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Jentzsch C, Fuchs J, Agaimy A, Vokuhl C, Escherich G, Blattmann C, Warmann SW, Schmidt A, Schäfer J, Brecht IB, Schneider DT, Abele M. Solid pseudopapillary neoplasms of the pancreas in childhood and adolescence-an analysis of the German Registry for Rare Pediatric Tumors (STEP). Eur J Pediatr 2023; 182:5341-5352. [PMID: 37733117 PMCID: PMC10746605 DOI: 10.1007/s00431-023-05203-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 09/22/2023]
Abstract
Solid pseudopapillary neoplasms (SPNs) are the most common entity among pediatric pancreatic tumors. Still, these are rare tumors with an annual incidence of 0.1-0.2/1,000,000, and little is known about their optimal treatment. This analysis aimed to increase knowledge about the occurrence and treatment strategies of SPN in childhood. Data regarding diagnostics, treatment, and outcome of children aged 0-18 years with SPN recorded in the German Registry for Rare Pediatric Tumors (STEP) were analyzed. Thirty-eight patients were identified with a median age of 14.5 years at diagnosis (range: 8-18) and a female preponderance (81.6%). The most frequent location of the tumor was the pancreatic tail. In histopathological and immunohistochemical examination, pseudopapillary, solid, and cystic lesions as well as expression of beta-catenin, progesterone receptors, and cyclin D1 were the most common findings. All patients underwent surgical resection. Most patients underwent open resection, predominantly tail resection for tumors in the tail region and pylorus-preserving pancreaticoduodenectomy for tumors in the head region. The main postoperative sequela was exogenous pancreatic insufficiency (23.7%), especially with SPN in the pancreatic head. No recurrence occurred during follow-up, although two patients underwent resection with microscopic residue. CONCLUSION SPN of the pancreas in childhood are low-grade malignancies with usually favorable treatment outcomes. However, therapy can lead to relevant long-term sequelae. To prevent recurrence, complete surgical resection is recommended, sparing as much healthy pancreatic tissue as possible. Interdisciplinary collaboration between specialists is essential to optimize treatment. Molecular genetic analysis of these tumors could improve understanding of their genesis. WHAT IS KNOWN • Solid pseudopapillary neoplasms (SPNs) of the pancreas are very rare tumors in childhood. • Little is known about tumorigenesis, and there are no specific guidelines for treatment and follow-up in pediatric patients. WHAT IS NEW • Characteristics, treatment, and outcome were comprehensively assessed in a large cohort of pediatric patients with SPN. • We propose recommendations for diagnosis, treatment, and follow-up of children with SPN, based on our analysis and considering published experience.
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Affiliation(s)
- Christian Jentzsch
- Pediatric Hematology/Oncology, Department of Pediatrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Jörg Fuchs
- Pediatric Surgery and Pediatric Urology, Department of Pediatrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Abbas Agaimy
- Institute of Pathology, University Hospital Erlangen, Erlangen, Germany
| | - Christian Vokuhl
- Section of Pediatric Pathology, Department of Pathology, University Hospital Bonn, Bonn, Germany
| | - Gabriele Escherich
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claudia Blattmann
- Department of Pediatric Oncology, Hematology and Immunology, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Steven W Warmann
- Pediatric Surgery and Pediatric Urology, Department of Pediatrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Andreas Schmidt
- Pediatric Surgery and Pediatric Urology, Department of Pediatrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Jürgen Schäfer
- Section of Pediatric Radiology, Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Ines B Brecht
- Pediatric Hematology/Oncology, Department of Pediatrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Dominik T Schneider
- Clinic of Pediatrics, Klinikum Dortmund, University Witten/Herdecke, Dortmund, Germany
| | - Michael Abele
- Pediatric Hematology/Oncology, Department of Pediatrics, University Hospital Tuebingen, Tuebingen, Germany.
