Objective To compare the effects of combined en bloc liver - pancreas transplantation ( LPT) with portal vein drainage and simultaneous combined kidney - pancreas transplantation ( KPT) with systemic venous drainage o...Objective To compare the effects of combined en bloc liver - pancreas transplantation ( LPT) with portal vein drainage and simultaneous combined kidney - pancreas transplantation ( KPT) with systemic venous drainage on the pancreatic endocrine function and related me-展开更多
Benign,premalignant or low-grade malignant pancreatic tumors are increasingly diagnosed owing to the widespread uptake of cross-sectional imaging.Surgical excision is a potential treatment option for these tumors.Panc...Benign,premalignant or low-grade malignant pancreatic tumors are increasingly diagnosed owing to the widespread uptake of cross-sectional imaging.Surgical excision is a potential treatment option for these tumors.Pancreatoduodenectomy and distal pancreatectomy are the standard resections for tumors located in the pancreatic head-neck or body-tail,respectively,and not uncommonly sacrifice a significant amount of healthy pancreatic parenchyma.Central pancreatectomy(CP)is a parenchyma-sparing procedure,initially performed by Dagradi and Serio in 1982,in a patient with pancreatic neck insulinoma.Since then,an increasing number of cases are being performed worldwide,either via open or minimally invasive surgical access.Additionally,pancreatic enucleation is reserved for tumors<3 cm,without involvement of the main pancreatic duct.CP remains an alternative approach in selected cases,albeit in the presence of some controversies,such as its use in early pancreatic ductal adenocarcinoma or metastatic deposits to the central aspect of the pancreas from other malignancies.In recent years,clarity is lacking as regards indications for CP,and despite accumulating evidence in favor of limited resections for suitable pancreatic tumors,no evidence-based consensus guidelines are yet available.Nevertheless,it appears that appropriate patient selection is of paramount importance to maximize the advantages of preservation of endocrine and exocrine pancreatic functions as well as to mitigate the risks of higher complication rates.In this comprehensive review,we explore the role of CP in the treatment of lesions located in the neck and proximal body of the pancreas.展开更多
Autoimmune pancreatitis, a recently recognized type of chronic pancreatitis, is not rare in Japan, but reports of it elsewhere are relatively uncommon. We report the first preoperatively diagnosed case of autoimmune p...Autoimmune pancreatitis, a recently recognized type of chronic pancreatitis, is not rare in Japan, but reports of it elsewhere are relatively uncommon. We report the first preoperatively diagnosed case of autoimmune pancreatitis in Hungary, which responded well to steroid treatment and provided radiographic and functional evidence of this improvement. A 62-year-old female presented with a 4-month history of recurrent epigastric pain and a 5-kg weight loss. The oral glucose tolerance test （OGTT） indicated diabetes mellitus and the result of the fecal elastase test was abnormal. Ultrasonography （US） and the CT scan demonstrated a diffusely enlarged pancreas, and endoscopic retrograde cholangiopancreatography （ERCP） an irregular main pancreatic duct with long strictures in the head and tail. Autoimmune pancreatitis was diagnosed. The patient was started on 32 mg prednisolone daily, After 4 wk, the OGTT and faecal elastase test results had normalized. The repeated US and CT scan revealed a marked improvement of the diffuse pancreatic swelling, while on repeated ERCP, the main pancreatic duct narrowing was seen to be ameliorated. It is important to be aware of this disease and its diagnosis, because AIP can clinically resemble pancreatobiliary malignancies, or chronic or acute pancreatitis, However, in contrast with chronic pancreatitis, its symptoms and morphologic and laboratory alterations are completely reversed by oral steroid therapy.展开更多
文摘Objective To compare the effects of combined en bloc liver - pancreas transplantation ( LPT) with portal vein drainage and simultaneous combined kidney - pancreas transplantation ( KPT) with systemic venous drainage on the pancreatic endocrine function and related me-
文摘Benign,premalignant or low-grade malignant pancreatic tumors are increasingly diagnosed owing to the widespread uptake of cross-sectional imaging.Surgical excision is a potential treatment option for these tumors.Pancreatoduodenectomy and distal pancreatectomy are the standard resections for tumors located in the pancreatic head-neck or body-tail,respectively,and not uncommonly sacrifice a significant amount of healthy pancreatic parenchyma.Central pancreatectomy(CP)is a parenchyma-sparing procedure,initially performed by Dagradi and Serio in 1982,in a patient with pancreatic neck insulinoma.Since then,an increasing number of cases are being performed worldwide,either via open or minimally invasive surgical access.Additionally,pancreatic enucleation is reserved for tumors<3 cm,without involvement of the main pancreatic duct.CP remains an alternative approach in selected cases,albeit in the presence of some controversies,such as its use in early pancreatic ductal adenocarcinoma or metastatic deposits to the central aspect of the pancreas from other malignancies.In recent years,clarity is lacking as regards indications for CP,and despite accumulating evidence in favor of limited resections for suitable pancreatic tumors,no evidence-based consensus guidelines are yet available.Nevertheless,it appears that appropriate patient selection is of paramount importance to maximize the advantages of preservation of endocrine and exocrine pancreatic functions as well as to mitigate the risks of higher complication rates.In this comprehensive review,we explore the role of CP in the treatment of lesions located in the neck and proximal body of the pancreas.
基金Supported by ETT (5 K.503), OTKA (5 K507) and the Hungarian Academy of Sciences (BO 5/2003)
文摘Autoimmune pancreatitis, a recently recognized type of chronic pancreatitis, is not rare in Japan, but reports of it elsewhere are relatively uncommon. We report the first preoperatively diagnosed case of autoimmune pancreatitis in Hungary, which responded well to steroid treatment and provided radiographic and functional evidence of this improvement. A 62-year-old female presented with a 4-month history of recurrent epigastric pain and a 5-kg weight loss. The oral glucose tolerance test （OGTT） indicated diabetes mellitus and the result of the fecal elastase test was abnormal. Ultrasonography （US） and the CT scan demonstrated a diffusely enlarged pancreas, and endoscopic retrograde cholangiopancreatography （ERCP） an irregular main pancreatic duct with long strictures in the head and tail. Autoimmune pancreatitis was diagnosed. The patient was started on 32 mg prednisolone daily, After 4 wk, the OGTT and faecal elastase test results had normalized. The repeated US and CT scan revealed a marked improvement of the diffuse pancreatic swelling, while on repeated ERCP, the main pancreatic duct narrowing was seen to be ameliorated. It is important to be aware of this disease and its diagnosis, because AIP can clinically resemble pancreatobiliary malignancies, or chronic or acute pancreatitis, However, in contrast with chronic pancreatitis, its symptoms and morphologic and laboratory alterations are completely reversed by oral steroid therapy.
