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Find video protocols related to scientific articles indexed in Pubmed.
Diagnosis and management of postoperative pancreatic fistula.
Langenbecks Arch Surg
PUBLISHED: 08-31-2014
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Postoperative pancreatic fistula (POPF) is the leading complication after partial pancreatic resection and is associated with increased length of hospital stay and resource utilization. The introduction of a common definition in 2005 by the International Study Group of Pancreatic Surgery (ISGPS), which has been since employed in the vast majority of reports, has allowed a reliable comparison of surgical results. Despite the systematic investigation of risk factors and of surgical techniques, the incidence of POPF did not change in recent years, whereas the associated mortality has decreased.
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Guidelines for time-to-event end-point definitions in trials for pancreatic cancer. Results of the DATECAN initiative (Definition for the Assessment of Time-to-event End-points in CANcer trials).
Eur. J. Cancer
PUBLISHED: 07-07-2014
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Using potential surrogate end-points for overall survival (OS) such as Disease-Free- (DFS) or Progression-Free Survival (PFS) is increasingly common in randomised controlled trials (RCTs). However, end-points are too often imprecisely defined which largely contributes to a lack of homogeneity across trials, hampering comparison between them. The aim of the DATECAN (Definition for the Assessment of Time-to-event End-points in CANcer trials)-Pancreas project is to provide guidelines for standardised definition of time-to-event end-points in RCTs for pancreatic cancer.
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An angiopoietin-like protein 2 autocrine signaling promotes EMT during pancreatic ductal carcinogenesis.
Oncotarget
PUBLISHED: 06-26-2014
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The identification of the earliest molecular events responsible for the metastatic dissemination of pancreatic ductal adenocarcinoma (PDAC) remains critical for early detection, prevention, and treatment interventions. In this study, we hypothesized that an autocrine signaling between Angiopoietin-like Protein (ANGPTL)2 and its receptor leukocyte immunoglobulin-like receptor B2 (LILRB2) might be responsible for the epithelial-to-mesenchymal transition (EMT) and, the early metastatic behavior of cells in pancreatic preneoplastic lesions. We demonstrated that the sequential activation of KRAS, expression of HER2 and silencing of p16/p14 are sufficient to progressively and significantly increase the secretion of ANGPTL2, and the expression of LILRB2. Silencing the expression of ANGPTL2 reverted EMT and reduced migration in these cell lines. Blocking ANGPTL2 receptor LILRB2 in KRAS, and KRAS/HER2/p16p14shRNA LILRB2- expressing cells reduced ANGPTL2-induced cell proliferation and invasion. An increasingly significant overexpression of ANGPTL2 was observed in in a series of 68 different human PanIN and 27 PDAC lesions if compared with normal pancreatic parenchyma. These findings showed that the autocrine signaling of ANGPTL2 and its receptor LILRB2 plays key roles in sustaining EMT and the early metastatic behavior of cells in pancreatic preneoplastic lesions supporting the potential role of ANGPTL2 for early detection, metastasis prevention, and treatment in PDAC.
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Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS).
Surgery
PUBLISHED: 06-17-2014
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The lymph node (Ln) status of patients with resectable pancreatic ductal adenocarcinoma is an important predictor of survival. The survival benefit of extended lymphadenectomy during pancreatectomy is, however, disputed, and there is no true definition of the optimal extent of the lymphadenectomy. The aim of this study was to formulate a definition for standard lymphadenectomy during pancreatectomy.
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Preconditioning with hyperbaric oxygen in pancreaticoduodenectomy: a randomized double-blind pilot study.
Anticancer Res.
PUBLISHED: 06-13-2014
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In a prospective randomized double-blind study, we evaluated the post-operative biological and clinical effects of a single preoperative hyperbaric-treatment the day before surgery for pancreatic ductal adenocarcinoma.
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Combined derivatization and high-performance liquid chromatography with fluorescence and ultraviolet detection for simultaneous analysis of octreotide and gabexate mesylate metabolite in human pancreatic juice samples.
Biomed. Chromatogr.
PUBLISHED: 06-04-2014
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A simple and sensitive method based on the combination of derivatization and high-performance liquid chromatography with ultraviolet and fluorimetric detection was developed for the simultaneous determination of octreotide and gabexate mesylate metabolite in human pancreatic juice samples. Parameters of the derivatization procedure affecting extraction efficiency were optimized. The developed method was validated according to the International Conference on Harmonization guidelines. The calibration curves were linear over a range of 0.1-15?µg/mL for octreotide and 0.20-15?µg/mL for gabexate mesylate metabolite. Derivatized products of octreotide and gabexate mesylate metabolite were separated on a Luna C18 column (4.6?×?250?mm; 5?µm particle size) using a gradient with a run time of 36?min, without further purification. The limits of detection were 0.025 and 0.05, respectively, for octreotide and gabexate mesylate metabolite. This paper reports the validation of a quantitative high performance liquid chromatography-photodiode array-fluorescence (HPLC-PDA-FL) method for the simultaneous analysis of octreotide and gabexate mesylate metabolite in pancreatic juice by protein precipitation using zinc sulfate-methanol-acetonitrile containing the derivatizing reagent, 4-fluoro-7-nitro-[2,1,3]-benzoxadiazole (NBD-F). Derivatized products of octreotide and gabexate mesylate metabolite were separated on a Luna C18 column (4.6?×?250?mm; 5?µm particle size) using a gradient with a run time of 36?min, without further purification. The method was validated over the concentration ranges 0.1-15 and 0.2-15?µg/mL for octreotide and gabexate mesylate metabolite, respectively, in human pancreatic juice. Biphalin and methyl-p-hydroxybenzoate were used as the internal standards. This method was successfully utilized to support clinical studies in humans. The results from assay validations show that the method is selective, sensitive and robust. The limit of quantification of the method was 0.1?µg/mL for octreotide and 0.2?µg/mL for gabexate mesylate metabolite, and matrix matched standard curves showed a good linearity up to 15?µg/mL. In the entire analytical range the intra- and inter-day precision (RSD%) values were respectively ?5.9% and ?3.1% for octreotide and ?2.0% and ?3.9% for gabexate mesylate metabolite. For both analytes the intra- and inter-day accuracy (bias) values ranged respectively from -6.8 to -2.5% and from -4.6 to -5.7%. This method utilizes derivatization with NBD-F and provides adequate sensitivity for both drugs. Copyright © 2014 John Wiley & Sons, Ltd.