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Yadav N, Dass R, Virmani J. Objective assessment of segmentation models for thyroid ultrasound images. J Ultrasound 2023; 26:673-685. [PMID: 36195781 PMCID: PMC10469139 DOI: 10.1007/s40477-022-00726-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/27/2022] [Indexed: 11/29/2022] Open
Abstract
Ultrasound features related to thyroid lesions structure, shape, volume, and margins are considered to determine cancer risk. Automatic segmentation of the thyroid lesion would allow the sonographic features to be estimated. On the basis of clinical ultrasonography B-mode scans, a multi-output CNN-based semantic segmentation is used to separate thyroid nodules' cystic & solid components. Semantic segmentation is an automatic technique that labels the ultrasound (US) pixels with an appropriate class or pixel category, i.e., belongs to a lesion or background. In the present study, encoder-decoder-based semantic segmentation models i.e. SegNet using VGG16, UNet, and Hybrid-UNet implemented for segmentation of thyroid US images. For this work, 820 thyroid US images are collected from the DDTI and ultrasoundcases.info (USC) datasets. These segmentation models were trained using a transfer learning approach with original and despeckled thyroid US images. The performance of segmentation models is evaluated by analyzing the overlap region between the true contour lesion marked by the radiologist and the lesion retrieved by the segmentation model. The mean intersection of union (mIoU), mean dice coefficient (mDC) metrics, TPR, TNR, FPR, and FNR metrics are used to measure performance. Based on the exhaustive experiments and performance evaluation parameters it is observed that the proposed Hybrid-UNet segmentation model segments thyroid nodules and cystic components effectively.
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Affiliation(s)
- Niranjan Yadav
- Department of Electronics and Communication Engineering, Deenbandhu Chhotu Ram University of Science and Technology Murthal, Sonepat, 131039 India
| | - Rajeshwar Dass
- Department of Electronics and Communication Engineering, Deenbandhu Chhotu Ram University of Science and Technology Murthal, Sonepat, 131039 India
| | - Jitendra Virmani
- Central Scientific Instruments Organization, Council of Scientific and Industrial Research, Chandigarh, 160030 India
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Cheng A, Lee JWK, Ngiam KY. Use of 3D ultrasound to characterise temporal changes in thyroid nodules: an in vitro study. J Ultrasound 2023; 26:643-651. [PMID: 36053484 PMCID: PMC10468465 DOI: 10.1007/s40477-022-00698-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/13/2022] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVE Thyroid nodules are extremely common, with prevalence rate up to 68%, yet only 7-15% of these are malignant. Many nodules require surveillance and 2-dimensional ultrasound (2D US) is used. Issues include the huge workload of obtaining and labeling images and difficulty comparing sizes of nodules over time due to large inter-operator variability. Inaccuracies may result in unnecessary FNAC or missed diagnosis of malignant nodules. METHODS We compared two techniques: freehand plain 2D US against freehand 2D US with gyroscopic guidance, both followed by 3D reconstruction using software. We measured the volume of nodules and a normal thyroid gland. RESULTS We found 2D US with gyroscopic guidance to be superior to plain 2D US as 3D reconstructions of greater accuracy are produced. The volume of the thyroid lobe measured 8.42 cm3 ± 0.94 was reasonably close to the normal average volume. However, the measured volume of the ellipsoidal nodule by the software is 8.69 cm3 ± 0.97 while the measured volume of the spherical nodule is 7.09 cm3 ± 0.79. As the expected volume of the nodules were 4.24cm3 and 4.19 cm3 respectively, the measured volume of the nodule was not accurate. The time taken to characterise nodules was reduced greatly from over 30 min in usual procedure to less than 10 min. CONCLUSION We find 3D US promising for evaluating size of thyroid nodules, with potential to study other TIRAD characteristics. Freehand 2D US with gyroscopic guidance shows the most promise for producing reliable, accurate and faster 3D reconstructions of thyroid nodules.
