Groove Pancreatitis with Biliary and Duodenal Stricture: An Unusual Cause of Obstructive Jaundice

INTRODUCTION: Groove pancreatitis is an uncommon cause of chronic pancreatitis that affects the groove anatomical area between the head of the pancreas, duodenum, and common bile duct. CLINICAL CASE: A 67-year-old man with frequent biliary colic and an alcohol consumption of 30-40 g/day was admitted to the hospital complaining of jaundice and pruritus. Laboratory analysis revealed cholestasis and the ultrasound scan showed intra-hepatic biliary ducts dilatation, middle third cystic dilatation of common bile duct, enlarged Wirsung and pancreatic atrophy. The magnetic resonance cholangiopancreatography showed imaging findings compatible with groove pancreatitis. An esophagogastroduodenoscopy later excluded duodenal neoplasia. He was submitted to a Roux-en-Y cholangiojejunostomy because of common bile duct stricture. Five months later a gastrojejunostomy was performed due to a duodenal stricture. The patient remains asymptomatic during follow-up. DISCUSSION: Groove pancreatitis is a benign cause of obstructive jaundice, whose main differential diagnosis is duodenal or pancreatic neoplasia. When this condition causes duodenal or biliary stricture, surgical treatment can be necessary.info:eu-repo/semantics/publishedVersio

Cholangiocarcinoma: from molecular biology to treatment

Abstract Cholangiocarcinoma is a rare tumor originating in the bile ducts, which, according to their anatomical location, is classified as intrahepatic, extrahepatic and hilar. Nevertheless, incidence rates have increased markedly in recent decades. With respect to tumor biology, several genetic alterations correlated with resistance to chemotherapy and radiotherapy have been identified. Here, we highlight changes in KRAS and TP53 genes that are normally associated with a more aggressive phenotype. Also IL-6 and some proteins of the BCL-2 family appear to be involved in the resistance that the cholangiocarcinoma presents toward conventional therapies. With regard to diagnosis, tumor markers most commonly used are CEA and CA 19-9, and although its use isolated appears controversial, their combined value has been increasingly advocated. In imaging terms, various methods are needed, such as abdominal ultrasound, computed tomography and cholangiopancreatography. Regarding therapy, surgical modalities are the only ones that offer chance of cure; however, due to late diagnosis, most patients cannot take advantage of them. Thus, the majority of patients are directed to other therapeutic modalities like chemotherapy, which, in this context, assumes a purely palliative role. Thus, it becomes urgent to investigate new therapeutic options for this highly aggressive type of tumor

Acção anti-cancerígena da Quercetina no Carcinoma Hepatocelular: o papel do GLUT-1

Hepatocellular Carcinoma (HCC) is one of the most fatal cancers, with rising incidence. Without specific treatment, the prognosis is very poor and diminished survival. The most effective therapy is liver transplantation and complete surgical resection, however, since only 15% of patients are candidates for such therapies, a wide range of patients are subjected to treatment with conventional therapies, and the rate success is greatly diminished. It is thought that the expression of glucose transporter 1 (GLUT-1) may be altered in HCC. A recent study showed that suppression of GLUT-1 expression, using siRNA (small interfering RNA) could significantly reduce tumorigenesis in HCC cell lines, suggesting that GLUT-1 may be a therapeutic target for this highly aggressive tumor. Thus, this project aims to evaluate the anticancer effect of quercetin, a possible inhibitor of GLUT-1, in a human HCC cell line HepG2, as well as check the effect of theis compound on 18F-FDG (a glucose radiolabelled analogue) uptake in this cell line. These results shown that quercetin have anti-proliferative effect on HCC cell line studied. This compound also have shown ability to decrease the 18F-FDG uptake. However, using flow cytometry it was found that HepG2 cells remain viable after treatment with quercetin, and this compound doesn’t inhibit the GLUT-1 protein expression. These results indicate that quercetin inhibits the GLUT-1 function, but doesn’t inhibit the expression of this transporter.Keywords: Quercetin, Hepatocellular Carcinoma, GLUT-1 O Carcinoma Hepatocelular (CHC) é um dos cancros mais letais, com uma crescente incidência em diversas regiões por todo o mundo. Sem tratamento específico, o prognóstico é muito pobre e a sobrevida diminuta. A terapia mais eficaz consiste no transplante hepático e na ressecção cirúrgica, no entanto, e uma vez que apenas 15% dos doentes são candidatos a tratamento cirúrgico, torna-se urgente a procura de novas opções terapêuticas para este tipo de tumor. Alguns estudos demonstraram que a expressão do transportador de glucose-1 (GLUT-1) pode estar alterada neste tipo de tumor. Um estudo recente demonstrou que a supressão da expressão de GLUT-1, recorrendo a siRNA (small interfering RNA) conseguiu reduzir significativamente a tumorigénese em culturas celulares de CHC, sugerindo que o GLUT-1 pode ser um alvo terapêutico para este tipo de tumor altamente agressivo. Assim, o objectivo deste trabalho experimental foi avaliar o efeito anti-cancerígeno da quercetina, um possível inibidor do GLUT-1, numa linha celular humana de CHC (HepG2, ATCC), assim como avaliar o seu efeito na captação de 18F-FDG, um análogo da glucose radiomarcado com Flúor-18. Com os resultados obtidos verificou-se que a quercetina possui a capacidade de inibir a proliferação da linha celular em estudo e, para além disso, parece ter influência na captação de 18F-FDG já que conseguiu diminuir a percentagem de captação do radiofármaco nesta linha celular. No entanto, através da técnica de citometria de fluxo verificou-se que as células permanecem viáveis, e que este composto não inibe a expressão proteica do GLUT-1. Estes resultados indicam que a quercetina inibe este transportador de glucose quanto à função, mas não quanto à expressão. Palavras-chave: Quercetina, Carcinoma Hepatocelular, GLUT-1

