1.An insulinoma with an aberrant feeder from the splenic artery detected by super-selective arterial calcium stimulation with venous sampling.
Joon Ho MOON ; Eun Ky KIM ; Ah Reum KHANG ; Hyo Cheol KIM ; Jin Young JANG ; Young Min CHO
The Korean Journal of Internal Medicine 2015;30(1):118-121
No abstract available.
Biopsy
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Blood Glucose/metabolism
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C-Peptide/blood
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Calcium Gluconate/administration & dosage/*diagnostic use
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Female
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Humans
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Immunohistochemistry
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Injections, Intra-Arterial
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Insulin/blood
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Insulinoma/blood/*blood supply/pathology/surgery
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Middle Aged
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Pancreatic Neoplasms/blood/*blood supply/pathology/surgery
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Pancreaticoduodenectomy
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Splenic Artery/*radiography
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*Tomography, X-Ray Computed
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Treatment Outcome
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Tumor Markers, Biological/blood
2.Role of pancreatic hilar vascular occlusion in sophisticated pancreaticoduodenectomy.
Shu-you PENG ; De-fei HONG ; Bin XU ; Li-feng YAN ; Jian-wei WANG ; Ying-bin LIU ; Jiang-tao LI ; Hao-ran QIAN ; Yi-ping MOU ; Xiu-jun CAI
Chinese Journal of Surgery 2007;45(21):1466-1468
OBJECTIVETo discuss the value of a simple occlusive technique of the triple vessels, ie, portal vein, superior mesenteric vessels and splenic vein, in complicated pancreaticoduodenectomy.
METHODSThe technique was fulfilled with a No.8 urethral catheter to encycle the portal vein, superior mesenteric vessels and its near tissue plus pancreatic tail and splenic vein than the neck of pancreas was transected and well exposure superior mesenteric vein and complete transaction of uncinate. From November 2005 to November 2006 the technique was applied to 12 cases of pancreatic malignancy which presented very infiltrated and adhesive to the hilar vascular structure.
RESULTSThe 12 cases were accomplished according with this technique. The operating time was (292.4 +/- 36.3) min (270 - 390 min) and the intraoperative blood loss was (833.3 +/- 618.4) ml (300 - 2500 ml). The postoperative complication included one case of lymphatic leakage, two cases of pneumonia, one case of abdominal infection and two cases of wound infection. There was no perioperative mortality. The postoperative hospital stay was 17 d (11 - 29 d).
CONCLUSIONSUse this triple vessels occlusive technique can improve the safety and feasibility in complicated cases of pancreaticoduodenectomy.
Aged ; Anastomosis, Surgical ; methods ; Female ; Humans ; Male ; Mesenteric Artery, Superior ; physiopathology ; Middle Aged ; Neoplasm Invasiveness ; Pancreas ; blood supply ; pathology ; surgery ; Pancreatic Neoplasms ; pathology ; surgery ; Pancreaticoduodenectomy ; methods ; Portal Vein ; physiopathology ; Splenic Vein ; physiopathology ; Treatment Outcome
3.MRI in the evaluation of peripancreatic vessel invasion and resectability of pancreatic carcinoma.
Dong-Qing WANG ; Meng-Su ZENG ; Da-Yong JIN ; Wen-Hui LOU ; Yuan JI ; Sheng-Xiang RAO ; Xun SHI ; Cai-Zhong CHEN ; Ren-Chen LI
Chinese Journal of Oncology 2007;29(11):846-849
OBJECTIVETo investigate the role of MRI in evaluating the peripancreatic vessel invasion and resectability of pancreatic carcinoma based on the comparison of MRI image with surgical exploration, and try to establish the criteria for assessment of the sensitivity, specificity and accuracy of resectability.
METHODSForty-one pancreatic carcinoma patients confirmed by pathology received preoperative plain and contrast enhanced MRI scan, and 37 of them had additional coronal MRA scan. Peripancreatic vessel invasion was preoperatively assessed based on MRI features, and the vessel invasion degree from the uninvolved to the severely involved was divided into 6 grades represented by 1, 2a, 2b, 3a, 3b and 4, respectively. Compared with the findings during the surgery, the sensitivity and specificity of each vessel invasion grade were studied and the receiver operator characteristic curve (ROC) was drawn. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of resectability evaluation based on 2 and 2a degree were calculated respectively. The resectability of involved arteries and veins of grade 2 were also analyzed.
