| 1. |
- Andersson, Bodil, et al.
(författare)
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Gemcitabine Treatment in Pancreatic Cancer – Prognostic Factors and Outcome.
- 2007
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Ingår i: Annals of Gastroenterology. - 1108-7471. ; 20:2, s. 130-137
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pancreatic cancer is generally associated with a poor prognosis and often diagnosed in an advanced stage. The aim of the present study was to evaluate gemcitabine treatment concerning prognostic factors, clinical benefit, tolerance/ toxicity and survival. Methods: Patients with surgically nonresectable, locally advanced or metastatic pancreatic cancer treated with gemcitabine were included. Different parameters, including clinical benefit, toxicity (WHO΄s criteria) and survival were registered. Kaplan-Meier and Cox regression analysis were performed. Results: Forty-two consecutive patients were included. Median age was 62.5 years, 42% were men. Gemcitabine treatment lasted in median for 5 months (0.5-29 months). Median survival from diagnosis was 9.4 months and from start of treatment 8.1 months. Thirteen patients (32%) were alive 12 months after treatment start. The treatment was overall well tolerated concerning toxicity. Seven patients had transient grade 4 reactions. Of 8 parameters selected from the univariate analysis, 3 were identified as independent predictors for longer survival: age >60 years, ≤5 % weight loss at diagnosis and absence of metastases. Conclusions: Gemcitabine treatment in locally advanced and metastatic pancreatic cancer showed to be of potential benefit and well tolerated. Age, weight loss and metastases were independent prognostic factors for survival. The median survival time was longer than previously reported. Keywords: pancreatic cancer; locally advanced; gemcitabine; treatment outcome; prognostic factors
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| 2. |
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| 3. |
- Ansari, Daniel, et al.
(författare)
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Safety of pancreatic resection in the elderly : a retrospective analysis of 556 patients
- 2016
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Ingår i: Annals of Gastroenterology. - : Hellenic Society of Gastroenterology. - 1108-7471 .- 1792-7463. ; 29:2, s. 5-221
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The safety of pancreatic resection for elderly patients is still controversial. We examined the postoperative morbidity and mortality in patients aged 75 years or more undergoing pancreatic resection.METHODS: Patients undergoing pancreatic resection were studied retrospectively and the outcomes were compared between patients aged <75 and ≥75 years.RESULTS: Of the 556 patients enrolled, 78 (14%) were ≥75 years old. Elderly patients had significantly more co-morbidities, especially cardiovascular pathology (P=0.005). Also, elderly patients had significantly lower body mass index prior to surgery (P=0.005). There were no significant differences in terms of surgical procedures and tumor types between age groups. The incidence of postoperative pancreatic fistula grade A was significantly lower in the elderly group (P=0.022), but no significant differences were noted in the overall morbidity or the incidence of postpancreatectomy hemorrhage, delayed gastric emptying, bile leakage, cardiac complications, pulmonary complications or septic complications. The 30-day mortality rate was similar between groups (0.8% vs. 1.3%; P=0.532).CONCLUSION: Pancreatic resection is a safe option for selected elderly patients. Our study confirms that age alone should not preclude potentially curative surgical therapy.
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| 4. |
- Axelsson, Jakob B, et al.
(författare)
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Intestinal bacteria and permeability during experimental acute pancreatitis in rats
- 2006
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Ingår i: Annals of Gastroenterology. - 1108-7471. ; 19:3, s. 276-284
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Tidskriftsartikel (refereegranskat)abstract
- Background: An increase in intestinal permeability and subsequent bacterial translocation has been demonstrated in critical illness. Cellulose derivatives have in the past been shown to reduce gut leakage following liver resection. Aims: The aim of the present study was to evaluate changes in microbial counts in experimental acute pancreatitis and the effect of pre-treatment with cellulose derivatives and N-acetyl cysteine. Subjects: 92 male Sprague Dawley rats. Methods: Acute pancreatitis was induced by intraductal taurodeoxycholic acid infusion. Animals received oral pretreatment and were randomized to either sham operation or the pancreatitis groups, with or without pre-treatment with cellulose derivatives, the antioxidant or their combinations. Intestinal bacterial populations and permeability were evaluated using bacterial counts and Ussing chamber, respectively. Results: The number of E. coli increased in the luminal content and ileal and colonic mucosa, but levels were restored to almost those seen in controls in all pre-treatment groups except for N-acetyl cysteine. When intestinal permeability was measured, none of the treatment groups showed significant differences compared to challenge, except for Nacetyl cysteine, which significantly increased permeability. Conclusion: Pre-treatment with cellulose derivatives was more efficient against disturbances in intestinal permeability and microbial populations than the antioxidant Nacetyl cysteine.