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Multigene mutational profiling of cholangiocarcinomas identifies actionable molecular subgroups.
Oncotarget
PUBLISHED: 05-29-2014
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One-hundred-fifty-three biliary cancers, including 70 intrahepatic cholangiocarcinomas (ICC), 57 extrahepatic cholangiocarcinomas (ECC) and 26 gallbladder carcinomas (GBC) were assessed for mutations in 56 genes using multigene next-generation sequencing. Expression of EGFR and mTOR pathway genes was investigated by immunohistochemistry. At least one mutated gene was observed in 118/153 (77%) cancers. The genes most frequently involved were KRAS (28%), TP53 (18%), ARID1A (12%), IDH1/2 (9%), PBRM1 (9%), BAP1 (7%), and PIK3CA (7%). IDH1/2 (p=0.0005) and BAP1 (p=0.0097) mutations were characteristic of ICC, while KRAS (p=0.0019) and TP53 (p=0.0019) were more frequent in ECC and GBC. Multivariate analysis identified tumour stage and TP53 mutations as independent predictors of survival. Alterations in chromatin remodeling genes (ARID1A, BAP1, PBRM1, SMARCB1) were seen in 31% of cases. Potentially actionable mutations were seen in 104/153 (68%) cancers: i) KRAS/NRAS/BRAF mutations were found in 34% of cancers; ii) mTOR pathway activation was documented by immunohistochemistry in 51% of cases and by mutations in mTOR pathway genes in 19% of cancers; iii) TGF-ß/Smad signaling was altered in 10.5% cancers; iv) mutations in tyrosine kinase receptors were found in 9% cases. Our study identified molecular subgroups of cholangiocarcinomas that can be explored for specific drug targeting in clinical trials.
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Effects of Dietary Components on Cancer of the Digestive System.
Crit Rev Food Sci Nutr
PUBLISHED: 05-21-2014
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ABSTRACT Cancer is the second leading cause of death in developed countries and poor diet and physical inactivity are major risk factors in cancer-related deaths. Therefore, interventions to reduce levels of smoking, improve diet, and increase physical activity must become much higher priorities in the general population's health and health care systems. The consumption of fruit and vegetables exerts a preventive effect towards cancer and in recent years natural dietary agents have attracted great attention in the scientific community and among the general public. Foods such as tomatoes, olive oil, broccoli, garlic, onions, berries, soy bean, honey, tea, aloe vera, grapes, rosemary, basil, chili peppers, carrots, pomegranate, and curcuma contain active components that can influence the initiation and the progression of carcinogenesis, acting on pathways implied in cell proliferation, apoptosis and metastasis. The present review illustrates the main foods and their active components, including their antioxidant, cytotoxic and pro-apoptotic properties, with a particular focus on the evidence related to cancers of the digestive system.
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Assessment of a complication risk score and study of complication profile in laparoscopic distal pancreatectomy.
J. Gastrointest. Surg.
PUBLISHED: 05-10-2014
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This study assessed the patient-specific risk for major postoperative morbidity in a series of 100 laparoscopic distal pancreatectomies (LDP).
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Evaluation of cell-free DNA as a biomarker for pancreatic malignancies.
Int. J. Biol. Markers
PUBLISHED: 05-08-2014
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Currently, no reliable blood-based assay for early detection of pancreatic ductal adenocarcinoma (PDAC) is available. Cell-free DNA (cfDNA) quantitation in patients' plasma has been recently applied in monitoring several cancer types. This study evaluates the diagnostic potential of cfDNA in PDAC patients.
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Pancreaticoduodenectomy with Harmonic Focus® Curved Shears for Cancer.
Dig Surg
PUBLISHED: 04-13-2014
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Ultrasonically activated shears enable the effective cutting and hemostasis of tissue, and have been shown to offer significant benefits in surgical procedures requiring fine dissection. Harmonic Focus®, one of the latest ultrasonic devices, is a clip-like, light-weight, hand-held instrument with curved thin shears. Experience with Harmonic Focus in pancreatic surgery is limited. We have performed more than 1,000 pancreatic resections with this device. It may well represent a valuable tool for the extensive tissue and vascular dissection that is required in pancreaticoduodenectomy. In particular, Harmonic Focus performs very well in lymph node dissection, which is central in cancer surgery. In this report, we describe pancreaticoduodenectomy for pancreatic-head and periampullary cancer with the Harmonic Focus device. © 2014 S. Karger AG, Basel.
