In case of chronic pancreatitis with inflammatory enlargement of the pancreatic head, several operations exist for the treatment, such as the Beger-, Frey-, Whipple-procedures and the Berne modification. A comparison of the results of these procedures is presented in this study. In addition to this, innovations in pancreatojejunal and biliodigestive anastomosis are also described.231 pancreatic head resections were carried out between 1991 and 2021. The data were retrospectively evaluated. Late results were also examined using questionnaires.The Berne modification and the Frey-procedure were more advantageous, than the Whipple- and the Beger-operation in terms of operating time, need for transfusion (P < 0,001), while regarding, the postoperative intensive care unit and total hospital stay both procedures were more favourable, than the Whipple one (P < 0,001). The early morbidity rate was the highest after the Whipple-procedure (P = 0,004). These differences were statistically significant. The reoperation and mortality rates were comparable between the groups. The quality of life of the patients was acceptable, nevertheless in the majority of the cases the alcohol and nicotine abuse was not stopped.The Frey-operation and the Berne modification were the most advantageous, regarding the early postoperative outcomes. However the latter one is preferable, due to its simplicity. During these procedures a single layer continuous suture technique was used for the pancreatojejunal anastomosis, and an extrapancreatic biliodigestive anastomosis is recommended for the solution of cholestasis. due to the superior results.A krónikus pancreatitisnek gyulladásos pancreasfej-megnagyobbodással járó formájában a sebészi kezelésre többféle beavatkozás is kínálkozik, úgymint a Beger-, Frey-, Whipple-műtét és a berni módosítás. Jelen tanulmány az ezekkel elért eredményeket hasonlítja össze, továbbá a pancreatojejunalis és biliodigesztív anastomosis terén végzett innovációkat is ismerteti.1991 és 2021 között összesen 231 pancreasfej resectiót végeztünk. Az adatokat retrospektíven elemeztük. Kérdőívek útján vizsgáltuk a késői eredményeket is. Eredmények: A statisztikai feldolgozás alapján a berni módosítás és a Frey-műtét előnyösebbnek bizonyult a Whipple- és a Beger-műtétnél az operáció időtartama és a transzfúziós igény (P < 0,001) tekintetében, míg az intenzív osztályos és teljes posztoperatív ápolási idő (P < 0,001) terén a Whipple-műtéthez viszonyítva voltak kedvezőbbek. A korai morbiditás gyakorisága a Whipple-műtétet követően volt a legnagyobb (P = 0,004). Ezek a különbségek szignifikánsak voltak. A reoperáció és a mortalitás aránya hasonló volt a csoportokban. A betegek életminősége elfogadható volt, annak ellenére, hogy az esetek zömében az alkohol és nikotin abúzus megmaradt.A Frey-műtét és a berni módosítás volt a legkedvezőbb a korai posztoperatív kimenetel szempontjából, technikailag egyszerűbb volta miatt viszont inkább az utóbbi beavatkozást részesítjük előnyben. Mindkét műtét során a pancreatojejunalis anastomosis készítésére egyrétegű tovafutó varratot, és epepangás esetén annak megoldására egy extrapancreaticusan végzett biliodigesztív összeköttetés létesítését ajánljuk a kedvező tapasztalatok alapján.
Aims and background The mortality of colorectal cancer continues to stagnate despite the development of new therapeutic approaches. Therefore, identifying high-risk population groups could contribute to the prevention of a considerable part of deaths caused by colorectal tumors. Methods Fifty patients with colon cancer and 50 patients with other, nonmalignant diseases were selected for the study. Expression of the c-myc, Ha-ras and p53 genes was determined in the peripheral leukocytes of the participants. Results Marked elevations of the expression of all three investigated genes were seen in the colon cancer patients when compared to the controls. Conclusions Our investigations showed that increases in the expression of c-myc, Ha-ras and p53 genes can be demonstrated in the peripheral leukocytes of colon cancer patients. By applying our method to clinical investigations, individuals with a high risk of having developed colon cancer may be identified and early diagnosis may be established.
Although 21 pancreatic cancer susceptibility loci have been identified in individuals of European ancestry through genome-wide association studies (GWASs), much of the heritability of pancreatic cancer risk remains unidentified. A recessive genetic model could be a powerful tool for identifying additional risk variants. To discover recessively inherited pancreatic cancer risk loci, we performed a re-analysis of the largest pancreatic cancer GWAS, the Pancreatic Cancer Cohort Consortium (PanScan) and the Pancreatic Cancer Case-Control Consortium (PanC4), including 8,769 cases and 7,055 controls of European ancestry. Six single nucleotide polymorphisms (SNPs) showed associations with pancreatic cancer risk according to a recessive model of inheritance. We replicated these variants in 3,212 cases and 3,470 controls collected from the PANcreatic Disease ReseArch (PANDoRA) consortium. The results of the meta-analyses confirmed that rs4626538 (7q32.2), rs7008921 (8p23.2) and rs147904962 (17q21.31) showed specific recessive effects (p<10 −5 ) compared with the additive effects (p>10 −3 ), although none of the six SNPs reached the conventional threshold for genome-wide significance (p < 5×10 −8 ). Additional bioinformatic analysis explored the functional annotations of the SNPs and indicated a possible relationship between rs36018702 and expression of the BCL2L11 and BUB1 genes, which are known to be involved in pancreatic biology. Our findings, while not conclusive, indicate the importance of considering non-additive genetic models when performing GWAS analysis. The SNPs associated with pancreatic cancer in this study could be used for further meta-analysis for recessive association of SNPs and pancreatic cancer risk and might be a useful addiction to improve the performance of polygenic risk scores.
