P-P07 The incidence of Malignancy in Patients with Suspected Periampullary Tumours Who Underwent Blind Whipple Resections: A Single Institution Cross Sectional Review at King Hussein Medical Centre, Amman, Jordan

Abstract Background In this study, we evaluated the incidence of malignant and benign histopathological findings in patients undergoing blind pancreaticoduedenectomy (PD) for presumed periampullary cancer based on clinical, radiological and endoscopic findings. Methods Medical records of 29 patients who underwent pancreaticoduedenectomy at King Hussein Medical Centre were reviewed. Demographics, clinical presentation, preoperative imaging and postoperative histopathological results were analysed Results The percentage of malignancy was 82.8% and that of a benign lesion was 17.2%.All patients with benign results on final histopathology had chronic pancreatitis (100%), and all of them (100%) had abdominal pain on initial presentation. Out of all patients with periampullary malignancy, 21 (87.5%) had jaundice on initial presentation. The most important radiological correlate of malignancy is dilatation of the common bile duct greater than 6mm. Conclusions The finding of chronic pancreatitis in pancreaticoduedenectomy specimens of patients with suspected periampullary malignancy is justifiable, because none of the differences in clinical presentation or available diagnostic modalities can be reliably used to distinguish between benign versus malignant disease. Moreover, Pancreaticoduedenectomy in these patients offers the best chance for long term survival with acceptable mortality and morbidity.

Download Full-text

Diagnosis and Management of Pancreatic Adenocarcinoma in the Background of Chronic Pancreatitis: Core Issues

Digestive Diseases ◽

10.1159/000496507 ◽

2019 ◽

Vol 37 (4) ◽

pp. 315-324 ◽

Cited By ~ 7

Author(s):

Rajvilas A. Narkhede ◽

Gunjan S. Desai ◽

Pande P. Prasad ◽

Prasad K. Wagle

Keyword(s):

Chronic Pancreatitis ◽

Pancreatic Adenocarcinoma ◽

Core Biopsy ◽

Histopathological Examination ◽

False Negative ◽

Cross Sectional ◽

Term Survival ◽

Cross Sectional Imaging ◽

Sectional Imaging

Background: The incidence of pancreatic adenocarcinoma (PDAC) in patients with chronic pancreatitis (CP) is as high as 5%. It is a commonly encountered diagnostic challenge in patients with CP on long-term follow-up. Summary: This review consolidates the existing literature on assessment of PDAC in background of CP, its evaluation through the available investigations, surgical management, and prognostication. Recent change in symptomatology of an otherwise stable CP should raise a suspicion of malignancy. Endoscopic ultrasound (EUS) is more specific and sensitive in establishing the diagnosis of PDAC compared to cross-sectional imaging (computed tomography/magnetic resonance imaging). Intraoperative assessment with careful palpation coupled with careful clinical judgment helps in differentiating between an inflammatory mass and pancreatic cancer. Confirmation can be obtained with either preoperative EUS-guided fine needle cytology/core biopsy or intraoperative core biopsy under ultrasound guidance. However, despite complete evaluation with above options, 1–6% patients often show malignancy on final histopathological examination. Key Messages: Diagnosis of PDAC in CP needs a high index of suspicion. Cross-sectional imaging has poor negative predictive value. CA 19-9 with MUC5AC combination may become an ideal investigation. EUS with core biopsy/frozen section has a good sensitivity and specificity and low false negative results. Complete radical resection should be the aim to get long-term survival.

Download Full-text

Types and clinical presentation of stroke

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20201927 ◽

2020 ◽

Vol 8 (5) ◽

pp. 1784

Author(s):

Muhammad D. Khan ◽

Zeeshan Chaughtai ◽

Shaheryar Qazi ◽

Sobaan Taj ◽

Henna Pervaiz ◽

...

