Pancreatic cancer is one of the most aggressive malignant diseases due high rate of recurrence and the lack effective medical therapy. Surgery remains the only option for curable treatment but unfortunately, less than 20% of patients are eligibles at the time of diagnosis therefore identifying the risk factors represent a big step for cancer research. Pancreatic cancer is frequently associated with diabetes or glucose intolerance. There are two hypotheses at the base of this observation: either the diabetes cause pancreatic cancer or is a concequences of the cancer. In these theses we studied the patients diagnosticated with pancreatic cancer and with diabetes mellitus type 2. A total of 256 pancreatic cancer cases were identified and 71 patients had diabetes mellitus and 21 patients had glucose intolerance. Mean age 62.2 years, 81% cases were male and in 71% cancer originated form the pancreatic head. In 51.4% cases the diagnosis was in stage IV of the disease. Patients with pancreatic cancer and diabetes mellitus had reduced survival compared with those without diabetes but the difference was not statistically significant. Diabetes mellitus is associated with a decreased survival among patients with pancreatic cancer and reveal a link between chronic glucose intolerance and pancreatic cancer survival. The complex relationship between pancreatic cancer and diabetes requires more clinical research in order to developed new therapeutical posibilities.

Introduction: Malignant tumors are associated with a low incidence of postoperative pancreatic fistulas. The presence of peritumoral fibrosis is considered the protective factor for the development of postoperative pancreatic fistulas after pancreatic resections for pancreatic ductal adenocarcinomas. Methods: We analyzed a series of 109 consecutive patients with pancreatic resections for malignant pathology: pancreatic ductal adenocarcinomas and periampullary adenocarcinomas. The incidence of postoperative pancreatic fistulas has been reported in tumor histological type, in the presence of peritumoral fibrosis, and in the association between adenocarcinomas and areas of acute pancreatitis. The data obtained were processed with the statistical analysis program SPSS, and statistically significant p were considered at a value <0.05. Results: For the entire study group, the incidence of postoperative pancreatic fistulas was 11.01%. The lowest incidence was observed in the group of patients with pancreatic ductal adenocarcinomas (4.06% vs. 25.72% in the group with periampullary adenocarcinoma), with a p = 0.002. The presence of peritumoral fibrous tissue was observed in 49.31% of cases without pancreatic fistulas, and in 54.54% of cases that developed this postoperative complication (p = 0.5). Also, the peritumoral fibrous tissue had a uniform distribution depending on the main diagnosis (56.14% in pancreatic ductal adenocarcinoma group vs. 37.04% in periampullary adenocarcinoma group, with a p = 0.08). In the group of patients who associated areas of acute pancreatitis on the resections, the incidence of postoperative pancreatic fistulas was 7.8 times higher (30% vs. 3.8%, p = 0.026). Conclusions: Peritumoral fibrous tissue was not a factor involved in the developing of postoperative pancreatic fistulas. The association of adenocarciomas with areas of acute pancreatitis has led to a significant increase in postoperative pancreatic fistulas, which is a significant and independent risk factor.

