Focal nodular hyperplasia--a review of myths and truths.

Background: Focal nodular hyperplasia (FNH) is a benign hyperplastic lesion of the liver with no known malignant potential. It has generated much interest due to the frequency with which it presents with atypical features on radiological imaging. Often resulting in misdiagnosis.

Reduction of magnetic field fluctuations in powered magnets for NMR using inductive measurements and sampled-data feedback control.

Resistive and hybrid (resistive/superconducting) magnets provide substantially higher magnetic fields than those available in low-temperature superconducting magnets, but their relatively low spatial homogeneity and temporal field fluctuations are unacceptable for high resolution NMR. While several techniques for reducing temporal fluctuations have demonstrated varying degrees of success, this paper restricts attention to methods that utilize inductive measurements and feedback control to actively cancel the temporal fluctuations. In comparison to earlier studies using analog proportional control, this paper shows that shaping the controller frequency response results in significantly higher reductions in temporal fluctuations.

Multivisceral resection of pancreatic neuroendocrine tumours: a report of two cases.

Pancreatic neuroendocrine tumours (pNETs) are rare and surgical resection offers the only possibility of cure for localised disease. The role of surgery in the setting of locally advanced and metastatic disease is more controversial. Emerging data suggests that synchronous surgical resection of pancreas and liver may be associated with increased survival.

One hundred and seventy-eight consecutive pancreatoduodenectomies without mortality: role of the multidisciplinary approach.

Background: Pancreatoduodenectomy offers the only chance of cure for patients with periampullary cancers. This, however, is a major undertaking in most patients and is associated with a significant morbidity and mortality. A multidisciplinary approach to the workup and follow-up of patients undergoing pancreatoduodenectomy was initiated at our institution to improve the diagnosis, resection rate, mortality and morbidity.

Pyogenic liver abscess: an audit of 10 years' experience.

Aim: To describe our own experience with pyogenic liver abscesses over the past 10 years and investigate the risk factors associated with failure of initial percutaneous therapy.

Methods: A retrospective study of records of 63 PLA patients presenting between 1998 and 2008 to Australian tertiary referral centre, were reviewed. Amoebic and hydatid abscesses were excluded.

The role of peribiliary cysts in biliary obstruction.

Peribiliary cysts are cystic dilatations of the extramural glands of the intrahepatic biliary tree. This disorder is uncommon and is usually asymptomatic. However, it may cause extrinsic biliary compression and consequently, obstructive jaundice.

The infracolic approach to pancreatoduodenectomy for large pancreatic head tumours invading the colon.

Background: Tumours arising from the head of the pancreas can invade both the proximal transverse colon and its mesocolon. At laparoscopy, this may be considered a contraindication to proceeding to pancreatoduodenectomy. However, in some patients, pancreatoduodenectomy can still be performed with an R0 resection using an en-bloc resection technique by an infracolic approach.

Immunohistochemistry for SDHB divides gastrointestinal stromal tumors (GISTs) into 2 distinct types.

The Carney triad (CT) is gastrointestinal stromal tumor (GIST), paraganglioma, and pulmonary chondroma. The GISTs of CT show different clinical, molecular, and morphologic features to usual adult GISTs but are similar to the majority of pediatric GISTs. We postulated that these GISTs would show negative staining for succinate dehydrogenase B (SDHB).

Malignant transformation of residual endometriosis after hysterectomy: a case series.

Objective: To explore the role of long-standing hormone replacement therapy (HRT) in the malignant transformation of endometriosis.

Design: Short case series. Three cases of women with pelvic clearance receiving long-standing HRT studied in detail.

Pediatric convulsive status epilepticus in Honduras, Central America.

Convulsive status epilepticus (SE) in children is an important public health problem, particularly in low-resource countries. A surveillance study was performed with consecutive enrollment of all children presenting with convulsive SE to Hospital Escuela Materno-Infantil Emergency Department in Tegucigalpa, Honduras over a 13-week period in 2003. In the 47 children with SE, the mean age was 4.

Synoptic reporting improves histopathological assessment of pancreatic resection specimens.

Aim: We examined whether introduction of a standardised pancreatic cancer minimum data set improved the reporting of key pathological features across multiple institutions.

Methods: From seven different pathology departments that are members of the New South Wales Pancreatic Cancer Network, 109 free text reports and 68 synoptic reports were compared.

