ACUTE PANCREATITIS in HELSINKI in 2016-2018 : INCIDENCE, ETIOLOGY and RISK FACTORS-analysis of 1378 acute pancreatitis episodes in a Finnish normal population

Objectives Updated population-based studies on acute pancreatitis (AP) in Finland are lacking. Our aim was to evaluate the current data for AP in Helsinki. Materials and methods We performed an electronic health care records (EHRs) search on AP patients treated at Helsinki University Hospital between the years 2016 - 2018. Incidence was calculated, etiological and potential risk factors, as well as severity of AP were documented and analyzed. Results Between 2016 and 2018 we found 1378 AP episodes on 1084 patients, 35% of the patients had several AP episodes, i.e., recurrent AP (RAP). The domicile-adjusted incidence was 42.2/100 000. 47% of the patients had alcohol etiology (59% men, 27% women) and 23% had biliary etiology, 21% were idiopathic and 2.9% were post-ERCP pancreatitis. 13.1% of the patients had passed at the end of September 2021. 45% of the patients were currently smoking, 11% were ex-smokers, and the highest percentage of smokers was in the group of alcohol-caused AP with 74% ever-smokers. Biliary AP had the highest amount of overweight patients. 24% of the patients used anticoagulation (AC) medication, and the percentage was significantly higher with idiopathic AP (48%). RAP, female sex and normal BMI associated with a mild form of AP. Conclusions Incidence of AP and the percentage of alcohol etiology are lower than earlier reported for Finland although still higher than in other Nordic countries. Smoking and the use of AC medication associate with AP.Peer reviewe

Lymph node metastases and elevated postoperative calcitonin : Predictors of poor survival in medullary thyroid carcinoma

Background Total thyroidectomy is the treatment of choice for medullary thyroid carcinoma (MTC), but the extent of neck dissection is controversial. Lymph node metastases, distant metastases, and old age are known predictors of poor survival. Patients Patients treated for primary MTC at Helsinki University Hospital from 1990 to 2009 were included (n = 54). Their clinical characteristics, treatment, and outcome were analysed retrospectively, these patients were followed until death or their last follow-up date. Results At last follow-up (3.4-23 years), of 54 MTC patients, 19 (35%) were disease-free, 17 (32%) were alive with disease, and 12 (22%) had died of MTC; six patients died of unrelated causes (11%). All disease-free patients were node negative and had normal postoperative calcitonin level. Of 19 disease-free patients, only four (21%) had undergone lymph node dissection. All patients who died of MTC were Stage IV at diagnosis and died with distant metastases. Disease-specific five-and 10-year survival was 84% and 76.2%. Advanced T-stage (p = 0.004), lymph node metastases (p <0.001), distant metastases (p <0.001), stage (p <0.001), and elevated postoperative calcitonin (p <0.001) significantly associated with survival. Conclusions Lymph node metastasis and elevated postoperative calcitonin are important prognostic factors. Patients with lymph node metastasis and/or elevated postoperative calcitonin with present treatments cannot become disease-free, but most of them can live a long life with metastasis.Peer reviewe

Diclofenac Does Not Reduce the Risk of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis in Low-Risk Units

Background Nonsteroidal anti-inflammatory drugs have an inhibitory role in pathogenesis of pancreatitis. Guidelines from the European Society of Gastrointestinal Endoscopy recommend routine rectal administration of 100 mg of diclofenac or indomethacin immediately before or after ERCP for all patients without contraindications. Aims Our aim was to evaluate the effect of diclofenac in preventing post-ERCP pancreatitis (PEP) in a high-volume, low-PEP-risk ERCP unit. Methods The rate and severity of PEP were compared in groups of 1000 historical controls prior to the routine use of diclofenac and in 1000 patients receiving 100 mg diclofenac before ERCP. Results PEP occurred in 56 (2.8%) of the 2000 patients, and the rate of the pancreatitis was 2.8% in control group and 2.8% in diclofenac group (p = 1.000). The PEP rate among the native papilla patients was 3.9% in control group and 3.6% in diclofenac group (p = 0.803). In subgroup analysis of patients with a high risk of PEP, diclofenac neither prevented PEP nor made its course milder. Conclusions In an unselected patient population in a center with a low incidence of PEP, diclofenac seems to have no beneficial effect.Peer reviewe

Nekroptoosi syöpätaudeissa - pahantekijä vai pelastaja?

