Treatment of type 2 diabetes mellitus and risk of pancreatic cancer

Pancreatic ductal adenocarcinoma (PDAC) is the most common cancer of the exocrine part of the pancreas with poor prognosis. Up to 85% of PDAC patients are diagnosed with diabetes or hyperglycaemia at the time of diagnosis indicating that impaired glucose homeostasis is a common event in this cancer. A mechanism of association between PDAC and diabetes is very complex and still not fully understood. Currently, the various classes of anti-diabetic drugs are used in diabetes treatment. It is possible that specific types of anti-diabetic drugs for diabetes may have different impacts on pancreatic cancer development. Moreover, the intriguing question of whether diabetes can facilitate PDAC development remains unanswered. This paper presents the results of recent studies on the effect of the anti-diabetic treatment used on pancreatic cancer risk in diabetic patients

Patients' opinions about Polish surgeons and surgical treatment

In Polish society Stereotypes about the surgeons are deeply rooted, which could really affect their relationship with the patient and the entire treatment process. The aim of the study was to evaluate the results of an opinion survey on the image of the surgeon and operative treatment. Material and methods. Between 1 January and 30 October 2012, 1000 patients were examined by use of a original questionnaire containing 25 questions. Results were analyzed statistically by STATISTICA test. Differences between groups were tested using Chi-square test (X²) with Yates modification, adopting the significance level α = 0.05. Results. The study group consisted of 1000 patients, including 56% of women (n = 560) and 44% of men (n = 440). The media image of Polish surgeon was identified as positive by 78% of respondents. A majority of patients (74%) considered that the Polish surgeons had equal level of competence and skills as foreign specialists. The greatest trust of the respondents (n = 537) had surgeons in middle age (40‑60 years). For the majority of patients (n = 649) a sex of the surgeon had no significance. Respondents clearly stated that a surgeon performing the operation should not have additional financial rewards. Almost all respondents in medical emergencies without hesitation declared their agreement to surgery (n = 974). Conclusions. Present knowledge of Polish patients about surgeons and surgical treatment is high. The surgeon has a high social prestige, respect and appreciation, and his image in the opinion of the vast majority of respondents is positive

Memorandum of understanding relating to the comprehensive, continuing and cooperative transportation planning process in the Boston Metropolitan Area

INTRODUCTION:We undertook a comparative survey of gastric emptying (GE) kinetics after two variants of bypass surgery for upper bowel obstruction. MATERIAL & METHODS:In 10 dogs with experimental upper bowel obstruction, five were randomized to obtain gastrojejunal anastomosis (GA), and the other five received Roux-en-Y duodenojejunal anastomosis (DA). Duplicate scintigraphic measurements of GE of a solid meal were accomplished in every animal before surgery and during the early (2-3 weeks), medium (3 months), and late (6 months) post-operative period. The GE curves were fitted with a power-exponential function to derive the GE half time T½, and the curve shape parameter S. RESULTS:Early after surgery T½ slightly decreased by -18±21 min in the DA group and lengthened by 91±37 min in the GA group (p = 0.042). In both groups an increase in the S parameter was found then. In either group T½ gradually declined towards the basal value during the medium and late post-operative period. On the other hand, net differences relative to the basal situation in the S values appeared to be positive in the GA group (0.32±0.11 at 3 months; 0.64±0.19 at six months), and negative in the DA group (-0.30±0.09 at 3 months; -0.01±0.20 at six months). Hence a statistically significant contrast was found between those differences: p = 0.0022 at 3 months, and p = 0.045 at six months after the surgery. CONCLUSION:Roux-en-Y duodenojejunal anastomosis appears to be superior to the classical gastrojejunal anastomosis while restoring patency of the gastrointestinal passage in the case of upper bowel obstruction

Giant pseudocyst of the retroperitoneal space mimicking a lesion arising from the left adrenal gland

Not required for Clinical Vignette

Modifiable and Non-Modifiable Risk Factors for the Development of Non-Hereditary Pancreatic Cancer

Pancreatic cancer is becoming an increasing healthcare concern. Though it is a 14th most common cancer worldwide, its incidence is steadily rising. Results of currently available therapies are still not satisfactory. Therefore, great attention should be put on the identification and reduction of risk factors for pancreatic cancer. A thorough up-to-date review of available data on the impact of well-established and novel risk factors of pancreatic cancer development have been performed. Several risk factors associated with lifestyle have significant impact on the risk of pancreatic cancer (i.e., smoking, obesity, alcohol consumption). Physicians should also be aware of the novel findings suggesting increasing role of microbiome, including viral and bacterial infections, in the development of pancreatic cancer. A growing body of evidence suggest also an increased risk during certain occupational exposures. In general, lifestyle seems to be a major contributor in the development of pancreatic cancer. Special attention should be given to individuals with a vicious cluster consisting of metabolic syndrome, tobacco smoking and alcohol consumption. Physicians should urge patients to comply to healthy diet, cessation of smoking and moderation of alcohol consumption, which may halve pancreatic cancer incidence. Further studies are warranted to explore the potential use of therapeutic approach on novel risk factors (e.g., microbiome)

Opinie pacjentów o polskich chirurgach i leczeniu operacyjnym

W polskim społeczeństwie występują silnie zakorzenione stereotypy myślenia na temat chirurga, któ- re mogą w istotny sposób wpływać na proces leczenia. Celem pracy było zaprezentowanie wyników badania ankietowego dotyczącego opinii chorych przebywających w szpitalu na temat wizerunku chirurga i leczenia operacyjnego. Materiał i metodyka. W okresie od 1 stycznia do 30 października 2012 r. badaniem ankietowym objęto 1000 chorych. Badanie ankietowe zostało przeprowadzone przy użyciu autorskiego kwestionariusza zawierającego 25 pytań. Uzyskane wyniki zostały opracowane statystycznie z użyciem programu STATISTICA. Różnice między grupami sprawdzono przy użyciu testu chi-kwadrat z modyfikacją Yatesa, przyjmując poziom istotności α = 0,05. Wyniki. Grupa badana liczyła 1000 chorych, w tym 56% kobiet (n= 560) oraz 44% mężczyzn (n= 440). Medialny obraz polskiego chirurga jako pozytywny określiło 78% ankietowanych. Większość chorych (74%) uznała, że polscy chirurdzy dorównują poziomem kompetencji i umiejętności zagranicznym specjalistom. Największym zaufaniem ankietowanych (n=537) cieszyli się chirurdzy w średnim wieku (40‑60 r.ż.). Płeć chirurga dla większości chorych (n=649) nie miała znaczenia. Prawie wszyscy ankietowani w sytuacji zagrożenia zdrowia i życia bez wahania zadeklarowali zgodę na operację (n=974). Wnioski. Współczesna wiedza polskich pacjentów na temat chirurgów i leczenia operacyjnego jest duża. Chirurg cieszy się wysokim prestiżem społecznym, szacunkiem i uznaniem, a jego obraz w opinii zdecydowanej większości ankietowanych jest pozytywny