In modern medicine, imaging and intervention have become so advanced it is tempting to give it little thought before use. Yet, providers still carry the responsibility of knowing when and if to intervene with novel, invasive techniques. We present a 73-year-old male with type 2 diabetes, coronary artery disease, rheumatoid arthritis, and bladder carcinoma who underwent EUS-FNA for a 15 × 14 mm hypoechoic, heterogeneous pancreatic mass. Post-procedure, he developed acute interstitial edematous pancreatitis, progressing to fulminant pancreatitis complicated by acute respiratory distress syndrome, cholecystitis, and gallbladder empyema. This case highlights the elevated risk of complications in elderly patients with comorbidities undergoing EUS-FNA of cystic lesions, emphasizing the need for robust risk stratification and vigilant post-procedure monitoring.
Pancreatic Ductal Adenocarcinoma (PDAC) is a disease with high mortality rates due to metastasis. Epithelial-Mesenchymal Transition (EMT) is correlated with metastasis and drug resistance in PDAC. Therefore, elucidating the changes in cellular characteristics in PDAC before and after EMT is essential to understand EMT in PDAC cells and to develop novel therapeutic methods for PDAC. The human PDAC cell line Panc-1 was used to measure cell stiffness before and after EMT induction by TGF-β. EMT biomarker expression levels were measured to identify cell status using real-time PCR, immune cytochemistry. Changes in cell stiffness before and after EMT were investigated by Atomic Force Microscope with Young’s modulus. Cell size was determined by image analysis. Cellular lipids were examined. Expression levels of lamin A, the gene associated with cell stiffness, were quantified by real-time PCR. After induced EMT, PDAC cells were stiffer with larger cell sizes than before EMT. The expression levels of cytoskeletal proteins did not change significantly, but lamin A expression was significantly reduced after EMT. The amount of polyunsaturated fatty acids in the cell membrane increased, while monounsaturated fatty acids decreased. We reported the changes of cell stiffness and other biological characteristics in PDAC cells after EMT. Cell stiffness was determined by multiple factors before and after EMT. These results provide new directions for understanding EMT in PDAC, which is critical for developing new therapies for PDAC.
Extracorporeal Shock Wave Lithotripsy (ESWL) offers a non-invasive alternative for managing gallstones, particularly in high-risk surgical patients. We present a case of an impacted gallbladder fundus stone following acute cholecystitis, successfully treated with ESWL. The patient, deemed unfit for cholecystectomy due to comorbidities, underwent targeted lithotripsy with subsequent stone fragmentation and symptom resolution. Imaging confirmed clearance of the obstructing stone, and the patient remained asymptomatic during follow-up. This case highlights the potential of ESWL as a safe and effective option for selected patients with impacted gallbladder stones, particularly when surgery poses significant risks. Further studies are warranted to validate outcomes.
Context: Surgery is often indicated for children presenting with intractable abdominal pain secondary to chronic calcific pancreatitis. Frey's procedure involves an upper abdominal incision that mandates effective perioperative analgesia Although epidural analgesia is considered the gold standard, it has limitations. Erector spinae plane analgesia is a novel technique in children with a favourable risk profile. Case Report: Eight children undergoing Frey's surgery for chronic calcific pancreatitis were offered the technique. Additional intrathecal opioid analgesia was performed in five adolescent children to provide enhanced visceral analgesia. Outcomes included numerical rating scale pain scores, surgical outcomes, and parental satisfaction. Conclusion: Continuous erector spinae plane analgesia with or without intrathecal opioid can provide effective perioperative analgesia in children undergoing surgery for chronic calcific pancreatitis.
Pancreatic injuries following blunt abdomen trauma is a rare and potentially life-threatening occurrence. Pancreatic trauma is often missed on the initial clinical examination and ultrasound done for trauma as it is a retroperitoneal organ. Additionally, injury to the pancreas initially may be silent with just mild abdominal discomfort and later can present as necrotising pancreatitis, pancreatic ascites, pseudocyst, abscesses, fistulae, pseudoaneurysm rupture with hemoperitoneum etc which becomes challenging for the clinician to manage. Management of pancreatic injuries are still a challenge to surgeons as surgically intervention in these cases can be lifesaving or lead to more damage.