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| 5. |
- Björk Werner, Josefin, et al.
(författare)
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Mucinous cystadenocarcinoma of the pancreas - outcome following different modes of treatment
- 2011
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Ingår i: Annals of Gastroenterology. - 1108-7471. ; 24:3, s. 213-217
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Mucinous cystadenocarcinomas (MCAC) of the pancreas are rare tumors. When localized to the pancreas alone, surgical resection is mostly associated with a favorable prognosis. The potential value of palliative treatment with chemotherapy for irresectable disease is scarcely described though. The aim of this study was to describe a single-center series of patients with MCAC of the pancreas focusing on the outcome following different treatment strategies.METHODS: 15 patients, 10 females and 5 males, with histologically or cytologically verified MCAC, were divided into three groups: surgical resection (n=7), chemotherapy (n=5) and no treatment (n=3).RESULTS: There was no obvious difference in gender distribution between the subgroups. A tendency towards higher age was seen in the group without treatment, as was a larger tumor size as compared to the chemotherapy group. Patients were administered chemotherapy and the group without treatment seemed to present with the same prevalence of metastatic disease (3/5 and 2/3, respectively). All patients in the group without treatment died after in median 1 month following pathological diagnosis. One patient in the chemotherapy group was alive at 9-month follow up, and the others survived a median of 11 months. In the surgically treated group, 4/7 were alive at follow-up of a median of 154 months. Of the three deceased patients who had survived 44, 53 and 151 months, respectively, two had microscopically non-radical resection.CONCLUSIONS: MCAC of the pancreas is, when locally confined and without metastases, associated with fairly good prognosis after surgical resection. In inoperable patients and for metastatic disease, outcome is poor.
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| 6. |
- Byrling, Johannes, et al.
(författare)
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Outcome and evaluation of prognostic factors after pancreaticoduodenectomy for distal cholangiocarcinoma
- 2017
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Ingår i: Annals of Gastroenterology. - : Hellenic Society of Gastroenterology. - 1108-7471 .- 1792-7463. ; 30:5, s. 571-577
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Tidskriftsartikel (refereegranskat)abstract
- Background The aim of the present study was to examine the outcomes and prognostic factors after surgery with curative intent for distal cholangiocarcinoma during a modern timespan, in a Swedish tertiary referral center. Methods All patients who underwent pancreaticoduodenectomy for distal cholangiocarcinoma between April 2008 and December 2015 were identified. Survival was estimated using the Kaplan-Meier analysis. Demographic, clinical, laboratory and histopathological data were evaluated for prognostic factors relating to mortality, using univariable and multivariable statistical analysis. Results Fifty-four patients were included. The mean age was 68±8 years and 21 (39%) of the patients were female. Jaundice was present at diagnosis in 73% of the patients. There was no 90-day mortality. Complications graded as Clavien-Dindo ≥3 occurred in 10 (19%) of the patients. Twenty-eight (52%) received adjuvant therapy. Overall survival rates at 1, 3, and 5 years were 80%, 21%, and 9.2%, respectively. Median survival was 22.2 months. The presence of lymph node metastases was found to be the only independent predictor of survival (hazard ratio 2.88, 95% confidence interval 1.22-6.84; P=0.016). The total number of lymph node metastases, lymph node ratio or total number of resected nodes did not improve the prediction. Conclusions We found that the recurrence rate was higher and the survival poorer after surgery for distal cholangiocarcinoma than has previously been reported. Lymph node status at the time of resection was the most important prognostic factor for survival in the current material.
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| 7. |
- Ek, Weronica E, et al.
(författare)
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The history of genetics in inflammatory bowel disease
- 2014
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Ingår i: Annals of Gastroenterology. - Athens, Greece : Hellenic Society of Gastroenterology. - 1108-7471 .- 1792-7463. ; 27:4, s. 294-303
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Forskningsöversikt (refereegranskat)abstract
- The influence of genetics in the etiology of inflammatory bowel disease (IBD) was initially demonstrated by epidemiological data, including differences in prevalence among different ethnic groups, familial aggregation of IBD, concordance in twins, and association with genetic syndromes. These early observations paved the way to molecular genetics in IBD, and culminated in the identification of nucleotide-binding oligomerization domain containing 2 (NOD2) gene as an IBD risk gene in 2001. As in other complex diseases, the advent of Genome Wide Association studies has dramatically improved the resolution of the IBD genome and our understanding of the pathogenesis of IBD. However, the complexity of the genetic puzzle in IBD seems more pronounced today than ever previously. In total, 163 risk genes/loci have been identified, and the corresponding number of possible causal variants is challenging. The great majority of these loci are associated with both Crohn's disease and ulcerative colitis, suggesting that nearly all of the biological mechanisms involved in one disease play some role in the other. Interestingly, a large proportion of the IBD risk loci are also shared with other immune-mediated diseases, primary immunodeficiencies and mycobacterial diseases.
