As the detection rate of pancreatic cystic neoplasms (PCN) increases,recommendations or guidelines for the diagnosis and treatment of PCN have been released from professional organizations.From the perspective of radiology,we compared seven guidelines in terms of general introduction,preoperative monitoring methods and strategies,stratification of risk factors,surgical indications,and postoperative follow-ups,aiming to provide references for the evaluation of images and the formulation of individualized approach for the treatment of PCN.
Humans ; Pancreatic Cyst/therapy* ; Pancreatic Neoplasms/therapy* ; Pregnenolone Carbonitrile ; Radiography ; Radiology

PURPOSE: According to surgical dogma, patients who are recovering from general anesthesia after abdominal surgery should begin with a clear liquid diet, progress to a full liquid diet and then to a soft diet before taking regular meals. We propose patient-controlled nutrition (PCN), which is a novel concept in postoperative nutrition after abdominal surgery. METHODS: A retrospective pilot study was conducted to evaluate the feasibility and effects of PCN. This study was carried out with a total of 179 consecutive patients who underwent a laparoscopic appendectomy between August 2014 and July 2016. In the PCN group, diet was advanced depending on the choice of the patients themselves; in the traditional group, diet was progressively advanced to a full liquid or soft diet and then a regular diet as tolerated. The primary endpoints were time to tolerance of regular diet and postoperative hospital stay. RESULTS: Time to tolerance of a regular diet (P < 0.001) and postoperative hospital stay (P < 0.001) showed statistically significant differences between the groups. Multivariate analysis using linear regression showed that the traditional nutrition pattern was the only factor associated with postoperative hospital stay (P < 0.001). Multivariate analysis using logistic regression showed that traditional nutrition was the only risk factor associated with prolonged postoperative hospital stay (≥3 days). CONCLUSION: After abdominal surgery, PCN may be a feasible and effective concept in postoperative nutrition. In our Early Recovery after Surgery program, our PCN concept may reduce the time to tolerance of a regular diet and shorten the postoperative hospital stay.
Anesthesia, General ; Appendectomy ; Diet ; Humans ; Length of Stay ; Linear Models ; Logistic Models ; Meals ; Multivariate Analysis ; Nutritional Support ; Pilot Projects ; Postoperative Care ; Pregnenolone Carbonitrile ; Retrospective Studies ; Risk Factors

We evaluated the effect of the pregnane X receptor agonist, pregnenolone 16 alpha-carbonitrile (PCN) on the expression levels of plasma monoamine transporter (PMAT) in the intestine. Male C57/BL6 mice were divided into two 2 groups: mice in the PCN group (n=3) were administered PCN once a day for 4 days, while those in the control group (n=3) received the same volume of vehicle once a day for 4 days. After the mice were killed 24 h after administration of the last dose of PCN or vehicle, and the expression levels of PMAT in the intestine tissues were isolated and measured the expression level of PMAT using immunohistochemical and western blotting analyses. The expression level of PMAT expression levels in the small intestine increased after PCN treatment. These results suggest that the induction of PMAT may play a clinically significant role by increasing intestinal absorption of PMAT substrates such as metformin.
Animals ; Blotting, Western ; Cell Membrane* ; Humans ; Intestinal Absorption ; Intestine, Small ; Intestines ; Male ; Metformin ; Mice ; Plasma ; Pregnenolone Carbonitrile

