Solid pseudopapillary neoplasms-experience from a tertiary care centre

Introduction: Solid pseudopapillary neoplasms (SPN/FRANTZ TUMOUR) of the pancreas are rare neoplasms of low grade malignant potential which were first described in 1959 by Frantz. These account for 0.13–2.7% of pancreatic neoplasms and approximately 13% of surgically resected cystic lesions of the pancreas. We present our experience with these rare tumors. Methods: Total 406 patients with pancreatic tumours were admitted in our department during the 10year period (Between 2007 and 2017) were reviewed, only 18 were diagnosed as having SPN(4.4%). Clinico-pathological details, intervention done and follow up of all the cases were studied and reported here. Results: 17 patients were woman and1was Man with median age of 23 years (range 11 to 54 years). The tumor size ranged from 3.8 to17cm (average 6.4 cm).12 patients presented with pain in the abdomen, 4 presented with a painless mass, 1 was detected incidentally and1presented with Malena. In 7 patients the tumor was in the pancreatic head, in 3 it was in the neck, and in the remaining 8 it is in the body and tail. CECT was done in all cases. 8 patients under went Distal pancreatectomy with splenectomy, 1 underwent a PPPD, 6 patients required classical Whipple operation. 3 underwent central pancreatectomy. Immuno histochemistry showed positivity for beta catenin, vimentin, PR receptor and chromogranin negativity. All 18 patients were free of disease in a median follow- up period of 32 months (range 6 – 84) months. Conclusion: SPNs are rare neoplasms, typically affecting young women without notable symptoms, with a low malignant potential but excellent prognosis. Radical surgical resection with clear margins is the treatment of choice

Contrast-enhanced ultrasound for the evaluation of hepatic artery occlusion after liver transplantation

Introduction:Vascular complications after liver transplantation remain a major threat to the survival of recipients.HAT is a major cause of graft loss and patient mortality, with an incidence between 3% to 8% in transplant recipients.Early detection of HAT is critical because urgent revascularization is required to avoid severe graft loss. Although ultrasound is the preferred first-line imaging modality in patients with suspected HAT, the accuracy and positive predictive value of HAT on Doppler US are reported to be low. Moreover, Doppler examination of the hepatic vasculature is time consuming and requires a high level of operator skill. Conventional angiography remains the gold standard for diagnosis. Recently, contrast-enhanced ultrasound (CEUS) has begun providing real-time angiographic-like images of vessels at bed side and allowing the accurate diagnosis of arterial diseases such as hepatic artery thrombosis. The purpose of this study was to evaluate the efficacy of CEUS in detecting HAT after liver transplantation: Materials and Methods: This is a retrospective data of the medical records of patients undergoing Liver transplantation in the Osmania General Hospital, Hyderabad between 2016 to 2018. Status of hepatic vascular assessment following liver transplantation done by conventional Doppler Ultra sonography and Contrast Enhanced Ultrasonography tests were obtained from registries of medical records. Results:23 cases of post Liver transplantation aged between 4years and 58 years, with a median age of 30 years were included in the analysis. There were 20 males and 3 females. 14 patients underwent DDLT, 7 patients underwent LDLT, 1underwent split Liver transplantation and another 1 patient underwent Auto liver transplantation. Doppler US was inconclusive regarding patency of the hepatic artery (HA) circulation in 5 (21.7 %) of 23 transplantations. CEUS was performed in these 5 patients and detected HA thrombosis (HAT) in 2 cases and patent HA in 3 transplants. These 5 Transplants were confirmed by CT Angiography /conventional Angiography. In the subset of transplantations examined with CEUS, the sensitivity, specificity and accuracy of CEUS were 100%. CEUS was done at bedside without any Radiation and Nephro toxicity. In approximately 21.7% of cases, conventional Doppler US did not provide sufficient visualization of the HA after liver transplantation. In these cases, correct diagnosis was achieved by supplementary CEUS. Conclusion:CEUS may be a new approach for early diagnosis of postoperative vascular complications after Liver Transplantation, and it can be performed at the bedside. It is safe will not cause any nephron toxicity and Radiation. CEUS is a fast, non-ionizing imaging modality for the initial exclusion of vascular complications after liver transplantation. CEUS shows a high specificity and PPV in the detection of vascular complications. In unclear cases CT still is considered as the gold standar

Diagnosis and treatment in chronic pancreatitis: an international survey and case vignette study

Background The aim of the study was to evaluate the current opinion and clinical decision-making process of international pancreatologists, and to systematically identify key study questions regarding the diagnosis and treatment of chronic pancreatitis (CP) for future research. Methods An online survey, including questions regarding the diagnosis and treatment of CP and several controversial clinical case vignettes, was send by e-mail to members of various international pancreatic associations: IHPBA, APA, EPC, ESGE and DPSG. Results A total of 288 pancreatologists, 56% surgeons and 44% gastroenterologists, from at least 47 countries, participated in the survey. About half (48%) of the specialists used a classification tool for the diagnosis of CP, including the Mayo Clinic (28%), Mannheim (25%), or Büchler (25%) tools. Overall, CT was the preferred imaging modality for evaluation of an enlarged pancreatic head (59%), pseudocyst (55%), calcifications (75%), and peripancreatic fat infiltration (68%). MRI was preferred for assessment of main pancreatic duct (MPD) abnormalities (60%). Total pancreatectomy with auto-islet transplantation was the preferred treatment in patients with parenchymal calcifications without MPD abnormalities and in patients with refractory pain despite maximal medical, endoscopic, and surgical treatment. In patients with an enlarged pancreatic head, 58% preferred initial surgery (PPPD) versus 42% initial endoscopy. In patients with a dilated MPD and intraductal stones 56% preferred initial endoscopic ± ESWL treatment and 29% preferred initial surgical treatment. Conclusion Worldwide, clinical decision-making in CP is largely based on local expertise, beliefs and disbeliefs. Further development of evidence-based guidelines based on well designed (randomized) studies is strongly encouraged