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Outcome of superior mesenteric-portal vein resection during pancreatectomy for borderline ductal adenocarcinoma: results of a prospective comparative study.
Langenbecks Arch Surg
PUBLISHED: 04-11-2014
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Approximately 20 % of patients affected by pancreatic ductal adenocarcinoma are amenable to surgical resection. Several tumours are reported as "borderline resectable" because of their proximity to the major vessels. In the effort to achieve a radical tumour removal, vein resection has been proposed, but its oncological benefits remain debated.
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Laparoscopic distal pancreatectomy: analysis of trends in surgical techniques, patient selection, and outcomes.
Surg Endosc
PUBLISHED: 04-10-2014
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This study analyzed the time trends of demographic, operative, and pathologic variables in a consecutive series of patients undergoing laparoscopic distal pancreatectomy (LDP). In addition, we assessed the parameters potentially related to the learning curve, and evaluated the long-term outcomes.
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Incidental diagnosis as prognostic factor in different tumor stages of nonfunctioning pancreatic endocrine tumors.
Surgery
PUBLISHED: 03-21-2014
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Incidentally discovered nonfunctioning pancreatic endocrine tumors (NF-pNETs) increasingly are being detected, and their management is debated. Moreover, the prognostic importance of incidental diagnosis for locally advanced or metastatic NF-pNETs is unknown. The aim of this study is to analyze the outcomes of incidentally discovered/symptomatic NF-pNETs stratified by tumor stage. A preliminary experience with nonoperative treatment of incidental NF-pNETs is reported.
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Is routine imaging necessary after pancreatic resection? An appraisal of postoperative ultrasonography for the detection of pancreatic fistula.
Pancreas
PUBLISHED: 02-13-2014
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This study aimed to assess whether routine transabdominal ultrasonography (US) is clinically helpful for the early detection of postoperative pancreatic fistula (PF).
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Targeted next-generation sequencing of cancer genes dissects the molecular profiles of intraductal papillary neoplasms of the pancreas.
J. Pathol.
PUBLISHED: 02-03-2014
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Intraductal neoplasms are important precursors to invasive pancreatic cancer and provide an opportunity to detect and treat pancreatic neoplasia before an invasive carcinoma develops. The diagnostic evaluation of these lesions is challenging, as diagnostic imaging and cytological sampling do not provide accurate information on lesion classification, the grade of dysplasia or the presence of invasion. Moreover, the molecular driver gene mutations of these precursor lesions have yet to be fully characterized. Fifty-two intraductal papillary neoplasms, including 48 intraductal papillary mucinous neoplasms (IPMNs) and four intraductal tubulopapillary neoplasms (ITPNs), were subjected to the mutation assessment in 51 cancer-associated genes, using ion torrent semiconductor-based next-generation sequencing. P16 and Smad4 immunohistochemistry was performed on 34 IPMNs and 17 IPMN-associated carcinomas. At least one somatic mutation was observed in 46/48 (96%) IPMNs; 29 (60%) had multiple gene alterations. GNAS and/or KRAS mutations were found in 44/48 (92%) of IPMNs. GNAS was mutated in 38/48 (79%) IPMNs, KRAS in 24/48 (50%) and these mutations coexisted in 18/48 (37.5%) of IPMNs. RNF43 was the third most commonly mutated gene and was always associated with GNAS and/or KRAS mutations, as were virtually all the low-frequency mutations found in other genes. Mutations in TP53 and BRAF genes (10% and 6%) were only observed in high-grade IPMNs. P16 was lost in 7/34 IPMNs and 9/17 IPMN-associated carcinomas; Smad4 was lost in 1/34 IPMNs and 5/17 IPMN-associated carcinomas. In contrast to IPMNs, only one of four ITPNs had detectable driver gene (GNAS and NRAS) mutations. Deep sequencing DNA from seven cyst fluid aspirates identified 10 of the 13 mutations detected in their associated IPMN. Using next-generation sequencing to detect cyst fluid mutations has the potential to improve the diagnostic and prognostic stratification of pancreatic cystic neoplasms.
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Extended pancreatectomy in pancreatic ductal adenocarcinoma: definition and consensus of the International Study Group for Pancreatic Surgery (ISGPS).
Surgery
PUBLISHED: 02-01-2014
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Complete macroscopic tumor resection is one of the most relevant predictors of long-term survival in pancreatic ductal adenocarcinoma. Because locally advanced pancreatic tumors can involve adjacent organs, "extended" pancreatectomy that includes the resection of additional organs may be needed to achieve this goal. Our aim was to develop a common consistent terminology to be used in centers reporting results of pancreatic resections for cancer.
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When to perform a pancreatoduodenectomy in the absence of positive histology? A consensus statement by the International Study Group of Pancreatic Surgery.
Surgery
PUBLISHED: 01-02-2014
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Pancreatoduodenectomy (PD) provides the best chance for cure in the treatment of patients with localized pancreatic head cancer. In patients with a suspected, clinically resectable pancreatic head malignancy, the need for histologic confirmation before proceeding with PD has not historically been required, but remains controversial.
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Effect of hyperbaric oxygenation and gemcitabine on apoptosis of pancreatic ductal tumor cells in vitro.
Anticancer Res.
