Colloid Carcinoma of the Pancreas: A Distinct Pancreatic Neoplasm with Good Prognosis. Report of a Case

Context: Colloid carcinoma is considered a distinct type of pancreatic neoplasia with specific histopathological and molecular features, and a better prognosis. Case report We present the case of a patient with a 15cm locally invasive colloid carcinoma of the pancreas, in which an aggressive surgical approach achieved no evidence of disease 24 months after surgery. Conclusions If an accurate diagnostic approach and surgical resection are performed, the 5-year survival rate can reach 60%. Presence of invasive intraductal papillary mucinous neoplasm has been reported, and this can affect the prognosis. Adjuvant therapy has not demonstrated improvement of survival in surgically-resected patients

Biliary complications following liver transplantation in the model for end-stage liver disease era: Effect of donor, recipient, and technical factors

Biliary complications remain a significant problem following liver transplantation in the Model for End-Stage Liver Disease (MELD) era. We hypothesized that donor, recipient, and technical variables may differentially affect anastomotic biliary complications in MELD era liver transplants. We reviewed 256 deceased donor liver transplants after the institution of MELD at our center and evaluated these variables' association with anastomotic biliary complications. The bile leak rate was 18%, and the stricture rate was 23%. Univariate analysis revealed that recipient age, MELD, donor age, and warm ischemia were risk factors for leak, whereas a Roux limb or stent was protective. A bile leak was a risk factor for anastomotic stricture, whereas use of histidine tryptophan ketoglutarate (HTK) versus University of Wisconsin (UW) solution was protective. Additionally, use of a transcystic tube/stent was also protective. Multivariate analysis showed that warm ischemia was the only independent risk factor for a leak, whereas development of a leak was the only independent risk factor for a stricture. HTK versus UW use and transcystic tube/stent use were the only independent protective factors against stricture. Use of an internal stent trended in the multivariate analysis toward being protective against leaks and strictures, but this was not quite statistically significant. This represents one of the first MELD era studies of deceased donor liver transplants evaluating factors affecting the incidence of anastomotic bile leaks and strictures. Donor, recipient, and technical factors appear to differentially affect the incidence of anastomotic biliary complications, with warm ischemia, use of HTK, and use of a stent emerging as the most important variables. Liver Transpl 14:73–80, 2008. © 2007 AASLD.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/57538/1/21354_ftp.pd

The Balloon Dilatation and Large Profile Catheter Maintenance Method for the Management of the Bile Duct Stricture Following Liver Transplantation

We dated a continuous, ∼22-m long sediment sequence from Lake Challa (Mt. Kilimanjaro area, Kenya/Tanzania) to produce a solid chronological framework for multi-proxy reconstructions of climate and environmental change in equatorial East Africa over the past 25,000 years. The age model is based on a total of 168 AMS 14C dates on bulk-organic matter, combined with a 210Pb chronology for recent sediments and corrected for a variable old-carbon age offset. This offset was estimated by i) pairing bulk-organic 14C dates with either 210Pb-derived time markers or 14C dates on grass charcoal, and ii) wiggle-matching high-density series of bulk-organic 14C dates. Variation in the old-carbon age offset through time is relatively modest, ranging from ∼450 yr during glacial and late glacial time to ∼200 yr during the early and mid-Holocene, and increasing again to ∼250 yr today. The screened and corrected 14C dates were calibrated sequentially, statistically constrained by their stratigraphical order. As a result their constrained calendar-age distributions are much narrower, and the calibrated dates more precise, than if each 14C date had been calibrated on its own. The smooth-spline age-depth model has 95% age uncertainty ranges of ∼50-230 yr during the Holocene and ∼250-550 yr in the glacial section of the record. The δ13C values of paired bulk-organic and grass-charcoal samples, and additional 14C dating on selected turbidite horizons, indicates that the old-carbon age offset in Lake Challa is caused by a variable contribution of old terrestrial organic matter eroded from soils, and controlled mainly by changes in vegetation cover within the crater basin

Safety and Efficacy of Endoscopic Retrograde Cholangiopancreatography in Patients with Post-Liver Transplant Biliary Complications: Results of a Cohort Study with Long-Term Follow-Up

BACKGROUND/AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is the standard approach for the management of biliary complications in liver transplant patients; however, its safety and efficacy have not been established in this setting. This study was performed to evaluate the safety and long-term efficacy of ERCP in transplant patients. METHODS: The case reports of 1,500 liver transplant patients were reviewed. Orthotopic liver transplantation (OLT) patients were matched 1:2 with non-OLT patients and followed-up for long-term outcome (median, 7.4 years). RESULTS: Of the 1,500 liver transplant patients, 94 (6.3%) underwent 150 ERCPs after OLT. Anastomotic strictures were present in 45 patients, biliary stones in 24, biliary leaks in 7, papillary stenosis in 2, and primary sclerosing cholangitis in 1. An ERCP success rate of 90.7% was achieved; biliary stenting led to resolution of the bile leak in 7/7 (100%) patients, and biliary stones were removed in 21/24 (87.5%) patients. In addition, 34 of 45 patients with anastomotic stricture underwent endoscopic dilation. We obtained complete resolution in 22/34 (64.7%) patients. OLT patients did not show a higher probability of complications (odds ratio [OR], 1.04), of pancreatitis (OR, 0.80) or of bleeding (OR, 1.34). CONCLUSIONS: ERCP is safe and effective for the treatment of post-OLT biliary complications, has a low rate of pancreatitis and results in a durable effect

2016 Comprehensive Update of the Banff Working Group on Liver Allograft Pathology: Introduction of Antibody-Mediated Rejection

The Banff Working Group on Liver Allograft Pathology reviewed and discussed literature evidence regarding antibody-mediated liver allograft rejection at the 11th (Paris, France, June 5-10, 2011), 12th (Comandatuba, Brazil, August 19-23, 2013), and 13th (Vancouver, British Columbia, Canada, October 5-10, 2015) meetings of the Banff Conference on Allograft Pathology. Discussion continued online. The primary goal was to introduce guidelines and consensus criteria for the diagnosis of liver allograft antibody-mediated rejection and provide a comprehensive update of all Banff Schema recommendations. Included are new recommendations for complement component 4d tissue staining and interpretation, staging liver allograft fibrosis, and findings related to immunosuppression minimization. In an effort to create a single reference document, previous unchanged criteria are also included