Keyword(s):

Blood Flow ◽

Ischemic Stroke ◽

Clinical Presentation ◽

Brain Infarction ◽

Haemorrhagic Stroke ◽

Cross Sectional Study ◽

Cross Sectional ◽

Complete Obstruction ◽

Mortality And Morbidity ◽

Causes Of Mortality

Background: Stroke is one of the leading causes of mortality and morbidity worldwide. In this study, authors worked on clinical presentation and types of stroke. The two main types of strokes are ischemic and haemorrhagic. Brain infarction is caused by decrease blood flow due to either narrowing of artery or complete obstruction to blood flow owing to embolism. While haemorrhage is caused by rupture of artery or aneurysms leading to accumulation of blood in the brain parenchyma.Methods: Cross sectional study of group of patients in Nishtar hospital Multan, Pakistan who presented with variety of neurological symptoms who were subsequently diagnosed as non-traumatic stroke. All patients were subjected to a detailed history and thorough clinical examination and investigations after obtaining informed consent.Results: Of 122 patient, 66 patients were male and 56 were female. Ischemic stroke was more common: present in 76 patients as compared to 46 patients with hemorrhagic stroke. Hypertension was present in 40.9% of ischemic stroke and 27.8% of hemorrhagic strokes. Most of the patients (67.2%) had altered sensorium at presentation followed by hemiplegia in 39.3 % of patients.Conclusions: Prevalence of ischemic strokes is higher than that of haemorrhagic stroke. Hypertension is associated with both types of these strokes. Moreover, hyperglycaemia and high blood pressure are common in early phase of stroke. Vomiting in stroke favors haemorrhagic stroke.

Download Full-text

Editorial

Swiss Surgery ◽

10.1024/1023-9332.5.3.91 ◽

1999 ◽

Vol 5 (3) ◽

pp. 91-91 ◽

Cited By ~ 1

Author(s):

Baer ◽

Seiler ◽

Büchler

Keyword(s):

Liver Resection ◽

Hepatic Resection ◽

Ct Scan ◽

Sub Saharan Africa ◽

Preoperative Imaging ◽

Term Survival ◽

Liver Remnant ◽

Mortality And Morbidity ◽

Imaging Methods ◽

Number Of Patients

Hepatocellular carcinoma (HCC) is a highly malignant tumor with a poor prognosis and an annual incidence of between 250,000 and 1.2 million cases in high risk areas, such as Southeast Asia, coastal areas of mainland China, and sub-Saharan Africa. Worldwide, it is the seventh most common cancer with the highest incidence of adult malignancy in areas endemic for then hepatitis B virus. From a clinical point of view, the number of HCC cases in Switzerland is expected to possibly increase, due to the increasing number of patients with chronic hepatitis C. The only established treatment to cure the HCC involves hepatic resection or, in selected cases, transplantation. However, the success of these operations is frequently limited due to the often-advanced stage of the tumor at the time of diagnosis. Recent advances in techniques of liver surgery, better preoperative imaging methods and therefore better patient selection have helped to lower mortality and morbidity after hepatic resection. The most frequently used imaging methods today, CT-scan and dynamic CT-scan, may be replaced by the MRI in the near future because of it's more detailed and more sensitive image of liver tumours. A still unresolved problem is the possibly life-threatening postoperative liver insufficiency caused by poor or insufficient liver remnant tissue which may occur after even limited liver resection especially in cirrhotic livers. A prevention of this problem would require a reliable preoperative assessment of the functional capacity of the liver remnant. But these functional assessments are still not satisfactory although the aminopyrin breathing test and galactose eliminating capacity test achieve remarkably good results. The clinical experience of important series of liver resection reported in this issue of Swiss Surgery for HCC from Switzerland, liver resection for HCC in cirrhotic patients from China as well as liver resection for cholangiocellular carcinomas demonstrate that the surgical procedures performed by experts today have a low mortality and morbidity rate and achieve quite remarkable long term survival results. As surgeons and physicians alike we are therefore encouraged today to resect these HCC whenever technically possible and whenever the clinical condition of the patients allow these operations.

Download Full-text

Patterns of Clinical Presentation of COVID-19 Patients in Federal Medical Centre, Asaba, Nigeria

Journal of Community Medicine and Primary Health Care ◽

10.4314/jcmphc.v33i1.10 ◽

2021 ◽

Vol 33 (1) ◽

pp. 115-127

Author(s):

A.Q. Aigbokhaode ◽

N.L. Orhue ◽

A.N. Ofili ◽

M. Oseji ◽

V.A. Osiatuma ◽

...

