Center for Pancreatic Disease

Anderson, United States

Center for Pancreatic Disease

Anderson, United States
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Paulo J.A.,Proteomics Center at Childrens Hospital Boston | Paulo J.A.,Center for Pancreatic Disease | Paulo J.A.,Harvard University | Kadiyala V.,Center for Pancreatic Disease | And 9 more authors.
Open Proteomics Journal | Year: 2013

Chronic pancreatitis (CP) is currently diagnosed using invasive endoscopic and imaging techniques. However, urine can be collected safely and noninvasively and as such may offer a superior alternative to current techniques of CP diagnosis. We use mass spectrometry-based methods to discover proteins which are exclusive to or differentially abundant in urine of chronic pancreatitis patients. We have performed a comparative quantitative proteomic analysis of urine collected from 5 healthy controls, 5 severe CP patients, and 5 patients of a mixed cohort with clinical representation typical of patients referred for CP, but not diagnosed with the disease. Proteins from urine were fractionated via SDS-PAGE and digested in-gel with trypsin prior to reversedphase liquid chromatography in-line with a mass spectrometer. ProteinPilot software and the QSPEC algorithm identified proteins and determined statistically significant differences between cohorts. We identified over 600 proteins from urine, of which several hundred were either exclusive to or differ quantitatively in severe CP patients. Members of the cathepsin protein family were of significantly higher abundance in the severe CP cohort. In addition, we have identified a core set of 50 proteins in all 15 samples, 25 of which showed no significant difference among the cohorts. The differentially abundant proteins in severe CP patients represent an initial set of targets for directed proteomics experiments for further validation studies.However, larger matched cohorts will be required to determine if these differences have statistically significant diagnostic potential. © Paulo et al.


Kadiyala V.,Center for Pancreatic Disease | Lee L.S.,Center for Pancreatic Disease | Banks P.A.,Center for Pancreatic Disease | Suleiman S.,Center for Pancreatic Disease | And 6 more authors.
Journal of the Pancreas | Year: 2013

Objective To compare pancreatic duct cell function in smokers (current and past) and never smokers by measurement of secretin-stimulated peak bicarbonate concentration ([HCO3 -]) in endoscopic collected pancreatic fluid (PF). Methods This retrospective study was cross-sectional in design, recording demographic information (age, gender, etc.), smoking status (former, current, never), alcohol intake, clinical data (imaging, endoscopy), and laboratory results (peak PF [HCO3 -]) from subjects evaluated for pancreatic disease at a tertiary pancreas center. Univariate and multivariate statistical analysis (SAS Version 9.2, Cary, NC, USA) was performed to assess the relationship between cigarette smoking and secretin-stimulated pancreatic fluid bicarbonate concentration. Results A total of 131 subjects underwent pancreatic fluid collection (endoscopic pancreatic function test, ePFT) for bicarbonate analysis: 25.2% (33 out of 131) past smokers, 31.3% (41 out of 131) current smokers, and 43.5% (57 out of 131) were never smokers. Measures of Association: The mean peak PF [HCO3 -] in never smokers (81.3±18.5 mEq/L) was statistically higher (indicating better duct cell function) when compared to past smokers (66.8±24.7 mEq/L, P=0.005) and current smokers (70.0±20.2 mEq/L, P=0.005). However, the mean peak [HCO3 -] in past smokers was not statistically different from that in current smokers (P=0.575), and therefore, the two smoking groups were combined to form a single "smokers cohort". When compared to the never smokers, the smokers cohort was older (P=0.037) and had a greater proportion of subjects with definite chronic pancreatitis imaging (P=0.010), alcohol consumption ≥20 g/day (P=0.012), and abnormal peak PF [HCO3-] (P<0.001). Risk-Based Estimates: Cigarette smoking (risk ratio, RR: 2.2, 95% CI: 1.3-3.5; P<0.001), diagnosis of definite chronic pancreatitis imaging (RR: 2.2, 95% CI: 1.6- 3.2; P<0.001) and alcohol consumption ≥20 g/day (RR: 1.6, 95% CI: 1.1-2.4; P=0.033) were all associated with low mean peak PF [HCO3 -] (indicating duct cell secretory dysfunction). Multivariate Analysis: Smoking (odds ratio, OR: 3.8, 95% CI: 1.6-9.1; P=0.003) and definite chronic pancreatitis imaging (OR: 5.7, 95% CI: 2.2-14.8; P<0.001) were determined to be independent predictors of low peak PF [HCO3 -], controlling for age, gender, and alcohol intake. Furthermore there was no interaction between smoking status and alcohol intake in predicting duct cell dysfunction (P=0.571). Conclusion Measurement of pancreatic fluid bicarbonate in smokers reveals that cigarette smoking (past and current) is an independent risk factor for pancreatic duct cell secretory dysfunction (low PF [HCO3 -]). Furthermore, the risk of duct cell dysfunction in subjects who smoked was approximately twice the risk (RR: 2.2) in never smokers. Further in depth, translational research approaches to pancreatic fluid analysis may help unravel mechanisms of cigarette smoking induced pancreatic duct cell injury.


