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Serum tumor markers not useful in screening patients with pancreatic mucinous cystic lesions associated with malignant changes

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Hepatobiliary & Pancreatic Diseases International 2016年第5期15卷 553-557页

作者： Raffaele Pezzilli lucia calculli Gianvico Melzi d'Eril Alessandra Barassi Department of Digestive System Sant’Orsola-Malpighi Hospital Department of Radiology Sant’Orsola-Malpighi Hospital Department of Health Sciences SanPaolo HospitalUniversity of Milan

BACKGROUND: Serum cancer antigen 19-9 (CA19-9) pro-vides additional information about mucinous cystic pancre-atic neoplasm (MPN). This study was undertaken to assess both CA19-9 and carcinoembryonic antigen (CEA) serum concentrations in consecutive patients affected by MPNs and other chronic benign and malignant pancreatic diseases. We also evaluated whether serum CA19-9 and CEA determina-tions provide additional information such as the presence of invasive carcinoma in MPN patients. METHODS: Serum CA19-9 and CEA from 91 patients with pancreatic diseases were tested by commercially available kits at the time of diagnosis. The upper reference limit of serum CA19-9 was 37 U/mL and that of serum CEA was 3 ng/mL. RESULTS: Thirty-ifve patients was diagnosed with chronic pancreatitis (CP), 32 with MPN, and 24 with pancreatic ductal adenocarcinoma (PDAC) conifrmed histologically. Surgery was carried out in 5 CP patients, in 10 MPN patients (7 of them had severe dysplasia), and 9 PDAC patients. Serum CA19-9 activity was high in 12 (34.3%) CP patients, in 7 (21.9%) MPN patients, and in 12 (50.0%) PDAC patients (P=0.089). High se-rum CEA concentrations were noted in 6 (17.1%) CP patients, in 6 (18.8%) MPN patients, and in 12 (50.0%) PDAC patients (P=0.010). In the 7 MPN patients associated with histological-ly conifrmed severe dysplasia, 3 (42.9%) patients had elevated serum activity of serum CA19-9, and 2 (28.6%) patients had high levels of CEA. CONCLUSION: Serum determination of oncological markers is not useful in selecting MPN patients with malignant changes.

关键词： cancer antigen 19-9 carcinoembryonic antigen cystic pancreatic neoplasms chronic pancreatitis pancreatic ductal adenocarcinoma laboratory assessment

Exocrine pancreatic function assessed by secretin cholangio-Wirsung magnetic resonance imaging

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Hepatobiliary & Pancreatic Diseases International 2008年第2期7卷 192-195页

作者： lucia calculli Raffaele Pezzilli Marta Fiscaletti Riccardo Casadei Carla Brindisi Giampaolo Gavelli Departments of Radiology Digestive Diseases and Internal Medicineand General SurgerySant'Orsola-Malpighi Hospital Bologna Italy

BACKGROUND:Magnetic resonance cholangiopancreato-graphy (MRCP) is useful to assess exocrine pancreatic function by combining rapid imaging acquisition with the administration of secretin, a gastrointestinal hormone that stimulates the secretion of bile and pancreatic juice. However, extensive data on this method are lacking. This study aimed to determine whether MRCP with secretin administration is able to simultaneously detect alterations of both the pancreatic ducts and exocrine pancreatic function. METHODS:All subjects older than 18 years who underwent magnetic resonance imaging (MRI) and cholangio-Wirsung magnetic resonance imaging (CWMRI) for suspicion of benign or malignant pancreatic diseases from January 2006 to December 2006 were enrolled in the study. MRI and CWMRI were carried out using a dedicated apparatus. RESULTS:Eighty-seven patients (46 males, 41 females, mean age 59.7±14.6, range 27-87 years) were enrolled. Of the 87 patients, 39 had a normal pancreas on imaging, 20 had an intrapapillary mucinous tumor (IPMT), and the rest had chronic pancreatitis (7), serous cystadenoma (6), a previous attack of acute biliary pancreatitis (5), congenital ductal abnormalities (5), mucinous cystadenoma (3), previous pancreatic head resection for autoimmune pancreatitis (1), or cholangiocarcinoma (1). Morphologically, we found two pseudocysts (one of the 7 patients with chronic pancreatitis, and one of the 5 patients after an attack of acute pancreatitis;the latter pseudocyst communicated with the main pancreatic duct). Calcifications were found in 3 of the 7 patients with chronic pancreatitis. All patients with IPMT and mucinous cystadenoma and 3 patients with serous cystadenoma were histologically confirmed. The remaining patients were followed up adequately to confirm the diagnosis by imaging. According to the Matos criteria, 73 patients (83.9%) were of grade 3, 8 grade 2, 4 grade 1, and 2 grade 0. The only pancreatic diseases which impaired the exocrine pancreati

关键词： chronic pancreatitis magnetic resonance cholangiopancreatography pancreatic neoplasms pancreatic insufficiency

A prospective study on radiofrequency ablation locally advanced pancreatic cancer

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Hepatobiliary & Pancreatic Diseases International 2010年第3期9卷 306-311页