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Affiliation(s)
- Aldred Cheng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - James Wai Kit Lee
- Division of Endocrine Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Kee Yuan Ngiam
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Endocrine Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
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Roic AC, Milošević D, Turudić D, Roic G. An innovative diagnostic procedure in children: videourodynamics with contrast-enhanced voiding urosonography. J Ultrasound 2023; 26:583-587. [PMID: 36417175 PMCID: PMC10247938 DOI: 10.1007/s40477-022-00721-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/12/2022] [Indexed: 11/24/2022] Open
Abstract
Contemporary videourodynamic (VUD) investigation combines voiding cystourethrography (VCUG) and urodynamics into one study, which allows simultaneous visualization of the urinary tract by ionizing radiation alongside the measurement of sensation, capacity, compliance, and detrusor pressure during bladder filling and voiding using one double lumen catheter. Today VUD is a benchmark for evaluating the lower urinary tract disorders in children because it evaluates urinary bladder and sphincter function and visualizes bladder morphology and vesicoureteral reflux (VUR) presence at the same time. Several previous studies of fluoroscopic videourodynamics issued concerns regarding radiation exposure. This technical report aims to describe a new modality of VUD in children by replacing fluoroscopic VCUG with contrast-enhanced voiding urosonography (ceVUS). ceVUS using second-generation contrast media and harmonic imaging is a radiation-free and highly sensitive imaging modality used to detect VUR in children. We simultaneously performed an infusion of ultrasound contrast through the double lumen urodynamic catheter during urodynamic evaluation. This article describes the advantages of this method compared with a conventional technique. In addition to being radiation-free, this procedure of advanced videourodynamics method can better detect vesicoureteral reflux and intrarenal reflux combined with urodynamic disorders associated with VUR.
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Affiliation(s)
- Andrea Cvitkovic Roic
- Helena Clinic for Pediatric Medicine, Kneza Branimira 71, 10000, Zagreb, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, 31000, Osijek, Croatia
- Faculty of Medicine, University of Rijeka, Braće Branchetta 20/1, 51000, Rijeka, Croatia
| | - Danko Milošević
- University of Zagreb, School of Medicine, Šalata 3, 10000, Zagreb, Croatia
- Department of Pediatrics, General Hospital Zabok and Hospital of Croatian Veterans, Bracak 8, 49210, Bracak, Croatia
| | - Daniel Turudić
- Department of Pediatrics, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia.
| | - Goran Roic
- Faculty of Medicine, University of Rijeka, Braće Branchetta 20/1, 51000, Rijeka, Croatia
- Department of Radiology, Children's Hospital Zagreb, Ul. Vjekoslava Klaića 16, 10000, Zagreb, Croatia
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Verma A, Suryawanshi P, Chetan C, Oka G, Singh Y, Kallimath A, Singh P, Garegrat R. A detailed echocardiographic evaluation of ventricular functions in stable full term small for gestational age babies. J Ultrasound 2023; 26:117-127. [PMID: 35616853 PMCID: PMC10063694 DOI: 10.1007/s40477-022-00691-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/23/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE SGA infants with fetal growth restriction have reduced ability to adapt themselves to the postnatal life because of certain epigenetic changes in cardiac function. The aim of the present study is to assess and compare the cardiac functions of fetal growth restricted SGA newborns to the term stable AGA newborns, and evaluate any differences in the cardiac functions during the postnatal transitional circulation. METHOD This observational study was conducted at a multispecialty tertiary care hospital in Western India from June to November 2021. The newborns were evaluated using bedside echocardiography at 24-48 h and repeat screening after 48 h. The echocardiographic assessment of the systolic function was done using EF, FS, FAC and TAPSE; diastolic function using E/A wave ratio and global functioning using LV MPI. RESULT Twnety-four babies were included in cases and 30 in the control arm of the study. Maternal and newborn characteristics were comparable between the two groups. FS, EF for left ventricle and TAPSE, FAC for right ventricular systolic function were significantly lower in SGA group (p = 0.02, 0.02, 0.00 and 0.01; respectively). The current study revealed a lower tricuspid E/A ratio and higher mitral E/A ratio with a significant difference beyond 48 h in the first week of life (p value 0.00). Left ventricular MPI was significantly higher in SGA infants compared to AGA infants during two subsequent readings in immediate newborn period with p values 0.01 and 0.02 respectively. The subgroup analysis revealed that fetal growth-restricted neonates with absent end-diastolic flow had a greater impact on ventricular functions. CONCLUSION Present study showed a significant systolic and diastolic dysfunction during initial newborn period in growth restricted SGA infants.
