scholarly journals Diagnosis and management of pancreatic cystic neoplasms

2019 ◽  
Vol 10 (3) ◽  
pp. 300-308 ◽  
Author(s):  
Mathew James Keegan ◽  
Bharat Paranandi
Keyword(s):  
Endoscopic Ultrasound ◽  
Clinical Guidelines ◽  
Clinicopathological Features ◽  
Evidence Based ◽  
Cystic Lesions ◽  
Cystic Neoplasms ◽  
Cross Sectional ◽  
Current Classification ◽  
Pancreatic Cystic Neoplasms

This review outlines the current classification of pancreatic cystic lesions, with a particular emphasis on pancreatic cystic neoplasms (PCNs). It will describe the diagnostic approach to PCNs, with reference to clinicopathological features, cross-sectional radiology and endoscopic ultrasound. This review will conclude with an evidence-based discussion of the management of PCNs focused on recent clinical guidelines.

scholarly journals Learning longitudinal patterns and identifying subtypes of pediatric Crohn disease treated with infliximab via trajectory cluster analysis of electronic health records

2021 ◽  
Author(s):  
Andrew Chen ◽  
Ronen Stein ◽  
Robert N. Baldassano ◽  
Jing Huang
Keyword(s):  
Electronic Health Records ◽  
Disease Activity ◽  
Crohn Disease ◽  
Cross Sectional ◽  
Health Records ◽  
Disease Evolution ◽  
Current Classification ◽  
Electronic Health ◽  
Over Time

ABSTRACTBackgroundThe current classification of pediatric CD is mainly based on cross-sectional data. The objective of this study is to identify subgroups of pediatric CD through trajectory cluster analysis of disease activity using data from electronic health records.MethodsWe conducted a retrospective study of pediatric CD patients who had been treated with infliximab. The evolution of disease over time was described using trajectory analysis of longitudinal data of C-Reactive Protein (CRP). Patterns of disease evolution were extracted through functional principal components analysis and subgroups were identified based on those patterns using the Gaussian mixture model. We compared patient characteristics, a biomarker for disease activity, received treatments, and long-term surgical outcomes across subgroups.ResultsWe identified four subgroups of pediatric CD patients with differential relapse-and-remission risk profiles. They had significantly different disease phenotype (p < 0.001), CRP (p < 0.001) and calprotectin (p = 0.037) at diagnosis, with increasing percentage of inflammatory phenotype and declining CRP and fecal calprotectin levels from Subgroup 1 through 4. The risk of colorectal surgery within 10 years after diagnosis was significantly different between groups (p < 0.001). We did not find statistical significance in gender or age at diagnosis across subgroups, but the BMI z-score was slightly smaller in subgroup 1 (p =0.055).ConclusionsReadily available longitudinal data from electronic health records can be leveraged to provide a deeper characterization of pediatric Crohn disease. The identified subgroups captured novel forms of variation in pediatric Crohn disease that were not explained by baseline measurements and treatment information.SummaryThe current classification of pediatric Crohn disease mainly relies on cross-sectional data, e.g., the Paris classification. However, the phenotypic classification may evolve over time after diagnosis. Our study utilized longitudinal measures from the electronic health records and stratified pediatric Crohn disease patients with differential relapse-and-remission risk profiles based on patterns of disease evolution. We found trajectories of well-maintained low disease activity were associated with less severe disease at baseline, early initiation of infliximab treatment, and lower risk of surgery within 10 years of diagnosis, but the difference was not fully explained by phenotype at diagnosis.

Benign and Premalignant Lesions of the Pancreas

2016 ◽  
Author(s):  
Abdurrahman Kadayifci ◽  
William R. Brugge
Keyword(s):  
Malignant Tumors ◽  
Balloon Dilation ◽  
Pancreatic Head ◽  
Premalignant Lesions ◽  
World Health ◽  
Pancreatic Tumors ◽  
Thick Wall ◽  
Cystic Lesions ◽  
Cystic Neoplasms

Pancreatic cancer is among the most aggressive human cancers, with few symptoms and clinical findings until it is detected in an advanced stage. Today, the only favorable treatment is surgical resection before progression to an invasive stage. There are a variety of benign and premalignant conditions of the pancreas that may appear similar to malignant tumors; early detection and management of those premalignant pancreatic lesions may provide a significant improvement in patient outcome. This review covers cystic neoplasms of the pancreas, premalignant solid lesions of the pancreas, and inflammatory lesions of the pancreas. Figures show a 30 mm diameter hypoechoic lesion without septae in the pancreatic head, an oval 20 mm diameter pancreatic mass with mixed solid and cystic components, a 24 mm diameter hypoechoic mass with well-defined borders in the tail of the pancreas, a 22 × 18 mm cystic lesion with a thick wall and internal debris in the head of the pancreas, and an endoscopic cyst gastrostomy after balloon dilation. Tables list World Health Organization (WHO) 2010 classification of pancreatic tumors, classification of pancreatic cystic lesions, main characteristics of common pancreatic cystic lesions, high-risk stigmata and worrisome features of intraductal papillary mucinous neoplasm on cross-sectional imaging, and WHO classification of pancreatic neuroendocrine tumors.   This review contains 5 highly rendered figures, 5 tables and 55 references

