Autoimmune Pancreatitis – Diagnosis, Management and Longterm Follow-up

2014 ◽  
Vol 23 (2) ◽  
pp. 179-185 ◽  
Author(s):  
Suvadip Chatterjee ◽  
Kofi W. Oppong ◽  
John S. Scott ◽  
Dave E. Jones ◽  
Richard M. Charnley ◽  
...  
Keyword(s):  
Autoimmune Pancreatitis ◽  
Rare Condition ◽  
Team Approach ◽  
Diagnostic Challenge ◽  
Multisystem Disorder ◽  
North East ◽  
The North ◽  
Work Up ◽  
Igg4 Level

Background & Aims: Autoimmune pancreatitis (AIP) is a fibroinflammatory condition affecting the pancreas and could present as a multisystem disorder. Diagnosis and management can pose a diagnostic challenge in certain groups of patients. We report our experience of managing this condition in a tertiary pancreaticobiliary centre in the North East of England.Methods: Patients were identified from a prospectively maintained database of patients diagnosed with AIP between 2005 and 2013. Diagnosis of definite/probable AIP was based on the revised HISORt criteria. When indicated, patients were treated with steroids and relapses were treated with azathioprine. All patients have been followed up to date.Results: Twenty-two patients were diagnosed with AIP during this period. All patients had pancreatic protocol CT performed while some patients had either MR or EUS as part of the work up. Fourteen out of 22 (64%) had an elevated IgG4 level (mean: 10.9 g/L; range 3.4 - 31 g/L). Four (18%) patients underwent surgery. Extrapancreatic involvement was seen in 15 (68%) patients, with biliary involvement being the commonest. Nineteen (86%) were treated with steroids and five (23%) required further immunosuppression for treatment of relapses. The mean follow up period was 36.94 months (range 7 - 94).Conclusion: Autoimmune pancreatitis is being increasingly recognized in the British population. Extrapancreatic involvement, particularly extrahepatic biliary involvement seems to be a frequent feature.Diagnosis should be based on accepted criteria as this significantly reduces the chances of overlooking malignancy. Awareness of this relatively rare condition and a multi-disciplinary team approach will help us to diagnose and treat this condition more efiectively thereby reducing unnecessary interventions.

Features of degenerative mitral valve prolapse in the North East of China: repair characteristics, and short-term follow-up results

2020 ◽  
Vol 68 (5) ◽  
Author(s):  
Silvia Corona ◽  
Paolo Barbier ◽  
Guangyu Liu ◽  
Osafo A. Annoh ◽  
Marcio Scorsin ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Prolapse ◽  
Short Term ◽  
North East ◽  
The North

Surgery in autoimmune pancreatitis

2021 ◽  
Author(s):  
Sara Nikolic ◽  
Poya Ghorbani ◽  
Raffaella Pozzi Mucelli ◽  
Sam Ghazi ◽  
Francisco Baldaque- Silva ◽  
...  
Keyword(s):  
Autoimmune Pancreatitis ◽  
University Hospital ◽  
Premalignant Lesions ◽  
Single Centre ◽  
Age At Surgery ◽  
Diagnostic Work ◽  
Work Up

Introduction: Autoimmune pancreatitis (AIP) is a disease that may mimic malignant pancreatic lesions both in terms of symptomatology and imaging appearance. The aim of the present study is to analyse experiences of surgery in patients with AIP in one of the largest European cohorts. Methods: We performed a single-centre retrospective study of patients diagnosed with AIP at the Department of Abdominal Diseases at Karolinska University Hospital in Stockholm, Sweden, between January 2001 and October 2020. Results: There were 159 patients diagnosed with AIP, and among them 35 (22.0%) patients had surgery: 20 (57.1%) males and 15 (42.9%) females; average age at surgery was 59 years (range 37-81). Follow-up period after surgery was 67 months (range 1-235). AIP type 1 was diagnosed in 28 (80%) patients and AIP type 2 in 7 (20%) patients. Malignant and premalignant lesions were diagnosed in 8 (22.9%) patients for whom AIP was not the primary differential diagnosis but, in all cases, it was described as a simultaneous finding and recorded in retrospective analysis in histological reports of surgical specimens. Conclusions: Diagnosis of AIP is not always straightforward, and, in some cases, it is not easy to differentiate it from the malignancy. Surgery is generally not indicated for AIP but might be considered in patients when suspicion of malignant/premalignant lesions cannot be excluded after complete diagnostic work-up.

