Pancreas
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Pancreaticopleural fistula (PPF) is an unusual complication of chronic pancreatitis. Its diagnosis is obscured by predominance of pulmonary symptoms. A review of clinical presentation, etiology, diagnostic, and treatment modalities is presented in context of 2 cases from our institution. ⋯ Pancreaticopleural fistula is a rare finding and requires a high index of suspicion for patients presenting with chest symptoms or pleural effusion and with history of pancreatitis or alcoholism. Magnetic resonance cholangiopancreatography is the better initial choice for being a noninvasive procedure and for better demonstration of complete main pancreatic duct obstruction. Restoring anatomic continuity is important if conservative approach fails.
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Comparative Study
Total pancreatectomy with and without islet cell transplantation for chronic pancreatitis: a series of 85 consecutive patients.
This study examined 85 consecutive patients undergoing total pancreatectomy (+/-islet cell transplant), examining pain relief, insulin requirements, and glycemic control postoperatively. ⋯ Total pancreatectomy is effective in reducing pain and dependence on opioid analgesia in patients with chronic pancreatitis. The addition of an islet cell transplant results in a reduction in 24-hour insulin demands, as well as potentially achieving insulin independence.
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We aimed to investigate preoperative findings that are useful to distinguish intraductal papillary-mucinous neoplasm (IPMN) subtypes. ⋯ For preoperative evaluation of patients with IPMN, it is recommended to rule out IC-IPMC using multidetector-row computed tomography and then to categorize IPMN other than IC-IPMC according to malignant potential based on the diagnostic score.