PUBLISHED: 11-14-2013
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Gemcitabine is first-line therapy for advanced pancreatic ductal adenocarcinoma (PDAC) with a poor survival and response rate. Hyperbaric oxygenation (HBO) enhances delivery of oxygen to hypoxic tumor cells and increases their susceptibility to cytotoxic effects of chemotherapy. We hypothesized that the anticancer activity of gemcitabine (GEM) may be enhanced if tumor cells are placed in an oxygen-rich environment. The present study evaluated the effects of gemcitabine, HBO and their combination on apoptosis of tumor cells.
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Randomized, Multicenter, Phase II Study of CO-101 Versus Gemcitabine in Patients With Metastatic Pancreatic Ductal Adenocarcinoma: Including a Prospective Evaluation of the Role of hENT1 in Gemcitabine or CO-101 Sensitivity.
J. Clin. Oncol.
PUBLISHED: 11-12-2013
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Gemcitabine requires transporter proteins to cross cell membranes. Low expression of human equilibrative nucleoside transporter-1 (hENT1) may result in gemcitabine resistance in pancreatic ductal adenocarcinoma (PDAC). CO-101, a lipid-drug conjugate of gemcitabine, was rationally designed to enter cells independently of hENT1. We conducted a randomized controlled trial to determine whether CO-101 improved survival versus gemcitabine in patients with metastatic PDAC (mPDAC) with low hENT1. The study also tested the hypothesis that gemcitabine is more active in patients with mPDAC tumors with high versus low hENT1 expression.
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Autoantibodies to Ezrin are an early sign of pancreatic cancer in humans and in genetically engineered mouse models.
J Hematol Oncol
PUBLISHED: 07-17-2013
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Pancreatic Ductal Adenocarcinoma (PDAC) is a highly aggressive malignancy with only a 5% 5-year survival rate. Reliable biomarkers for early detection are still lacking. The goals of this study were (a) to identify early humoral responses in genetically engineered mice (GEM) spontaneously developing PDAC; and (b) to test their diagnostic/predictive value in newly diagnosed PDAC patients and in prediagnostic sera.
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Exocrine pancreatic insufficiency in adults: A shared position statement of the Italian association for the study of the pancreas.
World J. Gastroenterol.
PUBLISHED: 07-09-2013
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This is a medical position statement developed by the Exocrine Pancreatic Insufficiency collaborative group which is a part of the Italian Association for the Study of the Pancreas (AISP). We covered the main diseases associated with exocrine pancreatic insufficiency (EPI) which are of common interest to internists/gastroenterologists, oncologists and surgeons, fully aware that EPI may also occur together with many other diseases, but less frequently. A preliminary manuscript based on an extended literature search (Medline/PubMed, Cochrane Library and Google Scholar) of published reports was prepared, and key recommendations were proposed. The evidence was discussed at a dedicated meeting in Bologna during the National Meeting of the Association in October 2012. Each of the proposed recommendations and algorithms was discussed and an initial consensus was reached. The final draft of the manuscript was then sent to the AISP Council for approval and/or modification. All concerned parties approved the final version of the manuscript in June 2013.
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Pancreatic Hepatoid Carcinoma: A Review of the Literature.
Dig Surg
PUBLISHED: 06-05-2013
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Background: Hepatoid carcinomas (HCs) are extrahepatic neoplasms exhibiting features of hepatocellular tumors in terms of morphology and immunohistochemistry. They have been described in several organs, most notably in the stomach and ovary. They can present in pure forms or in association with other morphological aspects, such as endocrine tumors or ductal adenocarcinomas. The aim of this review is to describe aspects of hepatoid adenocarcinoma of the pancreas with regard to epidemiology, diagnosis, and treatment. Methods: The PubMed database was searched for publications addressing hepatoid adenocarcinoma of the pancreas. We have searched for articles including the following keywords: pancreatic hepatoid carcinoma, ectopic liver cancer and rare pancreas neoplasm published to date. As references, we used case reports and review articles. Results: Pancreatic forms of HCs are extremely uncommon: only 22 cases have been reported. Conclusions: The possibility of an HC of the pancreas should be considered in the differential diagnosis of an uncommon pathological mass of the pancreas. Treatment seems to be related to the association with other neoplasms, tumor extension at the time of diagnosis and the possibility to perform a radical resection. The common embryologic origin of the pancreas and liver, together with peculiar environmental factors, may explain the development of pancreatic HCs. © 2013 S. Karger AG, Basel.
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Short term chemotherapy followed by radiofrequency ablation in stage III pancreatic cancer: results from a single center.
J Hepatobiliary Pancreat Sci
PUBLISHED: 04-18-2013
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BACKGROUND: Neo-adjuvant chemotherapy (CHT) has gained increasing importance in resectable and borderline resectable pancreatic cancer leading to a better performing surgery when we look at negative resection margins and selection of patients with less aggressive disease. We apply this principle to patients with Stage III (LAC) pancreatic cancer undergoing RFA and try to select patients who may benefit from a local treatment. METHODS: All patients affected by LAC were treated with RFA for a stable disease after a short CHT. Postoperative morbidity and mortality were evaluated together with overall survival (OS) and disease specific survival (DSS). RESULTS: We consecutively treated 57 patients affected by LAC. Median duration of CHT before RFA was 5 months. The postoperative mortality rate was zero. Overall morbidity was 14 % with RFA-related morbidity of 3.5 %. The OS and DSS were 19 months and when compared to a similar population who received RFA as up front treatment, there was no difference. CONCLUSIONS: Our results do not support the adoption of a short CHT as a way to identify patients to treat with RFA with the most benefit. Based on this and by knowing the role of immune modulation after RFA and its specific involvement in pancreatic carcinoma, we can propose RFA as upfront treatment.