Keyword(s):

Clinical Presentation ◽

Close Contact ◽

Cross Sectional Study ◽

Medical Centre ◽

Cross Sectional ◽

Presenting Symptoms ◽

Global Pandemic ◽

Treatment Measures ◽

Ethical Approval ◽

Education Fever

Background: COVID-19 is a global pandemic affecting over 25 million people with more than one million deaths and having different patterns of clinical presentation. The study aimed to describe the patterns of clinical presentation of COVID-19 patients in Federal Medical Centre, Asaba, Nigeria. Methods: After obtaining an ethical approval, a facility-based retrospective cross-sectional study was carried out among 50 eligible patients in the hospital’s isolation ward. Data was collected from the patients’ case notes using a proforma to describe the epidemiological history, medical history, symptoms, signs, treatment measures and complications. Data were analyzed with Statistical Package for Social Science (SPSS) version 20 and presented as percentages, mean and standard deviation. Results: The mean age of respondents was 44.7 ± 17.3 years with slightly higher proportion of female 26 (52.0%) and majority 41 (82.0%) had tertiary level of education. Fever 29 (76.3%), followed by malaise 19 (50.0%), cough 18 (47.4%), difficulty with breathing 14 (36.8%) and headache 14 (36.8%) were the most common presenting symptoms while majority 43 (86.0%) of the respondents had mild to moderate clinical presentation. The commonest source of the infection was close contact with confirmed case 33 (66.0%). Conclusion: Mild to moderate cases of COVID-19 were more, with over two-third of the patients being symptomatic. The replication of this study in other COVID-19 treatment centers/isolation wards will aid in the better management of COVID-19 patients.

Download Full-text

Angiogenin—A Proposed Biomarker for Cardiovascular Disease—Is Not Associated With Long-Term Survival in Patients With Peripheral Artery Disease

Angiology ◽

10.1177/00033197211004393 ◽

2021 ◽

pp. 000331972110043

Author(s):

Clemens Höbaus ◽

Gerfried Pesau ◽

Bernhard Zierfuss ◽

Renate Koppensteiner ◽

Gerit-Holger Schernthaner

Keyword(s):

Peripheral Artery Disease ◽

Cox Regression ◽

Ankle Brachial Index ◽

Limb Ischemia ◽

Cross Sectional Study ◽

Enzyme Linked Immunosorbent Assay ◽

Peripheral Artery ◽

Cross Sectional ◽

Term Survival ◽

Artery Disease

We evaluated angiogenin as a prospective biomarker in peripheral artery disease (PAD) patients with and without claudication symptoms. A pilot study suggested an elevation of angiogenin in critical limb ischemia. However, in PAD patients, the predictive value of angiogenin has not yet been evaluated. For this purpose, 342 patients with PAD (age: 69 ± 10 years, 34.5% women) were followed-up for 7 years in a cross-sectional study. Angiogenin was measured by enzyme-linked immunosorbent assay. All-cause and cardiovascular mortality were analyzed by Cox regression. Angiogenin levels were higher in men ( P = .001) and were associated with patient waist-to-hip ratio ( P < .001), fasting triglycerides ( P = .011), and inversely with estimated glomerular filtration rate ( P = .009). However, angiogenin showed no association with age, characteristics of diabetes, markers of lipid metabolism, or C-reactive protein. Angiogenin did not correlate with markers of angiogenesis such as vascular endothelial growth factor, angiopoietin-2, or tie-2. Furthermore, angiogenin was not associated with PAD Fontaine stages or with patient ankle-brachial index in addition to all-cause mortality (hazard ratio [HR] = 1.09 [95% CI: 0.89-1.34]) or cardiovascular morality (HR = 1.05 [0.82-1.35]). These results suggest that angiogenin does not provide further information regarding outcome prediction in patients with PAD.

Download Full-text

Evidence for diagnosis of early chronic pancreatitis after three episodes of acute pancreatitis: a cross-sectional multicentre international study with experimental animal model

Scientific Reports ◽

10.1038/s41598-020-80532-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Péter J. Hegyi ◽

Alexandra Soós ◽

Emese Tóth ◽

Attila Ébert ◽

Viktória Venglovecz ◽

...