Wang X.,Center for Pancreatic Disease | Xu Y.,Center for Pancreatic Disease | Qiao Y.,Center for Pancreatic Disease | Qiao Y.,Fourth Center Hospital | And 11 more authors.
Pancreas | Year: 2013

OBJECTIVES: Early, efficient, and accurate evaluation for organ failure is an important step for improving outcome in severe acute pancreatitis (SAP). We aim to develop a method that can early, efficiently, and accurately evaluate the in-hospital organ failure in patients with SAP. METHODS: Using multivariate logistic regression analysis, the associative factors for in-hospital organ failure were evaluated retrospectively from conventional data obtained from 393 patients with SAP from 2000 to 2012. In classification and regression tree analysis, a new clinical scoring system was developed for the evaluation of in-hospital organ failure in SAP. We also compared the accuracy of our new scoring system with multiple organ dysfunction score and Acute Physiology and Chronic Health Examination II score by the receiver operating characteristic curve. RESULTS: Laboratory results revealed serum calcium level greater than or equal to 1.84 mmol/L, serum creatinine level greater than or equal to 110 μmol/L, age greater than or equal to 72 years, activated partial thromboplastin time less than or equal to 30.95 seconds, and Balthazar computed tomography score greater than or equal to 7 (CCAAB) score system, each contributed 1 point for the prediction of organ failure. The area under the curve of the CCAAB score system was similar to multiple organ dysfunction scores and Acute Physiology and Chronic Health Examination II scores. CONCLUSIONS: The new scoring system CCAAB is an efficient and accurate method for the early evaluation of patients with SAP for in-hospital organ failure. Copyright © 2013 Lippincott Williams & Wilkins.


Moriya T.,Virginia Mason Medical Center | Traverso L.W.,Virginia Mason Medical Center | Traverso L.W.,Center for Pancreatic Disease
Archives of Surgery | Year: 2012

Objective: To determine the occurrence of new disease in the pancreatic remnant after resection for intraductal papillary mucinous neoplasms. Design: A longitudinal level II cohort study. Setting: Virginia Mason Medical Center, Seattle, Washington. Patients: The primary cohort was a "resection cohort"of 203 patients who underwent partial pancreatic resection for an intraductal papillary mucinous neoplasm. Main Outcome Measures: The occurrence rate of lesions in the pancreatic remnant after resection for an intraductal papillary mucinous neoplasm, determined by use of an annual computed tomographic scan of the pancreas. Results: New lesions were observed in the remnant of 17 of the 203 patients (8%) after a median follow-up of 40 months and a median interval of 38 months from the initial resection. Only 1 of these 17 patients with new lesions had a surgical margin that was positive for an adenoma at the time of resection. Comparing the 17 patients with new lesions with the 186 patients without new lesions, we found no difference in age, sex, procedure type, location in ductal system, original histology, or original margin status. In the new lesion group, no treatment was used for 12 patients who had side-branch disease detected by imaging (6% of all patients). Surgical treatment was used for 5 patients (2% of all patients): 2 with adenomas, 1 with a carcinoma in situ, and 2 with an invasive ductal carcinoma (1 with liver metastases). Conclusions: We found that, following a partial pancreatic resection for an intraductal papillary mucinous neoplasm and a 40-month follow-up with an annual computed tomographic scan of the pancreas, 17 of 203 patients (8%) developed a new intraductal papillary mucinous neoplastic lesion in the pancreatic remnant. As follow-up time increases, we suspect that new lesions will constantly appear regardless of whether the surgical margin was negative at initial resection.