Vertaisarvioitu.Ohjelmoitunut apoptoosi, joka ei aiheuta tulehdusvastetta ja kontrolloimaton nekroosi, joka aiheuttaa tulehdusreaktion vapauttamalla solun sisältöä soluvälitilaan, ovat hyvin tunnettuja solukuolemamuotoja. Ohjelmoitunut nekroptoosi on tulehdusreaktion aiheuttava solukuolema, jonka aktivoitumis- ja signaalireitit muistuttavat apoptoosia. Nekroptoosilla on monitahoinen osuus syövän synnyssä, kasvussa ja estossa. Nekroptoosin muokkaama mikroympäristö voi edistää tai hidastaa syövän kasvua. Nekroptoosi pystyy aktivoimaan immuunijärjestelmän tunnistamaan ja tuhoamaan pahanlaatuisesti käyttäytyviä soluja. Toisaalta nekroptoosin aiheuttama tulehdusvaste voi suosia angiogeneesiä, syöpäsolujen jakautumista ja etäpesäkkeiden lähettämistä. On kehitetty syöpälääkkeitä, joilla voidaan tuhota syöpäsoluja ohittamalla apoptoosiresistenssi nekroptoosin välityksellä. Ymmärtämällä paremmin nekroptoosin osuus myös tulehduksellisten tautien patogeneesissä voitaisiin nekroptoosiin vaikuttamalla mahdollisesti estää tulehdukseen liittyvää syövän kehittymistä.Peer reviewe

Nekroptoosi infektioissa ja tulehdussairauksissa - solut viimeisellä portilla

Vertaisarvioitu. English summaryOhjelmoitunutta solukuolemaa tarvitaan elinten kehittymisessä, kudosten homeostaasin ja uusiutumiskyvyn ylläpidossa sekä puolustussolujen toiminnan säätelyssä. Sen ainoana muotona pidettiin pitkään kaspaasientsyymien säätelemää, tulehdusta lietsomatonta apoptoosia. Nykyään tiedetään, ettei tulehdus- ja soluvauriosignaalien laukaisema nekroosikaan ole vain kontrolloimaton solutuho, vaan siitä on aktivoitumiskykyisiä geneettisesti ohjelmoituneita muotoja, joista tunnetuin on nekroptoosi eli tulehduksellisesti ohjelmoitunut nekroottinen solukuolema. Keskeiset solunsisäisessä nekroptoosisignaloinnissa toimivat proteiinit ovat RIP (receptor-interacting protein kinase) 1, RIP3 ja MLKL (mixed lineage kinase domain-like protein). Niiden aktivoituessa, esimerkiksi virus- (muun muassa koronavirus) tai bakteeri-infektion yhteydessä, nekroptoottisesta solusta vapautuu vaarasignaalimolekyylejä. Nekroptoosi aiheuttaa tulehdusreaktion, jolla voi kudostuhon ohella olla regeneratiivisia vaikutuksia. Nekroptoositutkimus on avannut uusia näkymiä immuunipuolustuksen keinoihin ja tulehduksellisten sairauksien patogeneesiin sekä mahdollisuuksiin vaikuttaa näihin.Peer reviewe

Variable somatostatin receptor subtype expression in 151 primary pheochromocytomas and paragangliomas

