Hepatology and Pancreatic Science

Pancreatic neuroendocrine neoplasms (PanNETs) are rare, representing approximately 3% of primary pancreatic neoplasms, although their incidence has risen sharply within the us, increasing quite 100% over the past three decades. within the past, classification of PanNETs has been fraught with different nomenclature and multiple grading and staging systems. The 2010 WHO Classification of Tumours of the gastrointestinal system and therefore the 7th edition of AJCC Cancer Staging Manual have tried to handle these issues, however, controversies still exist. This lecture will address this grading and staging systems, issues encountered in everyday practice, clinical significance and future direction.

Background: Improvement in weight control remains the foremost important goal of any treatment program in Prader-Willi syndrome (PWS). To date, bariatric surgery experience in Prader-Willi syndrome (PWS) is proscribed, and different procedures are used with varying success. Malabsorptive procedures, like biliopancreatic diversion (BPD), aren't always recommended for PWS because of lack of safety data and might involve long-term complications. Patients & Methods: We report 10 severely obese patients (6 males) with genetically confirmed PWS (7 del15, 3 UPD15) who underwent Scopinaro’s BPD after inability to regulate food intake with the classical approaches. Surgery was performed on patients aged 18.8±3 yrs. (mean±SD) (range: 15.4-24.4) and also the BMI (kg/m2) was ≥40 all told cases (49.9±6.7). At baseline, severe co-morbidities were present, like obstructive apnea (OSAS), type 2 DM (T2DM), hypertension, metabolic syndrome and/or steatohepatitis. Results: No perioperative complications were observed. After a follow-up period of 13.9±7.3 yrs. (range 4.8-27; mean age at followup: 32.5±6.8 yrs) the most weight leader (MWL%) was 30.7±10 (10.1-52.6). Following BPD, BMI decreased in six patients, stable in three subjects and increased in one individual. The mean BMI at the last visit was 40.5±8.8 (28.9-51.6). After BPD, appetite was reduced in seven cases; eight subjects had hypochromic anaemia and 7 had diarrhea; OSAS were present in 5 patients and osteoporosis/osteopenia altogether individuals. T2DM disappeared and behavioral problems improved in some cases. One patient suddenly died at the age of 37.3 yrs. After surgery all patients received medical therapy to forestall nutritional deficiency. Conclusion: The long-term outcome of BPD in our PWS seems to be favorable, with a big reduction of weight excess within the majority of subjects.

Background: The etiology of carcinoma remains largely unknown. Although epidemiological studies have reported that a lot of environmental factors may contribute to the event of carcinoma, only age and cigarette smoking are established as consistent risk factors for the disease. Objective: Studying the biological clinical and histological features of patients with carcinoma so as to assess the possible risk factors for carcinoma in a very geographical area population. Methods: An epidemiological retrospective descriptive study has been performed at the extent of surgery department of the University Hospital of Sidi bel Abbes region, western Algeria, from 2007 to 2013. Results: a complete of 87 patients were diagnosed with cancer of the pancreas (55 males and 32 females) with a mean age of 63.1 years, starting from 16 to 96 years old, and a sex ratio of 1.71. In 92% of cases, pancreatic tumors were located at the pinnacle of the pancreas; the foremost predominant histological type was the adenocarcinoma; cigarette smokers represented the speed of 24.3% and alcoholics 13.5%. the foremost recorded disease among patients case history was DM (25.28%). About 35.63% was the prominent rate of patients who underwent cholecystectomy and was diagnosed with carcinoma after a mean duration of 5.23 years. Our patients were mostly diagnosed with cancer at M1 and T3 stages. Conclusion: in step with our results, cholecystectomy could possibly be a risk factor for carcinoma in Algerian population. In the last decade, a trend towards a rise of carcinoma incidence and mortality rates was observed irrespective of the gender. Analysis of statistic data reported by SEER 13 demonstrated that between years 2000 and 2014, there's an age-specific trend towards a rise in carcinoma incidence in two particularly group of ages, 20 - 29 years old and > 80 years within the USA.

Pancreatic ductal adenocarcinoma (PDAC) may be a uniformly lethal malignancy with near 6 months median survival. it's a stromarich, vascular-poor and hypo-perfused tumor, which was considered to prevents efficient drug or nutrient delivery in tumor microenvironment. Paradoxically, the tumor cells have robust glucose uptake and rare necrosis, suggesting that the microvasculature has might adopted an alternate way for nutrient uptake and cellular trafficking. Using adapted thick tumor section immunostaining and three-dimensional (3D) construction imaging in human fresh tissue samples, we identified an undiscovered feature of the mature microvasculature in advanced PDAC tumors; long, hair-like projections on the basal surface of micro vessels that we visit as ’basal microvilli’. Basal microvilli were also observed in intrahepatic cholangiocarcinoma (ICC) and metastatic pancreatic neuroendocrine tumor (panNET), but not in hepatocarcinoma, glioblastoma and renal clear cell carcinoma. Basal microvilli in PDAC are richer and denser than ICC and panNET. Functionally, these basal microvilli have an actin-rich cytoskeleton and endocytic and exocytic properties and contain glucose transporter-1 (GLUT-1)-positive vesicles. Clinically, as demonstrated by PET-CT, the tumor microvasculature with the longest and most abundant basal microvilli correlated with high glucose uptake of the PDAC tumor itself. additionally, these basal microvilli were found in regions of the tumor with low GLUT-1 expression, suggesting that their presence may be dependent upon the glucose concentration within the tumor milieu.

Background & Aim: The diagnosis of carcinoma of head of pancreas may be established by many modalities including X-radiation (CT) and Ultrasonography (USG). USG is taken into account a least invasive, readily available and cheap investigation as compared to CT scan. Aim of this study was to see the diagnostic accuracy of USG for detection of pancreatic head tumors taking Endoscopic Retrograde Cholangiopancreatography (ERCP) as gold standard. Method: This cross-sectional study of six months duration was conducted in New Radiology Department of Services Hospital, Lahore. Patients of both genders, 125 in number, having suspicion of pancreatic tumor supported clinical and laboratory findings were enrolled for the study. Ultrasound abdomen was done by consultant radiologist and findings were noted regarding presence or absence of pancreatic carcinoma.