Pancreatico-gastric fistula arising from IPMN associated with ductal adenocarcinoma of the pancreas: a case report and a literature review

IntroductionAn intraductal papillary mucinous neoplasm (IPMN) is a potentially malignant cystic tumor that is characterized by an excessive papillary proliferation of mucin-producing epithelial cells. The IPMN usually exhibits different degrees of dysplasia and is accompanied by cystic dilation of the main pancreatic duct (MPD) or side branch. We report a case of an IPMN that has penetrated the stomach and has differentiated into an adenocarcinoma.Case presentationA 69-year-old female, suffering from chronic pancreatitis of unknown etiology, visited our outpatient clinic with complaints of sudden weight loss, diarrhea, and abdominal pain. She underwent several examinations to evaluate the reasons for her sudden onset of symptoms. A gastroscopy showed an ulcerated lesion covered with mucus. CT and magnetic resonance cholangiopancreatography images revealed that the MPD was dilated to 1.3 cm with a fistula formation between the MPD and the stomach. After a multidisciplinary discussion of this case, a total pancreatectomy was proposed. An en bloc total pancreatectomy with gastric wedge resection including the fistula together with splenectomy was carried out. A Roux-en-Y choledochojejunostomy and gastrojejunostomy were performed. Histology results revealed the association of IPMN with invasive carcinoma.DiscussionMany reports on IPMN of the pancreas have been published recently. Fistula formation between IPMN and adjacent organs is possible. Given the CT and endoscopic ultrasonography findings, it shows that in our case a main duct IPMN (MD-IPMN) formed a pancreatico-gastric fistula. We point out that the adherence of invasive cancer cells contributed to the fistula formation between the pancreas and the stomach.ConclusionThis case report provides evidence for the possibility of IPMN becoming complicated with pancreatico-gastric fistula. Thus, we suggest that surgical resection should be considered in the case of MD-IPMN because of its high propensity for malignant transformation

ESTUDO DA INFLUÊNCIA DE JUSTICIA ACUMINATISSIMA (MIQ.) BREMEK. SOBRE A AGREGAÇÃO PLAQUETÁRIA E COAGULAÇÃO SANGUÍNEA

Justicia acuminatissima (Miq.) Bremek (Acanthaceae) é uma espécie vegetal amplamente utilizada pela população do estado do Amazonas devido às suas propriedades medicinais antiinflamatórias. É conhecida popularmente como “sara-tudo” e suas folhas são utilizadas em decoctos, infusões e macerações. Baseado em relatos de seu uso, o presente trabalho avaliou a interferência da preparação extrativa das folhas obtida por maceração aquosa sobre agregação plaquetária e coagulação sanguínea. Nenhuma influência significativa estatisticamente foi observada sobre as duas cascatas, não sendo possível calcular o IC 50

A rare variant of the superficial ulnar artery, and its clinical implications: a case report

The superficial ulnar artery is a rare variation of the upper limb arterial system that arises from the brachial or axillary artery and runs superficial to the muscles arising from the medial epicondyle [1-3]. The incidence is about 0.7 to 7% [1,4,5]. In our routine dissections we found a superficial ulnar artery, which crossed the cubital fossa superficial to the bicipital aponeurosis making it highly vulnerable to intra-arterial injection. This is a rare variation that every medical and nursing staff member should know about

Magnetic and Charge Correlations in La{2-x-y}Nd_ySr_xCuO_4: Raman Scattering Study

Two aspects in connection with the magnetic properties of La_{2-x-y}Nd_ySr_xCuO_4 single crystals are discussed. The first is related to long wavelength magnetic excitations in x = 0, 0.01, and 0.03 La_{2-x}Sr_xCuO_4 detwinned crystals as a function of doping, temperature and magnetic field. Two magnetic modes were observed within the AF region of the phase diagram. The one at lower energies was identified with the spin-wave gap induced by the antisymmetric DM interaction and its anisotropic properties in magnetic field could be well explained using a canonical form of the spin Hamiltonian. A new finding was a magnetic field induced mode whose dynamics allowed us to discover a spin ordered state outside the AF order which was shown to persist in a 9 T field as high as 100 K above the N\'eel temperature T_N for x = 0.01. For these single magnon excitations we map out the Raman selection rules in magnetic fields and demonstrate that their temperature dependent spectral weight is peaked at the N\'eel temperature. The second aspect is related to phononic and magnetic Raman scattering in La_{2-x-y}Nd_ySr_xCuO_4 with three doping concentrations: x = 1/8, y = 0; x = 1/8, y = 0.4; and x = 0.01, y = 0. We observed that around 1/8 Sr doping and independent of Nd concentration there exists substantial disorder in the tilt pattern of the CuO_6 octahedra in both the orthorhombic and tetragonal phases which persist down to 10 K and are coupled to bond disorder in the cation layers. The weak magnitude of existing charge/spin modulations in the Nd doped structure did not allow us to detect specific Raman signatures on lattice dynamics or two-magnon scattering around 2200 cm-1.Comment: 26 pages, 22 figure

