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pancreatitis advances in management

Guru Trikudanathan, Daan Wolbrink, Hjalmar van Santvoort, Shawn Mallery, Martin Freeman, Marc Besselink
The incidence of acute pancreatitis continues to rise, inducing substantial medical and social burden, with annual costs exceeding two billion dollars in the USA alone. Although the majority of patients develop mild pancreatitis, 20% develop severe and/or necrotizing pancreatitis, requiring advanced medical and interventional care. Morbidity resulting from local and systemic complications as well as invasive interventions result in mortality rates historically as high as 30%. There has been substantial evolution of strategies for interventions in recent years, from open surgery to minimally invasive surgical and endoscopic step-up approaches...
February 15, 2019: Gastroenterology
Mohamad Bassam Sonbol, Daniel H Ahn, David Goldstein, Takuji Okusaka, Josep Tabernero, Teresa Macarulla, Michele Reni, Chung-Pin Li, Bert O'Neil, Eric Van Cutsem, Tanios Bekaii-Saab
Napabucasin (also known as BBI-608 or BBI608) is an investigational, oral agent hypothesized to inhibit multiple oncogenic pathways. In this article, we describe the design and rationale for the CanStem111P clinical trial, a multicenter, randomized, open-label, Phase III study designed to determine the efficacy and safety of combining napabucasin with nab-paclitaxel and gemcitabine for first-line treatment of patients with metastatic pancreatic adenocarcinoma (NCT02993731). Patients were randomized in a 1:1 fashion to receive weekly gemcitabine and nab-paclitaxel with or without napabucasin...
February 15, 2019: Future Oncology
Mahya Faghih, Christopher Fan, Vikesh K Singh
PURPOSE OF REVIEW: Despite the increasing incidence of acute pancreatitis, the overall mortality of AP has decreased. RECENT FINDINGS: The findings of recent studies on fluid therapy, analgesics, antibiotics, and enteral nutrition as well as the management of AP complications have led to improvements in clinical care. However, there are still no pharmacologic treatment(s) for AP. Experimental studies have revealed many potential therapeutic targets, but these will need to be further developed and tested before they can be assessed in randomized controlled trials with important clinical endpoints...
January 30, 2019: Current Treatment Options in Gastroenterology
Katherine A Baugh, Nicole Villafane, Carlos Farinas, Sadhna Dhingra, Eric J Silberfein, Nader N Massarweh, H Tran Cao, William E Fisher, George Van Buren
BACKGROUND: Identification of incidental pancreatic lesions is increasing because of advancements in imaging. Diagnosis remains a challenge for clinicians, with intrapancreatic accessory spleens (IPAS) posing a unique dilemma. IPAS are frequently resected because of inability to exclude alternate diagnoses, subjecting patients to unnecessary risk. The purpose of this study was to examine our institutional experience with IPAS and develop a multidisciplinary algorithm to improve preoperative diagnosis...
December 17, 2018: Journal of Surgical Research
Scott A Soefje
Pancreatic cancer is typically diagnosed in the late stage of the disease, making it the fourth leading cause of cancer-related death in the United States. It is also one of the few cancers with an increasing incidence, particularly in the younger population. By 2030, it is expected to become the second leading cause of cancer-related death. Patients with pancreatic cancer encounter monthly medical costs 15 times higher than those without, with costs highest in the later stages of the disease. Treatments for pancreatic cancer include surgery (available to fewer than 20% of newly diagnosed patients) and, for advanced disease, chemotherapy with gemcitabine with nab-paclitaxel or FOLFIRINOX, which can increase overall survival (OS) by a few months...
January 2019: American Journal of Managed Care
Wolfgang Huber, Hana Algül, Tobias Lahmer, Ulrich Mayr, Miriam Lehmann, Roland M Schmid, Andreas Faltlhauser
BACKGROUND: Acute pancreatitis (AP) usually has a mild course with a mortality rate below 1%. However, around 10% of patients develop severe AP (SAP) involving extra-pancreatic tissues and other organ systems. The mortality of SAP is around 42%. The outcome of SAP is closely related to the development of systemic inflammation and consecutive organ failures. Most current therapies including fluid resuscitation, antimicrobial therapy, drainage procedures, and endoscopic management of complications are symptomatic rather than causative approaches, except sphincterotomy for gallstone pancreatitis...
January 2019: Medicine (Baltimore)
Maryam Rameshrad, Bibi Marjan Razavi, Gordon A A Ferns, Hossein Hosseinzadeh
OBJECTIVES: Despite advances in our understanding of metabolic syndrome (MetS) and the treatment of each of its components separately, currently there is no single therapy approved to manage it as a single condition. Since multi-drug treatment increases drug interactions, decreases patient compliance and increases health costs, it is important to introduce single therapies that improve all of the MetS components. EVIDENCE ACQUISITION: We conducted a PubMed, Scopus, Google Scholar, Web of Science, US FDA, utdo...