Plasmatic Oxidative and Metabonomic Profile of Patients with Different Degrees of Biliary Acute Pancreatitis Severity

Acute pancreatitis (AP) is an inflammatory process of the pancreas with variable involvement of the pancreatic and peripancreatic tissues and remote organ systems. The main goal of this study was to evaluate the inflammatory biomarkers, oxidative stress (OS), and plasma metabolome of patients with different degrees of biliary AP severity to improve its prognosis. Twenty-nine patients with biliary AP and 11 healthy controls were enrolled in this study. We analyzed several inflammatory biomarkers, multifactorial scores, reactive oxygen species (ROS), antioxidants defenses, and the plasma metabolome of biliary AP and healthy controls. Hepcidin (1.00), CRP (0.94), and SIRI (0.87) were the most accurate serological biomarkers of AP severity. OS played a pivotal role in the initial phase of AP, with significant changes in ROS and antioxidant defenses relating to AP severity. Phenylalanine (p < 0.05), threonine (p < 0.05), and lipids (p < 0.01) showed significant changes in AP severity. The role of hepcidin and SIRI were confirmed as new prognostic biomarkers of biliary AP. OS appears to have a role in the onset and progression of the AP process. Overall, this study identified several metabolites that may predict the onset and progression of biliary AP severity, constituting the first metabonomic study in the field of biliary AP

Cinética da regeneração hepática e sua correlação com a função hepática após hepatectomia

Resumo da comunicação apresentado ao XII Congresso Nacional de Medicina Nuclear, 12-14 Novembro 2009, Mealhad

Estudo da cinética da regeneração hepática no homem pós-hepatectomia por métodos radioisotopicos

Resumo da comunicação apresentado ao XII Congresso Nacional de Medicina Nuclear, 12-14 Novembro 2009, Mealhad

