International Consensus Guidelines for Risk Factors in Chronic Pancreatitis. Recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with the International Association of Pancreatology, the American Pancreatic Association, the Japan Pancreas Society, and European Pancreatic Club

Chronic pancreatitis (CP) is a complex inflammatory disease with remarkably impaired quality of life and permanent damage of the pancreas. This paper is part of the international consensus guidelines on CP and presents the consensus on factors elevating the risk for CP.An international working group with 20 experts on CP from the major pancreas societies (IAP, APA, JPS, and EPC) evaluated 14 statements generated from evidence on four questions deemed to be the most clinically relevant in CP. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to evaluate the level of evidence available per statement. To determine the level of agreement, the working group voted on the 14 statements for strength of agreement, using a nine-point Likert scale in order to calculate Cronbach's alpha reliability coefficient.Strong consensus and agreement were obtained for the following statements: Alcohol, smoking, and certain genetic alterations are risk factors for CP. Past history, family history, onset of symptoms, and life-style factors including alcohol intake and smoking history should be determined. Alcohol consumption dose-dependently elevates the risk of CP up to 4-fold. Ever smokers, even smoking less than a pack of cigarettes per day, have an increased risk for CP, as compared to never smokers.Both genetic and environmental factors can markedly elevate the risk for CP. Therefore, health-promoting lifestyle education and in certain cases genetic counselling should be employed to reduce the incidence of CP

Pancreasrák. A Magyar Hasnyálmirigy Munkacsoport bizonyítékon alapuló kezelési irányelvei

A pancreasrák gyakran későn diagnosztizált kórkép, amely a legrosszabb kórlefolyású betegségek csoportjába sorolható, ezért a szűrése, diagnosztikája, kezelése és palliációja korszerű és bizonyítékokon alapuló útmutatót igényel. A Magyar Hasnyálmirigy Munkacsoport célul tűzte ki, hogy a jelenleg elérhető nemzetközi irányvonalakat, illetve evidenciákat alapul véve a pancreasrák kezelésének kulcskérdései vonatkozásában bizonyíték alapú irányelveket fogalmazzon meg. A Magyar Hasnyálmirigy Munkacsoport által kijelölt előkészítő és konzulens munkacsoport lefordította, és ahol szükségesnek találta, kiegészítette és/vagy módosította a nemzetközi irányelveket. Összesen 10 témakörben (Rizikófaktorok és genetika, Szűrés, Diagnózis, Staging, Sebészi kezelés, Patológiai feldolgozás, Szisztémás kezelés, Sugárterápia, Palliáció és szupportív kezelés, Utánkövetés és rekurrencia) 37 releváns irányelv került összeállításra. Az evidencia osztályozása a National Comprehensive Cancer Network (NCCN) rendszere alapján került meghatározásra. Az összeállított irányelvek a 2014. szeptember 12-ei konszenzustalálkozón kerültek bemutatásra és megvitatásra. A résztvevők 15 irányelvet teljes (95% feletti) egyetértéssel, míg 22 irányelvet erős (70% feletti) egyetértéssel fogadtak el. A Magyar Hasnyálmirigy Munkacsoport kezelési irányelvei az első, bizonyíték alapján készült pancreasrák-kezelési útmutató hazánkban. Az irányelv komoly segítséget nyújthat a pancreasrák oktatásához, a mindennapi betegellátáshoz és a megfelelő finanszírozás kialakításához. Ezért a szerzők bíznak abban, hogy ezen irányelvek minél szélesebb körben alapreferenciaként fognak szolgálni Magyarországon. Orv. Hetil., 2015, 156(8), 326–339

New experimental study of the

The total cross section of the 3He(α,γ)7Be reaction was measured by the activation technique in the energy range of Ecm = 2.6 - 3.1 MeV, covering the first known resonance in the reaction. Consistent results were obtained with the only one available literature dataset in this energy range

A novel percutaneous transhepatic treatment of a benign bile duct stricture – a pilot study

Aim To assess the effectiveness and outcome of repeated percutaneous transhepatic balloon dilatation combined with targeted intramucosal corticosteroid injection in patients with benign biliary stricture. Methods This single-center pilot study, conducted between February 2014 and June 2016, involved five patients with benign biliary stricture (4 men and 1 woman, mean age 58.2 years). The study included only patients in whom previous surgical or/and non-surgical treatments failed or could not be performed due to patients’ medical history and local status.Results We successfully developed an alternative treatment for patients with benign biliary stricture and performed it without side effects. There were no major complications, and the only one minor complication was cholangitis. In the median follow-up period of 30.24 months (range 14.5 to 44.6 months), no re-occlusion was detected. The disease-free survival, calculated after excluding the first patient (who died of heart attack), was 34.175 months. Conclusion Percutaneous transhepatic corticosteroid injection combined with balloon dilatation could provide an alternative method for the treatment of benign biliary strictures that is effective in the long term and results in positive outcomes

Efficacy and safety of FOLFIRINOX in locally advanced pancreatic cancer: a single center experience

The management of locally advanced pancreatic cancer (LAPC) is a major challenge. Although new drugs are available for the treatment of metastatic disease, the optimal treatment of non-metastatic cases remains controversial. The role of neoadjuvant therapy is still a question of debate in this setting. The aim of the study was to prospectively collect and analyse data on efficacy and safety of a modified FOLFIRINOX regimen in LAPC patients treated in a single institution. Another major objective was to assess the capability of FOLFIRINOX to render primary non-resectable cancer to resectable. No bolus fluorouracil was given and a 20% dose reduction of oxaliplatin and irinotecan was applied. Primary G-CSF prophylaxis was applied to prevent febrile neutropenia. Thirty-two patients (mean age 60.2 years, range: 40-77 years) have been enrolled into the study. All patients had ECOG performance status of 0 or 1. Best response to therapy was stable disease (SD) or partial regression (PR) in 18 (56.2%) and 6 (18.8%) cases. Two patients (6.3%) underwent surgical resection (100% R0). The most frequent grade 3/4 adverse events were nausea (18.8%), fatigue (12.5%) and diarrhea (12.5%). The incidence of severe neutropenia was 28.1%, with only one documented case of febrile neutropenia. The probability of disease progression was 25% and 50% after 75 and 160 days with 88.4% of possibility of disease progression after 500 days. OS probability was 92.1, 71.5% and 49.5% at 180-, 365 and 540 days. Our data does not support the capability of FOLFIRINOX to render primary non-resectable cancer to resectable. However, due to the high disease control rate observed, FOLFRINOX might be recommended as first line option for the palliative treatment of LAPC. Despite reduced chemotherapy doses significant toxicity has been seen