Breast Cancer Metastases to the Pancreas

Introduction

The pancreas can serve as the destination for metastatic spread of malignancies from multiple organ sites. Breast cancer metastases to the pancreas are part of this spectrum and surgeons evaluate such patients as part of their practice. Uniform clinical guidelines for these cases do not exist and care is primarily driven by the personal experience of the treating surgeon.

Discussion

We present two patients with breast cancer metastases to their pancreas and review their workup and clinical management in light of our experience and the existing published literature. We propose that metastatic disease to the pancreas has to remain in the differential diagnosis for any patient with a new pancreatic mass and prior cancer history. Surgical resection is a viable treatment option for patients with isolated metastatic disease to the pancreas if the underlying biology of the metastatic tumor is favorable.     

The structure of the Montgomery–Åsberg depression rating scale over the course of treatment for depression

The Montgomery–Åsberg Depression Rating Scale (MADRS) is a widely used clinician‐rated measure of depressive severity. Empirical support for the factor structure of the MADRS is mixed; further, the comparison of MADRS scores within and between patients requires the demonstration of consistent instrument properties. The objective of the current investigation was to evaluate MADRS factor structure as well as MADRS factorial invariance across time and gender. The MADRS was administered to 821 depressed outpatients participating in a large‐scale effectiveness study of combined pharmacotherapy and psychotherapy for depression. Treatment outcome did not differ across treatment groups. Factor structure and invariance was evaluated via confirmatory factor analysis. A four‐factor model consisting of Sadness, Negative Thoughts, Detachment and Neurovegetative symptoms demonstrated a good fit to the data. This four‐factor structure was invariant across time and gender. A hierarchical model, in which these four factors served as indicators of a general depression factor, was also supported. A limitation of the current study is the lack of comprehensive characterization of patient clinical features; results need to be replicated in more severely depressed or treatment refractory patients. Overall, evidence supported the use of the MADRS total score as well as subscales focused on affective, cognitive, social and somatic aspects of depression in male and female outpatients. Copyright © 2013 John Wiley & Sons, Ltd.     

Mathematical Modelling of Glucose‐Dependent Insulinotropic Polypeptide and Glucagon‐like Peptide‐1 following Ingestion of Glucose

The incretin hormones, glucose‐dependent insulinotropic polypeptide (GIP) and glucagon‐like peptide‐1 (GLP‐1), play an important role in glucose homeostasis by potentiating glucose‐induced insulin secretion. Furthermore, GLP‐1 has been reported to play a role in glucose homeostasis by inhibiting glucagon secretion and delaying gastric emptying. As the insulinotropic effect of GLP‐1 is preserved in patients with type 2 diabetes (T2D), therapies based on GLP‐1 have been developed in recent years, and these have proven to be efficient in the treatment of T2D. The endogenous secretion of both GIP and GLP‐1 is stimulated by glucose in the small intestine, and the release is dependent on the amount. In this work, we developed a semimechanistic model describing the release of GIP and GLP‐1 after ingestion of various glucose doses in healthy volunteers and patients with T2D. In the model, the release of both hormones is stimulated by glucose in the proximal small intestine, and no differences in the secretion dynamics between healthy individuals and patients with T2D were identified after taking differences in glucose profiles into account.     

Childhood adversity, recent life events and depression in late life

BACKGROUND: The study investigates whether persons who have experienced childhood adversity are more likely to develop depressive symptoms when faced with recent events. METHOD: Data were used from a population-based sample, aged 55 to 85 years (n=1887), which were not depressed at baseline. Childhood adversities and recent stressful life events were retrospectively assessed. Depressive symptoms were measured with the CES-D. RESULTS: 14.4% of our sample experienced adverse events during childhood (<18 yrs) and 35.4% experienced recent events. Associations of depressive symptoms were found with both, childhood adversity (OR 1.80, 95% CI 1.21-2.69) and recent life events (OR 1.42, 95% CI 1.01-2.00). The effect of recent events on depressive symptoms was not modified by childhood adversity. LIMITATIONS: Underreporting may be present due to unwillingness to report embarrassing events or to disclose painful memories. CONCLUSIONS: No evidence was found for the assumption that older persons were more vulnerable for depression in reaction to recent life events when they were exposed to childhood adversity.     

The use of a wax bite wafer and a double computed tomography scan procedure to obtain a three-dimensional augmented virtual skull model

A detailed visualization of the interocclusal relationship is essential in a three-dimensional virtual planning setup for orthognathic and facial orthomorphic surgery. The purpose of this study was to introduce and evaluate the use of a wax bite wafer in combination with a double computed tomography (CT) scan procedure to augment the three-dimensional virtual model of the skull with a detailed dental surface. A total of 10 orthognathic patients were scanned after a standardized multislice CT scanning protocol with dose reduction with their wax bite wafer in place. Afterward, the impressions of the upper and lower arches and the wax bite wafer were scanned for each patient separately using a high-resolution standardized multislice CT scanning protocol. Accurate fitting of the virtual impressions on the wax bite wafer was done with surface matching using iterative closest points. Consecutively, automatic rigid point-based registration of the wax bite wafer on the patient scan was performed to implement the digital virtual dental arches into the patient's skull model (Maxilim, version 2.0; Medicim NV, St-Niklaas, Belgium). Probability error histograms showed errors of < or =0.16 mm (25% percentile), < or =0.31 mm (50% percentile), and < or =0.92 (90% percentile) for iterative closest point surface matching. The mean registration error for automatic point-based registration was 0.17 +/- 0.07 mm (range, 0.12-0.22 mm). The combination of the wax bite wafer with the double CT scan procedure allowed for the setup of an accurate three-dimensional virtual augmented model of the skull with detailed dental surface. However, from a clinical workload, data handling, and computational point of view, this method is too time-consuming to be introduced in the clinical routine.