PURPOSE: The aim of this study was to determine early predictive value of acute pyelonephritis and urosepsis in patients with urolithiasis in the emergency department. METHODS: We retrospectively reviewed medical records of patients who visited the emergency department and were diagnosed with urolithiasis by computed tomography for three years. Patients with urolithiasis were grouped according to the presence of computed tomography (CT) findings with acute pyelonephritis. In baseline characteristics, laboratory and CT findings of the two groups were compared. Group 1 was defined as urolithiasis without acute pyelonephritis and group 2 was defined as urolithiasis with acute pyelonephritis. In addition, we compared the sepsis versus non-sepsis and percutaneous nephrostomy (PCN) versus non-PCN group in Group 2 for analysis of the hs-CRP level of each group. RESULTS: The total number of urolithiasis patients was 744. Among the patients, 84 (11.3%) had urolithiasis with acute pyelonephritis in CT findings. Age, sex, history of diabetes, history of urolithiasis, size of stone, duration of symptom, body temperature, blood pressure, heart rate, respiratory rate, leukocyte count, existence of pyuria, and hs-CRP differed significantly between the two groups, respectively. In multivariate logistic regression analysis, age, history of urolithiasis, existence of pyuria, and hs-CRP were shown to be independent predictors affecting acute pyelonephritis in patients with urolithiasis. The area under the receiving operator characteristics (ROC) curve for CRP was 0.820 (95% CI, 0.754-0.886) and leukocyte count was 0.631 [95% confidence interval (CI), 0.542-0.721]. Sepsis and PCN groups showed significantly higher hs-CRP level than non-sepsis and non-PCN groups. CONCLUSION: There were some independent predictive values of urolithiasis with acute pyelonephritis. It can be useful in early detection of acute pyelonephritis or sepsis, and it can be helpful in making treatment plans for patients of urolithiasis.
Blood Pressure ; Body Temperature ; C-Reactive Protein ; Emergency Service, Hospital ; Heart Rate ; Humans ; Leukocyte Count ; Logistic Models ; Medical Records ; Nephrostomy, Percutaneous ; Pregnenolone Carbonitrile ; Pyelonephritis* ; Pyuria ; Respiratory Rate ; Retrospective Studies ; Sepsis ; Staphylococcal Protein A* ; Urolithiasis*

Congenital lipoid adrenal hyperplasia (lipoid CAH) is the most fatal form of CAH, as it disrupts adrenal and gonadal steroidogenesis. Most cases of lipoid CAH are caused by recessive mutations in the gene encoding steroidogenic acute regulatory protein (StAR). Affected patients typically present with signs of severe adrenal failure in early infancy and 46,XY genetic males are phenotypic females due to disrupted testicular androgen secretion. The StAR p.Q258X mutation accounts for about 70% of affected alleles in most patients of Japanese and Korean ancestry. However, it is more prevalent (92.3%) in the Korean population. Recently, some patients have been showed that they had late and mild clinical findings. These cases and studies constitute a new entity of 'nonclassic lipoid CAH'. The cholesterol side-chain cleavage enzyme, P450scc (CYP11A1), plays an essential role converting cholesterol to pregnenolone. Although progesterone production from the fetally derived placenta is necessary to maintain a pregnancy to term, some patients with P450scc mutations have recently been reported. P450scc mutations can also cause lipoid CAH and establish a recently recognized human endocrine disorder.
Alleles ; Asian Continental Ancestry Group ; Cholesterol ; Cholesterol Side-Chain Cleavage Enzyme ; Female ; Gonads ; Humans ; Hyperplasia* ; Male ; Placenta ; Pregnancy ; Pregnenolone ; Progesterone

The steroidal enzyme cytochrome P45017alpha catalyzes the conversion of progesterone and pregnenolone into androgens, androstenedione and dehydroepiandrosterone, respectively, the direct precursors of estrogens and testosterone. Dihydrotestosterone is the principal active androgen in the prostate, testosterone is also an active stimulant of the growth of prostatic cancer tissue. Inhibition of this enzyme as a mechanism for inhibiting androgen biosynthesis could be a worthwhile therapeutic strategy for the treatment of PCA. In this paper, four categories of steroidal inhibitors of cytochrome P45017alpha will be reviewed, a diverse range of steroidal inhibitors had been synthesized and shown to be potent inhibitors of P45017alpha.
Androstenedione ; biosynthesis ; Androstenes ; Androstenols ; chemical synthesis ; chemistry ; pharmacology ; Animals ; Antineoplastic Agents ; chemical synthesis ; chemistry ; pharmacology ; Dehydroepiandrosterone ; biosynthesis ; Dihydrotestosterone ; metabolism ; Enzyme Inhibitors ; chemical synthesis ; chemistry ; pharmacology ; Humans ; Male ; Molecular Structure ; Pregnenolone ; metabolism ; Progesterone ; metabolism ; Prostatic Neoplasms ; pathology ; Steroid 17-alpha-Hydroxylase ; antagonists & inhibitors ; Testosterone ; biosynthesis

