Pancreatic pseudocysts: 10 years of experience

Background. Pancreatic pseudocysts (PP) are considered to be one of the major complications of acute, chronic, and posttraumatic pancreatitis. Their treatment has always been a surgical challenge. Surgical treatment was for many years the only choice in the management of PP. However, technological development has provided new alternatives in their management. Purpose. The purpose of this retrospective study is to present our experience in the treatment of PP and to define the criteria for the selection of the treatment method. Methods. During the past decade, 14 patients were treated for PP in our clinic. We classified our patients in three groups based on the treatment: A, conservative treatment; B, surgical treatment with internal drainage; and C, percutaneous external drainage (PED) under CT guidance. Results. Conservative treatment had excellent outcome when it was applied in patients with small cysts. Internal drainage was always successful, but patients needed more hospitalization and showed increased morbidity compared to PED. PED was successful in two of three patients. Conclusions. Conservative treatment is a good choice for small asymptomatic cysts, particularly for patients who are poor candidates for operation. Internal drainage is a good method of treatment and should be used as the first choice by experienced surgeons. Finally, PED is a good first choice for patients with a unilocular cyst and contraindications for surgery.     

Immunopathology of Sjögren's syndrome

Sj?gren's syndrome is a chronic autoimmune disorder characterized by mononuclear cell infiltration around epithelial cells of exocrine glands. In recent years, several studies have tried to elucidate the components of the immunopathologic interaction in Sj?gren's syndrome as well as the function of these components. The majority of the mononuclear infiltrating cells are CD4 positive T lymphocytes (60-70%) whereas B cells constitute one fourth of the infiltrating cells. Macrophages and natural killer cells are poorly represented in the lesion. Epithelial cells of minor salivary glands of patients with Sj?gren's syndrome express several cytokines (IL-1 beta, IL-6, NO), protooncogenes (c-myc), autoantigens (Ro, La, Fodrin) and costimulatory molecules (B71, B72). The characteristic destruction of epithelial cells of Sj?gren's syndrome patients is probably due to activation of several apoptotic pathways since epithelial cells express different apoptosis related molecules such as Fas, FasL, Bax, while mononuclear cells express Perforin and Granzymes. Finally epithelial cells seem to exert a regenerative effort since they express trefoil proteins (pS2). The above mentioned properties give epithelial cells the leading role in the pathophysiology of the syndrome but the exact causative agent which drives the immune system towards an autoimmune reaction still remains obscure.     

Pancreatic pseudocysts: 10 years of experience

BACKGROUND: Pancreatic pseudocysts (PP) are considered to be one of the major complications of acute, chronic, and posttraumatic pancreatitis. Their treatment has always been a surgical challenge. Surgical treatment was for many years the only choice in the management of PP. However, technological development has provided new alternatives in their management. PURPOSE: The purpose of this retrospective study is to present our experience in the treatment of PP and to define the criteria for the selection of the treatment method. METHODS: During the past decade, 14 patients were treated for PP in our clinic. We classified our patients in three groups based on the treatment: A, conservative treatment; B, surgical treatment with internal drainage; and C, percutaneous external drainage (PED) under CT guidance. RESULTS: Conservative treatment had excellent outcome when it was applied in patients with small cysts. Internal drainage was always successful, but patients needed more hospitalization and showed increased morbidity compared to PED. PED was successful in two of three patients. CONCLUSIONS: Conservative treatment is a good choice for small asymptomatic cysts, particularly for patients who are poor candidates for operation. Internal drainage is a good method of treatment and should be used as the first choice by experienced surgeons. Finally, PED is a good first choice for patients with a unilocular cyst and contraindications for surgery.     

Rapid quality control of 99Tcm-sestamibi.

The thin layer chromatographic (TLC) method for determining the radiochemical purity of 99Tcm-sestamibi suggested by the manufacturer of the kit is slow and inconvenient. In this study a more rapid reversed phase chromatography (Sep-Pak) technique is compared with the TLC method for measurement of the radiochemical purity of 99Tcm-sestamibi. The levels of free 99Tcm-pertechnetate in 99Tcm-sestamibi were accurately determined using the Sep-Pak technique. However, due to binding of variable amounts of reduced-hydrolysed unbound 99Tcm to the chromatography cartridge, the Sep-Pak method overestimated the radiochemical purity of the radiopharmaceutical by approximately 3%. In practice, this overestimation is not important and the Sep-Pak technique can be used as a rapid method of determining radiochemical purity of 99Tcm-sestamibi.