Short-Term and Long-Term Outcomes for Patients with Autoimmune Pancreatitis After Pancreatectomy: A Multi-institutional Study

Background

Autoimmune pancreatitis (AIP) is a rare subtype of chronic pancreatitis that may mimic adenocarcinoma of the pancreas. The aim of this study was to evaluate the short-term and long-term outcomes of pancreatectomy for patients with AIP.

Methods

In this multi-institutional study, we identified all patients who underwent pancreatectomy for AIP from 1986 to 2011. AIP was confirmed by pathology review. Clinical presentation, operative details, and postoperative outcomes were analyzed.

Results

Seventy-four patients (median age, 60 years; 69 % male) with AIP underwent pancreatectomy. The main indication for operation was concern for malignancy (n?=?59, 80 %). No patients were found to have pancreatic adenocarcinoma on final pathology. Major complications occurred in ten (14 %) patients, with one perioperative death (1 %). Clinically relevant (grade B/C) pancreatic fistulae occurred in two patients. No patients required reoperation for AIP and 11 (17 %) patients developed recurrent AIP.

Conclusion

Although we do not advocate pancreatectomy for AIP, strong suspicion of malignancy may require an operation in selected patients. For patients with AIP, pancreatectomy resulted in few pancreatic fistulae, a low rate of re-intervention, and a 17 % recurrence rate.     

微小染色体维持蛋白5和细胞增殖核抗原在肺癌组织中的表达及其临床意义

目的:检测MCM5蛋白和PCNA在肺癌组织中的表达,探讨两者与肺癌各临床病理因素之间的关系及两者相互的联系,从而为评估肺癌的发生发展、预后及治疗提供理论依据。方法:运用免疫组织化学技术分别检测MCM5蛋白和PCNA在68例肺癌组织和20例正常组织中的表达情况,分析其与临床病理因素之间的关系及两者相互的联系。结果:MCM5表达的阳性信号位于细胞核,胞浆无着色。在正常肺组织中,MCM5的表达局限在上皮基底部的1/3至1/2的细胞,在肺癌组织中,MCM5的表达分布广泛,靠近上皮表面的细胞也可见大量表达。(1)正常肺组织和肺癌组织的MCM5的表达的差别有统计学意义(P<0.01)。(2)肺癌中MCM5表达与分化程度、淋巴结转移有显著相关性(P<0.05),与病人年龄、性别无显著相关性(P>0.05)。(3)PCNA的表达与肺癌的分化程度无显著相关性(P>0.05)。(4)在肺正常组织中,PCNA标记指数高于MCM5标记指数,两者具有显著差异性(P<0.05)。在肺癌组织中,PCNA与MCM5标记指数无显著差异性(P>0.05)。结论:(1)在肺组织中,微小染色体维持蛋白5(MCM5)是一种可靠的细胞增殖标志物。根据MCM5染色的组织结构差异和平均光密度能比较准确区分肺正常组织和癌组织。MCM5表达与肺癌的分化程度显著相关,因此MCM5表达可以提示肺癌的恶性程度,有助于临床判断病人的预后以及选择合适的治疗方法。MCM5与其他增殖标志PCNA相比是一种更好的细胞增殖标志物,是肺癌细胞的更好标志和分级指标。(2)PCNA在肺癌组织中过表达,提示PCNA的过表达与肺癌的发生发展关系密切。     

Coronal decompensation produced by Cotrel-Dubousset "derotation" maneuver for idiopathic right thoracic scoliosis

From 1985 to 1987, 82 patients with idiopathic scoliosis followed 12 to 44 months underwent selective fusion and correction of their right thoracic curves by Cotrel-Dubousset instrumentation using the "derotation" maneuver. Preoperative, postoperative, and follow-up standing anteroposterior roentgenograms of the spine were analyzed. For curves in which there was deviation from the midline (plumb line) and rotation of the lumbar segments, an increased incidence of decompensation was produced after surgery, when posterior Cotrel-Dubousset instrumentation and fusion were carried to the "stable" vertebra with one rod bend and hook alignment on the left sided derotation rod. Previous guidelines established for selective fusion with conventional posterior instrumentation (Harrington or Luque rods) may not be applicable to derotation with Cotrel-Dubousset instrumentation.     

Scoliosis surgery in neurofibromatosis

Twenty-three patients who were treated by posterior spinal fusion with neurofibromatous scoliosis were reviewed to study the adequacy of spinal fusion, rate of pseudarthrosis, and incidence of complications. Twenty patients achieved a solid fusion with posterior surgery alone. Thirteen patients required one or more posterior augmentation procedures because of progressive deformity. Three patients with dystrophic kyphoscoliosis required an anterior spinal fusion in addition to the posterior fusion to achieve a solid fusion mass. The type of graft material, Harrington instrumentation, and degree of kyphosis or scoliosis had no effect on the rate of pseudarthrosis. Preoperative neuroradiographic evaluation was found to be warranted for all patients with neurofibromatous scoliosis.     

Panniculitis–an unusual cutaneous manifestation of systemic sclerosis

Systemic sclerosis (SSc) is an autoimmune systemic disease characterized by small vessel involvement that leads to tissue ischemia and fibroblast stimulation resulting in accumulation of collagen (fibrosis) in the skin and internal organs. Lipomembranous panniculitis is a peculiar type of fat necrosis and has been reported with clinical conditions, commonly with peripheral vascular diseases. We describe a case of a 43‐year‐old woman with SSc manifestations, who presented with black scaly skin plaques, associated with thickening of the subcutaneous fat tissue, on the lateral surface of her thighs, her calves, gluteal area and lower abdomen. Biopsy revealed lipomembranous panniculitis. Lipomembranous changes have been seen in connective tissue disorders such as lupus profundus, morphea, systemic sclerosis and panniculitis associated with dermatomyositis, but rarely in thighs, calves, gluteal area and lower abdomen. Almeida MSTM, Lima SCB, Carvalho LL, Almeida JVM, Santos LG, Rolim JRA, Rocha TE. Panniculitis–An unusual cutaneous manifestation of systemic sclerosis.