Autoimmune pancreatitis (AIP) is a rare and unique cause of obstructive jaundice in adults. Due to overlapping symptomatology, clinical presentation, and laboratory findings with malignant pathologies such as cholangiocarcinoma or pancreatic cancer, it is important to consider AIP in the differential diagnosis of new-onset obstructive jaundice. To underscore this, we present a case of obstructive jaundice resulting from isolated porta-hepatis adenopathy secondary to autoimmune pancreatitis in a previously healthy 62-year-old male.
This case report describes a 73 -year -old male with pancreatic adenocarcinoma expressing a KRAS G12R mutational variant among KRAS-mutated PDACs. The patient demonstrated a response to treatment with a combination of gemcitabine, nab-paclitaxel, and the MEK inhibitor, Cobimetinib. Imaging revealed resolution of abdominal distention and the CA 19-9 laboratory marker regressed into a normal range. Molecular profiling revealed distinct differences between G12R PDAC tumors, including lower PD -L1 expression, immune infiltration, and metabolic markers in G12R tumors, suggesting reduced immunogenicity. However, the G12R population showed the highest overall survival among codon 12 variants. This case highlights the potential vulnerability of G12R PDAC to targeted MEK inhibition alongside standard chemotherapy, leading to clinical benefits. Further investigation into the unique biology of G12R tumors may uncover novel therapeutic strategies.
The pancreas stands as a pivotal organ in the intricate machinery of human digestion. Its exocrine function, primarily responsible for producing and secreting digestive enzymes, is crucial for breaking down complex nutrients into absorbable forms [1]. Among the pancreatic arsenal, enzymes like amylase, lipase, and protease play indispensable roles, transforming ingested food into essential nutrients. However, the journey from zymogen to active enzyme is a fascinating tale of molecular essay delves into the intricate pathways involved in the activation and regulation of pancreatic enzymes, shedding light on both physiological function and pathological implications [2]. initial form as zymogens, inactive precursors awaiting
Background: The molecular mechanisms underlying the chronic pain associated with pancreatitis are poorly understood. Hypercalcemia is a risk factor and the role of cytosolic calcium is described as a modulator of pancreatitis. Blockade of Ca2+ signals may be useful as prophylactic treatment of pancreatitis. Agents that modulate the activity of the Voltage-Sensitive Calcium Channels (VSCCs) exhibit experimentally and clinically significant pain relief in visceral pain. Between these agents, the toxins Ph alpha 1 beta and omega-conotoxin MVIIA are effectively reducing the chronic pain in rodent models. Patients and Methods: AP was induced in rats that received 5 times hourly an intraperitoneal injection of cerulein (5 mu g/kg in 100 mu L of volume). Blood serum pancreatic enzymes and ROS analysis were monitored after 8 hours of the first injection cerulein. Behavioral testing of the nociceptive state of the abdominal area was included in the study. Results: Compared with control groups, rats receiving cerulein demonstrated an increase in withdrawal events after analgesimeter stimulation. The abdominal mechanical hyperalgesia was reduced after application of the VSCCs blockers omega-conotoxin MVIIA, Ph alpha beta native and recombinant CTK-01512-2. The treatments reduced the cerulein-induced increase in ROS, amylase and lipase levels. Ph alpha 1 beta and CTK 01512-2 did not affect the horizontal and vertical exploration activities while omega-conotoxin MVIIA increased then. Conclusion: These results indicate that animals injected with cerulein-induced experimental pancreatitis expressed by visceral hyperalgesia, ROS, serum amylase and lipase characteristics of pancreatitis. The treatments of the animals with the VSCCs reduced the effects of pancreatitis.
