Lege Artis Medicinae

[THE DIFFERENTIATION OF CHRONIC PANCREATITIS FROM PANCREATIC CANCER]

CZAKÓ László

FEBRUARY 22, 2007

Lege Artis Medicinae - 2007;17(02)

[The poor prognosis of pancreatic cancer is mainly due to late diagnosis. The differentiation between pancreatic cancer and chronic pancreatitis is difficult, because the two diseases cause similar clinical symptoms and morphological alterations. Furthermore, chronic pancreatitis is associated with an increased risk of malignant transformation, thus the two diseases may be present simultaneously. The recent developments in molecular genetic tests and in imaging techniques, such as multidetector computed tomography, magnetic resonance cholangio- pancreatography, endoscopic ultrasoundguided fine needle aspiration and positron emission tomography/computed tomography, have fundamentally transformed the differentiation of the two disorders. This paper provides a systematic review of the recent evidence-based results concerning the differentiation of pancreatic cancer and chronic pancreatitis.]

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[DIFFUSE LARGE B-CELL NON-HODGKIN LYMPHOMA OF UNUSUAL LOCALISATION]

RESS Zsuzsa, ILLÉS Árpád, MATOLCSY András, TANYI Miklós, SZÖVÖRDI Éva, GERGELY Lajos

[INTRODUCTION - Diffuse large B-cell lymphoma frequently has bone involvement, but primary bone lymphoma is rare (around 4% of primary extranodal lymphomas). Long bones are most often affected, followed in frequency by the ribs, vertebrae, and pelvic bones. The main symptom is bone pain. CASE REPORT - The case of a young man is presented whose disease started with lumboischialgia. Since rheumatological treatment did not relieve the symptoms, MRI was performed, which showed a tumour with massive iliac bone destruction. Three months after the initial symptoms a surgical biopsy from the right ilium showed diffuse large B-cell lymphoma. Soon after acute renal insufficiency developed and the patient was put on haemodialysis. Based on the findings the disease was staged as Ann Arbor IV/B (bone and kidney), ECOG PS 3, International Prognostic Index 4. On the basis of the preliminary histological findings, reduced-dose CHOP chemotherapy was given, which resulted in a significant improvement of the renal function and haemodialysis could be abandoned. This was followed by 6 additional cycles of Rituximab-CHOP treatment and further 2 cycles of Rituximab-DHAP salvage chemotherapy with intrathecal prophylaxis, and, finally, since no response could be detected, R-IVAC treatment was given. After an initial response, the disease became progressive, and the patient died 9 months after the diagnosis was made from a disseminated chemoresistant disease. Autopsy confirmed extensive infiltration of the right iliac bone, kidneys, bone marrow, spleen, supraclavicular and abdominal lymph nodes, pancreas, scalp and brain. CONCLUSIONS - This case was chosen to be presented because of the unusual localisation of the diffuse large B-cell lymphoma, the initial diagnostic difficulty, and the very rapid progression despite the application of several aggressive chemotherapy schemes. A primary bone large B-cell lymphoma represents a diagnostic challenge with its rheumatological symptoms thus delaying diagnosis.]

Lege Artis Medicinae

[57th Annual Meeting of the American Association for the Study of Liver Diseases]

PÉTER Zoltán

Lege Artis Medicinae

[Is there a need for infectologists?]

SZALKA András

Lege Artis Medicinae

[EFFECT OF END-OF-LIFE EDUCATION ON MEDICAL STUDENTS’ AND HEALTH CARE WORKERS’ DEATH ATTITUDE]

HEGEDÛS Katalin, ZANA Ágnes, SZABÓ Gábor

[INTRODUCTION - The aim of our research was to evaluate the effect of courses for health care workers and medical students that deal with death, dying and bereavement and that of courses on hospice care of dying patients. The goal of the courses is to make communication on death more open by exploring critical issues related to fear of death to reduce inner anxiety and to improve attitude to dying patients. PARTICIPANTS AND METHOD - Participants (n=168) completed Neimeyer and Moore's Multi-dimensional Fear of Death Scale (MFODS) and Shortened Beck Depression Questionnaire (BDI) on the first and last day of the courses. In case of health care workers a follow-up survey was also performed 2 to 3 months after the course (n=32). RESULTS - The most significant factors of fear of death are: fear for significant others, fear of the dying process and fear of premature death. Overall fear of death scores are reduced as an effect of the courses, the alteration of the components of fear of death depends on the participants’ gender, age and profession as well. Improvement was observed in both groups in attitudes that can be related to the increase of knowledge on the quality care of dying patients like fear from the process of dying and fear from conscious experience of death. CONCLUSION - Besides education containing training as well it is important to strengthen the support function of workplaces in caring for the mental health of the health care staff. Furthermore it is important during gradual education that students participate in courses that aim to achieve opened communication in the most anxiety-evoking issues.]

