Pancreatic carcinoma Diagnostic and prognostic implications of a normal pancreatogram

Hewitt, Peter; Beningfield, Steve; Bornman, P. C.; Wyk, M. E. C. van; Terblanche, J.

doi:10.1007/s004649900731

Cited by 9 publications

(6 citation statements)

References 11 publications

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“…LVSS utilizes a new bipolar technology for vascular sealing with a higher current and lower voltage as compared to conventional electrocautery. The system has the ability to regulate output based on the particular kind of tissue and stop automatically in order to minimize the effect on surrounding tissue [13] , [14] . Transmission of heat to the surrounding tissue occurs within a distance of 1.0 to 1.5 mm [13] .…”

Section: Discussionmentioning

confidence: 99%

“…The system has the ability to regulate output based on the particular kind of tissue and stop automatically in order to minimize the effect on surrounding tissue [13] , [14] . Transmission of heat to the surrounding tissue occurs within a distance of 1.0 to 1.5 mm [13] . Its use has already been authorized by the US Food and Drugs Administration for all general surgery and urological operations as well as most gynecological procedures [7] - [9] .…”

Section: Discussionmentioning

confidence: 99%

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A single institution experience using the LigaSure vessel sealing system in video-assisted thoracoscopic surgery for primary spontaneous pneumothorax

Li¹,

Chen²,

Wang³

et al. 2014

J Biomed Res

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This study sought to report our 6-year experience with the LigaSure vessel sealing system (LVSS) in video-assisted thoracoscopic surgery (VATS) for primary spontaneous pneumothorax. A series of 180 consecutive patients with primary spontaneous pneumothorax were operated on in our institution from May 2005 to December 2010. Intraoperatively, large lesions (bullae or blebs) with a diameter more than 2 cm were resected by staplers, and the residual lesions were treated by LVSS. LVSS was also used to ablate the apical area when no lesions were found. Conventional apical pleural abrasion was done in all cases. All patients were successfully treated using VATS with minimal perioperative bleeding. The mean operating time was 76 minutes (range, 43–160 minutes) for single-side procedures and 169 minutes (range, 135–195 minutes) for bilateral procedures, the mean number of applied staples was 1.93 per patient (range, 0–8 days), the duration of drainage was 3.8 days (range, 2–15 days), and the duration of hospital stay was 5.8 days (range, 3–16 days). Postoperative complications included persistent air leak (> 5 days) in 11 cases (6.1%) and residual pneumothorax in 6 (3.3%). None required reoperation. The mean duration of follow-up was 57 months (range, 24–105 months). Recurrence was seen in three cases (1.7%), and all underwent another operation thereafter. None of the lesions in the relapse cases received ablation with LVSS in the first operation. LVSS can optimize VATS for primary spontaneous pneumothorax and reduces the use of single-use staples. The method is safe, easy to use, and cost-effective and produces satisfactory results.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A single institution experience using the LigaSure vessel sealing system in video-assisted thoracoscopic surgery for primary spontaneous pneumothorax

Li¹,

Chen²,

Wang³

et al. 2014

J Biomed Res

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“…Most of the patients with pancreatic duct disrup tion were managed without surgery. Hewitt et al [49] ana lyzed 30 cases of pancreatic carcinoma with normal ERCP. In 15 cases, the initial interpretation of pancreatogram was found to be incorrect.…”

Section: Miscellaneousmentioning

confidence: 98%

Diagnostic Endoscopic Retrograde Cholangiopancreatography

Ponchon¹

2000

Endoscopy

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The importance of diagnostic endoscopic retrograde cholangiography (ERCP) has dramatically decreased owing to the development of less invasive techniques such as ultrasonography, computed tomography, endoscopic ultrasonography, and finally magnetic resonance cholangiopancreatography (MRCP). MRCP is becoming the gold standard in the diagnostic work-up of the pancreaticobiliary duct. However, MRCP cannot solve all the problems that occur, and still has inadequate resolution for small stones and tiny pancreatic and bile duct lesions. ERCP continues to be useful in difficult cases and when the diagnosis is uncertain, particularly when fluid collection and tissue sampling are necessary. However, several alternatives to sphincter of Oddi manometry have been proposed. Finally, ERCP is always the first step before endoscopic treatment, which in contrast to diagnostic ERCP is still widely used.

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“…This involvement, particularly complete obstruction, in turn often results in upstream (prestenotic) dilatation of the MPD, and detection of MPD dilatation as well as demonstration of the pancreatic mass per se in cross‐sectional images, such as obtained by ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI), are clues to the diagnosis of pancreatic carcinomas. Carcinomas with mild MPD stenosis or without MPD involvement, however, are not associated with MPD dilatation 3,4 . Moreover, some pancreatic head carcinomas do not present with upstream MPD dilatation despite complete MPD obstruction, but this unique type of pancreatic carcinoma has not been well documented.…”

Section: Introductionmentioning

confidence: 99%

“…Carcinomas with mild MPD stenosis or without MPD involvement, however, are not associated with MPD dilatation. 3,4 Moreover, some pancreatic head carcinomas do not present with upstream MPD dilatation despite complete MPD obstruction, but this unique type of pancreatic carcinoma has not been well documented. In this study, we analyzed pancreatograms obtained by ERCP in pancreatic head carcinomas to investigate the incidence of the unique type of pancreatic carcinoma and to clarify the mechanism of the paradoxical pancreatograms.…”

Section: Introductionmentioning

confidence: 99%

Pancreatic carcinoma that completely obstructs the Wirsung duct without dilatation of the main pancreatic duct

Sugiyama¹,

Izumisato²,

Abe³

et al. 2006

J of Gastro and Hepatol

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Background and Aim: Pancreatic carcinomas in which the main pancreatic duct (MPD) is completely obstructed are almost always associated with dilatation of the upstream MPD. However, some carcinomas are not associated with MPD dilatation despite complete MPD obstruction. This paradoxical phenomenon has not been well documented. Methods: The findings from endoscopic retrograde cholangiopancreatography in 207 cases of pancreatic head carcinomas were analyzed with special reference to this unique type of carcinoma. Twenty-five of the patients were found to exhibit no MPD dilatation on ultrasonography, computed tomography or magnetic resonance imaging. Results: Pancreatography via the major papilla showed complete obstruction of the MPD (112 patients with MPD dilatation and 6 without), stenosis (70 and 10, respectively), or no abnormal findings (0 and 9, respectively). In all six patients with complete MPD obstruction but without upstream MPD dilatation, injection of the minor papilla revealed a nondilated dorsal pancreatic duct. The size of the obstructive carcinomas with and without MPD dilatation was comparable. Conclusions: Some (3%) pancreatic head carcinomas are not associated with MPD dilatation despite complete obstruction of the Wirsung duct. In such cases, the Santorini duct drains the dorsal pancreatic duct, completely compensating for the obstructed Wirsung duct. Attention should be paid to this unique type of carcinoma in diagnosing pancreatic head carcinomas.

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Pancreatic carcinoma Diagnostic and prognostic implications of a normal pancreatogram

Abstract: A normal pancreatogram does not exclude the diagnosis of pancreatic cancer, nor does it confer a better prognosis.

Cited by 9 publications

References 11 publications

A single institution experience using the LigaSure vessel sealing system in video-assisted thoracoscopic surgery for primary spontaneous pneumothorax

A single institution experience using the LigaSure vessel sealing system in video-assisted thoracoscopic surgery for primary spontaneous pneumothorax

Diagnostic Endoscopic Retrograde Cholangiopancreatography

Pancreatic carcinoma that completely obstructs the Wirsung duct without dilatation of the main pancreatic duct

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