PET/CT incidental detection of second tumor in patients investigated for pancreatic neoplasms

Positron Emission Tomography/computed tomography (PET/CT) is an imaging technique which has a role in the detection and staging malignancies (both in first diagnosis and follow-up). The finding of an unexpected region of FDG (Fluorodeoxyglucose) uptake can occur when performing whole-body FDG-PET, raising the possibility of a second primary tumor. The aim of this study was to evaluate our experience of second primary cancer incidentally discovered during PET/CT examination performed for pancreatic diseases, during the initial work-up or follow-up after surgical resection

Solid-pseudopapillary tumor of the pancreas: A single center experience

open6noAim of this study was to review the institutional experience of solid-pseudopapillary tumors of the pancreas with particular attention to the problems of preoperative diagnosis and treatment. From 1997 to 2013, SPT was diagnosed in 18 patients among 451 pancreatic cystic neoplasms (3.7%). All patients underwent preoperative abdominal ultrasound, computed assisted tomography, and tumor markers (CEA and CA 19-9) determinations. In some instances, magnetic resonance, positron emission tomography, and endoscopic ultrasound with aspiration cytology were performed. There were two males and 16 females. Serum CA 19-9 was slightly elevated in one case. Preoperative diagnosis was neuroendocrine tumor (n = 2), mucinous tumor (n = 2), and SPT (n = 14). Two patients underwent previous operation before referral to our department: one explorative laparotomy and one enucleation of SPT resulting in surgical margins involvement. All patients underwent pancreatic resection associated with portal vein resection (n = 1) or liver metastases (n = 1). One patient died of metastatic disease, 77 months after operation, and 17 are alive and free with a median survival time of 81.5 months (range 36-228 months). Most of SPT can be diagnosed by CT or MRI, and the role of other diagnostic tools is very limited. We lack sufficient information regarding clinicopathologic features predicting prognosis. Caution is needed when performing limited resection, and long and careful follow-up is required for all patients after surgery.openBeltrame, Valentina; Pozza, Gioia; Dalla Bona, Enrico; Fantin, Alberto; Valmasoni, Michele; Sperti, CosimoBeltrame, Valentina; Pozza, Gioia; DALLA BONA, Enrico; Fantin, Alberto; Valmasoni, Michele; Sperti, Cosim

Complementary and alterative treatments in functional dyspepsia

INTRODUCTION AND AIM: The popularity of complementary and alternative medicine (CAM) in treating functional gastrointestinal disorders (FGIDs) has steadily increased in Western countries. We aimed at analyzing available data on CAM effectiveness in functional dyspepsia (FD) patients. METHODS: A bibliographical search was performed in PubMed using the following keywords: "complementary/alternative medicine”, “hypnosis”, “acupuncture” and/or “functional dyspepsia”. RESULTS: In community settings, almost 50% of patients with FGIDs used CAM therapies. Herbal remedies consist in multi-component preparations, whose mechanisms of action have not been systematically clarified. Few studies analyzed the effectiveness of Acupuncture in Western countries, yielding conflicting results and possibly reflecting a population bias of this treatment. Hypnosis has been extensively used in irritable bowel syndrome, but few data support its role in treating FD. CONCLUSIONS: Although some supporting well-designed studies have been recently performed, additional randomized control trials are needed before stating any recommendation on CAM effectiveness in treating FD

Complementary and alternative treatment in functional dyspepsia

The popularity of complementary and alternative medicine (CAM) in treating functional gastrointestinal disorders (FGIDs) has steadily increased in Western countries. We aimed at analyzing available data on CAM effectiveness in functional dyspepsia (FD) patients

Small airway dysfunction predicts excess ventilation and dynamic hyperinflation during exercise in patients with COPD

Introduction: Small airway dysfunction (SAD) is a pathophysiological characteristic of chronic obstructive pulmonary disease (COPD). Excess ventilation and dynamic hyperinflation (DH) are two main pathophysiological traits and limiting factors of COPD patients while exercising. We aimed to ascertain whether or not SAD, assessed by the multiple breath nitrogen washout (MBNW), may predict exercise ventilatory inefficiency and DH. Methods: Fifty stable COPD patients were prospectively studied and underwent MBNW and incremental cardio-pulmonary exercise test (CPET). Indices of conductive (Scond) and acinar (Sacin) ventilation heterogeneity as well as minute ventilation/CO2 production (VE/VCO2) linear relationship and the change in inspiratory capacity (IC) were analyzed. Results: Sacin was significantly and directly related to VE/VCO2 slope and inversely related to IC change and to peak O2 uptake (p < 0.01 for all correlations). No significant correlation was found between Scond and CPET parameters. The regression equation generated by stepwise multiple regression analysis for the VE/VCO2 slope and IC change, as dependent variables, included only Sacin, as independent variable. This model accounted for 31% and 36% of the total variance for the VE/VCO2 slope and IC change, respectively. Conclusion: Our study shows the value of the SAD as determinant of the excess ventilation and DH during exercise in patients with stable COPD

Evidence of multiple paternal contribution in Podocnemis sextuberculata (Testudines: Podocnemididae) detected by microsatellite markers