Excavations at Alchester, 1928

1932 ◽  
Vol 12 (1) ◽  
pp. 35-67 ◽  
Author(s):  
J. H. Iliffe
Keyword(s):  
Ground Plan ◽  
North East ◽  
The North ◽  
Primary Object ◽  
External Angle ◽  
The Town ◽  
Heavy Structure

The primary object of the work of 1928 was to follow up the discovery in 1927 of the unexpectedly strong and heavy foundation underlying the north-east corner mound. As a result of this year's work it is evident that this corner mound represents some heavy structure which is best explained as a circular corner tower built into the town walls at their northeast angle; but even its foundations were so broken up that it was impossible to discover any outline or recover a complete ground plan. Oh the outside, instead of extending beyond the walls themselves, the circumference of the structure lay flush with the curved external angle of the walls, while on the inside its circumference projected slightly beyond the angle of the walls proper. It was thus rather an internal than an external tower, a fact which it is important to bear in mind.

scholarly journals Computer-assisted Follow-up Register for the North-East of Scotland

BMJ ◽  
1970 ◽  
Vol 1 (5695) ◽  
pp. 556-558 ◽  
Author(s):  
A. J. Hedley ◽  
A. M. Scott ◽  
R. D. Weir ◽  
J. Crooks
Keyword(s):  
Computer Assisted ◽  
North East ◽  
The North

Hypoglycemia

2016 ◽  
Author(s):  
Claire Douillard
Keyword(s):  
Adult Patient ◽  
Inborn Error ◽  
Inborn Errors Of Metabolism ◽  
Newly Diagnosed ◽  
Multisystem Disorder ◽  
Inborn Errors ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

Newly diagnosed hypoglycemia in an adult patient caused by a hitherto undiagnosed inborn error of metabolism is rare. However, the implications are important as follow-up and treatments may differ, especially when hypoglycemia is part of a multisystem disorder. This chapter describes the different inborn errors of metabolism that can present with or be revealed by hypoglycemia, with emphasis on the diagnostic work-up and symptoms.

scholarly journals AB0679 SKIN ULCERS IN SYSTEMIC SCLEROSIS: 10 YEARS’ FOLLOW-UP OF 211 PATIENTS FROM A MONOCENTRIC COHORT IN THE NORTH EAST OF ITALY

2019 ◽  
Author(s):  
Pamela Polito ◽  
Elisabetta Zanatta ◽  
Mara Felicetti ◽  
Maria Favaro ◽  
Mariagrazia Lorenzin ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
North East ◽  
The North ◽  
Skin Ulcers

Archaeology in Greece, 1932–1933

1933 ◽  
Vol 53 (2) ◽  
pp. 266-299 ◽  
Author(s):  
H. G. G. Payne
Keyword(s):  
Fourth Century ◽  
Sixth Century ◽  
North East ◽  
The North ◽  
Work Up