Determining when endoscopic ultrasound changes management for patients with pancreatic cystic neoplasms

2020 ◽  
Author(s):  
Hasrit Sidhu ◽  
Safia Maher ◽  
Michael S. Bleszynski ◽  
Leo Chen ◽  
Dave Farnell ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Cystic Neoplasms ◽  
Pancreatic Cystic Neoplasms

Mucinous Cystic Neoplasms of the Pancreas: How Much Preoperative Evaluation is Needed?

2010 ◽  
Vol 76 (8) ◽  
pp. 812-817 ◽  
Author(s):  
Tom P. Theruvath ◽  
Katherine A. Morgan ◽  
David B. Adams
Keyword(s):  
Operative Treatment ◽  
Endoscopic Ultrasound ◽  
Preoperative Evaluation ◽  
Mucinous Cystic Neoplasm ◽  
Cystic Neoplasm ◽  
Cystic Lesions ◽  
Mri Imaging ◽  
Diagnostic Dilemma ◽  
Cystic Neoplasms ◽  
Preoperative Workup

Cystic lesions of the pancreas are identified with increasing frequency by modern imaging. The mucinous cystic neoplasm (MCN) is treated with resection for its malignant potential. How much preoperative evaluation is needed before undertaking operation is frequently a diagnostic dilemma. A retrospective review of 32 patients who underwent resection of a MCN between 1994 and 2007 was performed to define the preoperative evaluation and operative treatment of MCN patients. Thirty-two patients (30 women; mean age 49) had histology-proven MCN. Twenty-seven patients had symptomatic cysts (84%). Five had a history of gallstones and/or acute pancreatitis. All patients were worked up with CT and/or MRI. Endoscopic ultrasound was performed in 14 (44%) and endoscopic retrograde cholangiopancreatography in six (18%). Cytology was obtained in 13 (40%). Pathology revealed 22 benign MCNs (68%), five malignant MCNs (16%), and five MCNs with borderline pathology. Preoperative workup including CT or MRI imaging and cytology suggested MCN as the lesion in 15 patients (46%). CT features by itself predicted MCN in three patients (9%). Cytology revealed another six patients (19%) with possible MCN. In this series, preoperative workup did not identify three of five patients with MCN malignancy. A preoperative diagnosis cannot be made in most patients with MCN. Operative treatment can be based on clinical presentation and CT imaging because endoscopic ultrasound and fine needle aspiration for evaluation may be misleading. Middle-aged women with cystic lesions in the tail of the pancreas without prior gallstone or pancreatitis history most typically fit the profile of the MCN patient.

Long-term follow-up of patients with incidentally discovered pancreatic cystic neoplasms evaluated by endoscopic ultrasound

Surgery ◽  
2010 ◽  
Vol 147 (1) ◽  
pp. 13-20 ◽  
Author(s):  
Nonthalee Pausawasdi ◽  
David Heidt ◽  
Richard Kwon ◽  
Diane Simeone ◽  
James Scheiman
Keyword(s):  
Endoscopic Ultrasound ◽  
Cystic Neoplasms ◽  
Long Term Follow Up ◽  
Pancreatic Cystic Neoplasms

scholarly journals Clinical guidelines «Obesity in children»

2021 ◽  
Vol 67 (5) ◽  
pp. 67-83
Author(s):  
V. A. Peterkova ◽  
O. B. Bezlepkina ◽  
N. V. Bolotova ◽  
E. A. Bogova ◽  
O. V. Vasyukova ◽  
...  
Keyword(s):  
Childhood Obesity ◽  
Clinical Guidelines ◽  
Evidence Based ◽  
Urgent Problem ◽  
Pediatric Endocrinology ◽  
Metabolic Complications ◽  
Widespread Occurrence ◽  
Modern Classification ◽  
Based Medicine

Childhood obesity is an urgent problem of pediatric endocrinology due to the widespread occurrence, the development of metabolic complications and their steady tracking into adulthood. The developed clinical guidelines are the main working tool of the practitioner. They briefly and structurally present the main information about the epidemiology and modern classification of obesity, methods of its diagnosis and treatment based on the principles of evidence-based medicine.

Sign in / Sign up

Export Citation Format

Share Document