Lege Artis Medicinae

[The Sides of the Coin]

ZSUZSA Gábor

All articles in the issue

Related contents

Lege Artis Medicinae

[DISEASES OF THE EXOCRINE PANCREAS AND DIABETES MELLITUS]

CZAKÓ László

[Exocrine and endocrine pancreas constitutes close anatomical and functional links accordingly, any disease affecting one of these sectors will inevitably affect the other. Acute and chronic pancreatitis, pancreatic surgery, cystic fibrosis and pancreatic cancer are those pancreatic conditions that might cause diabetes mellitus. The development of diabetes greatly influences the prognosis and quality of life of patients with exocrine pancreatic diseases. The lack of glucagon and the impaired absorption of nutrients may cause life-threatening complications, such as hypoglycaemia, and the micro- and macrovascular complications may impair the organ functions. Diabetes mellitus is an independent risk factor of mortality in those with exocrine pancreatic diseases. Pancreatic diabetes is a distinct metabolic and clinical form of diabetes, requires special treatment. Diet and pancreatic enzyme replacement therapy may be sufficient in the early stages. Oral antidiabetic drugs are not recommended. If the diet proves inadequate to reach the glycaemic goals, regular insulin treatment is demanded. There are special impairments of the exocrine function and the pancreatic morphology at diabetic patients that resemble to chronic pancreatitis. Atrophy of the exocrine tissue may caused by the lack of trophic insulin. Hyperglycaemia can activate the stellate cells that lead to pancreatic fibrosis. The microangiopathy and neuropathy, as well as the lack of islet hormone action - responsible for the exocrine pancreas regulation - will cause further damage on the pancreas glandular tissue. In the event of a proven impairment of the pancreatic exocrine function in diabetes mellitus, pancreatic enzyme replacement therapy is recommended. This may improve the nutritional condition and decrease the metabolic instability.]

Hungarian Radiology

[Radiology of pancreas: review from the last year - Gastro Update 2007]

FORRAI Gábor

[PURPOSE - To demonstrate the recent results in radiological diagnostics of pancreas, and the actual place of the imaging and interventional methods. METHOD - Systematic review of the most recent articles from the last year in the following subjects: acute, chronic and autoimmune pancreatitis, pancreatic cancer and other tumors, PET and special imaging problems in pancreas transplantation. RESULTS - Annually, experience in pancreatic diagnostical methods are accumulating rapidly. Therefore, there is a continuous change in the examination algorithm with new diagnostic and therapeutic modalities making their way into the daily routine. Some of the algorithms become obsolete within a few years and their further application is considered mismanagement. Some other methods become obligatory steps in the diagnostics. These are the reasons why up-to-date knowledge of the literature is mandatory.]

Clinical Oncology

[Management of pancreatic cancer today]

BODOKY György, LAKATOS Gábor

[Pancreatic cancer (PC) is a major health problem with a poor prognosis. The number of patients with PC is increasing globally. There are no screening tests for early detection of PC, but even when diagnosed early, surgery is possible in only a minority of cases. Managing PC remains a big challenge. For selected patients with borderline or unresectable disease, neoadjuvant therapy offers the potential for tumor downstaging. In patients with resectable disease, adjuvant chemotherapy improves the fi ve year survival rate, whereas the use of adjuvant radiochemotherapy is still controversial. In metastatic cancer, monotherapy with gemcitabine remained the main therapeutic option during more than 10 years. Many different combinations with other drugs and new targeted therapies have been tested with gemcitabine. Only a combination of erlotinib and gemcitabine has shown a modest survival benefi t until now. Many gene alterations that directly contribute to pancreas tumorigenesis have been identifi ed or are under active investigation. Recently, the FOLFIRINOX regimen has been reported to be more active than gemcitabine in selected metastatic patients. Quality of life is an extremly important factor, when treating a patient with PC. CA 19-9 serum level can provide important information with regards to prognosis, overall survival, and response to chemotherapy as well as predict post-operative recurrence. There is a strong need for other predictive biomarkers to select patients, who might benefi t from available and new therapeutic options.]

Lege Artis Medicinae

[AUTOIMMUNE PANCREATITIS - AN UNDERDIAGNOSED DISEASE?]

CZAKÓ László

[Autoimmune pancreatitis is a recently recognized type of chronic pancreatitis that is clearly distinct from alcoholic chronic pancreatitis. Its clinical symptoms include jaundice, abdominal pain, weight loss and diabetes mellitus. It may be associated with other autoimmune diseases. IgG levels are elevated and autoantibodies can be detected. Pancreatic imaging reveals a diffuse enlargement of the pancreas and irregular narrowing of the main pancreatic duct. The characteristic histological features are lymphoplasmacytic infiltration and fibrosis. Autoimmune pancreatitis responds dramatically to steroid therapy, in contrast to other types of chronic pancreatitis, which hardly respond to any of the various therapies. It is important to be aware of this disease because it may be mistaken for other forms of chronic pancreatitis or pancreatic cancer, which leads to pancreatic resection when steroid treatment would be sufficient. This review discusses the clinical, laboratory, histological and imaging findings that are seen in autoimmune pancreatitis with particular focus on diagnosis. With the improvement of the diagnostic work-up less unnecessary pancreatic resections are expected to happen in patients with autoimmune pancreatitis.]

Hungarian Radiology

[Radiological diagnostics of the pancreas neoplasms - Onco Update 2005]

FORRAI Gábor, BODOKY György

[Authors reviewed the recent results of pancreas tumour radiological diagnostics and the place of the imaging and interventional methods. Systematical review of the most recent articles were summarized (July 2003-December 2004) in the following subjects: the etiology and clinico-pathology, general diagnostic and therapeutical questions of early pancreatic neoplasms, abdominal ultrasound, computed tomography, multidetector computed tomography, magnetic resonance imaging, MR-cholangiopancreatography, endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, intraductal ultrasound, endoscopic ultrasound-guided cytology, percutaneous biopsy, positron emission tomography, positron emission tomography - computed tomography, special pancreatic tumours. Experiences about the pancreas diagnostic methods are accumulating year-to-year rapidly. Therefore the current examination algorithm is changing continuously. New diagnostic and therapeutic modalities are entering in the daily practice. These are the reasons why the up-to-date knowledge of the literature is mandatory.]