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Cyst fluid SPINK1 may help to differentiate benign and potentially malignant cystic pancreatic lesions.
Pancreatology
PUBLISHED: 04-16-2013
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Differential diagnosis between benign and potentially malignant cystic pancreatic lesions may be difficult. Previously we have compared cyst fluid serine protease inhibitor Kazal type I (SPINK1) with some traditionally used tumour markers (amylase, CEA, Ca19-9) and found that it may be a new promising maker in the differential diagnosis of cystic pancreatic lesions. In the present study, we focused on cyst fluid SPINK1 levels in benign and potentially malignant cystic pancreatic lesions.
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Adequacy of lymph node retrieval for ampullary cancer and its association with improved staging and survival.
World J Surg
PUBLISHED: 04-03-2013
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The aim of the present study was to determine the optimal number of lymph nodes (LN) examined to stage pN0 tumors after surgery for ampulla of Vater carcinoma (AVC).
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Clinicopathological correlates of activating GNAS mutations in intraductal papillary mucinous neoplasm (IPMN) of the pancreas.
Ann. Surg. Oncol.
PUBLISHED: 03-27-2013
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Intraductal papillary mucinous neoplasms (IPMNs) are the most common cystic precursor lesions of invasive pancreatic cancer. The recent identification of activating GNAS mutations at codon 201 in IPMNs is a promising target for early detection and therapy. The purpose of this study was to explore clinicopathological correlates of GNAS mutational status in resected IPMNs.
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Virtual analysis of pancreatic cystic lesion fluid content by ultrasound acoustic radiation force impulse quantification.
J Ultrasound Med
PUBLISHED: 03-26-2013
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The purpose of this study was to prospectively evaluate the application of acoustic radiation force impulse (ARFI) imaging implemented with Virtual Touch tissue quantification (Siemens AG, Erlangen, Germany) in the study of pancreatic cystic lesions by using different analysis methods compared with the final diagnosis (pathologic or by magnetic resonance imaging and endoscopic sonographic findings).
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MicroRNA from Pancreatic Duct Aspirate Differentiates Cystic Lesions of the Pancreas.
Ann. Surg. Oncol.
PUBLISHED: 03-22-2013
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Prognostication for cystic neoplasms of the pancreas continues to evolve. Beyond simple size and cystic fluid CEA determination, microRNA (miRNA) detection holds great promise as molecular diagnostics for cancer risk. In this study, we sought to identify miRNAs that could predict malignant potential of pancreatic cystic lesions.
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Ezrin Expression Is an Independent Prognostic Factor in Gastro-intestinal Cancers.
J. Gastrointest. Surg.
PUBLISHED: 03-15-2013
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Ezrin, a member of the ezrin-radixin-moesin (ERM) family of plasma membrane-cytoskeleton linker proteins, has been associated with metastatic behavior.
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Histomolecular phenotypes and outcome in adenocarcinoma of the ampulla of vater.
J. Clin. Oncol.
PUBLISHED: 02-25-2013
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Individuals with adenocarcinoma of the ampulla of Vater demonstrate a broad range of outcomes, presumably because these cancers may arise from any one of the three epithelia that converge at that location. This variability poses challenges for clinical decision making and the development of novel therapeutic strategies.
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Long term outcome of acute pancreatitis in Italy: results of a multicentre study.
Dig Liver Dis
PUBLISHED: 02-23-2013
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In Italy, no long-term studies regarding the natural history of acute pancreatitis have been carried out.
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Lymph nodes metastasis and recurrences justify an aggressive treatment of gastrinoma.
Updates Surg
PUBLISHED: 01-30-2013
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In the current study, short- and long-term outcomes after aggressive surgical treatment for gastrinoma were evaluated. From August 1990 to August 2009, 20 patients diagnosed with Zollinger Ellison syndrome were reviewed. Eleven pancreaticoduodenectomies, three total pancreatectomies, four lymph node dissections, four enucleations and two palliative procedures were performed. Four (27.8 %) patients had disease associated with MEN1 syndrome, 13 (72.2 %) had sporadic gastrinomas (SG) and 3 had disease of unknown primary origin. No in-hospital mortality was observed. After radical resection, lymph node metastasis was present in 82 % of the cases. Eight percent of patients who underwent radical resection developed recurrence compared with 100 % of those who underwent enucleoresection (p = 0.03). Average time to recurrence in patients with sporadic gastrinoma was 66.7 months (confidence interval (CI) 62.9-70.5) in those treated with enucloeresection compared to 181.1 months (CI 124.3-237.8) in the radical resection group (p = 0.007). One recurrence was observed in the MEN1 group. Based on post-operative mortality, recurrence and lymph node metastasis, our data suggest that patients with gastrinoma should undergo abdominal exploration with aggressive resection of the primary tumour and regional lymph nodes in place of conservative treatment.
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ICAT is a novel Ptf1a interactor that regulates pancreatic acinar differentiation and displays altered expression in tumours.
Biochem. J.