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Affiliation(s)
- Arjun Verma
- Department of Neonatology, Bharati Vidyapeeth University Medical College, Hospital and Research Center, Pune, Maharashtra, India
| | - Pradeep Suryawanshi
- Department of Neonatology, Bharati Vidyapeeth University Medical College, Hospital and Research Center, Pune, Maharashtra, India.
| | - Chinmay Chetan
- Department of Neonatology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Gauri Oka
- Department of Research, Bharati Vidyapeeth University Medical College, Hospital and Research Center, Pune, Maharashtra, India
| | - Yogen Singh
- Department of Pediatrics, Division of Neonatology, Loma Linda University School of Medicine, Loma Linda, CA, 92354, USA
| | - Aditya Kallimath
- Department of Neonatology, Bharati Vidyapeeth University Medical College, Hospital and Research Center, Pune, Maharashtra, India
| | - Pari Singh
- Department of Neonatology, Bharati Vidyapeeth University Medical College, Hospital and Research Center, Pune, Maharashtra, India
| | - Reema Garegrat
- Department of Neonatology, Bharati Vidyapeeth University Medical College, Hospital and Research Center, Pune, Maharashtra, India
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Duyan M, Saridas A. Relation between partial arterial carbon dioxide pressure and pH value and optic nerve sheath diameter: a prospective self-controlled non-randomized trial study. J Ultrasound 2023; 26:107-116. [PMID: 35511351 PMCID: PMC10063762 DOI: 10.1007/s40477-022-00677-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/14/2022] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE This study aims to determine if there is a correlation between differences in optic nerve sheath diameter (ONSD) and changes in PaCO2 and pH values that were measured in the arterial blood gas (ABG) before and after treatment in COPD patients with acute hypercarbic respiratory failure (AHRF). MATERIALS AND METHODS This study serves as a prospective self-controlled non-randomized trial study conducted in the emergency clinic of a tertiary hospital. Forty-four patients with COPD, who were found to have acidosis and hypercarbia in ABG and had an indication for non-invasive mechanic ventilation (NIMV), were analyzed prospectively. Demographic information, vital findings, initial ABG values, the ONSD measurement (before the NIMV treatment), consciousness state, and the ABG results obtained in the second hour of the monitoring and the ONSD measurement (after the NIMV treatment) were recorded. RESULTS In this study, 13 (29.5%) of the patients were female and 31 (70.5%) were male. The age distribution was evaluated as 68.3 ± 9.2 years; the minimum age was 54 and the maximum was 91. A high level of positively significant correlation was found between the mean ONSD and PaCO2 (p < 0.0001). There is a high fit (0.72) between the mean ONSD and PaCO2. A moderate level of negatively significant correlation was found between the mean ONSD and the pH (p < 0.0001). However, there is an insignificant low fit (0.32) between the mean ONSD and the pH. CONCLUSION The ONSD changed significantly and in a highly correlated manner to acute changes in PaCO2 levels.
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Affiliation(s)
- Murat Duyan
- Department of Emergency Medicine, Emergency Medicine Specialist, Antalya Training and Research Hospital, Varlik District, Kazim Karabekir Street, 07100 Antalya, Turkey
| | - Ali Saridas
- Department of Emergency Medicine, Emergency Medicine Specialist, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
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Tummolo A, Brunetti G, Giordano M, Carbone V, Faienza MF, Aricò M, Pesce S. The use of quantitative ultrasound in a tertiary-level children hospital: role in the follow-up of chronically ill patients. J Ultrasound 2022; 25:563-570. [PMID: 35092603 PMCID: PMC9402826 DOI: 10.1007/s40477-021-00624-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/09/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate the use of QUS for the bone status assessment in children cared because of a chronic disease such as: inherited metabolic disorder, kidney disease and endocrine defect and considered by the attending physician as at specific risk. METHODS QUS outputs were calculated for each disorder and compared to: sex, age, Tanner stage, Z-score for height, weight and BMI (body mass index). RESULTS One-hundred-sixty-eight subjects aged between 3.5 and 18 years met the inclusion criteria. The overall bone quality indexes were under the normal range in all the groups considered. Impairment of bone quality parameters was more evident in the group of patients with inherited metabolic disorders, in which 65% of patients in charge were studied by QUS. Older age and sexual development were associated with less pronounced bone quality impairment, as measured by QUS, in the vast majority of conditions. Overall, the diseases for which the prediction of outcome was the strongest were: hyperphenylalaninemia, nephrotic syndrome and insulin dependent diabetes mellitus. CONCLUSIONS QUS is capable to provide information on skeletal status in children. Initial evaluation by QUS may allow defining patients with chronic disorders who deserve further, more invasive diagnostic studies. Inherited metabolic disorders warrant specific attention and strict monitoring for their potential effect on bone.