Recent years, various percutaneous procedures including cervical nucleoplasty have been developed for disc decompressions to relieve radicular pains caused by disc herniations. We report the application of percutaneous cervical nucleoplasty (PCN) by using the navigable disc decompression device in two patients of cervical herniated intervertebral discs (HIVD). A 38-year-old female diagnosed with C4-C5 disc extrusion with bilateral C5 roots impingement received nucleoplasty twice at C4-C5 disc level. After second procedure, her pain was improved from 6-7/10 to 1-2/10 by visual analog scale (VAS). The second case, a 51-year-male was diagnosed with C6-C7 disc extrusion with right C7 roots impingement and received the procedure at C6-C7 disc level. The pain improved from 8/10 to 3-4/10 by VAS. Successfully, we decompressed cervical herniated discs in 2 HIVD patients without major complications. The PCN with the navigable device will be recommended as an alternative treatment method for cervical HIVD.
Adult ; Decompression* ; Female ; Humans ; Intervertebral Disc Displacement ; Intervertebral Disc* ; Neck Pain ; Pregnenolone Carbonitrile

PURPOSE: Preoperative percutaneous nephrostomy (PCN) can be applied to urinary stone patients with pyelonephritis as well as obstructive uropathy; thus, some patients undergo flexible ureteroscopy (fURS) in the presence of a PCN tube. We evaluated the effectiveness of PCN during fURS for the management of renal stones. MATERIALS AND METHODS: We retrospectively analyzed 130 consecutive patients who underwent fURS for renal stones between January 2009 and December 2011. All fURS procedures were performed by a single experienced surgeon. The patients were divided into two groups depending on the presence of PCN during the surgery: patients with PCN (group 1, n=41) and patients without PCN (group 2, n=89). To evaluate operative outcomes, we compared success rates, operative times, and complication rates. We defined success as the absence of any residual stones in the kidney or stone fragments less than 2 mm that were too small to be extracted during follow-up. RESULTS: There were no significant differences in age, sex, body mass index, stone laterality, burden, or location between the two groups. The mean operative times of groups 1 and 2 were 50.1 and 58.3 minutes, respectively (p=0.102). The success rates of groups 1 and 2 were 95.1% and 82.0%, respectively (p=0.044). There was no statistically significant difference in the complication rate between groups 1 and 2 (p=0.888). CONCLUSIONS: Flexible ureteroscopy in the presence of PCN produced a superior outcome in terms of the success rate without increasing the operative time or complication rate. PCN may be helpful to induce better outcomes of fURS.
Body Mass Index ; Humans ; Kidney ; Kidney Calculi ; Nephrostomy, Percutaneous ; Operative Time ; Pregnenolone Carbonitrile ; Pyelonephritis ; Retrospective Studies ; Ureteroscopy ; Urinary Calculi

OBJECTIVETo explore the pathogenesis of premenstrual syndrome (PMS), and the correlation between anger and depression and PMS of Gan-yang ascending syndrome (GYAS) and Gan-qi stagnation syndrome (GQSS) by detecting the neuro-reproductive hormones of PMS patients of GYAS and GOSS, thus providing theoretical reliance for diagnostic standards for clinical normative PMS.

