare ectopic location of spleen tissue and it should be considered in the differential diagnosis of pancreatic solid tumors.
Topics: Aged; Choristoma; Diagnosis, Differential; Female; Humans; Incidental Findings; Pancreas; Pancreatectomy; Pancreatic Cyst; Pancreatic Diseases; Spleen
PubMed: 28614428
DOI: 10.1590/S1679-45082017RC3942 -
Revista Espanola de Enfermedades... Aug 2021Endoscopic treatment of local complications in patients with chronic pancreatitis has gained ground over the surgical alternative in the last few years. The lower... (Review)
Review
Endoscopic treatment of local complications in patients with chronic pancreatitis has gained ground over the surgical alternative in the last few years. The lower aggressiveness of endoscopic treatment, as well as the possibility to use it repeatedly in high-risk patients, has favored this development. In addition, the incorporation of new, highly accurate endoscopic therapeutic options such as pancreatoscopy-guided lithotripsy and endoscopic ultrasound-guided treatments make endoscopic treatment the first choice in many cases, despite discordant data in the literature. This article reviews the endoscopic treatment of the most common local complications of chronic pancreatitis, such as pancreatolithiasis, pseudocysts, and pancreatic, biliary, and duodenal ductal stenosis.
Topics: Cholangiopancreatography, Endoscopic Retrograde; Drainage; Endoscopy; Endosonography; Humans; Lithotripsy; Pancreatic Diseases; Pancreatic Pseudocyst; Pancreatitis, Chronic
PubMed: 33267598
DOI: 10.17235/reed.2020.7372/2020 -
Pancreas Nov 2015
Topics: Acute Disease; Biomarkers; Genetic Predisposition to Disease; Humans; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis; Pancreatitis, Chronic; Recurrence; Risk Factors; Sensitivity and Specificity
PubMed: 26465944
DOI: 10.1097/MPA.0000000000000550 -
Pancreatology : Official Journal of the... Jan 2022Within the last two decades, an increased incidence of acute pancreatitis (AP) has been reported in childhood, with some progressing to acute recurrent pancreatitis...
BACKGROUND/OBJECTIVES
Within the last two decades, an increased incidence of acute pancreatitis (AP) has been reported in childhood, with some progressing to acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP). Training future pancreatologists is critical to improve the care of children with pancreatic diseases. There are no studies to assess whether the pediatric gastroenterology (GI) fellowship curriculum prepares specialists to care for children with pancreatic diseases.
METHODS
An electronic survey was distributed to all North American Pediatric Gastroenterology Fellows. The survey included 31 questions on pancreatology training including academic resources, research experience, clinical exposure, clinical confidence, and career plans.
RESULTS
A total of 112 (25.8%) fellows responded from 41 (41/72, 56.9%) training centers in North America. Pancreas-specific didactic lectures were reported by 90.2% (n = 101); 49.5% (50/101) had at least quarterly or monthly lectures. Clinical confidence (Likert 4-5) was highest in managing and treating AP (94.6% and 93.8% respectively), relatively lower for ARP (84.8% and 71.4%) and lowest for CP (63.4% and 42.0%). Confidence in diagnosing both ARP and CP was associated with the variety of pancreatic diseases seen (p < 0.001) and total number of patients followed over a 6 month period (p = 0.04). Nine (8%) reported interest in specializing in pancreatology, 12 (10.7%) in pursuing research in the pancreatology.
CONCLUSIONS
Trainee confidence is highest in managing AP, lowest in CP, and seems to be directly correlated with the variety of pancreatic diseases and number of patients followed. Continued commitment is necessary to foster training of the next generation of pediatric pancreatologists.
Topics: Child; Clinical Competence; Fellowships and Scholarships; Gastroenterology; Humans; North America; Pancreatic Diseases; Pediatrics; Surveys and Questionnaires
PubMed: 34753657
DOI: 10.1016/j.pan.2021.10.008 -
International Journal of Molecular... Mar 2024The aryl hydrocarbon receptor (AHR) serves as a ligand-activated transcription factor crucial for regulating fundamental cellular and molecular processes, such as... (Review)
Review
The aryl hydrocarbon receptor (AHR) serves as a ligand-activated transcription factor crucial for regulating fundamental cellular and molecular processes, such as xenobiotic metabolism, immune responses, and cancer development. Notably, a spectrum of endocrine-disrupting chemicals (EDCs) act as agonists or antagonists of AHR, leading to the dysregulation of pivotal cellular and molecular processes and endocrine system disruption. Accumulating evidence suggests a correlation between EDC exposure and the onset of diverse pancreatic diseases, including diabetes, pancreatitis, and pancreatic cancer. Despite this association, the mechanistic role of AHR as a linchpin molecule in EDC exposure-related pathogenesis of pancreatic diseases and cancer remains unexplored. This review comprehensively examines the involvement of AHR in EDC exposure-mediated regulation of pancreatic pathogenesis, emphasizing AHR as a potential therapeutic target for the pathogenesis of pancreatic diseases and cancer.