PUBLISHED: 01-24-2013
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The PTF1 (pancreas transcription factor 1) complex is a master regulator of differentiation of acinar cells, responsible for the production of digestive enzymes. In the adult pancreas, PTF1 contains two pancreas-restricted transcription factors: Ptf1a and Rbpjl. PTF1 recruits P/CAF [p300/CREB (cAMP-response-element-binding protein)-binding protein-associated factor] which acetylates Ptf1a and enhances its transcriptional activity. Using yeast two-hybrid screening, we identified ICAT (inhibitor of ?-catenin and Tcf4) as a novel Ptf1a interactor. ICAT regulates the Wnt pathway and cell proliferation. We validated and mapped the ICAT-Ptf1a interaction in vitro and in vivo. We demonstrated that, following its overexpression in acinar tumour cells, ICAT regulates negatively PTF1 activity in vitro and in vivo. This effect was independent of ?-catenin and was mediated by direct binding to Ptf1a and displacement of P/CAF. ICAT also modulated the expression of Pdx1 and Sox9 in acinar tumour cells. ICAT overexpression reduced the interaction of Ptf1a with Rbpjl and P/CAF and impaired Ptf1a acetylation by P/CAF. ICAT did not affect the subcellular localization of Ptf1a. In human pancreas, ICAT displayed a cell-type-specific distribution; in acinar and endocrine cells, it was nuclear, whereas in ductal cells, it was cytoplasmic. In ductal adenocarcinomas, ICAT displayed mainly a nuclear or mixed distribution and the former was an independent marker of survival. ICAT regulates acinar differentiation and it does so through a novel Wnt pathway-independent mechanism that may contribute to pancreatic disease.
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Time trends in the treatment and prognosis of resectable pancreatic cancer in a large tertiary referral centre.
HPB (Oxford)
PUBLISHED: 01-16-2013
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Mortality in pancreatic cancer has remained unchanged over the last 20-30 years. The aim of the present study was to analyse survival trends in a selected population of patients submitted to resection for pancreatic cancer at a single institution.
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Growth pattern of serous cystic neoplasms of the pancreas: observational study with long-term magnetic resonance surveillance and recommendations for treatment.
Gut
PUBLISHED: 09-22-2011
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The natural history and growth pattern of pancreatic serous cystic neoplasms (SCNs) are not well understood. This study was designed in order to get insight into the growth rate of SCNs and to suggest recommendations for their management.
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Drain management after pancreatic resection: state of the art.
J Hepatobiliary Pancreat Sci
PUBLISHED: 08-24-2011
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BACKGROUND: Placement of intraperitoneal drain (ID) after abdominal surgery is a common practice. Postoperative pancreatic fistula (POPF), incidence of which ranges from 2% to more than 30%, represents the most common major complication after pancreatic resection. The goal of this paper is to review the state of the art in ID management after pancreatic resection. METHODS: Data from randomized controlled trials (RCT) are reported together with data from our institution in the period before and after the start of the two reported RCTs. RESULTS: One thousand five hundred eighty patients underwent surgical resection for pancreatic lesions at our institution from 1990 to 2010. The overall rate of POPF was 23% before and 19.5% after (P = 0.24) the performance of the RCTs. Both postoperative morbidity and average in-hospital stay were higher in the period before the RCTs (13.6 ± 11.4 versus 13.4 ± 10.3 days, respectively). CONCLUSIONS: POPF is a complex and multifactorial complication after pancreatic surgery. On the basis of the present results and review of the RCTs, the value of ID and its management after pancreatic surgery remain unclear.
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Neoadjuvant/preoperative gemcitabine for patients with localized pancreatic cancer: a meta-analysis of prospective studies.
Ann. Surg. Oncol.
PUBLISHED: 07-14-2011
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Long-term prognosis for localized pancreatic cancer remains poor. We sought to assess the benefit of neoadjuvant/preoperative chemotherapy with or without radiotherapy.
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Pseudopapillary tumor in pediatric age: clinical and surgical management.
Pediatr. Surg. Int.
PUBLISHED: 07-04-2011
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Solid pseudopapillary tumors of the pancreas are rare exocrine pancreatic tumors. Through a review of pediatric cases in a single Institution, we present the clinical and surgical management of this neoplasm.
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Elevated urinary levels of urokinase-type plasminogen activator receptor (uPAR) in pancreatic ductal adenocarcinoma identify a clinically high-risk group.
BMC Cancer
PUBLISHED: 03-28-2011
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The urokinase plasminogen activator receptor is highly expressed and its gene is amplified in about 50% of pancreatic ductal adenocarcinomas; this last feature is associated with worse prognosis. It is unknown whether the level of its soluble form (suPAR) in urine may be a diagnostic-prognostic marker in these patients.
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Pancreaticoduodenectomy for pancreatic cancer: the Verona experience.
Surg. Today
PUBLISHED: 03-23-2011
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Pancreatic ductal adenocarcinoma is the fourth leading cause of cancer-related mortality in the Western world. The current treatment is multimodal, and in resectable patients radical surgery represents the key-step toward long-term survival. Pancreaticoduodenectomy (PD) is the most widely performed operation, because the majority of ductal carcinomas arise in the head of the pancreas. Once considered extremely hazardous, PD has evolved into a safe procedure, with mortality below 5% and morbidity rates in the range from 20% to 60% at high-volume centers. Verona is regarded as one of the most prominent institutions for pancreatic surgery in Europe. More than 5500 patients with pancreatic diseases have been managed, and the surgical case load has increased substantially, with more than 1350 PDs performed. This review discusses this centers experience in surgical treatment of pancreatic head cancer. Furthermore, the preliminary results of radiofrequency thermal ablation of locally advanced ductal cancer are presented.