RESULTSOf the 41 patients, 22 had resectable tumor, with 20 curative resection and 2 palliative. Compared with the findings during surgery, seven vessels including three arteries and four veins were not correctly interpreted by MRI. If grade 1,2a,2b,3a and 3b was used as the resectable standard,respectively, the sensitivity to predict the unresectbility was 78.3%, 84.8%, 67.4%, 56.5% and 47.8%, respectively. Receiver operator characteristic curve demonstrated that grade 2a was the optimal critical point. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of grade 2a in predicting the unresectbility were 84.8%, 98.5%, 92.9%, 96.6% and 95.9%.
CONCLUSIONOur data showed that grade 2a (tumor involvement < 2 cm long and < 1/2 circumference of the vessel) may be more sensitive and accurate in predicting the resectability, which may be considered as the line of demarcation between the respectable and unresectable cases in clinical practice.
Adult ; Aged ; Carcinoma, Pancreatic Ductal ; diagnosis ; pathology ; surgery ; Celiac Artery ; pathology ; Cholangiopancreatography, Magnetic Resonance ; Female ; Hepatic Artery ; pathology ; Humans ; Image Enhancement ; Magnetic Resonance Imaging ; methods ; Male ; Mesenteric Artery, Superior ; pathology ; Mesenteric Veins ; pathology ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Staging ; Pancreas ; blood supply ; Pancreatectomy ; methods ; Pancreatic Neoplasms ; diagnosis ; pathology ; surgery ; Portal Vein ; pathology ; Predictive Value of Tests ; Sensitivity and Specificity
4."Total arterial devascularization first" technique for resection of pancreatic head cancer during pancreaticoduodenectomy.
Feng PENG ; Min WANG ; Feng ZHU ; Rui TIAN ; Cheng-Jian SHI ; Meng XU ; Xin WANG ; Ming SHEN ; Jun HU ; Shu-You PENG ; Ren-Yi QIN
Journal of Huazhong University of Science and Technology (Medical Sciences) 2013;33(5):687-691
Integrated resection of the pancreatic head is the most difficult step in radical pancreaticoduodenectomy (RPD) in patients with the portal vein (PV) and superior mesenteric vein (SMV) invasion or oppression by the tumor. This study introduced a new idea and skill named the "total arterial devascularization first" (TADF) technique and its applications in RPD. Three arterial blood supplies of pancreatic head were obstructed before dissection of veins. The critical steps included exposure of the anterior surface of the abdominal aorta (AA) by completely transecting neural and connective tissue between superior mesenteric artery (SMA) and pancreatic mesounsinate, and transection of the mesounsinate from the origin of SMA to the root of the celiac trunk. From January 2012 through May 2013, a total of 58 patients with PV/SMV invasion or oppression underwent RPD using this technique. The median operative time was 5.1 h (ranging 4.5-8.1 h). The median intraoperative blood loss was 450 mL (ranging 200-900 mL). No intraoperative and postoperative bleeding of pancreatic head region occurred. Among the 58 patients, 21 were subjected to vessel lateral wall angiectomy or angiorrhaphy, and 10 to angiectomy and end-to-end anastomosis. The incidence of postoperative bleeding, postoperative pancreatic fistula and biliary fistula was 5.2%, 6.8%, and 1.7%, respectively. No patients died 3 months after operation. The TADF technique is a new method for intricate RPD and could improve the security of surgery and reduce intraoperative bleeding, which is expected to become standardized surgical approach for RPD.
Adult
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Aged
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Arteries
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physiopathology
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Blood Loss, Surgical
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prevention & control
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Female
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Humans
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Male
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Mesenteric Veins
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pathology
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surgery
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Neoplasm Invasiveness
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Pancreatic Neoplasms
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blood supply
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surgery
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Pancreaticoduodenectomy
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methods
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Portal Vein
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pathology
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surgery
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Postoperative Hemorrhage
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prevention & control
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Reproducibility of Results
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Time Factors
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Vascular Surgical Procedures
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methods