Evidência de contribuição paterna múltipla em Podocnemis sextuberculata (Chelonia: Podocnemididae) por meio de marcadores microssatélites. Encontramos evidências de paternidade múltipla em uma amostra de 80 recém-eclodidos de sete ninhos de Podocnemis sextuberculata situados ao longo do rio Amazonas, no município de Barreirinha, AM, Brasil, e 54 indivíduos recém-eclodidos de cinco ninhos na Reserva Biológica Abufari, Tapauá, AM, Brasil. Como observado em outras espécies do gênero, P. sextuberculata apresentou comportamento poliândrico. Por meio da frequência alélica e variação em seis locos microssatélite para cada localidade, a ocorrência de paternidade múltipla em ninhos amostrados dessa espécie foi inferida, mesmo o genótipo da mãe sendo desconhecido. Para um dos ninhos, um mínimo de quatro machos contribuíram para a prole, enquanto que para quase todos os outros ninhos, pelo menos dois machos contribuíram. Apenas um dos 12 ninhos não mostrou evidência clara de contribuição de mais de um macho. Esta é a primeira evidência genética de paternidade múltipla em P. sextuberculata.Evidence of multiple paternity in Podocnemis sextuberculata (Testudines: Podocnemididae) detected by microsatellite markers. We found evidence of multiple paternity in a sample of 12 Podocnemis sextuberculata nests including seven nests (80 hatchlings) collected along the Amazonas River, in the municipality of Barreirinha, AM, Brazil and five nests in the Abufari Biological Reserve, Tapauá, AM, Brazil (54 hatchlings). As observed in other species of the genus, P. sextuberculata also presented polyandric behavior. By means of allelic frequency and variation in six microsatellite loci for each location, the occurrence of multiple paternity in sampled nests of this species was inferred, even though the maternal genotype was unknown. For one of the nests, a minimum of four males contributed to the clutch, whereas for nearly all remaining nests at least two males contributed. Only one of the twelve nests did not show clear evidence for contributions from more than one male. This is the first genetic evidence of multiple paternity in P. sextuberculat

Multidisciplinary expertise in the diagnosis of cecal lymphoma

This particular case highlights the importance of a multidisciplinary team expertise in the differential diagnostic process of acute abdominal pain. The case involves a 10-year old Chinese boy who presented with intermittent abdominal pain; the clinical and radiologic picture narrowed the differential diagnosis between an acute appendicitis and an intestinal lymphoma. Diagnosis of a high grade - B lymphoma was made by performing a colonoscopy; this procedure was deemed the best option to obtain a quick diagnosis with low invasiveness

Solid-Pseudopapillary Tumor of the Pancreas: A Single Center Experience

Aim of this study was to review the institutional experience of solid-pseudopapillary tumors of the pancreas with particular attention to the problems of preoperative diagnosis and treatment. From 1997 to 2013, SPT was diagnosed in 18 patients among 451 pancreatic cystic neoplasms (3.7%). All patients underwent preoperative abdominal ultrasound, computed assisted tomography, and tumor markers determinations. In some instances, magnetic resonance, positron emission tomography, and endoscopic ultrasound with aspiration cytology were performed. There were two males and 16 females. Serum CA 19-9 was slightly elevated in one case. Preoperative diagnosis was neuroendocrine tumor ( = 2), mucinous tumor ( = 2), and SPT ( = 14). Two patients underwent previous operation before referral to our department: one explorative laparotomy and one enucleation of SPT resulting in surgical margins involvement. All patients underwent pancreatic resection associated with portal vein resection ( = 1) or liver metastases ( = 1). One patient died of metastatic disease, 77 months after operation, and 17 are alive and free with a median survival time of 81.5 months (range 36-228 months). Most of SPT can be diagnosed by CT or MRI, and the role of other diagnostic tools is very limited. We lack sufficient information regarding clinicopathologic features predicting prognosis. Caution is needed when performing limited resection, and long and careful follow-up is required for all patients after surgery

Vegan Diet Advice Might Benefit Liver Enzymes in Nonalcoholic Fatty Liver Disease: an Open Observational Pilot Study.

Background and Aims: The Western diet is rich in saturated fats, refined sugars and meat consistent with a high-energy load and secondary risk of increased metabolic diseases including nonalcoholic fatty liver disease (NAFLD). However, no data are available on potential benefit of vegan diets in NAFLD and/or nonalcoholic steatohepatitis (NASH). We aimed to study prospectively the effect of a vegan diet, excluding all animal products on liver chemistry in a group of consecutive NAFLD patients. Methods: This was a prospective, pilot study run on 40 consecutive patients affected by NAFLD. Eight subjects refused to join the study for poor diet palatability, leaving 32 patients (19 males, mean age 50 years), with abnormal measures of liver function who agreed to adhere to a vegan diet for six months. The caloric intake was tailored by the dietitian to obtain a weight loss ≥5% of body weight in overweight patients [body-mass index (BMI) ≥25] and ranged from 1500 Kcal to 1800 Kcal. Patients were contacted monthly by phone to reinforce diet and lifestyle advice and were seen at the gastrointestinal clinic when doubtful about diet advice. Results: At six-month follow-up, 6 subjects did not attend the clinic leaving only 26 patients for data analysis. Initial anthropometric values were mean weight 78 kg (range 52-95), mean body mass index (BMI) 26.8 Kg/m2 (range 20.3-31.2). Liver function tests showed mean ALT value 99 U/L (SD±45), mean AST value 54 U/L (SD±44), mean GGT value 160 U/L (SD±122), pre-treatment. After six months mean body weight was 73 Kg (range 52-87), mean BMI was 25.2 Kg/m2 (range 20.3-29.7) (p<0.001 compared to baseline for both parameters). Liver enzymes improved to a mean of ALT value 36 U/L (SD±21), AST value 27 U/L (SD±10) and GGT value 55 U/L (SD±57), respectively (p<0.001 compared to baseline for all enzymes). Normalization of liver function tests as a whole was observed in 20/26 patients (76.9%). A loss of ≥ 5% of body weight was observed in 12 patients (46.1%), but it did not correlate with the normalization of liver function tests (p=0.5). Conclusions: Our data provide preliminary evidence of improved liver enzymes in NAFLD patients with a strict vegan diet and although our study sample is limited, decreased body weight did not seem critical to the outcome