Pancreas
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Intraductal papillary-mucinous neoplasms (IPMNs) of the pancreas are classified into 4 types--gastric, intestinal, pancreatobiliary, and oncocytic--on the basis of their morphology and immunohistochemistry. We classified IPMNs at our institute and used this classification to determine the clinicopathological features, prognosis, and malignant potential of the 4 types. ⋯ Intraductal papillary-mucinous neoplasm of the gastric and intestinal types may have less malignant potential than that of the pancreatobiliary type. Invasive carcinomas derived from intestinal-type IPMNs may be less invasive and slower growing than those derived from the pancreatobiliary type.
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To study the use of intestinal fatty acid binding protein (I-FABP) in diagnosing gut dysfunction in patients with acute pancreatitis (AP). ⋯ The serum level of I-FABP can be used for assessing the gut dysfunction and disease severity of AP.
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For some procedures, epidural anesthesia and analgesia (EAA) improves clinical outcomes. It is used during pancreatoduodenectomy (PD) to mitigate morbidities and shorten hospitalizations. Although widespread, the use of this practice has not been examined extensively. The objective of this study was to do so. ⋯ For patients undergoing PD, EAA was not associated with clinical benefits except for a modest reduction in postoperative pain, which was limited to a single day. Therefore, in this study, the clinical benefits of EAA seem underwhelming.
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Obstructive pancreatic duct stones can cause recurrent attacks of acute pancreatitis and chronic abdominal pain. Use of extracorporeal shock wave lithotripsy (ESWL) for treatment of abdominal pain associated with obstructive pancreatic duct stones has been well documented. However, its effect on prevention of recurrent pancreatitis in this group of patients has not been studied. ⋯ CT - computed tomography, ERCP - endoscopic retrograde cholangiopancreatography, ESWL - extracorporeal shock wave lithotripsy.
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In branch duct intraductal papillary mucinous neoplasm (IPMN) of the pancreas, the importance of the cyst size to predict malignancy is still controversial. Our aim was to elucidate the malignant potential of branch duct IPMN without mural nodules (flat branch duct IPMN). ⋯ We conclude that the size criteria (> or =30 mm) to predict malignancy proposed in the international consensus guidelines is appropriate and resection or meticulous follow-up using cytological examination and MPD dilatation is needed in patients with flat branch duct IPMNs.