Keyword(s):

Acute Pancreatitis ◽

Chronic Pancreatitis ◽

Morphological Changes ◽

International Study ◽

Study Data ◽

Cross Sectional ◽

Clinical Biomarkers ◽

Stage Disease ◽

Significant Difference ◽

End Stage

AbstractChronic pancreatitis (CP) is an end-stage disease with no specific therapy; therefore, an early diagnosis is of crucial importance. In this study, data from 1315 and 318 patients were analysed from acute pancreatitis (AP) and CP registries, respectively. The population from the AP registry was divided into AP (n = 983), recurrent AP (RAP, n = 270) and CP (n = 62) groups. The prevalence of CP in combination with AP, RAP2, RAP3, RAP4 and RAP5 + was 0%, 1%, 16%, 50% and 47%, respectively, suggesting that three or more episodes of AP is a strong risk factor for CP. Laboratory, imaging and clinical biomarkers highlighted that patients with RAP3 + do not show a significant difference between RAPs and CP. Data from CP registries showed 98% of patients had at least one AP and the average number of episodes was four. We mimicked the human RAPs in a mouse model and found that three or more episodes of AP cause early chronic-like morphological changes in the pancreas. We concluded that three or more attacks of AP with no morphological changes to the pancreas could be considered as early CP (ECP).The new diagnostic criteria for ECP allow the majority of CP patients to be diagnosed earlier. They can be used in hospitals with no additional costs in healthcare.

Download Full-text

Evaluation of Cancer Patients with Older Adult for Awareness and Hospital Arrival Process of COVID-19 Pandemic During: A Cross-Sectional Study

Gerontology and Geriatric Medicine ◽

10.1177/2333721421997666 ◽

2021 ◽

Vol 7 ◽

pp. 233372142199766

Author(s):

Zeynep Sipahi Karslı ◽

Berna Kurt ◽

İbrahim Karadağ ◽

Berna Çakmak Öksüzoğlu

Keyword(s):

Cancer Patients ◽

Older Adult ◽

Cross Sectional Study ◽

Arrival Process ◽

Cross Sectional ◽

Protective Measures ◽

Hospital Arrival ◽

Mortality And Morbidity ◽

Correlational Design ◽

Study Results

The study aimed to evaluate the Coronavirus pandemic awareness of cancer patients ≥65 years of age, considered a vulnerable group, and their hospital arrival process, follow-ups and treatments during the pandemic. COVID-19 pandemic was found to increases the mortality and morbidity rates of individuals who aged 65 years and older. The research was conducted with a cross-sectional descriptive correlational design. The sample consist of 77 cancer patients aged 65 years and older adult. Participants were recruited through convenience sampling. In total, 77 patients from the Oncology Hospital located in Ankara from April 29, 2020 to May 20, 2020. Data were collected using a two-part form and a questionnaire. The study was undertaken in accordance with the STROBE checklist for observational studies. Of the participants, 59.7% were female, the mean age was 70 years, 79.2% resided in Ankara and 98.7% traveled to the hospital by car. Looking at the gender and the protective measures taken at home, female participants were found to perform a statistically significant higher level of protective measures. In conclusion, the study results suggest that the restrictions for older adult oncology patients during the pandemic did not negatively affect the delivery of health care.

Download Full-text

Occurrence, associated risk factors, and treatment of surgical site infections in Pakistan

European Journal of Inflammation ◽

10.1177/2058739220960547 ◽

2020 ◽

Vol 18 ◽

pp. 205873922096054

Author(s):

Faiz Ullah Khan ◽

Yu Fang ◽

Zakir Khan ◽

Farman Ullah Khan ◽

Zafar Iqbal Malik ◽

...

Keyword(s):