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Affiliation(s)
- Albina Tummolo
- Department of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXIII Children Hospital, Azienda Ospedaliero-Universitaria Consorziale, Via Amendola 207, 70126, Bari, Italy.
| | - Giacomina Brunetti
- Section of Human Anatomy and Histology, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari A. Moro, Bari, Italy
| | - Mario Giordano
- Pediatric Nephrology and Dialysis Unit, Giovanni XXIII Children Hospital, Azienda Ospedaliero-Universitaria Consorziale, Bari, Italy
| | - Vincenza Carbone
- Pediatric Nephrology and Dialysis Unit, Giovanni XXIII Children Hospital, Azienda Ospedaliero-Universitaria Consorziale, Bari, Italy
| | - Maria Felicia Faienza
- Department of Biomedical Sciences and Human Oncology, Pediatric Section, University "A. Moro", Bari, Italy
| | - Maurizio Aricò
- Rare Diseases Unit, Giovanni XXIII Children Hospital, Azienda Ospedaliero-Universitaria Consorziale, Bari, Italy
| | - Sabino Pesce
- Department of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXIII Children Hospital, Azienda Ospedaliero-Universitaria Consorziale, Via Amendola 207, 70126, Bari, Italy
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Giant malignant sacrococcygeal germ cell tumor in a newborn: A rare case report. Radiol Case Rep 2022; 17:2416-2423. [PMID: 35601377 PMCID: PMC9118099 DOI: 10.1016/j.radcr.2022.03.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/30/2022] [Indexed: 11/23/2022] Open
Abstract
Malignant germ cell tumors constitute about 3%-4% of all neoplasms occurring before the age of 15. They arise in the ovaries, the testes, and in several other locations, including the lower back, the chest, the brain, and the abdomen. In infants and young children, the sacrococcygeal region is the most common site for extragonadal germ cell tumors, and teratomas account for the vast majority of sacrococcygeal germ cell tumors. Neonatal sacrococcygeal teratomas are usually benign and rarely they may contain a malignant component that is predominantly a yolk sac tumor. In this article, we describe a rare case of a male newborn with a giant sacrococcygeal mixed germ cell tumor composed of grade 3 immature teratoma and malignant yolk sac elements.
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Sawai T, Zuo S, Terai T, Nishiwada S, Nakagawa K, Nagai M, Akahori T, Kanehiro H, Sho M. Nonalcoholic fatty liver disease developed after pancreatoduodenectomy for solid pseudopapillary neoplasm in a 10-year-old girl: a case report. Surg Case Rep 2022; 8:61. [PMID: 35381910 PMCID: PMC8983797 DOI: 10.1186/s40792-022-01414-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background Solid pseudopapillary neoplasms of the pancreas are rare. Moreover, pancreatoduodenectomy (PD) and postoperative care are not common in pediatric surgery. Herein, we report a case of PD and nonalcoholic fatty liver disease (NAFLD) after PD and present a literature review. Case presentation A 10-year-old girl with a suspected liver tumor was referred to our hospital. Echography, enhanced computed tomography and magnetic resonance imaging showed that the tumor coexisted with the solid and cystic parts of the pancreatic head. Since the patient was a young woman and the imaging findings were consistent with that of pancreatic solid pseudopapillary neoplasms (SPNs), we diagnosed her with pancreatic SPN. Thereafter, PD was performed, and she was discharged 10 days after the operation. Although her postoperative course was mostly uneventful, she experienced few episodes of abdominal pain and diarrhea before hospital discharge. These symptoms subsequently became more frequent and severe. The patient was urgently readmitted to the hospital for watery steatorrhea and lower abdominal colic pain. Her serum aspartate aminotransferase and alanine aminotransferase levels were elevated, and a fatty liver was detected on echography. The patient was diagnosed with steatorrhea, peristaltic pain, and NAFLD after PD. Pancrelipase (containing pancreatic digestive enzymes), antidiarrheal agents, and probiotics were started. Dosage increase of these drugs reduced the defecation frequency and abdominal pain and switched diarrhea to loose stools. However, more lipids in meals or more meals caused diarrhea and abdominal pain. Therefore, the doses of these drugs were further increased, and another antidiarrheal agent, loperamide hydrochloride, was added. Exocrine pancreatic enzymes supplementation and careful follow-up should prevent NAFLD progression after PD. At present, the patient has occasional abdominal pain, but has tangible soft stools once or twice a day. Although echography still shows a mottled fatty liver, her hepatic enzymes are only mildly elevated. Conclusions Pediatric PD is rare, and residual pancreatic function is usually sufficient, unlike in adult cases. However, we experienced a case of NAFLD after PD for a pediatric pancreatic SPN, in which pancreatic enzyme supplementation effectively improved this condition. Further attention must be paid to worsening of NAFLD that can develop nonalcoholic steatohepatitis.