January 23, 2019: Daru: Journal of Faculty of Pharmacy, Tehran University of Medical Sciences
Rei Suzuki, Tadayuki Takagi, Takuto Hikichi, Mitsuru Sugimoto, Naoki Konno, Hiroyuki Asama, Ko Watanabe, Jun Nakamura, Shigeru Marubashi, Hiromasa Ohira
Pancreatic ductal adenocarcinoma (PDAC) is characterized by an aggressive course; therefore, it was hypothesized that waiting times during disease management may serve as a prognostic factor for patients with PDAC. Data for all patients with PDAC who received treatment in Fukushima Medical University Hospital were collected. Median disease-free survival and overall survival time were calculated using the Kaplan-Meier method and utilized as cut-off points to divide the patients into 2 groups: A short and a long survival group...
January 2019: Oncology Letters
Subrat Kumar Bhattamisra, Tiew Chin Siang, Chieng Yi Rong, Naveenya Chetty Annan, Esther Ho Yung Sean, Lim Wen Xi, Ong Siu Lyn, Liew Hui Shan, Hira Choudhury, Manisha Pandey, Bapi Gorain
BACKGROUND: The incidence of diabetes is increasing steeply; the number of diabetics has doubled over the past three decades. Surprisingly, the knowledge of type 3c diabetes mellitus (T3cDM) is still unclear to the researchers, scientist and medical practitioners, leading towards erroneous diagnosis, which is sometimes misdiagnosed as type 1 diabetes mellitus (T1DM), or more frequently type 2 diabetes mellitus (T2DM). This review is aimed to outline recent information on the etiology, pathophysiology, diagnostic procedures, and therapeutic management of T3cDM patients...
January 15, 2019: Current Diabetes Reviews
Sang Myung Woo, Mi Kyung Song, Meeyoung Lee, Jungnam Joo, Dae Hyun Kim, Jong-Heun Kim, Sung-Sik Han, Sang-Jae Park, Tae Hyun Kim, Woo Jin Lee
Background: The present study assessed whether early palliative care (EPC) targeting pain and depression and automated symptom monitoring could improve symptoms in patients with advanced pancreatobiliary cancer. Methods: Patients diagnosed with pathologically confirmed locally advanced or metastatic pancreatic or biliary tract cancer who had cancer-related pain (brief pain inventory (BPI) worst pain score >3) and/or depression (Center for Epidemiological Studies-Depression Scale (CES-D) >16) were randomized within 8 weeks after diagnosis to receive EPC or on-demand palliative care ( n = 144 each)...
January 11, 2019: Cancers
Piera Gargiulo, Daniel Dietrich, Richard Herrmann, György Bodoky, Thomas Ruhstaller, Werner Scheithauer, Bengt Glimelius, Simona Berardi, Sandro Pignata, Peter Brauchli
Background: The prognosis of advanced pancreatic cancer (APC) is poor and differs considerably among patients. Therefore, it is clinically relevant to identify patients with APC who are more likely to benefit from palliative chemotherapy with reduced risk of toxicity. To date, there is no prognostic score universally recommended to help clinicians in planning the therapeutic management. Methods: Using individual patient data from 319 cases of APC treated with gemcitabine-based chemotherapy and enrolled in the SAKK 44/00-CECOG/PAN...
2019: Therapeutic Advances in Medical Oncology
Adnan Salim, Sadia Jabbar, Farhan Ul Amin, Kashif Malik
BACKGROUND: Obstructive jaundice due to malignancies of the biliary tree, gall bladder and pancreas account for a significant number of patients managed by tertiary centres. Management options are curative or palliative, depending on disease stage. This study was performed to see the effectiveness of treatment modalities for these patients and eventual outcome. METHODS: This cross-sectional analytical study was conducted at the Department of Gastroenterology and Hepatology, Shaikh Zayed Hospital Lahore, from January 2015 to June 2016...
October 2018: Journal of Ayub Medical College, Abbottabad: JAMC
Alexandros Papalampros, Michail G Vailas, Ioanna Deladetsima, Demetrios Moris, Maria Sotiropoulou, Athanasios Syllaios, Athanasios Petrou, Evangelos Felekouras
BACKGROUND: Primary pancreatic leiomyosarcoma is an extremely rare entity that needs high clinical suspicion in order to diagnose it at an early stage. Clinical characteristics, diagnosis, and management still remain challenging and controversial, especially in advanced stages, when tumor invades adjacent vessels and organs or gives distant metastases. CASE PRESENTATION: Herein, we describe a case of a 57-year-old woman suffering from advanced pancreatic leiomyosarcoma with thrombosis of the superior mesenteric vein, as well as liver lesions which were suspicious for metastasis...