Impacto na Função Sexual Após Resseção Anterior do Reto: Estudo Transversal

Introduction: As the surgical technique and the medical support care progresses, que lifespan of our patients increases, therefore aspects such as the quality of life after invasive treatments have been more and more valued. The anterior rectal resection (ARR) is an option for patients with certain pathologies localized to the rec- tum (for instance adenocarcinoma). This procedure has the risk of resulting in important morbidities, not only gastrointestinal, but also urological, such as incontinence and sexual dysfunction (e.g. erectile dysfunction [ED]). Our objective was to assess the impact in erectile and sexual function of patients submitted to anterior rectal resection. Materials and Methods: It was conducted a cross-sectional study, including all patients of the masculine sex, that went through ARR between November 2018 and September 2019 in the Centro Hospitalar e Universitário de Coimbra (CHUC) (n=43). The population presented a median age of 66.1±9.9 years old (ages between 29 and 90). Telephone interviews were carried out and a questionnaire about sexual performance and erectile function before surgery, as well as after the procedure, was performed. For this, we used the International Index of Erectile Function 5 (IIEF-5) with a cut-off of &lt;22 to define erectile dysfunction. Verbal consent was obtained from all patients. Results: Of the 43 patients, only 32 met the inclusion criteria and were included in the study. Before surgery, 26 participants (81,3%) said to be sexually active, with the sample presenting an average score in the IIEF-5 of 18.7±6.4. After surgery, 16 patients (50%), stated to be sexually active, with the sample presenting an average score in the IIEF-5 of 11.1±6.2. The prevalence of ED (IIEF-5 &lt; 22) in the sample before the procedure was 53,1%, with this number increasing to 90% after surgery. Twenty three patients admitted a decrease in their erectile function. Of them, 4 (17.3%) stated mild improvement in function over time, with the remaining patients denying changes since surgery. A negative impact in the erectile function of patients submitted to ARR was found (p&lt;0.05). Ten patients sexually active before surgery never resumed sexual activity after the procedure. Among the subjects that reported a decrease in erectile function, only 4 spoke about it with a healthcare professional and 3 were referred to an urologist. None of the patients referred to have been actively asked about the impact of surgery in its sexual function during the postoperative follow-up. Conclusion: This study demonstrated a clear negative impact in erectile function of patients submitted to ARR. We stress the importance of surveilling the impact in erectile function in every man during the postoperative surveillance of ARR. We believe that a timely and adequate sexual rehabilitation is possible, allowing an improvement in the quality of life of these individuals.Introdução: Com a evolução e melhoria da técnica cirúrgica e dos cuidados médicos de suporte, a esperança média de vida dos doentes aumentou, pelo que aspetos como a qualidade de vida após cirurgia têm sido cada vez mais valorizados. A resseção anterior do reto (RAR) é uma opção terapêutica para doentes com certas patologias localizadas ao reto (como adenocarcinoma). Esta técnica tem potencial de acarretar importantes morbilidades pós cirúrgicas, não só gastrointestinais, mas também urológicas, como incontinência e disfunção erétil. O objetivo foi avaliar o impacto na função erétil e sexual de doentes submetidos a RAR. Material e Métodos: Estudo transversal, que incluiu todos os doentes do sexo masculino submetidos a RAR entre novembro de 2018 e setembro 2019 no Centro Hospitalar e Universitário de Coimbra (CHUC) (n=43). A população apresentou uma média de idade de 66,1±9,9 anos (idades compreendidas entre 29 e 90). Foram realizadas entrevistas telefónicas e foi efetuado um questionário acerca da sexualidade e função erétil prévios à cirurgia, bem como após a mesma. Para este fim, foi utilizado o Index Internacional da Função Erétil Simplificado (IIEF-5) com um cut-off de pontuação &lt;22 para definição de disfunção erétil. Obteve-se consentimento verbal por parte de todos os participantes. Resultados: Da amostra inicial, apenas 32 cumpriram os critérios de inclusão e integraram o estudo. Previamente à cirurgia, 26 dos participantes (81,3%) referiram ser sexualmente ativos, com a amostra a obter uma pontuação média no IIEF-5 de 18,7±6,4. Após cirurgia, 16 doentes (50%) referiram manter vida sexual ativa, com a amostra a demonstrar uma pontuação média no IIEF-5 de 11,1±6,2. A prevalência de DE (IIEF-5&lt;22) na amostra estudada foi de 53,1%, previamente à cirurgia, com subida da prevalência para 90,6% após a intervenção cirúrgica. Admitiram diminuição na função erétil (FE) 23 doentes (69,7%). Destes, 4 (17,3%) referiram ligeira melhoria da função erétil ao longo do tempo, tendo os restantes negado alteração desde a cirurgia. Demonstrou-se um impacto negativo na função erétil dos doentes submetidos a RAR (p&lt;0,05). De salientar que 10 doentes sexualmente ativos previamente à cirurgia, não retomaram a vida sexual após a mesma. De entre os doentes com agravamento da função erétil pós-operatório, 4 falaram com um profissional de saúde e 3 foram encaminhados para consulta de Urologia. Nenhum doente referiu ter sido inquirido ativamente acerca da sua função erétil após a cirurgia. Conclusão: Este estudo demonstrou um impacto negativo na função erétil de doentes submetidos a ressecção anterior do reto. Por este motivo, considera-se pertinente uma pesquisa ativa desta prevalente morbilidade em todos os homens submetidos a RAR, no sentido de uma atempada e adequada reabilitação sexual pós-operatória e consequente melhoria da qualidade de vida destes indivíduos

Bariatric Surgery Induces Alterations in the Immune Profile of Peripheral Blood T Cells

Low-grade inflammation is closely linked to obesity and obesity-related comorbidities; therefore, immune cells have become an important topic in obesity research. Here, we performed a deep phenotypic characterization of circulating T cells in people with obesity, using flow cytometry. Forty-one individuals with obesity (OB) and clinical criteria for bariatric surgery were enrolled in this study. We identified and quantified 44 different circulating T cell subsets and assessed their activation status and the expression of immune-checkpoint molecules, immediately before (T1) and 7–18 months after (T2) the bariatric surgery. Twelve age- and sex-matched healthy individuals (nOB) were also recruited. The OB participants showed higher leukocyte counts and a higher percentage of neutrophils. The percentage of circulating Th1 cells were negatively correlated to HbA1c and insulin levels. OB Th1 cells displayed a higher activation status and lower PD-1 expression. The percentage of Th17 and Th1/17 cells were increased in OB, whereas the CD4+ Tregs’ percentage was decreased. Interestingly, a higher proportion of OB CD4+ Tregs were polarized toward Th1- and Th1/17-like cells and expressed higher levels of CCR5. Bariatric surgery induced the recovery of CD4+ Treg cell levels and the expansion and activation of Tfh and B cells. Our results show alterations in the distribution and phenotype of circulating T cells from OB people, including activation markers and immune-checkpoint proteins, demonstrating that different metabolic profiles are associated to distinct immune profiles, and both are modulated by bariatric surgery