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| 8. |
- Gundewar, Chinmay, et al.
(författare)
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Antiproliferative effects of curcumin analog L49H37 in pancreatic stellate cells: a comparative study.
- 2015
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Ingår i: Annals of Gastroenterology. - 1108-7471. ; 28:3, s. 391-398
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Tidskriftsartikel (refereegranskat)abstract
- Pancreatic cancer is a devastating disease with poor prognosis. It is characterized by a pronounced stromal reaction, which resists chemotherapeutics and effective tumor treatment. Pancreatic stellate cells (PSCs) are mainly responsible for this stromal reaction. Moreover, the cancer and stromal interaction seems to promote tumor proliferation. In this study, L49H37, a newly synthesized curcumin analog, was used as intervention to target the stromal compartment of pancreatic cancer.
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| 9. |
- Hallerbäck, Bengt, et al.
(författare)
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A prospective nationwide study on the impact of the level of sedation on cannulation success and complications of endoscopic retrograde cholangiopancreatography
- 2020
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Ingår i: Annals of Gastroenterology. - : Hellenic Soc Gastroenterology. - 1108-7471 .- 1792-7463. ; 33:3, s. 299-304
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Tidskriftsartikel (refereegranskat)abstract
- Background: Difficult or unsuccessful cannulation of the papilla of Vater is associated with complications during endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to investigate whether deep sedation facilitates the cannulation and reduces the complication rate.Methods: Nationwide data from ERCP procedures were registered prospectively in the web-based Swedish Registry for Gallstone Surgery and ERCP (GallRiks). These data were used for a case-control study comparing the outcomes when using propofol sedation (PS) or basic sedation (BS) with midazolam in combination with opioids.Results: We analyzed 31,001 ERCP procedures in patients who had no previous ERCP. Of these, 14,907 were performed using PS and 16,094 using BS. The cannulation rate was higher in the PS group than the BS group: 89.0% vs. 86.7%, P<0.0001. The procedure time was longer in the PS group than in the BS group: 35.7 vs. 31.2 min, P<0.0001. The rate of intra-procedural complications was lower in the PS group than in the BS group: 2.9% vs. 3.7%, P<0.0001. The total frequency of post-procedural complications was 13.0% in the PS and 12.6% in the BS group (P=0.2607). The frequency of post-ERCP pancreatitis (PEP) was higher in the PS group than in the BS group: 4.6% vs. 4.0%, P=0.0136.Conclusions: PS in ERCP leads to a significantly higher cannulation success rate and fewer intra-procedural complications, but there was no significant difference in total post-ERCP complications. The procedure time was longer, and PEP was more common in the PS group. A plausible explanation could be that deep sedation might lead to more aggressive attempts to cannulate the papilla, resulting in a higher risk for PEP.
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| 10. |
- Kartalis, Nikolaos, et al.
(författare)
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Recent developments in imaging of pancreatic neuroendocrine tumors
- 2015
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Ingår i: Annals of Gastroenterology. - 1108-7471 .- 1792-7463. ; 28:2, s. 193-202
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Tidskriftsartikel (refereegranskat)abstract
- Pancreatic neuroendocrine tumors (PNETs) are very rare, accounting for 1-2% of all pancreatic neoplasms. They are classified into functioning and non-functioning and their behavior varies widely from benign to highly malignant. For their investigation, a variety of anatomical and functional imaging methods are available. Anatomical methods include computed tomography (CT), magnetic resonance imaging, and ultrasonography. Functional methods include scintigraphy and positron emission tomography (PET). A combination of anatomical and morphological methods results in the so-called hybrid imaging, such as PET/CT. We herein discuss the currently available imaging modalities for the investigation of PNETs and, more specifically, their applications in tumor detection and staging as well as in choice of therapy, imaging follow up and prediction of response, with emphasis on the recent developments.
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