Topics: Humans; Receptors, Aryl Hydrocarbon; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis; Endocrine System
PubMed: 38612627
DOI: 10.3390/ijms25073818 -
Alimentary Pharmacology & Therapeutics Nov 2003
Review
Topics: Acute Disease; Chronic Disease; Europe; Health Care Costs; Humans; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis
PubMed: 14531743
DOI: 10.1046/j.0953-0673.2003.01731.x -
World Journal of Gastroenterology Nov 2014Current understanding of autoimmune pancreatitis (AIP) recognizes a histopathological subtype of the disease to fall within the spectrum of IgG4-related disease. Along... (Review)
Review
Current understanding of autoimmune pancreatitis (AIP) recognizes a histopathological subtype of the disease to fall within the spectrum of IgG4-related disease. Along with clinical, laboratory, and histopathological data, imaging plays an important role in the diagnosis and management of AIP, and more broadly, within the spectrum of IgG4-related disease. In addition to the defined role of imaging in consensus diagnostic protocols, an array of imaging modalities can provide complementary data to address specific clinical concerns. These include contrast-enhanced computed tomography (CT) and magnetic resonance (MR) imaging for pancreatic parenchymal lesion localization and characterization, endoscopic retrograde and magnetic resonance cholangiopancreatography (ERCP and MRCP) to assess for duct involvement, and more recently, positron emission tomography (PET) imaging to assess for extra-pancreatic sites of involvement. While the imaging appearance of AIP varies widely, certain imaging features are more likely to represent AIP than alternate diagnoses, such as pancreatic cancer. While nonspecific, imaging findings which favor a diagnosis of AIP rather than pancreatic cancer include: delayed enhancement of affected pancreas, mild dilatation of the main pancreatic duct over a long segment, the "capsule" and "penetrating duct" signs, and responsiveness to corticosteroid therapy. Systemic, extra-pancreatic sites of involvement are also often seen in AIP and IgG4-related disease, and typically respond to corticosteroid therapy. Imaging by CT, MR, and PET also play a role in the diagnosis and monitoring after treatment of involved sites.
Topics: Adrenal Cortex Hormones; Autoimmune Diseases; Biomarkers; Cholangiopancreatography, Endoscopic Retrograde; Diagnosis, Differential; Diagnostic Imaging; Endosonography; Humans; Immunoglobulin G; Magnetic Resonance Imaging; Pancreatic Diseases; Pancreatic Neoplasms; Positron-Emission Tomography; Predictive Value of Tests; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 25386067
DOI: 10.3748/wjg.v20.i41.15177 -
International Journal of Molecular... May 2024The pancreas is an organ with both exocrine and endocrine functions, comprising a highly organized and complex tissue microenvironment composed of diverse cellular and... (Review)
Review
The pancreas is an organ with both exocrine and endocrine functions, comprising a highly organized and complex tissue microenvironment composed of diverse cellular and non-cellular components. The impairment of microenvironmental homeostasis, mediated by the dysregulation of cell-to-cell crosstalk, can lead to pancreatic diseases such as pancreatitis, diabetes, and pancreatic cancer. Macrophages, key immune effector cells, can dynamically modulate their polarization status between pro-inflammatory (M1) and anti-inflammatory (M2) modes, critically influencing the homeostasis of the pancreatic microenvironment and thus playing a pivotal role in the pathogenesis of the pancreatic disease. This review aims to summarize current findings and provide detailed mechanistic insights into how alterations mediated by macrophage polarization contribute to the pathogenesis of pancreatic disorders. By analyzing current research comprehensively, this article endeavors to deepen our mechanistic understanding of regulatory molecules that affect macrophage polarity and the intricate crosstalk that regulates pancreatic function within the microenvironment, thereby facilitating the development of innovative therapeutic strategies that target perturbations in the pancreatic microenvironment.
Topics: Humans; Macrophages; Animals; Pancreatic Diseases; Cellular Microenvironment; Pancreas; Pancreatic Neoplasms; Macrophage Activation
PubMed: 38891952
DOI: 10.3390/ijms25115765 -
CMAJ : Canadian Medical Association... Feb 2012
Topics: Aged; Female; Humans; Leg; Pancreatic Diseases; Panniculitis; Skin
PubMed: 22158400
DOI: 10.1503/cmaj.110530