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Affiliation(s)
- Toshio Sawai
- Department of Surgery, Nara Medical University, 840 Shijo-chou, Kashihara, Nara, 634-8522, Japan.
| | - Shogo Zuo
- Department of Surgery, Nara Medical University, 840 Shijo-chou, Kashihara, Nara, 634-8522, Japan
| | - Taichi Terai
- Department of Surgery, Nara Medical University, 840 Shijo-chou, Kashihara, Nara, 634-8522, Japan
| | - Satoshi Nishiwada
- Department of Surgery, Nara Medical University, 840 Shijo-chou, Kashihara, Nara, 634-8522, Japan
| | - Kenji Nakagawa
- Department of Surgery, Nara Medical University, 840 Shijo-chou, Kashihara, Nara, 634-8522, Japan
| | - Minako Nagai
- Department of Surgery, Nara Medical University, 840 Shijo-chou, Kashihara, Nara, 634-8522, Japan
| | - Takehiro Akahori
- Department of Surgery, Nara Medical University, 840 Shijo-chou, Kashihara, Nara, 634-8522, Japan
| | - Hiromichi Kanehiro
- Department of Surgery, Nara Medical University, 840 Shijo-chou, Kashihara, Nara, 634-8522, Japan
| | - Masayuki Sho
- Department of Surgery, Nara Medical University, 840 Shijo-chou, Kashihara, Nara, 634-8522, Japan
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Walsh P, Chaigneau FRC, Lebedev M, Mutua V, McEligot H, Lam SHF, Hwang B, Bang H, Gershwin LJ. Validating a bovine model for lung ultrasound of bronchiolitis. J Ultrasound 2022; 25:611-624. [PMID: 35067896 PMCID: PMC8784226 DOI: 10.1007/s40477-021-00635-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/28/2021] [Indexed: 02/06/2023] Open
Affiliation(s)
- Paul Walsh
- Pediatric Emergency Medicine, Sutter Medical Center Sacramento, 2825 Capitol Avenue, Sacramento, CA, 95816, USA.
| | - Francisco R Carvallo Chaigneau
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis, Davis, CA, 95616, USA
- California Animal Health and Food Safety Laboratory, San Bernardino Branch, 105 W Central Ave, San Bernardino, CA, 92408, USA
- Department of Biomedical Sciences and Pathobiology, Virginia Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, 24060, USA
| | - Maxim Lebedev
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis, Davis, CA, 95616, USA
| | - Victoria Mutua
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis, Davis, CA, 95616, USA
| | - Heather McEligot
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis, Davis, CA, 95616, USA
| | - Samuel H F Lam
- Pediatric Emergency Medicine, Sutter Medical Center Sacramento, 2825 Capitol Avenue, Sacramento, CA, 95816, USA
| | - Benjamin Hwang
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis, Davis, CA, 95616, USA
| | - Heejung Bang
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, Davis, CA, 95616, USA
| | - Laurel J Gershwin
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis, Davis, CA, 95616, USA.
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