Pancreatic duct stones and laser treatment: A case report

A 62 years-old Caucasian male, who had a consumptive condition associated with recurrent episodes of abdominal pain, was evaluated in a Gastroenterology consultation. Physical examination was quite innocent and the following imaging exams were performed. A Computed Tomography (CT) showed a thin gallbladder and chronic pancreatitis signs with pancreatic intraductal stones, dominant at tail and body, associated with pancreatic tail atrophy. An abdominal-Magnetic Resonance Imaging (MRI) showed an abnormal pancreatic parenchyma, a mild Wirsung dilatation and an unknown pancreatic head stenosis etiology. Therefore, to clarify the pancreatic stenosis, an echo-endoscopy (EUS) was performed. This exam showed a 10-mmstone associated with a focal narrowing in the head/tail transition. A pancreatoscopy-guided holmium laser using a mini-endoscope inserted into the pancreatic duct successfully broke the impacted stone and cleared the obstruction, without complications. After that, endotherapy with plastic stents was repeatedly done, during the following 6 months. After endoscopic treatment, the patient recovered quite well, without any symptoms, without pancreatic stenosis and higher quality of life.

Role of SCO-792, A Novel Enteropeptidase Inhibitor, In the Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

Acute pancreatitis is the most common iatrogenic dilemma of endoscopic retrograde cholangiopancreatography, and it is associated with significant morbidity and mortality. Several factors have been implicated in the pathogenesis of post-endoscopic retrograde cholangiopancreatography pancreatitis, and preventive measures were practiced accordingly. This study aims to refine the potential mechanisms that trigger post-endoscopic retrograde cholangiopancreatography pancreatitis and define the role of enteropeptidase in the pathogenesis of post-endoscopic retrograde cholangiopancreatography pancreatitis. Furthermore, address the role of a new novel medication known as SCO-792, a potent enteropeptidase inhibitor, in the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis.Post-endoscopic retrograde cholangiopancreatography pancreatitis is caused by premature activation of the pancreatic enzymes within the pancreatic parenchyma. This activation is either an autoactivation due to direct provocation of intra-acinar enzymes as a result of the procedure or due to activation by enterpeptidase, a rate-limiting enzyme. Endoscopic retrograde cholangiopancreatography interjects duodenal juice that is rich in enterokinase into the pancreatic-biliary tract, which in turn leads to intra-ductal activation of trypsinogen and subsequent enzymes. Given the vital role of enterokinase in initiating the pathogenesis of pancreatitis, enteropeptidase inhibition may prevent and reduce the severity of post-endoscopic retrograde cholangiopancreatography pancreatitis.SCO-792, a novel enteropeptidase inhibitor, is developed by SCOHIA Pharma, and pre-clinical trials confirmed its efficacy in inhibiting enteropeptidase. Studies are needed to confirm the efficacy of enteropeptidase inhibitors in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis.

STRUCTURAL FEATURES OF THE PANCREAS IN PATIENTS WITH VARIOUS CLINICAL AND MORPHOLOGICAL FORMS OF CHRONIC PANCREATITIS

The article presents the results of our own studies of structural changes in the pancreas according to computed tomography data in patients with various clinical and morphological forms of the disease. It was shown that the identification of structural changes in the pancreatic parenchyma using computed tomography with contrast (calcifications and calcifications, pancreatic cysts, fibrosis, expansion of pancreatic ducts) is a reliable confirmation of the diagnosis of chronic pancreatitis and allows to determine clinical and morphological form of the disease. Severe structural changes in the pancreatic parenchyma were found in 71.8% of the examined patients, in 18.5% of patients - moderate, in 8.7% - mild.

Weight and histopathological changes in pancreas in alleged suicide cases

Pancreas will respond differently to stress situations, which results in histopathological changes in the gland. Glucagon and insulin are both secreted by pancreas, the former by alpha cells and latter by beta cells. Insulin may decrease during stress. These endocrine secretions enter the portal vein so that liver is exposed to high concentration of these hormones. This along with increase in its antagonistic hormones can contribute to the stressed induced hyperglycaemia. The aim is to find and compare the weight and histopathological changes of Pancreas in suicide and non suicide deaths. The pancreas were dissected during the autopsy from the cases with known history of death due to alleged suicide with clear history of non administration of steroids and was declared brought dead at GMCH, Chandigarh. The removed glands were preserved and fixed with 10% formalin for more than 2 weeks. After the period of fixation, grossing and section of gland was done, and slides of each subject was prepared and studied.In suicide group maximum weight is 78.2 grams and minimum is 67.3 grams. In non suicide maximum weight is 78.2 grams and minimum is 65.5 grams. The mean weight of the pancreas in the suicidal group was 71.27 grams and the standard deviation was 2.18 grams, whereas the mean weight of the pancreas in the non- suicidal group was 70.87 grams and the standard deviation was 2.63 grams. The P value comes out to be 0.41. Of the total 100 cases, only three (3%) revealed significant pathological findings and the rest 97 (97%) were histologically normal. In the study group there was one case each of pancreatic abscess, and necrotising pancreatitis. Pancreatitis abscess was diagnosed when the histology revealed focus of necrosis of the pancreatic parenchyma with dense neutrophilic infiltration. Necrotising pancreatitis showed extensive necrotising inflammation of the pancreatic parenchyma. In the control group there was only 1 case (2%), of chronic pancreatitis. Chronic pancreatitis was labelled when fibrosis of the pancreatic parenchyma with mild lymphomononuclear cell infiltration. There was no significant difference between the weight of the pancreas in the suicidal and the non-suicidal group. Pathological findings were twice as common in the suicidal group as compared to the non-suicidal group.