The American excavations in the Athenian Agora were resumed in February 1933, and continued till the middle of July. An account of the work up to May 1 has been published in AJA. 1933, 305 ff. The work is being carried on in four sectors (see AJA. pl. 35)The wells and cisterns cleared during the latter part of the summer of 1932 are described by Homer Thompson in AJA. 1933, 289 ff. These provide clear evidence of the existence of houses where all traces of walls and foundations have disappeared, notably along the north foot of the Areopagus and north-east of the Theseum, and their contents shew that the inhabitation of this area goes back at least to the early sixth century B.C. In some cases (wells closed in the late sixth and early fifth centuries) the pottery found in the wells seems to indicate the proximity of potters' workshops or warehouses, and pots have been found which had contained miltos. This is further proved for the fourth century by the presence of misfired vase-fragments and lamps. Several pieces of archaic pottery found in these wells are illustrated in the article mentioned above— notably a large one-piece amphora of the earliest class, decorated with a massive sphinx (loc. cit. fig. 3), and from the same shaft an exquisite plastic vase (loc. cit. fig. 5, here Pl XVI)—Ionian, or Ionising, work of about 540 B.C., and without question one of the finest of all existing plastic vases.

scholarly journals Operative results after xiphoidectomy in patients with xiphodynia

2021 ◽  
pp. 021849232110191
Author(s):  
Frank P Garssen ◽  
Margot B Aalders ◽  
Marcel J van der Poel ◽  
Wietse P Zuidema
Keyword(s):  
Response Rate ◽  
Case Series ◽  
Rare Condition ◽  
Atypical Presentation ◽  
Retrospective Case ◽  
Xiphoid Process ◽  
Operative Results ◽  
Upper Abdominal ◽  
Work Up

Background Xiphodynia, the painful xiphoid process, is a rare condition with an atypical presentation. Symptoms differ in severity and site, and can consist of chest, throat, and upper abdominal pain. Primarily, other more severe causes of these symptoms need to be excluded. After this exclusion as xiphodynia is diagnosed, treatment can consist of a multitude of options, since there is no consensus regarding the optimal treatment. The aim of this study was to describe the outcomes and efficacy of one of the options, namely surgical resection of the xiphoid in patients with xiphodynia. Methods In this retrospective case series, all consecutive patients that underwent xiphoidectomy for xiphodynia between January 2014 and December 2017 were included. Patients’ medical files including pre-operative work up, NRS scores, surgical outcomes, and follow up were reviewed. All patients received a questionnaire with follow-up questions. Results A total of 19 patients were included. None of the patients had surgery-related complications. Response rate of the questionnaire was 84% and showed that 94% of patients had an improvement of complaints after surgery, with 10 patients (63%) being totally pain free, after a mean follow-up from 34 months after surgery. Conclusions Xiphoidectomy is feasible and safe for the treatment of patients with xiphodynia with an improvement of complaints in nearly all patients.

An Analysis of Out-patient Services

1973 ◽  
Vol 122 (568) ◽  
pp. 301-306 ◽  
Author(s):  
D. A. W. Johnson
Keyword(s):  
Special Functions ◽  
Family Doctors ◽  
North East ◽  
The North ◽  
Comprehensive Information ◽  
Wide Range ◽  
Discharged Patients ◽  
Treatment And Disposal ◽  
Patient Department

The psychiatric out-patient department fulfils a comprehensive role in the diagnosis and treatment of a wide range of psychiatric disorders; it is no longer an annexe of the mental hospital principally concerned with providing follow-up and support for discharged patients. But despite the enormous growth of out-patient facilities and treatments, there have been few studies analysing the out-patient services. The Bethlem Royal and Maudsley Hospitals present detailed accounts of their out-patients, but although they serve a defined area their special functions possibly make their clientele unrepresentative. Diagnoses of out-patients in Buckinghamshire were analysed by Kessel and Shepherd (1962), but this survey gives no information about the treatment or disposal of patients. Innes and Sharp (1962) presented detailed statistics for combined inpatient and out-patients in the North East of Scotland, but did not separate the two classes of patients. The most comprehensive information concerning patients attending a hospital psychiatric out-patient department—their diagnosis, treatment and disposal—comes from Kessel and Hassall (1965 and 1971) in their evaluation of the functioning of the new Plymouth Nuffield Clinic, and from Kaeser and Cooper (1971) who investigated a group of general practitioner referrals to the Maudsley Hospital to assess the satisfaction gained by the patients and family doctors from such consultations.

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