Traverso L.W.,Center for Pancreatic Disease | Moriya T.,Center for Pancreatic Disease | Hashimoto Y.,Center for Pancreatic Disease
Current Gastroenterology Reports | Year: 2012

The process of Intraductal papillary mucinous neoplasms (IPMN) follows the adenoma-to-carcinoma sequence. If it progresses to malignancy about 5 years is required. Even though the process is slow IPMN provides the clinician with the opportunity to avoid malignancy if the patient is at risk. The natural history as observed through Kaplan Meier event curves for occurrence of malignancy show the process to malignancy is much faster (50% within 2 years) if pancreatitis-like symptoms are present or if the main pancreatic duct (MPD) is involved. Almost all decisions to resect (95% in our experience) are based on the presence of symptoms or the MPD location. Cyst size is used infrequently. Every patient with an IPMN should always have a planned follow-up and the frequency depends on the perceived risk of malignancy - immediate imaging if becomes symptomatic to every 2 to 3 years if asymptomatic side branch lesions. The natural history provides modern guidelines for making decisions in patients with a newly discovered IPMN. © Springer Science+Business Media, LLC 2012.


Moriya T.,Virginia Mason Medical Center | Hashimoto Y.,Virginia Mason Medical Center | Traverso L.W.,Virginia Mason Medical Center | Traverso L.W.,Center for Pancreatic Disease
Journal of Gastrointestinal Surgery | Year: 2011

Introduction: Using Kaplan-Meier curves, a 2006 study illustrated a shorter time interval between development of symptoms and detection of malignant IPMN in the main pancreatic duct versus a side-branch duct location. Of 93 cases, only 62 were confirmed histologically. To support these interesting findings, we examined a larger cohort of cases where the diagnosis was confirmed histologically and asked if symptoms by themselves, as well as main duct location, were associated with malignant detection. Methods: Between 1989 and 2009, 210 IPMN cases meeting international criteria were resected and histologically examined. Actuarial rates of malignant detection over time were calculated from the first clinical symptom to malignant detection (resection). These rates of malignant detection over time were compared for main vs. side-branch duct location and symptomatic vs. asymptomatic cases. Results: The most common indications for resection were symptoms (88%) and main pancreatic duct location (65%). The actuarial malignant detection rates were significantly shorter for main duct location and also for symptomatic cases, regardless of duct location. Conclusions: Presence of symptoms followed by main pancreatic duct location had a significantly shorter elapsed time to malignant detection. The visual depiction of these actuarial rates highlights the importance of the clinical history. To determine malignant risk, the primary determinants for resection were either symptoms or main duct location (but not cyst size), confirming the 2006 study with a larger cohort of histologically confirmed cases. © 2011 The Society for Surgery of the Alimentary Tract.


Gluck M.,Virginia Mason Medical Center | Ross A.,Virginia Mason Medical Center | Irani S.,Virginia Mason Medical Center | Lin O.,Virginia Mason Medical Center | And 8 more authors.
Journal of Gastrointestinal Surgery | Year: 2012

Background: Symptomatic walled-off pancreatic necrosis (WOPN) treated with dual modality endoscopic and percutaneous drainage (DMD) has been shown to decrease length of hospitalization (LOH) and use of radiological resources in comparison to standard percutaneous drainage (SPD). Aim: The aim of this study is to demonstrate that as the cohort of DMD and SPD patients expand, the original conclusions are durable. Methods: The database of patients receiving treatment for WOPN between January 2006 and April 2011 was analyzed retrospectively. Patients: One hundred two patients with symptomatic WOPN who had no previous drainage procedures were evaluated: 49 with DMD and 46 with SPD; 7 were excluded due to a salvage procedure. Results: Patient characteristics including age, sex, etiology of pancreatitis, and severity of disease based on computed tomographic severity index were indistinguishable between the two cohorts. The DMD cohort had shorter LOH, time until removal of percutaneous drains, fewer CT scans, drain studies, and endoscopic retrograde cholangiopancreatography (ERCPs; p < 0.05 for all). There were 12 identifiable complications during DMD, which were successfully treated without the need for surgery. The 30-day mortality in DMD was 4% (one multi-system organ failure and one out of the hospital with congestive heart failure). Three patients receiving SPD had surgery, and three (7%) died in the hospital. Conclusion: DMD for symptomatic WOPN reduces LOH, radiological procedures, and number of ERCPs compared to SPD. © 2011 The Society for Surgery of the Alimentary Tract.

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