Quantitative changes in the microstructure of the pancreas under the influence of sublethal dehydration, subsequent readaptation and correction

Dehydration is a pathological condition caused by insufficient water intake and is accompanied by metabolic disorders that have significant consequences for human health and performance. The endocrine system takes part in a number of functions of the water exchange system, optimizing body fluid volume. In the literature, there is no systematic data on changes in the pancreas under conditions of various types of dehydration. This article is devoted to the study of structural changes in the pancreas in conditions of sublethal degrees of various types of dehydration, followed by readaptation and correction with a drug that has anti-ischemic, membrane-stabilizing, antioxidant, hepatoprotective and immunomodulatory properties that allow to normalize protein, carbohydrate and lipid metabolism. The purpose of the study was to research the features of changes in the endocrine and exocrine parenchyma of the pancreas by the method of morphometry of histological preparations under conditions of sublethal dehydration with subsequent readaptation and correction with thiazotic acid morpholinium salt. The study group consisted of 60 mature male rats, which were simulated sublethal degree of general, cellular and extracellular dehydration by the method of A.D.Soboleva, V.Z.Sikora, J.Ya.Bodnar. After reaching a severe degree of dehydration, part of the rats were transferred to a regular drinking diet, the second part received a corrector drug for 14 days. The animals were withdrawn from the experiment by decapitation under anesthesia on 24th, 44th and 104th days in accordance with the type of dehydration. After analyzing the results obtained, it was found that there were no significant differences in most morphometric parameters under conditions of exposure to sublethal dehydration in comparison with subsequent readaptation. Significant changes in the area of the islets of Langerhans and the area of nuclei of exocrinocytes were revealed under conditions of exposure to various types of sublethal dehydration in comparison with readaptation and correction; in all experimental groups. Other morphometric parameters of the pancreatic parenchyma had changes of varying statistical significance, which depended on the type of dehydration. It has been established that the use of the thiazotic acid morpholinium salt leads to partial restoration of the structural components of the pancreatic parenchyma in comparison with the period of readaptation.

Relationship between pancreatic parenchyma loss and early postoperative hyperglycemia in patients with benign pancreatic diseases

Objective To evaluate the relationship between pancreatic parenchyma loss and early postoperative hyperglycemia in patients with benign pancreatic diseases. Methods A total of 171 patients with benign pancreatic tumors or chronic pancreatitis, whose preoperative fasting blood glucose (FBG) was normal and who underwent partial pancreatectomy were reviewed. The pancreatic volume was measured by CT imaging before and after the operation. According to their different pancreatic resection volume (PRV), 171 patients were divided into five groups: < 30%, 30%–39%, 40%–49%, 50%–59%, and ≥ 60%. The correlation between the PRV and postoperative FBG was investigated. According to the postoperative FBG value, the patients were divided into a hyperglycemia group (HG) and nonhyperglycemia group (non-HG) to explore the best cutoff value of the PRV between the two groups. Results There were significant differences in the postoperative FBG among the five groups (PRV < 30%, 30%–39%, 40%–49%, 50%–59%, and ≥ 60%). The PRV was positively correlated with postoperative FBG in the benign tumor group and chronic pancreatitis group (R = 0.727 and 0.651, respectively). ROC curve analysis showed that the best cutoff value of the PRV between the HG (n = 84) and non-HG (n = 87) was 39.95% with an AUC = 0.898; the sensitivity was 89.29%, and the specificity was 82.76%. Conclusion There was a linear positive correlation between the postoperative FBG level and PRV. Patients with a PRV ≥ 40% are more likely to develop early postoperative hyperglycemia.

Variability measurements provide additional value to shear wave elastography in the diagnosis of pancreatic cancer

Shear wave elastography (SWE) is a technique to non-invasively and quantitatively evaluate tissue stiffness. We aimed to investigate whether we can differentiate pancreatic cancer (PC) from normal pancreatic parenchyma (NPP) by SWE using transabdominal ultrasound. We investigated a total of 106 patients (84 with NPP and 22 with PC) whose pancreatic elastic modulus was measured by two-dimensional SWE (2D-SWE). Intra-rater reliability in this study was examined, and three measurements were sufficiently reliable. There were no differences between the two groups in factors that could affect SWE measurements. The median value of the elastic modulus was 5.70 kPa in the PC patients and 5.66 kPa in the NPP group, which was not significantly different (P = 0.785). On the contrary, the range was 8.64 kPa and 4.72 kPa, with a significantly greater range in the PC patients (P = 0.001). In conclusion, the median elastic modulus measured by 2D-SWE was not significantly different between PC and NPP, and evaluating the obtained elastic modulus itself is not useful in differentiation. However, the variability was significantly greater in PC than in NPP. Evaluating the range of elasticities will provide additional information in SWE, which may be useful in the diagnosis of PC.