Numerical Calculations of the B1g Raman Spectrum of the Two-Dimensional Heisenberg Model

The B1g Raman spectrum of the two-dimensional S=1/2 Heisenberg model is discussed within Loudon-Fleury theory at both zero and finite temperature. The exact T=0 spectrum for lattices with up to 6*6 sites is computed using Lanczos exact diagonalization. A quantum Monte Carlo (QMC) method is used to calculate the corresponding imaginary-time correlation function and its first two derivatives for lattices with up to 16*16 spins. The imaginary-time data is continued to real frequency using the maximum-entropy method, as well as a fit based on spinwave theory. The numerical results are compared with spinwave calculations for finite lattices. There is a surprisingly large change in the exact spectrum going from 4*4 to 6*6 sites. In the former case there is a single dominant two-magnon peak at frequency w/J appr. 3.0, whereas in the latter case there are two approximately equal-sized peaks at w/J appr. 2.7 and 3.9. This is in good qualitative agreement with the spinwave calculations including two-magnon processes on the same lattices. Both the Lanczos and the QMC results indicate that the actual infinite-size two-magnon profile is broader than the narrow peak obtained in spinwave theory, but the positions of the maxima agree to within a few percent. The higher-order contributions present in the numerical results are merged with the two-magnon profile and extend up to frequencies w/J appr. 7. The first three frequency cumulants of the spectrum are in excellent agreement with results previously obtained from a series expansion around the Ising limit. Typical experimental B1g$ spectra for La2CuO4 are only slightly broader than what we obtain here. The exchange constant extracted from the peak position is J appr. 1400K, in good agreement with values obtained from neutron scattering and NMR experiments.Comment: 15 pages, Revtex, 13 PostScript figure

Putative role of the adenosine A3 receptor in the antiproliferative action of N6-(2-isopentenyl)adenosine

We tested a panel of naturally occurring nucleosides for their affinity towards adenosine receptors. Both N6-(2-isopentenyl)adenosine (IPA) and racemic zeatin riboside were shown to be selective human adenosine A3 receptor (hA3R) ligands with affinities in the high nanomolar range (Ki values of 159 and 649 nM, respectively). These values were comparable to the observed Ki value of adenosine on hA3R, which was 847 nM in the same radioligand binding assay. IPA also bound with micromolar affinity to the rat A3R. In a functional assay in Chinese hamster ovary cells transfected with hA3R, IPA and zeatin riboside inhibited forskolin-induced cAMP formation at micromolar potencies. The effect of IPA could be blocked by the A3R antagonist VUF5574. Both IPA and reference A3R agonist 2-chloro-N6-(3-iodobenzyl)adenosine-5′-N-methylcarboxamide (Cl-IB-MECA) have known antitumor effects. We demonstrated strong and highly similar antiproliferative effects of IPA and Cl-IB-MECA on human and rat tumor cell lines LNCaP and N1S1. Importantly, the antiproliferative effect of low concentrations of IPA on LNCaP cells could be fully blocked by the selective A3R antagonist MRS1523. At higher concentrations, IPA appeared to inhibit cell growth by an A3R-independent mechanism, as was previously reported for other A3R agonists. We used HPLC to investigate the presence of endogenous IPA in rat muscle tissue, but we could not detect the compound. In conclusion, the antiproliferative effects of the naturally occurring nucleoside IPA are at least in part mediated by the A3R

Evaluation of Greenbug and Yellow Sugarcane Aphid Feeding Behavior on Resistant and Susceptible Switchgrass Cultivars

Switchgrass (Panicum virgatum L.) is an emerging biofuel crop that serves as host for aphids. To discern the effects of plant age and possible resistance mechanisms, the feeding behavior of greenbugs (Schizaphis graminum Rondani.) and the yellow sugarcane aphid (Sipha flava Forbes.) was monitored on three diverse switchgrasses by the electrical penetration graph (EPG) technique. Callose deposition and genes associated with callose metabolism were also analyzed to discern their association with plant resistance. There was a strong host effect on greenbugs feeding on lowland cultivar Kanlow at the V3 stage of development, as compared to the greenbug-susceptible upland cultivar Summer and plants derived from Kanlow (♂) × Summer (♀) (K×S) crosses. These data confirmed that Kanlow at the V3 stage had antibiosis to greenbugs, which was absent in the Summer and K×S plants. In contrast, similar effects were not observed for yellow sugarcane aphids, excluding significant differences in the time to first probe on Kanlow plants at the V1 stage and reduction in time spent on pathway processes on Kanlow plants at the V3 stage. These data demonstrated that Kanlow plants may have multiple sources of resistance to the two aphids, and possibly some were phloem based. Microscopy of leaf sections stained with aniline blue for callose was suggestive of increased callose deposition in the sieve elements in Kanlow plants relative to Summer and K×S plants. RT-qPCR analysis of several genes associated with callose metabolism in infested plants was equivocal. Overall, these studies suggest the presence of multiple defense mechanisms against aphids in Kanlow plants, relative to Summer and K×S plants