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Perioperative and long-term results of laparoscopic spleen-preserving distal pancreatectomy with or without splenic vessels conservation: a retrospective analysis.
J Surg Oncol
PUBLISHED: 03-05-2011
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Laparoscopic spleen-preserving distal pancreatectomy can be performed with or without splenic vessels conservation. The formation of perigastric varices is the main long-term complication and represents the area of major concern among surgeons. Aim of this paper was to evaluate the outcomes of patients who underwent spleen-preserving distal pancreatectomy (with or without splenic vessels conservation) at our institution.
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Perioperative and long-term results after left pancreatectomy: a single-institution, non-randomized, comparative study between open and laparoscopic approach.
Surg Endosc
PUBLISHED: 01-28-2011
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Laparoscopic left pancreatic resections are being increasingly performed. In this study, we provide a nonrandomized comparison between laparoscopic and open left pancreatectomy (OLP) for benign and borderline tumors, focusing on both perioperative and long-term results.
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Italian consensus guidelines for chronic pancreatitis.
Dig Liver Dis
PUBLISHED: 11-17-2010
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This paper gives practical guidelines for diagnosis and treatment of chronic pancreatitis. Statements have been elaborated by working teams of experts, by searching for and analysing the literature, and submitted to a consensus process by using a Delphi modified procedure. The statements report recommendations on clinical and nutritional approach, assessment of pancreatic function, treatment of exocrine pancreatic failure and of secondary diabetes, treatment of pain and prevention of painful relapses. Moreover, the role of endoscopy in approaching pancreatic pain, pancreatic stones, duct narrowing and dilation, and complications was considered. Recommendations for most appropriate use of various imaging techniques and of ultrasound endoscopy are reported. Finally, a group of recommendations are addressed to the surgical treatment, with definition of right indications, timing, most appropriate procedures and techniques in different clinical conditions and targets, and clinical and functional outcomes following surgery.
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Delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy: validation of International Study Group of Pancreatic Surgery classification and analysis of risk factors.
HPB (Oxford)
PUBLISHED: 09-02-2010
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This study evaluates the incidence and clinical features and associated risk factors of delayed gastric emptying (DGE) after pancreaticoduodenectomy, employing the International Study Group of Pancreatic Surgery (ISGPS) consensus definition.
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Surgical management of acute pancreatitis in Italy: lessons from a prospective multicentre study.
HPB (Oxford)
PUBLISHED: 09-02-2010
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This study aimed to evaluate the surgical treatment of acute pancreatitis in Italy and to assess compliance with international guidelines.
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Radiofrequency ablation of locally advanced pancreatic adenocarcinoma: an overview.
World J. Gastroenterol.
PUBLISHED: 07-24-2010
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Radiofrequency ablation (RFA) of pancreatic neoplasms is restricted to locally advanced, non-resectable but non-metastatic tumors. RFA of pancreatic tumors is nowadays an ultrasound-guided procedure performed during laparotomy in open surgery. Intraoperative ultrasound covers the mandatory role of staging, evaluation of feasibility, guidance and monitoring of the procedure. Different types of needle can be used. The first aim in the evaluation of RFA as a treatment for locally advanced pancreatic ductal adenocarcinoma, in order of evaluation but not of importance, is to determine the feasibility of the procedure. The second aim is to establish the effect of RFA on tumoral mass in terms of necrosis and cytoreduction. The most important aim, third in order of evaluation, is the potential improvement of quality of life and survival rate. Nowadays, only a few studies assess the feasibility of the procedure. The present paper is an overview of RFA for pancreatic adenocarcinoma.
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Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial.
Ann. Surg.
PUBLISHED: 07-13-2010
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The role of surgically placed intra-abdominal drainages after pancreatic resections has not been clearly established. In particular, their effect on morbidity rates and the optimal timing for their removal remains controversial.
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Differences between main-duct and branch-duct intraductal papillary mucinous neoplasms of the pancreas.
World J Gastrointest Surg
PUBLISHED: 05-18-2010
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In the last decade, intraductal papillary mucinous neoplasms (IPMNs) have become commonly diagnosed. From a morphological standpoint, they are classified in main-duct IPMNs (MD-IPMNs) and branch-duct IPMNs (BD-IPMNs), depending on the type of involvement of the pancreatic ductal system by the neoplasm. Despite the fact that our understanding of their natural history is still incomplete, recent data indicate that MD-IPMNs and BD-IPMNs show significant differences in terms of biological behaviour with MD-IPMNs at higher risk of malignant degeneration. In the present paper, clinical and epidemiological characteristics, rates of malignancy and the natural history of MD-IPMNs and BD-IPMNs are analyzed. The profile of IPMNs involving both the main pancreatic duct and its side branches (combined-IPMNs) are also discussed. Finally, general recommendations for management based on these differences are given.
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ERCP in acute pancreatitis: What takes place in routine clinical practice?
World J Gastrointest Endosc
PUBLISHED: 05-17-2010
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To evaluate the data from a survey carried out in Italy regarding the endoscopic approach to acute pancreatitis in order to obtain a picture of what takes place after the release of an educational project on acute pancreatitis sponsored by the Italian Association for the Study of the Pancreas.
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Total pancreatectomy: indications, different timing, and perioperative and long-term outcomes.
