AIM:To determine predictors of clinically relevant pancreatic fistulas(CRPF)by measuring drain fluid amylase(DFA)in the early postoperative period.METHODS:This prospective clinical study included382 patients with peri...AIM:To determine predictors of clinically relevant pancreatic fistulas(CRPF)by measuring drain fluid amylase(DFA)in the early postoperative period.METHODS:This prospective clinical study included382 patients with periampullary tumors that were surgically resected at our department between March 2005and October 2012.A cephalic duodenopancreatectomy (DP)was performed on all patients.Two closed suction drains were placed at the end of the surgery.The highest postoperative DFA value was recorded and analyzed during the first three postoperative days and on subsequent days if the drains were kept longer.Pancreatic fistula(PF)was classified according to the International Study Group of Pancreatic Fistula(ISGPF)criteria.Postoperative complications were defined according to the Dindo-Clavien classification.All data were statistically analyzed.The optimal thresholds of DFA levels on the first,second and third postoperative days were estimated by constructing receiver operating curves,generated by calculating the sensitivities and specificities of the DFA levels.The DFA level limits were used to differentiate between the group without PF and the groups with biochemical pancreatic fistula(BPF)and CRPF.RESULTS:Pylorus-preserving duodenopancreatectomy was performed on 289(75.6%)patients,while the remaining patients underwent a classic Whipple procedure(CW).The total incidence of PF was 37.7%(grade A22.8%,grade B 11.0%and grade C 3.9%).Soft pancreatic texture(SPT)was present in 58.3%of patients who developed PF.Mortality was 4.2%.The median DFA value on the first postoperative day(DFA1)in patients who developed PF was 4520 U/L(range 350-99000 U/L)for grade A fistula(BPF)with a SPT and a diameter of the main pancreatic duct(MPD)of≤3 mm.For grade B/C(CRPF),the median DFA1 value was 8501 U/L(range377-92060 U/L)with a SPT and MPD of≤3 mm.These values were significantly higher when compared to the patients who did not have PF(122;range 5-37875 U/L).The upper limit of DFA values for the first 3 postoperative days in the examined stages of PF were:DFA1 1200U/L for the BPF and CRPF;DFA3 350 U/L for BPF and DFA3 800 U/L for CRPF.The determined values were highly significant and demonstrated a reliable diagnostic test for both BPF and CRPF.CONCLUSION:DFA1≥1200 U/L is an important predictive factor for PF of any degree.The trend of DFA3(decrease of<50%)compared to DFA1 is a significant factor in the differentiation of CRPF from transient BPF.展开更多
Ewing's sarcoma (ES) is a neoplasm of undifferentiated small round cells, which occurs in the bones and deep soft tissues of children and adolescents. We present a rare case of a 44-year-old woman with gastric ES ...Ewing's sarcoma (ES) is a neoplasm of undifferentiated small round cells, which occurs in the bones and deep soft tissues of children and adolescents. We present a rare case of a 44-year-old woman with gastric ES presenting with epigastric pain and weight loss. Ultrasound and computed tomography scans indicated a solid/cystic mass in the pancreatic tail. At laparotomy, the tumor was found attached to the posterior surface of the stomach, completely free from the pancreas, with no lymphadenopathy or local metastases. The polynodal, partly pseudocystic, dark-red soft tumor was excised. Histopathology revealed an anaplastic small-round-cell tumor with strong membranous CD99 immunoexpression. Additionally, there was patchy immunostaining for S-100 protein, vimentin, protein gene product (PGP) 9.5 and neuron-specifi c enolase, and weak focal CD117 cytoplasmic immunoreactivity. The patient had no adjuvant chemotherapy; her postoperative recovery was uneventful, and she remains symptom-free, and without any sign of recurrence at 20 mo. To the best of our knowledge, this is only the third ever case of gastric ES.展开更多
文摘AIM:To determine predictors of clinically relevant pancreatic fistulas(CRPF)by measuring drain fluid amylase(DFA)in the early postoperative period.METHODS:This prospective clinical study included382 patients with periampullary tumors that were surgically resected at our department between March 2005and October 2012.A cephalic duodenopancreatectomy (DP)was performed on all patients.Two closed suction drains were placed at the end of the surgery.The highest postoperative DFA value was recorded and analyzed during the first three postoperative days and on subsequent days if the drains were kept longer.Pancreatic fistula(PF)was classified according to the International Study Group of Pancreatic Fistula(ISGPF)criteria.Postoperative complications were defined according to the Dindo-Clavien classification.All data were statistically analyzed.The optimal thresholds of DFA levels on the first,second and third postoperative days were estimated by constructing receiver operating curves,generated by calculating the sensitivities and specificities of the DFA levels.The DFA level limits were used to differentiate between the group without PF and the groups with biochemical pancreatic fistula(BPF)and CRPF.RESULTS:Pylorus-preserving duodenopancreatectomy was performed on 289(75.6%)patients,while the remaining patients underwent a classic Whipple procedure(CW).The total incidence of PF was 37.7%(grade A22.8%,grade B 11.0%and grade C 3.9%).Soft pancreatic texture(SPT)was present in 58.3%of patients who developed PF.Mortality was 4.2%.The median DFA value on the first postoperative day(DFA1)in patients who developed PF was 4520 U/L(range 350-99000 U/L)for grade A fistula(BPF)with a SPT and a diameter of the main pancreatic duct(MPD)of≤3 mm.For grade B/C(CRPF),the median DFA1 value was 8501 U/L(range377-92060 U/L)with a SPT and MPD of≤3 mm.These values were significantly higher when compared to the patients who did not have PF(122;range 5-37875 U/L).The upper limit of DFA values for the first 3 postoperative days in the examined stages of PF were:DFA1 1200U/L for the BPF and CRPF;DFA3 350 U/L for BPF and DFA3 800 U/L for CRPF.The determined values were highly significant and demonstrated a reliable diagnostic test for both BPF and CRPF.CONCLUSION:DFA1≥1200 U/L is an important predictive factor for PF of any degree.The trend of DFA3(decrease of<50%)compared to DFA1 is a significant factor in the differentiation of CRPF from transient BPF.
文摘Ewing's sarcoma (ES) is a neoplasm of undifferentiated small round cells, which occurs in the bones and deep soft tissues of children and adolescents. We present a rare case of a 44-year-old woman with gastric ES presenting with epigastric pain and weight loss. Ultrasound and computed tomography scans indicated a solid/cystic mass in the pancreatic tail. At laparotomy, the tumor was found attached to the posterior surface of the stomach, completely free from the pancreas, with no lymphadenopathy or local metastases. The polynodal, partly pseudocystic, dark-red soft tumor was excised. Histopathology revealed an anaplastic small-round-cell tumor with strong membranous CD99 immunoexpression. Additionally, there was patchy immunostaining for S-100 protein, vimentin, protein gene product (PGP) 9.5 and neuron-specifi c enolase, and weak focal CD117 cytoplasmic immunoreactivity. The patient had no adjuvant chemotherapy; her postoperative recovery was uneventful, and she remains symptom-free, and without any sign of recurrence at 20 mo. To the best of our knowledge, this is only the third ever case of gastric ES.