Background and Objectives: Postoperative pancreatic fistula after cephalic pancreatoduodenectomy (CPD) is still the leading cause of postoperative morbidity, entailing long hospital stay and costs or even death. The aim of this study was to propose the use of morphologic parameters based on a preoperative multisequence computer tomography (CT) scan in predicting the clinically relevant postoperative pancreatic fistula (CRPF) and a risk score based on a multiple regression analysis. Materials and Methods: For 78 consecutive patients with CPD, we measured the following parameters on the preoperative CT scans: the density of the pancreas on the unenhanced, arterial, portal and delayed phases; the unenhanced density of the liver; the caliber of the main pancreatic duct (MPD); the preoperatively estimated pancreatic remnant volume (ERPV) and the total pancreatic volume. We assessed the correlation of the parameters with the clinically relevant pancreatic fistula using a univariate analysis and formulated a score using the strongest correlated parameters; the validity of the score was appreciated using logistic regression models and an ROC analysis. Results: When comparing the CRPF group (28.2%) to the non-CRPF group, we found significant differences of the values of unenhanced pancreatic density (UPD) (44.09 ± 6.8 HU vs. 50.4 ± 6.31 HU, p = 0.008), delayed density of the pancreas (48.67 ± 18.05 HU vs. 61.28 ± 16.55, p = 0.045), unenhanced density of the liver (UDL) (44.09 ± 6.8 HU vs. 50.54 ± 6.31 HU, p = 0.008), MPD (0.93 ± 0.35 mm vs. 3.14 ± 2.95 mm, p = 0.02) and ERPV (46.37 ± 10.39 cm3 vs. 34.87 ± 12.35 cm3, p = 0.01). Based on the odds ratio from the multiple regression analysis and after calculating the optimum cut-off values of the variables, we proposed two scores that both used the MPD and the ERPV and differing in the third variable, either including the UPD or the UDL, producing values for the area under the receiver operating characteristic curve (AUC) of 0.846 (95% CI 0.694–0.941) and 0.774 (95% CI 0.599–0.850), respectively. Conclusions: A preoperative CT scan can be a useful tool in predicting the risk of clinically relevant pancreatic fistula.

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Pancreatic cancer is an aggressive neoplasia and has a fatal prognosis, with approximately 85% of patients diagnosed in advanced stages of the disease. The purpose of this study was to determine if the loss of e-cadherin expression in pancreatic pancreatic is a predictor of the prognosis of this disease. This research is based on a retrospective study performed on a group of 81 patients who benefited from pancreatic resection in our Surgical Clinic, between January 2008 and December 2016 and assessing the positivity of e-cadherin. There were no correlations between e-cadherin expression and other clinic-pathological factors, including gender, age, tumor status, lymph node metastasis, microscopic vascular invasion, perineural invasion. Low-differentiated pancreatic cancer was more likely to exhibit e-cadherin expression loss than well-differentiated forms of cancer (p-0.07). The mean survival in e-cadherin positive patients (17.1 months) was significantly worse compared to those with E-cadherin absent (6.8 months).In conclusion, we found that partial loss of e-cadherin in primary pancreatic adenocarcinomas is an independent predictor of a negative outcome among patients with curative surgical resection of pancreatic lesions.

Despite being one of the most debilitating conditions encountered in the field of toxicology, there is a lack of neutralization measures for the toxins involved in acute corrosive poisoning, and this promotes progressive contact injury of deep tissues after poisoning has occurred. Multiple controversies still surround management strategies during the acute phase of poisoning and the long-term follow-up of the patient. Here, we report a severe case of intentional poisoning with nitric acid complicated by extensive injury of the upper digestive tract, multiple stricture formation, and complete dysphagia. Serial endoscopic dilation and insertion of a jejunostomy feeding tube were necessary, and underlying psychiatric illness negatively affected the outcome of the patient. We conclude that an interdisciplinary approach is necessary to properly reduce the extent of lesions and sequelae induced by corrosion. Early endoscopic mapping of injuries is of major importance to better predict the evolution and possible complications of poisoning. Interventional and reconstructive surgical procedures may significantly improve the life expectancy and quality of life of patients following intoxication with corrosive substances.

Pancreatic fistula is the most frecquent and severe postoperative complication after pancreatic surgery, with impressive implications for the quality of life and vital prognosis of the patient and for these reasons it is essential to identify risk factors. In the current study, who included 109 patient admitted to a single university center and who underwent pancreatic resection for malignant pathology, we assessed the following factors as risk factors: age, sex, preoperative hemoglobin value, preoperative total protein value, obesity and postoperative administration of sandostatin. Of the analyzed factors, it appears that only obesity and long-term administration of sandostatin influences the occurrence of pancreatic fistula.