作者： Riccardo Casadei Claudio Ricci Raffaele Pezzilli Carla Serra lucia calculli Antonio Maria Morselli-Labate Donatella Santini Francesco Minni Department of Surgery S.Orsola-Malpighi Hospital University of Bologna Department of Internal Medicine and Gastroenterology S.Orsola-Malpighi Hospital University of Bologna Department of Radiology S.Orsola-Malpighi Hospital University of Bologna Department of Internal Medicine and Gastroenterology Department of Pathology S.Orsola-Malpighi Hospital University of Bologna

BACKGROUND:Radiofrequency ablation(RFA)has been suggested as a new treatment option for patients with locally advanced *** study aimed to prospectively evaluate the efficacy and safety of intraoperative RFA in patients with unresectable,locally advanced,non-metastatic carcinoma of the pancreatic ***:RFA was the first step of the surgical procedure and was carried out on the mobilized pancreatic head followed by biliary by-pass and ***-and post-operative morbidity and mortality,performance status, pain control,quality of life,and survival at 24 months were ***:Seven patients(3 men and 4 women;median age 66 years,range 47-80 years)were studied and 4 were eligible for *** RFA procedure was carried out in 3 of the 4 patients;in one patient it was not carried out because of the upstaging of the *** all 3 patients RFA achieved complete necrosis of the lesion.A biliary fistula developed 7 days after the procedure in one patient;all 3 patients developed ascites 8.6 days(range 7-9 days)on average after *** patients died respectively,at 3,4,and 5 months after the ***:In our experience,RFA is a feasible procedure, but it presents a very high rate of postoperative ***,pain control,life quality and survival rate are *** few data suggest no impact on survival.

关键词： pancreatic neoplasms radiofrequency ablation survival efficacy safety

Cystic dystrophy of the duodenal wall is not always associated with chronic pancreatitis

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World Journal of Gastroenterology 2011年第39期17卷 4349-4364页

作者： Raffaele Pezzilli Donatella Santini lucia calculli Riccardo Casadei Antonio Maria Morselli-Labate Andrea Imbrogno Dario Fabbri Giovanni Taffurelli Claudio Ricci Roberto Corinaldesi Pancreas Unit Department of Digestive Diseases and Internal MedicineSant'Orsola-Malpighi Hospital Department of Pathology Sant'Orsola-Malpighi HospitalUniversity of Bologna Department of Radiology Sant'Orsola-Malpighi HospitalUniversity of Bologna Department of Surgery Sant'Orsola-Malpighi HospitalUniversity of Bologna

Cystic dystrophy of the duodenal wall is a rare form of the disease which was described in 1970 by French authors who reported the presence of focal pancreatic disease localized in an area comprising the C-loop of the duodenum and the head of the ***-man authors have defined this area as a"groove".We report our recent experience on cystic dystrophy of the paraduodenal space and systematically review the data in the literature regarding the alterations of this space.A MEDLINE search of papers published between 1966 and 2010 was carried out and 59 paperswere considered for the present study;there were 19 cohort studies and 40 case *** majority of patients having groove pancreatitis were middle *** age was significantly higher in patients having groove *** diagnosis of cystic dystrophy of the duodenal wall can now be assessed by multi-detector computer tomography,magnetic resonance imaging and endoscopic *** latter two techniques may also add more information on the involvement of the remaining pancreatic gland not involved by the duodenal malformation and they may help in differentiating"groove pancreatitis"from "groove adenocarcinoma".In conclusion,chronic pan-creatitis involving the entire pancreatic gland was present in half of the patients with cystic dystrophy of the duodenal wall and,in the majority of them,the pan-creatitis had calcifications.

关键词：营养不良症胰腺炎肠壁慢性 MEDLINE 计算机断层扫描十二指肠磁共振成像

Pancreatic steatosis: Is it related to either obesity or diabetes mellitus?

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World Journal of Diabetes 2014年第4期5卷 415-419页

作者： Raffaele Pezzilli lucia calculli Department of Digestive Diseases and Internal Medicine Sant’Orsola-Malpighi Hospital 40138 Bologna Italy Department of Radiology Sant’Orsola-Malpighi Hospital 40138 Bologna Ital

The accumulation of fat in the pancreatic gland has been referred to using various synonyms,such as pancreatic lipomatosis,fatty replacement,fatty infiltration,fatty pancreas,lipomatous pseudohypertrophy,non-alcoholic fatty pancreatic disease and pancreatic steatosis We believe that pancreatic steatosis is the best description of fat accumulation in the pancreatic gland without fat replacement,and this term also describes the possibility that the fat accumulation is a reversible process.A review of the existing literature was carried out,and it was found that there was notable evidence from both the pathological and the imaging point of view that pancreatic steatosis is an increasing problem due to the increasing incidence of *** conclusion was that pancreatic steatosis was easily detectable using modern imaging techniques,such as ultrasonography,endoscopic ultrasonography,computed tomography and magnetic resonance *** steatosis was not due to the presence of diabetes mellitus but was highly associated with the metabolic *** possible presence of steatopancreatitis should be better evaluated,especially regarding the inflammatory cascade,and additional studies are needed which are capable of assessing whether non-alcoholic steatopancreatitis really exists as does non-alcoholic ***,the presence of exocrine pancreatic function should be extensively evaluated in patients with pancreatic steatosis.

关键词： Computed tomography Endoscopic ultrasonography Magnetic resonance imaging Metabolic syndrome Pancreatic steatosis Pathology Type 2 diabetes mellitus Ultrasonography