Successful treatment of pediatric IgG4 related systemic disease with mycophenolate mofetil: case report and a review of the pediatric autoimmune pancreatitis literature

Autoimmune pancreatitis is frequently associated with elevated serum and tissue IgG4 levels in the adult population, but there are few reports of pediatric autoimmune pancreatitis, and even fewer reports of IgG4 related systemic disease in a pediatric population. The standard of care treatment in adults is systemic corticosteroids with resolution of symptoms in most cases; however, multiple courses of corticosteroids are occasionally required and some patients require long term corticosteroids. In these instances, steroid sparing disease modify treatments are in demand. We describe a 13-year-old girl with IgG4 related systemic disease who presented with chronic recurrent autoimmune pancreatitis resulting in surgical intervention for obstructive hyperbilirubinemia and chronic corticosteroid treatment. In addition, she developed fibrosing medianstinitis as part of her IgG4 related systemic disease. She was eventually successfully treated with mycophenolate mofetil allowing for discontinuation of corticosteroids. This is the first reported use of mycophenolate mofetil for IgG4 related pancreatitis. Although autoimmune pancreatitis as part of IgG4 related systemic disease is rarely reported in pediatrics, autoimmune pancreatitis is also characterized as idiopathic fibrosing pancreatitis. All pediatric autoimmune pancreatitis cases reported in the world medical literature were identified via a PUBMED search and are reviewed herein. Twelve reports of pediatric autoimmune pancreatitis were identified, most of which were treated with corticosteroids or surgical approaches. Most case reports failed to report IgG4 levels, so it remains unclear how commonly IgG4 related autoimmune pancreatitis occurs during childhood. Increased evaluation of IgG4 levels in patients with autoimmune pancreatitis may shed further light on the association of IgG4 with pancreatitis and the underlying pathophysiology

Iodine-125 brachytherapy for brain tumours - a review

Iodine-125 brachytherapy has been applied to brain tumours since 1979. Even though the physical and biological characteristics make these implants particularly attractive for minimal invasive treatment, the place for stereotactic brachytherapy is still poorly defined

Improvement in breast lesion characterization with dynamic contrast-enhanced MRI using pharmacokinetic modeling and bookend T-1 measurements

Dynamic contrast-enhanced breast MR imaging was performed on 14 patients (five cancerous lesions, nine benign) with slice-selective spoiled gradient-recalled echo (2D SPGR) imaging. Adiabatic saturation recovery T-1 measurements were performed before (T-1pre) and after (T-1post) 2D SPGR imaging. These two "book-end" T-1 measurements were used to calibrate the equations which were employed to convert the time course of the 2D SPGR signal strength to T-1-vs.-time, which in turn was used to compute the gadolinium concentration-vs.-time ([C](t)) in the lesion. The extraction-flow product (EF) was computed for each lesion by pharmacokinetic modeling of [C](t). For this study, EF provided a sensitivity and specificity for cancer of 100% and 78%, respectively. When only T-1pre was used to estimate [C](t) (which assumes a priori knowledge of the shape and amplitude of the slice profile), the sensitivity and specificity fell to 80% and 56%, respectively. This is presumably due to unexpected variations in the shape and/or amplitude of the slice profile, which could be caused by factors such as patient-to-patient variations in breast geometry or inconsistently set transmit gains. Therefore, both T-1pre and T-1post measurements are necessary for optimum sensitivity and specificity using pharmacokinetic analysis. (C) 2004 Wiley-Liss, Inc

A comparison of T-2(*)-weighted magnitude and phase imaging for measuring the arterial input function in the rat aorta following intravenous injection of gadolinium contrast agent

The arterial input function (AIF) is important for quantitative MR imaging perfusion experiments employing Gd contrast agents. This study compared the accuracy of T-2*-weighted magnitude and phase imaging for noninvasive measurement of the AIF in the rat aorta. Twenty-eight in vivo experiments were performed involving simultaneous arterial blood sampling and MR imaging following Gd injection. In vitro experiments were also performed to confirm the in vivo results. At 1.89 T and TE = 3 ms, the relationship between changes in 1/T-2* in blood (estimated from MR signal magnitude) and Gd concentration ([Gd]) was measured to be similar to 19 s(-1) mM(-1), while that between phase and [Gd] was similar to 0.19 rad mM(-1). Both of these values are consistent with previously published results. The in vivo phase data had approximately half as much scatter with respect to [Gd] than the in vivo magnitude data (r(2) = .34 vs. r(2)= .17, respectively). This is likely due to the fact that the estimated change in 1/T2* is more sensitive than the phase to a variety of factors such as partial volume effects and T, weighting. Therefore, this study indicates that phase imaging may be a preferred method for measuring the AIF in the rat aorta compared to T2*-weighted magnitude imaging. (c) 2005 Elsevier Inc. All rights reserved

An assessment of banking operation strategies of private banking institutions in the Philippines

[[abstract]]Attempts to assess the performance of five selected private banking institutions in the Philippines in order to determine how these perform at their vital functions, and to what extent they implement their savings consciousness programme, marketing campaign programme, technological innovation and outreach programmes. Findings reveal that all the banking functions perform well except for insurance. Suggests the banks are implementing the programmes as a gesture of sensitivity to the needs of their customers. Discusses how they use a variety of marketing tools such as posters, brochures, leaflets, product kits and media exposure through broadcast and print media, which are considered by the research as the most effective means of promoting the bank’s products and services.[[journaltype]]國外[[booktype]]紙本[[countrycodes]]GB