Risk Factors ◽

Transurethral Resection ◽

Surgical Site Infections ◽

Exploratory Laparotomy ◽

Cross Sectional Study ◽

Surgical Patients ◽

Related Factors ◽

Cross Sectional ◽

Mortality And Morbidity ◽

Associated Risk Factors

Globally, surgical site infections are one of the common infections which lead to a large amount of mortality and morbidity in postsurgical care. The risk for surgical site infection is multidimensional which includes mainly; patient, surgery, and hospital-related factors. This study is aimed to determine the burden of SSIs along with contributed risk factors. A prospective observational cross-sectional study was conducted in one of the largest public-sector hospitals in Pakistan. A total of 412 patients were recruited in the study with full consent and monitored for 30 days after surgery with direct and indirect surveillance. Overall, in seven different surgical procedures the incidence (29.8%) rate of SSI was observed; in appendectomy ( n = 17, 4.1%), exploratory laparotomy ( n = 51, 12.6%), laparoscopic cholecystectomy ( n = 12, 2.90%), mesh repair ( n = 17, 4.01%), thyroidectomy (5, 1.2%), transurethral resection of the prostate ( n = 11, 2.6%), and transurethral resection of the bladder (10, 2.4%). The average SSI rate in every single procedure was about 18 (4.27%) per surgical procedure out of 123 (29.85%) SSI cases. Types of SSI identified were superficial, deep incisional and organ/space ( n = 76, 18.4%, n = 23, 5.5%, and n = 24, 5.7%). Incidence of SSIs during admission, at readmission, and post-surveillance cases were ( n = 50, 12.1%, n = 25, 6.0% and n = 48, 11.6%). Associated risk factors found contributed to the incidence of SSI ( p < 0.05). Pre-operative ( n = 348, 84.5%) and 6 (1.5%) surgical patients did not received the post-operative antibiotics. The P. aeruginosa ( n = 15, 12.1%) and S. aureus (13, 10.5%). Cefoperazone and sulbactam were the most prescribed antibiotics. Associated risk factors and treatment outcomes of surgical patients have a direct association with the incidence of SSI. Hospital-based antimicrobial stewardship, implementation of surgical guidelines, patient care, and education are needed to develop at wards level in hospitals.

Download Full-text

Long‐term survival after resection for non‐pancreatic periampullary cancer followed by adjuvant intra‐arterial chemotherapy and concomitant radiotherapy

HPB ◽

10.1111/hpb.12401 ◽

2015 ◽

Vol 17 (7) ◽

pp. 573-579 ◽

Cited By ~ 4

Author(s):

Joris I. Erdmann ◽

Marjolein J.M. Morak ◽

Hugo J. Duivenvoorden ◽

Herman van Dekken ◽

Geert Kazemier ◽

...

Keyword(s):

Periampullary Cancer ◽

Term Survival ◽

Long Term Survival ◽

Concomitant Radiotherapy

Download Full-text

Surgery Combined With Peritonectomy Procedures and Intraperitoneal Chemohyperthermia in Abdominal Cancers With Peritoneal Carcinomatosis: A Phase II Study

Journal of Clinical Oncology ◽

10.1200/jco.2003.06.139 ◽

2003 ◽

Vol 21 (5) ◽

pp. 799-806 ◽

Cited By ~ 183

Author(s):

O. Glehen ◽

F. Mithieux ◽

D. Osinsky ◽

A.C. Beaujard ◽

G. Freyer ◽

...

Keyword(s):

Peritoneal Carcinomatosis ◽

Phase Ii ◽

Phase Ii Study ◽

Complete Resection ◽

Morbidity Rate ◽

Term Survival ◽

Mortality And Morbidity ◽

Peritonectomy Procedures ◽

Experienced Team

Purpose: To evaluate the tolerance of peritonectomy procedures (PP) combined with intraperitoneal chemohyperthermia (IPCH) in patients with peritoneal carcinomatosis (PC), a phase II study was carried out from January 1998 to September 2001. Patients and Methods: Fifty-six patients (35 females, mean age 49.3) were included for PC from colorectal cancer (26 patients), ovarian cancer (seven patients), gastric cancer (six patients), peritoneal mesothelioma (five patients), pseudomyxoma peritonei (seven patients), and miscellaneous reasons (five patients). Surgeries were performed mainly on advanced patients (40 patients stages 3 and 4 and 16 patients stages 2 and 1) and were synchronous in 36 patients. All patients underwent surgical resection of their primary tumor with PP and IPCH (with mitomycin C, cisplatinum, or both) with a closed sterile circuit and inflow temperatures ranging from 46° to 48°C. Three patients were included twice. Results: A macroscopic complete resection was performed in 27 cases. The mortality and morbidity rates were one of 56 and 16 of 56, respectively. The 2-year survival rate was 79.0% for patients with macroscopic complete resection and 44.7% for patients without macroscopic complete resection (P = .001). For the patients included twice, two are alive without evidence of disease, 54 and 47 months after the first procedure. Conclusion: IPCH and PP are able to achieve unexpected long-term survival in patients with bulky PC. However, one must be careful when selecting the patients for such an aggressive treatment, as morbidity rate remains high even for an experienced team.

Download Full-text