METHODSUsing techniques such as HPLC, HPLC-MC, ELISA, and radioimmunoassay (RIA), levels of serum sex hormones (follicle stimulating hormone, luteinizing hormone, estradiol, progesterone, testosterone, and prolactin), plasma neurotransmitters (gamma-aminobutyric acid, beta-endorphin, glutamic acid, dopamine, 5-HT, adrenaline, and noradrenaline), neurosteroids (allopregnanolone, pregnenolone, and dehydroepiandrosterone) in the follicular phase and the luteal phase of PMS patients of GYAS (30 cases) and GQSS (30 cases) were detected, and compared with the healthy control group (30 cases).

RESULTSThere was no statistical difference in either index of the follicular phase among the 3 groups. Compared with the healthy control group, the testosterone level in PMS patients of GYAS in the luteal phase showed increasing tendency (P > 0.05). The levels of dopamine and 5-HT of PMS patients of GYAS in the luteal phase were higher and the gamma-aminobutyric acid level was lower than those of the healthy control group (all P < 0.05). The levels of adrenaline and noradrenaline of PMS patients of GYAS and GQSS in the luteal phase were higher than those of the healthy control group (all P < 0.05). The levels of allopregnanolone and pregnenolone of PMS patients of GYAS and GQSS in the luteal phase were lower, and the dehydroepiandrosterone level was higher than those of the healthy control group (all P < 0.05). The ratios of dehydroepiandrosterone/allopregnanolone and dehydroepiandrosterone/pregnenolone of PMS patients of GYAS and GQSS in the luteal phase were higher than those of the healthy control group (P < 0.05).

CONCLUSIONThe decreased levels of pregnenolone and allopregnanolone, increased dehydroepiandrosterone levels, and increased ratios of dehydroepiandrosterone/allopregnanolone and dehydroepiandrosterone/pregnenolone might be one of biological factors for anger and depression in PMS patients of GYAS and GQSS.

Adult ; Case-Control Studies ; Dehydroepiandrosterone ; blood ; Estradiol ; blood ; Female ; Follicular Phase ; blood ; Humans ; Luteal Phase ; blood ; Medicine, Chinese Traditional ; methods ; Middle Aged ; Neurotransmitter Agents ; Pregnanolone ; blood ; Pregnenolone ; blood ; Premenstrual Syndrome ; blood ; diagnosis ; Progesterone ; blood ; Young Adult

PURPOSE: To review our experience with the management of fragmented and retained pigtail percutaneous nephrostomy (PCN) tubes and to explore the reasons for the fragmentation. MATERIALS AND METHODS: We retrospectively reviewed our institute database from January 2006 to December 2011 for patients who had undergone retrieval of fragmented PCN tubes. We assessed the preoperative factors, operative technique, and post-operative outcomes. RESULTS: A total of seven patients (4 males and 3 females) had been diagnosed with fragmented PCN tubes. The mean age of the patients was 41.5 years. Of the seven patients, five required antegrade instrumentation by way of a percutaneous tract to remove the foreign body, mostly along with stone retrieval. One patient underwent ureterorenoscopy and pneumolithotripsy for a ureteric stone along with ureteroscopic removal of the PCN fragment. Another patient underwent nephrectomy of the kidney containing the PCN fragment because it had become nonfunctioning. All patients were free of stones and symptoms on follow-up. CONCLUSIONS: A prolonged waiting period for definitive surgery, urinary infection, and associated stone disease are significant factors causing fragmentation of PCN tubes. Proper insertion techniques, regular timed changes of the PCN tube, appropriate care of the PCN tube, and early surgery for underlying stone disease are required to avoid this complication. Patients with retained PCN tubes can be managed effectively with antegrade or retrograde endoscopic techniques while definitive management of the primary pathology is carried out, without any additional morbidity.
Foreign Bodies ; Humans ; Kidney ; Kidney Calculi ; Male ; Nephrectomy ; Nephrostomy, Percutaneous ; Polyurethanes ; Pregnenolone Carbonitrile ; Pyonephrosis ; Retrospective Studies ; Ureter