Results: AJCC stage could not be inferred from 44% of free text reports, whereas stage was reported in all 68 synoptic reports.

Laparoscopic ePTFE mesh repair of incisional and ventral hernias.

Incisional hernia is a relatively frequent complication of abdominal surgery. The use of mesh to repair incisional and ventral hernias results in lower recurrence rates compared with primary suture techniques. The laparoscopic approach may be associated with lower postoperative morbidity compared with open procedures.

Direct percutaneous puncture embolization of a peripancreatic pseudoaneurysm presenting with haemosuccus pancreaticus.

Haemosuccus pancreaticus is a rare cause of gastrointestinal haemorrhage. It is commonly due to a pseudoaneurysm in a setting of chronic pancreatitis. Treatment of aneurysms has traditionally been surgery; however, recently percutaneous radiological intervention has achieved good results with minimum morbidity and mortality.

Pancreatoduodenectomy: role of drain fluid analysis in the management of pancreatic fistula.

Background: Pancreatic fistula remains an important cause of death following pancreatoduodenectomy. There is still uncertainty regarding the use of drains following pancreatoduodenectomy with recent reports suggesting that it might be harmful with increased complications. We evaluated the use of drain fluid analysis in the management of patients following pancreatoduodenectomy.

Surgical management of carcinoma of the head of pancreas: extended lymphadenectomy or modified en bloc resection?

Pancreatoduodenectomy for the treatment of periampullary cancer was described over 70 years ago. The technique has evolved in an attempt to improve the dismal prognosis for patients with pancreatic cancers. Radical regional resection has been proposed to decrease the incidence of local recurrence as well as to improve survival.

Classification of pancreatic cystic lesions using SELDI-TOF mass spectrometry.

Background: The diagnosis of pancreatic cystic lesions is problematical with difficulties arising in the differentiation between malignant, premalignant or benign lesions. This preliminary study aimed to analyse pancreatic cyst fluid, using a proteomic approach, to generate reproducible protein profiles to assist in the classification of malignant and non-carcinoma samples.

Methods: Pancreatic cyst fluid samples from patients with pancreatic adenocarcinoma and non-carcinoma cystic lesions were analysed on hydrophobic protein chip arrays by surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS).

Intrapancreatic splenunculus.

Intrapancreatic accessory spleens are uncommon, however, the recognition and appropriate confirmatory diagnostic imaging of an intrapancreatic splenunculus is important to avoid an unnecessary surgery for a suspected pancreatic tumor. We present a patient who underwent a distal pancreatectomy for a suspected pancreatic neuroendocrine tumor based on clinical history, radiologic imaging, and a positive labeled octreotide scan. A brief review of intrapancreatic splenunculi and confirmatory diagnostic imaging is discussed.

Modified extended pancreatoduodenectomy: en bloc resection of the peripancreatic retroperitoneal tissue and the head of pancreas.

Malignant periampullary tumours often invade into retroperitoneal peripancreatic tissues and a positive resection margin following pancreatoduodenectomy is associated with a poor survival. For complete extirpation of the tumour, en bloc resection of the pancreatic head with all retroperitoneal peripancreatic tissue is essential to achieve negative resection margin. A modified radical pancreatoduodenectomy technique that aims to resect all peripancreatic retroperitoneal tissue en bloc with the head of the pancreas is described.

Proteomic profiling of cholangiocarcinoma: diagnostic potential of SELDI-TOF MS in malignant bile duct stricture.

Proteomic techniques promise to improve the diagnosis of cholangiocarcinoma (CC) in both tissue and serum as histological diagnosis and existing serum markers exhibit poor sensitivities. We explored the use of surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS) to identify potential protein biomarkers of CC. Twenty-two resected CC samples were compared with adjacent noninvolved bile duct tissue.

Proteomic classification of pancreatic adenocarcinoma tissue using protein chip technology.

Background & Aims: Pancreatic adenocarcinoma is a most devastating cancer that presents late and is rapidly progressive. This study aimed to identify unique, tissue-specific protein biomarkers capable of differentiating pancreatic adenocarcinoma (PC) from adjacent uninvolved pancreatic tissue (AP), benign pancreatic disease (B), and nonmalignant tumor tissue (NM).

Methods: Tissue samples representing PC (n = 31), AP (n = 44), and B (n = 19) tissue were analyzed on hydrophobic protein chip arrays by surface-enhanced laser desorption/ionization time-of-flight mass spectrometry.