January 5, 2019: World Journal of Surgical Oncology
Giorgio Sesti, Angelo Avogaro, Sara Belcastro, Benedetta Maria Bonora, Marina Croci, Giuseppe Daniele, Marco Dauriz, Francesco Dotta, Caterina Formichi, Simona Frontoni, Cecilia Invitti, Emanuela Orsi, Fabiana Picconi, Veronica Resi, Enzo Bonora, Francesco Purrello
Achieving and maintaining recommended glycemic targets without causing adverse e ffects, including hypoglycemia, is challenging, especially in older patients with type 2 diabetes mellitus (T2DM). The introduction of dipeptidyl peptidase-4 (DPP-4) inhibitors, more than 10 years ago, has provided an alternative to conventional medications for the intensification of glucose-lowering treatment after failure of metformin monotherapy, and therefore, marked an important advance in the management of T2DM. By prolonging the activity of incretin hormones, DPP-4 inhibitors induce insulin release and decrease glucagon secretion in a glucose-dependent manner...
January 2, 2019: Acta Diabetologica
Adriana Blakaj, Stacey M Stein, Sajid A Khan, Kimberly L Johung
Pancreatic cancer is characterized by a high rate of metastatic spread and overall poor prognosis. Yet 30% of patients have progressive local disease at the time of death, and local progression can cause significant morbidity. Approximately 30-40% of patients present with locally advanced pancreatic cancer (LAPC) that is not surgically resectable, and the optimal treatment for these patients continues to evolve. The role of radiation in the management of LAPC is an area of controversy, and the recent LAP07 randomized trial reported no survival benefit of radiation following gemcitabine plus or minus erlotinib...
December 2018: Journal of Gastrointestinal Oncology
John Ramage, Boris G Naraev, Thorvardur R Halfdanarson
177 Lu-DOTATATE peptide receptor radionuclide therapy (PRRT) is now approved for patients with advanced gastroenteropancreatic neuroendocrine tumors (NET), and it is therefore important to understand the efficacy and safety of PRRT in this patient population. PRRT efficacy and safety outcomes have frequently been summarized for patient populations with gastroenteropancreatic NET, but not specifically in patients with pancreatic NET (panNET). The pivotal phase 3 trial of 177 Lu-DOTATATE PRRT in NET was restricted to patients with a midgut primary site...
August 2018: Seminars in Oncology
Xinzhe Yu, Jichun Gu, Haoxuan Wu, Deliang Fu, Ji Li, Chen Jin
Purpose: Nonsurgical therapies, including biotherapy, chemotherapy, and liver-directed therapy, provided a limit survival benefit for PNET patients with hepatic metastases. With the development of liver resection technique, there was a controversy on whether to perform a liver resection for these patients. Methods: A computerized search was made of the Medline/PubMed, EMbase, Cochrane Library, and SinoMed (CBM) before March 2018. A meta-analysis was performed to investigate the differences in the efficacy of liver resection and nonliver resection treatments based on the evaluation of morbidity, 30-day mortality, symptom relief rate, and 1-, 3-, and 5-year survival...
2018: Journal of Oncology
E González-Flores, R Serrano, I Sevilla, A Viúdez, J Barriuso, M Benavent, J Capdevila, P Jimenez-Fonseca, C López, R Garcia-Carbonero
NENs are a heterogeneous family of tumors of challenging diagnosis and clinical management. Their incidence and prevalence continue to rise across all sites, stages and grades. Although improved diagnostic techniques have led to earlier detection and stage migration, the improved prognosis documented over time for advanced gastrointestinal and pancreatic neuroendocrine tumors also reflect improvements in therapy. The aim of this guideline is to update practical recommendations for the diagnosis and treatment of gastroenteropancreatic and lung NENs...
December 7, 2018: Clinical & Translational Oncology
Roxanne L Massoumi, O Joe Hines, Guido Eibl, Jonathan C King
The last 5 years have seen a dramatic increased interest in the field of exosome biology. Although much is unknown about the role of exosomes in human health and disease, disparate scientific disciplines are recognizing the highly conserved role that exosomes play in fundamental biological processes. Recently, there have been intriguing discoveries defining the role of exosomes in cancer biology. We performed a structured review of the English-language literature using the PubMed database searching for articles relating to exosomes and pancreatic ductal adenocarcinoma (PDAC)...
January 2019: Pancreas
Jichun Yang, Long Jiang Zhang, Fan Wang, Tianpei Hong, Zhaofei Liu
Diabetes is a chronic non-communicable disease affecting over 400 million people worldwide. Diabetic patients are at a high risk of various complications, such as cardiovascular, renal, and other diseases. The pathogenesis of diabetes (both type 1 and type 2 diabetes) is associated with a functional impairment of pancreatic β-cells. Consequently, most efforts to manage and prevent diabetes have focused on preserving β-cells and their function. Advances in imaging techniques, such as magnetic resonance imaging, magnetic resonance spectroscopy, positron emission tomography, and single-photon-emission computed tomography, have enabled noninvasive and quantitative detection and characterization of the population and function of β-cells in vivo...
December 5, 2018: Advanced Drug Delivery Reviews
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