Pheochromocytomas (PHEOs) and paragangliomas (PGLs) are neuroendocrine tumors that express somatostatin receptors (SSTRs), a phenomenon that constitutes a basis for tumor imaging and treatment with somatostatin analogues and peptide receptor radionuclide therapy. We studied the immunohistochemical expression of SSTR1-5 in 151 primary tumors, including 14 metastasized and 16 SDHB-deficient tumors. SSTR2 and SSTR3 were most abundantly present in these tumors, whereas the tumors were mostly negative for SSTR1, SSTR4, and SSTR5. All metastasized PGLs (9/9), but only one metastasized PHEO (1/5), were strongly SSTR2 positive. SSTR3 expression was lower in metastatic tumors and tumors with a high proliferation rate (MIB1 >= 5%), but tumors had variable individual SSTR profiles. No correlation was found between SDHB status and SSTR expression. Our results suggest that new SSTR analogues with affinity for several SSTRs could be relevant for a subgroup of patients with these tumors. Better knowledge of tumor SSTR profiles could open the door for personalized imaging and treatment in the future. Because SSTR profiles vary in PHEOs and PGLs, individual analysis is required for each tumor. (C) 2018 The Authors. Published by Elsevier Inc.Peer reviewe

Necroptosis Is an Important Severity Determinant and Potential Therapeutic Target in Experimental Severe Pancreatitis

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Intraoperative colonic pulse oximetry in left-sided colorectal surgery : can it predict anastomotic leak?

An anastomotic leak is a fairly common and a potentially lethal complication in colorectal surgery. Objective methods to assess the viability and blood circulation of the anastomosis could help in preventing leaks. Intraoperative pulse oximetry is a cheap, easy to use, fast, and readily available method to assess tissue viability. Our aim was to study whether intraoperative pulse oximetry can predict the development of an anastomotic leak. The study was a prospective single-arm study conducted between the years 2005 and 2011 in Helsinki University Hospital. Patient material consisted of 422 patients undergoing elective left-sided colorectal surgery. The patients were operated by one of the three surgeons. All of the operations were partial or total resections of the left side of the colon with a colorectal anastomosis. The intraoperative colonic oxygen saturation was measured with pulse oximetry from the colonic wall, and the values were analyzed with respect to post-operative complications. 2.3 times more operated anastomotic leaks occurred when the colonic StO(2) was Low intraoperative colonic StO(2) values are associated with the occurrence of anastomotic leak. Despite its handicaps, the method seems to be useful in assessing anastomotic viability.Peer reviewe

Somatostatin receptor expression in parathyroid neoplasms

Introduction: Parathyroid carcinoma represents a rare cause of primary hyperparathyroidism. Distinguishing carcinoma from the benign tumors underlying primary hyperparathyroidism remains challenging. The diagnostic criteria for parathyroid carcinoma are local and/or metastatic spreading. Atypical parathyroid adenomas share other histological features with carcinomas but lack invasive growth. Somatostatin receptors are commonly expressed in different neuro endocrine tumors, but whether this also holds for parathyroid tumors remains unknown. Aim: Our aim is to examine the immunohistochemical expression of somatostatin receptor 1-5 in parathyroid typical adenomas, atypical adenomas and carcinomas. Methods: We used a tissue microarray construct from a nationwide cohort of parathyroid carcinomas (n = 32), age- and gender-matched typical parathyroid adenomas (n = 72) and atypical parathyroid adenomas (n = 27) for immunohistochemistry of somatostatin receptor subtypes 1-5. We separately assessed cytoplasmic, membrane and nuclear expression and also investigated the associations with histological, biochemical and clinical characteristics. Results: All parathyroid tumor subgroups expressed somatostatin receptors, although membrane expression appeared negligible. Except for somatostatin receptor 1, expression patterns differed between the three tumor types. Adenomas exhibited the weakest and carcinomas the strongest expression of somatostatin receptor 2, 3, 4 and 5. We observed the largest difference for cytoplasmic somatostatin receptor 5 expression. Conclusions: Parathyroid adenomas, atypical adenomas and carcinomas all express somatostatin receptor subtypes 1-5. Somatostatin receptor 5 may serve as a potential tumor marker for malignancy. Studies exploring the role of somatostatin receptor imaging and receptor-specific therapies in patients with parathyroid car cinomas are needed.Peer reviewe