Decreased Intestinal Microbiota Diversity Is Associated With Increased Gastrointestinal Symptoms in Patients With Chronic Pancreatitis.

Objectives: Chronic pancreatitis (CP) is characterized by abdominal pain, recurrent hospitalizations, frequent exposure to antibiotics, nutritional deficiencies, and chronic opioid use. Data describing the gut microbial community structure of patients with CP is limited. We aimed to compare gut microbiota of a group of patients with severe CP being considered for total pancreatectomy with islet autotransplantation (TPIAT) with those of healthy controls and to associate these differences with severity of clinical symptoms.

Surgical microwave ablation for multifocal non-resectable liver metastases: a single institution experience treating five or more liver lesions.

Background: Thermal ablation is an effective treatment for patients with metastatic colon and rectal cancer and allows surgeons to offer curative intent therapy to patients who are otherwise not candidates for resection. We aimed to report outcomes of a single institution experience using microwave ablation (MWA) with or without resection to treat five or more liver metastases.

Methods: In this retrospective cohort study, the University of Minnesota Division of Surgical Oncology liver surgery database was queried to identify all patients who underwent thermal ablation of five or more colorectal liver metastases (CRLM) between 2012-2018.

Reduced bone mineral density in the first year after total pancreatectomy with islet autotransplantation (TPIAT).

Background/objectives: The effect of total pancreatectomy with islet autotransplantation (TPIAT) on bone mineral density (BMD) in patients with CP is unknown. We aimed to assess bone health in patients with CP after TPIAT.

Methods: We measured BMD, BMD Z-score, and bone mineral content (BMC) for total body, lumbar spine, right and left hip in 78 patients before and after TPIAT using dual-energy X-ray absorptiometry (DXA, n = 78 pre-TPIAT, n = 65 paired pre- and 12 months post-TPIAT, n = 33 paired 12 and 18 months post-TPIAT), and tested for association with clinical history including age, smoking status, and medications using paired and two-sample t-tests, linear regression, and Fisher's exact test.

Atypical Hepatic Steatosis Patterns on MRI After Total Pancreatectomy With Islet Autotransplant.

The purpose of this retrospective study was to investigate the prevalence and patterns of hepatic steatosis after total pancreatectomy with islet autotransplant (TPIAT) and to determine if the unique patterns of steatosis seen in this study correlated with islet graft function. Fifty-two subjects who had undergone MRI after TPIAT were reviewed for the presence of hepatic steatosis. Patterns of steatosis were categorized into three groups: normal (no steatosis), homogeneous, and atypical.

Surgical microwave ablation of otherwise non-resectable colorectal cancer liver metastases: Expanding opportunities for long term survival.

Background: Colorectal liver metastases (CRLM) are the most common extra-lymphatic metastases in colorectal cancers, however, only 15-20% of these patients are candidates for resection. We reviewed our institutional experience with 135 surgical ablations for unresectable CRLM.

Methods: Retrospective review of surgically ablated CRLM from 2009 to 2018.

Early use of continuous glucose monitoring in children and adolescents after total pancreatectomy with islet autotransplantation.

Background: Children undergoing total pancreatectomy with islet autotransplantation (TPIAT) for chronic pancreatitis require intensive insulin therapy early after TPIAT with narrow glycemic targets, which can a present significant care burden. Outpatient use of continuous glucose monitoring (CGM) systems by children and caregivers early after TPIAT is inadequately studied.

Methods: In this open-label study, we randomized 14 children and adolescents (mean age 15.

Performance of modified Igls criteria to evaluate islet autograft function after total pancreatectomy with islet autotransplantation - a retrospective study.

The Igls criteria assess islet function after islet allotransplant, based on C-peptide, insulin use, hemoglobin A1c, and severe hypoglycemia. However, these criteria as currently defined cannot be applied to total pancreatectomy islet autotransplant (TPIAT) patients. We tested modified criteria for assessing islet function in a large cohort of TPIAT patients (n = 379).

Fat-soluble Vitamin Deficiency is Common in Children With Chronic Pancreatitis Undergoing Total Pancreatectomy With Islet Autotransplantation.

The prevalence of fat-soluble vitamin (FSV) deficiency in children undergoing total pancreatectomy with islet autotransplantation (TPIAT) for chronic pancreatitis (CP) is unknown. We quantified FSV deficiency in 100 children (age ≤18) undergoing TPIAT. FSV levels (vitamins A, E, D) and clinical history were abstracted from medical records.

Alterations in Enteroendocrine Hormones After Total Pancreatectomy With Islet Autotransplantation.

Objective: When total pancreatectomy with islet autotransplantation (TPIAT) is performed for chronic pancreatitis, the pancreas and most of the duodenum are removed, with Roux-en-Y reconstruction of the gastrointestinal tract. Enteroendocrine cells in the intestines and pancreas secrete hormones coordinating digestion and motility, but anatomic reconstruction alters transit of nutrients to these cells. We hypothesized that TPIAT leads to changes in enteroendocrine hormones.

Utility of arginine stimulation testing in preoperative assessment of children undergoing total pancreatectomy with islet autotransplantation.

Metabolic outcomes after total pancreatectomy with islet autotransplantation (TPIAT) are influenced by the islet mass transplanted. Preclinical and clinical studies indicate that insulin and C-peptide levels measured after intravenous administration of the beta cell secretagogue arginine can be used to estimate the available islet mass. We sought to determine if preoperative arginine stimulation test (AST) results predicted transplanted islet mass and metabolic outcomes in pediatric patients undergoing TPIAT.

Total pancreatectomy and islet autotransplantion for chronic and recurrent acute pancreatitis.

Purpose Of Review: We reviewed the current state of total pancreatectomy with islet autotransplantation (TPIAT) for chronic pancreatitis and recurrent acute pancreatitis (RAP).

Recent Findings: An increasing number of centers in the United States and internationally are performing TPIAT. In selected cases, TPIAT may be performed partially or entirely laparoscopically.

Emergency Management of the Ingested Magnet: An Algorithmic Approach.

Introduction: Accidental ingestion of foreign bodies is an increasing problem in the pediatric population. Symptoms are often nonspecific and may lead to a missed diagnosis because the ingestion event often goes unwitnessed.

Case: We present a case of a missed diagnosis of a multiple magnet ingestion event in a pediatric patient leading to operative management.

Extradural sacrococcygeal subcutaneous ependymoma misdiagnosed as pilonidal disease: case report and review of the literature.

Ependymoma is a type of glial tumor that arises from the ependymal lining of the ventricular system of the central nervous system. These tumors may present as a rare extraspinal variety at the sacrococcygeal region, and may be misdiagnosed as pilonidal disease in the post-sacral area or present with mass-effect symptoms on the bowel or bladder in the pre-sacral region. This is a case of soft tissue swelling at the post-sacral area that, after clinical examination, was diagnosed as pilonidal disease.