Introduction Acute pancreatitis (AP) is an inflammatory disease with no specific treatment. Mitochondrial injury followed by ATP depletion in both acinar and ductal cells is a recently discovered early event in its pathogenesis. Importantly, preclinical research has shown that intracellular ATP delivery restores the physiological function of the cells and protects from cell injury, suggesting that restoration of energy levels in the pancreas is therapeutically beneficial. Despite several high quality experimental observations in this area, no randomised trials have been conducted to date to address the requirements for energy intake in the early phase of AP. Methods/design This is a randomised controlled two-arm double-blind multicentre trial. Patients with AP will be randomly assigned to groups A (30 kcal/kg/day energy administration starting within 24 hours of hospital admission) or B (low energy administration during the first 72 hours of hospital admission). Energy will be delivered by nasoenteric tube feeding with additional intravenous glucose supplementation or total parenteral nutrition if necessary. A combination of multiorgan failure for more than 48 hours and mortality is defined as the primary endpoint, whereas several secondary endpoints such as length of hospitalisation or pain will be determined to elucidate more detailed differences between the groups. The general feasibility, safety and quality checks required for high quality evidence will be adhered to. Ethics and dissemination The study has been approved by the relevant organisation, the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (55961-2/2016/EKU). This study will provide evidence as to whether early high energy nutritional support is beneficial in the clinical management of AP. The results of this trial will be published in an open access way and disseminated among medical doctors. Trial registration The trial has been registered at the ISRCTN (ISRTCN 63827758).
BACKGROUND/AIMS A single-centre experience gained by middle segmental pancreatic resection and a brief survey of technique and indications are reported. METHODOLOGY During the past 7 years 7 middle segmental pancreatic resections were performed for benign and low-grade malignant pancreatic lesions and in 1 case for pancreatic trauma. The preferred method was anastomosing the distal remnant to a Roux-en-Y limb, closure of the proximal cut end with sutures and in the last 4 patients covering this suture line with the limb. RESULTS There were 3 complications out of 8 cases (37%) and the surgical morbidity rate was 12%. It did not come to reoperation and lethal outcome. During the follow-up time both the endocrine and exocrine functions remained normal in all patients. CONCLUSIONS Middle segmental pancreatic resection could be carried out with an acceptable morbidity rate. However the proper indication and surgical technique are important factors in achieving advantageous results.
Autoimmune pancreatitis is a rare disease which can even mimic pancreatic tumor, however, unlike the latter, it requires not surgical but conservative management. Correct diagnosis and differential diagnosis of autoimmune pancreatitis and treatment of these patients requires up-to-date and evidence based management guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available international guidelines and evidences. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and complemented and/or modified the international guidelines if it was necessary. 29 relevant clinical questions in 4 topics were defined (Basics; Diagnosis; Differential diagnostics; Therapy). Evidence was classified according to the UpToDate ® grading system. The draft of the guidelines was presented and discussed at the consensus meeting on September 12, 2014. All clinial questions were accepted with almost total (more than 95%) agreement. The present guideline is the first evidence based autoimmune pancreatitis guideline in Hungary. The guideline may provide very important and helpful data for tuition of autoimmune pancreatitis, for everyday practice and for establishing proper finance. Therefore, the authors believe that these guidelines will widely become a basic reference in Hungary. Orv. Hetil., 2015, 156(8), 292–307.
Introduction: The adenoma-carcinoma sequence is well-known at tumors of Vater papilla, too. These could be removed endoscopically or surgically with ampullectomy or partial pancreatoduodenectomy.
Abstract For the surgical treatment of chronic pancreatitis with inflammatory head enlargement, several types of resections are available, like the Beger, Frey, Berne, and Whipple procedures. The present work gives a comparison of these techniques and new recommendations about the pancreatojejunal and the biliary anastomosis. Two hundred thirty pancreatic head resections were performed during the last 30 years. Pre-, intra-, and postoperative data were analyzed, respectively. A questionnaire was used to investigate the late results. The statistical analysis proved that the Berne and the Frey procedure were the most advantageous regarding the length of the operation, the need for transfusion, the postoperative intensive care unit, and total hospital stay. The early morbidity rate was significantly better after the Frey, than after the Whipple procedure. There were no differences between the operations, concerning the reoperation and mortality rates. Patients’ quality of life was acceptable, despite the continuous alcohol and nicotine abuse in most of them. Due to the better early outcomes, both the Frey and the Berne operations are preferable; however, the latter one is technically the simplest and the shortest intervention. During both procedures, a modification of the pancreatojejunal anastomosis and, in case of a cholestasis, an extrapancreatic biliodigestive anastomosis are recommended, due to the advantageous experiences.
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