Surgery
PUBLISHED: 04-15-2010
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Total pancreatectomy (TP) has been performed rarely in the past because of its high morbidity and mortality. Because outcomes of pancreatic surgery as well as management of pancreatic insufficiency have improved markedly, enthusiasm for TP has an increased.
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Laparoscopic pancreatectomy for solid pseudo-papillary tumors of the pancreas is a suitable technique; our experience with long-term follow-up and review of the literature.
Ann. Surg. Oncol.
PUBLISHED: 03-14-2010
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Solid pseudopapillary tumors (SPTs) are rare pancreatic neoplasms of low malignant potential that occur mainly in young women. Only 17 cases of SPT treated laparoscopically have been published in the literature and long-term follow-up data are still lacking.
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Endoscopic transmural drainage of pseudocysts associated with pancreatic resections or pancreatitis: a comparative study.
Surg Endosc
PUBLISHED: 03-07-2010
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Endoscopy has been regarded as an effective modality for draining pancreatic collections, pseudocysts, and abscesses. This study analyzes our experience with endoscopic transmural drainage of pancreatic pseudocysts and compares the outcomes in patients with postsurgical and pancreatitis-associated ones.
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Parenchyma-preserving resections for small nonfunctioning pancreatic endocrine tumors.
Ann. Surg. Oncol.
PUBLISHED: 02-17-2010
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Parenchyma-preserving resections (PPRs), including enucleation and middle pancreatectomy (MP), are accepted procedures for insulinomas, but their role in the treatment of nonfunctioning pancreatic endocrine tumors (NF-PETs) is debated. The aim of this study was to evaluate perioperative and long-term outcomes after PPRs for NF-PETs.
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Invasive intraductal papillary mucinous carcinomas of the pancreas: predictors of survival and the role of lymph node ratio.
Ann. Surg.
PUBLISHED: 02-10-2010
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Intraductal papillary mucinous neoplasms (IPMNs) are being increasingly recognized, and often harbor cancer. Lymph node metastases are an important prognostic factor for patients with invasive intraductal papillary carcinoma (I-IPMC), but the role of lymph node ratio (LNR) in predicting survival after surgery for I-IPMC is unknown.
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Pancreatic cystic endocrine tumors: a different morphological entity associated with a less aggressive behavior.
Neuroendocrinology
PUBLISHED: 02-02-2010
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Cystic pancreatic endocrine tumors (CPETs) are rare lesions and their biological features have been scarcely investigated. Aim: To compare clinical and pathological features of resected non-functioning sporadic CPETs (NF-CPETs) with solid pancreatic endocrine tumors (SPETs) in a single-institution experience.
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Intraductal papillary mucinous neoplasms of the pancreas with multifocal involvement of branch ducts.
Am. J. Surg.
PUBLISHED: 11-06-2009
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The appropriate management of patients with branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) with multiple involvements of branch ducts (multifocal BD-IPMN) remains challenging.
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Contrast-enhanced ultrasonography of the pancreas.
Pancreatology
PUBLISHED: 08-04-2009
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Ultrasound is often the first examination performed in patients with suspicion of pancreatic disease. The introduction of contrast-enhanced ultrasonography (CEUS) has led to great developments in the diagnostic capabilities of ultrasound. Dynamic observation of an enhancement allows a highly sensitive evaluation of any perfusion of the abdominal organs. Study of the pancreas is a new and promising application of CEUS, and can be used to characterize pancreatic lesions visible with conventional ultrasonography (US). This article reviews the clinical and surgical applications of CEUS in different pancreatic diseases and in their management.
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The Clavien-Dindo classification of surgical complications: five-year experience.
Ann. Surg.
PUBLISHED: 07-30-2009
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The lack of consensus on how to define and grade adverse postoperative events has greatly hampered the evaluation of surgical procedures. A new classification of complications, initiated in 1992, was updated 5 years ago. It is based on the type of therapy needed to correct the complication. The principle of the classification was to be simple, reproducible, flexible, and applicable irrespective of the cultural background. The aim of the current study was to critically evaluate this classification from the perspective of its use in the literature, by assessing interobserver variability in grading complex complication scenarios and to correlate the classification grades with patients, nurses, and doctors perception.
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Acute pancreatitis at the beginning of the 21st century: the state of the art.
World J. Gastroenterol.
PUBLISHED: 06-26-2009
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Acute pancreatitis is an acute inflammatory disease of the pancreas which can lead to a systemic inflammatory response syndrome with significant morbidity and mortality in 20% of patients. Gallstones and alcohol consumption are the most frequent causes of pancreatitis in adults. The treatment of mild acute pancreatitis is conservative and supportive; however severe episodes characterized by necrosis of the pancreatic tissue may require surgical intervention. Advanced understanding of the pathology, and increased interest in assessment of disease severity are the cornerstones of future management strategies of this complex and heterogeneous disease in the 21st century.
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Mucin-producing neoplasms of the pancreas: an analysis of distinguishing clinical and epidemiologic characteristics.
Clin. Gastroenterol. Hepatol.
PUBLISHED: 05-14-2009
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Mucin-producing neoplasms (MPNs) of the pancreas include mucinous cystic neoplasms (MCNs) and main-duct, branch-duct, and combined intraductal papillary mucinous neoplasms (IPMNs). MCNs and branch-duct IPMNs are frequently confused; it is unclear whether main-duct, combined, and branch-duct IPMNs are a different spectrum of the same disease. We evaluated their clinical and epidemiologic characteristics.
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JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

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In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.